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Tousizadeh S, Mohammadi-Moghadam F, Mohammadian-Hafshejani A, Sadeghi R. Comparison of zinc levels in mothers with and without abortion: A systematic review and meta-analysiss. Heliyon 2024; 10:e30605. [PMID: 38774104 PMCID: PMC11106818 DOI: 10.1016/j.heliyon.2024.e30605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 04/30/2024] [Accepted: 04/30/2024] [Indexed: 05/24/2024] Open
Abstract
Introduction Zinc is an essential trace element involved in different physiological functions. During pregnancy, it plays a crucial role in healthy embryogenesis. Abortion is the most severe problem associated with early pregnancy complications. This study aims to compare the levels of Zn in mothers with and without abortion. Methods This study is a systematic review and meta-analysis of studies published between 1980 and 2022 in PubMed, Science Direct, Pro Quest, Wiley, Web of Science, and Scopus databases. The search was conducted using both main and Mesh keywords, specifically targeting terms related to abortion, pregnancy loss, and zinc. Heterogeneity in the studies included in the meta-analysis was evaluated using statistical tests such as the chi-square test, I2, and forest plots. Publication bias was assessed using Begg's and Egger's tests. All analyses were conducted using Stata 15, and statistical significance was considered at p < 0.05. Results In general, nine studies were included in this analysis. Based on the results of the meta-analysis, the mean difference in the Zn level between mothers with and without abortion is equal to 193.18 (95 % CI; 107.11 to 279.25, P ≤ 0.001). In other words, the level of Zn in the group of mothers without abortion is 193 units higher than the group of mothers with abortion. The investigation into the comparison of Zn levels in mothers with and without abortion did not reveal any indication of publication bias according to both Begg's test (P-value = 0.858) and Egger's test (P-value = 0.270). Conclusion the study findings indicate a significant association between lower levels of Zn in mothers with abortion compared to mothers without abortion. This suggests that a higher level of Zn may have a preventive effect on the occurrence of abortion in pregnant women. The data also highlights the positive role of trace metals, particularly Zn, in influencing pregnancy outcomes and suggests that maintaining adequate levels of Zn may reduce the likelihood of abortion occurrence, along with other contributing factors. It is important to note that further research, including prospective cohort and experimental studies, is needed to provide more substantial evidence and strengthen these findings.
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Affiliation(s)
- Sepideh Tousizadeh
- Student Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran
- Department of Environmental Health Engineering, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Fazel Mohammadi-Moghadam
- Department of Environmental Health Engineering, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
- Social Determinants of Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | | | - Ramezan Sadeghi
- Department of Environmental Health Engineering, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
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Rahaman M, Roy A, Chouhan P, Das KC, Rana MJ. Revisiting the predisposing, enabling, and need factors of unsafe abortion in India using the Heckman Probit model. J Biosoc Sci 2024; 56:459-479. [PMID: 37982282 DOI: 10.1017/s002193202300024x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Unsafe abortion refers to induced abortions performed without trained medical assistance. While previous studies have investigated predictors of unsafe abortion in India, none have addressed these factors with accounting sample selection bias. This study aims to evaluate the contributors to unsafe abortion in India by using the latest National Family Health Survey data conducted during 2019-2021, incorporating the adjustment of sample selection bias. The study included women aged 15 to 49 who had terminated their most recent pregnancy within five years prior to the survey (total weighted sample (N) = 4,810). Descriptive and bivariate statistics and the Heckman Probit model were employed. The prevalence of unsafe abortion in India was 31%. Key predictors of unsafe abortion included women's age, the gender composition of their living children, gestation stage, family planning status, and geographical region. Unsafe abortions were typically performed in the early stages of gestation, often involving self-administered medication. The primary reasons cited were unintended pregnancies and health complications. This study underscores the urgent need for targeted interventions that take into account regional, demographic, and social dynamics influencing abortion practices in India.
