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Hwang J, Kim S, Kim H, Kim C, Kim SH, Yang M, Ahn SY, Sung SI, Chang YS. Predictive factors for perinatal bacterial transmission from colonized mothers to delivered very-low-birth-weight infants: a retrospective cohort study. Sci Rep 2024; 14:16835. [PMID: 39039134 PMCID: PMC11263601 DOI: 10.1038/s41598-024-67674-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 07/15/2024] [Indexed: 07/24/2024] Open
Abstract
This study investigated the predictive factors for perinatal bacterial transmission in very-low-birth-weight infants (VLBWIs) born to mothers with a history of intrapartum colonization. We retrospectively reviewed the medical records of 173 VLBWIs, wherein pathogens were confirmed in maternal cultures obtained from the blood, urine, and vagina during the intrapartum period from 2013 to 2020. Newborns were categorized based on microbiological tests, including gastric aspirates, endotracheal aspirates, blood, and skin/nasal swab cultures collected immediately after birth. Infants whose cultures matched their maternal pathogens were categorized into the "transmission group" (n = 45), while those who tested negative were assigned to the "control group" (n = 128). The predominant maternal-colonizing pathogen observed was Escherichia coli (30.6%), which also emerged as the primary colonizing pathogen in neonates (35.6%). Transmission group had higher incidences of maternal leukocytosis, chorioamnionitis, and cervical cerclage. Regarding neonatal characteristics, the transmission group demonstrated lower initial base excesses (- 6.3 ± 3.9 vs. - 9.2 ± 4.9, P < 0.05) and higher C-reactive protein levels (0.1 ± 0.3 vs. 0.4 ± 0.8, P < 0.05). Notably, regarding major neonatal outcomes, transmission group had higher mortality rates and incidences of severe intraventricular hemorrhage. These findings may be useful for making decisions when considering antibiotic treatment for infants with a history of maternal colonization.
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Affiliation(s)
- Jieun Hwang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Sumin Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Hanna Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Chan Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Seung Hyun Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Misun Yang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
- Cell and Gene Therapy Institute for Future Medicine, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - So Yoon Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
- Cell and Gene Therapy Institute for Future Medicine, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
| | - Se In Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
- Cell and Gene Therapy Institute for Future Medicine, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
- Cell and Gene Therapy Institute for Future Medicine, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
- Department of Health Science and Technology, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
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LaPointe S, Mendola P, Lin S, Tian L, Bonell A, Adamba C, Palermo T. Impact of cash transfers on the association between prenatal exposures to high temperatures and low birthweight: Retrospective analysis from the LEAP 1000 study. BJOG 2024; 131:641-650. [PMID: 38238994 DOI: 10.1111/1471-0528.17761] [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: 07/14/2023] [Revised: 12/06/2023] [Accepted: 01/01/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE To explore the associations between prenatal temperature exposures and low birthweight (LBW) and modification by cash transfer (CT) receipt. DESIGN Retrospective cohort study. SETTING Five rural districts in Northern Ghana. POPULATION OR SAMPLE A total of 3016 infants born to women interviewed as part of the Livelihood Empowerment Against Poverty (LEAP 1000) impact evaluation between 2015 and 2017. METHODS Birthweight was collected using household surveys administered to LEAP 1000 eligible women. We used a UNICEF-developed multiple imputation approach to address missingness of birthweight and applied an empirical heaping correction to the multiply imputed birthweight data. Survey data were linked to the European Centre for Medium-Range Weather Forecasts Reanalysis 5-hourly temperature averaged to weeks for 2011-2017 using community centroids. Using distributed-lag nonlinear models, we explored the lag-specific associations between weekly average temperatures greater than 30°C and LBW, and stratified by LEAP 1000 treatment. MAIN OUTCOME MEASURES Low birthweight (<2.5 kg). RESULTS Twelve percent (n = 365) of infants were LBW; the mean ± SD birthweight was 3.02 ± 0.37 kg. Overall, increasing temperatures were associated with increased odds of LBW, with the greatest odds observed in the 3 weeks before birth (odds ratio 1.005-1.025). These positive associations were even larger among comparison infants and null among treatment infants. CONCLUSIONS Our study found increased odds of LBW with high weekly average temperatures throughout pregnancy and the preconception period and demonstrate mitigated effects by the LEAP 1000 CT program. More evidence on the potential of CTs to serve as adaptation interventions in low- and middle-income countries is needed to protect pregnant persons and their infants from the impacts of climate change.
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Affiliation(s)
- Sarah LaPointe
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Pauline Mendola
- Department of Epidemiology and Environmental Health, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Shao Lin
- Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, New York, USA
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York, USA
| | - Lili Tian
- Department of Biostatistics, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Ana Bonell
- Medical Research Council Unit, London School of Hygiene and Tropical Medicine, Banjul, The Gambia
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Clement Adamba
- School of Education and Leadership, University of Ghana, Accra, Ghana
| | - Tia Palermo
- Department of Epidemiology and Environmental Health, University at Buffalo, State University of New York, Buffalo, New York, USA
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3
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Suleri A, Cecil C, Rommel AS, Hillegers M, White T, de Witte LD, Muetzel RL, Bergink V. Long-term effects of prenatal infection on the human brain: a prospective multimodal neuroimaging study. Transl Psychiatry 2023; 13:306. [PMID: 37789021 PMCID: PMC10547711 DOI: 10.1038/s41398-023-02597-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 09/15/2023] [Accepted: 09/15/2023] [Indexed: 10/05/2023] Open
Abstract
There is convincing evidence from rodent studies suggesting that prenatal infections affect the offspring's brain, but evidence in humans is limited. Here, we assessed the occurrence of common infections during each trimester of pregnancy and examined associations with brain outcomes in adolescent offspring. Our study was embedded in the Generation R Study, a large-scale sociodemographically diverse prospective birth cohort. We included 1094 mother-child dyads and investigated brain morphology (structural MRI), white matter microstructure (DTI), and functional connectivity (functional MRI), as outcomes at the age of 14. We focused on both global and focal regions. To define prenatal infections, we composed a score based on the number and type of infections during each trimester of pregnancy. Models were adjusted for several confounders. We found that prenatal infection was negatively associated with cerebral white matter volume (B = -0.069, 95% CI -0.123 to -0.015, p = 0.011), and we found an association between higher prenatal infection scores and smaller volumes of several frontotemporal regions of the brain. After multiple testing correction, we only observed an association between prenatal infections and the caudal anterior cingulate volume (B = -0.104, 95% CI -0.164 to -0.045, p < 0.001). We did not observe effects of prenatal infection on other measures of adolescent brain morphology, white matter microstructure, or functional connectivity, which is reassuring. Our results show potential regions of interest in the brain for future studies; data on the effect of severe prenatal infections on the offspring's brain in humans are needed.
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Affiliation(s)
- Anna Suleri
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- The Generation R Study Group, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Charlotte Cecil
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Anna-Sophie Rommel
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Manon Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Tonya White
- Section on Social and Cognitive Developmental Neuroscience, National Institute of Mental Health, Bethesda, MD, USA
| | - Lot D de Witte
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Ryan L Muetzel
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Veerle Bergink
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA.
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
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Ozarslan N, Gaw SL, Cassidy AG, Caughey AB. Predictors of antepartum maternal sepsis and effects on neonatal outcomes: a population-based cohort study. J Perinatol 2023; 43:752-757. [PMID: 37217673 DOI: 10.1038/s41372-023-01696-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 04/12/2023] [Accepted: 04/28/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To examine the relationship between maternal sepsis, type of infection, and short-term neonatal outcomes. STUDY DESIGN We conducted a retrospective cohort study investigating pregnancies between 2005 and 2008 in California with antepartum maternal sepsis diagnosis. Comparisons were made between sepsis cases and controls, using chi-squared or Fisher's exact test. Multivariable logistic regression was performed, adjusting for maternal characteristics. RESULTS Several maternal characteristics were associated with increased odds of maternal sepsis. Both obstetric and non-obstetric infections were associated with maternal sepsis (p < 0.001). The positive predictive value of maternal sepsis for preterm delivery was 55.03%. Neonates born to maternal sepsis patients had a higher risk of developing neonatal complications including neonatal shock. CONCLUSION Maternal sepsis was associated with neonatal complications. Efforts to reduce maternal sepsis may improve neonatal outcomes. Further studies are required for a better understanding of these associations and whether prevention or more rapid diagnosis and treatment can lower these risks.
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Affiliation(s)
- Nida Ozarslan
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Stephanie L Gaw
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Arianna G Cassidy
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA.
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Galletta MAK, Schultz R, Sartorelli MFGDOP, Guerra ECL, Agra IKR, Peres SV, Francisco RPV. Clinical characteristics, complications, and predictive model of histological chorioamnionitis in women with preterm premature rupture of membranes. PLoS One 2023; 18:e0283974. [PMID: 37023210 PMCID: PMC10079121 DOI: 10.1371/journal.pone.0283974] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 03/21/2023] [Indexed: 04/08/2023] Open
Abstract
We aimed to analyze the impact of histological chorioamnionitis (HCA) in the presence of preterm premature rupture of the membranes (PPROM) on obstetric and neonatal outcomes, and its possible predictability. A retrospective cohort analysis of PPROM cases (20-37 weeks) was conducted comparing the patients with and without HCA, seeking a predictive model of HCA using logistic regression. A total of 295 cases of PPROM were selected, of which 72 (24.4%) had HCA. The group with HCA had a shorter latency period and a greater number of clinical and laboratory criteria in the evolution. The group with HCA had a worse comparative result and presented: lower gestational age at delivery, lower average birth weight, lower Apgar scores, longer neonatal hospitalization, worse maternal clinical conditions and, higher rates of stillbirth, low birth weight (LBW), very low birth weight (VLBW), complications in pregnancy and childbirth, and cesarean delivery due to fetal distress or chorioamnionitis. A predictive model for HCA was developed, with the following independent variables: abdominal pain (odds ratio [OR] = 11.61), uterine activity (noticeable contractions on physical exam) (OR = 5.97), fever (OR = 5.77), latency > 3 days (OR = 2.13), and C-reactive protein (OR = 1.01). With this model, an adequate receiver operating characteristic curve was found, with an area under the curve of 0.726, and some HCA probability curves were constructed for different clinical situations. In this novel study, we present a non-invasive predictive model, with clinical and laboratory variables, which may help in decision-making in a patient with PPROM.
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Affiliation(s)
- Marco Aurélio Knippel Galletta
- Department of Obstetrics and Gynecology, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Regina Schultz
- Division of Pathological Anatomy, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | | | - Eliane Cerqueira Leite Guerra
- Department of Obstetrics and Gynecology, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Isabela Karine Rodrigues Agra
- Department of Obstetrics and Gynecology, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Stela Verzinhasse Peres
- Department of Obstetrics and Gynecology, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
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Green EA, Garrick SP, Peterson B, Berger PJ, Galinsky R, Hunt RW, Cho SX, Bourke JE, Nold MF, Nold-Petry CA. The Role of the Interleukin-1 Family in Complications of Prematurity. Int J Mol Sci 2023; 24:2795. [PMID: 36769133 PMCID: PMC9918069 DOI: 10.3390/ijms24032795] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/20/2023] [Accepted: 01/22/2023] [Indexed: 02/05/2023] Open
Abstract
Preterm birth is a major contributor to neonatal morbidity and mortality. Complications of prematurity such as bronchopulmonary dysplasia (BPD, affecting the lung), pulmonary hypertension associated with BPD (BPD-PH, heart), white matter injury (WMI, brain), retinopathy of prematurity (ROP, eyes), necrotizing enterocolitis (NEC, gut) and sepsis are among the major causes of long-term morbidity in infants born prematurely. Though the origins are multifactorial, inflammation and in particular the imbalance of pro- and anti-inflammatory mediators is now recognized as a key driver of the pathophysiology underlying these illnesses. Here, we review the involvement of the interleukin (IL)-1 family in perinatal inflammation and its clinical implications, with a focus on the potential of these cytokines as therapeutic targets for the development of safe and effective treatments for early life inflammatory diseases.
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Affiliation(s)
- Elys A. Green
- Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC 3168, Australia
- Department of Paediatrics, Monash University, Melbourne, VIC 3168, Australia
- Monash Newborn, Monash Children’s Hospital, Melbourne, VIC 3168, Australia
| | - Steven P. Garrick
- Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC 3168, Australia
- Department of Paediatrics, Monash University, Melbourne, VIC 3168, Australia
| | - Briana Peterson
- Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC 3168, Australia
- Department of Paediatrics, Monash University, Melbourne, VIC 3168, Australia
| | - Philip J. Berger
- Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC 3168, Australia
- Department of Paediatrics, Monash University, Melbourne, VIC 3168, Australia
| | - Robert Galinsky
- Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC 3168, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC 3168, Australia
| | - Rod W. Hunt
- Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC 3168, Australia
- Department of Paediatrics, Monash University, Melbourne, VIC 3168, Australia
- Monash Newborn, Monash Children’s Hospital, Melbourne, VIC 3168, Australia
| | - Steven X. Cho
- Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC 3168, Australia
- Department of Paediatrics, Monash University, Melbourne, VIC 3168, Australia
| | - Jane E. Bourke
- Department of Pharmacology, Biomedicine Discovery Institute, Monash University, Melbourne, VIC 3168, Australia
| | - Marcel F. Nold
- Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC 3168, Australia
- Department of Paediatrics, Monash University, Melbourne, VIC 3168, Australia
- Monash Newborn, Monash Children’s Hospital, Melbourne, VIC 3168, Australia
| | - Claudia A. Nold-Petry
- Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC 3168, Australia
- Department of Paediatrics, Monash University, Melbourne, VIC 3168, Australia
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Felder JN, Baer RJ, Rand L, Ryckman KK, Jelliffe-Pawlowski L, Prather AA. Adverse infant outcomes among women with sleep apnea or insomnia during pregnancy: A retrospective cohort study. Sleep Health 2023; 9:26-32. [PMID: 36371381 PMCID: PMC10881279 DOI: 10.1016/j.sleh.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 08/01/2022] [Accepted: 09/26/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate whether sleep apnea or insomnia among pregnant people is associated with increased risk for adverse infant outcomes. DESIGN Retrospective cohort study SETTING: California PARTICIPANTS: The sample included singleton live births. Sleep apnea and insomnia were defined based on ICD-9 and -10 codes. A referent group was selected using exact propensity score matching on maternal characteristics, obstetric factors, and infant factors among individuals without a sleep disorder. MEASUREMENTS Adverse infant outcomes were obtained from birth certificate, hospital discharge, and death records (eg, Apgar scores, neonatal intensive care unit (NICU) stay, infant death, long birth stay, etc.). Logistic regression was used to calculate odds of an adverse infant outcome by sleep disorder type. RESULTS Propensity-score matched controls were identified for 69.9% of the 3371 sleep apnea cases and 68.8% of the 3213 insomnia cases. Compared to the propensity-matched referent group, individuals with a diagnosis of sleep apnea (n = 2357) had infants who were more likely to have any adverse outcome, low 1-min Apgar scores, NICU stay, and an emergency room visit in the first year of life. Infants born to mothers with a diagnosis of insomnia (n = 2212) were at increased risk of few negative outcomes relative to the propensity matched referent group, with the exception of an emergency room visit. CONCLUSIONS In unadjusted analyses, infants born to individuals with a diagnosis of sleep apnea or insomnia were at increased risk of several adverse outcomes. These were attenuated when using propensity score matching, suggesting these associations were driven by other comorbidities.
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Affiliation(s)
- Jennifer N Felder
- Osher Center for Integrative Health, University of California, San Francisco, San Francisco, California, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Rebecca J Baer
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA; UCSF California Preterm Birth Initiative, University of California, San Francisco, San Francisco, California, USA; Department of Pediatrics, University of California, San Diego, San Diego, California, USA
| | - Larry Rand
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA; UCSF California Preterm Birth Initiative, University of California, San Francisco, San Francisco, California, USA
| | - Kelli K Ryckman
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Laura Jelliffe-Pawlowski
- UCSF California Preterm Birth Initiative, University of California, San Francisco, San Francisco, California, USA; Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Aric A Prather
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA; Center for Health and Community, University of California, San Francisco, San Francisco, California, USA
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Lodefalk M, Chelslín F, Patriksson Karlsson J, Hansson SR. Placental Changes and Neuropsychological Development in Children-A Systematic Review. Cells 2023; 12:cells12030435. [PMID: 36766778 PMCID: PMC9913696 DOI: 10.3390/cells12030435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/16/2023] [Accepted: 01/19/2023] [Indexed: 01/31/2023] Open
Abstract
Placental dysfunction may increase the offspring's later-life disease risk. The objective of this systematic review was to describe associations between pathological placental changes and neuropsychological outcomes in children after the neonatal period. The inclusion criteria were human studies; original research; direct placental variables; neuropsychological outcomes; and analysis between their associations. The exclusion criterion was the offspring's age-0-28 days or >19 years. The MEDLINE and EMBASE databases were last searched in May 2022. We utilized the ROBINS-I for the risk of bias assessment and performed a narrative synthesis. In total, 3252 studies were identified, out of which 16 were included (i.e., a total of 15,862 participants). Half of the studies were performed on children with neonatal complications, and 75% of the studies reported an association between a placental change and an outcome; however, following the completion of the funnel plots, a risk of publication bias was indicated. The largest study described a small association between placental size and a risk of psychiatric symptoms in boys only. Inconsistency between the studies limited the evidence in this review. In general, no strong evidence was found for an association between pathological placental changes and childhood neuropsychological outcomes after the neonatal period. However, the association between placental size and mental health in boys indicates a placental sexual dimorphism, thereby suggesting an increased vulnerability for male fetuses.
