1
|
Misgana T, Gebremichael B, Weldesenbet AB, Tesfaye D, Tamiru D, Tariku M, Alemu D, Dheresa M. Association between antenatal common mental disorders symptoms, and adverse obstetric and perinatal outcomes: A community-based prospective cohort study in Eastern Ethiopia. J Affect Disord 2024; 355:31-39. [PMID: 38548209 DOI: 10.1016/j.jad.2024.03.153] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND Maternal common mental disorders have broad implications for maternal and child mental and physical health that may have a long-lasting social and economic impact. This study aimed to assess the association between symptoms of antenatal common mental disorders and obstetric and perinatal outcomes in Eastern Ethiopia. METHODS A community-based prospective cohort study was conducted and a total of 1011 randomly selected pregnant women were followed up from February 1, 2021, to January 30, 2022. The modified Poisson regression model with a robust variance was fitted to examine the effect of the symptoms of antenatal common mental disorders on obstetric and perinatal outcomes. RESULTS Antenatal common mental disorders (SRQ ≥ 6) were presented among 390 (38.58 %) pregnant women. In the final multivariate Poisson regression model, women with antenatal common mental disorders symptoms had an increased risk of some pregnancy complications (ARR = 1.65, 95 % CI: 1.59, 1.84). In the current study, symptoms of antenatal common mental disorders increased also the risk of preterm birth (ARR = 1.71; 95 % CI: 1.20, 2.42) and low birth weight (ARR = 1.93; 95 % CI: 1.36, 2.74). LIMITATION The indirect effects of some potential mediators and moderators were not assessed in this study. CONCLUSION The study found a high rate of symptoms of antenatal common mental disorders and adverse obstetric and perinatal outcomes. Antenatal common mental disorders symptoms may have considerable effects on individual and combined pregnancy complications and adverse perinatal outcomes.
Collapse
Affiliation(s)
- Tadesse Misgana
- Department of Psychiatry, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
| | - Berhe Gebremichael
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Adisu Birhanu Weldesenbet
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Dejene Tesfaye
- Department of Psychiatry, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Dawit Tamiru
- Department of Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mandaras Tariku
- Department of Psychiatry, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Daniel Alemu
- Department of Psychiatry, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Merga Dheresa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| |
Collapse
|
2
|
Dall'Asta A, Frusca T, Rizzo G, Ramirez Zegarra R, Lees C, Figueras F, Ghi T. Assessment of the cerebroplacental ratio and uterine arteries in low-risk pregnancies in early labour for the prediction of obstetric and neonatal outcomes. Eur J Obstet Gynecol Reprod Biol 2024; 295:18-24. [PMID: 38325239 DOI: 10.1016/j.ejogrb.2024.02.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/28/2024] [Accepted: 02/02/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND The evidence-based management of human labor includes the antepartum identification of patients at risk for intrapartum hypoxia. However, available evidence has shown that most of the hypoxic-related complications occur among pregnancies classified at low-risk for intrapartum hypoxia, thus suggesting that the current strategy to identify the pregnancies at risk for intrapartum fetal hypoxia has limited accuracy. OBJECTIVE To evaluate the role of the combined assessment of the cerebroplacental ratio (CPR) and uterine arteries (UtA) Doppler in the prediction of obstetric intervention (OI) for suspected intrapartum fetal compromise (IFC) within a cohort of low-risk singleton term pregnancies in early labor. METHODS Prospective multicentre observational study conducted across four tertiary Maternity Units between January 2016 and September 2019. Low-risk term pregnancies with spontaneous onset of labor were included. A two-step multivariable model was developed to assess the risk of OI for suspected IFC. The baseline model included antenatal and intrapartum characteristics, while the combined model included antenatal and intrapartum characteristics plus Doppler anomalies such as CPR MoM < 10th percentile and mean UtA Doppler PI MoM ≥ 95th percentile. Predictive performance was determined by receiver-operating characteristics curve analysis. RESULTS 804 women were included. At logistic regression analysis, CPR MoM < 10th percentile (aOR 1.269, 95 % CI 1.188-1.356, P < 0.001), mean UtA PI MoM ≥ 95th percentile (aOR 1.012, 95 % CI 1.001-1.022, P = 0.04) were independently associated with OI for suspected IFC. At ROC curve analysis, the combined model including antenatal characteristics plus abnormal CPR and mean UtA PI yielded an AUC of 0.78, 95 %CI(0.71-0.85), p < 0.001, which was significantly higher than the baseline model (AUC 0.61, 95 %CI(0.54-0.69), p = 0.007) (p < 0.001). The combined model was associated with a 0.78 (95 % CI 0.67-0.89) sensitivity, 0.68 (95 % CI 0.65-0.72) specificity, 0.15 (95 % CI 0.11-0.19) PPV, and 0.98 (0.96-0.99) NPV, 2.48 (95 % CI 2.07-2.97) LR + and 0.32 (95 % CI 0.19-0.53) LR- for OI due to suspected IFC. CONCLUSIONS A predictive model including antenatal and intrapartum characteristics combined with abnormal CPR and mean UtA PI has a good capacity to rule out and a moderate capacity to rule in OI due to IFC, albeit with poor predictive value.
Collapse
Affiliation(s)
- Andrea Dall'Asta
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy; Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College London, United Kingdom.
| | - Tiziana Frusca
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynaecology, Fondazione Policlinico di Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Ruben Ramirez Zegarra
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
| | - Christoph Lees
- Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College London, United Kingdom; Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Francesc Figueras
- Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, Spain
| | - Tullio Ghi
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
| |
Collapse
|
3
|
Ozler S, Kebapcilar A, Ozdemir EM, Mert M, Arıkan MN, Celik C. Are Vascular Endothelium and Angiogenesis Effective MicroRNA Biomarkers Associated with the Prediction of Early-Onset Preeclampsia (EOPE) and Adverse Perinatal Outcomes? Reprod Sci 2024; 31:803-810. [PMID: 37848644 DOI: 10.1007/s43032-023-01367-w] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 09/20/2023] [Indexed: 10/19/2023]
Abstract
MicroRNA is associated with angiogenesis, invasion, proliferation, and vascular endothelial remodeling of various diseases. We aimed to investigate serum MicroRNA (miRNA) levels in preeclampsia (PE) and to determine whether any changes in miRNA levels are useful in predicting early onset preeclampsia (EOPE) and adverse perinatal outcomes. A total of 89 pregnant patients were enrolled in this prospective case-control study (55 PE and 34 healthy controls). miR-17, miR-20a, miR-20b, miR126, miR155, miR-200, miR-222, and miR-210 levels were studied in maternal serum in preeclamptic pregnant women. Multiple logistic regression analyses analyzed the risk factors which are associated with EOPE and adverse maternal outcomes. The Real-time RT-PCR method was used to determine maternal serum miRNA levels. Serum miR-17, miR-20a, miR-20b, miR126, and miR-210 levels were significantly higher in PE than the control group (p < .001, p < .001, p < .001, p < .001 and p = .047 respectively). Increased miR-17, miR-20a, and miR-20b levels were independently associated with PE (OR: 0.642, 95%Cl: 0.486-0.846, p = .002; OR: 0.899, 95%Cl: 0.811-0.996, p = .042 and OR: 0.817, 95%Cl: 0.689-0.970, p = .021). Increased miR-17 and miR-126 levels were negatively correlated with serum EOPE in PE (r = -.313, p = .020), and increased miR-210 levels were significantly positively correlated with EOPE in PE (r = .285, p = .005). Increased expression of serum miR-17, miR-20a, miR-20b, miR126, and miR-210 were found to be associated with PE, also increased expression of miR-17, miR-20a, and miR-20b were to be predicted with PE, also increased maternal serum miR-17 and miR-126 expressions were negatively correlated and increased miR-210 expression was positively correlated with EOPE in PE women.
Collapse
Affiliation(s)
- Sibel Ozler
- Department of Perinatology, KTO Karatay University Faculty of Medicine, Konya, Turkey.
| | - Aysegul Kebapcilar
- Obstetrics and Gynecology, Selcuk University Faculty of Medicine, Konya, Turkey
| | | | - Muhammed Mert
- Obstetrics and Gynecology, Health Ministry Of Turkish Republic, Dr. Ali Kemal Belviranlı Obstetrıcs And Gynecology Hospıtal, Konya, Turkey
| | | | - Cetin Celik
- Obstetrics and Gynecology, Selcuk University Faculty of Medicine, Konya, Turkey
| |
Collapse
|
4
|
Zhang S, Luo Q, Meng R, Yan J, Wu Y, Huang H. Long-term health risk of offspring born from assisted reproductive technologies. J Assist Reprod Genet 2024; 41:527-550. [PMID: 38146031 PMCID: PMC10957847 DOI: 10.1007/s10815-023-02988-5] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/02/2023] [Indexed: 12/27/2023] Open
Abstract
Since the world's first in vitro fertilization baby was born in 1978, there have been more than 8 million children conceived through assisted reproductive technologies (ART) worldwide, and a significant proportion of them have reached puberty or young adulthood. Many studies have found that ART increases the risk of adverse perinatal outcomes, including preterm birth, low birth weight, small size for gestational age, perinatal mortality, and congenital anomalies. However, data regarding the long-term outcomes of ART offspring are limited. According to the developmental origins of health and disease theory, adverse environments during early life stages may induce adaptive changes and subsequently result in an increased risk of diseases in later life. Increasing evidence also suggests that ART offspring are predisposed to an increased risk of non-communicable diseases, such as malignancies, asthma, obesity, metabolic syndrome, diabetes, cardiovascular diseases, and neurodevelopmental and psychiatric disorders. In this review, we summarize the risks for long-term health in ART offspring, discuss the underlying mechanisms, including underlying parental infertility, epigenetic alterations, non-physiological hormone levels, and placental dysfunction, and propose potential strategies to optimize the management of ART and health care of parents and children to eliminate the associated risks. Further ongoing follow-up and research are warranted to determine the effects of ART on the long-term health of ART offspring in later life.
Collapse
Affiliation(s)
- Siwei Zhang
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, No. 419, Fangxie Rd, Shanghai, 200011, China
| | - Qinyu Luo
- Key Laboratory of Reproductive Genetics, Ministry of Education, Zhejiang University School of Medicine, Hangzhou, China
| | - Renyu Meng
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, No. 419, Fangxie Rd, Shanghai, 200011, China
| | - Jing Yan
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, No. 419, Fangxie Rd, Shanghai, 200011, China
| | - Yanting Wu
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, No. 419, Fangxie Rd, Shanghai, 200011, China.
- Research Unit of Embryo Original Diseases (No. 2019RU056), Chinese Academy of Medical Sciences, Shanghai, China.
| | - Hefeng Huang
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, No. 419, Fangxie Rd, Shanghai, 200011, China.
- Key Laboratory of Reproductive Genetics, Ministry of Education, Zhejiang University School of Medicine, Hangzhou, China.
- Research Unit of Embryo Original Diseases (No. 2019RU056), Chinese Academy of Medical Sciences, Shanghai, China.
| |
Collapse
|
5
|
Pan S, Xu A, Lu X, Chen B, Chen X, Hua Y. Umbilical artery thrombosis risk factors and perinatal outcomes. BMC Pregnancy Childbirth 2024; 24:137. [PMID: 38355469 PMCID: PMC10865511 DOI: 10.1186/s12884-024-06335-z] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 02/08/2024] [Indexed: 02/16/2024] Open
Abstract
PURPOSE The purpose of this study was to investigate the risk factors for umbilical artery thrombosis (UAT) and the relationship between umbilical artery thrombosis and perinatal outcomes. METHODS This was a retrospective study that enrolled singleton pregnant women who were diagnosed with umbilical artery thrombosis. The control group recruited pregnant woman with three umbilical vessels or those with isolated single umbilical artery (iSUA) who were matched with umbilical artery thrombosis group. The risk factors and perinatal outcomes were compared between the groups. RESULTS Preconception BMI (OR [95%CI]: 1.212 [1.038-1.416]), abnormal umbilical cord insertion (OR [95%CI]: 16.695 [1.333-209.177]) and thrombophilia (OR [95%CI]: 15.840 [1.112-223.699]) were statistically significant risk factors for umbilical artery thrombosis. An elongated prothrombin time (OR [95%CI]: 2.069[1.091-3.924]) was strongly associated with the occurrence of UAT. The risks of cesarean delivery, preterm birth, fetal growth restriction, neonatal asphyxia, and intraamniotic infection were higher in pregnancies with UAT than in pregnancies with three umbilical vessels or isolated single umbilical artery (P<0.05). Additionally, the incidence of thrombophilia was higher in pregnant women with umbilical artery thrombosis than those with isolated single umbilical artery (P = 0.032). Abnormal umbilical cord insertion was also found to be associated with an elevated risk of iSUA (OR [95%CI]: 15.043[1.750-129.334]). CONCLUSIONS Abnormal umbilical cord insertion was the risk factor for both umbilical artery thrombosis and isolated single umbilical artery. The pregnancies with umbilical artery thrombosis had a higher risk of the adverse perinatal outcomes.
