Transcriptional profiling with pathway analysis identifies dysregulated molecular phenotypes in the endometrium of PCOS patients. Several key pathways related to cell cycle, glycolysis, and integrin-Rho cytoskeleton networks are downregulated in the endometrium of PCOS patients. Validation with real-time PCR on laser-captured cell types shows cell-type specific aberrations. The findings suggest impaired proliferation, glucose metabolism, and cell adhesion in the endometrium of PCOS patients.
This document discusses several types of skin conditions that can occur during pregnancy including Pemphigoid Gestationis, Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP), Polymorphic Eruption of Pregnancy (PEP), and Prurigo of Pregnancy. It provides details on the clinical presentation, pathogenesis, diagnosis, and treatment options for each condition. The document emphasizes that most of these skin conditions do not pose risks to the fetus or mother, but may recur in subsequent pregnancies. Topical corticosteroids and oral antihistamines are usually first-line treatments.
This document discusses early diagnosis of fetal alcohol spectrum disorder (FASD). It provides 3 key points:
1. FASD is caused by prenatal alcohol exposure and can cause facial abnormalities, growth issues, and central nervous system anomalies. Early diagnosis is important but challenging.
2. Biomarkers in meconium, hair, and blood can indicate prenatal alcohol exposure. Neuropsychological tests and brain imaging can help identify effects on the brain and behavior.
3. The Bayley Scales of Infant Development is a standardized developmental assessment that evaluates cognitive, language, motor, social-emotional, and adaptive functioning to help diagnose FASD.
The document discusses several key points about medication and breastfeeding:
1. Nearly all drugs transfer into breast milk to some extent through passive diffusion, with rare exceptions like heparin and insulin.
2. The amount transferred depends on factors like the mother's serum drug level, protein binding, lipophilicity, and molecular weight of the drug.
3. The infant's exposure also depends on the volume of milk consumed and the infant's ability to absorb and eliminate the drug.
4. Drugs are generally classified based on their safety profile during breastfeeding, with categories for compatible, compatible with monitoring, avoid if possible, and contraindicated drugs.
<마더리스크라운드>Type 2 diabetes in pregnancymothersafe
This document discusses the risks and management of type 2 diabetes during pregnancy. Strict glycemic control is emphasized as key to improving outcomes for both mother and baby. Women with diabetes who want to become pregnant should receive preconception counseling and care to optimize health and control before and during pregnancy. Preconception screening for undiagnosed diabetes is also important given increasing rates of obesity and type 2 diabetes.
Hormonal changes during pregnancy can cause dental issues like gingivitis. Maintaining oral health is important because periodontal disease has been linked to preterm birth and low birth weight, while dental caries can be transmitted from mother to child. Some studies have found that treating periodontal disease during pregnancy may reduce preterm births, but the evidence is conflicting. Dental treatment during pregnancy, including x-rays, fillings, and cleanings, has been shown to be safe for both mother and baby when precautions are taken. However, many pregnant women do not receive adequate dental care due to lack of education, finances, or access to a provider.
The document discusses contraception options for perimenopausal women. It begins with a brief history of contraception and family planning in Malaysia. It then notes the changing scenario of unwanted pregnancies occurring in older women. Pregnancy after age 35 presents increased medical risks for both mother and baby. However, it can also have advantages like financial stability. The document evaluates various contraceptive methods and their classifications and recommendations for use in perimenopausal women according to the WHO medical eligibility criteria. Options like combined oral contraceptives, progestin-only contraceptives, implants, IUDs and barrier methods can generally be used safely in older women without additional risk factors. LNG IUS and implants are good long-
Transcriptional profiling with pathway analysis identifies dysregulated molecular phenotypes in the endometrium of PCOS patients. Several key pathways related to cell cycle, glycolysis, and integrin-Rho cytoskeleton networks are downregulated in the endometrium of PCOS patients. Validation with real-time PCR on laser-captured cell types shows cell-type specific aberrations. The findings suggest impaired proliferation, glucose metabolism, and cell adhesion in the endometrium of PCOS patients.
