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Mu F, Huo H, Wang C, Hu N, Wang F. A new prognostic model for recurrent pregnancy loss: assessment of thyroid and thromboelastograph parameters. Front Endocrinol (Lausanne) 2024; 15:1415786. [PMID: 38883610 PMCID: PMC11177760 DOI: 10.3389/fendo.2024.1415786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 05/16/2024] [Indexed: 06/18/2024] Open
Abstract
Objective This study aimed to identify predictors associated with thyroid function and thromboelastograph (TEG) examination parameters and establish a nomogram for predicting the risk of subsequent pregnancy loss in recurrent pregnancy loss (RPL). Methods In this retrospective study, we analyzed the medical records of 575 RPL patients treated at Lanzhou University Second Hospital, China, between September 2020 and December 2022, as a training cohort. We also included 272 RPL patients from Ruian People's Hospital between January 2020 and July 2022 as external validation cohort. Predictors included pre-pregnancy thyroid function and TEG examination parameters. The study outcome was pregnancy loss before 24 weeks of gestation. Variable selection was performed using least absolute shrinkage and selection operator regression and stepwise regression analyses, and the prediction model was developed using multivariable logistic regression. The study evaluated the model's performance using the area under the curve (AUC), calibration curve, and decision curve analysis. Additionally, dynamic and static nomograms were constructed to provide a visual representation of the models. Results The predictors used to develop the model were body mass index, previous pregnancy losses, triiodothyronine, free thyroxine, thyroid stimulating hormone, lysis at 30 minutes, and estimated percent lysis which were determined by the multivariable logistic regression with the minimum Akaike information criterion of 605.1. The model demonstrated good discrimination with an AUC of 0.767 (95%CI 0.725-0.808), and the Hosmer-Lemeshow test indicated good fitness of the predicting variables with a P value of 0.491. Identically, external validation confirmed that the model exhibited good performance with an AUC of 0.738. Moreover, the clinical decision curve showed a positive net benefit in the prediction model. Meanwhile, the web version we created was easy to use. The risk stratification indicated that high-risk patients with a risk score >147.9 had a higher chance of pregnancy loss (OR=6.05, 95%CI 4.09-8.97). Conclusions This nomogram well-predicted the risk of future pregnancy loss in RPL and can be used by clinicians to identify high-risk patients and provide a reference for pregnancy management of RPL.
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Affiliation(s)
| | | | | | | | - Fang Wang
- Department of Reproductive Medicine, Lanzhou University Second Hospital, Lanzhou, China
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Roger J, Xie F, Costello J, Tang A, Liu J, Oskotsky T, Woldemariam S, Kosti I, Le B, Snyder MP, Giudice LC, Torgerson D, Shaw GM, Stevenson DK, Rajkovic A, Glymour MM, Aghaeepour N, Cakmak H, Lathi RB, Sirota M. Leveraging electronic health records to identify risk factors for recurrent pregnancy loss across two medical centers: a case-control study. RESEARCH SQUARE 2023:rs.3.rs-2631220. [PMID: 36993325 PMCID: PMC10055527 DOI: 10.21203/rs.3.rs-2631220/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Recurrent pregnancy loss (RPL), defined as 2 or more pregnancy losses, affects 5-6% of ever-pregnant individuals. Approximately half of these cases have no identifiable explanation. To generate hypotheses about RPL etiologies, we implemented a case-control study comparing the history of over 1,600 diagnoses between RPL and live-birth patients, leveraging the University of California San Francisco (UCSF) and Stanford University electronic health record databases. In total, our study included 8,496 RPL (UCSF: 3,840, Stanford: 4,656) and 53,278 Control (UCSF: 17,259, Stanford: 36,019) patients. Menstrual abnormalities and infertility-associated diagnoses were significantly positively associated with RPL in both medical centers. Age-stratified analysis revealed that the majority of RPL-associated diagnoses had higher odds ratios for patients <35 compared with 35+ patients. While Stanford results were sensitive to control for healthcare utilization, UCSF results were stable across analyses with and without utilization. Intersecting significant results between medical centers was an effective filter to identify associations that are robust across center-specific utilization patterns.
