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Introduction to Drugs and Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Epidemiologic studies have several limitations. Spurious associations often occur because many epidemiologists lack medical or biological training, and fail to scrutinize their “statistical associations” for biological plausibility. Other confounders include sample size. Some investigations involve small numbers of exposed or affected subjects because exposures are sometimes rare. Rarity of the maternal disease or situation that led to the exposure may be responsible for an observed association with a congenital anomaly, rather than the agent itself. Of paramount importance is that the observed association be biologically plausible.
Concurrent Congenital Diaphragmatic Hernia and Extralobar Pulmonary Sequestration
Published in Wickii T. Vigneswaran, Thoracic Surgery, 2019
Kate Gallo, Gillian Alex, Christopher W. Seder
When a congenital anomaly is identified, there should be a high level of suspicion that additional anomalies may be present. Congenital anomalies can, and often do, present in adulthood, and physicians working with adults should maintain a working knowledge of prenatal and pediatric pathologies.
Endocrine disorders
Published in Anne Lee, Sally Inch, David Finnigan, Therapeutics in Pregnancy and Lactation, 2019
Fetal and neonatal death occurs in about 2–4% of Type I DM pregnancies in specialist centres1 compared with about 1.2% in the general population.4 Poor fetal outcome may be slightly more likely in non-specialist settings – one study showed a 4.5% rate of fetal and neonatal death in the absence of specialist regional guidelines.4 Stillbirth incidence is greatest at 36 weeks gestation. The risk of this is particularly high if there is a history of poor glycaemic control, maternal vascular disease, ketoacidosis, pre-eclampsia or fetal macrosomia. Major congenital anomalies occur in 5–10% of Type I DM pregnancies (between two and four times higher than in normal pregnancies). Risk factors for major congenital anomaly include poor diabetic control, both preconception and during pregnancy, duration of Type I DM greater than 10 years and diabetic vasculopathy. Anomalies include cardiac malformations (4% of diabetic vs 0.08% of normal pregnancies), most commonly ventricular septal defects, transposition of the great vessels and coarctation of the aorta; neural tube defect (2% vs 0.2%); caudal regression syndrome in 0.5%, which includes sacral agenesis and phocomelic diabetic embryopathy; and renal and gastrointestinal defects.1 In the Casson study the overall malformation rate of total births was 9.7% in the Type I DM patients compared with 1.0% in the general population; of these, 40% were cardiovascular. Neonatal jaundice has been reported in 53% of pregnancies complicated by Type I DM and 38% of pregnancies with gestational diabetes.5
The effect of hydroxychloroquine on pregnancy outcomes in patients with unexplained recurrent pregnancy loss: a placebo-controlled study “pilot study”
Published in Journal of Obstetrics and Gynaecology, 2022
Ashraf Moini, Mahdi Sepidarkish, Ahmad Reza Dehpour, Maryam Rabiei, Ameneh Abiri, Reihaneh Pirjani
Demographic and baseline characteristics of the participants are summarised in Table 1. There was no statistically significant difference between HCQ and placebo groups in terms of age, BMI, gravidity, number of previous abortion, relative married couple, infertility and past medical history. During the study period, miscarriage occurred in five women including one in the HCQ group (7.69%) and four in the placebo group (28.57%) (OR: 2.36, 95% PL CI: 1.07, 8.93). After adjusting for potential confounders, no significant difference was observed in term of miscarriage between the two groups (aOR: 2.96, 95%CI: 0.91, 10.02). Interestingly, there were no missed abortions in the HCQ group, and the only abortion in this group was a blighted ovum, but all four abortions in the placebo group were missed abortions between six to nine gestational weeks. Participants who did not have an abortion (22 women) were followed up until the end of pregnancy and their outcomes such as adverse pregnancy complications, neonatal weight and NICU admission were assessed and the results showed no significant difference between the two groups forthe mentioned outcomes (Table 2). Adverse pregnancy complications included three cases of PTL, one case of preeclampsia, one case of IUGR, and nine cases of GDM. No congenital anomaly was detected in newborns.
The safety of metronidazole in pregnancy
Published in Health Care for Women International, 2021
Ozioma C. Nwosu, Kathaleen Bloom
On February 2, 2018, a search of PubMed and ProQuest was conducted using “peer review” and “English” as limiters. Keyword, Boolean and MeSH searching included the following terms: Newborn OR Infant OR Neonate OR Fetus (Line 1) AND, Maternal OR Mother OR pregna* (line 2) AND, Metronidazole OR Flagyl (line 3) AND, Congenital abnormality OR Congenital Anomaly OR Congenital disorder OR Fetal anomaly OR fetal defect (line 4). Only 3 articles were ultimately selected for inclusion in the review. One of the articles was a systematic review (Sheehy et al., 2015). A replication of their search strategies failed to uncover any studies that were not previously analyzed. Two articles by Muanda and colleagues were found by a third party. One of these articles (Muanda et al., 2017) addressed the link between antibiotic use during pregnancy and the risk of spontaneous abortion. The other addressed the link between antibiotic use in pregnancy and the risk of major congenital malformations. However, metronidazole was not one of the antibiotics considered so this study was excluded. Figure 1 depicts the flow of the search.
Neonatal outcomes and congenital anomalies in pregnancies affected by hypothyroidism
Published in Annals of Medicine, 2021
Zareen Kiran, Aisha Sheikh, Khadija Nuzhat Humayun, Najmul Islam
Most studies reported major congenital anomalies as a perinatal outcome of hypothyroid mothers but did not describe the details of the anomalies [18]. Among the significant congenital anomalies, our cohort had more cardiovascular defects (CVD) with highest prevalence of Patent Ductus Arteriosus (PDA) (1.2%) followed by Ventricular Septal Defect (VSD) (1.1%). Literature is limited regarding neonates of hypothyroid mothers without congenital hypothyroidism developing cardiovascular defects. A study from India reported higher CVD than other anomalies amongst congenital hypothyroid neonates [42], which is similar to a Mexican study with a larger sample size and with PDA as the second most common CVD [43]. Urogenital tract was the second clinically important organ system involved in our neonates. A study from Iran has reported significant association of presence of urogenital anomalies with congenital hypothyroidism (OR 2.04; 95%CI: 1.1–3.6; p ≤0.05) [38]. We also observed that births to women diagnosed during pregnancy are 2.3 times more likely to have a congenital anomaly or condition. We have no local data to compare this effect, however, this subject is also rarely explored in literature. One of our neonates also had Zellweger syndrome and the other had Edward syndrome, which have never been reported before. Although there are number of miscellaneous cutaneous (most common Mongolian spots) and musculoskeletal conditions present in our cohort of neonates, we need to identify their significance only after conducting a case–control study.