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Mazzocco MI, Donati S, Maraschini A, Corsi E, Colciago E, Guelfi F, Cetin I. Spontaneous hemoperitoneum in pregnancy: Italian prospective population-based cohort study. Acta Obstet Gynecol Scand 2022; 101:1220-1226. [PMID: 36047477 PMCID: PMC9812087 DOI: 10.1111/aogs.14431] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/17/2022] [Accepted: 07/16/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Spontaneous hemoperitoneum in pregnancy is defined as a sudden non-traumatic intraperitoneal bleeding in pregnancy and up to 42 days postpartum. In the present study we aim to estimate the incidence and investigate the risk factors, the management and the outcomes of spontaneous hemoperitoneum in pregnancy in order to improve its clinical identification and reduce avoidable maternal deaths. MATERIAL AND METHODS This is a prospective population-based cohort study, set in maternity units from nine Italian regions covering 75% of the national births. The study population comprises all women admitted for spontaneous intraperitoneal hemorrhage during pregnancy and up to 42 days postpartum between November 2017 and March 2020. Incident cases were reported by trained clinicians through electronic data collection forms. Descriptive statistics were performed. The main outcome measures included incidence rate of spontaneous hemoperitoneum in pregnancy, association with potential risk factors, clinical management and maternal and perinatal outcomes. RESULTS Twenty-nine cases met the adopted definition of spontaneous hemoperitoneum in pregnancy with an estimated incidence rate of 0.04 per 1000 births. An increased risk ratio (RR) of this condition was observed in pregnancies conceived by assisted reproductive technology (RR = 6.60, 95% CI 2.52-17.29), in the case of multiple pregnancies (RR = 6.57, 95% CI 1.99-21.69) and maternal age ≥35 years (RR 2.10, 95% CI 1.01-4.35). In 17/29 cases the bleeding site was intra-pelvic (23.5% in the posterior uterine wall and 35.2% in the left hemipelvis). Laparotomy represented the surgical treatment in 27 cases (93%), and most women underwent a cesarean delivery (92.6%). Median blood loss was 1900 mL, one hysterectomy was necessary, and two women died. Twenty-two preterm births were recorded. CONCLUSIONS Spontaneous hemoperitoneum in pregnancy is a rare, life-threatening condition associated with high perinatal morbidity and mortality. Maternal age ≥35 years, multiple pregnancies and assisted reproductive technology were associated to a higher risk of the condition. Two women of 29 died and 70% of births occurred preterm.
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Affiliation(s)
- Martina Ilaria Mazzocco
- Obstetrics and Gynecology, Hospital Vittore BuzziDepartment of Biomedical and Clinical Sciences, University of MilanMilanItaly
| | - Serena Donati
- National Center for Disease Prevention and Health PromotionIstituto Superiore di Sanità ‐ Italian National Institute of HealthRomeItaly
| | - Alice Maraschini
- Technical‐scientific statistical serviceItalian National Institute of HealthRomeItaly
| | - Edoardo Corsi
- National Center for Disease Prevention and Health PromotionIstituto Superiore di Sanità ‐ Italian National Institute of HealthRomeItaly,Department of Biomedicine and PreventionUniversity of Rome Tor VergataRomeItaly
| | | | - Fabiola Guelfi
- Obstetrics and Gynecology, Hospital Vittore BuzziDepartment of Biomedical and Clinical Sciences, University of MilanMilanItaly
| | - Irene Cetin
- Obstetrics and Gynecology, Hospital Vittore BuzziDepartment of Biomedical and Clinical Sciences, University of MilanMilanItaly
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Pileri P, Sartani A, Mazzocco MI, Giani S, Rimoldi S, Pietropaolo G, Pertusati A, Vella A, Bazzi L, Cetin I. Management of Breast Abscess during Breastfeeding. Int J Environ Res Public Health 2022; 19:5762. [PMID: 35565158 PMCID: PMC9099791 DOI: 10.3390/ijerph19095762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/05/2022] [Accepted: 05/07/2022] [Indexed: 02/01/2023]
Abstract
