Maternal exercise during pregnancy may protect the child against asthma, reports research

The risk of asthma in the child can be reduced by nearly half if the mother engages in active physical exercise at least three times a week during pregnancy, compared to a child of a mother who is less active, a new study by the University of Eastern Finland (UEF), Kuopio University Hospital (KUH) and the Finnish Institute for Health and Welfare (THL) shows. The researchers utilised data from nearly 1,000 mother-child pairs in the Kuopio Birth Cohort study, KuBiCo, followed from pregnancy until the child was seven years old.

Maternal exercise during pregnancy is known to have positive effects on the health of both the mother and the child. In a previous study, maternal exercise during pregnancy was also associated with strengthened newborn lung function.

“This is the first time we are observing an association between maternal exercise and the development of asthma in the child,” says Doctoral Researcher Emma-Reetta Musakka, BM, MSc, of the University of Eastern Finland.

Association of exercise with reduced risk of asthma in the child was independent of other maternal health, lifestyle and environmental factors

Maternal exercise and the risk of asthma in the child are associated with many of the same health, lifestyle and environmental factors, such as maternal weight, stress, illness, family exercise habits, nutrition and, for example, owning a dog. The present study accounted for the potential impact of these and several other similar factors on the results, but they did not explain the protective association of maternal exercise with the risk of asthma in the child.

“Our findings strongly suggest that maternal exercise during pregnancy has an independent positive effect on the foetus and on the later health of the child,” Musakka says.

Maternal exercise is known to affect foetal activity and foetal breathing movements, which support lung development.

“We don’t yet know why maternal exercise manifests as a reduced risk of asthma in the child, but one possibility is that it supports foetal lung maturation,” Musakka notes.

Asthma is the most common chronic illness in children– some cases would be preventable

“Until today, avoidance of cigarette smoke during pregnancy has been among the only effective ways to reduce a child’s risk of asthma. Thus, it is intriguing that moderate maternal exercise during pregnancy may have an equally strong protective effect on a child’s asthma risk as if one of the parents quits smoking,” says Dr Pirkka Kirjavainen, the lead researcher of the study.

The findings did not indicate that an increase in the amount of exercise beyond three times a week would be associated with an even lower risk of asthma. However, further research on the role of the amount and intensity of exercise during pregnancy in the prevention of asthma is needed. The World Health Organization, WHO, recommends that pregnant women engage in about 2.5 hours of moderate exercise per week.

“The findings are very promising in terms of asthma prevention. It is highly encouraging to see that by engaging in reasonable amounts of exercise, mothers can significantly influence not only their own health, but also the health of their child,” Kirjavainen says.

Reference:

Musakka, Emma-Reetta et al., Maternal exercise during pregnancy is associated with reduced risk of asthma in the child: A prospective birth cohort study, Med, DOI:10.1016/j.medj.2024.09.003.

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Do people with multiple sclerosis have an increased risk of cancer?

A new study has found some cancers to be slightly more frequent in people with multiple sclerosis (MS) than in people without MS. The study is published in the October 9, 2024, online issue of Neurology®, the medical journal of the American Academy of Neurology. Types of cancers found to have a small increased risk include bladder, brain and cervical cancers. The study does not prove that MS increases a person’s risk of cancer. It only shows an association.

With MS, the body’s immune system attacks myelin, the fatty, white substance that insulates and protects the nerves. MS is chronic and can be unpredictable and disabling.

“People with MS undergo an increased number of tests to monitor MS, making it more likely to detect other diseases,” said study author Emmanuelle Leray, PhD, of Rennes University in France. “We found an association between some types of cancer and MS which may have different explanations depending on a person’s age and the types of cancer. Overall, our study found the increased risk of cancer was quite small.”

For the study, researchers reviewed 10 years of data in the French national health care database. Researchers identified 140,649 people with MS and matched them for factors such as age, sex and residence to 562,596 people without MS. All participants were cancer free three years before the study. They were followed for an average of eight years.

During the study, 8,368 people with MS and 31,796 people without MS developed cancer.

Researchers determined there were 799 cancers per 100,000 person-years for people with MS and 736 cancers per 100,000 person-years for people without MS. Person-years represent both the number of people in the study and the amount of time each person spends in the study.

