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Hercus JC, Metcalfe KX, Christians JK. Sex differences in growth and mortality in pregnancy-associated hypertension. PLoS One 2024; 19:e0296853. [PMID: 38206980 PMCID: PMC10783718 DOI: 10.1371/journal.pone.0296853] [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: 02/24/2023] [Accepted: 12/20/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND It is hypothesized that male fetuses prioritize growth, resulting in increased mortality, whereas females reduce growth in the presence of adversity. Preeclampsia reflects a chronic condition, in which fetuses have the opportunity to adjust growth. If females reduce their growth in response to preeclampsia, but males attempt to maintain growth at the cost of survival, we predict that differences in birthweight between preeclamptic and non-preeclamptic pregnancies will be greater among females, whereas differences in mortality will be greater among males. METHODS We analysed data from the Centers for Disease Control and Prevention. We compared pregnancies with pregnancy-associated hypertension (PAH) and controls. RESULTS The difference in birthweight between pregnancies affected by PAH and controls varied by fetal sex and gestational age. Among pregnancies of White individuals, at 34-35 weeks, the difference between PAH and controls was higher among females, as predicted. However, this pattern was reversed earlier in pregnancy and around term. Such variation was not significant in Black pregnancies. In both Black and White pregnancies, early in gestation, males had lower odds of death in PAH pregnancies, but higher odds of death in control pregnancies, counter to our prediction. Later, males had higher odds of death in PAH and controls, although the increased odds of death in males was not higher in PAH pregnancies than in controls. Overall, the difference in birthweight between surviving and non-surviving infants was greater in males than in females, opposite to our prediction. CONCLUSIONS The impact of PAH on birthweight and survival varies widely throughout gestation. Differences in birthweight and survival between male and female PAH and controls are generally not consistent with the hypothesis that males prioritize fetal growth more than females, and that this is a cause of increased mortality in males.
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Affiliation(s)
- Jess C. Hercus
- Department of Biological Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Katherine X. Metcalfe
- Department of Biological Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Julian K. Christians
- Department of Biological Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Centre for Cell Biology, Development and Disease, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Children’s Hospital Research Institute, Vancouver, BC, Canada
- Women’s Health Research Institute, BC Women’s Hospital and Health Centre, Vancouver, British Columbia, Canada
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Dixit P, Mishra TK, Nargawe D, Singh S. Maternal and Perinatal Outcome in Patients With Eclampsia: A Study Done at a Tertiary Care Centre. Cureus 2023; 15:e45971. [PMID: 37900531 PMCID: PMC10600615 DOI: 10.7759/cureus.45971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
Background One of the leading causes contributing to morbidity and mortality globally is attributed to eclampsia. Hence, it is vital to comprehensively review each female having eclampsia and to evaluate the factors that govern the outcomes in females with eclampsia. Aim To decode the fetal and maternal outcomes in subjects having eclampsia and to evaluate various factors that govern the outcomes. Methods This retrospective cohort and epidemiological study commenced at the Department of Obstetrics and Gynaecology, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, in January 2016 till April 2017, and included females that either developed eclampsia in hospital stay duration or presented with pre-existing eclampsia. In included females, various fetal and maternal parameters were assessed along with the outcome of pregnancy. The institutional data records and the database were also used to determine the prevalence and incidence of eclampsia. Baseline maternal parameters were recorded from the already-existing institute data. These included the gestational age (in years), socioeconomic status, educational attainment, parity, gravidity, and the number of weeks of gestation present at the time of delivery. Antenatal care data assessed were blood pressure recordings, any proteinuria documented in the data, and the number of antenatal visits by the subjects. Statistical analysis was performed to assess both parameters. Results In the current investigation, there were 0.34% eclampsia cases among females visiting the institution for deliveries. Incidences of stillbirth were seen in 19.04% and 8% of study participants, respectively. We found 9.52% (n=4) of female infants to have perished from eclampsia. Preterm births, a delayed start to the treatment, and insufficient care were all linked to poor foetal and mother outcomes. The longer the period between the beginning of a fit and delivery, the greater the likelihood of unfavourable results. Seizure onset before or after birth, parity, or subject age had no impact on mother or foetal health. The p-value for statistical significance was kept at 0.05. Conclusion Most of the research participant women, had intrapartum eclampsia, postpartum eclampsia, and antepartum eclampsia, based on the time of the convulsions in relation to the labor. It was highlighted that there was no conclusive evidence linking the date of the fit's beginning to unfavourable results or an elevated risk of complications. Neonatal mortality and stillbirth were observed with vaginal delivery in eclampsia cases. Outcomes in eclampsia can be improved by early treatment initiation, timely and appropriate referral, early disease recognition, and appropriate antenatal care.
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Affiliation(s)
- Pratibha Dixit
- Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Ratlam, IND
| | - Tarunendra K Mishra
- Department of General Medicine, Government Medical College and Hospital, Ratlam, IND
| | - Devendra Nargawe
- Department of Pediatrics, Government Medical College and Hospital, Ratlam, IND
| | - Sandeep Singh
- Department of General Medicine, Netaji Subhash Chandra Bose Medical College, Jabalpur, IND
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An H, Jin M, Li Z, Zhang L, Li H, Zhang Y, Ye R, Li N. Impact of gestational hypertension and pre-eclampsia on preterm birth in China: a large prospective cohort study. BMJ Open 2022; 12:e058068. [PMID: 36167382 PMCID: PMC9516080 DOI: 10.1136/bmjopen-2021-058068] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To investigate the impact of gestational hypertension and pre-eclampsia on preterm birth. DESIGN The data were collected from the China-US Collaborative Project for Neural Tube Defect Prevention; this was a large population-based cohort study. SETTING AND PARTICIPANTS We selected participants registered in two southern provinces, for whom we had exact information on gestational blood pressure and pregnancy outcomes, and who were not affected by chronic hypertension. In total, 200 103 participants were recruited from 1993 to 1995. OUTCOME MEASURES Preterm birth was defined as a singleton pregnancy and birth before 37 gestational weeks. RESULTS The incidences of gestational hypertension and pre-eclampsia were 5.47% and 5.44%, respectively, for women who gave birth at full term, and 5.63% and 7.33%, respectively, for those who gave birth preterm. After adjusting for potential confounders, the risk ratios (RRs) of preterm birth in women with gestational hypertension and pre-eclampsia were 1.04 (95% CI 0.98 to 1.11) and 1.39 (95% CI 1.25 to 1.55), respectively. The associations were stronger for early-onset (<28 weeks of gestation) gestational hypertension (adjusted RR=2.13, 95% CI 1.71 to 2.65) and pre-eclampsia (adjusted RR=8.47, 95% CI 5.59 to 12.80). CONCLUSIONS Pre-eclampsia was associated with a higher risk of preterm birth. The early-onset gestational hypertension and pre-eclampsia were associated with more severe risks than late-onset conditions.
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Affiliation(s)
- Hang An
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Ming Jin
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Zhiwen Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Le Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Hongtian Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Institute of Reproductive and Child Health/Key Laboratory of Reproductive Health, Peking University/National Health and Family Planning Commission of the People's Republic of China, Beijing, China
| | - Yali Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Rongwei Ye
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Nan Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
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Boneh HR, Pariente G, Baumfeld Y, Yohay D, Rotem R, Weintraub AY. Superimposed Versus De‐Novo Preeclampsia: Is There a Difference? Int J Gynaecol Obstet 2022; 159:392-397. [DOI: 10.1002/ijgo.14112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/20/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Hilly R. Boneh
- Department of Obstetrics and Gynecology Soroka University Medical Center affiliated with the Faculty of Health Sciences, Ben‐Gurion University of the Negev Beer‐Sheva Israel
| | - Gali Pariente
- Department of Obstetrics and Gynecology Soroka University Medical Center affiliated with the Faculty of Health Sciences, Ben‐Gurion University of the Negev Beer‐Sheva Israel
| | - Yael Baumfeld
- Department of Obstetrics and Gynecology Soroka University Medical Center affiliated with the Faculty of Health Sciences, Ben‐Gurion University of the Negev Beer‐Sheva Israel
| | - David Yohay
- Department of Obstetrics and Gynecology Soroka University Medical Center affiliated with the Faculty of Health Sciences, Ben‐Gurion University of the Negev Beer‐Sheva Israel
| | - Reut Rotem
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center affiliated with the Hebrew University Medical School of Jerusalem Jerusalem Israel
| | - Adi Y. Weintraub
- Department of Obstetrics and Gynecology Soroka University Medical Center affiliated with the Faculty of Health Sciences, Ben‐Gurion University of the Negev Beer‐Sheva Israel
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Monteiro VNP, Moreira de Sá RA, de Oliveira CA, Vellarde G. Doppler Velocimetry of the Ophthalmic Artery Behavior in Twin Pregnancy. Ultrasound Q 2021; 36:263-267. [PMID: 32890328 PMCID: PMC7495985 DOI: 10.1097/ruq.0000000000000480] [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] [Indexed: 11/25/2022]
Abstract
Our main objective was to evaluate the ophthalmic artery Doppler behavior in twin pregnancies and compare with singleton pregnancies. We studied 64 healthy twin pregnant women between 12 to 38 weeks of gestation. Resistance index (RI), pulsatility index (PI), and peak ratio (PR) were determined. The control group consisted of 289 singletons. Linear regression analysis was performed to evaluate the association between gestational age and the ophthalmic indexes. Student t test was used to compare the means and standard deviation of the Doppler indexes. There was a decrease in RI and PI and an increase in PR with advancing gestational age (ρ < 0.0001, 0.0052, and 0.0033). The means ± SDs for RI, PI, and PR were 0.77 ± 0.07, 1.79 ± 0.46, and 0.53 ± 0.12, in women with twin pregnancies and 0.75 ± 0.05, 1.88 ± 0.43, and 0.52 ± 0.10 in singletons. No significant difference was found between the PI and PR values, but significant difference was found in the RI values between the groups (P = 0.0332). We concluded that there are no significant differences in ophthalmic artery behavior in twins and the same reference values established in singleton pregnancies can be applied for PI and PR indexes in the evaluation of twin pregnancies. These indexes were the best to evaluate twin pregnancies.
