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Immune checkpoint inhibitors and pregnancy: Considerations for treating medically complex patients with the best available therapy 免疫检查点抑制剂与妊娠：用最佳可用疗法治疗复杂患者的考虑
IF 3.2 3区 医学
Seminars in perinatology Pub Date : 2025-03-01 DOI: 10.1016/j.semperi.2025.152045
Elad Sharon
{"title":"Immune checkpoint inhibitors and pregnancy: Considerations for treating medically complex patients with the best available therapy","authors":"Elad Sharon","doi":"10.1016/j.semperi.2025.152045","DOIUrl":"10.1016/j.semperi.2025.152045","url":null,"abstract":"<div><div>In recent decades, the mean age of childbearing has increased in the United States and other developed countries, coinciding with a rise in cancer diagnoses during pregnancy. This trend is partly due to the increased use of assisted reproductive technologies and a decrease in the mean age of cancer onset for several malignancies. Concurrently, immune checkpoint inhibitors (ICIs) have become a standard treatment for various cancers, yet their safety during pregnancy remains under-researched. This article explores the complex intersection of cancer treatment and pregnancy, focusing on the use of ICIs. Despite societal concerns, data on the safety of ICIs during pregnancy are limited, primarily derived from preclinical animal studies and case reports. While most case reports suggest no significant adverse effects on live births, isolated incidents of severe neonatal complications have been documented. The potential for immune-related adverse events (irAEs) in neonates, such as thyroiditis or enterocolitis, underscores the need for caution. Given the lack of comprehensive data, clinicians face challenging decisions when treating pregnant cancer patients, particularly in metastatic settings where ICIs may be the only viable option. This article advocates for a careful risk-benefit analysis and informed patient discussions, emphasizing the need for further research to guide clinical decision-making in these complex scenarios.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"49 2","pages":"Article 152045"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Managing pregnancy-associated breast cancer: A practical approach 管理妊娠相关乳腺癌：一个实用的方法
IF 3.2 3区 医学
Seminars in perinatology Pub Date : 2025-03-01 DOI: 10.1016/j.semperi.2025.152037
Prarthna V. Bhardwaj , Yara Abdou
{"title":"Managing pregnancy-associated breast cancer: A practical approach","authors":"Prarthna V. Bhardwaj ,&nbsp;Yara Abdou","doi":"10.1016/j.semperi.2025.152037","DOIUrl":"10.1016/j.semperi.2025.152037","url":null,"abstract":"<div><div>Pregnancy-Associated Breast Cancer (PABC) is a rare but complex condition that presents both professional and ethical challenges. Diagnosis is often delayed due to breast changes associated with pregnancy and puerperium, which can mask malignant findings. Management requires a multidisciplinary approach that carefully balances maternal and fetal risks.</div><div>Chemotherapy is generally reserved for the second and third trimesters to avoid teratogenicity, with anthracyclines being the most well-studied and safest agents in this setting. Surgical decisions are influenced by factors such as cancer stage, gestational age, and the timing of potential radiation therapy. Notably, radiation therapy, endocrine therapy, and most targeted therapies are contraindicated during pregnancy due to potential harm to the fetus.</div><div>Comprehensive care should include robust social and mental health support for the mother and her family to help navigate the physical and emotional challenges during this period.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"49 2","pages":"Article 152037"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Ovarian cancer in pregnancy 妊娠期卵巢癌
IF 3.2 3区 医学
Seminars in perinatology Pub Date : 2025-03-01 DOI: 10.1016/j.semperi.2025.152043
Jennifer R. Jorgensen , Molly A. Brewer , Carolyn D. Runowicz
{"title":"Ovarian cancer in pregnancy","authors":"Jennifer R. Jorgensen ,&nbsp;Molly A. Brewer ,&nbsp;Carolyn D. Runowicz","doi":"10.1016/j.semperi.2025.152043","DOIUrl":"10.1016/j.semperi.2025.152043","url":null,"abstract":"<div><div>Objective: The objective of this manuscript is to review the epidemiology, diagnosis, treatment and outcomes of ovarian cancers diagnosed during pregnancy. Finding: Ovarian cancer in pregnancy, although rare, is more likely to be diagnosed early during pregnancy due to the increased use of high resolution ultrasound. Treatment will depend on a multidisciplinary team. These cancers are usually treated with surgery alone during pregnancy, optimally between 13–20 weeks to reduce the risk of miscarriage or preterm labor. Chemotherapy is usually given after delivery if appropriate to the tumor type, unless the patient has widely metastatic disease. Conclusion: The majority of ovarian cancers diagnosed during pregnancy are Stage I due to both young age and increased use of early ultrasound during pregnancy and have a better overall prognosis than the cancers detected in older women.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"49 2","pages":"Article 152043"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Extending CPAP in stable preterm infants to increase lung growth and development as measured by pulmonary function testing. 通过肺功能测试，延长稳定早产儿的CPAP以促进肺生长发育。
