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Rashidi SY, Rafiyan M, Asemi R, Asemi Z, Mohammadi S. Effect of melatonin as a therapeutic strategy against intrauterine growth restriction: a mini-review of current state. Ann Med Surg (Lond) 2024; 86:5320-5325. [PMID: 39238981 PMCID: PMC11374193 DOI: 10.1097/ms9.0000000000002350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 06/26/2024] [Indexed: 09/07/2024] Open
Abstract
Intrauterine growth restriction (IUGR) or intrauterine growth retardation is a condition that the fetus does not grow as expected. And the biometric profile does not match with the age of fetus. This condition is associated with increased mortality and morbidity of the neonates along with increased risk of cardiovascular, lung, and central nervous system damage. Despite close monitoring of high-risk mothers and the development of new therapeutic approaches, the optimal outcome has not been achieved yet that it indicates the importance of investigations on new therapeutic approaches. Melatonin (MLT) is a neurohormone mainly produced by the pineal gland and has a wide range of effects on different organs due to the broad dispersion of its receptors. Moreover, melatonin is produced by the placenta and also its receptors have been found on the surface of this organ. Not only studies showed the importance of this neurohormone on growth and development of fetus but also they proved its highly anti-oxidant properties. As in IUGR the oxidative stress and inflammation increased melatonin could counteract these changes and improved organ's function. In this study, we found that use of MLT could be a good clinical approach for the treatment of IUGR as its high anti-oxidant activity and vasodilation could dampen the mechanisms lead to the IUGR development.
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Affiliation(s)
| | - Mahdi Rafiyan
- Student Research Committee
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan
| | - Reza Asemi
- Department of Internal Medicine, School of Medicine, Cancer Prevention Research Center, Seyyed Al-Shohada Hospital, Isfahan University of Medical Sciences, Isfahan
| | - Zatollah Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan
| | - Sotoudeh Mohammadi
- Department of Obstetrics and Gynecology, Shahid Beheshti university of medical sciences, Tehran, Iran
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Ricci CA, Crysup B, Phillips NR, Ray WC, Santillan MK, Trask AJ, Woerner AE, Goulopoulou S. Machine learning: a new era for cardiovascular pregnancy physiology and cardio-obstetrics research. Am J Physiol Heart Circ Physiol 2024; 327:H417-H432. [PMID: 38847756 PMCID: PMC11442027 DOI: 10.1152/ajpheart.00149.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/31/2024] [Accepted: 05/31/2024] [Indexed: 06/10/2024]
Abstract
The maternal cardiovascular system undergoes functional and structural adaptations during pregnancy and postpartum to support increased metabolic demands of offspring and placental growth, labor, and delivery, as well as recovery from childbirth. Thus, pregnancy imposes physiological stress upon the maternal cardiovascular system, and in the absence of an appropriate response it imparts potential risks for cardiovascular complications and adverse outcomes. The proportion of pregnancy-related maternal deaths from cardiovascular events has been steadily increasing, contributing to high rates of maternal mortality. Despite advances in cardiovascular physiology research, there is still no comprehensive understanding of maternal cardiovascular adaptations in healthy pregnancies. Furthermore, current approaches for the prognosis of cardiovascular complications during pregnancy are limited. Machine learning (ML) offers new and effective tools for investigating mechanisms involved in pregnancy-related cardiovascular complications as well as the development of potential therapies. The main goal of this review is to summarize existing research that uses ML to understand mechanisms of cardiovascular physiology during pregnancy and develop prediction models for clinical application in pregnant patients. We also provide an overview of ML platforms that can be used to comprehensively understand cardiovascular adaptations to pregnancy and discuss the interpretability of ML outcomes, the consequences of model bias, and the importance of ethical consideration in ML use.
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Affiliation(s)
- Contessa A Ricci
- College of Nursing, Washington State University, Spokane, Washington, United States
- IREACH: Institute for Research and Education to Advance Community Health, Washington State University, Seattle, Washington, United States
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, United States
| | - Benjamin Crysup
- Department of Microbiology, Immunology and Genetics, University of North Texas Health Science, Fort Worth, Texas, United States
- Center for Human Identification, University of North Texas Health Science Center, Fort Worth, Texas, United States
| | - Nicole R Phillips
- Department of Microbiology, Immunology and Genetics, University of North Texas Health Science, Fort Worth, Texas, United States
| | - William C Ray
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, United States
| | - Mark K Santillan
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
| | - Aaron J Trask
- Center for Cardiovascular Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, United States
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, United States
| | - August E Woerner
- Department of Microbiology, Immunology and Genetics, University of North Texas Health Science, Fort Worth, Texas, United States
- Center for Human Identification, University of North Texas Health Science Center, Fort Worth, Texas, United States
| | - Styliani Goulopoulou
- Lawrence D. Longo Center for Perinatal Biology, Departments of Basic Sciences, Gynecology and Obstetrics, Loma Linda University, Loma Linda, California, United States
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Wondemagegn AT, Bekana M, Bekuretsion Y, Afework M. The effect of possible mediators on the association between chewing khat during pregnancy and fetal growth and newborn size at birth in Eastern Ethiopia. BMC Pregnancy Childbirth 2024; 24:63. [PMID: 38218789 PMCID: PMC10787403 DOI: 10.1186/s12884-024-06243-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 01/01/2024] [Indexed: 01/15/2024] Open
Abstract
INTRODUCTION Restriction in the growth of the fetus is a leading cause of stillbirth, neonatal mortality, and short- and long-term morbidity. Documented existing scientific evidence have shown the effects of maternal drugs use, alcohol drinking, tobacco smoking, cocaine use and heroin use on fetal growth restriction. However, data is lacking on the effects of khat chewing during pregnancy on fetal growth status and newborn size at birth. Therefore, the aim of the present study was to measure the effect of chewing khat during pregnancy on fetal growth and size at birth in eastern Ethiopia. METHOD A cohort study was conducted in selected health institutions in eastern Ethiopia. All pregnant women fulfilled the eligibility criteria in the selected health institutions was the source population. The calculated sample size of exposed and unexposed groups included in the study, in total, was 344. Data collection was performed prospectively by interviewers administered questionnaires, and anthropometric, clinical and ultrasound measurements. Data was analyzed using SPSS version 27 and STATA version 16 software. The survival analysis (cox proportional hazards model) and generalized linear model (GLM) for the binomial family analysis were performed to estimate the crude and adjusted relative risk and attributable risk (AR) with corresponding 95% CI of chewing khat on fetal growth restriction. The mediation effect has been examined through Generalized Structural Equation Modeling (GSEM) analysis using the Stata 'gsem' command. Statistically significant association was declared at p-value less than 5%. RESULTS In the present study, the incidence of fetal growth restriction (FGR) among the study cohorts was 95 (29.7%); of this, 81 (85.3%) were among khat chewer cohorts. The relative risk of fetal growth restriction among khat chewer cohort mothers was significantly higher (aRR = 4.32; 95%CI 2.62-7.12). Moreover, the incidence of small for gestational age at birth among the present study cohorts was 100 (31.3%); 84 (84%) were from khat chewer cohorts' deliveries. More importantly, in the present study, 98.95% of the ultrasound-identified fetuses with FGR were found to be SGA at birth. Hence, in the current study, FGR was highly associated with SGA at birth. In additional analysis, the regression coefficient of khat chewing during pregnancy on fetal growth restriction has been decreased in size from path o, β = 0.43, p < 0.001 to path o', β = 0.32, p < 0.001, after adjusting for gestational hypertension and maternal anemia. CONCLUSION In sum, the present study showed khat chewing during pregnancy is not simply affected the mothers, but it also affected the unborn fetuses. Therefore, the health workers as well as the local community and religious leaders should give high emphasis on provision of health education regarding the damage of chewing khat by pregnant mothers, with especial focus of the effects on their fetuses.
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Affiliation(s)
- Amsalu Taye Wondemagegn
- Department of Anatomy, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
- Department of Biomedical Sciences, School of Medicine, Debre Markos University, Debre Markos, Ethiopia.
| | - Miressa Bekana
- Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Haramaya University, Harar, Ethiopia
| | - Yonas Bekuretsion
- Department of Pathology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mekbeb Afework
- Department of Anatomy, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Bartlett CW, Bossenbroek J, Ueyama Y, McCallinhart P, Peters OA, Santillan DA, Santillan MK, Trask AJ, Ray WC. Invasive or More Direct Measurements Can Provide an Objective Early-Stopping Ceiling for Training Deep Neural Networks on Non-invasive or Less-Direct Biomedical Data. SN COMPUTER SCIENCE 2023; 4:161. [PMID: 36647373 PMCID: PMC9836982 DOI: 10.1007/s42979-022-01553-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 12/08/2022] [Indexed: 01/15/2023]
Abstract
Early stopping is an extremely common tool to minimize overfitting, which would otherwise be a cause of poor generalization of the model to novel data. However, early stopping is a heuristic that, while effective, primarily relies on ad hoc parameters and metrics. Optimizing when to stop remains a challenge. In this paper, we suggest that for some biomedical applications, a natural dichotomy of invasive/non-invasive measurements, or more generally proximal vs distal measurements of a biological system can be exploited to provide objective advice on early stopping. We discuss the conditions where invasive measurements of a biological process should provide better predictions than non-invasive measurements, or at best offer parity. Hence, if data from an invasive measurement are available locally, or from the literature, that information can be leveraged to know with high certainty whether a model of non-invasive data is overfitted. We present paired invasive/non-invasive cardiac and coronary artery measurements from two mouse strains, one of which spontaneously develops type 2 diabetes, posed as a classification problem. Examination of the various stopping rules shows that generalization is reduced with more training epochs and commonly applied stopping rules give widely different generalization error estimates. The use of an empirically derived training ceiling is demonstrated to be helpful as added information to leverage early stopping in order to reduce overfitting.
