Pub Date : 2024-08-01DOI: 10.1016/j.ajog.2024.04.053
{"title":"Maternal mortality surveillance must go beyond death certificates","authors":"","doi":"10.1016/j.ajog.2024.04.053","DOIUrl":"10.1016/j.ajog.2024.04.053","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":8.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140955377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.ajog.2024.05.009
Background
Pessaries are an effective treatment for pelvic organ prolapse, yet currently available pessaries can cause discomfort during removal and insertion. An early feasibility trial of an investigational, collapsible pessary previously demonstrated mechanical feasibility during a brief 15-minute office trial. Longer-term, patient-centered safety and efficacy data are needed.
Objective
This study aimed to assess the effectiveness and safety of the investigational vaginal pessary for pelvic organ prolapse at 3 months.
Study Design
This was a prospective, 7-center, open-label equivalence study with participants serving as their own controls. Subjects were current users of a Gellhorn or ring pessary with ≥stage 2 prolapse. Subjective and objective data were collected at baseline for 1 month while subjects used their current pessary. Data were then collected throughout a 3-month treatment phase with the study pessary. The primary outcome was change in Pelvic Floor Distress Inventory-20 score. Secondary outcome measures included objective assessment of prolapse support, changes in the Pelvic Floor Impact Questionnaire-7, and pain with insertion and removal, measured using a visual analog scale. Data from subjects fitted with the study pessary were analyzed using an intention-to-treat approach, and those who dropped out were assigned scores at the upper limit of the predefined equivalence limits. Secondary per protocol analyses included subjects who completed treatment. The study was powered to 80% with a minimal important change equivalence limit of 18.3 points on the Pelvic Floor Distress Inventory-20 scale. Square root transformations were used for nonparametric data, and P values were adjusted for multiple comparisons.
Results
A total of 78 subjects were enrolled, however, 16 withdrew before study pessary placement. The study pessary was fitted in 62 subjects (50 ring and 12 Gellhorn pessary users), and 48 (62%) completed the 3-month intervention. The change in Pelvic Floor Distress Inventory-20 scores at 3 months demonstrated equivalence when compared with the subjects’ baseline scores (mean difference, −3.96 [improvement]; 90% confidence interval, −11.99 to 4.08; P=.002). Among those completing study, the Pelvic Floor Distress Inventory-20 scores, equivalence was not demonstrated and scores favored the study pessary (mean difference, −10.45; 90% confidence interval, −20.35 to 0.54; P=.095). Secondary outcomes included objective measures of support, which were similar (mean difference: Ba, 0.54 cm; Bp, 0.04 cm, favoring study pessary; improvement in mean Pelvic Floor Impact Questionnaire-7 scores for those who completed the trial: before, 32.23; after, 16.86; P=.019), and pain with insertion and removal, which was lower with the study pessary than with the subject’s own pessary (m
{"title":"Effectiveness and safety of a novel, collapsible pessary for management of pelvic organ prolapse","authors":"","doi":"10.1016/j.ajog.2024.05.009","DOIUrl":"10.1016/j.ajog.2024.05.009","url":null,"abstract":"<div><h3>Background</h3><p>Pessaries<span> are an effective treatment for pelvic organ prolapse, yet currently available pessaries can cause discomfort during removal and insertion. An early feasibility trial of an investigational, collapsible pessary previously demonstrated mechanical feasibility during a brief 15-minute office trial. Longer-term, patient-centered safety and efficacy data are needed.</span></p></div><div><h3>Objective</h3><p>This study aimed to assess the effectiveness and safety of the investigational vaginal pessary for pelvic organ prolapse at 3 months.</p></div><div><h3>Study Design</h3><p><span>This was a prospective, 7-center, open-label equivalence study with participants serving as their own controls. Subjects were current users of a Gellhorn or ring pessary with ≥stage 2 prolapse. Subjective and objective data were collected at baseline for 1 month while subjects used their current pessary. Data were then collected throughout a 3-month treatment phase with the study pessary. The primary outcome was change in Pelvic Floor<span> Distress Inventory-20 score. Secondary outcome measures included objective assessment of prolapse support, changes in the Pelvic Floor Impact Questionnaire-7, and pain with insertion and removal, measured using a visual analog scale. Data from subjects fitted with the study pessary were analyzed using an intention-to-treat approach, and those who dropped out were assigned scores at the upper limit of the predefined equivalence limits. Secondary per protocol analyses included subjects who completed treatment. The study was powered to 80% with a minimal important change equivalence limit of 18.3 points on the Pelvic Floor Distress Inventory-20 scale. Square root transformations were used for nonparametric data, and </span></span><em>P</em> values were adjusted for multiple comparisons.</p></div><div><h3>Results</h3><p>A total of 78 subjects were enrolled, however, 16 withdrew before study pessary placement. The study pessary was fitted in 62 subjects (50 ring and 12 Gellhorn pessary users), and 48 (62%) completed the 3-month intervention. The change in Pelvic Floor Distress Inventory-20 scores at 3 months demonstrated equivalence when compared with the subjects’ baseline scores (mean difference, −3.96 [improvement]; 90% confidence interval, −11.99 to 4.08; <em>P</em>=.002). Among those completing study, the Pelvic Floor Distress Inventory-20 scores, equivalence was not demonstrated and scores favored the study pessary (mean difference, −10.45; 90% confidence interval, −20.35 to 0.54; <em>P</em>=.095). Secondary outcomes included objective measures of support, which were similar (mean difference: Ba, 0.54 cm; Bp, 0.04 cm, favoring study pessary; improvement in mean Pelvic Floor Impact Questionnaire-7 scores for those who completed the trial: before, 32.23; after, 16.86; <em>P</em>=.019), and pain with insertion and removal, which was lower with the study pessary than with the subject’s own pessary (m","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":8.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140955193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.ajog.2023.12.020
Background
Medication use during pregnancy has increased in the United States despite the lack of safety data for many medications.
