scholarly journals THE PERINATALAND MATERNAL OUTCOME IN PREGNANCY WITH ADVANCED MATERNALAGE 35 YEARS AND >35 YEARS IN WESTERN RAJASTHAN

2020 ◽  
pp. 66-68
Author(s):  
Sangeeta Sangeeta ◽  
Kalpana Mehta ◽  
Vimla Choudhary ◽  
Vinod Vinod ◽  
Anusha Anusha
Keyword(s):  
Developing Countries ◽  
Maternal Age ◽  
Economic Status ◽  
Male Child ◽  
Chronic Hypertension ◽  
Advanced Technique ◽  
Risk Pregnancy ◽  
Increased Risk ◽  
Nicu Admission ◽  
In Pregnancy

BACKGROUND Pregnancy is affected by maternal age from conception till delivery. Various studies have been conducted globally to study this effect; few in developing countries. It is associated with decreased fertility and increased risk. Simultaneously higher advanced technique and better supported maternal and neonatal care also exist. Maternal age is increasing in developing countries as well, so we have conducted this study. METHOD: It is observational prospective analytic study, conducted in umaid hospital , Dr S N medical college ,jodhpur. Total 322 patients were included in study, fulfilling inclusion criteria over period of 6 months. RESULT : A total no. of 322 elderly pregnant patients were selected for the study. Most of the cases were in the age group 35 to 39 years (89.93%). Multi gravida (71.8%) and grand multi para (22.22%) constituted the largest group. Most of the cases belong to lower socio-economic status (90%). Percentage of unbooked cases was 82.98%. The causes of delay in pregnancy were preference for male child (25.1%) and unawareness of contraception (22.36%). The incidence of diabetes mellitus and chronic hypertension were increased. Overall caesarean rate was increased (35.4%). Incidence of abortions 21(6.5%), preterm delivery 18(5.6%), oligohydramnios 20(6.21%), APH 9(2.8%) and PROM 16(4.96%), low birth weight baby 33(10.25%), NICU admission 18 (5.6%), IUGR 14(4.34%) all were high. The preference for male child 81(25.1%) and lack of awareness 72(22.36%) were two major reason for continuing pregnancies and deliveries till late age. CONCLUSION The present study showed that pregnancy at advanced age is a higher risk pregnancy in term of increased maternal and perinatal morbidity and mortality.

scholarly journals Effects of advanced maternal age on pregnancy outcome

2018 ◽  
Vol 7 (10) ◽  
pp. 3941 ◽  
Author(s):  
Neelam Rajput ◽  
Deepak Paldiya ◽  
Yogendra S. Verma
Keyword(s):  
Maternal Age ◽  
Economic Status ◽  
Advanced Maternal Age ◽  
Male Child ◽  
Chronic Hypertension ◽  
Medical College ◽  
Risk Pregnancy ◽  
Nicu Admission ◽  
One Year ◽  
A Prospective Study

Background: Advanced maternal age, generally signify age after 35 years at the time of delivery. It is associated with decreased fertility and increased risk.Methods: This was a prospective study conducted in Kamla Raja Hospital, G.R. Medical College, Gwalior (M.P.) during the period of one year from July 2015 to June 2016.  Pregnant women aged 35 years and older at the time of delivery were selected and analyzed for maternal and perinatal outcome.Results: A total no. of 288 elderly pregnant patients were selected for the study. Most of the cases were in the age group 35 to 39 years (89.93%). Multi gravida (71.8%) and grand multi para (22.22%) constituted the largest group. Most of the cases belong to lower socio-economic status (90%). Percentage of unbooked cases was 82.98%. The causes of delay in pregnancy were preference for male child (23.95%) and unwareness of contraception (21.52%). The incidence of diabetes mellitus and chronic hypertension were increased. Overall cesarean rate was increased (35%). Incidence of abortions 28(9.72%), preterm delivery 18(6.25%), oligohydramnios 18(6.25%), APH 18(6.25%) and PROM 17(5.90%), low birth weight baby 30(13.19%), NICU admission 20 (6.94%), IUGR 11(3.81%) all were high. The preference for male child 69(23.95%) and lack of awareness 62(21.52%) were two major reason for continuing pregnancies and deliveries till late age.Conclusions: The present study showed that pregnancy at advanced age is a higher risk pregnancy in term of increased maternal and perinatal morbidity and mortality.