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Affiliation(s)
- Margubur Rahaman
- Department of Migration & Urban Studies, International Institute for Population Sciences (IIPS), Mumbai, India
| | - Avijit Roy
- Department of Geography, University of Gour Banga, West Bengal, India
| | - Pradip Chouhan
- Department of Geography, Malda College, West Bengal, India
| | - Kailash Chandra Das
- Department of Migration & Urban Studies, International Institute for Population Sciences (IIPS), Mumbai, India
| | - Md Juel Rana
- Govind Ballabh Pant Social Science Institute (GBPSSI), Allahabad, India
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3
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Eldhose R, Viggeswarpu S, Jambugulam M. Unmasking herbal medication-induced lead poisoning in a geriatric patient with gastrointestinal symptoms. BMJ Case Rep 2023; 16:e258065. [PMID: 38086570 PMCID: PMC10728943 DOI: 10.1136/bcr-2023-258065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Lead poisoning, often associated with occupational exposure, can also arise from intake of traditional and herbal medicines with high lead content. Geriatric patients displaying gastrointestinal symptoms from such sources are frequently misdiagnosed. An individual in his 70s reported to our geriatric clinic with vomiting, constipation and anaemia. A meticulous history unveiled his recent intake of herbal remedies. Heavy metal assay indicated elevated lead levels in his blood and urine, consistent with the high lead content we measured in the herbal medication. Following supportive treatment, nutritional supplementation and chelation therapy with calcium disodium EDTA, he improved. Follow-up tests indicated a decrease in lead levels and resolution of anaemia. This case emphasises the importance of considering lead poisoning as a potential diagnosis in patients with unexplained symptoms, particularly when there is a history of herbal or alternative medication intake. Timely recognition and appropriate management can lead to better outcome.
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Affiliation(s)
- Raeba Eldhose
- Department of Geriatrics, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Surekha Viggeswarpu
- Department of Geriatrics, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Mohan Jambugulam
- Department of General Medicine, Christian Medical College, Vellore, Tamilnadu, India
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Sakko Y, Turesheva A, Gaipov A, Aimagambetova G, Ukybassova T, Marat A, Kaldygulova L, Amanzholkyzy A, Nogay A, Khamidullina Z, Mussenov Y, Almawi WY, Atageldiyeva K. Epidemiology of spontaneous pregnancy loss in Kazakhstan: A national population-based cohort analysis during 2014-2019 using the national electronic healthcare system. Acta Obstet Gynecol Scand 2023; 102:1682-1693. [PMID: 37667510 PMCID: PMC10619606 DOI: 10.1111/aogs.14669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 07/19/2023] [Accepted: 07/29/2023] [Indexed: 09/06/2023]
Abstract
INTRODUCTION Spontaneous pregnancy loss (SPL) is a common health problem that affects 1:10 of childbearing women, and is linked with physical and psychological complications. As the number of nationwide studies on the incidence of SPL is few, especially from middle-income countries, in this study we investigated the epidemiology, complications and outcomes of SPL before 22 weeks of gestation by analyzing large-scale healthcare data from the Unified Nationwide Electronic Healthcare System (UNEHS) in Kazakhstan. MATERIAL AND METHODS A population-based study among women who experienced SPL in any healthcare setting of the Republic of Kazakhstan during the period of 2014-2019. The International Classification of Diseases (ICD) 10th edition and ICD 9th edition's procedural codes were utilized to retrieve data using relevant diagnostic and procedural codes. RESULTS In total, 207 317 records of women who have experienced an SPL before 22 weeks of gestation were analyzed from all Kazakhstani regions. The estimated prevalence of SPL was 8.7%, with a 20% decline over a 6-year period. The SPL cases ratio comprises on average 6.2 per 1000 reproductive-age women. Incomplete miscarriage (ICD-10 code "O03.4") was the most common type (37.8%), followed by blighted ovum (ICD-10 code "O02.0"; 34.1%) and missed abortion (ICD-10 code "O02.1"; 13.5%). The most common management methods were dilation and curettage of the uterus (ICD-9 code "69.0"; 84.7%) and aspiration curettage of the uterus (ICD-9 code "65.0"; 15%), whereas medical management was rarely performed (2.6%). CONCLUSION The information available in UNEHS adequately identifies types of miscarriages and treatment methods. Although the prevalence of SPL before 22 weeks of gestation is decreasing, management of miscarriages requires closer attention.
