My Treatment Approach to Management of the Pregnant Patient With Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is frequently diagnosed in women of childbearing age. Of paramount concern are questions about the effect of the disease on a woman's ability to conceive and carry the pregnancy safely to term, as well as the effect of the disease and its therapies on the health of the fetus. For health care providers, there is also the issue of medication dose adjustments and management of flares during pregnancy. Growing experience with IBD in pregnancy suggests that most women will have good outcomes; however, concerns and uncertainty remain for both the patient and the physician. This article outlines our approach to the treatment of these patients with respect to preconception counseling and management during pregnancy and the postpartum period.     

Maternal periodontal disease, pregnancy, and neonatal outcomes

The purpose of this article is to review the current literature on the association between maternal periodontal disease and poor pregnancy and neonatal outcomes and outline the role nurses can play in improving the oral health of pregnant women. Maternal periodontal disease is linked to preterm birth, low birthweight, and preterm low birthweight, but treatment of periodontal disease during pregnancy has been shown to be safe and effective. Nurses, nurse practitioners, and nurse-midwives are in a position to educate pregnant women on the benefits of good oral health and identify and refer women who are in need of dental care for treatment.     

Pregnancy and oral health: a review and recommendations to reduce gaps in practice and research

This article presents a review of the research relevant to oral health during pregnancy and includes nursing practice recommendations for referral of women to a dentist for safe and effective dental care during pregnancy. In recent years, research linking periodontitis to the risk for adverse birth outcomes has resulted in increased interest in the topic of oral health during pregnancy. The achievement of optimal oral health in pregnant women as its own benefit, however, has in the past been hampered by myths surrounding the safety of dental care during pregnancy. Many women also lack access to dental care and dental insurance, which interferes with their ability to receive adequate oral care during pregnancy. Intraoral changes that occur with pregnancy because of hormonal changes, combined with lack of routine exams and delays in treatment for oral disease, place pregnant women at higher risk for dental infections.     

Exit strategies in inflammatory bowel disease: Looking beyond anti-tumor necrosis factors

The long-term management of patients with inflammatory bowel disease (IBD) is still a matter of debate, and no clear guidelines have been issued. In clinical practice, gastroenterologists often have to deal with patients in prolonged remission after immunomodulatory or immunosuppressive therapies. When planning an exit strategy for drug withdrawal, the risk of disease relapse must be balanced against the risk of drug-related adverse events and healthcare costs. Furthermore, there is still a dearth of data on the withdrawal of novel biologics, such as the anti-α4β7 integrin antibody (vedolizumab) and anti-IL12/23 antibody (ustekinumab), as well as the small molecule tofacitinib. Models for estimating the risk of disease relapse and the efficacy of retreatment should be evaluated according to the patient's age and IBD phenotype. These models should guide clinicians in programming a temporary drug withdrawal after discussing realistic outcomes with the patient. This would shift the paradigm from an exit strategy to a holiday strategy.     

Nephrotic syndrome and pregnancy. Potential problems for mother and child

The pregnant patient with nephrotic syndrome should be carefully evaluated for the presence of chronic renal disease. Proteinuria itself may be associated with an increase in perinatal mortality and in the incidence of small-for-gestational-age infants. Coexistent hypertension and/or renal dysfunction add to the risk of an unsuccessful pregnancy. The use of tocolytic agents in pregnant women with nephrotic syndrome theoretically may be hazardous. The patient with systemic lupus erythematosus may be at particular risk of unsuccessful pregnancy if the disease is active; postponement of conception until a remission of six months or longer has been achieved may be well advised.     

Platelet dysfunction and pregnancy in gestational exacerbation of chronic glomerulonephritis]

