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Hassen TA, Chojenta C, Khan MN, Shifti DM, Harris ML. Short birth interval in the Asia-Pacific region: A systematic review and meta-analysis. J Glob Health 2024; 14:04072. [PMID: 38700432 PMCID: PMC11067827 DOI: 10.7189/jogh.14.04072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024] Open
Abstract
Background Short birth interval is associated with an increased risk of adverse health outcomes for mothers and children. Despite this, there is a lack of comprehensive evidence on short birth interval in the Asia-Pacific region. Thus, this study aimed to synthesise evidence related to the definition, classification, prevalence, and predictors of short birth interval in the Asia-Pacific region. Methods Five databases (MEDLINE, Scopus, Cumulative Index to Nursing and Allied Health Literature, Maternity and Infant Care, and Web of Science) were searched for studies published between September 2000 and May 2023 (the last search was conducted for all databases in May 2023). We included original studies published in English that reported on short birth interval in the Asia-Pacific region. Studies that combined birth interval with birth order, used multi-country data and were published as conference abstracts and commentaries were excluded. Three independent reviewers screened the articles for relevancy, and two reviewers performed the data extraction and quality assessment. The risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool. The findings were both qualitatively and quantitatively synthesised and presented. Results A total of 140 studies met the inclusion criteria for this review. About 58% (n = 82) of the studies defined short birth interval, while 42% (n = 58) did not. Out of 82 studies, nearly half (n = 39) measured a birth-to-birth interval, 37 studies measured a birth-to-pregnancy, four measured a pregnancy-to-pregnancy, and two studies measured a pregnancy loss-to-conception. Approximately 39% (n = 55) and 6% (n = 8) of studies classified short birth intervals as <24 months and <33 months, respectively. Most of the included studies were cross-sectional, and about two-thirds had either medium or high risk of bias. The pooled prevalence of short birth interval was 33.8% (95% confidence interval (CI) = 23.0-44.6, I2 = 99.9%, P < 0.01) among the studies that used the World Health Organization definition. Conclusions This review's findings highlighted significant variations in the definition, measurement, classification, and reported prevalence of short birth interval across the included studies. Future research is needed to harmonise the definition and classification of short birth interval to ensure consistency and comparability across studies and facilitate the development of targeted interventions and policies. Registration PROSPERO CRD42023426975.
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Affiliation(s)
- Tahir Ahmed Hassen
- Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Australia
| | - Catherine Chojenta
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Australia
| | - Md Nuruzzaman Khan
- Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Australia
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh
| | - Desalegn Markos Shifti
- Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Australia
- Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Melissa Leigh Harris
- Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Australia
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Úbeda F, Wild G. Microchimerism as a source of information on future pregnancies. Proc Biol Sci 2023; 290:20231142. [PMID: 37608718 PMCID: PMC10445024 DOI: 10.1098/rspb.2023.1142] [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: 05/23/2023] [Accepted: 07/27/2023] [Indexed: 08/24/2023] Open
Abstract
Small numbers of fetal cells cross the placenta during pregnancy turning mothers into microchimeras. Fetal cells from all previous pregnancies accumulate forming the mother's fetal microchiome. What is significant about microchimeric cells is that they have been linked to health problems including reproductive and autoimmune diseases. Three decades after the discovery of fetal microchimerism, the function of these cells remains a mystery. Here, we contend that the role of microchimeric cells is to inform the fetus about the likelihood that its genes are present in future pregnancies. We argue that, when genes are more likely than average to be in future maternal siblings, fetuses will send a fixed number of cells that will not elicit a maternal immune response against them. However, when genes are less likely to be in future maternal siblings, fetuses will send an ever-increasing number of cells that will elicit an ever-stronger maternal immune response. Our work can explain the observed clinical association between microchimeric cells and pre-eclampsia. However, our work predicts that this association should be stronger in women with a genetically diverse microchiome. If supported by medical tests, our work would allow establishing the likelihood of pregnancy or autoimmune problems advising medical interventions.