Migraine is a Risk Factor for Hypertensive Disorders in Pregnancy: A Prospective Cohort Study

Cephalalgia ◽  
2009 ◽  
Vol 29 (3) ◽  
pp. 286-292 ◽  
Author(s):  
F Facchinetti ◽  
G Allais ◽  
RE Nappi ◽  
R D'Amico ◽  
L Marozio ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Primary Headaches ◽  
Chronic Hypertension ◽  
Hypertensive Disorders ◽  
Increased Risk ◽  
Hypertensive Disorders In Pregnancy ◽  
History Of ◽  
In Pregnancy

The aim was to assess whether women suffering from migraine are at higher risk of developing hypertensive disorders in pregnancy. In a prospective cohort study, performed at antenatal clinics in three maternity units in Northern Italy, 702 normotensive women with singleton pregnancy at 11–16 weeks' gestation were enrolled. Women with a history of hypertensive disorders in pregnancy or presenting chronic hypertension were excluded. The presence of migraine was investigated according to International Headache Society criteria. The main outcome measure was the onset of hypertension in pregnancy, defined as the occurrence of either gestational hypertension or preeclampsia. Two hundred and seventy women (38.5%) were diagnosed with migraine. The majority (68.1%) suffered from migraine without aura. The risk of developing hypertensive disorders in pregnancy was higher in migraineurs (9.1%) compared with non-migraineurs (3.1%) [odds ratio (OR) adjusted for age, family history of hypertension and smoking 2.85, 95% confidence interval (CI) 1.40, 5.81]. Women with migraine also showed a trend to increased risk for low birth weight infants with respect to women without migraine (OR 1.97, 95% CI 0.98, 3.98). Women with migraine are to be considered at increased risk of developing hypertensive disorders in pregnancy. The diagnosis of primary headaches should be taken into account at antenatal examination.

scholarly journals Risk Perception in Pregnancy

2015 ◽  
Vol 20 (2) ◽  
pp. 120-127 ◽  
Author(s):  
Monique Robinson ◽  
Craig E. Pennell ◽  
Neil J. McLean ◽  
Jessica E. Tearne ◽  
Wendy H. Oddy ◽  
...  
Keyword(s):  
Risk Perception ◽  
Prenatal Testing ◽  
Obstetric Care ◽  
Fertility Treatment ◽  
Care Providers ◽  
Perception Of Risk ◽  
Emotional Context ◽  
Risk Pregnancy ◽  
Increased Risk ◽  
In Pregnancy

Despite huge advances in obstetric management and technology in recent decades, there has not been an accompanying decrease in patients’ perception of risk during pregnancy. The aim of this paper is to examine the context of risk perception in pregnancy and what practitioners can do to manage it. The modern pregnancy may induce a heightened perception of risk due to increased prenatal testing and surveillance, medico-legal complexity, fertility treatment, and the increasing use of the internet and social media as a source of information. The consequences of an inflated perception of risk during pregnancy include stress, anxiety, and depression, and these issues may have long-lasting implications for patients, their babies, and their families. There are numerous resilience and vulnerability factors that can help care providers identify those who may be predisposed to increased risk perception in pregnancy, and there is a role for both obstetric care providers and psychologists engaged in obstetric settings to manage and reduce risk perception in patients where possible. Ultimately, the medical management of risk during pregnancy can be complex but a thorough understanding of the social and emotional context can assist providers to support their patients through both high- and low-risk pregnancy and birth.

scholarly journals Hypertensive Disorders in Pregnancy

2018 ◽  
Vol 03 (02/03) ◽  
pp. 068-078
Author(s):  
Lalita Nemani
Keyword(s):  
Blood Pressure ◽  
Gestational Hypertension ◽  
Stress Test ◽  
Later Life ◽  
Chronic Hypertension ◽  
Prevention Measures ◽  
Hypertensive Disorders ◽  
Increased Risk ◽  
Hypertensive Disorders In Pregnancy ◽  
In Pregnancy

