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  1. Article ; Online: The impact of maternal-fetal omalizumab transfer on peanut-specific responses in an ex vivo placental perfusion model.

    Kothari, Akash / Hirschmugl, Birgit / Lee, Jean-Soo / Pfaller, Birgit / Schmidthaler, Klara / Szépfalusi, Zsolt / Wadsack, Christian / Eiwegger, Thomas

    Allergy

    2022  Volume 77, Issue 12, Page(s) 3684–3686

    MeSH term(s) Female ; Humans ; Pregnancy ; Omalizumab/therapeutic use ; Arachis ; Placenta ; Peanut Hypersensitivity ; Perfusion ; Maternal-Fetal Exchange
    Chemical Substances Omalizumab (2P471X1Z11)
    Language English
    Publishing date 2022-08-14
    Publishing country Denmark
    Document type Letter ; Research Support, Non-U.S. Gov't
    ZDB-ID 391933-x
    ISSN 1398-9995 ; 0105-4538
    ISSN (online) 1398-9995
    ISSN 0105-4538
    DOI 10.1111/all.15468
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  2. Article ; Online: Management of allergic diseases in pregnancy.

    Pfaller, Birgit / Bendien, Sarah / Ditisheim, Agnès / Eiwegger, Thomas

    Allergy

    2021  Volume 77, Issue 3, Page(s) 798–811

    Abstract: Allergic diseases like asthma, allergic rhinitis, food allergy, hymenoptera allergy, or atopic dermatitis are highly prevalent in women of childbearing age and may affect up to 30% of this age group. This review focuses on the management of allergic ... ...

    Abstract Allergic diseases like asthma, allergic rhinitis, food allergy, hymenoptera allergy, or atopic dermatitis are highly prevalent in women of childbearing age and may affect up to 30% of this age group. This review focuses on the management of allergic diseases during pregnancy. Furthermore, we discuss the challenges of counseling women with allergic diseases in the reproductive age, including considerations relevant to the ongoing SARS-CoV-2 pandemic. To create the optimal milieu for the unborn child, a multitude of immunological changes occur during pregnancy which may favor type 2 responses and aggravate disease phenotypes. In co-occurrence with suboptimal preconception disease control, this elevated Th2 responses may aggravate allergic disease manifestations during pregnancy and pose a risk for mother and child. Due to limitations in conducting clinical trials in pregnant women, safety data on anti-allergic drugs during pregnancy are limited. The lack of information and concerns among pregnant patients demands counseling on the benefits of anti-allergic drugs and the potential and known risks. This includes information on the risk for mother and child of disease aggravation in the absence of treatment. By doing so, informed decisions and shared decision-making can take place.
    MeSH term(s) COVID-19 ; Dermatitis, Atopic ; Female ; Food Hypersensitivity ; Humans ; Pregnancy ; Rhinitis, Allergic ; SARS-CoV-2
    Language English
    Publishing date 2021-09-04
    Publishing country Denmark
    Document type Journal Article ; Review
    ZDB-ID 391933-x
    ISSN 1398-9995 ; 0105-4538
    ISSN (online) 1398-9995
    ISSN 0105-4538
    DOI 10.1111/all.15063
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  3. Article ; Online: Knowledge and care regarding long-term cardiovascular risk after hypertensive disorders of pregnancy and gestational diabetes.

    Pfaller, Birgit / Busvine, Constance / Rosenauer, Alena / Schenzel, Andreas / Fournier, Camille / Aringer, Ida / Lösch, Alexander / Wiesholzer, Martin / Schubert, Susanne / Wichert-Schmitt, Barbara

    Wiener klinische Wochenschrift

    2024  Volume 136, Issue 3-4, Page(s) 110–117

    Abstract: Background: Adverse pregnancy outcomes (APO), such as preeclampsia (PE) and gestational diabetes (GDM) are substantial risk factors for cardiovascular disease (CVD) later in life. Identifying these high-risk female individuals during pregnancy offers ... ...