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Affiliation(s)
- Francisco Úbeda
- Department of Biological Sciences, Royal Holloway, University of London, Egham TW20 0EX, UK
| | - Geoff Wild
- Department of Mathematics, The University of Western Ontario, London, Ontario, Canada N6A 5B7
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Laskewitz A, Kieffer TEC, van Benthem KL, Erwich JJHM, Faas MM, Prins JR. Differences in Immune phenotype in decidual tissue from multigravid women compared to primigravid women. Am J Reprod Immunol 2023; 89:e13658. [PMID: 36414574 DOI: 10.1111/aji.13658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 10/26/2022] [Accepted: 11/15/2022] [Indexed: 11/24/2022] Open
Abstract
PROBLEM Women with a previous uncomplicated pregnancy have lower risks of immune-associated pregnancy disorders in a subsequent pregnancy. This could indicate a different maternal immune response in multigravid women compared to primigravid women. In a previous study, we showed persistent higher memory T cell proportions with higher CD69 expression after uncomplicated pregnancies. To our knowledge no studies have reported on immune cells in general, and immune memory cells and macrophages specifically in multigravid and primigravid women. METHOD OF STUDY T cells and macrophages were isolated from term decidua parietalis and decidua basalis tissue from healthy primigravid women (n = 12) and multigravid women (n = 12). Using flow cytometry, different T cell populations including memory T cells and macrophages were analyzed. To analyze whether a different immune phenotype is already present in early pregnancy, decidual tissue from uncomplicated ongoing pregnancies between 9 and 12 weeks of gestation from multigravida and primigravid women was investigated using qRT-PCR. RESULTS Nearly all T cell subsets analyzed in the decidua parietalis had significantly higher CD69+ proportions in multigravid women compared to primigravid women. A higher proportion of decidual (CD50- ) M2-like macrophages was found in the decidua parietalis in multigravid women compared to primigravid women. In first trimester decidual tissue higher FOXP3 mRNA expression was found in multigravid women compared to primigravid women. CONCLUSIONS This study shows that decidual tissue from multigravid women has a more activated and immunoregulatory phenotype compared to decidual tissue from primigravid women in early pregnancy and at term which could suggest a more balanced immune adaptation towards pregnancy after earlier uncomplicated pregnancies.
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Affiliation(s)
- Anne Laskewitz
- Division of Medical Biology, Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tom E C Kieffer
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Currently: Department of Obstetrics and Gynecology, OLVG, Amsterdam, The Netherlands
| | - Karlijn L van Benthem
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan Jaap H M Erwich
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marijke M Faas
- Division of Medical Biology, Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jelmer R Prins
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Jaatinen N, Jääskeläinen T, Ekholm E, Laivuori H, Laivuori H, Heinonen S, Kajantie E, Kere J, Kivinen K, Pouta A. Searching for a paternal phenotype for preeclampsia. Acta Obstet Gynecol Scand 2022. [DOI: 10.1111/aogs.14388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Noora Jaatinen
- Department of Obstetrics and Gynecology Turku University Central Hospital and University of Turku Turku Finland
- Department of Obstetrics and Gynecology University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Tiina Jääskeläinen
- Medical and Clinical Genetics University of Helsinki and Helsinki University Hospital Helsinki Finland
- Department of Food and Nutrition University of Helsinki Helsinki Finland
| | - Eeva Ekholm
- Department of Obstetrics and Gynecology Turku University Central Hospital and University of Turku Turku Finland
| | - Hannele Laivuori
- Medical and Clinical Genetics University of Helsinki and Helsinki University Hospital Helsinki Finland
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science University of Helsinki Helsinki Finland
- Department of Obstetrics and Gynecology Tampere University Hospital Tampere Finland
- Center for Child, Adolescent, and Maternal Health Research, Faculty of Medicine and Health Technology Tampere University Tampere Finland
