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Suker A, Li Y, Robson D, Marren A. Australasian Recurrent Pregnancy Loss Clinical Management Guideline 2024 Part I. Aust N Z J Obstet Gynaecol 2024. [PMID: 38934264 DOI: 10.1111/ajo.13821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 04/03/2024] [Indexed: 06/28/2024]
Abstract
Guidelines for the investigation and management of recurrent pregnancy loss (RPL) have been developed in Europe, USA and UK, but there is currently no Australasian guideline. The Australasian Certificate of Reproductive Endocrinology and Infertility Consensus Expert Panel on Trial Evidence group has prepared a two-part guideline to provide guidance on the management of RPL. In Part I chromosomal, anatomical, and endocrine factors are outlined along with relevant recommendations for clinical management, levels of evidence and grades of consensus. In Part II thrombophilia, autoimmune factors, infective, inflammatory, and endometrial causes, environmental and lifestyle factors, male factor and unexplained causes will be outlined.
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Affiliation(s)
- Adriana Suker
- Department of Obstetrics & Gynaecology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Ying Li
- Department of Reproductive Endocrinology & Infertility, Royal Prince Alfred Hospital, Women & Babies, Sydney, New South Wales, Australia
| | - Danielle Robson
- Department of Reproductive Endocrinology & Infertility, Royal Prince Alfred Hospital, Women & Babies, Sydney, New South Wales, Australia
| | - Anthony Marren
- Department of Reproductive Endocrinology & Infertility, Royal Prince Alfred Hospital, Women & Babies, Sydney, New South Wales, Australia
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2
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Su X, Sun L. Prevalence and associated factors of abortion among women with severe mental disorders. J Affect Disord 2024; 355:432-439. [PMID: 38548200 DOI: 10.1016/j.jad.2024.03.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/23/2024] [Accepted: 03/23/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Abortion behaviors among individuals with mental disorders presented major obstacles to women's health. However, few studies reported the prevalence and associated factors of abortion among women with severe mental disorders in China. Consequently, this study aims to investigate the prevalence of abortion among female patients in rural communities and identify potential health risks. METHOD This was a cross-sectional study of 276 women aged 18 years and older with severe mental disorders in rural areas of Shandong Province, China. The pregnancy history, abortion history and socio-demographic characteristics of women were investigated by questionnaire. Logistic regression analysis was employed to examine the associated factors for different abortion behaviors. RESULT The study showed that 82.61 % (228/276) of patients had a pregnancy history. Among the patients with a pregnancy history, 43.42 % (99/228) reported having had at least one abortion, and 15.79 % (36/228) had more than one. In the other side, 31.58 % (72/228) of them experienced spontaneous abortion, while 12.72 % (29/228) experienced induced abortion. Age at first gestation (aOR 0.80, 95 % CI 0.70-0.90) and age at last gestation (aOR 1.17, 95 % CI 1.07-1.27) were both associated with abortion. Anxiety was related to spontaneous (aOR 1.08, 95 % CI 1.02-1.15) and repeat abortions (aOR 1.10, 95 % CI 1.01-1.19). In addition, religion (aOR 10.47, 95 % CI 2.81-39.01), number of children≥2 (aOR 0.18, 95 % CI 0.04-0.77), and family functioning (aOR 1.31, 95 % CI 1.06-1.63) were associated with induced abortion. CONCLUSION Women with severe mental disorders in rural regions have notably higher rates of abortion compared to the general female population, particularly for spontaneous abortions. Gestational age and anxiety of pregnant patients deserve attention and preventive measures to avoid the outcomes of abortion.
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Affiliation(s)
- Xiaoying Su
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; National Health Commission of China (NHC), Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan 250012, China
| | - Long Sun
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; National Health Commission of China (NHC), Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan 250012, China.
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3
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Schon SB, Cabre HE, Redman LM. The impact of obesity on reproductive health and metabolism in reproductive-age females. Fertil Steril 2024:S0015-0282(24)00270-X. [PMID: 38704081 DOI: 10.1016/j.fertnstert.2024.04.036] [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: 03/14/2024] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 05/06/2024]
Abstract
Obesity is a highly prevalent chronic disease that impacts >40% of reproductive-aged females. The pathophysiology of obesity is complex and can be understood simply as a chronic energy imbalance whereby caloric intake exceeds caloric expenditure with an energy surplus stored in adipose tissue. Obesity may be categorized into degrees of severity as well as different phenotypes on the basis of metabolic health and underlying pathophysiology. Obesity and excess adiposity have a significant impact on fertility and reproductive health, with direct effects on the hypothalamic-pituitary-ovarian axis, the ovary and oocyte, and the endometrium. There are significant adverse pregnancy outcomes related to obesity, and excess weight gain before, during, and after pregnancy that can alter the lifelong risk for metabolically unhealthy obesity. Given the high prevalence and pervasive impact of obesity on reproductive health, there is a need for better and individualized care for reproductive-aged females that considers obesity phenotype, underlying pathophysiology, and effective and sustainable interventions to treat obesity and manage weight gain before, during, and after pregnancy.
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Affiliation(s)
- Samantha B Schon
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.
| | - Hannah E Cabre
- Reproductive Endocrinology and Women's Health Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Leanne M Redman
- Reproductive Endocrinology and Women's Health Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana
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4
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Yao Y, Ye Y, Chen J, Zhang M, Cai X, Zheng C. Maternal-fetal immunity and recurrent spontaneous abortion. Am J Reprod Immunol 2024; 91:e13859. [PMID: 38722063 DOI: 10.1111/aji.13859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 06/26/2024] Open
Abstract
Recurrent Spontaneous Abortion (RSA) is a common pregnancy complication, that has multifactorial causes, and currently, 40%-50% of cases remain unexplained, referred to as Unexplained RSA (URSA). Due to the elusive etiology and mechanisms, clinical management is exceedingly challenging. In recent years, with the progress in reproductive immunology, a growing body of evidence suggests a relationship between URSA and maternal-fetal immunology, offering hope for the development of tailored treatment strategies. This article provides an immunological perspective on the pathogenesis, diagnosis, and treatment of RSA. On one hand, it comprehensively reviews the immunological mechanisms underlying RSA, including abnormalities in maternal-fetal interface immune tolerance, maternal-fetal interface immune cell function, gut microbiota-mediated immune dysregulation, and vaginal microbiota-mediated immune anomalies. On the other hand, it presents the diagnosis and existing treatment modalities for RSA. This article offers a clear knowledge framework for understanding RSA from an immunological standpoint. In conclusion, while the "layers of the veil" regarding immunological factors in RSA are gradually being unveiled, our current research may only scratch the surface. In terms of immunological etiology, effective diagnostic tools for RSA are currently lacking, and the efficacy and safety of immunotherapies, primarily based on lymphocyte immunotherapy and intravenous immunoglobulin, remain contentious.
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Affiliation(s)
- Yao Yao
- Department of Pharmacy, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Hangzhou, China
| | - Yiqing Ye
- Department of Pharmacy, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Hangzhou, China
| | - Jia Chen
- School of Pharmacy, Hangzhou Medical College, Hangzhou, China
| | - Meng Zhang
- Department of Pharmacy, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Hangzhou, China
| | - Xiaoyu Cai
- Department of Pharmacy, Hangzhou First People's Hospital, Hangzhou, China
| | - Caihong Zheng
- Department of Pharmacy, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Hangzhou, China
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5
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Jameel S, Bhuwalka R, Begum M, Bonu R, Jahan P. Circulating levels of cytokines (IL-6, IL-10 and TGF- β) and CD4 +CD25 +FOXP3 +Treg cell population in recurrent pregnancy loss. Reprod Biol 2024; 24:100842. [PMID: 38176116 DOI: 10.1016/j.repbio.2023.100842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/03/2023] [Accepted: 12/08/2023] [Indexed: 01/06/2024]
Abstract
Recurrent pregnancy loss (RPL), a serious reproductive health issue, characterized by two or more pregnancy losses before 20th week of gestation. Globally, it affects 2-5% couples and the basis of the crisis is still unknown in 50% cases. Successful pregnancy is associated with pro and anti-inflammatory gestational phases that tolerate the semi-allogenic foetus, and disturbance leads to pregnancy complications like RPL. This case-control study aimed to assess the inflammatory status in the mid-gestation of ongoing pregnancy of women with (RPL) and without (NRPL) the history of RPL. Blood samples were processed for PBMC isolation, subjected to Flow-cytometry for CD4+CD25+FOXP3+Treg-cell population count and serum samples for IL-6, TGF-β, IL-10 cytokine levels (ELISA). Significant reduction in the percentage of Treg cells, and elevated values for IL-6/TGF-β and IL-6/IL-10 ratios were observed in RPL over NRPL group (p = 0.0001). Opposing results were seen with respect to the magnitude of history of RPL (2 vs. >2 losses). ROC curve analysis showed the superior discriminatory ability of cytokine ratios (IL-6/TGF-β > IL-6/IL-10) for RPL over Treg cells. Our findings are suggestive of pro-inflammatory dominance in mid-gestation of pregnant women with a history of RPL in general and greater than normal anti-inflammatory milieu in cases with > 2 pregnancy loss. As both sterile and infection related inflammation plays a role in pregnancy loss, studies enrolling women with favourable and unfavourable ongoing pregnancies may shed light on the importance of the present study for developing better management/therapeutic strategies.
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Affiliation(s)
- Sufaya Jameel
- School of Sciences (Zoology), Maulana Azad National Urdu University, Gachibowli, Hyderabad 32, Telangana, India
| | - Rashmi Bhuwalka
- School of Sciences (Zoology), Maulana Azad National Urdu University, Gachibowli, Hyderabad 32, Telangana, India
| | - Mahmooda Begum
- School of Sciences (Zoology), Maulana Azad National Urdu University, Gachibowli, Hyderabad 32, Telangana, India
| | - Rajeshwari Bonu
- Gynaecology and Obstetrics Department, Niloufer Hospital, Hyderabad, Telangana, India
| | - Parveen Jahan
- School of Sciences (Zoology), Maulana Azad National Urdu University, Gachibowli, Hyderabad 32, Telangana, India.
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6
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Prodan NC, Schmidt M, Hoopmann M, Abele H, Kagan KO. Obesity in prenatal medicine: a game changer? Arch Gynecol Obstet 2024; 309:961-974. [PMID: 37861742 PMCID: PMC10867045 DOI: 10.1007/s00404-023-07251-x] [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: 07/31/2023] [Accepted: 09/29/2023] [Indexed: 10/21/2023]
Abstract
Obesity is recognized by the World Health Organization (WHO) as a disease in its own right. Moreover, obesity is an increasingly concerning public health issue across the world and its prevalence is rising amongst women of reproductive age. The fertility of over-weight and obese women is reduced and they experience a higher rate of miscarriage. In pregnant women obesity not only increases the risk of antenatal complications, such as preeclampsia and gestational diabetes, but also fetal abnormalities, and consequently the overall feto-maternal mortality. Ultrasound is one of the most valuable methods to predict and evaluate pregnancy complications. However, in overweight and obese pregnant women, the ultrasound examination is met with several challenges, mainly due to an impaired acoustic window. Overall obesity in pregnancy poses special challenges and constraints to the antenatal care and increases the rate of pregnancy complications, as well as complications later in life for the mother and child.
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Affiliation(s)
- Natalia Carmen Prodan
- Department of Prenatal Diagnosis, University Clinic of Obstetrics and Gynaecology, Calwerstr. 7, Tuebingen, Germany.
| | - Markus Schmidt
- Clinic for Obstetrics and Gynaecology. Sana Kliniken, Zu den Rehwiesen 9-11, Duisburg, Germany
| | - Markus Hoopmann
- Department of Prenatal Diagnosis, University Clinic of Obstetrics and Gynaecology, Calwerstr. 7, Tuebingen, Germany
| | - Harald Abele
- Department of Prenatal Diagnosis, University Clinic of Obstetrics and Gynaecology, Calwerstr. 7, Tuebingen, Germany
| | - Karl Oliver Kagan
- Department of Prenatal Diagnosis, University Clinic of Obstetrics and Gynaecology, Calwerstr. 7, Tuebingen, Germany
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Yue C, Ma Y, Wang M, Yuan M, Meng Y, Wang Z, Ying C. CPY27B1-related vitamin D deficiency contributes to the impaired function of CD4 +T cells in Recurrent spontaneous miscarriage. Heliyon 2024; 10:e24499. [PMID: 38298727 PMCID: PMC10827770 DOI: 10.1016/j.heliyon.2024.e24499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 02/02/2024] Open
Abstract
The study aimed to explore the relationship between the expression of cytochrome P450 family 27 subfamily B member 1 (CYP27B1), vitamin D, and impaired T cell subsets in recurrent spontaneous miscarriage (RSM). A Total of 779 healthy women of childbearing age and 1031 women with a history of RSM were involved in this study. The results of flow cytometry showed that the proportion of Tregs was higher in healthy women than in the women with RSM. For cytokines, the levels of interleukin-17 (IL-17) and interferon-gamma (IFN-γ) were significantly higher in RSM patients than in healthy women, while IL-10 was notably lower in RSM patients. Furthermore, compared to healthy individuals, RSM patients had lower levels of serum 25(OH)D detected by chemiluminescence. The frequency of Tregs was negatively correlated with 25(OH)D. Specifically, for every 10 ng/ml increase in 25(OH)D, the percentage of Tregs increased by 0.58 as calculated. IL-17 and IFN-γ were inversely correlated with 25(OH)D, while the serum interleukin-10 (IL-10) level was positively correlated with 25(OH)D. CYP27B1 was found to be expressed in both cytotrophoblast and extracellular villi trophoblast cells. However, reduced expression of CYP27B1 was observed in the placenta with RSM. Notably, the level of 25(OH)D increased in the supernatant of CYP27B1 knockdown BeWo compared to normal cells, while human chorionic gonadotropin (hCG) was significantly reduced. The hCG secretion of CYP27B1 KO BeWo cells was partially restored after 1,25(OH)2D3 supplementation. In addition, 1,25(OH)2D3 treatment could induce more CD4+ T cells to convert to Foxp3+iTreg, which in turn inhibited the secretion of IL-17, IFN-γ. In summary, this research unveiled a connection between reduced CYP27B1 and vitamin D deficiency in RSM. Our study underscores the potential benefits of vitamin D treatment supplementation in the context of RSM. However, it is important to note that further research is imperative to validate these observations.