(1) Background: Breast abscess (BA) is a condition leading in the majority of cases to breastfeeding interruption. Abscesses are commonly treated with antibiotics, needle aspiration or incision and drainage (I&D), but there is still no consensus on the optimal treatment. Since there are no well-defined clinical guidelines for abscess management, we conducted a retrospective, observational study with the aim of assessing ultrasound (US)-guided management of BA without surgery, regardless of the BA size. The secondary objective was the microbiologic characterization and, in particular, the S. aureus methicillin resistance identification. (2) Methods: our population included 64 breastfeeding mothers with diagnosis of BA. For every patient, data about maternal, perinatal and breastfeeding features were collected. All patients underwent office US scans and 40 out of 64 required a more detailed breast diagnostic ultrasound performed by a radiologist. In all cases, samples of milk or abscess material were microbiologically tested. All patients received oral antibiotic treatment. We performed needle aspiration, when feasible, even on abscesses greater than 5 cm. (3) Results: most of the women developed BA during the first 100 days (68.8% during the first 60 days) after delivery and 13 needed hospitalization. Four abscesses were bilateral and 16 had a US major diameter greater than 5 cm. All patients were treated with antibiotic therapy according to our clinical protocol and 71.9% (46/64) underwent fine needle aspiration. None of them required I&D. The average duration of breastfeeding was 5 months (IR 2; 9.5) and 40.6% of women with BA continued to breastfeed for more than 6 months. Only 21 mothers interrupted breastfeeding before 3 months. (4) Conclusions: our observational data suggest, regardless of the size and the clinical features of the BA, a conservative approach with antibiotic therapy targeted at the Methicillin-Resistant Staphilococcus aureus (MRSA) identified and needle aspiration, if feasible. In our experience, treatment with needle aspiration is a cost- effective method. Unlike drainage, it is an outpatient procedure, easily repeatable, with no cosmetic damage. In addition, it has lower risk of recurrences since, differently from surgical incision, it does not cause interruption of the ducts. Moreover, needle aspiration is less painful, does not require the separation of the mother-child dyad and allows for a quicker, if not immediate, return to breastfeeding.
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Affiliation(s)
- Paola Pileri
- Department of Woman, Child and Neonate, Buzzi Children Hospital, ASST Fatebenefratelli Sacco, Via L. Castelvetro 32, 20154 Milan, Italy; (M.I.M.); (I.C.)
- Departmental Breast Unit, ASST Fatebenefratelli Sacco, University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy;
| | - Alessandra Sartani
- Department of Biomedical and Clinical Sciences, University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy; (A.S.); (G.P.); (A.P.)
| | - Martina Ilaria Mazzocco
- Department of Woman, Child and Neonate, Buzzi Children Hospital, ASST Fatebenefratelli Sacco, Via L. Castelvetro 32, 20154 Milan, Italy; (M.I.M.); (I.C.)
| | - Sofia Giani
- Departmental Breast Unit, ASST Fatebenefratelli Sacco, University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy;
| | - Sara Rimoldi
- Laboratory of Clinical Microbiology, Virology and Diagnostics of Bioemergencies, ASST Fatebenefratelli Sacco, University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy;
| | - Gaia Pietropaolo
- Department of Biomedical and Clinical Sciences, University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy; (A.S.); (G.P.); (A.P.)
| | - Anna Pertusati
- Department of Biomedical and Clinical Sciences, University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy; (A.S.); (G.P.); (A.P.)
| | - Adriana Vella
- Department of Radiology, “Luigi Sacco” University Hospital, Via G.B. Grassi 74, 20157 Milan, Italy; (A.V.); (L.B.)
| | - Luca Bazzi
- Department of Radiology, “Luigi Sacco” University Hospital, Via G.B. Grassi 74, 20157 Milan, Italy; (A.V.); (L.B.)
| | - Irene Cetin
- Department of Woman, Child and Neonate, Buzzi Children Hospital, ASST Fatebenefratelli Sacco, Via L. Castelvetro 32, 20154 Milan, Italy; (M.I.M.); (I.C.)
