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Christiansen CH, Kirk M, Worda K, Hegaard HK, Rode L. Inflammatory markers in relation to maternal lifestyle and adverse pregnancy outcomes in twin pregnancies. J Reprod Immunol 2024; 164:104286. [PMID: 38964134 DOI: 10.1016/j.jri.2024.104286] [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: 02/02/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 07/06/2024]
Abstract
It is well known that inflammatory markers play an important role in the development and maintenance of healthy pregnancies. However, the literature regarding inflammation in relation to lifestyle and adverse pregnancy outcomes in twin pregnancies is remarkably uncovered. Therefore, this study aimed at evaluating the concentration of inflammatory markers in dried capillary blood spot samples from 523 women with twin pregnancies, included at a median gestational age of 21+1 weeks. The relationship between inflammatory markers and maternal lifestyle (current smoking status and pre-pregnancy body mass index) in addition to adverse pregnancy outcomes (preeclampsia, gestational diabetes mellitus, and small for gestational age) was analyzed. The study showed that active smoking at inclusion was associated with an elevated concentration of interleukin-8. Furthermore, maternal obesity was associated with an elevated concentration of C-reactive protein and monocyte chemoattractant protein-1. Analysis of the data showed no statistically significant variations in the concentration of the assessed inflammatory markers for neither preeclampsia, gestational diabetes mellitus, nor small for gestational age. The current study promotes future research on the pathophysiology of twin pregnancies in relation to adverse pregnancy outcomes, as the literature within the area remains scarce.
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Affiliation(s)
- Cecilie Holm Christiansen
- Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Mille Kirk
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Valdemar Hansens Vej 13, 2600 Glostrup, Denmark; Translational Research Centre, Nordstjernevej 42-44, Rigshospitalet, 2600 Glostrup, Denmark
| | - Katharina Worda
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Hanne Kristine Hegaard
- Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark; Institute of Clinical Medicine, Faculty of Health Sciences and Medicine, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen, Denmark
| | - Line Rode
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Valdemar Hansens Vej 13, 2600 Glostrup, Denmark; Translational Research Centre, Nordstjernevej 42-44, Rigshospitalet, 2600 Glostrup, Denmark.
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Singh SB, Mahajan S, Ps K, Mangla D. Study of C-reactive Protein Levels in Hypertensive Disorders of Pregnancy. Cureus 2024; 16:e66946. [PMID: 39280386 PMCID: PMC11401602 DOI: 10.7759/cureus.66946] [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: 08/15/2024] [Indexed: 09/18/2024] Open
Abstract
Introduction Globally, one of the main causes of maternal and perinatal deaths is hypertensive disorders of pregnancy (HDP). Preeclampsia is a pregnancy-specific syndrome characterized by high blood pressure and proteinuria after 20-week gestation. Women who develop preeclampsia are at increased risk for the development of many systemic complications. Materials and methods A cross-sectional study was conducted in the Department of Biochemistry, SHKM, Nuh, Haryana in collaboration with the Department of Obstetrics & Gynecology. 200 study subjects; Group 1: cases - 100 HDP, Group 2: controls - 100 age-matched normotensive pregnant women. The specimen of 3 mL venous blood was collected under aseptic precautions. The data was evaluated using statistical evaluation tools. Result Out of 200 subjects, mean C-reactive protein (CRP) levels were normal in three cases and 35 controls. Minor elevation of CRP was observed in 11 cases and 29 controls (very significant). Moderate elevation of CRP was observed in 61 cases and 36 controls (highly significant). Marked elevation of CRP was observed in 25 cases. Mean CRP levels increased from preeclampsia without severe features (3.9 mg/dL), preeclampsia with severe features (5.2 mg/dL), and eclampsia (12.7 mg/dL) when compared with the respective control group (1.1 mg/dL, 1.16 mg/dL, and 1.2 mg/dL). Conclusion There is a highly significant association between CRP levels and HDP. Additionally, one useful indicator of the severity of preeclampsia is CRP, a measure of systemic inflammation. Elevated CRP levels in mild PE can be used as an indicator of the progress of the disease and early prevention can be done.
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Affiliation(s)
- Sangeeta B Singh
- Biochemistry, Shaheed Hasan Khan Mewati Government Medical College, Nuh, IND
| | - Shikhaa Mahajan
- Biochemistry, Shaheed Hasan Khan Mewati Government Medical College, Nuh, IND
| | - Krishnanand Ps
- Biochemistry, Shaheed Hasan Khan Mewati Government Medical College, Nuh, IND
| | - Divya Mangla
- Obstetrics and Gynecology, Shaheed Hasan Khan Mewati Government Medical College, Nuh, IND
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Tissarinen P, Tiensuu H, Haapalainen AM, Ronkainen E, Laatio L, Vääräsmäki M, Öhman H, Hallman M, Rämet M. Maternal serum alpha-1 antitrypsin levels in spontaneous preterm and term pregnancies. Sci Rep 2024; 14:10819. [PMID: 38734716 PMCID: PMC11088650 DOI: 10.1038/s41598-024-61206-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 05/02/2024] [Indexed: 05/13/2024] Open
Abstract
Currently, there are no accurate means to predict spontaneous preterm birth (SPTB). Recently, we observed low expression of alpha-1 antitrypsin (AAT) in SPTB placentas. Present aim was to compare the concentrations of maternal serum AAT in pregnancies with preterm and term deliveries. Serum C-reactive protein (CRP) was used as a reference inflammatory marker. Two populations were studied. The first population comprised women who eventually gave birth spontaneously preterm (SPTB group) or term (control group). The second population included pregnant women shortly before delivery and nonpregnant women. We observed that serum AAT levels were higher in the SPTB group than in the controls, and a similar difference was observed when serum CRP was considered in multivariable analysis. However, the overlap in the AAT concentrations was considerable. No statistical significance was observed in serum AAT levels between preterm and term pregnancies at delivery. However, AAT levels were higher at delivery compared to nonpregnant controls. We did not observe a strong correlation between serum AAT and CRP in early pregnancy samples and at labor. We propose that during early pregnancy, complicated by subsequent SPTB, modest elevation of serum AAT associates with SPTB.
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Affiliation(s)
- Pinja Tissarinen
- Research Unit of Clinical Medicine and Medical Research Center, Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, University of Oulu, PO Box 5000, 90014, Oulu, Finland
| | - Heli Tiensuu
- Research Unit of Clinical Medicine and Medical Research Center, Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, University of Oulu, PO Box 5000, 90014, Oulu, Finland
| | - Antti M Haapalainen
- Research Unit of Clinical Medicine and Medical Research Center, Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, University of Oulu, PO Box 5000, 90014, Oulu, Finland
| | - Eveliina Ronkainen
- Research Unit of Clinical Medicine and Medical Research Center, Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, University of Oulu, PO Box 5000, 90014, Oulu, Finland
| | - Liisa Laatio
- Research Unit of Clinical Medicine, Department of Obstetrics and Gynecology, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Marja Vääräsmäki
- Research Unit of Clinical Medicine and Medical Research Center, Department of Obstetrics and Gynecology, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Hanna Öhman
- Faculty of Medicine, Biobank Borealis of Northern Finland, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Mikko Hallman
- Research Unit of Clinical Medicine and Medical Research Center, Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, University of Oulu, PO Box 5000, 90014, Oulu, Finland.
| | - Mika Rämet
- Research Unit of Clinical Medicine and Medical Research Center, Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, University of Oulu, PO Box 5000, 90014, Oulu, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Sturla Irizarry SM, Cathey AL, Rosario Pabón ZY, Vélez Vega CM, Alshawabkeh AN, Cordero JF, Watkins DJ, Meeker JD. Urinary phenol and paraben concentrations in association with markers of inflammation during pregnancy in Puerto Rico. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 921:170889. [PMID: 38360311 DOI: 10.1016/j.scitotenv.2024.170889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 02/17/2024]
Abstract
Exposure to phenols and parabens may contribute to increased maternal inflammation and adverse birth outcomes, but these effects are not well-studied in humans. This study aimed to investigate relationships between concentrations of 8 phenols and 4 parabens with 6 inflammatory biomarkers (C-reactive protein (CRP); matrix metalloproteinases (MMP) 1, 2, and 9; intercellular adhesion molecule-1 (ICAM-1); and vascular cell adhesion molecule-1 (VCAM-1)) measured at two time points in pregnancy in the PROTECT birth cohort in Puerto Rico. Linear mixed models were used, adjusting for covariates of interest. Results are expressed as the percent change in outcome per interquartile range (IQR) increase in exposure. Particularly among phenols, numerous significant negative associations were found, for example, between benzophenone-3 and CRP (-11.21 %, 95 % CI: -17.82, -4.07) and triclocarban and MMP2 (-9.87 %, 95 % CI: -14.05, -5.5). However, significant positive associations were also detected, for instance, between bisphenol-A (BPA) and CRP (9.77 %, 95 % CI: 0.67, 19.68) and methyl-paraben and MMP1 (10.78 %, 95 % CI: 2.17, 20.11). Significant interactions with female fetal sex and the later study visit (at 24-28 weeks gestation) showed more positive associations compared to male fetal sex and the earlier study visit (16-20 weeks gestation). Our results suggest that phenols and parabens may disrupt inflammatory processes pertaining to uterine remodeling and endothelial function, with important implications for pregnancy outcomes. More research is needed to further understand maternal inflammatory status in an effort to improve reproductive and developmental outcomes.
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Affiliation(s)
| | - Amber L Cathey
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Zaira Y Rosario Pabón
- Department of Civil and Environmental Engineering, Northeastern University, Boston, MA 02115, USA.
| | - Carmen M Vélez Vega
- Department of Social Sciences, Doctoral Program in Social Determinants of Health, University of Puerto Rico, Medical Sciences Campus, San Juan, PR 00936, USA.
| | - Akram N Alshawabkeh
- Department of Civil and Environmental Engineering, Northeastern University, Boston, MA 02115, USA.
| | - José F Cordero
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA 30606, USA.
| | - Deborah J Watkins
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI 48109, USA.
| | - John D Meeker
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI 48109, USA.
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Fussell JC, Jauniaux E, Smith RB, Burton GJ. Ambient air pollution and adverse birth outcomes: A review of underlying mechanisms. BJOG 2024; 131:538-550. [PMID: 38037459 PMCID: PMC7615717 DOI: 10.1111/1471-0528.17727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 12/02/2023]
Abstract
Epidemiological data provide varying degrees of evidence for associations between prenatal exposure to ambient air pollutants and adverse birth outcomes (suboptimal measures of fetal growth, preterm birth and stillbirth). To assess further certainty of effects, this review examines the experimental literature base to identify mechanisms by which air pollution (particulate matter, nitrogen dioxide and ozone) could cause adverse effects on the developing fetus. It likely that this environmental insult impacts multiple biological pathways important for sustaining a healthy pregnancy, depending upon the composition of the pollutant mixture and the exposure window owing to changes in physiologic maturity of the placenta, its circulations and the fetus as pregnancy ensues. The current body of evidence indicates that the placenta is a target tissue, impacted by a variety of critical processes including nitrosative/oxidative stress, inflammation, endocrine disruption, epigenetic changes, as well as vascular dysregulation of the maternal-fetal unit. All of the above can disturb placental function and, as a consequence, could contribute to compromised fetal growth as well increasing the risk of stillbirth. Furthermore, given that there is often an increased inflammatory response associated with preterm labour, inflammation is a plausible mechanism mediating the effects of air pollution on premature delivery. In the light of increased urbanisation and an ever-changing climate, both of which increase ambient air pollution and negatively affect vulnerable populations such as pregnant individuals, it is hoped that the collective evidence may contribute to decisions taken to strengthen air quality policies, reductions in exposure to air pollution and subsequent improvements in the health of those not yet born.
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Affiliation(s)
- Julia C. Fussell
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
- National Institute for Health and Care Research Health Protection Research Unit in Environmental Exposures and Health, Imperial College London, London, United Kingdom
| | - Eric Jauniaux
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Rachel B. Smith
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
- National Institute for Health and Care Research Health Protection Research Unit in Environmental Exposures and Health, Imperial College London, London, United Kingdom
- Mohn Centre for Children’s Health and Wellbeing, School of Public Health, Imperial College London, London, UK
| | - Graham J. Burton
- Department of Physiology, Development and Neuroscience, University of Cambridge
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Liu X, Chen L, Li J, Holtermann A, Lu R, Birukov A, Weir NL, Tsai MY, Zhang C. Physical Activity and High-Sensitivity C-Reactive Protein in Pregnancy: Does It Matter during Leisure or Work? Med Sci Sports Exerc 2024; 56:110-117. [PMID: 38098149 DOI: 10.1249/mss.0000000000003287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
INTRODUCTION Physical activity (PA), regardless of domain, is recommended for pregnant individuals in clinical guidelines, but limited evidence is available for work-related PA. This study aimed to examine the associations of occupational (OPA) and leisure-time PA (LTPA) with plasma high-sensitivity C-reactive protein (hs-CRP), a risk marker for adverse pregnancy outcomes, among pregnant individuals. METHODS This longitudinal study included 257 workers in the fetal growth cohort. OPA/LTPA and hs-CRP were measured in each trimester. OPA/LTPA was divided into high and low groups by the median level. Multivariable linear regressions were applied to estimate the adjusted geometric mean differences of hs-CRP (mg·L-1) comparing high versus low OPA/LTPA in each trimester and the changes in OPA/LTPA over pregnancy. RESULTS OPA was positively associated with hs-CRP (high: 5.14 vs low: 3.59; P value: 0.001) in the first trimester, particularly for standing/walking or walking fast, regardless of carrying things. LTPA was negatively associated with hs-CRP in the second (high: 3.93 vs low: 5.08; 0.02) and third trimesters (high: 3.30 vs low: 4.40; 0.046). Compared with the low OPA + high LTPA group, hs-CRP was higher in both the high OPA + high LTPA and high OPA + low LTPA groups in the first trimester, and in the high OPA + low LTPA group only in the third trimester. The change in OPA during pregnancy was positively associated with hs-CRP, whereas the change in LTPA was negatively associated with hs-CRP from the second to the third trimester. CONCLUSIONS In pregnant individuals, LTPA was negatively associated with hs-CRP, whereas OPA was positively associated with hs-CRP. More research on OPA's health impact among pregnant individuals is needed, and guidelines may consider the potential unfavorable influence of OPA on pregnant individuals.
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Affiliation(s)
- Xinyue Liu
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA
| | - Liwei Chen
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA
| | | | - Andreas Holtermann
- National Research Centre for the Working Environment, Copenhagen, DENMARK
| | - Ruijin Lu
- School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Anna Birukov
- Department of Nutrition, T.H. Chan School of Public Health, Harvard University, Boston, MA
| | - Natalie L Weir
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Michael Y Tsai
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
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Keenan-Devlin L, Miller GE, Ernst LM, Freedman A, Smart B, Britt JL, Singh L, Crockett AH, Borders A. Inflammatory markers in serum and placenta in a randomized controlled trial of group prenatal care. Am J Obstet Gynecol MFM 2023; 5:101200. [PMID: 37875178 PMCID: PMC11325478 DOI: 10.1016/j.ajogmf.2023.101200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/28/2023] [Accepted: 10/18/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Racial and socioeconomic disparities in preterm birth and small for gestational age births are growing in the United States, increasing the burden of morbidity and mortality particularly among Black women and birthing persons and their infants. Group prenatal care is one of the only interventions to show potential to reduce the disparity, but the mechanism is unclear. OBJECTIVE The goal of this project was to identify if group prenatal care, when compared with individual prenatal care, was associated with a reduction in systemic inflammation during pregnancy and a lower prevalence of inflammatory lesions in the placenta at delivery. STUDY DESIGN The Psychosocial Intervention and Inflammation in Centering Study was a prospective cohort study that exclusively enrolled participants from a large randomized controlled trial of group prenatal care (the Cradle study, R01HD082311, ClinicalTrials.gov: NCT02640638) that was performed at a single site in Greenville, South Carolina, from 2016 to 2020. In the Cradle study, patients were randomized to either group prenatal care or individual prenatal care, and survey data were collected during the second and third trimesters. The Psychosocial Intervention and Inflammation in Centering Study cohort additionally provided serum samples at these 2 survey time points and permitted collection of placental biopsies for inflammatory and histologic analysis, respectively. We examined associations between group prenatal care treatment and a composite of z scored serum inflammatory biomarkers (C-reactive protein, interleukin-6, interleukin-1 receptor antagonist, interleukin-10, and tumor necrosis factor α) in both the second and third trimesters and the association with the prevalence of acute and chronic maternal placental inflammatory lesions. Analyses were conducted using the intent to treat principle, and the results were also examined by attendance of visits in the assigned treatment group (modified intent to treat and median or more number of visits) and were stratified by race and ethnicity. RESULTS A total of 1256 of 1375 (92%) Cradle participants who were approached enrolled in the Psychosocial Intervention and Inflammation in Centering Study, which included 54% of all the Cradle participants. The Psychosocial Intervention and Inflammation in Centering Study cohort did not differ from the Cradle cohort by demographic or clinical characteristics. Among the 1256 Psychosocial Intervention and Inflammation in Centering Study participants, 1133 (89.6%) had placental data available for analysis. Among those, 549 were assigned to group prenatal care and 584 of 1133 were assigned to individual prenatal care. In the intent to treat and modified intent to treat cohorts, participation in group prenatal care was associated with a higher serum inflammatory score, but it was not associated with an increased prevalence of placental inflammatory lesions. In the stratified analyses, group prenatal care was associated with a higher second trimester inflammatory biomarker composite (modified intent to treat: B=1.17; P=.02; and median or more visits: B=1.24; P=.05) among Hispanic or Latine participants. CONCLUSION Unexpectedly, group prenatal care was associated with higher maternal serum inflammation during pregnancy, especially among Hispanic or Latine participants.
