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Liao L, Wei X, Liu M, Gao Y, Yin Y, Zhou R. The Association Between Season and Hypertensive Disorders in Pregnancy: a Systematic Review and Meta-analysis. Reprod Sci 2023; 30:787-801. [PMID: 35764856 DOI: 10.1007/s43032-022-01010-0] [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: 03/21/2022] [Accepted: 06/10/2022] [Indexed: 10/17/2022]
Abstract
There is increasing and inconsistent evidence of a relationship between hypertensive disorders in pregnancy (HDPs) and season of delivery or conception. In this systematic review and meta-analysis, we assessed the association between season and HDPs. The review protocol was registered in PROSPERO (CRD42021285539). Four databases, the Cochrane Library, PubMed, EMBASE, and Web of Science, were searched until September 29th, 2021. Two authors extracted data independently and used the Newcastle-Ottawa quality assessment scale (NOS) to evaluate study quality. A random effects model and the Mantel-Haenszel method were used to calculate pooled Odds ratios (ORs) and 95% confidence intervals (95% CIs). Subgroup analyses and sensitivity analyses were performed to find the source of heterogeneity and Begg's funnel plot and Egger's test were used to check for the risk of publication bias. Finally, twenty articles were included in the systematic review, and 11 articles were included in the meta-analysis. The quantitative analysis of the association between delivery season and HDPs showed that the odds of HDPs was higher in women who delivered in winter than in those who delivered in summer (OR = 1.18, 95% CI 1.02-1.38, P < 0.001) and all other seasons (OR = 1.17, 95% CI 1.03-1.34, P < 0.001). In the qualitative analysis of the association between conception season and HDPs, four of seven studies suggested that women who conceived in summer had a higher risk of HDPs than those who conceived in other seasons. Based on the evidence to date, we found weakly positive relationships between HDPs and summer conception and winter delivery.
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Affiliation(s)
- Lingyun Liao
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) of Ministry of Education, Chengdu, Sichuan, China
| | - Xiaohong Wei
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) of Ministry of Education, Chengdu, Sichuan, China
| | - Min Liu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) of Ministry of Education, Chengdu, Sichuan, China
| | - Yijie Gao
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) of Ministry of Education, Chengdu, Sichuan, China
| | - Yangxue Yin
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) of Ministry of Education, Chengdu, Sichuan, China
| | - Rong Zhou
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) of Ministry of Education, Chengdu, Sichuan, China.
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Kim EH, Lee SA, Min S, Jung YW. Seasonal variations in the occurrence of preeclampsia and potential implication of upper respiratory infections in South Korea. Sci Rep 2022; 12:10791. [PMID: 35750780 PMCID: PMC9232506 DOI: 10.1038/s41598-022-14942-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/18/2022] [Indexed: 11/09/2022] Open
Abstract
The aim of this study was to examine the effect of seasonal changes on the incidence of preeclampsia (PE) in South Korea and East Asian populations, and to evaluate the relationship between upper respiratory infection (URI) during pregnancy and the development of PE. This cohort study included women who had singleton births between 2012 and 2018 in South Korea. A total of 548,080 first singleton births were analyzed, and 9311 patients (1.70%) were diagnosed with PE. Multivariate analysis showed that older age (≥ 30 years old), low income, residing in the southern part of South Korea, history of cigarette smoking, heavy drinking, higher body mass index, hypertension, or diabetes mellitus were risk factors for PE. Univariate analysis showed that URI was associated with the incidence of PE (P = 0.0294). However, this association was not statistically significant in the multivariate analysis (aOR 1.01; 95% CI 0.95-1.07). After adjusting for confounding variables, the occurrence of PE was the highest in December (aOR 1.21; 95% CI 1.10-1.34) and lowest in July and August. This study demonstrated that there are seasonal variations in the occurrence of PE in South Korea. Moreover, URI may be associated with the development of PE.
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Affiliation(s)
- Eui Hyeok Kim
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang-si, Republic of Korea
| | - Sang Ah Lee
- Korea Research and Analysis Team, National Health Insurance Service Ilsan Hospital, Goyang-si, Republic of Korea
| | - Seunggi Min
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, 566, Nonhyeon-ro, Gangnam-gu, Seoul, 06135, Republic of Korea
| | - Yong Wook Jung
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, 566, Nonhyeon-ro, Gangnam-gu, Seoul, 06135, Republic of Korea.
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Lu D, Li M, Gan Y, Yu G, Zhang Q, Zhang J. Prenatal exposure to solar radiation and hypertensive disorders of pregnancy. BJOG 2021; 129:393-401. [PMID: 34324790 DOI: 10.1111/1471-0528.16851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/24/2021] [Accepted: 07/10/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine the association between prenatal exposure to solar radiation and hypertensive disorders of pregnancy (HDP). DESIGN A multicentre retrospective study. SETTING 19 hospitals in the USA. POPULATION 205 888 women with singleton gestation from the Consortium on Safe Labor (2002-2008). MAIN OUTCOME MEASURES Gestational hypertension, pre-eclampsia/eclampsia, and pre-eclampsia superimposed on chronic hypertension. METHODS Medical records of the participants were linked to solar radiation obtained from the National Solar Radiation Database. Average daily solar radiation of each woman was estimated over the entire pregnancy period and over three trimesters during pregnancy according to hospital sites. Generalised estimated equation was applied to investigate the relationship between quartiles of average daily solar radiation and HDP. Restricted cubic spline was applied to assess the nonlinear associations. RESULTS Higher average solar radiation during the entire pregnancy was associated with reduced risks of HDP. Compared with the 1st quartile of solar radiation during the entire pregnancy, odds ratios (ORs) of the 2nd, 3rd and 4th quartiles were respectively 0.80 (95% CI 0.72-0.90), 0.63 (95% CI 0.55-0.73), 0.65 (95% CI 0.54-0.78) for gestational hypertension; 0.66 (95% CI 0.57-0.76), 0.61 (95% CI 0.51-0.73), 0.77 (95% CI 0.62-0.95) for pre-eclampsia, and 0.44 (95% CI 0.36-0.55), 0.42 (95% CI 0.35-0.49), 0.60 (95% CI 0.46-0.78) for superimposed pre-eclampsia. CONCLUSION Exposure to higher daily solar radiation during pregnancy is associated with a decreased risk of HDP. The protective effect was stronger for superimposed pre-eclampsia than for pre-eclampsia or gestational hypertension. TWEETABLE ABSTRACT Exposure to higher daily solar radiation during pregnancy is associated with a decreased risk of HDP.
