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Rosen EM, Stevens DR, McNell EE, Wood ME, Engel SM, Keil AP, Calafat AM, Botelho JC, Sinkovskaya E, Przybylska A, Saade G, Abuhamad A, Ferguson KK. Longitudinal associations between urinary biomarkers of phthalates and replacements with novel in vivo measures of placental health. Hum Reprod 2024:deae152. [PMID: 38970902 DOI: 10.1093/humrep/deae152] [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: 11/13/2023] [Revised: 06/10/2024] [Indexed: 07/08/2024] Open
Abstract
STUDY QUESTION What is the longitudinal association between gestational phthalate exposure and in vivo placental outcomes? SUMMARY ANSWER Phthalates were adversely associated with placental microvasculature, stiffness, and presence of calcification, with different metabolites associated with different outcomes. WHAT IS KNOWN ALREADY Phthalate exposure is ubiquitous and implicated as a contributor to adverse pregnancy outcomes, possibly through impacts on the placenta. STUDY DESIGN, SIZE, DURATION A total of 303 women were recruited in early pregnancy and prospectively followed for up to eight visits across gestation in the Human Placenta and Phthalates study. PARTICIPANTS/MATERIALS, SETTING, METHODS At each visit, women provided urine samples and underwent placental ultrasounds. Urine was analyzed for 18 metabolites of phthalates and replacements. We took the geometric mean of repeated measurements to reflect pregnancy-averaged phthalate or replacement exposure for each participant (n = 303). Placental microvasculature, stiffness, and microcalcification presence were quantified from ultrasounds at each visit. Higher scores reflected worse placental function for all measures. Generalized linear mixed models were created to estimate the association between pregnancy-averaged exposure biomarker concentrations and repeated outcome measurements for microvasculature and stiffness. Gestational age at the time of calcification detection was modeled using Cox proportional hazards models. MAIN RESULTS AND THE ROLE OF CHANCE Monocarboxyisononyl phthalate and summed di(2-ethylhexyl) phthalate metabolites were associated with impaired microvasculature development, such that an interquartile range increase in concentration was associated with 0.11 standard deviation increase in the microvasculature ratio, indicating poorer vascularization (95% CI: 0.00, 0.22); 0.11 [95% CI: -0.01, 0.22], respectively. Monoethyl phthalate was associated with increased placental stiffness (0.09 [95% CI: -0.01, 0.19]) while summed di-iso-butyl phthalate metabolites and monobenzyl phthalate were associated with increased hazard of calcification detection (hazard ratios: 1.18 [95% CI: 0.98, 1.42]; 1.13 [95% CI: 0.96, 1.34]). LIMITATIONS, REASONS FOR CAUTION Outcomes used in this study are novel and further investigation is needed to provide clinical context and relevance. WIDER IMPLICATIONS OF THE FINDINGS We found evidence of associations between select phthalate biomarkers and various aspects of in vivo placental health, although we did not observe consistency across placental outcomes. These findings could illustrate heterogeneous effects of phthalate exposure on placental function. STUDY FUNDING/COMPETING INTEREST(S) This research was supported in part by the Intramural Research Program of the NIH, National Institute of Environmental Health Sciences (ZIA ES103344), and NIEHS T32ES007018. The authors declare that they have no competing interests to disclose. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Use of trade names is for identification only and does not imply endorsement by the CDC, the Public Health Service, or the US Department of Health and Human Services. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Emma M Rosen
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Danielle R Stevens
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA
| | - Erin E McNell
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA
- Curriculum in Toxicology and Environmental Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Mollie E Wood
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Stephanie M Engel
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Alexander P Keil
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Antonia M Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Julianne Cook Botelho
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elena Sinkovskaya
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Ann Przybylska
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - George Saade
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, USA
| | - Alfred Abuhamad
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Kelly K Ferguson
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA
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Newby-Kew A, Sandström A, Wikström AK, Stephansson O, Snowden JM. Severe Perineal Lacerations in First Delivery: Association with Subsequent Reproductive Outcomes. J Womens Health (Larchmt) 2024; 33:542-550. [PMID: 38061037 DOI: 10.1089/jwh.2023.0312] [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] [Indexed: 04/25/2024] Open
Abstract
Background: Severe perineal lacerations (SPLs), common worldwide, are associated with short- and long-term complications: pelvic floor disorders, fecal incontinence, fistula, and profound psychological impacts. Limited research suggests that experiencing SPL may influence future reproductive intentions, but research on outcomes is lacking. Methods: We analyzed the effect of experiencing SPL during a first delivery among a large cohort of Swedish births between 1992 and 2013. We used linear and multinomial logistic regression to estimate the associations between SPL and four reproductive outcomes: subsequent total birth number, probability of a second birth, interpregnancy interval (IPI), and subsequent scheduled cesarean birth. Results: Among 947,035 singleton live-born first-births, we found that experiencing SPL was associated with slightly fewer overall births in fully adjusted models (a decrease of -0.020 births; 95% confidence interval [CI]: -0.028 to -0.012), but no difference in the probability of a second birth (risk ratio [RR]: 1.00; 95% CI: 0.99 to 1.00) or IPI. Scheduled cesarean was increased in births after SPL (adjusted RR: 4.57; 95% CI: 4.42 to 4.73). A secondary comparison of SPL to severe postpartum hemorrhage suggests that some of these observed differences may be related to experiencing any severe outcome, and some specifically to perineum disruption. Conclusion: This study provides a deeper understanding of the long-term impacts of SPL, which may be useful in informing best clinical practices for supporting women who have experienced SPL.
