Biomedical subjects

Moshe Hod

Publications and source records attributed to Moshe Hod.

10 recordsLinked to original sources

PubMed2003

Is immunosuppression therapy in renal allograft recipients teratogenic? A single-center experience.

The aim of the study was to determine whether immunosuppressive agents used in renal allograft recipients are teratogenic or otherwise associated with pregnancy outcome. The study population consisted of 38 renal allograft recipients treated with combinations of prednisone, azathioprine, cyclosporin A, and tacrolimus attending our Hypertension in Pregnancy Clinic. The 48 live offspring of 73 pregnancies in this group were evaluated for major congenital malformations and mild errors of morphogenesis. Findings were compared with those in 48 offspring of 41 women with primary renal disease not treated with immunosuppressive drugs. Pregnancy outcome parameters were also compared between the study and control groups in the perinatal period and on a long-term basis (2-7 years after birth). Two major anomalies (4.2%), subcoronal hypospadias and rudimentary thumb, and 10 mild errors of morphogenesis (20.8%) were detected in the study group. These rates did not differ significantly from those in the control group (4.2% and 16.6%, respectively). Pregnancy outcome was worse in the renal transplant patients than in the women with primary renal disease in terms of prematurity (60% vs. 21%, P = 0.001), growth restriction (52% vs. 17%, P = 0.001), and hospitalization in a neonatal intensive care unit (35% vs. 6%, P = 0.01). In conclusion, the similar prevalence of major anomalies and mild errors of morphogenesis in offspring of the renal transplant patients and the women with primary renal disease suggests that immunosuppressive therapy is not a teratogenic factor. It may, however, be associated with worse pregnancy outcome.

Abnormalities, Drug-Induced↗

PubMed2003

Continuous glucose monitoring for the evaluation of gravid women with type 1 diabetes mellitus.

OBJECTIVE: To compare the daily glycemic profile reflected by continuous and intermittent blood glucose monitoring in pregnant women with type 1 diabetes and to compare the treatment protocols based on the two monitoring methods. METHODS: The study sample consisted of 34 gravid patients at gestational weeks 16-32, with type 1 diabetes being treated by multiple insulin injections. Data derived from the continuous glucose monitoring system for 72 hours were compared with finger stick glucose measurements performed 6-8 times per day. During the study period, patients documented the time of food intake, insulin injections, and hypoglycemic events. Data on demographics, gravidity, parity, body mass index, hemoglobin A1c, and fructosamine levels were collected for each patient. RESULTS: An average (+/- standard deviation) of 780 +/- 54 glucose measurements was recorded for each patient with continuous glucose monitoring. The mean total time of hyperglycemia (glucose level greater than 140 mg/dL) undetected by the finger stick method was 192 +/- 28 minutes per day. Nocturnal hypoglycemic events (glucose level less than 50 mg/dL) were recorded in 26 patients; in all cases, there was an interval of 1-4 hours before clinical manifestations appeared or the event was revealed by random blood glucose examination. Based on the additional information obtained by continuous monitoring, the insulin therapeutic regimen was adjusted in 24 patients (70%). CONCLUSION: Continuous glucose monitoring can diagnose high postprandial blood glucose levels and nocturnal hypoglycemic events that are unrecognized by intermittent blood glucose monitoring and may serve as a basis for determining treatment regimens. A large, prospective study on maternal and neonatal outcome is needed to evaluate the clinical implications of this new monitoring technique.

Adult↗

PubMed2003

Surface expression of neutrophil adhesion molecules in pregnant women at risk for hypertensive complications.

OBJECTIVE: To determine if neutrophil activation is a pathogenetic factor in hypertensive disorders in pregnancy, the neutrophil expression of adhesion molecules was prospectively investigated in pregnant women at risk, prior to the development of hypertensive complications. METHODS: Two neutrophil activation parameters, beta2-integrin (CD11b) and l-selectin (CD62L), were assessed at admission between 14 and 24 weeks of gestation in 82 pregnant women at risk of preeclampsia and other hypertensive complications. Results were compared to those in 20 healthy normotensive women. RESULTS: Of the 82 women at risk, 23 (28%) developed hypertensive complications: 9 (11%) preeclampsia and 14 (17%) others, such as intrauterine growth restriction (n = 6), fetal or neonatal loss (n = 8), and preterm delivery (< or = 30 weeks of gestation) (n = 8). All pregnancy outcome measures were significantly worse in the patients with complications than in those at risk but without complications or the healthy controls. Expression of beta2-integrin was significantly higher in early stages of pregnancy in the women who eventually developed complications than the women who did not, P =.019, or the healthy controls, P =.049. CONCLUSIONS: Surface expression of beta2-integrin is increased in pregnant women at risk for hypertensive complications before the clinical manifestations of the disorder.

