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[PMID]:28465095
[Au] Autor:Arriola CS; Vasconez N; Thompson MG; Olsen SJ; Moen AC; Bresee J; Ropero AM
[Ad] Endereço:Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, GA, USA; Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: wus3@cdc.gov.
[Ti] Título:Association of influenza vaccination during pregnancy with birth outcomes in Nicaragua.
[So] Source:Vaccine;35(23):3056-3063, 2017 05 25.
[Is] ISSN:1873-2518
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Studies have shown that influenza vaccination during pregnancy reduces the risk of influenza disease in pregnant women and their offspring. Some have proposed that maternal vaccination may also have beneficial effects on birth outcomes. In 2014, we conducted an observational study to test this hypothesis using data from two large hospitals in Managua, Nicaragua. METHODS: We conducted a retrospective cohort study to evaluate associations between influenza vaccination and birth outcomes. We carried out interviews and reviewed medical records post-partum to collect data on demographics, influenza vaccination during pregnancy, birth outcomes and other risk factors associated with adverse neonatal outcomes. We used influenza surveillance data to adjust for timing of influenza circulation. We assessed self-reports of influenza vaccination status by further reviewing medical records of those who self-reported but did not have readily available evidence of vaccination status. We performed multiple logistic regression (MLR) and propensity score matching (PSM). RESULTS: A total of 3268 women were included in the final analysis. Of these, 55% had received influenza vaccination in 2014. Overall, we did not observe statistically significant associations between influenza vaccination and birth outcomes after adjusting for risk factors, with either MLR or PSM. With PSM, after adjusting for risk factors, we observed protective associations between influenza vaccination in the second and third trimester and preterm birth (aOR: 0.87; 95% confidence interval (CI): 0.75-0.99 and aOR: 0.66; 95% CI: 0.45-0.96, respectively) and between influenza vaccination in the second trimester and low birth weight (aOR: 0.80; 95% CI: 0.64-0.97). CONCLUSIONS: We found evidence to support an association between influenza vaccination and birth outcomes by trimester of receipt with data from an urban population in Nicaragua. The study had significant selection and recall biases. Prospective studies are needed to minimize these biases.
[Mh] Termos MeSH primário: Vacinas contra Influenza/administração & dosagem
Influenza Humana/prevenção & controle
Complicações Infecciosas na Gravidez/prevenção & controle
Resultado da Gravidez
[Mh] Termos MeSH secundário: Adolescente
Adulto
Estudos de Coortes
Feminino
Seres Humanos
Recém-Nascido de Baixo Peso
Recém-Nascido
Modelos Logísticos
Registros Médicos
Nicarágua/epidemiologia
Gravidez
Complicações Infecciosas na Gravidez/epidemiologia
Trimestres da Gravidez
Nascimento Prematuro/epidemiologia
Pontuação de Propensão
Estudos Retrospectivos
População Urbana/estatística & dados numéricos
Vacinação
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY; RESEARCH SUPPORT, NON-U.S. GOV'T; RESEARCH SUPPORT, U.S. GOV'T, P.H.S.
[Nm] Nome de substância:
0 (Influenza Vaccines)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE


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[PMID]:28460045
[Au] Autor:Lekva T; Roland MCP; Michelsen AE; Friis CM; Aukrust P; Bollerslev J; Henriksen T; Ueland T
[Ad] Endereço:Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, 0027 Oslo, Norway.
[Ti] Título:Large Reduction in Adiponectin During Pregnancy Is Associated With Large-for-Gestational-Age Newborns.
[So] Source:J Clin Endocrinol Metab;102(7):2552-2559, 2017 Jul 01.
