1
|
Zhao R, Ran L, Yao H, He Y, Lu X, Zhu W, Zhang Y, Zhang T, Shi S, Luo Z, Zhang C. Moxibustion ameliorates ovarian function in premature ovarian insufficiency rats by activating cAMP/PKA/CREB to promote steroidogenesis in ovarian granulosa cells. J Steroid Biochem Mol Biol 2024; 242:106547. [PMID: 38754522 DOI: 10.1016/j.jsbmb.2024.106547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 05/05/2024] [Accepted: 05/12/2024] [Indexed: 05/18/2024]
Abstract
Premature ovarian insufficiency (POI) presents a substantial challenge to women's physiological and psychological well-being. Hormone replacement therapy, as the preferred therapeutic approach, involves solely exogenous supplementation of estrogen. Moxibustion, a traditional Chinese external treatment, has been investigated in our previous studies. It not only improves hormone levels and clinical symptoms in POI patients but also safeguards ovarian reserve. This study aims to explore the regulatory mechanisms by which moxibustion modulates hormone levels and restores ovarian function in POI. A POI rat model was established using cyclophosphamide, and moxibustion treatment was applied at acupoints "CV4" and "SP6" for a total of four courses. Subsequently, ovaries from each group were subjected to transcriptome sequencing (Bulk RNA-seq). Target pathways and key genes were selected through enrichment analysis and GSVA scoring, with validation using various techniques including electron microscopy, ELISA, Western blot, and immunohistochemistry. The results demonstrated that moxibustion restored the estrous cycle in POI rats, improved sex hormone levels, reduced the number of atretic follicles, and increased the count of dominant follicles (P<0.05). Bulk RNA-seq analysis revealed that moxibustion downregulated pathways associated with ovarian dysfunction, infertility, and immune responses, upregulated pathways related to follicular development and ovarian steroidogenesis. Furthermore, our data confirmed that moxibustion significantly increased the number of ovarian granulosa cells (GCs) and upregulated the expression of proteins related to steroidogenesis in GCs, including FSHR, P450 arom, cAMP, PKA, and CREB (P<0.05), with no significant effect observed on proteins related to steroidogenesis in theca cells. These outcomes aligned with the RNA-seq results. In conclusion, these findings propose that moxibustion enhances steroidogenesis in GCs through the activation of the cAMP/PKA/CREB pathway, consequently improving impaired ovarian function in POI rats. This study provides robust evidence supporting moxibustion as a targeted intervention for treating POI by specifically regulating steroidogenesis in GCs.
Collapse
Affiliation(s)
- Rui Zhao
- Department of Acupuncture and Moxibustion, Nanjing Hospital of Chinese Medicine affiliated to Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210022, China
| | - Lingxiang Ran
- Department of Acupuncture and Moxibustion, Nanjing Hospital of Chinese Medicine affiliated to Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210022, China; Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, China
| | - Hanyue Yao
- Department of Acupuncture and Moxibustion, Nanjing Hospital of Chinese Medicine affiliated to Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210022, China
| | - Yizhi He
- Department of Acupuncture and Moxibustion, Nanjing Hospital of Chinese Medicine affiliated to Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210022, China
| | - Xinru Lu
- Department of Acupuncture and Moxibustion, Nanjing Hospital of Chinese Medicine affiliated to Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210022, China
| | - Weina Zhu
- Central Laboratory, Nanjing Hospital of Chinese Medicine affiliated to Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210022, China; Department of Biobank, Nanjing Hospital of Chinese Medicine affiliated to Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210022, China
| | - Yajie Zhang
- Central Laboratory, Nanjing Hospital of Chinese Medicine affiliated to Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210022, China; Department of Biobank, Nanjing Hospital of Chinese Medicine affiliated to Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210022, China
| | - Tianyi Zhang
- Department of Acupuncture and Moxibustion, Nanjing Hospital of Chinese Medicine affiliated to Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210022, China
| | - Shijie Shi
- Department of Acupuncture and Moxibustion, Nanjing Hospital of Chinese Medicine affiliated to Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210022, China
| | - Zheng Luo
- Department of Acupuncture and Moxibustion, Nanjing Hospital of Chinese Medicine affiliated to Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210022, China
| | - Cairong Zhang
- Department of Acupuncture and Moxibustion, Nanjing Hospital of Chinese Medicine affiliated to Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210022, China.
| |
Collapse
|
2
|
Hughes ZH, Hughes LM, Huang X, Petito LC, Grobman WA, Khan SS. Changes in Age Distribution and Maternal Mortality in a Subset of the U.S., 2014-2021. Am J Prev Med 2024; 67:114-119. [PMID: 38506785 PMCID: PMC11193619 DOI: 10.1016/j.amepre.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 02/13/2024] [Accepted: 02/13/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION This study aimed to determine the association between changes in age distribution and maternal mortality rates (MMR) in a subset of the United States between 2014 and 2021. METHODS A serial cross-sectional analysis of birthing individuals aged 15-44 years from 2014 to 2021 was performed. States that had not adopted the pregnancy checkbox as of 2014 were excluded from the primary analysis. A significant inflection point in MMR was identified in 2019 with the Joinpoint Regression Program, so all analyses were stratified: 2014-2019 and 2019-2021. The Kitagawa decomposition was applied to quantify the contribution from (1) changes in age distribution and (2) changes in age-specific MMR (ASMR) to total MMR. Data analysis occurred between 2022 and 2023. RESULTS From 2014 to 2021, the mean (standard deviation) age of birthing individuals changed from 28.3 (5.8) to 29.4 (5.7) years. The MMR (95% CI) increased significantly from 16.5 (15.8-18.5) to 18.9 (17.4-20.5) per 100,000 live births from 2014 to 2019 with acceleration in MMR to 31.8 (30.0-33.8) by 2021. The change in maternal age distribution contributed to 36% of the total change in the MMR from 2014 to 2019 and 4% from 2019 to 2021. Age-specific MMR components increased significantly for those aged 25-29 years and 30-34 years from 2014 to 2019. All 5-year age strata except the 15-19 year old group saw increases in age-specific MMR from 2019 to 2021. CONCLUSIONS MMR increased significantly from 2014 to 2021 with rapid increase after 2019. However, older age of birthing individuals explained only a minority of the increased MMR in both periods. The greatest contribution to MMR arose from increases in age-specific MMR.
Collapse
Affiliation(s)
- Zachary H Hughes
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lydia M Hughes
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Xiaoning Huang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lucia C Petito
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - William A Grobman
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Sadiya S Khan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| |
Collapse
|
3
|
Faieta M, Falcone R, Duca S, Corsetti E, Giannico R, Gigante L, Diano L, Calugi G, Spinella F, Pizzuti F. Test performance and clinical utility of expanded non-invasive prenatal test: Experience on 71,883 unselected routine cases from one single center. Prenat Diagn 2024; 44:936-945. [PMID: 38686956 DOI: 10.1002/pd.6580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 02/29/2024] [Accepted: 04/08/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE The balance between benefits and risks of discordant outcomes makes the Genome-Wide Non-Invasive Prenatal Test (GW-NIPT) controversial. This study aims to evaluate performance and clinical utility in a wide cohort of unselected clinical cases from a single center when a standardized protocol is applied and integrated with a secondary algorithm for data interpretation. METHOD In 2 years, over 70,000 pregnant patients underwent GW-NIPT for fetal common trisomies, sex chromosome aneuploidies, rare autosomal aneuploidies, segmental abnormalities (CNVs ≥ 7 Mb) and microdeletions (CNVs < 7 Mb). All samples were uniformly processed with Veriseq NIPT Solution v2 and analyzed using all data metrics along with a home-made algorithm for sequencing data analysis. Results were retrospectively reviewed for clinical outcomes. RESULTS Among 71,883 eligible cases including twin pregnancies, 1011 (1.4%) received a positive result and 781 were confirmed by invasive prenatal diagnosis. Clinical sensitivity ranged from 99.65% for common trisomy (T21, T18, T13) to 83.33% for microdeletions, while specificity remained high (99.98%) for each class of fetal abnormalities detected. CONCLUSIONS Integrating a standardized protocol with an internal algorithm allowed discordant results to be reduced, yielding high accuracy. Observed reliability in detecting genome-wide chromosomal conditions reinforced the expanded NIPT utility in clinical practice.
Collapse
Affiliation(s)
- Monica Faieta
- Department of NIPT, Eurofins Genoma Group, Rome, Italy
| | - Rossella Falcone
- Department of NIPT, Eurofins Genoma Group, Rome, Italy
- Department of Genetic Counselling, Eurofins Genoma Group, Rome, Italy
| | - Sara Duca
- Department of NIPT, Eurofins Genoma Group, Rome, Italy
| | | | | | - Laura Gigante
- Department of Genetic Counselling, Eurofins Genoma Group, Rome, Italy
| | - Laura Diano
- Department of Genetic Counselling, Eurofins Genoma Group, Rome, Italy
| | - Graziella Calugi
- Department of Research and Development, Eurofins Genoma Group, Rome, Italy
| | - Francesca Spinella
- Department of Research and Development, Eurofins Genoma Group, Rome, Italy
| | | |
Collapse
|
4
|
Hardie I, Murray A, King J, Hall HA, Luedecke E, Marryat L, Thompson L, Minnis H, Wilson P, Auyeung B. Prenatal maternal infections and early childhood developmental outcomes: analysis of linked administrative health data for Greater Glasgow & Clyde, Scotland. J Child Psychol Psychiatry 2024. [PMID: 38934255 DOI: 10.1111/jcpp.14028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Previous research has linked prenatal maternal infections to later childhood developmental outcomes and socioemotional difficulties. However, existing studies have relied on retrospectively self-reported survey data, or data on hospital-recorded infections only, resulting in gaps in data collection. METHODS This study used a large linked administrative health dataset, bringing together data from birth records, hospital records, prescriptions and routine child health reviews for 55,856 children born in Greater Glasgow & Clyde, Scotland, 2011-2015, and their mothers. Logistic regression models examined associations between prenatal infections, measured as both hospital-diagnosed prenatal infections and receipt of infection-related prescription(s) during pregnancy, and childhood developmental concern(s) identified by health visitors during 6-8 week or 27-30 month health reviews. Secondary analyses examined whether results varied by (a) specific developmental outcome types (gross-motor-skills, hearing-communication, vision-social-awareness, personal-social, emotional-behavioural-attention and speech-language-communication) and (b) the trimester(s) in which infections occurred. RESULTS After confounder/covariate adjustment, hospital-diagnosed infections were associated with increased odds of having at least one developmental concern (OR: 1.30; 95% CI: 1.19-1.42). This was broadly consistent across all developmental outcome types and appeared to be specifically linked to infections occurring in pregnancy trimesters 2 (OR: 1.34; 95% CI: 1.07-1.67) and 3 (OR: 1.33; 95% CI: 1.21-1.47), that is the trimesters in which foetal brain myelination occurs. Infection-related prescriptions were not associated with any clear increase in odds of having at least one developmental concern after confounder/covariate adjustment (OR: 1.03; 95% CI: 0.98-1.08), but were associated with slightly increased odds of concerns specifically related to personal-social (OR: 1.12; 95% CI: 1.03-1.22) and emotional-behavioural-attention (OR: 1.15; 95% CI: 1.08-1.22) development. CONCLUSIONS Prenatal infections, particularly those which are hospital-diagnosed (and likely more severe), are associated with early childhood developmental outcomes. Prevention of prenatal infections, and monitoring of support needs of affected children, may improve childhood development, but causality remains to be established.
Collapse
Affiliation(s)
- Iain Hardie
- Department of Psychology, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, UK
| | - Aja Murray
- Department of Psychology, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, UK
| | - Josiah King
- Department of Psychology, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, UK
| | - Hildigunnur Anna Hall
- Centre for Health Security and Communicable Disease Control, Directorate of Health, Reykjavík, Iceland
| | - Emily Luedecke
- Department of Psychology, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, UK
| | - Louise Marryat
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Lucy Thompson
- Centre for Rural Health, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden
| | - Helen Minnis
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Philip Wilson
- Centre for Rural Health, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Centre for Research and Education in General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Bonnie Auyeung
- Department of Psychology, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
5
|
Ahrens KA, Palmsten K, Lipkind HS, Ackerman-Banks CM, Grantham CO. Does reversible postpartum contraception reduce the risk of pregnancy condition recurrence? A longitudinal claims-based study from Maine. Ann Epidemiol 2024; 96:58-65. [PMID: 38885800 DOI: 10.1016/j.annepidem.2024.06.001] [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: 11/22/2023] [Revised: 05/17/2024] [Accepted: 06/14/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE To estimate the effect of reversible postpartum contraception use on the risk of recurrent pregnancy condition in the subsequent pregnancy and if this effect was mediated through lengthening the interpregnancy interval (IPI). METHODS We used data from the Maine Health Data Organization's Maine All Payer Claims dataset. Our study population was Maine women with a livebirth index pregnancy between 2007 and 2019 that was followed by a subsequent pregnancy starting within 60 months of index pregnancy delivery. We examined recurrence of three pregnancy conditions, separately, in groups that were not mutually exclusive: prenatal depression, hypertensive disorders of pregnancy (HDP), and gestational diabetes (GDM). Effective reversible postpartum contraception use was defined as any intrauterine device, implant, or moderately effective method (pills, patch, ring, injectable) initiated within 60 days of delivery. Short IPI was defined as ≤ 12 months. We used log-binomial regression models to estimate risk ratios and 95 % confidence intervals, adjusting for potential confounders. RESULTS Approximately 41 % (11,448/28,056) of women initiated reversible contraception within 60 days of delivery, the prevalence of short IPI was 26 %, and the risk of pregnancy condition recurrence ranged from 38 % for HDP to 55 % for prenatal depression. Reversible contraception initiation within 60 days of delivery was not associated with recurrence of the pregnancy condition in the subsequent pregnancy (aRR ranged from 0.97 to 1.00); however, it was associated with lower risk of short IPI (aRR ranged from 0.67 to 0.74). CONCLUSION(S) Although initiation of postpartum reversible contraception within 60 days of delivery lengthens the IPI, our findings suggest that it does not reduce the risk of prenatal depression, HDP, or GDM recurrence. This indicates a missed opportunity for providing evidence-based healthcare and health interventions in the intrapartum period to reduce the risk of recurrence.
Collapse
Affiliation(s)
- Katherine A Ahrens
- Associate Research Professor, Muskie School of Public Service, University of Southern Maine, Portland, ME, USA.
| | - Kristin Palmsten
- Pregnancy and Child Health Research Center, HealthPartners Institute, Minneapolis, MN, USA
| | - Heather S Lipkind
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York City, NY, USA
| | | | - Charlie O Grantham
- Associate Research Professor, Muskie School of Public Service, University of Southern Maine, Portland, ME, USA
| |
Collapse
|
6
|
Kanjanakaew A, Song M, Driessnack M, Erickson EN. Examining Cesarean Among Individuals of Advanced Maternal Age in Nurse-Midwifery Care. J Midwifery Womens Health 2024. [PMID: 38856042 DOI: 10.1111/jmwh.13656] [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] [Revised: 03/01/2024] [Indexed: 06/11/2024]
Abstract
INTRODUCTION Cesarean rates are rising, especially for individuals of advanced maternal age (AMA), defined as aged 35 or older. The Robson 10-Group Classification System (TGCS) facilitates assessment and comparison of cesarean rates among individuals in different settings. In midwifery-led care, in which pregnant people are typically healthier and seek a vaginal birth, it is unknown whether individuals of AMA have different antecedents leading to cesarean compared with younger counterparts. This study aimed to examine antecedents contributing to cesarean using Robson TGCS for individuals across age groups in midwifery care. METHODS This study was a secondary analysis of 2 cohort data sets from Oregon Health & Science University (OHSU) and University of Michigan Health Systems (UMHS) hospitals. The samples were individuals in midwifery-led care birthing at either OHSU from 2012 to 2019 or UMHS from 2007 to 2019. RESULTS A total of 11,951 individuals were studied. Overall cesarean rates were low; however, the rate for individuals of AMA was higher than the rate of their younger counterparts (18.30% vs 15.10%). The Robson groups were similar; however, the primary contributor among AMA individuals was group 5 (multiparous with previous cesarean), followed by group 2 [nulliparous with labor induced or prelabor cesarean], and group 1 [nulliparous with spontaneous labor]. In contrast, the primary contributors for younger individuals were groups 1, 2, and 5, respectively. In addition, prelabor cesarean and induced labor partly mediated the relationship between AMA and cesarean among nulliparous individuals, whereas prelabor cesarean was the key contributor to cesarean among multiparous people. DISCUSSION The cesarean rate in midwifery-led care was low. Using Robson TGCS provided additional insight into the antecedents to cesarean, rather than viewing cesarean as a single outcome. Future studies should continue to use Robson TGCS and investigate antecedents to cesarean, including factors influencing successful vaginal birth after cesarean in individuals of AMA.
