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Gill EA, Zeng W, Lamme JS, Kawakita T, Lutgendorf MA, Richard P, Brown JE. Decision and economic evaluation of abortion availability in the United States military. Am J Obstet Gynecol 2025; 232:301.e1-301.e10. [PMID: 39260534 DOI: 10.1016/j.ajog.2024.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 08/25/2024] [Accepted: 09/06/2024] [Indexed: 09/13/2024]
Abstract
BACKGROUND Active-duty service women rely on the civilian sector for most abortion care due to limits on federal funding for abortion. Abortion is now banned in many states with large military presences. The Department of Defense has implemented policies to assist active-duty service women in accessing abortion, but there is debate to reverse this support. OBJECTIVE Our goal was to compare the cost-effectiveness and incidence of adverse maternal and neonatal outcomes of a hypothetical cohort of active-duty service women living in abortion-restricted states comparing restricted abortion access (abortion not available cohort) to abortion available with Department of Defense travel support (abortion available cohort). STUDY DESIGN We developed a decision tree model to compare abortion not available and abortion available cohorts for active-duty service women living in abortion-restricted states. Our cohorts were subdivided into normal pregnancies and those with a major fetal anomaly. Cost estimates, probabilities, and disability weights of various health conditions associated with abortion and pregnancy were obtained and derived from the literature. Effectiveness was expressed in disability-adjusted life years and the willingness-to-pay threshold was set to $100,000 per disability-adjusted life year gained or averted. We completed probabilistic sensitivity analyses with 10,000 simulations to test the robustness of our results. Secondary outcomes included numbers of stillbirths, neonatal deaths, neonatal intensive care unit admissions, maternal deaths, severe maternal morbidities, and first and second trimester abortions. RESULTS The abortion not available cohort had a higher annual cost to the military ($299.1 million, 95% confidence interval 239.2-386.6, vs $226.0 million, 95% confidence interval 181.9-288.5) and was associated with 203 more disability-adjusted life years compared to the abortion available cohort. The incremental cost-effectiveness ratio was dominant for abortion available. Abortion not available resulted in an annual additional 7 stillbirths, 1 neonatal death, 112 neonatal intensive care unit admissions, 0.016 maternal deaths, 24 severe maternal morbidities, 27 less second trimester abortions, and 602 less first trimester abortions. Probabilistic sensitivity analysis revealed that the chance of the abortion available cohort being the more cost-effective strategy was greater than 95%. CONCLUSION Limiting active-duty service women's access to abortion care increases costs to the military, even with costs of travel support, and increases adverse maternal and neonatal outcomes. This analysis provides important information for policymakers about economic and health burdens associated with barriers to abortion care in the military.
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Affiliation(s)
- Elizabeth A Gill
- Department of Gynecologic Surgery & Obstetrics, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Wu Zeng
- Department of Global Health, Georgetown University, Washington, District of Columbia
| | - Jacqueline S Lamme
- Navy Medicine Readiness and Training Unit, Iwakuni, Japan; Department of Gynecologic Surgery & Obstetrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Tetsuya Kawakita
- Department of Obstetrics & Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Monica A Lutgendorf
- Department of Gynecologic Surgery & Obstetrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Patrick Richard
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jill E Brown
- Department of Gynecologic Surgery & Obstetrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
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Adam H, Ghenimi N, Minsart AF, Narchi H, Al Awar S, Al Hajeri OM, Elbarazi I, Al-Rifai RH, Ahmed LA. The impact of major congenital anomalies on obstetric outcomes in the United Arab Emirates: the Mutaba'ah Study. Sci Rep 2025; 15:2708. [PMID: 39838153 PMCID: PMC11751165 DOI: 10.1038/s41598-025-87263-6] [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: 07/14/2024] [Accepted: 01/17/2025] [Indexed: 01/23/2025] Open
