1
|
Keenan-Devlin LS, Caplan M, Freedman A, Kuchta K, Grobman W, Buss C, Adam EK, Entringer S, Miller GE, Borders AEB. Using principal component analysis to examine associations of early pregnancy inflammatory biomarker profiles and adverse birth outcomes. Am J Reprod Immunol 2021; 86:e13497. [PMID: 34477256 DOI: 10.1111/aji.13497] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Inflammation as a risk factor for preterm birth is well-established. The primary objective of this analysis was to examine whether individual cytokines versus a composite indicator of mid-pregnancy inflammation are significantly associated with risk for adverse birth outcomes. STUDY DESIGN A multi-site prospective study was conducted in a socio-demographically diverse cohort of 610 pregnant participants. At a study visit between 12 and 20 6/7 weeks' gestation, low-grade inflammation was measured via log-transformed serum concentrations of the biomarkers IFN-γ, IL-10, IL-13, IL-6, IL-8, TNF-α, and CRP. Principal component analysis (PCA) was used to identify underlying dimensions of inflammatory activity from the seven biomarkers measured. Gestational age and birth weight at delivery were obtained from medical chart review. The associations between inflammatory profiles and birth outcomes were assessed via linear and logistic regression models. Results were compared with those from individual inflammatory biomarkers, and model fit was assessed using Akaike's Information Criterion (AIC). RESULTS Principal component analysis analysis yielded a two-factor solution, with the first factor (IF1) composed of IL-8, IL-10, IL-13, IFN-ɣ, and TNF-α, and the second factor (IF2) containing IL-6 and CRP. When adjusted for race, education, BMI, smoking status, gestational age at time of blood draw, and study site, a one standard deviation (SD) increase in IF1 remained significantly associated with a decrease in standardized gestational age (β = -.13, 95% CI: -.21, -.05) and an increase in odds of preterm delivery (OR = 1.46, 95% CI: 1.13, 1.88) (Table 3). A one SD increase in IF2 was similarly associated with a decrease in standardized gestational age at delivery (β = -.13, 95% CI: -.23, -.04) and an increase in odds of preterm delivery (OR: 1.46, 95% CI: 1.04, 2.05). Neither IF1 nor IF2 was associated with measures of fetal growth. AIC identified that IL-6 was a slightly better fit for length of gestation compared to either composite measure, though all performed similarly. CONCLUSION Independent of known sociodemographic risk factors, an elevated mid-pregnancy inflammatory profile was associated with a nearly 50% increase in odds of preterm delivery. The composite performed similarly to IL-6. These results suggest that maternal low-grade inflammation is a risk factor for preterm delivery, and that mid-pregnancy inflammatory biomarkers may be useful in predicting risk for preterm delivery.
Collapse
Affiliation(s)
- Lauren S Keenan-Devlin
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, Illinois, USA.,University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Madeleine Caplan
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, Illinois, USA.,Duke University School of Medicine, Durham, North Carolina, USA
| | - Alexa Freedman
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, Illinois, USA.,Department of Psychology, Northwestern University, Evanston, Illinois, USA.,Institute for Policy Research, Northwestern University, Evanston, Illinois, USA
| | - Kristine Kuchta
- Center for Biomedical Research Informatics, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - William Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Institute for Public Health and Medicine, Center for Healthcare Studies, Northwestern University, Chicago, Illinois, USA
| | - Claudia Buss
- Development, Health and Disease Research Program, University of California Irvine, Irvine, California, USA.,Department of Medical Psychology, Charité, University Medicine Berlin, Berlin, Germany
| | - Emma K Adam
- Institute for Policy Research, Northwestern University, Evanston, Illinois, USA.,School of Education and Social Policy, Northwestern University, Evanston, Illinois, USA
| | - Sonja Entringer
- Development, Health and Disease Research Program, University of California Irvine, Irvine, California, USA.,Department of Medical Psychology, Charité, University Medicine Berlin, Berlin, Germany
| | - Gregory E Miller
- Department of Psychology, Northwestern University, Evanston, Illinois, USA.,Institute for Policy Research, Northwestern University, Evanston, Illinois, USA
| | - Ann E B Borders
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, Illinois, USA.,University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA.,Institute for Public Health and Medicine, Center for Healthcare Studies, Northwestern University, Chicago, Illinois, USA
| |
Collapse
|
2
|
Gómez-Chávez F, Correa D, Navarrete-Meneses P, Cancino-Diaz JC, Cancino-Diaz ME, Rodríguez-Martínez S. NF-κB and Its Regulators During Pregnancy. Front Immunol 2021; 12:679106. [PMID: 34025678 PMCID: PMC8131829 DOI: 10.3389/fimmu.2021.679106] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/23/2021] [Indexed: 12/25/2022] Open
Abstract
The transcriptional factor NF-κB is a nuclear factor involved in both physiological and pathological processes. This factor can control the transcription of more than 400 genes, including cytokines, chemokines, and their modulators, immune and non-immune receptors, proteins involved in antigen presentation and cell adhesion, acute phase and stress response proteins, regulators of apoptosis, growth factors, other transcription factors and their regulators, as well as different enzymes; all these molecules control several biological processes. NF-κB is a tightly regulated molecule that has also been related to apoptosis, cell proliferation, inflammation, and the control of innate and adaptive immune responses during onset of labor, in which it has a crucial role; thus, early activation of this factor may have an adverse effect, by inducing premature termination of pregnancy, with bad outcomes for the mother and the fetus, including product loss. Reviews compiling the different activities of NF-κB have been reported. However, an update regarding NF-κB regulation during pregnancy is lacking. In this work, we aimed to describe the state of the art around NF-κB activity, its regulatory role in pregnancy, and the effect of its dysregulation due to invasion by pathogens like Trichomonas vaginalis and Toxoplasma gondii as examples.
Collapse
Affiliation(s)
- Fernando Gómez-Chávez
- Secretaría de Salud, Cátedras CONACyT-Instituto Nacional de Pediatría, Mexico City, Mexico
- Secretaría de Salud, Laboratorio de Inmunología Experimental, Instituto Nacional de Pediatría, Mexico City, Mexico
- Departamento de Formación Básica Disciplinaria, Escuela Nacional de Medicina y Homeopatía-Instituto Politécnico Nacional, Mexico City, Mexico
| | - Dolores Correa
- Dirección de Investigación, Universidad Anáhuac, Huixquilucan, Mexico
| | - Pilar Navarrete-Meneses
- Laboratorio de Genética y Cáncer, Instituto Nacional de Pediatría, Secretaría de Salud Mexico City, Mexico City, Mexico
| | - Juan Carlos Cancino-Diaz
- Laboratorio de Inmunomicrobiología, Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas-Instituto Politécnico Nacional, Mexico City, Mexico
| | - Mario Eugenio Cancino-Diaz
- Laboratorio de Inmunidad Innata, Departamento de Inmunología, ENCB-Instituto Politécnico Nacional, Mexico City, Mexico
| | - Sandra Rodríguez-Martínez
- Laboratorio de Inmunidad Innata, Departamento de Inmunología, ENCB-Instituto Politécnico Nacional, Mexico City, Mexico
| |
Collapse
|
3
|
Carroll JE, Rentscher KE, Cole SW, Luo JJ, Ramilo O, Webber S, Lamkin DM, Christian LM. Sleep disturbances and inflammatory gene expression among pregnant women: Differential responses by race. Brain Behav Immun 2020; 88:654-660. [PMID: 32360438 PMCID: PMC7526416 DOI: 10.1016/j.bbi.2020.04.065] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 04/20/2020] [Accepted: 04/25/2020] [Indexed: 12/27/2022] Open
Abstract
Excessive inflammation in pregnancy predicts adverse birth outcomes, including shortened gestational length and lower birthweight, with African American women at greater risk. As substantial racial disparities in sleep quality, and evidence that African Americans have increased vulnerability for sleep-induced inflammatory dysregulation, sleep may be a critical, modifiable health behavior that contributes to racial disparities in birth outcomes. The present study examined sleep disturbance as a predictor of genome-wide transcriptome profiles of peripheral blood samples from 103 pregnant women (33 African American, 70 white) assessed at 18.7 ± 7.2 weeks gestation. We hypothesized that pregnant women with significant sleep disturbances would have gene expression profiles indicating over-expression of inflammatory pathways, with greater effects among African American compared to white women. Promoter-based bioinformatics analyses of differentially expressed genes indicated greater activation of NF-кB, AP1, and CREB transcription factors among African American women with sleep disturbances (all p < 0.05), and enhanced activation of AP1, but not NF-кB and reduced CREB activity among white women with sleep disturbances (p < 0.05). Differences in glucocorticoid receptor (GR) activity were also observed, in which African American women with sleep disturbances had reduced GR activity (p < 0.05), but white women with sleep disturbances showed a trend for enhanced GR activity (p = 0.11). Similarly, Interferon Response Factor (IRF) activity was reduced in African American women while increased in white women with sleep disturbances (p < 0.05). The current study provides novel evidence for gene expression related to inflammation, glucocorticoids, and anti-viral immunity among pregnant women with sleep disturbances, with differential effects by race. African Americans showed greater breadth and magnitude in these proinflammatory and anti-viral pathways than whites, with divergence in anti-inflammatory glucocorticoid, proinflammatory adrenergic-mediated cAMP, and anti-viral interferon responses. These data elucidate the role of sleep disturbances in intracellular inflammatory and anti-viral immunity in pregnancy and provide a potential target for intervention.
