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Zeleke ME, Chekol WB, Kasahun HG, Mekonnen ZA, Filatie TD, Melesse DY, Admassie BM, Admass BA. Perioperative management of surgical procedure during pregnancy: a systematic review. Ann Med Surg (Lond) 2024; 86:3432-3441. [PMID: 38846888 PMCID: PMC11152784 DOI: 10.1097/ms9.0000000000002057] [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: 03/14/2024] [Accepted: 04/02/2024] [Indexed: 06/09/2024] Open
Abstract
Background Approximately 1-2% of pregnant women undergo non-obstetric surgery under anaesthesia during their pregnancy. This review specifically targets anaesthesia management for pregnant women undergoing non-obstetric surgery in resource-limited settings. Methods Following the delineation of primary questions, scope, and inclusion criteria, a comprehensive search strategy utilizing advanced techniques was implemented across electronic sources, databases, and websites to identify relevant articles. A rigorous screening process was applied during the literature evaluation. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement guided the conduct of this review, ensuring adherence to standardized reporting practices. Results A total of 240 articles were initially identified from databases and websites. After screening titles and abstracts, 85 papers were excluded, and an additional 43 were removed due to duplication. Subsequently, 68 items were subjected to eligibility screening. Finally, 30 papers that specifically addressed anaesthetic considerations for pregnant women undergoing non-obstetric operations were reviewed. Conclusion Thorough preoperative evaluation is essential for all patients, with particular attention to modifications in anaesthetic management to accommodate physiological changes during pregnancy. Urgent and emergent surgeries should proceed promptly during pregnancy to optimize outcomes for both the mother and foetus. Maintaining uteroplacental perfusion generally involves avoiding maternal hypoxaemia, hypotension, hyper- and hypocapnia, temperature extremes, and stress. When deemed safe, regional anaesthesia may offer favourable outcomes for both the mother and foetus.
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Affiliation(s)
| | | | | | | | | | | | - Belete Muluadam Admassie
- Department of Anesthesia, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Paradiso FV, Silvaroli S, Rizzo R, Nanni L. Anorectal Malformations: The Pivotal Role of the Good Clinical Practice. Case Rep Pediatr 2023; 2023:3669723. [PMID: 37942057 PMCID: PMC10630000 DOI: 10.1155/2023/3669723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/02/2023] [Accepted: 10/07/2023] [Indexed: 11/10/2023] Open
Abstract
Anorectal malformations (ARM) without a fistula are a rare congenital condition. Although may seem more simple to repair compared with ARM with fistulas, surgery has proved to be challenging. We report the case of a newborn who presented a well-formed anus and normal genitalia; a blind-ending anal canal was detected after the insertion of a rectal probe, thus allowing the diagnosis of ARM. Anal probing straight after birth avoids the possible complications related to intestinal obstruction due to a missed diagnosis of ARM. Examination of the perineal region is an important step in the evaluation of the newborn and represents the tool for a prompt identification of ARM. Adding anal probing to accurate inspection perineum is a good clinical practice and should always be performed even in presence of a normal-looking perineum.
