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Freisthler M, Winchester PW, Young HA, Haas DM. Perinatal health effects of herbicides exposures in the United States: the Heartland Study, a Midwestern birth cohort study. BMC Public Health 2023; 23:2308. [PMID: 37993831 PMCID: PMC10664386 DOI: 10.1186/s12889-023-17171-9] [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: 11/30/2022] [Accepted: 11/03/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND The objective of the Heartland Study is to address major knowledge gaps concerning the health effects of herbicides on maternal and infant health. To achieve this goal, a two-phased, prospective longitudinal cohort study is being conducted. Phase 1 is designed to evaluate associations between biomarkers of herbicide concentration and pregnancy/childbirth outcomes. Phase 2 is designed to evaluate potential associations between herbicide biomarkers and early childhood neurological development. METHODS People (target enrollment of 2,000) who are seeking prenatal care, are ages 18 or older, and are ≤ 20 + 6 weeks gestation will be eligible for recruitment. The Heartland Study will utilize a combination of questionnaire data and biospecimen collections to meet the study objectives. One prenatal urine and buccal sample will be collected per trimester to assess the impact of herbicide concentration levels on pregnancy outcomes. Infant buccal specimens will be collected post-delivery. All questionnaires will be collected by trained study staff and clinic staff will remain blinded to all individual level research data. All data will be stored in a secure REDCap database. Hospitals in the agriculturally intensive states in the Midwestern region will be recruited as study sites. Currently participating clinical sites include Indiana University School of Medicine- affiliated Hospitals in Indianapolis, Indiana; Franciscan Health Center in Indianapolis, Indiana; Gundersen Lutheran Medical Center in La Crosse, Wisconsin, and University of Iowa in Iowa City, Iowa. An anticipated 30% of the total enrollment will be recruited from rural areas to evaluate herbicide concentrations among those pregnant people residing in the rural Midwest. Perinatal outcomes (e.g. birth outcomes, preterm birth, preeclampsia, etc.) will be extracted by trained study teams and analyzed for their relationship to herbicide concentration levels using appropriate multivariable models. DISCUSSION Though decades of study have shown that environmental chemicals may have important impacts on the health of parents and infants, there is a paucity of prospective longitudinal data on reproductive impacts of herbicides. The recent, rapid increases in herbicide use across agricultural regions of the United States necessitate further research into the human health effects of these chemicals, particularly in pregnant people. The Heartland Study provides an invaluable opportunity to evaluate health impacts of herbicides during pregnancy and beyond. TRIAL REGISTRATION The study is registered at clinicaltrials.gov, NCT05492708 with initial registration and release 05 August, 2022.
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Affiliation(s)
- Marlaina Freisthler
- Department of Environmental and Occupational Health, Milken Institute of Public Health, George Washington University, 950 New Hampshire Ave NW #2, Washington, DC, 20052, USA
| | - Paul W Winchester
- Neonatal-Perinatal Medicine, Riley Children's Hospital, Indiana University School of Medicine, 699 Riley Hospital Dr RR 208, Indianapolis, IN, 46202, USA
- Franciscan Health, Indianapolis, 8111 South Emerson Avenue, Indianapolis, IN, 46237, USA
| | - Heather A Young
- Department of Epidemiology, Milken Institute for Public Health, George Washington University, 950 New Hampshire Ave NW #2, Washington, DC, 20052, USA
| | - David M Haas
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, 550 N. University Blvd, Indianapolis, IN, UH2440, USA.
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2
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Williamson C, Nana M, Poon L, Kupcinskas L, Painter R, Taliani G, Heneghan M, Marschall HU, Beuers U. EASL Clinical Practice Guidelines on the management of liver diseases in pregnancy. J Hepatol 2023; 79:768-828. [PMID: 37394016 DOI: 10.1016/j.jhep.2023.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/10/2023] [Indexed: 07/04/2023]
Abstract
Liver diseases in pregnancy comprise both gestational liver disorders and acute and chronic hepatic disorders occurring coincidentally in pregnancy. Whether related to pregnancy or pre-existing, liver diseases in pregnancy are associated with a significant risk of maternal and fetal morbidity and mortality. Thus, the European Association for the Study of Liver Disease invited a panel of experts to develop clinical practice guidelines aimed at providing recommendations, based on the best available evidence, for the management of liver disease in pregnancy for hepatologists, gastroenterologists, obstetric physicians, general physicians, obstetricians, specialists in training and other healthcare professionals who provide care for this patient population.