[Is] ISSN:1945-7197
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Context: Fetuses exposed to an obese intrauterine environment are more likely to be born large-for-gestational age (LGA) and are at increased risk of obesity in childhood and cardiovascular disease and/or type 2 diabetes mellitus as adults, but which factors that influence the intrauterine environment is less clear. Objective: To investigate the association between circulating levels of leptin and adiponectin, measured multiple times during pregnancy, and birth weight and prevalence of LGA or small-for-gestational-age infants. The association between birth weight and messenger RNA (mRNA) expression of adiponectin receptors and genes involved in nutrient transport in the placenta was also investigated. Design: Population-based prospective cohort [substudy of the STORK study (STORe barn og Komplikasjoner, translated as Large Babies and Complications)] from 2001 to 2008. Setting: University hospital. Patients or other participants: 300 women. Main Outcome Measures: Oral glucose tolerance test was performed twice along with adiponectin and leptin levels measured four times during pregnancy. Results: Circulating adiponectin was lower in mothers who gave birth to LGA offspring or had fetuses with high intrauterine abdominal circumference late in pregnancy. Adiponectin decreased most from early to late pregnancy in mothers who gave birth to LGA offspring, and the decrease was an independent predictor of birth weight. Adiponectin receptor 2 and system A amino acid transporter mRNA expression in placentas was negatively correlated with birth weight and was lower in placentas from LGA infants. Conclusions: Our findings suggest that maternal adiponectin may be an important predictor of fetal growth and birth weight, independent of body mass index and insulin resistance.
[Mh] Termos MeSH primário: Adiponectina/sangue
Peso ao Nascer
Desenvolvimento Fetal
Macrossomia Fetal/sangue
Resultado da Gravidez
Receptores de Adiponectina/metabolismo
[Mh] Termos MeSH secundário: Adulto
Estudos de Coortes
Feminino
Idade Gestacional
Teste de Tolerância a Glucose
Hospitais Universitários
Seres Humanos
Recém-Nascido
Resistência à Insulina/fisiologia
Leptina/sangue
Masculino
Gravidez
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (ADIPOR2 protein, human); 0 (Adiponectin); 0 (Leptin); 0 (Receptors, Adiponectin)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.1210/jc.2017-00289


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[PMID]:29325265
[Au] Autor:Wang S; Yang HX
[Ad] Endereço:Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China.
[Ti] Título:[Clinical analysis of 105 intrauterine fetal deaths in 17 years].
[So] Source:Zhonghua Fu Chan Ke Za Zhi;52(12):818-821, 2017 Dec 25.
[Is] ISSN:0529-567X
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:To study the cause of intrauterine fetal death (IUFD) in 17 years. From June 1(st), 2000 to May 31(st), 2017, 65 621 women delivered in Peking University First Hospital. Clinical data of 105 cases of IUFD (including 82 singleton pregnancies and 23 twin pregnancies) during the 17 years were analyzed retrospectively. (1) In singleton pregnancies, the leading cause of IUFD was maternal complications, including severe pre-eclampsia (36/82, 43.9%) and diabetes mellitus (6/82, 7.3%). The second reason was umbilical cord factors (13/82, 15.9%), including over-screwed umbilical cord, cord entanglement, true knot of cord. 54 women of singleton pregnancy (65.9%, 54/82) felt abnormal fetal movements (decreased or disappeared). (2) In twin pregnancies, the leading cause was complications of monochorionic twins (12/23, 52.2%). Seven woman of twin pregnancy (65.9%, 54/82) felt abnormal fetal movements. To reduce the occurrence of IUFD, the pregnancy complications should be managed in time and properly. Monochorionic twins should be determined as early as possible. More attention should be paid toabnormal fetal movement and the application of ultrasound.
[Mh] Termos MeSH primário: Morte Fetal/etiologia
Pré-Eclâmpsia/epidemiologia
Gravidez de Gêmeos
Cordão Umbilical
[Mh] Termos MeSH secundário: Adulto
China/epidemiologia
Diabetes Mellitus/epidemiologia
Feminino
Seres Humanos
Gravidez
Resultado da Gravidez
Estudos Retrospectivos
Gêmeos
Gêmeos Monozigóticos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180112
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.0529-567x.2017.12.005


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[PMID]:29215512
[Au] Autor:Gibbs Pickens CM; Kramer MR; Howards PP; Badell ML; Caughey AB; Hogue CJ
[Ad] Endereço:Department of Epidemiology, Rollins School of Public Health, and Laney Graduate School and the Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia; and the Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon.
