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Kanninen T, Jung E, Gallo DM, Diaz-Primera R, Romero R, Gotsch F, Suksai M, Bosco M, Chaiworapongsa T. Soluble suppression of tumorigenicity-2 in pregnancy with a small-for-gestational-age fetus and with preeclampsia. J Matern Fetal Neonatal Med 2023; 36:2153034. [PMID: 36521862 DOI: 10.1080/14767058.2022.2153034] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Preeclampsia and fetal growth disorders are pregnancy-specific conditions that share common pathophysiological mechanisms. Yet, why some patients develop preeclampsia while others experience fetal growth restriction, or a combination of both clinical presentations, is unknown. We propose that the difference in severity of the maternal inflammatory response can contribute to the clinical phenotypes of preeclampsia vs. small for gestational age (SGA). To assess this hypothesis, we measured maternal plasma concentrations of the soluble isoform of suppression of tumorigenicity-2 (sST2), a member of the interleukin-1 receptor family that buffers proinflammatory responses. Previous reports showed that serum sST2 concentrations rise in the presence of intravascular inflammation and Th1-type immune responses and are significantly higher in patients with preeclampsia compared to those with normal pregnancy. The behavior of sST2 in pregnancies complicated by SGA has not been reported. This study was conducted to compare sST2 plasma concentrations in normal pregnancies, in those with preeclampsia, and in those with an SGA fetus. METHODS This retrospective cross-sectional study included women with an SGA fetus (n = 52), women with preeclampsia (n = 106), and those with normal pregnancy (n = 131). Maternal plasma concentrations of sST2 were determined by enzyme-linked immunosorbent assay. Doppler velocimetry of the uterine and umbilical arteries was available in a subset of patients with SGA (42 patients and 43 patients, respectively). RESULTS (1) Women with an SGA fetus had a significantly higher median plasma concentration of sST2 than normal pregnant women (p = .008); (2) women with preeclampsia had a significantly higher median plasma concentration of sST2 than those with normal pregnancy (p < .001) and those with an SGA fetus (p < .001); (3) patients with SGA and abnormal uterine artery Doppler velocimetry had a higher median plasma concentration of sST2 than controls (p < .01) and those with SGA and normal uterine artery Doppler velocimetry (p = .02); (4) there was no significant difference in the median plasma sST2 concentration between patients with SGA who had normal uterine artery Doppler velocimetry and controls (p = .4); (5) among patients with SGA, those with abnormal and those with normal umbilical artery Doppler velocimetry had higher median plasma sST2 concentrations than controls (p = .001 and p = .02, respectively); and (6) there was no significant difference in the median plasma sST2 concentrations between patients with SGA who did and those who did not have abnormal umbilical artery Doppler velocimetry (p = .06). CONCLUSIONS Preeclampsia and disorders of fetal growth are conditions characterized by intravascular inflammation, as reflected by maternal plasma concentrations of sST2. The severity of intravascular inflammation is highest in patients with preeclampsia.
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Affiliation(s)
- Tomi Kanninen
- 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, United States Department of Health and Human Services, Detroit, MI, USA.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Eunjung Jung
- 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, United States Department of Health and Human Services, Detroit, MI, USA.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Dahiana M Gallo
- 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, United States 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 Gynecology and Obstetrics, Universidad del Valle, Cali, Colombia
| | - Ramiro Diaz-Primera
- 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, United States Department of Health and Human Services, Detroit, MI, USA.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Roberto 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, United States 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 School of Medicine, Detroit, MI, USA.,Detroit Medical Center, Detroit, MI, USA
| | - Francesca Gotsch
- 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, United States Department of Health and Human Services, Detroit, MI, USA.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Manaphat Suksai
- 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, United States Department of Health and Human Services, Detroit, MI, USA.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Mariachiara Bosco
- 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, United States Department of Health and Human Services, Detroit, MI, USA.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Tinnakorn Chaiworapongsa
- 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, United States Department of Health and Human Services, Detroit, MI, USA.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
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Ushida T, Kotani T, Kinoshita F, Imai K, Nakano-Kobayashi T, Nakamura N, Moriyama Y, Yoshida S, Yamashita M, Kajiyama H. Maternal low birth weight and hypertensive disorders of pregnancy. Pregnancy Hypertens 2020; 23:5-10. [PMID: 33160130 DOI: 10.1016/j.preghy.2020.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/08/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate the association between maternal own low birth weight (<2500 g) and subsequent risks for hypertensive disorders of pregnancy (HDP) and preeclampsia. STUDY DESIGN A multicenter retrospective study was conducted using clinical data from 12 primary maternity care units from 2012 to 2018. A total of 17,119 women with information about their own birth weight, who delivered at term, were subdivided into four groups according to maternal birth weights [(<2500, 2500-3499, 3500-3999, and ≥4000) g]. MAIN OUTCOME MEASURES Multivariate regression analyses were conducted to evaluate the risks for HDP and preeclampsia among women born with low birth weight compared with women born with a birth weight of 2500-3499 g. We evaluated these risks, stratified by pre-pregnancy BMI or their infants' birth weight categories. RESULTS Maternal low birth weight was an independent risk factor for HDP after adjustment for several covariates, but not for preeclampsia. A 100-g increase in maternal birth weight was associated with a 3% risk reduction for HDP. Additionally, women born with low birth weight had the highest risk for HDP among those with a pre-pregnancy BMI of ≥25 kg/m2. Conversely, women born with high birth weight (≥4000 g) had the highest risk for preeclampsia if they complicate with fetal growth restrictions. CONCLUSION Women born with low birth weight had an increased risk for HDP. Collection of information on maternal birth weight may facilitate the prediction of HDP and patients' self-awareness of such risk, allowing the modification of lifestyle factors associated with HDP.
