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Al-Alami Z, Abu-Huwaij R, Hamadneh S, Taybeh E. Understanding Miscarriage Prevalence and Risk Factors: Insights from Women in Jordan. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1044. [PMID: 39064473 PMCID: PMC11279235 DOI: 10.3390/medicina60071044] [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: 05/14/2024] [Revised: 06/18/2024] [Accepted: 06/20/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: Miscarriage is a complication that is influenced by many risk factors that have been reported in different studies and that vary among countries. Despite the influence of various known risk factors for miscarriage, 30% to 50% of miscarriages are from unidentified causes. The aim of this study is to determine the prevalence of miscarriages in Jordan and the associated risk factors. Materials and Methods: A cross-sectional online survey was conducted in Jordan among married women to investigate the prevalence of miscarriages and identify potential risk factors. Results: Women (n = 704) were surveyed, and 17.9% reported a history of miscarriage. The identified risk factors were being an active smoker during pregnancy, having more than four children, having a family history of miscarriage, having fertility problems, receiving medical assistance for conception, and traveling by air during pregnancy. Conclusions: The results suggest that there are both modifiable and non-modifiable risk factors for miscarriages in Jordan and that a proportion of these may be preventable. The findings can be used to enhance patient awareness and inform policy development to decrease the incidence of miscarriage in the country.
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Affiliation(s)
- Zina Al-Alami
- Department of Basic Medical Sciences, Faculty of Allied Medical Sciences, Al-Ahliyya Amman University, Amman P.O. Box 19328, Jordan
| | - Rana Abu-Huwaij
- College of Pharmacy, Amman Arab University, P.O. Box 2234, Amman 11953, Jordan;
| | - Shereen Hamadneh
- Department of Maternal and Child Health, Princess Salma Faculty of Nursing, Al al-Bayt University, Mafraq P.O. Box 130040, Jordan;
| | - Esra’ Taybeh
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, P.O. Box 22, Amman 11622, Jordan;
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罗 靓, 李 云, 王 红, 相 晓, 赵 静, 孙 峰, 张 晓, 贾 汝, 李 春. [Anti-endothelial cell antibodies in predicting early miscarriage]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2023; 55:1039-1044. [PMID: 38101786 PMCID: PMC10723987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE To explore the clinical significance of anti-endothelial cell antibodies (AECA) in predicting early miscarriage. METHODS A total of 122 pregnant women with no history of autoimmune diseases who underwent prenatal examination at Peking University People's Hospital from January 2020 to December 2022 were selected, and they were tested for AECA. Based on the history of early miscarriage (gestational age at miscarriage < 12 weeks), the participants were divided into an early miscarriage group and a control group. t-tests, non-parametric Wilcoxon tests, Chi-square tests, and Fisher's exact probability method were used to compare general information and laboratory indicators between the two groups. A multivariate Logistic regression model was used to analyze the factors associated with early miscarriage. The natural miscarriage rates were assessed through follow-up with pregnant women, and Kaplan-Meier survival analysis was employed to compare the natural miscarriage rates between AECA-positive and AECA-negative pregnant women. RESULTS (1) A total of 122 pregnant women were enrolled, comprising 35 cases (28.7%) in the early miscarriage group, with an average age of (32.1±6.1) years, and 87 cases (71.3%) in the control group, with an average age of (30.7±5.1) years. The early miscarriage group had higher gravidity [3 (2, 4) vs. 1 (1, 2), Z=-6.402, P < 0.001] and a higher prevalence of hypertension (11.4% vs.1.1%, P=0.024). The positive rate of AECA in the early miscarriage group (34.3% vs. 8.0%, χ2=13.070, P < 0.001) and the proportion of elevated immunoglobulin G (17.1% vs. 4.6%, P=0.032) were significantly higher than that in the control group. (2) Multivariate logistic regression analysis showed that higher gravidity (OR=4.149, 95%CI: 2.287-7.529, P < 0.001), AECA positivity (OR= 4.288, 95% CI: 1.157-15.893, P=0.029), and elevated immunoglobulin G levels (OR =6.177, 95%CI: 1.156-33.015, P=0.033) were risk factors for early miscarriage. (3) The 122 pregnant women were categorized into two groups: the AECA-positive group (19 cases) and the AECA-negative group (103 cases). Survival analysis demonstrated that at the end of 12 weeks of gestation, the fetal survival rate in the AECA-positive group was significantly lower than that in the AECA-negative group (84.2% vs. 96.1%, P= 0.035). CONCLUSION Higher gravidity, AECA positivity, and elevated immunoglobulin G levels are significant risk factors for early miscarriage. The results demonstrate that AECA is a novel predicting test in early miscarriage.
