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Le Vu M, Cortina-Borja M, Wells JCK. Evaluating the Concept of Brain Sparing in a High Income Setting, Using Historical Records of Maternal Influenza or Syphilis Infection. Am J Hum Biol 2024:e24143. [PMID: 39180148 DOI: 10.1002/ajhb.24143] [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: 04/16/2024] [Revised: 07/18/2024] [Accepted: 07/21/2024] [Indexed: 08/26/2024] Open
Abstract
INTRODUCTION In the context of adverse in utero environments, the fetal brain might be preserved at the expense of other tissues. This trade-off, brain sparing, has not been studied in the context of maternal infection. We investigated cases of maternal syphilis in the early 20th century and influenza during the 1918-1920 pandemic, in the Swiss city of Lausanne, a relatively high-income setting. We tested the brain sparing hypothesis, that head circumference is protected at the expense of birth weight. METHODS A total of 8530 individual birth records from 1911 to 1922 from the University Maternity Hospital of Lausanne were used. We fitted generalized linear and additive linear models to explain how neonatal size varies under disease exposure. RESULTS Influenza reduced head circumference and birth weight among livebirths similarly, by -0.11 and -0.14 standard deviation (SD) units respectively. Conversely, for syphilis-exposed infants, head circumference was affected more than birth weight (-0.61 SD vs. -0.46 SD). Stillborn infants exposed to syphilis experienced a much greater reduction in head circumference (-1.92 SD) than liveborn infants. After adjustment for gestational age, these findings persisted in the case of influenza, but the effects of syphilis were reduced. Furthermore, half of syphilis-exposed infants were born before term, suggesting that lower infant size was partly mediated by shorter gestation. Nevertheless, head circumference among stillbirths exposed to syphilis was still substantially reduced, even after adjustment for gestational age (-1.26 SD). CONCLUSION Our findings do not support the brain sparing hypothesis. Moreover, the substantial reduction in head circumference among syphilis-exposed fetuses might help explain why a quarter of them were stillborn.
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Affiliation(s)
- Mathilde Le Vu
- Anthropometrics & Historical Epidemiology Group, Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
| | - Mario Cortina-Borja
- Population, Policy and Practice Research and Teaching Department, University College London, Great Ormond Street, Institute of Child Health, London, UK
| | - Jonathan C K Wells
- Childhood Nutrition Research Centre, Population, Policy and Practice Research and Teaching Department, University College London, Great Ormond Street, Institute of Child Health, London, UK
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Hassen TA, Harris ML, Shifti DM, Beyene T, Khan MN, Feyissa TR, Chojenta C. Effects of short inter-pregnancy/birth interval on adverse perinatal outcomes in Asia-Pacific region: A systematic review and meta-analysis. PLoS One 2024; 19:e0307942. [PMID: 39083535 PMCID: PMC11290688 DOI: 10.1371/journal.pone.0307942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 07/16/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Short inter-pregnancy or birth interval is associated with an increased risk of adverse perinatal outcomes. However, some emerging evidence questions this association and there are also inconsistencies among the existing findings. This study aimed to systematically review the evidence regarding the effect of short inter-pregnancy or birth intervals on adverse perinatal outcomes in the Asia-Pacific region. METHODS A comprehensive search of five databases was conducted targeting studies published between 2000 to 2023. Studies that reported on short inter-pregnancy or birth interval and examined adverse perinatal outcomes, such as low birthweight (LBW) preterm birth (PTB), small for gestational age (SGA), and neonatal mortality were included and appraised for methodological quality using the Joanna Briggs Institute critical appraisal tools. Three reviewers independently screened the studies and performed data extraction. Narrative synthesis and meta-analyses were conducted to summarise the key findings. RESULTS A total of 41 studies that fulfilled the inclusion criteria were included. A short-interpregnancy interval was associated with an increased risk of low birthweight (odds ratio [OR] = 1.65; 95%CI:1.39, 1.95), preterm birth (OR = 1.50; 95%CI: 1.35, 1.66), and small for gestational age (OR = 1.24; 95%CI:1.09, 1.41). We also found elevated odds of early neonatal mortality (OR = 1.91; 95%CI: 1.11, 3.29) and neonatal mortality (OR = 1.78; 95%CI: 1.25, 2.55) among women with short birth intervals. CONCLUSION This review indicates that both short inter-pregnancy and birth interval increased the risk of adverse perinatal outcomes. This underscores the importance of advocating for and implementing strategies to promote optimal pregnancy and birth spacing to reduce the occurrence of adverse perinatal outcomes. Reproductive health policies and programs need to be further strengthened and promote access to comprehensive family planning services and increase awareness about the importance of optimal pregnancy and birth spacing.
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Affiliation(s)
- Tahir Ahmed Hassen
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Melissa L Harris
- Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Desalegn Markos Shifti
- Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Faculty of Medicine, Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Tesfalidet Beyene
- Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Md Nuruzzaman Khan
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Trishal, Mymensingh, Bangladesh
| | - Tesfaye Regassa Feyissa
- Faculty of Health, Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, Princes Hwy, VIC, Australia
| | - Catherine Chojenta
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
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Shu C, Street K, Breton CV, Bastain TM, Wilson ML. A review of single-cell transcriptomics and epigenomics studies in maternal and child health. Epigenomics 2024; 16:775-793. [PMID: 38709139 PMCID: PMC11318716 DOI: 10.1080/17501911.2024.2343276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/11/2024] [Indexed: 05/07/2024] Open
Abstract
Single-cell sequencing technologies enhance our understanding of cellular dynamics throughout pregnancy. We outlined the workflow of single-cell sequencing techniques and reviewed single-cell studies in maternal and child health. We conducted a literature review of single cell studies on maternal and child health using PubMed. We summarized the findings from 16 single-cell atlases of the human and mammalian placenta across gestational stages and 31 single-cell studies on maternal exposures and complications including infection, obesity, diet, gestational diabetes, pre-eclampsia, environmental exposure and preterm birth. Single-cell studies provides insights on novel cell types in placenta and cell type-specific marks associated with maternal exposures and complications.
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Affiliation(s)
- Chang Shu
- Center for Genetic Epidemiology, Division of Epidemiology & Genetics, Department of Population & Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
| | - Kelly Street
- Division of Biostatistics, Department of Population & Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
| | - Carrie V Breton
- Division of Environmental Health, Department of Population & Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
| | - Theresa M Bastain
- Division of Environmental Health, Department of Population & Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
| | - Melissa L Wilson
- Division of Disease Prevention, Policy, & Global Health, Department of Population & Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles,CA USA
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Nosaka R, Ushida T, Kidokoro H, Kawaguchi M, Shiraki A, Iitani Y, Imai K, Nakamura N, Sato Y, Hayakawa M, Natsume J, Kajiyama H, Kotani T. Intrauterine exposure to chorioamnionitis and neuroanatomical alterations at term-equivalent age in preterm infants. Arch Gynecol Obstet 2024; 309:1909-1918. [PMID: 37178219 DOI: 10.1007/s00404-023-07064-y] [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: 12/15/2022] [Accepted: 05/01/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE Infants born to mothers with chorioamnionitis (CAM) are at increased risk of developing adverse neurodevelopmental disorders in later life. However, clinical magnetic resonance imaging (MRI) studies examining brain injuries and neuroanatomical alterations attributed to CAM have yielded inconsistent results. We aimed to determine whether exposure to histological CAM in utero leads to brain injuries and alterations in the neuroanatomy of preterm infants using 3.0- Tesla MRI at term-equivalent age. METHODS A total of 58 preterm infants born before 34 weeks of gestation at Nagoya University Hospital between 2010 and 2018 were eligible for this study (CAM group, n = 21; non-CAM group, n = 37). Brain injuries and abnormalities were assessed using the Kidokoro Global Brain Abnormality Scoring system. Gray matter, white matter, and subcortical gray matter (thalamus, caudate nucleus, putamen, pallidum, hippocampus, amygdala, and nucleus accumbens) volumes were evaluated using segmentation tools (SPM12 and Infant FreeSurfer). RESULTS The Kidokoro scores for each category and severity in the CAM group were comparable to those observed in the non-CAM group. White matter volume was significantly smaller in the CAM group after adjusting for covariates (postmenstrual age at MRI, infant sex, and gestational age) (p = 0.007), whereas gray matter volume was not significantly different. Multiple linear regression analyses revealed significantly smaller volumes in the bilateral pallidums (right, p = 0.045; left, p = 0.038) and nucleus accumbens (right, p = 0.030; left, p = 0.004) after adjusting for covariates. CONCLUSIONS Preterm infants born to mothers with histological CAM showed smaller volumes in white matter, pallidum, and nucleus accumbens at term-equivalent age.
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Affiliation(s)
- Rena Nosaka
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takafumi Ushida
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
- Division of Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan.
| | - Hiroyuki Kidokoro
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiro Kawaguchi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Division of Neurology, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Anna Shiraki
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukako Iitani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kenji Imai
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Noriyuki Nakamura
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
- Department of Obstetrics and Gynecology, Anjo Kosei Hospital, Anjo, Aichi, Japan
| | - Yoshiaki Sato
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Masahiro Hayakawa
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Jun Natsume
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Developmental Disability Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tomomi Kotani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
- Division of Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
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Le Vu M, Matthes KL, Brabec M, Riou J, Skrivankova VW, Hösli I, Rohrmann S, Staub K. Health of singleton neonates in Switzerland through time and crises: a cross-sectional study at the population level, 2007-2022. BMC Pregnancy Childbirth 2024; 24:218. [PMID: 38528502 DOI: 10.1186/s12884-024-06414-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/12/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Being exposed to crises during pregnancy can affect maternal health through stress exposure, which can in return impact neonatal health. We investigated temporal trends in neonatal outcomes in Switzerland between 2007 and 2022 and their variations depending on exposure to the economic crisis of 2008, the flu pandemic of 2009, heatwaves (2015 and 2018) and the COVID-19 pandemic. METHODS Using individual cross-sectional data encompassing all births occurring in Switzerland at the monthly level (2007-2022), we analysed changes in birth weight and in the rates of preterm birth (PTB) and stillbirth through time with generalized additive models. We assessed whether the intensity or length of crisis exposure was associated with variations in these outcomes. Furthermore, we explored effects of exposure depending on trimesters of pregnancy. RESULTS Over 1.2 million singleton births were included in our analyses. While birth weight and the rate of stillbirth have remained stable since 2007, the rate of PTB has declined by one percentage point. Exposure to the crises led to different results, but effect sizes were overall small. Exposure to COVID-19, irrespective of the pregnancy trimester, was associated with a higher birth weight (+12 grams [95% confidence interval (CI) 5.5 to 17.9 grams]). Being exposed to COVID-19 during the last trimester was associated with an increased risk of stillbirth (odds ratio 1.24 [95%CI 1.02 to 1.50]). Exposure to the 2008 economic crisis during pregnancy was not associated with any changes in neonatal health outcomes, while heatwave effect was difficult to interpret. CONCLUSION Overall, maternal and neonatal health demonstrated resilience to the economic crisis and to the COVID-19 pandemic in a high-income country like Switzerland. However, the effect of exposure to the COVID-19 pandemic is dual, and the negative impact of maternal infection on pregnancy is well-documented. Stress exposure and economic constraint may also have had adverse effects among the most vulnerable subgroups of Switzerland. To investigate better the impact of heatwave exposure on neonatal health, weekly or daily-level data is needed, instead of monthly-level data.
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Affiliation(s)
- Mathilde Le Vu
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
| | - Katarina L Matthes
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
| | - Marek Brabec
- Institute of Computer Science of the Czech Academy of Sciences, Prague, Czech Republic
| | - Julien Riou
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Veronika W Skrivankova
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Irene Hösli
- Department of Obstetrics and Gynaecology, University Hospital of Basel, Basel, Switzerland
| | - Sabine Rohrmann
- Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Kaspar Staub
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland.
- Swiss School of Public Health (SSPH+), Zurich, Switzerland.
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Marti DT, Bratosin F, Rosca O, Folescu R, Citu C, Ratiu A, Popa ZL. Impact of Genital Infections and Antibiotic Use on Incidence of Preterm Birth: A Retrospective Observational Study. Antibiotics (Basel) 2024; 13:240. [PMID: 38534675 DOI: 10.3390/antibiotics13030240] [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: 01/30/2024] [Revised: 03/02/2024] [Accepted: 03/05/2024] [Indexed: 03/28/2024] Open
Abstract
This study investigates the complex interplay among genital infections, antibiotic usage, and preterm birth. This study aims to identify common genital pathogens associated with preterm births, assess the impact of various antibiotic treatments on pregnancy outcomes, and understand antibiotic resistance patterns among these pathogens. This study included 71 pregnant women who experienced preterm birth and 94 women with genital infections who delivered at term. Various maternal characteristics, medical history, signs and symptoms, gestational weight, gestational age, type of birth, vaginal pH, Nugent scores, and vaginal flora were analyzed. Antibiotic resistance patterns of isolated microorganisms were also examined. The prevalence of sexually transmitted diseases (STDs) and genital herpes was significantly higher in the preterm group. Preterm births were associated with fever, pelvic pain, vaginal spotting, and fatigue. Vaginal pH levels and Nugent scores were significantly higher in the preterm group, indicating disturbed vaginal flora. The presence of Extended-Spectrum Beta-Lactamases (ESBLs) was a particularly strong risk factor, increasing by more than four times the odds of preterm birth (OR = 4.45, p = 0.001). Vancomycin-Resistant Enterococci (VRE) presence was another critical factor, with a four-fold increase in the odds of preterm birth (OR = 4.01, p = 0.034). The overall presence of Multidrug-Resistant (MDR) organisms significantly increased the odds of preterm birth (OR = 3.73, p = 0.001). Specific pathogens like Chlamydia trachomatis (OR = 3.12, p = 0.020) and Mycoplasma hominis (OR = 3.64, p = 0.006) were also identified as significant risk factors. Ureaplasma urealyticum also showed a significantly higher risk of preterm birth (OR = 2.76, p = 0.009). This study highlights the importance of screening for and treating genital infections during pregnancy, especially STDs and genital herpes, as they can significantly increase the risk of preterm birth. Additionally, the presence of specific microorganisms and antibiotic resistance patterns plays an essential role in preterm birth risk. Early detection and targeted antibiotic treatment may help mitigate this risk and improve pregnancy outcomes.