This document discusses several types of skin conditions that can occur during pregnancy including Pemphigoid Gestationis, Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP), Polymorphic Eruption of Pregnancy (PEP), and Prurigo of Pregnancy. It provides details on the clinical presentation, pathogenesis, diagnosis, and treatment options for each condition. The document emphasizes that most of these skin conditions do not pose risks to the fetus or mother, but may recur in subsequent pregnancies. Topical corticosteroids and oral antihistamines are usually first-line treatments.
This document discusses early diagnosis of fetal alcohol spectrum disorder (FASD). It provides 3 key points:
1. FASD is caused by prenatal alcohol exposure and can cause facial abnormalities, growth issues, and central nervous system anomalies. Early diagnosis is important but challenging.
2. Biomarkers in meconium, hair, and blood can indicate prenatal alcohol exposure. Neuropsychological tests and brain imaging can help identify effects on the brain and behavior.
3. The Bayley Scales of Infant Development is a standardized developmental assessment that evaluates cognitive, language, motor, social-emotional, and adaptive functioning to help diagnose FASD.
The document discusses several key points about medication and breastfeeding:
1. Nearly all drugs transfer into breast milk to some extent through passive diffusion, with rare exceptions like heparin and insulin.
2. The amount transferred depends on factors like the mother's serum drug level, protein binding, lipophilicity, and molecular weight of the drug.
3. The infant's exposure also depends on the volume of milk consumed and the infant's ability to absorb and eliminate the drug.
4. Drugs are generally classified based on their safety profile during breastfeeding, with categories for compatible, compatible with monitoring, avoid if possible, and contraindicated drugs.
<마더리스크라운드>Type 2 diabetes in pregnancymothersafe
This document discusses the risks and management of type 2 diabetes during pregnancy. Strict glycemic control is emphasized as key to improving outcomes for both mother and baby. Women with diabetes who want to become pregnant should receive preconception counseling and care to optimize health and control before and during pregnancy. Preconception screening for undiagnosed diabetes is also important given increasing rates of obesity and type 2 diabetes.
Hormonal changes during pregnancy can cause dental issues like gingivitis. Maintaining oral health is important because periodontal disease has been linked to preterm birth and low birth weight, while dental caries can be transmitted from mother to child. Some studies have found that treating periodontal disease during pregnancy may reduce preterm births, but the evidence is conflicting. Dental treatment during pregnancy, including x-rays, fillings, and cleanings, has been shown to be safe for both mother and baby when precautions are taken. However, many pregnant women do not receive adequate dental care due to lack of education, finances, or access to a provider.
The document discusses contraception options for perimenopausal women. It begins with a brief history of contraception and family planning in Malaysia. It then notes the changing scenario of unwanted pregnancies occurring in older women. Pregnancy after age 35 presents increased medical risks for both mother and baby. However, it can also have advantages like financial stability. The document evaluates various contraceptive methods and their classifications and recommendations for use in perimenopausal women according to the WHO medical eligibility criteria. Options like combined oral contraceptives, progestin-only contraceptives, implants, IUDs and barrier methods can generally be used safely in older women without additional risk factors. LNG IUS and implants are good long-
Safety of Mebendazole Use During Lactationmothersafe
This case series study evaluated the safety of mebendazole use in 45 lactating women and their infants. Mebendazole was administered using single or repeated doses and was well tolerated by both the mothers and infants, with no adverse effects observed in infants. Mild GI irritability occurred in two treated mothers. This study provides the first evidence that mebendazole is safe for use in breastfeeding.
This document summarizes a study that examined the relationship between the drug domperidone, which is commonly used off-label to stimulate lactation, and the risk of ventricular arrhythmia and mortality during the postpartum period. The study used a retrospective cohort of over 225,000 women in British Columbia between 2002-2011. It found a possible doubling of the risk of hospitalization for ventricular arrhythmia among those exposed to domperidone, though the results were not statistically significant. Larger studies are needed to confirm any association.
