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Shiferaw MA, Solomon A, Getachew S, Gudu W. Maternal and perinatal outcomes of oligohydramnios in late term and post term pregnancies at public hospitals in Ethiopia: a cross-sectional study. BMC Womens Health 2024; 24:113. [PMID: 38347537 PMCID: PMC10863224 DOI: 10.1186/s12905-024-02952-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 02/04/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The prevalence of oligohydramnios ranges from 12 to 14% after 41 weeks to as high as 30% in post term pregnancies. Oligohydramnios poses a dilemma in the choice of mode of labor and delivery in a setup where there is lack of continuous electronic fetal monitoring during labor. The condition also puts the mother at risks of operative interventions and cesarean delivery. We aimed to asses the maternal and perinatal outcomes in pregnancies with oligohydramnios in late term and post term pregnancy in this study. METHODS A cross-sectional study was conducted among mothers with diagnosis of oligohydramnios after 40+ 6 weeks of gestation at four hospitals at four public hospitals in Addis Ababa, Ethiopia from May 1, 2021 to September 30, 2021. Data were collected using structured questionnaire. Logistic regression were performed to assess factors associated with the adverse maternal and perinatal outcomes. RESULTS From a total of 142 mothers with oligohydramnios in late term and post tem pregnancies, 40.8% delivered through cesarean section. Spontaneous labor and elective cesarean section were more likely to occurr in parous women (AOR 2.5, 95% CI 1.06-6.04, p = 0.04), but with less likely in those with secondary level education (AOR 0.13, 95% CI 0.02-0.74, p = 0.02). There was no statistically significant difference in adverse outcomes between those who had induction of labor and those who had either spontaneous labor or had elective cesarean section. CONCLUSIONS The adverse maternal and perinatal outcomes in late term and post term pregnancies with oligohydramnios may not be different among different modes of delivery. Induction of labor can be safe in these particular group of women with intermittent auscultation with fetoscope in a setup where continuous electronic fetal monitoring is not readily available.
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Affiliation(s)
- Matiyas Asrat Shiferaw
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
| | - Ananya Solomon
- Department of Obstetrics and Gynecology, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | - Sintayehu Getachew
- Department of Obstetrics and Gynecology, Ras Desta Damtew Hospital, Addis Ababa, Ethiopia
| | - Wondimu Gudu
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Zhu C, Zhang S, Shen L, Ye L, Zhan M, Cai S, Huang J, Wang Z, Chen H. Changes in the characteristics and outcomes of high-risk pregnant women who delivered prior to and after China's universal two-child policy: a real-world retrospective study, 2010-2021. BMC Public Health 2024; 24:336. [PMID: 38297279 PMCID: PMC10829306 DOI: 10.1186/s12889-024-17810-9] [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: 03/01/2023] [Accepted: 01/18/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND In 2016, the "universal two-child" policy, allowing each couple to have two children, was introduced in China. The characteristic change of the long-term period after the implementation of the universal two-child policy was unclear. We studied trends in the obstetric characteristics and their potential impact on the rates of cesarean section and preterm birth in the era of China's universal two-child policy. METHODS A tertiary center-based study (2010-2021) retrospectively focused single high-risk pregnancies who delivered from the one-child policy period (OCP, 2010-2015) to the universal two-child policy period (TCP, 2016-2021). A total of 39, 016 pregnancies were enrolled. Maternal demographics, complications, delivery mode and obstetric outcomes were analyzed. Furthermore, logistic regression analysis was used to explore the association between the cesarean section rate, preterm birth and implementation of the universal two-child policy, adjusting maternal age, parity, and fetal distress. RESULTS Ultimately a total of 39,016 pregnant women met the criteria and were included in this analysis. The proportion of women with advanced maternal age (AMA) increased from 14.6% in the OCP to 31.6% in the TCP. The number of multiparous women increased 2-fold in the TCP. In addition, the overall rate of cesarean section significantly decreased over the policy change, regardless of maternal age, whereas the risk of preterm birth significantly increased in the TCP. Adjusting for maternal age, parity and fetal distress, the universal two-child policy showed a significantly favorable impact on the cesarean section rate (RR 0.745, 95%CI (0.714-0.777), P < 0.001). Compared to the OCP group, a higher increase in fetal distress and premature rupture of membranes (PROM) were observed in the TCP group. In pregnancies with AMA, there was no increase in the risk of postpartum hemorrhage, whereas more women who younger than 35 years old suffered from postpartum hemorrhage in TCP. The logistic regression model showed that the universal two-child policy was positively associated with the risk of postpartum hemorrhage (RR: 1.135, 95%CI: 1.025-1.257, P = 0.015). CONCLUSIONS After the implementation of the universal two-child policy in China, the rate of the cesarean section significantly decreased, especially for women under 35 years old. However, the overall risk of postpartum hemorrhage increased in women under 35 years old, while there was no change in women with AMA. Under the new population policy, the prevention of postpartum hemorrhage in the young women should not be neglected.
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Affiliation(s)
- Caixia Zhu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shaofeng Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lixia Shen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lisha Ye
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Minjin Zhan
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shiqin Cai
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jingwan Huang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zilian Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Haitian Chen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Xholli A, Londero AP, Magnetti E, Vadrucci S, Neri I, Marcantognini G, Tramontano AL, Monari F, Cagnacci A. Paternal age and perinatal outcomes: an observational study. J Perinat Med 2024; 52:58-64. [PMID: 37596820 DOI: 10.1515/jpm-2023-0205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 07/26/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVES The study's primary aim was to examine the relationship between paternal age and perinatal outcomes. METHODS This study used data from two hospital birth registries to examine the association between paternal age and adverse perinatal outcomes. The sample included all live singleton births between 2010 and 2022. The primary exposure was paternal age, and the following perinatal outcomes were considered: mode of conception, mode of delivery, pregnancy complications, and neonatal outcomes. RESULTS A total of 15,232 pregnant women were considered. Maternal and paternal ages were 31.9 ± 5.3 and 36.5 ± 6.5 years, respectively. Independent of maternal, paternal age was associated with lower odds of spontaneous conceptions (OR 0.930, 95 % CI 0.968/0.993; p=0.003) and higher odds of intracytoplasmatic sperm injection (OR 1.054, 95 % CI 1.045/1.062; p=0.0001), respectively. In contrast to maternal age, paternal age decreased the odds of any (OR 0.922, 95 % CI 0.985/0.999; p=0.032) and urgent/emergent (OR 0.984, 95 % CI 0.975/0.993; p=0.0001) cesarean delivery. Paternal age did not affect the gestation length, placental or neonatal weight, blood loss during delivery, and neonatal 5th-minute Apgar score. CONCLUSIONS Paternal age is associated with perinatal outcomes. These findings suggest that advanced paternal age may have implications for reproductive counseling and prenatal care.
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Affiliation(s)
- Anjeza Xholli
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale San Martino, Genoa, Italy
| | - Ambrogio P Londero
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health, University of Genoa, Genova (GE), Italy
- Obstetrics and Gynecology Unit, IRCCS Istituto Giannina Gaslini, Genova (GE), Italy
| | - Elena Magnetti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health, University of Genoa, Genova (GE), Italy
| | - Sabrina Vadrucci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health, University of Genoa, Genova (GE), Italy
| | - Isabella Neri
- Obstetrics and Gynecology Unit, Mother-Infant and Adult Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Gaia Marcantognini
- School of Midwifery, Department of, Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Anna Luna Tramontano
- Obstetrics and Gynecology Unit, Mother-Infant and Adult Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Monari
- Obstetrics and Gynecology Unit, Mother-Infant and Adult Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Angelo Cagnacci
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale San Martino, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health, University of Genoa, Genova (GE), Italy
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Havrljenko J, Kopitovic V, Pjevic AT, Milatovic S, Pavlica T, Andric N, Pogrmic-Majkic K. The Prediction of IVF Outcomes with Autologous Oocytes and the Optimal MII Oocyte/Embryo Number for Live Birth at Advanced Maternal Age. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1799. [PMID: 37893517 PMCID: PMC10608663 DOI: 10.3390/medicina59101799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/11/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Delayed childbearing in advanced age might be associated with a low prognosis for achieving pregnancy. Therefore, it is important to establish a predictive tool that will optimize the likelihood of a live birth at advanced age. Material and Methods: The retrospective study was conducted at the Ferona Fertility Clinic in Novi Sad (Republic of Serbia), between January 2020 and May 2021. The survey included 491 women aged ≥35 who met the inclusion criteria and who were subjected to an IVF (in vitro fertilization) treatment cycle. Results: The average number of retrieved oocytes, MII (metaphase II) oocytes, and developed embryos significantly decreased in advanced age. Age was also found to have a significant adverse effect on pregnancy and live birth rates. In women aged ≥35, 10/12 MII oocytes or 10/11 embryos are required for reaching an optimal live birth rate/cumulative live birth rate. Optimal CLBR (cumulative live birth rate) per one oocyte was achieved when 9 MII oocyte were retrieved. Conclusions: The study indicates that the cut-off for increased risk is ≥42 year. However, despite low live birth rates, autologous IVF for these women is not futile. An increase in the number of retrieved mature oocytes and a generation of surplus cryopreserved embryos could reinforce LBR (live birth rate) and CLBR. Clinicians should be very cautious in counseling, as autologous IVF may only be applicable to women with good ovarian reserve.
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Affiliation(s)
- Jelena Havrljenko
- Ferona Fertility Clinic, Sarplaninska 19, 21000 Novi Sad, Serbia or (J.H.); (V.K.); (A.T.P.)
