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Peris M, Crompton K, Shepherd DA, Amor DJ. The association between human chorionic gonadotropin and adverse pregnancy outcomes: a systematic review and meta-analysis. Am J Obstet Gynecol 2024; 230:118-184. [PMID: 37572838 DOI: 10.1016/j.ajog.2023.08.007] [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: 05/10/2023] [Revised: 07/28/2023] [Accepted: 08/02/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVE This study aimed to evaluate the association between human chorionic gonadotropin and adverse pregnancy outcomes. DATA SOURCES Medline, Embase, PubMed, and Cochrane were searched in November 2021 using Medical Subject Headings (MeSH) and relevant key words. STUDY ELIGIBILITY CRITERIA This analysis included published full-text studies of pregnant women with serum human chorionic gonadotropin testing between 8 and 28 weeks of gestation, investigating fetal outcomes (fetal death in utero, small for gestational age, preterm birth) or maternal factors (hypertension in pregnancy: preeclampsia, pregnancy-induced hypertension, placental abruption, HELLP syndrome, gestational diabetes mellitus). METHODS Studies were extracted using REDCap software. The Newcastle-Ottawa scale was used to assess for risk of bias. Final meta-analyses underwent further quality assessment using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) method. RESULTS A total of 185 studies were included in the final review, including the outcomes of fetal death in utero (45), small for gestational age (79), preterm delivery (62), hypertension in pregnancy (107), gestational diabetes mellitus (29), placental abruption (17), and HELLP syndrome (2). Data were analyzed separately on the basis of categorical measurement of human chorionic gonadotropin and human chorionic gonadotropin measured on a continuous scale. Eligible studies underwent meta-analysis to generate a pooled odds ratio (categorical human chorionic gonadotropin level) or difference in medians (human chorionic gonadotropin continuous scale) between outcome groups. First-trimester low human chorionic gonadotropin levels were associated with preeclampsia and fetal death in utero, whereas high human chorionic gonadotropin levels were associated with preeclampsia. Second-trimester high human chorionic gonadotropin levels were associated with fetal death in utero and preeclampsia. CONCLUSION Human chorionic gonadotropin levels are associated with placenta-mediated adverse pregnancy outcomes. Both high and low human chorionic gonadotropin levels in the first trimester of pregnancy can be early warning signs of adverse outcomes. Further analysis of human chorionic gonadotropin subtypes and pregnancy outcomes is required to determine the diagnostic utility of these findings in reference to specific cutoff values.
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Affiliation(s)
- Monique Peris
- Neurodisability and Rehabilitation Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Australia
| | - Kylie Crompton
- Neurodisability and Rehabilitation Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Australia
| | - Daisy A Shepherd
- Neurodisability and Rehabilitation Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - David J Amor
- Neurodisability and Rehabilitation Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Australia.
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Bunyapipat P, Pruksanusak N, Suwanrath C, Geater A. Combined maternal risk factors and the Quadruple test to predict late-onset preeclampsia in pregnant Thai women. BMC Pregnancy Childbirth 2023; 23:277. [PMID: 37087431 PMCID: PMC10122335 DOI: 10.1186/s12884-023-05623-4] [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: 12/02/2022] [Accepted: 04/18/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the predictive power of a model combining maternal risk factors and the Quadruple screen test for late-onset preeclampsia (PE). METHODS All pregnant women that received the Quadruple test for Down syndrome at 15+ 0-20+ 6 weeks' gestation were recruited. Maternal serum α-fetoprotein, β-human chorionic gonadotropin, unconjugated estriol, and inhibin A were measured as multiples of the median. A logistic regression model was used to identify predictors associated with late-onset PE with severe features. The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to assess the model's predictive ability. RESULTS Fifty-five of the 2,000 pregnant women had PE, and 31 of 55 women had late-onset PE. Multivariate analysis identified maternal age ≥ 35 years, inhibin A, history of previous PE, history of infertile, cardiac disease, chronic hypertension, and thyroid disease as significant risk factors. The area under the curve of the receiver operating characteristic curve was 0.78. The likelihood ratio to predict late-onset PE was 49.4 (total score > 60). CONCLUSIONS Our model combining serum inhibin A with maternal risk factors was useful in predicting late-onset PE. Close monitoring of these patients is recommended.
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Affiliation(s)
- Phattarika Bunyapipat
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Songkhla, 90110, Thailand
| | - Ninlapa Pruksanusak
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Songkhla, 90110, Thailand.
| | - Chitkasaem Suwanrath
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Songkhla, 90110, Thailand
| | - Alan Geater
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
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Yarşılıkal Güleroğlu F, Ekmez M, Ekmez F, Karacabey S, Çetin A. Second-trimester Uterine Artery Doppler Parameters but not Triple Test Analytes, May Predict Gestational Diabetes Mellitus. ISTANBUL MEDICAL JOURNAL 2023. [DOI: 10.4274/imj.galenos.2022.58046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
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Muacevic A, Adler JR, Cundubey CR, Cam S. Evaluation of Low-Molecular-Weight Heparin Treatment on First- and Second-Trimester Screening Test Results. Cureus 2023; 15:e35137. [PMID: 36846633 PMCID: PMC9944636 DOI: 10.7759/cureus.35137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2023] [Indexed: 02/20/2023] Open
Abstract
Background The serum markers used in first- and second-trimester screening tests can be affected by different causes such as smoking, infertility treatment, and the presence of diabetes mellitus, which should be considered by obstetricians when giving information to patients. Low molecular weight heparin (LMWH) has a critical importance in the prophylaxis of deep vein thrombosis both in the antenatal and postnatal period. The aim of the current study is to investigate the effect of LMWH use on the first- and second-trimester screening results. Methods A retrospective analysis in our outpatient clinic between July 2018 and January 2021 of first- and second-trimester screening test results was conducted to assess the impact of LMWH treatment for patients with thrombophilia who started LMWH after pregnancy was detected were included. Test results were obtained as a multiple of median (MoM) combined with ultrasound measurements, maternal serum markers, and maternal age in addition to the nuchal translucency first-trimester test. Results The pregnancy-associated plasma protein-A (PAPP-A) MoM was lower and alpha-fetoprotein (AFP) and unconjugated estriol (uE3) MoMs were higher in patients treated with LMWH than in the control group (0.78 MoM vs 0.96 MoM; 1.00 MoM vs 0.97 MoM; and 0.89 MoM vs 0.76 MoM, respectively). Human chorionic gonadotropin (HCG) levels did not differ between groups at either time point. Conclusions Treatment of pregnant women with LMWH for thrombophilia may change the MoM values of serum markers for both first- and second-trimester screening tests. Obstetricians should be aware of this when advising screening tests to thrombophilia patients and should consider offering fetal DNA tests for this group instead.
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Affiliation(s)
- Alexander Muacevic
- Obstetrics and Gynecology, Kayseri City Training and Research Hospital, Kayseri, TUR
| | - John R Adler
- Obstetrics and Gynecology, Kayseri City Training and Research Hospital, Kayseri, TUR
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The Effect of Serum β-Human Chorionic Gonadotropin on Pregnancy Complications and Adverse Pregnancy Outcomes: A Systematic Review and Meta-Analysis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8315519. [PMID: 36118828 PMCID: PMC9481379 DOI: 10.1155/2022/8315519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/20/2022] [Accepted: 08/26/2022] [Indexed: 11/30/2022]
Abstract
Background The relationship among elevated serum β-human chorionic gonadotropin (β-hCG), the incidence of pregnancy complications, and adverse pregnancy outcomes has been controversial. Differences in study design, subject bias due to demographic characteristics, and differences in local medical levels could contribute to inconsistent results. Methods Literature searches were performed in PubMed, EMBASE, Medline, Central, China National Knowledge Infrastructure (CNKI), Wanfang, and China Science Digital Library (CSDL) databases. Inclusion criteria were as follows: (1) research subjects were singleton pregnant women; (2) the study is identified as cohort study; (3) the subjects were assigned to the high β-hCG group and control group according to whether the exposure factors increased β-hCG in the second trimester; (4) the observed outcomes include at least pregnancy-induced hypertension (PIH), diabetes (gestational diabetes mellitus, GMD), preterm delivery (PD), and intrauterine growth restriction (IUGR); and (5) the odds ratio (OR) and 95% confidence interval (CI) of exposure factors are calculated based on literature dataset. To determine the risk bias of selected literatures, Newcastle-Ottawa scale was applied. The chi-square test was further used for heterogeneity analysis. If heterogeneity was identified, subgroup analyses were then performed for source investigation. Results A total of 13 literatures were included and analyzed, including 67,355 pregnant women and 5980 pregnant women assigned to the high β-HCG group and 61,375 pregnant women to the control group. The incidence of PIH in the high β-HCG group was higher than that in the control group (OR = 2.11, 95% CI [1.90, 2.35], Z = 13.85, P < 0.00001). There was no heterogeneity among literatures (χ2 = 8.53, P = 0.38, I2 = 6%), and thus there is no identified publication bias (P > 0.05). The incidence of preterm birth in the high β-HCG group was higher than that in the control group (OR = 2.11, 95% CI [1.90, 2.35], Z = 13.85, P < 0.00001). The analysis suggested no heterogeneity among included literatures (χ2 = 11.78, P = 0.11, I2 = 41%) and no publication bias (P > 0.05). Higher incidence of abortion was observed in the high β-HCG group compared with the control group (OR = 2.80, 95% CI [1.92, 4.09], Z = 5.32, P < 0.00001). There was no heterogeneity among literatures (χ2 = 3.43, P = 0.33, I2 = 13%) and no publication bias (P > 0.05). The incidence of gestational diabetes was higher in the high β-HCG group than in the control group (OR = 2.15, 95% CI [1.05, 4.40], Z = 2.09, P = 0.04). Heterogeneity was identified among literatures (χ2 = 47.01, P < 0.00001, I2 = 87%). Sensitivity analysis showed that the results were not robust, and there was no publication bias (P > 0.05). Compared with control, the incidence of IGUR was higher in the high β-HCG group (OR = 2.70, 95% CI [1.75, 4.19], Z = 4.45, P < 0.0001) with no heterogeneity among literatures (χ2 = 3.92, P = 0.14, I2 = 49%) and no publication bias (P > 0.05). Conclusion High levels of β-hCG during pregnancy in singleton women are associated with a high incidence of pregnancy complications and adverse pregnancy outcomes. Pregnant women with high levels of β-hCG should be monitored more closely, followed up, and given timely medical interventions to reduce the incidence of pregnancy complications and adverse outcomes.
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Alizadeh-Dibazari Z, Alizadeh-Ghodsi Z, Fathnezhad-kazemi A. Association Between Serum Markers Used in the Routine Prenatal Screening with Pregnancy Outcomes: A Cohort Study. J Obstet Gynaecol India 2022; 72:6-18. [PMID: 35928095 PMCID: PMC9343500 DOI: 10.1007/s13224-021-01508-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 05/24/2021] [Indexed: 11/24/2022] Open
Abstract
Background Early detection of adverse pregnancy outcomes is an important topic in prenatal care. This study aimed to evaluate the association between maternal serum markers and pregnancy outcomes. Materials and Methods This hospital-based cohort study was performed according to the national Down syndrome screening protocol on 2923 eligible pregnant women. Pregnancies were classified into three groups of based on each biomarker. The participants were followed up until delivery, and the pregnancy outcomes were identified by hospital discharge records. Results High levels of free BHCG were significantly associated with an increased risk of preterm birth (B = - 0.31, SE = 0.158, OR = 0.730; P = 0.046). Based on multivariate analysis the high levels of MSAFP had a direct relationship with premature birth (B = - 0.84, SE = 0.361, OR = 0.431, P = 0.020), gestational hypertension (B = - 0.59, SE = 0.354, OR = 0.549. P = 0.091), IUGR (B = - 1.46, SE = 0.433, OR = 0.231, P = 0.001), and fetal death (B = - 1.50, SE = 0.533, OR = 0.223, P = 0.005). Furthermore, an increase in the levels of Inhibin-A could more likely lead to gestational hypertension (B = - 0.63, SE = 0.235, OR = 0.533). Discussion According to the result, maternal biomarkers, especially MSAFP, can be beneficial in identifying high-risk cases, in addition to examining the possibility of Down syndrome, facilitating achievement of the desired pregnancy outcomes.
