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Sardar F, Kamsani YS, Ramly F, Mohamed Noor Khan NA, Sardar R, Aminuddin AA. Cadmium Associated Preeclampsia: A Systematic Literature Review of Pregnancy and Birth Outcomes. Biol Trace Elem Res 2024:10.1007/s12011-024-04364-5. [PMID: 39256331 DOI: 10.1007/s12011-024-04364-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 08/30/2024] [Indexed: 09/12/2024]
Abstract
Preeclampsia (PE), caused by multiple factors, is one of the most serious complications of pregnancy. Cadmium (Cd) is a heavy metal environmental pollutant, reproductive toxicant, and endocrine disruptor, which can increase the risk of PE. Cd toxicity due to occupational, diet, and environmental factors has worsened the risk. Studies showed elevated Cd concentration in maternal blood and placenta of PE women. However, the implicit association between Cd associated PE is still not highlighted. We systematically reviewed Cd-associated PE and its effect on pregnancy and birth outcomes. Based on "Preferred reporting items for systematic reviews and meta-analyses (PRISMA)" guidelines, eighty-six studies were identified by PubMed, Web of Science (WOS), and Scopus databases. Publications were included until October 2023 and articles screened based on our inclusion criteria. Our study identified that the exposure of controlled and uncontrolled Cd induces PE, which negatively affects pregnancy and birth outcomes. Given the serious nature of this finding, Cd is a potential adverse agent that impacts pregnancy and future neonatal health. Further comprehensive studies covering the whole trimesters of pregnancy and neonatal developments are warranted. Data on the molecular mechanisms behind Cd-induced PE is also essential for potential preventive, diagnostic, or therapeutic targets.
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Affiliation(s)
- Fatima Sardar
- Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - Yuhaniza Shafinie Kamsani
- Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia.
- Maternofetal and Embryo (MatE) Research Group, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia.
| | - Fathi Ramly
- Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - Nor Ashikin Mohamed Noor Khan
- Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
- Maternofetal and Embryo (MatE) Research Group, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - Razia Sardar
- Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - Anisa Aishah Aminuddin
- Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
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Kabir Y, Shaykhon N, Atkin S. Biomarkers of Pre-eclampsia in Pregnant Women With Gestational Diabetes and Pre-existing Type 2 Diabetes: A Systematic Review. Cureus 2024; 16:e53207. [PMID: 38425589 PMCID: PMC10902745 DOI: 10.7759/cureus.53207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 03/02/2024] Open
Abstract
Pre-eclampsia (PE) is one of the leading causes of maternal and perinatal health morbidity, producing more than 4.6% of complications in pregnancy worldwide. This systematic review was conducted to determine the significance of specific biomarkers in predicting PE in gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (DM). The review measured and explained the significant abnormalities in lipids, blood glucose, cytokines, inflammatory markers, placental proteins, urinary proteins, and other serum biomarkers that contribute to the development of PE in GDM and type 2 DM populations. We searched CINAHL, EMBASE, Medline, Maternity and Infant care, Scopus, and Web of Science. Studies were included if they had a measurable component in the blood serum or urine of women who developed PE and suffered from GDM or pre-existing type 2 DM. A narrative synthesis was conducted instead of a meta-analysis due to the high heterogeneity of data from the studies. A total of 2,593 studies were screened, producing eight relevant studies. Twenty-seven different biomarkers were investigated from the study group of 40 to 1,344 participants. No single biomarker was identified; however, there is a need for further research on specific biomarkers of PE, especially in CRP, FABP4, and microalbuminuria in the GDM-PE group and calprotectin in the type 2 DM population. Many biomarkers were identified as practical in predicting PE when combined with other biomarkers and more data are required to verify the predictability of the diagnostic markers in pregnant women.
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Affiliation(s)
- Yasmin Kabir
- Medicine and Surgery, Royal College of Surgeons in Ireland, Manama, BHR
| | - Norhan Shaykhon
- Medicine and Surgery, Royal College of Surgeons in Ireland, Manama, BHR
| | - Stephen Atkin
- Medicine and Surgery, Royal College of Surgeons in Ireland, Manama, BHR
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Li J, Yan J, Jiang W. The role of maternal age on adverse pregnancy outcomes among primiparous women with singleton birth: a retrospective cohort study in urban areas of China. J Matern Fetal Neonatal Med 2023; 36:2250894. [PMID: 37635092 DOI: 10.1080/14767058.2023.2250894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 08/07/2023] [Accepted: 08/17/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Both young and advanced maternal age pregnancies have strong associations with adverse pregnancy outcomes; however, there is limited understanding of how these associations present in an urban environment in China. This study aimed to analyze the associations between maternal age and pregnancy outcomes among Chinese urban women. METHODS We performed a population-based study consisting of 60,209 singleton pregnancies of primiparous women whose newborns were delivered after 20 weeks' gestation between January 2012 and December 2015 in urban areas of China. Participants were divided into six groups (19 or younger, 20-24, 25-29, 30-34, 35-39, 40 or older). Pregnancy outcomes include gestational diabetes mellitus (GDM), preeclampsia, placental abruption, placenta previa, premature rupture of membrane (PROM), postpartum hemorrhage, preterm birth, low birthweight, small for gestational age (SGA), large for gestational age (LGA), fetal distress, congenital microtia, and fetal death. Logistic regression models were used to assess the role of maternal age on the risk of adverse pregnancy outcomes with women aged 25-29 years as the reference group. RESULTS The risks of GDM, preeclampsia, placenta previa, and postpartum hemorrhage were decreased for women at a young maternal age and increased for women with advanced maternal age. Both young and advanced maternal age increased the risk of preterm birth and low birthweight. Young maternal age was also associated with increased risk of SGA (aOR 1.64, 95% CI 1.46-1.83) and fetal death (aOR 2.08, 95% CI 1.35-3.20). Maternal age over 40 years elevated the odds of placental abruption (aOR 3.44, 95% CI 1.47-8.03), LGA (aOR 1.47, 95% CI 1.09-1.98), fetal death (aOR 2.67, 95% CI 1.16-6.14), and congenital microtia (aOR 13.92, 95% CI 3.91-49.57). There were positive linear associations between maternal age and GDM, preeclampsia, placental abruption, placenta previa, PROM, postpartum hemorrhage, preterm birth, LGA and fetal distress (all P for linear trend < .05), and a negative linear association between maternal age and SGA (P for linear trend < .001). The analysis of the associations between maternal age and adverse fetal outcomes showed U-shape for preterm birth, low birth weight, SGA, fetal death and congenital microtia (all P for quadratic trend < .001). CONCLUSIONS Advanced maternal age predisposes women to adverse obstetric outcomes. Young maternal age manifests a bidirectional effect on adverse pregnancy outcomes. The findings may contribute to improving women's antenatal care and management.
