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Messias TS, Silva KCP, Silva TC, Soares S. Potential of Viruses as Environmental Etiological Factors for Non-Syndromic Orofacial Clefts. Viruses 2024; 16:511. [PMID: 38675854 PMCID: PMC11053622 DOI: 10.3390/v16040511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
In this study, we analyzed the potential of viral infections in the species Homo sapiens as environmental causes of orofacial clefts (OFCs). A scoring system was adapted for qualitatively assessing the potential of viruses to cause cleft lip and/or palate (CL/P). This assessment considered factors such as information from the literature, nucleotide and amino acid similarities, and the presence of Endogenous Viral Elements (EVEs). The analysis involved various algorithm packages within Basic Local Alignment Search Tool 2.13.0 software and databases from the National Center for Biotechnology Information and the International Committee on Taxonomy of Viruses. Twenty significant viral species using different biosynthesis strategies were identified: Human coronavirus NL63, Rio Negro virus, Alphatorquevirus homin9, Brisavirus, Cosavirus B, Torque teno mini virus 4, Bocaparvovirus primate2, Human coronavirus HKU1, Monkeypox virus, Mammarenavirus machupoense, Volepox virus, Souris mammarenavirus, Gammapapillomavirus 7, Betainfluenzavirus influenzae, Lymphocytic choriomeningitis mammarenavirus, Ledantevirus kern, Gammainfluenzavirus influenzae, Betapolyomavirus hominis, Vesiculovirus perinet, and Cytomegalovirus humanbeta5. The evident viral etiological potential in relation to CL/P varies depending on the Baltimore class to which the viral species belongs. Given the multifactorial nature of CL/P, this relationship appears to be dynamic.
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Affiliation(s)
- Thiago S. Messias
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru 17012-901, SP, Brazil; (T.S.M.); (K.C.P.S.)
| | - Kaique C. P. Silva
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru 17012-901, SP, Brazil; (T.S.M.); (K.C.P.S.)
- Faculty of Medicine, Nove de Julho University, Bauru 17011-102, SP, Brazil
| | - Thiago C. Silva
- Faculty of Architecture, Arts, Communication and Design, São Paulo State University, Bauru 17033-360, SP, Brazil;
| | - Simone Soares
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru 17012-901, SP, Brazil; (T.S.M.); (K.C.P.S.)
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of São Paulo, 9-75, Bauru 17012-901, SP, Brazil
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2
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Yates EF, Mulkey SB. Viral infections in pregnancy and impact on offspring neurodevelopment: mechanisms and lessons learned. Pediatr Res 2024:10.1038/s41390-024-03145-z. [PMID: 38509227 DOI: 10.1038/s41390-024-03145-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/28/2024] [Accepted: 03/04/2024] [Indexed: 03/22/2024]
Abstract
Pregnant individuals with viral illness may experience significant morbidity and have higher rates of pregnancy and neonatal complications. With the growing number of viral infections and new viral pandemics, it is important to examine the effects of infection during pregnancy on both the gestational parent and the offspring. Febrile illness and inflammation during pregnancy are correlated with risk for autism, attention deficit/hyperactivity disorder, and developmental delay in the offspring in human and animal models. Historical viral epidemics had limited follow-up of the offspring of affected pregnancies. Infants exposed to seasonal influenza and the 2009 H1N1 influenza virus experienced increased risks of congenital malformations and neuropsychiatric conditions. Zika virus exposure in utero can lead to a spectrum of abnormalities, ranging from severe microcephaly to neurodevelopmental delays which may appear later in childhood and in the absence of Zika-related birth defects. Vertical infection with severe acute respiratory syndrome coronavirus-2 has occurred rarely, but there appears to be a risk for developmental delays in the infants with antenatal exposure. Determining how illness from infection during pregnancy and specific viral pathogens can affect pregnancy and neurodevelopmental outcomes of offspring can better prepare the community to care for these children as they grow. IMPACT: Viral infections have impacted pregnant people and their offspring throughout history. Antenatal exposure to maternal fever and inflammation may increase risk of developmental and neurobehavioral disorders in infants and children. The recent SARS-CoV-2 pandemic stresses the importance of longitudinal studies to follow pregnancies and offspring neurodevelopment.
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Affiliation(s)
- Emma F Yates
- Frank H. Netter School of Medicine at Quinnipiac University, North Haven, CT, USA
| | - Sarah B Mulkey
- Children's National Hospital, Washington, DC, USA.
- Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
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3
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Patel J, Politis MD, Howley MM, Browne ML, Bolin EH, Ailes EC, Johnson CY, Magann E, Nembhard WN. Fever and antibiotic use in maternal urinary tract infections during pregnancy and risk of congenital heart defects: Findings from the National Birth Defects Prevention Study. Birth Defects Res 2024; 116:e2281. [PMID: 38093546 PMCID: PMC11071646 DOI: 10.1002/bdr2.2281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/21/2023] [Accepted: 11/22/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Previous studies report an association between prenatal maternal urinary tract infections (UTI) and specific congenital heart defects (CHDs); however, the role of fever and antibiotic use on this association is poorly understood. Using data from the National Birth Defects Prevention Study, we examined whether the relationship between maternal UTIs during the periconceptional period and occurrence of CHDs is modified by the presence of fever due to UTI and corresponding antibiotic use among 11,704 CHD case infants and 11,636 live-born control infants. METHODS Information on UTIs, fever associated with UTI and antibiotic use (sulfonamides, nitrofurantoin, cephalosporins, penicillin, macrolides, and quinolones) during pregnancy were obtained using a computer-assisted telephone interview. Using unconditional multivariable logistic regression, we calculated adjusted odds ratios (ORs) to determine the association between maternal UTIs and subtypes of CHDs. Analyses were stratified by the presence of fever and medication use associated with UTI. RESULTS The prevalence of UTIs during the periconceptional period was 7.6% in control mothers, and 8.7% in case mothers. In the absence of fever, UTI was associated with secundum atrial septal defects (ASD) (OR 1.3; 95% confidence interval [CI] 1.1-1.5) and in the absence of antibiotics, UTI was associated with conotruncal defects as a group and for four specific CHDs. When fever and UTI occurred concomitantly, no significantly elevated odds ratios were noticed for any subtypes of CHD. Among women with UTIs who used antibiotics, an elevated but statistically non-significant estimate was observed for secundum ASD (OR 1.4; 95% CI 1.0-2.0). CONCLUSION Findings in the present study suggest that fever due to UTI and corresponding maternal antibiotic use do not substantially modify the association between maternal UTIs and specific CHDs in offspring. Further studies with larger sample sizes are warranted to guide clinical management of UTIs during the periconceptional period.
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Affiliation(s)
- Jenil Patel
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, Texas, USA
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Arkansas Center for Birth Defects Research and Prevention, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Maria D. Politis
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Arkansas Center for Birth Defects Research and Prevention, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Meredith M. Howley
- Birth Defects Registry, New York State Department of Health, Albany, New York, USA
| | - Marilyn L. Browne
- Birth Defects Registry, New York State Department of Health, Albany, New York, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York, USA
| | - Elijah H. Bolin
- Department of Pediatrics, Section of Pediatric Cardiology, University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, Little Rock, Arkansas, USA
| | - Elizabeth C. Ailes
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Candice Y. Johnson
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
| | - Everett Magann
- Department of Obstetrics and Gynecology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Wendy N. Nembhard
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Arkansas Center for Birth Defects Research and Prevention, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Mátrai Á, Teutsch B, Pethő B, Kaposi AD, Hegyi P, Ács N. Reducing the Risk of Birth Defects Associated with Maternal Influenza: Insights from a Hungarian Case-Control Study. J Clin Med 2023; 12:6934. [PMID: 37959399 PMCID: PMC10650197 DOI: 10.3390/jcm12216934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/25/2023] [Accepted: 11/03/2023] [Indexed: 11/15/2023] Open
Abstract
Influenza viruses can cause several complications during pregnancy. Therefore, we aimed to investigate the effects of influenza on the development of congenital abnormalities (CAs) by analyzing the database of the Hungarian Case-Control Surveillance of Congenital Abnormalities (HCCSCA). In our multicenter, case-control, population-based study, we processed clinician-reported outcomes and diagnoses collected in the HCCSCA. The case group included newborns with different non-chromosomal birth defects, while the controls were newborns without CAs. Maternal influenza, as a risk factor for CAs, was analyzed by using a logistic regression model and odds ratios with 95% confidence intervals (CIs). Our results showed that maternal influenza in the first trimester was associated with increased odds of developing non-chromosomal CAs (OR: 1.41, CI: 1.28-1.55). There were increased odds of neural tube defects (OR: 2.22, CI: 1.78-2.76), orofacial clefts (OR: 2.28, CI: 1.87-2.78), and congenital heart defects (OR: 1.28, CI: 1.10-1.49) after influenza infection. In all cases, we found a protective effect of folic acid supplementation in the first trimester. In summary, the odds of non-chromosomal birth defects are higher after maternal influenza in the first trimester, and folic acid or pregnancy vitamin supplementation and antipyretic therapy may reduce the effect of maternal influenza during the first trimester.
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Affiliation(s)
- Ákos Mátrai
- Department of Obstetrics and Gynecology, Semmelweis University, 1082 Budapest, Hungary; (Á.M.); (B.P.)
- Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (B.T.); (P.H.)
| | - Brigitta Teutsch
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (B.T.); (P.H.)
- Institute for Translational Medicine, Medical School, University of Pécs, 7623 Pécs, Hungary
| | - Boglárka Pethő
- Department of Obstetrics and Gynecology, Semmelweis University, 1082 Budapest, Hungary; (Á.M.); (B.P.)
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (B.T.); (P.H.)
| | - András D. Kaposi
- Department of Biophysics and Radiation Biology, Semmelweis University School of Medicine, 1094 Budapest, Hungary;
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (B.T.); (P.H.)
- Institute for Translational Medicine, Medical School, University of Pécs, 7623 Pécs, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, 1083 Budapest, Hungary
| | - Nándor Ács
- Department of Obstetrics and Gynecology, Semmelweis University, 1082 Budapest, Hungary; (Á.M.); (B.P.)
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Dong J, Yin LL, Deng XD, Ji CY, Pan Q, Yang Z, Peng T, Wu JN. Initiation and duration of folic acid supplementation in preventing congenital malformations. BMC Med 2023; 21:292. [PMID: 37545008 PMCID: PMC10405478 DOI: 10.1186/s12916-023-03000-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/24/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Folic acid (FA) supplementation is associated with a lower risk of the neural tube and heart defects and is recommended for women of childbearing age. Although there are detailed recommendations, differences in the initiation time and duration of FA supplementation remain poorly studied. METHODS A multicentre prospective study of 17,713 women was conducted. The incidence of congenital malformations in women taking a recommended dosage (e.g. 0.4 or 0.8 mg/day) of FA was compared with that in women without supplementation. The predicted probability of malformations by the initiation time and duration of FA use was estimated to determine optimal options. RESULTS Periconceptional FA supplementation was associated with a lower and insignificant risk of congenital malformations (1.59% vs. 2.37%; odds ratio [OR] 0.69; 95% confidence interval [CI]: 0.44-1.08), heart defects (3.8 vs. 8.0 per 1000 infants; OR, 0.47; 0.21-1.02), and neural tube defects (7.0 vs. 11.5 per 10,000 infants; OR, 0.64; 0.08-5.15). FA use after pregnancy provided greater protection against total malformations. Statistically significant associations were found in women who initiated FA supplementation in the first month of gestation (OR, 0.55; 95% CI: 0.33-0.91) and in those who supplemented for 1 to 2 months (OR, 0.59; 95% CI: 0.36-0.98). Similar results were found for heart defects. The optimal initiation time was 1.5 (optimal range: 1.1 to 1.9) months before pregnancy and a duration of 4.0 (3.7 to 4.4) months was reasonable to achieve the lowest risk of congenital malformations. Heart defect prevention required an earlier initiation (2.2 vs. 1.1 months before pregnancy) and a longer duration (4.7 vs. 3.7 months) than the prevention of other malformations. CONCLUSIONS The timely initiation of FA supplementation for gestation was associated with a decreased risk of congenital malformations, which was mainly attributed to its protection against heart defects. The initiation of FA supplementation 1.5 months before conception with a duration of 4 months is the preferred option for congenital malformation prevention. TRIAL REGISTRATION Chictr.org.cn identifier: ChiCTR-SOC-17010976.
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Affiliation(s)
- Jing Dong
- Medical Center of Diagnosis and Treatment for Cervical Disease, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, China
| | - Lin-Liang Yin
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, 215006, China
| | - Xue-Dong Deng
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, 215006, China
| | - Chun-Ya Ji
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, 215006, China
| | - Qi Pan
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, 215006, China
| | - Zhong Yang
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, 215006, China
| | - Ting Peng
- Department of Obstetrics, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, China.
| | - Jiang-Nan Wu
- Department of Clinical Epidemiology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, China.
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Shi FP, Huang YY, Dai QQ, Chen YL, Jiang HY, Liang SY. Maternal Common Cold or Fever During Pregnancy and the Risk of Orofacial Clefts in the Offspring: A Systematic Review and Meta-analysis. Cleft Palate Craniofac J 2023; 60:446-453. [PMID: 34918551 DOI: 10.1177/10556656211067695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The common cold and/or an associated fever during pregnancy have/has been suspected to harm the developing fetus. We sought possible correlations between a maternal common cold or fever during pregnancy and the risk of orofacial clefts in the offspring. We systematically searched PubMed and Embase using appropriate keywords, and we checked the reference lists of retrieved articles. We used random-effects models to estimate overall relative risks. Incidence of orofacial clefts. We included 13 case-control studies. Modest but statistically significant associations were found between a maternal common cold and cleft lip with or without a cleft palate (CL/CP) (odds ratio [OR] 2.17; 95% confidence interval [CI] 1.66-2.83) and a cleft palate only (CPO) (OR 3.08; 95% CI 1.5-6.34). Furthermore, maternal fever was also associated with an increased risk of CL/CP (OR 1.91, 95% CI 1.3-2.8) and CPO (OR 1.48, 95% CI 0.83-2.63) in the offspring. Further analyses of maternal influenza (alone) yielded similar results. Although evidence of heterogeneity should be carefully evaluated, our findings suggest that maternal common cold or fever during pregnancy may be associated with a greater risk of CL/CP or CPO in the offspring. Future cohort studies using valid assessments of maternal common cold exposure during pregnancy that consider the severity of fever are needed to clarify the contribution of maternal common cold or fever status to the risk of orofacial clefts in children.
