1
|
Gumusoglu SB, Kiel MD, Gugel A, Schickling BM, Weaver KR, Lauffer MC, Sullivan HR, Coulter KJ, Blaine BM, Kamal M, Zhang Y, Devor EJ, Santillan DA, Gantz SC, Santillan MK. Anti-angiogenic mechanisms and serotonergic dysfunction in the Rgs2 knockout model for the study of psycho-obstetric risk. Neuropsychopharmacology 2024; 49:864-875. [PMID: 37848733 PMCID: PMC10948883 DOI: 10.1038/s41386-023-01749-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 10/19/2023]
Abstract
Psychiatric and obstetric diseases are growing threats to public health and share high rates of co-morbidity. G protein-coupled receptor signaling (e.g., vasopressin, serotonin) may be a convergent psycho-obstetric risk mechanism. Regulator of G Protein Signaling 2 (RGS2) mutations increase risk for both the gestational disease preeclampsia and for depression. We previously found preeclampsia-like, anti-angiogenic obstetric phenotypes with reduced placental Rgs2 expression in mice. Here, we extend this to test whether conserved cerebrovascular and serotonergic mechanisms are also associated with risk for neurobiological phenotypes in the Rgs2 KO mouse. Rgs2 KO exhibited anxiety-, depression-, and hedonic-like behaviors. Cortical vascular density and vessel length decreased in Rgs2 KO; cortical and white matter thickness and cell densities were unchanged. In Rgs2 KO, serotonergic gene expression was sex-specifically changed (e.g., cortical Htr2a, Maoa increased in females but all serotonin targets unchanged or decreased in males); redox-related expression increased in paraventricular nucleus and aorta; and angiogenic gene expression was changed in male but not female cortex. Whole-cell recordings from dorsal raphe serotonin neurons revealed altered 5-HT1A receptor-dependent inhibitory postsynaptic currents (5-HT1A-IPSCs) in female but not male KO neurons. Additionally, serotonin transporter blockade by the SSRI sertraline increased the amplitude and time-to-peak of 5-HT1A-IPSCs in KO neurons to a greater extent than in WT neurons in females only. These results demonstrate behavioral, cerebrovascular, and sertraline hypersensitivity phenotypes in Rgs2 KOs, some of which are sex-specific. Disruptions may be driven by vascular and cell stress mechanisms linking the shared pathogenesis of psychiatric and obstetric disease to reveal future targets.
Collapse
Affiliation(s)
- Serena B Gumusoglu
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, USA
- Iowa Neuroscience Institute, University of Iowa, Iowa City, USA
| | - Michaela D Kiel
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Aleigha Gugel
- Iowa Neuroscience Institute, University of Iowa, Iowa City, USA
- Department of Molecular Physiology and Biophysics, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Brandon M Schickling
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Kaylee R Weaver
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Marisol C Lauffer
- Iowa Neuroscience Institute, University of Iowa, Iowa City, USA
- Neural Circuits and Behavior Core, Iowa Neuroscience Institute, University of Iowa, Iowa City, USA
| | - Hannah R Sullivan
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Kaylie J Coulter
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Brianna M Blaine
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Mushroor Kamal
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Yuping Zhang
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Eric J Devor
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Donna A Santillan
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Stephanie C Gantz
- Iowa Neuroscience Institute, University of Iowa, Iowa City, USA
- Department of Molecular Physiology and Biophysics, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Mark K Santillan
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, USA.
| |
Collapse
|
2
|
Developmental Programming in Animal Models: Critical Evidence of Current Environmental Negative Changes. Reprod Sci 2023; 30:442-463. [PMID: 35697921 PMCID: PMC9191883 DOI: 10.1007/s43032-022-00999-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/02/2022] [Indexed: 11/23/2022]
Abstract
The Developmental Origins of Health and Disease (DOHaD) approach answers questions surrounding the early events suffered by the mother during reproductive stages that can either partially or permanently influence the developmental programming of children, predisposing them to be either healthy or exhibit negative health outcomes in adulthood. Globally, vulnerable populations tend to present high obesity rates, including among school-age children and women of reproductive age. In addition, adults suffer from high rates of diabetes, hypertension, cardiovascular, and other metabolic diseases. The increase in metabolic outcomes has been associated with the combination of maternal womb conditions and adult lifestyle-related factors such as malnutrition and obesity, smoking habits, and alcoholism. However, to date, "new environmental changes" have recently been considered negative factors of development, such as maternal sedentary lifestyle, lack of maternal attachment during lactation, overcrowding, smog, overurbanization, industrialization, noise pollution, and psychosocial stress experienced during the current SARS-CoV-2 pandemic. Therefore, it is important to recognize how all these factors impact offspring development during pregnancy and lactation, a period in which the subject cannot protect itself from these mechanisms. This review aims to introduce the importance of studying DOHaD, discuss classical programming studies, and address the importance of studying new emerging programming mechanisms, known as actual lifestyle factors, during pregnancy and lactation.
Collapse
|
3
|
Gumusoglu SB, Schickling BM, Vignato JA, Santillan DA, Santillan MK. Selective serotonin reuptake inhibitors and preeclampsia: A quality assessment and meta-analysis. Pregnancy Hypertens 2022; 30:36-43. [PMID: 35963154 PMCID: PMC9712168 DOI: 10.1016/j.preghy.2022.08.001] [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: 05/25/2022] [Revised: 07/27/2022] [Accepted: 08/02/2022] [Indexed: 10/15/2022]
Abstract
Serotonin modulates vascular, immune, and neurophysiology and is dysregulated in preeclampsia. Despite biological plausibility that selective serotonin reuptake inhibitors (SSRIs) prevent preeclampsia pathophysiology, observational studies have indicated increased risk and providers may be hesitant. The objective of this meta-analysis and quality assessment was to evaluate the evidence linking SSRI use in pregnancy to preeclampsia/gestational hypertension. PubMed was searched through June 5, 2020 manually and using combinations of terms: "preeclampsia", "serotonin", and "SSRI". This review followed MOOSE guidelines. Inclusion criteria were: 1) Observational cohort or population study, 2) exposure defined as SSRI use during pregnancy, 3) cases defined as preeclampsia or gestational hypertension, and 4) human participants. Studies were selected that addressed the hypothesis that gestational SSRI use modulates preeclampsia and/or gestational hypertension risk. Review Manager Web was used to synthesize study findings. Articles were read and scored (Newcastle-Ottawa Quality Assessment Scale) for quality by two independent reviewers. Publication bias was assessed using a funnel plot and the Egger test. Of 179 screened studies, nine were included. The pooled risk ratio (random effects model) was 1.43 (95 % CI: 1.15-1.78, P < 0.001; range 0.96-4.86). Two studies were rated as moderate quality (both with total score of 6); others were high quality. Heterogeneity was high (I2 = 88 %) and funnel asymmetry was significant (p < 0.00001). Despite evidence for increased preeclampsia risk with SSRIs, shared risk factors and other variables are poorly controlled. Depression treatment should not be withheld due to perceived gestational hypertension risk. Mechanistic evidence for serotonin modulation in preeclampsia demonstrates a need for future research.
Collapse
Affiliation(s)
- Serena B Gumusoglu
- University of Iowa Department of Obstetrics and Gynecology and University of Iowa Department of Psychiatry, 200 Hawkins Dr., Iowa City, IA 52242, United States.
| | - Brandon M Schickling
- University of Iowa Department of Obstetrics and Gynecology, 200 Hawkins Dr., Iowa City, IA 52242, United States.
| | - Julie A Vignato
- University of Iowa College of Nursing, 50 Newton Rd, Iowa City IA 52242, United States.
| | - Donna A Santillan
- University of Iowa Department of Obstetrics and Gynecology, 200 Hawkins Dr., Iowa City IA 52242, United States.
| | - Mark K Santillan
- University of Iowa Department of Obstetrics and Gynecology, 200 Hawkins Dr., Iowa City IA 52242, United States.
| |
Collapse
|
4
|
Pop VJM, Boekhorst MGBM, Deneer R, Oei G, Endendijk JJ, Kop WJ. Psychological Distress During Pregnancy and the Development of Pregnancy-Induced Hypertension: A Prospective Study. Psychosom Med 2022; 84:446-456. [PMID: 35067651 DOI: 10.1097/psy.0000000000001050] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Pregnancy-induced hypertension (PIH) is associated with serious complications in both the mother and the unborn child. We examined the possible association between trajectories of maternal psychological distress symptoms and PIH separately in primiparous and multiparous women. METHODS Pregnancy-specific negative affect (P-NA) and depressive symptoms were assessed prospectively at each trimester using the Tilburg Pregnancy Distress Scale pregnancy negative affect subscale (P-NA) and the Edinburgh Depression Scale (EDS). Data on PIH were collected from medical records. Growth mixture modeling analysis was used to identify trajectories of P-NA and EDS. The independent role of P-NA and EDS symptom trajectories on developing PIH was examined using multivariate logistic regression models. RESULTS One hundred (7.6%) women developed PIH and were compared with 1219 women without hypertension or other complications during pregnancy. Three P-NA trajectories were identified: low stable (reference group; 90%), decreasing (5.2%), and increasing (4.8%). The latter two classes showed persistently and significantly higher P-NA symptoms during pregnancy compared with the reference group. In multiparous women, high P-NA scores (belonging to classes 2 and 3) were related to PIH (odds ratio [OR] = 6.91, 95% confidence interval [CI] = 2.26-21.2), independent of body mass index (OR = 1.17, 95% CI = 1.06-1.27) and previous PIH (OR = 14.82, 95% CI = 6.01-32.7). No associations between P-NA and PIH were found in primiparous women. EDS trajectories were not related to PIH in both primiparous and multiparous women. CONCLUSIONS In multiparous women, persistently high levels of P-NA symptoms but not depressive symptoms were independently associated with development of PIH.
