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Qiu C, Gelaye B, Denis M, Tadesse MG, Enquobahrie DA, Ananth CV, Pacora PN, Salazar M, Sanchez SE, Williams MA. Placental genetic variations in circadian clock-related genes increase the risk of placental abruption. Int J Mol Epidemiol Genet 2016; 7:32-40. [PMID: 27186326 PMCID: PMC4858614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 02/29/2016] [Indexed: 06/05/2023]
Abstract
The genetic architecture of placental abruption (PA) remains poorly understood. We examined variations in SNPs of circadian clock-related genes in placenta with PA risk. We also explored placental and maternal genomic contributions to PA risk. Placental genomic DNA samples were isolated from 280 PA cases and 244 controls. Genotyping was performed using the Illumina Cardio-MetaboChip. We examined 116 SNPs in 13 genes known to moderate circadian rhythms. Logistic regression models were fit to estimate odds ratios (ORs). The combined effect of multiple SNPs on PA risk was estimated using a weighted genetic risk score. We examined independent and joint associations of wGRS derived from placental and maternal genomes with PA. Seven SNPs in five genes (ARNTL2, CRY2, DEC1, PER3 and RORA), in the placental genome, were associated with PA risk. Each copy of the minor allele (G) of a SNP in the RORA gene (rs2899663) was associated with a 30% reduced odds of PA (95% CI 0.52-0.95). The odds of PA increased with increasing placental-wGRS (Ptrend<0.001). The ORs were 1.00, 2.16, 3.24 and 4.48 across quartiles. Associations persisted after the maternal-wGRS was included in the model. There was evidence of an additive contribution of placental and maternal genetic contributions to PA risk. Participants with placental- and maternal-wGRS in the highest quartile, compared with those in the lowest quartile, had a 15.57-fold (95% CI 3.34-72.60) increased odds of PA. Placental variants in circadian clock-related genes are associated with PA risk; and the association persists after control of genetic variants in the maternal genome.
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Affiliation(s)
- Chunfang Qiu
- Center for Perinatal Studies, Swedish Medical CenterSeattle, WA, USA
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T.H. Chan School of Public HealthBoston, MA, USA
| | - Marie Denis
- UMR Amélioration Génétique et Adaptation des Plantes Méditerranéennes et Tropicales (AGAP), CIRADMontpellier, France
| | - Mahlet G Tadesse
- Department of Mathematics and Statistics, Georgetown UniversityWashington, DC, USA
| | - Daniel A Enquobahrie
- Center for Perinatal Studies, Swedish Medical CenterSeattle, WA, USA
- Department of Epidemiology, School of Public Health, University of WashingtonSeattle, WA, USA
| | - Cande V Ananth
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University Medical CenterNew York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia UniversityNew York, NY, USA
| | - Percy N Pacora
- Department of Obstetrics and Gynecology, San Marcos UniversityLima, Peru
| | - Manuel Salazar
- Department of Obstetrics and Gynecology, San Marcos UniversityLima, Peru
| | - Sixto E Sanchez
- Facultad de Medicina Humana, Universidad Peruana de Ciencias AplicadasPeru
- A.C. PROESALima, Peru
| | - Michelle A Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public HealthBoston, MA, USA
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Workalemahu T, Enquobahrie DA, Moore A, Sanchez SE, Ananth CV, Pacora PN, Liang L, Salazar M, Williams MA. Genome-wide and candidate gene association studies of placental abruption. Int J Mol Epidemiol Genet 2013; 4:128-139. [PMID: 24046805 PMCID: PMC3773564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 09/10/2013] [Indexed: 06/02/2023]
Abstract
Placental abruption (PA), a pregnancy-related vascular disorder, is a leading cause of maternal and perinatal morbidity and mortality. The success of identifying genetic susceptibility loci for PA, a multi-factorial heritable disorder, has been limited. We conducted a genome-wide association study (GWAS) and candidate gene association study using 470 PA cases and 473 controls from Lima, Peru. Genotyping for common genetic variations (single nucleotide polymorphisms, SNPs) was conducted using the Illumina Cardio-Metabo Chip platform. Common variations in 35 genes that participate in mitochondrial biogenesis (MB) and oxidative phosphorylation (OS) were selected for the candidate gene study. Regression models were fit to examine associations of each SNP with risk of PA. In pathway analyses, we examined functions and functional relationships of genes represented by the top GWAS hits. Genetic risk scores (GRS), based on top hits of the GWAS and candidate gene analyses, respectively, were computed using the risk allele counting method. The top hit in the GWAS analyses was rs1238566 (empirical P-value=1.04e-4 and FDR-adjusted P-value=5.65E-04) in FLI-1 gene, a megakaryocyte-specific transcription factor. Networks of genes involved in lipid metabolism and cell signaling were significantly enriched by the 51 genes whose SNPs were among the top 200 GWAS hits (P-value <2.1e-3). SNPs known to regulate MB (e.g. CAMK2B, NR1H3, PPARG, PRKCA, and THRB) and OP (e.g., COX5A, and NDUF family of genes) were associated with PA risk (P-value <0.05). GRS was significantly associated with PA risk (trend P-value <0.001 and 0.01 for GWAS and candidate gene based GRS, respectively). Our study suggests that integrating multiple analytical strategies in genetic association studies can provide opportunities for identifying genetic risk factors and novel molecular mechanisms that underlie PA.
