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O’Kelly AC, Scott NS. Cardiovascular Evaluation and Considerations for Women of Advanced Maternal Age Desiring Pregnancy. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00857-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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102
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Waites BT, Walker AR, Skeith AA, Caughey AB. First trimester fasting plasma glucose screen in advanced maternal age women: a cost-effectiveness analysis. J Matern Fetal Neonatal Med 2020; 35:4123-4129. [PMID: 33179564 DOI: 10.1080/14767058.2020.1847073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The prevalence of preexisting type 2 diabetes mellitus (T2DM) in the United States is on the rise. Women of advanced maternal age (AMA, ≥35 years) are more likely to have preexisting T2DM in pregnancy because glucose intolerance increases with age. Diabetes in pregnancy is associated with significant maternal and neonatal morbidity and mortality, and earlier treatment initiation improves pregnancy outcomes. However, maternal age is not currently recognized as an independent risk factor that warrants diabetes screening prior to the traditional screen at 24-28 weeks gestation. OBJECTIVE To evaluate the cost-effectiveness of screening all AMA women with a first trimester fasting plasma glucose (FPG) test for earlier diagnosis and management of preexisting T2DM. STUDY DESIGN A decision-analytic model was created to compare pregnancy outcomes in AMA women who undergo a first trimester FPG test vs third trimester oral glucose tolerance test alone. Probabilities were obtained from the literature. Outcomes examined included preeclampsia, preterm delivery, macrosomia, shoulder dystocia, brachial plexus injury (BPI), intrauterine fetal demise (IUFD), cerebral palsy, and neonatal death. The cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio of the first trimester screening strategy were examined as well. Sensitivity analyses and a Monte Carlo simulation were performed to test the model's robustness. RESULTS In AMA women, screening for preexisting T2DM in the first trimester with an FPG test resulted in fewer cases of preeclampsia, preterm delivery, BPI, IUFD, cerebral palsy, and neonatal death compared to performing a third trimester oral glucose tolerance test alone, and is cost-effective. Monte Carlo analysis incorporating the distribution of all probabilities showed that first trimester FPG screening remained cost-effective as long as the incremental cost of initiating diabetes treatment in the first trimester was less than $150,000 and the cost of the FPG screen was less than $2700. CONCLUSION Compared to third trimester oral glucose tolerance test alone, performing a first trimester FPG screen in AMA women is cost-saving and more effective.
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Affiliation(s)
- Bethany T Waites
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Allison R Walker
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Ashley A Skeith
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
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103
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Maternal altitude and risk of low birthweight: A systematic review and meta-analyses. Placenta 2020; 101:124-131. [DOI: 10.1016/j.placenta.2020.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/07/2020] [Accepted: 09/10/2020] [Indexed: 11/18/2022]
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104
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Guo XD, Gao F, Jia YN, Wang AH. Birth experiences of urban women of advanced age having their second child after introduction of the universal two-child policy in China: A qualitative study. Midwifery 2020; 91:102853. [PMID: 33070025 DOI: 10.1016/j.midw.2020.102853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE to investigate the birth experiences of women of advanced age having a second child in urban China after introduction of the universal two-child policy in 2016. DESIGN data were collected using semi-structured in-depth interviews, and were processed and analysed using a qualitative phenomenological method. SETTING obstetric department of a class 1, level 3 hospital in Henan Province, China. PARTICIPANTS purposive sampling was undertaken, and 11 hospitalized women from urban backgrounds were selected as the participants. They were all aged >35 years and were having their second child. The interviews were conducted 2-4 days post partum. FINDINGS the findings were divided into four themes: motives for the birth of a second child; anticipations for the child's gender; difficulty in conceiving; and conflicts after birth. The main reason for having a second child was no longer in accordance with the traditional Chinese mindset to 'raise sons to secure a happy life when one gets old'; instead, it was to secure family balance and harmony to respond to the new policy. Educated women from urban backgrounds were able to accept the gender of the second child 'as it came', without the old mindset that 'men are superior to women' and 'only boys can carry on family lines'. Advanced maternal age and gestational complications were the major difficulties facing these women. Chinese medicine and regimens were recognised as effective and conducive. Following the birth of their second child, the women experienced both positive feelings (joy due to the arrival of the new baby) and negative feelings (pressures and challenges on family finances, demands for more living space, and balancing their affections between two children). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE women of advanced age who choose to have a second child have sensible motives and, for the most part, their experience is positive. That said, the participants faced and overcame many difficulties before, during and after the birth of their second child. They were in need of help from the government and their employers in terms of policy, and proper education on care-taking and recuperation from medical professionals. Families who have a second child should treat the second child calmly and with common sense, make quick adjustments to family structural changes, and strike a proper balance in an effort to divide love and care equally between the two children.
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Affiliation(s)
- Xiao Dong Guo
- The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshedonglu, Zhengzhou, Henan, China
| | - Feng Gao
- The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshedonglu, Zhengzhou, Henan, China.
| | - Ya Nan Jia
- The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshedonglu, Zhengzhou, Henan, China
| | - Ai Hua Wang
- The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshedonglu, Zhengzhou, Henan, China
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105
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Mersha A, Ayele G, Worku T, Zerdo Z, Shibiru S, Bante A, Chonka T. Association between maternal age and adverse perinatal outcomes in Arba Minch zuria, and Gacho Baba district, southern Ethiopia: a prospective cohort study. BMC Pregnancy Childbirth 2020; 20:590. [PMID: 33023526 PMCID: PMC7541292 DOI: 10.1186/s12884-020-03285-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/25/2020] [Indexed: 12/02/2022] Open
Abstract
Background Globally, delayed childbearing to the advanced age is a growing option. It is an emerging public health issue in developing countries. Currently, adverse perinatal outcomes significantly increased. A few studies showed the effect of advanced maternal age on adverse perinatal outcomes. However, most used secondary data or chart reviews, and this increases the risk of biases. Besides, there are limited studies in-country Ethiopia as advanced maternal age steadily increased. Therefore, this study aimed to assess the status of advanced maternal age and its effect on perinatal outcomes in the study setting. Methods A community-based prospective cohort study was conducted among 709 study participants from October 15, 2018, to September 30, 2019, in Arba Minch zuria, and Gacho Baba district, southern Ethiopia. The data were collected by a pretested interviewer-administered structured Open Data Kit survey tool and analyzed by SPSS version 25. The log-linear regression model was used to compare perinatal outcomes among women aged 20–34 years and ≥ 35 years. The log-likelihood ratio tested for the goodness of fit. In this study, P-value < 0.05 was considered to declare a result as a statistically significant association. Results In this study, 209(29.5%) of the women were age group ≥35 years old, and 500(70.5%) were age group from20–34 years old. Stillbirth (β = 0.29, 95%CI: 0.05, 0.52), and neonatal mortality (β = 0.11, 95%CI: 0.01, 0.21) were significantly associated with the advanced maternal age. Conclusions Perinatal outcomes such as stillbirth and neonatal mortality were independently associated with advanced maternal age after controlling for possible cofounders. Therefore, different strategies should design for the women who planned to bear child, and information should provide for women who are advanced age or delayed childbearing to alert them.
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Affiliation(s)
- Abera Mersha
- School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
| | - Gistane Ayele
- School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Tilahun Worku
- School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Zerihun Zerdo
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Shitaye Shibiru
- School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Agegnehu Bante
- School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Tamiru Chonka
- School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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106
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Ogrizek-Pelkič K, Sobočan M, Takač I. Low Selenium Levels in Amniotic Fluid Correlate with Small-For-Gestational Age Newborns. Nutrients 2020; 12:nu12103046. [PMID: 33027985 PMCID: PMC7600462 DOI: 10.3390/nu12103046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/28/2020] [Accepted: 10/02/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Identifying women at risk for small-for-gestational-age newborns (SGA) is an important challenge in obstetrics. Several different risk factors have been suggested to contribute to the development of SGA. Previous research is inconclusive on the role selenium (Se) plays in the development of SGA. The aim of the study was therefore to explore the role of Se concentrations in amniotic fluid in order to understand its possible role in the development of SGA. Study Design: This prospective, single center study investigated the relationships between Se concentrations in amniotic fluid and pregnancy outcomes. Amniotic fluid was collected from pregnant women during amniocentesis at 16/17 weeks of pregnancy. Se values were determined using the electrothermal atomic absorption spectrometry and expressed in µg/L. Characteristics of mothers and newborns were obtained from women and delivery records. Results: 327 samples of amniotic fluid were evaluated. Patients with SGA newborns had significantly lower mean values of amniotic fluid concentrations of Se compared to appropriate-for-gestational-age (AGA) newborns (4.8 ± 1.9 µg/L versus 5.6 ± 2.5 µg/L (p = 0.017)). Adjusting for different risk factors, Se remained the only significant factor impacting the outcome of a newborn (b = −0.152, s.e. = 0.077; p < 0.048). Se levels in amniotic fluid did not correlate with pre-eclampsia or preterm delivery. Conclusion: Amniotic fluid Se levels represent a viable root of further investigation and assessment in order to identify women with low birth weight newborns early. Women with decreased Se levels had a statistically significant chance of developing SGA. Further research is needed to elucidate the link between Se, other trace elements, and other risk factors and their impact on the development of SGA newborns.
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Affiliation(s)
- Ksenija Ogrizek-Pelkič
- Faculty of Medicine, Department of Obstetrics and Gynaecology, University of Maribor, Taborska ulica 8, 2000 Maribor, Slovenia; (K.O.-P.); (I.T.)
| | - Monika Sobočan
- Faculty of Medicine, Department of Obstetrics and Gynaecology, University of Maribor, Taborska ulica 8, 2000 Maribor, Slovenia; (K.O.-P.); (I.T.)
- University Medical Centre Maribor, Division of Gynaecology and Perinatology, Ljubljanska ulica 5, 2000 Maribor, Slovenia
- Correspondence: ; Tel.: +386-2321-2173
| | - Iztok Takač
- Faculty of Medicine, Department of Obstetrics and Gynaecology, University of Maribor, Taborska ulica 8, 2000 Maribor, Slovenia; (K.O.-P.); (I.T.)
- University Medical Centre Maribor, Division of Gynaecology and Perinatology, Ljubljanska ulica 5, 2000 Maribor, Slovenia
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107
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Gao XX, Ye MY, Liu Y, Li JY, Li L, Chen W, Lu X, Nie G, Chen YH. Prevalence and risk factors of intrahepatic cholestasis of pregnancy in a Chinese population. Sci Rep 2020; 10:16307. [PMID: 33004915 PMCID: PMC7530728 DOI: 10.1038/s41598-020-73378-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/07/2020] [Indexed: 12/24/2022] Open
Abstract
Studies on the risk factors for intrahepatic cholestasis of pregnancy (ICP) in a population-based cohort are lacking. We assess the prevalence and risk factors of ICP in a Chinese population. In this study, a cohort study was conducted that included 12,200 eligible pregnant women. The overall incidence of ICP in this cohort was 6.06%. With increasing maternal age, the incidence of ICP decreased in women younger than 30 years of age but increased in those older than 30. With increasing pre-pregnancy BMI, the incidence of ICP decreased if the pre-pregnancy BMI was less than 23 kg/m2 but increased if it was 23 kg/m2 or higher. Further analysis showed that the risk of ICP increased when maternal age was < 25 years (Adjusted RR 2.01; 95% CI 1.64–2.47) or ≥ 35 years (Adjusted RR 1.34; 95% CI 1.02–1.76). Furthermore, an increased risk of ICP was associated with pre-pregnancy underweight (adjusted RR 1.27; 95% CI 1.04–1.56), inadequate gestational weight gain (GWG) (adjusted RR 1.58; 95% CI 1.28–1.96), lower maternal education (adjusted RR 2.96; 95% CI 2.35–3.74), multiparity (adjusted RR 1.54; 95% CI 1.23–1.93), and twin/multiple pregnancies (adjusted RR 2.12; 95% CI 1.25–3.58). Maternal age (< 25 or ≥ 35 years), underweight, inadequate GWG, lower maternal education, multiparity, and twin/multiple pregnancies were identified as risk factors of ICP.
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Affiliation(s)
- Xing-Xing Gao
- Department of Histology and Embryology, Anhui Medical University, No. 81 Meishan Road, Shushan District, Hefei, 230032, Anhui, People's Republic of China
| | - Meng-Ying Ye
- Department of Histology and Embryology, Anhui Medical University, No. 81 Meishan Road, Shushan District, Hefei, 230032, Anhui, People's Republic of China
| | - Yan Liu
- Department of Histology and Embryology, Anhui Medical University, No. 81 Meishan Road, Shushan District, Hefei, 230032, Anhui, People's Republic of China
| | - Jin-Yan Li
- Department of Histology and Embryology, Anhui Medical University, No. 81 Meishan Road, Shushan District, Hefei, 230032, Anhui, People's Republic of China
| | - Li Li
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Anhui Medical University, Hefei, 230022, People's Republic of China
| | - Wei Chen
- Department of Histology and Embryology, Anhui Medical University, No. 81 Meishan Road, Shushan District, Hefei, 230032, Anhui, People's Republic of China
| | - Xue Lu
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, 230032, People's Republic of China
| | - Guiying Nie
- Implantation and Placental Development Laboratory, RMIT University, Bundoora, VIC, 3083, Australia. .,Implantation and Placental Development Laboratory, Centre for Reproductive Health, Hudson Institute of Medical Research, Melbourne, 3168, Australia.
| | - Yuan-Hua Chen
- Department of Histology and Embryology, Anhui Medical University, No. 81 Meishan Road, Shushan District, Hefei, 230032, Anhui, People's Republic of China. .,Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, 230032, People's Republic of China. .,Implantation and Placental Development Laboratory, RMIT University, Bundoora, VIC, 3083, Australia. .,Implantation and Placental Development Laboratory, Centre for Reproductive Health, Hudson Institute of Medical Research, Melbourne, 3168, Australia.
