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Coscia LA, Kliniewski D, Constantinescu S, Moritz MJ. Pregnancy after transplant in the older adolescent: Anticipatory guidance for the pediatric provider. Pediatr Transplant 2024; 28:e14752. [PMID: 38682682 DOI: 10.1111/petr.14752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Healthcare providers who care for adolescent and young adult transplant recipients should be aware of contraception counseling and potential for pregnancy in this at-risk cohort. METHODS This paper will review contraceptive options in general for transplant recipients. There will also be a review of common immunosuppressive medications and their risk profile regarding pregnancy after transplantation. Data from the Transplant Pregnancy Registry International were analyzed looking at recipients conceiving under the age of 21 and were compared to overall pregnancy outcomes. RESULTS Overall pregnancy outcomes in recipients under the age of 21 are like the adult cohort. CONCLUSION It is imperative to provide contraception counseling to the adolescent and young adult and inform their caregiver that pregnancy can happen if the recipient is sexually active. Pregnant adolescent and young adult transplant recipients should be followed by a multidisciplinary team to assure a positive outcome for the recipient, transplant, and neonate.
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Affiliation(s)
- Lisa A Coscia
- Transplant Pregnancy Registry International, a division of Gift of Life Institute, Philadelphia, Pennsylvania, USA
| | - Dorothy Kliniewski
- Transplant Pregnancy Registry International, a division of Gift of Life Institute, Philadelphia, Pennsylvania, USA
| | - Serban Constantinescu
- Transplant Pregnancy Registry International, a division of Gift of Life Institute, Philadelphia, Pennsylvania, USA
- Department of Medicine, Section of Nephrology, Hypertension and Kidney Transplantation, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Michael J Moritz
- Transplant Pregnancy Registry International, a division of Gift of Life Institute, Philadelphia, Pennsylvania, USA
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Panda A, Parida J, Jena S, Pradhan A, Pati S, Kaur H, Acharya SK. Perception, practices and understanding of teenage pregnancy among the adolescent girls in India: A scoping review protocol. J Family Med Prim Care 2024; 13:1169-1177. [PMID: 38827697 PMCID: PMC11142008 DOI: 10.4103/jfmpc.jfmpc_1674_22] [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: 08/22/2022] [Revised: 05/23/2023] [Accepted: 08/23/2023] [Indexed: 06/04/2024] Open
Abstract
Introduction Teenage pregnancy is a subject of concern among adolescents. Inadequate knowledge and misperceptions about pregnancy are major contributing factors to teenage pregnancy. Without a proper understanding, adolescents are involved in unsafe sexual practices, which results in pregnancy. So, perception and understanding are important aspects to explore among adolescents. In this planned scope review, all eligible studies will be identified around the perception, practices, and understanding of teenage pregnancy among married and unmarried adolescent girls. Methods The Arksey and O'Malley (2005) scoping review framework and the Joanna Briggs Institute Reviewers' Manual (2015) will be used for the planned scoping review. The population, concept, and context strategy (PCC) will be used to develop the research question, search strategy, and eligibility criteria. Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews (PRISMA ScR) will be used for the findings of the study. For the literature search, authors will use Google Scholar, PubMed, and ResearchGate electronic databases with specific words such as "teenage", "adolescence", "pregnancy", "perception", "knowledge", "awareness" and "abortion". Result The planned scoping review will be helpful in addressing the lack of adolescent misperception, malpractices, and misunderstandings regarding teenage pregnancy. It can provide detailed information about teenage pregnancy in the Indian context. Conclusion The evidence synthesis and gap analysis will be helpful in suggesting insights into the issue of teenage pregnancy, which will be helpful in future policies and programs.
