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Chen H, Zhang X, Cai S, Li J, Tang S, Hocher CF, Rösing B, Hu L, Lin G, Gong F, Krämer BK, Hocher B. Even high normal blood pressure affects live birth rate in women undergoing fresh embryo transfer. Hum Reprod 2022; 37:2578-2588. [PMID: 36125002 PMCID: PMC9627811 DOI: 10.1093/humrep/deac201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 08/13/2022] [Indexed: 11/24/2022] Open
Abstract
STUDY QUESTION Do differences in blood pressure within the normal range have any impacts on the live birth rate (primary outcome) or biochemical pregnancy rate (beta-hCG positivity), clinical pregnancy rate (heart beating in ultrasound), abortion rate and ectopic pregnancy rate (secondary outcomes) of fresh embryo transfer in women undergoing their IVF/ICSI treatment? SUMMARY ANSWER Even rather small differences in baseline blood pressure in women with normal blood pressure according to current guidelines undergoing fresh embryo transfer after IVF/ICSI affects substantially the live birth rate. WHAT IS KNOWN ALREADY Pre-pregnancy hypertension is a well-known risk factor for adverse pregnancy events such as preeclampsia, fetal growth restriction, placental abruption and adverse neonatal events. It is likewise well known that hypertension during pregnancy in women undergoing ART is associated with adverse pregnancy outcomes. However, whether blood pressure at the high end of the normal range has an impact on ART is unknown. STUDY DESIGN, SIZE, DURATION It is a prospective observational cohort study based on a single IVF center between January 2017 and December 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS Two thousand four hundred and eighteen women with normal blood pressure undergoing fresh embryo transfer after IVF/ICSI at the Reproductive and Genetic Hospital of CITIC-Xiangya were enrolled in this study. MAIN RESULTS AND THE ROLE OF CHANCE Blood pressure was measured at the first visit when women consulted the IVF center due to infertility. In women with a successful pregnancy outcome (1487 live births out of 2418 women undergoing fresh embryo transfer after IVF/ICSI), systolic blood pressure (SBP) (114.1 ± 9.48 mmHg versus 115.4 ± 9.8 mmHg, P = 0.001) and diastolic blood pressure (DBP) (74.5 ± 7.5 mmHg versus 75.3 ± 7.34 mmHg, P = 0.006) were lower than in those who did not achieve live births. Multivariate logistic regression analysis revealed that SBP (OR: 0.987, 95% CI: 0.979–0.996, P = 0.004) and DBP (OR: 0.986, 95% CI: 0.975–0.998, P = 0.016) were negatively associated with live birth. Similarly, SBP was significantly negatively related to clinical pregnancy rate (OR: 0.990, 95% CI: 0.981–0.999, P = 0.033), while for DBP the association was not statistically significant (OR: 0.994, 95% CI: 0.982–1.006, P = 0.343). However, both SBP and DBP were positively associated with miscarriage OR: 1.021 (95% CI: 1.004–1.037, P = 0.013) and OR: 1.027 (95% CI: 1.005–1.049, P = 0.014), respectively. Both SBP and DBP were unrelated to biochemical pregnancy (hCG positivity), implantation and ectopic pregnancy rate. LIMITATIONS, REASONS FOR CAUTION Whether lowering blood pressure before initiating ART treatment in women with SBP or DBP higher than the thresholds defined in our study will confer a benefit is unknown. Also, we cannot exclude bias due to different ethnicities. Moreover, participants in our study only received fresh embryo transfer, whether the results could apply to frozen embryo transfer is unclear. WIDER IMPLICATIONS OF THE FINDINGS Our study challenges the current blood pressure goals in women undergoing fresh embryo transfer after IVF/ICSI. Further studies are needed to figure out the mechanism and effective approach to increase IVF/ICSI pregnancy outcomes. STUDY FUNDING/COMPETING INTEREST(S) Hunan Provincial Grant for Innovative Province Construction (2019SK4012). The authors declare that there were no conflicts of interest in this study. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Huijun Chen
- Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology/Pneumology), University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.,Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-XIANGYA, Changsha, Hunan, China
| | - Xiaoli Zhang
- Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology/Pneumology), University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.,Institute of Pharmacy, Freie Universität Berlin, Berlin, Germany
| | - Sufen Cai
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-XIANGYA, Changsha, Hunan, China.,Institute of Reproductive and Stem Cell Engineering, NHC Key Laboratory of Human Stem Cell and Reproductive Engineering, School of Basic Medical Science, Central South University, Changsha, Hunan, China
| | - Jian Li
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
| | - Sha Tang
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-XIANGYA, Changsha, Hunan, China
| | - Carl-Friedrich Hocher
- Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology/Pneumology), University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Benjamin Rösing
- Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology/Pneumology), University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.,Department of OB/GYN and REI (UniKiD), Duesseldorf University Hospital, Duesseldorf, Germany
| | - Liang Hu
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-XIANGYA, Changsha, Hunan, China.,Institute of Reproductive and Stem Cell Engineering, NHC Key Laboratory of Human Stem Cell and Reproductive Engineering, School of Basic Medical Science, Central South University, Changsha, Hunan, China.,Key Laboratory of Stem Cells and Reproductive Engineering, Ministry of Health, Changsha, China