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Affiliation(s)
- Chaoyan Yue
- Department of Laboratory Medicine, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Yanhui Ma
- Department of Laboratory Medicine, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Mingyan Wang
- Department of Laboratory Medicine, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Minmin Yuan
- Department of Laboratory Medicine, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Yi Meng
- Department of Laboratory Medicine, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Zhiheng Wang
- Department of Laboratory Medicine, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Chunmei Ying
- Department of Laboratory Medicine, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
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8
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Michalopoulou M, Jebb SA, Astbury NM. Dietary interventions in pregnancy for the prevention of gestational diabetes: a literature review. Proc Nutr Soc 2023:1-13. [PMID: 38124663 DOI: 10.1017/s0029665123004822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
The aim of this review is to provide an overview of dietary interventions delivered during pregnancy for the prevention of gestational diabetes mellitus (GDM). GDM increases the risk of adverse pregnancy and neonatal outcomes, and also increases future cardiometabolic risks for both the mother and the offspring. Carrying or gaining excessive weight during pregnancy increases the risk of developing GDM, and several clinical trials in women with overweight or obesity have tested whether interventions aimed at limiting gestational weight gain (GWG) could help prevent GDM. Most dietary interventions have provided general healthy eating guidelines, while some had a specific focus, such as low glycaemic index, increased fibre intake, reducing saturated fat or a Mediterranean-style diet. Although trials have generally been successful in attenuating GWG, the majority have been unable to reduce GDM risk, which suggests that limiting GWG may not be sufficient in itself to prevent GDM. The trials which have shown effectiveness in GDM prevention have included intensive face-to-face dietetic support, and/or provision of key foods to participants, but it is unclear whether these strategies could be delivered in routine practice. The mechanism behind the effectiveness of some interventions over others remains unclear. Dietary modifications from early stages of pregnancy seem to be key, but the optimum dietary composition is unknown. Future research should focus on designing acceptable and scalable dietary interventions to be tested early in pregnancy in women at risk of GDM.
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Affiliation(s)
- Moscho Michalopoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Nerys M Astbury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
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Gonçalves CCRA, Feitosa BM, Cavalcante BV, Lima ALGDSB, de Souza CM, Joventino LB, Cavalcante MB. Obesity and recurrent miscarriage: The interconnections between adipose tissue and the immune system. Am J Reprod Immunol 2023; 90:e13757. [PMID: 37641378 DOI: 10.1111/aji.13757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/16/2023] [Accepted: 07/17/2023] [Indexed: 08/31/2023] Open
Abstract
Currently, obesity is considered a global public health problem. It is the main risk factor for noncommunicable diseases and reproductive complications, such as recurrent miscarriage (RM). RM affects approximately 1% of couples of reproductive age, and recent studies suggest that its prevalence is increasing. Immunological abnormalities may be responsible for a significant number of cases of unexplained RM. Obesity is recognized as a chronic low-grade inflammatory condition. The accumulation of fat in obese adipose tissue promotes changes in the local and systemic immune response. Adipokines, exosomes, micro-RNAs, lipids, and other factors released or secreted by adipose tissue are responsible for the interconnection between obesity and the immune system. Obesity-induced dysregulation of the innate and acquired immune response is also involved in the immunopathology of pregnancy loss in patients with unexplained RM. Therefore, understanding the communication pathways between maternal adipose tissue and the immune response in women living with obesity and RM is an important objective. Thus, diagnostic tools and new immunomodulatory therapies may be proposed for the management of patients with concurrent obesity and RM.
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Affiliation(s)
| | | | | | | | | | | | - Marcelo Borges Cavalcante
- Medical School, Universidade de Fortaleza (UNIFOR), Fortaleza, CE, Brazil
- Postgraduate Program in Medical Sciences, Universidade de Fortaleza (UNIFOR), Fortaleza, CE, Brazil
- CONCEPTUS - Reproductive Medicine, Fortaleza, Brazil
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Potdar N, Iyasere C. Early pregnancy complications including recurrent pregnancy loss and obesity. Best Pract Res Clin Obstet Gynaecol 2023; 90:102372. [PMID: 37451193 DOI: 10.1016/j.bpobgyn.2023.102372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 07/18/2023]
Abstract
This review on early pregnancy complications and obesity will focus on the known pregnancy complications such as miscarriage (whether spontaneous or after fertility treatment), polycystic ovaries and risk of miscarriage, recurrent pregnancy loss, ectopic pregnancy, hyperemesis gravidarum and birth defects. Evidence will be assessed and mechanistic pathways for the outcomes will be described. We know that obesity is now a pandemic and has an impact on early pregnancy complications. The evidence has been summarised to provide the reader with a comprehensive overview and advice for pregnant women with obesity in early pregnancy.
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Affiliation(s)
- Neelam Potdar
- Department of Reproductive Medicine, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, LE1 5WW, UK; Department of Health Sciences, University of Leicester, UK.
| | - Cecilia Iyasere
- Department of Reproductive Medicine, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, LE1 5WW, UK; Department of Health Sciences, University of Leicester, UK
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11
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McLean S, Boots CE. Obesity and Miscarriage. Semin Reprod Med 2023; 41:80-86. [PMID: 38101448 DOI: 10.1055/s-0043-1777759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Obesity affects nearly 40% of reproductive-aged women and has serious implications for women's overall and reproductive health. Women with an elevated body mass index (BMI) have higher rates of anovulation and irregular menses, lower success with fertility treatment, and significantly higher rates of pregnancy complications, such as hypertension/preeclampsia, gestational diabetes, and preterm delivery. Many studies have also shown an association between obesity and early pregnancy loss. However, the causal association between BMI and miscarriage has not been elucidated, likely due to the multifactorial effects that BMI may have on early pregnancy development. In addition, BMI as an isolated variable fails to capture other relevant confounding health risk factors, such as nutrition, physical activity, and insulin resistance. In this review, we will summarize the current literature demonstrating the association between BMI and miscarriage, highlight the research that attempts to explain the association, and finally provide data on therapeutic interventions to improve reproductive outcomes in women suffering from obesity and early pregnancy loss.
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Affiliation(s)
- Samantha McLean
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Christina E Boots
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
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12
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Turesheva A, Aimagambetova G, Ukybassova T, Marat A, Kanabekova P, Kaldygulova L, Amanzholkyzy A, Ryzhkova S, Nogay A, Khamidullina Z, Ilmaliyeva A, Almawi WY, Atageldiyeva K. Recurrent Pregnancy Loss Etiology, Risk Factors, Diagnosis, and Management. Fresh Look into a Full Box. J Clin Med 2023; 12:4074. [PMID: 37373766 DOI: 10.3390/jcm12124074] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Recurrent pregnancy loss is a complex health challenge with no universally accepted definition. Inconsistency in definitions involves not only the number of spontaneous abortions (two or three) that are accepted for recurrent pregnancy loss but the types of pregnancy and gestational age at miscarriage. Due to the heterogeneity of definitions and criteria applied by international guidelines for recurrent pregnancy loss, the true incidence of recurrent miscarriage, which is reported to range from 1% to 5%, is difficult to estimate. Moreover, the exact etiology of recurrent pregnancy loss remains questionable; thus, it is considered a polyetiological and multifactorial condition with many modifiable and non-modifiable factors involved. Even after thoroughly evaluating recurrent pregnancy loss etiology and risk factors, up to 75% of cases remain unexplained. This review aimed to summarize and critically analyze accumulated knowledge on the etiology, risk factors, relevant diagnostic options, and management approach to recurrent pregnancy loss. The relevance of various factors and their proposed roles in recurrent pregnancy loss pathogenesis remains a matter of discussion. The diagnostic approach and the management largely depend on the etiology and risk factors taken into consideration by a healthcare professional as a cause of recurrent miscarriage for a particular woman or couple. Underestimation of social and health consequences of recurrent pregnancy loss leads to compromised reproductive health and psychological well-being of women after miscarriage. Studies on etiology and risk factors for recurrent pregnancy loss, especially idiopathic, should be continued. The existing international guidelines require updates to assist clinical practice.
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Affiliation(s)
- Akbayan Turesheva
- Department of Normal Physiology, West-Kazakhstan Marat Ospanov Medical University, Aktobe 030000, Kazakhstan
| | | | - Talshyn Ukybassova
- Clinical Academic Department of Women's Health, CF "University Medical Center", Astana 010000, Kazakhstan
| | - Aizada Marat
- Department of Obstetrics and Gynecology #1, NJSC "Astana Medical University", Astana 010000, Kazakhstan
| | - Perizat Kanabekova
- Department of Medicine, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan
| | - Lyazzat Kaldygulova
- Department of Obstetrics and Gynecology #2, West-Kazakhstan Marat Ospanov Medical University, Aktobe 030000, Kazakhstan
| | - Ainur Amanzholkyzy
- Department of Normal Physiology, West-Kazakhstan Marat Ospanov Medical University, Aktobe 030000, Kazakhstan
| | - Svetlana Ryzhkova
- Department of Obstetrics and Gynecology #2, West-Kazakhstan Marat Ospanov Medical University, Aktobe 030000, Kazakhstan
| | - Anastassiya Nogay
- Department of Medicine, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan
| | - Zaituna Khamidullina
- Department of Obstetrics and Gynecology #1, NJSC "Astana Medical University", Astana 010000, Kazakhstan
| | - Aktoty Ilmaliyeva
- Department of Medicine #3, NJSC "Astana Medical University", Astana 010000, Kazakhstan
| | - Wassim Y Almawi
- Faculte' des Sciences de Tunis, Universite' de Tunis El Manar, Tunis 5000, Tunisia
| | - Kuralay Atageldiyeva
- Department of Medicine, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan
- Clinical Academic Department of Internal Medicine, CF "University Medical Center", Astana 010000, Kazakhstan
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Wootton RE, Lawn RB, Magnus MC, Treur JL, Corfield EC, Njølstad PR, Andreassen OA, Lawlor DA, Munafò MR, Håberg SE, Davey Smith G, Reichborn-Kjennerud T, Magnus P, Havdahl A. Associations between health behaviours, fertility and reproductive outcomes: triangulation of evidence in the Norwegian Mother, Father and Child Cohort Study (MoBa). BMC Med 2023; 21:125. [PMID: 37013617 PMCID: PMC10071662 DOI: 10.1186/s12916-023-02831-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 03/13/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Guidance to improve fertility includes reducing alcohol and caffeine consumption, achieving healthy weight-range and stopping smoking. Advice is informed by observational evidence, which is often biased by confounding. METHODS This study primarily used data from a pregnancy cohort, the Norwegian Mother, Father and Child Cohort Study. First, we conducted multivariable regression of health behaviours (alcohol and caffeine consumption, body-mass index (BMI), and smoking) on fertility outcomes (e.g. time to conception) and reproductive outcomes (e.g. age at first birth) (n = 84,075 females, 68,002 males), adjusting for birth year, education and attention-deficit and hyperactive-impulsive (ADHD) traits. Second, we used individual-level Mendelian randomisation (MR) to explore possible causal effects of health behaviours on fertility/reproductive outcomes (n = 63,376 females, 45,460 males). Finally, we performed summary-level MR for available outcomes in UK Biobank (n = 91,462-1,232,091) and controlled for education and ADHD liability using multivariable MR. RESULTS In multivariable regression analyses, higher BMI associated with fertility (longer time to conception, increased odds of infertility treatment and miscarriage), and smoking was associated with longer time to conception. In individual-level MR analyses, there was strong evidence for effects of smoking initiation and higher BMI on younger age at first birth, of higher BMI on increased time to conception, and weak evidence for effects of smoking initiation on increased time to conception. Age at first birth associations were replicated in summary-level MR analysis; however, effects attenuated using multivariable MR. CONCLUSIONS Smoking behaviour and BMI showed the most consistent associations for increased time to conception and a younger age at first birth. Given that age at first birth and time to conception are positively correlated, this suggests that the mechanisms for reproductive outcomes are distinct to the mechanisms acting on fertility outcomes. Multivariable MR suggested that effects on age at first birth might be explained by underlying liability to ADHD and education.
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Affiliation(s)
- Robyn E Wootton
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway.
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
- School of Psychological Science, University of Bristol, Bristol, UK.
