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Chen C, Lei Z, Xiong Y, Ni M, He B, Gao J, Zheng P, Xie X, He C, Yang X, Cheng W. Gestational weight gain of multiparas and risk of primary preeclampsia: a retrospective cohort study in Shanghai. Clin Hypertens 2023; 29:32. [PMID: 38037134 PMCID: PMC10691081 DOI: 10.1186/s40885-023-00254-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/09/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND In all studies conducted so far, there was no report about the correlation between excessive gestational weight gain (GWG) and the risk of preeclampsia (PE) in multiparas, especially considering that multiparity is a protective factor for both excessive GWG and PE. Thus, the aim of this retrospective cohort study was to determine whether GWG of multiparas is associated with the increased risk of PE. METHODS This was a study with 15,541 multiparous women who delivered in a maternity hospital in Shanghai from 2017 to 2021, stratified by early-pregnancy body mass index (BMI) category. Early-pregnancy body weight, height, week-specific and total gestational weight gain as well as records of antenatal care were extracted using electronic medical records, and antenatal weight gain measurements were standardized into gestational age-specific z scores. RESULTS Among these 15,541 multiparous women, 534 (3.44%) developed preeclampsia. The odds of preeclampsia increased by 26% with every 1 z score increase in pregnancy weight gain among normal weight women and by 41% among overweight or obese women. For normal weight women, pregnant women with preeclampsia gained more weight than pregnant women without preeclampsia beginning at 25 weeks of gestation, while accelerated weight gain was more obvious in overweight or obese women after 25 weeks of gestation. CONCLUSIONS In conclusion, excessive GWG in normal weight and overweight or obese multiparas was strongly associated with the increased risk of preeclampsia. In parallel, the appropriate management and control of weight gain, especially in the second and third trimesters, may lower the risk of developing preeclampsia.
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Affiliation(s)
- Chao Chen
- Department of obstetrics, School of Medicine, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China
- Shanghai Key Laboratory of Embryo Original Disease, Shanghai, 200030, China
| | - Zhijun Lei
- Department of Cardiology, School of Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, China
| | - Yaoxi Xiong
- Department of obstetrics, School of Medicine, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China
- Shanghai Key Laboratory of Embryo Original Disease, Shanghai, 200030, China
| | - Meng Ni
- Department of obstetrics, School of Medicine, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China
- Shanghai Key Laboratory of Embryo Original Disease, Shanghai, 200030, China
| | - Biwei He
- Department of obstetrics, School of Medicine, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Jing Gao
- Department of obstetrics, School of Medicine, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Panchan Zheng
- Department of obstetrics, School of Medicine, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Xianjing Xie
- Department of obstetrics, School of Medicine, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Chengrong He
- Department of obstetrics, School of Medicine, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China
- Shanghai Key Laboratory of Embryo Original Disease, Shanghai, 200030, China
| | - Xingyu Yang
- Department of obstetrics, School of Medicine, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China.
- Shanghai Key Laboratory of Embryo Original Disease, Shanghai, 200030, China.
| | - Weiwei Cheng
- Department of obstetrics, School of Medicine, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China.
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Sharifi-Heris Z, Amiri-Farahani L, Shahabadi Z, Sanaei M. Impact of social support and mindfulness in the associations between perceived risk of COVID-19 acquisition and pregnancy outcomes in Iranian population: a longitudinal cohort study. BMC Psychol 2023; 11:328. [PMID: 37821989 PMCID: PMC10566097 DOI: 10.1186/s40359-023-01371-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 10/03/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND AND AIMS Various devastating infection outbreaks including COVID-19, threat both mother and fetus health. These life-threating outbreaks as potential harms are highly associated with relevant perceived risk. Social support and mindfulness are two factors that may moderate the associations between the perceived risk of COVID-19 and pregnancy outcomes. In this study we investigated the potential moderating impact of social support and mindfulness in the aforementioned association. METHODS This study is a longitudinal cohort study in which 483 Iranian pregnant women in Tehran have been studied. Perceived risk of COVID-19 questions, Mindful Attention Awareness Scale (MAAS), and Multidimensional Scale of Perceived Social Support (MSPSS) were used through an online platform to assess the independent variables during pregnancy. Neonatal and maternal outcomes including gestational diabetes, gestational hypertension, preeclampsia, abortion, birth weight, and gestational age at birth, was extracted from Electronic Health Record (EHR) after childbirth as the dependent variables. The aim of the study is to investigate whether social support and mindfulness can affect the associations between perceived risk of Covid-19 acquisition and pregnancy outcomes. RESULTS Perceived risk of COVID-19 was negatively associated with pregnancy outcomes including birth weight (-28, 95% CI [-53, -3.4], p < .05) and gestational age at birth (-0.9, 95% CI [-2,0.11], p < .05). However, social support could not moderate these associations. Mindfulness, on the other hand, moderated the association between perceived risk and stillbirth meaning that by increasing mindfulness, the association between the perceived risk and stillbirth may also be increased (OR = 0.03; p < .05). CONCLUSION The findings of this study showed that social support lacks the moderating impact on the association between perceived risk of COVID-19 and pregnancy outcomes. Mindfulness, on the other hand, indicate a positive moderating impact for the association between perceived risk of Covid-19 and stillbirth. More studies in different populations are suggested to investigate the impact of mindfulness and social support on the association between perceived risk and pregnancy outcomes.
