Maternal-fetal Medicine
RCT: Free Access to Water vs. Fasting Pre-Cesarean Reduces Vomiting and Increases Maternal Satisfaction
25 Mar, 2024 | 11:17h | UTCStudy Design and Population: This randomized controlled trial was carried out at the Obstetric Unit, Universiti Malaya Medical Center from October 2020 to May 2022. A total of 504 women scheduled for planned cesarean delivery under spinal anesthesia were randomized into two groups: 252 were allowed free access to water up until being called to the operating theater, and 252 were required to fast from midnight before the procedure. The study primarily aimed to evaluate the effects of these preoperative oral intake policies on perioperative vomiting and maternal satisfaction.
Main Findings: The results demonstrated significant benefits for the group with free access to water. Specifically, perioperative vomiting was observed in 3.6% of women with water access compared to 9.5% of those fasting, indicating a relative risk reduction. Maternal satisfaction scores were notably higher in the water access group, with median scores of 9 versus 5 for the fasting group. Additional findings included lower reports of thirst, fewer instances of preoperative intravenous hydration, reduced ketone presence in urine, and a lower average number of vasopressor doses needed. Significantly, 95.2% of participants in the water access group would recommend their regimen to a friend, compared to only 39.7% in the fasting group.
Implications for Practice: Allowing free access to water up until the time of surgery for women scheduled for cesarean delivery under spinal anesthesia significantly reduces the risk of perioperative vomiting and improves maternal satisfaction, without adversely affecting post-cesarean recovery or neonatal outcomes. These findings support revising current preoperative fasting guidelines to improve patient experience and potentially enhance clinical outcomes.
Cohort Study: Elevated autism spectrum disorder risk in children exposed to valproate during pregnancy
21 Mar, 2024 | 13:16h | UTCStudy Design and Population: This cohort study utilized two health care utilization databases in the United States, covering the period from 2000 to 2020, to investigate the association between prenatal exposure to antiseizure medications and the risk of autism spectrum disorder (ASD) in children. The study compared children exposed to topiramate, valproate, or lamotrigine during the second half of pregnancy to those unexposed to any antiseizure medication, specifically focusing on a population-based cohort of pregnant women and their offspring.
Main Findings: The cumulative incidence of ASD at 8 years of age was found to be higher in children exposed to these medications compared to the general population. Notably, the incidence was 6.2% for children exposed to topiramate, 10.5% for valproate, and 4.1% for lamotrigine among children born to mothers with epilepsy. However, after adjusting for potential confounders, the increased risk of ASD remained significant only for valproate exposure, with a hazard ratio of 2.67, indicating a substantial risk compared to unexposed children. Topiramate and lamotrigine showed no significant increase in risk after adjustment.
Implications for Practice: The findings underscore the importance of carefully considering the risks and benefits of using antiseizure medications during pregnancy. Specifically, valproate should be used with caution, if at all, given its significant association with an increased risk of ASD in offspring. This study supports the need for targeted counseling and monitoring of pregnant women with epilepsy and highlights the necessity for further research to fully understand the neurodevelopmental impact of prenatal exposure to antiseizure medications.
Reference: Sonia Hernández-Díaz et al. (2024). Cohort Study: Assessing Autism Spectrum Disorder Risk in Children Exposed to Antiseizure Medications During Pregnancy. N Engl J Med, 390(13), 1069-1079. DOI: 10.1056/NEJMoa2309359. Access the study here: [Link]
Caring for two in the ICU: pharmacologic management of pregnancy-related complications
7 Aug, 2023 | 14:31h | UTCCaring for two in the ICU: Pharmacologic management of pregnancy-related complications – Pharmacotherapy (free for a limited period)
USPSTF | Reaffirming the importance of folic acid to all women planning to or who could become pregnant to prevent neural tube defects
4 Aug, 2023 | 12:15h | UTCEvidence Report: Folic Acid Supplementation to Prevent Neural Tube Defects: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force – JAMA
Patient Page: Folic Acid to Prevent Neural Tube Defects – JAMA
Commentary on Twitter
2023 Recommendation Statement from the USPSTF: all persons planning to or who could become pregnant should take a daily supplement containing 0.4 to 0.8 mg (400 to 800 μg) of folic acid (A recommendation). https://t.co/gdavbWyZZ7 pic.twitter.com/2PAjb0OCBO
— JAMA (@JAMA_current) August 1, 2023
M-A | Antenatal corticosteroid exposure linked to negative outcomes in term-born infants
4 Aug, 2023 | 11:59h | UTCRelated Study: Association between antenatal corticosteroids and risk of serious infection in children: nationwide cohort study – The BMJ
Editorial: Antenatal corticosteroids and longer term outcomes – The BMJ
News Releases:
