To identify common social media misconceptions about COVID-19 vaccination in pregnancy, explain the spread of misinformation, and identify solutions to guide clinical practice and policy.
A ...systematic review was conducted and the databases Embase and Medline were searched from December 2019 until February 8, 2023, using terms related to social media, pregnancy, COVID-19 vaccines and misinformation. The inclusion criteria were: original research studies and discuss misinformation about COVID-19 vaccination during pregnancy on social media. The exclusion criteria were: review articles, no full-text, and not published in English. Two independent reviewers conducted screening, extraction, and quality assessment.
Our search identified 76 articles, and 3 fulfilled eligibility criteria. Included studies were of moderate and high quality. The social media platforms investigated included Facebook, Google Searches, Instagram, Reddit, Tik Tok, and Twitter. Misinformation was related to concerns regarding vaccine safety, and its association with infertility. Misinformation was increased due to lack of content monitoring on social media, exclusion of pregnant women from early vaccine trials, lack of information from reputable health sources on social media, and others. Suggested solutions were directed at pregnancy care providers (PCP) and public health/government. Suggestions included integrating COVID-19 vaccination information into antenatal care, PCPs and public health should increase their social media presence to disseminate information, address population-specific vaccine concerns in a culturally relevant manner, and others.
Increased availability of information from reputable health sources through multiple channels could increase COVID-19 vaccine uptake in the pregnant population and help combat misinformation.
Pregnancy, which is associated with profound cardiovascular changes and higher risk of thrombosis, increases the risk of cardiovascular complications in women with pre-existing heart disease. A ...comprehensive history and physical examination, 12-lead electrocardiogram, and transthoracic echocardiogram remain the foundation of assessing cardiac risk during pregnancy in women with heart disease. These are often combined to generate risk scores, which are statistically derived. Several statistically derived risk and 1 lesion-specific classification system are currently available. A suggested clinical approach to risk stratification is first to identify pregnancies in women with cardiac lesions at risk for serious or life-threatening maternal cardiac complications and for the remainder to use the Cardiac Disease in Pregnancy II (CARPREG II) risk score, integrating additional lesion-specific and patient-specific information. Conversely, clinicians can use the modified World Health Organization (mWHO) risk classification system and integrate general risk predictors and patient-specific information. Importantly, cardiac-risk assessment should always incorporate clinical judgement in addition to the use of risk scores or risk-classification systems. As pregnant women with heart disease are also at risk for obstetric and fetoneonatal complications, risk assessment should be performed by a multidisciplinary team, preferably before conception, or as soon as conception is confirmed, and repeated at regular intervals during the course of pregnancy.
La grossesse, qui est associée à des modifications cardiovasculaires importantes et à un risque plus élevé de thrombose, augmente le risque de complications cardiovasculaires chez les femmes déjà atteintes d’une cardiopathie. L’anamnèse et l’examen physique approfondis, l’électrocardiogramme à 12 dérivations et l’échocardiographie transthoracique demeurent le fondement de l’évaluation du risque cardiaque durant la grossesse des femmes atteintes d’une cardiopathie. Ils sont souvent combinés pour générer des scores de risque, qui sont établis à partir de statistiques. Plusieurs systèmes de classification des risques et 1 système de classification des lésions établis à partir de statistiques sont actuellement disponibles. L’approche clinique proposée pour la stratification du risque consiste d’abord à repérer les femmes enceintes ayant des lésions cardiaques qui sont exposées à des complications maternelles sérieuses ou qui mettent en danger leur vie, et ensuite à utiliser le score de risque CARPREG II (Cardiac Disease in Pregnancy II), qui intègre des informations supplémentaires propres à ces lésions et à ces patientes. En contrepartie, les cliniciens peuvent utiliser la révision du système de classification de l’Organisation mondiale de la Santé (rOMS) et intégrer les prédicteurs de risque généraux et les informations sur la patiente. Notamment, l’évaluation du risque cardiaque devrait toujours tenir compte du jugement clinique en plus d’utiliser les scores de risque ou les systèmes de classification des risques. Puisque les femmes enceintes atteintes d’une cardiopathie sont également exposées aux risques de complications obstétricales, fœtales et néonatales, l’évaluation des risques devrait être réalisée par une équipe multidisciplinaire, de préférence avant la conception, ou aussitôt que la conception est confirmée, et répétée à des intervalles réguliers au cours de la grossesse.