[Ti] Título:Term Elective Induction of Labor and Pregnancy Outcomes Among Obese Women and Their Offspring.
[So] Source:Obstet Gynecol;131(1):12-22, 2018 Jan.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To evaluate whether elective induction of labor between 39 through 41 weeks of gestation, as compared with expectant management, is associated with reduced cesarean delivery and other adverse outcomes among obese women and their offspring. METHODS: We conducted a retrospective cohort study using the 2007-2011 California Linked Patient Discharge Data-Birth Cohort File of 165,975 singleton, cephalic, nonanomalous deliveries to obese women. For each gestational week (39-41), we used multivariable logistic regression models, stratified by parity, to assess whether elective induction of labor or expectant management was associated with lower odds of cesarean delivery and other adverse outcomes. RESULTS: At 39 and 40 weeks of gestation, cesarean delivery was less common in obese nulliparous women who were electively induced compared with those who were expectantly managed (at 39 weeks of gestation, frequencies were 35.9% vs 41.0%, respectively [P<.05]; adjusted odds ratio [OR] 0.82, 95% CI 0.77-0.88). Severe maternal morbidity was less frequent among electively induced obese nulliparous patients (at 39 weeks of gestation, 5.6% vs 7.6% [P<.05]; adjusted OR 0.75, 95% CI 0.65-0.87). Neonatal intensive care unit admission was less common among electively induced obese nulliparous women (at 39 weeks of gestation, 7.9% vs 10.1% [P<.05]; adjusted OR 0.79, 95% CI 0.70-0.89). Patterns were similar among obese parous women at 39 weeks of gestation (crude frequencies and adjusted ORs [95% CIs] were as follows: for cesarean delivery, 7.0% vs 8.7% [P<.05] and 0.79 [0.73-0.86]; for severe maternal morbidity, 3.3% vs 4.0% [P<.05] and 0.83 [0.74-0.94]; for neonatal intensive care unit admission: 5.3% vs 7.4% [P<.05] and 0.75 [0.68-0.82]). Similarly, elective induction at 40 weeks of gestation was associated with reduced odds of cesarean delivery, maternal morbidity, and neonatal intensive care unit admission among both obese nulliparous and parous patients. CONCLUSION: Elective labor induction after 39 weeks of gestation was associated with reduced maternal and neonatal morbidity among obese women. Further prospective investigation is necessary.
[Mh] Termos MeSH primário: Cesárea/estatística & dados numéricos
Procedimentos Cirúrgicos Eletivos
Saúde do Lactente
Trabalho de Parto Induzido/métodos
Obesidade/complicações
Resultado da Gravidez
[Mh] Termos MeSH secundário: Adulto
Índice de Massa Corporal
Estudos de Coortes
Feminino
Idade Gestacional
Seres Humanos
Recém-Nascido
Trabalho de Parto
Modelos Logísticos
Análise Multivariada
Obesidade/diagnóstico
Razão de Chances
Gravidez
Estudos Retrospectivos
Medição de Risco
Estados Unidos
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180307
[Lr] Data última revisão:
180307
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171208
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002408


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[PMID]:28748341
[Au] Autor:David M; Borde T; Brenne S; Ramsauer B; Henrich W; Breckenkamp J; Razum O
[Ad] Endereço:Department of Gynecology, Charité University Medicine Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany. matthias.david@charite.de.
[Ti] Título:Obstetric and perinatal outcomes among immigrant and non-immigrant women in Berlin, Germany.
[So] Source:Arch Gynecol Obstet;296(4):745-762, 2017 Oct.