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Affiliation(s)
- Fang-Ping Shi
- Ningbo Urology and Nephrology Hospital, Ningbo, Zhejiang, China
| | - Ying-Ying Huang
- Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiao-Qun Dai
- Ningbo Urology and Nephrology Hospital, Ningbo, Zhejiang, China
| | - Yu-Lu Chen
- Ningbo Urology and Nephrology Hospital, Ningbo, Zhejiang, China
| | - Hai-Yin Jiang
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, 12377Zhejiang University, Hangzhou, Zhejiang, China
| | - Si-Yuan Liang
- Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Chughtai AA, He WQ, Liu B. Associations between severe and notifiable respiratory infections during the first trimester of pregnancy and congenital anomalies at birth: a register-based cohort study. BMC Pregnancy Childbirth 2023; 23:203. [PMID: 36964492 PMCID: PMC10037767 DOI: 10.1186/s12884-023-05514-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 03/13/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Evidence regarding the association between acute respiratory infections during pregnancy and congenital anomalies in babies, is limited and conflicting. The aim of this study was to examine the association between acute respiratory infections during the first trimester of pregnancy and congenital anomalies in babies using record linkage. METHODS We linked a perinatal register to hospitalisation and disease notifications in the Australian state of New South Wales (NSW) between 2001 to 2016. We quantified the risk of congenital anomalies, identified from the babies' linked hospital record in relation to notifiable respiratory and other infections during pregnancy using generalized Estimating Equations (GEE) adjusted for maternal sociodemographic and other characteristics. RESULTS Of 1,453,037 birth records identified from the perinatal register between 2001 and 2016, 11,710 (0.81%) mothers were hospitalised for acute respiratory infection, 2850 (0.20%) had influenza and 1011 (0.07%) had high risk infections (a record of cytomegalovirus, rubella, herpes simplex, herpes zoster, toxoplasmosis, syphilis, chickenpox (varicella) and zika) during the pregnancy. During the first trimester, acute respiratory infection, influenza and high-risk infections were reported by 1547 (0.11%), 399 (0.03%) and 129 (0.01%) mothers. There were 15,644 (1.08%) babies reported with major congenital anomalies, 2242 (0.15%) with cleft lip/ plate, 7770 (0.53%) with all major cardiovascular anomalies and 1746 (0.12%) with selected major cardiovascular anomalies. The rate of selected major cardiovascular anomalies was significantly higher if the mother had an acute respiratory infection during the first trimester of pregnancy (AOR 3.64, 95% CI 1.73 to 7.66). The rates of all major congenital anomalies and all major cardiovascular anomalies were also higher if the mother had an acute respiratory infection during the first trimester of pregnancy, however the difference was no statistically significant. Influenza during the first trimester was not associated with major congenital anomalies, selected major cardiovascular anomalies or all major cardiovascular anomalies in this study. CONCLUSION This large population-based study found severe acute respiratory infection in first trimester of pregnancy was associated with a higher risk of selected major cardiovascular anomalies in babies. These findings support measures to prevent acute respiratory infections in pregnant women including through vaccination.
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Affiliation(s)
- Abrar A Chughtai
- School of Population Health, University of New South Wales, Samuels Building, Kensington Campus, Sydney, NSW, 2052, Australia.
| | - Wen-Qiang He
- School of Population Health, University of New South Wales, Samuels Building, Kensington Campus, Sydney, NSW, 2052, Australia
| | - Bette Liu
- School of Population Health, University of New South Wales, Samuels Building, Kensington Campus, Sydney, NSW, 2052, Australia
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Chakraborty S, Chauhan A. Fighting the flu: a brief review on anti-influenza agents. Biotechnol Genet Eng Rev 2023:1-52. [PMID: 36946567 DOI: 10.1080/02648725.2023.2191081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
The influenza virus causes one of the most prevalent and lethal infectious viral diseases of the respiratory system; the disease progression varies from acute self-limiting mild fever to disease chronicity and death. Although both the preventive and treatment measures have been vital in protecting humans against seasonal epidemics or sporadic pandemics, there are several challenges to curb the influenza virus such as limited or poor cross-protection against circulating virus strains, moderate protection in immune-compromised patients, and rapid emergence of resistance. Currently, there are four US-FDA-approved anti-influenza drugs to treat flu infection, viz. Rapivab, Relenza, Tamiflu, and Xofluza. These drugs are classified based on their mode of action against the viral replication cycle with the first three being Neuraminidase inhibitors, and the fourth one targeting the viral polymerase. The emergence of the drug-resistant strains of influenza, however, underscores the need for continuous innovation towards development and discovery of new anti-influenza agents with enhanced antiviral effects, greater safety, and improved tolerability. Here in this review, we highlighted commercially available antiviral agents besides those that are at different stages of development including under clinical trials, with a brief account of their antiviral mechanisms.
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Affiliation(s)
| | - Ashwini Chauhan
- Department of Microbiology, Tripura University, Agartala, India
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Xu W, Li D, Shao Z, You Y, Pan F, Lou H, Li J, Jin Y, Wu T, Pan L, An J, Xu J, Cheng W, Tao L, Lei Y, Huang C, Shu Q. The prenatal weekly temperature exposure and neonatal congenital heart disease: a large population-based observational study in China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:38282-38291. [PMID: 36580248 PMCID: PMC9797890 DOI: 10.1007/s11356-022-24396-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/21/2022] [Indexed: 06/17/2023]
Abstract
We aim to explore the link between maternal weekly temperature exposure and CHD in offspring and identify the relative contributions from heat and cold and from moderate and extreme atmospheric temperature. From January 2019 to December 2020, newborns who were diagnosed with CHD by echocardiography in the Network Platform for Congenital Heart Disease (NPCHD) from 11 cities in eastern China were enrolled in the present study. We appraised the exposure lag response relationship between temperature and CHDs in the distributed lag nonlinear model and further probed the pooled estimates by multivariate meta-analysis. We further performed the exposure-response curves in extreme temperature (5th percentile for cold and 95th for hot events). We also delve into the cumulative risk ratios (CRRs) of temperature on CHDs in general and subgroups. In this study, 5904 of 983, 523 infants were diagnosed with CHDs. The temperature-CHD combination performed positive significance in two exposure windows, gestational weeks 10-16 and 26-31, and reached the maximum effect in the 28th week. Compared with extreme cold (5th, 6.14℃), these effects were higher in extreme heat (95th, 29.26℃). The cumulative exposure-response curve showed a steep nonlinear rise in the hot tail but showed non-significance at low temperatures. In this range, the CRRs of temperature showed an increment to a ceiling of 3.781 (95% CI: 1.460-10.723). The temperature- CHD curves for both sex groups showed a general growth trend. No statistical significance was observed between these two groups (P = 0.106). The cumulative effect of the temperature related CHD was significant in regions with lower education levels (maximum CRR was 9.282 (3.019-28.535)). A degree centigrade increase in temperature exposure was associated with the increment of CHD risk in the first and second trimesters, especially in extreme heat. Neonates born in lower education regions were more vulnerable to temperature-related CHDs.
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Affiliation(s)
- Weize Xu
- Department of Cardiac Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310000, China
| | - Die Li
- Department of Cardiac Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310000, China
| | - Zehua Shao
- Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, 450003, China
| | - Yanqin You
- Department of Obstetrics and Gynecology, First Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
| | - Feixia Pan
- Department of Cardiac Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310000, China
| | - Hongliang Lou
- Jinhua Maternal and Child Health Care Hospital, Jinhua, 321000, China
| | - Jing Li
- Jiaxing Maternity and Child Health Care Hospital, Jiaxing, 314000, China
| | - Yueqin Jin
- Shaoxing Maternity and Child Health Care Hospital, Shaoxing, 312000, China
| | - Ting Wu
- Hangzhou Women's Hospital, Hangzhou, 310000, China
| | - Lulu Pan
- Wenzhou Guidance Center for Maternity and Child Health, Wenzhou, 325000, China
| | - Jing An
- Huzhou Maternity and Child Health Care Hospital, Huzhou, 313000, China
| | - Junqiu Xu
- Zhoushan Women and Children Hospital, Zhoushan, 316000, China
| | - Wei Cheng
- Ningbo Women and Children Hospital, Ningbo, 315000, China
| | - Linghua Tao
- Taizhou Women and Children's Hospital, Taizhou, 318000, China
| | - Yongliang Lei
- Lishui Maternity and Child Health Care Hospital, Lishui, 323000, China
| | - Chengyin Huang
- Quzhou Maternity and Child Health Care Hospital, Quzhou, 324000, China
| | - Qiang Shu
- Department of Cardiac Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310000, China.
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Gershater E, Liu Y, Xue B, Shin MK, Koo H, Zheng Z, Li C. Characterizing the microbiota of cleft lip and palate patients: a comprehensive review. Front Cell Infect Microbiol 2023; 13:1159455. [PMID: 37143743 PMCID: PMC10152472 DOI: 10.3389/fcimb.2023.1159455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/31/2023] [Indexed: 05/06/2023] Open
Abstract
Orofacial cleft disorders, including cleft lip and/or palate (CL/P), are one of the most frequently-occurring congenital disorders worldwide. The health issues of patients with CL/P encompass far more than just their anatomic anomaly, as patients with CL/P are prone to having a high incidence of infectious diseases. While it has been previously established that the oral microbiome of patients with CL/P differs from that of unaffected patients, the exact nature of this variance, including the relevant bacterial species, has not been fully elucidated; likewise, examination of anatomic locations besides the cleft site has been neglected. Here, we intended to provide a comprehensive review to highlight the significant microbiota differences between CL/P patients and healthy subjects in various anatomic locations, including the teeth inside and adjacent to the cleft, oral cavity, nasal cavity, pharynx, and ear, as well as bodily fluids, secretions, and excretions. A number of bacterial and fungal species that have been proven to be pathogenic were found to be prevalently and/or specifically detected in CL/P patients, which can benefit the development of CL/P-specific microbiota management strategies.
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Affiliation(s)
| | - Yuan Liu
- Biofilm Research Laboratories, Levy Center for Oral Health, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Preventive and Restorative Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Binglan Xue
- School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Min Kyung Shin
- Department of Orthodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Hyun Koo
- Biofilm Research Laboratories, Levy Center for Oral Health, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Center for Innovation & Precision Dentistry, School of Dental Medicine and School of Engineering & Applied Sciences, University of Pennsylvania, Philadelphia, PA, United States
| | - Zhong Zheng
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- *Correspondence: Zhong Zheng, ; Chenshuang Li,
| | - Chenshuang Li
- Department of Orthodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, United States
- *Correspondence: Zhong Zheng, ; Chenshuang Li,
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11
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First-Trimester Influenza Infection Increases the Odds of Non-Chromosomal Birth Defects: A Systematic Review and Meta-Analysis. Viruses 2022; 14:v14122708. [PMID: 36560711 PMCID: PMC9781815 DOI: 10.3390/v14122708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/27/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Viral infections during pregnancy raise several clinical challenges, including birth defects in the offspring. Thus, this systematic review and meta-analysis aims to prove and highlight the risk of birth defects after first-trimester maternal influenza infection. Our systematic search was performed on 21 November 2022. Studies that reported maternal influenza infection in the first trimester and non-chromosomal congenital abnormalities were considered eligible. We used odds ratios (OR) with 95% confidence intervals (CIs) to measure the effect size. Pooled ORs were calculated with a random effects model. Heterogeneity was measured with I² and Cochran's Q tests. We found that first-trimester maternal influenza was associated with increased odds of developing any type of birth defects (OR: 1.5, CI: 1.30-1.70). Moreover, newborns were more than twice as likely to be diagnosed with neural tube defects (OR: 2.48, CI: 1.95-3.14) or cleft lip and palate (OR: 2.48, CI: 1.87-3.28). We also found increased odds of developing congenital heart defects (OR: 1.63, CI: 1.27-2.09). In conclusion, influenza increases the odds of non-chromosomal birth defects in the first trimester. The aim of the present study was to estimate the risk of CAs in the offspring of mothers affected by first-trimester influenza infection.
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12
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Boyd R, McMullen H, Beqaj H, Kalfa D. Environmental Exposures and Congenital Heart Disease. Pediatrics 2022; 149:183839. [PMID: 34972224 DOI: 10.1542/peds.2021-052151] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2021] [Indexed: 12/16/2022] Open
Abstract
Congenital heart disease (CHD) is the most common congenital abnormality worldwide, affecting 8 to 12 infants per 1000 births globally and causing >40% of prenatal deaths. However, its causes remain mainly unknown, with only up to 15% of CHD cases having a determined genetic cause. Exploring the complex relationship between genetics and environmental exposures is key in understanding the multifactorial nature of the development of CHD. Multiple population-level association studies have been conducted on maternal environmental exposures and their association with CHD, including evaluating the effect of maternal disease, medication exposure, environmental pollution, and tobacco and alcohol use on the incidence of CHD. However, these studies have been done in a siloed manner, with few examining the interplay between multiple environmental exposures. Here, we broadly and qualitatively review the current literature on maternal and paternal prenatal exposures and their association with CHD. We propose using the framework of the emerging field of the exposome, the environmental complement to the genome, to review all internal and external prenatal environmental exposures and identify potentiating or alleviating synergy between exposures. Finally, we propose mechanistic pathways through which susceptibility to development of CHD may be induced via the totality of prenatal environmental exposures, including the interplay between placental and cardiac development and the internal vasculature and placental morphology in early stages of pregnancy.
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13
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Li H, Long D, Lv G, Cheng X, Wang G, Yang X. The double-edged sword role of TGF-β signaling pathway between intrauterine inflammation and cranial neural crest development. FASEB J 2021; 36:e22113. [PMID: 34939699 DOI: 10.1096/fj.202101343r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/25/2021] [Accepted: 12/06/2021] [Indexed: 11/11/2022]
Abstract
Intrauterine infection would harm a developing embryo/fetus, thereby increasing the risk of developmental malformation. But, whether or not the infection-induced inflammation affects neural crest development still remains obscure. In this study, we employed meta-analysis to demonstrate the potential correlation between infection-induced inflammation and craniofacial anomalies, which was usually derived from the problems in neural crest cell development. The correlation was further verified by inflammatory cytokine release and the activation of nuclear factor kappa-light-chain enhancer of activated B cells signaling in lipopolysaccharide-treated HH10 chicken embryos. In such an inflammatory condition, AP-2α- and Pax7-labeled pre-migratory and migratory neural crest cells in HH10 chicken embryos were significantly less than the ones in control. The bioinformatics analysis of RNA-seq data demonstrated that the principal differential gene expression occurred in transforming growth factor-beta (TGF-β) signaling pathway, which was confirmed by the subsequent experimental results of quantitative PCR and immunofluorescent staining. Under this inflammatory circumstance, whole-mount in situ hybridization, immunofluorescence, and quantitative PCR showed the gene expression changes of key EMT-related transcription factors including upregulated Msx1, downregulated Slug, and FoxD3, as well as adhesion molecules and extracellular matrix protein including upregulated Cadherrin6B, E-cadherin, N-cadherin, and Laminin at the dorsal portion of neural tube of HH10 chicken embryos. Meanwhile, the bioinformatics analysis of RNA-seq data also manifested the differential gene expressions relevant to cell proliferation, which was confirmed by proliferating cell nuclear antigen Western blot data and co-immunofluorescence staining of human natural killer-1 and phosphorylated histone H3. In brief, this study revealed for the first time that the double-edged sword role of TGF-β signaling pathway between intrauterine inflammation (protective role) and cranial neural crest development (harmful role).