Collapse
Affiliation(s)
- Shuangjia Pan
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, China
| | - Anjian Xu
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, China
| | - Xinyue Lu
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, China
| | - Baoyi Chen
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, China
| | - Xianjun Chen
- Department of Obstetrics and Gynecology, Taizhou Women and Childrens Hospital of Wenzhou Medical University, Taizhou, 325000, China.
| | - Ying Hua
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, China.
| |
Collapse
|
6
|
Jjuuko M, Lugobe HM, Migisha R, Agaba DC, Tibaijuka L, Kayondo M, Ngonzi J, Kalyebara PK, Kanyesigye H. Maternal near miss as a predictor of adverse perinatal outcomes: findings from a prospective cohort study in southwestern Uganda. BMC Pregnancy Childbirth 2024; 24:42. [PMID: 38184536 PMCID: PMC10770958 DOI: 10.1186/s12884-024-06244-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 01/01/2024] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Despite efforts, Uganda has not met the World Health Organization target of < 12 newborn deaths per 1,000 live births. Severe maternal morbidity or 'near miss' is a major contributor to adverse perinatal outcomes, particularly in low-resource settings. However, the specific impact of maternal near miss on perinatal outcomes in Uganda remains insufficiently investigated. We examined the association between maternal near miss and adverse perinatal outcomes at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda. METHODS We conducted a prospective cohort study among women admitted for delivery at MRRH's maternity ward from April 2022 to August 2022. We included mothers at ≥ 28 weeks of gestation with singleton pregnancies, while intrauterine fetal death cases were excluded. For the near-miss group, we consecutively included mothers with any one of the following: antepartum hemorrhage with shock, uterine rupture, hypertensive disorders, coma, and cardiac arrest; those without these complications constituted the non-near-miss group. We followed the mothers until delivery, and their infants until seven days postpartum or death. Adverse perinatal outcomes considered were low birth weight (< 2,500 g), low Apgar score (< 7 at five minutes), intrapartum stillbirths, early neonatal death, or admission to neonatal intensive care unit. Multivariable log-binomial regression was used to determine predictors of adverse perinatal outcomes. RESULTS We enrolled 220 participants (55 maternal near misses and 165 non-near misses) with a mean age of 27 ± 5.8 years. Most of the near misses were pregnancies with hypertensive disorders (49%). Maternal near misses had a four-fold (adjusted risk ratio [aRR] = 4.02, 95% CI: 2.32-6.98) increased risk of adverse perinatal outcomes compared to non-near misses. Other predictors of adverse perinatal outcomes were primigravidity (aRR = 1.53, 95%CI: 1.01-2.31), and gestational age < 34 weeks (aRR = 1.81, 95%CI: 1.19-2.77). CONCLUSION Maternal near misses, primigravidity, and preterm pregnancies were independent predictors of adverse perinatal outcomes in this study. We recommend implementing maternal near-miss surveillance as an integral component of comprehensive perinatal care protocols, to improve perinatal outcomes in Uganda and similar low-resource settings. Targeted interventions, including specialized care for women with maternal near misses, particularly primigravidas and those with preterm pregnancies, could mitigate the burden of adverse perinatal outcomes.
Collapse
Affiliation(s)
- Mark Jjuuko
- Department of Obstetrics and Gynaecology, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda.
| | - Henry Mark Lugobe
- Department of Obstetrics and Gynaecology, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Richard Migisha
- Department of Physiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - David Collins Agaba
- Department of Physiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Leevan Tibaijuka
- Department of Obstetrics and Gynaecology, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Musa Kayondo
- Department of Obstetrics and Gynaecology, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Joseph Ngonzi
- Department of Obstetrics and Gynaecology, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Paul Kato Kalyebara
- Department of Obstetrics and Gynaecology, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Hamson Kanyesigye
- Department of Obstetrics and Gynaecology, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| |
Collapse
|
7
|
İpek G, Tanaçan A, Ağaoğlu Z, Peker A, Şahin D. Can SIRI or other inflammatory indices predict HELLP syndrome in the first trimester? J Reprod Immunol 2023; 159:104126. [PMID: 37573651 DOI: 10.1016/j.jri.2023.104126] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE To investigate the use of systemic immune-response index (SIRI) and other inflammatory indices for the prediction of HELLP syndrome STUDY DESIGN: The presented retrospective case-control study was conducted with twenty-eight pregnant women diagnosed with HELLP syndrome and 100 low-risk pregnant women. The possible predictive indices for HELLP syndrome were determined as NLR (neutrophil/lymphocyte), MLR (monocyte/lymphocyte), HbLR (hemoglobin/lymphocyte), SII (neutrophil×platelet/lymphocyte), and SIRI (neutrophil×monocyte/lymphocyte). The indices were evaluated in the first trimester and at the admission time for delivery for all participants. The statistical analyses were carried out using SPSS 23. Descriptive statistics were presented as the mean and standard deviation (SD), as they conform to a normal distribution. To compare the parameters between the groups, the Student-t test was used. Categorical variables were presented as numbers and percentages. The chi-square test was used to compare categorical variables between groups. The paired sample t-test was used to compare correlated samples. Statistical significance was defined as a two-tailed P value of 0.05. RESULTS In the first trimester; WBC, neutrophil, and monocyte counts were statistically higher in the HELLP syndrome group. However, no significant difference was observed between the groups for the concerned indices. The hemoglobin, WBC, neutrophil, monocyte counts, NLR, SIRI and MLR were significantly higher in the HELLP group at the delivery time. Platelet count was decreased and ALT/AST counts and adverse outcomes were found to be significantly higher at delivery time admission in the HELLP syndrome group. CONCLUSION To the best of our knowledge, this was the first study investigating SIRI with the other indices for the prediction of HELLP syndrome in accordance with its inflammatory etiology. The underlying inflammatory process was observed at the delivery time. However, none of the investigated indices was found effective in the first trimester in the prediction. Simple and non-invasive prediction indices might be valuable tools for the prediction and management of HELLP syndrome. Further and larger studies are needed for this purpose.
Collapse
Affiliation(s)
- Göksun İpek
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey.
| | - Atakan Tanaçan
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Zahid Ağaoğlu
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Ayça Peker
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Dilek Şahin
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| |
Collapse
|
8
|
Gigi RMS, Buitrago-Garcia D, Taghavi K, Dunaiski CM, van de Wijgert JHHM, Peters RPH, Low N. Vulvovaginal yeast infections during pregnancy and perinatal outcomes: systematic review and meta-analysis. BMC Womens Health 2023; 23:116. [PMID: 36944953 PMCID: PMC10029297 DOI: 10.1186/s12905-023-02258-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/06/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Vulvovaginal yeast infections in pregnancy are common and can cause extensive inflammation, which could contribute to adverse pregnancy outcomes. Symptomatic yeast infections are likely to cause more inflammation than asymptomatic. The objective of this study was to investigate associations between symptomatic and asymptomatic vulvovaginal yeast infections in pregnancy and perinatal outcomes. METHODS We did a systematic review and searched eight databases until 01 July 2022. We included studies reporting on pregnant women with and without laboratory confirmed vulvovaginal yeast infection and preterm birth or eight other perinatal outcomes. We used random effects meta-analysis to calculate summary odds ratios (OR), 95% confidence intervals (CI) and prediction intervals for the association between yeast infection and outcomes. We described findings from studies with multivariable analyses. We assessed the risk of bias using published tools. RESULTS We screened 3909 references and included 57 studies. Only 22/57 studies reported information about participant vulvovaginal symptoms. Preterm birth was an outcome in 35/57 studies (49,161 women). In 32/35 studies with available data, the summary OR from univariable analyses was 1.01 (95% CI 0.84-1.21, I2 60%, prediction interval 0.45-2.23). In analyses stratified by symptom status, we found ORs of 1.44 (95% CI 0.92-2.26) in two studies with ≥ 50% symptomatic participants, 0.84 (95% CI 0.45-1.58) in seven studies with < 50% symptomatic participants, and 1.12 (95% CI 0.94-1.35) in four studies with asymptomatic participants. In three studies with multivariable analysis, adjusted ORs were greater than one but CIs were compatible with there being no association. We did not find associations between vulvovaginal yeast infection and any secondary outcome. Most studies were at high risk of bias in at least one domain and only three studies controlled for confounding. CONCLUSIONS We did not find strong statistical evidence of an increased risk for preterm birth or eight other adverse perinatal outcomes, in pregnant women with either symptomatic or asymptomatic vulvovaginal yeast infection. The available evidence is insufficient to make recommendations about testing and treatment of vulvovaginal yeast infection in pregnancy. Future studies should assess vulvovaginal symptoms, yeast organism loads, concomitant vaginal or cervical infections, and microbiota using state-of-the-art diagnostics. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020197564.
Collapse
Affiliation(s)
- Ranjana M S Gigi
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Research Unit, Foundation for Professional Development, East London, South Africa
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Diana Buitrago-Garcia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Katayoun Taghavi
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Cara-Mia Dunaiski
- School of Health Sciences, Namibia University of Sciences and Technology, Windhoek, Namibia
| | - Janneke H H M van de Wijgert
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Remco P H Peters
- Research Unit, Foundation for Professional Development, East London, South Africa
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
| |
Collapse
|
9
|
Li H, Nawsherwan, Fan C, Mubarik S, Nabi G, Ping YX. The trend in delayed childbearing and its potential consequences on pregnancy outcomes: a single center 9-years retrospective cohort study in Hubei, China. BMC Pregnancy Childbirth 2022; 22:514. [PMID: 35751047 PMCID: PMC9233367 DOI: 10.1186/s12884-022-04807-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 06/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to the advancement of modern societies, the proportion of women who delay childbearing until or beyond 30 years has dramatically increased in the last three decades and has been linked with adverse maternal-neonatal outcomes. OBJECTIVE To determine the trend in delayed childbearing and its negative impact on pregnancy outcomes. MATERIAL AND METHODS A tertiary hospital-based retrospective study was conducted in Wuhan University Renmin Hospital, Hubei Province, China, during the years 2011-2019. The joinpoint regression analysis was used to find a trend in the delayed childbearing and the multiple binary logistic regression model was used to estimate the association between maternal age and pregnancy outcomes. RESULTS Between 2011 and 2019, the trend in advanced maternal age (AMA ≥35 years) increased by 75% [AAPC 7.5% (95% CI: - 10.3, 28.9)]. Based on maternal education and occupation, trend in AMA increased by 130% [AAPC 11.8% (95% CI: 1.1, 23.7)] in women of higher education level, and 112.5% [AAPC 10.1% (95% CI: 9.4, 10.9)] in women of professional services. After adjusting for confounding factors, AMA was significantly associated with increased risk of gestational hypertension (aOR 1.5; 95% CI: 1.2, 2.1), preeclampsia (aOR 1.6; 95% CI: 1.4, 1.9), sever preeclampsia (aOR 1.7; 95% CI: 1.1, 2.6), placenta previa (aOR 1.8; 95% CI: 1.5, 2.2), gestational diabetes mellitus (aOR 2.5; 95% CI: 2.3, 2.9), preterm births (aOR 1.6; 95% CI: 1.4, 1.7), perinatal mortality (aOR 1.8; 95% CI: 1.3, 2.3), and low birth weight (aOR 1.3; 95% CI: 1.2, 1.4) compared with women aged < 30 years. CONCLUSION Our findings show a marked increase in delayed childbearing and its negative association with pregnancy outcomes.