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3
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Zhu Y, Hedderson MM, Brown SD, Badon SE, Feng J, Quesenberry CP, Ferrara A. Healthy preconception and early-pregnancy lifestyle and risk of preterm birth: a prospective cohort study. Am J Clin Nutr 2021; 114:813-821. [PMID: 33900396 PMCID: PMC8326036 DOI: 10.1093/ajcn/nqab089] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 03/03/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Preterm birth (PTB) remains a leading cause of neonatal mortality and long-term morbidity. Individual factors have been linked to PTB risk. The impact of a healthy lifestyle, with multiple modifiable prenatal factors, remains unknown. OBJECTIVES We aimed to examine the associations of preconceptional and early-pregnancy low-risk modifiable factors (individually and in combination) with PTB risk. METHODS This prospective cohort study included 2449 women with singleton pregnancies in the Pregnancy Environment and Lifestyle Study. PTB was defined as ultrasound-confirmed obstetric estimate-based gestational age at delivery <37 wk. A set of low-risk modifiable factors were identified: healthy weight (prepregnancy BMI: 18.5-24.9 kg/m2) based on clinical measurements and high-quality diet (Alternate Healthy Eating Index-Pregnancy score ≥75th percentile) and low-to-moderate stress during early pregnancy (Perceived Stress Scale score <75th percentile) assessed at gestational weeks 10-13. Poisson regression estimated adjusted relative risk (aRR) of PTB in association with individual and combined low-risk modifiable prenatal factors, adjusting for sociodemographic, clinical, and other prenatal factors. RESULTS One hundred and sixty women (6.5%) delivered preterm. Risk of PTB was lower among women who had a healthy weight (aRR: 0.58; 95% CI: 0.39, 0.86), high-quality diet (aRR: 0.68; 95% CI: 0.39, 0.99), and low-to-moderate stress (aRR: 0.60; 95% CI: 0.41, 0.88). Women with 1, 2, or 3 low-risk modifiable prenatal factors compared with none had a 38% (aRR: 0.72; 95% CI: 0.45, 1.16), 51% (aRR: 0.49; 95% CI: 0.29, 0.84), or 70% (aRR: 0.30; 95% CI: 0.13, 0.70) lower PTB risk, respectively. Associations of having ≥1 low-risk factor with PTB risk were more pronounced for medically indicated than for spontaneous PTB and for late than for early or moderate PTB. Associations also varied by race or ethnicity, although with overlapping 95% CIs. CONCLUSIONS A healthy prenatal lifestyle with multiple low-risk modifiable factors was associated with lower risk of PTB. Our findings may inform multicomponent preconceptional or early-pregnancy prevention strategies to mitigate PTB risk.
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Affiliation(s)
- Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Monique M Hedderson
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Susan D Brown
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Division of General Medicine, University of California, Davis, Davis, CA, USA
| | - Sylvia E Badon
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Juanran Feng
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | | | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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4
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Abdallah AY, Joho AA, Yahaya JJ. Influence of maternal lifestyle behaviors on birth weight and Apgar score. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2021.100334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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5
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Sarkar M, Brady CW, Fleckenstein J, Forde KA, Khungar V, Molleston JP, Afshar Y, Terrault NA. Reproductive Health and Liver Disease: Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 2021; 73:318-365. [PMID: 32946672 DOI: 10.1002/hep.31559] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/08/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Monika Sarkar
- University of California, San Francisco, San Francisco, CA
| | | | | | | | | | - Jean P Molleston
- Indiana University and Riley Hospital for Children, Indianapolis, IN
| | - Yalda Afshar
- University of California, Los Angeles, Los Angeles, CA
| | - Norah A Terrault
- Keck School of Medicine, University of Southern California, Los Angeles, CA
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6
