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Barclay K, Kolk M, Kravdal Ø. Birth Spacing and Parents' Physical and Mental Health: An Analysis Using Individual and Sibling Fixed Effects. Demography 2024; 61:393-418. [PMID: 38456775 DOI: 10.1215/00703370-11204828] [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] [Indexed: 03/09/2024]
Abstract
An extensive literature has examined the relationship between birth spacing and subsequent health outcomes for parents, particularly for mothers. However, this research has drawn almost exclusively on observational research designs, and almost all studies have been limited to adjusting for observable factors that could confound the relationship between birth spacing and health outcomes. In this study, we use Norwegian register data to examine the relationship between birth spacing and the number of general practitioner consultations for mothers' and fathers' physical and mental health concerns immediately after childbirth (1-5 and 6-11 months after childbirth), in the medium term (5-6 years after childbearing), and in the long term (10-11 years after childbearing). To examine short-term health outcomes, we estimate individual fixed-effects models: we hold constant factors that could influence parents' birth spacing behavior and their health, comparing health outcomes after different births to the same parent. We apply sibling fixed effects in our analysis of medium- and long-term outcomes, holding constant mothers' and fathers' family backgrounds. The results from our analyses that do not apply individual or sibling fixed effects are consistent with much of the previous literature: shorter and longer birth intervals are associated with worse health outcomes than birth intervals of approximately 2-3 years. Estimates from individual fixed-effects models suggest that particularly short intervals have a modest negative effect on maternal mental health in the short term, with more ambiguous evidence that particularly short or long intervals might modestly influence short-, medium-, and long-term physical health outcomes. Overall, these results are consistent with small to negligible effects of birth spacing behavior on (non-pregnancy-related) parental health outcomes.
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Affiliation(s)
- Kieron Barclay
- Department of Sociology, Stockholm University, Stockholm, Sweden; Swedish Collegium for Advanced Study, Uppsala, Sweden; Max Planck Institute for Demographic Research, Rostock, Germany
| | - Martin Kolk
- Department of Sociology and Centre for Cultural Evolution, Stockholm University, Stockholm, Sweden; Institute for Futures Studies, Stockholm, Sweden
| | - Øystein Kravdal
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway; Department of Economics, Oslo University, Oslo, Norway
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Preston M, Hall M, Shennan A, Story L. The role of placental insufficiency in spontaneous preterm birth: A literature review. Eur J Obstet Gynecol Reprod Biol 2024; 295:136-142. [PMID: 38359634 DOI: 10.1016/j.ejogrb.2024.02.020] [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: 10/18/2023] [Revised: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 02/17/2024]
Abstract
Preterm Birth (delivery before 37 weeks of gestation) is the leading cause of childhood mortality and is also associated with significant morbidity both in the neonatal period and beyond. The aetiology of spontaneous preterm birth is unclear and likely multifactorial incorporating factors such as infection/inflammation and cervical injury. Placental insufficiency is emerging as an additional contributor to spontaneous preterm delivery; however, the mechanisms by which this occurs are not fully understood. Serum biomarkers and imaging techniques have been investigated as potential predictors of placental insufficiency, however none have yet been found to have a sufficient predictive value. This review examines the evidence for the role of the placenta in preterm birth, preterm prelabour rupture of the membranes and abruption as well as highlighting areas where further research is required.
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Affiliation(s)
- Megan Preston
- Department of Women and Children's Health, St Thomas' Hospital, King's College, London, UK
| | - Megan Hall
- Department of Women and Children's Health, St Thomas' Hospital, King's College, London, UK; Department of Perinatal Imaging, St Thomas' Hospital, King's College, London, UK
| | - Andrew Shennan
- Department of Women and Children's Health, St Thomas' Hospital, King's College, London, UK
| | - Lisa Story
- Department of Women and Children's Health, St Thomas' Hospital, King's College, London, UK; Department of Perinatal Imaging, St Thomas' Hospital, King's College, London, UK.
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3
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Peris M, Crompton K, Shepherd DA, Amor DJ. The association between human chorionic gonadotropin and adverse pregnancy outcomes: a systematic review and meta-analysis. Am J Obstet Gynecol 2024; 230:118-184. [PMID: 37572838 DOI: 10.1016/j.ajog.2023.08.007] [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: 05/10/2023] [Revised: 07/28/2023] [Accepted: 08/02/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVE This study aimed to evaluate the association between human chorionic gonadotropin and adverse pregnancy outcomes. DATA SOURCES Medline, Embase, PubMed, and Cochrane were searched in November 2021 using Medical Subject Headings (MeSH) and relevant key words. STUDY ELIGIBILITY CRITERIA This analysis included published full-text studies of pregnant women with serum human chorionic gonadotropin testing between 8 and 28 weeks of gestation, investigating fetal outcomes (fetal death in utero, small for gestational age, preterm birth) or maternal factors (hypertension in pregnancy: preeclampsia, pregnancy-induced hypertension, placental abruption, HELLP syndrome, gestational diabetes mellitus). METHODS Studies were extracted using REDCap software. The Newcastle-Ottawa scale was used to assess for risk of bias. Final meta-analyses underwent further quality assessment using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) method. RESULTS A total of 185 studies were included in the final review, including the outcomes of fetal death in utero (45), small for gestational age (79), preterm delivery (62), hypertension in pregnancy (107), gestational diabetes mellitus (29), placental abruption (17), and HELLP syndrome (2). Data were analyzed separately on the basis of categorical measurement of human chorionic gonadotropin and human chorionic gonadotropin measured on a continuous scale. Eligible studies underwent meta-analysis to generate a pooled odds ratio (categorical human chorionic gonadotropin level) or difference in medians (human chorionic gonadotropin continuous scale) between outcome groups. First-trimester low human chorionic gonadotropin levels were associated with preeclampsia and fetal death in utero, whereas high human chorionic gonadotropin levels were associated with preeclampsia. Second-trimester high human chorionic gonadotropin levels were associated with fetal death in utero and preeclampsia. CONCLUSION Human chorionic gonadotropin levels are associated with placenta-mediated adverse pregnancy outcomes. Both high and low human chorionic gonadotropin levels in the first trimester of pregnancy can be early warning signs of adverse outcomes. Further analysis of human chorionic gonadotropin subtypes and pregnancy outcomes is required to determine the diagnostic utility of these findings in reference to specific cutoff values.
