IntroductionData regarding delayed-release dimethyl fumarate (DMF) use, an approved MS treatment, in pregnant women is limited. United Kingdom (UK) and Ireland are enrolling DMF-exposed pregnant ...women into TecGistry, an ongoing prospective, observational registry to assess pregnancy outcomes.MethodsPregnant women with MS exposed to DMF since the first day of their last menstrual period prior to conception or at any time during pregnancy were included. The UK and Ireland Coordinating Centres (Manchester Centre for Clinical Neurosciences and St. Vincent’s University Hospital, Dublin) liaise directly with DMF-exposed patients and their HCPs.ResultsAs of 24 April 2018, 220 patients (11 patients from UK/Ireland) were enrolled; 161 pregnancy outcomes were reported: 147 (91.3%) live births, 14 (8.7%) spontaneous abortions (< 22 weeks). In UK/Ireland, 9 outcomes were reported: all live births, 8 full term, none premature (details pending on 1 case). Globally, 4 adjudicator-confirmed birth defects were reported: pyloric stenosis (1), transposition of the great vessels (1), ventricular septal defect (2; 1 in UK/Ireland). No maternal, neonatal, perinatal, or infant deaths were reported.ConclusionsConsistent with previous reports, there was no safety signal for DMF exposure on pregnancy outcomes based on ongoing registry results.Support: Biogen; disclosures to be included on poster.
Background
Helminthiasis is an infestation of the human body with parasitic worms. It is estimated to affect 44 million pregnancies, globally, each year. Intestinal helminthiasis (hookworm ...infestation) is associated with blood loss and decreased supply of nutrients for erythropoiesis, resulting in iron‐deficiency anaemia. Over 50% of the pregnant women in low‐ and middle‐income countries (LMIC) suffer from iron‐deficiency anaemia. Though iron‐deficiency anaemia is multifactorial, hookworm infestation is a major contributory cause in women of reproductive age in endemic areas. Antihelminthics are highly efficacious, but evidence of their beneficial effect and safety when given during pregnancy has not been established. This is an update of a Cochrane Review last published in 2015.
Objectives
To determine the effects of mass deworming with antihelminthics for soil‐transmitted helminths (STH) during the second or third trimester of pregnancy on maternal and pregnancy outcomes.
Search methods
For this update, we searched Cochrane Pregnancy and Childbirth’s Trials Register, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP) (8 March 2021) and reference lists of retrieved studies.
Selection criteria
We included all prospective randomised controlled trials evaluating the effect of administration of antihelminthics versus placebo or no treatment during the second or third trimester of pregnancy; both individual‐randomised and cluster‐randomised trials were eligible. We excluded quasi‐randomised trials and studies that were only available as s with insufficient information.
Data collection and analysis
Two review authors independently assessed trials for inclusion and risk of bias, extracted data, checked accuracy and assessed the certainty of the evidence using the GRADE approach.
Main results
We included a total of six trials (24 reports) that randomised 7873 pregnant women. All of the included trials were conducted in antenatal clinics within hospitals in LMICs (Uganda, Nigeria, Peru, India, Sierra Leone and Tanzania). Among primary outcomes, five trials reported maternal anaemia, one trial reported preterm birth and three trials reported perinatal mortality. Among secondary outcomes, included trials reported maternal worm prevalence, low birthweight (LBW) and birthweight. None of the included studies reported maternal anthropometric measures or infant survival at six months. Overall, we judged the included trials to be generally at low risk of bias for most domains, while the certainty of evidence ranged from low to moderate.
Analysis suggests that administration of a single dose of antihelminthics in the second trimester of pregnancy may reduce maternal anaemia by 15% (average risk ratio (RR) 0.85, 95% confidence interval (CI) 0.72 to 1.00; I²= 86%; 5 trials, 5745 participants; low‐certainty evidence). We are uncertain of the effect of antihelminthics during pregnancy on preterm birth (RR 0.84, 95% CI 0.38 to 1.86; 1 trial, 1042 participants; low‐certainty evidence) or perinatal mortality (RR 1.01, 95% CI 0.67 to 1.52; 3 trials, 3356 participants; low‐certainty evidence).