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Affiliation(s)
| | - Sara Silvaroli
- Division of Pediatric Surgery, “Agostino Gemelli” University Polyclinic Foundation IRCCS, Rome 00168, Italy
| | - Riccardo Rizzo
- Division of Pediatric Surgery, “Agostino Gemelli” University Polyclinic Foundation IRCCS, Rome 00168, Italy
| | - Lorenzo Nanni
- Division of Pediatric Surgery, “Agostino Gemelli” University Polyclinic Foundation IRCCS, Rome 00168, Italy
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Benefits and Risks of Antidepressant Drugs During Pregnancy: A Systematic Review of Meta-analyses. Paediatr Drugs 2023; 25:247-265. [PMID: 36853497 DOI: 10.1007/s40272-023-00561-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND The prescription of antidepressant drugs during pregnancy has been steadily increasing for several decades. Meta-analyses (MAs), which increase the statistical power and precision of results, have gained interest for assessing the safety of antidepressant drugs during pregnancy. OBJECTIVE We aimed to provide a meta-review of MAs assessing the benefits and risks of antidepressant drug use during pregnancy. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a literature search on PubMed and Web of Science databases was conducted on 25 October, 2021, on MAs assessing the association between antidepressant drug use during pregnancy and health outcomes for the pregnant women, embryo, fetus, newborn, and developing child. Study selection and data extraction were carried out independently and in duplicate by two authors. The methodological quality of included studies was evaluated with the AMSTAR-2 tool. Overlap among MAs was assessed by calculating the corrected covered area. Data were presented in a narrative synthesis, using four levels of evidence. RESULTS Fifty-one MAs were included, all but one assessing risks. These provided evidence for a significant increase in the risks for major congenital malformations (selective serotonin reuptake inhibitors, paroxetine, fluoxetine, no evidence for sertraline; eight MAs), congenital heart defects (paroxetine, fluoxetine, sertraline; 11 MAs), preterm birth (eight MAs), neonatal adaptation symptoms (eight MAs), and persistent pulmonary hypertension of the newborn (three MAs). There was limited evidence (only one MA for each outcome) for a significant increase in the risks for postpartum hemorrhage, and with a high risk of bias, for stillbirth, impaired motor development, and intellectual disability. There was inconclusive evidence, i.e., discrepant results, for an increase in the risks for spontaneous abortion, small for gestational age and low birthweight, respiratory distress, convulsions, feeding problems, and for a subsequent risk for autism with an early antidepressant drug exposure. Finally, MAs provided no evidence for an increase in the risks for gestational hypertension, preeclampsia, and for a subsequent risk for attention-deficit/hyperactivity disorder. Only one MA assessed benefits, providing limited evidence for preventing relapse in severe or recurrent depression. Effect sizes were small, except for neonatal symptoms (small to large). Results were based on MAs in which overall methodological quality was low (AMSTAR-2 score = 54.8% ± 12.9%, [19-81%]), with a high risk of bias, notably indication bias. The corrected covered area was 3.27%, which corresponds to a slight overlap. CONCLUSIONS This meta-review has implications for clinical practice and future research. First, these results suggest that antidepressant drugs should be used as a second-line treatment during pregnancy (after first-line psychotherapy, according to the guidelines). The risk of major congenital malformations could be prevented by observing guidelines that discourage the use of paroxetine and fluoxetine. Second, to decrease heterogeneity and bias, future MAs should adjust for maternal psychiatric disorders and antidepressant drug dosage, and perform analyses by timing of exposure.
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Lowry RB, Bedard T, Grevers X, Crawford S, Greenway SC, Brindle ME, Sarnat HB, Harrop AR, Kiefer GN, Thomas MA. The Alberta Congenital Anomalies Surveillance System: a 40-year review with prevalence and trends for selected congenital anomalies, 1997-2019. Health Promot Chronic Dis Prev Can 2023; 43:40-48. [PMID: 36651885 PMCID: PMC9894292 DOI: 10.24095/hpcdp.43.1.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Current published long-term provincial or territorial congenital anomaly data are lacking for Canada. We report on prevalence (per 1000 total births) and trends in 1997-2019, in Alberta, Canada, for selected congenital anomalies. Associated risk factors are also discussed. METHODS We used data from the Alberta Congenital Anomalies Surveillance System (ACASS) to calculate the prevalence and perform chi-square linear trend analyses. RESULTS From 1997 to 2019, the overall prevalence of neural tube defects was stable, at 0.74 per 1000 total births. The same was true for spina bifida (0.38), orofacial clefts (1.99), more severe CHDs (transposition of the great arteries, 0.38; tetralogy of Fallot, 0.33; and hypoplastic left heart syndrome, 0.32); and gastroschisis (0.38). Anencephaly, cleft palate and anorectal malformation significantly decreased with a prevalence of 0.23, 0.75 and 0.54 per 1000 total births, respectively. Significantly increasing trends were reported for anotia/microtia (0.24), limb reduction anomalies (0.73), omphalocele (0.36) and Down syndrome (2.21) and for hypospadias and undescended testes (4.68 and 5.29, respectively, per 1000 male births). CONCLUSION Congenital anomalies are an important public health concern with significant social and societal costs. Surveillance data gathered by ACASS for over 40 years can be used for planning and policy decisions and the evaluation of prevention strategies. Contributing genetic and environmental factors are discussed as is the need for continued surveillance and research.