Collapse
Affiliation(s)
- Antita Kanjanakaew
- Department of Obstetric and Gynaecological Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - MinKyoung Song
- School of Nursing, Oregon Health & Science University, Portland, Oregon
| | - Martha Driessnack
- School of Nursing, Oregon Health & Science University, Portland, Oregon
| | | |
Collapse
|
7
|
Pacyga DC, Papandonatos GD, Rosas L, Whalen J, Smith S, Park JS, Gardiner JC, Braun JM, Schantz SL, Strakovsky RS. Associations of per- and polyfluoroalkyl substances with maternal early second trimester sex-steroid hormones. Int J Hyg Environ Health 2024; 259:114380. [PMID: 38657330 PMCID: PMC11127781 DOI: 10.1016/j.ijheh.2024.114380] [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: 10/12/2023] [Revised: 03/30/2024] [Accepted: 04/09/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND/AIMS Pregnant women are exposed to persistent environmental contaminants, including per- and polyfluoroalkyl substances (PFAS) that disrupt thyroid function. However, it is unclear if PFAS alter maternal sex-steroid hormone levels, which support pregnancy health and fetal development. METHODS In Illinois women with relatively high socioeconomic status (n = 460), we quantified perfluorononanoic (PFNA), perfluorooctane sulfonic (PFOS), perfluorooctanoic (PFOA), methyl-perfluorooctane sulfonamide acetic acid, perfluorohexanesulphonic (PFHxS), perfluorodecanoic (PFDeA), and perfluoroundecanoic (PFUdA) acid concentrations in fasting serum samples at median 17 weeks gestation, along with plasma progesterone, testosterone, and estradiol. We evaluated covariate-adjusted associations of ln-transformed hormones with each ln-transformed PFAS individually using linear regression and with the PFAS mixture using quantile-based g-computation (QGComp). RESULTS Interquartile range (IQR) increases in PFOS were associated with higher progesterone (%Δ 3.0; 95%CI: -0.6, 6.6) and estradiol (%Δ: 8.1; 95%CI: 2.2, 14.4) levels. Additionally, PFHxS was positively associated with testosterone (%Δ: 10.2; 95%CI: 4.0, 16.7), whereas both PFDeA and PFUdA were inversely associated with testosterone (%Δ: -5.7; 95%CI: -10.3, -0.8, and %Δ: -4.1; 95%CI: -7.6, -0.4, respectively). The IQR-standardized PFAS mixture was not associated with progesterone (%Δ: 1.6; 95%CI: -5.8, 9.2), due equal partial positive (%Δ: 9.2; driven by PFOA) and negative (%Δ: -7.4; driven by PFOS) mixture associations. Similarly, the mixture was not associated with testosterone (%Δ: 5.3; 95%CI: -9.0, 20.1), due to similar partial positive (%Δ: 23.6; driven by PFHxS) and negative (%Δ: -17.4; driven by PFDeA) mixture associations. However, we observed a slightly stronger partial positive (%Δ: 25.6; driven by PFOS and PFUdA) than negative (%Δ: -16.3; driven by PFOA) association resulting in an overall non-significant positive trend between the mixture and estradiol (%Δ: 8.5; 95%CI: -3.7, 20.9). CONCLUSION PFAS mixture modeled using QGComp was not associated with maternal sex-steroid hormones due to potential opposing effects of certain PFAS. Additional prospective studies could corroborate these findings.
Collapse
Affiliation(s)
- Diana C Pacyga
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, USA; Institute for Integrative Toxicology, Michigan State University, East Lansing, MI 48824, USA; Department of Epidemiology, University of North Carolina, Chapel Hill, NC 27599, USA
| | | | - Libeth Rosas
- The Beckman Institute, University of Illinois, Urbana-Champaign, IL 61801, USA
| | - Jason Whalen
- Michigan Diabetes Research Center Chemistry Laboratory, University of Michigan, Ann Arbor, MI 48109, USA
| | - Sabrina Smith
- Environmental Chemistry Laboratory, Department of Toxic Substances Control, California Environmental Protection Agency, Berkeley, CA 94710, USA
| | - June-Soo Park
- Environmental Chemistry Laboratory, Department of Toxic Substances Control, California Environmental Protection Agency, Berkeley, CA 94710, USA; Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA 94158, USA
| | - Joseph C Gardiner
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI 48824, USA
| | - Joseph M Braun
- Department of Epidemiology, Brown University, Providence, RI 02912, USA
| | - Susan L Schantz
- The Beckman Institute, University of Illinois, Urbana-Champaign, IL 61801, USA; Department of Comparative Biosciences, University of Illinois, Urbana-Champaign, IL 61802, USA
| | - Rita S Strakovsky
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, USA; Institute for Integrative Toxicology, Michigan State University, East Lansing, MI 48824, USA.
| |
Collapse
|
8
|
Linström M, Musekwa E, Nell EM, de Waard L, Chapanduka Z. The influence of hematological profiles on the transfusion management and mortality risk of mothers presenting to the obstetric unit of a South African tertiary medical facility. Transfusion 2024; 64:986-997. [PMID: 38661229 DOI: 10.1111/trf.17849] [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: 10/26/2022] [Revised: 01/09/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Laboratory results are frequently abnormal in pregnant mothers. Abnormalities usually relate to pregnancy or associated complications. Hematological abnormalities and age in pregnancy may increase the likelihood for transfusion and mortality. STUDY DESIGN AND METHODS Hematological profiles and transfusion history of pregnant mothers presenting to a tertiary hospital, were evaluated over 2 years. Age, anemia, leukocytosis and thrombocytopenia were assessed for transfusion likelihood. Iron deficiency and coagulation were assessed in transfused patients. Anemia, leukocytosis, thrombocytopenia, human immunodeficiency virus (HIV) and transfusion were assessed for mortality likelihood. RESULTS There were 12,889 pregnant mothers included. Mothers <19-years-old had the highest prevalence of anemia (31.5%) and proportion of transfusions (19%). The transfusion likelihood was increased in mothers with anemia (odds ratios [OR] = 6.41; confidence intervals at 95% [95% CI] 5.46-7.71), leukocytosis (OR = 2.35; 95% CI 2.00-2.76) or thrombocytopenia (OR = 2.71; 95% CI 2.21-3.33). Mothers with prolonged prothrombin times received twice as many blood products as their normal counterparts (p = .03) and those with iron deficiency anemia five times more blood products (p < .001). Increased likelihood for mortality was seen in patients with anemia (OR = 4.15, 95% CI 2.03-8.49), leukocytosis (OR = 2.68; 95% CI 1.19-6.04) and those receiving blood transfusion (OR = 3.6, 95% CI 1.75-7.47). DISCUSSION Adolescence, anemia, leukocytosis and thrombocytopenia expose mothers to a high risk for transfusion and/or mortality. These risk factors should promptly trigger management and referral of patients. Presenting hematological profiles are strong predictors of maternal outcome and transfusion risk.
Collapse
Affiliation(s)
- Michael Linström
- Division of Hematological Pathology, Department of Pathology, Stellenbosch University, Cape Town, South Africa
- Division of Hematopathology, National Health Laboratory Services, Tygerberg Hospital, Cape Town, South Africa
| | - Ernest Musekwa
- Division of Hematological Pathology, Department of Pathology, Stellenbosch University, Cape Town, South Africa
- Division of Hematopathology, National Health Laboratory Services, Tygerberg Hospital, Cape Town, South Africa
| | - Erica-Mari Nell
- Division of Hematological Pathology, Department of Pathology, Stellenbosch University, Cape Town, South Africa
- Division of Hematopathology, National Health Laboratory Services, Tygerberg Hospital, Cape Town, South Africa
| | - Liesl de Waard
- Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa
| | - Zivanai Chapanduka
- Division of Hematological Pathology, Department of Pathology, Stellenbosch University, Cape Town, South Africa
- Division of Hematopathology, National Health Laboratory Services, Tygerberg Hospital, Cape Town, South Africa
| |
Collapse
|
9
|
Utari A, Cayami FK, Rahardjo TA, Sabatini SE, Ulvyana V, Winarni TI. Critical issue in the identification of Down syndrome and its problems in Central Java, Indonesia: The fact of needing health care and better management. Intractable Rare Dis Res 2024; 13:121-125. [PMID: 38836178 PMCID: PMC11145408 DOI: 10.5582/irdr.2023.01103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/26/2024] [Accepted: 03/16/2024] [Indexed: 06/06/2024] Open
Abstract
We conducted a cross-sectional study to describe the health care problems of children with Down syndrome in Central Java, Indonesia. A total of 162 children (81 boys, 81 girls) with Down syndrome were included. Congenital heart defects and hypothyroidism were found in about 50%, followed by vision and hearing problems in 27.7% and 17.3%, respectively. Almost half of cases were diagnosed after the first month of age. Advanced maternal age was identified in more than 50%, and less than 10% was based on karyotype analysis. This study describes the essential issues such as critical co-morbidities, delayed diagnosis, advanced maternal age, and lack of (accessibility to) genetic testing facilities; thus, better health care and management is needed.
Collapse
Affiliation(s)
- Agustini Utari
- Center for Biomedical Research (CEBIOR), Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia of Medicine, Universitas Diponegoro, Semarang, Indonesia
- Department of Paediatrics, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
| | - Ferdy Kurniawan Cayami
- Center for Biomedical Research (CEBIOR), Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia of Medicine, Universitas Diponegoro, Semarang, Indonesia
- Department of Anatomy, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
| | | | | | - Vynda Ulvyana
- Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
| | - Tri Indah Winarni
- Center for Biomedical Research (CEBIOR), Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia of Medicine, Universitas Diponegoro, Semarang, Indonesia
- Department of Anatomy, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
| |
Collapse
|
10
|
Pethő B, Váncsa S, Váradi A, Agócs G, Mátrai Á, Zászkaliczky-Iker F, Balogh Z, Bánhidy F, Hegyi P, Ács N. Very young and advanced maternal age strongly elevates the occurrence of nonchromosomal congenital anomalies: a systematic review and meta-analysis of population-based studies. Am J Obstet Gynecol 2024:S0002-9378(24)00592-1. [PMID: 38761840 DOI: 10.1016/j.ajog.2024.05.010] [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: 01/17/2024] [Revised: 05/02/2024] [Accepted: 05/11/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Nonchromosomal congenital anomalies (NCAs) are the most common cause of infant mortality and morbidity. The role of maternal age is well known, although the specifics are not thoroughly elucidated in the literature. OBJECTIVE To evaluate the role of maternal age in the incidence of NCAs and to pinpoint age groups at higher risk to refine screening protocols. STUDY DESIGN A systematic review and meta-analysis were conducted following the PRISMA 2020 guidelines and Cochrane Handbook. Searches were performed on October 19, 2021, across MEDLINE (via PubMed), Cochrane Library (CENTRAL), and Embase. Population-based studies assessing the impact of maternal age on the incidence of NCAs in pregnant women were included, without restrictions on age range, country, or comorbidities. A random-effects model was used for pooling effect sizes, considering the heterogeneity across studies. RESULTS From 15,547 studies, 72 were synthesized. Maternal age >35 showed an increased NCA risk (risk ratio [RR]: 1.31, confidence interval [CI]: 1.07 -1.61), rising notably after>40 (RR: 1.44, CI: 1.25 -1.66). The latter changes to 1.25 (CI: 1.08 -1.46) if the co-occurrence of chromosomal aberrations is excluded. Specific anomalies like cleft lip/palate (>40, RR: 1.57, CI: 1.11 -2.20) and circulatory system defects (>40, RR: 1.94, CI: 1.28 -2.93) were significantly associated with advanced maternal age. Conversely, gastroschisis was linked to mothers <20 (RR: 3.08, CI: 2.74 -3.47). CONCLUSION The study confirms that both very young and advanced maternal ages significantly increase the risk of NCAs. There is a pressing need for age-specific prenatal screening protocols to better detect these anomalies, especially considering the current trend of delayed childbearing. Further research is required to fully understand the impact of maternal age on the prevalence of rarer NCAs.
Collapse
Affiliation(s)
- Boglárka Pethő
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Szilárd Váncsa
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Alex Váradi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Department of Metagenomics, University of Debrecen, Debrecen, Hungary; Department of Laboratory Medicine, University of Pécs, Pécs, Hungary
| | - Gergely Agócs
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Institute of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary
| | - Ákos Mátrai
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Franciska Zászkaliczky-Iker
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Zita Balogh
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Ferenc Bánhidy
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Nándor Ács
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
| |
Collapse
|
11
|
Masembe S, Migisha R, Turyasingura G, Aheisibwe H, Nzabandora E, Lule JC. Adverse maternal outcomes and associated factors among mothers of advanced age delivering at a tertiary hospital, southwestern Uganda: a cross-sectional study. BMC Pregnancy Childbirth 2024; 24:348. [PMID: 38714930 PMCID: PMC11075274 DOI: 10.1186/s12884-024-06557-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/29/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Mothers of advanced age, defined as pregnant women aged ≥ 35 years at the time of giving birth, are traditionally known to be associated with increased risks of adverse maternal outcomes. We determined the prevalence of adverse maternal outcomes and associated factors among mothers of advanced age who delivered at Kabale Regional Referral Hospital (KRRH), in Southwestern Uganda. METHODS We conducted a cross-sectional study at the Maternity Ward of KRRH from April to September 2023. We consecutively enrolled pregnant women aged ≥ 35 years during their immediate post-delivery period and before discharge. We obtained data on their socio-demographic, obstetric, medical characteristics and their maternal outcomes using interviewer-administered questionnaires. We defined adverse maternal outcome as any complication sustained by the mother that was related to pregnancy, delivery and immediate post-partum events (obstructed labour, antepartum haemorrhage, mode of delivery [cesarean or vacuum extraction], postpartum haemorrhage, hypertensive disorders of pregnancy, preterm or postdate pregnancy, anemia, premature rupture of membranes, multiple pregnancy, and maternal death). A participant was considered to have an adverse outcome if they experienced any one of these complications. We identified factors associated with adverse outcomes using modified Poisson regression. RESULTS Out of 417 participants, most were aged 35-37 years (n = 206; 49.4%), and had parity ≥ 5 (65.5%). The prevalence of adverse maternal outcomes was 37.6% (n = 157, 95%CI: 33.1-42.4%). Common adverse maternal outcomes included caesarian delivery (23%), and obstructed labour (14.4%). Other complications included anemia in pregnancy (4.5%), chorioamnionitis (4.1%), preterm prelabour rupture of membranes (3.9%), and chronic hypertension and preeclampsia (both 2.4%). Factors associated with adverse maternal outcomes were precipitate labour (adjusted prevalence ratio [aPR] = 1.95, 95%CI: 1.44-2.65), prolonged labour, lasting > 12 h (aPR = 2.86, 95%CI: 1.48-3.16), and chronic hypertension (aPR = 2.01, 95%CI: 1.34-3.9). CONCLUSION Approximately two-fifth of the advanced-aged mothers surveyed had adverse outcomes. Mothers with prolonged labour, precipitate labour and chronic hypertension were more likely to experience adverse outcomes. We recommend implementation of targeted interventions, emphasizing proper management of labor as well as close monitoring of hypertensive mothers, and those with precipitate or prolonged labor, to mitigate risks of adverse outcomes within this study population.