    Abstract Background: Adverse pregnancy outcomes (APO), such as preeclampsia (PE) and gestational diabetes (GDM) are substantial risk factors for cardiovascular disease (CVD) later in life. Identifying these high-risk female individuals during pregnancy offers the possibility of preventing long-term CVD and chronic kidney disease via a structured therapeutic and surveillance plan. We aimed to evaluate the current practice of postpartum care in women after APO and the impact on the women's awareness about their future risk for CVD.
    Methods: Women diagnosed with PE and GDM at the University Hospital of St. Poelten/Lilienfeld between 2015-2020 were identified and participated in a structured telephone interview about postpartum medical care and knowledge about the impact of APOs on long-term cardiovascular health.
    Results: Of 161 out of the 750 women contacted, 29% (n = 46) were diagnosed with PE and 71% (n = 115) with GDM. One third of all women and up to 44% of women diagnosed with PE, were unaware that APOs are related to CVD. Women diagnosed with PE were less likely to receive postpartum care information than those with GDM (30.4% vs. 49.6%, p = 0.027), and only one third of all women after APOs were counselled by a physician or healthcare professional. Of the women 50% received recommendations regarding lifestyle changes after delivery; significantly more women with GDM than women with PE (54% vs. 37%, p = 0.05). Only 14% had at least one long-term follow-up.
    Conclusion: This study identified a significant deficit of structured postpartum care and a lack of awareness among women after APO and their healthcare providers about the increased risk of long-term CVD.
    MeSH term(s) Pregnancy ; Female ; Humans ; Diabetes, Gestational/diagnosis ; Diabetes, Gestational/epidemiology ; Diabetes, Gestational/therapy ; Cardiovascular Diseases/diagnosis ; Cardiovascular Diseases/epidemiology ; Hypertension, Pregnancy-Induced/diagnosis ; Hypertension, Pregnancy-Induced/epidemiology ; Hypertension, Pregnancy-Induced/therapy ; Risk Factors ; Pre-Eclampsia ; Heart Disease Risk Factors
    Language English
    Publishing date 2024-01-03
    Publishing country Austria
    Document type Journal Article
    ZDB-ID 200462-8
    ISSN 1613-7671 ; 0043-5325 ; 0300-5178
    ISSN (online) 1613-7671
    ISSN 0043-5325 ; 0300-5178
    DOI 10.1007/s00508-023-02313-1
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  4. Article ; Online: Cardiovascular Deaths in Pregnancy: Growing Concerns and Preventive Strategies.

    Keepanasseril, Anish / Pfaller, Birgit / Metcalfe, Amy / Siu, Samuel C / Davis, Melinda B / Silversides, Candice K

    The Canadian journal of cardiology

    2021  Volume 37, Issue 12, Page(s) 1969–1978

    Abstract: There has been an increase in maternal deaths from cardiovascular disease in many countries. In high-income countries, cardiovascular deaths secondary to cardiomyopathies, ischemic heart disease, sudden arrhythmic deaths, aortic dissection, and valve ... ...

    Abstract There has been an increase in maternal deaths from cardiovascular disease in many countries. In high-income countries, cardiovascular deaths secondary to cardiomyopathies, ischemic heart disease, sudden arrhythmic deaths, aortic dissection, and valve disease are responsible for up to one-third of all pregnancy-related maternal deaths. In low- and middle-income countries, rheumatic heart disease is a much more common cause of cardiac death during pregnancy. Although deaths occur in women with known heart conditions or cardiovascular risk factors such as hypertension, many women present for the first time in pregnancy with unrecognised heart disease or with de novo cardiovascular conditions such as preeclampsia, peripartum cardiomyopathy, spontaneous coronary artery dissection. Not only has maternal cardiovascular mortality increased, but serious cardiac morbidity, or "near misses," during pregnancy also have increased in frequency. Although maternal morbidity and mortality are often preventable, many health professionals remain unaware of the impact of cardiovascular disease in this population, and the lack of awareness contributes to inappropriate care and preventable deaths. In this review, we discuss the maternal mortality from cardiovascular causes in both high- and low- and middle-income countries and strategies to improve outcomes.
    MeSH term(s) Cause of Death/trends ; Female ; Global Health ; Guidelines as Topic ; Humans ; Maternal Death/etiology ; Maternal Death/prevention & control ; Maternal Mortality/trends ; Morbidity/trends ; Pregnancy ; Pregnancy Complications, Cardiovascular/epidemiology ; Prevalence ; Preventive Medicine/standards ; Risk Factors
    Language English
    Publishing date 2021-09-29
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 632813-1
    ISSN 1916-7075 ; 0828-282X
    ISSN (online) 1916-7075
    ISSN 0828-282X
    DOI 10.1016/j.cjca.2021.09.022
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  5. Article: Pregnancy in a woman with a chronic descending thoracic aortic dissection.