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108
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Usuzaki T, Ishikuro M, Metoki H, Murakami K, Noda A, Ueno F, Kikuya M, Obara T, Kuriyama S. Comparison among research, home, and office blood pressure measurements for pregnant women: The TMM BirThree Cohort Study. J Clin Hypertens (Greenwich) 2020; 22:2004-2013. [PMID: 32966692 DOI: 10.1111/jch.14050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/02/2020] [Accepted: 08/21/2020] [Indexed: 11/28/2022]
Abstract
Blood pressure (BP) measurements of pregnant women have been collected in offices and at home for previous research. However, it remains uncertain whether there is difference between research BP, defined as BP measured for the purpose of epidemiological research and BP measured at home or in an office. Therefore, the present study aimed to compare research BP with home and unstandardized office BP. Research, home, and office BP were measured among pregnant women who participated in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study (TMM BirThree Cohort Study). Research BP was measured twice at our research center while the participant was seated and after resting for 1-2 minutes. Research, home, and office BP were compared and agreement among the values was assessed. Differences among research, home, and office BP values and possible factors affecting differences were analyzed. Among 656 pregnant women, the mean (± standard deviations) research systolic (S), diastolic (D) BP, home SBP, home DBP office SBP, and office DBP were 103.8 ± 8.5, 61.8 ± 7.3, 104.4 ± 9.2, 61.2 ± 6.8, 110.5 ± 10.8, and 63.8 ± 8.7mmHg, respectively. Research SBP value was lower than home value (P = .0072; difference between mean research and home BP: -0.61 ± 7.8 mmHg). Research SBP and DBP values were lower than office values (P < .0001 for both SBP and DBP; means ± standard deviations of differences between research and office BP: 6.7 ± 10.1 and 2.0 ± 8.5 mmHg for SBP and DBP, respectively). In conclusion, when research BP is measured under conditions controlled, research BP can give close values to home BP for pregnant women.
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Affiliation(s)
| | - Mami Ishikuro
- Division of Molecular Epidemiology, Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.,Division of Molecular Epidemiology, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Hirohito Metoki
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Keiko Murakami
- Division of Molecular Epidemiology, Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.,Division of Molecular Epidemiology, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Aoi Noda
- Division of Molecular Epidemiology, Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.,Division of Molecular Epidemiology, Graduate School of Medicine, Tohoku University, Sendai, Japan.,Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Japan
| | - Fumihiko Ueno
- Division of Molecular Epidemiology, Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.,Division of Molecular Epidemiology, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Masahiro Kikuya
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Taku Obara
- Division of Molecular Epidemiology, Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.,Division of Molecular Epidemiology, Graduate School of Medicine, Tohoku University, Sendai, Japan.,Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Japan
| | - Shinichi Kuriyama
- Division of Molecular Epidemiology, Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.,Division of Molecular Epidemiology, Graduate School of Medicine, Tohoku University, Sendai, Japan.,Division of Disaster Public Health, International Research Institute of Disaster Science, Tohoku University, Sendai, Japan
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109
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Magistrado L, Tolcher MC, Suhag A, Zambare S, Aagaard KM. Pregnancy and Lactation in a 67-Year-Old Elderly Gravida following Donor Oocyte In Vitro Fertilization. Case Rep Obstet Gynecol 2020; 2020:9801565. [PMID: 33005465 PMCID: PMC7509548 DOI: 10.1155/2020/9801565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 08/18/2020] [Accepted: 09/04/2020] [Indexed: 11/25/2022] Open
Abstract
There is limited data on the anticipated perinatal course among gravidae in their sixth and seventh decades. Our objective was to describe the relatively uncomplicated prenatal, intrapartum, and postpartum course of a 67-year-old essential primigravida. Briefly, our patient conceived a singleton pregnancy via IVF with donor oocytes, then presented at 13 6/7 weeks of gestation to initiate prenatal care. Her medical history was significant for chronic hypertension, hyperlipidemia, and obesity. Her cardiac function was monitored throughout pregnancy, and she delivered at 36 1/7 weeks by cesarean for a decline in left ventricular function with mitral regurgitation. Her intrapartum and postpartum course was uncomplicated, and she was able to successfully breastfeed for six months and resume prepregnancy activity. For comparison, we analyzed deliveries among gravidae > 45 years of age from our institutional obstetrical database (2011-2018). This case represents the eldest gravidae identified in the literature and illustrates the potential for a relatively uncomplicated perinatal course with successful lactation. This case may enable other providers to counsel elderly patients on anticipated outcomes inclusive of ability to breastfeed.
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Affiliation(s)
- Leila Magistrado
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Mary C. Tolcher
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Anju Suhag
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Sonal Zambare
- Department of Anesthesiology, Division of Obstetric Anesthesia, Baylor College of Medicine, Houston, TX, USA
| | - Kjersti M. Aagaard
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Houston, TX, USA
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Department of Molecular & Cell Biology, Baylor College of Medicine, Houston, TX, USA
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110
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Lewandowska M, Więckowska B, Sajdak S, Lubiński J. Pre-Pregnancy Obesity vs. Other Risk Factors in Probability Models of Preeclampsia and Gestational Hypertension. Nutrients 2020; 12:nu12092681. [PMID: 32887442 PMCID: PMC7551880 DOI: 10.3390/nu12092681] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 08/29/2020] [Accepted: 08/31/2020] [Indexed: 12/11/2022] Open
Abstract
In the face of the obesity epidemic around the world, attention should be focused on the role of maternal obesity in the development of pregnancy. The purpose of this analysis was to evaluate the prediction of preeclampsia (PE) and isolated gestational hypertension (GH) for a number of maternal factors, in order to investigate the importance of pre-pregnancy obesity (body mass index, BMI ≥ 30 kg/m2), compared to other risk factors (e.g., prior PE, pregnancy weight gain (GWG), infertility treatment, interpregnancy interval, family history, the lack of vitamin supplementation, urogenital infection, and socioeconomic factors). In total, 912 women without chronic diseases were examined in a Polish prospective cohort of women with a singleton pregnancy (recruited in 2015–2016). Separate analyses were performed for the women who developed GH (n = 113) vs. 775 women who remained normotensive, as well as for those who developed PE (n = 24) vs. 775 controls. The probability of each disease was assessed for the base prediction model (age + primiparity) and for the model extended by one (test) variable, using logistic regression. Three measures were used to assess the prediction: area under curve (AUC) of the base and extended model, integrated discrimination improvement (IDI) (the index shows the difference between the value of the mean change in the predicted probability between the group of sick and healthy women when a new factor is added to the model), and net reclassification improvement (NRI) (the index focuses on the reclassification table describing the number of women in whom an upward or downward shift in the disease probability value occurred after a new factor had been added, including results for healthy and sick women). In the GH prediction, AUC increased most strongly when we added BMI (kg/m2) as a continuous variable (AUC = 0.716, p < 0.001) to the base model. The highest IDI index was obtained for prior GH/PE (IDI = 0.068, p < 0.001). The addition of BMI as a continuous variable or BMI ≥ 25 kg/m2 improved the classification for healthy and sick women the most (NRI = 0.571, p < 0.001). In the PE prediction, AUC increased most strongly when we added BMI categories (AUC = 0.726, p < 0.001) to the base model. The highest IDI index was obtained for prior GH/PE (IDI = 0.050, p = 0.080). The addition of BMI categories improved the classification for healthy and sick women the most (NRI = 0.688; p = 0.001). After summing up the results of three indexes, the probability of hypertension in pregnancy was most strongly improved by BMI, including BMI ≥ 25 kg/m2 for the GH prediction, and BMI ≥ 30 kg/m2 for the PE prediction. Main conclusions: Pre-pregnancy BMI was the most likely factor to increase the probability of developing hypertension in pregnancy, compared to other risk factors. Hierarchies of PE and GH risk factors may suggest different (or common) mechanisms of their development.
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Affiliation(s)
- Małgorzata Lewandowska
- Medical Faculty, Lazarski University, 02-662 Warsaw, Poland
- Division of Gynecological Surgery, University Hospital, 33 Polna Str., 60-535 Poznan, Poland;
- Correspondence:
| | - Barbara Więckowska
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, 60-806 Poznan, Poland;
| | - Stefan Sajdak
- Division of Gynecological Surgery, University Hospital, 33 Polna Str., 60-535 Poznan, Poland;
| | - Jan Lubiński
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, 71-252 Szczecin, Poland;
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111
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Grant I, Soria R, Julian CG, Vargas E, Moore LG, Aiken CE, Giussani DA. Parental ancestry and risk of early pregnancy loss at high altitude. FASEB J 2020; 34:13741-13749. [PMID: 32856356 DOI: 10.1096/fj.202001257r] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/20/2020] [Accepted: 07/31/2020] [Indexed: 11/11/2022]
Abstract
High altitude pregnancy is associated with increased frequency of low birth weight infants and neonatal complications, the risks of which are higher in women of low-altitude ancestry. Does ancestry also influence the risk of miscarriage (pregnancy loss <20 weeks) in high-altitude pregnancy? To answer this, 5386 women from La Paz, Bolivia (3300-4150 m) with ≥1 live-born infant were identified. Data were extracted from medical records including maternal and paternal ancestry, demographic factors, and reproductive history. The risk of miscarriage by ancestry was assessed using multivariate logistic regression, adjusting for parity, and maternal age. Andean women experienced first live-births younger than Mestizo or European women (21.7 ± 4.6 vs 23.4 ± 8.0 vs 24.1 ± 5.1, P < .001). Andeans experienced more pregnancies per year of reproductive life (P < .001) and had significantly higher ratios of live-births to miscarriages than women of Mestizo or European ancestry (P < .001). Andean women were 24% less likely to have ever experienced a miscarriage compared to European women (OR:0.76; CI:0.62-0.90, P < .001). The woman's partner's ancestry wasn't a significant independent predictor of miscarriage. In conclusion, the risk of miscarriage at high altitude is lower in Andean women. The lack of a paternal ancestry effect suggests underlying mechanisms relate more to differential maternal adaptation in early pregnancy than fetal genetics.
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Affiliation(s)
- I Grant
- Department of Obstetrics and Gynaecology, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - R Soria
- Instituto Boliviano de Biología de Altura, La Paz, Bolivia
| | - C G Julian
- Department of Medicine, University of Colorado, Denver, CO, USA
| | - E Vargas
- Instituto Boliviano de Biología de Altura, La Paz, Bolivia
| | - L G Moore
- Department of Obstetrics/Gynecology, University of Colorado, Denver, CO, USA
| | - C E Aiken
- Department of Obstetrics and Gynaecology, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - D A Giussani
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
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112
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Chen GD, Pang TT, Li PS, Zhou ZX, Lin DX, Fan DZ, Guo XL, Liu ZP. Early pregnancy vitamin D and the risk of adverse maternal and infant outcomes: a retrospective cohort study. BMC Pregnancy Childbirth 2020; 20:465. [PMID: 32795269 PMCID: PMC7427871 DOI: 10.1186/s12884-020-03158-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 08/05/2020] [Indexed: 12/14/2022] Open
Abstract
Background Previous evidence has suggested that lower gestational vitamin D levels might increase the risks of adverse pregnancy and birth outcomes. The results remain inconsistent and require further exploration. Methods A total of 2814 Chinese mother-infant pairs were included in this retrospective cohort study. Serum concentrations of 25(OH)D were reviewed in early pregnancy (16.3 ± 2.3 weeks). Outcomes of maternal gestational diabetes mellitus (GDM), cesarean section, fetal distress, preterm birth, low birth weight (LBW), and macrosomia were extracted from the medical records. Cox regression analysis was used to explore these associations. Results In total, 19.3% of mothers were pregnant at an advanced age (≥35 years), and 40.3% of pregnant women had vitamin D deficiency (< 50 nmol/L). After adjusting for potential covariates, the hazard ratio (HR) (95% CI) per standard deviation (SD) increase of serum 25(OH)D concentrations was 0.86 (0.779, 0.951) for GDM, 0.844 (0.730, 0.976) for preterm birth, and 0.849 (0.726, 0.993) for LBW. Similar protective associations were found for GDM, cesarean section, and preterm birth for a better vitamin D status when compared with vitamin D deficiency. Conclusion Higher early pregnancy vitamin D was associated with a lower risk of GDM, cesarean section, preterm birth, and LBW.
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Affiliation(s)
- Geng-Dong Chen
- Foshan Institute of Fetal Medicine, Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Ting-Ting Pang
- Department of Medical Records, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Peng-Sheng Li
- Foshan Institute of Fetal Medicine, Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Zi-Xing Zhou
- Foshan Institute of Fetal Medicine, Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Dong-Xin Lin
- Foshan Institute of Fetal Medicine, Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Da-Zhi Fan
- Foshan Institute of Fetal Medicine, Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Xiao-Ling Guo
- Foshan Institute of Fetal Medicine, Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Zheng-Ping Liu
- Foshan Institute of Fetal Medicine, Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, 528000, Guangdong, China.
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113
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Association between obesity and miscarriage among women of reproductive age in Nepal. PLoS One 2020; 15:e0236435. [PMID: 32760090 PMCID: PMC7410243 DOI: 10.1371/journal.pone.0236435] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/06/2020] [Indexed: 12/16/2022] Open
Abstract
Background Obesity is a major health problem in low and middle income countries (LMICs) and is associated with miscarriage. This study aims to examine the association between obesity and miscarriage among reproductive age women (15–49 years) in Nepal. Methods The combined 19160 cross-sectional pregnancy data from the Nepal Demographic and Health Survey (NDHS) for the years 2001, 2006, 2011 and 2016 was utilized. Miscarriage was defined as a spontaneous loss of pregnancy that occurred before the foetus reached 7 months of gestational age. Logistic regression analyses that adjusted for clustering, stratification and sampling weights were used to examine the association between obesity and miscarriage among women of reproductive age. Results The odds of miscarriage were 1.45 times higher (Adjusted odds ratio (AOR) = 1.45; 95%Cl: 1.06, 1.98, P = 0.021) among women with obesity. Women who did not use contraception, younger (15–19 years), and older women (35 years or more) were significantly more likely to have miscarriage. Women who smoked tobacco reported higher odds of miscarriage than women who did not smoke tobacco (AOR = 1.27; 95%Cl: 1.07,1.50, P = 0.006). Stratification of maternal smoking status by maternal Body Mass Index (BMI), after adjusting for contraception, mother age and year of survey revealed that tobacco smoking and obesity are associated with miscarriage (AOR = 1.46; 95%Cl: 1.05,2.04, P = 0.025). Conclusions Findings from this study show that obesity and tobacco smoking are associated with miscarriage. Smoking cessation, pregnancy planning and counselling on healthy weight for women of reproductive age in Nepal may help promote healthy behaviours and decrease the likelihood of miscarriage.