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Affiliation(s)
- Jacquelyn Roger
- Bakar Computational Health Sciences Institute, University of California San Francisco
| | - Feng Xie
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University
- Department of Pediatrics, Stanford University
- Department of Biomedical Data Science, Stanford University
| | - Jean Costello
- Bakar Computational Health Sciences Institute, University of California San Francisco
| | - Alice Tang
- Bakar Computational Health Sciences Institute, University of California San Francisco
| | - Jay Liu
- Bakar Computational Health Sciences Institute, University of California San Francisco
| | - Tomiko Oskotsky
- Bakar Computational Health Sciences Institute, University of California San Francisco
| | - Sarah Woldemariam
- Bakar Computational Health Sciences Institute, University of California San Francisco
| | - Idit Kosti
- Bakar Computational Health Sciences Institute, University of California San Francisco
| | - Brian Le
- Bakar Computational Health Sciences Institute, University of California San Francisco
| | | | - Linda C. Giudice
- Department of Obstetrics and Gynecology, University of California San Francisco
| | - Dara Torgerson
- Department of Epidemiology and Biostatistics, University of California San Francisco
| | | | | | - Aleksandar Rajkovic
- Department of Pathology, University of California San Francisco
- Institute of Human Genetics, University of California San Francisco
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California San Francisco
| | - Nima Aghaeepour
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University
- Department of Pediatrics, Stanford University
- Department of Biomedical Data Science, Stanford University
| | - Hakan Cakmak
- Department of Obstetrics and Gynecology, University of California San Francisco
| | - Ruth B. Lathi
- Department of Obstetrics and Gynecology, Stanford University
| | - Marina Sirota
- Bakar Computational Health Sciences Institute, University of California San Francisco
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Hantoushzadeh S, Kohandel Gargari O, Shafiee A, Seighali N, Ghaemi M. Glucose metabolism tests and recurrent pregnancy loss: evidence from a systematic review and meta-analysis. Diabetol Metab Syndr 2023; 15:3. [PMID: 36604717 PMCID: PMC9817346 DOI: 10.1186/s13098-022-00973-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/24/2022] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To synthesize the published citations to determine the association between glucose metabolism tests and recurrent pregnancy loss (RPL). METHOD The electronic databases including PubMed, Scopus and Web of Science were searched for the original articles that evaluated the correlation between glucose metabolism tests including fasting blood glucose (FBG), fasting insulin (FI), homeostatic model assessment for insulin resistance (HOMA-IR), the rate of individuals with HOMA-IR > 4.5, insulin resistance, fasting glucose/fasting insulin (FG/FI) and FG/FI > 4.5.and recurrent pregnancy loss with a combination of proper keywords. RESULTS The database search led to finding 390 articles. Detailed screening of titles and abstracts for potential eligibility was performed, and after excluding the duplicated and irrelevant citations, finally, 8 studies were selected to be included in this study, 7 observational studies and one controlled clinical trial. A significant difference in the amount of FI, HOMA-IR, the rate of HOMA-IR > 4.5, the rate of individuals with insulin resistance, fasting glucose/fasting insulin (FG/FI), and the rate of FG/FI > 4.5 were found among RPL patients compared to controls. There was no difference when comparing FBG between the groups. CONCLUSION This study indicates an important link between abnormal glucose metabolism tests and a history of recurrent pregnancy loss. These data may encourage clinicians to request glucose metabolism tests other than FBG in women with recurrent pregnancy loss.
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Affiliation(s)
- Sedigheh Hantoushzadeh
- Vali-E-Asr Reproductive Health Research Center, Imam Complex, Family Health Research Institute, Tehran University of Medical Sciences, East Bagherkhan Ave, Tehran, Iran
| | - Omid Kohandel Gargari
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Arman Shafiee
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Niloofar Seighali
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Marjan Ghaemi
- Vali-E-Asr Reproductive Health Research Center, Imam Complex, Family Health Research Institute, Tehran University of Medical Sciences, East Bagherkhan Ave, Tehran, Iran.
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Cai WY, Luo X, Lv HY, Fu KY, Xu J. Insulin resistance in women with recurrent miscarriage: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2022; 22:916. [PMID: 36482358 PMCID: PMC9733104 DOI: 10.1186/s12884-022-05256-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
PURPOSE This review aimed to investigate the association of insulin resistance (IR) in women with recurrent pregnancy loss compared to women with normal pregnancy history. METHODS PubMed, EMBASE, the Web of Science and Google Scholar databases were accessed to collect published observational studies that compared IR of recurrent pregnancy loss women with healthy women until the 6th of October 2022. Outcomes assessed in this review and meta-analysis included fasting blood glucose, fasting plasma insulin, homeostasis model assessment for IR, glucose to insulin ratio. Mean differences, odds ratios with 95% confidence interval were pooled using the fixed or random effect models. Sensitivity analyses were performed to validate the robustness of the results. Review Manager version 5.4.1 and Stata version 8.0 were used. RESULTS A total of nineteen studies involving 4453 individuals were included. Recurrent pregnancy loss patients presented significantly higher fasting blood glucose, fasting plasma insulin, homeostasis model assessment for IR, and lower glucose to insulin ratios. Additionally, recurrent pregnancy loss patients had higher rates of IR as defined by abnormal fasting plasma insulin, homeostasis model assessment for IR, and glucose to insulin ratio. Sensitivity analyses validated the robustness of the results. CONCLUSION In the current review, we show that recurrent pregnancy loss is associated with a higher degree of IR and highlight the importance of screening and treatment of IR.
