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Heinosalo T, Saarinen N, Biehl A, Rytkönen KT, Villa PM, Juhila J, Koskimies P, Laiho A, Hämäläinen E, Kajantie E, Räikkönen K, Elo LL, Laivuori H, Poutanen M. Serum hydroxysteroid (17beta) dehydrogenase 1 concentration in pregnant women correlates with pregnancy-associated plasma protein A but does not serve as an independent marker for preeclampsia†. Biol Reprod 2024; 111:436-447. [PMID: 38780059 DOI: 10.1093/biolre/ioae078] [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: 11/16/2023] [Revised: 04/28/2024] [Accepted: 05/22/2024] [Indexed: 05/25/2024] Open
Abstract
Hydroxysteroid (17beta) dehydrogenase 1 (HSD17B1) is a steroid synthetic enzyme expressed in ovarian granulosa cells and placental syncytiotrophoblasts. Here, HSD17B1 serum concentration was measured with a validated immunoassay during pregnancy at three time points (12-14, 18-20 and 26-28 weeks of gestation). The concentration increased 2.5-fold (P < 0.0001) and 1.7-fold (P = 0.0019) during the follow-up period for control women and women who later developed preeclampsia (PE), respectively, and a significant difference was observed at weeks 26-28 (P = 0.0266). HSD17B1 concentration at all the three time points positively correlated with serum PAPPA measured at the first time point (first time point r = 0.38, P = 1.1 × 10-10; second time point r = 0.27, P = 5.9 × 10-6 and third timepoint r = 0.26, P = 2.3 × 10-5). No correlation was observed between HSD17B1 and placental growth factor (PLGF). Serum HSD17B1 negatively correlated with the mother's weight and body mass index (BMI), mirroring the pattern observed for PAPPA. The univariable logistic regression identified a weak association between HSD17B1 at 26-28 weeks and later development of PE (P = 0.04). The best multivariable model obtained using penalized logistic regression with stable iterative variable selection at 26-28 weeks included HSD17B1, together with PLGF, PAPPA and mother's BMI. While the area under the receiver operating characteristic curve of the model was higher than that of the adjusted PLGF, the difference was not statistically significant. In summary, the serum concentration of HSD17B1 correlated with PAPPA, another protein expressed in syncytiotrophoblasts, and with mother's weight and BMI but could not be considered as an independent marker for PE.
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Affiliation(s)
- Taija Heinosalo
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Niina Saarinen
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- Forendo Pharma, Turku, Finland
| | - Alexander Biehl
- Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku, Finland
| | - Kalle T Rytkönen
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku, Finland
| | - Pia M Villa
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | | | - Asta Laiho
- Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku, Finland
| | - Esa Hämäläinen
- Department of Clinical Chemistry, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Eero Kajantie
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki and Oulu, Finland
- Clinical Medicine Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Katri Räikkönen
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Laura L Elo
- Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku, Finland
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Hannele Laivuori
- Department of Obstetrics and Gynecology, Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
- Center for Child, Adolescence and Maternal Health, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Matti Poutanen
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
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Na M, Shetty SS, Niu X, Hinkle SN, Zhang C, Gao X. Sleep duration, napping behaviors and restless legs syndrome during pregnancy and the trajectories of ultrasonographic measures of fetal growth: Findings from the NICHD Fetal Growth Studies-Singletons. Sleep Health 2024; 10:462-469. [PMID: 38862351 DOI: 10.1016/j.sleh.2024.04.004] [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: 09/26/2023] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 06/13/2024]
Abstract
OBJECTIVES Given the plausible mechanisms and the lacking of empirical evidence, the study aims to investigate how gestational sleep behaviors and the development of sleep disorders, such as restless legs syndrome, influence ultrasonographic measures of fetal growth. METHODS The study included 2457 pregnant women from the NICHD Fetal Growth Studies - Singletons (2009-2013), who were recruited between 8-13 gestational weeks and followed up to five times during pregnancy. Women were categorized into six groups based on their total sleep hours and napping frequency. The trajectory of estimated fetal weight from 10-40weeks was derived from three ultrasonographic measures. Linear mixed effect models were applied to model the estimated fetal weight in relation to self-reported sleep-napping behaviors and restless legs syndrome status, adjusting for age, race and ethnicity, education, parity, prepregnancy body mass index category, infant sex, and prepregnancy sleep-napping behavior. RESULTS From enrollment to near delivery, pregnant women's total sleep duration and nap frequency declined and restless legs syndrome symptoms frequency increased generally. No significant differences in estimated fetal weight were observed by sleep-napping group or by restless legs syndrome status. Results remained similar in sensitivity analyses and stratified analyses by women's prepregnancy body mass index category (normal vs. overweight/obese) or by infant sex. CONCLUSIONS Our data indicate that there is no association between sleep during pregnancy-assessed as total sleep duration and napping frequency, nor restless legs syndrome symptoms-and fetal growth from weeks 10 to 40 in healthy pregnant women.
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Affiliation(s)
- Muzi Na
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Samidha Sudhakar Shetty
- Department of Mathematical Sciences, College of Letters and Science, Montana State University, Bozeman, Montana, USA
| | - Xiaoyue Niu
- Department of Statistics, Eberly College of Science, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Stefanie N Hinkle
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cuilin Zhang
- Global Center for Asian Women's Health (GloW) and Bia-Echo Asia Centre for Reproductive Longevity and Equality (ACRLE), National University of Singapore, Singapore, Singapore; Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
| | - Xiang Gao
- Department of Nutrition and Food Hygiene, School of Public Health, Institute of Nutrition, Fudan University, Shanghai, China.
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Damasceno AADA, Matijasevich A, Mosquera PS, Malta MB, Cardoso MA. Hypertensive disorders of pregnancy in Western Brazilian Amazon: Associated factors and neonatal outcomes. Am J Hum Biol 2024; 36:e24026. [PMID: 38041520 DOI: 10.1002/ajhb.24026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 09/27/2023] [Accepted: 11/18/2023] [Indexed: 12/03/2023] Open
Abstract
OBJECTIVE Hypertensive disorders of pregnancy (HDP) are responsible for several maternal and fetal complications. This study investigated the occurrence of HDP, associated factors, and neonatal complications in women living in the Western Brazilian Amazon. METHODS This is a population-based cross-sectional study with 1521 mother-child pairs enrolled in the Maternal and Child Health and Nutrition in Acre birth cohort (MINA-Brazil study). All parturients with HDP (registered in the medical records) were identified. Crude and adjusted prevalence ratios were calculated in Poisson regression models with robust variance. RESULTS The prevalence of HDP was 11.0% (95% CI: 9.5-12.7). Factors associated with the prevalence of HDP were maternal age ≥ 35 years (PR: 1.9; 95% CI: 1.3-3.0), primigravida status (PR: 2.0; 95% CI: 1.5-2.7), pre-pregnancy obesity (PR: 2.7; 95% CI: 1.9-4.0), higher gestational weight gain (highest quartile RP: 2.5; 95% CI: 1.6-3.8), chronic hypertension (RP: 3.6; 95% CI: 2.7-4.9), and diabetes in pregnancy (RP: 1.9; 95% CI: 1.1-3.2). HDP was associated with risk for caesarean delivery (PR: 1.8; 95% CI: 1.6-2.0) and prematurity (PR: 2.0; 95% CI: 1.3-3.2). Gestational malaria was not associated with HDP in Amazonian pregnant women. CONCLUSIONS Evaluating risk factors before pregnancy and during the prenatal period is essential for reducing adverse maternal and neonatal outcomes.
