צום יום הכיפורים בנשים הרות ובמהלך טיפולי פריון

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Presentation transcript:

צום יום הכיפורים בנשים הרות ובמהלך טיפולי פריון ד"ר אורית ברנהולץ גולצ'ין המרכז הרפואי שערי צדק ירושלים

רקע רפואי

צום וטיפולי פוריות אין כמעט ספרות על צום קצר טווח Hormonal and metabolic adaptation to fasting: effects on the hypothalamic- pituitary-ovarian axis and reproductive performance of rabbit does. Domest Anim Endocrinol. 2006 Aug;31(2):105-22 Rabbit does were either fed ad libitum (control, AL), or fasted for 24 (STF) or 48 h (LTF) before induction of ovulation with GnRH injection. Blood samples were collected during the last 3 h of fasting, and the following 4 h after GnRH injection Before re-feeding, plasma leptin, insulin, and T3 concentrations were lower (P < or = 0.01) in both fasted groups than in controls During fasting, plasma glucose concentrations did not differ among groups, but upon re- feeding they markedly increased (P < or= 0.01) both in STF and LTF does. .Following GnRH injection, LH peak was lower (P < or = 0.01) in LTF than in AL and STF does. Estradiol-17beta showed higher pulse frequency and amplitude in AL than in STF and LTF does. Compared to controls, receptivity rate of STF and LTF artificially inseminated does declined respectively by -20.5% (P < or = 0.05) and -22.7%, and fertility rate by -23.9% (P < or = 0.05) and 21.4%, but no difference was found in ovulation rate. I n summary, nutritional status of does, as modified by fasting, greatly influenced fertility, metabolic and reproductive hormones.

צום וטיפולי פוריות Post-implantation fasting does not induce pregnancy failure in newly inseminated mice. Archunan et al, Acta Physiol Hung. 1994;82(4):377-81 The pre-implantation fasting for 48 h beginning on day 4 or 5 postcoitum induced a high rate of pregnancy failure in newly inseminated females. However, fasting for 48 h on day 6 had a moderate effect in inducing pregnancy failure

צום ופרופיל ביופיזיקלי Ramadan fasting and pregnancy: implications for fetal development in summer season. Sakar et al, J Perinat Med. 2015 May;43(3):319-23. This is a prospective case-control study carried out in the month of Ramadan in 2013 (9 July-7 August). 106 pregnant women, 2nd-3rd trimester At the end of the Ramadan, increase in biparietal diameter, head circumference, and femur length showed a statistically significant difference from initial measurements (P<0.05). When fasting and non-fasting groups were compared separately, an increase in amniotic fluid index was statistically significant in the non-fasting group (P<0.05).

צום ופרופיל ביופיזיקלי The effect of intermittent maternal fasting on human fetal breathing movements. Mirgahni et al, J Obstet Gynaecol. 2004 Sep;24(6):635-7 63 healthy pregnant women with singleton uncomplicated pregnancies of 30 weeks' gestation or more, and who were fasting during Ramadan Maternal blood glucose level and fetal movements were recorded during and after fasting The time needed to detect breathing movements was significantly longer (P = 0.005) during fasting than postprandial.

Conclusion In third trimester uncomplicated pregnancies, short-term fasting of 10–12 h caused a reversible decrease in BPP scores, but not below 8. AFI and Doppler indices of umbilical and fetal middle cerebral arteries were unchanged. Mean uterine artery RI, PI and S/D values were increased.

In conclusion, maternal fasting for 10–12 hours during the third trimester had no effect on uterine, umbilical, and middle cerebral artery Doppler indices. Fasting for this period of time does have a significant, though transient, effect on maternal serum glucose levels. Significant changes in fetal biophysical profile and fetal movement may be attributed to fetal behavioral changes secondary to fasting.

In summary, there was no association of religious fasting (prolongedcessation of food and fluid intake) with fetal parameters such as biometry, Doppler flow parameters, and neonatal outcomes among pregnant women. However, there was a significant association between fasting and decreased AFI, and fasting shortened the interval for oligohydramnios development. Therefore, close prenatal surveillance is warranted for these women

צום ולידות מוקדמות

In conclusion A 25-hour fast such as during the Day of Atonement is a significant risk factor for preterm delivery. The data established by this study, could help counseling pregnant women who face the desire to fast, for religious or other non-medical reasons. Other studies with accurate data on fasting status and with higher population diversity are needed to further understand the effects of fasting on pregnancy and delivery outcomes.