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Affiliation(s)
- Takafumi Ushida
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Division of Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan.
| | - Tomomi Kotani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Division of Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Fumie Kinoshita
- Data Science Division, Data Coordinating Center, Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Kenji Imai
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoko Nakano-Kobayashi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Noriyuki Nakamura
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshinori Moriyama
- Department of Obstetrics and Gynecology, Fujita Health University School of Medicine, Toyoake, Japan
| | | | | | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Association between maternal hypertensive disorders of pregnancy and child neurodevelopment at 3 years of age: a retrospective cohort study. J Dev Orig Health Dis 2020; 12:428-435. [PMID: 32624083 DOI: 10.1017/s2040174420000586] [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] [Indexed: 02/04/2023]
Abstract
Hypertensive disorders of pregnancy (HDP) affect up to 10% of women during pregnancy and influence child neurodevelopment, including mental and motor function. We assessed whether HDP, including gestational hypertension, preeclampsia, superimposed preeclampsia, and eclampsia, correlate with motor and mental developmental abnormalities in 3-year-old children, using data obtained between April 2004 and March 2013 through a mandatory population-based health checkup of mothers and children in Kobe city, Japan. The primary outcome was motor and mental developmental abnormalities at 3 years of age; parental-reported questionnaires and physician's medical examinations were evaluated. The association between maternal HDP and child neurodevelopmental abnormality was evaluated using a logistic regression model. Of the 43,854 participating children, 1120 were born to women with HDP and 42,734 were born to women without HDP. The prevalence of motor developmental abnormality was 1.7% in the exposed group and 0.95% in the control group; the prevalence of mental developmental abnormality was 2.41% in the exposed group and 1.22% in the control group. Children born to mothers with HDP did not have an increased risk of motor developmental abnormality at the age of 3 years [adjusted odds ratio (OR) 1.17, 95% confidence interval 0.72-1.91], but had an increased risk of mental developmental abnormality (adjusted OR 1.80, 95% confidence interval 1.21-2.69). Maternal HDP were associated with mental development abnormality in 3-year-old children. These findings may be clinically relevant; mental abnormality in children born to women with HDP could be detected during early stages, which would facilitate early intervention.
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4
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Behaviour of the Foramen Ovale Flow in Fetuses with Intrauterine Growth Restriction. Obstet Gynecol Int 2018; 2018:1496903. [PMID: 29581724 PMCID: PMC5822859 DOI: 10.1155/2018/1496903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/30/2017] [Accepted: 09/20/2017] [Indexed: 12/05/2022] Open
Abstract
Background Foramen ovale (FO) flow may be altered in IUGR. This study was designed to test this hypothesis. Methods Forty pregnant women (24–38 weeks) were divided into 3 groups: group I (IUGR), group II (adequate growth and maternal hypertension), and group III (normal controls). Impedance across the FO was assessed by the FO pulsatility index (FOPI): (systolic velocity − presystolic velocity)/mean velocity. Statistical analysis utilized ANOVA, Tukey test, and ROC curves. Results Mean FOPI in IUGR fetuses (n = 15) was 3.70 ± 0.99 (3.15–4.26); in the group II (n = 12), it was 2.84 ± 0.69 (2.40–3.28), and in the group III (n = 13), it was 2.77 ± 0.44 (2.50–3.04) (p=0.004). FOPI and UtA RI were correlated (r = 0.375, p=0.017), as well as FOPI and UA RI (r = 0.356, p=0.024) and, inversely, FOPI and MCA RI (r = −0.359, p=0.023). Conclusions The FO flow pulsatility index is increased in fetuses with IUGR, probably as a result of impaired left ventricular diastolic function.