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Weile LKK, Hegaard HK, Wu C, Tabor A, Wolf HT, Kesmodel US, Henriksen TB, Nohr EA. Alcohol Intake in Early Pregnancy and Spontaneous Preterm Birth: A Cohort Study. Alcohol Clin Exp Res 2019; 44:511-521. [PMID: 31803953 DOI: 10.1111/acer.14257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 11/19/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Limited research has addressed whether maternal alcohol intake in early pregnancy increases the risk of spontaneous preterm birth. In the current study, we examined how alcohol binge drinking and weekly alcohol intake in early pregnancy were associated with spontaneous preterm birth in a contemporary cohort of Danish women. METHODS We included 15,776 pregnancies of 14,894 women referred to antenatal care at Copenhagen University Hospital, Denmark, between 2012 and 2016. Self-reported alcohol intake in early pregnancy was obtained from a Web-based questionnaire completed prior to the women's first visit at the department. Information on spontaneous preterm birth was extracted from the Danish Medical Birth Register. Adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) of spontaneous preterm birth according to self-reported alcohol binge drinking and weekly intake of alcohol in early pregnancy were derived from Cox regression. RESULTS Women reporting 1, 2, and ≥ 3 binge drinking episodes had an aHR for spontaneous preterm birth of 0.88 (95% CI 0.68 to 1.14), 1.34 (95% CI 0.98 to 1.82), and 0.93 (95% CI 0.62 to 1.41), respectively, compared to women with no binge drinking episodes. Women who reported an intake of ≥ 1 drink per week on average had an aHR for spontaneous preterm birth of 1.09 (95% CI 0.63 to 1.89) compared to abstainers. When restricting to nulliparous women or cohabiting women with ≥ 3 years of higher education, this estimate was 1.28 (95% CI 0.69 to 2.40) and 1.20 (95% CI 0.67 to 2.15), respectively. CONCLUSION We found no evidence that maternal alcohol intake in early pregnancy was associated with a higher risk of spontaneous preterm birth, neither for alcohol binge drinking nor for a low average weekly intake of alcohol.
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Affiliation(s)
- Louise Katrine Kjaer Weile
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense C, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark.,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense C, Denmark
| | - Hanne Kirstine Hegaard
- Department of Obstetrics, Copenhagen University Hospital (Rigshospitalet), Copenhagen Ø, Denmark.,The Research Unit Women's and Children's Health, Juliane Marie Centre, Copenhagen University Hospital (Rigshospitalet), Copenhagen N, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
| | - Chunsen Wu
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense C, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Ann Tabor
- Department of Obstetrics, Copenhagen University Hospital (Rigshospitalet), Copenhagen Ø, Denmark.,The Research Unit Women's and Children's Health, Juliane Marie Centre, Copenhagen University Hospital (Rigshospitalet), Copenhagen N, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
| | - Hanne Trap Wolf
- Department of Obstetrics and Gynecology, Hvidovre University Hospital, Hvidovre, Denmark
| | - Ulrik Schiøler Kesmodel
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
| | - Tine Brink Henriksen
- Department of Pediatrics (Intensive Care Neonatology), Aarhus University Hospital, Aarhus N, Denmark.,Perinatal Epidemiology Research Unit, Department of Pediatrics, Aarhus University Hospital, Aarhus N, Denmark
| | - Ellen Aagaard Nohr
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense C, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
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7
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Ikehara S, Kimura T, Kakigano A, Sato T, Iso H. Association between maternal alcohol consumption during pregnancy and risk of preterm delivery: the Japan Environment and Children's Study. BJOG 2019; 126:1448-1454. [PMID: 31386246 PMCID: PMC7003893 DOI: 10.1111/1471-0528.15899] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine the association between maternal alcohol consumption during pregnancy and the risk of preterm delivery. DESIGN Prospective cohort study. SETTING The Japan Environment and Children's Study (JECS). POPULATION A total of 94 349 singleton pregnancies. METHODS Participants completed questionnaires detailing alcohol consumption during the first trimester and during the second and third trimesters. Participants were divided into four categories according to alcohol consumption (non-drinkers, consumers of 1-149 g, 150-299 g and ≥300 g ethanol/week). We examined the effect of alcohol consumption during different stages of pregnancy on the risk of preterm delivery. Odds ratios (OR) and 95% CI were calculated relative to non-drinkers using logistic regression. MAIN OUTCOME MEASURES Medical record-based preterm delivery. RESULTS Alcohol consumption during the second and third trimesters, but not during the first trimester, was associated with increased risk of preterm delivery. Heavy alcohol consumption (≥300 g ethanol/week) during the second and third trimesters was associated with a four-fold higher risk compared with non-drinkers (multivariable OR 4.52; 95% CI 1.68-12.2). Light alcohol consumption (1-149 g ethanol/week) tended to be associated with lower risk of preterm delivery (multivariable OR 0.78; 95% CI 0.60-1.00). CONCLUSIONS Heavy alcohol consumption during the second and third trimesters was associated with increased risk of preterm delivery among pregnant women. TWEETABLE ABSTRACT Heavy drinking during pregnancy may increase the risk of preterm delivery.