[Is] ISSN:1432-0711
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: In Germany, regular immigrants and their descendants have legal and financial access to health care equal to the general citizenry. Nonetheless, some of their health outcomes are comparatively unfavorable, and that is only partially explained by their lower socioeconomic status (SES). The aim of this study was to assess whether this disparity exists also for obstetric and perinatal outcomes. METHODS: We compared obstetric and perinatal outcomes between immigrant women (first or second generation) and non-immigrant women, delivering at three maternity hospitals in Berlin, Germany, 2011-2012. Multivariable logistic regression analysis was used to assess immigrant status and other possible risk factors for the baby being delivered preterm, small for gestational age (SGA), or transferred to neonatal care. RESULTS: The final database retained 6702 women, of whom 53.1% were first- or second-generation immigrants. First-generation Turkish immigrant women had significantly lower odds of preterm birth (OR 0.37, P < 0.001), SGA (OR 0.60, P = 0.0079), and transfer of the newborn to neonatal care (OR 0.61, P = 0.0034). Second-generation immigrant women had significantly lower odds of preterm birth (OR 0.67, P = 0.0049) or transfer of the newborn to neonatal care (OR 0.76, P = 0.0312). Moreover, women with education below university level, age 35+, or smokers had higher odds for poor outcomes. CONCLUSIONS: This study provides strong evidence that health disparities for obstetric and perinatal health outcomes do not exist in immigrants relative to native Germans, but exist instead in women without post-secondary-level education compared to women with such education, regardless of ethnicity or migration history.
[Mh] Termos MeSH primário: Emigrantes e Imigrantes/estatística & dados numéricos
Resultado da Gravidez/etnologia
Nascimento Prematuro/etnologia
[Mh] Termos MeSH secundário: Adulto
Berlim
Escolaridade
Feminino
Alemanha/epidemiologia
Seres Humanos
Recém-Nascido
Recém-Nascido Pequeno para a Idade Gestacional
Gravidez
Fatores de Risco
Turquia/etnologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170728
[St] Status:MEDLINE
[do] DOI:10.1007/s00404-017-4450-5


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[PMID]:29480852
[Au] Autor:Yang W; Zhang T; Li Z; Ren X; Huang B; Zhu G; Jin L
[Ad] Endereço:Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, JieFang Avenue, Wuhan, People's Republic of China.
[Ti] Título:Combined analysis of endometrial thickness and pattern in predicting clinical outcomes of frozen embryo transfer cycles with morphological good-quality blastocyst: A retrospective cohort study.
[So] Source:Medicine (Baltimore);97(2):e9577, 2018 Jan.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:To evaluate the combined effect of endometrial thickness and pattern on clinical outcomes in females following in vitro fertilization/intracytoplasmic sperm injection and frozen-thawed embryo transfer (IVF/ICSI-FET).FET cycles using at least 1 morphological good-quality blastocyst conducted between 2012 and 2013 at a university-based reproductive center were reviewed retrospectively. Endometrial ultrasonographic characteristics were recorded on the day of progesterone supplementation in FET cycles. In the combined analysis, endometrial thickness groups (group 1: equal or < 8 mm; group 2: >8 mm) were subdivided into 2 endometrial patterns (pattern A: triple-line; pattern B: no-triple line). Clinical pregnancy rate, spontaneous abortion rate, and live birth rate in different groups were analyzed.A total of 1512 cycles were reviewed. The results showed that significant differences in endometrial thickness and pattern were observed between the pregnant group (n = 1009) and no pregnant group (n = 503) (P < .05), while no significant differences were found between the live birth group (n = 844) and no live birth group (n = 668). Combined analysis revealed those with endometrial thickness > 8 mm and triple-line endometrial pattern had significant higher clinical pregnancy rates, while spontaneous abortion rates and live birth rates showed no significant differences among these subgroups.This study suggested neither individual nor combined analysis of endometrial thickness and pattern had predicting effects on live birth following IVF treatments, and embryo quality might be the one that really has effects.
[Mh] Termos MeSH primário: Transferência Embrionária
Endométrio/diagnóstico por imagem
Injeções de Esperma Intracitoplásmicas
[Mh] Termos MeSH secundário: Adulto
Blastocisto
Feminino
Seres Humanos
Modelos Logísticos
Tamanho do Órgão
Gravidez
Resultado da Gravidez
Prognóstico
Curva ROC
Estudos Retrospectivos
Ultrassonografia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180227
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009577


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[PMID]:29419378
[Au] Autor:Chappell LC; Chambers J; Thornton JG; Williamson C
[Ad] Endereço:Women's Health Academic Centre, King's College London, London, UK lucy.chappell@kcl.ac.uk.