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Sharma KJ, Esakoff TF, Guillet A, Burwick RM, Caughey AB. Pregnancies complicated by both preeclampsia and growth restriction between 34 and 37 weeks’ gestation are associated with adverse perinatal outcomes. J Matern Fetal Neonatal Med 2016; 30:2342-2345. [DOI: 10.1080/14767058.2016.1248394] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Kathryn J. Sharma
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA and
| | - Tania F. Esakoff
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA and
| | - Alyson Guillet
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Oregon Health & Science University in Portland, Portland, OR, USA
| | - Richard M. Burwick
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Oregon Health & Science University in Portland, Portland, OR, USA
| | - Aaron B. Caughey
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Oregon Health & Science University in Portland, Portland, OR, USA
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Irwinda R, Surya R, Nembo LF. Impact of pregnancy-induced hypertension on fetal growth. MEDICAL JOURNAL OF INDONESIA 2016. [DOI: 10.13181/mji.v25i2.1381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Background: Pregnancy-induced hypertension (PIH) is still a major cause of maternal and infant morbidity and mortality worldwide. The aim of this study to investigate the impact of PIH on fetal growth.Methods: A longitudinal cross-sectional study was conducted by 2,076 obstetric patients registered in the book of delivery emergency room BLUD RSUD Ende/ Ende hospital from September 1st 2014 to August 31st 2015. Pregnancy-induced hypertension was classified into gestational hypertension, preeclampsia, and severe preeclampsia. Categorical comparative chi-square continued by logistic regression analysis were performed to examine the effect of PIH to infants’ growth outcome.Results: Women with preeclampsia had higher number of preterm delivery (26.7%). Infants born from preeclamptic women had lower birth weight (median 2,575 gram; p<0.001), birth length (median 49 cm; p<0.001), and also head circumference (median 32 cm; p<0.001). Severe preeclampsia contributed statistically significance to SGA (OR=1.90; 95% CI=1.20-3.01; adjusted OR=1.91; 95% CI=1.20-3.01) and LGA (OR=2.70; 95% CI=1.00-7.29; adjusted OR=2.92; 95% CI=1.07-8.00). Based on birth weight independent of gestational age, severe preeclampsia had an impact to VLBW (OR=11.45; 95% CI=2.77-47.38; adjusted OR=8.68; 95% CI=1.57-48.04) and LBW (OR=6.57; 95% CI=4.01-10.79; adjusted OR=5.71; 95% CI=3.33-9.78) where it showed statistical significance.Conclusion: PIH women who had SGA or VLBL or LBW infants were caused by the hypoperfusion model as the pathogenesis of preeclampsia. Meanwhile, LGA infants born by preeclamptic women were due to the compensation of the decrease from uteroplacental perfusion or other diseases such as obese mother or gestational.diabetes mellitus.
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Villamonte-Calanche W, Manrique-Corazao F, Jerí-Palomino M, De-La-Torre C, Roque-Roque JS, Wilson NA. Neonatal anthropometry at 3400 m above sea level compared with INTERGROWTH 21st standards*. J Matern Fetal Neonatal Med 2016; 30:155-158. [DOI: 10.3109/14767058.2016.1163682] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Gibson KS, Waters TP, Gunzler DD, Catalano PM. A retrospective cohort study of factors relating to the longitudinal change in birth weight. BMC Pregnancy Childbirth 2015; 15:344. [PMID: 26693917 PMCID: PMC4687143 DOI: 10.1186/s12884-015-0777-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 12/04/2015] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Recent reports have shown a decrease in birth weight, a change from prior steady increases. Therefore we sought to describe the demographic and anthropometric changes in singleton term fetal growth. METHODS This was a retrospective cohort analysis of term singleton deliveries (37-42 weeks) from January 1, 1995 to January 1, 2010 at a single tertiary obstetric unit. We included all 43,217 neonates from term, singleton, non-anomalous pregnancies. Data were grouped into five 3-year intervals. Mean and median birth weight (BW), birth length (BL), and Ponderal Index (PI) were estimated by year, race and gestational age. Our primary outcome was change in BW over time. The secondary outcomes were changes in BL and PI over time. RESULTS Mean and median BW decreased by 72 and 70 g respectively (p < 0.0001) over the 15 year period while BL also significantly decreased by 1.0 cm (P < 0.001). This contributed to an increase in the neonatal PI by 0.11 kg/m(3) (P < 0.001). Mean gestational age at delivery decreased while maternal BMI at delivery, hypertension, diabetes, and African American race increased. Adjusting for gestational age, race, infant sex, maternal BMI, smoking, diabetes, hypertension, and parity, year of birth contributed 0.1 % to the variance (-1.7 g/year; 26 g) of BW, 1.8% (-0.06 cm/year; 0.9 cm) of BL, and 0.7% (+0.008 kg/m(3)/year; 0.12 kg/m(3)) of PI. These findings were independent of the proportional change in race or gestational age. CONCLUSIONS We observed a crude decrease in mean BW of 72 g and BL of 1 cm over 15 years. Furthermore, once controlling for gestational age, race, infant sex, maternal BMI, smoking, diabetes, hypertension, and parity, we identified that increasing year of birth was associated with a decrease in BW of 1.7 g/year. The significant increase in PI, despite the decrease in BW emphasizes the limitation of using birth weight alone to define changes in fetal growth.
