Crack abuse during pregnancy: maternal,fetal and neonatal complication

Objective: The aim of this study was to assess the effects of crack on pregnancy outcomes.

Methods: We studied 88 crack user pregnant women in this study. These women were matched to a drug-free group (n?=?90) chosen from the population of the same hospital. Maternal outcomes including preeclampsia, placenta abruption, gestational diabetes and preterm labor, and neonatal complication including low birth weight and low Apgar score in 5?min were compared in crack using and drug-free groups. Data were analyzed by SPSS software. Chi-square test and Student’s t-test and Relative Risks (RRs) were used in this study.

Results: The results of our study showed that crack abuse during pregnancy was associated with higher rate of preeclampsia p?=?0.003 (RR, 1.731; 95% CI, 1.777–2.545), placental abruption p?=?0.001 (RR, 2.439; 95% CI, 1.369–4.343), preterm labor p?<?0.000 (RR, 3.249; 95% CI, 2.053–5.141) and low birth weight p?<?0.000 (RR, 2.179; 95% CI, 1.462–3.247).

Conclusions: Crack abuse had significant influence on pregnancy outcomes. Crack appears to influence the prevalence of low birth weight, preterm labor, preeclampsia and placental abruption.     

Outcomes in an obstetrical population with hereditary thrombophilia and high tobacco use

Objective: The purpose of this study was to examine birth outcomes in women treated or untreated for thrombophilia during pregnancies affected or not by tobacco exposure.

Methods: This was a retrospective cohort study of consecutive women from a single maternal fetal medicine clinic who delivered between January 2009 and December 2013. We compared birth outcomes by four groups of thrombophilia and smoking combinations and then by treated or untreated groups.

Results: Of the 8889 pregnant women in this study, 113 had thrombophilia and 97 received treatment. Thromboprophylaxis included: low molecular weight heparin, aspirin, unfractionated heparin, folic acid, and combinations of these. Smokers with thrombophilia had significantly higher rates of preeclampsia, intrauterine growth restriction, preterm birth (<37?weeks gestation) and low birth weight (all p?≤?.001). Conversely, this group had significantly lower rates of hemolysis, elevated liver enzymes, low platelet count (HELLP syndrome) and placental abruption. Women with thrombophilia who received thromboprophylaxis had lower rates of adverse birth outcomes, reaching significance for preterm birth?<32?weeks gestation (4.3% versus 21.1%, p?=?.026).

Conclusion: Pregnant women who smoke and have thrombophilia may be more likely to experience adverse birth outcomes and receive more benefit from thromboprophylaxis than their nonsmoking counterparts.     

Is low-dose aspirin therapy to prevent preeclampsia more efficacious in non-obese women or when initiated early in pregnancy?

Objective: Late timing of intervention and maternal obesity are potential explanations for the modest effect of aspirin for preeclampsia prevention. We explored whether low-dose aspirin (LDA) is more effective in women at increased risk when initiated before 16 weeks' gestation or given to non-obese women.

Methods: Secondary analysis of a trial to evaluate LDA (60?mg/d) for preeclampsia prevention in high-risk women. Participants were randomized to LDA or placebo between 13 and 26 weeks. We stratified the effect of LDA on preeclampsia by (a) timing of randomization (Results: Of 2503 women, 461 (18.4%) initiated LDA?p value for interaction?=?0.87). Similarly, LDA effect was not better in non-obese (RR: 0.91, 95% CI: 0.7–1.13) versus obese women (RR: 0.89, 95% CI: 0.7–1.13), (p value for interaction?=?0.85).

Conclusion: LDA for preeclampsia prevention was not more effective when initiated 相似文献   

Impact of early supplementation with low-dose aspirin on functional first trimester parameters in low-risk pregnancies

Introduction: There is recent evidence that prophylaxis with 150?mg of aspirin given before 14–16 weeks significantly reduces preeclampsia rates and may improve pregnancy outcome. We conducted an observational study that investigates the effect of low-dose aspirin initiated early in pregnancy or in preconception on functional parameters assessed at 11–14 weeks.