Adult↗

PubMed2003

Telemedicine for antenatal surveillance of high-risk pregnancies with ambulatory and home fetal heart rate monitoring--an update.

Antepartum fetal surveillance is routinely used to assess the risk of fetal death in high-risk pregnancies. Traditionally, testing is performed in the hospital or outpatient clinic by trained medical staff. New equipment is now available that is easy to operate and can be used for self-monitoring of the fetal heart rate (FHR) in the home setting. The tracings are transmitted by modem to a referral center for immediate interpretation by a health provider. The aim of this review was to assess the current data on the application of this new technology with regard to feasibility, access to care, maternal and neonatal outcome, patient and physician satisfaction, and cost-effectiveness.

Ambulatory Care↗

PubMed2003

Accuracy of sonographic estimation of fetal weight before induction of labor in diabetic pregnancies and pregnancies with suspected fetal macrosomia.

AIMS: To evaluate the accuracy of sonographic estimation of fetal weight (EFW) in diabetic pregnancies and pregnancies with suspected fetal macrosomia. METHODS: 63 women with diabetic pregnancies, 74 nondiabetic women with suspected large-for-gestational-age (LGA) infants, and 161 controls underwent ultrasound assessment prior to induction of labor. EFW was compared to the weight at birth, 1-3 days later. RESULTS: EFW was highly correlated to birth weight. Absolute or actual weight differences between the birth weight and the EFW, and the rate of EFW within 10% of birth weight were not different between the groups. A linear regression model controlling for maternal and gestational age, diagnosis of gestational or pregestational diabetes, birth weight, gravidity, parity, nulliparity, placental location and AFI was not significantly correlated to the absolute or actual weight differences. In pregnancies with suspected LGA, higher birth weight was an independent and significant predictor of high weight difference inaccuracy. CONCLUSIONS: The ultrasonographic EFW 1-3 days before delivery is highly correlated with birth weight, reaffirming the clinical use of abdominal circumference and femur length in estimating fetal weight near labor at term. In pregnancies with suspected LGA fetuses and higher prevalence of macrosomia, ultrasound has higher sensitivity but lower specificity than the controls.

Birth Weight↗

PubMed2002

The elevated plasma lipoprotein(a) concentrations in preeclampsia do not precede the development of the disorder.

We sought to determine whether maternal plasma lipoprotein(a) [Lp(a)] levels are elevated in the second trimester, before the development of preeclampsia and other obstetrical complications, in women at risk. In the first part of the study (cross-sectional), plasma concentrations of Lp(a) were compared among 16 women with preeclampsia, 35 normotensive pregnant women and 18 healthy nonpregnant women. In the second part (nested case-control), blood samples were collected prospectively from 82 women at risk of preeclampsia, at 14-24 weeks of gestation, and Lp(a) levels were compared between those in whom preeclampsia or other obstetrical complications developed and those in whom they did not. In the cross-sectional study, plasma concentrations of Lp(a) were significantly higher in women with preeclampsia than in normotensive pregnant and healthy nonpregnant women (41 +/- 31 vs. 24 +/- 16 and 15 +/- 10 mg/dl, respectively; P=.001). Of the 82 women in the second part of the study, 9 (11%) developed preeclampsia and 19 (23%) had complications such as intrauterine growth restriction, preterm delivery and fetal or neonatal loss. There were no differences in plasma Lp(a) concentrations between the women with preeclampsia and those without complications, though Lp(a) levels were significantly higher in women with other complications than in those with either preeclampsia or uncomplicated pregnancies (40 +/- 29 vs. 17 +/- 13 or 28 +/- 18 mg/dl, respectively; P=.05). In conclusion, elevated plasma levels of Lp(a), associated with clinically established preeclampsia, are not detected before the appearance of the disorder in pregnant women at risk.

Adult↗

PubMed2002

Mode of delivery following successful external cephalic version.