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Affiliation(s)
- Monique Peris
- Neurodisability and Rehabilitation Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Australia
| | - Kylie Crompton
- Neurodisability and Rehabilitation Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Australia
| | - Daisy A Shepherd
- Neurodisability and Rehabilitation Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - David J Amor
- Neurodisability and Rehabilitation Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Australia.
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Keller JM, Norton JA, Zhang F, Paul R, Madden T, Raghuraman N, Stout MJ, Carter EB. The Impact of Group Prenatal Care on Interpregnancy Interval. Am J Perinatol 2023; 40:1659-1664. [PMID: 34891199 DOI: 10.1055/s-0041-1739413] [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] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate whether participation in CenteringPregnancy group prenatal care is associated with decreased risk of an interpregnancy interval (IPI) ≤6 months. STUDY DESIGN We conducted a retrospective cohort study of women enrolled in Missouri Medicaid from 2007 to 2014 using maternal Medicaid data linked to infant birth certificate records. Inclusion criteria were women ≥11 years old, ≥1 viable singleton delivery during the study period, residency in St. Louis city or county, and ≥2 prenatal visits. The primary outcome was an IPI ≤6 months. Secondary outcomes included IPI ≤12 months, IPI ≤18 months, postpartum long-acting reversible contraception (LARC) uptake, and postpartum LARC or depot medroxyprogesterone acetate (DMPA) uptake. Data were analyzed using descriptive statistics and logistic regression. Backward stepwise logistic regression was used to adjust for potential confounders including maternal age, race, obesity, nulliparity, marital status, diabetes, hypertension, prior preterm birth, and maternal education. RESULTS Of the 54,968 pregnancies meeting inclusion criteria, 1,550 (3%) participated in CenteringPregnancy. CenteringPregnancy participants were less likely to have an IPI ≤6 months (adjusted odds ratio [aOR]: 0.61; 95% confidence interval [CI]: 0.47-0.79) and an IPI ≤12 months (aOR: 0.74; 95% CI: 0.62-0.87). However, there was no difference for an IPI ≤18 months (aOR: 0.89; 95% CI: 0.77-1.13). Women in CenteringPregnancy were more likely to use LARC for postpartum contraception (aOR: 1.37; 95% CI: 1.20-1.57). CONCLUSION Participation in CenteringPregnancy is associated with a significant decrease in an IPI ≤6 and ≤12 months and a significant increase in postpartum LARC uptake among women enrolled in Missouri Medicaid compared with women in traditional prenatal care. KEY POINTS · CenteringPregnancy is associated with a significant decrease in interpregnancy intervals ≤6 and ≤12 months.. · LARC uptake is significantly higher among patients participating in CenteringPregnancy.. · CenteringPregnancy participation enhances self-efficacy in making contraception decisions and promotes healthy pregnancy spacing..
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Affiliation(s)
- Justine M Keller
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | | | - Fan Zhang
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Rachel Paul
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Tessa Madden
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Nandini Raghuraman
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Molly J Stout
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ebony B Carter
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
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Weiss A, Sela HY, Grisaru-Granovsky S, Rottenstreich M. Short Interpregnancy Interval Following a Multifetal Pregnancy: Maternal and Neonatal Outcomes. J Clin Med 2023; 12:jcm12072576. [PMID: 37048660 PMCID: PMC10094927 DOI: 10.3390/jcm12072576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
Objective: To evaluate the maternal and neonatal outcomes of women with short interpregnancy intervals (IPI < 6 months) following a multifetal pregnancy. Study design: A multicenter retrospective cohort study of women with an index multifetal delivery and a subsequent singleton gestation between 2005 and 2021. The obstetrical outcomes of pregnancies following short IPI (<6 months) were compared to those with an IPI of 18–48 months. Additional analyses were also conducted for the other IPI groups: 7–17 months, and longer than 49 months, while women with an IPI of 18–48 months served as the reference group. The primary outcome was preterm birth (<37 weeks) rate. Secondary outcomes were other adverse maternal and neonatal outcomes. Univariate and multiple logistic regression analyses were performed. Results: Overall, 2514 women had a primary multifetal delivery with a subsequent singleton gestation at our medical centers; 160 (6.4%) had a short IPI, and 1142 (45.4%) had an optimal IPI. Women with a singleton gestation following a short IPI were younger, with lower rates of previous cesarean and fertility treatments. Women in the short IPI group had significantly higher rates of preterm birth <37 weeks, anemia (Hb < 11 gr%) on admission to the delivery room, and placental abruption. Multivariable logistic regression analysis demonstrated that short IPI is associated with an increased risk for preterm birth (aOR 2.39, 95% CI 1.12–5.11, p = 0.03). Conclusion: Short IPI following a multifetal gestation is associated with an increased risk for preterm birth in subsequent singleton pregnancy.
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Affiliation(s)
- Ari Weiss
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91031, Israel
| | - Hen Y. Sela
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91031, Israel
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91031, Israel
| | - Misgav Rottenstreich
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91031, Israel
- Department of Nursing, Jerusalem College of Technology, Jerusalem 9116001, Israel
- Correspondence: ; Tel.: +972-2-655-5562; Fax: +972-2-666-6053
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Reproductive Justice for the Deaf Community. Obstet Gynecol 2022; 140:560-564. [PMID: 36075071 PMCID: PMC9484760 DOI: 10.1097/aog.0000000000004944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/14/2022] [Indexed: 01/05/2023]
Abstract
Almost half of all pregnancies each year in the United States are mistimed or unwanted and associated with adverse health outcomes. Deaf women are as likely to be pregnant as their hearing counterparts but are 67% more likely to experience unintended pregnancy. Although there are limited data on the sexual health behaviors of deaf individuals, research has shown that deaf people are more likely than the general population to rely on withdrawal and condoms to prevent pregnancy. Further, health resources and communication with physicians are often not fully accessible, with the former often in spoken or written English and the latter when sign language interpreters are not present. The combination of use of less--effective methods of contraception and inaccessible health resources puts deaf women at heightened risk for unintended pregnancy. Deaf women are denied reproductive justice when they are inadequately equipped to practice bodily autonomy and prevent unintended pregnancies. In this commentary, I present literature to illustrate the disparity deaf women face compared with hearing women and to make the case for the association among unintended pregnancy, its adverse effects, and reproductive injustice for deaf women. As a medically trained deaf woman conducting reproductive health research, I leverage my lived experience and accrued knowledge to elucidate the shortcomings and strategies to use. As public health researchers and health care professionals, we can alleviate this injustice with inclusive research methodology, representation on research and health care teams, and ensuring access to health information with time given and accommodations provided.