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.
| | - Rebecca B Lawn
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Maria C Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Jorien L Treur
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Elizabeth C Corfield
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
| | - Pål R Njølstad
- Center for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway
- Children and Youth Clinic, Haukeland University Hospital, Bergen, Norway
| | - Ole A Andreassen
- NORMENT Centre, Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marcus R Munafò
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Siri E Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ted Reichborn-Kjennerud
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Per Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Alexandra Havdahl
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
- Center for Genetic Epidemiology and Mental Health, Norwegian Institute of Public Health, Oslo, Norway
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Andreescu M, Frîncu F, Plotogea M, Mehedințu C. Recurrent Abortion and the Involvement of Killer-Cell Immunoglobulin-like Receptor (KIR) Genes, Activated T Cells, NK Abnormalities, and Cytokine Profiles. J Clin Med 2023; 12:jcm12041355. [PMID: 36835892 PMCID: PMC9968158 DOI: 10.3390/jcm12041355] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/21/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023] Open
Abstract
Immune tolerance at the feto-maternal interface is crucial for the growth of the semi-allograft fetus in the womb. The outcome of pregnancy is dependent on a fine balance between various immunological forces. For a long time, the potential role of the immune system in pregnancy disorders has remained enigmatic. Current evidence has revealed that natural killer (NK) cells are the predominant immune cell population in the uterine decidua. NK cells cooperate with T-cells to provide an optimal microenvironment for the growth of the developing fetus by producing cytokines, chemokines, and angiogenic factors. These factors support trophoblast migration and angiogenesis which regulates the process of placentation. NK cells differentiate between "self" and "non-self" through their surface receptors known as killer-cell immunoglobulin-like receptors (KIRs). They induce immune tolerance through communication via their KIR and fetal human leucocyte antigens (HLA). KIRs are surface receptors of NKs that comprise both activating and inhibiting receptors. Due to the wide diversity manifested by its genes, the KIR repertoire is different in each individual. Significant evidence has implicated KIRs in recurrent spontaneous abortion (RSA); however, maternal KIR gene diversity in RSA is still unclear. Research has shown that immunological aberrancies including activating KIRs, NK abnormalities, and T cell downregulation are risk factors for RSA. In this review, we discuss relevant data from experimental studies on NK cell abnormalities, KIR, and T-cells in the incidence of recurrent spontaneous abortion.
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Affiliation(s)
- Mihaela Andreescu
- Department of Clinical Sciences, Hematology, Faculty of Medicine, Titu Maiorescu University of Bucharest, 040051 Bucharest, Romania
- Department of Hematology, Colentina Clinical Hospital, 020125 Bucharest, Romania
- Correspondence: (M.A.); (F.F.)
| | - Francesca Frîncu
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 01171 Bucharest, Romania
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Correspondence: (M.A.); (F.F.)
| | - Mihaela Plotogea
- Department of Obstetrics and Gynecology, Nicolae Malaxa Clinical Hospital, 022441 Bucharest, Romania
| | - Claudia Mehedințu
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 01171 Bucharest, Romania
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
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15
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Sakali AK, Papagianni M, Bargiota A, Rasic-Markovic A, Macut D, Mastorakos G. Environmental factors affecting pregnancy outcomes. Endocrine 2023; 80:459-469. [PMID: 36729371 DOI: 10.1007/s12020-023-03307-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 01/10/2023] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Pregnancy represents a fragile period in the life of a woman, vulnerable to hazardous environmental substances which might affect maternal and fetal metabolism. The possible influence of environmental factors, including endocrine disrupting chemicals (EDCs), upon the mother and the fetus before and/or during pregnancy might be associated directly and/or indirectly to deleterious pregnancy outcomes. Because the existence of such associations would be, to our view, of major importance to the scientific community, their investigation is the scope of this critical review. METHODS This critical review includes in vivo animal and human studies regarding the role of environmental factors, including EDCs, on pregnancy outcomes complying with the SANRA (a scale for the quality assessment of narrative review articles) questions for narrative reviews. Studies were identified by searching the MEDLINE (PubMed and PubMed Central), the Cochrane library and the Google Scholar databases till October 2022 with the combinations of the appropriate key words (detailed environmental factors including EDCs AND detailed negative pregnancy outcomes) as well as by scanning references from already included articles and relevant reviews manually. Because environmental factors and EDCs have been associated to epigenetic alterations, special care has been given to EDC-induced transgenerational effects on pregnancy outcomes. RESULTS The existing evidence suggests positive associations between specific environmental factors and negative pregnancy outcomes such as ectopic pregnancies, pregnancy losses, gestational diabetes, hypertensive disorders of pregnancy, preterm births, birth defects, intrauterine growth restriction, and small or large for gestational age babies. CONCLUSION Environmental factors and EDCs may have a catalytic effect on the course and the outcomes of pregnancy.
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Affiliation(s)
- Anastasia-Konstantina Sakali
- Department of Endocrinology and Metabolic Diseases, Larissa University Hospital, University of Thessaly, Larissa, Greece
| | - Maria Papagianni
- Department of Nutrition and Dietetics, School of Physical Education and Sport Science and Dietetics, University of Thessaly, Trikala, Greece
- Endocrine Unit, 3rd Department of Pediatrics, Hippokration Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandra Bargiota
- Department of Endocrinology and Metabolic Diseases, Larissa University Hospital, University of Thessaly, Larissa, Greece
| | - Aleksandra Rasic-Markovic
- Institute of Medical Physiology, Faculty of Medicine, University of Belgrade, Visegradska 26, 11000, Belgrade, Serbia
| | - Djuro Macut
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - George Mastorakos
- Unit of Endocrinology, Diabetes Mellitus and Metabolism, Aretaieion Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.
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16
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Sommerfeldt B, Skårderud F, Kvalem IL, Gulliksen KS, Holte A. IVF-induced pregnancy and early motherhood among women with a history of severe eating disorders. Front Psychol 2023; 14:1126941. [PMID: 37138985 PMCID: PMC10149691 DOI: 10.3389/fpsyg.2023.1126941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 03/29/2023] [Indexed: 05/05/2023] Open
Abstract
Background There is a higher prevalence of eating disorders among women seeking in vitro fertilization (IVF). Women with a history of eating disorders may be particularly vulnerable to eating disorder relapse during IVF, pregnancy, and early motherhood. The experience of these women during this process has hardly been studied scientifically, despite its high clinical relevance. The overall aim of this study is to describe how women with a history of eating disorders experience the process of becoming a mother through IVF, pregnancy, and the postpartum period. Methods We recruited women with a history of severe anorexia nervosa who had undergone IVF (n = 7) at public family health centers in Norway. Semi-openly, the participants were interviewed extensively first during pregnancy, and then 6 months after birth. The 14 narratives were analyzed using interpretative phenomenological analyses (IPA). All participants were required to complete the Eating Disorder Examination Questionnaire (EDE-Q) and were diagnosed (DSM-5) by using the Eating Disorder Examination (EDE), during both pregnancy and postpartum. Results All participants experienced a relapse of an eating disorder during IVF. They perceived IVF, pregnancy, and early motherhood to be overwhelming, confusing, a source of severe loss of control, and a source of body alienation. There were four core phenomena that were reported that were strikingly similar across all participants: "anxiousness and fear," "shame and guilt," "sexual maladjustment," and "non-disclosure of eating problems." These phenomena persisted continuously throughout IVF, pregnancy, and motherhood. Conclusion Women with a history of severe eating disorders are highly susceptible to relapse when undergoing IVF, pregnancy, and early motherhood. The process of IVF is experienced as extremely demanding and provoking. There is evidence that eating problems, purging, over-exercising, anxiousness and fear, shame and guilt, sexual maladjustment, and non-disclosure of eating problems continue throughout IVF, pregnancy, and the early years of motherhood. Therefore, it is necessary for healthcare workers providing services to women undergoing IVF to be attentive and intervene when they suspect a history of eating disorders.
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Affiliation(s)
- Bente Sommerfeldt
- Institute of Eating Disorders, Oslo, Norway
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
- *Correspondence: Bente Sommerfeldt,
| | - Finn Skårderud
- Institute of Eating Disorders, Oslo, Norway
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Ingela Lundin Kvalem
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Kjersti S. Gulliksen
- Institute of Eating Disorders, Oslo, Norway
- The Norwegian Psychological Association, Oslo, Norway
| | - Arne Holte
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
- Norwegian Institute of Public Health (NIPH), Oslo, Norway
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17
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Trend and risk factors of fatal pregnancy termination: A long-term nationwide population-based cross-section survey in Bangladesh. PLoS One 2023; 18:e0263467. [PMID: 36706092 PMCID: PMC9882646 DOI: 10.1371/journal.pone.0263467] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/19/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Pregnant women often experience the fatal outcome of their pregnancy both in developed and impoverished countries. Due to strong health systems and services, factual and historical data are available from developed countries. However, the prevalence trend and risk factors of a fatal termination of pregnancy in developing countries like Bangladesh are still lacking. OBJECTIVE The objective of the current study was to determine the 20 years trend of prevalence and risk factors of fatal pregnancy termination from 1997 to 2018 in Bangladesh. METHOD This study utilised the publicly available seven consecutive cross-data on Bangladesh Demographic and Health Surveys data since 1997 following identical methods among women of reproductive age. Respondent was asked if they had had a fatal pregnancy termination ever. A Generalised Linear model with a log-Poisson link was used to estimate the relative risk of different predictors for four survey time points (1998, 2004, 2011, 2018). RESULTS The proportions of fatal pregnancy termination in urban and rural areas were 24% vs. 19% and 24% vs. 22% in 1997 and 2018, respectively. In multivariable analysis, maternal age 30 years and above and obesity were strongly associated in all survey time points. The richest wealth index had a weak association in 1997 but was strongly associated in 2011 and 2018. A significant modest association with secondary complete education level was only observed in 2018. CONCLUSION The overall proportions of fatal pregnancy termination in Bangladesh remain nearly static; however, its risk factors differed across different survey time points.
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18
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Lee DS, Nitsche N, Barclay K. Body mass index in early adulthood and transition to first birth: Racial/ethnic and sex differences in the United States NLSY79 Cohort. POPULATION STUDIES 2022:1-21. [DOI: 10.1080/00324728.2022.2128396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | - Kieron Barclay
- Max Planck Institute for Demographic Research
- Swedish Collegium for Advanced Study
- Stockholm University
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19
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Aimuzi R, Huang S, Luo K, Ma S, Huo X, Li G, Tian Y, Zhang J, Yu Y. Levels and health risks of urinary phthalate metabolites and the association between phthalate exposure and unexplained recurrent spontaneous abortion: a large case-control study from China. ENVIRONMENTAL RESEARCH 2022; 212:113393. [PMID: 35504341 DOI: 10.1016/j.envres.2022.113393] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/24/2022] [Accepted: 04/28/2022] [Indexed: 06/14/2023]
Abstract
Phthalate acid esters (PAEs) are environmental endocrine disruptors that can interfere with endocrine processes and cause adverse reproductive outcomes. The link between PAE exposure and unexplained recurrent spontaneous abortion (URSA) remains unknown. In this study, nine urinary metabolites of PAEs (mPAEs) were measured in 594 URSA cases and 569 healthy controls. The measured mPAEs were ubiquitously detected and present at higher levels (median: 203 ng/mL) in the URSA cases than in the controls (median: 161 ng/mL). Multiple logistic regression analysis showed that URSA was associated with higher concentrations of mono (2-ethyl-5-hydroxyhexyl) phthalate (mEHHP), mono (2-ethylhexyl) phthalate (mEHP), and mono-ethyl phthalate (mEP) and lower concentrations of mono-isobutyl phthalate (miBP). Moreover, a quantile-based g-computation (QGC) model revealed a positive association between mPAEs mixture and URSA. The URSA cases showed significantly higher concentrations of di-(2-ethylhexyl) phthalate (DEHP) than the controls. This was consistent with the health risk assessment, which suggested that DEHP is the main contributors to potential non-carcinogenic risk. DEHP accounted for over 80% of total risk. The large case-control study results suggest that PAE exposure may increase the risk of URSA, and that policy-makers and public health experts should pay more attention to DEHP exposure.
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Affiliation(s)
- Ruxianguli Aimuzi
- Ministry of Education -Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Senyuan Huang
- Guangdong Key Laboratory of Environmental Catalysis and Health Risk Control, Guangdong-Hong Kong-Macao Joint Laboratory for Contaminants Exposure and Health, Institute of Environmental Health and Pollution Control, Guangdong University of Technology, Guangzhou 510006, China; Key Laboratory of City Cluster Environmental Safety and Green Development, School of Environmental Science and Engineering, Guangdong University of Technology, Guangzhou 510006, China
| | - Kai Luo
- Ministry of Education -Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China; School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Shengtao Ma
- Guangdong Key Laboratory of Environmental Catalysis and Health Risk Control, Guangdong-Hong Kong-Macao Joint Laboratory for Contaminants Exposure and Health, Institute of Environmental Health and Pollution Control, Guangdong University of Technology, Guangzhou 510006, China; Key Laboratory of City Cluster Environmental Safety and Green Development, School of Environmental Science and Engineering, Guangdong University of Technology, Guangzhou 510006, China
| | - Xiaona Huo
- Ministry of Education -Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Guiying Li
- Guangdong Key Laboratory of Environmental Catalysis and Health Risk Control, Guangdong-Hong Kong-Macao Joint Laboratory for Contaminants Exposure and Health, Institute of Environmental Health and Pollution Control, Guangdong University of Technology, Guangzhou 510006, China; Key Laboratory of City Cluster Environmental Safety and Green Development, School of Environmental Science and Engineering, Guangdong University of Technology, Guangzhou 510006, China
| | - Ying Tian
- Ministry of Education -Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China; School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Jun Zhang
- Ministry of Education -Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China; School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.
| | - Yingxin Yu
- Guangdong Key Laboratory of Environmental Catalysis and Health Risk Control, Guangdong-Hong Kong-Macao Joint Laboratory for Contaminants Exposure and Health, Institute of Environmental Health and Pollution Control, Guangdong University of Technology, Guangzhou 510006, China; Key Laboratory of City Cluster Environmental Safety and Green Development, School of Environmental Science and Engineering, Guangdong University of Technology, Guangzhou 510006, China.