Abstract
Major congenital anomalies (MCAs) are a public health concern. However, studies on obstetric outcomes in pregnancies complicated by MCAs are scarce, emphasizing the need for research to enhance management strategies. This study aimed to investigate the impact of MCAs on fetal presentation and delivery mode in the United Arab Emirates. The analysis was based on a cohort of single live births in the Mutaba'ah study (2017-2023). Univariable and multivariable regression models assessed the associations between MCAs and obstetric outcomes, adjusting for maternal and neonatal characteristics. For any and single MCAs, significant associations with breech presentation were detected in women below 35 years (AOR = 2.7, 95% CI: 1.5-5.0; AOR = 2.5, 95% CI: 1.3-4.8) and among term deliveries (AOR = 2.5, 95% CI: 1.4-4.3; AOR = 2.4, 95% CI: 1.3-4.3). These associations remained significant in young (< 35 years) multiparous and older (≥ 35 years) nulliparous, as well as among term multiparous and preterm nulliparous women. The association with cesarean delivery was significant among multiparous below 35 years, where mothers of neonates with any MCAs had twice the odds of cesarean delivery (AOR = 2.1, 95% CI: 1.3-3.4). This study revealed a significant association between MCAs and the risk of breech presentation and cesarean delivery, varying by maternal age, gestational age, and parity. These findings underscore the need for early detection of MCAs in pregnancy, as this may help avoid obstetric complications. However, addressing the risk factors for MCAs and promoting a multidisciplinary approach would lead to even better outcomes for both mother and newborn.
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Affiliation(s)
- Hiba Adam
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 15551, Al Ain, United Arab Emirates.
| | - Nadirah Ghenimi
- Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 15551, Al Ain, United Arab Emirates
| | - Anne F Minsart
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mediclinic Middle East, Dubai, UAE
| | - Hassib Narchi
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 15551, Al Ain, United Arab Emirates
| | - Shamsa Al Awar
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 15551, Al Ain, United Arab Emirates
| | - Omniyat M Al Hajeri
- Community Health Sector, Abu Dhabi Public Health Center, P.O. Box 5674, Abu Dhabi, United Arab Emirates
| | - Iffat Elbarazi
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 15551, Al Ain, United Arab Emirates
| | - Rami H Al-Rifai
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 15551, Al Ain, United Arab Emirates
| | - Luai A Ahmed
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 15551, Al Ain, United Arab Emirates
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Fernandez-Campos BA, Grewal J, Kiess M, Siu SC, Pfaller B, Sermer M, Mason J, Silversides CK, Haberer K. Adverse fetal/neonatal and obstetric outcomes in pregnancies with both maternal and fetal heart disease. J Perinatol 2024; 44:1424-1431. [PMID: 39043994 PMCID: PMC11442303 DOI: 10.1038/s41372-024-02058-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 06/16/2024] [Accepted: 07/09/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVE To investigate fetal/neonatal and obstetric events in pregnancies with both maternal and fetal heart disease. STUDY DESIGN From the CARPREG database, singleton pregnancies (>24 weeks) in patients with structural heart disease that underwent fetal/neonatal echocardiograms were selected and separated in two groups: maternal heart disease only (M-HD) and maternal and fetal heart disease (MF-HD). Differences in adverse fetal/neonatal (death, preterm birth, and small for gestational age) and obstetric (preeclampsia/eclampsia) outcomes between groups were analyzed. RESULTS From 1011 pregnancies, 93 had MF-HD. Fetal/neonatal events (38.7% vs 25.3%, p = 0.006) and spontaneous preterm birth (10.8% vs 4.9%, p = 0.021) were more frequent in MF-HD compared to M-HD, with no difference in obstetric events. MF-HD remained as a significant predictor of fetal/neonatal events after adjustment (OR:1.883; 95% CI:1.182-3.000; p = 0.008). CONCLUSIONS Pregnancies with MF-HD are at risk of adverse fetal/neonatal events and spontaneous preterm birth. Larger studies are needed to determine their association with preeclampsia.
