Exposure to fifth disease in pregnancy.

QUESTION: One of my pregnant patients came for a routine prenatal visit at 20 weeks' gestation. Near the end of the consultation, she asked me about "slapped cheek" disease and pregnancy, as her son had been diagnosed with fifth disease the previous week. What is the current guideline for pregnant women exposed to parvovirus B19? ANSWER: The rate of vertical transmission during maternal parvovirus B19 infection is estimated at 33%, with fetal complications occurring in 3% of infected women. Fetal complications comprising hemolysis, anemia, and nonimmune hydrops fetalis and fetal loss are more frequent when maternal infection occurs before 20 weeks of gestation. The first step in the management of this patient would be to obtain immunoglobulin (Ig) M and IgG titres against parvovirus to evaluate if the patient has had previous immunity against the disease. If results are negative for IgG but positive for IgM (ie, primary infection), this patient would need close obstetrical monitoring for the following weeks, including serial ultrasounds to rule out fetal anemia and hydrops fetalis.

Both parental psychopathology and prenatal maternal alcohol dependency can predict the behavioral phenotype in children.

OBJECTIVE: To identify whether a child's behavior phenotype can be predicted by parental psychopathology and/or prenatal maternal alcohol dependency by using the Child Behavior List (CBCL) as a screening tool. METHODS: A retrospective cohort of four non-exclusive groups of children (aged 8-15 years) was studied: (i) children exposed to alcohol in utero (n = 25); (ii) children not exposed to alcohol in utero (n = 46); (iii) children exposed to parental psychopathology (n = 37); (iv) children not exposed to parental psychopathology (n = 34). To distinguish between the effects of alcohol and parental psychopathology, the children were further subdivided into groups with alcohol exposure in utero and parental psychopathology (n = 23), and psychopathology without alchohol exposure (n = 14). Each child was assessed with the CBCL. Subscale scores and selected subscale items were compared between the groups using t-tests and regression analysis. RESULTS: Children exposed to alcohol in utero scored significantly lower than unexposed children on school competency (p = 0.015). They were more likely to attend special classes (p = 0.048), repeat a grade (p = 0.011), and display more disobedience (p = 0.039) and vandalism (p = 0.033). For special classes and disobedience at school, gender proved to be a significant predictor, while maternal alcohol dependency was a significant predictor of vandalism and repeated grades. Children with parental psychopathology differed from children without parental psychopathology in the anxious/depressed (p = 0.04), social problems (p = 0.004), and attention problems (p = 0.04) subscales. The subscale items that were significantly different between the groups were nervousness (p = 0.002), self-consciousness (p = 0.019), feelings of worthlessness (p = 0.041), loneliness (p = 0.005), and difficulty with concentration (p = 0.02). Parental psychopathology was a significant predictor of all five items. Age and gender, however, were significant predictors only of difficulty with concentration. No significant differences were found when the groups with alcohol exposure in utero and parental psychopathology, and psychopathology without alcohol exposure were compared. In summary, parental psychopathology was a significant predictor of a child's internalizing behavior, as well as social problems, whereas alcohol exposure was more predictive of externalizing behaviour. CONCLUSION: Parental psychopathology and prenatal exposure to maternal alcohol can contribute to the child's behavioral phenotype as measured by the CBCL. Therefore, the CBCL can be used to screen for such behaviors.

Hemorrhoids in pregnancy.

QUESTION: One of my patients is in the third trimester of her first pregnancy. She has recently experienced spotting during her bowel movements. She has hemorrhoids. What medications are safe? ANSWER: The treatment is mainly symptomatic for most patients. Most forms of the condition can be treated by increasing fibre content in the diet, administering stool softeners, increasing liquid intake, and training in toilet habits. Although none of the topical antihemorrhoidal agents commonly used have been assessed for safety in pregnancy, it is unlikely that the constituent parts (anesthetic, corticosteroids, and anti-inflammatory agents) will harm the third-trimester infant. In most women, most symptoms of the condition will resolve spontaneously soon after giving birth.

Fetal exposure to isotretinoin-an international problem.

BACKGROUND: Isotretinoin is a known teratogen. Pregnancy prevention programs aimed at minimizing isotretinoin exposure in pregnancy have been implemented in North America with limited success. OBJECTIVE: To compare the management of fetal risk of isotretinoin in three countries, including information given to women, implementation of contraceptive methods, and pregnancy outcomes. METHODS: Pregnant women exposed to isotretinoin who called teratogen information services (TIS) in Israel, Italy and Canada between July 1998 and October 2006 were interviewed at the time of initial consultation and after the expected day of delivery. RESULTS: Fifty-three pregnant women exposed to isotretinoin contacted the TIS. Only 41% reported using a birth control method. Just one patient reported using two different forms. Forty-five percent of exposed pregnancies were terminated before delivery and 22% delivered healthy babies. Two babies were born with malformations. CONCLUSIONS: Since isotretinoin-exposed pregnancies still occur, there is a need for more effective strategies, which should take into account the cultural differences.