Collapse
Affiliation(s)
- Victor J M Pop
- From the Department of Medical and Clinical Psychology (Pop, Boekhorst, Deneer, Kop), Tilburg University, Tilburg; Department of Obstetrics and Gynecology (Oei), Máxima Medical Centre Veldhoven, Veldhoven; and Child and Adolescent Studies (Endendijk), Utrecht University, Utrecht, the Netherlands
| | | | | | | | | | | |
Collapse
|
5
|
Aminuddin NA, Sutan R, Mahdy ZA, Rahman RA, Nasuruddin DN. The feasibility of soluble Fms-Like Tyrosine kinase-1 (sFLT-1) and Placental Growth Factor (PlGF) ratio biomarker in predicting preeclampsia and adverse pregnancy outcomes among medium to high risk mothers in Kuala Lumpur, Malaysia. PLoS One 2022; 17:e0265080. [PMID: 35275947 PMCID: PMC8916650 DOI: 10.1371/journal.pone.0265080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 02/23/2022] [Indexed: 11/18/2022] Open
Abstract
Background Preeclampsia significantly contributes to maternal and perinatal morbidity and mortality. It is imperative to identify women at risk of developing preeclampsia in the effort to prevent adverse pregnancy outcomes through early intervention. Soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) level changes are noticeable several weeks before the onset of preeclampsia and its related complications. This study evaluated the feasibility of the sFlt-1/PlGF biomarker ratio in predicting preeclampsia and adverse pregnancy outcomes using a single cut-off point of >38. Methods This is a prospective cohort study conducted at a single tertiary centre, in an urban setting in Kuala Lumpur, Malaysia, between December 2019 and April 2021. A total of 140 medium to high risk mothers with singleton pregnancies were recruited at ≥20 weeks’ gestation. sFlt-1/PlGF ratio was measured and the participant monitored according to a research algorithm until delivery. The primary outcome measure was incidence of preeclampsia and the secondary outcome measure was incidence of other adverse pregnancy outcomes. Results The overall incidence of preeclampsia was 20.7% (29/140). The mean sFlt-1/PlGF ratio was significantly higher in preeclampsia (73.58 ± 93.49) compared to no preeclampsia (13.41 ± 21.63) (p = 0.002). The risk of preeclampsia (adjusted OR 28.996; 95% CI 7.920–106.164; p<0.001) and low Apgar score (adjusted OR 17.387; 95% CI 3.069–98.517; p = 0.028) were significantly higher among women with sFlt-1/PlGF ratio >38 compared with sFLT-1/PlGF ratio ≤38. The area under the receiver-operator characteristic curve (AUC) for a combined approach (maternal clinical characteristics and biomarker) was 86.9% (p<0.001, 95% CI 78.7–95.0) compared with AUC biomarker alone, which was 74.8% (p<0.001, 95% CI 63.3–86.3) in predicting preeclampsia. The test sensitivity(SEN) was 58.6%, specificity (SPEC) 91%,positive predictive value (PPV) 63% and negative predictive value (NPV) 89.3% for prediction of preeclampsia. For predicting a low Apgar score at 5 minutes, the SEN was 84.6%, SPEC 87.4%, PPV 40.7%, and NPV 98.2%; low birth weight with SEN 52.6%,SPEC 86.0%, PPV 37.0%, NPV 92.0%; premature delivery with SEN 48.5%, SPEC 89.5%, PPV 59.3%, NPV 84.7% and NICU admission with SEN 50.0%, SPEC 85.8%, PPV 37.0% and NPV 91.2%. Conclusions It is feasible to use single cut-off point of >38 ratio of the biomarkers sFlt-1/PlGF in combination with other parameters (maternal clinical characteristics) in predicting preeclampsia and adverse pregnancy outcomes among medium to high risk mothers without restricting outcome measurement period to 1 and 4 weeks in a single urban tertiary centre in Kuala Lumpur, Malaysia.
Collapse
Affiliation(s)
- Nurul Afzan Aminuddin
- Community Health Department, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Rosnah Sutan
- Community Health Department, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- * E-mail:
| | - Zaleha Abdullah Mahdy
- Obstetrics and Gynaecology Department, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Rahana Abd Rahman
- Obstetrics and Gynaecology Department, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Dian Nasriana Nasuruddin
- Pathology Department, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| |
Collapse
|
6
|
Caplan M, Keenan-Devlin LS, Freedman A, Grobman W, Wadhwa PD, Buss C, Miller GE, Borders AEB. Lifetime Psychosocial Stress Exposure Associated with Hypertensive Disorders of Pregnancy. Am J Perinatol 2021; 38:1412-1419. [PMID: 32615616 DOI: 10.1055/s-0040-1713368] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Hypertensive disorders of pregnancy (HDP) complicate 5 to 10% of all pregnancies and are a major cause of pregnancy-related morbidity. Exposure to psychosocial stress has been associated with systemic inflammation and adverse birth outcomes in pregnant women. Thus, it is probable that psychosocial stress and inflammation play a role in the development of HDP. The primary objective of this analysis was to determine if a woman's lifetime psychosocial stress exposure was associated with an increased risk of HDP. Additionally, we examined whether serum inflammation was an underlying biological mediator for this relationship. STUDY DESIGN A multisite prospective study was conducted in a sociodemographically diverse cohort of 647 pregnant women. At a study visit between 12 and 206/7 weeks' gestation, maternal psychosocial stress was assessed with six validated assessments and inflammation was measured via log-transformed serum concentrations of interferon-γ, interleukin (IL)-10, IL-13, IL-6, IL-8, and tumor necrosis factor-α. A composite stress score was calculated for each participant from the six stress assessments. The diagnosis of HDP was abstracted from the medical record and was defined as the presence of gestational hypertension after 20 weeks of pregnancy and/or preeclampsia. The association between composite stress and HDP was determined using binary logistic regression. Inflammation, using the six inflammatory biomarkers, was tested as a potential mediator between stress and HDP. RESULTS Participants with higher composite stress scores were more likely to develop HDP (odds ratio [OR]: 1.50, 95% confidence interval [CI]: 1.06-2.12). When adjusted for known risk modifiers, including maternal age, race/ethnicity, parity, pre-pregnancy body mass index, diabetes, chronic hypertension, and smoking during pregnancy, the risk remained unchanged (OR: 1.50, 95% CI: 1.03-2.20). No mediation effect by inflammation was observed. CONCLUSION Independent of known risk factors, women exposed to greater composite stress burden across the life course are at increased risk of developing HDP. KEY POINTS · This study was conducted to determine if women with high levels of psychosocial stress have differences in risk for hypertensive disorders of pregnancy (HDP).. · Independent of known risk factors, women with increased lifetime psychosocial burden are at higher risk for HDP.. · A model that captures multiple domains of life stress may better predict HDP than a unimodal stress assessment..
Collapse
Affiliation(s)
- Madeleine Caplan
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, School of Medicine, Duke University, Durham, North Carolina
| | - Lauren S Keenan-Devlin
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Evanston, Illinois
| | - Alexa Freedman
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Institute for Policy Research, Northwestern University, University of Chicago Pritzker School of Medicine, Evanston, Illinois
| | - William Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Pathik D Wadhwa
- Department of Psychiatry and Human Behavior, University of California, School of Medicine, UC Irvine Development, Health and Disease Research Program, Irvine, California
| | - Claudia Buss
- UC Irvine Development, Health and Disease Research Program, University of California Irvine, Irvine, California.,Department of Medical Psychology, Charité, University Medicine Berlin, Berlin, Germany
| | - Gregory E Miller
- Department of Psychology, Institute for Policy Research, Northwestern University, Evanston, Illinois
| | - Ann E B Borders
- Department of Obstetrics and Gynecology, NorthShore University Health System, Center for Healthcare Studies, Institute for Public Health and Medicine, University of Chicago Pritzker School of Medicine, Northwestern University, Evanston, Illinois
| |
Collapse
|
7
|
Spadarella E, Leso V, Fontana L, Giordano A, Iavicoli I. Occupational Risk Factors and Hypertensive Disorders in Pregnancy: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168277. [PMID: 34444025 PMCID: PMC8392340 DOI: 10.3390/ijerph18168277] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/29/2021] [Accepted: 07/31/2021] [Indexed: 12/28/2022]
Abstract
Hypertensive disorders in pregnancy (HDP), including gestational hypertension (GH) and preeclampsia (PE), characterize a major cause of maternal and prenatal morbidity and mortality. In this systematic review, we tested the hypothesis that occupational factors would impact the risk for HDP in pregnant workers. MEDLINE, Scopus, and Web of Knowledge databases were searched for studies published between database inception and 1 April 2021. All observational studies enrolling > 10 pregnant workers and published in English were included. Un-experimental, non-occupational human studies were excluded. Evidence was synthesized according to the risk for HDP development in employed women, eventually exposed to chemical, physical, biological and organizational risk factors. The evidence quality was assessed through the Newcastle–Ottawa scale. Out of 745 records identified, 27 were eligible. No definite conclusions could be extrapolated for the majority of the examined risk factors, while more homogenous data supported positive associations between job-strain and HDP risk. Limitations due to the lack of suitable characterizations of workplace exposure (i.e., doses, length, co-exposures) and possible interplay with personal issues should be deeply addressed. This may be helpful to better assess occupational risks for pregnant women and plan adequate measures of control to protect their health and that of their children.
Collapse
|
8
|
Lewandowska M. The Association of Familial Hypertension and Risk of Gestational Hypertension and Preeclampsia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137045. [PMID: 34280982 PMCID: PMC8296897 DOI: 10.3390/ijerph18137045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 12/22/2022]
Abstract
It has not been established how history of hypertension in the father or mother of pregnant women, combined with obesity or smoking, affects the risk of main forms of pregnancy-induced hypertension. A cohort of 912 pregnant women, recruited in the first trimester, was assessed; 113 (12.4%) women developed gestational hypertension (GH), 24 (2.6%) developed preeclampsia (PE) and 775 women remained normotensive (a control group). Multiple logistic regression was used to calculate adjusted odds ratios (AOR) (and 95% confidence intervals) of GH and PE for chronic hypertension in the father or mother of pregnant women. Some differences were discovered. (1) Paternal hypertension (vs. absence of hypertension in the family) was an independent risk factor for GH (AOR-a = 1.98 (1.2–3.28), p = 0.008). This odds ratio increased in pregnant women who smoked in the first trimester (AOR-a = 4.71 (1.01–21.96); p = 0.048) or smoked before pregnancy (AOR-a = 3.15 (1.16–8.54); p = 0.024), or had pre-pregnancy overweight (AOR-a = 2.67 (1.02–7.02); p = 0.046). (2) Maternal hypertension (vs. absence of hypertension in the family) was an independent risk factor for preeclampsia (PE) (AOR-a = 3.26 (1.3–8.16); p = 0.012). This odds ratio increased in the obese women (AOR-a = 6.51 (1.05–40.25); p = 0.044) and (paradoxically) in women who had never smoked (AOR-a = 5.31 (1.91–14.8); p = 0.001). Conclusions: Chronic hypertension in the father or mother affected the risk of preeclampsia and gestational hypertension in different ways. Modifiable factors (overweight/obesity and smoking) may exacerbate the relationships in question, however, paradoxically, beneficial effects of smoking for preeclampsia risk are also possible. Importantly, paternal and maternal hypertension were not independent risk factors for GH/PE in a subgroup of women with normal body mass index (BMI).
Collapse
Affiliation(s)
- Małgorzata Lewandowska
- Medical Faculty, Lazarski University, 02-662 Warsaw, Poland;
- Division of Gynecological Surgery, University Hospital, 60-535 Poznan, Poland
| |
Collapse
|
9
|
Kay VR, Wedel N, Smith GN. Family History of Hypertension, Cardiovascular Disease, or Diabetes and Risk of Developing Preeclampsia: A Systematic Review. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 43:227-236.e19. [PMID: 33268309 DOI: 10.1016/j.jogc.2020.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 12/27/2022]
Abstract
Preeclampsia is a severe pregnancy complication with high potential for adverse effects on maternal and fetal health during the perinatal period. It is also associated with an increased risk of maternal cardiovascular disease later in life. Development of preeclampsia can be decreased by prescribing low-dose aspirin to high-risk women. At present, maternal and pregnancy factors are used to assess the risk of preeclampsia. One additional factor that could add to the assessment of risk is a family history of hypertension, cardiovascular disease, or diabetes, especially for nulliparous women who do not have a pregnancy history to inform treatment decisions. Therefore, we conducted a systematic review to assess the association between family history of the aforementioned conditions and preeclampsia. Four databases including MEDLINE, EMBASE, the Cochrane Library, and CINAHL/pre-CINAHL were searched for observational studies that examined a family history of hypertension, cardiovascular disease, or diabetes in women with preeclampsia and in a control population. Studies were evaluated for quality using the Newcastle-Ottawa Scale. A total of 84 relevant studies were identified. A meta-analysis was not conducted due to suspected heterogeneity in the included studies. Most studies reported a positive association between a family history of hypertension or cardiovascular disease and the development of preeclampsia. The majority of studies examining family history of diabetes reported non-significant associations. Overall, family history of hypertension or cardiovascular disease is associated with a higher risk for developing preeclampsia and should be considered when assessing women in the first trimester for low-dose aspirin.