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Affiliation(s)
- Haiyang Li
- Division of Histology and Embryology, International Joint Laboratory for Embryonic Development & Prenatal Medicine, Medical College, Jinan University, Guangzhou, China
| | - Denglu Long
- Division of Histology and Embryology, International Joint Laboratory for Embryonic Development & Prenatal Medicine, Medical College, Jinan University, Guangzhou, China.,Medical Records Department, Quality and Safety Management Office, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Guohua Lv
- Division of Histology and Embryology, International Joint Laboratory for Embryonic Development & Prenatal Medicine, Medical College, Jinan University, Guangzhou, China
| | - Xin Cheng
- Division of Histology and Embryology, International Joint Laboratory for Embryonic Development & Prenatal Medicine, Medical College, Jinan University, Guangzhou, China
| | - Guang Wang
- Division of Histology and Embryology, International Joint Laboratory for Embryonic Development & Prenatal Medicine, Medical College, Jinan University, Guangzhou, China
| | - Xuesong Yang
- Division of Histology and Embryology, International Joint Laboratory for Embryonic Development & Prenatal Medicine, Medical College, Jinan University, Guangzhou, China.,Key Laboratory for Regenerative Medicine of the Ministry of Education, Jinan University, Guangzhou, China
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14
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Costantino C, Mazzucco W, Bonaccorso N, Cimino L, Conforto A, Sciortino M, Catalano G, D’Anna MR, Maiorana A, Venezia R, Corsello G, Vitale F. Educational Interventions on Pregnancy Vaccinations during Childbirth Classes Improves Vaccine Coverages among Pregnant Women in Palermo's Province. Vaccines (Basel) 2021; 9:vaccines9121455. [PMID: 34960202 PMCID: PMC8707644 DOI: 10.3390/vaccines9121455] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/02/2021] [Accepted: 12/06/2021] [Indexed: 12/02/2022] Open
Abstract
Maternal immunization is considered the best intervention in order to prevent influenza infection of pregnant women and influenza and pertussis infection of newborns. Despite the existing recommendations, vaccination coverage rates in Italy remain very low. Starting from August 2018, maternal immunization against influenza and diphtheria-tetanus-pertussis were strongly recommended by the Italian Ministry of Health. We conducted a cross sectional study to estimate the effectiveness of an educational intervention, conducted during childbirth classes in three general hospitals in the Palermo metropolitan area, Italy, on vaccination adherence during pregnancy. To this end, a questionnaire on knowledge, attitudes, and immunization practices was structured and self-administered to a sample of pregnant women attending childbirth classes. Then, an educational intervention on maternal immunization, followed by a counseling, was conducted by a Public Health medical doctor. After 30 days following the interventions, the adherence to the recommended vaccinations (influenza and pertussis) was evaluated. At the end of the study 326 women were enrolled and 201 responded to the follow-up survey. After the intervention, among the responding pregnant women 47.8% received influenza vaccination (+44.8%), 57.7% diphtheria-tetanus-pertussis vaccination (+50.7%) and 64.2% both the recommended vaccinations (+54.8%). A significant association was found between pregnant women that received at least one vaccination during pregnancy and higher educational level (graduation degree/master’s degree), employment status (employed part/full-time) and influenza vaccination adherence during past seasons (at least one during last five years). The implementation of vaccination educational interventions, including counseling by healthcare professionals (HCPs), on maternal immunization during childbirth courses improved considerably the vaccination adherence during pregnancy.
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Affiliation(s)
- Claudio Costantino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (W.M.); (N.B.); (L.C.); (A.C.); (M.S.); (G.C.); (R.V.); (G.C.); (F.V.)
- Correspondence:
| | - Walter Mazzucco
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (W.M.); (N.B.); (L.C.); (A.C.); (M.S.); (G.C.); (R.V.); (G.C.); (F.V.)
| | - Nicole Bonaccorso
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (W.M.); (N.B.); (L.C.); (A.C.); (M.S.); (G.C.); (R.V.); (G.C.); (F.V.)
| | - Livia Cimino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (W.M.); (N.B.); (L.C.); (A.C.); (M.S.); (G.C.); (R.V.); (G.C.); (F.V.)
| | - Arianna Conforto
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (W.M.); (N.B.); (L.C.); (A.C.); (M.S.); (G.C.); (R.V.); (G.C.); (F.V.)
| | - Martina Sciortino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (W.M.); (N.B.); (L.C.); (A.C.); (M.S.); (G.C.); (R.V.); (G.C.); (F.V.)
| | - Gabriele Catalano
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (W.M.); (N.B.); (L.C.); (A.C.); (M.S.); (G.C.); (R.V.); (G.C.); (F.V.)
| | - Maria Rosa D’Anna
- HCU Obstetrics and Gynecology, Buccheri La Ferla—Fatebenefratelli Hospital, 90100 Palermo, Italy;
| | - Antonio Maiorana
- HCU Obstetrics and Gynecology, ARNAS Ospedale Civico Di Cristina-Benfratelli Hospital, 90127 Palermo, Italy;
| | - Renato Venezia
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (W.M.); (N.B.); (L.C.); (A.C.); (M.S.); (G.C.); (R.V.); (G.C.); (F.V.)
| | - Giovanni Corsello
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (W.M.); (N.B.); (L.C.); (A.C.); (M.S.); (G.C.); (R.V.); (G.C.); (F.V.)
| | - Francesco Vitale
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (W.M.); (N.B.); (L.C.); (A.C.); (M.S.); (G.C.); (R.V.); (G.C.); (F.V.)
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15
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Orefice R, Quinlivan JA. Improving vaccination of pregnant women against seasonal influenza through use of a mandatory field in the obstetric electronic medical record. J Public Health (Oxf) 2021; 43:420-424. [PMID: 31774534 DOI: 10.1093/pubmed/fdz099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 07/12/2019] [Accepted: 07/24/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim of the present study was to determine whether using a mandatory data field in an electronic health record would increase compliance with the recommendation to vaccinate pregnant women against influenza. METHODS Two cohorts of women who delivered at the Centenary Hospital for Women and Children between 1-31 July 2015 and 1-31 July 2017 were compared for compliance with the national public health recommendation to vaccinate all pregnant women against influenza. The single change between audit periods was programming the electronic health record to include a mandatory field preventing clinicians from closing patient files unless they selected an answer to the question asking whether influenza vaccination had been performed. Data were audited and compliance rates were compared. RESULTS A total of 275 and 299 women delivered in the two audit periods. There were no significant differences in maternal or neonatal characteristics between the two cohorts except for maternal age, which was younger in the second period (33.3 versus 31.5 years; P = 0.001). Vaccination rates doubled between audit periods (35.0% versus 79.8%, P < 0.0001). CONCLUSION Introducing a mandatory data field into an electronic health record system may increase compliance with public health interventions, such as influenza vaccination in pregnant women.
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Affiliation(s)
- Roberto Orefice
- Department of Obstetrics and Gynaecology, Centenary Hospital for Women and Children, Garran, ACT 2605, Australia
| | - Julie A Quinlivan
- Department of Obstetrics and Gynaecology, Centenary Hospital for Women and Children, Garran, ACT 2605, Australia.,School of Medicine, Australian National University, Canberra, ACT 2600, Australia.,Institute for Health Research, University of Notre Dame Australia, Fremantle, WA 6160, Australia
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16
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Mate A, Reyes-Goya C, Santana-Garrido Á, Sobrevia L, Vázquez CM. Impact of maternal nutrition in viral infections during pregnancy. Biochim Biophys Acta Mol Basis Dis 2021; 1867:166231. [PMID: 34343638 PMCID: PMC8325560 DOI: 10.1016/j.bbadis.2021.166231] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 07/05/2021] [Accepted: 07/23/2021] [Indexed: 12/11/2022]
Abstract
Other than being a physiological process, pregnancy is a condition characterized by major adaptations of maternal endocrine and metabolic homeostasis that are necessary to accommodate the fetoplacental unit. Unfortunately, all these systemic, cellular, and molecular changes in maternal physiology also make the mother and the fetus more prone to adverse outcomes, including numerous alterations arising from viral infections. Common infections during pregnancy that have long been recognized as congenitally and perinatally transmissible to newborns include toxoplasmosis, rubella, cytomegalovirus, and herpes simplex viruses (originally coined as ToRCH infections). In addition, enterovirus, parvovirus B19, hepatitis virus, varicella-zoster virus, human immunodeficiency virus, Zika and Dengue virus, and, more recently, coronavirus infections including Middle Eastern respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS) infections (especially the novel SARS-CoV-2 responsible for the ongoing COVID-19 pandemic), constitute relevant targets for current research on maternal-fetal interactions in viral infections during pregnancy. Appropriate maternal education from preconception to the early postnatal period is crucial to promote healthy pregnancies in general and to prevent and/or reduce the impact of viral infections in particular. Specifically, an adequate lifestyle based on proper nutrition plans and feeding interventions, whenever possible, might be crucial to reduce the risk of virus-related gestational diseases and accompanying complications in later life. Here we aim to provide an overview of the emerging literature addressing the impact of nutrition in the context of potentially harmful viral infections during pregnancy.
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Affiliation(s)
- Alfonso Mate
- Departamento de Fisiología, Facultad de Farmacia, Universidad de Sevilla, 41012 Sevilla, Spain; Epidemiología Clínica y Riesgo Cardiovascular, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain.
| | - Claudia Reyes-Goya
- Departamento de Fisiología, Facultad de Farmacia, Universidad de Sevilla, 41012 Sevilla, Spain
| | - Álvaro Santana-Garrido
- Departamento de Fisiología, Facultad de Farmacia, Universidad de Sevilla, 41012 Sevilla, Spain; Epidemiología Clínica y Riesgo Cardiovascular, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain
| | - Luis Sobrevia
- Departamento de Fisiología, Facultad de Farmacia, Universidad de Sevilla, 41012 Sevilla, Spain; Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Medical School (Faculty of Medicine), São Paulo State University (UNESP), Brazil; University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston, QLD 4029, Australia; Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen (UMCG), 9713GZ Groningen, the Netherlands
| | - Carmen M Vázquez
- Departamento de Fisiología, Facultad de Farmacia, Universidad de Sevilla, 41012 Sevilla, Spain; Epidemiología Clínica y Riesgo Cardiovascular, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain
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17
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Graham JM. Update on the gestational effects of maternal hyperthermia. Birth Defects Res 2021; 112:943-952. [PMID: 32686349 DOI: 10.1002/bdr2.1696] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 04/14/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVES I plan to review the types of defects caused by gestational hyperthermia. Hyperthermia-induced malformations in animals and humans involve many organs and structures, particularly the central nervous system, as well as other defects. The type of defect is related to the timing of the hyperthermic insult, and the underlying mechanisms include cell death, membrane disruption, vascular disruption, and placental infarction. METHODS Review of recent epidemiologic studies (2005-2020) has confirmed an association between gestational hyperthermia and birth defects. RESULTS There are strong associations between neural tube defects and maternal fever, and other studies have demonstrated associations between first trimester hyperthermia and an increased risk for cardiovascular defects, oral clefts, isolated congenital ear defects, cataracts, hypospadias, renal anomalies, possibly anorectal malformations, and congenital anomalies in general, suggesting that this association between maternal hyperthermia and birth defects in humans is causal. The first prospective evaluation of maternal fever was reported in 1998, and this study confirmed findings from previous case-control studies and case series regarding the magnitude and duration of elevated maternal body temperature in relation to an increased risk for neural tube defects as well as a specific pattern of malformation. CONCLUSIONS The consistency of findings across these different study designs supports the causal nature of the relationship between maternal fever and specific birth defects. This review summarizes the recent human evidence documenting the gestational effects of maternal hyperthermia.
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Affiliation(s)
- John M Graham
- Clinical Genetics and Dysmorphology, Cedars-Sinai Medical Center and Harbor-UCLA Medical Center, Professor Emeritus of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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18
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Chow EJ, Beigi RH, Riley LE, Uyeki TM. Clinical Effectiveness and Safety of Antivirals for Influenza in Pregnancy. Open Forum Infect Dis 2021; 8:ofab138. [PMID: 34189160 DOI: 10.1093/ofid/ofab138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/19/2021] [Indexed: 11/14/2022] Open
Abstract
Seasonal influenza epidemics result in substantial health care burden annually. Early initiation of antiviral treatment of influenza has been shown to reduce the risk of complications and duration of illness. Pregnant and postpartum women may be at increased risk for influenza-associated complications; however, pregnant women have been generally excluded from clinical trials of antiviral treatment of influenza. In this review, we summarize the available evidence on the clinical effectiveness and safety of antiviral treatment of pregnant women with influenza. Observational data show a reduction of severe outcomes when pregnant and postpartum women are treated with oseltamivir and other neuraminidase inhibitors without increased risk of adverse maternal, fetal, or neonatal outcomes. Due to lack of safety and efficacy data for baloxavir treatment of pregnant and postpartum women, baloxavir is currently not recommended for use in these populations.
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Affiliation(s)
- Eric J Chow
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Richard H Beigi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,University of Pittsburgh Magee-Womens Hospital, Pittsburgh, Pennsylvania, USA
| | - Laura E Riley
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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19
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Yang G, Deng X, Xiao J, Huang P, Zhang K, Li Y. Maternal fever during preconception and conception is associated with congenital heart diseases in offspring: An updated meta-analysis of observational studies. Medicine (Baltimore) 2021; 100:e24899. [PMID: 33655950 PMCID: PMC7939217 DOI: 10.1097/md.0000000000024899] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 02/01/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUNDS Many studies have evaluated the effect of maternal fever on the development risk of congenital heart diseases (CHDs) in offspring, but the findings were inconsistent. Furthermore, a complete overview of the existing data was also missing. Therefore, we intend to provide updated epidemiologic evidence to estimate the association between maternal fever and the risk of overall CHDs and specific CHD phenotypes in offspring. METHODS Pubmed, Embase, and Web of Science were searched through March 2020 to identify eligible studies that assessed the association between maternal fever and CHDs risk in offspring. The summary risk estimates were calculated using random-effects models. Potential heterogeneity source was explored by subgroup analyses and potential publication bias was assessed by Begg funnel plots and Begg rank correlation test. RESULTS Sixteen studies involving 31,922 CHDs cases among 183,563 participants were included in this meta-analysis. Overall, mothers who had a fever experience during preconception and conception periods had a significantly higher risk of overall CHDs in offspring (odds ratio [OR] = 1.45, 95% confidence interval [CI]: 1.21-1.73) when compared with those who did not have a fever experience. For specific CHD phenotypes in offspring, a statistically significant association was found between maternal fever and risk of conotruncal defects (CTD) (OR = 1.38, 95%CI: 1.01-1.89), atrial septal defects (ASD) (OR = 1.48, 95% CI: 1.01-2.17), transposition of the great vessels (TGA) (OR = 1.81, 95% CI: 1.14-2.88), and right ventricular outflow tract obstruction (RVOTO) (OR = 1.66, 95% CI: 1.04-2.65). Relevant heterogeneity moderators have been identified by subgroup analyses, and sensitivity analyses yielded consistent results. CONCLUSIONS Although the role of potential bias and evidence of heterogeneity should be carefully evaluated, our review indicates that maternal fever is significantly associated with the risk of CHDs in offspring, which highlights that preventing maternal fever during the preconception and conception periods play an important role in decreasing the risk of CHDs in offspring. However, given the limited number of current case-control studies, larger-sample prospective studies are required to further confirm our results. Besides, due to the underlying mechanisms between maternal fever and the risk of specific CHD phenotypes in offspring are still unreported, more research is needed to explore the possible mechanisms.