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Affiliation(s)
- Beatriz A Fernandez-Campos
- Division of Cardiology, University of Toronto, Pregnancy and Heart Disease Program, Mount Sinai and Toronto General Hospitals, Toronto, ON, Canada
| | - Jasmine Grewal
- Division of Cardiology, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Marla Kiess
- Division of Cardiology, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Samuel C Siu
- Division of Cardiology, University of Toronto, Pregnancy and Heart Disease Program, Mount Sinai and Toronto General Hospitals, Toronto, ON, Canada
- Division of Cardiology, University of Western Ontario, London, ON, Canada
| | - Birgit Pfaller
- Department of Internal Medicine 1, University Hospital of St. Pölten, Karl Landsteiner University of Health Sciences, Karl Landsteiner Institute for Nephrology, St. Pölten, Austria
| | - Mathew Sermer
- Division of Maternal Fetal Medicine, University of Toronto, Special Pregnancy Program, Mount Sinai Hospital, Toronto, ON, Canada
| | - Jennifer Mason
- Division of Maternal Fetal Medicine, University of Toronto, Special Pregnancy Program, Mount Sinai Hospital, Toronto, ON, Canada
| | - Candice K Silversides
- Division of Cardiology, University of Toronto, Pregnancy and Heart Disease Program, Mount Sinai and Toronto General Hospitals, Toronto, ON, Canada
| | - Kim Haberer
- Division of Pediatric Cardiology, Cohen Children's Medical Center of New York- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA.
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Sgayer I, Skliar T, Lowenstein L, Wolf MF. Fetal major anomalies and related maternal, obstetrical, and neonatal outcomes. Arch Gynecol Obstet 2024; 310:1919-1926. [PMID: 39103623 DOI: 10.1007/s00404-024-07682-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 07/30/2024] [Indexed: 08/07/2024]
Abstract
PURPOSE To examine maternal, obstetrical, and neonatal outcomes of pregnancies complicated by major fetal anomalies. METHODS A 10 year retrospective cohort study at a tertiary university hospital compared maternal and obstetrical outcomes between women with singleton pregnancies complicated by major fetal anomalies, and a control group with non-anomalous fetuses. RESULTS For the study compared to the control group, the median gestational age at delivery was lower: 37.0 vs. 39.4 weeks (p < 0.001); and the preterm delivery rates were higher, both at < 37 weeks (46.2 vs. 6.2%, p < 0.001) and < 32 weeks (15.4 vs. 1.2%, p < 0.001). For the study compared to the control group, the placental abruption rate was higher (6.8 vs. 0.9%, p = 0.002); 87.5 vs. 100% occurred before labor. For the respective groups, the mean gestational ages at abruption were 32.8 ± 1.3 and 39.9 ± 1.7 weeks (p = 0.024); and cesarean section and postpartum hemorrhage rates were: 53.8 vs. 28.3% (p < 0.001) and 11.3 vs. 2.8% (p = 0.001), respectively. For the respective groups, hypertensive disorders of pregnancy rates were 9.5 vs. 2.1% (p = 0.004), stillbirth rates were 17.1 vs. 0.3% (p < 0.001), and neonatal death rates 12.5 vs. 0.0% (p < 0.001). Major fetal anomalies were found to be associated with adverse maternal outcomes (OR = 2.47, 95% CI 1.50-4.09, p < 0.001). Polyhydramnios was identified as an independent risk factor in a multivariate analysis that adjusted for fetal anomalies, conception by IVF, and primiparity for adverse maternal outcomes (OR = 4.7, 95% CI 1.7-13.6, p < 0.001). CONCLUSIONS Pregnancies with major fetal anomalies should be treated as high-risk due to the increased likelihood of adverse maternal and neonatal outcomes.
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Affiliation(s)
- Inshirah Sgayer
- Department of Obstetrics and Gynecology, Galilee Medical Center, 2210001, Nahariya, Israel.