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Affiliation(s)
- R Brian Lowry
- Alberta Congenital Anomalies Surveillance System, Alberta Health Services, Calgary, Alberta, Canada
- Departments of Pediatrics and Medical Genetics, University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tanya Bedard
- Alberta Congenital Anomalies Surveillance System, Alberta Health Services, Calgary, Alberta, Canada
| | - Xin Grevers
- Alberta Congenital Anomalies Surveillance System, Alberta Health Services, Calgary, Alberta, Canada
| | - Susan Crawford
- Alberta Perinatal Health Program, Alberta Health Services, Calgary, Alberta, Canada
| | - Steven C Greenway
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Cardiac Sciences and Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Biochemistry & Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mary E Brindle
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Division of Pediatric General and Thoracic Surgery, Department of Surgery, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Harvey B Sarnat
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Departments of Pediatrics (Neurology), Pathology (Neuropathology) and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - A Robertson Harrop
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Section of Plastic Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Section of Pediatric Surgery, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Gerhard N Kiefer
- Section of Pediatric Surgery, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mary Ann Thomas
- Alberta Congenital Anomalies Surveillance System, Alberta Health Services, Calgary, Alberta, Canada
- Departments of Pediatrics and Medical Genetics, University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Caut C, Schoenaker D, McIntyre E, Vilcins D, Gavine A, Steel A. Relationships between Women's and Men's Modifiable Preconception Risks and Health Behaviors and Maternal and Offspring Health Outcomes: An Umbrella Review. Semin Reprod Med 2022; 40:170-183. [PMID: 35830867 DOI: 10.1055/s-0042-1744257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Parental health before conception effects maternal and offspring health outcomes. Preconception care provides healthcare to prospective parents addressing modifiable preconception risks and health behaviors. This umbrella review aimed to consolidate evidence on women's and men's modifiable preconception risks or health behaviors associated with maternal and offspring health outcomes. MEDLINE, EMBASE, Maternity and Infant Care, CINAHL, and PsycINFO were searched from March 4, 2010, to March 4, 2020. Eligible studies were systematic reviews or meta-analyses of observational studies examining associations between modifiable preconception risks or health behaviors and maternal and offspring health outcomes. Screening, data extraction, and methodological quality assessment (AMSTAR 2) occurred independently by two reviewers. Degree of overlap was examined. Findings were summarized for evidence synthesis. Twenty-seven systematic reviews were included. Modifiable preconception risks and health behaviors were identified across categories: body composition (e.g., overweight, obesity), lifestyle behaviors (e.g., caffeine, smoking), nutrition (e.g., micronutrients), environmental exposures (e.g., radiation), and birth spacing (e.g., short interpregnancy intervals). Outcomes associated with exposures affected embryo (e.g., embryonic growth), maternal (e.g., gestational diabetes mellitus), fetal/neonate (e.g., preterm birth), and child (e.g., neurocognitive disorders) health. For real-world practice and policy relevance, evidence-based indicators for preconception care should include body composition, lifestyle, nutrition, environmental, and birth spacing.
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Affiliation(s)
| | - Danielle Schoenaker
- School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Erica McIntyre
- Australian Research Centre in Complementary and Integrative Medicine, School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.,Institute for Sustainable Futures, University of Technology Sydney, Sydney, Australia
| | - Dwan Vilcins
- Children's Health Environmental Program (CHEP), Child Health Research Centre, University of Queensland, South Brisbane, Australia
| | - Anna Gavine
- School of Nursing and Health Sciences, University of Dundee, Dundee, Scotland, United Kingdom
| | - Amie Steel
- Australian Research Centre in Complementary and Integrative Medicine, School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Wu F, Wang Z, Bi Y, Guo Z, Wang Y. Investigation of the risk factors of anorectal malformations. Birth Defects Res 2021; 114:136-144. [PMID: 34967143 DOI: 10.1002/bdr2.1974] [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: 09/16/2021] [Revised: 11/09/2021] [Accepted: 12/07/2021] [Indexed: 11/06/2022]
Abstract
PURPOSE To investigate the factors that influence the occurrence of anorectal malformations (ARMs). METHODS From December 2018 to December 2019, 136 children treated for ARMs at the Children's Hospital of Chongqing Medical University were included in the case group. The control group consisted of children with intussusception or perianal abscesses. A uniform questionnaire was filled by the parents of the enrolled children. RESULTS The birth weight of the cases was significantly lower than that of the controls (p < .01), and children with ARMs were more likely to be complicated with single umbilical artery (SUA) (p < .001). Maternal upper respiratory tract infection (adjusted odds ratio [ORadj ], 2.44; 95% confidence interval [CI], 1.29-4.63) and urogenital infection (ORadj , 2.67; 95% CI 1.11-6.38) during the first trimester of pregnancy, anemia during pregnancy (ORadj , 5.69; 95% CI, 1.01-32.07), and exposure to hazardous substances 6 months before pregnancy and during the first trimester of pregnancy (ORadj , 13.82; 95% CI, 3.86-49.35) are associated with increased risk of ARMs. Folic acid supplements (ORadj , 0.31; 95% CI, 0.14-0.65) and multivitamin (ORadj , 0.34; 95% CI, 0.15-0.79) had a protective effect on ARMs. Paternal drug use (ORadj , 9.17; 95% CI, 2.19-38.49) 6 months before their wives' conception increased the risk of ARMs. CONCLUSION Maternal infection, anemia during pregnancy, and maternal hazardous substances exposure are possible risk factors for ARMs. Folic acid supplements and multivitamin can reduce the occurrence of ARMs. Meanwhile, paternal drug use may also be a risk factor for ARMs.