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Affiliation(s)
- Guihong Yang
- Department of Cardiothoracic Surgery, Hunan Children's Hospital
| | - Xicheng Deng
- Department of Cardiothoracic Surgery, Hunan Children's Hospital
| | - Jianfeng Xiao
- Department of Clinical Laboratory, Geological Mining Hospital of Hunan Province, Changsha, Hunan, China
| | - Peng Huang
- Department of Cardiothoracic Surgery, Hunan Children's Hospital
| | - Kai Zhang
- Department of Cardiothoracic Surgery, Hunan Children's Hospital
| | - Yunfei Li
- Department of Cardiothoracic Surgery, Hunan Children's Hospital
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20
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Orgul G, Keles AI, Yucel A, Sahin D. The Rate of Influenza Vaccination after Face-to-Face Interview in Pregnancy. Z Geburtshilfe Neonatol 2021; 225:423-427. [PMID: 33461221 DOI: 10.1055/a-1332-2623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Most societies recommend routine influenza vaccine to all pregnant women. In Turkey, the Ministry of Health provides the influenza vaccine free of charge to pregnant women during the second and third trimesters. Pregnant women may not be willing to accept vaccination despite their knowledge and attitudes. We aimed to investigate the rate and determining factors of influenza vaccine acceptance after receipt of face-to-face information. METHODS Pregnant women were informed about the benefits of the influenza vaccine and asked if they would get the vaccine. RESULTS A total of 353 Turkish women were involved, and 191 (54.1%) accepted influenza vaccination. There was no statistically significant difference in terms of maternal age, body mass index, gravida, number of children, socioeconomic status, smoking and occupation between groups. Women in the third trimester had lower vaccination rates compared to first- and second-trimester pregnancies (35.7% vs. 67.7-64.2%). Women with at least a university degree also had lower vaccine uptake rates (58.1% vs. 59.5-36.8%). While 82.2% of women who accepted vaccination believed the benefit of the vaccine to the baby, the rate was 54.9% in the non-vaccinated group. The most common reason for refusal was the belief that influenza was not a serious disease. Vaccination uptake was higher especially for women who understood the benefits of the influenza vaccine for the baby (OR=3.79, 95%Cl=2.34-6.14). CONCLUSION Women who had enough information, who had a lower education level, who had a previous history of influenza infection, and who had decided to have their babies vaccinated were more likely to accept influenza vaccine.
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Affiliation(s)
- Gokcen Orgul
- Department of Perinatology, Etlik Zubeyde Hanim Women's Health Care, Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ayse Istek Keles
- Department of Perinatology, Etlik Zubeyde Hanim Women's Health Care, Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Aykan Yucel
- Department of Perinatology, Etlik Zubeyde Hanim Women's Health Care, Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Dilek Sahin
- Department of Perinatology, Etlik Zubeyde Hanim Women's Health Care, Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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21
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Garland MA, Reynolds K, Zhou CJ. Environmental mechanisms of orofacial clefts. Birth Defects Res 2020; 112:1660-1698. [PMID: 33125192 PMCID: PMC7902093 DOI: 10.1002/bdr2.1830] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 10/07/2020] [Accepted: 10/13/2020] [Indexed: 12/11/2022]
Abstract
Orofacial clefts (OFCs) are among the most common birth defects and impart a significant burden on afflicted individuals and their families. It is increasingly understood that many nonsyndromic OFCs are a consequence of extrinsic factors, genetic susceptibilities, and interactions of the two. Therefore, understanding the environmental mechanisms of OFCs is important in the prevention of future cases. This review examines the molecular mechanisms associated with environmental factors that either protect against or increase the risk of OFCs. We focus on essential metabolic pathways, environmental signaling mechanisms, detoxification pathways, behavioral risk factors, and biological hazards that may disrupt orofacial development.
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Affiliation(s)
- Michael A. Garland
- Department of Biochemistry and Molecular Medicine, University of California at Davis, School of Medicine, Sacramento, CA 95817
- Institute for Pediatric Regenerative Medicine of Shriners Hospitals for Children, University of California at Davis, School of Medicine, Sacramento, CA 95817
| | - Kurt Reynolds
- Department of Biochemistry and Molecular Medicine, University of California at Davis, School of Medicine, Sacramento, CA 95817
- Institute for Pediatric Regenerative Medicine of Shriners Hospitals for Children, University of California at Davis, School of Medicine, Sacramento, CA 95817
- Biochemistry, Molecular, Cellular, and Developmental Biology (BMCDB) graduate group, University of California, Davis, CA 95616
| | - Chengji J. Zhou
- Department of Biochemistry and Molecular Medicine, University of California at Davis, School of Medicine, Sacramento, CA 95817
- Institute for Pediatric Regenerative Medicine of Shriners Hospitals for Children, University of California at Davis, School of Medicine, Sacramento, CA 95817
- Biochemistry, Molecular, Cellular, and Developmental Biology (BMCDB) graduate group, University of California, Davis, CA 95616
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22
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Nie Z, Qu Y, Han F, Bell EM, Zhuang J, Chen J, François M, Lipton E, Matale R, Cui W, Liang Q, Lu X, Huang H, Lv J, Ou Y, Mai J, Wu Y, Gao X, Huang Y, Lin S, Liu X. Evaluation of interactive effects between paternal alcohol consumption and paternal socioeconomic status and environmental exposures on congenital heart defects. Birth Defects Res 2020; 112:1273-1286. [PMID: 32696579 DOI: 10.1002/bdr2.1759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND While the maternal risk factors on congenital heart defects (CHDs) have often been assessed, paternal contribution to CHDs, especially the joint effects of paternal risk factors on CHDs remain unknown. This study examined the major impacts of paternal alcohol consumption and its interaction (on multiplicative and additive scales) with paternal socioeconomic status (SES) and environmental exposures on CHDs in China. METHODS A population-based case-control study involving 4,726 singleton CHDs cases and 4,726 controls (without any malformation and matched on hospital, gender, and gestational age) was conducted in Guangdong, China, 2004-2014. Information on parental demographics, behavioral patterns, disease/medication, and environmental exposures (3 months before pregnancy) was collected through face-to-face interviews. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) while controlling for all parental factors. RESULTS Paternal alcohol consumption was associated with an increased OR of CHDs (adjusted OR = 2.87, 95% CI: 2.25-3.65). Additionally, paternal smoking, industry occupation, organic solvent contact, virus infection and antibiotic use, living in rural areas, low household income, and migrant status were significantly associated with CHDs (ORs ranged: 1.42-4.44). Significant additive or multiplicative interactions were observed between paternal alcohol consumption and paternal smoking, industrial occupation, and low income on any CHDs (interaction contrast ratio [ICR] = 4.72, 95% CI: 0.96-8.47] and septal defects (ICRs ranged from 2.04 to 2.79, p < .05). CONCLUSIONS Paternal alcohol consumption and multiple paternal factors were significantly associated with CHDs in China. Paternal smoking and low SES factors modified paternal alcohol consumption-CHDs relationships. Further studies are needed to confirm these findings.
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Affiliation(s)
- Zhiqiang Nie
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Yanji Qu
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Fengzhen Han
- Department of Obstetrics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Erin M Bell
- Department of Environmental Health Sciences, University at Albany, State University of New York, Albany, New York, USA.,Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Albany, New York, USA
| | - Jian Zhuang
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Jimei Chen
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Melissa François
- Department of Environmental Health Sciences, University at Albany, State University of New York, Albany, New York, USA.,Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Albany, New York, USA
| | - Emily Lipton
- Department of Environmental Health Sciences, University at Albany, State University of New York, Albany, New York, USA.,Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Albany, New York, USA
| | - Rosemary Matale
- Department of Environmental Health Sciences, University at Albany, State University of New York, Albany, New York, USA.,Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Albany, New York, USA
| | - Weilun Cui
- Department of Neonatology, Panyu General Hospital, Guangzhou, Guangdong, China
| | - Qianhong Liang
- Department of Echocardiography, Panyu Maternal and Child Care Service Centre, Guangzhou, Guangdong, China
| | - Xiangzhang Lu
- Department of Echocardiography, Huadu Maternal and Child Care Service Centre, Guangzhou, Guangdong, China
| | - Huiwen Huang
- Department of Neonatology, Zhuhai Maternal and Child Care Service Center, Zhuhai, Guangdong, China
| | - Junfeng Lv
- Department of Neonatology, Boai Hospital of Zhongshan, Zhongshan, Guangdong, China
| | - Yanqiu Ou
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Jinzhuang Mai
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Yong Wu
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Xiangmin Gao
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Yating Huang
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Shao Lin
- Department of Environmental Health Sciences, University at Albany, State University of New York, Albany, New York, USA.,Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Albany, New York, USA
| | - Xiaoqing Liu
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
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23
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Xia YQ, Zhao KN, Zhao AD, Zhu JZ, Hong HF, Wang YL, Li SH. Associations of maternal upper respiratory tract infection/influenza during early pregnancy with congenital heart disease in offspring: evidence from a case-control study and meta-analysis. BMC Cardiovasc Disord 2019; 19:277. [PMID: 31791237 PMCID: PMC6889668 DOI: 10.1186/s12872-019-1206-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 09/24/2019] [Indexed: 01/04/2023] Open
Abstract
Background Evidences regarding the associations between maternal upper respiratory tract infection/influenza during pregnancy and the risk of congenital heart disease (CHD) is still controversial. This study was specifically designed to examine the associations by a case-control study and a meta-analysis of the published evidences and our finding. Methods A hospital-based case-control study involving 262 children with simple CHD and 262 children with complex CHD, along with 262 control children, was conducted through June, 2016 to December, 2017. All children were aged 0–2 years old. Furthermore, a meta-analysis based on both previously published studies and our case-control study was performed. Results In the case-control study, after adjusting for possible confounders, maternal upper respiratory tract infection/influenza during early pregnancy was found to be related to an increased risk of CHD (OR = 3.40 and 95% CI: 2.05–5.62 for simple CHD; OR = 2.39 and 95% CI: 1.47–3.88 for complex CHD). After a meta-analysis, the adverse impact was still kept significant (OR = 1.47 and 95% CI: 1.28–1.67 for simple CHD; OR = 1.44 and 95% CI: 1.14–1.75 for complex CHD). The very similar associations were also observed among single type of CHD, herein, ventricular septal defects (VSD) and tetralogy of fallot (TOF) in the case-control study. In the subsequent meta-analysis, however, the significant association only existed in VSD. Conclusions Although there is still conflicting in TOF, the results are overall consistent, which provide new enforced evidence that maternal upper respiratory tract infection/influenza during early pregnancy, in general, play an important role in the occurrence of CHD.
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Affiliation(s)
- Y Q Xia
- School of Public Health, Shanghai Jiao Tong University, 227 South Chongqing Road, Huangpu District, Shanghai, 200025, China
| | - K N Zhao
- School of Public Health, Shanghai Jiao Tong University, 227 South Chongqing Road, Huangpu District, Shanghai, 200025, China
| | - A D Zhao
- School of Public Health, Shanghai Jiao Tong University, 227 South Chongqing Road, Huangpu District, Shanghai, 200025, China
| | - J Z Zhu
- China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China
| | - H F Hong
- Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Y L Wang
- Prenatal Diagnosis Department, International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, 910 Hengshan Road, Xuhui District, Shanghai, 200030, China.
| | - S H Li
- School of Public Health, Shanghai Jiao Tong University, 227 South Chongqing Road, Huangpu District, Shanghai, 200025, China.
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24
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Van Bennekom CM, Kerr SM, Mitchell AA. Oseltamivir exposure in pregnancy and the risk of specific birth defects. Birth Defects Res 2019; 111:1479-1486. [PMID: 31397115 DOI: 10.1002/bdr2.1563] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 07/19/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Influenza during pregnancy contributes to maternal morbidity and mortality. Neuraminidase inhibitors, including oseltamivir, are recommended for treating women with influenza during pregnancy. METHODS Data from the Slone Birth Defects Study from 2009 to 2015 were used to investigate associations between oseltamivir and specific birth defects. We classified exposures according to timing in pregnancy and examined 52 and 16 defects with early and potential late pregnancy etiology, respectively; we calculated crude odds ratios (ORs) and 95% confidence intervals (CIs) for defects with three or more exposures. RESULTS Among 8,379 cases and 4,190 nonmalformed controls, we identified 79 and 42 oseltamivir exposures, respectively. The majority of defects had no exposures. ORs were elevated for several defects, but the CI excluded the null only for intestinal malrotation (OR: 10.7 [1.8, 45.2]; three exposures). CONCLUSIONS Largely null findings for specific defects are reassuring. The association with intestinal malrotation, while unstable, warrants further investigation.
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Affiliation(s)
| | - Stephen M Kerr
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | - Allen A Mitchell
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
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25
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Lai T, Xiang L, Liu Z, Mu Y, Li X, Li N, Li S, Chen X, Yang J, Tao J, Zhu J. Association of maternal disease and medication use with the risk of congenital heart defects in offspring: a case-control study using logistic regression with a random-effects model. J Perinat Med 2019; 47:455-463. [PMID: 30794526 DOI: 10.1515/jpm-2018-0281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 01/21/2019] [Indexed: 01/29/2023]
Abstract
Objective To examine the association between maternal diseases and congenital heart defects (CHDs) and to evaluate whether those associations vary with corresponding medication use. Methods A multi-hospital case-control study conducted from February 2010 to December 2014 analysed 916 controls and 1236 cases. Participating mothers were asked whether they suffered from influenza, common cold, herpes and threatened abortion or had used corresponding medication during the periconception period or the early pregnancy period. We used a random-effects logistic regression model to compute the odds ratios (ORs), adjusted odds ratios (AORs) and 95% confidence intervals (CIs) while controlling for potential confounders. Results Compared with the results for mothers with no exposure, there were significant associations between maternal diseases with medication non-use and CHDs in the aggregate, including influenza (AOR, 1.83; 95% CI, 1.13-2.95), common cold (AOR, 2.05; 95% CI, 1.60-2.64) and herpes (AOR, 7.00; 95% CI, 2.15-22.84). There was no significant association between medication users and offspring with any subtype of CHDs, except that maternal common cold with medication use slightly increased the risk of the specific subtype, namely, isolated cardiac defects. However, an association was observed between maternal threatened abortion and medication and isolated cardiac defects (AOR, 1.33; 95% CI, 1.01-1.75). Conclusion Maternal influenza, common cold, herpes and threatened abortion from 3 months before pregnancy through the first trimester were associated with an increased risk of congenital heart disease in offspring. The teratogenic effect of these conditions may be attenuated by medication use, except for threatened abortion.