- Departmental Breast Unit, ASST Fatebenefratelli Sacco, University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy;
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Pileri P, di Bartolo I, Mazzocco MI, Casazza G, Giani S, Cetin I, Savasi VM. Breastfeeding: Biological and Social Variables in Different Modes of Conception. Life (Basel) 2021; 11:life11020110. [PMID: 33535450 PMCID: PMC7912739 DOI: 10.3390/life11020110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Received: 01/09/2021] [Revised: 01/21/2021] [Accepted: 01/28/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Breastfeeding has effects on health throughout the lives of mothers and babies. In 2014 in Italy, 10,976 babies were born through ART (assisted reproductive technology), accounting for 2.2% of annual births. The study aims to assess how both social and biological variables and the mode of conception influence breastfeeding. Methods: This observational study involves 161 pregnancies from three different modes of conception: homologous in vitro fertilization, ovum donation, and spontaneous pregnancies. Neonatal and maternal characteristics were collected from the hospital database, while breastfeeding outcomes were obtained through telephone interviews. Results: The mode of conception did not influence any of the breastfeeding outcomes. Breastfeeding duration was negatively affected by smoking. Vaginal delivery, birth weight > 2500 g, delivery > 37 gestational weeks, breastfeeding intention, and rooming-in are positively associated with the initiation of breastfeeding, while skin-to-skin contact and receiving information concerning breastfeeding are the most significant variables associated with its exclusivity and duration. Conclusions: The duration and exclusivity of breastfeeding are mainly related with information thereon, promotion, and breastfeeding support, but not with the mode of conception. It is essential to adequately support women from the outset in breastfeeding, as recommended by the World Health Organization (WHO) guidelines.
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Affiliation(s)
- Paola Pileri
- Department of Woman, Child and Neonate, Buzzi Children Hospital, ASST Fatebenefratelli Sacco, via L. Castelvetro 32, 20154 Milan, Italy; (I.d.B.); (M.I.M.); (I.C.)
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, via G.B. Grassi 74, 20157 Milan, Italy; (G.C.); (S.G.); (V.M.S.)
- Correspondence: ; Tel.: +39-3496428084
| | - Ilenia di Bartolo
- Department of Woman, Child and Neonate, Buzzi Children Hospital, ASST Fatebenefratelli Sacco, via L. Castelvetro 32, 20154 Milan, Italy; (I.d.B.); (M.I.M.); (I.C.)
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, via G.B. Grassi 74, 20157 Milan, Italy; (G.C.); (S.G.); (V.M.S.)
| | - Martina Ilaria Mazzocco
- Department of Woman, Child and Neonate, Buzzi Children Hospital, ASST Fatebenefratelli Sacco, via L. Castelvetro 32, 20154 Milan, Italy; (I.d.B.); (M.I.M.); (I.C.)
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, via G.B. Grassi 74, 20157 Milan, Italy; (G.C.); (S.G.); (V.M.S.)
| | - Giovanni Casazza
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, via G.B. Grassi 74, 20157 Milan, Italy; (G.C.); (S.G.); (V.M.S.)
| | - Sofia Giani
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, via G.B. Grassi 74, 20157 Milan, Italy; (G.C.); (S.G.); (V.M.S.)
- Department of Woman, Child and Neonate, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, via G.B. Grassi 74, 20157 Milan, Italy
| | - Irene Cetin
- Department of Woman, Child and Neonate, Buzzi Children Hospital, ASST Fatebenefratelli Sacco, via L. Castelvetro 32, 20154 Milan, Italy; (I.d.B.); (M.I.M.); (I.C.)
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, via G.B. Grassi 74, 20157 Milan, Italy; (G.C.); (S.G.); (V.M.S.)
| | - Valeria Maria Savasi
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, via G.B. Grassi 74, 20157 Milan, Italy; (G.C.); (S.G.); (V.M.S.)