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Affiliation(s)
- Jiangheng Li
- Department of Maternity-Child Health and Family Planning Services, Nanning Maternal and Child Health Hospital, Nanning, Guangxi Province, P.R. China
| | - Jingli Yan
- Department of Maternity-Child Health and Family Planning Services, Nanning Maternal and Child Health Hospital, Nanning, Guangxi Province, P.R. China
| | - Wu Jiang
- Department of Maternity-Child Health and Family Planning Services, Nanning Maternal and Child Health Hospital, Nanning, Guangxi Province, P.R. China
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Ludidi A, Siboto A, Nkosi A, Xulu ND, Khathi A, Sibiya NH, Ngubane PS. High-fat, high-carbohydrate diet-induced prediabetes preconception in Sprague-Dawley rats as a risk factor for the development of preeclampsia: assessing changes in placental metabolic insults. Front Nutr 2023; 10:1241785. [PMID: 37937252 PMCID: PMC10626547 DOI: 10.3389/fnut.2023.1241785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 09/26/2023] [Indexed: 11/09/2023] Open
Abstract
Introduction Hyperglycemia preconception deranges the establishment of a functional placenta; however, the risk of developing preeclampsia (PE) in prediabetic patients remains obscure. The aim was to assess abnormal placental changes as a risk factor for the development of PE in high-fat, high-carbohydrate (HFHC) diet-induced prediabetic (PD) rats. Methods HFHC diet-induced female prediabetic Sprague-Dawley rats were mated, and blood glucose concentrations, mean arterial pressure (MAP), and body weights were monitored on gestational days (GNDs) 0, 9, and 18. On GND 18, animals were euthanized. Blood and placentas were collected for biochemical analysis. Results Prediabetic rats showed significantly increased blood glucose concentration, proinflammatory cytokines, MAP, placental weight, and fetoplacental ratio compared with non-prediabetic (NPD) rats. Prediabetic rats showed significantly decreased placental vascular endothelial growth factor receptor 1 (VEGFR1) and placental growth factor (PLGF) and plasma nitric oxide (NO) compared with NPD. Discussion Prediabetes may have promoted endothelial dysfunction in the placenta and hypoxia, thus reducing PLGF and VEGFR1, which may have promoted proinflammation, endothelial dysfunction associated with NO decline, and hypertension, which is also observed in preeclamptic patients. Prediabetes may have promoted lipogenesis in placentas and fetuses that may have induced macrosomia and IUGR, also observed in preeclamptic patients. The findings from this study highlight the need for screening and monitoring of prediabetes during pregnancy to reduce the risk of developing preeclampsia.
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Affiliation(s)
- Asiphaphola Ludidi
- School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Anelisiwe Siboto
- School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Ayanda Nkosi
- School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Nombuso Duduzile Xulu
- School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Andile Khathi
- School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | | | - Phikelelani Siphosethu Ngubane
- School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Das S, Maharjan R, Bajracharya R, Shrestha R, Karki S, Das R, Odland JØ, Odland ML. Pregnancy outcomes in women with gestational hypertension and preeclampsia at Paropakar Maternity and Women's Hospital, Nepal: A retrospective study. PLoS One 2023; 18:e0286287. [PMID: 37267349 DOI: 10.1371/journal.pone.0286287] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/13/2023] [Indexed: 06/04/2023] Open
Abstract
INTRODUCTION Gestational hypertension and preeclampsia are the most common types of hypertensive disorder in pregnancy and these conditions are associated with adverse maternal and fetal outcomes. This study aims to determine the differences in pregnancy outcomes in women with gestational hypertension and preeclampsia. METHODS A retrospective study was done at The Paropakar Maternity and Women's Hospital, a tertiary level hospital, in the Kathmandu, Nepal. Pregnant women who had given birth at the hospital between September 17 and December 18 of 2017 were included. Data were obtained from the non-digitalized hospital records. The adjusted odds ratio (AOR) and 95% confidence interval were computed using logistic regression analysis. Multivariable analysis of pregnancy outcomes (cesarean sections, low birth weight, and preterm birth) was adjusted for maternal age, parity, twin birth, gestational age, calcium supplementation, and maternal co-morbidity. RESULTS Preeclampsia was strongly associated with cesarean section compared to normal pregnancies (OR = 8.11, p<0.001). Whereas the odds of cesarean section among women with gestational hypertension was almost 2 times (OR = 1.89, p<0.001). Preterm birth was not significantly associated with gestational hypertension but was associated with preeclampsia (OR = 3.39, p<0.001). Gestational hypertension and preeclampsia were not associated with low birth weight. CONCLUSION In Nepal, women who develop preeclampsia seem at higher risk of having adverse pregnancy outcomes than women with gestational hypertension. These findings should be considered by national health authorities and other health organizations when setting new priorities to improve pregnancy outcomes.
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Affiliation(s)
- Seema Das
- Research and Development Division, Department of Public Health and Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal
| | - Renusha Maharjan
- Department of Sociology and Gerontology, Miami University, Oxford, Ohio, United States of America
| | - Rashmita Bajracharya
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland, United States of America
| | - Rabina Shrestha
- Research and Development Division, Department of Public Health and Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal
| | - Sulata Karki
- Research and Development Division, Department of Public Health and Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal
| | - Rupesh Das
- Department of Medicine, Janaki Medical College Teaching Hospital, Janakpur, Nepal
| | - Jon Øyvind Odland
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Maria Lisa Odland
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynecology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Malawi-Liverpool-Wellcome Trust Research Institute, Blantyre, Malawi
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
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Dooley N, Healy C, Brannigan R, Cotter D, Clarke M, Cannon M. Explaining the Association Between Fetal Growth and Childhood ADHD Symptoms: Cross-cohort Replication. Res Child Adolesc Psychopathol 2023; 51:247-259. [PMID: 36114937 PMCID: PMC9867674 DOI: 10.1007/s10802-022-00971-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2022] [Indexed: 01/26/2023]
Abstract
The association between restricted fetal growth and symptoms of attention deficit/hyperactivity disorder (ADHD) in childhood is well-replicated and robust. However, fetal growth is determined by many prenatal factors and associations with mental health may be confounded by familial and social context. In this study, we sought to quantify the relative contributions of prenatal factors and familial confounds to the association between fetal growth and ADHD symptoms. Two independent cohorts were analyzed, the Adolescent Brain Cognitive Development study (ABCD; United States) and the Growing Up in Ireland (GUI) study. ADHD symptoms were measured by the Child Behavior Checklist (ABCD) and the Strengths & Difficulties questionnaire (GUI) at age 9-10. Using sequential regression models, we assessed the change-in-association between fetal growth and ADHD symptoms after controlling for sex, familial factors (socioeconomic/demographic factors & family psychiatric history) and prenatal factors (pregnancy complications & maternal substance-use during pregnancy). Converging findings from cohorts suggested that over a quarter of the association between fetal growth and ADHD symptoms is attributable to familial confounds. The degree to which the association was explained by prenatal factors differed by cohort-pregnancy complications explained a larger proportion of the effect in ABCD (7.9%) than GUI (2.7%), and maternal substance-use explained a larger proportion of the effect in GUI (22.7%) compared to ABCD (4.8%). Different explanations of the fetal growth-ADHD association across cohorts suggests cohort-specific, and potentially nationally-specific, risk factors for fetal growth and related neurodevelopmental outcomes. The evidence suggests early prevention of ADHD in Ireland should focus on minimizing maternal smoking during pregnancy. In the US, prevention and treatment of pregnancy complications are highlighted as viable targets for intervention.