[Ti] Título:Does ursodeoxycholic acid improve perinatal outcomes in women with intrahepatic cholestasis of pregnancy?
[So] Source:BMJ;360:k104, 2018 02 01.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Colagogos e Coleréticos/efeitos adversos
Colestase Intra-Hepática/tratamento farmacológico
Feto/efeitos dos fármacos
Complicações na Gravidez/tratamento farmacológico
Ácido Ursodesoxicólico/efeitos adversos
[Mh] Termos MeSH secundário: Colagogos e Coleréticos/administração & dosagem
Colagogos e Coleréticos/uso terapêutico
Colestase Intra-Hepática/epidemiologia
Feminino
Seres Humanos
Gravidez
Complicações na Gravidez/epidemiologia
Resultado da Gravidez/epidemiologia
Ácido Ursodesoxicólico/administração & dosagem
Ácido Ursodesoxicólico/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Cholagogues and Choleretics); 724L30Y2QR (Ursodeoxycholic Acid)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180209
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.k104


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[PMID]:29351561
[Au] Autor:Snijdewind IJM; Smit C; Godfried MH; Bakker R; Nellen JFJB; Jaddoe VWV; van Leeuwen E; Reiss P; Steegers EAP; van der Ende ME
[Ad] Endereço:Department of Internal Medicine, Section Infectious Diseases, Erasmus Medical Center, Rotterdam, The Netherlands.
[Ti] Título:Preconception use of cART by HIV-positive pregnant women increases the risk of infants being born small for gestational age.
[So] Source:PLoS One;13(1):e0191389, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The benefits of combination anti-retroviral therapy (cART) in HIV-positive pregnant women (improved maternal health and prevention of mother to child transmission [pMTCT]) currently outweigh the adverse effects due to cART. As the variety of cART increases, however, the question arises as to which type of cART is safest for pregnant women and women of childbearing age. We studied the effect of timing and exposure to different classes of cART on adverse birth outcomes in a large HIV cohort in the Netherlands. MATERIALS AND METHODS: We included singleton HEU infants registered in the ATHENA cohort from 1997 to 2015. Multivariate logistic regression analysis for single and multiple pregnancies was used to evaluate predictors of small for gestational age (SGA, birth weight <10th percentile for gestational age), low birth weight and preterm delivery. RESULTS: A total of 1392 children born to 1022 mothers were included. Of these, 331 (23.8%) children were SGA. Women starting cART before conception had an increased risk of having a SGA infant compared to women starting cART after conception (OR 1.35, 95% CI 1.03-1.77, p = 0.03). The risk for SGA was highest in women who started a protease inhibitor-(PI) based regimen prior to pregnancy, compared with women who initiated PI-based cART during pregnancy. While the association of preterm delivery and preconception cART was significant in univariate analysis, on multivariate analysis only a non-significant trend was observed (OR 1.39, 95% CI 0.94-1.92, p = 0.06) in women who had started cART before compared to after conception. In multivariate analysis, the risk of low birth weight (OR 1.34, 95% CI 0.94-1.92, p = 0.11) was not significantly increased in women who had started cART prior to conception compared to after conception. CONCLUSION: In our cohort of pregnant HIV-positive women, the use of cART prior to conception, most notably a PI-based regimen, was associated with intrauterine growth restriction resulting in SGA. Data showed a non-significant trend in the risk of PTD associated with preconception use of cART compared to its use after conception. More studies are needed with regard to the mechanisms taking place in the placenta during fetal growth in pregnant HIV-positive women using cART. It will only be with this knowledge that we can begin to understand the potential impact of HIV and cART on the fetus, in order to be able to determine the optimal individualised drug regimen for HIV-infected women of childbearing age.