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Linde LE, Ebbing C, Moster D, Kessler J, Baghestan E, Gissler M, Rasmussen S. Recurrence of postpartum hemorrhage, maternal and paternal contribution, and the effect of offspring birthweight and sex: a population-based cohort study. Arch Gynecol Obstet 2022; 306:1807-1814. [PMID: 34999924 PMCID: PMC9519656 DOI: 10.1007/s00404-021-06374-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 12/20/2021] [Indexed: 12/17/2022]
Abstract
Purpose This study examines individual aggregation of postpartum hemorrhage (PPH), paternal contribution and how offspring birthweight and sex influence recurrence of PPH. Further, we wanted to estimate the proportion of PPH cases attributable to a history of PPH or current birthweight. Methods We studied all singleton births in Norway from 1967 to 2017 using data from Norwegian medical and administrational registries. Subsequent births in the parents were linked. Multilevel logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CI) for PPH defined as blood loss > 500 ml, blood loss > 1500 ml, or the need for blood transfusion in parous women. Main exposures were previous PPH, high birthweight, and fetal sex. We calculated adjusted population attributable fractions for previous PPH and current high birthweight. Results Mothers with a history of PPH had three- and sixfold higher risks of PPH in their second and third deliveries, respectively (adjusted OR 2.9; 95% CI 2.9–3.0 and 6.0; 5.5–6.6). Severe PPH (> 1500 ml) had the highest risk of recurrence. The paternal contribution to recurrence of PPH in deliveries with two different mothers was weak, but significant. If the neonate was male, the risk of PPH was reduced. A history of PPH or birthweight ≥ 4000 g each accounted for 15% of the total number of PPH cases. Conclusion A history of PPH and current birthweight exerted strong effects at both the individual and population levels. Recurrence risk was highest for severe PPH. Occurrence and recurrence were lower in male fetuses, and the paternal influence was weak. Supplementary Information The online version contains supplementary material available at 10.1007/s00404-021-06374-3.
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Affiliation(s)
| | - Cathrine Ebbing
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
| | - Dag Moster
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Jörg Kessler
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
| | - Elham Baghestan
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
| | - Mika Gissler
- Department of Information Services, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Svein Rasmussen
- Department of Clinical Science, University of Bergen, Bergen, Norway
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Weiss A, Sela HY, Rotem R, Grisaru-Granovsky S, Rottenstreich M. Recurrent short interpregnancy interval: Maternal and neonatal outcomes. Eur J Obstet Gynecol Reprod Biol 2021; 264:299-305. [PMID: 34358877 DOI: 10.1016/j.ejogrb.2021.07.040] [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: 06/03/2021] [Revised: 07/18/2021] [Accepted: 07/23/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate maternal and neonatal outcomes associated with recurrent short interpregnancy interval (IPI) in women in their third delivery. METHODS A retrospective computerized database study of all women who delivered their first three consecutive deliveries in a single tertiary medical center over 20 years (1999-2019). Maternal and neonatal outcomes of women with recurrent short IPI (<6 months between the 1st and 2nd pregnancy and the 2nd and 3rd pregnancy) were compared to women with recurrent optimal IPI (18-48 months), and to women with a single short IPI (<6 months between the 1st and 2nd pregnancy followed by an optimal IPI of 18-48 months between the 2nd and 3rd pregnancy). Additionally, in the recurrent short IPI groups, outcomes of the 2nd and 3rd pregnancies were compared in order to achieve an ideal adjustment to background characteristics. Univariate analysis was followed by multiple logistic regression models; adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. RESULTS During the study period 10,569 women had three consecutive deliveries at our medical center, of those 338 (3.2%) women had recurrent short IPIs, and 1,021 (9.7%) had recurrent optimal IPIs. Recurrent short IPI was associated with a significantly higher risk of maternal anemia (Hb < 10gr%) on admission to labor (aOR 3.4 [95% CI 1.09-10.65], p = 0.04) and higher risk of small for gestational age neonates (aOR 10.4 [95% CI 2.32-46.93], p < 0.01), as compared with women with recurrent optimal IPI and significantly higher rates of low neonatal birth weights (2500 gr) and anemia (Hb < 10gr%) alongside lower rates of operative vaginal deliveries as compared with women with single short IPI followed by an optimal IPI. In the recurrent short IPI groups, the 3rd deliveries had significantly higher rates of in-labor cesarean and anemia (Hb < 10gr%) on admission as compared to their 2nd deliveries. CONCLUSION Recurrent short IPI is associated with maternal anemia and small for gestational age neonates. Guiding patients towards prolongation of the IPI should include explanatory comments on these outcomes.
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Affiliation(s)
- Ari Weiss
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Hen Y Sela
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Reut Rotem
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Misgav Rottenstreich
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel; Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel.
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Easily generated hematological biomarkers and prediction of placental abruption. J Gynecol Obstet Hum Reprod 2021; 50:102082. [PMID: 33545414 DOI: 10.1016/j.jogoh.2021.102082] [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: 11/25/2020] [Revised: 01/19/2021] [Accepted: 01/27/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Placental abruption (PA) is associated with adverse maternal and neonatal outcomes. Increasing evidence has shown an association between abruption and inflammation as well as utilization of hematological biomarkers to predict the later. We aimed to evaluate the feasibility of using neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ration (PLR) taken early in pregnancy in predicting later occurrence of PA. STUDY DESIGN A nested case control study, which compared parturient with PA (cases) to parturient without PA (controls). Parturient were matched by hospitalization date and maternal age. Demographic, clinical, and obstetrical characteristics were retrieved. Hematological indices derived from complete blood count taken during the first trimester of pregnancy, specifically NLR and PLR were retrieved and compared between the groups. Mann-Whitney and T-test were performed for not normally and normally distributed continuous variables respectively, categorical variables were analyzed using Chi-Square or Fisher Exact test as appropriate. RESULTS The study comprised of 232 patients. Of these, 131 had suffered from PA and 131 without PA. Parturient who had PA has significantly higher rates of hypertensive disorders of pregnancy, mean neutrophil, lymphocyte and platelet count did not differ between the groups. A comparison of NLR and PLR between the study groups yielded no significant differences. CONCLUSION NLR and PLR taken early in the course of pregnancy were not found associated with PA. Given the potentially severe consequences of PA, the biological plausibility and the readiness of these hematological markers, further investigation of this method with larger, prospective studies are needed.