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Glezerson BA, Trivedi V, McIsaac DI. On the stated association between labour epidural analgesia and risk of autism spectrum disorder in offspring. Can J Anaesth 2020; 68:428-429. [PMID: 33215355 DOI: 10.1007/s12630-020-01869-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/07/2020] [Accepted: 11/09/2020] [Indexed: 02/01/2023] Open
Affiliation(s)
- Bryan A Glezerson
- Krembil Brain Institute, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada.
| | - Vatsal Trivedi
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel I McIsaac
- Department of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
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Dieterich R, Demirci J. Communication practices of healthcare professionals when caring for overweight/obese pregnant women: A scoping review. PATIENT EDUCATION AND COUNSELING 2020; 103:1902-1912. [PMID: 32513475 DOI: 10.1016/j.pec.2020.05.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 04/09/2020] [Accepted: 05/07/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To synthesize existing research on communication practices between healthcare professionals and overweight and obese pregnant women. METHODS Following PRISMA guidance on conducting scoping reviews, we included original research addressing communication/counseling practices of healthcare professionals with overweight and/or obese pregnant women, published between 2008-2018, and available in English. Fourteen articles are included in this review. RESULTS Study findings were organized into three themes: (a) topics addressed during encounters, (b) providers' comfort/confidence, knowledge and methods in communicating with overweight/obese pregnant women, and (c) overweight/obese pregnant women's experiences in communicating with healthcare providers. The most prevalent topics addressed were gestational weight gain, physical activity, and nutrition. Healthcare professionals experience discomfort and are reluctant to address weight status with overweight/obese pregnant patients, use vague statements about weight gain and weight-related obstetric risks, and report low confidence when counseling obese pregnant women. Overweight/obese pregnant women perceive weight stigma when interacting with providers. CONCLUSION Weight-related counseling in obstetric care is suboptimal. Providers may benefit from training to more confidently and effectively counsel overweight and obese pregnant women about gestational weight gain, physical activity, and nutrition. PRACTICE IMPLICATIONS Patients perceive weight stigma in the obstetric setting, which may be prevented by effective, patient-centered communication.
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Affiliation(s)
- Rachel Dieterich
- University of Pittsburgh, Pittsburgh, PA, USA; University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA, 15213, USA.
| | - Jill Demirci
- Department of Health Promotion & Development, Development of Pediatrics, Division of General Academic Pediatrics, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA; University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA, 15213, USA.
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8
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Truta B, Leeds IL, Canner JK, Efron JE, Fang SH, Althumari A, Safar B. Early Discontinuation of Infliximab in Pregnant Women With Inflammatory Bowel Disease. Inflamm Bowel Dis 2020; 26:1110-1117. [PMID: 31670762 DOI: 10.1093/ibd/izz250] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Early discontinuation of infliximab (IFX) in pregnant women with inflammatory bowel disease (IBD) decreases the intrauterine fetal exposure to the drug but may increase the risk of disease flaring leading to poor pregnancy outcomes. In this study, we assessed the impact of early IFX discontinuation on mother's disease activity and on their at-risk babies. METHODS In a retrospective study of the Truven Health Analytics MarketScan database from 2011 to 2015, we compared IBD patients who discontinued IFX more than 90 days ("early IFX") with those who discontinue IFX 90 days or less ("late IFX) before delivery. We evaluated the risk of flaring, defined by new steroid prescriptions, visits to emergency room and/or hospital admissions, the pregnancy outcomes, and the at-risk babies. RESULTS After IFX discontinuation, the early IFX group (68 deliveries) required significantly more steroid prescriptions than the late IFX group (318 deliveries) to control disease activity (P < 001). There were more preterm babies in the early IFX group (P < 049), but no difference within the 2 groups was noticed in the rate of intrauterine growth retardation, small for gestation, and stillborn babies. Similarly, there was no increase in acute respiratory infections, development delays, and congenital malformations in babies of the mothers from the late IFX vs early IFX groups. CONCLUSIONS Steroid-free remission IBD mothers are at risk for disease flares and preterm babies when IFX is discontinued early in pregnancy. Continuation of IFX seems to be safe at least for the first year of life.
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Affiliation(s)
- Brindusa Truta
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ira L Leeds
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph K Canner
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonathan E Efron
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sandy H Fang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Azah Althumari
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bashar Safar
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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9
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Moresi S, Martino C, Salvi S, Del Sordo G, Fruci S, Garofalo S, Lanzone A, De Carolis S, Ferrazzani S. Perinatal outcome in gestational hypertension: Which role for developing preeclampsia. A population-based cohort study. Eur J Obstet Gynecol Reprod Biol 2020; 251:218-222. [PMID: 32559606 DOI: 10.1016/j.ejogrb.2020.05.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To analyze perinatal outcome in singleton pregnancies complicated by gestational hypertension (GH), to investigate the rate of women developing preeclampsia (PE) and to describe maternal features associated with progression to PE. STUDY DESIGN This is a population-based retrospective cohort-study involving 514 singleton pregnancies with a diagnosis of GH at admission. RESULTS In pregnancies with GH, a poorer pregnancy outcome in comparison to healthy controls was observed in terms of gestational age at delivery, birthweight and birthweight percentile. The observed overall rate of developing PE was 11.7 %. Of all pregnancies with GH at admission, two different groups were identified based on the diagnosis at delivery: GHPE, i.e. women who developed PE (60/514; 11.7 %), and GHnoPE, i.e. women who did not develop PE (454/514; 88.3 %). In the GHPE group it was observed that the 62 % of the women with diagnosis of GH earlier than 28 weeks developed PE while only 2% developed PE if the diagnosis of GH was performed later than 36 weeks. The observed rate of developing PE was 14.7 % in pharmacologically treated hypertensive women, whereas the diagnosis of PE has been made in only 3% of non-treated women. CONCLUSION Pregnant women with raised blood pressure are at risk of having a less favourable perinatal outcome. The risk is mainly associated with the progression to PE. Major determinants of the risk of developing PE are the earlier gestational age at diagnosis of GH, the necessity of treatment and the number of anti-hypertensive drugs needed for controlling blood pressure.
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Affiliation(s)
- Sascia Moresi
- UOC di Patologia Ostetrica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Roma, Italy.
| | - Carmelinda Martino
- UOC di Patologia Ostetrica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Roma, Italy.
| | - Silvia Salvi
- UOC di Patologia Ostetrica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Roma, Italy.
| | - Gelsomina Del Sordo
- UOC di Patologia Ostetrica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Roma, Italy.
| | - Stefano Fruci
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, L.go Francesco Vito 1, Roma, Italy.
| | - Serafina Garofalo
- UOC di Patologia Ostetrica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Roma, Italy.
| | - Antonio Lanzone
- UOC di Patologia Ostetrica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Roma, Italy; Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, L.go Francesco Vito 1, Roma, Italy.
| | - Sara De Carolis
- UOC di Patologia Ostetrica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Roma, Italy; Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, L.go Francesco Vito 1, Roma, Italy.
| | - Sergio Ferrazzani
- UOC di Patologia Ostetrica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Roma, Italy; Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, L.go Francesco Vito 1, Roma, Italy.
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DiPrisco B, Kumar A, Kalra B, Savjani GV, Michael Z, Farr O, Papathanasiou AE, Christou H, Mantzoros CS. GLYCOSYLATED FIBRONECTIN AND INHIBIN ARE LOWER AND ANTI-MÜLLERIAN HORMONE IS HIGHER IN UMBILICAL CORD BLOOD WHEN MOTHERS HAVE PREECLAMPSIA. Endocr Pract 2019; 26:318-327. [PMID: 31859547 DOI: 10.4158/ep-2019-0448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Preeclampsia is a common disorder of pregnancy, causing significant morbidity and mortality for mothers and infants. Several molecules, including glycosylated fibronectin (GlyFn), the inhibin-related proteins, anti-müllerian hormone (AMH), and the insulin-like growth factor axis, are altered in maternal plasma in the setting of preeclampsia; however, these molecules have not been previously measured in cord blood of infants born to mothers with preeclampsia, which may represent changes in fetal physiology. We evaluated potential biomarkers of preeclampsia in umbilical cord blood to fill the gap in knowledge. Methods: This is a case-control study of 196 neonates born at a tertiary teaching hospital in Boston from 2010-2017. Forty-nine neonates born to mothers with preeclampsia were matched 1:3 by gestational age, sex, and birth weight z-score with 147 controls. Eleven analytes were measured in cord blood by enzyme-linked immunosorbent assay. Binary logistic regression analyses were performed to evaluate associations between preeclampsia and analytes. Results: Mean cord blood levels of GlyFn and total inhibin were significantly lower in neonates born to mothers with preeclampsia compared to controls, and AMH levels were significantly higher in males born to mothers with preeclampsia than male controls. Associations remained significant after controlling for maternal and neonatal characteristics. Conclusion: Cord blood levels of GlyFn and inhibin are decreased and AMH (male) levels are increased in infants of preeclamptic mothers, which is opposite the pattern these biomarkers show in serum of mothers with preeclampsia. These molecules may be important in the pathophysiology and long-term effects of preeclampsia on the developing fetus. Abbreviations: AMH = anti-müllerian hormone; ELISA = enzyme-linked immunosorbent assay; GlyFn = glycosylated fibronectin; IGF = insulin-like growth factor; IGFBP5 = insulin-like growth factor binding protein 5; LOD = limit of detection; PAPP-A = pregnancy-associated plasma protein A; PAPP-A2 = pregnancy-associated plasma protein A2.