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Besimoglu B, Öcal FD, Sinaci S, Atalay A, Tanaçan A, Şahin D. Effect of antiepileptic drugs on serum biochemical marker levels of first and second trimester screening tests. J Obstet Gynaecol Res 2022; 48:1607-1612. [PMID: 35411996 DOI: 10.1111/jog.15250] [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: 01/09/2022] [Revised: 03/12/2022] [Accepted: 03/21/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Our aim in this study was to evaluate the effect of antiepileptic drugs on biochemical components of screening tests. MATERIALS AND METHODS This longitudinal case-control study was performed at Ankara City Hospital, Ankara, Turkey, from June 2020 to January 2021. The case group included epileptic singleton pregnant women which were using antiepileptic drugs, between 18 and 44 years of age. The control group included healthy pregnant women between 18 and 44 years old who did not use any drugs. Maternal medical, obstetric, and gynecological history were recorded. The antiepileptic agents that are used in our study were; lamotrigine, levetiracetam, carbamazepine, oxcarbazepine, valproic acid, and clonazepam. For the aneuploidy screening program conducted in our laboratory, the biochemical markers that are analyzed include; free b-hCG and PAPP-A in the first trimester, as well as AFP, HCG, and unconjugated estriol (uE3) in the second trimester. MoM values of these markers were compared between the case and control groups. RESULTS Fifty-three pregnant women with epilepsy using antiepileptic drugs were compared with 106 healthy pregnant women. The levels of serum-free b-hCG, and PAPP-A were similar between the case and control groups (p = 0.653, p = 0.351). For the second-trimester screening biochemical markers, the maternal serum uE3 and AFP levels expressed as MoM were significantly higher in the epileptic group than in the control patients (p = 0.015 and p = 0.001). CONCLUSION Serum marker levels of second-trimester screening tests may be affected by antiepileptic drugs, which may lead to misinterpretation of the risk level. Antiepileptic drug usage should be considered when evaluating screening test results.
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Affiliation(s)
- Berhan Besimoglu
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara City Hospital, Ankara, Turkey
| | - Fatma Doğa Öcal
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara City Hospital, Ankara, Turkey
| | - Selcan Sinaci
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara City Hospital, Ankara, Turkey
| | - Ayşegül Atalay
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara City Hospital, Ankara, Turkey
| | - Atakan Tanaçan
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara City Hospital, Ankara, Turkey
| | - Dilek Şahin
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara City Hospital, Ankara, Turkey
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Sperling MM, Towner D, Davis J, Yamasato K. Second trimester prediction of gestational diabetes: maternal analytes as an additional screening tool. J Perinat Med 2022; 50:63-67. [PMID: 34315194 DOI: 10.1515/jpm-2021-0054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/30/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Early diagnosis of gestational diabetes can lead to greater optimization of glucose control. We evaluated associations between maternal serum analytes (alpha-fetoprotein [AFP], free beta-human chorionic gonadotropin [beta-hCG], inhibin, and estriol) and the development of gestational diabetes mellitus (GDM). METHODS This retrospective cohort study identified single-ton pregnancies with available second trimester serum analytes between 2009 and 2017. GDM was identified by ICD-9 and -10 codes. We examined the associations between analyte levels and GDM and to adjust for potential confounders routinely collected during genetic serum screening (maternal age, BMI, and race) using logistic regression. Optimal logistic regression predictive modeling for GDM was then performed using the analyte levels and the above mentioned potential confounders. The performance of the model was assessed by receiver operator curves. RESULTS Out of 5,709 patients, 660 (11.6%) were diagnosed with GDM. Increasing AFP and estriol were associated with decreasing risk of GDM, aOR 0.76 [95% CI 0.60-0.95] and aOR 0.67 [95% CI 0.50-0.89] respectively. Increasing beta-hCG was associated with a decreasing risk for GDM(aOR 0.84 [95% CI 0.73-0.97]). There was no association with inhibin. The most predictive GDM predictive model included beta-hCG and estriol in addition to the clinical variables of age, BMI, and race (area under the curve (AUC 0.75), buy this was not statistically different than using clinical variables alone (AUC 0.74) (p=0.26). CONCLUSIONS Increasing second trimester AFP, beta-hCG, and estriol are associated with decreasing risks of GDM, though do not improve the predictive ability for GDM when added to clinical risk factors of age, BMI, and race.
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Affiliation(s)
- Meryl M Sperling
- Division of Maternal-Fetal Medicine Fellow, Department of Obstetrics and Gynecology, Stanford University, Palo Alto, CA, USA
| | - Dena Towner
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Hawaii, Honolulu, HI, USA
| | | | - Kelly Yamasato
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Hawaii, Honolulu, HI, USA
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Wu W, Zhang LF, Li YT, Hu TX, Chen DQ, Tian YH. Early Rise of Serum hCG in Gestational Diabetes Mellitus Women With Live Birth Through In Vitro Fertilization Procedure. Front Endocrinol (Lausanne) 2022; 13:724198. [PMID: 35242105 PMCID: PMC8886717 DOI: 10.3389/fendo.2022.724198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 01/12/2022] [Indexed: 11/13/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy. The characteristics of early human chorionic gonadotropin (hCG) levels and the rise pattern in patients with GDM after in vitro fertilization (IVF) are unclear. The present investigation was a retrospective cohort analysis of eligible viable pregnancies achieved through IVF in the authors' hospital between October 2015 and June 2020. The characteristics of initial hCG concentration and the rise pattern in patients with GDM after IVF, and the difference between those of normoglycemic pregnant women, were explored. Using random-effects models, the preferred pattern to describe the increase in log hCG was a quadratic. When gestational age was within 39 days, the linear model adequately characterized the profile, and the average slope was 0.173, yielding a predicted increase of 1.55 (55%) in 1 day and 3.11 (211%) in 2 days. Absolute hCG values-but not the rate of rise-were significantly higher in double embryo transfers and twin pregnancies. Curves reflecting hCG rise from the GDM and non-GDM groups did not differ substantially. The proportion of patients with low initial hCG values (16 days post-oocyte retrieval <100 mIU/ml) was higher in the GDM group (5% vs. 2.09%), although the difference was not statistically significant. Early hCG rise in pregnant women after IVF-whether GDM or non-GDM-could be characterized by quadratic and linear models. However, hCG values on days 14 and 16 post-oocyte retrieval in the GDM group were lower than those in the non-GDM group, with the exception of twin pregnancies. Low hCG values in early pregnancy may be a clue to help predict GDM in the subsequent gestation period.
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Affiliation(s)
- Wei Wu
- Department of Reproductive Endocrinology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Li-Feng Zhang
- Department of Reproductive Endocrinology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yi-Ting Li
- Department of Reproductive Endocrinology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tian-Xiao Hu
- Department of Endocrinology, Chinese PLA 903rd Hospital (Former Chinese PLA 117th Hospital), Hangzhou, China
- College of Life Science, Zhejiang Chinese Medical University, Hangzhou, China
| | - Dan-Qing Chen
- Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Yong-Hong Tian, ; Dan-Qing Chen,
| | - Yong-Hong Tian
- Department of Reproductive Endocrinology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Reproductive Genetics, Ministry of Education, Hangzhou, China
- *Correspondence: Yong-Hong Tian, ; Dan-Qing Chen,
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Clinical risk models for preterm birth less than 28 weeks and less than 32 weeks of gestation using a large retrospective cohort. J Perinatol 2021; 41:2173-2181. [PMID: 34112965 DOI: 10.1038/s41372-021-01109-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 05/06/2021] [Accepted: 05/18/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To develop risk prediction models for singleton preterm birth (PTB) < 28 weeks and <32 weeks. METHODS Using a retrospective cohort of 267,226 singleton births in Ontario hospitals, we included variables from the first and second trimester in multivariable logistic regression models to predict overall and spontaneous PTB < 28 weeks and <32 weeks. RESULTS During the first trimester, the area under the curve (AUC) for prediction of PTB < 28 weeks for nulliparous and multiparous women was 68.5% (95% CI: 63.5-73.6%) and 73.4% (68.6-78.2%), respectively, while for PTB < 32 weeks it was 68.9% (65.5-72.3%) and 75.5% (72.3-78.7%), respectively. AUCs for second-trimester models were 72.4% (95% CI: 69.7-75.1%) and 78.2% (95% CI: 75.8-80.5%), respectively, in nulliparous and multiparous women. Predicted probabilities were well-calibrated within a wide range around expected base prevalence for the study outcomes. CONCLUSIONS Our prediction models generated acceptable AUCs for PTB < 28 weeks and <32 weeks with good calibration during the first and second trimester.
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Corneal Biomechanical Changes in Third Trimester of Pregnancy. ACTA ACUST UNITED AC 2021; 57:medicina57060600. [PMID: 34200925 PMCID: PMC8230443 DOI: 10.3390/medicina57060600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 12/22/2022]
Abstract
Background and Objectives: There is a clear evidence that pregnancy is associated with high production of sex hormones. During the first, second and third trimester of pregnancy, blood hormones levels increase gradually. Cells with affinity for sex hormones have been identified in different ocular tissues, such as: lid, lacrimal gland, meibomian gland, bulbar and palpebral conjunctivae, cornea, iris, ciliary body, lens, retina (retinal pigment epithelium) and choroid. This is why pregnancy is associated with changes at ocular level, involving anterior and posterior segments. Several clinical trials have been made trying to highlight changes in corneal biomechanics during pregnancy. By conducting this review, we want to evaluate both the changes in parameters that define corneal biomechanics and intraocular pressure values in pregnant. Materials and Methods: Following a systematic search in the literature related mainly to changes in corneal biomechanics during pregnancy, focusing on the paper published in the last decade, we included in a meta-analysis the cumulative results of three prospective comparative studies. Results: Important changes in corneal biomechanics (corneal hysteresis and corneal resistance factor) parameters were observed in women in the third trimester of pregnancy, but these variations were not statistically significant. Also, a decrease in intraocular pressure was mentioned in these women, but only the corneal compensation intraocular pressure showed a decrease with statistical significance. Conclusions: A decrease in corneal compensatory intraocular pressure was observed in pregnant women in the third trimester of pregnancy, but without other statistically significant changes resulting from the analysis of the other three parameters (corneal hysteresis, corneal resistance factor and Goldmann-correlated intraocular pressure).
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Pylypjuk CL, Monarrez-Espino J. False-Positive Maternal Serum Screens in the Second Trimester as Markers of Placentally Mediated Complications Later in Pregnancy: A Systematic Review and Meta-Analysis. DISEASE MARKERS 2021; 2021:5566234. [PMID: 34336005 PMCID: PMC8295507 DOI: 10.1155/2021/5566234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/21/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Multiple-marker, maternal serum screening (MSS) has been the cornerstone of prenatal diagnosis since the 1980s. While combinations of these markers are used to predict fetal risk of Down syndrome and other genetic conditions, there is some evidence that individual markers may also predict nongenetic pregnancy complications, particularly those related to placental dysfunction. The objective of this meta-analysis was to investigate the utility of false-positive, second-trimester MSS for Down syndrome as a marker of placentally mediated complications amongst singleton pregnancies globally. METHODS Electronic searches of PubMed, Medline, Embase, CINAHL, Web of Science, Scopus, and grey literature to 2019 were performed to identify observational studies comparing risk of pregnancy complications amongst pregnancies with false-positive MSS versus controls. A random-effects model of pooled odds ratios by outcome of interest (stillbirth, preeclampsia, fetal growth restriction, and preterm birth) and subgrouped by type of MSS test (double-, triple-, and quadruple-marker MSS) was used. RESULTS 16 studies enrolling 68515 pregnancies were included. There were increased odds of preeclampsia (OR 1.28, 95% CI 1.09-1.51) and stillbirth (OR 2.46, 95% CI 1.94-3.12) amongst pregnancies with false-positive MSS. There was no significant association with preterm birth or growth restriction. CONCLUSIONS There is some evidence of an association between false-positive, second-trimester MSS for Down syndrome and increased odds of preeclampsia and stillbirth. Future large-scale prospective studies are still needed to best determine the predictive value of false-positive MSS as a marker of placentally mediated complications later in pregnancy and evaluate potential clinical interventions to reduce these risks.
