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Tseng TC, Wang TM, Hsu YC, Hsu CT, Lin YH, Lin MC. Impact of COVID-19 pandemic on neurodevelopmental outcomes of premature infants: a retrospective national cohort study. BMJ Paediatr Open 2024; 8:e002493. [PMID: 38823798 PMCID: PMC11149170 DOI: 10.1136/bmjpo-2024-002493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 05/05/2024] [Indexed: 06/03/2024] Open
Abstract
OBJECTIVE To compare the neurodevelopmental outcomes of preterm infants before and during the COVID-19 pandemic. DESIGN Premature infants born in 2018 were assigned to the pre-pandemic group, while those born in 2019 were assigned to the during-pandemic group. SETTING Nationwide cohort study. PATIENTS Very low birthweight premature infants registered in the Taiwan Premature Infant Follow-up Network database. INTERVENTIONS Anti-epidemic measures, including quarantine and isolation protocols, social distancing, the closure of public spaces and restrictions on travel and gatherings during COVID-19 pandemic. MAIN OUTCOME MEASURES Outcomes were measured by Bayley Scales of Infant and Toddler Development Third Edition at corrected ages of 6, 12 and 24 months old. Generalised estimating equation (GEE) was applied to incorporate all measurements into a single model. RESULTS Among the 1939 premature infants who were enrolled, 985 developed before the pandemic, while 954 developed during the pandemic. Premature infants whose development occurred during the pandemic exhibited better cognitive composite at the corrected age of 6 months (beta=2.358; 95% CI, 1.07 to 3.65; p<0.001), and motor composite at corrected ages of 12 months (beta=1.680; 95% CI, 0.34 to 3.02; p=0.014). GEE analysis showed that infants who had grown during the pandemic achieved higher scores in cognitive composite (beta=1.416; 95% CI, 0.36 to 2.48; p=0.009). CONCLUSION Premature infants in Taiwan who developed during the pandemic showed better neurodevelopment compared with those born before the pandemic.
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Affiliation(s)
- Tzu-Cheng Tseng
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Teh-Ming Wang
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ya-Chi Hsu
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chung-Ting Hsu
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Yi-Hsuan Lin
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Chih Lin
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Food and Nutrition, Providence University, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Schmidt JK, Wilson RL, Davenport BN, Hacker TA, Fitz C, Simmons HA, Schotzko ML, Golos TG, Jones HN. Nanoparticle-mediated delivery of placental gene therapy via uterine artery catheterization in a pregnant rhesus macaque. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.04.10.588902. [PMID: 38645086 PMCID: PMC11030404 DOI: 10.1101/2024.04.10.588902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Nanoparticles offer promise as a mechanism to non-invasively deliver targeted placental therapeutics. Our previous studies utilizing intraplacental administration demonstrate efficient nanoparticle uptake into placental trophoblast cells and overexpression of human IGF1 ( hIGF1 ). Nanoparticle-mediated placental overexpression of hIGF1 in small animal models of placental insufficiency and fetal growth restriction improved nutrient transport and restored fetal growth. The objective of this pilot study was to extend these studies to the pregnant nonhuman primate and develop a method for local delivery of nanoparticles to the placenta via maternal blood flow from the uterine artery. Nanoparticles containing hIGF1 plasmid driven by the placenta-specific PLAC1 promoter were delivered to a mid-gestation pregnant rhesus macaque via a catheterization approach that is clinically used for uterine artery embolization. Maternal-fetal interface, fetal and maternal tissues were collected four days post-treatment to evaluate the efficacy of hIGF1 treatment in the placenta. The uterine artery catheterization procedure and nanoparticle treatment was well tolerated by the dam and fetus through the four-day study period following catheterization. Nanoparticles were taken up by the placenta from maternal blood as plasmid-specific hIGF1 expression was detected in multiple regions of the placenta via in situ hybridization and qPCR. The uterine artery catheterization approach enabled successful delivery of nanoparticles to maternal circulation in close proximity to the placenta with no concerns to maternal or fetal health in this short-term feasibility study. In the future, this delivery approach can be used for preclinical evaluation of the long-term safety and efficacy of nanoparticle-mediated placental therapies in a rhesus macaque model. Highlights Novel method to deliver therapeutics to maternal-fetal interfaceDelivery of nanoparticles to the placenta via maternal catheterization.
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Scher MS. The science of uncertainty guides fetal-neonatal neurology principles and practice: diagnostic-prognostic opportunities and challenges. Front Neurol 2024; 15:1335933. [PMID: 38352135 PMCID: PMC10861710 DOI: 10.3389/fneur.2024.1335933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/08/2024] [Indexed: 02/16/2024] Open
Abstract
Fetal-neonatal neurologists (FNNs) consider diagnostic, therapeutic, and prognostic decisions strengthened by interdisciplinary collaborations. Bio-social perspectives of the woman's health influence evaluations of maternal-placental-fetal (MPF) triad, neonate, and child. A dual cognitive process integrates "fast thinking-slow thinking" to reach shared decisions that minimize bias and maintain trust. Assessing the science of uncertainty with uncertainties in science improves diagnostic choices across the developmental-aging continuum. Three case vignettes highlight challenges that illustrate this approach. The first maternal-fetal dyad involved a woman who had been recommended to terminate her pregnancy based on an incorrect diagnosis of an encephalocele. A meningocele was subsequently identified when she sought a second opinion with normal outcome for her child. The second vignette involved two pregnancies during which fetal cardiac rhabdomyoma was identified, suggesting tuberous sclerosis complex (TSC). One woman sought an out-of-state termination without confirmation using fetal brain MRI or postmortem examination. The second woman requested pregnancy care with postnatal evaluations. Her adult child experiences challenges associated with TSC sequelae. The third vignette involved a prenatal diagnosis of an open neural tube defect with arthrogryposis multiplex congenita. The family requested prenatal surgical closure of the defect at another institution at their personal expense despite receiving a grave prognosis. The subsequent Management of Myelomeningocele Study (MOMS) would not have recommended this procedure. Their adult child requires medical care for global developmental delay, intractable epilepsy, and autism. These three evaluations involved uncertainties requiring shared clinical decisions among all stakeholders. Falsely negative or misleading positive interpretation of results reduced chances for optimal outcomes. FNN diagnostic skills require an understanding of dynamic gene-environment interactions affecting reproductive followed by pregnancy exposomes that influence the MPF triad health with fetal neuroplasticity consequences. Toxic stressor interplay can impair the neural exposome, expressed as anomalous and/or destructive fetal brain lesions. Functional improvements or permanent sequelae may be expressed across the lifespan. Equitable and compassionate healthcare for women and families require shared decisions that preserve pregnancy health, guided by person-specific racial-ethnic, religious, and bio-social perspectives. Applying developmental origins theory to neurologic principles and practice supports a brain health capital strategy for all persons across each generation.
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Affiliation(s)
- Mark Steven Scher
- Fetal/Neonatal Neurology Program, Division of Pediatric Neurology, Department of Pediatrics, Case Western Reserve University, Cleveland, OH, United States
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Liu B, Lu X, Jiang A, Lv Y, Zhang H, Xu B. Influence of maternal endocrine disrupting chemicals exposure on adverse pregnancy outcomes: A systematic review and meta-analysis. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 270:115851. [PMID: 38157800 DOI: 10.1016/j.ecoenv.2023.115851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024]
Abstract
Maternal endocrine disrupting chemicals (EDCs) exposure, the common environmental pollutants, was capable of involving in adverse pregnancy outcomes. However, the evidence of their connection is not consistent. Our goal was to comprehensively explore the risk of EDCs related to adverse pregnancy outcomes. One hundred and one studies were included from two databases before 2023 to explore the association between EDCs and adverse pregnancy outcomes including miscarriage, small for gestational age (SGA), low birth weight (LBW) and preterm birth (PTB). We found that maternal PFASs exposure was positively correlated with PTB (OR:1.13, 95% CI:1.04-1.23), SGA (OR:1.10, 95% CI:1.04-1.16) and miscarriage (OR:1.09, 95% CI:1.00-1.19). The pooled estimates also showed maternal PAEs exposure was linked with PTB (OR:1.16, 95% CI:1.11-1.21), SGA (OR:1.20, 95% CI:1.07-1.35) and miscarriage (OR:1.55, 95% CI:1.33-1.81). In addition, maternal exposure to some specific class of EDCs including PFOS, MBP, MEHP, DEHP, and BPA was associated with PTB. Maternal exposure to PFOS, PFOA, PFHpA was associated with SGA. Maternal exposure to BPA was associated with LBW. Maternal exposure to MMP, MEHP, MEHHP, MEOHP, BPA was associated with miscarriage. Maternal PFASs, PAEs and BPA exposure may increase adverse pregnancy outcomes risk according to our study. However, the limited number of studies on dose-response hampered further explanation for causal association.
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Affiliation(s)
- Bin Liu
- Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Medical Aspects of Specific Environments, School of Basic Medicine, Anhui Medical University, Hefei, China
| | - Xiaoling Lu
- Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Medical Aspects of Specific Environments, School of Basic Medicine, Anhui Medical University, Hefei, China
| | - Antong Jiang
- Department of Medical Aspects of Specific Environments, School of Basic Medicine, Anhui Medical University, Hefei, China
| | - Yanming Lv
- Department of Toxicology, School of Public Health, Harbin Medical University, Harbin, China
| | - Hongmei Zhang
- Department of Toxicology, School of Public Health, Harbin Medical University, Harbin, China
| | - Bin Xu
- Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Medical Aspects of Specific Environments, School of Basic Medicine, Anhui Medical University, Hefei, China.
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Scher MS. Interdisciplinary fetal-neonatal neurology training applies neural exposome perspectives to neurology principles and practice. Front Neurol 2024; 14:1321674. [PMID: 38288328 PMCID: PMC10824035 DOI: 10.3389/fneur.2023.1321674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 12/07/2023] [Indexed: 01/31/2024] Open
Abstract
An interdisciplinary fetal-neonatal neurology (FNN) program over the first 1,000 days teaches perspectives of the neural exposome that are applicable across the life span. This curriculum strengthens neonatal neurocritical care, pediatric, and adult neurology training objectives. Teaching at maternal-pediatric hospital centers optimally merges reproductive, pregnancy, and pediatric approaches to healthcare. Phenotype-genotype expressions of health or disease pathways represent a dynamic neural exposome over developmental time. The science of uncertainty applied to FNN training re-enforces the importance of shared clinical decisions that minimize bias and reduce cognitive errors. Trainees select mentoring committee participants that will maximize their learning experiences. Standardized questions and oral presentations monitor educational progress. Master or doctoral defense preparation and competitive research funding can be goals for specific individuals. FNN principles applied to practice offer an understanding of gene-environment interactions that recognizes the effects of reproductive health on the maternal-placental-fetal triad, neonate, child, and adult. Pre-conception and prenatal adversities potentially diminish life-course brain health. Endogenous and exogenous toxic stressor interplay (TSI) alters the neural exposome through maladaptive developmental neuroplasticity. Developmental disorders and epilepsy are primarily expressed during the first 1,000 days. Communicable and noncommunicable illnesses continue to interact with the neural exposome to express diverse neurologic disorders across the lifespan, particularly during the critical/sensitive time periods of adolescence and reproductive senescence. Anomalous or destructive fetal neuropathologic lesions change clinical expressions across this developmental-aging continuum. An integrated understanding of reproductive, pregnancy, placental, neonatal, childhood, and adult exposome effects offers a life-course perspective of the neural exposome. Exosome research promises improved disease monitoring and drug delivery starting during pregnancy. Developmental origins of health and disease principles applied to FNN practice anticipate neurologic diagnoses with interventions that can benefit successive generations. Addressing health care disparities in the Global South and high-income country medical deserts require constructive dialogue among stakeholders to achieve medical equity. Population health policies require a brain capital strategy that reduces the global burden of neurologic diseases by applying FNN principles and practice. This integrative neurologic care approach will prolong survival with an improved quality of life for persons across the lifespan confronted with neurological disorders.
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Affiliation(s)
- Mark S. Scher
- Division of Pediatric Neurology, Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, United States
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Volqvartz T, Andersen HHB, Pedersen LH, Larsen A. Obesity in pregnancy-Long-term effects on offspring hypothalamic-pituitary-adrenal axis and associations with placental cortisol metabolism: A systematic review. Eur J Neurosci 2023; 58:4393-4422. [PMID: 37974556 DOI: 10.1111/ejn.16184] [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: 04/21/2022] [Accepted: 10/20/2023] [Indexed: 11/19/2023]
Abstract
Obesity, affecting one in three pregnant women worldwide, is not only a major obstetric risk factor. The resulting low-grade inflammation may have a long-term impact on the offspring's HPA axis through dysregulation of maternal, placental and fetal corticosteroid metabolism, and children born of obese mothers have increased risk of diabetes and cardiovascular disease. The long-term effects of maternal obesity on offspring neurodevelopment are, however, undetermined and could depend on the specific effects on placental and fetal cortisol metabolism. This systematic review evaluates how maternal obesity affects placental cortisol metabolism and the offspring's HPA axis. Pubmed, Embase and Scopus were searched for original studies on maternal BMI, obesity, and cortisol metabolism and transfer. Fifteen studies were included after the screening of 4556 identified records. Studies were small with heterogeneous exposures and outcomes. Two studies found that maternal obesity reduced placental HSD11β2 activity. In one study, umbilical cord blood cortisol levels were affected by maternal BMI. In three studies, an altered cortisol response was consistently seen among offspring in childhood (n = 2) or adulthood (n = 1). Maternal BMI was not associated with placental HSD11β1 or HSD11β2 mRNA expression, or placental HSD11β2 methylation. In conclusion, high maternal BMI is associated with reduced placental HSD11β2 activity and a dampened cortisol level among offspring, but the data is sparse. Further investigations are needed to clarify whether the HPA axis is affected by prenatal factors including maternal obesity and investigate if adverse effects can be ameliorated by optimising the intrauterine environment.
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Affiliation(s)
- Tabia Volqvartz
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Lars Henning Pedersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Biomedicine, Pharmacology, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Agnete Larsen
- Department of Biomedicine, Pharmacology, Aarhus University, Aarhus, Denmark
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Adlakha YK. Human 3D brain organoids: steering the demolecularization of brain and neurological diseases. Cell Death Discov 2023; 9:221. [PMID: 37400464 DOI: 10.1038/s41420-023-01523-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 07/05/2023] Open
Abstract
Understanding of human brain development, dysfunction and neurological diseases has remained limited and challenging due to inability to recapitulate human brain-specific features in animal models. Though the anatomy and physiology of the human brain has been understood in a remarkable way using post-mortem, pathological samples of human and animal models, however, modeling of human brain development and neurological diseases remains a challenge owing to distinct complexity of human brain. In this perspective, three-dimensional (3D) brain organoids have shown a beam of light. Tremendous growth in stem cell technologies has permitted the differentiation of pluripotent stem cells under 3D culture conditions into brain organoids, which recapitulate the unique features of human brain in many ways and also offer the detailed investigation of brain development, dysfunction and neurological diseases. Their translational value has also emerged and will benefit the society once the protocols for the upscaling of brain organoids are in place. Here, we summarize new advancements in methods for generation of more complex brain organoids including vascularized and mixed lineage tissue from PSCs. How synthetic biomaterials and microfluidic technology is boosting brain organoid development, has also been highlighted. We discuss the applications of brain organoids in studying preterm birth associated brain dysfunction; viral infections mediated neuroinflammation, neurodevelopmental and neurodegenerative diseases. We also highlight the translational value of brain organoids and current challenges that the field is experiencing.