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11
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Dassah ET, Kusi-Mensah E, Morhe ESK, Odoi AT. Maternal and perinatal outcomes among women with hypertensive disorders in pregnancy in Kumasi, Ghana. PLoS One 2019; 14:e0223478. [PMID: 31584982 PMCID: PMC6777792 DOI: 10.1371/journal.pone.0223478] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 09/23/2019] [Indexed: 11/18/2022] Open
Abstract
Background Data pertaining to maternal and perinatal outcomes associated with the complete spectrum of hypertensive disorders in pregnancy (HDPs) is sparse in low resource settings. This study aimed to determine adverse maternal and perinatal outcomes among women admitted with HDPs in a tertiary hospital in Ghana, and directly compare these outcomes among women with pre-eclampsia/eclampsia and those with chronic/gestational hypertension. Methods An analytical cross-sectional study was conducted among women who were admitted with HDPs to Komfo Anokye Teaching Hospital from July 1, 2014 to September 30, 2014. Data was collected on their socio-demographic and reproductive characteristics using a pretested structured questionnaire and review of their antenatal records. Crude and adjusted relative risks (RRs), with 95% confidence intervals (CIs), associated with adverse maternal and perinatal outcomes were compared using multivariable binomial regression. P ≤0.05 was considered statistically significant. Results A total of 451 women with HDPs were studied: 5.3%, 32.4%, 48.8% and 13.5% had chronic hypertension, gestational hypertension, pre-eclampsia and eclampsia respectively. Over 80% were either referrals or “self-referred” from other facilities. Overall, 87% had adverse maternal or perinatal outcomes. Women with pre-eclampsia/eclampsia were at increased risks of caesarean section (adjusted RR, 1.37; 95% CI, 1.01–1.87), preterm delivery at <34 weeks’ gestation (adjusted RR, 2.74; 95% CI, 1.40–5.36) and preterm delivery at <37 weeks’ gestation (adjusted RR, 1.89; 95% CI, 1.25–2.85), compared to women with chronic/gestational hypertension. Conclusion Women with pre-eclampsia/eclampsia were at higher risk of adverse pregnancy outcome compared to those with chronic/gestational hypertension. Strategies for prevention and management of pre-eclampsia/eclampsia to improve pregnancy outcomes are required in this major maternity care centre.
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Affiliation(s)
- Edward T. Dassah
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
- * E-mail:
| | - Eunice Kusi-Mensah
- Transfusion Medicine Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Alexander T. Odoi
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
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Wilmink FA, den Dekker HT, de Jongste JC, Reiss IKM, Jaddoe VWV, Steegers EA, Duijts L. Maternal blood pressure and hypertensive disorders during pregnancy and childhood respiratory morbidity: the Generation R Study. Eur Respir J 2018; 52:13993003.00378-2018. [PMID: 30309974 DOI: 10.1183/13993003.00378-2018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 09/29/2018] [Indexed: 12/20/2022]
Abstract
Pre-eclampsia is associated with an increased risk of bronchopulmonary dysplasia, wheezing and asthma in later childhood. Currently, there are no studies available investigating maternal blood pressure measurements during multiple time-points in pregnancy and respiratory outcome measures in the child.We examined the associations of maternal blood pressure and hypertensive disorders with the risk of lower lung function, wheezing and asthma in children aged 10 years. This study among 4894 children was embedded in a population-based prospective cohort study. We used multivariate analyses, taking lifestyle and socioeconomic factors into account.We observed consistent associations per 5 mmHg higher maternal blood pressure in early pregnancy with a lower forced expiratory volume in 1 s/forced vital capacity ratio (z-score -0.03 (95% CI -0.05- -0.01)) and per 5 mmHg higher blood pressure in late pregnancy with a higher risk for current wheezing and current asthma (OR 1.07 (95% CI 1.02-1.12) and 1.06 (95% CI 1.00-1.11), respectively). We found no associations of maternal hypertensive disorders during pregnancy with child lung function, current wheezing or current asthma.Our results suggest that higher blood pressure in pregnant women is associated with lower lung function and increased risks of current wheezing and current asthma in children. The associations may be trimester specific.
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Affiliation(s)
- Freke A Wilmink
- Dept of Obstetrics and Neonatology, Radboudumc, Nijmegen, The Netherlands.,The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands.,Dept of Gynaecology and Obstetrics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Herman T den Dekker
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands.,Dept of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Dept of Paediatrics, Division of Respiratory Medicine and Allergology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Johan C de Jongste
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands.,Dept of Paediatrics, Division of Respiratory Medicine and Allergology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Irwin K M Reiss
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands.,Dept of Paediatrics, Division of Neonatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands.,Dept of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Dept of Paediatrics, Division of Respiratory Medicine and Allergology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Eric A Steegers
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands.,Dept of Gynaecology and Obstetrics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Liesbeth Duijts
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands.,Dept of Paediatrics, Division of Respiratory Medicine and Allergology, Erasmus Medical Center, Rotterdam, The Netherlands.,Dept of Paediatrics, Division of Neonatology, Erasmus Medical Center, Rotterdam, The Netherlands
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Farzaneh F, Tavakolikia Z, Soleimanzadeh Mousavi SH. Assessment of occurrence of preeclampsia and some clinical and demographic risk factors in Zahedan city in 2017. Clin Exp Hypertens 2018; 41:583-588. [PMID: 30388904 DOI: 10.1080/10641963.2018.1523919] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Blood pressure dysfunctions are one of the biggest complications and causes of maternal mortality during pregnancy. The aim of the present study is to evaluate some of the clinical and demographic risk factors in various aspects, both of which can help to better understand the causes and reduce the incidence of preeclampsia. Method: This nested case-control study was carried out on 270 pregnant women with preeclampsia as the case group and 270 pregnant women who did not have symptoms of preeclampsia at the time of referral were interviewed according to inclusion criteria as the control group. The factors studied included age, body mass index, history of hypertension in mother, history of diabetes in mother, history of lupus in mother, number of pregnancies, history of preeclampsia in previous pregnancies, twin or more pregnancies, season of occurrence, maternal educational level, maternal blood group, maternal occupation status, infant's sex and smoking status which were compared etween the two groups. t test and Chi-square tests were used to compare the variables in both groups. Fisher's exact test or Mann-Whitney U test was used if necessary. Findings: Of the 6929 pregnant women who participated in our study, 541 (7.8%) had preeclampsia. The means of body mass index (BMI) (24.86% versus 23.52%) (P = 0.032), the history of hypertension (19.3% versus 10.7%) (P = 0.006), history of preeclampsia in previous pregnancies (60.2% versus 13.3%) (P < 0.001), low level of education and illiteracy (51.1% versus 39.6%) (P = 0.028), and twin or more pregnancies (5.6% versus 2.2%) (P = 0.045) were significantly higher in the case group when compared to the control group. There was no statistically significant difference between the mean and standard deviation of age and number of pregnancies and the frequency of diabetes and lupus, the frequency of maternal occupation, maternal smoking, maternal blood group, and season of occurrence in the two groups (P > 0.05). Conclusion: Maternal BMI, maternal hypertension, history of preeclampsia in previous pregnancies, low maternal educational status, and twin or multiple pregnancies might be the risk factors for preeclampsia during pregnancy.
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Affiliation(s)
- Farahnaz Farzaneh
- a Obstetrics and Gynecology Department , Zahedan University of Medical Sciences , Zahedan , Iran (the Islamic Republic of)
| | - Zeinab Tavakolikia
- b Medical Science , Ali-Ibn Abitalib Hospital , Zahedan , Iran (the Islamic Republic of)
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14
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Bajaj M, Natarajan G, Shankaran S, Wyckoff M, Laptook AR, Bell EF, Stoll BJ, Carlo WA, Vohr BR, Saha S, Van Meurs KP, Sanchez PJ, D'Angio CT, Higgins RD, Das A, Newman N, Walsh MC. Delivery Room Resuscitation and Short-Term Outcomes in Moderately Preterm Infants. J Pediatr 2018; 195:33-38.e2. [PMID: 29306493 PMCID: PMC5869086 DOI: 10.1016/j.jpeds.2017.11.039] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 10/14/2017] [Accepted: 11/16/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To describe the frequency and extent of delivery room resuscitation and evaluate the association of delivery room resuscitation with neonatal outcomes in moderately preterm (MPT) infants. STUDY DESIGN This was an observational cohort study of MPT infants delivered at 290/7 to 336/7 weeks' gestational age (GA) enrolled in the Neonatal Research Network MPT registry. Infants were categorized into 5 groups based on the highest level of delivery room intervention: routine care, oxygen and/or continuous positive airway pressure, bag and mask ventilation, endotracheal intubation, and cardiopulmonary resuscitation including chest compressions and/or epinephrine use. The association of antepartum and intrapartum risk factors and discharge outcomes with the intensity of resuscitation was evaluated. RESULTS Of 7014 included infants, 1684 (24.0%) received routine care and no additional resuscitation, 2279 (32.5%) received oxygen or continuous positive airway pressure, 1831 (26.1%) received bag and mask ventilation, 1034 (14.7%) underwent endotracheal intubation, and 186 (2.7%) received cardiopulmonary resuscitation. Among the antepartum and intrapartum factors, increasing GA, any exposure to antenatal steroids and prolonged rupture of membranes decreased the likelihood of receipt of all levels of resuscitation. Infants who were small for GA (SGA) had increased risk of delivery room resuscitation. Among the neonatal outcomes, respiratory support at 28 days, days to full oral feeds and length of stay were significantly associated with the intensity of delivery room resuscitation. Higher intensity of resuscitation was associated with increased risk of mortality. CONCLUSIONS The majority of MPT infants receive some level of delivery room resuscitation. Increased intensity of delivery room interventions was associated with prolonged respiratory and nutritional support, increased mortality, and a longer length of stay.
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Affiliation(s)
- Monika Bajaj
- Department of Pediatrics, Wayne State University, Detroit, MI.
| | | | | | - Myra Wyckoff
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Abbot R Laptook
- Department of Pediatrics, Women and Infants Hospital, Brown University, Providence, RI
| | - Edward F Bell
- Department of Pediatrics, University of Iowa, Iowa City, IA
| | - Barbara J Stoll
- Department of Pediatrics, University of Texas Health Science Center, Houston, TX
| | - Waldemar A Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | - Betty R Vohr
- Department of Pediatrics, Women and Infants Hospital, Brown University, Providence, RI
| | - Shampa Saha
- Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, MD
| | - Krisa P Van Meurs
- Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA
| | - Pablo J Sanchez
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Carl T D'Angio
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Rosemary D Higgins
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Abhik Das
- Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, MD
| | - Nancy Newman
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH
| | - Michele C Walsh
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH
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Examining the Prevalence Rates of Preexisting Maternal Medical Conditions and Pregnancy Complications by Source: Evidence to Inform Maternal and Child Research. Matern Child Health J 2018; 21:852-862. [PMID: 27549105 DOI: 10.1007/s10995-016-2177-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Objectives We sought to examine whether there are systematic differences in ascertainment of preexisting maternal medical conditions and pregnancy complications from three common data sources used in epidemiologic research. Methods Diabetes mellitus, chronic hypertension, gestational diabetes mellitus (GDM), gestational hypertensive disorders (GHD), placental abruption and premature rupture of membranes (PROM) among 4821 pregnancies were identified via birth certificates, maternal self-report at approximately 4 months postpartum and by discharge codes from the Statewide Planning and Research Cooperative System (SPARCS), a mandatory New York State hospital reporting system. The kappa statistic (k) was estimated to ascertain beyond chance agreement of outcomes between birth certificates with either maternal self-report or SPARCS. Results GHD was under-ascertained on birth certificates (5.7 %) and more frequently indicated by maternal report (11 %) and discharge data (8.2 %). PROM was indicated more on birth certificates (7.4 %) than maternal report (4.5 %) or discharge data (5.7 %). Confirmation across data sources for some outcomes varied by maternal age, race/ethnicity, prenatal care utilization, preterm delivery, parity, mode of delivery, infant sex, use of infertility treatment and for multiple births. Agreement between maternal report and discharge data with birth certificates was generally poor (kappa < 0.4) to moderate (0.4 ≤ kappa < 0.75) but was excellent between discharge data and birth certificates for GDM among women who underwent infertility treatment (kappa = 0.79, 95 % CI 0.74, 0.85). Conclusions for Practice Prevalence and agreement of conditions varied across sources. Condition-specific variations in reporting should be considered when designing studies that investigate associations between preexisting maternal medical and pregnancy-related conditions with health outcomes over the life-course.