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Affiliation(s)
- Ana Alice de Araújo Damasceno
- Programa de pós-graduação em Saúde Pública, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil
- Campus Floresta, Universidade Federal do Acre, Cruzeiro do Su, Brazil
| | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Paola Soledad Mosquera
- Programa de pós-graduação em Saúde Pública, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil
| | - Maíra Barreto Malta
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil
| | - Marly Augusto Cardoso
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil
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Hahka TM, Slotkowski RA, Akbar A, VanOrmer MC, Sembajwe LF, Ssekandi AM, Namaganda A, Muwonge H, Kasolo JN, Nakimuli A, Mwesigwa N, Ishimwe JA, Kalyesubula R, Kirabo A, Anderson Berry AL, Patel KP. Hypertension Related Co-Morbidities and Complications in Women of Sub-Saharan Africa: A Brief Review. Circ Res 2024; 134:459-473. [PMID: 38359096 PMCID: PMC10885774 DOI: 10.1161/circresaha.123.324077] [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] [Indexed: 02/17/2024]
Abstract
Hypertension is the leading cause of cardiovascular disease in women, and sub-Saharan African (SSA) countries have some of the highest rates of hypertension in the world. Expanding knowledge of causes, management, and awareness of hypertension and its co-morbidities worldwide is an effective strategy to mitigate its harms, decrease morbidities and mortality, and improve individual quality of life. Hypertensive disorders of pregnancy (HDPs) are a particularly important subset of hypertension, as pregnancy is a major stress test of the cardiovascular system and can be the first instance in which cardiovascular disease is clinically apparent. In SSA, women experience a higher incidence of HDP compared with other African regions. However, the region has yet to adopt treatment and preventative strategies for HDP. This delay stems from insufficient awareness, lack of clinical screening for hypertension, and lack of prevention programs. In this brief literature review, we will address the long-term consequences of hypertension and HDP in women. We evaluate the effects of uncontrolled hypertension in SSA by including research on heart disease, stroke, kidney disease, peripheral arterial disease, and HDP. Limitations exist in the number of studies from SSA; therefore, we will use data from countries across the globe, comparing and contrasting approaches in similar and dissimilar populations. Our review highlights an urgent need to prioritize public health, clinical, and bench research to discover cost-effective preventative and treatment strategies that will improve the lives of women living with hypertension in SSA.
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Affiliation(s)
- Taija M Hahka
- Department of Cellular and Integrative Physiology (T.M.H., A.L.A.B., K.P.P.), University of Nebraska Medical Center, Omaha, NE
- Department of Pediatrics (T.M.H., R.A.S., A.A., M.C.V., A.L.A.B.), University of Nebraska Medical Center, Omaha, NE
| | - Rebecca A Slotkowski
- Department of Pediatrics (T.M.H., R.A.S., A.A., M.C.V., A.L.A.B.), University of Nebraska Medical Center, Omaha, NE
| | - Anum Akbar
- Department of Pediatrics (T.M.H., R.A.S., A.A., M.C.V., A.L.A.B.), University of Nebraska Medical Center, Omaha, NE
| | - Matt C VanOrmer
- Department of Pediatrics (T.M.H., R.A.S., A.A., M.C.V., A.L.A.B.), University of Nebraska Medical Center, Omaha, NE
| | - Lawrence Fred Sembajwe
- Department of Medical Physiology (L.F.S., A.M.S., A. Namaganda, H.M., J.N.K., R.K.), Makerere University College of Health Sciences, Kampala, Uganda
| | - Abdul M Ssekandi
- Department of Medical Physiology (L.F.S., A.M.S., A. Namaganda, H.M., J.N.K., R.K.), Makerere University College of Health Sciences, Kampala, Uganda
| | - Agnes Namaganda
- Department of Medical Physiology (L.F.S., A.M.S., A. Namaganda, H.M., J.N.K., R.K.), Makerere University College of Health Sciences, Kampala, Uganda
| | - Haruna Muwonge
- Department of Medical Physiology (L.F.S., A.M.S., A. Namaganda, H.M., J.N.K., R.K.), Makerere University College of Health Sciences, Kampala, Uganda
| | - Josephine N Kasolo
- Department of Medical Physiology (L.F.S., A.M.S., A. Namaganda, H.M., J.N.K., R.K.), Makerere University College of Health Sciences, Kampala, Uganda
| | - Annettee Nakimuli
- Department of Obstetrics and Gynecology (A. Nakimuli), Makerere University College of Health Sciences, Kampala, Uganda
| | - Naome Mwesigwa
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN (N.M., J.A.I., A.K.)
| | - Jeanne A Ishimwe
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN (N.M., J.A.I., A.K.)
| | - Robert Kalyesubula
- Department of Medical Physiology (L.F.S., A.M.S., A. Namaganda, H.M., J.N.K., R.K.), Makerere University College of Health Sciences, Kampala, Uganda
| | - Annet Kirabo
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN (N.M., J.A.I., A.K.)
| | - Ann L Anderson Berry
- Department of Cellular and Integrative Physiology (T.M.H., A.L.A.B., K.P.P.), University of Nebraska Medical Center, Omaha, NE
- Department of Pediatrics (T.M.H., R.A.S., A.A., M.C.V., A.L.A.B.), University of Nebraska Medical Center, Omaha, NE
| | - Kaushik P Patel
- Department of Cellular and Integrative Physiology (T.M.H., A.L.A.B., K.P.P.), University of Nebraska Medical Center, Omaha, NE
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Page L, Younge N, Freemark M. Hormonal Determinants of Growth and Weight Gain in the Human Fetus and Preterm Infant. Nutrients 2023; 15:4041. [PMID: 37764824 PMCID: PMC10537367 DOI: 10.3390/nu15184041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/13/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
The factors controlling linear growth and weight gain in the human fetus and newborn infant are poorly understood. We review here the changes in linear growth, weight gain, lean body mass, and fat mass during mid- and late gestation and the early postnatal period in the context of changes in the secretion and action of maternal, placental, fetal, and neonatal hormones, growth factors, and adipocytokines. We assess the effects of hormonal determinants on placental nutrient delivery and the impact of preterm delivery on hormone expression and postnatal growth and metabolic function. We then discuss the effects of various maternal disorders and nutritional and pharmacologic interventions on fetal and perinatal hormone and growth factor production, growth, and fat deposition and consider important unresolved questions in the field.
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Affiliation(s)
- Laura Page
- Division of Pediatric Endocrinology, Duke University Medical Center, Durham, NC 27710, USA;
| | - Noelle Younge
- Neonatology, Duke University Medical Center, Durham, NC 27710, USA;
| | - Michael Freemark
- Division of Pediatric Endocrinology, Duke University Medical Center, Durham, NC 27710, USA;
- The Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC 27710, USA
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Cardoso MIMP, Rezende KBDC, Da Matta FG, Saunders C, Cardoso FFO, Costa Junior IB, Gama LB, Amim J, Bornia RG. The prevalence and perinatal repercussions of preeclampsia after the implementation of a prophylaxis protocol with aspirin. Pregnancy Hypertens 2023; 33:17-21. [PMID: 37327650 DOI: 10.1016/j.preghy.2023.06.001] [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: 08/12/2022] [Revised: 06/01/2023] [Accepted: 06/09/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES To evaluate the prevalence and perinatal repercussions of preeclampsia (PE) after the implementation of a prophylaxis protocol with aspirin in singleton pregnancy at Maternity School of Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (2015-2106). METHODOLOGY PE prevalence according to gestational age (GA) and the prevalence ratio (PR) between PE and prematurity, small for gestational age (SGA), and fetal death were calculated in patients assisted during 2015 and 2016. RESULTS PE occurred in 373(10.75%) of 3468 investigated cases, where PE < 37 weeks was of 2.79% and PE greater than 37 weeks was of 7.95%. A total of 413 (11.9%) prematurity cases, 320 SGA (9.22%), and 50 fetal deaths (1.44%) occurred. In the PE group, 97 premature newborns (PR 0.90) and 51 SGA (PR 1.16) were born, and two fetal deaths occurred (PR 7.46). Concerning PE < 37 weeks, 27 SGA cases (PR 1.42) and two fetal deaths (PR 2.62) were observed. Regarding PE greater than 37 weeks, 24 SGA (PR 1.09) were born, and no fetal deaths were observed. Our findings were compared to previously published results. CONCLUSIONS PE was significantly associated with SGA newborns, especially premature PE. Prescribing aspirin for PE prophylaxis based only on clinical risk factors in a real-life scenario does not appear to be effective but resulted in a PE screening and prophylaxis protocol review and update at ME/UFRJ.