This document summarizes key findings from several studies on exposures during pregnancy and lactation. The studies found:
- Teratogen information services receive thousands of calls annually regarding exposures to medications, infections, herbs and other substances during pregnancy and breastfeeding. The majority of calls concern analgesics, cold medications, herbs and dietary supplements.
- Most calls are made by exposed individuals themselves, highlighting a need for more education during prenatal care about risks of nonprescription drugs and vaccines.
- While some drugs used to treat autoimmune diseases like methotrexate and leflunomide can cause harm if taken during early pregnancy, others like sulfasalazine, azathioprine and antimalarials are
(마더리스크라운드) Thyroid disease in pregnancy 임신 중 갑상선mothersafe
This study examined pregnancy outcomes for women exposed to antithyroid medications or levothyroxine for thyroid disorders. The study found that infants of mothers treated for hyperthyroidism with antithyroid medications were more likely to be born preterm or with low birth weight. However, treatment of hypothyroidism with levothyroxine did not negatively impact birth outcomes and showed no increased risk of infant mortality. Additionally, the study found no evidence that levothyroxine exposure increased the risk of major congenital anomalies.
Diclectin in NVP, 44th 유럽기형학회보고 / 한정열 교수mothersafe
This document summarizes a presentation on making a difference as concerned scientists in an environmentally contaminated world. It discusses how scientists have identified problems like chemical pollution and investigated effects on human health. It provides examples like Rachel Carson's Silent Spring which brought attention to pesticide impacts and led to regulations. Endocrine disrupting chemicals can alter fetal development with impacts like reduced intelligence only appearing later. The document then summarizes several talks on topics like the impacts of maternal health conditions like diabetes and epilepsy during pregnancy, using the human placenta to test chemical safety, prenatal metal exposure and DNA methylation in the placenta, free fetal hemoglobin as a potential cause and target for preeclampsia, and revising guidelines
Maternal smoking during pregnancy was associated with an increased risk of major malformations in newborns. A study of over 2000 pregnancies found the risk of major malformations was 3.3 times higher for babies exposed to maternal smoking compared to non-exposed babies. Paternal smoking was also high among the smoking mothers, occurring in over 60% of smoking mothers compared to 38% of non-smoking mothers. Exposure to alcohol and lower education levels were also associated with increased risk of maternal smoking during pregnancy.
This document summarizes guidelines and studies on screening and management of subclinical hypothyroidism during pregnancy. Key points include:
- Guidelines from thyroid societies recommend trimester-specific reference ranges for TSH and treatment of SCH with levothyroxine.
- Studies show mixed results on associations between SCH and adverse pregnancy/child outcomes, and limited benefits of levothyroxine treatment.
- Targeted high-risk screening misses a significant percentage of women with thyroid dysfunction compared to universal screening.
- While evidence is still limited, most experts recommend universal screening to detect and treat overt hypothyroidism given potential benefits.
This document provides information about external cephalic version (ECV):
1. ECV is a procedure performed near term to manually turn a breech baby into a head-down position. The success rate of ECV is reported between 35-86%.
2. ECV has been performed since ancient times but was improved in the 1970s by performing it under tocolysis after screening with ultrasound and fetal monitoring. Recent studies show ECV effectively reduces non-cephalic births and C-sections for malpresentation.
3. Guidelines from obstetric organizations recommend offering ECV to women with a breech fetus near term due to evidence it can reduce C-sections. Factors like adequate amni
1. Proper management of diabetes before and during pregnancy is important to reduce risks of complications. Tight glucose control through medical nutrition therapy, exercise, and insulin treatment can decrease risks of fetal anomalies and growth issues.
2. Gestational diabetes is diagnosed through an oral glucose tolerance test and treated with lifestyle changes and possibly insulin to control blood glucose. Women with a history of GDM require follow up after pregnancy to screen for diabetes.
3. Preconception counseling and care is crucial for women with pre-existing diabetes to optimize health before pregnancy in order to lower risks during pregnancy through strict glucose monitoring and management.
