Browsing by Subject "pregnancy"

Now showing 1 - 10 of 37
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    Abuse-Related Post-Traumatic Stress, Coping, and Tobacco Use in Pregnancy
    (2011-07-01) Lopez, William D.; Konrath, Sara H.; Seng, Julia S.
    Objective: To examine the relationship between trauma history, posttraumatic stress disorder (PTSD), coping, and smoking in a diverse sample of pregnant women, some of whom are active smokers. Design: Secondary analysis from a prospective study on PTSD and pregnancy outcomes. Setting: Maternity clinics at three health systems in the midwestern United States. Participants: Women age 18 or older (1,547) interviewed at gestational age fewer than 28 weeks. Methods: Participants were classified at nonsmokers, quitters (stopped smoking during pregnancy), and pregnancy smokers. Demographic, trauma, and pregnancy factors, substance use, and use of tobacco to cope were compared across groups. Logistic regression assessed the influence of these factors on being a smoker versus a nonsmoker and a quitter versus a pregnancy smoker. Results: Smokers differed from nonsmokers on all demographic risk factors (being African American, being pregnant as a teen, having lower income and less education, and living in high-crime areas), had higher rates of current and lifetime PTSD, and were more likely to report abuse as their worst trauma. Pregnancy smokers had lower levels of education, were more likely to classify their worst trauma as “extremely troubling,” and were more likely to exhibit PTSD hyperarousal symptoms. In regression models, smoking “to cope with emotions and problems” doubled the odds of continuing to smoke while pregnant even after accounting for several relevant risk factors. Conclusion: Smoking behavior in pregnancy may be influenced by the need to cope with abuse-related PTSD symptoms. Clinicians should consider using trauma-informed interventions when working with tobacco-using pregnant women.
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    Allostatic Load and Adverse Pregnancy Outcomes
    (Wolters Kluwer, 2022-01-12) Lueth, Amir J.; Allshouse, Amanda A.; Blue, Nathan M.; Grobman, William A.; Levine, Lisa D.; Simhan, Hyagriv N.; Kim, Jin Kyung; Johnson, Jasmine; Wilson, Fernando A.; Murtaugh, Maureen; Silver, Robert M.; National Institutes of Health (NIH); National Institute of Child Health and Human Development (NICHD); Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b); National Heart, Lung, and Blood Institute (NHLBI) nuMoM2b Heart Health Study; Obstetrics and Gynecology, School of Medicine
    Objective: To assess the association between allostatic load, as an estimate of chronic stress, and adverse pregnancy outcomes. Methods: This was a secondary analysis of the Nulliparous Pregnancy Outcomes Study Monitoring-to-be (nuMoM2b) study, a prospective observational cohort study. Our primary exposure was dichotomous high allostatic load in the first trimester, defined as four or more out of 12 biomarkers in the “worst” quartile. The primary outcome was a composite adverse pregnancy outcome: hypertensive disorders of pregnancy (HDP), preterm birth, small for gestational age (SGA) neonate, and stillbirth. Secondary outcomes included components of the composite. Multivariable logistic regression was used to test the association between high allostatic load and adverse pregnancy outcomes, adjusted for potential confounders. Mediation and moderation analyses were conducted to assess the role of allostatic load along the causal pathway between racial disparities and adverse pregnancy outcomes. Results: Among 4,266 individuals, 34.7% had a high allostatic load. Composite adverse pregnancy outcome occurred in 1,171 (27.5%): 14.0% HDP, 8.6% preterm birth (48.0% spontaneous and 52.2% indicated), 11.0% SGA, and 0.3% stillbirth. After adjustment for maternal age, gravidity, smoking, bleeding in the first trimester, and health insurance, high allostatic load was significantly associated with composite adverse pregnancy outcome (aOR 1.5, 95% CI: 1.3, 1.7) and HDP (2.5, 2.0–2.9), but not preterm birth and SGA. High allostatic load partially mediated the association between self-reported race and adverse pregnancy outcomes. The association between allostatic load and HDP differed by self-reported race, but not for composite adverse pregnancy outcome, preterm birth, and SGA. Conclusion: High allostatic load in the first trimester is associated with adverse pregnancy outcomes, particularly HDP. Allostatic load was a partial mediator between race and adverse pregnancy outcomes. The association between allostatic load and HDP differed by self-reported race.
