Search

Introduction: Preeclampsia (PE) is a heterogeneous disorder and research to date has principally focused on maternal factors. In this study, however, we considered the associations between background factors and preeclampsia in men who fathered preeclamptic and non‐preeclamptic pregnancies. Material and methods: From 2008 to 2011, participants in the Finnish Genetics of Pre‐eclampsia Consortium (FINNPEC) cohort completed a questionnaire on their background information. Questionnaire data were available from 586 men who had fathered a preeclamptic pregnancy (PE fathers) and 660 control men who had fathered a non‐preeclamptic pregnancy. Two different control groups were established: Group 1: healthy controls (n = 457), which consisted of fathers whose current partners were healthy women with uncomplicated pregnancies; Group 2: other controls (n = 203), which also included fathers whose current partners had other pregnancy complications. Results: The PE fathers more often reported preeclampsia in a previously fathered pregnancy (p < 0.05 for all). The PE and control fathers were similar in age, body mass index, smoking, and preexisting medical conditions. There were no differences in the socioeconomic background or health history of the PE and control fathers or their parents. Conclusions: In the FINNPEC study cohort, the occurrence of preeclampsia in a previously fathered pregnancy was more common among the men who had fathered a preeclamptic pregnancy; other paternal phenotypic and lifestyle characteristics did not play a significant role in preeclampsia susceptibility of their partners. [ABSTRACT FROM AUTHOR]

Introduction: Hypertensive disorders of pregnancy are a leading cause of maternal and perinatal mortality and morbidity worldwide. We studied the prevalence of hypertensive disorders of pregnancy among women of migrant origin in Finland. Material and Methods: This study used data from the nationwide Medical Birth Register. Information on the most recent singleton birth of women who delivered between 2004 and 2014 (n = 382 233) was included. Women were classified into nine regional categories based on the country of origin. Women of Finnish origin were the reference group. Generalized linear models adjusted for maternal age, socioeconomic position, smoking in pregnancy, parity, pre‐pregnancy body mass index, preexisting diabetes and delivery year were used to study the association between region/country of origin and hypertensive disorders of pregnancy. Results: Among the study population, almost 8% were of migrant origin. The prevalence of hypertensive disorders of pregnancy varied from 1.3% (women of East Asian origin) to 4.2% (women of Sub‐Saharan African origin), compared with 4.6% in the Finnish origin reference group. Compared with women of Finnish origin, the risk for any hypertensive disorders of pregnancy after adjustment for confounders was lower for women of migrant origin, with an exception for women of Sub‐Saharan African origin. When analyzing gestational hypertension and preeclampsia outcomes separately, Sub‐Saharan African origin women had a lower risk for gestational hypertension (risk ratio [RR] 0.41, 95% confidence interval [CI] 0.30–0.56) but a higher risk for preeclampsia (RR 1.77, 95% CI 1.44–2.17) than women of Finnish origin. Conclusions: In general, women of migrant origin in Finland had a lower risk for any hypertensive disorders of pregnancy and gestational hypertension. The risk for preeclampsia was higher among women of Sub‐Saharan African origin and may warrant special attention. [ABSTRACT FROM AUTHOR]

Introduction: Peripartum cardiomyopathy (PPCM) is a rare but potentially fatal disease defined by heart failure towards the end of pregnancy or in the months following delivery. We aim to raise awareness of the condition and give the clinician an overview of current knowledge on the mechanisms of pathophysiology, diagnostics and clinical management.Material and Methods: Systematic literature searches were performed in PubMed and Embase up to June 2016. Cohorts of more than 20 women with PPCM conducted after 2000 were selected to report contemporary outcomes and prognostic data. Guidelines and reviews that provided comprehensive overviews were included, too.Results: New research on the pathophysiological mechanisms of PPCM points towards a two-hit multifactorial cause involving genetic factors and an antiangiogenic hormonal environment of late gestation with high levels of prolactin and sFlt-1. The prevalence of concomitant preeclampsia is high (often 30-45%) and symptoms can be similar, posing diagnostic difficulties. Most women (71-98%) present postpartum. Echocardiography is essential for diagnosis, and cardiac magnetic resonance imaging may provide new insights to pathophysiology and prognosis. Management is multidisciplinary and involves advanced heart failure therapy. Treatment, timing and mode of delivery in pregnant women depend on disease severity. The risk of relapse in subsequent pregnancies is >20%, and women are often advised against a new pregnancy.Conclusions: PPCM has a huge impact on cardiovascular health and reproductive life perspective. New insights into genetics, molecular pathophysiological mechanisms and clinical studies have resulted in potential disease-specific therapies, but many questions remain unanswered. [ABSTRACT FROM AUTHOR]