Collapse
Affiliation(s)
- Judith E Carroll
- Cousins Center for Psychoneuroimmunology, Department of Psychiatry & Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA.
| | - Kelly E Rentscher
- Cousins Center for Psychoneuroimmunology, Department of Psychiatry & Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
| | - Steven W Cole
- Cousins Center for Psychoneuroimmunology, Department of Psychiatry & Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
| | - James J Luo
- Cousins Center for Psychoneuroimmunology, Department of Psychiatry & Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
| | - Octavio Ramilo
- Department of Psychiatry & Behavioral Health and The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Shannon Webber
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Donald M Lamkin
- Cousins Center for Psychoneuroimmunology, Department of Psychiatry & Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
| | - Lisa M Christian
- Department of Psychiatry & Behavioral Health and The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| |
Collapse
|
4
|
Ross KM, Carroll JE, Dunkel Schetter C, Hobel C, Cole SW. Pro-inflammatory immune cell gene expression during the third trimester of pregnancy is associated with shorter gestational length and lower birthweight. Am J Reprod Immunol 2019; 82:e13190. [PMID: 31529581 DOI: 10.1111/aji.13190] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/26/2019] [Accepted: 08/19/2019] [Indexed: 12/12/2022] Open
Abstract
PROBLEM Altered maternal immune function predicts risk for shorter gestation and low birthweight. Few studies examine associations between prenatal immune cell gene expression and gestational length or birthweight. No studies examine which cell types drive associations. The purpose of this study is to explore associations between peripheral blood immune cell gene expression and gestational length and birthweight, using transcript origin analysis. METHOD OF STUDY Eighty-nine women were drawn from the Community Child Health Network cohort. Third trimester maternal dried blood spots were used for genome-wide transcriptional (mRNA) profiling. Gestational length and birthweight were obtained from medical charts. Covariates were age, race/ethnicity, pre-pregnancy body mass index, smoking, gestational age at blood sampling, and pregnancy infections. Associations between gene expression profiles and gestational length and birthweight were tested using general linear models. The Transcription Element Listening System (TELiS) bioinformatics analysis quantified upstream transcription factor activity. Transcript origin analysis identified leukocyte subsets mediating observed effects. RESULTS Shorter gestation was predicted by increased NF-kB (TFBM ratio = -0.582 ± 0.172, P < .001) and monocyte activity (diagnosticity score = 0.172 ± 0.054, P < .001). Longer gestation was associated with increased dendritic cell activity (diagnosticity score = 0.194 ± 0.039, P < .001). Increased AP-1 activity predicted lower birthweight (TFBM ratio = -0.240 ± 0.111, P = .031). Dendritic cells and CD4+ and CD8+ T cells predicted birthweight-related gene expression differences (diagnosticity score P's < 0.021). CONCLUSION Higher third trimester pro-inflammatory gene expression predicted shorter gestation and lower birthweight. Variations in monocyte and dendritic cell biology contributed to both effects, and T-cell biology contributed to higher birthweight. These analyses clarify the role of myeloid/lymphoid lineage immune regulation in pregnancy outcomes.
Collapse
Affiliation(s)
- Kharah M Ross
- Owerko Centre, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta
| | - Judith E Carroll
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California - Los Angeles, Los Angeles, California
| | | | - Calvin Hobel
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Steve W Cole
- Department of Medicine and Psychiatry and Biobehavioral Sciences, University of California - Los Angeles, Los Angeles, California
| |
Collapse
|
5
|
Huang L, Hou Q, Huang Y, Ye J, Huang S, Tian J, Tang R, Liu C, Long Y, Qin X, Weng X, Huang Y, Li M, Yang X, Mo Z. Serum multiple cytokines for the prediction of spontaneous preterm birth in asymptomatic women: A nested case-control study. Cytokine 2019; 117:91-97. [PMID: 30831445 DOI: 10.1016/j.cyto.2019.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/25/2019] [Accepted: 02/07/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Current biomarkers such as fetal fibronectin and cervical length are accurate predictors of spontaneous preterm birth (sPTB) in women with clinically suspected preterm risk; however, these are not effective for predicting the risk of sPTB in asymptomatic women. Therefore, we performed this study with the objective of determining whether the combinations of specific serum cytokines could accurately predict the sPTB risk in asymptomatic women. METHODS We conducted a nested case-control study with 129 incident sPTB cases and 258 individually matched controls who participated in an ongoing birth cohort study. The maternal serum levels of the selected 35 cytokines were measured. We evaluated the relationship between the multiple cytokines and sPTB risk using conditional logistic regression and elastic net model. RESULTS A panel of cytokines was significantly associated with an increased risk of sPTB. The odds ratio (OR) of sPTB per standard deviation (SD) increase of the predictive model score was 1.57 (95% CI 1.25-1.97) for the cytokines model. The combination of the selected serum cytokines was substantially more effective in predicting the risk for sPTB, as the receiver-operator characteristic curve (AUC) values were 0.546 and 0.559 in the single cytokine model and it improved to 0.642 in the multiple cytokines model (PAUC difference = 0.02 for TNF-α vs. multiple cytokines; PAUC difference = 0.05 for TRAIL vs. multiple cytokines). Moreover, the prediction was more accurate in overweight pregnant women, with an AUC = 0.879. CONCLUSIONS The current study suggested that the combination of selected serum cytokines can more effectively predict the risk of sPTB in asymptomatic women compared with the use of single cytokine.
Collapse
Affiliation(s)
- Lulu Huang
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning 530021, Guangxi, China; School of Public Health of Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Qingzhi Hou
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning 530021, Guangxi, China; School of Public Health of Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Yaling Huang
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning 530021, Guangxi, China; School of Public Health of Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Juan Ye
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning 530021, Guangxi, China; School of Public Health of Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Shengzhu Huang
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning 530021, Guangxi, China; School of Public Health of Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Jiarong Tian
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning 530021, Guangxi, China; School of Public Health of Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Ruiqiang Tang
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning 530021, Guangxi, China; School of Public Health of Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Chaoqun Liu
- Department of Nutrition and Food Hygiene, School of Public Health, Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Yu Long
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Xiaolian Qin
- Department of Medical Services Section, Maternal & Child Health Hospital of Yulin, Yulin 537000, Guangxi, China
| | - Xunjin Weng
- Department of Surgery, Maternal & Child Health Hospital of Qinzhou, Qinzhou 535000, Guangxi, China
| | - Yifeng Huang
- Department of Gynecology and Obstetrics, Maternal & Child Health Hospital of Guigang, Guigang 537100, Guangxi, China
| | - Mujun Li
- Department of Reproductive Center, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Xiaobo Yang
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning 530021, Guangxi, China; Department of Occupational Health and Environmental Health, School of Public Health, Guangxi Medical University, Nanning 530021, Guangxi, China.
| | - Zengnan Mo
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning 530021, Guangxi, China; Institute of Urology and Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi, China.
| |
Collapse
|
6
|
Ross KM, Cole SW, Carroll JE, Schetter CD. Elevated pro-inflammatory gene expression in the third trimester of pregnancy in mothers who experienced stressful life events. Brain Behav Immun 2019; 76:97-103. [PMID: 30447280 PMCID: PMC6348125 DOI: 10.1016/j.bbi.2018.11.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/25/2018] [Accepted: 11/13/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Stress exposure is associated with risk for adverse pregnancy outcomes, potentially in part through dysregulated immune and inflammatory activity. Evidence suggests that stress during pregnancy is associated with inflammation during pregnancy, consistent with risk for preterm birth. However, research has not tested whether complementary changes are reflected in immune cell gene expression, or upstream regulation of inflammation. The purpose of this study was to test associations between preconception and prenatal stress exposure and third trimester immune cell gene expression, focusing specifically on sets of genes previously linked to stress in non-pregnant samples: Pro-inflammatory genes, and antiviral and antibody genes. METHODS A sample of 116 low-income, diverse women was recruited from 5 U.S. sites by the Community Child and Health Network at the birth of a child. This study is of the subgroup of women who became pregnant again over the two-year follow-up period, and provided information on stressful life events that occurred both preconception and during the third trimester of the subsequent pregnancy. Dried blood spots (DBS) were collected in the third trimester of pregnancy, and used for gene expression analysis. RESULTS Women with more prenatal stressful life events had higher expression of pro-inflammatory genes when compared to those with fewer life events, and the effect was driven by increased activation of pro-inflammatory transcription factors, NF-κB and AP-1. Preconception stressful life event exposure was not associated with gene expression profiles. When entered into models simultaneously, only prenatal stressful life events were associated with up-regulation of pro-inflammatory genes. No differences between high or low stress groups emerged for antiviral or antibody genes. CONCLUSIONS Prenatal stress exposure was associated with up-regulated pro-inflammatory gene expression during pregnancy, and increased activity of NF-κB and AP-1. In contrast, stress occurring preconception was not associated with gene expression. These results are consistent with the hypothesis that stress-induced activation of pro-inflammatory transcriptional pathways in pregnancy, but not earlier, may increase risk for inflammation-driven adverse pregnancy outcomes.
Collapse
Affiliation(s)
- Kharah M. Ross
- Department of Psychology, University of California – Los Angeles, Los Angeles, CA.,Department of Psychology, University of California – Los Angeles, 1285 Franz Hall, 502 Portola Plaza, Los Angeles, CA 90095-1563, USA,
| | - Steve W. Cole
- Cousins Center for Psychoneuroimmunology, David Geffen School of Medicine, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences - University of California – Los Angeles, Los Angeles, CA
| | - Judith E. Carroll
- Cousins Center for Psychoneuroimmunology, David Geffen School of Medicine, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences - University of California – Los Angeles, Los Angeles, CA
| | | |
Collapse
|
7
|
Abstract
In the United States, African-American infants have significantly higher mortality than white infants. Previous work has identified associations between individual socioeconomic factors and select community-level factors. In this review, the authors look beyond traditional risk factors for infant mortality and examine the social context of race in this country, in an effort to understand African-American women's long-standing birth outcome disadvantage. In the process, recent insights are highlighted concerning neighborhood-level factors such as crime, segregation, built environment, and institutional racism, other likely causes for the poor outcomes of African-American infants in this country compared with infants in most other industrialized nations.
