Ema Ferreira

Effects of Selective Serotonin Reuptake Inhibitors and Venlafaxine During Pregnancy in Term and Preterm Neonates

OBJECTIVES. Our goals were to (a) describe neonatal behavioral signs in a group of newborns exposed in utero to selective serotonin reuptake inhibitors or venlafaxine at the time of delivery, (b) compare the rate of neonatal behavioral signs, prematurity, and admission to specialized neonatal care between a group of exposed and unexposed newborns, and (c) compare the effects in exposed preterm and term newborns. PATIENTS AND METHODS. This was a retrospective cohort study including mothers taking selective serotonin reuptake inhibitors or venlafaxine during the third trimester and mothers who were not taking any antidepressants, psychotropic agents, or benzodiazepines at the time of delivery of their newborns. Neonatal behavioral signs included central nervous, respiratory, and digestive systems, as well as hypoglycemia and the need for phototherapy. RESULTS. Seventy-six mothers taking antidepressants and 90 untreated mothers and their newborns were analyzed. Smoking, alcohol intake, and substance abuse were more frequent among treated mothers. In infants in the exposed group, signs involving the central nervous and the respiratory systems were often observed (63.2% and 40.8%, respectively). These signs appeared during the first day of life, with a median duration of 3 days for exposed newborns. The signs resolved in 75% of cases within 3 to 5 days for term and premature newborns, respectively. All exposed premature newborns presented behavioral manifestations compared with 69.1% of term exposed newborns. Median length of stay was almost 4 times longer for exposed premature newborns than for those who were unexposed (14.5 vs 3.7 days). CONCLUSIONS. Neonatal behavioral signs were frequently found in exposed newborns, but symptoms were transient and self-limited. Premature infants could be more susceptible to the effects of selective serotonin reuptake inhibitors and venlafaxine.

Nausea and vomiting of pregnancy: what about quality of life?

Objective  The objective of this study was to determine the impact of nausea and vomiting of pregnancy (NVP) and other determinants on generic and NVP‐specific health‐related quality of life (QOL) in the first trimester of pregnancy.

Validity of a modified Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) scoring index to assess severity of nausea and vomiting of pregnancy.

OBJECTIVE The only validated nausea and vomiting of pregnancy (NVP) severity index is the Motherisk Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) index that covers symptoms in the previous 12 hours. We sought to assess the validity of a modified-PUQE index that covers the entire first trimester of pregnancy by comparing NVP severity scores between the 12-hour PUQE index and our modified-PUQE index and by measuring the extent of the association between the modified-PUQE score and quality-of-life (QOL) score during the first trimester of pregnancy. STUDY DESIGN A prospective study that included women who attended the Centre Hospitalier Universitaire Sainte-Justine or René-Laennec clinic for their prenatal visits was conducted from 2004-2006. Women were eligible if they were > or = 18 years old and < or = 16 weeks of gestation at the time of their first prenatal visit. Women who reported NVP were asked to fill out the 12-hour PUQE, the modified PUQE index, and the Short-Form Health Survey QOL index simultaneously. Intraclass correlation coefficients were calculated to determine concordance between the 2 scores. Linear regression models were built to measure the association between the modified-PUQE score and Short-Form Health Survey QOL scores. RESULTS Among participants (n = 287), the mean NVP severity score was 5.7 vs 6.7 on the 12-hour PUQE and modified PUQE, respectively (P < .05). There was substantial concordance between the indices (intraclass correlation coefficient, 0.71). Severity of NVP that was measured by the new modified index was associated with QOL. CONCLUSION We are confident that, on the basis of the modified-PUQE, the relationship between QOL and severity of NVP justify the use of this new index.