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Affiliation(s)
- Fang Wu
- Gastrointestinal and Neonatal Surgery Department, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Zhili Wang
- Gastrointestinal and Neonatal Surgery Department, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Bi
- Pediatric Research Institute, Chongqing Key Laboratory of Pediatrics, Stem Cell Biology and Therapy Laboratory, Chongqing, China
| | - Zhenhua Guo
- Gastrointestinal and Neonatal Surgery Department, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yi Wang
- Gastrointestinal and Neonatal Surgery Department, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
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Kasanga TK, Mujinga DT, Zeng FT, Banza MI, Mukakala AK, Musapudi EM, Mwamba FK, Katambwa PM, Nafatalewa DK, Ngoie CN, Cabala VDPK, Kapessa ND, Mbuyi-Musanzayi S. [Anorectal malformations: a 6-years review at the University Clinics of Lubumbashi]. Pan Afr Med J 2021; 38:64. [PMID: 33889230 PMCID: PMC8028361 DOI: 10.11604/pamj.2021.38.64.22768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 11/07/2020] [Indexed: 11/16/2022] Open
Abstract
Les malformations anorectales (MAR) sont des dysgénésies de la filière anogénitale comprenant plusieurs variétés anatomopathologiques. Leur diagnostic précoce permet une prise en charge précoce, laquelle réduit la morbi-mortalité y associée, surtout dans les pays en développement. L´objectif de cette étude est d´analyser les aspects épidémio-cliniques, thérapeutiques et évolutifs des malformations anorectales (MAR) aux Cliniques Universitaires de Lubumbashi. Il s´agit d´une étude descriptive transversale, ayant concerné 24 patients de 0 à 1 an admis dans notre service pour MAR. Sont exclus para cliniques dans notre série, les patients âgés de plus d'une année et non porteurs des examens demandés. Les données ont été recueillies sur base d´une fiche d´enquête reprenant les différents paramètres: l´âge au moment de la consultation, le sexe, le poids de naissance, la circonstance de découverte, la variété anatomique, le type de traitement et évolution des malades. La fréquence était de 24 cas (20,68%) des MAR sur 116 cas des malformations congénitales. L´âge médian était de 2 jours, le sexe-ratio de 1/3 en faveur des filles. L´occlusion intestinale était le diagnostic à l´admission le plus fréquent (50%). Les MAR basses étaient les plus fréquentes (11 patients soit 45,7%) dont 10 sans fistule. L´atrésie intestinale a été la malformation associée la plus fréquente (3 patients). L´anoplastie par abaissement abdomino-périnéal couplée aux dilatations anales postopératoires a été faite chez 13 patients, soit dans 54,1% des cas. Six patients sont décédés de causes inconnues et 6 autres ont été perdus de vues. Pour le résultat fonctionnel, sur les 12 des 24 patients pris en charge qui se sont présentés à la réévaluation 3 mois après sortie de l´hôpital, 3 d´entre eux ont présenté des signes d´incontinence, et 9 d´entre eux étaient continents parmi lesquels 8 étaient diagnostiqués avec MAR basse et 1 avec MAR haute. Les MAR sont une réalité dans notre milieu, cependant, le diagnostic n´est majoritairement posé qu´au décours des occlusions intestinales. Le taux des décès reste élevé et des mesures devrait être prises pour permettre des évaluations à long terme, lesquelles sont encore difficiles à faire vu le nombre des perdus de vue.