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Lentz EJM, Park AL, Langlois AWR, Huang T, Meschino WS, Ray JG. Risk of Severe Maternal Morbidity or Death in Relation to Prenatal Biochemical Screening: Population-Based Cohort Study. Am J Perinatol 2021; 38:44-59. [PMID: 31412403 DOI: 10.1055/s-0039-1694731] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study aimed to examine whether prenatal biochemical screening analytes are associated with an increased risk of severe maternal morbidity (SMM) or maternal mortality. STUDY DESIGN This population-based cohort study includes all women in Ontario, Canada, who underwent prenatal screening from 2001 to 2011. Increasing fifth percentiles of the multiple of the median (MoM) for alphafetoprotein (AFP), total human chorionic gonadotropin, unconjugated estriol (uE3), dimeric inhibin-A (DIA), and pregnancy-associated plasma protein A were evaluated. An abnormally high concentration (>95th percentile MoM) for each analyte, individually and combined, was also evaluated. The main outcome assessed was the adjusted relative risk (aRR) of SMM or maternal mortality from 20 weeks' gestation up to 26 weeks thereafter. RESULTS Among 748,972 pregnancies, 11,177 resulted in SMM or maternal mortality (1.5%). Except for uE3, the aRR of SMM or maternal mortality increased in association with increasing fifth percentiles of the MoM for all analytes. AFP (aRR: 2.10; 95% confidence interval [CI]: 1.97-2.25) and DIA (aRR: 2.33; 95% CI: 1.98-2.74) > 95th versus ≤ 5th percentile of the MoM were especially associated with SMM or death. CONCLUSION Women with abnormally high concentrations of certain prenatal biochemical analytes may be at a higher risk of SMM or death in pregnancy or postpartum.
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Affiliation(s)
- Eric J M Lentz
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Alison L Park
- Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Alec W R Langlois
- Faculty of Arts and Science, Queen's University, Kingston, Ontario, Canada
| | - Tianhua Huang
- Genetics Program, North York General Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Wendy S Meschino
- Genetics Program, North York General Hospital, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Joel G Ray
- Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Health Policy Management and Evaluation, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,Department of Obstetrics and Gynaecology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Yeaton-Massey A, Baer RJ, Rand L, Jelliffe-Pawlowski LL, Lyell DJ. Adverse Pregnancy Outcomes by Degree of Maternal Serum Analyte Elevation: A Retrospective Cohort Study. AJP Rep 2020; 10:e369-e379. [PMID: 33240563 PMCID: PMC7681250 DOI: 10.1055/s-0040-1716741] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/04/2020] [Indexed: 11/04/2022] Open
Abstract
Objective The aim of this study was to evaluate rates of preterm birth (PTB) and obstetric complication with maternal serum analytes > 2.5 multiples of the median (MoM) by degree of elevation. Study Design Retrospective cohort study of singleton live-births participating in the California Prenatal Screening Program (2005-2011) examining PTB and obstetric complication for α-fetoprotein (AFP), human chorionic gonadotropin (hCG), unconjugated estriol (uE3), and inhibin A (INH) by analyte subgroup (2.5 to < 6.0, 6.0 to < 10.0, and ≥ 10.0 MoM vs. < 2.5 MoM). Results The risk of obstetric complication increased with increasing hCG, AFP, and INH MoM, and were greatest for AFP and INH of 6.0 to <10.0 MoM. The greatest risk of any adverse outcome was seen for hCG MoM ≥ 10.0, with relative risk (RR) of PTB < 34 weeks of 40.8 (95% confidence interval [CI]: 21.7-77.0) and 13.8 (95% CI: 8.2-23.1) for obstetric complication. Conclusions In euploid, structurally normal fetuses, all analyte elevations > 2.5 MoM confer an increased risk of PTB and, except for uE3, obstetric complication, and risks for each are not uniformly linear. These data can help guide patient counseling and antenatal management.
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Affiliation(s)
- Amanda Yeaton-Massey
- Department of Obstetrics and Gynecology, Stanford University, Stanford, California
| | - Rebecca J. Baer
- Department of Pediatrics, University of California San Diego, La Jolla, California
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, California
| | - Larry Rand
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, California
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California
| | - Laura L. Jelliffe-Pawlowski
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, California
| | - Deirdre J. Lyell
- Department of Obstetrics and Gynecology, Stanford University, Stanford, California
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Gabbay-Benziv R, Ashwal E, Hadar E, Aviram A, Yogev Y, Melamed N, Hiersch L. Interpregnancy interval and the risk for recurrence of placental mediated pregnancy complications. J Perinat Med 2020; 48:322-328. [PMID: 32492998 DOI: 10.1515/jpm-2019-0471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/18/2020] [Indexed: 11/15/2022]
Abstract
Objective The aim of this study was to investigate the effect of short or long interpregnancy interval (IPI) with placental mediated pregnancy complications after already complicated first delivery. Methods We performed a retrospective cohort analysis of all women with singleton pregnancies who delivered their first three consecutive deliveries in one university-affiliated medical center (1994-2013). Placental mediated complications included placental abruption, small for gestational age, preeclampsia, gestational hypertension, or preterm delivery. Following first complicated delivery, IPI was compared stratified by second delivery outcome. Following two complicated deliveries, IPI was compared stratified by third delivery outcome. IPI was evaluated as continuous or categorical variable (>18, 18-60, >60 months). Related samples Cochrans' Q test and Mann-Whitney analysis were used as appropriate. Results Overall, 4310 women entered analysis. Of them, 18.3%, 10.5%, and 9.3% had complicated first, second, and third delivery, consecutively. Evaluated continuously, longer IPI, but not short IPI, was associated with higher rates of complicated second delivery. Stratified to categories, IPI had no effect on recurrent complications evaluated separately or as composite. Conclusion Our results suggest that long IPI may increase risk for placental mediated pregnancy complications. Further studies are needed to evaluate this effect.