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Affiliation(s)
- Maria Lodefalk
- Department of Pediatrics, Faculty of Medicine and Health, Örebro University, 701 82 Örebro, Sweden
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, 701 82 Örebro, Sweden
- Correspondence:
| | - Felix Chelslín
- Department of Pediatrics, Faculty of Medicine and Health, Örebro University, 701 82 Örebro, Sweden
| | - Johanna Patriksson Karlsson
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, 701 82 Örebro, Sweden
| | - Stefan R. Hansson
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences Lund, Lund University, 221 00 Lund, Sweden
- Department of Obstetrics and Gynecology, Skåne University Hospital, 214 28 Malmö, Sweden
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Liu D, Liu J, Ye F, Su Y, Cheng J, Zhang Q. Risk factors and postnatal biomarkers for acute placental inflammatory lesions and intrauterine infections in preterm infants. Eur J Pediatr 2022; 181:3429-3438. [PMID: 35831682 PMCID: PMC9395443 DOI: 10.1007/s00431-022-04545-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/12/2022] [Accepted: 06/23/2022] [Indexed: 11/23/2022]
Abstract
The purpose of this study is to explore risk factors of acute placental inflammatory lesions and the potential postnatal serum biomarkers for predicting the severity of intrauterine infection in preterm infants. We performed a retrospective analysis of premature infants with or without acute placental inflammatory lesions and their mothers by chart review for clinical data and placental histopathology. The preterm infants with acute placental inflammatory lesions had a higher rate of premature rupture of membranes (PROM), a longer duration of PROM, and a higher level of serum sialic acid (SIA) than those of the non-inflammation group (all p < 0.001). According to the different inflammatory histological structures, preterm infants with funisitis had a dominant longer duration of PROM than others (p < 0.05), and their gestational age was youngest among all the infants (p < 0.05). Furthermore, they had the highest content of serum SIA above other groups. The preterm infants in the acute histological chorioamnionitis group showed a similar trend of clinical manifestation and laboratory parameters with the funisitis group. Moreover, the closer the placental lesions were to the fetus, the lower the gestational age of preterm infants was, and the higher the serum SIA content was. CONCLUSION We utilized a simple and precise anatomically category method of placental inflammatory histopathology for pediatricians to distinguish the extent of fetal inflammatory response for representing early-onset infectious diseases of preterm infants. SIA might be one of the potential early-stage serum biomarkers to reflect the severe intrauterine infections and could guide the postnatal anti-infection treatment. WHAT IS KNOWN • Acute placental inflammatory lesion contributes to preterm birth and a series of complications in preterm infants. • C-reactive protein and interleukin-6 in neonatal blood can be used as biomarkers for potential early-onset sepsis, but they are influenced by the postnatal physiological changes of preterm infants. WHAT IS NEW • The value of serum sialic acids of preterm infants within 1-hour afterbirth may be one of the rapid postnatal biomarkers for evaluating the severity of intra-amniotic infection. • The closer the placental lesions are to the fetus, the higher the content of serum sialic acid is.
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Affiliation(s)
- Die Liu
- Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China
| | - Jing Liu
- Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China
| | - Fang Ye
- Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China
| | - Yunchao Su
- Department of Pathology, China-Japan Friendship Hospital, Beijing, China
| | - Jiaoying Cheng
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing, China.
| | - Qi Zhang
- Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China.
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Camerota M, Wylie AC, Goldblum J, Wideman L, Cheatham CL, Propper CB. Testing a cascade model linking prenatal inflammation to child executive function. Behav Brain Res 2022; 431:113959. [PMID: 35690156 PMCID: PMC10652221 DOI: 10.1016/j.bbr.2022.113959] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/21/2022] [Accepted: 06/06/2022] [Indexed: 01/08/2023]
Abstract
Inflammation during pregnancy is beginning to be understood as a risk factor predicting poor infant health and neurodevelopmental outcomes. The long-term sequelae associated with exposure to prenatal inflammation are less well established. The current study examined associations between maternal inflammation during pregnancy, markers of infant neurodevelopment (general cognitive ability, negative affect, and sleep quality), and preschool executive function (EF) in a longitudinal sample of 40 African American mother-infant dyads. Mothers completed a blood draw in the third trimester of pregnancy to measure plasma levels of C-reactive protein (CRP) and pro-inflammatory cytokines (e.g., interleukin 6 [IL-6], tumor necrosis factor-alpha [TNF-α]). When infants were 6 months of age, we assessed general cognitive ability via the Bayley-III, negative affect via the Still-Face Paradigm, and sleep quality via actigraphy monitoring. When children were 4 years of age, we assessed their EF ability using four tasks from the EF Touch battery. Elevated levels of maternal CRP, IL-6, and TNF-α were associated with poorer infant general cognitive ability. Although there were no direct effects of prenatal inflammation on preschool EF, we observed an indirect relationship between IL-6 and preschool EF ability via infant general cognitive ability. Our findings suggest that prenatal inflammation may have long-lasting, cascading implications for child neurodevelopment. Implications of these findings for health disparities in women and children of color are discussed.
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Affiliation(s)
- Marie Camerota
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, United States
| | - Amanda C Wylie
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, United States; Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States
| | - Jessica Goldblum
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, United States; Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States
| | - Laurie Wideman
- Department of Kinesiology, University of North Carolina at Greensboro, United States
| | - Carol L Cheatham
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States; Nutrition Research Institute, University of North Carolina at Chapel Hill, United States
| | - Cathi B Propper
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, United States; Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States.
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11
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Motomura K, Romero R, Plazyo O, Garcia-Flores V, Gershater M, Galaz J, Miller D, Gomez-Lopez N. The alarmin S100A12 causes sterile inflammation of the human chorioamniotic membranes as well as preterm birth and neonatal mortality in mice†. Biol Reprod 2021; 105:1494-1509. [PMID: 34632484 PMCID: PMC8689293 DOI: 10.1093/biolre/ioab188] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/23/2021] [Accepted: 10/06/2021] [Indexed: 01/08/2023] Open
Abstract
Sterile inflammation is triggered by danger signals, or alarmins, released upon cellular stress or necrosis. Sterile inflammation occurring in the amniotic cavity (i.e. sterile intra-amniotic inflammation) is frequently observed in women with spontaneous preterm labor resulting in preterm birth, the leading cause of neonatal morbidity and mortality worldwide; this condition is associated with increased amniotic fluid concentrations of alarmins. However, the mechanisms whereby alarmins induce sterile intra-amniotic inflammation are still under investigation. Herein, we investigated the mechanisms whereby the alarmin S100A12 induces inflammation of the human chorioamniotic membranes in vitro and used a mouse model to establish a causal link between this alarmin and adverse perinatal outcomes. We report that S100A12 initiates sterile inflammation in the chorioamniotic membranes by upregulating the expression of inflammatory mediators such as pro-inflammatory cytokines and pattern recognition receptors. Importantly, S100A12 induced the priming and activation of inflammasomes, resulting in caspase-1 cleavage and the subsequent release of mature IL-1β by the chorioamniotic membranes. This alarmin also caused the activation of the chorioamniotic membranes by promoting MMP-2 activity and collagen degradation. Lastly, the ultrasound-guided intra-amniotic injection of S100A12 at specific concentrations observed in the majority of women with sterile intra-amniotic inflammation induced preterm birth (rates: 17% at 200 ng/sac; 25% at 300 ng/sac; 25% at 400 ng/sac) and neonatal mortality (rates: 22% at 200 ng/sac; 44% at 300 ng/sac; 31% at 400 ng/sac), thus demonstrating a causal link between this alarmin and adverse perinatal outcomes. Collectively, our findings shed light on the inflammatory responses driven by alarmins in the chorioamniotic membranes, providing insight into the immune mechanisms leading to preterm birth in women with sterile intra-amniotic inflammation.
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Affiliation(s)
- Kenichiro Motomura
- 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 (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, 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, US Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA
- Detroit Medical Center, Detroit, Michigan, USA
| | - Olesya Plazyo
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Valeria 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 (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Meyer Gershater
- 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 (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Jose Galaz
- 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 (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Derek 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 (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Nardhy 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 (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Department of Biochemistry, Microbiology, and Immunology, Wayne State University School of Medicine, Detroit, Michigan, USA
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12
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Ni M, Zhang Q, Zhao J, Shen Q, Yao D, Wang T, Liu Z. Relationship between maternal vitamin D status in the first trimester of pregnancy and maternal and neonatal outcomes: a retrospective single center study. BMC Pediatr 2021; 21:330. [PMID: 34325665 PMCID: PMC8320191 DOI: 10.1186/s12887-021-02730-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 05/17/2021] [Indexed: 12/28/2022] Open
Abstract
Background This study aimed to investigate the relationship between maternal serum vitamin D status in the first trimester of pregnancy and maternal as well as neonatal outcomes, considered the prevalence of vitamin D deficiency (serum 25(OH)D < 50 nmol/L) around the world, especially in the pregnant women. Methods From January 2015 to December 2016, in this cross-sectional retrospective study, we enrolled women receiving regular prenatal examinations and giving birth in the International Peace Maternity and Child Health Hospital. Cases confirmed as multiple pregnancy, incomplete medical records, and vitamin D level recorded after 13 weeks of gestation were excluded. A total of 23,394 mother-infant pairs were included ultimately. Obstetric and neonatal information were extracted from the database. Maternal serum vitamin D concentration was measured by chemiluminescence microparticle immunoassay. Logistic regression analysis (unadjusted and adjusted models) was used to analyze the association between vitamin D and maternal and neonatal outcomes. Results The average 25(OH) D concentration was 43.20 ± 0.10 nmol/L; 67.09% of patients were vitamin D deficient(25(OH) D < 50.00 nmol/L), 29.84% were vitamin D insufficient (50 nmol/L ≤ 25(OH)D < 75 nmol/L), 3.07% were sufficient (25(OH)D ≥ 75 nmol/L). The maternal 25(OH)D levels varied with age, pre-pregnancy BMI, season when blood sample was collected, number of previous-pregnancy. Notably, newborns delivered by women with deficient vitamin D status had a higher incidence rate of admission to NICU (Deficiency: 12.20% vs Insufficiency: 10.90% vs Sufficiency: 11.70%, Pbonferroni = .002) and a longer stay (deficiency: 6.2 ± 4.1 days vs insufficiency: 5.9 ± 3.1 days vs sufficiency: 5.1 ± 2.1 days, Pbonferroni = .010). Moreover, maternal vitamin D deficiency was a dependent risk factor for admission to NICU (unadjusted OR = 1.35, 95% CI,1.05–1.74 Pbonferroni = .022; adjusted OR = 1.31, 95% CI,1.010–1.687 Pbonferroni = .042). Conclusions Maternal vitamin D deficiency (25(OH) D < 50 nmol/L) was prevalent in eastern coastal China. The incidence rate of GDM as well as preeclampsia was higher in vitamin D insufficient group while vitamin D deficiency group was liable to intrauterine infection when compared with the other two groups. Most importantly, low vitamin D status in the first trimester of pregnancy was a dependent risk factor for admission to NICU. More well-designed perspective researches are necessary to clarify the role of vitamin D in the early stage of pregnancy.
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Affiliation(s)
- Meng Ni
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910# Hengshan Road, Shanghai, 20030, China.,International Peace Maternity and Child Health Hospital of China Welfare Institution, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
| | - Qianqian Zhang
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910# Hengshan Road, Shanghai, 20030, China.,International Peace Maternity and Child Health Hospital of China Welfare Institution, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
| | - Jiuru Zhao
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910# Hengshan Road, Shanghai, 20030, China.,International Peace Maternity and Child Health Hospital of China Welfare Institution, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
| | - Qianwen Shen
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910# Hengshan Road, Shanghai, 20030, China.,International Peace Maternity and Child Health Hospital of China Welfare Institution, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
| | - Dongting Yao
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910# Hengshan Road, Shanghai, 20030, China.,International Peace Maternity and Child Health Hospital of China Welfare Institution, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
| | - Tao Wang
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910# Hengshan Road, Shanghai, 20030, China.,International Peace Maternity and Child Health Hospital of China Welfare Institution, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
| | - Zhiwei Liu
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910# Hengshan Road, Shanghai, 20030, China. .,International Peace Maternity and Child Health Hospital of China Welfare Institution, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. .,Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China.
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13
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Cumulative Damage: Cell Death in Posthemorrhagic Hydrocephalus of Prematurity. Cells 2021; 10:cells10081911. [PMID: 34440681 PMCID: PMC8393895 DOI: 10.3390/cells10081911] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/23/2021] [Accepted: 07/25/2021] [Indexed: 12/19/2022] Open
Abstract
Globally, approximately 11% of all infants are born preterm, prior to 37 weeks’ gestation. In these high-risk neonates, encephalopathy of prematurity (EoP) is a major cause of both morbidity and mortality, especially for neonates who are born very preterm (<32 weeks gestation). EoP encompasses numerous types of preterm birth-related brain abnormalities and injuries, and can culminate in a diverse array of neurodevelopmental impairments. Of note, posthemorrhagic hydrocephalus of prematurity (PHHP) can be conceptualized as a severe manifestation of EoP. PHHP impacts the immature neonatal brain at a crucial timepoint during neurodevelopment, and can result in permanent, detrimental consequences to not only cerebrospinal fluid (CSF) dynamics, but also to white and gray matter development. In this review, the relevant literature related to the diverse mechanisms of cell death in the setting of PHHP will be thoroughly discussed. Loss of the epithelial cells of the choroid plexus, ependymal cells and their motile cilia, and cellular structures within the glymphatic system are of particular interest. Greater insights into the injuries, initiating targets, and downstream signaling pathways involved in excess cell death shed light on promising areas for therapeutic intervention. This will bolster current efforts to prevent, mitigate, and reverse the consequential brain remodeling that occurs as a result of hydrocephalus and other components of EoP.
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14
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Prasad JD, Gunn KC, Davidson JO, Galinsky R, Graham SE, Berry MJ, Bennet L, Gunn AJ, Dean JM. Anti-Inflammatory Therapies for Treatment of Inflammation-Related Preterm Brain Injury. Int J Mol Sci 2021; 22:4008. [PMID: 33924540 PMCID: PMC8069827 DOI: 10.3390/ijms22084008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 12/13/2022] Open
Abstract
Despite the prevalence of preterm brain injury, there are no established neuroprotective strategies to prevent or alleviate mild-to-moderate inflammation-related brain injury. Perinatal infection and inflammation have been shown to trigger acute neuroinflammation, including proinflammatory cytokine release and gliosis, which are associated with acute and chronic disturbances in brain cell survival and maturation. These findings suggest the hypothesis that the inhibition of peripheral immune responses following infection or nonspecific inflammation may be a therapeutic strategy to reduce the associated brain injury and neurobehavioral deficits. This review provides an overview of the neonatal immunity, neuroinflammation, and mechanisms of inflammation-related brain injury in preterm infants and explores the safety and efficacy of anti-inflammatory agents as potentially neurotherapeutics.
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Affiliation(s)
- Jaya D. Prasad
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1010, New Zealand; (J.D.P.); (K.C.G.); (J.O.D.); (L.B.); (A.J.G.)
| | - Katherine C. Gunn
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1010, New Zealand; (J.D.P.); (K.C.G.); (J.O.D.); (L.B.); (A.J.G.)
| | - Joanne O. Davidson
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1010, New Zealand; (J.D.P.); (K.C.G.); (J.O.D.); (L.B.); (A.J.G.)
| | - Robert Galinsky
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC 3168, Australia;
| | - Scott E. Graham
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1010, New Zealand;
| | - Mary J. Berry
- Department of Pediatrics and Health Care, University of Otago, Dunedin 9016, New Zealand;
| | - Laura Bennet
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1010, New Zealand; (J.D.P.); (K.C.G.); (J.O.D.); (L.B.); (A.J.G.)
| | - Alistair J. Gunn
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1010, New Zealand; (J.D.P.); (K.C.G.); (J.O.D.); (L.B.); (A.J.G.)
| | - Justin M. Dean
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1010, New Zealand; (J.D.P.); (K.C.G.); (J.O.D.); (L.B.); (A.J.G.)
