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At least 217 records · Page 12Linked to original sources
PubMed2004

Outcomes in type 1 diabetic pregnancies: a nationwide, population-based study.

OBJECTIVE: The aim of this study was to compare pregnancy outcomes in type 1 diabetic pregnancies with the background population. RESEARCH DESIGN AND METHODS: This nationwide prospective multicenter study took place in eight Danish centers treating pregnant women with type 1 diabetes during 1993-1999. A total of 990 women with 1,218 pregnancies and delivery after 24 weeks (n=1,215) or early termination due to severe congenital malformations (n=3) were included. Data were collected prospectively by one to three caregivers in each center and reported to a central registry. RESULTS: The perinatal mortality rate was 3.1% in type 1 diabetic pregnancies compared with 0.75% in the background population (RR 4.1 [95% CI 2.9-5.6]), and the stillbirth rate was 2.1% compared with 0.45 (4.7 [3.2-7.0]). The congenital malformation rate was 5.0% in the study population and 2.8% (1.7 [1.3-2.2]) in the background population. Six of the perinatal deaths (16%) were related to congenital malformations. Only 34% of women performed daily home monitoring of blood glucose at conception, and 58% received preconceptional guidance. Pregnancies with serious adverse outcomes (perinatal death and/or congenital malformations) were characterized by higher HbA1c values before and during pregnancy and a lesser degree of maternal self-care and preconceptional guidance. Women who performed daily self-monitoring of blood glucose at any time during pregnancy had lower HbA1c values than women who did not measure their daily profile. Likewise, daily self-monitoring was associated with a reduction in serious adverse outcomes. The caesarean section rate was 55.9 and 12.6%, respectively, and the risk of preterm delivery was 41.7 and 6.0%, respectively. CONCLUSIONS: Type 1 diabetic pregnancies are still complicated by considerably higher rates of severe perinatal complications compared with the background population, and women with poor self-care are at the highest risk. Adequate glycemic control using daily glucose monitoring before and during pregnancy is a crucial step toward reaching the goals of the St. Vincent declaration.

Congenital Abnormalities↗
PubMed1999

Gender difference in management of epilepsy-what women are hearing.

This study reports the results of a questionnaire survey of female members of the British Epilepsy Association (BEA). The women were asked about their concerns about their epilepsy with respect to being female, and, in particular, asked about the information they had been given on important topics such as contraception and pregnancy. A questionnaire was sent to 6000 BEA female members of whom 1855 (31%) replied. Forty-six percent of the women (mainly aged between 26 and 45) stated that they currently used some form of contraception. The most frequently used method was the condom (34%). Twenty-two percent of the women using contraception were taking the oral contraceptive pill whilst a further 4% were using a hormonal contraceptive injection. Fifty-one percent of the women aged between 16 and 55 claimed not to have received any advice about possible interactions between contraception and antiepileptic drug therapy. With regards to pregnancy, 34% claimed they had not received any advice and 25% had not discussed pregnancy with anyone. The women planning to have children over the subsequent 2 years received the greatest amount of advice about epilepsy and pregnancy, although 20% still claimed not to have received any information. Thirty-four percent of the women in the study stated that they were either menopausal or post-menopausal. Twenty-nine percent of women who had taken hormone replacement therapy in the past reported an increase in seizure frequency compared with 18% amongst current users. This survey has shown that women with epilepsy want, and need, more information and counselling about issues relating to contraception, pregnancy and the menopause.

Adolescent↗
PubMed1999

Obstetrical outcome of pregnancy in patients with systemic Lupus erythematosus. A study of 60 cases.