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Affiliation(s)
- Maria Isabel M P Cardoso
- Maternity School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Professional Master Perinatal Health, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Karina B de C Rezende
- Maternity School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Clinical Medicine Postgraduate Program, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Fabio G Da Matta
- Maternity School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Professional Master Perinatal Health, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Pedro Ernesto University Hospital, Rio de Janeiro State University, Brazil
| | - Cláudia Saunders
- Maternity School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Professional Master Perinatal Health, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernanda F O Cardoso
- Maternity School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Pedro Ernesto University Hospital, Rio de Janeiro State University, Brazil
| | - Ivo B Costa Junior
- Maternity School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luiza B Gama
- Professional Master Perinatal Health, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Joffre Amim
- Maternity School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Professional Master Perinatal Health, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rita G Bornia
- Maternity School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Professional Master Perinatal Health, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Kono Y, Yonemoto N, Nakanishi H, Hosono S, Hirano S, Kusuda S, Fujimura M. A Retrospective Cohort Study on Mortality and Neurodevelopmental Outcomes of Preterm Very Low Birth Weight Infants Born to Mothers with Hypertensive Disorders of Pregnancy. Am J Perinatol 2022; 39:1465-1477. [PMID: 33535243 DOI: 10.1055/s-0041-1722874] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE We examined the effects of maternal hypertensive disorders of pregnancy (HDP) on the mortality and neurodevelopmental outcomes in preterm very low birth weight (VLBW) infants (BW ≤1,500 g) based on their intrauterine growth status and gestational age (GA). STUDY DESIGN We included singleton VLBW infants born at <32 weeks' gestation registered in the Neonatal Research Network Japan database. The composite outcomes including death, cerebral palsy (CP), and developmental delay (DD) at 3 years of age were retrospectively compared among three groups: appropriate for GA (AGA) infants of mothers with and without HDP (H-AGA and N-AGA) and small for GA (SGA) infants of mothers with HDP (H-SGA). The adjusted odds ratios (AOR) and 95% confidence intervals (CI) stratified by the groups of every two gestational weeks were calculated after adjusting for the center, year of birth, sex, maternal age, maternal diabetes, antenatal steroid use, clinical chorioamnionitis, premature rupture of membranes, non-life-threatening congenital anomalies, and GA. RESULTS Of 19,323 eligible infants, outcomes were evaluated in 10,192 infants: 683 were H-AGA, 1,719 were H-SGA, and 7,790 were N-AGA. Between H-AGA and N-AGA, no significant difference was observed in the risk for death, CP, or DD in any GA groups. H-AGA had a lower risk for death, CP, or DD than H-SGA in the 24 to 25 weeks group (AOR: 0.434, 95% CI: 0.202-0.930). The odds for death, CP, or DD of H-SGA against N-AGA were found to be higher in the 24 to 25 weeks (AOR: 2.558, 95% CI: 1.558-3.272) and 26 to 27 weeks (AOR: 1.898, 95% CI: 1.427-2.526) groups, but lower in the 30 to 31 weeks group (AOR: 0.518, 95% CI: 0.335-0.800). CONCLUSION There was a lack of follow-up data; however, the outcomes of liveborn preterm VLBW infants of mothers with HDP depended on their intrauterine growth status and GA at birth. KEY POINTS · The effects of HDP on preterm low birth weight infants need to be further examined.. · The outcomes were not different between AGA infants with and without maternal HDP.. · The outcomes of SGA infants with maternal HDP were dependent on their GA..
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Affiliation(s)
- Yumi Kono
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Naohiro Yonemoto
- Department of Psychoneuropharmacology, National institute of Mental Health, National Center of Neurology and Psychiatry, Kodira, Tokyo, Japan
| | - Hidehiko Nakanishi
- Division of Neonatal Intensive Care Medicine, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Shigeharu Hosono
- Department of Perinatal and Neonatal Medicine, Jichi Medical University Saitama Medical Center, Saitama, Saitama, Japan
| | - Shinya Hirano
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Satoshi Kusuda
- Department of Pediatrics, Kyorin University, Mitaka, Tokyo, Japan
| | - Masanori Fujimura
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
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Yisahak SF, Hinkle SN, Mumford SL, Gleason JL, Grantz KL, Zhang C, Grewal J. Periconceptional and First Trimester Ultraprocessed Food Intake and Maternal Cardiometabolic Outcomes. Diabetes Care 2022; 45:2028-2036. [PMID: 35852359 PMCID: PMC9472493 DOI: 10.2337/dc21-2270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 06/12/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Ultraprocessed foods (UPFs) have been linked with obesity and cardiometabolic diseases in the general population but are understudied in pregnancy. We examined associations of UPF intake with gestational weight gain (GWG), glycemic, and blood pressure outcomes in pregnancy. RESEARCH DESIGN AND METHODS Pregnant women (n = 1,948) in a prospective U.S. cohort self-reported the past 3-month diet using a food frequency questionnaire (FFQ) at 8-13 weeks of gestation. The intake quantity (g/day) of foods and beverages identified as UPFs was ranked into quartiles. Associations of UPFs were evaluated, after adjusting for confounders, with 2nd and 3rd trimester Institute of Medicine (IOM) GWG categories, gestational diabetes mellitus (GDM), and hypertensive disorders of pregnancy (GHTN). Secondary outcomes included GWG rate, glucose challenge test 1-h glucose, and blood pressure trajectories from linear mixed models. RESULTS A total of 492 (25.2%) and 699 women (35.9%) had 2nd and 3rd trimester excessive GWG, respectively, and 85 women (4.4%) had GDM and 63 (3.2%) had severe hypertension or preeclampsia. UPF intake was not associated with higher odds of excessive GWG (quartile 4 vs. 1: adjusted odds ratio 0.68 [95% CI 0.44, 1.05], P-trend = 0.10 for 2nd trimester) or GDM risk (quartile 4 vs. 1: adjusted risk ratio 0.99 [95% CI 0.46, 2.11], P-trend = 0.85). Although UPF intake was positively associated with minor differences blood pressure trajectories, associations with GHTN were null. CONCLUSIONS The expected unfavorable association of higher UPF intake with excessive GWG, GDM, and GHTN was not observed in our cohort of low-risk pregnant women. These results are based on a limited sample size and require replication.