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Affiliation(s)
- Christy L. Pylypjuk
- Department Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Canada R3A 1R9
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Canada R3E 3P4
- Department of Epidemiology and Population Health, University of London (London School of Hygiene and Tropical Medicine), London WC1E 7HT, UK
| | - Joel Monarrez-Espino
- Department of Epidemiology and Population Health, University of London (London School of Hygiene and Tropical Medicine), London WC1E 7HT, UK
- Department of Health Research, Christus Muguerza Hospital Chihuahua - University of Monterrey, Chihuahua 31000, Mexico
- Department of Global Public Health, Karolinska Institute, Stockholm SE-171 77, Sweden
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13
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Hong SY, Kim SY, Kim JH, Hong JY, Sung JH, Choi SJ, Oh SY, Roh CR. Predictive value of quad serum markers for adverse pregnancy outcome in antiphospholipid antibody syndrome. Lupus 2021; 30:981-990. [PMID: 33709835 DOI: 10.1177/09612033211001126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE We investigated the validity of quad serum markers for the prediction of adverse pregnancy outcome (APO) in women with antiphospholipid antibody syndrome (APS). METHODS We included 75 women with APS delivered at our institution. APO was defined as stillbirth, small for gestational age (SGA), severe preeclampsia, or preterm delivery. First, we compared clinical characteristics between patients with or without composite APO. Second, we compared the rate of APO according to abnormal level of quad serum markers. Lastly, receiver operating characteristic (ROC) curve analysis was performed. RESULTS APS mothers with APO showed higher median α-fetoprotein (AFP) and inhibin A compared with those without APO. They were also associated with higher rates of positive risk of Down syndrome and neural tube defect. Elevated AFP, human chorionic gonadotropin (hCG), and inhibin A level was associated with higher rates of stillbirth, SGA, preterm delivery, and composite APO. ROC curve for prediction of stillbirth revealed an area under the curve of 0.835 for AFP, 0.781 for hCG, and 0.932 for inhibin A. For composite APO, the area under the ROC curve was 0.692 for AFP and 0.810 for inhibin A. CONCLUSION Elevated AFP, hCG, and inhibin A in women with APS demonstrated a high predictive value for APO, especially stillbirth.
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Affiliation(s)
- Sir-Yeon Hong
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seo-Yeon Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jin-Ha Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jee-Youn Hong
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ji-Hee Sung
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Suk-Joo Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Soo-Young Oh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Cheong-Rae Roh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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14
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First trimester serum PAPP-A is associated with placenta accreta: a retrospective study. Arch Gynecol Obstet 2021; 303:645-652. [PMID: 33515274 DOI: 10.1007/s00404-020-05960-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Our objective of this study was to investigate whether first trimester serum pregnancy-associated plasma protein-A (PAPP-A) differed amongst pregnancies with placenta previa-accreta and non-adherent placenta previa and healthy pregnancies by a retrospective cohort analysis. METHODS A total of 177 pregnant females were included in the study, as follows: 35 cases of placenta previa-accreta, 30 cases of non-adherent placenta previa, and 112 cases of BMI and age matched, healthy pregnant controls. PAPP-A multiples of the median (MoM) were acquired from laboratory data files in 1 January 2017-30 September 2019. The probable maternal serum biochemical predictor of placenta accreta was analyzed by using multiple logistic regression analysis. RESULTS PAPP-A MoM of placenta previa-accreta group was significantly higher than those of the non-adherent placenta previa group and control group (p = 0.009 < 0.05, p < 0.001). Serum PAPP-A was found to be significantly positively associated with placenta accreta after adjusted gestational week at time of blood sampling, BMI, age, smoking, and previous cesarean section history (OR: 3.51; 95% CI: 1.77-6.94; p = 0.0003 < 0.05). In addition, smoking (OR: 9.17; 95% CI: 1.69-49.62; p = 0.010 < 0.05) and previous cesarean section history (OR: 2.75; 95% CI: 1.23-6.17; p = 0.014 < 0.05) were also significantly associated with placenta accreta. CONCLUSION Increased first trimester serum PAPP-A was significantly positively associated with placenta accreta, suggesting that the potential role of PAPP-A in identifying pregnancies at high risk for placenta accreta. Smoking and previous cesarean section history may be the risk factors for accreta in placenta previa patients.
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15
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Worsham W, Dalton S, Bilder DA. The Prenatal Hormone Milieu in Autism Spectrum Disorder. Front Psychiatry 2021; 12:655438. [PMID: 34276434 PMCID: PMC8280339 DOI: 10.3389/fpsyt.2021.655438] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/17/2021] [Indexed: 01/03/2023] Open
Abstract
Though the etiology of autism spectrum disorder (ASD) remains largely unknown, recent findings suggest that hormone dysregulation within the prenatal environment, in conjunction with genetic factors, may alter fetal neurodevelopment. Early emphasis has been placed on the potential role of in utero exposure to androgens, particularly testosterone, to theorize ASD as the manifestation of an "extreme male brain." The relationship between autism risk and obstetric conditions associated with inflammation and steroid dysregulation merits a much broader understanding of the in utero steroid environment and its potential influence on fetal neuroendocrine development. The exploration of hormone dysregulation in the prenatal environment and ASD development builds upon prior research publishing associations with obstetric conditions and ASD risk. The insight gained may be applied to the development of chronic adult metabolic diseases that share prenatal risk factors with ASD. Future research directions will also be discussed.
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Affiliation(s)
- Whitney Worsham
- University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Susan Dalton
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, United States
| | - Deborah A Bilder
- Division of Child & Adolescent Psychiatry, Department of Psychiatry, University of Utah, Salt Lake City, UT, United States
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16
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Boonpiam R, Wanapirak C, Sirichotiyakul S, Sekararithi R, Traisrisilp K, Tongsong T. Quad test for fetal aneuploidy screening as a predictor of small-for-gestational age fetuses: a population-based study. BMC Pregnancy Childbirth 2020; 20:621. [PMID: 33059628 PMCID: PMC7559175 DOI: 10.1186/s12884-020-03298-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To identify the relationship between quadruple test for aneuploidy screening (alpha-fetoprotein: AFP; free beta-human chorionic gonadotropin: b-hCG; unconjugated estriol: uE3 and inhibin-A: IHA) and fetal growth restriction and to construct predictive models for small-for-gestational-age (SGA) fetuses. METHODS Women who underwent quadruple test for aneuploidy were followed-up for final outcomes. The multiples of the median (MoMs) of the four biochemical markers for the SGA group and those of normal fetuses were compared. The models for predicting SGA by the individual biomarkers and their combination were constructed using binary logistic regression analysis, and their diagnostic performances in predicting SGA were determined. RESULTS Of 10,155 eligible pregnant women, 578 (5.7%) and 9577 (94.3%) had SGA and normal growth, respectively. High levels of AFP, b-hCG and IHA but low levels of uE3 significantly increased the risk of SGA. The constructed predictive equations had predictive performance for SGA, with areas under the receiver-operated characteristic curve of 0.724, 0.655, 0.597, 0.664 and 0.754 for AFP, b-hCG, uE3, IHA, and the combination, respectively. CONCLUSION The quad test for aneuploidy screening could also be used as a predictor of SGA, without extra-effort and extra-cost.
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Affiliation(s)
- Rakchanok Boonpiam
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Chanane Wanapirak
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Supatra Sirichotiyakul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Ratanaporn Sekararithi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Kuntharee Traisrisilp
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
| | - Theera Tongsong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
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17
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Wang F, Zhang L, Zhang F, Wang J, Wang Y, Man D. First trimester serum PIGF is associated with placenta accreta. Placenta 2020; 101:39-44. [PMID: 32916477 DOI: 10.1016/j.placenta.2020.08.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/09/2020] [Accepted: 08/31/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES In this retrospective study, we investigated whether first trimester serum placental growth factor (PIGF) differed amongst pregnancies with placenta previa-accreta and non-adherent placenta previa and healthy pregnancies. METHODS In 1 January 2017-30 September 2019, a total of 177 pregnant females were included in the study, as follows: 35 cases of placenta previa-accreta, 30 cases of non-adherent placenta previa, and 112 cases of age and BMI-matched, healthy pregnant controls. PIGF multiples of the median (MoM) were acquired from laboratory data files. The predictor of placenta accreta was analyzed by using multiple logistic regression analysis. RESULTS PIGF MoM of placenta previa-accreta group was significantly higher than those of the non-adherent placenta previa group and control group (p = 0.0098 < 0.01, p = 0.0002 < 0.01). Serum PIGF was found to be significantly positively associated with placenta accreta after adjusted gestational week at time of blood sampling, BMI, and age (OR: 4.83; 95% CI: 1.91-12.24;p = 0.0009 < 0.01). In addition, previous cesarean section history (OR: 2.75; 95% CI: 1.23-6.17; p = 0.014 < 0.05) and smoking (OR: 9.17; 95% CI: 1.69-49.62; p = 0.010 < 0.05) were also significantly associated with placenta accreta. CONCLUSION Increased first trimester serum PIGF was significantly positively associated with placenta accreta, suggesting that the potential role of PIGF in identifying pregnancies at high risk for placenta accreta. Previous cesarean section history and smoking may be the risk factors for accreta in placenta previa patients.
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Affiliation(s)
- Fengge Wang
- Department of Obstetric, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China
| | - Lihua Zhang
- Department of Obstetric, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China
| | - Fanyong Zhang
- Department of Obstetric, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China
| | - Jishui Wang
- Department of Obstetric, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China
| | - Yangping Wang
- Department of Obstetric, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China
| | - Dongmei Man
- Department of Obstetric, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China.
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18
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Yang Y, Ye J, Ng TK, Wu N, Sun X, Chen Y, Chen Y. Changes in corneal biomechanics during pregnancy in Chinese healthy female. Eur J Ophthalmol 2020; 31:361-366. [PMID: 31983220 DOI: 10.1177/1120672120902034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate the changes of corneal biomechanics and the intraocular pressure during pregnancy in a Chinese healthy female population. METHODS A total of 222 unrelated Chinese females were recruited: 52 non-pregnant, 15 pregnant in the first trimester, 68 pregnant in the second trimester, and 87 pregnant in the third trimester. The intraocular pressure and corneal biomechanical parameters, including corneal-compensated intraocular pressure, Goldmann-correlated intraocular pressure, corneal hysteresis, and corneal resistance factor, were measured by an Ocular Response Analyzer G3. Central corneal thickness was measured by Lenstar (LS900). RESULTS Corneal hysteresis and corneal resistance factor were significantly higher in pregnant women at the second and third trimesters. Corneal-compensated intraocular pressure was lower in women at the third trimester of pregnancy (p = 0.023), but the difference became insignificant after adjustment for corneal hysteresis. Central corneal thickness was marginally higher in pregnant women than non-pregnant women (p = 0.032). There was a negative correlation between corneal-compensated intraocular pressure and corneal hysteresis (r = -0.337, p < 0.001) and a positive correlation between central corneal thickness and corneal hysteresis (r = 0.711, p < 0.0001). After adjustment for corneal-compensated intraocular pressure, corneal hysteresis remained significantly higher in the second and third trimesters of pregnant women than non-pregnant women (p = 0.031, p = 0.005). CONCLUSION This study revealed a significant increase in corneal hysteresis and corneal resistance factor in the second and third trimesters. The increase of corneal hysteresis was independent of corneal-compensated intraocular pressure, indicating pregnant females have unique characteristics in corneal-compensated intraocular pressure and corneal biomechanical properties that may be related to glaucoma and corneal ectatic diseases in pregnancy.