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Affiliation(s)
- Ting Lai
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Liangcheng Xiang
- National Center for Birth Defect Monitoring, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Zhen Liu
- National Center for Birth Defect Monitoring, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sec. 3 No. 17, South RenMin Road, Chengdu, Sichuan, P.R. China
| | - Yi Mu
- National Center for Birth Defect Monitoring, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Xiaohong Li
- National Center for Birth Defect Monitoring, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Nana Li
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sec. 3 No. 17, South RenMin Road, Chengdu, Sichuan, P.R. China
| | - Shengli Li
- Department of Ultrasound, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, P.R. China
| | - Xinlin Chen
- Department of Ultrasound, Hubei Maternity and Child Healthcare Hospital, Wuhan, Hubei, P.R. China
| | - Jiaxiang Yang
- Department of Ultrasound, Sichuan Maternity and Child Healthcare Hospital, Chengdu, P.R. China
| | - Jing Tao
- National Center for Birth Defect Monitoring, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China, Tel.: +86-028-85501362
| | - Jun Zhu
- National Center for Birth Defect Monitoring, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sec. 3 No. 17, South RenMin Road, Chengdu, Sichuan 610041, P.R. China, Tel.: +86-028-85503121
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26
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Ye Z, Wang L, Yang T, Chen L, Wang T, Chen L, Zhao L, Zhang S, Zheng Z, Luo L, Qin J. Maternal Viral Infection and Risk of Fetal Congenital Heart Diseases: A Meta-Analysis of Observational Studies. J Am Heart Assoc 2019; 8:e011264. [PMID: 30995883 PMCID: PMC6512143 DOI: 10.1161/jaha.118.011264] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 03/25/2019] [Indexed: 12/20/2022]
Abstract
Background At present, the association between maternal viral infection and risk of congenital heart diseases ( CHD ) in offspring is uncertain; additionally, a complete overview is missing. A meta-analysis of observational studies was performed to address the question of whether women who had a history of viral infection in early pregnancy were at an increased risk of CHD in offspring, compared with mothers without viral infection. Methods and Results Unrestricted searches were conducted, with an end date parameter of July 15, 2018, of PubMed, Embase, Google Scholar, Cochrane Libraries, and Chinese databases, to identify studies that met prestated inclusion criteria. Seventeen case-control studies involving 67 233 women were included for analysis. Both fixed-effects models (odds ratio [OR], 1.83; 95% CI , 1.58-2.12; P<0.0001) and random-effects models ( OR , 2.28; 95% CI , 1.54-3.36; P<0.0001) suggested that mothers who had a history of viral infection in early pregnancy experienced a significantly increased risk of developing CHD in offspring. For specific viral infections, the risk of developing CHD in offspring was significantly increased among mothers with rubella virus (OR, 3.49, 95% CI, 2.39-5.11 in fixed-effects models; and OR, 3.54; 95% CI, 1.75-7.15 in random-effects models) and cytomegalovirus (OR, 3.95; 95% CI, 1.87-8.36 in fixed-effects models) in early pregnancy; however, other maternal viral infections in early pregnancy were not significantly associated with risk of CHD in offspring. Sensitivity analysis yielded consistent results. No evidence of publication bias was observed. Conclusions Although the role of potential bias and evidence of heterogeneity should be carefully evaluated, the present study suggests that maternal viral infection is significantly associated with risk of CHD in offspring.
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Affiliation(s)
- Ziwei Ye
- Department of Epidemiology and Health StatisticsXiangya School of Public HealthCentral South UniversityHunanChina
| | - Lesan Wang
- Department of Epidemiology and Health StatisticsXiangya School of Public HealthCentral South UniversityHunanChina
| | - Tubao Yang
- Department of Epidemiology and Health StatisticsXiangya School of Public HealthCentral South UniversityHunanChina
| | - Lizhang Chen
- Department of Epidemiology and Health StatisticsXiangya School of Public HealthCentral South UniversityHunanChina
| | - Tingting Wang
- Department of Epidemiology and Health StatisticsXiangya School of Public HealthCentral South UniversityHunanChina
| | - Letao Chen
- Department of Epidemiology and Health StatisticsXiangya School of Public HealthCentral South UniversityHunanChina
| | - Lijuan Zhao
- Department of Epidemiology and Health StatisticsXiangya School of Public HealthCentral South UniversityHunanChina
| | - Senmao Zhang
- Department of Epidemiology and Health StatisticsXiangya School of Public HealthCentral South UniversityHunanChina
| | - Zan Zheng
- Department of Epidemiology and Health StatisticsXiangya School of Public HealthCentral South UniversityHunanChina
| | - Liu Luo
- Department of Epidemiology and Health StatisticsXiangya School of Public HealthCentral South UniversityHunanChina
| | - Jiabi Qin
- Department of Epidemiology and Health StatisticsXiangya School of Public HealthCentral South UniversityHunanChina
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27
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Newsome K, Alverson CJ, Williams J, McIntyre AF, Fine AD, Wasserman C, Lofy KH, Acosta M, Louie JK, Jones-Vessey K, Stanfield V, Yeung A, Rasmussen SA. Outcomes of infants born to women with influenza A(H1N1)pdm09. Birth Defects Res 2019; 111:88-95. [PMID: 30623611 PMCID: PMC6771262 DOI: 10.1002/bdr2.1445] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/27/2018] [Accepted: 10/12/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Pregnant women with influenza are more likely to have complications, but information on infant outcomes is limited. METHODS Five state/local health departments collected data on outcomes of infants born to pregnant women with 2009 H1N1 influenza reported to the Centers for Disease Control and Prevention from April to December 2009. Collaborating sites linked information on pregnant women with confirmed 2009 H1N1 influenza, many who were severely ill, to their infants' birth certificates. Collaborators also collected birth certificate data from two comparison groups that were matched with H1N1-affected pregnancies on month of conception, sex, and county of residence. RESULTS 490 pregnant women with influenza, 1,451 women without reported influenza with pregnancies in the same year, and 1,446 pregnant women without reported influenza with prior year pregnancies were included. Women with 2009 H1N1 influenza admitted to an intensive care unit (ICU; n = 64) were more likely to deliver preterm infants (<37 weeks), low birth weight infants, and infants with Apgar scores <=6 at 5 min than women in comparison groups (adjusted relative risk, aRR = 3.9 [2.7, 5.6], aRR = 4.6 [2.9, 7.5], and aRR = 8.7 [3.6, 21.2], for same year comparisons, respectively). Women with influenza who were not hospitalized and hospitalized women not admitted to the ICU did not have significantly elevated risks for adverse infant outcomes. CONCLUSIONS Severely ill women with 2009 H1N1 influenza during pregnancy were more likely to have adverse birth outcomes than women without influenza, providing more support for influenza vaccination during pregnancy.
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Affiliation(s)
- Kim Newsome
- Centers for Disease Control and Prevention, Atlanta,
Georgia
| | - C. J. Alverson
- Centers for Disease Control and Prevention, Atlanta,
Georgia
| | | | | | - Anne D. Fine
- New York City Department of Health and Mental Hygiene,
Queens, New York
| | | | | | - Meileen Acosta
- California Health and Human Services Agency, Sacramento,
California
| | - Janice K. Louie
- California Health and Human Services Agency, Sacramento,
California
| | | | | | - Alice Yeung
- New York City Department of Health and Mental Hygiene,
Queens, New York
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28
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Soim A, Sheridan SC, Hwang SA, Hsu WH, Fisher SC, Shaw GM, Feldkamp ML, Romitti PA, Reefhuis J, Langlois PH, Browne ML, Lin S. A population-based case-control study of the association between weather-related extreme heat events and orofacial clefts. Birth Defects Res 2018; 110:1468-1477. [PMID: 30338937 DOI: 10.1002/bdr2.1385] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/24/2018] [Accepted: 07/31/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Limited epidemiologic research exists on the association between weather-related extreme heat events (EHEs) and orofacial clefts (OFCs). We estimated the associations between maternal exposure to EHEs in the summer season and OFCs in offspring and investigated the potential modifying effect of body mass index on these associations. METHODS We conducted a population-based case-control study among mothers who participated in the National Birth Defects Prevention Study for whom at least 1 day of their first two post-conception months occurred during summer. Cases were live-born infants, stillbirths, and induced terminations with OFCs; controls were live-born infants without major birth defects. We defined EHEs using the 95th and the 90th percentiles of the daily maximum universal apparent temperature distribution. We used unconditional logistic regression with Firth's penalized likelihood method to estimate adjusted odds ratios and 95% confidence intervals, controlling for maternal sociodemographic and anthropometric variables. RESULTS We observed no association between maternal exposure to EHEs and OFCs overall, although prolonged duration of EHEs may increase the risk of OFCs in some study sites located in the Southeast climate region. Analyses by subtypes of OFCs revealed no associations with EHEs. Modifying effect by BMI was not observed. CONCLUSIONS We did not find a significantly increased risk of OFCs associated with maternal exposure to EHEs during the relevant window of embryogenesis. Future studies should account for maternal indoor and outdoor activities and for characteristics such as hydration and use of air conditioning that could modify the effect of EHEs on pregnant women.
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Affiliation(s)
- Aida Soim
- Congenital Malformations Registry, New York State Department of Health, Albany, New York.,Department of Environmental Health Science, University at Albany School of Public Health, Rensselaer, New York
| | | | - Syni-An Hwang
- Congenital Malformations Registry, New York State Department of Health, Albany, New York.,Department of Environmental Health Science, University at Albany School of Public Health, Rensselaer, New York
| | - Wan-Hsiang Hsu
- Congenital Malformations Registry, New York State Department of Health, Albany, New York
| | - Sarah C Fisher
- Congenital Malformations Registry, New York State Department of Health, Albany, New York
| | - Gary M Shaw
- Department of Pediatrics, Stanford School of Medicine, Stanford, California
| | | | - Paul A Romitti
- Department of Pediatrics, College of Public Health, The University of Iowa, Iowa City, Iowa
| | | | | | - Marilyn L Browne
- Congenital Malformations Registry, New York State Department of Health, Albany, New York.,Department of Environmental Health Science, University at Albany School of Public Health, Rensselaer, New York
| | - Shao Lin
- Congenital Malformations Registry, New York State Department of Health, Albany, New York.,Department of Environmental Health Science, University at Albany School of Public Health, Rensselaer, New York
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Ehrenstein V, Kristensen NR, Monz BU, Clinch B, Kenwright A, Sørensen HT. Oseltamivir in pregnancy and birth outcomes. BMC Infect Dis 2018; 18:519. [PMID: 30326840 PMCID: PMC6192366 DOI: 10.1186/s12879-018-3423-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 09/27/2018] [Indexed: 01/16/2023] Open
Abstract
Background Prenatal exposure to influenza or fever is associated with risk of congenital malformations. Oseltamivir is used to treat influenza and to provide post-exposure prophylaxis. We examined the association between oseltamivir use during pregnancy and birth outcomes. Methods This was a nationwide registry-based prevalence study with individual level data linkage, in a setting of universal health care access. We included all recorded pregnancies in Denmark in 2002–2013, and used data from population registries to examine associations between dispensings for oseltamivir during pregnancy (first trimester, second/third trimester, none) and congenital malformations, foetal death, preterm birth, foetal growth, and low 5-min Apgar score. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were computed using propensity score matching. Results The study included 946,176 pregnancies. Of these, 449 had first-trimester exposure and 1449 had second/third-trimester exposure to oseltamivir. Adjusted ORs following first-trimester exposure were 0.94 (95% CI 0.49 to 1.83) for any major congenital malformation and 1.75 (95% CI 0.51 to 5.98) for congenital heart defects, based on 7 exposed cases. The association with congenital heart defects was present for etiologically implausible exposure periods and for known safe exposures. There was no evidence of an association between prenatal exposure to oseltamivir and any of the other birth outcomes assessed. Conclusions The study does not provide evidence of risk associated with oseltamivir treatment additional to that associated with influenza infection. Electronic supplementary material The online version of this article (10.1186/s12879-018-3423-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark.
| | - Nickolaj Risbo Kristensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | | | | | | | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
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Deng Y, Song L, Nie X, Shou W, Li X. Prenatal inflammation exposure-programmed cardiovascular diseases and potential prevention. Pharmacol Ther 2018; 190:159-172. [PMID: 29803628 DOI: 10.1016/j.pharmthera.2018.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In recent years, the rapid development of medical and pharmacological interventions has led to a steady decline in certain noncommunicable chronic diseases (NCDs), such as cancer. However, the overall incidence of cardiovascular diseases (CVDs) has not seemed to decline. CVDs have become even more prevalent in many countries and represent a global health threat and financial burden. An increasing number of epidemiological and experimental studies have demonstrated that maternal insults not only can result in birth defects but also can cause developmental functional defects that contribute to adult NCDs. In the current review, we provide an overview of evidence from both epidemiological investigations and experimental animal studies supporting the concept of developmental reprogramming of adult CVDs in offspring that have experienced prenatal inflammation exposure (PIE) during fetal development (PIE-programmed CVDs), a disease-causing event that has not been effectively controlled. This review describes the epidemiological observations, data from animal models, and related mechanisms for the pathogenesis of PIE-programmed CVDs. In addition, the potential therapeutic interventions of PIE-programmed CVDs are discussed. Finally, we also deliberate the need for future mechanistic studies and biomarker screenings in this important field, which creates a great opportunity to combat the global increase in CVDs by managing the adverse effects of inflammation for prepregnant and pregnant individuals who are at risk for PIE-programmed CVDs.
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Affiliation(s)
- Youcai Deng
- Institute of Materia Medica, College of Pharmacy, Army Medical University (Third Military Medical University), 30# Gaotanyan Rd., Shapingba District, Chongqing 400038, China; Center of Translational Medicine, College of Pharmacy, Army Medical University (Third Military Medical University), 30# Gaotanyan Rd., Shapingba District, Chongqing 400038, China.
| | - Liang Song
- Institute of Materia Medica, College of Pharmacy, Army Medical University (Third Military Medical University), 30# Gaotanyan Rd., Shapingba District, Chongqing 400038, China; Center of Translational Medicine, College of Pharmacy, Army Medical University (Third Military Medical University), 30# Gaotanyan Rd., Shapingba District, Chongqing 400038, China
| | - Xuqiang Nie
- Institute of Materia Medica, College of Pharmacy, Army Medical University (Third Military Medical University), 30# Gaotanyan Rd., Shapingba District, Chongqing 400038, China; Center of Translational Medicine, College of Pharmacy, Army Medical University (Third Military Medical University), 30# Gaotanyan Rd., Shapingba District, Chongqing 400038, China
| | - Weinian Shou
- Institute of Materia Medica, College of Pharmacy, Army Medical University (Third Military Medical University), 30# Gaotanyan Rd., Shapingba District, Chongqing 400038, China; Center of Translational Medicine, College of Pharmacy, Army Medical University (Third Military Medical University), 30# Gaotanyan Rd., Shapingba District, Chongqing 400038, China; Herman B Wells Center for Pediatric Research, Department of Pediatrics, Indiana University School of Medicine, 1044 W. Walnut Street, R4 W302D, Indianapolis, IN 46202, USA
| | - Xiaohui Li
- Institute of Materia Medica, College of Pharmacy, Army Medical University (Third Military Medical University), 30# Gaotanyan Rd., Shapingba District, Chongqing 400038, China; Center of Translational Medicine, College of Pharmacy, Army Medical University (Third Military Medical University), 30# Gaotanyan Rd., Shapingba District, Chongqing 400038, China.
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Xie L, Deng Y, Yuan Y, Tan X, Liu L, Li N, Deng C, Liu H, Dai L. Association of SNP rs1867277 in FOXE1 Gene and Cleft Lip with or without Cleft Palate in a Han Chinese Population. Fetal Pediatr Pathol 2018; 37:89-94. [PMID: 29509083 DOI: 10.1080/15513815.2018.1424278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND The genetic factors causing cleft lip with or without cleft palate (CL ± P) are still unclear. The SNPs in FOXE1 gene were associated with CL ± P. However, the results have been inconsistent. OBJECTIVE We explored the associations of four SNPs in FOXE1 gene and CL ± P by a family based study. MATERIALS AND METHODS 128 children with CL ± P and their parents were recruited. rs3758249 and rs1867277 were genotyped by high-resolution melting curve (HRM) method, whereas rs1443434 and rs907577 were genotyped by Sequenom MassARRAY® method. The software PLINK, FBAT and FAMHAP were used for analyzing data. RESULTS rs1867277 was associated with CL ± P (Pm = 0.0395). The patients were divided into two subgroups, individuals with cleft lip only and persons with cleft lip and palate. There were no associations in subgroup analyses. CONCLUSION We confirmed the association of FOXE1 gene and CL ± P by a family based study. For the first time, rs1867277 was significantly associated with CL ± P.
