Gianluca Straface

Gadolinium periconceptional exposure: pregnancy and neonatal outcome

Background. Gadolinium derivatives are ionic paramagnetic contrast agents used to enhance magnetic resonance images, labeled as a pregnancy category C by the Food and Drug Administration because of a lack of epidemiological studies concerning first‐trimester exposure. Methods. Prospective cohort study to determine whether gadolinium derivatives exposure in periconceptional period is a risk factor for pregnancy or fetal development. Results. We report the outcome of 26 pregnant women exposed to gadolinium derivatives in the first trimester without adverse effect on pregnancy and neonatal outcome. Conclusions. Currently, this study represents the only prospective investigation of gadolinium derivatives in pregnancy, but more data are necessary to exclude a teratogenic risk.

Syphilis Infection during Pregnancy: Fetal Risks and Clinical Management

Congenital syphilis is still a cause of perinatal morbidity and mortality. Untreated maternal infection leads to adverse pregnancy outcomes, including early fetal loss, stillbirth, prematurity, low birth weight, neonatal and infant death, and congenital disease among newborns. Clinical manifestations of congenital syphilis are influenced by gestational age, stage of maternal syphilis, maternal treatment, and immunological response of the fetus. It has been traditionally classified in early congenital syphilis and late congenital syphilis. Diagnosis of maternal infection is based on clinical findings, serological tests, and direct identification of treponemes in clinical specimens. Adequate treatment of maternal infection is effective for preventing maternal transmission to the fetus and for treating fetal infection. Prenatal diagnosis of congenital syphilis includes noninvasive and invasive diagnosis. Serological screening during pregnancy and during preconception period should be performed to reduce the incidence of congenital syphilis.

Herpes Simplex Virus Infection in Pregnancy

Infection with herpes simplex is one of the most common sexually transmitted infections. Because the infection is common in women of reproductive age it can be contracted and transmitted to the fetus during pregnancy and the newborn. Herpes simplex virus is an important cause of neonatal infection, which can lead to death or long-term disabilities. Rarely in the uterus, it occurs frequently during the transmission delivery. The greatest risk of transmission to the fetus and the newborn occurs in case of an initial maternal infection contracted in the second half of pregnancy. The risk of transmission of maternal-fetal-neonatal herpes simplex can be decreased by performing a treatment with antiviral drugs or resorting to a caesarean section in some specific cases. The purpose of this paper is to provide recommendations on management of herpes simplex infections in pregnancy and strategies to prevent transmission from mother to fetus.

First-trimester itraconazole exposure and pregnancy outcome: a prospective cohort study of women contacting teratology information services in Italy.

AbstractBackground: Itraconazole is an effective fungal treatment; however, there are few human data on prenatal exposure. Objectives: To evaluate the major malformation rate in itraconazole prenatally exposed infants. The secondary objective includes evaluation of the pregnancy outcome. Methods: A prospective cohort study was conducted from January 2002 to October 2006 in women who called two Italian Teratology Information Services (TIS). Pregnant women who were exposed to itraconazole during the first trimester and gave informed consent were matched with a contemporary group of pregnant women who contacted the TIS because they had undergone a non-teratogenic drug exposure during the first trimester. Information was obtained via a structured questionnaire at the time of the initial call to the TIS and no earlier than 1 month after delivery. A trained operator conducted the interview. The main outcome measure was information about major congenital anomalies, type of delivery, birth weight, and any pregnancy or neonatal complications. Results: Data were collected on 206 women who called the TIS because of first-trimester exposure to itraconazole, and 207 controls. There were no significant differences in terms of major congenital anomalies in the exposed group versus the control group (3/163 [1.8%] vs 4/190 [2.1%], respectively). There was no statistical difference in the rate of vaginal delivery between the exposed and control groups (101/162 [62.3%] vs 102/190 [53.8%]), premature birth (11/162 [6.8%] vs 15/190 [7.9%]), low birth weight (1/152 [0.7%] vs 4/175 [2.3%]) and high birth weight (10/152 [6.5%] vs 7/175 [4.0%], respectively). The rates of live births (163/206 [79.1%] vs 190/207 [91.8%]), spontaneous abortion (23/206 [11.2%] vs 10/207 [4.8%]) and termination of pregnancy (19/206 [9.2%] vs 7/207 [3.4%] in the exposed and control groups, respectively) were significantly different (p<0.05). Conclusion: First-trimester itraconazole-exposed infants were not at increased risk of major congenital anomalies, but the rates of spontaneous and induced abortion were higher in the exposed group versus the control group. Larger studies are warranted to confirm these observations.

Early first-trimester Sibutramine exposure. Pregnancy outcome and neonatal follow-up.

AbstractBackground: Sibutramine is a drug that is used in the treatment of obesity. There are currently no epidemiological studies relating to sibutramine exposure in pregnancy. The objective of our study was to determine whether sibutramine exposure during pregnancy constitutes a risk factor to the mother and developing fetus. Methods: Fifty-two pregnant women who were exposed to sibutramine in the first trimester of pregnancy, when they were unaware of being pregnant, contacted our Teratology Information Service. We recorded the prospective outcomes of this case series between May 2001 and September 2004 with a complete neonatal follow-up up to 1 month after delivery. Results: Seven cases of hypertensive complications were observed during pregnancies. No cases of congenital anomalies in neonates were observed. Conclusion: Although many more cases are necessary to demonstrate that sibutramine is not teratogenic in pregnancy, our experience improves the counseling of pregnancies occurring involuntarily during sibutramine therapy.