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15
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Abstract
Background: This study was performed to investigate the clinical significance of miR-4535 and miR-1915-5p in severe chorioamnionitis. Materials & methods: Amniotic fluid samples from 37 patients with severe chorioamnionitis were subjected to miRNA array analysis and ddPCR™. Diagnostic values were assessed using the receiver operating characteristic curve. The patients were separated into three groups according to Blanc’s criteria. Results: The expression of miR-4535 and miR-1915-5p was significantly correlated with the copy number of 16S rDNA, had extremely high diagnostic accuracy for severe chorioamnionitis, and was linked to maternal and fetal inflammation. Conclusion: miR-4535 and miR-1915-5p serve as promising biomarkers for the diagnosis of severe chorioamnionitis. Chorioamnionitis and fetal inflammatory response syndrome, which is linked to chorioamnionitis, are considered serious diseases in perinatal care. In this study, miR-4535 and miR-1915-5p are recognized as promising biomarkers for the diagnosis of chorioamnionitis before delivery. In particular, the increased expression of miR-4535 in amniotic fluid is expected to be regarded as a positive indicator for fetal inflammatory response syndrome, and the elevated expression of miR-4535 in serum is also considered to predictively diagnose intrauterine infection in pregnancy. Our results highlight that further studies should explore the underlying clinical significance of miR-4535 and miR-1915-5p.
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16
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The Relationship Between Matrix Metalloproteinase-8 in After Birth Oral Fluid and Acute Histologic Chorioamnionitis in Preterm Delivery. Reprod Sci 2021; 28:2023-2028. [PMID: 33475979 DOI: 10.1007/s43032-020-00448-4] [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: 09/11/2020] [Accepted: 12/27/2020] [Indexed: 10/22/2022]
Abstract
Elevated concentration of matrix metalloproteinase-8 (MMP-8) in amniotic fluid is a known predictor of intra-amniotic inflammation and infection. The aim of this study was to determine the nature of the association between MMP-8 levels in oral fluid obtained immediately after birth and acute histologic chorioamnionitis (HCA) in preterm delivery. Oral fluid was collected from 93 consecutive preterm birth newborns between gestational weeks of 24 + 0 and 36 + 6. Concentrations of MMP-8 and interleukin-8 (IL-8) in after birth oral fluid were measured by ELISA. Acute HCA was defined as the presence of neutrophils infiltration into chorioamnionic membranes. Logistic regression analysis was used for the statistical analysis. MMP-8 concentrations in after birth oral fluid were significantly higher for women with acute HCA than for those without (median [range]; 68.3 ng/mL [0.06-12,479.6] vs. 10.2 ng/mL [0.06-1808.2], p = 0.002). A strong association was observed between MMP-8 and IL-8 levels (γ2 = 0.87, p < 0.01). The cutoff level of MMP-8 in after birth oral fluid for acute HCA was 39.7 ng/mL (sensitivity of 63.2%, specificity of 81.1%). Multivariable logistic regression analysis showed MMP-8 in after birth oral fluid had an odds ratio of 4.17 for acute HCA (95% confidence interval [CI] = 1.08-16.17, p = 0.03). An elevated MMP-8 level in after birth oral fluid is associated with acute HCA in preterm birth. Newborn oral fluid immediately after birth might provide another source for information of intra-amniotic condition just before birth.
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17
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Goedicke-Fritz S, Werner T, Niemarkt HJ, Wolfs TGAM, Baumbach JI, Kemp MW, Jobe AH, Rogosch T, Bous M, Kaiser E, Stutz R, Meyer S, Maier RF, Koczulla AR, Spiller OB, Kramer BW, Zemlin M. Detection of Volatile Organic Compounds as Potential Novel Biomarkers for Chorioamnionitis - Proof of Experimental Models. Front Pediatr 2021; 9:698489. [PMID: 34368028 PMCID: PMC8339372 DOI: 10.3389/fped.2021.698489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/28/2021] [Indexed: 12/09/2022] Open
Abstract
Background: Histologic chorioamnionitis is only diagnosed postnatally which prevents interventions. We hypothesized that volatile organic compounds (VOCs) in the amniotic fluid might be useful biomarkers for chorioamnionitis and that VOC profiles differ between amnionitis of different origins. Methods: Time-mated ewes received intra-amniotic injections of media or saline (controls), or live Ureaplasma parvum serovar 3 (Up) 14, 7 or 3d prior to c-section at day 124 gestational age (GA). 100 μg recombinant ovine IL-1α was instilled at 7, 3 or 1d prior to delivery. Headspace VOC profiles were measured from amniotic fluids at birth using ion mobility spectrometer coupled with multi-capillary columns. Results: 127 VOC peaks were identified. 27 VOCs differed between samples from controls and Up- or IL-1α induced amnionitis. The best discrimination between amnionitis by Up vs. IL-1α was reached by 2-methylpentane, with a sensitivity/specificity of 96/95% and a positive predictive value/negative predictive values of 96 and 95%. The concentration of 2-methylpentane in VOCs peaked 7d after intra-amniotic instillation of Up. Discussion: We established a novel method to study headspace VOC profiles of amniotic fluids. VOC profiles may be a useful tool to detect and to assess the duration of amnionitis induced by Up. 2-methylpentane was previously described in the exhalate of women with pre-eclampsia and might be a volatile biomarker for amnionitis. Amniotic fluids analyzed by ion mobility spectrometry coupled with multi-capillary columns may provide bedside diagnosis of amnionitis and understanding inflammatory mechanisms during pregnancy.
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Affiliation(s)
- Sybelle Goedicke-Fritz
- Children's Hospital, Philipps University, Marburg, Germany.,Department of General Paediatrics and Neonatology, Saarland University Medical School, Homburg, Germany
| | - Thomas Werner
- Children's Hospital, Philipps University, Marburg, Germany
| | - Hendrik J Niemarkt
- Department of Neonatology, Máxima Medical Centre, Veldhoven, Netherlands
| | - Tim G A M Wolfs
- Department of Pediatrics, School of Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
| | - Jörg Ingo Baumbach
- Center of Competence Breath Analysis, Branch Dortmund, B. Braun Melsungen AG, Melsungen, Germany
| | - Matthew W Kemp
- Division of Obstetrics and Gynecology, School of Women's and Infants' Health, University of Western Australia, Crawley, WA, Australia
| | - Alan H Jobe
- Department of Pediatrics, School of Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
| | - Tobias Rogosch
- Children's Hospital, Philipps University, Marburg, Germany
| | - Michelle Bous
- Department of General Paediatrics and Neonatology, Saarland University Medical School, Homburg, Germany
| | - Elisabeth Kaiser
- Department of General Paediatrics and Neonatology, Saarland University Medical School, Homburg, Germany
| | - Regine Stutz
- Department of General Paediatrics and Neonatology, Saarland University Medical School, Homburg, Germany
| | - Sascha Meyer
- Department of General Paediatrics and Neonatology, Saarland University Medical School, Homburg, Germany
| | | | - Andreas Rembert Koczulla
- Department of Pulmonology, German Center of Lung Research DZL, Institute for Internal Medicine, Philipps-University of Marburg, Marburg, Germany
| | - Owen Brad Spiller
- Division of Obstetrics and Gynecology, School of Women's and Infants' Health, University of Western Australia, Crawley, WA, Australia.,Department of Microbiology, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Boris W Kramer
- Department of Pediatrics, School of Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands.,Division of Obstetrics and Gynecology, School of Women's and Infants' Health, University of Western Australia, Crawley, WA, Australia
| | - Michael Zemlin
- Department of General Paediatrics and Neonatology, Saarland University Medical School, Homburg, Germany
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18
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Perez M, Robbins ME, Revhaug C, Saugstad OD. Oxygen radical disease in the newborn, revisited: Oxidative stress and disease in the newborn period. Free Radic Biol Med 2019; 142:61-72. [PMID: 30954546 PMCID: PMC6791125 DOI: 10.1016/j.freeradbiomed.2019.03.035] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/06/2019] [Accepted: 03/29/2019] [Indexed: 12/28/2022]
Abstract
Thirty years ago, there was an emerging appreciation for the significance of oxidative stress in newborn disease. This prompted a renewed interest in the impact of oxygen therapy for the newborn in the delivery room and beyond, especially in premature infants. Today, the complexity of oxidative stress both in normal regulation and pathology is better understood, especially as it relates to neonatal mitochondrial oxidative stress responses to hyperoxia. Mitochondria are recipients of oxidative damage and have a propensity for oxidative self-injury that has been implicated in the pathogenesis of neonatal lung diseases. Similarly, both intrauterine growth restriction (IUGR) and macrosomia are associated with mitochondrial dysfunction and oxidative stress. Additionally, reoxygenation with 100% O2 in a hypoxic-ischemic newborn lamb model increased the production of pro-inflammatory cytokines in the brain. Moreover, the interplay between inflammation and oxidative stress in the newborn is better understood because of animal studies. Transcriptomic analyses have found a number of genes to be differentially expressed in murine models of bronchopulmonary dysplasia (BPD). Epigenetic changes have also been detected both in animal models of BPD and premature infants exposed to oxygen. Antioxidant therapy to prevent newborn disease has not been very successful; however, new therapeutic principles, like melatonin, are under investigation.
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Affiliation(s)
- Marta Perez
- Division of Neonatology, Stanley Manne Children's Research Institute, Ann and Robert H Lurie Children's Hospital, Chicago, IL, United States; Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
| | - Mary E Robbins
- Division of Neonatology, Stanley Manne Children's Research Institute, Ann and Robert H Lurie Children's Hospital, Chicago, IL, United States; Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
| | - Cecilie Revhaug
- Department of Pediatric Research, University of Oslo, Oslo University Hospital, Norway
| | - Ola D Saugstad
- Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States; Department of Pediatric Research, University of Oslo, Oslo University Hospital, Norway.
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Camerota M, Willoughby MT. Prenatal Risk Predicts Preschooler Executive Function: A Cascade Model. Child Dev 2019; 91:e682-e700. [PMID: 31206640 DOI: 10.1111/cdev.13271] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Little research has considered whether prenatal experience contributes to executive function (EF) development above and beyond postnatal experience. This study tests direct, mediated, and moderated associations between prenatal risk factors and preschool EF and IQ in a longitudinal sample of 1,292 children from the Family Life Project. A composite of prenatal risk factors (i.e., low birth weight, prematurity, maternal emotional problems, maternal prepregnancy obesity, and obstetric complications) significantly predicted EF and IQ at age 3, above quality of the postnatal environment. This relationship was indirect, mediated through infant general cognitive abilities. Quality of the postnatal home and child-care environments did not moderate the cascade model. These findings highlight the role of prenatal experience as a contributor to individual differences in cognitive development.
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Sodré Barmpas DB, Monteiro DLM, Taquette SR, Rodrigues NCP, Trajano AJB, Cunha JDC, Nunes CL, Villela LHC, Teixeira SAM, Sztajnbok DCDN, Bóia MN. Pregnancy outcomes and mother-to-child transmission rate in HTLV-1/2 infected women attending two public hospitals in the metropolitan area of Rio de Janeiro. PLoS Negl Trop Dis 2019; 13:e0007404. [PMID: 31181057 PMCID: PMC6586357 DOI: 10.1371/journal.pntd.0007404] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 06/20/2019] [Accepted: 04/22/2019] [Indexed: 11/30/2022] Open
Abstract
HTLV-1/2 are transmitted sexually, by whole cell blood products and from mother-to-child (MTC), mainly through breastfeeding. HTLV-1/2 prevalence in pregnant women is high in Rio de Janeiro, however there were no local studies addressing the rate of adverse pregnancy outcomes (APO) and MTC transmission. The aim was to study sociodemographic characteristics which may be associated to HTLV-1/2 infection and describe pregnancy outcomes and MTC transmission in HTLV-1/2-positive women. The cross-sectional study screened 1,628 pregnant women in of Rio de Janeiro (2012–2014) and found 12 asymptomatic carrier mothers (prevalence = 0.74%). Pregnancy outcome information was retrieved from medical records. Sociodemographic characteristics were similar between the positive and negative groups except for maternal age, which was higher in carrier mothers. The incidence of adverse pregnancy outcomes was similar in infected and non-infected patients (p = 0.33), however there was a high rate of premature rupture of membranes (PROM) amid infected mothers (3/12). Multilevel logistic regression found that for each additional year of age, the chance of being HTLV-1/2-positive increased 11% and that having another sexually transmitted infection (STI) increased 9 times the chance of being infected. Carrier mothers had more antenatal visits (OR = 5.26). Among the children of HTLV-1/2-positive mothers there was one fetal death, one infant death and one loss of follow-up. After two years of follow-up there was one case of MTC transmission (1/9). The mother reported breastfeeding for one month only. Knowledge about factors associated to HTLV-1/2 infection, its impact on pregnancy outcomes and the MTC transmission rate is important to guide public health policies on antenatal screening and management. HTLV-1/2 are retroviruses transmitted by sex, blood products and from mother to child (MTC), mainly through breastfeeding. There is currently no vaccine, treatment or cure. Although it’s mostly asymptomatic it can cause disabling and even lethal diseases in carriers. The prevalence of HTLV-1/2 in pregnant women at the metropolitan area of Rio de Janeiro is high (0.74%). Our aim was to study the sociodemographic characteristics which may be associated to HTLV-1/2 infection and describe pregnancy outcomes and MTC transmission in the infected population. Apart from being slightly older, there were no differences in the carrier mothers’ sociodemographic profile. Pregnant women with sexually transmitted infections had a 9-fold chance of being HTLV-1/2 positive. Although adverse pregnancy outcomes were not increased, infected mothers had a high rate of ruptured membranes. Among the children of HTLV-1/2-positive mothers there was one fetal death, one infant death and one loss of follow-up. There was one case of MTC transmission (1/9), after one month of breastfeeding. Knowledge about factors associated to HTLV-1/2 infection, its impact on pregnancy, and the MTC transmission rate is important to guide further research and public health policies.
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Affiliation(s)
| | - Denise Leite Maia Monteiro
- Department of Obstetrics, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
- Department of Gynecology and Obstetrics, Centro Universitário Serra dos Órgãos (UNIFESO), Teresópolis, RJ, Brazil
| | - Stella Regina Taquette
- Department of Internal Medicine, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | - Nádia Cristina Pinheiro Rodrigues
- Department of Epidemiology, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
- Department of Epidemiology, Escola Nacional de Saúde Pública (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Alexandre José Baptista Trajano
- Department of Obstetrics, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
- Department of Gynecology and Obstetrics, Universidade Unigranrio, Rio de Janeiro, RJ, Brazil
| | - Juliana de Castro Cunha
- Department of Obstetrics, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | - Camila Lattanzi Nunes
- Department of Obstetrics, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | | | - Sérgio A. M. Teixeira
- Department of Obstetrics, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | | | - Márcio Neves Bóia
- Department of Epidemiology, Escola Nacional de Saúde Pública (Fiocruz), Rio de Janeiro, RJ, Brazil
- Department of Infectology, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
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Basu R, Rau R, Pearson D, Malig B. Temperature and Term Low Birth Weight in California. Am J Epidemiol 2018; 187:2306-2314. [PMID: 29901701 DOI: 10.1093/aje/kwy116] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 05/25/2018] [Indexed: 11/12/2022] Open
Abstract
Few investigations have explored temperature and birth outcomes. In a retrospective cohort study, we examined apparent temperature, a combination of temperature and relative humidity, and term low birth weight (LBW) among 43,629 full-term LBW infants and 2,032,601 normal-weight infants in California (1999-2013). The California Department of Public Health provided birth certificate data, while meteorological data came from the California Irrigation Management Information System, US Environmental Protection Agency, and National Centers for Environmental Information. After considering several temperature metrics, we observed the best model fit for term LBW over the full gestation (per 10-degrees-Fahrenheit (°F) increase in apparent temperature, 13.0% change, 95% confidence interval: 4.1, 22.7) above 55°F, and the greatest association was for third-trimester exposure above 60°F (15.8%, 95% confidence interval: 5.0, 27.6). Apparent temperature during the first month of pregnancy exhibited no significant risk, while the first trimester had a significantly negative association, and second trimester, last month, and last 2 weeks had slightly increased risks. Mothers who were black or older, delivered male infants, or gave birth during the warm season had infants at the highest risks. This study provides further evidence for adverse birth outcomes from heat exposure for vulnerable subgroups of pregnant women.
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Affiliation(s)
- Rupa Basu
- Air and Climate Epidemiology Section, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, California
- Department of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Reina Rau
- Department of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Dharshani Pearson
- Air and Climate Epidemiology Section, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, California
| | - Brian Malig
- Air and Climate Epidemiology Section, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, California
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22
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Littauer EQ, Skountzou I. Hormonal Regulation of Physiology, Innate Immunity and Antibody Response to H1N1 Influenza Virus Infection During Pregnancy. Front Immunol 2018; 9:2455. [PMID: 30420854 PMCID: PMC6215819 DOI: 10.3389/fimmu.2018.02455] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/04/2018] [Indexed: 12/13/2022] Open
Abstract
In 2009, the H1N1 swine flu pandemic highlighted the vulnerability of pregnant women to influenza viral infection. Pregnant women infected with influenza A virus were at increased risk of hospitalization and severe acute respiratory distress syndrome (ARDS), which is associated with high mortality, while their newborns had an increased risk of pre-term birth or low birth weight. Pregnant women have a unique immunological profile modulated by the sex hormones required to maintain pregnancy, namely progesterone and estrogens. The role of these hormones in coordinating maternal immunotolerance in uterine tissue and cellular subsets has been well researched; however, these hormones have wide-ranging effects outside the uterus in modulating the immune response to disease. In this review, we compile research findings in the clinic and in animal models that elaborate on the unique features of H1N1 influenza A viral pathogenesis during pregnancy, the crosstalk between innate immune signaling and hormonal regulation during pregnancy, and the role of pregnancy hormones in modulating cellular responses to influenza A viral infection at mid-gestation. We highlight the ways in which lung architecture and function is stressed by pregnancy, increasing baseline inflammation prior to infection. We demonstrate that infection disrupts progesterone production and upregulates inflammatory mediators, such as cyclooxygenase-2 (COX-2) and prostaglandins, resulting in pre-term labor and spontaneous abortions. Lastly, we profile the ways in which pregnancy alters innate and adaptive cellular immune responses to H1N1 influenza viral infection, and the ways in which these protect fetal development at the expense of effective long-term immune memory. Thus, we highlight advancements in the field of reproductive immunology in response to viral infection and illustrate how that knowledge might be used to develop more effective post-infection therapies and vaccination strategies.
