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Li Y, Zhong X, Yang M, Yuan L, Wang D, Li T, Guo Y. A risk prediction model of gestational diabetes mellitus based on traditional and genetic factors. J OBSTET GYNAECOL 2024; 44:2372665. [PMID: 38963181 DOI: 10.1080/01443615.2024.2372665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/21/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a prevalent pregnancy complication during pregnancy. We aimed to evaluate a risk prediction model of GDM based on traditional and genetic factors. METHODS A total of 2744 eligible pregnant women were included. Face-to-face questionnaire surveys were conducted to gather general data. Serum test results were collected from the laboratory information system. Independent risk factors for GDM were identified using univariate and multivariate logistic regression analyses. A GDM risk prediction model was constructed and evaluated with the Hosmer-Lemeshow goodness-of-fit test, goodness-of-fit calibration plot, receiver operating characteristic curve and area under the curve. RESULTS Among traditional factors, age ≥30 years, family history, GDM history, impaired glucose tolerance history, systolic blood pressure ≥116.22 mmHg, diastolic blood pressure ≥74.52 mmHg, fasting plasma glucose ≥5.0 mmol/L, 1-hour postprandial blood glucose ≥8.8 mmol/L, 2-h postprandial blood glucose ≥7.9 mmol/L, total cholesterol ≥4.50 mmol/L, low-density lipoprotein ≥2.09 mmol/L and insulin ≥11.5 mIU/L were independent risk factors for GDM. Among genetic factors, 11 single nucleotide polymorphisms (SNPs) (rs2779116, rs5215, rs11605924, rs7072268, rs7172432, rs10811661, rs2191349, rs10830963, rs174550, rs13266634 and rs11071657) were identified as potential predictors of the risk of postpartum DM among women with GDM history, collectively accounting for 3.6% of the genetic risk. CONCLUSIONS Both genetic and traditional factors contribute to the risk of GDM in women, operating through diverse mechanisms. Strengthening the risk prediction of SNPs for postpartum DM among women with GDM history is crucial for maternal and child health protection.
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Affiliation(s)
- Ying Li
- Xinjiang Medical University, Urumqi, China
| | - Xinli Zhong
- Department of Gynecology and Obstetrics, The First People's Hospital of Shuangliu District, Chengdu, China
| | - Mengjiao Yang
- Department of Laboratory, The First People's Hospital of Shuangliu District, Chengdu, China
| | - Lu Yuan
- Department of Endocrinology, The First People's Hospital of Shuangliu District, Chengdu, China
| | - Dandan Wang
- Department of Endocrinology, The First People's Hospital of Shuangliu District, Chengdu, China
| | - Ting Li
- Department of Endocrinology, The First People's Hospital of Shuangliu District, Chengdu, China
| | - Yanying Guo
- Department of Endocrinology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
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Jani A, Field K, Shields M, Cabiya M. Risk factors for readmission with preeclampsia: a call for more preventative surveillance and counseling. Arch Gynecol Obstet 2024; 310:899-905. [PMID: 38902403 DOI: 10.1007/s00404-024-07582-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 06/04/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Postpartum readmission for preeclampsia is a difficult predicament for patients which creates financial, psychosocial, and physical stress. It is often a challenge to predict postpartum preeclampsia and therefore identify patients that may be at risk prior to discharge. This study aims to identify risk factors in patients that are at high risk for readmission due to preeclampsia. The identification of these risk factors may also lead to enhanced education and counseling prior to discharge. METHODS Researchers conducted a case-control study using a data set collected from 2015 to 2022 looking at obstetric readmissions within 6 weeks of delivery and then stratified these patients for preeclampsia diagnosis. A control set was created within the healthcare system's electronic medical record's search tools for patients diagnosed with preeclampsia who were not readmitted to the hospital. This study evaluates 78 patients who were readmitted with a diagnosis of preeclampsia and compared to 77 patients who were diagnosed with preeclampsia who were not readmitted. Again, the aim of this study was to investigate risk factors for readmission among patients with preeclampsia. RESULTS A multivariable logistic regression model was used to assess predictors which revealed that older age (OR 1.13, CI 1.03-1.24), no history of preeclampsia with or without severe features within pregnancy before delivery (OR 15.29, CI 5.56-41.98 and 13.58, CI 4.46-12.85), no aspirin use in pregnancy (OR 4.38, CI 2.02-9.48), and number of triage visits related to hypertension during prenatal care were all significant predictors for readmission due to preeclampsia. CONCLUSION With these risk factors in mind, better counseling and preventative surveillance can be provided to patients. Future studies are needed to evaluate the effectiveness of predictive models developed using these found risk factors.
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Affiliation(s)
- Akash Jani
- Department of Obstetrics & Gynecology, Illinois Masonic Medical Center, Chicago, USA
| | - Kathryn Field
- Department of Obstetrics & Gynecology, Illinois Masonic Medical Center, Chicago, USA.
| | | | - Marie Cabiya
- Department of Obstetrics & Gynecology, Illinois Masonic Medical Center, Chicago, USA
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Tesega AE, Enyew A, Tesfaye DG, Geta G, Argaw M, Belay AE. Determinants of advanced age pregnancy in Ethiopian; multi-level analysis of Ethiopian demographic health survey 2016. PLoS One 2024; 19:e0304954. [PMID: 38917226 PMCID: PMC11198901 DOI: 10.1371/journal.pone.0304954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 05/22/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Advanced maternal-age pregnancy has become a serious public health problem in both developed and developing countries due to adverse birth outcomes for the mother, fetus, or newborn. However, there are limited studies conducted to identify determinants of advanced-age pregnancy in Ethiopia. Therefore, this study aimed to assess individual and community-level determinants of advanced age pregnancy in Ethiopia. METHODS This study was based on 2016 Ethiopian Demographic and Health Survey data. Three thousand two hundred ninety-two weighted samples of pregnant women were included in this analysis. A multilevel logistic regression model was conducted to assess the determinants of advanced-age pregnancy among the study participants in Ethiopia. RESULTS maternal age at first birth (AOR = 4.05, 95% CI: 1.77-9.22), level of maternal education [primary education 2.72 times (AOR = 2.27, 95 CI: 1.55-4.76) and secondary and above education (AOR = 5.65, 95% CI: 1.77-17.70)], having a history of alcohol (AOR = 11.8, 95% CI: 5.71-24.42), parity (AOR = 3.22, 95% CI: 2.69-3.84), number of household member (AOR = 1.22, 95% CI: 1.05-1.41), family planning unmet need for spacing of pregnancy (AOR = 4.79, 95% CI: 2.63-8.74), having sons/daughters elsewhere (AOR = 1.89, 95% CI: 1.22-2.94), had higher community poverty level (AOR = 2.37, 95% CI: 1.16-4.85), those had higher community unmet need for family planning (AOR = 5.19, 95% CI: 2.72-9.92) were more likely to have advanced age pregnancy. Whereas Living in an Emerging region (AOR = 0.29, 95% CI: 0.14-0.59) and living in a metropolitan city (AOR = 0.03, 95% CI: 0.03-0.38), were less likely to have advanced age pregnancy. CONCLUSIONS increased Maternal age at first birth, level of maternal education, history of alcohol drinking, increased number of parity and household members, family planning unmet need for spacing, had sons/daughters elsewhere, had higher community poverty level, those had higher community unmet need for family planning positively, whereas living in the emerging region and living in metropolitan's city was negatively affect advanced age pregnancy. Help women to have informed decision-making and create platforms to women have special care during this age of pregnancy. Empower women on family planning and socioeconomic status.
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Affiliation(s)
- Aynamaw Embiale Tesega
- Midwifery Department, College of Medicine and Health Science, Madda Walabu University, Bale Goba, Ethiopia
| | - Aynadis Enyew
- Marie Stopes International Ethiopia Shashemene BEmONC Center, Shashemene, Ethiopia
| | - Degefa Gomora Tesfaye
- Midwifery Department, College of Medicine and Health Science, Madda Walabu University, Bale Goba, Ethiopia
| | - Girma Geta
- Midwifery Department, College of Medicine and Health Science, Madda Walabu University, Bale Goba, Ethiopia
| | - Muche Argaw
- Midwifery Department, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Alamirew Enyew Belay
- Surgical Nursing Department, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
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Luo Y, Mo Y, Xiong Y, Huang S. The association between serum uric acid and low birth weight in advance maternal age women with hypertension: An observational study. Medicine (Baltimore) 2024; 103:e38486. [PMID: 38905390 PMCID: PMC11191933 DOI: 10.1097/md.0000000000038486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 05/16/2024] [Indexed: 06/23/2024] Open
Abstract
In China, the implementation of 2-child policy since 2015 entitles increasing number of advanced maternal age. Recently, Chinese hypertensive disorders of pregnancy (HDP) in advanced-age women have attracted significant clinical and epidemiological research interest. Previous studies have shown an association between serum uric acid (SUA) levels and low birth weight (LBW) in children. Several studies have reported that advanced maternal age is a risk factor for many complications in pregnancy, including LBW. However, it remains unclear whether SUA affects LBW risk in advanced maternal age mothers with hypertensive diseases. The study was observational in nature. A total of 692 advanced maternal age with hypertension were enrolled in our study. A variety of demographic and vital sign data, laboratory test results, and pregnancy outcomes were collected. Children born with LBW served as the clinical endpoint. On admission, blood samples were taken, and women with advanced maternal ages were divided into 2 groups based on their SUA levels. In order to investigate the association between SUA and LBW, a logistic regression model was used. E-value analysis was used to determine the residual unmeasured confounding. The mean SUA level was increased in advanced maternal age patients with HDP. Of 692 newborns, 244 (35.26%) have LBW. With possible confounders adjusted, high SUA levels were independent risk factors for LBW (odds ratio [OR]2.88, 95% confidence intervals [CI]1.22-6.81), multivariate logistic regression analysis using SUA as a continuous variable recapitulated the pattern (OR 1.01, 95% CI 1.00-1.01). In addition, SUA levels in women with advanced maternal age and hypertension were linearly related to LBW incidence. According to this study, SUA levels in patients with advanced maternal age and HDP are associated with LBW incidence.
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Affiliation(s)
- Yanlan Luo
- Cardiovascular Medicine Department, The First People’s Hospital of Changde, Hunan Province, China
| | - Yeping Mo
- Ultrasound Diagnosis Department, The First People’s Hospital of Changde, Hunan Province, China
| | - Yingzhu Xiong
- Brain Electrophysiology Department, The First People’s Hospital of Changde, Hunan Province, China
| | - Sulan Huang
- Cardiovascular Medicine Department, The First People’s Hospital of Changde, Hunan Province, China
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Schneider D, Bouhali F, Richter CG, Costache R, Costache C, Kirchhoffer K, Sheth V, MacDonald I, Hoeft F. Perinatal influences on academic achievement and the developing brain: a scoping systematic review. Front Psychol 2024; 15:1352241. [PMID: 38962224 PMCID: PMC11221367 DOI: 10.3389/fpsyg.2024.1352241] [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: 12/07/2023] [Accepted: 04/16/2024] [Indexed: 07/05/2024] Open
Abstract
Introduction and methods In this PRISMA-compliant systematic review, we identify and synthesize the findings of research in which neuroimaging and assessments of achievement have been used to examine the relationships among aspects of developmental programming, neurodevelopment, and achievement in reading and mathematics. Results Forty-seven studies met inclusion criteria. The majority examined the impact of prematurity (n = 32) and prenatal alcohol exposure (n = 13). Several prematurity studies reported a positive correlation between white-matter integrity of callosal fibers and executive functioning and/or achievement, and white matter properties were consistently associated with cognitive and academic performance in preterm and full-term children. Volumetric studies reported positive associations between academic and cognitive abilities and white and gray matter volume in regions such as the insula, putamen, and prefrontal lobes. Functional MRI studies demonstrated increased right-hemispheric language processing among preterm children. Altered activation of the frontoparietal network related to numerical abilities was also reported. Prenatal alcohol exposure studies reported alterations in white matter microstructure linked to deficits in cognitive functioning and academic achievement, including mathematics, reading, and vocabulary skills. Volumetric studies reported reductions in cerebral, cerebellar, and subcortical gray matter volumes associated with decreased scores on measures of executive functioning, attention, working memory, and academic performance. Functional MRI studies demonstrated broad, diffuse activation, reduced activation in canonical regions, and increased activation in non-canonical regions during numeric tasks. Discussion A preponderance of studies linked prematurity and prenatal alcohol exposure to altered neurodevelopmental processes and suboptimal academic achievement. Limitations and recommendations for future research are discussed. Systematic review registration Identifier: DOI 10.17605/OSF.IO/ZAN67.
