1
|
Ren J, Zhao C, Fan Z, Wang Y, Sheng H, Hua S. The interval between the onset of increased blood pressure and proteinuria in preeclampsia and the contributing factors. Arch Gynecol Obstet 2024; 310:757-767. [PMID: 38133812 DOI: 10.1007/s00404-023-07284-2] [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: 05/04/2023] [Accepted: 10/28/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE New-onset proteinuria, as a pivotal sign of representative renal lesions in preeclampsia, is still the most common diagnostic tool for this condition and has been proven to be related to a significantly abnormal sFlt-1/VEGF ratio in circulation. At the same time, blood pressure control plays a vital role in the occurrence and evolution of proteinuria. Therefore, it is particularly helpful to investigate their interval, not only for performing urinalysis for protein more accurately but also for evaluating blood pressure as well as the aggravation of illness, as the related research is limited. METHODS This retrospective study included 515 preeclampsia patients and 358 normotensive pregnant women who labored in the Second Hospital of Tianjin Medical University from January 2016 to January 2020. First, we described the onset circumstance of high blood pressure and proteinuria as well as the interval among the case group and the subgroups. Then, we determined whether there were significant differences in the basic information, laboratory test results, and newborns between the case and normal groups. Finally, multifactor ANOVA was used to determine the factors influencing the interval. RESULTS 1. The two most common complications in preeclampsia were proteinuria (88.35%) and placental dysfunction (5.05%). Moreover, 72.04% of preeclampsia cases were diagnosed by abnormal blood pressure together with new-onset proteinuria. 2. The average interval between high blood pressure and proteinuria was 22 gestational days (from 0 to 106 days), and this interval was not significantly different between mild and severe PE (26 days vs. 21 days, P > 0.05) but significantly differed between early-onset and late-onset PE (9 days vs. 28 days, P < 0.05). 3. The number of prenatal visits, serum creatinine in the early trimester, gestational time and diastolic blood pressure value when increased blood pressure was initially detected may influence the interval between the onset of increased blood pressure and proteinuria. CONCLUSION New-onset proteinuria was still the main parameter for identifying preeclampsia. The interval between increased blood pressure and proteinuria was probably related to the imbalance in the sFlt-1/VEGF ratio; therefore, we should pay attention to monitor proteinuria during the prenatal visits, especially for patients with a lower frequency of prenatal visits, higher serum creatinine in the early trimester, earlier onset and higher diastolic blood pressure at the initial onset of increased blood pressure.
Collapse
Affiliation(s)
- Jie Ren
- Obstetrics Department, The Second Hospital of Tianjin Medical University, No. 23, Pingjiang Road, Tianjin, 300211, China
| | - Caiyun Zhao
- Obstetrics Department, The Second Hospital of Tianjin Medical University, No. 23, Pingjiang Road, Tianjin, 300211, China
| | - Zhuoran Fan
- Obstetrics Department, The Second Hospital of Tianjin Medical University, No. 23, Pingjiang Road, Tianjin, 300211, China
| | - Yanli Wang
- Obstetrics Department, The Second Hospital of Tianjin Medical University, No. 23, Pingjiang Road, Tianjin, 300211, China
| | - Hongna Sheng
- Obstetrics Department, The Second Hospital of Tianjin Medical University, No. 23, Pingjiang Road, Tianjin, 300211, China
| | - Shaofang Hua
- Obstetrics Department, The Second Hospital of Tianjin Medical University, No. 23, Pingjiang Road, Tianjin, 300211, China.
| |
Collapse
|
2
|
Tejaswi MS, Kanthi Mangala J, Vinya P, Bhaskaran R. Urine Calcium-Creatinine Ratio in Prediction of Pre-eclampsia. J Obstet Gynaecol India 2023; 73:51-56. [PMID: 36879943 PMCID: PMC9984577 DOI: 10.1007/s13224-022-01712-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 09/09/2022] [Indexed: 11/24/2022] Open
Abstract
Background Hypertensive disorders of pregnancy are first identified during pregnancy (gestational hypertension, pre-eclampsia, eclampsia, and HELLP syndrome) or may present as a complication of previously existing disease (chronic hypertension, renal disease, and systemic disease). These hypertensive disorders complicate the pregnancy, leading to significant maternal and perinatal morbidity and mortality, especially in low- and middle-income countries (Chappell in Lancet 398(10297):341-354, 2021). These hypertensive disorders are about 5-10% of all pregnancies. Methods This is a single institutional study, which was conducted among 100 normotensive asymptomatic antenatal women at, 20-28 weeks of gestation attending our OPD. Voluntary participants were selected based on inclusion and exclusion criteria. Spot urine sample was taken for estimation of UCCR by an enzymatic colorimetric method. These patients were followed up throughout the pregnancy and monitored for the development of pre-eclampsia. UCCR is compared in both groups. Pre-eclampsia women were further followed up to observe the perinatal outcomes. Results Among 100 antenatal women, 25 of them developed pre-eclampsia. UCCR of < 0.04 was considered as cutoff and compared between pre-eclampsia and normotensive women. This ratio yielded a sensitivity of 61.54%, specificity 87.84%, positive predictive value 64%, and negative predictive value of 86.67%. It was also observed that primigravida had more sensitivity (83.3%) and specificity (91.7%) in predicting pre-eclampsia compared to multigravida. The mean and median UCCR among pre-eclamptic women was significantly low (0.062 ± 0.076, 0.03) compared to normotensive women (0.15 ± 0.115, 0.12) with a p value of < 0.001. Conclusions Spot UCCR is a good predictor of pre-eclampsia in primigravida women and can be considered as a routine screening test at 20-28 weeks of gestation during regular antenatal visits.
