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At least 19 recordsLinked to original sources
PubMed1988

Early measures of maternal alcohol misuse as predictors of adverse pregnancy outcomes.

Pregnancy outcome was studied in 531 obstetric outpatients with respect to maternal alcohol consumption prior to pregnancy recognition, (absolute alcohol per day prior to pregnancy, PPAA) and indications of problem drinking (IPD). Multiple regression was used to predict pregnancy outcome with PPAA and IPD, controlling for potentially confounding sociodemographic and health factors. PPAA predicted spontaneous abortion and lowered Apgar scores. The risk of spontaneous abortion increased an average of 25% for each additional ounce of absolute alcohol consumed per day (p less than 0.05). Adverse pregnancy outcomes related to intrauterine growth were more strongly related to IPD than PPAA, and IPD remained a significant predictor even after controlling for PPAA. The strongest association was with head circumference (p less than 0.01); logistic regression indicated that for each additional indication of problem drinking reported, risk of head circumference below the 10th percentile increased 2.77 times. Other pregnancy outcome measures negatively related to IPD were 5-min Apgar scores (p less than 0.05), birth weight (p less than 0.10), and 1-min Apgar scores (p less than 0.10). No significant curvilinear alcohol effects or interactions were observed. These findings highlight the potential clinical utility of PPAA and IPD in the early identification of women whose alcohol use puts their pregnancies at high risk.

Abortion, Spontaneous↗
PubMed1991

Peripartum cocaine use: estimating risk of adverse pregnancy outcome.

Pregnancy outcome of 83 patients with a positive urine toxicology screen for cocaine in the third trimester were reviewed. The outcomes of pregnancies complicated by cocaine abuse were compared to those of matched controls selected from our general obstetric population. We observed a statistically significant increase in the incidence of premature separation of the placenta, low birthweight infants, preterm deliveries, and the incidence of fetal distress requiring cesarean section. On admission, 55% of patients denied recent cocaine use. These observations have implications for planning perinatal services.

Abruptio Placentae↗
PubMed2005

Thrombophilia and pregnancy outcomes.

Pregnancy complications are still a challenge for physicians, because knowledge of pathomechanisms and prophylactic measures is still limited. In recent years thrombophilia as a risk factor for pregnancy complications has gained much attention in the scientific community. However, data on this topic in the literature are conflicting. Besides an established association between antiphospholipid antibodies and pregnancy loss, available data suggest additional associations for antithrombin deficiency, hyperhomocysteinemia and also for factor (F)V Leiden, prothrombin G20210A variation, and protein S-deficiency. The contribution of thrombophilia to the risk of pre-eclampsia is less well established and recent studies did not confirm earlier data suggesting an association between thrombophilia and pre-eclampsia. A limited number of prospective studies have failed to reveal an increased risk of pregnancy complications in unselected women with thrombosis risk factors. Low-molecular weight heparin (LMWH) seems to have a positive effect on pregnancy outcome after single or recurrent abortions, however, data from only one controlled trial are available. Experience in the prevention of pre-eclampsia by prophylactic heparin is very limited, and in addition, data on pregnancy complications in women with known heritable thrombophilia or a history of thrombosis are inconsistent. These women will usually have a favorable pregnancy outcome referring to the European Prospective Cohort on Thrombophilia Study. In conclusion, thrombophilia screening might be justified in women with pregnancy loss and treatment with LMWH might be considered in those with pregnancy loss and thrombophilia. Further prospective studies and controlled interventional trials are urgently needed.

Antibodies, Antiphospholipid↗
PubMed1990

Maternal body weight and pregnancy outcome.

Pregnancies that produced 56,857 children were analyzed to evaluate the relationship of the mothers' relative pregravid body weight to pregnancy outcome. Perinatal mortality rates progressively increased from 37 of 1000 in offspring of thin subjects to 121 of 1000 in the offspring of obese subjects (p less than 0.001). Nearly half of this mortality increase was due to preterm deliveries, particularly before 31 wk of gestation. More than half of the increase in preterm births was caused by acute chorioamnionitis. Other factors that made major contributions to the overall mortality increase were rises in the frequencies of older gravidas (ages 35-50 y), gravidas who had diabetes mellitus, children who had major congenital malformations, and dizygous twins.