| | - Ge Lin
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-XIANGYA, Changsha, Hunan, China.,Institute of Reproductive and Stem Cell Engineering, NHC Key Laboratory of Human Stem Cell and Reproductive Engineering, School of Basic Medical Science, Central South University, Changsha, Hunan, China.,Key Laboratory of Stem Cells and Reproductive Engineering, Ministry of Health, Changsha, China
| | - Fei Gong
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-XIANGYA, Changsha, Hunan, China.,Institute of Reproductive and Stem Cell Engineering, NHC Key Laboratory of Human Stem Cell and Reproductive Engineering, School of Basic Medical Science, Central South University, Changsha, Hunan, China.,Key Laboratory of Stem Cells and Reproductive Engineering, Ministry of Health, Changsha, China
| | - Bernhard K Krämer
- Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology/Pneumology), University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.,European Center for Angioscience ECAS, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Berthold Hocher
- Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology/Pneumology), University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.,Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-XIANGYA, Changsha, Hunan, China.,Institute of Medical Diagnostics, IMD, Berlin, Germany
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Magee LA, von Dadelszen P, Singer J, Lee T, Rey E, Ross S, Asztalos E, Murphy KE, Menzies J, Sanchez J, Gafni A, Helewa M, Hutton E, Koren G, Lee SK, Logan AG, Ganzevoort W, Welch R, Thornton JG, Moutquin JM. The CHIPS Randomized Controlled Trial (Control of Hypertension in Pregnancy Study): Is Severe Hypertension Just an Elevated Blood Pressure? Hypertension 2016; 68:1153-1159. [PMID: 27620393 PMCID: PMC5058640 DOI: 10.1161/hypertensionaha.116.07862] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 08/12/2016] [Indexed: 11/17/2022]
Abstract
Supplemental Digital Content is available in the text. To determine whether clinical outcomes differed by occurrence of severe hypertension in the international CHIPS trial (Control of Hypertension in Pregnancy Study), adjusting for the interventions of “less tight” (target diastolic blood pressure [dBP] 100 mm Hg) versus “tight” control (target dBP 85 mm Hg). In this post-hoc analysis of CHIPS data from 987 women with nonsevere nonproteinuric preexisting or gestational hypertension, mixed effects logistic regression was used to compare the following outcomes according to occurrence of severe hypertension, adjusting for allocated group and the influence of baseline factors: CHIPS primary (perinatal loss or high-level neonatal care for >48 hours) and secondary outcomes (serious maternal complications), birth weight <10th percentile, preeclampsia, delivery at <34 or <37 weeks, platelets <100×109/L, elevated liver enzymes with symptoms, maternal length of stay ≥10 days, and maternal readmission before 6 weeks postpartum. Three hundred and thirty-four (34.1%) women in CHIPS developed severe hypertension that was associated with all outcomes examined except for maternal readmission (P=0.20): CHIPS primary outcome, birth weight <10th percentile, preeclampsia, preterm delivery, elevated liver enzymes (all P<0.001), platelets <100×109/L (P=0.006), and prolonged hospital stay (P=0.03). The association between severe hypertension and serious maternal complications was seen only in less tight control (P=0.02). Adjustment for preeclampsia (464, 47.3%) did not negate the relationship between severe hypertension and the CHIPS primary outcome (P<0.001), birth weight <10th percentile (P=0.005), delivery at <37 (P<0.001) or <34 weeks (P<0.001), or elevated liver enzymes with symptoms (P=0.02). Severe hypertension is a risk marker for adverse maternal and perinatal outcomes, independent of BP control or preeclampsia co-occurrence.
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Affiliation(s)
- Laura A Magee
- From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.).
| | - Peter von Dadelszen
- From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.)
| | - Joel Singer
- From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.)
| | - Terry Lee
- From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.)
| | - Evelyne Rey
- From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.)
| | - Susan Ross
- From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.)
| | - Elizabeth Asztalos
- From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.)
| | - Kellie E Murphy
- From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.)
| | - Jennifer Menzies
- From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.)
| | - Johanna Sanchez
- From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.)
| | - Amiram Gafni
- From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.)
| | - Michael Helewa
- From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.)
| | - Eileen Hutton
- From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.)
| | - Gideon Koren
- From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.)
| | - Shoo K Lee
- From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.)
| | - Alexander G Logan
- From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.)
| | - Wessel Ganzevoort
- From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.)
| | - Ross Welch
- From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.)
| | - Jim G Thornton
- From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.)
| | - Jean-Marie Moutquin
- From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.)
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