Maternal history of recurrent pregnancy loss is associated with increased risk for long-term pediatric gastrointestinal morbidity in the offspring

Endoplasmic reticulum stress and unfolded protein response play roles in recurrent pregnancy loss: A bioinformatics study

This study aims to explore whether endoplasmic reticulum stress (ERS) and unfolded protein response (UPR) processes could be potential targets for preventive, diagnostic, and therapeutic for recurrent pregnancy loss (RPL). RPL datasets GSE165004 and GSE26787 were sourced from the GEO database, and ERS- and UPR-related gene sets were obtained from the MsigDB database. After differentially expressed genes (DEGs) identification, key genes were screened from intersecting DEGs in RPL-ERS and RPL-UPR datasets. The z-score algorithm was conducted to obtain phenotype scores. Functional enrichment and machine learning analyses were performed to assess gene function and diagnostic value evaluation. Interaction networks were conducted to investigate upstream regulated relationships of the key genes. Immune infiltration and single-cell RNA sequencing (scRNA-seq) were assessed to explore ERS and UPR functions at the cellular level. Totally 25 key genes RPL-ERS DEGs and 16 key genes RPL-UPR DEGs were identified. Among them, six key genes (NFYB, EXOSC2, UBQLN2, RNF139, DERL1, and FBXO27) were validated to show consistent expression trends in both RPL datasets. Functional enrichment highlighted their involvement in the immunity of RPL. Machine learning indicated the significant diagnostic value of these validated genes for RPL, with an accuracy rate of > 80 %. scRNA-seq analysis revealed elevated ERS and UPR expressions in monocytes/macrophages in RPL samples. In conclusion, ERS and UPR processes are associated with RPL occurrences, and were mainly upregulated in monocytes/macrophages within RPL samples. ERS and UPR processes may serve as potential targets for the prevention, diagnosis, and treatment of RPL.

Mode of delivery and long-term gastrointestinal-related hospitalization of the offspring

OBJECTIVE

We set out to ascertain a possible association between mode of delivery (cesarean vs. vaginal delivery) and gastrointestinal hospitalization of the offspring.

STUDY DESIGN

A population based cohort analysis including all uncomplicated singleton deliveries occurring between the years 1991-2014 at a tertiary medical center was performed, comparing long-term gastrointestinal hospitalization of offspring, according to mode of delivery. Multiple gestations, fetuses with congenital malformations and perinatal deaths were excluded, as were cases of urgent cesarean delivery and pregnancy complications. Gastrointestinal hospitalizations (up to age 18 years) were defined using predefined ICD9 codes, as recorded in hospital records. A Kaplan Meier survival curve was constructed to compare cumulative incidence of first gastrointestinal hospitalizations. A Cox proportional hazard model was used to control for confounders.

RESULTS

During the study period 139,232 deliveries met the inclusion criteria; 13,242 (9.5%) of which were elective cesarean deliveries, and the remaining 125,990 (90.5%) were delivered vaginally. Cesarean delivery was associated with more offspring hospitalizations for gastrointestinal morbidity (p < .001). The Kaplan Meier survival curve demonstrated higher cumulative incidence of gastrointestinal hospitalizations in the cesarean delivery group (log rank test p < .001). Utilizing a Cox proportional hazards model to control for confounders, cesarean delivery was found to be an independent risk factor for long-term gastrointestinal hospitalization of the offspring (adjusted HR 1.409, 95%CI 1.306-1.521, p < .001). Specifically, inflammatory bowel disease was more common among offspring following cesarean delivery aHR 1.386 95% CI 1.215-1.582 p < .001.

CONCLUSION

Elective cesarean delivery is an independent risk factor for long-term gastrointestinal-related hospitalization of the offspring.

Anesthesia, sex and miscarriage history may influence the association between cesarean delivery and autism spectrum disorder

BACKGROUND

To explore the association between cesarean section (CS) and risk of autism spectrum disorder (ASD), and evaluate the possible factors influencing this association.