Researchers found people with MS had a 6% increased risk of developing any type of cancer regardless of age, sex and residence. They also found cancer risk was higher in those under 55 and lower in people 65 and older when compared to people without MS.

Researchers then looked at cancer types. People with MS had a 71% increased risk for bladder cancer, a 68% increased risk for brain cancer and a 24% increased risk for cervical cancer. However, they also had a 20% lower risk of prostate cancer, a 10% lower risk of colorectal cancer and a 9% lower risk of breast cancer.

“While our study found a higher risk for brain cancer, it may be due in part to earlier detection in those with MS since they regularly have brain scans which may detect cancers earlier, before a person has symptoms,” said Leray. “Frequent urinary tract infections in people with MS and the use of immunosuppressant drugs may contribute to their higher risk of bladder and cervical cancers.”

Leray added, “The lower risk for colorectal and breast cancers may be due in part to fewer people with MS getting screened for cancer in older age when they may be experiencing more MS symptoms. More research is needed, including studies that look at more closely at how cancer screenings may play a role.”

A limitation of the study was that researchers were unable to adjust for factors such as education, income, smoking and alcohol consumption since this information was not available in the national database.

Reference:

Chloe Pierret, Aurelien Mulliez, Christine Le Bihan-Benjamin, Xavier Moisset, Philippe-Jean Bousquet, Emmanuelle Leray. Cancer Risk Among Patients With Multiple Sclerosis. Neurology, 2024; 103 (9) DOI: 10.1212/WNL.0000000000209885.

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No significant protective effect of Antibiotic prophylaxis on post-extraction complications: Study

Antibiotic prophylaxis has no significant protective effect on post-extraction complications suggests a study published in the Journal of Public Health Dentistry.

The study was aimed to evaluate the association between antibiotic prophylaxis and adverse outcomes following tooth extraction within the Veterans Affairs Healthcare System. They conducted a retrospective cohort study of patients undergoing dental extractions in 2015–2019. The primary exposure was antibiotic prophylaxis. The primary outcome was post-extraction complication within 7 days (e.g., alveolar osteitis and surgical site infection); the secondary outcome was subsequent medical care relating to a post-extraction oral complication within 7 days. Multivariable logistic regression models assessed the independent effect of antibiotic prophylaxis on each outcome. Results: Of 385,880 visits with a dental extraction, 122,810 (31.8%) received antibiotic prophylaxis. Overall, 3387 (0.9%) experienced a post-extraction complication and 350 (0.09%) received medical care relating to a post-extraction oral complication within 7 days. In multivariable regression, diabetes was a statistically significant (p = 0.01) effect modifier of the association between antibiotic prophylaxis and post-extraction complication. Among visits for patients without diabetes, antibiotic prophylaxis was significantly associated with an increased odds of post-extraction complication (odds ratio [OR] = 1.25, 95% confidence interval [CI]: 1.13–1.38), but among visits for patients with diabetes no significant effect was observed (OR = 1.03, 95% CI: 0.92–1.15). Antibiotic prophylaxis was not significantly associated with post-extraction medical care (OR = 1.04; 95% CI: 0.83–1.30). In this large retrospective cohort, we observed no significant protective effect of antibiotic prophylaxis on post-extraction complications or subsequent medical care utilization in a setting with low complication rates. These data suggest that use of antibiotic prophylaxis in similar settings may need to be re-evaluated to minimize unnecessary antibiotic use.

Reference:

McGregor JC, Wilson GM, Gibson G, Jurasic MM, Evans CT, Suda KJ. The effect of antibiotic premedication on postoperative complications following dental extractions. J Public Health Dent. 2024. https://doi.org/10.1111/jphd.12634

Keywords:

Antibiotic, prophylaxis, significant, protective, effect, post-extraction, complications, study, McGregor JC, Wilson GM, Gibson G, Jurasic MM, Evans CT, Suda KJ, Journal of Public Health Dentistry

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Plate and screws system viable osteosynthesis method for treatment of unstable and comminuted scaphoid fractures: study

For unstable scaphoid fractures failure rates are as high as 92% especially with an initial displacement exceeding one millimeter, which is why surgical treatment became the gold standard.

The primary method employed worldwide for the treatment of scaphoid fractures is screw fixation. However, in unstable and comminuted fractures, percutaneous fixation could produce complications due to technical challenges, such as improper axis positioning, inaccurate screw length measurement, intra-articular screw penetration, and impingement.