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Affiliation(s)
- Yogita K Adlakha
- Amity Institute of Molecular Medicine and Stem Cell Research, Amity University, Noida, Uttar Pradesh, India.
- Maternal and Child Health Domain, Translational Health Science and Technology Institute (THSTI), Faridabad, Haryana, India.
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8
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Upreti D, Rouzer SK, Bowring A, Labbe E, Kumar R, Miranda RC, Mahnke AH. Microbiota and nutrition as risk and resiliency factors following prenatal alcohol exposure. Front Neurosci 2023; 17:1182635. [PMID: 37397440 PMCID: PMC10308314 DOI: 10.3389/fnins.2023.1182635] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/23/2023] [Indexed: 07/04/2023] Open
Abstract
Alcohol exposure in adulthood can result in inflammation, malnutrition, and altered gastroenteric microbiota, which may disrupt efficient nutrient extraction. Clinical and preclinical studies have documented convincingly that prenatal alcohol exposure (PAE) also results in persistent inflammation and nutrition deficiencies, though research on the impact of PAE on the enteric microbiota is in its infancy. Importantly, other neurodevelopmental disorders, including autism spectrum and attention deficit/hyperactivity disorders, have been linked to gut microbiota dysbiosis. The combined evidence from alcohol exposure in adulthood and from other neurodevelopmental disorders supports the hypothesis that gut microbiota dysbiosis is likely an etiological feature that contributes to negative developmental, including neurodevelopmental, consequences of PAE and results in fetal alcohol spectrum disorders. Here, we highlight published data that support a role for gut microbiota in healthy development and explore the implication of these studies for the role of altered microbiota in the lifelong health consequences of PAE.
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Affiliation(s)
| | | | | | | | | | | | - Amanda H. Mahnke
- Department of Neuroscience and Experimental Therapeutics, Texas A&M University School of Medicine, Bryan, TX, United States
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Saeed H, Lu YC, Andescavage N, Kapse K, Andersen NR, Lopez C, Quistorff J, Barnett S, Henderson D, Bulas D, Limperopoulos C. Influence of maternal psychological distress during COVID-19 pandemic on placental morphometry and texture. Sci Rep 2023; 13:7374. [PMID: 37164993 PMCID: PMC10172401 DOI: 10.1038/s41598-023-33343-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 04/12/2023] [Indexed: 05/12/2023] Open
Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic has been accompanied by increased prenatal maternal distress (PMD). PMD is associated with adverse pregnancy outcomes which may be mediated by the placenta. However, the potential impact of the pandemic on in vivo placental development remains unknown. To examine the impact of the pandemic and PMD on in vivo structural placental development using advanced magnetic resonance imaging (MRI), acquired anatomic images of the placenta from 63 pregnant women without known COVID-19 exposure during the pandemic and 165 pre-pandemic controls. Measures of placental morphometry and texture were extracted. PMD was determined from validated questionnaires. Generalized estimating equations were utilized to compare differences in PMD placental features between COVID-era and pre-pandemic cohorts. Maternal stress and depression scores were significantly higher in the pandemic cohort. Placental volume, thickness, gray level kurtosis, skewness and run length non-uniformity were increased in the pandemic cohort, while placental elongation, mean gray level and long run emphasis were decreased. PMD was a mediator of the association between pandemic status and placental features. Altered in vivo placental structure during the pandemic suggests an underappreciated link between disturbances in maternal environment and perturbed placental development. The long-term impact on offspring is currently under investigation.
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Affiliation(s)
- Haleema Saeed
- Department of Obstetrics & Gynecology, MedStar Washington Hospital Center, Washington, DC, 20010, USA
| | - Yuan-Chiao Lu
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Nickie Andescavage
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
- Division of Neonatology, Children's National Hospital, Washington, DC, 20010, USA
| | - Kushal Kapse
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Nicole R Andersen
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Catherine Lopez
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Jessica Quistorff
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Scott Barnett
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Diedtra Henderson
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Dorothy Bulas
- Division of Radiology, Children's National Hospital, Washington, DC, 20010, USA
| | - Catherine Limperopoulos
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA.
- Division of Radiology, Children's National Hospital, Washington, DC, 20010, USA.
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Wang S, Zhang C, Sun M, Zhang D, Luo Y, Liang K, Xu T, Pan X, Zheng R, Shangguan F, Wang J. Effectiveness of mindfulness training on pregnancy stress and the hypothalamic-pituitary-adrenal axis in women in China: A multicenter randomized controlled trial. Front Psychol 2023; 14:1073494. [PMID: 36935954 PMCID: PMC10018028 DOI: 10.3389/fpsyg.2023.1073494] [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: 10/18/2022] [Accepted: 02/14/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction In the past two decades, mindfulness-based intervention programs have gradually become popular.Many studies have confirmed that these programs can effectively alleviate prenatal stress and negative emotion.The mindfulness-based stress-buffering hypothesis suggests that mindfulness training can induce changes in the levels of the cortisol secreted by the HPA axis, thereby reducing stress susceptibility. However, to date, only a few high-quality evidence-based medical studies have analyzed the effect of the mindfulness-based intervention in a maternal population.Thus, this study investigated the effects of a mindfulness-based psychosomatic intervention on pregnancy stress and the HYPERLINK "javascript:;" hypothalamic-pituitary-adrenal (HPA) axis of pregnant Chinese women. Methods Women experiencing first-time pregnancy (n = 117) were randomly allocated to the intervention group or parallel active control group, and data were collected at baseline and post-intervention periods. The participants completed questionnaires regarding mindfulness and pregnancy stress. Saliva samples was collected at the time of waking up, and 30, 45, and 60 min after waking up for analyzing the salivary cortisol levels. We analyzed differences between the two groups and changes within the same group before and after the intervention. Results and discussion A total of 95 participants completed the trial. Compared with the parallel active control group, the intervention group exhibited lower levels of stress after the intervention (P = 0.047). For HPA-axis-related indicators after the intervention, Delta value (P = 0.01) and AUCM value (P = 0.031) of the intervention group were significantly higher than that of the control group. Mindfulness-based interventions effectively reduced the level of pregnancy stress and adjusted the HPA axis function in pregnant women in China. Clinical Trial Registration https://www.chictr.org.cn, identifier ChiCTR 2000033149.
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Affiliation(s)
- Shulei Wang
- National Center for Women and Children’s Health, China CDC, Beijing, China
- Yantai Center for Disease Control and Prevention, Yantai, Shandong, China
| | - Chen Zhang
- Fengtai Mental Health Center, Beijing, China
- School of Psychology, Capital Normal University, Beijing, China
| | - Mengyun Sun
- National Center for Women and Children’s Health, China CDC, Beijing, China
| | - Daming Zhang
- Shanxi Maternal and Child Health Hospital, Taiyuan, Shanxi, China
| | - Ying Luo
- Shandong Maternal and Child Health Hospital, Jinan, Shandong, China
| | - Kairu Liang
- Sichuan Maternal and Child Health Hospital, Chengdu, Sichuan, China
| | - Tao Xu
- National Center for Women and Children’s Health, China CDC, Beijing, China
| | - XiaoPing Pan
- National Center for Women and Children’s Health, China CDC, Beijing, China
| | - Ruimin Zheng
- National Center for Women and Children’s Health, China CDC, Beijing, China
- *Correspondence: Ruimin Zheng,
| | - Fangfang Shangguan
- School of Psychology, Capital Normal University, Beijing, China
- Fangfang Shangguan,
| | - Jia Wang
- Shandong Provincial Hospital, Jinan, Shandong, China
- Jia Wang,
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Roberts DJ, Baergen RN, Boyd TK, Carreon CK, Duncan VE, Ernst LM, Faye-Petersen OM, Folkins AK, Hecht JL, Heerema-McKenney A, Heller DS, Linn RL, Polizzano C, Ravishankar S, Redline RW, Salafia CM, Torous VF, Castro EC. Criteria for placental examination for obstetrical and neonatal providers. Am J Obstet Gynecol 2022; 228:497-508.e4. [PMID: 36549567 DOI: 10.1016/j.ajog.2022.12.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/28/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
Pathologic examination of the placenta can provide insight into likely (and unlikely) causes of antepartum and intrapartum events, diagnoses with urgent clinical relevance, prognostic information for mother and infant, support for practice evaluation and improvement, and insight into advancing the sciences of obstetrics and neonatology. Although it is true that not all placentas require pathologic examination (although alternative opinions have been expressed), prioritization of placentas for pathologic examination should be based on vetted indications such as maternal comorbidities or pregnancy complications in which placental pathology is thought to be useful for maternal or infant care, understanding pathophysiology, or practice modifications. Herein we provide placental triage criteria for the obstetrical and neonatal provider based on publications and expert opinion of 16 placental pathologists and a pathologists' assistant, formulated using a modified Delphi approach. These criteria include indications in which placental pathology has clinical relevance, such as pregnancy loss, maternal infection, suspected abruption, fetal growth restriction, preterm birth, nonreassuring fetal heart testing requiring urgent delivery, preeclampsia with severe features, or neonates with early evidence of multiorgan system failure including neurologic compromise. We encourage a focused gross examination by the provider or an attendant at delivery for all placentas and provide guidance for this examination. We recommend that any placenta that is abnormal on gross examination undergo a complete pathology examination. In addition, we suggest practice criteria for placental pathology services, including a list of critical values to be used by the relevant provider. We hope that these sets of triage indications, criteria, and practice suggestions will facilitate appropriate submission of placentas for pathologic examination and improve its relevance to clinical care.
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Affiliation(s)
- Drucilla J Roberts
- Massachusetts General Hospital Department of Pathology and Harvard Medical School, Boston, MA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Texas Children's Hospital Department of Pathology, Houston, TX; Boston's Children's Hospital Department of Pathology and Harvard Medical School, Boston, MA; University of Alabama at Birmingham Department of Pathology, Division of Women's Health, Birmingham, AL; NorthShore University Health System, Department of Pathology, Evanston, IL; Heersink School of Medicine, University of Alabama at Birmingham, Departments of Pathology and Obstetrics and Gynecology, Birmingham, AL; Stanford Healthcare Department of Pathology and Stanford University, Stanford, CA; Beth Israel Deaconess Medical Center Department of Pathology and Harvard Medical School, Boston, MA; Cleveland Clinic, Cleveland, OH; Rutgers-New Jersey Medical School, Newark, NJ; Children's Hospital of Philadelphia, Department of Pathology, Philadelphia, PA; MidState Medical Center Department of Pathology, Meriden, CT; Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Department of Pathology, Cleveland, OH; Case Western Reserve University School of Medicine Departments of Pathology and Reproductive Biology and University Hospitals Cleveland Medical Center, Cleveland, OH; Placental Analytics LLC, New Rochelle, NY; Texas Children's Hospital and Baylor College of Medicine, Department of Pathology, Houston, TX.