    Nair, Govind Krishna Kumar / Bhagra, Catriona / Sermer, Mathew / Silversides, Candice K / Pfaller, Birgit

    Obstetric medicine

    2020  Volume 14, Issue 2, Page(s) 102–104

    Abstract: Pregnancy increases aortic wall stress and, for a woman with a chronic dissection, this can lead to extension of the dissection, aortic rupture, and death. We report a pregnancy in a woman with a history of a chronic type B aortic dissection. As a child, ...

    Abstract Pregnancy increases aortic wall stress and, for a woman with a chronic dissection, this can lead to extension of the dissection, aortic rupture, and death. We report a pregnancy in a woman with a history of a chronic type B aortic dissection. As a child, she had repeat balloon dilation of aortic coarctation, and one of the procedures was complicated by an iatrogenic dissection at the dilation site. At the age of 27 years, she had a planned pregnancy.
    Language English
    Publishing date 2020-02-04
    Publishing country England
    Document type Case Reports
    ZDB-ID 2612229-7
    ISSN 1753-4968 ; 1753-495X
    ISSN (online) 1753-4968
    ISSN 1753-495X
    DOI 10.1177/1753495X19900410
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  6. Article: Tachycardia-induced cardiomyopathy in three consecutive pregnancies.

    Pfaller, Birgit / Wichert-Schmitt, B / Spears, Danna / D'Souza, Rohan / Silversides, Candice K

    Obstetric medicine

    2020  Volume 14, Issue 4, Page(s) 269–271

    Abstract: Tachycardia-induced cardiomyopathy is rare during pregnancy and is reversible when the underlying arrhythmia is effectively treated. Management can be complex due to the risks of antiarrhythmic medications and cardiac interventions on the developing ... ...

    Abstract Tachycardia-induced cardiomyopathy is rare during pregnancy and is reversible when the underlying arrhythmia is effectively treated. Management can be complex due to the risks of antiarrhythmic medications and cardiac interventions on the developing fetus. The care requires a well-coordinated multidisciplinary team of cardiologists, electrophysiologists, and maternal-fetal specialists. In this report, we describe a case of recurrent atrial tachycardia-induced cardiomyopathy in pregnancy.
    Language English
    Publishing date 2020-10-06
    Publishing country England
    Document type Case Reports
    ZDB-ID 2612229-7
    ISSN 1753-4968 ; 1753-495X
    ISSN (online) 1753-4968
    ISSN 1753-495X
    DOI 10.1177/1753495X20958853
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  7. Article ; Online: A critical review of the reproductive safety of Leflunomide.

    Pfaller, Birgit / Pupco, Anna / Leibson, Tom / Aletaha, Daniel / Ito, Shinya

    Clinical rheumatology

    2019  Volume 39, Issue 2, Page(s) 607–612

    Abstract: Leflunomide, an inhibitor of pyrimidine synthesis, is used for the treatment of rheumatic diseases, which are prevalent in women of childbearing age. Due to the very long half-life of the active metabolite, its mechanism of action and the teratogenicity ... ...

    Abstract Leflunomide, an inhibitor of pyrimidine synthesis, is used for the treatment of rheumatic diseases, which are prevalent in women of childbearing age. Due to the very long half-life of the active metabolite, its mechanism of action and the teratogenicity observed in animal studies at doses similar to or lower than human therapeutic doses on a weight basis, it is recommended that women stop the treatment before conception and a drug elimination procedure be performed. However, unintended gestational exposures may occur, posing challenges in risk assessment. In order to address the safety of leflunomide in unintended exposures in pregnancy, we performed a critical review of human studies. We located 13 publications in Medline and Embase, which reported on 222 pregnancies with known outcomes exposed to leflunomide preconception and/or during pregnancy. Among the 169 live births, there were eight congenital malformations with no consistent pattern of anomalies. These studies collectively showed no significant difference in the rates of malformations between exposed and unexposed pregnancies. At present, accumulating human data do not point toward leflunomide as a potent human teratogen, which may inform risk assessment of unintended gestational exposure to leflunomide.
    MeSH term(s) Abnormalities, Drug-Induced ; Animals ; Female ; Humans ; Immunosuppressive Agents/adverse effects ; Leflunomide/adverse effects ; Pregnancy ; Teratogens
    Chemical Substances Immunosuppressive Agents ; Teratogens ; Leflunomide (G162GK9U4W)
    Language English
    Publishing date 2019-11-22
    Publishing country Germany
    Document type Journal Article ; Review
    ZDB-ID 604755-5
    ISSN 1434-9949 ; 0770-3198
    ISSN (online) 1434-9949
    ISSN 0770-3198
    DOI 10.1007/s10067-019-04819-4
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  8. Article ; Online: The risk of venous thromboembolism in women with inflammatory bowel disease during pregnancy and the postpartum period: A systematic review and meta-analysis.