Collapse
Affiliation(s)
- Hui Li
- Department of Medicine, Taixing People Hospital, Taizhou, Jiangsu, China
| | - Nawsherwan
- Department of Preventive Medicine, School of Health Sciences, Wuhan University, Wuhan, Hubei, China.
| | - Cuifang Fan
- Department of Obstetrics and Gynecology, Renmin Hospital, Wuhan University, Wuhan, Hubei, China
| | - Sumaira Mubarik
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, Hubei, China
| | - Ghulam Nabi
- Institute of Nature Conservation, Polish Academy of Sciences, Krakow, Poland
| | - Yin Xiao Ping
- Department of Pediatrics, Taixing People Hospital, Taizhou, Jiangsu, China.
| |
Collapse
|
10
|
Nakanishi K, Saijo Y, Yoshioka E, Sato Y, Kato Y, Nagaya K, Takahashi S, Ito Y, Kobayashi S, Miyashita C, Ikeda-Araki A, Kishi R. Severity of low pre-pregnancy body mass index and perinatal outcomes: the Japan Environment and Children's Study. BMC Pregnancy Childbirth 2022; 22:121. [PMID: 35148693 PMCID: PMC8840606 DOI: 10.1186/s12884-022-04418-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 01/21/2022] [Indexed: 11/28/2022] Open
Abstract
Background The extremes of maternal pre-pregnancy body mass index (BMI) are known to be risk factors associated with obstetric and adverse perinatal outcomes. Among Japanese women aged 20 years or older, the prevalence of underweight (BMI < 18.5 kg/m2) was 11.5% in 2019. Maternal thinness is a health problem caused by the desire to become slim. This study aimed to investigate the association between the severity of maternal low pre-pregnancy BMI and adverse perinatal outcomes, including preterm birth (PTB), low birth weight (LBW), and small-for-gestational age (SGA). Methods We conducted a prospective cohort study using data from the Japan Environment and Children’s Study, which recruited pregnant individuals between 2011 and 2014. Pre-pregnancy BMI was categorized as severe-moderate underweight (BMI < 16.9 kg/m2), mild underweight (BMI, 17.0–18.4 kg/m2), low-normal weight (BMI, 18.5–19.9 kg/m2), high-normal weight (BMI, 20.0–22.9 kg/m2), overweight (BMI, 23.0–24.9 kg/m2), and obese (BMI ≥ 25.0 kg/m2). The high-normal weight group was used as the reference for statistical analyses. Adjusted logistic regression was performed to evaluate the association between pre-pregnancy BMI and PTB, LBW, and SGA. Results Of 92,260 singleton pregnant individuals, the prevalence was 2.7% for severe-moderate underweight, 12.9% for mild underweight, and 24.5% for low-normal weight. The prevalence of adverse outcomes was 4.6% for PTB, 8.1% for LBW, and 7.6% for SGA. The adjusted odds ratios (aORs) for PTB were 1.72 (95% confidence interval [CI], 1.46–2.03) for severe-moderate underweight and 1.26 (95% CI, 1.14–1.39) for mild underweight. The aORs of LBW were 2.55 (95% CI, 2.27–2.86) for severe-moderate underweight, 1.64 (95% CI, 1.53–1.76) for mild underweight, and 1.23 (95% CI, 1.16–1.31) for low-normal weight. The aORs of SGA were 2.53 (95% CI, 2.25–2.84) for severe-moderate underweight, 1.66 (95% CI, 1.55–1.79) for mild underweight, and 1.29 (95% CI, 1.21–1.38) for low-normal weight. Conclusions A dose-response relationship was found between the severity of low pre-pregnancy BMI and PTB, LBW, and SGA. Even low-normal BMI (18.5–19.9 kg/m2) increased the risk of LBW and SGA. This study provides useful information for pre-conception counseling in lean individuals. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04418-3.
Collapse
Affiliation(s)
- Kentaro Nakanishi
- Department of Obstetrics and Gynecology, Asahikawa Medical University, 1-1-1, Midorigaoka higashi2-jo, Asahikawa, Hokkaido, 078-8510, Japan
| | - Yasuaki Saijo
- Division of Public Health and Epidemiology, Department of Social Medicine, Asahikawa Medical University, 1-1-1, Midorigaoka higashi2-jo, Asahikawa, Hokkaido, 078-8510, Japan.
| | - Eiji Yoshioka
- Division of Public Health and Epidemiology, Department of Social Medicine, Asahikawa Medical University, 1-1-1, Midorigaoka higashi2-jo, Asahikawa, Hokkaido, 078-8510, Japan
| | - Yukihiro Sato
- Division of Public Health and Epidemiology, Department of Social Medicine, Asahikawa Medical University, 1-1-1, Midorigaoka higashi2-jo, Asahikawa, Hokkaido, 078-8510, Japan
| | - Yasuhito Kato
- Department of Obstetrics and Gynecology, Asahikawa Medical University, 1-1-1, Midorigaoka higashi2-jo, Asahikawa, Hokkaido, 078-8510, Japan.,Division of Public Health and Epidemiology, Department of Social Medicine, Asahikawa Medical University, 1-1-1, Midorigaoka higashi2-jo, Asahikawa, Hokkaido, 078-8510, Japan
| | - Ken Nagaya
- Division of Neonatology, Perinatal Medical Center, Asahikawa Medical University Hospital, 1-1-1, Midorigaoka higashi2-jo, Asahikawa, Hokkaido, 078-8510, Japan
| | - Satoru Takahashi
- Department of Pediatrics, Asahikawa Medical University, 1-1-1, Midorigaoka higashi2-jo, Asahikawa, Hokkaido, 078-8510, Japan
| | - Yoshiya Ito
- Faculty of Nursing, Japanese Red Cross Hokkaido College of Nursing, 664-1, Akebono-cho, Kitami, Hokkaido, 090-0011, Japan
| | - Sumitaka Kobayashi
- Center for Environmental and Health Sciences, Hokkaido University, Kita12-jo, Nishi7-chome, Kita-ku, Sapporo, Hokkaido, 060-0812, Japan
| | - Chihiro Miyashita
- Center for Environmental and Health Sciences, Hokkaido University, Kita12-jo, Nishi7-chome, Kita-ku, Sapporo, Hokkaido, 060-0812, Japan
| | - Atsuko Ikeda-Araki
- Center for Environmental and Health Sciences, Hokkaido University, Kita12-jo, Nishi7-chome, Kita-ku, Sapporo, Hokkaido, 060-0812, Japan.,Faculty of Health Sciences, Hokkaido University, Kita12-jo, Nishi5-chome, Kita-ku, Sapporo, Hokkaido, 060-0812, Japan
| | - Reiko Kishi
- Center for Environmental and Health Sciences, Hokkaido University, Kita12-jo, Nishi7-chome, Kita-ku, Sapporo, Hokkaido, 060-0812, Japan
| | | |
Collapse
|
11
|
Litman EA, Yin Y, Nelson SJ, Capbarat E, Kerchner D, Ahmadzia HK. Adverse Perinatal Outcomes in a Large US Birth Cohort During the COVID-19 Pandemic: Adverse Perinatal Outcomes During COVID-19. Am J Obstet Gynecol MFM 2022;:100577. [PMID: 35114422 DOI: 10.1016/j.ajogmf.2022.100577] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/24/2022] [Accepted: 01/27/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To investigate whether coronavirus disease 2019 (COVID-19) is associated with adverse perinatal outcomes in a large national dataset and to examine rates of adverse outcomes during the pandemic compared to pre-pandemic period. METHODS This observational cohort study included 683,905 patients, between the ages of 12-50, hospitalized for childbirth and abortion between January 1, 2019 and May 31, 2021. During the pre-pandemic period, 271,444 women were hospitalized for childbirth. During the pandemic, 308,532 women were hospitalized for childbirth and 2,708 had COVID-19. Associations between COVID-19 and in-hospital adverse perinatal outcomes were examined using propensity score-adjusted logistic regression. RESULTS Compared to women without COVID-19, women with COVID-19 were more likely to experience both early and late preterm birth (aOR 1.38 [95% CI 1.1-1.7], aOR 1.62 [95% CI 1.3-1.7], respectively), preeclampsia (aOR 1.2 [95% CI 1.0-1.4]), disseminated intravascular coagulopathy (DIC) (aOR 1.57 [95% CI 1.1-2.2]), pulmonary edema (aOR 2.7 [95% CI 1.1- 6.3]), and need for mechanical ventilation (aOR 8.1 [95% CI 3.8-17.3]). There was no significant difference in the prevalence of stillbirth among women with (n= 16 / 2,708) and without (n= 174 / 39,562) COVID-19, p=0.257. There were no differences in adverse outcomes among women who delivered during the pandemic versus pre-pandemic period. Combined in-hospital mortality was significantly higher for women with COVID-19 (147 [95% CI 3.0 -292] vs 2.5 [95% CI 0-7.5] deaths per 100,000 women). Women diagnosed with COVID-19 within 30 days prior to hospitalization were more likely to experience early preterm birth, placental abruption, and mechanical ventilation, compared to women diagnosed with COVID-19 > 30 days prior to hospitalization for childbirth (4.0% vs. 2.4% for early preterm birth, aOR 1.7 [95% CI 1.1-2.7]; 2.2% vs. 1.2% for placental abruption, aOR 1.86 [95% CI 1.0 - 3.4]); 0.9% vs. 0.1% for mechanical ventilation, aOR 13.7 [95% CI 1.8-107.2])). CONCLUSION Women with COVID-19 had a higher prevalence of adverse perinatal outcomes and increased in-hospital mortality, with highest risk occurring when diagnosis was within 30 days of hospitalization, raising the possibility of a high-risk period.
Collapse
|
12
|
Dieste Pérez P, Esteban LM, Savirón-Cornudella R, Pérez-López FR, Castán-Mateo S, Sanz G, Tajada-Duaso M. Reduced Growth in Non-Small for Gestational Age Fetuses from 35 Weeks of Gestation to Birth and Perinatal Outcomes. Fetal Diagn Ther 2021; 48:768-777. [PMID: 34727547 DOI: 10.1159/000519639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 09/10/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study aimed to assess reduced fetal growth between 35 weeks of gestation and birth in non-small for gestational age fetuses associated with adverse perinatal outcomes (APOs). MATERIAL AND METHOD It is a retrospective cohort study of 9,164 non-small for gestational age fetuses estimated by ultrasound at 35 weeks. The difference between the birth weight percentile and the estimated percentile weight (EPW) at 35 weeks of gestation was calculated, and we studied the relationship of this difference with the appearance of APO. APOs were defined as cesarean or instrumental delivery rates for nonreassuring fetal status, 5-min Apgar score <7, arterial cord blood pH <7.10, and stillbirth. Fetuses that exhibited a percentile decrease between both moments were classified into 6 categories according to the amount of percentile decrease (0.01-10.0, 10.01-20.0, 20.01-30.0, 30.01-40.0, 40.01-50.0, and >50.0 percentiles). It was evaluated whether the appearance of APO was related to the amount of this percentile decrease. Relative risk (RR) was calculated in these subgroups to predict APOs in general and for each APO in particular. Receiver operating characteristic and area under curves (AUC) for the difference in the percentile was calculated, used as a continuous parameter in the entire study population. RESULTS The median gestational age at delivery in uncomplicated pregnancies was 40.0 (39.1-40.7) and in pregnancies with APOs 40.3 (49.4-41.0), p < 0.001. The prevalence of APOs was greater in the group of fetuses with a decrease in percentile (7.6%) compared to those with increased percentile (4.8%) (p < 0.001). The RR was 1.63 (95% CI: 1.365-1.944, p < 0.001). Although the differences were significant in all decreased percentile groups, RRs were significantly higher when decreased growth values were >40 points (RR: 2.036, 95% CI: 1.581-2.623, p < 0.001). The estimated value of the AUC for percentile decrease was 0.58 (0.56-0.61, p < 0.001). CONCLUSION Fetuses with a decrease in the EPW between the ultrasound at 35 weeks of gestation and birth have a higher risk of APOs, being double in fetuses with a decrease of >40 percentile points.