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Affiliation(s)
- Trésor Kibangula Kasanga
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Didier Tshibangu Mujinga
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Florent Tshibwid Zeng
- Service de Chirurgie, Hôpital Provincial de Référence Jason Sendwe de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Manix Ilunga Banza
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Augustin Kibonge Mukakala
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo.,Département de Chirurgie, Faculté de Médecine et Pharmacie, Cliniques Universitaires de Bukavu, Bukavu, République Démocratique du Congo
| | - Eric Mbuya Musapudi
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - François Katshitsthi Mwamba
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Prince Muteba Katambwa
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Dimitri Kanyanda Nafatalewa
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Christelle Ngoie Ngoie
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Vincent De Paul Kaoma Cabala
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Nathalie Dinganga Kapessa
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Sébastien Mbuyi-Musanzayi
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo
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Kapapa M, Becker N, Serra A. Risk factors for anorectal and associated malformations in German children: A 10-year analysis. Pediatr Neonatol 2021; 62:97-105. [PMID: 33071156 DOI: 10.1016/j.pedneo.2020.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 07/29/2020] [Accepted: 09/16/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Incidences of anorectal malformations (ARM) occur in 1 of 2000-5000 live births and up to 64% have associated malformations (ARMa). The aim of the study was to evaluate possible prenatal risk factors for ARM in a tertiary hospital. METHODS A case-control design was used to compare risk factors in ARM (n = 44) to a control group (CG; n = 26). We used modified prenatal questionnaires, analyzed mothers' prenatal records and participants completed a structured interview. Endpoints were medical history, drug consumption, occupational risk factors, and time point of diagnosis, associated malformations and sensitivity of radiological imaging. RESULTS Our results showed that ARM couples had a significantly higher age difference (p = 0.028) compared to CG. ARM mothers had more abnormalities during pregnancy (p = 0.002), more positive vaginal smears of group B streptococci (p = 0.024), urogenital infections (p = 0.005), gestosis (p = 0.03), emesis (p = 0.025) and higher numbers of chronic diseases (p = 0.018). ARM mothers took less medication during pregnancy (p = 0.013) than CG mothers including folic acid (p = 0.041); their intake of iodine tablets was significantly higher (p = 0.035) and they continued smoking for longer (p = 0.036) than CG mothers, and they had more stillbirths (p = 0.035). In using illegal drug and alcohol use, the groups did not show significant differences. ARMa was present in 68.1% (n = 30), of which 45.5% were of urogenital origin (n = 20). ARM diagnosis was made on the first day of life in 72.7% (n = 32), while diagnosis was delayed in 12 patients (27.3%). CONCLUSION A combination of different risk factors seem to be associated with the development of ARM, which takes place at an early stage (<7th week) of pregnancy. Therefore, risk factors influencing fetal development must be critically considered. We advocate an interdisciplinary assessment in unclear clinical findings on first day of life to optimize the therapy and positively influence the outcome.
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Affiliation(s)
- Melanie Kapapa
- Division of Pediatric Surgery, Department of Surgery, Ulm University, Eythstrasse 24, 89075, Ulm, Germany.
| | - Nastassja Becker
- Division of Pediatric Surgery, Department of Surgery, Ulm University, Eythstrasse 24, 89075, Ulm, Germany
| | - Alexandre Serra
- Division of Pediatric Surgery, Department of Surgery, Ulm University, Eythstrasse 24, 89075, Ulm, Germany
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9
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Maternal intake of one-carbon metabolism-related B vitamins and anorectal malformations in the Japan Environment and Children's Study. Br J Nutr 2020; 124:865-873. [PMID: 32468981 DOI: 10.1017/s0007114520001816] [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: 11/07/2022]
Abstract
The occurrence of anorectal malformations (ARM) is thought to be reduced with sufficient folate intake. However, there is no apparent evidence. We focused on enzyme cofactors for one-carbon metabolism, including folate (vitamin B9), vitamin B6 and vitamin B12, and explored the association between maternal combined intake of these B vitamins and the risk of ARM. Using baseline data from a Japanese nationwide birth cohort study between 2011 and 2014, we analysed data of 89 235 women (mean age at delivery = 31·2 years) who delivered singleton live births without chromosomal anomalies. Information on dietary intake was obtained via a FFQ focused on early pregnancy and used to estimate B vitamin intake. We also collected information on the frequency of folic acid supplement use. ARM occurrence was ascertained from medical records. We identified forty-three cases of ARM diagnosed up to the first month after birth (4·8 per 10 000 live births). In terms of individual intake of the respective B vitamins, high vitamin B6 intake was non-significantly associated with reduced odds of ARM. Compared with women in the low combined B vitamin intake group, the OR of having an infant with ARM was 0·4 (95 % CI 0·2, 1·0) in the high intake group (folate ≥400 μg/d, and upper half of vitamin B6 and/or vitamin B12). In conclusion, our cohort analysis suggested an inverse association between the combined intake of one-carbon metabolism-related B vitamins in early pregnancy and ARM occurrence.