Induction of labour (IoL) is generally conducted when maternal and foetal risks of remaining pregnant outweigh the risks of delivery. With emerging literature around non-medically indicated IoL, ...contemporary clinical practice has seen an increase in IoL at 39 weeks’ gestation. This review highlights recent evidence on the most common indications for IoL including gestational diabetes, hypertensive disorders of pregnancy, intrahepatic cholestasis of pregnancy, and post-term pregnancies. It also summarizes the evidence related to the timing of IoL for other common conditions based on recent literature reviews.
•Avoid induction of labour (IoL) < 39 weeks without a strong clinical indication.•The timing of IoL in diabetic pregnancies should consider the need for insulin, glycaemic control and microvascular involvement.•Consider IoL at 37 weeks with pre-eclampsia, even in the absence of severe features.•For patients with IHCP, offer IoL at 36 weeks if the serum bile acid >100 μmol/L.
A core outcome set for studies on cardiac disease in pregnancy is being developed. Incorporating perspectives of patients and health care providers (HCPs) is an essential step in developing this core ...outcome set, and eliciting these outcomes is the objective of this study.
We interviewed pregnant women with heart disease, family members, and HCPs, until data saturation was attained. Participants were asked to share experiences and perspectives, and comment on outcomes they deemed important. Interviews were recorded and transcribed verbatim, and interpretive analysis was used to translate experiences into measurable outcomes. These were classified under 5 core outcome areas, based on a taxonomy of outcomes for medical research. A comparison of the distribution of outcomes within outcome areas, between patients and HCPs, and between interviews and published literature is presented.
We obtained 17 outcomes from 13 patients and 3 family members, mostly related to general wellness of the baby, congenital anomalies, mental health, and health care delivery; and 45 outcomes from 10 HCPs, which were mostly clinical. Outcomes in published literature when compared with participant interviews put greater emphasis on clinical outcomes (94% vs 76.5%, P = 0.03) and limited emphasis on life impact (0% vs 17.6%, P < 0.001).
Although clinical outcomes are the main focus of published research in heart disease and pregnancy, patients and HCPs emphasize the importance of outcomes related to general maternal and fetal well-being and life impact, which are seldom reported. Including these outcomes in future studies is essential to facilitating patient-centred care for pregnant women with cardiac disease.
Les auteurs s'emploient actuellement à établir un ensemble de paramètres de base aux fins des études sur la cardiopathie durant la grossesse. L’intégration des points de vue des patientes et des professionnels de la santé constitue une étape essentielle à l’élaboration de cet ensemble de paramètres de base; c’est là l’objectif de l’étude présentée ici.
Nous avons interviewé des femmes enceintes atteintes d’une cardiopathie, des membres de leur famille et des professionnels de la santé jusqu’à ce que le seuil de saturation des données soit atteint. Les participants étaient invités à faire part de leur vécu et de leurs points de vue, et à fournir des commentaires quant aux paramètres qu’ils estimaient importants. Les entrevues ont été enregistrées puis transcrites mot à mot; nous avons ensuite utilisé une analyse interprétative pour traduire les expériences relatées en paramètres mesurables. Ces expériences ont été regroupées en cinq grandes catégories, en fonction d’une taxonomie des résultats mesurés dans le domaine de la recherche médicale. Nous comparons ici la répartition des paramètres dans les différentes catégories entre patientes et professionnels de la santé, et entre résultats des entrevues et littérature médicale publiée.
Nous avons cerné 17 paramètres auprès de 13 patientes et trois membres de leur famille, généralement associés au bien-être du bébé, aux anomalies congénitales, à la santé mentale et à la prestation des soins de santé, ainsi que 45 paramètres auprès de 10 professionnels de la santé, principalement de nature clinique. Les paramètres publiés dans la littérature médicale sont quant à eux plus axés sur les résultats cliniques que les paramètres dégagés à l’issue des entrevues (94 % vs 76,5 %, p = 0,03) et moins sur les répercussions sur la qualité de vie (0 % vs 17,6 %, p < 0,001).
