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PubMed2001

Pregnancy in women with epilepsy.

The aim of this study was to analyze the outcome of pregnancy and delivery in epileptic women. A retrospective review of the 41 pregnant women with epilepsy who delivered in the Department of Obstetrics and Perinatology of the University School of Medicine in Lublin over 7 years (1993-1999) was carried out. Women with epilepsy had more pregnancy complications including premature labor, anemia, hypertension, vaginal bleeding, urinary tract infection, nausea and vomiting. An increased risk of congenital malformations and intrauterine fetal growth retardation was observed. Women with epilepsy require more extensive pregnancy planning including neurologic and preconceptional care.

Adult↗
PubMed2006

Aiming to increase birth weight: a randomised trial of pre-pregnancy information, advice and counselling in inner-urban Melbourne.

BACKGROUND: In the 1980s there was substantial interest in early pregnancy and pre-pregnancy interventions to increase birth weight and reduce preterm birth. We developed an inter-pregnancy intervention, implemented in a randomised controlled trial, to be provided by midwives at home soon after women's first birth. METHODS: MCH nurses invited women to take part during their home visit to new mothers. Women's contact details, with their permission, were passed to the study midwife. She had a randomisation schedule to which women's names were added before she met the women or their partners. All women recruited had a home visit from the study midwife with a discussion of their first pregnancy, labour and birth and the postpartum experience. Women in the intervention arm received in addition a pre-pregnancy intervention with discussion of social, health or lifestyle problems, preparation and timing for pregnancy, family history, rubella immunisation, referrals for health problems, and a reminder card. The primary outcome was defined as a birth weight difference in the second birth of 100 g (one-sided) in favour of the intervention. Additional data collected were gestational age, perinatal deaths and birth defects. Analyses used EPI-INFO and STATA. RESULTS: Intervention and comparison groups were comparable on socioeconomic factors, prior reproductive history and first birth outcomes. Infant birth weight in the second birth was lower (-97.4 g,)) among infants in the intervention arm. There were no significant differences between intervention and comparison arms in the proportion of women having a preterm birth, an infant with low birthweight, or an infant with a birth weight <10th percentile. There were more adverse outcomes in the intervention arm: ten births <32 weeks), compared with one in standard care, and more infants with a birth weight <2000 g, 16 compared with two in standard care CONCLUSION: As the primary outcome was envisaged to be either improved birth weight or no effect, the study was not designed to identify the alternative outcome with confidence. Despite widespread support for pre-pregnancy interventions to improve maternal and perinatal health, this first randomised controlled trial of a multi-component intervention provided at home, did not have a beneficial outcome.

Adult↗
PubMedDate not supplied

Diabetes in pregnancy.

A number of risk factors exist for pregnant women with diabetes and their babies. Collaborative care can ensure that women with pre-existing diabetes, and those who develop diabetes during pregnancy, receive appropriate and individualised care.

Cooperative Behavior↗
PubMed2000

Poland-Möbius syndrome and disruption spectrum affecting the face and extremities: a review paper and presentation of five cases.

The author summarizes hitherto assembled experience with the clinical and genetic characteristics of Poland's and Möbius syndrome. Five selected case-records with this disease and the sequence of the Poland-Möbius syndrome are presented. Another case-record is devoted to an allied syndrome, hypoglossia-hypodactyly, found in a spontaneously aborted fetus. For establishment of a more accurate symptomatology, an irreplaceable place is held by anthropometric examination; for objectifying the asymmetry of the chest the so-called cyrtogram, the chest circumference recorded by means of a wire, is valuable. From the aspect of genetic counseling, preconception care is always provided to mothers from families with reproductive intentions, as well as ultrasonographic examination of the fetus in areas of assumed acral symptomatology (signaling phenotype). In two families ultrasonography was used for prenatal diagnosis. Invasive prenatal diagnosis by amniocentesis was employed in a family with Möbius syndrome. In these families dermatoglyphs have certain common characteristics, such a tendency towards simple patterns. In the wider family of one of our patients we detected in a cousin Parkes-Weber-Klippel-Trenaunay's syndrome, which may indicate common vascular predisposing factors.