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Affiliation(s)
- Daniela Teodora Marti
- Clinical Analysis Laboratory, Emergency Clinical Hospital of Arad County, 310037 Arad, Romania
- Department of Biology and Life Sciences, Vasile Goldis University of Medicine, 310048 Arad, Romania
| | - Felix Bratosin
- Department of Infectious Diseases, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
- Doctoral School, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Ovidiu Rosca
- Department of Infectious Diseases, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
- Doctoral School, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Roxana Folescu
- Department of Family Medicine, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Cosmin Citu
- Department of Obstetrics and Gynecology, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Adrian Ratiu
- Department of Obstetrics and Gynecology, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Zoran Laurentiu Popa
- Department of Obstetrics and Gynecology, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
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Nakitanda AO, Odsbu I, Pasternak B, Karlsson P, Pazzagli L. Antibiotic use during pregnancy in Sweden: A nationwide utilization study covering 2007-2019. Acta Obstet Gynecol Scand 2024; 103:531-539. [PMID: 38108616 PMCID: PMC10867394 DOI: 10.1111/aogs.14741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/08/2023] [Accepted: 11/16/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Antibiotics are often prescribed during pregnancy. Assessing the current state of prenatal antibiotic use is therefore imperative for optimizing prescribing and identifying emerging research priorities. The study aimed to describe recent trends and patterns in antibiotic use during pregnancy among women who gave birth in Sweden, including user characteristics. MATERIAL AND METHODS Population-based descriptive study using linked nationwide registers. All pregnancies delivered in Sweden from 2007 to 2019 were included. Prevalence of use was defined as the percentage of pregnancies during which at least one prescription forantibiotics was filled. Temporal trends in the prevalence of antibiotic use by calendar year, trimester and weeks of gestation were assessed from time series graphs. RESULTS Prescriptions for systemic antibiotics were filled in 20.7% of 1 434 431 pregnancies overall, decreasing from 24.7% in 2007 to 18.0% in 2019. Phenoxymethylpenicillin (8.5%), pivmecillinam (6.5%), nitrofurantoin (4.7%), amoxicillin (1.6%) and cefadroxil (1.5%) use were the most prevalent. Their use decreased over the 13-year period, except for pivmecillinam, which increased from 4.0% to 7.4%. Prevalence of use was highest in the second trimester (9.5%), with weekly trends peaking at 13 and 34 weeks of gestation. Compared with non-users, antibiotic users more often belonged to the youngest and oldest age strata, carried multipleton pregnancies, had delivered before, had attained a lower education level and smoked in early pregnancy. A higher body mass index, asthma, chronic renal disease and diabetes mellitus were more prevalent among antibiotic users than among non-users. CONCLUSIONS Although outpatient antibiotic use during pregnancy in Sweden has been declining, one in five pregnancies was exposed to systemic antibiotics.
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Affiliation(s)
- Aya Olivia Nakitanda
- Center for Pharmacoepidemiology, Department of Medicine SolnaKarolinska InstitutetStockholmSweden
| | - Ingvild Odsbu
- Center for Pharmacoepidemiology, Department of Medicine SolnaKarolinska InstitutetStockholmSweden
- Department of Chronic DiseasesNorwegian Institute of Public HealthOsloNorway
| | - Björn Pasternak
- Clinical Epidemiology Division, Department of Medicine SolnaKarolinska InstitutetStockholmSweden
- Department of Epidemiology ResearchStatens Serum InstitutCopenhagenDenmark
| | - Pär Karlsson
- Center for Pharmacoepidemiology, Department of Medicine SolnaKarolinska InstitutetStockholmSweden
| | - Laura Pazzagli
- Clinical Epidemiology Division, Department of Medicine SolnaKarolinska InstitutetStockholmSweden
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Zou J, Anai S, Ota S, Ishitani S, Oginuma M, Ishitani T. Determining zebrafish dorsal organizer size by a negative feedback loop between canonical/non-canonical Wnts and Tlr4/NFκB. Nat Commun 2023; 14:7194. [PMID: 37938219 PMCID: PMC10632484 DOI: 10.1038/s41467-023-42963-3] [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: 01/25/2023] [Accepted: 10/26/2023] [Indexed: 11/09/2023] Open
Abstract
In vertebrate embryos, the canonical Wnt ligand primes the formation of dorsal organizers that govern dorsal-ventral patterns by secreting BMP antagonists. In contrast, in Drosophila embryos, Toll-like receptor (Tlr)-mediated NFκB activation initiates dorsal-ventral patterning, wherein Wnt-mediated negative feedback regulation of Tlr/NFκB generates a BMP antagonist-secreting signalling centre to control the dorsal-ventral pattern. Although both Wnt and BMP antagonist are conserved among species, the involvement of Tlr/NFκB and feedback regulation in vertebrate organizer formation remains unclear. By imaging and genetic modification, we reveal that a negative feedback loop between canonical and non-canonical Wnts and Tlr4/NFκB determines the size of zebrafish organizer, and that Tlr/NFκB and Wnts switch initial cue and feedback mediator roles between Drosophila and zebrafish. Here, we show that canonical Wnt signalling stimulates the expression of the non-canonical Wnt5b ligand, activating the Tlr4 receptor to stimulate NFκB-mediated transcription of the Wnt antagonist frzb, restricting Wnt-dependent dorsal organizer formation.
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Affiliation(s)
- Juqi Zou
- Department of Homeostatic Regulation, Division of Cellular and Molecular Biology, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka, 565-0871, Japan
| | - Satoshi Anai
- Yuuai Medical Center, Tomigusuku, Okinawa, 901-0224, Japan
| | - Satoshi Ota
- Genome Science Division, Research Center for Advanced Science and Technology, The University of Tokyo, Komaba 4-6-1, Meguro-ku, Tokyo, 153-8904, Japan
| | - Shizuka Ishitani
- Department of Homeostatic Regulation, Division of Cellular and Molecular Biology, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka, 565-0871, Japan
| | - Masayuki Oginuma
- Department of Homeostatic Regulation, Division of Cellular and Molecular Biology, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka, 565-0871, Japan
| | - Tohru Ishitani
- Department of Homeostatic Regulation, Division of Cellular and Molecular Biology, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka, 565-0871, Japan.
- Center for Infectious Disease Education and Research (CiDER), Osaka University, Suita, Osaka, 565-0871, Japan.
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Saint-Lary L, Benevent J, Damase-Michel C, Vayssière C, Leroy V, Sommet A. Adverse perinatal outcomes associated with prenatal exposure to protease-inhibitor-based versus non-nucleoside reverse transcriptase inhibitor-based antiretroviral combinations in pregnant women with HIV infection: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2023; 23:80. [PMID: 36717801 PMCID: PMC9885641 DOI: 10.1186/s12884-023-05347-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/04/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND About 1.3 million pregnant women lived with HIV and were eligible to receive antiretroviral therapy (ART) worldwide in 2021. The World Health Organization recommends protease inhibitors (PI)-based regimen as second or third-line during pregnancy. With remaining pregnant women exposed to PIs, there is still an interest to assess whether this treatment affects perinatal outcomes. Adverse perinatal outcomes after prenatal exposure to PI-based ART remain conflicting: some studies report an increased risk of preterm birth (PTB) and low-birth-weight (LBW), while others do not find these results. We assessed adverse perinatal outcomes associated with prenatal exposure to PI-based compared with non-nucleoside reverse transcriptase (NNRTI)-based ART. METHODS We performed a systematic review searching PubMed, Reprotox, Clinical Trial Registry (clinicaltrials.gov) and abstracts of HIV conferences between 01/01/2002 and 29/10/2021. We used Oxford and Newcastle-Ottawa scales to assess the methodological quality. Studied perinatal outcomes were spontaneous abortion, stillbirth, congenital abnormalities, PTB (< 37 weeks of gestation), very preterm birth (VPTB, < 32 weeks of gestation), LBW (< 2500 grs), very low-birth-weight (VLBW, < 1500 g), small for gestational age (SGA) and very small for gestational age (VSGA). The association between prenatal exposure to PI-based compared to NNRTI-based ART was measured for each adverse perinatal outcome using random-effect meta-analysis to estimate pooled relative risks (RR) and their corresponding 95% confidence intervals (CI). Pre-specified analyses were stratified according to country income and study quality assessment, and summarized when homogeneous. RESULTS Out of the 49,171 citations identified, our systematic review included 32 published studies, assessing 45,427 pregnant women. There was no significant association between prenatal exposure to PIs compared to NNRTIs for VPTB, LBW, SGA, stillbirth, and congenital abnormalities. However, it was inconclusive for PTB, and PI-based ART is significantly associated with an increased risk of VSGA (sRR 1.41 [1.08-1.84]; I2 = 0%) compared to NNRTIs. CONCLUSIONS We did not report any significant association between prenatal exposure to PIs vs NNRTIs-based regimens for most of the adverse perinatal outcomes, except for VSGA significantly increased (+ 41%). The evaluation of antiretroviral exposure on pregnancy outcomes remains crucial to fully assess the benefice-risk balance, when prescribing ART in women of reproductive potential with HIV. PROSPERO NUMBER CRD42022306896.
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Affiliation(s)
- Laura Saint-Lary
- grid.15781.3a0000 0001 0723 035XInserm U1295, CERPOP (Center for Epidemiology and Research in POPulation Health), Team SPHERE (Study of Perinatal, Paediatric and Adolescent Health: Epidemiological Research and Evaluation), Université Paul Sabatier Toulouse 3, 37 Allées Jules Guesde, 31000 Toulouse, France
| | - Justine Benevent
- grid.15781.3a0000 0001 0723 035XInserm U1295, CERPOP (Center for Epidemiology and Research in POPulation Health), Team SPHERE (Study of Perinatal, Paediatric and Adolescent Health: Epidemiological Research and Evaluation), Université Paul Sabatier Toulouse 3, 37 Allées Jules Guesde, 31000 Toulouse, France ,grid.411175.70000 0001 1457 2980Service de Pharmacologie Clinique, CHU de Toulouse, Université Toulouse 3, Toulouse, France
| | - Christine Damase-Michel
- grid.15781.3a0000 0001 0723 035XInserm U1295, CERPOP (Center for Epidemiology and Research in POPulation Health), Team SPHERE (Study of Perinatal, Paediatric and Adolescent Health: Epidemiological Research and Evaluation), Université Paul Sabatier Toulouse 3, 37 Allées Jules Guesde, 31000 Toulouse, France ,grid.411175.70000 0001 1457 2980Service de Pharmacologie Clinique, CHU de Toulouse, Université Toulouse 3, Toulouse, France
| | - Christophe Vayssière
- grid.15781.3a0000 0001 0723 035XInserm U1295, CERPOP (Center for Epidemiology and Research in POPulation Health), Team SPHERE (Study of Perinatal, Paediatric and Adolescent Health: Epidemiological Research and Evaluation), Université Paul Sabatier Toulouse 3, 37 Allées Jules Guesde, 31000 Toulouse, France ,grid.414282.90000 0004 0639 4960Service de Gynécologie-Obstétrique, CHU de Toulouse Purpan, Toulouse, France
| | - Valériane Leroy
- grid.15781.3a0000 0001 0723 035XInserm U1295, CERPOP (Center for Epidemiology and Research in POPulation Health), Team SPHERE (Study of Perinatal, Paediatric and Adolescent Health: Epidemiological Research and Evaluation), Université Paul Sabatier Toulouse 3, 37 Allées Jules Guesde, 31000 Toulouse, France
| | - Agnès Sommet
- grid.15781.3a0000 0001 0723 035XInserm U1295, CERPOP (Center for Epidemiology and Research in POPulation Health), Team SPHERE (Study of Perinatal, Paediatric and Adolescent Health: Epidemiological Research and Evaluation), Université Paul Sabatier Toulouse 3, 37 Allées Jules Guesde, 31000 Toulouse, France ,grid.411175.70000 0001 1457 2980Service de Pharmacologie Clinique, CHU de Toulouse, Université Toulouse 3, Toulouse, France
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10
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Pregnancy outcomes following maternal macrolide use: A systematic review and meta-analysis. Reprod Toxicol 2023; 115:124-146. [PMID: 36549458 DOI: 10.1016/j.reprotox.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/04/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
To determine whether gestational use of all or specific macrolides (azithromycin, clarithromycin, roxithromycin or erythromycin) lead to an increase in rates of overall major congenital malformations, organ-specific malformations, and other adverse pregnancy outcomes in infants. PubMed/MEDLINE, Cochrane Central Register of Controlled Trials and Reprotox® databases were searched. Dichotomous outcomes or calculated log odds ratios and standard errors from observational studies are combined using the random-effects method in Review Manager 5.3. No significant increased risks for major congenital malformation (OR 1.06 [95% CI 0.99, 1.13]) and congenital heart defect (OR 1.05 [95% CI 0.92, 1.19]) following all macrolides use during the first trimester were detected. Prenatal azithromycin use was associated with a significantly increased risk of major congenital malformations in the analysis of cohort studies (OR 1.21 [95% CI 1.08-1.36]). This significance was also present in the sensitivity analysis. There were no statistically significant associations between the risk of organ specific malformations and all or specific macrolide exposures except for the decreased risk in hypospadias following erythromycin use in the meta-analysis of case-control studies (OR 0.38 [95% CI 0.18, 0.81]. Also, a significant 1.5-fold increased risk for spontaneous abortion following macrolide use was detected. A slight yet significantly increased rate of major congenital malformation with azithromycin exposure during pregnancy may be associated with maternal confounders. Nevertheless, level II ultrasound can be suggested following maternal azithromycin use during the first trimester. Future studies should take into account the inclusion of a disease-matched control group and accurate classification of the malformations.
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11
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Infection of the murine placenta by Listeria monocytogenes induces sex-specific responses in the fetal brain. Pediatr Res 2022; 93:1566-1573. [PMID: 36127406 DOI: 10.1038/s41390-022-02307-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/06/2022] [Accepted: 08/30/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Epidemiological data indicate that prenatal infection is associated with an increased risk of several neurodevelopmental disorders in the progeny. These disorders display sex differences in presentation. The role of the placenta in the sex-specificity of infection-induced neurodevelopmental abnormalities is not well-defined. We used an imaging-based animal model of the bacterial pathogen Listeria monocytogenes to identify sex-specific effects of placental infection on neurodevelopment of the fetus. METHODS Pregnant CD1 mice were infected with a bioluminescent strain of Listeria on embryonic day 14.5 (E14.5). Excised fetuses were imaged on E18.5 to identify the infected placentas. The associated fetal brains were analyzed for gene expression and altered brain structure due to infection. The behavior of adult offspring affected by prenatal Listeria infection was analyzed. RESULTS Placental infection induced sex-specific alteration of gene expression patterns in the fetal brain and resulted in abnormal cortical development correlated with placental infection levels. Furthermore, male offspring exhibited abnormal social interaction, whereas females exhibited elevated anxiety. CONCLUSION Placental infection by Listeria induced sex-specific abnormalities in neurodevelopment of the fetus. Prenatal infection also affected the behavior of the offspring in a sex-specific manner. IMPACT Placental infection with Listeria monocytogenes induces sexually dichotomous gene expression patterns in the fetal brains of mice. Abnormal cortical lamination is correlated with placental infection levels. Placental infection results in autism-related behavior in male offspring and heightened anxiety levels in female offspring.