[Mh] Termos MeSH primário: Fármacos Anti-HIV/efeitos adversos
Infecções por HIV/complicações
Infecções por HIV/tratamento farmacológico
Complicações Infecciosas na Gravidez/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Fármacos Anti-HIV/administração & dosagem
Estudos de Coortes
Quimioterapia Combinada
Feminino
Retardo do Crescimento Fetal/etiologia
Infecções por HIV/transmissão
Seres Humanos
Recém-Nascido de Baixo Peso
Recém-Nascido
Recém-Nascido Pequeno para a Idade Gestacional
Transmissão Vertical de Doença Infecciosa/prevenção & controle
Masculino
Países Baixos
Cuidado Pré-Concepcional/métodos
Gravidez
Resultado da Gravidez
Nascimento Prematuro/etiologia
Estudos Retrospectivos
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Anti-HIV Agents)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180120
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191389


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[PMID]:28454703
[Au] Autor:Starikov RS; Inman K; Has P; Iqbal SN; Coviello E; He M
[Ad] Endereço:Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Women & Infants Hospital of Rhode Island, Providence, RI, USA; Phoenix Perinatal Associates, Phoenix, AZ, USA; Warren Alpert Medical School of Brown University, Providence, RI, USA.
[Ti] Título:Correlation of placental pathology and perinatal outcomes with Hemoglobin A1c in early pregnancy in gravidas with pregestational diabetes mellitus.
[So] Source:Placenta;52:94-99, 2017 Apr.
[Is] ISSN:1532-3102
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Data on the correlation among Hemoglobin A1c (HbA1c), placental pathology, and perinatal outcome in the pregestational diabetic population is severely lacking. We believe that this knowledge will enhance the management of pregnancies complicated by pregestational diabetes. We hypothesize that placental pathology correlates with glycemic control at an early gestational age. METHODS: This is a retrospective cohort study conducted from 2003 to 2011 at a large tertiary care center. Women included had a singleton gestation, preexisting diabetes mellitus, and information about delivery and placental pathology available for review. Placental pathology and perinatal outcomes were compared across three groups of patients with differing HbA1c levels (<6.5%, 6.5-8.4%, and ≥8.5%). RESULTS: 293 placentas were examined. HbA1c was measured at a mean of 9.5week gestation. Median HbA1c was 7.5%, interquartile range 6.5%-8.9%. 23% of the cohort had HbA1c <6.5%, 41.9% between 6.5% and 8.4%, and 34.8% > 8.5%. BMI varied significantly by group (35.4 vs. 34.4 vs. 32.0 respectively, P = 0.04). Individual placental lesions did not vary with HbA1c levels. The incidence of acute chorioamnionitis differed significantly in the type 1 population and "distal villous hypoplasia" varied in the type 2 population. DISCUSSION: The results show that HbA1c values in early pregnancy are poor predictors of future placental pathologies. As a result, HbA1c values obtained during early gestation (which reflect the level of glycemic control over an extended period of time) do not correlate with any particular placental pathology, despite reflecting the potential for placental insults secondary to pre-gestational diabetes.
[Mh] Termos MeSH primário: Glicemia
Diabetes Mellitus Tipo 1/patologia
Diabetes Mellitus Tipo 2/patologia
Hemoglobina A Glicada/análise
Placenta/patologia
Gravidez em Diabéticas/patologia
[Mh] Termos MeSH secundário: Adulto
Diabetes Mellitus Tipo 1/sangue
Diabetes Mellitus Tipo 2/sangue
Feminino
Seres Humanos
Gravidez
Resultado da Gravidez
Gravidez em Diabéticas/sangue
Estudos Retrospectivos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Blood Glucose); 0 (Glycated Hemoglobin A); 0 (hemoglobin A1c protein, human)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170430
[St] Status:MEDLINE


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[PMID]:29450525
[Au] Autor:Daw JR; Sommers BD
[Ad] Endereço:Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
[Ti] Título:Association of the Affordable Care Act Dependent Coverage Provision With Prenatal Care Use and Birth Outcomes.