Adult↗
PubMed2001

The increasing knowledge of the role of periconceptional folate in Victorian women of child-bearing age: follow-up of a randomised community intervention trial.

OBJECTIVES: To determine the changes since 1996 in knowledge of folate for the prevention of neural tube defects (NTDs) among women of child-bearing age and measure the residual effect of an earlier consumer-directed information campaign. DESIGN: A community, randomised trial with three matched pairs of geographically distinct local government areas in Victoria. INTERVENTION: Printed information recommending folate intake to decrease the risk of NTDs was disseminated in 1997 to women of child-bearing age. MAIN OUTCOME MEASURE: The proportion of women aware of the association between folate and spina bifida was established in 1996, 1997 and 2000 (approximately 200 respondents per local government area in each survey). RESULTS: 12.5% (adjusted for population sampling fraction) of 1,196 women interviewed in 1996, prior to the intervention, were aware of folate and NTDs. Independent surveys after the intervention in 1997 and again in 2000 showed that this had increased to 17.4% (n=1204) and 30.2% (n=1227) respectively. The intervention had a significant impact on folate awareness (a 4% difference in 1997 and a residual 3.3% in 2000, ORadj=1.24, 95% CI 1.19-1.37, p=0.007). CONCLUSIONS AND IMPLICATIONS: There has been a continuing increased awareness of folate in women of child-bearing age since 1996. Within this setting, the provision of printed educational material in a brief intervention in 1997 has caused enduring increased awareness of the association between folate and NTDs. The need for ongoing health promotion action on folate remains.

Adolescent↗
PubMed2002

[Evaluation of antiepileptic therapy during pregnancy].

OBJECTIVE: The aim of the study was to analyse the course of pregnancy and labour in women with epilepsy. MATERIAL AND METHODS: The study was carried out on 53 pregnant women with epilepsy who delivered in the Department of Obstetrics and Perinatology of the University School of Medicine in Lublin (group E). RESULTS: In the group of women with epilepsy there were observed more pregnancy complications. The mean birth weight of infants and the condition of the infant after birth evaluated were lower in the study group E according to Apgar score. The increased risk of congenital malformations and intrauterine foetal growth retardation were observed in children exposed to valproate or carbamazepine in monotherapy or combination of phenobarbital and phenytoin and the combination of phenobarbital, phenytoin and primidone in polytherapy. CONCLUSION: Women with epilepsy require appropriate pregnancy planning and appropriate neurologic and obstetric care preconceptionally and during pregnancy.

Adult↗
PubMed1976

[Genetic and gynecologic prevention of congenital developmental disorders].

The authores investigated 273 women who bore one or more children with birth defects. These defects were classified genetically as polygenic inherited. The authors describe the bases and results of preconceptional care as a method to reduce the risk of polygenic inherited birth defects.

Central Nervous System↗
PubMed2005

The Australasian Diabetes in Pregnancy Society consensus guidelines for the management of type 1 and type 2 diabetes in relation to pregnancy.

Strict control of blood glucose levels should be pursued before conception and maintained throughout the pregnancy (glycohaemoglobin [HbA(1c)] level as close as possible to the reference range). Before conception: high-dose (5 mg daily) folate supplementation should be commenced; oral hypoglycaemic agents should be ceased; and diabetes complications screening should take place. Management should be by a multidisciplinary team experienced in the management of diabetes in pregnancy. Blood glucose monitoring is mandatory during pregnancy, and targets are: fasting 4.0-5.5 mmol/L; postprandial < 8.0 mmol/L at 1 hour; < 7 mmol/L at 2 hours. A first trimester nuchal translucency (possibly with first trimester biochemical screening with pregnancy-associated plasma protein A and beta-human chorionic gonadotropin) should be offered. Ultrasound should be performed for fetal morphology at 18-20 weeks, if required, for cardiac views at 24 weeks and for fetal growth at 28-30 and 34-36 weeks. Induction of labour or operative delivery should be based on obstetric and/or fetal indications. Level 3 neonatal nursing facilities may be required and should be anticipated when birth occurs before 36 weeks, or if there has been poor glycaemic control. Insulin requirements fall rapidly during labour and in the puerperium. At this time, close monitoring and adjustment of insulin therapy is necessary.