Introduction: Eclampsia is a rare but serious threat to maternal and fetal well-being. Magnesium sulfate was introduced in Finland as management of eclampsia in the late 1990s. The aim of this study was to assess the incidence of eclampsia in Finland after the increased use of magnesium sulfate.Material and Methods: Eclampsia diagnoses in Finland during 2006 to 2010 were retrieved from the national Medical Birth Register and the Care Register for Health Care. Medical records were reviewed.Results: In 2006-10, 295 447 deliveries were registered in Finland and 46 women with eclampsia were identified. Hence, the incidence of eclampsia was 1.5 per 10 000 deliveries. The median gestational age at the time of eclampsia was 38 gestational weeks. There were no maternal deaths due to eclampsia, but 46% of the women had severe complications. Eighty-seven per cent received magnesium sulfate for treatment and 7% for prevention of eclampsia. The perinatal mortality rate was 8%. Thirty-four per cent of the newborns were preterm and 15% were small-for-gestational-age.Conclusions: The incidence of eclampsia in Finland was very low. Increased use of magnesium sulfate probably contributed to the low incidence, as well as to the low number of recurrent seizures and prolonged complications. However, some women at risk of eclampsia still remain undetected and untreated. Seven percent had magnesium sulfate for prevention of eclampsia. Increased use of prophylactic magnesium sulfate might further reduce the incidence of eclampsia. [ABSTRACT FROM AUTHOR]

Introduction: To systematically develop a set of guideline-based quality indicators for postpartum hemorrhage (PPH) as a tool to measure guideline adherence in actual PPH care.Material and Methods: A Rand-modified Delphi procedure was used to systematically achieve consensus among a panel of 22 experts on PPH care on recommendations extracted from evidence-based guidelines, Managing-Obstetrics-Emergencies-Trauma (MOET) instructions and international literature. The selected recommendations were individually rated on health gain (prevention of maternal mortality and morbidity) and overall efficiency by the expert panel. Subsequently, consensus about the most important recommendations to measure quality of PPH care among the panel members was reached, followed by a final approval. Last, definition of the final set by critical appraisal of the recommendations regarding measurability took place. The main outcome measure was a set of valid quality indicators for prevention and management of PPH.Results: From the 69 extracted recommendations, 50 were selected and translated into 22 quality indicators on professional performance (n = 17) and organization of PPH care (n = 5). The professional performance indicators covered all fields of PPH care, such as prevention (n = 2) and management of PPH, including communication and documentation (n = 4), monitoring and prevention of shock (n = 3), use of blood products (n = 3) and treatment of PPH (n = 5). Organizational indicators (n = 5) were clustered into protocols and agreements, audit, accessibility and documentation.Conclusions: This study describes a stepwise systematic development of 22 performance and organizational indicators to use for measuring the whole care process of prevention and management of PPH. [ABSTRACT FROM AUTHOR]

Massive postpartum hemorrhage ( PPH) is a major life-threatening complication. When conventional management fails, pelvic arterial embolization ( PAE) can be used. The aim of our study was to find out the success rate of PAE in cases of acute PPH, and to study the safety of this procedure in a retrospective case series from a tertiary teaching hospital. Forty-five women with acute PPH were managed by PAE. Hospital charts were reviewed. The most common causes of PPH in cases treated with PAE were lower genital tract injury (40%), placental retention (36%) and uterine atony (13%). The overall success rate was 89%. Five of the 45 women needed additional procedures. The overall complication rate was 9%. We conclude that PAE is a safe and effective procedure for PPH and may prevent hysterectomy. [ABSTRACT FROM AUTHOR]

Objective. Preeclampsia has been linked to subsequent vascular disease with many shared predisposing factors. We investigated the association between severe preeclampsia, and its subtypes, and specific vascular-related polymorphisms. Design. The study was a retrospective nested case-cohort design. Setting. Pregnant Danish women participating in the Danish National Birth Cohort. Population. 263 cases of severe preeclampsia and 1851 random controls were selected from the Danish National Birth Cohort. Methods. We validated all cases of severe preeclampsia and genotyped for 108 single nucleotide polymorphisms (SNPs) that were selected based on previous publications on the association with vascular disease. Logistic models were used for statistical analyses. Main outcome measures. Maternal polymorphisms in genomic models. Results. We found 17 of 108 SNPs associated with severe preeclampsia ( p < 0.05). Women homozygous for the rs1799983 in NOS3 were 1.6-fold [95% confidence interval (CI) 1.0-2.4] more likely to develop severe preeclampsia. Women homozygous for the rs1010 SNP in VAMP8 were twofold (95%CI 1.1-3.5) more likely to deliver preterm when preeclampsia was present. Women homozygous for the rs10811661 SNP were 2.1-fold (95%CI 1.1-3.9) more likely to develop severe preeclampsia and 3.7-fold (95%CI 1.1-12.4) more likely to deliver a small-for-gestational age child when preeclampsia was present. All associations are available as Supporting Information. Conclusion. We found several vascular-associated SNPs linked to severe preeclampsia; however, most of these associations are probably by pure chance, which warrants replication and further translational research. To date, no specific SNP has yet proven valuable in a clinical setting in predicting preeclampsia. [ABSTRACT FROM AUTHOR]