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20
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Abstract
PURPOSE OF REVIEW The objective of this review is to highlight the recent literature on how obesity affects reproductive capacity in men and women. RECENT FINDINGS The relationship between fertility and obesity is complex and involves the hypothalamic-pituitary-ovarian axis, neuroendocrine systems and adipose tissue. The exact pathophysiology of how obesity lowers fertility rates is unknown, but is likely multifactorial involving anovulation, insulin resistance and alterations in gonadotropins. In addition, there is controversy on whether oocyte quality or endometrial receptivity plays a larger role in obese infertile women. Data on effects of bariatric surgery and weight loss on obese infertile men and women are mixed. SUMMARY Obesity alters the hormonal profile, gonadotropin secretion, embryo development and in-vitro fertilization outcomes in both men and women.
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Affiliation(s)
- Abigail Armstrong
- Department of Obstetrics & Gynecology, University of California Los Angeles, Los Angeles, California, USA
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21
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Affiliation(s)
- Andreea A Creanga
- From the Departments of International Health and Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, and the Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine - both in Baltimore (A.A.C.); the Mother Infant Research Institute, Tufts Medical Center, and the Department of Obstetrics and Gynecology, Tufts University School of Medicine - both in Boston (P.M.C.); and the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA (B.T.B.)
| | - Patrick M Catalano
- From the Departments of International Health and Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, and the Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine - both in Baltimore (A.A.C.); the Mother Infant Research Institute, Tufts Medical Center, and the Department of Obstetrics and Gynecology, Tufts University School of Medicine - both in Boston (P.M.C.); and the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA (B.T.B.)
| | - Brian T Bateman
- From the Departments of International Health and Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, and the Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine - both in Baltimore (A.A.C.); the Mother Infant Research Institute, Tufts Medical Center, and the Department of Obstetrics and Gynecology, Tufts University School of Medicine - both in Boston (P.M.C.); and the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA (B.T.B.)
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22
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Bortoletto P, Lucas ES, Melo P, Gallos ID, Devall AJ, Bourne T, Quenby S, Bennett PR, Coomarasamy A, Brosens JJ. Miscarriage syndrome: Linking early pregnancy loss to obstetric and age-related disorders. EBioMedicine 2022; 81:104134. [PMID: 35779492 PMCID: PMC9244729 DOI: 10.1016/j.ebiom.2022.104134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 12/03/2022] Open
Abstract
Upon embryo implantation, the uterine mucosa - the endometrium - transforms into a robust decidual matrix that accommodates the fetal placenta throughout pregnancy. This transition is driven by the differentiation of endometrial fibroblasts into specialised decidual cells. A synchronised influx of circulating natural killer (NK) cells and bone marrow-derived mesenchymal stem/progenitor cells (BM-MSC) is pivotal for decidual homeostasis and expansion in early pregnancy. We hypothesise that pathological signals interfering with the recruitment or activity of extrauterine cells at the maternal-fetal interface link miscarriage to subsequent adverse pregnancy outcomes, including further pregnancy losses and preterm labour. NK cells and BM-MSC are key homeostatic regulators in multiple tissues, pointing towards a shared aetiology between recurrent miscarriage and age-related disorders, including cardiometabolic disease. We propose the term ‘miscarriage syndrome’ to capture the health risks associated with miscarriage and discuss how this paradigm can inform clinical practice and accelerate the development of preventative strategies.
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Meierhofer R, Tomberge VMJ, Inauen J, Shrestha A. Water carrying in hills of Nepal–associations with women’s musculoskeletal disorders, uterine prolapse, and spontaneous abortions. PLoS One 2022; 17:e0269926. [PMID: 35737697 PMCID: PMC9223305 DOI: 10.1371/journal.pone.0269926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/06/2022] [Indexed: 11/19/2022] Open
Abstract
More than a third of women in Nepal have to carry water from source to home to satisfy their families’ daily needs. A cross-sectional study was carried out in a hilly area in Nepal to assess water-carrying practices and their association with women’s health. Quantitative interviews were conducted with 1001 women of reproductive age and were complemented with health surveys carried out by health professionals and structured observations of water carrying. Multivariate mixed logistic regression models were used to assess the associations between water-carrying-related risk factors and health issues for women. Around 46% of women faced considerably increased to excessive physical stress due to water carrying during the dry season. Women suffered from a disproportionately high prevalence of back pain (61%), with about 18% of this pain being horrible to excruciating; pain in the knees (34%); uterine prolapse (11.3%); and at least one spontaneous abortion (9%). The risk category of water carrying was significantly associated with uterine prolapse (OR = 1.44, 95%CI = 1.12–1.85, p = 0.031) and pain in the hips (OR = 1.69, 95%CI = 1.27–2.26, p<0.001). Receiving help with water carrying during pregnancy and during the first three months after delivery was associated with reduced odds ratios for uterine prolapse (OR = 0.10, 95% CI = 0.01–0.87, p = 0.037), and strong back pain (OR = 0.32, 95% CI = 0.12–0.87, p = 0.026). Improvements to water supply infrastructure and the promotion of social support for carrying water during pregnancy and after delivery are recommended to reduce water-carrying-related health risks.
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Affiliation(s)
- Regula Meierhofer
- Department of Sanitation, Swiss Federal Institute of Aquatic Science and Technology (Eawag), Water and Solid Waste for Development (Sandec), Dübendorf, Switzerland
- * E-mail:
| | - Vica Marie Jelena Tomberge
- Department of Health Psychology & Behavioral Medicine, Institute of Psychology, University of Bern, Bern, Switzerland
| | - Jennifer Inauen
- Department of Health Psychology & Behavioral Medicine, Institute of Psychology, University of Bern, Bern, Switzerland
| | - Akina Shrestha
- Department of Sanitation, Swiss Federal Institute of Aquatic Science and Technology (Eawag), Water and Solid Waste for Development (Sandec), Dübendorf, Switzerland
- Kathmandu University, School of Medical Sciences, Kathmandu, Nepal
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Liang C, Chung HF, Dobson AJ, Hayashi K, van der Schouw YT, Kuh D, Hardy R, Derby CA, El Khoudary SR, Janssen I, Sandin S, Weiderpass E, Mishra GD. Infertility, recurrent pregnancy loss, and risk of stroke: pooled analysis of individual patient data of 618 851 women. BMJ 2022; 377:e070603. [PMID: 35732311 PMCID: PMC9214882 DOI: 10.1136/bmj-2022-070603] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To examine the associations of infertility, recurrent miscarriage, and stillbirth with the risk of first non-fatal and fatal stroke, further stratified by stroke subtypes. DESIGN Individual participant pooled analysis of eight prospective cohort studies. SETTING Cohort studies across seven countries (Australia, China, Japan, Netherlands, Sweden, the United Kingdom, and the United States) participating in the InterLACE (International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease Events) consortium, which was established in June 2012. PARTICIPANTS 618 851 women aged 32.0-73.0 years at baseline with data on infertility, miscarriage, or stillbirth, at least one outcome event (non-fatal or fatal stroke), and information on covariates were included; 93 119 women were excluded. Of the participants, 275 863 had data on non-fatal and fatal stroke, 54 716 only had data on non-fatal stroke, and 288 272 only had data on fatal stroke. MAIN OUTCOME AND MEASURES Non-fatal strokes were identified through self-reported questionnaires, linked hospital data, or national patient registers. Fatal strokes were identified through death registry data. RESULTS The median follow-up for non-fatal stroke and fatal stroke was 13.0 years (interquartile range 12.0-14.0) and 9.4 years (7.6-13.0), respectively. A first non-fatal stroke was experienced by 9265 (2.8%) women and 4003 (0.7%) experienced a fatal stroke. Hazard ratios for non-fatal or fatal stroke were stratified by hypertension and adjusted for race or ethnicity, body mass index, smoking status, education level, and study. Infertility was associated with an increased risk of non-fatal stroke (hazard ratio 1.14, 95% confidence interval 1.08 to 1.20). Recurrent miscarriage (at least three) was associated with higher risk of non-fatal and fatal stroke (1.35, 1.27 to 1.44, and 1.82, 1.58 to 2.10, respectively). Women with stillbirth were at 31% higher risk of non-fatal stroke (1.31, 1.10 to 1.57) and women with recurrent stillbirth were at 26% higher risk of fatal stroke (1.26, 1.15 to 1.39). The increased risk of stroke (non-fatal or fatal) associated with infertility or recurrent stillbirths was mainly driven by a single stroke subtype (non-fatal ischaemic stroke and fatal haemorrhagic stroke), while the increased risk of stroke (non-fatal or fatal) associated with recurrent miscarriages was driven by both subtypes. CONCLUSION A history of recurrent miscarriages and death or loss of a baby before or during birth could be considered a female specific risk factor for stroke, with differences in risk according to stroke subtypes. These findings could contribute to improved monitoring and stroke prevention for women with such a history.
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Affiliation(s)
- Chen Liang
- University of Queensland, School of Public Health, Queensland, Australia
| | - Hsin-Fang Chung
- University of Queensland, School of Public Health, Queensland, Australia
| | - Annette J Dobson
- University of Queensland, School of Public Health, Queensland, Australia
| | | | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, Netherlands
| | - Diana Kuh
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, London, UK
| | | | - Carol A Derby
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Samar R El Khoudary
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA, USA
| | - Imke Janssen
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Sven Sandin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Elisabete Weiderpass
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Gita D Mishra
- University of Queensland, School of Public Health, Queensland, Australia
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Abstract
PURPOSE OF REVIEW To summarize recent findings related to the risk of miscarriage in women with elevated BMI undergoing IVF, and the mechanisms involved in said risk. RECENT FINDINGS Miscarriage rates are increased in overweight and obese women in both natural and assisted reproduction. Oocyte and embryo quality assessed according to classic morphological static parameters does not seem to be affected by excessive female body weight. Despite the initial lack of consensus between studies regarding embryo morphokinetics in obese women, blastocyst formation and quality have recently been shown to be similar across BMI groups, even in the case of euploid embryos. However, some metabolomic differences have been described in oocytes and embryos from obese women, thus pointing to a functional alteration. In women with elevated BMI, the percentage of aneuploid embryos is similar to that of normal weight women, and rates of miscarriage are higher, despite the transfer of euploid embryos. Therefore, the origin of the increased pregnancy loss rate after IVF in these women may be related to metabolomic, epigenetic or mitochondrial oocyte and embryo disturbances, or to the abnormal endocrine, metabolic and inflammatory uterine environment induced by obesity, which seems to be also responsible for other numerous complications during pregnancy and the in-utero fetal programming of postnatal diseases. A displacement of the window of implantation in obese women undergoing artificial endometrial preparation has recently been described and may be related to the poorer embryo implantation rates and increased risk of miscarriage observed following fresh and frozen embryo transfers with autologous oocytes, and with donated ova in recipients with extremely high BMI. SUMMARY Female obesity is related to poorer outcome in natural and assisted conception, including an increased risk of miscarriage. Embryo morphology, assessed by conventional methods or by morphokinetics, does not seem to be affected by excess weight, with similar blastocyst formation and quality than normal weight women reported in IVF cycles. Embryo aneuploidy is not increased, and higher miscarriages rates are seen after euploid embryo transfer in obese women. Disturbances of the uterus or its environment induced by female obesity seem to be the most likely cause of the increased risk of miscarriage, although metabolomic, epigenetic or mitochondrial oocyte and embryo dysfunction cannot be ruled out as cannot congenital anomalies. In the context of all the above, weight reduction before pregnancy should be advised in obese women trying to become pregnant.
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Li S, Li J, Ai Q, Liu H. Development and validation of nomograms for predicting adverse neonatal outcomes in women with polycystic ovary syndrome: a retrospective study. J OBSTET GYNAECOL 2022; 42:1922-1930. [PMID: 35603687 DOI: 10.1080/01443615.2022.2054682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Shanshan Li
- Department of Medical Ultrasound, The Central Hospital of Enshi Prefecture, En Shi, China
- Department of Obstetrics and Gynecology, People’s Hospital of Henan University, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Jinlan Li
- Department of Neurology, The Central Hospital of Enshi Prefecture, En Shi, China
| | - Qingxiu Ai
- Department of Medical Ultrasound, The Central Hospital of Enshi Prefecture, En Shi, China
| | - Huichun Liu
- Department of Neurology, The Central Hospital of Enshi Prefecture, En Shi, China
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27
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Luo Y, Qiao X, Xu L, Huang G. Irisin: circulating levels in serum and its relation to gonadal axis. Endocrine 2022; 75:663-671. [PMID: 35040046 PMCID: PMC8888466 DOI: 10.1007/s12020-022-02981-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/09/2022] [Indexed: 11/09/2022]
Abstract
Irisin is an exercise-induced myokine/adipokine in mice and humans that plays an important role in 'browning' of white adipose tissue and has shown great potential as a treatment for some metabolic diseases, such as obesity, insulin resistance, and inflammation. The circulating irisin level is reported to be associated with exercise, obesity, diet, diseases, and exposure to different pharmacological agents. Several studies have attempted to characterize the role of irisin in PCOS and other reproductive diseases, but contradictory results have been reported. Our previous study showed that irisin may serve further functions in folliculogenesis and fertility. In this review, we present the current knowledge on the physiology of irisin and its role in gonadal axis. Firstly, we describe irisin circulating levels and speculate on the potential mechanisms involved in irisin secretion and regulation. Then, we focus on the irisin levels in PCOS, and explore the relationships between, BMI, insulin resistance, and hyperandrogenism. Finally, we present the results from animal interventional studies and in vitro experiments to investigate the relationship between irisin and gonadal axis, indicating its novel effects on reproduction and fertility.
