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Peyronnet V, Le Faou AL, Berlin I. [Smoking cessation during pregnancy]. Rev Mal Respir 2024:S0761-8425(24)00236-5. [PMID: 39209565 DOI: 10.1016/j.rmr.2024.06.009] [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: 03/11/2024] [Accepted: 06/07/2024] [Indexed: 09/04/2024]
Abstract
Smoking during pregnancy is associated with negative pregnancy and perinatal health outcomes. Physiological and societal particularities can modify the smoking behavior of pregnant women. Pregnancy is a teachable moment for smoking cessation. Increased nicotine clearance may lead to exacerbated tobacco withdrawal symptoms and desire to smoke, which need to be taken into account when helping pregnant smokers to quit. Although most pregnant smokers try to quit on their own, 12% of pregnant women in France reported smoking in 2021 during the 3rd trimester of pregnancy. Health care professionals should screen for tobacco consumption and assess the level of addiction. Management of smoking cessation can be multidisciplinary, including non-pharmacological support such as counselling, behavioral support, financial reward contingent on abstinence, and medication (nicotine replacement therapies). Assessment and limitation of secondhand smoke exposure (SHS) is needed because SHS can also have negative maternal and fetal consequences. Management of relapse during the postpartum period is also to be anticipated; in 2021, it concerned 22.4% of women who had stopped smoking during pregnancy. While electronic cigarette use is increasing overall and among pregnant women who smoke (5.4 before pregnancy, 1.3% during the 3rd trimester in 2021), well-conducted smoking cessation studies are necessary to assess its benefits and potential risks in this specific group of smokers.
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Affiliation(s)
- V Peyronnet
- Service de gynécologue-obstétrique, hôpital Louis-Mourier, AP-HP, Colombes, France.
| | - A-L Le Faou
- Centre ambulatoire d'addictologie, hôpital européen Georges-Pompidou, centre - université Paris-Cité, AP-HP, Paris, France
| | - I Berlin
- Département de pharmacologie médicale, hôpital Pitié-Salpêtrière, Sorbonne université, Paris, France
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Dunn MC, Ananth CV, Rosen T. Maternal Smoking and Risk of Hypertensive Disorders of Pregnancy: Effect Modification by Body Mass Index and Gestational Weight Gain. Hypertension 2024; 81:1728-1736. [PMID: 38328939 DOI: 10.1161/hypertensionaha.123.22025] [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: 10/03/2023] [Accepted: 01/21/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Although smoking cigarettes has been shown to have a protective effect on preeclampsia, quitting smoking also results in weight gain. Weight gain leading to an obese body mass index is a risk factor for hypertensive disorders of pregnancy (HDP). METHODS The objective of this study was to explore the relationship between smoking status, body mass index, and gestational weight gain on the risk of HDP. A cross-sectional analysis was performed utilizing US birth certificate data. We examined HDP risks in relation to maternal smoking, body mass index, and gestational weight gain. Associations were expressed as rate ratios with 95% CIs and adjusted for potential confounders. Clinically important outcomes of smoking throughout pregnancy were also evaluated. RESULTS Of the 22 191 568 women studied, HDP rates among nonsmokers, those who quit smoking, and persistent smokers were 6.8%, 8.6%, and 7.0%, respectively. The rate ratio of HDP was higher for women who quit smoking, especially evident among those with excessive gestational weight gain. Corrections for exposure misclassification and unmeasured confounding strengthened the associations among women who quit smoking. There was an almost 6-fold increase in the rate of stillbirth for persistent smokers (2.3%) compared with those who quit smoking (0.4%) and nonsmokers (0.4%). CONCLUSIONS Women who quit smoking during pregnancy were more likely to gain excessive weight and develop HDP. Although quitting smoking during pregnancy may be associated with an increase in the risk of HDP, it is also associated with a reduced risk of stillbirth. Pregnant women counseled to quit smoking should also receive counseling on nutrition and exercise to prevent excessive gestational weight gain.
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Affiliation(s)
- Morgan C Dunn
- Department of Obstetrics, Gynecology, and Reproductive Sciences (M.C.D.), Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Cande V Ananth
- Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences (C.V.A.), Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
- Cardiovascular Institute of New Jersey and Department of Medicine (C.V.A.), Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
- Environmental and Occupational Health Sciences Institute (C.V.A.), Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ (C.V.A.)
| | - Todd Rosen
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences (T.R.), Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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Daggy JK, Silver RM, Guise D, Haas DM. The Impact of Self-Reported Alcohol, Tobacco, and Recreational Drug Use during Pregnancy on Adverse Pregnancy Outcomes in First-Time Mothers. Am J Perinatol 2024; 41:1311-1320. [PMID: 36096135 PMCID: PMC11267155 DOI: 10.1055/s-0042-1753502] [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] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The objective of this study was to derive profiles of alcohol, tobacco, and recreational drug use during pregnancy for first-time mothers with latent class growth analysis (LCGA) and determine the association of these classes with the risk of adverse pregnancy outcomes (APO). STUDY DESIGN A secondary analysis of a prospective cohort of Nulliparous Outcomes in Pregnancy: Monitoring Mothers-to-Be was conducted in eight medical centers across the United States from September 30, 2010, to September 23, 2013. Self-reported use of any alcohol, tobacco, or recreational drugs in the 1 month prior to the visit was assessed at up to four visits throughout pregnancy, and APOs included a composite of preterm birth, hypertensive disorder of pregnancy (HDP), small for gestational age (SGA) infant, or stillbirth, and each adverse outcome separately. RESULTS Four latent classes were identified from the LCGA for 10,031 nulliparous pregnant women that were on average 26.9 years old (standard deviation [SD] = 5.7) and mostly non-Hispanic White (59.7%). Classes included consistent tobacco users (N = 517, 5.2%), nonusers (N = 8,945, 89.2%), alcohol users (N = 500, 5.0%), and a combination of alcohol/tobacco/drug users (N = 69, 0.7%). Logistic regression demonstrated that the class of tobacco users was more likely to have an APO (odds ratio [OR] = 1.48, 95% confidence interval [CI] = 1.22-1.81), preterm birth (OR = 1.53, 95% CI = 1.15-2.02), and SGA (OR = 1.79, 95% CI = 1.36-2.35) relative to the class of nonusers. The class of alcohol users was more likely to have HDP (OR = 1.37, 95% CI = 1.11-1.70) and less likely to have preterm birth (OR = 0.59, 95% CI = 0.38-0.90) and SGA (OR = 0.61, 95% CI = 0.40-0.93) compared to nonusers. CONCLUSION Trajectories of substance use are associated with APOs; thus, interventions to mitigate the use when encountered early in pregnancy are warranted. KEY POINTS · Four classes of substance use were identified.. · Tobacco users were at a higher risk of APO and alcohol users were at higher risk of HDP.. · Mitigation strategies are warranted to reduce APO..
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Affiliation(s)
- Joanne K Daggy
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana
| | - Robert M Silver
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - David Guise
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana
| | - David M Haas
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
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Pedersen M, Nobile F, Stayner LT, de Hoogh K, Brandt J, Stafoggia M. Ambient air pollution and hypertensive disorders of pregnancy in Rome. ENVIRONMENTAL RESEARCH 2024; 251:118630. [PMID: 38452913 DOI: 10.1016/j.envres.2024.118630] [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: 12/07/2023] [Revised: 02/25/2024] [Accepted: 03/04/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Ambient air pollution has been associated with hypertensive disorders of pregnancy (HDP), but few studies rely on assessment of fine-scale variation in air quality, specific subtypes and multi-pollutant exposures. AIM To study the impact of long-term exposure to individual and mixture of air pollutants on all and specific subtypes of HDP. METHODS We obtained data from 130,470 liveborn singleton pregnacies in Rome during 2014-2019. Spatiotemporal land-use random-forest models at 1 km spatial resolution assigned to the maternal residential addresses were used to estimate the exposure to particulate matter (PM2.5 and PM10), nitrogen dioxide (NO2), and ozone (O3). RESULTS For PM2.5, PM10 and NO2, there was suggestive evidence of increased risk of preeclampsia (PE, n = 442), but no evidence of increased risk for all subtypes of HDP (n = 2297) and gestational hypertension (GH, n = 1901). For instance, an interquartile range of 7.0 μg/m3 increase in PM2.5 exposure during the first trimester of pregnancy was associated with an odds ratio (OR) of 1.06 (95% confidence interval: 0.81, 1.39) and 1.04 (0.92, 1.17) after adjustment for NO2 and the corresponding results for a 15.7 μg/m3 increase in NO2 after adjustment for PM2.5 were 1.11 (0.92, 1.34) for PE and 0.83 (0.76, 0.90) for HDP. Increased risks for HDP and GH were suggested for O3 in single-pollutant models and for PM after adjustment for NO2, but all other associations were stable or attenuated in two-pollutant models. CONCLUSIONS The results of our study suggest that PM2.5, PM10 and NO2 increases the risk of PE and that these effects are robust to adjustment for O3 while the increased risks for GH and HDP suggested for O3 attenuated after adjustment for PM or NO2. Additional studies are needed to evaluate the effects of source-specific component of PM on subtypes as well as all types of HDP which would help to target preventive actions.
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Affiliation(s)
- Marie Pedersen
- Department of Epidemiology, Lazio Region Health Service/ASL Roma, Rome, Italy.
| | - Federica Nobile
- Department of Epidemiology, Lazio Region Health Service/ASL Roma, Rome, Italy; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Kees de Hoogh
- The Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Region Health Service/ASL Roma, Rome, Italy; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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de Ruyter H, Aitokari L, Lahti S, Riekki H, Huhtala H, Lakka T, Laivuori H, Kurppa K. Maternal gestational hypertension, smoking and pre-eclampsia are associated with metabolic dysfunction-associated fatty liver disease in overweight offspring. Acta Obstet Gynecol Scand 2024; 103:1183-1191. [PMID: 38433535 PMCID: PMC11103127 DOI: 10.1111/aogs.14816] [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: 11/08/2023] [Revised: 01/19/2024] [Accepted: 02/16/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Due to a steep increase in obesity, metabolic dysfunction-associated fatty liver disease (MAFLD) has also become the most common chronic hepatic condition among children and adolescents. Various maternal and pregnancy-related factors have also been implicated in the development of MAFLD, but human studies remain scarce. MATERIAL AND METHODS Comprehensive data of 460 overweight or obese children aged 2-16 years were collected and combined with data on selected maternal and pregnancy-related factors for a case-control study. MALFD was defined as alanine aminotransferase >2× upper limit of normal. Children with and without MAFLD were compared regarding to the study variables and multivariable regression analysis was utilized. RESULTS Median age of the study children was 11.8 (quartiles 9.1-14.2) years; 44% were girls and 17.8% had MAFLD. Children with MAFLD were older (12.7 vs. 11.6 years, p = 0.002), while the groups did not differ age-standardized body mass index (BMI-SDS) or gender. Factors associated with MAFLD in a multivariable model considering also the offspring's present BMI-SDS, sex, and maternal prepregnancy overweight, were child's older age (odds ratio [OR] 1.16, 95% confidence interval [CI]: 1.06-1.28), maternal gestational smoking (OR 2.01, 95% CI: 1.16-3.47), gestational hypertension (OR 3.44, 95% CI: 1.08-11.0) and pre-eclampsia (OR 2.93, 95% CI: 1.15-7.45). There was no significant association between MAFLD and maternal BMI, birth anthropometrics or perinatal complications. CONCLUSIONS Maternal smoking, gestational hypertension and pre-eclampsia were associated with MAFLD among overweight or obese children. Further prospective studies are needed to verify causal relationships.
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Affiliation(s)
- Hanna de Ruyter
- Tampere Center for Child, Adolescent and Maternal Health ResearchTampere University and Tampere University Hospital, Wellbeing Services County of PirkanmaaTampereFinland
| | - Linnea Aitokari
- Tampere Center for Child, Adolescent and Maternal Health ResearchTampere University and Tampere University Hospital, Wellbeing Services County of PirkanmaaTampereFinland
- Celiac Disease Research CenterTampere UniversityTampereFinland
| | - Siiri Lahti
- Tampere Center for Child, Adolescent and Maternal Health ResearchTampere University and Tampere University Hospital, Wellbeing Services County of PirkanmaaTampereFinland
| | - Hanna Riekki
- Tampere Center for Child, Adolescent and Maternal Health ResearchTampere University and Tampere University Hospital, Wellbeing Services County of PirkanmaaTampereFinland
| | - Heini Huhtala
- Faculty of Social SciencesTampere UniversityTampereFinland
| | - Timo Lakka
- Institute of BiomedicineUniversity of Eastern FinlandKuopioFinland
- Department of Clinical Physiology and Nuclear MedicineKuopio University HospitalKuopioFinland
- Kuopio Research Institute of Exercise MedicineKuopioFinland
| | - Hannele Laivuori
- Tampere Center for Child, Adolescent and Maternal Health ResearchTampere University and Tampere University Hospital, Wellbeing Services County of PirkanmaaTampereFinland
- Medical and Clinical GeneticsUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Kalle Kurppa
- Tampere Center for Child, Adolescent and Maternal Health ResearchTampere University and Tampere University Hospital, Wellbeing Services County of PirkanmaaTampereFinland
- Celiac Disease Research CenterTampere UniversityTampereFinland
- University Consortium of SeinäjokiSeinäjokiFinland
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Morales-Suárez-Varela M, Peraita-Costa I, Guerrero Cervera B, Llopis-Morales A, Botella Juan L, Marcos Puig B. Arterial hypertension and smoking in pregnant women in the Valencian Community: maternal and neonatal outcomes. Semergen 2024; 50:102171. [PMID: 38159344 DOI: 10.1016/j.semerg.2023.102171] [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: 09/21/2023] [Revised: 11/24/2023] [Accepted: 12/01/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Hypertension and smoking during pregnancy have been linked to various adverse maternal and fetal outcomes. The objective of this work is to study how the smoking influences the development of hypertension, its effects on the pregnant woman, and on the newborn. MATERIALS AND METHODS An observational study in two phases was carried out: the descriptive first phase allows characterization of the sample and the analytical second phase is a case-control nested in a retrospective cohort corresponding to pregnancy. RESULTS A total of 712 women were included in the study. Of the 672 (94.4%) non-hypertensive women, 533 (79.3%) were non-smoking and 139 (20.7%) smoking. For the 40 (5.6%) hypertensive women, 30 (75.0%) were non-smoking and 10 (25.0%) smoking. The prevalence of hypertension was of 5.6%. Women who quit smoking before pregnancy saw a reduced risk of hypertension. For women who smoke during pregnancy, those of younger ages, with a normal body mass index, who are primiparous, employed and with a low-medium level of education have higher risk of hypertension. The risk of hypertension according to the level of physical activity during leisure time follows a "U" shape, with those who perform light physical activity at the lowest risk of hypertension. Hypertensive women have a higher risk of small for gestational age newborns. Smoking does not pose an additional risk for adverse outcomes once hypertension is diagnosed. CONCLUSIONS Future studies should aim to determine the role of smoking habit in the appearance of hypertension in pregnancy in order to establish adequate intervention guidelines that may aid in reducing the prevalence of hypertension.