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Affiliation(s)
- Deborah Schneider
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States
- Webster University, Geneva, Switzerland
| | | | - Caroline G. Richter
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Radu Costache
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States
| | - Catalina Costache
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States
| | - Kaitlyn Kirchhoffer
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States
| | - Vatsa Sheth
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States
| | - Ibo MacDonald
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Fumiko Hoeft
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States
- Department of Psychiatry and Behavioral Sciences and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
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范 咏, 张 文, 章 志. [Comparative Study of the Embryo Development and Clinical Outcomes of 3 Ovarian Stimulation Protocols in Different Age Groups]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2024; 55:580-587. [PMID: 38948300 PMCID: PMC11211777 DOI: 10.12182/20240560508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Indexed: 07/02/2024]
Abstract
Objective The main purpose of this study is to compare the embryo development and clinical outcomes of women in different age groups undergoing in vitro fertilization (IVF) processes using gonadotrophin-releasing hormone (GnRH) antagonist protocol, GnRH agonist long protocol, and early follicular phase protocol. We aim to provide reliable reference for future clinical treatments. Methods We conducted a detailed analysis of patients who underwent treatment between January 2021 and February 2023. 1) In the overall patient population, we comprehensively compared the basic characteristics, the embryo development, and the clinical outcomes of patients treated with three different ovarian stimulation protocols, including the GnRH antagonist protocol group (n=4173), the agonist long protocol group (n=2410), and the early follicular phase long protocol group (n=341). 2) We divided the overall population into three age groups, one group for patients under 30 years old (n=2576), one for patients aged 30-35 (n=3249), and one for patients older than 35 years old (n=1099). Then, we compared the three stimulation protocols based on the group division. We separately compared the embryo development and clinical outcomes of patients using the three stimulation protocols in the under 30 years old, the 30-35 years old, and the over 35 years old age groups. With this analysis, we aimed to explore the response of different age groups to different stimulation protocols and their impact on the success rate of IVF. Results 1) In the overall population, we found that the average number of oocytes retrieved in the GnRH agonist long protocol group was significantly higher than that in the GnRH antagonist protocol group ([13.85±7.162] vs. [13.36±7.862], P=0.0224), as well as the early follicular phase long protocol group ([13.85±7.162] vs. [11.86±6.802], P<0.0001). Patients in the GnRH antagonist protocol group not only had a significantly lower starting dose of gonadotrophin (Gn) compared to the other two groups (P<0.05) but also had a significantly lower number of days of Gn use (P<0.05). The blastocyst formation rate in the GnRH antagonist protocol group was the highest among the three groups, significantly higher compared to the GnRH agonist long protocol group (64.91% vs. 62.35%, P<0.0001) and the early follicular phase long protocol group (64.91% vs. 61.18%, P=0.0001). However, there were no significant differences in the clinical pregnancy rates or the live birth rates among the three groups treated with different ovarian stimulation protocols (P>0.05). 2) In the <30 age group, the blastocyst formation rate in the GnRH antagonist protocol group was the highest among the three groups, significantly higher compared to the GnRH agonist long protocol group (66.12% vs. 63.33%, P<0.0001) and the early follicular phase long protocol group (66.12% vs. 62.13%, P=0.0094). In the 30-35 age group, the blastocyst formation rate in the GnRH antagonist protocol group was the highest among the three groups, significantly higher compared to the GnRH agonist long protocol group (64.88% vs. 62.93%, P=0.000 9) and the early follicular phase long protocol group (64.88% vs. 60.39%, P=0.0011). In the >35 age group, the blastocyst formation rate in the GnRH antagonist protocol group was significantly higher than that in the GnRH agonist long protocol group (59.83% vs. 56.51%, P=0.0093), while there was no significant difference compared to that of the early follicular phase long protocol group (P>0.05). In the three age groups, we found that there were no significant differences in clinical pregnancy rate, live birth rate, and neonatal outcome indicators (fetal weight and Apgar score) among the three stimulation protocols (antagonist protocol, GnRH agonist long protocol, and early follicular phase long protocol) (P>0.05). The findings showed no significant differences between clinical and neonatal outcomes in patients of all ages, regardless of the ovarian stimulation protocol, suggesting that the three ovarian stimulation protocols have similar therapeutic effects in patients of different ages. The results of this study have important implications for the selection of an appropriate ovarian stimulation protocol and the prediction of treatment outcomes. Conclusion In the younger than 30 and 30-35 age groups, the GnRH antagonist protocol showed a more significant advantage over the GnRH agonist long protocol and the early follicular phase long protocol. This suggests that for younger and middle-aged patients, the antagonist protocol may lead to better outcomes during ovarian stimulation. In the older than 35 age group, while the antagonist protocol still outperformed the GnRH agonist long protocol, there was no significant difference compared to the early follicular phase long protocol. This may imply that with increasing age, the early follicular phase long protocol may have effects similar to the antagonist protocol to some extent. The advantages of the antagonist protocol lie in its ability to reduce stimulation duration and the dosage of GnRH, while enhancing patient compliance with treatment. This means that patients may find it easier to accept and adhere to this treatment protocol, thereby improving treatment success rates. Particularly for older patients, the use of the antagonist protocol may significantly increase the blastocyst formation rate, which is crucial for improving the success rates. Although there were no significant differences in the clinical outcomes of patients treated with the three protocols in each age group, further research is still needed to validate these findings. Future multicenter studies and increased sample sizes may help comprehensively assess the efficacy of different stimulation protocols. Additionally, prospective studies are needed to further validate these findings and determine the optimal treatment strategies.
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Affiliation(s)
- 咏琪 范
- 安徽医科大学第一附属医院 妇产科生殖中心 (合肥 230032)Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei 230032, China
| | - 文香 张
- 安徽医科大学第一附属医院 妇产科生殖中心 (合肥 230032)Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei 230032, China
| | - 志国 章
- 安徽医科大学第一附属医院 妇产科生殖中心 (合肥 230032)Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei 230032, China
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Masembe S, Migisha R, Turyasingura G, Aheisibwe H, Nzabandora E, Lule JC. Adverse maternal outcomes and associated factors among mothers of advanced age delivering at a tertiary hospital, southwestern Uganda: a cross-sectional study. BMC Pregnancy Childbirth 2024; 24:348. [PMID: 38714930 PMCID: PMC11075274 DOI: 10.1186/s12884-024-06557-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/29/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Mothers of advanced age, defined as pregnant women aged ≥ 35 years at the time of giving birth, are traditionally known to be associated with increased risks of adverse maternal outcomes. We determined the prevalence of adverse maternal outcomes and associated factors among mothers of advanced age who delivered at Kabale Regional Referral Hospital (KRRH), in Southwestern Uganda. METHODS We conducted a cross-sectional study at the Maternity Ward of KRRH from April to September 2023. We consecutively enrolled pregnant women aged ≥ 35 years during their immediate post-delivery period and before discharge. We obtained data on their socio-demographic, obstetric, medical characteristics and their maternal outcomes using interviewer-administered questionnaires. We defined adverse maternal outcome as any complication sustained by the mother that was related to pregnancy, delivery and immediate post-partum events (obstructed labour, antepartum haemorrhage, mode of delivery [cesarean or vacuum extraction], postpartum haemorrhage, hypertensive disorders of pregnancy, preterm or postdate pregnancy, anemia, premature rupture of membranes, multiple pregnancy, and maternal death). A participant was considered to have an adverse outcome if they experienced any one of these complications. We identified factors associated with adverse outcomes using modified Poisson regression. RESULTS Out of 417 participants, most were aged 35-37 years (n = 206; 49.4%), and had parity ≥ 5 (65.5%). The prevalence of adverse maternal outcomes was 37.6% (n = 157, 95%CI: 33.1-42.4%). Common adverse maternal outcomes included caesarian delivery (23%), and obstructed labour (14.4%). Other complications included anemia in pregnancy (4.5%), chorioamnionitis (4.1%), preterm prelabour rupture of membranes (3.9%), and chronic hypertension and preeclampsia (both 2.4%). Factors associated with adverse maternal outcomes were precipitate labour (adjusted prevalence ratio [aPR] = 1.95, 95%CI: 1.44-2.65), prolonged labour, lasting > 12 h (aPR = 2.86, 95%CI: 1.48-3.16), and chronic hypertension (aPR = 2.01, 95%CI: 1.34-3.9). CONCLUSION Approximately two-fifth of the advanced-aged mothers surveyed had adverse outcomes. Mothers with prolonged labour, precipitate labour and chronic hypertension were more likely to experience adverse outcomes. We recommend implementation of targeted interventions, emphasizing proper management of labor as well as close monitoring of hypertensive mothers, and those with precipitate or prolonged labor, to mitigate risks of adverse outcomes within this study population.
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Affiliation(s)
- Sezalio Masembe
- Department of Obstetrics and Gynaecology, Kabale School of Medicine, Kabale University, P.0 Box 317, Kabale, Uganda.
| | - Richard Migisha
- Department of Physiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Godwin Turyasingura
- Department of Obstetrics and Gynaecology, Kabale School of Medicine, Kabale University, P.0 Box 317, Kabale, Uganda
| | - Hillary Aheisibwe
- Department of Obstetrics and Gynaecology, Kabale Regional Referral Hospital, Kabale, Uganda
| | - Emmanuel Nzabandora
- Department of Obstetrics and Gynaecology, Kabale Regional Referral Hospital, Kabale, Uganda
| | - John C Lule
- Department of Obstetrics and Gynaecology, Kabale School of Medicine, Kabale University, P.0 Box 317, Kabale, Uganda
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Davis OS, Favetta LA, Deniz S, Faghih M, Amin S, Karnis M, Neal MS. Potential Costs and Benefits of Incorporating PGT-A Across Age Groups: A Canadian Clinic Perspective. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102361. [PMID: 38272217 DOI: 10.1016/j.jogc.2024.102361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 01/27/2024]
Abstract
OBJECTIVE To assess the potential costs and benefits of preimplantation genetic testing for aneuploidy (PGT-A) across age groups, considering financial costs, total euploidy rates and the potential for morphology grading to predict a euploid embryo. METHODS This study is a blinded retrospective chart review of patients who incorporated PGT-A as part of their in vitro fertilization (IVF) treatment cycle at a university-affiliated fertility clinic. Patients between 25-44 years of age undergoing IVF with intracytoplasmic sperm injection and PGT-A with autologous oocytes (n = 220) were included in this study. Number of blastocysts achieved, euploidy rates and PGT-A costs were compared between 3 age groups: <35 years, 35-37, and ≥38. Additionally, agreement on the top-quality embryo based on morphology assessment alone versus PGT-A selection was analyzed and further compared based on the number of blastocysts achieved. RESULTS A significant negative correlation between patient age and number of embryos produced, PGT-A costs, and euploidy rates (P < 0.001) was observed. Additionally, morphology alone ratings were able to predict the top-quality euploid embryo 78% of the time in the <35 age group, but only 32% of the time in the ≥38 age group (P < 0.05), with a trend toward even lower agreement when 3 or fewer blastocysts were produced. CONCLUSION Based on our cost analysis, it may be advantageous to incorporate PGT-A when maternal age is ≥38, given the lower financial costs associated with each cycle and the low likelihood of transferring a euploid embryo on the first attempt for this age group. Nevertheless, we acknowledge that PGT-A remains a complex decision influenced by a multitude of factors.
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Affiliation(s)
- Ola S Davis
- Reproductive Health and Biotechnology Lab, Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Laura A Favetta
- Reproductive Health and Biotechnology Lab, Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Stacy Deniz
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McMaster University, Hamilton, ON, Canada; ONE Fertility, Burlington, ON, Canada
| | - Mehrnoosh Faghih
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McMaster University, Hamilton, ON, Canada; ONE Fertility, Burlington, ON, Canada
| | - Shilpa Amin
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McMaster University, Hamilton, ON, Canada; ONE Fertility, Burlington, ON, Canada
| | - Megan Karnis
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McMaster University, Hamilton, ON, Canada; ONE Fertility, Burlington, ON, Canada
| | - Michael S Neal
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McMaster University, Hamilton, ON, Canada; ONE Fertility, Burlington, ON, Canada.
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Han Y, Wang D, Cai S, Zhang L, Xue J. Resolvin D1 level during different trimesters of pregnancy for predicting the risk of fetal growth retardation in elderly pregnancy. Scand J Clin Lab Invest 2024; 84:154-159. [PMID: 38639268 DOI: 10.1080/00365513.2024.2338739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/01/2024] [Indexed: 04/20/2024]
Abstract
Resolvin D1 (RvD1) is potentially associated with fetal growth retardation (FGR) through alleviating maternal inflammation and its linkage with several pregnancy complications. Thus, this study detected RvD1 levels at different trimesters of pregnancy, aiming to investigate its role in predicting FGR risk of elderly pregnant women. This prospective, observational cohort study enrolled 165 elderly pregnant women aged ≥35 years. Serum RvD1 was detected at 10-13 weeks (early pregnancy), 20-23 weeks (middle pregnancy), and 30-33 weeks (late pregnancy) of gestational week by enzyme-linked immunosorbent assay. RvD1 was varied among different trimesters of pregnancy in elderly pregnant women (p < 0.001). FGR occurred in 25 (15.2%) women in this study. RvD1 at early (p = 0.009), middle (p = 0.002), and late (p = 0.003) pregnancy was decreased in women with FGR versus those without. By multivariate analysis, RvD1 at middle pregnancy (odds ratio (OR): 0.477, p < 0.001), pre-pregnancy body mass index (OR: 0.763, p = 0.025), and gestational diabetes mellitus (yes versus no) (OR: 0.071, p = 0.031) were independently correlated with declined FGR risk. While age (OR: 1.382, p = 0.009) was independently associated with elevated risk of FGR. Furthermore, the combination of these independent factors as a predictive model exhibited a good potential for assessing FGR risk (area under the curve: 0.802, 95% confidence interval: 0.711-0.894). In conclusion, RvD1 at different trimesters of pregnancy is negatively linked with the risk of FGR, whose level at middle pregnancy serves as an independent factor for FGR risk in elderly pregnant women.
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Affiliation(s)
- Ying Han
- Department of Ultrasound, Xianxian Hospital of TCM, Xianxian, China
| | - Dandan Wang
- Department of Ultrasound, Xianxian Hospital of TCM, Xianxian, China
| | - Shufang Cai
- Department of Gynecology and Obstetrics, Xianxian Hospital of TCM, Xianxian, China
| | - Lina Zhang
- Department of Gynecology and Obstetrics, Mengcun Hui Autonomous County Hospital, Cangzhou, China
| | - Jingxian Xue
- Department of Gynecology, Shijiazhuang Changcheng Hospital of Integrated Traditional Chinese and Western Medicine, Shijiazhuang, China
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Savukyne E, Kliucinskas M, Malakauskiene L, Berskiene K. Caesarean Section Scar and Placental Location at the First Trimester of Pregnancy-A Prospective Longitudinal Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:719. [PMID: 38792902 PMCID: PMC11123301 DOI: 10.3390/medicina60050719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/13/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: This study aims to report the location of the placenta in the first trimester of pregnancy in groups of women according to the number of previous caesarean deliveries and the visibility of the caesarean scar niche. Materials and Methods: The prospective observational research included adult women aged 18 to 41 years during pregnancy after one or more previous caesarean sections (CSs). Transvaginal (TVS) and transabdominal sonography (TAS) was used to examine the uterine scar and placental location during 11-14 weeks. The CS scar niche ("defect") was bordered in the sagittal plane as a notch at the previous CS scar's site with a depth of 2.0 mm or more. A comparative analysis of the placental location (high or low and anterior or posterior) was performed between groups of women according to the CS number and the CS scar niche. Results: A total of 122 participants were enrolled during the first-trimester screening. The CS scar defect ("niche") was visible in 40.2% of cases. In cases after one previous CS, the placenta was low in the uterine cavity (anterior or posterior) at 77.4%, and after two or more CSs, it was at 67.9%. Comparing the two groups according to the CS scar niche, the placenta was low in 75.5% of cases in the participant group with a CS scar niche and in 75% of cases without a CS scar niche (p = 0.949). Conclusions: The number of previous caesarean deliveries has no effect on the incidence rate of low-lying placentas in the first trimester. Moreover, the presence of the CS scar niche is not associated with anterior low-lying placentas.
