Clinical Medicine Insights-Reproductive Health最新文献

{"title":"A Survey of Health Care Professionals' Knowledge and Experience of Foetal Alcohol Spectrum Disorder and Alcohol Use in Pregnancy.","authors":"Helen Howlett,&nbsp;Shonag Mackenzie,&nbsp;Eugen-Matthias Strehle,&nbsp;Judith Rankin,&nbsp;William K Gray","doi":"10.1177/1179558119838872","DOIUrl":"https://doi.org/10.1177/1179558119838872","url":null,"abstract":"<p><strong>Background: </strong>Foetal alcohol spectrum disorders (FASDs) are one of the most common preventable forms of developmental disability and congenital abnormalities globally, particularly in countries where alcohol is considered socially acceptable. Screening for alcohol use early in pregnancy can facilitate the detection of alcohol-exposed pregnancies and identify women who require further assessment. However, only a small percentage of children with FASD are identified in the United Kingdom. This may be partly attributed to a lack of awareness of the condition by National Health Service (NHS) health professionals.</p><p><strong>Methods: </strong>We developed an online survey to determine health care professionals' (midwives, health visitors, obstetricians, paediatricians, and general practitioners) perceived knowledge, attitudes, and clinical practices relating to alcohol in pregnancy and FASD.</p><p><strong>Results: </strong>There were a total of 250 responses to the surveys (78 midwives, 60 health visitors, 55 obstetricians, 31 paediatricians, and 26 general practitioners). About 58.1% of paediatricians had diagnosed a patient with foetal alcohol syndrome (FAS) or FASD and 36.7% worried about stigmatisation with diagnosis. Paediatricians reported the highest levels of FASD training (54.8%), with much lower levels in midwives (21.3%). This was reflected in perceived knowledge levels; overall, only 19.8% of respondents knew the estimated UK prevalence of FASD for example.</p><p><strong>Conclusions: </strong>We identified a need for training in alcohol screening in pregnancy and FASD to improve awareness and recognition by UK professionals. This could improve patient care from the antenatal period and throughout childhood.</p>","PeriodicalId":44130,"journal":{"name":"Clinical Medicine Insights-Reproductive Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179558119838872","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37280675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Infant Care Competence Among Mothers With Postpartum Depression.","authors":"Debbie Jones,&nbsp;Nicole Letourneau,&nbsp;Linda Duffett Leger","doi":"10.1177/1179558119834910","DOIUrl":"https://doi.org/10.1177/1179558119834910","url":null,"abstract":"<p><strong>Background/objective: </strong>Postpartum depression is linked to decreased quality mother-infant interactions and long-term negative impacts on children's behavior and health. Infant care competence may be reduced by postpartum depression and other maternal or environmental variables. Thus, the objective of this study was to explain factors that contribute to perceived infant care competence among mothers with postpartum depression.</p><p><strong>Methods: </strong>Multiple regression analysis and correlational analysis were conducted to study associations between the predictors (depression severity, social support, child development, family functioning) and the outcome of perceived infant care competence among a peer support intervention study for mothers with postpartum depression (n = 55).</p><p><strong>Results: </strong>Child development, specifically communication (<i>P</i> = .04), gross (<i>P </i>= .00) and fine (<i>P</i> = .00) motor skills, problem solving (<i>P</i> = .00), and personal-social development (<i>P</i> = .01), explained maternal perceptions of responsiveness, an aspect of infant care competence. The best-fit model was obtained for the responsiveness subscale, in which 37% of the variance was explained by mothers' reports of infants' fine motor skills (<i>P</i> = .000) and nurturance (<i>P</i> = .039) as an aspect of social support and family functioning (<i>P</i> = .078).</p><p><strong>Conclusions: </strong>Recognition of the importance of infant development to perceived infant care competence, particularly mothers' perceptions of infant responsiveness, may offer targets for intervention. Helping mothers identify infant cues and milestones that signal infant responsiveness may be beneficial. Moreover, social support and family functioning may be targets for intervention to promote perceived infant care competence in mothers affected by postpartum depression.