Objective
This study aimed to inform research priorities by examining trends in medication use during pregnancy and identifying gaps in safety information on the most commonly prescribed medications.
Study Design
We identified population-based cohorts of commercially (MarketScan 2011–2020) and publicly (Medicaid Analytic eXtract/Transformed Medicaid Statistical Information System Analytic Files 2011–2018) insured pregnancies ending in live birth from 2 health care utilization databases. Medication use was based on filled prescriptions between the date of last menstrual period through delivery, as well as the period before the last menstrual period and during specific trimesters. We also included a cross-sectional representative sample of pregnancies ascertained by the National Health and Nutrition Examination Survey (2011–2020), with information on prescription medication use during the preceding month obtained through maternal interviews. Teratogen Information System was used to classify the available evidence on teratogenic risk.
Results
Among over 3 million pregnancies, the medications most commonly dispensed at any time during pregnancy were analgesics, antibiotics, and antiemetics. The top medications were ondansetron (16.8%), amoxicillin (13.5%), and azithromycin (12.4%) in MarketScan, nitrofurantoin (22.2%), acetaminophen (21.3%; mostly as part of acetaminophen–hydrocodone products), and ondansetron (19.5%) in Medicaid Analytic eXtract/Transformed Medicaid Statistical Information System Analytic Files, and levothyroxine (5.0%), sertraline (2.9%), and insulin (2.9%) in the National Health and Nutrition Examination Survey group. The most commonly dispensed suspected teratogens during the first trimester were antithyroid medications. The use of antidiabetic and psychotropic medications has continued to increase in the United States during the last decade, opioid dispensation has decreased by half, and antibiotics and antiemetics continue to be common. For one-quarter of medications, there is insufficient evidence available to characterize their safety profile in pregnancy.
Conclusion
There is a need for more drug research in pregnant patients. Future research should focus on anti-infectives with high utilization and limited level of evidence on safety for use during pregnancy. Although lack of evidence is not evidence of safety concerns, it does not indicate risk either. In many instances, the benefits outweigh the risks when these medications are used clinically, and some of the medications with no proven safety may be necessary to treat patients.
{"title":"Prescription medication use during pregnancy in the United States from 2011 to 2020: trends and safety evidence","authors":"","doi":"10.1016/j.ajog.2023.12.020","DOIUrl":"10.1016/j.ajog.2023.12.020","url":null,"abstract":"<div><h3>Background</h3><p>Medication use during pregnancy has increased in the United States despite the lack of safety data for many medications.</p></div><div><h3>Objective</h3><p>This study aimed to inform research priorities by examining trends in medication use during pregnancy and identifying gaps in safety information on the most commonly prescribed medications.</p></div><div><h3>Study Design</h3><p>We identified population-based cohorts of commercially (MarketScan 2011–2020) and publicly (Medicaid Analytic eXtract/Transformed Medicaid Statistical Information System Analytic Files 2011–2018) insured pregnancies ending in live birth from 2 health care utilization databases. Medication use was based on filled prescriptions between the date of last menstrual period through delivery, as well as the period before the last menstrual period and during specific trimesters. We also included a cross-sectional representative sample of pregnancies ascertained by the National Health and Nutrition Examination Survey (2011–2020), with information on prescription medication<span> use during the preceding month obtained through maternal interviews. Teratogen Information System was used to classify the available evidence on teratogenic risk.