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Affiliation(s)
- D Lu
- MOE-Shanghai Key Laboratory of Children's Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - M Li
- MOE-Shanghai Key Laboratory of Children's Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Y Gan
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - G Yu
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Q Zhang
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - J Zhang
- MOE-Shanghai Key Laboratory of Children's Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Hastie CE, Mackay DF, Clemens TL, Cherrie MPC, Megaw LJ, Smith GCS, Stock SJ, Dibben C, Pell JP. Antenatal Exposure to UV-B Radiation and Preeclampsia: A Retrospective Cohort Study. J Am Heart Assoc 2021; 10:e020246. [PMID: 34155917 PMCID: PMC8403301 DOI: 10.1161/jaha.120.020246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Risk of preeclampsia varies by month of delivery. We tested whether this seasonal patterning may be mediated through maternal vitamin D concentration using antenatal exposure to UV‐B radiation as an instrumental variable. Methods and Results Scottish maternity records were linked to antenatal UV‐B exposure derived from satellites between 2000 and 2010. Logistic regression analyses were used to explore the association between UV‐B and preeclampsia, adjusting for the potential confounding effects of month of conception, child's sex, gestation, parity, and mean monthly temperature. Of the 522 896 eligible singleton deliveries, 8689 (1.66%) mothers developed preeclampsia. Total antenatal UV‐B exposure ranged from 43.18 to 101.11 kJ/m2 and was associated with reduced risk of preeclampsia with evidence of a dose‐response relationship (highest quintile of exposure: adjusted odds ratio, 0.57; 95% CI, 0.44–0.72; P<0.001). Associations were demonstrated for UV‐B exposure in all 3 trimesters. Conclusions The seasonal patterning of preeclampsia may be mediated through low maternal vitamin D concentration in winter resulting from low UV‐B radiation. Interventional studies are required to determine whether vitamin D supplements or UV‐B–emitting light boxes can reduce the seasonal patterning of preeclampsia.
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Affiliation(s)
- Claire E Hastie
- Institute of Health and Wellbeing University of Glasgow United Kingdom
| | - Daniel F Mackay
- Institute of Health and Wellbeing University of Glasgow United Kingdom
| | - Tom L Clemens
- Centre for Research on Environment, Society and Health School of Geosciences University of Edinburgh United Kingdom
| | - Mark P C Cherrie
- Centre for Research on Environment, Society and Health School of Geosciences University of Edinburgh United Kingdom
| | - Lauren J Megaw
- King Edward Memorial Hospital for Women Subiaco Australia
| | - Gordon C S Smith
- Department of Obstetrics and Gynaecology University of Cambridge United Kingdom
| | - Sarah J Stock
- Usher Institute University of Edinburgh United Kingdom
| | - Chris Dibben
- Institute of Geography University of Edinburgh United Kingdom
| | - Jill P Pell
- Institute of Health and Wellbeing University of Glasgow United Kingdom
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Stougaard M, Damm P, Frederiksen P, Jacobsen R, Heitmann BL. Extra vitamin D from fortification and the risk of preeclampsia: The D-tect Study. PLoS One 2018; 13:e0191288. [PMID: 29370249 PMCID: PMC5784930 DOI: 10.1371/journal.pone.0191288] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 01/02/2018] [Indexed: 11/18/2022] Open
Abstract
The objective of the study was to examine if exposure to extra vitamin D from food fortification was associated with a decrease in the risk of preeclampsia. The study was based on a natural experiment exploring the effect of the abolition of the Danish mandatory vitamin D fortification of margarine in 1985. The effect of the extra vitamin D (1.25μg vitamin D/100 g margarine) was examined by comparing preeclampsia risk in women who have been exposed or unexposed to extra vitamin D from the fortified margarine during pregnancy, and who gave birth in the period from June 1983 to August 1988. The Danish National Patient Registry allowed the identification of pregnancies complicated by preeclampsia. The study included 73,237 women who gave birth during 1983–1988. We found no association between exposure to vitamin D fortification during pregnancy and the risk of any of the pregnancy related hypertensive disorders, including preeclampsia: Odds ratios (OR, 95%) for all hypertensive pregnancy related disorders among exposed vs. unexposed women was (OR 1.04, 95%CI: 0.98,1.10). In conclusion, the extra vitamin D from the mandatory vitamin D fortification did not influence the risk of preeclampsia.