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12
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Kondracki AJ, Li W, Bursac Z, Mokhtari M, Reddick B, Barkin JL. Interaction Effects of Maternal Sexually Transmitted Infections with Prenatal Care Utilization Status on Preterm Birth and Low Birthweight: U.S. National Data. J Clin Med 2022; 11:jcm11175184. [PMID: 36079115 PMCID: PMC9456665 DOI: 10.3390/jcm11175184] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022] Open
Abstract
This case-control study aimed to test interaction between the most common sexually transmitted infections (STIs) (i.e., chlamydia, gonorrhea, and syphilis) and prenatal care (PNC) utilization status on preterm birth (PTB) (<37 weeks gestation) and low birthweight (LBW) (<2500 g). We used data of participants with singleton live births (N = 3,418,028) from the 2019 United States National Vital Statistics System. There were 280,206 participants in the PTB group and 3,137,822 in the control group, and 221,260 participants in the LBW group and 3,196,768 in the control group. Nearly 1.9% of the participants had chlamydia, 0.3% had gonorrhea, and 0.2% had syphilis. Interaction effects of STIs with PNC utilization status on the risk of PTB and LBW were tested on the multiplicative and additive scales. Using measures of the relative excess risk of interaction (RERI), the attributable proportion of interaction (AP), and the synergy index (S), we observed the highest significant synergistic interaction between syphilis and inadequate PNC utilization increasing the risk of PTB (RERI 2.12, AP 38%, and SI 1.88), and between gonorrhea and inadequate PNC utilization increasing the risk of LBW (RERI 1.03, AP 28%, and SI 1.64). Findings from this study help improve our understanding of disease etiology and inform prevention planning.
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Affiliation(s)
- Anthony J. Kondracki
- Department of Community Medicine, Mercer University School of Medicine, Macon, GA 31207, USA
- Correspondence:
| | - Wei Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Zoran Bursac
- Department of Biostatistics, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL 33199, USA
| | - Manouchehr Mokhtari
- Department of Family Science, University of Maryland School of Public Health, College Park, MD 20742, USA
| | - Bonzo Reddick
- Department of Community Medicine, Mercer University School of Medicine, Macon, GA 31207, USA
| | - Jennifer L. Barkin
- Department of Community Medicine, Mercer University School of Medicine, Macon, GA 31207, USA
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13
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Associations of gestational age with gyrification and neurocognition in healthy adults. Eur Arch Psychiatry Clin Neurosci 2022; 273:467-479. [PMID: 35904633 PMCID: PMC10070217 DOI: 10.1007/s00406-022-01454-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 06/20/2022] [Indexed: 11/03/2022]
Abstract
Epidemiological studies have shown that gestational age and birth weight are linked to cognitive performance in adults. On a neurobiological level, this effect is hypothesized to be related to cortical gyrification, which is determined primarily during fetal development. The relationships between gestational age, gyrification and specific cognitive abilities in adults are still poorly understood. In 542 healthy participants, gyrification indices were calculated from structural magnetic resonance imaging T1 data at 3 T using CAT12. After applying a battery of neuropsychological tests, neuropsychological factors were extracted with a factor analysis. We conducted regressions to test associations between gyrification and gestational age as well as birth weight. Moderation analyses explored the relationships between gestational age, gyrification and neuropsychological factors. Gestational age is significantly positively associated with cortical folding in the left supramarginal, bilaterally in the superior frontal and the lingual cortex. We extracted two neuropsychological factors that describe language abilities and working memory/attention. The association between gyrification in the left superior frontal gyrus and working memory/attention was moderated by gestational age. Further, the association between gyrification in the left supramarginal cortex and both, working memory/attention as well as language, were moderated by gestational age. Gyrification is associated with gestational age and related to specific neuropsychological outcomes in healthy adulthood. Implications from these findings for the cortical neurodevelopment of cognitive domains and mental health are discussed.
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14
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Everett C, Kye Y, Panda S, Singh AP. Outcome of Neonates Born to SARS-CoV-2-Infected Mothers: Tertiary Care Experience at US–Mexico Border. CHILDREN 2022; 9:children9071033. [PMID: 35884017 PMCID: PMC9319885 DOI: 10.3390/children9071033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/29/2022] [Accepted: 07/10/2022] [Indexed: 11/16/2022]
Abstract
Background: SARS-CoV-2 has affected millions of people around the world. There is a need for data on the effects of this infection on neonates admitted to neonatal intensive care (NICU) units born to infected mothers. Here, we decided to analyze neonates born to mothers who tested positive for SARS-CoV-2 and admitted to NICU compared with neonates who remained with their mothers. Methods: All pregnant mothers who tested positive for SARS-CoV-2 during pregnancy between 1 June 2020 and 30 June 2021, along with all neonates born to infected pregnant women, were included in this study. We then compared the neonates admitted to NICU with the neonates who remained with their mothers. Results: Eighty-eight neonates were born to eighty-eight SARS-CoV-2-positive mothers. Fifteen of these neonates were admitted to the NICU. The mothers of the neonates admitted to the NICU were more likely to have received prenatal care outside of the USA. In addition, the neonates admitted to the NICU were more likely to have needed significant resuscitation at birth. Respiratory distress was the most common reason for NICU admission. None of the NICU-admitted neonates were SARS-CoV-2-positive. There were no differences between the values of the complete blood counts, morbidities at discharge, lengths of hospitalization, or rates of readmission to hospital in the first month of life observed between the two groups. Conclusions: The vertical transmission of the SARS-CoV-2 infection remains rare; there was no difference in the hospital outcomes in the neonates of infected mothers. Unlike other studies, which show an increased tendency toward preterm birth in SARS-CoV-2-positive mothers, our study indicates no such association.
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Affiliation(s)
- Colleen Everett
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79912, USA; (C.E.); (Y.K.); (S.P.)
| | - Yae Kye
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79912, USA; (C.E.); (Y.K.); (S.P.)
| | - Sanjeet Panda
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79912, USA; (C.E.); (Y.K.); (S.P.)
- El Paso Children’s Hospital, 4800 Alberta Ave, El Paso, TX 79905, USA
| | - Ajay Pratap Singh
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79912, USA; (C.E.); (Y.K.); (S.P.)
- El Paso Children’s Hospital, 4800 Alberta Ave, El Paso, TX 79905, USA
- Correspondence: ; Tel.: +1-915-215-5749; Fax: +1-915-545-6975
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15
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Dwivedi N, Mahdi AA, Deo S, Ahmad MK, Kumar D. Assessment of genotoxicity and oxidative stress in pregnant women contaminated to organochlorine pesticides and its correlation with pregnancy outcome. ENVIRONMENTAL RESEARCH 2022; 204:112010. [PMID: 34520748 DOI: 10.1016/j.envres.2021.112010] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 06/13/2023]
Abstract
The present study was aimed to assess the correlation between transplacental transfer of xenobiotics and resulting biochemical alterations (including genotoxicity and oxidative stress) in non-occupational pregnant women of North India along with the effect on pregnancy outcomes. Maternal and cord blood samples were collected from 221 healthy mother-infant couples and divided according to their gestational age and birth weight. Genotoxic effects in mother and cord blood were examined using comet assay. The quantitative determination of Organo-chlorine pesticides in blood serum of study population was carried out using gas chromatography-mass spectrometry (GC-MS). Notably higher Organo-chlorine pesticides levels were observed in maternal blood of preterm than term subjects for almost all of the compounds detected, with the maximum concentration found for aldrin (3.26 mg/l) in maternal blood and dieldrin (2.69 mg/l) in cord blood. The results showed a significant increment in olive tail moment, tail full length, catalase, super-oxide dismutase, and malondialdehyde levels whereas lower glutathione reductase and peroxidase were found in preterm babies when compared with term group and it varied in the order: maternal blood > cord blood. A clear trend was observed for preterm babies with their lower birth weight and cesarean mode of delivery. Therefore, reduction in birth weight in newborns may be the consequence of increased oxidative damage and genotoxicity brought about by pesticides and these markers could be employed for early detection of pesticides related ailments and toxicities. To the best of our knowledge, this was a pioneering study and it may help to increase our knowledge with regard to xenobiotic exposure in biological system and the need for stringent guidelines for agricultural use of pesticides.
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Affiliation(s)
- Naina Dwivedi
- Department of Biochemistry, King George's Medical University, Lucknow, 226003, India
| | - Abbas Ali Mahdi
- Department of Biochemistry, King George's Medical University, Lucknow, 226003, India.
| | - Sujata Deo
- Department of Obstetrics and Gynaecology, King George's Medical University, Lucknow, 226003, India
| | - Mohammad Kaleem Ahmad
- Department of Biochemistry, King George's Medical University, Lucknow, 226003, India
| | - Durgesh Kumar
- Department of Biochemistry, King George's Medical University, Lucknow, 226003, India
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16
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Jash S, Sharma S. Pathogenic Infections during Pregnancy and the Consequences for Fetal Brain Development. Pathogens 2022; 11:pathogens11020193. [PMID: 35215136 PMCID: PMC8877441 DOI: 10.3390/pathogens11020193] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/21/2022] [Accepted: 01/27/2022] [Indexed: 12/10/2022] Open
Abstract
Pathogens comprised of viruses, bacteria, gut microbiome, and parasites are a leading cause of ever-emerging diseases in humans. Studying pathogens for their ability to cause diseases is a topic of critical discussion among scientists and pharmaceutical centers for effective drug development that diagnose, treat, and prevent infection-associated disorders. Pathogens impact health either directly by invading the host or by eliciting an acute inflammatory immune response. This paradigm of inflammatory immune responses is even more consequential in people who may be immunocompromised. In this regard, pregnancy offers an altered immunity scenario, which may allow the onset of severe diseases. Viruses, such as Influenza, HIV, and now SARS-CoV-2, associated with the COVID-19 pandemic, raise new concerns for maternal and fetal/neonatal health. Intrauterine bacterial and parasitic infections are also known to impact pregnancy outcomes and neonatal health. More importantly, viral and bacterial infections during pregnancy have been identified as a common contributor to fetal brain development defects. Infection-mediated inflammatory uterine immune milieu is thought to be the main trigger for causing poor fetal brain development, resulting in long-term cognitive impairments. The concept of in utero programming of childhood and adult disorders has revolutionized the field of neurodevelopment and its associated complications. Recent findings in mice and humans clearly support the idea that uterine immunity during pregnancy controls the health trajectory of the child and considerably influences the cognitive function and mental health. In this review, we focus on the in utero programming of autism spectrum disorders (ASD) and assess the effects of pathogens on the onset of ASD-like symptoms.
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17
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Fabre C, Pauly V, Baumstarck K, Etchecopar-Etchart D, Orleans V, Llorca PM, Blanc J, Lancon C, Auquier P, Boyer L, Fond G. Pregnancy, delivery and neonatal complications in women with schizophrenia: a national population-based cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2021; 10:100209. [PMID: 34806069 PMCID: PMC8589714 DOI: 10.1016/j.lanepe.2021.100209] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Existing studies evaluating the association between schizophrenia and complications associated with pregnancy, delivery and neonatal outcomes are based on data prior to 2014 and have reported heterogeneous results. The objective of our study was to determine whether pregnant women with schizophrenia were at increased risk of pregnancy, delivery and neonatal complications compared with women without severe mental disorders. Methods We performed a population-based cohort study of all singleton deliveries in France between Jan. 1, 2015, and Dec. 31, 2019. We divided this population into cases (i.e., women with schizophrenia) and controls (i.e., women without a diagnosis of severe mental disorder). Cases and controls were matched (1:4) inside the same hospital and the same year by age, social deprivation, parity, smoking, alcohol and substance addictions, malnutrition, obesity, and comorbidities. Univariate and multivariate models with odds ratios and 95% confidence intervals (ORs [95% CIs]) were used to estimate the association between schizophrenia and 24 pregnancy, delivery and neonatal outcomes. Findings Over 5 years, 3,667,461 singleton deliveries were identified, of which 3,108 occurred in women with schizophrenia. Compared to controls, women with schizophrenia were found to be older; have more frequent smoking, alcohol and substance addictions; suffer from obesity, diabetes and chronic obstructive pulmonary disease; and often be hospitalized in tertiary maternity hospitals. Compared to matched controls, women with schizophrenia had more pregnancy complications (adjusted OR=1.41[95%CI 1.31-1.51]) (i.e., gestational diabetes, gestational hypertension, genito-urinary infection, intrauterine growth retardation and threatened preterm labour). They had more delivery complications (aOR=1.18[95%CI 1.09 1.29]) with more still births/medical abortions (aOR=2.17[95%CI 1.62-2.90]) and caesarean sections (aOR=1.15[95%CI 1.05-1.25]). Newborns of women with schizophrenia had more neonatal complications (aOR=1.38[95%CI 1.27-1.50]) with more born preterm (aOR=1.64[95%CI1.42 -1.90]), small for gestational age (aOR=1.34[95%CI 1.19-1.50]) and low birth weight (aOR=1.75[95%CI 1.53-2.00]). Interpretation Our results highlight the importance of health disparities between pregnant women with and without schizophrenia, as well as in their newborns. Our study calls for health policy interventions during and before pregnancy, including proportionate intensified care to the level of needs, effective case management and preventive and social determinant approaches. Funding No funding.
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Affiliation(s)
- Cyprien Fabre
- Aix-Marseille Univ., CEReSS - Health Service Research and Quality of Life Center, Marseille, France.,Department of Medical Information, Assistance Publique - Hôpitaux Marseille, Marseille, France.,Department of Epidemiology and Health Economics, Assistance Publique - Hôpitaux Marseille, Marseille, France
| | - Vanessa Pauly
- Aix-Marseille Univ., CEReSS - Health Service Research and Quality of Life Center, Marseille, France.,Department of Medical Information, Assistance Publique - Hôpitaux Marseille, Marseille, France
| | - Karine Baumstarck
- Aix-Marseille Univ., CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | | | - Veronica Orleans
- Department of Medical Information, Assistance Publique - Hôpitaux Marseille, Marseille, France
| | - Pierre-Michel Llorca
- Department of Psychiatry, CHU Clermont-Ferrand, Clermont-Ferrand, France.,FondaMental Fondation, Creteil, France
| | - Julie Blanc
- Aix-Marseille Univ., CEReSS - Health Service Research and Quality of Life Center, Marseille, France.,Department of Obstetrics and Gynaecology, APHM, Nord Hospital, Marseille, France
| | - Christophe Lancon
- Aix-Marseille Univ., CEReSS - Health Service Research and Quality of Life Center, Marseille, France.,Department of Psychiatry, Assistance Publique - Hôpitaux Marseille, Marseille, France
| | - Pascal Auquier
- Aix-Marseille Univ., CEReSS - Health Service Research and Quality of Life Center, Marseille, France.,Department of Epidemiology and Health Economics, Assistance Publique - Hôpitaux Marseille, Marseille, France
| | - Laurent Boyer
- Aix-Marseille Univ., CEReSS - Health Service Research and Quality of Life Center, Marseille, France.,Department of Medical Information, Assistance Publique - Hôpitaux Marseille, Marseille, France.,Department of Epidemiology and Health Economics, Assistance Publique - Hôpitaux Marseille, Marseille, France.,FondaMental Fondation, Creteil, France
| | - Guillaume Fond
- Aix-Marseille Univ., CEReSS - Health Service Research and Quality of Life Center, Marseille, France.,Department of Medical Information, Assistance Publique - Hôpitaux Marseille, Marseille, France.,Department of Epidemiology and Health Economics, Assistance Publique - Hôpitaux Marseille, Marseille, France.,Department of Obstetrics and Gynaecology, APHM, Nord Hospital, Marseille, France.,FondaMental Fondation, Creteil, France
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18
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Johnson LJ, Azari S, Webb A, Zhang X, Gavrilin MA, Marshall JM, Rood K, Seveau S. Human Placental Trophoblasts Infected by Listeria monocytogenes Undergo a Pro-Inflammatory Switch Associated With Poor Pregnancy Outcomes. Front Immunol 2021; 12:709466. [PMID: 34367171 PMCID: PMC8346206 DOI: 10.3389/fimmu.2021.709466] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/05/2021] [Indexed: 12/21/2022] Open
Abstract
The placenta controls the growth of the fetus and ensures its immune protection. Key to these functions, the syncytiotrophoblast (SYN) is a syncytium formed by fusion of underlying mononuclear trophoblasts. The SYN covers the placental surface and is bathed in maternal blood to mediate nutritional and waste exchanges between the mother and fetus. The bacterial pathogen Listeria monocytogenes breaches the trophoblast barrier and infects the placental/fetal unit resulting in poor pregnancy outcomes. In this work, we analyzed the L. monocytogenes intracellular lifecycle in primary human trophoblasts. In accordance with previous studies, we found that the SYN is 20-fold more resistant to infection compared to mononuclear trophoblasts, forming a protective barrier to infection at the maternal interface. We show for the first time that this is due to a significant reduction in L. monocytogenes uptake by the SYN rather than inhibition of the bacterial intracellular division or motility. We here report the first transcriptomic analysis of L. monocytogenes-infected trophoblasts (RNA sequencing). Pathway analysis showed that infection upregulated TLR2, NOD-like, and cytosolic DNA sensing pathways, as well as downstream pro-inflammatory circuitry (NF-κB, AP-1, IRF4, IRF7) leading to the production of mediators known to elicit the recruitment and activation of maternal leukocytes (IL8, IL6, TNFα, MIP-1). Signature genes associated with poor pregnancy outcomes were also upregulated upon infection. Measuring the release of 54 inflammatory mediators confirmed the transcriptomic data and revealed sustained production of tolerogenic factors (IL-27, IL-10, IL-1RA, TSLP) despite infection. Both the SYN and mononuclear trophoblasts produced cytokines, but surprisingly, some cytokines were predominantly produced by the SYN (IL-8, IL-6) or by non-fused trophoblasts (TNFα). Collectively, our data support that trophoblasts act as placental gatekeepers that limit and detect L. monocytogenes infection resulting in a pro-inflammatory response, which may contribute to the poor pregnancy outcomes if the pathogen persists.