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Affiliation(s)
- Kelly S Gibson
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, 2500 Metrohealth Drive, Cleveland, OH, 44109, USA.
| | - Thaddeus P Waters
- Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL, 60153, USA.
| | - Douglas D Gunzler
- Center for Health Care Research & Policy, Case Western Reserve University School of Medicine, 2500 Metrohealth Drive, Cleveland, OH, 44109, USA.
| | - Patrick M Catalano
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, 2500 Metrohealth Drive, Cleveland, OH, 44109, USA.
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Li C, Liu Y, Zhang W. Joint and Independent Associations of Gestational Weight Gain and Pre-Pregnancy Body Mass Index with Outcomes of Pregnancy in Chinese Women: A Retrospective Cohort Study. PLoS One 2015; 10:e0136850. [PMID: 26313941 PMCID: PMC4552294 DOI: 10.1371/journal.pone.0136850] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 07/17/2015] [Indexed: 11/18/2022] Open
Abstract
Objective To explore the joint and independent effects of gestational weight gain (GWG) and pre-pregnancy body mass index (BMI) on pregnancy outcomes in a population of Chinese Han women and to evaluate pregnant women’s adherence to the 2009 Institute of Medicine (IOM) gestational weight gain guidelines. Methods This was a multicenter, retrospective cohort study of 48,867 primiparous women from mainland China who had a full-term singleton birth between January 1, 2011 and December 30, 2011. The independent associations of pre-pregnancy BMI, GWG and categories of combined pre-pregnancy BMI and GWG with outcomes of interest were examined using an adjusted multivariate regression model. In addition, women with pre-pregnancy hypertension were excluded from the analysis of the relationship between GWG and delivery of small-for-gestational-age (SGA) infants, and women with gestational diabetes (GDM) were excluded from the analysis of the relationship between GWG and delivery of large-for-gestational-age (LGA) infants. Results Only 36.8% of the women had a weight gain that was within the recommended range; 25% and 38.2% had weight gains that were below and above the recommended range, respectively. The contribution of GWG to the risk of adverse maternal and fetal outcomes was modest. Women with excessive GWG had an increased likelihood of gestational hypertension (adjusted OR 2.55; 95% CI = 1.92–2.80), postpartum hemorrhage (adjusted OR 1.30; 95% CI = 1.17–1.45), cesarean section (adjusted OR 1.31; 95% CI = 1.18–1.36) and delivery of an LGA infant (adjusted OR 2.1; 95% CI = 1.76–2.26) compared with women with normal weight gain. Conversely, the incidence of GDM (adjusted OR 1.64; 95% CI = 1.20–1.85) and SGA infants (adjusted OR 1.51; 95% CI = 1.32–1.72) was increased in the group of women with inadequate GWG. Moreover, in the obese women, excessive GWG was associated with an apparent increased risk of delivering an LGA infant. In the women who were underweight, poor weight gain was associated with an increased likelihood of delivering an SGA infant. After excluding the mothers with GDM or gestational hypertension, the ORs for delivery of LGA and SGA infants decreased for women with high GWG and increased for women with low GWG. Conclusions GWG above the recommended range is common in this population and is associated with multiple unfavorable outcomes independent of pre-pregnancy BMI. Obese women may benefit from avoiding weight gain above the range recommended by the 2009 IOM. Underweight women should avoid low GWG to prevent delivering an SGA infant. Pregnant women should therefore be monitored to comply with the IOM recommendations and should have a balanced weight gain that is within a range based on their pre-pregnancy BMI.
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Affiliation(s)
- Chunming Li
- Department of Obstetrics, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Yajun Liu
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Weiyuan Zhang
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- * E-mail:
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Geyl C, Clouqueur E, Lambert J, Subtil D, Debarge V, Deruelle P. [Links between preeclampsia and intrauterine growth restriction]. ACTA ACUST UNITED AC 2014; 42:229-33. [PMID: 24533991 DOI: 10.1016/j.gyobfe.2014.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 12/19/2013] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Preeclampsia is one of the most frequent and most serious complications of pregnancy. Its occurrence is around 5% of the pregnancies. Its pathophysiology is complex and includes several hypotheses. Preeclampsia is inconsistently associated with intrauterine growth retardation (IUGR). The determinants that explain the variability of this association are unknown. The objective of our study was to identify in a population of French patients who had preeclampsia and/or HELLP syndrome, incidence and risk factors of IUGR to isolate specific characteristics of these women. PATIENTS AND METHODS We studied 578 pregnant women treated for preeclampsia or HELLP syndrome according to the presence or absence of IUGR (database compiled since 1996). Comparisons between the groups were done with Wilcoxon test (quantitative data) or Fisher's exact test (qualitative data). RESULTS We found that pre-eclampsia appeared earlier and was more severe in the group with IUGR. In addition foetal issues were more defavorable when IUGR was associated with preeclampsia. CONCLUSION Combination of IUGR and pre-eclampsia or HELLP syndrome is a criterion of severity for both the mother and the fetus. Our data do not allow distinguishing physiopathological mechanism to explain these differences.