Acute Disease↗
PubMedDate not supplied

Doppler velocimetry of the umbilical artery as a predictor of pregnancy outcome in pregnancies characterized by elevated maternal serum alpha-fetoprotein and normal amniotic fluid alpha-fetoprotein.

OBJECTIVE: Women with elevated maternal serum alpha-fetoprotein (MSAFP) and normal amniotic fluid alpha-fetoprotein (AFAFP) are at an increased risk of an adverse pregnancy outcome. Such MSAFP elevations are probably the consequence of transplacental leakage caused by placental abnormalities. These may result in disturbed bloodflow through placental vessels. The purpose of this study was to assess whether measurement of such disturbances by Doppler velocimetry of the umbilical artery has a predictive value for pregnancy outcome. STUDY DESIGN: The study group consisted of 85 patients, in whom the only finding was elevated maternal serum alpha-fetoprotein. Systolic/diastolic (S/D) ratios were calculated using a continuous wave Doppler measurement of the umbilical artery, performed at 6 to 8-week intervals. Serial results for each individual were incorporated into a single 'Velocimetry Score'. RESULTS: In group B (14 patients) with an abnormally elevated umbilical S/D ratio, a higher incidence of intrauterine growth retardation (42.9%), preterm deliveries (78.6%), and fetal loss (42.9%) was noted, as compared with group A (71 patients) with a normal S/D ratio. CONCLUSIONS: Umbilical artery Doppler velocimetry may serve as a predictor of pregnancy outcome in the high-risk group characterized by elevated MSAFP.

Adult↗
PubMed2006

Prevalence of risk factors for adverse pregnancy outcomes during pregnancy and the preconception period--United States, 2002-2004.

OBJECTIVES: To assess the prevalence of risk factors for adverse pregnancy outcome during the preconception stage and during pregnancy, and to assess differences between women in preconception and pregnancy. METHODS: Data from the 2002 and 2004 Behavioral Risk Factor Surveillance System, United States, were used to estimate the prevalence of selected risk factors among women 18-44 in the preconception period (women who wanted a baby in the next 12 months, and were not using contraception, not sterile and not already pregnant) with women who reported that they were pregnant at the time of interview. RESULTS: Major health risks were reported by substantial proportions of women in the preconceptional period and were also reported by many pregnant women, although pregnant women tended to report lower levels of risk than preconception women. For example, 54.5% of preconception women reported one or more of 3 risk factors (frequent drinking, current smoking, and absence of an HIV test), compared with 32.0% of pregnant women (p < .05). The difference in the prevalence of these three risk factors between preconception and pregnancy was significant for women with health insurance (52.5% in preconception vs. 29.4% in pregnancy, p < .05), but not for women without insurance (63.4% vs. 52.7%, p > .05). CONCLUSIONS: Women appear to be responding to messages regarding behaviors that directly affect pregnancy such as smoking, alcohol consumption and taking folic acid, but many remain unaware of the benefits of available interventions to prevent HIV transmission and birth defects. Although it appears that some women reduce their risk for adverse pregnancy outcomes after learning of their pregnancy, the data suggest that a substantial proportion of women do not. Furthermore, if such change occurs it is often too late to affect outcomes, such as birth defects resulting from alcohol consumption during the periconception period. Preconception interventions are recommended to achieve a more significant reduction in risk and further improvement in perinatal outcomes.

Adolescent↗
PubMed1981

Moderate alcohol use and pregnancy outcome.

Pregnancy outcome has been studied in relation to maternal alcohol consumption in two prospective surveys in public hospitals in Paris and one retrospective survey on a national sample. These studies have not shown any relationship between alcohol use during pregnancy and major congenital malformations. There was an excess of stillbirths, significant only in the first study, and a decrease in placental weight among women drinking more than 40 cl of wine or its equivalent in other alcoholic beverages per day. The national survey also showed a higher pre-term delivery rate. A decrease in birthweight was observed mainly for moderate or heavy beer drinker. These relationships remained after adjusting for confounding factors.

Abnormalities, Drug-Induced↗
PubMed1996

Stress, immune function, and relationship to pregnancy outcome.

Pregnancy and the postpartal period are a time of immunosuppression. The normal immunosuppression that occurs during the puerperium may be aggravated by stress. Normal mechanisms of immunosuppression are discussed, and the research related to stress and childbearing is examined in this article.