Mode of delivery of pregnancies following successful external cephalic version (ECV) was evaluated in a retrospective case-controlled study. Successful ECV was performed in 105 of 223 (47%) attempts. Data were obtained in 96 of 105 (91.4%) pregnancies that were matched 1:2 fashion to the next consecutive singleton deliveries for maternal age, gravidity, parity, and ethnic origin. The groups were compared for mode of delivery, indications for cesarean section (CS) and instrumental delivery, gestational age at delivery, birth weight and Apgar score. There was no significant difference between the groups in maternal age or the rates of low 5-minute Apgar score (</= 7) and instrumental delivery. The rate of intrapartum CS in the study group was 19.8% (19 of 96), which was 3.2 times higher than that of the control group (12 of 192, 6.25%, p <0.001). Gestational age at delivery was significantly higher in the study group (40.0 +/- 1.2 vs. 39.3 +/- 1.5 weeks, p <0.001) as was the birth weight (3,411 +/- 426 vs. 3,291 +/- 490 g, p = 0.041). There was no significant difference in the rate of non-reassuring fetal heart rate patterns, but the rates of labor dystocia and malpresentation were higher in the study group. Patients in the study group who underwent CS and instrumental delivery ( n = 24) were characterized by a significantly higher nulliparity rate and birth weight and a near-significantly longer interval from ECV to delivery. In conclusion, pregnancies after a successful ECV are at higher risk of CS, which is not associated with fetal distress, but might be attributable to higher rates of labor dystocia and malpresentation, higher nulliparity rate birth weight, and gestational age at delivery. ECV to delivery interval may also be an important factor.

Adult↗

PubMed2002

Plasma levels of vitamin E in pregnant women prior to the development of preeclampsia and other hypertensive complications.

Our aim was to investigate whether decreased levels of vitamin E can be measured during the early stages of pregnancy in women at risk of developing preeclampsia or other associated complications before the onset of the clinical syndrome. We prospectively measured the plasma concentrations of vitamin E in 62 pregnant women at 7-32 weeks of gestation who were at risk of developing preeclampsia and other complications, before the appearance of clinical signs. The results were compared with those of 16 healthy controls. Of the 62 study patients, 8 (13%) developed preeclampsia, and 18 (29%) had other complications, such as intrauterine growth restriction (n = 8), fetal or neonatal loss (n = 9), and preterm delivery (< or = 30 weeks of gestation; n = 7). Both gestational age at delivery and birth weight were significantly lower in the patients with complications than in the healthy controls. However, there were no significant differences in vitamin E levels between women who developed preeclampsia or other complications and those who did not. There was no significant correlation between plasma vitamin E and creatinine concentrations. A significant positive correlation was found in both the complicated and normal pregnancies between plasma vitamin E concentration and gestational week of blood collection (R = 0.485, p < 0.001, and R = 0.718, p = 0.004, respectively). We conclude that the vitamin E concentrations are not decreased prior to the development of preeclampsia or other complications in women at risk.

Adult↗

PubMed2002

Maternal adjustment and infant outcome in medically defined high-risk pregnancy.

Biological and psychosocial risk factors in high-risk pregnancy and their relation to infant developmental outcomes were explored in a sample of 153 pregnant Israeli women who had pregestational diabetes mellitus, gestational diabetes mellitus, or were nondiabetic. Questionnaires on coping and resources as well as well-being and distress during the 2nd trimester were administered. Estimates of maternal fuels (HbAlc and fructosamine) were obtained throughout pregnancy. At 1 year, offspring were administered the Bayley Scales of Infant Development and mother-infant interactions were observed. Infants of mothers in the diabetic groups scored lower on the Bayley Scales and revealed fewer positive and more negative behaviors than did infants of mothers in the nondiabetic group. Infant outcomes in the maternal diabetic groups were associated with maternal metabolism. Maternal coping and resources differed in the 3 groups and differentially predicted infant development.

Adaptation, Psychological↗

PubMed2002

[New developments in labor induction].

INTRODUCTION: Misoprostol is a prostaglandin E1 analogue. During the last 8 years it has been examined in clinical trials in obstetrics for the induction of labor and cervical ripening. AIM: To review the current literature concerning its efficacy, safety and dosage for induction of labor. MATERIALS AND METHODS: This review is based on the results of 33 articles published during the years 1993-2001. Data was gathered by searching the internet at Pubmed, Medline and the list of references in the relevant articles. RESULTS: Misoprostol is a highly effective medication for the induction of labor in comparison to prostaglandin E1 or oxytocin. It is stable for years and the cost of treatment is low. Its disadvantage is based on its tendency to evoke increased uterine activity such as tachysystole and hyperstimulation and the fear of uterine rupture. These disadvantages can be overcome by safety measures such as decreasing the dose, increasing time intervals between doses and careful selection of patients. CONCLUSIONS: Misoprostol is an important and efficient medication in obstetrics for cervical ripening and induction of labor. Therefore, we believe it is appropriate to start clinical trials in Israel too.

Female↗