Sabrina Nicola

The impact of oral contraception on vulvovaginal candidiasis

To evaluate risk factors related to sociodemographic and clinical variables, oral contraception and sexual behavior of women with recurrent vulvovaginal candidiasis, we conducted a case-control study comparing 153 patients with recurrent vulvovaginal candidiasis with both asymptomatic women with negative vaginal cultures and patients with nonrecurrent symptomatic vulvovaginal candidiasis. In logistic regression analysis, patients with recurrent Candida vaginitis were more likely than negative controls to have used any contraceptive method in the year before evaluation, to have used antibiotics in the month preceding the visit, and to have a higher number of lifetime sex partners. Compared to patients with nonrecurrent Candida vaginitis, patients with recurrent infection were more likely to use oral contraception and to have a higher frequency of monthly intercourse. The proportion of recur rent disease attributable to the pill averages 11-12%. We conclude that oral contraceptives may influence the recurrence of symptomatic vulvovaginal candidiasis.

Torulopsis glabrata Vaginitis

Objective To study the sociodemographic risk factors and clinical features of Torulopsis glabrata vaginal infection. Methods We evaluated the sociodemographic and clinical characteristics of 86 consecutive symptomatic women attending a vaginitis clinic and isolated T glabrata. Case patients were compared with a control group of 174 asymptomatic women with negative vaginal cultures and an additional group of 625 symptomatic women with vaginal cultures positive for Candida albicans. In addition, the sensitivity of the isolates to the more common antimycotic agents used was tested by the modified Kirby-Bauer method. Results Patients with T glabrata vaginal infection were from lower socioeconomic backgrounds and had less education. They were more likely to use vaginal tampons and to be seropositive for human immunodeficiency virus than were negative controls. Compared with C albicans infection, T glabrata was more frequent among women over 38 years of age and in those with less education and of lower social class. In logistic regression analysis, T glabrata was associated more frequently with recurrent vaginal candidiasis than was C albicans (odds ratio 2.46, 95% confidence interval 1.33–4.54; P = .004). Six of the 86 (7%) T glabrata isolates and none of the C albicans isolates (P < .001 by Fisher exact test) were resistant to the imidazole derivatives tested. Conclusion Torulopsis glabrata was isolated in 10% of women with vulvovaginal candidiasis attending a vaginitis clinic. This infection was associated with recurrent vaginitis in almost one-third of case patients presenting with symptoms.

The Effect of Work Activity in Pregnancy on the Risk of Severe Preeclampsia

Summary: The aim of this study was to evaluate the impact of type of employment and level of physical activity at work on the risk of severe preeclampsia. For this purpose, we carried out a case control study of 160 nulliparous pregnant women with severe preeclampsia and 320 normotensive nulliparous controls who received prenatal care from members of one medical staff. The type of employment and the level of physical activity sustained at work were ascertained at birth through an interview based on a standard questionnaire. The degree of physical activity at work was assessed by a 4‐level activity score based on type of work, physical intensity, posture at work, and weekly working hours. In logistic regression analysis, after adjustment for potential confounders (maternal age, time of stopping work, prepregnancy body mass index, social status of the partner, history of previous abortion, and prepregnancy smoking status), clerical workers had a significantly lower risk of severe preeclampsia than women who were unemployed at the beginning of pregnancy (OR 0.53, 95% CI 0.30, 0.96). In multivariate analysis, there was a significant linear trend relating the degree of physical activity at work, to the risk of preeclampsia (likelihood chi‐square = 9.38, 3 df, p = 0.002). We then restricted the analysis to women who had ever worked in pregnancy (n = 339) also adjusting for confounders, and found that clerical workers were still at significantly lower risk of severe preeclampsia dian women not formally employed (OR 0.2,95% CI 0.08,0.49). In addition, moderate/high physical activity at work was associated with a 2‐fold increase in the risk of severe preeclampsia compared to mild activity (OR 2.08, 95% CI 1.11,3.88). We conclude that moderate to high physical activity at work seems to increase the risk of severe preeclampsia.

Interaction between fetal gender and risk factors for fetal growth retardation.