Antibody Formation↗
PubMed1992

EUROMAC. A European concerted action: maternal alcohol consumption and its relation to the outcome of pregnancy and child development at 18 months. Results--strategy of analysis and analysis of pregnancy outcome.

Analyses were made of the relation between maternal alcohol consumption before and in early pregnancy and five infant outcome variables: birthweight, crown-heel length, occipitofrontal circumference and the Apgar scores at 1 and 5 minutes. The data were analysed for all centres combined and separately. From tabulation of the mean values of the outcome variables by alcohol consumption, it appeared that a poorer outcome was related to consumption of 120 g/week absolute alcohol or more. Multiple regression analysis was used to allow for possible confounding by the child's gestational age at birth and sex, the mother's age, parity and smoking habit, and survey centre. Two threshold models were applied to the combined data, taking the confounders into account. The offset threshold model (assuming no effect of alcohol up to a threshold value, and then a constant multiplicative effect at higher levels) suggested a negative effect on birthweight at about 60 g/week absolute alcohol, but with a wide 85% confidence interval of 5-130 g/week. A step function threshold model, which assumes a constant effect above the threshold value, behaved erratically. Similar analyses for crown-heel length and occipitofrontal circumference provided only a very poor fit to the data. Data on reported congenital anomalies are presented by survey centre and maternal alcohol consumption, but due to the unstandardized method of collection they were not analysed further.

Alcohol Drinking↗
PubMed1996

The utilization rate and pregnancy outcome of multifetal pregnancy reduction in the Nordic countries.

OBJECTIVE: To review the utilization rate and pregnancy outcome of multifetal pregnancy reductions (MFR) in the Nordic countries during the period January 1986-June 1992. STUDY DESIGN: All centers offering assisted conception in Denmark, Finland, Norway and Sweden were retrospectively surveyed by means of a questionnaire with regard to the number and methods used for MFR, pregnancy loss and the outcomes of the pregnancies. The response rate was 100%. RESULTS: During the period studied, 185 births of triplets or higher multiples occurred in Sweden, 120 in Finland and 102 in Denmark. MFR was performed in 42 women (Sweden 26, Finland 10, Denmark 6) but not in Norway at all. This gives an estimated average utilization rate of 1/7 multiple births of three or more in Sweden, 1/17 in Denmark and 1/12 in Finland. The most frequently used method was intracardiac or intrathoracic injection of a potassium chloride solution in gestational weeks 9-12. One pregnancy was reduced from seven to four fetuses, two from five to three, 10 from five to two, one from four to three, 17 from four to two, one from four to one, five from three to two, four from three to one and one from two to one. Nine (21%) pregnancies terminated in a spontaneous abortion within one week (n = 2) to several weeks (n = 7) after the procedure. Of the remaining 33 (79%) pregnancies which continued to delivery, two fetuses died in utero in the second trimester, three infants died perinatally and one child had transverse limb reduction defects. A successful pregnancy defined by the discharge home of at least one infant occurred in 79% of the cases. CONCLUSION: This study gives national estimates on the utilization rate of MFR. Although MFR is performed more frequently in Sweden than in Denmark and Finland, the overall figures remain low in the Nordic countries. The incidence of pregnancy loss in this study is somewhat higher than in several larger reported series, probably reflecting the learning curve of the procedure. It seems reasonable that MFR should be performed in only a few centers in the Nordic countries.

Female↗
PubMed1982

Influence of pregnancy outcome on subsequent pregnancy.

In this study to determine the harmful effect of abnormal pregnancy outcome on the immediately following pregnancy, 573 recently delivered women (with 2347 pregnancies) were interviewed. Data were recorded on their pregnancy outcomes (normal, abortion, stillbirth and congenital malformation), as well as on their interpregnancy intervals. A significant difference was found between the chances of having a spontaneous abortion following a normal outcome (5.5%) against that following a spontaneous abortion (31.1%). Also, the chances of a normal outcome following a normal outcome were 92.4%, compared with 63.9% following a spontaneous abortion. The delivery of a malformed baby is associated with a larger proportion of abortion and congenital malformation in the subsequent pregnancy, while stillbirth was followed by a larger proportion of abortion and stillbirth. A longer interpregnancy interval did not appear to have any protective effect on the subsequent pregnancy.