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Affiliation(s)
- Yesbolat Sakko
- Department of Medicine, School of MedicineNazarbayev UniversityAstanaKazakhstan
| | - Akbayan Turesheva
- Department of Normal PhysiologyWest‐Kazakhstan Marat Ospanov Medical UniversityAktobeKazakhstan
| | - Abduzhappar Gaipov
- Department of Medicine, School of MedicineNazarbayev UniversityAstanaKazakhstan
| | | | - Talshyn Ukybassova
- Clinical Academic Department of Women's HealthCF “University Medical Center”AstanaKazakhstan
| | - Aizada Marat
- Department of Obstetrics and Gynecology #1NJSC “Astana Medical University”AstanaKazakhstan
| | - Lyazzat Kaldygulova
- Department of Obstetrics and Gynecology #2West‐Kazakhstan Marat Ospanov Medical UniversityAktobeKazakhstan
| | - Ainur Amanzholkyzy
- Department of Normal PhysiologyWest‐Kazakhstan Marat Ospanov Medical UniversityAktobeKazakhstan
| | - Anastassiya Nogay
- Department of Medicine, School of MedicineNazarbayev UniversityAstanaKazakhstan
| | - Zaituna Khamidullina
- Department of Obstetrics and Gynecology #1NJSC “Astana Medical University”AstanaKazakhstan
| | | | - Wassim Y. Almawi
- Science Faculty of TunisiaUniversité de Tunis El ManarTunisTunisia
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Gonzalez-Martin R, Grau-Perez M, Sebastian-Leon P, Diaz-Gimeno P, Vidal C, Tellez-Plaza M, Dominguez F. Association of blood cadmium and lead levels with self-reported reproductive lifespan and pregnancy loss: The national health and nutrition examination survey 1999-2018. ENVIRONMENTAL RESEARCH 2023; 233:116514. [PMID: 37392826 DOI: 10.1016/j.envres.2023.116514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/09/2023] [Accepted: 06/25/2023] [Indexed: 07/03/2023]
Abstract
Cadmium and lead are known to interfere with the endocrine function. Thus, hormonally regulated processes such as menarche, menopause and pregnancy are likely influenced by chronic exposure to these metals. In US post-menopausal women, who already completed their reproductive lifespan, we evaluated the association between blood cadmium and lead levels with self-reported reproductive lifespan and personal history of pregnancy loss. We selected 5317 post-menopausal women participating in the National Health and Nutrition Examination Survey (NHANES), 1999-2018. Blood cadmium and lead levels were measured by inductively coupled plasma mass spectrometry. Reproductive lifespan was defined as the number of years between self-reported age at menarche and menopause. Personal history of pregnancy loss was defined as number of self-reported pregnancy losses out of the self-reported number of pregnancies. The fully adjusted mean difference in reproductive lifespan (95% confidence interval [CI]) comparing the 80th to the 20th percentiles of blood cadmium and lead distributions was, respectively, 0.50 (0.10, 0.91) and 0.72 (0.41, 1.03) years. Ever smoker showed stronger association of blood lead with reproductive lifespan. For self-reported pregnancy loss, the corresponding fully adjusted relative prevalence (95% CI) was 1.10 (0.93, 1.31) for cadmium and 1.10 (1.00, 1.21) for lead, and remained similar after additional adjustment for reproductive lifespan. In never smokers, the relative prevalence was 1.07 (1.04, 1.11) and 1.16 (1.05, 1.28) for blood cadmium and lead, respectively. These findings suggest that blood cadmium and lead exposures increase reproductive lifespan and prevalence of pregnancy loss in the general population. Additional studies are needed to improve the understanding of mechanisms and prevention potential of metals-related pregnancy outcomes.
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Affiliation(s)
- Roberto Gonzalez-Martin
- IVI Foundation/ISS LaFe Biomedical Research Institute, Avenida Fernando Abril Martorell, 106, 46026, Valencia, Spain.