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114
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Kalafat E, Barratt I, Nawaz A, Thilaganathan B, Khalil A. Maternal cardiovascular function and risk of intrapartum fetal compromise in women undergoing induction of labor: pilot study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:233-239. [PMID: 31710723 DOI: 10.1002/uog.21918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/23/2019] [Accepted: 10/13/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Identification of the fetus at risk of intrapartum compromise has many benefits. Impaired maternal cardiovascular function is associated with placental hypoperfusion predisposing to intrapartum fetal distress. The aim of this study was to assess the predictive accuracy of maternal hemodynamics for the risk of operative delivery due to presumed fetal compromise in women undergoing induction of labor (IOL). METHODS In this prospective cohort study, patients were recruited between November 2018 and January 2019. Women undergoing IOL were invited to participate in the study. A non-invasive ultrasonic cardiac output monitor (USCOM-1A®) was used for cardiovascular assessment. The study outcome was operative delivery due to presumed fetal compromise, which included Cesarean or instrumental delivery for abnormal fetal heart monitoring. Regression analysis was used to test the association between cardiovascular markers, as well as the maternal characteristics, and the risk of operative delivery due to presumed fetal compromise. Receiver-operating-characteristics-curve analysis was used to assess the predictive accuracy of the cardiovascular markers for the risk of operative delivery for presumed fetal compromise. RESULTS A total of 99 women were recruited, however four women were later excluded from the analysis due to semi-elective Cesarean section (n = 2) and failed IOL (n = 2). The rate of operative delivery due to presumed fetal compromise was 28.4% (27/95). Women who delivered without suspected fetal compromise (controls) were more likely to be parous, compared to those who had operative delivery due to fetal compromise (52.9% vs 18.5%; P = 0.002). Women who underwent operative delivery due to presumed fetal compromise had a significantly lower cardiac index (median, 2.50 vs 2.60 L/min/m2 ; P = 0.039) and a higher systemic vascular resistance (SVR) (median, 1480 vs 1325 dynes × s/cm5 , P = 0.044) compared to controls. The baseline model (being parous only) showed poor predictive accuracy, with an area under the curve of 0.67 (95% CI, 0.58-0.77). The addition of stroke volume index (SVI) < 36 mL/m2 , SVR > 7.2 logs or SVR index (SVRI) > 7.7 logs improved significantly the predictive accuracy of the baseline model (P = 0.012, P = 0.026 and P = 0.012, respectively). CONCLUSION In this pilot study, we demonstrated that prelabor maternal cardiovascular assessment in women undergoing IOL could be useful for assessing the risk of intrapartum fetal compromise necessitating operative delivery. The addition of SVI, SVR or SVRI improved significantly the predictive accuracy of the baseline antenatal model. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- E Kalafat
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Middle East Technical University, Department of Statistics, Ankara, Turkey
| | - I Barratt
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - A Nawaz
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - B Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
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115
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Afiaz A, Biswas RK, Shamma R, Ananna N. Intimate partner violence (IPV) with miscarriages, stillbirths and abortions: Identifying vulnerable households for women in Bangladesh. PLoS One 2020; 15:e0236670. [PMID: 32722708 PMCID: PMC7386588 DOI: 10.1371/journal.pone.0236670] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 07/10/2020] [Indexed: 11/17/2022] Open
Abstract
Intimate partner violence (IPV) is a social problem in Bangladesh with adverse effects on maternal healthcare. This study analyzed the sociodemographic factors responsible for intimate partner violence and its overall association with reproductive healthcare–specifically miscarriages, stillbirths and induced abortions (MSA)–using Bangladesh Demographic Health Survey 2007, which contains the latest available intimate partner violence data till date, with the hypothesis that intimate partner violence is associated with miscarriages, stillbirths and induced abortions. The generalized linear regression model was fitted to 3,920 women adjusting survey weights and cluster/strata variations. The study concluded that 1 out of every 4 women who reported experiencing intimate partner violence also reported having one or more of miscarriages, stillbirths and induced abortions. The results revealed that intimate partner violence and miscarriages, stillbirths and induced abortions were significantly associated with the age of the women, residence, age of the women at their first birth, sex of household head and the household’s financial condition. Furthermore, the odds of having one or more miscarriages, stillbirths and abortions was increased by 35% for women who were victims to intimate partner violence, establishing a significant association between miscarriages, stillbirths and abortions and intimate partner violence. There appeared to be a need to address the issue in both paradigms, particularly for the poor rural women in Bangladeshi patriarchal society. These findings demand a combined intervention effort in the vulnerable cohorts, especially if Bangladesh intends to attain the goals 3.1 and 5.2 of the Sustainable Development Goals (SDG) by 2030.
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Affiliation(s)
- Awan Afiaz
- Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
| | - Raaj Kishore Biswas
- Transport and Road Safety (TARS) Research Centre, School of Aviation, University of New South Wales, NSW, Australia
| | - Raisa Shamma
- Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
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116
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Frick AP. Advanced maternal age and adverse pregnancy outcomes. Best Pract Res Clin Obstet Gynaecol 2020; 70:92-100. [PMID: 32741623 DOI: 10.1016/j.bpobgyn.2020.07.005] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/17/2020] [Accepted: 07/01/2020] [Indexed: 12/31/2022]
Abstract
A wide range of adverse pregnancy outcomes are associated with women of advanced maternal age (AMA). These include increased risks for miscarriage, chromosomal abnormalities, stillbirth, foetal growth restriction, preterm birth, pre-eclampsia, gestational diabetes mellitus and caesarean section. While a wide body of literature has reported on these risks, varying definitions in both AMA and reported outcomes can make synthesizing the information difficult when counselling an individual women about her specific risks. In this chapter, we discuss the role of AMA on adverse pregnancy outcomes with a view to clarifying the magnitude of the risks for each outcome in the context to enable more informed clinical counselling and decision-making.
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Affiliation(s)
- Alexander P Frick
- St George's University Hospital NHS Foundation Trust, Fetal Medicine Unit, 4th Floor, Lanesborough Wing, Blackshaw Road, Tooting, SW17 0QT, UK.
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117
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Bouzaglou A, Aubenas I, Abbou H, Rouanet S, Carbonnel M, Pirtea P, Ayoubi JMB. Pregnancy at 40 years Old and Above: Obstetrical, Fetal, and Neonatal Outcomes. Is Age an Independent Risk Factor for Those Complications? Front Med (Lausanne) 2020; 7:208. [PMID: 32537454 PMCID: PMC7266997 DOI: 10.3389/fmed.2020.00208] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 04/27/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives: Maternal age has been increasing for several decades with many of these late pregnancies between 40 and 45 years old. The main objective of this study is to assess whether maternal age is an independent factor of obstetric, fetal, and neonatal complications. Patients and methods: A monocentric, French study “exposed-unexposed” was conducted during 11 years in a maternity level IIB. Maternal and perinatal outcomes were studied using univariates and multivariate analysis. We compared women aged 40 and above in a 1:1 ratio with women of 25–35 years old. Results: One thousand nine hundred eighty-two women were 40 or older (mean age: 41.9) on the day of their delivery and compared to other 1,982 women who were aged between 25 and 35 years old (mean age: 30.7) Preeclampsia, gestational diabetes, were significantly higher in the study group (4.6 vs. 1.5% and 14.5 vs. 6.9%, respectively, p < 0.001). We found also a significant difference for gestational hypertension (3.1 vs. 1.1% p < 0.001), preterm birth (10.4 vs. 6.5% p < 0.001), cesarean (16.6 vs. 5.4% for scheduled cesarean, and 50.4 vs. 13.9% for emergency cesarean, p < 0.001) and fetal death in utero (2.1 vs. 0.5% in the study group, p < 0.001). These results were also significantly different in multivariate analysis. Conclusion: A pregnancy after 40 years old is worth considering today as far as the risk factors are controlled and understand by the patient and the obstetrician. However, they have a significantly higher risks of cesarean, preterm delivery, pre-eclampsia, gestational diabetes, and fetal death in utero (FDIU). It is therefore the responsibility of the obstetrician to inform correctly these women in a detailed way, to reassure them and to adapt the monitoring of their pregnancy accordingly.
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Affiliation(s)
- Ana Bouzaglou
- Department of Gynecology and Obstetrics, Hospital Foch, Suresnes, France
| | - Ines Aubenas
- Department of Gynecology and Obstetrics, Hospital Foch, Suresnes, France
| | - Hind Abbou
- Department of Gynecology and Obstetrics, Hospital Foch, Suresnes, France
| | | | - Marie Carbonnel
- Department of Gynecology and Obstetrics, Hospital Foch, Suresnes, France
| | - Paul Pirtea
- Department of Gynecology and Obstetrics, Hospital Foch, Suresnes, France
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118
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Yong HY, Mohd Shariff Z, Mohd Yusof BN, Rejali Z, Tee YYS, Bindels J, van der Beek EM. Independent and combined effects of age, body mass index and gestational weight gain on the risk of gestational diabetes mellitus. Sci Rep 2020; 10:8486. [PMID: 32444832 PMCID: PMC7244566 DOI: 10.1038/s41598-020-65251-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/15/2020] [Indexed: 11/25/2022] Open
Abstract
This study aimed to identify the independent and combined effects of age, BMI at first prenatal visit and GWG on the risk of GDM. A retrospective cohort study of 1,951 pregnant women in Seremban district, Negeri Sembilan, Malaysia. GDM was defined as fasting plasma glucose (FPG) ≥5.6 mmol/l and/or 2-hour postprandial plasma glucose (2hPPG) ≥7.8 mmol/l. A higher percentage of women with GDM had 2 risk factors (29.0%) or >2 risk factors (8.6%) compared to non-GDM women (2 risk factors: 25.5%; >2 risk factors: 5.0%). In general, women with ≥2 risk factors were respectively 1.36-2.06 times more likely to have GDM compared to those without risk factors. Older maternal age and being overweight/obese were significantly associated with risk of GDM. Overweight/obese women with age ≥35 years had 2.45 times higher risk of GDM and having excessive GWG at second trimester further increased the risk of GDM. Age and BMI are independent risk factors for GDM but not GWG in the first and second trimester. The findings emphasize the need to focus on a healthy BMI before pregnancy and optimal GWG during pregnancy to improve pregnancy outcomes.
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Affiliation(s)
- Heng Yaw Yong
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Zalilah Mohd Shariff
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia.
| | - Barakatun Nisak Mohd Yusof
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Zulida Rejali
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Yvonne Yee Siang Tee
- Danone Specialized Nutrition (Malaysia) Sdn Bhd, 59200, Mid Valley City, Lingkaran Syed Putra, Kuala Lumpur, Malaysia
| | - Jacques Bindels
- Danone Nutricia Research, Uppsalalaan 12, 3584, CT, Utrecht, The Netherlands
| | - Eline M van der Beek
- Danone Nutricia Research, Uppsalalaan 12, 3584, CT, Utrecht, The Netherlands
- Department of Pediatrics, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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119
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Levenson D, Romero R, Garcia-Flores V, Miller D, Xu Y, Sahi A, Hassan SS, Gomez-Lopez N. The effects of advanced maternal age on T-cell subsets at the maternal-fetal interface prior to term labor and in the offspring: a mouse study. Clin Exp Immunol 2020; 201:58-75. [PMID: 32279324 DOI: 10.1111/cei.13437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 03/30/2020] [Accepted: 04/02/2020] [Indexed: 12/11/2022] Open
Abstract
Women who conceive at 35 years of age or older, commonly known as advanced maternal age, have a higher risk of facing parturition complications and their children have an increased risk of developing diseases later in life. However, the immunological mechanisms underlying these pathological processes have yet to be established. To fill this gap in knowledge, using a murine model and immunophenotyping, we determined the effect of advanced maternal age on the main cellular branch of adaptive immunity, T cells, at the maternal-fetal interface and in the offspring. We report that advanced maternal age impaired the process of labor at term, inducing dystocia and delaying the timing of delivery. Advanced maternal age diminished the number of specific proinflammatory T-cell subsets [T helper type 1 (Th1): CD4+ IFN-γ+ , CD8+ IFN-γ+ and Th9: CD4+ IL-9+ ], as well as CD4+ regulatory T cells (CD4+ CD25+ FoxP3+ T cells), at the maternal-fetal interface prior to term labor. Advanced maternal age also altered fetal growth and survival of the offspring in early life. In addition, infants born to advanced-age mothers had alterations in the T-cell repertoire but not in CD71+ erythroid cells (CD3- CD71+ TER119+ cells). This study provides insight into the immune alterations observed at the maternal-fetal interface of advanced-age mothers and their offspring.
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Affiliation(s)
- D Levenson
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Detroit, MI, USA.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - R Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Detroit, MI, USA.,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.,Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA.,Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA.,Detroit Medical Center, Detroit, MI, USA.,Department of Obstetrics and Gynecology, Florida International University, Miami, FL, USA
| | - V Garcia-Flores
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Detroit, MI, USA.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - D Miller
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Detroit, MI, USA.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Y Xu
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Detroit, MI, USA.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - A Sahi
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Detroit, MI, USA.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - S S Hassan
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA.,Office of Women's Health, Integrative Biosciences Center, Wayne State University, Detroit, MI, USA.,Department of Physiology, Wayne State University School of Medicine, Detroit, MI, USA
| | - N Gomez-Lopez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Detroit, MI, USA.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA.,Department of Biochemistry, Microbiology and Immunology, Wayne State University School of Medicine, Detroit, MI, USA
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Miremerg H, Frig O, Rona S, Ganer Herman H, Mizrachi Y, Schreiber L, Bar J, Kovo M, Weiner E. Is advanced maternal age associated with placental vascular malperfusion? A prospective study from a single tertiary center. Arch Gynecol Obstet 2020; 301:1441-1447. [PMID: 32363549 DOI: 10.1007/s00404-020-05562-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/20/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Pregnancy at advanced maternal age (AMA) has become more common. There has been concern regarding the adverse effect deferring pregnancy might have on pregnancy outcomes. We aimed to prospectively study the effect of AMA on placental pathology. METHODS A prospective case-control study was performed in a single university center. Placental histopathology, maternal demographics, labor characteristics, and neonatal outcomes of pregnancies with AMA were collected and compared to matched controls. We defined AMA as maternal age > 35 years at delivery. In attempt to isolate the effect of maternal age, we excluded cases complicated by preterm birth, hypertensive disorders, diabetes mellitus, small for gestational age, and congenital/genetic anomalies. RESULTS The study group included 110 AMA patients that were matched with controls. The groups did not differ in maternal demographics, but the AMA group had a higher rate of assisted reproductive technologies (ART) as compared to the control group (p < 0.001). Placentas in the AMA group were characterized by a higher rate of maternal vascular lesions (MVM) (39.1% vs. 24.5%, p = 0.003), but not fetal vascular malperfusion lesions (p = 0.576). In multivariable analysis maternal age was associated with placental MVM lesions independent of all other maternal demographics (aOR 1.18 95% CI 1.06-3.17). Neonatal outcomes did not significantly differ between the groups. CONCLUSIONS After excluding all background morbidities-AMA was associated with a higher rate of placental MVM lesions vs. controls. These findings suggest an independent effect of AMA on placental function. Large prospective trials are needed to study the clinical importance of these findings.