</span></p></div><div><h3>Results</h3><p><span>Among over 3 million pregnancies, the medications most commonly dispensed at any time during pregnancy were analgesics, antibiotics, and antiemetics<span><span><span><span>. The top medications were ondansetron (16.8%), </span>amoxicillin<span><span> (13.5%), and azithromycin<span> (12.4%) in MarketScan, nitrofurantoin (22.2%), </span></span>acetaminophen (21.3%; mostly as part of acetaminophen–hydrocodone products), and ondansetron (19.5%) in Medicaid Analytic eXtract/Transformed Medicaid Statistical Information System Analytic Files, and </span></span>levothyroxine (5.0%), </span>sertraline (2.9%), and insulin (2.9%) in the National Health and Nutrition Examination Survey group. The most commonly dispensed suspected teratogens during the first trimester were </span></span>antithyroid<span><span> medications. The use of antidiabetic and </span>psychotropic medications has continued to increase in the United States during the last decade, opioid dispensation has decreased by half, and antibiotics and antiemetics continue to be common. For one-quarter of medications, there is insufficient evidence available to characterize their safety profile in pregnancy.</span></p></div><div><h3>Conclusion</h3><p>There is a need for more drug research in pregnant patients. Future research should focus on anti-infectives with high utilization and limited level of evidence on safety for use during pregnancy. Although lack of evidence is not evidence of safety concerns, it does not indicate risk either. In many instances, the benefits outweigh the risks when these medications are used clinically, and some of the medications with no proven safety may be necessary to treat patients.</p></div>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":8.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138740194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.ajog.2024.01.014
Objective
This study aimed to investigate whether uterine artery embolization offers a better quality of life than myomectomy in premenopausal women diagnosed with leiomyomas of the uterus.
Data Sources
A literature search was performed using the electronic databases of PubMed and Cochrane Central Register of Controlled Trials from inception to January 2023.
Study Eligibility Criteria
Randomized controlled trials comparing uterine artery embolization with myomectomy in women of premenopausal age suffering from uterine leiomyomas were considered.
Methods
The primary outcome was quality of life. The secondary outcomes were reintervention rate and timing, successful pregnancy, stillbirth and miscarriage, cesarean delivery on delivery, and perioperative morbidity. Moreover, time-to-event and standard pairwise meta-analyses were performed, as appropriate. The certainty of the evidence was assessed in line with the Grading of Recommendations, Assessment, Development, and Evaluations methodology.
Results
A total of 6 randomized controlled trials met our inclusion criteria. The meta-analysis suggested little to no difference in terms of quality of life between uterine artery embolization and myomectomy (standard mean difference, 0.05; 95% confidence interval, −0.38 to 0.48; I2=92%; very low certainty of evidence). Sensitivity analysis, including randomized controlled trials, which included solely myomectomy procedures in the control arm, demonstrated better quality of life for women treated with myomectomy (standard mean difference, −0.32; 95% confidence interval, −0.49 to −0.15; I2=15%). Concerning reintervention, myomectomy was likely associated with a decreased risk of future reintervention (risk ratio, 0.32; 95% confidence interval, 0.15–0.69; I2=60%; low certainty of evidence) and a more prolonged time interval since a potential reintervention because of recurrence than uterine artery embolization (hazard ratio, 0.41; 95% confidence interval, 0.22–0.77; I2=77%; low certainty of evidence). No difference was found between the 2 interventions concerning severe perioperative adverse events (relative risk, 4.13; 95% confidence interval, 0.44–39.20; I2=0%; low certainty of evidence).
Conclusion
Uterine artery embolization is likely associated with increased reintervention rates and less time to reintervention compared with myomectomy in premenopausal women diagnosed with uterine leiomyomas. Evidence suggests no difference between the 2 interventions regarding perioperative morbidity. Uterine artery embolization may exert no effect on quality of life and successful pregnancy; however, the evidence is very uncertain.