- Department of Woman, Child and Neonate, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, via G.B. Grassi 74, 20157 Milan, Italy
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Rimoldi SG, Pileri P, Mazzocco MI, Romeri F, Bestetti G, Calvagna N, Tonielli C, Fiori L, Gigantiello A, Pagani C, Magistrelli P, Sartani A, De Silvestri A, Gismondo MR, Cetin I. The Role of Staphylococcus aureus in Mastitis : A Multidisciplinary Working Group Experience. J Hum Lact 2020; 36:503-509. [PMID: 31593644 DOI: 10.1177/0890334419876272] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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] [Indexed: 01/12/2023]
Abstract
BACKGROUND Breastfeeding women are at risk of developing mastitis during the lactation period. Staphylococcus aureus has emerged as the community-acquired pathogen responsible for virulence (methicillin resistance and Panton-Valentine leukocidin toxin producing). RESEARCH AIM The aim was to compare the microorganisms responsible for mastitis and breast abscesses during breastfeeding. METHODS This observational study was conducted with a sample of women (N = 60) admitted to our hospital between 2016 and 2018. Participants affected by mastitis and breast abscess were studied and cared for by a multidisciplinary working group. A diagnostic breast ultrasound identified the pathology. RESULTS Twenty-six participants (43.3%) were affected by mastitis and 34 (56.7%) by breast abscess. The most common microorganism identified was Staphylococcus aureus (S. aureus; mastitis, n = 13; abscesses, n = 24). Methicillin resistance was identified in 21 (44.7%) S. aureus strains: 17 (80.9%) cases of abscess and four (19.1%) cases of mastitis. The median number of months of breastfeeding was smaller in the methicillin-resistant S. aureus (MRSA) cases (median = 3, range = 1-20 months) than in the methicillin-sensitive S. aureus (MSSA) cases (median = 6.5, range = 3-21 months). The Panton-Valentine leukocidin toxin gene was detected in 12 (25.5%) cases (MRSA, n = 8, 66.7%; MSSA, n = 4, 33.3%). Hospitalization was required more frequently in MRSA (n = 8, 38%; five Panton-Valentine leukocidin positive) than in MSSA cases (n = 5, 19%; one Panton-Valentine leukocidin positive). Four women out of the eight MRSA cases (50%) that were Panton-Valentine leukocidin positive stopped breastfeeding during mammary pathologies, three (37.5%) participants continued breastfeeding until the follow-up recall, and one case was lost at follow-up. CONCLUSION Clinical severity was probably complicated by the presence of the Panton-Valentine leukocidin toxin, which required hospitalization more frequently.
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Affiliation(s)
| | - Paola Pileri
- 472674 ASST Fatebenefratelli Sacco-Polo Universitario, Milan, Italy
| | | | - Francesca Romeri
- 472674 ASST Fatebenefratelli Sacco-Polo Universitario, Milan, Italy
| | | | | | - Claudia Tonielli
- 472674 ASST Fatebenefratelli Sacco-Polo Universitario, Milan, Italy
| | - Lorenza Fiori
- 472674 ASST Fatebenefratelli Sacco-Polo Universitario, Milan, Italy
| | - Anna Gigantiello
- 472674 ASST Fatebenefratelli Sacco-Polo Universitario, Milan, Italy
| | - Cristina Pagani
- 472674 ASST Fatebenefratelli Sacco-Polo Universitario, Milan, Italy
| | | | | | | | | | - Irene Cetin
- 472674 ASST Fatebenefratelli Sacco-Polo Universitario, Milan, Italy
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Anelli GM, Mandò C, Letizia T, Mazzocco MI, Novielli C, Lisso F, Personeni C, Vago T, Cetin I. Placental ESRRG-CYP19A1 Expressions and Circulating 17-Beta Estradiol in IUGR Pregnancies. Front Pediatr 2019; 7:154. [PMID: 31069202 PMCID: PMC6491753 DOI: 10.3389/fped.2019.00154] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 04/01/2019] [Indexed: 12/04/2022] Open
Abstract
Introduction: Sex steroids are regulating factors for intrauterine growth. 17-β Estradiol (E2) is particularly critical to a physiological pregnancy, as increased maternal E2 was correlated to lower fetal weight at delivery. The placenta itself is a primary source of estrogens, synthetized from cholesterol precursors. Cytochrome P450 aromatase (encoded by CYP19A1 gene) is a rate-limiting enzyme for E2 biosynthesis. CYP19A1 transcription is supported by Estrogen Related-Receptor Gamma (ERRγ- ESRRG gene), which thus has an indirect role in placental steroidogenesis. Here we investigated maternal E2 levels and placental CYP19A1 and ESRRG expressions in pregnancies with IntraUterine Growth Restriction (IUGR). Methods: Singleton pregnancies were studied. E2 was measured in maternal plasma by electrochemiluminescence in 16 term controls and 11 IUGR (classified by umbilical artery doppler pulsatility index) at elective cesarean section, and also in 13 controls during pregnancy at a gestational age comparable to IUGR. CYP19A1 and ESRRG expressions were analyzed in placental tissue. Maternal/fetal characteristics, placental and molecular data were compared among study groups and tested for correlations. Results: Maternal E2 plasma concentrations were significantly decreased in IUGR compared to controls at delivery. When analyzing normal pregnancies at a gestational age similar to IUGR, E2 levels were not different to pathological cases. However, E2 levels at delivery positively correlated with placental efficiency. Placental CYP19A1 levels were significantly higher in IUGR placental tissue vs. controls, and specifically increased in female IUGR placentas. ESRRG expression was not different among groups. Discussion: We report a positive correlation between 17-β Estradiol levels and placental efficiency, that might indicate a disrupted steroidogenesis in IUGR pregnancies. Moreover, we show alterations of CYP19A1 expression in IUGR placentas, possibly indicating a compensatory effect to the adverse IUGR intrauterine environment, also depending on fetal sex. Further studies are needed to deeper investigate IUGR alterations in the complex interaction among molecules involved in placental steroidogenesis.