METHODS

In total, 950 patients diagnosed with ASD and 764 healthy controls were recruited in this study. Socio-demographic characteristics and prenatal, perinatal, and neonatal characteristics were compared between the two groups. Univariate and multivariable conditional logistic regression analyses were applied to adjust for confounders. Further stratified analyses based on sex and miscarriage history were similarly performed to explore the factors influencing the association between CS and ASD.

RESULTS

CS was evidently associated with an elevated risk of ASD (adjusted odds ratio [aOR] = 1.606, 95% confidence interval (CI) = 1.311-1.969). Unlike regional anesthesia (RA), only CS performed under general anesthesia (GA) consistently elevated the risk of ASD (aOR = 1.887, 95% CI = 1.273-2.798) in females and males in further stratified analysis. The risk of children suffering from ASD following emergency CS was apparently increased in males (aOR = 2.390, 95% CI = 1.392-5.207), whereas a higher risk of ASD was observed among voluntary CS and indicated CS subgroups (aOR = 2.167, 95% CI = 1.094-4.291; aOR = 2.919, 95% CI = 1.789-4.765, respectively) in females. Moreover, the interaction term of CS and past miscarriage history (β = - 0.68, Wald χ2 = 7.5, df = 1, p = 0.006)) was similarly defined as influencing ASD.

CONCLUSIONS

The exposure of children to GA during CS may explain the possible/emerging association between CS and ASD. In addition, sex and miscarriage history could equally be factors influencing the association between CS and ASD.

Maternal history of recurrent pregnancy loss and future risk of ophthalmic morbidity in the offspring

OBJECTIVE

The objective of the study was to investigate whether maternal history of recurrent pregnancy loss (RPL) is associated with offspring childhood ophthalmic morbidity.

METHOD

A hospital-based cohort analysis comparing long-term offspring ophthalmic morbidity in women with and without a history of RPL was performed. Ophthalmic morbidity included hospitalizations involving a pre-defined set of ICD-9 codes. Offspring with congenital anomalies, perinatal mortality cases, and multifetal pregnancies were excluded from the analysis. Cumulative morbidity incidence was compared using Kaplan-Meier survival curves, and the risk of long-term ophthalmic morbidity was assessed by Cox proportional hazards model after adjustment for confounders.

RESULTS

During the study period, 242,187 newborns met the inclusion criteria; 5% (12,182) of them were offspring born to mothers with a history of RPL. Ophthalmic morbidity was significantly more common in the RPL group (1.3% vs 0.9%, p < .001, Kaplan-Meier log-rank p < .001). Adjustment for confounders, such as maternal age, gestational age, hypertensive disorders, and maternal diabetes, using Cox regression found that being born to a mother with RPL was independently associated with long-term ophthalmic morbidity (adjusted HR 1.35, 95% CI 1.15-1.59, p < .001).

CONCLUSION

Being born to a mother with RPL is independently associated with an increased risk of ophthalmic morbidity.

Maternal history of recurrent pregnancy loss increases the risk for long-term pediatric respiratory morbidity of the offspring

BACKGROUND

While the etiology in many cases of recurrent pregnancy loss (RPL) is unclear, recent evidence suggests possible immunological dysfunction, which is also implicated in the pathophysiology of many pediatric respiratory diseases.

OBJECTIVE

We sought to investigate whether maternal history of RPL is associated with long-term respiratory morbidity of the offspring.

STUDY DESIGN

A population based cohort analysis was performed comparing the risk of long-term respiratory morbidity (up to the age of 18 years) of children born to mothers with and without a history of RPL (defined as two or more losses). Respiratory morbidity included hospitalizations involving a predefined set of ICD-9 codes, as recorded in the hospital medical records. Deliveries occurred between the years 1991 and 2014 in a tertiary medical center. A Kaplan-Meier survival curve was constructed to compare cumulative respiratory morbidity, and a Cox proportional hazards model was used to control for confounders.