Collapse
Affiliation(s)
- Nana Matoba
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - James W Collins
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
| |
Collapse
|
8
|
Valdez-Velazquez LL, Quintero-Ramos A, Perez SA, Mendoza-Carrera F, Montoya-Fuentes H, Rivas F, Olivares N, Celis A, Vazquez OF, Rivas F. Genetic polymorphisms of the renin-angiotensin system in preterm delivery and premature rupture of membranes. J Renin Angiotensin Aldosterone Syst 2016; 8:160-8. [DOI: 10.3317/jraas.2007.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Introduction. Premature rupture of membranes (PRM) is a late pregnancy complication commonly associated with preterm delivery (PD).Although several markers related to the renin-angiotensin system (RAS) have been evaluated in certain pregnancy complications, only the angiotensin-converting enzyme (ACE) I/D variant has been studied in PD-PRM.The aim of this survey was to investigate the association of the polymorphisms (angiotensin II type 1 [AT1] receptor T174M and M235T, renin G2805A,ACE I/D and AT1-receptor A1166C) of the genes of RAS in women with PD-PRM. Design. Deoxyribonucleic acid samples from 89 Mexican Mestizo women with PD and PRM and 224—288 controls were studied. Polymorphisms were analysed by polymerase chain reaction-sequence specific primer assays. restricted fragment length polymorphism or sequence specific prim assays. Results. For all loci , genotype distribution was in agreement with Hardy—Weinberg expectations in the control group. Significant intergroup difference (case vs. control) was seen for angiotensinogen (AGT) M235T polymorphism, with an increased allele M235 in affected cases (50% vs. 40% in controls).Analysis of two- locus haplotype agrees with an independent segregation of physically unlinked genes. Haplotype AGT 174T-235M was also increased (50 % vs. 40% in controls). Conclusions. Physically unlinked genes involved in RAS segregate independently. The AGT 174—235 region is associated with PD-PRM in this population.
Collapse
Affiliation(s)
- Laura L Valdez-Velazquez
- Universidad de Colima, Facultad de Ciencias Químicas. Kilometro 9 carretera Colima-Coquimatlán, Colima, México. 28400, lauravaldez @ucol.mx, Universidad de Guadalajara Centro Universitario de Ciencias de la Salud Estudios de Posgrado en Genética Humana Sierra Mojada No. 950 Col. Independencia (puerta 7). Guadalajara, Jalisco, México. 44340
| | - Antonio Quintero-Ramos
- Universidad de Guadalajara Centro Universitario de Ciencias de la Salud Estudios de Posgrado en Genética Humana Sierra Mojada No. 950 Col. Independencia (puerta 7). Guadalajara, Jalisco, México. 44340
| | - Sandra A Perez
- Instituto Mexicano del Seguro Social Hospital General Regional No. 46 Lazaro Cardenas 2063 Col. Morelos Guadalajara, Jalisco, México. 44910
| | - Francisco Mendoza-Carrera
- Instituto Mexicano del Seguro Social Centro de Investigación Biomédica de Occidente Sierra Mojada 800 Col. Independencia, Guadalajara, Jalisco, México. 44340
| | - Hector Montoya-Fuentes
- Instituto Mexicano del Seguro Social Centro de Investigación Biomédica de Occidente Sierra Mojada 800 Col. Independencia, Guadalajara, Jalisco, México. 44340
| | - Fernando Rivas
- Instituto Mexicano del Seguro Social Centro de Investigación Biomédica de Occidente Sierra Mojada 800 Col. Independencia, Guadalajara, Jalisco, México. 44340
| | - Norma Olivares
- Secretaría de Salud Jalisco Hospital General de Occidente Av. Zoquipan 1050 Col. Seattle Zapopan, Jalisco, México. 45130
| | - Alfredo Celis
- Universidad de Guadalajara Departamento de Salud publica Sierra Morena No. 950 Edificio N Col. Independencia Guadalajara, Jalisco, México. 44340
| | - Oscar F Vazquez
- Universidad de Colima Facultad de Ciencias Químicas. Kilometro 9 carretera Colima-Coquimatlán, Colima, México. 28400
| | - Fernando Rivas
- Instituto Mexicano del Seguro Social Centro de Investigación Biomédica de Occidente Sierra Mojada 800 Col. Independencia, Guadalajara, Jalisco, México. 44340
| |
Collapse
|
9
|
Dunlop AL, Mulle JG, Ferranti EP, Edwards S, Dunn AB, Corwin EJ. Maternal Microbiome and Pregnancy Outcomes That Impact Infant Health: A Review. Adv Neonatal Care 2015; 15:377-85. [PMID: 26317856 PMCID: PMC4658310 DOI: 10.1097/anc.0000000000000218] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The maternal microbiome is recognized as a key determinant of a range of important maternal and child health outcomes, and together with perinatal factors influences the infant microbiome. This article provides a summary review of research investigating (1) the role of the maternal microbiome in pregnancy outcomes known to adversely influence neonatal and infant health, including preterm birth, cardiometabolic complications of pregnancy such as preeclampsia and gestational diabetes, and excessive gestational weight gain; (2) factors with an established link to adverse pregnancy outcomes that are known to influence the composition of the maternal microbiome; and (3) strategies for promoting a healthy maternal microbiome, recognizing that much more research is needed in this area.
Collapse
Affiliation(s)
- Anne L. Dunlop
- Emory University School of Nursing, 1520 Clifton Road NE, Atlanta, GA 30322, 404-712-8520 (phone); 404-727-6945 (fax)
| | - Jennifer G. Mulle
- Rollins School of Public Health & School of Medicine, Department of Human Genetics, Emory University Atlanta, GA 30322
| | - Erin P. Ferranti
- Nell Hodgson Woodruff School of Nursing, Emory University,Atlanta, GA 30322
| | - Sara Edwards
- Nell Hodgson Woodruff School of Nursing, Emory University,Atlanta, GA 30322
| | - Alexis B. Dunn
- Nell Hodgson Woodruff School of Nursing, Emory University,Atlanta, GA 30322
| | | |
Collapse
|
10
|
Christian LM, Porter K. Longitudinal changes in serum proinflammatory markers across pregnancy and postpartum: effects of maternal body mass index. Cytokine 2014; 70:134-40. [PMID: 25082648 PMCID: PMC4254150 DOI: 10.1016/j.cyto.2014.06.018] [Citation(s) in RCA: 182] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 06/12/2014] [Accepted: 06/27/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND The maternal immune system undergoes substantial changes to support healthy pregnancy. Although obesity is a primary driver of inflammation and predictive of perinatal complications, additive effects of pregnancy and obesity on changes in inflammatory processes are not well delineated. METHODS This study examined serum proinflammatory markers interleukin(IL)-6, IL-8, tumor necrosis factor (TNF)-α, IL-1β, and C-reactive protein (CRP) during each trimester of pregnancy and 4-6 weeks postpartum among 57 women. RESULTS Overall, IL-6 showed an increasing trend across pregnancy and significant increase at postpartum. Similarly, TNF-α increased significantly across gestation, with a further increase at postpartum. Both IL-8 and IL-1β showed a U-shaped curve, decreasing from early to later pregnancy, and increasing at postpartum. Finally, serum CRP decreased significantly across pregnancy, with further decreases at postpartum. Maternal obesity predicted higher IL-6 at each study visit. Obese women showed a trend toward elevated serum CRP during pregnancy, and significantly higher levels at postpartum. DISCUSSION The course of pregnancy and postpartum is characterized by significant changes in serum proinflammatory mediators. Obese women show elevations in serum proinflammatory markers relative to normal weight women during pregnancy and postpartum. Further research is needed to determine the extent to which obesity-induced inflammation affects maternal and fetal health.
Collapse
Affiliation(s)
- Lisa M Christian
- Department of Psychiatry, The Ohio State University Wexner Medical Center, United States; The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, United States; Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, United States; Psychology, The Ohio State University Wexner Medical Center, United States.
| | - Kyle Porter
- Center for Biostatistics, The Ohio State University Wexner Medical Center, United States
| |
Collapse
|
11
|
Christian LM, Iams J, Porter K, Leblebicioglu B. Self-rated health among pregnant women: associations with objective health indicators, psychological functioning, and serum inflammatory markers. Ann Behav Med 2014; 46:295-309. [PMID: 23765366 DOI: 10.1007/s12160-013-9521-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Biobehavioral correlates of self-rated health in pregnancy are largely unknown. PURPOSE The goals of this study were to examine, in pregnant women, associations of self-rated health with (1) demographics, objective health status, health behaviors, and psychological factors, and (2) serum inflammatory markers. METHODS In the second trimester of pregnancy, 101 women provided a blood sample, completed measures of psychosocial stress, health status, and health behaviors, and received a comprehensive periodontal examination. RESULTS The following independently predicted poorer self-rated health: (1) greater psychological stress, (2) greater objective health diagnoses, (3) higher body mass index, and (4) past smoking (versus never smoking). Poorer self-rated health was associated with higher serum interleukin-1β (p = 0.02) and marginally higher macrophage migration inhibitory factor (p = 0.06). These relationships were not fully accounted for by behavioral/psychological factors. CONCLUSIONS This study provides novel data regarding factors influencing subjective ratings of health and the association of self-rated health with serum inflammatory markers in pregnant women.