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Affiliation(s)
- Hadas Miremerg
- Departments of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O Box 5, 58100, Holon, Israel. .,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Omry Frig
- Departments of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O Box 5, 58100, Holon, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Shiran Rona
- Departments of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O Box 5, 58100, Holon, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Hadas Ganer Herman
- Departments of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O Box 5, 58100, Holon, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Yossi Mizrachi
- Departments of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O Box 5, 58100, Holon, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Letizia Schreiber
- Departments of Pathology, The Edith Wolfson Medical Center, Holon, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Departments of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O Box 5, 58100, Holon, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- Departments of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O Box 5, 58100, Holon, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Eran Weiner
- Departments of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O Box 5, 58100, Holon, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Tallarek AC, Stepan H. Die ältere Schwangere über 40. GYNAKOLOGISCHE ENDOKRINOLOGIE 2020. [DOI: 10.1007/s10304-020-00310-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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122
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Erkamp JS, Jaddoe VWV, Duijts L, Reiss IKM, Mulders AGMGJ, Steegers EAP, Gaillard R. Population screening for gestational hypertensive disorders using maternal, fetal and placental characteristics: A population-based prospective cohort study. Prenat Diagn 2020; 40:746-757. [PMID: 32181502 PMCID: PMC7317936 DOI: 10.1002/pd.5683] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 12/12/2022]
Abstract
Objective To determine screening performance of maternal, fetal and placental characteristics for selecting pregnancies at risk of gestational hypertension and preeclampsia in a low‐risk multi‐ethnic population. Method In a prospective population‐based cohort among 7124 pregnant women, we collected maternal characteristics including body mass index, ethnicity, parity, smoking and blood pressure in early‐pregnancy. Fetal characteristics included second and third trimester estimated fetal weight and sex determined by ultrasound. Placental characteristics included first and second trimester placental growth factor concentrations and second and third trimester uterine artery resistance indices. Results Maternal characteristics provided the best screening result for gestational hypertension (area‐under‐the‐curve [AUC] 0.79 [95% Confidence interval {CI} 0.76‐0.81]) with 40% sensitivity at 90% specificity. For preeclampsia, the maternal characteristics model led to a screening performance of AUC 0.74 (95% CI 0.70‐0.78) with 33% sensitivity at 90% specificity. Addition of second and third trimester placental ultrasound characteristics only improved screening performance for preeclampsia (AUC 0.78 [95% CI 0.75‐0.82], with 48% sensitivity at 90% specificity). Conclusion Routinely measured maternal characteristics, known at the start of pregnancy, can be used in screening for pregnancies at risk of gestational hypertension or preeclampsia within a low‐risk multi‐ethnic population. Addition of combined second and third trimester placental ultrasound characteristics only improved screening for preeclampsia.
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Affiliation(s)
- Jan S Erkamp
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Liesbeth Duijts
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Paediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Irwin K M Reiss
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Paediatrics, Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Annemarie G M G J Mulders
- Department of Obstetrics & Gynaecology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics & Gynaecology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Romy Gaillard
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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123
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Li Y, Ren X, He L, Li J, Zhang S, Chen W. Maternal age and the risk of gestational diabetes mellitus: A systematic review and meta-analysis of over 120 million participants. Diabetes Res Clin Pract 2020; 162:108044. [PMID: 32017960 DOI: 10.1016/j.diabres.2020.108044] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 12/20/2019] [Accepted: 01/27/2020] [Indexed: 11/20/2022]
Abstract
AIMS The objective of the present analysis was to evaluate and quantify the risk for gestational diabetes mellitus (GDM) according to maternal age. METHODS Three electronic databases were searched for publications from inception to July 2018. Odds ratio (OR) and 95% confidence interval (95% CI) were calculated. A dose-response analsis was performed using generalised least squares regression. Subgroup and meta-regression analyses were conducted to explore the source of identified heterogeneity among studies. RESULTS Twenty-four studies were included in the present meta-analysis. The ORs and 95% CIs for women aged <20 years vs 25-29 years, 30-34 years, 35-39 years and ≥40 years were 0.60 (95% CI = 0.50-0.72), 1.69 (95% CI = 1.49-1.93), 2.73 (95% CI = 2.28-3.27), 3.54 (95% CI = 2.88-4.34) and 4.86 (95% CI = 3.78-6.24), respectively. Dose-response analysis showed that GDM risk exhibited a linear relationship with maternal age (Ptrend < 0.001). For each one-year increase in maternal age from 18 years, GDM risk for the overall population, Asian, and Europid increased by 7.90%, 12.74%, and 6.52%, respectively. Subgroup analyses indicated that from the age of 25, Asian women had a significantly higher risk of developing GDM than Europid women (all Pinteractions < 0.001). CONCLUSIONS This meta-analysis demonstrates that the risk of GDM increases linearly with successive age-groups.
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Affiliation(s)
- Yueyi Li
- The First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Xinghua Ren
- School of Traditional Chinese Medicine, Jinan University, Guangzhou 510630, China
| | - Lilan He
- The First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Jing Li
- The First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Shiyi Zhang
- The First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Weiju Chen
- The First Affiliated Hospital, Jinan University, Guangzhou 510630, China.
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Mandakh Y, Rittner R, Flanagan E, Oudin A, Isaxon C, Familari M, Hansson SR, Malmqvist E. Maternal Exposure to Ambient Air Pollution and Risk of Preeclampsia: A Population-Based Cohort Study in Scania, Sweden. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1744. [PMID: 32155988 PMCID: PMC7084298 DOI: 10.3390/ijerph17051744] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 02/28/2020] [Accepted: 03/04/2020] [Indexed: 12/16/2022]
Abstract
The aim of this study was to investigate the risk of developing preeclampsia (PE) associated with gestational exposure to ambient air pollutants in southern Sweden, a low-exposure area. We used a cohort of 43,688 singleton pregnancies and monthly mean exposure levels of black carbon (BC), local and total particulate matter (PM2.5 and PM10), and NOX at the maternal residential address estimated by Gaussian dispersion modeling from 2000 to 2009. Analyses were conducted using binary logistic regression. A subtype analysis for small-for-gestational age (SGA) was performed. All analyses were adjusted for obstetrical risk factors and socioeconomic predictors. There were 1286 (2.9%) PE cases in the analysis. An adjusted odds ratio (AOR) of 1.35 with a 95% confidence interval (CI) of 1.11-1.63 was found when comparing the lowest quartile of BC exposure to the highest quartile in the third trimester The AOR for PE associated with each 5 µg/m3 increase in locally emitted PM2.5 was 2.74 (95% CI: 1.68, 4.47) in the entire pregnancy. Similar patterns were observed for each 5 µg/m3 increment in locally emitted PM10. In pregnancies complicated by PE with SGA, the corresponding AOR for linear increases in BC was 3.48 (95% CI: 1.67, 7.27). In this low-level setting, maternal exposure to ambient air pollution during gestation was associated with the risk of developing PE. The associations seemed more pronounced in pregnancies with SGA complications, a finding that should be investigated further.
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Affiliation(s)
- Yumjirmaa Mandakh
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Scheelevägen 8, Building 402A, 22381 Lund, Sweden; (Y.M.); (R.R.); (E.F.); (A.O.)
| | - Ralf Rittner
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Scheelevägen 8, Building 402A, 22381 Lund, Sweden; (Y.M.); (R.R.); (E.F.); (A.O.)
| | - Erin Flanagan
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Scheelevägen 8, Building 402A, 22381 Lund, Sweden; (Y.M.); (R.R.); (E.F.); (A.O.)
| | - Anna Oudin
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Scheelevägen 8, Building 402A, 22381 Lund, Sweden; (Y.M.); (R.R.); (E.F.); (A.O.)
| | - Christina Isaxon
- Department of Ergonomics and Aerosol Technology, Lund University, Sölvegatan 26, Box 118, 22100 Lund, Sweden;
| | - Mary Familari
- School of BioSciences, University of Melbourne, Parkville, Melbourne 3010, Australia;
| | - Stefan Rocco Hansson
- Division of Obstetrics and Gynecology, Department of Clinical Sciences, Lund University, Klinikgatan 12, 22185 Lund, Sweden;
| | - Ebba Malmqvist
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Scheelevägen 8, Building 402A, 22381 Lund, Sweden; (Y.M.); (R.R.); (E.F.); (A.O.)
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Guo Z, Xu X, Zhang L, Zhang L, Yan L, Ma J. Endometrial thickness is associated with incidence of small-for-gestational-age infants in fresh in vitro fertilization-intracytoplasmic sperm injection and embryo transfer cycles. Fertil Steril 2020; 113:745-752. [PMID: 32147172 DOI: 10.1016/j.fertnstert.2019.12.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/26/2019] [Accepted: 12/06/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate whether endometrial thickness (EMT) is associated with adverse obstetric and neonatal outcomes in fresh in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) cycles. DESIGN Retrospective cohort study. SETTING University-based reproductive medical center. PATIENT(S) Women under the age of 42 years who underwent IVF/ICSI treatment and received fresh ET in our unit from January 2017 to December 2018, resulting in a live singleton birth. INTERVENTION(S) Controlled ovarian hyperstimulation and IVF/ICSI; fresh ET. MAIN OUTCOME MEASURE(S) Birth weight, gestational age, small for gestational age (SGA), large for gestational age (LGA), placenta previa, placental abruption, hypertensive disorders, and gestational diabetes mellitus. RESULT(S) The risk of being born SGA was statistically significantly increased in the EMT ≤7.5 mm group compared with those from the EMT >12 mm group (adjusted odds ratio [aOR] 2.391; 95% confidence interval [CI], 1.155-4.950). Moreover, maternal body mass index, secondary infertility, preterm delivery, and hypertensive disorders were all independent predictors for SGA. The mean birth weights of singletons in women with EMT ≤7.5 mm were lower than in the groups with EMT >7.5-12 mm and EMT >12 mm (3.25 ± 0.56 kg vs. 3.38 ± 0.51 kg and 3.39 ± 0.53 kg, respectively). CONCLUSION(S) After fresh IVF/ICSI-ET, the risk of SGA was increased twofold in women with EMT ≤7.5 mm compared with women with EMT >12 mm. We suggest that women with a thin EMT after obtaining a pregnancy by IVF should receive improved prenatal care to reduce the risk of delivering a SGA infant.
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Affiliation(s)
- Zizhen Guo
- School of Medicine, Shandong University, Jinan, People's Republic of China; Center for Reproductive Medicine, Reproductive Hospital Affiliated to Shandong University, Jinan, People's Republic of China; National Research Centre for Assisted Reproductive Technology and Reproductive Genetics, Jinan, People's Republic of China; Key Laboratory of Reproductive Endocrinology at Shandong University, Ministry of Education, Jinan, People's Republic of China
| | - Xinxin Xu
- Center for Reproductive Medicine, Reproductive Hospital Affiliated to Shandong University, Jinan, People's Republic of China
| | - Lin Zhang
- Key Laboratory of Birth Regulation and Control Technology of National Health Commission of China, Shandong Maternal and Child Health Care Hospital, Jinan, People's Republic of China
| | - Liping Zhang
- School of Medicine, Shandong University, Jinan, People's Republic of China; Center for Reproductive Medicine, Reproductive Hospital Affiliated to Shandong University, Jinan, People's Republic of China; National Research Centre for Assisted Reproductive Technology and Reproductive Genetics, Jinan, People's Republic of China; Key Laboratory of Reproductive Endocrinology at Shandong University, Ministry of Education, Jinan, People's Republic of China
| | - Lei Yan
- School of Medicine, Shandong University, Jinan, People's Republic of China; Center for Reproductive Medicine, Reproductive Hospital Affiliated to Shandong University, Jinan, People's Republic of China; National Research Centre for Assisted Reproductive Technology and Reproductive Genetics, Jinan, People's Republic of China; Key Laboratory of Reproductive Endocrinology at Shandong University, Ministry of Education, Jinan, People's Republic of China.
| | - Jinlong Ma
- Center for Reproductive Medicine, Reproductive Hospital Affiliated to Shandong University, Jinan, People's Republic of China; National Research Centre for Assisted Reproductive Technology and Reproductive Genetics, Jinan, People's Republic of China; Key Laboratory of Reproductive Endocrinology at Shandong University, Ministry of Education, Jinan, People's Republic of China
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Minglu L, Fang F, Guanxi L, Yuxiang Z, Chaoqiong D, Xueqin Z. Influencing factors and correlation of anxiety, psychological stress sources, and psychological capital among women pregnant with a second child in Guangdong and Shandong Province. J Affect Disord 2020; 264:115-122. [PMID: 32056740 DOI: 10.1016/j.jad.2019.11.148] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/11/2019] [Accepted: 11/30/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND After the one-child policy has been effective for over 30 years, China implemented the universal two-child policy in 2015. The number of high-risk pregnant women had increased dramatically ever since, increasing negative health outcomes for both mothers and children. Our study aims to investigate the status of anxiety, psychological stress sources, and psychological capital among women pregnant with a second child, and to assess influencing factors and correlations, providing scientific basis for promoting women's health during pregnancy. METHODS We recruited 513 participants from maternity hospitals in Guangdong and Shandong Province. All participants completed the Zung Self-Rating Anxiety Scale (SAS), Pregnant women psychological stress sources questionnaire and the psychological capital questionnaire (PCQ-24). RESULTS The prevalence of anxiety of women pregnant with a second child was 27.5%. The score of psychological stress sources was 74.93 ± 16.07. The risk factors for the anxiety of the women pregnant with a second child included low education level of the husband, gender expectation and the sources of psychological stress of the pregnant woman. The risk factors for psychological stress were dissatisfaction of residence and unplanned pregnancy. The main factors influencing psychological capital were the participants' education level, whether they have learned antenatal care knowledge and satisfaction with the residence. LIMITATIONS All participants were recruited only from tertiary hospitals in Guangdong and Shandong province. CONCLUSIONS Anxiety and psychological stress is prevalent during pregnancy among women pregnant with a second child in Guangdong and Shandong. Psychological capital was a protective factor for anxiety.