Collapse
Affiliation(s)
- Vanessa R Kay
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON.
| | - Naomi Wedel
- Department of Obstetrics and Gynecology, Queen's University, Kingston, ON
| | - Graeme N Smith
- Department of Obstetrics and Gynecology, Queen's University, Kingston, ON
| |
Collapse
|
10
|
Liu H, Huang W, Chen L, Xu Q, Ye D, Zhang D. Glucocorticoid Exposure Induces Preeclampsia via DampeningLipoxin A 4, an Endogenous Anti-Inflammatory and Proresolving Mediator. Front Pharmacol 2020; 11:1131. [PMID: 32848749 PMCID: PMC7399346 DOI: 10.3389/fphar.2020.01131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/13/2020] [Indexed: 12/19/2022] Open
Abstract
The pathogenesis of preeclampsia (PE) involves several pathophysiological processes that may be affected by glucocorticoid (GC). We confirmed previously that GC exposure could result in PE, while PE is linked to a deficiency of lipoxin A4 (LXA4), an endogenous dual anti-inflammatory and proresolving mediator. The present study was to investigate whether GC exposure induces PE via dampening LXA4. In the study, cortisol levels of PE women were higher than those of normal pregnancies, LXA4 levels were downregulated in both PE patients and GC-mediated PE rats, and leukotriene B4 (LTB4) levels were upregulated in both PE patients and GC- mediated PE rats. Moreover, cortisol levels were negatively correlated to LXA4 levels, while positively correlated to LTB4 levels in PE patients. Mechanically, GC downregulated LXA4 via disturbing its biosynthetic enzymes, including ALOX15, ALOX5B and ALOX5, especially activating ALOX5, the key enzyme for class switching between LXA4 and LTB4. Importantly, replenishing LXA4 could ameliorate PE-related symptoms and placental oxidative stress in PE rat model induced by GC. Moreover, LXA4 could inhibit GC-mediated ALOX5 activation and LTB4 increase, and also suppress 11β-HSD2 expression and corticosterone upregulation. The protective actions of LXA4 might be explained by its roles in antagonizing the adverse effects of GC on trophoblast development. Together, our findings indicate that GC exposure could contribute to PE through dampening LXA4, and GC/LXA4 axis may represent a common pathway through which PE occurs.
Collapse
Affiliation(s)
- Haojing Liu
- Department of Science and Education, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Huang
- Department of Clinical Laboratory, Wuhan First Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liping Chen
- Department of Gynecology and Obstetrics, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiang Xu
- Department of Pathophysiology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Duyun Ye
- Department of Pathophysiology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dongxin Zhang
- Department of Clinical Laboratory, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
11
|
Abstract
Pre-eclampsia is a common disorder that particularly affects first pregnancies. The clinical presentation is highly variable but hypertension and proteinuria are usually seen. These systemic signs arise from soluble factors released from the placenta as a result of a response to stress of syncytiotrophoblast. There are two sub-types: early and late onset pre-eclampsia, with others almost certainly yet to be identified. Early onset pre-eclampsia arises owing to defective placentation, whilst late onset pre-eclampsia may center around interactions between normal senescence of the placenta and a maternal genetic predisposition to cardiovascular and metabolic disease. The causes, placental and maternal, vary among individuals. Recent research has focused on placental-uterine interactions in early pregnancy. The aim now is to translate these findings into new ways to predict, prevent, and treat pre-eclampsia.
Collapse
Affiliation(s)
- Graham J Burton
- Department of Physiology, Development & Neuroscience, University of Cambridge, UK
- Centre for Trophoblast Research, University of Cambridge, UK
| | | | - James M Roberts
- Magee-Womens Research Institute, Depts. Obstetric Gynecology and Reproductive Sciences, Epidemiology, and Clinical and Translational Research, University of Pittsburgh, USA
| | - Ashley Moffett
- Centre for Trophoblast Research, University of Cambridge, UK
- Dept of Pathology, University of Cambridge, UK
| |
Collapse
|
12
|
Williams AD, Wallace M, Nobles C, Mendola P. Racial residential segregation and racial disparities in stillbirth in the United States. Health Place 2018; 51:208-216. [PMID: 29715639 DOI: 10.1016/j.healthplace.2018.04.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/18/2018] [Accepted: 04/23/2018] [Indexed: 12/19/2022]
Abstract
We examined whether current and/or persistent racial residential segregation is associated with black-white stillbirth disparities among 49,969 black and 71,785 white births from the Consortium on Safe Labor (2002-2008). Black-white segregation was measured using the dissimilarity index and the isolation index, categorized into population-based tertiles. Using hierarchical logistic models, we found low and decreasing levels of segregation were associated with decreased odds of stillbirth, with blacks benefitting more than whites. Decreasing segregation may prevent approximately 900 stillbirths annually among U.S. blacks. Reducing structural racism, segregation in particular, could help reduce black-white stillbirth disparities.
Collapse
Affiliation(s)
- Andrew D Williams
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge, Bethesda, MD 20892, USA
| | - Maeve Wallace
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2210, New Orleans, LA 70117, USA
| | - Carrie Nobles
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge, Bethesda, MD 20892, USA
| | - Pauline Mendola
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge, Bethesda, MD 20892, USA.
| |
Collapse
|
13
|
Glucocorticoid exposure induces preeclampsia via dampening 1,25-dihydroxyvitamin D 3. Hypertens Res 2017; 41:104-111. [PMID: 29093562 DOI: 10.1038/hr.2017.98] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 04/03/2017] [Accepted: 05/05/2017] [Indexed: 11/08/2022]
Abstract
The pathogenesis of preeclampsia (PE) involves a number of biological processes that may be directly or indirectly affected by glucocorticoid (GC) and vitamin D. GC exposure increases the risk of PE, and 1,25-dihydroxyvitamin D3 (1,25-(OH)2D3) deficiency may result in PE. The purpose of the present study was to confirm the involvement of GC/1,25-(OH)2D3 axis in the pathogenesis of PE. In the study, cortisol levels of PE patients were found to be higher than that of non-complicated pregnancies, while 1,25-(OH)2D3 were decreased in both PE women and GC-induced PE rats. Mechanically, GC reduced 1,25-(OH)2D3 levels via disturbing its biosynthetic and catabolic enzymes, including Cyp3a1,Cyp24a1 and Cyp27b1, especially enhancing the expressions of Cyp3a1, the dominant enzyme for vitamin D degeneration. Moreover, replenishing 1,25-(OH)2D3 ameliorated the symptoms and placental oxidative stress of GC-induced rat PE. The protective actions of 1,25-(OH)2D3 might be explained by its roles in antagonizing the effects of GC on trophoblast proliferation and apoptosis. Together, these findings suggest that GC exposure could lead to PE via dampening 1,25-(OH)2D3 biosynthesis, and GC/1,25-(OH)2D3 axis might represent a common pathway through which PE occurs.
Collapse
|
14
|
Physical Activity During Pregnancy and Subsequent Risk of Preeclampsia and Gestational Hypertension: A Case Control Study. Matern Child Health J 2017; 20:1193-202. [PMID: 26910608 DOI: 10.1007/s10995-016-1919-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Physical activity (PA) is hypothesized to reduce the risk of preeclampsia, but few epidemiologic studies have simultaneously evaluated leisure time PA (LTPA), sedentary activity, occupational activity, and non-occupational, non-leisure time PA. Thus, we assessed the independent and combined effects of these different types of PA during pregnancy on preeclampsia and gestational hypertension risk. METHODS Preeclamptic (n = 258), gestational hypertensive (n = 233), and normotensive (n = 182) women identified from Iowa live birth records (2002-2005) were participants in Study of Pregnancy Hypertension in Iowa. Disease status was verified by medical chart review. All PA exposures were self-reported. Multinomial logistic regression was used to test for associations between various PA types and risk for preeclampsia or gestational hypertension. RESULTS After adjusting for prepregnancy BMI, increasing levels of LTPA were associated with a reduced risk of preeclampsia (trend, p = 0.02). Additionally, increasing amount of time spent active each day was associated with decreasing risks for preeclampsia (adjusted, trend; p = 0.03). Increasing amount of time spent sitting per day was associated with an increasing risk of preeclampsia (adjusted, trend; p = 0.10). Women whose activity averaged >8.25 h per day were at a significantly reduced risk of preeclampsia relative to women active <4.2 h per day (adjusted OR 0.58, 95 % CI 0.36, 0.95). Most analyses evaluating the risk of gestational hypertension yielded null results or results that trended in the direction opposite of the preeclampsia results. CONCLUSION Consistent with previous studies, these data suggest increasing PA during pregnancy may reduce preeclampsia risk while increasing levels of sedentary activity may increase disease risk.
Collapse
|
15
|
Paiva SPC, Veloso CA, Campos FFC, Carneiro MM, Tilan JU, Wang H, Umans JG, Zukowska Z, Kitlinska J. Elevated levels of neuropeptide Y in preeclampsia: A pilot study implicating a role for stress in pathogenesis of the disease. Neuropeptides 2016; 55:127-35. [PMID: 26431933 PMCID: PMC4755897 DOI: 10.1016/j.npep.2015.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 09/20/2015] [Accepted: 09/20/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine if preeclampsia (PE) is associated with dysregulation of the neuropeptide Y (NPY) system. METHODS The study enrolled 114 subjects either with normal pregnancy (NP) or with PE. Systolic blood pressure (SBP) was collected from patients using a standard sphygmomanometer. The PE patients were divided into two groups based on the gestational age (GA) at delivery - placental PE (PLPE, GA <34 weeks) or maternal PE (MTPE, GA ≥34 weeks). NPY was measured in platelet rich plasma (PRP), platelet poor plasma (PPP) and in the serum of NP and PE patients utilizing radioimmunoassay. Serum levels of soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) were measured in NP and PE subjects by ELISA. RESULTS SBP was higher in PE compared to NP. Circulating NPY in serum and PRP, as well as NPY content per 100,000 platelets, but not its concentrations in PPP, were elevated in PE, as compared to NP. The highest NPY concentrations were observed in sera and PRP of patients with MTPE. PE patients had also elevated levels of sFlt-1, as compared to NP, although no difference between PLPE and MTPL groups were observed. There was no increase in P1GF in PE patients. CONCLUSION Systemic NPY is elevated in PE patients, as compared to NP. This increase is observed in blood fractions containing platelets, suggesting accumulation of the peptide in these cells. NPY concentrations are particularly high in patients with MTPE, underlying differences in etiology between PLPE and MTPE. Our study implicates NPY as a potential target in antihypertensive therapies for PE patients.