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Affiliation(s)
- Lauren Keenan-Devlin
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL (Drs Keenan-Devlin and Freedman, Ms Smart, and Dr Borders); University of Chicago Pritzker School of Medicine, Chicago, IL (Dr Ernst and Drs Keenan-Devlin, Freedman, and Dr Borders).
| | - Gregory E Miller
- Institute for Policy Research and Department of Psychology, Northwestern University, Evanston, IL (Dr Miller)
| | - Linda M Ernst
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, IL (Dr Ernst); University of Chicago Pritzker School of Medicine, Chicago, IL (Dr Ernst and Drs Keenan-Devlin, Freedman, and Dr Borders)
| | - Alexa Freedman
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL (Drs Keenan-Devlin and Freedman, Ms Smart, and Dr Borders); University of Chicago Pritzker School of Medicine, Chicago, IL (Dr Ernst and Drs Keenan-Devlin, Freedman, and Dr Borders)
| | - Britney Smart
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL (Drs Keenan-Devlin and Freedman, Ms Smart, and Dr Borders)
| | - Jessica L Britt
- Department of Obstetrics and Gynecology, Prisma Health, Greenville, SC (Dr Britt)
| | - Lavisha Singh
- Department of Biostatistics, NorthShore University HealthSystem, Evanston, IL (Ms. Singh)
| | - Amy H Crockett
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Prisma Health/University of South Carolina School of Medicine Greenville, Greenville SC (Dr Crockett)
| | - Ann Borders
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL (Drs Keenan-Devlin and Freedman, Ms Smart, and Dr Borders); University of Chicago Pritzker School of Medicine, Chicago, IL (Dr Ernst and Drs Keenan-Devlin, Freedman, and Dr Borders)
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Purdue-Smithe AC, Stuart JJ, Farland LV, Kang JH, Harriott AM, Rich-Edwards JW, Rexrode K. Prepregnancy Migraine, Migraine Phenotype, and Risk of Adverse Pregnancy Outcomes. Neurology 2023; 100:e1464-e1473. [PMID: 36657989 PMCID: PMC10104618 DOI: 10.1212/wnl.0000000000206831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 12/05/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Migraine is a highly prevalent neurovascular disorder among reproductive-aged women. Whether migraine history and migraine phenotype might serve as clinically useful markers of obstetric risk is not clear. The primary objective of this study was to examine associations of prepregnancy migraine and migraine phenotype with risks of adverse pregnancy outcomes. METHODS We estimated associations of self-reported physician-diagnosed migraine and migraine phenotype with adverse pregnancy outcomes in the prospective Nurses' Health Study II (1989-2009). Log-binomial and log-Poisson models with generalized estimating equations were used to estimate relative risks (RRs) and 95% CIs for gestational diabetes mellitus (GDM), preeclampsia, gestational hypertension, preterm delivery, and low birthweight. RESULTS The analysis included 30,555 incident pregnancies after cohort enrollment among 19,694 participants without a history of cardiovascular disease, diabetes, or cancer. After adjusting for age, adiposity, and other health and behavioral factors, prepregnancy migraine (11%) was associated with higher risks of preterm delivery (RR = 1.17; 95% CI = 1.05-1.30), gestational hypertension (RR = 1.28; 95% CI = 1.11-1.48), and preeclampsia (RR = 1.40; 95% CI = 1.19-1.65) compared with no migraine. Migraine was not associated with low birthweight (RR = 0.99; 95% CI = 0.85-1.16) or GDM (RR = 1.05; 95% CI = 0.91-1.22). Risk of preeclampsia was somewhat higher among participants with migraine with aura (RR vs no migraine = 1.51; 95% CI = 1.22-1.88) than migraine without aura (RR vs no migraine = 1.30; 95% CI = 1.04-1.61; p-heterogeneity = 0.32), whereas other outcomes were similar by migraine phenotype. Participants with migraine who reported regular prepregnancy aspirin use had lower risks of preterm delivery (<2×/week RR = 1.24; 95% CI = 1.11-1.38; ≥2×/week RR = 0.55; 95% CI = 0.35-0.86; p-interaction < 0.01) and preeclampsia (<2×/week RR = 1.48; 95% CI = 1.25-1.75; ≥2×/week RR = 1.10; 95% CI = 0.62-1.96; p-interaction = 0.39); however, power for these stratified analyses was limited. DISCUSSION Migraine history, and to a lesser extent migraine phenotype, appear to be important considerations in obstetric risk assessment and management. Future research should determine whether aspirin prophylaxis may be beneficial for preventing adverse pregnancy outcomes among pregnant individuals with a history of migraine.
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Affiliation(s)
- Alexandra C Purdue-Smithe
- From the Division of Women's Health (A.C.P.-S., J.J.S., J.W.R.-E., K.R.) and Channing Division of Network Medicine (J.H.K.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology (J.J.S., J.W.R.-E.), Harvard T.H. Chan School of Public Health, Boston; Department of Epidemiology and Biostatistics (L.V.F.), Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson; Department of Obstetrics and Gynecology (L.V.F.), University of Arizona, College of Medicine, Tucson; and Department of Neurology (A.M.H.), Mass General Hospital and Harvard Medical School, Boston, MA.
| | - Jennifer J Stuart
- From the Division of Women's Health (A.C.P.-S., J.J.S., J.W.R.-E., K.R.) and Channing Division of Network Medicine (J.H.K.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology (J.J.S., J.W.R.-E.), Harvard T.H. Chan School of Public Health, Boston; Department of Epidemiology and Biostatistics (L.V.F.), Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson; Department of Obstetrics and Gynecology (L.V.F.), University of Arizona, College of Medicine, Tucson; and Department of Neurology (A.M.H.), Mass General Hospital and Harvard Medical School, Boston, MA
| | - Leslie V Farland
- From the Division of Women's Health (A.C.P.-S., J.J.S., J.W.R.-E., K.R.) and Channing Division of Network Medicine (J.H.K.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology (J.J.S., J.W.R.-E.), Harvard T.H. Chan School of Public Health, Boston; Department of Epidemiology and Biostatistics (L.V.F.), Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson; Department of Obstetrics and Gynecology (L.V.F.), University of Arizona, College of Medicine, Tucson; and Department of Neurology (A.M.H.), Mass General Hospital and Harvard Medical School, Boston, MA
| | - Jae H Kang
- From the Division of Women's Health (A.C.P.-S., J.J.S., J.W.R.-E., K.R.) and Channing Division of Network Medicine (J.H.K.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology (J.J.S., J.W.R.-E.), Harvard T.H. Chan School of Public Health, Boston; Department of Epidemiology and Biostatistics (L.V.F.), Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson; Department of Obstetrics and Gynecology (L.V.F.), University of Arizona, College of Medicine, Tucson; and Department of Neurology (A.M.H.), Mass General Hospital and Harvard Medical School, Boston, MA
| | - Andrea M Harriott
- From the Division of Women's Health (A.C.P.-S., J.J.S., J.W.R.-E., K.R.) and Channing Division of Network Medicine (J.H.K.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology (J.J.S., J.W.R.-E.), Harvard T.H. Chan School of Public Health, Boston; Department of Epidemiology and Biostatistics (L.V.F.), Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson; Department of Obstetrics and Gynecology (L.V.F.), University of Arizona, College of Medicine, Tucson; and Department of Neurology (A.M.H.), Mass General Hospital and Harvard Medical School, Boston, MA
| | - Janet W Rich-Edwards
- From the Division of Women's Health (A.C.P.-S., J.J.S., J.W.R.-E., K.R.) and Channing Division of Network Medicine (J.H.K.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology (J.J.S., J.W.R.-E.), Harvard T.H. Chan School of Public Health, Boston; Department of Epidemiology and Biostatistics (L.V.F.), Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson; Department of Obstetrics and Gynecology (L.V.F.), University of Arizona, College of Medicine, Tucson; and Department of Neurology (A.M.H.), Mass General Hospital and Harvard Medical School, Boston, MA
| | - Kathryn Rexrode
- From the Division of Women's Health (A.C.P.-S., J.J.S., J.W.R.-E., K.R.) and Channing Division of Network Medicine (J.H.K.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology (J.J.S., J.W.R.-E.), Harvard T.H. Chan School of Public Health, Boston; Department of Epidemiology and Biostatistics (L.V.F.), Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson; Department of Obstetrics and Gynecology (L.V.F.), University of Arizona, College of Medicine, Tucson; and Department of Neurology (A.M.H.), Mass General Hospital and Harvard Medical School, Boston, MA
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9
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Couture C, Brien ME, Boufaied I, Duval C, Soglio DD, Enninga EAL, Cox B, Girard S. Proinflammatory changes in the maternal circulation, maternal-fetal interface, and placental transcriptome in preterm birth. Am J Obstet Gynecol 2023; 228:332.e1-332.e17. [PMID: 36027951 DOI: 10.1016/j.ajog.2022.08.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/15/2022] [Accepted: 08/15/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Preterm birth remains a leading obstetrical complication because of the incomplete understanding of its multifaceted etiology. It is known that immune alterations toward a proinflammatory profile are observed in women with preterm birth, but therapeutic interventions are still lacking because of scarcity of evidence in the integration of maternal and placental interrelated compartments. OBJECTIVE This study aimed to obtain an integrated view of the maternal and placental contribution to preterm birth compared with normal term pregnancies for an in-depth understanding of the immune/inflammatory involvement, intending to identify novel strategies to mitigate the negative impact of inflammation. STUDY DESIGN We prospectively recruited 79 women with preterm or term deliveries and collected placentas for RNA sequencing, histologic analyses, and to assess levels of inflammatory mediators. Blood samples were also collected to determine the circulating immune profiles by flow cytometry and to evaluate the circulating levels of inflammatory mediators. RESULTS Placental transcriptomic analyses revealed 102 differentially expressed genes upregulated in preterm birth, including known and novel targets, which were highly enriched for inflammatory biological processes according to gene ontology analyses. Analysis of maternal immune cells revealed distinct profiles in preterm births vs term births, including an increased percentage of CD3- cells and monocyte subsets and decreased CD3+ cells along with Th17 subsets of CD4+ lymphocytes. Supporting our bioinformatic findings, we found increases in proinflammatory mediators in the plasma, placenta, and fetal membranes (primarily the amnion) of women with preterm birth, such as interleukin-6 and tumor necrosis factor-α. These findings were not distinct between spontaneous and iatrogenic preterm births except at a molecular level where spontaneous preterm birth presented with an elevated inflammatory profile compared with iatrogenic preterm birth. Analysis of placental histology revealed increased structural and inflammatory lesions in preterm vs term births. We found that genes upregulated in placentas with inflammatory lesions have enrichment of proinflammatory pathways. CONCLUSION This work sheds light on changes within the immune system in preterm birth on multiple levels and compartments to help identify pregnancies at high risk of preterm birth and to discover novel therapeutic targets for preterm birth.
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Affiliation(s)
- Camille Couture
- Departments of Microbiology, Infectiology and Immunology, Centre Hospitalier Universitaire (CHU) Sainte-Justine Research Center, Université de Montréal, Montreal, Canada
| | | | - Ines Boufaied
- CHU Sainte-Justine Research Center, Montreal, Canada
| | - Cyntia Duval
- CHU Sainte-Justine Research Center, Montreal, Canada
| | | | - Elizabeth Ann L Enninga
- Departments of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN; Immunology, Mayo Clinic, Rochester, MN
| | - Brian Cox
- Departments of Physiology, University of Toronto, Toronto, Canada; Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| | - Sylvie Girard
- Departments of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN; Immunology, Mayo Clinic, Rochester, MN; Department of Obstetrics and Gynecology, Université de Montréal, Montreal, Canada.
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10
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Lee CW, Cathey AL, Watkins DJ, Rosario-Pabón ZY, Vélez-Vega CM, Alshawabkeh AN, Cordero JF, Meeker JD. Associations of urinary phthalate metabolites and inflammatory biomarkers among pregnant women in Puerto Rico. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 854:158773. [PMID: 36113809 PMCID: PMC10323976 DOI: 10.1016/j.scitotenv.2022.158773] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/31/2022] [Accepted: 09/10/2022] [Indexed: 06/11/2023]
Abstract
Phthalates are ubiquitous environmental exposures that may be implicated in inflammatory processes, as demonstrated by previous in vivo and in vitro studies. Few human studies have substantiated these observations. This study sought to examine whether maternal phthalate exposures impact inflammatory processes, as measured by circulating inflammatory biomarkers, in the PROTECT cohort in northern Puerto Rico. Inflammatory biomarkers included matrix metalloproteinases 1, 2, and 9 (MMPs), C-reactive protein (CRP), vascular cell adhesion molecule-1 (VCAM), and intercellular cell adhesion molecule-1 (ICAM). Biomarkers were measured in maternal serum samples collected during pregnancy. 19 phthalate metabolites were assessed in urinary samples collected at three study visits across pregnancy. Phthalates with <50 % of measurements above the limit of detection were excluded from analysis. We utilized linear mixed effect models to estimate associations between interquartile range increases in phthalate metabolite concentrations and percent changes in inflammatory biomarkers. Our results revealed significant associations between mono-n-butyl phthalate (MBP) and higher MMP1 by 7.86 % (95 % CI: 0.49, 15.76) and between mono oxononyl phthalate (MONP) and higher MMP2 by 8.30 % (95 % CI: 2.22, 14.75). We observed negative or null associations between phthalate metabolites and MMP2, MMP9, ICAM, VCAM, and CRP. Many results were significantly modified by fetal sex, particularly those between di-2-ethylhexyl phthalate (DEHP) metabolites and MMP1 (p-interaction: MEHHP = 0.01, MEOHP = 0.04, MECPP = 0.01) and MMP2 (p-interaction: MEHHP = 0.03, MEOHP = 0.01, MECPP = 0.01), for which associations were positive among only women carrying female fetuses. MMPs have been previously associated with preeclampsia and hypertensive pregnancy disorders as mediators of artery remodeling. Hence, our findings suggest a potential role for phthalates in mediating the maternal inflammatory response, as well as significant sexual dimorphism in these relationships, which has implications for several adverse pregnancy outcomes.
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Affiliation(s)
- Christine W Lee
- Department of Environmental Health Sciences, University of Michigan School of Public Health,Ann Arbor, MI, USA
| | - Amber L Cathey
- Department of Environmental Health Sciences, University of Michigan School of Public Health,Ann Arbor, MI, USA
| | - Deborah J Watkins
- Department of Environmental Health Sciences, University of Michigan School of Public Health,Ann Arbor, MI, USA
| | | | - Carmen M Vélez-Vega
- Graduate School of Public Health, University of Puerto Rico, San Juan, PR, USA
| | | | - José F Cordero
- College of Public Health, University of Georgia, Athens, GA, USA
| | - John D Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health,Ann Arbor, MI, USA..