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Affiliation(s)
- 靓 罗
- 北京大学人民医院风湿免疫科, 北京 100044Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
- 重庆市渝北区人民医院中医科, 重庆 401120Department of Chinese Medicine, the People's Hospital of Yubei District of Chongqing City, Chongqing 401120, China
| | - 云 李
- 北京大学人民医院风湿免疫科, 北京 100044Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
| | - 红彦 王
- 北京大学人民医院风湿免疫科, 北京 100044Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
| | - 晓红 相
- 北京大学人民医院风湿免疫科, 北京 100044Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
| | - 静 赵
- 北京大学人民医院风湿免疫科, 北京 100044Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
| | - 峰 孙
- 北京大学人民医院风湿免疫科, 北京 100044Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
| | - 晓盈 张
- 北京大学人民医院风湿免疫科, 北京 100044Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
| | - 汝琳 贾
- 北京大学人民医院风湿免疫科, 北京 100044Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
| | - 春 李
- 北京大学人民医院风湿免疫科, 北京 100044Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
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Santana AB, Spelta LEW, Sobalvarro JVM, Podestá MHMC, Garcia RCT, Dos Reis TM, Torres LH. Gestational lead exposure and its effects on fetal/infant development - A systematic review. Reprod Toxicol 2023; 117:108342. [PMID: 36758879 DOI: 10.1016/j.reprotox.2023.108342] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/05/2023] [Indexed: 02/10/2023]
Abstract
Studies suggest that gestational exposure to lead (Pb) is related to spontaneous abortions, preterm birth, lower infant birth weight and length, and neurological dysfunctions. However, the evidence about its effects during pregnancy exposure on fetal and child development is still poor. Thus, the aim of this systematic review was to verify the association between prenatal exposure to Pb and the occurrence of neurobehavioral deficits, miscarriages, and child mortality. Observational studies with pregnant women exposed to Pb during pregnancy were included, without gender or ethnicity restrictions. The MEDLINE, Cochrane Library, EMBASE, Scopus, Web of Science, and LILACS databases were searched. The reading of titles and abstracts was conducted, followed by reading in full format and data extraction, that were performed independently by two reviewers. The included studies were evaluated by Downs and Black tool and qualitatively synthesized. Certainty of evidence was assessed by Grading of Recommendations Assessment, Development, and Evaluations (GRADE). The study protocol was registered with the Prospective Registry of Systematic Reviews (PROSPERO; CRD42022296750). Among twenty-one studies included, sixteen were classified as prospective cohort, two case-control, one nested case-control, one cohort, and one longitudinal study. No study that evaluated child mortality associated with gestational Pb exposure was found. There is a very low certainty of evidence in the association of gestational Pb exposure and neurobehavioral deficits or miscarriages. This systematic review reflects the poor evidence and the challenges of human toxicology studies, since it was not possible to associate gestational Pb exposure to neurobehavioral deficits, miscarriages, and child mortality.
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Affiliation(s)
- Aleksander Brandão Santana
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700, Alfenas 37130-001, MG, Brazil
| | - Lídia Emmanuela Wiazowski Spelta
- Department of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, University of São Paulo, Av. Prof. Lineu Prestes, 580, Butantã, São Paulo 05508-000, SP, Brazil
| | - Joselin Valeska Martinez Sobalvarro
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700, Alfenas 37130-001, MG, Brazil; Department of Health Sciences, Federal University of Paraná, Av. Mayor Lothário Meissner, 623, Jardim Botânico, Curitiba 80210-170, PR, Brazil
| | - Márcia Helena Miranda Cardoso Podestá
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700, Alfenas 37130-001, MG, Brazil
| | - Raphael Caio Tamborelli Garcia
- Department of Pharmaceutical Sciences, Institute of Environmental, Chemical and Pharmaceutical Sciences, Federal University of São Paulo, Diadema, SP, Brazil
| | - Tiago Marques Dos Reis
- Department of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700, Alfenas 37130-001, MG, Brazil
| | - Larissa Helena Torres
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700, Alfenas 37130-001, MG, Brazil.
