Cisapride Use During Human Pregnancy (A Prospective, Controlled Multicenter Study)

The objective of this prospective multicenterstudy was to determine whether cisapride is associatedwith increased risk of malformations, spontaneousabortions, or decreased birthweight when used during pregnancy. Cases were paired for age, smoking,and alcohol consumption with controls exposed tononteratogens, as well as with disease-paired controls.One hundred and twenty-nine pregnant women were exposed to cisapride during pregnancy, including 88during the period of fetal organogenesis. There were nodifferences in maternal history, birthweight,gestational age at delivery, and rates of livebirths,spontaneous or therapeutic abortions, fetal distress, andmajor or minor malformations among groups. It isconcluded that exposure to cisapride during pregnancy isnot associated with a major increased risk ofmalformations or spontaneous abortions or with decreasedbirthweight.     

Women With Pregnancy and Lactation–Associated Osteoporosis (PLO) Have Low Bone Remodeling Rates at the Tissue Level

Pregnancy and lactation–associated osteoporosis (PLO) is a rare, severe, early form of osteoporosis in which young women present with fractures, usually multiple vertebral fractures, during late pregnancy or lactation. In studies of idiopathic osteoporosis (IOP) in premenopausal women, we enrolled 78 women with low-trauma fractures and 40 healthy controls, all with normal menses and no secondary cause of bone loss. In 15 of the affected women, the PLO subgroup, fractures had occurred during late pregnancy or lactation. We hypothesized that clinical, bone structural, and metabolic characteristics would differ between women with PLO and those with (non-PLO) IOP and controls. All were evaluated > 12 months postpartum, when structural and remodeling characteristics would be expected to reflect baseline premenopausal status rather than transient postpartum changes. As previously reported, affected subjects (PLO and IOP) had BMD and microarchitectural deficiencies compared to controls. Women with PLO did not differ from those with IOP in terms of age, BMI, body fat, menarcheal age, parity, or age at first pregnancy. However, women with PLO had a more severe clinical presentation than those with IOP: more fractures (5.5 ± 3.3 versus 2.6 ± 2.1; p = 0.005); more vertebral fractures (80% versus 17%; p < 0.001); and higher prevalence of multiple fractures. BMD deficits were more profound and cortical width tended to be lower in PLO. PLO subjects also had significantly lower tissue-level mineral apposition rate and bone formation rates (0.005 ± 0.005 versus 0.011 ± 0.010 mm²/mm/year; p = 0.006), as well as lower serum P1NP (33 ± 12 versus 44 ± 18 µg/L; p = 0.02) and CTX (257 ± 102 versus 355 ± 193 pg/mL; p = 0.01) than IOP. The finding that women with PLO have a low bone remodeling state assessed more than a year postpartum increases our understanding of the pathogenic mechanism of PLO. We conclude that women with PLO may have underlying osteoblast functional deficits which could affect their therapeutic response to osteoanabolic medications. © 2019 American Society for Bone and Mineral Research.     

Associations of Breastfeeding,Maternal Smoking,and Birth Weight With Bone Density and Microarchitecture in Young Adulthood: a 25-Year Birth-Cohort Study

We have found that early-life exposures are associated with areal bone mineral density (aBMD) at ages 8 and 16 years. This study aimed to assess whether these associations persist into young adulthood when peak bone mass (PBM) is achieved and extend this analysis to microarchitecture. Participants were followed from perinatal period to 25 years old (n = 201). Outcomes were total body, spine, and hip aBMD (by dual-energy X-ray absorptiometry [DXA]), and cortical and trabecular bone measures at the distal radius and tibia (by high-resolution peripheral quantitative computed tomography [HRpQCT]). Early-life exposures including breastfeeding, maternal smoking during pregnancy, and birth weight. Sex, weight, height, vegetables, fruit and calcium intake at age 25 years were regarded as potential confounders in the analysis. There were significant interactions between period of gestation and early-life exposures for bone measures, so all analyses were stratified by period of gestation. Breastfeeding was beneficially associated with hip and total body aBMD, total, cortical and trabecular volumetric BMD (vBMD), cortical thickness, porosity, trabecular number (Tb.N), separation (Tb.Sp), and bone volume fraction (Tb.BV/TV) at radius and/or tibia at age 25 years in participants born prematurely (β ranged from −0.92 to 0.94), but there were no associations in those born at term. Maternal smoking had no association with any DXA/HRpQCT measures in those born prematurely but was detrimentally associated with inner transitional zone porosity and Tb.N (β = 0.40 and β = −0.37, respectively) in those full-term participants. Associations of birth weight with bone measures did not persist after adjustment for weight gain since birth. Breastfeeding was associated with a lower risk of lower limb fractures and maternal smoking had a deleterious association with upper limb fractures. In conclusion, breastfeeding and maternal smoking may have effects on peak bone microarchitecture whereas the association with birth weight is countered by subsequent growth. © 2020 American Society for Bone and Mineral Research.     

Pregnancy outcome after multifetal pregnancy reduction

Objective: To study the effects of multifetal pregnancy reduction (MFPR) as a means to reduce the adverse outcome of multiple gestations.

Methods: This was a retrospective study evaluating the outcome of 334 multiple pregnancies after embryo reduction.

