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Kyozuka H, Yasuda S, Murata T, Fukuda T, Furukawa S, Fujimori K. Changes in fetal baroreceptor sensitivity during intrauterine inflammation in preterm fetal sheep. J Matern Fetal Neonatal Med 2023; 36:2150392. [PMID: 36443245 DOI: 10.1080/14767058.2022.2150392] [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: 11/30/2022]
Abstract
OBJECTIVE Baroreflex is a regulatory mechanism that slows the fetal heart rate. This study aimed to investigate the effects of lipopolysaccharide (LPS)-induced endotoxemia on fetal baroreceptor sensitivity in preterm fetal sheep. METHODS The changes in fetal baroreceptor sensitivity were measured in seven chronically instrumented preterm fetal sheep. Fetal baroreceptor sensitivity was measured in three phases: (A) control phase, defined as the 24 h before the first injection of LPS; (B) acute phase, defined as the 24 h between the first and second injections of LPS; and (C) fetal acidosis phase, defined as the time from the second LPS injection until intrauterine fetal death. Histological examinations of the fetal membrane and umbilical cord were also conducted. RESULTS Each fetus developed metabolic acidosis after the second injection of LPS. The fetuses died 24.7 (SD = 6.1) hours after the second injection of LPS. Both the umbilical cord and fetal membranes showed histological evidence of severe inflammation. In total, 163 fetal baroreceptor measurements were performed in this experiment (A, n = 77 times; B, n = 60 times; C, n = 26 times). Fetal baroreceptor sensitivity showed significant differences in all three phases (A: 2.7 [SD = 0.2]; B: 2.5 [SD = 0.2]; and C: 1.5 [SD = 0.2]). Post hoc tests showed that baroreceptor sensitivity in the acidosis phase had decreased significantly compared to that in the control and acute phases (p<.001 and p=.002, respectively). CONCLUSIONS Fetal baroreceptor sensitivity decreased during fetal acidosis induced by LPSs.
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Affiliation(s)
- Hyo Kyozuka
- Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Shun Yasuda
- Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Tsuyoshi Murata
- Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Toma Fukuda
- Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Shigenori Furukawa
- Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Keiya Fujimori
- Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University, Fukushima, Japan
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Diaz NM, Zemtsov GE, Ryan E, Chao A, Santoli CMA, Grace MR, Dotters-Katz SK. Maternal and peripartum risk factors for acute funisitis among term deliveries complicated by intraamniotic infection. Am J Obstet Gynecol MFM 2023; 5:101013. [PMID: 37178719 DOI: 10.1016/j.ajogmf.2023.101013] [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: 04/21/2023] [Accepted: 05/09/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Acute funisitis-the histologic diagnosis of inflammation within the umbilical cord-represents a fetal inflammatory response and has been associated with adverse neonatal outcomes. Little is known regarding the maternal and intrapartum risk factors associated with the development of acute funisitis among term deliveries complicated by intraamniotic infection. OBJECTIVE This study aimed to identify the maternal and intrapartum risk factors associated with developing acute funisitis among term deliveries complicated by intraamniotic infection. STUDY DESIGN After institutional review board approval, we conducted a retrospective cohort study of term deliveries affected by clinical intraamniotic infection at a single tertiary center between 2013 and 2017, with placental pathology consistent with histologic chorioamnionitis. The exclusion criteria included intrauterine fetal demise, missing delivery information or placental pathology, and documented congenital fetal abnormalities. Maternal sociodemographic, antepartum, and intrapartum factors were compared among patients with acute funisitis on pathology to those without acute funisitis using bivariate statistics. Regression models were developed to estimate the adjusted odds ratios. RESULTS Of 123 patients meeting the inclusion criteria, 75 (61%) had acute funisitis on placental pathology. Compared with placental specimens without acute funisitis, acute funisitis was observed more frequently among patients with maternal BMI ≥30 kg/m2 (58.7% vs 39.6%, P=.04) and labor courses with increased rupture of membrane duration (17.3 vs 9.6 hours, P=.001). Use of fetal scalp electrode was observed less frequently in acute funisitis (5.3% vs 16.7%, P=.04) than cases without acute funisitis. In regression models, maternal BMI ≥30 kg/m2 (adjusted odds ratio, 2.67; 95% confidence interval, 1.21-5.90) and rupture of membrane >18 hours (adjusted odds ratio, 2.48; 95% confidence interval, 1.07-5.75) were significantly associated with acute funisitis. Fetal scalp electrode use (adjusted odds ratio, 0.18; 95% confidence interval, 0.04-0.71) was negatively associated with acute funisitis. CONCLUSION In term deliveries with intraamniotic infection and histologic chorioamnionitis, maternal BMI ≥30 kg/m2, and rupture of membrane>18 hours were associated with acute funisitis on placental pathology. As insight into the clinical impact of acute funisitis grows, the ability to predict which pregnancies are at the greatest risk for its development may allow for a tailored approach to predicting neonatal risk for sepsis and related comorbidity.