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Affiliation(s)
- Elizabeth Q Littauer
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA, United States.,Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, United States
| | - Ioanna Skountzou
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA, United States.,Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, United States
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Zhang Q, Chen H, Wang Y, Zhang C, Tang Z, Li H, Huang X, Ouyang F, Huang H, Liu Z. Severe vitamin D deficiency in the first trimester is associated with placental inflammation in high-risk singleton pregnancy. Clin Nutr 2018; 38:1921-1926. [PMID: 30031659 DOI: 10.1016/j.clnu.2018.06.978] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 05/17/2018] [Accepted: 06/23/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND & AIMS Vitamin D deficiency during pregnancy is a worldwide epidemic. This study aimed to identify whether vitamin D deficiency in early pregnancy is associated with placental inflammation in high-risk pregnancy. METHODS This study comprised 23,396 women who provided serum samples in the first trimester for vitamin D analysis from January 2015 to December 2016. Among them, 2648 women with high-risk pregnancy underwent placental pathologic examination. Women were divided into placental inflammation positive (PIP) and placental inflammation negative (PIN) groups based on placental pathology. Multivariate logistic regression was used to evaluate the relationship between vitamin D levels and placental inflammation. RESULTS We found that severe vitamin D deficiency in early pregnancy was associated with placental inflammation. Maternal vitamin D levels were significantly lower in the PIP group than those in the PIN group (P = 0.025). Compared with the highest quartile of vitamin D levels, risk for placental inflammation was significantly higher in women with extremely low vitamin D levels (<5th percentile; P = 0.012). The effect estimate was slightly decreased but still significant (P = 0.027) after adjusting for maternal age, gestational age at birth, birth weight, infant sex, and sample collection season. In addition, compared with the PIN group, the incidences of adverse neonatal outcomes, including sepsis (0.5% vs 2.4%) and fetal intrauterine infection (5.7% vs 15.6%), were significantly higher in the PIP group than that in the PIN group (P < 0.001). CONCLUSIONS Severe vitamin D deficiency in the first trimester is a risk factor for placental inflammation in high-risk pregnancy.
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Affiliation(s)
- Qianqian Zhang
- International Peace Maternity and Child Health Hospital of China Welfare Institution, School of Medicine, Shanghai Jiao Tong University, Shanghai 20030, China
| | - Hao Chen
- Departments of Neonatology, Children's Hospital of Shanghai, School of Medicine, Shanghai Jiao Tong University, Shanghai 20040, China
| | - Yi Wang
- International Peace Maternity and Child Health Hospital of China Welfare Institution, School of Medicine, Shanghai Jiao Tong University, Shanghai 20030, China
| | - Chen Zhang
- International Peace Maternity and Child Health Hospital of China Welfare Institution, School of Medicine, Shanghai Jiao Tong University, Shanghai 20030, China
| | - Zhen Tang
- International Peace Maternity and Child Health Hospital of China Welfare Institution, School of Medicine, Shanghai Jiao Tong University, Shanghai 20030, China
| | - Hong Li
- International Peace Maternity and Child Health Hospital of China Welfare Institution, School of Medicine, Shanghai Jiao Tong University, Shanghai 20030, China
| | - Xiaoyi Huang
- International Peace Maternity and Child Health Hospital of China Welfare Institution, School of Medicine, Shanghai Jiao Tong University, Shanghai 20030, China
| | - Fengxiu Ouyang
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Hefeng Huang
- International Peace Maternity and Child Health Hospital of China Welfare Institution, School of Medicine, Shanghai Jiao Tong University, Shanghai 20030, China.
| | - Zhiwei Liu
- International Peace Maternity and Child Health Hospital of China Welfare Institution, School of Medicine, Shanghai Jiao Tong University, Shanghai 20030, China.
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Peng CC, Chang JH, Lin HY, Cheng PJ, Su BH. Intrauterine inflammation, infection, or both (Triple I): A new concept for chorioamnionitis. Pediatr Neonatol 2018; 59:231-237. [PMID: 29066072 DOI: 10.1016/j.pedneo.2017.09.001] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 06/19/2017] [Accepted: 09/01/2017] [Indexed: 12/13/2022] Open
Abstract
Chorioamnionitis is a common cause of preterm birth and may cause adverse neonatal outcomes, including neurodevelopmental sequelae. Chorioamnionitis has been marked to a heterogeneous setting of conditions characterized by infection or inflammation or both, followed by a great variety in clinical practice for mothers and their newborns. Recently, a descriptive term: "intrauterine inflammation or infection or both" abbreviated as "Triple I" has been proposed by a National Institute of Child Health and Human Development expert panel to replace the term chorioamnionitis. It is particularly important to recognize that an isolated maternal fever does not automatically equate to chorioamnionitis. This article will review the current literature on chorioamnionitis, and introduce the concept of Triple I, as well as recommendations for assessment and management of pregnant women and their newborns with a diagnosis of Triple I.
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Affiliation(s)
- Chun-Chih Peng
- Department of Medicine, Mackay Medical College, Taipei, Taiwan; Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan
| | - Jui-Hsing Chang
- Department of Medicine, Mackay Medical College, Taipei, Taiwan; Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan
| | - Hsiang-Yu Lin
- Department of Neonatology, China Medical University Children's Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Po-Jen Cheng
- Department of Obstetrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Bai-Horng Su
- Department of Neonatology, China Medical University Children's Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan.
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25
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Maternal body mass index and risk of intraventricular hemorrhage in preterm infants. Pediatr Res 2018; 83:1146-1151. [PMID: 29624572 DOI: 10.1038/pr.2018.47] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 02/27/2018] [Indexed: 12/16/2022]
Abstract
BackgroundIntraventricular hemorrhage (IVH) and pre-pregnancy obesity and underweight have been linked to inflammatory states. We hypothesize that IVH in preterm infants is associated with pre-pregnancy obesity and underweight due to an inflammatory intrauterine environment.MethodsPopulation-based study of infants born between 22 and 32 weeks' gestation from 2007 to 2011. Data were extracted from vital statistics and the California Perinatal Quality Care Collaborative. Results were examined for all cases (any IVH) and for severe IVH.ResultsAmong 20,927 infants, 4,818 (23%) had any IVH and 1,514 (7%) had severe IVH. After adjustment for confounders, there was an increased risk of IVH associated with pre-pregnancy obesity, relative risk 1.14 (95% confidence interval (CI) 1.06, 1.32) for any IVH, and 1.25 (85% CI 1.10, 1.42) for severe IVH. The direct effect of pre-pregnancy obesity on any IVH was significant (P<0.001) after controlling for antenatal inflammation-related conditions, but was not significant after controlling for gestational age (P=0.56).ConclusionPre-pregnancy obesity was found to be a risk factor for IVH in preterm infants; however, this relationship appeared to be largely mediated through the effect of BMI on gestational age at delivery. The etiology of IVH is complex and it is important to understand the contributing maternal factors.
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26
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Deng Y, Song L, Nie X, Shou W, Li X. Prenatal inflammation exposure-programmed cardiovascular diseases and potential prevention. Pharmacol Ther 2018; 190:159-172. [PMID: 29803628 DOI: 10.1016/j.pharmthera.2018.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In recent years, the rapid development of medical and pharmacological interventions has led to a steady decline in certain noncommunicable chronic diseases (NCDs), such as cancer. However, the overall incidence of cardiovascular diseases (CVDs) has not seemed to decline. CVDs have become even more prevalent in many countries and represent a global health threat and financial burden. An increasing number of epidemiological and experimental studies have demonstrated that maternal insults not only can result in birth defects but also can cause developmental functional defects that contribute to adult NCDs. In the current review, we provide an overview of evidence from both epidemiological investigations and experimental animal studies supporting the concept of developmental reprogramming of adult CVDs in offspring that have experienced prenatal inflammation exposure (PIE) during fetal development (PIE-programmed CVDs), a disease-causing event that has not been effectively controlled. This review describes the epidemiological observations, data from animal models, and related mechanisms for the pathogenesis of PIE-programmed CVDs. In addition, the potential therapeutic interventions of PIE-programmed CVDs are discussed. Finally, we also deliberate the need for future mechanistic studies and biomarker screenings in this important field, which creates a great opportunity to combat the global increase in CVDs by managing the adverse effects of inflammation for prepregnant and pregnant individuals who are at risk for PIE-programmed CVDs.
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Affiliation(s)
- Youcai Deng
- Institute of Materia Medica, College of Pharmacy, Army Medical University (Third Military Medical University), 30# Gaotanyan Rd., Shapingba District, Chongqing 400038, China; Center of Translational Medicine, College of Pharmacy, Army Medical University (Third Military Medical University), 30# Gaotanyan Rd., Shapingba District, Chongqing 400038, China.
| | - Liang Song
- Institute of Materia Medica, College of Pharmacy, Army Medical University (Third Military Medical University), 30# Gaotanyan Rd., Shapingba District, Chongqing 400038, China; Center of Translational Medicine, College of Pharmacy, Army Medical University (Third Military Medical University), 30# Gaotanyan Rd., Shapingba District, Chongqing 400038, China
| | - Xuqiang Nie
- Institute of Materia Medica, College of Pharmacy, Army Medical University (Third Military Medical University), 30# Gaotanyan Rd., Shapingba District, Chongqing 400038, China; Center of Translational Medicine, College of Pharmacy, Army Medical University (Third Military Medical University), 30# Gaotanyan Rd., Shapingba District, Chongqing 400038, China
| | - Weinian Shou
- Institute of Materia Medica, College of Pharmacy, Army Medical University (Third Military Medical University), 30# Gaotanyan Rd., Shapingba District, Chongqing 400038, China; Center of Translational Medicine, College of Pharmacy, Army Medical University (Third Military Medical University), 30# Gaotanyan Rd., Shapingba District, Chongqing 400038, China; Herman B Wells Center for Pediatric Research, Department of Pediatrics, Indiana University School of Medicine, 1044 W. Walnut Street, R4 W302D, Indianapolis, IN 46202, USA
| | - Xiaohui Li
- Institute of Materia Medica, College of Pharmacy, Army Medical University (Third Military Medical University), 30# Gaotanyan Rd., Shapingba District, Chongqing 400038, China; Center of Translational Medicine, College of Pharmacy, Army Medical University (Third Military Medical University), 30# Gaotanyan Rd., Shapingba District, Chongqing 400038, China.
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Yan H, Li H, Zhu L, Gao J, Li P, Zhang Z. Increased TLR4 and TREM-1 expression on monocytes and neutrophils in preterm birth: further evidence of a proinflammatory state. J Matern Fetal Neonatal Med 2018. [PMID: 29534643 DOI: 10.1080/14767058.2018.1452903] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Objective: Increased inflammation is considered as a risk factor and a promoter of preterm birth (PTB). Monocytes and neutrophils are the main sources of cytokines in the early inflammatory phase. So far, very few studies have indicated CD14/TLR4 and TREM-1 on the monocytes and neutrophils as important targets in PTB. Materials and methods: TLR4 and TREM-1 on CD14+ maternal and cord blood monocytes and neutrophils were detected using flow cytometry in 48 normal term women, 48 PTB with chorioamnionitis (CCA) women, and 40 PTB without CCA women. In the fetal membranes, mRNA and protein levels of the CD14/TLR4-TREM-1 signaling pathway, CD14, TLR4, NF-κBp65, and TREM-1 were analyzed by qRT-PCR and western blot. ELISA was further used to detect TLR4 and TREM-1 levels in maternal and cord serums. Results: Compared with the normal term and PTB without CCA women, we found that (1) TLR4 and TREM-1 levels on CD14+ maternal and cord blood monocytes and neutrophils in the PTB with CCA group were elevated (p < .001); (2) the protein and mRNA expressions of CA14, TLR4, NF-κBp65, and TREM-1 of the PTB with CCA group were upregulated (p < .001); (3) Maternal and cord serum concentrations of TLR4 and TREM-1 in the PTB with CCA group were greater (p < .001). Conclusions: The high levels of TLR4 and TREM-1 surface expression were observed on CD14+ maternal and cord blood monocyte and neutrophils, confirming their proinflammatory profiles in PTB with CCA. TLR4 and TREM-1 on monocyte and neutrophils might have a role in infection-related PTB.
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Affiliation(s)
- Huan Yan
- a Department of Obstetrics and Gynecology , the Third Affiliated Hospital of Zhengzhou University , Zhengzhou , China.,b Department of Pathology and Laboratory Medicine , University of Tennessee Health Science Center , Memphis , TN , USA
| | - Hong Li
- a Department of Obstetrics and Gynecology , the Third Affiliated Hospital of Zhengzhou University , Zhengzhou , China
| | - Linlin Zhu
- c Department of Clinical Laboratory , the Third Affiliated Hospital of Zhengzhou University , Zhengzhou , China.,d Collaborative Innovation Center of Molecular Diagnosis and Laboratory Medicine, School of Laboratory Medicine , Xinxiang Medical University , Xinxiang , China
| | - Junjun Gao
- c Department of Clinical Laboratory , the Third Affiliated Hospital of Zhengzhou University , Zhengzhou , China
| | - Pengyun Li
- c Department of Clinical Laboratory , the Third Affiliated Hospital of Zhengzhou University , Zhengzhou , China
| | - Zhan Zhang
- a Department of Obstetrics and Gynecology , the Third Affiliated Hospital of Zhengzhou University , Zhengzhou , China.,e Shangqiu Medical College , Shangqiu , China
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Chaemsaithong P, Romero R, Docheva N, Chaiyasit N, Bhatti G, Pacora P, Hassan SS, Yeo L, Erez O. Comparison of rapid MMP-8 and interleukin-6 point-of-care tests to identify intra-amniotic inflammation/infection and impending preterm delivery in patients with preterm labor and intact membranes . J Matern Fetal Neonatal Med 2018; 31:228-244. [PMID: 28081646 PMCID: PMC5769687 DOI: 10.1080/14767058.2017.1281904] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 01/04/2017] [Accepted: 01/10/2017] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Among patients presenting with preterm labor and intact membranes, those with intra-amniotic inflammation have adverse obstetrical and neonatal outcomes. The diagnosis of intra-amniotic inflammation can easily be made by detecting an elevated concentration of the cytokine interleukin (IL)-6 or the enzyme neutrophil collagenase, also known as matrix metalloproteinase (MMP)-8. The diagnostic performances of MMP-8 and IL-6 enzyme-linked immunosorbent assay tests are similar. Recently, a rapid test has become available for point-of-care determination of either MMP-8 or IL-6. The objectives of this study were to compare the diagnostic indices and predictive values between the rapid MMP-8 and IL-6 tests for the identification of intra-amniotic inflammation in patients with preterm labor and intact membranes. MATERIALS AND METHODS We performed a retrospective cohort study including 124 women with singleton pregnancies who presented with symptoms of preterm labor and underwent transabdominal amniocentesis for the evaluation of microbial invasion of the amniotic cavity (MIAC). MIAC was defined according to amniotic fluid culture results (aerobic and anaerobic bacteria as well as genital Mycoplasmas). Amniotic fluid white blood cell (WBC) counts were determined using a hemocytometer chamber. An elevated amniotic fluid MMP-8 concentration was assessed using Yoon's MMP-8 Check® (cutoff: 10 ng/mL). An elevated amniotic fluid IL-6 concentration was scored when there was a positive result for the lateral flow-based immunoassay (cutoff: ≥745 pg/mL and ≥1000 pg/mL). In order to objectively compare rapid MMP-8 and rapid IL-6 tests to identify intra-amniotic inflammation, an amniotic fluid WBC count of ≥50 cells/mm3 was used to define intra-amniotic inflammation. RESULTS (1) The rapid tests had the same sensitivity for the detection of intra-amniotic inflammation [85.7% (18/21) for all]; (2) the specificity of the rapid MMP-8 test was higher than that of the rapid IL-6 test (cutoff: 745 pg/mL) for the identification of intra-amniotic inflammation [72.8% (75/103) vs. 64.1% (66/103); p < 0.05]; and (3) there were no differences in the sensitivity and specificity between the rapid MMP-8 test and the rapid IL-6 test (cutoff:1000 pg/mL) in the identification of intra-amniotic inflammation. Of 13 patients with discrepant results between the rapid MMP-8 and rapid IL-6 tests, two had a positive MMP-8 but a negative rapid IL-6 test, and both delivered preterm - one within 24 h, and the other within 10 days - and both had acute histologic chorioamnionitis. On the other hand, there were 11 patients with a positive rapid IL-6 but a negative rapid MMP-8 result: 10 delivered preterm, 3 had acute histologic chorioamnionitis and 1 had subacute chorionitis. CONCLUSION We conclude that the rapid MMP-8 test has a better specificity than the rapid IL-6 (cutoff: 745 pg/mL) assay for the detection of intra-amniotic infection. Moreover, we observed that among patients who were not identified as having intra-amniotic infection or inflammation by the standard cultivation technique and amniotic fluid WBC count, those who had a positive MMP-8 rapid test delivered preterm and had acute histologic chorioamnionitis.