AIM: To evaluate platelet dysfunctions and pregnancy outcomes in females with gestational exacerbation of chronic glomerulonephritis (CGN) and the disease remission. MATERIALS AND METHODS: Platelet metabolism was studied by activity of intraplatelet LDG, platelet secretory activity by plasm beta-TG and ADP-aggregation in 75 gravidae. Of them 16 had exacerbation of CGN, 40 females were in remission of CGN and 19 healthy pregnant women served control. RESULTS: Enhanced LDG activity and intensity of maximal ADP aggregation, high beta-TG levels compared to control were recorded in gravidae with CGN both in exacerbation and remission. The frequency of preterm deliveries, intrauterine growth retardation, neonatal hypotrophy was greater in women with gestational exacerbation of nephritis compared to pregnant women with stable nephritis. CONCLUSION: Metabolic and functional platelet hyperactivity with platelet intravascular activation in pregnancy in aggravated CGN suggest contribution of platelets to onset of the disease gestational exacerbation. Pregnancy-induced overactivation of platelets in CGN exacerbation stimulates intravascular coagulation in placental circulation with resultant microthrombi in placental vessels responsible for high rate of unfavorable pregnancy outcomes in relevant patients.     

Laparoscopic appendectomy during the second trimester of a twin pregnancy

Acute appendicitis during pregnancy may lead to increased maternal and fetal risks. Laparoscopic appendectomy is commonly performed during pregnancy. Compared with open appendectomy in pregnant women, laparoscopic appendectomy has shown non-inferior safety for pregnancy outcomes and superior safety for surgical outcomes. Over the last few decades, the occurrence of twin pregnancy has been increasing. Performing an operation on a patient with a twin pregnancy is more difficult than with a singleton pregnancy. Only a few operations of this kind have been reported. Here, we present a case of a 20-week twin pregnant woman who presented with acute appendicitis. Laparoscopic appendectomy was performed, and no maternal complications occurred. This report contributes to discussions on the safety of the laparoscopic approach for appendicitis during twin pregnancies.     

TPOAb、HbA1c、PLGF及血脂水平对妊娠期糖尿病孕妇妊娠结局的影响

目的 探讨妊娠期糖尿病(GDM)孕妇抗甲状腺过氧化物酶抗体(TPOAb)、糖化血红蛋白(HbA1c)、胎盘生长因子(PLGF)、血脂等水平及意义.方法 选取在南京市妇幼保健院治疗的GDM患者180例为观察组;选取同期在南京市妇幼保健院产检的健康产妇180例为对照组.于妊娠24～27周,采集空腹静脉血,检测TPOAb、H...     

Apheresis: A cell-based therapeutic tool for the inflammatory bowel disease

Inflammatory Bowel Disease (IBD) is a hallmark of leukocyte infiltration, followed by the release of cytokines and interleukins. Disease progression to Ulcerative Colitis (UC) or Crohn’s Disease (CD) remained largely incurable. The genetic and environmental factors disrupt enteral bacteria in the gut, which hampers the intestinal repairing capability of damaged mucosa. Commonly practiced pharmacological therapies include 5-aminosalicylic acid with corticosteroids and tumor necrosis factor (TNF)-α. New interventions such as CDP571 and TNF-blocking RDP58 report the loss of patient response. This review discusses the non-pharmacologic selective granulocyte–monocyte-apheresis (GMA) and leukocytapheresis (LCAP) that have been proposed as treatment modalities that reduce mortality. GMA, an extracorporeal vein-to-vein technique, presents a strong safety profile case for its use as a viable therapeutic option compared to GMA's conventional medication safety profile. GMA reported minimal to no side effects in the pediatric population and pregnant women. Numerous studies report the efficacious nature of GMA in UC patients, whereas data on CD patients is insufficient. Its benefits outweigh the risks and are emerging as a favored non-pharmacological treatment option. On the contrary, LCAP uses a general extracorporeal treatment that entraps leukocytes and suppresses cytokine release. It has been deemed more efficacious than conventional drug treatments, the former causing better disease remission, and maintenance. Patients with UC/CD secondary to complications have responded well to the treatment. Side effects of the procedure have remained mild to moderate, and there is little evidence of any severe adverse event occurring in most age groups. LCAP decreases the dependence on steroids and immunosuppressive therapies for IBD. The review will discuss the role of GMA and LCAP.     