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Affiliation(s)
- Maria Stougaard
- Research Unit for Dietary Studies at the Parker Institute and Department of Clinical Epidemiology, Bispebjerg og Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
- * E-mail:
| | - Peter Damm
- Department of Obstetrics, Rigshospitalet and Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peder Frederiksen
- Research Unit for Dietary Studies at the Parker Institute and Department of Clinical Epidemiology, Bispebjerg og Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
| | - Ramune Jacobsen
- Research Unit for Dietary Studies at the Parker Institute and Department of Clinical Epidemiology, Bispebjerg og Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
- Research Unit for Chronic Conditions, Bispebjerg og Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
| | - Berit Lilienthal Heitmann
- Research Unit for Dietary Studies at the Parker Institute and Department of Clinical Epidemiology, Bispebjerg og Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Section for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Purswani JM, Gala P, Dwarkanath P, Larkin HM, Kurpad A, Mehta S. The role of vitamin D in pre-eclampsia: a systematic review. BMC Pregnancy Childbirth 2017; 17:231. [PMID: 28709403 PMCID: PMC5513133 DOI: 10.1186/s12884-017-1408-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 07/03/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The etiology of pre-eclampsia (PE) is not yet fully understood, though current literature indicates an upregulation of inflammatory mediators produced by the placenta as a potential causal mechanism. Vitamin D is known to have anti-inflammatory properties and there is evidence of an inverse relationship between dietary calcium intake and the incidence of PE. Evidence of the role of vitamin D status and supplementation in the etiology and prevention of PE is reviewed in this article along with identification of research gaps to inform future studies. METHODS We conducted a structured literature search using MEDLINE electronic databases to identify published studies until February 2015. These sources were retrieved, collected, indexed, and assessed for availability of pregnancy-related data on PE and vitamin D. RESULTS Several case-control studies and cross-sectional studies have shown an association between vitamin D status and PE, although evidence has been inconsistent. Clinical trials to date have been unable to show an independent effect of vitamin D supplementation in preventing PE. CONCLUSIONS The included clinical trials do not show an independent effect of vitamin D supplementation in preventing PE; however, issues with dose, timing, and duration of supplementation have not been completely addressed.
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Affiliation(s)
- Juhi M. Purswani
- Division of Nutritional Sciences, Cornell University, 314 Savage Hall, Ithaca, NY 14853 USA
| | - Pooja Gala
- Weill-Cornell Medical College, New York, NY USA
| | | | - Heather M. Larkin
- Division of Nutritional Sciences, Cornell University, 314 Savage Hall, Ithaca, NY 14853 USA
| | - Anura Kurpad
- St. John’s Research Institute, Bangalore, Karnataka India
| | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, 314 Savage Hall, Ithaca, NY 14853 USA
- St. John’s Research Institute, Bangalore, Karnataka India
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7
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Weinberg CR, Shi M, Basso O, DeRoo LA, Harmon Q, Wilcox AJ, Skjærven R. Season of Conception, Smoking, and Preeclampsia in Norway. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:067022. [PMID: 28669933 PMCID: PMC5743488 DOI: 10.1289/ehp963] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 01/24/2017] [Accepted: 01/25/2017] [Indexed: 05/17/2023]
Abstract
BACKGROUND Preeclampsia (PE) is a dangerous and unpredictable pregnancy complication. A seasonal pattern of risk would suggest that there are potentially preventable environmental contributors, but prior analyses have not adjusted for confounding by PE risk factors that are associated with season of conception. METHODS Seasonal effects were modeled and tested by representing each day of the year as an angle on a unit circle and using trigonometric functions of those angles in predictive models, using "harmonic analysis." We applied harmonic Cox regression to model confounder-adjusted effects of the estimated day of the year of conception on risk of PE for births from the Medical Birth Registry of Norway for deliveries between 1999 and 2009. We also examined effect measure modification by parity, latitude (region), fetal sex, and smoking. RESULTS In adjusted models, PE risk was related to season, with higher risk in spring conceptions and lower risk in autumn conceptions, with a risk amplitude (maximum compared with minimum) of about 20%. The pattern replicated across subpopulations defined by parity, latitude (region), fetal sex, and smoking. CONCLUSIONS These results suggest that there is a seasonal driver for PE, with effects that are not modified by parity, latitude, fetal sex, or smoking. https://doi.org/10.1289/EHP963.
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Affiliation(s)
- Clarice R Weinberg
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences , Research Triangle Park, North Carolina, USA
| | - Min Shi
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences , Research Triangle Park, North Carolina, USA
| | - Olga Basso
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Lisa A DeRoo
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Quaker Harmon
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Allen J Wilcox
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Rolv Skjærven
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Institute of Public Health, Medical Birth Registry of Norway, Bergen, Norway
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Zhao X, Fang R, Yu R, Chen D, Zhao J, Xiao J. Maternal Vitamin D Status in the Late Second Trimester and the Risk of Severe Preeclampsia in Southeastern China. Nutrients 2017; 9:E138. [PMID: 28216561 PMCID: PMC5331569 DOI: 10.3390/nu9020138] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/11/2017] [Accepted: 02/10/2017] [Indexed: 12/13/2022] Open
Abstract
The association between maternal vitamin D deficiency and the risk of severe preeclampsia is still debated. In the present study, we aimed to evaluate vitamin D status in Chinese pregnant women and investigate its correlation with the odds of developing severe preeclampsia. A cohort study was performed on 13,806 pregnant women who routinely visited the antenatal care clinics and subsequently delivered at the Wuxi Maternity and Child Health Hospital. All the subjects in the cohort had their serum 25-hydroxyvitamin D (25(OH)D) concentrations measured during pregnancy. A high prevalence of maternal vitamin D deficiency (25(OH)D < 50 nmol/L) was found. Pregnant women who had different BMIs before pregnancy had significantly different serum concentrations of 25(OH)D. There was also a significant difference in the serum 25(OH)D concentration among pregnant women of different ages. The serum 25(OH)D concentration was significantly lower in pregnant women who subsequently developed severe preeclampsia compared with those who did not. Maternal vitamin D deficiency at 23-28 weeks of gestation was strongly associated with increased odds for severe preeclampsia after adjusting for relevant confounders (adjusted OR, 3.16; 95% CI, 1.77-5.65). Further studies are required to investigate whether vitamin D supplementation would reduce the risk of severe preeclampsia and improve pregnancy outcomes.
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Affiliation(s)
- Xin Zhao
- Department of Obstetrics, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi 214002, China.