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Affiliation(s)
- Egle Savukyne
- Department of Obstetrics and Gynaecology, Medicine Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (M.K.); (L.M.)
| | - Mindaugas Kliucinskas
- Department of Obstetrics and Gynaecology, Medicine Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (M.K.); (L.M.)
| | - Laura Malakauskiene
- Department of Obstetrics and Gynaecology, Medicine Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (M.K.); (L.M.)
| | - Kristina Berskiene
- Department of Sports Medicine, Lithuanian University of Health Sciences, Tilzes Street’ 18, 47181 Kaunas, Lithuania;
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11
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Su Q, Pan Z, Yin R, Li X. The value of G-CSF in women experienced at least one implantation failure: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2024; 15:1370114. [PMID: 38694938 PMCID: PMC11061619 DOI: 10.3389/fendo.2024.1370114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 03/22/2024] [Indexed: 05/04/2024] Open
Abstract
Objective Despite the developments of in vitro fertilization (IVF) protocols, implantation failure remains a challenging problem, owing to the unbalance between the embryo, endometrium, and immune system interactions. Effective treatments are urgently required to improve successful implantation. Recently, many researchers have focused on granulocyte colony-stimulating factor (G-CSF) to regulate immune response and embryo-endometrium cross-talk. However, previous studies have reported inconsistent findings on the efficacy of G-CSF therapy on implantation failure. The objective of this review was to further explore the effects of G-CSF according to administration dosage and timing among women who experienced at least one implantation failure. Methods We systematically searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, Scopus, and Web of Science for randomized controlled trials of G-CSF on implantation failure up to July 21, 2023. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated and the heterogeneity of the studies with the I2 index was analyzed. Results We identified a total of 2031 studies and finally included 10 studies in the systematic review and meta-analysis. G-CSF administration improved the clinical pregnancy rate (CPR), implantation rate (IR), biochemical pregnancy rate (BPR), and live birth rate (LBR) in women with at least one implantation failure. Subgroup analyses showed that G-CSF treatment could exert good advantages in improving CPR [OR=2.49, 95%CI (1.56, 3.98), I2 = 0%], IR [OR=2.82, 95%CI (1.29, 6.15)], BPR [OR=3.30, 95%CI (1.42, 7.67)] and LBR [OR=3.16, 95%CI (1.61, 6.22), I2 = 0%] compared with the blank control group. However, compared with placebo controls, G-CSF showed beneficial effects on CPR [OR=1.71, 95%CI (1.04, 2.84), I2 = 38%] and IR [OR=2.01, 95%CI (1.29, 3.15), I2 = 24%], but not on LBR. In addition, >150μg of G-CSF treatment increased CPR [OR=2.22, 95%CI (1.47, 3.35), I2 = 0%], IR [OR=2.67, 95%CI (1.47, 4.82), I2 = 0%] and BPR [OR=2.02, 95%CI (1.17, 3.47), I2 = 22%], while ≤150μg of G-CSF treatment improved miscarriage rate (MR) [OR=0.14, 95%CI (0.05, 0.38), I2 = 0%] and LBR [OR=2.65, 95%CI (1.56, 4.51), I2 = 0%]. Moreover, G-CSF administration on the day of embryo transfer (ET) could increase CPR [OR=2.81, 95%CI (1.37, 5.75), I2 = 0%], but not on the day of ovum pick-up (OPU) or human chorionic gonadotropin (HCG) injection. Conclusion G-CSF has a beneficial effect on pregnancy outcomes to some extent among women who experienced at least one implantation failure, and the administration dosage and timing influence the effect size.Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023447046.
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Affiliation(s)
- Qing Su
- Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing, China
| | - Zhuo Pan
- Center for Reproductive Medicine, Chongqing Key Laboratory of Human Embryo Engineering, Chongqing Reproduction Genetics Institute, Chongqing Health Center for Women and Children, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Rong Yin
- Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing, China
| | - Xuemei Li
- Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing, China
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Schreiber H, Cohen G, Shalev-Ram H, Heresco L, Daykan Y, Arbib N, Biron-Shental T, Markovitch O. Vacuum-assisted delivery outcomes: is advanced maternal age a factor? Arch Gynecol Obstet 2024; 309:1281-1286. [PMID: 36867307 DOI: 10.1007/s00404-023-06983-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/14/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE This study evaluated age-related maternal outcomes of vacuum-assisted vaginal deliveries (VAD). METHODS This retrospective cohort study included all nulliparous women with singleton VAD in one academic institution. Study group parturients were maternal age ≥ 35 years and controls < 35. Power analysis revealed that 225 women/group would be sufficient to detect a difference in the rate of third- and fourth-degree perineal tears (primary maternal outcome) and umbilical cord pH < 7.15 (primary neonatal outcome). Secondary outcomes were maternal blood loss, Apgar scores, cup detachment, and subgaleal hematoma. Outcomes were compared between groups. RESULTS From 2014 to 2019, 13,967 nulliparas delivered at our institution. Overall, 8810 (63.1%) underwent normal vaginal delivery, 2432 (17.4%) instrumental, and 2725 (19.5%) cesarean. Among 11,242 vaginal deliveries, 10,116 (90%) involved women < 35, including 2067 (20.5%) successful VAD vs. 1126 (10%) women ≥ 35 years with 348 (30.9%) successful VAD (p < 0.001). Rates of third- and fourth-degree perineal lacerations were 6 (1.7%) with advanced maternal age and 57 (2.8%) among controls (p = 0.259). Cord pH < 7.15 was similar: 23 (6.6%) study group and 156 (7.5%) controls (p = 0.739). CONCLUSION Advanced maternal age and VAD are not associated with higher risk for adverse outcomes. Older, nulliparous women are more likely to undergo vacuum delivery than younger parturients.
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Affiliation(s)
- Hanoch Schreiber
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Gal Cohen
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hila Shalev-Ram
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Heresco
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Daykan
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nissim Arbib
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Biron-Shental
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Markovitch
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Yu Z, Dong Y, Chen Y, Aleya L, Zhao Y, Yao L, Gu W. It is time to explore the impact of length of gestation and fetal health on the human lifespan. Aging Cell 2024; 23:e14157. [PMID: 38558485 PMCID: PMC11019132 DOI: 10.1111/acel.14157] [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: 12/13/2023] [Revised: 02/20/2024] [Accepted: 03/12/2024] [Indexed: 04/04/2024] Open
Abstract
A recently proposed principal law of lifespan (PLOSP) proposes to extend the whole human lifespan by elongating different life stages. As the preborn stage of a human being, gestation is the foundation for the healthy development of the human body. The antagonistic pleiotropy (AP) theory of aging states that there is a trade-off between early life fitness and late-life mortality. The question is whether slower development during the gestation period would be associated with a longer lifespan. Among all living creatures, the length of the gestation period is highly positively correlated to the length of the lifespan, although such a correlation is thought to be influenced by the body sizes of different species. While examining the relationship between lifespan length and body size within the same species, dogs exhibit a negative correlation between lifespans and body sizes, while there is no such correlation among domestic cats. For humans, most adverse gestational environments shorten the period of gestation, and their impacts are long-term. While many issues remain unsolved, various developmental features have been linked to the conditions during the gestation period. Given that the length of human pregnancies can vary randomly by as long as 5 weeks, it is worth investigating whether a slow steady healthy gestation over a longer period will be related to a longer and healthier lifespan. This article discusses the potential benefits, negative impacts, and challenges of the relative elongation of the gestation period.
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Affiliation(s)
- Zhuo Yu
- Heilongjiang Academy of Traditional Chinese MedicineHarbinChina
| | - Yushan Dong
- Graduate School of Heilongjiang University of Chinese MedicineHarbinHeilongjiangChina
| | - Yuhan Chen
- Guang'anmen Hospital, China Academy of Chinese Medical SciencesBeijingChina
| | - Lotfi Aleya
- Chrono‐Environnement Laboratory, UMR CNRS 6249Bourgogne Franche‐Comté UniversityBesançon CedexFrance
| | - Yinhuan Zhao
- Department of Rheumatism, Shanghai Traditional Chinese Medicine Integrated HospitalShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Lan Yao
- College of Health Management, Harbin Medical UniversityHarbinHeilongjiangChina
- Department of Orthopedic Surgery and BME‐Campbell ClinicUniversity of Tennessee Health Science CentreMemphisTennesseeUSA
| | - Weikuan Gu
- Department of Orthopedic Surgery and BME‐Campbell ClinicUniversity of Tennessee Health Science CentreMemphisTennesseeUSA
- Research Lt. Col. Luke WeathersJr. VA Medical CenterMemphisTennesseeUSA
- Department of Pharmaceutical SciencesUniversity of Tennessee Health Science CenterMemphisTennesseeUSA
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14
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Damiri B, Abumohsen H, BelKebir S, Hamdan M, Saudi L, Hindi H, Abdaldaem R, Bustami B, Almusleh A, Yasin O. The epidemiology of gestational diabetes, gestation hypertension, and anemia in North Palestine from 2018 to 2020: A retrospective study. PLoS One 2024; 19:e0301145. [PMID: 38551942 PMCID: PMC10980252 DOI: 10.1371/journal.pone.0301145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/11/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND In Palestine, women face a challenging environment and a demanding lifestyle, which puts them at a higher risk of experiencing complications during pregnancy. This study aimed to examine the risk factors linked with abnormal hemoglobin (Hb) levels, gestational diabetes (GD), and gestational hypertension (GH) among pregnant women. The results was compared between women residing in cities or villages areas and those in refugee camps. METHODS Medical records (N = 7889) for pregnant women at primary healthcare centers in the North West Bank were reviewed for sociodemographic and medical data along with the reported fasting blood sugar, hemoglobin, and blood pressure in the first and second trimesters from July 2018 to July 2020. However, only 6640 were included in the analysis as 1249 were excluded for having multiple pregnancy or lost to follow up. Complications and risk factors were defined according to the available global guidelines. Then, descriptive analysis was used to show the percentages of different risk factors and complications among them. The correlation between the several characteristics and variables with these complications was assessed by calculating the odds ratios (OR) using logistic regression. P-values of <0.05 were considered significant. RESULTS The prevalence of adolescent pregnancy was the highest among women living in rural areas (9.8%) and grand multigravidity among refugee women (22%). The overall prevalence of anemia was higher in the second-trimester (16.2%) than in the first-trimester (11.2%), with anemic women in the first-trimester being more likely to be anemic in the second-trimester (OR = 8.223, P-value<0.001). Although anemia was less common in the first-trimester among refugees than among women living in urban areas (OR = 0.768, P-value = 0.006), it was more prevalent in the second-trimester (OR = 1.352, P-value<0.001). Moreover, refugee women were at lower risk than women living in urban areas of having GD (OR = 0.687, P-value<0.001) and diabetes mellitus (OR = 0.472, P-value<0.001) in the second-trimester. GH was associated with GD (OR = 1.401, P-value = 0.003) and DM (OR = 1.966, P-value<0.001). CONCLUSION The findings of this study provide evidence-based data on the considerable prevalence of pregnancy complications, anemia, GD, and GH among Palestinian pregnant women living in the north of the West Bank. Multi gravida, gestational age, Hb levels, and the type of settings were strong predictors of pregnancy complications. Therefore, a national plan is needed to ensure adequate maternal care for all, especially disadvantaged women, those in rural areas and refugee camps.
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Affiliation(s)
- Basma Damiri
- Medicine & Health Science Faculty, Drug, and Toxicology Division, An-Najah National University, Nablus, Palestine
| | - Haytham Abumohsen
- Medicine & Health Science Faculty, Department of Medicine, An-Najah National University, Nablus, Palestine
| | - Souad BelKebir
- Medicine & Health Science Faculty, Family and Community Medicine, An-Najah National University, Nablus, Palestine
| | - Mahmoud Hamdan
- Medicine & Health Science Faculty, Graduate School, Clinical Laboratory Science Program, An-Najah National University, Nablus, Palestine
| | - Lubna Saudi
- Medicine & Health Science Faculty, Family and Community Medicine, An-Najah National University, Nablus, Palestine
| | - Hiba Hindi
- Medicine & Health Science Faculty, Department of Medicine, An-Najah National University, Nablus, Palestine
| | - Rawnaq Abdaldaem
- Medicine & Health Science Faculty, Department of Medicine, An-Najah National University, Nablus, Palestine
| | - Baraa Bustami
- Medicine & Health Science Faculty, Department of Medicine, An-Najah National University, Nablus, Palestine
| | - Abeer Almusleh
- Medicine & Health Science Faculty, Department of Medicine, An-Najah National University, Nablus, Palestine
| | - Osama Yasin
- Medicine & Health Science Faculty, Department of Medicine, An-Najah National University, Nablus, Palestine
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Ji JS, Liu L, Huang H, Chen HW, Xiao L, Lu XY, Ni YY, Jia WJ, Huang L. The body mass index and the risk of ectopic pregnancy: a 5-year retrospective case-control study. BMC Pregnancy Childbirth 2024; 24:143. [PMID: 38368325 PMCID: PMC10873945 DOI: 10.1186/s12884-024-06319-z] [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: 03/13/2023] [Accepted: 02/04/2024] [Indexed: 02/19/2024] Open
Abstract
PURPOSE Acknowledging the associated risk factors may have a positive impact on reducing the incidence of ectopic pregnancy (EP). In recent years, body mass index (BMI) has been mentioned in research. However, few studies are available and controversial on the relationship between EP and BMI. METHODS We retrospectively studied the EP women as a case group and the deliveries as a control group in the central hospital of Wuhan during 2017 ~ 2021. χ2 test of variables associated with ectopic pregnancy was performed to find differences. Univariate and multivariate binary logistic regression analysis was conducted to analyze the association of the variables of age, parity, history of induced abortion, history of ectopic pregnancy, history of spontaneous abortion, history of appendectomy surgery and BMI (< 18.5 kg/m2, 18.5 ~ 24.9 kg/m2, 25 kg/m2 ~ 29.9 kg/m2, ≥ 30 kg /m2) with EP. RESULTS They were 659 EP and 1460 deliveries. The variables of age, parity, history of induced abortion, history of ectopic pregnancy and BMI were different significantly(P < 0.05). Multivariate analysis showed that the variables of age > 35 years old [(OR (Odds Ratio), 5.415; 95%CI (Confidence Interval), 4.006 ~ 7.320, P < 0.001], history of ectopic pregnancy (OR, 3.944; 95%CI, 2.405 ~ 6.467; P < 0.001), history of induced abortion(OR, 3.365; 95%CI, 2.724 ~ 4.158, P < 0.001) and low BMI (< 18.5 kg/m2) (OR, 1.929; 95%CI, 1.416 ~ 2.628, P < 0.001])increased the risk of EP. CONCLUSION The history of ectopic pregnancy, history of induced abortion and age > 35 years old were the risk factors with EP. In addition to these traditional factors, we found low BMI (< 18.5 kg/m2) with women may increase the risk to EP.