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Affiliation(s)
- Samrawit F. Yisahak
- Office of the Director, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Stefanie N. Hinkle
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sunni L. Mumford
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jessica L. Gleason
- Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Katherine L. Grantz
- Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Cuilin Zhang
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- NUS Bia-Echo Asia Centre for Reproductive Longevity and Equality, National University of Singapore, Singapore
| | - Jagteshwar Grewal
- Office of the Director, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
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Korzeniewski SJ, Sutton E, Escudero C, Roberts JM. The Global Pregnancy Collaboration (CoLab) symposium on short- and long-term outcomes in offspring whose mothers had preeclampsia: A scoping review of clinical evidence. Front Med (Lausanne) 2022; 9:984291. [PMID: 36111112 PMCID: PMC9470009 DOI: 10.3389/fmed.2022.984291] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Preeclampsia is a maternal syndrome characterized by the new onset of hypertension after 20 weeks of gestation associated with multisystemic complications leading to high maternal and fetal/neonatal morbidity and mortality. However, sequelae of preeclampsia may extend years after pregnancy in both mothers and their children. In addition to the long-term adverse cardiovascular effects of preeclampsia in the mother, observational studies have reported elevated risk of cardiovascular, metabolic, cerebral and cognitive complications in children born from women with preeclampsia. Less clear is whether the association between maternal preeclampsia and offspring sequelae are causal, or to what degree the associations might be driven by fetal factors including impaired growth and the health of its placenta. Our discussion of these complexities in the 2018 Global Pregnancy Collaboration annual meeting prompted us to write this review. We aimed to summarize the evidence of an association between maternal preeclampsia and neurobehavioral developmental disorders in offspring in hopes of generating greater research interest in this important topic.
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Affiliation(s)
- Steven J. Korzeniewski
- Department of Family Medicine and Population Health Sciences, Wayne State University School of Medicine, Detroit, MI, United States
- *Correspondence: Steven J. Korzeniewski
| | - Elizabeth Sutton
- Magee-Womens Research Institute, Pittsburgh, PA, United States
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, United States
| | - Carlos Escudero
- Group of Research and Innovation in Vascular Health, Chillán, Chile
- Vascular Physiology Laboratory, Department of Basic Sciences, Faculty of Sciences, University of Bío-Bío, Chillán, Chile
| | - James M. Roberts
- Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA, United States
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Han JH, Yoon SJ, Lee HS, Park G, Lim J, Shin JE, Eun HS, Park MS, Lee SM. Application of Machine Learning Approaches to Predict Postnatal Growth Failure in Very Low Birth Weight Infants. Yonsei Med J 2022; 63:640-647. [PMID: 35748075 PMCID: PMC9226835 DOI: 10.3349/ymj.2022.63.7.640] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/22/2022] [Accepted: 03/25/2022] [Indexed: 01/05/2023] Open
Abstract
PURPOSE The aims of the study were to develop and evaluate a machine learning model with which to predict postnatal growth failure (PGF) among very low birth weight (VLBW) infants. MATERIALS AND METHODS Of 10425 VLBW infants registered in the Korean Neonatal Network between 2013 and 2017, 7954 infants were included. PGF was defined as a decrease in Z score >1.28 at discharge, compared to that at birth. Six metrics [area under the receiver operating characteristic curve (AUROC), accuracy, precision, sensitivity, specificity, and F1 score] were obtained at five time points (at birth, 7 days, 14 days, 28 days after birth, and at discharge). Machine learning models were built using four different techniques [extreme gradient boosting (XGB), random forest, support vector machine, and convolutional neural network] to compare against the conventional multiple logistic regression (MLR) model. RESULTS The XGB algorithm showed the best performance with all six metrics across the board. When compared with MLR, XGB showed a significantly higher AUROC (p=0.03) for Day 7, which was the primary performance metric. Using optimal cut-off points, for Day 7, XGB still showed better performances in terms of AUROC (0.74), accuracy (0.68), and F1 score (0.67). AUROC values seemed to increase slightly from birth to 7 days after birth with significance, almost reaching a plateau after 7 days after birth. CONCLUSION We have shown the possibility of predicting PGF through machine learning algorithms, especially XGB. Such models may help neonatologists in the early diagnosis of high-risk infants for PGF for early intervention.
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Affiliation(s)
- Jung Ho Han
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - So Jin Yoon
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Goeun Park
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Joohee Lim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong Eun Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Seon Eun
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Min Soo Park
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Soon Min Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
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11
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Lewis R, Gupta C, Punja R. Comparison of anthropometric measurements of foetuses in normal, gestational diabetes-affected, and hypertensive pregnancies. J Taibah Univ Med Sci 2021; 16:887-893. [PMID: 34899134 PMCID: PMC8626796 DOI: 10.1016/j.jtumed.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 07/20/2021] [Accepted: 08/06/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Foetal anthropometry evaluates and monitors foetal development and assesses the nutritional state of the developing foetus. It is a vital indicator of the normalcy of foetal development in-utero. The most relevant parameters in foetal anthropometry are biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL). Gestational diabetes mellitus (GDM) and gestational hypertension (GHTN) are the major reasons for variations in foetal development. In this study, we compare foetal anthropometric measurements taken using ultrasounds of normal, gestational diabetes-affected, and hypertensive pregnancies. METHOD In this study, a total of 615 anomaly scans were done between the gestational ages of 18-22 weeks from 2016 to 2018. The patients' data were collected from the register of the anomaly scanning room. The foetal anthropometric parameters measured BPD, HC, AC, and FL. RESULTS All the measurements including BPD, HC, and AC were lower in foetuses affected by GHTN, and all the measurements, including FL, were higher in foetuses affected by GDM than in normal pregnancies. A post-hoc analysis using Tukey's test showed that each foetal parameter had a significant correlation with pregnancy-related co-morbidities (p-value < 0.05). CONCLUSION It is clear from our study that the foetuses of mothers with GDM showed a consistent variation of 10 mm above the normal average in terms of the BPD, HC, AC, and FL measurements. The GHTN-affected foetuses had averages that were lower than normal for BPD, HC, and AC.
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Affiliation(s)
- Rhea Lewis
- Department of Anatomy, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Chandni Gupta
- Department of Anatomy, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Rohini Punja
- Department of Anatomy, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
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12
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Goin DE, Sudat S, Riddell C, Morello-Frosch R, Apte JS, Glymour MM, Karasek D, Casey JA. Hyperlocalized Measures of Air Pollution and Preeclampsia in Oakland, California. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2021; 55:14710-14719. [PMID: 34648281 PMCID: PMC8968652 DOI: 10.1021/acs.est.1c02151] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Exposure to nitrogen dioxide (NO2), black carbon (BC), and ultrafine particles (UFPs) during pregnancy may increase the risk of preeclampsia, but previous studies have not assessed hyperlocalized differences in pollutant levels, which may cause exposure misclassification. We used data from Google Street View cars with mobile air monitors that repeatedly sampled NO2, BC, and UFPs every 30 m in Downtown and West Oakland neighborhoods during 2015-2017. Data were linked to electronic health records of pregnant women in the 2014-2016 Sutter Health population, who resided within 120 m of monitoring data (N = 1095), to identify preeclampsia cases. We used G-computation with log-binomial regression to estimate risk differences (RDs) associated with a hypothetical intervention reducing pollutant levels to the 25th percentile observed in our sample on preeclampsia risk, overall and stratified by race/ethnicity. Prevalence of preeclampsia was 6.8%. Median (interquartile range) levels of NO2, BC, and UFPs were 10.8 ppb (9.0, 13.0), 0.34 μg/m3 (0.27, 0.42), and 29.2 # × 103/cm3 (26.6, 32.6), respectively. Changes in the risk of preeclampsia achievable by limiting each pollutant to the 25th percentile were NO2 RD = -1.5 per 100 women (95% confidence interval (CI): -2.5, -0.5); BC RD = -1.0 (95% CI: -2.2, 0.02); and UFP RD = -0.5 (95% CI: -1.8, 0.7). Estimated effects were the largest for non-Latina Black mothers: NO2 RD = -2.8 (95% CI: -5.2, -0.3) and BC RD = -3.0 (95% CI: -6.4, 0.4).