- Centre for Reproductive Medicine, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi 214002, China.
| | - Rui Fang
- Centre for Reproductive Medicine, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi 214002, China.
| | - Renqiang Yu
- Department of Newborn, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi 214002, China.
| | - Daozhen Chen
- Central Laboratory, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi 214002, China.
| | - Jun Zhao
- Central Laboratory, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi 214002, China.
| | - Jianping Xiao
- Department of Obstetrics, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi 214002, China.
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Abstract
Introduction: Hypertension in pregnancy is one of the three factors of maternal mortality. Etiology of the disease is unknown, but the many factors contributing to the identification and control of it can be taken a step to prevent and reduce the symptoms of the disease. The purpose of this study was to determine the prevalence of preeclampsia (high-blood pressure) in different seasons of the year. Methods: The present retrospective cross-sectional study was conducted on more than 8,000 pregnant women visiting Assali specialized hospital from 2011 to 2013. Required data was collected through questionnaire checklist. The Chi-square test with multiple comparisons was used to compare the frequencies of pregnancy-induced hypertension (PIH) according to the month of year, and adjustment of multiplicity was conducted using Bonferroni's method. Student's t-test was used to compare the means of PIH prevalence rates. In all analyses, P < 0.05 was taken to indicate statistical significance. Results: In these 8000 woman admitted to labor, overall prevalence of PIH was 3.8 ± 0.6%. The prevalence rate of PIH was highest in the summer (4.5%) and lowest frequent in the winter (2.7%), respectively. In July, the prevalence rate was significantly higher than those for any other month (4.7%), and in March, it was lower prevalence than for any month (2.2%), respectively. Using the Chi-square test, a significant difference between the incidence of disease was observed in summer and winter (P < 0.001). Conclusion: The prevalence rate of PIH was higher for delivery in summer and early spring and lowest for winter delivery among Khorramabad women based on these results; it seems that changes in temperature and humidity in different seasons can affect preeclampsia, and preeclampsia increases with increasing frequency temperature.
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Affiliation(s)
- Fatemeh Janani
- Social Determinants of Health Research Center, Faculty of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Farahnaz Changaee
- Social Determinants of Health Research Center, Faculty of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
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The reduction in circulating levels of melatonin may be associated with the development of preeclampsia. J Hum Hypertens 2016; 30:666-671. [PMID: 27251079 DOI: 10.1038/jhh.2016.37] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/05/2016] [Accepted: 04/14/2016] [Indexed: 12/15/2022]
Abstract
Placental dysfunction and oxidative stress contribute to the pathogenesis of preeclampsia, which is a pregnancy-specific disorder. It has been suggested that the incidence of preeclampsia has a seasonal variation. Melatonin, as a seasonal factor, has been suggested to be involved in a successful pregnancy. In this study, we investigated the association of circulating levels of melatonin with preeclampsia. Serum was collected from women with preeclampsia (n=113) and gestation-matched healthy pregnant women, and the levels of melatonin were measured. In addition, the expression of melatonin receptors was examined in preeclamptic placentae (n=27). The association of the incidence of preeclampsia and seasonal variation was also analysed from 1491 women with preeclampsia within 77 745 healthy pregnancies. The serum levels of melatonin were significantly reduced in women with preeclampsia at presentation and these reduced serum levels of melatonin were not associated with the severity or time onset of preeclampsia nor with seasonal variation. The expression of melatonin receptor, MT1 was reduced in preeclamptic placentae. The incidence of preeclampsia was did exhibit seasonal variation, but this was largely due to the increase in the incidence of mild or late-onset preeclampsia. Our results demonstrate that reduced melatonin levels are associated with the development of preeclampsia but that the circulating levels of melatonin do not appear to be subject to seasonal variation during pregnancy.
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Rohr Thomsen C, Uldbjerg N, Hvidman L, Atladóttir HÓ, Henriksen TB, Milidou I. Seasonal variation of dystocia in a large Danish cohort. PLoS One 2014; 9:e94432. [PMID: 24736600 PMCID: PMC3988070 DOI: 10.1371/journal.pone.0094432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 03/16/2014] [Indexed: 11/18/2022] Open
Abstract
Background Dystocia is one of the most frequent causes of cesarean delivery in nulliparous women. Despite this, its causes are largely unknown. Vitamin D receptor (VDR) has been found in the myometrium. Thus, it is possible that vitamin D affects the contractility of the myometrium and may be involved in the pathogenesis of dystocia. Seasonal variation of dystocia in areas with distinct seasonal variation in sunlight exposure, like Denmark, could imply that vitamin D may play a role. This study examined whether there was seasonal variation in the incidence of dystocia in a Danish population. Method We used information from a cohort of 34,261 nulliparous women with singleton pregnancies, spontaneous onset of labor between 37 and 42 completed gestational weeks, and vertex fetal presentation. All women gave birth between 1992 and 2010 at the Department of Obstetrics and Gynecology, Aarhus University Hospital, Skejby. Logistic regression combined with cubic spline was used to estimate the seasonal variation for each outcome after adjusting for calendar time. Results No evidence for seasonal variation was found for any of the outcomes: acute cesarean delivery due to dystocia (p = 0.44); instrumental vaginal delivery due to dystocia (p = 0.69); oxytocin augmentation due to dystocia (p = 0.46); and overall dystocia (p = 0.91). Conclusion No seasonal variation in the incidence of dystocia was observed in a large cohort of Danish women. This may reflect no association between vitamin D and dystocia, or alternatively that other factors with seasonal variation and influence on the occurrence of dystocia attenuate such an association.