Alternative open approaches for the surgical management of scaphoid fractures have been proposed, and in recent years, a new specific volar locking plate for the treatment of scaphoid fractures has been developed.

L. Marzella et al conducted a study to verify the effectiveness of the volar plate in the treatment of comminuted scaphoid fractures and the necessity for plate removal when consolidation has occurred. It has been published in ‘European Journal of Orthopaedic Surgery & Traumatology.’

The authors present results and consideration about a case series of 44 comminuted scaphoid fractures treated with volar locking and angular stability plate. A retrospective study was conducted involving all patients, consisting of continuous clinical and radiographic assessments, functional evaluations (using QuickDASH and MHQ), and patient satisfaction surveys. The Kolmogorov–Smirnov test was used to determine the normal distribution of data. A paired t test was performed to evaluate the difference between the preoperative and postoperative values. A P-value of

Key findings of the study were:

• All fractures had traumatic causes, with the majority resulting from car accidents.

• All patients achieved clinical and radiographic recovery. However, the plate can impinge with nearby structures and should be removed once the fracture is consolidated.

• After plate removal, further improvement in range of motion was observed.

The authors concluded that – “The plate and screws system is a viable and appropriate method of osteosynthesis in the treatment of unstable and comminuted recent fractures occurring in the middle third of the carpal scaphoid.” 

Further reading:

Volar locking and angular stability plate for treatment of comminuted scaphoid fractures: a case series of 44 cases.L. Marzella et al European Journal of Orthopaedic Surgery & Traumatology

https://doi.org/10.1007/s00590-024-04095-2

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Antibiotic Prophylaxis may Not Significantly Benefit in Preventing Infections in Clean-Wound Surgeries: Study

Researchers found that antibiotic prophylaxis in clean-wound surgeries does not significantly reduce the incidence of surgical site infections (SSIs), with consideration to reevaluate its routine use. A recent retrospective study in Thailand was published in the journal of BMC Surgery. The study was conducted by Mai C. and colleagues. This study aimed to assess the benefit of antibiotic prophylaxis in prevention of SSIs following skin excision, thyroidectomy, inguinal herniorraphy, as well as other breast surgeries.

These were aseptic surgical procedures, which incorporated regional or general anesthesia to be performed for the evaluation of the SSI rates in clean wounds. In this procedure, antibiotic prophylaxis was given at the discretion of the attending surgeons since institution practices vary related to this aspect. Out of the initial list of 501 surgeries, a total number of 417 surgeries were included after excluding the 84 cases based on the reason of incompleteness. Standardized criteria defined SSI, and medical records and reports from the infection control unit were abstracted for data. The study analyzed risk factors for infection by applying propensity score weighting to balance covariates between the groups of patients who received antibiotics and those who did not.

  • A total of 417 surgeries were involved with 233 patients receiving prophylaxis antibiotics, and 184 not receiving prophylaxis.

  • The SSIs rate among the patients who received the prophylactic antibiotics was at 1.3% while that of patients not receiving the antibiotics was slightly at 2.2%.

  • The study used propensity scoring-based inverse probability treatment weighting and found that in terms of SSI, both the groups were not statistically significant when in comparison with each other (risk ratio [95% confidence interval]: 0.54 [0.11, 2.50]; p = 0.427).

  • The research showed that in the given environment, there was no significant reduction of the risk of SSIs using antibiotic prophylaxis in clean-wound surgeries.

This study concluded no statistically significant difference in the rates of SSIs for patients who were, and were not, given antibiotic prophylaxis during common clean-wound surgeries. These results may indicate that routine antibiotic prophylaxis has no role in such cases and existing recommendations should be reassessed to prevent patients from being driven into unnecessary antibiotic use without posing risks to their health condition. More research must be set up to fine-tune the prophylactic use of antibiotics so as to ensure it can be used only when it serves to have positive utility.