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Affiliation(s)
- S Ikehara
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita-shi, Japan
| | - T Kimura
- Department of Public Health, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - A Kakigano
- Department of Obstetrics and Gynaecology, Osaka University Graduate School of Medicine, Suita-shi, Japan
| | - T Sato
- Osaka Maternal and Child Health Information Centre, Osaka Women's and Children's Hospital, Izumi, Japan
| | - H Iso
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita-shi, Japan
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8
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Stokkeland K, Ludvigsson JF, Hultcrantz R, Ekbom A, Höijer J, Bottai M, Stephansson O. Pregnancy outcome in more than 5000 births to women with viral hepatitis: a population-based cohort study in Sweden. Eur J Epidemiol 2017; 32:617-625. [PMID: 28550648 PMCID: PMC5570776 DOI: 10.1007/s10654-017-0261-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 05/17/2017] [Indexed: 01/09/2023]
Abstract
Previous studies have shown inconsistent results with respect to hepatitis B (HBV), hepatitis C (HCV) and pregnancy outcome. The aim of this study was to investigate pregnancy outcome in women with HBV or HCV. In a nationwide cohort of births between 2001 and 2011 we investigated the risks of adverse pregnancy outcomes in 2990 births to women with HBV and 2056 births to women with HCV using data from Swedish healthcare registries. Births to women without HBV (n = 1090 979), and births without HCV (n = 1091 913) served as population controls. Crude and adjusted relative risks (aRR) were calculated using Poisson regression analysis. Women with HCV were more likely to smoke (46.7 vs. 8.0%) and to have alcohol dependence (18.9 vs. 1.3%) compared with population controls. Most women with HBV were born in non-Nordic countries (91.9%). Maternal HCV was associated with a decreased risk of preeclampsia (aRR: 0.39, 95% CI: 0.24–0.64), but an increased risk of preterm birth (aRR: 1.32, 95% CI: 1.08–1.60) and late neonatal death (7–27 days: aRR: 3.79, 95% CI: 1.07–13.39) Preterm birth were also more common in mothers with HBV, aRR: 1.21 (95% CI: 1.02–1.45). Both HBV and HCV are risk factors for preterm birth, while HCV seems to be associated with a decreased risk for preeclampsia. Future studies should corroborate these findings.
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Affiliation(s)
- Knut Stokkeland
- Department of Medicine, Visby Hospital, St Görans Str. 8, 621 84, Visby, Sweden. .,Department of Medicine, Gastroenterology and Hepatology Unit, Karolinska Institutet, Stockholm, Sweden.
| | - Jonas Filip Ludvigsson
- Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Rolf Hultcrantz
- Department of Medicine, Gastroenterology and Hepatology Unit, Karolinska Institutet, Stockholm, Sweden.,Division of Hepatology, Karolinska Hospital, Stockholm, Sweden
| | - Anders Ekbom
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Hospital and Institutet, Stockholm, Sweden
| | - Jonas Höijer
- Unit of Biostatistics, IMM, Karolinska Institutet, Stockholm, Sweden
| | - Matteo Bottai
- Unit of Biostatistics, IMM, Karolinska Institutet, Stockholm, Sweden
| | - Olof Stephansson
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Hospital and Institutet, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Popova S, Lange S, Probst C, Parunashvili N, Rehm J. Prevalence of alcohol consumption during pregnancy and Fetal Alcohol Spectrum Disorders among the general and Aboriginal populations in Canada and the United States. Eur J Med Genet 2017; 60:32-48. [DOI: 10.1016/j.ejmg.2016.09.010] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 08/30/2016] [Accepted: 09/12/2016] [Indexed: 11/26/2022]
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10
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AISF position paper on liver disease and pregnancy. Dig Liver Dis 2016; 48:120-37. [PMID: 26747754 DOI: 10.1016/j.dld.2015.11.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 10/29/2015] [Accepted: 11/06/2015] [Indexed: 12/11/2022]
Abstract
The relationship between liver disease and pregnancy is of great clinical impact. Severe liver disease in pregnancy is rare; however, pregnancy-related liver disease is the most frequent cause of liver dysfunction during pregnancy and represents a severe threat to foetal and maternal survival. A rapid differential diagnosis between liver disease related or unrelated to pregnancy is required in women who present with liver dysfunction during pregnancy. This report summarizes the recommendation of an expert panel established by the Italian Association for the Study of the Liver (AISF) on the management of liver disease during pregnancy. The article provides an overview of liver disease occurring in pregnancy, an update on the key mechanisms involved in its pathogenesis, and an assessment of the available treatment options. The report contains in three sections: (1) specific liver diseases of pregnancy; (2) liver disease occurring during pregnancy; and (3) pregnancy in patients with pre-existing chronic liver disease. Each topic is discussed considering the most relevant data available in literature; the final statements are formulated according to both scientific evidence and clinical expertise of the involved physicians, and the AISF expert panel recommendations are reported.