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Affiliation(s)
- Abigail Newby-Kew
- School of Public Health, Oregon Health and Science University-Portland State University, Portland, Oregon, USA
| | - Anna Sandström
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
| | - Anna-Karin Wikström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Olof Stephansson
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - Jonathan M Snowden
- School of Public Health, Oregon Health and Science University-Portland State University, Portland, Oregon, USA
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
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Fang Y, Liu H, Li Y, Cheng J, Wang X, Shen B, Chen H, Wang Q. A Prediction Model of Preeclampsia in Hyperglycemia Pregnancy. Diabetes Metab Syndr Obes 2024; 17:1321-1333. [PMID: 38525162 PMCID: PMC10959306 DOI: 10.2147/dmso.s453204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/12/2024] [Indexed: 03/26/2024] Open
Abstract
Purpose To investigate the risk factors associated with preeclampsia in hyperglycemic pregnancies and develop a predictive model based on routine pregnancy care. Patients and Methods The retrospective collection of clinical data was performed on 951 pregnant women with hyperglycemia, including those diagnosed with diabetes in pregnancy (DIP) and gestational diabetes mellitus (GDM), who delivered after 34 weeks of gestation at the Maternal and Child Health Hospital Affiliated to Anhui Medical University between January 2017 and December 2019. Observation indicators included liver and kidney function factors testing at 24-29+6 weeks gestation, maternal age, and basal blood pressure. The indicators were screened univariately, and the "rms" package in R language was applied to explore the factors associated with PE in HIP pregnancy by stepwise regression. Multivariable logistic regression analysis was used to develop the prediction model. Based on the above results, a nomogram was constructed to predict the risk of PE occurrence in pregnant women with HIP. Then, the model was evaluated from three aspects: discrimination, calibration, and clinical utility. The internal validation was performed using the bootstrap procedure. Results Multivariate logistic regression analysis showed that cystatin C, uric acid, glutamyl aminotransferase, blood urea nitrogen, and basal systolic blood pressure as predictors of PE in pregnancy with HIP. The predictive model yielded an area under curve (AUC) value of 0.8031 (95% CI: 0.7383-0.8679), with an optimal threshold of 0.0805, at which point the sensitivity was 0.8307 and specificity of 0.6604. Hosmer-Lemeshow test values were P = 0.3736, Brier score value was 0.0461. After 1000 Bootstrap re-samplings for internal validation, the AUC was 0.7886, the Brier score was 0.0478 and the predicted probability of the calibration curve was similar to the actual probability. A nomogram was constructed based on the above to visualize the model. Conclusion This study developed a model for predicting PE in pregnant women with HIP, achieving high predictive performance of PE risk through the information of routine pregnancy care.