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Affiliation(s)
- Christine Rohr Thomsen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Skejby, Aarhus, Denmark
- * E-mail:
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Lone Hvidman
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | | | - Tine Brink Henriksen
- Department of Pediatrics, Aarhus University Hospital, Skejby, Aarhus, Denmark
- Perinatal Epidemiology Research Unit, Institute of Clinical Medicine, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Ioanna Milidou
- Perinatal Epidemiology Research Unit, Institute of Clinical Medicine, Aarhus University Hospital, Skejby, Aarhus, Denmark
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Beltran AJ, Wu J, Laurent O. Associations of meteorology with adverse pregnancy outcomes: a systematic review of preeclampsia, preterm birth and birth weight. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 11:91-172. [PMID: 24362545 PMCID: PMC3924438 DOI: 10.3390/ijerph110100091] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 11/25/2013] [Accepted: 11/27/2013] [Indexed: 11/24/2022]
Abstract
The relationships between meteorology and pregnancy outcomes are not well known. This article reviews available evidence on the relationships between seasonality or meteorology and three major pregnancy outcomes: the hypertensive disorders of pregnancy (including preeclampsia, eclampsia and gestational hypertension), gestational length and birth weight. In total 35, 28 and 27 studies were identified for each of these outcomes. The risks of preeclampsia appear higher for women with conception during the warmest months, and delivery in the coldest months of the year. Delivery in the coldest months is also associated with a higher eclampsia risk. Patterns of decreased gestational lengths have been observed for births in winter, as well as summer months. Most analytical studies also report decreases in gestational lengths associated with heat. Birth weights are lower for deliveries occurring in winter and in summer months. Only a limited number of studies have investigated the effects of barometric pressure on gestational length or the effects of temperature and sunshine exposure on birth weight, but these questions appear worth investigating further. Available results should encourage further etiological research aiming at enhancing our understanding of the relationships between meteorology and adverse pregnancy outcomes, ideally via harmonized multicentric studies.
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Affiliation(s)
| | - Jun Wu
- Program in Public Health, Anteater Instruction & Research Bldg (AIRB), 653 East Peltason Drive, University of California, Irvine, CA 92697, USA.
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Wolf J, Armstrong B. The association of season and temperature with adverse pregnancy outcome in two German states, a time-series analysis. PLoS One 2012; 7:e40228. [PMID: 22792247 PMCID: PMC3391296 DOI: 10.1371/journal.pone.0040228] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 06/03/2012] [Indexed: 11/23/2022] Open
Abstract
Background A seasonality of low birth weight (LBW) and preterm birth (PTB) has been described for most regions and there is evidence that this pattern is caused by ambient outdoor temperature. However, the association as such, the direction of effect and the critical time of exposure remain controversial. Methods Logistic, time-series regression was performed on nearly 300,000 births from two German states to study the association between season and daily mean temperature and changes in daily proportions of term LBW (tLBW) or PTB. Analyses were adjusted for time-varying factors. Temperature exposures were examined during different periods of pregnancy. Results Weak evidence for an association between season of conception, season of birth or ambient outdoor temperature and tLBW or PTB was found. Results of analyses of temperature were not consistent between the two states. Different sources of bias which would have artificially led to stronger findings were detected and are described. Conclusions No clear evidence for an association between season of conception, season of birth or temperature and tLBW or PTB was found. In the study of pregnancy outcome different sources of bias can be identified which can potentially explain heterogeneous findings of the past.
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Affiliation(s)
- Jennyfer Wolf
- Department of Social and Environmental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Abstract
Vitamin D is a pleiotropic secosteroid hormone important for health and disease prevention. The actions of vitamin D are mediated by the vitamin D receptor that binds the active form of vitamin D [1,25(OH)(2)D] to induce both transcriptional and non-genomic responses. Vitamin D has well known classical functions in calcium uptake and bone metabolism, but more recent work highlights the importance of the nonclassical actions of vitamin D in a variety of cell types. These actions include modulation of the innate and adaptive immune systems and regulation of cell proliferation. Adequate vitamin D intake is essential for maternal and fetal health during pregnancy, and epidemiological data indicate that many pregnant women have sub-optimal vitamin D levels. Notably, vitamin D deficiency correlates with preeclampsia, gestational diabetes mellitus, and bacterial vaginosis, and an increased risk for C-section delivery. Recent work emphasizes the importance of nonclassical roles of vitamin D in pregnancy and the placenta. The placenta produces and responds to vitamin D where vitamin D functions as a modulator of implantation, cytokine production and the immune response to infection. We describe vitamin D metabolism and the cellular responses to vitamin D, and then summarize the role of vitamin D in placental trophoblast, pregnancy and the fetus.
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Affiliation(s)
- J S Shin
- Department of Obstetrics and Gynecology, CHA University School of Medicine, Seoul, Republic of Korea
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Shin JS, Choi MY, Longtine MS, Nelson DM. Vitamin D effects on pregnancy and the placenta. Placenta 2010; 31:1027-34. [PMID: 20863562 DOI: 10.1016/j.placenta.2010.08.015] [Citation(s) in RCA: 201] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 08/18/2010] [Accepted: 08/26/2010] [Indexed: 12/19/2022]
Abstract
Vitamin D is a pleiotropic secosteroid hormone important for health and disease prevention. The actions of vitamin D are mediated by the vitamin D receptor that binds the active form of vitamin D [1,25(OH)(2)D] to induce both transcriptional and non-genomic responses. Vitamin D has well known classical functions in calcium uptake and bone metabolism, but more recent work highlights the importance of the nonclassical actions of vitamin D in a variety of cell types. These actions include modulation of the innate and adaptive immune systems and regulation of cell proliferation. Adequate vitamin D intake is essential for maternal and fetal health during pregnancy, and epidemiological data indicate that many pregnant women have sub-optimal vitamin D levels. Notably, vitamin D deficiency correlates with preeclampsia, gestational diabetes mellitus, and bacterial vaginosis, and an increased risk for C-section delivery. Recent work emphasizes the importance of nonclassical roles of vitamin D in pregnancy and the placenta. The placenta produces and responds to vitamin D where vitamin D functions as a modulator of implantation, cytokine production and the immune response to infection. We describe vitamin D metabolism and the cellular responses to vitamin D, and then summarize the role of vitamin D in placental trophoblast, pregnancy and the fetus.