Abstract Hypertension in pregnancy is defined as systolic blood pressure (SBP) ≥ 140 mm Hg or diastolic blood pressure (DBP) ≥ 90 mm Hg or both on two different occasions at least 6 hours apart. Severe hypertension is SBP ≥ 160 mm Hg or DBP ≥ 110 mm Hg. Hypertension is the most common medical problem in pregnancy and one of the major causes of maternal and perinatal mortality and morbidity. Hypertensive disorders in pregnancy (HDP) are classified as (1) chronic hypertension, (2) chronic hypertension with superimposed preeclampsia, (3) preeclampsia-eclampsia, and (4) gestational hypertension. HDP contributes to increased risk of hypertension, stroke, and maternal cardiovascular disease (CVD) in later life. HDP can be considered as a failed cardiovascular stress test identifying women susceptible to CVD in later life. Further research is required to identify the mechanisms in HDP that contribute to CVD in later life so as to initiate appropriate prevention measures.

scholarly journals Hipertensi pada Kehamilan

2019 ◽  
Vol 2 (2) ◽  
pp. 27
Author(s):  
Haidar Alatas
Keyword(s):  
Gestational Hypertension ◽  
Organ Damage ◽  
Antihypertensive Drug Therapy ◽  
Chronic Hypertension ◽  
First Line ◽  
Hypertension In Pregnancy ◽  
Increased Risk ◽  
Hypertensive Disorders In Pregnancy ◽  
In Pregnancy

Hipertensi pada kehamilan sering terjadi (6-10 %) dan meningkatkan risiko morbiditas dan mortalitas pada ibu, janin dan perinatal. Pre-eklampsia/eklampsia dan hipertensi berat pada kehamilan risikonya lebih besar. Hipertensi pada kehamilan dapat digolongkan menjadi pre-eklampsia/ eklampsia, hipertensi kronis pada kehamilan, hipertensi kronis disertai pre-eklampsia, dan hipertensi gestational. Pengobatan hipertensi pada kehamilan dengan menggunakan obat antihipertensi ternyata tidak mengurangi atau meningkatkan risiko kematian ibu, proteinuria, efek samping, operasi caesar, kematian neonatal, kelahiran prematur, atau bayi lahir kecil. Penelitian mengenai obat antihipertensi pada kehamilan masih sedikit. Obat yang direkomendasikan adalah labetalol, nifedipine dan methyldopa sebagai first line terapi. Penatalaksanaan hipertensi pada kehamilan memerlukan pendekatan multidisiplin dari dokter obsetri, internis, nefrologis dan anestesi. Hipertensi pada kehamilan memiliki tingkat kekambuhan yang tinggi pada kehamilan berikutnya. Hypertension complicates 6% to 10% of pregnancies and increases the risk of maternal, fetal and perinatal morbidity and mortality. Preeclampsia / eclampsia and severe hypertension in pregnancy are at greater risk. Four major hypertensive disorders in pregnancy have been described by the American College of Obstetricians and Gynecologists (ACOG): chronic hypertension; preeclampsia-eclampsia; chronic hypertension with superimposed preeclampsia; and gestational hypertension. The current review suggests that antihypertensive drug therapy does not reduce or increase the risk of maternal death, proteinuria, side effects, cesarean section, neonatal and birth death, preterm birth, or small for gestational age infants. The quality of evidence was low. Recommendations for treatment of hypertension in pregnancy are labetalol, nifedipine and methyldopa as first line drugs therapy. Although the obstetrician manages most cases of hypertension during pregnancy, the internist, cardiologist, or nephrologist may be consulted if hypertension precedes conception, if end organ damage is present, or when accelerated hypertension occurs. Women who have had preeclampsia are also at increased risk for hypertension in future pregnancies.