| | - Maria Grau-Perez
- Area of Cardiometabolic and Renal Risk. Instituto de Investigacion Sanitaria Hospital Clinic de Valencia INCLIVA, Valencia, Spain
| | - Patricia Sebastian-Leon
- IVI Foundation/ISS LaFe Biomedical Research Institute, Avenida Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Patricia Diaz-Gimeno
- IVI Foundation/ISS LaFe Biomedical Research Institute, Avenida Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Carmen Vidal
- IVI Foundation/ISS LaFe Biomedical Research Institute, Avenida Fernando Abril Martorell, 106, 46026, Valencia, Spain; IVI/RMA Valencia, Plaza de la Policía Local, 3. 46015, Valencia, Spain
| | - Maria Tellez-Plaza
- Area of Cardiometabolic and Renal Risk. Instituto de Investigacion Sanitaria Hospital Clinic de Valencia INCLIVA, Valencia, Spain; Department of Chronic Diseases Epidemiology, National Center for Epidemiology, Carlos III Health Institutes, Madrid, Spain
| | - Francisco Dominguez
- IVI Foundation/ISS LaFe Biomedical Research Institute, Avenida Fernando Abril Martorell, 106, 46026, Valencia, Spain
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Kaur M, Kaur R, Chhabra K, Khetarpal P. Maternal candidate gene variants, epigenetic factors, and susceptibility to idiopathic recurrent pregnancy loss: A systematic review. Int J Gynaecol Obstet 2023; 162:829-841. [PMID: 36710639 DOI: 10.1002/ijgo.14701] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/13/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recurrent pregnancy loss is defined as the loss of two or more pregnancies and is a distressing condition for couples. OBJECTIVE To investigate the relationship between variants in the candidate susceptibility genes and epigenetic factors to identify risk factors for idiopathic recurrent pregnancy loss (iRPL). SEARCH STRATEGY A systematic literature search was performed using PubMed, Google Scholar, ScienceDirect, and Scopus databases. Insilico analysis was carried out using ShinyGO and STRING software. SELECTION CRITERIA Research papers examining the association between variations in genetic and epigenetic factors and iRPL. DATA COLLECTION AND ANALYSIS Data were independently extracted by two authors. MAIN RESULTS In total, 83 research papers were finally selected for the present study. Among all the genes involved in the pathogenesis of recurrent pregnancy loss, polymorphisms in IL superfamily genes, VEGF, ESR, and MTHFR were the most investigated. CONCLUSION Polymorphisms in angiogenesis, immune tolerance, and thrombophilia pathway genes, which occur independently or synergistically, may lead to various complications during fetal development. Identification of multi-allele risk variants and epigenetic factors in women will be helpful in the identification of high-risk pregnancies. PROSPERO REGISTRATION NUMBER Prospero CRD42021287315.
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Affiliation(s)
- Mandeep Kaur
- Human Genetics Department, Punjabi University Patiala, Patiala, India
| | - Rajinder Kaur
- Human Genetics Department, Punjabi University Patiala, Patiala, India
| | - Kiran Chhabra
- Chhabra Hospital & Test Tube Baby Centre, Bathinda, India
| | - Preeti Khetarpal
- Human Genetics and Molecular Medicine Department, Central University of Punjab, Bathinda, India
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Ren M, Wang L, Wen L, Chen J, Quan S, Shi X. Association between female circulating heavy metal concentration and abortion: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1216507. [PMID: 37711903 PMCID: PMC10497972 DOI: 10.3389/fendo.2023.1216507] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/31/2023] [Indexed: 09/16/2023] Open
Abstract
Objective This study aimed to evaluate the association between blood heavy metal (zinc (Zn), copper (Cu), lead (Pb), and cadmium (Cd)) concentrations and spontaneous abortion (SA) and recurrent pregnancy loss (RPL) and explore the possible endocrine dysfunction associated with it. Methods A literature search was performed in the PubMed, Embase, Cochrane Library, and Web of Science databases up to April 2023. The overall effects were expressed as the standard mean difference (SMD). Subgroup analysis was performed according to the type of abortion (SA or RPL). Stata 16.0 was utilized for data analysis. Results Based on the integrated findings, abortion women showed significantly lower Zn (SMD = -1.05, 95% CI: -1.74 to -0.36, p = 0.003) and Cu concentrations (SMD = -1.42, 95% CI: -1.97 to -0.87, p <0.001) and higher Pb (SMD = 1.47, 95% CI: 0.89-2.05, p <0.001) and Cd concentrations (SMD = 1.15, 95% CI: 0.45-1.85, p = 0.001) than normal pregnant women. Subgroup analysis showed that Zn and Cu deficiency and Cd and Pb exposure were significantly (p <0.05) associated with RPL, whereas Cu deficiency and Cd and Pb exposure were significantly (p <0.05) associated with SA. Conclusion Zn and Cu deficiencies and Pb and Cd exposure were associated with abortion. Endocrine dysfunction, such as insulin resistance, vitamin D insufficiency, and abnormal thyroid and sex hormone concentrations, is thought to be involved in heavy metal-related abortion.