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Affiliation(s)
- C Geyl
- Pôle d'obstétrique, maternité Jeanne-de-Flandre, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| | - E Clouqueur
- Pôle d'obstétrique, maternité Jeanne-de-Flandre, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| | - J Lambert
- Service de biostatistique et information médicale, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - D Subtil
- Pôle d'obstétrique, maternité Jeanne-de-Flandre, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| | - V Debarge
- Pôle d'obstétrique, maternité Jeanne-de-Flandre, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France; EA 4489, environnement périnatal et croissance, IMPRT IFR 114, faculté de médecine université Lille-2, rue Paul-Duez, 59045 Lille cedex, France
| | - P Deruelle
- Pôle d'obstétrique, maternité Jeanne-de-Flandre, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France; EA 4489, environnement périnatal et croissance, IMPRT IFR 114, faculté de médecine université Lille-2, rue Paul-Duez, 59045 Lille cedex, France.
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Kulandavelu S, Whiteley KJ, Bainbridge SA, Qu D, Adamson SL. Endothelial NO Synthase Augments Fetoplacental Blood Flow, Placental Vascularization, and Fetal Growth in Mice. Hypertension 2013; 61:259-66. [DOI: 10.1161/hypertensionaha.112.201996] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is not known whether eNOS deficiency in the mother or the conceptus (ie, placenta and fetus) causes fetal growth restriction in mice lacking the endothelial NO synthase gene (eNOS knockout [KO]). We hypothesized that eNOS sustains fetal growth by maintaining low fetoplacental vascular tone and promoting fetoplacental vascularity and that this is a conceptus effect and is independent of maternal genotype. We found that eNOS deficiency blunted fetal growth, and blunted the normal increase in umbilical blood flow and umbilical venous diameter and the decrease in umbilical arterial Resistance Index in late gestation (14.5–17.5 days) in eNOS KO relative to C57Bl/6J controls. On day 17.5, fetoplacental capillary lobule length and capillary density in vascular corrosion casts were reduced in eNOS KO placentas. Reduced vascularization may be a result of decreased vascular endothelial growth factor mRNA and protein expression in eNOS KO placentas at this stage. These factors, combined with significant anemia found in eNOS KO fetuses, would be anticipated to reduce fetal oxygen delivery and contribute to the fetal tissue hypoxia that was detected in the heart, lung, kidney, and liver by immunohistochemistry using pimonidazole. Although maternal eNOS deficiency impairs uteroplacental adaptations to pregnancy, maternal genotype was not a significant factor affecting growth in heterozygous conceptuses. This indicates that fetal growth restriction was primarily caused by conceptus eNOS deficiency. In mice, placental hemodynamic and vascular changes with gestation and growth restriction showed strong parallels with human pregnancy. Thus, the eNOS KO model could provide insights into the pathogenesis of human intrauterine growth restriction.
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Affiliation(s)
- Shathiyah Kulandavelu
- From the Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada (S.K., K.J.W., S.A.B., D.Q., S.L.A.); and the Departments of Physiology, and Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada (S.K., S.A.B., S.L.A.)
| | - Kathie J. Whiteley
- From the Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada (S.K., K.J.W., S.A.B., D.Q., S.L.A.); and the Departments of Physiology, and Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada (S.K., S.A.B., S.L.A.)
| | - Shannon A. Bainbridge
- From the Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada (S.K., K.J.W., S.A.B., D.Q., S.L.A.); and the Departments of Physiology, and Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada (S.K., S.A.B., S.L.A.)
| | - Dawei Qu
- From the Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada (S.K., K.J.W., S.A.B., D.Q., S.L.A.); and the Departments of Physiology, and Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada (S.K., S.A.B., S.L.A.)
| | - S. Lee Adamson
- From the Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada (S.K., K.J.W., S.A.B., D.Q., S.L.A.); and the Departments of Physiology, and Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada (S.K., S.A.B., S.L.A.)
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12
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Heude B, Thiébaugeorges O, Goua V, Forhan A, Kaminski M, Foliguet B, Schweitzer M, Magnin G, Charles MA. Pre-pregnancy body mass index and weight gain during pregnancy: relations with gestational diabetes and hypertension, and birth outcomes. Matern Child Health J 2012; 16:355-63. [PMID: 21258962 DOI: 10.1007/s10995-011-0741-9] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
To study the relationship between pre-pregnancy body mass index (BMI) and weight gain during pregnancy with pregnancy and birth outcomes, with a focus on gestational diabetes and hypertension and their role in the association with fetal growth. We studied 1,884 mothers and offspring from the Eden mother-child cohort. Weight before pregnancy (W1) and weight after delivery (W2) were collected and we calculated BMI and net gestational weight gain (netGWG = (W2 - W1)/(weeks of gestation)). Gestational diabetes, hypertension gestational age and birth weight were collected. We used multivariate linear or logistic models to study the association between BMI, netGWG and pregnancy and birth outcomes, adjusting for center, maternal age and height, parity and average number of cigarettes smoked per day during pregnancy. High BMI was more strongly related to the risk of giving birth to a large-for-gestational-age (LGA) baby than high netGWG (odds ratio OR [95% CI] of 3.23 [1.86-5.60] and 1.61 [0.91-2.85], respectively). However, after excluding mothers with gestational diabetes or hypertension the ORs for LGA, respectively weakened (OR 2.57 [1.29-5.13]) for obese women and strengthened for high netGWG (OR 2.08 [1.14-3.80]). Low in comparison to normal netGWG had an OR of 2.18 [1.20-3.99] for pre-term birth, which became stronger after accounting for blood pressure and glucose disorders (OR 2.70 [1.37-5.34]). Higher net gestational weight gain was significantly associated with an increased risk of LGA only after accounting for blood pressure and glucose disorders. High gestational weight gain should not be neglected in regard to risk of LGA in women without apparent risk factors.