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16
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Jin B, Liu L, Zhang S, Cao X, Xu Y, Wang J, Sun L. Nuclear Magnetic Resonance-Assisted Metabolic Analysis of Plasma for Mild Gestational Diabetes Mellitus Patients. Metab Syndr Relat Disord 2017; 15:439-449. [PMID: 29022831 DOI: 10.1089/met.2017.0065] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Bai Jin
- Department of Obstetrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Liping Liu
- Department of Obstetrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shuxuan Zhang
- Department of Obstetrics and Gynecology, The First People's Hospital of Xuzhou, Xuzhou, China
| | - Xiaohui Cao
- Department of Obstetrics, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Yuhong Xu
- Department of Obstetrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Junsong Wang
- Department of Natural Medicinal Chemistry, State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China
| | - Lizhou Sun
- Department of Obstetrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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17
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Sarmiento-Piña M, Reyna-Villasmil E, Mejia-Montilla J, Santos-Bolívar J, Torres-Cepeda D, Reyna-Villasmil N. Valor predictivo de la proteinuria en 24 horas en la resultante neonatal de las preeclámpsicas. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2017. [DOI: 10.1016/j.gine.2015.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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18
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Ray JG, De Souza LR, Park AL, Connelly PW, Bujold E, Berger H. Preeclampsia and Preterm Birth Associated With Visceral Adiposity in Early Pregnancy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 39:78-81. [PMID: 27998690 DOI: 10.1016/j.jogc.2016.10.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 10/18/2016] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To determine if an increasing amount of visceral adipose tissue, measured by ultrasound in early pregnancy, is associated with a higher risk of preeclampsia and preterm birth (PTB). METHODS We completed a prospective cohort study of 463 pregnant women. Maternal visceral adiposity tissue (VAT) depth was measured by ultrasound at 11 to 14 weeks' gestation. Relative risks (RR) were adjusted for age, parity, chronic hypertension, pre-pregnancy BMI, and use of acetylsalicylic acid. RESULTS The rate of preeclampsia was much higher at quintile (Q) 5 of VAT depth (9.8%) than at Q1 to Q4 (1.6%) but not significantly so in the adjusted model (RR 3.39, 95% CI 0.86 to 13.39). The adjusted RR of PTB was significantly elevated at Q5 VAT depth (6.53, 95% CI 1.47 to 6.53), as was preeclampsia with PTB (16.91, 95% CI 1.24 to 231.07). CONCLUSION Higher amounts of VAT in pregnancy may play a direct role in the pathogenesis of preeclampsia, including early onset preeclampsia necessitating preterm delivery.
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Affiliation(s)
- Joel G Ray
- Department of Medicine, St. Michael's Hospital, Toronto, ON; Department of Obstetrics and Gynaecology, St. Michael's Hospital, Toronto, ON; Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON
| | - Leanne R De Souza
- Department of Obstetrics and Gynaecology, St. Michael's Hospital, Toronto, ON
| | - Alison L Park
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON
| | - Philip W Connelly
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON
| | - Emmanuel Bujold
- Department of Obstetrics, Gynecology, and Reproduction, Université Laval, Québec, QC
| | - Howard Berger
- Department of Obstetrics and Gynaecology, St. Michael's Hospital, Toronto, ON
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Thornton C, Tooher J, Ogle R, von Dadelszen P, Makris A, Hennessy A. Benchmarking the Hypertensive Disorders of Pregnancy. Pregnancy Hypertens 2016; 6:279-284. [DOI: 10.1016/j.preghy.2016.04.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 04/29/2016] [Indexed: 11/15/2022]
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20
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Superimposed Preeclampsia. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 956:409-417. [DOI: 10.1007/5584_2016_82] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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21
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Iacobelli S, Bonsante F, Robillard PY. Pre-eclampsia and preterm birth in Reunion Island: a 13 years cohort-based study. Comparison with international data. J Matern Fetal Neonatal Med 2015; 29:3035-40. [PMID: 26512885 DOI: 10.3109/14767058.2015.1114081] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To assess the prevalence of preterm birth in pre-eclamptic deliveries in Reunion Island, a tropical overseas French department (départements d'outre-mer, DOM) and to compare this prevalence with that of international literature. METHODS All singleton live-born deliveries referred to three maternity centers in Reunion Island over 13 years were eligible. Data for comparison were found through searches of MEDLINE, bibliographies of identified studies, proceedings of meetings on pre-eclampsia and contact with relevant researchers. Incidence of pre-eclampsia, proportion of preterm (<37(0/7) weeks gestation), late (34(0/7)-36(6/7) weeks) and early (<34(0/7) weeks) preterm birth in pre-eclamptic deliveries were analyzed. RESULTS Pre-eclampsia occurred in 2.3% of 51 927 singleton live-born deliveries in Reunion Island. The prevalence of preterm birth among pre-eclamptic deliveries was 59.8% (28.6% late and 31.2% early preterm birth). Among identified reports, only one prospective study from Canada (1986-1995) described preterm and early preterm birth rates higher than Reunion Island. A cohort-based report from Guadeloupe, another tropical French DOM, showed a preterm birth prevalence of 60.9%, with 30.8% of early preterm birth. CONCLUSIONS Predominance of early- or late-onset pre-eclampsia has huge geographical differences. Further investigations are required to address risk factors for preterm birth and early onset pre-eclampsia in French DOM.
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Affiliation(s)
- Silvia Iacobelli
- a Centre d'Études Périnatales de l'Océan Indien (CEPOI) - EA 7388, CHU de La Réunion - Site Sud , BP 350, Saint Pierre Cedex, La Réunion , France , and.,b Réanimation Néonatale et Pédiatrique, Néonatologie , CHU de La Réunion - Site Sud, BP 350, Saint Pierre Cedex, La Réunion , France
| | - Francesco Bonsante
- a Centre d'Études Périnatales de l'Océan Indien (CEPOI) - EA 7388, CHU de La Réunion - Site Sud , BP 350, Saint Pierre Cedex, La Réunion , France , and.,b Réanimation Néonatale et Pédiatrique, Néonatologie , CHU de La Réunion - Site Sud, BP 350, Saint Pierre Cedex, La Réunion , France
| | - Pierre-Yves Robillard
- a Centre d'Études Périnatales de l'Océan Indien (CEPOI) - EA 7388, CHU de La Réunion - Site Sud , BP 350, Saint Pierre Cedex, La Réunion , France , and.,b Réanimation Néonatale et Pédiatrique, Néonatologie , CHU de La Réunion - Site Sud, BP 350, Saint Pierre Cedex, La Réunion , France
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Cicero AF, Degli Esposti D, Immordino V, Morbini M, Baronio C, Rosticci M, Borghi C. Independent Determinants of Maternal and Fetal Outcomes in a Sample of Pregnant Outpatients With Normal Blood Pressure, Chronic Hypertension, Gestational Hypertension, and Preeclampsia. J Clin Hypertens (Greenwich) 2015; 17:777-782. [PMID: 26173048 PMCID: PMC8031729 DOI: 10.1111/jch.12614] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 04/09/2015] [Accepted: 04/12/2015] [Indexed: 11/22/2023]
Abstract
The aim of this retrospective study was to evaluate the main independent prognostic factors of negative maternal and fetal outcomes in a relatively large sample of pregnant outpatients (N=906) who were normotensive or affected by chronic hypertension, gestational hypertension, or preeclampsia. Among the studied parameters, the ones significantly associated with negative maternal outcomes were a diagnosis of preeclampsia (vs other forms of hypertension or normotension) and higher serum uric acid level, while antihypertensive treatment, number of previous deliveries, and blood pressure (BP) control at deliveries seemed to be protective. Regarding negative fetal outcomes, the parameters significantly associated with a negative maternal outcome were a diagnosis of preeclampsia (vs other forms of hypertension or normotension) and mother pre-pregnancy body mass index, while antihypertensive treatment and BP control at delivery seemed to be protective. Specific patient characteristics should help to predict the risk of negative maternal and fetal outcomes.
