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Browsing by Author "Burger, Taylor"
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Item Atypical HUS: A Rare Life-Threatening Pregnancy Complication Not to Miss(2021-03) Khan, Maria; Burger, Taylor; Mulcahey, Caitlyn; Taber-Hight, ElizabethCase Description: 32yo G2P2002 woman developed hypertension and AKI on the day after her c-section. She also had vision and mental status changes, headaches, paresthesia, dyspnea, and abdominal pain. Her labs were significant for increased LFTs, thrombocytopenia, and worsening kidney function. After receiving urgent hemodialysis and not responding to plasmapheresis, she was diagnosed with atypical hemolytic-uremic syndrome (aHUS) and started on eculizumab which resulted in significant improvement. She continued to receive dialysis for 2.5 weeks. Conclusions: Atypical hemolytic uremic syndrome is a rare but life-threatening postpartum complication that can resemble other conditions like preeclampsia, HELLP, and TTP. Post-partum patients experiencing hypertension or other kidney injury symptoms should be evaluated further and started on eculizumab early to prevent permanent kidney damage. Clinical Significance: Pregnancy represents a complement amplifying condition which may reveal underlying genetic abnormalities. When working up women who experience acute kidney injury (AKI) during pregnancy, it is important to consider risk preceding obstetric conditions such as hypertensive disorders (preeclampsia, HELLP), fetal death, and hemorrhagic events which may trigger disorders like aHUS/TTP. Plasma exchange response can help differentiate TTP from aHUS. If unresponsive to plasmapheresis, eculizumab effectively treats aHUS by inhibiting the terminal complement cascade. Renal recovery after aHUS is variable. Women can undergo complete recovery or long term dialysis with eventual kidney transplantation. Early initiation of Eculizumab is linked to greater improvement in GFR after one month and fewer incidences of end-stage renal disease. Recurrent episodes of aHUS are possible and prophylactic Eculizumab has been shown to decrease the likelihood of recurrence. Future pregnancies are advised against due to the risk of pregnancy to cause further thrombotic events.Item Effects of maternal depression on fetal health(2022-03) Burger, Taylor; Crowley, Evelyn; Koester, Jami; Noel, Josey; Raza, MubashraCase Description Patient is a 27 years old pregnant (18 weeks) female with a past medical history of depression, post-traumatic stress disorder (PTSD), and military sexual trauma admitted for suicidal ideation with intent and plan. During admission, the patient refused all antidepressants after emesis on sertraline and prenatal vitamins. Patient was discharged after clinical stabilization and scheduled for follow-up outpatient. Conclusions Depression during pregnancy can have numerous adverse effects on mother as well as fetal and child development and thus treatment is of the utmost importance. Depression leads to alterations in the serotonin system and the HPA axis, as well as causes epigenetic changes to the infant glucocorticoid receptor gene. Changes in these pathways are most apparent during the second trimester and have downstream consequences leading to altered fetal heart rate variability, preterm birth, and low birth weight. Maternal depression can also lead to altered cortisol reactivity, and delayed motor and cognitive development in childhood. Furthermore, prevalence of depression varies throughout the pregnancy with depression more prevalent in the second and third trimesters. Clinical Significance Pregnant women are less likely to receive any mental health treatment for depression than their non-pregnant counterparts; 49% and 57% respectively, and screening for depression focuses on postpartum screening with few guidelines to screening during pregnancy. Due to the adverse effects on the fetus, maternal surveillance and treatment of depression during pregnancy is essential.Item Obesity and Fertility: A Prospective Cohort Study(2020-07-31) Burger, Taylor; Li, Joanna; Zhao, Qiuhong; Peipert, Jeffrey F.Background and Hypothesis: Previous studies have linked body mass index (BMI) with time to pregnancy. The objective of this analysis was to determine if obesity (BMI > 30 kg/m2) is associated with reduced fertility in a cohort of women who discontinued contraceptive method to attempt conception. We hypothesized that BMI is associated with time to conception after controlling for potential confounding variables. Methods: We performed a secondary analysis of the FACT (Fertility After Contraceptive Termination) study. We included 432 women, aged 18-35 years old, who discontinued contraception in an effort to conceive, were sexually active with a male partner, had the ability to consent, and had a minimum of 12 months of follow-up data. Participants were excluded who were already pregnant, had a history of infertility or medically induced sterility or, used depot medroxyprogesterone acetate (DMPA) in the past 5 months. We collected participant data on demographic, reproductive, medical characteristics, and sexual history, as well as date of contraceptive termination. We used Cox proportional hazard models to assess associations between BMI and time to conception while controlling for race, socioeconomic status, and prior contraceptive method. Results: A BMI of 30 or greater was associated with reduced fertility compared to participants with a BMI of less than 25 after controlling for race, low SES, and prior contraceptive method (HRadj=0.72; 95% CI 0.53, 0.97; p=0.03). We also noted that obese women with regular menses had reduced fertility compared to normal weight participants with regular cycles (HRadj 0.58; 95% CI 0.39, 0.86, p=0.007). For participants with irregular menstrual cycles, BMI was not associated with time to conception. Conclusion & Potential Impact: Our study supports the association of obesity with reduced fertility and increased time to conception. Future studies of weight loss should be considered as a method to improve conception rates.Item Pre- and post-conception planning in autoimmune disorders(2020-03) Kumar, Nimisha; Aksu, Eric; Gensel, Annie; Burger, Taylor; Pease, KenseyBackground: Autoimmune diseases are often multisystem, requiring many specialists. However, there are no clear recommendations for many of these disorders for planning pregnancy and preventing exacerbations. Intervention: Little time is devoted to patient counseling about contraception or care antepartum, intrapartum, and postpartum. Contraception and many first-line interventions can have varying effects in different diseases, which can be further complicated by multiple diagnoses. Many of these disorders also can have postpartum complications, making follow-up essential. Results:Systemic lupus erythematosus (SLE) is known to cause exacerbations during pregnancy and has serious adverse outcomes for both mother and baby. Active disease is associated with higher rates of preterm birth, pre-eclampsia, thromboses, fetal loss, and neonatal lupus. Patients are at increased risk of these complications with a history of lupus nephritis, cessation of hydroxychloroquine, and primigravidity. Multiple sclerosis (MS) has lower rates of relapse during pregnancy, but higher rates in the first postpartum year. This has been attributed to the rapid increase in progesterone during pregnancy improving symptoms, while the rapid decrease after pregnancy promotes relapses. Additionally, neonatal morbidity does not increase as a result of MS. For other autoimmune diseases such as Sjögren's Syndrome or Grave’s Disease, the clinical picture may be complicated by the physiology of pregnancy, but is unclear whether pregnancy exacerbates the autoimmune component of the disease. Conclusions: Pregnancy and contraception could improve or worsen symptoms in autoimmune diseases, even up to a year postpartum. There is a significant gap in practice guidelines regarding contraception and pregnancy despite many diseases’ onset during childbearing years. Pregnancy and contraception counseling should be part of initial conversations at diagnosis to prepare women.