| | - Rebecca N Baergen
- Massachusetts General Hospital Department of Pathology and Harvard Medical School, Boston, MA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Texas Children's Hospital Department of Pathology, Houston, TX; Boston's Children's Hospital Department of Pathology and Harvard Medical School, Boston, MA; University of Alabama at Birmingham Department of Pathology, Division of Women's Health, Birmingham, AL; NorthShore University Health System, Department of Pathology, Evanston, IL; Heersink School of Medicine, University of Alabama at Birmingham, Departments of Pathology and Obstetrics and Gynecology, Birmingham, AL; Stanford Healthcare Department of Pathology and Stanford University, Stanford, CA; Beth Israel Deaconess Medical Center Department of Pathology and Harvard Medical School, Boston, MA; Cleveland Clinic, Cleveland, OH; Rutgers-New Jersey Medical School, Newark, NJ; Children's Hospital of Philadelphia, Department of Pathology, Philadelphia, PA; MidState Medical Center Department of Pathology, Meriden, CT; Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Department of Pathology, Cleveland, OH; Case Western Reserve University School of Medicine Departments of Pathology and Reproductive Biology and University Hospitals Cleveland Medical Center, Cleveland, OH; Placental Analytics LLC, New Rochelle, NY; Texas Children's Hospital and Baylor College of Medicine, Department of Pathology, Houston, TX
| | - Theonia K Boyd
- Massachusetts General Hospital Department of Pathology and Harvard Medical School, Boston, MA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Texas Children's Hospital Department of Pathology, Houston, TX; Boston's Children's Hospital Department of Pathology and Harvard Medical School, Boston, MA; University of Alabama at Birmingham Department of Pathology, Division of Women's Health, Birmingham, AL; NorthShore University Health System, Department of Pathology, Evanston, IL; Heersink School of Medicine, University of Alabama at Birmingham, Departments of Pathology and Obstetrics and Gynecology, Birmingham, AL; Stanford Healthcare Department of Pathology and Stanford University, Stanford, CA; Beth Israel Deaconess Medical Center Department of Pathology and Harvard Medical School, Boston, MA; Cleveland Clinic, Cleveland, OH; Rutgers-New Jersey Medical School, Newark, NJ; Children's Hospital of Philadelphia, Department of Pathology, Philadelphia, PA; MidState Medical Center Department of Pathology, Meriden, CT; Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Department of Pathology, Cleveland, OH; Case Western Reserve University School of Medicine Departments of Pathology and Reproductive Biology and University Hospitals Cleveland Medical Center, Cleveland, OH; Placental Analytics LLC, New Rochelle, NY; Texas Children's Hospital and Baylor College of Medicine, Department of Pathology, Houston, TX
| | - Chrystalle Katte Carreon
- Massachusetts General Hospital Department of Pathology and Harvard Medical School, Boston, MA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Texas Children's Hospital Department of Pathology, Houston, TX; Boston's Children's Hospital Department of Pathology and Harvard Medical School, Boston, MA; University of Alabama at Birmingham Department of Pathology, Division of Women's Health, Birmingham, AL; NorthShore University Health System, Department of Pathology, Evanston, IL; Heersink School of Medicine, University of Alabama at Birmingham, Departments of Pathology and Obstetrics and Gynecology, Birmingham, AL; Stanford Healthcare Department of Pathology and Stanford University, Stanford, CA; Beth Israel Deaconess Medical Center Department of Pathology and Harvard Medical School, Boston, MA; Cleveland Clinic, Cleveland, OH; Rutgers-New Jersey Medical School, Newark, NJ; Children's Hospital of Philadelphia, Department of Pathology, Philadelphia, PA; MidState Medical Center Department of Pathology, Meriden, CT; Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Department of Pathology, Cleveland, OH; Case Western Reserve University School of Medicine Departments of Pathology and Reproductive Biology and University Hospitals Cleveland Medical Center, Cleveland, OH; Placental Analytics LLC, New Rochelle, NY; Texas Children's Hospital and Baylor College of Medicine, Department of Pathology, Houston, TX
| | - Virginia E Duncan
- Massachusetts General Hospital Department of Pathology and Harvard Medical School, Boston, MA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Texas Children's Hospital Department of Pathology, Houston, TX; Boston's Children's Hospital Department of Pathology and Harvard Medical School, Boston, MA; University of Alabama at Birmingham Department of Pathology, Division of Women's Health, Birmingham, AL; NorthShore University Health System, Department of Pathology, Evanston, IL; Heersink School of Medicine, University of Alabama at Birmingham, Departments of Pathology and Obstetrics and Gynecology, Birmingham, AL; Stanford Healthcare Department of Pathology and Stanford University, Stanford, CA; Beth Israel Deaconess Medical Center Department of Pathology and Harvard Medical School, Boston, MA; Cleveland Clinic, Cleveland, OH; Rutgers-New Jersey Medical School, Newark, NJ; Children's Hospital of Philadelphia, Department of Pathology, Philadelphia, PA; MidState Medical Center Department of Pathology, Meriden, CT; Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Department of Pathology, Cleveland, OH; Case Western Reserve University School of Medicine Departments of Pathology and Reproductive Biology and University Hospitals Cleveland Medical Center, Cleveland, OH; Placental Analytics LLC, New Rochelle, NY; Texas Children's Hospital and Baylor College of Medicine, Department of Pathology, Houston, TX
| | - Linda M Ernst
- Massachusetts General Hospital Department of Pathology and Harvard Medical School, Boston, MA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Texas Children's Hospital Department of Pathology, Houston, TX; Boston's Children's Hospital Department of Pathology and Harvard Medical School, Boston, MA; University of Alabama at Birmingham Department of Pathology, Division of Women's Health, Birmingham, AL; NorthShore University Health System, Department of Pathology, Evanston, IL; Heersink School of Medicine, University of Alabama at Birmingham, Departments of Pathology and Obstetrics and Gynecology, Birmingham, AL; Stanford Healthcare Department of Pathology and Stanford University, Stanford, CA; Beth Israel Deaconess Medical Center Department of Pathology and Harvard Medical School, Boston, MA; Cleveland Clinic, Cleveland, OH; Rutgers-New Jersey Medical School, Newark, NJ; Children's Hospital of Philadelphia, Department of Pathology, Philadelphia, PA; MidState Medical Center Department of Pathology, Meriden, CT; Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Department of Pathology, Cleveland, OH; Case Western Reserve University School of Medicine Departments of Pathology and Reproductive Biology and University Hospitals Cleveland Medical Center, Cleveland, OH; Placental Analytics LLC, New Rochelle, NY; Texas Children's Hospital and Baylor College of Medicine, Department of Pathology, Houston, TX
| | - Ona M Faye-Petersen
- Massachusetts General Hospital Department of Pathology and Harvard Medical School, Boston, MA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Texas Children's Hospital Department of Pathology, Houston, TX; Boston's Children's Hospital Department of Pathology and Harvard Medical School, Boston, MA; University of Alabama at Birmingham Department of Pathology, Division of Women's Health, Birmingham, AL; NorthShore University Health System, Department of Pathology, Evanston, IL; Heersink School of Medicine, University of Alabama at Birmingham, Departments of Pathology and Obstetrics and Gynecology, Birmingham, AL; Stanford Healthcare Department of Pathology and Stanford University, Stanford, CA; Beth Israel Deaconess Medical Center Department of Pathology and Harvard Medical School, Boston, MA; Cleveland Clinic, Cleveland, OH; Rutgers-New Jersey Medical School, Newark, NJ; Children's Hospital of Philadelphia, Department of Pathology, Philadelphia, PA; MidState Medical Center Department of Pathology, Meriden, CT; Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Department of Pathology, Cleveland, OH; Case Western Reserve University School of Medicine Departments of Pathology and Reproductive Biology and University Hospitals Cleveland Medical Center, Cleveland, OH; Placental Analytics LLC, New Rochelle, NY; Texas Children's Hospital and Baylor College of Medicine, Department of Pathology, Houston, TX
| | - Ann K Folkins
- Massachusetts General Hospital Department of Pathology and Harvard Medical School, Boston, MA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Texas Children's Hospital Department of Pathology, Houston, TX; Boston's Children's Hospital Department of Pathology and Harvard Medical School, Boston, MA; University of Alabama at Birmingham Department of Pathology, Division of Women's Health, Birmingham, AL; NorthShore University Health System, Department of Pathology, Evanston, IL; Heersink School of Medicine, University of Alabama at Birmingham, Departments of Pathology and Obstetrics and Gynecology, Birmingham, AL; Stanford Healthcare Department of Pathology and Stanford University, Stanford, CA; Beth Israel Deaconess Medical Center Department of Pathology and Harvard Medical School, Boston, MA; Cleveland Clinic, Cleveland, OH; Rutgers-New Jersey Medical School, Newark, NJ; Children's Hospital of Philadelphia, Department of Pathology, Philadelphia, PA; MidState Medical Center Department of Pathology, Meriden, CT; Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Department of Pathology, Cleveland, OH; Case Western Reserve University School of Medicine Departments of Pathology and Reproductive Biology and University Hospitals Cleveland Medical Center, Cleveland, OH; Placental Analytics LLC, New Rochelle, NY; Texas Children's Hospital and Baylor College of Medicine, Department of Pathology, Houston, TX
| | - Jonathon L Hecht
- Massachusetts General Hospital Department of Pathology and Harvard Medical School, Boston, MA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Texas Children's Hospital Department of Pathology, Houston, TX; Boston's Children's Hospital Department of Pathology and Harvard Medical School, Boston, MA; University of Alabama at Birmingham Department of Pathology, Division of Women's Health, Birmingham, AL; NorthShore University Health System, Department of Pathology, Evanston, IL; Heersink School of Medicine, University of Alabama at Birmingham, Departments of Pathology and Obstetrics and Gynecology, Birmingham, AL; Stanford Healthcare Department of Pathology and Stanford University, Stanford, CA; Beth Israel Deaconess Medical Center Department of Pathology and Harvard Medical School, Boston, MA; Cleveland Clinic, Cleveland, OH; Rutgers-New Jersey Medical School, Newark, NJ; Children's Hospital of Philadelphia, Department of Pathology, Philadelphia, PA; MidState Medical Center Department of Pathology, Meriden, CT; Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Department of Pathology, Cleveland, OH; Case Western Reserve University School of Medicine Departments of Pathology and Reproductive Biology and University Hospitals Cleveland Medical Center, Cleveland, OH; Placental Analytics LLC, New Rochelle, NY; Texas Children's Hospital and Baylor College of Medicine, Department of Pathology, Houston, TX
| | - Amy Heerema-McKenney
- Massachusetts General Hospital Department of Pathology and Harvard Medical School, Boston, MA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Texas Children's Hospital Department of Pathology, Houston, TX; Boston's Children's Hospital Department of Pathology and Harvard Medical School, Boston, MA; University of Alabama at Birmingham Department of Pathology, Division of Women's Health, Birmingham, AL; NorthShore University Health System, Department of Pathology, Evanston, IL; Heersink School of Medicine, University of Alabama at Birmingham, Departments of Pathology and Obstetrics and Gynecology, Birmingham, AL; Stanford Healthcare Department of Pathology and Stanford University, Stanford, CA; Beth Israel Deaconess Medical Center Department of Pathology and Harvard Medical School, Boston, MA; Cleveland Clinic, Cleveland, OH; Rutgers-New Jersey Medical School, Newark, NJ; Children's Hospital of Philadelphia, Department of Pathology, Philadelphia, PA; MidState Medical Center Department of Pathology, Meriden, CT; Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Department of Pathology, Cleveland, OH; Case Western Reserve University School of Medicine Departments of Pathology and Reproductive Biology and University Hospitals Cleveland Medical Center, Cleveland, OH; Placental Analytics LLC, New Rochelle, NY; Texas Children's Hospital and Baylor College of Medicine, Department of Pathology, Houston, TX
| | - Debra S Heller
- Massachusetts General Hospital Department of Pathology and Harvard Medical School, Boston, MA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Texas Children's Hospital Department of Pathology, Houston, TX; Boston's Children's Hospital Department of Pathology and Harvard Medical School, Boston, MA; University of Alabama at Birmingham Department of Pathology, Division of Women's Health, Birmingham, AL; NorthShore University Health System, Department of Pathology, Evanston, IL; Heersink School of Medicine, University of Alabama at Birmingham, Departments of Pathology and Obstetrics and Gynecology, Birmingham, AL; Stanford Healthcare Department of Pathology and Stanford University, Stanford, CA; Beth Israel Deaconess Medical Center Department of Pathology and Harvard Medical School, Boston, MA; Cleveland Clinic, Cleveland, OH; Rutgers-New Jersey Medical School, Newark, NJ; Children's Hospital of Philadelphia, Department of Pathology, Philadelphia, PA; MidState Medical Center Department of Pathology, Meriden, CT; Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Department of Pathology, Cleveland, OH; Case Western Reserve University School of Medicine Departments of Pathology and Reproductive Biology and University Hospitals Cleveland Medical Center, Cleveland, OH; Placental Analytics LLC, New Rochelle, NY; Texas Children's Hospital and Baylor College of Medicine, Department of Pathology, Houston, TX
| | - Rebecca L Linn
- Massachusetts General Hospital Department of Pathology and Harvard Medical School, Boston, MA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Texas Children's Hospital Department of Pathology, Houston, TX; Boston's Children's Hospital Department of Pathology and Harvard Medical School, Boston, MA; University of Alabama at Birmingham Department of Pathology, Division of Women's Health, Birmingham, AL; NorthShore University Health System, Department of Pathology, Evanston, IL; Heersink School of Medicine, University of Alabama at Birmingham, Departments of Pathology and Obstetrics and Gynecology, Birmingham, AL; Stanford Healthcare Department of Pathology and Stanford University, Stanford, CA; Beth Israel Deaconess Medical Center Department of Pathology and Harvard Medical School, Boston, MA; Cleveland Clinic, Cleveland, OH; Rutgers-New Jersey Medical School, Newark, NJ; Children's Hospital of Philadelphia, Department of Pathology, Philadelphia, PA; MidState Medical Center Department of Pathology, Meriden, CT; Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Department of Pathology, Cleveland, OH; Case Western Reserve University School of Medicine Departments of Pathology and Reproductive Biology and University Hospitals Cleveland Medical Center, Cleveland, OH; Placental Analytics LLC, New Rochelle, NY; Texas Children's Hospital and Baylor College of Medicine, Department of Pathology, Houston, TX
| | - Carolyn Polizzano
- Massachusetts General Hospital Department of Pathology and Harvard Medical School, Boston, MA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Texas Children's Hospital Department of Pathology, Houston, TX; Boston's Children's Hospital Department of Pathology and Harvard Medical School, Boston, MA; University of Alabama at Birmingham Department of Pathology, Division of Women's Health, Birmingham, AL; NorthShore University Health System, Department of Pathology, Evanston, IL; Heersink School of Medicine, University of Alabama at Birmingham, Departments of Pathology and Obstetrics and Gynecology, Birmingham, AL; Stanford Healthcare Department of Pathology and Stanford University, Stanford, CA; Beth Israel Deaconess Medical Center Department of Pathology and Harvard Medical School, Boston, MA; Cleveland Clinic, Cleveland, OH; Rutgers-New Jersey Medical School, Newark, NJ; Children's Hospital of Philadelphia, Department of Pathology, Philadelphia, PA; MidState Medical Center Department of Pathology, Meriden, CT; Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Department of Pathology, Cleveland, OH; Case Western Reserve University School of Medicine Departments of Pathology and Reproductive Biology and University Hospitals Cleveland Medical Center, Cleveland, OH; Placental Analytics LLC, New Rochelle, NY; Texas Children's Hospital and Baylor College of Medicine, Department of Pathology, Houston, TX
| | - Sanjita Ravishankar
- Massachusetts General Hospital Department of Pathology and Harvard Medical School, Boston, MA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Texas Children's Hospital Department of Pathology, Houston, TX; Boston's Children's Hospital Department of Pathology and Harvard Medical School, Boston, MA; University of Alabama at Birmingham Department of Pathology, Division of Women's Health, Birmingham, AL; NorthShore University Health System, Department of Pathology, Evanston, IL; Heersink School of Medicine, University of Alabama at Birmingham, Departments of Pathology and Obstetrics and Gynecology, Birmingham, AL; Stanford Healthcare Department of Pathology and Stanford University, Stanford, CA; Beth Israel Deaconess Medical Center Department of Pathology and Harvard Medical School, Boston, MA; Cleveland Clinic, Cleveland, OH; Rutgers-New Jersey Medical School, Newark, NJ; Children's Hospital of Philadelphia, Department of Pathology, Philadelphia, PA; MidState Medical Center Department of Pathology, Meriden, CT; Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Department of Pathology, Cleveland, OH; Case Western Reserve University School of Medicine Departments of Pathology and Reproductive Biology and University Hospitals Cleveland Medical Center, Cleveland, OH; Placental Analytics LLC, New Rochelle, NY; Texas Children's Hospital and Baylor College of Medicine, Department of Pathology, Houston, TX
| | - Raymond W Redline
- Massachusetts General Hospital Department of Pathology and Harvard Medical School, Boston, MA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Texas Children's Hospital Department of Pathology, Houston, TX; Boston's Children's Hospital Department of Pathology and Harvard Medical School, Boston, MA; University of Alabama at Birmingham Department of Pathology, Division of Women's Health, Birmingham, AL; NorthShore University Health System, Department of Pathology, Evanston, IL; Heersink School of Medicine, University of Alabama at Birmingham, Departments of Pathology and Obstetrics and Gynecology, Birmingham, AL; Stanford Healthcare Department of Pathology and Stanford University, Stanford, CA; Beth Israel Deaconess Medical Center Department of Pathology and Harvard Medical School, Boston, MA; Cleveland Clinic, Cleveland, OH; Rutgers-New Jersey Medical School, Newark, NJ; Children's Hospital of Philadelphia, Department of Pathology, Philadelphia, PA; MidState Medical Center Department of Pathology, Meriden, CT; Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Department of Pathology, Cleveland, OH; Case Western Reserve University School of Medicine Departments of Pathology and Reproductive Biology and University Hospitals Cleveland Medical Center, Cleveland, OH; Placental Analytics LLC, New Rochelle, NY; Texas Children's Hospital and Baylor College of Medicine, Department of Pathology, Houston, TX
| | - Carolyn M Salafia
