Myla E Moretti

Bio: Myla E Moretti is an academic researcher from University of Toronto. The author has contributed to research in topics: Pregnancy & Breast feeding. The author has an hindex of 38, co-authored 82 publications receiving 4402 citations.

Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta-analysis of epidemiological studies

Abstract: Background Corticosteroids are first-line drugs for the treatment of a variety of conditions in women of childbearing age Information regarding human pregnancy outcome with corticosteroids is limited Methods We collected prospectively and followed up 184 women exposed to prednisone in pregnancy and 188 pregnant women who were counseled by Motherisk for nonteratogenic exposure The primary outcome was the rate of major birth defects A meta-analysis of all epidemiological studies was conducted The Mantel-Haenszel summary odds ratio was calculated for the pooled studies with 95% confidence intervals A cumulative summary odds ratio was also calculated by combining studies in chronological order Chi-squared for homogeneity was determined to establish the comparability of the studies Results In our prospective study, there was no statistical difference in the rate of major anomalies between the corticosteroid-exposed and control groups In the meta-analysis, the Mantel-Haenszel summary odds ratio for major malformations with all cohort studies was 145 [95% CI 080, 260] and 303 [95% CI 108, 854] when Heinonen et al ('77) was removed This suggests a marginally increased risk of major malformations after first-trimester exposure to corticosteroids In addition, summary odds ratio for case-control studies examining oral clefts was significant (335 [95% CI 197, 569]) Conclusions Although prednisone does not represent a major teratogenic risk in humans at therapeutic doses, it does increase by an order of 34-fold the risk of oral cleft, which is consistent with the existing animal studies Teratology 62:385–392, 2000 © 2000 Wiley-Liss, Inc

Medication use in pregnancy: a cross-sectional, multinational web-based study.

Abstract: Objectives Intercountry comparability between studies on medication use in pregnancy is difficult due to dissimilarities in study design and methodology. This study aimed to examine patterns and factors associated with medications use in pregnancy from a multinational perspective, with emphasis on type of medication utilised and indication for use. Design Cross-sectional, web-based study performed within the period from 1 October 2011 to 29 February 2012. Uniform collection of drug utilisation data was performed via an anonymous online questionnaire. Setting Multinational study in Europe (Western, Northern and Eastern), North and South America and Australia. Participants Pregnant women and new mothers with children less than 1 year of age. Primary and secondary outcome measures Prevalence of and factors associated with medication use for acute/short-term illnesses, chronic/long-term disorders and over-the-counter (OTC) medication use. Results The study population included 9459 women, of which 81.2% reported use of at least one medication (prescribed or OTC) during pregnancy. Overall, OTC medication use occurred in 66.9% of the pregnancies, whereas 68.4% and 17% of women reported use of at least one medication for treatment of acute/short-term illnesses and chronic/long-term disorders, respectively. The extent of self-reported medicated illnesses and types of medication used by indication varied across regions, especially in relation to urinary tract infections, depression or OTC nasal sprays. Women with higher age or lower educational level, housewives or women with an unplanned pregnancy were those most often reporting use of medication for chronic/long-term disorders. Immigrant women in Western (adjusted OR (aOR): 0.55, 95% CI 0.34 to 0.87) and Northern Europe (aOR: 0.50, 95% CI 0.31 to 0.83) were less likely to report use of medication for chronic/long-term disorders during pregnancy than non-immigrants. Conclusions In this study, the majority of women in Europe, North America, South America and Australia used at least one medication during pregnancy. There was a substantial inter-region variability in the types of medication used.

Maternal hyperthermia and the risk for neural tube defects in offspring: systematic review and meta-analysis.