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Affiliation(s)
- J S Shin
- Department of Obstetrics and Gynecology, CHA University School of Medicine, Seoul, Republic of Korea
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Bodnar LM, Simhan HN. Vitamin D may be a link to black-white disparities in adverse birth outcomes. Obstet Gynecol Surv 2010; 65:273-84. [PMID: 20403218 PMCID: PMC3222336 DOI: 10.1097/ogx.0b013e3181dbc55b] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
UNLABELLED In the United States, significant, intractable disparities exist in rates of major pregnancy outcomes between non-Hispanic black and non-Hispanic white women. A previously unexplored candidate influence on the black-white disparity in adverse birth outcomes is maternal vitamin D status. This review summarizes the evidence relating maternal vitamin D to preeclampsia, spontaneous preterm birth, gestational diabetes, and fetal growth restriction, and addresses gaps in our understanding of the contribution of vitamin D to the intractable black-white disparity in these conditions. The literature reviewed highlights strong biologic plausibility of role for vitamin D in the pathophysiology of these poor pregnancy outcomes. Data also suggest that maternal vitamin D deficiency may increase the risk of preeclampsia and fetal growth restriction. Less research has been done in support of relations with spontaneous preterm birth and gestational diabetes, and fetal and infant survival have rarely been studied. Few trials of vitamin D supplementation have been conducted in pregnant women with adequate power to test effects on birth outcomes. Importantly, black pregnant women have rarely been studied in vitamin D-birth outcomes research. Although vitamin D is a promising candidate influence on black-white disparities in preeclampsia, spontaneous preterm birth, fetal growth restriction, and gestational diabetes, these associations require further study in large samples of black US women. Because vitamin D deficiency is widespread and black-white disparities in pregnancy outcomes and infant survival have been resistant to previous interventions, research to test vitamin D as a causal factor is of major public health significance. TARGET AUDIENCE Obstetricians & Gynecologist, Family Physicians. LEARNING OBJECTIVES After completion of this educational activity, the reader will be able to appreciate risk factors for inadequate vitamin D status. Understand the basic aspects of vitamin D metabolism. Become aware of recent literature linking inadequate vitamin D status and adverse pregnancy outcomes such as preeclampsia and preterm birth.
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Affiliation(s)
- Lisa M Bodnar
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA 15261, USA.
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Ullah MI, Uwaifo GI, Nicholas WC, Koch CA. Does vitamin d deficiency cause hypertension? Current evidence from clinical studies and potential mechanisms. Int J Endocrinol 2009; 2010:579640. [PMID: 20049157 PMCID: PMC2798112 DOI: 10.1155/2010/579640] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Revised: 07/26/2009] [Accepted: 08/29/2009] [Indexed: 11/25/2022] Open
Abstract
Vitamin D deficiency is widely prevalent across all ages, races, geographical regions, and socioeconomic strata. In addition to its important role in skeletal development and calcium homeostasis, several recent studies suggest its association with diabetes, hypertension, cardiovascular disease, certain types of malignancy, and immunologic dysfunction. Here, we review the current evidence regarding an association between vitamin D deficiency and hypertension in clinical and epidemiological studies. We also look into plausible biological explanations for such an association with the renin-angiotensin-aldosterone system and insulin resistance playing potential roles. Taken together, it appears that more studies in more homogeneous study populations are needed before a firm conclusion can be reached as to whether vitamin D deficiency causes or aggravates hypertension and whether vitamin D supplementation is safe and exerts cardioprotective effects. The potential problems with bias and confounding factors present in previous epidemiological studies may be overcome or minimized by well designed randomized controlled trials in the future.
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Affiliation(s)
- M. Iftekhar Ullah
- Division of General Internal Medicine and Hypertension, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Gabriel I. Uwaifo
- Division of Endocrinology, University of Mississippi Medical Center, Jackson, MS 39216, USA
- Department of Medicine, G.V. (Sonny) Montgomery VA Medical Center, Jackson, MS 39216, USA
| | - William C. Nicholas
- Division of Endocrinology, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Christian A. Koch
- Division of Endocrinology, University of Mississippi Medical Center, Jackson, MS 39216, USA
- Department of Medicine, G.V. (Sonny) Montgomery VA Medical Center, Jackson, MS 39216, USA
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Abstract
The theory that natural selection has conserved mechanisms by which women subjected to environmental stressors abort frail male fetuses implies that climate change may affect sex ratio at birth and male longevity. Using time series methods, we find that cold ambient temperatures during gestation predict lower secondary sex ratios and longer life span of males in annual birth cohorts composed of Danes, Finns, Norwegians, and Swedes born between 1878 (earliest year with complete life tables) and 1914 (last birth cohort for which male life span can be estimated). We conclude that ambient temperature affects the characteristics of human populations by influencing who survives gestation, a heretofore unrecognized effect of climate on humanity.