Collapse
Affiliation(s)
- Lisa M Christian
- Department of Psychiatry, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA,
| | | | | | | |
Collapse
|
12
|
Burris HH, Baccarelli AA, Motta V, Byun HM, Just AC, Mercado-Garcia A, Schwartz J, Svensson K, Téllez-Rojo MM, Wright RO. Association between length of gestation and cervical DNA methylation of PTGER2 and LINE 1-HS. Epigenetics 2014; 9:1083-91. [PMID: 24827772 DOI: 10.4161/epi.29170] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Worldwide, more than 1 in 10 infants is born prior to 37 weeks gestation. Preterm birth can lead to increased mortality risk and poor life-long health and neurodevelopmental outcomes. Whether environmental risk factors affect preterm birth through epigenetic phenomena is largely unstudied. We sought to determine whether preterm risk factors, such as smoke exposure and education, were associated with cervical DNA methylation in the prostaglandin E receptor 2 gene (PTGER2) and a repetitive element, long interspersed nuclear element-1 Homo sapiens-specific (LINE 1-HS). Second, we aimed to determine whether mid-pregnancy DNA methylation of these regions in cervical samples could predict the length of gestation. We obtained a cervical swab between 16-19 weeks gestation from 80 women participating in a Mexico City birth cohort, used pyrosequencing to analyze DNA methylation of PTGER2 and LINE 1-HS, and examined associations with maternal covariates. We used accelerated failure time models to analyze associations of DNA methylation with the length of gestation. DNA methylation of both sequences was associated with Pap smear inflammation. LINE 1-HS methylation was associated with smoke exposure, BMI and parity. In adjusted models, gestations were 3.3 days longer (95%CI 0.6, 6.0) for each interquartile range of PTGER2 DNA methylation. Higher LINE 1-HS methylation was associated with shorter gestations (-3.3 days, 95%CI -6.5, -0.2). In conclusion, cervical DNA methylation was associated with risk factors for preterm birth and the length of gestation.
Collapse
Affiliation(s)
- Heather H Burris
- Department of Neonatology; Beth Israel Deaconess Medical Center and Division of Newborn Medicine; Boston Children's Hospital and Harvard Medical School; Boston, MA USA
| | - Andrea A Baccarelli
- Laboratory of Environmental Epigenetics; Exposure Epidemiology and Risk Program; Harvard School of Public Health; Boston, MA USA; Department of Environmental Health; Harvard School of Public Health; Boston, MA USA
| | - Valeria Motta
- Laboratory of Environmental Epigenetics; Exposure Epidemiology and Risk Program; Harvard School of Public Health; Boston, MA USA; Department of Clinical Sciences and Community Health; University of Milan, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico; Milan, Italy
| | - Hyang-Min Byun
- Laboratory of Environmental Epigenetics; Exposure Epidemiology and Risk Program; Harvard School of Public Health; Boston, MA USA; Department of Environmental Health; Harvard School of Public Health; Boston, MA USA
| | - Allan C Just
- Department of Environmental Health; Harvard School of Public Health; Boston, MA USA
| | - Adriana Mercado-Garcia
- Center for Evaluation Research and Surveys; National Institute of Public Health; Cuernavaca, Mexico
| | - Joel Schwartz
- Department of Environmental Health; Harvard School of Public Health; Boston, MA USA
| | - Katherine Svensson
- Department of Pediatrics and Preventative Medicine; Icahn School of Medicine at Mount Sinai; New York, NY USA
| | - Martha M Téllez-Rojo
- Center for Evaluation Research and Surveys; National Institute of Public Health; Cuernavaca, Mexico
| | - Robert O Wright
- Department of Pediatrics and Preventative Medicine; Icahn School of Medicine at Mount Sinai; New York, NY USA
| |
Collapse
|
13
|
Lee JS, Yoon JM, Cheon EJ, Ko KO, Shim JW, Park CG, Bae CW, Lim JW. Comparison of Neonatal and Infant Mortality Rates between Infants Born in South Korea and Those Born in the United States. NEONATAL MEDICINE 2014. [DOI: 10.5385/nm.2014.21.4.211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Ji Sun Lee
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
| | - Jung Min Yoon
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
| | - Eun Jung Cheon
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
| | - Kyong Og Ko
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
| | - Jae Won Shim
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunwkan University School of Medicine, Seoul, Korea
| | - Chang Gi Park
- Department of Pediatrics, Comer Children's Hospital, The University of Chicago Medicine, Chicago, United States
| | - Chong Woo Bae
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae Woo Lim
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
| |
Collapse
|
14
|
Kim J, Stirling KJ, Cooper ME, Ascoli M, Momany AM, McDonald EL, Ryckman KK, Rhea L, Schaa KL, Cosentino V, Gadow E, Saleme C, Shi M, Hallman M, Plunkett J, Teramo KA, Muglia LJ, Feenstra B, Geller F, Boyd HA, Melbye M, Marazita ML, Dagle JM, Murray JC. Sequence variants in oxytocin pathway genes and preterm birth: a candidate gene association study. BMC MEDICAL GENETICS 2013; 14:77. [PMID: 23889750 PMCID: PMC3737028 DOI: 10.1186/1471-2350-14-77] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 07/18/2013] [Indexed: 11/10/2022]
Abstract
Background Preterm birth (PTB) is a complex disorder associated with significant neonatal mortality and morbidity and long-term adverse health consequences. Multiple lines of evidence suggest that genetic factors play an important role in its etiology. This study was designed to identify genetic variation associated with PTB in oxytocin pathway genes whose role in parturition is well known. Methods To identify common genetic variants predisposing to PTB, we genotyped 16 single nucleotide polymorphisms (SNPs) in the oxytocin (OXT), oxytocin receptor (OXTR), and leucyl/cystinyl aminopeptidase (LNPEP) genes in 651 case infants from the U.S. and one or both of their parents. In addition, we examined the role of rare genetic variation in susceptibility to PTB by conducting direct sequence analysis of OXTR in 1394 cases and 1112 controls from the U.S., Argentina, Denmark, and Finland. This study was further extended to maternal triads (maternal grandparents-mother of a case infant, N=309). We also performed in vitro analysis of selected rare OXTR missense variants to evaluate their functional importance. Results Maternal genetic effect analysis of the SNP genotype data revealed four SNPs in LNPEP that show significant association with prematurity. In our case–control sequence analysis, we detected fourteen coding variants in exon 3 of OXTR, all but four of which were found in cases only. Of the fourteen variants, three were previously unreported novel rare variants. When the sequence data from the maternal triads were analyzed using the transmission disequilibrium test, two common missense SNPs (rs4686302 and rs237902) in OXTR showed suggestive association for three gestational age subgroups. In vitro functional assays showed a significant difference in ligand binding between wild-type and two mutant receptors. Conclusions Our study suggests an association between maternal common polymorphisms in LNPEP and susceptibility to PTB. Maternal OXTR missense SNPs rs4686302 and rs237902 may have gestational age-dependent effects on prematurity. Most of the OXTR rare variants identified do not appear to significantly contribute to the risk of PTB, but those shown to affect receptor function in our in vitro study warrant further investigation. Future studies with larger sample sizes are needed to confirm the findings of this study.
Collapse
Affiliation(s)
- Jinsil Kim
- Department of Anatomy and Cell Biology, University of Iowa, Iowa City, IA 52242, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Laudanski P, Raba G, Kuc P, Lemancewicz A, Kisielewski R, Laudanski T. Assessment of the selected biochemical markers in predicting preterm labour. J Matern Fetal Neonatal Med 2013; 25:2696-9. [PMID: 22646705 DOI: 10.3109/14767058.2012.699116] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The differential diagnosis between preterm and false labour remains one of the most challenging issues in perinatal medicine. AIM To assess the prognostic importance of the selected biochemical markers in predicting preterm labour. MATERIAL AND METHODS 74 patients hospitalized due to threatening preterm labour. 51 women gave birth prematurely; the remaining 23 were diagnosed with false labour. We used ELISA arrays to study 13 proteins: IGFBP-1, IGFBP-2, BDNF, L-Selectin, E-Selectin, ICAM-1, PECAM, VCAM-1, MIP-1 delta (MIP-1d) MIP-3β (MIP-3b), Eotaxin-1, Eotaxin-2, BLC. RESULTS An increased risk of preterm labour should be expected when the serum concentration for: IGFBP-1 > 158.83 pg/ml (sens. 0.608, sp. 0.609, p < 0.0001); MIP-1d < 27.66 pg/ml (sens. 0.627, sp. 0.627, p = 0.021); BDNF >36.54 pg/ml (sens. 0.630, sp. 0.647, p = 0.002); BLC >25.46 pg/ml (sens. 0.588, sp. 0.609, p < 0.001); Eotaxin-1 >1.16 pg/ml (sens. 0.633, sp. 0.652). CONCLUSION There have been reported statistically significant differences in serum concentrations of selected proteins in women with preterm labour and false labour.
Collapse
Affiliation(s)
- Piotr Laudanski
- Department of Perinatology, Medical University of Białystok, Poland
| | | | | | | | | | | |
Collapse
|
16
|
Christian LM. Psychoneuroimmunology in pregnancy: immune pathways linking stress with maternal health, adverse birth outcomes, and fetal development. Neurosci Biobehav Rev 2012; 36:350-61. [PMID: 21787802 PMCID: PMC3203997 DOI: 10.1016/j.neubiorev.2011.07.005] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 07/05/2011] [Accepted: 07/08/2011] [Indexed: 02/01/2023]
Abstract
It is well-established that psychological stress promotes immune dysregulation in nonpregnant humans and animals. Stress promotes inflammation, impairs antibody responses to vaccination, slows wound healing, and suppresses cell-mediated immune function. Importantly, the immune system changes substantially to support healthy pregnancy, with attenuation of inflammatory responses and impairment of cell-mediated immunity. This adaptation is postulated to protect the fetus from rejection by the maternal immune system. Thus, stress-induced immune dysregulation during pregnancy has unique implications for both maternal and fetal health, particularly preterm birth. However, very limited research has examined stress-immune relationships in pregnancy. The application of psychoneuroimmunology research models to the perinatal period holds great promise for elucidating biological pathways by which stress may affect adverse pregnancy outcomes, maternal health, and fetal development.