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Affiliation(s)
- Rinat Gabbay-Benziv
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera 38100, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Eran Ashwal
- Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Hadar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Rabin Medical Center, Petach-Tikva, Israel
| | - Amir Aviram
- Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yariv Yogev
- Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Melamed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, and Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
| | - Liran Hiersch
- Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Adane AA, Shepherd CCJ, Lim FJ, White SW, Farrant BM, Bailey HD. The impact of pre-pregnancy body mass index and gestational weight gain on placental abruption risk: a systematic review and meta-analysis. Arch Gynecol Obstet 2019; 300:1201-1210. [PMID: 31576448 DOI: 10.1007/s00404-019-05320-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/21/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE The aim of this systematic review was to evaluate the associations between pre-pregnancy body mass index and gestational weight gain and placental abruption. METHODS Relevant studies were identified from PubMed, EMBASE, Scopus and CINAHL. Unpublished findings from analyses of linked population-based data sets from Western Australia (2012-2015, n = 114,792) were also included. Studies evaluating pre-pregnancy body mass index and/or gestational weight gain and placental abruption were included. Two independent reviewers evaluated studies for inclusion and quality. Data including odds ratios (ORs) and 95% confidence intervals (CIs) were extracted and analysed by random effects meta-analysis. RESULTS 21 studies were included, of which 15 were eligible for meta-analyses. The summary ORs for the association of being underweight, overweight and obese, and placental abruption, compared to normal weight women, were 1.4 (95% CI 1.1, 1.7), 0.8 (95% CI 0.8, 0.9) and 0.8 (95% CI 0.7, 0.9), respectively. These findings remained unchanged when each study was eliminated from the analysis and in subgroup analyses. Although data were scarce, women with gestational weight gain below the Institute of Medicine recommendations appeared to be at greater risk of abruption compared with women who had optimal weight gain. CONCLUSIONS Mothers that are underweight prior to or in early pregnancy are at a moderately increased risk of placental abruption.
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Affiliation(s)
- Akilew A Adane
- Telethon Kids Institute, The University of Western Australia, P.O. Box 855, West Perth, WA, 6872, Australia.
| | - Carrington C J Shepherd
- Telethon Kids Institute, The University of Western Australia, P.O. Box 855, West Perth, WA, 6872, Australia.,Ngangk Yira Aboriginal Health and Social Equity Research Centre, Murdoch University, 90 South Street, Murdoch, WA, 6150, Australia
| | - Faye J Lim
- Telethon Kids Institute, The University of Western Australia, P.O. Box 855, West Perth, WA, 6872, Australia
| | - Scott W White
- Division of Obstetrics and Gynaecology (M550), The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.,Department of Maternal Fetal Medicine, King Edward Memorial Hospital, 374 Bagot Road, Subiaco, WA, 6008, Australia
| | - Brad M Farrant
- Telethon Kids Institute, The University of Western Australia, P.O. Box 855, West Perth, WA, 6872, Australia
| | - Helen D Bailey
- Telethon Kids Institute, The University of Western Australia, P.O. Box 855, West Perth, WA, 6872, Australia
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Chin TH, Hsu YC, Soong YK, Lee CL, Wang HS, Huang HY, Wu HM, Yu HT, Huang SY, Chang CL. Obstetric and perinatal outcomes of pregnancy in patients with repeated implantation failure. Taiwan J Obstet Gynecol 2019; 58:487-491. [DOI: 10.1016/j.tjog.2019.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2019] [Indexed: 01/08/2023] Open
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15
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Ahrens KA, Hutcheon JA, Ananth CV, Basso O, Briss PA, Ferré CD, Frederiksen BN, Harper S, Hernández‐Díaz S, Hirai AH, Kirby RS, Klebanoff MA, Lindberg L, Mumford SL, Nelson HD, Platt RW, Rossen LM, Stuebe AM, Thoma ME, Vladutiu CJ, Moskosky S. Report of the Office of Population Affairs' expert work group meeting on short birth spacing and adverse pregnancy outcomes: Methodological quality of existing studies and future directions for research. Paediatr Perinat Epidemiol 2019; 33:O5-O14. [PMID: 30300948 PMCID: PMC6378402 DOI: 10.1111/ppe.12504] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/09/2018] [Accepted: 08/12/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND The World Health Organization (WHO) recommends that women wait at least 24 months after a livebirth before attempting a subsequent pregnancy to reduce the risk of adverse maternal, perinatal, and infant health outcomes. However, the applicability of the WHO recommendations for women in the United States is unclear, as breast feeding, nutrition, maternal age at first birth, and total fertility rate differs substantially between the United States and the low- and middle-resource countries upon which most of the evidence is based. METHODS To inform guideline development for birth spacing specific to women in the United States, the Office of Population Affairs (OPA) convened an expert work group meeting in Washington, DC, on 14-15 September 2017 among reproductive, perinatal, paediatric, social, and public health epidemiologists; obstetrician-gynaecologists; biostatisticians; and experts in evidence synthesis related to women's health. RESULTS Presentations and discussion topics included the methodological quality of existing studies, evaluation of the evidence for causal effects of short interpregnancy intervals on adverse perinatal and maternal health outcomes, good practices for future research, and identification of research gaps and priorities for future work. CONCLUSIONS This report provides an overview of the presentations, discussions, and conclusions from the expert work group meeting.