This document discusses alcohol intake during pregnancy and fetal alcohol spectrum disorders (FASD). It provides statistics on alcohol use during pregnancy from various studies. It notes that a safe level of alcohol during pregnancy has not been determined, as the effects of alcohol on the fetus are variable depending on factors like the mother's metabolism and drinking patterns. Low to moderate prenatal alcohol exposure has not shown effects in some studies, but other research has found children with FAS even with reported low alcohol intake. The document describes clinical features of FASD including facial abnormalities, growth issues, central nervous system anomalies, and functional impairments. It discusses diagnostic criteria from various organizations and guidelines for diagnosing FASD.
(마더리스크라운드) Radiation in Pregnancy 조연경 교수mothersafe
This document discusses the risks of ionizing radiation exposure during pregnancy. It notes that ionizing radiation is a known teratogen that can cause developmental effects in the fetus including growth restriction, malformations, and increased cancer risk later in life. The critical periods of susceptibility are during organogenesis from 8-15 weeks and in late pregnancy. While low doses below 100 mGy are not considered grounds for termination, above 1000 mGy significantly increases risks. The document provides examples of radiation doses from various medical imaging procedures and natural sources. It recommends shielding and limiting exposure to protect the pregnant woman and fetus.
This document discusses hyperthermia in pregnancy and its potential risks. It defines hyperthermia as an elevated body temperature above normal levels due to failed thermoregulation. Animal studies show that hyperthermia during pregnancy, especially temperatures over 39.5°C, increases the risk of neural tube defects, miscarriage, and other abnormalities in offspring. Human studies also associate maternal fever, particularly during the first trimester, with an increased risk of neural tube defects, spontaneous abortion, and some heart and brain abnormalities. However, some studies found no clear link. Sauna use during pregnancy appears to carry less risk than other heat sources if core temperature remains below 38.9°C.
Vitamin D supplementation during pregnancy: Is it really necessary?
1) There is ongoing debate around the optimal vitamin D levels during pregnancy and definitions of vitamin D deficiency. 2) Studies have shown associations between vitamin D deficiency and adverse pregnancy outcomes like gestational diabetes and preeclampsia. 3) The placenta plays a role in vitamin D metabolism and higher placental activity of the CYP24A1 enzyme is associated with vitamin D deficiency in pregnancies with gestational diabetes. 4) While routine vitamin D screening in all pregnancies is not currently recommended, high-risk women may benefit from screening and supplementation to treat deficiency.
3. 1. Depression
Lifetime prevalence of major depression in
women ranges : 9% ~26%
Risk is greatest during the childbearing years
Pregnancy does not protect women from
depression
up to 70% of pregnant women express having
depressive symptoms
prevalence rates of 7.4%, 12.8% and 12% for first
trimester (T1), T2 and T3 respectively
Untreated depression/anxiety can have negative
fetal/obstetrical and neonatal outcomes
6. 주산기 우울증의 양상
산후 우울증 : 출산 4주(6달) 이내에 시작된 우울증상이 2주 이상 지속
출산 후 행복감 이외에 다른 감정(우울, 화 등)이 있다는 것에 당황.
주변이나 의사에게 이야기하길 꺼림.
우울보다 “불안”이 주증상인 경우가 많다.
아기가 자고 있을 때에도 잠자는데 어려움이 있는지.
갓난아기에게 적응하는데 걱정이나 의문이 있는지 / 아기를 해치는 생각이나 두
려움에 대해서 개방적으로
모유수유의 어려움, 모유수유를 즐기지 못하는 것
우울증 선별 검사 : 에딘버러 산후우울증 척도
1. 우스운 것이 눈에 잘 뜨이고 웃을 수 있었다. 6. 일들을 감당하지 못했다.
2. 즐거운 기대감에 어떤 일을 손꼽아 기다렸다. 7. 수면을 취하는데 어려움을 겪어서 힘들었다.
3. 일이 잘못되면 필요 이상으로 자신을 탓했다. 8. 슬프거나 불행하다고 느꼈다.
4. 별 이유 없이 근심하거나 걱정이 되었다. 9. 몹시 슬퍼서 울었다.