OBJECTIVE Our purpose was to evaluate the interactions between fetal gender and recognized risk factors of fetal growth retardation. STUDY DESIGN A case-control study of 530 singleton pregnancies complicated by fetal growth retardation and 782 control pregnancies with appropriately grown fetuses was conducted. Interactions were evaluated by logistic regression analysis. RESULTS In logistic regression analysis fetal growth retardation was more frequent in female than male fetuses (odds ratio 1.39, 95% confidence interval 1.06 to 1.82). In female fetuses hypertension-related fetal growth retardation was three times more common than in males. On the other hand, a low (< 50 kg) maternal prepregnancy weight and a low (< 18) body mass index (kg/m2) were significant risk factors for fetal growth retardation in male fetuses only. Although maternal smoking in pregnancy was a significant risk factor for growth retardation in both male and female fetuses, its effect was significantly stronger in male fetuses. CONCLUSION Fetal gender can affect the magnitude of the classic risk factors for fetal growth retardation.

The effect of work activity in pregnancy on the risk of fetal growth retardation

Background. The relationship between physical activity at work and risk of fetal growth restriction is controversial. For the most part, previous studies investigated the effect of work activity on birthweight alone. We evaluated the impact of type of occupation and physical effort at work on the risk of ultrasonographically confirmed fetal growth retardation among nulliparous women.

Frequency and significance of drug resistance in vulvovaginal candidiasis.

The rates of non-albicans species and susceptibility to the main antimycotic drugs were evaluated in a series of 472 cultures of vulvar or vaginal specimens positive for Candida species. Torulopsis glabrata was associated more frequently than C. albicans with recurrent vulvovaginal candidiasis (18/40 vs. 72/379; p = 0.003, chi 2 test). As evaluated by the results of susceptibility testing, C. albicans isolates were uniformly sensitive to the antifungals tested, whereas 7.5% (3/40) of T. glabrata strains were resistant to imidazole derivatives. All these patients had a history of repeated antimycotic treatments. Previous antimycotic therapies in susceptible individuals could cause a selection of non-albicans species, especially T. glabrata, which is occasionally resistant to the commonly used antimycotic drugs.

Factors potentiating the smoking‐related risk of fetal growth retardation

Objective To estimate the risk of fetal growth retardation resulting from the interaction between maternal smoking during pregnancy and other recognized risk factors.

Sociodemographic and clinical variables modifying the smoking-related risk of low birth weight

Objective: The purpose of the study was to evaluate the sociodemographic and clinical variables modifying the smoking‐related risk of low birth weight (<2500 g). Method: This case‐control study included a population of 967 singleton low birth weight deliveries and 967 selected controls. Unconditional logistic regression analysis was used to test statistical significance of the interactions between smoking in pregnancy and other risk factors for low birth weight. Results: Increasing maternal age and parity potentiate the smoking‐related risk of a low birth weight infant. The effect of maternal smoking on the risk of low birth weight was significantly increased in patients with a history of previous spontaneous abortion (excess risk 2.30, 95% C.I. 1.24–4.27) and in patients of high compared with patients of intermediate or low social class (excess risk 1.97, 95% C.I. 1.1–3.57). Smokers with less than two prenatal visits per trimester were at significantly greater risk of delivering a low birth weight infant (excess risk 2.36, 95% C.I. 1.14–4.87) than their counterparts with more frequent prenatal visits. Among clinical variables, the effect of maternal smoking on the risk of low birth weight was significantly increased in women with a history of first trimester hemorrhage during the current pregnancy (excess risk 2.67, 95% C.I. 1.30–5.49). Conclusions: The smoking‐related risk of low birth weight is very high in some subgroups of women. Identification of these subgroups could be important for prenatal counseling.

Cigarette Smoking in Pregnancy and Risk of Pre-Eclampsia

The relationship between smoking in pregnancy and the development of pre-eclampsia has not been well studied. Smoking habits were prospectively evaluated in 117 patients with pre-eclampsia and 468 normotensive control pregnancies. Twenty cases (17.1%) and 120 controls (25.6%) reported smoking at any time during pregnancy. In stepwise multiple logistic regression analysis, smoking in pregnancy was a significant protective factor against the occurrence of pre-eclampsia (adjusted odds ratio = 0.50; 95% confidence interval 0.28-0.80, P = 0.018). On the other hand, a history of pre-eclampsia in previous pregnancies, low (< 6th grade) educational level, a body mass index > 24 and maternal blood group AB were factors independently associated with an increased risk of pre-eclampsia. In conclusion, this study confirms that smoking in pregnancy reduces the risk of pre-eclampsia. However, the harmful consequences of smoking on pregnancy outcome far outweigh this risk reduction.