</p>","PeriodicalId":44130,"journal":{"name":"Clinical Medicine Insights-Reproductive Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179558119834910","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37110664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of 2-Hour Oral Glucose Tolerance Test and Hemoglobin A1C in the Identification of Pre-Diabetes in Women with Infertility and Recurrent Pregnancy Loss.","authors":"Alice J Shapiro,&nbsp;Emily C Holden,&nbsp;Peter G McGovern,&nbsp;Donald Alderson,&nbsp;Sara S Morelli","doi":"10.1177/1179558119831280","DOIUrl":"10.1177/1179558119831280","url":null,"abstract":"<p><strong>Research question: </strong>Does hemoglobin A1C (HbA1C) predict pre-diabetes (pre-DM) in a population of women with infertility and/or recurrent pregnancy loss (RPL), when considering the 75 g, 2-hour oral glucose tolerance test (2h GTT) as the gold standard?</p><p><strong>Design: </strong>Retrospective study of 242 patients with infertility or RPL presenting to a university-affiliated reproductive endocrinology and infertility clinic between January 2012 and December 2016 who underwent screening for disorders of glucose metabolism with a 2h GTT. The prevalence of pre-DM as defined by HbA1C 5.7% to 6.4% and 2h GTT values of 140-199 mg/dL, and predictive values of HbA1C for the identification of pre-DM when compared with 2h GTT, were calculated and compared.</p><p><strong>Results: </strong>Of 242 patients, 188 (77.7%) women had both HbA1C and 2h GTT performed. Of these, 89 (47.3%) tested positive for pre-DM by one or both methods. Of 89 patients, 14 (15.7%) had both an abnormal 2h GTT and an abnormal HbA1C. Only 6 out of 89 (6.7%) patients tested positive for pre-DM by an abnormal 2h GTT in the setting of a normal HbA1C result. Conversely, 69 of these 89 patients (77.5%) tested positive for pre-DM by an abnormal HbA1C in the setting of a normal 2h GTT. The prevalence of pre-DM, as defined by 2h GTT, was 10.6% (20/188) (95% CI, 6.6-16.0), compared with a prevalence of 44.1% (83/188) (95% CI, 36.9-51.6) when pre-DM was defined by HbA1C alone. When the 2h GTT was considered the gold standard for the identification of pre-DM, the negative predictive value (NPV) of HbA1C compared with 2h GTT was 94.3% (95% CI, 88.0-97.9), whereas the positive predictive value (PPV) of HbA1C compared with 2h GTT was only 16.9% (95% CI, 9.5-26.7).</p><p><strong>Conclusions: </strong>Although a normal HbA1C was highly predictive of a normal 2h GTT, the two tests demonstrate poor agreement in the identification of pre-DM in women with infertility and/or RPL. Hemoglobin A1C is superior to the 2h GTT as an initial screening test for pre-DM in this population, since it identified a substantial number of women who would otherwise remain undiagnosed in the setting for a normal 2h GTT alone. However, the long-term clinical relevance of an elevated HbA1C in this population needs to be better defined.</p>","PeriodicalId":44130,"journal":{"name":"Clinical Medicine Insights-Reproductive Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179558119831280","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37100282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ovarian Function and Fertility Preservation in Breast Cancer: Should Gonadotropin-Releasing Hormone Agonist be administered to All Premenopausal Patients Receiving Chemotherapy?","authors":"Matteo Lambertini,&nbsp;François Richard,&nbsp;Bastien Nguyen,&nbsp;Giulia Viglietti,&nbsp;Cynthia Villarreal-Garza","doi":"10.1177/1179558119828393","DOIUrl":"https://doi.org/10.1177/1179558119828393","url":null,"abstract":"<p><p>Chemotherapy-induced premature ovarian insufficiency (POI) is one of the potential drawbacks of chemotherapy use of particular concern for newly diagnosed premenopausal breast cancer patients. Temporary ovarian suppression obtained pharmacologically with the administration of a gonadotropin-releasing hormone agonist (GnRHa) during chemotherapy has been specifically developed as a method to counteract chemotherapy-induced gonadotoxicity with the main goal of diminishing the risk of POI. In recent years, important clinical evidence has become available on the efficacy and safety of this strategy that should now be considered a standard option for ovarian function preservation in premenopausal breast cancer patients, including women who are not interested in conceiving after treatment or that would not be candidates for fertility preservation strategies because of their age. Nevertheless, in women interested in fertility preservation, this is not an alternative to gamete cryopreservation, which remains as the first option to be offered. In this setting, temporary ovarian suppression with GnRHa during chemotherapy should be also proposed following gamete cryopreservation or to women who have no access, refuse, or have contraindications to surgical fertility preservation techniques. In this article, we present an overview about the role of temporary ovarian suppression with GnRHa during chemotherapy in breast cancer patients by addressing the available clinical evidence with the aim of identifying both the best candidates for the use of this strategy and the still existing gray zones requiring further investigation.