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Affiliation(s)
- Jin-Shuang Ji
- Department of Gynecology & Obstetrics, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Ling Liu
- The Diagnosis and Therapy Center of Pelvic Floor Rehabilitation and Electrophysiology, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Huan Huang
- Department of Gynecology & Obstetrics, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Hong-Wei Chen
- Department of Gynecology & Obstetrics, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Li Xiao
- Department of Gynecology & Obstetrics, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
- The Diagnosis and Therapy Center of Pelvic Floor Rehabilitation and Electrophysiology, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Xiang-Yi Lu
- Department of Gynecology & Obstetrics, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Yang-Yang Ni
- Department of Gynecology & Obstetrics, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Wen-Juan Jia
- Department of Gynecology & Obstetrics, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Lei Huang
- Department of Gynecology & Obstetrics, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China.
- The Diagnosis and Therapy Center of Pelvic Floor Rehabilitation and Electrophysiology, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China.
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16
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Luo L, Huang S, Zhuang Z, Mo Y, Guo N, Ge L. The Impact of Serum Uric Acid Levels on Hypertensive Disorders of Pregnancy in Advanced Maternal Age Women: A Retrospective Study from a Single Center in China. Med Sci Monit 2024; 30:e942629. [PMID: 38356254 PMCID: PMC10877967 DOI: 10.12659/msm.942629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND In many countries, including China, women are delaying pregnancy until later in life; therefore, hypertensive disorders of pregnancy (HDP) are increasing. This retrospective study from a single center in China aimed to evaluate the association between serum uric acid (SUA) levels and HDP in 288 women of advanced maternal age >35 years. MATERIAL AND METHODS A total of 780 pregnant women of advanced maternal age were included in the study - 288 were had HDP (including gestational hypertension and preeclampsia) and 492 had normal blood pressure using 1: 2 (84: 168) propensity score matching. SUA (collected before 20 weeks' gestation) and HDP incidence in advanced maternal age women were assessed using multivariate logistic modeling and 3 propensity score-based methods. RESULTS Median patient age was 37 years. The risk of developing HDP increases with higher SUA (30.19% vs 13.65%, P<0.001). In the PS-matched cohort, the risk ratio (OR) for HDP with high uric acid after adjusting for confounders was 2.88 (95% CI: 1.44-5.75, P=0.0027). It has been demonstrated that high uric acid is strongly associated with HDP incidence in both the crude population (OR=3.43, 95% CI: 2.01-4.66, P<0.0001) and the weighted cohorts (OR=3.62, 95% CI: 2.81-4.66, P<0.0001). As a successive variable, after adjusting for the clinical confounders, a 1-SD increase in SUA was related to a 135% increased risk of HDP (OR=2.35; 95% CI: 1.57-3.50; P<0.0001) based on the fully adjusted model. There were similar conclusions in the sensitivity analysis. CONCLUSIONS There was a significant association between SUA and HDP in women of advanced maternal age, supporting the importance of early detection of SUA in pregnant women.
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Affiliation(s)
- Li Luo
- The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, PR China
- Department of Cardiovascular Medicine, The First People’s Hospital of Changde, Changde, Hunan, PR China
| | - Sulan Huang
- Department of Cardiovascular Medicine, The First People’s Hospital of Changde, Changde, Hunan, PR China
| | - Zhijie Zhuang
- Department of Gastroenterology, The First People’s Hospital of Changde, Changde, Hunan, PR China
| | - Yeping Mo
- Department of Ultrasonic, The First People’s Hospital of Changde, Changde Hunan, PR China
| | - Ning Guo
- Department of Cardiovascular Medicine, The First People’s Hospital of Changde, Changde, Hunan, PR China
| | - Liangqing Ge
- The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, PR China
- Department of Cardiovascular Medicine, The First People’s Hospital of Changde, Changde, Hunan, PR China
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Mnabwiru LR, Cho YS, Mahande MJ, Mazugun N, Mchome BL, Park EY. Impact of advanced maternal age on perinatal outcomes in Tanzania: Insights from Kilimanjaro Christian Medical Center Birth Registry. Heliyon 2024; 10:e24608. [PMID: 38298701 PMCID: PMC10828067 DOI: 10.1016/j.heliyon.2024.e24608] [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: 11/06/2023] [Revised: 01/10/2024] [Accepted: 01/10/2024] [Indexed: 02/02/2024] Open
Abstract
The increasing prevalence of advanced maternal age (AMA) births necessitates the exploration of associated pregnancy outcomes within the healthcare-limited context of northern Tanzania to elucidate potential region-specific risks and implications. This study explored the influence of AMA on pregnancy outcomes in northern Tanzania, where healthcare resources and infrastructure are constrained in comparison to developed countries. This cross-sectional hospital-based study utilized maternally linked data from the Kilimanjaro Christian Medical Center (KCMC) Medical Registry and included 32,798 women who delivered single infants between 2004 and 2013. Multiple logistic regression models were used to determine adjusted odds ratios (aORs) and 95 % confidence intervals (CIs) for AMA-associated adverse pregnancy outcomes. A total of 16 % of mothers belonged to AMA with increased odds of undergoing a cesarean section (aOR: 1.32; 95%CI [1.24-1.41]; P < 0.001), gestational diabetes (aOR: 13.16; 95%CI [3.28-52.86]; P < 0.001) or pregestational diabetes (aOR: 3.15; 95%CI [1.87-5.31]; P < 0.000), and developing pre-eclampsia (aOR: 1.63; 95%CI [1.41-1.89]; P < 0.000). More women with AMA reported alcohol use during pregnancy and had preexisting conditions before conception than did younger women. Maternal education level, employment status, urban residency, and Christianity were statistically significant. This study establishes a connection between AMA and higher odds of cesarean section, gestational diabetes, pregestational diabetes, and pre-eclampsia. Women with AMA were more inclined to consume alcohol during pregnancy and exhibited preexisting conditions before conception. Moreover, AMA was linked to increased odds of low birth weight, stillbirths, and NICU transfers.
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Affiliation(s)
- Lilian Remigius Mnabwiru
- Department of Obstetrics and Gynecology, Muhimbili National Hospital, Ilala, Upanga Magharibi, Tanzania
| | - Yeon Seo Cho
- Department of Obstetrics and Gynecology, Yonsei University Wonju College of Medicine, Wonju, Gangwondo, Republic of Korea
| | - Michael Johnson Mahande
- Institute of Public Health, Department of Epidemiology & Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Nicholous Mazugun
- Department of Obstetrics and Gynecology, Kilimanjaro Fertility Institute (KFI), Tanzania
| | - Bariki Lawrence Mchome
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Eun Young Park
- Department of Obstetrics and Gynecology, Yonsei University Wonju College of Medicine, Wonju, Gangwondo, Republic of Korea
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Jost E, Kosian P, Greiner GG, Icks A, Schmitz MT, Schmid M, Merz WM. Obstetric Medicine: the protocol for a prospective three-dimensional cohort study to assess maternity care for women with pre-existing conditions (ForMaT). Front Med (Lausanne) 2024; 10:1258716. [PMID: 38274449 PMCID: PMC10808351 DOI: 10.3389/fmed.2023.1258716] [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: 07/21/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024] Open
Abstract
Background Pregnancies in women with pre-existing medical conditions are on the rise. These pregnancies are characterized by an increased rate of maternal and perinatal complications, which can result in higher health care expenditures and altered pregnancy experiences. The purpose of this study is to integrally analyze maternity care for women with pre-existing conditions in the framework of a risk-adapted, interdisciplinary care by recording three substantial parts of maternity care: (1) maternal and perinatal outcome; (2) hospital costs and reimbursements covering the period from preconception counseling or initial antenatal visit to discharge after birth; and (3) women's experience of reproductive choice and becoming a mother in the presence of a pre-existing condition. Methods In this observational, prospective, longitudinal, and monocentric cohort study, we aim to include a total of 1,500 women over a recruitment period of 15 months. Women registering for care at the Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Germany, are allocated to three groups based on their health and risk status: women with pre-existing conditions, as well as healthy women with obstetric risk factor and healthy women with a low-risk pregnancy. Participants are observed from time of initial consultation until discharge after birth. Analysis focuses on (1) maternal and perinatal outcome, especially rate of severe maternal and neonatal morbidity; (2) costs and reimbursements; and (3) surveys to capture of women's experience and health-related quality of life during the time of reproductive choice, pregnancy, and childbirth in the presence of pre-existing medical conditions. Discussion With its complex three-dimensional design, the ForMaT-Trial is aiming to provide a comprehensive analysis of pregnancy and childbirth in women with pre-existing conditions. The results may serve as a basis for counseling and care of these women. By analyzing costs of specialized care, data for discussing reimbursement are generated. Lastly, our results may increase awareness for the perception of reproductive choice, pregnancy and motherhood in this continuously rising population.Clinical trial registration: German Clinical Trials Register, DRKS00030061, October 28, 2022.
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Affiliation(s)
- Elena Jost
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Philipp Kosian
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Gregory Gordon Greiner
- Institute of Health Services Research and Health Economics, Faculty of Medicine, Center for Health and Society, Heinrich Heine University Düsseldorf and University Hospital, Düsseldorf, Germany
- Institute of Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research Germany, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Andrea Icks
- Institute of Health Services Research and Health Economics, Faculty of Medicine, Center for Health and Society, Heinrich Heine University Düsseldorf and University Hospital, Düsseldorf, Germany
- Institute of Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research Germany, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Marie-Therese Schmitz
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Matthias Schmid
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Waltraut M. Merz
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
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Yu J, Peng Y, Yu L, Shi S. Laparoscopic surgery for ectopic pregnancy: A comparative study on the clinical benefits and impact on tubal patency and reproductive outcomes. Technol Health Care 2024; 32:2183-2192. [PMID: 38517813 DOI: 10.3233/thc-230920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
BACKGROUND Ectopic pregnancy is a major contributor to maternal morbidity and mortality across the globe. OBJECTIVE This study aims to investigate the clinical benefits of laparoscopic surgery in treating ectopic pregnancy, and its impact on tubal patency and reproductive outcomes. METHODS A clinical study was conducted to compare laparoscopic and medical conservative treatment for ectopic pregnancy. A total of 206 patients were treated for ectopic pregnancy at our hospital from January 2018 to June 2020. Among them, 46 underwent laparoscopic ipsilateral salpingectomy, 54 underwent laparoscopic ipsilateral salpingostomy with lesion removal, and 106 were treated conservatively with medication. RESULTS The age range and average age of each group are provided, with no significant differences in these general demographic characteristics (p> 0.05). Both the salpingostomy and medication groups had higher rates of ectopic pregnancy compared to the salpingectomy group, with statistically significant differences (p< 0.05). The comparison of ectopic pregnancy rates between the salpingostomy and medication groups showed no significant difference. Within three years, the salpingostomy group had 10 cases of recurrent ectopic pregnancy, with 2 cases on the same side, while the medication group had 18 cases, with 8 cases on the same side. At 3 months after the normalization of blood β-HCG, the salpingostomy group showed 43 cases of tubal patency (patency rate: 79.63%), while the medication group showed 57 cases (patency rate: 53.77%), with a statistically significant difference between the two groups (p= 0.01). CONCLUSION Laparoscopic surgery for ectopic pregnancy offers significant clinical benefits over conservative medical treatment, including higher rates of tubal patency and improved reproductive outcomes. These findings support laparoscopic surgery as an effective approach for the management of ectopic pregnancy.