Collapse
Affiliation(s)
- Lisa M Christian
- Department of Psychiatry, The Ohio State University Medical Center, Columbus, OH 43210, USA.
| |
Collapse
|
17
|
Li X, Sundquist J, Kane K, Jin Q, Sundquist K. Parental occupation and preterm births: a nationwide epidemiological study in Sweden. Paediatr Perinat Epidemiol 2010; 24:555-63. [PMID: 20955233 DOI: 10.1111/j.1365-3016.2010.01149.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The hypothesis was that some occupations could lead to preterm birth (PTB) because of potential exposures to various agents. The objective in this nationwide follow-up study was to analyse the association between PTB and parental occupational groups, controlling for potential confounders. Data from the Swedish Medical Birth Register, in which all children born in Sweden from 1990 onward are registered with their parents, were linked to census data. Inclusion criteria for the study population were employment (both women and men) and age >20 years (women). There were 816,743 first singleton live births from 1990 to 2004, of whom 43,956 were PTBs. A total of 7659 of the 43,956 PTBs were very PTBs. Odds ratios (ORs) with 95% confidence intervals were calculated separately for mothers and fathers to estimate the odds of PTB and very PTB in 51 occupational groups (reference groups: mothers or fathers who were 'Technical, science research-related workers and physicians') and by family income level. Women and men with low family incomes had increased ORs of PTB and very PTB. Significantly increased ORs of PTB (including very PTB) were found in four maternal and nine paternal occupational groups after accounting for family income, geographic region of residence, civil status, smoking habits, maternal age at infant's birth and period of birth. Further studies should examine specific agents in those parental occupations that were associated with increased odds of PTB and very PTB.
Collapse
Affiliation(s)
- Xinjun Li
- Center for Primary Health Care Research, Lund University, Malmö, Sweden.
| | | | | | | | | |
Collapse
|
18
|
Mustafa M, Pathak R, Ahmed T, Ahmed RS, Tripathi A, Guleria K, Banerjee B. Association of glutathione S-transferase M1 and T1 gene polymorphisms and oxidative stress markers in preterm labor. Clin Biochem 2010; 43:1124-8. [DOI: 10.1016/j.clinbiochem.2010.06.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2010] [Revised: 06/10/2010] [Accepted: 06/27/2010] [Indexed: 11/25/2022]
|
19
|
Pathak R, Ahmed RS, Tripathi A, Guleria K, Sharma C, Makhijani S, Banerjee B. Maternal and cord blood levels of organochlorine pesticides: Association with preterm labor. Clin Biochem 2009; 42:746-9. [DOI: 10.1016/j.clinbiochem.2008.11.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Revised: 11/14/2008] [Accepted: 11/16/2008] [Indexed: 11/17/2022]
|
20
|
Abstract
In the United States, African-American infants have significantly worse outcomes than white infants. In this review, the authors look beyond traditional risk factors and explore the social context of race in this country in an effort to understand African-American women's long-standing pregnancy outcome disadvantage. In the process, new insights are highlighted concerning likely causes for the poor birth outcomes of white infants in this country compared with infants in most other industrialized nations.
Collapse
Affiliation(s)
- James W Collins
- Department of Pediatrics, Northwestern University's Feinberg School of Medicine, Children's Memorial Hospital, 2300 Children's Plaza, Division of Neonatology, Box 45, Chicago, IL 60614, USA.
| | | |
Collapse
|
21
|
Himes KP, Simhan HN. Genetic susceptibility to infection-mediated preterm birth. Infect Dis Clin North Am 2009; 22:741-753. [PMID: 18954761 DOI: 10.1016/j.idc.2008.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Preterm birth is a heterogeneous disorder that is responsible for significant neonatal morbidity and mortality. Intrauterine infection is implicated in a significant proportion of preterm birth-particularly in early gestation. Epidemiologic evidence supports a genetic component to infection overall and preterm birth in particular. Furthermore, a number of studies examining genes involved in pathogen recognition and our response to pathogens suggest a genetic susceptibility to infection-mediated preterm birth. On the whole, however, these studies have been difficult to replicate and explain only a small portion of the phenotypic variation in preterm birth. Given this, methodological considerations are emphasized to improve our understanding of the genetic susceptibility to infection-mediated preterm birth.
Collapse
Affiliation(s)
- Katherine P Himes
- Division of Maternal Fetal Medicine, University of Pittsburgh Medical Center, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, USA
| | - Hyagriv N Simhan
- Division of Maternal Fetal Medicine, University of Pittsburgh Medical Center, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, USA.
| |
Collapse
|
22
|
Nenadić DB, Pavlović MD. Cervical fluid cytokines in pregnant women: Relation to vaginal wet mount findings and polymorphonuclear leukocyte counts. Eur J Obstet Gynecol Reprod Biol 2008; 140:165-70. [PMID: 18406509 DOI: 10.1016/j.ejogrb.2008.02.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2006] [Revised: 12/07/2007] [Accepted: 02/24/2008] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The purpose of the study was to measure and compare concentrations of IFN-gamma, IL-8, IL-10 and IL-12 in cervical fluids of pregnant women with normal and pathologic microscopic findings of vaginal wet mount. STUDY DESIGN Vaginal samples were obtained from 100 pregnant women (22-32 weeks of gestation) without signs and symptoms of preterm labour (PTL), selected on the basis of the microscopic examination of vaginal wet mounts. Cytokine (IFN-gamma, IL-8, IL-10 and IL-12) concentrations were measured in cervical fluids by an enzyme-linked immunosorbent assay. RESULTS The cytokines were found in cervical fluids of the majority of pregnant women, with IFN-gamma and IL-8 detected in all samples. Concentrations of IL-8 were significantly higher in pregnant women with pathologic findings on vaginal wet mount, including elevated polymorphonuclear (PMN) cell counts. CONCLUSION A significant correlation between microscopic findings and cervical fluid IL-8 concentrations may make vaginal wet mount microscopy a useful tool for identification of patients with cervicovaginal inflammation, which is considered a risk factor for spontaneous preterm delivery.
Collapse
Affiliation(s)
- Dane B Nenadić
- Departments of Gynecology, Military Medical Academy, Belgrade, Serbia
| | | |
Collapse
|
23
|
Abstract
Cerebral palsy refers to a collective of neurologic conditions that share in common disorders of motor function and posture. Traditionally, and still today in many circles, the term is considered almost synonymous with brain injury. Multiple lines of evidence, however, point to the fact that cerebral palsy is rarely caused by problems with perinatal management. In fact, a mounting body of evidence points to strong genetic influences on the occurrence of cerebral palsy. Like most neurogenetic conditions, cerebral palsy exhibits complex inheritance. The best descriptor of the inheritance of cerebral palsy would be that of "multifactorial inheritance." This implies etiologic and genetic heterogeneity with complex interactions with multiple environmental influences. This article reviews known genetic influences on the origin of cerebral palsy. A proposed scheme for the genetic evaluation in identifying the etiology of cerebral palsy is provided.
Collapse
Affiliation(s)
- G Bradley Schaefer
- University of Nebraska Medical Center, Munroe-Meyer Institute for Rehabilitation and Genetics Medicine, Omaha, NE 68198-5430, USA.
| |
Collapse
|
24
|
Steffen KM, Cooper ME, Shi M, Caprau D, Simhan HN, Dagle JM, Marazita ML, Murray JC. Maternal and fetal variation in genes of cholesterol metabolism is associated with preterm delivery. J Perinatol 2007; 27:672-80. [PMID: 17855807 PMCID: PMC2706423 DOI: 10.1038/sj.jp.7211806] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine the contribution of variants in fetal and maternal cholesterol metabolism genes in preterm delivery (PTD). STUDY DESIGN A total of 40 single-nucleotide polymorphisms (SNPs) in 16 genes related to cholesterol metabolism were examined for 414 preterm infants (gestational ages 22 to 36 weeks; comprising 305 singletons and 109 twins) and at least 1 parent. Fetal effects were assessed using the transmission disequilibrium test (TDT) for each SNP, followed by a log linear model-based approach to utilize families with missing parental genotypes for those SNPs showing significance under TDT. Genetic variant effects were examined for a role in PTD, gestational age and birth weight. Maternal effects were estimated using a log linear model-based approach. RESULT Among singleton gestations, suggestive association (P<0.01 without adjusting for multiple comparisons) was found between birth weight and fetal DHCR7 gene/SNP combinations (rs1630498, P=0.002 and rs2002064, P=0.003). Among all gestations, suggestive associations were found between PTD and fetal HMGCR (rs2303152, P=0.002) and APOA1 (rs 5070, P=0.004). The result for HMGCR was further supported by the log linear model-based test in the single births (P=0.007) and in all births (P=0.006). New associations (APOE and ABCA1) were observed when birth weight was normalized for gestational age suggesting independent effects of variants on birth weight separate from effects on PTD. Testing for maternally mediated genetic effects has identified suggestive association between ABCA1 (rs4149313, P=0.004) and decreased gestational age. CONCLUSION Variants in maternal and fetal genes for cholesterol metabolism were associated with PTD and decreased birth weight or gestational age in this study. Genetic markers may serve as one mechanism to identify high-risk mothers and fetuses for targeted nutritional treatment and/or prevention of low birth weight or PTD.
Collapse
Affiliation(s)
- KM Steffen
- University of Iowa College of Medicine, Iowa City, IA, USA
| | - ME Cooper
- Department of Oral Biology, Center for Craniofacial and Dental Genetics, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - M Shi
- National Institute of Environmental Health Science, Research Triangle Park, NC, USA
| | - D Caprau
- Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - HN Simhan
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA, USA
| | - JM Dagle
- Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - ML Marazita
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - JC Murray
- Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| |
Collapse
|
25
|
Abstract
The identification of women at risk of preterm labour remains an important challenge. While current prevention programmes rely on overt clinical and environmental parameters, the clustering of preterm labour within families and recurrence in susceptible women presents the case for a complex underlying genetic predisposition. Genetic polymorphisms are useful markers to identify high risk groups, although they provide little information either to their underlying functionality or the pathophysiological mechanisms involved; these must be validated through complementary analytical approaches. Data interpretation and inter-study comparisons must be made with caution, taking into account population size, study power, racial differences, inclusion/exclusion criteria and any underlying gene-environment and feto-maternal interactions. Large-scale, multicentre genetic studies coupled with high-throughput screening techniques are the most viable approaches to identify multilocus preterm labour susceptibility screening panels. Preventive strategies may then be applied to those women most likely to benefit from intervention.