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Affiliation(s)
- Meiqi Ren
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, NanFang Hospital, Southern Medical University, Guangzhou, China
| | - Liantong Wang
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, NanFang Hospital, Southern Medical University, Guangzhou, China
| | - Liqin Wen
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Jinghua Chen
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Song Quan
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, NanFang Hospital, Southern Medical University, Guangzhou, China
| | - Xiao Shi
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, NanFang Hospital, Southern Medical University, Guangzhou, China
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Tian Y, Pan Z, Lan L, Chang Y, Zhao T, Fu Z, Wu S, Deng T, Cao M, Wang W, Bi Y, Yang R, Yang Lee BJ, Liu Q. Amelioration of intestinal barrier function and reduction of blood lead level in adult women with recurrent spontaneous abortion by a novel product of dietary fiber mixture, Holofood. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:63. [PMID: 37420277 DOI: 10.1186/s41043-023-00394-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/29/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND The elevated circulating toxins secondary to the impairment of intestinal barrier integrity commonly elicit a chronic inflammatory response and finally contribute to multiple diseases. These toxins, including bacterial by-products and heavy metals, are the potent risk factors for the development of recurrent spontaneous abortion (RSA). Preclinical evidence suggests that several dietary fibers can restore intestinal barrier function and decrease the accumulation of heavy metals. However, it is uncertain whether treatment with a newly developed blend of dietary fibers product (Holofood) benefits patients with RSA. METHODS In this trial, we enrolled 70 adult women with RSA, who were randomly assigned into the experiment group and the control group in a 2:1 ratio. Upon the basis of conventional therapy, subjects in the experiment group (n = 48) received 8 weeks oral administration with Holofood three times daily at a dose of 10 g each time. Subjects without Holofood consumption were set as the control (n = 22). Blood samples were collected for the determinations of metabolic parameters, heavy mental lead, and the indices related to intestinal barrier integrity (D-lactate, bacterial endotoxin, and diamine oxidase activity). RESULTS The reduction amplitude in blood lead from baseline to week 8 was 40.50 ± 54.28 (μg/L) in the experiment group as compared with 13.35 ± 36.81 (μg/L) in the control group (P = 0.037). The decreased level of serum D-lactate from baseline to week 8 was 5.58 ± 6.09 (mg/L) in the experiment group as compared with - 2.38 ± 8.90 (mg/L, P < 0.0001) in the control group. The change in serum DAO activity from baseline to week 8 was 3.26 ± 2.23 (U/L) in the experiment group as compared with - 1.24 ± 2.22 (U/L, P < 0.0001) in the control group. Participants who received Holofood had a greater decline in blood endotoxin from baseline to week 8 than those in the control group. Moreover, by comparing with the self-baseline, Holofood consumption significantly decreased the blood levels of lead, D-lactate, bacterial endotoxin, and DAO activity. CONCLUSION Our results suggest that Holofood affords a clinically relevant improvements in blood lead level and intestinal barrier dysfunction in patients with RSA.
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Affiliation(s)
- Ye Tian
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
- Shenzhen Key Laboratory of Fertility Regulation, Center of Assisted Reproduction and Embryology, The University of Hong Kong - Shenzhen Hospital, Shenzhen, 518053, China
| | - Zhiyuan Pan
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, China
| | - Liling Lan
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, No. 3012, Fuqiang Road, Futian District, Shenzhen, 518028, China
| | - Yuxiao Chang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, China
| | - Ting Zhao
- Guangzhou First People's Hospital, Guangzhou, 510180, China
| | - Zhihong Fu
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, No. 3012, Fuqiang Road, Futian District, Shenzhen, 518028, China
| | - Shuhua Wu
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, No. 3012, Fuqiang Road, Futian District, Shenzhen, 518028, China
| | - Tianqin Deng
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, No. 3012, Fuqiang Road, Futian District, Shenzhen, 518028, China
| | - Meilan Cao
- Center of Assisted Reproduction and Embryology, The University of Hong Kong - Shenzhen Hospital, Shenzhen, 518053, China
| | - Weizhou Wang
- Department of Obstetrics and Gynecology, The Seventh Medical Center of Chinese People's Liberation Army General Hospital, Beijing, 100007, China
| | - Yujing Bi
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, China
| | - Ruifu Yang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, China
| | - B J Yang Lee
- Beijing Future Science & Technology Development Co., Ltd., Rm. 1702A #1 Guanhu International Plaza, 105 Yaojiayuan Road, Chaoyang District, Beijing, 100025, China.
| | - Qingzhi Liu
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, No. 3012, Fuqiang Road, Futian District, Shenzhen, 518028, China.
- Center of Assisted Reproduction and Embryology, The University of Hong Kong - Shenzhen Hospital, Shenzhen, 518053, China.