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Affiliation(s)
- Tsegaselassie Workalemahu
- Department of Epidemiology, Harvard School of Public Health, Harvard UniversityBoston, Massachusetts
| | - Daniel A Enquobahrie
- Center for Perinatal Studies, Swedish Medical CenterSeattle, Washington
- Department of Epidemiology, University of WashingtonSeattle, Washington
| | - Amy Moore
- Department of Epidemiology, University of WashingtonSeattle, Washington
| | - Sixto E Sanchez
- Sección de Post Grado, Facultad de Medicina Humana, Universidad San Martín de PorresLima, Peru
- A.C. PROESALima, Peru
| | - Cande V Ananth
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University Medical CenterNew York
- Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia UniversityNew York
| | - Percy N Pacora
- Department of Obstetrics and Gynecology, San Marcos UniversityLima, Peru
| | - Liming Liang
- Department of Epidemiology, Harvard School of Public Health, Harvard UniversityBoston, Massachusetts
| | - Manuel Salazar
- Department of Obstetrics and Gynecology, San Marcos UniversityLima, Peru
| | - Michelle A Williams
- Department of Epidemiology, Harvard School of Public Health, Harvard UniversityBoston, Massachusetts
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de Paz NC, Sanchez SE, Huaman LE, Chang GD, Pacora PN, Garcia PJ, Ananth CV, Qiu C, Williams MA. Risk of placental abruption in relation to maternal depressive, anxiety and stress symptoms. J Affect Disord 2011; 130:280-4. [PMID: 20692040 PMCID: PMC2994998 DOI: 10.1016/j.jad.2010.07.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 06/04/2010] [Accepted: 07/17/2010] [Indexed: 01/09/2023]
Abstract
BACKGROUND Little is known about the influence of psychiatric factors on the etiology of placental abruption (PA), an obstetrical condition that complicates 1-2% of pregnancies. We examined the risk of PA in relation to maternal psychiatric symptoms during pregnancy. METHODS This case-control study included 373 PA cases and 368 controls delivered at five medical centers in Lima, Peru. Depressive, anxiety and stress symptoms were assessed using the Patient Health Questionnaire (PHQ-9) and the Depression Anxiety Stress Scales (DASS-21). Multivariable logistic regression models were fit to calculate odds ratios (aOR) and 95% confidence intervals (CI) adjusted for confounders. RESULTS Depressive symptoms of increasing severity (using the DASS depression subscale) was associated with PA (p for trend=0.02). Compared with women with no depressive symptoms, the aOR (95%CI) for PA associated with each level of severity of depression symptoms based on the DASS assessment were as follows: mild 1.84 (0.91-3.74); moderate 1.25 (0.67-2.33); and severe 4.68 (0.98-22.4). The corresponding ORs for mild, moderate, and moderately severe depressive symptoms based on the PHQ assessment were 1.10 (0.79-1.54), 3.31 (1.45-7.57), and 5.01 (1.06-23.6), respectively. A positive gradient was observed for the odds of PA with severity of anxiety (p for trend=0.002) and stress symptoms (p for trend=0.002). LIMITATIONS These cross-sectionally collected data may be subject to recall bias. CONCLUSIONS Maternal psychiatric disorders may be associated with an increased occurrence of AP. Larger studies that allow for more precise evaluations of maternal psychiatric health in relation to PA risk are warranted.