Collapse
Affiliation(s)
- Sezalio Masembe
- Department of Obstetrics and Gynaecology, Kabale School of Medicine, Kabale University, P.0 Box 317, Kabale, Uganda.
| | - Richard Migisha
- Department of Physiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Godwin Turyasingura
- Department of Obstetrics and Gynaecology, Kabale School of Medicine, Kabale University, P.0 Box 317, Kabale, Uganda
| | - Hillary Aheisibwe
- Department of Obstetrics and Gynaecology, Kabale Regional Referral Hospital, Kabale, Uganda
| | - Emmanuel Nzabandora
- Department of Obstetrics and Gynaecology, Kabale Regional Referral Hospital, Kabale, Uganda
| | - John C Lule
- Department of Obstetrics and Gynaecology, Kabale School of Medicine, Kabale University, P.0 Box 317, Kabale, Uganda
| |
Collapse
|
12
|
Veenstra J, Cohen Z, Korteweg FJ, van der Ham DP, Kuppens SM, Kroese JA, Hermsen BB, Kamphuis MM, Vanhommerig JW, van Pampus MG. Unplanned cesarean sections in advanced maternal age: A predictive model. Acta Obstet Gynecol Scand 2024; 103:927-937. [PMID: 38217302 PMCID: PMC11019528 DOI: 10.1111/aogs.14765] [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: 06/21/2023] [Revised: 12/01/2023] [Accepted: 12/11/2023] [Indexed: 01/15/2024]
Abstract
INTRODUCTION As maternal age during pregnancy is rising all over the world, there is a growing need for prognostic factors that determine maternal and perinatal outcomes in older women. MATERIAL AND METHODS This study is a retrospective cohort study of women aged 40 years or older at the time of delivery in four Santeon hospitals across the Netherlands between January 2016 and December 2019. Outcomes were compared between women of 40-44 years (advanced maternal age) and 45 years and older (very advanced maternal age). Primary outcome was unplanned cesarean section, secondary outcomes included postpartum hemorrhage and neonatal outcomes. Multivariate regression analysis was performed to analyze predictive factors for unplanned cesarean sections in women who attempted vaginal delivery. Subsequently, a predictive model and risk scores were constructed to predict unplanned cesarean section. RESULTS A cohort of 1660 women was analyzed; mean maternal age was 41.4 years, 4.8% of the women were 45 years and older. In both groups, more than half of the women had not delivered vaginally before. Unplanned cesarean sections were performed in 21.1% of the deliveries in advanced maternal age and in 29.1% in very advanced maternal age. Four predictive factors were significantly correlated with unplanned cesarean sections: higher body mass index (BMI), no previous vaginal delivery, spontaneous start of delivery and number of days needed for cervical priming. A predictive model was constructed from these factors with an area under the curve of 0.75 (95% confidence interval 0.72-0.78). A sensitivity analysis in nulliparous women proved that BMI, days of cervical priming, age, and gestational age were risk factors, whereas spontaneous start of delivery and induction were protective factors. There was one occurrence of neonatal death. CONCLUSIONS Women of advanced maternal age and those of very advanced maternal age have a higher chance of having an unplanned cesarean section compared to the general obstetric population in the Netherlands. Unplanned cesarean sections can be predicted through use of our predictive model. Risk increases with higher BMI, no previous vaginal delivery, and increasing number of days needed for cervical priming, whereas spontaneous start of labor lowers the risk. In nulliparous women, age and gestational age also increase risk, but induction lowers the risk of having an unplanned cesarean section.
Collapse
Affiliation(s)
- Joyce Veenstra
- Department of Obstetrics and GynecologyFlevoziekenhuisAlmerethe Netherlands
| | - Zoë Cohen
- Emergency DepartmentDijklander ZiekenhuisPurmerend and Hoornthe Netherlands
| | | | | | - Simone M. Kuppens
- Department of Obstetrics and GynecologyCatharina HospitalEindhoventhe Netherlands
| | - Janna A. Kroese
- Department of Obstetrics and GynecologyMedisch Spectrum TwenteEnschedethe Netherlands
| | | | | | | | | |
Collapse
|
13
|
Grossini E, Aquino CI, Venkatesan S, Troìa L, Tizzoni E, Fumagalli F, Ferrante D, Vaschetto R, Remorgida V, Surico D. Plasma Redox Balance in Advanced-Maternal-Age Pregnant Women and Effects of Plasma on Umbilical Cord Mesenchymal Stem Cells. Int J Mol Sci 2024; 25:4869. [PMID: 38732088 PMCID: PMC11084157 DOI: 10.3390/ijms25094869] [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: 03/19/2024] [Revised: 04/24/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024] Open
Abstract
Pregnancy at advanced maternal age (AMA) is a condition of potential risk for the development of maternal-fetal complications with possible repercussions even in the long term. Here, we analyzed the changes in plasma redox balance and the effects of plasma on human umbilical cord mesenchymal cells (hUMSCs) in AMA pregnant women (patients) at various timings of pregnancy. One hundred patients and twenty pregnant women younger than 40 years (controls) were recruited and evaluated at various timings during pregnancy until after delivery. Plasma samples were used to measure the thiobarbituric acid reactive substances (TBARS), glutathione and nitric oxide (NO). In addition, plasma was used to stimulate the hUMSCs, which were tested for cell viability, reactive oxygen species (ROS) and NO release. The obtained results showed that, throughout pregnancy until after delivery in patients, the levels of plasma glutathione and NO were lower than those of controls, while those of TBARS were higher. Moreover, plasma of patients reduced cell viability and NO release, and increased ROS release in hUMSCs. Our results highlighted alterations in the redox balance and the presence of potentially harmful circulating factors in plasma of patients. They could have clinical relevance for the prevention of complications related to AMA pregnancy.
Collapse
Affiliation(s)
- Elena Grossini
- Laboratory of Physiology, Department of Translational Medicine, Università del Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy;
| | - Carmen Imma Aquino
- Gynecology and Obstetrics, Department of Translational Medicine, Università del Piemonte Orientale, “Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.I.A.); (E.T.); (F.F.); (V.R.); (D.S.)
| | - Sakthipriyan Venkatesan
- Laboratory of Physiology, Department of Translational Medicine, Università del Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy;
| | - Libera Troìa
- Gynecology and Obstetrics, Department of Translational Medicine, Università del Piemonte Orientale, “Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.I.A.); (E.T.); (F.F.); (V.R.); (D.S.)
| | - Eleonora Tizzoni
- Gynecology and Obstetrics, Department of Translational Medicine, Università del Piemonte Orientale, “Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.I.A.); (E.T.); (F.F.); (V.R.); (D.S.)
| | - Federica Fumagalli
- Gynecology and Obstetrics, Department of Translational Medicine, Università del Piemonte Orientale, “Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.I.A.); (E.T.); (F.F.); (V.R.); (D.S.)
| | - Daniela Ferrante
- Medical Statistics, Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy;
| | - Rosanna Vaschetto
- Anesthesia and Intensive Care, Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy;
| | - Valentino Remorgida
- Gynecology and Obstetrics, Department of Translational Medicine, Università del Piemonte Orientale, “Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.I.A.); (E.T.); (F.F.); (V.R.); (D.S.)
| | - Daniela Surico
- Gynecology and Obstetrics, Department of Translational Medicine, Università del Piemonte Orientale, “Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.I.A.); (E.T.); (F.F.); (V.R.); (D.S.)
| |
Collapse
|
14
|
Jacovides C, Papadopoulou SK, Pavlidou E, Dakanalis A, Alexatou O, Vorvolakos T, Lechouritis E, Papacosta E, Chrysafi M, Mitsiou M, Mentzelou M, Kosti RI, Giaginis C. Association of Pregnant Women's Perinatal Depression with Sociodemographic, Anthropometric and Lifestyle Factors and Perinatal and Postnatal Outcomes: A Cross-Sectional Study. J Clin Med 2024; 13:2096. [PMID: 38610861 PMCID: PMC11012430 DOI: 10.3390/jcm13072096] [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: 02/25/2024] [Revised: 03/25/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
Background: In recent decades, the incidence of depression has gradually increased in the general population globally. Depression is also common during gestation and could result in detrimental gestational complications for both the mother and the fetus. The survey presented aimed to evaluate whether pregnant women's perinatal depression could be associated with socio-demographic, anthropometry and lifestyle factors, and perinatal and postnatal outcomes. Methods: This is a cross-sectional survey conducted on 5314 pregnant women. Socio-demographic and lifestyle factors were recorded by relevant questionnaires via face-to-face interviews. Anthropometric parameters were measured by qualified personnel. Perinatal depressive symptomatology status was evaluated by Beck's Depression Inventory (BDI-II) questionnaire. Results: Depressive symptoms throughout gestation were found in 35.1% of the enrolled women. Perinatal depression was significantly associated with lower educational and economic level, pre-pregnancy regular smoking and reduced levels of Mediterranean diet adherence levels, a higher prevalence of gestational diabetes and preterm birth, as well as a higher incidence of delivering by caesarean section and abnormal childbirth weight. Perinatal depression was also significantly associated with a higher prevalence of maternal postpartum depression and lower prevalence of exclusive breastfeeding practices, as well as with a higher incidence of childhood asthma. Conclusions: Pregnant women's perinatal depression appears to be associated with various socio-demographic, anthropometry, and lifestyle characteristics and with a higher frequency of several adverse pregnancy complications. The present findings emphasize the importance of pregnant women's perinatal mental health, highlighting the need to develop and apply public strategies and policies for psychological counseling and support of future mothers to minimize probable risk factors that may trigger perinatal depression. Novel well-organized, follow-up surveys of enhanced validity are highly recommended to establish more definitive conclusions.
Collapse
Affiliation(s)
- Constantina Jacovides
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece
| | - Sousana K Papadopoulou
- Department of Nutritional Sciences and Dietetics, Faculty of Health Sciences, International Hellenic University, 57001 Thessaloniki, Greece
| | - Eleni Pavlidou
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece
| | - Antonios Dakanalis
- Department of Mental Health, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Olga Alexatou
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece
| | - Theofanis Vorvolakos
- Department of Psychiatry, School of Health Sciences, University General Hospital of Alexandroupolis, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Eleftherios Lechouritis
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece
| | - Elena Papacosta
- Department of Physical Education and Sport Sciences, School of Education and Social Sciences, Frederick University, 3080 Limassol, Cyprus
| | - Maria Chrysafi
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece
| | - Maria Mitsiou
- Department of Physiotherapy, School of Health Sciences, International Hellenic University, 57001 Thessaloniki, Greece
| | - Maria Mentzelou
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece
| | - Rena I Kosti
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42132 Trikala, Greece
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece
| |
Collapse
|
15
|
Adediran OA. The effect of women's decision-making on child nutritional outcomes in South Africa. ECONOMICS AND HUMAN BIOLOGY 2024; 53:101355. [PMID: 38350224 DOI: 10.1016/j.ehb.2024.101355] [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: 11/14/2022] [Revised: 01/04/2024] [Accepted: 01/26/2024] [Indexed: 02/15/2024]
Abstract
Women's decision-making is a phenomenon in children's nutritional outcomes. This study investigated the causal effect of women's decision-making on child nutritional outcomes using a panel dataset from the South African National Income Dynamic Survey (NIDS) from 2014/15-2017. The child's nutritional outcomes comprised three anthropometric measurements, which included weight-for-height, weight-for-age, and height-for-age. The study used variables, which include daily expenditure, large purchases, where children attended school, who lived with the family, and where the household lived, to create a decision-making index using Multiple Correspondence Analysis (MCA). A control function approach (CFA) was used to control for endogeneity issues. Using this approach, the findings suggested that women's decision-making had a significant positive effect on the child's nutritional outcomes. While women's decision-making improves a child's weight-for-age and weight-for-height, the result was inconclusive on the child's height-for-age. The policy implications of these findings indicate that the role of women's empowerment is important and could significantly help in achieving better child nutritional outcomes. Overall, the findings suggest the evaluation of policies that ameliorate gender inequality and children's health and well-being.
Collapse
Affiliation(s)
- Olanrewaju Adewole Adediran
- Department of Sustainable Livelihoods, School of Business Leadership (SBL), University of South Africa, South Africa.
| |
Collapse
|
16
|
Sananmuang T, Mankong K, Chokeshaiusaha K. Multilayer perceptron and support vector regression models for feline parturition date prediction. Heliyon 2024; 10:e27992. [PMID: 38533015 PMCID: PMC10963322 DOI: 10.1016/j.heliyon.2024.e27992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/24/2024] [Accepted: 03/10/2024] [Indexed: 03/28/2024] Open
Abstract
A crucial challenge in feline obstetric care is the accurate prediction of the parturition date during late pregnancy. The classic simple linear regression (SLR) model, which employed the fetal biparietal diameter (BPD) as the single input feature, was frequently applied for such prediction with limited accuracy. Since Multilayer Perceptron (MLP) and Support Vector Regression (SVR) are now two of the most potent scientific regression models, this study, for the first time, introduced such models as the new promising tools for feline parturition date prediction. The following features were candidate inputs for our models: biparietal diameter (BPD), litter size, and maternal weight. We observed and compared the performance results for each model. As the best-performed model, MLP delivered the highest coefficient score (0.972 ± 0.006), lowest mean absolute error score (1.110 ± 0.060), and lowest mean squared error score (1.540 ± 0.141), respectively. For the first time in this study, BPD, litter size, and maternal weight were considered the essential features for the innovative MLP and SVR modeling. With the optimized model parameters and the described analytical platform, further verification of these advanced models in feline obstetric practices is feasible.
Collapse
Affiliation(s)
- Thanida Sananmuang
- Faculty of Veterinary Medicine, Rajamangala University of Technology Tawan-Ok, Chonburi, Thailand
| | | | - Kaj Chokeshaiusaha
- Faculty of Veterinary Medicine, Rajamangala University of Technology Tawan-Ok, Chonburi, Thailand
| |
Collapse
|
17
|
Yang H, Xiao C, Tu J. The effect of gestational diabetes mellitus on pregnancy outcomes in advanced primiparous women: A retrospective study. Medicine (Baltimore) 2024; 103:e37570. [PMID: 38552062 PMCID: PMC10977535 DOI: 10.1097/md.0000000000037570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/20/2024] [Indexed: 04/02/2024] Open
Abstract
Gestational diabetes mellitus (GDM) could have a variable degree of adverse effects on pregnancy outcomes for both pregnant women and newborns. The purpose of the study was to explore the effect of GDM on pregnancy outcomes in advanced primiparous women. A total of 1076 advanced primiparous women were included between January 2020 and December 2022. All these women were divided into the GDM group (n = 434) and the non-GDM group (n = 642). Variables included baseline characteristics, maternal, and newborn outcomes were collected. The risk of each adverse outcome was analyzed by multivariate logistic regression models. The effect of blood glucose control on pregnancy outcomes was further analyzed among GDM women with good glycaemic control (n = 381) and poor glycaemic control (n = 53). Analysis of baseline characteristics demonstrated a significant difference in prepregnancy body mass index (median, IQR: 22.27 [20.58-24.44] vs 21.17 [19.53-22.86], P < .01) between the GDM group and the non-GDM group. A significantly higher incidence rate of adverse pregnancy outcomes was found in advanced primiparous women with GDM, such as polyhydramniosis, premature birth, low-birth weight, macrosomia, and neonatal intensive care unit admission (all P < .05). Compared with the non-GDM group, the risk of polyhydramniosis was nearly twice as high in the GDM group (adjusted odds ratio: 1.94, 95% confidence interval: 1.01-3.72, P = .04) after adjusted baseline characteristics. Among the GDM group, the women with poor glycaemic control showed a significantly higher incidence rate of polyhydramnios, hypertensive disorders of pregnancy, cesarean delivery, premature birth, low-birth weight, macrosomia, and neonatal intensive care unit admission was significant than the women with good glycaemic control (all P < .05). GDM was an independent risk factor for polyhydramnios in advanced primiparous women. At the same time, good glycaemic control in diabetics advanced primiparous women could reduce adverse pregnancy outcomes.
Collapse
Affiliation(s)
- Hong Yang
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, P.R. China
| | - Chanyun Xiao
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, P.R. China
| | - Jiahui Tu
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, P.R. China
| |
Collapse
|
18
|
Kohn R, Ashana DC, Vranas KC, Viglianti EM, Hauschildt K, Chen C, Vail EA, Moroz L, Gershengorn HB. The Association of Pregnancy With Outcomes Among Critically Ill Reproductive-Aged Women: A Propensity Score-Matched Retrospective Cohort Analysis. Chest 2024:S0012-3692(24)00400-8. [PMID: 38513965 DOI: 10.1016/j.chest.2024.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 03/04/2024] [Accepted: 03/16/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND The maternal mortality rate in the United States is unacceptably high. However, the relative contribution of pregnancy to these outcomes is unknown. Studies comparing outcomes among pregnant vs nonpregnant critically ill patients show mixed results and are limited by small sample sizes. RESEARCH QUESTION What is the association of pregnancy with critical illness outcomes? STUDY DESIGN AND METHODS We performed a retrospective cohort study of women 18 to 55 years of age who received invasive mechanical ventilation (MV) on hospital day 0 or 1 or who demonstrated sepsis on admission (infection with organ failure) discharged from Premier Healthcare Database hospitals from 2008 through 2021. The exposure was pregnancy. The primary outcome was in-hospital mortality. We created propensity scores for pregnancy (using patient and hospital characteristics) and performed 1:1 propensity score matching without replacement within age strata (to ensure exact age matching). We performed multilevel multivariable mixed-effects logistic regression for propensity-matched pairs with pair as a random effect. RESULTS Three thousand ninety-three pairs were included in the matched MV cohort, and 13,002 pairs were included in the sepsis cohort. The characteristics of both cohorts were well balanced (all standard mean differences, < 0.1). Among matched pairs, unadjusted mortality was 8.0% vs 13.8% for MV and 1.4% vs 2.3% for sepsis among pregnant and nonpregnant patients, respectively. In adjusted regression, pregnancy was associated with lower odds of in-hospital mortality (MV: OR, 0.50; 95% CI, 0.41-0.60; P < .001; sepsis: OR, 0.52; 95% CI, 0.40-0.67; P < .001). INTERPRETATION In this large US cohort, critically ill pregnant women receiving MV or with sepsis showed better survival than propensity score-matched nonpregnant women. These findings must be interpreted in the context of likely residual confounding.