- Faculty of Sciences, Department of Biology and Ecology, University of Novi Sad, Trg Dositeja Obradovica 2, 21000 Novi Sad, Serbia; (N.A.); (K.P.-M.)
| | - Vesna Kopitovic
- Ferona Fertility Clinic, Sarplaninska 19, 21000 Novi Sad, Serbia or (J.H.); (V.K.); (A.T.P.)
| | | | - Stevan Milatovic
- Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia;
| | - Tatjana Pavlica
- Faculty of Sciences, Department of Biology and Ecology, University of Novi Sad, Trg Dositeja Obradovica 2, 21000 Novi Sad, Serbia; (N.A.); (K.P.-M.)
| | - Nebojsa Andric
- Faculty of Sciences, Department of Biology and Ecology, University of Novi Sad, Trg Dositeja Obradovica 2, 21000 Novi Sad, Serbia; (N.A.); (K.P.-M.)
| | - Kristina Pogrmic-Majkic
- Faculty of Sciences, Department of Biology and Ecology, University of Novi Sad, Trg Dositeja Obradovica 2, 21000 Novi Sad, Serbia; (N.A.); (K.P.-M.)
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Ferreira AF, Soares M, Almeida-Santos T, Ramalho-Santos J, Sousa AP. Aging and oocyte competence: A molecular cell perspective. WIREs Mech Dis 2023; 15:e1613. [PMID: 37248206 DOI: 10.1002/wsbm.1613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 12/30/2022] [Accepted: 04/19/2023] [Indexed: 05/31/2023]
Abstract
Follicular microenvironment is paramount in the acquisition of oocyte competence, which is dependent on two interconnected and interdependent processes: nuclear and cytoplasmic maturation. Extensive research conducted in human and model systems has provided evidence that those processes are disturbed with female aging. In fact, advanced maternal age (AMA) is associated with a lower chance of pregnancy and live birth, explained by the age-related decline in oocyte quality/competence. This decline has largely been attributed to mitochondria, essential for oocyte maturation, fertilization, and embryo development; with mitochondrial dysfunction leading to oxidative stress, responsible for nuclear and mitochondrial damage, suboptimal intracellular energy levels, calcium disturbance, and meiotic spindle alterations, that may result in oocyte aneuploidy. Nuclear-related mechanisms that justify increased oocyte aneuploidy include deoxyribonucleic acid (DNA) damage, loss of chromosomal cohesion, spindle assembly checkpoint dysfunction, meiotic recombination errors, and telomere attrition. On the other hand, age-dependent cytoplasmic maturation failure is related to mitochondrial dysfunction, altered mitochondrial biogenesis, altered mitochondrial morphology, distribution, activity, and dynamics, dysmorphic smooth endoplasmic reticulum and calcium disturbance, and alterations in the cytoskeleton. Furthermore, reproductive somatic cells also experience the effects of aging, including mitochondrial dysfunction and DNA damage, compromising the crosstalk between granulosa/cumulus cells and oocytes, also affected by a loss of gap junctions. Old oocytes seem therefore to mature in an altered microenvironment, with changes in metabolites, ribonucleic acid (RNA), proteins, and lipids. Overall, understanding the mechanisms implicated in the loss of oocyte quality will allow the establishment of emerging biomarkers and potential therapeutic anti-aging strategies. This article is categorized under: Reproductive System Diseases > Molecular and Cellular Physiology.
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Affiliation(s)
- Ana Filipa Ferreira
- Reproductive Medicine Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, Azinhaga de Santa Comba, University of Coimbra, Coimbra, Portugal
- CNC-Center for Neuroscience and Cell Biology, CIBB, University of Coimbra, Coimbra, Portugal
| | - Maria Soares
- CNC-Center for Neuroscience and Cell Biology, CIBB, University of Coimbra, Coimbra, Portugal
- PhD Programme in Experimental Biology and Biomedicine (PDBEB), Institute for Interdisciplinary Research (IIIUC), University of Coimbra, Coimbra, Portugal
| | - Teresa Almeida-Santos
- Reproductive Medicine Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, Azinhaga de Santa Comba, University of Coimbra, Coimbra, Portugal
- CNC-Center for Neuroscience and Cell Biology, CIBB, University of Coimbra, Coimbra, Portugal
| | - João Ramalho-Santos
- CNC-Center for Neuroscience and Cell Biology, CIBB, University of Coimbra, Coimbra, Portugal
- Department of Life Sciences, Calçada Martim de Freitas, University of Coimbra, Coimbra, Portugal
| | - Ana Paula Sousa
- Reproductive Medicine Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- CNC-Center for Neuroscience and Cell Biology, CIBB, University of Coimbra, Coimbra, Portugal
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Erickson EN, Gotlieb N, Pereira LM, Myatt L, Mosquera-Lopez C, Jacobs PG. Predicting labor onset relative to the estimated date of delivery using smart ring physiological data. NPJ Digit Med 2023; 6:153. [PMID: 37598232 PMCID: PMC10439919 DOI: 10.1038/s41746-023-00902-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 08/10/2023] [Indexed: 08/21/2023] Open
Abstract
The transition from pregnancy into parturition is physiologically directed by maternal, fetal and placental tissues. We hypothesize that these processes may be reflected in maternal physiological metrics. We enrolled pregnant participants in the third-trimester (n = 118) to study continuously worn smart ring devices monitoring heart rate, heart rate variability, skin temperature, sleep and physical activity from negative temperature coefficient, 3-D accelerometer and infrared photoplethysmography sensors. Weekly surveys assessed labor symptoms, pain, fatigue and mood. We estimated the association between each metric, gestational age, and the likelihood of a participant's labor beginning prior to (versus after) the clinical estimated delivery date (EDD) of 40.0 weeks with mixed effects regression. A boosted random forest was trained on the physiological metrics to predict pregnancies that naturally passed the EDD versus undergoing onset of labor prior to the EDD. Here we report that many raw sleep, activity, pain, fatigue and labor symptom metrics are correlated with gestational age. As gestational age advances, pregnant individuals have lower resting heart rate 0.357 beats/minute/week, 0.84 higher heart rate variability (milliseconds) and shorter durations of physical activity and sleep. Further, random forest predictions determine pregnancies that would pass the EDD with accuracy of 0.71 (area under the receiver operating curve). Self-reported symptoms of labor correlate with increased gestational age and not with the timing of labor (relative to EDD) or onset of spontaneous labor. The use of maternal smart ring-derived physiological data in the third-trimester may improve prediction of the natural duration of pregnancy relative to the EDD.
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Affiliation(s)
- Elise N Erickson
- College of Nursing / College of Pharmacy, The University of Arizona, Tucson, AZ, USA.
- Midwifery Division, School of Nursing, Oregon Health & Science University, Portland, OR, USA.
| | | | - Leonardo M Pereira
- Department of Obstetrics & Gynecology, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Leslie Myatt
- Department of Obstetrics & Gynecology, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Clara Mosquera-Lopez
- Artificial Intelligence for Medical Systems (AIMS) Lab, Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
| | - Peter G Jacobs
- Artificial Intelligence for Medical Systems (AIMS) Lab, Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
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Braggion A, Favre G, Lepigeon K, Sichitiu J, Baud D, Desseauve D. Advanced Maternal Age Among Nulliparous at Term and Risk of Unscheduled Cesarean Delivery. Am J Obstet Gynecol MFM 2023; 5:100972. [PMID: 37062508 DOI: 10.1016/j.ajogmf.2023.100972] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/05/2023] [Accepted: 04/09/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND With the rise in the number of women giving birth at an advanced age, the association between advanced maternal age and adverse obstetrical outcomes is a growing concern in developed countries. Despite the well-established link between advanced maternal age and pregnancy-related complications, there has been limited research examining the specific risks related to unscheduled cesarean delivery in nulliparas at term. OBJECTIVE This study aimed to evaluate the risks associated with unscheduled cesarean delivery in nulliparas at ≥37 weeks of gestation, comparing the outcomes of younger patients with those aged ≥40 years. STUDY DESIGN This retrospective cohort study was conducted in a tertiary maternity hospital in Switzerland (high-income country). The study included nulliparas who delivered a live-born infant at ≥37 weeks between January 2015 and December 2019. We excluded pregnant women who had a planned cesarean delivery, were aged <18 years, multiparous, delivered before 37 weeks of gestation, or had pregnancies that ended in stillbirth. Participants were divided into 2 age groups: (1) ≥40 years and (2) <40 years. The primary outcome was the incidence of unscheduled cesarean delivery. Its association with advanced maternal age was evaluated after adjusting for confounding factors by multivariate logistic regression, expressed as an adjusted odds ratio. Secondary outcomes included pregnancy outcomes and neonatal outcomes. RESULTS A total of 5211 patients were included: 173 in the ≥40-years (advanced maternal age) group and 5038 in the <40-years (non-advanced maternal age) group; 26.01% (95% confidence interval, 19.65-33.22; n=45) of women in the advanced maternal age group had an unscheduled cesarean delivery, whereas 15.26% (95% confidence interval, 14.28-16.29; n=769) of women in the non-advanced maternal age group underwent the procedure. Advanced maternal age was associated with unscheduled cesarean delivery, with an adjusted odds ratio of 1.51 (95% confidence interval, 1.06-2.17; P=.024). Among vaginal deliveries, assisted procedures were performed on 29.7% (95% confidence interval, 21.9-38.4; n=38) of advanced maternal age patients vs 20.1% (95% confidence interval, 18.9-21.3; n=856) of non-advanced maternal age patients. Postpartum blood loss >1000 mL occurred in 5.8% (95% confidence interval, 2.8-10.4; n=10) of advanced maternal age patients and 3.1% (95% confidence interval, 2.6-3.6; n=156) of non-advanced maternal age patients. CONCLUSION Advanced maternal age is associated with increased risk of unscheduled cesarean delivery among nulliparas. This provides healthcare professionals with confirmation that advanced age may represent an individual risk factor, suggesting that nulliparous patients aged over 40 years may benefit from improved information regarding the factors contributing to this pregnancy outcome.