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Affiliation(s)
- Piya Chaemsaithong
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Roberto Romero
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA
| | - Nikolina Docheva
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Noppadol Chaiyasit
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Gaurav Bhatti
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Percy Pacora
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Sonia S. Hassan
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Lami Yeo
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Offer Erez
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
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Matta P, Sherrod SD, Marasco CC, Moore DJ, McLean JA, Weitkamp JH. In Utero Exposure to Histological Chorioamnionitis Primes the Exometabolomic Profiles of Preterm CD4 + T Lymphocytes. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2017; 199:3074-3085. [PMID: 28947540 PMCID: PMC5659751 DOI: 10.4049/jimmunol.1601880] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 08/23/2017] [Indexed: 11/19/2022]
Abstract
Histological chorioamnionitis (HCA) is an intrauterine inflammatory condition that increases the risk for preterm birth, death, and disability because of persistent systemic and localized inflammation. The immunological mechanisms sustaining this response in the preterm newborn remain unclear. We sought to determine the consequences of HCA exposure on the fetal CD4+ T lymphocyte exometabolome. We cultured naive CD4+ T lymphocytes from HCA-positive and -negative preterm infants matched for gestational age, sex, race, prenatal steroid exposure, and delivery mode. We collected conditioned media samples before and after a 6-h in vitro activation of naive CD4+ T lymphocytes with soluble staphylococcal enterotoxin B and anti-CD28. We analyzed samples by ultraperformance liquid chromatography ion mobility-mass spectrometry. We determined the impact of HCA on the CD4+ T lymphocyte exometabolome and identified potential biomarker metabolites by multivariate statistical analyses. We discovered that: 1) CD4+ T lymphocytes exposed to HCA exhibit divergent exometabolomic profiles in both naive and activated states; 2) ∼30% of detected metabolites differentially expressed in response to activation were unique to HCA-positive CD4+ T lymphocytes; 3) metabolic pathways associated with glutathione detoxification and tryptophan degradation were altered in HCA-positive CD4+ T lymphocytes; and 4) flow cytometry and cytokine analyses suggested a bias toward a TH1-biased immune response in HCA-positive samples. HCA exposure primes the neonatal adaptive immune processes by inducing changes to the exometabolomic profile of fetal CD4+ T lymphocytes. These exometabolomic changes may link HCA exposure to TH1 polarization of the neonatal adaptive immune response.
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Affiliation(s)
- Poojitha Matta
- Department of Pediatrics, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN 37232
| | - Stacy D Sherrod
- Department of Chemistry, Vanderbilt University, Nashville, TN 37235; and
| | | | - Daniel J Moore
- Department of Pediatrics, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN 37232
| | - John A McLean
- Department of Chemistry, Vanderbilt University, Nashville, TN 37235; and
| | - Joern-Hendrik Weitkamp
- Department of Pediatrics, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN 37232;
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Chaiyasit N, Romero R, Chaemsaithong P, Docheva N, Bhatti G, Kusanovic JP, Dong Z, Yeo L, Pacora P, Hassan SS, Erez O. Clinical chorioamnionitis at term VIII: a rapid MMP-8 test for the identification of intra-amniotic inflammation. J Perinat Med 2017; 45:539-550. [PMID: 28672752 PMCID: PMC5625338 DOI: 10.1515/jpm-2016-0344] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 12/09/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Clinical chorioamnionitis is the most common infection/inflammatory process diagnosed in labor and delivery units worldwide. The condition is a syndrome that can be caused by (1) intra-amniotic infection, (2) intra-amniotic inflammation without demonstrable microorganisms (i.e. sterile intra-amniotic inflammation), and (3) maternal systemic inflammation that is not associated with intra-amniotic inflammation. The presence of intra-amniotic inflammation is a risk factor for adverse maternal and neonatal outcomes in a broad range of obstetrical syndromes that includes clinical chorioamnionitis at term. Although the diagnosis of intra-amniotic infection has relied on culture results, such information is not immediately available for patient management. Therefore, the diagnosis of intra-amniotic inflammation could be helpful as a proxy for intra-amniotic infection, while results of microbiologic studies are pending. A rapid test is now available for the diagnosis of intra-amniotic inflammation, based on the determination of neutrophil collagenase or matrix metalloproteinase-8 (MMP-8). The objectives of this study were (1) to evaluate the diagnostic indices of a rapid MMP-8 test for the identification of intra-amniotic inflammation/infection in patients with the diagnosis of clinical chorioamnionitis at term, and (2) to compare the diagnostic performance of a rapid MMP-8 test to that of a conventional enzyme-linked immunosorbent assay (ELISA) interleukin (IL)-6 test for patients with clinical chorioamnionitis at term. MATERIALS AND METHODS A retrospective cohort study was conducted. A transabdominal amniocentesis was performed in patients with clinical chorioamnionitis at term (n=44). Amniotic fluid was analyzed using cultivation techniques (for aerobic and anaerobic bacteria as well as genital Mycoplasmas) and broad-range polymerase chain reaction (PCR) coupled with electrospray ionization mass spectrometry (PCR/ESI-MS). Amniotic fluid IL-6 concentrations were determined by ELISA, and rapid MMP-8 results were determined by Yoon's MMP-8 Check®. Intra-amniotic inflammation was defined as an elevated amniotic fluid IL-6 concentration ≥2.6 ng/mL, and intra-amniotic infection was diagnosed by the presence of microorganisms in the amniotic fluid accompanied by intra-amniotic inflammation. The diagnostic indices of Yoon's MMP-8 Check® for the identification of intra-amniotic inflammation were calculated. In order to objectively compare Yoon's MMP-8 Check® with the ELISA IL-6 test for the identification of intra-amniotic inflammation, we used an amniotic fluid white blood cell (WBC) count ≥50 cells/mm3 to define intra-amniotic inflammation. RESULTS (1) A positive rapid MMP-8 test had a sensitivity of 82.4% (28/34), specificity of 90% (9/10), positive predictive value of 96.6% (28/29), negative predictive value of 60% (9/15), positive likelihood ratio 8.2 (95% CI 1.3-53.2), and negative likelihood ratio 0.2 (95% CI 0.1-0.4) for the identification of intra-amniotic inflammation (prevalence 77.3%); (2) a positive rapid MMP-8 test had a sensitivity of 91.7% (22/24), specificity of 65% (13/20), positive predictive value of 75.9% (22/29), negative predictive value of 86.7% (13/15), positive likelihood ratio of 2.6 (95% CI 1.4-4.8), and negative likelihood ratio of 0.1 (95% CI 0.03-0.5) for the identification of intra-amniotic infection; (3) the rapid MMP-8 test had a significantly higher specificity than the ELISA IL-6 test in the identification of intra-amniotic inflammation as determined by an amniotic fluid WBC count ≥50 cells/mm3. The sensitivity and accuracy of the rapid MMP-8 test were comparable to those of the ELISA IL-6 test; and (4) importantly, the rapid MMP-8 test had 100% sensitivity and 100% negative predictive value in the identification of neonates affected with fetal inflammatory response syndrome (FIRS). CONCLUSION The rapid diagnosis of intra-amniotic inflammation is possible by analysis of amniotic fluid using a point-of-care test for MMP-8. Patients with a positive test are at risk of delivering a neonate affected with systemic inflammation, a risk factor for adverse neonatal outcome.
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Affiliation(s)
- Noppadol Chaiyasit
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Roberto Romero
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA
| | - Piya Chaemsaithong
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Nikolina Docheva
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Gaurav Bhatti
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Juan Pedro Kusanovic
- Center for Research and Innovation in Maternal-Fetal Medicine (CIMAF), Department of Obstetrics and Gynecology, Sótero del Río Hospital, Santiago, Chile
- Division of Obstetrics and Gynecology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Zhong Dong
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Lami Yeo
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Percy Pacora
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
| | - Sonia S. Hassan
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Offer Erez
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
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Oh KJ, Kim SM, Hong JS, Maymon E, Erez O, Panaitescu B, Gomez-Lopez N, Romero R, Yoon BH. Twenty-four percent of patients with clinical chorioamnionitis in preterm gestations have no evidence of either culture-proven intraamniotic infection or intraamniotic inflammation. Am J Obstet Gynecol 2017; 216:604.e1-604.e11. [PMID: 28257964 PMCID: PMC5769703 DOI: 10.1016/j.ajog.2017.02.035] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 02/15/2017] [Accepted: 02/21/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Recent studies on clinical chorioamnionitis at term suggest that some patients with this diagnosis have neither intraamniotic infection nor intraamniotic inflammation. A false-positive diagnosis of clinical chorioamnionitis in preterm gestation may lead to unwarranted preterm delivery. OBJECTIVE We sought to determine the frequency of intraamniotic inflammation and microbiologically proven amniotic fluid infection in patients with preterm clinical chorioamnionitis. STUDY DESIGN Amniocentesis was performed in singleton pregnant women with preterm clinical chorioamnionitis (<36 weeks of gestation). Amniotic fluid was cultured for aerobic and anaerobic bacteria and genital mycoplasmas and assayed for matrix metalloproteinase-8 concentration. Microbial invasion of the amniotic cavity was defined as a positive amniotic fluid culture; intraamniotic inflammation was defined as an elevated amniotic fluid matrix metalloproteinase-8 concentration of >23 ng/mL. Nonparametric and survival techniques were used for analysis. RESULTS Among patients with preterm clinical chorioamnionitis, 24% (12/50) had neither microbiologic evidence of intraamniotic infection nor intraamniotic inflammation. Microbial invasion of the amniotic cavity was present in 34% (18/53) and intraamniotic inflammation in 76% (38/50) of patients. The most common microorganisms isolated from the amniotic cavity were the Ureaplasma species. Finally, patients without microbial invasion of the amniotic cavity or intraamniotic inflammation had significantly lower rates of adverse outcomes (including lower gestational age at delivery, a shorter amniocentesis-to-delivery interval, acute histologic chorioamnionitis, acute funisitis, and significant neonatal morbidity) than those with microbial invasion of the amniotic cavity and/or intraamniotic inflammation. CONCLUSION Among patients with preterm clinical chorioamnionitis, 24% had no evidence of either intraamniotic infection or intraamniotic inflammation, and 66% had negative amniotic fluid cultures, using standard microbiologic techniques. These observations call for a reexamination of the criteria used to diagnose preterm clinical chorioamnionitis.
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Affiliation(s)
- Kyung Joon Oh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Sun Min Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Joon-Seok Hong
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Eli Maymon
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Offer Erez
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Bogdan Panaitescu
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Nardhy Gomez-Lopez
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Department of Immunology, Microbiology and Biochemistry, Wayne State University School of Medicine, Detroit, MI
| | - Roberto Romero
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI; Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI.
| | - Bo Hyun Yoon
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.
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DeSilva M, Vazquez-Benitez G, Nordin JD, Lipkind HS, Klein NP, Cheetham TC, Naleway AL, Hambidge SJ, Lee GM, Jackson ML, McCarthy NL, Kharbanda EO. Maternal Tdap vaccination and risk of infant morbidity. Vaccine 2017; 35:3655-3660. [PMID: 28552511 DOI: 10.1016/j.vaccine.2017.05.041] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/15/2017] [Accepted: 05/15/2017] [Indexed: 01/24/2023]
Abstract
INTRODUCTION An increased risk of diagnosed chorioamnionitis in women vaccinated with Tdap during pregnancy was previously detected at two Vaccine Safety Datalink (VSD) sites. The clinical significance of this finding related to infant outcomes remains uncertain. METHODS Retrospective cohort study of singleton live births born to women who were continuously insured from 6months prior to their last menstrual period through 6weeks postpartum, with ≥1 outpatient visit during pregnancy from January 1, 2010 to November 15, 2013 at seven integrated United States health care systems part of the VSD. We re-evaluated the association between maternal Tdap and chorioamnionitis and evaluated whether specific infant morbidities differ among infants born to mothers who did and did not receive Tdap during pregnancy. We focused on 2 Tdap exposure windows: the recommended 27-36weeks gestation or anytime during pregnancy. We identified inpatient diagnostic codes for transient tachypnea of the newborn (TTN), neonatal sepsis, neonatal pneumonia, respiratory distress syndrome (RDS), and newborn convulsions associated with an infant's first hospitalization. A generalized linear model with Poisson distribution and log-link was used to estimate propensity score adjusted rate ratios (ARR) with 95% confidence intervals (CI). RESULTS The analyses included 197,564 pregnancies. Chorioamnionitis was recorded in 6.4% of women who received Tdap vaccination any time during pregnancy and 5.2% of women who did not (ARR [95% CI]: 1.23 [1.17, 1.28]). Compared with unvaccinated women, there were no significant increased risks (ARR [95% CI]) for TTN (1.04 [0.98, 1.11]), neonatal sepsis (1.06 [0.91, 1.23]), neonatal pneumonia (0.94 [0.72, 1.22]), RDS (0.91 [0.66, 1.26]), or newborn convulsions (1.16 [0.87, 1.53]) in infants born to Tdap-vaccinated women. CONCLUSIONS AND RELEVANCE Despite an observed association between maternal Tdap vaccination and maternal chorioamnionitis, we did not find increased risk for clinically significant infant outcomes associated with maternal chorioamnionitis.
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Affiliation(s)
| | | | | | - Heather S Lipkind
- Obstetrics and Gynecology, Yale University, New Haven, United States
| | - Nicola P Klein
- Kaiser Permanente Northern California, Oakland, United States
| | | | - Allison L Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, United States
| | - Simon J Hambidge
- Institute for Health Research, Kaiser Permanente Colorado and Department of Ambulatory Care Services, Denver Health, Denver, United States
| | - Grace M Lee
- Harvard Pilgrim Health Care Institute & Lee Harvard Medical School, Boston, United States
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Jung EY, Park KH, Han BR, Cho SH, Yoo HN, Lee J. Amniotic Fluid Infection, Cytokine Levels, and Mortality and Adverse Pulmonary, Intestinal, and Neurologic Outcomes in Infants at 32 Weeks' Gestation or Less. J Korean Med Sci 2017; 32:480-487. [PMID: 28145652 PMCID: PMC5290108 DOI: 10.3346/jkms.2017.32.3.480] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 12/03/2016] [Indexed: 11/20/2022] Open
Abstract
To what extent the risks of neonatal morbidities are directly related to premature birth or to biological mechanisms of preterm birth remains uncertain. We aimed to examine the effect of exposure to amniotic fluid (AF) infection and elevated cytokine levels on the mortality and pulmonary, intestinal, and neurologic outcomes of preterm infants, and whether these associations persist after adjustment for gestational age at birth. This retrospective cohort study included 152 premature singleton infants who were born at ≤ 32 weeks. AF obtained by amniocentesis was cultured; and interleukin-6 (IL-6) and IL-8 levels in AF were determined. The primary outcome was adverse perinatal outcome defined as the presence of one or more of the followings: stillbirth, neonatal death, bronchopulmonary dysplasia, necrotizing enterocolitis, intraventricular hemorrhage, and periventricular leukomalacia. Logistic regression analysis was adjusted for gestational age at birth and other potential confounders. In bivariate analyses, elevated AF IL-6 and IL-8 levels were significantly associated with adverse perinatal outcome. These results were not changed after adjusting for potential confounders, such as low Apgar scores, mechanical ventilation, and surfactant application. However, the independent effect of elevated cytokine levels in AF disappeared when additionally adjusted for low gestational age at birth; consequently, low gestational age remained strongly associated with the risk of adverse perinatal outcome. In conclusion, elevated levels of pro-inflammatory cytokines in AF are associated with increased risk of adverse perinatal outcomes, but this risk is not independent of low gestational age at birth. Culture-proven AF infection is not associated with this risk.