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Affiliation(s)
- Lauren J Johnson
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH, United States.,Department of Microbiology, The Ohio State University, Columbus, OH, United States
| | - Siavash Azari
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH, United States.,Department of Microbiology, The Ohio State University, Columbus, OH, United States
| | - Amy Webb
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States
| | - Xiaoli Zhang
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, OH, United States
| | - Mikhail A Gavrilin
- Pulmonary, Critical Care and Sleep Medicine Division, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Joanna M Marshall
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH, United States
| | - Kara Rood
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, The Ohio State University, Columbus, OH, United States
| | - Stephanie Seveau
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH, United States.,Department of Microbiology, The Ohio State University, Columbus, OH, United States.,Infectious Diseases Institute, The Ohio State University, Columbus, OH, United States
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19
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Fennell C, Diseko M, Zash R, Mayondi G, Mabuta J, Mmalane M, Davey S, Luckett R, Morroni C, Dintwa EN, Lockman S, Makhema J, Caniglia E, Shapiro R. The Impact of Syndromic Management of Vaginal Discharge Syndrome on Adverse Birth Outcomes in Botswana. Open Forum Infect Dis 2021; 8:ofab366. [PMID: 34381845 PMCID: PMC8351807 DOI: 10.1093/ofid/ofab366] [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: 01/07/2021] [Accepted: 07/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background Vaginal discharge syndrome (VDS) is a common clinical diagnosis during pregnancy in Botswana; it is treated with broad-spectrum antibiotics using a syndromic approach. We evaluated associations between the syndromic management of VDS and adverse birth outcomes. Methods The Tsepamo Study performs birth outcomes surveillance at government hospitals throughout Botswana. Obstetric record data collected from August 2014 to March 2019 were analyzed. Chi-square tests were conducted to compare proportions of maternal characteristics and infant outcomes. To avoid immortal time bias, all analyses were conducted among women who presented to care before 24 weeks gestation, with VDS categorized as present or absent by 24 weeks gestation. Log-binomial regression models were generated to determine associations between treated VDS and infant outcomes. Results VDS was diagnosed in 36 731 (30.7%) pregnant women, of whom 33 328 (90.7%) received antibiotics. Adjusted analyses yielded a harmful association between treated VDS and very preterm delivery (adjusted risk ratio, 1.11; 95% CI, 1.02-1.21). This association remained when restricting to women with VDS who received the recommended antibiotic treatment regimen. Sensitivity analyses produced nonsignificant associations when women with treated VDS were compared with women without VDS who received antibiotics for other indications. Conclusions A clinical diagnosis of VDS is common among pregnant women in Botswana, and the majority receive antibiotics in pregnancy. Although analyses of VDS occurring later in pregnancy are precluded by immortal time bias, a modest association between treated VDS and very preterm delivery was observed among women diagnosed with VDS by 24 weeks gestation.
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Affiliation(s)
- Christina Fennell
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Modeigi Diseko
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana
| | - Rebecca Zash
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana.,Division of Infectious Disease, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Gloria Mayondi
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana
| | - Judith Mabuta
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana
| | - Mompati Mmalane
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana
| | - Sonya Davey
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana.,Department of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rebecca Luckett
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana.,Scottish Livingston Hospital, Molepolole, Botswana.,Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Obstetrics and Gynecology, University of Botswana, Gaborone, Botswana
| | - Chelsea Morroni
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana.,Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Eldah N Dintwa
- Botswana Ministry of Health and Wellness, Gaborone, Botswana
| | - Shahin Lockman
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana.,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Joseph Makhema
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana.,Division of Infectious Disease, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Ellen Caniglia
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Roger Shapiro
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana.,Division of Infectious Disease, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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20
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Terzic M, Aimagambetova G, Terzic S, Radunovic M, Bapayeva G, Laganà AS. Periodontal Pathogens and Preterm Birth: Current Knowledge and Further Interventions. Pathogens 2021; 10:pathogens10060730. [PMID: 34207831 PMCID: PMC8227634 DOI: 10.3390/pathogens10060730] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/05/2021] [Accepted: 05/24/2021] [Indexed: 12/03/2022] Open
Abstract
Preterm labor is defined as a birth before 37 weeks of gestation and occurs in 5–20% of pregnancies. Preterm labor, as multifactorial entity associated with a high risk of neonatal morbidity and mortality, is influenced by maternal, fetal and environmental factors. Microbiological studies suggest that infectious pathogens may account for 25–40% of preterm birth. Infections of different sites, like genital, urinary tract infections, and pneumonia, are linked to the preterm labor. The most recent epidemiological studies consistently report that maternal periodontal disease is associated with preterm delivery, as well as the association between the presence of pathogenic oral bacteria in the placenta and adverse pregnancy outcomes. On the other hand, some previously published papers found periodontal bacteria in placentas of term pregnancies. In spite of a huge research done on the topic, both experimental and clinical, there are many controversial opinions about the role of periodontal infections in preterm birth. Thus, this comprehensive review addresses this very important topic and evaluates novel strategies of preventive and therapeutic approaches.
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Affiliation(s)
- Milan Terzic
- Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan 010000, Kazakhstan; (M.T.); (S.T.)
- Clinical Academic Department of Women’s Health, National Research Center of Mother and Child Health, University Medical Center, Nur-Sultan 010000, Kazakhstan;
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Gulzhanat Aimagambetova
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Nur-Sultan 010000, Kazakhstan
- Correspondence:
| | - Sanja Terzic
- Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan 010000, Kazakhstan; (M.T.); (S.T.)
| | - Milena Radunovic
- Laboratory for Microbiology, School of Dental Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Gauri Bapayeva
- Clinical Academic Department of Women’s Health, National Research Center of Mother and Child Health, University Medical Center, Nur-Sultan 010000, Kazakhstan;
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy;
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21
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Campillo JT, Chabot EB, Awaca-Uvon NP, Tambwe JP, Kuyangisa-Simuna G, Boussinesq M, Chesnais CB, Pion SD. Effect of Lymphatic Filariasis and Hookworm Infection on Pregnancy Course and Outcome in Women Living in the Democratic Republic of the Congo. Am J Trop Med Hyg 2021; 104:2074-2081. [PMID: 33939636 PMCID: PMC8176502 DOI: 10.4269/ajtmh.20-1422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/29/2021] [Indexed: 11/26/2022] Open
Abstract
Little is known about the effect of helminth infections on the natural gynecological and pregnancy course. Our goal was to assess the relationship between Wuchereria bancrofti and hookworm (HW) infections with pregnancy course and outcome in a group of 82 women living in a rural area of the Democratic Republic of the Congo. Demographics and information on gynecological and obstetrical histories were collected retrospectively with standardized questionnaires. Wuchereria bancrofti and HW infections were diagnosed using a filarial antigen-detection test and the Kato-Katz method, respectively. Analyses consisted of multivariable logistic regressions adjusting for age, number of deliveries, and history of anthelmintic treatment (HAHT). The median age of study participants was 35 (interquartile range [IQR]: 30-44) years, and the median number of deliveries was five (IQR: 3-7). Wuchereria bancrofti and HW infection rates were 44.5% and 43.3%, respectively. Filarial antigenemia and HW infection were not significantly associated with the number of deliveries. The proportions of women with a history of pregnancy resulting in neonatal death, miscarriage, premature birth, and postpartum hemorrhage were 56%, 44%, 23%, and 36%, respectively. History of pregnancy associated with neonatal death was less frequent in women with HAHT, tended to be more frequent in women with filarial antigenemia, and was not associated with HW infection. None of the three other pregnancy events studied (miscarriage, premature birth, and postpartum hemorrhage) were associated with filarial antigenemia or HW infection. The positive association found between HAHT and lower risk of neonatal death warrants investigation in larger groups of women.
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Affiliation(s)
- Jérémy T Campillo
- 1UMI 233, Institut de Recherche pour le Développement (IRD), INSERM Unité 1175 and University of Montpellier, Montpellier, France
| | - Emmanuel B Chabot
- 1UMI 233, Institut de Recherche pour le Développement (IRD), INSERM Unité 1175 and University of Montpellier, Montpellier, France
- 2UMR1027, Institut National de la Santé et de la Recherche Nationale (Inserm) and University of Toulouse, Toulouse, France
| | - Naomi-Pitchouna Awaca-Uvon
- 3Programme National de Lutte contre les Maladies Tropicales Négligées à Chimiothérapie Préventive, Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo
| | - Jean-Paul Tambwe
- 3Programme National de Lutte contre les Maladies Tropicales Négligées à Chimiothérapie Préventive, Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo
| | - Godefroy Kuyangisa-Simuna
- 3Programme National de Lutte contre les Maladies Tropicales Négligées à Chimiothérapie Préventive, Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo
| | - Michel Boussinesq
- 1UMI 233, Institut de Recherche pour le Développement (IRD), INSERM Unité 1175 and University of Montpellier, Montpellier, France
| | - Cédric B Chesnais
- 1UMI 233, Institut de Recherche pour le Développement (IRD), INSERM Unité 1175 and University of Montpellier, Montpellier, France
| | - Sébastien D Pion
- 1UMI 233, Institut de Recherche pour le Développement (IRD), INSERM Unité 1175 and University of Montpellier, Montpellier, France
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22
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Li J, Fan M, Ma F, Zhang S, Li Q. The effects of Helicobacter pylori infection on pregnancy-related diseases and fetal development in diabetes in pregnancy. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:686. [PMID: 33987384 PMCID: PMC8106047 DOI: 10.21037/atm-21-1209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background This study aimed to determine the association of Helicobacter pylori (H. pylori) infection with pregnancy-related diseases and fetal development in women with diabetes in pregnancy (DIP). Methods All the participants were recruited before 16 weeks of gestation. According to their medical history and the results of a 75-g oral glucose tolerance test at the 24th week of pregnancy, the participants were divided into a normal control group (NC group), a gestational diabetes mellitus group (GDM group), and a pre-pregnancy diabetes mellitus group (PGDM group). According to the results of an H. pylori serum antibody detection test, each group was further divided into two subgroups: an H. pylori positive subgroup (HP+ subgroup) and an H. pylori negative group (HP- subgroup). The incidences of pregnancy-related diseases, the fetal developmental status, and the newborn status were compared among the groups. Results This study recruited 356 pregnant women. The infection rates of type I H. pylori were significantly higher in the GDM group and the PGDM group than in the NC group (χ2=6.949, P=0.031). With the exception of the NC-HP+ subgroup, there were higher incidences of pregnancy-related diseases in the HP+ subgroups than in the HP− subgroups (P<0.05). Furthermore, the incidences of pregnancy-induced hypertension (PIH), preeclampsia, and premature delivery were significantly higher in the GDM-HP+ subgroup and the PGDM-HP+ subgroup than in the NC-HP+ subgroup (P<0.05). At the end of pregnancy, all 3 HP− subgroups showed better fetal development than the HP+ subgroups (P<0.05), and the NC-HP+ subgroup showed better fetal development than the GDM-HP+ and PGDM-HP+ subgroups (P<0.05). Meanwhile, the PGDM-HP+ subgroup showed poor fetal development, even in the 2nd trimester of pregnancy. Conclusions H. pylori infection is extremely common in DIP. For women with DIP, infection with H. pylori can increase the risks of pregnancy-related diseases and poor fetal development. H. pylori screening and eradication therapy before pregnancy may aid in preventing pregnancy-related diseases and improve fetal development.
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Affiliation(s)
- Jun Li
- Endocrinology Department, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengdi Fan
- Endocrinology Department, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fei Ma
- General Surgery Department, The Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China
| | - Suhe Zhang
- Endocrinology Department, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qingju Li
- Endocrinology Department, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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23
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Maternal Microbiome and Infections in Pregnancy. Microorganisms 2020; 8:microorganisms8121996. [PMID: 33333813 PMCID: PMC7765218 DOI: 10.3390/microorganisms8121996] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/09/2020] [Accepted: 12/13/2020] [Indexed: 12/14/2022] Open
Abstract
Pregnancy induces unique changes in maternal immune responses and metabolism. Drastic physiologic adaptations, in an intricately coordinated fashion, allow the maternal body to support the healthy growth of the fetus. The gut microbiome plays a central role in the regulation of the immune system, metabolism, and resistance to infections. Studies have reported changes in the maternal microbiome in the gut, vagina, and oral cavity during pregnancy; it remains unclear whether/how these changes might be related to maternal immune responses, metabolism, and susceptibility to infections during pregnancy. Our understanding of the concerted adaption of these different aspects of the human physiology to promote a successful pregnant remains limited. Here, we provide a comprehensive documentation and discussion of changes in the maternal microbiome in the gut, oral cavity, and vagina during pregnancy, metabolic changes and complications in the mother and newborn that may be, in part, driven by maternal gut dysbiosis, and, lastly, common infections in pregnancy. This review aims to shed light on how dysregulation of the maternal microbiome may underlie obstetrical metabolic complications and infections.