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Affiliation(s)
- Yunyao Luo
- Chongqing Key Laboratory of Human Embryo Engineering, Chongqing Reproduction and Genetics Institute, Chongqing Health Center for women and Children, No.64 Jin Tang Street, Yu Zhong District, Chongqing, 400013, China
| | - Xiaoyong Qiao
- Reproductive Endocrinology and Regulation Laboratory West China Second University Hospital, Sichuan University, Chengdu, China
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Liangzhi Xu
- Reproductive Endocrinology and Regulation Laboratory West China Second University Hospital, Sichuan University, Chengdu, China.
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China.
| | - Guoning Huang
- Chongqing Key Laboratory of Human Embryo Engineering, Chongqing Reproduction and Genetics Institute, Chongqing Health Center for women and Children, No.64 Jin Tang Street, Yu Zhong District, Chongqing, 400013, China.
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Barrea L, Vetrani C, Verde L, Frias-Toral E, Garcia-Velasquez E, Ranasinghe P, Mendez V, Jayawardena R, Savastano S, Colao A, Muscogiuri G. Gestational obesity: An unconventional endocrine disruptor for the fetus. Biochem Pharmacol 2022; 198:114974. [PMID: 35202578 DOI: 10.1016/j.bcp.2022.114974] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 12/16/2022]
Abstract
Obesity has reached pandemic proportions and is a growing concern throughout the world. A parallel trend has also been observed among women in reproductive age, leading to the increasing global prevalence of gestational obesity (GO). The well-known obesity-related health problems also extend to pregnancy, where they are responsible for giving rise to a variety of medical and obstetrical complications, resulting in an increased incidence of adverse maternal and fetal outcomes. In this context, several epidemiological and clinical studies have shown that nutritional changes through different stages of gestation can have a substantial impact on the future health and development of the child. Therefore, it is clear that GO is a modifiable endocrine disruptor that negatively influences the health of the fetus and the newborn, with long-term metabolic implications. This review aims to describe the impact of GO on maternal and fetal outcomes using the available scientific literature and highlighting the evidence-based nutritional approaches currently recommended for the management of GO.
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Affiliation(s)
- Luigi Barrea
- Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, 80143 Napoli, Italy; Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Naples, Italy
| | - Claudia Vetrani
- Dipartimento di Medicina Clinica e Chirurgia, Endocrinology Unit, University Federico II, Italy
| | - Ludovica Verde
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Naples, Italy
| | - Evelyn Frias-Toral
- Universidad Católica Santiago de Guayaquil, Av Pdte. Carlos Julio Arosemena Tola, Guayaquil 090615, Ecuador
| | | | - Priyanga Ranasinghe
- Department of Pharmacology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Verna Mendez
- Department of Internal Medicine, Hospital General de Zona 49, Mexican Institute of Social Security, Los Mochis, Sinaloa, Mexico
| | - Ranil Jayawardena
- Department of Physiology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka; Queensland University of Technology (QUT), Faculty of Health, School of Exercise and Nutrition Sciences, Brisbane, Queensland, Australia
| | - Silvia Savastano
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Naples, Italy; Dipartimento di Medicina Clinica e Chirurgia, Endocrinology Unit, University Federico II, Italy
| | - Annamaria Colao
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Naples, Italy; Dipartimento di Medicina Clinica e Chirurgia, Endocrinology Unit, University Federico II, Italy; Cattedra Unesco "Educazione alla salute e allo sviluppo sostenibile", University Federico II, Italy
| | - Giovanna Muscogiuri
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Naples, Italy; Dipartimento di Medicina Clinica e Chirurgia, Endocrinology Unit, University Federico II, Italy; Cattedra Unesco "Educazione alla salute e allo sviluppo sostenibile", University Federico II, Italy.
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29
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Vinsonneau L, Labrosse J, Porcu-Buisson G, Chevalier N, Galey J, Ahdad N, Ayel JP, Rongières C, Bouet PE, Mathieu d’Argent E, Cédrin-Durnerin I, Pessione F, Massin N. Impact of endometrial preparation on early pregnancy loss and live birth rate after frozen embryo transfer: a large multicenter cohort study (14,421 frozen cycles). Hum Reprod Open 2022; 2022:hoac007. [PMID: 35274060 PMCID: PMC8902977 DOI: 10.1093/hropen/hoac007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 02/01/2022] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Does the endometrial preparation protocol (artificial cycle (AC) vs natural cycle (NC) vs stimulated cycle (SC)) impact the risk of early pregnancy loss and live birth rate after frozen/thawed embryo transfer (FET)? SUMMARY ANSWER In FET, ACs were significantly associated with a higher pregnancy loss rate and a lower live birth rate compared with SC or NC. WHAT IS KNOWN ALREADY To date, there is no consensus on the optimal endometrial preparation in terms of outcomes. Although some studies have reported a higher pregnancy loss rate using AC compared with NC or SC, no significant difference was found concerning the pregnancy rate or live birth rate. Furthermore, no study has compared the three protocols in a large population. STUDY DESIGN, SIZE, DURATION A multicenter retrospective cohort study was conducted in nine reproductive health units in France using the same software to record medical files between 1 January 2012 and 31 December 2016. FET using endometrial preparation by AC, modified NC or SC were included. The primary outcome was the pregnancy loss rate at 10 weeks of gestation. The sample size required was calculated to detect an increase of 5% in the pregnancy loss rate (21–26%), with an alpha risk of 0.5 and a power of 0.8. We calculated that 1126 pregnancies were needed in each group, i.e. 3378 in total. PARTICIPANTS/MATERIALS, SETTING, METHODS Data were collected by automatic extraction using the same protocol. All consecutive autologous FET cycles were included: 14 421 cycles (AC: n = 8139; NC: n = 3126; SC: n = 3156) corresponding to 3844 pregnancies (hCG > 100 IU/l) (AC: n = 2214; NC: n = 812; SC: n = 818). Each center completed an online questionnaire describing its routine practice for FET, particularly the reason for choosing one protocol over another. MAIN RESULTS AND THE ROLE OF CHANCE AC represented 56.5% of FET cycles. Mean age of women was 33.5 (SD ± 4.3) years. The mean number of embryos transferred was 1.5 (±0.5). Groups were comparable, except for history of ovulation disorders (P = 0.01) and prior delivery (P = 0.03), which were significantly higher with AC. Overall, the early pregnancy loss rate was 31.5% (AC: 36.5%; NC: 25.6%; SC: 23.6%). Univariable analysis showed a significant association between early pregnancy loss rate and age >38 years, history of early pregnancy loss, ovulation disorders and duration of cryopreservation >6 months. After adjustment (multivariable regression), the early pregnancy loss rate remained significantly higher in AC vs NC (odds ratio (OR) 1.63 (95% CI) [1.35–1.97]; P < 0.0001) and in AC vs SC (OR 1.87 [1.55–2.26]; P < 0.0001). The biochemical pregnancy rate (hCG > 10 and lower than 100 IU/l) was comparable between the three protocols: 10.7% per transfer. LIMITATIONS, REASONS FOR CAUTION This study is limited by its retrospective design that generates missing data. Routine practice within centers was heterogeneous. However, luteal phase support and timing of embryo transfer were similar in AC. Univariable analysis showed no difference between centers. Moreover, a large number of parameters were included in the analysis. WIDER IMPLICATIONS OF THE FINDINGS Our study shows a significant increase in early pregnancy loss when using AC for endometrial preparation before FET. These results suggest either a larger use of NC or SC, or an improvement of AC by individualizing hormone replacement therapy for patients in order to avoid an excess of pregnancy losses. STUDY FUNDING/COMPETING INTEREST(S) The authors declare no conflicts of interest in relation to this work. G.P.-B. declares consulting fees from Ferring, Gedeon-Richter, Merck KGaA, Theramex, Teva; Speaker’s fees or equivalent from Merck KGaA, Ferring, Gedeon-Richter, Theramex, Teva. N.C. declares consulting fees from Ferring, Merck KGaA, Theramex, Teva; Speaker’s fees or equivalent from Merck KGaA, Ferring. C.R. declares a research grant from Ferring, Gedeon-Richter; consulting fees from Gedeon-Richter, Merck KGaA; Speaker’s fees or equivalent from Merck KGaA, Ferring, Gedeon-Richter; E.M.d’A. declares Speaker’s fees or equivalent from Merck KGaA, MSD, Ferring, Gedeon-Richter, Theramex, Teva. I.C-D. declares Speaker’s fees or equivalent from Merck KGaA, MSD, Ferring, Gedeon-Richter, IBSA. N.M. declares a research grant from Merck KGaA, MSD, IBSA; consulting fees from MSD, Ferring, Gedeon-Richter, Merck KGaA; Speaker’s fees or equivalent from Merck KGaA, MSD, Ferring, Gedeon-Richter, Teva, Goodlife, General Electrics. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- L Vinsonneau
- Hopital Tenon, Department of Reproductive Medicine, Paris, France
| | - J Labrosse
- CHU Jean-Verdier, Department of Reproductive Medicine and Fertility Preservation, Bondy, France
| | - G Porcu-Buisson
- Institut de Médecine de la Reproduction, Department of Reproductive Medicine, Marseille, France
| | - N Chevalier
- Polyclinique Saint-Roch, Department of Reproductive Medicine, Montpellier, France
| | - J Galey
- Institut Montsouris, Department of Reproductive Medicine, Paris, France
| | - N Ahdad
- Hopital Tenon, Department of Reproductive Medicine, Paris, France
- Grand Hôpital de l'Est Francilien, Department of Reproductive Medicine, Meaux, France
| | - J P Ayel
- Groupe Hospitalier Diaconesses Croix Saint-Simon, Department of Reproductive Medicine, Paris, France
| | - C Rongières
- Centre Médico-Chirurgical Obstétrique, Department of Reproductive Medicine, Strasbourg, France
| | - P E Bouet
- CHU Angers, Department of Reproductive Medicine, Angers, France
| | | | - I Cédrin-Durnerin
- CHU Jean-Verdier, Department of Reproductive Medicine and Fertility Preservation, Bondy, France
| | - F Pessione
- Agence de la Biomédecine, Department of Procreation- Embryology and Human genetics, Paris, France
| | - N Massin
- Intercommunal Hospital - University Paris Est, Department of Obstetrics-Gynaecology and Reproduction, Créteil, France
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Hecht LM, Hadwiger A, Patel S, Hecht BR, Loree A, Ahmedani BK, Miller-Matero LR. Disordered eating and eating disorders among women seeking fertility treatment: A systematic review. Arch Womens Ment Health 2022; 25:21-32. [PMID: 34175997 DOI: 10.1007/s00737-021-01156-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
The purpose of this systematic review is to evaluate the prevalence of disordered eating and eating disorders among women seeking fertility treatment.Observational studies were searched in Ovid MEDLINE, Web of Science, Embase, and PsycInfo. Studies published prior to September 2020 when the search was conducted were considered. Inclusion criteria included (1) original and empirical research, (2) published in a peer-reviewed journal, and (3) reported on disordered eating among women seeking fertility treatment in the sample or reported on prevalence of eating disorders among women seeking fertility treatment in the sample. Independent screening of abstracts was conducted by two authors (LH and AH). Ten studies met the inclusion criteria. Sample size, study location, measures, and results for each study in this review were reported.Among women pursuing fertility treatment, rates of current eating disorders ranged from 0.5 to 16.7%, while past eating disorder prevalence rates ranged from 1.4 to 27.5%. Current anorexia nervosa or bulimia nervosa was reported by up to 2% and 10.3% of women, respectively, while history of anorexia nervosa or bulimia nervosa was reported by up to 8.5% and 3.3% of women, respectively. Binge eating disorder or other eating disorders were reported by up to 18.5% and 9.1% of women, respectively. Disordered eating pathology was endorsed by 1.6 to 48% of women seeking fertility treatment. Endorsement of pathological eating attitudes was generally higher among women seeking fertility treatment with current or past eating disorders as compared to community samples, with the exception of dietary restraint. Rates of current and past eating disorders are higher among women seeking fertility treatment than in the general population. Providers treating women with infertility should be cognizant of these prevalence rates and consider screening for eating pathology in their patients as this may contribute to their likelihood of successful conception and/or subsequent pregnancy outcomes.
