COVID-19 vaccination in pregnant and lactating diabetic women

AimTo discuss available information on the opportunity for pregnant women affected by diabetes/obesity to receive COVID-19 vaccine.Data synthesisPregnant women with SARS-CoV-2 (COVID-19) infection are at high risk for severe acute respiratory syndrome and adverse outcomes. Pregnant women with severe COVID-19 present increased rates of preterm delivery (<37 gestational weeks), cesarean delivery and neonatal admissions to the intensive care unit. Comorbidity such as diabetes (pregestational or gestational) or obesity further increased maternal and fetal complications. It is known that diabetic or obese patients with COVID-19 present an unfavorable course and a worse prognosis, with a direct association between worse outcome and suboptimal glycol-metabolic control or body mass index (BMI) levels. Critical COVID-19 infection prevention is important for both mother and fetus. Vaccination during pregnancy is a common practice. Vaccines against COVID-19 are distributed across the world with some population considered to have a priority. Since pregnant women are excluded from clinical trials very little information are available on safety and efficacy of COVD-19 vaccines during pregnancy. However, it is well known the concept of passive immunization of the newborn obtained with transplacental passage of protective antibodies into the fetal/neonatal circulation after maternal infection or vaccination. Moreover, it has been reported that COVID-19 vaccine-induced IgG pass to the neonates through breastmilk. Therefore, maternal vaccination can protect mother, fetus and baby.ConclusionsAfter an individual risk/benefit evaluation pregnant and lactating women should be counselled to receive COVID-19 vaccines.     

Administration of praziquantel to pregnant and lactating women

Praziquantel (PZQ) is the safest of all anti-helminthics and now forms the backbone for all national control programs against schistosomiasis (Med. Res. Rev. 3 (1983) 147-200; Bull. WHO 57 (1979) 767-771; Wegner, D.H.G, Therapeutic Drugs (1991), Churchill Livingstone; Adv. Intern. Med. 32 (1987) 193-206; Drugs 42 (1991) 379-405; Pharmac. Ther. 68 (1995) 35-85; Ann. Intern. Med. 110 (1989) 290-296). Despite its lack of known toxicity, the drug was not tested on pregnant or lactating women prior to release. It is currently listed as Pregnancy Category B by the US FDA, which is a drug presumed safe based in animal studies. Unfortunately, this has been interpreted by most national control programs and WHO (1998) to exclude lactating and pregnant women from treatment. In fact, some experts advocate excluding adolescent girls from mass treatment campaigns over this issue. As a result, a large number of women living in endemic countries are currently left untreated or have treatment significantly delayed. A review of the current known toxicology of PZQ, combined with over two decades of clinical experience with this drug, suggest very low potential for adverse effects on either the mother or her unborn child. In contrast, significant animal and human data are presented in this review that suggest both the pregnant woman and her unborn fetus suffer morbid sequella from schistosomiasis. A double-blind placebo-controlled trial that could resolve this issue would require a very large and expensive study and in light of the above facts might not now be ethically appropriate. The author concludes that pregnant women should be treated with PZQ, that women of childbearing age should be included in all mass treatment programs and that lactating women are not systematically excluded from treatment.     

Guidelines for sedation in gastroenterological endoscopy

Recently, the need for sedation in gastrointestinal endoscopy has been increasing. However, the National Health Insurance Drug Price list in Japan does not include any drug specifically used for the sedation. Although benzodiazepines are the main medication, their use in cases of gastrointestinal endoscopy has not been approved. This has led the Japan Gastrointestinal Endoscopy Society to develop the first set of guidelines for sedation in gastrointestinal endoscopy on the basis of evidence‐based medicine in collaboration with the Japanese Society for Anesthesiologists. The present guidelines comprise 14 statements, five of which were judged to be valid on the highest evidence level and three on the second highest level. The guidelines are not intended to strongly recommend the use of sedation for gastrointestinal endoscopy, but rather to indicate the policy as to the choice of appropriate procedures when such sedation is deemed necessary. In clinical practice, the final decision as to the use of sedation should be made by physicians considering patient willingness and physical condition.     