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Affiliation(s)
- Liang Xie
- a Department of Pediatric Respiration , West China Second University Hospital, Sichuan University , Chengdu , Sichuan , China.,b The Vascular Remodeling and Developmental Defects Research Unit , West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University , Chengdu , Sichuan , China.,c Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education , West China Second University Hospital, Sichuan University , Chengdu , Sichuan , China
| | - Ying Deng
- c Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education , West China Second University Hospital, Sichuan University , Chengdu , Sichuan , China.,d National Center for Birth Defect Monitoring , West China Second University Hospital, Sichuan University , Chengdu , China.,e Laboratory of Molecular Epidemiology for Birth Defect , West China Institute of Women and Children's Health, Sichuan University , Chengdu , China
| | - Yumei Yuan
- f Hengyang Maternity and Child Healthcare Hospital , Hengyang , Hunan , China
| | - Xiong Tan
- f Hengyang Maternity and Child Healthcare Hospital , Hengyang , Hunan , China
| | - Lijun Liu
- b The Vascular Remodeling and Developmental Defects Research Unit , West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University , Chengdu , Sichuan , China.,c Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education , West China Second University Hospital, Sichuan University , Chengdu , Sichuan , China
| | - Nana Li
- c Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education , West China Second University Hospital, Sichuan University , Chengdu , Sichuan , China.,d National Center for Birth Defect Monitoring , West China Second University Hospital, Sichuan University , Chengdu , China.,e Laboratory of Molecular Epidemiology for Birth Defect , West China Institute of Women and Children's Health, Sichuan University , Chengdu , China
| | - Changfei Deng
- c Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education , West China Second University Hospital, Sichuan University , Chengdu , Sichuan , China.,d National Center for Birth Defect Monitoring , West China Second University Hospital, Sichuan University , Chengdu , China
| | - Hanmin Liu
- a Department of Pediatric Respiration , West China Second University Hospital, Sichuan University , Chengdu , Sichuan , China.,b The Vascular Remodeling and Developmental Defects Research Unit , West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University , Chengdu , Sichuan , China.,c Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education , West China Second University Hospital, Sichuan University , Chengdu , Sichuan , China
| | - Li Dai
- b The Vascular Remodeling and Developmental Defects Research Unit , West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University , Chengdu , Sichuan , China.,c Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education , West China Second University Hospital, Sichuan University , Chengdu , Sichuan , China.,d National Center for Birth Defect Monitoring , West China Second University Hospital, Sichuan University , Chengdu , China.,e Laboratory of Molecular Epidemiology for Birth Defect , West China Institute of Women and Children's Health, Sichuan University , Chengdu , China
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Kerr SM, Parker SE, Mitchell AA, Tinker SC, Werler MM. Periconceptional maternal fever, folic acid intake, and the risk for neural tube defects. Ann Epidemiol 2017; 27:777-782.e1. [PMID: 29133009 PMCID: PMC5824687 DOI: 10.1016/j.annepidem.2017.10.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 10/13/2017] [Accepted: 10/16/2017] [Indexed: 11/23/2022]
Abstract
PURPOSE Previous studies have shown an association between maternal fever in early pregnancy and neural tube defects (NTDs) such as spina bifida. Periconceptional folic acid intake has been shown to reduce the risk of these outcomes. METHODS Using data from the Slone Epidemiology Center Birth Defects Study (1998-2015), we examined the impact of folic acid on the relationship between maternal fever in the periconceptional period (28 days before and after the last menstrual period) and NTDs. Logistic regression models were used to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Mothers of 375 cases and 8247 nonmalformed controls were included. We observed an elevated risk for NTDs for fever in the periconceptional period (OR: 2.4; 95% CI: 1.5-4.0). This association was weaker for mothers who reported consuming the recommended amount of folic acid (≥400 μg per day; OR: 1.8; 95% CI: 0.8-4.0) than mothers with low folic acid intake (<400 μg per day; OR: 4.2; 95% CI: 2.2-8.2). CONCLUSIONS Our data support an association between maternal periconceptional fever and an increased risk for NTDs and also provide evidence that this association was attenuated for mothers who reported consuming folic acid at recommended levels in the periconceptional period.
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Affiliation(s)
- Stephen M Kerr
- Slone Epidemiology Center at Boston University, Boston, MA
| | - Samantha E Parker
- Slone Epidemiology Center at Boston University, Boston, MA; Department of Epidemiology, Boston University, Boston, MA.
| | | | - Sarah C Tinker
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA
| | - Martha M Werler
- Slone Epidemiology Center at Boston University, Boston, MA; Department of Epidemiology, Boston University, Boston, MA
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Waller DK, Hashmi SS, Hoyt AT, Duong HT, Tinker SC, Gallaway MS, Olney RS, Finnell RH, Hecht JT, Canfield MA. Maternal report of fever from cold or flu during early pregnancy and the risk for noncardiac birth defects, National Birth Defects Prevention Study, 1997-2011. Birth Defects Res 2017; 110:342-351. [PMID: 29094488 DOI: 10.1002/bdr2.1147] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/23/2017] [Accepted: 10/02/2017] [Indexed: 11/05/2022]
Abstract
BACKGROUND As maternal fever affects approximately 6-8% of early pregnancies, it is important to expand upon previous observations of an association between maternal fever and birth defects. METHODS We analyzed data from the National Birth Defects Prevention Study, a multistate, case-control study of major structural birth defects. Telephone interviews were completed by mothers of cases (n = 17,162) and controls (n = 10,127). Using multivariable logistic regression, we assessed the association between maternal self-report of cold or flu with fever and cold or flu without fever during early pregnancy and 30 categories of non-cardiac birth defects. RESULTS Maternal report of cold or flu with fever was significantly associated with 8 birth defects (anencephaly, spina bifida, encephalocele, cleft lip with or without cleft palate, colonic atresia/stenosis, bilateral renal agenesis/hypoplasia, limb reduction defects, and gastroschisis) with elevated adjusted odds ratios ranging from 1.2 to 3.7. Maternal report of cold or flu without fever was not associated with any of the birth defects studied. CONCLUSIONS This study adds to the evidence that maternal fever during early pregnancy is associated with an increased risk for selected birth defects. Elevated associations were limited to mothers who reported a fever, suggesting that it is fever that contributes to the excess risk rather than illnesses associated with it. However, fever may also serve as a marker for more severe infections.
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Affiliation(s)
| | | | - Adrienne T Hoyt
- Texas Department of State Health Services, Birth Defects Epidemiology and Surveillance Branch, Austin, Texas
| | - Hao T Duong
- The Partnership for Health Advancement in Vietnam (HAIVN), HCMC, Vietnam
| | - Sarah C Tinker
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael Shayne Gallaway
- U.S. Army Public Health Command, Behavioral and Social Health Outcomes Program, Aberdeen Proving Ground, Maryland
| | - Richard S Olney
- Genetic Disease Screening Program, California Department of Public Health, Richmond, California
| | - Richard H Finnell
- Department of Pediatrics, Dell Pediatric Research Institute, The University of Texas at Austin Dell Medical School, Austin, Texas
| | | | - Mark A Canfield
- Texas Department of State Health Services, Birth Defects Epidemiology and Surveillance Branch, Austin, Texas
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Hutson MR, Keyte AL, Hernández-Morales M, Gibbs E, Kupchinsky ZA, Argyridis I, Erwin KN, Pegram K, Kneifel M, Rosenberg PB, Matak P, Xie L, Grandl J, Davis EE, Katsanis N, Liu C, Benner EJ. Temperature-activated ion channels in neural crest cells confer maternal fever-associated birth defects. Sci Signal 2017; 10:10/500/eaal4055. [PMID: 29018170 DOI: 10.1126/scisignal.aal4055] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Birth defects of the heart and face are common, and most have no known genetic cause, suggesting a role for environmental factors. Maternal fever during the first trimester is an environmental risk factor linked to these defects. Neural crest cells are precursor populations essential to the development of both at-risk tissues. We report that two heat-activated transient receptor potential (TRP) ion channels, TRPV1 and TRPV4, were present in neural crest cells during critical windows of heart and face development. TRPV1 antagonists protected against the development of hyperthermia-induced defects in chick embryos. Treatment with chemical agonists of TRPV1 or TRPV4 replicated hyperthermia-induced birth defects in chick and zebrafish embryos. To test whether transient TRPV channel permeability in neural crest cells was sufficient to induce these defects, we engineered iron-binding modifications to TRPV1 and TRPV4 that enabled remote and noninvasive activation of these channels in specific cellular locations and at specific developmental times in chick embryos with radio-frequency electromagnetic fields. Transient stimulation of radio frequency-controlled TRP channels in neural crest cells replicated fever-associated defects in developing chick embryos. Our data provide a previously undescribed mechanism for congenital defects, whereby hyperthermia activates ion channels that negatively affect fetal development.
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Affiliation(s)
- Mary R Hutson
- Division of Neonatology, Department of Pediatrics, Duke University Medical Center, Jean and George Brumley, Jr. Neonatal-Perinatal Institute, Durham, NC 27710, USA
| | - Anna L Keyte
- Division of Neonatology, Department of Pediatrics, Duke University Medical Center, Jean and George Brumley, Jr. Neonatal-Perinatal Institute, Durham, NC 27710, USA.,Brain Imaging and Analysis Center, Duke University School of Medicine, Durham, NC 27710, USA.,Department of Radiology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Miriam Hernández-Morales
- Brain Imaging and Analysis Center, Duke University School of Medicine, Durham, NC 27710, USA.,Department of Radiology, Duke University School of Medicine, Durham, NC 27710, USA.,Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, CA 94720, USA.,Helen Wills Neuroscience Institute, University of California, Berkeley, CA 94720, USA
| | - Eric Gibbs
- Brain Imaging and Analysis Center, Duke University School of Medicine, Durham, NC 27710, USA.,Department of Radiology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Zachary A Kupchinsky
- Center for Human Disease Modeling, Duke University Medical Center, Durham, NC 27710, USA
| | - Ioannis Argyridis
- Brain Imaging and Analysis Center, Duke University School of Medicine, Durham, NC 27710, USA.,Department of Radiology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Kyle N Erwin
- Division of Neonatology, Department of Pediatrics, Duke University Medical Center, Jean and George Brumley, Jr. Neonatal-Perinatal Institute, Durham, NC 27710, USA
| | - Kelly Pegram
- Division of Neonatology, Department of Pediatrics, Duke University Medical Center, Jean and George Brumley, Jr. Neonatal-Perinatal Institute, Durham, NC 27710, USA
| | - Margaret Kneifel
- Brain Imaging and Analysis Center, Duke University School of Medicine, Durham, NC 27710, USA.,Department of Radiology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Paul B Rosenberg
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
| | - Pavle Matak
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Luke Xie
- Brain Imaging and Analysis Center, Duke University School of Medicine, Durham, NC 27710, USA.,Department of Radiology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Jörg Grandl
- Department of Neurobiology, Duke University Medical Center, Durham, NC 27710, USA
| | - Erica E Davis
- Center for Human Disease Modeling, Duke University Medical Center, Durham, NC 27710, USA
| | - Nicholas Katsanis
- Center for Human Disease Modeling, Duke University Medical Center, Durham, NC 27710, USA
| | - Chunlei Liu
- Brain Imaging and Analysis Center, Duke University School of Medicine, Durham, NC 27710, USA. .,Department of Radiology, Duke University School of Medicine, Durham, NC 27710, USA.,Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, CA 94720, USA.,Helen Wills Neuroscience Institute, University of California, Berkeley, CA 94720, USA
| | - Eric J Benner
- Division of Neonatology, Department of Pediatrics, Duke University Medical Center, Jean and George Brumley, Jr. Neonatal-Perinatal Institute, Durham, NC 27710, USA.
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Boland MR, Parhi P, Li L, Miotto R, Carroll R, Iqbal U, Nguyen PAA, Schuemie M, You SC, Smith D, Mooney S, Ryan P, Li YCJ, Park RW, Denny J, Dudley JT, Hripcsak G, Gentine P, Tatonetti NP. Uncovering exposures responsible for birth season - disease effects: a global study. J Am Med Inform Assoc 2017; 25:275-288. [PMID: 29036387 PMCID: PMC7282503 DOI: 10.1093/jamia/ocx105] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 08/24/2017] [Accepted: 09/05/2017] [Indexed: 01/08/2023] Open
Abstract
Objective Birth month and climate impact lifetime disease risk, while the underlying exposures remain largely elusive. We seek to uncover distal risk factors underlying these relationships by probing the relationship between global exposure variance and disease risk variance by birth season. Material and Methods This study utilizes electronic health record data from 6 sites representing 10.5 million individuals in 3 countries (United States, South Korea, and Taiwan). We obtained birth month–disease risk curves from each site in a case-control manner. Next, we correlated each birth month–disease risk curve with each exposure. A meta-analysis was then performed of correlations across sites. This allowed us to identify the most significant birth month–exposure relationships supported by all 6 sites while adjusting for multiplicity. We also successfully distinguish relative age effects (a cultural effect) from environmental exposures. Results Attention deficit hyperactivity disorder was the only identified relative age association. Our methods identified several culprit exposures that correspond well with the literature in the field. These include a link between first-trimester exposure to carbon monoxide and increased risk of depressive disorder (R = 0.725, confidence interval [95% CI], 0.529-0.847), first-trimester exposure to fine air particulates and increased risk of atrial fibrillation (R = 0.564, 95% CI, 0.363-0.715), and decreased exposure to sunlight during the third trimester and increased risk of type 2 diabetes mellitus (R = −0.816, 95% CI, −0.5767, −0.929). Conclusion A global study of birth month–disease relationships reveals distal risk factors involved in causal biological pathways that underlie them.