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Affiliation(s)
- M Morales-Suárez-Varela
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estelles s/n, 46100 Burjassot (València), Spain; CIBER of Epidemiology and Public Health (CIBERESP), Carlos III Health Institute, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain.
| | - I Peraita-Costa
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estelles s/n, 46100 Burjassot (València), Spain; CIBER of Epidemiology and Public Health (CIBERESP), Carlos III Health Institute, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - B Guerrero Cervera
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estelles s/n, 46100 Burjassot (València), Spain; Department of Cardiology, La Fe University Hospital, Avinguda de Fernando Abril Martorell, 106, 46026 València, Spain
| | - A Llopis-Morales
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estelles s/n, 46100 Burjassot (València), Spain
| | - L Botella Juan
- Area of Preventive Medicine and Public Health, Department of Biomedical Sciences, Faculty of Health Sciences, Universidad de León, 24071 León, Spain; The Research Group in Gene-Environment and Health Interactions (GIIGAS), Institute of Biomedicine (IBIOMED), Universidad de León, 24071 León, Spain
| | - B Marcos Puig
- Department of Obstetrics, La Fe University Hospital, Avinguda de Fernando Abril Martorell, 106, 46026 València, Spain
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Chen YCS, Mirzakhani H, Knihtilä H, Fichorova RN, Luu N, Laranjo N, Jha A, Kelly RS, Weiss ST, Litonjua AA, Lee-Sarwar KA. The Association of Prenatal C-Reactive Protein and Interleukin-8 Levels with Maternal Characteristics and Preterm Birth. Am J Perinatol 2024; 41:e843-e852. [PMID: 36241210 PMCID: PMC10244485 DOI: 10.1055/a-1961-2425] [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] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The determinants of preterm birth remain unknown. Excessive maternal inflammation during pregnancy may play an important role in the pathogenesis of preterm birth. Our objective was to describe the association of prenatal levels of proinflammatory C-reactive protein (CRP) and interleukin-8 (IL-8) with preterm birth in participants of the Vitamin D Antenatal Asthma Reduction Trial. STUDY DESIGN Five hundred and twenty-eight patients with available samples of both first- and third-trimester plasma were included in this analysis. CRP and IL-8 were measured from maternal prenatal samples. We examined the association between prenatal CRP and IL-8 with maternal health characteristics and the outcome of preterm birth. We also described the patterns of change in CRP and IL-8 from first to third trimester and their association with preterm birth. A subgroup analysis comparing only those with a spontaneous preterm birth phenotype to those with term birth was also performed. RESULTS Maternal characteristics including lower educational attainment, higher prepregnancy body mass index, gestational diabetes, lower vitamin D, and an unhealthy diet were associated with elevated levels of prenatal CRP and IL-8. Higher third trimester CRP and an increase in CRP from first to third trimester were associated with an increased odds of preterm birth when compared to lower levels of CRP (adjusted odds ratio [aOR] = 1.49, 95% confidence interval: 1.02, 2.23, p = 0.04) or a decrease in CRP over pregnancy (aOR = 3.06, 95% CI = 1.31,7.55, p = 0.01), after adjusting for potential confounders. These associations were strengthened when comparing only patients with spontaneous preterm birth (n = 22) to those with term births. CONCLUSION Higher levels of the proinflammatory markers CRP and IL-8 are associated with indicators of poor maternal health and preterm birth. Prenatal CRP levels may reflect maternal prenatal health status and serve as a predictor of preterm birth, especially among those with spontaneous preterm birth. KEY POINTS · Elevated prenatal CRP is associated with poor maternal health.. · High prenatal CRP may predict premature birth, especially spontaneous premature birth phenotypes.. · Vitamin D insufficiency may be a modifiable risk factor for prenatal inflammation..
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Affiliation(s)
- Yih-Chieh S. Chen
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Hooman Mirzakhani
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Hanna Knihtilä
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Raina N. Fichorova
- Department of Obstetrics, Gynecology and Reproductive Biology, Laboratory of Genital Tract Biology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ngan Luu
- Department of Obstetrics, Gynecology and Reproductive Biology, Laboratory of Genital Tract Biology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Nancy Laranjo
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Anjali Jha
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Rachel S. Kelly
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Scott T. Weiss
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Augusto A. Litonjua
- Division of Pediatric Pulmonary Medicine, Golisano Children’s Hospital at Strong, University of Rochester Medical Center, Rochester, New York
| | - Kathleen A. Lee-Sarwar
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
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Piccoli GB, Attini R, Torreggiani M, Chatrenet A, Manzione AM, Masturzo B, Casula V, Longhitano E, Dalmasso E, Biancone L, Pani A, Cabiddu G. Any reduction in maternal kidney mass makes a difference during pregnancy in gestational and fetal outcome. Kidney Int 2024; 105:865-876. [PMID: 38296027 DOI: 10.1016/j.kint.2023.12.018] [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: 02/28/2023] [Revised: 11/29/2023] [Accepted: 12/15/2023] [Indexed: 02/19/2024]
Abstract
Little is known about the effect tubulointerstitial nephropathies have in modulating maternal-fetal outcomes in pregnancy. Therefore, we analyzed the main outcomes of pregnancy in these women to gain a better understanding of the role of a reduction in maternal kidney mass. From the Torino Cagliari Observational Study (TOCOS) cohort, we selected 529 patients with a diagnosis of tubulointerstitial disease and focused on 421 patients with chronic kidney disease (CKD) stage 1, without hypertension but with proteinuria less than 0.5 g/day at referral. From a cohort of 2969 singleton deliveries from low-risk pregnancies followed in the same settings we selected a propensity score matched control cohort of 842 pregnancies match 2:1 for age, parity, body mass index, ethnicity, and origin. Time to delivery was significantly shorter in the study cohort 38.0 (Quartile 1-Quartile 3: 37.0-39.0) versus 39.0 (Q1-Q3 38.0-40.0) weeks, with respect to controls. Incidence of delivery of less than 37 gestational weeks significantly increased from controls (7.4%) to women with previous acute pyelonephritis (10.8%), other tubulointerstitial diseases (9.7%) and was the highest in patients with a single kidney (31.1%). Similarly, neonatal birthweight significantly and progressively decreased from controls (3260 g [Q1-Q3: 2980-3530]), previous acute pyelonephritis (3090 g [Q1-Q3: 2868-3405], other tubulointerstitial diseases (3110 g [Q1-Q3: 2840-3417]), and to solitary kidney (2910 g [Q1-Q3: 2480-3240]). Risk of developing preeclampsia was significantly higher in the CKD cohort (3.6% vs 1.7% in low-risk controls). Thus, even a small reduction in functional kidney mass, such as a pyelonephritic scar, is associated with a shorter duration of pregnancy and an increased risk of preterm delivery. The risk is proportional to the extent of parenchymal reduction and is highest in cases with a solitary kidney.
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Affiliation(s)
| | - Rossella Attini
- Department of Obstetrics and Gynecology SC2U, "Città della Salute e della Scienza", Sant'Anna Hospital, Turin, Italy
| | | | - Antoine Chatrenet
- Néphrologie et Dialyse, Centre Hospitalier Le Mans, Le Mans, France; APCoSS-Institute of Physical Education and Sports Sciences (IFEPSA), UCO Angers, Angers, France
| | - Ana Maria Manzione
- Division of Nephrology, Dialysis and Renal Transplantation, Department of Medical Sciences, "Città della Salute e della Scienza di Torino" University Hospital, University of Turin, Turin, Italy
| | - Bianca Masturzo
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, Italy
| | - Viola Casula
- Department of Obstetrics and Gynecology SC2U, "Città della Salute e della Scienza", Sant'Anna Hospital, Turin, Italy
| | - Elisa Longhitano
- Néphrologie et Dialyse, Centre Hospitalier Le Mans, Le Mans, France; Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, A.O.U. "G. Martino", University of Messina, Messina, Italy
| | - Eleonora Dalmasso
- Néphrologie et Dialyse, Centre Hospitalier Le Mans, Le Mans, France; Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Luigi Biancone
- Division of Nephrology, Dialysis and Renal Transplantation, Department of Medical Sciences, "Città della Salute e della Scienza di Torino" University Hospital, University of Turin, Turin, Italy
| | - Antonello Pani
- Nephrology, Department of Medical Science and Public Health, San Michele Hospital, ARNAS G. Brotzu, University of Cagliari, Cagliari, Italy
| | - Gianfranca Cabiddu
- Nephrology, Department of Medical Science and Public Health, San Michele Hospital, ARNAS G. Brotzu, University of Cagliari, Cagliari, Italy
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Zhu J, Chen J, Wang K, Yan H, Liu Q, Lan Y, Ren L, Wu S. Exposure to ambient black carbon and particulate matter during pregnancy in associations with risk of pre-eclampsia: A meta-analysis based on population-based studies. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 343:123230. [PMID: 38158011 DOI: 10.1016/j.envpol.2023.123230] [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: 10/04/2023] [Revised: 12/17/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024]
Abstract
Air pollution control protocols and policies formulated for PM2.5 and PM10 (particulate matter [PM] with an aerodynamic diameter of ≤2.5 and 10 μm), however, such protocols and policies have not been available for black carbon (BC). A growing number of studies have evaluated the association between long-term exposure to ambient air pollution with BC and PM and pre-eclampsia. We applied a meta-analysis to estimate pooled odds ratios (ORs) and 95 % confidence intervals (CIs) based on four exposure windows (first/second/third trimester and entire pregnancy). 24 studies meeting our selection criteria (8 for BC, 21 and 15 for PM2.5 and PM10) were finally included after screening studies published up to June 22, 2023. An increase of 1 μg/m3 BC during the second trimester and entire pregnancy were associated with a 16 % (OR: 1.16, 95 % CI: [1.02, 1.32]) and a 15 % (OR: 1.15, 95 % CI: [1.03, 1.29]) increased risk of pre-eclampsia, respectively. A 10 μg/m3 increase in second-trimester exposure to PM2.5 and PM10 was associated with a 1 % (OR: 1.01, 95 % CI: [1.00, 1.03]) and a 5 % (OR: 1.05, 95 % CI: [1.01, 1.10]) increased risk of pre-eclampsia. An 11 % (OR: 1.11, 95 % CI: [1.03, 1.21]) increased risk of pre-eclampsia was found to be associated with a 10 μg/m3 increase in PM10 exposure during the entire pregnancy. The results support the potential effect of exposure to ambient particulate pollutants on risk of pre-eclampsia and emphasize the necessity of strategies and protocols for controlling BC. Greater efforts in controlling ambient particulate pollution and especially BC are needed in order to prevent pregnant women from developing pre-eclampsia.
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Affiliation(s)
- Jiaqi Zhu
- Department of Occupational and Environmental Health, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China; Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, Shaanxi, China; Key Laboratory of Trace Elements and Endemic Diseases in Ministry of Health, Xi'an, Shaanxi, China; Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, China
| | - Juan Chen
- Department of Occupational and Environmental Health, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China; Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, Shaanxi, China; Key Laboratory of Trace Elements and Endemic Diseases in Ministry of Health, Xi'an, Shaanxi, China; Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, China
| | - Kai Wang
- Department of Occupational and Environmental Health, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China; Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, Shaanxi, China; Key Laboratory of Trace Elements and Endemic Diseases in Ministry of Health, Xi'an, Shaanxi, China; Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, China
| | - Hairong Yan
- Department of Occupational and Environmental Health, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China; Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, Shaanxi, China; Key Laboratory of Trace Elements and Endemic Diseases in Ministry of Health, Xi'an, Shaanxi, China; Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, China
| | - Qisijing Liu
- Research Institute of Public Health, School of Medicine, Nankai University, Tianjin, China
| | - Yang Lan
- Department of Occupational and Environmental Health, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China; Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, Shaanxi, China; Key Laboratory of Trace Elements and Endemic Diseases in Ministry of Health, Xi'an, Shaanxi, China; Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, China
| | - Lihua Ren
- School of Nursing, Peking University, Beijing, China
| | - Shaowei Wu
- Department of Occupational and Environmental Health, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China; Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, Shaanxi, China; Key Laboratory of Trace Elements and Endemic Diseases in Ministry of Health, Xi'an, Shaanxi, China; Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, China.
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Yang N, Quick HS, Melly SJ, Mullin AM, Zhao Y, Edwards J, Clougherty JE, Schinasi LH, Burris HH. Spatial Patterning of Spontaneous and Medically Indicated Preterm Birth in Philadelphia. Am J Epidemiol 2024; 193:469-478. [PMID: 37939071 DOI: 10.1093/aje/kwad207] [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: 01/20/2023] [Revised: 07/18/2023] [Accepted: 10/26/2023] [Indexed: 11/10/2023] Open
Abstract
Preterm birth (PTB) remains a key public health issue that disproportionately affects Black individuals. Since spontaneous PTB (sPTB) and medically indicated PTB (mPTB) may have different causes and interventions, we quantified racial disparities for sPTB and mPTB, and we characterized the geographic patterning of these phenotypes, overall and according to race/ethnicity. We examined a pregnancy cohort of 83,952 singleton births at 2 Philadelphia hospitals from 2008-2020, and classified each PTB as sPTB or mPTB. We used binomial regression to quantify the magnitude of racial disparities between non-Hispanic Black and non-Hispanic White individuals, then generated small area estimates by applying a Bayesian model that accounts for small numbers and smooths estimates of PTB risk by borrowing information from neighboring areas. Racial disparities in both sPTB and mPTB were significant (relative risk of sPTB = 1.83, 95% confidence interval: 1.70, 1.98; relative risk of mPTB = 2.20, 95% confidence interval: 2.00, 2.42). The disparity was 20% greater in mPTB than sPTB. There was substantial geographic variation in PTB, sPTB, and mPTB risks and racial disparity. Our findings underscore the importance of distinguishing PTB phenotypes within the context of public health and preventive medicine. Future work should consider social and environmental exposures that may explain geographic differences in PTB risk and disparities.