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Affiliation(s)
- Leah M Hecht
- Henry Ford Health System, Center for Health Policy and Health Services Research, 1 Ford Place Suite 3A, Detroit, MI, 48202, USA.
| | - Ashley Hadwiger
- Henry Ford Health System, Behavioral Health, 1 Ford Place Suite 1C, Detroit, MI, 48202, USA
| | - Shivali Patel
- Henry Ford Health System, Behavioral Health, 1 Ford Place Suite 1C, Detroit, MI, 48202, USA
| | - Bryan R Hecht
- MetroHealth Medical Center, Division of Reproductive Endocrinology, 2500 Metrohealth Dr, Cleveland, OH, 44109, USA
| | - Amy Loree
- Henry Ford Health System, Center for Health Policy and Health Services Research, 1 Ford Place Suite 3A, Detroit, MI, 48202, USA
| | - Brian K Ahmedani
- Henry Ford Health System, Center for Health Policy and Health Services Research, 1 Ford Place Suite 3A, Detroit, MI, 48202, USA.,Henry Ford Health System, Behavioral Health, 1 Ford Place Suite 1C, Detroit, MI, 48202, USA
| | - Lisa R Miller-Matero
- Henry Ford Health System, Center for Health Policy and Health Services Research, 1 Ford Place Suite 3A, Detroit, MI, 48202, USA.,Henry Ford Health System, Behavioral Health, 1 Ford Place Suite 1C, Detroit, MI, 48202, USA
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31
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Muter J, Kong CS, Brosens JJ. The Role of Decidual Subpopulations in Implantation, Menstruation and Miscarriage. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:804921. [PMID: 36303960 PMCID: PMC9580781 DOI: 10.3389/frph.2021.804921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/07/2021] [Indexed: 12/13/2022] Open
Abstract
In each menstrual cycle, the endometrium becomes receptive to embryo implantation while preparing for tissue breakdown and repair. Both pregnancy and menstruation are dependent on spontaneous decidualization of endometrial stromal cells, a progesterone-dependent process that follows rapid, oestrogen-dependent proliferation. During the implantation window, stromal cells mount an acute stress response, which leads to the emergence of functionally distinct decidual subsets, reflecting the level of replication stress incurred during the preceding proliferative phase. Progesterone-dependent, anti-inflammatory decidual cells (DeC) form a robust matrix that accommodates the conceptus whereas pro-inflammatory, progesterone-resistant stressed and senescent decidual cells (senDeC) control tissue remodelling and breakdown. To execute these functions, each decidual subset engages innate immune cells: DeC partner with uterine natural killer (uNK) cells to eliminate senDeC, while senDeC co-opt neutrophils and macrophages to assist with tissue breakdown and repair. Thus, successful transformation of cycling endometrium into the decidua of pregnancy not only requires continuous progesterone signalling but dominance of DeC over senDeC, aided by recruitment and differentiation of circulating NK cells and bone marrow-derived decidual progenitors. We discuss how the frequency of cycles resulting in imbalanced decidual subpopulations may determine the recurrence risk of miscarriage and highlight emerging therapeutic strategies.
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Affiliation(s)
- Joanne Muter
- Division of Biomedicine, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Tommy's National Centre for Miscarriage Research, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
- *Correspondence: Joanne Muter
| | - Chow-Seng Kong
- Division of Biomedicine, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Jan J. Brosens
- Division of Biomedicine, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Tommy's National Centre for Miscarriage Research, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
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32
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Parker PB, Urian W, Krieg SA. How much weight do we put into body mass index as a factor in recurrent pregnancy loss? Body mass index and recurrent pregnancy loss, a weighty topic. Fertil Steril 2021; 116:1349-1350. [PMID: 34756329 DOI: 10.1016/j.fertnstert.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Pamela B Parker
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Wes Urian
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Sacha A Krieg
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
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Silveira EA, Noll PRES, Mohammadifard N, Rodrigues APS, Sarrafzadegan N, de Oliveira C. Which Diets Are Effective in Reducing Cardiovascular and Cancer Risk in Women with Obesity? An Integrative Review. Nutrients 2021; 13:3504. [PMID: 34684505 PMCID: PMC8541423 DOI: 10.3390/nu13103504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 09/24/2021] [Accepted: 09/28/2021] [Indexed: 12/22/2022] Open
Abstract
Women are more affected by obesity than men which increases their risk of cancer and cardiovascular disease (CVD). Therefore, it is important to understand the effectiveness of different types of diet in the context of women's health. This review aims to summarize the scientific evidence on the effects of different types of diet for women with obesity and their impact on CVD and cancer risk. This review included epidemiological and clinical studies on adult women and different types of diets, such as the Mediterranean (MED) diet, the Traditional Brazilian Diet, the Dietary Approach to Stop Hypertension (DASH), intermittent fasting (IF), calorie (energy) restriction, food re-education, low-carbohydrate diet (LCD) and a very low-carbohydrate diet (VLCD). Our main findings showed that although LCDs, VLCD and IF are difficult to adhere to over an extended period, they can be good options for achieving improvements in body weight and cardiometabolic parameters. MED, DASH and the Traditional Brazilian Diet are based on natural foods and reduced processed foods. These diets have been associated with better women's health outcomes, including lower risk of CVD and cancer and the prevention and treatment of obesity.
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Affiliation(s)
- Erika Aparecida Silveira
- Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiânia 74690-900, Brazil
- Department of Epidemiology & Public Health, Institute of Epidemiology & Health Care, University College London, London WC1E 6BT, UK;
| | | | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran;
| | | | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran;
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Cesar de Oliveira
- Department of Epidemiology & Public Health, Institute of Epidemiology & Health Care, University College London, London WC1E 6BT, UK;
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Abstract
The purpose of this American Society for Reproductive Medicine Practice Committee report is to provide clinicians with principles and strategies for the evaluation and treatment of couples with infertility associated with obesity. This revised document replaces the Practice Committee document titled "Obesity and reproduction: an educational bulletin" last published in 2015 (Fertil Steril 2015;104:1116-26).
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Affiliation(s)
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- American Society for Reproductive Medicine, Birmingham, Alabama
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Magnus MC, Havdahl A, Morken NH, Wensaas KA, Wilcox AJ, Håberg SE. Risk of miscarriage in women with psychiatric disorders. Br J Psychiatry 2021; 219:501-506. [PMID: 33448259 PMCID: PMC7611718 DOI: 10.1192/bjp.2020.259] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Some psychiatric disorders have been associated with increased risk of miscarriage. However, there is a lack of studies considering a broader spectrum of psychiatric disorders to clarify the role of common as opposed to independent mechanisms. AIMS To examine the risk of miscarriage among women diagnosed with psychiatric conditions. METHOD We studied registered pregnancies in Norway between 2010 and 2016 (n = 593 009). The birth registry captures pregnancies ending in gestational week 12 or later, and the patient and general practitioner databases were used to identify miscarriages and induced abortions before 12 gestational weeks. Odds ratios of miscarriage according to 12 psychiatric diagnoses were calculated by logistic regression. CONCLUSIONS A wide range of psychiatric disorders were associated with increased risk of miscarriage. The heightened risk of miscarriage among women diagnosed with psychiatric disorders highlights the need for awareness and surveillance of this risk group in antenatal care.
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Affiliation(s)
- Maria C Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway; MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom; and Population Health Sciences, Bristol Medical School, Bristol, United Kingdom
| | - Alexandra Havdahl
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway; Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway; and MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
| | - Nils-Halvdan Morken
- Noren, Bergen, Norway; and Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Knut-Arne Wensaas
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - Allen J Wilcox
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, North Carolina, United States
| | - Siri E Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
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Chang WH, Chou WC, Waits A, Liao KW, Kuo PL, Huang PC. Cumulative risk assessment of phthalates exposure for recurrent pregnancy loss in reproductive-aged women population using multiple hazard indices approaches. ENVIRONMENT INTERNATIONAL 2021; 154:106657. [PMID: 34052604 DOI: 10.1016/j.envint.2021.106657] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 04/22/2021] [Accepted: 05/13/2021] [Indexed: 06/12/2023]
Abstract
Phthalates, which are commonly used in flexible plastics and consumer products, have been reported to be toxic to reproductive and developmental function in mammals. Past studies have focused on the toxic effects on male reproduction, with only a few studies conducted on the risks that cumulative exposure to phthalates have on the female reproductive system. We recruited 260 patients with recurrent pregnancy loss (RPL) of unknown etiology and 203 controls from the clinics of Obstetrics and Gynecology at a medical center in southern Taiwan from 2013 to 2020. The daily intake of phthalates was estimated from urine samples using the back-calculation method, after which the cumulative risk was determined using multiple hazard indices, including a dose-addition model, a receptor effect model, and a hazard index approach. The patients with RPL had a significantly higher cumulative exposure to phthalates (p < 0.05) than did the controls with a hazard index above one. After adjusted logistic regression analysis, we found that the risk of RPL was strongly related to the higher quartiles of DEHP, the DEHPTEQ for the antiandrogenic effect and adverse effects of the female reproductive system and the ERα binding effect (p < 0.05). Our work suggests that more attentions should be paid to the adverse effects induced by phthalates on female reproduction, especially the effects caused by the cumulative exposure to phthalates in women of reproductive age.
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Affiliation(s)
- Wei-Hsiang Chang
- Department of Food Safety/ Hygiene and Risk Management, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; Research Center of Environmental Trace Toxic Substances, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Wei-Chun Chou
- Institute of Computational Comparative Medicine (ICCM), Department of Anatomy and Physiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS, United States
| | - Alexander Waits
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Kai-Wei Liao
- School of Food Safety, College of Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Pao-Lin Kuo
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital and College of Medicine, Tainan, Taiwan
| | - Po-Chin Huang
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan; National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
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Maternal body mass index associates with blastocyst euploidy and live birth rates: the tip of an iceberg? Reprod Biomed Online 2021; 43:645-654. [PMID: 34446374 DOI: 10.1016/j.rbmo.2021.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/05/2021] [Accepted: 07/12/2021] [Indexed: 01/14/2023]
Abstract
RESEARCH QUESTION Does maternal preconceptional body mass index (BMI) associate with mean blastocyst euploidy rate (m-ER) per patient and live birth rate (LBR) after vitrified-warmed euploid single embryo transfer (SET)? DESIGN Observational study conducted between April 2013 and March 2020 at a private IVF clinic, involving 1811 Caucasian women undergoing trophectoderm biopsy and comprehensive chromosome testing. The outcomes of 1125 first vitrified-warmed euploid SET were also analysed. Patients were clustered as normal weight (BMI 18.5-25; n = 1392 performing 859 SET), underweight (BMI <18.5; n = 160 performing 112 SET) and overweight (BMI >25; n = 259 performing 154 SET). m-ER per patient was the primary outcome. The secondary outcomes were all clinical outcomes per euploid SET. All data were adjusted for confounders through regression analyses. RESULTS The m-ER per patient decreases as maternal BMI increases from 17 up to 22-23 before reaching a plateau. A linear regression adjusted for maternal age confirmed this moderate association (unstandardized coefficient B: -0.6%, 95% confidence interval [CI]: -1.1 to -0.1%, P = 0.02). All clinical outcomes were similar between normal weight and underweight women. Overweight women, instead, showed higher miscarriage rate per clinical pregnancy (n = 20/75, 26.7% versus n = 67/461, 14.5%; odds ratio [OR] adjusted for blastocyst quality and day of full blastulation: 2.0, 95% CI: 1.1-3.6, P = 0.01) and lower LBR per SET (n = 55/154, 35.7% versus n = 388/859, 45.2%; OR adjusted for blastocyst quality and day of full blastulation: 0.67, 95% CI: 0.46-0.96, P = 0.03). CONCLUSION These data indicate a need for future research on more sensitive metrics to assess body fat mass and distribution, as well as on the mechanisms leading to lipotoxicity, thereby impairing embryo competence and/or endometrial receptivity. Overweight women should be informed of their higher risk for miscarriage and, whenever possible, encouraged to lose weight, especially before transfer.
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Eapen A, Hayes ET, McQueen DB, Beestrum M, Eyck PT, Boots C. Mean differences in maternal body mass index and recurrent pregnancy loss: a systematic review and meta-analysis of observational studies. Fertil Steril 2021; 116:1341-1348. [PMID: 34412893 DOI: 10.1016/j.fertnstert.2021.06.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To investigate the association of maternal body mass index (BMI) and recurrent pregnancy loss (RPL). DESIGN Systematic review and meta-analysis. SETTING Not applicable. PATIENT(S) A total of 3,833 women with RPL and 4,083 women as controls. INTERVENTION(S) Studies were identified through a search of PubMed, Embase, Scopus, and Cochrane. MAIN OUTCOME MEASURE(S) The primary outcome of interest was RPL using the mean differences in maternal BMI as the predictor variable. The results of the meta-analysis were reported as the mean difference with a 95% confidence interval. RESULT(S) In total, 892 studies were reviewed. Pooled data from 25 studies suggested that the maternal BMI of women with a history of recurrent pregnancy loss was significantly higher than the BMI of controls, mean difference 0.7 kg/m2 [95% confidence interval 0.2-1.3]. CONCLUSION(S) These findings supported an association between maternal BMI and RPL. Large prospective studies are needed to evaluate the influence of maternal BMI on pregnancy outcomes in women with RPL.
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Affiliation(s)
- Abey Eapen
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Carver College of Medicine, University of Iowa, Iowa City, Iowa.
| | - Emily T Hayes
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Dana B McQueen
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern University, Chicago, Illinois
| | - Molly Beestrum
- Galter Health Sciences Library, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Patrick Ten Eyck
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa
| | - Christina Boots
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern University, Chicago, Illinois
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Capatina N, Hemberger M, Burton GJ, Watson ED, Yung HW. Excessive endoplasmic reticulum stress drives aberrant mouse trophoblast differentiation and placental development leading to pregnancy loss. J Physiol 2021; 599:4153-4181. [PMID: 34269420 DOI: 10.1113/jp281994] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/05/2021] [Indexed: 12/17/2022] Open
Abstract
KEY POINTS Endoplasmic reticulum (ER) stress promotes placental dysmorphogenesis and is associated with poor pregnancy outcomes. We show that unfolded protein response signalling pathways located in the ER drive differentiation of mouse trophoblast stem cells into trophoblast subtypes involved in development of the placental labyrinth zone and trophoblast invasion. In a mouse model of chronic ER stress (Eif2s1tm1RjK ), higher ER stress in homozygous blastocysts is accompanied by reduced trophectoderm cell number and developmental delay and also is associated with an increased incidence of early pregnancy loss. Administration of the chemical chaperone, tauroursodeoxycholic acid, to Eif2s1+/ tm1RjK heterozygous females during pregnancy alleviated ER stress in the mutant placenta, restored normal trophoblast populations and reduced the frequency of early pregnancy loss. Our results suggest that alleviation of intrauterine ER stress could provide a potential therapeutic target to improve pregnancy outcome in women with pre-gestational metabolic or gynaecological conditions. ABSTRACT Women with pre-gestational health conditions (e.g. obesity, diabetes) or gynaecological problems (e.g. endometriosis) are at increased risk of adverse pregnancy outcomes including miscarriage, pre-eclampsia and fetal growth restriction. Increasing evidence suggests that unfavourable intrauterine conditions leading to poor implantation and/or defective placentation are a possible causative factor. The endoplasmic reticulum (ER) unfolded protein response (UPRER ) signalling pathways are a convergence point of various physiological stress stimuli that can be triggered by an unfavourable intrauterine environment. Therefore, we explored the impact of ER stress on mouse trophoblast differentiation in vitro, mouse blastocyst formation and early placenta development in the Eif2s1tm1RjK mutant mouse model of chronic ER stress. Chemically-manipulated ER stress or activation of UPRER pathways in a mouse trophoblast stem cell line promoted lineage-specific differentiation. Co-treatment with specific UPRER pathway inhibitors rescued this effect. Although the inner cell mass was unaffected, the trophectoderm of homozygous Eif2s1tm1RjK blastocysts exhibited ER stress associated with a reduced cell number. Furthermore, one-third of Eif2s1tm1RjK homozygous blastocysts exhibited severe developmental defects. We have previously reported a reduced trophoblast population and premature trophoblast differentiation in Eif2s1tm1RjK homozygous placentas at mid-gestation. Here, we demonstrate that treatment of Eif2s1+/tm1RjK heterozygous pregnant females with the chemical chaperone tauroursodeoxycholic acid alleviated ER stress, restored the trophoblast population and reduced the frequency of embryonic lethality. Our data suggest that therapeutic targeting of ER stress may improve pregnancy outcome in women with pre-gestational metabolic or gynaecological conditions.
