1.
Antidepressant use in pregnancy and severe cardiac malformations: Danish register‐based study
Kolding, L; Ehrenstein, V; Pedersen, L ...
BJOG,
November 2021, 2021-11-00, 20211101, Letnik:
128, Številka:
12
Journal Article
Objective
Studies restricted to live births may underestimate severe teratogenic effects. We address the limitation by including data from both prenatal and postnatal diagnoses of cardiac ...
malformations.
Design
Register‐based study.
Setting
Denmark.
Population
364 012 singleton pregnancies from 2007 to 2014.
Methods
We used data from five nationwide registries. Exposure to antidepressants was measured using redeemed prescriptions.
Main outcome measures
Pregnancies with cardiac malformations that end in miscarriage, termination, stillbirth, postnatal death or cardiac surgery <1 year of birth were classified as severe cardiac malformations (SCM). Propensity scores with adjusted prevalence ratios (PRs) were calculated.
Results
SCM were reported in 972 of 364 012 pregnancies overall and in 16 of 4105 exposed. For venlafaxine, the PR for SCM was 2.13 (95% confidence interval CI 0.89–5.13), 1.73 (95% CI 1.08–2.77) for other cardiac malformations, and there was a cluster of hypoplastic left heart syndromes (HLHS) (crude PR 17.4 95% CI 6.41–47.2), none of which ended in a live birth. For HLHS, the absolute risk increase was 4.4/1000 and the number needed to harm was 225. For selective serotonin reuptake inhibitors, the PRs were 1.09 (95% CI 0.52–2.30) and 1.38 (95% CI 1.00–1.92) for SCM and other cardiac malformations, respectively.
Conclusions
Pregnancy exposure to venlafaxine is associated with an increased risk of severe cardiac malformations but with a low absolute risk. Potential mechanisms include direct effects or confounding by indication. Venlafaxine exposure is a marker for risk pregnancies for which fetal echocardiography may be considered.
Tweetable
Exposure to venlafaxine is associated with an increased risk of cardiac malformations but with a low absolute risk.
Tweetable
Exposure to venlafaxine is associated with an increased risk of cardiac malformations but with a low absolute risk.
več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
2.
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
3.
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
4.
Multicenter randomized trial exploring effects of simulation‐based ultrasound training on obstetricians' diagnostic accuracy: value for experienced operators
Andreasen, L. A.; Tabor, A.; Nørgaard, L. N. ...
Ultrasound in obstetrics & gynecology,
April 2020, 2020-Apr, 2020-04-00, 20200401, Letnik:
55, Številka:
4
Journal Article
ABSTRACT
Objective
To explore the effects of simulation‐based ultrasound training on the accuracy of fetal weight estimation in the third trimester among obstetricians with different levels of ...
clinical experience.
Methods
This was a multicenter, randomized pre–post‐test practical trial conducted between March 2016 and January 2018. Obstetricians with different levels of clinical experience were randomized to either simulation‐based ultrasound training focusing on fetal weight scans or no intervention. Participants completed two scans in pregnant women at term to establish baseline accuracy of fetal weight estimation. Another two scans were performed at follow‐up. Accuracy was defined by the percentage difference between estimated fetal weight and actual birth weight. Ultrasound image quality was rated by two expert raters.
Results
Seventy participants with different levels of clinical experience completed the study. Adjusting for clinical experience, the intervention group demonstrated an improvement in measurement accuracy of 31.9% (95% CI, 6.9–50.1%) (P = 0.02), whereas the control group did not improve (relative difference, 13.1% (95% CI, −17.9 to 55.9%); P = 0.45). The change in accuracy was significantly different between the groups (P = 0.02) and independent of clinical experience (P = 0.54). Image‐quality scores improved by a mean of 1.2 (95% CI, 0.4–2.1) (P < 0.01) in the intervention group, with no change in the control group (mean difference, 0.1 (95% CI, −0.8 to 1.0); P = 0.78). There was a strong negative correlation between time spent using the simulator and clinical experience (r = −0.70, P = 0.0001).
Conclusion
Simulation‐based ultrasound training improved accuracy and image quality when performing fetal weight estimation in women at term, independent of obstetricians' clinical experience. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
5.
Prenatal detection of orofacial clefts in Denmark from 2009 to 2018
Sander, F. H.; Jørgensen, D. S.; Jakobsen, L. P. ...