Effect of maternal moderate to severe asthma on perinatal outcomes

BACKGROUND/OBJECTIVES It has been reported that adverse fetal outcomes are more prevalent in pregnant women with asthma than they are in women without asthma. In our study, we investigated the effect that the severity of asthma during pregnancy has on the risk of a small for gestational age (SGA) infant, low birth weight (LBW), and preterm birth. METHODS A population-based cohort of 13,007 pregnancies from asthmatic women was reconstructed through the linking of three of Quebecs (Canada) administrative databases covering the period between 1990 and 2002. A two-stage sampling cohort design was used to collect additional information on the selected womens life-style habits via a mailed questionnaire. Asthma severity during pregnancy was measured with a validated database index. A logistic regression model was used to obtain the adjusted odds ratios of SGA, LBW and preterm birth as a function of the level of asthma severity. RESULTS The proportions of women with mild, moderate and severe asthma were 82.5%, 12.5% and 5.0%, respectively. We sent 3,168 questionnaires to selected women, with a 40.2% (n=1274) response rate. Final estimates showed that the risk of SGA was significantly higher among severe (OR:1.48, 95%CI: 1.15-1.91) and moderate asthmatic women (OR: 1.30, 95%CI:1.10-1.55) than mild asthmatic women. No significant associations were found between asthma severity, preterm birth and LBW. CONCLUSIONS Mothers with severe and moderate asthma during pregnancy have a higher risk of SGA babies than those with mild asthma.

Epidemiology of nausea and vomiting of pregnancy: prevalence, severity, determinants, and the importance of race/ethnicity.

BackgroundStudies that contributed to the epidemiology of nausea and vomiting of pregnancy have reported conflicting findings, and often failed to account for all possible co-variables necessary to evaluate the multidimensional associations. The objectives of this study were to: 1) Estimate the prevalence and the severity of nausea and vomiting of pregnancy during the 1st and the 2nd trimester of pregnancy, and 2) Identify determinants of presence and severity of nausea and vomiting of pregnancy during the 1st and 2nd trimesters separately, with a special emphasis on the impact of race/ethnicity.MethodsA prospective study including pregnant women attending the Centre Hospitalier Universitaire (CHU) Sainte-Justine or René-Laennec clinics for their prenatal care was conducted from 2004 to 2006. Women were eligible if they were ≥ 18 years of age, and ≤ 16 weeks of gestation. Women were asked to fill out a 1st trimester self-administered questionnaire and were interviewed over the telephone during their 2nd trimester of pregnancy. Presence of nausea and vomiting of pregnancy was based on the reporting of pregnant women (yes/no); severity of symptoms was measured by the validated modified-PUQE index.ResultsOf the 367 women included in the study, 81.2% were Caucasians, 10.1% Blacks, 4.6% Hispanics, and 4.1% Asians. Multivariate analyses showed that race/ethnicity was significantly associated with a decreased likelihood of reporting nausea and vomiting of pregnancy (Asians vs. Caucasians OR: 0.13; 95%CI 0.02–0.73; and Blacks vs. Caucasians OR: 0.29; 95%CI 0.09–0.99).ConclusionOur study showed that race/ethnicity was associated with the reporting of nausea and vomiting of pregnancy in the 1st trimester of pregnancy.

Metoclopramide and diphenhydramine in the treatment of hyperemesis gravidarum: Effectiveness and predictors of rehospitalisation

OBJECTIVES Hyperemesis gravidarum (HG) is the second most common reason for hospitalisation during pregnancy. Since 2002, a new HG treatment protocol consisting of metoclopramide plus diphenhydramine was put in place at CHU Sainte-Justine, affiliated to University of Montreal, Quebec, Canada. The objectives of this study were to evaluate the effectiveness of this new HG protocol regarding length of hospitalisation for HG, rate of rehospitalisation, evolution of nausea and vomiting symptoms, and rate of adverse events. STUDY DESIGN A retrospective cohort study was conducted from 2002 to 2006 on the population of pregnant women diagnosed with HG, and treated at CHU Sainte-Justine with the new protocol consisting of intravenous metoclopramide 1.2-1.8 mg/h plus diphenhydramine 50 mg every 6 h. These women were compared to a historical control group consisting of women diagnosed with HG, and treated in the same institution with intravenous droperidol 0.5-1 mg/h plus diphenhydramine 25-50 mg every 6h between 1998 and 2001. RESULTS During the study period, a total of 130 pregnant women were exposed to the new HG protocol versus 99 that were exposed to the droperidol and diphenhydramine combination between 1998 and 2001. Our study showed that the new HG protocol was associated with a greater improvement of vomiting symptoms (36% vs. 21%; p=0.0397), and with fewer adverse events. The new HG protocol was equivalent to the droperidol and diphenhydramine combination to reduce nausea symptoms, length of hospitalisation (3.7 days vs. 3.1 days), and rate of rehospitalisation for HG (19.23% vs. 24.44%). CONCLUSIONS The new protocol consisting of the combination of metoclopramide and diphenhydramine appears to be a good option in the management of hyperemesis gravidarum.