Abortion, Spontaneous↗
PubMedDate not supplied

Previous pregnancy outcome is an important determinant of subsequent pregnancy outcome in women with systemic lupus erythematosus.

Women with systemic lupus erythematosus (SLE) have increased adverse pregnancy outcomes. The reasons for these problems include maternal disease, clinical or serologic activity, medication use, and residual organ impairment from prior disease flares. In retrospective studies, pregnancy data are often treated cross-sectionally, with births rather than mothers as the unit of analysis. Multiple pregnancies from the same mother may be highly correlated with each other. In an unmatched retrospective study, the first two pregnancy outcomes in lupus patients with anticardiolipin antibody (anti-CL IgG or IgM isotype) (cases N = 47) and without anticardiolipin antibody (controls, N = 125) were assessed according to birth order. A good outcome was defined as a full-term (> 38 weeks) live birth without neonatal complications. All other pregnancy outcomes were considered adverse outcomes. Therapeutic abortions and ectopic or molar pregnancies were excluded. Both cases and controls with an adverse outcome in their first pregnancy had at least a 50% chance of another adverse outcome in their second pregnancy. Cases with a late miscarriage (fetal loss at 14 to 20 weeks' gestation) in their first pregnancy had the highest risk, 80%, of an adverse outcome in their second pregnancy. Both previous pregnancy loss and anti-CL antibody status should be considered in the analysis of pregnancy outcomes in women with SLE.

Antibodies, Anticardiolipin↗
PubMed2001

Clinical and pregnancy outcome following ectopic pregnancy; a prospective study comparing expectancy, surgery and systemic methotrexate treatment.

BACKGROUND: The improved possibility of an early diagnosis of ectopic pregnancy by use of serial quantitative beta-subunit human chorionic gonadotropin hormone levels together with transvaginal ultrasound has opened up options for conservative treatment. Systemic methotrexate treatment of unruptured ectopic pregnancy has emerged as a safe and effective alternative to surgical procedures. The aim of the present study was to investigate the effectiveness of methotrexate treatment in routine clinical practice, but also to assess pregnancy outcome during a 2.5-year follow-up period. METHODS: All patients presenting to the Department of Obstetrics and Gynecology, Umeå University Hospital, with signs and symptoms of ectopic pregnancy between January 1, 1995 and December 31, 1997 were included in this prospective study. Patients with ectopic pregnancy were either managed expectantly, treated with methotrexate or by laparoscopic or open surgery (salpingostomy/salpingectomy). Systemic methotrexate (Pharmacia & Upjohn, Stockholm, Sweden) was administered as an intramuscular injection of 50 mg/m(2). RESULTS: One hundred and seven patients presented with signs and symptoms of a possible ectopic pregnancy, of these 89 patients eventually were diagnosed as having an ectopic pregnancy. Twenty-six (29%) patients were treated with methotrexate, 46 (52%) patients with laparoscopy or laparotomy, and 17 (19%) patients by expectant management. Success rate in the methotrexate group, after one or more injections, was 77% (20 patients out of 26). The mean time to resolution was 24+/-9 days. There was no difference in pregnancy rate following methotrexate treatment compared to surgical treatment. CONCLUSIONS: Systemic single-dose methotrexate treatment is a safe treatment option with a reasonably high success rate, with similar probability of a later intrauterine pregnancy as conventional surgical treatment.

Abortifacient Agents, Nonsteroidal↗
PubMed1997

[The influence of chemical and physical factors in the work environment on the amount of risk for abnormal pregnancy outcome].

