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Flatt S, Velez MP. The cost of preterm birth and cesarean section as a result of infertility and its treatment: A review. Best Pract Res Clin Obstet Gynaecol 2023; 86:102304. [PMID: 36681599 DOI: 10.1016/j.bpobgyn.2022.102304] [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: 08/01/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022]
Abstract
Infertility, irrespective of receipt of fertility treatment, is associated with an increased risk of adverse pregnancy outcomes, including cesarean section (CS) and preterm birth (PTB). These complications are associated with significant physical, mental, emotional, social, and financial costs to individuals, healthcare systems, and society at large. Although multiple pregnancy is one of the most significant contributors to the elevated CS and PTB rates in women receiving fertility treatment, singleton pregnancy is also at an increased risk of these outcomes. Single embryo transfer policies through publicly funded in vitro fertilization programs have demonstrated beneficial health outcomes and cost savings. Low-dose aspirin prophylaxis may be considered for PTB reduction in patients with infertility. Finally, upstream prevention strategies such as lifestyle modification and social policies to address the underlying needs for fertility treatment may also beneficially impact both CS and PTB rates.
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Affiliation(s)
- Sydney Flatt
- Queen's University, School of Medicine, Kingston, K7L 3L4, Canada
| | - Maria P Velez
- Queen's University, Obstetrics and Gynecology, Kingston, K7L 2V7, Canada.
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Gaspari L, Soyer-Gobillard MO, Rincheval N, Paris F, Kalfa N, Hamamah S, Sultan C. Birth Outcomes in DES Children and Grandchildren: A Multigenerational National Cohort Study on Informative Families. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2542. [PMID: 36767903 PMCID: PMC9915936 DOI: 10.3390/ijerph20032542] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/27/2023] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Diethylstilbestrol (DES), a potent synthetic nonsteroidal estrogen belonging to the family of endocrine disrupting chemicals (EDCs), can cross the placenta and may cause permanent adverse health effects in the exposed mothers, their children (exposed in utero), and also their grandchildren through germline contribution to the zygote. This study evaluated pregnancy duration and birthweight (BW) variations in the children and grandchildren born before, during, and after maternal DES treatment in the same informative families, to rule out genetic, endocrine, and environmental factors. DESIGN AND SETTING Nationwide retrospective observational study on 529 families of DES-treated women registered at the HHORAGES-France Association. The inclusion criteria were: (i) women with at least three pregnancies and three viable children among whom the first was not exposed in utero to DES, followed by one or more children with fetal exposure to DES, and then by one or more children born after DES treatment; (ii) women with at least one pre-DES or post-DES grandchild and one DES grandchild; (iii) confirmed data on total DES dose. Women with severe pathologies or whose illness status, habitat, lifestyle habits, profession, treatment changed between pregnancies, and all mothers who reported pregnancy-related problems, were excluded. RESULTS In all, 74 women met all criteria. The preterm birth (PTB) rate was 2.7% in pre-DES, 14.9% in DES, and 10.8% in post-DES children (Cochran-Armitage test for trend, p = 0.0095). The mean BW was higher in DES than pre-DES full-term neonates (≥37 weeks of gestation) (p = 0.007). In grandchildren, BW was not different, whereas the PTB and low BW rates were slightly increased in children of DES women. CONCLUSIONS These data within the same informative families show the DES impact on BW and PTB in DES and post-DES children and grandchildren. In particular, mean BW was higher in DES than pre-DES full-term neonates. This result may be in opposition to previous data from American cohorts, which reported lower BW in DES children, but is consistent with animal study. Our retrospective observational study highlights a multigenerational and likely transgenerational effect of this EDC in humans.