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Affiliation(s)
- Arrigo F.G. Cicero
- Medical and Surgery Sciences DepartmentUniversity of BolognaBolognaItaly
| | | | - Vincenzo Immordino
- Medical and Surgery Sciences DepartmentUniversity of BolognaBolognaItaly
| | - Martino Morbini
- Medical and Surgery Sciences DepartmentUniversity of BolognaBolognaItaly
| | - Cristina Baronio
- Medical and Surgery Sciences DepartmentUniversity of BolognaBolognaItaly
| | - Martina Rosticci
- Medical and Surgery Sciences DepartmentUniversity of BolognaBolognaItaly
| | - Claudio Borghi
- Medical and Surgery Sciences DepartmentUniversity of BolognaBolognaItaly
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Farzan SF, Chen Y, Wu F, Jiang J, Liu M, Baker E, Korrick SA, Karagas MR. Blood Pressure Changes in Relation to Arsenic Exposure in a U.S. Pregnancy Cohort. ENVIRONMENTAL HEALTH PERSPECTIVES 2015; 123:999-1006. [PMID: 25793356 PMCID: PMC4590746 DOI: 10.1289/ehp.1408472] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 03/18/2015] [Indexed: 05/20/2023]
Abstract
BACKGROUND Inorganic arsenic exposure has been related to the risk of increased blood pressure based largely on cross-sectional studies conducted in highly exposed populations. Pregnancy is a period of particular vulnerability to environmental insults. However, little is known about the cardiovascular impacts of arsenic exposure during pregnancy. OBJECTIVES We evaluated the association between prenatal arsenic exposure and maternal blood pressure over the course of pregnancy in a U.S. METHODS The New Hampshire Birth Cohort Study is an ongoing prospective cohort study in which > 10% of participant household wells exceed the arsenic maximum contaminant level of 10 μg/L established by the U.S. EPA. Total urinary arsenic measured at 24-28 weeks gestation was measured and used as a biomarker of exposure during pregnancy in 514 pregnant women, 18-45 years of age, who used a private well in their household. Outcomes were repeated blood pressure measurements (systolic, diastolic, and pulse pressure) recorded during pregnancy. RESULTS Using linear mixed effects models, we estimated that, on average, each 5-μg/L increase in urinary arsenic was associated with a 0.15-mmHg (95% CI: 0.02, 0.29; p = 0.022) increase in systolic blood pressure per month and a 0.14-mmHg (95% CI: 0.02, 0.25; p = 0.021) increase in pulse pressure per month over the course of pregnancy. CONCLUSIONS In our U.S. cohort of pregnant women, arsenic exposure was associated with greater increases in blood pressure over the course of pregnancy. These findings may have important implications because even modest increases in blood pressure impact cardiovascular disease risk.
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Affiliation(s)
- Shohreh F Farzan
- Children's Environmental Health and Disease Prevention Research Center at Dartmouth, Hanover, New Hampshire, USA
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Kiy AM, Rugolo LM, Luca AKD, Corrente JE. Growth of preterm low birth weight infants until 24 months corrected age: effect of maternal hypertension. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2015. [DOI: 10.1016/j.jpedp.2015.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Growth of preterm low birth weight infants until 24 months corrected age: effect of maternal hypertension. J Pediatr (Rio J) 2015; 91:256-62. [PMID: 25431856 DOI: 10.1016/j.jped.2014.07.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 07/25/2014] [Accepted: 07/25/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the growth pattern of low birth weight preterm infants born to hypertensive mothers, the occurrence of growth disorders, and risk factors for inadequate growth at 24 months of corrected age (CA). METHODS Cohort study of preterm low birth weight infants followed until 24 months CA, in a university hospital between January 2009 and December 2010. INCLUSION CRITERIA gestational age < 37 weeks and birth weight of 1,500-2,499 g. EXCLUSION CRITERIA multiple pregnancies, major congenital anomalies, and loss to follow up in the 2nd year of life. The following were evaluated: weight, length, and BMI. OUTCOMES growth failure and risk of overweight at 0, 12, and 24 months CA. Student's t-test, Repeated measures ANOVA (RM-ANOVA), and multiple logistic regression were used. RESULTS A total of 80 preterm low birth weight infants born to hypertensive mothers and 101 born to normotensive mothers were studied. There was a higher risk of overweight in children of hypertensive mothers at 24 months; however, maternal hypertension was not a risk factor for inadequate growth. Logistic regression showed that being born small for gestational age and inadequate growth in the first 12 months of life were associated with poorer growth at 24 months. CONCLUSION Preterm low birth weight born infants to hypertensive mothers have an increased risk of overweight at 24 months CA. Being born small for gestational age and inadequate growth in the 1st year of life are risk factors for growth disorders at 24 months CA.
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Wildenschild C, Riis AH, Ehrenstein V, Hatch EE, Wise LA, Rothman KJ, Sørensen HT, Mikkelsen EM. A prospective cohort study of a woman's own gestational age and her fecundability. Hum Reprod 2015; 30:947-56. [PMID: 25678570 DOI: 10.1093/humrep/dev007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION What is the magnitude of the association between a woman's gestational age at her own birth and her fecundability (cycle-specific probability of conception)? SUMMARY ANSWER We found a 62% decrease in fecundability among women born <34 weeks of gestation relative to women born at 37-41 weeks of gestation, whereas there were few differences in fecundability among women born at later gestational ages. WHAT IS KNOWN ALREADY One study, using retrospectively collected data on time-to-pregnancy (TTP), and self-reported data on gestational age, found a prolonged TTP among women born <37 gestational weeks (preterm) and with a birthweight ≤1500 g. Other studies of women's gestational age at birth and subsequent fertility, based on data from national birth registries, have reported a reduced probability of giving birth among women born <32 weeks of gestation. STUDY DESIGN, SIZE, DURATION We used data from a prospective cohort study of Danish pregnancy planners ('Snart-Gravid'), enrolled during 2007-2011 and followed until 2012. In all, 2814 women were enrolled in our study, of which 2569 had complete follow-up. PARTICIPANTS/MATERIALS, SETTING, METHODS Women eligible to participate were 18-40 years old at study entry, in a relationship with a male partner, and attempting to conceive. Participants completed a baseline questionnaire and up to six follow-up questionnaires until the report of pregnancy, discontinuation of pregnancy attempts, beginning of fertility treatment, loss to follow-up or end of study observation after 12 months. MAIN RESULTS AND THE ROLE OF CHANCE Among women born <34 gestational weeks, the cumulative probability of conception was 12, 28 and 48% within 3, 6 and 12 cycles, respectively. Among women born at 37-41 weeks of gestation, cumulative probability of conception was 47, 67 and 84% within 3, 6 and 12 cycles, respectively. Relative to women born at 37-41 weeks' gestation, women born <34 weeks had decreased fecundability (fecundability ratio (FR) 0.38, 95% confidence interval (CI): 0.17-0.82). Our data did not suggest reduced fecundability among women born at 34-36 weeks of gestation or at ≥42 weeks of gestation (FR 1.03, 95% CI: 0.80-1.34, and FR 1.13, 95% CI: 0.96-1.33, respectively). LIMITATIONS, REASONS FOR CAUTION Data on gestational age, obtained from the Danish Medical Birth Registry, were more likely to be based on date of last menstrual period than early ultrasound examination, possibly leading to an overestimation of gestational age at birth. Such overestimation, however, would not explain the decrease in fecundability observed among women born <34 gestational weeks. Another limitation is that the proportion of women born before 34 weeks of gestation was low in our study population, which reduced the precision of the estimates. WIDER IMPLICATIONS OF THE FINDINGS By using prospective data on TTP, our study elaborates on previous reports of impaired fertility among women born preterm, suggesting that women born <34 weeks of gestation have reduced fecundability. STUDY FUNDING/COMPETING INTERESTS The study was supported by the National Institute of Child Health and Human Development (R21-050264), the Danish Medical Research Council (271-07-0338), and the Health Research Fund of Central Denmark Region (1-01-72-84-10). The authors have no competing interests to declare.
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Affiliation(s)
- C Wildenschild
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
| | - A H Riis
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
| | - V Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
| | - E E Hatch
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA 617857, USA
| | - L A Wise
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA 617857, USA Slone Epidemiology Center, Boston University, 1010 Commonwealth Ave, 4th Floor, Boston, MA 02215, USA
| | - K J Rothman
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA 617857, USA RTI Health Solutions, 200 Park Offices Drive, Research Triangle Park, NC 27709, USA
| | - H T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA 617857, USA
| | - E M Mikkelsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
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Regev RH, Arnon S, Litmanovitz I, Bauer-Rusek S, Boyko V, Lerner-Geva L, Reichman B. Outcome of singleton preterm small for gestational age infants born to mothers with pregnancy-induced hypertension. A population-based study. J Matern Fetal Neonatal Med 2014; 28:666-73. [DOI: 10.3109/14767058.2014.928851] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bramham K, Parnell B, Nelson-Piercy C, Seed PT, Poston L, Chappell LC. Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis. BMJ 2014; 348:g2301. [PMID: 24735917 PMCID: PMC3988319 DOI: 10.1136/bmj.g2301] [Citation(s) in RCA: 394] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/12/2014] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To provide an accurate assessment of complications of pregnancy in women with chronic hypertension, including comparison with population pregnancy data (US) to inform pre-pregnancy and antenatal management strategies. DESIGN Systematic review and meta-analysis. DATA SOURCES Embase, Medline, and Web of Science were searched without language restrictions, from first publication until June 2013; the bibliographies of relevant articles and reviews were hand searched for additional reports. STUDY SELECTION Studies involving pregnant women with chronic hypertension, including retrospective and prospective cohorts, population studies, and appropriate arms of randomised controlled trials, were included. DATA EXTRACTION Pooled incidence for each pregnancy outcome was reported and, for US studies, compared with US general population incidence from the National Vital Statistics Report (2006). RESULTS 55 eligible studies were identified, encompassing 795,221 pregnancies. Women with chronic hypertension had high pooled incidences of superimposed pre-eclampsia (25.9%, 95% confidence interval 21.0% to 31.5 %), caesarean section (41.4%, 35.5% to 47.7%), preterm delivery <37 weeks' gestation (28.1% (22.6 to 34.4%), birth weight <2500 g (16.9%, 13.1% to 21.5%), neonatal unit admission (20.5%, 15.7% to 26.4%), and perinatal death (4.0%, 2.9% to 5.4%). However, considerable heterogeneity existed in the reported incidence of all outcomes (τ(2)=0.286-0.766), with a substantial range of incidences in individual studies around these averages; additional meta-regression did not identify any influential demographic factors. The incidences (the meta-analysis average from US studies) of adverse outcomes in women with chronic hypertension were compared with women from the US national population dataset and showed higher risks in those with chronic hypertension: relative risks were 7.7 (95% confidence interval 5.7 to 10.1) for superimposed pre-eclampsia compared with pre-eclampsia, 1.3 (1.1 to 1.5) for caesarean section, 2.7 (1.9 to 3.6) for preterm delivery <37 weeks' gestation, 2.7 (1.9 to 3.8) for birth weight <2500 g, 3.2 (2.2 to 4.4) for neonatal unit admission, and 4.2 (2.7 to 6.5) for perinatal death. CONCLUSIONS This systematic review, reporting meta-analysed data from studies of pregnant women with chronic hypertension, shows that adverse outcomes of pregnancy are common and emphasises a need for heightened antenatal surveillance. A consistent strategy to study women with chronic hypertension is needed, as previous study designs have been diverse. These findings should inform counselling and contribute to optimisation of maternal health, drug treatment, and pre-pregnancy management in women affected by chronic hypertension.