Collapse
Affiliation(s)
- Sara P C Paiva
- Department of Physiology & Biophysics, Georgetown University Medical Center, Washington, DC, USA; Instituto de Ciências Biológicas e da Saúde, Centro Universitário de Belo Horizonte UNIBH, Belo Horizonte MG, Brazil; Hospital das Clínicas, Universidade Federal de Minas Gerais UFMG, Belo Horizonte Brazil
| | - Clara A Veloso
- Instituto de Ciências Biológicas e da Saúde, Centro Universitário de Belo Horizonte UNIBH, Belo Horizonte MG, Brazil
| | - Fernanda F C Campos
- Instituto de Ciências Biológicas e da Saúde, Centro Universitário de Belo Horizonte UNIBH, Belo Horizonte MG, Brazil
| | - Márcia M Carneiro
- Hospital das Clínicas, Universidade Federal de Minas Gerais UFMG, Belo Horizonte Brazil
| | - Jason U Tilan
- Department of Nursing, School of Nursing and Health Studies, Georgetown University, Washington, DC 20057, USA; Department of Human Science, School of Nursing and Health Studies, Georgetown University, Washington, DC 20057, USA
| | - Hongkun Wang
- Department of Biostatistics and Bioinformatics, Georgetown University Medical Center, Washington, DC, USA
| | - Jason G Umans
- Department of Obstetrics and Gynecology, Georgetown University Medical Center, Washington, DC, USA; Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Zofia Zukowska
- Department of Physiology & Biophysics, Georgetown University Medical Center, Washington, DC, USA
| | - Joanna Kitlinska
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University Medical Center, Washington, DC, USA.
| |
Collapse
|
16
|
Li X, Tan H, Huang X, Zhou S, Hu S, Wang X, Xu X, Liu Q, Wen SW. Similarities and differences between the risk factors for gestational hypertension and preeclampsia: A population based cohort study in south China. Pregnancy Hypertens 2015; 6:66-71. [PMID: 26955775 DOI: 10.1016/j.preghy.2015.11.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 11/12/2015] [Accepted: 11/25/2015] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To compare the risk factors for gestational hypertension (GH) and preeclampsia (PE) in the same population, which may provide clues to better understanding of their etiologic mechanisms. METHODS We conducted a cohort study in Liuyang, China, during 2010-2011. Twelve potential risk factors were investigated, including maternal age, body mass index at first antenatal visit, gender of newborn, parity, abortion history, smoking history, family history of hypertension, gestational diabetes mellitus, pregnancy complications of diabetes mellitus/renal disease/cardiac disease, reproductive tract infection, season of delivery, and district level average per capita income. Logistic regression were used to estimate odds ratios for potential risk factors. RESULTS Of 6223 pregnancies, 1.8% was complicated by PE, and 5.4% by GH. Maternal age older than 35, body mass index above 24, and pregnancy complicated with gestational diabetes mellitus increased the risk of both PE and GH, while with different effect sizes. Primiparity and deliver in winter and spring (compared with summer delivery) were risk factors for GH only. Pregnancy complicated with diabetes mellitus/renal disease/cardiac disease was risk factor for PE only. Significantly lower risk of GH was observed for women younger than 25 or with low body mass index in the first trimester. Mothers carrying a male fetus were more likely to develop PE. CONCLUSIONS Risk factors for GH and PE were not exactly the same. Underling those differences might be their different etiology and mechanism. To confirm the similarities and differences been found in single study, it is important to conduct investigation in other population.
Collapse
Affiliation(s)
- Xun Li
- School of Public Health, Central South University, 90 Xiangya Road, Changsha, Hunan, China.
| | - Hongzhuan Tan
- School of Public Health, Central South University, 90 Xiangya Road, Changsha, Hunan, China.
| | - Xin Huang
- School of Public Health, Central South University, 90 Xiangya Road, Changsha, Hunan, China.
| | - Shujin Zhou
- Liuyang Municipal Hospital of Maternal and Child Health, 53 Beizheng North Road, Liuyang, Hunan, China.
| | - Shimin Hu
- School of Public Health, Central South University, 90 Xiangya Road, Changsha, Hunan, China.
| | - Xiaojuan Wang
- School of Public Health, Central South University, 90 Xiangya Road, Changsha, Hunan, China.
| | - Xin Xu
- School of Public Health, Central South University, 90 Xiangya Road, Changsha, Hunan, China.
| | - Qian Liu
- School of Public Health, Central South University, 90 Xiangya Road, Changsha, Hunan, China; Criminal Investigation Division, Changsha Public Security Bureau, Hunan, China.
| | - Shi Wu Wen
- OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa, 501 Smyth Road, Box 241, Ottawa, Ontario K1H 8L6, Canada.
| |
Collapse
|
17
|
Eiríksdóttir VH, Valdimarsdóttir UA, Ásgeirsdóttir TL, Hauksdóttir A, Lund SH, Bjarnadóttir RI, Cnattingius S, Zoëga H. Pregnancy-Induced Hypertensive Disorders before and after a National Economic Collapse: A Population Based Cohort Study. PLoS One 2015; 10:e0138534. [PMID: 26379126 PMCID: PMC4575018 DOI: 10.1371/journal.pone.0138534] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 09/01/2015] [Indexed: 12/11/2022] Open
Abstract
Background Data on the potential influence of macroeconomic recessions on maternal diseases during pregnancy are scarce. We aimed to assess potential change in prevalence of pregnancy-induced hypertensive disorders (preeclampsia and gestational hypertension) during the first years of the major national economic recession in Iceland, which started abruptly in October 2008. Methods and Findings Women whose pregnancies resulted in live singleton births in Iceland in 2005–2012 constituted the study population (N = 35,211). Data on pregnancy-induced hypertensive disorders were obtained from the Icelandic Medical Birth Register and use of antihypertensive drugs during pregnancy, including β-blockers and calcium channel blockers, from the Icelandic Medicines Register. With the pre-collapse period as reference, we used logistic regression analysis to assess change in pregnancy-induced hypertensive disorders and use of antihypertensives during the first four years after the economic collapse, adjusting for demographic and pregnancy characteristics, taking aggregate economic indicators into account. Compared with the pre-collapse period, we observed an increased prevalence of gestational hypertension in the first year following the economic collapse (2.4% vs. 3.9%; adjusted odds ratio [aOR] 1.47; 95 percent confidence interval [95%CI] 1.13–1.91) but not in the subsequent years. The association disappeared completely when we adjusted for aggregate unemployment rate (aOR 1.04; 95% CI 0.74–1.47). Similarly, there was an increase in prescription fills of β-blockers in the first year following the collapse (1.9% vs.3.1%; aOR 1.43; 95% CI 1.07–1.90), which disappeared after adjusting for aggregate unemployment rate (aOR 1.05; 95% CI 0.72–1.54). No changes were observed for preeclampsia or use of calcium channel blockers between the pre- and post-collapse periods. Conclusions Our data suggest a transient increased risk of gestational hypertension and use of β-blockers among pregnant women in Iceland in the first and most severe year of the national economic recession.
Collapse
Affiliation(s)
- Védís Helga Eiríksdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- * E-mail:
| | - Unnur Anna Valdimarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | | | - Arna Hauksdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Sigrún Helga Lund
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | | | - Sven Cnattingius
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Helga Zoëga
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| |
Collapse
|
18
|
Oni O, Harville E, Xiong X, Buekens P. Relationships among stress coping styles and pregnancy complications among women exposed to Hurricane Katrina. J Obstet Gynecol Neonatal Nurs 2015; 44:256-67. [PMID: 25712783 DOI: 10.1111/1552-6909.12560] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine the relationship between maternal stress exposure, stress coping styles, and pregnancy complications. DESIGN Quantitative, cross-sectional, and prospective study. SETTING Tulane-Lakeside Hospital, New Orleans, LA and Women's Hospital, Baton Rouge, LA. PARTICIPANTS The study included 146 women (122 from New Orleans and 24 from Baton Rouge), who were pregnant during or immediately after Hurricane Katrina. METHODS Participants were interviewed regarding their hurricane experiences and perceived stress, and coping styles were assessed using the Brief COPE. Medical charts were also reviewed to obtain information about pregnancy outcomes. Logistic regression was performed to determine possible associations. RESULTS Hurricane exposure was significantly associated with induction of labor (adjusted odds ratio [aOR] = 1.39; 95% confidence interval [CI] [1.03, 1.86], P = .03) and current perceived stress (aOR = 1.50, CI [1.34, 1.99], P < .01). Stress perception significantly predisposed to pregnancy-induced hypertension (aOR = 1.16, CI [1.05, 1.30], P < .01) and gestational diabetes (aOR = 1.13, CI [1.02, 1.25], P = .03). Use of planning, acceptance, humor, instrumental support, and venting coping styles were associated with a significantly reduced occurrence of pregnancy complications (P < .05). Higher rates for gestational diabetes was found among women using the denial coping style (aOR = 2.25, CI [1.14, 4.45], P = .02). CONCLUSION Exposure to disaster-related stress may complicate pregnancy, whereas some coping styles may mitigate its effects. Further research should explore how coping styles may mitigate or exacerbate the effect of major stressors and how positive coping styles can be encouraged or augmented.
Collapse
|
19
|
Clements AD, Fletcher TR, Cyphers NA, Ermakova AV, Bailey B. RSAS-3: validation of a very brief measure of Religious Commitment for use in health research. JOURNAL OF RELIGION AND HEALTH 2015; 54:134-152. [PMID: 24186557 DOI: 10.1007/s10943-013-9791-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Religious Commitment is a construct known to be predictive of various health-related factors of importance to researchers. However, data collection efficiency and instrument brevity in healthcare settings are priorities regardless of the construct being measured. Brief, valid instruments are particularly valuable in health research and will be vital for testing mechanisms by which health may be improved or maintained. This series of studies aims to demonstrate that Religious Commitment can be validly measured with a very brief instrument, the Religious Surrender & Attendance Scale-3 (RSAS-3), which combines a 2-item measure of Surrender, a specific type of religious coping, with a 1-item measure of Attendance at religious services. Three studies are reported, two utilizing undergraduate university students (Ns = 964 and 466) and one utilizing a clinical-based pregnant population (N = 320), all in southern Appalachia. The original 12-item Surrender Scale, a 2-item subset of Surrender items, and Attendance were found to be highly positively correlated with each other and with Intrinsic Religiosity, an additional measure of Religious Commitment employed to demonstrate concurrent validity. Religiosity variables were found to be strongly negatively correlated with Anxiety and stress, which were the health outcomes of interest. Hierarchical multiple regression analysis was used to confirm the similarity of Anxiety and stress prediction using the 12-item and 2-item Surrender measures and to confirm the superior stress prediction of the 3-item instrument RSAS-3. The RSAS-3 is recommended as a measure of Religious Commitment in future health research.