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Kim HY, Seok YS, Moon HY, Cho GJ, Ahn KH, Hong SC, Oh MJ, Kim HJ. The Role of the Aryl Hydrocarbon Receptor in Vascular Factors Related to Preeclampsia in a Smoking Mouse Model. Curr Issues Mol Biol 2024; 46:741-752. [PMID: 38248350 PMCID: PMC10814390 DOI: 10.3390/cimb46010048] [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: 12/20/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 01/23/2024] Open
Abstract
Smoking cigarettes is known to lower the risk of preeclampsia. The objective of this study is to evaluate the effect of smoking on the expression of soluble FMS-like tyrosine kinase-1 (sFlt-1), vascular endothelial growth factor (VEGF), and endoglin (sEng)-1 and the role of the aryl hydrocarbon receptor (AhR) in pregnant mice. We developed a smoking mouse model using a gas-filling system. One or two cigarettes per day were exposed to each of the five pregnant mice for five days a week throughout pregnancy. AhR agonist and antagonist were injected. Serum levels and expression in the placenta of sFlt-1, VEGF, and sEng-1 were analyzed and compared among the cigarette smoke and no-exposure groups after delivery. Compared to the no-smoke exposure group, the serum level of sFlt-1 was significantly decreased in the two-cigarette-exposed group (p < 0.001). When the AhR antagonist was added to the two-cigarette-exposed group, sFlt-1 levels were significantly increased compared to the two-cigarette group (p = 0.002). The levels of sFlt-1 in the AhR antagonist group did not change regardless of two-cigarette exposure (p = 0.064). With the AhR agonist, sFlt-1 decreased significantly compared to the control (p = 0.001) and AhR antagonist group (p = 0.002). The sFlt-1 level was significantly decreased after the injection of the AhR agonist compared to the control group (p = 0.001). Serum levels of VEGF were significantly decreased in the one-cigarette-exposed group compared to the control group; however, there was no difference between the control and the two-cigarette-exposed groups. The placental expression of sFlt-1, VEGF, and sEng were inconsistent. This study offers insights into the potential role of AhR on antiangiogenic sFlt-1 associated with preeclampsia. It may support the invention of a new treatment strategy for preeclampsia using AhR activation.
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Affiliation(s)
- Ho-Yeon Kim
- Department of Obstetrics and Gynecology, Korea University School of Medicine, Seoul 02841, Republic of Korea; (H.-Y.K.); (H.-Y.M.); (K.-H.A.); (S.-C.H.); (H.-J.K.)
| | - Ye-Seon Seok
- Department of Obstetric and Gynecology, Korea University Guro Hospital, Seoul 08308, Republic of Korea;
| | - Hye-Yeon Moon
- Department of Obstetrics and Gynecology, Korea University School of Medicine, Seoul 02841, Republic of Korea; (H.-Y.K.); (H.-Y.M.); (K.-H.A.); (S.-C.H.); (H.-J.K.)
| | - Geum-Joon Cho
- Department of Obstetrics and Gynecology, Korea University School of Medicine, Seoul 02841, Republic of Korea; (H.-Y.K.); (H.-Y.M.); (K.-H.A.); (S.-C.H.); (H.-J.K.)
| | - Ki-Hoon Ahn
- Department of Obstetrics and Gynecology, Korea University School of Medicine, Seoul 02841, Republic of Korea; (H.-Y.K.); (H.-Y.M.); (K.-H.A.); (S.-C.H.); (H.-J.K.)
| | - Soon-Cheol Hong
- Department of Obstetrics and Gynecology, Korea University School of Medicine, Seoul 02841, Republic of Korea; (H.-Y.K.); (H.-Y.M.); (K.-H.A.); (S.-C.H.); (H.-J.K.)
| | - Min-Jeong Oh
- Department of Obstetrics and Gynecology, Korea University School of Medicine, Seoul 02841, Republic of Korea; (H.-Y.K.); (H.-Y.M.); (K.-H.A.); (S.-C.H.); (H.-J.K.)
| | - Hai-Joong Kim
- Department of Obstetrics and Gynecology, Korea University School of Medicine, Seoul 02841, Republic of Korea; (H.-Y.K.); (H.-Y.M.); (K.-H.A.); (S.-C.H.); (H.-J.K.)
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12
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Selvaratnam RJ, Sovio U, Cook E, Gaccioli F, Charnock-Jones DS, Smith GCS. Objective measures of smoking and caffeine intake and the risk of adverse pregnancy outcomes. Int J Epidemiol 2023; 52:1756-1765. [PMID: 37759082 PMCID: PMC10749751 DOI: 10.1093/ije/dyad123] [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: 03/12/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND In pregnancy, women are encouraged to cease smoking and limit caffeine intake. We employed objective definitions of smoking and caffeine exposure to assess their association with adverse outcomes. METHODS We conducted a case cohort study within the Pregnancy Outcome Prediction study to analyse maternal serum metabolomics in samples from 12, 20, 28 and 36 weeks of gestational age. Objective smoking status was defined based on detectable cotinine levels at each time point and objective caffeine exposure was based on tertiles of paraxanthine levels at each time point. We used logistic and linear regression to examine the association between cotinine, paraxanthine and the risk of pre-eclampsia, spontaneous pre-term birth (sPTB), fetal growth restriction (FGR), gestational diabetes mellitus and birthweight. RESULTS There were 914 and 915 women in the smoking and caffeine analyses, respectively. Compared with no exposure to smoking, consistent exposure to smoking was associated with an increased risk of sPTB [adjusted odds ratio (aOR) = 2.58, 95% CI: 1.14 to 5.85)] and FGR (aOR = 4.07, 95% CI: 2.14 to 7.74) and lower birthweight (β = -387 g, 95% CI: -622 g to -153 g). On univariate analysis, consistently high levels of paraxanthine were associated with an increased risk of FGR but that association attenuated when adjusting for maternal characteristics and objective-but not self-reported-smoking status. CONCLUSIONS Based on objective data, consistent exposure to smoking throughout pregnancy was strongly associated with sPTB and FGR. High levels of paraxanthine were not independently associated with any of the studied outcomes and were confounded by smoking.
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Affiliation(s)
- Roshan J Selvaratnam
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, VIC, Melbourne, Australia
| | - Ulla Sovio
- Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, UK
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Emma Cook
- Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, UK
| | - Francesca Gaccioli
- Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, UK
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - D Stephen Charnock-Jones
- Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, UK
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Gordon C S Smith
- Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, UK
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
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13
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Yagel S, Cohen SM, Admati I, Skarbianskis N, Solt I, Zeisel A, Beharier O, Goldman-Wohl D. Expert review: preeclampsia Type I and Type II. Am J Obstet Gynecol MFM 2023; 5:101203. [PMID: 37871693 DOI: 10.1016/j.ajogmf.2023.101203] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 10/25/2023]
Abstract
Pregnancy involves an interplay between maternal and fetal factors affecting changes to maternal anatomy and physiology to support the developing fetus and ensure the well-being of both the mother and offspring. A century of research has provided evidence of the imperative role of the placenta in the development of preeclampsia. Recently, a growing body of evidence has supported the adaptations of the maternal cardiovascular system during normal pregnancy and its maladaptation in preeclampsia. Debate surrounds the roles of the placenta vs the maternal cardiovascular system in the pathophysiology of preeclampsia. We proposed an integrated model of the maternal cardiac-placental-fetal array and the development of preeclampsia, which reconciles the disease phenotypes and their proposed origins, whether placenta-dominant or maternal cardiovascular system-dominant. These phenotypes are sufficiently diverse to define 2 distinct types: preeclampsia Type I and Type II. Type I preeclampsia may present earlier, characterized by placental dysfunction or malperfusion, shallow trophoblast invasion, inadequate spiral artery conversion, profound syncytiotrophoblast stress, elevated soluble fms-like tyrosine kinase-1 levels, reduced placental growth factor levels, high peripheral vascular resistance, and low cardiac output. Type I is more often accompanied by fetal growth restriction, and low placental growth factor levels have a measurable impact on maternal cardiac remodeling and function. Type II preeclampsia typically occurs in the later stages of pregnancy and entails an evolving maternal cardiovascular intolerance to the demands of pregnancy, with a moderately dysfunctional placenta and inadequate blood supply. The soluble fms-like tyrosine kinase-1-placental growth factor ratio may be normal or slightly disturbed, peripheral vascular resistance is low, and cardiac output is high, but these adaptations still fail to meet demand. Emergent placental dysfunction, coupled with an increasing inability to meet demand, more often appears with fetal macrosomia, multiple pregnancies, or prolonged pregnancy. Support for the notion of 2 types of preeclampsia observable on the molecular level is provided by single-cell transcriptomic survey of gene expression patterns across different cell classes. This revealed widespread dysregulation of gene expression across all cell types, and significant imbalance in fms-like tyrosine kinase-1 (FLT1) and placental growth factor, particularly marked in the syncytium of early preeclampsia cases. Classification of preeclampsia into Type I and Type II can inform future research to develop targeted screening, prevention, and treatment approaches.
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Affiliation(s)
- Simcha Yagel
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University Faculty of Medicine, Jerusalem, Israel (Dr Yagel, Ms Cohen, and Drs Beharier and Goldman-Wohl).
| | - Sarah M Cohen
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University Faculty of Medicine, Jerusalem, Israel (Dr Yagel, Ms Cohen, and Drs Beharier and Goldman-Wohl)
| | - Inbal Admati
- Department of Biotechnology and Food Engineering, Technion - Israel Institute of Technology, Haifa, Israel (Ms Admati, Mr Skarbianskis, and Dr Zeisel)
| | - Niv Skarbianskis
- Department of Biotechnology and Food Engineering, Technion - Israel Institute of Technology, Haifa, Israel (Ms Admati, Mr Skarbianskis, and Dr Zeisel)
| | - Ido Solt
- Department of Obstetrics and Gynecology, Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel (Dr Solt)
| | - Amit Zeisel
- Department of Biotechnology and Food Engineering, Technion - Israel Institute of Technology, Haifa, Israel (Ms Admati, Mr Skarbianskis, and Dr Zeisel)
| | - Ofer Beharier
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University Faculty of Medicine, Jerusalem, Israel (Dr Yagel, Ms Cohen, and Drs Beharier and Goldman-Wohl)
| | - Debra Goldman-Wohl
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University Faculty of Medicine, Jerusalem, Israel (Dr Yagel, Ms Cohen, and Drs Beharier and Goldman-Wohl)
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14
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Zhang M, Qiao J, Xie P, Li Z, Hu C, Li F. The Association between Maternal Urinary Phthalate Concentrations and Blood Pressure in Pregnancy: A Systematic Review and Meta-Analysis. Metabolites 2023; 13:812. [PMID: 37512519 PMCID: PMC10384991 DOI: 10.3390/metabo13070812] [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: 05/29/2023] [Revised: 06/15/2023] [Accepted: 06/24/2023] [Indexed: 07/30/2023] Open
Abstract
Phthalates are commonly found in a wide range of environments and have been linked to several negative health outcomes. While earlier research indicated a potential connection between phthalate exposure and blood pressure (BP) during pregnancy, the results of these studies remain inconclusive. The objective of this meta-analysis was to elucidate the relationship between phthalate exposure and BP in pregnancy. A comprehensive literature search was carried out with PubMed, EMBASE, and Web of Science, and pertinent studies published up until 5 March 2023 were reviewed. Random-effects models were utilized to consolidate the findings of continuous outcomes, such as diastolic and systolic BP, as well as the binary outcomes of hypertensive disorders of pregnancy (HDP). The present study included a total of 10 studies. First-trimester MBP exposure exhibited a positive association with mean systolic and diastolic BP during both the second and third trimesters (β = 1.05, 95% CI: 0.27, 1.83, I2 = 93%; β = 0.40, 95% CI: 0.05, 0.74, I2 = 71%, respectively). Second-trimester monobenzyl phthalate (MBzP) exposure was positively associated with systolic and diastolic BP in the third trimester (β = 0.57, 95% CI: 0.01, 1.13, I2 = 0; β = 0.70, 95% CI: 0.27, 1.13, I2 = 0, respectively). Conversely, first-trimester mono-2-ethylhexyl phthalate (MEHP) exposure demonstrated a negative association with mean systolic and diastolic BP during the second and third trimesters (β = -0.32, 95% CI: -0.60, -0.05, I2 = 0; β = -0.32, 95% CI: -0.60, -0.05, I2 = 0, respectively). Additionally, monoethyl phthalate (MEP) exposure was found to be associated with an increased risk of HDP (OR = 1.12, 95% CI: 1.02, 1.23, I2 = 26%). Our study found that several phthalate metabolites were associated with increased systolic and diastolic BP, as well as the risk of HDP across pregnancies. Nevertheless, given the limited number of studies analyzed, additional research is essential to corroborate these findings and elucidate the molecular mechanisms linking phthalates to BP changes during pregnancy.
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Affiliation(s)
- Mengyue Zhang
- Department of Clinical Medicine, The Second School of Clinical Medicine, Anhui Medical University, 81 Meishan Road, Hefei 230032, China
- Department of Prevention and Health Care, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Jianchao Qiao
- Department of Clinical Medicine, The Second School of Clinical Medicine, Anhui Medical University, 81 Meishan Road, Hefei 230032, China
| | - Pinpeng Xie
- Department of Clinical Medicine, The Second School of Clinical Medicine, Anhui Medical University, 81 Meishan Road, Hefei 230032, China
| | - Zhuoyan Li
- Department of Clinical Medicine, The Second School of Clinical Medicine, Anhui Medical University, 81 Meishan Road, Hefei 230032, China
| | - Chengyang Hu
- Department of Humanistic Medicine, School of Humanistic Medicine, Anhui Medical University, 81 Meishan Road, Hefei 230032, China
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei 230032, China
| | - Fei Li
- Department of Prevention and Health Care, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
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15
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Wu P, Green M, Myers JE. Hypertensive disorders of pregnancy. BMJ 2023; 381:e071653. [PMID: 37391211 DOI: 10.1136/bmj-2022-071653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
Hypertensive disorders of pregnancy (HDP) are one of the most commonly occurring complications of pregnancy and include chronic hypertension, gestational hypertension, and pre-eclampsia. New developments in early pregnancy screening to identify women at high risk for pre-eclampsia combined with targeted aspirin prophylaxis could greatly reduce the number of affected pregnancies. Furthermore, recent advances in the diagnosis of pre-eclampsia, such as placental growth factor based testing, have been shown to improve the identification of those pregnancies at highest risk of severe complications. Evidence from trials has refined the target blood pressure and timing of delivery to manage chronic hypertension and pre-eclampsia with non-severe features, respectively. Importantly, a wealth of epidemiological data now links HDP to future cardiovascular disease and diabetes decades after an affected pregnancy. This review discusses the current guidelines and research data on the prevention, diagnosis, management, and postnatal follow-up of HDP. It also discusses the gap in knowledge regarding the long term risks for cardiovascular disease following HDP and illustrates the importance of improving adherence to postnatal guidelines to monitor hypertension and the need for more research focused on primary prevention of future cardiovascular disease in women identified as being at high risk because of HDP.