Effect of the Yom Kippur fast on parturition Wiser et al, Harefuah Effect of the Yom Kippur fast on parturition Wiser et al, Harefuah. 1997 Jun 1;132(11):745-8, 824. Full term deliveries of Jewish women, with non-fasting Bedouin women as controls (1988-1995, 1,313 Jewish and 1,091 Bedouin deliveries). The mean delivery rate in the Jewish population was significantly higher during Yom Kippur and the day after, than during the 7 days before Yom Kippur (15.1 +/- 5.1 and 14.6 +/- 4.7 vs 10.7 +/- 3.5, p < 0.04 and p < 0.01, respectively). There was an increase in delivery rate during the 6 hours before the end of the fast. In the Bedouin women there were no changes in delivery rate during any of these periods. There were no significant differences in the rates of deliveries during the Sukkot festival between Jewish and Bedouin women. We conclude that fasting is associated with a significant increase in the rate of deliveries at term.

Fasting and the Precipitation of Labor Fasting and the Precipitation of Labor. The Yom Kippur Effect Michael Kaplan, MB, ChB; Arthur I. Eidelman, MD; Yeshaya Aboulafia, MD JAMA. 1983;250(10):1317-1318. The mean baseline number of deliveries for our study period was 11.9 and 12.0 for 1981 and 1982, respectively. The number of deliveries on Yom Kippur was not significantly different from the mean. However, the number of deliveries for the 24-hour period after termination of the fast was 22 and 26 for 1981 and 1982, respectively. This difference attained statistical significance.

מטופלות פריון במהלך השראת ביוץ לפני/ אחרי החזרת עוברים רקע של כשלונות IVF חוזרים בעבר. במהלך המחצית הראשונה להריון במהלך המחצית השניה להריון (ללא סיבוכים במחצית הראשונה להריון )

קרישיות יתר עם/ ללא טיפול בנוגדי קרישה עם/ ללא סיבוכים מיילדותיים עם/ ללא סיבוכים טרומבואמבוליים בהריון/ משכב לידה ובכלל איזו טרומבופיליה – APLA או אחר?

צירים מוקדמים/ לידה מוקדמת צירים מוקדמים ללא קיצור צוואר ולידות במועד בעבר צירים מוקדמים והיסטוריה של לידה מוקדמת – שליש ראשון/שני / שלישי צירים מוקדמים וקיצור צוואר רחם היסטוריה של לידה מוקדמת עם מהלך תקין בהריון נוכחי – שליש ראשון/ שני/ שלישי הריונות מרובי עוברים – שליש ראשון/שני/ שלישי

דימום משך התקופה לאחר דימום שיש להימנע מצום מוחלט בשלבים שונים בהריון משך התקופה לאחר דימום שיש להימנע מצום מוחלט בשלבים שונים בהריון עם/ ללא ממצאים באולטרסאונד מקור הדימום ? שלית פתח עם/ללא דימום קודם שלית פתח בשלבים שונים בהריון

סוכרת סוכרת הריונית מאוזנת בדיאטה סוכרת הריונית מאוזנת עם טיפול תרופתי סוכרת טרום הריונית סוג 1 מאוזנת/לא מאוזנת סוכרת טרום הריונית סוג 2 מאוזנת/לא מאוזנת

היסטוריה מיילדותית הפלות חוזרות (מתי אירעו ההפלות ? באיזה שלב של הריון האישה כעת? ) IUFD ניתוחים קיסריים חוזרים

סיבוכים נוספים IUGR יתר לחץ דם כרוני/ הריוני מאוזן/ לא מאוזן עם / ללא טיפול תרופתי

הריון במועד ואם מתחילים צירים ?

הנקה שלבים שונים להנקה כמות החלב האם התינוק צורך גם תמ"ל פגים

ומה עוד? התיחסות לתחושות ולחששות של האישה מתן פתח התיחסות יזומה ? שקלול מכלול גורמי הסיכון