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Affiliation(s)
- Arpita Panda
- Division of Socio-Behavioural Health, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Jayashree Parida
- Division of Socio-Behavioural Health, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Susangita Jena
- Division of Socio-Behavioural Health, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Abinash Pradhan
- Division of Socio-Behavioural Health, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Sanghamitra Pati
- Director, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Harpreet Kaur
- Division of Epidemiology and Communicable Diseases (Tribal Health), ICMR Head Quarters, New Delhi, India
| | - Subhendu Kumar Acharya
- Division of Socio-Behavioural Health, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
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Zou C, Zhang Y, Yuan Z. An intelligent adverse delivery outcomes prediction model based on the fusion of multiple obstetric clinical data. Comput Methods Biomech Biomed Engin 2023:1-15. [PMID: 37771231 DOI: 10.1080/10255842.2023.2262663] [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: 05/04/2023] [Accepted: 09/17/2023] [Indexed: 09/30/2023]
Abstract
Adverse delivery outcomes is a major re-productive health problem that affects the physical and mental health of pregnant women. Obviously, obstetric clinical data has periodically time series characteristics. This paper proposed a three stage adverse delivery outcomes prediction model via the fusion of multiple time series clinical data. The first stage is data aggregation, in which the data set is collected from the obstetric clinical data and divided based on time series features. In the second stage, a multi-channel gated cycle unit is used to solve the calculation error caused by irregular sampling of time series data. The hidden layer feature vector is connected with the fully connected layer, reshaped into a new one-dimensional feature, and fused with the non-time series data into a new data set. The third stage is the prediction stage of adverse delivery outcomes. By connecting the multi-channel gated cycle unit with the extreme gradient lift, the data transmitted in the corresponding channel is used in the feature extraction stage, in which the weighted entropy-based feature extraction is adopted. With the help of the extracted features, a hybrid artificial neural network architecture (MGRU-XGB) was developed to predict adverse delivery outcomes. The experimental results showed that the hybrid model had the best prediction performance for adverse delivery outcomes compared with other single models in terms of sensitivity, specificity, AUC and other evaluation indexes.
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Affiliation(s)
- Chen Zou
- School of Information Science and Technology, Hangzhou Normal University, Hangzhou, China
| | - Yichao Zhang
- School of Information Science and Technology, Hangzhou Normal University, Hangzhou, China
| | - Zhenming Yuan
- School of Information Science and Technology, Hangzhou Normal University, Hangzhou, China
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Zegeye B, Idriss-Wheeler D, Oladimeji O, Yaya S. Exploring health insurance and knowledge of the ovulatory cycle: evidence from Demographic and Health Surveys of 29 countries in Sub-Saharan Africa. Reprod Health 2023; 20:129. [PMID: 37649040 PMCID: PMC10466883 DOI: 10.1186/s12978-023-01675-z] [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: 04/30/2023] [Accepted: 08/23/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Unplanned pregnancy continues to be a major public health concern in Sub-Saharan Africa (SSA). Understanding the ovulatory cycle can help women avoid unplanned pregnancy. Though a wide range of factors for ovulatory cycle knowledge in SSA countries has not been well assessed, the influence of health insurance on ovulatory cycle knowledge is largely unknown. As a result, we set out to investigate the relationship between health insurance enrollment and knowledge of the ovulatory cycle among women of childbearing age. This study aims to investigate the relationship between health insurance enrollment and knowledge of the ovulatory cycle among women of childbearing age in sub-Saharan Africa (SSA). METHODS Demographic and Health Surveys (DHSs) data from 29 SSA countries were analyzed. The association between health insurance and ovulatory cycle knowledge was investigated using bivariate and multivariate multilevel logistic regression models among 372,692 women of reproductive age (15-49). The findings were presented as adjusted odds ratios (AOR) with 95% confidence intervals (CI). A p-value of 0.05 was considered statistically significant. RESULTS The pooled result shows that the prevalence of knowledge of ovulatory cycle in the studied 29 SSA countries was 25.5% (95% CI; 24.4%-26.6%). Findings suggest higher odds of ovulatory cycle knowledge among women covered by health insurance (AOR = 1.27, 95% CI; 1.02-1.57), with higher education (higher-AOR = 2.83, 95% CI; 1.95-4.09), from the richest wealth quintile (richest-AOR = 1.39, 95% CI; 1.04-1.87), and from female headed households (AOR = 1.16, 95% CI; 1.01-1.33) compared to women who had no formal education, were from the poorest wealth quintile and belonged to male headed households, respectively. We found lower odds of ovulatory cycle knowledge among women who had 2-4 parity history (AOR = 0.80, 95% CI; 0.65-0.99) compared to those with history of one parity. CONCLUSIONS The findings indicate that the knowledge of the ovulatory cycle is lacking in SSA. Improving health insurance enrollment should be considered to increase ovulatory cycle knowledge as an approach to reduce the region's unplanned pregnancy rate. Strategies for improving opportunities that contribute to women's empowerment and autonomy as well as sexual and reproductive health approaches targeting women who are in poorest quintiles, not formally educated, belonging to male headed households, and having high parity should be considered.