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Affiliation(s)
- Axelle Braggion
- Materno-Fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Guillaume Favre
- Materno-Fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland.
| | - Karine Lepigeon
- Materno-Fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Joanna Sichitiu
- Materno-Fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - David Baud
- Materno-Fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - David Desseauve
- Materno-Fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
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Baños Cándenas L, Abehsera Davó D, Castaño Frías L, González Mesa E. Retrospective Study of First Trimester Metrorrhagia: Pregnancy Follow-Up and Relationship with the Appearance of Gestational Complications. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1370. [PMID: 37629660 PMCID: PMC10456544 DOI: 10.3390/medicina59081370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: The purpose of this study was to describe and evaluate the bleeding that occurs during the first weeks of gestation and its implications throughout pregnancy. Secondarily, we assessed the associated complications in order to identify potential risk factors that could be used to select women at higher risk of adverse outcomes that could benefit from an early diagnosis and improved monitoring. Materials and Methods: We made a selection of all the women who consulted in the Emergency Department of the Hospital QuirónSalud in Malaga on 2015 presenting with first trimester metrorrhagia. We refer to first trimester metrorrhagia as that which occurs until week 12 + 6. Once these pregnant women were identified, we studied several variables not related to the gestation and some others associated with it and its natural course. Results: The average age of the patients assessed was 34.1. Associated gestational complications were metrorrhagia in the second trimester (6.3%), threatened preterm labor (7.4%), preeclampsia (2.5%), gestational diabetes (7.4%), late abortion (1.2%), and early postpartum hemorrhage (1.8%). We sought associations to assess possible risk factors, establishing an increased maternal age as an aggravating factor for the development of complications. We also studied gestational complications, finding a higher prevalence of them in older women, such as prematurity (33.11 vs. 34.48 years), gestational diabetes (33.11 vs. 36.06 years), and preeclampsia (33.25 vs. 35 years). Conclusions: Maternal age is a risk factor for first-trimester spontaneous miscarriage and for the development of complications of pregnancy. It is crucial to perform a correct screening of different pathologies throughout the pregnancy to anticipate potential complications.
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Affiliation(s)
- Laura Baños Cándenas
- Medicine School, Malaga University, 29071 Málaga, Spain
- Obstetrics and Gynecology Service, Virgen de la Victoria University Hospital, 29010 Málaga, Spain
| | | | - Lucía Castaño Frías
- Obstetrics and Gynecology Service, Regional University Hospital of Malaga, 29011 Málaga, Spain
| | - Ernesto González Mesa
- Obstetrics and Gynecology Service, Regional University Hospital of Malaga, 29011 Málaga, Spain
- Surgical Specialties, Biochemistry and Immunology Department, Malaga University, 29071 Málaga, Spain
- Biomedical Research Institute of Malaga (IBIMA) Research Group in Maternal-Fetal Medicine, Epigenetics, Women’s Diseases and Reproductive Health, 29071 Málaga, Spain
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Patek K, Friedman P. Postpartum Hemorrhage-Epidemiology, Risk Factors, and Causes. Clin Obstet Gynecol 2023; 66:344-356. [PMID: 37130373 DOI: 10.1097/grf.0000000000000782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The incidence of postpartum hemorrhage (PPH) is increasing worldwide and in the United States. Coinciding, is the increased rate of severe maternal morbidity with blood transfusion in the United States over the past 2 decades. Consequences of PPH can be life-threatening and carry significant cost burden to the health care system. This review will discuss the current trends, distribution, and risk factors for PPH. Causes of PPH will be explored in detail.
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Affiliation(s)
- Kara Patek
- Corewell Health William Beaumont University Hospital, Royal Oak, Michigan
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Qin M, Chen W, Hua L, Meng Y, Wang J, Li H, Yang R, Yan L, Qiao J. DNA methylation abnormalities induced by advanced maternal age in villi prime a high-risk state for spontaneous abortion. Clin Epigenetics 2023; 15:44. [PMID: 36945044 PMCID: PMC10029192 DOI: 10.1186/s13148-023-01432-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/20/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Advanced maternal age (AMA) has increased in many high-income countries in recent decades. AMA is generally associated with a higher risk of various pregnancy complications, and the underlying molecular mechanisms are largely unknown. In the current study, we profiled the DNA methylome of 24 human chorionic villi samples (CVSs) from early pregnancies in AMA and young maternal age (YMA), 11 CVSs from early spontaneous abortion (SA) cases using reduced representation bisulfite sequencing (RRBS), and the transcriptome of 10 CVSs from AMA and YMA pregnancies with mRNA sequencing(mRNA-seq). Single-cell villous transcriptional atlas presented expression patterns of targeted AMA-/SA-related genes. Trophoblast cellular impairment was investigated through the knockdown of GNE expression in HTR8-S/Vneo cells. RESULTS AMA-induced local DNA methylation changes, defined as AMA-related differentially methylated regions (DMRs), may be derived from the abnormal expression of genes involved in DNA demethylation, such as GADD45B. These DNA methylation changes were significantly enriched in the processes involved in NOTCH signaling and extracellular matrix organization and were reflected in the transcriptional alterations in the corresponding biological processes and specific genes. Furthermore, the DNA methylation level of special AMA-related DMRs not only significantly changed in AMA but also showed more excessive defects in CVS from spontaneous abortion (SA), including four AMA-related DMRs whose nearby genes overlapped with AMA-related differentially expressed genes (DEGs) (CDK11A, C19orf71, COL5A1, and GNE). The decreased DNA methylation level of DMR near GNE was positively correlated with the downregulated expression of GNE in AMA. Single-cell atlas further revealed comparatively high expression of GNE in the trophoblast lineage, and knockdown of GNE in HTR8-S/Vneo cells significantly impaired cellular proliferation and migration. CONCLUSION Our study provides valuable resources for investigating AMA-induced epigenetic abnormalities and provides new insights for explaining the increased risks of pregnancy complications in AMA pregnancies.
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Affiliation(s)
- Meng Qin
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, 100191, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, 100191, China
| | - Wei Chen
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, 100191, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, 100191, China
| | - Lingyue Hua
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, 100191, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, 100191, China
| | - Yan Meng
- Department of Obstetrics and Gynecology, Beijing Jishuitan Hospital, Beijing, 100096, China
| | - Jing Wang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, 100191, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, 100191, China
| | - Hanna Li
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, 100191, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, 100191, China
| | - Rui Yang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, 100191, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, 100191, China
| | - Liying Yan
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China.
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, 100191, China.
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China.
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, 100191, China.
- National Center for Healthcare Quality Management in Obstetrics, Beijing, 100191, China.
| | - Jie Qiao
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China.
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, 100191, China.
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China.
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, 100191, China.
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China.
- Beijing Advanced Innovation Center for Genomics, Beijing, 100871, China.
- Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, 100871, China.
- Research Units of Comprehensive Diagnosis and Treatment of Oocyte Maturation Arrest, Beijing Jishuitan Hospital, Beijing, 100191, China.
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11
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St Clair LA, Eldesouki RE, Sachithanandham J, Yin A, Fall A, Morris CP, Norton JM, Forman M, Abdullah O, Dhakal S, Barranta C, Golding H, Bersoff-Matcha SJ, Pilgrim-Grayson C, Berhane L, Cox AL, Burd I, Pekosz A, Mostafa HH, Klein EY, Klein SL. Reduced control of SARS-CoV-2 infection is associated with lower mucosal antibody responses in pregnant women. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.19.23287456. [PMID: 36993216 PMCID: PMC10055594 DOI: 10.1101/2023.03.19.23287456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Importance Pregnant women are at increased risk of severe COVID-19, but the contribution of viral RNA load, the presence of infectious virus, and mucosal antibody responses remain understudied. Objective To evaluate the association of COVID-19 outcomes following confirmed infection with vaccination status, mucosal antibody responses, infectious virus recovery and viral RNA levels in pregnant compared with non-pregnant women. Design A retrospective observational cohort study of remnant clinical specimens from SARS-CoV-2 infected patients between October 2020-May 2022. Setting Five acute care hospitals within the Johns Hopkins Health System (JHHS) in the Baltimore, MD-Washington, DC area. Participants Participants included confirmed SARS-CoV-2 infected pregnant women and matched non-pregnant women (matching criteria included age, race/ethnicity, and vaccination status). Exposure SARS-CoV-2 infection, with documentation of SARS-CoV-2 mRNA vaccination. Main Outcomes The primary dependent measures were clinical COVID-19 outcomes, infectious virus recovery, viral RNA levels, and mucosal anti-spike (S) IgG titers from upper respiratory tract samples. Clinical outcomes were compared using odds ratios (OR), and measures of virus and antibody were compared using either Fisher's exact test, two-way ANOVA, or regression analyses. Results were stratified according to pregnancy, vaccination status, maternal age, trimester of pregnancy, and infecting SARS-CoV-2 variant. Resultss A total of 452 individuals (117 pregnant and 335 non-pregnant) were included in the study, with both vaccinated and unvaccinated individuals represented. Pregnant women were at increased risk of hospitalization (OR = 4.2; CI = 2.0-8.6), ICU admittance, (OR = 4.5; CI = 1.2-14.2), and of being placed on supplemental oxygen therapy (OR = 3.1; CI =13-6.9). An age-associated decrease in anti-S IgG titer and corresponding increase in viral RNA levels (P< 0.001) was observed in vaccinated pregnant, but not non-pregnant, women. Individuals in their 3rd trimester had higher anti-S IgG titers and lower viral RNA levels (P< 0.05) than those in their 1st or 2nd trimesters. Pregnant individuals experiencing breakthrough infections due to the omicron variant had reduced anti-S IgG compared to non-pregnant women (P< 0.05). Conclusions and Relevance In this cohort study, vaccination status, maternal age, trimester of pregnancy, and infecting SARS-CoV-2 variant were each identified as drivers of differences in mucosal anti-S IgG responses in pregnant compared with non-pregnant women. Observed increased severity of COVID-19 and reduced mucosal antibody responses particularly among pregnant participants infected with the Omicron variant suggest that maintaining high levels of SARS-CoV-2 immunity may be important for protection of this at-risk population.