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Affiliation(s)
- Nicole C. de Paz
- Department of Epidemiology, Universitry of Washington, Multidisciplinary International Research Training Program, Seattle, Washington, USA
| | - Sixto E. Sanchez
- Department of Obstetrics and Gynecology, Hospital Nacional dos de Mayo, & Universidad San Martin de Porres, Lima, PERU
| | - Luis E. Huaman
- Office of Research and Specialized Training, Instituto Especializado Materno Perinatal, Lima, PERU
| | - Guillermo Diez Chang
- Department of Obstetrics and Gynecology, Hospital Edgardo Rebagliati Martins, Lima, PERU
| | - Percy N. Pacora
- Department of Obstetrics and Gynecology, Hospital Nacional Docente Madre Niño San Bartolomè; & Universidad Nacional Mayor de San Marcos, Lima, PERU
| | - Pedro J. Garcia
- Department of Obstetrics and Gynecology, Instituto Especializado Materno Perinatal, Lima, PERU
| | - Cande V. Ananth
- Division of Epidemiology and Biostatistics; Department of Obstetrics, Gynecology, and Reproductive Sciences UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Chungfang Qiu
- Center for Perinatal Studies, Swedish Medical Center, Seattle, WA, USA
| | - Michelle A. Williams
- Department of Epidemiology, Universitry of Washington, Multidisciplinary International Research Training Program, Seattle, Washington, USA
- Center for Perinatal Studies, Swedish Medical Center, Seattle, WA, USA
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Sanchez SE, Williams MA, Pacora PN, Ananth CV, Qiu C, Aurora SK, Sorensen TK. Risk of placental abruption in relation to migraines and headaches. BMC Womens Health 2010; 10:30. [PMID: 20977769 PMCID: PMC2984417 DOI: 10.1186/1472-6874-10-30] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Accepted: 10/26/2010] [Indexed: 11/17/2022]
Abstract
Background Migraine, a common chronic-intermittent disorder of idiopathic origin characterized by severe debilitating headaches and autonomic nervous system dysfunction, and placental abruption, the premature separation of the placenta, share many common pathophysiological characteristics. Moreover, endothelial dysfunction, platelet activation, hypercoagulation, and inflammation are common to both disorders. We assessed risk of placental abruption in relation to maternal history of migraine before and during pregnancy in Peruvian women. Methods Cases were 375 women with pregnancies complicated by placental abruption, and controls were 368 women without an abruption. During in-person interviews conducted following delivery, women were asked if they had physician-diagnosed migraine, and they were asked questions that allowed headaches and migraine to be classified according to criteria established by the International Headache Society. Logistic regression procedures were used to calculate odds ratios (aOR) and 95% confidence intervals (CI) adjusted for confounders. Results Overall, a lifetime history of any headaches or migraine was associated with an increased odds of placental abruption (aOR = 1.60; 95% CI 1.16-2.20). A lifetime history of migraine was associated with a 2.14-fold increased odds of placental abruption (aOR = 2.14; 95% CI 1.22-3.75). The odds of placental abruption was 2.11 (95% CI 1.00-4.45) for migraineurs without aura; and 1.59 (95% 0.70-3.62) for migraineurs with aura. A lifetime history of tension-type headache was also increased with placental abruption (aOR = 1.61; 95% CI 1.01-2.57). Conclusions This study adds placental abruption to a growing list of pregnancy complications associated with maternal headache/migraine disorders. Nevertheless, prospective cohort studies are needed to more rigorously evaluate the extent to which migraines and/or its treatments are associated with the occurrence of placental abruption.
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Affiliation(s)
- Sixto E Sanchez
- Department of Obstetrics and Gynecology, Hospital Nacional dos de Mayo, & Universidad San Martin de Porres, Lima, Peru
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Sanchez SE, Pacora PN, Farfan JH, Fernandez A, Qiu C, Ananth CV, Williams MA. Risk factors of abruptio placentae among Peruvian women. Am J Obstet Gynecol 2006; 194:225-30. [PMID: 16389036 DOI: 10.1016/j.ajog.2005.05.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2005] [Revised: 05/02/2005] [Accepted: 05/02/2005] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We examined the relation of maternal sociodemographic, medical, and behavioral characteristics with risk of abruptio placentae in Peruvian women. STUDY DESIGN This case-control study included 255 abruptio placentae cases and 258 pregnant controls. Multivariable logistic regression models were fit to calculate odds ratios (OR) and 95% CIs adjusted for putative abruptio placentae risk factors. RESULTS History of delivering a stillborn infant (OR 10.0; 95%CI 4.0-25.2), pregnancy complicated by preeclampsia/eclampsia (OR 3.7; 95%CI 2.2-6.3); and a low rate of pregnancy weight gain (<0.15 kg/wk) (OR 2.5; 95%CI 1.3-4.7), were associated with significantly increased risk of abruptio placentae. Advanced maternal age, low educational attainment, male infant gender, cigarette smoking, and grand multiparty were not risk factors of abruptio placentae in this population. CONCLUSION At present, the constellation of abruptio placentae risk factors do not provide clinically meaningful opportunities for identifying high-risk patients.
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Affiliation(s)
- Sixto E Sanchez
- Department of Obstetrics & Gynecology, Hospital Nacional Dos de Mayo, Lima, Peru
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