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Affiliation(s)
- Christopher W. Bartlett
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH USA
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Battelle Center for Computational Biology, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH USA
| | - Jamie Bossenbroek
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Battelle Center for Computational Biology, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH USA
- Department of Computer Science and Engineering, The Ohio State University College of Engineering, Columbus, OH USA
| | - Yukie Ueyama
- Center for Cardiovascular Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH USA
| | - Patricia McCallinhart
- Center for Cardiovascular Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH USA
| | - Olivia A. Peters
- Department of Obstetrics & Gynecology, University of Iowa Hospitals & Clinics, Iowa City, IA USA
| | - Donna A. Santillan
- Department of Obstetrics & Gynecology, University of Iowa Hospitals & Clinics, Iowa City, IA USA
| | - Mark K. Santillan
- Department of Obstetrics & Gynecology, University of Iowa Hospitals & Clinics, Iowa City, IA USA
| | - Aaron J. Trask
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH USA
- Center for Cardiovascular Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH USA
| | - William C. Ray
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH USA
- The Interdisciplinary Graduate Program in Biophysics, The Ohio State University Graduate School, Columbus, OH USA
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Tesfa D, Tadege M, Digssie A, Abebaw S. Intrauterine growth restriction and its associated factors in South Gondar zone hospitals, Northwest Ethiopia, 2019. Arch Public Health 2020; 78:89. [PMID: 33005403 PMCID: PMC7526174 DOI: 10.1186/s13690-020-00475-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 09/22/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND After prematurity, intrauterine growth restriction (IUGR) is the second leading cause of perinatal mortality. IUGR has significant consequences in fetal, neonatal, and adult life. Currently, Ethiopia lacks information on IUGR's prevalence and its determinants. This study aimed to assess the proportion of IUGR at birth and its associated factors. METHODS A cross-sectional study was carried out among women who give birth in four hospitals of south Gonder zone from November 2018 to February 2019. Multi-stage sampling was applied to select the required samples. IUGR was assessed using a standardized cutoff percentile/mean for each measurement. Data were collected by trained MSc clinical midwives. Bi-variable and multivariable logistic analyses were deployed to identify the association. RESULTS A total of 803 maternity women were participating in this study with a response rate of 95%. The proportion of IUGR 23.5% (95% CI: 20.7-26.6), low birth weight 13.3%, small-for- gestational-age 19.7%,and preterm birth 23.16%. Women who was unable to read and write, (AOR; 2.46, 95% CI: 1.02-5.92), total family size ≥7 (AOR; 1.67, 95% CI: 1.04-2.66), maternal mid-upper arm circumference (MUAC) < 23 cm (AOR; 2.10, 95% CI: 1.39-3.01), body mass index (BMI) < 18.5 kg/m2 (AOR; 2.57, 95% CI: 1.72-3.83), altitude > 3000 m (AOR; 1.89 95% CI: 1.19-3.01), small placental size (< 350 g) (AOR; 2.42, 95% CI: 1.67-3.54) and small-for-gestational-age (AOR; 1.94, 95% CI:1.86-4.52) were the most predictors of IUGR. CONCLUSIONS IUGR was a major public health concern in this study. Women who were unable to read and write, small-for-gestational-age, maternal BMI < 18.5 kg/m2, family size ≥7, maternal MUAC < 23 cm, small placental size, and altitude > 3000 m were found the most predictor variables. Strengthen female education, nutritional intervention before and during pregnancy, and routine maternity care is critical. Further clinical follow-up research is essential which includes maternal, fetal, and placental gens.
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Affiliation(s)
- Desalegn Tesfa
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debretabor, Ethiopia
| | - Melaku Tadege
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debretabor, Ethiopia
| | - Alemayehu Digssie
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debretabor, Ethiopia
| | - Sofonyas Abebaw
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debretabor, Ethiopia
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Shahgheibi S, Mardani R, Babaei E, Mardani P, Rezaie M, Farhadifar F, Roshani D, Naqshbandi M, Jalili A. Platelet Indices and CXCL12 Levels in Patients with Intrauterine Growth Restriction. Int J Womens Health 2020; 12:307-312. [PMID: 32368159 PMCID: PMC7183349 DOI: 10.2147/ijwh.s233860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 03/30/2020] [Indexed: 01/09/2023] Open
Abstract
Background Intrauterine growth restriction (IUGR) is a multifactorial condition, and the precise mechanism is still unknown. In the current study, we aimed to determine the relationship between the platelet (PLT) indices and CXC12 levels in patients with IUGR. Patients and Materials In this study, 36 patients with IUGR and 36 healthy pregnant mothers were enrolled as the case and control groups, respectively. Gestational age for both groups was between 24 and 40 years. Blood samples were taken, and platelet indices were examined by a full-diff cell counter. Serum levels of CXCL12 were measured by ELISA, and the data were analyzed using an independent Student's t-test. Results In this study, we observed that the mean value of PLT count (154.3 ± 50 vs 236 ± 36) and plateletcrit (0.124 ± 0.038 vs 0.178 ± 0.021) were significantly lower in the case than the control group. In contrast, the mean platelet volume (7.94 ± 0.55 vs 7.62 ± 0.53) and platelet distribution width (17.57 ± 0.7 vs 16.96 ± 0.59) were significantly higher in the case than the control group. More importantly, we found that the serum levels of CXCL12 were significantly higher (5.3 ng/mL± 3.1 vs 2.8 ± 1.6) in the patients compared to the pregnancy controls. Conclusion Our data show that platelet indices are changed in IUGR, and the levels of circulating CXCL12 are increased in patients with IUGR. These findings provide a base for further studies to better defining the pathophysiology of IUGR.
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Affiliation(s)
- Shole Shahgheibi
- Deparment of Obstetrics and Gynecology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Roya Mardani
- Deparment of Obstetrics and Gynecology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Erfan Babaei
- Cancer & Immunology Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Parastoo Mardani
- Department of Biology, Faculty of Sciences, Payame Noor University, Sanandaj, Iran
| | - Masomeh Rezaie
- Deparment of Obstetrics and Gynecology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Fariba Farhadifar
- Deparment of Obstetrics and Gynecology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Daem Roshani
- Cancer & Immunology Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mobin Naqshbandi
- Cancer & Immunology Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ali Jalili
- Cancer & Immunology Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Craenmehr MHC, Haasnoot GW, Drabbels JJM, Spruyt-Gerritse MJ, Cao M, van der Keur C, Kapsenberg JM, Uyar-Mercankaya M, van Beelen E, Meuleman T, van der Hoorn MLP, Heidt S, Claas FHJ, Eikmans M. Soluble HLA-G levels in seminal plasma are associated with HLA-G 3'UTR genotypes and haplotypes. HLA 2019; 94:339-346. [PMID: 31321883 PMCID: PMC6772099 DOI: 10.1111/tan.13628] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/18/2019] [Accepted: 07/15/2019] [Indexed: 12/31/2022]
Abstract
Soluble HLA-G (sHLA-G) levels in human seminal plasma (SP) can be diverse and may affect the establishment of maternal-fetal tolerance and thereby the outcome of pregnancy. We investigated whether sHLA-G levels in SP are associated with polymorphisms in the 3'-untranslated region (UTR) and UTR haplotypes of the HLA-G gene. Furthermore, we compared the HLA-G genotype distribution and sHLA-G levels between men, whose partner experienced unexplained recurrent miscarriage (RM), and controls. Soluble HLA-G levels (n = 156) and HLA-G genotyping (n = 176) were determined in SP samples. The concentration of sHLA-G was significantly associated with several single-nucleotide polymorphisms (SNPs): the 14 base pair (bp) insertion/deletion (indel), +3010, +3142, +3187, +3196, and + 3509. High levels of sHLA-G were associated with UTR-1 and low levels with UTR-2, UTR-4, and UTR-7 (P < .0001). HLA-G genotype distribution and sHLA-G levels in SP were not significantly different between the RM group (n = 44) and controls (n = 31). In conclusion, seminal sHLA-G levels are associated with both singular SNPs and 3UTR haplotypes. HLA-G genotype and sHLA-G levels in SP are not different between men whose partner experienced RM and controls, indicating that miscarriages are not solely the result of low sHLA-G levels in SP. Instead, it is more likely that these miscarriages are the result of a multifactorial immunologic mechanism, whereby the HLA-G 3'UTR 14 bp ins/ins genotype plays a role in a proportion of the cases. Future studies should look into the functions of sHLA-G in SP and the consequences of low or high levels on the chance to conceive.