[So] Source:JAMA;319(6):579-587, 2018 02 13.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: The effect of the Affordable Care Act (ACA) dependent coverage provision on pregnancy-related health care and health outcomes is unknown. Objective: To determine whether the dependent coverage provision was associated with changes in payment for birth, prenatal care, and birth outcomes. Design, Setting, and Participants: Retrospective cohort study, using a differences-in-differences analysis of individual-level birth certificate data comparing live births among US women aged 24 to 25 years (exposure group) and women aged 27 to 28 years (control group) before (2009) and after (2011-2013) enactment of the dependent coverage provision. Results were stratified by marital status. Main Exposures: The dependent coverage provision of the ACA, which allowed young adults to stay on their parent's health insurance until age 26 years. Main Outcomes and Measures: Primary outcomes were payment source for birth, early prenatal care (first visit in first trimester), and adequate prenatal care (a first trimester visit and 80% of expected visits). Secondary outcomes were cesarean delivery, premature birth, low birth weight, and infant neonatal intensive care unit (NICU) admission. Results: The study population included 1 379 005 births among women aged 24-25 years (exposure group; 299 024 in 2009; 1 079 981 in 2011-2013), and 1 551 192 births among women aged 27-28 years (control group; 325 564 in 2009; 1 225 628 in 2011-2013). From 2011-2013, compared with 2009, private insurance payment for births increased in the exposure group (36.9% to 35.9% [difference, -1.0%]) compared with the control group (52.4% to 51.1% [difference, -1.3%]), adjusted difference-in-differences, 1.9 percentage points (95% CI, 1.6 to 2.1). Medicaid payment decreased in the exposure group (51.6% to 53.6% [difference, 2.0%]) compared with the control group (37.4% to 39.4% [difference, 1.9%]), adjusted difference-in-differences, -1.4 percentage points (95% CI, -1.7 to -1.2). Self-payment for births decreased in the exposure group (5.2% to 4.3% [difference, -0.9%]) compared with the control group (4.9% to 4.3% [difference, -0.5%]), adjusted difference-in-differences, -0.3 percentage points (95% CI, -0.4 to -0.1). Early prenatal care increased from 70% to 71.6% (difference, 1.6%) in the exposure group and from 75.7% to 76.8% (difference, 0.6%) in the control group (adjusted difference-in-differences, 0.6 percentage points [95% CI, 0.3 to 0.8]). Adequate prenatal care increased from 73.5% to 74.8% (difference, 1.3%) in the exposure group and from 77.5% to 78.8% (difference, 1.3%) in the control group (adjusted difference-in-differences, 0.4 percentage points [95% CI, 0.2 to 0.6]). Preterm birth decreased from 9.4% to 9.1% in the exposure group (difference, -0.3%) and from 9.1% to 8.9% in the control group (difference, -0.2%) (adjusted difference-in-differences, -0.2 percentage points (95% CI, -0.3 to -0.03). Overall, there were no significant changes in low birth weight, NICU admission, or cesarean delivery. In stratified analyses, changes in payment for birth, prenatal care, and preterm birth were concentrated among unmarried women. Conclusions and Relevance: In this study of nearly 3 million births among women aged 24 to 25 years vs those aged 27 to 28 years, the Affordable Care Act dependent coverage provision was associated with increased private insurance payment for birth, increased use of prenatal care, and modest reduction in preterm births, but was not associated with changes in cesarean delivery rates, low birth weight, or NICU admission.
[Mh] Termos MeSH primário: Cobertura do Seguro
Reembolso de Seguro de Saúde/estatística & dados numéricos
Patient Protection and Affordable Care Act
Resultado da Gravidez
Cuidado Pré-Natal/utilização
[Mh] Termos MeSH secundário: Adulto
Fatores Etários
Cesárea/estatística & dados numéricos
Feminino
Seres Humanos
Recém-Nascido de Baixo Peso
Cobertura do Seguro/estatística & dados numéricos
Seguro Saúde
Unidades de Terapia Intensiva Neonatal
Modelos Lineares
Medicaid/estatística & dados numéricos
Gravidez
Nascimento Prematuro/epidemiologia
Cuidado Pré-Natal/economia
Estudos Retrospectivos
Estados Unidos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180217
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2018.0030



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