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    Altered angiogenesis as a common mechanism underlying preterm birth, small for gestational age, and stillbirth in women living with HIV
    (Elsevier, 2017-12) Conroy, Andrea L.; McDonald, Chloe R.; Gamble, Joel L.; Olwoch, Peter; Natureeba, Paul; Cohan, Deborah; Kamya, Moses R.; Havlir, Diane V.; Dorsey, Grant; Kain, Kevin C.; Pediatrics, School of Medicine
    Background Angiogenic processes in the placenta are critical regulators of fetal growth and impact birth outcomes, but there are limited data documenting these processes in HIV-infected women or women from low-resource settings. Objective We sought to determine whether angiogenic factors are associated with adverse birth outcomes in HIV-infected pregnant women started on antiretroviral therapy. Study Design This is a secondary analysis of samples collected as part of a clinical trial randomizing pregnant women and adolescents infected with HIV to lopinavir/ritonavir-based (n = 166) or efavirenz-based (n = 160) antiretroviral therapy in Tororo, Uganda. Pregnant women living with HIV were enrolled between 12-28 weeks of gestation. Plasma samples were evaluated for angiogenic biomarkers (angiopoietin-1, angiopoietin-2, vascular endothelial growth factor, soluble fms-like tyrosine kinase-1, placental growth factor, and soluble endoglin) by enzyme-linked immunosorbent assay between: 16-<20, 20-<24, 24-<28, 28-<32, 32-<36, 36-<37 weeks of gestation. The primary outcome was preterm birth. Results In all, 1115 plasma samples from 326 pregnant women and adolescents were evaluated. There were no differences in angiogenic factors according to antiretroviral therapy group (P > .05 for all). The incidence of adverse birth outcomes was 16.9% for spontaneous preterm births, 25.6% for small-for-gestational-age births, and 2.8% for stillbirth. We used linear mixed effect modelling to evaluate longitudinal changes in angiogenic factor concentrations between birth outcome groups adjusting for gestational age at venipuncture, maternal age, body mass index, gravidity, and the interaction between treatment arm and gestational age. Two angiogenic factors–soluble endoglin and placental growth factor–were associated with adverse birth outcomes. Significantly higher concentrations of soluble endoglin throughout gestation were found in study participants destined to deliver preterm [likelihood ratio test, χ2(1) = 12.28, P < .0005] and in those destined to have stillbirths [χ2(1) = 5.67, P < .02]. By contrast, significantly lower concentrations of placental growth factor throughout gestation were found in those destined to have small-for-gestational-age births [χ2(1) = 7.89, P < .005] and in those destined to have stillbirths [χ2(1) = 21.59, P < .0001]. Conclusion An antiangiogenic state in the second or third trimester is associated with adverse birth outcomes, including stillbirth in women and adolescents living with HIV and receiving antiretroviral therapy.
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    Developmental origins of disease highlight the immediate need for expanded access to comprehensive prenatal care
    (Frontiers, 2022-11-23) McDonald, Chloe R.; Weckman , Andrea M.; Wright , Julie K.; Conroy, Andrea L.; Kain, Kevin C.; Pediatrics, School of Medicine
    The prenatal environment plays a critical role in shaping fetal development and ultimately the long-term health of the child. Here, we present data linking prenatal health, via maternal nutrition, comorbidities in pregnancy (e.g., diabetes, hypertension), and infectious and inflammatory exposures, to lifelong health through the developmental origins of disease framework. It is well-established that poor maternal health puts a child at risk for adverse outcomes in the first 1,000 days of life, yet the full health impact of the in utero environment is not confined to this narrow window. The developmental origins of disease framework identifies cognitive, neuropsychiatric, metabolic and cardiovascular disorders, and chronic diseases in childhood and adulthood that have their genesis in prenatal life. This perspective highlights the enormous public health implications for millions of pregnancies where maternal care, and therefore maternal health and fetal health, is lacking. Despite near universal agreement that access to antenatal care is a priority to protect the health of women and children in the first 1,000 days of life, insufficient progress has been achieved. Instead, in some regions there has been a political shift toward deprioritizing maternal health, which will further negatively impact the health and safety of pregnant people and their children across the lifespan. In this article we argue that the lifelong health impact attributed to the perinatal environment justifies policies aimed at improving access to comprehensive antenatal care globally.