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Affiliation(s)
- Moniek H C Craenmehr
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Geert W Haasnoot
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Jos J M Drabbels
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Marijke J Spruyt-Gerritse
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Milo Cao
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Carin van der Keur
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Johanna M Kapsenberg
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Merve Uyar-Mercankaya
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Els van Beelen
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Tess Meuleman
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Sebastiaan Heidt
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Frans H J Claas
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Michael Eikmans
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
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Wilding S, Ziauddeen N, Roderick P, Smith D, Chase D, Macklon N, McGrath N, Hanson M, Alwan NA. Are socioeconomic inequalities in the incidence of small-for-gestational-age birth narrowing? Findings from a population-based cohort in the South of England. BMJ Open 2019; 9:e026998. [PMID: 31362961 PMCID: PMC6678068 DOI: 10.1136/bmjopen-2018-026998] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To investigate socioeconomic inequalities, using maternal educational attainment, maternal and partner employment status, and lone motherhood indicators, in the risk of small-for-gestational-age (SGA) births, their time trend, potential mediation by maternal smoking and body mass index, and effect modification by parity. DESIGN Population-based birth cohort using routine antenatal healthcare data. SETTING Babies born at University Hospital Southampton, UK, between 2004 and 2016. PARTICIPANTS 65 909 singleton live births born to mothers aged ≥18 years between 24-week and 42-week gestation. MAIN OUTCOME MEASURES SGA (birth weight <10th percentile for others born at the same number of completed weeks compared with 2013/2014 within England and Wales). RESULTS Babies born to mothers educated up to secondary school level (adjusted OR (aOR) 1.32, 99% CI 1.19 to 1.47), who were unemployed (aOR 1.27, 99% CI 1.16 to 1.38) or with unemployed partners (aOR 1.27, 99% CI 1.13 to 1.43), were at greater risk of being SGA. There was no statistically significant change in the magnitude of this risk difference by these indicators over time between 2004 and 2016, as estimated by linear interactions with year of birth. Babies born to lone mothers were not at higher risk compared with partnered mothers after adjusting for maternal smoking (aOR 1.05, 99% CI 0.93 to 1.20). The inverse association between maternal educational attainment and SGA risk appeared greater in multiparous (aOR 1.40, 99% CI 1.10 to 1.77) compared with primiparous women (aOR 1.28, 99% CI 1.12 to 1.47), and the reverse was true for maternal and partner's unemployment where the association was stronger in primiparous women. CONCLUSIONS Socioeconomic inequalities in SGA risk by educational attainment and employment status are not narrowing over time, with differences in association strength by parity. The greater SGA risk in lone mothers was potentially explained by maternal smoking. Preventive interventions should target socially disadvantaged women, including preconception and postpartum smoking cessation to reduce SGA risk.
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Affiliation(s)
- Sam Wilding
- School of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Nida Ziauddeen
- School of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Paul Roderick
- School of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Dianna Smith
- Geography & Environment, University of Southampton, Southampton, UK
| | - Debbie Chase
- Public Health, Southampton City Council, Southampton, UK
| | - Nick Macklon
- Department of Obstetrics and Gynaecology, University of Copenhagen, Roskilde, Denmark
- London Women's Clinic, London, UK
| | - Nuala McGrath
- School of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- School of Economic, Social and Political Science, Faculty of Social Sciences, University of Southampton, Southampton, UK
| | - Mark Hanson
- Institute of Developmental Sciences, Academic Unit of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nisreen A Alwan
- School of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Orefice R, Kent A, Sethna F, Dahlstrom JE. Of pregnancies complicated by small for gestational age babies at term, what proportions have placental findings with implications for future pregnancies or neonatal outcomes? J Matern Fetal Neonatal Med 2019; 33:2990-2995. [PMID: 30646781 DOI: 10.1080/14767058.2019.1566899] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Small for gestational age (SGA) is a term to define any baby born with birth weight <10th centile. SGA can be associated with a number of placental pathology findings, which may influence maternal outcomes, neonatal neurodevelopment, and future pregnancies.Aims: To identify the proportion of term pregnancies complicated by SGA with placental findings that may have implications for future pregnancies or neonatal outcomes.Method: A retrospective review between 2011 and 2015 of babies and placentas born at term with SGA histopathological findings were categorized as to whether they had a high recurrence rate and where the long-term neurodevelopmental outcome may affect the neonate.Results: Six hundred and ninety-eight babies were identified as SGA. Only 335 (47.8%) placentas were sent for histopathological assessment. Of these, 60 (17.9%) had histopathological findings associated with high recurrence rates and 68 (20.2%) had findings associated with potential adverse neonatal outcomes.Conclusions: Of those placentas sent for examination between 17.9% and 20.2% had findings associated with either high recurrence rates or findings that may benefit from neonatal follow-up. Under 50% of pregnancies complicated by SGA at term had a placental examination, resulting in a significant number of potential important clinical consequences being missed.
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Affiliation(s)
| | - Alison Kent
- Department of Neonatology, Canberra Hospital, Canberra, Australia
| | - Farah Sethna
- Fetal Medicine Unit, Canberra Hospital, Canberra, Australia
| | - Jane E Dahlstrom
- Department of Anatomical Pathology, Canberra Hospital, Canberra, Australia
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Ahrens KA, Nelson H, Stidd RL, Moskosky S, Hutcheon JA. Short interpregnancy intervals and adverse perinatal outcomes in high-resource settings: An updated systematic review. Paediatr Perinat Epidemiol 2019; 33:O25-O47. [PMID: 30353935 PMCID: PMC7379643 DOI: 10.1111/ppe.12503] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/06/2018] [Accepted: 08/12/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND This systematic review summarises association between short interpregnancy intervals and adverse perinatal health outcomes in high-resource settings to inform recommendations for healthy birth spacing for the United States. METHODS Five databases and a previous systematic review were searched for relevant articles published between 1966 and 1 May 2017. We included studies meeting the following criteria: (a) reporting of perinatal health outcomes after a short interpregnancy interval since last livebirth; (b) conducted within a high-resource setting; and (c) estimates were adjusted for maternal age and at least one socio-economic factor. RESULTS Nine good-quality and 18 fair-quality studies were identified. Interpregnancy intervals <6 months were associated with a clinically and statistically significant increased risk of adverse outcomes in studies of preterm birth (eg, aOR ≥ 1.20 in 10 of 14 studies); spontaneous preterm birth (eg, aOR ≥ 1.20 in one of two studies); small-for-gestational age (eg, aOR ≥ 1.20 in 5 of 11 studies); and infant mortality (eg, aOR ≥ 1.20 in four of four studies), while four studies of perinatal death showed no association. Interpregnancy intervals of 6-11 and 12-17 months generally had smaller point estimates and confidence intervals that included the null. Most studies were population-based and few included adjustment for detailed measures of key confounders. CONCLUSIONS In high-resource settings, there is some evidence showing interpregnancy intervals <6 months since last livebirth are associated with increased risks for preterm birth, small-for-gestational age and infant death; however, results were inconsistent. Additional research controlling for confounding would further inform recommendations for healthy birth spacing for the United States.
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Affiliation(s)
- Katherine A. Ahrens
- Office of Population AffairsOffice of the Assistant Secretary for HealthU.S. Department of Health and Human ServicesRockvilleMaryland
| | - Heidi Nelson
- Department of Medical Informatics and Clinical EpidemiologyOregon Health & Science UniversityPortlandOregon
| | | | - Susan Moskosky
- Office of Population AffairsOffice of the Assistant Secretary for HealthU.S. Department of Health and Human ServicesRockvilleMaryland
| | - Jennifer A. Hutcheon
- Department of Obstetrics and GynaecologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
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Spradley FT, Smith JA, Alexander BT, Anderson CD. Developmental origins of nonalcoholic fatty liver disease as a risk factor for exaggerated metabolic and cardiovascular-renal disease. Am J Physiol Endocrinol Metab 2018; 315:E795-E814. [PMID: 29509436 PMCID: PMC6293166 DOI: 10.1152/ajpendo.00394.2017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Intrauterine growth restriction (IUGR) is linked to increased risk for chronic disease. Placental ischemia and insufficiency in the mother are implicated in predisposing IUGR offspring to metabolic dysfunction, including hypertension, insulin resistance, abnormalities in glucose homeostasis, and nonalcoholic fatty liver disease (NAFLD). It is unclear whether these metabolic disturbances contribute to the developmental origins of exaggerated cardiovascular-renal disease (CVRD) risk accompanying IUGR. IUGR impacts the pancreas, adipose tissue, and liver, which are hypothesized to program for hepatic insulin resistance and subsequent NAFLD. NAFLD is projected to become the major cause of chronic liver disease and contributor to uncontrolled type 2 diabetes mellitus, which is a leading cause of chronic kidney disease. While NAFLD is increased in experimental models of IUGR, lacking is a full comprehension of the mechanisms responsible for programming of NAFLD and whether this potentiates susceptibility to liver injury. The use of well-established and clinically relevant rodent models, which mimic the clinical characteristics of IUGR, metabolic disturbances, and increased blood pressure in the offspring, will permit investigation into mechanisms linking adverse influences during early life and later chronic health. The purpose of this review is to propose mechanisms, including those proinflammatory in nature, whereby IUGR exacerbates the pathogenesis of NAFLD and how these adverse programmed outcomes contribute to exaggerated CVRD risk. Understanding the etiology of the developmental origins of chronic disease will allow investigators to uncover treatment strategies to intervene in the mother and her offspring to halt the increasing prevalence of metabolic dysfunction and CVRD.