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Affiliation(s)
- Kate Bramham
- Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, St Thomas' Hospital, London SE1 7EH, United Kingdom
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Magee LA, Pels A, Helewa M, Rey E, von Dadelszen P. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. Pregnancy Hypertens 2014; 4:105-45. [PMID: 26104418 DOI: 10.1016/j.preghy.2014.01.003] [Citation(s) in RCA: 245] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 01/17/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This guideline summarizes the quality of the evidence to date and provides a reasonable approach to the diagnosis, evaluation and treatment of the hypertensive disorders of pregnancy (HDP). EVIDENCE The literature reviewed included the previous Society of Obstetricians and Gynaecologists of Canada (SOGC) HDP guidelines from 2008 and their reference lists, and an update from 2006. Medline, Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Registry of Controlled Trials (CCRCT) and Database of Abstracts and Reviews of Effects (DARE) were searched for literature published between January 2006 and March 2012. Articles were restricted to those published in French or English. Recommendations were evaluated using the criteria of the Canadian Task Force on Preventive Health Care and GRADE.
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Affiliation(s)
| | - Anouk Pels
- Academic Medical Centre, Amsterdam, The Netherlands
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Oliveira LC, Costa AARD. Fetal and neonatal deaths among cases of maternal near miss. Rev Assoc Med Bras (1992) 2013; 59:487-94. [PMID: 24080346 DOI: 10.1016/j.ramb.2013.08.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 03/10/2013] [Accepted: 08/26/2013] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To determine the prevalence of fetal and neonatal deaths among patients with maternal near miss and the factors associated with this fatal outcome. METHODS The authors conducted a descriptive, cross-sectional, analyzing medical records of patients admitted to the ICU of a tertiary obstetric Recife (Brazil), between January 2007 and December 2010, who had at least one criterion of near miss defined by WHO. Statistical analysis was performed with Epi-Info 3.3.2, using chi-square and Fisher's exact test, considering a significance level of 5%. For multivariate analysis was constructed as a hierarchical model with the response variable fetal and neonatal deaths. RESULTS We included 246 cases of maternal near miss. Among women in the study, hypertensive disorders occurred in 62.7% to 41.2% in HELLP syndrome and the laboratory criteria for near miss in 59.6%. There were 48 (19.5%) stillbirths and 19 (7.7%) neonatal deaths. After analyzing the variables that remained statistically associated with fetal and neonatal deaths were: severe preeclampsia, placental abruption, endometritis, cesarean delivery, prematurity and the laboratory criteria for maternal near miss. CONCLUSION The high incidence of fetal and neonatal deaths among patients with maternal near miss. Among these women there is an overlap of factors contributing to this fatal outcome, in our study, those who had severe preeclampsia, placental abruption, endometritis, premature birth or laboratory criteria positively associated with deaths.
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Affiliation(s)
- Leonam Costa Oliveira
- Unidade de ensino de pós-graduação em Saúde Materno Infantil, Instituto de Medicina Integral Prof. Fernando Figueira, Recife, PE, Brasil.
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McDonald SD, Ray J, Teo K, Jung H, Salehian O, Yusuf S, Lonn E. Measures of cardiovascular risk and subclinical atherosclerosis in a cohort of women with a remote history of preeclampsia. Atherosclerosis 2013; 229:234-9. [DOI: 10.1016/j.atherosclerosis.2013.04.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 04/05/2013] [Accepted: 04/13/2013] [Indexed: 11/17/2022]
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Lal AK, Gao W, Hibbard JU. Eclampsia: Maternal and neonatal outcomes. Pregnancy Hypertens 2013; 3:186-90. [DOI: 10.1016/j.preghy.2013.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 04/08/2013] [Indexed: 11/16/2022]
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Terwisscha van Scheltinga JA, Krabbendam I, Spaanderman ME. Differentiating between gestational and chronic hypertension; an explorative study. Acta Obstet Gynecol Scand 2013; 92:312-7. [DOI: 10.1111/aogs.12061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Accepted: 11/23/2012] [Indexed: 11/30/2022]
Affiliation(s)
| | - Ineke Krabbendam
- Department of Obstetrics and Gynecology; Radboud University Nijmegen Medical Center; Nijmegen; the Netherlands
| | - Marc E.A. Spaanderman
- Department of Obstetrics and Gynecology; Radboud University Nijmegen Medical Center; Nijmegen; the Netherlands
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Ahmad AS, Samuelsen SO. Hypertensive disorders in pregnancy and fetal death at different gestational lengths: a population study of 2 121 371 pregnancies. BJOG 2012; 119:1521-8. [PMID: 22925135 DOI: 10.1111/j.1471-0528.2012.03460.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the proportion of offspring that was stillborn in pregnancies with pre-eclampsia, gestational hypertension or chronic hypertension with those in normotensive pregnancies. DESIGN Register-based observational study. SETTING The Medical Birth Registry of Norway. POPULATION All singleton births after 20 completed weeks of gestation in Norway from 1967 to 2006 (n = 2 121 371). METHODS The proportion of stillborn offspring was estimated in normotensive pregnancies, and in pregnancies with pre-eclampsia, gestational and chronic hypertension at different gestational lengths. In addition, changes in the proportions of stillborn offspring by maternal hypertensive disorder from 1967-1986 to 1987-2006 were estimated. MAIN OUTCOME MEASURES Fetal death. RESULTS The prevalence of hypertensive disorders in pregnancy was 4.7%. In total, 17 933 fetal deaths occurred and 9.2% of these were in hypertensive pregnancies. In normotensive pregnancies, 0.8% (16 290/2 022 400) experienced fetal death. This was true for 1.9% (1170/62 261) of the pregnancies with pre-eclampsia, 1.2% (390/32 068) with gestational hypertension and 1.8% (83/4642) with chronic hypertension. There was a 44% overall reduction in fetal death rate from 1967-1986 to 1987-2006. The largest decline was in women with pre-eclampsia (80% reduction). In women with gestational hypertension and chronic hypertension, the overall reductions in fetal death rates were 49% and 57%, respectively, comparable with the 41% decline in normotensive pregnancies. CONCLUSIONS In our nationwide study during 1967-2006, the risk of fetal death among women with hypertensive disorders in pregnancy has been greatly reduced, especially among pre-eclamptic women at term. The risk of fetal death among women with gestational or chronic hypertension has also decreased, but in a different manner.
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Affiliation(s)
- A S Ahmad
- Department of Obstetrics and Gynaecology and Medical Faculty Division, Akershus University Hospital, Lørenskog, Norway.
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Lee PC, Talbott EO, Roberts JM, Catov JM, Bilonick RA, Stone RA, Sharma RK, Ritz B. Ambient air pollution exposure and blood pressure changes during pregnancy. ENVIRONMENTAL RESEARCH 2012; 117:46-53. [PMID: 22835955 PMCID: PMC3656658 DOI: 10.1016/j.envres.2012.05.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 05/22/2012] [Accepted: 05/24/2012] [Indexed: 05/17/2023]
Abstract
BACKGROUND Maternal exposure to ambient air pollution has been associated with adverse birth outcomes such as preterm delivery. However, only one study to date has linked air pollution to blood pressure changes during pregnancy, a period of dramatic cardiovascular function changes. OBJECTIVES We examined whether maternal exposures to criteria air pollutants, including particles of less than 10 μm (PM(10)) or 2.5 μm diameter (PM(2.5)), carbon monoxide (CO), nitrogen dioxide (NO(2)), sulfur dioxide (SO(2)), and ozone (O(3)), in each trimester of pregnancy are associated with magnitude of rise of blood pressure between the first 20 weeks of gestation and late pregnancy in a prospectively followed cohort of 1684 pregnant women in Allegheny County, PA. METHODS Air pollution measures for maternal ZIP code areas were derived using Kriging interpolation. Using logistic regression analysis, we evaluated the associations between air pollution exposures and blood pressure changes between the first 20 weeks of gestation and late pregnancy. RESULTS First trimester PM(10) and ozone exposures were associated with blood pressure changes between the first 20 weeks of gestation and late pregnancy, most strongly in non-smokers. Per interquartile increases in first trimester PM(10) and O(3) concentrations were associated with mean increases in systolic blood pressure of 1.88 mm Hg (95% CI=0.84 to 2.93) and 1.84 (95% CI=1.05 to 4.63), respectively, and in diastolic blood pressure of 0.63 mm Hg (95% CI=-0.50 to 1.76) and 1.13 (95% CI=-0.46 to 2.71) in non-smokers. CONCLUSIONS Our novel finding suggests that first trimester PM(10) and O(3) air pollution exposures increase blood pressure in the later stages of pregnancy. These changes may play a role in mediating the relationships between air pollution and adverse birth outcomes.
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Affiliation(s)
- Pei-Chen Lee
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
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Role of antihypertensive therapy in mild to moderate pregnancy-induced hypertension: a prospective randomized study comparing labetalol with alpha methyldopa. Arch Gynecol Obstet 2012; 285:1553-62. [DOI: 10.1007/s00404-011-2205-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 12/28/2011] [Indexed: 10/14/2022]
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Bakker R, Steegers EAP, Hofman A, Jaddoe VWV. Blood pressure in different gestational trimesters, fetal growth, and the risk of adverse birth outcomes: the generation R study. Am J Epidemiol 2011; 174:797-806. [PMID: 21859836 DOI: 10.1093/aje/kwr151] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Researchers have suggested that maternal hypertensive disorders during pregnancy affect fetal growth. The authors examined the associations between systolic and diastolic blood pressures in different trimesters of pregnancy and both repeatedly measured fetal growth characteristics and the risks of adverse birth outcomes. The present study (2001-2005) was performed in 8,623 women who were participating in a population-based prospective cohort study from fetal life onwards. Blood pressure and fetal growth characteristics were assessed in each trimester of pregnancy. Information on hypertensive complications and adverse birth outcomes was obtained from medical records. The results suggested that higher blood pressure was associated with smaller fetal head circumference and femur length, as well as lower fetal weight from the third trimester onward. An increase in blood pressure from the second trimester to the third trimester was associated with an increased risk of adverse birth outcomes. Compared with women who did not experience hypertension during pregnancy, women with preeclampsia had increased risks of having children who were preterm (odds ratio = 5.89, 95% confidence interval: 2.63, 13.14), had a low birth weight (odds ratio = 8.94, 95% confidence interval: 6.19, 12.90), or were small for their gestational age (odds ratio = 5.03, 95% confidence interval: 3.31, 7.62). The present results suggest that higher maternal blood pressure is associated with impaired fetal growth during the third trimester of pregnancy and increased risks of adverse birth outcomes.