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Affiliation(s)
- Pensée Wu
- School of Medicine, Keele University, Newcastle-under-Lyme, UK
- Academic Department of Obstetrics and Gynaecology, University Hospital of North Midlands, Stoke-on-Trent, UK
- Department of Obstetrics and Gynecology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | | | - Jenny E Myers
- Maternal and Fetal Health Research Centre, University of Manchester, Manchester, UK
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16
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Eissa GA, Khurmi RA, Holbah TJ, Alabdullah DW, Aleban SA, Aljohani AA, Zaidan SM, Hakami AM. The Effect of Sleeve Gastrectomy on Pregnancy Complications: A Cross-Sectional Study in Saudi Arabia. Cureus 2023; 15:e40157. [PMID: 37431342 PMCID: PMC10329566 DOI: 10.7759/cureus.40157] [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] [Accepted: 06/08/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Obesity is defined as abnormal or excessive fat accumulation that may impair health. Until recently, the only effective method for treating morbid obesity over the long term was bariatric surgery (BS). During pregnancy, obesity is correlated with higher risks for numerous complications, including gestational diabetes mellitus, pre-eclampsia, mortality, and large-for-gestational-age neonates. The most commonly reported complications among women who underwent sleeve gastrectomy and experienced pregnancy were placental bleeding, oligohydramnios, urinary tract infection, appendicitis, and recurrent abortions. OBJECTIVES We aim to estimate the consequence of sleeve gastrectomy and its relation with pregnancy outcomes among women in Saudi Arabia. METHODOLOGY This study adopted a quantitative, descriptive, cross-sectional design. It was conducted in Saudi Arabia between February and May 2023 among women who became pregnant after undergoing sleeve gastrectomy. Result: Anemia was experienced by 78.8% of the patients during pregnancy. In our study, 18% of the individuals experienced complications during or right after delivery, with postpartum hemorrhage being the most frequent (43.1%). We discovered that pre-eclampsia and delivering a baby small for gestational age were considerably more common in pregnant women who smoked (p ≤ 0.05). On the other hand, no significant association was discovered between any comorbidity and mode of delivery, birth weight, child complications, or difficulties that occurred during or right after labor. CONCLUSION We concluded that weight gain after sleeve gastrectomy negatively impacted pregnancy and increased the probability of several complications for the mother and fetus. Healthcare providers must inform every woman undergoing BS about the possible complication of an unhealthy lifestyle after the procedure.
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Affiliation(s)
- Ghaida A Eissa
- Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | | | | | - Durrah W Alabdullah
- Faculty of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Sarah A Aleban
- Faculty of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
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17
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Rodriguez-Lopez M, Escobar MF, Merlo J, Kaufman JS. Reevaluating the protective effect of smoking on preeclampsia risk through the lens of bias. J Hum Hypertens 2023; 37:338-344. [PMID: 37041252 PMCID: PMC10156598 DOI: 10.1038/s41371-023-00827-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/18/2023] [Accepted: 03/27/2023] [Indexed: 04/13/2023]
Abstract
Preeclampsia is a hypertensive disorder that is usually diagnosed after 20 weeks' gestation. Despite the deleterious effect of smoking on cardiovascular disease, it has been frequently reported that smoking has a protective effect on preeclampsia risk and biological explanations have been proposed. However, in this manuscript, we present multiple sources of bias that could explain this association. First, key concepts in epidemiology are reviewed: confounder, collider, and mediator. Then, we describe how eligibility criteria, losses of women potentially at risk, misclassification, or performing incorrect adjustments can create bias. We provide examples to show that strategies to control for confounders may fail when they are applied to variables that are not confounders. Finally, we outline potential approaches to manage this controversial effect. We conclude that there is probably no single epidemiological explanation for this counterintuitive association.
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Affiliation(s)
- Merida Rodriguez-Lopez
- Faculty of Health Science, Universidad Icesi, Cali, Colombia.
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden.
| | - Maria Fernanda Escobar
- Faculty of Health Science, Universidad Icesi, Cali, Colombia
- Clinical Research Center, Fundación Valle del Lili, Cali, Colombia
- Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cali, Colombia
| | - Juan Merlo
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Jay S Kaufman
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, QC, Canada
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Yagel S, Cohen SM, Goldman-Wohl D, Beharier O. Redefining pre-eclampsia as Type I or II: implementing an integrated model of the maternal-cardiovascular-placental-fetal array. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:293-301. [PMID: 36378064 DOI: 10.1002/uog.26121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/04/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Affiliation(s)
- S Yagel
- Division of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - S M Cohen
- Division of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - D Goldman-Wohl
- Division of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - O Beharier
- Division of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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19
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Nanninga EK, Weiland S, Berger MY, Feijen-de Jong EI, Erwich JJHM, Peters LL. Adverse Maternal and Infant Outcomes of Women Who Differ in Smoking Status: E-Cigarette and Tobacco Cigarette Users. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20032632. [PMID: 36768007 PMCID: PMC9915204 DOI: 10.3390/ijerph20032632] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/27/2023] [Accepted: 01/28/2023] [Indexed: 05/12/2023]
Abstract
The electronic cigarette (e-cigarette) became commercially available around 2004, yet the characteristics of pregnant women who use these devices and their effects on maternal and infant health remain largely unknown. This study aimed to investigate maternal characteristics and pregnancy outcomes according to maternal smoking status. We conducted a cross-sectional study of Dutch women with reported pregnancies between February 2019 and May 2022, using an online questionnaire to collect data on smoking status and demographic, lifestyle, pregnancy, and infant characteristics. Smoking status is compared among non-smokers, tobacco cigarette users, e-cigarette users, and dual users (tobacco and e-cigarette). We report descriptive statistics and calculate differences in smoking status between women with the chi-square or Fisher (Freeman-Halton) test. Of the 1937 included women, 88.1% were non-smokers, 10.8% were tobacco cigarette users, 0.5% were e-cigarette users, and 0.6% were dual users. Compared with tobacco users, e-cigarette users more often reported higher education, having a partner, primiparity, and miscarriages. Notably, women who used e-cigarettes more often had small infants for gestational age. Despite including few women in the e-cigarette subgroup, these exploratory results indicate the need for more research to examine the impact of e-cigarettes on pregnancy outcomes.
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Affiliation(s)
- Eline K. Nanninga
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Stella Weiland
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, Dirk Huizingastraat 3-5, 9713 GL Groningen, The Netherlands
- Department of General Practice & Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
- Amsterdam Reproduction and Development, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Marjolein Y. Berger
- Department of General Practice & Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Esther I. Feijen-de Jong
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, Dirk Huizingastraat 3-5, 9713 GL Groningen, The Netherlands
- Department of General Practice & Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
- Amsterdam Reproduction and Development, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Jan Jaap H. M. Erwich
- Department of Obstetrics & Gynecology, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Lilian L. Peters
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, Dirk Huizingastraat 3-5, 9713 GL Groningen, The Netherlands
- Department of General Practice & Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
- Amsterdam Reproduction and Development, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Correspondence:
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20
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Feferkorn I, Badeghiesh A, Baghlaf H, Dahan MH. The relationship of smoking with gestational diabetes: a large population-based study and a matched comparison. Reprod Biomed Online 2023; 46:338-345. [PMID: 36564219 DOI: 10.1016/j.rbmo.2022.11.005] [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: 07/08/2022] [Revised: 11/05/2022] [Accepted: 11/09/2022] [Indexed: 11/19/2022]
Abstract
RESEARCH QUESTION Is smoking associated with an increased risk for gestational diabetes (GDM)? DESIGN A retrospective population-based study using data from the United States Healthcare Cost and Utilization Project-Nationwide Inpatient Sample. A dataset of all deliveries that took place between 2004 and 2014 (inclusive) was created. The population was divided into two groups according to smoking status and matched 1:1 for age, obesity, race, insurance type, thyroid disease, drug use and chronic hypertension. Delivery outcomes were compared between the two matched groups and the control group of non-smokers as a whole. A multivariate logistic analysis was performed adjusting for any statistically significant confounding baseline effects not matched for. RESULTS The study identified 9,096,788 births between 2004 and 2014, of which 443,590 (4.9%) were maternal smokers. When compared with the entire group of non-smokers as controls, there was an increased risk of GDM, adjusted odd ratio (aOR) 1.10 (95% confidence interval [CI] 1.07-1.14, P < 0.001). This relationship was of a mild nature and there were many confounding variables that differed between the groups. As such a matched control group was developed to compare the risk of GDM in the smokers and non-smokers. An increased risk for GDM among smokers remained, with an aOR of 1.07 (95% CI 1.05-1.10, P < 0.001). CONCLUSIONS The current data suggest that smoking is a small but significant risk factor for GDM with an aOR of 1.07.
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Affiliation(s)
- Ido Feferkorn
- Division of Reproductive Endocrinology and Infertility, McGill University Health Care Center, Montreal QC, Canada
| | - Ahmad Badeghiesh
- Division of Reproductive Endocrinology and Infertility, McGill University Health Care Center, Montreal QC, Canada
| | - Haitham Baghlaf
- Maternal-Fetal Medicine Division, Obstetrics and Gynecology, University of Tabuk, Tabuk, Saudi Arabia
| | - Michael H Dahan
- Division of Reproductive Endocrinology and Infertility, McGill University Health Care Center, Montreal QC, Canada.
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21
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Ohseto H, Ishikuro M, Obara T, Murakami K, Onuma T, Noda A, Takahashi I, Matsuzaki F, Ueno F, Iwama N, Kikuya M, Metoki H, Sugawara J, Kuriyama S. Dietary calcium intake was related to the onset of pre-eclampsia: The TMM BirThree Cohort Study. J Clin Hypertens (Greenwich) 2022; 25:61-70. [PMID: 36579409 PMCID: PMC9832228 DOI: 10.1111/jch.14606] [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: 09/23/2022] [Revised: 11/12/2022] [Accepted: 11/15/2022] [Indexed: 12/30/2022]
Abstract
This study aimed to explore the relationship between dietary electrolyte intake and the prevalence of hypertensive disorders of pregnancy (HDP) subtypes. Our analysis included 19 914 pregnant women from the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. A food frequency questionnaire was used to estimate dietary calcium, potassium, sodium, and magnesium intakes. HDP was determined based on the medical records during regular antenatal care. Logistic regression analysis assessed the relationship between dietary electrolytes intake quintiles, and HDP subtypes with adjustment for basic characteristics. Dietary electrolyte intakes were applied for the prediction model. Of the cohort, 547 participants delivered with pre-eclampsia (PE), 278 with superimposed PE (SP), and 896 with gestational hypertension (GH). PE was associated with low crude calcium intake (odds ratio of the first quintile [<251 mg/day] to the fifth quintile [>623 mg/day] and 95% confidence interval, 1.31 [1.00-1.70]) and P for trend was .02. SP was not associated with any nutritional intake; however, the combined outcome of PE and SP was related to low crude calcium and potassium and energy-adjusted calcium, potassium, and magnesium intakes (P for trend, .01, .048, .02, .04, and .02, respectively). The same tendency was observed for GH. A prediction model that included crude calcium and potassium intakes performed better than a model without them. In conclusion, low dietary calcium, potassium, and magnesium were associated with higher HDP subtypes prevalence. The prediction model implied that crude calcium and potassium intakes might play a critical role in PE and SP pathogenesis.
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Affiliation(s)
- Hisashi Ohseto
- Tohoku University Graduate School of MedicineSendaiJapan
| | - Mami Ishikuro
- Tohoku University Graduate School of MedicineSendaiJapan,Tohoku Medical Megabank OrganizationTohoku UniversitySendaiJapan
| | - Taku Obara
- Tohoku University Graduate School of MedicineSendaiJapan,Tohoku Medical Megabank OrganizationTohoku UniversitySendaiJapan,Tohoku University HospitalSendaiJapan
| | - Keiko Murakami
- Tohoku University Graduate School of MedicineSendaiJapan,Tohoku Medical Megabank OrganizationTohoku UniversitySendaiJapan
| | - Tomomi Onuma
- Tohoku Medical Megabank OrganizationTohoku UniversitySendaiJapan
| | - Aoi Noda
- Tohoku University Graduate School of MedicineSendaiJapan,Tohoku Medical Megabank OrganizationTohoku UniversitySendaiJapan,Tohoku University HospitalSendaiJapan
| | | | - Fumiko Matsuzaki
- Tohoku Medical Megabank OrganizationTohoku UniversitySendaiJapan
| | - Fumihiko Ueno
- Tohoku University Graduate School of MedicineSendaiJapan,Tohoku Medical Megabank OrganizationTohoku UniversitySendaiJapan
| | - Noriyuki Iwama
- Tohoku Medical Megabank OrganizationTohoku UniversitySendaiJapan,Tohoku University HospitalSendaiJapan
| | - Masahiro Kikuya
- Tohoku Medical Megabank OrganizationTohoku UniversitySendaiJapan,Teikyo University School of MedicineTokyoJapan
| | - Hirohito Metoki
- Tohoku Medical Megabank OrganizationTohoku UniversitySendaiJapan,Faculty of MedicineTohoku Medical and Pharmaceutical UniversitySendaiJapan
| | - Junichi Sugawara
- Tohoku University Graduate School of MedicineSendaiJapan,Tohoku Medical Megabank OrganizationTohoku UniversitySendaiJapan,Tohoku University HospitalSendaiJapan
| | - Shinichi Kuriyama
- Tohoku University Graduate School of MedicineSendaiJapan,Tohoku Medical Megabank OrganizationTohoku UniversitySendaiJapan,International Research Institute of Disaster ScienceTohoku UniversitySendaiJapan
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22
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Cahuana-Bartra MJ, Mazarico-Gallego E, Cahuana-Bartra AJ, Pascal R, Alonso-Garcia L, Targa J, Muñoz-Lozano C, Dadvand P, Gómez-Roig MD. Maternal short-term exposure to NO 2 during pregnancy and its relationship with Doppler markers of placental function. ENVIRONMENTAL RESEARCH 2022; 214:113813. [PMID: 35810817 DOI: 10.1016/j.envres.2022.113813] [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: 03/04/2022] [Revised: 06/08/2022] [Accepted: 06/30/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Maternal exposure to air pollution has been associated with poor obstetric outcomes. However, the available evidence on the impact of maternal exposure to air pollution on placental function is still scarce and is based on estimated ambient levels of air pollutants. OBJECTIVE To evaluate the association between short-term maternal exposure to NO2 based on the objective personal measure of NO2 exposure and Doppler markers of placental function. METHODS This study was based on a prospective cohort of 101 pregnant women, recruited at Hospital Sant Joan de Déu, Barcelona (Spain), between January 2017 and April 2018. NO2 diffusion tubes were worn by pregnant women to measure personal exposure to NO2 between weeks 28 and 32 of their pregnancy. Placental function was evaluated at the 32nd week of gestation by Doppler evaluation of mean uterine arteries pulsatility index (PI), umbilical artery PI, middle cerebral artery PI, cerebroplacental ratio (CPR) and ductus venosus PI. Linear regression models were applied to estimate the association of personal NO2 exposure and Doppler markers of placental function (one at a time), controlled for relevant covariates. RESULTS Higher personal exposure to NO2 was significantly associated with lower mean uterine artery PI. Each one-interquartile range (IQR) increase in the exposure to NO 2 was associated with -0.07 (95% confidence intervals (CIs): -0.12, -0.02) decrease in uterine arteries PI. We also observed some suggestions for an inverse association between this exposure and CPR. A one-IQR increase in NO2 was associated with -0.18 (95% CIs: -0.37, 0.01) decrease in CPR. The findings for the rest of Doppler markers were not conclusive. CONCLUSIONS Maternal exposure to NO2 could interfere with Doppler markers of placental function, potentially indicating a certain degree of cerebral vasodilatation with a decrease of mean uterine arteries PI.
