Objective: Bupropion was developed for the treatment of depression, but subsequently was found to be effective for smoking cessation. To date, there are no prospective comparative studies examining its safety in pregn...Objective: Bupropion was developed for the treatment of depression, but subsequently was found to be effective for smoking cessation. To date, there are no prospective comparative studies examining its safety in pregnancy. The primary objective was to determine whether bupropion increases the risks for major malformations above baseline. The secondary objective was to examine the rates of live births, stillbirths, spontaneous and therapeutic abortions, mean birth weight, and gestational age at birth. Study design: Women who were pregnant or planning a pregnancy and taking bupropion were enrolled in the study. Follow- up of pregnancy outcome was carried out between 4 months and 1 year after delivery. Three comparisons were carried out: 1) women exposed to bupropion vs a nonteratogen group; 2) those taking for depression vs other antidepressants, vs a nonteratogen group; 3) spontaneous abortions were compared between those taking for depression, vs another antidepressant group vs a nonteratogen group. Results: We completed follow- up on 136 women exposed to bupropion during the first trimester of pregnancy. There were (105) live births, no major malformations, the mean birth weight was (3450g), the mean gestational age at delivery was (40 weeks), the number of spontaneous abortions was 20, there were 10 therapeutic abortions, there was 1 stillbirth, and 1 neonatal death. There were no statistically significant differences between any of the end points we examined between the exposed and comparison groups, with the exception of significantly more spontaneous abortions in the bupropion group (P =. 009). Conclusion: These results suggest that bupropion does not increase the rates of major malformation above baseline. The higher rates of spontaneous abortions are similar to other studies examining the safety of antidepressants during pregnancy.展开更多
Objectives -Restorative proctocolectomy with ileoanal anastomosis (IPAA) is the surgical standard for patients with ulcerative colitis (UC). Significant reduction in female fertility and fecundity after IPAA has been ...Objectives -Restorative proctocolectomy with ileoanal anastomosis (IPAA) is the surgical standard for patients with ulcerative colitis (UC). Significant reduction in female fertility and fecundity after IPAA has been shown in recent studies. In selected cases, colectomy with ileorectal anastomosis (IRA) is another surgical option. The aim of this study was to evaluate fertility in women with UC who underwent IRA. Patients and methods -This study included all women with UC who underwent IRA between 1962 and 1999 and who were 40 years old or younger at the time of surgery, and older than 18 years of age at the time of the interview. Data were collected using a structured telephone interview concerning reproductive behavior and waiting times to pregnancy. Results -Among 40 eligible patients, 37 whose mean age at IRA was 28 years (range 11-39) answered the questionnaire. Twenty-two were unmarried, not wishful of pregnancy and / or already had children. Among 15 females wishing children after IRA, 10 (66%) became pregnant: one had therapeutic abortion, two had a miscarriage, four had 1 child, two had 2 children and one had 4 children. Five patients were sterile after IRA. Conclusion -These preliminary results suggest that IRA for UC preserves female fertility. If confirmed in other series this information should be provided to young women with UC before deciding surgical option.展开更多
Objective. Obstetrical prognosis for women suffering from Crohn’s disease and from ulcerative colitis, and consequences of pregnancy on inflammatory bowel diseases (IBD). Patients and methods. Retrospective study, of...Objective. Obstetrical prognosis for women suffering from Crohn’s disease and from ulcerative colitis, and consequences of pregnancy on inflammatory bowel diseases (IBD). Patients and methods. Retrospective study, of 76 pregnancies, after the diagnosis of IBD among 77 women (33 ulcerative colitis, 44 Crohn’s disease). Results. Pregnancy did not modify the evolutive profile of IBD. No particular gravity of IBD revealed during pregnancy or post-partum was noticed. The outcome of the 54 pregnancies associated with quiescent IBD was the same as in the general population. Five of