Collapse
Affiliation(s)
- Nicolas M Orsi
- Perinatal Research Group, The YCR & Liz Dawn Pathology & Translational Sciences Centre Level 4, Leeds Institute of Molecular Medicine, St James's University Hospital, Leeds LS9 7TF, UK.
| | | | | |
Collapse
|
26
|
Strunk T, Richmond P, Simmer K, Currie A, Levy O, Burgner D. Neonatal immune responses to coagulase-negative staphylococci. Curr Opin Infect Dis 2007; 20:370-5. [PMID: 17609595 DOI: 10.1097/qco.0b013e3281a7ec98] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Coagulase-negative staphylococci have emerged as the most common nosocomial pathogen in neonatal intensive care units worldwide. Our understanding of the interactions between coagulase-negative staphylococci and the immune system is incomplete, especially in the newborn. This review summarizes current knowledge on the human immune response to coagulase-negative staphylococci, with particular emphasis on the neonatal innate immune system. RECENT FINDINGS There are very limited data on innate immune responses to coagulase-negative staphylococci in neonates. Levels of serum proteins, including transplacental anti-coagulase-negative staphylococci immunoglobulin and complement, correlate with gestational age, and this relative deficiency in preterm infants contributes to their suboptimal opsonization and impaired bacterial killing of coagulase-negative staphylococci. In adults, coagulase-negative staphylococci elicit significant cytokine responses in vitro, which are probably partly mediated by Toll-like receptors, including Toll-like receptor type 2, but these pathways have not been characterized in the high-risk neonatal population. SUMMARY The susceptibility of human preterm neonates to coagulase-negative staphylococci relates partly to the immaturity of the neonatal immune response. Strategies to reduce the burden of coagulase-negative staphylococci infections require a thorough understanding of host-pathogen interactions, particularly the engagement of coagulase-negative staphylococci by the neonatal innate immune system.
Collapse
MESH Headings
- Anti-Bacterial Agents/therapeutic use
- Antibodies, Bacterial/immunology
- Bacteremia/immunology
- Coagulase/metabolism
- Cytokines/metabolism
- Humans
- Immunity, Innate
- Immunity, Maternally-Acquired
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/immunology
- Infant, Premature, Diseases/microbiology
- Infant, Premature, Diseases/therapy
- Phagocytes/immunology
- Phagocytosis
- Risk Factors
- Staphylococcal Infections/immunology
- Staphylococcal Infections/microbiology
- Staphylococcal Infections/therapy
- Staphylococcus/enzymology
- Staphylococcus/immunology
- Staphylococcus/pathogenicity
Collapse
Affiliation(s)
- Tobias Strunk
- School of Paediatrics and Child Health, University of Western Australia, Perth, Australia.
| | | | | | | | | | | |
Collapse
|
27
|
David R, Collins J. Disparities in infant mortality: what's genetics got to do with it? Am J Public Health 2007; 97:1191-7. [PMID: 17538073 PMCID: PMC1913086 DOI: 10.2105/ajph.2005.068387] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2006] [Indexed: 11/04/2022]
Abstract
Since 1950, dramatic advances in human genetics have occurred, racial disparities in infant mortality have widened, and the United States' international ranking in infant mortality has deteriorated. The quest for a "preterm birth gene" to explain racial differences is now under way. Scores of papers linking polymorphisms to preterm birth have appeared in the past few years. Is this strategy likely to reduce racial disparities? We reviewed broad epidemiological patterns that call this approach into question. Overall patterns of racial disparities in mortality and secular changes in rates of prematurity as well as birth-weight patterns in infants of African immigrant populations contradict the genetic theory of race and point toward social mechanisms. We postulate that a causal link to class disparities in health exists.
Collapse
Affiliation(s)
- Richard David
- Division of Neonatology, John H. Stroger Jr Hospital of Cook County, Chicago, Ill 60612, USA.
| | | |
Collapse
|
28
|
Abstract
Epidemiological studies suggest that partner change may affect perinatal outcomes in subsequent pregnancies. We conducted a systematic review on the association between paternity change and perinatal outcomes. We searched the literature in MEDLINE using keywords 'paternity', 'partner', 'pre-eclampsia', 'preterm birth', 'low birth weight', and 'birth defects' from 1966 to 2005. We identified 19 studies that examined the association between partner change and specific perinatal outcomes: 12 on pre-eclampsia or hypertension in pregnancy, three on birth defects, three on preterm birth, and two on low birthweight. Partner change was consistently associated with an increased risk of pre-eclampsia or hypertension in pregnancy in 11 of 12 studies (the unadjusted relative risk [RR] ranging from 1.2 to 8.3). However, after controlling for birth interval as a confounder in multivariate analysis, two studies using the same birth registry data showed a modestly reduced risk in relation to partner change (RR=0.84 and 0.73, respectively), while two studies found a slightly increased risk (both RR=1.3). Retrospective cohort studies presented inconsistent findings on the association between partner change and risk of preterm birth and low birthweight. Finally, three population-based cohort studies demonstrated that partner change significantly reduced the recurrence of the same or similar birth defects in subsequent births (RRs ranging from 0.1 to 0.76). We conclude that partner change reduces the risk of recurrent same birth defects. However, epidemiological evidence on the effect of partner change on pre-eclampsia, preterm birth and low birthweight is inconclusive. Whether birth interval should be controlled for in the association between partner change and pre-eclampsia warrants caution.
Collapse
Affiliation(s)
- Jun Zhang
- Epidemiology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
| | | |
Collapse
|
29
|
Santos-Pereira SA, Giraldo PC, Saba-Chujfi E, Amaral RLG, Morais SS, Fachini AM, Gonçalves AKS. Chronic periodontitis and pre-term labour in Brazilian pregnant women: an association to be analysed. J Clin Periodontol 2007; 34:208-13. [PMID: 17309595 DOI: 10.1111/j.1600-051x.2006.01038.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To investigate the association between chronic periodontitis (CP) and pre-maturity in a group of Brazilian pregnant women from the State of São Paulo. MATERIALS AND METHODS One hundred and twenty-four women were investigated consecutively in a cross-sectional study, between December 2003 and May 2005. Sixty-eight women had pre-term labour (PTL) and 56 had term labour. A periodontal examination was carried out to identify the presence of CP. Statistical analysis used the Fisher's exact test or chi(2) for the discrete variables and the Mann-Whitney test for the non-parametric variables. Odds ratio (OR) was calculated with a 95% confidence interval (CI), to evaluate the relation between CP and pre-maturity. RESULTS Periodontal indicators, such as clinical attachment loss (p<0.0001) and bleeding on probing (p=0.012), were observed more in the PTL group. The presence of CP increased the risk for PTL (OR: 4.7, 95% CI: 1.9-11.9), pre-term birth (PTB; OR: 4.9, 95% CI: 1.9-12.8) and low birth weight (<2500 g; OR: 4.2, 95% CI: 1.3-13.3). The pregnant women with PTL presented low levels of schooling (p=0.029) and the lowest number of pre-natal appointments (p=0.0001) when compared with those with term labour. CONCLUSION CP is strongly associated with PTL, PTB and low birth weight in a group of Brazilian pregnant women. These data point to the necessity of regularly investigating CP during pregnancy.
Collapse
Affiliation(s)
- Silvio A Santos-Pereira
- Department of Periodontics, São Leopoldo Mandic Dental Research Institute, Campinas, São Paulo, Brazil
| | | | | | | | | | | | | |
Collapse
|
30
|
Meirhaeghe A, Boreham CAG, Murray LJ, Richard F, Davey Smith G, Young IS, Amouyel P. A possible role for the PPARG Pro12Ala polymorphism in preterm birth. Diabetes 2007; 56:494-8. [PMID: 17259396 DOI: 10.2337/db06-0915] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The links between preterm birth, low birth weight, and adult vascular/metabolic morbidity remain unclear. Genetic susceptibility of babies related to these three conditions might contribute to this long-term association. We tested whether the Pro12Ala polymorphism of the peroxisome proliferator-activated receptor gamma (PPARG) gene could play a role in birth weight and duration of gestation. We genotyped two independent cross-sectional studies from Northern Ireland (n = 382 and 620). In combined populations, the PPARG Ala12 allele was associated (P = 0.03) with lower birth weight, primarily caused by shorter gestational duration (P = 0.04). The frequency of Ala12 allele carriers was higher (P = 0.027) in the group of individuals born before term (35%, n = 60) than in the group of individuals born at term (22%, n = 942). The odds ratios (95% CI) of preterm birth for Ala12 allele carriers were 1.9 (1.1-3.4), P = 0.022, and 4.2 (1.9-9.7), P = 0.0006 (adjusted for sex, maternal age, and study), when considering 37 or 35 weeks of pregnancy as a threshold for preterm birth, respectively. Interestingly, the same allele was also associated with a moderate decreased risk of miscarriages in mothers. In conclusion, the PPARG Pro12Ala polymorphism might represent a genetic susceptibility factor for preterm birth and constitute a link between preterm birth and metabolic diseases later in life.