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Affiliation(s)
- Katherine A. Ahrens
- Office of Population AffairsOffice of the Assistant Secretary for HealthRockvilleMaryland
| | - Jennifer A. Hutcheon
- Department of Obstetrics and GynaecologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Cande V. Ananth
- Department of Obstetrics and GynecologyVagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNew York,Department of EpidemiologyJoseph L. Mailman School of Public HealthColumbia UniversityNew YorkNew York
| | - Olga Basso
- Department of Obstetrics and GynecologyRoyal Victoria HospitalResearch Institute of McGill University Health CentreMontrealQuebecCanada,Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontrealQuebecCanada
| | - Peter A. Briss
- National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and PreventionAtlantaGeorgia
| | - Cynthia D. Ferré
- Maternal and Infant Health BranchDivision of Reproductive HealthNational Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGeorgia
| | - Brittni N. Frederiksen
- Office of Population AffairsOffice of the Assistant Secretary for HealthRockvilleMaryland
| | - Sam Harper
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontrealQuebecCanada
| | - Sonia Hernández‐Díaz
- Department of EpidemiologyHarvard T. H. Chan School of Public HealthBostonMassachusetts
| | - Ashley H. Hirai
- US Department of Health and Human ServicesHealth Resources and Services Administration, Maternal and Child Health BureauOffice of Epidemiology and ResearchRockvilleMaryland
| | - Russell S. Kirby
- Department of Community and Family HealthUniversity of South Florida College of Public HealthTampaFlorida
| | - Mark A. Klebanoff
- Center for Perinatal ResearchDepartments of Pediatrics and Obstetrics and Gynecology and Division of EpidemiologyThe Research Institute at Nationwide Children's HospitalThe Ohio State UniversityColumbusOhio
| | | | - Sunni L. Mumford
- Division of Intramural Population Health Research, Epidemiology BranchNational Institute of Child Health and Human DevelopmentBethesdaMaryland
| | - Heidi D. Nelson
- Department of Medical Informatics and Clinical EpidemiologyOregon Health & Science UniversityPortlandOregon
| | - Robert W. Platt
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontrealQuebecCanada
| | - Lauren M. Rossen
- Reproductive Statistics BranchDivision of Vital StatisticsNational Center for Health StatisticsCenters for Disease Control and PreventionHyattsvilleMaryland
| | - Alison M. Stuebe
- Department of Obstetrics and GynecologyDepartment of Maternal and Child HealthGillings School of Global Public HealthUniversity of North Carolina School of MedicineChapel HillNorth Carolina
| | - Marie E. Thoma
- Department of Family ScienceUniversity of MarylandCollege ParkMaryland
| | - Catherine J. Vladutiu
- US Department of Health and Human ServicesHealth Resources and Services Administration, Maternal and Child Health BureauOffice of Epidemiology and ResearchRockvilleMaryland
| | - Susan Moskosky
- Office of Population AffairsOffice of the Assistant Secretary for HealthRockvilleMaryland
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Hutcheon JA, Nelson HD, Stidd R, Moskosky S, Ahrens KA. Short interpregnancy intervals and adverse maternal outcomes in high-resource settings: An updated systematic review. Paediatr Perinat Epidemiol 2019; 33:O48-O59. [PMID: 30311955 PMCID: PMC7380038 DOI: 10.1111/ppe.12518] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/16/2018] [Accepted: 07/29/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Currently, no federal guidelines provide recommendations on healthy birth spacing for women in the United States. This systematic review summarises associations between short interpregnancy intervals and adverse maternal outcomes to inform the development of birth spacing recommendations for the United States. METHODS PubMed/Medline, POPLINE, EMBASE, CINAHL, the Cochrane Database of Systematic Reviews, and a previous systematic review were searched to identify relevant articles published from 1 January 2006 and 1 May 2017. Included studies reported maternal health outcomes following a short versus longer interpregnancy interval, were conducted in high-resource settings, and adjusted estimates for at least maternal age. Two investigators independently assessed study quality and applicability using established methods. RESULTS Seven cohort studies met inclusion criteria. There was limited but consistent evidence that short interpregnancy interval is associated with increased risk of precipitous labour and decreased risks of labour dystocia. There was some evidence that short interpregnancy interval is associated with increased risks of subsequent pre-pregnancy obesity and gestational diabetes, and decreased risk of preeclampsia. Among women with a previous caesarean delivery, short interpregnancy interval was associated with increased risk of uterine rupture in one study. No studies reported outcomes related to maternal depression, interpregnancy weight gain, maternal anaemia, or maternal mortality. CONCLUSIONS In studies from high-resource settings, short interpregnancy intervals are associated with both increased and decreased risks of adverse maternal outcomes. However, most outcomes were evaluated in single studies, and the strength of evidence supporting associations is low.
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Affiliation(s)
- Jennifer A. Hutcheon
- Department of Obstetrics and GynaecologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Heidi D. Nelson
- Department of Medical Informatics and Clinical EpidemiologyOregon Health & Science UniversityPortlandOregon
| | - Reva Stidd
- Atlas ResearchWashingtonDistrict of Columbia
| | - Susan Moskosky
- US Department of Health and Human ServicesOffice of Population Affairs, Office of the Assistant Secretary for HealthRockvilleMaryland
| | - Katherine A. Ahrens
- US Department of Health and Human ServicesOffice of Population Affairs, Office of the Assistant Secretary for HealthRockvilleMaryland
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17
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Baer RJ, McLemore MR, Adler N, Oltman SP, Chambers BD, Kuppermann M, Pantell MS, Rogers EE, Ryckman KK, Sirota M, Rand L, Jelliffe-Pawlowski LL. Pre-pregnancy or first-trimester risk scoring to identify women at high risk of preterm birth. Eur J Obstet Gynecol Reprod Biol 2018; 231:235-240. [PMID: 30439652 DOI: 10.1016/j.ejogrb.2018.11.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 11/04/2018] [Indexed: 11/16/2022]
Abstract
Objective To develop a pre-pregnancy or first-trimester risk score to identify women at high risk of preterm birth. Study design In this retrospective cohort analysis, the sample was drawn from California singleton livebirths from 2007 to 2012 with linked birth certificate and hospital discharge records. The dataset was divided into a training (2/3 of sample) and a testing (1/3 of sample) set for discovery and validation. Predictive models for preterm birth using pre-pregnancy or first-trimester maternal factors were developed using backward stepwise logistic regression on a training dataset. A risk score for preterm birth was created for each pregnancy using beta-coefficients for each maternal factor remaining in the final multivariable model. Risk score utility was replicated in a testing dataset and by race/ethnicity and payer for prenatal care. Results The sample included 2,339,696 pregnancies divided into training and testing datasets. Twenty-three maternal risk factors were identified including several that were associated with a two or more increased odds of preterm birth (preexisting diabetes, preexisting hypertension, sickle cell anemia, and previous preterm birth). Approximately 40% of women with a risk score ≥ 3.0 in the training and testing samples delivered preterm (40.6% and 40.8%, respectively) compared to 3.1-3.3% of women with a risk score of 0.0 [odds ratio (OR) 13.0, 95% confidence interval (CI) 10.7-15.8, training; OR 12.2, 95% CI 9.4-15.9, testing). Additionally, over 18% of women with a risk score ≥ 3.0 had an adverse outcome other than preterm birth. Conclusion Maternal factors that are identifiable prior to pregnancy or during the first-trimester can be used create a cumulative risk score to identify women at the lowest and highest risk for preterm birth regardless of race/ethnicity or socioeconomic status. Further, we found that this cumulative risk score could also identify women at risk for other adverse outcomes who did not have a preterm birth. The risk score is not an effective screening test, but does identify women at very high risk of a preterm birth.