Antihypertensive Agents↗
PubMed1990

[Possibilities of prevention of congenital developmental defects].

One of the still open questions of teratology is the relationship between experimental teratological investigations and their validity in human medicine. The aetiology of the development of inborn developmental defects comprises factors the ratio of which is the subject of discussions. The category of still unknown factors is the largest one. This means that in 70% of inborn developmental defects there is nothing to go by. The influence of the deteriorated living or working environment need not be manifested by a higher incidence of seriously damaged foetuses. Comprehensive preconception care is a way which may lead to improvement in the sphere of prevention, although its application is not unequivocal. An essential prerequisite of effective prevention of inborn developmental errors is recognition of the causes of and laws governing their development.

Congenital Abnormalities↗
PubMedDate not supplied

Changing provider practices to enhance preconceptional wellness.

Primary care providers who fail to provide preconceptional care to every woman of reproductive age during each primary care visit are losing key preventive opportunities. Changing provider practices involves multidisciplinary input into the planning of care, support of clinical leaders and professional organizations, and adequacy of funding for proposed changes. Programs in California, North Carolina, and South Carolina have demonstrated significant changes in provider acceptance of preconceptional.

Benchmarking↗
PubMed2002

Interdisciplinary development of a preconception health curriculum for four medical specialties.

A group of obstetricians and gynecologists, along with physicians from three other medical specialties, nurses, and midwives, developed a curriculum on preconception health care for women. This curriculum was specifically aimed at residents in obstetrics and gynecology, internal medicine, pediatrics, and family medicine. The curriculum was designed to convince these physicians that they needed to participate in promotion of preconception health for many reasons, such as the need to teach women to take folic acid daily because it significantly decreases the incidence of neural tube defects. Because over 50% of all pregnancies are unplanned, it is imperative that all physicians think of themselves as preconception health providers. Our group then taught the curriculum to medical students, residents, fellows, and attending physicians in all specialties at four hospitals affiliated with the medical college. Evaluation of the curriculum in 171 physicians who participated revealed that only a small percentage of physicians took folic acid daily themselves. Almost 36% of the obstetricians did not currently provide preconception care for their patients. Most physicians in all specialties believed that the curriculum provided them with useful information for their practice. The March of Dimes is currently distributing this curriculum on its Web site.

Curriculum↗
PubMed1998

[Preconception counseling in family practice; a survey of 100 family physicians].

OBJECTIVE: To assess the awareness, opinions on desirability and preconditions such as special knowledge with regard to the concept of preconceptional health counselling among general practitioners. DESIGN: Descriptive. SETTING: General practices in the Groot Gelre district of the Dutch General Practitioners Society. METHOD: A representative sample of 100 general practitioners were asked by phone for permission to send a questionnaire; 89 out of the 94 general practitioners who were sent a questionnaire replied (response: 89%). RESULTS: Almost all general practitioners (88%) knew about the concept of preconceptional health counselling and most of them already gave some kind of preconceptional advice. 93% considered preconceptional health counselling part of their job responsibility and 91% were prepared to give more preconceptional health care in the future. 53% of all general practitioners, however, indicated that they lacked sufficient knowledge to give adequate advice. The advantages of preconceptional health care were considered to outweigh possible disadvantages such as medicalization of pregnancy. CONCLUSION: The general practitioners knew about preconceptional health care and considered it part of their job. Many already provided preconceptional health care, although not in a structured way. General practitioners appeared to lack time and appropriate knowledge, which indicates a need for postgraduate training.

Data Collection↗