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Affiliation(s)
- Nicole M Diaz
- Duke University School of Medicine, Durham, NC (Ms Diaz).
| | - Gregory E Zemtsov
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC (Drs Zemtsov and Santoli)
| | - Emma Ryan
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN (Dr Ryan)
| | - Agnes Chao
- Division of Neonatology, Department of Pediatrics, Duke University Medical Center, Durham, NC (Dr Chao)
| | - Carmen M A Santoli
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC (Drs Zemtsov and Santoli)
| | - Matthew R Grace
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN (Dr Grace)
| | - Sarah K Dotters-Katz
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC (Dr Dotters-Katz)
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Pannain GD, Pereira AMG, Rocha MLTLFD, Lopes RGC. Amniotic Sludge and Prematurity: Systematic Review and Meta-analysis. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:e489-e498. [PMID: 37683661 PMCID: PMC10491474 DOI: 10.1055/s-0043-1772189] [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: 10/06/2022] [Accepted: 01/20/2023] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVE To perform a systematic review and meta-analysis of studies on maternal, fetal, and neonatal outcomes of women with singleton pregnancies, after spontaneous conception, and with the diagnosis of amniotic sludge before 37 weeks of gestational age. DATA SOURCES We conducted a search on the PubMed, Cochrane, Bireme, and Theses databases until June 2022. SELECTION OF STUDIES Using the keywords intra-amniotic sludge or fluid sludge or echogenic particles, we found 263 articles, 132 of which were duplicates, and 70 were discarded because they did not meet the inclusion criteria. DATA COLLECTION The articles retrieved were analyzed by 2 reviewers; 61 were selected for full-text analysis, 18 were included for a qualitative analysis, and 14, for a quantitative analysis. DATA SYNTHESIS Among the maternal outcomes analyzed, there was an increased risk of preterm labor (95% confidence interval [95%CI]: 1.45-2.03), premature rupture of ovular membranes (95%CI: 1.99-3.79), and clinical (95%CI: 1.41-6.19) and histological chorioamnionitis (95%CI: 1.75-3.12). Regarding the fetal outcomes, there was a significant increase in the risk of morbidity (95%CI: 1.80-3.17), mortality (95%CI: 1.14-18.57), admission to the Neonatal Intensive Care Unit (NICU; 95%CI: 1.17-1.95), and neonatal sepsis (95%CI: 2.29-7.55). CONCLUSION The results of the present study indicate that the presence of amniotic sludge is a risk marker for preterm delivery. Despite the heterogeneity of the studies analyzed, even in patients with other risk factors for prematurity, such as short cervix and previous preterm delivery, the presence of amniotic sludge increases the risk of premature labor. Moreover, antibiotic therapy seems to be a treatment for amniotic sludge, and it may prolong pregnancy.