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Affiliation(s)
- Niamh Dooley
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Colm Healy
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ross Brannigan
- Data Science Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David Cotter
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Psychiatry, Beaumont Hospital, Dublin, Ireland
| | - Mary Clarke
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Psychiatry, Beaumont Hospital, Dublin, Ireland
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Al-Wassia HK, Baarimah SK, Mohammedsaleh AH, Alsulami MO, Abbas RS, Rezqallah RA, Alawadi RA, Aljohani SM. Prevalence, Risk Factors, and Short-Term Outcomes of Full-Term Low Birth Weight Infants Born at a Tertiary Academic Center: A Prospective Case-Control Study. Am J Perinatol 2022; 39:1362-1366. [PMID: 33406535 DOI: 10.1055/s-0040-1722599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Low birth weight (LBW) infants (<2,500 g) continued to be a global health problem because of the associated short- and long-term adverse outcomes. The study aimed to determine the prevalence, risk factors, and short-term outcomes of term LBW infants STUDY DESIGN: A prospective and case-control study. All infants born consecutively from September 1, 2018 to August 31, 2019 were included. Cases, term LBW infants, were 1:1 matched to controls, appropriate for gestational age (AGA) term infants. Major congenital or chromosomal anomalies and multiple pregnancies were excluded. RESULTS The prevalence of term LBW in the studied period was 4.8%. Mothers of term LBW infants had significantly lower body mass index (p = 0.05), gained less weight (p = 0.01), had a history of previous LBW (p = 0.01), and lower monthly income (p = 0.04) compared with mothers of term AGA infants even after adjustment for confounders. A nonsignificant higher number of term LBW infants needed NICU admission, while their need for phototherapy was deemed significant. CONCLUSION We identified nutritional and socioeconomic maternal factors that are significantly associated with LBW infants and should be targeted during antenatal visits to improve neonatal outcomes. KEY POINTS · LBW infants (<2,500 g) are at risk of short- and long-term morbidities.. · Poor maternal nutritional and socioeconomic factors increase the risk of LBW infant.. · Targeting identified risk factors of LBW infant antenatally improve neonatal outcomes.
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Affiliation(s)
- Heidi K Al-Wassia
- Department of Pediatrics, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Shahd K Baarimah
- School of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Manal O Alsulami
- School of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ragad S Abbas
- School of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Raghda A Alawadi
- School of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Saja M Aljohani
- School of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Tousty P, Fraszczyk-Tousty M, Ksel-Hryciów J, Łoniewska B, Tousty J, Dzidek S, Michalczyk K, Kwiatkowska E, Cymbaluk-Płoska A, Torbé A, Kwiatkowski S. Adverse Neonatal Outcome of Pregnancies Complicated by Preeclampsia. Biomedicines 2022; 10:biomedicines10082048. [PMID: 36009597 PMCID: PMC9405653 DOI: 10.3390/biomedicines10082048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/10/2022] [Accepted: 08/18/2022] [Indexed: 11/28/2022] Open
Abstract
Despite many available treatments, infants born to preeclamptic mothers continue to pose a serious clinical problem. The present study focuses on the evaluation of infants born to preeclamptic mothers for the occurrence of early-onset complications and attempts to link the clinical status of such infants to the angiogenesis markers in maternal blood (sFlt-1, PlGF). The study included 77 newborns and their mothers diagnosed with preeclampsia. The infants were assessed for their perinatal outcomes, with an emphasis on adverse neonatal outcomes such us infections, RDS, PDA, NEC, IVH, ROP, or BPD during the hospitalization period. The cutoff point was established using the ROC curve for the occurrence of any adverse neonatal outcome and it was 204 for the sFlt-1/PlGF and 32 birth week with AOC 0.644 and 0.91, respectively. The newborns born to mothers with high ratios had longer hospitalization times and, generally, were more frequently diagnosed with any of the aforementioned adverse neonatal outcomes. Also, the neonates born prior to or at 32 wkGA with higher sFlt-1/PlGF ratios were statistically significantly more common to be diagnosed with any of the adverse neonatal outcomes compared to those with lower ratio born prior to or at 32 wkGA. The sFlt-1/PlGF ratio can be a useful tool in predicting short-term adverse neonatal outcomes. Infants born after a full 33 weeks gestation developed almost no severe neonatal complications. Appropriate screening and preventive healthcare for preeclampsia can contribute significantly to reducing the incidence of neonatal complications.