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Affiliation(s)
- Dana E. Goin
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, California, 94158, United States of America
| | - Sylvia Sudat
- Research, Development and Dissemination, Sutter Health, Walnut Creek, California, 94596, United States of America
| | - Corinne Riddell
- Division of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, California, 94720, United States of America
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California, 94720, United States of America
| | - Rachel Morello-Frosch
- Department of Environmental Science, Policy, and Management & School of Public Health, University of California, Berkeley, Berkeley, California, 94720, United States of America
| | - Joshua S. Apte
- Department of Civil and Environmental Engineering & School of Public Health, University of California, Berkeley, Berkeley, California, 94720, United States of America
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, 94158, United States of America
| | - Deborah Karasek
- Preterm Birth Initiative, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, 94158, United States of America
| | - Joan A. Casey
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York, 10032, United States of America
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13
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Hinkle SN, Gleason JL, Yisahak SF, Zhao SK, Mumford SL, Sundaram R, Grewal J, Grantz KL, Zhang C. Assessment of Caffeine Consumption and Maternal Cardiometabolic Pregnancy Complications. JAMA Netw Open 2021; 4:e2133401. [PMID: 34748005 PMCID: PMC8576579 DOI: 10.1001/jamanetworkopen.2021.33401] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
IMPORTANCE Women are recommended to limit caffeine consumption to less than 200 mg per day based on risks to fetal health. Impacts of caffeine on maternal health remain unclear. OBJECTIVE To determine whether caffeinated-beverage intake and plasma caffeine and paraxanthine are associated with cardiometabolic complications in pregnancy (ie, gestational diabetes [GDM], preeclampsia, and gestational hypertension [GH]). DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from a longitudinal pregnancy cohort study from the National Institute of Child Health and Human Development (NICHD) Fetal Growth Studies-Singletons (2009-2013). This post hoc secondary analysis of 2802 pregnant women without major chronic conditions enrolled at 12 US clinical sites was completed in 2021. The final sample for caffeinated beverage analyses included 2583 women. After excluding women who did not consent to have their biospecimens stored for future research (n = 54), plasma caffeine analyses included 2529 women. Analyses of caffeine consumption and fasting cardiometabolic profiles included 319 women. EXPOSURES Daily total caffeine intake was estimated at 10 to 13 gestational weeks and 16 to 22 gestational weeks based on self-reported past week intake of caffeinated coffee, tea, soda, and energy drinks. Plasma caffeine and paraxanthine were measured in specimens collected at 10 to 13 weeks. MAIN OUTCOMES AND MEASURES Clinical diagnoses of GDM, preeclampsia, GH, glucose concentrations from GDM screening, and blood pressure were extracted from medical records. RESULTS Participants had a mean (SD) age of 28.1 (5.5) years and 422 participants (16.3%) were Asian/Pacific Islander women, 741 (28.9%) were Hispanic women, 717 (27.8%) were non-Hispanic Black women, and 703 (27.2%) were non-Hispanic White women. At 10 to 13 weeks, 1073 women (41.5%) reported consuming no caffeinated beverages, 1317 (51.0%) reported consuming 1 mg/d to 100 mg/d, 173 (6.7%) reported consuming 101 mg/d to 200 mg/d, and 20 (0.8%) reported consuming more than 200 mg/d. At 16 to 22 weeks, 599 women (23.6%) reported consuming no caffeinated beverages, 1734 (68.3%) reported consuming 1 mg/d to 100 mg/d, 186 (7.3%) reported consuming 101 mg/d to 200 mg/d, and 20 (0.8%) reported consuming more than 200 mg/d caffeinated beverages. Intake at 16 to 22 weeks was associated with lower GDM risk and lower glucose concentrations (1 mg/d to 100 mg/d vs none: relative risk, 0.53 [95% CI, 0.35 to 0.80]; β, -2.7 mg/dL [95% CI, -5.4 mg/dL to 0 mg/dL]) and lower C-reactive protein and C-peptide concentrations and favorable lipid profiles. Total plasma caffeine and paraxanthine at 10 to 13 weeks was inversely associated with glucose (quartile 4 vs quartile 1: β = -3.8 mg/dL [95% CI, -7.0 mg/dL to -0.5 mg/dL]; trend of P = .01). No associations were observed with preeclampsia or GH. CONCLUSIONS AND RELEVANCE In this cohort study, second trimester caffeinated beverage intake within current recommendations was associated with lower GDM risk, but not preeclampsia or GH. These findings may be reassuring for women with moderate caffeine intake.
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Affiliation(s)
- Stefanie N. Hinkle
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jessica L. Gleason
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Samrawit F. Yisahak
- Office of the Director, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Sifang Kathy Zhao
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Sunni L. Mumford
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Rajeshwari Sundaram
- Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Jagteshwar Grewal
- Office of the Director, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Katherine L. Grantz
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Cuilin Zhang
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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14
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Ding AL, Hu H, Xu FP, Liu LY, Peng J, Dong XD. Pregnancy complications effect on the nickel content in maternal blood, placenta blood and umbilical cord blood during pregnancy. World J Clin Cases 2021; 9:8340-8348. [PMID: 34754843 PMCID: PMC8554420 DOI: 10.12998/wjcc.v9.i28.8340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/10/2021] [Accepted: 08/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Nickel (Ni) may accumulate in the human body and has biological toxicity and carcinogenicity. Ni has an extensive impact on the health of pregnant women and fetuses during gestation.
AIM To evaluate Ni exposure in pregnant women in Kunming, Yunnan Province, China; to describe the distribution of Ni in the maternal-fetal system and placental barrier function; and to investigate the effect of Ni exposure on fetal health in mothers with pregnancy complications.
METHODS Seventy-two pregnant women were selected using a case-control design. The women were divided into two groups: The control group (no disease; n = 29) and the disease group [gestational diabetes (GDM), hypertensive disorder complicating pregnancy (HDCP), or both; n = 43]. The pregnant women in the disease group were further divided as follows: 14 cases with GDM (GDM group), 13 cases with HDCP (HDCP group) and 16 cases with both GDM and HDCP (disease combination group). Basic information on the pregnant women was collected by questionnaire survey. Maternal blood, placenta blood and cord blood were collected immediately after delivery. The Ni content in paired samples was determined using inductively coupled plasma mass spectrometry.
RESULTS Compared to the control group, age was higher and body mass index was greater in pregnant women in the disease groups (28.14 ± 2.54 vs 28.42 ± 13.89, P < 0.05; 25.90 ± 3.86 vs 31.49 ± 5.30, P < 0.05). The birth weights of newborns in the HDCP group and the control group were significantly different (2.52 ± 0.74 vs 3.18 ± 0.41, P < 0.05). The content of Ni in umbilical cord blood in the entire disease group was higher than that in the control group (0.10 ± 0.16 vs 0.05 ± 0.07, P < 0.05).
CONCLUSION In the maternal-fetal system of women with pregnancy complications, the barrier effect of the placenta against Ni is weakened, thus affecting healthy growth of the fetus in the uterus.