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Affiliation(s)
- Juan Yu
- Department of Gynaecology and Obstetrics, Aviation General Hospital of China Medical University and Beijing Institute of Translational Medicine, Chinese Academy of Sciences, Beijing, China
| | - Yan Peng
- Department of Gynaecology and Obstetrics, Aviation General Hospital of China Medical University and Beijing Institute of Translational Medicine, Chinese Academy of Sciences, Beijing, China
| | - Liqun Yu
- Department of Gynaecology and Obstetrics, Aviation General Hospital of China Medical University and Beijing Institute of Translational Medicine, Chinese Academy of Sciences, Beijing, China
| | - Shutian Shi
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Kim S, Kim M, Oh MY, Seo Y, Yum SK. Impact of increased paternal age on neonatal outcomes in very-low-birth-weight infants. J Matern Fetal Neonatal Med 2023; 36:2257836. [PMID: 37710984 DOI: 10.1080/14767058.2023.2257836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/29/2023] [Accepted: 09/06/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE Despite the trend of increasing paternal age, its impact on neonatal outcomes, particularly in preterm infants, has not been thoroughly investigated. We aimed to evaluate the perinatal characteristics and neonatal outcomes associated with paternal age. METHODS Electronic medical records of very low-birthweight infants admitted to our unit from July 2013 to March 2022 were reviewed. Infants grouped according to paternal age (<35 years, 35-39 years, and ≥40 years) were analyzed for differences in perinatal findings and neonatal outcomes. RESULTS A total of 637 infants were included (194, 294, and 149 in the <35, 35-39, and ≥40 years groups, respectively). The increase in paternal age paralleled the increase in maternal age. The Z-score of head circumference at birth was significantly different between the groups, showing the lowest median value in the ≥40 years group. Small-for-gestational age (Odds ratio 71.074, p < .001, 95% confidence interval 19.337 - 261.236) and male sex (Odds ratio 3.309, p < .034, 95% confidence interval 1.089 - 8.425), but not paternal or maternal age groups were significant factors associated with head circumference Z-scores less than -2 standard deviation based on the multivariable logistic regression analysis. Infants affected by chromosomal or genetic anomaly were more frequently identified (3.4 vs 0.0 vs 0.5%) in the ≥40 years group than in the other two groups. When infants with anomalies or critical illnesses were excluded, overall neonatal outcomes did not statistically differ according to paternal age. CONCLUSION Although increased paternal age ≥40 years may be associated with relatively smaller head circumferences, the impact on fetal head growth does not imply a definite risk for microcephaly. Nonetheless, based on the possible negative impact on chromosomal/genetic anomaly, increased paternal age warrants attention, even though neonatal outcomes concerning prematurity were not significantly affected. A large-scale longitudinal study is needed to further elucidate the impact of advanced paternal age in preterm infants and provide guidelines for appropriate antenatal counseling and surveillance.
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Affiliation(s)
- Sol Kim
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Minsoo Kim
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Moon-Yeon Oh
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yumi Seo
- Department of Pediatrics, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sook Kyung Yum
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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21
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Aryan N, Grigorian A, Lucas AN, Tay-Lasso E, Zezoff DC, Fierro N, Dhillon NK, Ley EJ, Smith J, Dahan A, Johnson A, Ganske W, Biffl WL, Bayat D, Castelo M, Wintz D, Schaffer KB, Zheng DJ, Tillou A, Coimbra R, Santorelli JE, Schellenberg M, Inaba K, Emigh B, Duncan TK, Diaz G, Burruss S, Tuli R, Nahmias J. Outcomes for advanced aged (35 and older) versus younger aged pregnant trauma patients: A multicenter study. Am J Surg 2023; 226:798-802. [PMID: 37355376 DOI: 10.1016/j.amjsurg.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/25/2023] [Accepted: 06/01/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Effects of advanced maternal age (AMA) pregnancies (defined as ≥35 years) on pregnant trauma patients (PTPs) are unknown. This study compared AMA versus younger PTPs, hypothesizing AMA PTPs have increased risk of fetal delivery (FD). METHODS A retrospective (2016-2021) multicenter study included all PTPs. Multivariable logistic regression was used to evaluate risk of FD after trauma. RESULTS A total of 950 PTPs were included. Both cohorts had similar gestational age and injury severity scores. The AMA group had increased injuries to the pancreas, bladder, and stomach (p < 0.05). There was no difference in rate or associated risk of FD between cohorts (5.3% vs. 11.4%; OR 0.59, CI 0.19-1.88, p > 0.05). CONCLUSION Compared to their younger counterparts, some intra-abdominal injuries (pancreas, bladder, and stomach) were more common among AMA PTPs. However, there was no difference in rate or associated risk of FD in AMA PTPs, thus they do not require increased observation.
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Affiliation(s)
- Negaar Aryan
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, California, USA.
| | - Areg Grigorian
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, California, USA.
| | - Alexa N Lucas
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, California, USA.
| | - Erika Tay-Lasso
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, California, USA.
| | - Danielle C Zezoff
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, California, USA.
| | - Nicole Fierro
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Navpreet K Dhillon
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Eric J Ley
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Jennifer Smith
- Division of Trauma and Critical Care, Harbor-UCLA Hospital, Torrance, CA, USA.
| | - Alden Dahan
- University of California, Riverside School of Medicine, Riverside, CA, USA.
| | - Arianne Johnson
- Cottage Health Research Institute, Santa Barbara Cottage Hospital, Santa Barbara, CA, USA.
| | - William Ganske
- Cottage Health Research Institute, Santa Barbara Cottage Hospital, Santa Barbara, CA, USA.
| | - Walter L Biffl
- Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA, USA.
| | - Dunya Bayat
- Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA, USA.
| | - Matthew Castelo
- Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA, USA.
| | - Diane Wintz
- Department of Surgery, Sharp Memorial Hospital, San Diego, CA, USA.
| | | | - Dennis J Zheng
- Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
| | - Areti Tillou
- Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
| | - Raul Coimbra
- Riverside University Health System Medical Center, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, CA, USA.
| | - Jarrett E Santorelli
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California San Diego School of Medicine, San Diego, CA, USA.
| | - Morgan Schellenberg
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA.
| | - Kenji Inaba
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA.
| | - Brent Emigh
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA; Warren Alpert Medical School at Brown University, Department of Surgery, Division of Trauma, USA.
| | - Thomas K Duncan
- Department of Trauma, Ventura County Medical Center, Ventura, CA, USA.
| | - Graal Diaz
- Department of Trauma, Ventura County Medical Center, Ventura, CA, USA.
| | - Sigrid Burruss
- Department of Trauma, Acute Care Surgery, Surgical Critical Care, Loma Linda Medical Center, Loma Linda, CA, USA.
| | - Rahul Tuli
- Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, University of California Riverside School of Medicine, CA, USA.
| | - Jeffry Nahmias
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, California, USA.
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Bagayoko M, Kadengye DT, Odero HO, Izudi J. Effect of high-risk versus low-risk pregnancy at the first antenatal care visit on the occurrence of complication during pregnancy and labour or delivery in Kenya: a double-robust estimation. BMJ Open 2023; 13:e072451. [PMID: 37899166 PMCID: PMC10619084 DOI: 10.1136/bmjopen-2023-072451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 10/13/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVES We evaluated the causal effects of high-risk versus low-risk pregnancy at the first antenatal care (ANC) visit on the occurrence of complications during pregnancy and labour or delivery among women in Kenya. METHODS We designed a quasi-experimental study using observational data from a large mobile health wallet programme, with the exposure as pregnancy risk at the first ANC visit, measured on a binary scale (low vs high). Complications during pregnancy and at labour or delivery were the study outcomes on a binary scale (yes vs no). Causal effects of the exposure were examined using a double-robust estimation, reported as an OR with a 95% CI. RESULTS We studied 4419 women aged 10-49 years (mean, 25.6±6.27 years), with the majority aged 20-29 years (53.4%) and rural residents (87.4%). Of 3271 women with low-risk pregnancy at the first ANC visit, 833 (25.5%) had complications during pregnancy while 1074 (32.8%) had complications at labour/delivery. Conversely, of 1148 women with high-risk pregnancy at the first ANC visit, 343 (29.9%) had complication during pregnancy while 488 (42.5%) had complications at labour delivery. Multivariable adjusted analysis showed that women with high-risk pregnancy at the time of first ANC attendance had a higher occurrence of pregnancy during pregnancy (adjusted OR (aOR) 1.22, 95% CI 1.02 to 1.46) and labour or delivery (aOR 1.20, 95% CI 1.03 to 1.41). In the double-robust estimation, a high-risk pregnancy at first ANC visit increased the occurrence of complications during pregnancy (OR 1.23, 95% CI 1.04 to 1.46) and labour or delivery (OR 1.24, 95% CI 1.07 to 1.45). CONCLUSION Women with a high-risk pregnancy at the first ANC visit have an increased occurrence of complications during pregnancy and labour or delivery. These women should be identified early for close and appropriate obstetric and intrapartum monitoring and care to ensure maternal and neonatal survival.
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Affiliation(s)
- Moussa Bagayoko
- Data Science and Evaluation Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Damazo T Kadengye
- Data Science and Evaluation Unit, African Population and Health Research Center, Nairobi, Kenya
- Department of Economics and Statistics, Kabale University, Kabale, Uganda
| | - Henry Owoko Odero
- Data Science and Evaluation Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Jonathan Izudi
- Data Science and Evaluation Unit, African Population and Health Research Center, Nairobi, Kenya
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
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Havrljenko J, Kopitovic V, Pjevic AT, Milatovic S, Pavlica T, Andric N, Pogrmic-Majkic K. The Prediction of IVF Outcomes with Autologous Oocytes and the Optimal MII Oocyte/Embryo Number for Live Birth at Advanced Maternal Age. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1799. [PMID: 37893517 PMCID: PMC10608663 DOI: 10.3390/medicina59101799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/11/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Delayed childbearing in advanced age might be associated with a low prognosis for achieving pregnancy. Therefore, it is important to establish a predictive tool that will optimize the likelihood of a live birth at advanced age. Material and Methods: The retrospective study was conducted at the Ferona Fertility Clinic in Novi Sad (Republic of Serbia), between January 2020 and May 2021. The survey included 491 women aged ≥35 who met the inclusion criteria and who were subjected to an IVF (in vitro fertilization) treatment cycle. Results: The average number of retrieved oocytes, MII (metaphase II) oocytes, and developed embryos significantly decreased in advanced age. Age was also found to have a significant adverse effect on pregnancy and live birth rates. In women aged ≥35, 10/12 MII oocytes or 10/11 embryos are required for reaching an optimal live birth rate/cumulative live birth rate. Optimal CLBR (cumulative live birth rate) per one oocyte was achieved when 9 MII oocyte were retrieved. Conclusions: The study indicates that the cut-off for increased risk is ≥42 year. However, despite low live birth rates, autologous IVF for these women is not futile. An increase in the number of retrieved mature oocytes and a generation of surplus cryopreserved embryos could reinforce LBR (live birth rate) and CLBR. Clinicians should be very cautious in counseling, as autologous IVF may only be applicable to women with good ovarian reserve.
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Affiliation(s)
- Jelena Havrljenko
- Ferona Fertility Clinic, Sarplaninska 19, 21000 Novi Sad, Serbia or (J.H.); (V.K.); (A.T.P.)
- Faculty of Sciences, Department of Biology and Ecology, University of Novi Sad, Trg Dositeja Obradovica 2, 21000 Novi Sad, Serbia; (N.A.); (K.P.-M.)
| | - Vesna Kopitovic
- Ferona Fertility Clinic, Sarplaninska 19, 21000 Novi Sad, Serbia or (J.H.); (V.K.); (A.T.P.)
| | | | - Stevan Milatovic
- Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia;
| | - Tatjana Pavlica
- Faculty of Sciences, Department of Biology and Ecology, University of Novi Sad, Trg Dositeja Obradovica 2, 21000 Novi Sad, Serbia; (N.A.); (K.P.-M.)
| | - Nebojsa Andric
- Faculty of Sciences, Department of Biology and Ecology, University of Novi Sad, Trg Dositeja Obradovica 2, 21000 Novi Sad, Serbia; (N.A.); (K.P.-M.)
| | - Kristina Pogrmic-Majkic
- Faculty of Sciences, Department of Biology and Ecology, University of Novi Sad, Trg Dositeja Obradovica 2, 21000 Novi Sad, Serbia; (N.A.); (K.P.-M.)
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James S, Moulton JE, Assifi A, Botfield J, Black K, Hanson M, Mazza D. Women's needs for lifestyle risk reduction engagement during the interconception period: a scoping review. BMJ SEXUAL & REPRODUCTIVE HEALTH 2023; 49:274-281. [PMID: 36849222 DOI: 10.1136/bmjsrh-2022-201699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Unhealthy lifestyle is responsible for many chronic conditions, and antenatal engagement with women about lifestyle behaviours can be too late to prevent some adverse pregnancy outcomes and subsequent childhood risks. To reduce the risk of future adverse outcomes, the interconception period is an opportunity to implement positive health changes. The aim of this scoping review was to explore women's needs for lifestyle risk reduction engagement during the interconception period. METHODS The JBI methodology guided our scoping review. Six databases were searched for peer-reviewed, English-language research papers published between 2010 and 2021 on topics including perceptions, attitudes, lifestyle, postpartum, preconception and interconception. Title-abstract and full text screening was independently undertaken by two authors. Included papers' reference lists were searched to find additional papers. The main concepts were then identified using a descriptive and tabular approach. RESULTS A total of 1734 papers were screened and 33 met our inclusion criteria. Most included papers (82%, n=27) reported on nutrition and/or physical activity. Papers identified interconception through postpartum and/or preconception. Women's self-management needs for lifestyle risk reduction engagement during interconception included: informational needs, managing competing priorities, physical and mental health, self-perception and motivation, access to services and professional support, and family and peer networks. CONCLUSIONS There is a range of challenges for women to engage in lifestyle risk reduction during interconception. To enable women's preferences for how lifestyle risk reduction activities can be enacted, issues including childcare, ongoing and tailored health professional support, domestic support, cost and health literacy need to be addressed.