Reference:

Charernsuk, M., Tunruttanakul, S., Jamjumrat, L., & Chareonsil, B. (2024). Evaluation of preoperative antibiotic prophylaxis in clean-wound general surgery procedures: a propensity score-matched cohort study at a regional hospital. BMC Surgery, 24(1). https://doi.org/10.1186/s12893-024-02616-8

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Study Reveals Link Between Maternal Folate Levels and Increased Risk of Congenital Heart Disease in Offspring

China: A recent study published in JAMA Network Open has found that women with either low or high serum folate levels during mid-pregnancy had a higher likelihood of having infants with congenital heart disease (CHD). Maternal vitamin B12 and homocysteine levels also played a role in modulating this risk.

“The findings indicate that, alongside preventing folate deficiency, it is crucial to recognize the potentially harmful effects of excess folate on the risk of congenital heart disease in offspring,” the researchers wrote.

Maternal serum folate levels during pregnancy are crucial for fetal development. However, the association of folate supplementation with CHD prevention is controversial. In this context, Yanji Qu, Southern Medical University, Guangzhou, Guangdong, China, and colleagues investigate the relationship between maternal serum folate levels during early to mid-pregnancy and the risk of congenital heart disease in offspring.

For this purpose, the researchers conducted a case-control study at one of China’s largest cardiac referral centers between 2015 and 2018. They recruited participants by matching congenital heart disease (CHD) cases with non-CHD controls based on maternal age at a ratio of 1:4. Data analysis took place from May to August 2023.

Around 16 weeks of gestation, maternal serum levels of folate, vitamin B12, and homocysteine were measured. The primary outcome was CHD, confirmed through echocardiography. The study measured the relationship between maternal folate levels and the risk of CHD in offspring using adjusted odds ratios (aORs) in conditional logistic regression analyses. Additionally, the researchers assessed interactions between folate, vitamin B12, and homocysteine regarding CHD risk on a multiplicative scale.

Based on the study, the researchers reported the following findings:

  • The study included 129 cases of congenital heart disease (CHD), with ventricular septal defect being the most common type, and 516 matched controls. The average maternal age during pregnancy was 31.6 years.
  • There was a U-shaped relationship between maternal serum folate levels during early to mid-pregnancy and CHD risk in offspring.
  • Compared to children whose mothers had folate levels in the second and third quartiles, those in the lowest quartile had significantly higher odds of CHD (aOR, 3.09), as did those in the highest quartile (OR, 1.81).
  • The odds ratios increased when applying the World Health Organization criteria for normal serum folate levels.
  • Interaction analyses indicated that the negative effects of low and high maternal folate on CHD risk might be worsened by vitamin B12 deficiency or elevated homocysteine levels.

The study found that low maternal serum folate levels during early to mid-pregnancy are linked to a higher risk of congenital heart disease in offspring. Interestingly, it also suggested that very high folate levels could increase this risk. Furthermore, these associations may be influenced by vitamin B12 and homocysteine levels, although the exact mechanisms remain to be explored. These findings highlight the importance of a tailored folic acid supplementation strategy for pregnant women.

“Further research is necessary to establish causal links for the observed associations and to clarify the underlying mechanisms,” the researchers concluded.

Reference:

Qu Y, Liu X, Lin S, et al. Maternal Serum Folate During Pregnancy and Congenital Heart Disease in Offspring. JAMA Netw Open. 2024;7(10):e2438747. doi:10.1001/jamanetworkopen.2024.38747

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Study Emphasizes Urgent Need for Early Recognition and Intervention in Critically Ill Patients

UK: A recent study published in Anaesthesia & Intensive Care Medicine emphasizes the critical need for timely identification and management of patients experiencing severe health deterioration. Critical illness often entails multiple organ failures, leading to substantial morbidity and mortality. The research reveals that most patients exhibit recognizable signs of physiological decline before organ failure occurs, yet these warning signs are overlooked, delaying necessary interventions.

Despite ongoing efforts to enhance the detection and management of critical illness, the study indicates that many healthcare providers miss early signs of deterioration. This oversight can result in delays in transferring patients to critical care units, which can be detrimental to patient outcomes. To address these challenges, the study advocates for standardized approaches that implement an effective “chain of response.” Such systems are now being adopted worldwide to reduce the incidence of serious adverse events (SAEs), including in-hospital cardiac arrests and unplanned admissions to intensive care units (ICUs).