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
| | - Tal Skliar
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, 2210001, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Maya Frank Wolf
- Department of Obstetrics and Gynecology, Galilee Medical Center, 2210001, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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Kawakita T, Vilchez G, Nehme L, Huang JC, Houser M, Duncan J, Aziz M. Adverse maternal outcomes associated with major fetal malformations after singleton live birth. Am J Obstet Gynecol MFM 2023; 5:101132. [PMID: 37579946 DOI: 10.1016/j.ajogmf.2023.101132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Major fetal malformations complicate 2% to 5% of live births. It is unclear what effect fetal malformations have on severe maternal morbidity. OBJECTIVE This study aimed to compare maternal outcomes between individuals with a fetus with major or minor fetal malformations and those with a fetus without major or minor fetal malformations. STUDY DESIGN This was a secondary analysis of the Consortium on Safe Labor database. Our study was limited to the current analysis of pregnant individuals with a singleton live birth. Major fetal malformations based on the Centers for Disease Control and Prevention's criteria were defined. Fetal malformations that did not meet the criteria for major fetal malformations were categorized as minor fetal malformations. Our primary maternal outcome was severe maternal morbidity as defined by the Centers for Disease Control and Prevention. Missing values were imputed by multiple imputation using the k-nearest neighbor imputation method. Poisson regression with robust error variance was used to obtain adjusted relative risks with 95% confidence intervals, controlling for confounders. RESULTS Of 216,881 deliveries, there were 201,860 cases (93.1%) with no congenital malformation, 12,106 cases (5.6%) with minor fetal malformations, and 2845 cases (1.3%) with major fetal malformations. Compared with individuals with no fetal malformation, those with major fetal malformations were more likely to have severe maternal morbidity (0.7% vs 1.2%; adjusted relative risk, 1.51; 95% confidence interval, 1.07-2.12), postpartum hemorrhage (3.6% vs 6.9%; adjusted relative risk, 1.76; 95% confidence interval, 1.50-2.06), preeclampsia (5.1% vs 8.3%; adjusted relative risk, 1.48; 95% confidence interval, 1.31-1.67), and cesarean delivery (26.7% vs 42.3%; adjusted relative risk, 1.51; 95% confidence interval, 1.45-1.58). Compared with individuals with no fetal malformation, those with minor fetal malformations were more likely to have severe maternal morbidity (0.7% vs 1.4%; adjusted relative risk, 1.73; 95% confidence interval, 1.48-2.02), maternal death (0.01% vs 0.03%; adjusted relative risk, 4.50; 95% confidence interval, 1.18-17.19), postpartum hemorrhage (3.6% vs 6.1%; adjusted relative risk, 1.54; 95% confidence interval, 1.41-1.68), preeclampsia (5.1% vs 8.6%; adjusted relative risk, 1.50; 95% confidence interval, 1.41-1.60), superimposed preeclampsia (1.2% vs 2.4%; adjusted relative risk, 1.25; 95% confidence interval, 1.14-1.38), cesarean delivery (26.7% vs 39.6%; adjusted relative risk, 1.38; 95% confidence interval, 1.35-1.41), chorioamnionitis (3.0% vs 4.7%; adjusted relative risk, 1.41; 95% confidence interval, 1.29-1.53), and postpartum endometritis (0.6% vs 1.0%; adjusted relative risk, 1.58; 95% confidence interval, 1.31-1.90). CONCLUSION Major and minor congenital fetal malformations are independent risk factors for severe maternal morbidity and other pregnancy complications.
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Affiliation(s)
- Tetsuya Kawakita
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Drs Kawakita and Nehme).
