Study Objectives: To evaluate the effects of pediatric epilepsy on sleep in parents of epileptic children. Methods: Cohort design in which the sleep quality of parents of epileptic children (POEC) and parents of nonepileptic children (PONEC) in the month preceding recruitment were compared using the self-administered Pittsburgh Sleep Quality Index (PSQI). Results: Mothers of epileptic children had a 7-fold occurrence of sleep disturbances when compared to mothers of non-epileptic children (OR = 6.66 CI 95% 1.10-70.08). The sleep characteristics that showed statistically signifi cant differences were: sleep duration, sleep continuity, and selfevaluation of sleep quality (p < 0.05 for all parameters). No signifi cant difference in sleep quality was found between fathers of epileptic children and fathers of nonepileptic children. Conclusions: Sleep disturbances are more common in mothers of epileptic children. The sleep quality of mothers to epileptic children should be considered in their comprehensive management, and if necessary, the sleep disturbance should be addressed. S C I E N T I F I C I N V E S T I g A T I O N SE pilepsy is one of the most common chronic clinical problems in the pediatric population, and appears in approximately 0.5% children. As in other chronic pediatric diseases, epilepsy has an appreciable negative impact on the quality of life in the family in general, and the parents in particular.1,2 Furthermore, epilepsy has unique characteristics that contribute to a prolonged adaptive diffi culty of the parent. This includes unpredictable stressful events, social stigma of the child and family, extended treatment regimen subject to frequent changes, and cognitive disturbances accompanying the disease and treatment. Previous research has shown that even in comparison with other chronic pediatric diseases, parents of children with epilepsy suffer from higher rates of stress, anxiety, and depression, which manifest in signifi cant impairment in social, familial, and personal parental functioning. 3,4 Despite the fact that there has been research investigating the effects on the lives of the parents in chronic pediatric disease in general and pediatric epilepsy in particular, there is insuffi cient data on the effects on the sleep quality of the parents, even though this impairment is liable to be accompanied by negative repercussions.Insomnia, which may be a symptom, a sign, or a primary disturbance, is currently defi ned only as a symptom, in the presence of ≥ 1 of 4 characteristics: diffi culty in falling asleep, involuntary early awakening, diffi culty in remaining continually asleep, and unrefreshing sleep. As a syndrome, sleep diffi culties must occur in association with a complaint of impaired daytime functioning (e.g., diminished vocational functioning) and in the presence of adequate opportunity to sleep.For the purpose of this project we decided to use the ICSD-2 general criteria for insomnia that do not specify a frequency and duration for the insomnia symptoms.5 Studies of the pathophys...
Research CMAJBackground: Spontaneous abortion is the most common complication of pregnancy. Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used during pregnancy. Published data are inconsistent regarding the risk of spontaneous abortion following exposure to NSAIDs. Methods:We performed a historical cohort study involving all women who conceived between January 2003 and December 2009 and who were admitted for delivery or spontaneous abortion at Soroka Medical Center, Clalit Health Services, Israel. A computerized database of medication dispensation was linked with 2 computerized databases containing information on births and spontaneous abortions. We constructed time-varying Cox regression models and adjusted for maternal age, diabetes mellitus, hypothyroidism, obesity, hypercoagulation or inflammatory conditions, recurrent miscarriage, in vitro fertilization of the current pregnancy, intrauterine contraceptive device, ethnic background, tobacco use and year of admission. Results:The cohort included 65 457 women who conceived during the study period; of these, 58 949 (90.1%) were admitted for a birth and 6508 (9.9%) for spontaneous abortion. A total of 4495 (6.9%) pregnant women were exposed to NSAIDs during the study period. Exposure to NSAIDs was not an independent risk factor for spontaneous abortion (nonselective cyclooxygenase [COX] inhibitors: adjusted hazard ratio [HR] 1.10, 95% confidence interval [CI] 0.99-1.22; selective COX-2 inhibitors: adjusted HR 1.43, 95% CI 0.79-2.59). There was no increased risk for specific NSAID drugs, except for a significantly increased risk with exposure to indomethacin (adjusted HR 2.8, 95% CI 1.70-4.69). We found no dose-response effect. Interpretation:We found no increased risk of spontaneous abortion following exposure to NSAIDs. Further research is needed to assess the risk following exposure to selective COX-2 inhibitors. Abstract
Intrauterine exposure to NSAID was not associated with increased risk for major congenital malformations. Further studies are needed to assess the risk for malformations after exposure to COX-2 selective inhibitors.
Introduction Opioids constitute a cornerstone of pain relief treatment. However, opioid safety during pregnancy has not been well established. Recent studies reported an association between in utero opioid exposure and spina bifida. Methods In order to further evaluate the association of opioids exposure during pregnancy with adverse pregnancy outcomes, we conducted a large historical cohort by linking four databases: medications dispensations, births, pregnancy terminations for medical reasons and infant hospitalizations during the years of 1999–2009. Confounders that were controlled for included maternal age, ethnicity, maternal diabetes, smoking status, parity, obesity, year and folic acid intake. A secondary analysis for total major malformations and for spina bifida was performed using propensity score matching for first trimester exposure. Results Of the 101,586 women included in the study, 3003 were dispensed opioids during the first trimester. Intrauterine exposure to opioids was not associated with overall major malformations (adjusted odds ratio (aOR) 0.97, 95% CI 0.83–1.13), cardiovascular malformations (aOR = 0.89, 95% CI 0.70–1.13) other malformations by systems or spina bifida in particular. However, the risk for spina bifida among newborns and abortuses who were exposed to codeine was four times higher than that of the unexposed (aOR = 4.42, 95% CI 1.60–12.23). This association remained significant in a secondary analysis using propensity score matching. Third trimester exposure to opioids was not associated with low birth weight (aOR = 1.08, 95% CI 0.77–1.52), perinatal death (aOR = 1.38, 95% CI 0.64–2.99) and other adverse pregnancy outcomes. Conclusions These findings suggest that opioids exposure (as a homogenous group) is not a significant risk factor for overall major malformations. Exposure to codeine during the first trimester was found to be associated with increased risk of spina bifida. However, this finding was based on a small number of cases and need to be verified in future work.
Exposure to enoxaparin during pregnancy was not associated with an increased risk of major malformations in general or according to organ systems. Nonetheless, risk for specific malformations cannot be ruled out.
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