Collapse
Affiliation(s)
- Peña Dieste Pérez
- Department of Obstetrics and Gynecology, Miguel Servet University Hospital, Zaragoza, Spain
| | - Luis M Esteban
- Engineering School of La Almunia, University of Zaragoza, La Almunia de Doña Godina, Spain
| | - Ricardo Savirón-Cornudella
- Department of Obstetrics and Gynecology, Hospital Clínico San Carlos and Instituto de Investigación Sanitaria San Carlos (IdISSC), Universidad Complutense, Madrid, Spain
| | - Faustino R Pérez-López
- Department of Obstetrics and Gynecology, Aragón Health Research Institute, University of Zaragoza Faculty of Medicine, Zaragoza, Spain
| | - Sergio Castán-Mateo
- Department of Obstetrics and Gynecology, Miguel Servet University Hospital, Zaragoza, Spain
| | - Gerardo Sanz
- Department of Statistical Methods, Institute for Biocomputation and Physics of Complex Systems-BIFI, University of Zaragoza, Zaragoza, Spain
| | - Mauricio Tajada-Duaso
- Department of Obstetrics and Gynecology, Miguel Servet University Hospital, Zaragoza, Spain
| |
Collapse
|
13
|
Pampaka D, Papatheodorou SI, AlSeaidan M, Al Wotayan R, Wright RJ, Buring JE, Dockery DW, Christophi CA. Antenatal depressive symptoms and adverse perinatal outcomes. BMC Pregnancy Childbirth 2021; 21:313. [PMID: 33879069 PMCID: PMC8059279 DOI: 10.1186/s12884-021-03783-9] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 04/08/2021] [Indexed: 11/22/2022] Open
Abstract
Background The association of antenatal depression with adverse pregnancy, birth, and postnatal outcomes has been an item of scientific interest over the last decades. However, the evidence that exists is controversial or limited. We previously found that one in five women in Kuwait experience antenatal depressive symptoms. Therefore, the aim of this study was to examine whether antenatal depressive symptoms are associated with preterm birth (PTB), small for gestational age (SGA), or large for gestational age (LGA) babies in this population. Methods This was a secondary analysis based on data collected in the Transgenerational Assessment of Children’s Environmental Risk (TRACER) Study that was conducted in Kuwait. Logistic regression analysis was used to examine whether antenatal depressive symptoms assessed using the Edinburgh Depression Scale (EDS) were associated with preterm birth, small for gestational age, and large for gestational age babies. Results A total of 1694 women had complete information about the outcomes of interest. Women with depressive symptoms in pregnancy had increased, albeit non-significant, odds of having PTB (OR = 1.41; 95%CI: 0.81, 2.45), SGA babies (OR = 1.26; 0.80, 1.98), or LGA babies (OR = 1.27; 0.90, 1.79). Antenatal depressive symptoms had similar increased odds for the three outcomes even after adjusting for several covariates though none of these reached statistical significance. Conclusions In the present study, the depressive symptoms in pregnancy did not predict adverse birth outcomes, such as PTB, SGA, and LGA, which adds to the currently non-conclusive literature. However, further research is needed to examine these associations, as the available evidence is quite limited.
Collapse
Affiliation(s)
- Despina Pampaka
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, 95 Eirinis Street, 3041, Limassol, Cyprus
| | | | | | | | - Rosalind J Wright
- Department of Pediatrics & Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Julie E Buring
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Douglas W Dockery
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Costas A Christophi
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, 95 Eirinis Street, 3041, Limassol, Cyprus. .,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| |
Collapse
|
14
|
Preis H, Mahaffey B, Pati S, Heiselman C, Lobel M. Adverse Perinatal Outcomes Predicted by Prenatal Maternal Stress Among U.S. Women at the COVID-19 Pandemic Onset. Ann Behav Med 2021; 55:179-191. [PMID: 33724334 PMCID: PMC7980766 DOI: 10.1093/abm/kaab005] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background High stress prenatally contributes to poor maternal and infant well-being. The coronavirus disease 2019 (COVID-19) pandemic has created substantial stress for pregnant women. Purpose To understand whether stress experienced by women pregnant at the beginning of the pandemic was associated with a greater prevalence of adverse perinatal outcomes. Methods Pregnant women across the USA aged ≥18 years old enrolled in a prospective cohort study during the pandemic onset (T1) in April–May 2020. This report focuses on the 1,367 participants who gave birth prior to July–August 2020 (T2). Hierarchical logistic regression models predicted preterm birth, small for gestational age infants, and unplanned operative delivery from T1 stress, sociodemographic, and medical factors. Results After controlling for sociodemographic and medical factors, preterm birth was predicted by high prenatal maternal stress, delivering an infant small for gestational age was predicted by interpersonal violence and by stress related to being unprepared for birth due to the pandemic, and unplanned cesarean or operative vaginal delivery was predicted by prenatal appointment alterations, experiencing a major stressful life event, and by stress related to being unprepared for birth due to the pandemic. Independent of these associations, African American women were more likely than other groups to deliver preterm. Conclusion Pregnant women who are experiencing high stress during the COVID-19 pandemic are at risk of poorer perinatal outcomes. A longitudinal investigation is critical to determine whether prenatal maternal stress and resulting outcomes have longer-term consequences for the health and well-being of children born in the midst of the current pandemic.
Collapse
Affiliation(s)
- Heidi Preis
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA.,Department of Pediatrics, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Brittain Mahaffey
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Susmita Pati
- Department of Pediatrics, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Cassandra Heiselman
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Marci Lobel
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| |
Collapse
|
15
|
Savirón-Cornudella R, Esteban LM, Aznar-Gimeno R, Dieste Pérez P, Pérez-López FR, Castán-Larraz B, Sanz G, Tajada-Duaso M. Prediction of Large for Gestational Age by Ultrasound at 35 Weeks and Impact of Ultrasound-Delivery Interval: Comparison of 6 Standards. Fetal Diagn Ther 2020; 48:15-23. [PMID: 32898848 DOI: 10.1159/000510020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 07/08/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of the study was to assess the predictive ability of the ultrasound estimated percentile weight (EPW) at 35 weeks to predict large for gestational age (LGA) at term delivery according to 6 growth standards, including population, population-customized, and international references. The secondary objectives were to determine its predictive ability to detect adverse perinatal outcomes (APOs) and whether the ultrasound-delivery interval influences the detection rate of LGA newborns. METHODS This was a retrospective cohort study of 9,585 singleton pregnancies. Maternal clinical characteristics, fetal ultrasound data obtained at 35 weeks, and pregnancy and perinatal outcomes were used to calculate EPWs to predict LGAs at delivery according to the customized and the non-customized (NC) Miguel Servet University Hospital (MSUH), the customized Figueras, the NC Fetal Medicine Foundation (FMF), the NC INTERGROWTH-21st, and the NC World Health Organization (WHO) standards. RESULTS For a 10% false-positive rate, detection rates for total LGAs at delivery ranged from 31.2% with the WHO (area under the curve [AUC] 0.77; 95% confidence interval [CI], 0.76-0.79) to 56.5% with the FMF standard (AUC 0.85; 95% CI, 0.84-0.86). Detection rates and values of AUCs to predict LGAs by ultrasound-delivery interval (range 1-6 weeks) show higher detection rates as the interval decreases. APO detection rates ranged from 2.5% with the WHO to 12.6% with the Figueras standard. CONCLUSION The predictive ability of ultrasound estimated fetal weight at 35 weeks to detect LGA infants is significantly greater for FMF and MSUH NC standards. In contrast, the APO detection rate is significantly greater for customized standards. The shorter ultrasound-delivery interval relates to better prediction rates.
Collapse
Affiliation(s)
| | - Luis M Esteban
- Escuela Universitaria Politécnica de La Almunia, Universidad de Zaragoza, Zaragoza, Spain
| | | | - Peña Dieste Pérez
- Department of Obstetrics and Gynecology, Miguel Servet University Hospital, Zaragoza, Spain
| | - Faustino R Pérez-López
- Department of Obstetrics and Gynecology, University of Zaragoza Faculty of Medicine and Instituto de Investigaciones Sanitarias Aragón, Zaragoza, Spain
| | | | - Gerardo Sanz
- Department of Statistical Methods and Institute for Biocomputation and Physics of Complex Systems-BIFI, University of Zaragoza, Zaragoza, Spain
| | - Mauricio Tajada-Duaso
- Department of Obstetrics and Gynecology, Miguel Servet University Hospital, Zaragoza, Spain
| |
Collapse
|
16
|
Levy O, Pariente G, Rotem R, Yohai D, Weintraub AY. Early predictors of small-for-gestational-age neonates using non-invasive, low-cost, and readily available hematological markers. Int J Gynaecol Obstet 2020; 150:340-345. [PMID: 32433793 DOI: 10.1002/ijgo.13230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 04/04/2020] [Accepted: 05/15/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate whether neutrophil-to-lymphocyte ratio (NLR), a well-established inflammatory marker, can be used as an early predictor for small-for-gestational-age (SGA) neonates and other adverse pregnancy outcomes. METHODS A case-control study compared first-trimester hematological biomarkers in pregnancies of patients with and without SGA (n=149, n=151, respectively). Demographic, clinical, and obstetrical characteristics and first-trimester complete blood count were retrieved. Woman with singleton pregnancies who delivered at Soroka University Medical Center between January 2015 and December 2016 were included. Patients with known maternal infections, relevant medications, hematological conditions, and chronic diseases that may alter the blood count, those with multiple pregnancies, and those with congenital or chromosomal abnormalities were excluded. After univariate analysis, a linear regression model was constructed to assess the association between hematological indices and SGA. Receiver operating curves were constructed to evaluate the sensitivity and specificity of NLR. RESULTS First-trimester NLR values of the SGA group were significantly higher compared to controls (3.03 ± 1.68 vs 2.63 ± 1.2, P=0.016). Significantly higher levels of NLR were noted among the severely (<3%) SGA neonates (3.12 ± 1.62 vs 2.62 ± 1.2; P=0.034). CONCLUSION NLR may be an early, clinically useful marker in the prediction of SGA. As blood samples are routinely collected, correct implication of this result may serve as a valuable non-invasive, low-cost, readily available predicting tool.
Collapse
Affiliation(s)
- Ofir Levy
- Department of Obstetrics and Gynecology, Gynecology A Ward, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gali Pariente
- Department of Obstetrics and Gynecology, Gynecology A Ward, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Reut Rotem
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - David Yohai
- Department of Obstetrics and Gynecology, Gynecology A Ward, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Gynecology A Ward, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| |
Collapse
|
17
|
Heimberger S, Perdigao JL, Mueller A, Shahul S, Naseem H, Minhas R, Chintala S, Rana S. Effect of blood pressure control in early pregnancy and clinical outcomes in African American women with chronic hypertension. Pregnancy Hypertens 2020; 20:102-107. [PMID: 32229425 DOI: 10.1016/j.preghy.2020.03.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 03/05/2020] [Accepted: 03/20/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Chronic hypertension (cHTN) affects 3-5% of all pregnancies and is twice as prevalent in African American (AA) women. AA women develop more severe HTN at an earlier onset and have higher rates of adverse pregnancy outcomes. Blood pressure control during pregnancy is controversial. STUDY DESIGN This retrospective cohort included AA women with cHTN and singleton pregnancies delivering between January 2013 and December 2016. Patients were classified as not receiving antihypertensives in the first 20 weeks (Group A), on antihypertensives in the first 20 weeks but with an average BP <140/90 during pregnancy (Group B) and on antihypertensives in the first 20 weeks but with average BP during pregnancy ≥140/90 (Group C). Adverse outcomes including severe HTN and preterm delivery <35 weeks was compared between groups. RESULTS Of the 198 patients included, 68 received at least one AHT before 20 weeks including 45 patients with average BP <140/90 and 23 with average BP ≥140/90 during pregnancy. The incidence of superimposed PE and preterm birth was significantly higher among women with elevated BPs on AHT (39.1% vs 8.9% vs 17.7%, p = 0.01; preterm birth 52.2%, 8.9% and 9.2%, p < 0.001 for Groups C, B and A, respectively). A significantly higher proportion of adverse neonatal outcomes were observed in Group C (78.3%) as opposed to those in Group B (53.3%) or Group A (50.0%; p = 0.04). CONCLUSIONS Among AA women with cHTN, use of antihypertensives prior to 20 weeks and lower antenatal BP was associated with a decreased risk of adverse maternal and neonatal outcomes.