目的研究与子宫肌瘤切除术相比，子宫动脉栓塞术（UAE）是否能为绝经前子宫肌瘤妇女提供更好的生活质量（QoL）.数据来源我们检索了电子数据库 PubMed 和 Cochrane Central Register of Controlled trials（截至 2023 年 1 月）。研究资格标准我们考虑了随机对照试验（RCT），这些试验比较了UAE与子宫肌瘤切除术对绝经前妇女的治疗效果。次要结果为再次干预率和时间、成功妊娠、死胎和流产、分娩时剖腹产以及围手术期发病率。我们酌情进行了时间到事件分析和标准配对荟萃分析。根据 GRADE 方法对证据的确定性进行了评估。荟萃分析表明，UAE与子宫肌瘤剔除术在QoL方面几乎没有差异（SMD = 0.05，95% CI [-0.38 - 0.48]，I2 = 92%，证据确定性极低）。敏感性分析（包括对照组中仅包括子宫肌瘤剔除术的研究）显示，接受子宫肌瘤剔除术治疗的妇女的 QoL 更好（SMD = -0.32，95% CI [-0.49 -0.15]，I2 = 15%）。在再次干预方面，与超短波治疗相比，子宫肌瘤剔除术可能与未来再次干预的风险降低（RR = 0.32，95% CI [0.15-0.69]，I2 = 60%，证据确定性低）以及因复发而可能再次干预的时间间隔延长（HR = 0.41，95% CI [0.22-0.77]，I2 = 77%，证据确定性低）有关。结论 对于确诊患有子宫卵巢肌瘤的绝经前妇女，与子宫肌瘤剔除术相比，UAE可能会增加再介入率，缩短再介入时间。有证据表明，两种干预方法在围手术期发病率方面没有差异。超导可视无痛人流术可能对患者的生活质量和成功怀孕没有影响，但相关证据还很不确定。
{"title":"Uterine artery embolization vs myomectomy for the management of women with uterine leiomyomas: a systematic review and meta-analysis","authors":"","doi":"10.1016/j.ajog.2024.01.014","DOIUrl":"10.1016/j.ajog.2024.01.014","url":null,"abstract":"<div><h3>Objective</h3><p>This study aimed to investigate whether uterine artery embolization offers a better quality of life than myomectomy in premenopausal women diagnosed with leiomyomas of the uterus.</p></div><div><h3>Data Sources</h3><p>A literature search was performed using the electronic databases of PubMed and Cochrane Central Register of Controlled Trials from inception to January 2023.</p></div><div><h3>Study Eligibility Criteria</h3><p>Randomized controlled trials comparing uterine artery embolization with myomectomy in women of premenopausal age suffering from uterine leiomyomas were considered.</p></div><div><h3>Methods</h3><p>The primary outcome was quality of life. The secondary outcomes were reintervention rate and timing, successful pregnancy, stillbirth and miscarriage, cesarean delivery on delivery, and perioperative morbidity. Moreover, time-to-event and standard pairwise meta-analyses were performed, as appropriate. The certainty of the evidence was assessed in line with the Grading of Recommendations, Assessment, Development, and Evaluations methodology.</p></div><div><h3>Results</h3><p>A total of 6 randomized controlled trials met our inclusion criteria. The meta-analysis suggested little to no difference in terms of quality of life between uterine artery embolization and myomectomy (standard mean difference, 0.05; 95% confidence interval, −0.38 to 0.48; <em>I</em><sup><em>2</em></sup>=92%; very low certainty of evidence). Sensitivity analysis, including randomized controlled trials, which included solely myomectomy procedures in the control arm, demonstrated better quality of life for women treated with myomectomy (standard mean difference, −0.32; 95% confidence interval, −0.49 to −0.15; <em>I</em><sup><em>2</em></sup>=15%). Concerning reintervention, myomectomy was likely associated with a decreased risk of future reintervention (risk ratio, 0.32; 95% confidence interval, 0.15–0.69; <em>I</em><sup><em>2</em></sup>=60%; low certainty of evidence) and a more prolonged time interval since a potential reintervention because of recurrence than uterine artery embolization (hazard ratio, 0.41; 95% confidence interval, 0.22–0.77; <em>I</em><sup><em>2</em></sup>=77%; low certainty of evidence). No difference was found between the 2 interventions concerning severe perioperative adverse events (relative risk, 4.13; 95% confidence interval, 0.44–39.20; <em>I</em><sup><em>2</em></sup>=0%; low certainty of evidence).</p></div><div><h3>Conclusion</h3><p>Uterine artery embolization is likely associated with increased reintervention rates and less time to reintervention compared with myomectomy in premenopausal women diagnosed with uterine leiomyomas. Evidence suggests no difference between the 2 interventions regarding perioperative morbidity. Uterine artery embolization may exert no effect on quality of life and successful pregnancy; however, the evidence is very uncertain.</p></div>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":8.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139565911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.ajog.2024.03.006
{"title":"Pregnancies complicated by bulimia nervosa are at increased risk of chorioamnionitis, anemia, and preterm birth","authors":"","doi":"10.1016/j.ajog.2024.03.006","DOIUrl":"10.1016/j.ajog.2024.03.006","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":8.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140068053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.ajog.2024.04.038
{"title":"Prediction of venous thromboembolism in average-risk, young candidates for oral contraceptive use: to genotype, or not to genotype, that is the question","authors":"","doi":"10.1016/j.ajog.2024.04.038","DOIUrl":"10.1016/j.ajog.2024.04.038","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":8.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140849782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.ajog.2024.05.003
{"title":"Why improved surveillance is critical for reducing maternal deaths in the United States: a response to the American College of Obstetricians and Gynecologists","authors":"","doi":"10.1016/j.ajog.2024.05.003","DOIUrl":"10.1016/j.ajog.2024.05.003","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":8.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140903834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.ajog.2023.11.1242
Background
Previous findings related to the association of adverse pregnancy outcomes with anorexia nervosa are mixed.