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11
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Johnstone AM, Pudwell J, Ackerman-Banks CM, Lundsberg LS, Lipkind HS, Smith GN. High-sensitivity C-reactive protein use in cardiovascular risk screening at 6 to 12 months postpartum following hypertensive disorders of pregnancy. Am J Obstet Gynecol MFM 2023; 5:100776. [PMID: 36273813 DOI: 10.1016/j.ajogmf.2022.100776] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/30/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patients with a hypertensive disorder of pregnancy are more likely to have underlying cardiovascular risk factors and are at increased risk of future cardiovascular disease. These patients are more likely to be diagnosed with new-onset chronic hypertension and meet the criteria for metabolic syndrome postpartum. High-sensitivity C-reactive protein is a marker of general inflammation and may be used to identify increased risk for cardiovascular disease. OBJECTIVE This collaborative data-sharing study between Yale University, United States (Yale Hearts Moms study) and Queen's University, Canada (Maternal Health Clinic) aimed to study the utility of high-sensitivity C-reactive protein in postpartum cardiovascular risk screening, as determined by 30-year risk (Framingham) and metabolic syndrome 6 to 12 months postpartum. STUDY DESIGN Patients with a hypertensive disorder of pregnancy (n=478) or an uncomplicated, term pregnancy (n=90) had cardiovascular risk screening and risk scoring performed at 6 to 12 months postpartum. Patients were excluded if they had a multiple gestation or chronic hypertension, diabetes mellitus, or cardiovascular disease diagnosed before pregnancy. Patients were categorized according to high-sensitivity C-reactive protein (mg/L) into Normal (<3.0), High (3.1 to <10.0), and Acute (≥10.0) groups. The primary outcome of the study was risk for future cardiovascular events, calculated through surrogate measures such as hypertension and cholesterol. Kruskal-Wallis and chi-square tests were used to compare groups, with post hoc tests corrected using the Bonferroni method. Multivariable logistic regression was used to assess the association between high-sensitivity C-reactive protein and cardiovascular risk, adjusting for relevant medical and sociodemographic variables. Analysis was completed with IBM SPSS Statistics, version 27. RESULTS Patients in the High and Acute high-sensitivity C-reactive protein groups were more likely to have a body mass index ≥30, to have experienced a hypertensive disorder of pregnancy, to have a lower household income, and to have not breastfed or to have breastfed for <6 months, when compared with the Normal high-sensitivity C-reactive protein group (all P<.05). Patients in the High and Acute high-sensitivity C-reactive protein groups had higher 30-year cardiovascular risk scores and were more likely to have metabolic syndrome when compared with the Normal high-sensitivity C-reactive protein group (all P<.05). Patients with High high-sensitivity C-reactive protein had 2-fold odds of metabolic syndrome 6 to 12 months after delivery, compared with those in the Normal high-sensitivity C-reactive protein group (adjusted odds ratio, 2.85 [95% confidence interval, 1.66-4.91]), adjusting for hypertensive disorder of pregnancy, body mass index, clinic site, breastfeeding, income, and family history of cardiovascular disease. Those with Acute high-sensitivity C-reactive protein also seemed to have elevated odds of metabolic syndrome compared with the Normal high-sensitivity C-reactive protein group (adjusted odds ratio, 2.52 [95% confidence interval, 1.24-5.12]). The odds of chronic hypertension were significantly higher (P<.05) in the High high-sensitivity C-reactive protein group (adjusted odds ratio, 1.72 [95% confidence interval, 1.12-2.65]) compared with the Normal group. CONCLUSION Individuals with elevated postpartum high-sensitivity C-reactive protein are at increased risk of cardiovascular disease 6 to 12 months postpartum after a pregnancy complicated by a hypertensive disorder of pregnancy. Future research is critical to determine the most comprehensive and accurate method and timing of postpartum cardiovascular risk screening to decrease the incidence of preventable cardiovascular mortality among women.
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Affiliation(s)
- Ainsley M Johnstone
- From the Queen's Faculty of Health Sciences, Queen's University, Kingston, Canada (Ms Johnstone)
| | - Jessica Pudwell
- Department of Obstetrics and Gynaecology, Kingston General Hospital, Queen's University, Kingston, Canada (Ms Pudwell and Dr Smith)
| | | | - Lisbet S Lundsberg
- Yale School of Medicine, New Haven, CT (Drs Ackerman-Banks, Lundsberg, and Lipkind)
| | - Heather S Lipkind
- Yale School of Medicine, New Haven, CT (Drs Ackerman-Banks, Lundsberg, and Lipkind)
| | - Graeme N Smith
- Department of Obstetrics and Gynaecology, Kingston General Hospital, Queen's University, Kingston, Canada (Ms Pudwell and Dr Smith).
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12
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Dejani NN, Nicoletti CF, Argentato PP, Pereira LDS, Saraiva AC, de Assis LM, Nakandakare PY, Batista LPR, Teles LDFDS, Leitão MP, Luzia LA, de Medeiros AI, Rondó PH. Maternal plasma transforming growth factor-β1 (TGF-β1) and newborn size: the Araraquara Cohort Study. J Pediatr (Rio J) 2022; 99:284-288. [PMID: 36567066 DOI: 10.1016/j.jped.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To investigate associations of maternal and cord blood cytokine patterns with newborn size and body composition. METHODS This cross-sectional study involved 70 pregnant women and their healthy newborns selected from the "Araraquara Cohort Study". Newborn anthropometric measurements were recorded at birth. Body composition was evaluated by air displacement plethysmography. Maternal blood samples were collected from pregnant women between 30 and 36 weeks of gestation, and umbilical cord blood samples were collected immediately after placenta discharge. The concentrations of the cytokines were determined in plasma by ELISA. Multiple linear regression models were used to assess associations between maternal and cord blood cytokine concentrations and newborn anthropometry and body composition measurements. RESULTS Maternal plasma TGF-β1 concentration was inversely associated with newborn weight (β = -43.0; p = 0.012), length (β = -0.16, p = 0.028), head circumference (β = -0.13, p = 0.004), ponderal index (β = -0.32, p = 0.011) and fat-free mass (β = -0.05, p = 0.005). However, the association persisted just for head circumference (β = -0.26; p = 0.030) and ponderal index (β = - 0.28; p = 0.028), after adjusting for pre-gestational BMI, gestational weight gain, gestational age, hours after delivery, newborn sex, smoking and alcohol consumption. CONCLUSIONS Maternal plasma TGF-β1 concentration may be involved in the regulation of newborn size, mainly head circumference and ponderal index. Further cohort studies are necessary to investigate the role of TGF-β1 in different trimesters of pregnancy and its effect during the early stages of fetal development.
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Affiliation(s)
- Naiara Naiana Dejani
- Universidade Federal da Paraíba, Departamento de Fisiologia e Patologia, João Pessoa, PB, Brazil; Universidade Federal da Paraíba, Laboratório de Biologia Molecular, João Pessoa, PB, Brazil
| | - Carolina F Nicoletti
- Universidade de São Paulo, Faculdade de Medicina, Divisão de Reumatologia, Grupo de Pesquisa em Fisiologia Aplicada e Nutrição, São Paulo, SP, Brazil
| | - Perla Pizzi Argentato
- Universidade de São Paulo, Faculdade de Saúde Pública, Departamento de Nutrição, São Paulo, SP, Brazil
| | - Ludmilla da Silva Pereira
- Universidade Estadual Paulista, Faculdade de Ciências Farmacêuticas, Departamento de Ciências Biológicas, Araraquara, SP, Brazil
| | - Amanda Correia Saraiva
- Universidade Estadual Paulista, Faculdade de Ciências Farmacêuticas, Departamento de Ciências Biológicas, Araraquara, SP, Brazil
| | | | - Patrícia Yury Nakandakare
- Universidade de São Paulo, Faculdade de Saúde Pública, Departamento de Nutrição, São Paulo, SP, Brazil
| | | | | | - Maria Paula Leitão
- Universidade de São Paulo, Faculdade de Saúde Pública, Departamento de Nutrição, São Paulo, SP, Brazil
| | - Liania Alves Luzia
- Universidade de São Paulo, Faculdade de Saúde Pública, Departamento de Nutrição, São Paulo, SP, Brazil
| | - Alexandra Ivo de Medeiros
- Universidade Estadual Paulista, Faculdade de Ciências Farmacêuticas, Departamento de Ciências Biológicas, Araraquara, SP, Brazil; Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Bioquímica e Imunologia, Ribeirão Preto, SP, Brazil
| | - Patrícia Helen Rondó
- Universidade de São Paulo, Faculdade de Saúde Pública, Departamento de Nutrição, São Paulo, SP, Brazil.
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13
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Wang G, Tandon P, Rodriguez N, Ambrosio L, Sutton RT, Dieleman LA, Kroeker KI, Huang V. Impact of Disease Activity and Inflammatory Bowel Disease Subtype on Quality of Life in Preconception and Pregnant Patients. Dig Dis Sci 2022; 68:1156-1166. [PMID: 35930124 DOI: 10.1007/s10620-022-07638-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 07/19/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) and pregnancy both impact health-related quality of life (HRQoL). However, little is known about IBD-related HRQoL around pregnancy. AIMS To assess the trajectory and predictors of HRQoL in preconception and pregnant patients with Crohn's disease (CD) and ulcerative colitis (UC). METHODS Preconception and pregnant patients with IBD were followed prospectively from preconception to twelve months postpartum at a tertiary referral centre. Participants completed the Short IBD Questionnaire (SIBDQ) and were assessed for clinical disease activity (modified Harvey Bradshaw Index or partial Mayo score) and objective disease activity (C-reactive protein [CRP], fecal calprotectin [FCP]). RESULTS A total of 61 patients with IBD (25 CD, 36 UC) were included. During preconception, patients with UC had higher SIBDQ bowel and social sub-scores than those with CD, but this reversed during postpartum. Patients with CD but not UC developed a significant, sustained improvement in SIBDQ upon becoming pregnant, which persisted into 12 months postpartum. In a multivariable linear regression model, clinical disease activity negatively predicted SIBDQ at every pregnancy timepoint and up to 12 months postpartum. SIBDQ was significantly lower in patients with CRP ≥ 8.0 mg/L during trimester 1 (T1), but not later in pregnancy. SIBDQ bowel sub-scores were significantly lower in patients with FCP ≥ 250 mg/kg at T2, T3, and 6 months postpartum. CONCLUSIONS Clinical disease activity is a consistent negative predictor of HRQoL from conception to 12 months postpartum. Patients with UC experience better preconception HRQoL but suffer worse postpartum HRQoL than those with CD.
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Affiliation(s)
- Grace Wang
- Faculty of Medicine, University of Toronto, 1 King's College Cir, Toronto, M5S 1A8, Canada.
| | - Parul Tandon
- Faculty of Medicine, University of Toronto, 1 King's College Cir, Toronto, M5S 1A8, Canada.,Department of Gastroenterology, Mount Sinai Hospital, 600 University Ave, Toronto, M5G 1X5, Canada
| | - Nicole Rodriguez
- Faculty of Medicine, University of Alberta, 8440 112 St NW, Edmonton, T6G 2R7, Canada
| | - Lindsy Ambrosio
- Faculty of Medicine, University of Alberta, 8440 112 St NW, Edmonton, T6G 2R7, Canada.,Division of Gastroenterology, Zeidler Ledcor Centre, University of Alberta, 8540 112 St NW, Edmonton, T6G 2X8, Canada
| | - Reed T Sutton
- Faculty of Medicine, University of Alberta, 8440 112 St NW, Edmonton, T6G 2R7, Canada.,Division of Gastroenterology, Zeidler Ledcor Centre, University of Alberta, 8540 112 St NW, Edmonton, T6G 2X8, Canada
| | - Levinus A Dieleman
- Faculty of Medicine, University of Alberta, 8440 112 St NW, Edmonton, T6G 2R7, Canada.,Division of Gastroenterology, Zeidler Ledcor Centre, University of Alberta, 8540 112 St NW, Edmonton, T6G 2X8, Canada
| | - Karen I Kroeker
- Faculty of Medicine, University of Alberta, 8440 112 St NW, Edmonton, T6G 2R7, Canada.,Division of Gastroenterology, Zeidler Ledcor Centre, University of Alberta, 8540 112 St NW, Edmonton, T6G 2X8, Canada
| | - Vivian Huang
- Faculty of Medicine, University of Toronto, 1 King's College Cir, Toronto, M5S 1A8, Canada.,Department of Gastroenterology, Mount Sinai Hospital, 600 University Ave, Toronto, M5G 1X5, Canada
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14
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Maternal blood metal concentrations are associated with C-reactive protein and cell adhesion molecules among pregnant women in Puerto Rico. Environ Epidemiol 2022; 6:e214. [PMID: 35975168 PMCID: PMC9374188 DOI: 10.1097/ee9.0000000000000214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/20/2022] [Indexed: 01/08/2023] Open
Abstract
Studies have revealed a link between aberrant levels of maternal C-reactive protein (CRP) and cell adhesion molecules (CAMs) with adverse birth outcomes. Some epidemiologic studies have indicated that long-term metal exposures can modulate the levels of CRP and CAMs, but the associations between prenatal metal exposures and the levels of CRP and CAMs have yet to be studied more extensively. In this study, we assessed associations between maternal blood metal levels and CRP/CAMs among 617 pregnant women in the Puerto Rico PROTECT birth cohort.
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15
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de Jong M, Cranendonk A, Twisk JWR, van Weissenbruch MM. Cortisol and Cortisone in Early Childhood in Very-Low-Birthweight Infants and Term-Born Infants. Horm Res Paediatr 2021; 93:453-459. [PMID: 33535224 DOI: 10.1159/000512784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 09/16/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Besides programming of the hypothalamic-pituitary-adrenal (HPA) axis, changes in the activity of 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2) could contribute to the later metabolic and cardiovascular consequences of preterm birth. OBJECTIVE We compared serum cortisol, cortisone, and cortisol/cortisone ratio in early childhood in very-low-birthweight (VLBW) infants and term appropriate for gestational age (AGA) born infants. METHODS We included 41 VLBW infants, participating in the randomized controlled Neonatal Insulin Replacement Therapy in Europe trial, and 64 term AGA-born infants. Cortisol and cortisone were measured in blood samples taken at 6 months and 2 years corrected age (VLBW children) and at 3 months and 1 and 2 years (term children). At 2 years of (corrected) age (HDL) cholesterol, triglycerides, glucose, and insulin were also measured. RESULTS During the first 2 years of life, cortisol/cortisone ratio is higher in VLBW children compared to term children. In the total group of children, cortisol/cortisone ratio is positively related to triglycerides at 2 years of (corrected) age. In VLBW children, over the first 2 years of life both cortisol and cortisone are higher in the early-insulin group compared to the standard care group. CONCLUSIONS In VLBW infants, lower 11β-HSD2 activity probably contributes to the long-term metabolic and cardiovascular risks. In VLBW infants, early insulin treatment could affect programming of the HPA axis, resulting in higher cortisol and cortisone levels during early childhood.
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Affiliation(s)
- Miranda de Jong
- Department of Pediatrics, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Anneke Cranendonk
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jos W R Twisk
- Department of Clinical Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mirjam M van Weissenbruch
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands,
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16
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Kennelly MA, Killeen SL, Phillips CM, Alberdi G, Lindsay KL, Mehegan J, Cronin M, McAuliffe FM. Maternal C3 complement and C-reactive protein and pregnancy and fetal outcomes: A secondary analysis of the PEARS RCT-An mHealth-supported, lifestyle intervention among pregnant women with overweight and obesity. Cytokine 2021; 149:155748. [PMID: 34700074 PMCID: PMC9070411 DOI: 10.1016/j.cyto.2021.155748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 01/12/2023]
Abstract
Objectives: Elevated circulating levels of complement component 3 (C3) and C-reactive protein (CRP) have been linked with adverse pregnancy outcomes. Lifestyle interventions may hold potential to ameliorate these effects. We investigated the effect of an antenatal healthy lifestyle intervention on maternal C3 and CRP concentrations and assessed their relationship with maternal and fetal metabolic markers and outcomes. Study design: Secondary analysis of data from the Pregnancy Exercise And Nutrition Research Study (PEARS) randomized controlled trial. Methods: Women (n = 406) with C3 and CRP concentrations determined in early pregnancy (14–16 weeks) and/or late pregnancy (28-weeks) with corresponding fasting glucose, insulin, c-peptide, and lipid profiles were included in the analysis. Pregnancy outcomes included: diagnoses of gestational diabetes (GDM), pre-eclampsia (PET) or pregnancy induced hypertension (PIH), pre-term birth (delivery < 37 weeks), low birth weight (<2500 g), small-for-gestational age (SGA) defined using < 5th or 10th centile for birthweight and cord blood measures of glucose and lipid metabolism. T-tests investigated changes in C3 and CRP over time. Chi-square, Pearson’s’ correlations and multiple regression investigated relationships with outcomes. Results: The PEARS intervention did not influence maternal C3 or CRP concentrations in pregnancy. There was no relationship between CRP concentrations and any maternal or infant outcome. Women who developed GDM had higher C3 concentrations in early (p = 0.01) and late pregnancy (p = 0.02). Women who developed PIH/PET had lower C3 concentrations in early (p = 0.02), but not late (p = 0.10) pregnancy. Maternal C3 concentrations in early pregnancy were a small but significant predictor of maternal insulin concentrations in early (β = 0.40, 95% CI 0.27, 0.53; p < 0.001) and late (β = 0.30, 95% CI 0.17, 0.43p < 0.001) pregnancy, early total cholesterol (TC), and both early and late triglycerides, LDL and HDL Cholesterol concentrations (all p < 0.001). Women who delivered SGA babies (<10th centile) had lower C3 concentrations than women who did not in both early (p < 0.001) and late pregnancy (p = 0.01). No relationship between maternal C3 or CRP and fetal glucose concentrations or lipid profiles was observed. Conclusion: Maternal C3 may play a role in multiple adverse pregnancy outcomes including cardiometabolic ill-health. Further research on this, and strategies to reduce C3 in a pregnant population, are warranted.