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Garovic VD, Dechend R, Easterling T, Karumanchi SA, McMurtry Baird S, Magee LA, Rana S, Vermunt JV, August P. Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and Pharmacotherapy: A Scientific Statement From the American Heart Association. Hypertension 2022; 79:e21-e41. [PMID: 34905954 PMCID: PMC9031058 DOI: 10.1161/hyp.0000000000000208] [Citation(s) in RCA: 157] [Impact Index Per Article: 78.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Hypertensive disorders of pregnancy (HDP) remain one of the major causes of pregnancy-related maternal and fetal morbidity and mortality worldwide. Affected women are also at increased risk for cardiovascular disease later in life, independently of traditional cardiovascular disease risks. Despite the immediate and long-term cardiovascular disease risks, recommendations for diagnosis and treatment of HDP in the United States have changed little, if at all, over past decades, unlike hypertension guidelines for the general population. The reasons for this approach include the question of benefit from normalization of blood pressure treatment for pregnant women, coupled with theoretical concerns for fetal well-being from a reduction in utero-placental perfusion and in utero exposure to antihypertensive medication. This report is based on a review of current literature and includes normal physiological changes in pregnancy that may affect clinical presentation of HDP; HDP epidemiology and the immediate and long-term sequelae of HDP; the pathophysiology of preeclampsia, an HDP commonly associated with proteinuria and increasingly recognized as a heterogeneous disease with different clinical phenotypes and likely distinct pathological mechanisms; a critical overview of current national and international HDP guidelines; emerging evidence that reducing blood pressure treatment goals in pregnancy may reduce maternal severe hypertension without increasing the risk of pregnancy loss, high-level neonatal care, or overall maternal complications; and the increasingly recognized morbidity associated with postpartum hypertension/preeclampsia. Finally, we discuss the future of research in the field and the pressing need to study socioeconomic and biological factors that may contribute to racial and ethnic maternal health care disparities.
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Roble AK, Osman MO, Ibrahim AM, Wedajo GT, Abdi Usman S. Determinants of short birth interval among ever married reproductive age women living in Jigjiga, Eastern Ethiopia 2020 (unmatched case-control study). SAGE Open Med 2022; 9:20503121211067870. [PMID: 34992784 PMCID: PMC8725026 DOI: 10.1177/20503121211067870] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 12/02/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives: A short birth interval is a universal public health problem resulting in adverse maternal, neonatal, and child outcomes. Therefore, the aim of this study was to identify determinants of short birth interval among ever married reproductive age mothers who live in Jigjiga city administration, Eastern Ethiopia, 2020. Methods: A community-based unmatched case–control study was used among 194 cases and 194 controls in Jigjiga city administration from September to December 2020. Cases were women with short birth interval (less than 3 years) and controls were women with optimum birth interval (3–5 years). Simple random sampling technique was employed to select cases and controls. Data were entered into Epi data version 4.2 and analysis with SPSS version 22. Binary logistic regression with 95% confidence interval at p < 0.05 is used to declare significantly associated predictors of short birth interval. Result: This study reported that women who have not attended formal education (adjusted odds ratio = 5.28, 95% confidence interval: (2.25–12.36)), attended primary education (adjusted odds ratio = 2.79, 95% confidence interval: (1.46–5.34)), women who married to a polygamous husband (adjusted odds ratio = 3.69, 95% confidence interval: (1.80–7.58)), having a history of neonatal death (adjusted odds ratio = 2.15, 95% confidence interval: (1.07–4.32)), preceding child being female (adjusted odds ratio = 3.69, 95% confidence interval: (2.02–6.72)), and never used contraceptive methods (adjusted odds ratio = 3.69, 95% confidence interval: (2.02–6.72)) were identified as determinants of the short birth interval. Conclusion: Short birth intervals were associated with educational level of the women, sex of the baby, husband marriage types, history of neonatal death, and contraceptive utilization. Strategy should be engaged to enhance women education, contraceptive uses, and to decrease neonatal death.