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Affiliation(s)
- Nadejda Capatina
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Myriam Hemberger
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK.,Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Graham J Burton
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Erica D Watson
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Hong Wa Yung
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
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Zhang Y, Li D, Yan Q, Song X, Tian W, Wang Y, Teng F, Wei L, Wang J, Zhang H, Xue F. Weight Loss Improves Pregnancy and Livebirth Outcomes in Young Women with Early-Stage Endometrial Cancer and Atypical Hyperplasia. Cancer Manag Res 2021; 13:5711-5722. [PMID: 34285588 PMCID: PMC8286730 DOI: 10.2147/cmar.s316040] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/12/2021] [Indexed: 12/21/2022] Open
Abstract
Purpose To evaluate the effects of body weight loss on reproductive outcomes in young women with early-stage endometrial cancer (EC) and atypical hyperplasia (AH) who underwent fertility-sparing therapy. Patients and Methods Patients with well-differentiated EC (n=8, FIGO stage Ia) and AH (n=36) who achieved complete regression after fertility-sparing therapy were retrospectively reviewed. Patients were divided into a weight loss group (n=25) and a non-weight loss group (n=19). Subgroup analysis according to body mass index and relative weight loss were performed to investigate the effect of weight loss on pregnancy and live birth outcomes. Univariate and multivariate logistic regression analyses were undertaken to determine pregnancy-associated factors. Results Mean body weight and body mass index at pre-progestin treatment and at fertility treatment initiation were 70.63±12.03 and 67.08±8.18 kg, respectively, 27.06±4.44 and 25.73±3.15 kg/m2, respectively. Twenty-five patients (56.82%) lost weight, the median absolute weight loss was 5.00 kg (1.00–34.50), and the median relative weight loss was 6.70% (1.00–36.00%) over a median of 12 months (5.00–97.00). A favorable pregnancy rate (65.91%) and live birth rate (50.00%) were achieved. The pregnancy and live birth rates were meaningfully higher in the weight loss group than in the non-weight loss group (88.00% vs 36.84%, P=0.000; 64.00% vs 31.58%, P=0.033); weight loss ≥5% significantly increased pregnancy and live birth rate in patients with BMI ≥25 kg/m2. The risk ratio of weight loss ≥5% in multivariate logistic analysis for pregnancy was 10.448 (1.102, 99.056, P=0.041). Conclusion Weight loss could positively affect pregnancy rate and improve live birth rate in overweight and obese women with early-stage EC and AH during/after fertility-sparing therapy. Weight loss ≥5% increased pregnancy and livebirth rates significantly in overweight and obese women.
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Affiliation(s)
- Yanfang Zhang
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China; Tianjin Key laboratory of Female Reproductive Health and Eugenics, Tianjin, People's Republic of China
| | - Dan Li
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China; Tianjin Key laboratory of Female Reproductive Health and Eugenics, Tianjin, People's Republic of China
| | - Qi Yan
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China; Tianjin Key laboratory of Female Reproductive Health and Eugenics, Tianjin, People's Republic of China
| | - Xueru Song
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China; Tianjin Key laboratory of Female Reproductive Health and Eugenics, Tianjin, People's Republic of China
| | - Wenyan Tian
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China; Tianjin Key laboratory of Female Reproductive Health and Eugenics, Tianjin, People's Republic of China
| | - Yingmei Wang
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China; Tianjin Key laboratory of Female Reproductive Health and Eugenics, Tianjin, People's Republic of China
| | - Fei Teng
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China; Tianjin Key laboratory of Female Reproductive Health and Eugenics, Tianjin, People's Republic of China
| | - Likun Wei
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China; Tianjin Key laboratory of Female Reproductive Health and Eugenics, Tianjin, People's Republic of China
| | - Jinghua Wang
- Laboratory of Epidemiology, Tianjin Neurological Institute, Department of Neurology, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Huiying Zhang
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China; Tianjin Key laboratory of Female Reproductive Health and Eugenics, Tianjin, People's Republic of China
| | - Fengxia Xue
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China; Tianjin Key laboratory of Female Reproductive Health and Eugenics, Tianjin, People's Republic of China
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Kiremitli T, Kiremitli S, Ulug P, Dinc K, Uzel K, Arslan YK. Are the body shape index, the body roundness index and waist-to-hip ratio better than BMI to predict recurrent pregnancy loss? Reprod Med Biol 2021; 20:327-333. [PMID: 34262401 PMCID: PMC8254164 DOI: 10.1002/rmb2.12388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/09/2021] [Accepted: 04/30/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Etiology could not be determined in approximately 50% of recurrent pregnancy loss cases, and it was named unexpected recurrent pregnancy loss(URPL). A body shape index(ABSI), body roundness index(BRI), and waist-to-hip ratio(WtHR) are new indexes that are superior to BMI in showing body fat distribution. We aimed to investigate the potency of ABSI, BRI, and WtHR in URPL, their superiority to BMI, and their suitability for clinical use. METHODS One hundred and thirty-eight patients between the ages of 20-40 who applied to our hospital for URPL between January 2016 and December 31, 2020 were included in our study. Weight, height, waist circumference, and hip circumference were measured, and indexes were calculated. Differences between the URPL and control groups were calculated using the IBM SPSS program. RESULTS There was a significant difference between the two groups for BRI, ABSI, and WtHR values, while there was no significant difference in BMI. BRI(4.4 ± 1.7vs3.9 ± 1.5), ABSI(0.08 ± 0.005 vs 0.078 ± 0.004), and WtHR(0.84 ± 0.06vs0.82 ± 0.05) values were higher in the URPL group. ROC analysis showed us that BRI, ABSI, and WtHR have a diagnostic value for URPL(P < .05). When indexes were above the cutoff values, RPL risk increased 3.59 times in ABSI, 2.26 times in BRI, and 2.9 times in WtHR(P < .05). CONCLUSIONS The relationship between obesity and URPL can be explained more clearly by using effective indexes that show body fat distribution rather than BMI. Ethics committee approval was obtained from Erzincan Binali Yildirim University in 14.01.2021. Clinical Research Ethics Committee no: 01/01.
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Affiliation(s)
- Tunay Kiremitli
- Medical Faculty, Obstetrics and Gynaecology DepartmentErzincan Binali Yildirim UniversityErzincanTurkey
| | - Sevil Kiremitli
- Medical Faculty, Obstetrics and Gynaecology DepartmentErzincan Binali Yildirim UniversityErzincanTurkey
| | - Pasa Ulug
- Medical Faculty, Obstetrics and Gynaecology DepartmentErzincan Binali Yildirim UniversityErzincanTurkey
| | - Kemal Dinc
- Medical Faculty, Obstetrics and Gynaecology DepartmentErzincan Binali Yildirim UniversityErzincanTurkey
| | - Kemine Uzel
- Medical Faculty, Obstetrics and Gynaecology DepartmentErzincan Binali Yildirim UniversityErzincanTurkey
| | - Yusuf Kemal Arslan
- Biostatistics DepartmentMedical FacultyErzincan Binali Yildirim UniversityErzincanTurkey
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Pithois A, Mauppin C, Decaigny P, Tio G, Berdin A, Roux C, Pretalli JB. [Overweight or obesity: impact on the results of the first IVF/ICSI attempt]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2021; 49:593-600. [PMID: 33484901 DOI: 10.1016/j.gofs.2021.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To evaluate the influence of overweight and obesity on the results of the first in vitro fertilization attempt, without or with intracytoplasmic microinjection (IVF/ICSI), in terms of live births. METHODS Retrospective observational study concerning the first IVF/ICSI attempts from 01/01/2006 to 31/12/2017 carried out at the Assisted Reproductive Technology of the CHU of Besançon, studying the delivery rate (excluding frozen embryos transfers), and the data of Assisted Reproductive Technology attempts, in overweight (BMI 25 to 29.9kg/m2) and obese women (BMI≥30kg/m2), compared to women with a standard BMI (18 to 24.9kg/m2). RESULTS A total of 3192 patients were included. At the end of their first IVF/ICSI attempt, the delivery rate of women with standard BMI was 34.7%. The delivery rate was significantly lower in overweight women (29.5%, p=0.011) and comparable in obese women (32.4%, p=0.476). The birth rate of women with a BMI≥25 kg/m2 was also significantly lower than that of women with a standard BMI (30.4% versus 34.7%, p=0.019). After multivariate analysis, the delivery rate in overweight patients remained significantly lower compared to the population with standard BMI (OR=0.707; 95% CI 0.561-0.890), and comparable in obese patients (OR=0.796; 95% CI 0.585-1.084). CONCLUSION The delivery rate was lower in overweight women, whereas it was not significantly different in obese women.
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Affiliation(s)
- A Pithois
- Centre d'AMP, CHU Besançon, 25000 Besançon, France.
| | - C Mauppin
- Centre d'AMP, CHU Besançon, 25000 Besançon, France
| | - P Decaigny
- Centre d'AMP, CHU Besançon, 25000 Besançon, France
| | - G Tio
- Inserm CIC 1431, CHU Besançon, 25000 Besançon, France
| | - A Berdin
- Centre d'AMP, CHU Besançon, 25000 Besançon, France
| | - C Roux
- Centre d'AMP, CHU Besançon, 25000 Besançon, France; Inserm CIC 1431, CHU Besançon, 25000 Besançon, France
| | - J-B Pretalli
- Centre d'AMP, CHU Besançon, 25000 Besançon, France; Inserm CIC 1431, CHU Besançon, 25000 Besançon, France
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Risk of miscarriage in women with chronic diseases in Norway: A registry linkage study. PLoS Med 2021; 18:e1003603. [PMID: 33970911 PMCID: PMC8143388 DOI: 10.1371/journal.pmed.1003603] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 05/24/2021] [Accepted: 04/01/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Increased risk of miscarriage has been reported for women with specific chronic health conditions. A broader investigation of chronic diseases and miscarriage risk may uncover patterns across categories of illness. The objective of this study was to study the risk of miscarriage according to various preexisting chronic diseases. METHODS AND FINDINGS We conducted a registry-based study. Registered pregnancies (n = 593,009) in Norway between 2010 and 2016 were identified through 3 national health registries (birth register, general practitioner data, and patient registries). Six broad categories of illness were identified, comprising 25 chronic diseases defined by diagnostic codes used in general practitioner and patient registries. We required that the diseases were diagnosed before the pregnancy of interest. Miscarriage risk according to underlying chronic diseases was estimated as odds ratios (ORs) using generalized estimating equations adjusting for woman's age. The mean age of women at the start of pregnancy was 29.7 years (SD 5.6 years). We observed an increased risk of miscarriage among women with cardiometabolic diseases (OR 1.25, 95% CI 1.20 to 1.31; p-value <0.001). Within this category, risks were elevated for all conditions: atherosclerosis (2.22; 1.42 to 3.49; p-value <0.001), hypertensive disorders (1.19; 1.13 to 1.26; p-value <0.001), and type 2 diabetes (1.38; 1.26 to 1.51; p-value <0.001). Among other categories of disease, risks were elevated for hypoparathyroidism (2.58; 1.35 to 4.92; p-value 0.004), Cushing syndrome (1.97; 1.06 to 3.65; p-value 0.03), Crohn's disease (OR 1.31; 95% CI: 1.18 to 1.45; p-value 0.001), and endometriosis (1.22; 1.15 to 1.29; p-value <0.001). Findings were largely unchanged after mutual adjustment. Limitations of this study include our inability to adjust for measures of socioeconomic position or lifestyle characteristics, in addition to the rareness of some of the conditions providing limited power. CONCLUSIONS In this registry study, we found that, although risk of miscarriage was largely unaffected by maternal chronic diseases, risk of miscarriage was associated with conditions related to cardiometabolic health. This finding is consistent with emerging evidence linking cardiovascular risk factors to pregnancy complications.