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Affiliation(s)
- Yaping Yang
- Department of Ophthalmology and Visual Science, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Ministry of Health, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Jun Ye
- Department of Obstetrics and Gynecology, The Fifth People's Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Tsz Kin Ng
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, China.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Na Wu
- Department of Ophthalmology and Visual Science, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Ministry of Health, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Xinghuai Sun
- Department of Ophthalmology and Visual Science, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Ministry of Health, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration, Shanghai, China.,State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China
| | - Yaping Chen
- Department of Obstetrics and Gynecology, The Fifth People's Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yuhong Chen
- Department of Ophthalmology and Visual Science, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Ministry of Health, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration, Shanghai, China
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19
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Gomes ES, Leite FR, Ferraz BR, Mourão HA, Malagutti AR. Voltammetric sensor based on cobalt-poly(methionine)-modified glassy carbon electrode for determination of estriol hormone in pharmaceuticals and urine. J Pharm Anal 2020; 9:347-357. [PMID: 31929944 PMCID: PMC6951483 DOI: 10.1016/j.jpha.2019.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 03/26/2019] [Accepted: 04/01/2019] [Indexed: 11/19/2022] Open
Abstract
A voltammetric sensor based on the electropolymerization of cobalt-poly(methionine) (Co-poly(Met)) on a glassy carbon electrode (GCE) was developed and applied for the determination of estriol by differential pulse voltammetry (DPV) for the first time. The electrochemical properties of the Co-poly(Met)/GCE were analysed by cyclic voltammetry (CV) and electrochemical impedance spectroscopy (EIS). Scanning electron microscopy (SEM) and energy dispersive spectroscopy (EDS) were used to characterize the polymers on the GCE surface. The deposition of the Co-poly(Met) film on the GCE surface enhanced the sensor electronic transfer. CV studies revealed that estriol exhibits an irreversible oxidation peak at +0.58 V for the Co-poly(Met)/GCE (vs. Ag/AgCl reference electrode) in 0.10 mol/L Britton-Robinson buffer solution (pH = 7.0). Different voltammetric scan rates (10–200 mV/s) suggested that the estriol oxidation on the Co-poly(Met)/GCE surface is controlled by adsorption and diffusion processes. Based on the optimized DPV conditions, the linear responses for estriol quantification were from 0.596 μmol/L to 4.76 μmol/L (R2 = 0.996) and from 5.66 μmol/L to 9.90 μmol/L (R2 = 0.994) with a limit of detection (LOD) of 0.0340 μmol/L and a limit of quantification (LOQ) of 0.113 μmol/L. The DPV-Co-poly(Met)/GCE method provided good intra-day and inter-day repeatability with RSD values lower than 5%. Also, no interference of real sample matrices was observed on the estriol voltammetric response, making the DPV-Co-poly(Met)/GCE highly selective for estriol. The accuracy test showed that the estriol recovery was in the ranges 96.7%–103% and 98.7%–102% for pharmaceutical tablets and human urine, respectively. The estriol quantification in pharmaceutical tablets performed by the Co-poly(Met)/GCE-assisted DPV method was comparable to the official analytical protocols.
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Affiliation(s)
- Eliziana S. Gomes
- Department of Pharmacy, Faculty of Biological and Health Sciences, Federal University of Jequitinhonha and Mucuri Valleys, MGT 367 Highway – Km 583, CEP 39100-000, Diamantina, MG, Brazil
| | - Fernando R.F. Leite
- Department of Pharmacy, Faculty of Biological and Health Sciences, Federal University of Jequitinhonha and Mucuri Valleys, MGT 367 Highway – Km 583, CEP 39100-000, Diamantina, MG, Brazil
| | - Bruno R.L. Ferraz
- Department of Biology, Federal University of Espírito Santo, CEP 29500-000, Alegre, ES, Brazil
| | - Henrique A.J.L. Mourão
- Institute of Science and Technology, Federal University of Jequitinhonha and Mucuri Valleys, MGT 367 Highway – Km 583, CEP 39100-000, Diamantina, MG, Brazil
| | - Andréa R. Malagutti
- Department of Pharmacy, Faculty of Biological and Health Sciences, Federal University of Jequitinhonha and Mucuri Valleys, MGT 367 Highway – Km 583, CEP 39100-000, Diamantina, MG, Brazil
- Corresponding author.
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20
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Tong S, Joy Kaitu'u-Lino T, Walker SP, MacDonald TM. Blood-based biomarkers in the maternal circulation associated with fetal growth restriction. Prenat Diagn 2019; 39:947-957. [PMID: 31299098 DOI: 10.1002/pd.5525] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/28/2019] [Accepted: 07/03/2019] [Indexed: 11/11/2022]
Abstract
Fetal growth restriction (FGR) is associated with threefold to fourfold increased risk of stillbirth. Identifying FGR, through its commonly used surrogate-the small-for-gestational-age (SGA, estimated fetal weight and/or abdominal circumference <10th centile) fetus-and instituting fetal surveillance and timely delivery decrease stillbirth risk. Methods available to clinicians for antenatal identification of SGA fetuses have surprisingly poor sensitivity. About 80% of cases remain undetected. Measuring the symphysis-fundal height detects only 20% of SGA fetuses, and even universal third trimester ultrasound detects, at best, 57% of those born SGA. There is an urgent need to find better ways to identify this at-risk cohort. This review summarises efforts to identify molecular biomarkers (proteins, metabolites, or ribonucleic acids) that could be used to better predict FGR. Most studies examining potential biomarkers to date have utilised case-control study designs without proceeding to validation in independent cohorts. To develop a robust test for FGR, large prospective studies are required with a priori validation plans and cohorts. Given that current clinical care detects 20% of SGA fetuses, even a screening test with ≥60% sensitivity at 90% specificity could be clinically useful, if developed. This may be an achievable aspiration. If discovered, such a test may decrease stillbirth.
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Affiliation(s)
- Stephen Tong
- Mercy Perinatal, Mercy Hospital for Women, Melbourne, Victoria, Australia.,Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Tu'uhevaha Joy Kaitu'u-Lino
- Mercy Perinatal, Mercy Hospital for Women, Melbourne, Victoria, Australia.,Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Susan Philippa Walker
- Mercy Perinatal, Mercy Hospital for Women, Melbourne, Victoria, Australia.,Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Teresa Mary MacDonald
- Mercy Perinatal, Mercy Hospital for Women, Melbourne, Victoria, Australia.,Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
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21
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Riihimäki O, Tikkanen M, Melin J, Andersson S, Metsäranta M, Nuutila M, Gissler M, Paavonen J, Pukkala E. Subsequent risk of cancer among women with a history of placental abruption. Acta Oncol 2019; 58:52-56. [PMID: 30264633 DOI: 10.1080/0284186x.2018.1512155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Placentation is characterized by extensive cell proliferation and neovascularization, which is similar to the processes observed in the development of cancer. Nonetheless, little is known about the relation between abnormal placentation, such as placental abruption, and cancer. MATERIAL AND METHODS Data on women with placental abruption in a singleton pregnancy between 1971 and 2005 (n = 7804) were collected from the Finnish Hospital Discharge Registry and the Finnish Medical Birth Registry. The cohort was then linked with the Finnish Cancer Registry records until the end of 2013. Standardized incidence ratios (SIRs) were calculated for different cancers by dividing the observed numbers of cancers by those expected. The expected numbers were based on national cancer incidence rates. RESULTS During follow-up, 597 cancers were found among women with a history of placental abruption. The overall risk of cancer was not increased (SIR 0.95, 95% CI 0.88-1.02). However, the history of placental abruption was associated with an increased risk of lung cancer (SIR 1.51, 95% CI 1.05-2.10) and thyroid cancer (SIR 1.47, 95% CI 1.04-2.02). A decreased risk was found for breast cancer (SIR 0.85, 95% CI 0.75-0.96). The risk of rectal cancer was also decreased, although these numbers were small (SIR 0.49, 95% CI 0.20-1.01). CONCLUSIONS Overall, the risk of lung cancer was increased, and the risk of breast cancer decreased, in women with a history of placental abruption. These observations can be explained to some extent by risk factors or risk markers for placental abruption. The increased risk of thyroid cancer may be explained by surveillance bias.
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Affiliation(s)
- Outi Riihimäki
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Minna Tikkanen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Johanna Melin
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Sture Andersson
- Children’s Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marjo Metsäranta
- Children’s Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika Nuutila
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika Gissler
- THL National Institute for Health and Welfare, Helsinki, Finland and Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Stockholm, Sweden
| | - Jorma Paavonen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eero Pukkala
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
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22
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Yuan X, Long W, Liu J, Zhang B, Zhou W, Jiang J, Yu B, Wang H. Associations of serum markers screening for Down's syndrome with pregnancy outcomes: A Chinese retrospective cohort study. Clin Chim Acta 2018; 489:130-135. [PMID: 30529497 DOI: 10.1016/j.cca.2018.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/22/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND We examined the associations between Down's serum screening analytes and pregnancy outcomes in Chinese women. METHODS A retrospective cohort study of 2470 pregnant women was conducted. Maternal serum triple tests (AFP, fβ-hCG, uE3), maternal characteristics and pregnancy outcomes were recorded from our prenatal screening and hospitalization information system, respectively. RESULTS The elevated concentration of uE3 in the early-second trimester was associated with increased risk of LGA infants and macrosomia, decreased risk of PE and small SGA infants (for LGA: OR: 1.34, 95% CI: 1.09-1.65; for macrosomia: OR:1.39, 95% CI: 1.08-1.78; for PE: OR: 0.61, 95% CI: 0.40-0.95; for SGA: OR: 0.35, 95% CI: 0.25-0.49). The increased ratio of AFP/uE3 was associated with reduced risk of GDM in the study populations (BMI ≥ 25; OR: 0.96, 95% CI: 0.0.93-1.00). The higher ratio of AFP/fβ-hCG + uE3 associated with increased risk of SGA infants and ICP in these subjects (BMI ≥ 25) was also observed (for SGA: OR: 1.11, 95% CI: 1.03-1.18; for ICP: OR: 1.27, 95% CI: 1.06-1.53). CONCLUSIONS Down's serum screening analytes were associated with pregnancy outcomes in Chinese population and might provide an alternative tools for risk estimates on these unfavorable outcomes.
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Affiliation(s)
- Xiaosong Yuan
- Department of Prenatal Diagnosis Laboratory, Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, No. 16 Bo Ai Road, Changzhou, Jiangsu Province, China
| | - Wei Long
- Department of Prenatal Diagnosis Laboratory, Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, No. 16 Bo Ai Road, Changzhou, Jiangsu Province, China
| | - Jianbing Liu
- Department of Prenatal Diagnosis Laboratory, Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, No. 16 Bo Ai Road, Changzhou, Jiangsu Province, China
| | - Bin Zhang
- Department of Prenatal Diagnosis Laboratory, Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, No. 16 Bo Ai Road, Changzhou, Jiangsu Province, China
| | - Wenbai Zhou
- Department of Prenatal Diagnosis Laboratory, Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, No. 16 Bo Ai Road, Changzhou, Jiangsu Province, China
| | - Jian Jiang
- Department of Obstetrics and Gynecology, Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, No. 16 Bo Ai Road, Changzhou, Jiangsu Province, China
| | - Bin Yu
- Department of Prenatal Diagnosis Laboratory, Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, No. 16 Bo Ai Road, Changzhou, Jiangsu Province, China.
| | - Huiyan Wang
- Department of Obstetrics and Gynecology, Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, No. 16 Bo Ai Road, Changzhou, Jiangsu Province, China.