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10
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Uguz F. Selective serotonin reuptake inhibitors and the risk of congenital anomalies: a systematic review of current meta-analyses. Expert Opin Drug Saf 2020; 19:1595-1604. [PMID: 33001713 DOI: 10.1080/14740338.2020.1832080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective: A review of current meta-analyses examining the relationship between maternal use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy and congenital anomalies. Methods: PubMed was searched for meta-analyses published in English language between January 2010 and April 2020 by using the following combinations of key words: meta-analysis, pregnancy, antidepressant, SSRI, citalopram, escitalopram, fuloxetine, paroxetine, sertraline, fluvoxamine, neonatal outcome, birth outcome, congenital malformation, congenital anomaly, birth defect, cardiac malformation and heart defect. Results: A total of 15 meta-analyses met the search criteria. These meta-analyses consistently suggested a significant positive association between the use of SSRIs in general and paroxetine and fluoxetine in particular and the risk of major congenital anomalies. The data also showed a consistency in increased cardiovascular defects in infants due to maternal use of paroxetine. The risk of cardiovascular defects in infants of women using SSRIs in general and fluoxetine and sertraline in particular was controversial. Conclusion: Further large-scale prospective observational studies and meta-analyses on the effects of individual SSRIs other than paroxetine, especially escitalopram and fluvoxamine, are required to reach definitive conclusions.
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Affiliation(s)
- Faruk Uguz
- Department of Psychiatry, Meram Faculty of Medicine, Necmettin Erbakan University , Konya, Turkey
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11
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Taylor MA, Bucher BT, Reeder RW, Levitt M, Avansino J, Durham MM, Calkins CM, Wood R, Drake K, Rollins M. Comparison of Maternal Histories and Exposures in Children With Isolated Anorectal Malformation Versus Anorectal Malformation With Genitourinary Anomalies. Cureus 2020; 12:e8762. [PMID: 32714700 PMCID: PMC7377652 DOI: 10.7759/cureus.8762] [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] [Indexed: 11/05/2022] Open
Abstract
Introduction To our knowledge, there are no studies to date that have compared patients with isolated anorectal malformation (ARM) to patients with ARM and an associated genitourinary (GU) malformation despite a possible etiological difference between these two entities. We examined the differences in maternal and prenatal exposures and comorbidities between patients with isolated ARM and patients with ARM and associated GU malformations. Materials and methods A retrospective cohort study of children with ARM, enrolled in the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) between February 2017 and October 2019, was performed comparing those with isolated ARM to those with ARM and associated GU anomalies (GU +/- additional anomalies) as well as to those with ARM and a GU anomaly with no anomaly of any other system (GU-only). We compared the prevalence of prematurity, family history of colorectal disorders, as well as maternal and prenatal comorbidities and exposures between these two cohorts and the isolated ARM cohort. Results A total of 505 patients (117 with isolated ARM and 388 with ARM and associated GU anomalies) were enrolled. Of the 388 patients with ARM and associated GU anomalies, 48 had an ARM with a GU anomaly without an anomaly in any other system. There was an increased prevalence of premature births in the GU +/- additional anomalies cohort compared to the isolated ARM cohort (27 vs 14%, p=0.003). This difference was not seen in the GU-only cohort. There was no difference between the cohorts regarding prevalence of family history of ARM or maternal and prenatal comorbidities or exposures. Conclusions Patients with an ARM and an associated GU anomaly with or without other congenital anomalies are more likely to be born prematurely compared to patients with an isolated ARM. Parents of these children should be counseled on this increased risk.