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Affiliation(s)
- Laura A St Clair
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Raghda E Eldesouki
- Department of Pathology, Division of Medical Microbiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Medical Genetics Unit, Histology Department, School of Medicine, Suez Canal University, Egypt
| | - Jaiprasath Sachithanandham
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anna Yin
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amary Fall
- Department of Pathology, Division of Medical Microbiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C Paul Morris
- Department of Pathology, Division of Medical Microbiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, USA
| | - Julie M Norton
- Department of Pathology, Division of Medical Microbiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael Forman
- Department of Pathology, Division of Medical Microbiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Omar Abdullah
- Department of Pathology, Division of Medical Microbiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Santosh Dhakal
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Caelan Barranta
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hana Golding
- Division of Viral Products, Center of Biologics Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | | | - Catherine Pilgrim-Grayson
- Division of Urology, Obstetrics, and Gynecology; Office of Rare Diseases, Pediatrics, Urologic and Reproductive Medicine; Office of New Drugs; Center for Drug Evaluation and Research; U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Leah Berhane
- Division of Urology, Obstetrics, and Gynecology; Office of Rare Diseases, Pediatrics, Urologic and Reproductive Medicine; Office of New Drugs; Center for Drug Evaluation and Research; U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Andrea L Cox
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Bloomberg Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Irina Burd
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew Pekosz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Heba H Mostafa
- Department of Pathology, Division of Medical Microbiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eili Y Klein
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Center for Disease Dynamics, Economics, and Policy, Washington DC, USA
| | - Sabra L Klein
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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12
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Lu L, He L, Hu J, Li J. Association between very advanced maternal age women with gestational diabetes mellitus and the risks of adverse infant outcomes: a cohort study from the NVSS 2014-2019. BMC Pregnancy Childbirth 2023; 23:158. [PMID: 36899316 PMCID: PMC9999489 DOI: 10.1186/s12884-023-05449-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 02/15/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND To evaluate the association between gestational diabetes mellitus (GDM) and infant outcomes in women of very advanced maternal age (vAMA) (≥45 years). METHODS This cohort study utilized data from the National Vital Statistics System (NVSS) database (2014-2019) in the United States. Preterm birth was the primary outcome, which was subdivided into extremely preterm, very preterm, and moderate or late preterm. The secondary outcomes were neonatal intensive care unit (NICU) admission, low birthweight and small for gestational age. Univariate and multivariate logistic regression analyses were used to explore the association between GDM and infant outcomes among vAMA women. Subgroup analyses were performed based on race and use of infertility treatment. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. RESULTS A total of 52,544 vAMA pregnant women were included. All analysis made comparisons between women with vAMA and GDM and women with vAMA and no GDM. Women with GDM had a significantly higher risk of preterm birth than those without GDM (OR = 1.26, 95%CI = 1.18-1.36, P < 0.001). Compared with women without GDM, those with GDM had a significantly increased risk of moderate or late preterm birth (OR = 1.27, 95%CI = 1.18-1.37, P < 0.001); no significant association of GDM with extremely preterm birth and very preterm birth was observed. Women with GDM had a significantly greater risk of NICU admission than those without (OR = 1.33, 95%CI = 1.23-1.43, P < 0.001). GDM was associated with a significantly lower risk of low birthweight (OR = 0.91, 95%CI = 0.84-0.98, P = 0.010), and no significant association was found between GDM and small for gestational age (OR = 0.95, 95%CI = 0.87-1.03, P = 0.200) in vAMA women. CONCLUSION vAMA women with GDM had an increased risk of preterm birth, especially moderate or late preterm birth. NICU admission and low birthweight were also associated with GDM among vAMA women.
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Affiliation(s)
- Lin Lu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Fujian Medical University, No.20 Chazhong Road, Taijiang District, Fuzhou, 350005, Fujian, China
| | - Lidan He
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Fujian Medical University, No.20 Chazhong Road, Taijiang District, Fuzhou, 350005, Fujian, China
| | - Jifen Hu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Fujian Medical University, No.20 Chazhong Road, Taijiang District, Fuzhou, 350005, Fujian, China
| | - Jianhua Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Fujian Medical University, No.20 Chazhong Road, Taijiang District, Fuzhou, 350005, Fujian, China.
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13
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Dai J, Shi Y, Wu Y, Guo L, Lu D, Chen Y, Wang Y, Lai H, Kong X. The interaction between age and parity on adverse pregnancy and neonatal outcomes. Front Med (Lausanne) 2023; 10:1056064. [PMID: 36910494 PMCID: PMC9995429 DOI: 10.3389/fmed.2023.1056064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
Background Although age and parity are recognized as associated factors for adverse pregnancy outcomes, there are no studies exploring the interaction between the two during pregnancy. This study aimed to investigate the impact of the interaction between age and parity on adverse pregnancy outcomes. Methods This was a retrospective cohort study with 15,861 women aged ≥20 years. All women were grouped according to age, parity, and a mix of the two. The data were analyzed using multivariate logistic regression analysis. Results Age, parity, and interaction between the two were related with the risk of gestational hypertension, eclampsia/pre-eclampsia, placenta previa, placental implantation, postpartum hemorrhage, preterm birth, cesarean section, and Apgar score <7 within 5 min of birth. The risk of gestational diabetes mellitus and transfer to the neonatal unit was linked with age and the interaction between age and parity, but the impact of parity was not statistically significant. The risk of anemia, placental abruption, premature rupture of the membrane, oligohydramnios, and macrosomia was only associated with parity; the risk of fetal distress was only associated with age. Conclusion The interaction between advanced age and parity might results in more adverse outcomes for both puerpera and infants, necessitating additional prenatal screening and health education throughout pregnancy.
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Affiliation(s)
- Jiayang Dai
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China.,Department of Obstetrics and Gynecology, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Ya Shi
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China.,School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Yinshuang Wu
- Graduate School of Dalian Medical University, Dalian, China
| | - Lu Guo
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China
| | - Dan Lu
- Department of Obstetrics and Gynecology, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu Province, China.,Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, Jiangsu Province, China.,Jiangsu Key Laboratory of Experimental & Translational Non-Coding RNA Research, Yangzhou, Jiangsu Province, China
| | - Ying Chen
- Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yuanyuan Wang
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China
| | - Hanpeng Lai
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China
| | - Xiang Kong
- Department of Obstetrics and Gynecology, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu Province, China.,Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, Jiangsu Province, China.,Jiangsu Key Laboratory of Experimental & Translational Non-Coding RNA Research, Yangzhou, Jiangsu Province, China
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14
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Kappas C. Pregnancy and medical radiation. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2022.110478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Orellana J, Jacques N, Leventhal DGP, Marrero L, Morón-Duarte LS. Excess maternal mortality in Brazil: Regional inequalities and trajectories during the COVID-19 epidemic. PLoS One 2022; 17:e0275333. [PMID: 36264994 PMCID: PMC9584504 DOI: 10.1371/journal.pone.0275333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 09/14/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has exceeded 6 million known disease-related deaths and there is evidence of an increase in maternal deaths, especially in low- and middle-income countries. We aimed to estimate excess maternal deaths in Brazil and its macroregions as well as their trajectories in the first 15 months of the COVID-19 epidemic. METHODS This study evaluated maternal deaths from the Mortality Information System of the Ministry of Health, with excess deaths being assessed between March 2020 and May 2021 by quasi-Poisson generalized additive models adjusted for overdispersion. Observed deaths were compared to deaths expected without the pandemic, accompanied by 95% confidence intervals according to region, age group, and trimester of occurrence. Analyses were conducted in R version 3.6.1 and RStudio version 1.2.1335. RESULTS There were 3,291 notified maternal deaths during the study period, resulting in a 70% excess of deaths regardless of region, while in the North, Northeast, South and Southeast regions, excess deaths occurred regardless of age group. Excess deaths occurred in the March-May 2021 trimester regardless of region and age group. Excess deaths were observed in the Southeast region for the 25-36-year-old age group regardless of the trimester assessed, and in the North, Central-West and South regions, the only period in which excess deaths were not observed was September-November 2020. Excess deaths regardless of trimester were observed in the 37-49-year-old age group in the North region, and the South region displayed explosive behavior from March-May 2021, with a 375% excess of deaths. CONCLUSIONS Excess maternal deaths, with geographically heterogenous trajectories and consistently high patterns at the time of the epidemic's greatest impact, reflect not only the previous effect of socioeconomic inequalities and of limited access to maternal health services, but most of all the precarious management of Brazil's health crisis.