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Affiliation(s)
| | - Dina Idriss-Wheeler
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Olanrewaju Oladimeji
- Faculty of Health Sciences, Department of Public Health, Walter Sisulu University, Eastern Cape, Mthatha, South Africa
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
- The George Institute for Global Health, Imperial College London, London, UK
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Adesina OO, Brunson A, Fisch SC, Yu B, Mahajan A, Willen SM, Keegan THM, Wun T. Pregnancy outcomes in women with sickle cell disease in California. Am J Hematol 2023; 98:440-448. [PMID: 36594168 PMCID: PMC9942937 DOI: 10.1002/ajh.26818] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/28/2022] [Accepted: 12/06/2022] [Indexed: 01/04/2023]
Abstract
Adverse pregnancy outcomes occur frequently in women with sickle cell disease (SCD) across the globe. In the United States, Black women experience disproportionately worse maternal health outcomes than all other racial groups. To better understand how social determinants of health impact SCD maternal morbidity, we used California's Department of Health Care Access and Information data (1991-2019) to estimate the cumulative incidence of pregnancy outcomes in Black women with and without SCD-adjusted for age, insurance status, and Distressed Community Index (DCI) scores. Black pregnant women with SCD were more likely to deliver at a younger age, use government insurance, and live in at-risk or distressed neighborhoods, compared to those without SCD. They also experienced higher stillbirths (26.8, 95% confidence interval [CI]: 17.5-36.1 vs. 12.4 [CI: 12.1-12.7], per 1000 births) and inpatient maternal mortality (344.5 [CI: 337.6-682.2] vs. 6.1 [CI: 2.3-8.4], per 100 000 live births). Multivariate logistic regression models showed Black pregnant women with SCD had significantly higher odds ratios (OR) for sepsis (OR 14.89, CI: 10.81, 20.52), venous thromboembolism (OR 13.60, CI: 9.16, 20.20), and postpartum hemorrhage (OR 2.25, CI 1.79-2.82), with peak onset in the second trimester, third trimester, and six weeks postpartum, respectively. Despite adjusting for sociodemographic factors, Black women with SCD still experienced significantly worse pregnancy outcomes than those without SCD. We need additional studies to determine if early introduction to reproductive health education, continuation of SCD-modifying therapies during pregnancy, and increasing access to multidisciplinary perinatal care can reduce morbidity in pregnant women with SCD.
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Affiliation(s)
- Oyebimpe O. Adesina
- Center for Oncology Hematology Outcomes Research and Training, Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Ann Brunson
- Center for Oncology Hematology Outcomes Research and Training, Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Samantha C. Fisch
- University of California San Francisco School of Medicine, San Francisco, CA
| | - Bo Yu
- Department of Obstetrics & Gynecology, Stanford University School of Medicine; Stanford Maternal & Child Health Research Institute, Stanford, CA
| | - Anjlee Mahajan
- Center for Oncology Hematology Outcomes Research and Training, Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Shaina M. Willen
- Center for Oncology Hematology Outcomes Research and Training, Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA
- Division of Pediatric Pulmonary and Sleep Medicine, University of California, Davis School of Medicine, Sacramento, CA
| | - Theresa H. M. Keegan
- Center for Oncology Hematology Outcomes Research and Training, Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Ted Wun
- Center for Oncology Hematology Outcomes Research and Training, Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA
- UC Davis Clinical and Translational Science Center, University of California, Davis, CA
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Bertens LCM, Mohabier KSC, van der Hulst M, Broekharst DSE, Ismaili M’hamdi H, Burdorf A, Kok R, de Graaf JP, Steegers EAP. Complexity and interplay of faced adversities and perceived health and well-being in highly vulnerable pregnant women-the Mothers of Rotterdam program. BMC Public Health 2023; 23:43. [PMID: 36609315 PMCID: PMC9817271 DOI: 10.1186/s12889-023-14975-7] [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: 06/10/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Living in socially disadvantaged circumstances has a widespread impact on one's physical and mental health. That is why individuals living in this situation are often considered vulnerable. When pregnant, not only the woman's health is affected, but also that of her (unborn) child. It is well accepted that vulnerable populations experience worse (perinatal) health, however, little is known about the lived adversities and health of these vulnerable individuals. OBJECTIVES With this article, insights into this group of highly vulnerable pregnant women are provided by describing the adversities these women face and their experienced well-being. METHODS Highly vulnerable women were recruited when referred to tailored social care during pregnancy. Being highly vulnerable was defined as facing at least three different adversities divided over two or more life-domains. The heat map method was used to assess the interplay between adversities from the different life domains. Demographics and results from the baseline questionnaires on self-sufficiency and perceived health and well-being were presented. RESULTS Nine hundred nineteen pregnant women were referred to social care (2016-2020). Overall, women had a median of six adversities, distributed over four life-domains. The heat map revealed a large variety in lived adversities, which originated from two parental clusters, one dominated by financial adversities and the other by a the combination of a broad range of adversities. The perceived health was moderate, and 25-34% experienced moderate to severe levels of depression, anxiety or stress. This did not differ between the two parental clusters. CONCLUSIONS This study shows that highly vulnerable pregnant women deal with multiple adversities affecting not only their social and economic position but also their health and well-being.