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Sanchez Ortiz S, Huerta C, Llorente-García A, Ortega P, Astasio P, Cea-Soriano L. A Validation Study on the Frequency and Natural History of Miscarriages Using the Spanish Primary Care Database BIFAP. Healthcare (Basel) 2021; 9:healthcare9050596. [PMID: 34069788 PMCID: PMC8157258 DOI: 10.3390/healthcare9050596] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 12/17/2022] Open
Abstract
(1) Background: There is a major gap of knowledge towards the natural history of miscarriages in electronic medical records. We aimed to calculate the frequency of miscarriages using data from BIFAP database. (2) Methods: We identified all pregnancy losses and carried out a multistep validation exercise. Potential cases with positive predictive values (PPV) of miscarriage confirmation <85% or those confirming other pregnancy loss were excluded. Kaplan–Meier figures and incidence rates (IRs) of miscarriage with 95% confidence intervals (CIs) expressed by 1000 person-weeks were calculated. Stratifying analysis by age, specific high-risk groups, and drug exposure within the pre-pregnancy period were performed restricted to women with recording last menstrual period (LMP). (3) Results: Women with confirmed miscarriage (N = 18,070), tended to be older, with higher frequency of comorbidities and drug utilization. Restricting to women with LPM recorded, IR of miscarriage was 10.89 (CI 95% 10.68–11.10) per 1000 women-weeks, with a median follow-up of 10 weeks (IQR: 8–12). The IR according to age was: 2.71 (CI 95% 2.59–2.84) in those aged <30 years compared to 9.11 (CI 95% 8.55–9.70) in women aged ≥40 years. Advanced maternal age (Hazard Ratio (HR, 95% confidence interval) CI 95%: 3.34 (3.08–3.62)), use of antihypertensives (1.49 (1.21–1.84), and use of drugs classified as D or X during pregnancy (1.17 (1.07–1.29)) showed to be positive predictors associated with increased risk of miscarriages. (4) Conclusion: BIFAP database can be used to identify women suffering from miscarriages, which will serve to further study risk factors associated with miscarriages with special attention to drug utilization.
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Affiliation(s)
- Sara Sanchez Ortiz
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (S.S.O.); (C.H.); (P.O.); (P.A.)
| | - Consuelo Huerta
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (S.S.O.); (C.H.); (P.O.); (P.A.)
- BIFAP, Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency for Medicines and Medical Devices (AEMPS), 28040 Madrid, Spain;
| | - Ana Llorente-García
- BIFAP, Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency for Medicines and Medical Devices (AEMPS), 28040 Madrid, Spain;
| | - Paloma Ortega
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (S.S.O.); (C.H.); (P.O.); (P.A.)
| | - Paloma Astasio
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (S.S.O.); (C.H.); (P.O.); (P.A.)
| | - Lucía Cea-Soriano
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (S.S.O.); (C.H.); (P.O.); (P.A.)