Collapse
Affiliation(s)
- Sarah Heimberger
- University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - Joana Lopes Perdigao
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Pennsylvania, PA, United States
| | - Ariel Mueller
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Chicago, IL, United States; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Sana Shahul
- University of Chicago, Chicago, IL, United States
| | - Heba Naseem
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Chicago, IL, United States
| | - Ruby Minhas
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Chicago, IL, United States
| | - Sireesha Chintala
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Chicago, IL, United States
| | - Sarosh Rana
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Chicago, IL, United States.
| |
Collapse
|
18
|
Mehari MA, Maeruf H, Robles CC, Woldemariam S, Adhena T, Mulugeta M, Haftu A, Hagose H, Kumsa H. Advanced maternal age pregnancy and its adverse obstetrical and perinatal outcomes in Ayder comprehensive specialized hospital, Northern Ethiopia, 2017: a comparative cross-sectional study. BMC Pregnancy Childbirth 2020; 20:60. [PMID: 32000714 PMCID: PMC6993443 DOI: 10.1186/s12884-020-2740-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 01/14/2020] [Indexed: 11/25/2022] Open
Abstract
Background Advanced maternal age generally denotes age after 35 years during the time of delivery. Despite the fact that being pregnant at any reproductive age is not risk-free, older gravidity usually culminates with adverse outcomes both to the mother and fetus or neonate. This study aimed to determine the association of adverse obstetrical and perinatal outcomes with advanced maternal age pregnancy. The study was conducted in Ayder comprehensive specialized hospital, north Ethiopia, from 2015 to 2017. Methods chart review comparative cross-sectional study was employed. Data were retrieved from medical charts of 752 pregnant mothers (376 each for both the study;> 35-year-old and reference group;20-34 year old). Data was collected using a pretested and structured checklist using systematic sampling and data was entered & analyzed using SPSS version 20. Binary and multivariable logistic regression was run to determine the association of independent variables with dependent variables. Results This study revealed that advanced maternal age pregnancy was significantly associated with pregnancy induced hypertension [AOR 4.15, 95% CI (2.272–7.575), p < 0.001], ante partum hemorrhage [AOR 2.54, 95% CI (1.32–4.91), P = 0.005] & cesarean delivery [AOR 2.722, 95% CI (1.777–4.170), p < 0.001]. Furthermore, advanced maternal age pregnancy was also increasingly associated with adverse perinatal outcomes like preterm delivery [AOR 3.622, 95% CI (1.469–8.930), p = 0.005], low birth weight [AOR 3.137, 95% CI (1.324–7.433), p = 0.009], perinatal death [AOR 2.54, 95% CI (1.141–5.635), p = 0.022] and low fifth minute APGAR score [AOR 7.507, 95% CI (3.134–17.98), p < 0.001]. Notwithstanding this, maternal age was not found to be associated with amniotic fluid disturbances, premature rupture of membranes and post-term pregnancy. Conclusions Advanced maternal age is markedly linked with adverse obstetrical and perinatal outcomes. Therefore, it is better for health care providers to counsel couples, who seek to have a child in their later ages, about the risks of advanced maternal age pregnancy. In addition, health care workers need to emphasize on how to improve advanced age mothers’ health through the utilization of contraception to reduce pregnancy in this age group.
Collapse
Affiliation(s)
- Mihret-Ab Mehari
- Mekelle University, College of Health Sciences, P.O. Box 1871, Mekelle, Ethiopia.
| | - Hayat Maeruf
- Dr. Tewelde Legesse Health Sciences College, P.O. Box 306, Mekelle, Ethiopia
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Berhe AK, Ilesanmi AO, Aimakhu CO, Mulugeta A. Effect of pregnancy induced hypertension on adverse perinatal outcomes in Tigray regional state, Ethiopia: a prospective cohort study. BMC Pregnancy Childbirth 2019; 20:7. [PMID: 31892353 PMCID: PMC6938605 DOI: 10.1186/s12884-019-2708-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/26/2019] [Indexed: 12/20/2022] Open
Abstract
Background The prevalence of pregnancy-induced hypertension in Ethiopia ranges from 2.2 to 18.3%. However, so far little is known about the adverse perinatal outcomes of pregnancy-induced hypertension in Tigray regional state, Ethiopia. Therefore, the objective of this study was to assess the effect of pregnancy-induced hypertension on adverse perinatal outcomes in Tigray Regional State, Ethiopia. Methods a prospective cohort study was conducted on a total sample of 782 pregnant women attending antenatal care in hospitals of Tigray regional state, Ethiopia. Pregnant mothers diagnosed with PIH during the data collection period in the selected hospitals were included as exposed group and normotensive women were also enrolled as a control group. This study addresses women diagnosed with preeclampsia, eclampsia and gestational hypertension between 28 and 35 weeks of gestation. Data were collected using an interviewer-administered questionnaire and review of their medical records from February 2018, to February 2019. The adverse perinatal outcome event includes low birth weight, birth asphyxia, small for gestational age, preterm delivery, admission to neonatal intensive care unit and perinatal death. A modified Poisson regression model with robust standard errors was used to analyze relative risk. Results In this study, the overall incidence of adverse perinatal outcome was higher among women with pregnancy-induced hypertension than normotensive women (66.4% vs 22.2%). After adjusted for confounders women with pregnancy-induced hypertension were born babies with a higher risk of low birth weight (adjusted RR (95%CI) = 5.1(3.4,7.8)), birth asphyxia (aRR = 2.6(1.9,3.8)), small for gestational age (aRR = 3.3(2.3,4.6)), preterm delivery (aRR = 5.2(3.4,7.9)), stillbirth (aRR = 3.46(1.40,8.54)), admission to neonatal intensive care unit (aRR = 5.1(3.1,8.4)) and perinatal death (aRR = 3.6(1.8,7.4)) compared to normotensive pregnant women. Conclusions Higher incidences of adverse perinatal outcomes occurred among women pregnancy-induced hypertension in Tigray regional state, Ethiopia. Hence, health care providers should strengthen prevention, early diagnosis and prompt management of pregnancy-induced hypertension to reduce adverse perinatal outcomes of pregnancy-induced hypertension.
Collapse
Affiliation(s)
- Abadi Kidanemariam Berhe
- College of Medicine and Health Sciences, Adigrat University, Tigray, Ethiopia. .,Pan African University Institute for Life and Earth Sciences, University of Ibadan, Ibadan, Nigeria.
| | - Abiodun O Ilesanmi
- Department of Obstetrics and Gynaecology, College of Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria
| | - Christopher O Aimakhu
- Department of Obstetrics and Gynaecology, College of Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria
| | - Afework Mulugeta
- School of Public Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| |
Collapse
|
20
|
Crone MR, Luurssen-Masurel N, Bruinsma-van Zwicht BS, van Lith JMM, Rijnders MEB. Pregnant women at increased risk of adverse perinatal outcomes: A combination of less healthy behaviors and adverse psychosocial and socio-economic circumstances. Prev Med 2019; 127:105817. [PMID: 31445113 DOI: 10.1016/j.ypmed.2019.105817] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 07/05/2019] [Accepted: 08/20/2019] [Indexed: 12/23/2022]
Abstract
Smoking during pregnancy is associated with a multitude of health behaviors and with the psychosocial and socio-economic circumstances of pregnant women. Limited research has so far been conducted on the clustering of these characteristics and on their effect on pregnancy outcomes. This study aimed to identify different groups of pregnant women based on their behavioral, psychosocial and socio-economic characteristics and their pregnancy outcomes. In total, 2455 women who were 12 weeks pregnant completed a questionnaire on smoking behavior, health behaviors and psychosocial and socio-economic characteristics. Neonatal and maternal outcomes were extracted from the Dutch perinatal registration. Subgroups were identified with latent class analysis and adverse pregnancy outcomes were compared between subgroups with logistic regression. Women were classified into four latent classes. Two classes represented the healthy higher-educated pregnant women who did not smoke: one group of multigravida women and one of primigravida women, also characterized by less pregnancy-specific knowledge and more pregnancy-related stress. The remaining women were grouped into two less healthy groups. One group frequently quit smoking, reported less healthy eating, less physical activity and comparable stress levels as the healthy higher-educated groups. The last group contained the most smokers, had the highest scores on psychosocial and pregnancy-related stress and the most adverse socio-economic circumstances. This group had an increased risk of adverse maternal outcomes, in particular developing diabetes during pregnancy. A comprehensive and integrated approach is needed to improve outcomes in pregnancies with a combination of adverse health, psychosocial, and socio-economic conditions.
Collapse
|
21
|
Zhao L, Zheng X, Liu J, Zheng R, Yang R, Wang Y, Sun L. PPAR signaling pathway in the first trimester placenta from in vitro fertilization and embryo transfer. Biomed Pharmacother 2019; 118:109251. [PMID: 31351426 DOI: 10.1016/j.biopha.2019.109251] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/16/2019] [Accepted: 07/18/2019] [Indexed: 01/27/2023] Open
Abstract
Placenta is a temporary critical organ related to fetal development and pregnancy outcomes. And epidemiologic data demonstrate an increased risk of placental abnormality after in vitro fertilization and embryo transfer (IVF-ET). This study aims to explore the molecular mechanism for PPAR signaling pathway in placenta subjected to IVF-ET in the first trimester. Four first trimester placenta samples from double chorionic twins to single reduction in IVF-ET only because of oviducts factors. The other four control placenta samples from double chorionic twin were derived from those unplanned spontaneously conceived pregnancy after the legal termination. Affymetrix HG-U133 Plus 2.0 Array was performed to evaluate the global gene expressions. We confirmed microarray results from 10 significant differential genes using RT-qPCR. And 10 deregulated gene products were stained in the first trimester placenta by immunohistochemistry. These differentially expressed genes in IVF-ET placentas were submitted to functional annotation of clustering tools of bioinformatics resources and gene ontology enrichment analysis. Schematic representation of placental PPAR signaling pathway was labelled by Kyoto Encyclopedia of Genes and Genomes (KEGG). Analysis results of early placental PPAR signaling pathway gene expression from 8 women demonstrated 34 genes with a significant change in expression between IVF-ET and control group, 25 up-regulated; 9 down-regulated. KEGG pathway analysis indicated that IVF-ET manipulation extensively over-activated PPAR signaling pathway. Immune tolerance, trophoblast invasion, syncytia formation, lipid and glucose metabolism, inflammatory response and other complex biological functions were disturbed. RT-qPCR results and proteins staining intensity were consisted with microarray. Placental gene expressions and functions in PPAR signaling pathway were affected by IVF-ET treatment in the first trimester, which may offer a potential mechanism for the pathogenesis of various adverse outcomes during the perinatal period.
Collapse
Affiliation(s)
- Liang Zhao
- Department of Obstetrics and Gynecology, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Xiuli Zheng
- Department of Obstetrics and Gynecology, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Jingfang Liu
- Department of Obstetrics and Gynecology, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Rong Zheng
- Department of Obstetrics and Gynecology, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Rui Yang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, No. 49, Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Ying Wang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, No. 49, Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Lifang Sun
- Department of Obstetrics and Gynecology, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035, China.
| |
Collapse
|
22
|
Zhao L, Zheng X, Liu J, Zheng R, Yang R, Wang Y, Sun L. The placental transcriptome of the first-trimester placenta is affected by in vitro fertilization and embryo transfer. Reprod Biol Endocrinol 2019; 17:50. [PMID: 31262321 PMCID: PMC6604150 DOI: 10.1186/s12958-019-0494-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/17/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The placenta is a highly specialized temporary organ that is related to fetal development and pregnancy outcomes, and epidemiological data demonstrate an increased risk of placental abnormality after in vitro fertilization and embryo transfer (IVF-ET). METHODS This study examines alterations in the transcriptome profile of first-trimester placentas from IVF-ET pregnancies and analyzes the potential mechanisms that play a role in the adverse perinatal outcomes associated with IVF-ET procedures. Four human placental villi from first-trimester samples were obtained through fetal bud aspiration from patients subjected to IVF-ET due to oviductal factors. An additional four control human placental villi were derived from a group of subjects who spontaneously conceived a twin pregnancy. We analyzed their transcriptomes by microarray. Then, RT-qPCR and immunohistochemistry were utilized to analyze several dysregulated genes to validate the microarray results. Biological functions and pathways were analyzed with bioinformatics tools. RESULTS A total of 3405 differentially regulated genes were identified as significantly dysregulated (> 2-fold change; P < 0.05) in the IVF-ET placenta in the first trimester: 1910 upregulated and 1495 downregulated genes. Functional enrichment analysis of the differentially regulated genes demonstrated that the genes were involved in more than 50 biological processes and pathways that have been shown to play important roles in the first trimester in vivo. These pathways can be clustered into coagulation cascades, immune response, transmembrane signaling, metabolism, cell cycle, stress control, invasion and vascularization. Nearly the same number of up- and downregulated genes participate in the same biological processes related to placental development and maintenance. Procedures utilized in IVF-ET altered the expression of first-trimester placental genes that are critical to these biological processes and triggered a compensatory mechanism during early implantation in vivo. CONCLUSION These data provide a potential basis for further analysis of the higher frequency of adverse perinatal outcomes following IVF-ET, with the ultimate goal of developing safer IVF-ET protocols.