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Affiliation(s)
- Liao Minglu
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, 510370, China; School of Health Management, Guangzhou Medical University, Guangzhou, 510182, China.
| | - Fang Fang
- Faculty of Medicine, Macau University of Science and Technology
| | - Liu Guanxi
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, 510370, China; School of Health Management, Guangzhou Medical University, Guangzhou, 510182, China.
| | - Zhang Yuxiang
- Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde)
| | - Deng Chaoqiong
- School of Health Management, Guangzhou Medical University, Guangzhou, 510182, China
| | - Zhang Xueqin
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, 510370, China; School of Health Management, Guangzhou Medical University, Guangzhou, 510182, China.
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Cheng J, Li J, Tang X. Analysis of perinatal risk factors for small-for-gestational-age and appropriate-for-gestational-age late-term infants. Exp Ther Med 2020; 19:1719-1724. [PMID: 32104225 PMCID: PMC7026981 DOI: 10.3892/etm.2020.8417] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 11/05/2019] [Indexed: 01/26/2023] Open
Abstract
To investigate the potential risk factors for small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) late-term infants, 100 cases of single full-term SGA infants delivered in the Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University in 2017 were enrolled as the SGA group. A total of 100 healthy AGA who were born at the same time with the same gestational age were randomly included as the control group. The perinatal and postpartum adverse conditions of the two groups were recorded, and Apgar tests were performed on all newborns at 1 min (T1), 5 min (T2) and 10 min (T3) after birth. A follow-up survey was conducted in all patients at 6 and 12 months of age. At the second follow-up, the development quotient of the children was measured using the Gesell Developmental Schedule, and the perinatal risk factors of SGA were analyzed. The incidence of intrauterine distress, respiratory distress syndrome and infectious disease in the SGA group was significantly higher compared with that in the AGA group (P<0.05). The Apgar scores at T1, T2 and T3 were significantly lower in the SGA group compared with the AGA group (P<0.05). The Apgar score at T1 was lower compared with that at T2 in the SGA group (P<0.05), and the Apgar score at T2 was lower compared with that at T3 (P<0.05). The length of hospital stay in the SGA group was significantly longer compared with that in the AGA group (P<0.05). The development quotient at the 6 and 12th month in the SGA group was significantly lower compared with that in the AGA group (P<0.05). Logistic regression analysis showed that there was no correlation between SGA and maternal age, regardless of firstborn status, neonatal sex, mode of delivery and living environment. SGA was significantly associated with umbilical cord abnormalities, maternal pregnancy-induced hypertension, gestational diabetes, pregnancy infection and intrauterine distress (P<0.05). An abnormal umbilical cord, maternal pregnancy-induced hypertension, gestational diabetes, infection during pregnancy and intrauterine distress are all perinatal risk factors for SGA. Effective interventions are needed in clinical assessment to prevent the occurrence of SGA.
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Affiliation(s)
- Jing Cheng
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Junqi Li
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Xiqin Tang
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
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Jun S, Gahche JJ, Potischman N, Dwyer JT, Guenther PM, Sauder KA, Bailey RL. Dietary Supplement Use and Its Micronutrient Contribution During Pregnancy and Lactation in the United States. Obstet Gynecol 2020; 135:623-633. [PMID: 32028492 PMCID: PMC7138460 DOI: 10.1097/aog.0000000000003657] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To estimate the prevalence of use and the micronutrient contribution of dietary supplements among pregnant, lactating, and nonpregnant and nonlactating women in the United States. METHODS Cross-sectional data from 1,314 pregnant, 297 lactating, and 8,096 nonpregnant and nonlactating women (aged 20-44 years) in the 1999-2014 National Health and Nutrition Examination Survey were combined to produce statistically reliable, nationally representative estimates. Information about dietary supplements used in the past 30 days was collected through an interviewer-administered questionnaire and in-home inventory. The prevalence of nutrient-specific supplement use, mean daily nutrient intakes from supplements among users, and motivations for supplement use were assessed. Differences by age, income, and trimester within pregnant women were also tested. RESULTS Seventy-seven percent of pregnant women and 70% of lactating women used one or more dietary supplements, whereas 45% of nonpregnant and nonlactating women used supplements. In particular, 64% of pregnant and 54% of lactating women used prenatal supplements. Mean intakes of thiamin, riboflavin, niacin, folic acid, vitamins B6, B12, and C, iron, and zinc from supplements alone were at or above their respective recommended dietary allowances (RDAs) among pregnant and lactating supplement users. About half of pregnant and 40% of lactating women took supplements based on the recommendation of a health care provider. Among pregnant women, those in their first trimester, aged 20-34 years, or in a lower-income family were less likely to use supplements compared with their counterparts. CONCLUSION The majority of pregnant and lactating women used dietary supplements, which contributed many nutrients in doses above the RDAs. Although inadequate Intakes of folate and iron are of concern among pregnant women who are not using supplements, supplement users often consumed high doses, suggesting a potential need of health care providers to discuss dietary supplement use and the recommended doses of nutrients during pregnancy and lactation.
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Affiliation(s)
- Shinyoung Jun
- Department of Nutrition Science, Purdue University, West Lafayette, IN, 47907
| | - Jaime J. Gahche
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD 20892-7517
| | - Nancy Potischman
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD 20892-7517
| | - Johanna T. Dwyer
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD 20892-7517
| | - Patricia M. Guenther
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT 84112
| | - Katherine A. Sauder
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO 80045
| | - Regan L. Bailey
- Department of Nutrition Science, Purdue University, West Lafayette, IN, 47907
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129
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Pantos K, Sfakianoudis K, Grigoriadis S, Maziotis E, Tsioulou P, Rapani A, Giannelou P, Atzampos A, Koulouraki S, Koutsilieris M, Vlahos N, Mastorakos G, Simopoulou M. Could the Age Difference of a Single Calendar Year between Patients Undergoing IVF at 34, 35 or at 36 Years Old Affect the IVF Outcome? A Retrospective Data Analysis. ACTA ACUST UNITED AC 2020; 56:medicina56020092. [PMID: 32102386 PMCID: PMC7074270 DOI: 10.3390/medicina56020092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 01/24/2023]
Abstract
Background and Objectives: Clinicians are called to overcome age-related challenges in decision making during In Vitro Fertilization (IVF) treatment. The aim of this study was to investigate the possible impact of a single calendar year difference among patients aged 34, 35 and 36 on IVF outcomes. Materials and Methods: Medical records between 2008 and 2019 were analyzed retrospectively. The study group consisted of women diagnosed with tubal factor infertility. Sample size was divided in three categories at 34, 35 and 36 years of age. Embryo transfer including two blastocysts was performed for every patient. Comparisons were performed regarding hormonal profile, response to stimulation, quality of transferred embryos, positive hCG test and clinical pregnancy rate. Results: A total of 706 women were eligible to participate. Two-hundred and forty-eight women were 34, 226 were 35 while the remaining 232 were 36 years old. Regarding the hormonal profile, the number of accumulated oocytes and the quality of embryos transferred, no statistically significant difference was documented between the three age groups. Women aged 34 and 35 years old indicated a significantly increased positive hCG rate in comparison to women aged 36 years old (p-value = 0.009, p-value = 0.023, respectively). Women aged 34 and 35 years old presented with a higher clinical pregnancy rate in comparison to those aged 36 years old (p-value = 0.04, p-value = 0.05, respectively). Conclusion: A calendar year difference between patients undergoing IVF treatment at 34 or 35 years of age does not appear to exert any influence regarding outcome. When treatment involves patients above the age of 35, then a single calendar year may exert considerable impact on IVF outcome. This observation indicates that age 35 may serve as a valid cut-off point regarding IVF outcome.
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Affiliation(s)
- Konstantinos Pantos
- Centre for Human Reproduction, Genesis Athens Clinic, 14–16, Papanikoli, 15232 Athens, Greece; (K.P.); (K.S.); (P.G.)
| | - Konstantinos Sfakianoudis
- Centre for Human Reproduction, Genesis Athens Clinic, 14–16, Papanikoli, 15232 Athens, Greece; (K.P.); (K.S.); (P.G.)
| | - Sokratis Grigoriadis
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece; (S.G.); (E.M.); (P.T.); (A.R.); (A.A.); (M.K.)
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece; (S.K.); (N.V.); (G.M.)
| | - Evangelos Maziotis
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece; (S.G.); (E.M.); (P.T.); (A.R.); (A.A.); (M.K.)
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece; (S.K.); (N.V.); (G.M.)
| | - Petroula Tsioulou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece; (S.G.); (E.M.); (P.T.); (A.R.); (A.A.); (M.K.)
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece; (S.K.); (N.V.); (G.M.)
| | - Anna Rapani
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece; (S.G.); (E.M.); (P.T.); (A.R.); (A.A.); (M.K.)
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece; (S.K.); (N.V.); (G.M.)
| | - Polina Giannelou
- Centre for Human Reproduction, Genesis Athens Clinic, 14–16, Papanikoli, 15232 Athens, Greece; (K.P.); (K.S.); (P.G.)
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece; (S.G.); (E.M.); (P.T.); (A.R.); (A.A.); (M.K.)
| | - Anastasios Atzampos
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece; (S.G.); (E.M.); (P.T.); (A.R.); (A.A.); (M.K.)
| | - Sevasti Koulouraki
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece; (S.K.); (N.V.); (G.M.)
| | - Michael Koutsilieris
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece; (S.G.); (E.M.); (P.T.); (A.R.); (A.A.); (M.K.)
| | - Nikolaos Vlahos
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece; (S.K.); (N.V.); (G.M.)
| | - George Mastorakos
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece; (S.K.); (N.V.); (G.M.)
| | - Mara Simopoulou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece; (S.G.); (E.M.); (P.T.); (A.R.); (A.A.); (M.K.)
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece; (S.K.); (N.V.); (G.M.)
- Correspondence: ; Tel.: +302107462592
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Yaya S, Bishwajit G. Exposure to second-hand smoking as a predictor of fetal loss: Egypt Demographic and Health Survey 2014. Int Health 2020; 11:561-567. [PMID: 31184367 DOI: 10.1093/inthealth/ihz021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 02/13/2019] [Accepted: 03/18/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Exposure to tobacco smoking during pregnancy has been shown to be associated with elevated risk of adverse pregnancy outcomes such as miscarriage and stillbirth. However, little is known regarding the association between passive smoking and birth outcomes. This study aims to measure the prevalence of passive smoking and assess its relationship with adverse birth outcomes. METHODS Self-reported birth outcomes (stillbirth/miscarriage/abortion) was the dependent variable that was regressed against self-reported exposure to household smoking along with various individual and community-level factors. We used propensity score matching to identify the sample and used regression analysis to quantify the association between passive smoking and birth outcomes. Sensitivity analysis was conducted to check for the robustness of the associations. RESULTS Of the 5540 women studied, about half (50.3%, 95% CI=49.3-51.3) reported being exposed to smoking by household members. The prevalence of stillbirth was 14.6% (95% CI=13.9-15.3). In the logistic regression analysis, the confounder-adjusted OR of stillbirth in relation to exposure to smoking was 1.321 (95% CI=1.150-1.517). In the subgroup analysis, we found that the association was significant among certain age groups only. CONCLUSION The findings of the present study imply a mildly positive association between the occurrence of stillbirth and exposure to smoking in the household.
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Affiliation(s)
- Sanni Yaya
- Faculty of Social Sciences, School of International Development and Global Studies, University of Ottawa, Canada
| | - Ghose Bishwajit
- Faculty of Social Sciences, School of International Development and Global Studies, University of Ottawa, Canada.,School of Medicine and Health Medicine, Tongji Medical College, Wuhan, Hubei, China
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131
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Detti L, Francillon L, Christiansen ME, Peregrin-Alvarez I, Goeske PJ, Bursac Z, Roman RA. Early pregnancy ultrasound measurements and prediction of first trimester pregnancy loss: A logistic model. Sci Rep 2020; 10:1545. [PMID: 32005925 PMCID: PMC6994659 DOI: 10.1038/s41598-020-58114-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/10/2020] [Indexed: 11/09/2022] Open
Abstract
Our objective was to prospectively validate the use of gestational sac (GS), yolk sac (YS) diameter, crown-rump length (CRL), and embryonal heart rate (HR) dimensions to identify early pregnancy loss. This was a prospective cohort study of first trimester pregnancies. GS and YS diameter, CRL, and HR measurements were serially obtained in singleton and twin pregnancies from 6 through 10 weeks' gestation. Non-parametric tests and logistic regression models were used for comparisons of distributions and testing of associations. A total of 252 patients were included, of which 199 were singleton pregnancies, 51 were twins, and 2 were triplets (304 total fetuses). Fifty-two patients had 61 losses. We built nomograms with the changes of the parameters evaluated in ongoing, as well as in pregnancy loss. In the pregnancies which failed, all the parameters showed significant changes, with different temporal onsets: GS and YS were the first to become abnormal, deviating from normality as early as 6 weeks' gestation (OR 0.01, 95% CI 0.0-0.09, and OR 3.36, 95% CI 1.53-7.34, respectively), followed by changes in HR, and CRL, which became evident at 7 and 8 weeks (OR 0.96, 95% CI 0.92-1.0, and OR 0.59, 95% CI 0.48-0.73, respectively). Our observations showed that, after 5 complete weeks' gestation, a small GS and a large YS reliably predicted pregnancy loss. The YS reliably identified the occurrence of a miscarriage at least 7 days prior its occurrence. CRL and HR became abnormal at a later time in pregnancy and closer to the event. These findings have important implications for patient counseling and care planning, as well as a potential bearing on cost effectiveness within early pregnancy care.