ten pregnancies started during an active period of Crohn’s disease or ulcerative colitis ended in fetal loss (3 spontaneous abortions, 2 medical terminations). In women with a first acute episode or IBD reactivation during pregnancy (n=12), one-third of the newborns were low weight for gestational age, one-third were born preterm and only one-third were term babies with normal weight. Vaginal delivery did not trigger development or exacerbation of perianal Crohn’s disease (n=20). Cesarean section was performed in 2 with an ileal pouch-anal anastomosis (n=4) and 1 patient with an ileo-rectal anastomosis (n=3) to avoid injury to the anal sphincter. Ileostomy (n=2) did not contraindicate delivery. Conclusion. Control of IBD is the main obstetrical factor for prognosis. Starting pregnancy can be advised if the disease is quiescent, with rapid and efficient management of possible flare-ups. Delivery route must be determined on a case-by-case basis, each considering pregestational anal continence and the clinical presentation of the perineum.展开更多
This study was undertaken to evaluate the risks and preg-nancy outcome in women with prosthetic heart valves on different anticoagulent regimens.A retrospective chart re-view of 82pregnancies in 33women wit h mechanic...This study was undertaken to evaluate the risks and preg-nancy outcome in women with prosthetic heart valves on different anticoagulent regimens.A retrospective chart re-view of 82pregnancies in 33women wit h mechanical valve prostheses at a tertiary referral ce nter from 1987to 2002.The main outcome measures were majormaternal complica-tions and perinatal outcome.The valve replaced was mitral(60.6%),aortic(18.2%),and both(21.2%).Fifty -four pregnancies(65.9%)resulted in live births,9(11.0%)had stillbirths(all on warfarin),and 12(14.6%)had spontaneous and 7(8.5%)therapeutic abortions(all on warfarin).The rate of spontaneous abor-tion was highest in women on warfarin throughout preg-nancy(P<.01).The live birth rate was higher in wom en on heparin compared with those on warfarin(P<.01),and in those on heparin /warfarin com pared with warfarin alone(P<.01).There were no maternal deaths;howe v-er,3patients had mitral valve throm bosis(2on heparin and 1on warfarin)necessitating surgery in 1patient a nd medical thrombolysis in 2patients.Hemorrhagic compli-cations occurred in 5patients,4of whom required trans-fusion.No single anticoagulant regimen confers completeprotection from thromboembolic phenomena in pregnancy.Despite a high maternal morbidity ra te,the perinatal out-come is acceptable when pregnancy pr ogresses beyond the first trimester.展开更多
文摘Objective: Bupropion was developed for the treatment of depression, but subsequently was found to be effective for smoking cessation. To date, there are no prospective comparative studies examining its safety in pregnancy. The primary objective was to determine whether bupropion increases the risks for major malformations above baseline. The secondary objective was to examine the rates of live births, stillbirths, spontaneous and therapeutic abortions, mean birth weight, and gestational age at birth. Study design: Women who were pregnant or planning a pregnancy and taking bupropion were enrolled in the study. Follow- up of pregnancy outcome was carried out between 4 months and 1 year after delivery. Three comparisons were carried out: 1) women exposed to bupropion vs a nonteratogen group; 2) those taking for depression vs other antidepressants, vs a nonteratogen group; 3) spontaneous abortions were compared between those taking for depression, vs another antidepressant group vs a nonteratogen group. Results: We completed follow- up on 136 women exposed to bupropion during the first trimester of pregnancy. There were (105) live births, no major malformations, the mean birth weight was (3450g), the mean gestational age at delivery was (40 weeks), the number of spontaneous abortions was 20, there were 10 therapeutic abortions, there was 1 stillbirth, and 1 neonatal death. There were no statistically significant differences between any of the end points we examined between the exposed and comparison groups, with the exception of significantly more spontaneous abortions in the bupropion group (P =. 009). Conclusion: These results suggest that bupropion does not increase the rates of major malformation above baseline. The higher rates of spontaneous abortions are similar to other studies examining the safety of antidepressants during pregnancy.