IF 3.2 3区 医学
Seminars in perinatology Pub Date : 2025-02-28 DOI: 10.1016/j.semperi.2025.152059
Rachna R Mamidi, Cindy T McEvoy
{"title":"Extending CPAP in stable preterm infants to increase lung growth and development as measured by pulmonary function testing.","authors":"Rachna R Mamidi, Cindy T McEvoy","doi":"10.1016/j.semperi.2025.152059","DOIUrl":"10.1016/j.semperi.2025.152059","url":null,"abstract":"<p><p>Nasal continuous positive airway pressure (CPAP) is the standard of care for the acute management of preterm infants with respiratory distress, however, the optimal duration of CPAP in stable preterm infants is unknown. In utero, preclinical, and clinical data support the premise that mechanical stretch from CPAP can increase lung growth and development. This paper will review data to support this premise, studies examining weaning infants off CPAP, the current practices in the United States regarding CPAP application and duration, and clinical studies of the association of CPAP duration and subsequent lung growth and development. Pulmonary function testing will be presented as an important outcome throughout these trials.</p>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":" ","pages":"152059"},"PeriodicalIF":3.2,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Update on nasal high frequency oscillatory ventilation: A living review. 鼻高频振荡通气的最新进展：动态回顾。
IF 3.2 3区 医学
Seminars in perinatology Pub Date : 2025-02-26 DOI: 10.1016/j.semperi.2025.152056
Daniele De Luca, Costanza Neri, Roberta Centorrino
{"title":"Update on nasal high frequency oscillatory ventilation: A living review.","authors":"Daniele De Luca, Costanza Neri, Roberta Centorrino","doi":"10.1016/j.semperi.2025.152056","DOIUrl":"https://doi.org/10.1016/j.semperi.2025.152056","url":null,"abstract":"<p><p>Non-invasive high-frequency oscillatory ventilation (NHFOV) is the main non-conventional ventilatory mode used in newborn infants. NHFOV has been spreading, while knowledge about its physiology, mechanics and clinical application has increased overtime. This is to be considered as a living review, since we here update the knowledge that was originally summarized in a previously published review. We first focus on physiology of such a complex respiratory support technique with practical data on interfaces, patient-ventilator interaction and devices to provide NHFOV. We then move to the evidence-based review of parallel randomized clinical trial published so far. We provide both qualitative and quantitative synthesis of results for the two commonest outcomes, i.e. need for intubation and invasive ventilation and CO<sub>2</sub> elimination. We also provide our protocol to use NHFOV together with other respiratory support modes and we provide suggestions on parameters boundaries and identification of patients to treat. We finally identify still open questions needing future research to optimize the use of NHFOV In preterm infants.</p>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":" ","pages":"152056"},"PeriodicalIF":3.2,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Corrigendum to “Mechanical ventilation in special populations” [Seminars in Perinatology, 48(2), 2024, 151888] “特殊人群的机械通气”的勘误表[围产学研讨会，48(2),2024,151888]。
IF 3.2 3区 医学
Seminars in perinatology Pub Date : 2025-02-01 DOI: 10.1016/j.semperi.2024.152022
Huayan Zhang , Martin Keszler
{"title":"Corrigendum to “Mechanical ventilation in special populations” [Seminars in Perinatology, 48(2), 2024, 151888]","authors":"Huayan Zhang ,&nbsp;Martin Keszler","doi":"10.1016/j.semperi.2024.152022","DOIUrl":"10.1016/j.semperi.2024.152022","url":null,"abstract":"","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"49 1","pages":"Article 152022"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Non-pharmacologic and pharmacologic care of the neonate with opioid withdrawal syndrome 阿片类戒断综合征新生儿的非药物与药物护理。
IF 3.2 3区 医学
Seminars in perinatology Pub Date : 2025-02-01 DOI: 10.1016/j.semperi.2024.152020
Kimberly Spence , Sarah Milota
{"title":"Non-pharmacologic and pharmacologic care of the neonate with opioid withdrawal syndrome","authors":"Kimberly Spence ,&nbsp;Sarah Milota","doi":"10.1016/j.semperi.2024.152020","DOIUrl":"10.1016/j.semperi.2024.152020","url":null,"abstract":"<div><div>There has been a significant paradigm shift in the management of infants with NOWS to emphasizing the role of non-pharmacologic care centered on the mother-infant dyad. By promoting bonding through rooming-in, breast-feeding and skin-to skin contact in a low stimulation environment, short and long-term outcomes have dramatically improved, resulting in reduced length of stay and need for pharmacologic treatment of the newborn. This shift in care also empowers the mother and promotes bonding and attachment, providing a solid foundation for a safe discharge. When non-pharmacological treatments are not sufficient to control the infant's withdrawal symptoms then medications can be used as an adjunct, to the minimum extent necessary and should never be used in isolation of non-pharmacological interventions. Quality improvement efforts should focus on optimizing and standardizing both non-pharmacologic and pharmacologic care to best serve this population.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"49 1","pages":"Article 152020"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Addressing stigma for families affected by opioid use disorder 解决受阿片类药物使用障碍影响的家庭的耻辱问题。