Collapse
Affiliation(s)
- Rachel Kohn
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadelphia, PA.
| | | | - Kelly C Vranas
- Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadelphia, PA; Department of Medicine, Oregon Health & Science University, Portland, OR; Center to Improve Veteran Involvement in Care, Portland, OR
| | - Elizabeth M Viglianti
- Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI; Department of Internal Medicine, VA Ann Arbor, Ann Arbor, MI
| | - Katrina Hauschildt
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Catherine Chen
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Emily A Vail
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA
| | - Leslie Moroz
- Department of Obstetrics and Gynecology, Yale University, New Haven, CT
| | - Hayley B Gershengorn
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL; Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| |
Collapse
|
19
|
Lai S, Zhang L, Luo Y, Gu Z, Yan Z, Zhang Y, Liang Y, Huang M, Liang J, Gu S, Chen J, Li L, Chen D, Du L. A sonographic endometrial thickness <7 mm in women undergoing in vitro fertilization increases the risk of placenta accreta spectrum. Am J Obstet Gynecol 2024:S0002-9378(24)00414-9. [PMID: 38432419 DOI: 10.1016/j.ajog.2024.02.301] [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: 08/30/2023] [Revised: 01/06/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND The prevalence of placenta accreta spectrum, a potentially life-threatening condition, has exhibited a significant global rise in recent decades. Effective screening methods and early identification strategies for placenta accreta spectrum could enable early treatment and improved outcomes. Endometrial thickness plays a crucial role in successful embryo implantation and favorable pregnancy outcomes. Extensive research has been conducted on the impact of endometrial thickness on assisted reproductive technology cycles, specifically in terms of pregnancy rates, live birth rates, and pregnancy loss rates. However, limited knowledge exists regarding the influence of endometrial thickness on placenta accreta spectrum. OBJECTIVE This study aimed to evaluate the association between preimplantation endometrial thickness and the occurrence of placenta accreta spectrum in women undergoing assisted reproductive technology cycles. STUDY DESIGN A total of 4637 women who had not undergone previous cesarean delivery and who conceived by in vitro fertilization or intracytoplasmic sperm injection-embryo transfer treatment and subsequently delivered at the Third Affiliated Hospital of Guangzhou Medical University between January 2008 and December 2020 were included in this study. To explore the relationship between endometrial thickness and placenta accreta spectrum, we used smooth curve fitting, threshold effect, and saturation effect analysis. Multivariate logistic regression analysis was performed to evaluate the independent association between endometrial thickness and placenta accreta spectrum while adjusting for potential confounding factors. Propensity score matching was performed to reduce the influence of bias and unmeasured confounders. Furthermore, we used causal mediation effect analysis to investigate the mediating role of endometrial thickness in the relationship between gravidity and ovarian stimulation protocol and the occurrence of placenta accreta spectrum. RESULTS Among the 4637 women included in this study, pregnancies with placenta accreta spectrum (159; 3.4%) had significantly thinner endometrial thickness (non-placenta accreta spectrum, 10.08±2.04 mm vs placenta accreta spectrum, 8.88±2.21 mm; P<.001) during the last ultrasound before embryo transfer. By using smooth curve fitting, it was found that changes in endometrial thickness had a significant effect on the incidence of placenta accreta spectrum up to a thickness of 10.9 mm, beyond which the effect plateaued. Then, the endometrial thickness was divided into the following 4 groups: ≤7, >7 to ≤10.9, >10.9 to ≤13, and >13 mm. The absolute rates of placenta accreta spectrum in each group were 11.91%, 3.73%, 1.35%, and 2.54%, respectively. Compared with women with an endometrial thickness from 10.9 to 13 mm, the odds of placenta accreta spectrum increased from an adjusted odds ratio of 2.27 (95% confidence interval, 1.33-3.86) for endometrial thickness from 7 to 10.9 mm to an adjusted odds ratio of 7.15 (95% confidence interval, 3.73-13.71) for endometrial thickness <7 mm after adjusting for potential confounding factors. Placenta previa remained as an independent risk factor for placenta accreta spectrum (adjusted odds ratio, 11.80; 95% confidence interval, 7.65-18.19). Moreover, endometrial thickness <7 mm was still an independent risk factor for placenta accreta spectrum (adjusted odds ratio, 3.91; 95% confidence interval, 1.57-9.73) in the matched cohort after PSM. Causal mediation analysis revealed that approximately 63.9% of the total effect of gravidity and 18.6% of the total effect of ovarian stimulation protocol on placenta accreta spectrum were mediated by endometrial thickness. CONCLUSION The findings of our study indicate that thin endometrial thickness is an independent risk factor for placenta accreta spectrum in women without previous cesarean delivery undergoing assisted reproductive technology treatment. The clinical significance of this risk factor is slightly lower than that of placenta previa. Furthermore, our results demonstrate that endometrial thickness plays a significant mediating role in the relationship between gravidity or ovarian stimulation protocol and placenta accreta spectrum.
Collapse
Affiliation(s)
- Siying Lai
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangzhou, China
| | - Lizi Zhang
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangzhou, China
| | - Yang Luo
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangzhou, China; the Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Key Laboratory for Major Obstetric Diseases of Guangdong Provice, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhongjia Gu
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangzhou, China
| | - Zhenping Yan
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangzhou, China
| | - Yuliang Zhang
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangzhou, China
| | - Yingyu Liang
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangzhou, China
| | - Minshan Huang
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangzhou, China
| | - Jingying Liang
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangzhou, China
| | - Shifeng Gu
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangzhou, China
| | - Jingsi Chen
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangzhou, China
| | - Lei Li
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangzhou, China; the Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Key Laboratory for Major Obstetric Diseases of Guangdong Provice, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Dunjin Chen
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangzhou, China.
| | - Lili Du
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangzhou, China.
| |
Collapse
|
20
|
Suissa N, Czuzoj-Shulman N, Abenhaim HA. Amniotic fluid embolism: 20-year incidence and case-fatality trends in the United States. Eur J Obstet Gynecol Reprod Biol 2024; 294:92-96. [PMID: 38219609 DOI: 10.1016/j.ejogrb.2023.12.034] [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: 08/25/2023] [Revised: 12/12/2023] [Accepted: 12/21/2023] [Indexed: 01/16/2024]
Abstract
OBJECTIVE To estimate incidence and case-fatality rates of amniotic fluid embolism (AFE) and to examine their temporal trends. STUDY DESIGN Population-based retrospective cohort study using the 2000-2019 Health Care Cost and Utilization Project, Nationwide Inpatient Sample (HCUP-NIS). Annual population rates were estimated using HCUP-NIS specific weighting. Descriptive analyses and logistic regression described trends within the cohort. RESULTS Over the study period, AFE incidence rate remained stable (mean 4.9 cases/100,000 deliveries) and the case-fatality rate declined (mean 17.7 %,95 % CI 16.40-10.09). Highest AFE incidence rates and fatality rates were in women ≥ 35 years, African-Americans, and in urban-teaching hospitals. AFE mortality rates decreased among Hispanics. CONCLUSION AFE rates remained stable and fatality rates declined over time. Highest rates of AFE occurrence and death were in women who typically have greater risk of experiencing adverse obstetrical outcomes. Continued research into early diagnostic methods and effective treatments are needed to further improve AFE incidence and mortality rates.
Collapse
Affiliation(s)
- Naomi Suissa
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | | | - Haim Arie Abenhaim
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Quebec, Canada.
| |
Collapse
|
21
|
Siriratnam P, Huda S, Butzkueven H, van der Walt A, Jokubaitis V, Monif M. Risks and outcomes of pregnancy in neuromyelitis optica spectrum disorder: A comprehensive review. Autoimmun Rev 2024; 23:103499. [PMID: 38061621 DOI: 10.1016/j.autrev.2023.103499] [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: 11/13/2023] [Accepted: 11/30/2023] [Indexed: 04/30/2024]
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is a rare central nervous system autoimmune disease. Aquaporin-4 antibody (AQP4-IgG) is present in over 75% of cases and criteria also exist for the diagnosis of seronegative NMOSD. AQP4-IgG NMOSD has a strong female predominance (9:1 ratio), with a median onset age of 40 years. Pregnancy in those with NMOSD is therefore an important topic. Fecundity in NMOSD is likely impaired, and for females who conceive, obstetric complications including miscarriages and pre-eclampsia are significantly higher in NMOSD compared to the general population and in related conditions such as multiple sclerosis (MS). In contrast to MS, NMOSD disease activity does not subside during pregnancy. Also, relapse risk substantially rises above pre-pregnancy rates in the early postpartum period. In view of the evolving landscape of NMOSD, we provide a contemporary update of the impacts of pregnancy in NMOSD.
Collapse
Affiliation(s)
- Pakeeran Siriratnam
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Saif Huda
- Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Anneke van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Vilija Jokubaitis
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Mastura Monif
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia; Department of Neurology, The Royal Melbourne Hospital, Parkville, VIC, Australia.
| |
Collapse
|
22
|
Jiang C, Wen H, Hu T, Liu Y, Dai X, Chen Y. Perinatal characteristics and pregnancy outcomes of advanced maternal age women with gestational diabetes mellitus: A retrospective cohort study. Health Sci Rep 2024; 7:e1903. [PMID: 38410499 PMCID: PMC10895077 DOI: 10.1002/hsr2.1903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/28/2024] Open
Abstract
Background and Aims The prevalence of gestational diabetes mellitus (GDM) continues to increase, and the phenomenon of women giving birth at an older age is becoming more common worldwide. Less is known abouts the impact of GDM combined with advanced maternal age (AMA) on pregnancy outcomes. To explore the impact of AMA complicated with GDM on pregnancy outcomes. Methods This study included 34,602 pregnancies between 2018 and 2020 in Hangzhou, China. The pregnant women were divided into four groups according to advanced age (≥35 years) and GDM as follows: AMA women without GDM (non-AGDM) group (n = 2614), young pregnant women with GDM (YGDM) group (n = 4016), AMA women with GDM (AGDM) group (n = 850), and young pregnant women without GDM (non-YGDM) group (n = 27,122). Univariate analysis was carried out by Mann-Whitney U test or Pearson's χ 2 test. Multivariate logistic regression analysis was used to investigate the effect of AMA and GDM on pregnancy outcomes. Results Multivariate logistic regression analysis showed that in the comparison against non-YGDM garoup, the ORs of fetal chromosome abnormality, parity, urgent cesarean section, gravidity, scheduled cesarean section, body mass index (BMI) ≥30 kg/m2, pre-eclampsia, thrombocytopenia, hyperlipidemia, BMI 25-29.9 kg/m2, blood urea nitrogen, fasting blood glucose, and creatinine in AGDM group were 16.044, 4.284, 3.530, 3.284, 3.257, 2.049, 1.935, 1.898, 1.690, 1.471, 1.304, 1.216, and 1.026 (all p < 0.05). Conclusions The prevalence of pregnant women with AGDM was 2.46% in Hang Zhou, China. The increasing gravidity of AMA women was related to a greater risk of GDM. The AGDM group associated with a greater risks of chromosomal abnormality in offspring and cesarean section, especially urgent cesarean section.
Collapse
Affiliation(s)
- Chen Jiang
- Department of Medical Technology and Information EngineeringZhejiang Chinese Medical UniversityHangzhouZhejiangChina
| | - Haiyan Wen
- Department of ObstetricsHangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital)HangzhouZhejiangChina
| | - Tingting Hu
- Department of Medical Technology and Information EngineeringZhejiang Chinese Medical UniversityHangzhouZhejiangChina
- Department of Clinical LaboratoryHangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital)HangzhouZhejiangChina
| | - Yanfei Liu
- Department of Clinical LaboratoryHangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital)HangzhouZhejiangChina
| | - Xiaoqing Dai
- Department of Medical Technology and Information EngineeringZhejiang Chinese Medical UniversityHangzhouZhejiangChina
| | - Yiming Chen
- Department of Prenatal Diagnosis and Screening CenterHangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital)HangzhouZhejiangChina
- The Fourth School of Clinical MedicalZhejiang Chinese Medical UniversityHangzhouZhejiangChina
| |
Collapse
|
23
|
Mnabwiru LR, Cho YS, Mahande MJ, Mazugun N, Mchome BL, Park EY. Impact of advanced maternal age on perinatal outcomes in Tanzania: Insights from Kilimanjaro Christian Medical Center Birth Registry. Heliyon 2024; 10:e24608. [PMID: 38298701 PMCID: PMC10828067 DOI: 10.1016/j.heliyon.2024.e24608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/10/2024] [Accepted: 01/10/2024] [Indexed: 02/02/2024] Open
Abstract
The increasing prevalence of advanced maternal age (AMA) births necessitates the exploration of associated pregnancy outcomes within the healthcare-limited context of northern Tanzania to elucidate potential region-specific risks and implications. This study explored the influence of AMA on pregnancy outcomes in northern Tanzania, where healthcare resources and infrastructure are constrained in comparison to developed countries. This cross-sectional hospital-based study utilized maternally linked data from the Kilimanjaro Christian Medical Center (KCMC) Medical Registry and included 32,798 women who delivered single infants between 2004 and 2013. Multiple logistic regression models were used to determine adjusted odds ratios (aORs) and 95 % confidence intervals (CIs) for AMA-associated adverse pregnancy outcomes. A total of 16 % of mothers belonged to AMA with increased odds of undergoing a cesarean section (aOR: 1.32; 95%CI [1.24-1.41]; P < 0.001), gestational diabetes (aOR: 13.16; 95%CI [3.28-52.86]; P < 0.001) or pregestational diabetes (aOR: 3.15; 95%CI [1.87-5.31]; P < 0.000), and developing pre-eclampsia (aOR: 1.63; 95%CI [1.41-1.89]; P < 0.000). More women with AMA reported alcohol use during pregnancy and had preexisting conditions before conception than did younger women. Maternal education level, employment status, urban residency, and Christianity were statistically significant. This study establishes a connection between AMA and higher odds of cesarean section, gestational diabetes, pregestational diabetes, and pre-eclampsia. Women with AMA were more inclined to consume alcohol during pregnancy and exhibited preexisting conditions before conception. Moreover, AMA was linked to increased odds of low birth weight, stillbirths, and NICU transfers.
Collapse
Affiliation(s)
- Lilian Remigius Mnabwiru
- Department of Obstetrics and Gynecology, Muhimbili National Hospital, Ilala, Upanga Magharibi, Tanzania
| | - Yeon Seo Cho
- Department of Obstetrics and Gynecology, Yonsei University Wonju College of Medicine, Wonju, Gangwondo, Republic of Korea
| | - Michael Johnson Mahande
- Institute of Public Health, Department of Epidemiology & Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Nicholous Mazugun
- Department of Obstetrics and Gynecology, Kilimanjaro Fertility Institute (KFI), Tanzania
| | - Bariki Lawrence Mchome
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Eun Young Park
- Department of Obstetrics and Gynecology, Yonsei University Wonju College of Medicine, Wonju, Gangwondo, Republic of Korea
| |
Collapse
|
24
|
Yang L, Shang J, Wang H, Ma J, Wang L, Ma Y, Shuo J, Xu X, Cheng R, Duan X, Zhang Q. Promising anti-ovarian aging herbal formulation He's Yangchao promotes in vitro maturation of oocytes from advanced maternal age mice. JOURNAL OF ETHNOPHARMACOLOGY 2024; 318:116890. [PMID: 37423514 DOI: 10.1016/j.jep.2023.116890] [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: 05/23/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 07/11/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Marveled at the discovery of artemisinin, the world's expectations for traditional Chinese medicine are rising. He's Yangchao formula (HSYC) is a traditional Chinese herbal formula with the effects of tonifying kidney and essence, and reconciling yin and yang. It has been clinically proven to have anti-ovarian aging effects. Age is the primary cause of diminished ovarian reserve and assisted reproductive failure in women, whether HSYC has the potential to improve in vitro maturation of oocytes from advanced maternal age (AMA) mice has yet to be determined. AIM OF THE STUDY This study aims to evaluate the efficacy and possible mechanism of HSYC in promoting in vitro maturation of oocytes from AMA mice. MATERIALS AND METHODS The GV oocytes were obtained from young and aged mice. The GV oocytes from young mice were cultured in drops of M16 medium, and the GV oocytes from AMA mice were randomly divided four groups: Vehicle group (cultured in 90% M16 medium +10% blank serum), Low HSYC group (cultured in 90% M16 medium + 10% Low HSYC-medicated serum), High-HSYC group (cultured in 90% M16 medium +10% High HSYC-medicated serum), and Quercetin group (cultured in M16 medium supplemented with 10 μM quercetin). The rates of first polar body extrusion, reactive oxygen species (ROS), intracellular calcium, and mitochondrial membrane potential levels in each groups were observed. In addition, expression levels of mitochondrial function, autophagy, DNA damage, and antioxidant-related proteins were assessed. RESULTS Supplementation of HSYC in vitro alleviated age-associated meiotic progression defects in maternally aged oocytes. Importantly, HSYC supplementation eliminated the age-related ROS accumulation to suppress DNA damage and autophagy during the in vitro maturation of maternally aged oocytes. Meanwhile, the mitochondrial function was improved after HSYC treatment, as manifested by higher mitochondrial membrane potential and lower Ca2+ levels. Furthermore, we found that HSYC supplementation during in vitro maturation of maternally aged oocytes upregulated the expression level of SIRT3, a crucial protein in regulating mitochondrial function. Consistently, the expression levels of the SOD2, PCG1α, and TFAM were increased, while the SOD2 acetylation level was decreased, which further proved its antioxidant function. CONCLUSIONS HSYC supplementation promotes in vitro maturation of oocytes from AMA mice mainly via improving mitochondrial function and alleviating oxidative stress. The mechanism may be related to the regulation of SIRT3-dependent deacetylation of the SOD2 pathway.