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11
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Pregnancy outcomes and birth defects from an antiretroviral drug safety study of women in South Africa and Zambia. AIDS 2014; 28:2259-68. [PMID: 25115319 DOI: 10.1097/qad.0000000000000394] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the safety of combination antiretroviral therapy (ART) in conception and pregnancy in different health systems. DESIGN A pilot ART registry to measure the prevalence of birth defects and adverse pregnancy outcomes in South Africa and Zambia. METHODS HIV-infected pregnant women on ART prior to conception were enrolled until delivery, and their infants were followed until 1 year old. RESULTS Between October 2010 and April 2011, 600 women were enrolled. The median CD4 cell count at study enrollment was lower in South Africa than Zambia (320 vs. 430 cells/μl; P < 0.01). The most common antiretroviral drugs at the time of conception included stavudine, lamivudine, and nevirapine. There were 16 abortions (2.7%), one ectopic pregnancy (0.2%), 12 (2.0%) stillbirths, and 571 (95.2%) live infants. Deliveries were more often preterm (29.7 vs. 18.4%; P = 0.01) and the infants had lower birth weights (2900 vs. 2995 g; P = 0.11) in Zambia compared to South Africa. Thirty-six infants had birth defects: 13 major and 23 minor. There were more major anomalies detected in South Africa and more minor ones in Zambia. No neonatal deaths were attributed to congenital birth defects. CONCLUSIONS An Africa-specific, multi-site antiretroviral drug safety registry for pregnant women is feasible. Different prevalence for preterm delivery, delivery mode, and birth defect types between women on preconception ART in South Africa and Zambia highlight the potential impact of health systems on pregnancy outcomes. As countries establish ART drug safety registries, documenting health facility limitations may be as essential as the specific ART details.
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12
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Whiteman VE, August EM, Mogos M, Naik E, Garba M, Sanchez E, Weldeselasse HE, Salihu HM. Preterm birth in the first pregnancy and risk of neonatal death in the second pregnancy: a propensity score-weighted matching approach. J OBSTET GYNAECOL 2014; 35:30-6. [PMID: 25058689 DOI: 10.3109/01443615.2014.937328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The study purpose was to assess the relationship between various grades of preterm birth (moderate preterm: 33-36 weeks; severe preterm: 27-32 weeks; extreme preterm: ≤ 26 weeks) in the first pregnancy and neonatal mortality (death within 28 days of birth; early: 0-7 days; late: 8-28 days) in the second pregnancy. Using the Missouri maternally-linked dataset (1989-2005), a population-based, retrospective cohort analysis with propensity score-weighted matching was conducted on mothers with two consecutive singleton live births (n = 310,653 women). Women with a prior preterm birth were more likely to subsequently experience neonatal death. The odds increased in a dose-dependent pattern with ascending severity of the preterm event in the first pregnancy (moderate preterm: AOR = 1.32; 95% CI: 1.10-1.60; severe preterm: AOR = 2.62; 95% CI: 2.01-3.41; extreme preterm: AOR = 5.84; 95% CI: 4.28-7.97; p value for trend < 0.001). However, the pathway for the relationship between prior preterm birth and subsequent neonatal mortality may be the recurrence of preterm birth.