- Massachusetts General Hospital Department of Pathology and Harvard Medical School, Boston, MA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Texas Children's Hospital Department of Pathology, Houston, TX; Boston's Children's Hospital Department of Pathology and Harvard Medical School, Boston, MA; University of Alabama at Birmingham Department of Pathology, Division of Women's Health, Birmingham, AL; NorthShore University Health System, Department of Pathology, Evanston, IL; Heersink School of Medicine, University of Alabama at Birmingham, Departments of Pathology and Obstetrics and Gynecology, Birmingham, AL; Stanford Healthcare Department of Pathology and Stanford University, Stanford, CA; Beth Israel Deaconess Medical Center Department of Pathology and Harvard Medical School, Boston, MA; Cleveland Clinic, Cleveland, OH; Rutgers-New Jersey Medical School, Newark, NJ; Children's Hospital of Philadelphia, Department of Pathology, Philadelphia, PA; MidState Medical Center Department of Pathology, Meriden, CT; Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Department of Pathology, Cleveland, OH; Case Western Reserve University School of Medicine Departments of Pathology and Reproductive Biology and University Hospitals Cleveland Medical Center, Cleveland, OH; Placental Analytics LLC, New Rochelle, NY; Texas Children's Hospital and Baylor College of Medicine, Department of Pathology, Houston, TX
| | - Vanda F Torous
- Massachusetts General Hospital Department of Pathology and Harvard Medical School, Boston, MA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Texas Children's Hospital Department of Pathology, Houston, TX; Boston's Children's Hospital Department of Pathology and Harvard Medical School, Boston, MA; University of Alabama at Birmingham Department of Pathology, Division of Women's Health, Birmingham, AL; NorthShore University Health System, Department of Pathology, Evanston, IL; Heersink School of Medicine, University of Alabama at Birmingham, Departments of Pathology and Obstetrics and Gynecology, Birmingham, AL; Stanford Healthcare Department of Pathology and Stanford University, Stanford, CA; Beth Israel Deaconess Medical Center Department of Pathology and Harvard Medical School, Boston, MA; Cleveland Clinic, Cleveland, OH; Rutgers-New Jersey Medical School, Newark, NJ; Children's Hospital of Philadelphia, Department of Pathology, Philadelphia, PA; MidState Medical Center Department of Pathology, Meriden, CT; Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Department of Pathology, Cleveland, OH; Case Western Reserve University School of Medicine Departments of Pathology and Reproductive Biology and University Hospitals Cleveland Medical Center, Cleveland, OH; Placental Analytics LLC, New Rochelle, NY; Texas Children's Hospital and Baylor College of Medicine, Department of Pathology, Houston, TX
| | - Eumenia C Castro
- Massachusetts General Hospital Department of Pathology and Harvard Medical School, Boston, MA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Texas Children's Hospital Department of Pathology, Houston, TX; Boston's Children's Hospital Department of Pathology and Harvard Medical School, Boston, MA; University of Alabama at Birmingham Department of Pathology, Division of Women's Health, Birmingham, AL; NorthShore University Health System, Department of Pathology, Evanston, IL; Heersink School of Medicine, University of Alabama at Birmingham, Departments of Pathology and Obstetrics and Gynecology, Birmingham, AL; Stanford Healthcare Department of Pathology and Stanford University, Stanford, CA; Beth Israel Deaconess Medical Center Department of Pathology and Harvard Medical School, Boston, MA; Cleveland Clinic, Cleveland, OH; Rutgers-New Jersey Medical School, Newark, NJ; Children's Hospital of Philadelphia, Department of Pathology, Philadelphia, PA; MidState Medical Center Department of Pathology, Meriden, CT; Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Department of Pathology, Cleveland, OH; Case Western Reserve University School of Medicine Departments of Pathology and Reproductive Biology and University Hospitals Cleveland Medical Center, Cleveland, OH; Placental Analytics LLC, New Rochelle, NY; Texas Children's Hospital and Baylor College of Medicine, Department of Pathology, Houston, TX
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Scher MS. A Bio-Social Model during the First 1000 Days Optimizes Healthcare for Children with Developmental Disabilities. Biomedicines 2022; 10:3290. [PMID: 36552046 PMCID: PMC9775202 DOI: 10.3390/biomedicines10123290] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/28/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
Most children with developmental disabilities (DD) live in resource-limited countries (LMIC) or high-income country medical deserts (HICMD). A social contract between healthcare providers and families advocates for accurate diagnoses and effective interventions to treat diseases and toxic stressors. This bio-social model emphasizes reproductive health of women with trimester-specific maternal and pediatric healthcare interactions. Lifelong neuronal connectivity is more likely established across 80% of brain circuitries during the first 1000 days. Maladaptive gene-environment (G x E) interactions begin before conception later presenting as maternal-placental-fetal (MPF) triad, neonatal, or childhood neurologic disorders. Synergy between obstetrical and pediatric healthcare providers can reduce neurologic morbidities. Partnerships between healthcare providers and families should begin during the first 1000 days to address diseases more effectively to moderate maternal and childhood adverse effects. This bio-social model lowers the incidence and lessens the severity of sequalae such as DD. Access to genetic-metabolomic, neurophysiologic and neuroimaging evaluations enhances clinical decision-making for more effective interventions before full expression of neurologic dysfunction. Diagnostic accuracy facilitates developmental interventions for effective preschool planning. A description of a mother-child pair in a HIC emphasizes the time-sensitive importance for early interventions that influenced brain health throughout childhood. Partnership by her parents with healthcare providers and educators provided effective healthcare and lessened adverse effects. Effective educational interventions were later offered through her high school graduation. Healthcare disparities in LMIC and HICMD require that this bio-social model of care begin before the first 1000 days to effectively treat the most vulnerable women and children. Prioritizing family planning followed by prenatal, neonatal and child healthcare improves wellness and brain health. Familiarity with educational neuroscience for teachers applies neurologic diagnoses for effective individual educational plans. Integrating diversity and inclusion into medical and educational services cross socioeconomic, ethnic, racial, and cultural barriers with life-course benefits. Families require knowledge to recognize risks for their children and motivation to sustain relationships with providers and educators for optimal outcomes. The WHO sustainable development goals promote brain health before conception through the first 1000 days. Improved education, employment, and social engagement for all persons will have intergenerational and transgenerational benefits for communities and nations.
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Affiliation(s)
- Mark S. Scher
- Pediatrics and Neurology, Rainbow Babies and Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA;
- Department of Pediatrics, Division of Pediatric Neurology Fetal/Neonatal Neurology Program, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
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Non-invasive monitoring of blood oxygenation in human placentas via concurrent diffuse optical spectroscopy and ultrasound imaging. Nat Biomed Eng 2022; 6:1017-1030. [PMID: 35970929 PMCID: PMC9944515 DOI: 10.1038/s41551-022-00913-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 06/27/2022] [Indexed: 01/13/2023]
Abstract
Direct assessment of blood oxygenation in the human placenta can provide information about placental function. However, the monitoring of placental oxygenation involves invasive sampling or imaging techniques that are poorly suited for bedside use. Here we show that placental oxygen haemodynamics can be non-invasively probed in real time and up to 4.2 cm below the body surface via concurrent frequency-domain diffuse optical spectroscopy and ultrasound imaging. We developed a multimodal instrument to facilitate the assessment of the properties of the anterior placenta by leveraging image-reconstruction algorithms that integrate ultrasound information about the morphology of tissue layers with optical information on haemodynamics. In a pilot investigation involving placentas with normal function (15 women) or abnormal function (9 women) from pregnancies in the third trimester, we found no significant differences in baseline haemoglobin properties, but statistically significant differences in the haemodynamic responses to maternal hyperoxia. Our findings suggest that the non-invasive monitoring of placental oxygenation may aid the early detection of placenta-related adverse pregnancy outcomes and maternal vascular malperfusion.
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Brink LT, Roberts DJ, Wright CA, Nel DG, Schubert PT, Boyd TK, Hall DR, Odendaal H. Placental pathology in spontaneous and iatrogenic preterm birth: Different entities with unique pathologic features. Placenta 2022; 126:54-63. [PMID: 35777272 PMCID: PMC10555798 DOI: 10.1016/j.placenta.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/01/2022] [Accepted: 06/11/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Placental pathology is an important contributor to the understanding of preterm birth and reveals major differences between spontaneous preterm birth (SPTB) and iatrogenic preterm birth (IPTB). The aim of this study was to investigate these relationships. METHODS Research midwives collected placentas from 1101 women with singleton pregnancies who were enrolled in the Safe Passage Study. Trained pathology technologists prepared and processed placenta specimens for macroscopic and microscopic examination by designated pathologists. Statistical analyses were done with STATISTICA version 13. RESULTS In SPTB we found more cases of accelerated villous maturation; however, the other features of maternal vascular malperfusion (MVM) were not present. The prevalence rate of funisitis was also increased. In IPTB, multiple features of MVM - accelerated villous maturation, distal villous hypoplasia, decidual arteriopathy, increased syncytial knots, increased perivillous fibrin, and prominent extravillous trophoblast were increased, as were features of fetal vascular malperfusion (FVM) - umbilical cord vessel thrombosis, avascular villi, and fetal vascular thrombosis. Increased syncytial knots were found in 26% of preterm stillbirths and in 29% of preterm infant demises as compared to 81% of IPTB infants alive at one year. DISCUSSION SPTB and IPTB differ. The detected "abnormal" accelerated villous maturation pattern in SPTB and preterm demises, suggests an inability of the placenta to adapt and may be a trigger for SPTB. Funisitis was the only inflammatory response significant for SPTB. MVM and FVM are implicated in IPTB, but not an inflammatory process.
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Affiliation(s)
- Lucy T Brink
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, Cape Town, South Africa
| | - Drucilla J Roberts
- Massachusetts General Hospital, Department of Pathology, 55 Fruit Street, Warren 219, Boston, MA, 02114, United States
| | - Colleen A Wright
- Lancet Laboratories, Johannesburg, South Africa; Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, Cape Town, South Africa
| | - Daan G Nel
- Department of Statistics and Actuarial Science, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa
| | - Pawel T Schubert
- Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, Cape Town, South Africa
| | - Theonia K Boyd
- Department of Pathology, Texas Children's Hospital, Houston, TX, United States
| | - David R Hall
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, Cape Town, South Africa
| | - Hein Odendaal
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, Cape Town, South Africa.
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Scher MS. Gene-Environment Interactions During the First Thousand Days Influence Childhood Neurological Diagnosis. Semin Pediatr Neurol 2022; 42:100970. [PMID: 35868730 DOI: 10.1016/j.spen.2022.100970] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/01/2022] [Accepted: 04/02/2022] [Indexed: 10/18/2022]
Abstract
Gene-environment (G x E) interactions significantly influence neurologic outcomes. The maternal-placental-fetal (MPF) triad, neonate, or child less than 2 years may first exhibit significant brain disorders. Neuroplasticity during the first 1000 days will more likely result in life-long effects given critical periods of development. Developmental origins and life-course principles help recognize changing neurologic phenotypes across ages. Dual diagnostic approaches are discussed using representative case scenarios to highlight time-dependent G x E interactions that contribute to neurologic sequelae. Horizontal analyses identify clinically relevant phenotypic form and function at different ages. Vertical analyses integrate the approach using systems-biology from genetic through multi-organ system interactions during each developmental age to understand etiopathogenesis. The process of ontogenetic adaptation results in immediate or delayed positive and negative outcomes specific to the developmental niche, expressed either as a healthy child or one with neurologic sequelae. Maternal immune activation, ischemic placental disease, and fetal inflammatory response represent prenatal disease pathways that contribute to fetal brain injuries. These processes involve G x E interactions within the MPF triad, phenotypically expressed as fetal brain malformations or destructive injuries within the MPF triad. A neonatal minority express encephalopathy, seizures, stroke, and encephalopathy of prematurity as a continuum of trimester-specific G x E interactions. This group may later present with childhood sequelae. A healthy neonatal majority present at older ages with sequelae such as developmental disorders, epilepsy, mental health diseases, tumors, and neurodegenerative disease, often during the first 1000 days. Effective preventive, rescue, and reparative neuroprotective strategies require consideration of G x E interactions interplay over time. Addressing maternal and pediatric health disparities will maximize medical equity with positive global outcomes that reduce the burden of neurologic diseases across the lifespan.
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Affiliation(s)
- Mark S Scher
- Department of Pediatrics, Division of Pediatric Neurology, Fetal/Neonatal Neurology Program, Rainbow Babies and Children's Hospital/MacDonald Hospital for Women, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH.
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16
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Monk C, Dimidjian S, Galinsky E, Gregory KD, Hoffman MC, Howell EA, Miller ES, Osborne C, Rogers CE, Saxbe DE, D'Alton ME. The Transition to Parenthood in Obstetrics: Enhancing Prenatal Care for Two Generation Impact. Am J Obstet Gynecol MFM 2022; 4:100678. [PMID: 35728782 DOI: 10.1016/j.ajogmf.2022.100678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 11/25/2022]
Abstract
Obstetrics, the specialty overseeing infant and parent health before birth, could be expanded to address the inter-related areas of parents' prenatal impact on children's brain development and their own psychosocial needs during a time of immense change and neuroplasticity. Obstetrics is primed for the shift that is happening in pediatrics, which is moving from its traditional focus on physical health to a coordinated, whole child, two or multi-generation approach. Pediatric care now includes developmental screening, parenting education, parent coaching, access to developmental specialists, brain-building caregiving skills, linkages to community resources, and tiered interventions with psychologists. Drawing on decades of Developmental Origins of Health and Disease research highlighting the prenatal beginnings of future health and new studies on the transition to parenthood describing adult development from pregnancy to early postpartum, we propose that, similar to pediatrics, the integration of education and intervention strategies into the prenatal care ecosystem should be tested for its potential to improve child cognitive and social-emotional development and parental mental health. Pediatric care programs can serve as models of change for the systematic development, testing and, incorporation of new content into prenatal care as universal, first-tier treatment as well as evidenced-based, triaged interventions according to level of need. To promote optimal beginnings for the whole family, we propose an augmented prenatal care ecosystem that aligns with, and could build on, current major efforts to enhance perinatal care individualization through consideration of medical, social, and structural determinants of health.
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Affiliation(s)
- Catherine Monk
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY; Department of Psychiatry, Columbia University Irving Medical Center, New York, NY.
| | - Sona Dimidjian
- Department of Psychology and Neuroscience, University Colorado, Boulder
| | | | | | - M Camille Hoffman
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora; Department of Psychiatry, University of Colorado School of Medicine, Aurora
| | - Elizabeth A Howell
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Emily S Miller
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL; Department of Psychiatry and Behavioral Health Sciences, Northwestern University, Chicago, IL
| | - Cynthia Osborne
- Department of Leadership, Policy, and Organizations, Peabody College, Vanderbilt University, Nashville, TN
| | - Cynthia E Rogers
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Darby E Saxbe
- Department of Psychology, University of Southern California, Los Angeles
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY
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17
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Gardella B, Dominoni M, Scatigno AL, Cesari S, Fiandrino G, Orcesi S, Spinillo A. What is known about neuroplacentology in fetal growth restriction and in preterm infants: A narrative review of literature. Front Endocrinol (Lausanne) 2022; 13:936171. [PMID: 36060976 PMCID: PMC9437342 DOI: 10.3389/fendo.2022.936171] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
The placenta plays a fundamental role during pregnancy for fetal growth and development. A suboptimal placental function may result in severe consequences during the infant's first years of life. In recent years, a new field known as neuroplacentology has emerged and it focuses on the role of the placenta in fetal and neonatal brain development. Because of the limited data, our aim was to provide a narrative review of the most recent knowledge about the relation between placental lesions and fetal and newborn neurological development. Papers published online from 2000 until February 2022 were taken into consideration and particular attention was given to articles in which placental lesions were related to neonatal morbidity and short-term and long-term neurological outcome. Most research regarding the role of placental lesions in neurodevelopment has been conducted on fetal growth restriction and preterm infants. Principal neurological outcomes investigated were periventricular leukomalacia, intraventricular hemorrhages, neonatal encephalopathy and autism spectrum disorder. No consequences in motor development were found. All the considered studies agree about the crucial role played by placenta in fetal and neonatal neurological development and outcome. However, the causal mechanisms remain largely unknown. Knowledge on the pathophysiological mechanisms and on placenta-related risks for neurological problems may provide clues for early interventions aiming to improve neurological outcomes, especially among pediatricians and child psychiatrists.