Materials and methods: We have retrospectively selected 128 pregnant women that presented for the first trimester screening for aneuploidies between 11⁺⁰ and 13⁺⁶ weeks of gestation and received low-dose aspirin before 14 weeks. We excluded cases with an estimated high risk for early preeclampsia (cut-off?>?1:100). This group was matched to 1044 cases that did not receive aspirin in early pregnancy. We have selected for statistical analysis maternal parameters, ultrasound parameters (crown-rump length, nuchal translucency thickness, pulsatility index in uterine arteries – left, right, average and average uterine PI expressed in multiple of median (MoM)), first trimester maternal biochemical markers (free β hCG and PAPP-A expressed in MoM), and the calculated risk for early onset and late onset preeclampsia.

Results: The most common dosages of aspirin were 75?mg (77 cases) and 100?mg (32 cases). The most significant results are within the aspirin group. In the subgroup that received aspirin before 11 weeks (110 cases), irrespective of the dosage, the uterine blood flow is significantly improved (average uterine PI 1.7 compared with 2.22, p?p?>?.05, [(?0.65)???0.02] 95% CI). The estimated risk for both early and late onset preeclampsia in this group is reduced (1:2141 compared with 1:333 for early preeclampsia, p?p?Conclusion: Even though the results are not always statistically significant, they demonstrate that placentation parameters improve with higher doses of aspirin started before 11 weeks.     

妊娠合并抗磷脂综合征13例临床分析

目的探讨妊娠合并抗磷脂综合征患者的孕期治疗与母儿结局。方法回顾性分析北京大学人民医院1990年1月至2013年7月妊娠合并抗磷脂综合征患者的临床资料。结果妊娠期共13例患者符合抗磷脂综合征的诊断。其中,按诊断时间分孕前诊断10例,孕期诊断3例;按类型分原发性抗磷脂综合征12例,继发性抗磷脂综合征1例。13例患者中3次以上胎停育或胎死宫内病史者8例。孕期治疗以小剂量阿司匹林治疗2例,以低分子肝素治疗3例,以小剂量阿司匹林联合强的松治疗3例,以小剂量阿司匹林联合低分子肝素治疗3例,由于血小板减少以糖皮质激素及丙种球蛋白治疗1例,单独丙种球蛋白1例。母儿结局：13例患者均获活产新生儿,围产死亡率0%。足月分娩11例,早产2例,平均体重（2 921.43±1326.6）g。胎儿宫内生长受限2例。重度子痫前期1例,妊娠高血压1例。结论孕期适当的干预治疗可改善妊娠合并抗磷脂综合征患者的妊娠结局,应重视并提高对妊娠期出现的抗磷脂综合征的及时诊断及必要的治疗。     

Adverse maternal and neonatal outcomes in women with preeclampsia in Iran

Background: Preeclampsia is relatively a common complication in pregnancy and is characterized by high blood pressure and protein in urine during pregnancy. Consistent with the adverse outcomes followed by preeclampsia, this study designed to investigate the how preeclampsia is associated with preterm, low birth weight (LBW), cesarean section, and weigh gain during pregnancy.

Methods: In this population-based cross-sectional study, 5166 deliveries from 103 hospitals in Tehran (Capital of Iran) were included in the analysis in 2015. The independent variable was preeclampsia during pregnancy and weight gain during pregnancy, preterm birth, cesarean section, and LBW were considered as interested outcomes. The data were analyzed by statistical Stata software (version 13, Stata Inc., College Station, TX).

Results: Adjusted results showed that the mean of weight gain in women with preeclampsia was significantly higher than women without preeclampsia (mean difference: 1.77?kg, 95%CI: 0.76–12.78, p?=?.001). The adjusted odds ratio for preterm birth, cesarean section, and LBW were 4.19 (95%CI: 2.71–6.48, p?=?.001), 1.92 (95%CI: 1.24–2.98, p?=?.003), and 1.19 (95%CI: 0.61–2.31, p?=?.599), respectively.

Conclusion: Weight gain in women with preeclampsia was higher than women without preeclampsia and also the odds of preterm birth, cesarean section and LBW in women with preeclampsia was higher than women without preeclampsia.     