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Affiliation(s)
- Gaia Maria Anelli
- Unit of Obstetrics and Gynecology, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco University Hospital, University of Milan, Milan, Italy
| | - Chiara Mandò
- Unit of Obstetrics and Gynecology, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco University Hospital, University of Milan, Milan, Italy
| | - Teresa Letizia
- Endocrinology Laboratory, Sacco University Hospital, Milan, Italy
| | - Martina Ilaria Mazzocco
- Unit of Obstetrics and Gynecology, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco University Hospital, University of Milan, Milan, Italy
| | - Chiara Novielli
- Unit of Obstetrics and Gynecology, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco University Hospital, University of Milan, Milan, Italy
| | - Fabrizia Lisso
- Unit of Obstetrics and Gynecology, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco University Hospital, University of Milan, Milan, Italy
| | - Carlo Personeni
- Unit of Obstetrics and Gynecology, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco University Hospital, University of Milan, Milan, Italy
| | - Tarcisio Vago
- Endocrinology Laboratory, Sacco University Hospital, Milan, Italy
| | - Irene Cetin
- Unit of Obstetrics and Gynecology, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco University Hospital, University of Milan, Milan, Italy.,Unit of Obstetrics and Gynecology, Buzzi University Hospital, Milan, Italy
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Anelli GM, Cardellicchio M, Novielli C, Antonazzo P, Mazzocco MI, Cetin I, Mandò C. Mitochondrial content and hepcidin are increased in obese pregnant mothers. J Matern Fetal Neonatal Med 2017. [PMID: 28625088 DOI: 10.1080/14767058.2017.1344209] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Maternal obesity is characterized by systemic low-grade inflammation and oxidative stress (OxS) with the contribution of fetal sex dimorphism. We recently described increased mitochondrial content (mtDNA) in placentas of obese pregnancies. Here, we quantify mtDNA and hepcidin as indexes of OxS and systemic inflammation in the obese maternal circulation. METHODS Forty-one pregnant women were enrolled at elective cesarean section: 16 were normal weight (NW) and 25 were obese (OB). Obese women were further classified according to the presence/absence of maternal gestational diabetes mellitus (GDM); [OB/GDM(-)]: n = 15, [OB/GDM(+)]: n = 10. mtDNA and hepcidin were evaluated in blood (real-time PCR) and plasma (ELISA). RESULTS mtDNA and hepcidin levels were significantly increased in OB/GDM(-) versus NW, significantly correlating with pregestational BMI. Male/female (M/F) ratio was equal in study groups, and overall F-carrying pregnancies showed significantly higher mtDNA and hepcidin levels than M-carrying pregnancies both in obese and normal weight mothers. CONCLUSIONS Our results indicate a potential compensatory mechanism to increased obesity-related OxS and inflammation, indicated by the higher hepcidin levels found in obese mothers. Increased placental mitochondrial biogenesis, due to lipotoxic environment, may account for the greater mtDNA amount released in maternal circulation. This increase is namely related to F-carrying pregnancies, suggesting a gender-specific placental response.