    Kim, Yeon Hee / Pfaller, Birgit / Marson, Alanna / Yim, Hyeon Woo / Huang, Vivian / Ito, Shinya

    Medicine

    2019  Volume 98, Issue 38, Page(s) e17309

    Abstract: Pregnancy and inflammatory bowel disease (IBD) are independent risk factors for venous thromboembolism (VTE). Nevertheless, the optimal VTE prevention strategy for women with IBD in pregnancy and postpartum period has not been established yet. We ... ...

    Abstract Pregnancy and inflammatory bowel disease (IBD) are independent risk factors for venous thromboembolism (VTE). Nevertheless, the optimal VTE prevention strategy for women with IBD in pregnancy and postpartum period has not been established yet. We assessed VTE risks during pregnancy and the postpartum period in women with IBD through systematic review and meta-analysis.Systematic searches were conducted in MEDLINE (Ovid), Embase (Ovid), CENTRAL (Ovid), and Web of Science (Tomson Reuters) from the database inception till May 2017 to identify relevant studies reporting the risk of VTE during pregnancy and/or the postpartum period in women with IBD. Random effect meta-analyses were performed to compare VTE-related outcomes between women with IBD and without IBD. Our protocol was registered: CRD 42017060199 in the PROSPERO International prospective register of systematic reviews.In the analysis of 5 studies reviewed, IBD population (n = 17,636) had a significantly increased risk of VTE during pregnancy (pooled risk ratio (RR) 2.13, 95% confidence interval (CI) 1.66-2.73) and postpartum (RR 2.61, 95% CI 1.84-3.69), comparing to the non-IBD population (n = 11,251,778). According to the location of VTE, the risk of deep vein thrombosis increased significantly by RR of 2.74 (95% CI 1.73-4.36) during pregnancy, whilst risk increase of pulmonary embolism was not statistically significant. In the subgroup analysis, the degree of VTE risk was higher in both periods in the UC group than in the CD group, as compared to that in the non-IBD population (UC group, during pregnancy: RR 2.24, 95% CI 1.6-3.11; postpartum period: RR 2.85, 95% CI 1.79-4.52).Significantly increased risks of VTE during pregnancy were found in the women with IBD, according to the periods and type of IBD, which might support a detailed strategy regarding administration of prophylactic anticoagulants to women with IBD.
    MeSH term(s) Female ; Humans ; Inflammatory Bowel Diseases/complications ; Postpartum Period ; Pregnancy ; Pregnancy Complications/epidemiology ; Risk Factors ; Venous Thromboembolism/etiology
    Language English
    Publishing date 2019-09-30
    Publishing country United States
    Document type Journal Article ; Meta-Analysis ; Systematic Review
    ZDB-ID 80184-7
    ISSN 1536-5964 ; 0025-7974
    ISSN (online) 1536-5964
    ISSN 0025-7974
    DOI 10.1097/MD.0000000000017309
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  9. Article ; Online: Outcomes of Pregnancy in Women With Bioprosthetic Heart Valves With or Without Valve Dysfunction.

    Wichert-Schmitt, Barbara / Grewal, Jasmine / Malinowski, A Kinga / Pfaller, Birgit / Losenno, Katie L / Kiess, Marla C / Colman, Jack M / Tsang, Wendy / Mason, Jennifer / Siu, Samuel C / Silversides, Candice K

    Journal of the American College of Cardiology

    2022  Volume 80, Issue 21, Page(s) 2014–2024

    Abstract: Background: Although pregnancy outcomes in women with normally functioning bioprosthetic valves (BPVs) are often good, structural valve dysfunction (SVD) may adversely affect pregnancy outcomes, but this has not been studied.: Objectives: The aim of ... ...