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Affiliation(s)
- Ai-Ling Ding
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming 650500, Yunnan Province, China
- The Obstetrical Department, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming 650032, Yunnan Province, China
| | - Hong Hu
- Medical College, Kunming University of Science and Technology, Kunming 650500, Yunnan Province, China
- The Obstetrical Department, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming 650032, Yunnan Province, China
| | - Fan-Ping Xu
- Medical College, Kunming University of Science and Technology, Kunming 650500, Yunnan Province, China
- The Obstetrical Department, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming 650032, Yunnan Province, China
| | - Ling-Yan Liu
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming 650500, Yunnan Province, China
- The Obstetrical Department, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming 650032, Yunnan Province, China
| | - Juan Peng
- The Obstetrical Department, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming 650032, Yunnan Province, China
| | - Xu-Dong Dong
- The Obstetrical Department, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming 650032, Yunnan Province, China
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15
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Li M, Grewal J, Hinkle SN, Yisahak SF, Grobman WA, Newman RB, Skupski DW, Chien EK, Wing DA, Grantz KL, Zhang C. Healthy dietary patterns and common pregnancy complications: a prospective and longitudinal study. Am J Clin Nutr 2021; 114:1229-1237. [PMID: 34075392 PMCID: PMC8408886 DOI: 10.1093/ajcn/nqab145] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 04/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Adherence to alternate Healthy Eating Index (AHEI), alternate Mediterranean diet (AMED), and Dietary Approaches to Stop Hypertension (DASH) has been linked to lower risks of chronic diseases. However, their associations with common pregnancy complications are unclear. OBJECTIVES This study investigates the associations of AHEI, AMED, and DASH during periconception and pregnancy with common pregnancy complication risks. METHODS The study included 1887 pregnant women from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies-Singletons. Women responded to an FFQ at 8-13 gestational weeks, and they performed a 24-h dietary recall at 16-22 and 24-29 wk. Gestational diabetes (GDM), gestational hypertension, preeclampsia, and preterm delivery were ascertained using medical records. RESULTS Healthier diet indicated by higher AHEI, AMED, and DASH scores was generally related to lower risks of pregnancy complications. Significant inverse associations were observed between AHEI score reported at 16-22 wk and GDM risk [adjusted RR (95% CI), highest (Q4) vs. lowest quartile (Q1): 0.32 (0.16, 0.66), P-trend = 0.002]; DASH score reported at both 8-13 [adjusted RR (95% CI), Q4 vs. Q1: 0.45 (0.17, 1.17), P-trend = 0.04] and 16-22 wk [adjusted RR (95% CI), Q4 vs. Q1: 0.19 (0.05, 0.65), P-trend = 0.01] and gestational hypertension risk; AHEI score reported at 24-29 wk and preeclampsia risk [adjusted RR (95% CI), Q4 vs. Q1: 0.31 (0.11, 0.87), P-trend = 0.03]; AMED score reported at 8-13 wk [adjusted RR (95% CI), Q4 vs. Q1: 0.50 (0.25, 1.01), P-trend = 0.03] and DASH score reported at 24-29 wk [adjusted RR (95% CI), Q4 vs. Q1: 0.50, (0.26, 0.96), P-trend = 0.03] and preterm delivery risk. CONCLUSIONS Adherence to AHEI, AMED, or DASH during periconception and pregnancy was related to lower risks of GDM, gestational hypertension, preeclampsia, and preterm delivery.This study was registered at ClinicalTrials.gov as NCT00912132.
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Affiliation(s)
- Mengying Li
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Jagteshwar Grewal
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Stefanie N Hinkle
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Samrawit F Yisahak
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - William A Grobman
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Roger B Newman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Daniel W Skupski
- Department of Obstetrics and Gynecology, New York-Presbyterian Hospital/Queens, Queens, NY, USA
| | - Edward K Chien
- Department of Obstetrics and Gynecology, Brown University Alpert Medical School, Providence, RI, USA
| | - Deborah A Wing
- Division of Maternal-Fetal Medicine, Department of Obstetrics-Gynecology, University of California School of Medicine, Irvine, CA, USA
- Fountain Valley Regional Hospital and Medical Center, Fountain Valley, CA, USA
| | - Katherine L Grantz
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Cuilin Zhang
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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16
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Liu T, Zhang M, Rahman ML, Wang X, Hinkle SN, Zhang C, Mueller NT. Exposure to heavy metals and trace minerals in first trimester and maternal blood pressure change over gestation. ENVIRONMENT INTERNATIONAL 2021; 153:106508. [PMID: 33901931 DOI: 10.1016/j.envint.2021.106508] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 02/12/2021] [Accepted: 03/05/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND While several heavy metals and trace minerals have been linked with hypertensive disorders during pregnancy (HDP) in women, no studies have estimated the relationship of exposure to these chemicals, both independently and as a mixture, with systolic blood pressure (SBP) or diastolic blood pressure (DBP) over gestation. OBJECTIVES We examined individual and joint effects of 1st trimester chemicals with SBP and DBP over gestation, and whether those chemicals were associated with HDP. METHODS We used data from 1832 non-obese pregnant women with low-risk antenatal profiles from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies - Singleton cohort (2009-2013). In plasma collected from women at 8-13 weeks' gestation (baseline enrollment), we measured heavy metals, barium (Ba), cesium (Cs), antimony (Sb), as well as trace minerals, cobalt (Co), copper (Cu), molybdenum (Mo), selenium (Se), and zinc (Zn). We obtained BP at baseline and throughout gestation until delivery and diagnosis of HDP from medical records. We used Bayesian Kernel Machine Regression (BKMR) as well as traditional linear and logistic regressions to examine the cross-sectional associations of chemicals with baseline BP and HDP. We used linear mixed effect regression to examine longitudinal associations between chemicals and rate of weekly change in BP in each trimester. We adjusted for sociodemographic and lifestyle factors and pre-pregnancy body mass index in all models. RESULTS BKMR revealed that comparing the entire chemical mixture at the 90th percentile vs. the 50th percentile was associated with a 1.61 mmHg (95% CI: 0.41, 2.81) higher SBP and a 1.09 mmHg (0.10, 2.09) higher DBP. No interactions were observed between chemicals. Accounting for chemical co-exposure in BKMR, each interquartile range (IQR) increment in Cu was associated with a 0.67 mmHg (0.02, 1.32) higher SBP and a 0.60 mmHg (0.08, 1.12) higher DBP at baseline; each IQR increment in Se was associated with a 0.67 mmHg (0.05, 1.29) higher SBP but not DBP. In longitudinal analyses, women with higher (i.e., above median concentration) baseline Cu had a 0.09 mmHg (0.01, 0.17) and 0.06 mmHg (0.001, 0.12) larger weekly decrease in SBP and DBP in 2nd trimester, respectively. Women with higher baseline Ba had a 0.12 mmHg (0.04, 0.20) larger weekly increase in SBP in 2nd trimester, while women with higher Cs had a 0.05 mmHg (0.01, 0.10) larger weekly increase in DBP in 3rd trimester. None of the chemicals examined were significantly associated with HDP. CONCLUSIONS In this multi-ethnic cohort of women with low antenatal risk, plasma metals and trace minerals in early pregnancy, both individually and as a mixture, were statistically significantly associated with BP during gestation in small magnitude and in different directions, but not with HDP. The implications of these findings for women's postpartum BP and future cardiovascular health remains to be investigated.
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Affiliation(s)
- Tiange Liu
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mingyu Zhang
- Department of Epidemiology, Johns Hopkins Bloomberg of School of Public Health, Baltimore, MD, USA; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Mohammad L Rahman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Xiaobin Wang
- Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Division of General Pediatrics & Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Stefanie N Hinkle
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Cuilin Zhang
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
| | - Noel T Mueller
- Department of Epidemiology, Johns Hopkins Bloomberg of School of Public Health, Baltimore, MD, USA; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA.