Acetylsalicylic Acid for the Prevention of Preeclampsia and Intra-uterine Growth Restriction in Women with Abnormal Uterine Artery Doppler: A Systematic Review and Meta-analysis

BackgroundPreeclampsia is a major global cause of maternal, neonatal and perinatal mortality. From studies of placental pathophysiology in women with preeclampsia, a potentially important role of low-dose acetylsalicylic acid (ASA) in the prevention of preeclampsia was expected, but the results from clinical trials have been disappointing. While recent evidence has shown that uterine Doppler can predict preeclampsia as early as in the first trimester of pregnancy, most clinical trials have evaluated ASA in the second and third trimesters.ObjectivesWe performed a meta-analysis to assess the influence of gestational age at the time of introduction of ASA on the incidence of preeclampsia in women at increased risk, on the basis of abnormal uterine artery Doppler.MethodsComputerized searches of randomized controlled trials were conducted to retrieve studies in which pregnant women at increased risk of preeclampsia had been identified on the basis of abnormal uterine Doppler measurements. The trials compared women who received ASA with a control group. The primary outcome was preeclampsia. Secondary outcomes included severe preeclampsia, gestational hypertension, preterm birth, intrauterine growth restriction, placental abruption, birth weight and gestational age at delivery. Statistical analyses used fixed effects of risk ratio (RR) with the Mantel-Haenszel method and 95% confidence intervals.ResultsNine randomized controlled trials with a total of 1317 women met the inclusion criteria. ASA treatment beginning in early gestation was associated with a greater reduction in the incidence of preeclampsia than treatment beginning in late gestation: ASA treatment started at ≤16 weeks’ gestation resulted in RR 0.48 (95% CI 0.33 to 0.68), at 17–19 weeks RR 0.55 (95% CI 0.17 to 1.76), and at ≥ 20 weeks RR 0.82 (95% CI 0.62 to 1.09). ASA treatment started before 16 weeks was also linked with a significant reduction in the incidence of severe preeclampsia (RR 0.10; 95% CI 0.01 to 0.74), gestational hypertension (RR 0.31; 95% CI 0.13 to 0.78) and IUGR (RR 0.51; 95% CI 0.28 to 0.92).ConclusionASA treatment initiated early in pregnancy is an efficient method of reducing the incidence of preeclampsia and its consequences in women with ultrasonographic evidence of abnormal placentation diagnosed by uterine artery Doppler studies.     

Preventing preeclampsia and its fetal complications with low-dose aspirin in East Asians and non-East Asians:A systematic review and meta-analysis

Background: Low-dose aspirin can reduce the incidence of preeclampsia and intrauterine growth restriction (IUGR). However, the effects of ethnicity upon low-dose aspirin’s efficacy has not been analyzed. Here, we comparatively evaluated the efficacy of low-dose aspirin in preventing preeclampsia and related fetal complications in East Asian and non-East Asian pregnant women at risk for preeclampsia. Methods: Several databases were searched for randomized controlled trials (RCTs) comparing low-dose aspirin with either placebo or no treatment in pregnant women at risk for preeclampsia. Odds ratios (ORs) and associated 95% confidence intervals (CIs) for preeclampsia and related fetal outcomes were tabulated. Results: Low-dose aspirin significantly reduced preeclampsia risk in both East Asians (OR = 0.20, 95% CI: 0.11–0.35) and non-East Asians (OR = 0.84, 95% CI: 0.77–0.92). Low-dose aspirin significantly reduced IUGR risk in East Asians (OR = 0.36, 95% CI: 0.20–0.67) but not in non-East Asians (OR = 0.85, 95% CI: 0.41–1.77). Low-dose aspirin did not significantly reduce the risk of cesarean section in either East Asians (OR = 0.67, 95% CI: 0.14–3.22) or non-East Asians (OR = 1.01, 95% CI: 0.86–1.19). Conclusions: Low-dose aspirin is effective in reducing preeclampsia risk in both East Asians and non-East Asians and has differential effects in East Asians and non-East Asians with respect to IUGR.     

Pregnancy and delivery with an intrauterine device in situ: outcomes in the National Inpatient Sample Database

Background: Pregnancy with intrauterine device in place is rare and there are limited data that exist regarding associated perinatal outcomes.

