HIV and pregnancy: challenges in practice

Midwives face great challenges in practice in caring for women with multiple medical, social and psychological needs. This article highlights the issues such as extreme grief reaction, fear of abandonment and stigma and prejudice that women face when they are diagnosed HIV positive during pregnancy. The article also discusses the importance of communication and a multi-agency approach in providing safe antenatal care for vulnerable women and their families.     

Asthma and pregnancy: therapeutic challenges

Purpose

Asthma in pregnancy represents a complex therapeutic challenge as it can have unfavourable consequences on both the mother and the fetus. Pregnancy can have a variable impact on asthma, and there is no general rule to predict in whom is going to be better, stable or worse. On the other hand, asthma can increase the risks of fetal malformations, low birth weight or premature birth.

Methods and results

The review of the literature regarding the asthma pathogenic maternal and fetal effects and the current therapeutic recommendations.

Conclusions

A multidisciplinary team is needed to appropriately follow up a pregnant woman with asthma and this should involve a pulmonary disease physician, a neonatologist, an obstetrician and, if necessary, an allergolocist. Most of the medications used in asthma outside pregnancy can safely be used during it. An appropriate management according to existing guidelines can minimize both maternal and fetal risks.     

Asthma in pregnancy: current concepts

Asthma complicates pregnancy with the same frequency as cardiac disease (1%) does. Although the incidence of severe asthma during pregnancy is low, its effect on the mother and fetus can be disastrous. Recent advances have improved the management of this problem. Representative cases and a review of asthma treatment in pregnancy are presented.     

妊娠合并糖尿病：中国的现状与挑战

随着中国全面迈入小康社会,国民经济收入水平得到较大提升。经济发展不仅使人们的生活方式发生了显著变化,也使疾病谱出现了特征性改变,糖尿病是其中最为突出的一个疾病,发病率逐年增加,尤其是生育年龄群体的发病率增加,导致了妊娠合并糖尿病的患者日趋增多,给围产领域带来新的课题与挑战。妊娠合并糖尿病不仅会导致多种不良母儿结局,而且还严重危害母儿远期健康,如何开展妊娠合并糖尿病患者围孕期的科学化管理已经成为母胎医学研究领域的热门话题。     

Drug-prescribing challenges during pregnancy

Most women take either prescribed or over-the-counter medication during pregnancy. Pregnant women often make independent decisions about their treatment and require careful counselling that allows them to balance the risk of taking a drug against the risk of not taking a drug and leaving a medical condition untreated. Advice needs to be tailored to the individual and is hampered by the lack of safety data on drugs in pregnancy and the puerperium. Prescribing is further complicated by both the mother’s and the foetus’ changing physiologies as risk–benefit assessments alter throughout pregnancy. Treatment decisions may require the input of multi-disciplinary teams that consider the severity of the mother’s condition, maternal physiology, a drug’s pharmacokinetic, pharmacodynamic and safety profile and the developmental stage of the foetus.     

Drug therapy for diabetes mellitus during pregnancy and breastfeeding in the beginning of 21 century: status quo and new challenges

Diabetes mellitus is frequent during pregnancy and is associated with substantial risks both for the mother and the newborn. An adequate therapy ensures the normal course of pregnancy and delivery and postnatal development of the baby. Insulin, for its well known safety record, has long been considered the drug of first choice for achieving optimal glycemic control in pregnant women. Pregnancy is an indication for intensive insulin therapy. The pre-mixed insulins are not recommended due to their inability to provide the needed therapeutic flexibility during the different periods of pregnancy. The short acting insulin analogue aspart is currently registered for meal-time use in basal therapy with NPH insulin. The long-acting analogues glargine and detemir are still investigated clinically and for the moment are only used off label in pregnancy. Maternal hypoglycemia, the need of injection and the high cost are the main drawbacks of insulin therapy. Evidence has accumulated in recent years that some oral antidiabetics are as efficacious and safe as insulin in gestational diabetes. Metformin and glibenclamide are now increasingly viewed as a rational alternative to insulin therapy--a treatment both preferred by the women and a less expensive one, during pregnancy and breastfeeding.     

Oral contraceptives: current status

During the past four decades, oral contraceptives have remained a safe and effective method of birth control. Reductions in the estrogen and progestin dosages have significantly decreased the incidence of cardiovascular complications. The association between oral contraceptives and breast cancer appears to be primarily because of detection bias or possibly a promotional effect. Despite the changes in formulation, the problems related to side effects have not been totally solved. Because compliance and successful use is strongly affected by side effects, improvement in this area is probably the biggest challenge faced by developers of oral contraceptives. It is also clear that there are a growing number of significant noncontraceptive benefits that accrue in oral contraceptive users. Unfortunately, many women do not know about these benefits. Thus, one of the issues that providers need to continue to address is how to provide better information about oral contraceptives and contraception in general to patients.     

Toxoplasmosis and pregnancy: current trends in serological follow-up

Prevention of congenital toxoplasmosis is based on serological follow-up of pregnant patients. Routine serology includes search and titration of specific IgG and IgM. In presence of specific IgM, complementary tests should be carried out for a better dating of the contamination. Among them, the avidity test is the most currently used. It allows to exclude a recent infection in the majority of the cases. For difficult cases, it is useful to contact a specialized laboratory.     

Animal-derived surfactants versus past and current synthetic surfactants: current status

In this review, the authors assess major outcomes resulting from head-to-head comparison trials of animal-derived surfactants with previous and newer synthetic surfactants and among them. They also pay special attention to issues of study design and quality of the trials reviewed. Animal-derived surfactants that contain surfactant proteins (Survanta, Infasurf, and Curosurf) perform clinically better than Exosurf, a synthetic surfactant containing only phospholipids, primarily in outcomes related to acute management of respiratory distress syndrome (RDS; faster weaning and pneumothorax) but not in overall mortality or incidence of bronchopulmonary dysplasia (BPD). Trials comparing various animal-derived surfactants that provide different amounts of surface protein B (SP-B) or phospholipids have shown minor differences in outcomes related to the management of RDS or none at all. The exception is the suggestion of better survival using a high initial dose of Curosurf when compared with Survanta. This observation is based on analysis of trials of relatively lesser quality that have included a smaller number of infants than other surfactant comparisons, however. Data from recent trials comparing a new-generation synthetic surfactant that contains a peptide mimicking the action of SP-B, Surfaxin, have shown that it performs better than Exosurf (faster weaning and less BPD) and at least as well as the animal-derived surfactants Survanta and Curosurf. The ideal surfactant comparison trial to demonstrate which surfactant is better has yet to be conducted. Future surfactant comparison trials should pay particular attention to study design, be appropriately sized, and include long-term follow-up.     

Preimplantation genetic diagnosis: current status and perspective

Scientific and clinical aspects of preimplantation genetic are represented.