Collapse
Affiliation(s)
- Liuqing Yang
- Department of TCM Gynecology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, 310000, Zhejiang Province, China; Research Institute of Women's Reproductive Health, Zhejiang Chinese Medical University, No. 548 Binwen Road, Binjiang District, Hangzhou, 310053, China
| | - Jianzhou Shang
- Key Laboratory of Applied Technology on Green-Eco-Healthy Animal Husbandry of Zhejiang Province, College of Animal Science and Technology, College of Veterinary Medicine, Zhejiang A&F University, Hangzhou, 311300, China
| | - Heng Wang
- Department of TCM Gynecology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, 310000, Zhejiang Province, China
| | - Jing Ma
- Department of TCM Gynecology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, 310000, Zhejiang Province, China; Research Institute of Women's Reproductive Health, Zhejiang Chinese Medical University, No. 548 Binwen Road, Binjiang District, Hangzhou, 310053, China
| | - Ling Wang
- Zhejiang Chinese Medical University, No. 548 Binwen Road, Binjiang District, Hangzhou, 310053, China
| | - Yang Ma
- Zhejiang Chinese Medical University, No. 548 Binwen Road, Binjiang District, Hangzhou, 310053, China
| | - Jin Shuo
- Zhejiang Chinese Medical University, No. 548 Binwen Road, Binjiang District, Hangzhou, 310053, China
| | - Xiuling Xu
- Department of TCM Gynecology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, 310000, Zhejiang Province, China
| | - Ran Cheng
- Department of TCM Gynecology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, 310000, Zhejiang Province, China
| | - Xing Duan
- Key Laboratory of Applied Technology on Green-Eco-Healthy Animal Husbandry of Zhejiang Province, College of Animal Science and Technology, College of Veterinary Medicine, Zhejiang A&F University, Hangzhou, 311300, China.
| | - Qin Zhang
- Department of TCM Gynecology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, 310000, Zhejiang Province, China; Research Institute of Women's Reproductive Health, Zhejiang Chinese Medical University, No. 548 Binwen Road, Binjiang District, Hangzhou, 310053, China.
| |
Collapse
|
25
|
Khan R, Di Gesù CM, Lee J, McCullough LD. The contribution of age-related changes in the gut-brain axis to neurological disorders. Gut Microbes 2024; 16:2302801. [PMID: 38237031 PMCID: PMC10798364 DOI: 10.1080/19490976.2024.2302801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 01/04/2024] [Indexed: 01/22/2024] Open
Abstract
Trillions of microbes live symbiotically in the host, specifically in mucosal tissues such as the gut. Recent advances in metagenomics and metabolomics have revealed that the gut microbiota plays a critical role in the regulation of host immunity and metabolism, communicating through bidirectional interactions in the microbiota-gut-brain axis (MGBA). The gut microbiota regulates both gut and systemic immunity and contributes to the neurodevelopment and behaviors of the host. With aging, the composition of the microbiota changes, and emerging studies have linked these shifts in microbial populations to age-related neurological diseases (NDs). Preclinical studies have demonstrated that gut microbiota-targeted therapies can improve behavioral outcomes in the host by modulating microbial, metabolomic, and immunological profiles. In this review, we discuss the pathways of brain-to-gut or gut-to-brain signaling and summarize the role of gut microbiota and microbial metabolites across the lifespan and in disease. We highlight recent studies investigating 1) microbial changes with aging; 2) how aging of the maternal microbiome can affect offspring health; and 3) the contribution of the microbiome to both chronic age-related diseases (e.g., Parkinson's disease, Alzheimer's disease and cerebral amyloidosis), and acute brain injury, including ischemic stroke and traumatic brain injury.
Collapse
Affiliation(s)
- Romeesa Khan
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
- University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Claudia M. Di Gesù
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Juneyoung Lee
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Louise D. McCullough
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
- University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| |
Collapse
|
26
|
Xie Y, Peng G, Zhao H, Scharfe C. Association of Maternal Age and Blood Markers for Metabolic Disease in Newborns. Metabolites 2023; 14:5. [PMID: 38276295 PMCID: PMC10821442 DOI: 10.3390/metabo14010005] [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: 11/16/2023] [Revised: 12/14/2023] [Accepted: 12/17/2023] [Indexed: 01/27/2024] Open
Abstract
Pregnancy at an advanced maternal age is considered a risk factor for adverse maternal, fetal, and neonatal outcomes. Here we investigated whether maternal age could be associated with differences in the blood levels of newborn screening (NBS) markers for inborn metabolic disorders on the Recommended Universal Screening Panel (RUSP). Population-level NBS data from screen-negative singleton infants were examined, which included blood metabolic markers and covariates such as age at blood collection, birth weight, gestational age, infant sex, parent-reported ethnicity, and maternal age at delivery. Marker levels were compared between maternal age groups (age range: 1544 years) using effect size analyses, which controlled for differences in group sizes and potential confounding from other covariates. We found that 13% of the markers had maternal age-related differences, including newborn metabolites with either increased (Tetradecanoylcarnitine [C14], Palmitoylcarnitine [C16], Stearoylcarnitine [C18], Oleoylcarnitine [C18:1], Malonylcarnitine [C3DC]) or decreased (3-Hydroxyisovalerylcarnitine [C5OH]) levels at an advanced maternal age (≥35 years, absolute Cohen's d > 0.2). The increased C3DC levels in this group correlated with a higher false-positive rate in newborn screening for malonic acidemia (p-value < 0.001), while no significant difference in screening performance was seen for the other markers. Maternal age is associated with inborn metabolic differences and should be considered together with other clinical variables in genetic disease screening.
Collapse
Affiliation(s)
- Yuhan Xie
- Department of Biostatistics, Yale School of Public Health, New Haven, CT 06510, USA
- Department of Genetics, Yale School of Medicine, New Haven, CT 06510, USA
| | - Gang Peng
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Hongyu Zhao
- Department of Biostatistics, Yale School of Public Health, New Haven, CT 06510, USA
- Department of Genetics, Yale School of Medicine, New Haven, CT 06510, USA
| | - Curt Scharfe
- Department of Genetics, Yale School of Medicine, New Haven, CT 06510, USA
| |
Collapse
|
27
|
Osman KT, Nayfeh T, Alrukby J, Mehta N, Elkhabiry L, Spencer C, Aby ES. Type of donor liver transplant does not affect pregnancy outcomes-a systematic review and meta-analysis. Liver Transpl 2023; 29:1304-1312. [PMID: 37141916 DOI: 10.1097/lvt.0000000000000168] [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] [Received: 02/18/2023] [Accepted: 04/26/2023] [Indexed: 05/06/2023]
Abstract
Liver transplant (LT) has become increasingly common among reproductive-aged women. The effect of the type of liver donor, either a living donor LT (LDLT) or a deceased donor LT, on pregnancy outcomes is unknown. As such, we aim to review the available literature and assess obstetric, pregnancy, or delivery outcomes in LDLT. We conducted a comprehensive literature review of MEDLINE, EMBASE, Cochrane, and Scopus databases. Random-effect meta-regression assessed the association between the percentage of women who underwent LDLT (independent variable) and the proportion of outcomes. Meta-regression results were expressed as a regression coefficient, which transforms the proportion of outcomes of interest associated with a 1% increase in the percentage of LDLT patients. A value of 0 denotes no relationship between the outcomes and LDLT. A total of 6 articles (438 patients) were included, with a total of 806 pregnancies. Eighty-eight (20.09%) patients underwent LDLT. None of the studies segregated the data based on the type of donor LT. The median time from LT to pregnancy was 4.86 (4.62-5.03) years. Twelve (1.5%) stillbirths were reported. LDLT was statistically significantly associated with a higher rate of stillbirths (coefficient 0.002, p < 0.001; I 2 0%). The type of donor LT was not associated with an increased risk of other obstetric, pregnancy, or delivery complications. This is the first meta-analysis to evaluate the effect of the type of donor LT on pregnancy outcomes. This study highlights the lack of robust literature addressing this important topic. The results suggest that pregnancy outcomes after LDLT and deceased donor LT are comparable. Despite LDLT being statistically significantly associated with a higher rate of stillbirths, the association is weak and is unlikely to be clinically significant.
Collapse
Affiliation(s)
- Karim T Osman
- Department of Internal Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Tarek Nayfeh
- Evidence-based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Judy Alrukby
- Department of Internal Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Neev Mehta
- Department of Gastroenterology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Lina Elkhabiry
- Department of Internal Medicine, University of Alexandria, Alexandria, Egypt
| | - Carol Spencer
- Department of Library Services, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Elizabeth S Aby
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|
28
|
Mensing LC, Eliasen TU, Johansen MN, Berntsen J, Montag M, Iversen LH, Gabrielsen A. Using blastocyst re-expansion rate for deciding when to warm a new blastocyst for single vitrified-warmed blastocyst transfer. Reprod Biomed Online 2023; 47:103378. [PMID: 37862858 DOI: 10.1016/j.rbmo.2023.103378] [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: 06/19/2023] [Revised: 08/09/2023] [Accepted: 08/29/2023] [Indexed: 10/22/2023]
Abstract
RESEARCH QUESTION Can predictive post-warm parameters that support the decision to transfer a warmed blastocyst or to warm another blastocyst be identified in women with multiple frozen-vitrified blastocysts? DESIGN Retrospective single-centre observational cohort analysis. A total of 1092 single vitrified-warmed blastocyst transfers (SVBT) with known Gardner score, maternal age and live birth were used to develop live birth prediction models based on logistic regression, including post-warm re-expansion parameters. Time-lapse incubation was used for pre-vitrification and post-warm embryo culture. A dataset of 558 SVBT with the same inclusion criteria was used to validate the model, but with known clinical pregnancy outcome instead of live birth outcome. RESULTS Three different logistic regression models were developed for predicting live birth based on post-warm blastocyst re-expansion. Different post-warm assessment times indicated that a 2-h post-warm culture period was optimal for live birth prediction (model 1). Adjusting for pre-vitrification Gardner score (model 2) and in combination with maternal age (model 3) further increased predictability (area under the curve [AUC] = 0.623, 0.633, 0.666, respectively). Model validation gave an AUC of 0.617, 0.609 and 0.624, respectively. The false negative rate and true negative rate for model 3 were 2.0 and 10.1 in the development dataset and 3.5 and 8.0 in the validation dataset. CONCLUSIONS Clinical application of a simple model based on 2 h of post-warm re-expansion data, pre-vitrification Gardner score and maternal age can support a standardized approach for deciding if warming another blastocyst may increase the likelihood of live birth in SVBT.
Collapse
|
29
|
Aryan N, Grigorian A, Lucas AN, Tay-Lasso E, Zezoff DC, Fierro N, Dhillon NK, Ley EJ, Smith J, Dahan A, Johnson A, Ganske W, Biffl WL, Bayat D, Castelo M, Wintz D, Schaffer KB, Zheng DJ, Tillou A, Coimbra R, Santorelli JE, Schellenberg M, Inaba K, Emigh B, Duncan TK, Diaz G, Burruss S, Tuli R, Nahmias J. Outcomes for advanced aged (35 and older) versus younger aged pregnant trauma patients: A multicenter study. Am J Surg 2023; 226:798-802. [PMID: 37355376 DOI: 10.1016/j.amjsurg.2023.06.004] [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: 03/24/2023] [Revised: 05/25/2023] [Accepted: 06/01/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Effects of advanced maternal age (AMA) pregnancies (defined as ≥35 years) on pregnant trauma patients (PTPs) are unknown. This study compared AMA versus younger PTPs, hypothesizing AMA PTPs have increased risk of fetal delivery (FD). METHODS A retrospective (2016-2021) multicenter study included all PTPs. Multivariable logistic regression was used to evaluate risk of FD after trauma. RESULTS A total of 950 PTPs were included. Both cohorts had similar gestational age and injury severity scores. The AMA group had increased injuries to the pancreas, bladder, and stomach (p < 0.05). There was no difference in rate or associated risk of FD between cohorts (5.3% vs. 11.4%; OR 0.59, CI 0.19-1.88, p > 0.05). CONCLUSION Compared to their younger counterparts, some intra-abdominal injuries (pancreas, bladder, and stomach) were more common among AMA PTPs. However, there was no difference in rate or associated risk of FD in AMA PTPs, thus they do not require increased observation.
Collapse
Affiliation(s)
- Negaar Aryan
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, California, USA.
| | - Areg Grigorian
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, California, USA.
| | - Alexa N Lucas
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, California, USA.
| | - Erika Tay-Lasso
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, California, USA.
| | - Danielle C Zezoff
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, California, USA.
| | - Nicole Fierro
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Navpreet K Dhillon
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Eric J Ley
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Jennifer Smith
- Division of Trauma and Critical Care, Harbor-UCLA Hospital, Torrance, CA, USA.
| | - Alden Dahan
- University of California, Riverside School of Medicine, Riverside, CA, USA.
| | - Arianne Johnson
- Cottage Health Research Institute, Santa Barbara Cottage Hospital, Santa Barbara, CA, USA.
| | - William Ganske
- Cottage Health Research Institute, Santa Barbara Cottage Hospital, Santa Barbara, CA, USA.
| | - Walter L Biffl
- Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA, USA.
| | - Dunya Bayat
- Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA, USA.
| | - Matthew Castelo
- Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA, USA.
| | - Diane Wintz
- Department of Surgery, Sharp Memorial Hospital, San Diego, CA, USA.
| | | | - Dennis J Zheng
- Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
| | - Areti Tillou
- Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
| | - Raul Coimbra
- Riverside University Health System Medical Center, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, CA, USA.
| | - Jarrett E Santorelli
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California San Diego School of Medicine, San Diego, CA, USA.
| | - Morgan Schellenberg
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA.
| | - Kenji Inaba
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA.
| | - Brent Emigh
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA; Warren Alpert Medical School at Brown University, Department of Surgery, Division of Trauma, USA.
| | - Thomas K Duncan
- Department of Trauma, Ventura County Medical Center, Ventura, CA, USA.
| | - Graal Diaz
- Department of Trauma, Ventura County Medical Center, Ventura, CA, USA.
| | - Sigrid Burruss
- Department of Trauma, Acute Care Surgery, Surgical Critical Care, Loma Linda Medical Center, Loma Linda, CA, USA.
| | - Rahul Tuli
- Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, University of California Riverside School of Medicine, CA, USA.
| | - Jeffry Nahmias
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, California, USA.
| |
Collapse
|
30
|
Ooba H, Maki J, Tabuchi T, Masuyama H. Partner relationships, hopelessness, and health status strongly predict maternal well-being: an approach using light gradient boosting machine. Sci Rep 2023; 13:17032. [PMID: 37813926 PMCID: PMC10562477 DOI: 10.1038/s41598-023-44410-1] [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: 01/26/2023] [Accepted: 10/07/2023] [Indexed: 10/11/2023] Open
Abstract
No recent study has explicitly focused on predicting the well-being of pregnant women. This study used data from an extensive online survey in Japan to examine the predictors of the subjective well-being of pregnant women. We developed and validated a light Gradient Boosting Machine (lightGBM) model using data from 400 pregnant women in 2020 to identify three factors that predict subjective well-being. The results confirmed that the model could predict subjective well-being in pregnant women with 84% accuracy. New variables that contributed significantly to this prediction were "partner help", "hopelessness," and "health status". A new lightGBM model was built with these three factors, trained and validated using data from 400 pregnant women in 2020, and predicted using data from 1791 pregnant women in 2021, with an accuracy of 88%. These factors were also significant risk factors for subjective well-being in the regression analysis adjusted for maternal age, region, parity, education level, and the presence of mental illness. Mediation analysis, with "hopelessness" as the mediator, showed that both "partner help" and "health status" directly and indirectly affected the outcome.