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Affiliation(s)
- V E Whiteman
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, College of Medicine
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13
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Graignic-Philippe R, Dayan J, Chokron S, Jacquet AY, Tordjman S. Effects of prenatal stress on fetal and child development: A critical literature review. Neurosci Biobehav Rev 2014; 43:137-62. [DOI: 10.1016/j.neubiorev.2014.03.022] [Citation(s) in RCA: 179] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 02/19/2014] [Accepted: 03/31/2014] [Indexed: 12/13/2022]
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Miyake Y, Tanaka K, Okubo H, Sasaki S, Arakawa M. Alcohol consumption during pregnancy and birth outcomes: the Kyushu Okinawa Maternal and Child Health Study. BMC Pregnancy Childbirth 2014; 14:79. [PMID: 24555868 PMCID: PMC3933512 DOI: 10.1186/1471-2393-14-79] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 02/12/2014] [Indexed: 11/24/2022] Open
Abstract
Background A recent meta-analysis showed no relationships between light to moderate alcohol consumption during pregnancy and the risk of low birth weight (LBW), preterm birth (PTB), or small-for-gestational-age (SGA). Here, we present the first epidemiological study on this topic in Japan. Methods Study subjects were 1565 Japanese mothers with singleton pregnancies and the babies born from these pregnancies. Alcohol consumption during pregnancy was assessed using a self-administered diet history questionnaire. Alcohol consumption during pregnancy was classified into three categories (none, < 1 g/day, and ≥ 1 g/day). Results The mean birth weight of the babies was 3006.3 g. 7.7% were classified as LBW, 4.0% as PTB, and 7.8% as SGA. The range of maternal alcohol consumption during pregnancy was 0.0 to 11.7 g per day: 1356 (86.7%) mothers were abstainers and the 95th percentile value was 0.84 g per day. Compared with abstinence, alcohol consumption of 1.0 g or more per day during pregnancy was significantly associated with an increased risk of PTB with a significant positive linear trend: the adjusted OR for PTB associated with maternal alcohol consumption of 1.0 g or more per day was 2.58 (95% CI: 1.004 - 5.80, P for trend = 0.03). No significant relationships were observed between maternal alcohol consumption during pregnancy and the risk of LBW or SGA, and there was no material association between maternal alcohol consumption during pregnancy and birth weight. Conclusions This is the first study in Japan to show that maternal alcohol consumption during pregnancy of 1.0 g or more per day was significantly positively associated with the risk of PTB, but not LBW or SGA.
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Affiliation(s)
- Yoshihiro Miyake
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
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15
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Salihu HM, Diamond E, August EM, Rahman S, Mogos MF, Mbah AK. Maternal pregnancy weight gain and the risk of placental abruption. Nutr Rev 2013; 71 Suppl 1:S9-17. [DOI: 10.1111/nure.12063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
| | - Elise Diamond
- University of South Florida; College of Public Health; Department of Epidemiology and Biostatistics; Tampa; Florida; USA
| | | | - Shams Rahman
- University of South Florida; College of Public Health; Department of Epidemiology and Biostatistics; Tampa; Florida; USA
| | - Mulubrhan F Mogos
- University of South Florida; College of Public Health; Department of Epidemiology and Biostatistics; Tampa; Florida; USA
| | - Alfred K Mbah
- University of South Florida; College of Public Health; Department of Epidemiology and Biostatistics; Tampa; Florida; USA
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Truong KD, Reifsnider OS, Mayorga ME, Spitler H. Estimated number of preterm births and low birth weight children born in the United States due to maternal binge drinking. Matern Child Health J 2013; 17:677-88. [PMID: 22711260 PMCID: PMC3664940 DOI: 10.1007/s10995-012-1048-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The objective of this study was to estimate the aggregate burden of maternal binge drinking on preterm birth (PTB) and low birth weight (LBW) across American sociodemographic groups in 2008. To estimate the aggregate burden of maternal binge drinking on preterm birth (PTB) and low birth weight (LBW) across American sociodemographic groups in 2008. A simulation model was developed to estimate the number of PTB and LBW cases due to maternal binge drinking. Data inputs for the model included number of births and rates of preterm and LBW from the National Center for Health Statistics; female population by childbearing age groups from the U.S. Census; increased relative risks of preterm and LBW deliveries due to maternal binge drinking extracted from the literature; and adjusted prevalence of binge drinking among pregnant women estimated in a multivariate logistic regression model using Behavioral Risk Factor Surveillance System survey. The most conservative estimates attributed maternal binge drinking to 8,701 (95% CI: 7,804-9,598) PTBs (1.75% of all PTBs) and 5,627 (95% CI 5,121-6,133) LBW deliveries in 2008, with 3,708 (95% CI: 3,375-4,041) cases of both PTB and LBW. The estimated rate of PTB due to maternal binge drinking was 1.57% among all PTBs to White women, 0.69% among Black women, 3.31% among Hispanic women, and 2.35% among other races. Compared to other age groups, women ages 40-44 had the highest adjusted binge drinking rate and highest PTB rate due to maternal binge drinking (4.33%). Maternal binge drinking contributed significantly to PTB and LBW differentially across sociodemographic groups.