Collapse
Affiliation(s)
- Liang Zhao
- Department of Obstetrics and Gynecology, Beijing Jishuitan, Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035, People's Republic of China
| | - Xiuli Zheng
- Department of Obstetrics and Gynecology, Beijing Jishuitan, Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035, People's Republic of China
| | - Jingfang Liu
- Department of Obstetrics and Gynecology, Beijing Jishuitan, Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035, People's Republic of China
| | - Rong Zheng
- Department of Obstetrics and Gynecology, Beijing Jishuitan, Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035, People's Republic of China
| | - Rui Yang
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49, Huayuan North Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Ying Wang
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49, Huayuan North Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Lifang Sun
- Department of Obstetrics and Gynecology, Beijing Jishuitan, Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035, People's Republic of China.
| |
Collapse
|
23
|
Savirón-Cornudella R, Esteban LM, Tajada-Duaso M, Castán-Mateo S, Dieste-Pérez P, Cotaina-Gracia L, Lerma-Puertas D, Sanz G, Pérez-López FR. Detection of Adverse Perinatal Outcomes at Term Delivery Using Ultrasound Estimated Percentile Weight at 35 Weeks of Gestation: Comparison of Five Fetal Growth Standards. Fetal Diagn Ther 2019; 47:104-114. [PMID: 31212273 DOI: 10.1159/000500453] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 04/16/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the predictive ability of the ultrasound estimated percentile weight (EPW) at 35 weeks of pregnancy to predict adverse perinatal outcomes (APOs) at term delivery according to 5 fetal growth standards, including population, population-customized, and international references. METHODS This was a retrospective cohort study of 9,585 singleton pregnancies. Maternal clinical characteristics, fetal ultrasound data obtained at 35 weeks and pregnancy and perinatal outcomes were used to calculate EPWs to predict APOs according to: the customized and noncustomized (NC) Miguel Servet University Hospital (MSUH), the customized Figueras, the NC INTERGROWTH-21st, and the NC World Health Organization (WHO) international standards. APOs were defined as the occurrence of cesarean or instrumental delivery for nonreassuring fetal status, 5-min Apgar score < 7, arterial cord blood pH <7.10, or stillbirth. The predictive ability of EPW for APOs was analyzed using the area under the curve (AUC), and sensitivities were calculated for different false-positive rates (FPRs). RESULTS For a 10% FPR, detection rates for total APOs ranged between 12.7% with the customized MSUH (AUC 0.52; 95% CI 0.50-0.55) and 14.4% with the NC MSUH standard (AUC 0.55; 95% CI 0.53-0.57) for EPW by ultrasound; and from 22.0% with the customized MSUH standard (AUC 0.60; 95% CI 0.58-0.63) to 27.8% with the NC WHO (AUC 0.65; 95% CI 0.63-0.68) for EPW at delivery. CONCLUSIONS The predictive capacity of the EPW for APOS is limited and similar, by both ultrasound and at delivery, for the 5 growth standards, without significant differences between customized and NC standards.
Collapse
Affiliation(s)
| | - Luis M Esteban
- Escuela Universitaria Politécnica de La Almunia, University of Zaragoza, Zaragoza, Spain
| | - Mauricio Tajada-Duaso
- Department of Obstetrics and Gynecology, Miguel Servet University Hospital, Zaragoza, Spain,
| | - Sergio Castán-Mateo
- Department of Obstetrics and Gynecology, Miguel Servet University Hospital, Zaragoza, Spain
| | - Peña Dieste-Pérez
- Department of Obstetrics and Gynecology, Miguel Servet University Hospital, Zaragoza, Spain
| | - Laura Cotaina-Gracia
- Department of Obstetrics and Gynecology, Miguel Servet University Hospital, Zaragoza, Spain
| | - Diego Lerma-Puertas
- Department of Obstetrics and Gynecology, Miguel Servet University Hospital, Zaragoza, Spain
| | - Gerardo Sanz
- Department of Statistical Methods and Institute for Biocomputation and Physics of Complex Systems-BIFI, University of Zaragoza, Zaragoza, Spain
| | - Faustino R Pérez-López
- Department of Obstetrics and Gynecology, University of Zaragoza Faculty of Medicine and Lozano-Blesa University Hospital, Zaragoza, Spain
| |
Collapse
|
24
|
Turner JM, Flatley C, Kumar S. A low fetal cerebroplacental ratio confers a greater risk of intrapartum fetal compromise and adverse neonatal outcomes in low risk multiparous women at term. Eur J Obstet Gynecol Reprod Biol 2018; 230:15-21. [PMID: 30237135 DOI: 10.1016/j.ejogrb.2018.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/21/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND A low fetal cerebroplacental ratio (CPR) and nulliparity have independently been shown to be associated with adverse obstetric and perinatal outcomes. OBJECTIVES To assess the effect of parity on the CPR and investigate the utility of a CPR threshold of <10th centile for predicting adverse outcomes. We hypothesised that nulliparous women would have a lower CPR than multiparous women, impacting the diagnostic performance of the <10th centile threshold. This is an important consideration for interpretation of a low CPR in clinical practice. STUDY DESIGN This was a retrospective cohort study of low risk, singleton pregnancies delivering at term in Australia's largest maternity hospital. The primary outcome was emergency caesarean section for intrapartum fetal compromise (EmCS IFC). Data was dichotomised according to parity and further by CPR <10th centile. Multiple logistic regression was performed. RESULTS 4737 women were included for analysis, 2333 were nulliparous and 2404 were multiparous. Overall the z-score (mean [SD])(CPR standardised for gestation) was lower in nulliparous compared to multiparous women (-0.16 [-1.73 - 1.42] vs 0.04 [-1.63 - 1.69], p < 0.001). Multiparous women had a non-significantly lower mean z-score for those who delivered by EmCS IFC than nulliparous women (-0.52 [-2.23 - 2.02] vs -0.45 [-2.22 - 1.1]). Nulliparous women had greater odds of having a CPR <10th centile compared to the multiparous cohort (OR 1.24, 95% CI 1.02-1.5 vs. OR 0.81, 95% CI 0.7-0.98, p < 0.001). A CPR thresholdd <10th centile in nulliparous women was associated with increased odds of intrapartum fetal compromise (IFC), EmCS IFC (aOR 1.72, 95CI 1.2-2.6, p < 0.05) and birthweight <10th centile. A low CPR in multiparous women was associated with increased odds of all adverse perinatal outcomes measured: IFC, meconium stained liquor, EmCS IFC (aOR 4.99, 95%CI 2.5-9.9, p < 0.001), birthweight <10th centile, acidosis, neonatal intensive care admission and severe composite neonatal outcome. These aORs were associated with specificities of >90% and false positive rates of <10% for all outcomes in multiparous women. CONCLUSIONS A CPR <10th centile in multiparous women confers greater odds of adverse perinatal outcomes and as such of the influence of parity should be taken into account when decisions regarding clinical management are made because of a low CPR.
Collapse
Affiliation(s)
- Jessica M Turner
- Mater Research Institute, University of Queensland, Level 3 Aubigny Place, Raymond Terrace, S. Brisbane, QLD, 4101, Australia; Faculty of Medicine, University of Medicine, Whitty Building, Annerley Road, S. Brisbane, QLD, 4101, Australia
| | - Christopher Flatley
- Mater Research Institute, University of Queensland, Level 3 Aubigny Place, Raymond Terrace, S. Brisbane, QLD, 4101, Australia
| | - Sailesh Kumar
- Mater Research Institute, University of Queensland, Level 3 Aubigny Place, Raymond Terrace, S. Brisbane, QLD, 4101, Australia; Faculty of Medicine, University of Medicine, Whitty Building, Annerley Road, S. Brisbane, QLD, 4101, Australia.
| |
Collapse
|
25
|
Liyew EF, Yalew AW, Afework MF, Essén B. Maternal near-miss and the risk of adverse perinatal outcomes: a prospective cohort study in selected public hospitals of Addis Ababa, Ethiopia. BMC Pregnancy Childbirth 2018; 18:345. [PMID: 30134858 PMCID: PMC6106830 DOI: 10.1186/s12884-018-1983-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 08/15/2018] [Indexed: 11/20/2022] Open
Abstract
Background Presence of maternal near-miss conditions in women is strongly associated with the occurrence of adverse perinatal outcomes, but not well-understood in low-income countries. The study aimed to ascertain the effect of maternal near-miss on the risk of adverse perinatal outcomes in Ethiopia. Methods A prospective cohort study was conducted in five public hospitals of Addis Ababa, Ethiopia. Women admitted from May 1, 2015 to April 30, 2016 were recruited for the study. We followed a total of 828 women admitted for delivery or treatment of pregnancy-related complications along with their singleton newborn babies. Maternal near-miss was the primary exposure and was ascertained using the World Health Organization criteria. Women who delivered without complications were taken as the non-exposed groups. The main outcome was adverse perinatal outcomes. Data on maternal near-miss and perinatal outcomes were abstracted from medical records of the participants. Exposed and non-exposed women were interviewed by well-trained data collectors to obtain information about potential confounding factors. Logistic regressions were performed using Stata version 13.0 to determine the adjusted odds of adverse perinatal outcomes. Results A total of 207 women with maternal near-miss and 621 women with uncomplicated delivery were included in the study. After adjusting for potential confounders, women with maternal near-miss condition had more than five-fold increased odds of adverse perinatal outcomes compared to women who delivered without any complications (AOR = 5.69: 95% CI; 3.69–8.76). Other risk factors that were independently associated with adverse perinatal outcomes include: rural residence, history of prior stillbirth and primary educational level. Conclusions Presence of maternal near-miss in women is an independent risk factor for adverse perinatal outcomes. Hence, interventions rendered at improvement in maternal health of Ethiopia can lead to an improvement in perinatal outcomes.
Collapse
Affiliation(s)
- Ewnetu Firdawek Liyew
- Department of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
| | - Alemayehu Worku Yalew
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mesganaw Fantahun Afework
- Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Birgitta Essén
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| |
Collapse
|
26
|
Chainarong N, Petpichetchian C. The relationship between intrapartum cerebroplacental ratio and adverse perinatal outcomes in term fetuses. Eur J Obstet Gynecol Reprod Biol 2018; 228:82-6. [PMID: 29909268 DOI: 10.1016/j.ejogrb.2018.06.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/05/2018] [Accepted: 06/10/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The cerebroplacental ratio (CPR) Doppler has been proposed as an instrument for predicting adverse perinatal outcomes particularly during antepartum period. Abnormal CPR is associated with non-reassuring fetal status requiring operative delivery, low Apgar score and neonatal complications. The aim of this study was to assess the role of CPR Doppler in the labor triage suite, so as to identify fetuses at risk for non-reassuring status as well as other adverse perinatal outcomes. METHODS This was a prospective cohort study of term pregnancies who attended the labor room during the latent phase of labor. Both fetal Middle Cerebral Artery Pulsatility Index (MCA-PI) and Umbilical Artery Pulsatility Index (UA-PI) were measured and these values were converted to CPR values. Non-reassuring fetal status requiring operative delivery and other adverse perinatal outcomes were compared between women with normal and abnormal CPR values. Accuracy of CPR for predicting non-reassuring fetal status and abnormal fetal heart rate patterns were calculated. RESULTS A total of 384 women were recruited. Lower CPR values were observed in women who underwent operative delivery for non-reassuring fetal status. However, when dividing women into normal and abnormal CPR groups, using 3 different cut-off values, the rate of non-reassuring fetal status was not significantly different between the groups. There was a significantly higher rate of abnormal fetal heart rate monitoring in fetuses with CPR < 5th percentile and CPR < 1. CPR appeared to have a low positive predictive value (PPV) for predicting non-reassuring fetal heart rate patterns, however, the negative predictive value (NPV) was high. CONCLUSIONS In term fetuses, lower CPR is associated with non-reassuring fetal status. CPR measurement during the intrapartum period with currently available CPR cut-off values is not a good predictor for adverse perinatal outcomes, with the exception of abnormal fetal heart rate patterns. However, the high NPV may be used to stratify pregnant women who may benefit from continuous fetal heart rate monitoring.