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Affiliation(s)
- Piotr Tousty
- Department of Gynecology and Obstetrics, Pomeranian Medical University, 70-111 Szczecin, Poland
- Correspondence: ; Tel.: +48-735-923-533
| | - Magda Fraszczyk-Tousty
- Department of Neonatology and Neonatal Intensive Care, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Joanna Ksel-Hryciów
- Department of Gynecology and Obstetrics, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Beata Łoniewska
- Department of Neonatology and Neonatal Intensive Care, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Joanna Tousty
- Department of Neonatology and Neonatal Intensive Care, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Sylwia Dzidek
- Department of Gynecology and Obstetrics, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Kaja Michalczyk
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Ewa Kwiatkowska
- Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Aneta Cymbaluk-Płoska
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Andrzej Torbé
- Department of Gynecology and Obstetrics, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Sebastian Kwiatkowski
- Department of Gynecology and Obstetrics, Pomeranian Medical University, 70-111 Szczecin, Poland
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9
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Nielsen ST, Strandkjær N, Juul Rasmussen I, Hansen MK, Lytsen RM, Kamstrup PR, Rode L, Goetze JP, Iversen K, Bundgaard H, Frikke-Schmidt R. Coagulation parameters in the newborn and infant - the Copenhagen Baby Heart and COMPARE studies. Clin Chem Lab Med 2021; 60:261-270. [PMID: 34752018 DOI: 10.1515/cclm-2021-0967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/25/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The coagulation system is not fully developed at birth and matures during the first months of infancy, complicating clinical decision making within hemostasis. This study evaluates coagulation parameters at birth and two months after birth, and tests whether cord blood can be used as a proxy for neonatal venous blood measurements. METHODS The Copenhagen Baby Heart Study (CBHS) and the COMPARE study comprise 13,237 cord blood samples and 444 parallel neonatal venous blood samples, with a two month follow-up in 362 children. RESULTS Because coagulation parameters differed according to gestational age (GA), all analyses were stratified by GA. For neonatal venous blood, reference intervals for activated partial thromboplastin time (APTT) and prothrombin time (PT) were 28-43 s and 33-61% for GA 37-39 and 24-38 s and 30-65% for GA 40-42. Reference intervals for international normalized ratio (INR) and thrombocyte count were 1.1-1.7 and 194-409 × 109/L for GA 37-39 and 1.2-1.8 and 188-433 × 109/L for GA 40-42. Correlation coefficients between umbilical cord and neonatal venous blood for APTT, PT, INR, and thrombocyte count were 0.68, 0.72, 0.69, and 0.77 respectively, and the distributions of the parameters did not differ between the two types of blood (all p-values>0.05). CONCLUSIONS This study describes new GA dependent reference intervals for common coagulation parameters in newborns and suggests that cord blood may serve as a proxy for neonatal venous blood for these traits. Such data will likely improve clinical decision making within hemostasis among newborn and infant children.
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Affiliation(s)
- Sofie Taageby Nielsen
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark.,Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.,Department of Cardiology, Herlev-Gentofte Hospital, Herlev, Denmark
| | - Nina Strandkjær
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark.,Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.,Department of Cardiology, Herlev-Gentofte Hospital, Herlev, Denmark
| | - Ida Juul Rasmussen
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - Malene Kongsgaard Hansen
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark.,Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.,Department of Cardiology, Herlev-Gentofte Hospital, Herlev, Denmark
| | - Rikke Mohr Lytsen
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark.,Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.,Department of Cardiology, Herlev-Gentofte Hospital, Herlev, Denmark
| | - Pia R Kamstrup
- Department of Clinical Biochemistry, Herlev-Gentofte Hospital, Herlev, Denmark
| | - Line Rode
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - Jens P Goetze
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Iversen
- Department of Cardiology, Herlev-Gentofte Hospital, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ruth Frikke-Schmidt
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Alasztics B, Kovács ÁF, Molvarec A, Koller Á, Szabó G, Fekete N, Buzás EI, Pállinger É, Rigó J. Platelet-derived extracellular vesicles may contribute to the hypercoagulable state in preeclampsia. J Reprod Immunol 2021; 148:103380. [PMID: 34534879 DOI: 10.1016/j.jri.2021.103380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/03/2021] [Accepted: 09/08/2021] [Indexed: 12/14/2022]
Abstract
It has previously been shown that preeclampsia is associated with disturbed hemostasis and that extracellular vesicles (EVs) play important role in the regulation of hemostatic homeostasis. Thus, we hypothesized that the altered procoagulant characteristics of circulating platelet-derived EVs may contribute to the disturbed hemostasis in preeclampsia. Using multicolor flow cytometry, we have analyzed both tissue factor expressing procoagulant EVs and platelet-derived EV subpopulations derived from resting and activated thrombocytes by examining them in plasma samples of preeclamptic patients and pregnancy-matched healthy individuals. Compared to pregnancy-matched healthy individuals in preeclamptic patients a significantly (p < 0.05) higher ratio of Annexin-V positive activated platelets and a higher number of CD142+ tissue factor bearing procoagulant EVs were found, whereas the absolute amount of circulating CD41a+ platelet-derived EVs and CD62P+/CD41a+ EVs produced by activated thrombocytes was significantly lower in the plasma of preeclamptic women. In the plasma samples, there was no significant difference in the amount of CD63+ platelet-derived EVs. We propose that increased platelet activation and tissue factor expression of platelet derived extracellular vesicles may contribute to the hypercoagulable state observed in preeclampsia.
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Affiliation(s)
- Bálint Alasztics
- Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
| | - Árpád Ferenc Kovács
- Department of Genetics, Cell- and Immunobiology, Faculty of Medicine, Semmelweis University, Budapest, Hungary; 2(nd) Department of Pediatrics, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Attila Molvarec
- Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Ákos Koller
- Department of Translational Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary; Department of Morphology and Physiology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary; Department of Physiology, New York Medical College, Valhalla, NY, 10595, USA
| | - Gábor Szabó
- Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Nóra Fekete
- Department of Genetics, Cell- and Immunobiology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Edit Irén Buzás
- Department of Genetics, Cell- and Immunobiology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Éva Pállinger
- Department of Genetics, Cell- and Immunobiology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - János Rigó
- Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary; Department of Clinical Studies in Obstetrics and Gynecology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
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11
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Miele MJ, Souza RT, Calderon IM, Feitosa FE, Leite DF, Rocha Filho EA, Vettorazzi J, Mayrink J, Fernandes KG, Vieira MC, Pacagnella RC, Cecatti JG. Maternal Nutrition Status Associated with Pregnancy-Related Adverse Outcomes. Nutrients 2021; 13:2398. [PMID: 34371906 PMCID: PMC8308922 DOI: 10.3390/nu13072398] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/29/2021] [Accepted: 07/09/2021] [Indexed: 11/26/2022] Open
Abstract
Although maternal nutrition has an impact on fetal development and gestational outcome, tracking maternal nutrition in outpatient practice is still complex and involves proper technical capacitation in this area. Nevertheless, the association between nutritional variables may broaden the ability to predict the occurrence of gestational disorders and prevention management. We aimed to identify factors that could indicate the probability of adverse outcomes in mid-pregnancy. From a cohort of 1165 nulliparous pregnant women without any previous disease, the nutritional status was assessed by body mass index (BMI) and mid-upper arm circumference (MUAC), associated with dietary patterns and sociodemographic characteristics. Two predictive models with nutritional status for screening the occurrence of adverse outcomes of preterm birth, gestational diabetes mellitus, small-for-gestational-age newborns and preeclampsia were developed. The odds of adverse outcomes were higher in non-white (p < 0.05) obese women and with high protein consumption. There was no significant difference between the models, with an overall accuracy of 63% for both models and a probability of success in predicting adverse outcomes (BMI = 61%, MUAC = 52%). This study of Brazilian pregnant nulliparous women offers two possible options for early tracking of adverse gestational outcomes that should be further externally validated.
