Maternal and perinatal outcome of pregnancies complicated by cardiac disease
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Perinatal mortality
Objective To explore the relationship between pre-pregnancy and early pregnancy diseases and congenital heart disease.Methods A hospital-based case-control study was conducted.123 mothers in the case group and 246 mothers in the control group were enrolled and interviewed by questionnaires.Multi-factor non-conditional Logistic regression model was used to analyze the effects of pre-pregnancy and early pregnancy diseases on congenital heart disease.Results Pre-pregnancy and early pregnancy diseases,such as chronic diseases before pregnancy,flu in the early stage of pregnancy,pre-reproductive tract infections in the early stage of pregnancy or before pregnancy,and abnormal reproductive history,would increase the risk of congenital heart disease.Their OR values were 3.084(95% CI: 0.826~11.513),2.023(95% CI: 1.220~2.353),1.750(95% CI: 1.026~2.986),3.617(95% CI: 1.488~8.792),respectively.Conclusions Pre-pregnancy and early pregnancy diseases are associated with congenital heart disease.It is very important to prevent and treat pre-pregnancy and early pregnancy diseases in controlling congenital heart disease.
Early pregnancy factor
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To assess the outcomes of pregnancy following postpartum haemorrhage (PPH) in the first pregnancy.Cohort study.Aberdeen Maternity Hospital, Scotland, UK.All women with first deliveries recorded in the Aberdeen Maternity and Neonatal Databank (AMND) between 1986 and 2005.All women identified from the AMND were classified into exposed and unexposed cohorts, according to whether or not they had PPH in their first delivery. They were then linked to any records of a second pregnancy.Any second pregnancy, time to second pregnancy, early or late pregnancy loss, and prevalence of PPH in the second pregnancy.Out of 34 334 women, 10% had a PPH in their first pregnancy. There was no statistically significant difference in the time to a second pregnancy, nor in the outcome of that second pregnancy, between women who had experienced a PPH in their first pregnancy and women who had not. For women with a caesarean delivery, there was a significant reduction in the proportion conceiving again, comparing the exposed and unexposed cohorts.From this cohort study we can conclude that if a PPH occurs in a first pregnancy, there is no delay in achieving a second pregnancy, and no detrimental effect on the outcome of that pregnancy. Significantly fewer women conceive a second pregnancy if they have a caesarean section in their first pregnancy that is complicated by PPH.
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This study was undertaken to identify all congenital heart disease in infancy, including deaths before diagnosis, to provide a truer picture of the spectrum of congenital heart disease and to assess the 9treatability9 of those dying before diagnosis. All births, infant deaths, and surviving babies with congenital heart disease in one health region in 1985-90 were identified and were classified as 9complex9, 9significant9, or 9minor9. Of the 1074 infants diagnosed in infancy, 185 died and 56 of these (30%) died undiagnosed. Severe non-cardiac malformations were present in 29 of the 56 while 27 were otherwise normal. Cardiovascular abnormalities in the latter group were complex in 13/27 and significant in 14/27. Identification of undiagnosed cardiovascular anomalies will improve epidemiological evaluation of congenital heart disease and, more importantly, earlier recognition of treatable abnormalities may reduce mortality.
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In order to study the effects of abortion on subsequent pregnancy, 13,144 secundigravidae were studied. In 879 of those women the 1st pregnancy had ended in miscarriage, in 820 it ended in abortion, in 25 in tubal pregnancy, in 7 in molar pregnancy, in 294 in premature delivery, and in 11,119 in normal delivery at term. Of the complications of early pregnancy, threatened abortion was the most common. 13.8% of the women who had miscarried previously experienced this complication, as did 9.1% of those who had had an abortion, 9.1% of those who delivered prematurely, and 3.6% of women who experienced normal deliveries. Other complications were equally common in all 4 subgroups. In the 2nd half of pregnancy, miscarriage was about twice as common among women who had had an abortion or miscarriage during their 1st pregnancy as it was in women whose 1st pregnancy was not interrupted. Furthermore, women who had miscarried or aborted the 1st pregnancy were twice as likely as women who delivered at term to give birth to infants weighing less than 2500 gm. Women who had delivered the 1st pregnancy prematurely were about 4 times as likely to have a subsequent premature delivery as were women whose 1st pregnancies ended at term. Thus it appears that interruption of a 1st pregnancy - either by abortion or miscarriage - significantly increases the risk of miscarriage in a subsequent pregnancy.