妊娠期高血压疾病孕妇患病体验质性研究的Meta整合

目的 系统评价妊娠期高血压疾病孕妇患病体验和心理感受,为制订基于证据的该类患者专病管理措施提供依据。方法 计算机检索中国生物医学文献数据库、中国知网、万方数据库、维普数据库、PubMed、Cochrane Library、Web of Science、Embase、PsycINFO、Proquest、CINAHL数据库中关于妊娠期高血压疾病孕妇患病经历、心理体验和感受的质性研究,检索时限为建库至2021年11月10日。采用澳大利亚乔安娜布里格斯研究所循证卫生保健中心质性研究质量评价标准对文献质量进行评价,采用汇集性整合法对研究结果进行归纳整合。结果 共纳入16篇文献,提炼60个主题,归纳12个类别,形成4个整合结果：情感反应复杂且持久、打破妊娠的常态、寻求理解与支持、疾病经历中的获益和成长。结论 医护人员应加强对妊娠期高血压疾病孕妇心理健康的动态评估,通过协调、连续的孕产期保健服务,促进医护-家庭-自我多元应对系统的建立,增强该类孕妇的妊娠控制感,降低疾病因素对其妊娠结局及心理健康的不良影响,保障母婴安全。     

Healthy babies for mothers with serious mental illness: A case management framework for mental health clinicians

Women with a serious mental illness (SMI), notably schizophrenia, bipolar disorder, and personality disorders are considered high risk for adverse pregnancy and birth outcomes, which in turn, are associated with poor neurodevelopment in the child. Failure to access antenatal care, poor adherence with folate supplementation, an unhealthy lifestyle, and inappropriate health decisions can contribute to poor outcomes. Many women with SMI continue contact with mental health services while pregnant. This primary prevention project aimed to develop a framework for community mental health clinicians to improve the reproductive health outcomes for women with SMI. The consultation process involved discussions with key stakeholders, an environmental scan to determine current service delivery issues, a literature review, and individual and group interviews with community mental health clinicians, consumers, general practitioners, and midwives. Three key elements underpin the framework: early detection and monitoring of pregnancy, providing reproductive choices, and implementing a ‘small known team approach’ in the management of the pregnant client. Specific modules within the framework focus upon establishing a professional support network, assessing the risk of pregnancy, the early detection of pregnancy, monitoring during pregnancy, preparing for birth, and planning for the postnatal period. Implementation of the framework has the potential to significantly improve obstetric and neonatal outcomes for this high‐risk group.     

妊娠心脏病孕妇不良妊娠结局影响因素分析

目的调查妊娠心脏病孕妇不良妊娠结局的相关因素,以便采取相应的预防护理措施。方法选取2017年11月—2019年11月本院生产的妊娠心脏病孕妇240例,其中,30例发生不良妊娠结局者设为不良结局组(病例组),其余210例妊娠结局良好者为正常结局组(对照组)。收集两组孕妇的相关资料并进行统计学处理,分析不良妊娠结局发生的独立危险因素。结果单因素及多因素Logistic回归分析结果显示,合并高血压、孕次≥4次、心功能分级(Ⅲ或Ⅳ)均是妊娠心脏病不良妊娠结局发生的独立危险因素。结论合并高血压、孕次≥4次、心功能分级(Ⅲ或Ⅳ)均是妊娠心脏病不良妊娠结局发生的独立危险因素,且心脏功能级别较高的孕妇不良妊娠的发生率越高,应重视上述独立危险因素,采取相应的预防干预措施,减少不良妊娠的发生。     

Maternal smoking during pregnancy and evidence-based intervention to promote cessation.

Maternal smoking during pregnancy is hazardous to the developing fetus and mother. Smokers should be identified and offered personalized advice and assistance, including self-help materials tailored for pregnancy. Results of a meta-analysis of 16 randomized trials with validated outcomes indicate that such intervention increases cessation by 70% in diverse populations of pregnant women. At this time, intensive counseling on multiple occasions does not appear to increase cessation.     

Frequency and outcomes of maternal thyroid function abnormalities in early pregnancy