New studies shed more light on potential risks of antenatal steroids – BMJ Newsroom
Cohort Study | Antenatal corticosteroid exposure associated with increased incidence of pediatric serious infection
4 Aug, 2023 | 11:57h | UTCEditorial: Antenatal corticosteroids and longer term outcomes – The BMJ
M-A | Exploring perinatal interventions and their impact on severe intraventricular hemorrhage in preterm neonates
4 Aug, 2023 | 11:56h | UTC
Commentary on Twitter
A meta-analysis by @DrAbdulRazak_MD & colleagues on perinatal interventions are associated with a reduction or increase of IVH and PVL #EBNEOalerts #neoEBM #neotwitter https://t.co/SPzNHwy3HD pic.twitter.com/KDQBSYZjdq
— Evidence-Based Neo (@EBNEO) April 26, 2023
BSH guideline for anticoagulant management of pregnant individuals with mechanical heart valves
2 Aug, 2023 | 14:01h | UTC
RCT | Maternal egg intake in early neonatal period does not impact infant egg allergy risk
2 Aug, 2023 | 13:47h | UTCSee also: Visual Abstract
RCT | Early vs. delayed intrauterine balloon tamponade: no difference in severe postpartum hemorrhage
2 Aug, 2023 | 13:42h | UTCEfficacy of early intrauterine balloon tamponade for immediate postpartum hemorrhage after vaginal delivery: a randomized clinical trial – The American Journal of Obstetrics and Gynecology (link to abstract – $ for full-text)
Cohort Study | History of pregnancy loss linked to higher MI and stroke risk in women, but not in male partners
1 Aug, 2023 | 14:13h | UTCCommentary: Pregnancy Loss Linked to Increased Risk of Heart Attack in Women, But Not Male Partners – HCP Live
RCT | Cervical pessary fails to prevent preterm birth in short cervix singleton pregnancies
27 Jul, 2023 | 13:06h | UTCCervical Pessary for Prevention of Preterm Birth in Individuals With a Short Cervix: The TOPS Randomized Clinical Trial – JAMA (free for a limited period)
Editorial: The Vexing Problem of Preterm Birth Prevention – JAMA (free for a limited period)
See also: Visual Abstract
News Release: Cervical pessary no more effective than usual care in preventing preterm birth risk – NIH News Releases
RCT | Zuranolone, a potential rapid-acting oral treatment for severe postpartum depression
27 Jul, 2023 | 13:00h | UTCZuranolone for the Treatment of Postpartum Depression – American Journal of Psychiatry (link to abstract – $ for full-text)
Commentary: Postpartum Depression Pill Zuralonone Shows Promise in Women With Severe Symptoms – Psychiatric News Alert
Related: RCT | Zuranolone outperforms placebo in major depressive disorder treatment
Consensus Paper | Urinary tract infections in pregnant individuals
25 Jul, 2023 | 13:53h | UTCUrinary Tract Infections in Pregnant Individuals – Obstetrics & Gynecology
Key factors associated with quality of postnatal care: a pooled analysis of 23 countries
25 Jul, 2023 | 13:50h | UTC
Cohort Study | The role of antiphospholipid syndrome and specific antibodies in predicting SLE pregnancy complications
25 Jul, 2023 | 13:44h | UTCPregnancy outcomes in 1869 pregnancies in a large cohort from the Spanish Society of Rheumatology Lupus Register (RELESSER) – Seminars in Arthritis and Rheumatism (link to abstract – $ for full-text)
Commentary: SLE and Pregnancy Outcomes – RheumNow
RCT | Planned delivery from 34 weeks’ gestation effectively reduces pre-eclampsia related morbidity and mortality in LMICs
24 Jul, 2023 | 13:10h | UTCRelated:
RCT | Planned delivery for pre-eclampsia between 34 and 37 weeks of gestation
M-A | Planned delivery or expectant management in preeclampsia.
Randomized Trial: Planned Early Delivery vs. Expectant Management for Late Preterm Pre-eclampsia
Review | Oxytocin: physiology, pharmacology, and clinical application for labor management
24 Jul, 2023 | 13:04h | UTCOxytocin: physiology, pharmacology, and clinical application for labor management – American Journal of Obstetrics & Gynecology (free for a limited period)
Phase 2 Trial | Maternal GBS6 vaccine shows promise in infant group B strep prevention
21 Jul, 2023 | 13:34h | UTCCommentary: Maternal strep B vaccine slashes risk of infection among infants – CIDRAP
RCT | Molecular screening for bacterial vaginosis does not significantly reduce preterm birth rates
21 Jul, 2023 | 13:31h | UTCSee also: Visual Abstract
Guidelines and recommendations for performance of the fetal echocardiogram
17 Jul, 2023 | 13:45h | UTC
EASL Guidelines on the management of liver diseases in pregnancy
13 Jul, 2023 | 13:05h | UTC
USPSTF | Routine depression screening recommended for adults including pregnant and postpartum women
11 Jul, 2023 | 14:09h | UTCEvidence Report: Depression and Suicide Risk Screening: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force – JAMA
Patient Page: Screening for Depression and Suicide Risk in Adults – JAMA
Editorials:
Reframing the Key Questions Regarding Screening for Suicide Risk – JAMA
Suicidality Screening Guidelines Highlight the Need for Intervention Studies – JAMA Network Open
Related:
Cohort Study | Hypertensive disorders of pregnancy linked to a 66% higher stroke risk in U.S. black women
10 Jul, 2023 | 13:31h | UTCHypertensive Disorders of Pregnancy and Risk of Stroke in U.S. Black Women – NEJM Medicine
Review | Diabetes detection in women with gestational diabetes and polycystic ovarian syndrome
7 Jul, 2023 | 16:08h | UTCDiabetes detection in women with gestational diabetes and polycystic ovarian syndrome – The BMJ