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Affiliation(s)
- Sharon James
- SPHERE CRE, Department of General Practice, Monash University School of Public Health and Preventive Medicine, Melbourne, VIC, Australia
| | - Jessica E Moulton
- SPHERE CRE, Department of General Practice, Monash University School of Public Health and Preventive Medicine, Melbourne, VIC, Australia
| | - Anisa Assifi
- SPHERE CRE, Department of General Practice, Monash University School of Public Health and Preventive Medicine, Melbourne, VIC, Australia
| | - Jessica Botfield
- SPHERE CRE, Department of General Practice, Monash University School of Public Health and Preventive Medicine, Melbourne, VIC, Australia
| | - Kirsten Black
- SPHERE CRE, Department of General Practice, Monash University School of Public Health and Preventive Medicine, Melbourne, VIC, Australia
- Specialty of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Mark Hanson
- University of Southampton Faculty of Medicine Health and Life Sciences, Southampton, UK
| | - Danielle Mazza
- SPHERE CRE, Department of General Practice, Monash University School of Public Health and Preventive Medicine, Melbourne, VIC, Australia
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25
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Xia Q, Yu L, Song J, Sun Z. The role of acupuncture in women with advanced reproductive age undergoing in vitro fertilization-embryo transfer: A randomized controlled trial and follicular fluid metabolomics study. Medicine (Baltimore) 2023; 102:e34768. [PMID: 37682195 PMCID: PMC10489312 DOI: 10.1097/md.0000000000034768] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/25/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND The objective of this study was to determine the efficacy of acupuncture on the outcome of in vitro fertilization (IVF) in elderly infertile patients with kidney qi deficiency, and to explore its possible mechanism from the perspective of pseudo-targeted metabolomics of follicular fluid. METHODS Sixty cases of elderly women undergoing IVF were sampled and randomly divided into 2 equal groups: the treatment and the elderly control (HA) group. In the treatment group, routine ovulation induction combined with acupuncture treatment was used. Routine ovulation induction combined with sham acupuncture was used in the HA group. Reproductive outcomes of the 2 groups were compared. The follicular fluid of patients obtained on the day of oocyte retrieval was analyzed by the ultra-high-performance liquid chromatography-mass spectrometry analysis system. RESULTS Compared with the HA group, the score of kidney qi deficiency syndrome in the treatment group was significantly decreased, and the 2 PN fertilization rate, high-quality embryo rate and cumulative pregnancy rate were significantly increased (P < .05). Through the identification of target metabolites, 3 metabolic pathways were found to be closely related to the developmental potential of oocytes, namely: Retinol metabolism pathway; Glycine, serine, and threonine metabolism pathway; Glycerophospholipid metabolism pathway. CONCLUSION From our findings, acupuncture can improve the quality of oocytes thus bettering the outcome of IVF-assisted pregnancy in elderly patients with kidney qi deficiency. TRIAL REGISTRATION ChiCTR1800018329.
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Affiliation(s)
- Qingchang Xia
- College of Acupuncture and Massage, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Lingyu Yu
- Institute of Chinese Medical Literature and Culture, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Jingyan Song
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Zhengao Sun
- Reproductive Medicine Center of Integration of Traditional and Western Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
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Zabak S, Varma A, Bansod S, Pohane MR. Exploring the Complex Landscape of Delayed Childbearing: Factors, History, and Long-Term Implications. Cureus 2023; 15:e46291. [PMID: 37915872 PMCID: PMC10616531 DOI: 10.7759/cureus.46291] [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: 08/17/2023] [Accepted: 09/30/2023] [Indexed: 11/03/2023] Open
Abstract
This review article delves into the intricate landscape of delayed childbearing, shedding light on the factors influencing individuals' decisions to postpone parenthood. In a world undergoing rapid social, economic, and technological transformations, the concept of when and why to become a parent has evolved significantly. We explore historical trends, societal norms, psychological dynamics, policy implications, and prospects surrounding delayed childbearing. This review underscores the diverse influences shaping this trend, from economic considerations and changing cultural perspectives to advancements in reproductive technologies and the complexities of work-life balance. By examining the emotional dimensions and long-term consequences, we comprehensively understand the implications for individuals, families, and societies. As we conclude, we emphasize the importance of addressing challenges and embracing opportunities to create a supportive environment for those navigating the complex decisions tied to delayed childbearing.
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Affiliation(s)
- Siddharth Zabak
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ashish Varma
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Spandan Bansod
- Department of Obstetrics and Gynecology, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Meera R Pohane
- Medical Surgical Nursing, Shalinitai Meghe College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Togunwa TO, Babatunde AO, Abdullah KUR. Deep hybrid model for maternal health risk classification in pregnancy: synergy of ANN and random forest. Front Artif Intell 2023; 6:1213436. [PMID: 37476504 PMCID: PMC10354509 DOI: 10.3389/frai.2023.1213436] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/16/2023] [Indexed: 07/22/2023] Open
Abstract
Introduction Maternal health is a critical aspect of public health that affects the wellbeing of both mothers and infants. Despite medical advancements, maternal mortality rates remain high, particularly in developing countries. AI-based models provide new ways to analyze and interpret medical data, which can ultimately improve maternal and fetal health outcomes. Methods This study proposes a deep hybrid model for maternal health risk classification in pregnancy, which utilizes the strengths of artificial neural networks (ANN) and random forest (RF) algorithms. The proposed model combines the two algorithms to improve the accuracy and efficiency of risk classification in pregnant women. The dataset used in this study consists of features such as age, systolic and diastolic blood pressure, blood sugar, body temperature, and heart rate. The dataset is divided into training and testing sets, with 75% of the data used for training and 25% used for testing. The output of the ANN and RF classifier is considered, and a maximum probability voting system selects the output with the highest probability as the most correct. Results Performance is evaluated using various metrics, such as accuracy, precision, recall, and F1 score. Results showed that the proposed model achieves 95% accuracy, 97% precision, 97% recall, and an F1 score of 0.97 on the testing dataset. Discussion The deep hybrid model proposed in this study has the potential to improve the accuracy and efficiency of maternal health risk classification in pregnancy, leading to better health outcomes for pregnant women and their babies. Future research could explore the generalizability of this model to other populations, incorporate unstructured medical data, and evaluate its feasibility for clinical use.
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Affiliation(s)
- Taofeeq Oluwatosin Togunwa
- Department of Medicine and Surgery, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
- College Research and Innovation Hub, University College Hospital, Ibadan, Oyo, Nigeria
| | - Abdulhammed Opeyemi Babatunde
- Department of Medicine and Surgery, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
- College Research and Innovation Hub, University College Hospital, Ibadan, Oyo, Nigeria
- MyBelle Digital Maternal and Child Health Organisation, Ibadan, Nigeria
- Public Health Interest Group Africa (PHIGA), Lagos, Nigeria
| | - Khalil-ur-Rahman Abdullah
- Faculty of Clinical Sciences, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
- MCON Institute of Medical Research, Ilorin, Nigeria
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Melekoglu R. Increased prevalence of chronic medical conditions linked to higher rates of adverse perinatal outcomes in Dutch women. Evid Based Nurs 2023:ebnurs-2023-103705. [PMID: 37349087 DOI: 10.1136/ebnurs-2023-103705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Rauf Melekoglu
- Department of Obstetrics and Gynecology, Inonu University Faculty of Medicine, Malatya, TURKIYE
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Jeon S, Noh W. Psychosocial factors associated with health behaviors in pregnant women of advanced maternal age in Korea. Front Public Health 2023; 11:1179416. [PMID: 37397774 PMCID: PMC10310962 DOI: 10.3389/fpubh.2023.1179416] [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: 03/04/2023] [Accepted: 05/12/2023] [Indexed: 07/04/2023] Open
Abstract
Objectives To determine the association between psychosocial factors and health-promoting and health-impairing behaviors in pregnant women of advanced maternal age (AMA) in Korea. Design A cross-sectional survey study. Setting Online survey. Samples A total of 217 pregnant women aged 35 and older agreed to participate in the study, with 207 participants completing the self-report questionnaires. Methods We collected self-reported data on demographic, obstetric, and psychosocial factors and prenatal health behaviors using standardized measures. We conducted a descriptive analysis of the collected data and a linear regression to identify significant associations with health-promoting and health-impairing behaviors. Results We found that maternal-fetal attachment (β = 0.43, p < 0.001) and "social atmosphere" of pregnancy stress (β = 0.13, p = 0.047) were positively associated with prenatal health-promoting behaviors. We found that artificial conception (β =-0.16, p = 0.011) was negatively associated with prenatal health-impairing behaviors and that multiparity (β = 0.23, p = 0.001) and "maternal role" of pregnancy stress (β = 0.27, p = 0.003) positively associated with prenatal health-impairing behaviors. Conclusion Health-impairing behaviors of pregnant AMA women need assessment and the importance of health-promoting behaviors for maternal and infant health need reinforcing. We recommend pregnancy stress assessments at prenatal checkups and stress relief interventions that consider cultural differences and contexts rather than standardized interventions.
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Affiliation(s)
- Songi Jeon
- Department of Nursing, Catholic Kwandong University, Gangneung-si, Gangwon-do, Republic of Korea
| | - Wonjung Noh
- College of Nursing, Gachon University, Incheon, Republic of Korea
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Bhattacharya S, Ali W, Ghildiyal A. Correlation Between Maternal Age and Cytokine (IL-6 and TGF-Beta) Levels in Colostrum. Cureus 2023; 15:e39146. [PMID: 37384101 PMCID: PMC10294278 DOI: 10.7759/cureus.39146] [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] [Accepted: 05/17/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Cytokines are small proteins that play an important role in cell signaling, particularly in inflammatory pathways. There are both pro- as well as anti-inflammatory cytokines that regulate this pathway and modulate the immune responses. Advancing maternal age is associated with systemic inflammation. The present study intends to evaluate the effect of advancing maternal age on cytokine (IL-6 and TGF-β) levels in colostrum, the first breast milk secreted by mothers. METHODOLOGY A total of 77 term deliveries were enrolled in the study. Colostrum specimens were collected and evaluated for cytokine IL-6 and TGF-β levels. Colostrum IL-6 and TGF-β levels were correlated with maternal age and were assessed using the Spearman rank correlation coefficient. Multivariate analysis was done using a linear regression model comprising age, parity, and mode of delivery. RESULTS Mean colostrum IL-6 and TGF-β levels were 113.3±73.1 pg/ml and 20.9±23.6 pg/ml, respectively. No significant correlation between maternal age and colostrum IL-6 levels was observed (r=0.137; p=0.314). However, there was a significant positive correlation between maternal age and colostrum TGF-β levels (r=0.452; p<0.001). CONCLUSIONS The findings of the study show a significant association between maternal age and colostrum TGF-β levels. The impact of colostrum cytokine levels on neonatal growth and development in context with advancing maternal age needs to be evaluated.
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Affiliation(s)
| | - Wahid Ali
- Pathology, King George's Medical University, Lucknow, IND
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Tran P, Jreij B, Sistani F, Shaya FT. Disparities in maternal mortality. J Clin Transl Sci 2023; 7:e192. [PMID: 37745934 PMCID: PMC10514681 DOI: 10.1017/cts.2023.520] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/24/2023] [Accepted: 03/28/2023] [Indexed: 09/26/2023] Open
Abstract
Maternal mortality rates in the USA remain high, with persistent racial and socioeconomic disparities. We identified 207,016 hospital admissions for pregnant women in Maryland, from 2017 to 2019. Logistic regression was used to identity factors associated with maternal death. The health outcome for black women was more prone to give rise to maternal mortality than for white women. Our study revealed numerous racial and age discrepancies in gestational health outcomes, which opioid use disorder exacerbated. Our findings elaborate on the importance of identifying the drivers of adverse pregnancy outcomes, to help inform policy, and resource allocations.
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Affiliation(s)
- Phuong Tran
- Department of Practice, Sciences and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Barbara Jreij
- Faculty of Medicine and Medical Sciences, University of Balamand, Balamand, Lebanon
| | - Farideh Sistani
- Department of Practice, Sciences and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Fadia T. Shaya
- Department of Practice, Sciences and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
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Wolfson C, Strobino DM, Gemmill A. Does Delayed Fertility Explain the Rise in Comorbidities Among the Birthing Population? J Womens Health (Larchmt) 2023. [PMID: 36946768 DOI: 10.1089/jwh.2022.0370] [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: 03/23/2023] Open
Abstract
Background: The increasing prevalence of preexisting health conditions among pregnant people is often attributed to the concurrent rise in maternal age. However, the link between advanced maternal age (AMA) and increases in chronic conditions among the birthing population has not been systematically documented at the population level. Materials and Methods: This retrospective population-based cohort study was based on linked hospitalization discharge and birth certificate data for live birth deliveries in California from 1991 to 2012. Decomposition techniques evaluated whether changes in the prevalence of selected preexisting health conditions during delivery (autoimmune conditions, chronic hypertension, cardiac disease, diabetes, and renal disease) were explained by population-level increases in maternal age. Analyses further adjusted for maternal education, plurality, insurance status, and availability of paternal information on the birth certificate. Results: Between 1991 and 2012, there were more than 11.5 million live birth deliveries in California. AMA (≥35 years) increased nearly 70% over this period. The prevalence of autoimmune conditions, chronic hypertension, diabetes, and renal disease rose among the birthing population, while cardiac disease declined. The prevalence of all conditions was higher for AMA, but changes in maternal age accounted for only 5.3%, 8.4%, 13.9%, and 0.4%, of the increase in autoimmune conditions, chronic hypertension, diabetes, and renal disease, respectively. Conclusion: While AMA was associated with higher rates of preexisting health conditions, it contributed little to the increase in autoimmune conditions, chronic hypertension, and diabetes and nothing to the rise in renal disease during childbirth.
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Affiliation(s)
- Carrie Wolfson
- Department of International Health, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Donna M Strobino
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Alison Gemmill
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Fogarty S, Werner R, James JL. Applying Scientific Rationale to the Current Perceptions and Explanations of Massage and Miscarriage in the First Trimester. Int J Ther Massage Bodywork 2023; 16:30-43. [PMID: 36866184 PMCID: PMC9949615 DOI: 10.3822/ijtmb.v16i1.771] [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] [Indexed: 03/04/2023] Open
Abstract
Miscarriage is a relatively common occurrence, impacting 8-15% of clinically recognised pregnancies, and up to 30% of all conceptions. The public perception of the risk factors associated with miscarriage does not match the evidence. Evidence indicates that there are very few modifiable factors to prevent miscarriage, and the majority of the time little could have been done to prevent a spontaneous miscarriage. However, the public perception is that consuming drugs, lifting a heavy object, previous use of an intrauterine device, or massage can all contribute to miscarriage. While misinformation about the causes and risk factors of miscarriage continues to circulate, pregnant women will experience confusion about what activities they can (and cannot) do in early pregnancy, including receiving a massage. Pregnancy massage is an important component of massage therapy education. The resources that underpin pregnancy massage coursework consist of educational print content that includes direction and caution that massage in the first trimester, if done 'incorrectly' or in the 'wrong' location, can contribute to adverse outcomes such as miscarriage. The most common statements, perceptions and explanations for massage and miscarriage cover three broad areas: 1) maternal changes from massage affects the embryo/fetus; 2) massage leads to damage of the fetus/placenta; and 3) aspects of the massage treatment in the first trimester initiate contractions. The goal of this paper is to use scientific rationale to critically consider the validity of the current perceptions and explanations of massage therapy and miscarriage. Whilst direct evidence from clinical trials was lacking, considerations of physiological mechanisms regulating pregnancy and known risk factors associated with miscarriage provide no evidence that massage in pregnancy would increase a patient's risk of miscarriage. This scientific rationale should be addressed when teaching pregnancy massage courses.