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We have compared frequency and severity of epileptic seizures during pregnancy with the 9 months prior to pregnancy in 66 patients with a total of 78 pregnancies. Data on total number of seizures and major seizures are analysed separately. No statistically significant differences between frequency before and during pregnancy were found. Cases with seizures before pregnancy tended to have seizures during pregnancy, but there was no association between occurrence of seizures prior to pregnancy and increased frequency during pregnancy. There was no evidence that seizures became more severe during pregnancy. No relationship was found between type of epilepsy and change in seizure frequency during pregnancy. The data suggest that our therapeutic interventions may have influenced seizure frequency in at most a minority of cases. Serum concentrations of the anti-epileptic drugs were monitored regularly during pregnancy. Only data on patients on constant drug dosages and, therefore, presumedly with the mildest seizure disorders were analysed. In the majority of cases there was a decrease in drug levels during pregnancy. Most cases tolerated this decrease without an increase in seizure frequency. On the other hand, most cases with increased frequency also had decreased drug levels.
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Loss of control over eating (LOC) is common among women, particularly those with overweight and obesity (OV/OB), and predicts weight gain. Given the importance of understanding weight and eating behaviors during pregnancy, we sought to characterize LOC across pregnancy and the postpartum period among women with pre-pregnancy OV/OB.
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Abstract Purpose To describe the utilization of drugs with pregnancy exposure registries by trimester during pregnancy, in comparison with matched nonpregnant episodes and a pre‐pregnancy period. Methods We identified live‐born deliveries from women aged 10 to 54 years and matched the pregnancies 1:1 with nonpregnant episodes from a comparator cohort not delivering live‐born infants, using data from 2001 to 2013 in the Sentinel Distributed Database. We evaluated the utilization of 34 drugs with pregnancy exposure registries, comparing utilization during pregnancy to the matched nonpregnant episodes, and to the 90 days before pregnancy. Results We identified 1 895 597 pregnancies ending in live births in 1 598 697 women and 1 895 597 matched nonpregnant episodes in 1 582 581 women. We observed a lower prevalence of use for most drugs during pregnancy compared with the matched nonpregnant episodes, and the 90‐day pre‐pregnancy period. The median (interquartile range) prevalence ratio of use, at any time during pregnancy, for all products was 0.2 (0.1‐0.3) comparing pregnant to nonpregnant episodes. Overall, there was a decrease in drug utilization by trimester; from 2.6% in the 90 days preceding pregnancy to 2.1% in the first trimester, 1.1% in the second trimester, and 0.9% in the third trimester. Conclusions Among drugs with pregnancy exposure registries, use was less during pregnancy compared with before pregnancy and to the matched nonpregnant episodes. The lower utilization during pregnancy suggests that women may be avoiding these drugs to minimize potentially harmful exposure during pregnancy. This lower utilization may increase the challenges of further studying the safety of these drugs using pregnancy exposure registries.
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Abstract Background The clinical course of myasthenia gravis (MG) during pregnancy is highly variable and unpredictable. The management of MG in pregnancy has not been standardized. Methods Eight cases of MG in pregnancy, who were treated and gave birth in our hospital between 2004 and 2012, were retrospectively reviewed. Results In three patients, MG deteriorated during pregnancy. Three patients discontinued their medication for MG during their pregnancy, and the other five patients continued on corticosteroid or pyridostigmine. None of the infants showed any congenital abnormalities. Interestingly, there was a trend towards lower birth weight in infants born to women who had an exacerbation of MG during pregnancy. One patient who had unstable MG before pregnancy and voluntarily discontinued the medication for MG at the beginning of pregnancy, experienced MG exacerbation at the 30th week of pregnancy and gave birth prematurely to an infant with transient neonatal MG at the 34th week. The other seven patients had uneventful full-term pregnancy. Conclusion Women with unstable MG should postpone pregnancy to avoid potential risk of MG exacerbation and adverse effects on the fetus. Medication for MG should not be stopped abruptly during pregnancy, particularly for women with unstable MG. MG during pregnancy should be closely monitored and properly controlled.
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The influence of pregnancy on the relapse rate (number of relapses per person per year) in MS was analysed for 52 women who had a pregnancy during the disease. The relapse rate was lower during the pregnancy-year (9 months of pregnancy and 6 months immediately post partum) than the non-pregnancy time. There was a heterogeneous pattern during the pregnancy-year with a sharp decrease in the relapse rate observed during pregnancy and a slight non-significant increase in the puerperium: both these relapse rates were compared with figures observed in the same group of women during the non-pregnancy time. Pregnancy does not appear to be a period at greater risk for exacerbations but, on the contrary it seems to act, on the whole, as a protective event. These data allow physicians to provide reassuring counselling to women.
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