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Affiliation(s)
- Maria A Kennelly
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin 2, Ireland
| | - Sarah Louise Killeen
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin 2, Ireland
| | - Catherine M Phillips
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland
| | - Gouiri Alberdi
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin 2, Ireland
| | - Karen L Lindsay
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin 2, Ireland; Department of Pediatrics, University of California, Irvine, Irvine, CA, USA; Susan Samueli Integrative Health Institute, UCI College of Health Sciences, Irvine, CA, USA
| | - John Mehegan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland
| | | | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin 2, Ireland.
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17
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Friedman C, Dabelea D, Thomas DSK, Peel JL, Adgate JL, Magzamen S, Martenies SE, Allshouse WB, Starling AP. Exposure to ambient air pollution during pregnancy and inflammatory biomarkers in maternal and umbilical cord blood: The Healthy Start study. ENVIRONMENTAL RESEARCH 2021; 197:111165. [PMID: 33857458 PMCID: PMC8216209 DOI: 10.1016/j.envres.2021.111165] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 04/02/2021] [Accepted: 04/09/2021] [Indexed: 05/05/2023]
Abstract
BACKGROUND Air pollution exposure during pregnancy has been associated with adverse pregnancy and birth outcomes. Inflammation has been proposed as a potential link. We estimated associations between air pollution exposure during pregnancy and inflammatory biomarkers in maternal and cord blood. We evaluated whether maternal inflammation was associated with infant outcomes. METHODS Among 515 mother-infant dyads in the Healthy Start study (2009-2014), trimester-long, 7- and 30-day average concentrations of particulate matter ≤2.5 μm (PM2.5) and ozone (O3) during pregnancy were estimated, using inverse-distance-weighted interpolation. Inflammatory biomarkers were measured in maternal blood in mid-pregnancy (C-reactive protein [CRP], Interleukin [IL]-6, and tumor necrosis factor-α [TNFα]) and in cord blood at delivery (CRP, IL-6, IL-8, IL-10, monocyte chemoattractant protein-1 [MCP-1], and TNFα). We used linear regression to estimate associations between pollutants and inflammatory biomarkers and maternal inflammatory biomarkers and infant weight and body composition. RESULTS There were positive associations between PM2.5 during certain exposure periods and maternal IL-6 and TNFα. There were negative associations between recent O3 and maternal CRP, IL-6, and TNFα and positive associations between trimester-long O3 exposure and maternal inflammatory biomarkers, though some 95% confidence intervals included the null. Patterns were inconsistent for associations between PM2.5 and O3 and cord blood inflammatory biomarkers. No consistent associations between maternal inflammatory biomarkers and infant outcomes were identified. CONCLUSIONS Air pollution exposure during pregnancy may impact maternal inflammation. Further investigations should examine the health consequences for women and infants of elevated inflammatory biomarkers associated with air pollution exposure during pregnancy.
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Affiliation(s)
- Chloe Friedman
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Deborah S K Thomas
- Department of Geography and Earth Sciences, University of North Carolina Charlotte, NC, USA
| | - Jennifer L Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - John L Adgate
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sheryl Magzamen
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA; Department of Epidemiology, Colorado School of Public Health, Colorado State University, Fort Collins, CO, USA
| | - Sheena E Martenies
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - William B Allshouse
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Anne P Starling
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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18
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Hamadeh R, Mohsen A, Kobeissy F, Karouni A, Akoum H. C-Reactive Protein for Prediction or Early Detection of Pre-Eclampsia: A Systematic Review. Gynecol Obstet Invest 2021; 86:13-26. [PMID: 33902044 DOI: 10.1159/000515530] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/28/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Pre-eclampsia (PE) is a serious disease of pregnancy and one of the major causes of morbidity and mortality for both the mother and baby. This systematic review aims to detect the role of high-sensitivity C-reactive protein (CRP) in the detection of PE. METHODS Thirty-four articles published between 2001 and 2019 were included in this review. The articles were extracted from OVID Medline and Embase. The study designs of these articles are randomized controlled, cohort, case-control, and cross-sectional studies evaluating CRP as a marker to predict or early diagnose PE. The quality assessment of these articles is made by the modified Quality Assessment of Diagnostic Accuracy Studies 2 tool. Meta-analysis was not done because of clinical and statistical heterogeneity. RESULTS A positive association between CRP levels and the development of PE was confirmed in 18 studies. This positive effect was addressed in patients with normal BMI (<25 kg/m2) in 3 studies and in overweight patients in 2 studies. One study addressed this positive association in patients with a BMI ranging between 28 and 31 kg/m2. Three studies determined a cutoff level of CRP above which a significant risk of PE development should be suspected. These levels ranged between 7 and 15 mg/L. CONCLUSION CRP is a promising cost-effective biomarker that may be used in the prediction of PE. A CRP level higher than 15 mg/L may suggest initiation of low-dose aspirin in low-risk pregnancies.
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Affiliation(s)
- Rola Hamadeh
- Ecole Doctorale en Sciences et Technologie (EDST), Lebanese University, Beirut, Lebanon
| | - Amani Mohsen
- Consultant Obstetrics, Palestinian Red Crescent, Beirut, Lebanon
| | - Firas Kobeissy
- Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
| | - Ali Karouni
- Department of Engineering, Faculty of Technology, Lebanese University, Beirut, Lebanon
| | - Hikmat Akoum
- Faculty of Public Health, Lebanese University, Saida, Lebanon
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19
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Kidd MG, McDade TW. Association between C-reactive protein response to influenza vaccine during pregnancy and birth outcomes. Am J Hum Biol 2021; 34:e23569. [PMID: 33474785 DOI: 10.1002/ajhb.23569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/16/2020] [Accepted: 12/15/2020] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE A growing body of evidence suggests inflammatory markers can help predict poor outcomes in pregnancy. We evaluated C-reactive protein (CRP)-a key biomarker of inflammation-before and after a safe immune provocation (the seasonal influenza vaccine) during pregnancy. We evaluated predictors of the magnitude of response, as well as the association between CRP response and birth outcomes. METHODS Nonrandomized prospective cohort trial measuring CRP before and 3 days after administering seasonal flu vaccine to low-risk obstetrical patients in Calgary, Alberta. RESULTS We analyzed 27 prevaccination/postvaccination samples. Body mass index (BMI) was positively associated with CRP at Day 0, and women with higher prepregnancy BMI had a less robust response to vaccination than did leaner women. There was a strong positive association between CRP response and infant birth weight; women who had the greatest response to vaccination (by tertile) gave birth to babies that weighed, on average, 256.2 g more than babies born to women with the lowest response. CONCLUSIONS Higher BMI in pregnant women was associated with higher baseline CRP and less pronounced CRP response to vaccination. Stronger CRP response was associated with higher birth weight. These findings underscore the potential value of a more dynamic approach to studying the regulation of inflammation during pregnancy and its implications for birth outcomes. This study was registered as a clinical trial in clinicaltrials.gov (ID: REB15/1418).
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Affiliation(s)
- Monica G Kidd
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Thomas W McDade
- Department of Anthropology and Institute for Policy Research, Northwestern University, Evanston, Illinois, USA
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20
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Preeclampsia Among African American Pregnant Women: An Update on Prevalence, Complications, Etiology, and Biomarkers. Obstet Gynecol Surv 2020; 75:111-120. [PMID: 32105335 DOI: 10.1097/ogx.0000000000000747] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Importance Preeclampsia is a devastating disease of pregnancy associated with increased risk of fetal and maternal complications. African American pregnant women have a high prevalence of preeclampsia, but there is a need of systemic analyses of this high-risk group regarding complications, etiology, and biomarkers. Objective The aim of this study was to provide a synopsis of current research of preeclampsia specifically related to African American women. Evidence Acquisition A comprehensive search was performed in the bibliographic database PubMed with keywords "preeclampsia" and "African American." Results African American women with preeclampsia were at an increased risk of preterm birth, which resulted in low-birth-weight infants. Intrauterine fetal death among African American preeclamptic patients occurs at twice the rate as in other races. On the maternal side, African American mothers with preeclampsia have more severe hypertension, antepartum hemorrhage, and increased mortality. Those who survive preeclampsia have a high risk of postpartum cardiometabolic disease. Preexisting conditions (eg, systemic lupus erythematosus) and genetic mutations (eg, sickle cell disease in the mother, FVL or APOL1 mutations in the fetus) may contribute to the higher prevalence and worse outcomes in African American women. Many blood factors, for example, the ratio of proteins sFlt/PlGF, hormones, and inflammatory factors, have been studied as potential biomarkers for preeclampsia, but their specificity needs further investigation. Conclusions Further studies of preeclampsia among African American women addressing underlying risk factors and etiologies, coupled with identification of preeclampsia-specific biomarkers allowing early detection and intervention, will significantly improve the clinical management of this devastating disease.
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21
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Witteveen AB, Henrichs J, Bellers M, van Oenen E, Verhoeven CJ, Vrijkotte TGM. Mediating role of C-reactive protein in associations between pre-pregnancy BMI and adverse maternal and neonatal outcomes: the ABCD-study cohort. J Matern Fetal Neonatal Med 2020; 35:2867-2875. [PMID: 32838637 DOI: 10.1080/14767058.2020.1807510] [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: 10/23/2022]
Abstract
OBJECTIVES Increased body mass index (BMI) is associated with several adverse pregnancy outcomes, though the underlying mechanism of this association has not been fully elucidated. A mediating role of low-grade systemic inflammation in these associations is suspected but has been understudied. Our objective was to examine the effect of pre-pregnancy BMI (pBMI) on maternal and neonatal pregnancy outcomes and to explore potential mediation of these effects by C-reactive protein (CRP), a first trimester peripheral marker of inflammation. METHODS Data from the prospective community-based ABCD-study cohort (n = 3547) was used to assess associations between self-reported continuous and categorized pBMI and outcome measures gestational hypertension (GH) and preeclampsia (PE), preterm birth (PTB) and small for gestational age (SGA) based on national perinatal registration linkage data. High-sensitivity CRP concentrations determined in serum were used to explore potential mediation of these associations by inflammation. RESULTS Multivariable logistic regression analyses, adjusted for confounders, showed that pBMI was significantly related to gestational hypertensive disorders (odds ratio (OR) per standard deviation (SD) 1.66, 95% confidence interval (CI) 1.51-1.83) and PTB (OR 1.20, 95% CI 1.05-1.37). Dose-response relationships between categorical pBMI and gestational hypertensive disorders (overweight OR 2.37, 95% CI 1.85-3.03 and obese OR 4.45, 95% CI 2.93-6.72) and PTB (obese OR 2.12, 95% CI 1.16-3.87) were found as well. SGA was only significantly more prevalent in the underweight BMI category (OR 2.06, 95% CI 1.33-3.19). Mediation analyses revealed small but significant indirect effects of pBMI on overall PTB (0.037, bootstrapped 95% CI 0.005-0.065) and spontaneous PTB (0.038, bootstrapped 95% CI 0.002-0.069) through higher CRP. CRP was not a significant mediator of associations between BMI and gestational hypertensive disorders although larger mediation was found for GH than for PE. CONCLUSION Our findings provide additional evidence that high(er) pBMI increases the risk of adverse maternal and neonatal outcomes and that systemic inflammation mediates some of these risks. Further research in large cohorts including (morbidly) obese women is warranted to identify pathways that may be incorporated in future interventions to reduce the risk of adverse pregnancy outcomes due to maternal obesity.
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Affiliation(s)
- Anke B Witteveen
- Department of Midwifery Science and AVAG, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,AVAG Amsterdam Groningen Midwifery Academy, University of Applied Sciences Inholland, Amsterdam, The Netherlands
| | - Jens Henrichs
- Department of Midwifery Science and AVAG, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Mirthe Bellers
- AVAG Amsterdam Groningen Midwifery Academy, University of Applied Sciences Inholland, Amsterdam, The Netherlands
| | - Esmée van Oenen
- AVAG Amsterdam Groningen Midwifery Academy, University of Applied Sciences Inholland, Amsterdam, The Netherlands
| | - Corine J Verhoeven
- Department of Midwifery Science and AVAG, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, The Netherlands
| | - Tanja G M Vrijkotte
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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22
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Bobetsis YA, Graziani F, Gürsoy M, Madianos PN. Periodontal disease and adverse pregnancy outcomes. Periodontol 2000 2020; 83:154-174. [PMID: 32385871 DOI: 10.1111/prd.12294] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Periodontal diseases are considered not only to affect tooth-supporting tissues but also to have a cause-and-effect relationship with various systemic diseases and conditions, such as adverse pregnancy outcomes. Mechanistic studies provide strong evidence that periodontal pathogens can translocate from infected periodontium to the feto-placental unit and initiate a metastatic infection. However, the extent and mechanisms by which metastatic inflammation and injury contribute to adverse pregnancy outcomes still remain unclear. The presence of oral bacteria in the placenta of women with term gestation further complicates our understanding of the biology behind the role of periodontal pathogens in pregnancy outcomes. Epidemiological studies demonstrate many methodological inconsistencies and flaws that render comparisons difficult and conclusions insecure. Therefore, despite the fact that a number of prospective studies show a positive association between periodontal diseases and various adverse pregnancy outcomes, the evidence behind it is still weak. Future well-designed explanatory studies are necessary to verify this relationship and, if present, determine its magnitude. The majority of high-quality randomized controlled trials reveal that nonsurgical periodontal therapy during the second trimester of gestation does not improve pregnancy outcomes. From a biological standpoint, this can be partially explained by the fact that therapy rendered at the fourth to sixth months of pregnancy is too late to prevent placental colonization by periodontal pathogens and consequently incapable of affecting pathogen-induced injury at the feto-placental unit. Thus, interventions during the preconception period may be more meaningful. With the increase in our understanding on the potential association between periodontal disease and adverse pregnancy outcomes, it is clear that dental practitioners should provide periodontal treatment to pregnant women that is safe for both the mother and the unborn child. Although there is not enough evidence that the anti-infective therapy alters pregnancy outcomes, it improves health-promoting behavior and periodontal condition, which in turn advance general health and risk factor control.