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Affiliation(s)
- Sarah Fogarty
- Department of Medicine, School of Medicine, Western Sydney University, Sydney, Australia,Corresponding author: Sarah Fogarty, Department of Medicine, School of Medicine, Western Sydney University Campbelltown Campus, Narellan Road & Gilchrist Drive, Campbelltown, NSW 2560, Australia,
| | - Ruth Werner
- Author of A Massage Therapist’s Guide to Pathology, and Board Certified in Therapeutic Massage and Bodywork, USA
| | - Joanna L James
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Cahill C, Mica MC. Women in Hand Surgery: Considerations and Support. Hand Clin 2023; 39:65-72. [PMID: 36402527 DOI: 10.1016/j.hcl.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hand surgeons and trainees face many challenges in pursuit of their professional and familial goals. The culture of the training programs must change to aknowledge and address the needs of women as they naviagate career and their childbearing years. Challenges to maternity and family planning dissuade and perhaps prohibit female trainees from choosing surgical specialties and of those who do, from reaching their full professional potential. In the following chapter we will review current data on infertility, obstetrical complications, breastfeeding, maternity leave, career advancement and childcare in an effort to increase support for female trainees and practicing female hand surgeons.
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Affiliation(s)
- Cathleen Cahill
- UChicago Medicine and Biological Sciences, 5841 South Maryland Avenue, MC3079, Chicago, IL 60637, USA.
| | - Megan Conti Mica
- UChicago Medicine and Biological Sciences, 5841 South Maryland Avenue, MC3079, Chicago, IL 60637, USA
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Mothers of children with Down syndrome: a clinical and epidemiological study. J Community Genet 2022; 14:189-195. [PMID: 36562914 PMCID: PMC10104982 DOI: 10.1007/s12687-022-00627-7] [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: 09/15/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
Down syndrome is the main genetic cause of intellectual disability. Many studies describe the clinical characteristics of DS patients; however, few have investigated the clinical profile of mothers who have children with DS. Advanced maternal age (≥ 35 years old) is a risk factor for DS. Although there is an overall increase in pregnancies among women with advanced maternal age, there is still a lack of awareness of the increased risk of aneuploidy. Here, we reported the clinical and epidemiological profile of DS children and their mothers in a public reference hospital in the State of Rio de Janeiro, Brazil. For data collection, we performed a face-to-face interview guided by a structured questionnaire with closed-ended questions. A total of 344 individuals, 172 mothers and their DS children, were included in this study. Our results show that 56% of the mothers sampled were ≥ 35 years of age at childbirth. Although 98% of them received prenatal care, only 4% obtained a prenatal diagnosis of DS. Most mothers reported not drinking alcohol or smoking cigarettes during pregnancy. Furthermore, 91% of women took prenatal vitamins and supplements; however, 47% were not aware of their benefits for a healthy pregnancy. Given the strict correlation between advanced maternal age and DS, prenatal care should include genetic counseling for women over 35 years of age. This study highlights the importance of prenatal care and the urgent need for better DS screening allowing for immediate postnatal care, positively impacting the life expectancy of these patients.
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Ruhighira JJ, Mashili FL, Tungu AM, Mamuya S. Spirometry profiles among pregnant and non-pregnant African women: a cross-sectional study. BMC Womens Health 2022; 22:483. [PMID: 36461083 PMCID: PMC9716166 DOI: 10.1186/s12905-022-02081-6] [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: 04/05/2022] [Accepted: 11/17/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Spirometry is a commonly used lung function test. It assesses respiratory functions by measuring the air volume and the rate at which a person can exhale from lungs filled to their total capacity. The most helpful spirometry parameters are: forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and peak expiratory flow (PEF). Pregnancy derives an altered physiological state due to hormonal and anatomical changes that affect the respiratory system. Despite that, spirometry is less commonly done during pregnancy, and if done, test results are evaluated against non-pregnancy references. OBJECTIVE This study aimed to explore spirometry profiles in pregnant and non-pregnant women and describe their differences. METHODOLOGY This cross-sectional study involved age-matched pregnant and non-pregnant participants recruited from Mnazi Moja ANC and Muhimbili University (MUHAS). A digital spirometer was used to assess respiratory function. Data were entered and analyzed using SPSS version 23. The mean spirometry values of pregnant participants were compared to those of non-pregnant participants using an independent sample t-test. A p-value of < 0.05 was considered statistically significant. RESULTS The study included 92 pregnant and 98 non-pregnant participants subjected to spirometry. Both FVC and FEV1 values were significantly lower in pregnant than in non-pregnant participants (2.7 ± 0.5 L vs. 2.9 ± 0.5 L; p < 0.01 and 2.2 ± 0.4 L vs. 2.5 ± 0.4 L; p < 0.01 respectively). In addition, pregnant participants had significantly lower mean PEF values than their non-pregnant counterparts (303 ± 84 L/min versus 353 ± 64 L/min; p < 0.01). CONCLUSION Spirometry test values are lower in pregnancy than in non-pregnant participants. RECOMMENDATIONS Interpreting the spirometry test values of pregnant women using references obtained from non-pregnant women may be inappropriate. Future studies should evaluate the appropriateness of predicting spirometry values of pregnant women using reference equations derived from non-pregnant women.
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Affiliation(s)
- Jacktan Josephat Ruhighira
- grid.442459.a0000 0001 1998 2954Department of Physiology, University of Dodoma, P. O Box 395, Dodoma, Tanzania
| | - Fredirick L. Mashili
- grid.25867.3e0000 0001 1481 7466Department of Physiology, Muhimbili University of Health and Allied Sciences, P. O Box 65001, Dar es Salaam, Tanzania
| | - Alexander Mtemi Tungu
- grid.25867.3e0000 0001 1481 7466Department of Physiology, Muhimbili University of Health and Allied Sciences, P. O Box 65001, Dar es Salaam, Tanzania
| | - Simon Mamuya
- grid.25867.3e0000 0001 1481 7466Department of Environmental and Occupational Health, Muhimbili University of Health and Allied Sciences, P. O Box 65001, Dar es Salaam, Tanzania
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Efficacy of Autologous Intrauterine Infusion of Platelet-Rich Plasma in Patients with Unexplained Repeated Implantation Failures in Embryo Transfer: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11226753. [PMID: 36431229 PMCID: PMC9697934 DOI: 10.3390/jcm11226753] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/31/2022] [Accepted: 11/05/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Controversial conclusions have been made in previous studies regarding the influence of autologous platelet-rich plasma (PRP) in the reproductive outcomes of women with repeated implantation failures (RIF) who are undergoing embryo transfer (ET). (2) Methods: This study aimed to evaluate the effect of PRP intrauterine infusion in patients with unexplained RIF, who are undergoing in vitro fertilization (IVF) or intracytoplasmic injection (ICSI), by a systematic review and meta-analysis. (3) Results: A fixed-effects model was used, and 795 cases and 834 controls were included in these studies. The pooling of the results showed the beneficial effect of PRP which were compared with those of the control in terms of the clinical pregnancy rates (n = 10, risk ratio (RR) = 1.79, 95% confidence intervals (CI): 1.55, 2.06; p < 0.01, I2 = 40%), live birth rates (n = 4, RR = 2.92, 95% CI: 2.22, 3.85; p < 0.01, I2 = 83%), implantation rates (n = 3, RR = 1.74, 95% CI: 1.34, 2.26; p < 0.01, I2 = 0%), and positive serum β-HCG 14 days after the ET (n = 8, RR = 1.77, 95% CI: 1.54, 2.03; p < 0.01, I2 = 36%). However, we did not find that the miscarriage rates indicated a significant difference between the two groups (n = 6, RR = 1.04, 95% CI: 0.72, 1.51; p = 0.83, I2 = 0%). (4) Conclusions: The findings of this systemic review and meta-analysis suggest that PRP appears to improve the results of IVF/ICSI treatments in the cases of unexplained RIF.
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Erasmus CR, Chuturgoon AA, Maharaj NR. Maternal overweight and obesity and its associated factors and outcomes in human immunodeficiency virus (HIV)-infected and HIV-uninfected black South African pregnant women. J Obstet Gynaecol Res 2022; 48:2697-2712. [PMID: 36054675 DOI: 10.1111/jog.15392] [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: 01/24/2022] [Revised: 07/15/2022] [Accepted: 07/26/2022] [Indexed: 01/07/2023]
Abstract
AIM This study aimed to investigate various variables between maternal overweight and/or obesity versus normal-weight pregnant black South African women living with and without human immunodeficiency virus (HIV). METHODS A cross-sectional study design was employed. A total of 200 pregnant women were enrolled in the study, categorized according to body mass index (BMI) (kg/m2 ) into two groups: (1) overweight/obese (≥25 kg/m2 ) (n = 97); and (2) nonoverweight/nonobese (<25 kg/m2 ) (n = 103), where 90 were HIV-infected and 110 were HIV-uninfected. The differences between the maternal BMI categories were assessed using Fisher's exact t-test and the χ2 test. Simple and multiple logistic regression analyses were used to determine factors associated with maternal overweight and obesity. RESULTS Multiple logistic regression analysis showed that maternal age (odds ratio [OR]: 1.061; 95% confidence interval [CI] 1.008-1.117; p = 0.023) and gestational age (OR: 1.121; 95% CI 1.005-1.251; p = 0.041) were significantly associated with maternal overweight/obesity in both HIV-infected and HIV-uninfected. For maternal health outcomes, multiple logistic regression analysis showed that hypertensive disorders (OR: 0.273; 95% CI 0.124-0.601; p = 0.001) and anemia (OR: 2.420; 95% CI 1.283-4.563; p = 0.006) were significantly associated with maternal overweight/obesity in both HIV-infected and HIV-uninfected. The overweight/obese HIV-infected participants (OR: 0.233; 95% CI 0.075-0.717; p = 0.011) had increased odds for developing hypertensive disorders compared to HIV-uninfected overweight/obese participants (OR: 0.471; 95% CI 0.172-1.291; p = 0.143). CONCLUSIONS Maternal overweight/obesity in both HIV-infected and HIV-uninfected pregnant black South African women was significantly associated with maternal age, gestational age, HPT disorders, and anemia. Maternal overweight/obesity decreased the odds for anemia, but increased the odds for the development of HPT disorders, especially in the HIV-infected pregnant women.
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Affiliation(s)
- Christen R Erasmus
- Department of Dietetics and Human Nutrition, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Anil A Chuturgoon
- Department of Medical Biochemistry, University of KwaZulu-Natal, Durban, South Africa
| | - Niren R Maharaj
- Department of Obstetrics and Gynaecology, Prince Mshiyeni Memorial Hospital, Durban, South Africa
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Dallak FH, Gosadi IM, Haidar WN, Durayb AA, Alomaish AR, Alshamakhi AH, Khormi RM, Almudeer AH, Alibrahim MA. Prevalence of adverse birth outcomes and associated factors in Jazan, Saudi Arabia: A cross-sectional study. Medicine (Baltimore) 2022; 101:e31119. [PMID: 36254006 PMCID: PMC9575805 DOI: 10.1097/md.0000000000031119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study aimed to measure the prevalence of adverse birth outcomes and associated factors among mothers from the Jazan region in Saudi, Arabia. This was a cross-sectional investigation where data was collected via a semi-structured questionnaire. The questionnaire was completed during interviews to assess data regarding the participants' demographics, morbidity, the reported adverse birth outcomes, and maternal complications during pregnancy. Chi-squared and Fisher's Exact tests were both used to compare the distribution of demographic and obstetric risk factors according to the historical presence of adverse birth outcomes. A total of 1315 women with a combined history of 4950 pregnancies were involved in the current investigation. The mean age of the participants was 33.1 years. The total number of adverse birth outcomes was 1009. The most frequently reported adverse birth outcome was miscarriage (12.1%), followed by premature birth (2.3%) and underweight birth (1.9%). Reports of a minimum of 1 adverse birth outcome were higher among women who reported family incomes of more than 10,000 Saudi Arabian Riyal (SAR), women who were first-degree cousins of their husbands, and women with less than a secondary level education (P values <.05). This study found a relatively high prevalence of miscarriage. Further investigations are needed to assess factors associated with this high frequency level of miscarriage. Furthermore, these findings have preventive and clinical implications concerning pregnant women with a history of obesity, anemia, consanguinity, and hypertension. The goal is to target them with a better range of antenatal care services to reduce the incidence of potential adverse birth outcomes.