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Affiliation(s)
- Yan Fang
- Department of Obstetrics and Gynaecology, Maternal and Child Health Hospital Affiliated to Anhui Medical University, Hefei, People’s Republic of China
- The Fifth Clinical College of Anhui Medical University, Hefei, People’s Republic of China
| | - Huali Liu
- Department of Obstetrics and Gynaecology, Maternal and Child Health Hospital Affiliated to Anhui Medical University, Hefei, People’s Republic of China
- The Fifth Clinical College of Anhui Medical University, Hefei, People’s Republic of China
| | - Yuan Li
- Department of Obstetrics and Gynaecology, Maternal and Child Health Hospital Affiliated to Anhui Medical University, Hefei, People’s Republic of China
- The Fifth Clinical College of Anhui Medical University, Hefei, People’s Republic of China
| | - Ji Cheng
- Department of Obstetrics and Gynaecology, Maternal and Child Health Hospital Affiliated to Anhui Medical University, Hefei, People’s Republic of China
| | - Xia Wang
- Department of Obstetrics and Gynaecology, Maternal and Child Health Hospital Affiliated to Anhui Medical University, Hefei, People’s Republic of China
| | - Bing Shen
- School of Basic Medicine, Anhui Medical University, Hefei, People’s Republic of China
| | - Hongbo Chen
- Department of Obstetrics and Gynaecology, Maternal and Child Health Hospital Affiliated to Anhui Medical University, Hefei, People’s Republic of China
- The Fifth Clinical College of Anhui Medical University, Hefei, People’s Republic of China
| | - Qunhua Wang
- Department of Obstetrics and Gynaecology, the First Affiliated Hospital of USTC, Hefei, People’s Republic of China
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Sasidharan Pillai S, Fredette ME, Tanzer JR, Hoffman L, Topor LS. The Rising Incidence of Hyperinsulinemic Hypoglycemia: Connection With Maternal Health. Endocr Pract 2023; 29:980-985. [PMID: 37683825 DOI: 10.1016/j.eprac.2023.09.001] [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: 06/05/2023] [Revised: 08/24/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVE Due to a perceived rise in hyperinsulinemic hypoglycemia (HH) cases over time, notably during the COVID-19 pandemic, institutional experiences between 2013 and 2021 were reviewed to evaluate trends, characteristics, and outcomes in children with HH. METHODS Charts of all children diagnosed with HH during the study period and evaluated by Pediatric Endocrinology were reviewed. HH was defined per Pediatric Endocrine Society guidelines. Regression analysis compared rates of change in HH cases and maternal risk factors over time. RESULTS The incidence of HH began to rise in April 2016 and became significant in March 2017 (P < .001), with a more rapid rate of rise during the first year of the COVID-19 pandemic (P < .001). Seventy-four children with HH were identified over 9 years; 43% (n = 32) were diagnosed in 2020-2021. Maternal hypertensive disorders demonstrated longitudinal association with hyperinsulinism cases (P < .001). CONCLUSION While HH diagnoses were on the rise for much of the 9-year study period, nearly half of all infants were diagnosed during the COVID-19 pandemic in 2020 to 21. The trends in HH diagnoses correlated with maternal hypertensive disorders. More studies exploring the roles of maternal health, hypertension, and stress and development of HH in offspring are needed.
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Affiliation(s)
- Sabitha Sasidharan Pillai
- Division of Pediatric Endocrinology, Hasbro Children's Hospital, Providence, Rhode Island, USA; The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Meghan E Fredette
- Division of Pediatric Endocrinology, Hasbro Children's Hospital, Providence, Rhode Island, USA; The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Joshua Ray Tanzer
- Center for Statistical Sciences, Brown University, Providence, Rhode Island, USA
| | - Laurie Hoffman
- Women and Infants Hospital, Providence, Rhode Island, USA
| | - Lisa Swartz Topor
- Division of Pediatric Endocrinology, Hasbro Children's Hospital, Providence, Rhode Island, USA; The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
