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Query: UMLS:C0728731 (prematurity)
 7,134 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The perinatal mortality rate of infants of diabetic mothers (IDMs) has declined dramatically from 250 per 1000 live births in the 1960s to a near-normal 20 per 1000 live births in the 1980s. Five to 8% of all IDMs suffer from major congenital malformations, and it is the latter that are responsible for 50% of these perinatal deaths. It has been shown that tight glycemic control prior to conception and during pregnancy can prevent an excess rate of congenital malformations, fetal macrosomia, birth trauma, and neonatal respiratory distress syndrome. We briefly review the short- and long-range complications that occur in offspring of diabetic mothers (ODMs) from gestation through young adulthood. Short-term neonatal complications, such as hypoglycemia, hypocalcemia, hypomagnesemia, hyperbilirubinemia, and polycythemia, are related mainly to fetal hyperinsulinemia, hypoxemia, and prematurity. They are readily controllable within the setup of modern neonatal intensive care units. Long-range complications include an increased rate of childhood and adolescent obesity, impaired glucose tolerance or diabetes mellitus, and subtle neuropsychological dysfunctions. These may be related to the severity of the maternal hyperglycemia during pregnancy, the consequent fetal hyperinsulinemia, and third trimester maternal lipid metabolism disturbances. Today we have at hand the knowledge and tools to properly treat both pregestational and gestational diabetes. Increased education of the general practitioner and the target population regarding early referral of pregestational diabetic mothers and the implementation of screening programs for gestational diabetes will further reduce diabetic pregnancy-related morbidity.
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PMID:Short- and long-range complications in offspring of diabetic mothers. 888 19

The dual stresses of pregnancy and exercise may create conflicting physiological demands that could adversely affect pregnancy outcome. Specifically, redistribution of uterine blood flow and subsequent fetal hypoxia, hyperthermia and the risk of teratogenic effects, decreased carbohydrate availability for the fetus, and increased uterine contractility with a possible increase in risk for pre-term labour, all pose potential threats to fetal growth and development. However, despite these potential risks, literature dealing with exercise and pregnancy outcome generally shows neutral or somewhat favourable effects. A few studies have found reduced birthweight, shortened gestation, and less gestational weight gain among women who continue vigorous exercise during pregnancy compared with those who discontinue exercise or who are sedentary. However, most studies find little, if any, association between exercise and birthweight or gestational age. In contrast, studies of occupational physical activity often show an association between heavy physical work and lower birthweight and shorter gestation, especially in women in developing societies whose nutritional status may be compromised. Standing, in particular, may be associated with increased risk of prematurity. Although other outcomes, such as length of labour, type of delivery have not been well studied, there is no indication of any negative associations with exercise. There is limited evidence which suggests that exercise is related to shorter labour and is a useful treatment for gestational diabetes. Exercise is also associated with fewer symptoms and discomforts of pregnancy. This relationship is temporal in that exercise earlier in pregnancy is associated with fewer symptoms later in pregnancy. The lack of evidence for any harmful effects of exercise on pregnancy outcome indicates that, for healthy, well-nourished women, exercise during pregnancy is safe and subject to few restrictions. This conclusion is reflected in the revised, 1994 recommendations of the American College of Obstetricians and Gynecologists.
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PMID:Physical activity and pregnancy outcome. Review and recommendations. 901 58

Preterm labor, cervical cerclage (especially when performed as an emergency procedure), and diabetes mellitus are all associated with an increased risk of chorioamnionitis. It might be expected that the combination of all 3 could lead to especially severe infection. We report such a case. A woman with a history of two spontaneous midtrimester abortions had had cervical cerclage performed at 13 weeks. She was referred at 24 weeks' gestation with preterm labor, and the cervix was found to be dilated. An emergency repeat cerclage was performed. The following day, ultrasonography revealed the presence of intra-amniotic gas. Infection was confirmed by the presence of a purulent cervical discharge, a neutrophilia with a left shift, and an elevated C-reactive protein level. The cervical stitch was removed and labor induced. The infant was liveborn, but succumbed to the complications of prematurity and sepsis. E. coli was isolated. In her subsequent pregnancy, severe gestational diabetes was diagnosed and following pregnancy, permanent diabetes mellitus was confirmed. The combination of infection, diabetes, and intact membranes may lead to a particularly severe form of chorioamnionitis, with the production of gas within the amniotic cavity. Infection should be excluded before emergency cervical cerclage, especially in the woman with diabetes mellitus.
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PMID:Emphysematous chorioamnionitis diagnosed by ultrasonography. 925 46