Key components of these systems include the accurate recording of vital signs, recognizing and interpreting abnormal values, and conducting rapid bedside assessments by trained teams. Early warning systems (EWS) are important in identifying patients at risk of deterioration, allowing for timely interventions to prevent adverse outcomes. The study underscores the importance of a structured assessment format, such as the ABCDE approach—airway, breathing, circulation, disability, and exposure. This method allows healthcare providers to prioritize life-threatening issues systematically and ensures consistent communication among professionals.

Moreover, the timely involvement of the critical care team is crucial for making informed decisions about the most appropriate care environment for acutely unwell patients. The study highlights that prompt support and input from critical care experts can significantly enhance outcomes for these vulnerable patients.

By focusing on early recognition and escalation of therapy, the study calls for a cultural shift within healthcare settings, encouraging the implementation of structured assessment protocols and early warning systems. This proactive approach aims to foster a more responsive healthcare environment, ultimately leading to improved survival rates and quality of care for critically ill patients.

Overall, this study stresses the importance of vigilance in recognizing the signs of critical illness and the need for timely intervention to optimize patient outcomes.

Reference:

Brown, A., Ballal, A., & Al-Haddad, M. (2018). Recognition of the critically ill patient and escalation of therapy. Anaesthesia & Intensive Care Medicine, 20(1), 1-5. https://doi.org/10.1016/j.mpaic.2018.11.011

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mCC/eGFR Ratio: A New Indicator of Muscle Mass and Mortality Risk in ICU Patients, Study Finds

Netherlands: A recent study published in BMC Nephrology has shed light on the modified creatinine clearance/eGFR (mCC/eGFR) ratio as a potential indicator of musNetherlandscle mass in intensive care unit (ICU) patients, with significant implications for predicting mortality.

The findings showed that the mCC/eGFR ratio correlates with both in-hospital and long-term mortality, making it a readily accessible measure of muscle mass in ICU patients.

“In-hospital mortality rates were 27% for patients in the lowest mCC/eGFR quartile, compared to just 11% in the highest quartile. Five years after discharge, the mortality rate remained elevated at 37% for those in the lowest quartile, while it dropped to 19% for those in the highest,” the researchers reported. 

Muscle mass is a critical factor in the health of ICU patients, influencing their recovery trajectory and overall prognosis. Loss of muscle mass, or cachexia, is commonly observed in critically ill individuals, and it has been linked to poorer outcomes. While muscle mass can be assessed using 24-hour urinary creatinine excretion (UCE), its effectiveness for predicting risk in individual patients is hindered by the absence of age-, sex-, weight-, and length-specific reference values for UCE. The ratio of measured creatinine clearance (mCC) to estimated glomerular filtration rate (eGFR) may help address this limitation.

In response to these insights, Meint Volbeda, Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands, and colleagues aimed to evaluate the relationship between the mCC/eGFR ratio in ICU patients and both all-cause hospital mortality and long-term mortality.

For this purpose, the researchers calculated the mCC/eGFR ratio in patients admitted to the ICU between 2005 and 2021, specifically those with KDIGO acute kidney injury (AKI) stages 0–2 and an ICU stay of 24 hours or longer. The mCC was derived from urinary creatinine excretion and plasma creatinine levels, then indexed to 1.73 m². The mCC/eGFR was analyzed by dividing patients into quartiles and treating it as a continuous variable.

The study led to the following findings:

  • A total of 7,509 patients were studied (average age 61 years; 38% female).
  • In-hospital mortality was 27% for those in the lowest mCC/eGFR quartile, compared to just 11% in the highest quartile.
  • Five years after hospital discharge, mortality was 37% in the lowest quartile and 19% in the highest.
  • The mCC/eGFR ratio, when treated as a continuous variable, was independently linked to in-hospital mortality in multivariable logistic regression, with an odds ratio of 0.578. This ratio was significantly related to five-year post-discharge mortality in Cox regression analysis, with a hazard ratio of 0.27.

The authors suggest that the mCC/eGFR ratio could be a valuable tool for estimating overall muscle mass in ICU patients, irrespective of demographic factors, and is independently associated with both in-hospital and long-term mortality.

“Future studies may further clarify the utility of the mCC/eGFR ratio in clinical practice,” they concluded.