Collapse
Affiliation(s)
- Andrea D Clements
- Department of Psychology, East Tennessee State University, Box 70649, Johnson City, TN, 37614, USA,
| | | | | | | | | |
Collapse
|
20
|
Ghojazadeh M, Azami-Aghdash S, Mohammadi M, Vosoogh S, Mohammadi S, Naghavi-Behzad M. Prognostic risk factors for early diagnosing of Preeclampsia in Nulliparas. Niger Med J 2014; 54:344-8. [PMID: 24403715 PMCID: PMC3883237 DOI: 10.4103/0300-1652.122368] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Preeclampsia is of major complications of pregnancy that is associated with maternal morbidity and mortality. Therefore, prediction and early diagnosis of preeclampsia would be helpful for better controlling of related complications. Our study aimed to investigate risk factors helping to predict and early diagnose of preeclampsia. Materials and Methods: A total of 739 nulliparous women at their 24-28th weeks of the first pregnancy were enrolled in this multi-center cohort study. Incidence or absence of preeclampsia in this population was evaluated up to the end of pregnancy period. For each case, a record sheet was assigned that contained information about haematocrit level in weeks 24-28th of pregnancy, blood pressure, result of roll-over test in weeks 24-28th of pregnancy and the presence of disease up to end of the study. Diagnosis of preeclampsia was made based on gold standard. Results: Overall, 3.9 % of all cases developed preeclampsia. The mean maternal age, body mass index (BMI), years of education and positive roll-over test were significantly higher in preeclampsia group (P < 0.001). However, the mean gestational age and changes in the levels of haematocrit were significantly higher in normotensive cases (P < 0.001). Our combined model could predict preeclampsia with a sensitivity of 93% and a specificity of 80%. Conclusion: Simple combined model of demographic characteristics including maternal age, BMI, years of education and positive roll-over tests can predict preeclampsia without any cost for the patients.
Collapse
Affiliation(s)
- Morteza Ghojazadeh
- Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saber Azami-Aghdash
- Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Marziye Mohammadi
- Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shohre Vosoogh
- Department of Obstetrics and Gynecology, Golsetan University of Medical Sciences, Gorgan, Golestan, Iran
| | - Sahar Mohammadi
- Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Naghavi-Behzad
- Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
21
|
Neurologie (2). MEDECINE INTENSIVE REANIMATION 2014. [DOI: 10.1007/s13546-013-0804-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
22
|
|
23
|
The combined association of psychosocial stress and chronic hypertension with preeclampsia. Am J Obstet Gynecol 2013; 209:438.e1-438.e12. [PMID: 23850528 DOI: 10.1016/j.ajog.2013.07.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 05/25/2013] [Accepted: 07/01/2013] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This study aims to evaluate perceived lifetime stress, perceived stress during pregnancy, chronic hypertension, and their joint association with preeclampsia risk. STUDY DESIGN This study includes 4314 women who delivered a singleton live birth at the Boston Medical Center from October 1998 through February 2008. Chronic hypertension was defined as hypertension diagnosed before pregnancy. Information regarding lifetime stress and perceived stress during pregnancy was collected by questionnaire. Preeclampsia was diagnosed by clinical criteria. RESULTS Lifetime stress (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.6-2.9), perceived stress during pregnancy (OR, 1.7; 95% CI, 1.3-2.2), and chronic hypertension (OR, 10.4; 95% CI, 7.5-14.4) were each associated with an increased risk of preeclampsia. Compared to normotensive pregnancy with low lifetime stress, both normotensive pregnancy with high lifetime stress (OR, 2.1; 95% CI, 1.6-2.9) and pregnancy with chronic hypertension and low lifetime stress (OR, 10.2; 95% CI, 7.0-14.9) showed an increased risk of preeclampsia, while pregnancy with high lifetime stress and chronic hypertension yielded the highest risk of preeclampsia (OR, 21.3; 95% CI, 10.2-44.3). The joint association of perceived stress during pregnancy and chronic hypertension with preeclampsia was very similar to that of the joint association of lifetime stress and chronic hypertension with preeclampsia. CONCLUSION This finding indicates that high psychosocial stress and chronic hypertension can act in combination to increase the risk of preeclampsia up to 20-fold. This finding underscores the importance of efforts to prevent, screen, and manage chronic hypertension, along with those to reduce psychosocial stress, particularly among women with chronic hypertension.
Collapse
|
24
|
László KD, Liu XQ, Svensson T, Wikström AK, Li J, Olsen J, Obel C, Vestergaard M, Cnattingius S. Psychosocial stress related to the loss of a close relative the year before or during pregnancy and risk of preeclampsia. Hypertension 2013; 62:183-9. [PMID: 23608651 DOI: 10.1161/hypertensionaha.111.00550] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The role of stress in the pathogenesis of preeclampsia has only been investigated in a few studies, and the findings are not conclusive. We analyzed whether maternal bereavement shortly before or during pregnancy is associated with an increased risk of preeclampsia. We conducted a cohort study of singleton births in Denmark during 1978-2008 and in Sweden during 1973-2006 (n=4 122 490) by linking national population-based registers. Mothers were considered exposed to bereavement if they lost a parent, a sibling, a partner, or a child the year before or during pregnancy (n=124 553). The risk of preeclampsia was slightly increased for women who lost a close relative during the 6 months before conception (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.06-1.23) or during the first trimester of pregnancy (OR, 1.15; 95% CI, 1.03-1.29). Exposure during these periods tended to be more closely related to early preeclampsia (delivery before 34 weeks of gestation; OR, 1.37; 95% CI, 1.12-1.67) than to late preeclampsia (OR, 1.13; 95% CI, 1.06-1.20). The strongest association was observed between loss of a child and early preeclampsia when the exposure window was from 6 months before pregnancy until start of second trimester (OR, 4.03; 95% CI, 2.46-6.61). Our results related to timing of exposure suggest that severe stress may influence early placentation. However, the public health implications of our findings are limited in populations with a low prevalence of severe stress exposures.
Collapse
Affiliation(s)
- Krisztina D László
- Department of Medicine, Clinical Epidemiology Unit, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden.
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
László KD, Svensson T, Li J, Obel C, Vestergaard M, Olsen J, Cnattingius S. Maternal bereavement during pregnancy and the risk of stillbirth: a nationwide cohort study in Sweden. Am J Epidemiol 2013; 177:219-27. [PMID: 23296350 DOI: 10.1093/aje/kws383] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Increasing evidence suggests that maternal stress during pregnancy may influence pregnancy outcomes. In a nationwide Swedish study including almost 3 million births taking place during 1973-2006, we investigated whether maternal bereavement during pregnancy is associated with stillbirth risk. Through individual record linkage between several population-based registers, we obtained information on demographic, health-related, and pregnancy-related factors and deaths of mothers' first-degree relatives. There were 11,071 stillbirths (3.8 per 1,000 births) in the cohort. After adjustment for potential confounders, infants of mothers who had lost any first-degree relative the year before or during pregnancy had an 18% higher risk of stillbirth than unexposed offspring (95% confidence interval (CI): 1.06, 1.31). Corresponding hazard ratios were 1.67 (95% CI: 1.18, 2.36) for maternal loss of an older child, 2.06 (95% CI: 1.44, 2.94) for loss of a sibling, and 1.07 (95% CI: 0.95, 1.21) for loss of a parent. The relationship between maternal bereavement and stillbirth did not vary by time of death or by whether the relative's death was expected or unexpected. Death of a close relative is one of the most severe sources of stress, and future studies need to investigate whether less severe but more common stressors also increase stillbirth risk.
Collapse
Affiliation(s)
- Krisztina D László
- Department of Medicine, Clinical Epidemiology Unit, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden.
| | | | | | | | | | | | | |
Collapse
|
26
|
Bilhartz TD, Bilhartz P. Occupation as a risk factor for hypertensive disorders of pregnancy. J Womens Health (Larchmt) 2013; 22:188a-i. [PMID: 23350860 DOI: 10.1089/jwh.2012.3975] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) are leading causes of morbidity and mortality and have been rising in incidence. Little is known about the effects of worker classifications on HDP. This large-scale study examines associations between occupational classifications and HDP. METHODS We examined 385,537 Texas Electronic Registrar Birth Registration 2005 birth certificates. Maternal occupations were coded using the Standard Occupational Classification (SOC). Crude and adjusted risks for HDP among working women within occupational groupings were analyzed and compared with risks of nonemployed women. RESULTS The risk of developing HDP varies across SOC occupational classifications. After controlling for known confounders, women employed in business, management, and the legal and social services, teaching, counseling, and healthcare professions are at higher risk for developing HDP than women employed in support industries, such as food preparation, housekeeping, cosmetic and personal care services, or nonemployed women. Women employed in computer, engineering, architectural, and scientific occupations also carry greater risks, although these increased risks do not affect women of normal weight. CONCLUSIONS Worker classification is an independent risk factor for HDP. Additional work must be done to examine the complex interactions among individual maternal genetics, biology, and physical and mental abilities and how they affect adverse health outcomes. Examining job stressors may shed light on these occupational variations and their potential HDP associations. Strategies to mitigate job stressors in the workplace should be considered.
Collapse
Affiliation(s)
- Terry D Bilhartz
- 1 College of Humanities and Social Sciences, Sam Houston State University , Huntsville, Texas
| | | |
Collapse
|
27
|
Mishra N, Nugent WH, Mahavadi S, Walsh SW. Mechanisms of enhanced vascular reactivity in preeclampsia. Hypertension 2011; 58:867-73. [PMID: 21947470 DOI: 10.1161/hypertensionaha.111.176602] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Preeclamptic women have enhanced blood pressure response to angiotensin II and extensive systemic vascular infiltration of neutrophils. Neutrophils release reactive oxygen species that might activate the RhoA kinase pathway to enhance vascular reactivity. We hypothesized that enhanced vascular reactivity in preeclampsia is attributed to neutrophil-mediated reactive oxygen species activation of the RhoA kinase pathway. Omental arteries were obtained at cesarean section and studied using a myograph system. We found that arteries of preeclamptic women had extensive infiltration of neutrophils and enhanced reactivity to angiotensin II. Treatment of arteries of normal pregnant women with reactive oxygen species or activated neutrophils enhanced vessel reactivity to angiotensin II mimicking preeclamptic vessels. Pretreatment with superoxide dismutase/catalase to quench reactive oxygen species or RhoA kinase inhibitor blocked enhanced responses in preeclamptic and normal vessels. Reactive oxygen species also enhanced vessel reactivity to norepinephrine, which was blocked by RhoA kinase inhibition. Treatment of arteries with reactive oxygen species increased RhoA kinase activity 3-fold, whereas culture of human vascular smooth muscle cells with angiotensin II and activated neutrophils or reactive oxygen species resulted in phosphorylation of key proteins in the RhoA kinase pathway. We conclude that enhanced vascular reactivity of omental arteries in preeclampsia is attributed to reactive oxygen species activation of the RhoA kinase pathway and that enhanced vascular reactivity is likely attributed to the infiltration of neutrophils. We speculate that neutrophil infiltration into systemic vasculature of preeclamptic women is an important mechanism for hypertension.
Collapse
Affiliation(s)
- Nikita Mishra
- Virginia Commonwealth University Medical Center, Department of Obstetrics and Gynecology, Richmond, VA 23298-0034, USA
| | | | | | | |
Collapse
|
28
|
Wadhwa PD, Entringer S, Buss C, Lu MC. The contribution of maternal stress to preterm birth: issues and considerations. Clin Perinatol 2011; 38:351-84. [PMID: 21890014 PMCID: PMC3179976 DOI: 10.1016/j.clp.2011.06.007] [Citation(s) in RCA: 285] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Preterm birth represents the most significant problem in maternal-child health, with maternal stress identified as a variable of interest. The effects of maternal stress on risk of preterm birth may vary as a function of context. This article focuses on select key issues and questions highlighting the need to develop a better understanding of which particular subgroups of pregnant women may be especially vulnerable to the potentially detrimental effects of maternal stress, and under what circumstances and at which stages of gestation. Issues related to the characterization and assessment of maternal stress and candidate biologic mechanisms are addressed.