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Affiliation(s)
- G M Anelli
- a Department of Biomedical and Clinical Sciences, Unit of Obstetrics and Gynecology , "Luigi Sacco Hospital", Università degli Studi di Milano , Milano , Italy
| | - M Cardellicchio
- a Department of Biomedical and Clinical Sciences, Unit of Obstetrics and Gynecology , "Luigi Sacco Hospital", Università degli Studi di Milano , Milano , Italy
| | - C Novielli
- a Department of Biomedical and Clinical Sciences, Unit of Obstetrics and Gynecology , "Luigi Sacco Hospital", Università degli Studi di Milano , Milano , Italy
| | - P Antonazzo
- a Department of Biomedical and Clinical Sciences, Unit of Obstetrics and Gynecology , "Luigi Sacco Hospital", Università degli Studi di Milano , Milano , Italy
| | - M I Mazzocco
- a Department of Biomedical and Clinical Sciences, Unit of Obstetrics and Gynecology , "Luigi Sacco Hospital", Università degli Studi di Milano , Milano , Italy
| | - I Cetin
- a Department of Biomedical and Clinical Sciences, Unit of Obstetrics and Gynecology , "Luigi Sacco Hospital", Università degli Studi di Milano , Milano , Italy
| | - C Mandò
- a Department of Biomedical and Clinical Sciences, Unit of Obstetrics and Gynecology , "Luigi Sacco Hospital", Università degli Studi di Milano , Milano , Italy
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Mandò C, Calabrese S, Mazzocco MI, Novielli C, Anelli GM, Antonazzo P, Cetin I. Sex specific adaptations in placental biometry of overweight and obese women. Placenta 2015; 38:1-7. [PMID: 26907375 DOI: 10.1016/j.placenta.2015.12.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [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: 10/27/2015] [Revised: 11/30/2015] [Accepted: 12/14/2015] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Placental biometry at birth has been shown to predict chronic disease in later life. We hypothesized that maternal overweight/obesity, a state of low-grade inflammation and risk factor for adverse pregnancy outcome, could negatively influence placental development and that differences would be sex-specific. METHODS 696 women (537 normal-weight, NW; 112 overweight, OW; 47 obese, OB) with singleton uncomplicated pregnancies were prospectively enrolled at term delivery. Gestational age, maternal (age, height, pre-pregnancy BMI, gestational weight gain -GWG, hemoglobin, hematocrit and glycemia), fetal (weight, length, ponderal index, cranial circumference) and placental (weight, diameters) data were collected. Placental area, thickness and efficiency (fetal/placental weight ratio, F/P) were calculated. RESULTS GWG was within standard recommendations in OB, while OW exceeded it. Placental weight was significantly higher in OW versus NW, but not in OB, leading to significantly higher placental thickness and lower F/P in this group. In the total population, a significant interaction effect between maternal BMI and fetal sex on placental weight and efficiency was found. Indeed, differences in placental parameters were present only in female offspring. DISCUSSION In our population of OW and OB uncomplicated pregnancies only OW women, presenting GWG over standard recommendations, had thicker and less efficient placentas. We also reported different placental adaptation depending on fetal sex, with significant changes only in female fetuses. This may be part of a female-specific strategy aiming to ensure survival if another adverse event occurs. Customized counseling according to maternal BMI and fetal sex should be evaluated in clinical care.
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Affiliation(s)
- Chiara Mandò
- Department of Mother and Child, Hospital L. Sacco, Department of Biomedical and Clinical Sciences L. Sacco, and Center for Fetal Research Giorgio Pardi, Università degli studi di Milano, Italy.
| | - Stefania Calabrese
- Department of Mother and Child, Hospital L. Sacco, Department of Biomedical and Clinical Sciences L. Sacco, and Center for Fetal Research Giorgio Pardi, Università degli studi di Milano, Italy
| | - Martina Ilaria Mazzocco
- Department of Mother and Child, Hospital L. Sacco, Department of Biomedical and Clinical Sciences L. Sacco, and Center for Fetal Research Giorgio Pardi, Università degli studi di Milano, Italy
| | - Chiara Novielli
- Department of Mother and Child, Hospital L. Sacco, Department of Biomedical and Clinical Sciences L. Sacco, and Center for Fetal Research Giorgio Pardi, Università degli studi di Milano, Italy
| | - Gaia Maria Anelli
- Department of Mother and Child, Hospital L. Sacco, Department of Biomedical and Clinical Sciences L. Sacco, and Center for Fetal Research Giorgio Pardi, Università degli studi di Milano, Italy
| | - Patrizio Antonazzo
- Department of Mother and Child, Hospital L. Sacco, Department of Biomedical and Clinical Sciences L. Sacco, and Center for Fetal Research Giorgio Pardi, Università degli studi di Milano, Italy
| | - Irene Cetin
- Department of Mother and Child, Hospital L. Sacco, Department of Biomedical and Clinical Sciences L. Sacco, and Center for Fetal Research Giorgio Pardi, Università degli studi di Milano, Italy
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