Objective
This study aimed to investigate the association of adverse live-born pregnancy outcomes with anorexia nervosa using adjustment modeling accounting for confounding factors, and a mediation analysis addressing the contribution of underweight prepregnancy body mass index and gestational weight gain to those outcomes.
Study Design
The sample included California live-born singletons with births between 2007 and 2021. The administrative data set contained birth certificates linked to hospital discharge records. Anorexia nervosa diagnosis during pregnancy was obtained from International Classification of Diseases codes on hospital discharge records. Adverse pregnancy outcomes examined included gestational diabetes, gestational hypertension, preeclampsia, anemia, antepartum hemorrhage, premature rupture of membranes, premature labor, cesarean delivery, oligohydramnios, placenta previa, chorioamnionitis, placental abruption, severe maternal morbidity, small for gestational age, large for gestational age, low birthweight, and preterm birth (by timing and indication). Risk of each adverse outcome was calculated using Poisson regression models. Unadjusted risk of each adverse outcome was calculated, and then the risks were adjusted for demographic factors. The final adjusted model included demographic factors, anxiety, depression, substance use, and smoking. A mediation analysis was performed to estimate the excess risk of adverse outcomes mediated by underweight prepregnancy body mass index and gestational weight gain below the American College of Obstetricians and Gynecologists recommendation.
Results
The sample included 241 pregnant people with a diagnosis of anorexia nervosa and 6,418,236 pregnant people without an eating disorder diagnosis. An anorexia nervosa diagnosis during pregnancy was associated with many adverse pregnancy outcomes in unadjusted models (relative risks ranged from 1.65 [preeclampsia] to 3.56 [antepartum hemorrhage]) in comparison with people without an eating disorder diagnosis. In the final adjusted models, birthing people with an anorexia nervosa diagnosis were more likely to have anemia, preterm labor, oligohydramnios, severe maternal morbidity, a small for gestational age or low-birthweight infant, and preterm birth between 32 and 36 weeks with spontaneous preterm labor (adjusted relative risks ranged from 1.43 to 2.55). Underweight prepregnancy body mass index mediated 7.78% of the excess in preterm births and 18.00% of the excess in small for gestational age infants. G
{"title":"Adverse live-born pregnancy outcomes among pregnant people with anorexia nervosa","authors":"","doi":"10.1016/j.ajog.2023.11.1242","DOIUrl":"10.1016/j.ajog.2023.11.1242","url":null,"abstract":"<div><h3>Background</h3><p>Previous findings related to the association of adverse pregnancy outcomes with anorexia nervosa are mixed.</p></div><div><h3>Objective</h3><p>This study aimed to investigate the association of adverse live-born pregnancy outcomes with anorexia nervosa using adjustment modeling accounting for confounding factors, and a mediation analysis addressing the contribution of underweight prepregnancy body mass index<span> and gestational weight gain to those outcomes.</span></p></div><div><h3>Study Design</h3><p><span><span><span>The sample included California live-born singletons with births between 2007 and 2021. The administrative data set contained birth certificates linked to hospital discharge records. Anorexia nervosa diagnosis during pregnancy was obtained from International Classification of Diseases<span><span> codes on hospital discharge records. Adverse pregnancy outcomes examined included gestational diabetes<span>, gestational hypertension, </span></span>preeclampsia<span>, anemia, </span></span></span>antepartum hemorrhage<span><span>, premature rupture of membranes, </span>premature labor<span><span>, cesarean delivery, </span>oligohydramnios, </span></span></span>placenta previa<span><span>, chorioamnionitis<span><span>, placental abruption, severe maternal morbidity, </span>small for gestational age, </span></span>large for gestational age, low birthweight, and preterm birth (by timing and indication). Risk of each </span></span>adverse outcome<span> was calculated using Poisson regression models. Unadjusted risk of each adverse outcome was calculated, and then the risks were adjusted for demographic factors. The final adjusted model included demographic factors, anxiety, depression, substance use, and smoking. A mediation analysis was performed to estimate the excess risk of adverse outcomes mediated by underweight prepregnancy body mass index and gestational weight gain below the American College of Obstetricians and Gynecologists recommendation.</span></p></div><div><h3>Results</h3><p>The sample included 241 pregnant people with a diagnosis of anorexia nervosa and 6,418,236 pregnant people without an eating disorder diagnosis. An anorexia nervosa diagnosis during pregnancy was associated with many adverse pregnancy outcomes in unadjusted models (relative risks ranged from 1.65 [preeclampsia] to 3.56 [antepartum hemorrhage]) in comparison with people without an eating disorder diagnosis. In the final adjusted models, birthing<span><span> people with an anorexia nervosa diagnosis were more likely to have anemia, preterm labor, oligohydramnios, severe </span>maternal morbidity<span>, a small for gestational age or low-birthweight infant, and preterm birth between 32 and 36 weeks with spontaneous preterm labor (adjusted relative risks ranged from 1.43 to 2.55). Underweight prepregnancy body mass index mediated 7.78% of the excess in preterm births and 18.00% of the excess in small for gestational age infants. G","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":8.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138432600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.ajog.2023.11.1251
Background
Whether myomectomy increases the risk of placenta accreta spectrum in the following pregnancies remains controversial.