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    The Effect of Remdesivir and Convalescent Plasma in Severe COVID-19 in Pregnancy
    (ClinMed International Library, 2021-05-31) Elantably, Ahmed; Elantably, Dina; Ashraf, Usman; Medicine, School of Medicine
    There are limited data regarding treatment options for pregnant women with severe coronavirus disease 2019 (COVID-19). However, the use of convalescent plasma therapy and remdesivir in was reported to be successful in the management of a critically ill obstetric patient with novel coronavirus 2019 infection
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    Erythema nodosum treated by sulfasalazine in a pregnant patient
    (Wiley, 2020-11) Mohammed, Arooj; Rahnama-Moghadam, Sahand; Dermatology, School of Medicine
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    Evidence for potential underestimation of clinical folate deficiency in resource-limited countries using blood tests
    (Oxford, 2017-08) Antony, Aśok C.; Medicine, School of Medicine
    Although a low serum folate concentration is a useful biomarker of pure folate deficiency, the presence of vitamin B12 deficiency or hemolysis or both in individuals with low folate status predictably raises serum folate levels. Therefore, in resource-limited settings where dietary folate deficiency can coexist with vitamin B12 deficiency or malaria or both, the serum folate concentration can range from normal to high, leading to serious underestimation of tissue folate status. This review traces the genesis of an inappropriate overreliance on the serum folate concentration to rule out folate deficiency in vulnerable populations of women and children. Of significance, without due consideration of a chronically inadequate dietary folate intake, authors of influential studies have likely wrongly judged these populations to have an adequate folate status. Through repetition, this error has led to a dangerous entry into the contemporary medical literature that folate deficiency is rare in women and children. As a consequence, many millions of under-resourced women and children with mild to moderate tissue folate deficiency may have been deprived of folate replacement. This review uses historical documents to challenge earlier conclusions and re-emphasizes the need for contextual integration of clinical information in resource-limited settings.
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    Expectations and Experiences of First-Time Mothers
    (2008-08-22T14:01:43Z) Freund, Andrea; Gardner, Carol Brooks
    The aim of this qualitative study was to explore the expectations and experiences first-time mothers have before, during, and after pregnancy. Semi-structured interviews were conducted with fifteen first-time mothers, who gave birth within eighteen months before the date of the interview, and an additional interview was included with a first-time pregnant woman in her third trimester (N=16). The method of analysis was based on grounded theory, including line-by-line coding, focused coding and memo writing. Several themes emerged in the process. Approximately 70 percent of the women in this study became pregnant unintentionally. All of them described a certain amount of anxiety and fear about giving birth and becoming a mother. The measures taken in regard to activities and nutrition to improve pregnancy outcome were described. The most disconcerting findings were how the birth went for many of the women and the subject of postpartum emotional difficulties. Another theme was the different factors that negatively influenced the experience of giving birth. All of the women wanted to give birth vaginally and without medication, but seven of the women had to have medical interventions during birth - were administered Pitocin, mechanically induced, or had C-sections - which influenced their postpartum mental and emotional state severely. The disappointment after complications and diversions from a birth plan were significant. Fifty percent of the participating women reported to have suffered from postpartum emotional disorders, and three of them did not seek any help. Feelings of failure and low self-value due to emotional difficulties were described several times and also appeared in relation with body image issues. Physical changes, during and after pregnancy, were another major theme among the women. Transitions in their relationships were also mentioned in the interviews. Concluding, self-stigmatization was a main thread throughout the interviews. These findings are analyzed in relation to existing literature and the implications for future research are being discussed.