OBJECTIVE: To analyze the course of maternal diseases and the outcome of pregnancy in patients with systemic Lupus Erythematosus (SLE). STUDY DESIGN: During a period of 11 years we prospectively followed 60 pregnancies in 46 SLE patients in a tertiary care center in Barcelona (Spain). The management protocol included: (1) planning of conception when disease was inactive; (2) frequent follow-up visits by an internist-obstetrician team; (3) use of sequential ultrasonographic, Doppler and fetal echocardiographic examinations; (4) serial evaluations of maternal immunological condition; and (5) low dose aspirin from 1 month before attempting conception and throughout pregnancy was added in women with antiphospholipid antibodies. From 1985 until 1994 prednisone prophylaxis was used in all lupus patients during the last month of pregnancy and during the first month of the puerperium; from 1995 onwards this regime was abandoned. RESULTS: The mean (S.D.) age of patients was 28.6 (4.8) years (range 20 to 42) and the mean (S.D.) previous duration of SLE was 6.25 (4.8) years (range 0 to 17). SLE was diagnosed during the pregnancy in two cases (3.3%) and the disease was active at conception in four cases (6.7%); at that time nine patients (15%) were taking prednisone. Antiphospholipid antibodies were positive in 16 patients (30.4%) and there were 10 (16.7%) pregnancies in patients having lupus nephropathy. There were three first-trimester miscarriages (5%) and four (6.7%) voluntary abortions. Obstetric complications in the remaining 53 pregnancies included: preterm delivery, 11 cases (20.8%); intrauterine growth retardation, five cases (9.4%); hypertension, 10 patients (18.9%), five of them fulfilling the criteria of preeclampsia; premature rupture of membranes, four patients (7.5%); finally, 13 neonates had a birthweight lower than 2500 g. There were 15 lupus flares (28.3%), giving a flare rate of 0.044 per patient/month. There were five neonatal deaths (perinatal mortality rate, 94 per thousand): one because of complete heart block, three due to severe hyaline membrane disease resulting from extreme prematurity and one intrauterine death in a patient having the Leiden mutation. CONCLUSION: Pregnancy in patients with SLE should not be regarded as an unacceptable high-risk condition for the mother or her baby provided that conception is accurately planned and patients are managed according to a careful multidisciplinary treatment schedule.

Female↗
PubMed1995

Preconceptual obstetric risk assessment and health promotion.

Preconceptual risk assessment is an increasingly important part of obstetric care in the era of fetal therapeutics, invasive diagnostic techniques and "premium" pregnancies. The constant rates of the two greatest contributors to infant morbidity and mortality--congenital malformations and low birth weight--suggest that our basic approach to obstetric care is not sufficiently preventive. Preconceptual obstetric risk assessment, along with health promotion, education and therapeutic intervention, can reduce risk and improve outcome. A medical and psychosocial emphasis on preconceptual and early pregnancy care, along with promotion of the health of the pregnant woman, the fetus, the infant and the family up to one year after birth, may prove to be a way of decreasing infant morbidity and mortality. The identification of important risks associated with demographics, systemic disease, infection, environment, genetics and lifestyle will assist the family physician in promoting health strategies in obstetric care.

Adolescent↗
PubMed2006

Comparison of international and New Zealand guidelines for the care of pregnant women with diabetes.

OBJECTIVE: To compare international guidelines for the care of women with diabetes and pregnancy with reported current practice among New Zealand tertiary centres. RESEARCH DESIGN AND METHODS: A literature review of national and international guidelines for the care of women with diabetes in pregnancy was undertaken. Guideline activities were placed within nine facets of care, from preconception advice, through pregnancy from screening to follow-up. New Zealand tertiary centres guidelines were obtained and placed in the same framework. RESULTS: International guideline consensus was inconsistent across most facets of care. Those for the detection and diagnosis of gestational diabetes mellitus (GDM) were particularly discordant internationally, although intranational agreement has occurred. CONCLUSIONS: International guidelines for the care of women with diabetes in pregnancy remain fragmented. The development of one set of guidelines based on the consensus of international best practice could overcome many of the misconceptions associated with diabetes in pregnancy.

Consensus↗
PubMedDate not supplied

Maternal phenylketonuria: a new cause for concern.

The start of newborn screening for phenylketonuria (PKU) during the early 1970s has given rise to an increasing number of women who have been identified and successfully treated for the disease in childhood and are now preparing to have children of their own. Early detection and initiation of nutritional therapy before conception is key to a successful pregnancy outcome. Nurses who understand the pathophysiology, dietary limitations, and management of PKU in pregnancy can provide the care necessary for optimal maternal and neonatal health.