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Affiliation(s)
- B Heude
- INSERM, CESP Centre for Research in Epidemiology and Population Health, UMRS 1018, Epidemiology of Diabetes, Obesity and Chronic Kidney Disease Over the Lifecourse, 94807 Villejuif, France.
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Is fetal growth restriction associated with a more severe maternal phenotype in the setting of early onset pre-eclampsia? A retrospective study. PLoS One 2011; 6:e26937. [PMID: 22046419 PMCID: PMC3203930 DOI: 10.1371/journal.pone.0026937] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Accepted: 10/06/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Both pre-eclampsia and fetal growth restriction are thought to result from abnormal placental implantation in early pregnancy. Consistent with this shared pathophysiology, it is not uncommon to see growth restriction further confound the course of pre-eclampsia and vice versa. It has been previously suggested that superimposed growth restriction is associated with a more severe pre-eclamptic phenotype, however this has not been a consistent finding. Therefore, we set out to determine whether the presence of fetal growth restriction among women with severe early-onset pre-eclampsia was associated with more severe maternal disease compared to those without a growth-restricted fetus. METHODS AND FINDINGS We undertook a retrospective cohort study of women presenting to a tertiary hospital with severe early-onset pre-eclampsia (<34 weeks' gestation) between 2005-2009. We collected clinical data, including severity of pre-eclampsia, maternal and neonatal outcomes. Of 176 cases of severe pre-eclampsia, 39% (n = 68) were further complicated by fetal growth restriction. However, no significant difference was seen in relation to the severity of pre-eclampsia between those with or without a growth-restricted baby. The presence of concomitant growth restriction was however associated with a significantly increased risk of stillbirth (p = 0.003) and total perinatal mortality (p = 0.02). CONCLUSIONS The presence of fetal growth restriction among women with severe early-onset pre-eclampsia is not associated with increased severity of maternal disease. However the incidence of stillbirth and perinatal death is significantly increased in this sub-population.
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14
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Pravastatin induces placental growth factor (PGF) and ameliorates preeclampsia in a mouse model. Proc Natl Acad Sci U S A 2010; 108:1451-5. [PMID: 21187414 DOI: 10.1073/pnas.1011293108] [Citation(s) in RCA: 277] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Preeclampsia is a relatively common pregnancy-related disorder. Both maternal and fetal lives will be endangered if it proceeds unabated. Recently, the placenta-derived anti-angiogenic factors, such as soluble fms-like tyrosine kinase-1 (sFLT1) and soluble endoglin (sENG), have attracted attention in the progression of preeclampsia. Here, we established a unique experimental model to test the role of sFLT1 in preeclampsia using a lentiviral vector-mediated placenta-specific expression system. The model mice showed hypertension and proteinuria during pregnancy, and the symptoms regressed after parturition. Intrauterine growth restriction was also observed. We further showed that pravastatin induced the VEGF-like angiogenic factor placental growth factor (PGF) and ameliorated the symptoms. We conclude that our experimental preeclamptic murine model phenocopies the human case, and the model identifies low-dose statins and PGF as candidates for preeclampsia treatment.
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15
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Soto E, Romero R, Richani K, Espinoza J, Chaiworapongsa T, Nien JK, Edwin SS, Kim YM, Hong JS, Goncalves LF, Yeo L, Mazor M, Hassan SS, Kusanovic JP. Preeclampsia and pregnancies with small-for-gestational age neonates have different profiles of complement split products. J Matern Fetal Neonatal Med 2010; 23:646-57. [PMID: 19900030 PMCID: PMC3482544 DOI: 10.3109/14767050903301009] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The activation of the complement system results in the generation of split products with pro-inflammatory properties. The objective of this study was to determine whether preeclampsia and small-for-gestational age (SGA) are associated with changes in the maternal plasma concentrations of anaphylatoxins C3a, C4a and C5a. METHODS A cross-sectional study was conducted in the following groups: (a) normal pregnant women (n = 134); (b) women who delivered an SGA neonate (n = 53); (c) preeclampsia with (n = 52) and without SGA (n = 54). Maternal plasma anaphylatoxin concentrations were determined by enzyme-linked immunoassay. RESULTS (1) Women with preeclampsia with or without SGA had a significantly higher median plasma C5a concentration than that of normal pregnant women and those with SGA alone (all P < 0.01); (2) women with SGA alone did not have an increase in plasma C5a concentration; (3) in contrast, the median maternal plasma concentration of C4a was lower in women with preeclampsia and SGA than that of those with a normal pregnancy (P = 0.001); (4) no changes in C3a were observed among the study groups. CONCLUSION Preeclampsia is associated with increased plasma concentration of C5a, regardless of the presence or absence of an SGA fetus. In contrast, there was no difference in the plasma C3a, C4a and C5a concentration in patients with SGA.