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Affiliation(s)
- Jesem Orellana
- Leônidas and Maria Deane Institute, Oswaldo Cruz Foundation, Manaus, Amazonas, Brazil
- * E-mail:
| | - Nadège Jacques
- Postgraduate Program in Epidemiology, Department of Social Medicine, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | | | - Lihsieh Marrero
- Department of Nursing, Amazonas State University, Manaus, Amazonas, Brazil
| | - Lina Sofía Morón-Duarte
- Global Institute of Clinical Excellence, Keralty, Bogotá, Distrito Capital, Colombia
- Translational Research Group, Sanitas University Foundation, Bogotá, Distrito Capital, Colombia
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16
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Bruinsma A, Keulen JKJ, Kortekaas JC, van Dillen J, Duijnhoven RG, Bossuyt PMM, van Kaam AH, van der Post JAM, Mol BW, de Miranda E. Elective induction of labour and expectant management in late-term pregnancy: A prospective cohort study alongside the INDEX randomised controlled trial. Eur J Obstet Gynecol Reprod Biol X 2022; 16:100165. [PMID: 36262791 PMCID: PMC9574420 DOI: 10.1016/j.eurox.2022.100165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/21/2022] [Accepted: 10/01/2022] [Indexed: 11/06/2022] Open
Abstract
Objective To assess adverse perinatal outcomes and caesarean section of low-risk women receiving elective induction of labour at 41 weeks or expectant management until 42 weeks according to their preferred and actual management strategy. Design Multicentre prospective cohort study alongside RCT. Setting 90 midwifery practices and 12 hospitals in the Netherlands. Population 3642 low-risk women with uncomplicated singleton late-term pregnancy. Main outcome measures Composite adverse outcome (perinatal death, Apgar score 5′ < 7, NICU admission, meconium aspiration syndrome), composite severe adverse perinatal outcome (all above with Apgar score 5′ < 4 instead of < 7) and caesarean section. Results From 2012–2016, 3642 women out of 6088 eligible women for the INDEX RCT, participated in the cohort study for observational data collection (induction of labour n = 372; expectant management n = 2174; unknown preference/management strategy n = 1096). Adverse perinatal outcome occurred in 1.1 % (4/372) in the induction group versus 1.9 % (42/2174) in the expectant group (adjRR 0.56; 95 %CI: 0.17–1.79), with severe adverse perinatal outcome occurring in 0.3 % (1/372) versus 1.0 % (22/2174), respectively (adjRR 0.39; 95 % CI: 0.05–2.88). There were no stillbirths among all 3642 women; one neonatal death occurred in the unknown preference/management group. Caesarean section rates were 10.5 % (39/372) after induction and 8.9 % (193/2174) after expectant management (adjRR 1.32; 95 % CI: 0.95–1.84). A higher incidence of adverse perinatal outcome was observed in nulliparous compared to multiparous women. Nulliparous 1.8 % (3/170) in the induction group versus 2.6 % (30/1134) in the expectant management group (adjRR 0.58; 95 % CI 0.14–2.41), multiparous 0.5 % (1/201) versus 1.1 % (11/1039) (adjRR 0.54; 95 % CI 0.07–24.19). One maternal death due to amniotic fluid embolism occurred after elective induction at 41 weeks + 6 days. Conclusion In this cohort study among low-risk women receiving the policy of their preference in late-term pregnancy, a non-significant difference was found between induction of labour at 41 weeks and expectant management until 42 weeks in absolute risks of composite adverse (1.1 % versus 1.9 %) and severe adverse (0.3 % versus 1.0 %) perinatal outcome. The risks in this cohort study were lower than in the trial setting. There were no stillbirths among all 3642 women. Caesarean section rates were comparable. No stillbirths in late-term pregnancy (IOL or EM) of 3642 women in INDEX-cohort. Less adverse perinatal outcomes in INDEX-cohort than in trial with comparable risk difference. More women approaching late-term pregnancy prefer EM, not elective induction.
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Affiliation(s)
- Aafke Bruinsma
- Amsterdam UMC, University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Meibergdreef 9, Amsterdam, the Netherlands,Rotterdam University of Applied Sciences, School of Midwifery, Rochussenstraat 198, Rotterdam, the Netherlands,Corresponding author at: Amsterdam UMC, University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Judit KJ Keulen
- Amsterdam UMC, University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Meibergdreef 9, Amsterdam, the Netherlands,Zuyd University, Research Center for Midwifery Science, Faculty Midwifery Education & Studies Maastricht, Universiteitssingel 60, Maastricht, the Netherlands
| | - Joep C Kortekaas
- Elkerliek Medical Center, Department of Obstetrics & Gynaecology, Wesselmanlaan 25, Helmond, the Netherlands
| | - Jeroen van Dillen
- Radboud University Medical Center, Department of Obstetrics & Gynaecology, Geert Grooteplein Zuid 10, Nijmegen, the Netherlands
| | - Ruben G Duijnhoven
- Amsterdam UMC, University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Meibergdreef 9, Amsterdam, the Netherlands
| | - Patrick MM Bossuyt
- Amsterdam UMC, University of Amsterdam, Department of Epidemiology & Data Science, Meibergdreef 9, Amsterdam, the Netherlands
| | - Anton H van Kaam
- Amsterdam UMC, University of Amsterdam, Emma, Children’s hospital, Department of Neonatology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Joris AM van der Post
- Amsterdam UMC, University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Meibergdreef 9, Amsterdam, the Netherlands
| | - Ben W Mol
- Monash University, Department of Obstetrics and Gynaecology, 246 Clayton Road, Clayton, Victoria, Australia,University of Aberdeen, Aberdeen Centre for Women's Health Research, School of Medicine, Medical Sciences and Nutrition, AB24 3FX Aberdeen, UK
| | - Esteriek de Miranda
- Amsterdam UMC, University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Meibergdreef 9, Amsterdam, the Netherlands
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17
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Zhang C, Yan L, Qiao J. Effect of advanced parental age on pregnancy outcome and offspring health. J Assist Reprod Genet 2022; 39:1969-1986. [PMID: 35925538 PMCID: PMC9474958 DOI: 10.1007/s10815-022-02533-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/24/2021] [Indexed: 10/16/2022] Open
Abstract
PURPOSE Fertility at advanced age has become increasingly common, but the aging of parents may adversely affect the maturation of gametes and the development of embryos, and therefore the effects of aging are likely to be transmitted to the next generation. This article reviewed the studies in this field in recent years. METHODS We searched the relevant literature in recent years with the keywords of "advanced maternal/paternal age" combined with "adverse pregnancy outcome" or "birth defect" in the PubMed database and classified the effects of parental advanced age on pregnancy outcomes and birth defects. Related studies on the effect of advanced age on birth defects were classified as chromosomal abnormalities, neurological and psychiatric disorders, and other systemic diseases. The effect of assisted reproduction technology (ART) on fertility in advanced age was also discussed. RESULTS Differences in the definition of the range of advanced age and other confounding factors among studies were excluded, most studies believed that advanced parental age would affect pregnancy outcomes and birth defects in offspring. CONCLUSION To some extent, advanced parental age caused adverse pregnancy outcomes and birth defects. The occurrence of these results was related to the molecular genetic changes caused by aging, such as gene mutations, epigenetic variations, etc. Any etiology of adverse pregnancy outcomes and birth defects related to aging might be more than one. The detrimental effect of advanced age can be corrected to some extent by ART.
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Affiliation(s)
- Cong Zhang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49, North garden road, Haidian district, Beijing, 100191, People's Republic of China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, 100191, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, 100191, China
- Research Units of Comprehensive Diagnosis and Treatment of Oocyte Maturation Arrest (Chinese Academy of Medical Sciences), Beijing, 100191, China
- Savid Medical College (University of Chinese Academy of Sciences), Beijing, 100049, China
| | - Liying Yan
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49, North garden road, Haidian district, Beijing, 100191, People's Republic of China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, 100191, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, 100191, China
- Research Units of Comprehensive Diagnosis and Treatment of Oocyte Maturation Arrest (Chinese Academy of Medical Sciences), Beijing, 100191, China
| | - Jie Qiao
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49, North garden road, Haidian district, Beijing, 100191, People's Republic of China.
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, 100191, China.
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China.
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, 100191, China.
- Research Units of Comprehensive Diagnosis and Treatment of Oocyte Maturation Arrest (Chinese Academy of Medical Sciences), Beijing, 100191, China.
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Setti AS, Braga DPDAF, Guilherme P, Vingris L, Iaconelli A, Borges E. Paternal ageing impacts blastulation and the outcomes of pregnancy at different levels of maternal age: A clustering analysis of 21,960 oocytes and 3837 ICSI cycles. Andrologia 2022; 54:e14485. [PMID: 35698244 DOI: 10.1111/and.14485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/20/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022] Open
Abstract
The objective of this cross-sectional study was to investigate the impact of paternal age on the outcomes of intracytoplasmic sperm injection (ICSI) cycles at different values of maternal age. A total of 21,960 injected oocytes deriving from 3837 ICSI cycles performed between January 2014 and October 2020, performed in a private university-affiliated in vitro fertilization centre was included. The main effects of maternal and paternal age, as well as the effect of their product (interaction term) on embryo development and pregnancy outcomes were investigated considering the clustering of data. The coefficients for the interaction term were statistically significant for blastocyst development, top-quality blastocyst, implantation, pregnancy, miscarriage, and live-birth rates. For every 1-year increase in paternal age, the odds ratio of live-birth reduces by 1% in females aged 37 years, 1.6% in those aged 38 years, 2.4% in 39-year-old females, 5% in 42-year-old females and so on. An increase in the interaction term by 1 year decreases the pregnancy rate by 0.4% and live-birth rate by 0.8 and increases the miscarriage rate by 1.2%. The slopes of maternal age on blastulation, blastocyst quality, and implantation, pregnancy, miscarriage, and live-birth rate significantly changed (worsened) for every year increase in paternal age.