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Affiliation(s)
- Mary Regina Boland
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA.,Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, PA, USA.,Center for Excellence in Environmental Toxicology, University of Pennsylvania, Philadelphia, PA, USA.,Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Biomedical Informatics, Columbia University, New York, NY, USA.,Observational Health Data Sciences and Informatics, Columbia University, New York, NY, USA
| | - Pradipta Parhi
- Department of Earth and Environmental Engineering, Columbia University, New York, NY, USA
| | - Li Li
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Institute for Next Generation Healthcare, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Riccardo Miotto
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Institute for Next Generation Healthcare, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert Carroll
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Usman Iqbal
- Observational Health Data Sciences and Informatics, Columbia University, New York, NY, USA.,Masters Program in Global Health and Development Department, College of Public Health, Taipei Medical University, Taiwan.,College of Medical Science and Technology, Taipei Medical University, Taiwan
| | - Phung-Anh Alex Nguyen
- Observational Health Data Sciences and Informatics, Columbia University, New York, NY, USA.,Masters Program in Global Health and Development Department, College of Public Health, Taipei Medical University, Taiwan.,International Center for Health Information Technology, Taipei Medical University, Taiwan
| | - Martijn Schuemie
- Observational Health Data Sciences and Informatics, Columbia University, New York, NY, USA.,Janssen Research and Development, Raritan, NJ, USA
| | - Seng Chan You
- Observational Health Data Sciences and Informatics, Columbia University, New York, NY, USA.,Department of Biomedical Informatics, Ajou University School of Medicine, Republic of Korea
| | - Donahue Smith
- Department of Biomedical Informatics, University of Washington, Seattle, Washington, USA
| | - Sean Mooney
- Department of Biomedical Informatics, University of Washington, Seattle, Washington, USA
| | - Patrick Ryan
- Department of Biomedical Informatics, Columbia University, New York, NY, USA.,Observational Health Data Sciences and Informatics, Columbia University, New York, NY, USA.,Janssen Research and Development, Raritan, NJ, USA
| | - Yu-Chuan Jack Li
- Observational Health Data Sciences and Informatics, Columbia University, New York, NY, USA.,College of Medical Science and Technology, Taipei Medical University, Taiwan.,International Center for Health Information Technology, Taipei Medical University, Taiwan
| | - Rae Woong Park
- Observational Health Data Sciences and Informatics, Columbia University, New York, NY, USA.,Department of Biomedical Informatics, Ajou University School of Medicine, Republic of Korea
| | - Josh Denny
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joel T Dudley
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Institute for Next Generation Healthcare, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, NY, USA.,Observational Health Data Sciences and Informatics, Columbia University, New York, NY, USA
| | - Pierre Gentine
- Department of Earth and Environmental Engineering, Columbia University, New York, NY, USA
| | - Nicholas P Tatonetti
- Department of Biomedical Informatics, Columbia University, New York, NY, USA.,Observational Health Data Sciences and Informatics, Columbia University, New York, NY, USA
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Restivo V, Costantino C, Bono S, Maniglia M, Marchese V, Ventura G, Casuccio A, Tramuto F, Vitale F. Influenza vaccine effectiveness among high-risk groups: A systematic literature review and meta-analysis of case-control and cohort studies. Hum Vaccin Immunother 2017; 14:724-735. [PMID: 28481673 PMCID: PMC5890832 DOI: 10.1080/21645515.2017.1321722] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Vaccination represents the most effective intervention to prevent infection, hospitalization and mortality due to influenza. This meta-analysis quantifies data reporting influenza vaccine effectiveness (VE) on influenza visits and hospitalizations of case-control and cohort studies among high-risk groups. A systematic literature review including original articles published between 2007 and 2016, using a protocol registered on Prospero with No. 42017054854, and a meta-analysis were conducted. For 3 high-risk groups (subjects with underlying health conditions, pregnant women and health care workers) only a qualitative evaluation was performed. The VE quantitative analysis demonstrated a clear significant overall effect of 39% (95%CI: 32–46%) for visits and 57% (95%CI: 30–74%) for hospitalization among children. Considering the elderly influenza VE had a clear effect of 25% (95%CI: 6–40%) for visits and 14% (95%CI: 7–21%; p<0.001) for hospitalization. This study showed the high VE of influenza vaccination among high-risk groups, representing a tool for public health decision-makers to develop evidence-based preventive interventions to avoid influenza outcomes.
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Affiliation(s)
- Vincenzo Restivo
- a Department of Science for Health Promotion and Mother-Child Care "G. D'Alessandro" , University of Palermo , Palermo , Italy
| | - Claudio Costantino
- a Department of Science for Health Promotion and Mother-Child Care "G. D'Alessandro" , University of Palermo , Palermo , Italy
| | - Stefania Bono
- a Department of Science for Health Promotion and Mother-Child Care "G. D'Alessandro" , University of Palermo , Palermo , Italy
| | - Marialuisa Maniglia
- a Department of Science for Health Promotion and Mother-Child Care "G. D'Alessandro" , University of Palermo , Palermo , Italy
| | - Valentina Marchese
- a Department of Science for Health Promotion and Mother-Child Care "G. D'Alessandro" , University of Palermo , Palermo , Italy
| | - Gianmarco Ventura
- a Department of Science for Health Promotion and Mother-Child Care "G. D'Alessandro" , University of Palermo , Palermo , Italy
| | - Alessandra Casuccio
- a Department of Science for Health Promotion and Mother-Child Care "G. D'Alessandro" , University of Palermo , Palermo , Italy
| | - Fabio Tramuto
- a Department of Science for Health Promotion and Mother-Child Care "G. D'Alessandro" , University of Palermo , Palermo , Italy
| | - Francesco Vitale
- a Department of Science for Health Promotion and Mother-Child Care "G. D'Alessandro" , University of Palermo , Palermo , Italy
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Liang Q, Gong W, Zheng D, Zhong R, Wen Y, Wang X. The influence of maternal exposure history to virus and medicine during pregnancy on congenital heart defects of fetus. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2017; 24:5628-5632. [PMID: 28039625 DOI: 10.1007/s11356-016-8198-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 12/01/2016] [Indexed: 05/09/2023]
Abstract
Congenital heart disease (CHD) is the most common birth defect. It is due to dysfunction of the heart and great vessels during embryo development stage, or the channel was not closed after birth. This study focuses on investigating the influence of virus infection and medicine history during pregnancy on the incidence rate of CHD of fetus. We conducted a retrospective birth cohort study of infant born in the maternal and child health hospital of Fanyu district in Guangzhou. Five thousand three hundred eighty one cases with complete medical records, including mothers, fathers, and infants, were enrolled. The exposure history of mothers to virus and medicine from 6 months before pregnancy to prenatal examination was investigated, including mflu, mumps, measles, rubella, chickenpox, and hepatitis and antibiotics, tocolytic agent, anticonvulsants, antipyretic and analgesic, antitumor drug, folic acid supplement, and contraceptive. The relationship between virus infection and medicine history during pregnancy and CHD was analyzed. There was statistical difference between a normal group and a defected group in influenza infection and tocolytic agent and contraceptive pill. The exposure history to influenza and medicines, such as tocolytic agent and contraceptive pill, during pregnancy influenced the incidence rate of CHD of fetus.
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Affiliation(s)
- Qianhong Liang
- Department of Ultrasound, Panyu He Xian Memorial Hospital, No. 2 East Qinghe Road, Panyu District, Guangzhou City, Guangdong Province, China.
| | - Wei Gong
- Department of Ultrasound, Panyu He Xian Memorial Hospital, No. 2 East Qinghe Road, Panyu District, Guangzhou City, Guangdong Province, China
| | - Dongming Zheng
- Department of Ultrasound, Panyu He Xian Memorial Hospital, No. 2 East Qinghe Road, Panyu District, Guangzhou City, Guangdong Province, China
| | - Risheng Zhong
- Department of Ultrasound, Panyu He Xian Memorial Hospital, No. 2 East Qinghe Road, Panyu District, Guangzhou City, Guangdong Province, China
| | - Yunjie Wen
- Guangzhou Huayin Medical Laboratory Center. CO. Ltd, Guangzhou, 510663, China
| | - Xiaodan Wang
- Guangzhou Huayin Medical Laboratory Center. CO. Ltd, Guangzhou, 510663, China
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Abstract
Seasonal and pandemic influenza are the two faces of respiratory infections caused by influenza viruses in humans. As seasonal influenza occurs on an annual basis, the circulating virus strains are closely monitored and a yearly updated vaccination is provided, especially to identified risk populations. Nonetheless, influenza virus infection may result in pneumonia and acute respiratory failure, frequently complicated by bacterial coinfection. Pandemics are, in contrary, unexpected rare events related to the emergence of a reassorted human-pathogenic influenza A virus (IAV) strains that often causes increased morbidity and spreads extremely rapidly in the immunologically naive human population, with huge clinical and economic impact. Accordingly, particular efforts are made to advance our knowledge on the disease biology and pathology and recent studies have brought new insights into IAV adaptation mechanisms to the human host, as well as into the key players in disease pathogenesis on the host side. Current antiviral strategies are only efficient at the early stages of the disease and are challenged by the genomic instability of the virus, highlighting the need for novel antiviral therapies targeting the pulmonary host response to improve viral clearance, reduce the risk of bacterial coinfection, and prevent or attenuate acute lung injury. This review article summarizes our current knowledge on the molecular basis of influenza infection and disease progression, the key players in pathogenesis driving severe disease and progression to lung failure, as well as available and envisioned prevention and treatment strategies against influenza virus infection.
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Affiliation(s)
- Christin Peteranderl
- Department of Internal Medicine II, University of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany
| | - Susanne Herold
- Department of Internal Medicine II, University of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany
| | - Carole Schmoldt
- Department of Internal Medicine II, University of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany
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Louik C, Kerr S, Van Bennekom CM, Chambers C, Jones KL, Schatz M, Mitchell AA. Safety of the 2011-12, 2012-13, and 2013-14 seasonal influenza vaccines in pregnancy: Preterm delivery and specific malformations, a study from the case-control arm of VAMPSS. Vaccine 2016; 34:4450-9. [PMID: 27452865 DOI: 10.1016/j.vaccine.2016.06.078] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/13/2016] [Accepted: 06/27/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Pregnant women have higher risks of influenza complications, but vaccine coverage is incomplete. Because concern about fetal harm limits uptake, we investigated risks for preterm delivery (PTD) and specific birth defects following vaccination in the 2011-12 through 2013-14 influenza seasons. METHODS We used data from the Slone Epidemiology Center's Birth Defects Study. For PTD, propensity score-adjusted time-varying hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for exposure anytime in pregnancy and for each trimester. For 42 specific major birth defects or birth defect categories, propensity score-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. RESULTS For PTD (1803 fullterm deliveries, 107 PTD for all seasons combined), an elevated adjusted risk was observed for only the 2nd trimester of the 2011-12 season (HR=2.60, 95% CI 1.21, 5.61) - a reduction in gestational length of <2days. For the 42 specific defects or categories of defects (2866 cases, 1411 controls for all seasons combined) most adjusted risks were close to 1.0; the highest was 2.38 for omphalocele and the lowest was 0.50 for atrioventricular canal defects. None had lower confidence bounds >1.0. For each season separately, only one elevated OR had a lower 95% CI >1.0: omphalocele in 2011-12 (OR=5.19, 95% CI 1.44, 18.7). CONCLUSIONS Our results regarding risks for PTD and birth defects are generally reassuring. The few risks that were observed are compatible with chance, but warrant testing in other data. Given that vaccine components and manufacturing processes vary, continuing studies are needed to evaluate risks and safety of each season's vaccine and specific products.
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Affiliation(s)
- Carol Louik
- Slone Epidemiology Center at Boston University, Boston, MA, United States; Vaccines and Medications in Pregnancy Surveillance System (VAMPSS), United States
| | - Stephen Kerr
- Slone Epidemiology Center at Boston University, Boston, MA, United States; Vaccines and Medications in Pregnancy Surveillance System (VAMPSS), United States
| | - Carla M Van Bennekom
- Slone Epidemiology Center at Boston University, Boston, MA, United States; Vaccines and Medications in Pregnancy Surveillance System (VAMPSS), United States
| | - Christina Chambers
- Department of Pediatrics, University of California at San Diego, La Jolla, CA, United States; Vaccines and Medications in Pregnancy Surveillance System (VAMPSS), United States
| | - Kenneth L Jones
- Department of Pediatrics, University of California at San Diego, La Jolla, CA, United States; Vaccines and Medications in Pregnancy Surveillance System (VAMPSS), United States
| | - Michael Schatz
- American Academy of Allergy, Asthma, and Immunology, Milwaukee, WI, United States; Vaccines and Medications in Pregnancy Surveillance System (VAMPSS), United States
| | - Allen A Mitchell
- Slone Epidemiology Center at Boston University, Boston, MA, United States; Vaccines and Medications in Pregnancy Surveillance System (VAMPSS), United States.
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Ram D, Gowdappa B, Ashoka HG, Eiman N. Psychopharmacoteratophobia: Excessive fear of malformation associated with prescribing psychotropic drugs during pregnancy: An Indian perspective. Indian J Pharmacol 2016; 47:484-90. [PMID: 26600635 PMCID: PMC4621667 DOI: 10.4103/0253-7613.165186] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
“Psychopharmacoteratophobia is the fear or avoidance of prescribing psychotropic medicine to a pregnant woman on a given indication in anticipation of fetal malformation.” It is rooted in the tragedy associated with thalidomide use and is increasing due to the inability to predict accurately, strict legal provision of consumer protection, ethical and legal issues involved, and pitfalls in the available evidence of teratogenicity. In the Indian setting, the physicians face more challenges as the majority of the patients may ask them to decide, what is the best for their health. Most guidelines emphasize more on what not to do than what to do, and the locus of decision is left to the doctor and the patient. In this review, we have focused on relevant issues related to psychopharmacoteraophobia that may be helpful to understand this phenomenon and help to address the deprivation of a mentally ill woman from the required treatment.
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Affiliation(s)
- Dushad Ram
- Department of Psychiatry, JSS Medical College, JSS University, Mysore, Karnataka, India
| | - Basavnna Gowdappa
- Department of Medicine, JSS Medical College, JSS University, Mysore, Karnataka, India
| | - H G Ashoka
- Department of Medicine, JSS Medical College, JSS University, Mysore, Karnataka, India
| | - Najla Eiman
- Department of Psychiatry, JSS Medical College, JSS University, Mysore, Karnataka, India
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Wijers CHW, van Rooij IALM, Marcelis CLM, Brunner HG, de Blaauw I, Roeleveld N. Genetic and nongenetic etiology of nonsyndromic anorectal malformations: a systematic review. ACTA ACUST UNITED AC 2015; 102:382-400. [PMID: 25546370 DOI: 10.1002/bdrc.21068] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 08/06/2014] [Indexed: 12/12/2022]
Abstract
Congenital anorectal malformations (ARMs) are one of the most frequently observed birth defects of the digestive system. However, their etiology remains elusive. Therefore, we aim to summarize and critically appraise all existing literature on the genetic and nongenetic etiology of nonsyndromic ARM and to conclude with unifying hypotheses and directions for future research. A structured literature search on English language human studies was conducted in PubMed and Embase up to October 1, 2013, resulting in 112 included articles. Research on the identification of genes underlying nonsyndromic ARM is remarkably scarce. Most studies were focused on screening of candidate genes for mutations or single-nucleotide polymorphisms, which did not yield any substantial evidence. Nongenetic factors fairly consistently found to be associated with ARM are assisted reproductive techniques, multiple pregnancy, preterm delivery, low birth weight, maternal overweight or obesity, and preexisting diabetes. This review provides indications for the involvement of both genes and nongenetic risk factors in the etiology of ARM. In future studies, large cohorts of patients with ARM from national and international collaborations are needed to acquire new hypotheses and knowledge through hypothesis-generating approaches. Challenges for future studies may also lie in the investigation of gene-gene and gene-environment interactions.
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Affiliation(s)
- Charlotte H W Wijers
- Department for Health Evidence, Radboud university medical center, Nijmegen, The Netherlands
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Omer SB, Richards JL, Madhi SA, Tapia MD, Steinhoff MC, Aqil AR, Wairagkar N. Three randomized trials of maternal influenza immunization in Mali, Nepal, and South Africa: Methods and expectations. Vaccine 2015; 33:3801-12. [PMID: 26095508 DOI: 10.1016/j.vaccine.2015.05.077] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 05/05/2015] [Accepted: 05/27/2015] [Indexed: 10/23/2022]
Abstract
Influenza infection in pregnancy can have adverse impacts on maternal, fetal, and infant outcomes. Influenza vaccination in pregnancy is an appealing strategy to protect pregnant women and their infants. The Bill & Melinda Gates Foundation is supporting three large, randomized trials in Nepal, Mali, and South Africa evaluating the efficacy and safety of maternal immunization to prevent influenza disease in pregnant women and their infants <6 months of age. Results from these individual studies are expected in 2014 and 2015. While the results from the three maternal immunization trials are likely to strengthen the evidence base regarding the impact of influenza immunization in pregnancy, expectations for these results should be realistic. For example, evidence from previous influenza vaccine studies - conducted in general, non-pregnant populations - suggests substantial geographic and year-to-year variability in influenza incidence and vaccine efficacy/effectiveness. Since the evidence generated from the three maternal influenza immunization trials will be complementary, in this paper we present a side-by-side description of the three studies as well as the similarities and differences between these trials in terms of study location, design, outcome evaluation, and laboratory and epidemiological methods. We also describe the likely remaining knowledge gap after the results from these trials become available along with a description of the analyses that will be conducted when the results from these individual data are pooled. Moreover, we highlight that additional research on logistics of seasonal influenza vaccine supply, surveillance and strain matching, and optimal delivery strategies for pregnant women will be important for informing global policy related to maternal influenza immunization.