Objective
This study aimed to investigate the effect of myomectomy on the risk of placenta accreta spectrum in the following pregnancies. Moreover, different methods of myomectomy on the risk of placenta accreta spectrum were explored.
Study Design
A nationwide cohort study was conducted using data from the Taiwan National Health Insurance Research Database, including all pregnant patients in Taiwan who gave birth between January 2008 and December 2017. A 1:1 propensity score estimation matching was performed for the analysis of myomectomy on the risk of placenta accreta spectrum. Among pregnant patients who received myomectomy, different methods of myomectomy on the risk of placenta accreta spectrum were compared with the control group.
Results
Among the 1,371,458 pregnant patients in this study, 11,255 pregnant patients had a history of myomectomy. The risk of placenta accreta spectrum was higher in pregnant patients with a history of myomectomy than in pregnant patients without a history of myomectomy (incidence: 0.96% vs 0.20%; adjusted odds ratio, 2.28; 95% confidence interval, 1.85–2.81; P<.01). Among pregnant patients with a history of myomectomy, 5045 (46.87%) received laparotomic myomectomy, 3973 (36.93%) received laparoscopic myomectomy, and 1742 (16.20%) received hysteroscopic myomectomy. The incidence of placenta accreta spectrum was higher in the hysteroscopic group than in the laparotomic group or the laparoscopic group (1.89% [hysteroscopic group] vs 0.71% [laparotomic group] and 0.81% [laparoscopic group]; P<.05). Compared with patients without a history of myomectomy, the adjusted odds ratio for placenta accreta spectrum was 3.88 (95% confidence interval, 2.68–5.63; P<.05) in the hysteroscopic group.
Conclusion
Myomectomy, especially hysteroscopic myomectomy, is associated with an increased risk of placenta accreta spectrum in the subsequent pregnancy.
背景:子宫肌瘤切除术是否会增加后续妊娠发生胎盘增生谱(PAS)的风险仍存在争议。目的:本研究旨在探讨子宫肌瘤切除术对妊娠后患胎盘增生谱风险的影响。探讨不同子宫肌瘤切除方法对胎盘增生谱的影响。研究设计:使用台湾国民健康保险研究数据库的数据进行全国性队列研究，包括2008年1月至2017年12月在台湾分娩的所有孕妇。子宫肌瘤切除术对增生性胎盘风险谱的分析采用1:1倾向评分估计匹配。在接受子宫肌瘤切除术的妊娠患者中，与对照组比较不同子宫肌瘤切除术方式对胎盘增生风险谱的影响。结果:本研究1371458例妊娠患者中，有子宫肌瘤切除术史的妊娠患者11255例。有子宫肌瘤切除术史的妊娠患者发生PAS的风险高于无子宫肌瘤切除术史的妊娠患者(发生率0.96% vs. 0.20%，校正优势比2.28,95% CI 1.85 ~ 2.81, p)结论:子宫肌瘤切除术，特别是宫腔镜子宫肌瘤切除术与后续妊娠发生PAS的风险增加相关。
{"title":"Risk of placenta accreta spectrum following myomectomy: a nationwide cohort study","authors":"","doi":"10.1016/j.ajog.2023.11.1251","DOIUrl":"10.1016/j.ajog.2023.11.1251","url":null,"abstract":"<div><h3>Background</h3><p>Whether myomectomy increases the risk of placenta accreta spectrum in the following pregnancies remains controversial.</p></div><div><h3>Objective</h3><p>This study aimed to investigate the effect of myomectomy on the risk of placenta accreta spectrum in the following pregnancies. Moreover, different methods of myomectomy on the risk of placenta accreta spectrum were explored.</p></div><div><h3>Study Design</h3><p>A nationwide cohort study was conducted using data from the Taiwan National Health Insurance Research Database, including all pregnant patients in Taiwan who gave birth between January 2008 and December 2017. A 1:1 propensity score estimation matching was performed for the analysis of myomectomy on the risk of placenta accreta spectrum. Among pregnant patients who received myomectomy, different methods of myomectomy on the risk of placenta accreta spectrum were compared with the control group.