Results: In 313 multiple pregnancies in which MFPR was performed before 15 weeks, the rates of miscarriage, preterm delivery <?33 weeks, preterm delivery <?36 weeks and total fetal loss were 9.12%, 13.33%, 38.60% and 16.25%, respectively, and median gestational age at delivery was 35 weeks. There was a significant correlation between miscarriage and the finishing number of fetuses. In 185 triplets reduced to twins, miscarriage, preterm delivery <?33 weeks, preterm delivery <?36 weeks and total fetal loss occurred in 8.25%, 11.18%, 40.59% and 15.41% of cases, respectively, and median gestational age at delivery was 36 weeks. In the subgroup of 32 reduced triplet pregnancies that also had second-trimester amniocentesis, the risk of miscarriage (3.13%) was not significantly different from that in the rest of the group. Among 21 twin pregnancies that had selective termination at or after 15 weeks, the risk of preterm delivery <?33 weeks was three times higher than in the group of 22 twin pregnancies with first-trimester procedures.

Conclusion: MFPR resulted in at least one live neonate in 83.75% of cases and was effective in reducing the risks of pregnancy loss and severe prematurity in quadruplets and higher-order pregnancies. The risk of miscarriage increased with increasing finishing number of fetuses. In reduced triplets gestation was prolonged in comparison with average figures reported in the literature. In twin pregnancies selective termination in the first trimester carries a lower risk of severe preterm delivery and this emphasizes the need for first-trimester diagnosis.     

Advanced tubal pregnancy associated with severe fetal growth restriction: a case report

A case is described of advanced tubal pregnancy associated with severe fetal growth restriction delivered at 27 weeks. The placenta was implanted on the salpinx and on the uterotubal angle. Progressing tubal pregnancy and its placental histological characteristics could be a model of placental dysfunction typically associated with intrauterine growth restriction.     

Central nervous system lupus and pregnancy: 11-year experience at a single center

Objective: To describe the pregnancy outcomes in women with central nervous system (CNS) manifestations of lupus. Methods: Between 1991 and 2002, the outcome of five pregnancies in four patients with CNS lupus were retrospectively reviewed. All patients had an established history of systemic lupus erythematosus (SLE), and either a history of CNS lupus or active CNS lupus. Pregnancy outcomes assessed included term and preterm birth, intrauterine growth restriction, abnormal antepartum testing, perinatal mortality, pre-eclampsia and other maternal morbidities. Results: Evidence of active CNS lupus symptoms developed in three of the five pregnancies. Two pregnancies were complicated by early onset pre-eclampsia, abnormal antepartum testing and extreme prematurity, with one subsequent neonatal death. The remaining three pregnancies had good neonatal outcomes, but were complicated by severe maternal post-pregnancy exacerbations, and the eventual death of one patient. Conclusions: CNS lupus in pregnancy represents an especially severe manifestation of SLE, and may involve great maternal and fetal risks.     

The effect of maternal anemia and iron deficiency on fetal erythropoiesis: comparison between serum erythropoietin,hemoglobin and ferritin levels in mothers and newborns

Objective: Maternal and fetal serum erythropoietin levels were correlated with hemoglobin, mean corpuscular volume and serum ferritin in a group of anemic pregnant women to evaluate the effect of maternal anemia on fetal erythropoiesis. Methods: Serum erythropoietin, ferritin, hemoglobin and mean corpuscular volume were investigated in 33 pregnant women with anemia, 11 women with normal hematological parameters and in their newborns. Results: Maternal serum erythropoietin concentration (mean ± SEM) was significantly higher in the anemic group (145.2 ± 42.9 mU/ml) as compared to the control group (37.3 ± 7.6 mU/ml) (p < 0.05). In newborns, all parameters were comparable in both groups except cord serum erythropoietin concentration (mean ± SEM) which was significantly higher in newborns born to anemic women (43.9 ± 5.3 mU/ml) than controls (29.4 ± 3.7 mU/ml) (p < 0.05). In the anemic group, maternal serum erythropoietin was inversely correlated to maternal hemoglobin (r = -0.375, p = 0.03), maternal hemoglobin was inversely correlated to cord serum erythropoietin (r = -0.552, p = 0.001) and maternal ferritin was correlated to fetal ferritin (r = 0.521, p = 0.002). Conclusion: Although cord hemoglobin and mean corpuscular volume were not affected by maternal anemia, increased cord serum erythropoietin levels related to low maternal hemoglobin levels suggest an induced fetal erythropoiesis in maternal anemia.     

Contraceptive Treatment after Biliopancreatic Diversion Needs Consensus

Background: An important population of patients who undergo biliopancreatic diversion (BPD) are fertile women. A consensus is needed with regard to contraceptive therapy after BPD by evaluating the risks of pregnancy, the safety of oral contraception and the changes in fertility after this bariatric surgery. Method: From May 1997 until May 1998, 40 women who underwent a BPD were included in a prospective study evaluating the hormone status preoperatively and postoperatively after 2 and 7 days, 3 and 6 months and 1 year. An extensive questionnaire, with regard to fertility and obstetric history, was sent at least 2 years after inclusion. A literature search was performed to understand the complex physiology of hormone changes after excess weight loss, as well as absorption and metabolism of oral contraceptives. Results: Our laboratory results are consistent with hormone changes found in the literature, which show that rising levels of serum sex-hormone-binding globulin, follicle stimulating hormone and luteinizing hormone and decreasing levels of testosterone and dehydroepiandrosterone sulphate result in an improved fertility status, regulated through complex interactions, in particular with the gonatotropin-releasing-hormone pulse generator. The questionnaire shows the use of different types of contraception. From the 9 patients who only used oral contraception, 2 patients developed an unforeseen pregnancy after BPD. Although miscarriages and neonatal complications were seen in other patients in our hospital, none of these problems were seen in our study. Conclusion: Pregnancy should be avoided for 12 to 18 months after BPD. Fertility increases after BPD. As oral contraception is most popular and less reliable, we strongly believe that large multi-centre, prospective, randomized studies are necessary to come to a consensus about the use of contraceptive therapy after BPD.