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Affiliation(s)
- Amanda Souza Setti
- Fertility Medical Group, São Paulo, Brazil.,Sapientiae Institute - Centro de Estudos e Pesquisa em Reprodução Humana Assistida, São Paulo, Brazil
| | | | | | | | - Assumpto Iaconelli
- Fertility Medical Group, São Paulo, Brazil.,Sapientiae Institute - Centro de Estudos e Pesquisa em Reprodução Humana Assistida, São Paulo, Brazil
| | - Edson Borges
- Fertility Medical Group, São Paulo, Brazil.,Sapientiae Institute - Centro de Estudos e Pesquisa em Reprodução Humana Assistida, São Paulo, Brazil
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Yin Z, Li T, Zhou L, Fei J, Su J, Li D. Optimal delivery time for patients with diet-controlled gestational diabetes mellitus: a single-center real-world study. BMC Pregnancy Childbirth 2022; 22:356. [PMID: 35461241 PMCID: PMC9034608 DOI: 10.1186/s12884-022-04683-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/12/2022] [Indexed: 11/28/2022] Open
Abstract
Background To determine the optimal delivery time for women with diet-controlled gestational diabetes mellitus by comparing differences in adverse maternal–fetal outcome and cesarean section rates. Methods This real-world retrospective study included 1,050 patients with diet-controlled gestational diabetes mellitus who delivered at 35–42 weeks’ gestation. Data on patient characteristics, maternal–fetal outcomes, and cesarean section rate based on fetal gestational age were collected and analyzed. Differences between deliveries with and without iatrogenic intervention were also analyzed. Results The cesarean section rate at ≥ 41 weeks’ gestation was significantly higher than that at 39–39 + 6 weeks (56% vs. 39%, p = 0.031). There were no significant differences in multiple adverse maternal or neonatal outcomes at delivery before and after 39 weeks. Vaginal delivery rates were increased significantly at 39–39 + 6 weeks due to iatrogenic intervention (p = 0.005) and 40–40 + 6 weeks (p = 0.003) in patients without and with spontaneous uterine contractions, respectively. Conclusions It’s recommended that optimal delivery time for patients with diet-controlled gestational diabetes mellitus should be between 39- and 40 + 6 weeks’ gestation. Patients who have Bishop scores higher than 4 can undergo iatrogenic intervention at 39–39 + 6 weeks. However iatrogenic interventions are not recommended for patients with low Bishop scores.
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Affiliation(s)
- Zongzhi Yin
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China. .,Department of Obstetrics and Gynecology, Chaohu Hospital of Anhui Medical University, Chaohu, 238001, China. .,NHC Key Laboratory of the Study of Abnormal Gametes and the Reproductive Tract, Anhui Medical University, Hefei, 230022, China.
| | - Tengteng Li
- Department of Obstetrics and Gynecology, Chaohu Hospital of Anhui Medical University, Chaohu, 238001, China
| | - Lu Zhou
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Jiajia Fei
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Jingjing Su
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Dan Li
- Department of Scientific Research, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, China
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20
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Harrison TM, Morello S, Royal K, Petritz O, Snyder A. Effects of gender on income and family planning for diplomates of the American College of Zoological Medicine. J Am Vet Med Assoc 2022; 260:1-6. [PMID: 34843439 DOI: 10.2460/javma.20.05.0250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate income and family planning decisions of American College of Zoological Medicine (ACZM) diplomates. SAMPLE 98 ACZM diplomates. PROCEDURES An online survey was sent to 201 ACZM diplomates. Participation was voluntary. RESULTS 98 (49%) diplomates responded to the survey. The most commonly reported income categories were $90,000 to $94,999, $100,000 to $104,999, and $110,000 to $114,999. Overall, the mean of the salary-category midpoint responses was $105,357 but was $122,917 for those in academia and $94,508 for those working in zoos and aquaria. When incomes of males and females were matched (24 pairs matched for gender and age), no difference in income was observed. There were no significant differences in income between males and females with and without children. Diplomates who did not complete a residency had significantly higher incomes than diplomates who did. Sixteen of 21 (76%) females and 9 of 19 (47%) males reported delaying having children because of their career. Additionally, a higher percentage of females with children (13/20 [65%]) than males with children (3/19 [16%]) felt that having children had had a negative effect on their career. Thirty-five of 41 (85%) females without children and 4 of 9 (44%) males without children thought having children would have negatively affected their careers. CLINICAL RELEVANCE Although substantial differences in income between female and male ACZM diplomates were not identified, differences in family planning and perceptions of the impact of having children on their careers did exist.
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Affiliation(s)
- Tara M Harrison
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
| | - Samantha Morello
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI
| | - Kenneth Royal
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
| | - Olivia Petritz
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
| | - Amy Snyder
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
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21
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Development and external validation of a model for predicting adverse outcomes in women with preeclampsia: A retrospective study from two trans-regional centers in China. Pregnancy Hypertens 2021; 26:133-140. [PMID: 34794010 DOI: 10.1016/j.preghy.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/12/2021] [Accepted: 10/22/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Preeclampsia is a common complication of pregnancy that causes health problems for both the mother and her fetus. This study aimed to develop and externally validate a model to predict adverse outcomes in preeclampsia in a trans-regional two-center retrospective cohort of Chinese women. STUDY DESIGN To generate a model for the risk of women with adverse outcomes, we incorporated candidate variables in the development set in univariate, least absolute shrinkage and selection operator analysis and multivariable logistic regression. The performance of the model was evaluated for the receiver operating characteristic (ROC) curve, calibration and decision curve analysis. Further, we externally validated the model in an independent dataset. MAIN OUTCOME MEASURES Composite adverse outcomes within 48 h of admission. RESULTS There were 1 783 and 116 preeclampsia women in the development and validation set, respectively. The model included 10 predictors: gestational age at admission, irregular prenatal care, number of symptoms, mean arterial pressure, hematocrit, platelet count, fibrinogen, albumin, total bilirubin, and serum urea. The area under the ROC curve of the model was 0.867 in the development set and 0.841 in the external validation set. The calibration plots for the probability of adverse outcomes demonstrated a good correlation. Decision curve analysis further showed that our model had clinical application value. The nomogram and a software-based calculator (https://sdfyyfck.shinyapps.io/preeclampsia/) were constructed for convenient clinical use. CONCLUSIONS Such a model could be used as a useful tool for the assessment of hypertensive-related complications in Chinese preeclampsia patients.
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22
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Huang J, Wang C, Li X, Jing Y. Application of CEEMD noise reduction algorithm in ultrasound imaging in evaluating fetuses with abnormal glucose metabolism in late pregnancy. Pak J Med Sci 2021; 37:1590-1594. [PMID: 34712288 PMCID: PMC8520375 DOI: 10.12669/pjms.37.6-wit.4844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/09/2021] [Accepted: 07/08/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives: To explore the predictive effect of abnormal glucose metabolism and fetal hemodynamic parameters on adverse pregnancy outcome. Methods: One hundred and nine pregnant women with abnormal glucose metabolism during pregnancy from June 2016 to October 2018 were selected and divided into poor prognosis group (34 cases) and good prognosis group (75 cases). The hemodynamic parameters of fetal cerebral artery (MCA), umbilical artery (UA) and uterine artery of pregnancy (UT-A), including peak systolic velocity (s / D), resistance index (RI) and plasticity index (PI), were measured by color Doppler ultrasound. The receiver operating characteristic (ROC) curve of adverse pregnancy outcomes was drawn and the best threshold index was determined. Results: MCA-PI poor prognosis group, MCA-RI, RI ratio (MCA/UA) are lower than the good prognosis group, Ut-A-PI is higher than the good prognosis group (P<0.05,). ROC curve analysis results show that when the MCA-PI 1.56, the sensitivity of the predicted adverse outcomes of pregnancy, the highest specificity<, was 91.18%, 80.00%, respectively. Logistic regression analysis of risk factors shows poor pregnancy outcomes include: pregnant women, older age, body mass index ≥24.0kg/m2 and a family history of diabetes. Protective factors include exercise during pregnancy, MCA-PI≥1.56, MCA-RI≥0.63 and RI The ratio (MCA/UA) ≥0.84. Conclusion: Color Doppler ultrasound measured MCA-PI<1.56 the most important indicators of poor pregnancy outcomes as abnormal glucose metabolism during pregnancy and predict the exact cutoff. Pregnant women, older age, body mass index ≥24.0kg/m2 and a family history of diabetes and abnormal glucose metabolism during pregnancy risk factors for adverse outcomes of pregnancy.
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Affiliation(s)
- Junfeng Huang
- Junfeng Huang, Deputy Chief Nurse. Department of Nursing, Maternal and Child Health Hospital of Jinan City, Jinan City 250001, Shandong Province, China
| | - Cuiting Wang
- Cuiting Wang, Bachelor's Degrees. Department of Obstetrical, Maternal and Child Health Hospital of Jinan City, Jinan City 250001, Shandong Province, China
| | - Xianxia Li
- Xianxia Li, Supervisor nurse. Department of Obstetrical, Maternal and Child Health Hospital of Jinan City, Jinan City 250001, Shandong Province, China
| | - Yuqin Jing
- Yuqin Jing, Supervisor nurse. Department of Surgical, Maternal and Child Health Hospital of Jinan City, Jinan City 250001, Shandong Province, China
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23
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Chico-Sordo L, Córdova-Oriz I, Polonio AM, S-Mellado LS, Medrano M, García-Velasco JA, Varela E. Reproductive aging and telomeres: Are women and men equally affected? Mech Ageing Dev 2021; 198:111541. [PMID: 34245740 DOI: 10.1016/j.mad.2021.111541] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/01/2021] [Accepted: 07/05/2021] [Indexed: 02/06/2023]
Abstract
Successful reproduction is very important for individuals and for society. Currently, the human health span and lifespan are the object of intense and productive investigation with great achievements, compared to the last century. However, reproduction span does not progress concomitantly with lifespan. Reproductive organs age, decreasing the levels of sexual hormones, which are protectors of health through their action on several organs of the body. Thus, this is the starting point of the organismal decay and infertility. This starting point is easily detected in women. In men, it goes under the surface, undetected, but it goes, nevertheless. Regarding fertility, aging alters the hormonal equilibrium, decreases the potential of reproductive organs, diminishes the quality of the gametes and worsen the reproductive outcomes. All these events happen at a different pace and affecting different organs in women and men. The question is what molecular pathways are involved in reproductive aging and if there is a possible halting or even reversion of the aging events. Answers to all these points will be explained in the present review.