Collapse
Affiliation(s)
- Aline Meirhaeghe
- INSERM U744, Institut Pasteur de Lille, Université de Lille, 1 rue du Pr. Calmette, BP 245, 59019 Lille Cedex, France.
| | | | | | | | | | | | | |
Collapse
|
31
|
Keinan D, Smith P, Zilberman U. Microstructure and chemical composition of primary teeth in children with Down syndrome and cerebral palsy. Arch Oral Biol 2006; 51:836-43. [PMID: 16756941 DOI: 10.1016/j.archoralbio.2006.04.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2005] [Revised: 04/09/2006] [Accepted: 04/12/2006] [Indexed: 10/24/2022]
Abstract
This study was designed to test the hypothesis that prenatal growth insults leave permanent signs in the developing primary teeth that can be identified in later life. To test this hypothesis we examined exfoliated and extracted lower second primary molars of children with Down syndrome (DS) and cerebral palsy (CP). Teeth of children with no adverse medical history were used as a control group. Informed consent of parents and children was obtained in all cases. On each tooth two thin sections were cut, one bisecting the mesial cusps and one bisecting the distal cusps. Using a light microscope, the width of prenatal enamel and postnatal enamel was measured on each section at standardized locations from the dentin-enamel junction (DEJ) with the neonatal line used to distinguish between prenatal and postnatal enamel. Chemical analysis of each section was carried out using an energy dispersive spectrophotometer (ESR). The Ca/P ratios of enamel and dentin for each cusp were calculated and intercusp and intergroup differences analysed using non-parametric statistical tests. The results showed that significantly less enamel was laid down prenatally in DS and CP teeth than in the control group and that the enamel of the mesial cusps in these groups was less highly mineralised than that of the controls. The results also showed that in DS teeth growth and mineralisation of all cusps was affected. Based on these findings we propose that analysis of exfoliated deciduous teeth in developmentally challenged children may help in identifying the onset and severity of growth insults in utero and its impact on later development.
Collapse
Affiliation(s)
- David Keinan
- Laboratory of Bioanthropology and Ancient DNA, Hadassah School of Dental Medicine, Hebrew University, POB 12272, Jerusalem 91120, Israel
| | | | | |
Collapse
|
32
|
Abstract
This article summarizes the scientific evidence supporting a genetic predisposition to preterm birth (PTB) and current molecular methods used to study the genetic links. Selected candidate genes currently under consideration for study are also discussed. Understanding the etiology and pathophysiology of PTB remains at the forefront of research efforts to solve this critical problem. Awareness of the contributing factors is imperative to the development of prevention and early intervention strategies that can reduce the incidence of PTB and the consequence of long-term neonatal complications. The possibility of a genetic predisposition to preterm delivery is a relatively new area of study to emerge over the past few years, although for a long time it has been suspected that PTB results from gene-environment interactions. More advanced genetic research methods are now being applied to study this hypothesis. A sample of candidate genes under study and their speculated role in PTB are presented in this article. There will be more research that links genetic influences and environmental factors to PTB in future, and researchers are hopeful that genetic knowledge can be applied to better understand the entire spectrum of prematurity.
Collapse
Affiliation(s)
- Gloria Giarratano
- School of Nursing, Louisiana State University Health Sciences Center, LA, USA.
| |
Collapse
|
33
|
Crider KS, Whitehead N, Buus RM. Genetic variation associated with preterm birth: a HuGE review. Genet Med 2006; 7:593-604. [PMID: 16301860 DOI: 10.1097/01.gim.0000187223.69947.db] [Citation(s) in RCA: 146] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Preterm birth (PTB) is a major public health concern because of its high prevalence, associated mortality and morbidity, and expense from both short-term hospitalization and long-term disability. In 2002, 11.9% of U.S. births occurred before 37 weeks gestation. Epidemiologic studies have identified many demographic, behavioral, and medical characteristics associated with PTB risk. In addition, recent evidence indicates a role for genetic susceptibility. We reviewed 18 studies published before June 1, 2004, that examined associations between polymorphisms in the maternal or fetal genome and PTB risk. Studies of a polymorphism in tumor necrosis factor-alpha, a proinflammatory cytokine, showed the most consistent increase in the risk of PTB. Environmental factors such as infection, stress, and obesity, which activate inflammatory pathways, have been associated with PTB, suggesting that environmental and genetic risk factors might operate and interact through related pathways. This review highlights maternal and fetal genetic susceptibilities to PTB, the potential relationships with environmental risk factors, and the need for additional well-designed studies of this critical public health problem.
Collapse
Affiliation(s)
- Krista S Crider
- Division of Birth Defects and Developmental Disabilities, Atlanta, GA 30333, USA
| | | | | |
Collapse
|
34
|
Green NS, Damus K, Simpson JL, Iams J, Reece EA, Hobel CJ, Merkatz IR, Greene MF, Schwarz RH. Research agenda for preterm birth: recommendations from the March of Dimes. Am J Obstet Gynecol 2005; 193:626-35. [PMID: 16150253 DOI: 10.1016/j.ajog.2005.02.106] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2004] [Revised: 02/07/2005] [Accepted: 02/18/2005] [Indexed: 10/25/2022]
Abstract
Preterm birth (PTB) is a common, serious, and costly health problem affecting nearly 1 in 8 births in the United States. Burdens from PTB are especially severe for the very preterm infant (<32 weeks' gestation), comprising 2% of all US births. Successful prevention needs to include newly focused and adequately funded research, incorporating new technologies and recognition that genetic, environmental, social, and behavioral factors interact in complex pathogeneses and multiple pathways leading to PTB. The March of Dimes Scientific Advisory Committee created this prioritized research agenda, which is aimed at garnering serious attention and expanding resources to make major inroads into the prevention of PTB, targeting six major, overlapping categories: epidemiology, genetics, disparities, inflammation, biologic stress, and clinical trials. Analogous to other common, complex disorders, progress in prevention will require incorporating multipronged risk reduction strategies that are based on sound scientific discovery, as well as on effective translation into clinical care.
Collapse
|
35
|
Abstract
The completion of the Human Genome Project has provided insight into human genetic variation, most commonly represented by single-nucleotide polymorphisms. There is presently a great deal of interest in linking genetic and phenotypic variation in the form of severity of, and susceptibility to, common multifactorial diseases. This article provides a background to recent advances in genetics, focusing on the application to common neonatal disorders and the practical difficulties of genetic association studies, as well as highlighting the potential impact on clinical practice.
Collapse
Affiliation(s)
- Neil A Hanchard
- Department of Paediatrics, University of Oxford, Oxford, UK.
| |
Collapse
|
36
|
Pike IL. Maternal stress and fetal responses: evolutionary perspectives on preterm delivery. Am J Hum Biol 2005; 17:55-65. [PMID: 15611979 DOI: 10.1002/ajhb.20093] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
New epidemiological and neurohormonal evidence provides insights into the persistent public health issue of preterm delivery and its long-term health consequences for the newborn. Mechanisms linked to preterm delivery may originate early in gestation as a result of maternal cues signaling a stressful intrauterine environment. When these signals are present, the fetus responds with a series of facultative responses, including accelerated organ maturation. If these responses are unsuccessful and the environment remains insufficient, a series of feed-forward mechanisms initiate the hormonal cascade that leads to parturition, and thus, early expulsion from a stressful environment. The internal environmental cues are delivered via glucocorticoids (stress hormones) in the circulatory system, but fetal responses and the initiation of the final terminal pathway to parturition are regulated by placentally derived corticotropin-releasing hormone (CRH). The potential costs of early expulsion from a stressful intrauterine environment are high and include an increased likelihood of perinatal and infant mortality. Permanent alterations in organ and metabolic functioning may occur, suggesting considerable fitness trade-offs. There is some evidence that preterm parturition is a maternal adaptation to limit the energetic costs of individual pregnancies in the face of poor condition at the time of conception. Moreover, nutritional stress is not the only indicator that signals a stressful environment: maternal psychosocial stress, and thus her response to an assessment of the social environment, also signal an insufficient internal environment to the fetus. The epidemiological and neurohormonal evidence for these relationships and mechanisms responsible for regulating such delicate negotiations are explored. In turn, the implications of such findings are examined from life history and public health perspectives.
Collapse
Affiliation(s)
- Ivy L Pike
- Department of Anthropology, The University of Arizona, Tucson, Arizona 85721-0030, USA.
| |
Collapse
|
37
|
Patrick TE, Bryan Y. Research strategies for optimizing pregnancy outcomes in minority populations. Am J Obstet Gynecol 2005; 192:S64-70. [PMID: 15891714 DOI: 10.1016/j.ajog.2005.01.075] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The elimination of disparities in pregnancy outcomes is a common goal of clinicians and scientists and requires the collaboration of many disciplines to address the complexities of this still-increasing perinatal health concern. This commentary synthesizes the presentations and dialogue from a multidisciplinary workgroup meeting that was sponsored by the National Institute of Nursing Research in 2003. Concepts that are central to our understanding of the development and expression of such disparities are summarized, and approaches that are recognized as important in multiple disciplines that include basic, clinical, and social sciences are presented. Research strategies to foster a multidisciplinary research agenda are presented as a basis for future endeavors to improve pregnancy outcomes.
Collapse
Affiliation(s)
- Thelma E Patrick
- University of Pittsburgh School of Nursing, Magee Womens Research Institute, PA 15261, USA.
| | | |
Collapse
|
38
|
Abstract
Indirect evidence supports a possible genetic predisposition towards preterm birth. The recurrence of spontaneous preterm delivery in individual women, families and ethnic groups suggests a long-acting aetiology, consistent with a genetic factor. Genetic contributions from both mother and fetus probably play a role in determining gestational length. Preliminary genetic association studies implicate gene variants of tumor necrosis factor-alpha (TNF-alpha) in preterm birth. Further understanding of a genetic predisposition begins with investigation of the pathogenesis of preterm delivery. Technological advances in the study of the human genome (genomics) and protein complement (proteomics) will allow identification of novel genes and proteins involved in preterm delivery. Insight into the complex gene regulation and protein production in preterm delivery may contribute to an understanding of a genetic basis. A discovered genetic factor may lead to medical breakthroughs and reductions in prematurity, neonatal morbidity and mortality.