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Lin D, Luo BD C, Chen G, Fan D, Huang Z, Li P, Wu S, Ye BD S, Ma H, Rao J, Zhang H, Chen T, Zeng M, Guo X, Liu Z. The association of hypertensive disorders of pregnancy with small for gestational age and intertwin birthweight discordance. J Clin Hypertens (Greenwich) 2021; 23:1354-1362. [PMID: 34014022 PMCID: PMC8678671 DOI: 10.1111/jch.14257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/28/2021] [Accepted: 03/31/2021] [Indexed: 11/27/2022]
Abstract
Available evidence shows conflicting results regarding the association between hypertensive disorders of pregnancy (HDPs)/preeclampsia (PE) and small for gestational age (SGA) and birthweight discordance (BWD). This retrospective study of 2131 twin pregnancies aimed to evaluate the association of HDPs/PE with the presence of SGA and BWD. The eligible pregnancies were categorized into four study groups: concordant pairs without SGA fetuses, discordant pairs without SGA fetuses, concordant pairs with SGA fetuses, and discordant pairs with SGA fetuses. We applied binary logistic regression models to compare the incidence of HDPs/PE and multinomial logit regression models to evaluate the severity of PE between the study groups. The models were adjusted for potential confounders. Increases in HDPs were observed in concordant (aOR, 2.33; 95% CI: 1.46-3.73) and discordant (aOR, 3.50; 95% CI: 2.26-5.43) pregnancies with SGA fetuses but not in discordant pregnancies without SGA fetuses (aOR, 1.42; 95% CI: 0.81-2.49); increases in PE were also found in concordant (aOR, 1.87; 95% CI: 1.08-3.23) and discordant (aOR, 3.75; 95% CI: 2.36-5.96) pregnancies with SGA fetuses but not in discordant pregnancies without SGA fetuses (aOR, 1.34; 95% CI: 0.71-2.52). Discordant pregnancies with SGA fetuses were associated with severe PE (aRRR, 3.48; 95% CI: 1.79-6.77), whereas concordant pregnancies with SGA fetuses were associated with only mild PE (aRRR, 2.54; 95% CI: 1.33-4.88). Our results suggest that SGA is associated with the development of HDP/PE, while discordant growth is associated with the severity of PE. These associations need to be further investigated using estimated fetal weight (EFW).
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Affiliation(s)
- Dongxin Lin
- Foshan Institute of Fetal MedicineAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
- Department of ObstetricsAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
| | - Caihong Luo BD
- Department of ObstetricsAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
| | - Gengdong Chen
- Foshan Institute of Fetal MedicineAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
- Department of ObstetricsAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
| | - Dazhi Fan
- Foshan Institute of Fetal MedicineAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
- Department of ObstetricsAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
| | - Zheng Huang
- The First Affiliated Hospital of Guangdong Pharmaceutical UniversityGuangzhouChina
| | - Pengsheng Li
- Foshan Institute of Fetal MedicineAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
- Department of ObstetricsAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
| | - Shuzhen Wu
- Foshan Institute of Fetal MedicineAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
- Department of ObstetricsAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
| | - Shaoxin Ye BD
- Foshan Institute of Fetal MedicineAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
- Department of ObstetricsAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
| | - Huiting Ma
- Foshan Institute of Fetal MedicineAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
- Department of ObstetricsAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
| | - Jiaming Rao
- Foshan Institute of Fetal MedicineAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
- Department of ObstetricsAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
| | - Huishan Zhang
- Foshan Institute of Fetal MedicineAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
- Department of ObstetricsAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
| | - Ting Chen
- Foshan Institute of Fetal MedicineAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
- Department of ObstetricsAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
| | - Meng Zeng
- Department of ObstetricsAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
| | - Xiaoling Guo
- Foshan Institute of Fetal MedicineAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
- Department of ObstetricsAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
| | - Zhengping Liu
- Foshan Institute of Fetal MedicineAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
- Department of ObstetricsAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
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18
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Hu XQ, Zhang L. Hypoxia and Mitochondrial Dysfunction in Pregnancy Complications. Antioxidants (Basel) 2021; 10:antiox10030405. [PMID: 33800426 PMCID: PMC7999178 DOI: 10.3390/antiox10030405] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 02/07/2023] Open
Abstract
Hypoxia is a common and severe stress to an organism's homeostatic mechanisms, and hypoxia during gestation is associated with significantly increased incidence of maternal complications of preeclampsia, adversely impacting on the fetal development and subsequent risk for cardiovascular and metabolic disease. Human and animal studies have revealed a causative role of increased uterine vascular resistance and placental hypoxia in preeclampsia and fetal/intrauterine growth restriction (FGR/IUGR) associated with gestational hypoxia. Gestational hypoxia has a major effect on mitochondria of uteroplacental cells to overproduce reactive oxygen species (ROS), leading to oxidative stress. Excess mitochondrial ROS in turn cause uteroplacental dysfunction by damaging cellular macromolecules, which underlies the pathogenesis of preeclampsia and FGR. In this article, we review the current understanding of hypoxia-induced mitochondrial ROS and their role in placental dysfunction and the pathogenesis of pregnancy complications. In addition, therapeutic approaches selectively targeting mitochondrial ROS in the placental cells are discussed.
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19
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Yisahak SF, Hinkle SN, Mumford SL, Li M, Andriessen VC, Grantz KL, Zhang C, Grewal J. Vegetarian diets during pregnancy, and maternal and neonatal outcomes. Int J Epidemiol 2021; 50:165-178. [PMID: 33232446 PMCID: PMC7938506 DOI: 10.1093/ije/dyaa200] [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] [Accepted: 09/24/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Vegetarian diets are becoming increasingly popular in the USA. Limited research has examined the health consequences of vegetarian diets during pregnancy. We comprehensively examined associations of vegetarianism during pregnancy with maternal and neonatal outcomes. METHODS We used data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development's Fetal Growth Studies-Singletons, a prospective multi-site cohort of 1948 low-risk pregnant women of four races/ethnicities (White, Black, Hispanic, Asian/Pacific Islander) in the USA (2009-2013). Vegetarianism was self-reported and also defined based on dietary patterns measured using a self-administered first-trimester food-frequency questionnaire (full [lacto-ovo and vegan], pesco-, semi- and non-vegetarians). Neonatal outcomes included birthweight and neonatal anthropometric measures, small for gestational age, small for gestational age with neonatal morbidity and preterm delivery. Maternal outcomes included gestational weight gain, gestational diabetes, hypertensive disorders of pregnancy and gestational anaemia. RESULTS Ninety-nine (6.2%) women self-reported being vegetarian. The diet-based definition identified 32 (2.0%) full vegetarians, 7 (0.6%) pesco-vegetarians and 301 (17.6%) semi-vegetarians. Neonates of diet-based full vegetarians had higher odds of being small for gestational age [adjusted odds ratio (ORadj) = 2.51, 95% confidence interval: 1.01, 6.21], but not of being small for gestational age with a postnatal morbidity. Full vegetarians had marginally increased the odds of inadequate second-trimester gestational weight gain (ORadj = 2.24, 95% confidence interval: 0.95, 5.27). CONCLUSION Vegetarian diets during pregnancy were associated with constitutionally smaller neonatal size, potentially via the mothers' reduced gestational weight gain. Notably, vegetarianism was not associated with small-for-gestational-age-related morbidities or other adverse maternal outcomes.