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Affiliation(s)
- Yiorgos A Bobetsis
- Department of Periodontology, National and Kapodistrian University of Athens, Athens, Greece
| | - Filippo Graziani
- Department of Surgery, Medical, Molecular, and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Mervi Gürsoy
- Department of Periodontology, University of Turku, Turku, Finland
| | - Phoebus N Madianos
- Department of Periodontology, National and Kapodistrian University of Athens, Athens, Greece
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23
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de Souza Silva GA, da Silva SP, da Costa MAS, da Silva AR, de Vasconcelos Alves RR, Ângelo Mendes Tenório FDC, da Silva Melo AR, de Freitas AC, Lagos de Melo CM. SARS-CoV, MERS-CoV and SARS-CoV-2 infections in pregnancy and fetal development. J Gynecol Obstet Hum Reprod 2020; 49:101846. [PMID: 32599304 PMCID: PMC7319644 DOI: 10.1016/j.jogoh.2020.101846] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/11/2020] [Accepted: 06/24/2020] [Indexed: 12/15/2022]
Abstract
Recently, in China, in 2019, a new type of disease has arisen caused by a new strain of coronavirus, the SARS-CoV-2 virus, considered extremely worrying due to its high infectivity power and the easy ability to spread geographically. For patients in general, the clinical features resulting from respiratory syndromes can trigger an asymptomatic condition. However, 25 % of patients infected by SARS-CoV-2 can progress to severity. Pregnant women are an unknown field in this complex process, and although they have symptoms similar to non-pregnant women, some points should be considered, such as complications during pregnancy and postpartum. Thus, the aim of this study was to understand the consequences of pregnancy and fetal development, caused by infections by the SARS-CoV, MERS-CoV and SARS-CoV-2 viruses. Among the aforementioned infections, MERS-CoV seems to be the most dangerous for newborns, inducing high blood pressure, pre-eclampsia, pneumonia, acute renal failure, and multiple organ failure in mother. This also causes a higher occurrence of emergency cesarean deliveries and premature births, in addition, some deaths of mothers and fetuses were recorded. Meanwhile, SARS-CoV and SARS-CoV-2 appear to have less severe symptoms. Furthermore, although a study found the ACE2 receptor, used by SARS-CoV-2, widely distributed in specific cell types of the maternal-fetal interface, there is no evidence of vertical transmission for any of the coronaviruses. Thus, the limited reported obstetric cases alert to the need for advanced life support for pregnant women infected with coronaviruses and to the need for further investigation for application in clinical practice.
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Affiliation(s)
- Guilherme Antonio de Souza Silva
- Laboratory of Immunological and Antitumor Analysis, Department of Antibiotics, Bioscience Center, Federal University of Pernambuco, Brazil.
| | - Suéllen Pedrosa da Silva
- Laboratory of Protein Biochemistry, Department of Biochemistry, Bioscience Center, Federal University of Pernambuco, Brazil.
| | - Marcos Aurélio Santos da Costa
- Laboratory of Histology, Department of Histology and Embryology, Bioscience Center, Federal University of Pernambuco, Brazil.
| | - Abdênego Rodrigues da Silva
- Laboratory of Protein Biochemistry, Department of Biochemistry, Bioscience Center, Federal University of Pernambuco, Brazil.
| | | | | | - Alanne Rayssa da Silva Melo
- Laboratory of Molecular Studies and Experimental Therapy, Department of Genetics, Bioscience Center, Federal University of Pernambuco, Brazil.
| | - Antonio Carlos de Freitas
- Laboratory of Molecular Studies and Experimental Therapy, Department of Genetics, Bioscience Center, Federal University of Pernambuco, Brazil.
| | - Cristiane Moutinho Lagos de Melo
- Laboratory of Immunological and Antitumor Analysis, Department of Antibiotics, Bioscience Center, Federal University of Pernambuco, Brazil.
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24
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Brouillet S, Boursier G, Anav M, Du Boulet De La Boissière B, Gala A, Ferrieres-Hoa A, Touitou I, Hamamah S. C-reactive protein and ART outcomes: a systematic review. Hum Reprod Update 2020; 26:753-773. [DOI: 10.1093/humupd/dmaa012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/17/2020] [Indexed: 12/23/2022] Open
Abstract
Abstract
BACKGROUND
A dynamic balance between pro- and anti-inflammatory factors contributes to regulating human female reproduction. Chronic low-grade inflammation has been detected in several female reproductive conditions, from anovulation to embryo implantation failure. C-reactive protein (CRP) is a reliable marker of inflammation that is extensively used in clinical practice. Recent studies quantified CRP in the serum of infertile women undergoing ART and suggested its potential for the prediction of ART reproductive outcomes.
OBJECTIVE AND RATIONALE
The first objective of this systematic review of the available literature was to evaluate the association between pre-implantation circulating CRP concentration and pregnancy rates in women undergoing ART. The second objective was to describe serum CRP concentration changes after early embryo implantation. The changes in circulating CRP throughout the ART cycle, clinical implications of CRP quantification for the management of women undergoing ART, and future therapeutic options will also be discussed.
SEARCH METHODS
The MEDLINE database was systematically searched from inception to March 2019 using the following key words: (C-reactive protein) AND (assisted reproductive techniques OR ovulation induction OR insemination OR in vitro fertilization). Only articles in English were considered. Studies were selected based on title and abstract. The full text of potentially relevant articles was retrieved and assessed for inclusion by two reviewers (S.B. and S.H.). The protocol was registered in the International prospective register of systematic reviews (PROSPERO; registration number: CRD148687).
OUTCOMES
In total, 10 studies were included in this systematic review. Most of these studies reported lower circulating CRP values before the window of implantation and higher circulating CRP values during the peri-implantation period in women with successful ART outcome (biochemical or clinical pregnancy) compared to women without a successful outcome. Several lifestyle factors and/or drugs that reduce the concentration of circulating CRP significantly improve ART outcomes. Subgroup analyses according to female BMI and baseline circulating CRP concentration are highly recommended in future analyses.
WIDER IMPLICATIONS
These findings highlight a possible detrimental impact of preconception high circulating CRP concentration on ART outcomes. However, the biochemical or clinical pregnancy rate endpoints used in the studies examined here are insufficient (there were no data on live birth outcome), and the impact of major variables that can influence CRP and/or ART, for example maternal age, BMI, number of transferred embryos, and use of anti-inflammatory drugs, were not considered in the analyses. CRP quantification may be a potential marker of ART outcome, but its predictive value still needs to be investigated in large prospective studies. In future, the quantification of circulating CRP before starting ART could help to identify patients with a poor ART prognosis, leading to ART cycle cancellation or to preconception treatment to minimize the medical risks and costs.
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Affiliation(s)
- Sophie Brouillet
- Université Grenoble-Alpes, Inserm 1036, Commissariat à l'Énergie Atomique et aux Énergies Alternatives (CEA), Institut de Biosciences et Biotechnologies de Grenoble (BIG), Laboratoire Biologie du Cancer et de l’Infection (BCI), 38000 Grenoble, France
- Centre Hospitalier Universitaire de Grenoble, Hôpital Couple-Enfant, Centre Clinique et Biologique d’Assistance Médicale à la Procréation-Centre d'Étude et de Conservation des Oeufs et du Sperme Humains (CECOS), La Tronche, France
- Univ Montpellier, Développement Embryonnaire Précoce Humain et Pluripotence, INSERM 1203, Montpellier, France
- CHU Montpellier, Univ Montpellier, Département de Biologie de la Reproduction, Biologie de la Reproduction et Diagnostic Pre-Implantatoire, Montpellier, France
| | - Guilaine Boursier
- CHU Montpellier, Univ Montpellier, Département de Génétique Médicale, Maladies Rares et Médecine Personnalisée, Génétique des Maladies Rares et Autoinflammatoires, Montpellier, France
| | - Margaux Anav
- CHU Montpellier, Univ Montpellier, Département de Biologie de la Reproduction, Biologie de la Reproduction et Diagnostic Pre-Implantatoire, Montpellier, France
| | - Bertille Du Boulet De La Boissière
- CHU Montpellier, Univ Montpellier, Département de Biologie de la Reproduction, Biologie de la Reproduction et Diagnostic Pre-Implantatoire, Montpellier, France
| | - Anna Gala
- CHU Montpellier, Univ Montpellier, Département de Biologie de la Reproduction, Biologie de la Reproduction et Diagnostic Pre-Implantatoire, Montpellier, France
| | - Alice Ferrieres-Hoa
- CHU Montpellier, Univ Montpellier, Département de Biologie de la Reproduction, Biologie de la Reproduction et Diagnostic Pre-Implantatoire, Montpellier, France
| | - Isabelle Touitou
- CHU Montpellier, Univ Montpellier, Département de Génétique Médicale, Maladies Rares et Médecine Personnalisée, Génétique des Maladies Rares et Autoinflammatoires, Montpellier, France
- Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies, INSERM, Univ de Montpellier, Montpellier, France
| | - Samir Hamamah
- Univ Montpellier, Développement Embryonnaire Précoce Humain et Pluripotence, INSERM 1203, Montpellier, France
- CHU Montpellier, Univ Montpellier, Département de Biologie de la Reproduction, Biologie de la Reproduction et Diagnostic Pre-Implantatoire, Montpellier, France
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25
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Yeung EH, Guan W, Zeng X, Salas LA, Mumford SL, de Prado Bert P, van Meel ER, Malmberg A, Sunyer J, Duijts L, Felix JF, Czamara D, Hämäläinen E, Binder EB, Räikkönen K, Lahti J, London SJ, Silver RM, Schisterman EF. Cord blood DNA methylation reflects cord blood C-reactive protein levels but not maternal levels: a longitudinal study and meta-analysis. Clin Epigenetics 2020; 12:60. [PMID: 32354366 PMCID: PMC7193358 DOI: 10.1186/s13148-020-00852-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 04/15/2020] [Indexed: 02/22/2023] Open
Abstract
Background Prenatal inflammation has been proposed as an important mediating factor in several adverse pregnancy outcomes. C-reactive protein (CRP) is an inflammatory cytokine easily measured in blood. It has clinical value due to its reliability as a biomarker for systemic inflammation and can indicate cellular injury and disease severity. Elevated levels of CRP in adulthood are associated with alterations in DNA methylation. However, no studies have prospectively investigated the relationship between maternal CRP levels and newborn DNA methylation measured by microarray in cord blood with reasonable epigenome-wide coverage. Importantly, the timing of inflammation exposure during pregnancy may also result in different effects. Thus, our objective was to evaluate this prospective association of CRP levels measured during multiple periods of pregnancy and in cord blood at delivery which was available in one cohort (i.e., Effects of Aspirin in Gestation and Reproduction trial), and also to conduct a meta-analysis with available data at one point in pregnancy from three other cohorts from the Pregnancy And Childhood Epigenetics consortium (PACE). Secondarily, the impact of maternal randomization to low dose aspirin prior to pregnancy on methylation was assessed. Results Maternal CRP levels were not associated with newborn DNA methylation regardless of gestational age of measurement (i.e., CRP at approximately 8, 20, and 36 weeks among 358 newborns in EAGeR). There also was no association in the meta-analyses (all p > 0.5) with a larger sample size (n = 1603) from all participating PACE cohorts with available CRP data from first trimester (< 18 weeks gestation). Randomization to aspirin was not associated with DNA methylation. On the other hand, newborn CRP levels were significantly associated with DNA methylation in the EAGeR trial, with 33 CpGs identified (FDR corrected p < 0.05) when both CRP and methylation were measured at the same time point in cord blood. The top 7 CpGs most strongly associated with CRP resided in inflammation and vascular-related genes. Conclusions Maternal CRP levels measured during each trimester were not associated with cord blood DNA methylation. Rather, DNA methylation was associated with CRP levels measured in cord blood, particularly in gene regions predominately associated with angiogenic and inflammatory pathways. Trial registration Clinicaltrials.gov, NCT00467363, Registered April 30, 2007, http://www.clinicaltrials.gov/ct2/show/NCT00467363
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Affiliation(s)
- Edwina H Yeung
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Dr, MSC 7004, Bethesda, MD, 20817, USA.
| | - Weihua Guan
- Division of Biostatistics, School of Public Health, University of Minnesota, A460 Mayo Building, MMC 303, 420 Delaware St. SE, Minneapolis, MN, 55455, USA
| | | | - Lucas A Salas
- Department of Epidemiology, Geisel School of Medicine at Dartmouth College, Lebanon, NH, 03766, USA
| | - Sunni L Mumford
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Dr, MSC 7004, Bethesda, MD, 20817, USA
| | - Paula de Prado Bert
- ISGlobal, 08003, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), 08003, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Evelien R van Meel
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Anni Malmberg
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jordi Sunyer
- ISGlobal, 08003, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), 08003, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,IMIM (Hospital del Mar Medical Research Institute), 08003, Barcelona, Spain
| | - Liesbeth Duijts
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Janine F Felix
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Darina Czamara
- Department of Translational Research in Psychiatry, Max-Planck-Institute of Psychiatry, Munich, Germany
| | | | - Elisabeth B Binder
- Department of Translational Research in Psychiatry, Max-Planck-Institute of Psychiatry, Munich, Germany.,Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, USA
| | - Katri Räikkönen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jari Lahti
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Stephanie J London
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, Durham, NC, 27709, USA
| | - Robert M Silver
- University of Utah, Salt Lake City, 50 N Medical Dr, Salt Lake City, UT, 84132, USA
| | - Enrique F Schisterman
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Dr, MSC 7004, Bethesda, MD, 20817, USA
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Chopra A, Radhakrishnan R, Sharma M. Porphyromonas gingivalis and adverse pregnancy outcomes: a review on its intricate pathogenic mechanisms. Crit Rev Microbiol 2020; 46:213-236. [PMID: 32267781 DOI: 10.1080/1040841x.2020.1747392] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Porphyromonas gingivalis (P. gingivalis), a Gram-negative facultative anaerobe of the oral cavity, is associated with the onset of various adverse pregnancy outcomes. P. gingivalis is linked with the development of preeclampsia, preterm labour, spontaneous abortion, gestational diabetes, foetal growth restriction, and misconception. The unique virulence factors, surface adhesions, enzymes of P. gingivalis can directly injure and alter the morphology, microbiome the foetal and maternal tissues. P. gingivalis can even exaggerate the production of cytokines, free radicals and acute-phase proteins in the uterine compartment that increases the risk of myometrial contraction and onset of preterm labour. Although evidence confirms the presence of P. gingivalis in the amniotic fluid and placenta of women with poor pregnancy outcomes, the intricate molecular mechanisms by which P. gingivalis initiates various antenatal and postnatal maternal and foetal complications are not well explained in the literature. Therefore, the present review aims to comprehensively summarise and highlight the recent and unique molecular pathogenic mechanisms of P. gingivalis associated with adverse pregnancy outcomes.
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Affiliation(s)
- Aditi Chopra
- Department of Periodontology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Raghu Radhakrishnan
- Department of Oral Pathology and Microbiology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Mohit Sharma
- Department of Oral Pathology, Sudha Rustagi College of Dental Sciences & Research, Faridabad, India
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27
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Starling AP, Moore BF, Thomas DSK, Peel JL, Zhang W, Adgate JL, Magzamen S, Martenies SE, Allshouse WB, Dabelea D. Prenatal exposure to traffic and ambient air pollution and infant weight and adiposity: The Healthy Start study. ENVIRONMENTAL RESEARCH 2020; 182:109130. [PMID: 32069764 PMCID: PMC7394733 DOI: 10.1016/j.envres.2020.109130] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 05/06/2023]
Abstract
BACKGROUND Prenatal exposures to ambient air pollution and traffic have been associated with adverse birth outcomes, and may also lead to an increased risk of obesity. Obesity risk may be reflected in changes in body composition in infancy. OBJECTIVE To estimate associations between prenatal ambient air pollution and traffic exposure, and infant weight and adiposity in a Colorado-based prospective cohort study. METHODS Participants were 1125 mother-infant pairs with term births. Birth weight was recorded from medical records and body composition measures (fat mass, fat-free mass, and adiposity [percent fat mass]) were evaluated via air displacement plethysmography at birth (n = 951) and at ~5 months (n = 574). Maternal residential address was used to calculate distance to nearest roadway, traffic density, and ambient concentrations of fine particulate matter (PM2.5) and ozone (O3) via inverse-distance weighted interpolation of stationary monitoring data, averaged by trimester and throughout pregnancy. Adjusted linear regression models estimated associations between exposures and infant weight and body composition. RESULTS Participants were urban residents and diverse in race/ethnicity and socioeconomic status. Average ambient air pollutant concentrations were generally low; the median, interquartile range (IQR), and range of third trimester concentrations were 7.3 μg/m3 (IQR: 1.3, range: 3.3-12.7) for PM2.5 and 46.3 ppb (IQR: 18.4, range: 21.7-63.2) for 8-h maximum O3. Overall there were few associations between traffic and air pollution exposures and infant outcomes. Third trimester O3 was associated with greater adiposity at follow-up (2.2% per IQR, 95% CI 0.1, 4.3), and with greater rates of change in fat mass (1.8 g/day, 95% CI 0.5, 3.2) and adiposity (2.1%/100 days, 95% CI 0.4, 3.7) from birth to follow-up. CONCLUSIONS We found limited evidence of an association between prenatal traffic and ambient air pollution exposure and infant body composition. Suggestive associations between prenatal ozone exposure and early postnatal changes in body composition merit further investigation.