| | - Gustavo Vilchez
- Department of Obstetrics and Gynecology, University of Missouri, Kansas City, MO (Dr Vilchez)
| | - Lea Nehme
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Drs Kawakita and Nehme)
| | - Jim C Huang
- Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan (Dr Huang)
| | - Molly Houser
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN (Dr Houser)
| | - Jose Duncan
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL (Dr Duncan)
| | - Michael Aziz
- Department of Obstetrics and Gynecology, Allegheny Health Network, Pittsburgh, PA (Dr Aziz)
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Nehme L, Ye P, Huang JC, Kawakita T. Decision and economic analysis of hostile abortion laws compared with supportive abortion laws. Am J Obstet Gynecol MFM 2023; 5:101019. [PMID: 37178721 DOI: 10.1016/j.ajogmf.2023.101019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/09/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND On June 24, 2022, the US Supreme Court overturned Roe v Wade in Dobbs v Jackson Women's Health Organization. Therefore, several states banned abortion, and other states are considering more hostile abortion laws. OBJECTIVE This study aimed to assess the incidence of adverse maternal and neonatal outcomes in the hypothetical cohort where all states have hostile abortion laws compared with the pre-Dobbs v Jackson cohort (supportive abortion laws cohort) and examine the cost-effectiveness of these policies. STUDY DESIGN This study developed a decision and economic analysis model comparing the hostile abortion laws cohort with the supportive abortion laws cohort in a sample of 5.3 million pregnancies. Cost (inflated to 2022 US dollars) estimates were from a healthcare provider's perspective, including immediate and long-term costs. The time horizon was set to a lifetime. Probabilities, costs, and utilities were derived from the literature. The cost-effectiveness threshold was set to be at $100,000 per quality-adjusted life year. Probabilistic sensitivity analyses using the Monte Carlo simulation with 10,000 simulations were performed to assess the robustness of our results. The primary outcomes included maternal mortality and an incremental cost-effectiveness ratio. The secondary outcomes included hysterectomy, cesarean delivery, hospital readmission, neonatal intensive care unit admission, neonatal mortality, profound neurodevelopmental disability, and incremental cost and effectiveness. RESULTS In the base case analysis, the hostile abortion laws cohort had 12,911 more maternal mortalities, 7518 more hysterectomies, 234,376 more cesarean deliveries, 102,712 more hospital readmissions, 83,911 more neonatal intensive care unit admissions, 3311 more neonatal mortalities, and 904 more cases of profound neurodevelopmental disability than the supportive abortion laws cohort. The hostile abortion laws cohort was associated with more cost ($109.8 billion [hostile abortion laws cohort] vs $75.6 billion [supportive abortion laws cohort]) and 120,749,900 fewer quality-adjusted life years with an incremental cost-effectiveness ratio of negative $140,687.60 than the supportive abortion laws cohort. Probabilistic sensitivity analyses suggested that the chance of the supportive abortion laws cohort being the preferred strategy was more than 95%. CONCLUSION When states consider enacting hostile abortion laws, legislators should consider an increase in the incidence of adverse maternal and neonatal outcomes.
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Affiliation(s)
- Lea Nehme
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Drs Nehme and Kawakita)
| | - Peggy Ye
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, DC (Dr Ye); Georgetown University School of Medicine, Washington, DC (Dr Ye)
| | - Jim C Huang
- Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan (Dr Huang)
| | - Tetsuya Kawakita
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Drs Nehme and Kawakita).
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Khalid H, Karishma F, Mumtaz H, Saqib M, Iftikhar M, Shahab R. Current status and future of cardio-obstetrics-review. Ann Med Surg (Lond) 2023; 85:2774-2780. [PMID: 37363552 PMCID: PMC10289498 DOI: 10.1097/ms9.0000000000000773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/24/2023] [Indexed: 06/28/2023] Open
Abstract
Cardio-obstetrics refers to an approach to maternal care that is based upon teamwork with specialists from maternal-foetal medicine, cardiology, anaesthesiology, neonatology, nursing, social work, and pharmacy that work together to achieve appropriate outcomes for the pregnant patient. The aim of this paper is to highlight and provide a narrative review on the currently published research on the current status and future of cardio-obstetrics. A short review on the hemodynamic physiology in pregnancy has also been described in this paper. The authors have discussed the major risk factors associated with exacerbation of pregnancy and the possible remedies that are currently available in this paper in accordance to the updated research. The cardio-obstetrics team provides advice about healthy pregnancy planning before conception. Proper cardio-obstetric care is associated with better outcomes in women with a high cardiovascular risk with decreased adverse maternal and foetal outcomes. Such care should be given to underserved and marginalized communities with great care as they have largely lacked such care in the past. The authors conclude the paper by recommendations to advance this newly emerging field by way of further scientific research and public awareness. This review can serve helpful to any physician working in the healthcare as well as the public that are interested in awareness about the multidisciplinary needs of pregnant women with cardiovascular disease.