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Estrogen- and Progesterone-Induced Variation in Corneal Parameters According to Hormonal Status. Eye Contact Lens 2018; 44 Suppl 1:S179-S184. [PMID: 28244931 DOI: 10.1097/icl.0000000000000376] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the effects of estrogen and progesterone on corneal thickness, curvature, and biomechanics in healthy corneas according to hormonal status. METHODS The study included four groups of females: group A (menstruating, not pregnant, not lactating, and not menopausal; n=100), group B (pregnant; n=50), group C (lactating; n=50), and group D (menopausal; n=50). Group A was subdivided according to age, as subgroup A15-25 (age 15-25 years) and subgroup A>25 (age >25 years). Blood estradiol and progesterone levels were measured in each participant. All the participants underwent a full ophthalmologic examination, including corneal thickness and corneal topography measurement, and evaluation of corneal biomechanical properties. RESULTS The corneal resistance factor and anterior corneal flat keratometry values were significantly higher in group D (P=0.040 and P=0.026, respectively) than in the other three groups. Posterior corneal steep keratometry values were significantly higher in subgroup A>25 during the preovulatory phase than ovulatory and postovulatory phases (P=0.012). In group B, there was a significant negative correlation between gestational week and intraocular pressure (IOP) (r=-0.322, P=0.024). Corneal volume was significantly higher during the early postpartum period than the late postpartum period in group C (P=0.028). Intraocular pressure, Goldman-correlated IOP, and corneal-compensated IOP differed significantly between the groups (P<0.05). CONCLUSIONS Blood levels of estrogen and progesterone were associated with variations in IOP, but estrogen and progesterone did not have a consistent effect on topographic parameters or biomechanical properties in healthy corneas.
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Dreyer FE, Abdulrahman GO, Waring G, Hinshaw K. Placental steroid sulphatase deficiency: an approach to antenatal care and delivery. Ann Saudi Med 2018; 38:445-449. [PMID: 30531180 PMCID: PMC6302985 DOI: 10.5144/0256-4947.2018.445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Placental steroid sulphatase deficiency (SSD) is an X-linked inborn error of metabolism. Congenital X-linked ichthyosis (XLI) is a genetic disorder of keratinisation caused by steroid sulphatase (STS) deficiency, which results in a scaling skin condition in male infants shortly after birth. It may be associated with failed induction of labor and prolonged labor leading to cesarean delivery due to 'cervical dystocia'. We present two cases of congenital ichthyosis. Thorough counselling of women with a previously affected pregnancy during the antenatal period should include discussion about mode of delivery and a critical review of the complexities of prenatal diagnosis in this condition. We propose a clinical management pathway to offer women with a previous pregnancy affected by this rare condition. SIMILAR CASES PUBLISHED: Less than 50 cases reported.
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Affiliation(s)
- Frieda-Elsje Dreyer
- Frieda Elsje Dreyer, Department of Obstetrics and Gynaecology,, Sunderland Royal Hospital,, Sunderland SR4 7TP, United Kingdom, T: +44 0191 565 6256, , ORCID: http://orcid.org/0000-0002.0997-9919
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Oksuzoglu A, Engin Ustun Y, Aktulay A, Yoruk O, Seckin B, Danisman N. First and Second Trimester Biochemical Markers in Maternal Epilepsy: A Case-Control Study. Fetal Pediatr Pathol 2018; 37:319-325. [PMID: 30247941 DOI: 10.1080/15513815.2018.1502381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Our aim is to investigate whether the maternal serum levels of first and second trimester serum analytes are altered in women with epilepsy in pregnancy. METHODS Maternal serum biochemical markers (estriol, alpha-fetoprotein [AFP], human chorionic gonadotrophin [hCG], free β hCG, pregnancy-associated plasma protein-A) were compared in a series of 122 pregnant women with epilepsy and in a cohort of 122 normal pregnant women. The serum samples were obtained between 11-13 6/7 weeks and 16-18 weeks gestation. RESULTS Second trimester serum estriol levels, expressed as multiples of the median (MoM), in the epileptic group (1.55 ± 0.77 MoM) were significantly higher than those in the control patients (1.13 ± 0.40 MoM) (p < 0.001). Of the women with epilepsy, 66.3% (n = 81) were exposed to antiepileptic drugs. CONCLUSION Our study revealed that otherwise uncomplicated pregnant epileptic women had higher second trimester (18-20 weeks of gestation) estriol levels compared to non-epileptic pregnant women.
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Affiliation(s)
- Aysegul Oksuzoglu
- a Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Research and Education Hospital , Ankara , Turkey
| | - Yaprak Engin Ustun
- a Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Research and Education Hospital , Ankara , Turkey
| | - Ayla Aktulay
- a Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Research and Education Hospital , Ankara , Turkey
| | - Ozlem Yoruk
- a Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Research and Education Hospital , Ankara , Turkey
| | - Berna Seckin
- a Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Research and Education Hospital , Ankara , Turkey
| | - Nuri Danisman
- a Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Research and Education Hospital , Ankara , Turkey
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Gaccioli F, Aye ILMH, Sovio U, Charnock-Jones DS, Smith GCS. Screening for fetal growth restriction using fetal biometry combined with maternal biomarkers. Am J Obstet Gynecol 2018; 218:S725-S737. [PMID: 29275822 DOI: 10.1016/j.ajog.2017.12.002] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 11/24/2017] [Accepted: 12/01/2017] [Indexed: 12/31/2022]
Abstract
Fetal growth restriction is a major determinant of perinatal morbidity and mortality. Screening for fetal growth restriction is a key element of prenatal care but it is recognized to be problematic. Screening using clinical risk assessment and targeting ultrasound to high-risk women is the standard of care in the United States and United Kingdom, but the approach is known to have low sensitivity. Systematic reviews of randomized controlled trials do not demonstrate any benefit from universal ultrasound screening for fetal growth restriction in the third trimester, but the evidence base is not strong. Implementation of universal ultrasound screening in low-risk women in France failed to reduce the risk of complications among small-for-gestational-age infants but did appear to cause iatrogenic harm to false positives. One strategy to making progress is to improve screening by developing more sensitive and specific tests with the key goal of differentiating between healthy small fetuses and those that are small through fetal growth restriction. As abnormal placentation is thought to be the major cause of fetal growth restriction, one approach is to combine fetal biometry with an indicator of placental dysfunction. In the past, these indicators were generally ultrasonic measurements, such as Doppler flow velocimetry of the uteroplacental circulation. However, another promising approach is to combine ultrasonic suspicion of small-for-gestational-age infant with a blood test indicating placental dysfunction. Thus far, much of the research on maternal serum biomarkers for fetal growth restriction has involved the secondary analysis of tests performed for other indications, such as fetal aneuploidies. An exemplar of this is pregnancy-associated plasma protein A. This blood test is performed primarily to assess the risk of Down syndrome, but women with low first-trimester levels are now serially scanned in later pregnancy due to associations with placental causes of stillbirth, including fetal growth restriction. The development of "omic" technologies presents a huge opportunity to identify novel biomarkers for fetal growth restriction. The hope is that when such markers are measured alongside ultrasonic fetal biometry, the combination would have strong predictive power for fetal growth restriction and its related complications. However, a series of important methodological considerations in assessing the diagnostic effectiveness of new tests will have to be addressed. The challenge thereafter will be to identify novel disease-modifying interventions, which are the essential partner to an effective screening test to achieve clinically effective population-based screening.
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Affiliation(s)
- Francesca Gaccioli
- Department of Obstetrics and Gynaecology, National Institute for Health Research Cambridge Comprehensive Biomedical Research Center, and Center for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom
| | - Irving L M H Aye
- Department of Obstetrics and Gynaecology, National Institute for Health Research Cambridge Comprehensive Biomedical Research Center, and Center for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom
| | - Ulla Sovio
- Department of Obstetrics and Gynaecology, National Institute for Health Research Cambridge Comprehensive Biomedical Research Center, and Center for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom
| | - D Stephen Charnock-Jones
- Department of Obstetrics and Gynaecology, National Institute for Health Research Cambridge Comprehensive Biomedical Research Center, and Center for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom
| | - Gordon C S Smith
- Department of Obstetrics and Gynaecology, National Institute for Health Research Cambridge Comprehensive Biomedical Research Center, and Center for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom.
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Bonnin A, Muller F, Senat MV, Sault C, Galland A, Taieb J, Dreux S, Bouyer J, Benachi A. Down syndrome maternal serum markers in oocyte donation and other assisted reproductive technologies. Prenat Diagn 2017; 37:1155-1159. [DOI: 10.1002/pd.5157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/06/2017] [Accepted: 09/11/2017] [Indexed: 01/11/2023]
Affiliation(s)
- Aurore Bonnin
- Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Antoine Béclère, AP-HP; Université Paris Sud; 92140 Clamart France
| | - Françoise Muller
- Biochimie-Hormonologie; Hôpital Robert Debré, AP-HP; 75019 Paris France
| | - Marie-Victoire Senat
- Gynécologie-Obstétrique; Hôpital Bicêtre, AP-HP; 94270 Le Kremlin-Bicêtre France
| | | | | | - Joëlle Taieb
- Biochimie; Hôpital Antoine Béclère, AP-HP; 92140 Clamart France
| | - Sophie Dreux
- Biochimie-Hormonologie; Hôpital Robert Debré, AP-HP; 75019 Paris France
| | - Jean Bouyer
- Center for Research in Epidemiology and Population Health (CESP), Inserm, Univ Paris-Sud, UVSQ; Université Paris Saclay; F-94276 Le Kremlin Bicêtre France
| | - Alexandra Benachi
- Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Antoine Béclère, AP-HP; Université Paris Sud; 92140 Clamart France
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Miranda J, Rodriguez-Lopez M, Triunfo S, Sairanen M, Kouru H, Parra-Saavedra M, Crovetto F, Figueras F, Crispi F, Gratacós E. Prediction of fetal growth restriction using estimated fetal weight vs a combined screening model in the third trimester. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:603-611. [PMID: 28004439 DOI: 10.1002/uog.17393] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 10/16/2016] [Accepted: 12/16/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To compare the performance of third-trimester screening, based on estimated fetal weight centile (EFWc) vs a combined model including maternal baseline characteristics, fetoplacental ultrasound and maternal biochemical markers, for the prediction of small-for-gestational-age (SGA) neonates and late-onset fetal growth restriction (FGR). METHODS This was a nested case-control study within a prospective cohort of 1590 singleton gestations undergoing third-trimester (32 + 0 to 36 + 6 weeks' gestation) evaluation. Maternal baseline characteristics, mean arterial pressure, fetoplacental ultrasound and circulating biochemical markers (placental growth factor (PlGF), lipocalin-2, unconjugated estriol and inhibin A) were assessed in all women who subsequently delivered a SGA neonate (n = 175), defined as birth weight < 10th centile according to customized standards, and in a control group (n = 875). Among SGA cases, those with birth weight < 3rd centile and/or abnormal uterine artery pulsatility index (UtA-PI) and/or abnormal cerebroplacental ratio (CPR) were classified as FGR. Logistic regression predictive models were developed for SGA and FGR, and their performance was compared with that obtained using EFWc alone. RESULTS In SGA cases, EFWc, CPR Z-score and maternal serum concentrations of unconjugated estriol and PlGF were significantly lower, while mean UtA-PI Z-score and lipocalin-2 and inhibin A concentrations were significantly higher, compared with controls. Using EFWc alone, 52% (area under receiver-operating characteristics curve (AUC), 0.82 (95% CI, 0.77-0.85)) of SGA and 64% (AUC, 0.86 (95% CI, 0.81-0.91)) of FGR cases were predicted at a 10% false-positive rate. A combined screening model including a-priori risk (maternal characteristics), EFWc, UtA-PI, PlGF and estriol (with lipocalin-2 for SGA) achieved a detection rate of 61% (AUC, 0.86 (95% CI, 0.83-0.89)) for SGA cases and 77% (AUC, 0.92 (95% CI, 0.88-0.95)) for FGR. The combined model for the prediction of SGA and FGR performed significantly better than did using EFWc alone (P < 0.001 and P = 0.002, respectively). CONCLUSIONS A multivariable integrative model of maternal characteristics, fetoplacental ultrasound and maternal biochemical markers modestly improved the detection of SGA and FGR cases at 32-36 weeks' gestation when compared with screening based on EFWc alone. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- J Miranda
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, IDIBAPS, University of Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - M Rodriguez-Lopez
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, IDIBAPS, University of Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - S Triunfo
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, IDIBAPS, University of Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | | | - H Kouru
- PerkinElmer, Inc., Turku, Finland
| | - M Parra-Saavedra
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, IDIBAPS, University of Barcelona, Spain
- Maternal-Fetal Unit, CEDIFETAL, Centro de Diagnostico de Ultrasonido e Imágenes, CEDIUL, Barranquilla, Colombia
| | - F Crovetto
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, IDIBAPS, University of Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - F Figueras
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, IDIBAPS, University of Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - F Crispi
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, IDIBAPS, University of Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - E Gratacós
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, IDIBAPS, University of Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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Bartkute K, Balsyte D, Wisser J, Kurmanavicius J. Pregnancy outcomes regarding maternal serum AFP value in second trimester screening. J Perinat Med 2017; 45:817-820. [PMID: 27771626 DOI: 10.1515/jpm-2016-0101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 09/29/2016] [Indexed: 11/15/2022]
Abstract
AIM The aim of this study was to evaluate the predictive value of α-fetoprotein in maternal serum (MS-AFP) as a marker for diverse pregnancy outcomes. METHODS The study was based on pregnancy and delivery data from 5520 women between 1999 and 2014 at University Hospital of Zurich (UHZ). INCLUSION CRITERIA both MS-AFP and pregnancy outcome were known for the same pregnancy. Pregnancy outcomes and characteristics such as fetal malformation, intrauterine fetal death (IUFD) and intrauterine growth retardation as well as maternal age, weight before pregnancy, gestational age (GA) at delivery, newborn weight, length and head circumference were analyzed with respect to the MS-AFP value. MS-AFP value was categorized into three groups: elevated MS-AFP>2.5 multiples of the median (MoM), normal 0.5-2.49 MoM and decreased <0.5 MoM. RESULTS Newborn weight (g) and length (cm) were significantly lower in the elevated MS-AFP (P<0.001) group, and infants had 1 week lower GA at delivery (P<0.05). In the group of elevated MS-AFP (n=46), 26.1% of pregnancies were significantly related to adverse pregnancy outcomes, such as fetal malformations, fetuses small for gestational age (SGA) and IUFD. Adverse pregnancy outcomes of 5.6% were registered in the group of normal MS-AFP and 7.3% in the group of low MS-AFP (P<0.05). CONCLUSION MS-AFP level in the second trimester is still an important indicator of fetal surface malformations; however, ultrasound still outweighs as a screening method. Nevertheless, pregnant women with elevated MS-AFP values and with no sonographically detected fetal malformations should additionally receive the third trimester ultrasound examination to exclude other possible complications of pregnancy.