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Wang Y, Zeng C, Chen Y, Yang L, Tian D, Liu X, Lin Y. Short interpregnancy interval can lead to adverse pregnancy outcomes: A meta-analysis. Front Med (Lausanne) 2022; 9:922053. [PMID: 36530890 PMCID: PMC9747778 DOI: 10.3389/fmed.2022.922053] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 11/01/2022] [Indexed: 12/11/2023] Open
Abstract
BACKGROUND The evidence of some previous papers was insufficient in studying the causal association between interpregnancy interval (IPI) and adverse pregnancy outcomes. In addition, more literature have been updated worldwide during the last 10 years. METHODS English and Chinese articles published from January 1980 to August 2021 in the databases of PubMed, Cochrane Library, Ovid, Embase, China Biology Medicine disc (CBM), and China National Knowledge Infrastructure (CNKI) were searched. Then following the inclusion and exclusion criteria, we screened the articles. Utilizing the Newcastle-Ottawa Scale (NOS), we evaluated the quality of the included articles. The literature information extraction table was set up in Excel, and the meta-analysis was performed with Stata 16.0 software (Texas, USA). RESULTS A total of 41 articles were included in the meta-analysis, and NOS scores were four to eight. The short IPI after delivery was the risk factor of preterm birth (pooled odds ratio 1.49, 95% confidence interval 1.42-1.57), very preterm birth (pooled OR: 1.82, 95% CI: 1.55-2.14), low birth weight (pooled OR: 1.33, 95% CI: 1.24-1.43), and small for gestational age (pooled OR: 1.14, 95% CI: 1.07-1.21), offspring death (pooled OR: 1.60, 95% CI: 1.51-1.69), NICU (pooled OR: 1.26, 95% CI: 1.01-1.57), and congenital abnormality (pooled OR: 1.10, 95% CI: 1.05-1.16), while was not the risk factor of gestational hypertension (pooled OR: 0.95, 95% CI: 0.93-0.98) or gestational diabetes (pooled OR: 1.06, 95% CI: 0.93-1.20). CONCLUSION Short IPI (IPI < 6 months) can lead to adverse perinatal outcomes, while it is not a risk factor for gestational diabetes and gestational hypertension. Therefore, more high-quality studies covering more comprehensive indicators of maternal and perinatal pregnancy outcomes are needed to ameliorate the pregnancy policy for women of childbearing age.
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Affiliation(s)
- Yumei Wang
- Department of Health Care, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Can Zeng
- Department of Travel to Check, Customs of Chengdu Shuangliu Airport Belongs to Chengdu Customs, Chengdu, China
| | - Yuhong Chen
- Department of Health Care, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Liu Yang
- Department of Health Care, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Di Tian
- Department of Health Care, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xinghui Liu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yonghong Lin
- Department of Health Care, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Goldbart A, Pariente G, Sheiner E, Wainstock T. Identifying risk factors for placental abruption in subsequent pregnancy without a history of placental abruption. Int J Gynaecol Obstet 2022; 161:406-411. [PMID: 36083780 DOI: 10.1002/ijgo.14446] [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: 04/02/2022] [Revised: 08/18/2022] [Accepted: 08/30/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To identify first pregnancy risk factors for placental abruption in subsequent pregnancy. METHODS In a population-based nested case-control study, cases were defined as women with placental abruption in their second pregnancy, and controls as women without abruption. A total of 43,328 women were included in the study, 0.4%(n=186) of second pregnancies had placental abruption. Multivariable logistic models were used to study the association between first pregnancy complications and placental abruption in subsequent pregnancy. RESULTS Having either small for gestational age, preterm delivery, preeclampsia or caesarian delivery during first pregnancy were independently associated with increased risk for placental abruption, and the risk was higher with any additional complication (age adjusted OR=2.00; 95%CI 1.46-2.74, adjusted OR=3.61; 95%CI 2.23-5.86, and adjusted OR=3.86; 95%CI 1.56-9.56, for 1, 2 and ≥3 complications, respectively). CONCLUSION First pregnancy may serve as a window of opportunity to identify women at risk for future placental abruption.