- Correspondence: ; Tel.: +34-91-531-3404
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Pregnancy Loss in Women with HIV is not Associated with HIV Markers: Data from a National Study in Italy, 2001-2018. Mediterr J Hematol Infect Dis 2019; 11:e2019050. [PMID: 31528316 PMCID: PMC6736172 DOI: 10.4084/mjhid.2019.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/08/2019] [Indexed: 11/08/2022] Open
Abstract
Background There is limited information on pregnancy loss in women with HIV, and it is still debated whether HIV-related markers may play a role.Objectives: To explore potential risk factors for pregnancy loss in women with HIV, with particular reference to modifiable risk factors and markers of HIV disease. Methods Multicenter observational study of HIV-positive pregnant women. The main outcome measure was pregnancy loss, including both miscarriage (<22 weeks) and stillbirth (≥22 weeks). Possible associations of pregnancy loss were evaluated in univariate and multivariate analyses. Results Among 2696 eligible pregnancies reported between 2001 and 2018, 226 (8.4%) ended in pregnancy loss (miscarriage 198, 7.3%; stillbirth 28, 1.0%). In multivariate analyses, only older age (adjusted odds ratio [AOR] per additional year of age: 1.079, 95% confidence interval [CI] 1.046-1.113), HIV diagnosis before pregnancy (AOR: 2.533, 95%CI 1.407-4.561) and history of pregnancy loss (AOR: 1.625, 95%CI 1.178-2.243) were significantly associated with pregnancy loss. No significant association with pregnancy loss was found for parity, coinfections, sexually transmitted diseases, hypertension, smoking, alcohol and substance use, CD4 cell count, HIV-RNA viral load, and CDC HIV stage. Conclusions Older women and those with a previous history of pregnancy loss should be considered at higher risk of pregnancy loss. The severity of HIV disease and potentially modifiable risk factors did not increase the risk of pregnancy loss.
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Abstract
Early in pregnancy women frequently experience nausea, vomiting, and vaginal bleeding. Nausea and vomiting can be mild, managed by dietary modifications and medications, or severe, requiring intravenous fluids and medications. Care should be used when selecting medications for nausea to avoid additional side effects or potential harm to the developing fetus. When evaluating vaginal bleeding in early pregnancy, ectopic pregnancy must be ruled out. If an intrauterine pregnancy is seen, threatened miscarriage should be considered and the patient appropriately counseled. If neither intrauterine pregnancy nor ectopic pregnancy can be established, a management algorithm for pregnancy of unknown location is presented.
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Affiliation(s)
- Elizabeth Pontius
- Department of Emergency Medicine, Georgetown University School of Medicine, MedStar Georgetown University Hospital, MedStar Washington Hospital Center, 110 Irving Street, Northwest, NA 1177, Washington, DC 20010, USA
| | - Julie T Vieth
- Department of Emergency Medicine, Canton-Potsdam Hospital, 50 Leroy Street, Potsdam, NY 13676, USA.
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Horiuchi I, Wakimoto Y, Kuwata T, Sawai H, Shibahara H, Takagi K. Cytogenetic Analysis of Spontaneous Miscarriages Using Long-Term Culturing of Chorionic Villi. JOURNAL OF FETAL MEDICINE 2019. [DOI: 10.1007/s40556-018-0190-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Wang HY, Qiao J, Sun XX, Wang SY, Liang XY, Sun Y, Liu FH. Epidemiological Survey and Risk Factor Analysis of Recurrent Spontaneous Miscarriages in Infertile Women at Large Infertility Centers. Chin Med J (Engl) 2018; 130:2056-2062. [PMID: 28836548 PMCID: PMC5586173 DOI: 10.4103/0366-6999.213415] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: A higher frequency of spontaneous miscarriage has been observed in infertile couples, and there is a higher prevalence of infertility among patients with a history of recurrent spontaneous miscarriages (RSMs; ≥2 miscarriages). This study aimed to determine the proportion of infertile patients with RSM and examine risk factors associated in patients with RSM being treated with assisted reproductive technologies. Methods: This cross-sectional observational study was conducted at six reproductive medicine centers in three cities of China. Data of 751 patients with at least one spontaneous miscarriage were analyzed. Demographic data and etiological factors associated with infertility were compiled and compared between patients with a single spontaneous miscarriage (SSM) and those with RSM. Results: Two hundred (26.6%, 95% confidence interval [CI]: 23.50–29.95%) patients experienced RSMs and 551 (73.4%) had a single miscarriage. The odds of RSM increased with increasing age (odds ratio [OR] = 1.06), uterine disorders (OR = 2.09), endocrine disorders (OR = 2.48), and immune disorders (OR = 2.98). Higher education level, masters or above, and a pelvic cavity disorder were associated with lower risk of RSM (OR = 0.27 and 0.46, respectively). Late spontaneous miscarriages were more frequent in patients with RSM than in those with a SSM (31.5% vs. 14.2%, respectively, P < 0.001) and were associated with a history of uterine cavity procedures (OR = 2.095) and cervical factors related to infertility (OR = 4.136, 95% CI: 1.012–16.90). Conclusions: Compared to patients with only a SSM, the conditions of patients with RSM are more complicated. To increase the success rate of assisted reproductive technology, factors including uterus cavity adhesion, cervical relaxation, endocrine disorders, and immune disorders should be treated before assisted reproduction is initiated. These data may provide treatment guidance for infertile patients with a history of RSM.