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Affiliation(s)
- Gabriel Duque Pannain
- Departamento de Ginecologia e Obstetrícia, Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil
| | - Ana Maria Gomes Pereira
- Departamento de Ginecologia e Obstetrícia, Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil
| | | | - Reginaldo Guedes Coelho Lopes
- Departamento de Ginecologia e Obstetrícia, Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil
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Consonni S, Salmoiraghi E, Vaglio Tessitore I, Pintucci A, Vitale V, Calzi P, Moltrasio F, Locatelli A. Intra-Amniotic Inflammation or Infection: Suspected and Confirmed Diagnosis of "Triple I" at Term. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1110. [PMID: 37508607 PMCID: PMC10378617 DOI: 10.3390/children10071110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023]
Abstract
Chorioamnionitis (CA) at term of pregnancy can have an infectious and/or inflammatory origin and is associated with adverse outcomes. Triple I (intrauterine inflammation, infection, or both, TI) has been proposed to reduce the overdiagnosis of infection and neonatal overtreatment. The aim of this study is to identify clinical and histological variables that could predict adverse outcomes when TI is suspected and/or confirmed. This retrospective cohort study included 404 pregnancies (gestational age ≥ 37 weeks) that were divided into 5 all-inclusive and mutually exclusive groups. TI was defined according to the NICHD definition of 2015, and it could be confirmed (TI+) or not confirmed (TI-) via histological examination. Signs of infection/inflammation that did not conform to the definition of TI were classified as "clinical suspicion" and could be supported (CS+) or not supported (CS-) by histology. Cases of histological chorioamnionitis (HCA) without clinical manifestation represented a fifth group. Whole placental involvement (WPLI) was defined as a histological inflammation involving the maternal and fetal sides. There were 113 TI+, 30 TI-, 186 CS+, 35 CS-, and 40 isolated HCA cases. WPLI was diagnosed in 133 cases (39.2%). Composite neonatal outcome (CNO) occurred in 114 cases (28.2%) while composite maternal outcome (CMO) occurred in 192 cases (47.5%). Compared with CS+, TI+ was more predictive of CNO (p = 0.001), CMO (p < 0.001), and WPLI (p = 0.005). WPLI was related both to CNO (p < 0.001) and to CMO (p = 0.046). TI+ and WPLI showed similar sensitivity but different specificity in predicting CNO. At logistic regression, CNO was independently predicted by TI+ (OR 2.21; p = 0.001) and by WPLI (OR 2.23; p = 0.001). Compared with CS, TI is a better predictor of CNO and can be useful for the identification of newborns at risk.
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Affiliation(s)
- Sara Consonni
- Department of Obstetrics and Gynecology, Carate Hospital, ASST Brianza, 20871 Vimercate, Italy
| | - Elettra Salmoiraghi
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | | | - Armando Pintucci
- Department of Obstetrics and Gynecology, Desio Hospital, ASST Brianza, 20871 Vimercate, Italy
| | - Valentina Vitale
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Patrizia Calzi
- Department of Pediatrics, Carate Hospital, ASST Brianza, 20871 Vimercate, Italy
| | - Francesca Moltrasio
- Department of Pathology, Desio Hospital, ASST Brianza, 20871 Vimercate, Italy
| | - Anna Locatelli
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
- Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
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Association of labour duration in spontaneous deliveries with low neonatal Apgar scores and foetal acidosis: the Japan Environment and Children's Study. Sci Rep 2022; 12:21519. [PMID: 36513654 PMCID: PMC9747973 DOI: 10.1038/s41598-022-24359-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022] Open
Abstract
This study evaluated the association between labour duration (LD) and incidence of low neonatal Apgar scores and foetal acidosis. Data of 37,682 women with full-term singleton spontaneous vaginal deliveries from the Japan Environment and Children's Study were analysed. Women were classified according to the median LD as nulliparous (< 10 or ≥ 10 h) or multiparous (< 5 or ≥ 5 h) and further into five subcategories: nulliparous (< 10.0, 10.0-12.9, 13.0-15.9, 16.0-18.9, and ≥ 19 h) and multiparous (< 5.0, 5.0-7.9, 8.0-10.9, 11.0-13.9, and ≥ 14.0 h). Multiple logistic regression models were used to determine odds ratios (ORs) for outcomes in women with over-median LD. Over-median LD exhibited no statistically significant association with low neonatal Apgar scores. The adjusted ORs for both umbilical artery (UmA-pH) < 7.2 and < 7.1 were increased in nulliparous women with over-median LD, whereas only the adjusted OR for UmA-pH < 7.2 was increased in multiparous women with over-median LD. Moreover, this association manifested as a plateau in nulliparous women with LD ≥ 13 h and without dose-dependent association in multiparous women.