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Affiliation(s)
- Zahra Sharifi-Heris
- Sue & Bill Gross School of Nursing, University of California at Irvine, Irvine, CA, USA
| | - Leila Amiri-Farahani
- Department of Reproductive Health and Midwifery, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
| | - Zahra Shahabadi
- Student Research Committee, Department of Reproductive Health and Midwifery, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Mohaddeseh Sanaei
- Student Research Committee, Department of Reproductive Health and Midwifery, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
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Akum LA, Offei EA, Kpordoxah MR, Yeboah D, Issah AN, Boah M. Compliance with the World Health Organization's 2016 prenatal care contact recommendation reduces the incidence rate of adverse birth outcomes among pregnant women in northern Ghana. PLoS One 2023; 18:e0285621. [PMID: 37289811 PMCID: PMC10249792 DOI: 10.1371/journal.pone.0285621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 04/26/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Children born with adverse birth outcomes (ABOs) have a greater risk of mortality, stunting, and poor cognitive development. In 2016, the World Health Organization (WHO) recommended at least eight antenatal care (ANC) contacts before delivery for a healthy mother and baby. We examined the association between compliance with this recommendation and the risk of ABOs, such as low birthweight (LBW) and preterm birth (PTB), in the Tamale Metropolitan Area of the northern region of Ghana. METHODS We conducted a cross-sectional study in the Tamale Metropolis of the northern region of Ghana. We analysed a systematic random sample of 402 postnatal women aged 15-49 drawn from five public health facilities. We gathered information electronically on their birth outcomes, specifically their birthweight and gestation at delivery, using a structured questionnaire. Information on women's background characteristics, including the number of ANC contacts made before delivery, was also collected. The association between the number of ANC contacts and ABOs was investigated using regression models. RESULTS We found that 37.6% (95% CI: 32.9, 42.4) of our sample had at least eight ANC contacts before delivery. We estimated that 18.9% of babies were born prematurely and 9.0% were born LBW. ABOs were found in 22.9% (95% CI: 19.0, 27.3) of babies. A minimum of eight ANC contacts before delivery reduced the risk of ABOs (adjusted IRR = 0.43; 95% CI: 0.25, 0.73), PTB (AOR = 0.28; 95% CI: 0.14, 0.58), and LBW (AOR = 0.36; 95% CI: 0.14, 0.91). CONCLUSION In the current study's setting, about a quarter of newborns have ABOs, jeopardising their survival, health, and development. Compliance with at least eight ANC contacts prior to birth was associated with a reduced incidence rate ratio of ABOs. However, less than four out of every ten pregnant women make at least eight ANC contacts before delivery. Efforts are needed to increase coverage of eight contacts among pregnant women before delivery to reduce the risk of ABOs in the study setting.