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Affiliation(s)
- Barbara Gardella
- Department of Obstetrics and Gynecology, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
- Department of Obstetrics and Gynecology, University of Pavia, Pavia, Italy
- *Correspondence: Barbara Gardella,
| | - Mattia Dominoni
- Department of Obstetrics and Gynecology, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
- Department of Obstetrics and Gynecology, University of Pavia, Pavia, Italy
| | - Annachiara Licia Scatigno
- Department of Obstetrics and Gynecology, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
- Department of Obstetrics and Gynecology, University of Pavia, Pavia, Italy
| | - Stefania Cesari
- Department of Pathology, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Giacomo Fiandrino
- Department of Pathology, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Simona Orcesi
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Child Neurology and Psychiatry Unit, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Mondino Foundation, Pavia, Italy
| | - Arsenio Spinillo
- Department of Obstetrics and Gynecology, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
- Department of Obstetrics and Gynecology, University of Pavia, Pavia, Italy
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18
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Monaco-Brown M, Lawrence DA. Obesity and Maternal-Placental-Fetal Immunology and Health. Front Pediatr 2022; 10:859885. [PMID: 35573953 PMCID: PMC9100592 DOI: 10.3389/fped.2022.859885] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/30/2022] [Indexed: 12/12/2022] Open
Abstract
Obesity rates in women of childbearing age is now at 29%, according to recent CDC reports. It is known that obesity is associated with oxidative stress and inflammation, including disruptions in cellular function and cytokine levels. In pregnant women who are obese, associated placental dysfunction can lead to small for gestational age (SGA) infants. More frequently, however, maternal obesity is associated with large for gestational age (LGA) newborns, who also have higher incidence of metabolic disease and asthma due to elevated levels of inflammation. In addition, anthropogenic environmental exposures to "endocrine disrupting" and "forever" chemicals affect obesity, as well as maternal physiology, the placenta, and fetal development. Placental function is intimately associated with the control of inflammation during pregnancy. There is a large amount of literature examining the relationship of placental immunology, both cellular and humoral, with pregnancy and neonatal outcomes. Cells such as placental macrophages and NK cells have been implicated in spontaneous miscarriage, preeclampsia, preterm birth, perinatal neuroinflammation, and other post-natal conditions. Differing levels of placental cytokines and molecular inflammatory mediators also have known associations with preeclampsia and developmental outcomes. In this review, we will specifically examine the literature regarding maternal, placental, and fetal immunology and how it is altered by maternal obesity and environmental chemicals. We will additionally describe the relationship between placental immune function and clinical outcomes, including neonatal conditions, autoimmune disease, allergies, immunodeficiency, metabolic and endocrine conditions, neurodevelopment, and psychiatric disorders.
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Affiliation(s)
- Meredith Monaco-Brown
- Department of Pediatrics, Bernard and Millie Duker Children's Hospital at Albany Medical Center, Albany, NY, United States
| | - David A Lawrence
- New York State Department of Health, Wadsworth Center, Albany, NY, United States.,Department of Environmental Health Sciences, University at Albany School of Public Health, Rensselaer, NY, United States
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19
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Yousefi B, Kokhaei P, Mehranfar F, Bahar A, Abdolshahi A, Emadi A, Eslami M. The role of the host microbiome in autism and neurodegenerative disorders and effect of epigenetic procedures in the brain functions. Neurosci Biobehav Rev 2021; 132:998-1009. [PMID: 34742725 DOI: 10.1016/j.neubiorev.2021.10.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 10/13/2021] [Accepted: 10/31/2021] [Indexed: 12/19/2022]
Abstract
Autism Spectrum Disorder (ASD) is a severe neurological/neurodegenerative syndrome that results in cognitive and communication disorders. The degree of dysbiosis is related to the severity of ASD signs. The gut is conferred with a variety of sensory receptors that cooperate with effector systems including the endocrine, nervous and gut immune systems of the intestine. Gut dysbiosis causes amplified inflammation, the launch of the HPA axis, changed levels of neurotransmitters and bacterial metabolites; these may donate to abnormal signaling throughout the Vagus nerve in ASD. Decreased integrity of the gastrointestinal barrier led to extreme leakage of substances as of the intestine in early life and inflammation followed by disruption of BBB integrity maybe increase the risk of ASD. Microbiota, by controlling the barrier permeability, regulate the quantity and types of bioactive materials that are transferred from the intestine to the brain. Exposure to metabolites and microbial products regulate significant procedures in the CNS, including glial cell role, myelination, synaptic pruning, and play a role in neurobehavioral, neurodegenerative, psychiatric, and metabolic syndrome.
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Affiliation(s)
- Bahman Yousefi
- Department of Immunology, Semnan University of Medical Sciences, Semnan, Iran
| | - Parviz Kokhaei
- Department of Immunology, Semnan University of Medical Sciences, Semnan, Iran; Immune and Gene Therapy Lab, Cancer Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden
| | - Fatemeh Mehranfar
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
| | - Aisa Bahar
- Department of Biochemistry, Semnan University of Medical Sciences, Semnan, Iran
| | - Anna Abdolshahi
- Food Safety Research Center (Salt), Semnan University of Medical Sciences, Semnan, Iran
| | - Alireza Emadi
- Deputy of Research and Technology, Semnan University of Medical Sciences, Semnan, Iran
| | - Majid Eslami
- Cancer Research Center, Semnan University of Medical Sciences, Semnan, Iran; Department of Bacteriology and Virology, Semnan University of Medical Sciences, Semnan, Iran.
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20
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Zhong Q, Liu HL, Fu H, Niu QS, Wu HB, Huang F. Prenatal exposure to phthalates with preterm birth and gestational age: A systematic review and meta-analysis. CHEMOSPHERE 2021; 282:130991. [PMID: 34090006 DOI: 10.1016/j.chemosphere.2021.130991] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/13/2021] [Accepted: 05/24/2021] [Indexed: 06/12/2023]
Abstract
Phthalates are non-persistent chemicals used in products of daily necessities. The evidence on the relationship of prenatal phthalates exposure and preterm birth remain uncertain and dimed. We Searched Cochrane, EMBASE, PubMed and Qvid Medline and selected studies according to a priori defined inclusion criteria. A total of 20 relevant studies published before March 31, 2020, were included. The main methods to detect heterogeneity and publication bias of included studies were the Q-statistic and Begg's test. Overall summary estimates indicated positive association of prenatal exposure to di(2-ethylhexyl) phthalate [number of studies (n) = 11, odds ratio (OR) = 1.1; 95% confidence interval (CI): 0.89, 1.4], diethyl phthalate [n = 11, OR = 1.1; 95% CI: 0.92, 1.3], dibutyl phthalate [n = 10, OR = 1.1; 95% CI: 0.77, 1.4], butyl benzyl phthalate [n = 10, OR = 1.0; 95% CI: 0.91, 1.2], diisobutyl phthalate [n = 9, OR = 1.1; 95% CI: 0.92, 1.3], diisononyl phthalate [n = 4, OR = 1.1; 95% CI: 0.85, 1.3], and phthalates were negatively associated with gestational age except di(2-ethylhexyl) phthalate and diisononyl phthalate. Most of them were not statistically significant. Subgroup analysis indicated that the heterogeneity was mainly found in the studies conducted in China and matrix collected at first trimester of pregnancy. Substantial heterogeneity and inconsistency of research methods may lead to inconsistent results of maternal phthalates exposure with preterm birth. We recommend a multicenter cohort study with a consistent approach to unravel the complex associations of prenatal phthalates exposure with birth outcomes.
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Affiliation(s)
- Qi Zhong
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, China
| | - Hui-Li Liu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, China
| | - Hong Fu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, China
| | - Qin-Shan Niu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, China
| | - Hua-Bing Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, China
| | - Fen Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, China.
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21
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Nguyen T, Khaksari K, Khare SM, Park S, Anderson AA, Bieda J, Jung E, Hsu CD, Romero R, Gandjbakhche AH. Non-invasive transabdominal measurement of placental oxygenation: a step toward continuous monitoring. BIOMEDICAL OPTICS EXPRESS 2021; 12:4119-4130. [PMID: 34457403 PMCID: PMC8367252 DOI: 10.1364/boe.424969] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 06/13/2023]
Abstract
This study aimed to assess transabdominal placental oxygenation levels non-invasively. A wearable device was designed and tested in 12 pregnant women with an anterior placenta, 5 of whom had maternal pregnancy complications. Preliminary results revealed that the placental oxygenation level is closely related to pregnancy complications and placental pathology. Women with maternal pregnancy complications were found to have a lower placental oxygenation level (69.4% ± 6.7%) than those with uncomplicated pregnancy (75.0% ± 5.8%). This device is a step in the development of a point-of-care method designed to continuously monitor placental oxygenation and to assess maternal and fetal health.
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Affiliation(s)
- Thien Nguyen
- National Institute of Child Health and Human Development, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20814, USA
| | - Kosar Khaksari
- National Institute of Child Health and Human Development, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20814, USA
| | - Siddharth M. Khare
- National Institute of Child Health and Human Development, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20814, USA
| | - Soongho Park
- National Institute of Child Health and Human Development, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20814, USA
| | - Afrouz A. Anderson
- National Institute of Child Health and Human Development, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20814, USA
| | - Janine Bieda
- Department of Obstetrics and Gynecology, Wayne State University, 3990 John R. Street, Box 158, Detroit, MI 48201, USA
| | - Eunjung Jung
- Department of Obstetrics and Gynecology, Wayne State University, 3990 John R. Street, Box 158, Detroit, MI 48201, USA
| | - Chaur-Dong Hsu
- Department of Obstetrics and Gynecology, Wayne State University, 3990 John R. Street, Box 158, Detroit, MI 48201, USA
| | - Roberto Romero
- Department of Obstetrics and Gynecology, Wayne State University, 3990 John R. Street, Box 158, Detroit, MI 48201, USA
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, 20814 and Detroit, Michigan 48201, USA
| | - Amir H. Gandjbakhche
- National Institute of Child Health and Human Development, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20814, USA
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22
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McCartney SA, Kapur R, Liggitt HD, Baldessari A, Coleman M, Orvis A, Ogle J, Katz R, Rajagopal L, Adams Waldorf KM. Amniotic fluid interleukin 6 and interleukin 8 are superior predictors of fetal lung injury compared with maternal or fetal plasma cytokines or placental histopathology in a nonhuman primate model. Am J Obstet Gynecol 2021; 225:89.e1-89.e16. [PMID: 33412130 DOI: 10.1016/j.ajog.2020.12.1214] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/20/2020] [Accepted: 12/30/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Intra-amniotic infection or inflammation is common in early preterm birth and associated with substantial neonatal lung morbidity owing to fetal exposure to proinflammatory cytokines and infectious organisms. Amniotic fluid interleukin 8, a proinflammatory cytokine, was previously correlated with the development of neonatal bronchopulmonary dysplasia, but whether amniotic fluid cytokines or placental pathology more accurately predicts neonatal lung pathology and morbidity is unknown. We have used a pregnant nonhuman primate model of group B Streptococcus infection to study the pathogenesis of intra-amniotic infection, bacterial invasion of the amniotic cavity and fetus, and microbial-host interactions. In this nonhuman primate model, we have studied the pathogenesis of group B Streptococcus strains with differing potential for virulence, which has resulted in a spectrum of intra-amniotic infection and fetal lung injury that affords the opportunity to study the inflammatory predictors of fetal lung pathology and injury. OBJECTIVE This study aimed to determine whether fetal lung injury is best predicted by placental histopathology or the cytokine response in amniotic fluid or maternal plasma. STUDY DESIGN Chronically catheterized pregnant monkeys (Macaca nemestrina, pigtail macaque) at 116 to 125 days gestation (term at 172 days) received a choriodecidual inoculation of saline (n=5), weakly hemolytic group B Streptococcus strain (n=5, low virulence), or hyperhemolytic group B Streptococcus strain (n=5, high virulence). Adverse pregnancy outcomes were defined as either preterm labor, microbial invasion of the amniotic cavity, or development of the fetal inflammatory response syndrome. Amniotic fluid and maternal and fetal plasma samples were collected after inoculation, and proinflammatory cytokines (tumor necrosis factor alpha, interleukin beta, interleukin 6, interleukin 8) were measured by a multiplex assay. Cesarean delivery was performed at the time of preterm labor or within 1 week of inoculation. Fetal necropsy was performed at the time of delivery. Placental pathology was scored in a blinded fashion by a pediatric pathologist, and fetal lung injury was determined by a semiquantitative score from histopathology evaluating inflammatory infiltrate, necrosis, tissue thickening, or collapse scored by a veterinary pathologist. RESULTS The principal findings in our study are as follows: (1) adverse pregnancy outcomes occurred more frequently in animals receiving hyperhemolytic group B Streptococcus (80% with preterm labor, 80% with fetal inflammatory response syndrome) than in animals receiving weakly hemolytic group B Streptococcus (40% with preterm labor, 20% with fetal inflammatory response syndrome) and in controls (0% preterm labor, 0% fetal inflammatory response syndrome); (2) despite differences in the rate of adverse pregnancy outcomes and fetal inflammatory response syndrome, fetal lung injury scores were similar between animals receiving the weakly hemolytic group B Streptococcus strains and animals receiving the hyperhemolytic group B Streptococcus strains; (3) fetal lung injury score was significantly correlated with peak amniotic fluid cytokines interleukin 6 and interleukin 8 but not tumor necrosis factor alpha or interleukin 1 beta; and (4) fetal lung scores were poorly correlated with maternal and fetal plasma cytokine levels and placental pathology. CONCLUSION Amniotic fluid interleukin 6 and interleukin 8 levels were superior predictors of fetal lung injury than placental histopathology or maternal plasma cytokines. This evidence supports a role for amniocentesis in the prediction of neonatal lung morbidity owing to intra-amniotic infection, which cannot be provided by cytokine analysis of maternal plasma or placental histopathology.
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Affiliation(s)
- Stephen A McCartney
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Raj Kapur
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle Children's Hospital, Seattle, WA
| | - H Denny Liggitt
- Department of Comparative Medicine, University of Washington, Seattle, WA
| | - Audrey Baldessari
- Washington National Primate Research Center, University of Washington, Seattle, WA
| | - Michelle Coleman
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA
| | - Austyn Orvis
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA
| | - Jason Ogle
- Washington National Primate Research Center, University of Washington, Seattle, WA
| | - Ronit Katz
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Lakshmi Rajagopal
- Department of Pediatrics, Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA; Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA
| | - Kristina M Adams Waldorf
- Department of Obstetrics and Gynecology and Global Health, University of Washington, Seattle, WA; Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA; Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle, WA; Sahlgrenska Academy, University of Gothenburg, Sweden.
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23
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Martinat M, Rossitto M, Di Miceli M, Layé S. Perinatal Dietary Polyunsaturated Fatty Acids in Brain Development, Role in Neurodevelopmental Disorders. Nutrients 2021; 13:1185. [PMID: 33918517 PMCID: PMC8065891 DOI: 10.3390/nu13041185] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 12/26/2022] Open
Abstract
n-3 and n-6 polyunsaturated fatty acids (PUFAs) are essential fatty acids that are provided by dietary intake. Growing evidence suggests that n-3 and n-6 PUFAs are paramount for brain functions. They constitute crucial elements of cellular membranes, especially in the brain. They are the precursors of several metabolites with different effects on inflammation and neuron outgrowth. Overall, long-chain PUFAs accumulate in the offspring brain during the embryonic and post-natal periods. In this review, we discuss how they accumulate in the developing brain, considering the maternal dietary supply, the polymorphisms of genes involved in their metabolism, and the differences linked to gender. We also report the mechanisms linking their bioavailability in the developing brain, their transfer from the mother to the embryo through the placenta, and their role in brain development. In addition, data on the potential role of altered bioavailability of long-chain n-3 PUFAs in the etiologies of neurodevelopmental diseases, such as autism, attention deficit and hyperactivity disorder, and schizophrenia, are reviewed.