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Affiliation(s)
- Maria J Miele
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Campinas 13083-881, SP, Brazil; (M.J.M.); (R.T.S.); (D.F.L.); (J.M.); (K.G.F.); (M.C.V.); (R.C.P.)
| | - Renato T Souza
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Campinas 13083-881, SP, Brazil; (M.J.M.); (R.T.S.); (D.F.L.); (J.M.); (K.G.F.); (M.C.V.); (R.C.P.)
| | - Iracema M Calderon
- Department of Gynecology and Obstetrics, Botucatu Medical School, Sao Paulo State University (Unesp), Botucatu 18618-970, SP, Brazil;
| | - Francisco E Feitosa
- MEAC–Maternity School of the Federal University of Ceará, Fortaleza 60430-270, CE, Brazil;
| | - Debora F Leite
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Campinas 13083-881, SP, Brazil; (M.J.M.); (R.T.S.); (D.F.L.); (J.M.); (K.G.F.); (M.C.V.); (R.C.P.)
- Department of Maternal and Child Health, Federal University of Pernambuco, Recife 50670-901, PE, Brazil;
| | - Edilberto A Rocha Filho
- Department of Maternal and Child Health, Federal University of Pernambuco, Recife 50670-901, PE, Brazil;
| | - Janete Vettorazzi
- Department of Obstetrics and Gynecology, Maternity Hospital, Federal University of RS, Porto Alegre 90035-903, RS, Brazil;
| | - Jussara Mayrink
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Campinas 13083-881, SP, Brazil; (M.J.M.); (R.T.S.); (D.F.L.); (J.M.); (K.G.F.); (M.C.V.); (R.C.P.)
| | - Karayna G Fernandes
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Campinas 13083-881, SP, Brazil; (M.J.M.); (R.T.S.); (D.F.L.); (J.M.); (K.G.F.); (M.C.V.); (R.C.P.)
- Department of Gynecology and Obstetrics, Jundiai School of Medicine, Jundiaí 13202-550, SP, Brazil
| | - Matias C Vieira
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Campinas 13083-881, SP, Brazil; (M.J.M.); (R.T.S.); (D.F.L.); (J.M.); (K.G.F.); (M.C.V.); (R.C.P.)
- Division of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, London SE1 7EH, UK
| | - Rodolfo C Pacagnella
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Campinas 13083-881, SP, Brazil; (M.J.M.); (R.T.S.); (D.F.L.); (J.M.); (K.G.F.); (M.C.V.); (R.C.P.)
| | - José G. Cecatti
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Campinas 13083-881, SP, Brazil; (M.J.M.); (R.T.S.); (D.F.L.); (J.M.); (K.G.F.); (M.C.V.); (R.C.P.)
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12
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Abstract
OBJECTIVE Preeclampsia is one of the factors causing maternal and perinatal death. The purpose of this study was to find out the birth weight and the Apgar score of the newborn in correlation with fetal complications in mothers with severe preeclampsia. METHOD This study was a descriptive retrospective study by reviewing the medical records of pregnant women who have been diagnosed with severe preeclampsia during the period of January 2017-May 2019. The study was conducted in 4 hospitals in Makassar. Data were statistically analyzed using the chi-square test. RESULT There were 256 pregnant women who met the criteria of this study, 184 (71.9%) suffered severe preeclampsia, and 92 (28.1%) suffered severe preeclampsia with maternal complications. The patients with severe preeclampsia were mostly in age of 20-35 years old (59.2%), multiparous (69.6%), with gestational age on delivery≥37 weeks (56%) while In the severe preeclampsia with maternal complications group, most women were in age of 20-35 (69.4%), multiparous (73.6%), with preterm delivery (65.3%). Low birth weight was found more in the severe preeclampsia with maternal complications group (37.5%). The APGAR score of 7-10 in the first and fifth minutes was high in both groups. 41.7% of fetal complications occurred in the group of severe preeclampsia with complications. There are significant differences in gestational age on delivery, birth weight, Apgar score and fetal complications in the group of severe preeclampsia and severe preeclampsia with complications (p≤0.05) CONCLUSION: The incidence of preterm birth, low birth weight, and fetal complications are more common in the group of severe preeclampsia with complications.
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13
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Jarrick S, Lundberg S, Stephansson O, Symreng A, Bottai M, Höijer J, Ludvigsson JF. Pregnancy outcomes in women with immunoglobulin A nephropathy: a nationwide population-based cohort study. J Nephrol 2021; 34:1591-1598. [PMID: 33683676 PMCID: PMC8494659 DOI: 10.1007/s40620-021-00979-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 01/22/2021] [Indexed: 01/05/2023]
Abstract
Background Immunoglobulin A nephropathy (IgAN) incidence peaks in childbearing age. Data on pregnancy outcomes in women with IgAN are limited. Methods We performed a register-based cohort study in a nationwide cohort of women with biopsy-verified IgAN in Sweden, comparing 327 pregnancies in 208 women with biopsy-verified IgAN and 1060 pregnancies in a matched reference population of 622 women without IgAN, with secondary comparisons with sisters to IgAN women. Adverse pregnancy outcomes, identified by way of the Swedish Medical Birth Register, were compared through multivariable logistic regression and presented as adjusted odds ratios (aORs). Main outcome was preterm birth (< 37 weeks). Secondary outcomes were preeclampsia, small for gestational age (SGA), low 5-min Apgar score (< 7), fetal or infant loss, cesarean section, and gestational diabetes. Results We found that IgAN was associated with an increased risk of preterm birth (13.1% vs 5.6%; aOR = 2.69; 95% confidence interval [CI] = 1.52–4.77), preeclampsia (13.8% vs 4.2%; aOR = 4.29; 95%CI = 2.42–7.62), SGA birth (16.0% vs 11.1%; aOR = 1.84; 95%CI = 1.17–2.88), and cesarean section (23.9% vs 16.2%; aOR = 1.74, 95%CI = 1.14–2.65). Absolute risks were low for intrauterine (0.6%) or neonatal (0%) death and for low 5-min Apgar score (1.5%), and did not differ from the reference population. Sibling comparisons suggested increased risks of preterm birth, preeclampsia, and SGA in IgAN, but not of cesarean section. Conclusion We conclude that although most women with IgAN will have a favorable pregnancy outcome, they are at higher risk of preterm birth, preeclampsia and SGA. Intensified supervision during pregnancy is warranted. Supplementary Information The online version contains supplementary material available at 10.1007/s40620-021-00979-2.