scholarly journals Pregnancy vs. Paycheck: A qualitative study of patient’s experience with employment during pregnancy at high risk for preterm birth

2020 ◽  
Author(s):  
Sarahn M. Wheeler ◽  
Kelley E. C. Massengale ◽  
Konyin Adewumi ◽  
Thelma A. Fitzgerald ◽  
Carrie B. Dombeck ◽  
...  
Keyword(s):  
Preterm Birth ◽  
High Risk ◽  
Prenatal Care ◽  
Pregnant Women ◽  
Structured Interview ◽  
Close Monitoring ◽  
Risk Pregnancy ◽  
Increased Risk ◽  
History Of ◽  
In Pregnancy

Abstract Background: Pregnant women with a history of preterm birth are at risk for recurrence, often requiring frequent prenatal visits for close monitoring and/or preventive therapies. Employment demands can limit uptake and adherence to recommended monitoring and preterm birth prevention therapies. Method: We conducted a qualitative descriptive study using in-depth interviews (IDIs) of pregnant women with a history of preterm birth. IDIs were conducted by trained qualitative interviewers following a semi-structured interview guide focused on uncovering barriers and facilitators to initiation of prenatal care, including relevant employment experiences, and soliciting potential interventions to improve prompt prenatal care initiation. The IDIs were analyzed via applied thematic analysis. Results: We described the interview findings that address women’s employment experiences. The current analysis includes 27 women who are majority self-described as non-Hispanic Black (74%) and publically insured (70%). Participants were employed in a range of professions; food services, childcare and retail were the most common occupations. Participants described multiple ways that being pregnant impacted their earning potential, ranging from voluntary work-hour reduction, involuntary duty hour reductions by employers, truncated promotions, and termination of employment. Participants also shared varying experiences with workplace accommodations to their work environment and job duties based on their pregnancy. Some of these accommodations were initiated by a collaborative employee/employer discussion, others were initiated by the employer’s perception of safe working conditions in pregnancy, and some accommodations were based on medical recommendations. Participants described supportive and unsupportive employer reactions to requests for accommodations. Conclusions: Our findings provide novel insights into women’s experiences balancing a pregnancy at increased risk for preterm birth with employment obligations. While many women reported positive experiences, the most striking insights came from women who described negative situations that ranged from challenging to potentially unlawful. Many of the findings suggest profound misunderstandings likely exist at the patient, employer and clinical provider level about the laws surrounding employment in pregnancy, safe employment responsibilities during pregnancy, and the range of creative accommodations that often allow for continued workplace productivity even during high risk pregnancy.

scholarly journals A 646C > G (rs41423247) polymorphism of the glucocorticoid receptor as a risk factor for hyperglycaemia diagnosed in pregnancy—data from an observational study

2021 ◽  
Author(s):  
Agnieszka Zawiejska ◽  
Anna Bogacz ◽  
Rafał Iciek ◽  
Agnieszka Lewicka-Rabska ◽  
Maciej Brązert ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cohort Study ◽  
Glucocorticoid Receptor ◽  
Maternal Age ◽  
Prepregnancy Bmi ◽  
Increased Risk ◽  
Maternal And Neonatal Outcomes ◽  
Allelic Variations ◽  
The Relationship ◽  
In Pregnancy

Abstract Aim Hyperglycaemia diagnosed in pregnancy (HiP) is a serious and frequent complication of pregnancy, increasing the risk for adverse maternal and neonatal outcomes. Investigate whether allelic variations of the glucocorticoid receptor are related to an increased risk of HiP. Method The following polymorphisms of the glucocorticoid receptor (GR) were investigated in the cohort study of N = 197 pregnant women with HiP and N = 133 normoglycemic pregnant controls: 646C > G (rs41423247), N363S (rs6195), ER23/22EK (rs6190, rs6189). Results A GG variant of the rs41423247 polymorphism was associated with a significantly higher risk for HiP: OR 1.94 (1.18; 3.18), p = 0.009. The relationship remained significant after controlling for maternal age and prepregnancy BMI: OR 3.09 (1.25; 7.64), p = 0.014. Conclusions The allelic GG variant of the 646C > G (rs41423247) polymorphism is associated with an increased risk for hyperglycaemia in pregnancy.