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Affiliation(s)
- Laura Detti
- University of Tennessee Health Science Center, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Memphis, Tennessee, USA. .,Cleveland Clinic, Women's Health Institute, Department of Obstetrics and Gynecology, Cleveland, Ohio, USA.
| | - Ludwig Francillon
- University of Tennessee Health Science Center, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Memphis, Tennessee, USA
| | - Mary E Christiansen
- University of Tennessee Health Science Center, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Memphis, Tennessee, USA
| | - Irene Peregrin-Alvarez
- University of Tennessee Health Science Center, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Memphis, Tennessee, USA
| | - Patricia J Goeske
- University of Tennessee Health Science Center, Division of Biostatistics, Department of Preventive Medicine, Memphis, Tennessee, USA
| | - Zoran Bursac
- Cleveland Clinic, Women's Health Institute, Department of Obstetrics and Gynecology, Cleveland, Ohio, USA.,Florida International University, Department of Biostatistics, Miami, Florida, USA
| | - Robert A Roman
- University of Tennessee Health Science Center, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Memphis, Tennessee, USA
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Mehari MA, Maeruf H, Robles CC, Woldemariam S, Adhena T, Mulugeta M, Haftu A, Hagose H, Kumsa H. Advanced maternal age pregnancy and its adverse obstetrical and perinatal outcomes in Ayder comprehensive specialized hospital, Northern Ethiopia, 2017: a comparative cross-sectional study. BMC Pregnancy Childbirth 2020; 20:60. [PMID: 32000714 PMCID: PMC6993443 DOI: 10.1186/s12884-020-2740-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 01/14/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Advanced maternal age generally denotes age after 35 years during the time of delivery. Despite the fact that being pregnant at any reproductive age is not risk-free, older gravidity usually culminates with adverse outcomes both to the mother and fetus or neonate. This study aimed to determine the association of adverse obstetrical and perinatal outcomes with advanced maternal age pregnancy. The study was conducted in Ayder comprehensive specialized hospital, north Ethiopia, from 2015 to 2017. METHODS chart review comparative cross-sectional study was employed. Data were retrieved from medical charts of 752 pregnant mothers (376 each for both the study;> 35-year-old and reference group;20-34 year old). Data was collected using a pretested and structured checklist using systematic sampling and data was entered & analyzed using SPSS version 20. Binary and multivariable logistic regression was run to determine the association of independent variables with dependent variables. RESULTS This study revealed that advanced maternal age pregnancy was significantly associated with pregnancy induced hypertension [AOR 4.15, 95% CI (2.272-7.575), p < 0.001], ante partum hemorrhage [AOR 2.54, 95% CI (1.32-4.91), P = 0.005] & cesarean delivery [AOR 2.722, 95% CI (1.777-4.170), p < 0.001]. Furthermore, advanced maternal age pregnancy was also increasingly associated with adverse perinatal outcomes like preterm delivery [AOR 3.622, 95% CI (1.469-8.930), p = 0.005], low birth weight [AOR 3.137, 95% CI (1.324-7.433), p = 0.009], perinatal death [AOR 2.54, 95% CI (1.141-5.635), p = 0.022] and low fifth minute APGAR score [AOR 7.507, 95% CI (3.134-17.98), p < 0.001]. Notwithstanding this, maternal age was not found to be associated with amniotic fluid disturbances, premature rupture of membranes and post-term pregnancy. CONCLUSIONS Advanced maternal age is markedly linked with adverse obstetrical and perinatal outcomes. Therefore, it is better for health care providers to counsel couples, who seek to have a child in their later ages, about the risks of advanced maternal age pregnancy. In addition, health care workers need to emphasize on how to improve advanced age mothers' health through the utilization of contraception to reduce pregnancy in this age group.
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Affiliation(s)
- Mihret-ab Mehari
- Mekelle University, College of Health Sciences, P.O. Box 1871, Mekelle, Ethiopia
| | - Hayat Maeruf
- Dr. Tewelde Legesse Health Sciences College, P.O. Box 306, Mekelle, Ethiopia
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Yin O, Woods A, Koos B, DeVore G, Afshar Y. Central hemodynamics are associated with fetal outcomes in pregnancies of advanced maternal age. Pregnancy Hypertens 2019; 19:67-73. [PMID: 31923879 DOI: 10.1016/j.preghy.2019.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/17/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Age is a known risk factor for both maternal cardiovascular disease and adverse outcomes in pregnancy. We aimed to characterize the hemodynamic profiles in pregnancies of advanced maternal age (AMA) and correlate these with fetal outcomes. STUDY DESIGN This was a prospective observational study of pregnancies undergoing antenatal testing. Maternal hemodynamics were measured non-invasively using an imaging probe at the descending aorta and the Uscom BP + arm cuff utilizing pulse pressure wave analysis. The Wilcoxon rank-sum test, Fisher's exact test, and Spearman rank correlation test were used for statistical analysis in R. MAIN OUTCOME MEASURES Hemodynamic measurements, neonatal birthweight. RESULTS Twenty-one AMA and twenty-four control patients were enrolled. Mean age ± SD was 39 ± 3.22 in the AMA cohort and 28 ± 4.32 in the control cohort (p < 0.001). AMA patients were evaluated at a later gestational age (36 4/7 weeks) compared to control (34 1/7 weeks, p = 0.02). Between groups, there was no difference in BMI, race, hypertensive disease, diabetes, asthma, drug use, or indication for antenatal testing. 38% (AMA) and 37% (control) had hypertensive disorders of pregnancy. In AMA patients but not control patients, cardiac output (r = 0.52, p = 0.01), systemic vascular resistance (r = -0.53, p = 0.01), and systemic vascular resistance index (r = -0.62, p = 0.002) were significantly correlated with neonatal birthweight percentile. CONCLUSIONS Hemodynamic alterations consistent with a low output, high resistance cardiovascular circuit were associated with lower birthweight in AMA, but not in control pregnancies.
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Affiliation(s)
- Ophelia Yin
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, United States
| | - Allison Woods
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, United States
| | - Brian Koos
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, United States
| | - Greggory DeVore
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, United States
| | - Yalda Afshar
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, United States.
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Scime NV, Chaput KH, Faris PD, Quan H, Tough SC, Metcalfe A. Pregnancy complications and risk of preterm birth according to maternal age: A population-based study of delivery hospitalizations in Alberta. Acta Obstet Gynecol Scand 2019; 99:459-468. [PMID: 31713841 DOI: 10.1111/aogs.13769] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 11/04/2019] [Accepted: 11/06/2019] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Pregnancy-related medical complications are associated with a 2- to 5-fold increased risk of preterm birth (PTB), but the nature of this etiologic relation in context with maternal factors remains poorly understood. Previous studies have generally treated maternal age as a confounder but overlooked its potential as an effect modifier, whereby the magnitude of the effect of complications on PTB could differ significantly across age groups. We investigated whether advanced maternal age (≥35 years) modified the association between pregnancy complications and PTB, and compared population-attributable fractions of PTB from complications in women older vs younger than 35 years. MATERIAL AND METHODS We analyzed population-based, cross-sectional data from the Alberta Discharge Abstract Database for women aged 18-50 years with singleton live births in hospital between 2014 and 2017 (n = 152 246). Complications were preeclampsia, gestational diabetes, and placental disorders identified using diagnostic codes. Outcomes were spontaneous (sPTB) or iatrogenic (iPTB) PTB before 37 weeks of gestation. We estimated risk ratios and risk differences using modified Poisson and log binomial regression, respectively, adjusting for confounders (pregnancy history, comorbidities). Population-attributable fractions estimates were calculated from risk ratios. Age modification was tested using interaction terms and Z-tests. RESULTS Prevalence of advanced maternal age was 19.2%. Pregnancy complications and s/iPTB were more common among women aged ≥35 years. Age modified the risk of PTB from preeclampsia only, with risk differences of 9.9% (95% CI 7.2%-12.6%) in older women vs 6.1% (95% CI 4.8%-7.4%) in younger women (P-interaction = 0.012) for sPTB, and 29.5% (95% CI 26.0%-33.1%) vs 20.8% (95% CI 18.9%-22.6%, P-interaction <0.001) for iPTB. Population-attributable fractions of s/iPTB types for all complications were consistently 2%-5% larger in women aged ≥35 years, and significantly larger for preeclampsia (sPTB: 5.1% vs 2.7%, P = 0.002; iPTB: 18.8% vs 14.0%, P < 0.001) and placental disorders (sPTB: 12.5% vs 8.7%, P < 0.001; iPTB: 13.2% vs 8.9%, P < 0.001). CONCLUSIONS Of the pregnancy complications studied, advanced maternal age only modified the association between PTB and preeclampsia, such that older women with preeclampsia have a higher risk for s/iPTB than younger counterparts. Pregnancy complications contribute to a sizable proportion of PTBs in Alberta, especially among women aged ≥35 years. Findings may inform clinical risk assessment and population-level policy targeting PTB.
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Affiliation(s)
- Natalie V Scime
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Katie H Chaput
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Peter D Faris
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Hude Quan
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Suzanne C Tough
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Amy Metcalfe
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Association between advanced maternal age and maternal and neonatal morbidity: A cross-sectional study on a Spanish population. PLoS One 2019; 14:e0225074. [PMID: 31770385 PMCID: PMC6879127 DOI: 10.1371/journal.pone.0225074] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/27/2019] [Indexed: 11/19/2022] Open
Abstract
Background and objective Over recent decades, a progressive increase in the maternal age at childbirth has been observed in developed countries, posing a health risk for both women and infants. The aim of this study was to analyze the association between advanced maternal age (AMA) and maternal and neonatal morbidity. Material and methods A cross-sectional study of 3,315 births was conducted in the north of Spain in 2014. We compared childbirth between women aged 35 years or older, with a reference group of women aged between 24 and 27 years. AMA was categorized based on ordinal ranking into 35–38 years, 39–42 years, and >42 years to estimate a dose-response pattern (the older the age, the greater the risk). As an association measure, crude and adjusted Odds Ratios (OR) were estimated by non-conditional logistic regression and 95% Confidence Intervals (95%CI) were calculated. Results Repeated abortions were more common among women of AMA in comparison to pregnant women aged 24–27 years (reference group): adjusted OR = 2.68; 95%CI (1.52–4.73). A higher prevalence of gestational diabetes was also observed among women of AMA, reaching statistical significance when restricted to first time mothers: adjusted OR = 8.55; 95%CI (1.12–65.43). In addition, the possibility of an instrumental delivery was multiplied by 1.6 and the possibility of a cesarean by 1.5 among women of AMA, with these results reaching statistical significance, and observing a dose-response pattern. Lastly, there were associations between preeclampsia, preterm birth (<37 weeks) and low birthweight, however without reaching statistical significance. Conclusion Our results support the association between AMA and suffering repeated abortions. Likewise, being of AMA was associated with a greater risk of suffering from gestational diabetes, especially among primiparous women, as well as being associated with both instrumental deliveries and cesareans among both primiparous and multiparous women.
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136
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Does parity affect pregnancy outcomes in the elderly gravida? Arch Gynecol Obstet 2019; 301:85-91. [PMID: 31768744 DOI: 10.1007/s00404-019-05386-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/09/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To identify whether older primiparas have more complications than do women who continue to deliver children into their late reproductive age. Patients of at least 35 years of age at delivery were included. Within this cohort, data from primiparous and multiparous women were compared. METHODS This retrospective study was based on electronic medical records from a single academic center, with more than 7000 deliveries annually. The impact of parity on maternal complications was assessed using a multivariate logistic regression model that adjusted for baseline maternal characteristics and medical history. RESULTS During the study period, there were 54 283 deliveries in our medical center. A total of 13,982 (25.7%) patients were at least 35 years old at delivery. The rate of twin pregnancy was higher in the primiparous group (1.9%) as compared to the multiparous group (0.8%, 95% CI 0.30-0.64, P < 0.001), as was the incidence of delivery prior to 34 weeks (6.1% of the primiparas versus 2.9% of the multiparas, P < 0.001, OR 2.16, 95% CI 1.75-2.68); hypertensive disorders (3.9% versus 1.7%, P < 0.001, 95% CI 0.33-0.57); diabetes (4.6% versus 3.2%, P = 0.003, 95% CI 0.55-0.88); and IUGR (10.5% versus 4.7%, P < 0.001, 95% CI 0.35-049), respectively. The increased risk for pre-term delivery, hypertensive disorders, diabetes, and IUGR was maintained after logistic regression analysis. CONCLUSION We found that pregnancy complications typical to older parous women are significantly more common among primiparas, indicating that not only older age, but also having a first child relatively late in the reproductive period contributes to adverse pregnancy outcomes.
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137
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Rubenstein E, Durkin MS, Harrington RA, Kirby RS, Schieve LA, Daniels J. Relationship Between Advanced Maternal Age and Timing of First Developmental Evaluation in Children with Autism. J Dev Behav Pediatr 2019; 39:601-609. [PMID: 30004996 PMCID: PMC6195454 DOI: 10.1097/dbp.0000000000000601] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Mothers of advanced maternal age (AMA) at childbirth (age ≥35 years) may have different perceptions of autism spectrum disorder (ASD) risk, independent of sociodemographic factors, that may affect ASD identification. We aimed to estimate associations between AMA and both age of a child's first evaluation noting developmental concerns and time from first evaluation to first ASD diagnosis. METHODS We used data for 8-year-olds identified with ASD in the 2008 to 2012 Autism and Developmental Disabilities Monitoring Network. We estimated differences in age at first evaluation noting developmental concerns and time to first ASD diagnosis by AMA using quantile and Cox regression. RESULTS Of 10,358 children with ASD, 19.7% had mothers of AMA. AMA was associated with higher educational attainment and previous live births compared with younger mothers. In unadjusted analyses, AMA was associated with earlier first evaluation noting developmental concerns (median 37 vs 40 mo) and patterns in time to first evaluation (hazard ratio: 1.12, 95% confidence interval: 1.06-1.18). Associations between AMA and evaluation timing diminished and were no longer significant after adjustment for socioeconomic and demographic characteristics. Children's intellectual disability did not modify associations between AMA and timing of evaluations. CONCLUSION Advanced maternal age is a sociodemographic factor associated with younger age of first evaluation noting developmental concerns in children with ASD, but AMA was not independently associated likely, because it is a consequence or cofactor of maternal education and other sociodemographic characteristics. AMA may be a demographic factor to consider when aiming to screen and evaluate children at risk for ASD.