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Affiliation(s)
- Marc Josep Cahuana-Bartra
- BCNatal, Barcelona Centre for Maternal Foetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic. Universitat de Barcelona, Spain; Institut de Recerca Sant Joan de Déu (IR-SJD), 08028, Barcelona, Spain; Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin, RD21/0012/0001, Instituto de Salud Carlos III, Spain.
| | - Edurne Mazarico-Gallego
- BCNatal, Barcelona Centre for Maternal Foetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic. Universitat de Barcelona, Spain; Institut de Recerca Sant Joan de Déu (IR-SJD), 08028, Barcelona, Spain; Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin, RD21/0012/0001, Instituto de Salud Carlos III, Spain
| | - Alex Joan Cahuana-Bartra
- BCNatal, Barcelona Centre for Maternal Foetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic. Universitat de Barcelona, Spain
| | - Rosalia Pascal
- BCNatal, Barcelona Centre for Maternal Foetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic. Universitat de Barcelona, Spain; Institut de Recerca Sant Joan de Déu (IR-SJD), 08028, Barcelona, Spain; Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin, RD21/0012/0001, Instituto de Salud Carlos III, Spain
| | | | | | - Concha Muñoz-Lozano
- Institut de Recerca Sant Joan de Déu (IR-SJD), 08028, Barcelona, Spain; Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin, RD21/0012/0001, Instituto de Salud Carlos III, Spain
| | - Payam Dadvand
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - María Dolores Gómez-Roig
- BCNatal, Barcelona Centre for Maternal Foetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic. Universitat de Barcelona, Spain; Institut de Recerca Sant Joan de Déu (IR-SJD), 08028, Barcelona, Spain; Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin, RD21/0012/0001, Instituto de Salud Carlos III, Spain
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23
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Adverse events of recreational cannabis use during pregnancy reported to the French Addictovigilance Network between 2011 and 2020. Sci Rep 2022; 12:16509. [PMID: 36192621 PMCID: PMC9530152 DOI: 10.1038/s41598-022-19197-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/25/2022] [Indexed: 11/17/2022] Open
Abstract
Cannabis is the main illicit psychoactive substance used by pregnant women in France. The aim of the present national survey was to describe adverse events (AEs) of recreational cannabis use during pregnancy reported to the French Addictovigilance Network (FAN). Spontaneous reports (SRs) of AEs related to recreational cannabis use during pregnancy were collected by the FAN between 01/01/2011 and 31/01/2021 (excluding cannabidiol and synthetic cannabinoids). Over the study period, 160 SRs involved cannabis use alone or in association with tobacco (59% of all SRs) which increased. Among the 175 maternal AEs, the most commons were psychiatric AEs experienced by 96 (64.9%) women, in particular cannabis use disorders (n = 89, 60.1%), dependence (n = 54, 36.5%) and abuse (n = 21, 14.2%). Among the 57 fetal AEs, the most common were heart rhythm disorders that affected 25 (16.9%) fetuses and intrauterine growth restriction (IUGR) (n = 20, 13.5%). Among the 140 neonatal AEs, the most common were IUGR experienced by 39 (26.3%) newborns and prematurity (n = 32, 21.6%). Twelve cases of congenital malformations were observed and 4 intrauterine/neonatal deaths. Furthermore, some of these AEs (n = 13) were unexpected. Cannabis use during pregnancy has problematic consequences for both mothers and infants who need close monitoring.
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24
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Martin FZ, Fraser A, Zuccolo L. Alcohol Intake and Hypertensive Disorders of Pregnancy: A Negative Control Analysis in the ALSPAC Cohort. J Am Heart Assoc 2022; 11:e025102. [PMID: 36172928 DOI: 10.1161/jaha.121.025102] [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] [Indexed: 11/16/2022]
Abstract
Background Alcohol intake increases blood pressure yet estimates of associations between maternal intake and hypertensive disorders of pregnancy (HDP) are sparse and range from null to a protective effect. Here we estimated the association of maternal drinking during pregnancy with preeclampsia and gestational hypertension (separately and jointly, as HDP). We used partner's alcohol intake as a negative control exposure, beverage type-specific models, and a range of sensitivity analyses to strengthen causal inference and reduce the influence of bias. Methods and Results We performed a longitudinal analysis of prospectively collected data on self-reported alcohol intake and presence of HDP from the UK ALSPAC (Avon Longitudinal Study of Parents and Children) cohort. Multivariable multinomial regression models were adjusted for confounders and mutually adjusted for partner's or maternal alcohol intake in the negative control analysis. We also performed a beverage type analysis of the effect of beer and wine separately on HDP risk, owing to different social patterning associated with different drinks. Sensitivity analyses assessed the robustness of results to assumptions of no recall bias, no residual confounding, and no selection bias. Of the 8999 women eligible for inclusion, 1490 fulfilled the criteria for HDP (17%). Both maternal and partner's drinking were associated with decreased HDP odds (mutually adjusted odds ratio [OR], 0.86; [95% CI, 0.77-0.96], P=0.008 and OR, 0.82; [95% CI, 0.70-0.97], P=0.018, respectively). We demonstrate the validity of the negative control analyses using the same approach for smoking as the exposure. This confirmed an inverse association for maternal but not partner's smoking, as expected. Estimates were more extreme for increasing levels of wine intake compared with increasing levels of beer. Multiple sensitivity analyses did not alter our conclusions. Conclusions We observed an inverse relationship between alcohol intake during pregnancy and risk of HDP for both maternal and, more surprisingly, partner's drinking. We speculate that this is more likely to be due to common environmental exposures shared between pregnant women and their partners rather than a true causal effect. This warrants further investigation using different study designs, including Mendelian randomization.
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Affiliation(s)
- Florence Z Martin
- MRC Integrative Epidemiology Unit (IEU) University of Bristol United Kingdom
| | - Abigail Fraser
- MRC Integrative Epidemiology Unit (IEU) University of Bristol United Kingdom.,Department of Population Health Sciences, Bristol Medical School University of Bristol United Kingdom.,NIHR Biomedical Research Centre, Bristol Medical School University of Bristol United Kingdom
| | - Luisa Zuccolo
- MRC Integrative Epidemiology Unit (IEU) University of Bristol United Kingdom.,Department of Population Health Sciences, Bristol Medical School University of Bristol United Kingdom
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25
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Wajid A, Todem D, Schleiss MR, Colombo DF, Paneth NS. Gestational Antibodies to C. pneumoniae, H. pylori and CMV in Women with Preeclampsia and in Matched Controls. Matern Child Health J 2022; 26:2040-2049. [PMID: 35932403 DOI: 10.1007/s10995-022-03484-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Some research has suggested a possible role for past infection in the development of preeclampsia. The objective of this study was to explore the role of Helicobacter pylori, cytomegalovirus, and Chlamydophila pneumoniae in the development of preeclampsia in a prospective pregnancy sample. METHODS We conducted a nested case-control study in The Archive for Child Health (ARCH), a pregnancy cohort of 867 unselected women enrolled at the first prenatal visit with archived blood and urine in pregnancy. We matched 21 cases of preeclampsia to 52 unaffected controls on maternal age (±4 years), race, parity, and gestational age at blood draw. Using conditional logistic regression, we examined the association between preeclampsia status and immunoglobulins G (IgG) tested by indirect ELISA to each of the three microorganisms, adjusting for potential confounders. RESULTS No significant difference was found between cases and controls. The unadjusted odds ratio was 1.5 (95%CI: 0.2-9.1), 0.6 (95%CI: 0.2-1.9), and 1.9 (95%CI: 0.6-5.6) for H. pylori, cytomegalovirus and C. pneumoniae respectively. After controlling for confounders analysis found increased odds of H. pylori IgG (AOR: 1.9; 95% CI: 0.2-15.3) and C. pneumoniae IgG (AOR: 2.3; 95% CI: 0.6-9.2) for preeclampsia, albeit being not significant. Conversely, cytomegalovirus IgG had lower odds for preeclampsia (AOR: 0.4; 95% CI: 0.1-1.7). CONCLUSIONS Past infection with H. pylori, and C. pneumoniae in early pregnancy showed a higher risk of preeclampsia, but the findings failed to achieve statistical significance. Cytomegalovirus was not associated with preeclampsia in these data. These preliminary findings encourage future research in populations with high prevalence of these infections.
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Affiliation(s)
- Abdul Wajid
- Alberta Health Services, Calgary, AB, T3A 0P6, Canada.
| | - David Todem
- Department of Epidemiology & Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Mark R Schleiss
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.,Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - Nigel S Paneth
- Department of Epidemiology & Biostatistics, Michigan State University, East Lansing, MI, USA
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26
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Ekblad MO, Gissler M, Korhonen PE. New theory about the pathophysiology of preeclampsia derived from the paradox of positive effects of maternal smoking. J Hypertens 2022; 40:1223-1230. [PMID: 35703884 DOI: 10.1097/hjh.0000000000003142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate if maternal height affects the link between the inverse association on smoking during pregnancy and preeclampsia. STUDY DESIGN The study population consisted of all women with singleton pregnancies (n = 803 698) in Finland during the years 2004-2018, excluding women with unknown smoking and diagnosis of prepregnancy chronic hypertension. Information on smoking and background factors were derived from the Finnish Medical Birth Register. Smoking was categorized in three classes: no, quitted in the first trimester and continued throughout the pregnancy. Information on preeclampsia was derived from the Finnish Hospital Discharge Register and the Finnish Medical Birth Register. Multiple logistic regression models were used to estimate first the association between smoking and preeclampsia, and finally whether maternal height modified the association. RESULTS In the standard comparison, we found evidence of an association between preeclampsia and continued smoking [adjusted odds ratio = 0.74, 95% confidence interval (95% CI) = 0.67-0.81], but no association was found between quitted smoking and preeclampsia. Thus, the interaction of continued smoking and maternal height by z-scores was estimated. Among taller mothers, continued smoking was associated with a higher risk for preeclampsia than in smoking mothers with average height (β = 0.33, SE = 0.14, P = 0.02). CONCLUSION Our results partly challenge the smoking-preeclampsia paradox: smoking seems not to protect tall mothers against preeclampsia. We speculate the findings through a new theory about the pathophysiology of preeclampsia. It seems that tall pregnant smokers must raise their blood pressure aggressively to ensure perfusion in the dysfunctional placenta.
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Affiliation(s)
- Mikael O Ekblad
- Department of General Practice, Institute of Clinical Medicine, University of Turku and Turku University Hospital, Turku
| | - Mika Gissler
- THL Finnish Institute for Health and Welfare, Information Services Department, Helsinki.,Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,Karolinska Institute, Department of Molecular Medicine and Surgery.,Region Stockholm, Academic Primary Healthcare Centre, Stockholm, Sweden
| | - Päivi E Korhonen
- Department of General Practice, Institute of Clinical Medicine, University of Turku and Turku University Hospital, Turku
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27
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Cajachagua-Torres KN, El Marroun H, Reiss IKM, Jaddoe VWV. Maternal preconception and pregnancy tobacco and cannabis use in relation to placental developmental markers: A population-based study. Reprod Toxicol 2022; 110:70-77. [PMID: 35378220 DOI: 10.1016/j.reprotox.2022.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 11/30/2022]
Abstract
Maternal tobacco and cannabis use during pregnancy are associated with adverse perinatal outcomes. We hypothesized that maternal tobacco and cannabis use are associated with placental adaptations, which subsequently lead to adverse perinatal outcomes. In a population-based prospective cohort study of 8008 pregnant women, we assessed maternal tobacco and cannabis use by questionnaires. Placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) were measured in the first and second trimester and at delivery from blood samples. Placental weight and pregnancy complications were obtained from medical records. We observed that tobacco use before and during first-trimester only was not associated with any angiogenic factors. As compared to no tobacco use, continued use during pregnancy was associated with higher PlGF, lower sFlt-1 concentrations, and lower sFlt-1/PlGF ratio in second trimester (all p-values <0.05). Also, compared to no cannabis use, use before and during pregnancy was associated with higher PlGF concentrations and lower sFlt-1/PlGF ratio in first and second trimester (all p-values <0.05). First trimester only cannabis use was associated with higher sFlt-1 concentrations and higher sFlt-1/PlGF ratio at delivery (all p-values <0.05). Compared to non-use, tobacco use before pregnancy was associated with a higher placental weight, whereas continued tobacco use during pregnancy was associated with a lower placental weight. Continued tobacco or cannabis use was related to higher placental weight to birth weight ratio and higher risk of pregnancy complications (all p-values <0.05). These results suggest that maternal tobacco and cannabis use lead to placental vascular maladaptation predisposing to adverse pregnancy outcomes.
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Affiliation(s)
- Kim N Cajachagua-Torres
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; The Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Hanan El Marroun
- The Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; The Department of Child and Adolescent Psychiatry, Erasmus MC, University Medical Center Rotterdam, 3000 CB, Rotterdam, The Netherlands; The Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, 3062 PA, Rotterdam, The Netherlands
| | - Irwin K M Reiss
- The Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; The Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
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BANERJEE SOHINI, DEACON ALYSSA, SUTER MELISSAA, AAGAARD KJERSTIM. Understanding the Placental Biology of Tobacco Smoke, Nicotine, and Marijuana (THC) Exposures During Pregnancy. Clin Obstet Gynecol 2022; 65:347-359. [PMID: 35125390 PMCID: PMC9042338 DOI: 10.1097/grf.0000000000000691] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Widespread public health campaigns have reduces the prevalence of tobacco and nicotine exposures during pregnancy in the United States. However, tobacco and nicotine exposures during pregnancy persist as a common modifiable perinatal risk exposure. Furthermore, declines in tobacco use have been accompanied by parallel rises in both the prevalence and incidence of marijuana use in pregnancy. This is worrisome, as the macromolecules which comprise tobacco and marijuana smoke affect placental function. In this chapter we summarize the decades of evidence contributing to our understanding of the placental molecular pathophysiology accompanying these chemical exposures, thereby rendering risk of adverse perinatal outcomes.
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Affiliation(s)
- SOHINI BANERJEE
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | | | - MELISSA A. SUTER
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - KJERSTI M. AAGAARD
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
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Holme JA, Valen H, Brinchmann BC, Vist GE, Grimsrud TK, Becher R, Holme AM, Øvrevik J, Alexander J. Polycyclic aromatic hydrocarbons (PAHs) may explain the paradoxical effects of cigarette use on preeclampsia (PE). Toxicology 2022; 473:153206. [PMID: 35550401 DOI: 10.1016/j.tox.2022.153206] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/29/2022] [Accepted: 05/05/2022] [Indexed: 11/21/2022]
Abstract
Tobacco smoking and use of snus (smokeless tobacco) are associated with adverse effects on pregnancy and neonatal outcomes. Nicotine is considered a key toxicant involved in effects caused by both smoking and snus, while pyrolysis products including polycyclic aromatic hydrocarbons (PAHs) in cigarette smoke represents the constituents most unequally divided between these two groups of tobacco products. The aim of this review was: i) to compare the impact, in terms of relative effect estimates, of cigarette smoking and use of Swedish snus on pregnancy outcomes using similar non-tobacco user controls, and ii) to examine whether exposure to PAHs from smoking could explain possible differences in impact on pregnancy outcomes. We systematically searched MEDLINE, Embase, PsycInfo, Web of Science and the Cochrane Database of Systematic Reviews up to October 2021 and identified studies reporting risks for adverse pregnancy and neonatal outcomes associated with snus use and with smoking relative to pregnant women with no use of tobacco. Both snus use and smoking were associated with increased risk of stillbirth, preterm birth, and oral cleft malformation, with comparable point estimates. These effects were likely due to comparable nicotine exposure. We also found striking differences. While both smoking and snus increased the risk of having small for gestational age (SGA) infants, risk from maternal smoking was markedly higher as was the reduction in birthweight. In contrast, the risk of preeclampsia (PE) was markedly lower in smokers than in controls, while snus use was associated with a slightly increased risk. We suggest that PAHs acting via AhR may explain the stronger effects of tobacco smoking on SGA and also to the apparent protective effect of cigarette smoking on PE. Possible mechanisms involved include: i) disrupted endocrine control of fetal development as well as placental development and function, and ii) stress adaption and immune suppression in placenta and mother.