Sublingual nitroglycerin versus placebo as a tocolytic for external cephalic version: a randomized controlled trial in parous women ☆

OBJECTIVE The purpose of this study was to evaluate the efficacy of sublingual nitroglycerin as a tocolytic agent for external cephalic version in parous women. STUDY DESIGN A double-blinded randomized controlled trial was performed. Patients with parity of >or=1 at 36 to 40 weeks of gestation who were eligible for external cephalic version were included. Patients were randomized to receive either two sublingual sprays of 400 mug of nitroglycerin or two sprays of placebo 3 minutes before the trial of external cephalic version. Rates of successful external cephalic version and side effects were compared between groups. RESULTS Of 99 patients in the study, 50 patients received sublingual nitroglycerin, and 49 patients received placebo. There were no differences in maternal age, gestational age, estimated fetal weight, amniotic fluid index, and placental location between the two groups. The success rate of external cephalic version was 48% in the nitroglycerin group compared with 63% in the placebo group (P=.13). There was a higher incidence of headaches in the nitroglycerin group (42% vs 4%, P<.001). CONCLUSION Sublingual nitroglycerin was associated with a higher rate of headache and did not improve the rate of successful external cephalic version.

Prevention of Adverse Pregnancy Outcomes With Low-Dose ASA in Early Pregnancy: New Perspectives for Future Randomized Trials

Recent evidence suggests that treatment with low-dose acetylsalicylic acid (ASA) started early in pregnancy could prevent preeclampsia and intrauterine growth restriction (IUGR), two complications involving placental dysfunction. Preterm birth could also potentially be prevented, suggesting that it could share mechanisms of disease with preeclampsia and intrauterine growth restriction. Because there is new evidence that placental dysfunction can be predicted as early as in the first trimester, we argue that there is a need for randomized controlled trials of low-dose ASA for the prevention of preeclampsia, IUGR, and possibly preterm birth among nulliparous women with early indicators of placental dysfunction.

The Use of Metronidazole During Pregnancy: A Review of Evidence

OBJECTIVE To review the available evidence concerning the relationship between the exposure to metronidazole during pregnancy and the risk of preterm delivery and birth defects. METHODS Studies investigating the association between gestational use of oral metronidazole on human subjects and the risk of preterm birth or/and birth defects were systematically retrieved from MEDLINE and EMBASE databases. We selected studies published in English or French between 1964 and 2012. Where effect estimates were not reported, crude ORs along with 95% confidence intervals were calculated. RESULTS We selected 17 studies investigating the association between exposure to oral metronidazole and the risk of preterm birth, from which 12 were randomized clinical trials. In addition, we identified 13 studies devoted to the relationship between metronidazole and birth defects, from which 10 were cohort studies, 1 was a case-control study and 2 were meta-analysis. CONCLUSION During pregnancy, treating bacterial vaginosis and trichomoniasis with metronidazole is effective and offers no teratogen risk. Benefit of metronidazole in the reduction of preterm birth was demonstrated for the combination of this medication with other antibiotics. Additional information is needed when metronidazole is used in association with other agents.

Exposure to anti‐infective drugs during pregnancy and the risk of small‐for‐gestational‐age newborns: a case–control study

Please cite this paper as: Santos F, Sheehy O, Perreault S, Ferreira E, Berard A. Exposure to anti‐infective drugs during pregnancy and the risk of small‐for‐gestational‐age newborns: a case–control study. BJOG 2011;118:1374–1382.