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Abu Shqara R, Bussidan S, Glikman D, Rechnitzer H, Lowenstein L, Frank Wolf M. Clinical implications of uterine cultures obtained during urgent caesarean section. Aust N Z J Obstet Gynaecol 2022. [DOI: 10.1111/ajo.13630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/31/2022] [Indexed: 12/11/2022]
Affiliation(s)
- Raneen Abu Shqara
- Department of Obstetrics & Gynecology Galilee Medical Center Nahariya Israel
- Azrieli Faculty of Medicine Bar Ilan University Safed Israel
| | - Shay Bussidan
- Azrieli Faculty of Medicine Bar Ilan University Safed Israel
| | - Daniel Glikman
- Azrieli Faculty of Medicine Bar Ilan University Safed Israel
| | - Hagai Rechnitzer
- Department of Obstetrics & Gynecology Galilee Medical Center Nahariya Israel
| | - Lior Lowenstein
- Department of Obstetrics & Gynecology Galilee Medical Center Nahariya Israel
- Azrieli Faculty of Medicine Bar Ilan University Safed Israel
| | - Maya Frank Wolf
- Department of Obstetrics & Gynecology Galilee Medical Center Nahariya Israel
- Azrieli Faculty of Medicine Bar Ilan University Safed Israel
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Kyozuka H, Hiraiwa T, Murata T, Sugeno M, Jin T, Ito F, Suzuki D, Nomura Y, Fukuda T, Yasuda S, Fujimori K. Gestational weight gain as a risk factor for dystocia during first delivery: a multicenter retrospective cohort study in Japan. BMC Pregnancy Childbirth 2022; 22:728. [PMID: 36151536 PMCID: PMC9503209 DOI: 10.1186/s12884-022-05055-6] [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: 03/19/2022] [Accepted: 09/13/2022] [Indexed: 11/18/2022] Open
Abstract
Background Dystocia is a common obstetric complication among nulliparous women, which requires medical intervention and carries the risk of negative maternal and neonatal outcomes. Our aim was to examine the association between body mass index (BMI) and the occurrence of dystocia. We also identified cutoffs of gestational weight gain, based on pre-pregnancy BMI, associated with the risk of dystocia. Methods This was a multicenter, retrospective, cohort study conducted in two tertiary Maternal–Fetal medicine units in Fukushima, Japan. The study population included nullipara women who delivered at either of the two units between January 1, 2013, and December 31, 2020. Women (n = 2597) were categorized into six groups (G) based on their pre-pregnancy BMI: G1 (< 18.5 kg/m2), G2 (18.5 to < 20.0 kg/m2), G3 (20.0 to < 23.0 kg/m2), G4 (23.0 to < 25.0 kg/m2), G5 (25.0 to < 30.0 kg/m2), and G6 (≥ 30.0 kg/m2). Using G3 as a reference, multiple logistic regression analyses were performed to estimate the risk of dystocia for each BMI category. Receiver operating characteristic curve analyses were performed to determine the cutoff value of gestational weight gain for the risk of dystocia. Results The highest BMI category (G6) was an independent risk factor for dystocia (adjusted odds ratio, 3.0; 95% confidence interval, 1.5–5.8). The receiver operating characteristic curve analysis revealed no association between gestational weight gain and the occurrence of dystocia in G5 and G6 (P = 0.446 and P = 0.291, respectively). For G1 to G4, AUC and predictive cutoffs of gestational weight gain for dystocia were as follows: G1, AUC 0.64 and cutoff 11.5 kg (P < 0.05); G2, AUC 0.63 and cutoff 12.3 kg (P < 0.05); G3, AUC 0.67 and cutoff 14.3 kg (P < 0.01); and G4, AUC 0.63 and cutoff 11.5 kg (P < 0.05). Conclusion A pre-pregnancy BMI > 30.0 kg/m2 was an independent risk factor for dystocia. For women with a pre-pregnancy BMI < 25.0 kg/m2, the risk of dystocia increases as a function of gestational weight gain. These findings could inform personalized preconception care for women to optimize maternal and neonatal health.
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Affiliation(s)
- Hyo Kyozuka
- Department of Obstetrics and Gynecology, Ohta Nishinouchi Hospital, 2-5-20, Nishinouchi, Koriyama city, Fukushima, 963-8558, Japan. .,Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
| | - Tsuyoshi Hiraiwa
- Department of Obstetrics and Gynecology, Iwase General Hospital, 20, Kitamachi, Sukagawa city, Fukushima, 962-8503, Japan
| | - Tsuyoshi Murata
- Department of Obstetrics and Gynecology, Shirakawa Kosei General Hospital, Fukushima, 961-0005, Japan
| | - Misa Sugeno
- Department of Obstetrics and Gynecology, Ohta Nishinouchi Hospital, 2-5-20, Nishinouchi, Koriyama city, Fukushima, 963-8558, Japan
| | - Toki Jin