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Affiliation(s)
- Saad B Omer
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA; Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA; Emory Vaccine Center, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA.
| | - Jennifer L Richards
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Shabir A Madhi
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Swindon, UK; Department of Science and Technology-National Research Foundation, Vaccine-Preventable Diseases, Johannesburg, South Africa; National Institute for Communicable Diseases, The National Health Laboratory Service, Centre for Vaccines and Immunology, Johannesburg, South Africa
| | - Milagritos D Tapia
- Centre pour le Développement des Vaccins, Bamako, Mali; University of Maryland School of Medicine, Center for Vaccine Development, Baltimore, MD, USA
| | - Mark C Steinhoff
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Cincinnati Children's Hospital Global Health Center, Cincinnati, OH, USA
| | - Anushka R Aqil
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
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Salam RA, Das JK, Dojo Soeandy C, Lassi ZS, Bhutta ZA. Impact of Haemophilus influenzae type B (Hib) and viral influenza vaccinations in pregnancy for improving maternal, neonatal and infant health outcomes. Cochrane Database Syst Rev 2015; 2015:CD009982. [PMID: 26059051 PMCID: PMC10786331 DOI: 10.1002/14651858.cd009982.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Infections during pregnancy confers increased risk of maternal and perinatal morbidity and mortality. However, the case for advocating Haemophilus influenzae type B (Hib) and viral Influenza vaccinations in pregnancy is still debatable. OBJECTIVES To assess the impact of Hib and viral Influenza vaccinations during pregnancy on maternal, neonatal and infant health outcomes compared to placebo/control. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (29 January 2015) and reference lists of retrieved studies. SELECTION CRITERIA All randomised controlled clinical trials (including cluster-randomised trials) and quasi-randomised trials evaluating Hib or viral influenza vaccination during pregnancy compared with no vaccination or placebo. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion, risk of bias and extracted data. Data were checked for accuracy. MAIN RESULTS Two trials were included this review. One (involving 213 women and 213 neonates) evaluated the impact of Hib vaccination during pregnancy and the other study (involving 2116 women and 2049 neonates) evaluated the impact of viral influenza vaccination during pregnancy. Overall, the HiB vaccination trial was judged to be at 'high risk of bias' due to inadequate randomisation while the other trial was judged to be at 'low risk of bias'. Hib vaccination during pregnancy versus placeboOne trial involving 213 women and 213 neonates evaluating the impact of Hib vaccination during pregnancy was included under this comparison. The study did not report on any of this review's prespecified primary outcomes (including mortality, respiratory tract infection and sepsis) or secondary outcomes (including adverse events) except preterm delivery. There was no clear difference between the Hib vaccination and placebo control groups in terms of preterm delivery (risk ratio (RR) 1.28, 95% confidence interval (CI) 0.12 to 13.86, one study, 213 participants), fetal distress (RR 1.23, 95% CI 0.67 to 2.26, one study, 213 infants), intubation (RR 1.03, 95% CI 0.55 to 1.95, one study, 213 infants) and neonatal jaundice (RR 1.01, 95% CI 0.52 to 1.97, one study, 213 infants). We could not grade the evidence for quality due to lack of outcome data. Viral influenza vaccination during pregnancy versus placeboOne trial involving 2116 women and 2049 infants evaluating the impact of trivalent inactivated influenza vaccine (IIV3) during pregnancy was included under this comparison.There was no clear difference between the viral influenza and placebo control group in terms of most of this review's primary outcomes: maternal death (RR 4.96, 95% CI 0.24 to 103.24, moderate quality evidence), infant death up to 175 days after birth (RR 0.71, 95% CI 0.37 to 1.37, moderate quality evidence), perinatal death (stillbirth and death in the first week of life) (RR 1.32, 95% CI 0.73 to 2.38, moderate quality evidence), influenza-like illness in women (RR 0.96, 95% CI 0.79 to 1.16) or their babies (RR 1.02, 95% CI 0.94 to 1.09), any respiratory illness in women (RR 0.97, 95% CI 0.91 to 1.04, high quality evidence) or their babies (RR 1.01, 95% CI 0.95 to 1.07, high quality evidence). There were also no clear differences between vaccination and placebo control groups in terms of maternal hospitalisation for any infection (RR 2.27, 95% CI 0.94 to 5.49; 2116 women, moderate quality evidence), and neonatal hospitalisation for sepsis (RR 1.60, 95% CI 0.73 to 3.50; 2049 infants, moderate quality evidence). However, viral influenza vaccination during pregnancy was associated with a reduction in reverse-transcriptase-polymerase-chain-reaction (RT-PCR) confirmed influenza among infants (RR 0.51, 95% CI 0.30 to 0.88, one study, 2049 infants) and women (RR 0.50, 95% CI 0.29 to 0.86, one study, 2116 women).In terms of this review's secondary outcomes, there were no clear differences in terms of the impact on pregnancy outcomes (miscarriage, preterm labour and stillbirth), hospitalisation for respiratory infection among women and infants. Similarly, there was no difference between the viral influenza vaccine and placebo control groups in terms of any adverse systemic reactions. AUTHORS' CONCLUSIONS There is limited evidence (from one small trial at a high risk of bias) on the effectiveness on Hib during pregnancy for improving maternal, neonatal and infant health outcomes.Evidence from one large high quality trial on the effectiveness of viral influenza vaccine during pregnancy suggests reduced RT-PCR confirmed influenza among women and their babies, suggesting the potential of this strategy for scale up but further evidence from varying contexts is required.Further trials for both Hib and viral influenza vaccines with appropriate study designs and suitable comparison groups are required. There are currently two 'ongoing' studies - these will be incorporated into the review in future updates.
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Affiliation(s)
- Rehana A Salam
- Aga Khan University HospitalDivision of Women and Child HealthStadium RoadPO Box 3500KarachiSindPakistan74800
| | - Jai K Das
- Aga Khan University HospitalDivision of Women and Child HealthStadium RoadPO Box 3500KarachiSindPakistan74800
| | | | - Zohra S Lassi
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, The Robinson Research Institute, Discipline of Obstetrics and GynaecologyAdelaideSouth AustraliaAustralia5005
| | - Zulfiqar A Bhutta
- Hospital for Sick ChildrenCenter for Global Child HealthTorontoONCanadaM5G A04
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Bánhidy F, Ács N, Puhó EH, Czeizel AE. Paroxysmal supraventricular tachycardia in pregnant women and birth outcomes of their children: A population-based study. Am J Med Genet A 2015; 167A:1779-86. [DOI: 10.1002/ajmg.a.33759] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 09/12/2010] [Indexed: 11/12/2022]
Affiliation(s)
- Ferenc Bánhidy
- Second Department of Obstetrics and Gynecology; Semmelweis University; School of Medicine; Budapest Hungary
| | - Nándor Ács
- Second Department of Obstetrics and Gynecology; Semmelweis University; School of Medicine; Budapest Hungary
| | - Erzsébet H. Puhó
- Foundation for the Community Control of Hereditary Diseases; Budapest Hungary
| | - Andrew E. Czeizel
- Foundation for the Community Control of Hereditary Diseases; Budapest Hungary
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Suárez-Varela MM, González-Candelas F, Astray J, Alonso J, Garin O, Castro A, Galán JC, Baricot M, Castilla J, Godoy P, Delgado-Rodríguez M, Martin V, Mayoral JM, Pumarola T, Quintana JM, Tamames S, Llopis-González A, Dominguez A. Pandemic influenza A (H1N1) infection in pregnant and nonpregnant women in Spain (2009-2010). Jpn J Infect Dis 2015; 67:163-71. [PMID: 24858604 DOI: 10.7883/yoken.67.163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The present study aimed to compare the main features of infection with pandemic influenza A virus in pregnant and nonpregnant women admitted to hospitals in Spain during the first waves of the 2009-2010 influenza pandemic. This was a prospective (November 2009 to June 2010), multicenter observational study. All cases were women of reproductive age who had not been vaccinated against seasonal or pandemic influenza A. Influenza infection was confirmed by reverse transcription-polymerase chain reaction (RT-PCR). The sociodemographic and clinical data of all cases were reviewed. A total of 219 inpatients, including 49 pregnant women and 170 nonpregnant women, were enrolled in the study upon admission to participating hospitals. The most substantially different symptoms between the groups were respiratory distress and unilobar consolidation, both of which were more frequent among nonpregnant women. Antibiotics and systemic corticosteroids were more frequently used in nonpregnant women; however, there were no differences in the rates of treatment with antivirals. Our findings indicated that the compared with nonpregnant women, pregnant women in this study did not have significantly different symptoms and were not at increased risk of complications from pandemic influenza virus infection.
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Silasi M, Cardenas I, Kwon JY, Racicot K, Aldo P, Mor G. Viral infections during pregnancy. Am J Reprod Immunol 2015; 73:199-213. [PMID: 25582523 PMCID: PMC4610031 DOI: 10.1111/aji.12355] [Citation(s) in RCA: 303] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 12/05/2014] [Indexed: 12/11/2022] Open
Abstract
Viral infections during pregnancy have long been considered benign conditions with a few notable exceptions, such as herpes virus. The recent Ebola outbreak and other viral epidemics and pandemics show how pregnant women suffer worse outcomes (such as preterm labor and adverse fetal outcomes) than the general population and non-pregnant women. New knowledge about the ways the maternal-fetal interface and placenta interact with the maternal immune system may explain these findings. Once thought to be 'immunosuppressed', the pregnant woman actually undergoes an immunological transformation, where the immune system is necessary to promote and support the pregnancy and growing fetus. When this protection is breached, as in a viral infection, this security is weakened and infection with other microorganisms can then propagate and lead to outcomes, such as preterm labor. In this manuscript, we review the major viral infections relevant to pregnancy and offer potential mechanisms for the associated adverse pregnancy outcomes.
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MESH Headings
- Animals
- Coinfection
- Congenital Abnormalities/etiology
- Female
- Fetal Diseases/immunology
- HIV Infections/congenital
- HIV Infections/embryology
- HIV Infections/immunology
- HIV Infections/transmission
- Hepatitis, Viral, Human/embryology
- Hepatitis, Viral, Human/immunology
- Hepatitis, Viral, Human/transmission
- Herpesviridae Infections/embryology
- Herpesviridae Infections/immunology
- Herpesviridae Infections/transmission
- Humans
- Infant, Newborn
- Infectious Disease Transmission, Vertical
- Influenza, Human/embryology
- Influenza, Human/immunology
- Maternal-Fetal Exchange/immunology
- Obstetric Labor, Premature/etiology
- Placenta/immunology
- Placenta/virology
- Pregnancy
- Pregnancy Complications, Infectious/immunology
- Pregnancy Complications, Infectious/virology
- Pregnancy Outcome
- Risk
- Rubella/embryology
- Rubella/immunology
- Rubella/transmission
- Virus Diseases/immunology
- Virus Diseases/transmission
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Affiliation(s)
- Michelle Silasi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
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Ghulmiyyah LM, Alame MM, Mirza FG, Zaraket H, Nassar AH. Influenza and its treatment during pregnancy: A review. J Neonatal Perinatal Med 2015; 8:297-306. [PMID: 26836818 DOI: 10.3233/npm-15814124] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The influenza viral infection has dramatic effects during pregnancy on the mother and the fetus. We present a review article on the prevention and treatment recommendations of influenza infection in pregnant women, and the effects of antiviral medications on maternal-fetal outcomes. This viral infection not only leads to miscarriages, preterm deliveries and a high maternal mortality rate, but it also poses negative risks to the fetus including small-for-gestational age infants, and admissions to neonatal intensive care units. Vaccination is the most effective strategy for preventing influenza infection during pregnancy whereby can protect both maternal and fetal immunities. The safety profiles of antiviral drugs during pregnancy are limited. Available risk-benefit evidence has indicated that pregnant women with suspected or confirmed influenza should receive prompt antiviral therapy where these medications reduce the risk of complications among pregnant women, and attenuate the teratogenic effects of the influenza infection. Post-exposure prophylaxis is not recommended for most pregnant women, but it may be prescribed in pandemic settings, particularly to non-vaccinated women. Although some ex vivo models for pharmacokinetic studies have revealed that the transplacental transfer of oseltamivir to fetal circuits may occur, there is no evidence of adverse fetal outcomes as a result of most in utero exposures to neuraminidase inhibitors. Due to the large number of confounding variables, large, population-based studies are needed to assess the association between in utero oseltamivir exposure and fetal outcome.
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Affiliation(s)
- L M Ghulmiyyah
- Department of Obstetrics and Gynecology, American University of Beirut Medical Centerm Beirut, Lebanon
| | - M M Alame
- Department of Obstetrics and Gynecology, American University of Beirut Medical Centerm Beirut, Lebanon
| | - F G Mirza
- Department of Obstetrics and Gynecology, American University of Beirut Medical Centerm Beirut, Lebanon
| | - H Zaraket
- Department of Experimental Pathology, Immunology & Microbiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - A H Nassar
- Department of Obstetrics and Gynecology, American University of Beirut Medical Centerm Beirut, Lebanon
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50
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Collins J, Alona I, Tooher R, Marshall H. Increased awareness and health care provider endorsement is required to encourage pregnant women to be vaccinated. Hum Vaccin Immunother 2014; 10:2922-9. [PMID: 25483464 DOI: 10.4161/21645515.2014.971606] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Maternal immunization is an important strategy recommended to protect both mothers and infants from serious infectious diseases; however uptake of maternal immunization is poor in Australia. This study aimed to gain an in-depth understanding of the decision making process and factors influencing a pregnant woman's decisions about recommended immunizations. This qualitative study used semi-structured interviews with open-ended questions to interview pregnant women. Data were analyzed using thematic analysis techniques and drew on the Health Belief Model. Pregnant women (n = 17) were asked about their attitudes toward immunization during pregnancy and their perceptions about risk during pregnancy. Women were also asked to detail their decision making process and factors influencing their decisions about immunizations in relation to pregnancy. Most of the participants were not aware of the immunizations recommended during pregnancy, in pregnancy planning or after delivery. In addition to endorsement by their health care provider (HCP), perception of risk and benefit, including risk of infection, previous vaccination experiences and assessing cost benefit play a vital role in women's decisions whether to be immunized while pregnant. Although the role of the healthcare provider in advising pregnant women about immunizations was identified as vitally important, the majority of women had not been advised of recommended vaccines by their healthcare provider. Healthcare providers are key to ensuring pregnant mothers are informed about recommended vaccines and these need to be more proactively supported and encouraged by healthcare providers. This is likely to have a positive effect on acceptance and uptake of immunization by pregnant women.
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Affiliation(s)
- J Collins
- a Vaccinology and Immunology Research Trials Unit; Women's and Children's Hospital and School of Pediatrics and Reproductive Health ; University of Adelaide ; Adelaide , South Australia
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