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Affiliation(s)
- Jørn A Holme
- Division of Climate and Health, Norwegian Institute of Public Health, Oslo, Norway.
| | - Håkon Valen
- Division of Climate and Health, Norwegian Institute of Public Health, Oslo, Norway.
| | - Bendik C Brinchmann
- Division of Climate and Health, Norwegian Institute of Public Health, Oslo, Norway; Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway.
| | - Gunn E Vist
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway.
| | - Tom K Grimsrud
- Department of Research, Cancer Registry of Norway, Oslo, Norway.
| | - Rune Becher
- Division of Climate and Health, Norwegian Institute of Public Health, Oslo, Norway.
| | - Ane M Holme
- Department of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway.
| | - Johan Øvrevik
- Division of Climate and Health, Norwegian Institute of Public Health, Oslo, Norway; Department of Biosciences, University of Oslo, Oslo, Norway.
| | - Jan Alexander
- Division of Climate and Health, Norwegian Institute of Public Health, Oslo, Norway.
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Yang Y, Wu N. Gestational Diabetes Mellitus and Preeclampsia: Correlation and Influencing Factors. Front Cardiovasc Med 2022; 9:831297. [PMID: 35252402 PMCID: PMC8889031 DOI: 10.3389/fcvm.2022.831297] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/20/2022] [Indexed: 12/16/2022] Open
Abstract
Gestational diabetes mellitus (GDM) and preeclampsia (PE) are common pregnancy complications with similar risk factors and pathophysiological changes. Evidence from previous studies suggests that the incidence of PE is significantly increased in women with GDM, but whether GDM is independently related to the occurrence of PE has remained controversial. GDM complicated by PE further increases perinatal adverse events with greater impact on the future maternal and offspring health. Identify factors associated with PE in women with GDM women, specifically those that are controllable, is important for improving pregnancy outcomes. This paper provides the findings of a review on the correlation between GDM and PE, factors associated with PE in women with GDM, possible mechanisms, and predictive markers. Most studies concluded that GDM is independently associated with PE in singleton pregnancy, and optimizing the treatment and management of GDM can reduce the incidence of PE, which is very helpful to improve pregnancy outcomes.
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Affiliation(s)
- Ying Yang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Na Wu
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Skills Practice Teaching Center, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Na Wu
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Yagel S, Cohen SM, Goldman-Wohl D. An integrated model of preeclampsia: a multifaceted syndrome of the maternal cardiovascular-placental-fetal array. Am J Obstet Gynecol 2022; 226:S963-S972. [PMID: 33712272 DOI: 10.1016/j.ajog.2020.10.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/13/2020] [Accepted: 10/19/2020] [Indexed: 12/16/2022]
Abstract
Maternal tolerance of the semiallogenic fetus necessitates conciliation of competing interests. Viviparity evolved with a placenta to mediate the needs of the fetus and maternal adaptation to the demands of pregnancy and to ensure optimal survival for both entities. The maternal-fetal interface is imagined as a 2-dimensional porous barrier between the mother and fetus, when in fact it is an intricate multidimensional array of tissues and resident and circulating factors at play, encompassing the developing fetus, the growing placenta, the changing decidua, and the dynamic maternal cardiovascular system. Pregnancy triggers dramatic changes to maternal hemodynamics to meet the growing demands of the developing fetus. Nearly a century of extensive research into the development and function of the placenta has revealed the role of placental dysfunction in the great obstetrical syndromes, among them preeclampsia. Recently, a debate has arisen questioning the primacy of the placenta in the etiology of preeclampsia, asserting that the maternal cardiovascular system is the instigator of the disorder. It was the clinical observation of the high rate of preeclampsia in hydatidiform mole that initiated the focus on the placenta in the etiology of the disease. Over many years of research, shallow trophoblast invasion with deficient remodeling of the maternal spiral arteries into vessels of higher capacitance and lower resistance has been recognized as hallmarks of the preeclamptic milieu. The lack of the normal decrease in uterine artery resistance is likewise predictive of preeclampsia. In abdominal pregnancies, however, an extrauterine pregnancy develops without remodeling of the spiral arteries, yet there is reduced resistance in the uterine arteries and distant vessels, such as the maternal ophthalmic arteries. Proponents of the maternal cardiovascular model of preeclampsia point to the observed maternal hemodynamic adaptations to pregnancy and maladaptation in gestational hypertension and preeclampsia and how the latter resembles the changes associated with cardiac disease states. Recognition of the importance of the angiogenic-antiangiogenic balance between placental-derived growth factor and its receptor soluble fms-like tyrosine kinase-1 and disturbance in this balance by an excess of a circulating isoform, soluble fms-like tyrosine kinase-1, which competes for and disrupts the proangiogenic receptor binding of the vascular endothelial growth factor and placental-derived growth factor, opened new avenues of research into the pathways to normal adaptation of the maternal cardiovascular and other systems to pregnancy and maladaptation in preeclampsia. The significance of the "placenta vs heart" debate goes beyond the academic: understanding the mutuality of placental and maternal cardiac etiologies of preeclampsia has far-reaching clinical implications for designing prevention strategies, such as aspirin therapy, prediction and surveillance through maternal hemodynamic studies or serum placental-derived growth factor and soluble fms-like tyrosine kinase-1 testing, and possible treatments to attenuate the effects of insipient preeclampsia on women and their fetuses, such as RNAi therapy to counteract excess soluble fms-like tyrosine kinase-1 produced by the placenta. In this review, we will present an integrated model of the maternal-placental-fetal array that delineates the commensality among the constituent parts, showing how a disruption in any component or nexus may lead to the multifaceted syndrome of preeclampsia.
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Affiliation(s)
- Simcha Yagel
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Sarah M Cohen
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Debra Goldman-Wohl
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Tran YH, Huynh HK, Faas MM, de Vos S, Groen H. Antidepressant use during pregnancy and development of preeclampsia: A focus on classes of action and specific transporters/receptors targeted by antidepressants. J Psychiatr Res 2022; 146:92-101. [PMID: 34959164 DOI: 10.1016/j.jpsychires.2021.12.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/14/2021] [Accepted: 12/18/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The association between antidepressants and preeclampsia has been inconsistently reported. Given the compound-specific variable affinity for different transporters/receptors, their effect on preeclampsia risk could differ. Our study examined the risk of preeclampsia (and its subtypes) following exposure to different classes of antidepressants, also accounting for specific transporters/receptors targeted by antidepressants. METHODS We conducted a cohort study, combining data from the Netherlands Perinatal Registry and the PHARMO Database Network. Exposure to antidepressants was examined from conception to week 20 of gestation; extended use thereafter was also studied. Antidepressants were categorized according to classes [selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), serotonin-norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs) and other antidepressants] and according to target transporters/receptors. Women not using any antidepressants during 15 months before delivery were included as reference. RESULTS We included 2,103 exposed and 95,376 reference women. Preeclampsia occurred in 70 exposed women (15 early-onset, 55 late-onset) and in 2,582 reference women (387 early-onset, 2,195 late-onset). TCA monotherapy (214 women) was associated with an increased risk of preeclampsia (n = 15, RR 2.46, 95% CI 1.51-4.02) and late-onset preeclampsia (n = 12, RR 2.41, 95% CI 1.39-4.17, early-onset could not be evaluated). No association was detected with SSRIs, SNRIs and MAOIs. We did observe an increased risk of early-onset preeclampsia following exposure to 5-HT2A antagonizing antidepressants (6/405 women, excluding TCA users, RR 3.56, 95% CI 1.60-7.94). CONCLUSIONS Our results support an increased risk of preeclampsia and the late-onset subtype among TCA users. The association between 5-HT2A antagonists and the early-onset subtype needs to be interpreted with caution based on the relatively small number of exposed cases.
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Affiliation(s)
- Yen-Hao Tran
- Unit of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, 9713, AV, Groningen, the Netherlands; Department of Pharmacology and Clinical Pharmacy, Can Tho University of Medicine and Pharmacy, Ninh Kieu District, Can Tho, Viet Nam.
| | - Hieu K Huynh
- Department of Traumato-Orthopedics, European Hospital Georges Pompidou APHP, Paris, France; Department of International Relations, University of Medicine and Pharmacy at Ho Chi Minh City, District 5, Ho Chi Minh, Viet Nam
| | - Marijke M Faas
- Department of Pathology and Medical Biology, Division of Medical Biology, University of Groningen, University Medical Center Groningen, 9713, AV, Groningen, the Netherlands
| | - Stijn de Vos
- Unit of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, 9713, AV, Groningen, the Netherlands
| | - Henk Groen
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, 9700, RB, Groningen, the Netherlands
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Pétursdóttir Maack H, Sundström Poromaa I, Lindström L, Mulic-Lutvica A, Junus K, Wikström AK. Ultrasound estimated subcutaneous and visceral adipose tissue thicknesses and risk of pre-eclampsia. Sci Rep 2021; 11:22740. [PMID: 34815471 PMCID: PMC8611080 DOI: 10.1038/s41598-021-02208-z] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 11/10/2021] [Indexed: 12/14/2022] Open
Abstract
Early identification of high-risk pregnancies enables identification of those who would benefit from aspirin prophylaxis and increased surveillance for pre-eclampsia. A high body mass index (BMI) is a well-known predictor for pre-eclampsia. However, if abdominal adipose tissue distribution is associated with pre-eclampsia is limited investigated. Subcutaneous adipose tissue (SAT) thickness and visceral adipose tissue (VAT) thickness were measured by ultrasound on 3777 women at around 18 gestational weeks. SAT thickness was measured from the skin to linea alba and VAT from linea alba to the anterior aortic wall. The risk of developing pre-eclampsia (de novo hypertension at ≥ 20 gestational weeks in combination with proteinuria) was evaluated by logistic regression and expressed as odds ratio (OR) with 95% confidence intervals (CI). The risk of pre-eclampsia increased by 79% for every cm in SAT thickness (OR 1.79; 95% CI 1.48-2.17) and by 23% for every cm VAT thickness (OR 1.23; 95% CI 1.11-1.35). After adjustment for maternal age, parity, BMI, smoking and country of birth, the association between SAT thickness and pre-eclampsia remained (AOR 1.35; 95% CI 1.02-1.79). Greater SAT thickness measured with second trimester ultrasound is associated with increased risk of developing pre-eclampsia. The measurement may improve prediction models for pre-eclampsia.
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Affiliation(s)
| | | | - Linda Lindström
- Department of Women's and Children's Health, Uppsala University, 751 85, Uppsala, Sweden
| | - Ajlana Mulic-Lutvica
- Department of Women's and Children's Health, Uppsala University, 751 85, Uppsala, Sweden
| | - Katja Junus
- Department of Women's and Children's Health, Uppsala University, 751 85, Uppsala, Sweden
| | - Anna-Karin Wikström
- Department of Women's and Children's Health, Uppsala University, 751 85, Uppsala, Sweden
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Morales-Prieto DM, Fuentes-Zacarías P, Murrieta-Coxca JM, Gutierrez-Samudio RN, Favaro RR, Fitzgerald JS, Markert UR. Smoking for two- effects of tobacco consumption on placenta. Mol Aspects Med 2021; 87:101023. [PMID: 34521556 DOI: 10.1016/j.mam.2021.101023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/22/2021] [Accepted: 09/07/2021] [Indexed: 12/14/2022]
Abstract
Tobacco smoking is an important public health issue recognized by the world health organization as one of the most serious, preventable risk factors for developing a series of pregnancy pathologies. Maternal smoking is positively associated with intrauterine growth restriction (IUGR) and gestational diabetes (GDM), but negatively associated with preeclampsia (PE). In this review, we examine epidemiological, clinical and laboratory studies of smoking effects on immunoregulation during pregnancy, trophoblast function, and placental vasculature development and metabolism. We aim to identify effects of tobacco smoke components on specific placental compartments or cells, which may contribute to the understanding of the influences of maternal smoking on placenta function in normal and pathological pregnancies. Data corroborates that in any trimester, smoking is unsafe for pregnancy and that its detrimental effects outweigh questionable benefits. The effects of maternal smoking on the maternal immune regulation throughout pregnancy and the impact of different tobacco products on fetal growth have not yet been fully understood. Smoking cessation rather than treatment with replacement therapies is recommended for future mothers because also single components of tobacco and its smoke may have detrimental effects on placental function.
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Affiliation(s)
| | | | | | | | - Rodolfo R Favaro
- Placenta Lab, Department of Obstetrics, University Hospital Jena, Jena, Germany
| | - Justine S Fitzgerald
- Placenta Lab, Department of Obstetrics, University Hospital Jena, Jena, Germany; Zentrum für ambulante Medizin, University Hospital Jena, Jena, Germany
| | - Udo R Markert
- Placenta Lab, Department of Obstetrics, University Hospital Jena, Jena, Germany.
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Spadarella E, Leso V, Fontana L, Giordano A, Iavicoli I. Occupational Risk Factors and Hypertensive Disorders in Pregnancy: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168277. [PMID: 34444025 PMCID: PMC8392340 DOI: 10.3390/ijerph18168277] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/29/2021] [Accepted: 07/31/2021] [Indexed: 12/28/2022]
Abstract
Hypertensive disorders in pregnancy (HDP), including gestational hypertension (GH) and preeclampsia (PE), characterize a major cause of maternal and prenatal morbidity and mortality. In this systematic review, we tested the hypothesis that occupational factors would impact the risk for HDP in pregnant workers. MEDLINE, Scopus, and Web of Knowledge databases were searched for studies published between database inception and 1 April 2021. All observational studies enrolling > 10 pregnant workers and published in English were included. Un-experimental, non-occupational human studies were excluded. Evidence was synthesized according to the risk for HDP development in employed women, eventually exposed to chemical, physical, biological and organizational risk factors. The evidence quality was assessed through the Newcastle–Ottawa scale. Out of 745 records identified, 27 were eligible. No definite conclusions could be extrapolated for the majority of the examined risk factors, while more homogenous data supported positive associations between job-strain and HDP risk. Limitations due to the lack of suitable characterizations of workplace exposure (i.e., doses, length, co-exposures) and possible interplay with personal issues should be deeply addressed. This may be helpful to better assess occupational risks for pregnant women and plan adequate measures of control to protect their health and that of their children.