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24
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Krey FC, Stocchero BA, Creutzberg KC, Heberle BA, Tractenberg SG, Xiang L, Wei W, Kluwe-Schiavon B, Viola TW. Neurotrophic Factor Levels in Preterm Infants: A Systematic Review and Meta-Analysis. Front Neurol 2021; 12:643576. [PMID: 33868149 PMCID: PMC8047113 DOI: 10.3389/fneur.2021.643576] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/05/2021] [Indexed: 01/11/2023] Open
Abstract
Objectives: Through a systematic review and meta-analysis of the literature we aimed to compare the levels of BDNF, NGF, NT-3, NT-4, and GDNF between human term and preterm infants, and investigate factors implicated in the variability of effect size estimates. Methods: The analysis was performed in three online databases, MEDLINE Complete, PsycINFO, and CINAHL. A random effects model was used to calculate the standardized mean difference (SMD) of neurotrophic factor levels in preterm infants vs. term within a 95% confidence interval (CI). To explore sources of heterogeneity meta-regression models were implemented. Results: Sixteen studies were included in this meta-analysis. A combined sample of 1,379 preterm and 1,286 term newborns were evaluated. We identified significant lower BDNF (SMD = -0.32; 95% CI: -0.59, -0.06; p = 0.014) and NT-3 (SMD = -0.31; 95% CI: -0.52, -0.09; p = 0.004) levels in preterm compared to term infants. No significant difference was observed in NGF and NT-4 levels between groups. Given that only two effect sizes were generated for GDNF levels, no meta-analytical model was performed. Meta-regression models revealed sample type (placental tissue, cerebrospinal fluid, peripheral blood, and umbilical cord blood) as a significant moderator of heterogeneity for BDNF meta-analysis. No significant associations were found for gestational week, birth weight, and clinical comorbidity of newborns with effect sizes. Conclusions: Our findings indicated that lower BDNF and NT-3 levels may be associated with preterm birth. Future studies with larger samples sizes should investigate neurodevelopmental manifestations resulting from neurotrophic factor dysregulation among preterm infants.
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Affiliation(s)
- Francieli Cristina Krey
- Developmental Cognitive Neuroscience Lab (DCNL), Graduate Program in Pediatrics and Child Health-School of Medicine, Pontifical University Catholic of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - Bruna Alvim Stocchero
- Developmental Cognitive Neuroscience Lab (DCNL), Graduate Program in Pediatrics and Child Health-School of Medicine, Pontifical University Catholic of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | | | - Bernardo Aguzzoli Heberle
- Developmental Cognitive Neuroscience Lab (DCNL), Graduate Program in Pediatrics and Child Health-School of Medicine, Pontifical University Catholic of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | | | - Li Xiang
- Neuroepigenetic Research Lab, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wei Wei
- Neuroepigenetic Research Lab, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Bruno Kluwe-Schiavon
- DCNL, PUCRS, Graduate Program in Psychology-School of Health Sciences, Porto Alegre, Brazil.,School of Psychology, Psychology Research Centre, University of Minho, Braga, Portugal
| | - Thiago Wendt Viola
- Developmental Cognitive Neuroscience Lab (DCNL), Graduate Program in Pediatrics and Child Health-School of Medicine, Pontifical University Catholic of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil.,Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
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25
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Effects of 'rescue' dose of antenatal corticosteroids on placental histopathology in preterm births. Placenta 2021; 107:41-45. [PMID: 33761427 DOI: 10.1016/j.placenta.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/16/2021] [Accepted: 03/02/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Antenatal corticosteroids (ACS) are frequently used to reduce neonatal morbidity in preterm births (PTBs). A 'rescue' dose of ACS can be administer, if the risk of PTB remains. Some reports indicated that repeated doses of ACS might impact placental histology and possibly its function. We aimed to study whether repeated doses of ACS effect placental histopathology and pregnancy outcome. METHODS The medical files and placental reports of all PTB, at 24-336/7 weeks, between Nov 2008-Dec 2019, were reviewed. The study population was divided into three groups; no-ACS (PTBs without ACS treatment), one-ACS (PTBs after a full or partial ACS course), and rescue-ACS (PTBs after a 'rescue' course of ACS). Placental lesions were classified according to "Amsterdam" criteria into maternal and fetal vascular malperfusion lesions, maternal and fetal inflammatory responses and chronic villitis. Placental lesions and pregnancy outcome were compared between the study groups. RESULTS The no-ACS group (n = 58) was characterized by increased rates of PTB<28 weeks (p = 0.003), perinatal death (p < 0.001) and composite neonatal infectious morbidity (p = 0.022), as compared to the one-ACS group (n = 331) and the rescue-ACS group (n = 53). Placental MIR lesions were more common among the rescue-ACS group, compared to the one- and no-ACS groups (p = 0.022). Other placental lesions did not differ between the groups. On multivariate logistic regression analysis, MIR lesions were independently associated with rescue-ACS treatment (aOR 3.00, 95% CI 1.10-8/17, p = 0.031). DISCUSSION Rescue course of ACS is associated with increased rate of placental maternal inflammatory response. These findings probably result from maternal stress stimuli without an adverse impact on early neonatal outcome.
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Scher MS. "The First Thousand Days" Define a Fetal/Neonatal Neurology Program. Front Pediatr 2021; 9:683138. [PMID: 34408995 PMCID: PMC8365757 DOI: 10.3389/fped.2021.683138] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/27/2021] [Indexed: 01/11/2023] Open
Abstract
Gene-environment interactions begin at conception to influence maternal/placental/fetal triads, neonates, and children with short- and long-term effects on brain development. Life-long developmental neuroplasticity more likely results during critical/sensitive periods of brain maturation over these first 1,000 days. A fetal/neonatal program (FNNP) applying this perspective better identifies trimester-specific mechanisms affecting the maternal/placental/fetal (MPF) triad, expressed as brain malformations and destructive lesions. Maladaptive MPF triad interactions impair progenitor neuronal/glial populations within transient embryonic/fetal brain structures by processes such as maternal immune activation. Destructive fetal brain lesions later in pregnancy result from ischemic placental syndromes associated with the great obstetrical syndromes. Trimester-specific MPF triad diseases may negatively impact labor and delivery outcomes. Neonatal neurocritical care addresses the symptomatic minority who express the great neonatal neurological syndromes: encephalopathy, seizures, stroke, and encephalopathy of prematurity. The asymptomatic majority present with neurologic disorders before 2 years of age without prior detection. The developmental principle of ontogenetic adaptation helps guide the diagnostic process during the first 1,000 days to identify more phenotypes using systems-biology analyses. This strategy will foster innovative interdisciplinary diagnostic/therapeutic pathways, educational curricula, and research agenda among multiple FNNP. Effective early-life diagnostic/therapeutic programs will help reduce neurologic disease burden across the lifespan and successive generations.
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Affiliation(s)
- Mark S Scher
- Division of Pediatric Neurology, Department of Pediatrics, Fetal/Neonatal Neurology Program, Emeritus Scholar Tenured Full Professor in Pediatrics and Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, United States
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Santos HP, Bhattacharya A, Joseph RM, Smeester L, Kuban KCK, Marsit CJ, O'Shea TM, Fry RC. Evidence for the placenta-brain axis: multi-omic kernel aggregation predicts intellectual and social impairment in children born extremely preterm. Mol Autism 2020; 11:97. [PMID: 33308293 PMCID: PMC7730750 DOI: 10.1186/s13229-020-00402-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/30/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Children born extremely preterm are at heightened risk for intellectual and social impairment, including Autism Spectrum Disorder (ASD). There is increasing evidence for a key role of the placenta in prenatal developmental programming, suggesting that the placenta may, in part, contribute to origins of neurodevelopmental outcomes. METHODS We examined associations between placental transcriptomic and epigenomic profiles and assessed their ability to predict intellectual and social impairment at age 10 years in 379 children from the Extremely Low Gestational Age Newborn (ELGAN) cohort. Assessment of intellectual ability (IQ) and social function was completed with the Differential Ability Scales-II and Social Responsiveness Scale (SRS), respectively. Examining IQ and SRS allows for studying ASD risk beyond the diagnostic criteria, as IQ and SRS are continuous measures strongly correlated with ASD. Genome-wide mRNA, CpG methylation and miRNA were assayeds with the Illumina Hiseq 2500, HTG EdgeSeq miRNA Whole Transcriptome Assay, and Illumina EPIC/850 K array, respectively. We conducted genome-wide differential analyses of placental mRNA, miRNA, and CpG methylation data. These molecular features were then integrated for a predictive analysis of IQ and SRS outcomes using kernel aggregation regression. We lastly examined associations between ASD and the multi-omic-predicted component of IQ and SRS. RESULTS Genes with important roles in neurodevelopment and placental tissue organization were associated with intellectual and social impairment. Kernel aggregations of placental multi-omics strongly predicted intellectual and social function, explaining approximately 8% and 12% of variance in SRS and IQ scores via cross-validation, respectively. Predicted in-sample SRS and IQ showed significant positive and negative associations with ASD case-control status. LIMITATIONS The ELGAN cohort comprises children born pre-term, and generalization may be affected by unmeasured confounders associated with low gestational age. We conducted external validation of predictive models, though the sample size (N = 49) and the scope of the available out-sample placental dataset are limited. Further validation of the models is merited. CONCLUSIONS Aggregating information from biomarkers within and among molecular data types improves prediction of complex traits like social and intellectual ability in children born extremely preterm, suggesting that traits within the placenta-brain axis may be omnigenic.
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Affiliation(s)
- Hudson P Santos
- Biobehavioral Laboratory, School of Nursing, University of North Carolina, 544 Carrington Hall, Campus Box 7460, Chapel Hill, NC, 27599-7460, USA.
- Institute for Environmental Health Solutions, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
| | - Arjun Bhattacharya
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Robert M Joseph
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - Lisa Smeester
- Institute for Environmental Health Solutions, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Curriculum in Toxicology and Environmental Medicine, University of North Carolina, Chapel Hill, NC, USA
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Karl C K Kuban
- Department of Pediatrics, Division of Pediatric Neurology, Boston University Medical Center, Boston, MA, USA
| | - Carmen J Marsit
- Department of Environmental Health, Emory University, Atlanta, GA, 30322, USA
| | - T Michael O'Shea
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Rebecca C Fry
- Institute for Environmental Health Solutions, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Curriculum in Toxicology and Environmental Medicine, University of North Carolina, Chapel Hill, NC, USA
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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Chen C, Lu D, Xue L, Ren P, Zhang H, Zhang J. Association between Placental Inflammatory Pathology and Offspring Neurodevelopment at 8 Months and 4 and 7 Years of Age. J Pediatr 2020; 225:132-137.e2. [PMID: 32479832 DOI: 10.1016/j.jpeds.2020.05.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine whether placental inflammatory pathology is associated with subsequent child neurodevelopment. STUDY DESIGN We used the data of US Collaborative Perinatal Project cohort study. Placentas were examined by pathologists and child neurodevelopment was evaluated at 8 months and 4 and 7 years of age. Multivariable logistic regression modelling was used to assess the association. A mediation analysis was used to evaluate whether the association was mediated through shorter gestational age. RESULTS Multivariable analysis after adjusting for confounders showed that placental inflammatory pathology was significantly associated with low Bayley motor (adjusted OR (aOR), 2.15; 95% CI, 1.50-3.06) and mental scales (aOR, 1.51; 95% CI, 1.05-2.17) at 8 months and an IQ of 70-84 (aOR, 1.13; 95% CI, 1.01-1.26) at 4 years of age. The association diminished at 7 years of age (IQ of <70, aOR 1.20 [95% CI, 0.97-1.48]; IQ of 70-79, aOR 1.03 [95% CI, 0.89-1.18]). The mediation analysis demonstrated that associations between placental inflammatory pathology and development were primarily due to direct effects of placental inflammatory pathology rather than indirect effects of shorter gestational age. CONCLUSIONS Placental inflammation was associated with adverse offspring neurodevelopment up to 4 years of age.
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Affiliation(s)
- Chang Chen
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China; MOE and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Danni Lu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China; MOE and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lili Xue
- Department of Obstetrics, Jiaxing Maternity and Child Health Care Hospital, Zhejiang, China
| | - Peng Ren
- Department of Pathology, Jiaxing Maternity and Child Health Care Hospital, Zhejiang, China
| | - Huijuan Zhang
- Department of Pathology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jun Zhang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China; MOE and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Bagga R, Arora P. Genital Micro-Organisms in Pregnancy. Front Public Health 2020; 8:225. [PMID: 32612969 PMCID: PMC7308476 DOI: 10.3389/fpubh.2020.00225] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 05/14/2020] [Indexed: 01/12/2023] Open
Abstract
The microbiome of the female genital tract may undergo changes in pregnancy due to metabolic, endocrinological, and immunological alterations. These dysbiotic states may cause infections which may ascend upwards to the feto-placental unit or may be seeded hematogenously. These low grade and often low virulent infectious states lead to chronic inflammatory states and maybe associated with adverse maternal and neonatal outcome. Organisms have been isolated from amniotic fluid and placentae from women delivering pre-term; however the possibility of contamination cannot be conclusively ruled out. Common vaginal dysbiotic states often cause symptoms that are overlooked and often untreated. Vulvovaginal Candidiasis (VVC), Bacterial Vaginosis (BV), and Trichomonas Vaginitis (TV) are the commonly occurring dysbiotic states leading to vaginal infective states in pregnancy. With the advent of novel technologies like Next Generation sequencing (NGS), it will soon be possible to comprehensively map the vaginal microbiome and assess the interplay of each microbial state with their effects in pregnancy. This may open new avenues for antibiotic recommendations, probiotics and potential alternate therapies for dysbiotic states leading to pregnancy complications.
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Affiliation(s)
- Rashmi Bagga
- Department of Obstetrics & Gynaecology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Parul Arora
- Reproductive Medicine, Nova IVF Fertility, Ahmedabad, India
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Edvinsson Å, Hellgren C, Kunovac Kallak T, Åkerud H, Skalkidou A, Stener-Victorin E, Fornes R, Spigset O, Lager S, Olivier J, Sundström-Poromaa I. The effect of antenatal depression and antidepressant treatment on placental tissue: a protein-validated gene expression study. BMC Pregnancy Childbirth 2019; 19:479. [PMID: 31805950 PMCID: PMC6896358 DOI: 10.1186/s12884-019-2586-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 11/07/2019] [Indexed: 12/22/2022] Open
Abstract
Background Antenatal depression affects 10–20% of pregnant women. Around 2–4% of European pregnant women use antidepressant treatment, most commonly selective serotonin reuptake inhibitors (SSRIs). Poor pregnancy outcomes, such as preterm birth and low birth weight, have been described in women with antenatal depression and in pregnant women on SSRI treatment. However, the effects of antenatal depression and antidepressant treatment on the placenta are largely unknown. The aim of this work was to compare placental gene and protein expression in healthy women, women with untreated antenatal depression and women on antidepressant treatment during pregnancy. Methods Placental samples from 47 controls, 25 depressed and 45 SSRI-treated women were analysed by means of qPCR using custom-designed TaqMan low-density arrays (TLDAs) for 44 genes previously known to be involved in the pathophysiology of depression, and expressed in the placenta. Moreover, placental protein expression was determined by means of immunohistochemistry in 37 healthy controls, 13 women with untreated depression and 21 women on antidepressant treatment. Statistical comparisons between groups were performed by one-way ANOVA or the Kruskal–Wallis test. Results Nominally significant findings were noted for HTR1A and NPY2R, where women with untreated depression displayed higher gene expression than healthy controls (p < 0.05), whereas women on antidepressant treatment had similar expression as healthy controls. The protein expression analyses revealed higher expression of HTR1A in placentas from women on antidepressant treatment, than in placentas from healthy controls (p < 0.05). Conclusion The differentially expressed HTR1A, both at the gene and the protein level that was revealed in this study, suggests the involvement of HTR1A in the effect of antenatal depression on biological mechanisms in the placenta. More research is needed to elucidate the role of depression and antidepressant treatment on the placenta, and, further, the effect on the fetus.