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Affiliation(s)
- Laura Gaspari
- CHU Montpellier, Université de Montpellier, Unité d’Endocrinologie-Gynécologie Pédiatrique, Service de Pédiatrie, 34295 Montpellier, France
- CHU Montpellier, Université de Montpellier, Centre de Référence Maladies Rares du Développement Génital, Constitutif Sud, Hôpital Lapeyronie, 34295 Montpellier, France
- Université de Montpellier, INSERM 1203, DEFE, 34295 Montpellier, France
| | | | - Nathalie Rincheval
- Equipe de Recherche AESIO SANTE, Clinique Beausoleil, 34070 Montpellier, France
| | - Françoise Paris
- CHU Montpellier, Université de Montpellier, Unité d’Endocrinologie-Gynécologie Pédiatrique, Service de Pédiatrie, 34295 Montpellier, France
- CHU Montpellier, Université de Montpellier, Centre de Référence Maladies Rares du Développement Génital, Constitutif Sud, Hôpital Lapeyronie, 34295 Montpellier, France
- Université de Montpellier, INSERM 1203, DEFE, 34295 Montpellier, France
| | - Nicolas Kalfa
- CHU Montpellier, Université de Montpellier, Centre de Référence Maladies Rares du Développement Génital, Constitutif Sud, Hôpital Lapeyronie, 34295 Montpellier, France
- CHU Montpellier, Université de Montpellier, Département de Chirurgie Pédiatrique, Hôpital Lapeyronie, 34295 Montpellier, France
| | - Samir Hamamah
- Université de Montpellier, INSERM 1203, DEFE, 34295 Montpellier, France
- CHU Montpellier, Université de Montpellier, Service de Biologie de la Reproduction, 34295 Montpellier, France
| | - Charles Sultan
- CHU Montpellier, Université de Montpellier, Unité d’Endocrinologie-Gynécologie Pédiatrique, Service de Pédiatrie, 34295 Montpellier, France
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Disordered Maternal and Fetal Iron Metabolism Occurs in Preterm Births in Human. DISEASE MARKERS 2022; 2022:1664474. [PMID: 36046373 PMCID: PMC9423993 DOI: 10.1155/2022/1664474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/20/2022] [Indexed: 11/17/2022]
Abstract
Background. Increasing evidence reveals that iron deficiency during pregnancy causes adverse pregnancy outcomes. Thus far, the mechanisms underlying iron deficiency-associated preterm birth are mostly limited to animal studies. Whether the suggested mechanisms exist in human requires further investigation. The goal of this study was to characterize the iron metabolism in both the maternal side and fetal side in pregnant women with preterm birth. Methods. Serum and placenta samples were collected from 42 pregnant women divided into four groups according to the gestational week. Indicators of iron metabolism, including serum iron, serum hepcidin, placental tissue iron, ferroportin (FPN), transferrin receptor 1 (TfR1), and ferritin, were surveyed using enzyme-linked immunosorbent assays (Elisa), Western blots, and real-time quantitative polymerase chain reactions (qRT-PCR). Results. Significant reduction of maternal serum iron was observed in women with preterm birth relative to those with full-term birth, indicative of worsen iron deficiency in those mothers with preterm birth. Meanwhile, the maternal hepcidin levels were notably diminished in women with preterm birth, whereas the fetal hepcidin levels were comparable between the two groups. Moreover, the placental iron stores were remarkably reduced in the preterm group, associated with reduced concentration of TfR1 and increased FPN concentration relative to the normal controls. In other words, the ratio of placental FPN mass to TfR1 mass (PIDI index) was strikingly increased in the preterm group. Conclusions. Dysregulated iron homeostasis in both the maternal and fetal sides was implicated in preterm births, and disordered regulations in maintaining the placental iron equilibrium were also presumed to account for the compromised fetal iron supply.
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Titus L. Evidence of intergenerational transmission of Diethylstilbestrol (DES) health effects: Hindsight and insight. Biol Reprod 2021; 105:681-686. [PMID: 34387644 DOI: 10.1093/biolre/ioab153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/29/2021] [Accepted: 08/02/2021] [Indexed: 11/13/2022] Open
Abstract
This review summarizes key findings from the US National Cancer Institute (NCI) DES Combined Cohort Study with a focus on the results of the NCI Third Generation Study, a cohort of DES-exposed and unexposed granddaughters. Findings to date from the Third Generation Study are discussed in the context of other research efforts and case reports suggesting an intergenerational heritability of DES-related effects. The DES story serves as a model for the influence of endocrine disrupting chemicals on human health. It also serves as a warning of the special hazards of pregnancy exposures, and more broadly, of the potential for invisible health consequences arising from new or changing exposures.
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Affiliation(s)
- Linda Titus
- Muskie School of Public Service, University of Southern Maine, Portland, ME 04101, USA
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