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Affiliation(s)
- Rebecca J Baer
- Department of Pediatrics, University of California San Diego, La Jolla, CA, United States; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, United States.
| | - Monica R McLemore
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, United States; Department of Family Health Care Nursing, University of California San Francisco School of Nursing, San Francisco, CA, United States
| | - Nancy Adler
- Departments of Psychiatry and Pediatrics, Center for Health and Community, University of California San Francisco School of Medicine, San Francisco, CA, United States
| | - Scott P Oltman
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, United States; Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, CA, United States
| | - Brittany D Chambers
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, United States; Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, CA, United States
| | - Miriam Kuppermann
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, United States; Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, CA, United States; Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, San Francisco, CA, United States
| | - Matthew S Pantell
- Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, CA, United States
| | - Elizabeth E Rogers
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, United States; Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, CA, United States
| | - Kelli K Ryckman
- Departments of Epidemiology and Pediatrics, University of Iowa College of Public Health and Carver College of Medicine, Iowa City, IA, United States
| | - Marina Sirota
- Institute for Computational Health Sciences University of California San Francisco, San Francisco, CA, United States
| | - Larry Rand
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, United States; Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, San Francisco, CA, United States
| | - Laura L Jelliffe-Pawlowski
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, United States; Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, CA, United States
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18
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First-Trimester and Second-Trimester Maternal Serum Biomarkers as Predictors of Placental Abruption. Obstet Gynecol 2017; 129:465-472. [PMID: 28178056 DOI: 10.1097/aog.0000000000001889] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We hypothesized that the origins of abruption may extend to the stages of placental implantation; however, there are no reliable markers to predict its development. Based on this hypothesis, we sought to evaluate whether first-trimester and second-trimester serum analytes predict placental abruption. METHODS We performed a secondary analysis of data of 35,307 women (250 abruption cases) enrolled in the First and Second Trimester Evaluation of Risk cohort (1999-2003), a multicenter, prospective cohort study. Percentiles (based on multiples of the median) of first-trimester (pregnancy-associated plasma protein A and total and free β-hCG) and second-trimester (maternal serum alpha-fetoprotein, unconjugated estriol, and inhibin-A) serum analytes were examined in relation to abruption. Associations are based on risk ratio (RR) and 95% confidence interval (CI). RESULTS Women with an abnormally low pregnancy-associated plasma protein A (fifth percentile or less) were at increased risk of abruption compared with those without abruption (9.6% compared with 5.3%; RR 1.9, 95% CI, 1.2-2.8). Maternal serum alpha-fetoprotein 95th percentile or greater was more common among abruption (9.6%) than nonabruption (5.1%) pregnancies (RR 1.9, 95% CI 1.3-3.0). Inhibin-A fifth percentile or less (8.0% compared with 5.1%; RR 1.8, 95% CI 1.1-2.9), and 95th percentile or greater (9.6% compared with 5.0%; RR 2.0, 95% CI 1.3-3.1) were associated with abruption. Women with all three abnormal pregnancy-associated plasma protein A, maternal serum alpha-fetoprotein, and inhibin-A analytes were at 8.8-fold (95% CI 2.3-34.3) risk of abruption. No associations were seen with other analytes. CONCLUSION These data provide support for our hypothesis that the origins of placental abruption may extend to the early stages of pregnancy.
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Gomes MS, Carlos-Alves M, Trocado V, Arteiro D, Pinheiro P. Prediction of adverse pregnancy outcomes by extreme values of first trimester screening markers. Obstet Med 2017; 10:132-137. [PMID: 29051781 DOI: 10.1177/1753495x17704799] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 03/18/2017] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND To determine the association between extreme values of first trimester markers and adverse pregnancy outcomes. METHODS A retrospective cohort study of 916 women who underwent first-trimester combined screening during 2015 was performed. Extreme values of NT, pregnancy-associated plasma protein-A (PAPP-A) and free β-hCG, and their association with adverse pregnancy outcomes were analyzed. RESULTS Low PAPP-A (<10th percentile) was associated with an increased risk for preeclampsia (adjusted odds ratio (AOR) 4.13), fetal growth restriction (AOR 3.94) and abruptio placentae (AOR 52.63). Abnormally low or high free β-hCG, high PAPP-A or increased NT was not associated with an increased risk for adverse outcomes. DISCUSSION PAPP-A <10th percentile could be associated with an increased risk for adverse outcomes. However, the majority of patients with these events do not have abnormal PAPP-A and few patients with PAPP-A <10th percentile will have an adverse outcome.
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Affiliation(s)
- Marina S Gomes
- Department of Obstetrics and Gynecology, Alto Minho Local Healthcare Unit, Viana do Castelo, Portugal
| | - Mariana Carlos-Alves
- Department of Obstetrics and Gynecology, Alto Minho Local Healthcare Unit, Viana do Castelo, Portugal
| | - Vera Trocado
- Department of Obstetrics and Gynecology, Alto Minho Local Healthcare Unit, Viana do Castelo, Portugal.,School of Health Sciences, Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
| | - Diana Arteiro
- Department of Obstetrics and Gynecology, Alto Minho Local Healthcare Unit, Viana do Castelo, Portugal
| | - Paula Pinheiro
- Department of Obstetrics and Gynecology, Alto Minho Local Healthcare Unit, Viana do Castelo, Portugal
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Wallenstein MB, Jelliffe-Pawlowski LL, Yang W, Carmichael SL, Stevenson DK, Ryckman KK, Shaw GM. Inflammatory biomarkers and spontaneous preterm birth among obese women. J Matern Fetal Neonatal Med 2016; 29:3317-22. [PMID: 26700828 PMCID: PMC5108178 DOI: 10.3109/14767058.2015.1124083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To identify associations between second-trimester serum inflammatory biomarkers and preterm birth among obese women. METHODS In this nested case-control study, we compared 65 serum inflammatory biomarkers in obese women whose pregnancies resulted in early spontaneous preterm birth (<32 weeks gestation, n = 34) to obese women whose pregnancies resulted in term birth (n = 34). These women were selected from a larger population-based California cohort. Random forest and classification and regression tree techniques were employed to identify biomarkers of importance, and adjusted odds ratios (aORs) and 95% confidence intervals (CI) were estimated using logistic regression. RESULTS Random forest and classification and regression tree techniques found that soluble vascular endothelial growth factor receptor-3 (sVEGFR3), soluble interleukin-2 receptor alpha-chain (sIL-2RA) and soluble tumor necrosis factor receptor-1 (sTNFR1) were related to preterm birth. Using multivariable logistic regression to compare preterm cases and term controls, decreased serum levels of sVEGFR3 and increased serum levels of sIL-2RA and sTNFR1 were associated with increased risk of preterm birth among obese women, aOR = 3.2 (95% CI: 1.0-9.9), aOR = 2.8 (95% CI: 0.9-9.0), and aOR = 4.1 (95% CI: 1.2-14.1), respectively. CONCLUSIONS In this pilot study, we identified three serum biomarkers indicative of inflammation to be associated with spontaneous preterm birth among obese women: sVEGFR3, sIL-2RA and sTNFR1.