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Turesheva A, Aimagambetova G, Ukybassova T, Marat A, Kanabekova P, Kaldygulova L, Amanzholkyzy A, Ryzhkova S, Nogay A, Khamidullina Z, Ilmaliyeva A, Almawi WY, Atageldiyeva K. Recurrent Pregnancy Loss Etiology, Risk Factors, Diagnosis, and Management. Fresh Look into a Full Box. J Clin Med 2023; 12:4074. [PMID: 37373766 DOI: 10.3390/jcm12124074] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Recurrent pregnancy loss is a complex health challenge with no universally accepted definition. Inconsistency in definitions involves not only the number of spontaneous abortions (two or three) that are accepted for recurrent pregnancy loss but the types of pregnancy and gestational age at miscarriage. Due to the heterogeneity of definitions and criteria applied by international guidelines for recurrent pregnancy loss, the true incidence of recurrent miscarriage, which is reported to range from 1% to 5%, is difficult to estimate. Moreover, the exact etiology of recurrent pregnancy loss remains questionable; thus, it is considered a polyetiological and multifactorial condition with many modifiable and non-modifiable factors involved. Even after thoroughly evaluating recurrent pregnancy loss etiology and risk factors, up to 75% of cases remain unexplained. This review aimed to summarize and critically analyze accumulated knowledge on the etiology, risk factors, relevant diagnostic options, and management approach to recurrent pregnancy loss. The relevance of various factors and their proposed roles in recurrent pregnancy loss pathogenesis remains a matter of discussion. The diagnostic approach and the management largely depend on the etiology and risk factors taken into consideration by a healthcare professional as a cause of recurrent miscarriage for a particular woman or couple. Underestimation of social and health consequences of recurrent pregnancy loss leads to compromised reproductive health and psychological well-being of women after miscarriage. Studies on etiology and risk factors for recurrent pregnancy loss, especially idiopathic, should be continued. The existing international guidelines require updates to assist clinical practice.
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Affiliation(s)
- Akbayan Turesheva
- Department of Normal Physiology, West-Kazakhstan Marat Ospanov Medical University, Aktobe 030000, Kazakhstan
| | | | - Talshyn Ukybassova
- Clinical Academic Department of Women's Health, CF "University Medical Center", Astana 010000, Kazakhstan
| | - Aizada Marat
- Department of Obstetrics and Gynecology #1, NJSC "Astana Medical University", Astana 010000, Kazakhstan
| | - Perizat Kanabekova
- Department of Medicine, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan
| | - Lyazzat Kaldygulova
- Department of Obstetrics and Gynecology #2, West-Kazakhstan Marat Ospanov Medical University, Aktobe 030000, Kazakhstan
| | - Ainur Amanzholkyzy
- Department of Normal Physiology, West-Kazakhstan Marat Ospanov Medical University, Aktobe 030000, Kazakhstan
| | - Svetlana Ryzhkova
- Department of Obstetrics and Gynecology #2, West-Kazakhstan Marat Ospanov Medical University, Aktobe 030000, Kazakhstan
| | - Anastassiya Nogay
- Department of Medicine, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan
| | - Zaituna Khamidullina
- Department of Obstetrics and Gynecology #1, NJSC "Astana Medical University", Astana 010000, Kazakhstan
| | - Aktoty Ilmaliyeva
- Department of Medicine #3, NJSC "Astana Medical University", Astana 010000, Kazakhstan
| | - Wassim Y Almawi
- Faculte' des Sciences de Tunis, Universite' de Tunis El Manar, Tunis 5000, Tunisia
| | - Kuralay Atageldiyeva
- Department of Medicine, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan
- Clinical Academic Department of Internal Medicine, CF "University Medical Center", Astana 010000, Kazakhstan
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Santana AB, Spelta LEW, Sobalvarro JVM, Podestá MHMC, Garcia RCT, Dos Reis TM, Torres LH. Gestational lead exposure and its effects on fetal/infant development - A systematic review. Reprod Toxicol 2023; 117:108342. [PMID: 36758879 DOI: 10.1016/j.reprotox.2023.108342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/05/2023] [Indexed: 02/10/2023]
Abstract
Studies suggest that gestational exposure to lead (Pb) is related to spontaneous abortions, preterm birth, lower infant birth weight and length, and neurological dysfunctions. However, the evidence about its effects during pregnancy exposure on fetal and child development is still poor. Thus, the aim of this systematic review was to verify the association between prenatal exposure to Pb and the occurrence of neurobehavioral deficits, miscarriages, and child mortality. Observational studies with pregnant women exposed to Pb during pregnancy were included, without gender or ethnicity restrictions. The MEDLINE, Cochrane Library, EMBASE, Scopus, Web of Science, and LILACS databases were searched. The reading of titles and abstracts was conducted, followed by reading in full format and data extraction, that were performed independently by two reviewers. The included studies were evaluated by Downs and Black tool and qualitatively synthesized. Certainty of evidence was assessed by Grading of Recommendations Assessment, Development, and Evaluations (GRADE). The study protocol was registered with the Prospective Registry of Systematic Reviews (PROSPERO; CRD42022296750). Among twenty-one studies included, sixteen were classified as prospective cohort, two case-control, one nested case-control, one cohort, and one longitudinal study. No study that evaluated child mortality associated with gestational Pb exposure was found. There is a very low certainty of evidence in the association of gestational Pb exposure and neurobehavioral deficits or miscarriages. This systematic review reflects the poor evidence and the challenges of human toxicology studies, since it was not possible to associate gestational Pb exposure to neurobehavioral deficits, miscarriages, and child mortality.