Ultrasound in obstetrics & gynecology,
April 2024, 2024-04-00, 20240401, Letnik:
63, Številka:
4
Journal Article
ABSTRACT
Objective
To investigate the overall and type‐specific prenatal detection rates (DRs) of orofacial clefts in a national cohort in Denmark.
Methods
This study was based on data from the ...
Danish Fetal Medicine Database and included all fetuses and children from singleton pregnancies diagnosed with an orofacial cleft prenatally and/or postnatally between 2009 and 2018. The types of cleft included unilateral, bilateral or median cleft lip (CL); unilateral, bilateral or median cleft lip with secondary cleft palate (CLP); and cleft palate (CP). The clefts were grouped as cleft lip with or without cleft palate (CL(P)) or as all clefts (including CP). All cases with discordance between prenatal and postnatal diagnoses were validated in the local patient files (Astraia). Cases without prenatal validation of the postnatal diagnosis were marked as undetected. Postnatally diagnosed cases with a strong prenatal suspicion of a cleft but without an International Classification of Diseases‐10 code were registered as prenatally detected. Termination of pregnancy and intrauterine death were registered as true positives even if no autopsy could be performed. Liveborn cases with a prenatal diagnosis but without a postnatal validation were excluded.
Results
A total of 994 cases were included in the study, of which 933 were liveborn. The prevalence of orofacial cleft was 1.6 per 1000 live births. There were no differences in the baseline characteristics between detected and undetected cases. The DR for CL(P) was 71.7% (95% CI, 64.8–78.9%), with an increase from 60.0% in 2009 to 73.0% in 2018 (P = 0.018). The type‐specific DRs for the entire period were 56.4% (95% CI, 45.0–67.6%) for unilateral CL; 76.6% (95% CI, 71.7–82.9%) for unilateral CLP; 70.5% (95% CI, 52.1–87.6%) for bilateral CL; 82.3% (95% CI, 70.6–93.6%) for bilateral CLP; 0% (0/6) for median CL; 75.0% (3/4) for median CLP; and 3.3% (95% CI, 0.6–5.7%) for CP. A total of 20.9% (208/994) of the cases had associated findings, of which 33.2% (69/208) were genetic aberrations.
Conclusions
The DR for CL(P) has improved in Denmark over the last decade. The DR for CLP is high, with the highest DR for bilateral CLP. However, prenatal detection of CP remains a challenge. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
6.
Pre‐eclampsia screening in Denmark (PRESIDE): national validation study
Riishede, I.; Rode, L.; Sperling, L. ...
Ultrasound in obstetrics & gynecology,
June 2023, 2023-06-00, 20230601, Letnik:
61, Številka:
6
Journal Article
ABSTRACT
Objectives
To investigate the predictive performance of the Fetal Medicine Foundation (FMF) first‐trimester screening algorithm for pre‐eclampsia in a Danish population and compare screening ...
performance with that of the current Danish strategy, which is based on maternal risk factors.
Methods
This was a prospective study of women with a singleton pregnancy attending for their first‐trimester ultrasound scan and screening for aneuploidies at six Danish university hospitals between May 2019 and December 2020. Prenatal data on maternal characteristics and medical history were recorded, and measurements of mean arterial pressure (MAP), uterine artery pulsatility index (UtA‐PI), serum pregnancy‐associated plasma protein‐A (PAPP‐A) and serum placental growth factor (PlGF) were collected without performing a risk assessment for pre‐eclampsia. Information on acetylsalicylic acid use was recorded. After delivery, pregnancy outcome, including gestational age at delivery and pre‐eclampsia diagnosis, was recorded. Pre‐eclampsia risk assessment for each woman was calculated blinded to outcome using the FMF screening algorithm following adjustment to the Danish population. Detection rates (DRs) of the FMF algorithm were calculated for a fixed screen‐positive rate (SPR) of 10% and for the SPR achieved in the current Danish screening.