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Affiliation(s)
- Rachel Bakker
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, the Netherlands
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Rowland Hogue CJ, Silver RM. Racial and ethnic disparities in United States: stillbirth rates: trends, risk factors, and research needs. Semin Perinatol 2011; 35:221-33. [PMID: 21798402 DOI: 10.1053/j.semperi.2011.02.019] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
As with most adverse health outcomes, there has been long standing and persistent racial and ethnic disparity for stillbirth in the United States. In 2005, the stillbirth rate (fetal deaths ≥ 20 weeks' gestation per 1000 fetal deaths and live births) for non-Hispanic blacks was 11.13 compared with 4.79 for non-Hispanic whites. Rates were intermediate for American Indian or Alaska Natives (6.17) and Hispanics (5.44). There is racial disparity for both early (< 28 weeks' gestation) and late stillbirths. We review available data regarding risk factors for stillbirth with a focus on those factors that are more prevalent in certain racial/ethnic groups and those factors that appear to have a more profound effect in certain racial/ethnic groups. Although many factors, including genetics, environment, stress, social issues, access to and quality of medical care and behavior, contribute to racial disparity in stillbirth, the reasons for the disparity remain unclear. Knowledge gaps and recommendations for further research and interventions intended to reduce racial disparity in stillbirth are highlighted.
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Affiliation(s)
- Carol J Rowland Hogue
- Women's and Children's Center, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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Thornton C, Hennessy A, Grobman WA. Benchmarking and patient safety in hypertensive disorders of pregnancy. Best Pract Res Clin Obstet Gynaecol 2011; 25:509-21. [PMID: 21640655 DOI: 10.1016/j.bpobgyn.2011.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 02/14/2011] [Accepted: 03/05/2011] [Indexed: 10/18/2022]
Abstract
Hypertensive disorders of pregnancy are a major cause of morbidity and mortality worldwide. Reliable, published individual patient data from units and countries are lacking. Without these data, clinicians are unable to benchmark their incidence, treatments and outcomes, and patient safety is unable to be routinely assessed. Available data suggest that a notable proportion of the adverse events that occur with hypertensive disease of pregnancy may be preventable. Theory and practice indicate several methods that can offer the possibility of averting these preventable adverse events. These methods include benchmarking outcomes, standardisation of care processes, simulation, and enhancement of patient knowledge. However, data on optimal methods to enhance patient safety and quality of care of pregnant women with hypertensive disease remain limited, and further research is required.
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Ferrazzani S, Luciano R, Garofalo S, D'Andrea V, De Carolis S, De Carolis MP, Paolucci V, Romagnoli C, Caruso A. Neonatal outcome in hypertensive disorders of pregnancy. Early Hum Dev 2011; 87:445-9. [PMID: 21497462 DOI: 10.1016/j.earlhumdev.2011.03.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 03/08/2011] [Accepted: 03/17/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hypertensive disorders in pregnancy account for increased perinatal morbidity and mortality when compared to uneventful gestations. AIMS To analyze perinatal outcome of pregnancies complicated by different kinds of hypertension to uncomplicated pregnancies in a series of Italian women and to compare our data with series from other countries. STUDY DESIGN The sample was divided into four groups of hypertensive women: chronic hypertension (CH), gestational hypertension (GH), preeclampsia (PE), and chronic hypertension complicated by preeclampsia (CHPE). One thousand normal pregnancies served as controls. SUBJECTS Neonatal features of the offspring of 965 Italian women with hypertension in pregnancy were evaluated. MEASURES Gestational age, birthweight and the rate of small for gestational age were the outcomes. Perinatal asphyxia and mortality were also assessed. RESULTS Gestational age, the mean of birth weight and birth percentile were significantly lower in all groups with hypertensive complications when compared with controls. The rate of very early preterm delivery (<32 weeks) was 7.8% in CH, 5.9% in GH, 21.2% in PE and 37.2% in CHPE while it was to 1.2% in the control group. The rate of SGA was globally 16.2% in CH, 22.8% in GH, 50.7% in PE, 37.2% in CHPE and 5% in controls. The rate of SGA in PE was much higher than reported in series from other countries. CONCLUSION Comparing our data with those reported from other countries, it is evident that the rate of fetal growth restriction in PE we found in our center, is significantly higher even in the presence of a global lower incidence of PE.
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Affiliation(s)
- Sergio Ferrazzani
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
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Krieger EV, Landzberg MJ, Economy KE, Webb GD, Opotowsky AR. Comparison of risk of hypertensive complications of pregnancy among women with versus without coarctation of the aorta. Am J Cardiol 2011; 107:1529-34. [PMID: 21420058 DOI: 10.1016/j.amjcard.2011.01.033] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 01/11/2011] [Accepted: 01/11/2011] [Indexed: 01/01/2023]
Abstract
Hypertension is a common consequence of coarctation of the aorta. The frequency of hypertensive complications of pregnancy in women with coarctation in the general population is undefined. In this study, we used the 1998 to 2007 Nationwide Inpatient Sample, a nationally representative data set, to identify patients admitted to an acute care hospital for delivery. The frequency of hypertensive complications of pregnancy was compared between women with and without coarctation. Secondary outcomes, including length of stay, hospital charges, Caesarean delivery, and adverse maternal outcomes, were also assessed. There were an estimated 697 deliveries among women with coarctation, compared to 42,601,409 deliveries by women without coarctation. The frequency of hypertensive complications of pregnancy was 24.1 ± 3.3% for women with coarctation compared to 8.0 ± 0.1% for women without coarctation (multivariate odds ratio [OR] 3.6, 95% confidence interval [CI] 2.5 to 5.2). Preexisting hypertension complicating pregnancy (10.2 ± 2.5% vs 1.0% ± 0.02%, multivariate OR 10.8, 95% CI 5.9 to 19.8) and pregnancy-induced hypertension (13.9 ± 3.0% vs 7.0% ± 0.1%, multivariate OR 2.1, 95% CI 1.3 to 3.3) were more common in women with coarctation. Women with coarctation were more likely to deliver by Caesarean section (41.6 ± 3.3% vs 26.4% ± 0.2%, multivariate OR 2.0, 95% CI 1.4 to 2.8), have adverse cardiovascular outcomes (4.8 ± 2.2% vs 0.3 ± 0.01%, multivariate OR 16.7, 95% CI 6.7 to 41.5), have longer hospital stays, and incur higher hospital charges (both p values <0.0001) than women without coarctation. In conclusion, women with coarctation are more likely to have hypertensive complications of pregnancy, deliver by Caesarean section, have adverse cardiovascular outcomes, have longer hospitalizations, and incur higher hospital charges than women without coarctation.
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Affiliation(s)
- Eric V Krieger
- Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts, USA.
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Segev Y, Riskin-Mashiah S, Lavie O, Auslender R. Assisted reproductive technologies: medical safety issues in the older woman. J Womens Health (Larchmt) 2011; 20:853-61. [PMID: 21510806 DOI: 10.1089/jwh.2010.2603] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Abstract Previous study has shown that in the United States, most maternal deaths and severe obstetric complications due to chronic disease are potentially preventable through improved medical care before conception. Many women who need assisted reproductive technology (ART) because of infertility are older than the average pregnant woman. Risks for such chronic diseases as obesity, diabetes mellitus, chronic hypertension, cardiovascular disease (CVD), and malignancy greatly increase with maternal age. Chronic illness increases the risk of the in vitro fertilization (IVF) procedure and is also associated with increased obstetric risk and even death. The objective of this review is to outline the potential risks for older women who undergo ART procedures and pregnancy and to characterize guidelines for evaluation before enrollment in ART programs. A PubMed search revealed that very few studies have related to pre-ART medical evaluation. Therefore, we suggest a pre-ART medical assessment, comparable to the recommendations of the American Heart Association before noncompetitive physical activity and the American Society of Anesthesiologists before elective surgery. This assessment should include a thorough medical questionnaire and medical examination. Further evaluation and treatment should follow to ensure the safety of ART procedures and of ensuing pregnancies.
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Affiliation(s)
- Yakir Segev
- Department of Obstetrics and Gynecology, The Lady Davis Carmel Medical Center, Rappaport Faculty of Medicine, Technion, 7 Michal Street, Haifa, Israel .
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Kothari CL, Wendt A, Liggins O, Overton J, Sweezy LDC. Assessing maternal risk for fetal-infant mortality: a population-based study to prioritize risk reduction in a healthy start community. Matern Child Health J 2011; 15:68-76. [PMID: 20082128 DOI: 10.1007/s10995-009-0561-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Study goals were to distinguish between maternal risk factors for fetal versus infant mortality, and to identify which maternal characteristics contributed the greatest risk of mortality overall. This case-control retrospective study abstracted data on more than forty maternal characteristics from 261 prenatal and delivery records: all 26 fetal deaths, all 40 infant deaths and 195 randomly selected surviving births in a high-mortality Healthy Start community. Bivariate and multivariate analyses were conducted. The fetal-mortality population was significantly more likely than the infant-mortality population to have no insurance (P = .047), inadequate prenatal care (P = .039) and previous fetal death (P = .021). Comparing the combined mortality population with the surviving sample, two tiers of risk emerged: Rare-but-lethal risks, including no prenatal care (P < .001) and Child-Protective-Service involvement (P = .001), and common-and-dangerous risks, including inadequate maternal weight gain (OR = 13.55), drug or alcohol abuse (OR = 8.67), obesity (OR = 2.77) and anemia (OR = 3.61). Both fetal and infant mortality groups must be considered when identifying maternal risks. Inadequate prenatal weight gain, obesity and anemia contribute as much to feto-infant mortality as substance abuse. Public health efforts to improve maternal nutrition and healthy weight should be redoubled.