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Affiliation(s)
- Leticia Achangebe Akum
- Department of Population and Reproductive Health, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Eunice Amina Offei
- Department of Midwifery and Women’s Health, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Mary Rachael Kpordoxah
- Department of Global and International Health, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Daudi Yeboah
- Department of Epidemiology, Biostatistics, and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Abdul-Nasir Issah
- Department of Health Services, Policy, Planning, Management and Economics, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Michael Boah
- Department of Epidemiology, Biostatistics, and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana
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A Case Report of Ropeginterferon Alfa-2b for Polycythemia Vera during Pregnancy. Hematol Rep 2023; 15:172-179. [PMID: 36975731 PMCID: PMC10048098 DOI: 10.3390/hematolrep15010018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/07/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
Myeloproliferative neoplasms (MPN) such as essential thrombocythemia (ET) and polycythemia vera (PV) are rare during pregnancy. However, they are harmful because they are associated with an increased risk of thromboembolic, hemorrhagic, or microcirculatory disturbances or placental dysfunction leading to fetal growth restriction or loss. Low-dose aspirin and low-molecular-weight heparin (LMWH) are recommended to reduce pregnancy complications, and interferon (IFN) is the only treatment option for cytoreductive therapy based on the likelihood of live birth in pregnant women with MPN. Since ropeginterferon alfa-2b is the only available IFN in South Korea, we present a case report of ropeginterferon alfa-2b use during pregnancy in an MPN patient. A 40-year-old woman who had been diagnosed with low-risk PV in 2017 and had been maintained on phlebotomy, hydroxyurea (HU), and anagrelide (ANA) for 4 years was confirmed as 5 weeks pregnant on 9 December 2021. After stopping treatment with HU and ANA, the patient showed a rapid increase in platelet count (1113 × 109/L to 2074 × 109/L, normal range, 150–450 × 109/L) and white blood cell count (21.93 × 109/L to 35.55 × 109/L, normal range, 4.0–10.0 × 109/L). Considering the high risk of complications, aggressive cytoreductive treatment was required, for which we chose ropeginterferon alfa-2b, as it is the only available IFN agent in South Korea. The patient underwent 8 cycles of ropeginterferon alfa-2b over 6 months during pregnancy and delivered without any neonatal or maternal complications. This case report highlights the importance of considering treatment options for MPN patients who are pregnant or planning a pregnancy, as well as the need for further investigation into the safety and efficacy of ropeginterferon alfa-2b in this population.
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Dai J, Shi Y, Wu Y, Guo L, Lu D, Chen Y, Wang Y, Lai H, Kong X. The interaction between age and parity on adverse pregnancy and neonatal outcomes. Front Med (Lausanne) 2023; 10:1056064. [PMID: 36910494 PMCID: PMC9995429 DOI: 10.3389/fmed.2023.1056064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
Background Although age and parity are recognized as associated factors for adverse pregnancy outcomes, there are no studies exploring the interaction between the two during pregnancy. This study aimed to investigate the impact of the interaction between age and parity on adverse pregnancy outcomes. Methods This was a retrospective cohort study with 15,861 women aged ≥20 years. All women were grouped according to age, parity, and a mix of the two. The data were analyzed using multivariate logistic regression analysis. Results Age, parity, and interaction between the two were related with the risk of gestational hypertension, eclampsia/pre-eclampsia, placenta previa, placental implantation, postpartum hemorrhage, preterm birth, cesarean section, and Apgar score <7 within 5 min of birth. The risk of gestational diabetes mellitus and transfer to the neonatal unit was linked with age and the interaction between age and parity, but the impact of parity was not statistically significant. The risk of anemia, placental abruption, premature rupture of the membrane, oligohydramnios, and macrosomia was only associated with parity; the risk of fetal distress was only associated with age. Conclusion The interaction between advanced age and parity might results in more adverse outcomes for both puerpera and infants, necessitating additional prenatal screening and health education throughout pregnancy.