RESULTS

During the study period, 242 187 newborns met the inclusion criteria; 5% (n = 12 182) of which were offspring to mothers with a history of RPL. Respiratory morbidity was significantly more common in the exposed group (6.0% vs 4.8%, P < .001). Specifically, offspring to mothers with a history of RPL had higher rates of obstructive sleep apnea and asthma (P < .05). The Kaplan-Meier survival curve exhibited a higher cumulative incidence of total respiratory morbidity in offspring of mothers with a history of RPL (Log rank P < .001). In the Cox regression, maternal history of RPL was independently associated with increased pediatric respiratory morbidity of the offspring with an adjusted hazard ratio of 1.24 (95 % confidence interval [95%CI], 1.15-1.34, P < .001).

CONCLUSION

Maternal history of RPL is associated with a higher risk of future pediatric respiratory morbidity of the offspring; possibly explained by a common immunological etiology.

Perinatal outcome and long-term pediatric morbidity of pregnancies with a fibroid uterus

BACKGROUND

Uterine fibroids are a common morbidity in women and its prevalence is increasing with age. As maternal age rises, fibroids become more prevalent during pregnancy.

AIM

To assess perinatal outcome and long-term health of children to mothers with uterine fibroids during pregnancy.

STUDY DESIGN

A population-based cohort analysis assessing long-term hospitalizations of offspring, up to the age of 18 years, due to gastrointestinal, neurological, cardiovascular, endocrine, and respiratory morbidity, following pregnancies diagnosed with and without a fibroid uterus. Multivariable generalized estimating equation (GEE) analysis adjusted for maternal clusters and other possible confounders was performed. Kaplan-Meier survival curves and Cox survival regression models were used to compare cumulative morbidity incidence and control for confounders.

SUBJECTS

All singleton deliveries occurring between 1991 and 2014.

OUTCOME MEASURES

Perinatal outcome and long-term pediatric morbidity.

RESULTS

A total of 242,445 singleton deliveries were included; 0.5% of which were diagnosed with uterine fibroids (n = 1237). In the GEE multivariable analyses, advanced maternal age, hypertensive disorder and diabetes mellitus, fetal growth restriction, low birthweight (<2500 g), and small for gestational age newborns, were all independently associated with uterine fibroids during pregnancy. Hospitalizations up to the age of 18 years in the different health categories were comparable between the groups, using Cox regression models, controlled for clinically significant confounders in the long-term outcomes.

CONCLUSION

Maternal uterine fibroids appear to negatively impact perinatal outcome, mainly fetal growth. However, no independent major impact on future health of the offspring can be detected.

Maternal smoking during pregnancy and long-term neurological morbidity of the offspring

OBJECTIVE

To evaluate the long-term pediatric neurological morbidity of children born to mothers who reported smoking during pregnancy as compared with children born to non-smoking mothers.

STUDY DESIGN

A population-based cohort analysis was performed comparing all deliveries of mothers who reported smoking during pregnancy and non-smoking mothers between 1991 and 2014 at a single tertiary medical center. Hospitalizations of the offspring up to the age of 18 years involving neurological morbidities were evaluated according to a predefined set of ICD-9 codes, including autism, development and movement disorders, cerebral palsy and more. A Kaplan-Meier survival curve was used to compare cumulative hospitalization rate in exposed and unexposed offspring and a Cox proportional hazards model was used to control for confounders.

RESULTS

During the study period, 242,342 deliveries met the inclusion criteria. Of them, 2861 (1.2%) were children of smoking mothers. Neurological-related hospitalizations were significantly higher in children born to smoking mothers, as compared with the non-smoking group (5.3% vs. 3.1%, p < 0.01). Specifically, these children had higher rates of movement, eating and developmental disorders as well as attention deficit hyperactive disorder. The Kaplan-Meier survival curve demonstrated a significant higher cumulative incidence of neurological-related hospitalizations in the smoking group (log rank p < 0.01). Using a Cox proportional hazards model, controlling for potential confounders, maternal tobacco use was found to be independently associated with long-term neurological morbidity of the offspring (adjusted HR = 1.58, CI 1.33-1.89, p value < 0.01).

CONCLUSION

Maternal smoking during pregnancy is an independent risk factor for long-term neurological morbidity of the offspring.