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Seasonal variation in the incidence of preeclampsia and eclampsia in tropical climatic conditions. BMC WOMENS HEALTH 2007; 7:18. [PMID: 17937797 PMCID: PMC2169212 DOI: 10.1186/1472-6874-7-18] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Accepted: 10/15/2007] [Indexed: 11/15/2022]
Abstract
Background Observational studies have demonstrated various correlations between hypertensive disorders of pregnancy and different weather parameters. We aim to study if a correlation exists between the incidence of eclampsia and pre-eclampsia and various weather parameters in the tropical coastal city of Mumbai which has the distinction of having relatively uniform meteorological variables all throughout the year, except for the monsoon season. Methods We retrospectively analysed data from a large maternity centre in Mumbai, India over a period of 36 months from March 1993 to February 1996, recording the incidence of preeclampsia and eclampsia. Meteorological data was acquired from the regional meteorological centre recording the monthly average temperature, humidity, barometric pressure and rainfall during the study period. Study period was then divided into two climate conditions: monsoon season (June to August) and dry season September to May. The incidence of preeclampsia and eclampsia and the meteorological differences between the two seasons were compared. Results Over a 36-month period, a total of 29562 deliveries were recorded, of which 1238 patients developed preeclampsia (4.18%) and 34 developed eclampsia (0.11%). The incidence of preeclampsia did not differ between the monsoon and the dry season (4.3% vs. 4.15%, p = 0.5). The incidence of eclampsia was significantly higher in the monsoon (0.2% vs. 0.08%, p = 0.01). The monsoon was significantly cooler (median maximum temperature 30.7°C vs. 32.3°C, p = 0.01), more humid (median relative humidity 85% vs. 70%, p = 0.0008), and received higher rainfall (median 504.9 mm vs. 0.3 mm, p = 0.0002) than the rest of the year. The median barometric pressure (1005 mb) during the monsoon season was significantly lower than the rest of the year (1012 mb, p < 0.0001). Conclusion In the tropical climate of Mumbai, the incidence of eclampsia is significantly higher in monsoon, when the weather is cooler and humid with a lower barometric pressure than the rest of the year. This effect is not seen with preeclampsia. This strengthens the association of low temperature and high humidity with triggering of eclampsia.
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Bodnar LM, Catov JM, Simhan HN, Holick MF, Powers RW, Roberts JM. Maternal vitamin D deficiency increases the risk of preeclampsia. J Clin Endocrinol Metab 2007; 92:3517-22. [PMID: 17535985 PMCID: PMC4288954 DOI: 10.1210/jc.2007-0718] [Citation(s) in RCA: 549] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Vitamin D has direct influence on molecular pathways proposed to be important in the pathogenesis of preeclampsia, yet the vitamin D-preeclampsia relation has not been studied. OBJECTIVES We aimed to assess the effect of maternal 25-hydroxyvitamin D [25(OH)D] concentration on the risk of preeclampsia and to assess the vitamin D status of newborns of preeclamptic mothers. DESIGN AND SETTING We conducted a nested case-control study of pregnant women followed from less than 16 wk gestation to delivery (1997-2001) at prenatal clinics and private practices. PATIENTS Patients included nulliparous pregnant women with singleton pregnancies who developed preeclampsia (n = 55) or did not develop preeclampsia (n = 219). Women's banked sera were newly measured for 25(OH)D. MAIN OUTCOME MEASURE The main outcome measure was preeclampsia (new-onset gestational hypertension and proteinuria for the first time after 20 wk gestation). Our hypotheses were formulated before data collection. RESULTS Adjusted serum 25(OH)D concentrations in early pregnancy were lower in women who subsequently developed preeclampsia compared with controls [geometric mean, 45.4 nmol/liter, and 95% confidence interval (CI), 38.6-53.4 nmol/liter, vs. 53.1 and 47.1-59.9 nmol/liter; P < 0.01]. There was a monotonic dose-response relation between serum 25(OH)D concentrations at less than 22 wk and risk of preeclampsia. After confounder adjustment, a 50-nmol/liter decline in 25(OH)D concentration doubled the risk of preeclampsia (adjusted odds ratio, 2.4; 95% CI, 1.1-5.4). Newborns of preeclamptic mothers were twice as likely as control newborns to have 25(OH)D less than 37.5 nmol/liter (adjusted odds ratio, 2.2; 95% CI, 1.2-4.1). CONCLUSIONS Maternal vitamin D deficiency may be an independent risk factor for preeclampsia. Vitamin D supplementation in early pregnancy should be explored for preventing preeclampsia and promoting neonatal well-being.
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Affiliation(s)
- Lisa M Bodnar
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, A742 Crabtree Hall, 130 DeSoto Street, Pittsburgh, Pennsylvania, 15261, USA.
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Abstract
Immune system perturbations are involved in pre-eclampsia pathophysiology. We hypothesised that immunomodulating substances, such as mycotoxins, endotoxins or pesticides, affect pre-eclampsia risk. Associations between indicators of immunomodulating exposures in agriculture and pre-eclampsia are reported. In a Norwegian family cohort based on participants in agricultural censuses conducted by Statistics Norway 1969-89, 183 313 pregnancies to farmers were identified in the Medical Birth Registry of Norway. Cases notified as pre-eclampsia as well as pregnancies indicated by hypertension in combination with proteinuria were included. Data on farm production and meteorologically based fungal forecasts 1973-90 (a marker of temperate and humid climatic conditions known to favour fungal growth and mycotoxin formation in grain) were obtained and allocated to each farm. Pre-eclampsia prevalence rates were studied in strata of exposure indicators using Poisson regression models. Adjusted rate ratios (RR) and 95% confidence intervals [CI] were computed. We identified 4912 cases, equivalent to 26.8 pre-eclampsia cases per 1000 pregnancies [95% CI 26.1, 27.6]. Pre-eclampsia showed moderate associations with animal farming, RR 1.14, [95% CI 1.07, 1.22] and moderate negative associations with grain production, RR 0.93, [95% CI 0.86, 1.01], and two or more fungal forecasts appearing in any year 1973-90, RR 0.90 [95% CI 0.84, 0.97], using no years with two or more forecasts as reference. Exposure to immunomodulating substances as indicated by grain farming, animal farming and fungal warnings could possibly have moderate effects on pre-eclampsia risk, thus supporting the study hypothesis. The use of exposure indicators as surrogates for real exposures may introduce a non-differential misclassification of the exposure that would attenuate any true exposure-outcome association. The use of exposure proxies warrants that inferences from the study should be made with caution.