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Affiliation(s)
- Anne P Starling
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Brianna F Moore
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Deborah S K Thomas
- Department of Geography and Earth Sciences, University of North Carolina Charlotte, NC, USA
| | - Jennifer L Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Weiming Zhang
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - John L Adgate
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sheryl Magzamen
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA; Department of Epidemiology, Colorado School of Public Health, Colorado State University, Fort Collins, CO, USA
| | - Sheena E Martenies
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - William B Allshouse
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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28
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Mechanistic insights into the action of probiotics against bacterial vaginosis and its mediated preterm birth: An overview. Microb Pathog 2020; 141:104029. [PMID: 32014462 DOI: 10.1016/j.micpath.2020.104029] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/29/2020] [Indexed: 02/07/2023]
Abstract
The human body is a reservoir of numerous micro-creatures; whose role is substantial and indispensable in the overall development of human beings. The advances in omic approaches have offered powerful means to decipher the core microbiome and metabolome diversities in a specific organ system. The establishment of lactobacilli in the female reproductive tract is thought to be a paramount prerequisite that maintains homeostatic conditions for a sustainable and healthy pregnancy. Nevertheless, a plethora of such Lactobacillus strains of vaginal source revealed probiotic phenotypes. The plummeting in the occurrence of lactobacilli in the vaginal ecosystem is associated with several adverse pregnancy outcomes (APOs). One such pathological condition is "Bacterial Vaginosis" (BV), a pathogen dominated gynecological threat. In this scenario, the ascending traffic of notorious Gram-negative/variable BV pathogens to the uterus is one of the proposed pathways that give rise to inflammation-related APOs like preterm birth. Since antibiotic resistance is aggravating among urogenital pathogens, the probiotics intervention remains one of the alternative biotherapeutic strategies to overcome BV and its associated APOs. Perhaps, the increased inclination towards the safer and natural biotherapeutic strategies rather than pharmaceutical drugs for maintaining gestational and reproductive health resulted in the use of probiotics in pregnancy diets. In this context, the current review is an attempt to highlight the microbiome and metabolites signatures of BV and non-BV vaginal ecosystem, inflammation or infection-related preterm birth, host-microbial interactions, role and effectiveness of probiotics to fight against aforesaid diseased conditions.
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29
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Robinson JF, Kapidzic M, Hamilton EG, Chen H, Puckett KW, Zhou Y, Ona K, Parry E, Wang Y, Park JS, Costello JF, Fisher SJ. Genomic Profiling of BDE-47 Effects on Human Placental Cytotrophoblasts. Toxicol Sci 2019; 167:211-226. [PMID: 30202865 DOI: 10.1093/toxsci/kfy230] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Despite gradual legislative efforts to phase out flame retardants (FRs) from the marketplace, polybrominated diphenyl ethers (PBDEs) are still widely detected in human maternal and fetal tissues, eg, placenta, due to their continued global application in consumer goods and inherent biological persistence. Recent studies in rodents and human placental cell lines suggest that PBDEs directly cause placental toxicity. During pregnancy, trophoblasts play key roles in uterine invasion, vascular remodeling, and anchoring of the placenta-fetal unit to the mother. Thus, to study the potential consequences of PBDE exposures on human placental development, we used an in vitro model: primary villous cytotrophoblasts (CTBs). Following exposures, the endpoints that were evaluated included cytotoxicity, function (migration, invasion), the transcriptome, and the methylome. In a concentration-dependent manner, common PBDE congeners, BDE-47 and -99, significantly reduced cell viability and increased death. Upon exposures to sub-cytotoxic concentrations (≤ 5 µM), we observed BDE-47 accumulation in CTBs with limited evidence of metabolism. At a functional level, BDE-47 hindered the ability of CTBs to migrate and invade. Transcriptomic analyses of BDE-47 effects suggested concentration-dependent changes in gene expression, involving stress pathways, eg, inflammation and lipid/cholesterol metabolism as well as processes underlying trophoblast fate, eg, differentiation, migration, and vascular morphogenesis. In parallel assessments, BDE-47 induced low-level global increases in methylation of CpG islands, including a subset that were proximal to genes with roles in cell adhesion/migration. Thus, using a primary human CTB model, we showed that PBDEs induced alterations at cellular and molecular levels, which could adversely impact placental development.
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Affiliation(s)
- Joshua F Robinson
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Center for Reproductive Sciences, University of California, San Francisco (UCSF), San Francisco, California 94143.,Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco (UCSF), San Francisco, California 94143
| | - Mirhan Kapidzic
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Center for Reproductive Sciences, University of California, San Francisco (UCSF), San Francisco, California 94143.,Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco (UCSF), San Francisco, California 94143
| | - Emily G Hamilton
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Center for Reproductive Sciences, University of California, San Francisco (UCSF), San Francisco, California 94143.,Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco (UCSF), San Francisco, California 94143
| | - Hao Chen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Center for Reproductive Sciences, University of California, San Francisco (UCSF), San Francisco, California 94143.,Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco (UCSF), San Francisco, California 94143
| | - Kenisha W Puckett
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Center for Reproductive Sciences, University of California, San Francisco (UCSF), San Francisco, California 94143.,Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco (UCSF), San Francisco, California 94143
| | - Yan Zhou
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Center for Reproductive Sciences, University of California, San Francisco (UCSF), San Francisco, California 94143.,Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco (UCSF), San Francisco, California 94143
| | - Katherine Ona
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Center for Reproductive Sciences, University of California, San Francisco (UCSF), San Francisco, California 94143.,Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco (UCSF), San Francisco, California 94143
| | - Emily Parry
- Environmental Chemistry Laboratory, Department of Toxic Substances Control, California Environmental Protection Agency, Berkeley, California 94710
| | - Yunzhu Wang
- Environmental Chemistry Laboratory, Department of Toxic Substances Control, California Environmental Protection Agency, Berkeley, California 94710
| | - June-Soo Park
- Environmental Chemistry Laboratory, Department of Toxic Substances Control, California Environmental Protection Agency, Berkeley, California 94710
| | - Joseph F Costello
- Department of Neurological Surgery, University of California, San Francisco (UCSF), San Francisco, California 94158
| | - Susan J Fisher
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Center for Reproductive Sciences, University of California, San Francisco (UCSF), San Francisco, California 94143.,Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco (UCSF), San Francisco, California 94143
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30
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Ultra-high sensitive C-reactive protein during normal pregnancy and in preeclampsia. J Hypertens 2019; 37:1012-1017. [DOI: 10.1097/hjh.0000000000002003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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Arroyo V, Linares C, Díaz J. Premature births in Spain: Measuring the impact of air pollution using time series analyses. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 660:105-114. [PMID: 30639707 DOI: 10.1016/j.scitotenv.2018.12.470] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 12/27/2018] [Accepted: 12/30/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Premature birth (<37 weeks of gestation) is the principal indicator of neonatal death during the first month of life and the second cause of death of children under age five. There are 15 million premature births (PTB) worldwide. Air pollution in cities, primarily the result of urban traffic, greatly impacts PTBs, though there are few studies carried out on this topic at the country level. The objective of this study is to quantify the relative risks (RR) and the population attributable risk (PAR) of concentrations of contaminants on PTBs in Spain, and to analyze the most susceptible trimesters. METHODS For each province average weekly PTBs were calculated (ICD-10: P07.2-P07.3) during the period 2001-2009 as well as weekly average concentrations of PM10, NO2 and O3. Estimations were made of RR and PAR using generalized linear models with link Poisson, controlling for the trend, seasonality, the autoregressive nature of the series and the influence of temperature in periods of heat and/or cold waves. A meta-analysis was carried out to estimate RR and PAR at the global level based on the RR obtained for each of the provinces. RESULTS For all of Spain, the global RR of PTB due to the impact of PM10 was 1.071 (1.049, 1.093) and 1.150 (1.084, 1.220) for NO2, with no detected association for O3. Therefore, with decreases of 10 μg/m3 in the concentrations of PM10 and NO2, around 12.5% and 4.5% of PTBs could have been avoided respectively. CONCLUSIONS Around 1.35% of PTBs that occurred in Spain during the study period can be attributed to air pollution. The adoption of structural measures to reduce these air pollutants should result in a decrease in the number of PTBs in Spain.
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Affiliation(s)
- Virginia Arroyo
- National School of Public Health, Carlos III Institute of Health, Madrid, Spain; Autonomous University of Madrid, Spain
| | - Cristina Linares
- National School of Public Health, Carlos III Institute of Health, Madrid, Spain
| | - Julio Díaz
- National School of Public Health, Carlos III Institute of Health, Madrid, Spain.
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32
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Levine LD, Holland TL, Kim K, Sjaarda LA, Mumford SL, Schisterman EF. The role of aspirin and inflammation on reproduction: the EAGeR trial 1. Can J Physiol Pharmacol 2018; 97:187-192. [PMID: 30562044 DOI: 10.1139/cjpp-2018-0368] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Inflammation has been linked to several complications in pregnancy, including pregnancy loss. Due to its anti-inflammatory properties, aspirin, a widely available and inexpensive therapy, has potential to help mitigate the negative effects of inflammation along the reproductive pathway. Therefore, the Effects of Aspirin in Gestation and Reproduction (EAGeR) trial was designed to elucidate whether preconception-initiated daily low-dose aspirin would increase the live birth rate in women with 1-2 prior pregnancy losses and no infertility diagnosis and attempting unassisted conception. Here, we present an overview of the collected findings. Low-dose aspirin was associated with an increased live birth rate among women with a single loss at <20 weeks gestation within the past year. When stratified by tertile of C-reactive protein (CRP), a biomarker of inflammation, treatment with aspirin restored a decrement in the live birth rate in women in the highest CRP tertile (relative risk 1.35, 95% confidence interval 1.08-1.67), increasing to similar rates as women of the lower and mid-CRP tertiles. The same effect modification by inflammation status was observed when examining the effect of low-dose aspirin on offspring sex ratio. These results suggest that inflammation plays an important role in reproduction, and that chronic, low-grade inflammation may be amenable to aspirin treatment.
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Affiliation(s)
- Lindsay D Levine
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA.,Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
| | - Tiffany L Holland
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA.,Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
| | - Keewan Kim
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA.,Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
| | - Lindsey A Sjaarda
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA.,Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sunni L Mumford
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA.,Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
| | - Enrique F Schisterman
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA.,Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
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Vecchié A, Bonaventura A, Carbone F, Maggi D, Ferraiolo A, Carloni B, Andraghetti G, Affinito Bonabello L, Liberale L, Dallegri F, Montecucco F, Cordera R. C-Reactive Protein Levels at the Midpregnancy Can Predict Gestational Complications. BIOMED RESEARCH INTERNATIONAL 2018; 2018:1070151. [PMID: 30533423 PMCID: PMC6247639 DOI: 10.1155/2018/1070151] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/16/2018] [Accepted: 10/25/2018] [Indexed: 12/18/2022]
Abstract
Although essential for a successful pregnancy, a growing body of evidence suggests that maternal inflammation, when dysregulated, may represent a risk factor for both maternal and neonatal outcomes. Here, we assessed the accuracy of maternal C-reactive protein (CRP) concentrations at the middle phase of pregnancy in the identification of maternal adverse outcomes (MAO) until delivery. A correlation between CRP and a complicated pregnancy including both maternal and neonatal adverse outcomes has been investigated, too. In this retrospective study, conducted at the Diabetology Unit of IRCCS Ospedale Policlinico San Martino, Genoa (Italy), 380 outpatient pregnant women have been enrolled at the prenatal visit before performing a 75 g oral glucose tolerance test at 24th-26th gestational week for gestational diabetes mellitus (GDM) screening. Demographic, medical, and reproductive history has been obtained by verbal interview. Data about pregnancy and delivery have been retrieved from medical records. The median value of maternal baseline serum CRP was 3.25 μg/mL. Women experiencing MAO were older, more frequently suffering from hypertension, and showed higher CRP concentrations, with a cutoff value >1.86 μg/mL found by a ROC curve analysis to be accurately predictive for MAO. By a logistic regression analysis, serum CRP levels >1.86 μg/mL have been found to predict MAO also considering maternal age, hypertension, and GDM. Maternal CRP levels have been positively associated with overall pregnancy adverse outcomes (maternal and neonatal), too. In conclusion, in pregnant women serum levels of CRP can early recognize subjects at higher risk for maternal and neonatal complications needing a more stringent follow-up.
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Affiliation(s)
- Alessandra Vecchié
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Aldo Bonaventura
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Federico Carbone
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Davide Maggi
- Diabetology Unit, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Antonella Ferraiolo
- Department of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Beatrice Carloni
- Diabetology Unit, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Gabriella Andraghetti
- Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Laura Affinito Bonabello
- Diabetology Unit, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Luca Liberale
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
- Center for Molecular Cardiology, University of Zurich, 12 Wagistrasse, 8952 Schlieren, Switzerland
| | - Franco Dallegri
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
- IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, 10 Largo Benzi, 16132, Genoa, Italy
| | - Fabrizio Montecucco
- IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, 10 Largo Benzi, 16132, Genoa, Italy
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, 9 viale Benedetto XV, 16132 Genoa, Italy
| | - Renzo Cordera
- Diabetology Unit, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
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Genome-wide identification of the entire 90 glutathione S-transferase (GST) subfamily genes in four rotifer Brachionus species and transcriptional modulation in response to endocrine disrupting chemicals. COMPARATIVE BIOCHEMISTRY AND PHYSIOLOGY D-GENOMICS & PROTEOMICS 2018; 28:183-195. [PMID: 30290366 DOI: 10.1016/j.cbd.2018.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 02/08/2023]
Abstract
Genome-wide identification of glutathione S-transferase (GST), a major phase II detoxification enzyme, was investigated in four different aquatic model rotifer species Brachionus koreanus, B. plicatilis, B. rotundiformis, and B. calyciflorus. GSTs are ubiquitous antioxidant enzymes that play versatile function including cellular detoxification, stress alleviation, and production of the radical conjugates. Among the four rotifers, B. rotundiformis was found with the least number of GST genes (total 19 GST genes), whereas the other three species shared 23 to 24 GST genes. Among the identified GST genes, belonging to the cytosolic GST superfamily, the expansion of GST sigma classes mainly occurs through tandem duplication, resulting in tandem-arrayed gene clusters on the chromosomes. Overall, the number of genes discovered in this study was highest in the sigma class, zeta, alpha, and omega in descending order. With integration of phylogenetic analysis and xenobiotic-mediated GST mRNA expression patterns along with previous enzymatic activities, the functional divergence among species-specific GST genes was clearly observed. This study covers full identification of GST classes in three marine rotifer and one fresh-water rotifer species and their important role in marine environmental ecotoxicology.
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35
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Lauer JM, Duggan CP, Ausman LM, Griffiths JK, Webb P, Agaba E, Nshakira N, Tran HQ, Gewirtz AT, Ghosh S. Biomarkers of maternal environmental enteric dysfunction are associated with shorter gestation and reduced length in newborn infants in Uganda. Am J Clin Nutr 2018; 108:889-896. [PMID: 30247538 PMCID: PMC6186209 DOI: 10.1093/ajcn/nqy176] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 07/09/2018] [Indexed: 12/21/2022] Open
Abstract
Background Adverse birth outcomes, including preterm birth and stunting at birth, have long-term health implications. The relation between adverse birth outcomes and chronic, asymptomatic gastrointestinal inflammation (environmental enteric dysfunction-EED) is poorly understood. Objective We aimed to examine the relation between maternal EED and adverse birth outcomes in a sample of pregnant Ugandan women and their newborn infants. Design We conducted a prospective cohort study in Mukono, Uganda. A total of 258 pregnant women were enrolled at their first prenatal visit (∼18 weeks of gestation). EED was measured by urinary lactulose:mannitol (L:M) ratio and serum concentrations of antibodies to the bacterial components flagellin and LPS. Covariates were obtained from survey data collected at 2 time points. Associations were assessed through the use of unadjusted and adjusted simple linear regression models. Results Complete birth outcome data were recorded for 220 infants within 48 h of delivery. Mean ± SD gestational age was 39.7 ± 2.1 wk, and 7% were born preterm. Mean ± SD length and length-for-age z score (LAZ) at birth were 48.1 ± 3.2 cm and -0.44 ± 1.07, respectively. L:M ratio was not associated with any birth outcome. In adjusted models, higher concentrations of natural log-transformed anti-flagellin immunoglobin G (IgG) and anti-LPS IgG were significantly associated with shorter length of gestation (β: -0.89 wk; 95% CI: -1.77, -0.01 wk, and β: -1.01 wk; 95% CI: -1.87, -0.17 wk, respectively) and with reduced length (β: -0.80 cm; 95% CI: -1.55, -0.05 cm, and β: -0.79 cm; 95% CI: -1.54, -0.04 cm, respectively) and LAZ at birth (β -0.44 z score; 95% CI: -0.83, -0.05, and β: -0.40 z score; 95% CI: -0.79, -0.01, respectively). Conclusion Maternal anti-flagellin and anti-LPS IgG concentrations in pregnancy, but not L:M ratio, were associated with shorter gestation and reduced infant length at birth. Further research on the relation between maternal EED and birth outcomes is warranted.