Collapse
Affiliation(s)
- Pathik D Wadhwa
- Departments of Psychiatry & Human Behavior, Obstetrics & Gynecology, and Epidemiology, University of California, Irvine, School of Medicine, 3177 Gillespie Neuroscience Research Facility, Irvine, CA 92697, USA.
| | | | | | | |
Collapse
|
29
|
The Impact of Perceived Maternal Stress and Other Psychosocial Risk Factors on Pregnancy Complications. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2011; 33:344-52. [DOI: 10.1016/s1701-2163(16)34852-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|
30
|
Zhang X, Li J, Gu Y, Zhao Y, Wang Z, Jia G. A pilot study on environmental and behavioral factors related to missed abortion. Environ Health Prev Med 2011; 16:273-8. [PMID: 21431815 DOI: 10.1007/s12199-010-0196-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 11/08/2010] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the environmental and behavioral factors associated with the induction of missed abortion, with a particular focus on the relationship between job stress and missed abortion. METHODS This was a case-control study in which 552 women participated (267 cases, 285 controls). Job stress was measured using the Job Content Questionnaire 1.0 (JCQ1.0). RESULTS The case and control groups were significantly different for many factors, including age, physical exercise, exposure time to cell phone and computer, home refurbishment, ventilation, folic acid supplements, preference for fried food, reproductive knowledge, premarital health screening, parity, and supervisor support (P < 0.05). For job stress, the univariate analysis revealed that there was no significant difference between cases and controls. Logistic analysis revealed that physical exercise (2-3 times per week or >3 times per week) [odds ratio (OR) 0.433, 95% confidence interval (CI) 0.213-0.881 or OR 0.268, 95% CI 0.106-0.680, respectively], ventilation (OR 0.415, 95% CI 0.251-0.685), folic acid supplements (OR 0.409, 95% CI 0.265-0.633), age (OR 1.102, 95% CI 1.033-1.174), and supervisor support (OR 0.870, 95% CI 0.768-0.986) were the significant factors contributing to the missed abortion (P < 0.05). CONCLUSIONS Physical exercise, ventilation, folic acid supplements, and supervisor support were identified as protective factors for the prevention of missed abortion. Advanced age at pregnancy was a risk factor for missed abortion.
Collapse
Affiliation(s)
- Xueyan Zhang
- Department of Occupational and Environmental Health, Peking University, Beijing, 100191, China
| | | | | | | | | | | |
Collapse
|
31
|
Rossi NCF, Montebarocci O, Surcinelli P, Baldaro B, Immordino V, Borghi C. Greater pressor reactivity in women with pre-eclampsia is not related to specific psychological or emotional stressors. Psychol Rep 2010; 107:415-23. [PMID: 21117466 DOI: 10.2466/02.13.pr0.107.5.415-423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To investigate whether emotional or psychosocial factors could be significantly related with the development of pre-eclampsia, 15 pregnant women with early diagnosis of pre-eclampsia and 15 normotensive pregnant controls of comparable age (23-37 yr.), gestational age (10-37 wk.), parity (70% primiparous), amount of instruction, and marital status underwent a blood pressure monitoring during a specific psychological assessment based on a semistructured interview followed by the administration of three different questionnaires: the Symptom Checklist 90-Revised, the Perceived Stress Questionnaire-Recent, and the Questionnaire about Social Relationships. Systolic and diastolic blood pressure and heart rate were measured at 2-min. intervals by an automatic device both during the interview and the questionnaires' administration. Both systolic and diastolic responses were significantly increased in both groups during the interview (deltaSBP = 15 vs. 10%; deltaDBP=28 vs. 15.8%), whereas no differences were observed in blood pressure while answering questionnaires. Conversely, differences in questionnaire responses between groups were not statistically significant. Present results confirm a greater pressor reactivity in these women with pre-eclampsia but does not specifically support that this was related to psychological or emotional stress.
Collapse
Affiliation(s)
- Nicolino C F Rossi
- Department of Psychology, University of Bologna, v.le Berti Pichat 5, 40127 Bologna, Italy
| | | | | | | | | | | |
Collapse
|
32
|
Salihu H, Mbah AK, Alio AP, Kornosky JL, Whiteman VE, Belogolovkin V, Rubin LP. Nulliparity and preterm birth in the era of obesity epidemic. J Matern Fetal Neonatal Med 2010; 23:1444-50. [PMID: 20482286 DOI: 10.3109/14767051003678044] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess the impact of obesity on preterm birth among nulliparous women. METHODS Retrospective cohort study of nulliparous mothers delivering infants in Florida between 2004 and 2007. Women were classified as non-obese (pre-pregnancy body mass index (BMI) <30) or obese (BMI ≥ 30). The main outcomes assessed were preterm birth, very preterm birth and extremely preterm birth. Risk estimates were obtained using logistic regression. Multiparous non-obese mothers were the referent group for all analyses. RESULTS As compared to multiparous women, nulliparous mothers had an increased risk of very preterm and extremely preterm birth with the highest risk observed for extremely preterm birth (odds ratios (OR) = 1.37, 95% CI = 1.28, 1.47) (p for trend <0.01). Obese nulliparous mothers had an elevated risk of preterm, very preterm and extremely preterm birth, with the risk of extremely preterm birth being the most pronounced (OR=1.97, 95% CI=1.75-2.22) [p for trend <0.05]. The heightened risk associated with obesity among nulliparous women was observed across all racial/ethnic sub-populations, with black nulliparous obese mothers being at greatest risk of all preterm birth-subtypes. CONCLUSIONS Obesity is a risk marker for preterm, very preterm and extremely preterm birth among first-time mothers and particularly among blacks and Hispanics.
Collapse
Affiliation(s)
- Hamisu Salihu
- The Chiles Center for Healthy Mothers and Babies, University of South Florida, Tampa, FL 33613, USA.
| | | | | | | | | | | | | |
Collapse
|
33
|
Abstract
This study of 509 (340 female) undergraduate university students in southern Appalachia who completed the Adult Temperament Questionnaire (ATQ) and the State-Trait Anxiety Inventory (STAI), is the first phase in the development of a model to predict risk for stress-related health problems. Results indicate that high negative affect strongly predicted individuals with above average anxiety (OR = 3.7, 95% CI 2.43, 5.64), while high positive affect, effortful control, and sociability predicted that individuals would be low in reported anxiety (OR = .33 [95% CI .25, .44], .29 [95% CI .19, .45], and .69 [95% CI .56, .86], respectively).
Collapse
|
34
|
Shamsi U, Hatcher J, Shamsi A, Zuberi N, Qadri Z, Saleem S. A multicentre matched case control study of risk factors for preeclampsia in healthy women in Pakistan. BMC Womens Health 2010; 10:14. [PMID: 20433699 PMCID: PMC2881882 DOI: 10.1186/1472-6874-10-14] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 04/30/2010] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Preeclampsia is one of the leading causes of maternal and perinatal morbidity and mortality world-wide. The risk for developing preeclampsia varies depending on the underlying mechanism. Because the disorder is heterogeneous, the pathogenesis can differ in women with various risk factors. Understanding these mechanisms of disease responsible for preeclampsia as well as risk assessment is still a major challenge. The aim of this study was to determine the risk factors associated with preeclampsia, in healthy women in maternity hospitals of Karachi and Rawalpindi. METHODS We conducted a hospital based matched case-control study to assess the factors associated with preeclampsia in Karachi and Rawalpindi, from January 2006 to December 2007. 131 hospital-reported cases of PE and 262 controls without history of preeclampsia were enrolled within 3 days of delivery. Cases and controls were matched on the hospital, day of delivery and parity. Potential risk factors for preeclampsia were ascertained during in-person postpartum interviews using a structured questionnaire and by medical record abstraction. Conditional logistic regression was used to estimate matched odds ratios (ORs) and 95% confidence intervals (95% CIs). RESULTS In multivariate analysis, women having a family history of hypertension (adjusted OR 2.06, 95% CI; 1.27-3.35), gestational diabetes (adjusted OR 6.57, 95% CI; 1.94 -22.25), pre-gestational diabetes (adjusted OR 7.36, 95% CI; 1.37-33.66) and mental stress during pregnancy (adjusted OR 1.32; 95% CI; 1.19-1.46, for each 5 unit increase in Perceived stress scale score) were at increased risk of preeclampsia. However, high body mass index, maternal age, urinary tract infection, use of condoms prior to index pregnancy and sociodemographic factors were not associated with higher risk of having preeclampsia. CONCLUSIONS Development of preeclampsia was associated with gestational diabetes, pregestational diabetes, family history of hypertension and mental stress during pregnancy. These factors can be used as a screening tool for preeclampsia prediction. Identification of the above mentioned predictors would enhance the ability to diagnose and monitor women likely to develop preeclampsia before the onset of disease for timely interventions and better maternal and fetal outcomes.
Collapse
Affiliation(s)
- Uzma Shamsi
- Division of Epidemiology/Biostatistics, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Juanita Hatcher
- Division of Epidemiology/Biostatistics, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Azra Shamsi
- Combined Military Hospital, Rawalpindi, Pakistan
| | - Nadeem Zuberi
- Department of Obstetrics/Gynecology, Aga Khan University Hospital AKUH, Karachi, Pakistan
| | - Zeeshan Qadri
- Division of Epidemiology/Biostatistics, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Sarah Saleem
- Division of Epidemiology/Biostatistics, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| |
Collapse
|
35
|
Abstract
In France, the incidence of PE is estimated to range between 1 and 3% in the nuliparous and between 0.5 and 1.5% in the multiparous women. Factors associated with the development of PE are of various types. Studies conducted on families affected by PE suggest the existence of a genetic component to the disease, even though the association between PE and certain genes, allotypes and polymorphisms are still under scrutiny. The hypotheses suggesting an immunological mechanism is supported by several arguments. Indeed, being nuliparous, changing partner, insemination with donor semen are factors associated with the development of PE whereas pre-exposition to the father's sperm bears protection. Some factors qualified as physiological are also associated with the occurrence of PE although no clear pathophysiological explanation can be put forward. These are being a mother of African descent, an increase in the mothers' age or herself being born prematurely. Some gestational incidents are also associated with the occurrence of PE: multiparity, a congenital defect affecting the foetus, UTI. Similarly, some pre-existing conditions of the mother are associated with PE, i.e. chronic hypertension, kidney disease, obesity and diabetes mellitus. Several well designed epidemiological studies confirm that tobacco consumption is itself associated with a 20 to 50% reduction in the development of PE, although being itself associated with an increase in other vascular gestational complications such as retroplacental haemorrhage and IUGR. Living conditions and stress, especially at work are also associated with the occurrence of PE. All these identified risk factors by far do not account for all the reported cases of PE and do not bear sufficient positive or negative predictive value.