Thyroid function in pregnant women is of clinical importance considering the crucial role of thyroid hormones during fetal brain development, but the current level of evidence is insufficient to recommend for or against the routine testing of thyroid function in pregnant women. As part of this debate, it is important to evaluate the frequency of undiagnosed and untreated thyroid function abnormalities in pregnant women and to address challenges related to the biochemical assessment of maternal thyroid function in early pregnancy. A hypothesis of fetal programming by maternal thyroid disease has been proposed, but more evidence in humans is needed to extend the hypothesis and to evaluate child neurodevelopmental outcomes after in utero exposure to different abnormalities in maternal thyroid function. The nationwide registers in the Nordic countries provide unique opportunities within reproductive epidemiology to study the impact of various in utero exposures, and stored blood samples from pregnant women in nationwide birth cohorts provide a valuable source for the establishment of pregnancy specific reference ranges. This review addresses the frequency and outcomes of thyroid function abnormalities in pregnant women mainly focusing on observational studies that combine data from the Danish nationwide registers and biological specimens from the Danish National Birth Cohort. Dynamic changes in the reference range of maternal TSH and free T4 during the first trimester of pregnancy are described and discussed. A high frequency of unidentified maternal thyroid function abnormalities is illustrated, and outcomes of child neurodevelopment are evaluated according to subtypes and severity of maternal thyroid dysfunction.     

Cognitive behavioural therapy improves pregnancy outcomes of in vitro fertilization-embryo transfer treatment: a systematic review and meta-analysis

ObjectiveThe study aim was to examine the effects of cognitive behavioural therapy (CBT) on the pregnancy outcomes of women receiving in vitro fertilization-embryo transfer (IVF-ET) treatment.MethodsA literature review was performed using the databases MEDLINE, the Cochrane Database, Embase, Chinese National Knowledge Infrastructure (CNKI) and WANFANG. Eligible studies were selected according to inclusion and exclusion criteria. Relevant data were extracted and the quality of studies assessed. Odds ratios with 95% confidence intervals were pooled to statistically analyse the difference between intervention and control groups.ResultsTen studies were selected for the systematic review and meta-analysis. The findings showed that CBT and cognitive-related therapy significantly improved the pregnancy rate of women undergoing IVF-ET treatment. Subgroup analysis showed that patients who received CBT, rather than complex psychological interventions, and those who received interventions delivered by professional psychologists, were more likely to become pregnant during IVF-ET treatment.ConclusionCBT and cognitive-related interventions had significant effects on the pregnancy outcomes of women receiving IVF-ET treatment. CBT treatment (rather than complex psychological interventions) provided by professional psychologists is strongly recommended.     

The effect of obesity on heart rate (heart period) and physiologic parameters during pregnancy

Obesity and excess gestational weight gain (EGWG) in pregnancy increase the risk for adverse maternal and infant outcomes. Along with careful monitoring of weight gain during pregnancy, early identification of a maladaptive response to the changes of pregnancy may help to avoid adverse outcomes. Simple physiologic markers such as resting heart rate (HR), heart period (HP), and blood pressure (BP) may be powerful predictors of cardiovascular adaptation to pregnancy. This article summarizes the current state of the science regarding the effect of obesity (body mass index [BMI] > or =30 kg/m(2)) and EGWG in pregnant women at rest in laboratory settings. The impact of differences in weight gain (kg and BMI) on pregnancy outcomes is also examined. A search was conducted for articles published from 1985 to 2006 reporting data on body weight and HR or HP at rest from randomized controlled trials or controlled trials conducted in laboratory settings involving pregnant women at low or high risk for adverse pregnancy outcomes who were obese or had EGWG. A meta-analysis was conducted on the 23 studies meeting inclusion criteria to explore the relation of BMI to HR, HP, and physiologic parameters. Autonomic responsiveness was found to be diminished in obese women with a BMI > 30 kg/m(2) and in women with high risk for adverse pregnancy outcomes, which may indicate a maladaptive autonomic response that is imbalanced and disorganized and that reduces adaptation to environmental demands.     

Effects of the Dietary Approaches to Stop Hypertension (DASH) on Pregnancy/Neonatal Outcomes and Maternal Glycemic Control: A Systematic Review and Meta-analysis of Randomized Clinical Trials

