Irresponsible and responsible resource management in obstetrics

Arabin, Birgit

doi:10.1016/j.bpobgyn.2016.12.009

Cited by 6 publications

(2 citation statements)

References 110 publications

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“…The future MFM specialist will be less invasive, give less medicine but will interest patients in the cause and prevention of disease as Thomas Edison stated (151). We have to reduce health illiteracy, the misbalance between responsible and irresponsible resource management and thereby the burden of increasing rates of chronic diseases (211). …”

Section: Discussionmentioning

confidence: 99%

Pregnancy: An Underutilized Window of Opportunity to Improve Long-term Maternal and Infant Health—An Appeal for Continuous Family Care and Interdisciplinary Communication

2017

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Physiologic adaptations during pregnancy unmask a woman’s predisposition to diseases. Complications are increasingly predicted by first-trimester algorithms, amplify a pre-existing maternal phenotype and accelerate risks for chronic diseases in the offspring up to adulthood (Barker hypothesis). Recent evidence suggests that vice versa, pregnancy diseases also indicate maternal and even grandparent’s risks for chronic diseases (reverse Barker hypothesis). Pub-Med and Embase were reviewed for Mesh terms “fetal programming” and “pregnancy complications combined with maternal disease” until January 2017. Studies linking pregnancy complications to future cardiovascular, metabolic, and thrombotic risks for mother and offspring were reviewed. Women with a history of miscarriage, fetal growth restriction, preeclampsia, preterm delivery, obesity, excessive gestational weight gain, gestational diabetes, subfertility, and thrombophilia more frequently demonstrate with echocardiographic abnormalities, higher fasting insulin, deviating lipids or clotting factors and show defective endothelial function. Thrombophilia hints to thrombotic risks in later life. Pregnancy abnormalities correlate with future cardiovascular and metabolic complications and earlier mortality. Conversely, women with a normal pregnancy have lower rates of subsequent diseases than the general female population creating the term: “Pregnancy as a window for future health.” Although the placenta works as a gatekeeper, many pregnancy complications may lead to sickness and earlier death in later life when the child becomes an adult. The epigenetic mechanisms and the mismatch between pre- and postnatal life have created the term “fetal origin of adult disease.” Up to now, the impact of cardiovascular, metabolic, or thrombotic risk profiles has been investigated separately for mother and child. In this manuscript, we strive to illustrate the consequences for both, fetus and mother within a cohesive perspective and thus try to demonstrate the complex interrelationship of genetics and epigenetics for long-term health of societies and future generations. Maternal–fetal medicine specialists should have a key role in the prevention of non-communicable diseases by implementing a framework for patient consultation and interdisciplinary networks. Health-care providers and policy makers should increasingly invest in a stratified primary prevention and follow-up to reduce the increasing number of manifest cardiovascular and metabolic diseases and to prevent waste of health-care resources.

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Section: Discussionmentioning

confidence: 99%

Pregnancy: An Underutilized Window of Opportunity to Improve Long-term Maternal and Infant Health—An Appeal for Continuous Family Care and Interdisciplinary Communication

2017

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“…They can improve the understanding of statistical data and of benefits and harms. Although we already suggested the use of fact boxes, albeit not in combination with icon arrays 84 85 , unfortunately, these tools have not yet been integrated into maternal-fetal medicine. Fact boxes and icon arrays could supplement the state-of-the-art within guidelines for parents who must make decisions for or against screening tools, invasive procedures, medical treatments or the place of birth and support women in their decisions not biased by false incentives 86 .…”

Section: Discussionmentioning

confidence: 99%

Systematic Reviews on the Prevention of Adverse Pregnancy Outcomes Related to Maternal Obesity to Improve Evidence-Based Counselling

Behnam,

Arabin

2024

Geburtshilfe Frauenheilkd

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Health professionals and their patients should understand the importance of evidence. In the case of gestational diabetes mellitus, which is often associated with an abnormally high body mass index, the immediate and long-term outcome of women and their offspring depends in part on advice and implementation of lifestyle changes before, during and after pregnancy.Up to September 2023, MEDLINE, CENTRAL, and WEB OF SCIENCE were used to identify systematic reviews and meta-analyses on the prevention of gestational diabetes. The ROBIS and AMSTAR criteria were analyzed for all systematic reviews.A total of 36 systematic reviews were identified. Dietary interventions, physical activity or a combined approach all reduced adverse pregnancy outcomes such as gestational diabetes, pregnancy-induced hypertension and related morbidities. Within the randomized controlled trials included in the 36 systematic reviews, the type, intensity and frequency of interventions varied widely. The primary outcomes, reporting and methodological quality of the 36 systematic reviews and meta-analyses also varied.The meta-analysis with the highest ROBIS and AMSTAR-2 scores was selected to design an icon array based on a fact box simulating 100 patients.We propose a methodology for selecting the best evidence and transforming it into a format that illustrates the benefits and harms in a way that can be understood by lay patients, even if they cannot read. This model can be applied to counselling for expectant mothers in low and high-income countries, regardless of socioeconomic status, provided that women have access to appropriately trained healthcare providers.

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