Child↗
PubMed1995

[The premises of a policy of early childhood during the second empire: The association for the care of lying-in women].

As early as the 1830's, the social elite of Mulhouse was aware of the higher infant mortality in the working class. A family policy was adopted only during the Second Empire: the consciousness of the failure of the first philanthropic measures explains why the manufacturers decided to take direct responsibility for the working class family. The demographic preoccupations are directly linked to philanthropy. This paper analises the principles and evaluates the results of the Association for the care of lying-in women.

Charities↗
PubMed2005

Variation in health care provider definitions of moderate consumption of alcohol as related to recommendations regarding alcohol consumption during pregnancy: results from a Canadian survey.

Women rely on health care providers for general health care and preconception counseling, including advice on alcohol consumption. Definitions of moderate consumption may differ by individual provider, resulting in inconsistency in advice and lack of clarity for patients both before and during pregnancy. The objective of this study was to determine if health care providers' definition of moderate alcohol consumption was associated with advice to pregnant women regarding alcohol use during pregnancy and to describe health care providers' communication regarding alcohol consumption. Between October 2001 and October 2002, a survey was mailed to a national random sample of 3114 Canadian obstetricians and gynecologists, midwives, and family physicians. The main outcome measure was questionnaire responses regarding knowledge and prevention issues related to alcohol and pregnancy as well as provider characteristics. Response rates ranged from 31.1% among family physicians to 63.5% among midwives. Moderate alcohol consumption among nonpregnant women was defined as 1 to 2 drinks per occasion by about 89% of providers and did not relate to recommendations during pregnancy. Those who recommended abstinence during pregnancy were more likely to define moderation as 4 or more occasions per week as compared with those who did not recommend abstinence (P=0.022). Fewer than 50% of providers frequently defined "moderation" for their patients. More family physicians (90.0%) than obstetricians (83.9%) or midwives (81.1%) recommended alcohol abstinence during pregnancy (overall 87.8%, P=0.005). Thus, there is opportunity for providers to appropriately counsel their patients by advising alcohol abstinence during pregnancy and more frequently defining "moderation" for all clients.

Adult↗
PubMed2004

Pregnancy and pre-existing diabetes: key concerns.

Women with pre-existing diabetes in pregnancy are at increased risk of fetal loss, fetal congenital anomaly and abnormal fetal growth. Obstetric complications are more likely and good peripartum care is essential. This article also considers preconceptual counselling which may minimize these risks.

Counseling↗
PubMedDate not supplied

Reducing perinatal transmission of HIV: early diagnosis and interventions during pregnancy.

This article reviews the New York State regulations regarding expedited testing of newborns for exposure to HIV. Included is a review of statistics as well as the medical and obstetric management of HIV positive pregnant women, including route of delivery. The professional responsibility of midwives, physicians, and other clinicians regarding maternal and neonatal health care is emphasized, especially in states without expedited testing.

Female↗
PubMed2004

Current practice and future interest of GPs and prospective parents in pre-conception care in The Netherlands.

BACKGROUND: Evidence for the effectiveness of pre-conception care is growing. GPs are among the possible providers of pre-conception care. OBJECTIVES: Our first aim was to investigate current pre-conception care activities of GPs and to determine whether prospective parents would visit the GP in the existing health care system. A further aim was to determine the interest of GPs and prospective parents in the introduction of pre-conception care clinics. METHODS: A survey was conducted among 200 GPs and 303 recently married couples (606 individuals). RESULTS: Of the eligible GPs, 52% (n = 102) participated, as did 70% (n = 381) of the eligible individuals who are planning a pregnancy. In the current situation, only a few individuals visit their GP pre-conceptionally, and many GPs do not discuss family history or consanguinity with prospective parents. In general, the GPs and prospective parents had a positive attitude towards the introduction of pre-conception care clinics. CONCLUSION: Since most GPs and prospective parents favoured the introduction of pre-conception care, future research should focus on the most appropriate way of implementation.

Family Practice↗