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Affiliation(s)
- Adi Goldbart
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gali Pariente
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Wang M, Wang X, Chen Z, Zhang F. Gestational hypertensive disease and small for gestational age infants in twin pregnancy: A systematic review and meta-analysis. J Obstet Gynaecol Res 2022; 48:2677-2685. [PMID: 35975304 DOI: 10.1111/jog.15401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/12/2022] [Accepted: 08/01/2022] [Indexed: 11/28/2022]
Abstract
AIM The review is to explore the connection between gestational hypertension diseases (GHD) and small for gestational age (SGA) in twin pregnancies. METHODS According to the recommendations of PRISMA, relevant studies were systematically searched through PubMed, Web of Science, Cochrane Library, Embase from inception until January 16, 2022. Subgroup analysis was performed according to chorionicity and diagnostic criteria of SGA. Odds ratios (OR) were assessed to judge the link between GHD and SGA in twin pregnant women. A random-effect model was used to estimate the pooled hazard ratio when there was significant heterogeneity (I2 > 50%); otherwise, a fixed-effect model was conducted. RESULTS Seven articles containing 470 589 twin pregnant women were included. The increased risk of SGA was connected to the twin pregnancies complicated with GHD (OR = 1.57, 95% confidence interval [CI] = 1.10-2.24, p = 0.01). After subgroup analysis, the connection between SGA and GHD had no statistical significance (OR = 1.17, 95% CI = 0.95-1.44, p = 0.14) when the enrolled studies using the SGA diagnosis referred to singleton birth weight, but significant (OR = 2.14, 95% CI = 1.77-2.60, p<0.001) in the group using the SGA diagnosis referred to twin birth weight. Stratified by chorionicity, SGA was relevant to GHD in the dichorionic (DC) group (OR = 1.68, 95% CI = 1.17-2.42, p = 0.005), while not in the monochorionic (MC) group (OR = 1.68, 95% CI = 0.93-3.03, p = 0.09). More future articles are warranted to confirm these outcomes. CONCLUSIONS Our review demonstrated that GHD in DC twin pregnancies was related to an enlarged risk of SGA. Two SGA diagnosis references led to different results. Twin pregnancies complicated with GHD were at significantly higher risk of SGA when twin birth weight reference was used.
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Affiliation(s)
- Mingbo Wang
- Medical School of Nantong University, Nantong, China
| | - Xin Wang
- Medical School of Nantong University, Nantong, China
| | - Zhifang Chen
- Nantong Maternity and Child Health Care Hospital Affiliated to Nantong University, Nantong, China
| | - Feng Zhang
- Medical School of Nantong University, Nantong, China
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Clinical factors associated with preeclampsia recurrence. Pregnancy Hypertens 2022; 30:31-35. [DOI: 10.1016/j.preghy.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 07/10/2022] [Accepted: 08/02/2022] [Indexed: 11/15/2022]
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Yang Y, Wu N. Gestational Diabetes Mellitus and Preeclampsia: Correlation and Influencing Factors. Front Cardiovasc Med 2022; 9:831297. [PMID: 35252402 PMCID: PMC8889031 DOI: 10.3389/fcvm.2022.831297] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/20/2022] [Indexed: 12/16/2022] Open
Abstract
Gestational diabetes mellitus (GDM) and preeclampsia (PE) are common pregnancy complications with similar risk factors and pathophysiological changes. Evidence from previous studies suggests that the incidence of PE is significantly increased in women with GDM, but whether GDM is independently related to the occurrence of PE has remained controversial. GDM complicated by PE further increases perinatal adverse events with greater impact on the future maternal and offspring health. Identify factors associated with PE in women with GDM women, specifically those that are controllable, is important for improving pregnancy outcomes. This paper provides the findings of a review on the correlation between GDM and PE, factors associated with PE in women with GDM, possible mechanisms, and predictive markers. Most studies concluded that GDM is independently associated with PE in singleton pregnancy, and optimizing the treatment and management of GDM can reduce the incidence of PE, which is very helpful to improve pregnancy outcomes.
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Affiliation(s)
- Ying Yang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Na Wu
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Skills Practice Teaching Center, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Na Wu
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Toledano R, Wainstock T, Sheiner E, Kessous R. Impact of interpregnancy interval on long-term childhood neoplasm of the offspring. J Matern Fetal Neonatal Med 2021; 35:8611-8617. [PMID: 34662535 DOI: 10.1080/14767058.2021.1989406] [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: 10/20/2022]
Abstract
BACKGROUND The possible impact of interpregnancy interval (IPI) on perinatal outcomes has long been studied, however, a definition of the optimal interval is still not clear. Both short and long IPIs have been associated with obstetrical syndromes and short and long-term complications. In this study, we sought to explore the impact of IPI on the hazard for neoplasm of the offspring, thus contribute to the present literature in determining the preferred birth spacing. OBJECTIVE We aim to investigate the association between short and long IPIs and the hazard for childhood neoplasm of the offspring. METHODS A population-based retrospective cohort analysis comparing offspring neoplasm hazard following three different IPIs. Exposure was defined as short (<6 months), or long (>60 months) IPIs, whereas intermediate IPI (6 months - 60 months) served as the comparison group. The study included singleton live births in a tertiary regional hospital between 1991 and 2014. Offspring were followed for 18 years, and all hospitalization records for neoplasm diagnoses were collected. Kaplan-Meier survival curves were used for the cumulative incidence of neoplasm morbidity, and Cox proportional hazards models were used to control for confounders. RESULTS During the study period, 144,397 deliveries met the inclusion criteria. Of those, 18,947 (13.1%) occurred in women with short IPI, 114,012 (79%) in women with intermediate IPI, and 11,438 (7.9%) in women with long IPI. 61 benign neoplasms and 80 malignant neoplasms were registered in offspring born after long IPI. The total percentage of neoplasm were the highest in the long IPI group versus the intermediate and short IPI groups (malignant - 0.7%, 0.6%, 0.5% respectively, benign - 0.5%, 0.4%, 0.3% respectively). Controlling for maternal age, diabetes mellitus, preterm delivery, birth weight, smoking, cesarean section, and fertility treatments, long IPI was found to be independently associated with high hazard for long-term pediatric neoplasm related hospitalizations (adjusted HR 1.39, 95% CI 1.09, 1.77). Short IPI may be associated to decreased hazard for childhood neoplasms (adjusted HR 0.74, 95% Cl 0.59, 0.92). CONCLUSIONS Long IPI is associated with a high hazard for childhood neoplasms, compared with intermediate and short IPIs. Short IPI may be associated with decreased hazard for childhood neoplasms.