    Abstract Background: Although pregnancy outcomes in women with normally functioning bioprosthetic valves (BPVs) are often good, structural valve dysfunction (SVD) may adversely affect pregnancy outcomes, but this has not been studied.
    Objectives: The aim of this study was to examine outcomes in pregnant women with BPVs and the association with SVD.
    Methods: Pregnancy outcomes in women with BPVs were prospectively collected. Adverse maternal cardiac events (CEs) included cardiac death or arrest, sustained arrhythmia, heart failure, thromboembolism, and stroke. Adverse fetal events were also studied. Determinants of adverse events were examined using logistic regression.
    Results: Overall, 125 pregnancies in women with BPVs were included, 27% with left-sided and 73% with right-sided BPV. SVD was present in 27% of the pregnancies (44% with left-sided BPVs vs 21% with right-sided BPVs; P = 0.009). CEs occurred in 13% of pregnancies and were more frequent in women with SVD compared with those with normally functioning BPVs (26% vs 8%; P = 0.005). CEs were more common in women with left-sided BPVs with SVD vs normally functioning BPVs (47% vs 5%; P = 0.01) but not in women with right-sided BPVs (11% in those with SVD vs 8% in those without SVD; P = 0.67). Left-sided SVD (P = 0.007), maternal age >35 years (P = 0.001), and a composite variable of "high-risk" features (P = 0.006) were predictors of CEs. Fetal events occurred in 28% of pregnancies.
    Conclusions: In this cohort of young women with BPVs, SVD was present in 27% at the first antenatal visit and negatively affected pregnancy outcomes. In particular, SVD of left-sided BPVs was associated with high rates of adverse outcomes.
    MeSH term(s) Female ; Pregnancy ; Humans ; Adult ; Pregnancy Complications, Cardiovascular/epidemiology ; Pregnancy Outcome/epidemiology ; Heart Valve Prosthesis/adverse effects ; Mitral Valve ; Thromboembolism
    Language English
    Publishing date 2022-11-15
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 605507-2
    ISSN 1558-3597 ; 0735-1097
    ISSN (online) 1558-3597
    ISSN 0735-1097
    DOI 10.1016/j.jacc.2022.09.019
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  10. Article ; Online: Preventing Complications in Pregnant Women With Cardiac Disease.

    Pfaller, Birgit / Sathananthan, Gnalini / Grewal, Jasmine / Mason, Jennifer / D'Souza, Rohan / Spears, Danna / Kiess, Marla / Siu, Samuel C / Silversides, Candice K

    Journal of the American College of Cardiology

    2020  Volume 75, Issue 12, Page(s) 1443–1452

    Abstract: Background: Pregnancy can lead to complications in women with heart disease, and these complications can be life threatening. Understanding serious complications and how they can be prevented is important.: Objectives: The primary objectives were to ... ...

    Abstract Background: Pregnancy can lead to complications in women with heart disease, and these complications can be life threatening. Understanding serious complications and how they can be prevented is important.
    Objectives: The primary objectives were to determine the incidence of serious cardiac events (SCEs) in pregnant women with heart disease, whether they were preventable, and their impact on fetal and neonatal outcomes. Serious obstetric events were also examined.
    Methods: A prospectively assembled cohort of 1,315 pregnancies in women with heart disease was studied. SCEs included cardiac death or arrest, ventricular arrhythmias, congestive heart failure or arrhythmias requiring admission to an intensive care unit, myocardial infarction, stroke, aortic dissection, valve thrombosis, endocarditis, and urgent cardiac intervention. The Harvard Medical Study criteria were used to adjudicate preventability.
    Results: Overall, 3.6% of pregnancies (47 of 1,315) were complicated by SCEs. The most frequent SCEs were cardiac death or arrest, heart failure, arrhythmias, and urgent interventions. Most SCEs (66%) occurred in the antepartum period. Almost one-half of SCEs (49%) were preventable; the majority of preventable SCEs (74%) were secondary to provider management factors. Adverse fetal and neonatal events were more common in pregnancies with SCEs compared with those without cardiac events (62% vs. 29%; p < 0.001). Serious obstetric events were less common (1.7%) and were primarily due to pre-eclampsia with severe features.
    Conclusions: Pregnant women with heart disease are at risk for serious cardiac complications, and approximately one-half of all SCEs are preventable. Strategies to prevent serious cardiac complications in this high-risk cohort of women need to be developed.
    MeSH term(s) Adult ; Cohort Studies ; Female ; Humans ; Pre-Eclampsia/diagnosis ; Pre-Eclampsia/epidemiology ; Pre-Eclampsia/prevention & control ; Pregnancy ; Pregnancy Complications, Cardiovascular/diagnosis ; Pregnancy Complications, Cardiovascular/epidemiology ; Pregnancy Complications, Cardiovascular/prevention & control ; Pregnancy Outcome/epidemiology ; Pregnant Women ; Prospective Studies ; Retrospective Studies ; Risk Factors
    Language English
    Publishing date 2020-03-27
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 605507-2
    ISSN 1558-3597 ; 0735-1097
    ISSN (online) 1558-3597
    ISSN 0735-1097
    DOI 10.1016/j.jacc.2020.01.039
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