Collapse
Affiliation(s)
| | | | - Paladugu Vinya
- Department of Obstetrics and Gynecology, Amrita Hospital, Kochi, India
| | | |
Collapse
|
3
|
Secular trends and age-period-cohort effect on adverse perinatal outcomes in Hubei, China (2011-2019). Sci Rep 2022; 12:22558. [PMID: 36581710 PMCID: PMC9800403 DOI: 10.1038/s41598-022-27194-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/28/2022] [Indexed: 12/30/2022] Open
Abstract
The increasing trend in the incidence of adverse perinatal outcomes is a public health concern globally as well as in China. However, the causes of the increasing trend are not well understood. The present tertiary-hospital-based retrospective study (2011-2019) aims to determine the secular trends and age-period-cohort effect on adverse perinatal outcomes in Hubei, China. The age-standardized incidence rates of adverse perinatal outcomes significantly decreased such as preterm births by 22% [AAPC - 3.4% (95% CI - 7.8, - 1.2)], low birth weight (LBW) by 28.5% [AAPC - 4.7% (95% CI - 6.0, - 3.3)], and fetal distress by 64.2% [AAPC - 14.0% (95% CI - 17.8, - 10.0)] during 2011-2019. Both extremes of maternal age groups (18-20 years and 42-44 years) had a higher risk ratio for adverse perinatal outcomes including preterm birth, perinatal mortality, LBW, low ponderal index (LPI), low Apgar score, and congenital defect compared to the reference age group (30-32 years). A higher risk ratio for perinatal mortality, intrauterine growth restriction (IUGR), and fetal distress and a lower risk ratio for preterm births and LBW were observed in the period 2017-2019. Both the young cohort (1997-1999) and the old cohort (1976-1969) had a higher risk ratio for preterm birth, perinatal mortality, macrosomia, and congenital defect compared to the reference cohort (1982-1984). In conclusion, some of the adverse perinatal outcomes incidence significantly decreased in the last 9 years in Hubei. However, extremes of maternal age groups and both young and old cohorts were associated with a higher risk of preterm birth, perinatal mortality, and congenital defect.
Collapse
|
4
|
Wu B, Ning W, Chen Y, Wen C, Zhang H, Chen Y. A retrospective cohort study on the effects of Down's screening markers and maternal characteristics on pregnancy outcomes in preeclampsia. Clin Exp Hypertens 2022; 44:610-618. [PMID: 35787215 DOI: 10.1080/10641963.2022.2096055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND To investigate the effects of down's screening markers and maternal characteristics on preeclampsia (PE) pregnancy outcome during early and middle pregnancy. METHODS A retrospective study of a cohort of 246 PE and 18,709 No-PE pregnant women who participated in Down's screening during early and middle pregnancy was performed. Clinical data of pregnancy-related were collected. Multivariate binary logistic regression was used to analyze the adjusted odds ratio (aOR) and 95% confidence interval (CI) of Down's screening markers, maternal characteristics, pregnancy outcome, and other related variables, and to evaluate the influencing factors of each indicator on PE. P < .05 was considered to be statistically significant. RESULTS Compared with the non-PE group, the concentration and median multiple (MoM) of pregnancy-associated plasma protein-A (PAPP-A) and free beta subunit of human chorionic gonadotropin (free β-hCG) in PE group were both lower (P < .001). Multivariate binary logistic regression analysis showed that low birth weight, hydronephrosis, premature delivery, fetal growth retardation, cesarean section, live birth, hyperlipemia, infection, decreased free β-hCG and first trimester maternal weight were risk factors for PE (aOR were: 7.552, 6.684, 4.154, 3.762, 3.612, 2.454, 1.757, 1.562, 1.270, and 1.077, respectively), while uterine scar, premature rupture of membranes and elevated PAPP-A were protective factors of PE (aOR were: 0.222, 0.328 and 0.612, respectively). CONCLUSION Decreased maternal serum PAPP-A level, increased free β-hCG, hyperlipemia, premature delivery, cesarean section, live birth, hydronephrosis, fetal growth retardation, low birth weight, and infection are risk factors for PE, while uterine scar and premature rupture of membrane are protective factors for PE.