Objective: The objective of this study is to determine the association between presence of an intrauterine device during pregnancy and spontaneous abortion, induced abortion, and preterm or small for gestational age delivery outcomes.

Study design: The National Inpatient Sample database was analyzed for the years 2010 and 2011. Maternal records with an intrauterine device in situ during delivery were identified using International Classification of Diseases, Ninth Revision, diagnostic codes. Primary outcome was incidence of spontaneous abortion. Secondary outcomes were incidence of induced abortion, preterm delivery, and small for gestational age. Data were analyzed using Chi-square and Fisher’s exact tests to calculate odds ratios (ORs) of abortion in association with intrauterine device in situ during pregnancy. Maternal birth records were further analyzed for adverse neonatal outcomes using logistic regression models, controlling for possible confounding variables.

Results: The data included 8,597,284 maternal birth records; 0.02% with an intrauterine device in situ. Patients with an intrauterine device in situ experienced a higher frequency of the pregnancy ending in spontaneous abortion (OR: 7.15; 95% confidence interval (CI): 5.06–10.09; p?p?in situ was 2.04 (95% CI: 1.71–2.43; p?p?=?.022), after controlling for associated demographic and clinical variables.

Conclusion: The presence of an intrauterine device in situ during pregnancy was associated with increased spontaneous and induced abortions, and increased incidence of delivery of a preterm, but not small for gestational age infant.     

Prophylaxis of Recurrent Preeclampsia: Low-Molecular-Weight Heparin plus Low-Dose Aspirin versus Low-Dose Aspirin Alone

Objective: To verify whether prophylaxis with low-molecular-weight heparin (LMWH) and low-dose aspirin (LDA) could positively affect pregnancy outcome in women with a history of severe preeclampsia. Methods: We compared 23 pregnancies treated with LDA alone to 31 pregnancies treated with LMWH plus LDA. Results: Women treated with LMWH-LDA (n = 31) showed a better pregnancy outcome than those treated with LDA alone (n = 23) in terms of gestational age at delivery (p < 0.05), birth weight (p < 0.01), birth weight percentile (p < 0.01), and rate of preeclampsia (p < 0.01). Furthermore, comparing the intra-group outcome variation between previous and index pregnancies, an improvement appeared in each group, but a more pronounced gain was noted in the LMWH-LDA group in terms of gestational age at delivery (p< 0.005), birth weight (p < 0.005), and birth weight percentile (p < 0.005). Conclusions: Thromboprophylaxis with LMWH plus LDA can improve pregnancy outcome in women with previous severe preeclampsia.     

A Meta-Analysis on the Efficacy and Safety of Combined Vitamin C and E Supplementation in Preeclamptic Women

Objective: To evaluate whether vitamin C and E co-supplementation of women at risk of preeclampsia can reduce maternal and neonatal disorders. Method: Electronic databases were searched up to May 2008 to find studies investigating pregnancy outcomes in women at risk of preeclampsia following exposure to combined vitamin C and E supplementation. The outcomes of interest were gestational hypertension, preeclampsia, preterm delivery, small for gestational age, and low birth weight. The relative risk (RR) and confidence interval (CI) for the individual studies were pooled and heterogeneity analysis was performed. Results: Seven studies involving 5969 pregnant women at risk of preeclampsia were included: 2982 received vitamin C and E and 2987 received placebo. The RRs are 1.3 (95% CI of 1.08–1.57, p = 0.0066) for gestational hypertension, 0.7 (95% CI of 0.58–1.08, P = 0.1653) for preeclampsia, 1.12 (95% CI of 0.96–1.32, p = 0.141) for preterm delivery, 1.04 (95% CI of 0.94–1.15, p = 0.4789) for small for gestational age, and 1.13 (95% CI of 1.004–1.27, p = 0.0429) for low birth weight. Conclusion. Combined vitamin C and E supplementation not only have no potential benefit in improvement of maternal and neonatal outcome but increase the risk of gestational hypertension in women at risk of preeclampsia and low birth weight in neonates.     