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Affiliation(s)
- Hai-Yan Wang
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
| | - Jie Qiao
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
| | - Xiao-Xi Sun
- Shanghai Ji Ai Diagnosis and Treatment Center for Genetics and Infertility, Shanghai 200011, China
| | - Shu-Yu Wang
- Reproductive Medical Center, Beijing Obstetrics and Gynecology Hospital, Beijing 100006, China
| | - Xiao-Yan Liang
- Reproductive Medical Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510665, China
| | - Yun Sun
- Reproductive Medical Center, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai 200011, China
| | - Feng-Hua Liu
- Reproductive Medical Center, Maternal and Child Health Hospital of Guangdong Province, Guangzhou, Guangdong 511400, China
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Nobles CJ, Mendola P, Mumford SL, Naimi AI, Yeung EH, Kim K, Park H, Wilcox B, Silver RM, Perkins NJ, Sjaarda L, Schisterman EF. Preconception Blood Pressure Levels and Reproductive Outcomes in a Prospective Cohort of Women Attempting Pregnancy. Hypertension 2018; 71:904-910. [PMID: 29610265 DOI: 10.1161/hypertensionaha.117.10705] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 12/19/2017] [Accepted: 02/27/2018] [Indexed: 12/19/2022]
Abstract
Elevated blood pressure in young adulthood is an early risk marker for cardiovascular disease. Despite a strong biological rationale, little research has evaluated whether incremental increases in preconception blood pressure have early consequences for reproductive health. We evaluated preconception blood pressure and fecundability, pregnancy loss, and live birth in the EAGeR trial (Effects of Aspirin on Gestational and Reproduction; 2007-2011), a randomized clinical trial of aspirin and reproductive outcomes among 1228 women attempting pregnancy with a history of pregnancy loss. Systolic and diastolic blood pressure were measured during preconception in the first observed menstrual cycle and in early pregnancy and used to derive mean arterial pressure. Fecundability was assessed as number of menstrual cycles until pregnancy, determined through human chorionic gonadotropin testing. Pregnancy loss included both human chorionic gonadotropin-detected and clinical losses. Analyses adjusted for treatment assignment, age, body mass index, race, marital status, smoking, parity, and time since last loss. Mean preconception systolic and diastolic blood pressure were 111.6 mm Hg (SD, 12.1) and 72.5 (SD, 9.4) mm Hg. Risk of pregnancy loss increased 18% per 10 mm Hg increase in diastolic blood pressure (95% confidence interval, 1.03-1.36) and 17% per 10 mm Hg increase in mean arterial pressure (95% confidence interval, 1.02-1.35) in adjusted analyses. Findings were similar for early pregnancy blood pressure. Preconception blood pressure was not related to fecundability or live birth in adjusted analyses. Findings suggest that preconception blood pressure among healthy women is associated with pregnancy loss, and lifestyle interventions targeting blood pressure among young women may favorably impact reproductive health. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00467363.
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Affiliation(s)
- Carrie J Nobles
- From the Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (C.J.N., P.M., S.L.M., E.H.Y., K.K., H.P., N.J.P., L.S., E.F.S.); Graduate School of Public Health, University of Pittsburgh, PA (A.I.N.); Department of Obstetrics and Gynecology, Geisinger Commonwealth School of Medicine, Scranton, PA (B.W.); and Department of Obstetrics and Gynecology, School of Medicine, Salt Lake City, University of Utah (R.M.S.)