Collapse
Affiliation(s)
- Bin Wu
- Department of the Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, ZJ, China
| | - Wenwen Ning
- Department of the Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, ZJ, China
| | - Yijie Chen
- Department of the Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, ZJ, China
| | - Caihe Wen
- Department of Obstetrics, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, ZJ, China
| | - Huimin Zhang
- Department of the Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, ZJ, China
| | - Yiming Chen
- Department of the Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, ZJ, China.,Department of Prenatal Diagnosis and Screening Center, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, ZJ, China
| |
Collapse
|
5
|
Liu YH, Zheng L, Cheng C, Li SN, Shivappa N, Hebert JR, Fu WJ, Zhao XL, Cao Y, Dou WF, Chen HN, Duan DD, Lyu QJ, Zeng FF. Dietary inflammatory index, inflammation biomarkers and preeclampsia risk: a hospital-based case-control study. Br J Nutr 2022; 129:1-9. [PMID: 35581673 DOI: 10.1017/s0007114522001489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study evaluated the association between inflammatory diets as measured by the Dietary Inflammatory index (DII), inflammation biomarkers and the development of preeclampsia among the Chinese population. We followed the reporting guidelines of the Strengthening the Reporting of Observational Studies in Epidemiology statement for observational studies. A total of 466 preeclampsia cases aged over 18 years were recruited between March 2016 and June 2019, and 466 healthy controls were 1:1 ratio matched by age (±3 years), week of gestation (±1 week) and gestational diabetes mellitus. The energy-adjusted DII (E-DII) was computed based on dietary intake assessed using a seventy-nine item semiquantitative FFQ. Inflammatory biomarkers were analysed by ELISA kits. The mean E-DII scores were -0·65 ± 1·58 for cases and -1·19 ± 1·47 for controls (P value < 0·001). E-DII scores positively correlated with interferon-γ (r s = 0·194, P value = 0·001) and IL-4 (r s = 0·135, P value = 0·021). After multivariable adjustment, E-DII scores were positively related to preeclampsia risk (Ptrend < 0·001). The highest tertile of E-DII was 2·18 times the lowest tertiles (95 % CI = 1·52, 3·13). The odds of preeclampsia increased by 30 % (95 % CI = 18 %, 43 %, P value < 0·001) for each E-DII score increase. The preeclampsia risk was positively associated with IL-2 (OR = 1·07, 95 % CI = 1·03, 1·11), IL-4 (OR = 1·26, 95 % CI = 1·03, 1·54) and transforming growth factor beta (TGF-β) (OR = 1·17, 95 % CI = 1·06, 1·29). Therefore, proinflammatory diets, corresponding to higher IL-2, IL-4 and TGF-β levels, were associated with increased preeclampsia risk.
Collapse
Affiliation(s)
- Yan-Hua Liu
- Department of Nutrition, the First Affiliated Hospital of Zhengzhou University, Zhengzhou450052, Henan, People's Republic of China
| | - Lu Zheng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No.601 Huangpu Road West, Guangzhou510632, Guangdong, People's Republic of China
| | - Chen Cheng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No.601 Huangpu Road West, Guangzhou510632, Guangdong, People's Republic of China
| | - Shu-Na Li
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No.601 Huangpu Road West, Guangzhou510632, Guangdong, People's Republic of China
| | - Nitin Shivappa
- Cancer Prevention and Control Program, University of South Carolina, Columbia, USA; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, USA; Connecting Health Innovations LLC, Columbia, USA
| | - James R Hebert
- Cancer Prevention and Control Program, University of South Carolina, Columbia, USA; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, USA; Connecting Health Innovations LLC, Columbia, USA
| | - Wen-Jun Fu
- Department of Obstetrics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou450052, Henan, People's Republic of China
| | - Xian-Lan Zhao
- Department of Obstetrics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou450052, Henan, People's Republic of China
| | - Yuan Cao
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou450052, Henan, People's Republic of China
| | - Wei-Feng Dou
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou450000, Henan, People's Republic of China
| | - Hua-Nan Chen
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou450000, Henan, People's Republic of China
| | - Dan-Dan Duan
- Department of Clinical Nutrition, Luoyang New Area People's Hospital, Luoyang471023, Henan, People's Republic of China
| | - Quan-Jun Lyu
- Department of Nutrition, the First Affiliated Hospital of Zhengzhou University, Zhengzhou450052, Henan, People's Republic of China
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou450000, Henan, People's Republic of China
| | - Fang-Fang Zeng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No.601 Huangpu Road West, Guangzhou510632, Guangdong, People's Republic of China
| |
Collapse
|
6
|
Lawrence ER, Beyuo T, Kobernik EK, Moyer CA, Oppong SA. A Comparative Analysis of Neonatal Outcomes in Pregnancies Complicated by Preeclampsia and Eclampsia in Ghana. AJOG GLOBAL REPORTS 2022; 2:100061. [PMID: 36276785 PMCID: PMC9563915 DOI: 10.1016/j.xagr.2022.100061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Worldwide, hypertensive disorders of pregnancy are a serious complication of pregnancy, and contribute to poor maternal and neonatal outcomes. The most significant consequences of hypertensive disorders of pregnancy are observed in sub-Saharan Africa, where neonatal outcomes have not been fully described. Understanding relationships between maternal disease severity and neonatal outcomes can guide patient counseling and allow the targeting of limited resources to the most at-risk neonates. OBJECTIVE To describe and compare neonatal outcomes in pregnancies complicated by preeclampsia with severe features and eclampsia. STUDY DESIGN This study is a secondary analysis of data collected as part of a randomized controlled trial at the Korle-Bu Teaching Hospital in Ghana. Participants were adult pregnant women with preeclampsia with severe features or eclampsia and their neonates. Data include prospectively collected medical and obstetrical history, intrapartum events, and neonatal outcomes. The main outcome of this secondary analysis was a composite of poor neonatal outcomes, defined as 1 or more of the following: stillbirth, very low birthweight (<1500 g), 5-minute Apgar score <7, neonatal intensive care unit admission, or a live birth with a subsequent death before discharge. RESULTS Median gestational age at delivery was 36.6 weeks (interquartile range, 33.3–38.9). Median birthweight was 2.3 kg (interquartile range, 1.6–3.0), with 227 (19.0%) birthweights <1500 g. There were 162 neonates (15.5%) with an Apgar score <7 at 5 minutes and 144 (11.9%) were stillbirths. Of live births, half (n=524, 50.3%) were admitted to the neonatal intensive care unit and 7.9% (n=91) died before discharge. A composite of poor neonatal outcomes was experienced by 58.2% (n=707) of neonates and was twice as likely with a maternal diagnosis of eclampsia (odds ratio, 1.91; P=.04). For each additional week of gestational age, the probability of a poor neonatal outcome was reduced by 39% (odds ratio, 0.61; P<.0001). CONCLUSION Poor neonatal outcomes were experienced by more than half of pregnancies complicated by preeclampsia with severe features or eclampsia. Even after controlling for gestational age, pregnancies complicated by eclampsia were twice as likely to have poor neonatal outcomes.