</p></div><div><h3>Results</h3><p>Among the 1,371,458 pregnant patients in this study, 11,255 pregnant patients had a history of myomectomy. The risk of placenta accreta spectrum was higher in pregnant patients with a history of myomectomy than in pregnant patients without a history of myomectomy (incidence: 0.96% vs 0.20%; adjusted odds ratio, 2.28; 95% confidence interval, 1.85–2.81; <em>P</em><.01). Among pregnant patients with a history of myomectomy, 5045 (46.87%) received laparotomic myomectomy, 3973 (36.93%) received laparoscopic myomectomy, and 1742 (16.20%) received hysteroscopic myomectomy. The incidence of placenta accreta spectrum was higher in the hysteroscopic group than in the laparotomic group or the laparoscopic group (1.89% [hysteroscopic group] vs 0.71% [laparotomic group] and 0.81% [laparoscopic group]; <em>P</em><.05). Compared with patients without a history of myomectomy, the adjusted odds ratio for placenta accreta spectrum was 3.88 (95% confidence interval, 2.68–5.63; <em>P</em><.05) in the hysteroscopic group.</p></div><div><h3>Conclusion</h3><p>Myomectomy, especially hysteroscopic myomectomy, is associated with an increased risk of placenta accreta spectrum in the subsequent pregnancy.</p></div>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":8.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0002937823020653/pdfft?md5=d0dbc28349dfeafa74fdb61aaf655e8d&pid=1-s2.0-S0002937823020653-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138457242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.ajog.2023.11.1252
Background
Maternal depression is a serious condition that affects up to 1 in 7 pregnancies. Despite evidence linking maternal depression to pregnancy complications and adverse fetal outcomes, there remain large gaps in its identification and treatment. More work is needed to define the specific timing and severity of depression that most urgently requires intervention, where feasible, to protect maternal health and the developing fetus.
Objective
This study aimed to examine whether the timing and severity of maternal depression and/or anxiety during pregnancy affect child executive functioning at age 4.5 years. Executive functioning in the preschool years is a strong predictor of both school readiness and long-term quality of life.
Study Design
This longitudinal observational pregnancy cohort study included a sample of 323 mother-child dyads taking part in the Ontario Birth Study, an open pregnancy cohort in Toronto, Ontario, Canada. Maternal symptoms of depression and anxiety were assessed at 12 to 16 and 28 to 32 weeks of gestation and at the time of child testing at age 4.5 years using the 4-item Patient Health Questionnaire. Child executive functioning was measured during a home visit using standardized computerized administration of the Flanker test (a measure of attention) and the Dimensional Change Card Sort (a measure of cognitive flexibility). Stepwise linear regressions, controlling for possible confounding variables, were used to assess the predictive value of continuous measures of maternal depression and/or anxiety symptoms at each assessment time on the Flanker test and Dimensional Change Card Sort. Posthoc general linear models were used to assess whether maternal depression severity categories (no symptom, mild symptoms, or probable major depressive disorder) were helpful in identifying children at risk.
Results
Across all children, after controlling for potential confounds, greater maternal depressive symptoms at weeks 12 to 16 weeks of gestation predicted worse performance on both the Flanker test (ΔR2=0.058; P<.001) and the Dimensional Change Card Sort (ΔR2=0.017; P=.018). Posthoc general linear modeling further demonstrated that the children of mothers meeting the screening criteria for major depression in early pregnancy scored 11.3% lower on the Flanker test and 9.8% lower on the Dimensional Change Card Sort than the children of mothers without maternal depressive symptoms in early pregnancy. Mild depressive symptoms had no significant effect on executive function scores. There was no significant effect of anxiety symptoms or maternal antidepressant use in early pregnancy or pandemic conditions or maternal symptoms in later pregnancy or at the time of child testing on either the Flanker or Dimensional Change Card Sort results.