Fish oil supplementation improves pregnancy outcomes and size of the newborn: a meta-analysis of 21 randomized controlled trials

Objective: To observe the effects of fish oil on related pregnancy outcomes.

Methods: A systematic search of the Medline, EMBASE and Cochrane’s library databases was conducted for the randomized controlled trials published till February 2015 that compared the effects of fish oil supplementation with a control diet in women during pregnancy.

Results: Twenty-one studies comprising 10?802 pregnant women were included. Dietary fish oil was associated with a 5.8-day increase in gestational age of the newborn, a 22% reduced risk for early preterm delivery (risk ratio [RR]?=?0.78, 95% CI: 0.64–0.95, p?=?0.01) and a 10% reduction in preterm delivery (RR?=?0.90, 95% CI 0.81–1.00, p?=?0.05). Fish oil supplementation was associated with higher infantile birth weight (51.23?g), birth length (0.28?cm) and head circumference (0.09?cm), and a 23% lower risk of low birth weight. No benefit from fish oil supplementation was found with regard to risk of intrauterine growth restriction or stillbirth.

Conclusions: Dietary fish oil during pregnancy was associated with reduced risk of preterm delivery and improved size of the newborn. Fish oil during pregnancy may be an effective prophylactic for preterm delivery.     

Low-Molecular-Weight Heparin for the Prevention of Obstetric Complications in Women with Thrombophilias

Objective. To evaluate the benefit of combined low-molecular-weight (LMW) heparin and aspirin for prophylaxis in women carriers of thrombophilia who had previously suffered from severe obstetric complications.

Methods. The 33 studied women had an earlier pregnancy complicated by severe preeclampsia, abruptio placentae, intrauterine growth retardation, or intrauterine fetal death. All were subsequently diagnosed as carrying inherited thrombophilias. In their subsequent pregnancy, prophylactic therapy consisting of LMW heparin 40 mg/day (Enoxaparin, Rhone-Poulenc-Rorer, France) and aspirin was administered. Patients who were found to be homozygotes for the methylenetetrahydrofolate reductase mutation also received folic acid supplementation throughout their pregnancy.

Results. Low-molecular-weight heparin was well tolerated and none of the women or the newborns developed any hemorrhagic complications. Only three (9.1%) of the women developed pregnancy complications. The mean gestational age and the mean birth weight at delivery in the previously complicated pregnancies were 32.1 ± 5.0 weeks and 1175 ± 590 g, respectively, compared to 37.6 ± 2.3 weeks and 2719 ± 526 g, respectively, in the treated pregnancies (p ≤ 0.001).

Conclusions. This uncontrolled trial suggests that patients with obstetric complications and an inherited thrombophilia may benefit from treatment with combined LMW heparin and aspirin in subsequent pregnancies. However, this needs to be verified by controlled trials before considering clinical application.     

Decreased Pathological Placental Findings in Aspirin-Treated Pregnant Women at Risk of Hypertensive Complications

Objective: The small controlled trials reporting large reductions in the incidence of preeclampsia and intrauterine growth restriction (IUGR) in highrisk pregnant women treated with low-dose aspirin have recently been followed by large clinical trials suggesting less beneficial results. The effect of low-dose aspirin on placental lesions associated with preeclampsia and IUGR has not yet been studied.

Methods: We participated in the large multicenter randomized collaborative low-dose aspirin study in pregnancy (CLASP) trial of low-dose aspirin for the prevention and treatment of preeclampsia and intrauterine growth restriction. As part of this study, we evaluated placentae submitted from 25 women treated with aspirin and 28 with placebo.

Results: More of the pathological findings classically described in preeclampsia and IUGR were demonstrated in the placentae from the placebo group than from the aspirin group (54% vs. 16%, P = 0.02). The placental findings did not correlate with clinical pregnancy outcome or Doppler flow parameters of the fetal umbilical artery in either group.

Conclusions: Our results support the assumption that aspirin may have some inhibitory effect on the uteroplacental circulatory ischemic changes typically occurring in preeclampsia and IUGR.     