Collapse
|
7
|
Sex-specific association of high maternal psychological stress during pregnancy on newborn birthweight. PLoS One 2022; 17:e0262641. [PMID: 35051242 PMCID: PMC8775189 DOI: 10.1371/journal.pone.0262641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/03/2022] [Indexed: 02/06/2023] Open
Abstract
Birthweight is an important predictor of newborn health and has been linked to maternal psychological stress during pregnancy. However, it is unclear whether prenatal stress affects birthweight similarly for both male and female infants. We used a well-established pregnancy cohort to investigate the impact of high maternal psychological stress during pregnancy on birthweight as a function of infant sex. Overall, 5702 mother-newborn pairs were analysed. Of these, 198 mothers reported high levels of stress using the Psychological Stress Measure (nine-items version; PSM-9). Maternal psychological stress was assessed between the 24th and 28th week of gestation and analyses were performed jointly and independently as a function of neonatal sex (separate analyses for male and female infants). Newborns exposed to high maternal psychological stress during pregnancy (a score above 26 measured using the PSM-9 questionnaire, corresponding to >97.5th percentile) were compared to newborns of mothers who reported lower stress. ANCOVAs revealed that high levels of maternal stress during pregnancy were linked to infant birthweight as a function of infant sex. Male infants of mothers who reported high levels of stress had a greater birthweight whereas female infants had a lower birthweight under the same conditions, in comparison to mothers who did not report greater levels of stress. Although the effect size is small, these results underline the possibility that male and female fetuses may use different strategies when adapting to maternal adversity and highlight the need to consider infant sex as a moderator of the association between maternal psychological stress during pregnancy and infant birthweight.
Collapse
|
8
|
Matyas M, Hasmasanu M, Silaghi CN, Samasca G, Lupan I, Orsolya K, Zaharie G. Early Preeclampsia Effect on Preterm Newborns Outcome. J Clin Med 2022; 11:452. [PMID: 35054146 PMCID: PMC8778539 DOI: 10.3390/jcm11020452] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND An early form of preeclampsia is rare. Abnormal placentation, placental perfusion disorders, and inflammatory cytokine release will have an effect on the fetus and newborn. MATERIAL AND METHODS The study group consisted of preterm newborns whose mothers had a history of preeclampsia and a gestational age of between 30 weeks and 34 weeks + 6 days. The control group consists of neonates matched for gestational age with the case group, whose mothers had normal blood pressure. The incidence and severity of respiratory distress syndrome (RDS), intraventricular hemorrhage, hypoglycemia, pH gas changes, and hematological parameters were analyzed in the two groups. RESULTS The study group of preterm neonates had a lower birth weight than the control group (p < 0.001). Most of the deliveries in the group of newborns exposed to preeclampsia were performed by cesarean section. Severe forms of RDS were two times more frequent in the group of newborns exposed to preeclampsia compared to those in the control group. Even though we expected to see a lower incidence, owing to the high number of deliveries by cesarean section, we still observed a higher rate of intraventricular hemorrhage in the preeclampsia group (16 cases in the study group vs. 7 in the control, p = 0.085). Neutropenia and thrombocytopenia were more frequent in preterm newborns exposed to preeclampsia. CONCLUSIONS The study shows that early preeclampsia increases the risk of complications in preterm neonates. RDS was more frequent in the exposed group than in the control group. The severity of preeclampsia correlates with hematological changes.
Collapse
Affiliation(s)
- Melinda Matyas
- Department of Neonatology, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (M.M.); (M.H.); (G.Z.)
| | - Monica Hasmasanu
- Department of Neonatology, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (M.M.); (M.H.); (G.Z.)
| | - Ciprian N. Silaghi
- Department of Biochemistry, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania;
| | - Gabriel Samasca
- Department of Immunology, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Iulia Lupan
- Interdisciplinary Institute in Bio-Nano-Science, 400006 Cluj-Napoca, Romania;
| | - Kovacs Orsolya
- Department of Neonatology, County Clinical Emergency Hospital, 400006 Cluj-Napoca, Romania;
| | - Gabriela Zaharie
- Department of Neonatology, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (M.M.); (M.H.); (G.Z.)