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Affiliation(s)
- Aleksander Brandão Santana
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700, Alfenas 37130-001, MG, Brazil
| | - Lídia Emmanuela Wiazowski Spelta
- Department of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, University of São Paulo, Av. Prof. Lineu Prestes, 580, Butantã, São Paulo 05508-000, SP, Brazil
| | - Joselin Valeska Martinez Sobalvarro
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700, Alfenas 37130-001, MG, Brazil; Department of Health Sciences, Federal University of Paraná, Av. Mayor Lothário Meissner, 623, Jardim Botânico, Curitiba 80210-170, PR, Brazil
| | - Márcia Helena Miranda Cardoso Podestá
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700, Alfenas 37130-001, MG, Brazil
| | - Raphael Caio Tamborelli Garcia
- Department of Pharmaceutical Sciences, Institute of Environmental, Chemical and Pharmaceutical Sciences, Federal University of São Paulo, Diadema, SP, Brazil
| | - Tiago Marques Dos Reis
- Department of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700, Alfenas 37130-001, MG, Brazil
| | - Larissa Helena Torres
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700, Alfenas 37130-001, MG, Brazil.
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Mohany KM, El-Asheer OM, Raheem YFA, sayed AAE, El-Baz MAEHH. Neonatal heavy metals levels are associated with the severity of neonatal respiratory distress syndrome: a case–control study. BMC Pediatr 2022; 22:635. [PMID: 36333705 PMCID: PMC9635146 DOI: 10.1186/s12887-022-03685-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
Background This case–control study aimed to compare lead (Pb), cadmium (Cd), and arsenic (As) levels in neonates with respiratory distress syndrome (NRDS) with those levels in normal neonates and tested their associations with the severity of NRDS indicated by the levels of serum surfactant protein D (SP-D) and cord blood cardiac troponin I (CTnI), and high-sensitive C-reactive protein (hs-CRP). Methods The study included two groups: G1 (60 healthy neonates) and G2 (100 cases with NRDS). Cord blood Pb, erythrocytic Cd (E-Cd), neonatal scalp hair As (N-As), maternal urinary Cd (U-Cd), and arsenic (U-As) were measured by a Thermo Scientific iCAP 6200, while CTnI, hs-CRP, and SP-D by their corresponding ELISA kits. Results The levels of cord blood Pb, E-Cd, N-As, U-Cd, U-As, SP-D, CTnI, and hs-CRP were significantly higher in G2 than G1 (p = 0.019, 0.040, 0.003, 0.010, 0.011, < 0.001, 0.004, < 0.001, respectively). While the birth weight, and APGAR score at 1, 5 and 10 min were significantly lower in G2 than G1 (p = 0.002, < 0.001, < 0.001, < 0.001, respectively). The levels of the studied heavy metals correlated positively with the levels of SP-D, CTnI, and hs-CRP. Conclusion Heavy metals toxicity may be accused to be one of the causes of NRDS especially if other apparent causes are not there. Measuring and follow-up of heavy metal levels should be considered during pregnancy.