| | - Pauline Mendola
- From the Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (C.J.N., P.M., S.L.M., E.H.Y., K.K., H.P., N.J.P., L.S., E.F.S.); Graduate School of Public Health, University of Pittsburgh, PA (A.I.N.); Department of Obstetrics and Gynecology, Geisinger Commonwealth School of Medicine, Scranton, PA (B.W.); and Department of Obstetrics and Gynecology, School of Medicine, Salt Lake City, University of Utah (R.M.S.)
| | - Sunni L Mumford
- From the Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (C.J.N., P.M., S.L.M., E.H.Y., K.K., H.P., N.J.P., L.S., E.F.S.); Graduate School of Public Health, University of Pittsburgh, PA (A.I.N.); Department of Obstetrics and Gynecology, Geisinger Commonwealth School of Medicine, Scranton, PA (B.W.); and Department of Obstetrics and Gynecology, School of Medicine, Salt Lake City, University of Utah (R.M.S.)
| | - Ashley I Naimi
- From the Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (C.J.N., P.M., S.L.M., E.H.Y., K.K., H.P., N.J.P., L.S., E.F.S.); Graduate School of Public Health, University of Pittsburgh, PA (A.I.N.); Department of Obstetrics and Gynecology, Geisinger Commonwealth School of Medicine, Scranton, PA (B.W.); and Department of Obstetrics and Gynecology, School of Medicine, Salt Lake City, University of Utah (R.M.S.)
| | - Edwina H Yeung
- From the Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (C.J.N., P.M., S.L.M., E.H.Y., K.K., H.P., N.J.P., L.S., E.F.S.); Graduate School of Public Health, University of Pittsburgh, PA (A.I.N.); Department of Obstetrics and Gynecology, Geisinger Commonwealth School of Medicine, Scranton, PA (B.W.); and Department of Obstetrics and Gynecology, School of Medicine, Salt Lake City, University of Utah (R.M.S.)
| | - Keewan Kim
- From the Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (C.J.N., P.M., S.L.M., E.H.Y., K.K., H.P., N.J.P., L.S., E.F.S.); Graduate School of Public Health, University of Pittsburgh, PA (A.I.N.); Department of Obstetrics and Gynecology, Geisinger Commonwealth School of Medicine, Scranton, PA (B.W.); and Department of Obstetrics and Gynecology, School of Medicine, Salt Lake City, University of Utah (R.M.S.)
| | - Hyojun Park
- From the Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (C.J.N., P.M., S.L.M., E.H.Y., K.K., H.P., N.J.P., L.S., E.F.S.); Graduate School of Public Health, University of Pittsburgh, PA (A.I.N.); Department of Obstetrics and Gynecology, Geisinger Commonwealth School of Medicine, Scranton, PA (B.W.); and Department of Obstetrics and Gynecology, School of Medicine, Salt Lake City, University of Utah (R.M.S.)
| | - Brian Wilcox
- From the Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (C.J.N., P.M., S.L.M., E.H.Y., K.K., H.P., N.J.P., L.S., E.F.S.); Graduate School of Public Health, University of Pittsburgh, PA (A.I.N.); Department of Obstetrics and Gynecology, Geisinger Commonwealth School of Medicine, Scranton, PA (B.W.); and Department of Obstetrics and Gynecology, School of Medicine, Salt Lake City, University of Utah (R.M.S.)
| | - Robert M Silver
- From the Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (C.J.N., P.M., S.L.M., E.H.Y., K.K., H.P., N.J.P., L.S., E.F.S.); Graduate School of Public Health, University of Pittsburgh, PA (A.I.N.); Department of Obstetrics and Gynecology, Geisinger Commonwealth School of Medicine, Scranton, PA (B.W.); and Department of Obstetrics and Gynecology, School of Medicine, Salt Lake City, University of Utah (R.M.S.)
| | - Neil J Perkins
- From the Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (C.J.N., P.M., S.L.M., E.H.Y., K.K., H.P., N.J.P., L.S., E.F.S.); Graduate School of Public Health, University of Pittsburgh, PA (A.I.N.); Department of Obstetrics and Gynecology, Geisinger Commonwealth School of Medicine, Scranton, PA (B.W.); and Department of Obstetrics and Gynecology, School of Medicine, Salt Lake City, University of Utah (R.M.S.)