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Affiliation(s)
- Eric Rubenstein
- Waisman Center, University of Wisconsin-Madison, Madison, WI
| | - Maureen S Durkin
- Department of Population Health Science, Waisman Center, University of Wisconsin-Madison, Madison, WI
| | - Rebecca A Harrington
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Russell S Kirby
- Department of Community and Family Health, University of South Florida, Tampa, FL
| | - Laura A Schieve
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Julie Daniels
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, NC
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Koshida S, Arima H, Fujii T, Ito Y, Murakami T, Takahashi K. Impact of advanced maternal age on adverse infant outcomes: A Japanese population-based study. Eur J Obstet Gynecol Reprod Biol 2019; 242:178-181. [DOI: 10.1016/j.ejogrb.2019.08.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/12/2019] [Accepted: 08/21/2019] [Indexed: 10/26/2022]
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Chen YH, Li L, Chen W, Liu ZB, Ma L, Gao XX, He JL, Wang H, Zhao M, Yang YY, Xu DX. Pre-pregnancy underweight and obesity are positively associated with small-for-gestational-age infants in a Chinese population. Sci Rep 2019; 9:15544. [PMID: 31664141 PMCID: PMC6820714 DOI: 10.1038/s41598-019-52018-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 10/10/2019] [Indexed: 01/12/2023] Open
Abstract
The association between suboptimal pre-pregnancy body mass index (BMI) and small-for-gestational-age (SGA) infants is not well defined. We investigated the association between pre-pregnancy BMI and the risk of SGA infants in a Chinese population. We performed a cohort study among 12029 mothers with a pregnancy. This cohort consisted of pregnant women that were: normal-weight (62.02%), underweight (17.09%), overweight (17.77%) and obese (3.12%). Birth sizes were reduced in the underweight and obese groups compared with the normal-weight group. Linear regression analysis indicated that birth size was positively associated with BMI in both the underweight and normal-weight groups. Further analysis showed that 12.74% of neonates were SGA infants in the underweight group, higher than 7.43% of neonates reported in the normal-weight group (adjusted RR = 1.92; 95% CI: 1.61, 2.30). Unexpectedly, 17.60% of neonates were SGA infants in the obese group, much higher than the normal-weight group (adjusted RR = 2.17; 95% CI: 1.57, 3.00). Additionally, 18.40% of neonates were large-for-gestational-age (LGA) infants in the obese group, higher than 7.26% of neonates reported in the normal-weight group (adjusted RR = 3.00; 95% CI: 2.21, 4.06). These results suggest that pre-pregnancy underweight increases the risk of SGA infants, whereas obesity increases the risks of not only LGA infants, but also SGA infants.
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Affiliation(s)
- Yuan Hua Chen
- School of Basic Medical Sciences, Anhui Medical University, Hefei, 230032, China. .,School of Public Health, Anhui Medical University, Hefei, 230032, China. .,Implantation and Placental Development Laboratory, Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, VIC, Australia.
| | - Li Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Wei Chen
- School of Basic Medical Sciences, Anhui Medical University, Hefei, 230032, China
| | - Zhi Bing Liu
- School of Public Health, Anhui Medical University, Hefei, 230032, China
| | - Li Ma
- School of Public Health, Anhui Medical University, Hefei, 230032, China
| | - Xing Xing Gao
- School of Basic Medical Sciences, Anhui Medical University, Hefei, 230032, China
| | - Jia Liu He
- School of Public Health, Anhui Medical University, Hefei, 230032, China
| | - Hua Wang
- School of Public Health, Anhui Medical University, Hefei, 230032, China
| | - Mei Zhao
- School of Nursing, Anhui Medical University, Hefei, 230032, China
| | - Yuan Yuan Yang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - De Xiang Xu
- School of Public Health, Anhui Medical University, Hefei, 230032, China.
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Alzola I, Murua E, Rodríguez J, Burgos J, Maiz N. Can the Progression Angle before Labor Help to Predict Cesarean Section? Fetal Diagn Ther 2019; 47:284-291. [PMID: 31645041 DOI: 10.1159/000503387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 09/06/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to predict cesarean section on a single visit at term using a combination of maternal history and ultrasound markers, including some new markers such as the progression angle used to assess intrapartum progress. STUDY DESIGN This was an observational prospective cohort study of singleton term pregnancies that included 575 women. The maternal history and ultrasound markers were obtained on a single visit at 37-38 weeks' gestation. Multivariable logistic regression was used for prediction of cesarean section. RESULTS Five hundred and seventy-five women were examined at a median gestational age of 38.3 weeks (range: 35.6-41.6) and a cesarean section was performed on 104 women (18%) - 24 for a fetal indication and 80 for a maternal indication. The risk of cesarean section increased with a previous cesarean section, assisted reproduction techniques, a higher estimated fetal weight, and a greater cervical length, and decreased with a greater maternal height, multiparity, and a wider progression angle. The detection rate for a 20% false positive rate was 69.9% for all cesarean sections, 54.2% for those with a fetal indication, and 77.2% for those with a maternal indication. CONCLUSIONS Assessment at 37-38 weeks' gestation of ultrasound markers such as the cervical length, progression angle, and estimated fetal weight, in combination with the maternal history, can predict a cesarean section in labor. Cesarean section for a maternal indication is better predicted than cesarean section for a fetal indication.
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Affiliation(s)
| | | | | | - Jorge Burgos
- Obstetrics and Gynecology Service, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country (UPV/EHU), Barakaldo, Spain
| | - Nerea Maiz
- Maternal-Fetal Medicine Unit Department, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
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141
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Yang X, Zhang J, Wu J, Huang J, Chen Q, Lu X, Lyu Q, Kuang Y, Wang Y. Association between the number of oocytes retrieved and neonatal outcomes after freeze-all IVF cycles. Hum Reprod 2019; 34:1937-1947. [PMID: 31621863 DOI: 10.1093/humrep/dez137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 06/06/2019] [Accepted: 07/01/2019] [Indexed: 02/06/2023] Open
Abstract
STUDY QUESTION Is there any association between the number of oocytes retrieved and neonatal outcomes following IVF/ICSI treatment for patients using a freeze-all strategy? SUMMARY ANSWER There was no increased risk of adverse neonatal outcomes in cycles with high number of oocytes retrieved (≥ 16) compared to those with 10-15 oocytes retrieved in freeze-all cycles. WHAT IS KNOWN ALREADY Recent studies have found that there is an increased risk of preterm birth (PTB, <37 weeks gestation) and low birth weight (LBW, <2500 g) following IVF in women with a high number (>20) of oocytes retrieved in fresh embryo transfer (ET) cycles. Other studies have found that there is an association between the number of oocytes retrieved and placenta praevia. However, the association between the number of oocytes retrieved and neonatal outcomes when using a freeze-all strategy is unknown. STUDY DESIGN, SIZE, DURATION This retrospective cohort study included 14 170 women with singleton deliveries achieved by a freeze-all strategy performed between November 2006 and December 2017 in China. Only the first delivery from one episode of ovarian stimulation was included. PARTICIPANTS/MATERIALS, SETTING, METHODS Only cycles using a freeze-all strategy performed during the study period and resulting in singleton live births were included. Patients were categorized into five groups according to the number of oocytes retrieved: 1-3, 4-9, 10-15, 16-20 or >20 oocytes. In univariate and multivariate logistic regression analysis of the association between ovarian response and the outcomes of PTB, early PTB, LBW and other neonatal outcomes, the 10 to 15 oocyte category was used as a reference and other four groups were analysed as dummy variables. Multiple linear regression analysis was used to evaluate possible associations of birth weight z-scores and the number of oocytes retrieved (analysed as a continuous variable) with other confounding factors. MAIN RESULTS AND THE ROLE OF CHANCE After adjusted for confounding factors, no significant differences were observed in the risk of PTB (P = 0.837), LBW (P = 0.974), early PTB (P = 0.341), very LBW (P = 0.848), congenital malformation (P = 0.916) and other adverse neonatal outcome among patients with different number of oocytes retrieved. There was a higher risk of early PTB among women with a poor ovarian response (1-3 oocytes) compared with women with a normal response (10-15 oocytes) (1.5% vs 0.8%), crude odds ratio (OR): 2.001, 95% CI: 1.159-3.465, P = 0.013. However, the difference was not significant after adjusting for confounders, adjusted OR: 1.753, 95% CI: 0.997-3.081, P = 0.051. LIMITATIONS, REASONS FOR CAUTION Data on some known confounders such as smoking and medical history of gestational diabetes mellitus and preeclampsia were lacking. As with any retrospective study, unknown confounders may affect outcomes. WIDER IMPLICATIONS OF THE FINDINGS In the freeze-all cycles, there was no association between number of oocytes retrieved and adverse neonatal outcomes. This is a reassuring finding for both clinicians and patients who are planning to use freeze-all cycles for a variety of indications. STUDY FUNDING/COMPETING INTEREST(S) Grants from the National Natural Science Foundation of China (NSFC) (31770989 to Y.W.) and the Shanghai Ninth People's Hospital Foundation of China (JYLJ030 to Y.W.). None of the authors have any conflicts of interest to declare.
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Affiliation(s)
- Xiaoyan Yang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital Affiliated with JiaoTong University School of Medicine, Shanghai, China
| | - Jie Zhang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital Affiliated with JiaoTong University School of Medicine, Shanghai, China
| | - Jiayi Wu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital Affiliated with JiaoTong University School of Medicine, Shanghai, China
| | - Jiaan Huang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital Affiliated with JiaoTong University School of Medicine, Shanghai, China
| | - Qiuju Chen
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital Affiliated with JiaoTong University School of Medicine, Shanghai, China
| | - Xuefeng Lu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital Affiliated with JiaoTong University School of Medicine, Shanghai, China
| | - Qifeng Lyu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital Affiliated with JiaoTong University School of Medicine, Shanghai, China
| | - Yanping Kuang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital Affiliated with JiaoTong University School of Medicine, Shanghai, China
| | - Yun Wang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital Affiliated with JiaoTong University School of Medicine, Shanghai, China
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Social, Familial and Psychological Risk Factors for Endocrine, Nutritional and Metabolic Disorders in Childhood and Early Adulthood: a Birth Cohort Study Using the Danish Registry System. CURRENT PSYCHOLOGY 2019. [DOI: 10.1007/s12144-017-9687-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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143
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Asri H, Mousannif H, Al Moatassime H. Big Data Analytics in Healthcare. INTERNATIONAL JOURNAL OF DISTRIBUTED SYSTEMS AND TECHNOLOGIES 2019. [DOI: 10.4018/ijdst.2019100104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Sensors and mobile phones shine in the Big Data area due to their capabilities to retrieve a huge amount of real-time data; which was not possible previously. In the specific field of healthcare, we can now collect data related to human behavior and lifestyle for better understanding. This pushed us to benefit from such technologies for early miscarriage prediction. This research study proposes to combine the use of Big Data analytics and data mining models applied to smartphones real-time generated data. A K-means data mining algorithm is used for clustering the dataset and results are transmitted to pregnant woman to make quick decisions; with the intervention of her doctor; through an android mobile application that we created. As well, she receives recommendations based on her behavior. We used real-world data to validate the system and assess its performance and effectiveness. Experiments were made using the Big Data Platform Databricks.
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Affiliation(s)
- Hiba Asri
- OSER Laboratory, Faculty of Sciences and Technologies, Cadi Ayyad University, Marrakesh, Morocco
| | - Hajar Mousannif
- LISI Laboratory, Faculty of Siences Semlalia, Cadi Ayyad University, Marrakesh, Morocco
| | - Hassan Al Moatassime
- OSER Laboratory, Faculty of Sciences and Technologies, Cadi Ayyad University, Marrakesh, Morocco
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144
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De Viti D, Malvasi A, Busardò F, Beck R, Zaami S, Marinelli E. Cardiovascular Outcomes in Advanced Maternal Age Delivering Women. Clinical Review and Medico-Legal Issues. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E658. [PMID: 31569595 PMCID: PMC6843194 DOI: 10.3390/medicina55100658] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 02/07/2023]
Abstract
Background and objecives: Adverse cardiovascular outcomes during pregnancy have increased over the past few decades, with increased numbers of women delivering later in their reproductive life. Other factors include higher rates of female obesity, diabetes, hypertension, cardiovascular diseases and assisted reproductive technology, which has extended fertility. Those at risk require extensive prenatal maternal screening, constant pregnancy supervising, monitoring during labor, delivery and puerperium and careful anesthetic evaluation during delivery. Materials and Methods: The present review reports the relevant information available on cardiovascular outcomes in advanced maternal age delivering women and related medico-legal issues. The search was performed on Pubmed, Cochrane, Semantic Scholar, Medline and Embase databases, accessed by Ovid, including among others the terms "cardiomyopathy", "ischaemic heart disease", "arrhythmias", "hypertension", "peripartum period", "diabetes", "advanced maternal age" "anesthesia", "maternal morbidity and mortality" and "litigation". Results: To the extent that underestimating risk factors for peripartum cardiomyopathy (PPCM) can adversely impact maternal and fetal outcomes, the legal implications of misdiagnosis or mismanagement can result in high compensatory damages. Substantial indemnity payments drive up costs of insurance coverage. Conclusions: Multidisciplinary approaches are necessary from obstetricians, cardiologists, anesthesiologists and perinatologists for pregnancy monitoring and delivery outcomes.
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Affiliation(s)
- Daniele De Viti
- Department of Cardiology, Santa Maria Hospital, GVM Care & Research, 70124 Bari, Italy.
| | - Antonio Malvasi
- Department of Obstetrics and Gynecology, Santa Maria Hospital, GVM Care & Research, 70124 Bari, Italy.
| | - Francesco Busardò
- Section of Legal Medicine, Università Politecnica delle Marche, 60120 Ancona, Italy.
| | - Renata Beck
- Department of Anesthesia and Analgesia, Santa Maria Hospital, GVM Care & Research, 70124 Bari, Italy.
| | - Simona Zaami
- Unit of Forensic Toxicology (UoFT), Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University, 00161 Rome, Italy.
| | - Enrico Marinelli
- Unit of Forensic Toxicology (UoFT), Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University, 00161 Rome, Italy.
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145
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Claramonte Nieto M, Meler Barrabes E, Garcia Martínez S, Gutiérrez Prat M, Serra Zantop B. Impact of aging on obstetric outcomes: defining advanced maternal age in Barcelona. BMC Pregnancy Childbirth 2019; 19:342. [PMID: 31547808 PMCID: PMC6757376 DOI: 10.1186/s12884-019-2415-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 07/18/2019] [Indexed: 12/16/2022] Open
Abstract
Background Women of advanced maternal age (AMA) are a growing population, with higher obstetric risks. The Mediterranean population has specific characteristics different from other areas. Thus, the objective of this study was to establish a cut-off to define AMA in a selected mediterranean population coming from a tertiary referral private/mutual health hospital in Barcelona. Methods Retrospective cohort of euploid singleton pregnancies delivered from January 2007 to June 2017. Main maternal outcomes were: gestational diabetes, preeclampsia, placenta previa, c-section and prolonged hospitalization (≥ 7 days). Main adverse perinatal outcomes were: stillbirth, prematurity, preterm prelabor rupture of membranes, low birth weight, need of admission at a neonatal intensive care unit and perinatal mortality. Adjustment for confounding factors (smoking, previous comorbilities, parity, assisted reproductive techniques (ART) and obesity) was performed. Results A total of 25054 pregnancies were included. Mean maternal age was 34.7 ± 4.2 years, with 2807 patients in the group of age between 40 and 44 years (11.2%) and 280 patients ≥45 years (1.1%). Women at AMA had higher incidence of previous comorbilities (compared to the reference group of women < 30 years): prior c-section, chronic hypertension and obesity. In addition, they were more likely to use ART. After adjusting for confounding factors, maternal age was an independent and statistically significant risk factor for gestational diabetes (OR 1.66/2.80/3.14) for ages 30–39, 40–44 and ≥ 45 years respectively, c-section (OR 1.28/2.41/7.27) and placenta previa (OR 2.56/4.83) for ages 40–44 and ≥ 45 years respectively, but not for preeclampsia (neither early-onset nor late-onset). Risk of emergency c-section was only increased in women ≥45 years (OR, 2.03 (95% CI, 1.50–2.74). In the other groups of age, the increase in c-section rate was because of elective indications. Age ≥ 45 years was associated with iatrogenic prematurity < 37 weeks (OR 2.62, 95% CI 1.30–5.27). No other relevant associations between AMA and maternal or neonatal outcomes were found. Conclusions Maternal age is an independent risk factor for adverse obstetric outcomes. Age ≥ 40 years was associated to relevant increased risks and reveals to be an adequate cut-off to define AMA in our population.