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Affiliation(s)
- Roni Toledano
- The Goldman Medical School at the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Wainstock
- The Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Roy Kessous
- The Goldman Medical School at the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Ogunwole SM, Mwinnyaa G, Wang X, Hong X, Henderson J, Bennett WL. Preeclampsia Across Pregnancies and Associated Risk Factors: Findings From a High-Risk US Birth Cohort. J Am Heart Assoc 2021; 10:e019612. [PMID: 34398644 PMCID: PMC8649269 DOI: 10.1161/jaha.120.019612] [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: 11/28/2022]
Abstract
Background Preeclampsia increases women's risks for maternal morbidity and future cardiovascular disease. The aim of this study was to identify opportunities for prevention by examining the association between cardiometabolic risk factors and preeclampsia across 2 pregnancies among women in a high‐risk US birth cohort. Methods and Results Our sample included 618 women in the Boston Birth Cohort with index and subsequent pregnancy data collected using standard protocols. We conducted log‐binomial univariate regression models to examine the association between preeclampsia in the subsequent pregnancy (defined as incident or recurrent preeclampsia) and cardiometabolic risk factors (ie, obesity, hypertension, diabetes mellitus, preterm birth, low birth weight, and gestational diabetes mellitus) diagnosed before and during the index pregnancy, and between index and subsequent pregnancies. At the subsequent pregnancy, 7% (36/540) had incident preeclampsia and 42% (33/78) had recurrent preeclampsia. Compared with women without obesity, women with obesity had greater risk of incident preeclampsia (unadjusted risk ratio [RR], 2.2 [95% CI, 1.1–4.5]) and recurrent preeclampsia (unadjusted RR, 3.1 [95% CI, 1.5–6.7]). Preindex pregnancy chronic hypertension and diabetes mellitus were associated with incident, but not recurrent, preeclampsia (hypertension unadjusted RR, 7.9 [95% CI, 4.1–15.3]; diabetes mellitus unadjusted RR, 5.2 [95% CI, 2.5–11.1]. Women with new interpregnancy hypertension versus those without had a higher risk of incident and recurrent preeclampsia (incident preeclampsia unadjusted RR, 6.1 [95% CI, 2.9–13]); recurrent preeclampsia unadjusted RR, 2.4 [95% CI, 1.5–3.9]). Conclusions In this diverse sample of high‐risk US women, we identified modifiable and treatable risk factors, including obesity and hypertension for the prevention of preeclampsia.