</p>","PeriodicalId":44130,"journal":{"name":"Clinical Medicine Insights-Reproductive Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179558119828393","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37068779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fertility Preservation in Women With Malignancy: Future Endeavors","authors":"Z. Blumenfeld","doi":"10.1177/1179558119872490","DOIUrl":"https://doi.org/10.1177/1179558119872490","url":null,"abstract":"The area of fertility preservation is constantly developing. To date, the only noninvestigational and unequivocally accepted methods for fertility preservation are cryopreservation of embryos and unfertilized oocytes. This article is one of several in a monogram on fertility preservation. The debate, pros and cons, and equivocal data on the use of GnRH analogues for fertility preservation are elaborated by 3 other manuscripts, in this monogram. A repeat of the arguments, pros and cons of this debatable issue, would be a repetition and redundancy of what is already included in this monogram. The subject of ovarian cryopreservation for fertility preservation is also elaborated by several other authors in this monogram. It is possible that, in the not too far future, the technologies of in vitro maturation of primordial follicles to metaphase 2 oocytes, and the “artificial ovary,” will turn clinically available. These technologies may bypass the risk of resuming malignancy by autotransplantation of cryopreserved-thawed ovarian tissue in leukemia and diseases where malignant cells may persist in the cryopreserved ovarian tissue. We summarize here the suggested options for future endeavors in fertility preservation.","PeriodicalId":44130,"journal":{"name":"Clinical Medicine Insights-Reproductive Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82454417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Possible Practical Implication of High CRP Levels in PCOS","authors":"Z. Blumenfeld","doi":"10.1177/1179558119861936","DOIUrl":"https://doi.org/10.1177/1179558119861936","url":null,"abstract":"4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). https://doi.org/10.1177/1179558119861936 Clinical Medicine Insights: Reproductive Health Volume 13: 1–3 © The Author(s) 2019 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/1 79558119 6 936","PeriodicalId":44130,"journal":{"name":"Clinical Medicine Insights-Reproductive Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74955415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fertility Preservation Using GnRH Agonists: Rationale, Possible Mechanisms, and Explanation of Controversy","authors":"Z. Blumenfeld","doi":"10.1177/1179558119870163","DOIUrl":"https://doi.org/10.1177/1179558119870163","url":null,"abstract":"The only clinically accepted method of fertility preservation in young women facing gonadotoxic chemo- and/or radiotherapy for malignant or autoimmune diseases is cryopreservation of embryos or unfertilized ova, whereas cryopreservation of ovarian tissue for future reimplantation, or in vitro maturation of follicles, and the use of gonadotropin-releasing hormone agonists (GnRHa) are still considered investigational, by several authorities. Whereas previous publications have raised the fear of GnRHa’s possible detrimental effects in patients with hormone receptor-positive breast cancers, recent randomized controlled trials (RCTs) have shown that it either improves or does not affect disease-free survival (DFS) in such patients. This review summarizes the pros and cons of GnRHa co-treatment for fertility preservation, suggesting 5 theoretical mechanisms for GnRHa action: (1) simulating the prepubertal hypogonadotropic milieu, (2) direct effect on GnRH receptors, (3) decreased ovarian perfusion, (4) upregulation of an ovarian-protecting molecule such as sphingosine-1-phosphate, and (5) protecting a possible germinative stem cell. We try to explain the reasons for the discrepancy between most publications that support the use of GnRHa for fertility preservation and the minority of publications that did not support its efficiency.","PeriodicalId":44130,"journal":{"name":"Clinical Medicine Insights-Reproductive Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87718982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"To Get Back on Track: A Qualitative Study on Childless Women’s Expectations on Future Fertility Before Undergoing Bariatric Surgery","authors":"E. Nilsson-Condori, S. Järvholm, A. Thurin‐Kjellberg, I. Sidlovskaja, J. Hedenbro, B. Friberg","doi":"10.1177/1179558119874777","DOIUrl":"https://doi.org/10.1177/1179558119874777","url":null,"abstract":"Background: In Sweden, 4700 women seek bariatric surgery annually, many of those being nulliparous. Anovulation is common among obese women, but bariatric surgery is not considered a treatment for infertility. The aim of this study was to explore the motives of women in fertile age for seeking bariatric surgery and their expectations on future fertility. Materials and methods: A qualitative study with semi-structured interviews with childless women (n = 12) aged 20 to 35 years. Interviews were conducted 1 to 3 weeks prior to surgery, transcribed verbatim, and analyzed with thematic analysis. Results: “To get back on track” was identified as a master theme with 3 underlying subthemes, with the following headings: “A better me,” “A fertile me,” and “A pregnant me.” The participants were hoping that weight-loss would make them feel more content with themselves, break isolation, and make it easier to find a partner. The participants considered fertility to improve after bariatric surgery, mainly based on stories from other patients of bariatric surgery. Having a child was expressed to be of great importance to them. Conclusions: Even though obese young women do not seek bariatric surgery for fertility reasons alone, there is a general perception of enhanced fertility after surgery, which is regarded as positive and important.","PeriodicalId":44130,"journal":{"name":"Clinical Medicine Insights-Reproductive Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80480786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PCOS and Hyperprolactinemia: what do we know in 2019?","authors":"Clémence Delcour, G. Robin, Jacques Young, D. Dewailly","doi":"10.1177/1179558119871921","DOIUrl":"https://doi.org/10.1177/1179558119871921","url":null,"abstract":"Polycystic ovary syndrome (PCOS) and hyperprolactinemia (HPRL) are the two most common etiologies of anovulation in women. Since the 1950s, some authors think that there is a pathophysiological link between PCOS and HPRL. Since then, many authors have speculated about the link between these two endocrine entities, but no hypothesis proposed so far could ever be confirmed. Furthermore, PCOS and HPRL are frequent endocrine diseases and a fortuitous association cannot be excluded. The evolution of knowledge about PCOS and HPRL shows that studies conducted before the 2000s are obsolete given current knowledge. Indeed, most of the studies were conducted before consensual diagnosis criteria of PCOS and included small numbers of patients. In addition, the investigation of HPRL in these studies relied on obsolete methods and did not look for the presence of macroprolactinemia. It is therefore possible that HPRL that has been attributed to PCOS corresponded in fact to macroprolactinemia or to pituitary microadenomas of small sizes that could not be detected with the imaging methods of the time. Recent studies that have conducted a rigorous etiological investigation show that HPRL found in PCOS correspond either to non-permanent increase of prolactin levels, to macroprolactinemia or to other etiologies. None of this recent study found HPRL related to PCOS in these patients. Thus, the link between PCOS and HPRL seems to be more of a myth than a well-established medical reality and we believe that the discovery of an HPRL in a PCOS patient needs a standard etiological investigation of HPRL.","PeriodicalId":44130,"journal":{"name":"Clinical Medicine Insights-Reproductive Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74615964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathogenesis and Consequences of Disordered Sleep in PCOS","authors":"Susan Sam, D. Ehrmann","doi":"10.1177/1179558119871269","DOIUrl":"https://doi.org/10.1177/1179558119871269","url":null,"abstract":"Polycystic ovary syndrome (PCOS) is a common hormonal disorder that is characterized by hyperandrogenism and menstrual irregularity. Affected women have a high prevalence of insulin resistance and related metabolic complications. The frequency of sleep disturbances appears to be increased in women with PCOS, although most studies so far have included more severely affected obese women with PCOS who are referred to tertiary care clinics and may not represent the general population of women with PCOS. This article provides an overview of sleep disturbances in PCOS with the focus on obstructive sleep apnea (OSA), the most commonly reported sleep disturbance among these women. The pathogenesis and risk factors for OSA in PCOS and its association with metabolic disorders is discussed in detail.","PeriodicalId":44130,"journal":{"name":"Clinical Medicine Insights-Reproductive Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81366894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}