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Affiliation(s)
- Frank T Spradley
- Department of Surgery, Division of Transplant and Hepatobiliary Surgery, School of Medicine, The University of Mississippi Medical Center , Jackson, Mississippi
- Cardiovascular-Renal Research Center, The University of Mississippi Medical Center , Jackson, Mississippi
- Department of Physiology and Biophysics, The University of Mississippi Medical Center , Jackson, Mississippi
| | - Jillian A Smith
- Department of Surgery, Division of Transplant and Hepatobiliary Surgery, School of Medicine, The University of Mississippi Medical Center , Jackson, Mississippi
| | - Barbara T Alexander
- Cardiovascular-Renal Research Center, The University of Mississippi Medical Center , Jackson, Mississippi
- Department of Physiology and Biophysics, The University of Mississippi Medical Center , Jackson, Mississippi
| | - Christopher D Anderson
- Department of Surgery, Division of Transplant and Hepatobiliary Surgery, School of Medicine, The University of Mississippi Medical Center , Jackson, Mississippi
- Cardiovascular-Renal Research Center, The University of Mississippi Medical Center , Jackson, Mississippi
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Morales-Roselló J, Dias T, Khalil A, Fornes-Ferrer V, Ciammella R, Gimenez-Roca L, Perales-Marín A, Thilaganathan B. Birth-weight differences at term are explained by placental dysfunction and not by maternal ethnicity. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:488-493. [PMID: 29418032 DOI: 10.1002/uog.19025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 01/23/2018] [Accepted: 01/26/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate the influence of ethnicity, fetal gender and placental dysfunction on birth weight (BW) in term fetuses of South Asian and Caucasian origin. METHODS This was a retrospective study of 627 term pregnancies assessed at two public tertiary hospitals in Spain and Sri Lanka. All fetuses underwent biometry and Doppler examinations within 2 weeks of delivery. The influences of fetal gender and ethnicity, gestational age (GA) at delivery, cerebroplacental ratio (CPR) and maternal age, height, weight and parity on BW were evaluated by multivariable regression analysis. RESULTS Fetuses born in Sri Lanka were smaller than those born in Spain (mean BW = 3026 ± 449 g vs 3295 ± 444 g; P < 0.001). Multivariable regression analysis demonstrated that GA at delivery, maternal weight, CPR, maternal height and fetal gender (estimates = 0.168, P < 0.001; 0.006, P < 0.001; 0.092, P = 0.003; 0.009, P = 0.002; 0.081, P = 0.01, respectively) were associated significantly with BW. Conversely, no significant association was noted for maternal ethnicity, age or parity (estimates = -0.010, P = 0.831; 0.005, P = 0.127; 0.035, P = 0.086, respectively). The findings were unchanged when the analysis was repeated using INTERGROWTH-21st fetal weight centiles instead of BW (log odds, -0.175, P = 0.170 and 0.321, P < 0.001, respectively for ethnicity and CPR). CONCLUSION Fetal BW variation at term is less dependent on ethnic origin and better explained by placental dysfunction. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- J Morales-Roselló
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - T Dias
- Obstetrics and Gynecology Department, Colombo North Teaching Hospital, Ragama, Sri Lanka
- Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - V Fornes-Ferrer
- Data Science, Biostatistics and Bioinformatics, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - R Ciammella
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - L Gimenez-Roca
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - A Perales-Marín
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - B Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
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Poniedziałek B, Nowaczyk J, Ropacka-Lesiak M, Niedzielski P, Komosa A, Pańczak K, Rzymski P. The altered platelet mineral ratios in pregnancy complicated with intrauterine growth restriction. Reprod Toxicol 2018; 76:46-52. [DOI: 10.1016/j.reprotox.2017.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/12/2017] [Accepted: 12/21/2017] [Indexed: 01/27/2023]
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Kehl S, Dötsch J, Hecher K, Schlembach D, Schmitz D, Stepan H, Gembruch U. Intrauterine Growth Restriction. Guideline of the German Society of Gynecology and Obstetrics (S2k-Level, AWMF Registry No. 015/080, October 2016). Geburtshilfe Frauenheilkd 2017; 77:1157-1173. [PMID: 29375144 PMCID: PMC5784232 DOI: 10.1055/s-0043-118908] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 08/19/2017] [Accepted: 08/25/2017] [Indexed: 12/12/2022] Open
Abstract
AIMS The aim of this official guideline published and coordinated by the German Society of Gynecology and Obstetrics (DGGG) was to provide consensus-based recommendations obtained by evaluating the relevant literature for the diagnostic treatment and management of women with fetal growth restriction. METHODS This S2k guideline represents the structured consensus of a representative panel of experts with a range of different professional backgrounds commissioned by the Guideline Committee of the DGGG. RECOMMENDATIONS Recommendations for diagnostic treatment, management, counselling, prophylaxis and screening are presented.
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Affiliation(s)
- Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jörg Dötsch
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Köln, Köln, Germany
| | - Kurt Hecher
- Klinik für Geburtshilfe und Pränatalmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Dagmar Schmitz
- Institut für Geschichte, Theorie und Ethik der Medizin, Uniklinik RWTH Aachen, Aachen, Germany
| | - Holger Stepan
- Abteilung für Geburtsmedizin, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Ulrich Gembruch
- Abteilung für Geburtshilfe und Pränatale Medizin, Universitätsklinikum Bonn, Bonn, Germany
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Malacova E, Regan A, Nassar N, Raynes-Greenow C, Leonard H, Srinivasjois R, W Shand A, Lavin T, Pereira G. Risk of stillbirth, preterm delivery, and fetal growth restriction following exposure in a previous birth: systematic review and meta-analysis. BJOG 2017; 125:183-192. [PMID: 28856792 DOI: 10.1111/1471-0528.14906] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known about the risk of non-recurrent adverse birth outcomes. OBJECTIVES To evaluate the risk of stillbirth, preterm birth (PTB), and small for gestational age (SGA) as a proxy for fetal growth restriction (FGR) following exposure to one or more of these factors in a previous birth. SEARCH STRATEGY We searched MEDLINE, EMBASE, Maternity and Infant Care, and Global Health from inception to 30 November 2016. SELECTION CRITERIA Studies were included if they investigated the association between stillbirth, PTB, or SGA (as a proxy for FGR) in two subsequent births. DATA COLLECTION AND ANALYSIS Meta-analysis and pooled association presented as odds ratios (ORs) and adjusted odds ratios (aORs). MAIN RESULTS Of the 3399 studies identified, 17 met the inclusion criteria. A PTB or SGA (as a proxy for FGR) infant increased the risk of subsequent stillbirth ((pooled OR 1.70; 95% confidence interval, 95% CI, 1.34-2.16) and (pooled OR 1.98; 95% CI 1.70-2.31), respectively). A combination of exposures, such as a preterm SGA (as a proxy for FGR) birth, doubled the risk of subsequent stillbirth (pooled OR 4.47; 95% CI 2.58-7.76). The risk of stillbirth also varied with prematurity, increasing three-fold following PTB <34 weeks of gestation (pooled OR 2.98; 95% CI 2.05-4.34) and six-fold following preterm SGA (as a proxy for FGR) <34 weeks of gestation (pooled OR 6.00; 95% CI 3.43-10.49). A previous stillbirth increased the risk of PTB (pooled OR 2.82; 95% CI 2.31-3.45), and subsequent SGA (as a proxy for FGR) (pooled OR 1.39; 95% CI 1.10-1.76). CONCLUSION The risk of stillbirth, PTB, or SGA (as a proxy for FGR) was moderately elevated in women who previously experienced a single exposure, but increased between two- and three-fold when two prior adverse outcomes were combined. Clinical guidelines should consider the inter-relationship of stillbirth, PTB, and SGA, and that each condition is an independent risk factor for the other conditions. TWEETABLE ABSTRACT Risk of adverse birth outcomes in next pregnancy increases with the combined number of previous adverse events. PLAIN LANGUAGE SUMMARY Why and how was the study carried out? Each year, around 2.6 million babies are stillborn, 15 million are born preterm (<37 weeks of gestation), and 32 million are born small for gestational age (less than tenth percentile for weight, smaller than usually expected for the relevant pregnancy stage). Being born preterm or small for gestational age can increase the chance of long-term health problems. The effect of having a stillbirth, preterm birth, or small-for-gestational-age infant in a previous pregnancy on future pregnancy health has not been summarised. We identified 3399 studies of outcomes of previous pregnancies, and 17 were summarised by our study. What were the main findings? The outcome of the previous pregnancy influenced the risk of poor outcomes in the next pregnancy. Babies born to mothers who had a previous preterm birth or small-for-gestational-age birth were more likely to be stillborn. The smaller and the more preterm the previous baby, the higher the risk of stillbirth in the following pregnancy. The risk of stillbirth in the following pregnancy was doubled if the previous baby was born both preterm and small for gestational age. Babies born to mothers who had a previous stillbirth were more likely to be preterm or small for gestational age. What are the limitations of the work? We included a small number of studies, as there are not enough studies in this area (adverse birth outcomes followed by adverse cross outcomes in the next pregnancy). We found very few studies that compared the risk of small for gestational age after preterm birth or stillbirth. Definitions of stillbirth, preterm birth categories, and small for gestational age differed across studies. We did not know the cause of stillbirth for most studies. What are the implications for patients? Women who have a history of poor pregnancy outcomes are at greater risk of poor outcomes in following pregnancies. Health providers should be aware of this risk when treating patients with a history of poor pregnancy outcomes.