Primiparity: An ‘intermediate’ risk group for spontaneous and medically indicated preterm birth

Objective.?Most women in their first pregnancy are at ‘unknown’ risk for preterm birth. We hypothesized that such women may be at an increased risk for preterm birth in comparison to those with a prior term birth.

Methods.?We used Missouri's maternally-linked data (1989–97), comprised of women delivering their first singleton live birth (N = 259 431) and women delivering their first two consecutive singleton live births (N = 154 810). We compared preterm birth (<37 weeks) rates among women with a previous term birth, women with no reproductive history (primiparous women), and in those with a previous preterm birth. Risks of spontaneous and medically indicated preterm birth were also examined after adjustments for confounders through multivariate log-binomial regression models.

Results.?Preterm birth rates were 8.1%, 9.6%, and 23.3% among women with a previous term birth, among primiparous women, and among those with a previous preterm birth, respectively. In comparison to women with a prior term birth, risks of spontaneous preterm birth among primiparous women and among women with a prior preterm birth were 1.1-fold (95% confidence interval (CI) 1.0, 1.2) and 2.5-fold (95% CI 2.4, 2.6) higher, respectively. These risks were higher for medically indicated preterm birth among both primiparous women (RR 1.3, 95% CI 1.2, 1.4) and those with a prior preterm birth (RR 3.2, 95% CI 3.0, 3.5) than for spontaneous preterm births.

Conclusions.?Primiparous women are at increased risk of both medically indicated and spontaneous preterm birth. The findings suggest that studies on preterm birth should consider a risk assignment to include three groups: low-risk (prior term birth), intermediate risk (primiparity), and high-risk (prior preterm birth). This strategy will be informative for the identification of women with impending risk of delivering preterm, and complications associated with prematurity.     

Neighborhood deprivation and preterm birth in Plymouth,UK

Objective.?To assess the relationship between neighborhood deprivation and the preterm birth rate in Plymouth, UK, using routinely collected data from a clinical information system.

Methods.?We used a clinic-based prospective case register study of all births in Plymouth UK between 1 January 1996 and 31 December 1997 combined with indices of neighborhood deprivation to assess the relationship between neighborhood deprivation and the preterm birth rate. Areas (n = 43) were classified according to the Townsend index, measuring material deprivation. Preterm births were compared with term births.

Results.?The incidence of singleton preterm birth was 5.3% (95% confidence interval (CI) 4.6, 6.0). The singleton preterm birth rate increased with Townsend material deprivation score. Crude rates increased by 31% (relative risk (RR) (95% CI) 1.31 (0.94, 1.84), p = 0.056) among those living in the most deprived areas compared to those living in the least deprived areas. A stepwise binary logistic regression model showed an increase in the relative risk of preterm birth of 7% for every unit increase in the Townsend material deprivation score (RR (95% CI) 1.07 (1.03, 1.11)).

Conclusion.?Neighborhood deprivation is related to preterm birth. Examining individual and neighborhood factors together may increase understanding of the complex causes of preterm birth.     

Risk of coronary artery disease in women with history of pregnancies complicated by preeclampsia and LBW

Women with a history of pregnancy complicated by preeclampsia or intrauterine growth restriction and low infant birth weight looks at a higher risk for subsequent ischemic heart disease. Objective: To determine the relationship between pregnancy complications and maternal coronary artery disease (CAD) in the future. Materials and method: We performed a case-control study on 690 patients (345 patients in each group) referred to Tehran Heart Center. Women with CAD were in the case group and women without CAD were in the control group. The history of pregnancy complications (including preeclampsia, low birth weight [LBW] delivery, preterm labor and gestational hypertension) was evaluated in the two groups. Results: 12.5% of the patients in the case group had a history of preeclampsia, compared with the control group (1.7%). (p?<?0. 0001). Seven percent of the patients in the case group and 0.9% of the patients in the control group had history of LBW delivery. The difference was significant (p?<?0.0001). A history of preterm labor was recorded in 11% of cases and 3.2% of controls. Performing multivariate analysis showed that there is a strong association between preeclampsia and CAD (OR: 16.92; 95% CI; p?<?0.0001), LBW delivery and CAD (OR: 6.52; 95% CI; p: 0.0038), and also between high parity and CAD. (OR: 1.135; 95% CI; p: 0.0479). Conclusion: Our results suggest preeclampsia, LBW delivery and high parity of the mother as independent risk factors for CAD in the future.     