scholarly journals Chronic hypertension in pregnancy: impact of ethnicity and superimposed preeclampsia on placental, endothelial, and renal biomarkers

2018 ◽  
Vol 315 (1) ◽  
pp. R36-R47 ◽  
Author(s):  
Louise M. Webster ◽  
Carolyn Gill ◽  
Paul T. Seed ◽  
Kate Bramham ◽  
Cornelia Wiesender ◽  
...  
Keyword(s):  
Black Women ◽  
Adverse Pregnancy Outcome ◽  
Plasma Concentrations ◽  
Chronic Hypertension ◽  
Creatinine Ratio ◽  
Hypertension In Pregnancy ◽  
Increased Risk ◽  
Pregnancy And Postpartum ◽  
Adverse Pregnancy ◽  
In Pregnancy

Black ethnicity is associated with worse pregnancy outcomes in women with chronic hypertension. Preexisting endothelial and renal dysfunction and poor placentation may contribute, but pathophysiological mechanisms underpinning increased risk are poorly understood. This cohort study aimed to investigate the relationship between ethnicity, superimposed preeclampsia, and longitudinal changes in markers of endothelial, renal, and placental dysfunction in women with chronic hypertension. Plasma concentrations of placental growth factor (PlGF), syndecan-1, renin, and aldosterone and urinary angiotensinogen-to-creatinine ratio (AGTCR), protein-to-creatinine ratio (PCR), and albumin-to-creatinine ratio (ACR) were quantified during pregnancy and postpartum in women with chronic hypertension. Comparisons of longitudinal biomarker concentrations were made using log-transformation and random effects logistic regression allowing for gestation. Of 117 women, superimposed preeclampsia was diagnosed in 21% ( n = 25), with 24% ( n = 6) having an additional diagnosis of diabetes. The cohort included 63 (54%) women who self-identified as being of black ethnicity. PlGF concentrations were 67% lower [95% confidence interval (CI) −79 to −48%] and AGTCR, PCR, and ACR were higher over gestation, in women with subsequent superimposed preeclampsia (compared with those without superimposed preeclampsia). PlGF <100 pg/ml at 20–23.9 wk of gestation predicted subsequent birth weight <3rd percentile with 88% sensitivity (95% CI 47–100%) and 83% specificity (95% CI 70–92%). Black women had 43% lower renin (95% CI −58 to −23%) and 41% lower aldosterone (95%CI −45 to −15%) concentrations over gestation. Changes in placental (PlGF) and renal (AGTCR/PCR/ACR) biomarkers predated adverse pregnancy outcome. Ethnic variation in the renin-angiotensin-aldosterone system exists in women with chronic hypertension in pregnancy and may be important in treatment selection.

418 The Berlin Questionnaire in Pregnancy Predominantly Identifies Obesity

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A165-A166
Author(s):  
Louise O’Brien ◽  
Rivkah Levine ◽  
Galit Levi Dunietz
Keyword(s):  
Pregnant Women ◽  
Medical Center ◽  
Perinatal Outcomes ◽  
Poor Performance ◽  
Berlin Questionnaire ◽  
Chronic Hypertension ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Positive Score ◽  
In Pregnancy