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Affiliation(s)
- E Malacova
- School of Public Health, Curtin University, Perth, WA, Australia
| | - A Regan
- School of Public Health, Curtin University, Perth, WA, Australia
| | - N Nassar
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, NSW, Australia
| | - C Raynes-Greenow
- Sydney School of Public Health, University of Sydney, NSW, Australia
| | - H Leonard
- Telethon Kids Institute, Perth, WA, Australia
| | - R Srinivasjois
- Department of Neonatology and Paediatrics, Joondalup Health Campus, Joondalup, WA, Australia.,School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia
| | - A W Shand
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, NSW, Australia.,Department of Maternal Fetal Medicine, Royal Hospital for Women, Randwick, NSW, Australia
| | - T Lavin
- Centre for Health Services Research, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - G Pereira
- School of Public Health, Curtin University, Perth, WA, Australia
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Vos AA, Leeman A, Waelput AJ, Bonsel GJ, Steegers EA, Denktaş S. Assessment and care for non-medical risk factors in current antenatal health care. Midwifery 2015; 31:979-85. [DOI: 10.1016/j.midw.2015.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 04/27/2015] [Accepted: 06/13/2015] [Indexed: 10/23/2022]
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Feasibility and reliability of a newly developed antenatal risk score card in routine care. Midwifery 2015; 31:147-54. [DOI: 10.1016/j.midw.2014.08.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 06/30/2014] [Accepted: 08/01/2014] [Indexed: 11/20/2022]
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18
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Whiteman VE, August EM, Mogos M, Naik E, Garba M, Sanchez E, Weldeselasse HE, Salihu HM. Preterm birth in the first pregnancy and risk of neonatal death in the second pregnancy: a propensity score-weighted matching approach. J OBSTET GYNAECOL 2014; 35:30-6. [PMID: 25058689 DOI: 10.3109/01443615.2014.937328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The study purpose was to assess the relationship between various grades of preterm birth (moderate preterm: 33-36 weeks; severe preterm: 27-32 weeks; extreme preterm: ≤ 26 weeks) in the first pregnancy and neonatal mortality (death within 28 days of birth; early: 0-7 days; late: 8-28 days) in the second pregnancy. Using the Missouri maternally-linked dataset (1989-2005), a population-based, retrospective cohort analysis with propensity score-weighted matching was conducted on mothers with two consecutive singleton live births (n = 310,653 women). Women with a prior preterm birth were more likely to subsequently experience neonatal death. The odds increased in a dose-dependent pattern with ascending severity of the preterm event in the first pregnancy (moderate preterm: AOR = 1.32; 95% CI: 1.10-1.60; severe preterm: AOR = 2.62; 95% CI: 2.01-3.41; extreme preterm: AOR = 5.84; 95% CI: 4.28-7.97; p value for trend < 0.001). However, the pathway for the relationship between prior preterm birth and subsequent neonatal mortality may be the recurrence of preterm birth.
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Affiliation(s)
- V E Whiteman
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, College of Medicine
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19
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Fujiwara T, Ito J, Kawachi I. Income inequality, parental socioeconomic status, and birth outcomes in Japan. Am J Epidemiol 2013; 177:1042-52. [PMID: 23576676 DOI: 10.1093/aje/kws355] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The purpose of this study was to investigate the impact of income inequality and parental socioeconomic status on several birth outcomes in Japan. Data were collected on birth outcomes and parental socioeconomic status by questionnaire from Japanese parents nationwide (n = 41,499) and then linked to Gini coefficients at the prefectural level in 2001. In multilevel analysis, z scores of birth weight for gestational age decreased by 0.018 (95% confidence interval (CI): -0.029, -0.006) per 1-standard-deviation (0.018-unit) increase in the Gini coefficient, while gestational age at delivery was not associated with the Gini coefficient. For dichotomous outcomes, mothers living in prefectures with middle and high Gini coefficients were 1.24 (95% CI: 1.05, 1.47) and 1.23 (95% CI: 1.02, 1.48) times more likely, respectively, to deliver a small-for-gestational-age infant than mothers living in more egalitarian prefectures (low Gini coefficients), although preterm births were not significantly associated with income distribution. Parental educational level, but not household income, was significantly associated with the z score of birth weight for gestational age and small-for-gestational-age status. Higher income inequality at the prefectural level and parental educational level, rather than household income, were associated with intrauterine growth but not with shorter gestational age at delivery.
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Affiliation(s)
- Takeo Fujiwara
- Department of Social Medicine, National Research Institute for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan.
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Bandoli G, Lindsay S, Johnson DL, Kao K, Luo Y, Chambers CD. Change in paternity and select perinatal outcomes: causal or confounded? J OBSTET GYNAECOL 2013; 32:657-62. [PMID: 22943712 DOI: 10.3109/01443615.2012.698669] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Select social, behavioural and maternal characteristics were evaluated to determine if they were confounding factors in the association between paternity change and pre-eclampsia, small for gestational age (SGA) and pre-term delivery, in a sample of 1,409 women. Multivariate logistic regression analysis was used to determine if any of these risk factors modified the association between changing paternity and the selected perinatal outcomes. Results of the analysis showed that women who changed partners were more likely to possess potentially confounding risk factors compared with those who had not. Paternity change was 2.75 times more likely to be associated with the development of pre-eclampsia (95% CI 1.33; 5.68) and 2.25 times more likely to be associated with an SGA infant on weight (95% CI 1.13; 4.47), after adjusting for selected risk factors. Paternity change remains a significant risk factor for pre-eclampsia and SGA in the presence of select risk factors.
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Affiliation(s)
- G Bandoli
- Department of Pediatrics, University of California San Diego, San Diego, CA, USA.
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Höglund B, Lindgren P, Larsson M. Newborns of mothers with intellectual disability have a higher risk of perinatal death and being small for gestational age. Acta Obstet Gynecol Scand 2012; 91:1409-14. [PMID: 22924821 PMCID: PMC3549565 DOI: 10.1111/j.1600-0412.2012.01537.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To study mode of birth, perinatal health and death in children born to mothers with intellectual disability (ID) in Sweden. DESIGN Population-based register study. SETTING National registers; the National Patient Register linked to the Medical Birth Register. SAMPLE Children of first-time mothers with ID (n = 326; classified in the International Classification of Diseases 8-10) were identified and compared with 340 624 children of first-time mothers without ID or any other psychiatric diagnosis between 1999 and 2007. METHODS Population-based data were extracted from the National Patient Register and the Medical Birth Register. MAIN OUTCOME MEASURES Mode of birth, preterm birth, small for gestational age, Apgar score, stillbirth and perinatal death. RESULTS Children born to mothers with ID were more often stillborn (1.2 vs. 0.3%) or died perinatally (1.8 vs. 0.4%) than children born to mothers without ID. They had a higher proportion of cesarean section birth (24.5 vs. 17.7%) and preterm birth (12.2 vs. 6.1%), were small for gestational age (8.4 vs. 3.1%) and had lower Apgar scores (<7 points at five minutes; 3.7 vs 1.5%) compared with children born to mothers without ID. Logistic regression adjusted for maternal characteristics confirmed an increased risk of small for gestational age (odds ratio 2.25), stillbirth (odds ratio 4.53) and perinatal death (odds ratio 4.25) in children born to mothers with ID. CONCLUSIONS Unborn and newborn children of mothers with ID should be considered a risk group, and their mothers may need better individual-based care and support.