Collapse
Affiliation(s)
- F Goffinet
- Maternité Port-Royal, université Paris-Descartes, hôpital Cochin-Saint-Vincent-de-Paul, AP-HP, 123, boulevard de Port-Royal, 75014 Paris, France.
| |
Collapse
|
36
|
Chang PJ, Chu LC, Hsieh WS, Chuang YL, Lin SJ, Chen PC. Working hours and risk of gestational hypertension and pre-eclampsia. Occup Med (Lond) 2009; 60:66-71. [PMID: 19700491 DOI: 10.1093/occmed/kqp119] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The potential impact of employment on maternal health, particularly in relation to gestational hypertension and pre-eclampsia, has been subject to research. However, there is limited evidence on associations between shift work and long working hours on the incidence of these conditions. AIMS To evaluate potential associations between maternal shift work and long working hours during pregnancy and gestational hypertension or pre-eclampsia. METHODS Multistage stratified systematic sampling was used to recruit 24 200 post-partum women from the Taiwan national birth registration database in 2005. Subjects underwent home interview 6 months after their deliveries by structured questionnaire to obtain characteristics of maternal employment and potential confounders. Diagnosis of gestational hypertension and pre-eclampsia was obtained from the birth registration. RESULTS There was no association between employment status and gestational hypertension or pre-eclampsia. Also, no significant association between gestational hypertension or pre-eclampsia and maternal shift work or long working hours during pregnancy was found in all or primiparous women. CONCLUSIONS There was no convincing evidence that maternal shift work or long working hours had a higher risk of gestational hypertension or pre-eclampsia. However, further research is warranted to confirm these negative findings.
Collapse
Affiliation(s)
- Pei-Jen Chang
- Department of Nursing, National Taipei College of Nursing, Taipei 11219, Taiwan
| | | | | | | | | | | |
Collapse
|
37
|
Psychometric properties of the Thai version of the 22-item and 45-item Karasek job content questionnaire. Int J Occup Med Environ Health 2009; 21:331-44. [PMID: 19228579 DOI: 10.2478/v10001-008-0036-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To evaluate the validity and reliability of the Thai version of the job content questionnaire (TJCQ) both 22-item and 45-item versions. MATERIALS AND METHODS The study encompassed 10,450 employees in Songkhla province, Thailand. A 45-item job content questionnaire (JCQ) was translated and back translated complying with the JCQ usage policy. TJCQ covers seven scales as follows: psychological demand, decision latitude, supervisor support, coworker support, physical demand, job security and hazard at work. Internal consistency was examined using Cronbach's alpha coefficient. Factor validation was tested using both exploratory and confirmatory factor analysis. RESULTS Both 22-item and 45-item versions of TJCQ demonstrated acceptable internal consistency in nearly all scales except for psychological demand. The exploratory and confirmatory factor analysis result gave support to 5-factor model in 22-item version and 8-factor model in 45-item version of TJCQ. The psychological demand scale tended to split into two subscales. Other scales were consistent with the expected dimensions though some items extracted differently along the theoretical dimensions. CONCLUSIONS Our study provided evidence for the reliability and validity of the TJCQ among Thai employees and supported the ongoing debate on multifaceted psychological demand and its complexity, making it feasible to extend the TJCQ beyond its original structure.
Collapse
|
38
|
Toh S, Mitchell AA, Louik C, Werler MM, Chambers CD, Hernández-Díaz S. Selective serotonin reuptake inhibitor use and risk of gestational hypertension. Am J Psychiatry 2009; 166:320-8. [PMID: 19122006 PMCID: PMC2735348 DOI: 10.1176/appi.ajp.2008.08060817] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the effects of treatment with selective serotonin reuptake inhibitors (SSRIs) on the risks of gestational hypertension and preeclampsia. METHOD The authors analyzed data from 5,731 women with nonmalformed infants and no underlying hypertension who participated in the Slone Epidemiology Center Birth Defects Study from 1998 to 2007. Gestational hypertension was defined as incident hypertension diagnosed after 20 weeks of pregnancy, with and without proteinuria (i.e., with and without preeclampsia). The risks of gestational hypertension and preeclampsia were compared between women who did and did not receive SSRI treatment during pregnancy. Relative risks and 95% confidence intervals (CIs) were estimated using the Cox proportional hazards model, adjusting for prepregnancy sociodemographic, lifestyle, reproductive, and medical factors. RESULTS Gestational hypertension was present in 9.0% of the 5,532 women who were not treated with SSRIs and 19.1% of the 199 women who were treated with SSRIs. Among women who received treatment, gestational hypertension was present in 13.1% of the 107 women who received treatment only during the first trimester and in 26.1% of the 92 women who continued treatment beyond the first trimester. The occurrence of preeclampsia was 2.4% among women who were not treated with SSRIs, 3.7% among women who were exposed to SSRIs only during the first trimester, and 15.2% among women who continued SSRI treatment beyond the first trimester. Relative to women who did not receive treatment, the adjusted relative risk of preeclampsia was 1.4 for women who discontinued treatment and 4.9 for women who continued treatment. CONCLUSION SSRI exposure during late pregnancy-whether a causal factor or not-might identify women who are at an increased risk for gestational hypertension and preeclampsia. Further investigation is needed in order to separate the effects of treatment with SSRIs from those of underlying mood disorders.
Collapse
Affiliation(s)
- Sengwee Toh
- Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA.
| | | | - Carol Louik
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | | | | | - Sonia Hernández-Díaz
- Harvard School of Public Health, Boston, MA, USA, Slone Epidemiology Center at Boston University, Boston, MA, USA
| |
Collapse
|
39
|
Falcao S, Solomon C, Monat C, Bérubé J, Gutkowska J, Lavoie JL. Impact of diet and stress on the development of preeclampsia-like symptoms in p57kip2 mice. Am J Physiol Heart Circ Physiol 2009; 296:H119-26. [DOI: 10.1152/ajpheart.01011.2008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The cyclin-dependent kinase inhibitor p57kip2 regulates the cell cycle of trophoblastic cells. It has been established by a Japanese group that the heterozygous p57kip2 knockout (p57−/+) mice are a good model of preeclampsia as they develop hypertension, proteinuria, and placental pathology. However, apart from the placental pathology, we could not observe these symptoms in our laboratory. Hence, we investigated the impact of diet and stress on this model. To do so, we compared the effects of the Japanese diet to that of the North American diet used by our animal facility. Furthermore, the impact of stress was determined by placing the mice in a restraining device before and at the end of gestation. Although the Japanese diet did not have any impact on blood pressure or proteinuria, the mice did develop endothelial dysfunction, left ventricular hypertrophy, as well as increased placental pathology. Also, all mice had smaller litters when fed the Japanese diet. However, stress response of these mice was not increased during gestation; in fact, a decrease was observed in the p57−/+ mice, suggesting that this was probably not a player in the development of the pathology. Taken together, these results suggest that other environmental factors may have been implicated in the development of preeclampsia-like symptoms in this animal model. Moreover, we demonstrated that placental pathology and genetic factors are not sufficient to trigger preeclampsia-like symptoms in this model and that the diet might play an important part in the development of this multifactorial disease.
Collapse
|
40
|
Guendelman S, Pearl M, Graham S, Hubbard A, Hosang N, Kharrazi M. Maternity Leave In The Ninth Month of Pregnancy and Birth Outcomes Among Working Women. Womens Health Issues 2009; 19:30-7. [DOI: 10.1016/j.whi.2008.07.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 07/23/2008] [Accepted: 07/23/2008] [Indexed: 11/15/2022]
|
41
|
Facteurs de risque de la prééclampsie en cas de grossesse unique. ACTA ACUST UNITED AC 2008; 37:477-82. [DOI: 10.1016/j.jgyn.2008.04.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2007] [Revised: 04/26/2007] [Accepted: 04/08/2008] [Indexed: 11/21/2022]
|
42
|
Vollebregt KC, van der Wal MF, Wolf H, Vrijkotte TGM, Boer K, Bonsel GJ. Is psychosocial stress in first ongoing pregnancies associated with pre-eclampsia and gestational hypertension? BJOG 2008; 115:607-15. [PMID: 18333942 DOI: 10.1111/j.1471-0528.2008.01665.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Investigating the association of pre-eclampsia and gestational hypertension with psychosocial stress in the first half of pregnancy. DESIGN Prospective community-based cohort study. SETTING Amsterdam, The Netherlands. POPULATION Between January 2003 and March 2004, all pregnant Amsterdam women (n = 12 377) were invited to fill in a questionnaire with sociodemographic and psychosocial variables (response rate 67%). Only nulliparous women with a singleton pregnancy, who completed the questionnaire before 24 weeks, and delivered after 24 weeks, were included. METHODS A postpartum questionnaire was used to gather information on hypertension or proteinuria. If this questionnaire was not available, the national obstetric register was used for pregnancy outcome. Medical files were examined for women with hypertension and/or proteinuria to confirm the diagnosis of pre-eclampsia and gestational hypertension according to the International Society for the Study of Hypertension in Pregnancy guidelines. Psychosocial stress was defined as workstress (Work Experience and Appreciation Questionnaire partly based on the Job Content Instrument of Karasek et al.), anxiety (the State-Trait Anxiety Inventory), depression (Center for Epidemiological Studies Depression Scale) and pregnancy-related anxiety (PRAQ-R). The association of psychosocial stress with the incidence of pre-eclampsia and gestational hypertension was explored by multivariate analysis adjusted for sociodemographic and medical confounders. MAIN OUTCOME MEASURES Incidence of pre-eclampsia and gestational hypertension. RESULTS A total of 3679 women were included. The incidence of pre-eclampsia and gestational hypertension was 3.5 and 4.4%, respectively. Workstress, anxiety, pregnancy-related anxiety or depression had no effect on the incidence of pre-eclampsia or gestational hypertension. CONCLUSION Psychosocial stress in the first half of pregnancy does not influence the incidence of pre-eclampsia and gestational hypertension in nulliparous women.
Collapse
Affiliation(s)
- K C Vollebregt
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands.
| | | | | | | | | | | |
Collapse
|
43
|
Nejatizadeh A, Stobdan T, Malhotra N, Pasha MAQ. The genetic aspects of pre-eclampsia: achievements and limitations. Biochem Genet 2008; 46:451-79. [PMID: 18437552 DOI: 10.1007/s10528-008-9163-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2007] [Accepted: 11/03/2007] [Indexed: 10/22/2022]
Abstract
Pre-eclampsia, a life-threatening disease during pregnancy, is a leading cause of global maternal mortality. Although there is substantial evidence of a genetic background, the complexity of the processes involved and nature of the maternal-fetal phenomenon do not make the search for the causative genes easy. Recent retrospective studies on the subject suggest the heritable allelic variations, particularly the utero-placental renin-angiotensin system with defective placental vascular development, could become the cornerstone for the genetics of pre-eclampsia and hence might well be associated with such defective development. Moreover, the role of immune mechanisms (immune maladaptation) deserves not to be ignored. Large-scale studies entailing genomewide scanning, sib-pair linkage analysis, and family-based association studies with appropriate power to detect genes with a lower relative risk are necessary to understand the puzzle of the disease. Moreover, recently, the importance of epigenetic features and the effect of imprinted genes related to trophoblast growth as well as fetal development on hypertension in pregnancy have been highlighted. All these possibilities are intuitively attractive and are supported by some circumstantial evidence. Although the consistent tenor of a series of papers instill some confidence, we need meticulously designed larger-scale investigations including large numbers of affected women and their babies to provide the analytic stringency essential to study the polygenic multifactorial basis of pre-eclampsia.