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Affiliation(s)
- Samrawit F Yisahak
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Stefanie N Hinkle
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Sunni L Mumford
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Mengying Li
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Victoria C Andriessen
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Katherine L Grantz
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Cuilin Zhang
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Jagteshwar Grewal
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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20
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Dhillon P, Kaur I, Singh K. Pregnancy-induced hypertension: Role of drug therapy and nutrition in the management of hypertension. PHARMANUTRITION 2021. [DOI: 10.1016/j.phanu.2021.100251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Mulder EG, Ghossein-Doha C, Crutsen J, Van Kuijk S, Thilaganathan B, Spaanderman M. Effect of pregnancy prolongation in early-onset pre-eclampsia on postpartum maternal cardiovascular, renal and metabolic function in primiparous women: an observational study. BJOG 2020; 128:121-129. [PMID: 32725713 PMCID: PMC7754285 DOI: 10.1111/1471-0528.16435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2020] [Indexed: 12/12/2022]
Abstract
Objective To evaluate the association between deferred delivery in early‐onset pre‐eclampsia and offspring outcome and maternal cardiovascular, renal and metabolic function in the postpartum period. Design Observational study. Setting Tertiary referral hospital. Population Nulliparous women diagnosed with pre‐eclampsia before 34 weeks’ gestation who participated in a routine postpartum cardiovascular risk assessment programme. Women with hypertension, diabetes mellitus or renal disease prior to pregnancy were excluded. Methods Regression analyses were performed to assess the association between pregnancy prolongation and outcome measures. Main outcome measures Offspring outcome and prevalence of deviant maternal cardiovascular, renal and metabolic function. Results The study population included 564 women with a median pregnancy prolongation of 10 days (interquartile range [IQR] 4–18) who were assessed at on average 8 months (IQR 6–12) postpartum. Pregnancy prolongation after diagnosis resulted in a decrease in infant mortality (adjusted odd ratio [aOR] 0.907, 95% CI 0.852–0.965 per day prolongation). This improvement in offspring outcome was associated with an elevated risk of moderately increased albuminuria (aOR 1.025, 95% CI 1.006–1.045 per day prolongation), but not with aberrant cardiac geometry, cardiac systolic or diastolic dysfunction, persistent hypertension or metabolic syndrome. Conclusion Pregnancy prolongation in early‐onset pre‐eclampsia is associated with improved offspring outcome and survival. These effects do not appear to be deleterious to short‐term maternal cardiovascular and metabolic function but are associated with a modest increase in risk of residual albuminuria. Tweetable abstract Pregnancy prolongation in pre‐eclampsia has only a limited effect on postpartum maternal cardiovascular function. Pregnancy prolongation in pre‐eclampsia has only a limited effect on postpartum maternal cardiovascular function.
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Affiliation(s)
- E G Mulder
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - C Ghossein-Doha
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jrw Crutsen
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Smj Van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - B Thilaganathan
- St George's University of London, Molecular and Clinical Sciences Research Institute, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Mea Spaanderman
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands
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22
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Erkamp JS, Jaddoe VWV, Duijts L, Reiss IKM, Mulders AGMGJ, Steegers EAP, Gaillard R. Population screening for gestational hypertensive disorders using maternal, fetal and placental characteristics: A population-based prospective cohort study. Prenat Diagn 2020; 40:746-757. [PMID: 32181502 PMCID: PMC7317936 DOI: 10.1002/pd.5683] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 12/12/2022]
Abstract
Objective To determine screening performance of maternal, fetal and placental characteristics for selecting pregnancies at risk of gestational hypertension and preeclampsia in a low‐risk multi‐ethnic population. Method In a prospective population‐based cohort among 7124 pregnant women, we collected maternal characteristics including body mass index, ethnicity, parity, smoking and blood pressure in early‐pregnancy. Fetal characteristics included second and third trimester estimated fetal weight and sex determined by ultrasound. Placental characteristics included first and second trimester placental growth factor concentrations and second and third trimester uterine artery resistance indices. Results Maternal characteristics provided the best screening result for gestational hypertension (area‐under‐the‐curve [AUC] 0.79 [95% Confidence interval {CI} 0.76‐0.81]) with 40% sensitivity at 90% specificity. For preeclampsia, the maternal characteristics model led to a screening performance of AUC 0.74 (95% CI 0.70‐0.78) with 33% sensitivity at 90% specificity. Addition of second and third trimester placental ultrasound characteristics only improved screening performance for preeclampsia (AUC 0.78 [95% CI 0.75‐0.82], with 48% sensitivity at 90% specificity). Conclusion Routinely measured maternal characteristics, known at the start of pregnancy, can be used in screening for pregnancies at risk of gestational hypertension or preeclampsia within a low‐risk multi‐ethnic population. Addition of combined second and third trimester placental ultrasound characteristics only improved screening for preeclampsia.
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Affiliation(s)
- Jan S Erkamp
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Liesbeth Duijts
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Paediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Irwin K M Reiss
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Paediatrics, Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Annemarie G M G J Mulders
- Department of Obstetrics & Gynaecology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics & Gynaecology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Romy Gaillard
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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23
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Adiyaman D, Konuralp Atakul B, Kuyucu M, Toklu G, Golbasi H, Koc A, Kaya OO, Ozdemir TR, Ekin A. Can fetal fractions in the cell-free DNA test predict the onset of fetal growth restriction? J Perinat Med 2020; 48:/j/jpme.ahead-of-print/jpm-2020-0010/jpm-2020-0010.xml. [PMID: 32242833 DOI: 10.1515/jpm-2020-0010] [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: 01/10/2020] [Accepted: 03/09/2020] [Indexed: 11/15/2022]
Abstract
Objective To investigate the possible predictive value of fetal fraction in the cell-free DNA (cfDNA) test in pregnancies with early- and late-onset fetal growth restriction (FGR). Methods This retrospective study comprised 247 women who were screened using the cfDNA test for aneuploidies during the first or second trimester and had deliveries at our institution from January 2016 to December 2019. The fetal fractions of women with early- (n = 14) and late-onset (n = 83) FGR and those with uncomplicated pregnancies (n = 150) were compared. Results The median fetal fractions for the early-onset FGR, late-onset FGR, and control groups were 5.7 [interquartile range (IQR) 2.65], 7 (IQR 5), and 7.35 (IQR 3.65), respectively. The fetal fractions were significantly lower in the early-onset FGR group than in the late-onset FGR and control groups (P = 0.047 and P = 0.037, respectively). There was no difference in fetal fractions between the late-onset FGR and control groups (P = 1.00). Conclusion As a placenta-related disease, early-onset FGR had lower fetal fractions in the cfDNA test than uncomplicated pregnancies. For clinical use, lower fetal fractions can contribute as a biomarker for screening asymptomatic women for possible placenta-related diseases, such as early-onset FGR. However, more studies are needed to define the "lower" limit.
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Affiliation(s)
- Duygu Adiyaman
- Tepecik Training and Research Hospital, Department of Obstetrics and Gynecology, Division of Perinatology, Izmir, Turkey
- present address: Güney Mah., 1140/1. Sk. No: 1, 35180 Yenişehir, Konak, Izmir, Turkey
| | - Bahar Konuralp Atakul
- Tepecik Training and Research Hospital, Department of Obstetrics and Gynecology, Division of Perinatology, Izmir, Turkey
| | - Melda Kuyucu
- Tepecik Training and Research Hospital, Department of Obstetrics and Gynecology, Division of Perinatology, Izmir, Turkey
| | - Gizem Toklu
- Tepecik Training and Research Hospital, Department of Obstetrics and Gynecology, Izmir, Turkey
| | - Hakan Golbasi
- Tepecik Training and Research Hospital, Department of Obstetrics and Gynecology, Division of Perinatology, Izmir, Turkey
| | - Altug Koc
- Dokuz Eylul University, Faculty of Medicine, Department of Medical Genetics, Izmir, Turkey
| | - Ozge Ozer Kaya
- Tepecik Training and Research Hospital, Genetic Diagnosis Center, Izmir, Turkey
| | - Taha Resid Ozdemir
- Tepecik Training and Research Hospital, Genetic Diagnosis Center, Izmir, Turkey
| | - Atalay Ekin
- Tepecik Training and Research Hospital, Department of Obstetrics and Gynecology, Division of Perinatology, Izmir, Turkey
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24
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Prior Preterm Birth and Birthweight Below the 5th Percentile are Independent Risk Factors for Recurrence of a Small for Gestational Age Neonate. MATERNAL-FETAL MEDICINE 2020. [DOI: 10.1097/fm9.0000000000000034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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