Pregnancy

About: Pregnancy is a research topic. Over the lifetime, 163969 publications have been published within this topic receiving 4013502 citations. The topic is also known as: pregnancy & gestation.

Anticoagulation of pregnant women with mechanical heart valves: a systematic review of the literature.

Abstract: Background: The management of women with pros- thetic heart valves during pregnancy poses a particular challenge as there are no available controlled clinical tri- als to provide guidelines for effective antithrombotic therapy. Oral anticoagulants such as warfarin sodium cause fetal embryopathy; subcutaneous administration of heparin sodium has been reported to be ineffective in preventing thromboembolic complications. Methods: We performed a systematic review of the lit- erature to determine pooled estimates of maternal and fe- tal risks associated with the 3 commonly used approaches: (1) oral anticoagulants (OA) throughout pregnancy, (2) replacing OA with heparin in the first trimester (from 6-12 weeks' gestation), and (3) heparin use throughout preg- nancy. Fetal outcomes included spontaneous abortions and fetopathic effects, and maternal outcomes were ma- jor bleeding, thromboembolic complications, and death. Results: The use of OA throughout pregnancy is asso- ciated with warfarin embryopathy in 6.4% (95% confi- dence interval (CI), 4.6%-8.9%) of livebirths. The sub- stitution of heparin at or prior to 6 weeks, and continued until 12 weeks, eliminated this risk. Overall risks for fe- tal wastage (spontaneous abortion, stillbirths, and neo- natal deaths) were similar in women treated with OA throughout, compared with women treated with hepa- rin in the first trimester. Maternal mortality was 2.9% (95% CI, 1.9%-4.2%). Major bleeding events occurred in 2.5% (95% CI, 1.7%-3.5%) of all pregnancies, most at the time of delivery. The regimen associated with the lowest risk of valve thrombosis (3.9%; 95% CI, 2.9-5.9%) was the use of OA throughout; using heparin only between 6 and 12 weeks' gestation was associated with an increased risk of valve thrombosis (9.2%; 95% CI, 5.9%-13.9%). Conclusions: Thromboembolic prophylaxis of women with mechanical heart valves during pregnancy is best achieved with OA; however, this increases the risk of fe- tal embryopathy. Substituting OA with heparin be- tween 6 and 12 weeks reduces the risk of fetopathic ef- fects, but with an increased risk of thromboembolic complications. The use of low-dose heparin is definitely inadequate; the use of adjusted-dose heparin warrants ag- gressive monitoring and appropriate dose adjustment. Large prospective trials to determine the best regimen for these women are needed. Arch Intern Med. 2000;160:191-196

Short term outcomes after extreme preterm birth in England: comparison of two birth cohorts in 1995 and 2006 (the EPICure studies)

Abstract: Objective To determine survival and neonatal morbidity for babies born between 22 and 26 weeks’ gestation in England during 2006, and to evaluate changes in outcome since 1995 for babies born between 22 and 25 weeks’ gestation. Design Prospective national cohort studies. Setting Maternity and neonatal units in England. Participants 3133 births between 22 and 26 weeks’ gestation in 2006; 666 admissions to neonatal units in 1995 and 1115 in 2006 of babies born between 22 and 25 weeks’ gestation. Main outcome measures Survival to discharge from hospital, pregnancy and delivery outcomes, infant morbidity until discharge. Results In 2006, survival of live born babies was 2% (n=3) for those born at 22 weeks’ gestation, 19% (n=66) at 23 weeks, 40% (n=178) at 24 weeks, 66% (n=346) at 25 weeks, and 77% (n=448) at 26 weeks (P Conclusion Survival of babies born between 22 and 25 weeks’ gestation has increased since 1995 but the pattern of major neonatal morbidity and the proportion of survivors affected are unchanged. These observations reflect an important increase in the number of preterm survivors at risk of later health problems.

Unintended Pregnancy: Worldwide Levels, Trends, and Outcomes

Abstract: Unintended pregnancy can carry serious consequences for women and their families. We estimate the incidence of pregnancy by intention status and outcome at worldwide, regional, and subregional levels for 2008, and we assess recent trends since 1995. Numbers of births are based on United Nations estimates. Induced abortions are estimated by projecting from recent trends. A model-based approach is used to estimate miscarriages. The planning status of births is estimated using nationally representative and small-scale surveys of 80 countries. Of the 208 million pregnancies that occurred in 2008, we estimate that 41 percent were unintended. The unintended pregnancy rate fell by 29 percent in developed regions and by 20 percent in developing regions. The highest unintended pregnancy rates were found for Eastern and Middle Africa and the lowest for Southern and Western Europe and Eastern Asia. North America is the only region in which overall and unintended pregnancy rates have not declined. We conclude with a brief discussion of global and regional program and policy implications.

Hypertensive diseases of pregnancy and risk of hypertension and stroke in later life: results from cohort study

Abstract: Objective: To examine the association between hypertensive diseases of pregnancy (gestational hypertension and pre-eclampsia) and the development of circulatory diseases in later life. Design: Cohort study of women who had pre-eclampsia during their first singleton pregnancy. Two comparison groups were matched for age and year of delivery, one with gestational hypertension and one with no history of raised blood pressure. Setting: Maternity services in the Grampian region of Scotland. Participants: Women selected from the Aberdeen maternity and neonatal databank who were resident in Aberdeen and who delivered a first, live singleton from 1951 to 1970. Main outcome measures: Current vital and cardiovascular health status ascertained through postal questionnaire survey, clinical examination, linkage to hospital discharge, and mortality data. Results: There were significant positive associations between pre-eclampsia/eclampsia or gestational hypertension and later hypertension in all measures. The adjusted relative risks varied from 1.13-3.72 for gestational hypertension and 1.40-3.98 for pre-eclampsia or eclampsia. The adjusted incident rate ratio for death from stroke for the pre-eclampsia/eclampsia group was 3.59 (95% confidence interval 1.04 to 12.4). Conclusions: Hypertensive diseases of pregnancy seem to be associated in later life with diseases related to hypertension. If greater awareness of this association leads to earlier diagnosis and improved management, there may be scope for reducing a proportion of the morbidity and mortality from such diseases. What is already known on this topic Much is known about the effect of cardiovascular risks factors that are shared by men and women, but less on those specific to women Retrospective studies, based on patient recall, suggest that hypertension in pregnancy may be associated with increased risk of cardiovascular diseases in later life What this study adds Prospective recording of blood pressure and proteinuria shows that women who experienced raised blood pressure in pregnancy have a long term risk of hypertension Women who experience raise blood pressure in pregnancy have an increased risk of stroke and, to a lesser extent, an increased risk of ischaemic heart disease Long term cardiovascular risks are greater for women who had pre-eclampsia than those who experienced gestational hypertension (hypertension without proteinuria)