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24
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Wallin HP, Gissler M, Korhonen PE, Ekblad MO. Maternal Smoking and Hospital Treatment During Pregnancy. Nicotine Tob Res 2020; 22:1162-1169. [PMID: 31418024 DOI: 10.1093/ntr/ntz137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 08/02/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Previous research suggests that young maternal age, smoking, hospitalization during a previous pregnancy, and poor self-rated health could be risk factors for prenatal hospitalization. METHODS The objective of this retrospective observational register study was to investigate if maternal smoking during pregnancy is associated with mother's need for hospital treatment during pregnancy. The study population consists of all singleton pregnancies (n = 961 127) in 1999-2015 in Finland. Information on maternal smoking was received from the Medical Birth Register in three classes: nonsmoker, quit smoking in the first trimester, and continued smoking throughout the pregnancy. These data were linked with the Hospital Discharge Register data and analyzed according to ICD-10 chapters. RESULTS 10.7% of women continued to smoke after the first trimester. After adjusting for confounding factors women in both smoking groups had more hospital treatment compared with nonsmokers. Especially outpatient treatment was more common among mothers who continued to smoke compared to those who quit smoking in the first trimester in several ICD-10 chapters. Compared to non-smokers, aOR for mental and behavioral disorders (F00-F99) was 2.14 (95% confidence interval 2.00-2.30) in the quit smoking group and 3.88 (3.71-4.06) in the continued smoking group. Similarly, aOR for respiratory diseases (J00-J99) was 1.26 (1.15-1.39) and 1.61 (1.52-1.71), respectively and aOR for genitourinary diseases (N00-N99) was 1.10 (1.03-1.17) and 1.29 (1.23-1.35), respectively. Some similar findings were made also in inpatient care. Some similar findings were made also in inpatient care. CONCLUSIONS Women who smoke during pregnancy seem to require more hospital care for various reasons. These findings emphasize the importance of actions for smoking cessation during pregnancy and women should be encouraged to quit as early as possible. IMPLICATIONS Maternal smoking during pregnancy is associated with greater rates of both outpatient and inpatient hospital care during pregnancy. Women who quit smoking had a similar risk for hospital care during pregnancy with nonsmokers in certain diagnosis chapters, which is very motivational and could be used as an informational tool in prenatal clinics to encourage smoking cessation as it is never too late to quit smoking during pregnancy.
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Affiliation(s)
- Hanna P Wallin
- Department of Clinical Medicine; General Practice, University of Turku and Turku University Hospital, Turku, Finland.,Central Satakunta Health Federation of Municipalities, Harjavalta, Finland
| | - Mika Gissler
- National Institute for Health and Welfare (THL), Helsinki, Finland.,Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institute, Stockholm, Sweden
| | - Päivi E Korhonen
- Department of Clinical Medicine; General Practice, University of Turku and Turku University Hospital, Turku, Finland.,Central Satakunta Health Federation of Municipalities, Harjavalta, Finland
| | - Mikael O Ekblad
- Department of Clinical Medicine; General Practice, University of Turku and Turku University Hospital, Turku, Finland.,Central Satakunta Health Federation of Municipalities, Harjavalta, Finland.,Department of Human Development and Family Studies, Purdue University, West Lafayette, IN, USA
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25
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Lokken EM, Mandaliya K, Srinivasan S, Richardson BA, Kinuthia J, Lannon S, Jaoko W, Alumera H, Kemoli A, Fay E, John-Stewart G, Fredricks DN, McClelland RS. Impact of preconception vaginal microbiota on women's risk of spontaneous preterm birth: protocol for a prospective case-cohort study. BMJ Open 2020; 10:e035186. [PMID: 32102825 PMCID: PMC7045118 DOI: 10.1136/bmjopen-2019-035186] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Bacterial vaginosis (BV) and vaginal microbiota disruption during pregnancy are associated with increased risk of spontaneous preterm birth (SPTB), but clinical trials of BV treatment during pregnancy have shown little or no benefit. An alternative hypothesis is that vaginal bacteria present around conception may lead to SPTB by compromising the protective effects of cervical mucus, colonising the endometrial surface before fetal membrane development, and causing low-level inflammation in the decidua, placenta and fetal membranes. This protocol describes a prospective case-cohort study addressing this hypothesis. METHODS AND ANALYSIS HIV-seronegative Kenyan women with fertility intent are followed from preconception through pregnancy, delivery and early postpartum. Participants provide monthly vaginal specimens during the preconception period for vaginal microbiota assessment. Estimated date of delivery is determined by last menstrual period and first trimester obstetrical ultrasound. After delivery, a swab is collected from between the fetal membranes. Placenta and umbilical cord samples are collected for histopathology. Broad-range 16S rRNA gene PCR and deep sequencing of preconception vaginal specimens will assess species richness and diversity in women with SPTB versus term delivery. Concentrations of key bacterial species will be compared using quantitative PCR (qPCR). Taxon-directed qPCR will also be used to quantify bacteria from fetal membrane samples and evaluate the association between bacterial concentrations and histopathological evidence of inflammation in the fetal membranes, placenta and umbilical cord. ETHICS AND DISSEMINATION This study was approved by ethics committees at Kenyatta National Hospital and the University of Washington. Results will be disseminated to clinicians at study sites and partner institutions, presented at conferences and published in peer-reviewed journals. The findings of this study could shift the paradigm for thinking about the mechanisms linking vaginal microbiota and prematurity by focusing attention on the preconception vaginal microbiota as a mediator of SPTB.
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Affiliation(s)
- Erica M Lokken
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | - Sujatha Srinivasan
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Barbra A Richardson
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - John Kinuthia
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
- Obstetrics and Gynaecology, Kenyatta National Hospital, Nairobi, Kenya
| | | | - Walter Jaoko
- Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Hudson Alumera
- University of Nairobi School of Dental Sciences, Nairobi, Kenya
| | - Arthur Kemoli
- University of Nairobi School of Dental Sciences, Nairobi, Kenya
| | - Emily Fay
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA
| | - G John-Stewart
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - David N Fredricks
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - R Scott McClelland
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
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26
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Ananthan A, Nanavati R, Sathe P, Balasubramanian H. Placental Findings in Singleton Stillbirths: A Case-control Study. J Trop Pediatr 2019; 65:21-28. [PMID: 29420825 DOI: 10.1093/tropej/fmy006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS This prospective observational study compared placental lesions of stillbirth cases and live birth controls, and aimed to determine the cause of stillbirth. METHODS The study enrolled 85 stillbirths and 85 live births at the time of delivery. RESULTS There was significantly increased incidence of placental abruption (p = 0.005) and gestational diabetes (p = 0.032) in mothers with stillbirths. Histopathological examination of placenta was significantly abnormal in stillbirths compared with live births (p = 0.004). Delayed villous maturation was significantly more in stillbirths (38.82 vs. 16.47%; p = 0.002). Acute (30.59 vs. 16.47%; p = 0.04) and chronic diffuse villitis (16.47 vs. 4.7%; p = 0.02), chorionic plate acute vasculitis (28.235 vs. 14.11%; p = 0.04) were significantly more in stillbirths. Foetal vascular thrombi in the chorionic plate (30.58 vs. 14.12%; p = 0.02) and avascular villi (24.7 vs. 8.23%; p = 0.006) were significantly more in stillbirths. CONCLUSION These abnormal placental patterns could provide information about the etiopathogenisis in stillbirths of unknown aetiology.
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Affiliation(s)
- Anitha Ananthan
- Department of Neonatology, Seth G. S. Medical College and KEM Hospital, Mumbai, India
| | - Ruchi Nanavati
- Department of Neonatology, Seth G. S. Medical College and KEM Hospital, Mumbai, India
| | - Pragati Sathe
- Department of Pathology, Seth G. S. Medical College and KEM Hospital, Mumbai, India
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27
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Lee AC, Mullany LC, Quaiyum M, Mitra DK, Labrique A, Christian P, Ahmed P, Uddin J, Rafiqullah I, DasGupta S, Rahman M, Koumans EH, Ahmed S, Saha SK, Baqui AH. Effect of population-based antenatal screening and treatment of genitourinary tract infections on birth outcomes in Sylhet, Bangladesh (MIST): a cluster-randomised clinical trial. Lancet Glob Health 2019; 7:e148-e159. [PMID: 30554751 PMCID: PMC6293967 DOI: 10.1016/s2214-109x(18)30441-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/25/2018] [Accepted: 09/11/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND One-third of preterm births are attributed to pregnancy infections. We implemented a community-based intervention to screen and treat maternal genitourinary tract infections, with the aim of reducing the incidence of preterm birth. METHODS We did an unblinded cluster-randomised controlled trial in two subdistricts of Sylhet, Bangladesh. Clusters were defined as the contiguous area served by a single community health worker, and each cluster comprised several contiguous villages, contained roughly 4000 people, and had about 120 births per year. Eligible participants within clusters were all ever-married women and girls of reproductive age (ie, aged 15-49 years) who became pregnant during the study period. Clusters were randomly assigned (1:1) to the intervention or control groups via a restricted randomisation procedure. In both groups, community health workers made home visits to identify pregnant women and girls and provide antenatal and postnatal care. Between 13 and 19 weeks' gestation, participants in the intervention group received home-based screening for abnormal vaginal flora and urinary tract infections. A random 10% of the control group also received the intervention to examine the similarity of infection prevalence between groups. If present, abnormal vaginal flora (ie, Nugent score ≥4 was treated with oral clindamycin (300 mg twice daily for 5 days) and urinary tract infections with cefixime (400 mg once daily for 3 days) or oral nitrofurantoin (100 mg twice daily for 7 days). Both infections were retreated if persistent. The primary outcome was the incidence of preterm livebirths before 37 weeks' gestation among all livebirths. This trial is registered with ClinicalTrials.gov, number NCT01572532. The trial is closed to new participants, with follow-up completed. FINDINGS Between Jan 2, 2012, and July 28, 2015, 9712 pregnancies were enrolled (4840 in the intervention group, 4391 in the control group, and 481 in the control subsample). 3818 livebirths in the intervention group and 3557 livebirths in the control group were included in the primary analysis. In the intervention group, the prevalence of abnormal vaginal flora was 16·3% (95% CI 15·1-17·6) and that of urinary tract infection was 8·6% (7·7-9·5). The effective coverage of successful treatment in the intervention group was 58% in participants with abnormal vaginal flora (ie, abnormal vaginal flora resolved in 361 [58%] of the 622 participants who initially tested positive), and 71% in those with urinary tract infections (ie, resolution in 224 [71%] of the 317 participants who initially tested positive). Overall, the incidence of preterm livebirths before 37 weeks' gestation did not differ significantly between the intervention and control groups (21·8% vs 20·6%; relative risk 1·07 [95% CI 0·91-1·24]). INTERPRETATION A population-based antenatal screening and treatment programme for genitourinary tract infections did not reduce the incidence of preterm birth in Bangladesh. FUNDING Eunice Kennedy Shriver National Institute of Child Health and Human Development and Saving Lives at Birth Grand Challenges.
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Affiliation(s)
- Anne Cc Lee
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Luke C Mullany
- International Center for Maternal and Newborn Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mohammad Quaiyum
- International Center for Diarrheal Diseases-Bangladesh, Center for Reproductive Health, Dhaka, Bangladesh
| | | | - Alain Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Parul Christian
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Parvez Ahmed
- International Center for Diarrheal Diseases-Bangladesh, Center for Reproductive Health, Dhaka, Bangladesh
| | - Jamal Uddin
- Independent University, Bangladesh, Dhaka, Bangladesh
| | - Iftekhar Rafiqullah
- Department of Microbiology and Immunology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Sushil DasGupta
- International Center for Diarrheal Diseases-Bangladesh, Center for Reproductive Health, Dhaka, Bangladesh
| | - Mahmoodur Rahman
- International Center for Diarrheal Diseases-Bangladesh, Center for Reproductive Health, Dhaka, Bangladesh
| | | | | | - Samir K Saha
- Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Abdullah H Baqui
- International Center for Maternal and Newborn Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Barclay KJ, Kolk M. Birth Intervals and Health in Adulthood: A Comparison of Siblings Using Swedish Register Data. Demography 2018; 55:929-955. [PMID: 29785527 PMCID: PMC5992250 DOI: 10.1007/s13524-018-0673-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A growing body of research has examined whether birth intervals influence perinatal outcomes and child health as well as long-term educational and socioeconomic outcomes. To date, however, very little research has examined whether birth spacing influences long-term health. We use contemporary Swedish population register data to examine the relationship between birth-to-birth intervals and a variety of health outcomes in adulthood: for men, height, physical fitness, and the probability of falling into different body mass index categories; and for men and women, mortality. In models that do not adjust carefully for family background, we find that short and long birth intervals are clearly associated with height, physical fitness, being overweight or obese, and mortality. However, after carefully adjusting for family background using a within-family sibling comparison design, we find that birth spacing is generally not associated with long-term health, although we find that men born after very long birth intervals have a higher probability of being overweight or obese in early adulthood. Overall, we conclude that birth intervals have little independent effect on long-term health outcomes.
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Affiliation(s)
- Kieron J Barclay
- Max Planck Institute for Demographic Research, Konrad-Zuse-Straße 1, 18057, Rostock, Germany. .,Department of Social Policy, London School of Economics and Political Science, London, UK. .,Demography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden.
| | - Martin Kolk
- Demography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden.,Centre for the Study of Cultural Evolution, Stockholm University, Stockholm, Sweden.,Institute for Futures Studies, Stockholm, Sweden
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Zhang X, Liao Q, Wang F, Li D. Association of gestational diabetes mellitus and abnormal vaginal flora with adverse pregnancy outcomes. Medicine (Baltimore) 2018; 97:e11891. [PMID: 30142788 PMCID: PMC6112872 DOI: 10.1097/md.0000000000011891] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 07/07/2018] [Indexed: 12/26/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is associated with adverse perinatal outcomes. This study aimed to examine the association between GDM and abnormal vaginal flora, and the association between abnormal vaginal flora and adverse pregnancy outcomes.This was a prospective study of pregnant women who visited Xuanwu Hospital of the Capital Medical University (Beijing, China) between February and October 2015. All women were screened for GDM according to the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) recommendations. Vaginal secretions were sampled at 28 to 30 and 37 to 40 weeks. Microorganisms were examined.The women were 28.3 ± 2.6 years and their body mass index was 22.8 ± 1.4 kg/m. GDM was associated with higher frequencies of vulvovaginal candidiasis (22.6% vs 9.7%, P < .001), premature rupture of membranes (PROM) (22.6% vs 11.5%, P = .004), premature delivery (16.1% vs 5.5%, P = .02), chorioamnionitis/puerperal infection (19.4% vs 4.5%, P < .001), macrosomia (9.7% vs 4.0%, P = .04), neonatal hypoglycemia (5.4% vs 1.0%, P = .02), and neonatal referral (15.1% vs 6.5%, P = .008). Among healthy women, abnormal flora was associated with PROM (19.4% vs 7.5%, P = .02) and chorioamnionitis/puerperal infection (11.9% vs 0.8%, P < .001). Among women with GDM, abnormal flora was associated with PROM (32.1% vs 10.0%, P < .001), premature delivery (17.7% vs 6.3%, P = .04), and chorioamnionitis/puerperal infection (32.8% vs 2.5%, P < .001).The vaginal infection rate was higher in patients with GDM compared with healthy pregnant women. GDM and abnormal vaginal flora were both associated with adverse pregnancy outcomes. The vaginal Lactobacillus species were different between the 2 groups, which could contribute to the adverse outcomes.