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Affiliation(s)
- Khoa D Truong
- Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA.
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Pfinder M, Kunst AE, Feldmann R, van Eijsden M, Vrijkotte TGM. Preterm birth and small for gestational age in relation to alcohol consumption during pregnancy: stronger associations among vulnerable women? Results from two large Western-European studies. BMC Pregnancy Childbirth 2013; 13:49. [PMID: 23433310 PMCID: PMC3607897 DOI: 10.1186/1471-2393-13-49] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 02/14/2013] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Inconsistent data on the association between prenatal alcohol exposure and a range of pregnancy outcomes, such as preterm birth (PTB) and small for gestational age (SGA) raise new questions. This study aimed to assess whether the association between low-moderate prenatal alcohol exposure and PTB and SGA differs according to maternal education, maternal mental distress or maternal smoking. METHODS The Amsterdam Born Children and their Development (ABCD) Study (N = 5,238) and the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) (N = 16,301) are both large studies. Women provide information on alcohol intake in early pregnancy, 3 months postpartum and up to 17 years retrospectively. Multivariate logistic regression analyses and stratified regression analyses were performed to examine the association between prenatal alcohol exposure and PTB and SGA, respectively. RESULTS No association was found between any level of prenatal alcohol exposure (non-daily, daily, non-abstaining) and SGA. The offspring of daily drinkers and non-abstainers had a lower risk of PTB [ABCD: odds ratio (OR) 0.31, 95% confidence interval (CI) 0.13, 0.77; KiGGS: OR 0.75, 95% CI 0.57, 0.99]. Interactions with maternal education, maternal distress or maternal smoking were not significant. CONCLUSIONS Although these results should be interpreted with caution, both studies showed no adverse effects of low-moderate prenatal alcohol exposure on PTB and SGA, not even in the offspring of women who were disadvantaged in terms of low education, high levels of distress, or smoking during pregnancy.
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Affiliation(s)
- Manuela Pfinder
- Bielefeld Graduate School in History and Sociology, Faculty of Sociology, Bielefeld University, PO Box 100131, 33501 Bielefeld, Germany
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- FAS Ambulance, Polyclinic for Children’s and Youth Medicine, University Hospital Munster, Albert-Schweitzer-Straße 33, 48129 Munster, Germany
| | - Anton E Kunst
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Reinhold Feldmann
- FAS Ambulance, Polyclinic for Children’s and Youth Medicine, University Hospital Munster, Albert-Schweitzer-Straße 33, 48129 Munster, Germany
| | - Manon van Eijsden
- Department of Epidemiology, Documentation and Health Promotion, Public Health Service of Amsterdam (GGD), Nieuwe Achtergracht 100, 1018 WT Amsterdam, PO Box 22001000 CE, Amsterdam, The Netherlands
- Department of Health Sciences, VU University, De Boelelaan 1085, 1081 HV, Amsterdam,The Netherlands
| | - Tanja G M Vrijkotte
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Stokkeland K, Ebrahim F, Hultcrantz R, Ekbom A, Stephansson O. Mothers with alcoholic liver disease and the risk for preterm and small-for-gestational-age birth. Alcohol Alcohol 2012; 48:166-71. [PMID: 23161891 DOI: 10.1093/alcalc/ags122] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS To study pregnancy outcome in women with alcoholic liver disease (ALD). METHODS Using the Swedish nation-wide Patient and Medical Birth Registers, we investigated risk of adverse pregnancy outcome in 720 women diagnosed with ALD before and 1720 diagnosed after birth and compared them with 24 460 population-based control births. RESULTS Women with ALD diagnosed before or after birth were generally of higher age and body mass index, more likely to smoke cigarettes during pregnancy and to have a low socio-economic status compared with controls. Women diagnosed with ALD before birth had an increased risk of moderately and very preterm birth, adjusted odd ratio (OR) = 1.53 (95% confidence interval (CI): 1.37-1.72 and 1.15-2.06 95%), respectively. Infants of mothers with ALD before birth were more often small-for-gestational age, adjusted OR = 1.22 (95% CI: 1.05-1.43), and were at increased risk for low Apgar scores (<7) at 5 min, adjusted OR = 1.49 (95% CI: 1.15-1.92) compared with controls. Similar associations with slightly lower-risk estimates were found among women diagnosed with ALD after birth. CONCLUSIONS ALD is associated with adverse-birth outcomes, highlighting the importance of screening women for alcohol dependence in antenatal care.