Abstract Introduction Obstructive sleep apnea (OSA) is common in pregnant women and is a risk factor for poor perinatal outcomes. The Berlin Questionnaire (BQ) is a validated OSA screening tool that is often used in pregnancy. However, it performs poorly in this population, likely attributed to the scoring paradigm that primarily identifies obesity. Moreover, the associations between the BQ and pregnancy outcomes are often those same outcomes that are obesity-related. Therefore, this study examined associations between each of the three BQ domains, independently and jointly, in relation to gestational diabetes (GDM) and hypertensive disorders of pregnancy (HDP). Methods Pregnant third-trimester women aged at least 18 years with a single fetus were recruited from a tertiary medical center. All women completed the BQ, which includes three domains: snoring; sleepiness; and obesity/high blood pressure (BMI/BP). The latter domain was further examined as two separate sub-domains: obesity or chronic hypertension. A positive response in 2-of-3 domains identifies high OSA risk. Medical records were accessed for diagnoses of GDM and HDP. Results Of 1,588 women, 44% had a positive BQ. Women with positive domains of snoring exclusively, sleepiness exclusively, or their combination did not have an increased risk of GDM or HDP. However, women without snoring or sleepiness, but with a positive score on the BMI/BP domain had increased odds of GDM (OR 2.0, 95%CI 1.3–3.3) and HDP (OR 2.9, 95%CI 1.6–5.5). Any positive score in domain combinations that included BMI/BP had increased odds of GDM and HDP compared with negative scores in all domains. A positive score in BMI/BP-alone, BMI/BP-and-sleepiness, BMI/BP-and-snoring, and an intersection of all three domains, had increased HDP odds compared with controls: OR 2.9 (95%CI 1.6–5.5), OR 2.2 (95%CI 1.1–4.4), OR 2.9 (95%CI 1.5–5.7), and OR 4.6 (95%CI 2.6–8.6), respectively. Women absent of positive BMI/BP domain but with a positive score in the other two domains (or their combination) had similar odds of GDM and HDP as controls. Conclusion The poor performance of the BQ in screening for OSA risk in pregnant women may be attributed to its predominant reliance on identification of obesity. Support (if any) NIH NHLBIHL089918

scholarly journals Pregnancy vs. paycheck: a qualitative study of patient’s experience with employment during pregnancy at high risk for preterm birth

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sarahn M. Wheeler ◽  
Kelley E. C. Massengale ◽  
Konyin Adewumi ◽  
Thelma A. Fitzgerald ◽  
Carrie B. Dombeck ◽  
...  
Keyword(s):  
Preterm Birth ◽  
High Risk ◽  
Prenatal Care ◽  
Pregnant Women ◽  
Structured Interview ◽  
Close Monitoring ◽  
Risk Pregnancy ◽  
Increased Risk ◽  
History Of ◽  
In Pregnancy

Abstract Background Pregnant women with a history of preterm birth are at risk for recurrence, often requiring frequent prenatal visits for close monitoring and/or preventive therapies. Employment demands can limit uptake and adherence to recommended monitoring and preterm birth prevention therapies. Method We conducted a qualitative descriptive study using in-depth interviews (IDIs) of pregnant women with a history of preterm birth. IDIs were conducted by trained qualitative interviewers following a semi-structured interview guide focused on uncovering barriers and facilitators to initiation of prenatal care, including relevant employment experiences, and soliciting potential interventions to improve prompt prenatal care initiation. The IDIs were analyzed via applied thematic analysis. Results We described the interview findings that address women’s employment experiences. The current analysis includes 27 women who are majority self-described as non-Hispanic Black (74%) and publically insured (70%). Participants were employed in a range of professions; food services, childcare and retail were the most common occupations. Participants described multiple ways that being pregnant impacted their earning potential, ranging from voluntary work-hour reduction, involuntary duty hour reductions by employers, truncated promotions, and termination of employment. Participants also shared varying experiences with workplace accommodations to their work environment and job duties based on their pregnancy. Some of these accommodations were initiated by a collaborative employee/employer discussion, others were initiated by the employer’s perception of safe working conditions in pregnancy, and some accommodations were based on medical recommendations. Participants described supportive and unsupportive employer reactions to requests for accommodations. Conclusions Our findings provide novel insights into women’s experiences balancing a pregnancy at increased risk for preterm birth with employment obligations. While many women reported positive experiences, the most striking insights came from women who described negative situations that ranged from challenging to potentially unlawful. Many of the findings suggest profound misunderstandings likely exist at the patient, employer and clinical provider level about the laws surrounding employment in pregnancy, safe employment responsibilities during pregnancy, and the range of creative accommodations that often allow for continued workplace productivity even during high risk pregnancy.

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