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Affiliation(s)
- Xinhong Zhang
- Department of Obstetrics and Gynecology, Xuanwu Hospital, Capital Medical University
| | - Qinping Liao
- Department of Obstetrics and Gynecology, Xuanwu Hospital, Capital Medical University
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
| | - Fengying Wang
- Department of Obstetrics and Gynecology, Xuanwu Hospital, Capital Medical University
| | - Dan Li
- Department of Obstetrics and Gynecology, Xuanwu Hospital, Capital Medical University
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Post-Implant Management of Sacral Neuromodulation. CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0475-2] [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]
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Dyer E, Rowley A, Mannu U, Hoveyda F. Introducing a preterm surveillance clinic to manage high-risk women. ACTA ACUST UNITED AC 2018. [DOI: 10.12968/bjom.2018.26.5.301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Ellen Dyer
- Sonographer, Cambridge University Hospitals NHS Foundation Trust
| | - Amanda Rowley
- Midwife sonographer and clinical ultrasound manager, Cambridge University Hospitals NHS Foundation Trust
| | - Una Mannu
- Lead midwife, Maternal Assessment and Triage Unit, Cambridge University Hospitals NHS Foundation Trust
| | - Fatemeh Hoveyda
- Consultant obstetrician, Maternal Assessment and Triage Unit, Cambridge University Hospitals NHS Foundation Trust
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The Black-White Disparity in Sexually Transmitted Diseases During Pregnancy: How Do Racial Segregation and Income Inequality Matter? Sex Transm Dis 2018; 45:301-306. [PMID: 29485542 PMCID: PMC5895497 DOI: 10.1097/olq.0000000000000820] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND We investigate the roles of residential racial segregation and income inequality for the black-white disparity in acquiring sexually transmitted diseases (STD) during pregnancy in a multilevel framework. METHODS The analytic sample consisted of non-Hispanic white (n = 79,271) and non-Hispanic black (n = 17,669) mothers from 2012 population birth data from Pennsylvania. We used the 2009 to 2013 American Community Survey for neighborhood characteristics of mothers; we used multilevel models. RESULTS First, neighborhood-level factors are important for understanding this disparity because racial segregation and income inequality are significantly associated with acquiring STD during pregnancy, regardless of race. Second, racial segregation moderates the relationships between race/ethnicity and the acquisition of STD during pregnancy. White mothers are more vulnerable to neighborhood segregation than black mothers, and black mothers are less likely to acquire STD during pregnancy than white mothers if they reside with co-ethnics. Third, mothers residing in the most socioeconomically disadvantaged neighborhoods-as indicated by both absolute and relative measures of income inequality-have the highest odds of acquiring STD during pregnancy, regardless of race. CONCLUSIONS Neighborhood-level segregation and income inequality are important for understanding the acquisition of STDs during pregnancy. Our findings have important implications for future research and for place-specific prevention and intervention to reduce the racial disparity in STD during pregnancy.
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Roulette P, Castel-Lacanal E, Sanson S, Caremel R, Phé V, Bart S, Duchêne F, De Sèze M, Even A, Manunta A, Scheiber-Nogueira MC, Mouracade P, Loche CM, Chartier-Kastler E, Ruffion A, Karsenty G, Gamé X. Sacral neuromodulation and pregnancy: Results of a national survey carried out for the neuro-urology committee of the French Association of Urology (AFU). Neurourol Urodyn 2017; 37:792-798. [PMID: 29160571 DOI: 10.1002/nau.23349] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 06/06/2017] [Indexed: 11/09/2022]
Abstract
AIMS To assess the impact of sacral neuromodulation (SNM) on pregnancy and vice-versa, by identifying women who had received SNM for lower-urinary tract symptoms (LUTS) and had become pregnant. METHODS A cross-sectional descriptive study was carried out based on responses to an on-line questionnaire sent to practitioners listed on the InterStim enCaptureTM National Registry. Questions were related to pre-pregnancy health and SNM efficacy, deactivation of the device, its impact on LUTS, childbirth, the infant, its reactivation and postpartum effectiveness. RESULTS Twenty-seven pregnancies were recorded among 21 women. Six women had had a pregnancy prior to implantation, two of whom had had a c-section. A total of 18.5% of women had the device disabled prior to conception. The others had their device disabled during the first trimester and did not reactivate it before delivery. Complications were reported in 25.9% of pregnancies: six women had urinary infections, including three of the four treated for chronic retention of urine (CRU), and 1 woman had pain at the stimulation site. There were 24 live births (including one premature birth and four c-sections), one spontaneous miscarriage and two voluntary interruptions of pregnancy. No neonatal disorders have been reported. Effectiveness of sacral neuromodulation decreased in 20% in postpartum. CONCLUSIONS In 27 pregnancies established during SNM for LUTS, 18.5% of patients deactivated their case before pregnancy and the others switched it off during the first trimester. Three-quarters of women with CRU had urinary infection. No adverse effects on fetuses were found. SNM effectiveness deteriorated in 20% cases after childbirth.
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Affiliation(s)
- Pauline Roulette
- Department of Urology, Andrology and Transplantation, CHU Rangueil, Toulouse, France
| | | | - Sylvain Sanson
- Department of Urology, Clinique du Pont de Chaume, Montauban, France
| | - Romain Caremel
- Clinique du Cèdre, Cèdre's Urology Center, Bois Guillaume, France
| | - Véronique Phé
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School, Pitié-Salpêtrière Academic Hospital, Paris, France
| | - Stéphane Bart
- Department of Urology, CH René-Dubos, Pontoise, France
| | - Franck Duchêne
- Clinique de l'Alliance, Department of Urology, Saint Cyr sur Loire, France
| | - Marianne De Sèze
- Clinique Saint Augustin, Neuro-Urology, Pelviperineology and Urodynamic Clinical Center, Bordeaux, France
| | - Alexia Even
- Department of Physical Medicine and Rehabilitation, Hôpital Raymond-Poincaré AP-HP, Garches, France
| | - Andréa Manunta
- Department of Urology, University Hospital of Rennes, Rennes, France
| | | | - Pascal Mouracade
- Department of Urology, Strasbourg University Hospital, Strasbourg, France
| | - Catherine-Marie Loche
- Department of Physical Medicine and Rehabilitation, Assistance Publique des Hôpitaux de Paris, Henri Mondor Teaching Hospital, Créteil, France
| | - Emmanuel Chartier-Kastler
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School, Pitié-Salpêtrière Academic Hospital, Paris, France
| | - Alain Ruffion
- Department of Urology, Centre hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France
| | - Gilles Karsenty
- Department of Urology and Kidney Transplantation, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Xavier Gamé
- Department of Urology, Andrology and Transplantation, CHU Rangueil, Toulouse, France
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Miranda AE, Saraceni V, Pereira GFM, da Silveira MF, Araujo MAL. Vigilância epidemiológica da transmissão vertical da sífilis: dados de seis unidades federativas no Brasil. Rev Panam Salud Publica 2017. [PMID: 28614467 PMCID: PMC6612729 DOI: 10.26633/rpsp.2017.44] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objetivo. Descrever o perfil epidemiológico dos casos notificados de sífilis em gestantes e sífilis congênita nos estados brasileiros do Amazonas, Ceará, Espírito Santo, Rio de Janeiro e Rio Grande do Sul e no Distrito Federal a partir de dados do Sistema Nacional de Agravos de Notificação (SINAN).
Métodos. Estudo descritivo incluindo avaliação ecológica e transversal. Foram utilizados dados do SINAN Net. Foram calculadas a taxa de detecção de sífilis em gestantes e a taxa de incidência de sífilis congênita por 1 000 nascidos vivos. Para identificar as gestantes notificadas com sífilis com desfecho de sífilis congênita, as duas bases do SINAN foram relacionadas por meio do software RecLink. Como os dados eram de representatividade regional, as comparações foram feitas entre as unidades da federação, e não com a soma dos casos.
Resultados A taxa de detecção de sífilis em gestantes cresceu entre 21% (Amazonas) e 75% (Rio de Janeiro). A incidência de sífilis congênita seguiu o mesmo perfil de incremento, variando de 35,6% no Distrito Federal a 639,9% no Rio Grande do Sul, com redução de 0,7% no Amazonas. A realização de pré-natal nas mulheres com desfecho de sífilis congênita variou de 67,3% no Amazonas a 83,3% no Distrito Federal. Das gestantes com sífilis, 43% tiveram desfecho notificado de sífilis congênita. Nas gestantes com sífilis e desfecho de sífilis congênita, o diagnóstico materno ocorreu durante o pré-natal em 74% e no parto em 18%. Em 8% das mulheres ignorava-se o momento do diagnóstico.
Conclusão. O incremento nas taxas de detecção de sífilis pode ter resultado do aumento na notificação. O monitoramento constante em gestantes é essencial para a eliminação desses agravos.
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Affiliation(s)
- Angelica Espinosa Miranda
- Universidade Federal do Espírito Santo, Programa de Pós-Graduação em Saúde Coletiva, Vitória (ES), Brasil
| | - Valeria Saraceni
- Secretaria Municipal de Saúde do Rio de Janeiro, Superintendência de Vigilância em Saúde, Rio de Janeiro (RJ), Brasil
| | | | | | - Maria Alix Leite Araujo
- Universidade de Fortaleza, Programa de Pós-Graduação em Saúde Coletiva, Fortaleza (CE), Brasil
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Awadh A, Chughtai AA, Dyda A, Sheikh M, Heslop DJ, MacIntyre CR. Does Zika Virus Cause Microcephaly - Applying the Bradford Hill Viewpoints. PLOS CURRENTS 2017; 9:ecurrents.outbreaks.2fced6e886074f6db162a00d4940133b. [PMID: 28357156 PMCID: PMC5346029 DOI: 10.1371/currents.outbreaks.2fced6e886074f6db162a00d4940133b] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Zika virus has been documented since 1952, but been associated with mild, self-limiting disease. Zika virus is classified as an arbovirus from a family of Flaviviridae and primarily spread by Aedes Aegypti mosquitos. However, in a large outbreak in Brazil in 2015, Zika virus has been associated with microcephaly. METHODS In this review we applied the Bradford-Hill viewpoints to investigate the association between Zika virus and microcephaly. We examined historical studies, available data and also compared historical rates of microcephaly prior to the Zika virus outbreak. The available evidence was reviewed against the Bradford Hill viewpoints. RESULTS All the nine criteria were met to varying degrees: strength of association, consistency of the association, specificity, temporality, plausibility, coherence, experimental evidence, biological gradient and analogy. Conclusion: Using the Bradford Hill Viewpoints as an evaluation framework for causation is highly suggestive that the association between Zika virus and microcephaly is causal. Further studies using animal models on the viewpoints which were not as strongly fulfilled would be helpful.
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Affiliation(s)
- Asma Awadh
- University Of New South Wales University Of New South Wales
| | | | - Amalie Dyda
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | | | | | - Chandini Raina MacIntyre
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
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Kayem G, Lorthe E, Doret M. Prise en charge d’une menace d’accouchement prématuré. ACTA ACUST UNITED AC 2016; 45:1364-1373. [DOI: 10.1016/j.jgyn.2016.09.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 09/23/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
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Paramel Jayaprakash T, Wagner EC, van Schalkwyk J, Albert AYK, Hill JE, Money DM. High Diversity and Variability in the Vaginal Microbiome in Women following Preterm Premature Rupture of Membranes (PPROM): A Prospective Cohort Study. PLoS One 2016; 11:e0166794. [PMID: 27861554 PMCID: PMC5115810 DOI: 10.1371/journal.pone.0166794] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 11/03/2016] [Indexed: 11/18/2022] Open
Abstract
Objective To characterize the vaginal microbiota of women following preterm premature rupture of membranes (PPROM), and determine if microbiome composition predicts latency duration and perinatal outcomes. Design A prospective cohort study Setting Canada Population Women with PPROM between 24+0 and 33+6 weeks gestational age (GA). Methods Microbiome profiles, based on pyrosequencing of the cpn60 universal target, were generated from vaginal samples at time of presentation with PPROM, weekly thereafter, and at delivery. Main Outcome Measures Vaginal microbiome composition, latency duration, gestational age at delivery, perinatal outcomes. Results Microbiome profiles were generated from 70 samples from 36 women. Mean GA at PPROM was 28.8 wk (mean latency 2.7 wk). Microbiome profiles were highly diverse but sequences representing Megasphaera type 1 and Prevotella spp. were detected in all vaginal samples. Only 13/70 samples were dominated by Lactobacillus spp. Microbiome profiles at the time of membrane rupture did not cluster by gestational age at PPROM, latency duration, presence of chorioamnionitis or by infant outcomes. Mycoplasma and/or Ureaplasma were detected by PCR in 81% (29/36) of women, and these women had significantly lower GA at delivery and correspondingly lower birth weight infants than Mycoplasma and/or Ureaplasma negative women. Conclusion Women with PPROM had mixed, abnormal vaginal microbiota but the microbiome profile at PPROM did not correlate with latency duration. Prevotella spp. and Megasphaera type I were ubiquitous. The presence of Mollicutes in the vaginal microbiome was associated with lower GA at delivery. The microbiome was remarkably unstable during the latency period.
