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Connective tissue disease
Published in Catherine Nelson-Piercy, Handbook of Obstetric Medicine, 2020
Ideally this should begin with pre-conception counselling. Knowledge of the anti-Ro/La, aPLs, anti-dsDNA, complement C3 and C4, baseline proteinuria, renal function and blood pressure status allows prediction of the risks to the woman and her fetus.
Preconception Care: Optimization of Cardiac Risk
Published in Afshan B. Hameed, Diana S. Wolfe, Cardio-Obstetrics, 2020
The number of reproductive age women who are born with or develop heart disease is steadily growing, and with each decade the numbers continue to increase. While the exact numbers are unknown, advances in both medical and surgical arenas have created a larger pool of women of childbearing age with heart disease. Consequently, questions regarding pregnancy become an important issue for all providers who care for patients with heart disease, including congenital heart disease (CHD), acquired cardiac disorders, and those following cardiac transplant. In order to ensure their safety, it is imperative these patients undergo preconception counseling regardless of their desire to become pregnant; that they understand the actual or potential risk to them and to their fetus and the importance of avoiding an unplanned pregnancy. For cardiac and obstetrical providers, a number of risk scoring scales have been developed to help guide management. The importance of using risk assessment models to advise patients on the risk of pregnancy is reviewed.
Transitional care in colorectal and pelvic reconstruction surgery
Published in Alejandra Vilanova-Sánchez, Marc A. Levitt, Pediatric Colorectal and Pelvic Reconstructive Surgery, 2020
Pelvic anatomy is also important for reproductive potential. Preconception counseling should be offered by a high-risk obstetrician. Pregnancy is possible in patients with anorectal malformations and cloacal malformations. Mode of delivery must be individually addressed with a risk versus benefit especially for increased risk of fecal and urinary incontinence with vaginal delivery [11].
The potential role of GLP-1 receptor agonist targeting in fertility-sparing treatment in obese patients with endometrial malignant pathology: a call for research
Published in Expert Review of Anticancer Therapy, 2023
Caroline J. Violette, Ravi Agarwal, Rachel S. Mandelbaum, José L. González, Kurt M. Hong, Lynda D. Roman, Maximilan Klar, Jason D. Wright, Richard J. Paulson, Andreas Obermair, Koji Matsuo
Semaglutide allows for once weekly subcutaneous injection dosing due to its long half-life of 7 days, which may also improve patient satisfaction and compliance for many patients compared to earlier generation of GLP-1 RAs requiring daily subcutaneous injection dosing [74,75]. Additionally, the semaglutide is metabolized via proteolytic cleavage and beta oxidation, which is not confined to a single organ [76]. Importantly, animal studies have demonstrated reproductive toxicity with all GLP-1 RAs, therefore while human data is lacking, their use during pregnancy and/or breastfeeding is contraindicated at this time [77]. Pre-conception counseling is necessary once the patient achieves a complete response and prepares for future pregnancy to find a medication alternative. Given animal studies demonstrate teratogenicity without adequate studies in human pregnancy, the recommendation would be to discontinue the use of GLP-1 RAs prior to attempting pregnancy [77].
Use of medications during pregnancy and breastfeeding for Crohn’s disease and ulcerative colitis
Published in Expert Opinion on Drug Safety, 2021
Robyn Laube, Sudarshan Paramsothy, Rupert W Leong
Inflammatory bowel disease (IBD) frequently affects men and women of childbearing age, many of whom take immunosuppressive medications [1]. While patients commonly have concerns about medication adverse effects, these are often heightened during pregnancy due to the additional concern of fetal toxicity [2]. Patient misconceptions and unsubstantiated fears of medication teratogenicity contribute toward medication non-adherence during pregnancy and breastfeeding [3–7]. Non-adherence predisposes to active IBD, which is associated with worse pregnancy outcomes including increased rates of preterm delivery, low birth weight (LBW), spontaneous abortion and Cesarean delivery [8–17]. Women and men of childbearing age should receive pre-conception counseling to provide accurate information about fertility, pregnancy and medication safety, aiming to optimize pregnancy outcomes. The balance of minimizing both medication toxicity and active disease should be explained to patients, as well as the general population risk of adverse outcomes such as spontaneous abortion (approximately 10–30%) and congenital abnormalities (3%) [18,19]. This review will summarize the literature on the use of IBD medications during pregnancy (Figure 1).
Pre-conception status, obstetric outcome and use of medications during pregnancy of systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and inflammatory bowel disease (IBD) in Japan: Multi-center retrospective descriptive study
Published in Modern Rheumatology, 2020
Sayaka Tsuda, Azusa Sameshima, Michikazu Sekine, Haruna Kawaguchi, Daisuke Fujita, Shintaro Makino, Akio Morinobu, Yohko Murakawa, Kiyoshi Matsui, Takao Sugiyama, Mamoru Watanabe, Yasuo Suzuki, Masakazu Nagahori, Atsuko Murashima, Tatsuya Atsumi, Kenji Oku, Nobuaki Mitsuda, Syuji Takei, Takako Miyamae, Naoto Takahashi, Ken Nakajima, Shigeru Saito
In conclusion, planned pregnancy rates were about 50% in SLE, RA, and IBD. Pre-conception counseling is recommended to increase planned pregnancy rates. Our findings showed an average of close to 10 years from disease onset to delivery. Additionally, ART pregnancy rates were high in RA, SLE, and UC. Intensive treatment aimed at rapid remission, and referring obstetrician to prescribe pregnancy compatible medications following remission may further reduce the time from disease onset to delivery. SLE-complicated pregnancies should be monitored closely because the risk for obstetric complications and disease flare-ups is highest during pregnancy. Insufficient weight gain during pregnancy was a risk for pregnancy complications in CD and UC and nutrition management is recommended in these cases. In RA pregnancies, risks for PTD and thromboembolisms increased. Gestational anti-TNF inhibitor exposure did not increase adverse obstetric events or birth defects. Anti-TNF inhibitor use during pregnancy might be acceptable if it is needed to control disease activity.