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Rajagopalan V, Schmithorst V, El-Ali A, Reynolds W, Lee V, Wallace J, Weinberg J, Johnson J, Votava-Smith J, Adibi J, Panigrahy A. Associations between Maternal Risk Factors and Intrinsic Placental and Fetal Brain Functional Properties in Congenital Heart Disease. Int J Mol Sci 2022; 23:15178. [PMID: 36499505 PMCID: PMC9738149 DOI: 10.3390/ijms232315178] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/15/2022] [Accepted: 11/24/2022] [Indexed: 12/11/2022] Open
Abstract
The relationship between maternal risk factors (MRFs) (particularly pre-gravid obesity, diabetes, and hypertension) and congenital heart disease (CHD) to placental and fetal brain outcomes is poorly understood. Here, we tested the hypothesis that MRF and CHD would be associated with reduced intrinsic placental and fetal brain function using a novel non-invasive technique. Pregnant participants with and without MRF and fetal CHD were prospectively recruited and underwent feto-placental MRI. Using intrinsic properties of blood oxygen level dependent imaging (BOLD) we quantified spatiotemporal variance of placenta and fetal brain. MRFs and CHD were correlated with functional characteristics of the placenta and fetal brain. Co-morbid MRF (hypertension, diabetes, and obesity) reduced spatiotemporal functional variance of placenta and fetal brain (p < 0.05). CHD predicted reduced fetal brain temporal variance compared to non-CHD (p < 0.05). The presence of both MRF and CHD was associated with reduced intrinsic pBOLD temporal variance (p = 0.047). There were no significant interactions of MRFs and CHD status on either temporal or spatial variance of intrinsic brain BOLD. MRF and CHD reduced functional characteristic of placenta and brain in fetuses. MRF modification and management during pregnancy may have the potential to not only provide additional risk stratification but may also improve neurodevelopmental outcomes.
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Affiliation(s)
- Vidya Rajagopalan
- Department of Radiology, Children’s Hospital Los Angeles, 4650 Sunset Blvd., MS #32, Los Angeles, CA 90027, USA
- Keck School of Medicine of University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, USA
| | - Vanessa Schmithorst
- Pediatric Imaging Research Center, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave Floor 2, Pittsburgh, PA 15224, USA
- Department of Radiology, University of Pittsburgh School of Medicine, PUH Suite E204, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Alexander El-Ali
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave Floor 2, Pittsburgh, PA 15224, USA
| | - William Reynolds
- Department of Biomedical Informatics, University of Pittsburgh, 5607 Baum Blvd., Pittsburgh, PA 15206, USA
| | - Vincent Lee
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave Floor 2, Pittsburgh, PA 15224, USA
| | - Julia Wallace
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave Floor 2, Pittsburgh, PA 15224, USA
| | - Jacqueline Weinberg
- Department of Cardiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave Floor 3, Pittsburgh, PA 15224, USA
| | - Jennifer Johnson
- Department of Cardiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave Floor 3, Pittsburgh, PA 15224, USA
| | - Jodie Votava-Smith
- Keck School of Medicine of University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, USA
- Department of Pediatrics, Childrens Hospital Los Angeles, 4650 Sunset Blvd., MS #71, Los Angeles, CA 90027, USA
| | - Jennifer Adibi
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15213, USA
| | - Ashok Panigrahy
- Pediatric Imaging Research Center, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave Floor 2, Pittsburgh, PA 15224, USA
- Department of Radiology, University of Pittsburgh School of Medicine, PUH Suite E204, 200 Lothrop Street, Pittsburgh, PA 15213, USA
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave Floor 2, Pittsburgh, PA 15224, USA
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Freud L, Abbasi N. Towards Improving the Prenatal Diagnosis of Congenital Heart Disease: This Time, for Mother's Health. JACC. ADVANCES 2022; 1:100127. [PMID: 38939722 PMCID: PMC11198302 DOI: 10.1016/j.jacadv.2022.100127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- Lindsay Freud
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Nimrah Abbasi
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital & Ontario Fetal Centre, University of Toronto, Toronto, Ontario, Canada
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