Abstract: Background:In animals, excessive core body temperatures have been documented to cause malformations; neural tube defects (NTDs) are among the most frequently reported. In humans, data are inconclusive and often conflicting. The objective of our report is to determine the risk for neural tube defects

Pregnancy Outcome Following Gestational Exposure to Fluoroquinolones: a Multicenter Prospective Controlled Study

Abstract: Fluoroquinolones are a class of antibiotic agents that act by inhibiting bacterial DNA gyrase. Different factors combine to raise teratogenic and fetotoxic concerns regarding their use during pregnancy. Mammalian DNA shares similar topoisomerases with micropathogens. Together with the fact that fluoroquinolones cross the human placenta (5), they can theoretically have mutagenic and carcinogenic effects on the developing fetus. Furthermore, the quinolones have a high affinity for cartilage. Studies with beagle dogs and guinea pigs have demonstrated arthropathy of weight-bearing joints after the administration of 200 and 1,000 mg of pipemidic acid and oxolonic acid, respectively (6). This observation was further supported by human case reports (2, 3). A recent study suggested a high malformation rate (11.9%) among children who had been exposed to ofloxacin in utero (11). Moreover, 5 reported cases of abdominal wall malformations are an alarming sign in light of the published background rate of these malformations: 2 to 5/10,000 population. Finally, higher rates of fetal distress and delivery by cesarean section were reported for a cohort of 38 women exposed to quinolones compared to the rates for controls exposed to nonteratogenic drugs (1). In light of the increasing levels of resistance of many micropathogens to the antibiotics commonly prescribed during pregnancy, the clinical use of fluoroquinolones has been increasing substantially. Together with the fact that half of the pregnancies in North America are unplanned (12), the safety of fluoroquinolones during pregnancy is an increasing concern. Presently, the available data regarding the use of quinolones during pregnancy are very limited: only the results of one prospective controlled study with a very limited sample size (n = 38) (1) and an uncontrolled survey (11) have been reported. Therefore, we initiated a multicenter, prospective controlled study to evaluate the potential teratogenic and fetotoxic concerns related to the use of fluoroquinolones during human pregnancy.

Nonsteroidal Antiinflammatory Drugs During Third Trimester and the Risk of Premature Closure of the Ductus Arteriosus: A Meta-Analysis

Abstract: Background:Nonsteroidal antiinflammatory drugs (NSAIDs) are increasingly being used during pregnancy to treat a variety of conditions. An evaluation of the risk of premature closure of the ductus arteriosus is useful in determining the safety of NSAIDs at different stages of pregnancy.Objective:To determine whether NSAID use during the third trimester of pregnancy is associated with an increased risk of premature constriction of the ductus arteriosus.Methods:A systematic review was conducted of MEDLINE (1966–2004), Embase (1980–2004), and the Cochrane Database of Systematic Reviews (1991–2004). Summary estimates of the odds ratios, comparing ductal outcomes in exposed and unexposed fetuses, and their 95% confidence intervals were calculated assuming a random effects model.Results:Based on 217 patients exposed to indomethacin and 221 to placebo, the risk of ductal closure was 15-fold higher in the group of women exposed to NSAIDs compared with those receiving either placebo or other NSAIDs (8 studies; OR =...

2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

Abstract: Since 1980, the American College of Cardiology (ACC) and American Heart Association (AHA) have translated scientific evidence into clinical practice guidelines (guidelines) with recommendations to improve cardiovascular health. In 2013, the National Heart, Lung, and Blood Institute (NHLBI) Advisory

Gestational Diabetes Mellitus

Abstract: Background: Gestational diabetes mellitus, defined as diabetes diagnosed during pregnancy that is not clearly overt diabetes, is becoming more common as the epidemic of obesity and type 2 diabetes continues. Newly proposed diagnostic criteria will, if adopted universally, further increase the prevalence of this condition. Much controversy surrounds the diagnosis and management of gestational diabetes. Content: This review provides information regarding various approaches to the diagnosis of gestational diabetes and the recommendations of a number of professional organizations. The implications of gestational diabetes for both the mother and the offspring are described. Approaches to self-monitoring of blood glucose concentrations and treatment with diet, oral medications, and insulin injections are covered. Management of glucose metabolism during labor and the postpartum period are discussed, and an approach to determining the timing of delivery and the mode of delivery is outlined. Summary: This review provides an overview of current controversies as well as current recommendations for gestational diabetes care.