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Affiliation(s)
- Berit Höglund
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
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22
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Small size for gestational age and the risk for infant mortality in the subsequent pregnancy. Ann Epidemiol 2012; 22:764-71. [PMID: 22858049 DOI: 10.1016/j.annepidem.2012.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 07/05/2012] [Accepted: 07/06/2012] [Indexed: 11/23/2022]
Abstract
PURPOSE To examine the association between small for gestational age (SGA) in the first pregnancy and risk for infant mortality in the second pregnancy. METHODS This is a population-based, retrospective cohort study in which we used the Missouri maternally linked cohort dataset for 1978-2005. Analyses were restricted to women who had two singleton pregnancies during the study period. The exposure was SGA in the first pregnancy, whereas the primary outcome was infant mortality in the second pregnancy. Kaplan-Meier Estimate and Cox proportional hazard regression were conducted. RESULTS Infant mortality was significantly greater among mothers with previous SGA (P < .01). A persistent association of previous SGA with subsequent infant mortality was observed (adjusted hazard ratio [AHR] 1.35, 95% confidence interval [95% CI] 1.24-1.48). Race-specific data illustrated that black women with a previous SGA birth were 40% more likely to experience infant mortality (AHR 1.40, 95% CI 1.21-1.63) than their counterparts without a history of SGA, but white women with a previous SGA had an increased risk of 31% (AHR 1.31, 95% CI 1.17-1.46). CONCLUSIONS Women with previous SGA bear increased risks for subsequent infant mortality, which was greater among black mothers. Hence, SGA plays an important role in the black-white disparity in infant mortality. Women's previous childbearing experiences could serve as important criterion in determining appropriate interconception strategies to improve infant health and survival.
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Mokuolu OA, Adesiyun OO, Suleiman MB, Bello M. Intrauterine growth standards: a cross-sectional study in a population of nigerian newborns. Pediatr Rep 2012; 4:e29. [PMID: 25396034 PMCID: PMC4227316 DOI: 10.4081/pr.2012.e29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2011] [Revised: 07/20/2012] [Accepted: 07/20/2012] [Indexed: 11/23/2022] Open
Abstract
The aim of the study was to define an intrauterine growth curve for a population of Nigerian newborn babies. A cross-sectional observational study design was adopted. Weight, length and head circumference were all measured in consecutive singleton deliveries at the University of Ilorin Teaching Hospital over a 3-year period. Gestational age (GA) of the babies was estimated from the last menstrual period or first trimester ultrasound. The estimates obtained were clinically validated using the Ballard score. Mean birth weights and percentiles of the weight, length and head circumferences for the respective GA were estimated using the SPSS 15 software package. A total of 5273 babies were recruited for the study with GA ranging from 25-44 weeks. Comparison of the mean birth weights of the various GA with the data from Denver, Colorado, showed that Nigerian babes tended to weigh less at the early GA, although these differences were not statistically significant. Between 26-36 weeks, the average weights of both sexes were similar; however, beyond this time point there was a consistent increase in the average weight of the males over the female babies. Growth curves for Nigerian newborn babies were generated and showed that the mean birth weight of Nigerian preterm babies was lighter than that of babies in Colorado. The impact of these differences on the classification of newborns will require further evaluation.
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Affiliation(s)
| | | | | | - Mustapha Bello
- Department of Paediatrics University of Maiduguri Teaching Hospital , Nigeria
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Baldassarre ME, Laneve A, Fontana A, Manca F, Salvia G, Barcaglioni P, Cella A, Giannuzzo S, Esposito L, Capursi T, Mastrorilli C, Padovano A, Laforgia N. Usefulness of tissue transglutaminase type 2 antibodies in early pregnancy. Immunopharmacol Immunotoxicol 2012; 34:932-6. [PMID: 22537115 DOI: 10.3109/08923973.2012.680470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Celiac disease (CD), an autoimmune disease triggered by dietary gluten, is a multi-systemic disorder that primarily results in mucosal damage of the small intestine. Reproductive disorders and pregnancy complications have been associated with CD. Conflicting results have been published concerning CD and the risk of impaired fetal growth with reduced birthweight. The aim of our multicentric, perspective, case-control study was to determine the prevalence of undiagnosed CD in mothers of small for gestational age (SGA) newborns in two regions of Italy. The study included 480 mothers: group A consisted of 284 SGA newborns' mothers and group B consisted of 196 appropriate for gestational age (AGA) newborns' mothers. Tissue transglutaminase type 2 antibodies (TG2) IgA and IgG were measured in blood samples. We diagnosed two new cases of CD in asymptomatic mothers. It may be appropriate to include the TG2 to the panel of prenatal blood test.
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Affiliation(s)
- Maria Elisabetta Baldassarre
- Department of Gynecology, Obstetrics and Neonatology, Section of Neonatology and NICU, University of Bari, Bari, Italy.
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DELSING C, Van Den WITTENBOER E, LIU AJ, PEEK MJ, QUINTON A, MONGELLI M, POULTON A, NANAN R. The relationship between maternal opiate use, amphetamine use and smoking on fetal growth. Aust N Z J Obstet Gynaecol 2011; 51:446-51. [DOI: 10.1111/j.1479-828x.2011.01342.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Van Eerd EAM, Roex AJM, Nikpoor P, Dekker GA. Adverse perinatal outcome and maternal risk factors in population versus customized defined SGA babies. J Matern Fetal Neonatal Med 2011; 25:369-73. [DOI: 10.3109/14767058.2011.579210] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Edwards DRV, Romero R, Kusanovic JP, Hassan SS, Mazaki-Tovi S, Vaisbuch E, Kim CJ, Erez O, Chaiworapongsa T, Pearce BD, Bartlett J, Friel LA, Salisbury BA, Anant MK, Vovis GF, Lee MS, Gomez R, Behnke E, Oyarzun E, Tromp G, Menon R, Williams SM. Polymorphisms in maternal and fetal genes encoding for proteins involved in extracellular matrix metabolism alter the risk for small-for-gestational-age. J Matern Fetal Neonatal Med 2011; 24:362-80. [PMID: 20617897 PMCID: PMC3104673 DOI: 10.3109/14767058.2010.497572] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To examine the association between maternal and fetal genetic variants and small-for-gestational-age (SGA). METHODS A case-control study was conducted in patients with SGA neonates (530 maternal and 436 fetal) and controls (599 maternal and 628 fetal); 190 candidate genes and 775 SNPs were studied. Single-locus, multi-locus and haplotype association analyses were performed on maternal and fetal data with logistic regression, multifactor dimensionality reduction (MDR) analysis, and haplotype-based association with 2 and 3 marker sliding windows, respectively. Ingenuity pathway analysis (IPA) software was used to assess pathways that associate with SGA. RESULTS The most significant single-locus association in maternal data was with a SNP in tissue inhibitor of metalloproteinase 2 (TIMP2) (rs2277698 OR = 1.71, 95% CI [1.26-2.32], p = 0.0006) while in the fetus it was with a SNP in fibronectin 1 isoform 3 preproprotein (FN1) (rs3796123, OR = 1.46, 95% CI [1.20-1.78], p = 0.0001). Both SNPs were adjusted for potential confounders (maternal body mass index and fetal sex). Haplotype analyses resulted in associations in α 1 type I collagen preproprotein (COL1A1, rs1007086-rs2141279-rs17639446, global p = 0.006) in mothers and FN1 (rs2304573-rs1250204-rs1250215, global p = 0.045) in fetuses. Multi-locus analyses with MDR identified a two SNP model with maternal variants collagen type V α 2 (COL5A2) and plasminogen activator urokinase (PLAU) predicting SGA outcome correctly 59% of the time (p = 0.035). CONCLUSIONS Genetic variants in extracellular matrix-related genes showed significant single-locus association with SGA. These data are consistent with other studies that have observed elevated circulating fibronectin concentrations in association with increased risk of SGA. The present study supports the hypothesis that DNA variants can partially explain the risk of SGA in a cohort of Hispanic women.