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Affiliation(s)
- Matthew B. Wallenstein
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Laura L. Jelliffe-Pawlowski
- Genetic Disease Screening Program, California Department of Public Health, Richmond, CA
- Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, CA
| | - Wei Yang
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Suzan L. Carmichael
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - David K. Stevenson
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | | | - Gary M. Shaw
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
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Umazume T, Yamada T, Morikawa M, Ishikawa S, Kojima T, Cho K, Masauzi N, Minakami H. Occult fetomaternal hemorrhage in women with pathological placenta with respect to permeability. J Obstet Gynaecol Res 2016; 42:632-9. [PMID: 26935605 DOI: 10.1111/jog.12959] [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] [Received: 11/17/2015] [Accepted: 12/27/2015] [Indexed: 11/27/2022]
Abstract
AIM Women with pre-eclampsia (PE), placenta previa (PP), placental abruption (PA), and placental mesenchymal dysplasia (PMD) have been described as having placental permeability dysfunction. This study was performed to determine whether occult fetomaternal hemorrhage (FMH) is common in women with such complications and in women with non-reassuring fetal status. METHODS Forty-one antenatal and 39 postnatal blood samples were obtained from 46 women, including 11 with placental permeability dysfunction (5, 3, 2, and 1 with PE, PP, PA, and PMD, respectively) and 35 controls without such complications. To estimate the amount of fetal red blood cells, flow cytometry was performed using the fetal cell count system with two antibodies against fetal hemoglobin and carbonic anhydrase and the β-γ system with two monoclonal antibodies against hemoglobin β-chain and hemoglobin γ-chain. A diagnosis of FMH was made when the fraction size of the isolated cell population on scatter plots expressing fetal hemoglobin alone or hemoglobin γ-chain alone accounted for ≥0.02% of the total cell population on scatter plots. RESULTS FMH was identified in five women, including one each with PE, PA, PP, PMD, and no complications. Thus, the prevalence rate of FMH was significantly higher in women with complications than in controls (36% [4/11] vs 2.9% [1/35], respectively, P = 0.009). The FMH occurrence rate did not differ between women with and without non-reassuring fetal status (7.7% [1/13] vs 12% [4/33], respectively, P = 1.000). CONCLUSION The risk of fetal red blood cells trafficking into the maternal circulation may be increased in women complicated with PE, PA, PP, and PMD.
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Affiliation(s)
- T Umazume
- Department of Perinatal Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - T Yamada
- Department of Perinatal Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - M Morikawa
- Department of Perinatal Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - S Ishikawa
- Department of Perinatal Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - T Kojima
- Department of Perinatal Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - K Cho
- Department of Perinatal Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - N Masauzi
- Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - H Minakami
- Department of Perinatal Medicine, Hokkaido University Hospital, Sapporo, Japan
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Fetal sex differences in human chorionic gonadotropin fluctuate by maternal race, age, weight and by gestational age. J Dev Orig Health Dis 2015; 6:493-500. [PMID: 26242396 DOI: 10.1017/s2040174415001336] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Circulating levels of the placental glycoprotein hormone human chorionic gonadotropin (hCG) are higher in women carrying female v. male fetuses; yet, the significance of this difference with respect to maternal factors, environmental exposures and neonatal outcomes is unknown. As a first step in evaluating the biologic and clinical significance of sex differences in hCG, we conducted a population-level analysis to assess its stability across subgroups. Subjects were women carrying singleton pregnancies who participated in prenatal and newborn screening programs in CA from 2009 to 2012 (1.1 million serum samples). hCG was measured in the first and second trimesters and fetal sex was determined from the neonatal record. Multivariate linear models were used to estimate hCG means in women carrying female and male fetuses. We report fluctuations in the ratios of female to male hCG by maternal factors and by gestational age. hCG was higher in the case of a female fetus by 11 and 8% in the first and second trimesters, respectively (P<0.0001). There were small (1-5%) fluctuations in the sex difference by maternal race, weight and age. The female-to-male ratio in hCG decreased from 17 to 2% in the first trimester, and then increased from 2 to 19% in the second trimester (P<0.0001). We demonstrate within a well enumerated, diverse US population that the sex difference in hCG overall is stable. Small fluctuations within population subgroups may be relevant to environmental and physiologic effects on the placenta and can be probed further using these types of data.
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Maternal serum markers, characteristics and morbidly adherent placenta in women with previa. J Perinatol 2015; 35:570-4. [PMID: 25927270 DOI: 10.1038/jp.2015.40] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 02/23/2015] [Accepted: 03/18/2015] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To examine associations with morbidly adherent placenta (MAP) among women with placenta previa. STUDY DESIGN Women with MAP (cases) and previa alone (controls) were identified from a cohort of 236,714 singleton pregnancies with both first and second trimester prenatal screening, and live birth and hospital discharge records; pregnancies with aneuploidies and neural tube or abdominal wall defects were excluded. Logistic binomial regression was used to compare cases with controls. RESULT In all, 37 cases with MAP and 699 controls with previa alone were included. Risk for MAP was increased among multiparous women with pregnancy-associated plasma protein-A (PAPP-A) ⩾95th percentile (⩾2.63 multiple of the median (MoM); adjusted OR (aOR) 8.7, 95% confidence interval (CI) 2.8 to 27.4), maternal-serum alpha fetoprotein (MS-AFP) ⩾95th percentile (⩾1.79 MoM; aOR 2.8, 95% CI 1.0 to 8.0), and 1 and ⩾2 prior cesarean deliveries (CDs; aORs 4.4, 95% CI 1.5 to 13.6 and 18.4, 95% CI 5.9 to 57.5, respectively). CONCLUSION Elevated PAPP-A, elevated MS-AFP and prior CDs are associated with MAP among women with previa.
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Odibo AO. Pregnancy associated-plasma protein-A (PAPP-A) and alfa-fetoprotein (AFP) associated with placental abruption. Am J Obstet Gynecol 2014; 211:89-90. [PMID: 24837457 DOI: 10.1016/j.ajog.2014.03.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 03/31/2014] [Indexed: 10/25/2022]
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