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Affiliation(s)
- Jacqueline M Lauer
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy and,USAID Feed the Future Innovation Lab for Nutrition at Tufts University, Boston, MA,Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA,Address correspondence to JML (e-mail: )
| | - Christopher P Duggan
- USAID Feed the Future Innovation Lab for Nutrition at Tufts University, Boston, MA,Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Lynne M Ausman
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy and,USAID Feed the Future Innovation Lab for Nutrition at Tufts University, Boston, MA
| | - Jeffrey K Griffiths
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA,Tufts University Cummings School of Veterinary Medicine and Tufts University School of Engineering, Medford, MA
| | - Patrick Webb
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy and,USAID Feed the Future Innovation Lab for Nutrition at Tufts University, Boston, MA
| | - Edgar Agaba
- USAID Feed the Future Innovation Lab for Nutrition at Tufts University, Boston, MA
| | | | - Hao Q Tran
- Institute for Biomedical Sciences, Georgia State University, Atlanta, GA
| | - Andrew T Gewirtz
- Institute for Biomedical Sciences, Georgia State University, Atlanta, GA
| | - Shibani Ghosh
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy and,USAID Feed the Future Innovation Lab for Nutrition at Tufts University, Boston, MA
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Eastabrook G, Aksoy T, Bedell S, Penava D, de Vrijer B. Preeclampsia biomarkers: An assessment of maternal cardiometabolic health. Pregnancy Hypertens 2018; 13:204-213. [PMID: 30177053 DOI: 10.1016/j.preghy.2018.06.005] [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: 01/31/2018] [Revised: 05/09/2018] [Accepted: 06/09/2018] [Indexed: 12/15/2022]
Abstract
Preeclampsia is a serious pregnancy condition defined as new-onset hypertension and proteinuria, commonly characterized as either early, 'placental', or late onset, 'maternal', using a cut-off of 34 weeks gestation. However, it may be more useful to differentiate between the vascular remodelling and placental invasion vs. inflammation and metabolic pathophysiology that underlie these forms of preeclampsia. Due to rising rates of obesity, the late-onset, maternal form is increasingly occurring earlier in pregnancy. Predictive tests for preeclampsia typically include biophysical markers such as maternal body mass index and mean arterial pressure, indicating the importance of cardiovascular and metabolic health in its pathophysiology. In contrast, the placental, inflammatory, endothelial and/or metabolic biomarkers used in these tests are generally thought to indicate an abnormal response to placentation and predict the disease. However, many of these non-placental biomarkers are known to predict impaired metabolic health in non-pregnant subjects with obesity (metabolically unhealthy obesity) and coronary artery disease or stroke in people at risk for cardiovascular events. Similarities between the performance of these markers in the prediction of cardiovascular and metabolic health outside of pregnancy suggests that they may be more indicative of maternal health than predictive for preeclampsia. This paper reviews the biophysical and biochemical markers in preeclampsia prediction and compares their performance to tests assessing metabolic health and risk of cardiovascular disease, particularly in the obese population.
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Affiliation(s)
- Genevieve Eastabrook
- Department of Obstetrics and Gynaecology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada; Children's Health Research Institute and Lawson Health Research Institute, London, Ontario, Canada.
| | - Tuba Aksoy
- Department of Obstetrics and Gynecology, Mackenzie Richmond Hill Hospital, Richmond Hill, Ontario, Canada.
| | - Samantha Bedell
- Department of Obstetrics and Gynaecology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.
| | - Debbie Penava
- Department of Obstetrics and Gynaecology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada; Children's Health Research Institute and Lawson Health Research Institute, London, Ontario, Canada.
| | - Barbra de Vrijer
- Department of Obstetrics and Gynaecology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada; Children's Health Research Institute and Lawson Health Research Institute, London, Ontario, Canada.
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Holingue C, Owusu JT, Feder KA, Spira AP. Sleep duration and C-reactive protein: Associations among pregnant and non-pregnant women. J Reprod Immunol 2018; 128:9-15. [PMID: 29803192 DOI: 10.1016/j.jri.2018.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 04/27/2018] [Accepted: 05/09/2018] [Indexed: 12/30/2022]
Abstract
Pregnant women experience more sleep disturbances and greater systemic inflammation than non-pregnant women. However, the few studies that have examined the links between sleep and inflammation in pregnant women have been in clinical samples. We examined whether sleep duration is associated with C-reactive protein (CRP) levels, a marker of inflammation, in pregnant and non-pregnant women in a population-based sample of US women. Participants were 2865 women of reproductive age (aged 20-44 years) in the National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of Americans. Sleeping <5 h on weeknights or workdays was significantly associated with increased CRP levels among both pregnant and non-pregnant women in unadjusted analyses; however, after adjustment for demographic, and health-related variables (depressive symptoms, self-rated health status, body mass index (BMI), diabetes), sleeping <5 h was no longer significantly related to CRP levels. Pregnant women had significantly higher CRP levels, after adjusting for sleep duration, demographic, and health-related variables. Our findings suggest that pregnancy is associated with increased peripheral CRP, after adjustment for sleep duration, demographic, and health factors. Further, in both pregnant and non-pregnant U.S. women of reproductive age, short sleep duration is associated with higher CRP levels, but this link is explained by self-rated health, BMI, and diabetes. Further studies are needed to investigate links of other sleep parameters (e.g., sleep fragmentation) with CRP in these populations.
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Affiliation(s)
- Calliope Holingue
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
| | - Jocelynn T Owusu
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
| | - Kenneth A Feder
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
| | - Adam P Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States; Center on Aging and Health, Johns Hopkins University, Baltimore, MD, United States.
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38
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EVALUATION OF SERUM HIGH-SENSITIVITY C-REACTIVE PROTEIN LEVELS DURING VARIOUS PERIODS OF PREGNANCY IN WOMAN, INFECTED WITH PARVOVIRUS - B19 INFECTION. EUREKA: HEALTH SCIENCES 2018. [DOI: 10.21303/2504-5679.2018.00604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aim of the research was analyze of C-reactive protein levels in serum blood samples during various periods of pregnancy in women, infected with parvovirus B19 and in case of presence of clinical complications.
129 pregnant women, infected with parvovirus B19 infection and 16 women with physiological pregnancy during first, second and third trimesters of pregnancy were examined. Depending on the presence or absence of clinical complications each group of pregnant women (I, II, III) was divided into two subgroups. The concentration of C-reactive protein in blood serum was determined by the method of immunoassay analysis using diagnostic sets of reagents (ELISA kits, USA). Statistical processing of data was carried out using the package of applied programs Microsoft Office Excel 2010 and StatSoft Statistica 6.1.
The mean age of pregnant woman in our study was 26±6 years. In the Iand II groups of infected B19 parvovirus pregnant women were identified a significant increasing of C-reactive protein levels compared to controls by 62.5 % and 50.0 % (p<0.05). The largest increasing of C-reactive protein level relative to control values was observed in women with clinical complications in different pregnancy periods (p<0.05).
An increase levels of the marker of systemic inflammation the C-reactive protein in the blood testifies to its active participation in the launch of a complex mechanism for the development of labor activity and the occurrence of fetal disorders, which was confirmed in groups of pregnant women with clinical complications in different periods of pregnancy.
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Harjunmaa U, Doyle R, Järnstedt J, Kamiza S, Jorgensen JM, Stewart CP, Shaw L, Hallamaa L, Ashorn U, Klein N, Dewey KG, Maleta K, Ashorn P. Periapical infection may affect birth outcomes via systemic inflammation. Oral Dis 2018; 24:847-855. [PMID: 29230915 DOI: 10.1111/odi.12817] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 11/26/2017] [Accepted: 12/03/2017] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Maternal dental periapical infections are associated with preterm birth and intrauterine growth restriction. This study investigates whether the association is mediated through bacterial spread from periapical lesions to placenta (direct pathway) or systemic inflammatory reaction (indirect pathway). MATERIALS AND METHODS We compared birth outcomes in Malawian mothers with and without periapical infection. As markers of a direct pathway, we identified placental bacteria using a 16S rDNA approach and assessed histological evidence of inflammation in the placenta and amniotic membranes. We measured C-reactive protein, alpha-1-acid glycoprotein, and salivary cortisol as markers of an indirect pathway. We used regression models to associate the predictor variables with duration of pregnancy and newborn size. RESULTS Of 1,024 women, 23.5% had periapical infection. There was no association of periapical infection with either bacterial DNA or histological inflammation in placenta or membranes. Periapical infection was associated with C-reactive protein, alpha-1-acid glycoprotein, and cortisol concentrations in a dose-dependent manner at 36 weeks. Addition of alpha-1-acid glycoprotein or cortisol concentration into regression models attenuated the association between periapical infection and pregnancy outcomes. CONCLUSION There was no evidence of direct spread of periapical bacteria to the placenta. Periapical infections and adverse pregnancy outcomes are in part mediated through systemic inflammation.
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Affiliation(s)
- U Harjunmaa
- Center for Child Health Research, University of Tampere Faculty of Medicine and Life Sciences and Tampere University Hospital, Tampere, Finland
| | - R Doyle
- Microbiology, Virology & Infection Control, Great Ormond Street Hospital NHS Foundation Trust, London, UK.,Institute of Child Health, University College London, London, UK
| | - J Järnstedt
- Department of Radiology, Medical Imaging Center, Tampere University Hospital, Tampere, Finland
| | - S Kamiza
- Department of Pathology, University of Malawi College of Medicine, Blantyre, Malawi
| | - J M Jorgensen
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - C P Stewart
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - L Shaw
- Institute of Child Health, University College London, London, UK
| | - L Hallamaa
- Center for Child Health Research, University of Tampere Faculty of Medicine and Life Sciences and Tampere University Hospital, Tampere, Finland
| | - U Ashorn
- Center for Child Health Research, University of Tampere Faculty of Medicine and Life Sciences and Tampere University Hospital, Tampere, Finland
| | - N Klein
- Institute of Child Health, University College London, London, UK
| | - K G Dewey
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - K Maleta
- Department of Community Health, University of Malawi College of Medicine, Blantyre, Malawi
| | - P Ashorn
- Center for Child Health Research, University of Tampere Faculty of Medicine and Life Sciences and Tampere University Hospital, Tampere, Finland
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Michikawa T, Morokuma S, Fukushima K, Kato K, Nitta H, Yamazaki S. Maternal exposure to air pollutants during the first trimester and foetal growth in Japanese term infants. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2017; 230:387-393. [PMID: 28672151 DOI: 10.1016/j.envpol.2017.06.069] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 06/15/2017] [Accepted: 06/20/2017] [Indexed: 05/21/2023]
Abstract
Evidence supporting an inverse association between maternal exposure to air pollutants and foetal growth has been accumulating. However, the findings from Asian populations are limited, and the question of critical windows of exposure remains unanswered. We examined whether maternal exposure to air pollutants, in particular exposure during the first trimester (an important period of placental development), was associated with foetal growth in Japanese term infants. From the Japan Perinatal Registry Network database, we received birth data for 29,177 term singleton births in western Japan (Kyushu-Okinawa Districts) between 2005 and 2010. Exposure was expressed in terms of average concentrations of air pollutants (ozone, suspended particulate matter, nitrogen dioxide, and sulphur dioxide), as measured at the nearest monitoring stations to the respective delivery hospitals of the pregnant women, during the entire pregnancy and each trimester. As proxy markers of foetal growth restriction, we used small for gestational age (SGA), and adverse birth weight (low birth weight in addition to SGA). For pollutant exposure during the entire pregnancy, we did not observe the association with SGA and adverse birth weight. In the single-trimester model for the first trimester, however, we found a positive association between ozone exposure, and SGA (odds ratio [OR] per 10 ppb increase = 1.07, 95% confidence interval [CI] = 1.01-1.12) and adverse birth weight (OR = 1.07; 95% CI = 1.01-1.14). This association persisted in the multi-trimester model, and no association for exposure during the second or third trimester was observed. Exposure to other pollutants during each trimester was not associated with these outcomes. In conclusion, maternal exposure to ozone during the first trimester was independently associated with an elevated risk of poor foetal growth.
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Affiliation(s)
- Takehiro Michikawa
- Environmental Epidemiology Section, Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki 305-8506, Japan.
| | - Seiichi Morokuma
- Department of Obstetrics and Gynaecology, Kyushu University Hospital, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Kotaro Fukushima
- Fukushima Clinic, 1-14-23 Yoshizuka, Hakata-ku, Fukuoka 812-0041, Japan.
| | - Kiyoko Kato
- Department of Obstetrics and Gynaecology, Kyushu University Hospital, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Hiroshi Nitta
- Environmental Epidemiology Section, Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki 305-8506, Japan.
| | - Shin Yamazaki
- Environmental Epidemiology Section, Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki 305-8506, Japan.
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Larré AB, Parisotto A, Rockenbach BF, Pasin DM, Capellari C, Escouto DC, Pinheiro da Costa BE, Poli-de-Figueiredo CE. Phosphodiesterases and preeclampsia. Med Hypotheses 2017; 108:94-100. [DOI: 10.1016/j.mehy.2017.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 07/20/2017] [Accepted: 08/03/2017] [Indexed: 01/12/2023]
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Maternal pregnancy C-reactive protein predicts offspring birth size and body composition in metropolitan Cebu, Philippines. J Dev Orig Health Dis 2017; 8:674-681. [PMID: 28720162 DOI: 10.1017/s2040174417000502] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The gestational milieu is an important influence on fetal development and long-term disease risk. Here we assess relationships between maternal pregnancy inflammation, indicated by C-reactive protein (CRP), and offspring anthropometric outcomes measured soon after birth. Data come from female participants (n=327, age 24.4-30.2 years) in a longitudinal study located in Metropolitan Cebu, Philippines. Between 2009 and 2014, pregnancy interviews (n=429) were conducted during which questionnaire and anthropometric data were obtained along with dried blood spot cards for CRP measurement. Offspring body weight, length, head circumference and five skinfold thickness measures were obtained soon after birth. Maternal pregnancy CRP was borderline (-1.11±0.64 days/log-mg/l; P<0.1) inversely related to gestational age at delivery, but did not increase the likelihood of preterm delivery. After adjusting for maternal pre-pregnancy body mass index, height, pregnancy adiposity, age, parity and other covariates, CRP was significantly, inversely related to offspring body weight (-0.047±0.017 kg/log-mg/l), length (-0.259±0.092 cm/log-mg/l) and sum of skinfolds (-0.520±0.190 mm/log-mg/l) (all P<0.05), and borderline inversely related to offspring head circumference (-0.102±0.068 cm/log-mg/l; P<0.1). Notably, relationships were continuous across the full CRP range, and not limited to unusually high levels of inflammation. These findings point to an important role of maternal non-specific immune activation as a predictor of offspring birth outcomes. In light of evidence that early life microbial, nutritional and stress experiences influence adult inflammatory regulation, these findings point to inflammation as a potential pathway for the intergenerational transmission of maternal experience to offspring health.
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Desai G, Chu L, Guo Y, Myneni AA, Mu L. Biomarkers used in studying air pollution exposure during pregnancy and perinatal outcomes: a review. Biomarkers 2017; 22:489-501. [PMID: 28581828 DOI: 10.1080/1354750x.2017.1339294] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE This review focuses on studies among pregnant women that used biomarkers to assess air pollution exposure, or to understand the mechanisms by which it affects perinatal outcomes. METHODS We searched PubMed and Google scholar databases to find articles. RESULTS AND CONCLUSIONS We found 29 articles, mostly consisting of cohort studies. Interpolation models were most frequently used to assess exposure. The most consistent positive association was between polycyclic aromatic hydrocarbon (PAH) exposure during entire pregnancy and cord blood PAH DNA adducts. Exposure to particulate matter (PM) and nitrogen dioxide (NO2) showed consistent inverse associations with mitochondrial DNA (mtDNA) content, particularly in the third trimester of pregnancy. No single pollutant showed strong associations with all the biomarkers included in this review. C-reactive proteins (CRPs) and oxidative stress markers increased, whereas telomere length decreased with increasing air pollution exposure. Placental global DNA methylation and mtDNA methylation showed contrasting results with air pollution exposure, the mechanism behind which is unclear. Most studies except those on PAH DNA adducts and mtDNA content provided insufficient evidence for characterizing a critical exposure window. Further research using biomarkers is warranted to understand the relationship between air pollution and perinatal outcomes.