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Affiliation(s)
| | - Ibrahim M. Gosadi
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
- * Correspondence: Ibrahim M Gosadi, Faculty of Medicine, Jazan University, 2349, Jazan 82621, Saudi Arabia (e-mail: )
| | | | | | | | | | | | - Ali H. Almudeer
- Neonatology Department, King Fahd Central Hospital, Jazan, Saudi Arabia
| | - Majed A. Alibrahim
- Neonatal Intensive Care Unit, King Fahd Central Hospital, Jazan, Saudi Arabia
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Schrank M, Contiero B, Mollo A. Incidence and concomitant factors of cesarean sections in the bitch: A questionnaire study. Front Vet Sci 2022; 9:934273. [PMID: 36118330 PMCID: PMC9478343 DOI: 10.3389/fvets.2022.934273] [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] [Received: 05/02/2022] [Accepted: 08/09/2022] [Indexed: 11/13/2022] Open
Abstract
Dystocia in the canine species is a common problem, and elective cesarean sections (C-sections) have become more frequent in breeds that are at risk. The aim of this study was to evaluate the incidence of C-section and contributing factors and to compare data on elective and emergency C-sections (e.g., regarding stillbirth). Using a questionnaire, a total of 423 bitches of 80 breeds and their 899 litters were included. The mean number of litters per bitch was 2.1 ± 1.1 litters. The overall rate of stillbirth was 6.7%. Of all litters, 194 were born via C-sections (21.6%), of which 35 were declared as elective and 159 as emergency due to dystocia. Significantly more C-sections were performed in either small litters (1-2 pups) or large litters (>12 pups) (p < 0.001). Bitches that have had prior C-sections had a 4-fold increase in the risk of successive C-sections (RR = 4.54 (95%CI 2.56–7.70; p < 0.001). Furthermore, primiparous bitches of advanced age had a significantly higher incidence of emergency C-sections (p = 0.004). Stillbirth was significantly higher in emergency C-sections compared with that in elective C-sections (p = 0.003). Also, timing of intervention had a significant impact on stillbirth in emergency C-sections (p = 0.025). Within a breed-specific evaluation, significant differences were observed between breeds regarding incidence of C-section and stillbirth. Lesser-known breeds were represented in the population, and the results showed that the Norwich Terrier had the highest (51.6%) and the Gordon Setter had the lowest (4.8%) incidence of C-section (p < 0.001). The inclusion and evaluation of lesser-known breeds regarding incidence of C-section is of importance as it shows that certain breeds without phenotypical traits such as brachycephaly may also have an increased incidence of emergency C-section and stillbirth. We further conclude that more importance may be given to the age at first parturition concerning the occurrence of dystocia and the decision making regarding possible elective C-sections.
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Sun X, Lu J, Li H, Huang B. The Role of m 6A on Female Reproduction and Fertility: From Gonad Development to Ovarian Aging. Front Cell Dev Biol 2022; 10:884295. [PMID: 35712673 PMCID: PMC9197073 DOI: 10.3389/fcell.2022.884295] [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: 02/26/2022] [Accepted: 04/21/2022] [Indexed: 11/20/2022] Open
Abstract
The growth and maturation of oocyte is accompanied by the accumulation of abundant RNAs and posttranscriptional regulation. N6-methyladenosine (m6A) is the most prevalent epigenetic modification in mRNA, and precisely regulates the RNA metabolism as well as gene expression in diverse physiological processes. Recent studies showed that m6A modification and regulators were essential for the process of ovarian development and its aberrant manifestation could result in ovarian aging. Moreover, the specific deficiency of m6A regulators caused oocyte maturation disorder and female infertility with defective meiotic initiation, subsequently the oocyte failed to undergo germinal vesicle breakdown and consequently lost the ability to resume meiosis by disrupting spindle organization as well as chromosome alignment. Accumulating evidence showed that dysregulated m6A modification contributed to ovarian diseases including polycystic ovarian syndrome (PCOS), primary ovarian insufficiency (POI), ovarian aging and other ovarian function disorders. However, the complex and subtle mechanism of m6A modification involved in female reproduction and fertility is still unknown. In this review, we have summarized the current findings of the RNA m6A modification and its regulators in ovarian life cycle and female ovarian diseases. And we also discussed the role and potential clinical application of the RNA m6A modification in promoting oocyte maturation and delaying the reproduction aging.
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Affiliation(s)
- Xiaoyan Sun
- State Key Laboratory of Reproductive Medicine, Gusu School, Suzhou Municipal Hospital, Suzhou Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Suzhou, China
| | - Jiafeng Lu
- State Key Laboratory of Reproductive Medicine, Gusu School, Suzhou Municipal Hospital, Suzhou Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Suzhou, China
| | - Hong Li
- State Key Laboratory of Reproductive Medicine, Gusu School, Suzhou Municipal Hospital, Suzhou Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Suzhou, China
| | - Boxian Huang
- State Key Laboratory of Reproductive Medicine, Gusu School, Suzhou Municipal Hospital, Suzhou Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Suzhou, China
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Advanced Maternal Age and Its Association With Cardiovascular Disease in Later Life. Womens Health Issues 2022; 32:219-225. [PMID: 35058125 DOI: 10.1016/j.whi.2021.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/10/2021] [Accepted: 12/17/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Fertility among women at advanced maternal age (AMA) is increasing at a rapid rate in the United States. Although much is known about the impact of older maternal age on the risk for proximate adverse pregnancy outcomes, it is unclear whether older maternal age affects subsequent health. The objective of this study was to evaluate whether AMA is associated with cardiovascular disease (CVD) later in life, adjusting for important social and health factors related to maternal age. METHODS Data were obtained from the Nurses' Health Study II, a longitudinal prospective cohort study. We investigated whether women with an AMA first or subsequent birth were at higher risk for developing CVD (myocardial infarction or stroke) after age 42 than women without births at AMA. Cox proportional hazard models were estimated to evaluate this association, adjusting for demographic, fertility, and health characteristics. RESULTS A total of 5,471 women (7.7%) in the sample had a first birth at an AMA and 1,282 (1.8%) developed CVD at age 42 or older. Women with first births at AMA had a 26% lower unadjusted hazard of CVD than women not at an AMA during their first birth (hazard ratio, 0.74; 95% confidence interval, 0.57-0.95). This association was attenuated (hazard ratio, 0.80; 95% confidence interval, 0.62-1.05) and no longer significant after adjustment for covariates; the modest association remained significant for women with any AMA birth. CONCLUSIONS We found no evidence that AMA births were associated with increased risk for developing CVD later in life in this sample.
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Kim H, Kim MS, Seo Y, Yum SK. Short-term outcomes of very-low-birth-weight infants born to mothers of advanced and very advanced maternal age. J Matern Fetal Neonatal Med 2022; 35:9870-9877. [PMID: 35437100 DOI: 10.1080/14767058.2022.2065192] [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: 10/18/2022]
Abstract
OBJECTIVE To evaluate whether advanced maternal age (35-39 years, AMA)/very advanced maternal age (≥40 years, VAMA) impacts neonatal outcomes of very-low-birth-weight (VLBW) infants. METHODS Data of VLBW infants admitted to our unit were reviewed. Demographic findings and neonatal outcomes were compared among maternal age [(<35 years, not advanced maternal age, n = 329), AMA (n = 209), and VAMA (n = 43)] groups. Univariate and multivariate analyses were performed to identify the associated risk factors for neonatal outcomes. RESULT Mortality and overall morbidities showed no significant intergroup differences, except for massive pulmonary hemorrhage (MPH). Multivariate analysis revealed that AMA/VAMA was not significantly associated with MPH development, while ≥ two doses of surfactant administration was. Higher gestational age and antenatal corticosteroid administration were protective. CONCLUSION AMA/VAMA is not associated with neonatal mortality and morbidities. Since the proportion of AMA/VAMA mothers is expected to increase, perinatal medicine practitioners should focus on approaches before and immediately after birth of such infants.
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Affiliation(s)
- HyoYun Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min Soo Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yumi Seo
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sook Kyung Yum
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Gitman V, Stavropoulos A, Saenz V, Pasquarelli N, Zecevic D, Devonshire V. Pregnancy Outcomes of Women with Multiple Sclerosis Treated with Ocrelizumab in Canada: A Descriptive Analysis of Real-World Data. Mult Scler Relat Disord 2022; 62:103792. [DOI: 10.1016/j.msard.2022.103792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/24/2022] [Accepted: 04/03/2022] [Indexed: 10/18/2022]
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Declercq E, Feinberg E, Belanoff C. Racial inequities in the course of treating perinatal mental health challenges: Results from listening to mothers in California. Birth 2022; 49:132-140. [PMID: 34459012 PMCID: PMC9292331 DOI: 10.1111/birt.12584] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/12/2021] [Accepted: 08/17/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Concern with depression during the perinatal period has resulted in multiple states enacting legislation to require universal screening of mothers for postpartum depression. Despite this concern, rates of women receiving mental health counseling during pregnancy and postpartum remain low. This study examines factors, especially inequities in race/ethnicity, associated with receiving perinatal mental health counseling. METHODS This study draws on data from the Listening to Mothers in California survey of 2539 women, based on a representative sample of birth certificate files of women who gave birth in 2016. The survey included a series of mental health questions, based on the 4-item Patient Health Questionnaire (PHQ-4), and questions on the receipt of counseling, whether a practitioner asked respondents about their mental health, and whether the respondent was taking medications for anxiety or depression. RESULTS We found non-Latina Black women to experience both higher rates of prenatal depressive symptoms and significantly lower use of postpartum counseling services and medications than non-Latina White women. Among women with depressive symptoms, those asked by a practitioner about their mental health status reported a 46% rate of counseling compared with 20% who were not asked, and in a multivariable analysis, those asked were almost six times more likely (aOR 5.96; 95% CI 1.6-21.7) to report counseling. DISCUSSION These findings lend evidence to those advocating for state laws requiring universal screening for depressive symptoms to reduce inequities and help address the underuse of counseling services among all women with depressive symptoms, particularly women of color.
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Affiliation(s)
| | - Emily Feinberg
- Division of General PediatricsBoston University School of MedicineBostonMAUSA
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Han W, Pan Y, Han Z, Cheng L, Jiang L. Advanced Maternal Age Impairs Myelination in Offspring Rats. Front Pediatr 2022; 10:850213. [PMID: 35311052 PMCID: PMC8927774 DOI: 10.3389/fped.2022.850213] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
The effects of advanced maternal age (AMA) on the neurodevelopment of offspring are becoming increasingly important. Myelination is an important aspect of brain development; however, a limited number of studies have focused on the effects of AMA on myelination in offspring. The current study aims to evaluate the association between AMA and myelin sheath development in offspring. We studied the learning and memory function of immature offspring using the novel object recognition test. Then, we investigated the expression of myelin basic protein (MBP) in the immature offspring of young (3-month-old) and old (12-month-old) female rats at different time points (14, 28, and 60 days) after birth with immunofluorescence and western blotting. The myelin sheath ultrastructure was observed with transmission electron microscopy in immature and mature offspring. Extracellular signal-regulated kinase 1 and 2 (ERK1/2) and phosphorylated ERK1/2 (p-ERK1/2) were investigated by western blot in immature offspring at the above time points. AMA impaired the memory function of offspring during early postnatal days. The MBP expression level gradually increased with postnatal development in the offspring of both the AMA and Control (Ctl) groups, but the MBP level in the offspring of the AMA group was lower than that of the Ctl group at 14 days after birth. In addition, the ultrastructure of the myelin sheath was defective in AMA offspring during the early postnatal period; however, the myelin sheath was not significantly affected in offspring during adulthood. Interestingly, ERK phosphorylation at 14 days after birth was lower in AMA offspring than in Ctl offspring. However, ERK phosphorylation at 28 days after birth was higher in AMA offspring than in Ctl offspring. The peak of ERK phosphorylation in the AMA group was abnormal and delayed. Our results indicated that AMA is associated with poor developmental myelin formation in offspring. The ERK signaling pathway may play an essential role in the adverse effects of AMA on the offspring myelin sheath development.
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Affiliation(s)
- Wei Han
- Department of Neurology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ya'nan Pan
- Department of Neurology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ziyao Han
- Department of Neurology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Li Cheng
- Department of Neurology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Li Jiang
- Department of Neurology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Glick I, Kadish E, Rottenstreich M. Management of Pregnancy in Women of Advanced Maternal Age: Improving Outcomes for Mother and Baby. Int J Womens Health 2021; 13:751-759. [PMID: 34408501 PMCID: PMC8364335 DOI: 10.2147/ijwh.s283216] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/03/2021] [Indexed: 12/13/2022] Open
Abstract
Pregnancy at advanced maternal age (age >35 years old) is considered a risk factor for adverse maternal and perinatal outcomes. Yet, pregnancies of advanced maternal age have become more prevalent over the last few decades. Possible maternal complications of pregnancy at age 35 or older include increased risk of spontaneous miscarriage, preterm labor, gestational diabetes mellitus, pre-eclampsia, stillbirth, chromosomal abnormalities, and cesarean delivery. Possible adverse fetal outcomes include infants small for gestational age and intrauterine growth restrictions, low Apgar score, admission to neonatal intensive care units, and an autism spectrum disorder. This paper aims to present an up-to-date review of the literature, summarizing the most current studies and implications for the management of pregnancy of advanced maternal age.
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Affiliation(s)
- Itamar Glick
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ela Kadish
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Misgav Rottenstreich
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel
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Chen SF, Li YT, Chang WH, Wang PH. Pregnancy outcome in elder women. Taiwan J Obstet Gynecol 2021; 60:589-590. [PMID: 34247791 DOI: 10.1016/j.tjog.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- Shu-Fen Chen
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yiu-Tai Li
- Department of Obstetrics and Gynecology, Kuo General Hospital, Tainan, Taiwan
| | - Wen-Hsun Chang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Female Cancer Foundation, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
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Lu MC, Noursi S. Summary and Conclusion: Framing a New Research Agenda on Maternal Morbidities and Mortality in the United States. J Womens Health (Larchmt) 2020; 30:280-284. [PMID: 33216690 PMCID: PMC8020501 DOI: 10.1089/jwh.2020.8877] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Maternal mortality in the United States is at an alarming rate. Research can have an important role in addressing maternal mortality, but our current understanding of its causes and prevention remains woefully incomplete. The collection of articles in this volume begin to frame a new research agenda by asking four critical questions. First, what truly makes vulnerable populations vulnerable? Second, how do we prevent pregnancy complications and their long-term sequelae? Third, how can we make maternity care safer for all women? Finally, what can we do about the social, structural, and environmental determinants of maternal health? Answers to these questions can help inform practice, systems, and policy change to reduce and ultimately eradicate maternal deaths in the United States.
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Affiliation(s)
- Michael C Lu
- Berkeley School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Samia Noursi
- Office of Research on Women's Health, Office of the Director, National Institutes of Health, Bethesda, Maryland, USA
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