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Affiliation(s)
- Eun Young Jung
- Departments of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea
| | - Kyo Hoon Park
- Departments of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Bo Ryoung Han
- Departments of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Soo Hyun Cho
- Departments of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ha Na Yoo
- Departments of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Juyoung Lee
- Department of Pediatrics, Inha University College of Medicine, Inha University Hospital, Incheon, Korea
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Paules C, Pueyo V, Martí E, de Vilchez S, Burd I, Calvo P, Oros D. Threatened preterm labor is a risk factor for impaired cognitive development in early childhood. Am J Obstet Gynecol 2017; 216:157.e1-157.e7. [PMID: 27780701 DOI: 10.1016/j.ajog.2016.10.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 09/21/2016] [Accepted: 10/17/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Threatened preterm labor is a leading cause of hospital admission during pregnancy. Patients with an episode of threatened preterm labor who deliver at term are considered to have false preterm labor. However, threatened preterm labor has been proposed as a pathologic insult that is not always sufficient to induce irreversible spontaneous preterm birth but that could alter the normal course of pregnancy. OBJECTIVE The aim of this study was to evaluate threatened preterm labor during pregnancy as a risk factor of neurodevelopmental deficits of children at 2 years of age. STUDY DESIGN Two-year-old children who were born late preterm (n=22) or at term after threatened preterm labor (n=23) were compared with at-term control children (n=42). Neurodevelopment was evaluated at a corrected age of 24-29 months with the use of the Merrill-Palmer-Revised Scales of Development. RESULTS Children who were born at term after threatened preterm labor had lower scores than control children on global cognitive index (95.4 vs 104.2; P=.011), cognition (95.1 vs 103.1; P=.021), fine motor (95.2 vs 103.4; P=.003), gross motor (84.7 vs 99.8; P=.001), memory (92.9 vs 100.4; P=.015), receptive language (93.9 vs 102.9; P=.03), speed of processing (105.7 vs 113.3; P=.011), and visual motor coordination (98.8 vs 106.7; P=.003) subtests. Children born at term after threatened preterm labor had an increased risk of mild neurodevelopmental delay compared with control children (odds ratio for global cognitive index, 2.06; 95% confidence interval, 1.09-3.88; P=.033). There were no significant differences in any cognitive domain between children who were born late preterm and children who were born at term after threatened preterm labor. CONCLUSIONS Threatened preterm labor is a risk factor for impaired cognitive development at 2 years of age, even if birth occurred at term.
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Gisslen T, Alvarez M, Wells C, Soo MT, Lambers DS, Knox CL, Meinzen-Derr JK, Chougnet CA, Jobe AH, Kallapur SG. Fetal inflammation associated with minimal acute morbidity in moderate/late preterm infants. Arch Dis Child Fetal Neonatal Ed 2016; 101:F513-F519. [PMID: 27010018 DOI: 10.1136/archdischild-2015-308518] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 10/30/2015] [Accepted: 02/24/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine whether exposure to acute chorioamnionitis and fetal inflammation caused short-term adverse outcomes. DESIGN This is a prospective observational study: subjects were mothers delivering at 32-36 weeks gestation and their preterm infants at a large urban tertiary level III perinatal unit (N=477 infants). Placentae and fetal membranes were scored for acute histological chorioamnionitis based on the Redline criteria. Fetal inflammation was characterised by histological diagnosis of funisitis (umbilical cord inflammation), increased cord blood cytokines measured by ELISA, and activation of the inflammatory cells infiltrating the placenta and fetal membranes measured by immunohistology. Maternal and infant data were collected. RESULTS Twenty-four per cent of 32-36-week infants were exposed to histological chorioamnionitis and 6.9% had funisitis. Immunostaining for leucocyte subsets showed selective infiltration of the placenta and fetal membranes with activated neutrophils and macrophages with chorioamnionitis. Interleukin (IL) 6, IL-8 and granulocyte colony-stimulating factor were selectively increased in the cord blood of preterm infants with funisitis. Compared with infants without chorioamnionitis, funisitis was associated with increased ventilation support during resuscitation (43.8% vs 15.4%) and more respiratory distress syndrome postnatally (27.3% vs 10.2%) in univariate analysis. However, these associations disappeared after adjusting for prematurity. CONCLUSIONS Despite fetal exposure to funisitis, increased cord blood cytokines and activated placental inflammatory cells, we could not demonstrate neonatal morbidity specifically attributable to fetal inflammation after adjusting for gestational age in moderate and late preterm infants.
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Affiliation(s)
- Tate Gisslen
- Divisions of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Neonatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Manuel Alvarez
- Divisions of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Casey Wells
- Department of Immunobiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Man-Ting Soo
- Divisions of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, Kwong Wah Hospital, Hong Kong, Hong Kong
| | - Donna S Lambers
- Department of Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, Ohio, USA
| | - Christine L Knox
- Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Jareen K Meinzen-Derr
- Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Claire A Chougnet
- Department of Immunobiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alan H Jobe
- Divisions of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Suhas G Kallapur
- Divisions of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Puri K, Taft DH, Ambalavanan N, Schibler KR, Morrow AL, Kallapur SG. Association of Chorioamnionitis with Aberrant Neonatal Gut Colonization and Adverse Clinical Outcomes. PLoS One 2016; 11:e0162734. [PMID: 27658190 PMCID: PMC5033323 DOI: 10.1371/journal.pone.0162734] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 08/26/2016] [Indexed: 01/22/2023] Open
Abstract
Objective Chorioamnionitis (inflammation of the placenta and fetal membranes) and abnormal gastrointestinal colonization have been associated with an increased risk of sepsis and death in preterm infants, but whether chorioamnionitis causes abnormal pioneering gastrointestinal colonization in infants is not known. We determined the relationship between chorioamnionitis, altered infant fecal microbiome indicating abnormal gastrointestinal colonization, and adverse outcomes. Study Design Preterm infants ≤ 28 weeks at birth were enrolled from 3 level III NICUs in Cincinnati, Ohio and Birmingham, Alabama. Sequencing for 16S microbial gene was performed on stool samples in the first 3 weeks of life. Chorioamnionitis was diagnosed by placental histology. Late onset sepsis and death outcomes were analyzed in relation to fecal microbiota and chorioamnionitis with or without funisitis (inflammation of the umbilical cord). Results Of the 106 enrolled infants, 48 infants had no chorioamnionitis, 32 infants had chorioamnionitis but no funisitis (AC), and 26 infants had chorioamnionitis with funisitis (ACF). The fecal samples from ACF infants collected by day of life 7 had higher relative abundance of family Mycoplasmataceae (phylum Tenericutes), genus Prevotella (phylum Bacteroidetes) and genus Sneathia (phylum Fusobacteria). Further, AC and ACF infants had higher incidence of late-onset sepsis/death as a combined outcome. Presence of specific clades in fecal samples, specifically, order Fusobacteria, genus Sneathia or family Mycoplasmataceae, were significantly associated with higher risk of sepsis or death. Conclusion The results support the hypothesis that specific alterations in the pioneering infant gastrointestinal microbiota induced by chorioamnionitis predispose to neonatal sepsis or death.
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Affiliation(s)
- Kriti Puri
- Division of Neonatology and the Perinatal Institute, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, OH, United States of America
| | - Diana H. Taft
- Division of Neonatology and the Perinatal Institute, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, OH, United States of America
| | - Namasivayam Ambalavanan
- Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Kurt R. Schibler
- Division of Neonatology and the Perinatal Institute, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, OH, United States of America
| | - Ardythe L. Morrow
- Division of Neonatology and the Perinatal Institute, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, OH, United States of America
| | - Suhas G. Kallapur
- Division of Neonatology and the Perinatal Institute, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, OH, United States of America
- * E-mail:
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Deng Y, Zhang Q, Luo H, Chen X, Han Q, Wang F, Huang P, Lai W, Guan X, Pan X, Ji Y, Guo W, Che L, Tang Y, Gu L, Yu J, Namaka M, Deng Y, Li X. Sustained elevation of NF-κB activity sensitizes offspring of maternal inflammation to hypertension via impairing PGC-1α recovery. Sci Rep 2016; 6:32642. [PMID: 27616627 PMCID: PMC5018852 DOI: 10.1038/srep32642] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 08/11/2016] [Indexed: 02/07/2023] Open
Abstract
Growing evidence has demonstrated that maternal detrimental factors, including inflammation, contribute to the development of hypertension in the offspring. The current study found that offspring subjected to prenatal exposure of inflammation by lipopolysaccharide (LPS) challenge during the second semester showed significantly increased systolic blood pressure. In addition, these offspring also displayed augmented vascular damage and reactive oxygen species (ROS) levels in thoracic aortas when challenged with deoxycorticosterone acetate and high-salt diet (DOCA-salt). Interestingly, the antioxidant N-acetyl-L-cysteine markedly reversed these changes. Mechanistically, prenatal LPS exposure led to pre-existing elevated peroxisome proliferators-activated receptor-γ co-activator (PGC)-1α, a critical master of ROS metabolism, which up-regulated the ROS defense capacity and maintained the balance of ROS generation and elimination under resting state. However, continued elevation of NF-κB activity significantly suppressed the rapid recovery of PGC-1α expression response to DOCA-salt challenge in offspring that underwent prenatal inflammatory stimulation. This was further confirmed by using a NF-κB inhibitor (N-p-Tosyl-L-phenylalanine chloromethyl ketone) that restored PGC-1α recovery and prevented blood pressure elevation induced by DOCA-salt. Our results suggest that maternal inflammation programmed proneness to NF-κB over-activation which impaired PGC-1α-mediated anti-oxidant capacity resulting in the increased sensitivity of offspring to hypertensive damage.
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Affiliation(s)
- Yafei Deng
- Institute of Materia Medica, College of Pharmacy, Third Military Medical University, Chongqing, China
- Center of Translational Medicine, College of Pharmacy, Third Military Medical University, Chongqing, China
| | - Qi Zhang
- Institute of Materia Medica, College of Pharmacy, Third Military Medical University, Chongqing, China
- Center of Translational Medicine, College of Pharmacy, Third Military Medical University, Chongqing, China
| | - Hongqin Luo
- Institute of Materia Medica, College of Pharmacy, Third Military Medical University, Chongqing, China
- Center of Translational Medicine, College of Pharmacy, Third Military Medical University, Chongqing, China
| | - Xianhua Chen
- Diagosis and Treatment Center for Servicemen, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Qi Han
- Institute of Materia Medica, College of Pharmacy, Third Military Medical University, Chongqing, China
- Center of Translational Medicine, College of Pharmacy, Third Military Medical University, Chongqing, China
| | - Fangjie Wang
- Institute of Materia Medica, College of Pharmacy, Third Military Medical University, Chongqing, China
- Center of Translational Medicine, College of Pharmacy, Third Military Medical University, Chongqing, China
| | - Pei Huang
- Institute of Materia Medica, College of Pharmacy, Third Military Medical University, Chongqing, China
- Center of Translational Medicine, College of Pharmacy, Third Military Medical University, Chongqing, China
| | - Wenjing Lai
- Institute of Materia Medica, College of Pharmacy, Third Military Medical University, Chongqing, China
- Center of Translational Medicine, College of Pharmacy, Third Military Medical University, Chongqing, China
| | - Xiao Guan
- Institute of Materia Medica, College of Pharmacy, Third Military Medical University, Chongqing, China
- Center of Translational Medicine, College of Pharmacy, Third Military Medical University, Chongqing, China
| | - Xiaodong Pan
- Institute of Materia Medica, College of Pharmacy, Third Military Medical University, Chongqing, China
- Center of Translational Medicine, College of Pharmacy, Third Military Medical University, Chongqing, China
| | - Yan Ji
- Institute of Materia Medica, College of Pharmacy, Third Military Medical University, Chongqing, China
- Center of Translational Medicine, College of Pharmacy, Third Military Medical University, Chongqing, China
| | - Wei Guo
- Institute of Materia Medica, College of Pharmacy, Third Military Medical University, Chongqing, China
- Center of Translational Medicine, College of Pharmacy, Third Military Medical University, Chongqing, China
| | - Ling Che
- Institute of Materia Medica, College of Pharmacy, Third Military Medical University, Chongqing, China
- Center of Translational Medicine, College of Pharmacy, Third Military Medical University, Chongqing, China
| | - Yuan Tang
- Institute of Materia Medica, College of Pharmacy, Third Military Medical University, Chongqing, China
- Center of Translational Medicine, College of Pharmacy, Third Military Medical University, Chongqing, China
| | - Liangqi Gu
- The Center for Disease Control and Prevention of Chengdu Military Command, Chengdu, China
| | - Jianhua Yu
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Michael Namaka
- Colleges of Pharmacy and Medicine, University of Manitoba, Winnipeg, MB, Canada
- Joint Laboratory of Biological Psychiatry Between Shantou University Medical College and the College of Medicine University of Manitoba, Shantou, China
| | - Youcai Deng
- Institute of Materia Medica, College of Pharmacy, Third Military Medical University, Chongqing, China
- Center of Translational Medicine, College of Pharmacy, Third Military Medical University, Chongqing, China
| | - Xiaohui Li
- Institute of Materia Medica, College of Pharmacy, Third Military Medical University, Chongqing, China
- Center of Translational Medicine, College of Pharmacy, Third Military Medical University, Chongqing, China
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Huetz N, Triau S, Leboucher B, Sentilhes L, Hanf M, Nguyen S, Flamant C, Roze JC, Gascoin G. Association of severe placental inflammation with death prior to discharge and cerebral palsy in preterm infants. BJOG 2016; 123:1956-1963. [PMID: 27428037 DOI: 10.1111/1471-0528.14177] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objective of our study was to identify placental patterns associated with death before discharge or cerebral palsy in a large cohort of preterm infants with a high follow-up rate at 2 years of corrected age. DESIGN Population-based monocentric study. SETTINGS Monocentric study in the maternity unit of the University Hospital of Angers, France between 24+0 and 33+6 weeks of gestation, between January 2008 and December 2011. POPULATION All singleton infants born alive with a placental examination were eligible. METHODS Clinical data (obstetric and neonatal) were collected prospectively through the LIFT cohort. Placental data were collected retrospectively from medical records. The main outcome measure was death before discharge or cerebral palsy. RESULTS We did not find any significant association between severe inflammatory lesions on the placenta and death [odds ratio (OR) 1.49; 95% CI 0.55-4.01; P = 0.43] or cerebral palsy (OR 1.41; 95% CI 0.43-4.62; P = 0.57). This lack of significant association persisted even after adjustment (aOR 0.9; 95% CI 0.20-2.30; P = 0.54; aOR 0.98; 95% CI 0.27-3.58; P = 0.97). CONCLUSION Our results do not provide evidence for a significant association between severe inflammatory placental lesions and either death before discharge or cerebral palsy at 2 years of corrected age in preterm infants born at <34 weeks of gestational age. Further studies remain necessary to confirm this result. TWEETABLE ABSTRACT We found no significant association between inflammatory placental lesions and death or cerebral palsy.
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Affiliation(s)
- N Huetz
- Department of Neonatal Medicine, Angers University Hospital, Angers, France
| | - S Triau
- Department of Pathology, Angers University Hospital, Angers, France
| | - B Leboucher
- Department of Neonatal Medicine, Angers University Hospital, Angers, France.,Loire Infant Follow-Up Team (LIFT) Network, Pays de Loire, France
| | - L Sentilhes
- Department of Obstetrics and Gynaecology, Angers University Hospital, Angers, France
| | - M Hanf
- Loire Infant Follow-Up Team (LIFT) Network, Pays de Loire, France
| | - S Nguyen
- Loire Infant Follow-Up Team (LIFT) Network, Pays de Loire, France.,Department of Paediatric Neurology, Angers University Hospital, Angers, France
| | - C Flamant
- Loire Infant Follow-Up Team (LIFT) Network, Pays de Loire, France.,Department of Neonatal Medicine, Nantes University Hospital, Nantes, France
| | - J C Roze
- Loire Infant Follow-Up Team (LIFT) Network, Pays de Loire, France.,Department of Neonatal Medicine, Nantes University Hospital, Nantes, France
| | - G Gascoin
- Department of Neonatal Medicine, Angers University Hospital, Angers, France. .,Loire Infant Follow-Up Team (LIFT) Network, Pays de Loire, France.