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Affiliation(s)
- Eleazar Soto
- Perinatology Research Branch, NICHD/NIF/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Roberto Romero
- Perinatology Research Branch, NICHD/NIF/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA
| | - Karina Richani
- Perinatology Research Branch, NICHD/NIF/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
| | - Jimmy Espinoza
- Perinatology Research Branch, NICHD/NIF/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Tinnakorn Chaiworapongsa
- Perinatology Research Branch, NICHD/NIF/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Jyh Kae Nien
- Perinatology Research Branch, NICHD/NIF/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Sam S. Edwin
- Perinatology Research Branch, NICHD/NIF/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
| | - Yeon Mee Kim
- Perinatology Research Branch, NICHD/NIF/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
| | - Joon Seok Hong
- Department of Obstetrics and Gynecology, Seoul National University, Seoul, Korea
| | - Luis F. Goncalves
- Perinatology Research Branch, NICHD/NIF/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Lami Yeo
- Perinatology Research Branch, NICHD/NIF/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Moshe Mazor
- Department of Obstetrics and Gynecology, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Sonia S. Hassan
- Perinatology Research Branch, NICHD/NIF/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Juan Pedro Kusanovic
- Perinatology Research Branch, NICHD/NIF/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
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Naujorks AA, Zielinsky P, Beltrame PA, Castagna RC, Petracco R, Busato A, Nicoloso ALH, Piccoli A, Manica JL. Myocardial tissue Doppler assessment of diastolic function in the growth-restricted fetus. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 34:68-73. [PMID: 19565528 DOI: 10.1002/uog.6427] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Myocardial tissue Doppler (MTD) is a technique for the measurement of myocardial velocities in systole and diastole. This study evaluates the use of MTD in the assessment of cardiac diastolic function in fetuses with intrauterine growth restriction (IUGR) with placental insufficiency and in appropriate-for-gestational age (AGA) fetuses with hypertensive mothers. METHODS This study included 14 IUGR fetuses with placental insufficiency (Group 1), 13 AGA fetuses with hypertensive mothers (Group 2), and 29 AGA fetuses with healthy mothers (Group 3). Patients with other diseases were excluded. All fetuses had a gestational age of at least 25 weeks. MTD assessment was performed with the sample volume placed at the basal segment of the left ventricular side wall (LV), the interventricular septum (IVS) and the right ventricular free wall (RV). E'/A' ratios were calculated for each location. Mitral and tricuspid flows were assessed by conventional spectral pulsed Doppler. RESULTS Significant differences were found between groups for E'/A' at the IVS (P < 0.001) and LV (P = 0.009), with a higher mean (+/- SD) value in Group 1 (IVS: 0.92 +/- 0.28; LV: 0.85 +/- 0.19) than in Groups 2 (IVS: 0.62 +/- 0.09; LV: 0.68 +/- 0.14) and 3 (IVS: 0.71 +/- 0.14; LV: 0.69 +/- 0.15). In the RV, there was no statistically significant difference in the E'/A' ratio (P = 0.2). No differences were observed for mitral and tricuspid flow velocities and ratios. CONCLUSIONS Using MTD, the ratios between early and late diastolic myocardial velocities are higher in IUGR fetuses than in AGA fetuses at the IVS and the LV, regardless of the presence of maternal hypertension. MTD may be more sensitive than atrioventricular spectral Doppler for the detection of ventricular diastolic dysfunction in IUGR fetuses.