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Affiliation(s)
- Digna R. Velez Edwards
- Vanderbilt Epidemiology Center, Institute of Medicine and Public Health, Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tennessee, USA
| | - Roberto Romero
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Juan Pedro Kusanovic
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Sonia S. Hassan
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Shali Mazaki-Tovi
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Edi Vaisbuch
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Chong Jai Kim
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Pathology, Wayne State University, Detroit, Michigan, USA
| | - Offer Erez
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Tinnakorn Chaiworapongsa
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Brad D. Pearce
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jacquelaine Bartlett
- Center for Human Genetics Research, Vanderbilt University, Nashville, Tennessee, USA
| | - Lara A. Friel
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | | | | | | | | | - Ricardo Gomez
- CEDIP (Center for Perinatal Diagnosis and Research), Department of Obstetrics and Gynecology, Sotero del Rio Hospital, Santiago, Chile
- Department of Obstetrics and Gynecology, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Ernesto Behnke
- CEDIP (Center for Perinatal Diagnosis and Research), Department of Obstetrics and Gynecology, Sotero del Rio Hospital, Santiago, Chile
| | - Enrique Oyarzun
- Department of Obstetrics and Gynecology, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Gerard Tromp
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA
| | - Ramkumar Menon
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Scott M. Williams
- Center for Human Genetics Research, Vanderbilt University, Nashville, Tennessee, USA
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, Tennessee, USA
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McCowan LME, Roberts CT, Dekker GA, Taylor RS, Chan EHY, Kenny LC, Baker PN, Moss-Morris R, Chappell LC, North RA. Risk factors for small-for-gestational-age infants by customised birthweight centiles: data from an international prospective cohort study. BJOG 2010; 117:1599-607. [DOI: 10.1111/j.1471-0528.2010.02737.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Risk factors for small for gestational age infants. Best Pract Res Clin Obstet Gynaecol 2009; 23:779-93. [DOI: 10.1016/j.bpobgyn.2009.06.003] [Citation(s) in RCA: 241] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Accepted: 06/06/2009] [Indexed: 11/19/2022]
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30
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Fetal growth screening by fundal height measurement. Best Pract Res Clin Obstet Gynaecol 2009; 23:809-18. [DOI: 10.1016/j.bpobgyn.2009.09.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Accepted: 09/10/2009] [Indexed: 11/20/2022]
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Budde MP, De Lange TE, Dekker GA, Chan A, Nguyen AMT. Risk factors for placental abruption in a socio-economically disadvantaged region. J Matern Fetal Neonatal Med 2009; 20:687-93. [PMID: 17701669 DOI: 10.1080/14767050701482738] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study was undertaken in order to determine the risk factors for pregnancies complicated by placental abruption in a socio-economically disadvantaged region in metropolitan Adelaide. METHODS This was a retrospective case-control study including all singleton pregnancies resulting in placental abruption between 2001 and 2005. RESULTS The overall incidence of placental abruption was 1.0%; the overall perinatal mortality among the births with abruption was 13%. Univariate analyses showed the following significant risk factors for placental abruption: preterm pre-labor rupture of the membranes (PRE-PROM; odds ratio (OR) 4.79, 95% confidence interval (CI) 1.52-15.08), non-compliance with antenatal care (OR 2.93, 95% CI 1.06-8.90), severe intrauterine growth restriction (IUGR), and elevated homocysteine levels (OR 45.55, 95% CI 7.05-458.93). Severe IUGR was significantly more common in the abruption group compared with the control group (p = 0.032). In the multivariate analysis, PRE-PROM remained a significant independent risk factor for placental abruption. Marijuana use, domestic violence, and mental health problems were more common (borderline significance) in the abruption group. Smoking and preeclampsia were not found to be associated with placental abruption in this study. CONCLUSIONS In this high-risk population, PRE-PROM and elevated homocysteine levels appear to represent the major risk factors for placental abruption.
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Affiliation(s)
- Marenne P Budde
- Department of Obstetrics and Gynaecology, Lyell McEwin Health Service, University of Adelaide, Adelaide, South Australia, Australia
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Abstract
BACKGROUND The aim of the present study was to investigate the relationship between maternal and newborn anthropometry. METHODS In 1000 Sudanese mothers and newborns anthropometric measurements were taken within 24 h of birth. The relationship between maternal characteristics including age, years of education, social class and anthropometry, and newborn characteristics including gestational age, weight, body length, body circumference and skin-fold thickness, was investigated on multiple regression with backward selection, and multivariate anova (where appropriate) to identify the most important associations. RESULTS Maternal age and anthropometry were significantly associated with newborn anthropometry to a variable extent. The strongest associations (R2 > 5-6%) were found for mid-arm circumference, supine length and birthweight. The postpartum maternal lean body mass (LBM) was significantly associated with birthweight, body length and body circumference (P < 0.001), while skin-fold thickness was mainly associated with maternal age and maternal body mass index (BMI). Gestational age was only weakly associated with the maternal height (R2 > 1.3%) and the association between maternal anthropometry and the ponderal index (PI) of the newborn was negligible (R2 < 1%). Maternal education was significantly associated with birthweight and body circumference (except the abdominal), and the PI and the latter increased significantly with increasing number of years of education. No association between social class and newborn anthropometry was obtained. CONCLUSION There was a significant association between maternal LBM and newborn size and between maternal BMI and newborn fat stores. Maternal education and not social class was associated with newborn size.
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Affiliation(s)
- Eltahir M Elshibly
- Department of Paediatrics and Child Health, University of Khartoum, Khartoum, Sudan
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Auger N, Daniel M, Platt RW, Wu Y, Luo ZC, Choinière R. Association between perceived security of the neighbourhood and small-for-gestational-age birth. Paediatr Perinat Epidemiol 2008; 22:467-77. [PMID: 18782253 DOI: 10.1111/j.1365-3016.2008.00959.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Evidence points to an association between a mother's place of residence and her newborn's health, independent of individual characteristics. Neighbourhood constructs such as immigrant density, deprivation and crime have all been separately associated with birth outcomes. Little research has considered the joint influence of variables representing a spectrum of neighbourhood constructs. Subjective vs. objective measures of neighbourhood constructs (e.g. reported vs. perceived crime) are often not considered. We sought to evaluate the relationship between neighbourhood measures of reported crime, neighbourhood perceived security, immigrant density, material/social deprivation, residential stability and the odds of small-for-gestational-age (SGA) birth in an urban setting in Canada. Neighbourhood was defined as police districts (n = 49). We linked Montreal livebirths 1997-2001 (n = 98 330) to police district crime measures, survey data on perceived security, and 2001 census data. We used multi-level analysis to calculate odds ratios (OR) for neighbourhood effects on SGA birth accounting for individual characteristics. Mothers residing in neighbourhoods with the most favourable perception had a lower odds of SGA birth than neighbourhoods with the least favourable perception [OR 0.87, 95% CI 0.77, 0.97]. Mothers in neighbourhoods with lower proportions of immigrants had lower odds of SGA birth relative to neighbourhoods with the highest proportion of immigrants. Reported crime, residential stability and material/social deprivation (accounting for neighbourhood perception) were not associated with SGA birth. Immigrant density and subjective perceptions of neighbourhood security are associated with SGA birth. Public health strategies to improve fetal growth should target neighbourhoods with low perceived security and high immigrant density.
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Affiliation(s)
- Nathalie Auger
- Unité Etudes et Analyses de l'Etat de Santé de la Population, Institut National de Santé Publique du Québec, Québec, Canada.
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Auger N, Daniel M, Platt RW, Luo ZC, Wu Y, Choinière R. The joint influence of marital status, interpregnancy interval, and neighborhood on small for gestational age birth: a retrospective cohort study. BMC Pregnancy Childbirth 2008; 8:7. [PMID: 18307804 PMCID: PMC2268912 DOI: 10.1186/1471-2393-8-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2007] [Accepted: 02/28/2008] [Indexed: 12/05/2022] Open
Abstract
Background Interpregnancy interval (IPI), marital status, and neighborhood are independently associated with birth outcomes. The joint contribution of these exposures has not been evaluated. We tested for effect modification between IPI and marriage, controlling for neighborhood. Methods We analyzed a cohort of 98,330 live births in Montréal, Canada from 1997–2001 to assess IPI and marital status in relation to small for gestational age (SGA) birth. Births were categorized as subsequent-born with short (<12 months), intermediate (12–35 months), or long (36+ months) IPI, or as firstborn. The data had a 2-level hierarchical structure, with births nested in 49 neighborhoods. We used multilevel logistic regression to obtain adjusted effect estimates. Results Marital status modified the association between IPI and SGA birth. Being unmarried relative to married was associated with SGA birth for all IPI categories, particularly for subsequent births with short (odds ratio [OR] 1.60, 95% confidence interval [CI] 1.31–1.95) and intermediate (OR 1.48, 95% CI 1.26–1.74) IPIs. Subsequent births had a lower likelihood of SGA birth than firstborns. Intermediate IPIs were more protective for married (OR 0.50, 95% CI 0.47–0.54) than unmarried mothers (OR 0.65, 95% CI 0.56–0.76). Conclusion Being unmarried increases the likelihood of SGA birth as the IPI shortens, and the protective effect of intermediate IPIs is reduced in unmarried mothers. Marital status should be considered in recommending particular IPIs as an intervention to improve birth outcomes.
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Affiliation(s)
- Nathalie Auger
- Unité Etudes et analyses de l'état de santé de la population, Institut national de santé publique du Québec, Montréal, Québec, Canada.