The presence of insulin-dependent or non insulin-dependent diabetes mellitus in pregnant women has been associated with an adverse effect on the maternal an fetal outcomes of pregnancy. The incidence of obstetrical and diabetic complications is increased, and a continuum has been observed between maternal blood glucose levels and perinatal outcome. The incidence of congenital malformations, macrosomia and prematurity is increased in offspring of diabetic mothers. Programming and intensive collaborative follow-up improve the outcome of such pregnancies. Gestational diabetes mellitus is an heterogenous condition defined as carbohydrate intolerance of variable severity with onset or first recognition during pregnancy. Short term complications are mainly represented by fetal macrosomia and high cesarean section rate. Women with a history of gestational diabetes mellitus are at increased risk of future diabetes, predominantly type 2. Obesity and type 2 diabetes are increased among their children.
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PMID:[Diabetes and pregnancy]. 1054 52

The aim of the study was to estimate which factors contribute to high frequency of RDS in our newborns of the diabetic mothers treated with intensive insulin therapy. The study material consisted of 574 newborns (394 from GDM and 180 from IDDM mothers) born in the years 1987-1998. In the analysed group there were compared: frequency of occurrence of RDS, severity of RDS as well as factors which can contribute to occurrence of RDS. That was found that, in the PGDM group prematurity, low Apgar score and delivery by caesarean section and in the GDM group--prematurity, low Apgar score and male sex are factors contributed the most to occurrence of RDS. That was also found that the risk of occurrence of RDS in the PGDM group was 5 to (transient tachypnoe) to 3 times (RDS) greater than in the GDM group. We conclude that PGDM and prematurity are factors the most connected with the occurrence of RDS in newborns born to diabetic mothers.
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PMID:[Respiratory distress syndrome in newborns of diabetic mothers in the years 1987-1998]. 1061 22

Studies of maternal asthma in pregnancy have shown an increased risk of adverse neonatal and maternal outcomes such as preeclampsia, hypertension, cesarean delivery, prematurity, low birth weight, and perinatal/neonatal mortality. However, results are not consistent between studies. We studied the association between maternal asthma and various adverse neonatal and maternal outcomes and explored whether there is any evidence that pregnancy exacerbates maternal asthma. The data were collected as part of the Childhood Asthma Prevention Study. Pregnant women with asthma or women whose partners or other children had current symptoms of asthma were recruited at six Sydney hospitals. All women recruited were post 36 weeks gestation and were living within 30 km of the study recruitment center. Information about family history of asthma was collected using a questionnaire at 36 weeks gestation and subsequent information about antenatal and perinatal events was obtained from hospital records. Data from 611 pregnant women were available for analysis, 340 of whom had asthma. Hypertension was significantly more common in asthmatics than in nonasthmatics [OR = 2.16 (1.02-4.6), p < 0.043]. The prevalence of gestational diabetes, labor complications, delivery complications, and adverse neonatal outcomes did not differ significantly between the groups. We also found that the course of maternal asthma usually remains unchanged during pregnancy, but that more severe asthma is likely to get worse. We have confirmed previous observations that women with asthma are at increased risk of hypertension in pregnancy, which is consistent with studies that show that pregnant asthmatic women have a slightly increased risk of preeclampsia. However, we did not find evidence of an increased risk of adverse perinatal outcomes.
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PMID:Pregnancy and birth outcomes in families with asthma. 1276 20

The NTPR maintains an ongoing database to study the outcomes of pregnancies in female transplant recipients as well as those pregnancies fathered by male transplant recipients. Recipients are entered into the database by completing. a single page questionnaire. There is steady follow-up of recipients and their offspring. While the majority of pregnancy outcomes have occurred in kidney recipients, data continue to accrue in the other types of organ recipients. KIDNEY: A small percentage of pregnancies in female kidney recipients are complicated by rejection with poorer outcomes with respect to both maternal graft function and their newborn. Other analyses this year focused on outcomes of recipients with systemic lupus erythematosus and those with multiple gestations. It was observed that recipients with systemic lupus erythematosus were able to maintain a pregnancy with outcomes that appear to be similar to other diagnoses. In an analysis of multiple gestations in female kidney recipients maintained on calcineurin inhibitors, no multiple gestations higher than triplets have been reported to the NTPR. Successful outcomes have been noted among these recipients. This does require continued surveillance, as there has been an increase in the number of multiple gestations in the general population with the use of adjunctive technologies. OTHER ORGANS: In analyzing outcomes in female liver recipients, no specific graft or newborn outcome differences have been noted when a comparison has been made between different caicineurin inhibitor regimens. Pregnancies in female pancreas-kidney recipients appear to be tolerated with respect to pancreas graft function with no diagnoses of gestational diabetes reported to the NTPR. Data continue to accrue among thoracic recipients. Poorer maternal survival postpartum in lung recipients may be related to higher risks inherent in this population and requires further experience and investigation. OTHER ISSUES: With the recent proliferation of newer immunosuppressive agents, a question that is raised is whether a regimen can be specifically designed with recipients of childbearing age in mind. Extensive data published on azathioprine and cyclosporine treated recipients suggests that while there is a pattern of prematurity among the newborn there has not been an increase in the incidence or pattern of specific malformations noted among the newborn. Less assurance can be given with newer agents such as sirolimus and MMF. Calcineurin inhibitor minimization or steroid withdrawal would require that other agents with less reproductive information be implemented. The unknown risk of teratogenicity must be balanced against the potential risk of rejection or graft dysfunction when deciding which agent to use during pregnancy. Through each of the organ recipient groups, there are sporadic cases of rejection, graft dysfunction, and graft deterioration. Birth defect patterns have not appeared to be specific to any specific regimen as yet. Two newborns with malformations have been noted among a limited series with MMF exposure, but other factors may also be at play. The use of MMF during pregnancy continues to be an unresolved issue in the transplant community. As yet, no one regimen has been identified as superior to another for use during pregnancy. Continued surveillance with the newer agents is necessary. Investigators have taken differing views regarding the safety of breastfeeding in the transplant recipient population, especially with regard to drug exposure to the infant. This issue remains unresolved and some transplant recipient mothers have chosen to breastfeed. Other factors for consideration are the potential long-term effects on offspring of transplant recipients. While there may not be specific structural defects noted at birth, more subtle effects on either immunologic or reproductive function may not manifest until later in life. Scott and his group in Utah have raised this issue with a case report and have initiated a study to focus on the next generation. The safety of pregnancy for parent and child remain the goals of the NTPR. Continued entries to the registry, especially in light of newer combinations of immunosuppressive agents, should assist in developing guidelines needed for management in this era of expanding immunosuppressive agents. All centers are encouraged to participate.
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PMID:Report from the National Transplantation Pregnancy Registry (NTPR): outcomes of pregnancy after transplantation. 1297 41