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Affiliation(s)
- Åsa Edvinsson
- Department of Women's and Children's Health, Uppsala University, 751 85, Uppsala, Sweden.
| | - Charlotte Hellgren
- Department of Women's and Children's Health, Uppsala University, 751 85, Uppsala, Sweden
| | | | - Helena Åkerud
- Department of Immunology, Genetics and Pathology, Uppsala University, 751 85, Uppsala, Sweden
| | - Alkistis Skalkidou
- Department of Women's and Children's Health, Uppsala University, 751 85, Uppsala, Sweden
| | | | - Romina Fornes
- Department of Physiology and Pharmacology, Karolinska Institute, 171 77, Stockholm, Sweden
| | - Olav Spigset
- Department of Clinical Pharmacology, St. Olav University Hospital, 7006, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7491, Trondheim, Norway
| | - Susanne Lager
- Department of Women's and Children's Health, Uppsala University, 751 85, Uppsala, Sweden
| | - Jocelien Olivier
- Neurobiology, Unit Behavioral Neuroscience, Groningen Institute for Evolutionary Life Sciences, University of Groningen, 9747, AG, Groningen, The Netherlands
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Skoll A, Boutin A, Bujold E, Burrows J, Crane J, Geary M, Jain V, Lacaze-Masmonteil T, Liauw J, Mundle W, Murphy K, Wong S, Joseph KS. No. 364-Antenatal Corticosteroid Therapy for Improving Neonatal Outcomes. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 40:1219-1239. [PMID: 30268316 DOI: 10.1016/j.jogc.2018.04.018] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To assess the benefits and risks of antenatal corticosteroid therapy for women at risk of preterm birth or undergoing pre-labour Caesarean section at term and to make recommendations for improving neonatal and long-term outcomes. OPTIONS To administer or withhold antenatal corticosteroid therapy for women at high risk of preterm birth or women undergoing pre-labour Caesarean section at term. OUTCOMES Perinatal morbidity, including respiratory distress syndrome, intraventricular hemorrhage, bronchopulmonary dysplasia, infection, hypoglycemia, somatic and brain growth, and neurodevelopment; perinatal mortality; and maternal morbidity, including infection and adrenal suppression. INTENDED USERS Maternity care providers including midwives, family physicians, and obstetricians. TARGET POPULATION Pregnant women. EVIDENCE Medline, PubMed, Embase, and the Cochrane Library were searched from inception to September 2017. Medical Subject Heading (MeSH) terms and key words related to pregnancy, prematurity, corticosteroids, and perinatal and neonatal mortality and morbidity were used. Statements from professional organizations including that of the National Institutes of Health, the American College of Obstetricians and Gynecologists, the Society for Maternal Fetal Medicine, the Royal College of Obstetricians and Gynaecologists, and the Canadian Pediatric Society were reviewed for additional references. Randomized controlled trials conducted in pregnant women evaluating antenatal corticosteroid therapy and previous systematic reviews on the topic were eligible. Evidence from systematic reviews of non-experimental (cohort) studies was also eligible. VALIDATION METHODS This Committee Opinion has been reviewed and approved by the Maternal-Fetal Medicine Committee of the SOGC and approved by SOGC Council. BENEFITS, HARMS, AND/OR COSTS A course of antenatal corticosteroid therapy administered within 7 days of delivery significantly reduces perinatal morbidity/mortality associated with preterm birth between 24 + 0 and 34 + 6 weeks gestation. When antenatal corticosteroid therapy is given more than 7 days prior to delivery or after 34 + 6 weeks gestation, the adverse effects may outweigh the benefits. Evidence on long-term effects is scarce, and potential neurodevelopment harms are unquantified in cases of late preterm, term, and repeated exposure to antenatal corticosteroid therapy. GUIDELINE UPDATE Evidence will be reviewed 5 years after publication to evaluate the need for a complete or partial update of the guideline. If important evidence is published prior to the 5-year time point, an update will be issued to reflect new knowledge and recommendations. SPONSORS The guideline was developed with resources provided by the Society of Obstetricians and Gynaecologists of Canada with support from the Canadian Institutes of Health Research (APR-126338). SUMMARY STATEMENTS RECOMMENDATIONS: Gestational Age Considerations Agents, Dosage, Regimen, and Target Timing Subpopulations and Special Consideration.
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Hemberger M, Hanna CW, Dean W. Mechanisms of early placental development in mouse and humans. Nat Rev Genet 2019; 21:27-43. [PMID: 31534202 DOI: 10.1038/s41576-019-0169-4] [Citation(s) in RCA: 229] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2019] [Indexed: 02/08/2023]
Abstract
The importance of the placenta in supporting mammalian development has long been recognized, but our knowledge of the molecular, genetic and epigenetic requirements that underpin normal placentation has remained remarkably under-appreciated. Both the in vivo mouse model and in vitro-derived murine trophoblast stem cells have been invaluable research tools for gaining insights into these aspects of placental development and function, with recent studies starting to reshape our view of how a unique epigenetic environment contributes to trophoblast differentiation and placenta formation. These advances, together with recent successes in deriving human trophoblast stem cells, open up new and exciting prospects in basic and clinical settings that will help deepen our understanding of placental development and associated disorders of pregnancy.
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Affiliation(s)
- Myriam Hemberger
- Department of Biochemistry & Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, Canada. .,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada. .,Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, Canada. .,Epigenetics Programme, The Babraham Institute, Babraham Research Campus, Cambridge, UK. .,Centre for Trophoblast Research, University of Cambridge, Cambridge, UK.
| | - Courtney W Hanna
- Epigenetics Programme, The Babraham Institute, Babraham Research Campus, Cambridge, UK.,Centre for Trophoblast Research, University of Cambridge, Cambridge, UK
| | - Wendy Dean
- Department of Biochemistry & Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, Canada. .,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada. .,Epigenetics Programme, The Babraham Institute, Babraham Research Campus, Cambridge, UK. .,Department of Cell Biology and Anatomy, Cumming School of Medicine, University of Calgary, Calgary, Canada.
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Gao H, Wang YF, Huang K, Han Y, Zhu YD, Zhang QF, Xiang HY, Qi J, Feng LL, Zhu P, Hao JH, Tao XG, Tao FB. Prenatal phthalate exposure in relation to gestational age and preterm birth in a prospective cohort study. ENVIRONMENTAL RESEARCH 2019; 176:108530. [PMID: 31220737 DOI: 10.1016/j.envres.2019.108530] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 05/20/2019] [Accepted: 06/08/2019] [Indexed: 06/09/2023]
Abstract
This study enrolled 3266 pregnant women, to explore the relationship of prenatal phthalate exposure with the risk of preterm birth and gestational age. All participants filled questionnaires and provided with up to three urine samples during three trimesters. Seven phthalate metabolites in urines were measured. The incidences of very preterm, late preterm, early-term, late-term and postterm births were 0.58%, 3.52%, 24.22%, 10.53%, and 0.34%, respectively. Non-linear relationships were shown between phthalate metabolites and gestational age. Except for monomethyl phthalate (OR = 1.65, 95%CI = 1.17-2.34), the average concentrations of phthalate metabolites were associated with a slightly and insignificantly increased risk of overall preterm birth (<37+0 gestational weeks). Through a restricted cubic spline regression, phthalate metabolites were found to be related to the risk of overall preterm birth in a linear manner (p-value >0.05) or a non-linear manner (p-value <0.05). All curves indicated the overall preterm birth risk rose with the increase of phthalate metabolite concentrations. Finally, compared with full-term birth (39+0 to 40+6 gestational weeks), phthalate metabolites were associated with the elevated risks of very preterm, late preterm and postterm births, although some relationships were not statistically significant. In conclusion, these findings suggested non-linear associations between phthalate metabolites and gestational age. Exposure to some phthalate metabolites was associated with increased risks of overall preterm birth and postterm birth.
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Affiliation(s)
- Hui Gao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui Province, China
| | - Ya-Fei Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui Province, China
| | - Kun Huang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui Province, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, Anhui Province, China
| | - Yan Han
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui Province, China
| | - Yuan-Duo Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui Province, China
| | - Qiu-Feng Zhang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui Province, China
| | - Hai-Yun Xiang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui Province, China
| | - Juan Qi
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui Province, China
| | - Lan-Lan Feng
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui Province, China
| | - Peng Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui Province, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, Anhui Province, China
| | - Jia-Hu Hao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui Province, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, Anhui Province, China
| | - Xu-Guang Tao
- Division of Occupational and Environmental Medicine, Johns Hopkins School of Medicine, Baltimore, USA
| | - Fang-Biao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui Province, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, Anhui Province, China.
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Urizar GG, Caliboso M, Gearhart C, Yim IS, Dunkel Schetter C. Process Evaluation of a Stress Management Program for Low-Income Pregnant Women: The SMART Moms/Mamás LÍSTAS Project. HEALTH EDUCATION & BEHAVIOR 2019; 46:930-941. [PMID: 31390900 DOI: 10.1177/1090198119860559] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background. The SMART Moms/Mamás LÍSTAS Project was a randomized control trial that tested the efficacy of a prenatal stress management program in reducing stress and cortisol levels among low-income women. The current study is a process evaluation of the stress management program (intervention arm of the original randomized controlled trial) and assessed whether implementation fidelity factors (i.e., intervention delivery, receipt, and enactment) were associated with lower stress (perceived stress, salivary cortisol), improved negative and positive mood states (Positive and Negative Affect Schedule), and increased confidence to use relaxation and coping skills. Method. Fifty-five low-income pregnant women (71% Latina, 76% annual income <$20,000) attended weekly group-based sessions over an 8-week period in which a clinically trained researcher taught relaxation and coping skills. Process evaluation measures were obtained via participant self-report and videotaped class sessions that were coded for delivery, receipt, and enactment of the intervention to determine which implementation factors were associated with changes in program outcomes (stress, mood, confidence) over the 8-week period. Results. Women in stress management showed a significant reduction in their stress and cortisol levels (p < .001), improvements in negative and positive mood states (p < .001) and were more confident in using relaxation and coping skills postintervention (74%). The implementation factors of delivery (i.e., instructor adherence to intervention content; p = .03) and enactment (i.e., participant use of intervention skills; p = .02) were most associated with improvements in program outcomes. Conclusion. These findings highlight that implementation factors should be considered when delivering stress management interventions in underserved communities.
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Affiliation(s)
- Guido G Urizar
- California State University, Long Beach, Long Beach, CA, USA
| | | | | | - Ilona S Yim
- University of California, Irvine, Irvine, CA, USA
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O'Connor TG, Miller RK, Salafia C. Placental Studies for Child Development. CHILD DEVELOPMENT PERSPECTIVES 2019; 13:193-198. [PMID: 31413725 DOI: 10.1111/cdep.12338] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Research on children's psychological and behavioral development readily incorporates changing biological models and techniques. In this article, we suggest that, in response to increasing evidence of robust influences of prenatal exposures on children's neurodevelopment and mental and physical health, developmental science also needs to consider the placenta's role in development. We argue why placental mechanisms are plausible targets in developmental science, and suggest initial and practical steps toward integrating placenta markers and mechanisms into research on child development.
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Springer PE, Slogrove AL, Kidd M, Kalk E, Bettinger JA, Esser MM, Cotton MF, Zunza M, Molteno CD, Kruger M. Neurodevelopmental and behavioural outcomes of HIV-exposed uninfected and HIV-unexposed children at 2-3 years of age in Cape Town, South Africa. AIDS Care 2019; 32:411-419. [PMID: 31280587 DOI: 10.1080/09540121.2019.1637506] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Successful vertical HIV transmission prevention programmes (VTP) have resulted in an expanding population of HIV-exposed uninfected (HEU) infants whose growth, health and neurodevelopmental outcomes could have consequences for future resource allocation. We compared neurodevelopmental and behavioural outcomes in a prospective cohort of 2-3 year old HEU and HIV-unexposed uninfected (HU) children.Women living with and without HIV and their infants were enrolled within three days of birth from a low-risk midwife obstetric unit in Cape Town, South Africa during 2012 and 2013, under WHO Option A VTP guidelines. HIV-uninfected children aged 30-42 months were assessed using the Bayley scales of Infant Development-Third edition (BSID) and Strengths and Difficulties questionnaire (SDQ).Thirty-two HEU and 27 HU children (mean birth weight 3048g vs 3096g) were assessed. HEU children performed as well as HU children on BSID cognitive, language and motor domains. Mean scores fell within the low average range. Mothers of HEU children reported fewer conduct problems but stunting was associated with increased total difficulties on the SDQ.HEU and HU children's performance on the BSID was similar. In this low-risk cohort, HIV exposure did not confer additional risk. Stunting was associated with increased behavioural problems irrespective of HIV exposure.
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Affiliation(s)
- P E Springer
- Department of Paediatrics and Child Health and Tygerberg Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A L Slogrove
- Department of Paediatrics and Child Health and Tygerberg Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Ukwanda Centre for Rural Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - M Kidd
- Centre for Statistical Consultation, Stellenbosch University, Stellenbosch, South Africa
| | - E Kalk
- Centre for Infectious Diseases Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - J A Bettinger
- Vaccine Evaluation Center, Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - M M Esser
- Immunology Unit, Medical Microbiology, National Health Laboratory Service Tygerberg, Department of Pathology, Stellenbosch University, Cape Town, South Africa
| | - M F Cotton
- Department of Paediatrics and Child Health and Tygerberg Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Family Clinical Research Unit, Tygerberg Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - M Zunza
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - C D Molteno
- Department of Psychiatry, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - M Kruger
- Department of Paediatrics and Child Health and Tygerberg Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Preterm birth subtypes, placental pathology findings, and risk of neurodevelopmental disabilities during childhood. Placenta 2019; 83:17-25. [PMID: 31477202 DOI: 10.1016/j.placenta.2019.06.374] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 05/24/2019] [Accepted: 06/14/2019] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Preterm birth (PTB) and in-utero inflammation are recognized risk factors of neurodevelopmental disabilities (NDDs); however, their combined role in NDDs is unknown. We examined the independent and joint association of PTB and placental histological findings with the childhood risk of NDDs (overall and by subgroups including autism spectrum disorder (ASD) and ADHD). METHODS We analyzed data from the Boston Birth Cohort, where mother-infant pairs were enrolled at birth and followed from birth onwards. Birth outcomes, placental pathology and NDDs were obtained from electronic medical records. Placental pathology was categorized using a standardized classification system proposed by the Amsterdam Placental Workshop Group. RESULTS PTB (all, including spontaneous, medically indicated) was an independent risk factor for NDDs. Placental histological chorioamnionitis (CA) and PTB additively increased the odds of NDDs (aOR: 2.16, 95% CI: 1.37, 3.39), as well as ADHD (aOR: 2.75, 95% CI: 1.55, 4.90), other developmental disabilities (aOR: 1.96, 95% CI: 1.18, 3.25) and possibly ASD (aOR: 2.31, 95% CI: 0.99, 5.39). The above associations were more pronounced in spontaneous than medically indicated PTB. PTB alone in the absence of CA only had a moderate association with ASD and ADHD. Placental maternal vascular malperfusion alone or in combination with PTB was not associated with the risk of NDDs. DISCUSSION Our study provided new insights on PTB and NDDs by further considering preterm subtypes and placental histology. We revealed that children of spontaneous PTB along with histological CA were at the highest risk for a spectrum of NDDs.