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Muehlenbachs A, Mutabingwa TK, Edmonds S, Fried M, Duffy PE. Hypertension and maternal-fetal conflict during placental malaria. PLoS Med 2006; 3:e446. [PMID: 17105340 PMCID: PMC1635741 DOI: 10.1371/journal.pmed.0030446] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2006] [Accepted: 09/11/2006] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Malaria and hypertension are major causes of maternal mortality in tropical countries, especially during first pregnancies, but evidence for a relationship between these syndromes is contradictory. METHODS AND FINDINGS In a cross-sectional survey of Tanzanian parturients, the rate of hypertension was similar in placental malaria (PM)-positive (11/85 = 13%) and PM-negative (73/602 = 12%) individuals. However, we found that PM was associated with hypertension in first-time mothers aged 18-20 y but not other mothers. Hypertension was also associated with histologic features of chronic malaria, which is common in first-time mothers. Levels of soluble vascular endothelial growth factor receptor 1 (sVEGFR1), a preeclampsia biomarker, were elevated in first-time mothers with either PM, hypertension, or both, but levels were not elevated in other mothers with these conditions. In first-time mothers with PM, the inflammatory mediator vascular endothelial growth factor (VEGF) was localized to maternal macrophages in the placenta, while sVEGFR1, its soluble inhibitor, was localized to the fetal trophoblast. CONCLUSIONS The data suggest that maternal-fetal conflict involving the VEGF pathway occurs during PM, and that sVEGFR1 may be involved in the relationship between chronic PM and hypertension in first-time mothers. Because placental inflammation causes poor fetal outcomes, we hypothesize that fetal mechanisms that promote sVEGFR1 expression may be under selective pressure during first pregnancies in malaria-endemic areas.
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Affiliation(s)
- Atis Muehlenbachs
- MOMS Project, Seattle Biomedical Research Institute, Seattle, Washington, United States of America
- University of Washington, Seattle, Washington, United States of America
| | - Theonest K Mutabingwa
- MOMS Project, Seattle Biomedical Research Institute, Seattle, Washington, United States of America
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- National Institute for Medical Research, Dar es Salaam, Tanzania
- Muheza Designated District Hospital, Muheza, Tanzania
| | - Sally Edmonds
- Muheza Designated District Hospital, Muheza, Tanzania
| | - Michal Fried
- MOMS Project, Seattle Biomedical Research Institute, Seattle, Washington, United States of America
- University of Washington, Seattle, Washington, United States of America
| | - Patrick E Duffy
- MOMS Project, Seattle Biomedical Research Institute, Seattle, Washington, United States of America
- University of Washington, Seattle, Washington, United States of America
- Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- * To whom correspondence should be addressed. E-mail:
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Vigeh M, Yokoyama K, Ramezanzadeh F, Dahaghin M, Sakai T, Morita Y, Kitamura F, Sato H, Kobayashi Y. Lead and other trace metals in preeclampsia: a case-control study in Tehran, Iran. ENVIRONMENTAL RESEARCH 2006; 100:268-75. [PMID: 16029873 DOI: 10.1016/j.envres.2005.05.005] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2004] [Revised: 05/23/2005] [Accepted: 05/26/2005] [Indexed: 05/03/2023]
Abstract
To assess the effects of environmental exposures to trace metals on the incidence of preeclampsia, concentrations of lead (Pb), antimony (Sb), manganese (Mn), mercury, cadmium, cobalt and zinc in umbilical cord blood (UCB) and mother whole blood (MWB) were measured in 396 postpartum women without occupational exposure to metals in Tehran, Iran, using inductively coupled plasma mass spectrometry. Mother's ages ranged from 15 to 49 (mean 27) years. Preeclampsia was diagnosed in 31 subjects (7.8%). Levels of Pb, Sb and Mn in UCB were significantly higher in preeclampsia cases [mean+/-SD of 4.30+/-2.49 microg/dl, 4.16+/-2.73 and 46.87+/-15.03 microg/l, respectively] than in controls [3.52+/-2.09 microg/dl, 3.17+/-2.68 and 40.32+/-15.19 microg/l, respectively] (P<0.05). The logistic regression analysis revealed that one unit increase in the common logarithms of UCB concentration of Pb, Sb or Mn led to increase in the risk of preeclampsia several-fold; unit risks (95% CI) were 12.96 (1.57-107.03), 6.11 (1.11-33.53) and 34.2 (1.81-648.04) for Pb, Sb and Mn, respectively (P<0.05). These findings suggest that environmental exposure to Pb, Sb and Mn may increase the risk of preeclampsia in women without occupational exposure; levels of metals in UCB to be sensitive indicators of female reproductive toxicity as compared with those in mother MWB. Further studies are necessary to confirm these findings, especially on Sb and Mn.
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Affiliation(s)
- Mohsen Vigeh
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Hongo Bunkyo-ku, Tokyo, Japan
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Procopio M, Marriott PK, Davies RJE. Seasonality of birth in epilepsy: a Southern Hemisphere study. Seizure 2005; 15:17-21. [PMID: 16298147 DOI: 10.1016/j.seizure.2005.10.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2004] [Revised: 10/07/2005] [Accepted: 10/17/2005] [Indexed: 11/30/2022] Open
Abstract
A consistent pattern has emerged from research in Northern Hemisphere populations indicating differences in the seasonality of birth between patients with epilepsy and the general population. This is the first study using similar methodology to look at Southern Hemisphere data. The population studied is composed of patients discharged from Australian hospitals with a diagnosis of epilepsy, in the period 1998-1999. The results show a significantly higher incidence of epilepsy in the patients born during the Australian winter and summer and a deficit of patients born during the spring and fall. This pattern is consistent with the Northern Hemisphere findings. This study provides further evidence of the existence of a seasonal aetiological agent(s) for epilepsy acting in the perinatal period.
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Affiliation(s)
- Marco Procopio
- The Priory Hospital Hove, 14-18 New Church Road, Hove, East Sussex BN3 4FH, UK.
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