Collapse
Affiliation(s)
- Kristina M Adams
- Fred Hutchinson Cancer Research Center, Human Immunogenetics Program, Seattle, WA, USA
| | | |
Collapse
|
39
|
Abstract
Obstetric and neonatal interventions have improved the survival of preterm infants, but there has not been an equivalent reduction in long-term neurological disability. Thus, some effort must be invested in finding ways of preventing preterm birth. Numerous programmes have been promoted to address the matter of how the frequency of preterm birth could be prevented. Most interventions intended to prevent preterm labour do not have the desired effect, except for antibiotic treatment in cases of asymptomatic bacteriuria or bacterial vaginosis and progesterone administered prophylactically in high-risk women. Tocolytic drugs appear to delay delivery long enough for successful administration of corticosteroids in women in preterm labour, but without decreasing the risk of preterm birth. Some authors promote public health approaches that address all risk factors and affect the entire population of pregnant women, given that prevention programmes directed only at high-risk women have had little effect in preventing preterm births. However, the lack of progress in reducing the frequency of preterm births is also due to our limited understanding of the aetiology of preterm delivery. Although there is growing evidence that infection and neuroendocrine processes are involved, progress has remained slow. Recently, the hypothesis of a genetic predisposition to preterm delivery has been set up. Additional research exploring the pathophysiology of preterm labour is obviously needed, which will hopefully lead to the development of new therapeutic approaches.
Collapse
Affiliation(s)
- Pierre-Yves Ancel
- Epidemiological Research Unit on Perinatal and Women's Health, INSERM U149-IFR69, 16 Avenue Paul Vaillant-Couturier, 94807 Villejuif Cedex, France.
| |
Collapse
|
40
|
Fuchs IB, Henrich W, Osthues K, Dudenhausen JW. Sonographic cervical length in singleton pregnancies with intact membranes presenting with threatened preterm labor. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2004; 24:554-557. [PMID: 15386604 DOI: 10.1002/uog.1714] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Less than 10% of women presenting with preterm contractions progress to active labor and delivery. This study investigates whether cervical length measurements by ultrasound can discriminate between true and false labor in women presenting with threatened preterm labor. METHODS Cervical length was measured by transvaginal ultrasound in 253 women with singleton pregnancies presenting with painful uterine contractions at a median age of 31 (range, 24-35) weeks of gestation. Women presenting in active labor, defined by the presence of cervical dilatation of >or = 3 cm, those with ruptured membranes and those that underwent prior or subsequent cervical cerclage were excluded from the study. The clinical management was determined by the attending obstetrician without taking into account the cervical length. Primary outcome of the study was delivery within 7 days of presentation based on the results of randomized studies on the use of tocolytics in women with preterm labor that reported a prolongation of pregnancy by 7 days. RESULTS Delivery within 7 days of presentation occurred in 21/253 (8.3%) pregnancies and this was inversely related to cervical length. Receiver-operating characteristics (ROC) curves established a cervical length of 15 mm as the most relevant cut-off level for the prediction of preterm delivery within 7 days. In 217 cases the cervical length was > or = 15 mm and only four of these (1.8%) delivered within 7 days. In the 36 women with cervical length < 15 mm, delivery occurred in 17 (47.2%) within 7 days. Logistic regression analysis demonstrated that significant independent contribution in the prediction of delivery within 7 days was provided by cervical length, contraction frequency at presentation, previous history of preterm delivery and vaginal bleeding. There was no significant contribution from gestation at presentation, ethnic origin, maternal age, parity, cigarette smoking or the administration of tocolysis, antibiotics or steroids. Similar results were shown in a subanalysis of 162 patients presenting at a gestational age below 32 weeks: 9/19 patients (47.4%) with a cervical length below 15 mm delivered within 7 days compared to 3/143 (2.1%) with a cervical length > or = 15 mm. Univariate as well as multivariate analyses confirmed cervical length to be a significant independent predictor of delivery within 7 days in this population. CONCLUSIONS Sonographic measurement of cervical length helps to avoid overdiagnosis of preterm labor in women with preterm contractions and intact membranes.
Collapse
Affiliation(s)
- I B Fuchs
- Virchow Clinic Charité, Berlin, Germany.
| | | | | | | |
Collapse
|
41
|
|
42
|
Hassan MI, Aschner Y, Manning CH, Xu J, Aschner JL. Racial differences in selected cytokine allelic and genotypic frequencies among healthy, pregnant women in North Carolina. Cytokine 2003; 21:10-6. [PMID: 12668154 DOI: 10.1016/s1043-4666(02)00489-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Genetic susceptibility to diseases is likely influenced by common DNA variants in the form of single nucleotide polymorphisms (SNPs). The value of SNPs for linkage and association mapping studies may depend on the distribution of SNP allele frequencies across populations. OBJECTIVES To establish the SNP allelic frequencies among Caucasian and African American women for tumor necrosis factor (TNF)alpha, transforming growth factor (TGF)beta1, interleukin-10 (IL10), interleukin-6 (IL6), and interferon (IFN)gamma. MATERIALS AND METHODS DNA was extracted from whole blood from 123 healthy, pregnant women. PCR-based genotyping was performed for the genes encoding TNFalpha (-308G/A), TGFbeta1 (codon 10C/T, codon 25C/G), IL10 (-1082A/G, -819T/C, -592A/C), IL6 (-174C/G) and IFNgamma (874T/A). Allele frequencies were determined by Hardy-Weinberg Equilibrium and Linkage Disequilibrium tests. Differences in the SNP allelic frequencies between Caucasians and African Americans were assessed by the chi(2) of Amitage trend test. RESULTS SNP allelic and genotypic frequencies for IL6 and IFNgamma, but not for TNFalpha, TGFbeta1, and IL10, differed significantly between the Caucasian and African American women. CONCLUSIONS Recognition of racial differences in SNP allelic and genotypic frequencies for selected cytokines is important for designing and powering future linkage and association mapping studies investigating the role of cytokines in human disease.
Collapse
Affiliation(s)
- Mohamed I Hassan
- Department of Pediatrics, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1081, USA
| | | | | | | | | |
Collapse
|
43
|
Romero R, Kuivaniemi H, Tromp G, Olson J. The design, execution, and interpretation of genetic association studies to decipher complex diseases. Am J Obstet Gynecol 2002; 187:1299-312. [PMID: 12439524 DOI: 10.1067/mob.2002.128319] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Genetic association studies are becoming increasingly frequent in the obstetric and gynecologic literature and they are considered central to the deciphering of the genetic basis of complex disease. The purpose, design, execution, analysis, and interpretation of genetic association studies in reproduction are discussed. Frequently used terms are defined (eg, genotype, haplotype, polymorphism, single nucleotide polymorphism, linkage disequilibrium). Guidelines are proposed for the evaluation of reports of genetic association studies (including selection of polymorphisms for study, study design, assay characteristics, sample size, multiple testing, and multivariable analysis). The potential value of this type of investigation in elucidating the mechanisms of disease in reproduction is illustrated.
Collapse
Affiliation(s)
- Roberto Romero
- Perinatology Research Branch, National Institute of Child Health and Human Development, Detroit, Mich 48201, USA
| | | | | | | |
Collapse
|
44
|
Abstract
Studies in the past year have clarified the roles of inflammatory mediators in preterm labour. Exploration of possible genetic predisposition is just beginning. Ultrasound measurement of cervical length has the potential to predict women at risk of preterm delivery several weeks before it occurs. Biochemical testing such as fetal fibronectin can possibly increase its predictive value and differentiate true preterm labour from more innocent preterm contractions. The use of antibiotics for preterm premature rupture of membranes has been clarified with the ORACLE I trial, which shows health benefits for the neonate with the use of erythromycin, whereas antibiotics do not seem to play a beneficial role in spontaneous preterm labour without evidence of clinical infection. There have been further studies suggesting that agents other than beta-agonists are preferable for acute tocolysis and that repeated doses of corticosteroids should be used with caution.
Collapse
|
45
|
Hogue CJR, Vasquez C. Toward a strategic approach for reducing disparities in infant mortality. Am J Public Health 2002; 92:552-6. [PMID: 11919050 PMCID: PMC1447115 DOI: 10.2105/ajph.92.4.552] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The United States' international ranking for infant mortality slipped from 19th in the 1980s to 27th in 1997. This slippage may be related to the segregation of priorities that occurred early in the 1990s, when national concern was diverted from infant mortality to minority health. To rekindle concern about infant mortality to the level of effective action, public health professionals must refocus the public's attention on assuring that all women are provided adequate education and services to help them avoid unintended pregnancies, that all pregnant women receive services in appropriate facilities, and that the causes of preterm deliveries are discovered. Effective action in these areas would not only improve infant mortality overall; it would also reduce racial and ethnic disparities in infant health.
Collapse
Affiliation(s)
- Carol J Rowland Hogue
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
| | | |
Collapse
|
46
|
Johnston RB, Williams MA, Hogue CJ, Mattison DR. Overview: new perspectives on the stubborn challenge of preterm birth. Paediatr Perinat Epidemiol 2001; 15 Suppl 2:3-6. [PMID: 11520395 DOI: 10.1046/j.1365-3016.2001.00003.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- R B Johnston
- Department of Pediatrics, University of Colorado School of Medicine, Denver, CO, USA
| | | | | | | |
Collapse
|
47
|
Mattison DR, Damus K, Fiore E, Petrini J, Alter C. Preterm delivery: a public health perspective. Paediatr Perinat Epidemiol 2001; 15 Suppl 2:7-16. [PMID: 11520396 DOI: 10.1046/j.1365-3016.2001.00004.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- D R Mattison
- March of Dimes Birth Defects Foundation, 1272 Mamaroneck Ave., White Plains, NY, USA.
| | | | | | | | | |
Collapse
|