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Affiliation(s)
- Khalid M. Mohany
- grid.252487.e0000 0000 8632 679XDepartment of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Assiut University, Assiut, Egypt ,grid.252487.e0000 0000 8632 679XDepartment of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Assiut University, EL Gammaa Street, Assiut city, 00201146007069 Egypt
| | - Osama Mahmoud El-Asheer
- grid.252487.e0000 0000 8632 679XDepartment of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Yaser F. Abdel Raheem
- grid.252487.e0000 0000 8632 679XDepartment of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed Abd-Elrasoul sayed
- grid.252487.e0000 0000 8632 679XClinical Pharmacist at Assiut University Children Hospital, Assiut, Egypt
| | - Mona Abd El-Hamid Hassan El-Baz
- grid.252487.e0000 0000 8632 679XDepartment of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Assiut University, Assiut, Egypt
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12
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Neamtu RI, Craina M, Dahma G, Popescu AV, Erimescu AG, Citu I, Dobrescu A, Horhat FG, Vulcanescu DD, Gorun F, Bernad ES, Motoc A, Citu IC. Heavy metal ion concentration in the amniotic fluid of preterm and term pregnancies from two cities with different industrial output. Exp Ther Med 2022; 23:111. [PMID: 34970334 PMCID: PMC8713173 DOI: 10.3892/etm.2021.11034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/10/2021] [Indexed: 11/19/2022] Open
Abstract
The growth and development of the fetus is a complex phenomenon that can be influenced by several variables. High quantities of heavy metal ions in the amniotic fluid have been linked to poor health, especially in industrial, polluted and poor areas. The aim of the present study was to assess the differences in the concentration of these ions between preterm (weeks 15-37) and term pregnancies (starting at week 37). Another objective was to compare pregnancies from two cities with different industry levels. Two sample lots from two Romanian cities were analyzed. A total of 100 patients from Timisoara were compared with 60 from Petrosani, a heavy industry city in Romania. Demographic data were collected, and amniocentesis was performed on all women. Lead (Pb), copper (Cu), nickel (Ni), cadmium (Cd), arsenic (As), iron (Fe) and zinc (Zn) concentrations were assessed. Descriptive and analytical statistics were performed using the Mann-Whitney U test for non-parametric data and the Fisher's exact test for categorical data. In addition, categorical data was represented graphically. In the Timisoara cohort, the differences in heavy metal concentrations between preterm and term pregnancies were not statistically significant. In the Petrosani cohort, however, the concentrations of Zn (P=0.02606) and Cd (P=0.01512) were higher in preterm than in term pregnancies. When comparing the two cohorts as a whole, the concentration of Pb (P=0.04513), Cd (P=0.00002), As (P=0.03027) and Zn (P<0.00001) were higher in the patients from Petrosani than in those from Timisoara. Only Cu concentrations were higher in the Timisoara cohort (P<0.00001). The concentrations of Ni (P=0.78150) and Fe (P=0.44540) did not differ statistically. Thus, amniocentesis is an important diagnostic and exploratory tool in determining differences in the concentrations of elements such as heavy metal ions. Research over a longer period of time should be carried out to examine the relation between heavy metal ions concentration and possible postnatal health outcomes.
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Affiliation(s)
- Radu Ionut Neamtu
- Department of Obstetrics-Gynecology and Neonatology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Marius Craina
- Department of Obstetrics-Gynecology and Neonatology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - George Dahma
- Department of Obstetrics-Gynecology and Neonatology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Alin Viorel Popescu
- Department of Obstetrics-Gynecology and Neonatology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Adelina Geanina Erimescu
- Department of Obstetrics-Gynecology and Neonatology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Ioana Citu
- Department of Internal Medicine I, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Amadeus Dobrescu
- Department of Surgery, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Florin George Horhat
- Multidisciplinary Research Center on Antimicrobial Resistance (Multi-Rez), Microbiology Department, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania.,Clinical Laboratory, 'Louis Turcanu' Emergency Hospital for Children, 300011 Timisoara, Romania
| | - Dan Dumitru Vulcanescu
- Multidisciplinary Research Center on Antimicrobial Resistance (Multi-Rez), Microbiology Department, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania.,Clinical Laboratory, 'Louis Turcanu' Emergency Hospital for Children, 300011 Timisoara, Romania
| | - Florin Gorun
- Department of Obstetrics-Gynecology and Neonatology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Elena Silvia Bernad
- Department of Internal Medicine I, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Andrei Motoc
- Department of Obstetrics-Gynecology and Neonatology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania.,Department of Anatomy and Embryology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Ioan Cosmin Citu
- Department of Obstetrics-Gynecology and Neonatology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
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