Results
A total of 8783 pregnant women were included, with a median age of 30.8 (interquartile range (IQR), 28.1–33.9) years. The majority were white (95%), naturally conceiving (90%), non‐smokers (97%) and had no family history of pre‐eclampsia (96%). The median body mass index was 23.4 (IQR, 21.2–26.6) kg/m2. A complete risk assessment including maternal characteristics, MAP, UtA‐PI, PlGF and PAPP‐A was available for 8156 women (92.9%). In these women, UtA‐PI was measured bilaterally with a median value of 1.58 (IQR, 1.27–1.94) and the median resting MAP of 80.5 (IQR, 76.1–85.4) mmHg in two consecutive measurements. Among these, 303 (3.7%) developed pre‐eclampsia, including 55 (0.7%) cases of pre‐eclampsia with delivery < 37 weeks of gestation and 16 (0.2%) cases of pre‐eclampsia with delivery < 34 weeks. At a SPR of 10%, combined screening using the FMF algorithm based on maternal characteristics, MAP, UtA‐PI, PlGF and PAPP‐A had a DR of 77.4% (95% CI, 57.6–97.2%) for pre‐eclampsia with delivery < 34 weeks, 66.8% (95% CI, 54.4–79.1%) for pre‐eclampsia with delivery < 37 weeks and 44.1% (95% CI, 38.5–49.7%) for pre‐eclampsia with delivery at any gestational age. The current Danish screening strategy using maternal risk factors detected 25.0% of women with pre‐eclampsia with delivery < 34 weeks and 19.6% of women with pre‐eclampsia with delivery < 37 weeks at a SPR of 3.4%. When applying the FMF algorithm including maternal characteristics, MAP, UtA‐PI and PlGF at the fixed SPR of 3.4%, the DRs were 60.5% (95% CI, 36.9–84.1%) for PE with delivery < 34 weeks and 45.2% (95% CI, 32.0–58.5%) for PE with delivery < 37 weeks.
Conclusion
In this large Danish multicenter study, the FMF algorithm based on maternal characteristics, MAP, UtA‐PI, PlGF and PAPP‐A predicted 77.4% of cases with pre‐eclampsia with delivery < 34 weeks and 66.8% of cases with pre‐eclampsia with delivery < 37 weeks of gestation at a SPR of 10%, suggesting that the performance of the algorithm in a Danish cohort matches that in other populations. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
7.
Quadruplet pregnancy outcome with and without fetal reduction: Danish national cohort study (2008–2018) and comparison with dichorionic twins
Rasmussen, M. K.; Kristensen, S. E.; Ekelund, C. K. ...
Ultrasound in obstetrics & gynecology,
April 2024, 2024-04-00, 20240401, Letnik:
63, Številka:
4
Journal Article
ABSTRACT
Objectives
To perform a nationwide study of quadrichorionic quadriamniotic (QCQA) quadruplet pregnancies and to compare the pregnancy outcome in those undergoing fetal reduction with ...
non‐reduced quadruplets and dichorionic diamniotic (DCDA) twin pregnancies from the same time period.
Methods
This was a retrospective Danish national register‐based study performed using data from the national Danish Fetal Medicine Database, which included all QCQA quadruplets and all non‐reduced DCDA twin pregnancies with an estimated due date between 2008 and 2018. The primary outcome measure was a composite of adverse pregnancy outcomes, including pregnancy loss or intrauterine death of one or more fetuses. Secondary outcomes included gestational age at delivery, the number of liveborn children, preterm delivery before 28, 32 and 37 gestational weeks and birth weight. Data on pregnancy complications and baseline characteristics were also recorded. Outcomes were compared between reduced and non‐reduced quadruplet pregnancies, and between DCDA pregnancies and quadruplet pregnancies reduced to twins. A systematic literature search was performed to describe and compare previous results with our findings.
Results
Included in the study were 33 QCQA quadruplet pregnancies, including three (9.1%) non‐reduced pregnancies, 28 (84.8%) that were reduced to twin pregnancy and fewer than three (6.1%) that were reduced to singleton pregnancy, as well as 9563 DCDA twin pregnancies. Overall, the rate of adverse pregnancy outcome was highest in non‐reduced quadruplets (66.7%); it was 50% in quadruplets reduced to singletons and 10.7% in quadruplets reduced to twins. The proportion of liveborn infants overall was 91.1% of the total number expected to be liveborn in quadruplet pregnancies reduced to twins. This was statistically significantly different from 97.6% in non‐reduced dichorionic twins (P = 0.004), and considerably higher than 58.3% in non‐reduced quadruplets. The rates of preterm delivery < 28, < 32 and < 37 weeks were decreased in quadruplets reduced to twins compared with those in non‐reduced quadruplet pregnancies. Quadruplets reduced to twins did not achieve equivalent pregnancy outcomes to those of DCDA twins.
Conclusion
This national study of QCQA quadruplets has shown that multifetal pregnancy reduction improves pregnancy outcome, including a decreased rate of preterm delivery and higher proportion of liveborn children. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
8.
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
9.
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
10.
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
PDF