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Affiliation(s)
| | - Emily C. Wagner
- Women’s Health Research Institute, BC Women’s Hospital and Health Centre, Vancouver, BC, Canada
| | - Julie van Schalkwyk
- Women’s Health Research Institute, BC Women’s Hospital and Health Centre, Vancouver, BC, Canada
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Arianne Y. K. Albert
- Women’s Health Research Institute, BC Women’s Hospital and Health Centre, Vancouver, BC, Canada
| | - Janet E. Hill
- Department of Veterinary Microbiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Deborah M. Money
- Women’s Health Research Institute, BC Women’s Hospital and Health Centre, Vancouver, BC, Canada
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
- * E-mail:
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Amaya‐Guio J, Viveros‐Carreño DA, Sierra‐Barrios EM, Martinez‐Velasquez MY, Grillo‐Ardila CF. Antibiotic treatment for the sexual partners of women with bacterial vaginosis. Cochrane Database Syst Rev 2016; 10:CD011701. [PMID: 27696372 PMCID: PMC6458027 DOI: 10.1002/14651858.cd011701.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Bacterial vaginosis (BV) is an infection that has a prevalence between 10% to 50% worlwide. BV results in an imbalance of the normal vaginal flora. Microorganisms associated with BV have been isolated from the normal flora of the male genital tract, and their presence could be related to the recurrence of BV after antibiotic treatment. Therefore, the treatment of sexual partners could decrease the recurrence of infection and possibly the burden of the disease. OBJECTIVES To assess the effectiveness in women and the safety in men of concurrent antibiotic treatment for the sexual partners of women treated for BV. SEARCH METHODS We searched the Cochrane Sexually Transmitted Infections Group Specialized Register (23 July 2016), CENTRAL (1991 to 23 July 2016), MEDLINE (1946 to 23 July 2016), Embase (1974 to 23 July 2016), LILACS (1982 to 23 July 2016), the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (23 July 2016), ClinicalTrials.gov (23 July 2016) and the Web of Science™ (2001 to 23 July 2016). We also handsearched conference proceedings, contacted trial authors and reviewed the reference lists of retrieved studies. SELECTION CRITERIA Randomized controlled trials (RCTs) that compared the concurrent use of any antibiotic treatment with placebo, no intervention or any other intervention by the sexual partners of women treated for BV. DATA COLLECTION AND ANALYSIS Three review authors independently assessed trials for inclusion, extracted data and assessed the risk of bias in the included studies. We resolved any disagreements through consensus. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS Seven RCTs (1026 participants) met our inclusion criteria, and pharmaceutical industry funded four of these trials. Five trials (854 patients) compared any antibiotic treatment of sexual partners with placebo. Based on high quality evidence, antibiotic treatment does not increase the rate of clinical or symptomatic improvement in women during the first week (risk ratio (RR) 0.99, 95% confidence interval (CI) 0.96 to 1.03; 712 participants, four studies; RR 1.06, 95% CI 1.00 to 1.12; 577 patients, three studies, respectively), between the first and fourth week (RR 1.02, 95% CI 0.94 to 1.11; 590 participants, three studies; RR 0.93, 95% CI 0.84 to 1.03; 444 participants, two studies; respectively) or after the fourth week (RR 0.98, 95% CI 0.90 to 1.07; 572 participants, four studies; RR 1.03, 95% CI 0.90 to 1.17; 296 participants, two studies; respectively). Antibiotic treatment does not led to a lower recurrence during the first and fourth week (RR 1.28, 95% CI 0.68 to 2.43; 218 participants, one study; low quality evidence) or after the fourth week of treatment (RR 1.00, 95% CI 0.67 to 1.52; 372 participants, three studies; low quality evidence) in women, but increases the frequency of adverse events (most frequently gastrointestinal symptoms) reported by sexual partners (RR 2.55, 95% CI 1.55 to 4.18; 477 participants, three studies; low quality evidence). Two trials (172 participants) compared any antibiotic treatment for sexual partners with no intervention. When we compared it with no intervention, the effects of antibiotic treatment on recurrence rate after the fourth week (RR 1.71, 95% CI 0.65 to 4.55; 51 participants, one study), clinical improvement between the first and fourth week (RR 0.93, 95% CI 0.70 to 1.25; 152 participants, two studies) and symptomatic improvement after the fourth week (RR 0.66, 95% CI 0.39 to 1.11; 70 participants, one study) were imprecise and there were no differences between groups. We downgraded the quality of the evidence to low or very low. AUTHORS' CONCLUSIONS High quality evidence shows that antibiotic treatment for sexual partners of women with BV, compared with placebo, does not increase the rate of clinical or symptomatic improvement during the first, between the first and fourth or after the fourth week into the women. Low quality evidence suggests that antibiotic treatment does not led to a lower recurrence rate during the first and fourth or after the fourth week of treatment into the women, but increases the frequency of adverse events reported by sexual partners. Finally, compared with no intervention, antibiotic treatment does not decrease the recurrence rate after the fourth week and does not increase the frequency of clinical or symptomatic improvement between the first and fourth or after the fourth week into the women, respectively.
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Affiliation(s)
- Jairo Amaya‐Guio
- Faculty of Medicine, Universidad Nacional de ColombiaDepartment of Obstetrics and GynecologyBogotaColombia
| | | | | | | | - Carlos F Grillo‐Ardila
- Faculty of Medicine, Universidad Nacional de ColombiaDepartment of Obstetrics and GynecologyBogotaColombia
- Faculty of Medicine, Universidad Nacional de ColombiaClinical Research InstituteBogotaColombia
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Contribution of a Comparative Western Blot Method to Early Postnatal Diagnosis of Congenital Syphilis. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2016; 23:410-416. [PMID: 26961856 DOI: 10.1128/cvi.00032-16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 03/01/2016] [Indexed: 01/20/2023]
Abstract
Serology has a pivotal role in the diagnosis of congenital syphilis (CS), but problems arise because of the passive transfer of IgG antibodies across the placenta. The aim of this study was to assess the diagnostic value of a comparative Western blot (WB) method finalized to match the IgG immunological profiles of mothers and their own babies at birth in order to differentiate between passively transmitted maternal antibodies and antibodies synthesized by the infants against Treponema pallidum Thirty infants born to mothers with unknown or inadequate treatment for syphilis were entered in a retrospective study, conducted at St. Orsola-Malpighi Hospital, Bologna, Italy. All of the infants underwent clinical, instrumental, and laboratory examinations, including IgM WB testing. For the retrospective study, an IgG WB assay was performed by blotting T. pallidum antigens onto nitrocellulose sheets and incubating the strips with serum specimens from mother-child pairs. CS was diagnosed in 11 out of the 30 enrolled infants; 9/11 cases received the definitive diagnosis within the first week of life, whereas the remaining two were diagnosed later because of increasing serological test titers. The use of the comparative IgG WB testing performed with serum samples from mother-child pairs allowed a correct CS diagnosis in 10/11 cases. The CS diagnosis was improved by a strategy combining comparative IgG WB results with IgM WB results, leading to a sensitivity of 100%. The comparative IgG WB test is thus a welcome addition to the conventional laboratory methods used for CS diagnosis, allowing identification and adequate treatment of infected infants and avoiding unnecessary therapy of uninfected newborns.
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Madianos PN, Bobetsis YA, Offenbacher S. Adverse pregnancy outcomes (APOs) and periodontal disease: pathogenic mechanisms. J Periodontol 2016; 84:S170-80. [PMID: 23631577 DOI: 10.1902/jop.2013.1340015] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIM To evaluate the evidence on potential biological pathways underlying the possible association between periodontal disease (PD) and adverse pregnancy outcomes (APOs). MATERIAL & METHODS Human, experimental and in vitro studies were evaluated. RESULTS Periodontal pathogens/byproducts may reach the placenta and spread to the foetal circulation and amniotic fluid. Their presence in the foeto-placental compartment can stimulate a foetal immune/inflammatory response characterized by the production of IgM antibodies against the pathogens and the secretion of elevated levels of inflammatory mediators, which in turn may cause miscarriage or premature birth. Moreover, infection/inflammation may cause placental structural changes leading to pre-eclampsia and impaired nutrient transport causing low birthweight. Foetal exposure may also result in tissue damage, increasing the risk for perinatal mortality/morbidity. Finally, the elicited systemic inflammatory response may exacerbate local inflammatory responses at the foeto-placental unit and further increase the risk for APOs. CONCLUSIONS Further investigation is still necessary to fully translate the findings of basic research into clinical studies and practice. Understanding the systemic virulence potential of the individual's oral microbiome and immune response may be a distinctly different issue from categorizing the nature of the challenge using clinical signs of PD. Therefore, a more personalized targeted therapy could be a more predictive answer to the current "one-size-fits-all" interventions.
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Affiliation(s)
- Phoebus N Madianos
- Department of Periodontology, School of Dentistry, University of Athens, Athens, Greece.
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Madianos PN, Bobetsis YA, Offenbacher S. Adverse pregnancy outcomes (APOs) and periodontal disease: pathogenic mechanisms. J Clin Periodontol 2016; 40 Suppl 14:S170-80. [PMID: 23627327 DOI: 10.1111/jcpe.12082] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2012] [Indexed: 01/07/2023]
Abstract
AIM To evaluate the evidence on potential biological pathways underlying the possible association between periodontal disease (PD) and adverse pregnancy outcomes (APOs). MATERIAL & METHODS Human, experimental and in vitro studies were evaluated. RESULTS Periodontal pathogens/byproducts may reach the placenta and spread to the foetal circulation and amniotic fluid. Their presence in the foeto-placental compartment can stimulate a foetal immune/inflammatory response characterized by the production of IgM antibodies against the pathogens and the secretion of elevated levels of inflammatory mediators, which in turn may cause miscarriage or premature birth. Moreover, infection/inflammation may cause placental structural changes leading to pre-eclampsia and impaired nutrient transport causing low birthweight. Foetal exposure may also result in tissue damage, increasing the risk for perinatal mortality/morbidity. Finally, the elicited systemic inflammatory response may exacerbate local inflammatory responses at the foeto-placental unit and further increase the risk for APOs. CONCLUSIONS Further investigation is still necessary to fully translate the findings of basic research into clinical studies and practice. Understanding the systemic virulence potential of the individual's oral microbiome and immune response may be a distinctly different issue from categorizing the nature of the challenge using clinical signs of PD. Therefore, a more personalized targeted therapy could be a more predictive answer to the current "one-size-fits-all" interventions.
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Affiliation(s)
- Phoebus N Madianos
- Department of Periodontology, School of Dentistry, University of Athens, Athens, Greece.
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Lee ACC, Quaiyum MA, Mullany LC, Mitra DK, Labrique A, Ahmed P, Uddin J, Rafiqullah I, DasGupta S, Mahmud A, Koumans EH, Christian P, Saha S, Baqui AH. Screening and treatment of maternal genitourinary tract infections in early pregnancy to prevent preterm birth in rural Sylhet, Bangladesh: a cluster randomized trial. BMC Pregnancy Childbirth 2015; 15:326. [PMID: 26643558 PMCID: PMC4672554 DOI: 10.1186/s12884-015-0724-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 10/27/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Approximately half of preterm births are attributable to maternal infections, which are commonly undetected and untreated in low-income settings. Our primary aim is to determine the impact of early pregnancy screening and treatment of maternal genitourinary tract infections on the incidence of preterm live birth in Sylhet, Bangladesh. We will also assess the effect on other adverse pregnancy outcomes, including preterm birth (stillbirth and live birth), late miscarriage, maternal morbidity, and early onset neonatal sepsis. METHODS/DESIGN We are conducting a cluster randomized controlled trial that will enroll 10,000 pregnant women in Sylhet district in rural northeastern Bangladesh. Twenty-four clusters, each with ~4000 population (120 pregnant women/year) and served by a community health worker (CHW), are randomized to: 1) the control arm, which provides routine antenatal and postnatal home-based care, or 2) the intervention arm, which includes routine antenatal and postnatal home-based care plus screening and treatment of pregnant women between 13 and 19 weeks of gestation for abnormal vaginal flora (AVF) and urinary tract infection (UTI). CHWs conduct monthly pregnancy surveillance, make 2 antenatal and 4 postnatal home visits for all enrolled pregnant women and newborns, and refer mothers or newborns with symptoms of serious illness to the government sub-district hospital. In the intervention clusters, CHWs perform home-based screening of AVF and UTI. Self-collected vaginal swabs are plated on slides, which are Gram stained and Nugent scored. Women with AVF (Nugent score ≥4) are treated with oral clindamycin, rescreened and retreated, if needed, after 3 weeks. Urine culture is performed and UTI treated with nitrofurantoin. Repeat urine culture is performed after 1 week for test of cure. Gestational age is determined by maternal report of last menstrual period at study enrollment using prospectively completed study calendars, and in a subset by early (<20 week) ultrasound. CHWs prospectively collect data on all pregnancy outcomes, maternal and neonatal morbidity and mortality. IMPLICATIONS/DISCUSSION Findings will enhance our understanding of the burden of AVF and UTI in rural Bangladesh, the impact of a maternal screening-treatment program for genitourinary tract infections on perinatal health, and help formulate public health recommendations for infection screening in pregnancy in low-resource settings. TRIAL REGISTRATION The study was registered on ClinicalTrials.gov:NCT01572532 on December 15, 2011. The study was funded by NICHD: R01HD066156 .
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Affiliation(s)
- Anne C C Lee
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Department of International Health, International Center for Maternal and Newborn Health; Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Mohammad A Quaiyum
- International Centre for Diarrheal Diseases- Bangladesh, Centre for Reproductive Health, Mohakhali, Dhaka, 1212, Bangladesh
| | - Luke C Mullany
- Department of International Health, International Center for Maternal and Newborn Health; Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Dipak K Mitra
- Department of International Health, International Center for Maternal and Newborn Health; Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Alain Labrique
- Department of International Health, International Center for Maternal and Newborn Health; Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Parvez Ahmed
- International Centre for Diarrheal Diseases- Bangladesh, Centre for Reproductive Health, Mohakhali, Dhaka, 1212, Bangladesh
| | - Jamal Uddin
- Department of Microbiology, Child Health Research Foundation, Dhaka Shishu Hospital, Sher-E-Banglanagar, Dhaka, 1207, Bangladesh
| | - Iftekhar Rafiqullah
- Department of Microbiology, Child Health Research Foundation, Dhaka Shishu Hospital, Sher-E-Banglanagar, Dhaka, 1207, Bangladesh
| | - Sushil DasGupta
- International Centre for Diarrheal Diseases- Bangladesh, Centre for Reproductive Health, Mohakhali, Dhaka, 1212, Bangladesh
| | - Arif Mahmud
- Department of International Health, International Center for Maternal and Newborn Health; Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Emilia H Koumans
- Center for Disease Control, 1600 Clifton Road, Atlanta, GA, 30329, USA
| | - Parul Christian
- Department of International Health, International Center for Maternal and Newborn Health; Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Samir Saha
- Department of Microbiology, Child Health Research Foundation, Dhaka Shishu Hospital, Sher-E-Banglanagar, Dhaka, 1207, Bangladesh
| | - Abdullah H Baqui
- Department of International Health, International Center for Maternal and Newborn Health; Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
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Amaya-Guio J, Martinez-Velasquez MY, Viveros-Carreño DA, Sierra-Barrios EM, Grillo-Ardila CF. Antibiotic treatment for the sexual partners of women with bacterial vaginosis. Cochrane Database Syst Rev 2015. [DOI: 10.1002/14651858.cd011701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Mizumoto BR, Moreira BM, Santoro-Lopes G, Cunha AJ, Santos RMRD, Pessoa-Silva CL, Pinheiro AAN, Ferreira M, Leobons MB, Hofer CB. Quality of antenatal care as a risk factor for early onset neonatal infections in Rio de Janeiro, Brazil. Braz J Infect Dis 2015; 19:272-7. [PMID: 25795268 PMCID: PMC9425413 DOI: 10.1016/j.bjid.2015.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 02/24/2015] [Accepted: 02/25/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Neonatal infection is a serious public health problem. The aim of this study was to assess the influence of the antenatal care on the risk of early-onset neonatal healthcare associated infection in two Brazilian maternities. METHODS Cohort study - Newborns admitted at two public neonatal intensive care units from 2008 to 2009 were included in the study. Data on antenatal and perinatal variables were collected from maternal prenatal cards and medical charts. Newborns were actively surveyed for early-onset neonatal healthcare associated infection, defined as a neonatal infection diagnosed within 48h after birth. Multiple logistic regression was used to assess variables independently associated with early-onset neonatal healthcare associated infection. RESULTS 561 neonate-mother pairs were included in the study. Early-onset neonatal healthcare associated infection was diagnosed in 283 neonates (51%), an incidence rate of 43.5/1000 live births. Neonates whose mothers had less then six antenatal visits were under risk significantly higher for early-onset neonatal healthcare associated infection (OR=1.69, 95% CI=1.11-2.57), after adjusting for birth weight, membranes ruptured for >18h, maternal complications during delivery, maternal infection at admission, and hospital where patients received care. CONCLUSIONS The risk of neonatal early-onset neonatal healthcare associated infection was significantly associated with insufficient number of antenatal care visits. Further studies assessing the quality of antenatal care and targeting its improvement are warranted.