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Affiliation(s)
- Mark A Taylor
- Department of Surgery, University of Utah, Salt Lake City, USA
| | - Brian T Bucher
- Department of Surgery, University of Utah, Salt Lake City, USA
| | - Ron W Reeder
- Department of Pediatrics, University of Utah, Salt Lake City, USA
| | - Marc Levitt
- Division of Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, District of Columbia, USA
| | - Jeffrey Avansino
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, USA
| | - Megan M Durham
- Division of Pediatric Surgery, Emory University School of Medicine, Atlanta, USA
| | - Casey M Calkins
- Department of Pediatric Surgery, Children's Wisconsin, Milwaukee, USA
| | - Richard Wood
- Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, Columbus, USA
| | - Kaylea Drake
- Department of Pediatrics, University of Utah, Salt Lake City, USA
| | - Michael Rollins
- Department of Surgery, University of Utah, Salt Lake City, USA.,Department of Surgery, Primary Children's Hospital, Salt Lake City, USA
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12
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Almatrafi MA, Al-Zalabani AH, Almaramhy HH, Al-Dubai SA. Risk factors associated with anorectal malformations development. A case-control study. Saudi Med J 2020; 41:157-162. [PMID: 32020149 PMCID: PMC7841629 DOI: 10.15537/smj.2020.2.24882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objectives: To determine the risk factors for the development of anorectal malformations (ARM). Methods: This case-control study was conducted in the Maternity and Children Hospital (MCH), Al Madinah Al Munnawarah, Saudi Arabia. The sample was taken from the ARM cases admitted at MCH between January 2013 and December 2017. The controls were selected from well-baby clinics in primary health care centers. Parents of the cases and the controls were interviewed based on a questionnaire. Descriptive, univariate, and multivariate logistic regression were used in the analysis. Results: The study included 48 cases and 96 controls with 31 (64.6%) cases of isolated ARM and 17 (35.4%) cases of associated ARM. Among the ARM cases, 27 (56.3%) were males and 21 (43.8%) were females. In multivariate analysis, we found consanguinity to be associated with an increased risk of developing ARM with odds ratio (OR): 2.43, 95% CI: 1.12-5, and p=0.025, in addition to maternal obesity, with OR: 4.36, 95% CI: 1.2-15.8, and p=0.025. Conclusion: Consanguinity and maternal obesity (body mass index >30) were found to be risk factors for ARM development.
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Affiliation(s)
- Mohammed A Almatrafi
- Saudi Board of Preventive Medicine, Taibah University, Al Madinah Al Munnawarah, Kingdom of Saudi Arabia. E-mail.
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Amooee A, Lookzadeh MH, Mirjalili SR, Miresmaeili SM, Aghili K, Zare-Shehneh M, Neamatzadeh H. ASSOCIATION OF RS2435357 AND RS1800858 POLYMORPHISMS IN RET PROTO-ONCOGENE WITH HIRSCHSPRUNG DISEASE: SYSTEMATIC REVIEW AND META-ANALYSIS. ACTA ACUST UNITED AC 2019; 32:e1448. [PMID: 31644668 PMCID: PMC6812143 DOI: 10.1590/0102-672020190001e1448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 01/16/2019] [Indexed: 01/22/2023]
Abstract
Introduction:
Many published studies have estimated the association of rs2435357 and
rs1800858 polymorphisms in the proto-oncogene rearranged during transfection
(RET) gene with Hirschsprung disease (HSCR) risk. However, the results
remain inconsistent and controversial.
Aim:
To perform a meta-analysis get a more accurate estimation of the association
of rs2435357 and rs1800858 polymorphisms in the RET proto-oncogene with HSCR
risk.
Methods:
The eligible literatures were searched by PubMed, Google Scholar, EMBASE, and
Chinese National Knowledge Infrastructure (CNKI) up to June 30, 2018.
Summary odds ratios (ORs) and 95% confidence intervals (CIs) were used to
evaluate the susceptibility to HSCR.
Results:
A total of 20 studies, including ten (1,136 cases 2,420 controls) for
rs2435357 and ten (917 cases 1,159 controls) for rs1800858 were included.