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Wang C, Li AL, Pang Y, Lei YQ, Yu L. Changes in intraocular pressure and central corneal thickness during pregnancy: a systematic review and Meta-analysis. Int J Ophthalmol 2017; 10:1573-1579. [PMID: 29062778 DOI: 10.18240/ijo.2017.10.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 08/10/2017] [Indexed: 01/29/2023] Open
Abstract
AIM To conduct a Meta-analysis for investigating the variations in intraocular pressure (IOP) and central corneal thickness (CCT) during normal pregnancy. METHODS We searched for clinical trials published up to November 2015 without language or region restrictions in PubMed, EMBASE, Web of Science, the Cochrane Central Register of Controlled Trials, Ovid, EBSCO, Elsevier, the Chinese Biomedicine Database, WanFang, CNKI, CQVIP and Google Scholar. Studies of the ocular changes observed in pregnant women were selected. The main outcomes were assessed by changes in IOP and CCT. RESULTS Fifteen studies were included. In subgroup analyses, IOP was significantly decreased during the second MD=-1.53, 95%CI (-2.19, -0.87); P<0.00001, and third MD=-2.91, 95%CI (-3.74, -2.08); P<0.00001 trimesters of pregnancy. CCT was increased during the second MD=10.12, 95%CI (2.01, 18.22); P=0.01, trimester of pregnancy; moreover, during the third trimester of pregnancy, the CCT displayed an increasing trend, but the difference was not significant MD=5.98, 95%CI (-1.11, 13.07); P=0.1. CONCLUSION A decrease in IOP is accompanied by an increase in CCT in the second and third trimesters of a normal pregnancy in women.
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Affiliation(s)
- Chao Wang
- Department of Ophthalmology, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Ai-Ling Li
- Department of the School of Public Health of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Yu Pang
- Department of Ophthalmology, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Ying-Qing Lei
- Department of Ophthalmology, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Ling Yu
- Department of Ophthalmology, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
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Soni S, Krantz DA, Greenberg M, Vohra N, Rochelson B. Recurrence of extreme serum analytes in consecutive pregnancies and association with obstetrical outcomes . J Matern Fetal Neonatal Med 2017; 32:85-91. [PMID: 28838266 DOI: 10.1080/14767058.2017.1371695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate if presence of extreme maternal serum biochemical analytes recurs in consecutive pregnancies. We hypothesized that presence of >1 extreme analyte in prior pregnancy is associated with increased risk of adverse pregnancy outcome in subsequent pregnancy. METHODS Retrospective cohort study of singleton pregnancies evaluated and delivered in 2 consecutive pregnancies (2011-2015). Adverse outcomes were defined as indicated preterm delivery before 37 completed weeks due to preeclampsia, fetal growth restriction or other complications. RESULTS First and second trimester maternal serum analytes were assessed in 1434 patients in 2 consecutive pregnancies. The presence of >1 extreme serum analyte in prior pregnancy significantly increased likelihood of >1 extreme analyte in subsequent pregnancy. The likelihood increased as number of prior extreme markers increased. In patients with normal outcomes and 2 or more extreme serum analytes in prior pregnancy, there was an increased incidence of adverse pregnancy outcomes in subsequent pregnancy with relative risk (RR) of 5.42 [95% CI 1.6-18.3]. CONCLUSIONS The presence of more than 1 extreme serum marker in one pregnancy increases likelihood of recurrence in subsequent pregnancies. Risk of adverse outcomes in subsequent pregnancy can be evaluated based on biochemistry results as well as prior pregnancy outcomes.
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Affiliation(s)
- Shelly Soni
- a Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology , Hofstra-Northwell School of Medicine , Manhasset , NY , USA
| | | | - Meir Greenberg
- c Division of Obgyn Medical Informatics, Department of Obstetrics and Gynecology , Hofstra-Northwell School of Medicine , Manhasset , NY , USA
| | - Nidhi Vohra
- a Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology , Hofstra-Northwell School of Medicine , Manhasset , NY , USA
| | - Burton Rochelson
- a Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology , Hofstra-Northwell School of Medicine , Manhasset , NY , USA
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Savaş HB, Köse SA, Güler M, Gültekin F. Gebelerde ikinci trimester tarama testinde biyokimyasal belirteçler ile gebelik komplikasyonları arasındaki ilişki. ACTA MEDICA ALANYA 2017. [DOI: 10.30565/medalanya.265994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Yaron Y, Hyett J, Langlois S. Current controversies in prenatal diagnosis 2: for those women screened by NIPT using cell free DNA, maternal serum markers are obsolete. Prenat Diagn 2016; 36:1167-1171. [PMID: 27747900 DOI: 10.1002/pd.4944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 10/08/2016] [Accepted: 10/11/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Yuval Yaron
- Genetic Institute, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Jon Hyett
- Royal Prince Alfred Hospital Sydney, University of Sydney, Sydney, NSW, Australia
| | - Sylvie Langlois
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
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Agopian AJ, Hoang TT, Mitchell LE, Morrison AC, Tu D, Nassar N, Canfield MA. Maternal hypertension and risk for hypospadias in offspring. Am J Med Genet A 2016; 170:3125-3132. [PMID: 27570224 DOI: 10.1002/ajmg.a.37947] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/11/2016] [Indexed: 02/05/2023]
Abstract
Hypospadias is one of the most common birth defects in male infants. Maternal hypertension is a suspected risk factor; however, few previous studies have addressed the possibility of reporting bias, and several previous studies have not accounted for hypospadias severity. We analyzed data from the Texas Birth Defects Registry for 10,924 nonsyndromic cases and statewide vital records for deliveries during 1999-2009, using Poisson regression. After adjustment for potential confounders, hypospadias was associated with maternal hypertension (adjusted prevalence ratio: 1.5, 95% confidence interval: 1.4-1.7). Similar associations were observed with gestational and pregestational hypertension, including separate analyses restricted to the subset of cases with severe (second- or third-degree) hypospadias. All of these associations were also similar among the subset of cases with isolated hypospadias (without additional birth defects). To evaluate the potential for bias due to potential hypertension misclassification, we repeated our analyses using logistic regression, comparing the cases to controls with other birth defects. In these analyses, the associations with gestational hypertension were similar, but adjusted associations with pregestational hypertension were no longer observed. Our findings support an association between gestational hypertension and hypospadias in offspring, but also suggest that previously observed associations with pregestational hypertension may have been inflated due to differential misclassification of hypertension (e.g., reporting bias). As gestational hypertension is recognized after hypospadias development, more research is needed to determine if this association reflects an increase in gestational hypertension risk secondary to hypospadias or if both conditions have shared risk factors (e.g., precursors of gestational hypertension). © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- A J Agopian
- Department of Epidemiology, Human Genetics and Environmental Sciences, Human Genetics Center, University of Texas School of Public Health, Houston, Texas
| | - Thanh T Hoang
- Department of Epidemiology, Human Genetics and Environmental Sciences, Human Genetics Center, University of Texas School of Public Health, Houston, Texas
| | - Laura E Mitchell
- Department of Epidemiology, Human Genetics and Environmental Sciences, Human Genetics Center, University of Texas School of Public Health, Houston, Texas
| | - Alanna C Morrison
- Department of Epidemiology, Human Genetics and Environmental Sciences, Human Genetics Center, University of Texas School of Public Health, Houston, Texas
| | - Duong Tu
- Department of Urology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Natasha Nassar
- Menzies Centre for Health Policy, The University of Sydney, New South Wales, Australia
| | - Mark A Canfield
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas
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Çınar M, Timur H, Aksoy RT, Güzel Aİ, Tokmak A, Bedir Fındık R, Uygur D. Evaluation of maternal and perinatal outcomes among overweight women who experienced stillbirth. J Matern Fetal Neonatal Med 2016; 30:38-42. [PMID: 26857830 DOI: 10.3109/14767058.2016.1152255] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To investigate associations between overweight and adverse clinical outcomes among women who experienced stillbirth. METHODS 234 pregnant women (stillbirth group, n = 115; live birth group, n = 119) were included in this retrospective case-control study. Recorded risk factors were age, gravidity, parity, gestational weeks, fetal birth weight, gestational diabetes mellitus (GDM), preeclampsia (PE), intrauterine growth restriction (IUGR), levels of prenatal test markers (alpha-fetoprotein (AFP), pregnancy-associated plasma protein, human chorionic gonadotropin (β-hCG) and E3) and body mass index (BMI). RESULTS Statistically significant differences were observed between the groups in terms of birth weight, IUGR, GDM, PE, AFP level, β-hCG level, maternal E3 level and BMI (p < 0.05). Subgroup analyses revealed that 34 and 81 patients in the stillbirth group were of normal weight and overweight, respectively, fetal birth weight, IUGR, GDM, PE, AFP level, β-hCG level and E3 level differed significantly between these subgroups and the live birth group (p < 0.05). CONCLUSIONS Women who experience stillbirth tend to be more overweight than those who experience live birth. Additionally, IUGR, GDM and PE are more common among overweight women. Therefore, overweight women should be encouraged to lose weight before pregnancy. If they become pregnant without losing weight, they should be followed up closely to avoid adverse perinatal outcomes.