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Affiliation(s)
- Catherine L Kothari
- Research Department & Emergency Department, Kalamazoo Center for Medical Studies, Michigan State University, Kalamazoo, MI, USA.
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Bassan H, Stolar O, Geva R, Eshel R, Fattal-Valevski A, Leitner Y, Waron M, Jaffa A, Harel S. Intrauterine growth-restricted neonates born at term or preterm: how different? Pediatr Neurol 2011; 44:122-30. [PMID: 21215912 DOI: 10.1016/j.pediatrneurol.2010.09.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 08/05/2010] [Accepted: 09/27/2010] [Indexed: 10/18/2022]
Abstract
Late onset intrauterine growth restriction is a common form of growth restriction, mainly caused by placenta-vascular insufficiency. Whether the intrauterine or extrauterine environment offers a better long-term outcome for the growth-restricted fetus remains unclear. We compared the risk factors and long-term outcomes of late onset growth-restricted neonates delivered between 31-36 weeks of gestation vs those delivered at term. This prospective cohort study included 114 preterm and 193 term born growth-restricted neonates. They underwent a neurobehavioral examination (neonatal period), a neurodevelopmental assessment and the Bayley Scales of Infant Development (age 2 years), and neuromotor assessment and the Wechsler Preschool and Primary Scale of Intelligence (age 6 years). Growth-restricted neonates born prematurely exhibited a significantly higher incidence of maternal hypertension, a maternal history of abortions and stillbirths, increased intrapartum and postnatal complication rates, and abnormal neonatal neurobehavioral scores than expected. Both preterm and term born growth-restricted groups, however, exhibited comparable long-term neurodevelopmental and cognitive outcomes at ages 2 and 6 years. Although prematurely born neonates undergo an earlier growth restriction process and exhibit a higher perinatal risk factor profile, their long-term outcomes are comparable to those of growth-restricted neonates born at term.
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Affiliation(s)
- Haim Bassan
- Child Neurology and Development Unit, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Kleijer ME, Dekker GA, Heard AR. Risk factors for intrauterine growth restriction in a socio-economically disadvantaged region. J Matern Fetal Neonatal Med 2009; 18:23-30. [PMID: 16105788 DOI: 10.1080/14767050500127674] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Risk factors for pregnancies being complicated by the birth of a small-for-gestational age (SGA) infant were analysed in a socio-economically disadvantaged area, with separate analysis for population-based and customized-based birth weight percentiles. METHODS A retrospective case-controlled study of all singleton pregnancies resulting in the birth of an infant with a birth weight < 10 population-based centile, born in the Northern suburbs of metropolitan Adelaide, between 1998 and 2003. Significant risk factors in the univariate analysis were subsequently checked with multivariate analysis. RESULTS The analyses confirm marked differences between population-based and customized-birth weight centiles. Patterns of risk factors show clear differences in risk factors for these two different SGA groups. Univariate analyses of all (nulliparous and multiparous women) customized SGA infants shows us the following odds ratio's (OR); unemployment OR 2.06, 95% confidence interval (CI) 1.46-2.92, being a single mother OR 1.90, CI 1.76-2.05, smoking OR 3.24, CI 2.32 - 4.54, recreational drug use OR 2.40, CI 1.55-3.70, mental health problems OR 1.52, CI 1.04-2.23, domestic violence OR 3.42, CI 1.26-9.29, being healthy OR 0.43, CI 0.30-0.61, preeclampsia OR 1.73, CI 1.01-2.97, and BMI < 30 OR 0.63 CI 0.43-0.93. Length of pregnancy interval had no relationship whatsoever with the risk of being delivered of an SGA infant. Multivariate analyses for customized SGA showed five factors with an OR > 2 (95% CI not crossing 1), including unemployment, smoking, maternal age > 34 years, not being healthy and preeclampsia, while different paternity, age 25-34 compared to age < 25 were also found to be significant risk factors. Higher systolic blood pressure was found to convey significant protection. CONCLUSION When studying risk factors for pregnancies complicated by the birth of an SGA infant, both population-derived and customized growth centiles should be utilized. This study confirms the importance of smoking as a major risk factor, our data also show major protection being conveyed by having a regular job and being generally healthy. Pregnancy interval did not have any relationship with the birth of SGA infants, while paternity change was identified as a clear risk factor. Although genuine preeclampsia persists as a clear risk factor, higher systolic blood pressure appears to convey protection.
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Affiliation(s)
- Monique E Kleijer
- Department of Obstetrics and Gynaecology, Lyell McEwin Health Service, University of Adelaide, Adelaide, Australia
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Chauhan SP, Magann EF, Velthius S, Nunn SL, Reynolds D, Scardo JA, Sanderson M, Thigpen BD, Martin JN. Detection of fetal growth restriction in patients with chronic hypertension: is it feasible? J Matern Fetal Neonatal Med 2009; 14:324-8. [PMID: 14986806 DOI: 10.1080/jmf.14.5.324.328] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine the utility of sonographic estimated fetal weight (EFW) in diagnosing intrauterine growth restriction (IUGR, birth weight < 10% for gestational age) in patients with chronic hypertension. METHODS All pregnant patients with hypertension delivered during a 5-year period at three centers were identified retrospectively. Patients with gestational hypertension, pre-eclampsia, diabetes mellitus, fetal anomalies and absence of a sonographic examination within 3 weeks of delivery were excluded. Likelihood ratio (LR) and guidelines established by the Evidence-Based Medicine Working Group were used to determine whether sonographic EFW is a reliable diagnostic test to detect IUGR. RESULTS At the three centers, there were 264 patients with chronic hypertension (122, 77 and 65 at centers I, II and III, respectively). The incidence of IUGR ranged from 13% to 27% but was similar at the three locations (p = 0.064). The LR (with 95% confidence interval (CI)) of detecting IUGR was 4.4 (95% CI 2.5, 7.7), 2.3 (95% CI 1.4, 3.7) and 6.1 (95% CI 2.7, 13.7) at centers I, II and III, respectively. Based on the proportions of abnormal growth, we required 253 and 71 newborns with fetal growth restriction at centers I and II, respectively, to have narrow confidence intervals around the clinically important LR of 10. The extremely low incidence of IUGR at center III (13%) precluded the estimation of required sample size. CONCLUSION Use of Evidence-Based Medicine Working Group guidelines indicates that sonographic EFW is slightly to moderately useful in detecting fetal growth restriction in patients with chronic hypertension.
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Affiliation(s)
- S P Chauhan
- Spartanburg Regional Medical Center, Spartanburg, South Carolina, USA
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Chen XK, Wen SW, Smith GN, Yang Q, Walker MC. New-Onset Hypertension in Late Pregnancy and Fetal Growth: Different Associations Between Singletons and Twins. Hypertens Pregnancy 2009; 26:259-72. [PMID: 17710575 DOI: 10.1080/10641950701366825] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare the effects of new-onset hypertension (NOH) in late pregnancy on fetal growth in singletons and twins. METHODS A retrospective cohort study was conducted to evaluate the effect of NOH on fetal growth in 17, 720, 900 singletons and 463, 104 twins born in the United States between 1995 and 2000. RESULTS NOH was associated with lower mean birth weight in both preterm and term singletons. Increased risk of low birth weight and decreased risk of high birth weight was associated with NOH in preterm and term singletons. NOH was associated with increased risk for small-for-gestational-age (SGA) births and decreased risk for large-for-gestational-age (LGA) births in preterm singletons, whereas it was associated with increased risk of both SGA and LGA births in term singletons. NOH was associated with higher mean birth weight in early preterm twins, and lower mean birth weight in term twins. Decreased risk for low birth weight was found in the NOH group among early preterm twins, and increased risk for low birth weight in term twins. NOH was associated with increased risk of SGA births and decreased risk for large-for-gestational-age (LGA) births in early preterm twins, while increased risk of SGA births in term twins. CONCLUSION NOH is associated with slower fetal growth in singletons delivered at different gestational ages, but the effect varies in twins depending on gestational age at delivery with faster growth in early preterm twins.
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Affiliation(s)
- Xi-Kuan Chen
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Health Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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Póvoa AM, Costa F, Rodrigues T, Patrício B, Cardoso F. Prevalence of Hypertension During Pregnancy in Portugal. Hypertens Pregnancy 2009; 27:279-84. [DOI: 10.1080/10641950802000943] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- A. M. Póvoa
- Department of Gynecology and Obstetrics, Hospital São João—EPE. Faculdade de Medicina da Universidade do Porto, Portugal
| | - F. Costa
- Department of Gynecology and Obstetrics, Hospital São João—EPE. Faculdade de Medicina da Universidade do Porto, Portugal
| | - T. Rodrigues
- Department of Gynecology and Obstetrics, Hospital São João—EPE. Faculdade de Medicina da Universidade do Porto, Portugal
| | - B. Patrício
- Department of Gynecology and Obstetrics, Hospital São João—EPE. Faculdade de Medicina da Universidade do Porto, Portugal
| | - F. Cardoso
- Department of Gynecology and Obstetrics, Hospital São João—EPE. Faculdade de Medicina da Universidade do Porto, Portugal
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Pérez-Cuevas R, Morales HR, Doubova SV, Murillo VV. Development and Use of Quality of Care Indicators for Obstetric Care in Women with Preeclampsia, Severe Preeclampsia, and Severe Morbidity. Hypertens Pregnancy 2009; 26:241-57. [PMID: 17710574 DOI: 10.1080/10641950701356784] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To develop indicators for evaluating the quality of care in managing preeclampsia. METHODS An expert group helped to develop and validate the following indicators for evaluating quality of care: availability of intensive care; completeness of laboratory tests; appropriateness of drug treatment at admission and before delivery (antihypertensive drugs, anticonvulsants, and dexamethasone); gestational age at which pregnancy should be interrupted; and type of delivery. By using these indicators, it was possible to evaluate the quality of care in 432 patients with preeclampsia. RESULTS A significant percentage of patients with preeclampsia and "near misses" received low quality of care, regardless of disease severity. CONCLUSION A number of interventions are needed to increase the quality of care to help avert maternal deaths in patients with preeclampsia.
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Affiliation(s)
- Ricardo Pérez-Cuevas
- Epidemiology and Health Services Research Unit, CMN Siglo XXI, Instituto Mexicano del Seguro Social, Mexico.
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