内蒙古少数民族地区孕妇及乳母碘营养状况调查

目的了解内蒙古通辽地区孕妇、乳母碘营养状况,为指导本地区孕妇、乳母科学补碘提供依据。方法2011年,按照《全国碘缺乏病监测方案》中的抽样和检测方法,在随机抽样中选择8个旗县（市、区）,重点抽样选择2个旗县及2010～2011年各级盐业公司生产的部分碘盐,随机抽样监测采用直接滴定法（GB／T13025．7—1999）定量测定碘盐;重点抽样监测采用半定量法检测碘盐。共抽检120名孕妇、哺乳期妇女和400名8～10岁儿童尿样,采用过硫酸铵消化砷铈催化分光光度法测定尿碘。采用触诊法检查3963名8～10岁学龄儿童甲状腺肿大情况。结果共检测居民食用盐2328份,其中非碘盐率0．41％,碘盐覆盖率99．59％,碘盐合格率99．11％,合格碘盐食用率98．71％,碘盐中位数31．4mg／kg。重点抽样检测食用盐600份,碘盐覆盖率98．17％,非碘盐率1．84％。共检测120名孕妇、哺乳期妇女及400名8～10岁儿童的尿碘,其中孕妇尿碘中位数345．23μg／L,哺乳期妇女尿碘中位数245．07μg／L,8～10岁儿童尿碘中位数328．3μg／L。共抽检3963名8—10岁学龄儿童,检出甲状腺肿大106名,肿大率2．67％。结论通辽地区碘缺乏病防治工作取得了明显成效,各项指标均达到国家碘缺乏病消除标准。     

老年患者消化内镜操作指南

随着人口老龄化的加快、消化内镜设备的改良以及内镜诊疗技术的进步,老年患者接受消化内镜检查和治疗的机会亦随之增加;我国开展消化内镜诊疗技术已数十年,积累了丰富的临床经验,有必要对老年人群的消化内镜操作技术进行总结和规范,以提高我们的诊治水平。世界卫生组织把老年定义为年龄≥65岁,这一人群全身各脏器机能逐渐低下,各种各样基础疾病患者的比例增高。     

Earth-eating and reinfection with intestinal helminths among pregnant and lactating women in western Kenya

We conducted a longitudinal study among 827 pregnant women in Nyanza Province, western Kenya, to determine the effect of earth-eating on geohelminth reinfection after treatment. The women were recruited at a gestational age of 14-24 weeks (median: 17) and followed up to 6 months postpartum. The median age was 23 (range: 14-47) years, the median parity 2 (range: 0-11). After deworming with mebendazole (500 mg, single dose) of those found infected at 32 weeks gestation, 700 women were uninfected with Ascaris lumbricoides, 670 with Trichuris trichiura and 479 with hookworm. At delivery, 11.2%, 4.6% and 3.8% of these women were reinfected with hookworm, T. trichiura and A. lumbricoides respectively. The reinfection rate for hookworm was 14.8%, for T. trichiura 6.65, and for A. lumbricoides 5.2% at 3 months postpartum, and 16.0, 5.9 and 9.4% at 6 months postpartum. There was a significant difference in hookworm intensity at delivery between geophagous and non-geophagous women (P=0.03). Women who ate termite mound earth were more often and more intensely infected with hookworm at delivery than those eating other types of earth (P=0.07 and P=0.02 respectively). There were significant differences in the prevalence of A. lumbricoides between geophagous and non-geophagous women at 3 (P=0.001) and at 6 months postpartum (P=0.001). Women who ate termite mound earth had a higher prevalence of A. lumbricoides, compared with those eating other kinds of earth, at delivery (P=0.02), 3 months postpartum (P=0.001) and at 6 months postpartum (P=0.001). The intensity of infections with T. trichiura at 6 months postpartum was significantly different between geophagous and non-geophagous women (P=0.005). Our study shows that geophagy is associated with A. lumbricoides reinfection among pregnant and lactating women and that intensities built up more rapidly among geophagous women. Geophagy might be associated with reinfection with hookworm and T. trichiura, although these results were less unequivocal. These findings call for increased emphasis, in antenatal care, on the potential risks of earth-eating, and for deworming of women after delivery.     

Guidelines for the management of pregnant women with obesity: A systematic review

Multiple clinical practice guidelines (CPGs) have been established for pregnant women with obesity. The quality and consistency of recommendations remain unknown. The objective of this study is to conduct a systematic review to synthesize and appraise evidence from CPGs, available worldwide, for pregnant women affected by obesity. An experienced information specialist performed a rigorous search of the literature, searching MEDLINE, Embase, grey literature, and guideline registries to locate CPGs that reported on pregnancy care relating to obesity. CPGs related to antenatal care of pregnant women with obesity (pre‐pregnancy body mass index [BMI] ≥ 30 kg/m²) in low‐risk (eg, care provider = family physician or midwife) or high‐risk settings (eg, obstetrician or maternal fetal medicine) were included. CPGs were appraised for quality with independent data collection by two raters. Information was categorized into five domains: preconception care. care during pregnancy, diet and exercise during pregnancy, care immediately before, during, and after delivery, and postpartum care. The literature search yielded 2614 unique citations. Following screening of abstracts and full texts, 32 CPGs were included, with quality ranging between 0 and 100 on the AGREE II tool. The strongest evidence related to nutritional advice, exercise, and pregnancy risk counselling. Guidance was limited for timing of screening tests, antenatal visits and delivery, ideal postpartum care, and management of adverse pregnancy outcomes. Most guidelines in this population are not evidence based. Research is needed to bridge knowledge gaps pertaining to fetal antenatal surveillance, management of adverse outcomes and postpartum care, and enhance consistency across CPGs.     