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Affiliation(s)
- Simon Jarrick
- Department of Pediatrics, Örebro University Hospital, 701 85, Örebro, Sweden. .,Faculty of Health and Medicine, Örebro University, Örebro, Sweden.
| | - Sigrid Lundberg
- Department of Nephrology, Danderyd Hospital, Stockholm, Sweden.,Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Olof Stephansson
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Adina Symreng
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Matteo Bottai
- Division of Biostatisitcs, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Höijer
- Division of Biostatisitcs, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jonas F Ludvigsson
- Department of Pediatrics, Örebro University Hospital, 701 85, Örebro, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
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14
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Saw SN, Biswas A, Mattar CNZ, Lee HK, Yap CH. Machine learning improves early prediction of small-for-gestational-age births and reveals nuchal fold thickness as unexpected predictor. Prenat Diagn 2021; 41:505-516. [PMID: 33462877 DOI: 10.1002/pd.5903] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 01/05/2021] [Accepted: 01/10/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To investigate the performance of the machine learning (ML) model in predicting small-for-gestational-age (SGA) at birth, using second-trimester data. METHODS Retrospective data of 347 patients, consisting of maternal demographics and ultrasound parameters collected between the 20th and 25th gestational weeks, were studied. ML models were applied to different combinations of the parameters to predict SGA and severe SGA at birth (defined as 10th and third centile birth weight). RESULTS Using second-trimester measurements, ML models achieved an accuracy of 70% and 73% in predicting SGA and severe SGA whereas clinical guidelines had accuracies of 64% and 48%. Uterine PI (Ut PI) was found to be an important predictor, corroborating with existing literature, but surprisingly, so was nuchal fold thickness (NF). Logistic regression showed that Ut PI and NF were significant predictors and statistical comparisons showed that these parameters were significantly different in disease. Further, including NF was found to improve ML model performance, and vice versa. CONCLUSION ML could potentially improve the prediction of SGA at birth from second-trimester measurements, and demonstrated reduced NF to be an important predictor. Early prediction of SGA allows closer clinical monitoring, which provides an opportunity to discover any underlying diseases associated with SGA.
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Affiliation(s)
- Shier Nee Saw
- Bioinformatics Institute, Agency for Science, Technology and Research (A*STAR), Singapore.,Department of Artificial Intelligence, Faculty of Computer Science and Information Technology, University of Malaya, Malaysia
| | - Arijit Biswas
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health Systems, Singapore
| | - Citra Nurfarah Zaini Mattar
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health Systems, Singapore
| | - Hwee Kuan Lee
- Bioinformatics Institute, Agency for Science, Technology and Research (A*STAR), Singapore.,Rehabilitation Research Institute of Singapore, Singapore.,School of Computing, National University of Singapore, Singapore.,Image and Pervasive Access Lab (IPAL), CNRS UMI, Singapore.,Singapore Eye Research Institute, Singapore
| | - Choon Hwai Yap
- Department of Bioengineering, Imperial College London, London, UK
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15
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The Influence of Maternal BMI on Adverse Pregnancy Outcomes in Older Women. Nutrients 2020; 12:nu12092838. [PMID: 32948020 PMCID: PMC7551140 DOI: 10.3390/nu12092838] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/10/2020] [Accepted: 09/14/2020] [Indexed: 12/11/2022] Open
Abstract
As mothers age, the risk of adverse pregnancy outcomes may increase, but the results so far are controversial and several issues remain unknown, such as the impact of maternal weight on the effects associated with older age. In a prospective cohort of 912 Polish women with singleton pregnancies (recruited in 2015–2016), we assessed the pregnancy outcomes depending on the mother’s age (18–24, 25–29, 30–34, 35–39, and ≥40 years). Women aged ≥35 years (vs. <35 years) were assessed in terms of body mass index (BMI). Multidimensional logistic regression was used to calculate the odds ratios (with 95% confidence intervals) of the pregnancy results. The risk profiles (using the Lowess method) were applied to determine the threshold risk. We found that both the youngest and the oldest group members displayed higher adjusted odds ratios of preeclampsia (PE), intrauterine growth restriction (IUGR), and preterm birth <37th week (U-shaped risk). In the remaining cases, the age ≥40 years, compared to the youngest age 18–24 years, was associated with a higher adjusted risk of gestational hypertension (GH) (AOR = 5.76, p = 0.034), gestational diabetes mellitus GDM-1 (AOR = 7.06, p = 0.016), cesarean section (AOR = 6.97, p <0.001), and low birth weight LBW (AOR = 15.73, p = 0.033) as well as macrosomia >4000 g (AOR = 8.95, p = 0.048). We found that older age ≥35 years (vs. <35 years) was associated with higher adjusted odds ratios of all the pregnancy outcomes investigated. In obese women, these adverse older age related results were found to be more intense in GH study, as well as (though weaker) in birth <37th week study, small-for-gestational age birth weight (SGA), LBW, large-for-gestational age birth weight (LGA), and macrosomia. In overweight women, these adverse older age related results were found to be more intense in preterm birth study, as well as (though weaker) in SGA and LBW. In underweight women, adverse pregnancy outcomes related to older age were more intense in a study of cesarean section. At the same time, underweight was associated with reversal of some negative effects of older age (we found lower odds ratios of GDM-1 diabetes). The maternal threshold age above which the risk of GH, PE, GDM, caesarean section, and preterm birth increased was 33–34 years (lower than the threshold of 35 years assumed in the literature), and the threshold risk of IUGR, LBW, SGA, LGA, and macrosomia was 36–37 years. Main conclusions: Older maternal age was associated with a higher chance of all kinds of obstetric complications. Older women should particularly avoid obesity and overweight.