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Affiliation(s)
- Knut Stokkeland
- Department of Medicine, Visby Hospital, SE-62184 Visby, Sweden.
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Small size for gestational age and the risk for infant mortality in the subsequent pregnancy. Ann Epidemiol 2012; 22:764-71. [PMID: 22858049 DOI: 10.1016/j.annepidem.2012.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 07/05/2012] [Accepted: 07/06/2012] [Indexed: 11/23/2022]
Abstract
PURPOSE To examine the association between small for gestational age (SGA) in the first pregnancy and risk for infant mortality in the second pregnancy. METHODS This is a population-based, retrospective cohort study in which we used the Missouri maternally linked cohort dataset for 1978-2005. Analyses were restricted to women who had two singleton pregnancies during the study period. The exposure was SGA in the first pregnancy, whereas the primary outcome was infant mortality in the second pregnancy. Kaplan-Meier Estimate and Cox proportional hazard regression were conducted. RESULTS Infant mortality was significantly greater among mothers with previous SGA (P < .01). A persistent association of previous SGA with subsequent infant mortality was observed (adjusted hazard ratio [AHR] 1.35, 95% confidence interval [95% CI] 1.24-1.48). Race-specific data illustrated that black women with a previous SGA birth were 40% more likely to experience infant mortality (AHR 1.40, 95% CI 1.21-1.63) than their counterparts without a history of SGA, but white women with a previous SGA had an increased risk of 31% (AHR 1.31, 95% CI 1.17-1.46). CONCLUSIONS Women with previous SGA bear increased risks for subsequent infant mortality, which was greater among black mothers. Hence, SGA plays an important role in the black-white disparity in infant mortality. Women's previous childbearing experiences could serve as important criterion in determining appropriate interconception strategies to improve infant health and survival.
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Kramer MR, Hogue CJ, Dunlop AL, Menon R. Preconceptional stress and racial disparities in preterm birth: an overview. Acta Obstet Gynecol Scand 2011; 90:1307-16. [PMID: 21446927 PMCID: PMC5573146 DOI: 10.1111/j.1600-0412.2011.01136.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE We reviewed the evidence for three theories of how preconceptional psychosocial stress could act as a contributing determinant of excess preterm birth risk among African American women: early life developmental plasticity and epigenetic programming of adult neuroendocrine systems; blunting, weathering, or dysfunction of neuroendocrine and immune function in response to chronic stress activation through the life course; individuals' adoption of risky behaviors such as smoking as a response to stressful stimuli. METHODS Basic science, clinical, and epidemiologic studies indexed in MEDLINE and Web of Science databases on preconceptional psychosocial stress, preterm birth and race were reviewed. RESULTS Mixed evidence leans towards modest associations between preconceptional chronic stress and preterm birth (for example common odds ratios of 1.2-1.4), particularly in African American women, but it is unclear whether this association is causal or explains a substantial portion of the Black-White racial disparity in preterm birth. The stress-preterm birth association may be mediated by hypothalamic-pituitary-adrenal axis dysfunction and susceptibility to bacterial vaginosis, although these mechanisms are incompletely understood. Evidence for the role of epigenetic or early life programming as a determinant of racial disparities in preterm birth risk is more circumstantial. CONCLUSIONS Preconceptional stress, directly or in interaction with host genetic susceptibility or infection, remains an important hypothesized risk factor for understanding and reducing racial disparities in preterm birth. Future studies that integrate adequately sized epidemiologic samples with measures of stress, infection, and gene expression, will advance our knowledge and allow development of targeted interventions.
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Affiliation(s)
- Michael R Kramer
- Women's and Children's Center, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA.
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O'LEARY COLLEENM, BOWER CAROL. Guidelines for pregnancy: What's an acceptable risk, and how is the evidence (finally) shaping up? Drug Alcohol Rev 2011; 31:170-83. [DOI: 10.1111/j.1465-3362.2011.00331.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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