Reference:

Volbeda, M., Zijlstra, H.W., Post, A. et al. Creatinine clearance/eGFR ratio: a simple index for muscle mass related to mortality in ICU patients. BMC Nephrol 25, 330 (2024). https://doi.org/10.1186/s12882-024-03760-2

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Body weight important health factor in pregnancy – regardless of country of birth, States study

Overweight is a major contributor to complications during pregnancy and childbirth – this applies to both women born in Sweden and women who have moved here, something that has not been well researched so far. Interventions that promote a healthy weight have the potential to prevent complications for all women, the researchers conclude. The study was conducted by researchers at Linköping University and Karolinska Institutet and is published in The Lancet Public Health.

In Sweden and similar high-income countries, there are inequalities in women’s health during pregnancy and childbirth. Women who have migrated to Sweden from other countries are more affected by various serious complications compared to Swedish-born women. The risk of complications is particularly high in women born in certain parts of the world. It is not clear why, but many different factors that affect health can contribute to this inequality. One possible factor is body weight. It is more common among migrant women from certain regions to have underweight, overweight or obesity (a disease where the person has overweight with a BMI of 30 or more) when they become pregnant.

“We know that overweight and obesity are linked to many complications during pregnancy and childbirth for women born in Sweden. Therefore, we wanted to investigate whether the inequalities in pregnancy complications between women born in different countries can to some extent be explained by differences in body weight. If you know that there are health inequalities, you want to find out why, in order to be able to do something about the inequalities in the next step,” says Pontus Henriksson, senior associate professor at the Department of Health, Medicine and Caring Sciences at Linköping University, who led the study.

What is new about this study is that the researchers have been able to estimate to what extent the complications, such as gestational diabetes, could be avoided if all women were of normal weight when they became pregnant.

“For example, we concluded that about half of all cases of gestational diabetes could potentially be prevented. This applies to both women born in Sweden and foreign-born women,” says Maryam Shirvanifar, PhD student at Linköping University and first author of the study.

The researchers believe that efforts to promote a healthy weight could help all women, no matter where in the world they were born.

“A healthy weight is good for everyone. The earlier in life the better, because once obesity is established, it is difficult to treat,” says Pontus Henriksson.

The study paints a complex picture. The importance of body weight differs between different complications. For example, high body weight contributes more to gestational diabetes than other complications.

But what about being underweight in early pregnancy, how does this affect the risks? To the surprise of the researchers, underweight does not seem to contribute significantly to the complications investigated.

In their study, the researchers followed almost two million pregnancies – basically all births in Sweden from 2000 to 2020. The researchers studied eight complications that can affect the mother or baby during pregnancy, or during and after childbirth. Using data from several national registers, they were able to investigate the relationship between a woman’s BMI at the first antenatal visit and complications depending on which region of the world the mother was born in.

In their analyses, the researchers took into account several factors, including socio-economic data. However, some factors that could affect a woman’s health during pregnancy and childbirth, such as quality of treatment in healthcare, communication barriers, stress linked to migration and differences in health-promoting behaviour, could not be investigated in the current study as it uses register data. Therefore, further research is needed to study more factors that can affect health during pregnancy in different groups.

The research was funded with support from the Swedish Research Council and is a collaboration between researchers at LiU and Karolinska Institutet (among others Viktor Ahlqvist and Cecilia Magnusson).

In their study, the researchers examined eight different complications in the mother and baby:

– severe complication in the mother that could be fatal

– preeclampsia

– gestational diabetes

– infant mortality in the first year of life

– preterm birth (before 37 weeks of pregnancy) and extremely preterm birth (before 28 weeks of pregnancy)

– low Apgar score (assessment of newborn baby’s vitality)

– large baby (in relation to length of pregnancy)

– small baby (in relation to length of pregnancy)

Reference:

Shirvanifar, Maryam et al., Adverse pregnancy outcomes attributable to overweight and obesity across maternal birth regions: a Swedish population-based cohort study, The Lancet Public Health, DOI:10.1016/S2468-2667(24)00188-9.