Collapse
Affiliation(s)
- Azim Nejatizadeh
- Functional Genomics Unit, Institute of Genomics and Integrative Biology, Delhi, 110 007, India
| | | | | | | |
Collapse
|
44
|
Reference. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2008. [DOI: 10.1016/s1701-2163(16)32783-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
45
|
Bell JF, Zimmerman FJ, Diehr PK. Maternal Work and Birth Outcome Disparities. Matern Child Health J 2007; 12:415-26. [PMID: 17701331 DOI: 10.1007/s10995-007-0264-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2006] [Accepted: 07/24/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We tested relations between aspects of maternal work and birth outcomes in a national sample and in subgroups known to experience disparities. METHODS Three indices of work attributes (Status and Recognition, Physical Demands, and Exposure to Conflict) were derived by factor analysis of variables extracted from the Department of Labor's O*Net database. The indices were linked to the National Longitudinal Survey of Youth using occupation codes for the primary jobs held by women who gave birth between 1979 and 2000 and worked during the quarter prior to birth (n = 3,386 births to n = 2,508 mothers). Multiple regression was used to model birth outcomes as functions of the work attribute indices, controlling for several measures of socioeconomic status and risk factors for adverse birth outcomes. RESULTS In the full sample, work-related Physical Demands were associated with lower average birthweight and increased odds of preterm birth while Status and Recognition was associated with higher average birthweight and lower odds of fetal growth restriction. In stratified models, Status and Recognition was associated with higher birth weight among women with low (versus high) income and with lower odds of preterm birth among women with low (versus high) education. Physical Demands were associated with higher rates of preterm birth among women with low (versus high) income and education and among African-American mothers (compared to Whites). CONCLUSIONS The work environment is an important predictor of healthy births. Relations between maternal work attributes and birth outcomes differ by race/ethnicity and socioeconomic status and according to the outcome under investigation. Further research with measures of work attributes specific to maternal work experiences is recommended to confirm our findings.
Collapse
Affiliation(s)
- Janice F Bell
- Health Services, University of Washington, Box 357668, Seattle, WA, 98195, USA.
| | | | | |
Collapse
|
46
|
Khader Y, Jibreal M, Burgan S, Amarin Z. Risk Indicators of Pre-Eclampsia in North Jordan: Is Dental Caries Involved? Gynecol Obstet Invest 2007; 63:181-7. [PMID: 17139179 DOI: 10.1159/000097633] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2006] [Accepted: 09/20/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Despite a huge body of published research, understanding the basic pathology that leads to pre-eclampsia is still incomplete. This study was conducted among women in north Jordan to determine factors associated with pre-eclampsia and to determine if dental caries was involved. METHODS A case-control study was carried out among women who delivered at Princess Badea Teaching Hospital, Irbid, North Jordan, between September 1, 2004 and January 1, 2005. 115 women with pre-eclampsia and 230 normotensive controls were included in the study. Information regarding participants' demographics, antenatal history and family history were collected through personal interviews. Several oral parameters were measured for each participant. RESULTS In multivariate analysis, factors found to be associated with increased odds of pre-eclampsia were age > or =35 years (adjusted OR 2.20; 95% CI 1.08, 4.48), nulliparity (adjusted OR 2.73; 95% CI 1.38, 5.39), emotional stress during pregnancy (adjusted OR 4.22; 95% CI 1.79, 9.90), maternal history of pre-eclampsia (adjusted OR 16.04; 95% CI 5.82, 44.22), family history of cardiovascular diseases (adjusted OR 2.82; 95% CI 1.22, 6.51), family history of pre-eclampsia (adjusted OR 23.26; 95% CI 5.07, 106.78), twin births (adjusted OR 37.79; 95% CI 4.22, 338.51), and Body Mass Index (BMI). In comparison with women with pre-pregnancy BMI <25, adjusted OR were 1.97, 95% CI 1.02, 3.81 for women with BMI from 25 to 29.9, and 3.31, 95% CI 1.36, 8.03 for women with BMI > or =30. Mean decayed teeth surface was found to be associated with increased odds of pre-eclampsia (adjusted OR 1.14, 95% CI 1.03, 1.27). CONCLUSION This study demonstrated no difference to reported risk indicators of pre-eclampsia in other populations, but adds that dental caries may have an association with increased odds of pre-eclampsia.
Collapse
Affiliation(s)
- Yousef Khader
- Department of Public Health, Jordan University of Science and Technology, Irbid, Jordan
| | | | | | | |
Collapse
|
47
|
Wang L, Feng Y, Zhang Y, Zhou H, Jiang S, Niu T, Wei LJ, Xu X, Xu X, Wang X. Prolylcarboxypeptidase gene, chronic hypertension, and risk of preeclampsia. Am J Obstet Gynecol 2006; 195:162-71. [PMID: 16681991 DOI: 10.1016/j.ajog.2006.01.079] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2005] [Revised: 01/04/2006] [Accepted: 01/20/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Renin-angiotensin System is essential for the homeostasis of blood pressure in humans. The roles of renin-angiotensin system gene polymorphisms including angiotensinogen, angiotensin-converting enzyme, renin and angiotensin II receptor, type 1 genes in the pathogenesis of preeclampsia have been extensively studied, but most association studies produced either negative or inconsistent results. Prolylcarboxypeptidase encodes a lysosomal enzyme and is a regulator for both renin-angiotensin system and the kallikrein-kinin system. There is no published study on prolylcarboxypeptidase gene and preeclampsia. STUDY DESIGN We investigated the independent and joint association of five polymorphisms in angiotensinogen, angiotensin-converting enzyme, and prolylcarboxypeptidase gene and chronic hypertension with the risk of preeclampsia in 125 preeclamptic and 1040 non-preeclamptic black women enrolled at the Boston Medical Center. We used logistic regression models to estimate the odds ratios of risk for preeclampsia associated with each gene polymorphism and its joint association with chronic hypertension. RESULTS No association was found in four polymorphisms in angiotensinogen and angiotensin-converting enzyme. Prolylcarboxypeptidase E112D (rs2298668) D allele along and jointly with chronic hypertension were associated with a significantly increased risk of preeclampsia. Compared to women with homozygous EE genotype and without chronic hypertension, higher risks of preeclampsia were observed in DD women without chronic hypertension (OR = 3.7, 95% CI, 1.2 - 12.4) and EE women with chronic hypertension (OR = 9.1, 95% CI: 4.7 - 17.6). Women with both D allele and chronic hypertension had the highest risk (OR = 158, 95% CI, 25-infinite). This finding was validated in an independent sample of 1,015 non-black women. We further compared the prolylcarboxypeptidase transcript levels in peripheral blood cells of 23 preeclamptic (30% with chronic hypertension) and 51 non-preeclamptic (6% with chronic hypertension) women 2 - 3 days after delivery. The PRCP transcript levels were lower in ED/DD women than in EE woman (P = .03) and lower in preeclamptic women than in non-preeclamptic women (P = .007). CONCLUSION Our data showed that prolylcarboxypeptidase D allele coupled with chronic hypertension was associated with a significantly increased risk of preeclampsia in both black and non-black women. Gene expression assays lent further support for the functional significance of prolylcarboxypeptidase in the etiology of preeclampsia.
Collapse
Affiliation(s)
- Lin Wang
- Program for Population Genetics, Harvard School of Public Health, Boston, MA, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Estrés relacionado con el trabajo y exposición laboral en enfermeras de la Comunidad de Castilla y León. ENFERMERIA CLINICA 2006. [DOI: 10.1016/s1130-8621(06)71198-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
49
|
Kim C, Brawarsky P, Jackson RA, Fuentes-Afflick E, Haas JS. Changes in health status experienced by women with gestational diabetes and pregnancy-induced hypertensive disorders. J Womens Health (Larchmt) 2006; 14:729-36. [PMID: 16232105 DOI: 10.1089/jwh.2005.14.729] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To examine changes in health status among women with gestational diabetes mellitus (GDM) and pregnancy-induced hypertension (PIH). METHODS We examined perceived health status changes from the prepregnancy, as recalled at 12-20 weeks gestation, to the postpartum period in women with GDM (n = 64) vs. unaffected gravidas (n = 1233) and women diagnosed with PIH (n = 148) vs. unaffected gravidas. We used patient survey and medical record data from a prospective cohort study. Health status measures included the Short Form-36 scales for physical function, vitality, and self-rated health and the Center for Epidemiologic Studies-Depression Scale (CES-D). Multivariate logistic regression models controlled for age, parity, race, education, prepregnancy body mass index (BMI) and exercise levels, food insufficiency, and GDM or PIH during a prior pregnancy. RESULTS Women with PIH more often reported a significant decline in vitality (odds ratio [OR] 1.51, 95% confidence interval [CI] 1.02-2.23) and self-rated health (OR 2.12, 95% CI 1.19- 3.77) and an increase in depressive symptoms from prepregnancy to postpartum compared with unaffected women (OR 1.84, 95% CI 1.11-3.05). Decline in self-rated health was partially mediated by cesarean birth and preterm delivery. Similar proportions of women with GDM and unaffected women reported declines in health status measures. CONCLUSIONS Women with PIH, but not GDM, more often experience significant declines in health status from prepregnancy to postpartum than unaffected women.
Collapse
Affiliation(s)
- Catherine Kim
- Division of General Internal Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI 48109, USA.
| | | | | | | | | |
Collapse
|
50
|
Haelterman E, Qvist R, Barlow P, Alexander S. Social deprivation and poor access to care as risk factors for severe pre-eclampsia. Eur J Obstet Gynecol Reprod Biol 2003; 111:25-32. [PMID: 14557007 DOI: 10.1016/s0301-2115(03)00161-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To estimate the associations between biomedical, social and health care factors and the occurrence of severe pre-eclampsia, eclampsia or HELLP syndrome. STUDY DESIGN A case-control study conducted in 14 of the 15 maternity hospitals of Brussels. Cases were all 99 women who delivered in these hospitals in 1996 and who had severe pre-eclampsia, eclampsia or HELLP syndrome. Controls were 200 women without these severe maternal conditions, randomly selected among women who delivered in the same hospitals during the same period. Crude odds ratios were computed and adjusted odds ratios were derived from logistic regression. RESULTS Indicators of social deprivation such as low educational level, poverty and illegal residence or asylum request, were strongly associated with the outcome in univariate analysis. So were African or Turkish ethnicity, obesity, chronic hypertension and primiparity. Logistic regression showed that no access to national health insurance and history of residence in another country were strongly and independently associated with the outcome (adjusted odds ratio = 4.0 (95% confidence interval 1.1, 14.0) and 3.7 (95% confidence interval 1.9, 7.3), respectively). CONCLUSIONS The burden of pre-eclampsia is concentrated in socially disadvantaged women. Health services should be more responsive to the specific needs of these women. Low access to health care may contribute to the occurrence of severe pre-eclampsia in our setting.
Collapse
Affiliation(s)
- Edwige Haelterman
- Unité Santé Reproductive et Epidémiologie Périnatale, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium.
| | | | | | | |
Collapse
|