文摘Objectives -Restorative proctocolectomy with ileoanal anastomosis (IPAA) is the surgical standard for patients with ulcerative colitis (UC). Significant reduction in female fertility and fecundity after IPAA has been shown in recent studies. In selected cases, colectomy with ileorectal anastomosis (IRA) is another surgical option. The aim of this study was to evaluate fertility in women with UC who underwent IRA. Patients and methods -This study included all women with UC who underwent IRA between 1962 and 1999 and who were 40 years old or younger at the time of surgery, and older than 18 years of age at the time of the interview. Data were collected using a structured telephone interview concerning reproductive behavior and waiting times to pregnancy. Results -Among 40 eligible patients, 37 whose mean age at IRA was 28 years (range 11-39) answered the questionnaire. Twenty-two were unmarried, not wishful of pregnancy and / or already had children. Among 15 females wishing children after IRA, 10 (66%) became pregnant: one had therapeutic abortion, two had a miscarriage, four had 1 child, two had 2 children and one had 4 children. Five patients were sterile after IRA. Conclusion -These preliminary results suggest that IRA for UC preserves female fertility. If confirmed in other series this information should be provided to young women with UC before deciding surgical option.
文摘Objective. Obstetrical prognosis for women suffering from Crohn’s disease and from ulcerative colitis, and consequences of pregnancy on inflammatory bowel diseases (IBD). Patients and methods. Retrospective study, of 76 pregnancies, after the diagnosis of IBD among 77 women (33 ulcerative colitis, 44 Crohn’s disease). Results. Pregnancy did not modify the evolutive profile of IBD. No particular gravity of IBD revealed during pregnancy or post-partum was noticed. The outcome of the 54 pregnancies associated with quiescent IBD was the same as in the general population. Five of ten pregnancies started during an active period of Crohn’s disease or ulcerative colitis ended in fetal loss (3 spontaneous abortions, 2 medical terminations). In women with a first acute episode or IBD reactivation during pregnancy (n=12), one-third of the newborns were low weight for gestational age, one-third were born preterm and only one-third were term babies with normal weight. Vaginal delivery did not trigger development or exacerbation of perianal Crohn’s disease (n=20). Cesarean section was performed in 2 with an ileal pouch-anal anastomosis (n=4) and 1 patient with an ileo-rectal anastomosis (n=3) to avoid injury to the anal sphincter. Ileostomy (n=2) did not contraindicate delivery. Conclusion. Control of IBD is the main obstetrical factor for prognosis. Starting pregnancy can be advised if the disease is quiescent, with rapid and efficient management of possible flare-ups. Delivery route must be determined on a case-by-case basis, each considering pregestational anal continence and the clinical presentation of the perineum.
文摘This study was undertaken to evaluate the risks and preg-nancy outcome in women with prosthetic heart valves on different anticoagulent regimens.A retrospective chart re-view of 82pregnancies in 33women wit h mechanical valve prostheses at a tertiary referral ce nter from 1987to 2002.The main outcome measures were majormaternal complica-tions and perinatal outcome.The valve replaced was mitral(60.6%),aortic(18.2%),and both(21.2%).Fifty -four pregnancies(65.9%)resulted in live births,9(11.0%)had stillbirths(all on warfarin),and 12(14.6%)had spontaneous and 7(8.5%)therapeutic abortions(all on warfarin).The rate of spontaneous abor-tion was highest in women on warfarin throughout preg-nancy(P<.01).The live birth rate was higher in wom en on heparin compared with those on warfarin(P<.01),and in those on heparin /warfarin com pared with warfarin alone(P<.01).There were no maternal deaths;howe v-er,3patients had mitral valve throm bosis(2on heparin and 1on warfarin)necessitating surgery in 1patient a nd medical thrombolysis in 2patients.Hemorrhagic compli-cations occurred in 5patients,4of whom required trans-fusion.No single anticoagulant regimen confers completeprotection from thromboembolic phenomena in pregnancy.Despite a high maternal morbidity ra te,the perinatal out-come is acceptable when pregnancy pr ogresses beyond the first trimester.