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Morisaki N, Piedvache A, Nagata C, Michikawa T, Morokuma S, Kato K, Sanefuji M, Shibata E, Tsuji M, Shimono M, Ohga S, Kusuhara K. Maternal blood count parameters of chronic inflammation by gestational age and their associations with risk of preterm delivery in the Japan Environment and Children's Study. Sci Rep 2021; 11:15522. [PMID: 34330940 PMCID: PMC8324902 DOI: 10.1038/s41598-021-93101-2] [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: 03/17/2020] [Accepted: 06/21/2021] [Indexed: 11/09/2022] Open
Abstract
Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR), are three reportedly predictive biomarkers that reflect subclinical chronic inflammatory burden. However, how these biomarkers change during pregnancy and its clinical utility among pregnant women have been rarely studied. Among 76,853 singleton pregnancies delivered at 28–41 weeks of gestation that were enrolled in the Japan Environment and Children’s Study, we observed the distribution of maternal NLR, PLR, and LMR values from week 0 to week 36 using spline curves, as well as their predictive values for preterm delivery with and without hypertensive disorders in pregnancy, placental abruption and intrauterine growth restriction (collectively termed ischemic placental disease due to their shared pathological and pathophysiological features) for measurements at 8–11 weeks, 12–17 weeks, and 18–21 weeks. NLR and PLR increased, whereas LMR decreased, with increasing gestation. High LMR and low NLR observed at 18–21 weeks, but not at earlier gestations, were associated with higher risk of preterm delivery with IPD (odds ratio 1.80 [95% CI 1.02, 3.19] per log[LMR]; odds ratio 0.49 [95% CI 0.29, 0.82] per log[NLR]). All parameters were not predictive of preterm delivery without IPD. We provide a robust reference curve for maternal blood count parameters NLR, PLR, and LMR by gestational week.
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Affiliation(s)
- Naho Morisaki
- Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Aurélie Piedvache
- Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Chie Nagata
- Department of Education for Clinical Research, National Center for Child Health and Development, Tokyo, Japan
| | - Takehiro Michikawa
- Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan
| | - Seiichi Morokuma
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Kiyoko Kato
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masafumi Sanefuji
- Research Center for Environmental and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Eiji Shibata
- Regional Center for Japan Environment and Children's Study (JECS), University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Mayumi Tsuji
- Department of Environmental Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Masayuki Shimono
- Regional Center for Japan Environment and Children's Study (JECS), University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koichi Kusuhara
- Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
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Wedn AM, El-Bassossy HM, Eid AH, El-Mas MM. Modulation of preeclampsia by the cholinergic anti-inflammatory pathway: Therapeutic perspectives. Biochem Pharmacol 2021; 192:114703. [PMID: 34324867 DOI: 10.1016/j.bcp.2021.114703] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 12/12/2022]
Abstract
The cholinergic anti-inflammatory pathway (CAP) is vital for the orchestration of the immune and inflammatory responses under normal and challenged conditions. Over the past two decades, peripheral and central circuits of CAP have been shown to be critically involved in dampening the inflammatory reaction in a wide array of inflammatory disorders. Additionally, emerging evidence supports a key role for CAP in the regulation of the female reproductive system during gestation as well as in the advent of serious pregnancy-related inflammatory insults such as preeclampsia (PE). Within this framework, the modulatory action of CAP encompasses the perinatal maternal and fetal adverse consequences that surface due to antenatal PE programming. Albeit, a considerable gap still exists in our knowledge of the precise cellular and molecular underpinnings of PE/CAP interaction, which hampered global efforts in safeguarding effective preventive or therapeutic measures against PE complications. Here, we summarize reports in the literature regarding the roles of peripheral and reflex cholinergic neuroinflammatory pathways of nicotinic acetylcholine receptors (nAChRs) in reprogramming PE complications in mothers and their progenies. The possible contributions of α7-nAChRs, cholinesterases, immune cells, adhesion molecules, angiogenesis, and endothelial dysfunction to the interaction have also been reviewed.
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Affiliation(s)
- Abdalla M Wedn
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
| | - Hany M El-Bassossy
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
| | - Ali H Eid
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar; Biomedical and Pharmaceutical Research Unit, QU Health, Qatar University, Doha, Qatar
| | - Mahmoud M El-Mas
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt; Department of Pharmacology and Toxicology, Faculty of Medicine, Kuwait University, Kuwait.
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Schubert CL, Yusuf K. Serum levels of TGF-β1, cytokines, angiogenic, and anti-angiogenic factors in pregnant women who smoke. J Reprod Immunol 2021; 147:103351. [PMID: 34293588 DOI: 10.1016/j.jri.2021.103351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/18/2021] [Accepted: 07/05/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Women who smoke during pregnancy have a reduced risk of preeclampsia. The mechanism of this association is poorly understood. Preeclampsia is an anti-angiogenic and inflammatory state. Transforming growth factor beta 1 (TGF-β1) is a multi-functional anti-inflammatory cytokine that activates membrane bound endoglin on endothelial cells causing a myriad of vascular actions including vasorelaxation. The objective of the study was to determine serum levels of cytokines, angiogenic factors, placental growth factor (PlGF), TGF-β-1 and anti-angiogenic factors, soluble endoglin (sEng) and soluble vascular endothelial growth factor 1 (sVEGFR1) in smoking and non-smoking pregnant women. METHODS Using enzyme-linked immunosorbent and multiplex assays we prospectively analyzed serum levels of PIGF, TGF-β1, sEng, sVEGFR1 and cytokines in normotensive pregnant smokers and non-smokers. Exclusion criteria included maternal hypertension, autoimmune disorders, rupture of membranes, evidence of labor and drug use. RESULTS There were 59 women in the smoking and 66 in the non-smoking group. Compared to non-smoking mothers. maternal age was lower in smoking mothers with no significant difference in other demographic variables. There was no difference in levels of cytokines, anti-angiogenic factors and PlGF between the two groups. Median TGF-β1 levels were significantly higher in the smoking group (8120 pg/mL vs 6040 pg/mL, p < 0.001) and remained significant after controlling for confounders. TGF-β1 levels correlated positively with cotinine levels in the smoking group. CONCLUSIONS We speculate that higher TGF-β1 levels may explain the reduced incidence of preeclampsia in mothers who smoke by being available for action on maternal endothelium even after inactivation by circulating maternal sEng.
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Affiliation(s)
| | - Kamran Yusuf
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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Risk of chronic kidney disease in women with a history of preterm delivery: Tehran Lipid and Glucose Study. J Nephrol 2021; 34:1621-1629. [PMID: 34216382 DOI: 10.1007/s40620-021-01103-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/18/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Preterm delivery (PTD) may predict the risk of long-term maternal complications. Little is known about the association between preterm delivery and maternal risk of chronic kidney disease (CKD).This study aimed to explore whether a history of preterm delivery is associated with the risk of maternal CKD. METHODS In this population-based cohort study within the framework of the Tehran Lipid and Glucose Study (TLGS), a total of 3035 women with at least one delivery met our eligibility criteria. A time-dependent Cox proportional-hazards regression model was used to measure the hazard ratios (HRs) and 95% confidence intervals (CIs) for evaluating the association between history of preterm delivery and risk of CKD, adjusted for smoking, parity, age at first delivery, body mass index, educational level, preeclampsia, and gestational diabetes mellitus. RESULTS A total of 212 women with a history of at least one preterm delivery and 2823 women with term delivery were included. The median (interquartile range) follow-up in the preterm and term delivery groups was 16 (13.0-17.0) and 16 (14.0-17.0) years, respectively. The results of multivariate Cox regression model, adjusted for confounders, showed that the risk of CKD significantly increased by 46% in women with a history of preterm delivery. Moreover, according to the time-dependent Cox regression analysis, the risk of CKD in women with a history of preterm delivery was 2.68 (95% CI 1.02, 7.05, P = 0.04) fold higher than among those with no history of preterm delivery. CONCLUSION Pregnancy if complicated by preterm delivery, may increase the risk of future maternal morbidities. Our findings suggest that a history of preterm delivery was associated with an increased maternal risk of CKD in the long term. Further longitudinal studies are needed to confirm our findings.
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Wang J, Yang W, Xiao W, Cao S. The association between smoking during pregnancy and hypertensive disorders of pregnancy: A systematic review and meta-analysis. Int J Gynaecol Obstet 2021; 157:31-41. [PMID: 33864264 DOI: 10.1002/ijgo.13709] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/21/2021] [Accepted: 04/13/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Smoking is a major public health problem. However, its association with hypertensive disorders of pregnancy (HDP) is inconclusive. OBJECTIVE To find the association between smoking during pregnancy and HDP. SEARCH STRATEGY We searched PubMed, Ovid and Cochrane Library up to March, 2021, using terms including "smoking" and "HDP". SELECTION CRITERIA Observational studies that assessed the relationship between smoking during pregnancy and HDP were included. DATA COLLECTION AND ANALYSIS Odds ratios (OR) and 95% confidence intervals (CI), and other necessary data were extracted. Stata16.0 MP was used to analyze statistics. MAIN RESULTS A total of 13 studies were included. Meta-analysis revealed that smoking during pregnancy was a protective factor for HDP (OR 0.78, 95% CI 0.67-0.92), gestational hypertension (OR 0.74, 95% CI 0.69-0.79), and pre-eclampsia (OR 0.65, 95% CI 0.58-0.73). Subgroup analysis showed that smoking during pregnancy was a risk factor for HDP in Asia but a protective factor in Europe and North America. Neither quitting smoking before pregnancy nor during pregnancy had a statistically significant association with HDP. CONCLUSION This meta-analysis revealed that smoking during pregnancy might prevent HDP, gestational hypertension, and pre-eclampsia. Smoking during pregnancy was a risk factor for HDP in Asia but a protective factor in Europe and North America.
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Affiliation(s)
- Jianing Wang
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenbo Yang
- Department of Orthopedics, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Wenxuan Xiao
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shiyi Cao
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Bizoń A, Milnerowicz H, Kowalska-Piastun K, Milnerowicz-Nabzdyk E. The Impact of Early Pregnancy and Exposure to Tobacco Smoke on Blood Antioxidant Status and Copper, Zinc, Cadmium Concentration-A Pilot Study. Antioxidants (Basel) 2021; 10:antiox10030493. [PMID: 33809854 PMCID: PMC8004252 DOI: 10.3390/antiox10030493] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 12/18/2022] Open
Abstract
The aim of the study was to evaluate the impact of early pregnancy and exposure to tobacco smoke on antioxidant status and copper, zinc, and cadmium concentrations in the blood of non-smoking and smoking, as well as non-pregnant or pregnant women. The study included 213 women. More specifically, 150 women in first trimester of pregnancy and 63 non-pregnant women. Women were divided into subgroups according to exposure to tobacco smoke. Pregnancy significant influences higher copper and lower zinc concentration in the serum, whereas exposure to tobacco smoke during pregnancy is mainly associated with an elevation in cadmium and zinc concentration. It seems that metallothionein, superoxide dismutase, and glutathione peroxidase are the important antioxidants during early pregnancy, when exposure to tobacco smoke occurs, whereas the pregnancy itself is associated with a higher concentration of metallothionein and activity of catalase. Both pregnancy in the first trimester and exposure to tobacco smoke decrease glutathione concentration. In addition, active and passive maternal smoking have a similarly negative effect on antioxidant status in the first trimester. Early pregnancy as well as exposure to tobacco smoke is associated with significant alteration in antioxidant status and copper, zinc, and cadmium concentration. Due to a small number of smoking subjects (11 cases of non-pregnant, active smokers and 14 pregnant active smokers), the obtained results should be treated as a pilot, and this should be considered for future studies.
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Affiliation(s)
- Anna Bizoń
- Department of Biomedical and Environmental Analysis, Wroclaw Medical University, 50-556 Wroclaw, Poland; (H.M.); (K.K.-P.)
- Correspondence: ; Tel.: +48-71-784-0175; Fax: +48-71-784-0172
| | - Halina Milnerowicz
- Department of Biomedical and Environmental Analysis, Wroclaw Medical University, 50-556 Wroclaw, Poland; (H.M.); (K.K.-P.)
| | - Katarzyna Kowalska-Piastun
- Department of Biomedical and Environmental Analysis, Wroclaw Medical University, 50-556 Wroclaw, Poland; (H.M.); (K.K.-P.)
| | - Ewa Milnerowicz-Nabzdyk
- 2nd Department and Clinic of Obstetrics and Gynecology, Wroclaw Medical University, 50-556 Wroclaw, Poland;
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LIN L, LIN X, LIU Z, ZHANG H, HAN Q, CHEN R, CHEN L, YAN J. Identification and analysis of key regulatory genes associated with pre-eclampsia: a systems biology approach. MINERVA BIOTECNOL 2021. [DOI: 10.23736/s1120-4826.20.02687-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Powell MJ, Dufault SM, Gunderson EP, Benz CC. Cancer and Cardiovascular Risk in Women With Hypertensive Disorders of Pregnancy Carrying a Common IGF1R Variant. Mayo Clin Proc 2020; 95:2684-2696. [PMID: 33168159 DOI: 10.1016/j.mayocp.2020.03.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 03/31/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To evaluate the impact of insulin-like growth factor 1 receptor variant rs2016347 on the risk for breast and nonbreast cancers and cardiovascular disease in women with a history of hypertensive disorders of pregnancy (HDP). PATIENTS AND METHODS This retrospective cohort study included all parous women in the UK Biobank with prior rs2016347 genotyping (N=204,155), with enrollment taking place from March 2006 to July 2010. History of HDP was self-reported, and outcomes included breast and all nonbreast cancers, hospital diagnoses of hypertension and cardiovascular disease, and direct blood pressure measurements. RESULTS Women with previous HDP had a higher risk for future hypertension and cardiovascular diagnoses, increased blood pressures, and lower risk for breast cancer compared with women without HDP, consistent with prior studies. Hazard ratios for all nonbreast cancers were unchanged. However, when taking genotype into account, HDP-positive women carrying at least 1 thymine (T) allele of rs2016347 had a lower risk for nonbreast cancer (hazard ratio, 0.59; 95% CI, 0.37 to 0.92; P=.02) and lower systolic blood pressure (-2.08±0.98 mm Hg; P=.03) compared with women with the guanine/guanine (GG) genotype with positive evidence of interaction (HDP:T allele) for both outcomes; P=.04 and P=.03, respectively. CONCLUSION Women who experience HDP and carry a T allele of rs2016347 have 41% lower risk for developing nonbreast cancer and a lower systolic blood pressure of 2.08 mm Hg when compared with those with the GG genotype, suggesting a possible role of the insulin-like growth factor 1 axis for both cardiovascular and cancer risk in women with HDP.