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Kunze M, Klar M, Morfeld CA, Thorns B, Schild RL, Markfeld-Erol F, Rasenack R, Proempeler H, Hentschel R, Schaefer WR. Cytokines in noninvasively obtained amniotic fluid as predictors of fetal inflammatory response syndrome. Am J Obstet Gynecol 2016; 215:96.e1-8. [PMID: 26829512 DOI: 10.1016/j.ajog.2016.01.181] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 12/30/2015] [Accepted: 01/22/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND In patients with preterm premature rupture of membranes, intrauterine inflammation and/or infection is frequently present, can lead to fetal inflammatory response syndrome, and is associated with adverse neonatal outcome. Clinical decision making requires balancing the potential benefits of pregnancy prolongation against the risk of intrauterine infection. Diagnostic tests in maternal serum are of moderate prediction value and amniocentesis is an invasive procedure. Therefore, markers obtained noninvasively would be helpful in patients with expectant management. OBJECTIVES To determine the predictive values of amniotic fluid interleukin-6 and tumor necrosis factor-α in vaginal secretions for fetal inflammatory response syndrome and/or histologic funisitis and for adverse neonatal outcome in patients with preterm premature rupture of membranes. STUDY DESIGN In this prospective multicenter case-control study, vaginal secretions were sampled daily with a noninvasive method from 99 women with preterm premature rupture of membranes and expectant management. Amniotic fluid interleukin-6 and tumor necrosis factor-α were measured by 2 different immunoassays (an automated chemiluminescent enzyme immunoassay and a lateral flow immunoassay). After delivery, patients were divided into a control or a fetal inflammatory response syndrome group according to neonatal interleukin-6 in cord plasma and/or the presence of funisitis. Univariate and multivariate regression analyses were performed and prediction models were developed by calculating receiver operating characteristic curves. RESULTS Gestational age at delivery was lower and latency period was longer in the fetal inflammatory response syndrome group compared to the control group. The strongest risk factor for composite adverse neonatal outcome was fetal inflammatory response syndrome (odds ratio, 2.48; confidence interval, 1.40-4.38). The median concentrations of amniotic fluid interleukin-6 and tumor necrosis factor-α in vaginal secretions were significantly higher in the fetal inflammatory response group compared to the control group in both immunoassays (P < .001). The area under the curve of the clinical reference model (including common clinical parameters) was 0.66. Adding interleukin-6 and tumor necrosis factor-α into the model improved the area under the curve to 0.92 (in both assays, interleukin-6 IMMULITE and QuickLine); 0.87 (tumor necrosis factor-α IMMULITE) and 0.94 (tumor necrosis factor-α QuickLine), respectively. CONCLUSION The strongest risk factor for worse neonatal outcome (composite neonatal outcome) was fetal inflammatory response syndrome. Amniotic fluid interleukin-6 and tumor necrosis factor-α seem to be good predictors for fetal inflammatory response syndrome and for histologic funisitis and may improve the clinical management of patients with preterm premature rupture of membranes. The noninvasive technique of sampling amniotic fluid from vaginal secretions facilitates daily measurements and bedside assessment of cytokines and is in this respect preferable to invasive amniocentesis.
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Affiliation(s)
- Mirjam Kunze
- Department of Obstetrics and Gynecology, Medical Center - University of Freiburg, Freiburg, Germany.
| | - Maximilian Klar
- Department of Obstetrics and Gynecology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Christine A Morfeld
- Diakoniekrankenhaus Henriettenstiftung, Perinatalzentrum Hannover, Hannover, Germany
| | - Beena Thorns
- Diakoniekrankenhaus Henriettenstiftung, Perinatalzentrum Hannover, Hannover, Germany
| | - Ralf L Schild
- Diakoniekrankenhaus Henriettenstiftung, Perinatalzentrum Hannover, Hannover, Germany
| | - Filiz Markfeld-Erol
- Department of Obstetrics and Gynecology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Regina Rasenack
- Department of Obstetrics and Gynecology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Heinrich Proempeler
- Department of Obstetrics and Gynecology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Roland Hentschel
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Wolfgang R Schaefer
- Department of Obstetrics and Gynecology, Medical Center - University of Freiburg, Freiburg, Germany
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Histological chorioamnionitis shapes the neonatal transcriptomic immune response. Early Hum Dev 2016; 98:1-6. [PMID: 27318328 PMCID: PMC4947555 DOI: 10.1016/j.earlhumdev.2016.06.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 05/27/2016] [Accepted: 06/01/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Histologic chorioamnionitis (HCA) is commonly associated with preterm birth and deleterious post-natal outcomes including sepsis and necrotizing enterocolitis. Transcriptomic analysis has been used to uncover gene signatures that permit diagnosis and prognostication, show new therapeutic targets, and reveal mechanisms that underlie differential outcomes with other complex disease states in neonates such as sepsis. AIMS To define the transcriptomic and inflammatory protein response in peripheral blood among infants with exposure to histologic chorioamnionitis. STUDY DESIGN Prospective, observational study. SUBJECTS Uninfected preterm neonates retrospectively categorized based on placental pathology with no HCA exposure (n=18) or HCA exposure (n=15). OUTCOMES MEASURES We measured the transcriptomic and inflammatory mediator response in prospectively collected whole blood. RESULTS We found 488 significant (p<0.001), differentially expressed genes in whole blood samples among uninfected neonates with HCA exposure that collectively represented activated innate and adaptive immune cellular pathways and revealed a potential regulatory role for the pleotropic microRNA molecule miR-155. Differentially secreted plasma cytokines in patients with HCA exposure compared to patients without HCA included MCP-1, MPO, and MMP-9 (p<0.05). CONCLUSIONS Exposure to HCA distinctively activates the neonatal immune system in utero with potentially long-term health consequences.
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Keelan JA, Payne MS, Kemp MW, Ireland DJ, Newnham JP. A New, Potent, and Placenta-Permeable Macrolide Antibiotic, Solithromycin, for the Prevention and Treatment of Bacterial Infections in Pregnancy. Front Immunol 2016; 7:111. [PMID: 27066004 PMCID: PMC4817400 DOI: 10.3389/fimmu.2016.00111] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 03/14/2016] [Indexed: 01/24/2023] Open
Abstract
Intrauterine infection–inflammation is a major cause of early preterm birth and subsequent neonatal mortality and acute or long-term morbidity. Antibiotics can be administered in pregnancy to prevent preterm birth either prophylactically to women at high risk for preterm delivery, or to women with diagnosed intrauterine infection, prelabor rupture of membranes, or in suspected preterm labor. The therapeutic goals of each of these scenarios are different, with different pharmacological considerations, although effective antimicrobial therapy is an essential requirement. An ideal antibiotic for these clinical indications would be (a) one that is easily administered and orally bioactive, (b) has a favorable adverse effect profile (devoid of reproductive toxicity or teratogenicity), (c) is effective against the wide range of microorganisms known to be commonly associated with intra-amniotic infection, (d) provides effective antimicrobial protection within both the fetal and amniotic compartments after maternal delivery, (e) has anti-inflammatory properties, and (f) is effective against antibiotic-resistant microorganisms. Here, we review the evidence from clinical, animal, and ex vivo/in vitro studies that demonstrate that a new macrolide-derived antibiotic – solithromycin – has all of these properties and, hence, may be an ideal antibiotic for the treatment and prevention of intrauterine infection-related pregnancy complications. While this evidence is extremely encouraging, it is still preliminary. A number of key studies need to be completed before solithromycin’s true potential for use in pregnancy can be ascertained.
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Affiliation(s)
- Jeffrey A Keelan
- King Edward Memorial Hospital, School of Women's and Infants' Health, University of Western Australia , Perth, WA , Australia
| | - Matthew S Payne
- King Edward Memorial Hospital, School of Women's and Infants' Health, University of Western Australia , Perth, WA , Australia
| | - Matthew W Kemp
- King Edward Memorial Hospital, School of Women's and Infants' Health, University of Western Australia , Perth, WA , Australia
| | - Demelza J Ireland
- King Edward Memorial Hospital, School of Women's and Infants' Health, University of Western Australia , Perth, WA , Australia
| | - John P Newnham
- King Edward Memorial Hospital, School of Women's and Infants' Health, University of Western Australia , Perth, WA , Australia
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Faucett AM, Metz TD, DeWitt PE, Gibbs RS. Effect of obesity on neonatal outcomes in pregnancies with preterm premature rupture of membranes. Am J Obstet Gynecol 2016; 214:287.e1-287.e5. [PMID: 26435047 DOI: 10.1016/j.ajog.2015.09.093] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/21/2015] [Accepted: 09/24/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Maternal obesity is associated with increased systemic inflammation and an increased risk of preterm premature rupture of membranes. There is an established association between an inflammatory intrauterine environment and adverse neonatal outcomes that is independent of gestational age and mediated by the fetal inflammatory response. It is unknown whether the maternal systemic inflammation that is present in obese women influences the intrauterine environment and predisposes the fetus to adverse neonatal outcomes after preterm premature rupture of membranes. OBJECTIVE The purpose of this study was to determine whether maternal obesity is associated with adverse neonatal outcomes in pregnancies that are complicated by preterm premature rupture of membranes. STUDY DESIGN This was a secondary analysis of the Maternal-Fetal Medicine Units Network Randomized Clinical Trial on the Beneficial Effects of Antenatal Magnesium Sulfate. Women with singleton pregnancies that were affected by preterm premature rupture of membranes who delivered live-born infants between 24 + 0 and 33 + 6 weeks of gestation were included. An adverse neonatal outcome was defined as a composite outcome of neonatal death, severe necrotizing enterocolitis, respiratory distress syndrome, sepsis, or severe intraventricular hemorrhage. The rates of the composite outcome were compared between obese (body mass index, ≥30 kg/m(2)) and nonobese women. Multivariable logistic regression was used to evaluate the independent effect of obesity on neonatal outcomes. Magnesium sulfate administration, steroid administration, maternal diabetes mellitus, gestational age at delivery, indomethacin exposure, birthweight, and chorioamnionitis were all considered as possible covariates in the multivariable regression models. RESULTS Three hundred twenty-five of the 1288 women (25.2%) who were included were obese, and 202 of these women (62.2%) had neonates with adverse outcomes. In univariable analysis, maternal prepregnancy obesity was associated with increased odds of an adverse neonatal outcome (odds ratio, 0.30, 95% confidence interval, 1.00-1.68). However, in our multivariable logistic regression model, gestational age at delivery (odds ratio, 0.93, 95% confidence interval, 0.92-0.94 per day), but not maternal obesity (odds ratio, 1.02, 95% confidence interval, 0.75-1.38), was associated with adverse neonatal outcomes. Obese African American women experienced preterm premature rupture of membranes (189 vs 196 days; p < .001) and delivery (199 vs 205 days; p < .001) earlier than nonobese African American women. This difference was not seen in non-African American women. CONCLUSIONS Maternal obesity was not associated independently with adverse neonatal outcomes in pregnancies that were affected by preterm premature rupture of membranes after adjustment for gestational age at birth. However, obese African American women rupture and deliver earlier than other women, which causes increased neonatal morbidity.
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Affiliation(s)
- Allison M Faucett
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine University of Colorado School of Medicine, Denver, CO.
| | - Torri D Metz
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine University of Colorado School of Medicine, Denver, CO; Department of Obstetrics & Gynecology, Denver Health Medical Center, Denver, CO
| | - Peter E DeWitt
- Department of Biostatistics & Informatics, Colorado School of Public Health, Denver, CO
| | - Ronald S Gibbs
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine University of Colorado School of Medicine, Denver, CO
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Ehrmann Feldman D, Vinet É, Bernatsky S, Duffy C, Hazel B, Meshefedjian G, Sylvestre MP, Bérard A. Birth Outcomes in Women with a History of Juvenile Idiopathic Arthritis. J Rheumatol 2016; 43:804-9. [PMID: 26834215 DOI: 10.3899/jrheum.150592] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine whether children born to women who had juvenile idiopathic arthritis (JIA) had more adverse birth outcomes than children born to mothers who never had JIA. METHODS Our cohort study used data from physician billing and hospitalizations covering the province of Quebec, Canada. We identified all women with JIA with a first-time birth between January 1, 1983, and December 31, 2010, and assembled a control cohort of first-time mothers without JIA from the same administrative data, matching 4:1 for date of first birth, maternal age, and area of residence. We compared outcomes (stillbirth, prematurity, small for gestational age, and major congenital anomalies) in the JIA versus non-JIA groups using logistic regression. RESULTS Mean age at delivery was 24.7 years in the JIA group (n = 1681) and 25.0 years for the non-JIA group (n = 6724). Women who had JIA were at higher risk for a premature baby [adjusted relative risk (RR) 1.20, 95% CI 1.01-1.42], a baby small for gestational age (adjusted RR 1.19, 95% CI 1.04-1.37), and a child with a congenital malformation (adjusted RR 6.51, 95% CI 5.05-8.39). Neural tube defects were higher in the JIA offspring: 1.61% (95% CI 1.11-2.33) versus 0.03% (95% CI 0.01-0.11) in the non-JIA group, as were congenital heart defects: 1.07% (95% CI 0.68-1.69) versus 0.58% (95% CI 0.42-0.79). CONCLUSION Most women with JIA will deliver a normal baby, even though they are at higher risk for having a child with adverse birth outcomes. Research is needed to understand pathophysiologic mechanisms and to investigate the effects of medications during childhood and youth on future birth outcomes.
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Affiliation(s)
- Debbie Ehrmann Feldman
- From the École de réadaptation, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada.D. Ehrmann Feldman, PhD, École de réadaptation, Université de Montréal, and Direction de Santé Publique de Montréal, and Centre de recherche interdisciplinaire de réadaptation de Montréal, and Institut de recherche en santé publique de l'université de Montréal; É. Vinet, MD, McGill University Health Centre; S. Bernatsky, MD, PhD, McGill University Health Centre, Division of Clinical Epidemiology; C. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario, and Faculty of Medicine, University of Ottawa; B. Hazel, MD, McGill University Health Centre; G. Meshefedjian, PhD, Direction de Santé Publique de Montréal; M.P. Sylvestre, PhD, Département de médecine sociale et préventive, Université de Montréal; A. Bérard, PhD, Faculté de pharmacie, Université de Montréal et Centre de recherche CHU Ste-Justine.
| | - Évelyne Vinet
- From the École de réadaptation, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada.D. Ehrmann Feldman, PhD, École de réadaptation, Université de Montréal, and Direction de Santé Publique de Montréal, and Centre de recherche interdisciplinaire de réadaptation de Montréal, and Institut de recherche en santé publique de l'université de Montréal; É. Vinet, MD, McGill University Health Centre; S. Bernatsky, MD, PhD, McGill University Health Centre, Division of Clinical Epidemiology; C. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario, and Faculty of Medicine, University of Ottawa; B. Hazel, MD, McGill University Health Centre; G. Meshefedjian, PhD, Direction de Santé Publique de Montréal; M.P. Sylvestre, PhD, Département de médecine sociale et préventive, Université de Montréal; A. Bérard, PhD, Faculté de pharmacie, Université de Montréal et Centre de recherche CHU Ste-Justine
| | - Sasha Bernatsky
- From the École de réadaptation, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada.D. Ehrmann Feldman, PhD, École de réadaptation, Université de Montréal, and Direction de Santé Publique de Montréal, and Centre de recherche interdisciplinaire de réadaptation de Montréal, and Institut de recherche en santé publique de l'université de Montréal; É. Vinet, MD, McGill University Health Centre; S. Bernatsky, MD, PhD, McGill University Health Centre, Division of Clinical Epidemiology; C. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario, and Faculty of Medicine, University of Ottawa; B. Hazel, MD, McGill University Health Centre; G. Meshefedjian, PhD, Direction de Santé Publique de Montréal; M.P. Sylvestre, PhD, Département de médecine sociale et préventive, Université de Montréal; A. Bérard, PhD, Faculté de pharmacie, Université de Montréal et Centre de recherche CHU Ste-Justine
| | - Ciarán Duffy
- From the École de réadaptation, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada.D. Ehrmann Feldman, PhD, École de réadaptation, Université de Montréal, and Direction de Santé Publique de Montréal, and Centre de recherche interdisciplinaire de réadaptation de Montréal, and Institut de recherche en santé publique de l'université de Montréal; É. Vinet, MD, McGill University Health Centre; S. Bernatsky, MD, PhD, McGill University Health Centre, Division of Clinical Epidemiology; C. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario, and Faculty of Medicine, University of Ottawa; B. Hazel, MD, McGill University Health Centre; G. Meshefedjian, PhD, Direction de Santé Publique de Montréal; M.P. Sylvestre, PhD, Département de médecine sociale et préventive, Université de Montréal; A. Bérard, PhD, Faculté de pharmacie, Université de Montréal et Centre de recherche CHU Ste-Justine
| | - Beth Hazel
- From the École de réadaptation, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada.D. Ehrmann Feldman, PhD, École de réadaptation, Université de Montréal, and Direction de Santé Publique de Montréal, and Centre de recherche interdisciplinaire de réadaptation de Montréal, and Institut de recherche en santé publique de l'université de Montréal; É. Vinet, MD, McGill University Health Centre; S. Bernatsky, MD, PhD, McGill University Health Centre, Division of Clinical Epidemiology; C. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario, and Faculty of Medicine, University of Ottawa; B. Hazel, MD, McGill University Health Centre; G. Meshefedjian, PhD, Direction de Santé Publique de Montréal; M.P. Sylvestre, PhD, Département de médecine sociale et préventive, Université de Montréal; A. Bérard, PhD, Faculté de pharmacie, Université de Montréal et Centre de recherche CHU Ste-Justine
| | - Garbis Meshefedjian
- From the École de réadaptation, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada.D. Ehrmann Feldman, PhD, École de réadaptation, Université de Montréal, and Direction de Santé Publique de Montréal, and Centre de recherche interdisciplinaire de réadaptation de Montréal, and Institut de recherche en santé publique de l'université de Montréal; É. Vinet, MD, McGill University Health Centre; S. Bernatsky, MD, PhD, McGill University Health Centre, Division of Clinical Epidemiology; C. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario, and Faculty of Medicine, University of Ottawa; B. Hazel, MD, McGill University Health Centre; G. Meshefedjian, PhD, Direction de Santé Publique de Montréal; M.P. Sylvestre, PhD, Département de médecine sociale et préventive, Université de Montréal; A. Bérard, PhD, Faculté de pharmacie, Université de Montréal et Centre de recherche CHU Ste-Justine
| | - Marie-Pierre Sylvestre
- From the École de réadaptation, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada.D. Ehrmann Feldman, PhD, École de réadaptation, Université de Montréal, and Direction de Santé Publique de Montréal, and Centre de recherche interdisciplinaire de réadaptation de Montréal, and Institut de recherche en santé publique de l'université de Montréal; É. Vinet, MD, McGill University Health Centre; S. Bernatsky, MD, PhD, McGill University Health Centre, Division of Clinical Epidemiology; C. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario, and Faculty of Medicine, University of Ottawa; B. Hazel, MD, McGill University Health Centre; G. Meshefedjian, PhD, Direction de Santé Publique de Montréal; M.P. Sylvestre, PhD, Département de médecine sociale et préventive, Université de Montréal; A. Bérard, PhD, Faculté de pharmacie, Université de Montréal et Centre de recherche CHU Ste-Justine
| | - Anick Bérard
- From the École de réadaptation, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada.D. Ehrmann Feldman, PhD, École de réadaptation, Université de Montréal, and Direction de Santé Publique de Montréal, and Centre de recherche interdisciplinaire de réadaptation de Montréal, and Institut de recherche en santé publique de l'université de Montréal; É. Vinet, MD, McGill University Health Centre; S. Bernatsky, MD, PhD, McGill University Health Centre, Division of Clinical Epidemiology; C. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario, and Faculty of Medicine, University of Ottawa; B. Hazel, MD, McGill University Health Centre; G. Meshefedjian, PhD, Direction de Santé Publique de Montréal; M.P. Sylvestre, PhD, Département de médecine sociale et préventive, Université de Montréal; A. Bérard, PhD, Faculté de pharmacie, Université de Montréal et Centre de recherche CHU Ste-Justine
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Affiliation(s)
- Shali Mazaki-Tovi
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Edi Vaisbuch
- Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, and The Hebrew University and Hadassah School of Medicine, Jerusalem, Israel
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Lee J, Romero R, Kim SM, Chaemsaithong P, Yoon BH. A new antibiotic regimen treats and prevents intra-amniotic inflammation/infection in patients with preterm PROM. J Matern Fetal Neonatal Med 2015; 29:2727-37. [PMID: 26441216 DOI: 10.3109/14767058.2015.1103729] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To determine whether a new antibiotic regimen could reduce the frequency of intra-amniotic inflammation/infection in patients with preterm PROM. STUDY DESIGN This retrospective cohort study was conducted to evaluate the effect of antibiotics on the frequency of intra-amniotic inflammation/infection based on the results of follow-up transabdominal amniocenteses from 89 patients diagnosed with preterm PROM who underwent serial amniocenteses. From 1993-2003, ampicillin and/or cephalosporins or a combination was used ("regimen 1"). A new regimen (ceftriaxone, clarithromycin and metronidazole) was used from 2003-2012 ("regimen 2"). Amniotic fluid was cultured and matrix metalloproteinase-8 (MMP-8) concentrations were measured. RESULTS (1) The rates of intra-amniotic inflammation and intra-amniotic inflammation/infection in patients who received regimen 2 decreased during treatment from 68.8% to 52.1% and from 75% to 54.2%, respectively. In contrast, in patients who received regimen 1, the frequency of intra-amniotic inflammation and infection/inflammation increased during treatment (31.7% to 55% and 34.1% to 58.5%, respectively); and (2) intra-amniotic inflammation/infection was eradicated in 33.3% of patients who received regimen 2, but in none who received regimen 1. CONCLUSION The administration of ceftriaxone, clarithromycin and metronidazole was associated with a more successful eradication of intra-amniotic inflammation/infection and prevented secondary intra-amniotic inflammation/infection more frequently than an antibiotic regimen which included ampicillin and/or cephalosporins in patients with preterm PROM.