| |
Collapse
|
9
|
Manoochehri Z, Manoochehri S, Soltani F, Tapak L, Sadeghifar M. Predicting preeclampsia and related risk factors using data mining approaches: A cross-sectional study. Int J Reprod Biomed 2022; 19:959-968. [PMID: 34977453 PMCID: PMC8717074 DOI: 10.18502/ijrm.v19i11.9911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 12/23/2020] [Accepted: 03/02/2021] [Indexed: 11/24/2022] Open
Abstract
Background Preeclampsia is a type of pregnancy hypertension disorder that has adverse effects on both the mother and the fetus. Despite recent advances in the etiology of preeclampsia, no adequate clinical screening tests have been identified to diagnose the disorder. Objective We aimed to provide a model based on data mining approaches that can be used as a screening tool to identify patients with this syndrome and also to identify the risk factors associated with it. Materials and Methods The data used to perform this cross-sectional study were extracted from the clinical records of 726 mothers with preeclampsia and 726 mothers without preeclampsia who were referred to Fatemieh Hospital in Hamadan City during April 2005–March 2015. In this study, six data mining methods were adopted, including logistic regression, k-nearest neighborhood, C5.0 decision tree, discriminant analysis, random forest, and support vector machine, and their performance was compared using the criteria of accuracy, sensitivity, and specificity. Results Underlying condition, age, pregnancy season and the number of pregnancies were the most important risk factors for diagnosing preeclampsia. The accuracy of the models were as follows: logistic regression (0.713), k-nearest neighborhood (0.742), C5.0 decision tree (0.788), discriminant analysis (0.687), random forest (0.758) and support vector machine (0.791). Conclusion Among the data mining methods employed in this study, support vector machine was the most accurate in predicting preeclampsia. Therefore, this model can be considered as a screening tool to diagnose this disorder.
Collapse
Affiliation(s)
- Zohreh Manoochehri
- Department of Biostatistics, Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Sara Manoochehri
- Department of Biostatistics, Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Farzaneh Soltani
- Department of Midwifery, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Leili Tapak
- Modeling of Noncommunicable Disease Research Center, Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Majid Sadeghifar
- Department of Statistics, Faculty of Basic Sciences, Bu-Ali Sina University, Hamadan, Iran
| |
Collapse
|
10
|
Rocha de Moura MD, Margotto PR, Nascimento Costa K, Carvalho Garbi Novaes MR. Hypertension induced by pregnancy and neonatal outcome: Results from a retrospective cohort study in preterm under 34 weeks. PLoS One 2021; 16:e0255783. [PMID: 34407091 PMCID: PMC8372928 DOI: 10.1371/journal.pone.0255783] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 07/25/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The present study seeks to assess the impact of gestational hypertensive disorders on premature newborns below 34 weeks and to establish the main morbidities and mortality in the neonatal period and at 18 months. MATERIALS AND METHODS A retrospective observational study was carried out with 695 premature newborns of gestational age (GA) between 24 and 33 weeks and 6 days, born alive in the Neonatal ICU of Brasília's Mother and Child Hospital (HMIB), in the period from January 1, 2014, to July 31, 2019. In total, 308 infants were born to hypertensive mothers (G1) and 387 to normotensive mothers (G2). Twin pregnancies and diabetic patients with severe malformations were excluded. Outcomes during hospitalization and outcomes of interest were evaluated: respiratory distress syndrome (RDS), brain ultrasonography, diagnosis of bronchopulmonary dysplasia (BPD), diagnosis of necrotizing enterocolitis, retinopathy of prematurity, breastfeeding rate at discharge, survival at discharge and at 18 months of chronological age and relationship between weight and gestational age. RESULTS Newborns with hypertensive mothers had significantly lower measurements of birth weight and head circumference. The G1 group had a higher risk small for gestational age (OR 2.4; CI 95% 1.6-3.6; p <0.00), as well as a greater risk of being born with a weight less than 850 g (OR 2.4; 95% CI 1.2-3.5; p <0.00). Newborns of mothers with hypertension presented more necrotizing enterocolitis (OR 2.0; CI 95% 1.1-3.7); however, resuscitation in the delivery room and the need to use surfactant did not differ between groups, nor did the length of stay on mechanical ventilation, or dependence on oxygen at 36 weeks of gestational age. Survival was better in newborns of normotensive mothers, and this was a protective factor against death (OR 0.7; 95% CI 0.5-0.9; p <0.01). In the follow-up clinic, survival at 18 months of chronological age was similar between groups, with rates of 95.3% and 92.1% among hypertensive and normotensive mothers, respectively. Exclusive breastfeeding at discharge was 73.4% in the group of hypertensive women and 77.3% in the group of normotensive mothers. There were no significant differences between groups. CONCLUSION Among the analyzed outcomes, arterial hypertension during pregnancy can increase the risk of low weight, small babies for gestational age (SGA), deaths in the neonatal period and enterocolitis, with no differences in weight and survival at 18 months of chronological age. Arterial hypertension presents a high risk of prematurity in the neonatal period, with no difference at 18 months of age.