Collapse
Affiliation(s)
- Hikaru Ooba
- Department of Obstetrics and Gynecology, Okayama University Hospital, Okayama, Okayama, Japan
| | - Jota Maki
- Department of Obstetrics and Gynecology, Okayama University Hospital, Okayama, Okayama, Japan.
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Osaka, Japan
| | - Hisashi Masuyama
- Department of Obstetrics and Gynecology, Okayama University Hospital, Okayama, Okayama, Japan
| |
Collapse
|
31
|
Tinelli A, Kosmas I, Medvediev MV, Malvasi A, Morciano A, Sparić R, Mynbaev OA. Myomectomy in adult women of reproductive age: a propensity score-matched study for pregnancy rates. Arch Gynecol Obstet 2023; 308:1351-1360. [PMID: 37450263 DOI: 10.1007/s00404-023-07135-0] [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: 08/15/2022] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE To study whether it is better to perform or not a myomectomy, in terms of surgical and reproductive outcomes in patients of advanced reproductive age, by an observational prospective study in university-affiliated and Community Hospitals. MATERIALS AND METHODS 40 years and older patients affected by non-submucous symptomatic uterine fibroids and desiring future fertility were enrolled and treated by laparoscopic intracapsular myomectomy by (LIM) or by open laparotomy (OIM), or by a non-surgical management as control group, while attempting to conceive. The primary outcome measures were fibroid characteristics, pre- and post-surgical parameters, pregnancy achievement; the secondary outcome measures were the spontaneous or ART pregnancy outcomes, eventual week of abortion and type of delivery. Propensity scores have been calculated with logistic regression for binary and continuous variables. RESULTS 202 patients completed the study: 112 operated by LIM, 40 by OIM and 50 patients as control group. Patients undergoing OIM have a worse surgical outcome than LIM. No difference was seen in pregnancy either after myomectomy or control group during follow-up. In the LIM group, there were 44 pregnancies (39.2%), and in the OIM group, there were 9 (22.5%) and 16 in the control group (32%). The weeks of delivery were statistically greater for the control group versus the surgical groups, with no difference in Apgar score between the 3 groups. CONCLUSION Patients aged over 40 years did not show substantial differences in reproductive outcome, whether operated or not. Myomectomy in over 40-year-old patients has no detrimental effect on future pregnancy rates and over when compared to expectant management.
Collapse
Affiliation(s)
- Andrea Tinelli
- Department of Obstetrics and Gynecology and CERICSAL (Centro di RIcerca Clinico Salentino), "Veris Delli Ponti Hospital", Scorrano, Via Giuseppina Delli Ponti, 73020, Lecce, Italy.
| | - Ioannis Kosmas
- Department of Obstetrics and Gynecology, Ioannina State General Hospital G. Chatzikosta, Ioannina, Greece
| | - Mykhailo V Medvediev
- Department of Obstetrics and Gynecology, Dnipro State Medical University, Dnipro, 49044, Ukraine
| | - Antonio Malvasi
- Department of Biomedical Sciences and Human Oncology, Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Andrea Morciano
- Department of Gynaecology and Obstetrics, Pia Fondazione "Card. G. Panico", Tricase, Lecce, Italy
| | - Radmila Sparić
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ospan A Mynbaev
- Moscow Institute of Physics and Technology, 141701, Dolgoprudny, Russia
- New European Surgical Academy, Berlin, Germany
| |
Collapse
|
32
|
Donzelli G, Marcos-Puig B, Peraita-Costa I, Llopis-Morales J, Morales-Suarez-Varela M. Occupational Exposure during Pregnancy and Effects on Newborns: A Nested Case-Control Study. Life (Basel) 2023; 13:1962. [PMID: 37895344 PMCID: PMC10608645 DOI: 10.3390/life13101962] [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: 08/14/2023] [Revised: 09/19/2023] [Accepted: 09/23/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The protection of pregnant workers should be based on evidence regarding the risks to reproductive health from exposure to specific work environments and conditions. The objective of this study was to identify the effects on mothers and newborns resulting from environmental exposure to various occupational risks. METHODS The study cohort was composed of 399 women admitted to the Obstetrics/Postpartum ward at Hospital La Fe in Valencia, Spain. Face-to-face interviews were conducted to establish associations between workplace exposure during pregnancy and its effects on maternal and newborn health. Sex, anthropometric characteristics, and blood gas analysis in arterial and venous umbilical cord blood at delivery were collected. RESULTS A total of 138 women were exposed to biological and/or chemical risks, 122 to physical risks, and 139 at no risk of exposure. In the group with chemical and/or biological risks, the frequency of women who resorted to in vitro fertilization to achieve the studied pregnancy is less than half of the group exposed to physical risks, with statistically significant differences (p = 0.047). The mean values for the arterial analysis in both exposure groups were within average values, with similar pH values between them, but the mean values of PCO2 and PO2 were lower in the group of neonates of mothers exposed to physical risks, with a significant difference for arterial PO2 (p = 0.027). CONCLUSION Our analysis contributes evidence for planning and prioritizing preventive actions to protect women's reproductive health. The results suggest the continuation of a future project that would consider more factors and potentially increase the sample size.
Collapse
Affiliation(s)
- Gabriele Donzelli
- Institute of Clinical Physiology of the National Research Council (CNR-IFC), 56124 Pisa, Italy;
- Department of Health Sciences, University of Florence, 50134 Florence, Italy
| | - Beatriz Marcos-Puig
- Department of Gynecology and Obstetrics, La Fé University and Polytechnic Hospital, Avda. Fernando Abril Martorell 106, 46026 Valencia, Spain;
| | - Isabel 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, Burjassot, 46100 Valencia, Spain;
- Biomedical Research Center in Epidemiology and Public Health Network (CIBERESP), Carlos III Health Institute, Av. Monforte de Lemos 3-5 Pabellón 11 Planta 0, 28029 Madrid, Spain
| | - Juan Llopis-Morales
- Faculty of Pharmacy, Universidad Alfonso X el Sabio, Avda. de la Universidad 1, Villanueva de la Cañada, 28691 Madrid, Spain;
| | - María Morales-Suarez-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, Burjassot, 46100 Valencia, Spain;
- Biomedical Research Center in Epidemiology and Public Health Network (CIBERESP), Carlos III Health Institute, Av. Monforte de Lemos 3-5 Pabellón 11 Planta 0, 28029 Madrid, Spain
| |
Collapse
|
33
|
Antasouras G, Papadopoulou SK, Alexatou O, Papandreou D, Mentzelou M, Migdanis A, Psara E, Migdanis I, Chrysafi M, Tyrovolas S, Louka A, Giaginis C. Adherence to the Mediterranean Diet during Pregnancy: Associations with Sociodemographic and Anthropometric Parameters, Perinatal Outcomes, and Breastfeeding Practices. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1547. [PMID: 37763666 PMCID: PMC10536474 DOI: 10.3390/medicina59091547] [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: 07/23/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: The Mediterranean diet (MD) has been recognized as a beneficial nutritional pattern that promotes human health, decreasing the risks of a variety of human disorders and pathological states, including adverse pregnancy outcomes. In this aspect, the current survey aimed to assess the potential association of compliance with the MD during gestation with various sociodemographic and anthropometric parameters, perinatal outcomes, and breastfeeding practices. Materials and Methods: This was a cross-sectional study performed on 5688 pregnant women from 10 distinctive Greek areas. Face-to-face interviews with qualified questionnaires and thorough retrievals of medical records were performed to collect data concerning the participants' sociodemographic and anthropometric parameters, perinatal outcomes, and breastfeeding practices. Results: Elevated compliance with the MD during pregnancy was independently related with older age, higher educational status, and better economic status as well as decreased incidences of pre-pregnancy overweight/obesity and excess gestational weight gain and a lower likelihood of gestational diabetes. Moreover, greater adherence to the MD was independently associated with an increased prevalence of delivering vaginally and a greater prevalence of exclusive breastfeeding for at least 16 weeks postpartum. Conclusions: A higher level of compliance with the MD for the period of gestation was associated with several favorable lifestyle factors that may promote maternal health. Further studies with a prospective design as well as studies exploring the potential effects of maternal compliance with the MD for the period of pregnancy on the health of children should be performed. Future studies should also be extended beyond the MD by assessing the potential beneficial effects of adopting a Mediterranean lifestyle on maternal and child health.
Collapse
Affiliation(s)
- Georgios Antasouras
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, Myrina, 81400 Lemnos, Greece
| | - Sousana K Papadopoulou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece
| | - Olga Alexatou
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, Myrina, 81400 Lemnos, Greece
| | - Dimitrios Papandreou
- Department of Clinical Nutrition & Dietetics, College of Health, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
| | - Maria Mentzelou
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, Myrina, 81400 Lemnos, Greece
| | - Athanasios Migdanis
- Department of Gastroenterology, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece
| | - Evmorfia Psara
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, Myrina, 81400 Lemnos, Greece
| | - Ioannis Migdanis
- Department of Nutrition and Dietetics, University of Thessaly, 42132 Trikala, Greece
| | - Maria Chrysafi
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, Myrina, 81400 Lemnos, Greece
| | - Stefanos Tyrovolas
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon GH506, Hong Kong
| | - Aikaterini Louka
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, Myrina, 81400 Lemnos, Greece
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, Myrina, 81400 Lemnos, Greece
| |
Collapse
|
34
|
Foessleitner P, Budil MC, Mayer S, Kraft F, Zeilberger MS, Deinsberger J, Farr A. Peripartum Maternal Admission to the Intensive Care Unit: An Observational Study over a 15-Year Period at a Tertiary Center in Austria. J Clin Med 2023; 12:5386. [PMID: 37629428 PMCID: PMC10455968 DOI: 10.3390/jcm12165386] [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: 07/20/2023] [Revised: 08/10/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
Peripartum maternal admission to the intensive care unit is challenging for anesthesiologists, obstetricians, and all personnel involved. An understanding of altered maternal physiology, fetal considerations, and acute peripartum emergencies is required to ensure adequate maternal and neonatal outcomes. In this study, we analyzed data of peripartum maternal admissions to the intensive care unit at our large tertiary referral center in order to define trends and changes over time. This study retrospectively analyzed maternal morbidity, admission diagnoses, treatments, and outcomes of women with peripartum admission to the intensive care unit at our tertiary care center over a 15-year period. We found that patient characteristics and admission diagnoses remained remarkably consistent over the observational period; however, there was a significant increase in postpartum hemorrhage (r = 0.200, p < 0.001) and cesarean hysterectomy (r = 0.117, p = 0.027) over time. Moreover, we found a reduction in preterm births (r = -0.154, p = 0.004) and a decreased peripartum neonatal intensive care unit admission rate (r = -0.153, p = 0.006) among women who were transferred to the intensive care unit. Based on our long-term observational data, there is consistent need for intensive care in obstetrics due to a small number of different etiologies. Specialized training for the predominant diagnoses involved as well as multidisciplinary care of the affected patients are both warranted.
Collapse
Affiliation(s)
- Philipp Foessleitner
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (P.F.)
| | - Marie-Christin Budil
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (P.F.)
| | - Stefanie Mayer
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (P.F.)
| | - Felix Kraft
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Mira Stephanie Zeilberger
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Julia Deinsberger
- Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria
| | - Alex Farr
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (P.F.)
| |
Collapse
|
35
|
Wasserzug-Pash P, Klutstein M. Epigenetic aging in oocytes. Aging (Albany NY) 2023; 15:7334-7335. [PMID: 37552096 PMCID: PMC10457075 DOI: 10.18632/aging.204976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 04/24/2023] [Indexed: 08/09/2023]
Affiliation(s)
- Peera Wasserzug-Pash
- Institute of Biomedical and Oral Research, Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 9112001, Israel
| | - Michael Klutstein
- Institute of Biomedical and Oral Research, Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 9112001, Israel
| |
Collapse
|
36
|
Hong K, Park HJ, Jang HY, Shim SH, Jang Y, Kim SH, Cha DH. A Novel Paradigm for Non-Invasive Prenatal Genetic Screening: Trophoblast Retrieval and Isolation from the Cervix (TRIC). Diagnostics (Basel) 2023; 13:2532. [PMID: 37568895 PMCID: PMC10417081 DOI: 10.3390/diagnostics13152532] [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: 06/30/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
As the prevalence of pregnancies with advanced maternal age increases, the risk of fetal chromosomal abnormalities is on the rise. Therefore, prenatal genetic screening and diagnosis have become essential elements in contemporary obstetrical care. Trophoblast retrieval and isolation from the cervix (TRIC) is a non-invasive procedure that can be utilized for prenatal genetic diagnosis. The method involves the isolation of fetal cells (extravillous trophoblasts) by transcervical sampling; along with its non-invasiveness, TRIC exhibits many other advantages such as its usefulness in early pregnancy at 5 weeks of gestation, and no interference by various fetal and maternal factors. Moreover, the trophoblast yields from TRIC can provide valuable information about obstetrical complications related to abnormal placentation even before clinical symptoms arise. The standardization of this clinical tool is still under investigation, and the upcoming advancements in TRIC are expected to meet the increasing need for a safe and accurate option for prenatal diagnosis.
Collapse
Affiliation(s)
- Kirim Hong
- CHA Gangnam Medical Center, Department of Obstetrics and Gynecology, CHA University, Seoul 06125, Republic of Korea; (K.H.); (H.J.P.); (Y.J.)
| | - Hee Jin Park
- CHA Gangnam Medical Center, Department of Obstetrics and Gynecology, CHA University, Seoul 06125, Republic of Korea; (K.H.); (H.J.P.); (Y.J.)
| | - Hee Yeon Jang
- Department of Biomedical Science, College of Life Science, CHA University, Seongnam 13488, Republic of Korea; (H.Y.J.); (S.H.S.)
| | - Sung Han Shim
- Department of Biomedical Science, College of Life Science, CHA University, Seongnam 13488, Republic of Korea; (H.Y.J.); (S.H.S.)
| | - Yoon Jang
- CHA Gangnam Medical Center, Department of Obstetrics and Gynecology, CHA University, Seoul 06125, Republic of Korea; (K.H.); (H.J.P.); (Y.J.)
| | - Soo Hyun Kim
- CHA Gangnam Medical Center, Department of Obstetrics and Gynecology, CHA University, Seoul 06125, Republic of Korea; (K.H.); (H.J.P.); (Y.J.)
| | - Dong Hyun Cha
- CHA Gangnam Medical Center, Department of Obstetrics and Gynecology, CHA University, Seoul 06125, Republic of Korea; (K.H.); (H.J.P.); (Y.J.)
| |
Collapse
|
37
|
Chin AHB, Muhsin SM, Ahmad MF. Islamic Perspectives on Elective Ovarian Tissue Freezing by Single Women for Non-medical or Social Reasons. Asian Bioeth Rev 2023; 15:335-349. [PMID: 37396675 PMCID: PMC10313600 DOI: 10.1007/s41649-022-00236-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/17/2022] [Accepted: 11/22/2022] [Indexed: 01/04/2023] Open
Abstract
Non-medical or Social egg freezing (oocyte cryopreservation) is currently a controversial topic in Islam, with contradictory fatwas being issued in different Muslim countries. While Islamic authorities in Egypt permit the procedure, fatwas issued in Malaysia have banned single Muslim women from freezing their unfertilized eggs (vitrified oocytes) to be used later in marriage. The underlying principles of the Malaysian fatwas are that (i) sperm and egg cells produced before marriage, should not be used during marriage to conceive a child; (ii) extraction of mature egg cells from single women being unacceptable; and (iii) fertility preservation in anticipation of late marriage is a conjecture that has not yet occurred. Ovarian tissue freezing can potentially be a more Shariah-compliant alternative to social egg freezing, because once the frozen ovarian cortical tissue sections have been re-transplanted back into the woman, mature egg cells can readily be produced, collected, and fertilized by the husband's sperm only during the period of marriage contract ('akd al-nikāḥ). Unlike accidental mix-ups with frozen eggs, muddling of lineage (nasab) would be automatically avoided in ovarian tissue freezing due to immunological rejection. However, upon critical analysis based on Qawā'id Fiqhiyyah (Islamic Legal Maxims), Maqāṣid-al-Shariah (Higher Objectives of Islamic Law), and Maslaḥah-Mafsadah (benefits versus harmful effects on society), elective ovarian tissue freezing by healthy single women for social reasons would likely be a highly contentious and controversial issue within Muslim communities that may conflict with conservative social-religious norms. This thus needs further debate among Islamic jurists in dialogue with medical doctors and biomedical scientists.