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Affiliation(s)
- JoonHo Lee
- a Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Republic of Korea
| | - Roberto Romero
- b Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NICHD/NIH/DHHS , Bethesda, MD, and Detroit, MI , USA .,c Department of Obstetrics and Gynecology , University of Michigan , Ann Arbor , MI , USA .,d Department of Epidemiology and Biostatistics , Michigan State University , East Lansing , MI , USA .,e Center for Molecular Medicine and Genetics, Wayne State University , Detroit , MI , USA
| | - Sun Min Kim
- a Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Republic of Korea .,f Department of Obstetrics and Gynecology , Seoul Metropolitan Government --Seoul National University Boramae Medical Center , Seoul , Republic of Korea , and
| | - Piya Chaemsaithong
- b Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NICHD/NIH/DHHS , Bethesda, MD, and Detroit, MI , USA .,g Department of Obstetrics and Gynecology , Wayne State University School of Medicine , Detroit , MI , USA
| | - Bo Hyun Yoon
- a Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Republic of Korea
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Chaemsaithong P, Romero R, Korzeniewski SJ, Martinez-Varea A, Dong Z, Yoon BH, Hassan SS, Chaiworapongsa T, Yeo L. A rapid interleukin-6 bedside test for the identification of intra-amniotic inflammation in preterm labor with intact membranes. J Matern Fetal Neonatal Med 2015; 29:349-59. [PMID: 25758618 PMCID: PMC4776723 DOI: 10.3109/14767058.2015.1006620] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Preterm birth is associated with 5–18% of pregnancies and is the leading cause of neonatal morbidity and mortality. Amniotic fluid (AF) interleukin-6 (IL-6) is a key cytokine for the identification of intra-amniotic inflammation, and patients with an elevated AF IL-6 are at risk for impending preterm delivery. However, results of the conventional method of measurement (enzyme-linked immunosorbent assay; ELISA) are usually not available in time to inform care. The objective of this study was to determine whether a point of care (POC) test or lateral-flow-based immunoassay for measurement of AF IL-6 concentrations can identify patients with intra-amniotic inflammation and/or infection and those destined to deliver spontaneously before term among women with preterm labor and intact membranes. Methods: One-hundred thirty-six women with singleton pregnancies who presented with symptoms of preterm labor and underwent amniocentesis were included in this study. Amniocentesis was performed at the time of diagnosis of preterm labor. AF Gram stain and AF white blood cell counts were determined. Microbial invasion of the amniotic cavity (MIAC) was defined according to the results of AF culture (aerobic and anaerobic as well as genital mycoplasmas). AF IL-6 concentrations were determined by both lateral flow-based immunoassay and ELISA. The primary outcome was intra-amniotic inflammation, defined as AF ELISA IL-6 ≥ 2600 pg/ml. Results: (1) AF IL-6 concentrations determined by a POC test have high sensitivity (93%), specificity (91%) and a positive likelihood ratio of 10 for the identification of intra-amniotic inflammation by using a threshold of 745 pg/ml; (2) the POC test and ELISA for IL-6 perform similarly in the identification of MIAC, acute inflammatory lesions of placenta and patients at risk of impending spontaneous preterm delivery. Conclusion: A POC AF IL-6 test can identify intra-amniotic inflammation in women who present with preterm labor and intact membranes and those who will subsequently deliver spontaneously before 34 weeks of gestation. Results can be available within 20 min – this has important clinical implications and opens avenues for early diagnosis as well as treatment of intra-amniotic inflammation/infection.
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Affiliation(s)
- Piya Chaemsaithong
- a Division of Intramural Research , Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH , Bethesda, MD and Detroit , MI , USA .,b Department of Obstetrics and Gynecology , Wayne State University , Detroit , MI , USA
| | - Roberto Romero
- a Division of Intramural Research , Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH , Bethesda, MD and Detroit , MI , USA .,c Department of Obstetrics and Gynecology , University of Michigan , Ann Arbor , MI , USA .,d Department of Epidemiology and Biostatistics , Michigan State University , East Lansing , MI , USA , and
| | - Steven J Korzeniewski
- a Division of Intramural Research , Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH , Bethesda, MD and Detroit , MI , USA .,b Department of Obstetrics and Gynecology , Wayne State University , Detroit , MI , USA .,d Department of Epidemiology and Biostatistics , Michigan State University , East Lansing , MI , USA , and
| | - Alicia Martinez-Varea
- a Division of Intramural Research , Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH , Bethesda, MD and Detroit , MI , USA .,b Department of Obstetrics and Gynecology , Wayne State University , Detroit , MI , USA
| | - Zhong Dong
- a Division of Intramural Research , Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH , Bethesda, MD and Detroit , MI , USA .,b Department of Obstetrics and Gynecology , Wayne State University , Detroit , MI , USA
| | - Bo Hyun Yoon
- e Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Korea
| | - Sonia S Hassan
- a Division of Intramural Research , Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH , Bethesda, MD and Detroit , MI , USA .,b Department of Obstetrics and Gynecology , Wayne State University , Detroit , MI , USA
| | - Tinnakorn Chaiworapongsa
- a Division of Intramural Research , Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH , Bethesda, MD and Detroit , MI , USA .,b Department of Obstetrics and Gynecology , Wayne State University , Detroit , MI , USA
| | - Lami Yeo
- a Division of Intramural Research , Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH , Bethesda, MD and Detroit , MI , USA .,b Department of Obstetrics and Gynecology , Wayne State University , Detroit , MI , USA
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Lee J, Romero R, Kim SM, Chaemsaithong P, Park CW, Park JS, Jun JK, Yoon BH. A new anti-microbial combination prolongs the latency period, reduces acute histologic chorioamnionitis as well as funisitis, and improves neonatal outcomes in preterm PROM. J Matern Fetal Neonatal Med 2015; 29:707-20. [PMID: 26373262 DOI: 10.3109/14767058.2015.1020293] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Antibiotic administration is a standard practice in preterm premature rupture of membranes (PROM). Specific anti-microbial agents often include ampicillin and/or erythromycin. Anaerobes and genital mycoplasmas are frequently involved in preterm PROM, but are not adequately covered by antibiotics routinely used in clinical practice. Our objective was to compare outcomes of PROM treated with standard antibiotic administration versus a new combination more effective against these bacteria. STUDY DESIGN A retrospective study compared perinatal outcomes in 314 patients with PROM <34 weeks receiving anti-microbial regimen 1 (ampicillin and/or cephalosporins; n = 195, 1993-2003) versus regimen 2 (ceftriaxone, clarithromycin and metronidazole; n = 119, 2003-2012). Intra-amniotic infection/inflammation was assessed by positive amniotic fluid culture and/or an elevated amniotic fluid MMP-8 concentration (>23 ng/mL). RESULTS (1) Patients treated with regimen 2 had a longer median antibiotic-to-delivery interval than those with regimen 1 [median (interquartile range) 23 d (10-51 d) versus 12 d (5-52 d), p < 0.01]; (2) patients who received regimen 2 had lower rates of acute histologic chorioamnionitis (50.5% versus 66.7%, p < 0.05) and funisitis (13.9% versus 42.9%, p < 0.001) than those who had received regimen 1; (3) the rates of intra-ventricular hemorrhage (IVH) and cerebral palsy (CP) were significantly lower in patients allocated to regimen 2 than regimen 1 (IVH: 2.1% versus 19.0%, p < 0.001 and CP: 0% versus 5.7%, p < 0.05); and (4) subgroup analysis showed that regimen 2 improved perinatal outcomes in pregnancies with intra-amniotic infection/inflammation, but not in those without intra-amniotic infection/inflammation (after adjusting for gestational age and antenatal corticosteroid administration). CONCLUSION A new antibiotic combination consisting of ceftriaxone, clarithromycin, and metronidazole prolonged the latency period, reduced acute histologic chorioamnionitis/funisitis, and improved neonatal outcomes in patients with preterm PROM. These findings suggest that the combination of anti-microbial agents (ceftriaxone, clarithromycin, and metronidazole) may improve perinatal outcome in preterm PROM.
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Affiliation(s)
- JoonHo Lee
- a Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Korea
| | - Roberto Romero
- b Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development , NIH, Bethesda, MD and Detroit, MI , USA .,c Department of Obstetrics and Gynecology , University of Michigan , Ann Arbor , MI , USA .,d Department of Epidemiology and Biostatistics , Michigan State University , East Lansing , MI , USA .,e Center for Molecular Medicine and Genetics, Wayne State University , Detroit , MI , USA , and
| | - Sun Min Kim
- a Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Korea
| | - Piya Chaemsaithong
- b Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development , NIH, Bethesda, MD and Detroit, MI , USA .,f Department of Obstetrics and Gynecology , Wayne State University School of Medicine , Detroit , MI , USA
| | - Chan-Wook Park
- a Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Korea
| | - Joong Shin Park
- a Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Korea
| | - Jong Kwan Jun
- a Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Korea
| | - Bo Hyun Yoon
- a Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Korea
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Chaemsaithong P, Romero R, Korzeniewski SJ, Dong Z, Yeo L, Hassan SS, Kim YM, Yoon BH, Chaiworapongsa T. A point of care test for the determination of amniotic fluid interleukin-6 and the chemokine CXCL-10/IP-10. J Matern Fetal Neonatal Med 2015; 28:1510-9. [PMID: 25182862 PMCID: PMC5291337 DOI: 10.3109/14767058.2014.961417] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Intra-amniotic inflammation is a mechanism of disease implicated in preterm labor, preterm prelabor rupture of membrane, cervical insufficiency, a short cervix, and idiopathic vaginal bleeding. Determination of interleukin (IL)-6 with immunoassays has been proven for more than two decades to be an excellent method for the detection of intra-amniotic inflammation. However, assessment of IL-6 for this indication has been based on immunoassays which are not clinically available, and this has been an obstacle for the implementation of this test in clinical practice. It is now possible to obtain results within 20 min with a point of care (POC) test which requires minimal laboratory support. This test is based on lateral flow-based immunoassay. The objective of this study was to compare amniotic fluid (AF) IL-6 and interferon-γ - inducible protein 10 (IP-10 or CXCL-10) concentrations determined using lateral flow-based immunoassay or POC test and standard enzyme-linked immunosorbent assay (ELISA) techniques. MATERIAL AND METHODS AF samples were collected from patients with singleton gestations and symptoms of preterm labor (n = 20). AF IL-6 and IP-10 concentrations were determined by lateral flow-based immunoassay and ELISA. Intra-amniotic inflammation was defined as AF IL-6 ≥ 2.6 ng/ml. AF IL-6 and IP-10 concentrations between two assays were compared. RESULTS (1) Lateral flow-based immunoassay POC AF IL-6 and IP-10 test results were strongly correlated with concentrations of this cytokine/chemokine determined by ELISA (Spearman's ρ = 0.92 and 0.83, respectively, both p < 0.0001); (2) AF IL-6 concentrations determined by the lateral flow-based immunoassay test were, on average, 30% lower than those determined by ELISA, and the median difference was statistically significant (p < 0.0001); and (3) in contrast, AF IP-10 concentrations determined by the lateral flow-based immunoassay test were, on average, only 7% lower than those determined by ELISA, and the median difference was not statistically significant (p = 0.81). CONCLUSION AF IL-6 and IP-10 concentrations determined using a lateral flow-based immunoassay POC are strongly correlated with concentrations determined by conventional ELISA. This justifies further studies about the diagnostic indices and predictive values of this POC test.
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Affiliation(s)
- Piya Chaemsaithong
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Roberto Romero
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI
| | - Steven J. Korzeniewski
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI
| | - Zhong Dong
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD and Detroit, MI, USA
| | - Lami Yeo
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Sonia S. Hassan
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Yeon Mee Kim
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD and Detroit, MI, USA
- Department of Pathology, College of Medicine Inje University, Haeundae Paik Hospital, Seoul, Korea
| | - Bo Hyun Yoon
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Tinnakorn Chaiworapongsa
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
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Elovitz MA, Anton L, Bastek J, Brown AG. Can microRNA profiling in maternal blood identify women at risk for preterm birth? Am J Obstet Gynecol 2015; 212:782.e1-5. [PMID: 25617732 DOI: 10.1016/j.ajog.2015.01.023] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 12/15/2014] [Accepted: 01/19/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE MicroRNAs (miRNAs), which are highly conserved single-stranded noncoding RNAs that play a crucial role in gene regulation, have now been identified as important players in many diseases states. MiRNAs have also been demonstrated to be reliable and useful biomarkers to identify those women who are at risk for specific adverse outcomes. The objective of this study was to determine whether miRNA profiles in maternal blood are different in women who are destined to have a preterm, compared with a term, birth. STUDY DESIGN A nested case-control study was performed with maternal serum that was collected as part of a larger prospective cohort. MiRNA expression profiles in maternal serum were compared between women who ultimately had a preterm birth (n = 40) compared with term birth (n = 40). MiRNA expression profiles were created with the use of the Affymetrix GeneChip miRNA Array. The data were analyzed with the significance of analysis of microarrays and principle components analyses. A false discovery rate of 20% was used to determine the most differentially expressed miRNAs. RESULTS Of the 5640 miRNAs that were analyzed on the array, 4 miRNAs were significantly different between cases and control subjects. Two of the 4 miRNAs were mature miRNAs. The fold difference in expression was <2 for all 4 miRNAs. CONCLUSION MiRNA profiles in maternal blood were not significantly different in women who were destined to have a preterm, compared with a term, birth. MiRNAs in maternal blood are unlikely to become clinically useful biomarkers for the prediction of preterm birth.
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