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16
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Lin F, Yang C, Feng T, Yang S, Zhou R, Li H. The Maternal-Fetal Interface in Small-for-Gestational-Age Pregnancies Is Associated With a Reduced Quantity of Human Decidual NK Cells With Weaker Functional Ability. Front Cell Dev Biol 2020; 8:633. [PMID: 33015028 PMCID: PMC7509437 DOI: 10.3389/fcell.2020.00633] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 06/24/2020] [Indexed: 12/17/2022] Open
Abstract
Small for gestational age (SGA) refers to a birth weight that is less than the 10th percentile of the mean weight of infants at the same gestational age. This condition is associated with a variety of complications, and a high risk of cardiovascular and cerebrovascular diseases in adulthood. Decidual natural killer (dNK) cells at the maternal–fetal interface have received significant research attention in terms of normal pregnancy or miscarriage; however, data relating to SGA are limited. In this study, we aimed to investigate the characteristics and regulatory role of dNK cells at the maternal–fetal interface in SGA. Using immunofluorescence assays, we found that dNK cells maintained close contact with extra-villous trophoblasts, and the proportion of dNK cells in SGA decreased more than in appropriate for gestational age (AGA). Flow cytometry also showed that there was a significantly lower percentage of dNK cells in SGA (25.01 ± 2.43%) than in AGA (34.25 ± 2.30%) (p = 0.0103). The expression of the inhibitory receptor NKG2A on dNK cells and the secretion levels of both perforin and TGF-β1 from dNK cells were significantly higher in SGA than in AGA, while the cytotoxicity of dNK cells in SGA against K562 cells was attenuated. Compared to AGA, the functional ability of dNK cells in SGA showed significant functional impairment in promoting proliferation, migration, invasion, and tube formation in trophoblast cells or vascular endothelial cells. The abnormal function of dNK cells may affect fetal growth and development, and could therefore participate in the pathogenesis of SGA.
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Affiliation(s)
- Fang Lin
- Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Chuan Yang
- Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Ting Feng
- Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Shuo Yang
- Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Rong Zhou
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Hong Li
- Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
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17
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Jin Y, Li J, Deng X, Xia B, Song Q, Zhao Y, He X, Li Y, Xu Z, Xie A, Lin J, Zhang Y, Chen S. Association between fetal growth restriction and maternal exposure to polybrominated diphenyl ethers. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2020; 198:110623. [PMID: 32361490 DOI: 10.1016/j.ecoenv.2020.110623] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/30/2020] [Accepted: 04/09/2020] [Indexed: 05/06/2023]
Abstract
Humans are exposed to polybrominated diphenyl ethers (PBDEs) via ingestion of food, dust inhalation, and dermal absorption. Exposure to PBDEs via the placenta and breast milk is a special and important pathway in infants. This nested case-control study aimed to investigate the levels of PBDEs in maternal serum and colostrum, and to assess the association between the occurrence of fetal growth restriction (FGR) and prenatal exposure to PBDEs. We recruited 293 mother-newborn pairs, including 98 FGR cases and 195 healthy controls in Wenzhou, China. Maternal serum and colostrum samples were collected during pregnancy and after delivery, respectively, and the levels of PBDEs were measured by gas chromatography-tandem mass spectrometry. The total levels of PBDEs in maternal serum and colostrum were found to be in equilibrium, but congener profiles of PBDEs in these matrices were different. Increased BDE-207, BDE-209, ∑BDE196-209 and ∑PBDEs levels in maternal serum and BDE-99, ∑BDE17-154 and ∑PBDEs levels in colostrum were correlated with decreased birth weight Z score. Increased concentrations of higher brominated BDEs in maternal serum (odds ratio (OR) = 1.010, 95%CI = 1.003-1.018) and low-to moderately brominated BDEs in colostrum (OR = 1.004, 95%CI = 1.000-1.009) were associated with increased risk of FGR, which showed an exposure-response relationship. In addition, infants with FGR were more exposed to PBDEs in colostrum after birth than healthy infants. Longitudinal birth cohort studies are needed to determine the prolonged effect of PBDEs exposure on the growth of FGR infants in the future.
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Affiliation(s)
- Yuting Jin
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, China; Department of Pediatrics, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China
| | - Jialin Li
- Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Xiaokai Deng
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, China
| | - Bin Xia
- Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Qi Song
- Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Yingya Zhao
- Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Xiaoxiao He
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, China
| | - Yimei Li
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, China
| | - Zhangye Xu
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, China
| | - Ailan Xie
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, China
| | - Jing Lin
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, China; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Yunhui Zhang
- Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai, 200032, China.
| | - Shangqin Chen
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, China.
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18
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Bustan-Nahumson M, Bornstein S, Feldstein O, Levy M, Schreiber L, Bar J, Kovo M, Weiner E. Preeclampsia in Different Maternal Age Groups-Is There an Association with Pregnancy Outcomes and Placental Pathology? Reprod Sci 2020; 27:1879-1887. [PMID: 32562243 DOI: 10.1007/s43032-020-00207-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 04/23/2020] [Indexed: 11/27/2022]
Abstract
We aimed to compare maternal characteristics, pregnancy outcomes, and placental pathology in pregnancies complicated by preeclampsia at three different maternal age groups. Medical records and pathological reports of patients diagnosed with preeclampsia and delivered between 2008 and 2018 in a single tertiary center, were reviewed. Preeclampsia was diagnosed according to the current ACOG guidelines. Study population was divided into 3 groups of maternal age: group 1-< 27 years; group 2-27-35 years; and group 3-> 35 years (advanced maternal age = AMA). Data regarding maternal characteristics, neonatal outcomes, and placental histopathological lesions were compared between the groups. Composite adverse neonatal outcome was defined as ≥ 1 early neonatal complication. The AMA group (n = 145) was associated with a higher BMI, and higher rates of diabetes mellitus (DM), chronic hypertension (CHTN), and Cesarean deliveries compared with group 1 (n = 107) and group 2 (n = 255). The AMA group also had lower neonatal birthweights and a higher rate of composite adverse neonatal outcome compared with the other age groups. None of the placental lesions differed between the groups. By multivariable analysis, we found that maternal age (aOR 1.36, 95% CI 1.17-3.93), GA at delivery (aOR 0.80, 95% CI 0.61-0.90), DM (aOR 1.19, 95% CI 1.07-3.05), and CHTN (aOR 1.23, 95% CI 1.08-2.01) were independently associated with composite adverse neonatal outcome. Pregnancies at AMA were associated with higher complication rates, but without any differences in placental pathology, suggesting that the worse outcomes associated with AMA in preeclampsia are attributed to maternal chronic morbidities and not to differences observed in placental pathology.