Guidelines for the management of HIV infection in pregnant women and the prevention of mother-to-child transmission

Aims of the guidelines These guidelines, drawn up by a multidisciplinary group of clinicians and lay workers active in the management of pregnant women infected with HIV, aim to give up-to-date information on interventions to reduce the risk of mother to child transmission of the virus. The evidence on the use of interventions to prevent mother to child transmission of HIV has been graded according to the strength of the data as per the definitions of the US Agency for Health Care Policy and Research [ 1 ]. Weighted evidence on the use of combination antiretroviral therapy (ART) for the treatment of HIV infection per se is presented in the BHIVA guidelines for adults [ 2,3 ]. The highest level evidence (i.e. randomised controlled trials (RCTs) or large, well conducted meta-analyses) is only available for formula feeding, prelabour caesarean section and zidovudine monotherapy. The need to treat mothers for HIV infection has led to the widespread use of ART in pregnancy which in turn results in new questions such as how to deliver when the mother, on therapy, has no detectable plasma viraemia with the most sensitive assays. In addressing many common and/or difficult clinical scenarios in the absence of 'best evidence' the guidelines rely heavily on 'expert opinion'.
Recommendations for management are given in the section on clinical scenarios, and summarized in Table 3. An expanded version of these guidelines with an appendix on safety and toxicity data is available on the BHIVA website http://www.bhiva.org . The authors are available to discuss individual cases.     

Status of iodine nutrition in France: prevention of iodine deficiency in pregnant and lactating women

Iodine intake varies with age and physiological status: in pregnant and lactating women, recommended iodine intake ranges from 200 to 250 mg/day. Recent epidemiological studies in France demonstrate the presence of moderate iodine deficiency in the majority of pregnant and lactating women. This iodine deficiency induces maternal thyroid hyperplasia and then development of goiter in women, as well as impaired thyroid parameters. Maternal hypothyroxinemia during the first trimester of pregnancy can be associated with abnormal cognitive development and intellectual outcomes in the newborn and the children. According to the recent World Health Organization recommendations for the prevention and control of iodine deficiency in pregnant and lactating women, systematic iodine supplementation is indicated in France: 100 microg/day for women of reproductive age and 200 microg/day in pregnant and lactating women in order to eradicate iodine deficiency during pregnancy and lactation, and prevent the maternal and fetal consequences.     

Guidelines for conscious sedation and monitoring during gastrointestinal endoscopy

This is one of a series of statements discussing the utilization of GI endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy prepared this text. In preparing this guideline, a MEDLINE literature search was performed, and additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. When little or no data exist from well-designed prospective trials, emphasis is given to results from large series and reports from recognized experts. Guidelines for appropriate utilization of endoscopy are based on a critical review of the available data and expert consensus. Further controlled clinical studies are needed to clarify aspects of this statement, and revision may be necessary as new data appear. Clinical consideration may justify a course of action at variance to these recommendations.     

Guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment

Guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment have been produced by the Japan Gastroenterological Endoscopy Society in collaboration with the Japan Circulation Society, the Japanese Society of Neurology, the Japan Stroke Society, the Japanese Society on Thrombosis and Hemostasis and the Japan Diabetes Society. Previous guidelines from the Japan Gastroenterological Endoscopy Society have focused primarily on prevention of hemorrhage after gastroenterological endoscopy as a result of continuation ofantithrombotic therapy, without considering the associated risk of thrombosis. The new edition of the guidelines includes discussions of gastroenterological hemorrhage associated with continuation of antithrombotic therapy, as well as thromboembolism associated with withdrawal of antithrombotic therapy.     