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In pregnant women with SLE , spontaneous and indicated preterm birth proportions are high, Meta-analysis finds

Recent meta-analysis conducted by Abheiden et al. aimed to determine the proportions of spontaneous and indicated preterm birth in pregnancies of women with systemic lupus erythematosus (SLE). The study included 21 articles with data from 8157 pregnancies and found that, on average, 31% of the pregnancies resulted in preterm birth, including 14% spontaneous and 16% indicated preterm birth. It was noted that pregnancies were almost equally affected by spontaneous and indicated preterm birth, which is a noteworthy finding as the risk of spontaneous preterm birth is less well recognized in women with SLE. The study highlighted the implications of these findings for counseling and management in pregnancy. The authors emphasized the importance of applying this information in (prepregnancy) counseling and management in pregnancy. They also highlighted the need to increase awareness among treating physicians and to provide better instructions to patients during pregnancy. The high proportions of spontaneous and indicated preterm birth in women with SLE were considered important for guiding further research on associated risk factors and the development of interventions to reduce spontaneous preterm birth in SLE pregnancies.

Risk Factors and Causes

The study discussed possible risk factors for spontaneous preterm birth in women with SLE, including inflammation due to systemic disease, increased production of cytokines and prostaglandins, placental insufficiency, and other factors such as viral or bacterial infections and fibroid necrosis. It was also pointed out that the high proportion of preterm prelabor rupture of membranes (PPROM) instances in this study should be further investigated to determine the cause and whether the risk can be reduced.

Potential Interventions

The meta-analysis also discussed potential interventions to reduce spontaneous preterm birth in women with SLE, including routine universal midtrimester sonographic cervical length evaluation, the use of vaginal progesterone, and the prescription of aspirin to prevent hypertensive disorders of pregnancy. However, the authors noted a lack of studies in the specific population of women with SLE, and called for further research to evaluate the potential beneficial effects of these interventions.

Acknowledged Limitations

The study acknowledged certain limitations, such as heterogeneities in the available studies, possible publication bias, and the lack of detailed information concerning women with SLE experiencing preterm birth. Despite these limitations, the findings of the meta-analysis provide important insights into the high proportions of spontaneous and indicated preterm birth in women with SLE and the implications for counseling, management, and further research.

Key Points

1. The meta-analysis aimed to determine the proportions of spontaneous and indicated preterm birth in pregnancies of women with systemic lupus erythematosus (SLE) and included 21 articles with data from 8157 pregnancies. It found that, on average, 31% of the pregnancies resulted in preterm birth, including 14% spontaneous and 16% indicated preterm births. This suggests that pregnancies of women with SLE are almost equally affected by spontaneous and indicated preterm birth.

2. The study highlighted the implications of these findings for counseling and management in pregnancy. The authors emphasized the importance of applying this information in (prepregnancy) counseling and management in pregnancy. They also highlighted the need to increase awareness among treating physicians and to provide better instructions to patients during pregnancy.

3. The high proportions of spontaneous and indicated preterm birth in women with SLE were considered important for guiding further research on associated risk factors and the development of interventions to reduce spontaneous preterm birth in SLE pregnancies.

4. The study discussed possible risk factors for spontaneous preterm birth in women with SLE, including inflammation due to systemic disease, increased production of cytokines and prostaglandins, placental insufficiency, viral or bacterial infections, and fibroid necrosis. Furthermore, the study pointed out the need for further investigation into the high proportion of preterm prelabor rupture of membranes (PPROM) instances in this population.

5. Potential interventions to reduce spontaneous preterm birth in women with SLE were also discussed, including routine universal midtrimester sonographic cervical length evaluation, the use of vaginal progesterone, and the prescription of aspirin to prevent hypertensive disorders of pregnancy. However, the authors noted a lack of studies in the specific population of women with SLE and called for further research to evaluate the potential beneficial effects of these interventions.

6. The study acknowledged certain limitations, such as heterogeneities in the available studies, possible publication bias, and the lack of detailed information concerning women with SLE experiencing preterm birth. Despite these limitations, the findings of the meta-analysis provide important insights into the high proportions of spontaneous and indicated preterm birth in women with SLE and the implications for counseling, management, and further research.

Reference –

Abheiden CNH, Blomjous BS, Slaager C, Landman AJEMC, Ket JCF, Salmon JE, Buyon JP, Heymans MW, de Vries JIP, Bultink IEM, de Boer MA. Systemic lupus erythematosus is associated with an increased frequency of spontaneous preterm births: systematic review and meta-analysis. Am J Obstet Gynecol. 2024 Oct;231(4):408-416.e21. doi: 10.1016/j.ajog.2024.03.010. Epub 2024 Mar 16. PMID: 38492714.

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