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Affiliation(s)
| | - Suzanne M Dufault
- Graduate Group in Biostatistics, University of California, Berkeley, School of Public Health, Berkeley
| | - Erica P Gunderson
- Division of Research, Kaiser Permanente Northern California, Oakland
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Hasan S, Alshaikh B, Yusuf K. Serum levels of soluble Fas and Fas ligand in pregnant women who smoke. Am J Reprod Immunol 2020; 85:e13382. [PMID: 33247994 DOI: 10.1111/aji.13382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 11/23/2020] [Indexed: 12/20/2022] Open
Abstract
PROBLEM Cigarette smoking during pregnancy is associated with reduced incidence of preeclampsia. Mechanisms of this association are poorly understood. Cytokines, angiogenic, and anti-angiogenic factors are involved in the pathogenesis of preeclampsia. During normal pregnancy, Fas ligand (FasL) present on trophoblasts induces apoptosis of Fas bearing maternal immune cells. In preeclampsia, trophoblasts show increased apoptosis with reduced expression of FasL. We determined serum levels of cytokines, angiogenic (placental growth factor), anti-angiogenic factors (soluble endoglin, soluble fms-like tyrosine kinase-1), soluble Fas (sFas), and soluble FasL (sFasL) in smoking and non-smoking pregnant women. METHODS Using enzyme-linked immunosorbent and multiplex assays, we prospectively analyzed serum levels of angiogenic, anti-angiogenic factors, cytokines, sFas and sFasL in normotensive smoking and non-smoking mothers. Exclusion criteria included maternal hypertension, auto-immune disorders, rupture of membranes, evidence of labor, and drug use. RESULTS Of 100 women recruited to the study, 51 were in the non-smoking and 49 in the smoking group. Except for lower maternal age in the smoking group, there was no difference in gestation, BMI, gravidity, or ethnicity between the two groups. Levels of angiogenic, anti-angiogenic factors, cytokines, and sFas were similar between the two groups but sFasL levels were significantly higher in smoking group (38 pg/ml vs. 16 pg/ml, p < .001) and remained significant after controlling for confounders. CONCLUSION Our study demonstrates higher sFasL levels in pregnant women who smoke. Higher sFasL may explain the reduced incidence of preeclampsia in pregnant mothers who smoke by inducing apoptosis of immune cells which may otherwise induce trophoblast apoptosis.
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Affiliation(s)
- Sean Hasan
- Department of Pediatrics, Alberta Health Services, Calgary, AB, Canada
| | - Belal Alshaikh
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kamran Yusuf
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Wallin HP, Gissler M, Korhonen PE, Ekblad MO. Maternal Smoking and Hospital Treatment During Pregnancy. Nicotine Tob Res 2020; 22:1162-1169. [PMID: 31418024 DOI: 10.1093/ntr/ntz137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 08/02/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Previous research suggests that young maternal age, smoking, hospitalization during a previous pregnancy, and poor self-rated health could be risk factors for prenatal hospitalization. METHODS The objective of this retrospective observational register study was to investigate if maternal smoking during pregnancy is associated with mother's need for hospital treatment during pregnancy. The study population consists of all singleton pregnancies (n = 961 127) in 1999-2015 in Finland. Information on maternal smoking was received from the Medical Birth Register in three classes: nonsmoker, quit smoking in the first trimester, and continued smoking throughout the pregnancy. These data were linked with the Hospital Discharge Register data and analyzed according to ICD-10 chapters. RESULTS 10.7% of women continued to smoke after the first trimester. After adjusting for confounding factors women in both smoking groups had more hospital treatment compared with nonsmokers. Especially outpatient treatment was more common among mothers who continued to smoke compared to those who quit smoking in the first trimester in several ICD-10 chapters. Compared to non-smokers, aOR for mental and behavioral disorders (F00-F99) was 2.14 (95% confidence interval 2.00-2.30) in the quit smoking group and 3.88 (3.71-4.06) in the continued smoking group. Similarly, aOR for respiratory diseases (J00-J99) was 1.26 (1.15-1.39) and 1.61 (1.52-1.71), respectively and aOR for genitourinary diseases (N00-N99) was 1.10 (1.03-1.17) and 1.29 (1.23-1.35), respectively. Some similar findings were made also in inpatient care. Some similar findings were made also in inpatient care. CONCLUSIONS Women who smoke during pregnancy seem to require more hospital care for various reasons. These findings emphasize the importance of actions for smoking cessation during pregnancy and women should be encouraged to quit as early as possible. IMPLICATIONS Maternal smoking during pregnancy is associated with greater rates of both outpatient and inpatient hospital care during pregnancy. Women who quit smoking had a similar risk for hospital care during pregnancy with nonsmokers in certain diagnosis chapters, which is very motivational and could be used as an informational tool in prenatal clinics to encourage smoking cessation as it is never too late to quit smoking during pregnancy.
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Affiliation(s)
- Hanna P Wallin
- Department of Clinical Medicine; General Practice, University of Turku and Turku University Hospital, Turku, Finland.,Central Satakunta Health Federation of Municipalities, Harjavalta, Finland
| | - Mika Gissler
- National Institute for Health and Welfare (THL), Helsinki, Finland.,Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institute, Stockholm, Sweden
| | - Päivi E Korhonen
- Department of Clinical Medicine; General Practice, University of Turku and Turku University Hospital, Turku, Finland.,Central Satakunta Health Federation of Municipalities, Harjavalta, Finland
| | - Mikael O Ekblad
- Department of Clinical Medicine; General Practice, University of Turku and Turku University Hospital, Turku, Finland.,Central Satakunta Health Federation of Municipalities, Harjavalta, Finland.,Department of Human Development and Family Studies, Purdue University, West Lafayette, IN, USA
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Patorno E, Hernandez-Diaz S, Huybrechts KF, Desai RJ, Cohen JM, Mogun H, Bateman BT. Gabapentin in pregnancy and the risk of adverse neonatal and maternal outcomes: A population-based cohort study nested in the US Medicaid Analytic eXtract dataset. PLoS Med 2020; 17:e1003322. [PMID: 32870921 PMCID: PMC7462308 DOI: 10.1371/journal.pmed.1003322] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 07/30/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Despite the widespread use, only sparse information is available on the safety of gabapentin during pregnancy. We sought to evaluate the association between gabapentin exposure during pregnancy and risk of adverse neonatal and maternal outcomes. METHODS AND FINDINGS Using the United States Medicaid Analytic eXtract (MAX) dataset, we conducted a population-based study of 1,753,865 Medicaid-eligible pregnancies between January 2000 and December 2013. We examined the risk of major congenital malformations and cardiac defects associated with gabapentin exposure during the first trimester (T1), and the risk of preeclampsia (PE), preterm birth (PTB), small for gestational age (SGA), and neonatal intensive care unit admission (NICUa) associated with gabapentin exposure early, late, or both early and late in pregnancy. Gabapentin-unexposed pregnancies served as the reference. We estimated relative risks (RRs) and 95% confidence intervals (CIs) using fine stratification on the propensity score (PS) to control for over 70 confounders (e.g., maternal age, race/ethnicity, indications for gabapentin, other pain conditions, hypertension, diabetes, use of opioids, and specific morphine equivalents). We identified 4,642 pregnancies exposed in T1 (mean age = 28 years; 69% white), 3,745 exposed in early pregnancy only (28 years; 67% white), 556 exposed in late pregnancy only (27 years; 60% white), and 1,275 exposed in both early and late pregnancy (29 years; 75% white). The reference group consisted of 1,744,447 unexposed pregnancies (24 years; 40% white). The adjusted RR for major malformations was 1.07 (95% CI 0.94-1.21, p = 0.33) and for cardiac defects 1.12 (0.89-1.40, p = 0.35). Requiring ≥2 gabapentin dispensings moved the RR to 1.40 (1.03-1.90, p = 0.03) for cardiac defects. There was a higher risk of preterm birth among women exposed to gabapentin either late (RR, 1.28 [1.08-1.52], p < 0.01) or both early and late in pregnancy (RR, 1.22 [1.09-1.36], p < 0.001), SGA among women exposed to gabapentin early (1.17 [1.02-1.33], p = 0.02), late (1.39 [1.01-1.91], p = 0.05), or both early and late in pregnancy (RR, 1.32 [1.08-1.60], p < 0.01), and NICU admission among women exposed to gabapentin both early and late in pregnancy (RR, 1.35 [1.20-1.52], p < 0.001). There was no higher risk of preeclampsia among women exposed to gabapentin after adjustment. Study limitations include the potential for residual confounding and exposure misclassification. CONCLUSIONS In this large population-based study, we did not find evidence for an association between gabapentin exposure during early pregnancy and major malformations overall, although there was some evidence of a higher risk of cardiac malformations. Maternal use of gabapentin, particularly late in pregnancy, was associated with a higher risk of PTB, SGA, and NICUa.
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Affiliation(s)
- Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Sonia Hernandez-Diaz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Krista F. Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Rishi J. Desai
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jacqueline M. Cohen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Helen Mogun
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Brian T. Bateman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
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Suter MA, Aagaard KM. The impact of tobacco chemicals and nicotine on placental development. Prenat Diagn 2020; 40:1193-1200. [PMID: 32010988 PMCID: PMC7396310 DOI: 10.1002/pd.5660] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/23/2019] [Accepted: 01/19/2020] [Indexed: 12/12/2022]
Abstract
Despite decades of messages warning about the dangers of tobacco use in pregnancy, 10% to 15% of pregnant women continue to smoke. Furthermore, an increased popularity of electronic nicotine delivery systems (ENDS) over the past decade in women of childbearing age raises parallel concerns regarding the effects of vaporized nicotine use in pregnancy. While research using animal models which mimic tobacco smoke and nicotine exposure in pregnancy have largely replicated findings in humans, few studies focus directly on the effects of these exposures on the placenta. Because the placenta is a fetal derived tissue, and nicotine and other components of tobacco smoke are either processed by or transported directly through the placenta, such studies help us understand the risks of these exposures on the developing fetus. In this review, we summarize research on the placenta and placental-derived cells examining either tobacco smoke or nicotine exposure, including both histologic and subcellular (ie, epigenetic and molecular) modifications. Collectively, these studies reveal that tobacco and nicotine exposure are accompanied by some common and several unique molecular and epigenomic placental modifications. Consideration of the nature and sequelae of these molecular mediators of risk may help to better inform the public and more effectively curtail modifiable behavior.
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Affiliation(s)
- Melissa A Suter
- Baylor College of Medicine, Department of Obstetrics and Gynecology, Houston, TX
| | - Kjersti M Aagaard
- Baylor College of Medicine, Department of Obstetrics and Gynecology, Houston, TX
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Boujenah J. [Response of Jerémy Boujenah to Gilles Grangé et al.: CNGOF-SFT Expert Report and Guidelines for Smoking Management during Pregnancy-Short Text. Gynecol Obstet Fertil Senol [2020]; [7-8] : https://doi.org/10.1016/j.gofs.2020.04.005]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2020; 48:625-626. [PMID: 32448771 DOI: 10.1016/j.gofs.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Indexed: 06/11/2023]
Affiliation(s)
- J Boujenah
- Centre médical du Château, 20-22, rue Louis-Besquel, 94300 Vincennes, France.
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Diguisto C, Dochez V. [Consequences of Active Cigarette Smoking in Pregnancy - CNGOF-SFT Expert Report and Guidelines on the management of smoking during pregnancy]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2020; 48:559-566. [PMID: 32360705 DOI: 10.1016/j.gofs.2020.03.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To synthesize knowledge on the consequences of active smoking in pregnancy. METHODS The MedLine database, the Cochrane Library and French and foreign guidelines from 1999 to 2019 have been consulted. RESULTS Active maternal smoking is associated with an increased risk of first trimester complications such as early miscarriage and ectopic pregnancy with a dose-effect relationship between smoking and those risks. Active cigarette smoking during pregnancy is associated with an increased risk of certain type of birth defects, placenta abruptio, placenta previa, stillbirth and cesarean delivery. Active maternal smoking is associated with a reduced risk of pre-eclampsia. Children born to mothers who smoke are more at risk of premature birth and low birth weight with a dose-effect relationship for those two risks. CONCLUSION Apart from preeclampsia which is reduced in case of active maternal smoking, perinatal morbidity is increased among women who smoke during their pregnancy.
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Affiliation(s)
- C Diguisto
- Service de gynécologie obstétrique, maternité Olympe de Gouges, université François-Rabelais, centre hospitalier universitaire de Tours, 37100 Tours, France.
| | - V Dochez
- Service de gynécologie obstétrique, centre hospitalier universitaire de Nantes, 44093 Nantes cedex 1, France
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Lewandowska M, Więckowska B. The Influence of Various Smoking Categories on The Risk of Gestational Hypertension and Pre-Eclampsia. J Clin Med 2020; 9:jcm9061743. [PMID: 32512866 PMCID: PMC7356904 DOI: 10.3390/jcm9061743] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 05/31/2020] [Accepted: 06/03/2020] [Indexed: 12/11/2022] Open
Abstract
The relationship between smoking and the risk of pregnancy-induced hypertension (PIH) is not clearly established. Therefore, we conducted an analysis of cigarette smoking in a Polish cohort of women, recruited in the first trimester of a single pregnancy in 2015–2016. We evaluated the women who subsequently developed PIH (n = 137) (gestational hypertension—GH (n = 113) and pre-eclampsia—PE (n = 24)), and the women who remained normotensive (n = 775). The diseases odds ratios (and 95% CI—confidence intervals) were calculated in a multivariate logistic regression. In the PIH cases (vs. normotensive women) we found more smokers (25.6% vs. 17.2%, p = 0.020) including smokers in the first trimester (14.6% vs. 4.8%, p < 0.001). The average number of cigarettes smoked daily per smokers in the first trimester was 11.2 (range 2–30), and the average number of years of smoking was 11.6 (range 2–25). The number of years of smoking was a stronger risk factor for GH and PE than the number of cigarettes/day. Compared to the women who have never smoked, smoking ever before pregnancy was associated with a higher GH risk (AOR = 1.68; p = 0.043), and with no effect on PE risk (OR = 0.97; p = 0.950). Smokers in the first trimester had a higher odds ratio of GH (AOR = 4.75; p < 0.001) and PE (OR = 2.60; p = 0.136). Quitting smoking before pregnancy (ex-smokers) was associated with a lower odds ratio of GH (AOR = 0.83; p = 0.596) and PE (OR = 0.33; p = 0.288). However, quitting smoking during pregnancy was associated with a higher risk of GH (AOR = 11.63; p < 0.0001) and PE (OR = 3.57; p = 0.238). After dissection of the cohort into pre-pregnancy body–mass index (BMI) categories, smoking in the first trimester was associated with the higher hypertension risk in underweight women (OR = 22.00, p = 0.024). Conclusions: The factors that increased the risk of GH and PE were smoking in the first trimester and (paradoxically and more strongly) smoking cessation during pregnancy. Our results suggest that women of childbearing potential should be encouraged to quit smoking before pregnancy.
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Affiliation(s)
- Małgorzata Lewandowska
- Medical Faculty, Lazarski University, 02-662 Warsaw, Poland
- Division of Gynecological Surgery, University Hospital, 33 Polna Str., 60-535 Poznan, Poland
- Correspondence:
| | - Barbara Więckowska
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, 60-806 Poznan, Poland;
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