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Urizar GG, Yim IS, Rodriguez A, Schetter CD. The SMART Moms Program: A Randomized Trial of the Impact of Stress Management on Perceived Stress and Cortisol in Low-Income Pregnant Women. Psychoneuroendocrinology 2019; 104:174-184. [PMID: 30852278 DOI: 10.1016/j.psyneuen.2019.02.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 02/06/2019] [Accepted: 02/20/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Dysregulations in maternal hypothalamus-pituitary-adrenal function and the end product, cortisol, have been associated with a heightened risk for stress-related health complications during pregnancy and post partum. Given the adverse health impact that maternal cortisol may have on expectant mothers and their infants, empirically-based prenatal interventions are needed to target optimal management of stress and its biological effects in at-risk pregnant women, a primary example of which is cognitive behavioral stress management (CBSM). This randomized-controlled trial examined the effects of a prenatal CBSM intervention on reduction in perceived stress and regulation of salivary cortisol patterns [i.e., overall cortisol output (area under the curve), cortisol awakening response (CAR), diurnal slope] during pregnancy and the early postpartum period, as compared to a control group. METHODS One hundred low-income pregnant women (71% Latina; 76% annual income < $20 K) with low or high anxiety during pregnancy were randomized (stratified by anxiety) to either an eight-week CBSM group intervention (n = 55) or a control group (n = 45). They provided seven salivary cortisol samples (four am samples, 12 pm, 4 pm, and 8 pm samples on one collection day) at baseline (1st trimester; < 17 weeks of gestation), after their prenatal program (2nd trimester), and also in the third trimester and at three months post partum. RESULTS Women receiving CBSM had lower perceived stress levels throughout pregnancy and early post partum compared to women in the control group (p = .020). Among women with high prenatal anxiety, those in CBSM showed a steeper decline in their diurnal cortisol at three months post partum compared to those in the control group (p = .015). Further, non-Latina women in CBSM had a lower CAR at three months post partum compared to non-Latina women in the control group (p = .025); these randomization group differences on the CAR were not observed among Latina women. CONCLUSIONS These findings provide preliminary support for the efficacy of prenatal CBSM interventions in improving stress outcomes among low-income pregnant women and suggest the need to test the effects of these interventions on a larger scale for improving maternal and infant health outcomes long-term.
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Affiliation(s)
- Guido G Urizar
- Department of Psychology, California State University, Long Beach, 1250 Bellflower Blvd., Long Beach, CA 90840-0901, USA.
| | - Ilona S Yim
- Department of Psychological Science, University of California, Irvine, 4562 Social and Behavioral Sciences Gateway, Irvine, CA 92697-7085, USA.
| | - Anthony Rodriguez
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Los Angeles, CA 90095-1563, USA.
| | - Christine Dunkel Schetter
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Los Angeles, CA 90095-1563, USA.
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Chen HJ, Gur TL. Intrauterine Microbiota: Missing, or the Missing Link? Trends Neurosci 2019; 42:402-413. [PMID: 31053242 PMCID: PMC6604064 DOI: 10.1016/j.tins.2019.03.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/21/2019] [Accepted: 03/19/2019] [Indexed: 12/29/2022]
Abstract
The intrauterine environment provides a key interface between the mother and the developing fetus during pregnancy, and is a target for investigating mechanisms of fetal programming. Studies have demonstrated an association between prenatal stress and neurodevelopmental disorders. The role of the intrauterine environment in mediating this effect is still being elucidated. In this review, we discuss emerging preclinical and clinical evidence suggesting the existence of microbial communities in utero. We also outline possible mechanisms of bacterial translocation to the intrauterine environment and immune responses to the presence of microbes or microbial components. Lastly, we overview the effects of intrauterine inflammation on neurodevelopment. We hypothesize that maternal gestational stress leads to disruptions in the maternal oral, gut, and vaginal microbiome that may lead to the translocation of bacteria to the intrauterine environment, eliciting an inflammatory response and resulting in deficits in neurodevelopment.
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Affiliation(s)
- Helen J Chen
- Department of Neuroscience, Wexner Medical Center at The Ohio State University, Columbus, OH, USA
| | - Tamar L Gur
- Department of Psychiatry and Behavioral Health, Wexner Medical Center at The Ohio State University, Columbus, OH, USA; Department of Neuroscience, Wexner Medical Center at The Ohio State University, Columbus, OH, USA; Department of Obstetrics and Gynecology, Wexner Medical Center at The Ohio State University, Columbus, OH, USA; Institute of Behavioral Medicine Research, Wexner Medical Center at The Ohio State University, Columbus, OH, USA.
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Nist MD, Harrison TM, Steward DK. The biological embedding of neonatal stress exposure: A conceptual model describing the mechanisms of stress-induced neurodevelopmental impairment in preterm infants. Res Nurs Health 2018; 42:61-71. [PMID: 30499161 DOI: 10.1002/nur.21923] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 10/27/2018] [Indexed: 12/15/2022]
Abstract
The biological embedding of early life stress exposure may result in life-long neurodevelopmental impairment in preterm infants. Infants hospitalized in the neonatal intensive care unit are exposed to significant experiential, environmental, and physiologic stressors over the course of their extended hospitalization. Stress exposure during the sensitive period of brain development may alter biological processes, including functioning of the immune system, the autonomic nervous system, and the hypothalamic-pituitary-adrenal axis as well as gene expression. These alterations may subsequently affect brain structure and function. Changes to these processes may mediate the relationship between neonatal stress exposure and neurodevelopment in preterm infants and represent potential therapeutic targets to improve long-term outcomes. The purpose of this paper is to introduce a conceptual model, based on published research, that describes the mechanisms mediating stress exposure and neurodevelopment impairment in preterm infants and to provide the theoretical foundation on which to base future descriptive research, intervention studies, and clinical care.
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Kuban KCK, Heeren T, O’Shea TM, Joseph RM, Fichorova RN, Douglass L, Jara H, Frazier JA, Hirtz D, Taylor HG, Rollins JV, Paneth N. Among Children Born Extremely Preterm a Higher Level of Circulating Neurotrophins Is Associated with Lower Risk of Cognitive Impairment at School Age. J Pediatr 2018; 201:40-48.e4. [PMID: 30029870 PMCID: PMC6684153 DOI: 10.1016/j.jpeds.2018.05.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/23/2018] [Accepted: 05/11/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To test the hypothesis that higher blood levels of neurotrophic proteins (proteins that support neuronal survival and function) in the first 2 weeks of life are associated with a lower risk of cognitive impairment at 10 years. STUDY DESIGN We evaluated 812 10-year-old children with neonatal blood specimens enrolled in the multicenter prospective Extremely Low Gestational Age Newborn Study, assessing 22 blood proteins collected on 3 days over the first 2 weeks of life. Using latent profile analysis, we derived a cognitive function level based on standardized cognitive and executive function tests. We defined high exposure as the top quartile neurotrophic protein blood level on ≥2 days either for ≥4 proteins or for a specific cluster of neurotrophic proteins (defined by latent class analysis). Multinomial logistic regression analyzed associations between high exposures and cognitive impairment. RESULTS Controlling for the effects of inflammatory proteins, persistently elevated blood levels of ≥4 neurotrophic proteins were associated with reduced risk of moderate (OR, 0.35; 95% CI, 0.18-0.67) and severe cognitive impairment (OR, 0.22; 95% CI, 0.09-0.53). Children with a cluster of elevated proteins including angiopoietin 1, brain-derived neurotrophic factor, and regulated upon activation, normal T-cell expressed, and secreted had a reduced risk of adverse cognitive outcomes (OR range, 0.31-0.6). The risk for moderate to severe cognitive impairment was least with 0-1 inflammatory and >4 neurotrophic proteins. CONCLUSIONS Persisting elevations of circulating neurotrophic proteins during the first 2 weeks of life are associated with lowered risk of impaired cognition at 10 years of age, controlling for increases in inflammatory proteins.
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Affiliation(s)
- Karl C. K. Kuban
- Department of Pediatrics, Division of Pediatric Neurology, Boston Medical Center
| | - Timothy Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - T. Michael O’Shea
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of North Carolina, Chapel Hill, NC
| | - Robert M. Joseph
- Department of Anatomy and Neuroanatomy, Boston University School of Medicine, Boston
| | - Raina N. Fichorova
- Laboratory of Genital Tract Biology, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston
| | - Laurie Douglass
- Department of Pediatrics, Division of Pediatric Neurology, Boston Medical Center
| | - Hernan Jara
- Department of Radiology, Boston University School of Medicine, Boston
| | - Jean A. Frazier
- Department of Psychiatry, Eunice Kennedy Shriver Center, UMASS Medical School/ University of Massachusetts Memorial Health Care, Worcester, MA
| | - Deborah Hirtz
- National Institute of Neurological Disorders and Stroke, Bethesda, MD
| | - H. Gerry Taylor
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH
| | - Julie Vanier Rollins
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of North Carolina, Chapel Hill, NC
| | - Nigel Paneth
- Department of Epidemiology and Biostatistics and Pediatrics & Human Development, Michigan State University, East Lansing, MI
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Skoll A, Boutin A, Bujold E, Burrows J, Crane J, Geary M, Jain V, Lacaze-Masmonteil T, Liauw J, Mundle W, Murphy K, Wong S, Joseph KS. N° 364 - La Corticothérapie Prénatale Pour Améliorer Les Issues Néonatales. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1240-1262. [PMID: 30268317 DOI: 10.1016/j.jogc.2018.06.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIF Évaluer les avantages et les risques de la corticothérapie prénatale chez les femmes qui présentent un risque d'accouchement prématuré ou qui subissent une césarienne à terme avant début de travail, et formuler des recommandations visant l'amélioration des issues néonatales et des issues à long terme. OPTIONS Administrer ou ne pas administrer une corticothérapie prénatale aux femmes qui présentent un risque élevé d'accouchement prématuré ou qui subissent une césarienne avant travail à terme. RéSULTATS: Morbidité périnatale, notamment le syndrome de détresse respiratoire, l'hémorragie intraventriculaire, la dysplasie bronchopulmonaire, l'infection, l'hypoglycémie, ainsi que les troubles de la croissance somatique et cérébrale et du neurodéveloppement; mortalité périnatale; et morbidité maternelle, notamment l'infection et la suppression surrénalienne. UTILISATEURS CIBLES Fournisseurs de soins de maternité, notamment les sages-femmes, les médecins de famille et les obstétriciens. POPULATION CIBLE Femmes enceintes. ÉVIDENCE: Nous avons interrogé les bases de données Medline, PubMed et Embase ainsi que la Bibliothèque Cochrane, de leur création au mois de septembre 2017. Nous nous sommes servis de Medical Subjet Headings (MeSH) et de mots clés en lien avec la grossesse, la prématurité, les corticostéroïdes ainsi que la mortalité et la morbidité périnatales et néonatales. Nous avons également consulté les déclarations d'organismes professionnels tels que les National Institutes of Health, l'American College of Obstetricians and Gynecologists, la Society for Maternal-Fetal Medicine, le Royal College of Obstetricians and Gynaecologists et la Société canadienne de pédiatrie pour obtenir des références additionnelles. Les essais cliniques randomisés évaluant la corticothérapie prénatale menés sur des femmes enceintes et les revues systématiques antérieures sur le sujet étaient admissibles, tout comme les données venant de revues systématiques d'études non expérimentales (études de cohorte). VALEURS La présente opinion de comité a été révisée et approuvée par le Comité de médecine fœto-maternelle de la SOGC, et approuvée par le Conseil de la SOGC. AVANTAGES, INCONVéNIENTS ET COûTS: L'administration d'une corticothérapie prénatale dans les sept jours précédant l'accouchement réduit significativement la morbidité et la mortalité périnatales associées à la naissance prématurée survenant entre 24+0 et 34+6 semaines de grossesse. Si la corticothérapie prénatale est administrée plus de sept jours avant l'accouchement ou après 34+6 semaines de grossesse, les effets indésirables peuvent surpasser les avantages. Les données probantes sur l'impact à long terme de la corticothérapie prénatale sont rares. Par ailleurs, les effets neurodéveloppementaux néfastes potentiels de l'exposition répétée à la corticothérapie prénatale ou de l'administration de corticostéroïdes en période préterme tardive ou à terme n'ont pas été quantifiés. MIS-à-JOUR à LA DIRECTIVE: Une revue des données probantes sera menée cinq ans après la publication de la présente directive clinique afin d'évaluer si une mise à jour complète ou partielle s'impose. Si de nouvelles données probantes importantes sont publiées avant la fin de ces cinq ans, une mise à jour tenant compte des nouvelles connaissances et recommandations sera publiée. COMMANDITAIRES La présente directive clinique a été élaborée à l'aide de ressources fournies par la Société des obstétriciens et gynécologues du Canada et avec l'appui des Instituts de recherche en santé du Canada (APR-126338). MOTS CLéS: Corticothérapie prénatale, maturation fœtale, prématurité, période préterme tardive, césarienne avant travail DÉCLARATION SOMMAIRES: RECOMMANDATIONS: Considérations relatives à l'âge gestationnel.
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Inflammatory molecules and neurotrophic factors as biomarkers of neuropsychomotor development in preterm neonates: A Systematic Review. Int J Dev Neurosci 2017; 65:29-37. [PMID: 29051031 DOI: 10.1016/j.ijdevneu.2017.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/13/2017] [Accepted: 10/15/2017] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To provide a systematic review investigating the role of inflammatory molecules and neurotrophic factors as biomarkers of neuropsychomotor development in preterm neonates. DATA SOURCE Databases including PubMed, BIREME, and Scopus were systematically searched. Observational studies, as well as transversal, and cohort studies using human subjects published from 1990 to September 2017 were eligible for inclusion. Two authors independently identified eligible studies and analyzed their characteristics, quality, and accuracy in depth. DATA SYNTHESIS 11 eligible studies clearly investigated the association between peripheral inflammation and motor and/or cognitive development in preterm infants. However, the selected populations differed in relation to the events associated with prematurity and the risk factors to abnormal motor and/or cognitive development. These studies measured circulating levels of cytokines, chemokines, adhesion molecules, acute phase proteins, and growth factors. The most commonly analyzed proteins were IL-1β, IL-6, TNF, CCL5/RANTES, CXCL8/IL-8, IGFBP-1, and VEGF. In seven of the eligible studies, plasma levels of IL-6 correlated with development delay. Two studies reported correlation between CXCL8/IL-8 plasma levels with cognitive and motor delay. In one study, higher levels of MCP-1/CCL2 were associated with better cognitive and motor outcome. CONCLUSION There is preliminary evidence indicating that circulating inflammatory molecules are associated with motor and cognitive development in preterm neonates, even considering different populations.
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