Drug-induced congenital defects: strategies to reduce the incidence.

Approximately 1% of congenital anomalies relate to pharmacological exposure and are, in theory, preventable. Prevention consists of controlled administration of drugs known to have teratogenic properties (e.g. retinoids, thalidomide). When possible, prevention could take the form of the use of alternative pharmacological therapies during the pre-conception period for certain specific pathologies, selecting the most appropriate agent for use during pregnancy [e.g. haloperidol or a tricyclic antidepressant instead of lithium; anticonvulsant drug monotherapy in place of multitherapy; propylthiouracil instead of thiamazole (methimazole)], and substitution with The most suitable therapy during pregnancy (e.g. insulin in place of oral antidiabetics; heparin in place of oral anticoagulants; α-methyldopa instead of ACE inhibitors). Another strategy is the administration of drugs during pregnancy taking into account the pharmacological effects in relation to the gestation period (e.g. avoidance of chemotherapy during the first trimester, avoidance of nonsteroidal anti-inflammatory drugs in the third trimester, and avoidance of high doses of benzodiazepines in the period imminent to prepartum).

Head-to-body delivery by “two-step” approach: effect on cord blood hematocrit

Abstract Background: There is no study to support a relationship between placental transfusion and active management techniques of the second stage of labor. Objective: To examine the association between head-to-body delivery by a “two-step” approach (which includes waiting for the next contraction to deliver the shoulders) and its effect on the amount of blood that remains in the infant’s circulation at birth. Study design: Observational study on 500 consecutive, singleton, and at term deliveries from January to June 2012 in Policlinico Abano Terme, Abano Terme, Italy. Umbilical artery hematocrit (Htc) was evaluated in reference to contemporary tested pH values, involving neonates vaginally delivered by the “two-step” approach and by cesarean section, respectively. Results: Head-to-body delivery by the “two-step” approach significantly increased Htc values with respect to cesarean delivery (50.16% versus 47.24%, p < 0.001) and at the same time reduced pH (7.31 ± 0.09 versus 7.33 ± 0.06, p = 0.007) in umbilical artery. In addition, Htc levels for this group were significantly negatively correlated with umbilical artery pH (r = −0.137, p < 0.018). Conclusion: Head-to-body delivery by the “two-step” approach increases the red cell mass in term infants without any clinical risk of neonatal acidemia.

Screening and management of maternal colonization with Streptococcus agalactiae: an Italian cohort study

Abstract Introduction: Streptococcus agalactiae (Group B streptococcus [GBS]) is the most common cause of sepsis and meningitis in infants <3 months of age. Intrapartum antibiotic prophylaxis (IAP) is effective in preventing the transmission of GBS to newborns. The Centers for Disease Control and Prevention (CDC) guidelines suggest vaginal and rectal cultures to assess GBS colonization between 35 and 37 weeks’ gestation. Methods: Between July and December 2013, we identified 535 women admitted to the Obstetric and Gynecology Unit of Cardarelli Hospital (Campobasso, Italy) for delivery. We evaluated the indications for IAP, complete execution of IAP, and neonatal outcomes. Results: Our sample included 468 women and 475 live births. Correct screening for GBS was executed in 241 cases (51.5%), the number of women colonized was 96 (30.2%), and 136 women had indications to receive IAP, but only 68 (50%) received adequate treatment. Conclusions: GBS colonization status should be determined by collecting both vaginal and rectal specimens at 35–37 weeks’ gestation. Inadequate screening for GBS and incorrect IAP led to an increased incidence of early-onset disease in newborns. Local public health agencies should promote surveillance and educational programs to prevent neonatal GBS infections.

Symptoms of eating disorders and feeding practices in obese mothers

BACKGROUND The potential that obesity in pregnancy has to affect symptoms associated with eating disorders and breastfeeding is unclear. AIM This study analyzed symptoms of eating disorders and breastfeeding practices in obese mothers. STUDY DESIGN Prospective, case-control study. SUBJECTS Participants included 25 obese (BMI > 30 kg/m(2)) and 25 normal-weight puerperae, matched for parity and delivery route. OUTCOME MEASURES The participants completed the Eating Disorders Inventory (EDI-2), investigating cognitive, emotional, and behavioral symptoms of eating disorders before they were discharged from the maternity hospital and later participated in telephone interviews concerning breastfeeding practices which were classified according to WHO definitions. RESULTS Although none of the scores fell in the pathological range, the obese mothers had more and more pronounced symptoms of eating disorders in all EDI-2 subscales with respect to normal-weight mothers. They had, in particular, significantly higher scores in body dissatisfaction (p<.0001), ineffectiveness (p=.004), interoceptive awareness (p=.005), and maturity fear (p=.007). Finally, while breastfeeding practices were similar in the two groups, the obese mothers were more likely to maintain full breastfeeding at 6 months (20 vs 8%) and their tendency to postpone weaning was found to be significant (p<.04). CONCLUSIONS While the obese mothers studied have more pronounced symptoms of eating disorders with respect to their normal-weight counterparts, they tended to maintain breastfeeding longer, postponing weaning.

Cohort study of the depression, anxiety, and anhedonia components of the Edinburgh Postnatal Depression Scale after delivery

To investigate the applicability of the Edinburgh Postnatal Depression Scale (EPDS) for identifying depressive symptoms following vaginal or cesarean delivery.