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Affiliation(s)
- Gauri Desai
- a Department of Epidemiology and Environmental Health, School of Public Health and Health Professions , The State University of New York (SUNY) at Buffalo , Buffalo , NY , USA
| | - Li Chu
- b Department of Obstetrics and Gynecology , Anzhen Hospital , Beijing , China
| | - Yanjun Guo
- c Department of Obstetrics and Gynecology , Hang Tian General Hospital , Beijing , China
| | - Ajay A Myneni
- a Department of Epidemiology and Environmental Health, School of Public Health and Health Professions , The State University of New York (SUNY) at Buffalo , Buffalo , NY , USA
| | - Lina Mu
- a Department of Epidemiology and Environmental Health, School of Public Health and Health Professions , The State University of New York (SUNY) at Buffalo , Buffalo , NY , USA
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Ferguson KK, Meeker JD, McElrath TF, Mukherjee B, Cantonwine DE. Repeated measures of inflammation and oxidative stress biomarkers in preeclamptic and normotensive pregnancies. Am J Obstet Gynecol 2017; 216:527.e1-527.e9. [PMID: 28043842 DOI: 10.1016/j.ajog.2016.12.174] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/16/2016] [Accepted: 12/27/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Preeclampsia is a prevalent and enigmatic disease, in part characterized by poor remodeling of the spiral arteries. However, preeclampsia does not always clinically present when remodeling has failed to occur. Hypotheses surrounding the "second hit" that is necessary for the clinical presentation of the disease focus on maternal inflammation and oxidative stress. Yet, the studies to date that have investigated these factors have used cross-sectional study designs or small study populations. OBJECTIVE In the present study, we sought to explore longitudinal trajectories, beginning early in gestation, of a panel of inflammation and oxidative stress markers in women who went on to have preeclamptic or normotensive pregnancies. STUDY DESIGN We examined 441 subjects from the ongoing LIFECODES prospective birth cohort, which included 50 mothers who experienced preeclampsia and 391 mothers with normotensive pregnancies. Participants provided urine and plasma samples at 4 time points during gestation (median, 10, 18, 26, and 35 weeks) that were analyzed for a panel of oxidative stress and inflammation markers. Oxidative stress biomarkers included 8-isoprostane and 8-hydroxydeoxyguanosine. Inflammation biomarkers included C-reactive protein, the cytokines interleukin-1β, -6, and -10, and tumor necrosis factor-α. We created Cox proportional hazard models to calculate hazard ratios based on time of preeclampsia diagnosis in association with biomarker concentrations at each of the 4 study visits. RESULTS In adjusted models, hazard ratios of preeclampsia were significantly (P<.01) elevated in association with all inflammation biomarkers that were measured at visit 2 (median, 18 weeks; hazard ratios, 1.31-1.83, in association with an interquartile range increase in biomarker). Hazard ratios at this time point were the most elevated for C-reactive protein, for interleukin-1β, -6, and -10, and for the oxidative stress biomarker 8-isoprostane (hazard ratio, 1.68; 95% confidence interval, 1.14-2.48) compared to other time points. Hazard ratios for tumor necrosis factor-α were consistently elevated at all 4 of the study visits (hazard ratios, 1.49-1.63; P<.01). In sensitivity analyses, we observed that these associations were attenuated within groups typically at higher risk of experiencing preeclampsia, which include African American mothers, mothers with higher body mass index at the beginning of gestation, and pregnancies that ended preterm. CONCLUSIONS This study provides the most robust data to date on repeated measures of inflammation and oxidative stress in preeclamptic compared with normotensive pregnancies. Within these groups, inflammation and oxidative stress biomarkers show different patterns across gestation, beginning as early as 10 weeks. The start of the second trimester appears to be a particularly important time point for the measurement of these biomarkers. Although biomarkers alone do not appear to be useful in the prediction of preeclampsia, these data are useful in understanding the maternal inflammatory profile in pregnancy before the development of the disease and may be used to further develop an understanding of potentially preventative measures.
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de Jong M, Cranendonk A, Twisk JWR, van Weissenbruch MM. IGF-I and relation to growth in infancy and early childhood in very-low-birth-weight infants and term born infants. PLoS One 2017; 12:e0171650. [PMID: 28182752 PMCID: PMC5300132 DOI: 10.1371/journal.pone.0171650] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 01/23/2017] [Indexed: 11/24/2022] Open
Abstract
Background In very-low-birth-weight infants IGF-I plays an important role in postnatal growth restriction and is probably also involved in growth restriction in childhood. We compared IGF-I and its relation to growth in early childhood in very-low-birth-weight infants and term appropriate for gestational age born infants. Methods We included 41 very-low-birth-weight and 64 term infants. Anthropometry was performed at all visits to the outpatient clinic. IGF-I and insulin were measured in blood samples taken at 6 months and 2 years corrected age (very-low-birth-weight children) and at 3 months, 1 and 2 years (term children). Results Over the first 2 years of life growth parameters are lower in very-low-birth-weight children compared to term children, but the difference in length decreases significantly. During the first 2 years of life IGF-I is higher in very-low-birth-weight children compared to term children. In both groups there is a significant relationship between IGF-I and (change in) length and weight over the first 2 years of life and between insulin and change in total body fat. Conclusions Considering the relation of IGF-I to growth and the decrease in difference in length, higher IGF-I levels in very-low-birth-weight infants in early childhood probably have an important role in catch-up growth in length.
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Affiliation(s)
- Miranda de Jong
- Department of Pediatrics, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Anneke Cranendonk
- Department of Pediatrics, Division of Neonatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Jos W. R. Twisk
- Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Mirjam M. van Weissenbruch
- Department of Pediatrics, Division of Neonatology, VU University Medical Center, Amsterdam, The Netherlands
- * E-mail:
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Alma LJ, Bokslag A, Maas AHEM, Franx A, Paulus WJ, de Groot CJM. Shared biomarkers between female diastolic heart failure and pre-eclampsia: a systematic review and meta-analysis. ESC Heart Fail 2017; 4:88-98. [PMID: 28451444 PMCID: PMC5396047 DOI: 10.1002/ehf2.12129] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/25/2016] [Accepted: 11/15/2016] [Indexed: 12/11/2022] Open
Abstract
Evidence accumulates for associations between hypertensive pregnancy disorders and increased cardiovascular risk later. The main goal of this study was to explore shared biomarkers representing common pathogenic pathways between heart failure with preserved ejection fraction (HFpEF) and pre‐eclampsia where these biomarkers might be potentially eligible for cardiovascular risk stratification in women after hypertensive pregnancy disorders. We sought for blood markers in women with diastolic dysfunction in a first literature search, and through a second search, we investigated whether these same biochemical markers were present in pre‐eclampsia.This systematic review and meta‐analysis presents two subsequent systematic searches in PubMed and EMBASE. Search I yielded 3014 studies on biomarkers discriminating women with HFpEF from female controls, of which 13 studies on 11 biochemical markers were included. Cases had HFpEF, and controls had no heart failure. The second search was for studies discriminating women with pre‐eclampsia from women with non‐hypertensive pregnancies with at least one of the biomarkers found in Search I. Search II yielded 1869 studies, of which 51 studies on seven biomarkers were included in meta‐analyses and 79 studies on 12 biomarkers in systematic review.Eleven biological markers differentiated women with diastolic dysfunction from controls, of which the following 10 markers differentiated women with pre‐eclampsia from controls as well: C‐reactive protein, HDL, insulin, fatty acid‐binding protein 4, brain natriuretic peptide, N terminal pro brain natriuretic peptide, adrenomedullin, mid‐region pro adrenomedullin, cardiac troponin I, and cancer antigen 125.Our study supports the hypothesis that HFpEF in women shares a common pathogenic background with pre‐eclampsia. The biomarkers representing inflammatory state, disturbances in myocardial function/structure, and unfavourable lipid metabolism may possibly be eligible for future prognostic tools.
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Affiliation(s)
- Lisa J Alma
- Department of Obstetrics and GynecologyVU University Medical CenterAmsterdamThe Netherlands
| | - Anouk Bokslag
- Department of Obstetrics and GynecologyVU University Medical CenterAmsterdamThe Netherlands
| | - Angela H E M Maas
- Department of CardiologyRadboud University Nijmegen Medical CentreNijmegenThe Netherlands
| | - Arie Franx
- Division Woman and BabyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Walter J Paulus
- Department of PhysiologyVU University Medical CenterAmsterdamThe Netherlands
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de Oliveira LC, Franco-Sena AB, Farias DR, Rebelo F, Kac G. Maternal C-reactive protein concentrations during pregnancy and birth weight in a prospective cohort in Rio de Janeiro, Brazil. J Matern Fetal Neonatal Med 2016; 30:2346-2353. [PMID: 27756170 DOI: 10.1080/14767058.2016.1248395] [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: 12/25/2022]
Abstract
OBJECTIVE To evaluate the association between maternal C-reactive protein (CRP) concentrations during pregnancy and birth weight (BW) Z-score. METHODS A prospective cohort of pregnant women were followed at 5-13 (n = 203), 20-26 (n = 181), and 30-36 (n = 181) gestational weeks and at 30-45 d postpartum. Maternal CRP concentrations were assessed three times during pregnancy using immunoturbidimetric methods (ultra-sensitive kits). BW Z-score and newborns classified as small for gestational age (SGA) were evaluated according to Intergrowth-21st curves. Statistical analyses included SGA rates, BW Z-score means (SD) and a two-stage procedure: (1) a linear mixed-effect model (LME) to predict CRP intercept (mean exposure level) and slope (trend of change during pregnancy); and (2) a multiple linear regression model with BW Z-score as the outcome and CRP intercept and slope exposures. RESULTS A total of 4.4% (n = 9) women delivered SGA newborns. The mean BW was 3282.0 (37.3) g, and the mean gestational age at delivery was 38.8 (0.1) weeks. Women in the third tertile of the CRP rate of change gave birth to infants with a mean BW Z-score that was lower than those in the first/second tertiles (0.226 versus 0.381; p = 0.324). For the adjusted baseline CRP (β = 0.08; 95% CI: 0.03-0.14), the CRP trend of change was inversely associated with the BW Z-score (β= -3.77; 95% CI: -5.45 to -2.10). CONCLUSIONS The maternal CRP trend of change during pregnancy was negatively associated with BW Z-score.
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Affiliation(s)
- Livia Costa de Oliveira
- a Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro , Rio de Janeiro , Brazil
| | - Ana Beatriz Franco-Sena
- a Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro , Rio de Janeiro , Brazil
| | - Dayana Rodrigues Farias
- a Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro , Rio de Janeiro , Brazil
| | - Fernanda Rebelo
- a Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro , Rio de Janeiro , Brazil
| | - Gilberto Kac
- a Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro , Rio de Janeiro , Brazil
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Paydar K, Niakan Kalhori SR, Akbarian M, Sheikhtaheri A. A clinical decision support system for prediction of pregnancy outcome in pregnant women with systemic lupus erythematosus. Int J Med Inform 2016; 97:239-246. [PMID: 27919382 DOI: 10.1016/j.ijmedinf.2016.10.018] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 10/14/2016] [Accepted: 10/29/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Pregnancy among systemic lupus erythematosus (SLE)-affected women is highly associated with poor obstetric outcomes. Predicting the risk of foetal outcome is essential for maximizing the success of pregnancy. This study aimed to develop a clinical decision support system (CDSS) to predict pregnancy outcomes among SLE-affected pregnant women. METHODS We performed a retrospective analysis of 149 pregnant women with SLE, who were followed at Shariati Hospital (104 pregnancies) and a specialized clinic (45 pregnancies) from 1982 to 2014. We selected significant features (p<0.10) using a binary logistic regression model performed in IBM SPSS (version 20). Afterward, we trained several artificial neural networks (multi-layer perceptron [MLP] and radial basis function [RBF]) to predict the pregnancy outcome. In order to evaluate and select the most effective network, we used the confusion matrix and the receiver operating characteristic (ROC) curve. We finally developed a CDSS based on the most accurate network. MATLAB 2013b software was applied to design the neural networks and develop the CDSS. RESULTS Initially, 45 potential variables were analysed by the binary logistic regression and 16 effective features were selected as the inputs of neural networks (P-value<0.1). The accuracy (90.9%), sensitivity (80.0%), and specificity (94.1%) of the test data for the MLP network were achieved. These measures for the RBF network were 71.4%, 53.3%, and 79.4%, respectively. Having applied a 10-fold cross-validation method, the accuracy for the networks showed 75.16% accuracy for RBF and 90.6% accuracy for MLP. Therefore, the MLP network was selected as the most accurate network for prediction of pregnancy outcome. CONCLUSION The developed CDSS based on the MLP network can help physicians to predict pregnancy outcomes in women with SLE.
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Affiliation(s)
- Khadijeh Paydar
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.
| | - Sharareh R Niakan Kalhori
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.
| | - Mahmoud Akbarian
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.
| | - Abbas Sheikhtaheri
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran.
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Repeated measures analysis of associations between urinary bisphenol-A concentrations and biomarkers of inflammation and oxidative stress in pregnancy. Reprod Toxicol 2016; 66:93-98. [PMID: 27751756 DOI: 10.1016/j.reprotox.2016.10.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 09/16/2016] [Accepted: 10/13/2016] [Indexed: 12/31/2022]
Abstract
Bisphenol-A (BPA) exposure occurs commonly and may adversely impact pregnancy. Endocrine disruption is posited as the primary mechanism of action, but oxidative stress and inflammation pathways may also be important. We investigated associations between BPA exposure and oxidative stress and inflammation in 482 pregnant women. Participants were recruited early in pregnancy and provided urine and plasma at up to four visits. We measured total BPA and two biomarkers of oxidative stress (8-hydroxydeoxyguanosine and 8-isoprostane) in urine from each visit. Inflammation markers, including C-reactive protein and four cytokines were measured in plasma from the same time points. In adjusted models, an interquartile range increase in BPA was associated with significant increases in both oxidative stress biomarkers (5-9% increase). Additionally, we observed significantly higher IL-6 concentrations in association with an interquartile range increase in BPA (8.95% increase). These systemic changes consequent to BPA exposure may mediate adverse birth outcomes and/or fetal development.
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Fischer-Suárez N, Fernández-Alonso AM, Herrera-Muñoz A, Chedraui P, Pérez-López FR. Maternal serum 25-hydroxyvitamin D and C-reactive protein levels in pregnancies complicated with threatened preterm labour. Gynecol Endocrinol 2016; 32:777-781. [PMID: 27117202 DOI: 10.1080/09513590.2016.1177011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE AND METHODS To measure 25-hydroxyvitamin D [25(OH)D] and C-reactive protein (CRP) serum levels in singleton gestations complicated with threatened preterm labour (TPL, n = 59) and compare to normal controls matched for gestational age (n = 64). Cases were treated after blood sample according to institutional protocol. Also, analyte levels were compared among cases according to the outcome. RESULTS Mean serum 25(OH)D levels were similar between cases and controls, with median white blood cell count and CRP levels found significantly higher in TPL cases. Women with TPL delivering preterm displayed shorter mean cervical lengths along with higher CRP and lower 25(OH)D serum levels when compared to those delivering at term. Two multiple linear regression models were constructed to analyse factors related to gestational age at delivery (pooled analysis and only those with TPL). In both models, gestational age positively correlated to cervical length and inversely to CRP levels; whereas, in the TPL model, only 25(OH)D levels correlated positively. CONCLUSION Women complicated with TPL showed similar serum 25(OH)D yet higher CRP levels as compared to controls. TPL cases delivering preterm displayed lower 25(OH)D and higher CRP correlated levels.
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Affiliation(s)
| | | | | | - Peter Chedraui
- b Institute of Biomedicine, Research Area for Women's Health, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil , Guayaquil , Ecuador
- c Enrique C. Sotomayor Obstetrics and Gynecology Hospital , Guayaquil , Ecuador , and
| | - Faustino R Pérez-López
- d Department of Obstetrics and Gynecology , Facultad de Medicina, Universidad de Zaragoza, Hospital Clínico Lozano Blesa , Zaragoza , Spain
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