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Affiliation(s)
- Lucía Chico-Sordo
- IVI Foundation, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain.
| | - Isabel Córdova-Oriz
- IVI Foundation, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain.
| | - Alba María Polonio
- IVI Foundation, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain.
| | - Lucía Sánchez S-Mellado
- IVI Foundation, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain.
| | - Marta Medrano
- IVI Foundation, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain; IVIRMA Madrid, Spain.
| | - Juan Antonio García-Velasco
- IVI Foundation, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain; IVIRMA Madrid, Spain; Rey Juan Carlos University, Madrid, Spain.
| | - Elisa Varela
- IVI Foundation, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain; Rey Juan Carlos University, Madrid, Spain.
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Chen Z, Xiong L, Jin H, Yu J, Li X, Fu H, Wen L, Qi H, Tong C, Saffery R, Kilby MD, Baker PN. Advanced maternal age causes premature placental senescence and malformation via dysregulated α-Klotho expression in trophoblasts. Aging Cell 2021; 20:e13417. [PMID: 34105233 PMCID: PMC8282245 DOI: 10.1111/acel.13417] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 12/20/2022] Open
Abstract
Advanced maternal age (AMA) pregnancy is associated with higher risks of adverse perinatal outcomes, which may result from premature senescence of the placenta. α-Klotho is a well-known antiaging protein; however, its expression and effect on the placenta in AMA pregnancies have not yet been fully elucidated. The expression patterns of α-Klotho in mouse and human placentas from AMA pregnancies were determined by Western blotting and immunohistochemistry (IHC) staining. α-Klotho expression in JAR cells was manipulated to investigate its role in trophoblastic senescence, and transwell assays were performed to assess trophoblast invasion. The downstream genes regulated by α-Klotho in JAR cells were first screened by mRNA sequencing in α-Klotho-knockdown and control JAR cells and then validated. α-Klotho-deficient mice were generated by injecting klotho-interfering adenovirus (Ad-Klotho) via the tail vein on GD8.5. Ablation of α-Klotho resulted in not only a senescent phenotype and loss of invasiveness in JAR cells but also a reduction in the transcription of cell adhesion molecule (CAM) genes. Overexpression of α-Klotho significantly improved invasion but did not alter the expression of senescence biomarkers. α-Klotho-deficient mice exhibited placental malformation and, consequently, lower placental and fetal weights. In conclusion, AMA results in reduced α-Klotho expression in placental trophoblasts, therefore leading to premature senescence and loss of invasion (possibly through the downregulation of CAMs), both of which ultimately result in placental malformation and adverse perinatal outcomes.
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Affiliation(s)
- Zhi Chen
- Department of ObstetricsThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- State Key Laboratory of Maternal and Fetal Medicine of Chongqing MunicipalityChongqing Medical UniversityChongqingChina
- International Collaborative Laboratory of Reproduction and Development of Chinese Ministry of EducationChongqing Medical UniversityChongqingChina
| | - Liling Xiong
- Department of ObstetricsThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- State Key Laboratory of Maternal and Fetal Medicine of Chongqing MunicipalityChongqing Medical UniversityChongqingChina
- International Collaborative Laboratory of Reproduction and Development of Chinese Ministry of EducationChongqing Medical UniversityChongqingChina
| | - Huili Jin
- Department of ObstetricsThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- State Key Laboratory of Maternal and Fetal Medicine of Chongqing MunicipalityChongqing Medical UniversityChongqingChina
- International Collaborative Laboratory of Reproduction and Development of Chinese Ministry of EducationChongqing Medical UniversityChongqingChina
| | - Jiaxiao Yu
- Department of ObstetricsThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- State Key Laboratory of Maternal and Fetal Medicine of Chongqing MunicipalityChongqing Medical UniversityChongqingChina
- International Collaborative Laboratory of Reproduction and Development of Chinese Ministry of EducationChongqing Medical UniversityChongqingChina
| | - Xin Li
- Department of ObstetricsThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- State Key Laboratory of Maternal and Fetal Medicine of Chongqing MunicipalityChongqing Medical UniversityChongqingChina
- International Collaborative Laboratory of Reproduction and Development of Chinese Ministry of EducationChongqing Medical UniversityChongqingChina
| | - Huijia Fu
- Department of ObstetricsThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- State Key Laboratory of Maternal and Fetal Medicine of Chongqing MunicipalityChongqing Medical UniversityChongqingChina
- International Collaborative Laboratory of Reproduction and Development of Chinese Ministry of EducationChongqing Medical UniversityChongqingChina
| | - Li Wen
- Department of ObstetricsThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- State Key Laboratory of Maternal and Fetal Medicine of Chongqing MunicipalityChongqing Medical UniversityChongqingChina
- International Collaborative Laboratory of Reproduction and Development of Chinese Ministry of EducationChongqing Medical UniversityChongqingChina
| | - Hongbo Qi
- Department of ObstetricsThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- State Key Laboratory of Maternal and Fetal Medicine of Chongqing MunicipalityChongqing Medical UniversityChongqingChina
- International Collaborative Laboratory of Reproduction and Development of Chinese Ministry of EducationChongqing Medical UniversityChongqingChina
| | - Chao Tong
- Department of ObstetricsThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- State Key Laboratory of Maternal and Fetal Medicine of Chongqing MunicipalityChongqing Medical UniversityChongqingChina
- International Collaborative Laboratory of Reproduction and Development of Chinese Ministry of EducationChongqing Medical UniversityChongqingChina
| | - Richard Saffery
- International Collaborative Laboratory of Reproduction and Development of Chinese Ministry of EducationChongqing Medical UniversityChongqingChina
- Cancer, Disease and Developmental epigenetics, Murdoch Children's Research InstituteRoyal Children's HospitalMelbourneVICAustralia
| | - Mark D. Kilby
- Centre for Women's and Newborn HealthInstitute of Metabolism and Systems ResearchUniversity of BirminghamBirminghamUK
| | - Philip N. Baker
- International Collaborative Laboratory of Reproduction and Development of Chinese Ministry of EducationChongqing Medical UniversityChongqingChina
- College of Life SciencesUniversity of LeicesterLeicesterUK
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25
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Kim SH, Kim S, Park B, Lee S, Park S, Jeong GH, Kim KW, Kang SJ. Comparison of the number of live births, maternal age at childbirth, and weight of live births between Korean women and immigrant women in 2018. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2021; 27:40-48. [PMID: 36311989 PMCID: PMC9334167 DOI: 10.4069/kjwhn.2021.03.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 12/21/2022] Open
Abstract
Purpose This study compared maternal age at childbirth, the number of live births, and the weight of live births between Korean women and immigrant women using statistical data from the Republic of Korea for the period of 2008-2018. Methods The analysis was conducted using data from the Microdata Integrated Service of Statistics Korea (https://mdis.kostat.go.kr/index.do). Results Korean women and immigrant women showed a higher age at childbirth in 2018 than in 2008. The percentage of newborns of Korean women with a birth weight of less than 2.5 kg increased slightly for 3 consecutive years from 2016 to 2018, whereas for immigrant women, this percentage increased in 2017 compared to 2016 and then decreased again in 2018. Very low birth weight (less than 1.5 kg) became more common among immigrant women from 2016 to 2018. Birth at a gestational age of fewer than 37 weeks increased both among Korean and immigrant women from 2016 to 2018. In both groups, the percentage of women who had their first child within their first 2 years of marriage decreased from 2008 to 2018. Conclusion Immigrant women had higher birth rates than Korean women, while both groups showed an increasing trend in preterm birth. Greater attention should be paid to the pregnancy and birth needs of immigrant women, and steps are needed to ensure health equity and access in order to prevent preterm births. It is also necessary to identify factors that affect preterm birth and birth of very low birth weight infants among immigrant women in the future.
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Affiliation(s)
- Sun-Hee Kim
- College of Nursing, Daegu Catholic University, Daegu, Korea
| | - Sooyoung Kim
- Vital Statistics Division, Statistics Korea, Daejeon, Korea
| | - Byeongje Park
- Vital Statistics Division, Statistics Korea, Daejeon, Korea
| | - Seokmin Lee
- Vital Statistics Division, Statistics Korea, Daejeon, Korea
| | - Sanghee Park
- Vital Statistics Division, Statistics Korea, Daejeon, Korea
| | - Geum Hee Jeong
- School of Nursing and Research Institute in Nursing Science, Hallym University, Chuncheon, Korea
| | - Kyung Won Kim
- Department of Nursing, Daegu Haany University, Daegu, Korea
| | - Sook Jung Kang
- College of Nursing, Ewha Womans University, Seoul, Korea
- Corresponding author: Sook Jung Kang, College of Nursing, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea Tel: +82-02-3277-2882 E-mail:
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26
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Bi S, Zhang L, Chen J, Huang M, Huang L, Zeng S, Li Y, Liang Y, Jia J, Wen S, Cao Y, Wang S, Xu X, Feng L, Zhao X, Zhao Y, Zhu Q, Qi H, Zhang L, Li H, Wang Z, Du L, Chen D. Maternal age at first cesarean delivery related to adverse pregnancy outcomes in a second cesarean delivery: a multicenter, historical, cross-sectional cohort study. BMC Pregnancy Childbirth 2021; 21:126. [PMID: 33579220 PMCID: PMC7881558 DOI: 10.1186/s12884-021-03608-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 01/31/2021] [Indexed: 12/18/2022] Open
Abstract
Background To determine the effects of maternal age at first cesarean on maternal complications and adverse outcomes of pregnancy with the second cesarean. Methods This was a multicenter, historical, cross-sectional cohort study involving singleton pregnancies ≥28 gestational weeks, with a history of 1 cesarean delivery, and who underwent a second cesarean between January and December 2017 at 11 public tertiary hospitals in 7 provinces of China. We analyzed the effects of maternal age at first cesarean on adverse outcomes of pregnancy in the second cesarean using multivariate logistic regression analysis. Results The study consisted of 10,206 singleton pregnancies. Women were at first cesarean between 18 and 24, 25–29, 30–34, and ≥ 35 years of age; and numbered 2711, 5524, 1751, and 220 cases, respectively. Maternal age between 18 and 24 years at first cesarean increased the risk of placenta accreta spectrum (aOR, 1.499; 95% CI, 1.12–2.01), placenta previa (aOR, 1.349; 95% CI, 1.07–1.70), intrahepatic cholestasis of pregnancy (aOR, 1.947; 95% CI, 1.24–3.07), postpartum hemorrhage (aOR, 1.505; 95% CI, 1.05–2.16), and blood transfusion (aOR, 1.517; 95% CI, 1.21–1.91) in the second cesarean compared with the reference group (aged 25–29 years). In addition, maternal age ≥ 35 years at first cesarean was a risk factor for premature rupture of membranes (aOR, 1.556; 95% CI, 1.08–2.24), placental abruption (aOR, 6.464, 95% CI, 1.33–31.51), uterine rupture (aOR, 7.952; 95% CI, 1.43–44.10), puerperal infection (aOR, 6.864; 95% CI, 1.95–24.22), neonatal mild asphyxia (aOR, 4.339; 95% CI, 1.53–12.32), severe asphyxia (aOR, 18.439; 95% CI, 1.54–220.95), and admission to a neonatal intensive care unit (aOR, 2.825; 95% CI, 1.54–5.17) compared with the reference group (aged 25–29 years). Conclusions Maternal age between 18 and 24 years or advanced maternal age at first cesarean was an independent risk factor for adverse maternal outcomes with the second cesarean. Advanced maternal age at the first cesarean specifically increased adverse neonatal outcomes with the second. Therefore, decisions as to whether to perform a first cesarean at a young or advanced maternal age must be critically evaluated. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03608-9.