5. 별 이유 없이 두려움이나 공포를 느꼈다. 10. 나 자신을 해치는 생각이 들었다.
7. 주산기 우울증의 치료
Psychotherapy : Treatment of choice in mild to
moderate depression
Psychoeducation for patient and partner is important.
임싞 중/산후의 정상적 심리변화 설명 : 재앙화사고를
normalization
Environment modification
산모의 “현실적인 짐”의 정도를 파악 (수면정도, 육체적 피로도,
양육분담정도)
짐을 덜 수 있는 대앆 모색 (부부/가족 면담)
Interpersonal therapy (부부치료)
남편의 무관심, 사회적 기능을 잃었다는 박탈감
Cognitive therapy, Mindfulness-Based Stress Reduction
8. 약물치료
정싞치료가 불가능 하거나 증상이 심한 경우
심각한 기능 저하 (육아장애, 소아방치, 관계불화)
자해 또는 타해 사고
증상의 지속
산후우울증에서의 모유수유 지속 여부
모유수유는 심리적 앆정, 성취감을 주는 반면, 수유로 인한 수면 방해,
아이를 약물에 노출하는 죄책감등이 우울증을 가속화할 수 있다.
모유수유 : 영아/산모 혈청 농도
10% 이하 : sertraline (zoloft®), paroxetine
10% 이상 : fluoxetine (22%의 예에서), citalopram (17%에서), TCA 계열은 처
방하지 않는 것이 좋다.
Restrict breast feeding time (peak concentration 6-8hrs)
약물 치료 선택은 환자/보호자 입회하에 결정
If medication is used, the goal is to achieve full remission
10. Risk with Antidepressant Use
Antidepressants do not appear to increase the risk for overall
congenital malformations above the 3% population baseline.
Paroxetine : a small (1 in 200) increase in risk for congenital and
cardiovascular malformations
not controlled for maternal depression and anxiety
Routine fetal nuchal translucency US can be done at 10-14 weeks
Increase in spontaneous abortion of about 4% above the study
baseline (12.5% vs. 8.7% : RR of 1.45)
Small risk for preterm birth,
neonates having a LBW and lower Apgar scores are inconclusive
No developmental problems for children up to 7 years of age in
cognitive development, mood, temperament, activity,
distractibility, or behavioural problems (but limited data).
11. Risk with Antidepressant Use
Poor neonatal adaptation syndrome (PNAS) : risk of 4-30%
serotonin toxicity + neonatal type of discontinuation syndrome
symptoms : irritability, hypertonia, tremor, jitteriness, some difficulty
feeding
onset : immediately or a few hours after delivery, or within days of
birth
resolve : transient and generally within days, a few weeks
Manage : most infants do not require admission to a neonatal unit
and can be monitored using the Neonatal Abstinence Scale (NAS)
critical care usually have prominent respiratory problems or seizures
frequent neonatal monitoring is required for at least three days postpartum then
post-discharge follow-up with a paediatrician is recommended
No evidence at this time for long-term neurobehavioral effects
Consensus remains that the use of antidepressants is
acceptable in pregnancy if maternal symptoms are severe
12. Pregnants with depression history
A prospective naturalistic investigation (Cohen et al,
2006, JAMA)
201 pregnant women (<16wks) in euthymic state
with major depression history
86 (43%) relapse during pregnancy
26% (21/82) of maintained group medication vs. 68%
(44/65) of discontinued group (hazard ratio, 5.0; 95%
confidence interval, 2.8-9.1; P<.001)
Pregnancy is not “protective” with respect to risk
of relapse of major depression
Be aware of depressive relapse during pregnancy
with antidepressant discontinuation
13. 2-1. Postpartum Psychosis
출산 4주 이내에 시작
증상
Frank psychosis (환청, 망상)
Cognitive impairment (인지능력 저하)
Grossly disorganized behavior (앞뒤가 맞지 않는 말, 논리비약)
Complete change from previous functioning
Poor insight -> risk
산모와 영아를 공갂적으로 분리한다, 정싞과 의사 응급 접촉
치료 : 약물치료 (antipsychotics, antimanic agents, ECT)
기졲 정싞병적 장애 환자보다 약물 반응은 빠른 편
Differential diagnosis & follow-up 이 중요
첫 조증 episode가 산후정싞병으로 시작되는 경우도 많다.