Conclusion
This study demonstrated that f
母亲抑郁症是一种严重的疾病，每7次怀孕中就有1次受到影响。尽管有证据表明母亲抑郁症与妊娠并发症和不良胎儿结局有关，但在其识别和治疗方面仍存在重大差距。需要做更多的工作来确定抑郁症的具体时间和严重程度，在可行的情况下，最迫切需要干预，以保护孕产妇健康和发育中的胎儿。目的探讨妊娠期母亲抑郁和/或焦虑的时间和严重程度是否会影响4.5岁儿童的执行功能。学龄前的执行功能是对入学准备和长期生活质量的有力预测。研究设计:这项纵向观察妊娠队列研究包括323对参加安大略省出生研究的母子，这是加拿大安大略省多伦多的一项开放式妊娠队列研究。在怀孕12-16周和28-32周以及4.5岁儿童测试时，使用4项患者健康问卷评估母亲的抑郁和焦虑症状。在家访期间，使用标准化计算机管理的Flanker测试(一种注意力测量)和维度变化卡片分类(一种认知灵活性测量)来测量儿童的执行功能。在控制可能的混杂变量的情况下，采用逐步线性回归来评估在每个评估时间对孕妇抑郁和/或焦虑症状的连续测量的预测价值。事后一般线性模型评估了母亲抑郁严重程度类别(无症状、轻度症状、可能的重度抑郁障碍)是否有助于识别高危儿童。结果在所有儿童中，在控制了潜在的混杂因素后，怀孕12-16周时母亲抑郁症状加重预示着Flanker测试的表现更差(ΔR2=0.058, p <.001)和维度变化卡排序(ΔR2 = 0.017, p = 0.018)。事后一般线性模型进一步证明，母亲在怀孕早期达到严重抑郁症筛查标准的孩子在Flanker测试中的得分低11.3%，在维度变化卡片分类中得分低9.8%，而在怀孕早期没有母亲抑郁症状的孩子。轻度抑郁症状对执行功能评分无显著影响。妊娠早期的焦虑症状或母亲使用抗抑郁药没有显著影响，妊娠后期的大流行状况或母亲的症状也没有显著影响，在儿童测试时，无论是侧卫测试还是维度变化卡片分类结果。这是第一个研究表明，在怀孕的12-16周，胎儿暴露于母亲的重度抑郁症，而不是轻度抑郁症，与学龄前的执行功能受损有关。儿童的执行功能对于入学准备和预测长期生活质量至关重要。这强调了迫切需要提高对孕产妇重度抑郁症的认识和治疗，特别是在妊娠早期，以限制其对患者和儿童认知发展的负面影响。
{"title":"Maternal major depression during early pregnancy is associated with impaired child executive functioning at 4.5 years of age","authors":"","doi":"10.1016/j.ajog.2023.11.1252","DOIUrl":"10.1016/j.ajog.2023.11.1252","url":null,"abstract":"<div><h3>Background</h3><p>Maternal depression is a serious condition that affects up to 1 in 7 pregnancies. Despite evidence linking maternal depression to pregnancy complications and adverse fetal outcomes, there remain large gaps in its identification and treatment. More work is needed to define the specific timing and severity of depression that most urgently requires intervention, where feasible, to protect maternal health and the developing fetus.</p></div><div><h3>Objective</h3><p>This study aimed to examine whether the timing and severity of maternal depression and/or anxiety during pregnancy affect child executive functioning at age 4.5 years. Executive functioning in the preschool years is a strong predictor of both school readiness and long-term quality of life.</p></div><div><h3>Study Design</h3><p>This longitudinal observational pregnancy cohort study included a sample of 323 mother-child dyads taking part in the Ontario Birth Study, an open pregnancy cohort in Toronto, Ontario, Canada. Maternal symptoms of depression and anxiety were assessed at 12 to 16 and 28 to 32 weeks of gestation and at the time of child testing at age 4.5 years using the 4-item Patient Health Questionnaire. Child executive functioning was measured during a home visit using standardized computerized administration of the Flanker test (a measure of attention) and the Dimensional Change Card Sort (a measure of cognitive flexibility). Stepwise linear regressions, controlling for possible confounding variables, were used to assess the predictive value of continuous measures of maternal depression and/or anxiety symptoms at each assessment time on the Flanker test and Dimensional Change Card Sort. Posthoc general linear models were used to assess whether maternal depression severity categories (no symptom, mild symptoms, or probable major depressive disorder) were helpful in identifying children at risk.</p></div><div><h3>Results</h3><p>Across all children, after controlling for potential confounds, greater maternal depressive symptoms at weeks 12 to 16 weeks of gestation predicted worse performance on both the Flanker test (ΔR<sup>2</sup>=0.058; <em>P</em><.001) and the Dimensional Change Card Sort (ΔR<sup>2</sup>=0.017; <em>P</em>=.018). Posthoc general linear modeling further demonstrated that the children of mothers meeting the screening criteria for major depression in early pregnancy scored 11.3% lower on the Flanker test and 9.8% lower on the Dimensional Change Card Sort than the children of mothers without maternal depressive symptoms in early pregnancy. Mild depressive symptoms had no significant effect on executive function scores. There was no significant effect of anxiety symptoms or maternal antidepressant use in early pregnancy or pandemic conditions or maternal symptoms in later pregnancy or at the time of child testing on either the Flanker or Dimensional Change Card Sort results.</p></div><div><h3>Conclusion</h3><p>This study demonstrated that f","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":8.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0002937823021154/pdfft?md5=4bcdda9a4b16399e3356ab3306c8f6e2&pid=1-s2.0-S0002937823021154-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138469276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号