Obstetric outcomes in adolescent pregnancies: a racial/ethnic comparison

Abstract

Objective: To examine obstetric outcomes for adolescents among the major US racial/ethnic groups.

Methods: This is a retrospective cohort study of singleton births to nulliparous women aged 12 to 19 years from 1988 to 2008. The prevalence of preterm delivery, cesarean delivery, preeclampsia, gestational diabetes, low birth weight and low Apgar score were compared across African-American, Asian, Latina and White adolescents.

Results: 1865 adolescents were included in the analysis. Differences between racial/ethnic groups for rates of preterm delivery, cesarean delivery and gestational diabetes were statistically significant at p?<?0.05. African Americans had lower odds of preterm delivery (OR?=?0.58, 95% CI [0.38–0.90]) and gestational diabetes (OR?=?0.17, 95% CI [0.05–0.55]) than White adolescents. White adolescents had increased odds of cesarean delivery compared to African-American (OR?=?0.69, 95% CI [0.48–0.98]), Latina (OR?=?0.62, 95% CI [0.41–0.94]) and Asian adolescents (OR?=?0.41, 95% CI [0.25–0.68]). Although not statistically significant, White adolescents also had higher odds of low Apgar score. In the multivariate analysis, non-White adolescents continued to have improved outcomes, except in the case of low birth weight.

Conclusions: African-American, Asian and Latina adolescents may have similar or decreased risk of obstetric complications compared to White adolescents.     

Prophylaxis of recurrent preeclampsia: low-molecular-weight heparin plus low-dose aspirin versus low-dose aspirin alone.

OBJECTIVE: To verify whether prophylaxis with low-molecular-weight heparin (LMWH) and low-dose aspirin (LDA) could positively affect pregnancy outcome in women with a history of severe preeclampsia. METHODS: We compared 23 pregnancies treated with LDA alone to 31 pregnancies treated with LMWH plus LDA. RESULTS: Women treated with LMWH-LDA (n = 31) showed a better pregnancy outcome than those treated with LDA alone (n = 23) in terms of gestational age at delivery (p < 0.05), birth weight (p < 0.01), birth weight percentile (p < 0.01), and rate of preeclampsia (p < 0.01). Furthermore, comparing the intra-group outcome variation between previous and index pregnancies, an improvement appeared in each group, but a more pronounced gain was noted in the LMWH-LDA group in terms of gestational age at delivery (p< 0.005), birth weight (p < 0.005), and birth weight percentile (p < 0.005). CONCLUSIONS: Thromboprophylaxis with LMWH plus LDA can improve pregnancy outcome in women with previous severe preeclampsia.     

Preeclampsia and maternal risk of breast cancer: a meta-analysis of cohort studies

Background: Pregnancy-related hypertensive disorders, including preeclampsia (PE) and pregnancy-induced hypertension (PIH), may influence the maternal risk of breast cancer. However, results of the cohort studies were inconsistent.

Methods: An updated meta-analysis of cohort studies was performed to evaluate the association between PE, PIH and maternal breast cancer incidence. Relevant studies were identified via searching of PubMed and Embase databases. A random effect model was applied to synthesize the results. Stratified analyses were performed to evaluate the potential influence of parity, gender of offspring, and study design on the association between PE and maternal breast cancer incidence.

Results: Ten cohort studies with 2,417,899 pregnant women were included. Maternal risk of breast cancer was not significantly affected by PE (risk ration [RR]?=?0.93, 95% confidence interval [CI]: 0.82–1.06, p?=?.27), or PIH (RR?=?0.95, 95% CI: 0.81–1.12, p?=?.54). Interestingly, PE was associated with significantly lowered maternal incidence of breast cancer in women who give birth to male offspring (RR?=?0.79, p?p?Conclusions: Current evidence did not support a conclusive association between PE, PIH and the maternal risk of breast cancer. Gender of the offspring may influence the association between PE and maternal breast cancer incidence.