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Affiliation(s)
- Marta Claramonte Nieto
- Department of Obstetrics, Gynecology and Reproduction, Dexeus Mujer, Hospital Universitari Quiron Dexeus, Barcelona, Spain.
| | - Eva Meler Barrabes
- BCNatal, Hospital Clínic of Barcelona and Hospital Sant Joan de Déu, Barcelona, Spain
| | - Sandra Garcia Martínez
- Department of Epidemiology and Statistics, Dexeus Mujer, Hospital Universitari Quiron Dexeus, Barcelona, Spain
| | - Mireia Gutiérrez Prat
- Department of Obstetrics, Gynecology and Reproduction, Dexeus Mujer, Hospital Universitari Quiron Dexeus, Barcelona, Spain
| | - Bernat Serra Zantop
- Director of Obstetrics Department, Dexeus Mujer, Hospital Universitari Quiron Dexeus, Barcelona, Spain
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146
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Ertl R, Waldhoer T, Yang L. Moderate altitude impacts birth weight: 30 years retrospective sibling analyses using record linkage data. Pediatr Res 2019; 86:403-407. [PMID: 31112991 DOI: 10.1038/s41390-019-0434-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 04/09/2019] [Accepted: 05/06/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We investigated the effect of a change of altitude of maternal living address on infant birth weight. METHOD Data on infant birth weights of the first and second pregnancies from same women were extracted from all Austrian birth certificates between 1984 and 2016. RESULTS A total of 544,624 pair pregnancies were identified and analyzed. We observed a statistically significant interaction (p < .0001) between altitudes of two births and birth weight. Among women having first birth at low altitude (200 m), the estimated second mean birth weight was 3567 g for those remained at low altitudes, and reduced to 3536 g for those ascended (1200 m). In contrast, among women having first births at high altitudes, the estimated birth weight of second birth at high altitude was 3414 g, yet increased to 3499 g compared to those descended to lower altitudes. CONCLUSION We demonstrated a longitudinal negative effect of altitude on birth weight within the same mother from first and second birth. This association is likely to be casual. Relocation of mothers within low-to-medium altitude level may have profound effects on infants' birth weight.
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Affiliation(s)
| | - Thomas Waldhoer
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria.
| | - Lin Yang
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria.,Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, AL, Canada.,Departments of Oncology & Community Health Sciences, University of Calgary, Calgary, AL, Canada
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147
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Londero AP, Rossetti E, Pittini C, Cagnacci A, Driul L. Maternal age and the risk of adverse pregnancy outcomes: a retrospective cohort study. BMC Pregnancy Childbirth 2019; 19:261. [PMID: 31337350 PMCID: PMC6651936 DOI: 10.1186/s12884-019-2400-x] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 07/04/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The increased potential for negative pregnancy outcomes in both extremes of reproductive age is a well-debated argument. The aim of this study was to analyze the prevalence and the outcome of pregnancies conceived at extreme maternal ages. METHODS This retrospective study considered all single consecutive pregnancies delivered in a tertiary referral center between 2001 and 2014. Patients were categorized into 4 groups according to maternal age at delivery (< 17 years; 18-28 years; 29-39 years; > 40 years). The following outcomes were considered (amongst others): pregnancy-related hypertensive disorders (PRHDs), neonatal resuscitation (NR), neonatal intensive care unit (NICU) admission, periventricular leucomalacia (PVL), and grade 3 and 4 intraventicular hemorrhage (IVH). RESULTS During the considered period 22,933 single pregnancies gave birth in our unit. We observed 71 women aged < 17 years, and 1552 aged > 40 years. In each year throughout the study period, there was a significant increment in maternal age of 0.041 years (95% CI 0.024-0.058) every new year. Multivariate analysis concluded out that maternal age over 40 years was an independent risk factor for preterm delivery (OR 1.36 95% CI 1.16-1.61, p < 0.05, PRHDs (OR 2.36 95% CI 1.86-3.00, p < 0.05), GDM (OR 1.71 95% CI 1.37-2.12, p < 0.05) cesarean section (OR 1.99 95% CI 1.78-2.23, p < 0.05), abnormal fetal presentation (OR 1.29 95% CI 1.03-1.61, p < 0.05), and fetal PVL (OR 3.32 95% CI 1.17-9.44, p < 0.05). We also observed that maternal age under 17 years or over 40 years was an independent risk factor for grade 3 or 4 neonatal IVH (OR 2.97 95% CI 1.24-7.14, p < 0.05). CONCLUSIONS These findings confirm a negative impact of extreme maternal ages on pregnancy. These results should be carefully taken into account by maternal care providers in order to inform women adequately, supporting them in understanding potential risks associated with their procreation choices, and to improve clinical surveillance.
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Affiliation(s)
- Ambrogio P. Londero
- Clinic of Obstetrics and Gynecology, DAME, University of Udine, Academic Hospital of Udine, Piazza Santa Maria della Misericordia, 15, 33100 Udine, Italy
| | - Emma Rossetti
- Clinic of Obstetrics and Gynecology, DAME, University of Udine, Academic Hospital of Udine, Piazza Santa Maria della Misericordia, 15, 33100 Udine, Italy
| | - Carla Pittini
- Unit of Neonatology, Academic Hospital of Udine, 33100 Udine, Italy
| | - Angelo Cagnacci
- Clinic of Obstetrics and Gynecology, DAME, University of Udine, Academic Hospital of Udine, Piazza Santa Maria della Misericordia, 15, 33100 Udine, Italy
| | - Lorenza Driul
- Clinic of Obstetrics and Gynecology, DAME, University of Udine, Academic Hospital of Udine, Piazza Santa Maria della Misericordia, 15, 33100 Udine, Italy
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148
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Kanmaz AG, İnan AH, Beyan E, Ögür S, Budak A. Effect of advanced maternal age on pregnancy outcomes: a single-centre data from a tertiary healthcare hospital. J OBSTET GYNAECOL 2019; 39:1104-1111. [PMID: 31334677 DOI: 10.1080/01443615.2019.1606172] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The aim of this study was to assess the effect of advanced maternal age on pregnancy and neonatal outcomes in patients attending a tertiary centre hospital. Between January 2013 and December 2016, the records of all patients who were referred for pregnancy follow-ups and delivery were retrospectively reviewed and were divided according to their parity and age. Patients over 35 years old were categorised as advanced maternal age; (1) 35-40 years old. (2) 40-45 years old. (3) 45 years and over. Most of the prenatal complications were found to increase in the advanced maternal age group. The caesarian section rate was found to be higher in all advanced maternal age groups. There was no significant relationship between 5 Minute Apgar scores of <7 and perinatal mortality and post-term pregnancy and parity. Globally, advanced maternal age pregnancy shows an increase as a result pregnancy complication will increase. It is important to make a appropriate follow-up for pregnancies of advance maternal age mothers. Impact statement What is already known on this subject? Advanced maternal age is a poor prognostic factor for pregnancy outcomes. But there remains no consensus opinion or a plan for the management of pregnancy in this particular risk group. What do the results of this study add? This clinical study makes a contribution to the literature for advanced maternal age and pregnancy complications. This study is one of the few studies emphasising the importance of parity in advanced maternal age and the relationship between first trimester pregnancy complications and advanced maternal age. What are the implications of these findings for clinical practice and/or further research? After the ART pregnancies increasing all around the world not only advanced age but the parity become an important role. Due to an increase in advanced maternal age pregnancies in all around the world, we think that better understanding and management of the complications to be encountered in advanced maternal age and parity pregnancies will be appropriate.
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Affiliation(s)
- Ahkam Göksel Kanmaz
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital , Izmir , Turkey
| | - Abdurrahman Hamdi İnan
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital , Izmir , Turkey
| | - Emrah Beyan
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital , Izmir , Turkey
| | - Suriye Ögür
- Izmir provincial health directorate , Izmir , Turkey
| | - Adnan Budak
- Izmir provincial health directorate , Izmir , Turkey
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149
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Schmidt CB, Voorhorst I, van de Gaar VHW, Keukens A, Potter van Loon BJ, Snoek FJ, Honig A. Diabetes distress is associated with adverse pregnancy outcomes in women with gestational diabetes: a prospective cohort study. BMC Pregnancy Childbirth 2019; 19:223. [PMID: 31269913 PMCID: PMC6610799 DOI: 10.1186/s12884-019-2376-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 06/24/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Around 12% of pregnant women develop gestational diabetes mellitus (GDM), which is associated with increased health risks for both mother and child and pre- and postpartum depression. Little is known about the relationship of GDM with diabetes-specific emotional distress (diabetes distress). The aims of this study are to assess the prevalence of diabetes distress in GDM and its association with adverse pregnancy outcomes. METHODS A prospective cohort study was carried out in an Amsterdam based teaching hospital with an ethnic diverse population. Women diagnosed with GDM completed a set of questionnaires at three time points. Questionnaires consisted of Problem Areas in Diabetes Scale 5 (PAID-5) for diabetes distress (T0-T1), Patient Health Questionnaire 9 (PHQ-9) for depressive symptoms (T0-T2), and questions to assess adverse pregnancy outcomes (T2). Adverse pregnancy outcomes (collected via self-report and if feasible from the medical records) were defined as hypertension, pre-eclampsia, caesarean section, severe perineal tearing, postpartum hemorrhage, postpartum depression, shoulder dystocia, neonatal hospitalization, macrosomia, jaundice, hypoglycemia and other (among which low heart rate, fever, hypoxia). Adverse pregnancy outcomes were dichotomized into none and 1 or more. Additional information was collected from the medical charts. Missing data were imputed via predictive mean matching and a multivariable logistic regression analysis was performed with diabetes distress, depressive symptoms, socioeconomic status, parity and ethnicity as predictors and age, HbA1c, and BMI as covariates. RESULTS A total of 100 women were included, mean age 32.5 (4.1), mean BMI 26.7 (4.8), 71% were of non-Dutch ethnic background. Elevated diabetes distress (PAID score ≥ 8) was reported by 36% of the women. Multivariable logistic regression analyses revealed that both high diabetes distress (OR 4.70, p = .02) and parity (OR 0.21, p = .02) but not antepartum depressive symptoms were related to adverse pregnancy outcomes. CONCLUSIONS Diabetes distress is likely in women with GDM and our findings suggest an association between both diabetes distress, parity and adverse pregnancy outcomes in women with GDM. This warrants replication and further research into the underlying mechanisms explaining the impact of diabetes distress in GDM and potential interventions to reduce distress.
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Affiliation(s)
- Charlotte B. Schmidt
- Department of Psychiatry, OLVG, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Ilse Voorhorst
- Department of Psychiatry, OLVG, Amsterdam, the Netherlands
| | | | - Anne Keukens
- Department of Gynaecology, OLVG, Amsterdam, the Netherlands
| | | | - Frank J. Snoek
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Adriaan Honig
- Department of Psychiatry, OLVG, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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150
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Ge MM, Gao YY, Wu BB, Yan K, Qin Q, Wang H, Zhou W, Yang L. Relationship between phenotype and genotype of 102 Chinese newborns with Prader-Willi syndrome. Mol Biol Rep 2019; 46:4717-4724. [PMID: 31270759 DOI: 10.1007/s11033-019-04916-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 06/13/2019] [Indexed: 12/14/2022]
Abstract
High rates of misdiagnosis and delayed intervention in neonatal PWS are leading to poor prognoses. To determine the clinical and image characteristics of newborns with Prader-Willi syndrome (PWS). A total of 102 cases of newborns definitively diagnosed with PWS at the Children's Hospital of Fudan University from 02/2014 to 12/2017 were retrospectively analyzed. We analyzed the modulated voxel-based morphology (VBM) of gray matter in PWS by T2 weighted imaging. Of 102 cases, 75 (73.5%) have paternal deletion of 15q11.2-q13, whereas 27 (26.5%) have maternal uniparental disomy (UPD). Of the 75 deletion cases, 75 (100%) week crying, 71 (94.7%) hypotonia, 70 (93.3%) poor feeding, 46 (61.3%) hypopigmentation, 43 (57.3%) male cryptorchidism, 10 (13.3%) female labia minora, 48 (64%) characteristic facial features. Of 27 UPD cases, 27 (100%) week crying and hypotonia, 25 (92.6%) hypophagia, 20 (74.1%) male cryptorchidism, 1 (3.7%) female labia minora, 19 (70.4%) characteristic facial features, 12 (44.4%) hypopigmentation. The modulated VBM analysis shows that the middle frontal gyrus, orbitofrontal cortex (middle), and inferior frontal gyrus are the most variable brain regions that determine the endo-phenotype difference between the two genotypes. Hypotonia, hypophagia, and maldevelopment of sexual organs are general characteristics of newborns with PWS in Chinese population. In UPD cases, the proportions of premature newborns, elderly parturient women and congenital malformations were higher than for paternal deletion cases. The differences in the gray matter volume of these three regions between the two genotypes may explain the differences in maladaptive behaviors and emotions.
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Affiliation(s)
- Meng-Meng Ge
- Department of Neonates, Children's Hospital, Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Yan-Yan Gao
- Department of B Ultrasonography, Children's Hospital, Fudan University, Shanghai, China
| | - Bing-Bing Wu
- Clinical Genetic Center, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Kai Yan
- Department of Neonates, Children's Hospital, Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Qian Qin
- Clinical Genetic Center, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - HuiJun Wang
- Birth Defect Laboratory, Children's Hospital of Fudan University, Shanghai, China
| | - WenHao Zhou
- Department of Neonates, Children's Hospital, Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China.
- Birth Defect Laboratory, Children's Hospital of Fudan University, Shanghai, China.
| | - Lin Yang
- Clinical Genetic Center, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China.
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