Collapse
Affiliation(s)
| | - Sayyed Mohamed Muhsin
- Department of Fiqh and Uṣūl Al-Fiqh, International Islamic University Malaysia, Kuala Lumpur, Malaysia
| | - Mohd Faizal Ahmad
- Advanced Reproductive Centre (ARC), Department of Obstetrics & Gynecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| |
Collapse
|
38
|
Peled T, Nun ELB, Hochler H, Sela HY, Lipschuetz M, Weiss A, Grisaru-Granovsky S, Rottenstreich M. Perinatal outcomes in nulliparous women with a history of multiple pregnancy losses according to number of previous pregnancy losses. Am J Obstet Gynecol MFM 2023; 5:100946. [PMID: 37003569 DOI: 10.1016/j.ajogmf.2023.100946] [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: 01/08/2023] [Revised: 03/16/2023] [Accepted: 03/23/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND While it is widely acknowledged that pregnancy losses can lead to negative outcomes for both mothers and fetuses, there is limited information available on the specific levels of risk associated with each additional pregnancy loss. OBJECTIVE This study aimed to investigate the effect of number of previous pregnancy losses among nulliparous women on maternal and neonatal adverse outcomes. STUDY DESIGN This was a multicenter retrospective cohort study. The study population included all nulliparous women with singleton pregnancies who delivered in all university-affiliated obstetrical centers in a single geographic area between 2003 and 2021. Maternal and neonatal outcomes of women who delivered at our medical centers and had varying numbers of previous pregnancy losses were compared with women who had no previous pregnancy loss. The primary outcome of this study was preterm delivery rate at <37 weeks of gestation. The secondary outcomes were adverse maternal and neonatal outcomes. Univariate analysis was performed using multiple logistic regression modeling. RESULTS During the study period, 97,904 nulliparous women met the inclusion and exclusion criteria. Of those women, 84,245 (86%) had no previous pregnancy losses (reference group), 10,724 (11%) had 1 previous pregnancy loss, 2150 (2.2%) had 2 previous pregnancy losses, 516 (0.5%) had 3 previous pregnancy losses, 160 (0.2%) had 4 previous pregnancy losses, and 99 (0.1%) had ≥5 previous pregnancy losses. Women who had previous pregnancy losses had significantly higher rates of preterm delivery, hypertensive disorders of pregnancy, diabetes mellitus (pregestational and gestational), unplanned cesarean delivery, perinatal death, neonatal intensive care unit admissions, and neonatal hypoglycemia. The risks of preterm delivery and most other adverse obstetrical outcomes correlated with the number of previous pregnancy losses. Multivariate analyses showed that each previous pregnancy loss was associated with an additional, significant, increased risk of preterm delivery of 14% at <37 weeks of gestation, 37% at <34 weeks of gestation, 45% at <32 weeks of gestation, and 77% at <28 weeks of gestation. CONCLUSION A history of previous pregnancy losses increased the risk of preterm delivery and other perinatal outcomes in a dose-dependent manner. To minimize perinatal complications, obstetricians should be aware of the risks and complications in this unique population, consider close monitoring of the cervical length, and maintain high vigilance in case of complications with special attention to other potentially modifiable risks.
Collapse
Affiliation(s)
- Tzuria Peled
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel (Drs Peled, Nun, Sela, Weiss, Grisaru-Granovsky, and Rottenstreich)
| | - Eyal Lang Ben Nun
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel (Drs Peled, Nun, Sela, Weiss, Grisaru-Granovsky, and Rottenstreich)
| | - Hila Hochler
- Faculty of Medicine, Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel (Drs Hochler and Lipschuetz).
| | - Hen Y Sela
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel (Drs Peled, Nun, Sela, Weiss, Grisaru-Granovsky, and Rottenstreich)
| | - Michal Lipschuetz
- Faculty of Medicine, Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel (Drs Hochler and Lipschuetz)
| | - Ari Weiss
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel (Drs Peled, Nun, Sela, Weiss, Grisaru-Granovsky, and Rottenstreich)
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel (Drs Peled, Nun, Sela, Weiss, Grisaru-Granovsky, and Rottenstreich)
| | - Misgav Rottenstreich
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel (Drs Peled, Nun, Sela, Weiss, Grisaru-Granovsky, and Rottenstreich); Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel (Dr Rottenstreich)
| |
Collapse
|
39
|
Santos JX, Sampaio P, Rasga C, Martiniano H, Faria C, Café C, Oliveira A, Duque F, Oliveira G, Sousa L, Nunes A, Vicente AM. Evidence for an association of prenatal exposure to particulate matter with clinical severity of Autism Spectrum Disorder. ENVIRONMENTAL RESEARCH 2023; 228:115795. [PMID: 37028534 DOI: 10.1016/j.envres.2023.115795] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 03/06/2023] [Accepted: 03/28/2023] [Indexed: 05/16/2023]
Abstract
Early-life exposure to air pollutants, including ozone (O3), particulate matter (PM2.5 or PM10, depending on diameter of particles), nitrogen dioxide (NO2) and sulfur dioxide (SO2) has been suggested to contribute to the etiology of Autism Spectrum Disorder (ASD). In this study, we used air quality monitoring data to examine whether mothers of children with ASD were exposed to high levels of air pollutants during critical periods of pregnancy, and if higher exposure levels may lead to a higher clinical severity in their offspring. We used public data from the Portuguese Environment Agency to estimate exposure to these pollutants during the first, second and third trimesters of pregnancy, full pregnancy and first year of life of the child, for 217 subjects with ASD born between 2003 and 2016. These subjects were stratified in two subgroups according to clinical severity, as defined by the Autism Diagnostic Observational Schedule (ADOS). For all time periods, the average levels of PM2.5, PM10 and NO2 to which the subjects were exposed were within the admissible levels defined by the European Union. However, a fraction of these subjects showed exposure to levels of PM2.5 and PM10 above the admissible threshold. A higher clinical severity was associated with higher exposure to PM2.5 (p = 0.001), NO2 (p = 0.011) and PM10 (p = 0.041) during the first trimester of pregnancy, when compared with milder clinical severity. After logistic regression, associations with higher clinical severity were identified for PM2.5 exposure during the first trimester (p = 0.002; OR = 1.14, 95%CI: 1.05-1.23) and full pregnancy (p = 0.04; OR = 1.07, 95%CI: 1.00-1.15) and for PM10 (p = 0.02; OR = 1.07, 95%CI: 1.01-1.14) exposure during the third trimester. Exposure to PM is known to elicit neuropathological mechanisms associated with ASD, including neuroinflammation, mitochondrial disruptions, oxidative stress and epigenetic changes. These results offer new insights on the impact of early-life exposure to PM in ASD clinical severity.
Collapse
Affiliation(s)
- João Xavier Santos
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Avenida Padre Cruz, 1649-016, Lisboa, Portugal; BioISI - Biosystems & Integrative Sciences Institute, University of Lisboa, Faculty of Sciences, Campo Grande, C8, 1749-016, Lisboa, Portugal.
| | - Pedro Sampaio
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Avenida Padre Cruz, 1649-016, Lisboa, Portugal; BioISI - Biosystems & Integrative Sciences Institute, University of Lisboa, Faculty of Sciences, Campo Grande, C8, 1749-016, Lisboa, Portugal.
| | - Célia Rasga
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Avenida Padre Cruz, 1649-016, Lisboa, Portugal; BioISI - Biosystems & Integrative Sciences Institute, University of Lisboa, Faculty of Sciences, Campo Grande, C8, 1749-016, Lisboa, Portugal.
| | - Hugo Martiniano
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Avenida Padre Cruz, 1649-016, Lisboa, Portugal; BioISI - Biosystems & Integrative Sciences Institute, University of Lisboa, Faculty of Sciences, Campo Grande, C8, 1749-016, Lisboa, Portugal.
| | - Clarissa Faria
- Unidade de Neurodesenvolvimento e Autismo, Serviço Do Centro de Desenvolvimento da Criança, Centro de Investigação e Formação Clínica, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Cátia Café
- Unidade de Neurodesenvolvimento e Autismo, Serviço Do Centro de Desenvolvimento da Criança, Centro de Investigação e Formação Clínica, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, University Clinic of Pediatrics and Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Coimbra, Portugal
| | - Alexandra Oliveira
- Unidade de Neurodesenvolvimento e Autismo, Serviço Do Centro de Desenvolvimento da Criança, Centro de Investigação e Formação Clínica, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, University Clinic of Pediatrics and Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Coimbra, Portugal.
| | - Frederico Duque
- Unidade de Neurodesenvolvimento e Autismo, Serviço Do Centro de Desenvolvimento da Criança, Centro de Investigação e Formação Clínica, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, University Clinic of Pediatrics and Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Coimbra, Portugal.
| | - Guiomar Oliveira
- Unidade de Neurodesenvolvimento e Autismo, Serviço Do Centro de Desenvolvimento da Criança, Centro de Investigação e Formação Clínica, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, University Clinic of Pediatrics and Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Coimbra, Portugal.
| | - Lisete Sousa
- Departamento de Estatística e Investigação Operacional e Centro de Estatística e Aplicações, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal.
| | - Ana Nunes
- BioISI - Biosystems & Integrative Sciences Institute, University of Lisboa, Faculty of Sciences, Campo Grande, C8, 1749-016, Lisboa, Portugal; Departamento de Física, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal.
| | - Astrid Moura Vicente
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Avenida Padre Cruz, 1649-016, Lisboa, Portugal; BioISI - Biosystems & Integrative Sciences Institute, University of Lisboa, Faculty of Sciences, Campo Grande, C8, 1749-016, Lisboa, Portugal.
| |
Collapse
|
40
|
Gao Y, Yi L, Zhan J, Wang L, Yao X, Yan J, Jian S, Gao L, Farangez M, Gao M, Zou Y, Gao X, Wu K, Liu J, Chen ZJ. A clinical study of preimplantation DNA methylation screening in assisted reproductive technology. Cell Res 2023; 33:483-485. [PMID: 37150776 PMCID: PMC10235035 DOI: 10.1038/s41422-023-00809-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Affiliation(s)
- Yuan Gao
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, China.
- Shandong Key Laboratory of Reproductive Medicine, Shandong Provincial Clinical Research Center for Reproductive Health, Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, China.
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, China.
| | - Lizhi Yi
- CAS Key Laboratory of Genome Sciences and Information, Collaborative Innovation Center of Genetics and Development, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, China
- China National Center for Bioinformation, Beijing, China
- Nvwa life technology, Guangzhou, Guangdong, China
| | - Jianhong Zhan
- CAS Key Laboratory of Genome Sciences and Information, Collaborative Innovation Center of Genetics and Development, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, China
- China National Center for Bioinformation, Beijing, China
| | - Lijuan Wang
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Shandong Provincial Clinical Research Center for Reproductive Health, Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, China
| | - Xuelong Yao
- Nvwa life technology, Guangzhou, Guangdong, China
| | - Junhao Yan
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Shandong Provincial Clinical Research Center for Reproductive Health, Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, China
| | - Sijing Jian
- CAS Key Laboratory of Genome Sciences and Information, Collaborative Innovation Center of Genetics and Development, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, China
- China National Center for Bioinformation, Beijing, China
| | - Lei Gao
- CAS Key Laboratory of Genome Sciences and Information, Collaborative Innovation Center of Genetics and Development, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, China
- China National Center for Bioinformation, Beijing, China
| | - Mamadboqirova Farangez
- CAS Key Laboratory of Genome Sciences and Information, Collaborative Innovation Center of Genetics and Development, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, China
- China National Center for Bioinformation, Beijing, China
| | - Ming Gao
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Shandong Provincial Clinical Research Center for Reproductive Health, Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, China
| | - Yang Zou
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Shandong Provincial Clinical Research Center for Reproductive Health, Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, China
| | - Xuan Gao
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Shandong Provincial Clinical Research Center for Reproductive Health, Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, China
| | - Keliang Wu
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Shandong Provincial Clinical Research Center for Reproductive Health, Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, China
| | - Jiang Liu
- CAS Key Laboratory of Genome Sciences and Information, Collaborative Innovation Center of Genetics and Development, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, China.
- China National Center for Bioinformation, Beijing, China.
| | - Zi-Jiang Chen
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, China.
- Shandong Key Laboratory of Reproductive Medicine, Shandong Provincial Clinical Research Center for Reproductive Health, Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, China.
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, China.
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China.
| |
Collapse
|
41
|
Serour G, Ghaly M, Saifuddeen SM, Anwar A, Isa NM, Chin AHB. Sunni Islamic perspectives on lab-grown sperm and eggs derived from stem cells - in vitro gametogenesis (IVG). New Bioeth 2023; 29:108-120. [PMID: 36427532 DOI: 10.1080/20502877.2022.2142094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
An exciting development in the field of assisted reproductive technologies is In Vitro Gametogenesis (IVG) that enables production of functional gametes from stem cells in the laboratory. Currently, development of this technology is still at an early stage and has demonstrated to work only in rodents. Upon critically examining the ethical dimensions of various possible IVG applications in human fertility treatment from a Sunni Islamic perspective, together with benefit-harm (maslahah-mafsadah) assessment; it is concluded that utilization of IVG, once its efficacy and safety are guaranteed, could be permissible by strictly adhering to Islamic ethical principles related to marriage, biological/genetic relatedness, sexual intercourse, and moral status of the embryo/fetus versus that of the gamete. As a result, IVG will be acceptable for treating primary infertility, age-related infertility, and preventing genetic diseases. However, it will be unacceptable for application in posthumous reproduction, donor gametes, genetic enhancement, and procreation in same-sex couples.
Collapse
Affiliation(s)
- Gamal Serour
- International Islamic Center for Population Studies and Research, Al Azhar University, Cairo, Egypt
| | - Mohammed Ghaly
- Research Center for Islamic Legislation and Ethics (CILE), College of Islamic Studies, Hamad Bin Khalifa University, Education City, Qatar
| | | | - Ayaz Anwar
- School of Medical & Life Sciences, Sunway University, Bandar Sunway, Malaysia
| | - Noor Munirah Isa
- Department of Science and Technology Studies, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | | |
Collapse
|
42
|
Mann ES, Berkowitz D. The Biomedical Subjectification of Women of Advanced Maternal Age: Reproductive Risk, Privilege, and the Illusion of Control. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2023; 64:192-208. [PMID: 36440586 DOI: 10.1177/00221465221136252] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The United States is experiencing a demographic transition toward older motherhood. Biomedicine classifies pregnancies among all women of advanced maternal age (AMA) as high-risk; paradoxically, women having first births at AMA are typically economically and racially privileged, which can reduce the risk of risks. This article examines the implications of the biomedicalization of AMA for first-time mothers, age 35 and older, using qualitative interviews. We find participants had substantial cultural health capital, which informed their critiques of AMA and the medical model of birth. When they found themselves subjected to biomedical protocols and concerned about reproductive risk as their pregnancies progressed, their subsequent biomedical subjectification compelled most to accept biomedical interventions. Consequently, some participants had traumatic birth experiences. Our findings illustrate that while first-time mothers of AMA anticipated that they would have more control over the birth process because of their advantages, ultimately, most did not.
Collapse
|
43
|
Min J, Park JS, Kim HW, Ko Y, Oh JY, Jeong YJ, Na JO, Kwon SJ, Choe KH, Lee WY, Lee SS, Kim JS, Koo HK. Differential effects of sex on tuberculosis location and severity across the lifespan. Sci Rep 2023; 13:6023. [PMID: 37055508 PMCID: PMC10102118 DOI: 10.1038/s41598-023-33245-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/10/2023] [Indexed: 04/15/2023] Open
Abstract
Disparities exist between sexes regarding tuberculosis (TB) incidence, as well as disease severity and outcome. Using a nationwide TB registry database, we explored the impact of sex and age on extrapulmonary TB (EPTB) among all enrolled patients by (1) calculating the female proportion for every age category according to TB-affected locations, (2) calculating the proportions of EPTB stratified by sex according to age, (3) conducting multivariable analysis to examine the impact of sex and age on EPTB likelihood, and (4) assessing the odds of EPTB for female compared to male as reference in every age category. Further, we explored the impact of sex and age on disease severity among pulmonary TB (PTB) patients. Of all the TB patients, 40.1% were female, with a male-to-female ratio of 1.49. The proportion of females was lowest in their fifties, resembling a U-shape. The male-to-female ratios in PTB and EPTB were 1.67 and 1.03, respectively. Compared to men, women were significantly associated with EPTB in their forties, fifties, and sixties. Female patients with PTB had significantly lower odds of having cavitation and positive smear test results in their fifties. Significant differences were found concerning TB location and severity between sexes, especially during reproductive age.