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Ng KYB, Steegers-Theunissen R, Willemsen S, Wellstead S, Cheong Y, Macklon N. Smartphone-based lifestyle coaching modifies behaviours in women with subfertility or recurrent miscarriage: a randomized controlled trial. Reprod Biomed Online 2021; 43:111-119. [PMID: 34053852 DOI: 10.1016/j.rbmo.2021.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/18/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
RESEARCH QUESTION Is an online lifestyle coaching platform more effective at modifying periconceptional behaviours than standard advice offered by the UK National Health Service (NHS)? DESIGN Women with subfertility or recurrent miscarriage were recruited to a two-centre randomized controlled trial. They were randomized to either the online lifestyle coaching platform Smarter Pregnancy (intervention) or periconceptional advice provided by NHS websites (control). Participants completed a lifestyle questionnaire at baseline, 6, 12, 18 and 24 weeks, and the results were used to tailor lifestyle coaching in the intervention group. At baseline, 12 and 24 weeks, composite risk scores (CRS) were calculated. A lower CRS corresponds to a healthier lifestyle. RESULTS Of the 400 women recruited, 262 women were randomized (131 in each arm). At 12 weeks, a reduction in CRS (includes risk score for intake of folic acid, vegetables and fruits, smoking and alcohol) was observed in the intervention versus control arms. After correcting for baseline, the difference in the CRS between intervention and control was -0.47 (95% CI -0.97 to 0.02) at 12 weeks and -0.32 (95% CI -0.82 to 0.15) at 24 weeks. A statistically significant reduction in lifestyle risk scores was found in women with a body mass index (BMI) of 25 kg/m2 or above compared with those with a BMI below 25kg/m2. The odds of being pregnant at 24 weeks was increased in the intervention versus control (OR 2.83, 95% CI 0.35 to 57.76). CONCLUSIONS The Smarter Pregnancy coaching platform is more effective in delivering lifestyle advice and modulating behaviours to support women with a history of subfertility or recurrent miscarriage than standard online NHS advice.
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Affiliation(s)
- Ka Ying Bonnie Ng
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; Department of Obstetrics and Gynaecology, Princess Anne Hospital, Room F86, Level F, Coxford Road, Southampton SO16 5YA, UK.
| | - Régine Steegers-Theunissen
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Sten Willemsen
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Susan Wellstead
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; Department of Obstetrics and Gynaecology, Princess Anne Hospital, Room F86, Level F, Coxford Road, Southampton SO16 5YA, UK
| | - Ying Cheong
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; Department of Obstetrics and Gynaecology, Princess Anne Hospital, Room F86, Level F, Coxford Road, Southampton SO16 5YA, UK
| | - Nick Macklon
- Reprohealth, Zealand University Hospital, University of Copenhagen, Denmark; London Women's Clinic, London, UK
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Deng D, George J, Pasupathy D, Wah Cheung N. The prevalence of metabolic associated fatty liver detected by FibroScan® in women with gestational diabetes in a multiethnic population. Diabetes Res Clin Pract 2021; 174:108757. [PMID: 33744378 DOI: 10.1016/j.diabres.2021.108757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 03/02/2021] [Accepted: 03/09/2021] [Indexed: 02/08/2023]
Abstract
AIMS Metabolic associated fatty liver disease (MAFLD) is a leading cause of chronic liver disease and has been increasingly associated with gestational diabetes (GDM). This study aimed to assess the prevalence of MAFLD in women with GDM in the antenatal period. METHODS 108 pregnant women with GDM diagnosed on a 75-gram oral glucose tolerance test were enrolled from a multiethnic cohort attending a large obstetrics clinic in Sydney, Australia and had a single FibroScan® assessment after 24 weeks gestation to assess for hepatic steatosis and fibrosis. A control attenuated parameter (CAP) cut-off score of ≥ 233.5 dB/m was chosen to signify presence of hepatic steatosis which indicates MAFLD. Obstetric, anthropometric and metabolic measures were analysed. RESULTS 29 (26.9%) women had evidence of FibroScan®-detected MAFLD, whilst none had evidence of hepatic fibrosis. Increased maternal BMI (aOR 1.12, 95% CI: 1.04-1.20) was associated with the finding of MAFLD in this cohort. CONCLUSIONS We found a significant antenatal prevalence of FibroScan®-detected MAFLD in this cohort of multiethnic women with GDM. FibroScan® is a safe and rapid assessment tool which may have a role in screening for MAFLD in pregnancy in appropriate at-risk women.
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Affiliation(s)
- Difei Deng
- University of Sydney, Sydney, NSW, Australia; Dept of Diabetes & Endocrinology, Westmead Hospital, Sydney, NSW, Australia.
| | - Jacob George
- University of Sydney, Sydney, NSW, Australia; Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, NSW, Australia.
| | - Dharmintra Pasupathy
- University of Sydney, Sydney, NSW, Australia; Institute of Reproduction, Westmead Clinical School, University of Sydney, NSW, Australia.
| | - N Wah Cheung
- University of Sydney, Sydney, NSW, Australia; Dept of Diabetes & Endocrinology, Westmead Hospital, Sydney, NSW, Australia.
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Muhammad HFL, Pramono A, Rahman MN. The safety and efficacy of supervised exercise on pregnant women with overweight/obesity: A systematic review and meta-analysis of randomized controlled trials. Clin Obes 2021; 11:e12428. [PMID: 33167074 DOI: 10.1111/cob.12428] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 10/13/2020] [Accepted: 10/25/2020] [Indexed: 11/26/2022]
Abstract
Behavioural modification through physical activity and dietary counselling has been shown to have beneficial effects on pregnant women with overweight/obesity. Whether exercise alone with supervision (ie, supervised exercise) may also benefit for pregnant women with overweight/obesity is still unknown. This systematic review and meta-analysis aimed to determine the safety and efficacy of supervised exercise on pregnant women with overweight/obesity. PubMed, Cochrane library, Embase (Ovid), CINAHL (EBSCO), and Web of Science were used to search publications using a combination of main keywords "obesity", "exercise", "pregnant women", and "randomised controlled trial". From a total of 740 publications, 11 randomized controlled trials were included. All studies reported no adverse effects of supervised exercise on pregnant women with overweight/obesity. Of interest, this meta-analysis showed gestational weight gain (GWG) was lower in the supervised exercise group as compared to control (Mean difference 0.88 kg, 95%CI -1.73 to -0.03, P = .04). There was a significant effect of supervised exercise on post-prandial blood glucose (MD: -0.24, 95%CI -0.47 to -0.01, P = .04) and insulin resistance (HOMA-IR) (MD: -0.18, 95%CI -0.30 to -0.05, P = .005). There were no differences in risk of gestational diabetes mellitus, pre-eclampsia/gestational hypertension, and newborn outcomes (eg, infants birth weight, preterm birth incident, and gestational age) (all P > .05). This meta-analysis might suggest beneficial effects of supervised exercise on pregnant women with overweight/obesity to prevent excessive GWG, attenuates insulin resistance, and the post-prandial blood glucose level.
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Affiliation(s)
| | - Adriyan Pramono
- Department of Nutrition Science, Faculty of Medicine, Universitas Diponegoro, Central Java, Semarang, Indonesia
| | - Muhammad Nurhadi Rahman
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Systematic review and meta-analysis of female lifestyle factors and risk of recurrent pregnancy loss. Sci Rep 2021; 11:7081. [PMID: 33782474 PMCID: PMC8007745 DOI: 10.1038/s41598-021-86445-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 03/08/2021] [Indexed: 01/19/2023] Open
Abstract
It is known that lifestyle factors affect sporadic miscarriage, but the extent of this on RPL (recurrent pregnancy loss) is less well known. A systematic review and meta-analysis was performed to assess the associations between lifestyle factors and RPL. Studies that analysed RPL in the context of BMI, smoking, alcohol and caffeine intake were included. The primary and secondary outcomes were odds of having RPL in the general population and odds of further miscarriage, respectively. Underweight and women with BMI > 25 are at higher odds of RPL in the general population (OR 1.2, 95% CI 1.12-1.28 and OR 1.21, 95% CI 1.06-1.38, respectively). In women with RPL, having BMI > 30 and BMI > 25 has increased odds of further miscarriages (OR 1.77, 95% CI 1.25-2.50 and OR 1.35, 95% CI 1.07-1.72, respectively). The quality of the evidence for our findings was low or very low. Being underweight and BMI > 25 contributes significantly to increased risk of RPL (general population). BMI > 25 or BMI > 30 increases the risk of further miscarriages (RPL population). Larger studies addressing the effects of alcohol, cigarette smoking and caffeine on the risk of RPL with optimisation of BMI in this cohort of women are now needed.
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Magnus MC, Ferreira DDS, Borges MC, Tilling K, Lawlor DA, Fraser A. Cardiometabolic health during early adulthood and risk of miscarriage: a prospective study. Wellcome Open Res 2021; 5:205. [PMID: 33644403 PMCID: PMC7888356 DOI: 10.12688/wellcomeopenres.16245.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Several studies have found that women who are overweight or obese have an increased risk of miscarriage. There is also some evidence of associations of other aspects of cardiometabolic health, including blood pressure and lipids, with miscarriage risk, although these have not been examined to the same extent as body-mass index (BMI). Methods: Our objective was to investigate the risk of miscarriage according to pre-pregnancy cardiometabolic health. We examined pre-pregnancy levels of BMI, blood pressure, fasting insulin and metabolites profile at age 18 and risk of miscarriage by age 24. The study included adult female offspring in the Avon Longitudinal Study of Parents and Children with a pregnancy between 18 and 24 years of age (n=434 for BMI and blood pressure; n=265 for metabolites). We used log-binomial regression to calculate adjusted associations between cardiometabolic health measures and miscarriage. Results: The overall risk of miscarriage was 22%. The adjusted relative risks for miscarriage were 0.96 (95% CI: 0.92-1.00) for BMI (per unit increase), 0.98 (0.96-1.00) for systolic blood pressure, and 1.00 (0.97-1.04) for diastolic blood pressure (per 1 mmHg increase). Total cholesterol, total lipids and phospholipids in HDL-cholesterol were associated with increased likelihood of miscarriage, but none of the p-values for the metabolites were below the corrected threshold for multiple testing (p-value ≤0.003). Conclusions: Our findings indicate no strong evidence to support a relationship between pre-pregnancy cardiometabolic health and risk of miscarriage in young, healthy women who became pregnant before age 24. Future studies are necessary that are able to evaluate this question in samples with a wider age range.
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Affiliation(s)
- Maria C. Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, 0213, Norway
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Diana D. S. Ferreira
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Maria Carolina Borges
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kate Tilling
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Deborah A. Lawlor
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Abigail Fraser
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
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Abstract
The worldwide rates of obesity have increased significantly in recent decades. In the United States, more than 50% of pregnant women are overweight or obese. Obese gravid women are more prone to adverse pregnancy outcomes, including gestational diabetes, hypertensive disorders, and cardiovascular diseases. The adverse outcomes extend beyond the pregnant obese woman; offspring of obese women are themselves at increased risk of prematurity, fetal death, injury during birth, and transient respiratory problems and metabolic effects (ie, neonatal hypoglycemia). Furthermore, maternal obesity can predispose their offspring to long-term health problems, potentially generating an intergenerational cycle of obesity and insulin resistance.
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Affiliation(s)
- Carmen Paredes
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI.,Department of Obstetrics and Gynecology, Detroit Medical Center, Detroit, MI
| | - Richard C Hsu
- Wayne State University School of Medicine, Detroit, MI
| | - Anna Tong
- Wayne State University School of Medicine, Detroit, MI
| | - Jeffery R Johnson
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI.,Department of Obstetrics and Gynecology, Detroit Medical Center, Detroit, MI
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50
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Li H, Wang H, Zhu J, Xu J, Jiang Y, Chen W, Sun Y, Yang Q. Decreased DNA Repair Ability: A Mechanism for Low Early Embryonic Development Potential of Oocytes From Overweight Patients After Fertilization in IVF Cycles. Front Endocrinol (Lausanne) 2021; 12:756336. [PMID: 34887832 PMCID: PMC8651388 DOI: 10.3389/fendo.2021.756336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Whether female BMI impacts the DNA repair ability in the oocytes after fertilization has not been investigated. The aim of this study is to assess the early embryo quality and reproductive outcomes of oocytes from overweight women when fertilized with sperm with varying degrees of DNA fragmentation. METHODS A total number of 1,612 patients undergoing fresh autologous in vitro fertilization (IVF) cycles was included. These patients were divided into two groups according to maternal body mass index (BMI): normal weight group (18.5-24.9 kg/m2; n=1187; 73.64%) and overweight group (≥25 kg/m2; n=425; 26.36%). Each group was then subdivided into two groups by sperm DNA fragmentation index (DFI): low fragmentation group (<20% DFI, LF) and high fragmentation group (≥20% DFI, HF). Laboratory and clinical outcomes were compared between subgroups. RESULTS For the normal-weight group, there was no statistical significance in embryo quality and reproductive outcomes between the LF and HF groups. But in the overweight group, significantly lower fertilization rate (LF: 64%; HF: 59%; p=0.011), blastocyst development rate (LF: 57%; HF: 44%; p=0.001), as well as high-quality blastocyst rate (LF: 32%; HF: 22%; p=0.034) were found in the HF group, despite the similar pregnancy rates (LF: 56%; HF: 60%; p=0.630). CONCLUSIONS Decreased DNA repair activity in oocytes may be a possible mechanism for the low early development potential of embryos from overweight patients in in vitro fertilization cycles.
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Affiliation(s)
- Hui Li
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Huan Wang
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Zhu
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianmin Xu
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuqing Jiang
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenhui Chen
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingpu Sun
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Qingling Yang, ; Yingpu Sun,
| | - Qingling Yang
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Qingling Yang, ; Yingpu Sun,
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