Collapse
MESH Headings
- Bronchopulmonary Dysplasia
- Enterocolitis, Necrotizing/epidemiology
- Enterocolitis, Necrotizing/physiopathology
- Female
- Gestational Age
- Humans
- Hypertension, Pregnancy-Induced/epidemiology
- Hypertension, Pregnancy-Induced/physiopathology
- Infant
- Infant Mortality
- Infant, Extremely Premature/physiology
- Infant, Newborn
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/physiopathology
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/physiopathology
- Infant, Small for Gestational Age/physiology
- Infant, Very Low Birth Weight/physiology
- Intensive Care Units, Neonatal
- Pregnancy
- Pregnancy Complications, Cardiovascular/epidemiology
- Pregnancy Complications, Cardiovascular/physiopathology
- Respiration, Artificial
- Respiratory Distress Syndrome, Newborn/epidemiology
- Respiratory Distress Syndrome, Newborn/physiopathology
- Retrospective Studies
Collapse
Affiliation(s)
| | - Paulo Roberto Margotto
- Neonatal Intensive Care Unit, Brasília Mother and Child Hospital, Asa Sul, Brasília, Brazil
| | | | | |
Collapse
|
11
|
Nasri F, Zare M, Hesampour F, Ahmadi M, Ali-Hassanzadeh M, Mostafaei S, Gharesi-Fard B. Are genetic variations in IL-1β and IL-6 cytokines associated with the risk of pre-eclampsia? Evidence from a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2021; 35:6600-6609. [PMID: 34275427 DOI: 10.1080/14767058.2021.1918092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis study was performed to assess the potential association between interleukin-1 beta (IL-1β) single nucleotide polymorphisms (SNPs) (rs1143634 and rs16944) and interleukin-6 (IL-6) SNP (rs1800795) and pre-eclampsia (PE). METHODS A comprehensive literature search was conducted in the international search engines and databases, including MEDLINE (via PubMed), Scopus, and Web of Science (ISI) up to 9 March 2021. After retrieving relevant articles, data extraction was performed by four authors independently. Pooled ORs and corresponding 95% CIs were used to evaluate the association between IL-1β and IL-6 polymorphisms and PE risk. Cochran's Q test was used to check heterogeneity, and the I2 index was calculated for measuring the heterogeneity between the estimations of included studies. RESULTS After reviewing fully published studies, 21 studies were included in this study based on the eligibility criteria. Our results showed that rs16944 and rs1143634 of IL-1β were significantly associated with the risk of PE. Regarding rs16944, the minor C allele significantly decreased the risk of PE (C vs. T: OR = 0.79, 95% CI = 0.69-0.90). In contrast, the minor T allele of rs1143634 significantly increased the risk of PE (T vs. C: OR = 1. 28, 95% CI = 1.04-1.58). There was no significant association between IL-6 rs1800795 (C vs. G: OR = 1.04, 95% CI = 0.93-1.16) polymorphism and PE risk. CONCLUSIONS In conclusion, this meta-analysis suggests rs1143634 and rs16944 polymorphisms of IL-1β are related to the risk of PE.
Collapse
Affiliation(s)
- Fatemeh Nasri
- Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Laboratory Sciences, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.,Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Zare
- Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Hesampour
- Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Moslem Ahmadi
- Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ali-Hassanzadeh
- Department of Immunology, School of Medicine, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Shayan Mostafaei
- Department of Biostatistics, Faculty of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Epidemiology and Biostatistics Unit, Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Behrouz Gharesi-Fard
- Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
12
|
Fox H, Topp SM, Lindsay D, Callander E. Ethnic, socio-economic and geographic inequities in maternal health service coverage in Australia. Int J Health Plann Manage 2021; 36:2182-2198. [PMID: 34270134 DOI: 10.1002/hpm.3277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 03/05/2021] [Accepted: 06/29/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Disparities in health service use exist in many sectors of Australia's health system, particularly affecting the most vulnerable people in the population, who are typically those with the greatest healthcare needs. Understanding patterns of health service coverage is critical for acknowledging the underlying, systemic drivers including racialised practices that inhibit the uptake of health services for certain population groups. This study aims to determine whether there are disparities in health service utilisation between socioeconomic, geographic and ethnic groups of mothers who experience hypertension, diabetes and mental health conditions. METHODS This study utilised a linked administrative healthcare dataset containing data of all mothers who gave birth in Queensland, Australia, between 2012 and 2015 (n = 186,789), plus their resultant babies (n = 189,909). The study compared health service utilisation for mothers with maternal health conditions between population groups. RESULTS The results of this study showed a broad trend of inequitable health service utilisation, with mothers who experienced the greatest healthcare needs-First Nations, rural and remote and socio-economically disadvantaged mothers-being less likely to access health services and in some cases when care was accessed, fewer services being utilised during the perinatal period. CONCLUSION Access to health care during the perinatal period is a reflection of Australia's general health system strengths and weaknesses, in particular a failure of the government to translate national and state policy intent into acceptable and accessible care in rural and remote areas, for First Nations women and for mothers experiencing socio-economic disadvantage.
Collapse
Affiliation(s)
- Haylee Fox
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Daniel Lindsay
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Emily Callander
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
13
|
Rouholamin S, Razavi M, Rezaeinejad M, Sepidarkish M. A diagnostic profile on the PartoSure test. Expert Rev Mol Diagn 2020; 20:1163-1170. [PMID: 33175636 DOI: 10.1080/14737159.2020.1848549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Introduction: Preterm birth (PTB) is common, occurring in over 10% of all live births globally, and is increasing worldwide. The limitations of traditional biomarkers of PTB, such as fetal fibronectin (fFN) and phosphorylated insulin-like growth factor-binding protein-1 (phIGFBP-1) have been well demonstrated in the literature. Therefore, augmenting clinical assessment with newer biomarkers, such as placental alpha macroglobulin-1 (PAMG-1); PartoSure, has the potential to improve disease monitoring and the best interventions. Areas covered: The present expert opinion evaluates the utility and limitations of PAMG-1; PartoSure as a biomarker for PTB in light of the current literature. Expert opinion: Although fFN, phIGFBP-1 and PAMG-1; PartoSure test had similar negative predictive value (NPV) and negative likelihood ratio (LR-), the PAMG-1; PartoSure test had the highest specificity, positive predictive value (PPV), and positive likelihood ratio (LR+) across all at-risk pregnant women. Although findings of this review may be encouraging, the PartoSure test should not be interpreted as absolute evidence for prediction of PTB. The PartoSure test result should always be used in conjunction with information available from the clinical evaluation of the pregnant woman and other diagnostic procedures such as cervical examination, assessment of uterine activity, and evaluation of other risk factors.
