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2 results on '"Fernanda Ravagni"'

1. Antiretroviral Therapy at Conception in Pregnant Women with HIV in Italy: Wide Range of Variability and Frequent Exposure to Contraindicated Drugs

Author

Floridia, Marco, Tamburrini, Enrica, Ravizza, Marina, Anzidei, Gianfranco, Tibaldi, Cecilia, Bucceri, Anna, Maccabruni, Anna, Guaraldi, Giovanni, Meloni, Alessandra, Probizer, Maria Fernanda Ravagni, Guerra, Brunella, and Martinelli, Pasquale

Abstract

Methods Data from a large national surveillance study was used to describe antiretroviral regimens in pregnant women with HIV, with particular reference to the presence at conception of antiretroviral treatments contraindicated in pregnancy. Therapeutic changes during pregnancy were also analysed.Results Among 334 women on antiretroviral treatment at conception, less than half (42.4%) reported current pregnancy as planned. A large number of different regimens (80) was observed. All the regimens included at least one nucleoside or nucleotide reverse transcriptase inhibitor. Non-nucleoside reverse transcriptase inhibitors and protease inhibitors were present in similar proportions (39.2% and 40.7%, respectively). The most commonly used drugs were lamivudine (83.2% of regimens), zidovudine (50.0%), stavudine (d4T; 38.0%), nevirapine (25.7%), didanosine (ddI; 17.7%) and nelfinavir (17.7%). Treament with efavirenz (13.5% of regimens) and ddI+d4T (9.6%) was markedly frequent. Use of efavirenz at conception was associated with a subsequent treatment change during pregnancy (odds ratio [OR]: 13.2.; 95% confidence interval [CI]: 3.2–53.8, P<0.001). A similar but less strong association was found for ddI (OR: 1.8; 95% CI: 1.03–3.25, P=0.033), whereas being on nevirapine was associated with a lower risk (OR: 0.58; 95% CI: 0.38–0.81, P=0.013).Conclusions Our data show that treatment at conception frequently represents the regimen previously selected for the treatment of the non-pregnant woman. The observed rates of exposure to contraindicated treatment should lead prescribing physicians to consider in HIV-positive women therapeutic choices that take into account the likelihood of an unplanned pregnancy. Such an approach is likely to reduce not only unintended exposures to contraindicated drugs, but also therapeutic changes during pregnancy.

Published
2006
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2. EFFECT OF ACTIVE AND PASSIVE SMOKING ON VASCULAR REACTIVITY IN MOTHERS AND INFANTS

Author

Francesca Severi, Vittorio Danesino, Fernanda Ravagni, Antonella Gasparoni, Gaetano Chirico, Franco Locatelli, and Giorgio Rondini

Subjects
Adult, medicine.medical_specialty, Pregnancy, Passive smoking, business.industry, Birth weight, Smoking, Infant, Newborn, Physiology, General Medicine, Placental insufficiency, medicine.disease_cause, medicine.disease, Tobacco smoke, Surgery, Vasomotor System, Low birth weight, Blood pressure, Humans, Medicine, Female, Tobacco Smoke Pollution, medicine.symptom, business, Reactive hyperemia
Abstract

We have studied the effect of active and passive smoking during pregnancy on post-ischemic vascular reactivity in 40 mother-infant pairs (table). 10 mothers (controls) did not smoke and were not exposed to involuntary smoking; 20 mothers (active smokers) had smoked at least 10 cigarettes/day during pregnancy; and 10 mothers (passive smokers) had been exposed to tobacco smoke from their husbands who smoked more than 10 cigarettes/day. The mothers and the infants were healthy and no complications were recorded during pregnancy delivery or the 1st 5 days after birth. Post-ischemic vascular reactivity was evaluated during the 2nd day after birth. Transcutaneous PO2 (cPO2) was monitored with an Oxymonitor" (Hellige); the skin electrode (Transoxode) was fixed on the forearm and set at 37 degrees Celsius; a pneumatic cuff was applied to the upper arm and inflated to 50 mm Hg above systolic pressure to occlude forearm circulation for 4 minutes. The post-occlusive peak tcPO2 was taken as a measure of post-ischemic reactive hyperemia. This technique has proven useful for evaluating vascular abnormalities in diabetic children. A significant reduction in tcPO2 was found for both the smoking mothers and their infants for mothers indirectly exposed to tobacco smoke and their infants (table). Reactive hyperemia in response to arterial occlusion lasting more than 3 minutes is due to a fall in vessel wall PO2 to O causing direct vascular smooth-muscle relaxation by reduction in oxidative phosphorylation and the local production of vasodilator metabolites such as adenosine histamine or prostaglandins. The reduction in reductive hyperemia in mothers exposed to tobacco smoke and in their infants may therefore be partly related to impairment of prostacyclin production by endothelial cells. The vascular alterations caused by smoke can produce a dysfunction of placental blood flow similar to that observed in the chronic placental insufficiency syndromes; this may explain the reduction of birthweight observed in infants of mothers exposed to active or involuntary tobacco smoking. (full text)

Published
1987

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