The authors present a review of the literature on adverse effects of chemical and physical factors in the work environment on the course and outcome of pregnancy together with the results of their own study. The objective of the study was to identify the magnitude and frequency of exposures to chemical and physical factors at workposts where pregnant women were employed and to asses to what extent the existing exposure increased the risk for complications in pregnancy outcome The study involved the collection of information on factors with potential adverse effect on the course and outcome of pregnancy in employed women who were hospitalised in the Polish Mother Memorial Hospital in Lódź during the years 1992-94. The study was carried out in the group of 526 women with abnormal pregnancy outcome (N), including preterm birth (PB)--256; low birth weight < 2500 g (LBW)--232; small for gestational age (SGA)--196; asphyxia (APG)--116; and congenital malformations (M)--71. The control group (C) was composed of 683 women. As the reports on the work environment indicated working conditions in the group of women with abnormal pregnancy outcome were worse than in the control group; the presence of potentially harmful factors in the work environment were reported 57% of women in group N and 51.2% of women in group C. The increase in the risk of abnormal pregnancy outcome was relatively law (OR = 1.26). Taken into account the duration of exposure to these factors (period of employment under conditions of exposure to physical and/or chemical factors) it was revealed that pregnancy is at risk if women continue to work under such work conditions by the end of the second trimester. In this group of women odd ratio for abnormal pregnancy outcome accounted for 1.80 and it was statistically significant. The employment in the period preceding pregnancy and during the first trimester enhanced the risk insignificantly. A similar situation was observed if the risk of abnormal pregnancy outcome was assessed separately for exposure to chemical factors and to physical factors. A conclusion of great practical importance can be then drawn: expecting mothers should be prevented from working under harmful work conditions after the first trimester of gestation. Therefore, doctors attending occupationally working pregnant women should be obliged to make very careful inquiries about their working conditions. Logistic regression analysis helped to reveal and adverse effect of physical factors only in regard to newborns' body weight, but if failed to show negative effect of chemical factors on pregnancy outcome. On the other hand, the analysis highlighted a significant influence on certain social situations, lifestyles and mothers' health status on pregnancy outcome; a positive effect of higher education in the case of preterm birth and asphyxia; and a negative effect of mother's single status, smoking during pregnancy and the poor health condition during pregnancy on the incidence of congenital malformations.

Asphyxia Neonatorum↗
PubMed1991

Multifetal reduction of triplets and pregnancy outcome.

Multifetal pregnancy reduction has been suggested as a strategy to improve pregnancy outcome in grand multiple gestations of three or more fetuses. We prospectively investigated multifetal pregnancy reduction in 13 women with triplet pregnancies in the first trimester following ovulation induction, in vitro fertilization, or gamete intrafallopian transfer procedures. Eleven women whose triplet pregnancies followed similar reproductive technologies and who declined or were not offered the procedure were managed expectantly. Mean (+/- standard deviation) infant birth weight was 2227 +/- 478 g in the multifetal reduction group and 2239 +/- 399 g in the group managed expectantly. Gestational age was 35.5 +/- 2.3 weeks in the study group and 35.7 +/- 2.5 weeks in the triplets managed expectantly. Newborn hospital days as well as newborn and maternal complications were not statistically different between the management groups. Maternal interventions included tocolytic medication, home uterine activity monitoring, and extended hospitalization, and were more common in the triplets managed expectantly than in the study group of triplets reduced to twins. Multifetal pregnancy reduction for triplet pregnancies does not necessarily improve pregnancy outcome, though it may be offered on the basis of parental choice.

Abortion, Induced↗
PubMed2000

Doppler ultrasound screening predicts recurrence of poor pregnancy outcome in subsequent pregnancies, but not the recurrence of PIH or preeclampsia.

OBJECTIVE: To assess the role of Doppler uterine artery screening in the prediction of recurring hypertensive disorders in a high-risk population. METHODS: Ninety-four women with a history of hypertensive disorders in previous pregnancies underwent ultrasound color Doppler to analyze blood flow in the uterine arteries at 21-22 weeks of gestation. We evaluated the performance of the Pulsatility Index (PI) as well as the diastolic notch to predict recurring hypertensive disorders. Outcome measures were the recurrence of hypertensive disorders, and poor pregnancy outcome due to intrauterine death growth retardation, intrauterine death, placental abruption, hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome, eclampsia, or premature birth. Onset of symptoms was before 35 weeks in all cases of poor pregnancy outcome. RESULTS: Doppler flow recordings were obtained from a well-defined location in both uterine arteries. The predictive value of the uterine artery PI for recurring hypertensive disease was poor and not significant; interestingly, however, the predictive values for poor pregnancy outcome were good (sensitivity 83%, specificity 71%, p < 0.001). The PI also provides a good test for intrauterine growth retardation (sensitivity 80%, specificity 69%, p < 0.01). The "diastolic notch" did not perform as well as the PI. CONCLUSIONS: Uterine artery screening did significantly predict the recurrence of poor pregnancy outcome due to hypertensive complications in this high-risk group. In contrast, gestational hypertension and preeclampsia with normal pregnancy outcome were not significantly predicted by uterine artery screening.

Adult↗