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Affiliation(s)
- Jiayang Dai
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China.,Department of Obstetrics and Gynecology, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Ya Shi
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China.,School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Yinshuang Wu
- Graduate School of Dalian Medical University, Dalian, China
| | - Lu Guo
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China
| | - Dan Lu
- Department of Obstetrics and Gynecology, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu Province, China.,Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, Jiangsu Province, China.,Jiangsu Key Laboratory of Experimental & Translational Non-Coding RNA Research, Yangzhou, Jiangsu Province, China
| | - Ying Chen
- Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yuanyuan Wang
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China
| | - Hanpeng Lai
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China
| | - Xiang Kong
- Department of Obstetrics and Gynecology, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu Province, China.,Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, Jiangsu Province, China.,Jiangsu Key Laboratory of Experimental & Translational Non-Coding RNA Research, Yangzhou, Jiangsu Province, China
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Haggar F, Einarsdóttir K. Trends in cesarean birth rates in Iceland over a 19-year period. Birth 2021; 48:36-43. [PMID: 32945001 DOI: 10.1111/birt.12503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 08/04/2020] [Accepted: 08/12/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cesarean birth (CB) rates have increased in high-resource countries during the past two decades, yet it is not known whether CB rates have changed according to maternal age and/or gestational age. METHODS All singleton live births in Iceland between 1997 and 2015 were identified from the Icelandic Medical Birth Registry (80 130). Rates of cesarean births (intrapartum and prelabor) were calculated overall and separately for maternal age groups and gestational age groups and by parity. Logit binomial regression was used to calculate odds ratios (ORs) and confidence intervals (CIs) for annual change in cesarean birth rates adjusted for maternal characteristics and clinical indication groups. RESULTS The overall CB rate was 15.7% in 1997 and 15.8% in 2015; the CB rate did not change significantly during the study period. The overall CB rate for early-term deliveries (37-38 weeks) decreased for multiparas (annual aOR = 0.99 [95% CI = 0.98-0.99]), and the preterm (<37 weeks) prelabor cesarean rate increased significantly (1.11 [1.09-1.14]) for both primiparas and multiparas. For multiparas only, the intrapartum CB rate decreased (0.97 [0.97-0.98]), whereas the prelabor CB rate increased, predominantly for women aged over 35 years (1.03 [1.02-1.04]). Adjustment for clinical indication groups did not change these results. CONCLUSIONS Findings indicate a rise in prelabor cesarean for preterm births and women aged over 35 years (multiparas only). As adjustment for clinical indications did not affect these results, changes in obstetric practice are more likely to have affected these rate changes rather than changes in clinical indications.
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Affiliation(s)
- Fatima Haggar
- Chadian League Against Cancer (Ligue Tchadienne de Lutte Contre le Cancer), Ndjamena, Chad
| | - Kristjana Einarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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Naeh A, Hallak M, Gabbay-Benziv R. Parity and Interval from Previous Delivery-Influence on Perinatal Outcome in Advanced Maternal Age Parturients. J Clin Med 2021; 10:460. [PMID: 33530313 PMCID: PMC7865726 DOI: 10.3390/jcm10030460] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/21/2021] [Accepted: 01/21/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To investigate the effect of parity and interpregnancy interval (IPI) on perinatal outcomes in advanced maternal age (AMA) parturients. METHODS A population-based retrospective cohort study of all women older than 40 years, who had a singleton live birth after 24 weeks in the United States in 2017 Women were categorized to three groups by parity and interval from last delivery: primiparas, multiparas with IPI ≤ 5 years, and multiparas with IPI > 5 years. Primary outcome was composite adverse neonatal outcome (preterm delivery <34 weeks, birthweight <2000 g, neonatal seizure, neonatal intensive care unit admission, Apgar score <7 at 5 min, or assisted ventilation >6 h). Secondary outcome was composite adverse maternal outcome and other adverse perinatal outcomes. Univariate and multivariate analysis were used to compare between groups. RESULTS During 2017, 3,864,754 deliveries were recorded into the database. Following exclusion, 109,564 AMA gravidas entered analysis. Of them, 24,769 (22.6%) were nulliparas, 39,933 (36.4%) were multiparas with IPI ≤ 5 years, and 44,862 (40.9%) were multiparas with IPI > 5 years. Composite neonatal outcome was higher in nulliparas and in multiparas with IPI > 5 years, in comparison to multiparas with IPI ≤ 5 years (16% vs. 13% vs. 10%, respectively, p < 0.05). Maternal composite outcome was similar between groups. In the multivariable analysis, relative to nulliparas, only multiparity with IPI ≤ 5 years had a protective effect against the composite neonatal outcome (aOR 0.97, 95% CI 0.95-0.99, p < 0.001). CONCLUSION Among AMA gravidas, multiparity with IPI ≤ 5 years has a significant protective effect against adverse neonatal outcomes when compared to nulliparas. Multiparity with IPI > 5 years is no longer protective.
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Affiliation(s)
- Amir Naeh
- Obstetrics and Gynecology Department, Hillel Yaffe Medical Center, Hadera 38100, Israel; (M.H.); (R.G.-B.)
- The Rappaport Faculty of Medicine, Technion, Haifa 32000, Israel
| | - Mordechai Hallak
- Obstetrics and Gynecology Department, Hillel Yaffe Medical Center, Hadera 38100, Israel; (M.H.); (R.G.-B.)
- The Rappaport Faculty of Medicine, Technion, Haifa 32000, Israel
| | - Rinat Gabbay-Benziv
- Obstetrics and Gynecology Department, Hillel Yaffe Medical Center, Hadera 38100, Israel; (M.H.); (R.G.-B.)
- The Rappaport Faculty of Medicine, Technion, Haifa 32000, Israel
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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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