Background & objectiveNo systematic review to date has appraised the impact of the Dietary Approaches to Stop Hypertension (DASH) eating plan on maternal glycemic control and pregnancy outcomes. Thus, we conducted a systematic review and meta-analysis of randomized clinical trials (RCTs) to ascertain whether the DASH diet in pregnant women ameliorates their glycemic control and neonatal outcomes when compared to standard diets.MethodsWe performed a comprehensive systematic review and meta-analysis of RCTs on PubMed/MEDLINE, Web of Science, SCOPUS, and Embase from the inception until October 2019.ResultsSix studies met the eligibility criteria and were included in the quantitative meta-analysis. The pregnant women had cardiometabolic disorders such as gestational diabetes, obesity, and hypertension. The meta-analysis suggested a significant effect of DASH diet on fasting plasma levels of glucose (WMD = -6.239 mg/dl; 95% CI: -11.915, -0.563, p = 0.031), but not for the homeostasis model assessment of insulin resistance (WMD = -1.038; 95% CI: -2.704, 0.627, p = 0.22). Following the DASH diet during pregnancy decreased the risk of gestational preeclampsia (RR = 0.667; 95% CI: 0.451, 0.987, p = 0.043), macrosomia (birth weight >4000 g) (RR = 0.294; 95% CI: 0.120, 0.721, p = 0.043), and large for gestational age (RR = 0.452; 95% CI: 0.211, 0.969, p = 0.041). Consuming DASH diet during pregnancy neither increased nor decreased the risk of cesarean section, polyhydramnios, preterm birth (<37 weeks), and small for gestational age. The mean newborn head circumference (cm) (WMD = -0.807; 95% CI: -1.283, -0.331, p = 0.001) and ponderal index (kg/m³) (RR = -0.396; 95% CI: -0.441, -0.350, p = 0.000) in the group receiving the DASH diet were lower than in the control group.ConclusionThe adherence of pregnant women with cardiometabolic disorders to DASH eating pattern has a significant effect on decreasing fasting plasma glucose levels, ponderal index, incidence of preeclampsia, fetal macrosomia, large for gestational age, and newborn head circumference.     

Are probiotics safe for use during pregnancy and lactation?

QUESTION: There has been a great deal of discussion in both the medical and lay literature about the use of probiotics to improve general health. Subsequently, pregnant women have been asking me if probiotics used for treating conditions such as bacterial vaginosis and diarrhea are safe to use during pregnancy and lactation. ANSWER: Current data suggest that probiotic supplementation is rarely systemically absorbed when used by healthy individuals. One meta-analysis and several randomized controlled trials conducted with women during the third trimester of pregnancy did not report an increase in adverse fetal outcomes. There have been no published studies addressing Saccharomyces species use in pregnancy. Probiotics are unlikely to be transferred into breast milk.     

孕期食物结构与妊娠结局的相关性分析

目的探讨孕期食物结构与妊娠结局的相关性。方法选取2016年4月至2019年4月我院收治的50例不良妊娠结局孕产妇为研究组,同期50例正常妊娠结局孕产妇为对照组,采用统一拟定的调查问卷统计妊娠期食物结构和使用频次,并将采集数据录入相关性分析软件进行处理。结果研究组坚果禽肉结构、薯类水果结构、腌制油炸结构、速食为主结构评分高于对照组(P <0. 05)。妊娠期高血压疾病、妊娠期糖尿病、妊娠期贫血、低体重儿与多频次和不合理饮食结构存在正相关关系(P <0. 05)。结论护理人员应对备孕和已孕者进行孕期饮食结构指导,并根据阶段性母婴营养状况反应水平合理调整膳食计划,降低妊娠合并症所致不良妊娠结局的发生率。     

甲状腺功能减退症孕妇不良妊娠结局分析

目的分析妊娠期甲状腺功能减退症孕妇不良妊娠结局。方法选取100例甲状腺功能减退症孕妇作为观察组,并选取同期的120例健康孕妇作为对照组,以及同期的100例遵医嘱治疗的甲状腺功能减退症孕妇作为治疗组。治疗组给予左甲状腺素钠片,其余两组孕妇均无干预。比较三组孕妇的妊娠并发症发生情况及不良妊娠结局发生情况。结果观察组的妊娠期高血压疾病、贫血发生率及妊娠并发症总发生率均高于对照组和治疗组(P<0.05)。观察组的胎儿宫内窘迫发生率及不良妊娠结局总发生率均高于对照组和治疗组(P<0.05)。结论甲状腺功能减退症孕妇不良妊娠结局发生率明显增高,对于甲状腺功能减退症孕妇进行及时的筛查和治疗,可有效改善甲状腺功能,降低不良妊娠结局的发生率。