| | - Lindsey Sjaarda
- From the Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (C.J.N., P.M., S.L.M., E.H.Y., K.K., H.P., N.J.P., L.S., E.F.S.); Graduate School of Public Health, University of Pittsburgh, PA (A.I.N.); Department of Obstetrics and Gynecology, Geisinger Commonwealth School of Medicine, Scranton, PA (B.W.); and Department of Obstetrics and Gynecology, School of Medicine, Salt Lake City, University of Utah (R.M.S.)
| | - Enrique F Schisterman
- From the Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (C.J.N., P.M., S.L.M., E.H.Y., K.K., H.P., N.J.P., L.S., E.F.S.); Graduate School of Public Health, University of Pittsburgh, PA (A.I.N.); Department of Obstetrics and Gynecology, Geisinger Commonwealth School of Medicine, Scranton, PA (B.W.); and Department of Obstetrics and Gynecology, School of Medicine, Salt Lake City, University of Utah (R.M.S.).
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Zhou H, Liu Y, Liu L, Zhang M, Chen X, Qi Y. Maternal pre-pregnancy risk factors for miscarriage from a prevention perspective: a cohort study in China. Eur J Obstet Gynecol Reprod Biol 2016; 206:57-63. [DOI: 10.1016/j.ejogrb.2016.07.514] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 06/20/2016] [Accepted: 07/26/2016] [Indexed: 10/21/2022]
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Balsells M, García-Patterson A, Corcoy R. Systematic review and meta-analysis on the association of prepregnancy underweight and miscarriage. Eur J Obstet Gynecol Reprod Biol 2016; 207:73-79. [PMID: 27825031 DOI: 10.1016/j.ejogrb.2016.10.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 09/19/2016] [Accepted: 10/18/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Maternal underweight, overweight and obesity have been associated with a higher risk of miscarriage. Most individual reports and all meta-analyses have addressed high body mass index. OBJECTIVES To review the literature and summarize the risk of miscarriage in underweight women vs those with normal weight. METHODS A Medline Search (1st January 1990-20th November 2015, human, in English, French, Italian, Spanish or Portuguese) was conducted. Both spontaneous pregnancies and pregnancies after assisted reproduction techniques were considered. Cohort and case control studies were included if they reported data on the outcome of interest (clinical miscarriage), in underweight and normal weight women. Information on clinical miscarriage in other body mass index categories was collected when available. Two investigators reviewed the abstracts, full text papers and extracted data. Review Manager 5.1 software was used to summarize the results. RESULTS 32 studies (30 cohort, 2 case control) and a total of 265,760 women were included. In cohort studies, the relative risk (RR) of clinical miscarriage in underweight women was 1.08, 95% CI 1.05-1.11; p<0.0001). The corresponding figures were RR 1.09, 95% CI 1.04-1.13; p<0.0001 for overweight women and RR 1.21, 95% CI 1.15-1.27; p<0.00001 for obese women. In case control studies, the odds ratio (OR) of clinical miscarriage in underweight women was 1.02, 95% CI 0.46-2.30; p=0.95). The corresponding figures were OR 1.01, 95% CI 0.88-1.16; p=0.89 for overweight women and OR 1.26, 95% CI 1.01-1.57; p=0.04 for obese women. The limitations of this study are that it is restricted to studies with information on underweight women and that I2 ranges from 0 to 91% in different subgroups. CONCLUSION We conclude that maternal underweight is associated with a slightly increased risk of clinical miscarriage, similar to that of overweight women and lower than the risk observed in obesity. The heterogeneity displayed in some subgroups limits the strength of the conclusion.
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Affiliation(s)
- Montserrat Balsells
- Department of Endocrinology and Nutrition, Hospital Mútua de Terrassa, Plaça Dr Robert 5, Terrassa 08221 Barcelona, Spain.
| | - Apolonia García-Patterson
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, S Antoni Mª Claret 167, Barcelona 08025, Spain.
| | - Rosa Corcoy
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, S Antoni Mª Claret 167, Barcelona 08025, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; CIBER Bioengineering, Biomaterials and Nanotechnology, Instituto de Salud Carlos III, Zaragoza, Spain.
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