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Affiliation(s)
- Mor Bustan-Nahumson
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Sandy Bornstein
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Feldstein
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Levy
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Letizia Schreiber
- Department of Pathology, The Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Weiner
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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19
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Sukmawati S, Sunarno I, Arsyad MA, Idris I. Vaginal and cesarean section delivery with severe preeclampsia and preeclampsia with complications. ENFERMERIA CLINICA 2020. [DOI: 10.1016/j.enfcli.2019.07.155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Liu X, Xiao J, Sun X, Chen Q, Yao Z, Feng B, Cao G, Guo L, He G, Hu J, Zeng W, Rong Z, Wang Q, Zhang B, Dong M, Wang J, Chen D, Ma W, Liu T. Associations of maternal ambient temperature exposures during pregnancy with the risk of preterm birth and the effect modification of birth order during the new baby boom: A birth cohort study in Guangzhou, China. Int J Hyg Environ Health 2020; 225:113481. [PMID: 32058935 DOI: 10.1016/j.ijheh.2020.113481] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/28/2020] [Accepted: 02/03/2020] [Indexed: 10/25/2022]
Abstract
Maternal exposures to ambient temperatures during pregnancy may increase the preterm birth (PTB) risk; however, which periods have stronger effects remain controversial. The effects of temperature exposure on PTB in first- and second-born neonate groups may be different during the new baby boom that has followed the Two-child Policy in China. We examined a birth cohort of 4928 pregnant women beginning in 2016 in Guangzhou, China. An inverse distance weighted method was used to estimate the temperature exposure at each individual residential address. A distribution lag non-linear model incorporating a Cox proportional hazard model was employed to estimate the effects of temperature exposure on PTB and test the effects modification of birth order related to the new baby boom. A total of 4101 pregnant women were included, of which 234 (5.7%) experienced PTB. Compared with the mean temperature (23.0 °C), we found a significantly higher risks of PTB associated with high temperatures (i.e, 30 °C [95th centile]) from the 4th to 8th, and 22nd to 27th gestational weeks. A peak effect was found during the 6th week (HR = 1.79, 95% CI: 1.26, 2.54) and 24th week (HR = 1.83, 95% CI: 1.27, 2.62). The risks of PTB were reduced for low temperatures (i.e. 14 °C [5th centile] versus 23.0 °C) from the 2nd to 10th and 20th to 26th gestational weeks, and the negative peak effect was found during the 4th week (HR = 0.43, 95% CI: 0.26, 0.72) and 23rd week (HR = 0.59, 95% CI: 0.43, 0.83). Stratification analyses showed that significant effects of 30 °C versus 23 °C on PTB were observed during the 4th to 8th weeks in the second-born neonate, and the peak effect was found in the 6th week (HR = 2.13, 95% CI: 1.31, 3.47). However, we did not find significant effects of 30 °C during the same weeks in the first-born neonate group. Maternal exposures to higher temperatures during pregnancy may increase the risk of PTB, and lower temperatures may decrease the risk of PTB. Stronger effects of temperature exposures during the first trimester on PTB risk were found among the second-born neonates than among the first-born neonates.
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Affiliation(s)
- Xin Liu
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, 510080, China; Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Jianpeng Xiao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Xiaoli Sun
- Gynecology Department, Guangdong Women and Children Hospital, Guangzhou, 511442, China
| | - Qingsong Chen
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, 510080, China
| | - Zhenjiang Yao
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, 510080, China
| | - Baixiang Feng
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Ganxiang Cao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Lingchuan Guo
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Guanhao He
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Jianxiong Hu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Weilin Zeng
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Zuhua Rong
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Qiong Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Bo Zhang
- Food Safety and Health Research Center, School of Public Health, Southern Medical University, Guangzhou, 510515, China; Department of Environmental and Occupational Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Moran Dong
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Jiaqi Wang
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Dengzhou Chen
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Wenjun Ma
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Tao Liu
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, 510080, China; Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China.
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Liu C, Zhu X, Li D, Shi Y. Related Factors of Patent Ductus Arteriosus in Preterm Infants: A Systematic Review and Meta-Analysis. Front Pediatr 2020; 8:605879. [PMID: 33469523 PMCID: PMC7813817 DOI: 10.3389/fped.2020.605879] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/24/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Patent ductus arteriosus (PDA) is a dramatically harmful disease in the neonatal period, in particular common in preterm infants, and our study was to determine related factors of PDA in preterm infants. Methods: A comprehensive literature review was conducted in PubMed, EMBASE, and Web of Science. The pooled odds ratio and standard mean difference were calculated to compare dichotomous and continuous variables, respectively. In addition, we also assessed the heterogeneity and publication bias and carried out sensitivity analysis for each related factor. Results: We included 45 studies with 87,419 individuals. After the primary analysis and a series of adjustments, results showed chorioamnionitis, lower gestational age, lower birth weight, bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, respiratory distress syndrome, sepsis, surfactant treatment, ventilation, and lower platelet count had a positive correlation with PDA, while small for gestational age decreased the incidence of PDA in preterm infants. Besides, premature rupture of membranes, preeclampsia, antenatal steroids, male gender, mean platelet volume, and platelet distribution width were found to have no statistically significant relationship with PDA. Conclusion: Preterm infants with more immature characteristics generally have a higher likelihood to develop PDA. The prevention, diagnosis, and management of PDA may depend on these results, and effective measures can be taken accordingly.
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Affiliation(s)
- Chang Liu
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Xingwang Zhu
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Dinggang Li
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Yuan Shi
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Tannis C, Fletcher-Slater R, Lopez I, Gichingiri A, Cassara M, Lachapelle S, Garland E. Risk Factors for Preeclampsia in a High-Risk Cohort of Women Served by a Nursing-based Home Visiting Program. INTERNATIONAL PUBLIC HEALTH JOURNAL 2018; 10:411-419. [PMID: 31762934 PMCID: PMC6873224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This descriptive study aimed to identify the impact of psychosocial risk factors on pregnancy outcomes for high risk women in an urban setting. Women in this category tend to experience adverse pregnancy outcomes, like preeclampsia, at greater rates than low or medium risk women. A retrospective paper chart review of East Harlem women served by LSA Family Health Service (LSA) Maternal Outreach Program (MOP) was conducted. All women who enrolled in the MOP with a singleton pregnancy from January 2015 to December 2017, were eligible for inclusion in our analyses. Data were analyzed using SPSS (version 23). Of 379 total participants, 68.6% (n=203) were Hispanic/Latina women, 44.8% (n=163) were English only speakers, 67.4% (n=226) were identified as overweight/obese, 90.6% (n=328) were mothers over the age of 20 among those for whom data were available. Sixty-two percent (n=235) initiated prenatal care in their first trimester, and 71.5% (n=271) were referred to the MOP by a hospital or other healthcare provider. The percentage of preeclampsia among mothers was 26.9% (n=102). After adjustment for type of LSA services received, and race/ethnicity, there were no associations between psychosocial risk factors and preeclampsia diagnosis in this population. Further research is needed on the relationship between psychosocial risk factors and preeclampsia to identify potential areas of intervention and reduce the burden of disease.
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Affiliation(s)
- Candace Tannis
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai
| | - Rachel Fletcher-Slater
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai
| | - Inessa Lopez
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai
| | - Alexandrah Gichingiri
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai
| | - Mario Cassara
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai
| | | | - Elizabeth Garland
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai
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