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Affiliation(s)
- L. C. M. Bertens
- grid.5645.2000000040459992XDepartment of Obstetrics and Gynaecology, Erasmus University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - K. S. C. Mohabier
- grid.5645.2000000040459992XDepartment of Obstetrics and Gynaecology, Erasmus University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - M. van der Hulst
- grid.5645.2000000040459992XDepartment of Obstetrics and Gynaecology, Erasmus University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - D. S. E. Broekharst
- grid.5645.2000000040459992XDepartment of Obstetrics and Gynaecology, Erasmus University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - H. Ismaili M’hamdi
- grid.5645.2000000040459992XDepartment of Medical Ethics and Philosophy of Medicine, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - A. Burdorf
- grid.5645.2000000040459992XDepartment of Public Health, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - R. Kok
- grid.6906.90000000092621349Erasmus School of Social and Behavioural Sciences Clinical, Child and Family Studies, Erasmus University, Rotterdam, The Netherlands
| | - J. P. de Graaf
- grid.5645.2000000040459992XDepartment of Obstetrics and Gynaecology, Erasmus University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - E. A. P. Steegers
- grid.5645.2000000040459992XDepartment of Obstetrics and Gynaecology, Erasmus University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
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De la Calle M, Bartha JL, García L, Cuerva MJ, Ramiro-Cortijo D. Women Aged over 40 with Twin Pregnancies Have a Higher Risk of Adverse Obstetrical Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413117. [PMID: 34948726 PMCID: PMC8701912 DOI: 10.3390/ijerph182413117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/08/2021] [Accepted: 12/11/2021] [Indexed: 11/16/2022]
Abstract
Maternal age is related to a higher risk of adverse maternal, fetal, and neonatal outcomes in twin pregnancies. However, whether this increase in adverse outcomes is due solely to age or due to risk factors that are more common in women over 40 remains unknown. The aim of this study is to assess if maternal age over 40 years old is an independent risk factor for obstetric adverse outcomes in dichorionic diamniotic twin gestations. In this single-center retrospective cohort study, we compared the obstetric outcomes of women with dichorionic diamniotic twin pregnancies below and over 40 years of age. A twin pregnancy cohort enrolled between 2013 and 2019 was included in the study. Maternal, fetal, and labor complications were recorded. A total of 510 women were analyzed in two groups: 266 women below 40 years old and 244 women over 40 years old. Maternal age over 40 increased the odds of maternal (aOR = 1.9 (1.3; 2.9); p-value = 0.002), fetal (aOR = 1.8 (1.0; 3.0); p-value = 0.037), and labor complications (aOR = 2.5 (1.3; 4.6); p-value = 0.004). Maternal age over 40 years was the most important factor increasing the odds of having a caesarean section (C-section). Over 40 years old was an independent risk factor for complications in dichorionic diamniotic twin pregnancies.
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Affiliation(s)
- María De la Calle
- Department of Obstetrics and Gynecology, Hospital Universitario La Paz, 28046 Madrid, Spain; (M.D.l.C.); (J.L.B.); (M.J.C.)
| | - Jose L. Bartha
- Department of Obstetrics and Gynecology, Hospital Universitario La Paz, 28046 Madrid, Spain; (M.D.l.C.); (J.L.B.); (M.J.C.)
| | - Laura García
- Department of Pediatrics, Hospital Universitario Gregorio Marañón, 28007 Madrid, Spain;
| | - Marcos J. Cuerva
- Department of Obstetrics and Gynecology, Hospital Universitario La Paz, 28046 Madrid, Spain; (M.D.l.C.); (J.L.B.); (M.J.C.)
| | - David Ramiro-Cortijo
- Department of Physiology, Faculty of Medicine, Universidad Autonoma de Madrid, 28029 Madrid, Spain
- Correspondence:
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