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Affiliation(s)
- Mehmet Çınar
- a Department of Obstetrics and Gynecology , Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey
| | - Hakan Timur
- a Department of Obstetrics and Gynecology , Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey
| | - Rıfat Taner Aksoy
- a Department of Obstetrics and Gynecology , Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey
| | - Ali İrfan Güzel
- a Department of Obstetrics and Gynecology , Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey
| | - Aytekin Tokmak
- a Department of Obstetrics and Gynecology , Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey
| | - Rahime Bedir Fındık
- a Department of Obstetrics and Gynecology , Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey
| | - Dilek Uygur
- a Department of Obstetrics and Gynecology , Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey
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Blitz MJ, Rochelson B, Vohra N. Maternal Serum Analytes as Predictors of Fetal Growth Restriction with Different Degrees of Placental Vascular Dysfunction. Clin Lab Med 2016; 36:353-67. [PMID: 27235917 DOI: 10.1016/j.cll.2016.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Abnormal levels of maternal serum analytes have been associated with fetal growth restriction (FGR) and preeclampsia secondary to placental vascular dysfunction. Accurately identifying the FGR fetuses at highest risk for adverse outcomes remains challenging. Placental function can be assessed by Doppler analysis of the maternal and fetal circulation. Although the combination of multiple abnormal maternal serum analytes and abnormal Doppler findings is strongly associated with adverse outcomes, the predictive value remains too low to be used as a screening test in a low-risk population. Stratification of cases based on the severity of Doppler abnormalities may improve predictive models.
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Affiliation(s)
- Matthew J Blitz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hofstra North Shore-LIJ School of Medicine, North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030, USA.
| | - Burton Rochelson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hofstra North Shore-LIJ School of Medicine, North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030, USA
| | - Nidhi Vohra
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hofstra North Shore-LIJ School of Medicine, North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030, USA
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Abstract
Pregnancy is an immunological paradox that implies that a semi-allogeneic fetus is not rejected by the maternal immune system, from implantation of the embryo to delivery. Progesterone (P4), estradiol (E2) and human chorionic gonadotropin (hCG), contribute to the transformation of immune cells in a transient tolerance state, necessary to the maintenance of pregnancy. The effects of pregnancy hormones depend probably of their maternal plasma level. hCG is dangerous at high concentrations because it can stimulate autoantibodies production, whereas in physiological concentrations, hCG, P4 and E2 upregulate immune response expanding regulatory T and B cells, allowing the fetus to grow within the maternal uterus in a protective environment. A second example of fetal-maternal relation found recently is the role of maternal nutrition on development of the fetal hypothalamic neurons. Experiments in mice fed on a high fat diet reveal a critical timing when altered maternal metabolism affect formation of hypothalamic neurocircuits of the offspring and predispose him to long-term metabolic disorders.
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Alvarez-Nava F, Soto M, Lanes R, Pons H, Morales-Machin A, Bracho A. Elevated second-trimester maternal serum β-human chorionic gonadotropin and amniotic fluid alpha-fetoprotein as indicators of adverse obstetric outcomes in fetal Turner syndrome. J Obstet Gynaecol Res 2015; 41:1891-8. [PMID: 26369382 DOI: 10.1111/jog.12813] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 06/18/2015] [Indexed: 11/26/2022]
Abstract
AIM The objective of this study was to determine the ability of biochemical analytes to identify adverse outcomes in pregnancies with Turner syndrome. METHODS Maternal serum and amniotic fluid (AF) marker concentrations were measured in 73 singleton pregnancies with Turner syndrome (10-22 weeks of gestation). Fetal Turner syndrome was definitively established by cytogenetic analysis. Two subgroups, fetuses with hydrops fetalis versus fetuses with cystic hygroma, were compared. Receiver operating characteristic curves and relative risk were established for a cut-off multiples of the median ≥3.5 for β-subunit of human chorionic gonadotropin (hCG) or AF alpha-fetoprotein (AFP). RESULTS Forty-nine (67%) of 73 pregnant women had an abnormal maternal serum. While levels of pregnancy-associated plasma protein-A and free β-subunit (fβ)-hCG were not different to those of the control group, AFP, unconjugated estriol and β-hCG concentrations were significantly different in the study group (P < 0.05), when compared to those of unaffected pregnancies. Levels of β-hCG in pregnancies with hydrops fetalis were significantly higher than in those with cystic hygroma (P <0.0001), as were AF-AFP concentrations (P <0.0015). In addition, abnormalities in both maternal serum β-hCG and AF-AFP predicted fetal death. The relative risk of adverse obstetric outcome was 10.667 (P = 0.0004; 95% confidence interval [CI]: 1.554-73.203) for β-hCG and 2.19 (P = 0.0256; 95% CI: 1.001 to 4.779), for AF-AFP. CONCLUSION Maternal serum β-hCG and AF-AFP levels may preferentially identify those Turner syndrome pregnancies with the highest risk of fetal death.
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Affiliation(s)
| | - Marisol Soto
- Instituto de Investigaciones Genéticas, Universidad del Zulia, Maracaibo, Venezuela
| | - Roberto Lanes
- Unidad de Endocrinología Pediátrica, Hospital de Clínicas Caracas, Caracas, Venezuela
| | - Hector Pons
- Centro de Medicina Experimental, Universidad del Zulia, Maracaibo, Venezuela
| | | | - Ana Bracho
- Instituto de Investigaciones Genéticas, Universidad del Zulia, Maracaibo, Venezuela
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Sirikunalai P, Wanapirak C, Sirichotiyakul S, Tongprasert F, Srisupundit K, Luewan S, Traisrisilp K, Tongsong T. Associations between maternal serum free beta human chorionic gonadotropin (β-hCG) levels and adverse pregnancy outcomes. J OBSTET GYNAECOL 2015; 36:178-82. [DOI: 10.3109/01443615.2015.1036400] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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40
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Settiyanan T, Wanapirak C, Sirichotiyakul S, Tongprasert F, Srisupundit K, Luewan S, Traisrisilp K, Tongsong T. Association between isolated abnormal levels of maternal serum unconjugated estriol in the second trimester and adverse pregnancy outcomes. J Matern Fetal Neonatal Med 2015; 29:2093-7. [PMID: 27480207 DOI: 10.3109/14767058.2015.1075503] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the association between maternal serum unconjugated estriol (uE3) levels in the second trimester and adverse pregnancy outcomes. PATIENTS AND METHODS The prospective database of our fetal Down screening program was assessed and reviewed for maternal serum uE3 levels. Pregnancies with medical diseases, abnormal levels of beta-human chorionic gonadotropin, alpha-fetoprotein and fetal chromosomal or structural abnormalities were excluded. The recruited women were categorized into three groups: high (>95th percentile), normal (5-95th percentile) and low (<5th percentile) uE3 levels. RESULTS Of 14 212 screened women, 9183 (high; 455, normal; 8271 and low; 457) levels group, were available for outcome analysis. The rates of most adverse outcomes, including preterm birth, low Apgar scores, fetal death, placental abruption, preeclampsia and gestational diabetes mellitus, of the high and normal groups were comparable. Nevertheless, low uE3 levels increased risk of fetal growth restriction (FGR) (RR: 2.36, 95% CI: 1.79-3.10) and low birth weight (LBW) (RR: 1.87, 95% CI: 1.45-2.39), but not preterm birth. Logistic regression analysis indicated that low uE3 level was an independent risk factor for FGR and LBW. CONCLUSIONS High uE3 levels in the second trimester are not associated with poor outcomes, whereas low levels significantly increase risk of FGR and LBW but not other adverse outcomes.
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Affiliation(s)
- Thaniyaporn Settiyanan
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
| | - Chanane Wanapirak
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
| | - Supatra Sirichotiyakul
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
| | - Fuanglada Tongprasert
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
| | - Kasemsri Srisupundit
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
| | - Suchaya Luewan
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
| | - Kuntharee Traisrisilp
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
| | - Theera Tongsong
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
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Stegmann BJ, Santillan M, Leader B, Smith E, Santillan D. Changes in antimüllerian hormone levels in early pregnancy are associated with preterm birth. Fertil Steril 2015; 104:347-55.e3. [PMID: 26074093 DOI: 10.1016/j.fertnstert.2015.04.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 04/02/2015] [Accepted: 04/24/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine the association of preterm birth with antimüllerian hormone (AMH) levels both in isolation and in combination with other markers of fetoplacental health commonly measured during integrated prenatal screening (IPS) for aneuploidy. DESIGN Retrospective case-control study. SETTING Not applicable. PATIENT(S) Pregnant women in Iowa who elected to undergo IPS and who subsequently delivered in Iowa, including women giving birth at <37 weeks' gestation and controls who delivered at ≥37 weeks' gestation. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Probability of a preterm birth. RESULT(S) Second trimester AMH levels were not associated with preterm birth, either independently or after controlling for other markers of fetoplacental health. The AMH difference was not associated with preterm birth when modeled alone, but a statistically significant association was found after adjusting for maternal serum α-fetoprotein (MSAFP) and maternal weight change between the first and second trimesters. After stratifying the model by MSAFP level, most of the risk for preterm birth was identified in women with an MSAFP >1 multiple of the median and who had a stable or rising AMH level in early pregnancy. CONCLUSION(S) A lack of decline in the AMH level in early pregnancy can be used to identify women with a high probability for preterm birth, especially when MSAFP levels are >1 multiple of the median. Monitoring changes in the AMH level between the first and second trimesters of pregnancy may help identify women who would benefit from interventional therapies such as supplemental progesterone.
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Affiliation(s)
| | - Mark Santillan
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, University of Iowa, Iowa City, Iowa
| | | | - Elaine Smith
- Department of Epidemiology, College of Public Health, Iowa City, Iowa
| | - Donna Santillan
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, University of Iowa, Iowa City, Iowa
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Kim YM, Chaemsaithong P, Romero R, Shaman M, Kim CJ, Kim JS, Qureshi F, Jacques SM, Ahmed AI, Chaiworapongsa T, Hassan SS, Yeo L, Korzeniewski SJ. Placental lesions associated with acute atherosis. J Matern Fetal Neonatal Med 2014; 28:1554-62. [PMID: 25183023 DOI: 10.3109/14767058.2014.960835] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Acute atherosis is a lesion of the spiral arteries characterized by fibrinoid necrosis of the vessel wall, an accumulation of fat-containing macrophages, and a mononuclear perivascular infiltrate, which can be found in patients with preeclampsia, fetal death, small-for-gestational age, spontaneous preterm labor/premature prelabor rupture of membrane, and spontaneous mid-trimester abortion. This lesion is thought to decrease blood flow to the intervillous space which may lead to other vascular lesions of the placenta. The objective of this study was to test whether there is an association between acute atherosis and placental lesions that are consistent with maternal vascular underperfusion (MVU), amniotic fluid infection (AFI), fetal vascular thrombo-occlusive disease (FVTOD) or chronic inflammation. MATERIAL AND METHODS A retrospective cohort study of pregnant women who delivered between July 1998 and July 2014 at Hutzel Women's Hospital/Detroit Medical Center was conducted examine 16 457 placentas. The frequency of placenta lesions (diagnosed using the criteria of the Perinatal Section of the Society for Pediatric Pathology) was compared between pregnancies with and without acute atherosis. RESULTS Among 16 457 women who were enrolled, 10.2% (1671/16 457) were excluded, leaving 14 786 women who contributed data for analysis. Among them, the prevalence of acute atherosis was 2.2% (326/14 786). Women with acute atherosis were more than six times as likely as those without to have placental lesions consistent with maternal underperfusion (adjusted odds ratio - aOR: 6.7; 95% CI 5.2-8.6). To a lesser degree, acute atherosis was also associated with greater risks of having either lesions consistent with FVTOD (aOR 1.7; 95% CI 1.2-2.3) or chronic chorioamnionitis (aOR 1.9; 95% CI 1.3-3), but not with other chronic inflammatory lesions, after adjusting for gestational age at delivery. In contrast, women with acute atherosis were 60% less likely to have lesions consistent with AFI, adjusting for gestational age at delivery (aOR 0.4; 95% CI 0.3-0.5). CONCLUSIONS Acute atherosis is associated with increased risks of having placental lesions consistent with MVU, and to a lesser extent, chronic chorioamnionitis and those consistent with FVTOD.