Bien que les études publiées sur la cardiopathie et la grossesse soient principalement axées sur les résultats cliniques, les patientes et les professionnels de la santé ont fait ressortir l’importance des paramètres liés au bien-être général de la mère et du fœtus et aux répercussions sur leur qualité de vie, dont font peu souvent état les études publiées. Il est essentiel d’inclure ces paramètres dans les futures études pour favoriser des soins centrés sur les besoins des femmes enceintes atteintes d’une cardiopathie.
The past decade has seen an unprecedented rise in the demand for caesarean sections on maternal request (CSMR), in the absence of any medical or obstetric indication. Much of this rise is the result ...of the perceived myth of safety of caesarean sections and the changing attitudes of society and the medical profession to childbirth. The debate on the medical, ethical and cost implications of rising rates of caesarean section on maternal request have prompted the issuing of numerous guidelines over the past few years, including one by the National Institute of Health and Clinical Excellence (NICE) in the UK. All these guidelines are uniformly less critical of CSMR than guidelines issued even a decade ago, and suggest valid management strategies. In this chapter, I explore the reasons behind the increase in CSMR and review the current published research, including the risks, benefits, controversies, cost and ethics surrounding CSMR. I then discuss various guidelines, putting the NICE guidelines in perspective.
Dementia is a seriously disabling illness with substantial economic and social burdens. Alzheimer's disease and its related dementias (AD/ADRD) constitute about two-thirds of dementias. AD/ADRD ...patients have a high prevalence of comorbid conditions that are known to be exacerbated by exposure to ambient air pollution. Existing studies mostly focused on the long-term association between air pollution and AD/ADRD morbidity, while very few have investigated short-term associations. This study aims to estimate short-term associations between AD/ADRD emergency department (ED) visits and three common air pollutants: fine particulate matter (PM
), nitrogen dioxide (NO
), and warm-season ozone.
For the period 2005 to 2015, we analyzed over 7.5 million AD/ADRD ED visits in five US states (California, Missouri, North Carolina, New Jersey, and New York) using a time-stratified case-crossover design with conditional logistic regression. Daily estimated PM
, NO
and warm-season ozone concentrations at 1 km spatial resolution were aggregated to the ZIP code level as exposure.
The most consistent positive association was found for NO
. Across five states, a 17.1 ppb increase in NO
concentration over a 4-day period was associated with a 0.61% (95% confidence interval = 0.27%, 0.95%) increase in AD/ADRD ED visits. For PM
, a positive association with AD/ADRD ED visits was found only in New York (0.64%, 95% confidence interval = 0.26%, 1.01% per 6.3 µg/m
). Associations with warm-season ozone levels were null.
Our results suggest AD/ADRD patients are vulnerable to short-term health effects of ambient air pollution and strategies to lower exposure may reduce morbidity.
Background
Devic syndrome or neuromyelitis optica is an autoimmune neurological condition characterized by relapsing symptoms of optic neuritis and transverse myelitis. Women with neuromyelitis ...optica suffer from adverse pregnancy outcomes and high relapse rates during pregnancy and the postpartum period.
Methods
This case series describes 13 pregnancies in four women with neuromyelitis optica managed at a tertiary hospital in Toronto, Canada.
Results
In most cases, neurologic symptoms either worsened or developed for the first time during pregnancy or the postpartum period, and often responded to a combination of steroids, immunosuppressant medications, plasma exchange and intravenous immunoglobulin. The 13 pregnancies resulted in two miscarriages, three preterm and eight term births. One fetus whose mother was on gabapentin, prednisone and spironolactone, had congenital malformations (aplastic lung and fused fingers).
Conclusions
Despite high frequency of relapses in pregnancy and the postpartum period, with multidisciplinary team management, outcomes for women with neuromyelitis optica are encouraging.
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