The aim of the work was to analyse the basic parameters of perinatal care of diabetic pregnant women, hospitalized in the Clinical Hospital in Bytom in years 1992-2001. The retrospective analysis of 405 diabetic pregnant patients who delivered their babies there was carried out. Diabetes types were following: GDM--44.9%, DM without vascular lesion--43%, DM with vascular lesion--12.1%. Mean age of pregnant women was 28.8 +/- 16 years. 42% patients were primipara, 58% patients were secundipara and multipara. The most often complications during pregnancy were following: threatening premature labour (36.5%), PIH (11.7%), urinary tract infection (9.65%) obesity (8.27%). Mean time of pregnancy was 38 +/- 2 Hbd. Prematurity was 25.9%. 199 patients had caesarean section (49.1%). 24 unsuccessful cases included fetal congenital defects, abortions, missed labour, perinatal fetal death. The authors suggest that such complications in diabetic pregnant patients can be prevented by early diabetes detection, intensive biophysical and biochemical control over fetus, achievement of normoglycaemic condition and a proper choice of delivery time. During last 10 years in our clinical hospital there was observed a decrease in infantile and perinatal mortality, better condition of infants and decrease in number of complications.
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PMID:[Evaluation of the health care of diabetic pregnant women and their newborns in 1992-2001 in the Obstetrics and Gynaecology Department in Bytom]. 1500 17

Advances in HIV therapy and mother-to-child transmission (MTCT) prophylaxis have led to increasing use of antiretroviral drugs in pregnancy. Highly active antiretroviral therapy in pregnancy has been associated with prematurity, pre-eclampsia and gestational diabetes. Women may be at increased risk of nevirapine-associated hepatotoxicity but whether or not pregnancy is an additional risk is uncertain. Although animal studies suggest a possibility of congenital abnormalities with specific antiretrovirals, such as efavirenz, results from registries and cohort studies do not support an excess of congenital malformations associated with in utero antiretroviral exposure. Concerns regarding the health of uninfected, antiretroviral-exposed children include the potential for cancers, mitochondrial disease and haematological abnormalities. However, the absence of any excess mortality in large observational cohort studies of uninfected, antiretroviral therapy-exposed children born to HIV-infected women is reassuring. Based on current knowledge, the immense benefits of antiretroviral prophylaxis in reducing the risk of MTCT, far outweigh the potential for adverse effects.
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PMID:The safety of antiretroviral drugs in pregnancy. 1579 23

Our objective was to examine pregnancy outcome in women age 35 and over. We compared pregnancy delivery complications in 207 women aged 35 years and older with 219 control women aged 25 - 29 years. Data was collected retrospectively and stratified by parity. Results of statistical analysis showed that the older women differed significantly in (1) antepartum factors (previous pregnancy experience, chronic and pregnancy-induced hypertension, maternal and gestational diabetes, placenta previa) (2) intrapartum factors (malpresentations, fetal disproportions, abnormal labour, caesarean and operative vaginal delivery) (3) neonatal outcomes (birth asphyxia, prematurity, low birth weight, neonatal intensive care unit admissions). However, birth trauma and perinatal mortality did not differ between the two groups. We concluded that pregnancies in older women are prone to complications, but when managed accordingly the overall perinatal outcomes were good.
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PMID:Pregnancy outcome in nulliparous women aged 35 or older. 1672 62


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