Collapse
Affiliation(s)
- Jinsoo Min
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Seuk Park
- Division of Pulmonary Medicine, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Hyung Woo Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yousang Ko
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jee Youn Oh
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yun-Jeong Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Republic of Korea
| | - Ju Ock Na
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Sun-Jung Kwon
- Department of Internal Medicine, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Kang Hyeon Choe
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Won-Yeon Lee
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Yonsei University Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Sung-Soon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, 170 Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, 10380, Republic of Korea
| | - Ju Sang Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 56, Dongsu-ro, Incheon, 21431, Republic of Korea.
| | - Hyeon-Kyoung Koo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, 170 Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, 10380, Republic of Korea.
| |
Collapse
|
44
|
Taylor J, Sharp A, Rannard SP, Arrowsmith S, McDonald TO. Nanomedicine strategies to improve therapeutic agents for the prevention and treatment of preterm birth and future directions. NANOSCALE ADVANCES 2023; 5:1870-1889. [PMID: 36998665 PMCID: PMC10044983 DOI: 10.1039/d2na00834c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/27/2023] [Indexed: 06/19/2023]
Abstract
The World Health Organisation (WHO) estimates 15 million babies worldwide are born preterm each year, with 1 million infant mortalities and long-term morbidity in survivors. Whilst the past 40 years have provided some understanding in the causes of preterm birth, along with development of a range of therapeutic options, notably prophylactic use of progesterone or uterine contraction suppressants (tocolytics), the number of preterm births continues to rise. Existing therapeutics used to control uterine contractions are restricted in their clinical use due to pharmacological drawbacks such as poor potency, transfer of drugs to the fetus across the placenta and maternal side effects from activity in other maternal systems. This review focuses on addressing the urgent need for the development of alternative therapeutic systems with improved efficacy and safety for the treatment of preterm birth. We discuss the application of nanomedicine as a viable opportunity to engineer pre-existing tocolytic agents and progestogens into nanoformulations, to improve their efficacy and address current drawbacks to their use. We review different nanomedicines including liposomes, lipid-based carriers, polymers and nanosuspensions highlighting where possible, where these technologies have already been exploited e.g. liposomes, and their significance in improving the properties of pre-existing therapeutic agents within the field of obstetrics. We also highlight where active pharmaceutical agents (APIs) with tocolytic properties have been used for other clinical indications and how these could inform the design of future therapeutics or be repurposed to diversify their application such as for use in preterm birth. Finally we outline and discuss the future challenges.
Collapse
Affiliation(s)
- Jessica Taylor
- Department of Chemistry, University of Liverpool Crown Street Liverpool L69 7ZD UK
| | - Andrew Sharp
- Harris-Wellbeing Preterm Birth Research Centre, Department of Women's and Children's Health, Liverpool Women's Hospital, University of Liverpool Crown Street Liverpool L8 7SS UK
| | - Steve P Rannard
- Department of Chemistry, University of Liverpool Crown Street Liverpool L69 7ZD UK
- Centre of Excellence in Long-acting Therapeutics (CELT), University of Liverpool Liverpool L7 3NY UK
| | - Sarah Arrowsmith
- Department of Life Sciences, Manchester Metropolitan University Chester Street Manchester M1 5GD UK
| | - Tom O McDonald
- Department of Chemistry, University of Liverpool Crown Street Liverpool L69 7ZD UK
- Department of Materials, Henry Royce Institute, The University of Manchester Manchester M13 9PL UK
| |
Collapse
|
45
|
Contributors to Preterm Birth: Data from a Single Polish Perinatal Center. CHILDREN 2023; 10:children10030447. [PMID: 36980005 PMCID: PMC10047259 DOI: 10.3390/children10030447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/09/2023] [Accepted: 02/23/2023] [Indexed: 03/03/2023]
Abstract
Preterm birth may result from overlapping causes including maternal age, health, previous obstetric history and a variety of social factors. We aimed to identify factors contributing to preterm birth in respect to new social and environmental changes in the reproductive patterns. Our cross-sectional study included 495 mother–infant pairs and was based on maternal self-reporting in an originally developed questionnaire. Neonates were divided into two groups: 72 premature babies (study group) and 423 full-term babies (control group). We analyzed maternal, sociodemographic and economic characteristics, habits, chronic diseases, previous obstetric history and pregnancy complications. For statistical analysis, Pearson’s Chi-squared independence test was used with a statistical significance level of 0.05. Preterm births were more common among mothers living in villages (p < 0.001) and with lower education level (p = 0.01). Premature births were also positively associated with mothers who were running their own businesses (p = 0.031). Mothers with a history of previous miscarriages gave birth at a significantly older age (p < 0.001). The most frequent pregnancy complications were hypothyroidism (41.4%), pregestational and gestational diabetes mellitus (DM; 17.8%) and hypertension (8.1%). Pregestational DM significantly influenced the occurrence of prematurity (p < 0.05). Pregestational DM, being professionally active, a lower education level and living outside cities are important risk factors of prematurity.
Collapse
|
46
|
Galanis P, Vraka I, Katsiroumpa A, Siskou O, Konstantakopoulou O, Zogaki E, Kaitelidou D. Psychosocial Predictors of COVID-19 Vaccine Uptake among Pregnant Women: A Cross-Sectional Study in Greece. Vaccines (Basel) 2023; 11:269. [PMID: 36851147 PMCID: PMC9967309 DOI: 10.3390/vaccines11020269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 01/28/2023] Open
Abstract
An understanding of the factors associated with the COVID-19 vaccine uptake in pregnant women is paramount to persuade women to get vaccinated against COVID-19. We estimated the vaccination rate of pregnant women against COVID-19 and evaluated psychosocial factors associated with vaccine uptake among them. We conducted a cross-sectional study with a convenience sample. In particular, we investigated socio-demographic data of pregnant women (e.g., age, marital status, and educational level), COVID-19 related variables (e.g., previous COVID-19 diagnosis and worry about the side effects of COVID-19 vaccines), and stress due to COVID-19 (e.g., danger and contamination fears, fears about economic consequences, xenophobia, compulsive checking and reassurance seeking, and traumatic stress symptoms about COVID-19) as possible predictors of COVID-19 vaccine uptake. Among pregnant women, 58.6% had received a COVID-19 vaccine. The most important reasons that pregnant women were not vaccinated were doubts about the safety and effectiveness of the COVID-19 vaccines (31.4%), fear that COVID-19 vaccines could be harmful to the fetus (29.4%), and fear of adverse side effects of COVID-19 vaccines (29.4%). Increased danger and contamination fears, increased fears about economic consequences, and higher levels of trust in COVID-19 vaccines were related with vaccine uptake. On the other hand, increased compulsive checking and reassurance seeking and increased worry about the adverse side effects of COVID-19 vaccines reduced the likelihood of pregnant women being vaccinated. An understanding of the psychosocial factors associated with increased COVID-19 vaccine uptake in pregnant women could be helpful for policy makers and healthcare professionals in their efforts to persuade women to get vaccinated against COVID-19. There is a need for targeted educational campaigns to increase knowledge about COVID-19 vaccines and reduce vaccine hesitancy in pregnancy.
Collapse
Affiliation(s)
- Petros Galanis
- Clinical Epidemiology Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Irene Vraka
- Department of Radiology, P. & A. Kyriakou Children’s Hospital, 11527 Athens, Greece
| | - Aglaia Katsiroumpa
- Clinical Epidemiology Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Olga Siskou
- Department of Tourism Studies, University of Piraeus, 18534 Piraeus, Greece
| | - Olympia Konstantakopoulou
- Center for Health Services Management and Evaluation, Faculty of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Eleftheria Zogaki
- Faculty of Midwifery, University of West Attica, West Attica, 12243 Aigaleo, Greece
| | - Daphne Kaitelidou
- Center for Health Services Management and Evaluation, Faculty of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece
| |
Collapse
|
47
|
Yaghoobi A, Nazerian Y, Meymand AZ, Ansari A, Nazerian A, Niknejad H. Hypoxia-sensitive miRNA regulation via CRISPR/dCas9 loaded in hybrid exosomes: A novel strategy to improve embryo implantation and prevent placental insufficiency during pregnancy. Front Cell Dev Biol 2023; 10:1082657. [PMID: 36704201 PMCID: PMC9871368 DOI: 10.3389/fcell.2022.1082657] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023] Open
Abstract
Assisted reproductive techniques as a new regenerative medicine approach have significantly contributed to solving infertility problems that affect approximately 15% of couples worldwide. However, the success rate of an in vitro fertilization (IVF) cycle remains only about 20%-30%, and 75% of these losses are due to implantation failure (the crucial rate-limiting step of gestation). Implantation failure and abnormal placenta formation are mainly caused by defective adhesion, invasion, and angiogenesis. Placental insufficiency endangers both the mother's and the fetus's health. Therefore, we suggested a novel treatment strategy to improve endometrial receptivity and implantation success rate. In this strategy, regulating mir-30d expression as an upstream transcriptomic modifier of the embryo implantation results in modified expression of the involved genes in embryonic adhesion, invasion, and angiogenesis and consequently impedes implantation failure. For this purpose, "scaffold/matrix attachment regions (S/MARs)" are employed as non-viral episomal vectors, transfecting into trophoblasts by exosome-liposome hybrid carriers. These vectors comprise CRISPR/dCas9 with a guide RNA to exclusively induce miR-30d gene expression in hypoxic stress conditions. In order to avoid concerns about the fetus's genetic manipulation, our vector would be transfected specifically into the trophoblast layer of the blastocyst via binding to trophoblast Erb-B4 receptors without entering the inner cell mass. Additionally, S/MAR episomal vectors do not integrate with the original cell DNA. As an on/off regulatory switch, a hypoxia-sensitive promoter (HRE) is localized upstream of dCas9. The miR-30d expression increases before and during the implantation and placental insufficiency conditions and is extinguished after hypoxia elimination. This hypothesis emphasizes that improving the adhesion, invasion, and angiogenesis in the uterine microenvironment during pregnancy will result in increased implantation success and reduced placental insufficiency, as a new insight in translational medicine.
Collapse
Affiliation(s)
- Alireza Yaghoobi
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yasaman Nazerian
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arman Zeinaddini Meymand
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Ansari
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Hassan Niknejad
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran,*Correspondence: Hassan Niknejad,
| |
Collapse
|
48
|
Prenatal and Birth Care of Roma Women. Nurs Res 2023; 72:12-19. [PMID: 36096878 DOI: 10.1097/nnr.0000000000000621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The reproductive health of Roma women has been poorly studied. It is important to determine the follow-up care received by Roma women from pregnancy to the first postpartum visit, together with neonatal outcomes, to improve prenatal care and maternal-child outcomes. OBJECTIVE The aim of this study was to examine differences in prenatal care and maternal-infant outcomes between Roma and non-Roma women. METHODS A retrospective longitudinal study was conducted in 122 pregnant women (28 Roma and 94 non-Roma women) recruited from seven primary care centers in three districts of Asturias (Spain). Sociodemographic variables, prenatal control, birth characteristics, feeding, and neonatal outcomes (gestational age, weight, and APGAR [appearance, pulse, grimace, activity, and respiration]) were collected from the electronic medical records. Prenatal care was assessed using three indices: the Kessner index, the Modified Adequacy of Prenatal Care Utilization Spanish Index, and an ad hoc index that considered adherence to the recommendations for pregnant women in Spain. RESULTS Compared with non-Roma women, advanced maternal age (≥35 years) and primigravida were less common among Roma women. Roma women visited the dentist less often, smoked more, and underwent group B streptococcus screening less frequently. No differences were found in the number of prenatal visits between Roma and non-Roma women. Consequently, there were no differences between the Kessner index and the Modified Adequacy of Prenatal Care Utilization Spanish Index. Using the ad hoc index, the non-Roma women more frequently had adequate prenatal visits. There were no differences in birth characteristics, type of feeding, and neonatal outcomes. DISCUSSION Overall, prenatal care was slightly worse in Roma women; however, this did not imply worse neonatal health outcomes. Both study groups had similar birth characteristics and immediate puerperium, including feeding.
Collapse
|
49
|
Valade F, Béliveau MJ, Breault C, Chabot B, Labelle F. Individual and cumulative risk factors in developmental language disorder: A case-control study. Clin Child Psychol Psychiatry 2023; 28:398-414. [PMID: 35797616 PMCID: PMC9893307 DOI: 10.1177/13591045221113389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Many mental disorders (MD) share common etiology, fuelling debates about the specificity of clinical categories and whether the presence of specific risk factors (RF) can distinguish among them. The study of developmental language disorder (DLD), more specifically, has been further hindered by a lack of consensus regarding its definition. These limitations increase the risk of under-detection and lifelong consequences for affected children. This paper aims (1) to document which individual RF allow differentiating DLD from other MD and (2) to compare the cumulative RF between children with DLD versus other MD. This case-control design study used medical records of a psychiatric sample of 795 preschoolers (mean age 4:11, 75% boys). A logistic regression measured the predictive value of potential RF on DLD. Later first sentences, maternal immigration and family history of language delay were identified as significant in explaining 30% of the variance for DLD diagnosis. An ANCOVA revealed that children with DLD were exposed to a significantly higher number of RF than were children with other MD. Public health policies informed with the knowledge of specific RF associated with DLD, and their cumulative impact, could improve early detection and reduce the cascade of negative consequences associated with DLD.
Collapse
Affiliation(s)
- Florence Valade
- Department of Psychology, 5622University of Montreal, Montreal, QC, Canada.,CIUSSS Nord-de-l'Ile-de-Montréal, Hôpital en santé mentale Rivière-des-Prairies, Montreal, QC, Canada
| | - Marie-Julie Béliveau
- Department of Psychology, 5622University of Montreal, Montreal, QC, Canada.,CIUSSS Nord-de-l'Ile-de-Montréal, Hôpital en santé mentale Rivière-des-Prairies, Montreal, QC, Canada
| | - Chantale Breault
- CIUSSS Nord-de-l'Ile-de-Montréal, Hôpital en santé mentale Rivière-des-Prairies, Montreal, QC, Canada.,School of Speech-Language Pathology and Audiology, 5622University of Montreal, Montreal, QC, Canada
| | - Benjamin Chabot
- Department of Psychology, 5622University of Montreal, Montreal, QC, Canada
| | - Fannie Labelle
- Department of Psychology, 5622University of Montreal, Montreal, QC, Canada.,CIUSSS Nord-de-l'Ile-de-Montréal, Hôpital en santé mentale Rivière-des-Prairies, Montreal, QC, Canada
| |
Collapse
|
50
|
Samuels-Kalow ME, Agrawal P, Rodriguez G, Zeidan A, Love JS, Monette D, Lin M, Cooper RJ, Madsen TE, Dobiesz V. Post-Roe emergency medicine: Policy, clinical, training, and individual implications for emergency clinicians. Acad Emerg Med 2022; 29:1414-1421. [PMID: 36268814 PMCID: PMC9772035 DOI: 10.1111/acem.14609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/27/2022] [Accepted: 10/18/2022] [Indexed: 12/24/2022]
Abstract
In June 2022, the United States Supreme Court decision Dobbs v. Jackson Women's Health Organization overturned Roe v. Wade, removing almost 50 years of precedent and enabling the imposition of a wide range of state-level restrictions on abortion access. Historical data from the United States and internationally demonstrate that the removal of safe abortion options will increase complications and the health risks to pregnant patients. Because the emergency department is a critical access point for reproductive health care, emergency clinicians must be prepared for the policy, clinical, educational, and legal implications of this change. The goal of this paper, therefore, is to describe the impact of the reversal of Roe v. Wade on health equity and reproductive justice, the provision of emergency care education and training, and the specific legal and reproductive consequences for emergency clinicians. Finally, we conclude with specific recommended policy and advocacy responses for emergency medicine clinicians.
Collapse
Affiliation(s)
- Margaret E Samuels-Kalow
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Pooja Agrawal
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Giovanni Rodriguez
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy Zeidan
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jennifer S Love
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Derek Monette
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michelle Lin
- Department of Emergency Medicine, Stanford University, Palo Alto, California, USA
| | - Richelle J Cooper
- Department of Emergency Medicine, University of California Los Angeles, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Tracy E Madsen
- Department of Emergency Medicine, Alpert Medial School of Brown University, Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Valerie Dobiesz
- Department of Emergency Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|