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Affiliation(s)
- Shilei Bi
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Guangzhou, 510150, Guangdong, China
| | - Lizi Zhang
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave North, Guangzhou, 510515, Guangdong, China
| | - Jingsi Chen
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Guangzhou, 510150, Guangdong, China.,Key Laboratory for Major Obstetric Diseases of Guangdong Province, Guangzhou, People's Republic of China.,Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institutes, Guangzhou, People's Republic of China
| | - Minshan Huang
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Guangzhou, 510150, Guangdong, China
| | - Lijun Huang
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Guangzhou, 510150, Guangdong, China
| | - Shanshan Zeng
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Guangzhou, 510150, Guangdong, China
| | - Yulian Li
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Guangzhou, 510150, Guangdong, China
| | - Yingyu Liang
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Guangzhou, 510150, Guangdong, China
| | - Jinping Jia
- Department of Obstetrics and Gynecology, Guangzhou Huadu District Maternal and Child Health Hospital, Guangzhou, China
| | - Suiwen Wen
- Department of Obstetrics and Gynecology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Guangzhou, China
| | - Yinli Cao
- Department of Obstetrics and Gynecology, Northwest Women's and Children's Hospital, Xian, China
| | - Shaoshuai Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyan Xu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ling Feng
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xianlan Zhao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yangyu Zhao
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Qiying Zhu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Hongbo Qi
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lanzhen Zhang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hongtian Li
- Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China
| | - Zhijian Wang
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave North, Guangzhou, 510515, Guangdong, China.
| | - Lili Du
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Guangzhou, 510150, Guangdong, China. .,Key Laboratory for Major Obstetric Diseases of Guangdong Province, Guangzhou, People's Republic of China. .,Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institutes, Guangzhou, People's Republic of China.
| | - Dunjin Chen
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Guangzhou, 510150, Guangdong, China. .,Key Laboratory for Major Obstetric Diseases of Guangdong Province, Guangzhou, People's Republic of China. .,Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institutes, Guangzhou, People's Republic of China.
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27
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Ferrari DVDJ, Polettini J, de Moraes LL, de Campos LA, da Silva MG, Saeki EK, Morceli G. Profile of pro-inflammatory cytokines in colostrum of nursing mothers at the extremes of reproductive age. PLoS One 2020; 15:e0231882. [PMID: 32544178 PMCID: PMC7297348 DOI: 10.1371/journal.pone.0231882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 04/02/2020] [Indexed: 01/02/2023] Open
Abstract
Gestations at the extremes of reproductive age are characterized as high-risk pregnancies, conditions that might influence colostrum composition. This first milk secretion contains nutrients necessary for the development and immunity of the newborn; therefore, this study aims to compare adolescent and advanced maternal age mothers regarding sociodemographic, gestational, and perinatal characteristics and the colostrum levels of pro-inflammatory cytokines in these groups of study. This cross-sectional study has compared sociodemographic, gestational and perinatal data from adolescent mothers (between 10 and 24 years old) (n = 117), advanced maternal age mothers (over 35 years of age) (n = 39) and mothers considered a control group (25 to 34 years old) (n = 58). Additionally, colostrum samples were obtained from the studied and control group subjects by manual milking, between 48 and 72 hours postpartum, and the samples were analyzed for cytokine concentrations by enzyme-linked immunosorbent assay (ELISA). The majority of the studied mothers reported living a stable union, and 81.2% of the adolescent mothers did not carry out any paid activity. Mothers with advanced maternal age mainly delivered by cesarean section and presented a higher body mass index (BMI). Neonatal weight and Apgar score were not different between the groups. The concentrations of interleukin (IL)-1β and IL-6 were higher in the colostrum of mothers with advanced age compared to adolescent mothers, but did not differ from the control group. The concentrations of IL-8 and tumor necrosis factor alpha did not differ between the three groups. Therefore, our data demonstrated that maternal age influenced the sociodemographic and gestational characteristics as well as the composition of colostrum cytokines.
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Affiliation(s)
| | - Jossimara Polettini
- Mestrado em Ciências da Saúde-Universidade do Oeste Paulista/UNOESTE, Presidente Prudente, SP, Brasil
- Universidade Federal da Fronteira Sul/UFFS/Campus Passo Fundo, RS, Brasil
| | - Lucas Lima de Moraes
- Faculdade de Ciências da Saúde-Universidade do Oeste Paulista/UNOESTE, Presidente Prudente, SP, Brasil
| | - Letícia Aguiar de Campos
- Faculdade de Ciências da Saúde-Universidade do Oeste Paulista/UNOESTE, Presidente Prudente, SP, Brasil
| | | | | | - Glilciane Morceli
- Mestrado em Ciências da Saúde-Universidade do Oeste Paulista/UNOESTE, Presidente Prudente, SP, Brasil
- Universidade do Estado de Minas Gerais/UEMG/Campus Passos, MG, Brasil
- * E-mail:
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28
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Kortekaas JC, Kazemier BM, Keulen JKJ, Bruinsma A, Mol BW, Vandenbussche F, Van Dillen J, De Miranda E. Risk of adverse pregnancy outcomes of late- and postterm pregnancies in advanced maternal age: A national cohort study. Acta Obstet Gynecol Scand 2020; 99:1022-1030. [PMID: 32072610 PMCID: PMC7496606 DOI: 10.1111/aogs.13828] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 02/03/2020] [Accepted: 02/05/2020] [Indexed: 12/14/2022]
Abstract
Introduction There is an increase in women delivering ≥35 years of age. We analyzed the association between advanced maternal age and pregnancy outcomes in late‐ and postterm pregnancies. Material and methods A national cohort study was performed on obstetrical low‐risk women using data from the Netherlands Perinatal Registry from 1999 to 2010. We included women ≥18 years of age with a singleton pregnancy at term. Women with a pregnancy complicated by congenital anomalies, hypertensive disorders or diabetes mellitus were excluded. Composite adverse perinatal outcome was defined as stillbirth, neonatal death, meconium aspiration syndrome, 5‐minute Apgar score <7, neonatal intensive care unit admittance and sepsis. Composite adverse maternal outcome was defined as maternal death, placental abruption and postpartum hemorrhage of >1000 mL. Results We stratified the women into three age groups: 18‐34 (n = 1 321 366 [reference]); 35‐39 (n = 286 717) and ≥40 (n = 40 909). Composite adverse perinatal outcome occurred in 1.6% in women aged 18‐34, 1.7% in women aged 35‐39 (relative risk [RR] 1.06, 95% confidence interval [95% CI] 1.03‐1.08) and 2.2% in women aged ≥40 (RR 1.38, 95% CI 1.29‐1.47), with 5‐minute Apgar score <7 as the factor contributing most to the outcome. Composite adverse maternal outcome occurred in 4.6% in women aged 18‐34, 5.0% in women aged 35‐39 (RR 1.08, 95% CI 1.06‐1.10) and 5.2% in women aged ≥40 (RR 1.14, 95% CI 1.09‐1.19), with postpartum hemorrhage >1000 mL as the factor contributing most to the outcome. In all age categories, the risk of adverse pregnancy outcomes was higher for nulliparous than for multiparous women. The risk of adverse outcomes increased in both nulliparous and parous women with advancing gestational age. When adjusted for parity, onset of labor and gestational age, advanced maternal age is associated with an increase in both composite adverse perinatal and maternal outcomes. Conclusions The risk of adverse pregnancy outcome increases with advancing maternal age. Women aged ≥40 have an increased risk of adverse perinatal and maternal outcome when pregnancy goes beyond 41 weeks.
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Affiliation(s)
- Joep C Kortekaas
- Department of Obstetrics & Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Brenda M Kazemier
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Judit K J Keulen
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Aafke Bruinsma
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Ben W Mol
- Department of Obstetrics and Gynecology, Monash University, Clayton, VIC, Australia
| | - Frank Vandenbussche
- Department of Obstetrics & Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jeroen Van Dillen
- Department of Obstetrics & Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Esteriek De Miranda
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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