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Affiliation(s)
- Abdurahman Kedir Roble
- Department of Midwifery, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
| | - Mohamed Omar Osman
- Department of Public Health, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
| | - Ahmed Mohamed Ibrahim
- Department of Public Health, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
| | - Girma Tadesse Wedajo
- Department of Public Health, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
| | - Seid Abdi Usman
- Department of Nursing, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
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Simanjuntak MK, Idris I, Sunarno I, Arifuddin S, Sinrang AW. Mean arterial pressure and the endothelin-1 levels in preeclampsia. GACETA SANITARIA 2021; 35 Suppl 2:S242-S244. [PMID: 34929821 DOI: 10.1016/j.gaceta.2021.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/30/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study aims to determine the correlation between Endothelin-1 levels and mean arterial pressure (MAP) with preeclampsia so that their combination can be used as the predictor of PE in early pregnancy. METHOD This study used a cross-sectional study with a case-control design carried out in February to June 2020 in several hospitals and health centers in Makassar city, namely Dr. Wahidin Soedirohusodo General Hospital, Hasanuddin University State University Hospital, health center Bara Baraya, health center Mamajang, and health center Antang. Respondents in this study were divided into 37 pregnant women with preeclampsia and 53 pregnant women with normotension. This study's criteria for respondents were 20-35 years old, single pregnancy with > 20 weeks gestational. Data collected included education, body mass index (BMI), parity, the interval of pregnancy, and gestational age. ET-1 levels were determined using th ET-1 Elisa Kit with the ELISA method, and MAP was collected by measuring blood pressure when pregnant women came to health facilities. RESULTS The mean serum ET-1 levels in the preeclampsia were highest than normotensive with a significant p-value of 0.001 (p<0.05). The MAP in the preeclampsia was highest than normotensive too, with a significant value of p-value 0.001 (p<0.05), and there is a positive correlation between ET-1 and MAP with r=0.34 and p-value 0.001 (p<0.05). CONCLUSION The combination of ET-1 and MAP can be considered as a prognostic factor to detect PE in early pregnancy.
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Affiliation(s)
| | - Irfan Idris
- Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | | | - Sharvianty Arifuddin
- Department of Midwifery, Graduate School, Hasanuddin University, Makassar, Indonesia
| | - Andi Wardihan Sinrang
- Department of Midwifery, Graduate School, Hasanuddin University, Makassar, Indonesia
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Thiele K, Ahrendt LS, Hecher K, Arck PC. The mnemonic code of pregnancy: Comparative analyses of pregnancy success and complication risk in first and second human pregnancies. J Reprod Immunol 2019; 134-135:11-20. [PMID: 31374263 DOI: 10.1016/j.jri.2019.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/21/2019] [Accepted: 06/23/2019] [Indexed: 11/16/2022]
Abstract
Obstetrical complications such as spontaneous abortion/miscarriage, fetal growth restriction, preeclampsia or preterm birth occur in approx. 15% of human pregnancies. Clinical experts often state that a previous uncomplicated pregnancy reduces the risk for complications in subsequent pregnancies. Vice versa, a prior pregnancy affected by obstetrical complications increases the risk for reoccurrence. However, published evidence directly underpinning these clinical statements is sparse. Considering that the maternal immune adaptation may be causally involved in determining the outcome of subsequent pregnancies, a comprehensive analysis of clinical data was long overdue. We here present a systematic analysis of clinical data using a PubMed-based approach to identify human studies with relevant information on birth weight and incidences of pregnancy complications in first and second pregnancies. From initially 18,592 publications, 37 studies were included in the quantitative data analysis. Women with a previous pregnancy affected by complications where a derailed immune response can be inferred have a 2.2-3.2-fold increased risk to be affected again in a subsequent pregnancy. Conversely, a normally progressing primary pregnancy reduced the risk for complications in a subsequent pregnancy by 35-65%. Moreover, an uncomplicated primary pregnancy was associated with a 4.2% increased birth weight in a following pregnancy without a difference in gestational age at delivery. In conclusion, the increased birth weight after previously uncomplicated pregnancies suggests that an immune memory is mounted during primary pregnancies. This immune memory may promote the successful outcome of subsequent pregnancies or - if missing or compromised - account for a risk perpetuation of pregnancy complications.
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Affiliation(s)
- Kristin Thiele
- Division of Experimental Feto-Maternal Medicine, Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Lisa Sophie Ahrendt
- Division of Experimental Feto-Maternal Medicine, Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Petra Clara Arck
- Division of Experimental Feto-Maternal Medicine, Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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