The overall results indicated that the rs2435357 (allele model: OR=0.230,
95% CI 0.178-0.298, p=0.001; homozygote model: OR=0.079, 95% CI 0.048-0.130,
p=0.001; heterozygote model: OR=0.149, 95% CI 0.048-0.130, p=0.001; dominant
model: OR=0.132, 95% CI 0.098-0.179, p=0.001; and recessive model: OR=0.239,
95% CI 0.161-0.353, p=0.001) and rs1800858 (allele model: OR=5.594, 95% CI
3.653-8.877, p=0.001; homozygote model: OR=8.453, 95% CI 3.783-18.890,
p=0.001; dominant model: OR=3.469, 95% CI 1.881-6.396, p=0.001; and
recessive model: OR=6.120, 95% CI 3.608-10.381, p=0.001) polymorphisms were
associated with the increased risk of HSCR in overall.
Conclusions:
The results suggest that the rs2435357 and rs1800858 polymorphisms in the RET
proto-oncogene might be associated with HSCR risk.
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Affiliation(s)
| | | | | | | | - Kazem Aghili
- Shahid Sadoughi University of Medical Sciences, Radiology
| | - Masoud Zare-Shehneh
- Shahid Sadoughi University of Medical Sciences, Medical Genetics, Yazd, Yazd, Iran
| | - Hossein Neamatzadeh
- Shahid Sadoughi University of Medical Sciences, Medical Genetics, Yazd, Yazd, Iran
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14
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Jiang B, Liu J, He W, Wei S, Hu Y, Zhang X. The effects of preconception examinations on birth defects: a population-based cohort study in Dongguan City, China. J Matern Fetal Neonatal Med 2019; 33:2691-2696. [PMID: 30522364 DOI: 10.1080/14767058.2018.1557141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To evaluate the effect of preconception examinations programs on the prevention of birth defects in Dongguan City during 2013-2017.Methods: The data were from preconception examinations system and the birth defects surveillance system during 2013-2017. The study population included 63,175 infants born to mothers accepted preconception examinations during pregnancy (the screening group) and 649,862 infants whose mother did not check (the control group). The infants included for stillbirth, dead fetus, live birth between 28 weeks of gestation and 7 days after birth and legal pregnancy termination. The risk ratios (RRs) and 95% confidence intervals (CIs) were calculated to examine for the association between birth defects and preconception examinations. We also conducted a stratified analysis based on infant gender and disease classification, and maternal age and region.Results: The incidence of birth defects in the screening group was 134.55/10,000, while that in the control group was 241.53/10,000. Preconception examinations can effectively reduce the incidence of birth defects (BDs) (RR: 0.557, 95%CI: 0.520-0.597). Bifid spine (RR: 0.076, 95%CI: 0.011-0.545), anencephalia (RR: 0.134, 95%CI: 0.033-0.543) and anorectal atresia or stenosis (RR: 0.151, 95%CI: 0.048-0.471) were controlled best, and Down syndrome (RR: 0.684, 95%CI: 0.435-1.075) was no effect. Young maternal age (14-19 years) and old maternal age will increase the risk of birth defects. Preconception examinations had the best effect for pregnant women under 25 years of age (RR: 0.465, 95%CI: 0.387-0.559), and were relatively poor for women aged 30-34 years (RR: 0.678, 95%CI: 0.593-0.776). The incidence of the urban was significantly higher than that of the rural. The effect of preconception examinations to prevent birth defects was more effective in urban areas (RR: 0.453, 95%CI: 0.391-0.525) than in rural areas (RR: 0.577, 95%CI: 0.533-0.625). The incidence of BDs in males was higher than that in females.Conclusions: By implementing preconception examinations project, birth defects in Dongguan have been well controlled. This can provide reference for other developing countries to prevent birth defects.
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Affiliation(s)
- Bi Jiang
- Dongguan Maternal and Child Health Care Hospital, Dongguan, China
| | - Jianxin Liu
- Dongguan Maternal and Child Health Care Hospital, Dongguan, China
| | - Weichao He
- Dongguan Maternal and Child Health Care Hospital, Dongguan, China
| | - Sisi Wei
- Dongguan Maternal and Child Health Care Hospital, Dongguan, China
| | - Yanmei Hu
- Dongguan Maternal and Child Health Care Hospital, Dongguan, China
| | - Xinjian Zhang
- Dongguan Maternal and Child Health Care Hospital, Dongguan, China
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