preconception consultation
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We estimate the seroprevalence of IgG antibodies to varicella zoster virus (VZV) based on the first serological study in a cohort of pregnant women and newborns from the Aburrá Valley (Antioquia-Colombia) who attended delivery in eight randomly chosen hospitals. An indirect enzyme immunoassay was used to determine anti-VZV IgG antibodies. Generalized linear models were constructed to identify variables that modify seropositivity. In pregnant women, seropositivity was 85.8% (95% CI: 83.4–85.9), seronegativity was 12.6% (95% CI: 10.8–14.6), and concordance with umbilical cord titers was 90.0% (95% CI: 89–91). The seropositivity of pregnant women was lower in those who lived in rural areas (IRR: 0.4, 95% CI: 0.2–0.7), belonged to the high socioeconomic status (IRR: 0.4, 95% CI: 0.2–0.7), and had studied 11 years or more (IRR: 0.6, 95% CI: 0.4–0.8). Among newborns, seropositivity was lower in those who weighed less than 3000 g (IRR: 0.8, 95% CI: 0.6–1.0). The high seropositivity and seronegativity pattern indicates the urgent need to design preconception consultation and vaccination reinforcement for women of childbearing age according to their sociodemographic conditions, to prevent infection and complications in the mother and newborn.

Cervical insufficiency (CI) is classically characterized as painless dilation of the uterine cervix in the second trimester that results in delivery of the pregnancy, typically prior to 24 weeks’ gestation. Treatment of the condition has centered on prevention of recurrence in women with a history of CI or early preterm birth. Universal screening tools for CI in women without a history of prior PTB are lacking. Cervical change that is painless may occur with minimal symptoms such as increasing of vaginal discharge/mucous, vaginal pressure or fullness; many women and their providers can dismiss pathologic symptoms that would otherwise be benign in women without CI. The management of CI is categorized as surgical vs. nonsurgical. The cornerstone of surgical management is composed of cervical cerclage, and may be placed by a transvaginal or transabdominal approach depending on the obstetric history. Nonsurgical management includes pessary or activity restriction. For women who have experienced a midtrimester loss due to suspected cervical insufficiency, postnatal or preconception consultation is essential to identify modifiable risk factors, collect medical records of the delivery, and review pathology results if available.

Background:Cost of the complications that may appear during reproductive age in women living with inflammatory immune-mediated diseases have scarcely been studied.Objectives:To obtain an expert consensus in the use of resources associated to complications of women in reproductive age living with immune-mediated diseases: psoriasis (PSO), psoriatic arthritis (PsA), rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA) and estimate an economic impact.Methods:A cost-analysis was developed to estimate the impact associated with the complications of women of reproductive age with PSO, PsA, RA and axSpA.The analysis considered the complications during fertility and conception (preconception consultation and assisted reproduction), in pregnancy (miscarriage in the first trimester, late abortion in the second trimester, preeclampsia, delayed or restricted intrauterine growth and threat of premature delivery) and in the postpartum (admissions in neonatology of premature infants).An online questionnaire was designed for the validation of the inputs used in the cost-analysis. Subsequently, the questionnaire was sent to a multidisciplinary panel composed of, rheumatologist, gynecologists, neonatologists and dermatologist. A consensus meeting was carried out to validate and agree the parameters used in the analysis.Unitary cost for resources (€,2019) were obtained from national local databases.The perspective of analysis was the National Healthcare System and the time horizon was one year.Results:During fertility and conception, an annual cost per patient of € 229 was estimated for a preconception consultation in a patient with PSO, of € 3,642 for a preconception consultation in patients with PsA, RA and axSpA and € 4,339 for assisted reproduction.Women with complications in pregnancy had an annual cost per patient of € 1,214 for a miscarriage in the first trimester, € 4,419 for a late abortion in the second trimester, € 11,251 for preeclampsia € 3,183 for delayed or restricted intrauterine growth and € 12,122 for the threat of premature delivery.In the postpartum complications, an annual cost per patient of € 120,364, € 44,709 and € 5,507 were estimated associated with admissions in neonatology of premature infants of <28 weeks, from 28 to 32 weeks and from 33 to 37 weeks, respectively.Conclusion:This modeling provides insight on the economic burden of complications associated with women in reproductive age for immune-mediated diseases (PSO, PsA, RA, axSpA). Individualization of treatment, additional and close monitoring may reduce the risk and burden of these complications.Disclosure of Interests:Julia Martínez-Barrio Consultant of: UCB Pharma, Olga Villar Consultant of: UCB Pharma, Oníca Armijo Consultant of: UCB Pharma, María Castellanos Consultant of: UCB Pharma, Natalia Marín Huarte Consultant of: UCB Pharma, María Mareque Consultant of: UCB Pharma, Miguel Angel Casado Consultant of: UCB Pharma, Nuria Martínez Consultant of: UCB Pharma

Aim. The research was conducted for the assessment of the impact of chronic salpingoophoritis on the ovarian reserve of women in various phases of reproductive age.Materials and methods. A prospective, controlled and open cohort study was performed in 2013-2018 (n=202). The main group consisted of women with chronic salpingoophoritis (ChrSO) who applied for preconception consultation (n=138). In accordance with the reproductive age phase, the main group was divided into subgroups: the early reproductive age period (ERP, n=44), the peak reproductive age period (PRP, n=56), the late reproductive period (LRP, n=38). The control group consisted of conditionally healthy women of reproductive age (n=64). The ovarian reserve (OR) was estimated on the basis of the serum level of antimullerian hormone (AMH), inhibin B, estradiol, follicle stimulating hormone (FSH), an ultrasoundbased assessment of the number of antral follicles (AF), and the ovarian volume. Results. The age of women ranged from 18 to 40 years. Based on the discriminant analysis, it was found that the main indicators determining the specificity of the OR in ChrSO, depending on the phase of reproductive age, are the number of antral follicles, estradiol level and AMH (Wilks’ lambda = 0.35503, p<0.0001). The specificity of the OR of women with ChrSO (difference from the control group), regardless of the phase of reproductive age, initially and when evaluated after 6 months, is determined by the number of AF and the level of estradiol and AMH; the number of AF and AMH is determined with a similar estimate after 12 months. The specificity of the OR in ChrSO, which is dependent on the reproductive age phase, has been proved through the analysis with the neural networks training(the proportion of correct answers is more than 80%). The linear relationships were established between the values of each OR parameter in women with ChrSO. Initially, when estimating after 6 and 12 months, linear regression equations were calculated, allowing the values of individual OR parameters to be calculated over 6 and 12 months.Conclusion. Chronic salpingoophoritis (ChrSO) is associated with a decrease in ovarian reserve in women of reproductive age. The effect of ChrSO on some parameters of the ovarian reserve depends on the age phase of the reproductive period, which increases with time (after 6, 12 months). The presence of ChrSO in women planning future pregnancies requires preventive and therapeutic measures aimed at preserving the ovarian reserve and the preferred implementation of fertility in early reproductive age before the ovarian reserve starts to decline.