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Affiliation(s)
- A A Naujorks
- Fetal Cardiology Unit, Institute of Cardiology of Rio Grande do Sul, Porto Alegre, Brazil
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Sun G, Tang D, Liang J, Wu M. Increasing Prevalence of Hypospadias Associated With Various Perinatal Risk Factors in Chinese Newborns. Urology 2009; 73:1241-5. [DOI: 10.1016/j.urology.2008.12.081] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Revised: 12/17/2008] [Accepted: 12/29/2008] [Indexed: 11/16/2022]
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Erez O, Romero R, Hoppensteadt D, Than NG, Fareed J, Mazaki-Tovi S, Espinoza J, Chaiworapongsa T, Kim SS, Yoon BH, Hassan SS, Gotsch F, Friel L, Vaisbuch E, Kusanovic JP. Tissue factor and its natural inhibitor in pre-eclampsia and SGA. J Matern Fetal Neonatal Med 2008; 21:855-69. [PMID: 19065458 PMCID: PMC3171292 DOI: 10.1080/14767050802361872] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Tissue factor (TF), the major activator of the extrinsic pathway of coagulation, is abundant in the placenta and decidua. The aim of this study was to determine the maternal plasma concentrations of TF and its primary inhibitor, tissue factor pathway inhibitor (TFPI), in women who delivered small for gestational age (SGA) neonates, and in pre-eclampsia. STUDY DESIGN A cross-sectional study included the following groups: 1) women with normal pregnancies (n = 86); 2) patients who delivered SGA neonates (n = 61) and 3) women with pre-eclampsia (n = 133). Maternal plasma concentrations of TF and TFPI were measured by a sensitive immunoassay. Non-parametric statistics were used for analysis. RESULTS 1) Women with pre-eclampsia had a significantly higher median plasma concentration of TF than patients with a normal pregnancy (median: 1187 pg/mL; range: 69-11675 vs. median: 291.5 pg/mL; range: 6.3-2662.2; p < 0.0001, respectively); 2) Similarly, TFPI concentrations were higher in pre-eclampsia than in normal pregnancy (median: 87.5 ng/mL; range 25.4-165.1 vs. median: 66.1 ng/mL; range: 14.3-86.5; p < 0.0001, respectively); 3) Surprisingly, mothers with SGA neonates had a lower median maternal plasma concentration of TF (median: 112.2 pg/mL; range: 25.6-1225.3) than women with a normal pregnancy (p < 0.0001). CONCLUSION 1) Maternal plasma concentrations of TF in patients with pre-eclampsia, but not in those who delivered an SGA neonate, were higher than in women with normal pregnancies; 2) Although the role of immunoreactive plasma TF in coagulation remains controversial, our observations suggest that changes are present in the context of complications of pregnancy.
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Affiliation(s)
- Offer Erez
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Roberto Romero
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA
| | - Debra Hoppensteadt
- Loyola University Medical Center, Department of Pathology, Maywood, Illinois, USA
| | - Nandor Gabor Than
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, USA
| | - Jawed Fareed
- Loyola University Medical Center, Department of Pathology, Maywood, Illinois, USA
| | - Shali Mazaki-Tovi
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Jimmy Espinoza
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Tinnakorn Chaiworapongsa
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Sung-Su Kim
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, USA
| | - Bo Hyun Yoon
- Seoul National University College of Medicine, Department of Obstetrics and Gynecology, Seoul, South Korea
| | - Sonia S. Hassan
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Francesca Gotsch
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, USA
| | - Lara Friel
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Edi Vaisbuch
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Juan Pedro Kusanovic
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
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McElrath TF, Hecht JL, Dammann O, Boggess K, Onderdonk A, Markenson G, Harper M, Delpapa E, Allred EN, Leviton A. Pregnancy disorders that lead to delivery before the 28th week of gestation: an epidemiologic approach to classification. Am J Epidemiol 2008; 168:980-9. [PMID: 18756014 DOI: 10.1093/aje/kwn202] [Citation(s) in RCA: 259] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Epidemiologists have grouped the multiple disorders that lead to preterm delivery before the 28th week of gestation in a variety of ways. The authors sought to identify characteristics that would help guide how to classify disorders that lead to such preterm delivery. They enrolled 1,006 women who delivered a liveborn singleton infant of less than 28 weeks' gestation at 14 centers in the United States between 2002 and 2004. Each delivery was classified by presentation: preterm labor (40%), prelabor premature rupture of membranes (23%), preeclampsia (18%), placental abruption (11%), cervical incompetence (5%), and fetal indication/intrauterine growth restriction (3%). Using factor analysis (eigenvalue = 1.73) to compare characteristics identified by standardized interview, chart review, placental histology, and placental microbiology among the presentation groups, the authors found 2 broad patterns. One pattern, characterized by histologic chorioamnionitis and placental microbe recovery, was associated with preterm labor, prelabor premature rupture of membranes, placental abruption, and cervical insufficiency. The other, characterized by a paucity of organisms and inflammation but the presence of histologic features of dysfunctional placentation, was associated with preeclampsia and fetal indication/intrauterine growth restriction. Disorders leading to preterm delivery may be separated into two groups: those associated with intrauterine inflammation and those associated with aberrations of placentation.
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Affiliation(s)
- T F McElrath
- Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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20
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Gezginç K, Acar A, Peru H, Karataylı R, Çelik Ç, Çapar M. HOW TO MANAGE INTRAUTERINE GROWTH RESTRICTION ASSOCIATED WITH SEVERE PREECLAMPSIA AT 28-34 WEEKS OF GESTATION? ELECTRONIC JOURNAL OF GENERAL MEDICINE 2008. [DOI: 10.29333/ejgm/82609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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