Collapse
|
27
|
Simenc GB, Blickstein I, Verdenik I, Bregar AT, Lucovnik M, Tul N. Is forty the new thirty? Population based study of advanced maternal age. J Perinat Med 2018; 46:247-250. [PMID: 28708575 DOI: 10.1515/jpm-2017-0060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 06/12/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare perinatal outcomes in different advanced maternal age groups. PATIENTS AND METHODS We used a population-based data set to compare perinatal outcomes in three maternal age groups: 30-34.9, 35-39.9, and in women over 40 years. RESULTS Over a 10-year period there were 23,422 (25.2%) births in the 35-39.9 years group, 3987 (4.3%) in the over 40 years group, and 65,492 births (70.5%) in our reference group (30-34.9 years). A direct significant relationship was found between maternal age and BMI and between pregnancy complications such as diabetes and hypertensive disorders, whereas an inverse relationship was found between older age and nuliparity and spontaneous conceptions. Also, older mothers had a higher incidence of both types of cesareans, and more early as well as late preterm births. Perinatal mortality was similar in all groups. CONCLUSIONS Advanced maternal age is associated with higher, gradually increasing, incidence, of adverse perinatal outcomes.
Collapse
Affiliation(s)
- Gabrijela Brzan Simenc
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Isaac Blickstein
- Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot 76100, Israel, E-mail:
| | - Ivan Verdenik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Andreja Trojner Bregar
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Miha Lucovnik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Natasa Tul
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
28
|
Sahin E, Madendag Y, Tayyar AT, Sahin ME, Col Madendag I, Acmaz G, Unsal D, Senol V. Perinatal outcomes in uncomplicated late preterm pregnancies with borderline oligohydramnios. J Matern Fetal Neonatal Med 2017; 31:3085-3088. [PMID: 28782398 DOI: 10.1080/14767058.2017.1364722] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study is to determine the adverse perinatal outcomes in uncomplicated late preterm pregnancies with borderline oligohydramnios. METHODS A total of 430 pregnant women with an uncomplicated singleton pregnancy at a gestational age of 34 + 0-36 + 6 weeks were included. Borderline oligohydramnios was defined as an amniotic fluid index (AFI) of 5.1-8 cm, which was measured using the four-quadrant technique. Adverse perinatal outcomes were compared between the borderline and normal AFI groups. RESULTS Approximately 107 of the 430 pregnant women were borderline AFI, and 323 were normal AFI. The demographic and obstetric characteristics were similar in both groups. Delivery <37 weeks, cesarean delivery for non-reassuring fetal heart-rate testing, meconium-stained amniotic fluid, Apgar 5 min <7, transient tachypnea of the newborn, respiratory distress syndrome, neonatal intensive care unit, and hyperbilirubinemia were not statistically different between the groups (p = .054, p = .134, p = .749, p = 0.858, p = .703, p = .320, p = .185, and p = .996, respectively). Although gestational age was full-term, induction of labor rates were significantly higher in the borderline AFI group (p = .040). In addition, fetal renal artery pulsatility index pulsatility index (PI) was significantly lower in the borderline AFI group than in the normal AFI group (p = .014). CONCLUSION Our results indicated that borderline AFI was not a risk for adverse perinatal outcomes in uncomplicated, late preterm pregnancies.
Collapse
Affiliation(s)
- Erdem Sahin
- a Department of Obstetrics and Gynecology , Health Sciences University Kayseri Education and Research Hospital , Kayseri , Turkey
| | - Yusuf Madendag
- a Department of Obstetrics and Gynecology , Health Sciences University Kayseri Education and Research Hospital , Kayseri , Turkey
| | - Ahter Tanay Tayyar
- b Department of Obstetrics and Gynecology , Health Sciences University Zeynep Kamil Maternity and Childrens Training and Research Hospital , İstanbul , Turkey
| | - Mefkure Eraslan Sahin
- a Department of Obstetrics and Gynecology , Health Sciences University Kayseri Education and Research Hospital , Kayseri , Turkey
| | - Ilknur Col Madendag
- a Department of Obstetrics and Gynecology , Health Sciences University Kayseri Education and Research Hospital , Kayseri , Turkey
| | - Gokhan Acmaz
- a Department of Obstetrics and Gynecology , Health Sciences University Kayseri Education and Research Hospital , Kayseri , Turkey
| | - Deniz Unsal
- c Department of Radiology , Health Sciences University Kayseri Education, Kayseri, Turkey and Research Hospital , Kayseri , Turkey
| | - Vesile Senol
- d Department of Public Health , Erciyes Üniversitesi Faculty of Medicine , Kayseri , Turkey
| |
Collapse
|
29
|
Hollowell J, Li Y, Bunch K, Brocklehurst P. A comparison of intrapartum interventions and adverse outcomes by parity in planned freestanding midwifery unit and alongside midwifery unit births: secondary analysis of 'low risk' births in the birthplace in England cohort. BMC Pregnancy Childbirth 2017; 17:95. [PMID: 28320352 PMCID: PMC5359981 DOI: 10.1186/s12884-017-1271-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/08/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND For low risk women, there is good evidence that planned birth in a midwifery unit is associated with a reduced risk of maternal interventions compared with planned birth in an obstetric unit. Findings from the Birthplace cohort study have been interpreted by some as suggesting a reduced risk of interventions in planned births in freestanding midwifery units (FMUs) compared with planned births in alongside midwifery units (AMUs). However, possible differences have not been robustly investigated using individual-level Birthplace data. METHODS This was a secondary analysis of data on 'low risk' women with singleton, term, 'booked' pregnancies collected in the Birthplace national prospective cohort study. We used logistic regression to compare interventions and outcomes by parity in 11,265 planned FMU births and 16,673 planned AMU births, adjusted for potential confounders, using planned AMU birth as the reference group. Outcomes considered included adverse perinatal outcomes (Birthplace primary outcome measure), instrumental delivery, intrapartum caesarean section, 'straightforward vaginal birth', third or fourth degree perineal trauma, blood transfusion and maternal admission for higher-level care. We used a significance level of 1% for all secondary outcomes. RESULTS There was no significant difference in adverse perinatal outcomes between planned AMU and FMU births. The odds of instrumental delivery were reduced in planned FMU births (nulliparous: aOR 0.63, 99% CI 0.46-0.86; multiparous: aOR 0.41, 99% CI 0.25-0.68) and the odds of having a 'straightforward vaginal birth' were increased in planned FMU births compared with planned AMU births (nulliparous: aOR 1.47, 99% CI 1.17-1.85; multiparous: 1.86, 99% CI 1.35-2.57). The odds of intrapartum caesarean section did not differ significantly between the two settings (nulliparous: p = 0.147; multiparous: p = 0.224). The overall pattern of findings suggested a trend towards lower intervention rates and fewer adverse maternal outcomes in planned FMU births compared with planned AMU births. CONCLUSIONS The findings support the recommendation that 'low risk' women can be informed that planned birth in an FMU is associated with a lower rate of instrumental delivery and a higher rate of 'straightforward vaginal birth' compared with planned birth in an AMU; and that outcomes for babies do not appear to differ between FMUs and AMUs.
Collapse
Affiliation(s)
- Jennifer Hollowell
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF UK
| | - Yangmei Li
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF UK
| | - Kathryn Bunch
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF UK
| | - Peter Brocklehurst
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF UK
- Institute for Women’s Health, University College London, London, UK
| |
Collapse
|
30
|
Ozler S, Oztas E, Erel O, Guler BG, Ergin M, Uygur D, Danisman N. Impact of Gestational Diabetes Mellitus and Maternal Obesity on Cord Blood Dynamic Thiol/Disulfide Homeostasis. Fetal Pediatr Pathol 2017; 36:8-15. [PMID: 27629439 DOI: 10.1080/15513815.2016.1223237] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM Our aim in this study was to investigate the effect of maternal obesity and gestational diabetes mellitus (GDM) on cord blood dynamic thiol/disulfide homeostasis. METHODS A prospective case-control study was carried out in 125 pregnant women (27 GDM, 30 obese, 68 controls). Cord blood samples were collected from all participants and native thiol-disulfide exchanges were examined with automated method enabling the measurement of both sides of thiol-disulfide balance. RESULTS Disulfide amounts, disulfide/native thiol and disulfide/total thiol ratios were increased (p < 0.001), while native thiol/total thiol was decreased in the cord blood of babies born to an obese or diabetic mother (p < 0.001). Moreover, increased disulfide amounts, disulfide/native thiol, disulfide/totalthiol ratios and decreased native/total thiol were found to be significantly associated with adverse outcomes in GDM. CONCLUSION The current study suggests that the offsprings born to obese or diabetic mothers are exposed to increased oxidative stress.
Collapse
Affiliation(s)
- Sibel Ozler
- a Zekai Tahir Burak Women's Health Education and Research Hospital , Department of Perinatology , Ankara , Turkey
| | - Efser Oztas
- a Zekai Tahir Burak Women's Health Education and Research Hospital , Department of Perinatology , Ankara , Turkey
| | - Ozcan Erel
- b Department of Clinical Biochemistry, Faculty of Medicine , Yildirim Beyazit University , Ankara , Turkey
| | - Basak Gumus Guler
- c Department of Obstetrics and Gynecology , Liv Hospital , Ankara , Turkey
| | - Merve Ergin
- d Aralık State Hospital , Gaziantep , Turkey
| | - Dilek Uygur
- a Zekai Tahir Burak Women's Health Education and Research Hospital , Department of Perinatology , Ankara , Turkey
| | - Nuri Danisman
- a Zekai Tahir Burak Women's Health Education and Research Hospital , Department of Perinatology , Ankara , Turkey
| |
Collapse
|
31
|
Sepidarkish M, Almasi-Hashiani A, Maroufizadeh S, Vesali S, Pirjani R, Samani RO. Association between previous spontaneous abortion and pre-eclampsia during a subsequent pregnancy. Int J Gynaecol Obstet 2016; 136:83-86. [PMID: 28099708 DOI: 10.1002/ijgo.12008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/24/2016] [Accepted: 09/30/2016] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To determine the impact of a history of spontaneous abortion on pre-eclampsia during a subsequent pregnancy. METHODS A cross-sectional study enrolled pregnant women admitted to obstetrics and gynecology wards at 103 hospitals in Tehran, Iran for delivery between July 6 and July 21, 2015. Consenting participants were interviewed by midwives; data were collected using a five-part questionnaire and patients' medical records were retrieved. Patient data were analyzed by multiple logistic regression to identify variables associated with increased odds of pre-eclampsia. RESULTS In total, 5170 patients were interviewed and 252 had experienced pre-eclampsia. The number of previous spontaneous abortions was found to be associated with pre-eclampsia, and a higher number of previous spontaneous abortions was associated with increased odds of patients having experienced pre-eclampsia (adjusted odds ratio 1.28, 95% confidence interval 1.03-1.59; P=0.025). CONCLUSION A history of spontaneous abortion was associated with increased odds of pre-eclampsia during a subsequent pregnancy.