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Affiliation(s)
- S Michelle Ogunwole
- Department of Medicine Division of General Internal MedicineJohns Hopkins University School of Medicine Baltimore MD
| | - George Mwinnyaa
- Department of International HealthJohns Hopkins University Bloomberg School of Public Health Baltimore MD
| | - Xiaobin Wang
- Department of PediatricsJohns Hopkins University School of Medicine Baltimore MD.,Center on the Early Life Origins of Disease Department of Population, Family and Reproductive Health Johns Hopkins University Bloomberg School of Public Health Baltimore MD
| | - Xiumei Hong
- Center on the Early Life Origins of Disease Department of Population, Family and Reproductive Health Johns Hopkins University Bloomberg School of Public Health Baltimore MD
| | - Janice Henderson
- Department of Gynecology and Obstetrics Johns Hopkins University School of Medicine Baltimore MD
| | - Wendy L Bennett
- Department of Medicine Division of General Internal MedicineJohns Hopkins University School of Medicine Baltimore MD.,Center on the Early Life Origins of Disease Department of Population, Family and Reproductive Health Johns Hopkins University Bloomberg School of Public Health Baltimore MD
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Lin D, Luo BD C, Chen G, Fan D, Huang Z, Li P, Wu S, Ye BD S, Ma H, Rao J, Zhang H, Chen T, Zeng M, Guo X, Liu Z. The association of hypertensive disorders of pregnancy with small for gestational age and intertwin birthweight discordance. J Clin Hypertens (Greenwich) 2021; 23:1354-1362. [PMID: 34014022 PMCID: PMC8678671 DOI: 10.1111/jch.14257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/28/2021] [Accepted: 03/31/2021] [Indexed: 11/27/2022]
Abstract
Available evidence shows conflicting results regarding the association between hypertensive disorders of pregnancy (HDPs)/preeclampsia (PE) and small for gestational age (SGA) and birthweight discordance (BWD). This retrospective study of 2131 twin pregnancies aimed to evaluate the association of HDPs/PE with the presence of SGA and BWD. The eligible pregnancies were categorized into four study groups: concordant pairs without SGA fetuses, discordant pairs without SGA fetuses, concordant pairs with SGA fetuses, and discordant pairs with SGA fetuses. We applied binary logistic regression models to compare the incidence of HDPs/PE and multinomial logit regression models to evaluate the severity of PE between the study groups. The models were adjusted for potential confounders. Increases in HDPs were observed in concordant (aOR, 2.33; 95% CI: 1.46-3.73) and discordant (aOR, 3.50; 95% CI: 2.26-5.43) pregnancies with SGA fetuses but not in discordant pregnancies without SGA fetuses (aOR, 1.42; 95% CI: 0.81-2.49); increases in PE were also found in concordant (aOR, 1.87; 95% CI: 1.08-3.23) and discordant (aOR, 3.75; 95% CI: 2.36-5.96) pregnancies with SGA fetuses but not in discordant pregnancies without SGA fetuses (aOR, 1.34; 95% CI: 0.71-2.52). Discordant pregnancies with SGA fetuses were associated with severe PE (aRRR, 3.48; 95% CI: 1.79-6.77), whereas concordant pregnancies with SGA fetuses were associated with only mild PE (aRRR, 2.54; 95% CI: 1.33-4.88). Our results suggest that SGA is associated with the development of HDP/PE, while discordant growth is associated with the severity of PE. These associations need to be further investigated using estimated fetal weight (EFW).
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Affiliation(s)
- Dongxin Lin
- Foshan Institute of Fetal MedicineAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
- Department of ObstetricsAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
| | - Caihong Luo BD
- Department of ObstetricsAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
| | - Gengdong Chen
- Foshan Institute of Fetal MedicineAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
- Department of ObstetricsAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
| | - Dazhi Fan
- Foshan Institute of Fetal MedicineAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
- Department of ObstetricsAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
| | - Zheng Huang
- The First Affiliated Hospital of Guangdong Pharmaceutical UniversityGuangzhouChina
| | - Pengsheng Li
- Foshan Institute of Fetal MedicineAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
- Department of ObstetricsAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
| | - Shuzhen Wu
- Foshan Institute of Fetal MedicineAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
- Department of ObstetricsAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
| | - Shaoxin Ye BD
- Foshan Institute of Fetal MedicineAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
- Department of ObstetricsAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
| | - Huiting Ma
- Foshan Institute of Fetal MedicineAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
- Department of ObstetricsAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
| | - Jiaming Rao
- Foshan Institute of Fetal MedicineAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
- Department of ObstetricsAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
| | - Huishan Zhang
- Foshan Institute of Fetal MedicineAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
- Department of ObstetricsAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