- Department of Obstetrics and Gynecology, Ohta Nishinouchi Hospital, 2-5-20, Nishinouchi, Koriyama city, Fukushima, 963-8558, Japan
| | - Fumihito Ito
- Department of Obstetrics and Gynecology, Ohta Nishinouchi Hospital, 2-5-20, Nishinouchi, Koriyama city, Fukushima, 963-8558, Japan
| | - Daisuke Suzuki
- Department of Obstetrics and Gynecology, Ohta Nishinouchi Hospital, 2-5-20, Nishinouchi, Koriyama city, Fukushima, 963-8558, Japan
| | - Yasuhisa Nomura
- Department of Obstetrics and Gynecology, Ohta Nishinouchi Hospital, 2-5-20, Nishinouchi, Koriyama city, Fukushima, 963-8558, Japan
| | - Toma Fukuda
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Shun Yasuda
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Keiya Fujimori
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
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Sugeno M, Kyozuka H, Murata T, Hiraiwa T, Jin T, Fujimori M, Fukumoto Y, Ito F, Suzuki D, Toma F, Yasuda S, Fujimori K, Nomura Y. Optimal gestational weight gain to reduce the risk of hypertension disorders of pregnancy among women with obesity: A single tertiary referral center study in Japan. J Obstet Gynaecol Res 2022; 48:2766-2773. [PMID: 35894514 DOI: 10.1111/jog.15372] [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: 01/05/2022] [Revised: 05/26/2022] [Accepted: 07/09/2022] [Indexed: 12/01/2022]
Abstract
AIM To examine the effect of weight gain during pregnancy on hypertension disorders of pregnancy among women with a prepregnancy body mass index ≥30.0 kg/m2 . METHODS This retrospective cohort study included 257 Japanese women (116 primipara; 141 multipara) with singleton pregnancies with a prepregnancy body mass index ≥ 30.0 kg/m2 , who gave birth during 2013 to 2020 at Ohta Nishinouchi Hospital. Multiple logistic regression analyses were performed to identify the effect of gestational weight gain on early-onset (<34 weeks), late-onset (≥34 weeks), and overall hypertension disorders of pregnancy. RESULTS The prevalence of hypertension disorders of pregnancy in primiparas and multiparas was 28.4% and 11.3%, respectively. By multiple logistic regression analysis, gestational weight gain during pregnancy increased the risk of early-onset (adjusted odds ratio: 1.20, 95% confidence interval: 1.03-1.39, p < 0.05) and overall hypertension disorders of pregnancy (adjusted odds ratio: 1.12, 95% confidence interval: 1.03-1.22, p < 0.05) among primiparas. Based on receiver operating characteristic curve analyses for early-onset (area under the curve 0.67, 95% confidence interval: 0.56-0.78; p < 0.05) and overall hypertension disorders of pregnancy (area under the curve 0.76, 95% confidence interval: 0.61-0.91; p < 0.05) among primiparas, we determined the cut-off weight gain during pregnancy for early-onset and overall hypertension disorders of pregnancy as 3.85 kg, with sensitivity/specificity of 0.76/0.59 and 0.91/0.53, respectively. CONCLUSION We recommend that the optimal gestational weight gain for reducing HDP be under 3.85 kg. This information may facilitate personalized pre-conception counseling among women with obesity.
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Affiliation(s)
- Misa Sugeno
- Department of Obstetrics and Gynecology, Ohta Nisinouchi Hospital, Fukushima, Japan
| | - Hyo Kyozuka
- Department of Obstetrics and Gynecology, Ohta Nisinouchi Hospital, Fukushima, Japan
| | - Tsuyoshi Murata
- Department of Obstetrics and Gynecology, Fukushima Medical University, Fukushima, Japan
| | - Tsuyoshi Hiraiwa
- Department of Obstetrics and Gynecology, Iwase General Hospital, Fukushima, Japan
| | - Toki Jin
- Department of Obstetrics and Gynecology, Ohta Nisinouchi Hospital, Fukushima, Japan
| | - Mimori Fujimori
- Department of Obstetrics and Gynecology, Ohta Nisinouchi Hospital, Fukushima, Japan
| | - Yuki Fukumoto
- Department of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Fumihiro Ito
- Department of Obstetrics and Gynecology, Ohta Nisinouchi Hospital, Fukushima, Japan
| | - Daisuke Suzuki
- Department of Obstetrics and Gynecology, Ohta Nisinouchi Hospital, Fukushima, Japan
| | - Fukuda Toma
- Department of Obstetrics and Gynecology, Fukushima Medical University, Fukushima, Japan
| | - Shun Yasuda
- Department of Obstetrics and Gynecology, Fukushima Medical University, Fukushima, Japan
| | - Keiya Fujimori
- Department of Obstetrics and Gynecology, Fukushima Medical University, Fukushima, Japan
| | - Yasuhisa Nomura
- Department of Obstetrics and Gynecology, Ohta Nisinouchi Hospital, Fukushima, Japan
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