Incident HIV infection in pregnant and lactating women and its effect on mother-to-child transmission in South Africa

We described HIV incidence and mother-to-child transmission (MTCT) among women during pregnancy and lactation. Forty-eight (3.4%) of 1396 women seroconverted during pregnancy or <12 mo after delivery. This group of HIV-exposed children was at 2.3 times higher risk of infection (MTCT 20.5% [8 of 39] vs 9.0% (83 of 925]). An estimated 20% with CD4+ cell counts <350 would have been eligible for antiretroviral therapy (ART), yet all women with incident HIV infections are more likely to transmit HIV to their children. To ensure optimal prevention of MTCT, all women who seroconvert during pregnancy or lactation should be considered for ART for the purpose of prevention of MTCT, and women with CD4+ <350 should continue to receive ART.     

Immunoreactive beta-casomorphin-8 in cerebrospinal fluid from pregnant and lactating women: correlation with plasma levels

We measured plasma and cerebrospinal fluid (CSF) beta-casomorphin-8, a product of beta-casein hydrolysis which has opioid activity, by RIA in women during late pregnancy and lactation and in nonpregnant nonpuerperal women. Before RIA, the samples were acidified and extracted by reverse phase silica gel chromatography, which removed most of the beta-casein. Lactating women had a significantly higher mean plasma beta-casomorphin-8 concentration (2.66 nmol/L; n = 8) than women in late pregnancy (0.82 nmol/L; n = 8) and nonpregnant women (0.32 nmol/L; n = 5). The CSF beta-casomorphin-8 concentration also was significantly higher in lactating women (mean, 0.35 nmol/L; n = 8) than during late pregnancy (0.22 nmol/L; n = 8) or in nonpregnant women (0.15 nmol/L; n = 5). A positive correlation was found between plasma and CSF beta-casomorphin-8 levels in the entire study group. The milk beta-casomorphin-8 concentration, measured in five puerperal women, averaged 19.8 nmol/L. Thus, there is a decreasing concentration gradient between milk and plasma and between plasma and CSF. Chromatographic analysis revealed mol wt heterogeneity of the RIA-active material. In CSF at least three different components were detected, two of mol wt around 900-2,000 and one of approximately 12,000. One of the low mol wt components coeluted in several chromatographic systems with synthetic beta-casomorphin-8 (mol wt, 900). Such a component was not found in milk or plasma, in which the major activity was due to larger sized peptides. The major peaks in milk were around 1,500-2,000 and 12,000 mol wt, corresponding to the larger peaks in CSF. The results suggest that fragments of the milk protein beta-casein may cross the breast parenchyma-blood barrier into plasma and subsequently penetrate the blood-brain barrier to reach the central nervous system. Thus, mammary tissue may assume endocrine function during galactopoiesis, and beta-casein could be considered a prohormone.     

浙江省沿海地区孕妇及哺乳期妇女碘营养状况调查

目的 了解浙江省沿海与内陆地区孕妇及哺乳期妇女碘营养状况,为指导浙江省孕妇、哺乳期妇女科学补碘提供依据.方法 2009年,采用整群抽样法在浙江省抽取13个县(区)作为调查点,其中沿海城市、沿海农村调查点各5个,内陆地区调查点3个.每个调查点抽取1街道(乡、镇),每个街道(乡、镇)中抽取1个居委会(行政村),每个居委会(村)中选择30名孕妇、30名哺乳期妇女、50名8～ 10岁学龄儿童,采集日间即时尿样检测尿碘;抽取30户家中食用盐盐样进行盐碘测定,同时采集饮用水水样进行水碘测定.水源数多于5个时,按东、西、南、北、中5个方位各随机采取一份水样;水源数少于5个时,采样份数同调查点水源数.结果 沿海城市、沿海农村、内陆地区抽样家庭的碘盐中位数分别为28.42、25.29、33.24 mg/kg,水碘中位数分别为5.41、11.52、2.80 μg/L.孕妇和哺乳期妇女尿碘中位数分别为148.72、161.34μg/L,均低于当地8～ 10岁学龄儿童的231.02 μg/L(Z值分别为8.57、8.24,P均＜0.017);各地区中,内陆地区孕妇尿碘中位数最高为211.42μg/L,沿海农村次之为150.51 μg/L,沿海城市最低为123.33μg/L(Z值分别为2.80、5.31、2.42,P均＜0.017),而内陆地区孕妇尿碘中位数(197.43 μg/L)高于沿海城市(139.64 μg/L,Z=4.03,P＜0.017).结论 浙江省哺乳期妇女碘营养水平总体处于适宜水平,沿海农村、内陆地区的孕妇碘营养也处于适宜水平,但沿海城市孕妇则在一定程度上存在碘营养水平不足的问题.