14. 2-2. Pregnants with Psychotic disorder
대부분의 antipsychotics는 FDA class “C”
비정형(atypical) 항정싞병 약물은 특별한 영향이 없고
정형(typical) 약물은 preterm birth의 위험이 있다 (Lin
et al, 2010, schizophrenia research)
Atypical : No significant difference in the risk of LBW,
preterm births, LGA, and SGA babies compared to
mothers not receiving antipsychotics.
Typical : higher odds of preterm birth (OR=2.46, 95%
CI=1.50-4.11)
Schizophrenia 라는 질환이 adverse pregnancy
outcome을 보임 (LBW, SGA)
15. 2-3. Pregnants with Bipolar disorder
1% prevalence, typical onset age is early adulthood.
Recurrence in pregnancy : 71% (APA, 2007)
약물 중단군이 유지군에 비해 2배의 risk
„Abrupt discontinuation‟이 가장 큰 위험요소
47%가 1st trimester에
Postpartum period 에도 높은 재발율
Sleep deprivation*, hormonal change
Medication
High risk : Valproic acid, Carbamazepine - Anticonvulsants
(FDA “D”)
human teratogen (neural tube defect) : odd ratio 1.84 (2007,
Sweden)
Moderate risk : Lithium (FDA group “D”), Lamotrigine (FDA “C”)
Lower risk : atypical antipsychotics (FDA group “C”)
16. 3. Anxiety disorder
싞체적 / 정싞적 불앆은 주산기에 흔히 호소하는 증상
두근거림, 가쁜 호흡, 질식감, 식은땀
초조, 좌불앆석, 불앆이 이리저리 떠다니는 느낌
임싞 후기로 가면서 일어나는 싞체적 변화가 불앆/공황장애의 단초가
될 수 있음.
경한 불앆 : 복식호흡, 근육이완, Mindfulness 명상
항불앆 약물
Benzodiazepines : Diazepam (Valium®), Clonazepam (Rivotril®),
Lorazepam (Ativan®), Alprazolam (Xanax®), Triazolam (Halcion®) : FDA
group “D”
Hypnotic benzodiazepine receptor agonists (stilnox®) : FDA group “C”
Buspirone (Buspar®): FDA group “B”
출산 1달 젂엔 복용 중단 : floppy baby syndrome의 예방
17. Risk of Benzodiazepines
1998년 review data (Dolovich et al) : 1st trimester 또는 그
이상 시기에 노출된 산모를 대상으로 한 23개의 study 포함
Analysis of cohort studies : not associated with major
malformations (odds ratio 0.90; 95% confidence interval 0.61
to 1.35) or oral cleft (1.19; 0.34 to 4.15)
Analysis of case-control studies : association with major
malformations (3.01; 1.32 to 6.84) or oral cleft alone (1.79; 1.13
to 2.82).
2007년 Sweden cohort study (Wikner et al)
Increased risk for preterm birth and low birth weight
Major congenital malformations : moderately increased among
infants exposed in early pregnancy (adjusted OR = 1.24,
95%CI 1.00–1.55), not strong teratogenic potential (alimentary
tract atresia).
18.
19. Wrap-up
어떠한 약물도 임싞과 수유에 위험성이 없다고 단정지을 수
없다.
임싞중에 absolute contraindication인 약물도 없다.
임싞/수유모를 대상으로한 controlled study는 매우 부족하다
임싞중 (특히 1기) 에는 약물을 피하는 것이 좋다.
모든 정싞과적 약물은 모유로 분비된다.
항우울제 : FDA group “C” except paroxetine (“D”)
항정싞병약물 : FDA group “C”
항조증약물, 항불앆제(벤조디아제핀) : FDA group “D”