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Dekker G, Robillard PY. Pre-eclampsia: Is the immune maladaptation hypothesis still standing? An epidemiological update. J Reprod Immunol 2007; 76:8-16. [PMID: 17493684 DOI: 10.1016/j.jri.2007.03.015] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2006] [Revised: 03/28/2007] [Accepted: 03/28/2007] [Indexed: 11/26/2022]
Abstract
Despite much research, and clear improvement in our understanding of risk factors and pathogenetic mechanisms, the exact etiology of pre-eclampsia remains unknown. The immune maladaptation hypothesis has been challenged recently by several large epidemiological studies. One of the explanations for contradictory findings might be that the type of pre-eclampsia seen by obstetricians in developed countries mostly involves 30 and more years old, mildly obese pregnant women having near-term pre-eclampsia. It could be that this type of pre-eclampsia is primarily related to pre-existing maternal constitutional factors. This type of pre-eclampsia might be the dominant type of pre-eclampsia in the large Scandinavian and USA studies. In contrast, the epidemiology of pre-eclampsia in young women (age 15-25), so commonly seen in developing countries and certain lower socio-economic groups in developed countries, appears more in line with the immune maladaptation hypothesis. The aim here is to provide an updated review on studies supporting or challenging the immune maladaptation hypothesis.
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Affiliation(s)
- Gus Dekker
- Women's and Children's Division, Lyell McEwin Hospital, University of Adelaide, SA, Australia.
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Ingvarsson RF, Bjarnason AO, Dagbjartsson A, Hardardottir H, Haraldsson A, Thorkelsson T. The effects of smoking in pregnancy on factors influencing fetal growth. Acta Paediatr 2007; 96:383-6. [PMID: 17407461 DOI: 10.1111/j.1651-2227.2007.00103.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the influence of maternal smoking during pregnancy on factors influencing fetal growth. METHODS Thirty newborns of smoking mothers were prospectively compared with 60 newborns of non-smoking mothers. Pre-albumin, albumin, triglycerides, glucose, insulin, insulin-like growth factor I, IGF binding protein 3, pH, lactic acid, erythropoietin and hemoglobin concentrations were measured in umbilical cord blood. RESULTS Infants of smoking mothers had a significantly lower birth weight (3418 +/- 533 vs. 3863 +/- 503 g; p < 0.001), length (50.5 +/- 2,6 vs. 52.3 +/- 1.9 cm; p < 0.001) and head circumference (34.6 +/- 1.8 vs. 35.8 +/- 1.1 cm; p < 0.001) than controls. They also had significantly lower insulin (3.2 (2.0-4.9) vs. 5.8 (4.6-7.1) mU/L; p = 0.008), insulin-like growth factor I (54.4 +/- 32.5 vs. 93.8 +/- 54.5 microg/L; p = 0.001) and IGF binding protein 3 (1664 +/- 432 vs. 1943 +/- 421 microg/L; p = 0.01) concentrations, than controls. Infants of smoking mothers also had significantly higher hemoglobin (167 +/- 14 vs. 157 +/- 13 g/L; p = 0.002) and erythropoietin (42.3 (25.1-72.4) vs. 26.3 (21.9-30.9) U/L; p = 0.03) than controls, but not pH or lactate concentrations. There was no significant difference in pre-albumin, albumin, triglycerides and glucose concentrations. CONCLUSIONS Smoking during pregnancy causes symmetrical fetal growth impairment, possibly due to decreased oxygen transport to the fetus and decreased concentrations of fetal insulin, insulin-like growth factor I and IGF binding protein 3.
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Affiliation(s)
- Ragnar F Ingvarsson
- University of Iceland, Faculty of Medicine, Landspitali University Hospital Iceland, Reykjavik, Iceland
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Chambers CD, Chen BH, Kalla K, Jernigan L, Jones KL. Novel risk factor in gastroschisis: Change of paternity. Am J Med Genet A 2007; 143A:653-9. [PMID: 17163540 DOI: 10.1002/ajmg.a.31577] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In recent years, an increase in the rate of gastroschisis has been documented in several countries throughout the world. Based on accumulating evidence that a maternal immunologic response to a novel set of paternal antigens may be involved in risk for several adverse pregnancy outcomes, including preeclampsia, reduced birth weight, and preterm delivery, we tested the hypothesis that a pregnancy following a change in fathers (change in paternity) may be a risk factor for gastroschisis. Using a case-control design, we compared the prevalence of change in paternity with the index pregnancy in 102 mothers of isolated gastroschisis cases to the prevalence of change in paternity in 117 mothers of non-malformed infants and 78 mothers of infants with neural tube defects or oral clefts. In a multivariate analysis, the adjusted odds of change in paternity in multigravid case mothers were 7.81 times higher (95% Confidence interval 2.80-21.88) relative to multigravid mothers of malformed and non-malformed controls combined, after adjustment for maternal age. These data suggest that maternal immune factors may play a role in the cause of gastroschisis. Further research is needed to corroborate these findings and to elucidate possible immunologic mechanisms involved in the pathogenesis of gastroschisis.
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Affiliation(s)
- Christina D Chambers
- Division of Dysmorphology and Teratology, Department of Pediatrics, University of California San Diego, La Jolla, CA 92103, USA.
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Smith LM, LaGasse LL, Derauf C, Grant P, Shah R, Arria A, Huestis M, Haning W, Strauss A, Della Grotta S, Liu J, Lester BM. The infant development, environment, and lifestyle study: effects of prenatal methamphetamine exposure, polydrug exposure, and poverty on intrauterine growth. Pediatrics 2006; 118:1149-56. [PMID: 16951010 DOI: 10.1542/peds.2005-2564] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Methamphetamine use among pregnant women is an increasing problem in the United States. Effects of methamphetamine use during pregnancy on fetal growth have not been reported in large, prospective studies. We examined the neonatal growth effects of prenatal methamphetamine exposure in the multicenter, longitudinal Infant Development, Environment and Lifestyle study. DESIGN/METHOD The Infant Development, Environment and Lifestyle study screened 13808 subjects at 4 clinical centers: 1618 were eligible and consented, among which 84 were methamphetamine exposed, and 1534 were unexposed. Those who were methamphetamine exposed were identified by self-report and/or gas chromatography-mass spectrometry confirmation of amphetamine and metabolites in infant meconium. Those who were unexposed denied amphetamine use and had a negative meconium screen. Both groups included prenatal alcohol, tobacco, or marijuana use, but excluded use of opiates, LSD, PCP or cocaine only. Neonatal parameters included birth weight and gestational age in weeks. One-way analysis of variance and linear-regression analyses were conducted on birth weight by exposure. The relationship of methamphetamine exposure and the incidence of small for gestational age was analyzed using multivariate logistic-regression analyses. RESULTS The methamphetamine exposed group was 3.5 times more likely to be small for gestational age than the unexposed group. Mothers who used tobacco during pregnancy were nearly 2 times more likely to have small-for-gestational-age infants. In addition, less maternal weight gain during pregnancy was more likely to result in a small-for-gestational-age infant. Birthweight in the methamphetamine exposed group was lower than the unexposed group. CONCLUSIONS These findings suggest that prenatal methamphetamine use is associated with fetal growth restriction after adjusting for covariates. Continued follow-up will determine if these infants are at increased risk for growth abnormalities in the future.
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Affiliation(s)
- Lynne M Smith
- Department of Pediatrics, David Geffen School of Medicine at UCLA and Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502.
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Chaouat G, Robillard PY, Dekker G. Fourth International Workshop on immunology of pre-eclampsia, December 2004, Reunion, France. J Reprod Immunol 2006; 67:103-11. [PMID: 16315347 DOI: 10.1016/j.jri.2005.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The Fourth International Workshop on 'Reproductive Immunology, Immunological Tolerance and Immunology of Pre-eclampsia' was held in the Island of La Reunion in December 2004. Besides intense sharing of immunological data, it included also epidemiological studies from South Africa, USA and Australia, as well as genetic studies from South Africa and Mauritius, discussions on the future of graft transplant tolerance, implications of inositol-phosphoglycans in the pathogenesis of pre-eclampsia (PE), pathways to the inflammatory syndrome and other topics. Participants shared the belief that we may be witnessing significant steps forward in our comprehension of PE as an immunological event, with a prominent role for deregulation of the innate immune system, probably controlled by T cells and cytokine networks at the feto-placental interface. There was a growing consensus for an NK cell (KIR)-dependent event, with regulation exerted by T cells, as well as an important role for HLA-C presentation/recognition and HLA-G in mediating inflammatory cytokine imbalance, with an emphasis on IL-12 and IL-16 It is hoped that the next Workshop in 2006 will prove the immune involvement by dissecting the NK/Treg/Ts cell and HLA-CI HLA-G circuits leading to cytokine and vascular dysfunction.
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Affiliation(s)
- Gérard Chaouat
- INSERM U131, Unité Cytokines dans la Relation Materno-Faetale, 32 Rue des Carnets, 92141 Clamart, France
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