| | - Ting Chen
- Foshan Institute of Fetal MedicineAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
- Department of ObstetricsAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
| | - Meng Zeng
- Department of ObstetricsAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
| | - Xiaoling Guo
- Foshan Institute of Fetal MedicineAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
- Department of ObstetricsAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
| | - Zhengping Liu
- Foshan Institute of Fetal MedicineAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
- Department of ObstetricsAffiliated Foshan Maternity & Child Healthcare HospitalSouthern Medical UniversityFoshanChina
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Inter-pregnancy interval and later pediatric cardiovascular health of the offspring - a population-based cohort study. J Dev Orig Health Dis 2020; 12:819-823. [PMID: 33261705 DOI: 10.1017/s2040174420001130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Recent evidence suggests that a long inter-pregnancy interval (IPI: time interval between live birth and estimated time of conception of subsequent pregnancy) poses a risk for adverse short-term perinatal outcome. We aimed to study the effect of short (<6 months) and long (>60 months) IPI on long-term cardiovascular morbidity of the offspring. A population-based cohort study was performed in which all singleton live births in parturients with at least one previous birth were included. Hospitalizations of the offspring up to the age of 18 years involving cardiovascular diseases and according to IPI length were evaluated. Intermediate interval, between 6 and 60 months, was considered the reference. Kaplan-Meier survival curves were used to compare the cumulative morbidity incidence between the groups. Cox proportional hazards model was used to control for confounders. During the study period, 161,793 deliveries met the inclusion criteria. Of them, 14.1% (n = 22,851) occurred in parturient following a short IPI, 78.6% (n = 127,146) following an intermediate IPI, and 7.3% (n = 11,796) following a long IPI. Total hospitalizations of the offspring, involving cardiovascular morbidity, were comparable between the groups. The Kaplan-Meier survival curves demonstrated similar cumulative incidences of cardiovascular morbidity in all groups. In a Cox proportional hazards model, short and long IPI did not appear as independent risk factors for later pediatric cardiovascular morbidity of the offspring (adjusted HR 0.97, 95% CI 0.80-1.18; adjusted HR 1.01, 95% CI 0.83-1.37, for short and long IPI, respectively). In our population, extreme IPIs do not appear to impact long-term cardiovascular hospitalizations of offspring.
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Characterizing placental stiffness using ultrasound shear-wave elastography in healthy and preeclamptic pregnancies. Arch Gynecol Obstet 2020; 302:1103-1112. [PMID: 32676857 DOI: 10.1007/s00404-020-05697-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/09/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To measure the stiffness of the placenta in healthy and preeclamptic patients in the second and third trimesters of pregnancy using ultrasound shear-wave elastography (SWE). We also aimed to evaluate the effect of age, gestational age, gravidity, parity and body mass index (BMI) on placental stiffness and a possible correlation of stiffness with perinatal outcomes. METHODS In a case-control study, we recruited a total of 47 singleton pregnancies in the second and third trimesters of which 24 were healthy and 23 were diagnosed with preeclampsia. In vivo placental stiffness was measured once at the time of recruitment for each patient. Pregnancies with posterior placentas, multiple gestation, gestational hypertension, chronic hypertension, diabetes, autoimmune disease, fetal growth restriction and congenital anomalies were excluded. RESULTS The mean placental stiffness was significantly higher in preeclamptic pregnancies compared to controls in the third trimester (difference of means = 16.8; 95% CI (9.0, 24.5); P < 0.001). There were no significant differences in placental stiffness between the two groups in the second trimester or between the severe preeclampsia and preeclampsia without severe features groups (difference of means = 9.86; 95% CI (-5.95, 25.7); P ≥ 0.05). Peripheral regions of the placenta were significantly stiffer than central regions in the preeclamptic group (difference of means = 10.67; 95% CI (0.07, 21.27); P < 0.05), which was not observed in the control group (difference of means = 0.55; 95% CI (- 5.25, 6.35); P > 0.05). We did not identify a correlation of placental stiffness with gestational age, maternal age, gravidity or parity. However, there was a statistically significant correlation with BMI (P < 0.05). In addition, pregnancies with higher placental stiffness during the 2nd and 3rd trimesters had significantly reduced birth weight (2890 ± 176 vs. 2420 ± 219 g) and earlier GA (37.8 ± 0.84 vs. 34.3 ± 0.98 weeks) at delivery (P < 0.05). CONCLUSION Compared to healthy pregnancies, placentas of preeclamptic pregnancies are stiffer and more heterogeneous. Placental stiffness is not affected by gestational age or the severity of preeclampsia but there is a correlation with higher BMI and poor perinatal outcomes.
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