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Affiliation(s)
- B R Mizumoto
- Department of Preventive Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil; Secretaria Estadual de Saúde do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - B M Moreira
- Department of Preventive Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil; Instituto de Microbiologia Paulo Góes, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - G Santoro-Lopes
- Department of Preventive Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil; Infectious Diseases Clinic, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - A J Cunha
- Department of Pediatrics, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - R M R dos Santos
- Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | - M Ferreira
- Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - M B Leobons
- Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Cristina Barroso Hofer
- Department of Preventive Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.
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Geer LA, Pycke BFG, Sherer DM, Abulafia O, Halden RU. Use of amniotic fluid for determining pregnancies at risk of preterm birth and for studying diseases of potential environmental etiology. ENVIRONMENTAL RESEARCH 2015; 136:470-81. [PMID: 25460669 PMCID: PMC4279852 DOI: 10.1016/j.envres.2014.09.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 09/02/2014] [Accepted: 09/16/2014] [Indexed: 05/21/2023]
Abstract
Amniotic fluid (AF) is a biological medium uniquely suited for the study of early exposure of the human fetus to environmental contaminants acquired by the mother before and during pregnancy. Traditional diagnostic applications of AF have focused almost exclusively on the diagnosis of genetic aberrations such as Trisomy-21 and on heritable diseases in high-risk pregnancies. Since more than 50 anthropogenic compounds have been detected in AF, there is considerable potential in utilizing fetal protein biomarkers as indicators of health effects related to prenatal toxic exposure. Here, we focus on preterm birth (PTB) to illustrate opportunities and limitations of using AF as a diagnostic matrix. Representing a pervasive public health challenge worldwide, PTB cannot be managed simply by improving hygiene and broadening access to healthcare. This is illustrated by 15-year increases of PTB in the U.S. from 1989 to 2004. AF is uniquely suited as a matrix for early detection of the association between fetal exposures and PTB due to its fetal origin and the fact that it is sampled from women who are at higher risk of PTB. This critical review shows the occurrence in AF of a number of xenobiotics, including endocrine-disrupting compounds (EDCs), which are known or may reasonably be expected to shorten fetal gestation. It is not yet known whether EDCs, including bisphenol A, phytoestrogens, and polychlorinated biphenyls (PCBs), can affect the expression of proteins considered viable or potential biomarkers for the onset of PTB. As such, the diagnostic value of AF is broad and has not yet been fully explored for prenatal diagnosis of pregnancies at risk from toxic, environmental exposures and for the elucidation of mechanisms underlying important public health challenges including PTB.
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Affiliation(s)
- Laura A Geer
- Department of Environmental and Occupational Health Sciences, State University of New York, Downstate School of Public Health, Box 43, 450 Clarkson Avenue, Brooklyn, NY 11203-2533, USA.
| | - Benny F G Pycke
- Center for Environmental Security, The Biodesign Institute, Arizona State University, 781 E. Terrace Mall Tempe, AZ, USA.
| | - David M Sherer
- Department of Obstetrics and Gynecology, State University of New York Downstate Medical Center, 445 Lenox Road, Brooklyn, NY, USA.
| | - Ovadia Abulafia
- Department of Obstetrics and Gynecology, State University of New York Downstate Medical Center, 445 Lenox Road, Brooklyn, NY, USA.
| | - Rolf U Halden
- Center for Environmental Security, The Biodesign Institute, Arizona State University, 781 E. Terrace Mall Tempe, AZ, USA.
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Soeiro CMDO, Miranda AE, Saraceni V, Santos MCD, Talhari S, Ferreira LCDL. Syphilis in pregnancy and congenital syphilis in Amazonas State, Brazil: an evaluation using database linkage. CAD SAUDE PUBLICA 2014; 30:715-23. [PMID: 24896047 DOI: 10.1590/0102-311x00156312] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 10/10/2013] [Indexed: 11/22/2022] Open
Abstract
This study analyzes notification of syphilis in pregnancy and congenital syphilis in Amazo- nas State, Brazil, from 2007 to 2009 and verifies underreporting in databases in the National Information System on Diseases of Notification (SINAN) and the occurrence of perinatal deaths associated with congenital syphilis and not reported in the Mortality Information System (SIM). This was a cross-sectional study with probabilistic record linkage between the SINAN and SIM. There were 666 reports of syphilis in pregnant women, including 224 in 2007 (3.8/1,000), 244(4.5/1,000) in 2008, and 198(4.0/1,000) in 2009. The study found 486 cases of congenital syphilis, of which 153 in 2007 (2.1/1,000), 193 in 2008 (2.6/1,000), and 140 in 2009 (2.0/1,000). After linkage of the SINAN databases, 237 pregnant women (35.6%) had cases of congenital syphilis reported. The SIM recorded 4,905 perinatal deaths, of which 57.8% were stillbirths. Probabilistic record linkage between SIM and SINAN-Congenital Syphilis yielded 13 matched records. The use of SINAN and SIM may not reflect the total magnitude of syphilis, but provide the basis for monitoring and analyzing this health problem, with a view towards planning and management.
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Webb DA, Mathew L, Culhane JF. Lessons learned from the Philadelphia Collaborative Preterm Prevention Project: the prevalence of risk factors and program participation rates among women in the intervention group. BMC Pregnancy Childbirth 2014; 14:368. [PMID: 25361563 PMCID: PMC4230507 DOI: 10.1186/s12884-014-0368-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 10/15/2014] [Indexed: 11/21/2022] Open
Abstract
Background Women who deliver preterm infants are at a much greater risk for repeating a preterm birth (PTB), compared to women without a history of PTB. However, little is known about the prevalence of the risk factors which account for this markedly increased risk. Moreover, little or nothing is known about the feasibility of providing treatments and services to these women, outside of the context of prenatal care, during the inter-conception period, which provides the best opportunity for successful risk-reduction interventions. Methods The Philadelphia Collaborative Preterm Prevention Project (PCPPP), a large randomized control trial designed to identify and reduce six major risk factors for a repeat preterm birth among women immediately following the delivering of a preterm infant. For the women assigned to the PCPPP treatment group, we calculated the prevalence of the six risk factors in question, the percentages of women who agreed to receive high quality risk-appropriate treatments or services, and the of rates of participation among those who were offered and eligible for these treatments or services. Results Urogenital tract infections were identified in 57% of the women, while 59% were found to have periodontal disease. More than 39% were active smokers, and 17% were assessed with clinical depression. Low literacy, and housing instability were identified in, 22 and 83% of the study sample, respectively. Among women eligible for intervention, the percentages who accepted and at least minimally participated in treatment ranged from a low of 28% for smoking, to a high of 85% for urogenital tract infection. Most PCPPP enrollees (57%) had three or more major risk factors. Participation rates associated with the PCPPP treatments or services varied markedly, and were quite low in some cases, despite considerable efforts to reduce the barriers to receiving care. Conclusion The efficacy of individual level risk-reduction efforts designed to prevent preterm/repeat preterm in the pre- or inter-conception period may be limited if participation rates associated with interventions to reduce major risk factors for PTB are low. Achieving adequate participation may require identifying, better understanding, and eliminating barriers to access, beyond those associated with cost, transportation, childcare, and service location or hours of operation. Trial registration ClinicalTrials.gov (NCT01117922)
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Affiliation(s)
- David A Webb
- Children's Hospital of Philadelphia, National Children's Study Center, 3535 Market Street, Philadelphia, PA, 19104, USA.
| | - Leny Mathew
- Children's Hospital of Philadelphia, National Children's Study Center, 3535 Market Street, Philadelphia, PA, 19104, USA.
| | - Jennifer F Culhane
- Department of Pediatrics, University of Pennsylvania School of Medicine, and Department of Adolescent Medicine, Children's Hospital of Philadelphia, 3535 Market Street, Philadelphia, PA, 19104, USA.
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Broussard CS, Frey MT, Hernandez-Diaz S, Greene MF, Chambers CD, Sahin L, Collins Sharp BA, Honein MA. Developing a systematic approach to safer medication use during pregnancy: summary of a Centers for Disease Control and Prevention--convened meeting. Am J Obstet Gynecol 2014; 211:208-214.e1. [PMID: 24881821 PMCID: PMC4484789 DOI: 10.1016/j.ajog.2014.05.040] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 05/28/2014] [Indexed: 10/25/2022]
Abstract
To address information gaps that limit informed clinical decisions on medication use in pregnancy, the Centers for Disease Control and Prevention (CDC) solicited expert input on a draft prototype outlining a systematic approach to evaluating the quality and strength of existing evidence for associated risks. The draft prototype outlined a process for the systematic review of available evidence and deliberations by a panel of experts to inform clinical decision making for managing health conditions in pregnancy. At an expert meeting convened by the CDC in January 2013, participants divided into working groups discussed decision points within the prototype. This report summarizes their discussions of best practices for formulating an expert review process, developing evidence summaries and treatment guidance, and disseminating information. There is clear recognition of current knowledge gaps and a strong collaboration of federal partners, academic experts, and professional organizations willing to work together toward safer medication use during pregnancy.
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Affiliation(s)
- Cheryl S Broussard
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Meghan T Frey
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA; Oak Ridge Institute for Science and Education, Oak Ridge, TN
| | | | - Michael F Greene
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School and Massachusetts General Hospital, Boston, MA
| | - Christina D Chambers
- Departments of Pediatrics and Family and Preventive Medicine, University of California, San Diego, La Jolla, CA
| | - Leyla Sahin
- Pediatric and Maternal Health Staff, Maternal Health Team, Office of New Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD
| | | | - Margaret A Honein
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
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Valent F, Gongolo F, Deroma L, Zanier L. Prescription of systemic antibiotics during pregnancy in primary care in Friuli Venezia Giulia, Northeastern Italy. J Matern Fetal Neonatal Med 2014; 28:210-5. [PMID: 24766037 DOI: 10.3109/14767058.2014.906572] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To investigate the prescriptions of systemic antibiotics in a population of pregnant women in Italy, to identify socio-demographic factors associated with increased risk of being prescribed potentially unsafe medications, to compare prescriptions before and during pregnancy and to identify the prescribing General Practitioners (GPs). METHODS A retrospective study based on administrative anonymous databases included all women resident of the Friuli Venezia Giulia Region who delivered babies in 2011 (n=9196). The antibiotic prescription risk was calculated by trimester and overall, and compared with that in the year before. Multivariate logistic regression analyses assessed the role of socio-demographic factors on the risk of being prescribed medications that should not be used as first-line. RESULTS 6688 women (72.7%) were prescribed medicines (27363 prescriptions) during their pregnancies. Antibiotics were prescribed to 2279 women (24.8%), less commonly during pregnancy than before. Prescriptions were more frequent in the second and third trimesters. 1736 women were prescribed antibiotics other than first-line medicines (of which, seven tetracyclines and 58 quinolones, which are frankly not recommended). Those women were more frequently younger and less educated. The GPs responsible for those prescriptions were identified. CONCLUSIONS In order to improve the prescription of antibiotics in pregnancy, an audit with the GPs is warranted to understand their motivations, discuss clinical cases and build consensus guidelines on which antibiotics should be preferred for use in pregnancy.
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Affiliation(s)
- Francesca Valent
- Planning and Programming Area, Central Health Directorate, Friuli Venezia Giulia Region , Udine , Italy
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Romero R, Hassan SS, Gajer P, Tarca AL, Fadrosh DW, Nikita L, Galuppi M, Lamont RF, Chaemsaithong P, Miranda J, Chaiworapongsa T, Ravel J. The composition and stability of the vaginal microbiota of normal pregnant women is different from that of non-pregnant women. MICROBIOME 2014; 2:4. [PMID: 24484853 PMCID: PMC3916806 DOI: 10.1186/2049-2618-2-4] [Citation(s) in RCA: 468] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 12/18/2013] [Indexed: 05/04/2023]
Abstract
BACKGROUND This study was undertaken to characterize the vaginal microbiota throughout normal human pregnancy using sequence-based techniques. We compared the vaginal microbial composition of non-pregnant patients with a group of pregnant women who delivered at term. RESULTS A retrospective case-control longitudinal study was designed and included non-pregnant women (n = 32) and pregnant women who delivered at term (38 to 42 weeks) without complications (n = 22). Serial samples of vaginal fluid were collected from both non-pregnant and pregnant patients. A 16S rRNA gene sequence-based survey was conducted using pyrosequencing to characterize the structure and stability of the vaginal microbiota. Linear mixed effects models and generalized estimating equations were used to identify the phylotypes whose relative abundance was different between the two study groups. The vaginal microbiota of normal pregnant women was different from that of non-pregnant women (higher abundance of Lactobacillus vaginalis, L. crispatus, L. gasseri and L. jensenii and lower abundance of 22 other phylotypes in pregnant women). Bacterial community state type (CST) IV-B or CST IV-A characterized by high relative abundance of species of genus Atopobium as well as the presence of Prevotella, Sneathia, Gardnerella, Ruminococcaceae, Parvimonas, Mobiluncus and other taxa previously shown to be associated with bacterial vaginosis were less frequent in normal pregnancy. The stability of the vaginal microbiota of pregnant women was higher than that of non-pregnant women; however, during normal pregnancy, bacterial communities shift almost exclusively from one CST dominated by Lactobacillus spp. to another CST dominated by Lactobacillus spp. CONCLUSION We report the first longitudinal study of the vaginal microbiota in normal pregnancy. Differences in the composition and stability of the microbial community between pregnant and non-pregnant women were observed. Lactobacillus spp. were the predominant members of the microbial community in normal pregnancy. These results can serve as the basis to study the relationship between the vaginal microbiome and adverse pregnancy outcomes.
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Affiliation(s)
- Roberto Romero
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD and, Detroit, MI, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Sonia S Hassan
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD and, Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Pawel Gajer
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Adi L Tarca
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD and, Detroit, MI, USA
| | - Douglas W Fadrosh
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lorraine Nikita
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD and, Detroit, MI, USA
| | - Marisa Galuppi
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD and, Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Ronald F Lamont
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD and, Detroit, MI, USA
- Department of Obstetrics and Gynaecology, University of Southern Denmark, Odense, Denmark
- Division of Surgery, University College, Northwick Park Institute for Medical Research Campus, London, UK
| | - Piya Chaemsaithong
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD and, Detroit, MI, USA
| | - Jezid Miranda
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD and, Detroit, MI, USA
| | - Tinnakorn Chaiworapongsa
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD and, Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Jacques Ravel
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, USA
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