Objective. To investigate short stature and smoking habits as risk factors for birth outcome in international adoptees in comparison with non-adopted mothers. Design. Prospective cohort study. Setting. Nationwide study in Sweden. Population. Two study groups were identified from mothers who were born 1968-1979 and gave birth during 1982-2001 - 3,610 mother-child dyads with a mother adopted from a non-European country and 336,992 mother-child dyads with a mother born in Sweden. Method. Register study. Outcome measures. Pre-eclampsia, instrumental delivery, preterm delivery, small for gestational age (SGA), Apgar score, cephalhematoma and perinatal mortality and birth weight. Results. Short stature and smoking were more common in international adoptees compared with non-adopted, odds ratios (ORs) 29.07 (95% C.I.: 25.29-33.42) and 1.39 (1.27-1.52), respectively. International adoptees had a slightly increased risk for instrumental delivery (OR: 1.42; 1.32-1.54) and preterm delivery (<37 weeks) (OR: 1.39; 1.24-1.56) and there was a slightly increased risk for SGA (OR: 1.24; 1.01-1.52) in their offspring. However, when we adjusted for maternal height, preterm delivery was the only outcome that remained statistically significant. Adjustment for smoking habits had marginal effects on all outcomes. Conclusion. The short stature of international adoptees increased their risk for delivery and birth complications in a predictable manner, but otherwise outcomes were very similar to the general population. No special obstetric monitoring is indicated by adoption status in itself. [ABSTRACT FROM AUTHOR]

Background: To analyze the association of pregnancy complications with prepregnant body mass index and weight gain during pregnancy in Japanese women.Methods: A retrospective cohort study was conducted with 21,718 Japanese women with a singleton pregnancy. Pregnant women were grouped by prepregnant body mass index and evaluated for association with pregnancy complications using multivariate logistic regression analysis. The women in each body mass index group were then divided into groups by weight gain during pregnancy using intervals of 0.05 kg/week to analyze the relationship between the weight gain and pregnancy complications by multivariate logistic regression association analysis.Results: In both nulliparous and parous women, the least pregnancy complications were found among women with medium prepregnant body mass indexes (18-23.9). Significant risks of pregnancy complications were associated with low (< 18) and high (> or = 24) prepregnant body mass indexes, particularly high prepregnant body mass indexes. In nulliparous women, the optimal weight gain was 0.25-0.4 kg/week for low (< 18) prepregnant body mass index, 0.20-0.30 kg/week for medium (18-23.9) prepregnant body mass index, and > or = 0.05 kg/week for high (> or = 24) prepregnant body mass index. In parous women, the corresponding values were > or = 0.20, 0.20-0.30, and 0.05-0.30 kg/week.Conclusions: Japanese women with prepregnant body mass indexes from 18 to 23.9 are least associated with pregnancy complications, although there is a broad range of prepregnant body mass indexes associated with few pregnancy complications. Optimal weight gain is roughly inversely related to prepregnant body mass index. [ABSTRACT FROM AUTHOR]

Background. Behçet's disease (BD) is a multisystem inflammatory chronic disorder, which is characterized by relapsing oral and genital ulceration and iridocyclitis. While being of unknown etiology, vasculitic changes of possible autoimmune origin are common to all involved organs, and thrombotic complications, which may adversely affect gestation, are frequently seen. Very little is known to date about the reciprocal influence of BD and pregnancy. We have undertaken to explore the mutual effect of BD and pregnancy with emphasis on maternal and fetal complications. Methods. In this case-control study, we have evaluated pregnancies that occurred in women suffering from BD, who were treated in our institution during the last 25 years. All records were reviewed, and data were confirmed by a telephone interview and compared with a matched control group. To review the current knowledge, a Medline search together with a manual search of selected articles was performed. Results. Thirty-one Behçet's patients who had 135 pregnancies were studied. Remissions were significantly more frequent during both pregnancy and postpartum periods, while exacerbations were observed only in one-sixth of the patients (P < 0.001). Pregnancy complications (P < 0.001), cesarean section (P < 0.001), and miscarriage (P < 0.02) rates, however, were significantly higher in the study group. Conclusions. Our study suggests that pregnancy does not have a deleterious effect on the course of BD and may possibly ameliorate its course. However, it seems that BD may adversely affect pregnancy. The miscarriage rate was higher, and the pregnancy complications and cesarean section rates were significantly elevated. [ABSTRACT FROM AUTHOR]