IF 3.2 3区 医学
Seminars in perinatology Pub Date : 2025-02-01 DOI: 10.1016/j.semperi.2024.152018
Nichole Nidey , Grace Gerdts , Michelle Kavouras , Davida M. Schiff
{"title":"Addressing stigma for families affected by opioid use disorder","authors":"Nichole Nidey ,&nbsp;Grace Gerdts ,&nbsp;Michelle Kavouras ,&nbsp;Davida M. Schiff","doi":"10.1016/j.semperi.2024.152018","DOIUrl":"10.1016/j.semperi.2024.152018","url":null,"abstract":"<div><div>Pregnant and parenting people with opioid use disorder commonly experience stigma, or the enactment of negative attitudes, beliefs, and stereotypes, during their pregnancy and at delivery. We will describe four different domains of stigma: self, interpersonal, structural, and policy, and discuss how they intersect to amplify the experiences of shame, anxiety, isolation, lack of trust for birthing people and parents that can contribute to the avoidance of prenatal care and substance use treatment which can impact pregnancy and infant health outcomes. We will review a case example where stigma contributed to poor care, review preferred person-first language to use when talking to and about families impacted by opioid use disorder, and describe emerging interventions to address and mitigate the effects of stigma in the perinatal setting.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"49 1","pages":"Article 152018"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Beyond a simple cause and effect relationship: Exploring the long-term outcomes of children prenatally exposed to opioids and other substances 超越简单的因果关系：探索儿童在产前接触阿片类药物和其他物质的长期后果。
IF 3.2 3区 医学
Seminars in perinatology Pub Date : 2025-02-01 DOI: 10.1016/j.semperi.2024.152010
Ekaterina Burduli , Hendrée E Jones
{"title":"Beyond a simple cause and effect relationship: Exploring the long-term outcomes of children prenatally exposed to opioids and other substances","authors":"Ekaterina Burduli ,&nbsp;Hendrée E Jones","doi":"10.1016/j.semperi.2024.152010","DOIUrl":"10.1016/j.semperi.2024.152010","url":null,"abstract":"<div><div>The long-term outcomes of children exposed to opioids and other substances in utero, specifically those diagnosed with Neonatal Abstinence Syndrome (NAS), present a complex interaction of different factors. First, NAS and its clinical presentation will be defined, then summarized will be an overview of NAS prevalence, recent trends, and significance of NAS in the context of the rising synthetic opioid and polysubstance use. Highlighted will also be the identified risk factors for NAS, especially regarding the role of environmental and psychosocial stressors during pregnancy. Finally, reviewed will be the existing NAS literature, including its gaps and limitations, and suggested recommendations for future research and policy considerations for improving care for children and families impacted by NAS.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"49 1","pages":"Article 152010"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142795067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The role of genetics in neonatal abstinence syndrome 基因在新生儿戒断综合征中的作用。
IF 3.2 3区 医学
Seminars in perinatology Pub Date : 2025-02-01 DOI: 10.1016/j.semperi.2024.152006
Sarah Vernovsky , Ana Herning , Elisha M. Wachman
{"title":"The role of genetics in neonatal abstinence syndrome","authors":"Sarah Vernovsky ,&nbsp;Ana Herning ,&nbsp;Elisha M. Wachman","doi":"10.1016/j.semperi.2024.152006","DOIUrl":"10.1016/j.semperi.2024.152006","url":null,"abstract":"<div><div>Neonatal Abstinence Syndrome (NAS) after in-utero exposure to opioids remains a significant public health concern. NAS is a highly variable condition in which presentation and severity cannot be explained by clinical factors alone. Research in human subjects has identified both genetic and epigenetic associations with prenatal opioid exposure and NAS severity, including single nucleotide polymorphisms, DNA methylation differences, and gene expression modifications. Animal studies have also identified key gene pathways that are likely important contributors to NAS phenotype. The clinical significance of identified genetic associations with NAS are unclear and warrant further study to see how they could impact NAS management.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"49 1","pages":"Article 152006"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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