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Affiliation(s)
- Wang-Yu Cai
- grid.13402.340000 0004 1759 700XFourth Affiliated Hospital, Zhejiang University, School of Medicine, No. 1 Shang Cheng Avenue, Yiwu, 322000 Zhejiang China
| | - Xi Luo
- grid.268505.c0000 0000 8744 8924Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Hou-Yi Lv
- grid.13402.340000 0004 1759 700XInternational Institutes of Medicine, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, Zhejiang China
| | - Kai-You Fu
- grid.452661.20000 0004 1803 6319The First Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, Zhejiang China
| | - Jian Xu
- grid.13402.340000 0004 1759 700XFourth Affiliated Hospital, Zhejiang University, School of Medicine, No. 1 Shang Cheng Avenue, Yiwu, 322000 Zhejiang China ,grid.13402.340000 0004 1759 700XWomen’s Hospital, Zhejiang University, School of Medicine, Hangzhou, Zhejiang China
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Ye Z, Meng Q, Zhang W, He J, Zhao H, Yu C, Liang W, Li X, Wang H. Exploration of the Shared Gene and Molecular Mechanisms Between Endometriosis and Recurrent Pregnancy Loss. Front Vet Sci 2022; 9:867405. [PMID: 35601407 PMCID: PMC9120926 DOI: 10.3389/fvets.2022.867405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/14/2022] [Indexed: 12/14/2022] Open
Abstract
Endometriosis (EMs) is a common benign gynecological disease in women of childbearing age, which usually causes pelvic pain, secondary dysmenorrhea, and infertility. EMs has been linked to recurrent pregnancy loss (RPL) in epidemiological data. The relationship of both, however, remains unknown. The purpose of this study is to explore the underlying pathological mechanisms between EMs and RPL. We searched Gene Expression Omnibus (GEO) database to obtain omics data of EMs and RPL. Co-expression modules for EMs and RPL were investigated by using weighted gene co-expression network analysis (WGCNA). The intersections of gene modules with the strong correlation to EMs or RPL obtained by WGCNA analysis were considered as shared genes. MicroRNAs (miRNAs) and their corresponding target genes linked to EMs and RPL were found though the Human MicroRNA Disease Database (HMDD) and the miRTarbase database. Finally, we constructed miRNAs-mRNAs regulatory networks associated with the two disorders by using the intersection of previously obtained target genes and shared genes. We discovered as significant modules for EMs and RPL, respectively, by WGCNA. The energy metabolism might be the common pathogenic mechanism of EMs and RPL, according to the findings of a Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis. We discovered several target genes that might be linked to these two disorders, as well as the potential mechanisms. RAB8B, GNAQ, H2AFZ, SUGT1, and LEO1 could be therapeutic candidates for RPL and EMs. The PI3K-Akt signaling pathway and platelet activation were potentially involved in the mechanisms of EM-induced RPL. Our findings for the first time revealed the underlying pathological mechanisms of EM-induced RPL and identified several useful biomarkers and potential therapeutic targets.
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Affiliation(s)
- Zhuang Ye
- Department of Rheumatology, The First Hospital of Jilin University, Changchun, China
| | - Qingxue Meng
- Department of Pediatrics, Shenzhen University General Hospital, Shenzhen, China
| | - Weiwen Zhang
- Department of Obstetrics and Gynecology, Shenzhen University General Hospital, Shenzhen, China
| | - Junli He
- Department of Pediatrics, Shenzhen University General Hospital, Shenzhen, China
| | - Huanyi Zhao
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chengwei Yu
- School of Future Technology, University of Chinese Academy of Sciences, Beijing, China
- *Correspondence: Chengwei Yu
| | - Weizheng Liang
- Department of Pediatrics, Shenzhen University General Hospital, Shenzhen, China
- Weizheng Liang
| | - Xiushen Li
- Department of Obstetrics and Gynecology, Shenzhen University General Hospital, Shenzhen, China
- Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Shenzhen University Health Science Center, Shenzhen, China
- Shenzhen Key Laboratory, Shenzhen University General Hospital, Shenzhen, China
- Xiushen Li
| | - Hao Wang
- Department of Obstetrics and Gynecology, Shenzhen University General Hospital, Shenzhen, China
- Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Shenzhen University Health Science Center, Shenzhen, China
- Shenzhen Key Laboratory, Shenzhen University General Hospital, Shenzhen, China
- Hao Wang
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