Collapse
Affiliation(s)
- Mahdi Sepidarkish
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Amir Almasi-Hashiani
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Saman Maroufizadeh
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Samira Vesali
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Reihaneh Pirjani
- Division of Perinatology, Department of Obstetrics and Gynecology, Arash Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza O Samani
- Division of Perinatology, Department of Obstetrics and Gynecology, Arash Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
32
|
Ozgu-Erdinc AS, Iskender C, Uygur D, Oksuzoglu A, Seckin KD, Yeral MI, Kalaylioglu ZI, Yucel A, Danisman AN. One-hour versus two-hour postprandial blood glucose measurement in women with gestational diabetes mellitus: which is more predictive? Endocrine 2016; 52:561-70. [PMID: 26645814 DOI: 10.1007/s12020-015-0813-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 11/20/2015] [Indexed: 11/30/2022]
Abstract
The purpose of this study is to investigate postprandial 1-h (PP1) and 2-h (PP2) blood glucose measurements' correlation with adverse perinatal outcomes. This prospective cohort study consisted of 259 women with gestational diabetes mellitus. During each antenatal visit, HbA1c and fasting plasma glucose (FPG) as well as plasma glucose at PP1 and PP2 were analyzed. There were 144 patients on insulin therapy and 115 patients on diet therapy. A total of 531 blood glucose measurements were obtained at different gestational ages between 24 and 41 gestational weeks. PP2 plasma glucose measurements (but not PP1) were positively correlated with fetal macrosomia. But on adjusted analysis, neither PP1 nor PP2 measurements predicted perinatal complications. In addition to PP1 and PP2, neither FPG nor HbA1c were able to predict perinatal complications or fetal macrosomia when controlled for confounding factors except for a positive correlation between fetal macrosomia and HbA1c in patients on diet therapy. Postprandial 1-h and postprandial 2-h plasma glucose measurements were not superior to each other in predicting fetal macrosomia or perinatal complications. Based on our findings, it can be concluded that both methods may be suitable for follow-up as there are no clear advantages of one measurement over the other.
Collapse
Affiliation(s)
- A Seval Ozgu-Erdinc
- Department of Perinatology, Zekai Tahir Burak Women's Health Care, Training and Research Hospital, Talatpasa Bulvari, 06230, Ankara, Turkey.
| | - Cantekin Iskender
- Department of Perinatology, Zekai Tahir Burak Women's Health Care, Training and Research Hospital, Talatpasa Bulvari, 06230, Ankara, Turkey
| | - Dilek Uygur
- Department of Perinatology, Zekai Tahir Burak Women's Health Care, Training and Research Hospital, Talatpasa Bulvari, 06230, Ankara, Turkey
| | - Aysegul Oksuzoglu
- Department of Perinatology, Zekai Tahir Burak Women's Health Care, Training and Research Hospital, Talatpasa Bulvari, 06230, Ankara, Turkey
| | - K Doga Seckin
- Department of Perinatology, Zekai Tahir Burak Women's Health Care, Training and Research Hospital, Talatpasa Bulvari, 06230, Ankara, Turkey
| | - M Ilkin Yeral
- Department of Perinatology, Zekai Tahir Burak Women's Health Care, Training and Research Hospital, Talatpasa Bulvari, 06230, Ankara, Turkey
| | | | - Aykan Yucel
- Department of Perinatology, Zekai Tahir Burak Women's Health Care, Training and Research Hospital, Talatpasa Bulvari, 06230, Ankara, Turkey
| | - A Nuri Danisman
- Department of Perinatology, Zekai Tahir Burak Women's Health Care, Training and Research Hospital, Talatpasa Bulvari, 06230, Ankara, Turkey
| |
Collapse
|
33
|
Ozler S, Oztas E, Caglar AT, Uygur D, Ergin M, Erel O, Danisman N. Thiol/disulfide homeostasis in predicting adverse perinatal outcomes at 24-28 weeks of pregnancy in gestational diabetes. J Matern Fetal Neonatal Med 2016; 29:3699-704. [PMID: 26769102 DOI: 10.3109/14767058.2016.1141885] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The main aim of this study was to investigate thiol/disulfide homeostasis at 24-28 weeks of pregnancy and to evaluate whether it is predictive for adverse perinatal outcomes or not in gestational diabetes mellitus (GDM). METHODS A total of 110 pregnant women at 24-28 weeks of pregnancy (74 GDM patients and 36 age- and BMI-matched healthy pregnant women) were enrolled in this prospective case-control study. Thiol/disulfide homeostasis was evaluated with a novel spectrophotometric method to determine if there is an association with adverse perinatal outcomes in GDM, by using logistic regression analysis. RESULTS GDM patients, with decreased native thiol levels at 24-28 weeks (OR: 4.890, 95% CI: 1.355-5.764, p = 0.015) and with higher pre-pregnancy BMI (OR: 1.280, 95% CI: 1.072-1.528, p = 0.006), were found to be at increased risk of adverse perinatal outcomes in GDM. There were no statistically significant differences in thiol/disulfide homeostasis between diet- and insulin-treated GDM subgroups. Additionally, 1-h and 2-h glucose levels on 100 g OGTT were found to be predictive for the insulin need in achieving good glycemic control in GDM (OR: 1.022, 95% CI: 1.005-1.038, p = 0.010 and OR: 1.019, 95% CI: 1.004-1.035, p = 0.015). CONCLUSIONS GDM patients, with decreased native thiol levels at 24-28 weeks of pregnancy and with higher pre-pregnancy BMI, have an increased risk of possible adverse perinatal outcomes. Also, increased 1-h and 2-h glucose levels on 100 g OGTT can predict the need for insulin treatment for GDM.
Collapse
Affiliation(s)
- Sibel Ozler
- a Department of Perinatology , Zekai Tahir Burak Women's Health Training and Research Hospital , Ankara , Turkey and
| | - Efser Oztas
- a Department of Perinatology , Zekai Tahir Burak Women's Health Training and Research Hospital , Ankara , Turkey and
| | - Ali Turhan Caglar
- a Department of Perinatology , Zekai Tahir Burak Women's Health Training and Research Hospital , Ankara , Turkey and
| | - Dilek Uygur
- a Department of Perinatology , Zekai Tahir Burak Women's Health Training and Research Hospital , Ankara , Turkey and
| | - Merve Ergin
- b Department of Clinical Biochemistry , Faculty of Medicine, Yildirim Beyazit University , Ankara , Turkey
| | - Ozcan Erel
- b Department of Clinical Biochemistry , Faculty of Medicine, Yildirim Beyazit University , Ankara , Turkey
| | - Nuri Danisman
- a Department of Perinatology , Zekai Tahir Burak Women's Health Training and Research Hospital , Ankara , Turkey and
| |
Collapse
|
34
|
Oztas E, Ozler S, Ersoy E, Ersoy AO, Tokmak A, Ergin M, Uygur D, Danisman N. Prediction of gestational diabetes mellitus by first trimester serum secreted frizzle-related protein-5 levels. J Matern Fetal Neonatal Med 2015; 29:1515-9. [PMID: 26100762 DOI: 10.3109/14767058.2015.1052399] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The main aim of this study was to investigate the first trimester maternal serum secreted frizzle-related protein-5 (Sfrp-5) levels and to evaluate the predictive value on the subsequently developed gestational diabetes mellitus (GDM). METHODS A total of 40 pregnant women who subsequently developed GDM and 44 age- and pre-pregnancy BMI-matched healthy pregnant women were enrolled in this prospective case-control study. First trimester serum Sfrp-5 levels were evaluated to determine if there is an association with the onset of GDM, by using logistic regression analysis. RESULTS Decreased first trimester serum Sfrp-5 levels (OR = 14.332, 95%CI: 4.166-49.301, p < 0.001) were found to be significantly associated with the increased risk of GDM. There were no statistically significant differences in serum Sfrp-5 levels between the diet- and insulin-treated GDM groups and also serum Sfrp-5 levels were not found to be predictive for adverse perinatal outcomes (p > 0.05). CONCLUSIONS Decreased first trimester serum Sfrp-5 levels are significantly associated with the increased risk of GDM.
Collapse
Affiliation(s)
- Efser Oztas
- a Department of Obstetrics and Gynecology , Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey , and
| | - Sibel Ozler
- a Department of Obstetrics and Gynecology , Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey , and
| | - Ebru Ersoy
- a Department of Obstetrics and Gynecology , Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey , and
| | - Ali Ozgur Ersoy
- a Department of Obstetrics and Gynecology , Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey , and
| | - Aytekin Tokmak
- a Department of Obstetrics and Gynecology , Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey , and
| | - Merve Ergin
- b Department of Clinical Biochemistry , Yildirim Beyazit University Faculty of Medicine , Ankara , Turkey
| | - Dilek Uygur
- a Department of Obstetrics and Gynecology , Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey , and
| | - Nuri Danisman
- a Department of Obstetrics and Gynecology , Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey , and
| |
Collapse
|
35
|
LELONG A, JIROFF L, BLANQUET M, MOURGUES C, LEYMARIE MC, GERBAUD L, LÉMERY D, VENDITTELLI F. Is individual social deprivation associated with adverse perinatal outcomes? Results of a French multicentre cross-sectional survey. J Prev Med Hyg 2015; 56:E95-E101. [PMID: 26789995 PMCID: PMC4718350] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 05/27/2015] [Indexed: 11/04/2022]
Abstract
INTRODUCTION French national health programmes take into account social deprivation in their implementation, those targeting perinatal outcomes, especially. The main aim of the present work was to assess the association between individual social deprivation and adverse perinatal outcomes. METHODS A multicentre cross-sectional population-based survey was performed between October and December 2007. Eligible women delivered a baby in one of the three maternity hospitals of Clermont-Ferrand area, and read and spoke French fluently. Women who had undergone voluntary termination of pregnancy were excluded. Individual social deprivation was measured by the EPICES score. Standard prenatal follow-up defined by having less than 7 consultations and quality of prenatal care defined by having at least four consultations were measured. Adverse perinatal outcomes were measured by a composite criterion defined by women who had the occurrence of the three main causes of pregnancy-related disorders: preterm delivery, and/or diabetes, and/or obstetrical hypertension. RESULTS Of the 471 eligible women, 464 were finally included. One hundred and fifteen (24.78%) women were socially deprived. The most deprived women had poor standard prenatal follow-up (p = 0.003) and poor quality of prenatal care (0.03). Nationality was the sole confounding factor identified. Deprived women had a two-fold greater risk of adverse perinatal outcomes, adjusted odds ratio 1.95 [1.15; 3.29]. DISCUSSION Social deprivation was associated with adverse perinatal outcomes. Social deprivation should be systematically screened in pregnant women standard follow-up, among migrant women, especially.
Collapse
Affiliation(s)
- A. LELONG
- Service de Santé Publique, CHU de Clermont-Ferrand, Clermont-Ferrand Cedex 1, France;, Clermont Université, Université d'Auvergne, EA 4681, Peprade (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France;,Correspondence: Audrey Lelong, Service de Santé Publique, CHU de Clermont-Ferrand, 7, place Henri Dunant, 63058 Clermont- Ferrand Cedex 1, France - Tel. +33 473750604 - Fax +33 473750619 - E-mail:
| | - L. JIROFF
- Service de Gynécologie Obstétrique, CHU de Clermont-Ferrand
| | - M. BLANQUET
- Service de Santé Publique, CHU de Clermont-Ferrand, Clermont-Ferrand Cedex 1, France;, Clermont Université, Université d'Auvergne, EA 4681, Peprade (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France
| | - C. MOURGUES
- Service de Santé Publique, CHU de Clermont-Ferrand, Clermont-Ferrand Cedex 1, France;, Clermont Université, Université d'Auvergne, EA 4681, Peprade (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France
| | - M.-C. LEYMARIE
- Service de Santé Publique, CHU de Clermont-Ferrand, Clermont-Ferrand Cedex 1, France;, Clermont Université, Université d'Auvergne, EA 4681, Peprade (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France
| | - L. GERBAUD
- Service de Santé Publique, CHU de Clermont-Ferrand, Clermont-Ferrand Cedex 1, France;, Clermont Université, Université d'Auvergne, EA 4681, Peprade (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France
| | - D. LÉMERY
- Service de Gynécologie Obstétrique, CHU de Clermont-Ferrand;, Clermont Université, Université d'Auvergne, EA 4681, Peprade (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France;, Réseau de Santé Périnatale d'Auvergne, France
| | - F. VENDITTELLI
- Service de Santé Publique, CHU de Clermont-Ferrand, Clermont-Ferrand Cedex 1, France;, Service de Gynécologie Obstétrique, CHU de Clermont-Ferrand;, Clermont Université, Université d'Auvergne, EA 4681, Peprade (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France;, Réseau de Santé Périnatale d'Auvergne, France
| |
Collapse
|