We are uncertain of the effect of antihelminthics during pregnancy on hookworm (average RR 0.31, 95% CI 0.05 to 1.93; Tau² = 1.76, I² = 99%; 2 trials, 2488 participants; low‐certainty evidence). Among other secondary outcomes, findings suggest that administration of antihelminthics during pregnancy may reduce the prevalence of trichuris (average RR 0.68, 95% CI 0.48 to 0.98; I²=75%; 2 trials, 2488 participants; low‐certainty evidence) and ascaris (RR 0.24, 95% CI 0.19 to 0.29; I²= 0%; 2 trials, 2488 participants; moderate‐certainty evidence). Antihelminthics during pregnancy probably make little or no difference to LBW (RR 0.89, 95% CI 0.69 to 1.16; 3 trials, 2960 participants; moderate‐certainty evidence) and birthweight (mean difference 0.00 kg, 95% CI ‐0.03 kg to 0.04 kg; 3 trials, 2960 participants; moderate‐certainty evidence).
Authors' conclusions
The evidence suggests that administration of a single dose of antihelminthics in the second trimester of pregnancy may reduce maternal anaemia and worm prevalence when used in settings with high prevalence of maternal helminthiasis. Further data is needed to establish the benefit of antihelminthic treatment on other maternal and pregnancy outcomes.
Future research should focus on evaluating the effect of these antihelminthics among various subgroups in order to assess whether the effect varies. Future studies could also assess the effectiveness of co‐interventions and health education along with antihelminthics for maternal and pregnancy outcomes.
Abstract Objective To examine the feasibility of laparoscopic cornual resection for the treatment of heterotopic cornual pregnancy. Study design Women who underwent laparoscopic cornual resection for ...heterotopic cornual pregnancy at our hospital between January 2003 and March 2015 were retrospectively analyzed. We evaluated significant parameters such as operative complications and postoperative pregnancy outcomes of concomitant pregnancy. Results Thirteen patients with heterotopic cornual pregnancy were included in the study. All were pregnant through assisted reproductive technology, and the diagnosis was made at a median of 6 + 6 weeks (range 5 + 4 - 10 + 0). They were successfully treated with laparoscopic cornual resection and admitted for a median of 4 days (range, 2 - 7) postoperatively. The median operative time was 65 min (range, 35 - 145 min) and estimated blood loss was 200 mL (range, 10 - 3,000 mL). There was a spontaneous abortion at 7 + 6 gestational weeks in a patient who received bilateral cornual resection. Seven patients delivered babies at term and 3 at preterm. All 10 women delivered without any maternal or neonatal complications. Two were lost to follow-up. Conclusions Laparoscopic cornual resection is a feasible primary approach for the management of heterotopic cornual pregnancy.
Evaluation of relative fetal growth in the form of estimated fetal weight discordance (EFWd) is a necessary element of any ultrasound examination in twin pregnancies. It is one of the criteria for ...the diagnosis of selective fetal growth restriction (sFGR) according to the most established worldwide guidelines. Apart from the effectiveness of this parameter for the diagnosis of sFGR, it may also be used as an independent factor for risk stratification of neonatal and maternal complications. Furthermore, numerous studies have proven the greater prognostic value of EFWd in dichorionic pregnancies, which may result from differences in the pathogenesis of fetal growth abnormalities in mono- and dichorionic pregnancies. Because of the variability of this parameter throughout pregnancy, there is an ongoing discussion regarding replacing or individualizing it with percentile charts. An additional element, complementary to EFWd in assessing the risk of complications in twin pregnancies is the use of this measurement in combination with Doppler assessment, which increases its predictive value. The use of EFWd as one of the factors influencing care and decision-making in dichorionic twin pregnancies seems to be a simple and effective method, however, further research assessing the use and possible applications of this indicator is necessary.
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