Collapse
Affiliation(s)
- Safoura Rouholamin
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences , Isfahan, Iran
| | - Maryam Razavi
- Pregnancy Health Research Center, Department of Obstetrics and Gynecology, School of Medicine, Zahedan University of Medical Sciences , Zahedan, Iran
| | - Mahroo Rezaeinejad
- Department of Obstetrics and Gynecology, Imam Khomeini Hospital, Tehran University of Medical Sciences , Tehran, Iran
| | - Mahdi Sepidarkish
- Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences , Babol, Iran
| |
Collapse
|
14
|
Lewandowska M, Więckowska B, Sajdak S, Lubiński J. Pre-Pregnancy Obesity vs. Other Risk Factors in Probability Models of Preeclampsia and Gestational Hypertension. Nutrients 2020; 12:nu12092681. [PMID: 32887442 PMCID: PMC7551880 DOI: 10.3390/nu12092681] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 08/29/2020] [Accepted: 08/31/2020] [Indexed: 12/11/2022] Open
Abstract
In the face of the obesity epidemic around the world, attention should be focused on the role of maternal obesity in the development of pregnancy. The purpose of this analysis was to evaluate the prediction of preeclampsia (PE) and isolated gestational hypertension (GH) for a number of maternal factors, in order to investigate the importance of pre-pregnancy obesity (body mass index, BMI ≥ 30 kg/m2), compared to other risk factors (e.g., prior PE, pregnancy weight gain (GWG), infertility treatment, interpregnancy interval, family history, the lack of vitamin supplementation, urogenital infection, and socioeconomic factors). In total, 912 women without chronic diseases were examined in a Polish prospective cohort of women with a singleton pregnancy (recruited in 2015–2016). Separate analyses were performed for the women who developed GH (n = 113) vs. 775 women who remained normotensive, as well as for those who developed PE (n = 24) vs. 775 controls. The probability of each disease was assessed for the base prediction model (age + primiparity) and for the model extended by one (test) variable, using logistic regression. Three measures were used to assess the prediction: area under curve (AUC) of the base and extended model, integrated discrimination improvement (IDI) (the index shows the difference between the value of the mean change in the predicted probability between the group of sick and healthy women when a new factor is added to the model), and net reclassification improvement (NRI) (the index focuses on the reclassification table describing the number of women in whom an upward or downward shift in the disease probability value occurred after a new factor had been added, including results for healthy and sick women). In the GH prediction, AUC increased most strongly when we added BMI (kg/m2) as a continuous variable (AUC = 0.716, p < 0.001) to the base model. The highest IDI index was obtained for prior GH/PE (IDI = 0.068, p < 0.001). The addition of BMI as a continuous variable or BMI ≥ 25 kg/m2 improved the classification for healthy and sick women the most (NRI = 0.571, p < 0.001). In the PE prediction, AUC increased most strongly when we added BMI categories (AUC = 0.726, p < 0.001) to the base model. The highest IDI index was obtained for prior GH/PE (IDI = 0.050, p = 0.080). The addition of BMI categories improved the classification for healthy and sick women the most (NRI = 0.688; p = 0.001). After summing up the results of three indexes, the probability of hypertension in pregnancy was most strongly improved by BMI, including BMI ≥ 25 kg/m2 for the GH prediction, and BMI ≥ 30 kg/m2 for the PE prediction. Main conclusions: Pre-pregnancy BMI was the most likely factor to increase the probability of developing hypertension in pregnancy, compared to other risk factors. Hierarchies of PE and GH risk factors may suggest different (or common) mechanisms of their development.
Collapse
Affiliation(s)
- Małgorzata Lewandowska
- Medical Faculty, Lazarski University, 02-662 Warsaw, Poland
- Division of Gynecological Surgery, University Hospital, 33 Polna Str., 60-535 Poznan, Poland;
- Correspondence:
| | - Barbara Więckowska
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, 60-806 Poznan, Poland;
| | - Stefan Sajdak
- Division of Gynecological Surgery, University Hospital, 33 Polna Str., 60-535 Poznan, Poland;
| | - Jan Lubiński
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, 71-252 Szczecin, Poland;
| |
Collapse
|
15
|
Fox H, Callander EJ. The cost of Hypertensive Disorders of Pregnancy to the Australian healthcare system. Pregnancy Hypertens 2020; 21:197-199. [PMID: 32634609 DOI: 10.1016/j.preghy.2020.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 05/27/2020] [Accepted: 06/26/2020] [Indexed: 11/18/2022]
Abstract
In Australia, Hypertensive Disorders of Pregnancy are one of the leading causes of maternal death. Additionally, mothers and babies can experience significant morbidity associated with Hypertensive Disorders of Pregnancy. Currently, there is little understanding about the resources spent on this pregnancy complication in Australia. Therefore, using a linked administrative dataset from the Queensland population in Australia, this study aims to determine the difference in government expenditure between mothers that have Hypertensive Disorders of Pregnancy and mothers who do not. The total government expenditure on mothers that had HDP was significantly higher than in mothers who did not have HDP ($14,388 and $11,395 respectively). Most notably, the greatest difference in costs were experienced during the time of birth ($8696 and $6509).