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Affiliation(s)
- Yeon Mee Kim
- a Department of Pathology , Haeundae Paik Hospital, Inje University College of Medicine , Busan , Korea
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Conde-Agudelo A, Bird S, Kennedy SH, Villar J, Papageorghiou AT. First- and second-trimester tests to predict stillbirth in unselected pregnant women: a systematic review and meta-analysis. BJOG 2014; 122:41-55. [PMID: 25236870 DOI: 10.1111/1471-0528.13096] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Several biophysical and biochemical tests have been proposed to predict stillbirth but their predictive ability remains unclear. OBJECTIVE To assess the accuracy of tests performed during the first and/or second trimester of pregnancy to predict stillbirth in unselected women with singleton, structurally and chromosomally normal fetuses through use of formal methods for systematic reviews and meta-analytic techniques. SEARCH STRATEGY Electronic databases, bibliographies and conference proceedings. SELECTION CRITERIA Observational studies that evaluated the predictive accuracy for stillbirth of tests performed during the first two trimesters of pregnancy. DATA COLLECTION AND ANALYSIS Two reviewers selected studies, assessed risk of bias and extracted data. Summary receiver operating characteristic curves, pooled sensitivities, specificities and likelihood ratios (LRs) were generated. Data were synthesised separately for stillbirth as a sole category and for specific stillbirth categories. MAIN RESULTS Seventy-one studies, evaluating 16 single and five combined tests, met the inclusion criteria. A uterine artery pulsatility index >90th centile during the second trimester and low levels of pregnancy-associated plasma protein A (PAPP-A) during the first trimester had a moderate to high predictive accuracy for stillbirth related to placental abruption, small-for-gestational-age or pre-eclampsia (positive and negative LRs from 6.3 to 14.1, and from 0.1 to 0.4, respectively). All biophysical and biochemical tests assessed had a low predictive accuracy for stillbirth as a sole category. CONCLUSIONS Currently, there is no clinically useful first-trimester or second-trimester test to predict stillbirth as a sole category. Uterine artery pulsatility index and maternal serum PAPP-A levels appeared to be good predictors of stillbirth related to placental dysfunction disorders.
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Affiliation(s)
- A Conde-Agudelo
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD and Detroit, MI, USA
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Cıkman MS, Seckin KD, Karslı MF, Baser E, Cıkman DI, Cicek MN. The effect of inherited thrombophilia on second trimester combined aneuploidy screening test markers. Arch Gynecol Obstet 2014; 291:787-90. [DOI: 10.1007/s00404-014-3468-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 09/09/2014] [Indexed: 01/08/2023]
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Biological indicators of the in-utero environment and their association with birth weight for gestational age. J Dev Orig Health Dis 2014; 2:280-90. [PMID: 23316271 DOI: 10.1017/s2040174411000298] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Birth weight for gestational age (BW/GA) has been associated with a risk of adverse health outcomes. Biological indices of pregnancy complications, maternal mid-pregnancy serum biomarkers and placental pathology may shed light on these associations, but at present, they are most often examined as single entities and offer little insight about overlap. In addition, these indices are typically assessed in relation to the extremes of the BW/GA distribution, leaving open the question of how they relate to the entire BW/GA distribution. Addressing issues such as these may help elucidate why postnatal health outcomes vary across the BW/GA continuum. In this study, we focused on a subset of women who participated in the Pregnancy Outcomes and Community Health Study (n = 1371). We examined BW/GA (i.e. gestational age and sex-referenced z-scores) in relation to obstetric complications, second trimester maternal serum screening results and histologic evidence of placental pathology along with maternal demographics, anthropometrics and substance use. In adjusted models, mean reductions in BW/GA z-scores were associated with preeclampsia (β = -0.70, 95% CI -1.04, -0.36), high maternal serum alpha fetoprotein (β = -0.28, 95% CI -0.43, -0.13), unconjugated estriol (β = -0.31/0.5 multiples of the median decrease, 95% CI -0.41, -0.21) and high levels of maternal obstructive vascular pathology in the placenta (β = -0.46, 95% CI -0.67, -0.25). The findings were similar when preterm infants, small-for-gestational age or large-for-gestational age infants were excluded. More research is needed to examine how the factors studied here might directly mediate or mark risk when evaluating the associations between BW/GA and postnatal health outcomes.
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46
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Roman A, Desai N, Krantz D, Liu HP, Rosner J, Vohra N, Rochelson B. Maternal serum analytes as predictors of IUGR with different degrees of placental vascular dysfunction. Prenat Diagn 2014; 34:692-8. [DOI: 10.1002/pd.4369] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 03/24/2014] [Accepted: 03/25/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Amanda Roman
- Division of Maternal Fetal Medicine; Hofstra North Shore-LIJ School of Medicine; Manhasset NY USA
| | - Neeraj Desai
- Division of Maternal Fetal Medicine; Hofstra North Shore-LIJ School of Medicine; Manhasset NY USA
| | - David Krantz
- Division of Biostatistics; NTD Labs/PerkinElmer Corporation; Melville NY USA
| | - Hsiao-Pin Liu
- Division of Biostatistics; NTD Labs/PerkinElmer Corporation; Melville NY USA
| | - Jonathan Rosner
- Division of Maternal Fetal Medicine; Hofstra North Shore-LIJ School of Medicine; Manhasset NY USA
| | - Nidhi Vohra
- Division of Maternal Fetal Medicine; Hofstra North Shore-LIJ School of Medicine; Manhasset NY USA
| | - Burton Rochelson
- Division of Maternal Fetal Medicine; Hofstra North Shore-LIJ School of Medicine; Manhasset NY USA
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47
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Goetzinger KR, Odibo AO. Screening for abnormal placentation and adverse pregnancy outcomes with maternal serum biomarkers in the second trimester. Prenat Diagn 2014; 34:635-41. [DOI: 10.1002/pd.4370] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/17/2014] [Accepted: 03/25/2014] [Indexed: 11/08/2022]
Affiliation(s)
| | - Anthony O. Odibo
- Department of Obstetrics and Gynecology; Washington University; St. Louis MO USA
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48
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Savasan ZA, Goncalves LF, Bahado-Singh RO. Second- and third-trimester biochemical and ultrasound markers predictive of ischemic placental disease. Semin Perinatol 2014; 38:167-76. [PMID: 24836829 DOI: 10.1053/j.semperi.2014.03.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ischemic placental disease is a recently coined term that describes the vascular insufficiency now believed to be an important etiologic factor in preeclampsia, intrauterine fetal growth restriction, and placental abruption. Given the increased risk for poor maternal and fetal outcomes, early prediction and prevention of this disorder is of significant clinical interest for many. In this article, we review the second- and third-trimester serum and ultrasound markers predictive of ischemic placental disease. Limited first-trimester data is also presented. While current studies report a statistical association between marker levels and various adverse perinatal outcomes, the observed diagnostic accuracy is below the threshold required for clinical utility. An exception to this generalization is uterine artery Doppler for the prediction of early-onset preeclampsia. Metabolomics is a relatively new analytic platform that holds promise as a first-trimester marker for the prediction of both early- and late-onset preeclampsia.
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Affiliation(s)
- Zeynep Alpay Savasan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oakland University William Beaumont School of Medicine, Rochester, MI
| | - Luis F Goncalves
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oakland University William Beaumont School of Medicine, Rochester, MI
| | - Ray O Bahado-Singh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oakland University William Beaumont School of Medicine, Rochester, MI.
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49
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Bukowski R, Hansen NI, Willinger M, Reddy UM, Parker CB, Pinar H, Silver RM, Dudley DJ, Stoll BJ, Saade GR, Koch MA, Rowland Hogue CJ, Varner MW, Conway DL, Coustan D, Goldenberg RL. Fetal growth and risk of stillbirth: a population-based case-control study. PLoS Med 2014; 11:e1001633. [PMID: 24755550 PMCID: PMC3995658 DOI: 10.1371/journal.pmed.1001633] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 03/11/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Stillbirth is strongly related to impaired fetal growth. However, the relationship between fetal growth and stillbirth is difficult to determine because of uncertainty in the timing of death and confounding characteristics affecting normal fetal growth. METHODS AND FINDINGS We conducted a population-based case-control study of all stillbirths and a representative sample of live births in 59 hospitals in five geographic areas in the US. Fetal growth abnormalities were categorized as small for gestational age (SGA) (<10th percentile) or large for gestational age (LGA) (>90th percentile) at death (stillbirth) or delivery (live birth) using population, ultrasound, and individualized norms. Gestational age at death was determined using an algorithm that considered the time-of-death interval, postmortem examination, and reliability of the gestational age estimate. Data were weighted to account for the sampling design and differential participation rates in various subgroups. Among 527 singleton stillbirths and 1,821 singleton live births studied, stillbirth was associated with SGA based on population, ultrasound, and individualized norms (odds ratio [OR] [95% CI]: 3.0 [2.2 to 4.0]; 4.7 [3.7 to 5.9]; 4.6 [3.6 to 5.9], respectively). LGA was also associated with increased risk of stillbirth using ultrasound and individualized norms (OR [95% CI]: 3.5 [2.4 to 5.0]; 2.3 [1.7 to 3.1], respectively), but not population norms (OR [95% CI]: 0.6 [0.4 to 1.0]). The associations were stronger with more severe SGA and LGA (<5th and >95th percentile). Analyses adjusted for stillbirth risk factors, subset analyses excluding potential confounders, and analyses in preterm and term pregnancies showed similar patterns of association. In this study 70% of cases and 63% of controls agreed to participate. Analysis weights accounted for differences between consenting and non-consenting women. Some of the characteristics used for individualized fetal growth estimates were missing and were replaced with reference values. However, a sensitivity analysis using individualized norms based on the subset of stillbirths and live births with non-missing variables showed similar findings. CONCLUSIONS Stillbirth is associated with both growth restriction and excessive fetal growth. These findings suggest that, contrary to current practices and recommendations, stillbirth prevention strategies should focus on both severe SGA and severe LGA pregnancies. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Radek Bukowski
- University of Texas Medical Branch at Galveston, United States of America
- * E-mail:
| | - Nellie I. Hansen
- RTI International, Research Triangle Park, North Carolina, United States of America
| | - Marian Willinger
- The Pregnancy and Perinatology Branch, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Uma M. Reddy
- The Pregnancy and Perinatology Branch, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Corette B. Parker
- RTI International, Research Triangle Park, North Carolina, United States of America
| | - Halit Pinar
- Brown University School of Medicine, Providence, Rhode Island, United States of America
| | - Robert M. Silver
- University of Utah School of Medicine and Intermountain Health Care, Salt Lake City, Utah, United States of America
| | - Donald J. Dudley
- University of Texas Health Science Center at San Antonio, United States of America
| | - Barbara J. Stoll
- Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, United States of America
| | - George R. Saade
- University of Texas Medical Branch at Galveston, United States of America
| | - Matthew A. Koch
- RTI International, Research Triangle Park, North Carolina, United States of America
| | - Carol J. Rowland Hogue
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Michael W. Varner
- University of Utah School of Medicine and Intermountain Health Care, Salt Lake City, Utah, United States of America
| | - Deborah L. Conway
- University of Texas Health Science Center at San Antonio, United States of America
| | - Donald Coustan
- Brown University School of Medicine, Providence, Rhode Island, United States of America
| | - Robert L. Goldenberg
- Columbia University Medical Center, New York, New York, United States of America
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Güdücü N, Gönenç G, Işçi H, Yiğiter AB, Dünder I. Can quadruple test parameters predict SGA infants? J OBSTET GYNAECOL 2014; 33:269-71. [PMID: 23550855 DOI: 10.3109/01443615.2012.759915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this study was to investigate the role of quadruple test parameters in predicting the risk of delivering a small for gestational age (SGA) infant. The quadruple test results of patients performed at 16-18 weeks of pregnancy were searched retrospectively. Alpha-fetoprotein (AFP) levels higher than 2 MoM were associated with a risk of delivering an SGA infant (p = 0.025), sensitivity 8%, specificity 98%, positive predictive value 25%, negative predictive value 91%. Other quadruple test parameters were not related to delivery of an SGA infant. The introduction of AFP as a screening test for the detection of SGA infants does not seem feasible, but we suggest clinicians take it into account when counselling the patients about the results of Down syndrome screening tests.
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Affiliation(s)
- N Güdücü
- Department of Obstetrics and Gynecology, Avrupa Hospital, Istanbul Bilim University, Istanbul, Turkey.
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