Collapse
Affiliation(s)
- Haylee Fox
- School of Nursing and Midwifery, Griffith University, Queensland, Australia.
| | - Emily J Callander
- School of Nursing and Midwifery, Griffith University, Queensland, Australia
| |
Collapse
|
16
|
The Impact of Sleep-Disordered Breathing on Severity of Pregnancy-Induced Hypertension and Feto-Maternal Outcomes. J Obstet Gynaecol India 2018; 69:111-121. [PMID: 31686743 DOI: 10.1007/s13224-018-1134-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 05/08/2018] [Indexed: 10/14/2022] Open
Abstract
Background There is a close association between sleep-disordered breathing (SDB) and preeclampsia. Both conditions have poor pregnancy outcomes. Methods Forty women with new-onset hypertension of pregnancy and 60 age-matched normotensive pregnant women were subjected to polysomnography. The maternal and fetal outcomes of all the subjects were noted. Results SDB occurs more frequently (p = 0.018; OR 13.1) and with more severity (p 0.001; OR 1.8) in women with hypertensive disorders of pregnancy even after controlling for pre-pregnancy body mass index (BMI). Furthermore, the BMI significantly correlated with both the Apnea-Hypopnea Index (AHI; r = 0.745; p < 0.001) and the blood pressure (r = 0.617; p < 0.001) highlighting the contribution of obesity in the causation of hypertension and SDB. We also found a significant correlation between AHI and blood pressure even after adjustment for BMI pointing toward an independent role of SDB in the development of hypertension (r = 0.612; p = 0.01). Maternal and fetal complications significantly correlated with different parameters of SDB-AHI, Arousal Index and minimum oxygen saturation, in the cases and with the fetal complications in the controls as well. Conclusion SDB occurs more frequently and with more severity in women with pregnancy-induced hypertension and is associated with more severe preeclampsia and adverse feto-maternal outcomes.
Collapse
|
17
|
Omani-Samani R, Amini Rarani M, Sepidarkish M, Khedmati Morasae E, Maroufizadeh S, Almasi-Hashiani A. Socioeconomic inequality of unintended pregnancy in the Iranian population: a decomposition approach. BMC Public Health 2018; 18:607. [PMID: 29739402 PMCID: PMC5941631 DOI: 10.1186/s12889-018-5515-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 04/26/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There are several studies regarding the predictors or risk factors of unintended pregnancy, but only a small number of studies have been carried out concerning the socio-economic factors influencing the unintended pregnancy rate. This study aimed to determine the socioeconomic inequality of unintended pregnancy in Tehran, Iran, as a developing country. METHODS In this hospital based cross-sectional study, 5152 deliveries from 103 hospitals in Tehran (the capital of Iran) were included in the analysis in July 2015. Socioeconomic status (SES) was measured through an asset-based method and principal component analysis was carried out to calculate the household SES. The concentration index and curve was used to measure SES inequality in unintended pregnancy, and then decomposed into its determinants. The data was analyzed by statistical Stata software. RESULTS The Wagstaff normalized concentration index of unintended pregnancy (- 0.108 (95% Confidence Interval (CI) = - 0.119 ~ - 0.054)) endorses that unintended pregnancy is more concentrated among poorer mothers. The results showed that SES accounted for 27% of unintended pregnancy inequality, followed by the mother's nationality (19%), father's age (16%), mother's age (10%), father's education level (7%) and Body Mass Index (BMI) groups (5%). CONCLUSION Unintended pregnancy is unequally distributed among Iranian women and is more concentrated among poor women. Economic status had the most positive contribution, explaining 27% of inequality in unintended pregnancy.
Collapse
Affiliation(s)
- Reza Omani-Samani
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, P.O. Box: 16635148, Tehran, Iran
| | - Mostafa Amini Rarani
- Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahdi Sepidarkish
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, P.O. Box: 16635148, Tehran, Iran
| | - Esmaeil Khedmati Morasae
- Department of Health Services Research, National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care North West Coast (NIHR CLAHRC NWC), Institute of Psychology, Health, and Society, University of Liverpool, Liverpool, UK
| | - Saman Maroufizadeh
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, P.O. Box: 16635148, Tehran, Iran
| | - Amir Almasi-Hashiani
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, P.O. Box: 16635148, Tehran, Iran
| |
Collapse
|
18
|
Rezaei M, Eskandari F, Mohammadpour-Gharehbagh A, Teimoori B, Yaghmaei M, Mokhtari M, Salimi S. The Drosha rs10719 T>C polymorphism is associated with preeclampsia susceptibility. Clin Exp Hypertens 2017; 40:440-445. [DOI: 10.1080/10641963.2017.1392555] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mahnaz Rezaei
- Department of Clinical Biochemistry, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
- Cellular and Molecular Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Fatemeh Eskandari
- Department of Clinical Biochemistry, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
- Cellular and Molecular Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Abbas Mohammadpour-Gharehbagh
- Department of Clinical Biochemistry, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
- Cellular and Molecular Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Batool Teimoori
- Department of Obstetrics and Gynecology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Minoo Yaghmaei
- Department of Obstetrics and Gynecology, School of Medicine, Shahid Beheshty University of Medical Sciences, Tehran, Iran
| | - Mojgan Mokhtari
- Department of Obstetrics and Gynecology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Saeedeh Salimi
- Department of Clinical Biochemistry, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
- Cellular and Molecular Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| |
Collapse
|