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Anouilh F, de Moreuil C, Trémouilhac C, Jacquot M, Salnelle G, Bellec V, Touffet N, Cornec C, Muller M, Dupré PF, Bellot C, Morcel K, Joliff DL, Drugmanne G, Gelebart E, Lucier S, Nowak E, Bihan L, Couturaud F, Tromeur C, Moigne EL, Pan-Petesch B. Family history of postpartum hemorrhage is a risk factor for postpartum hemorrhage after vaginal delivery: results from the French prospective multicenter Haemorrhages and Thromboembolic Venous Disease of the Postpartum cohort study. Am J Obstet Gynecol MFM 2023; 5:101062. [PMID: 37343695 DOI: 10.1016/j.ajogmf.2023.101062] [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: 04/17/2023] [Revised: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Postpartum hemorrhage is a major component of perinatal morbidity and mortality that affects young women worldwide and is still often unpredictable. Reducing the incidence of postpartum hemorrhage is a major health issue and identifying women at risk for postpartum hemorrhage is a key element in preventing this complication. OBJECTIVE This study aimed to estimate postpartum hemorrhage prevalence after vaginal delivery and to identify postpartum hemorrhage risk factors. STUDY DESIGN Unselected pregnant women ≥16 years of age admitted to 1 of 6 maternity wards in Brittany (France) for vaginal birth after 15 weeks of gestation were recruited in this prospective, multicenter cohort study between June 1, 2015, and January 31, 2019. Postpartum hemorrhage was defined as blood loss ≥500 mL in the 24 hours following delivery. Independent risk factors for postpartum hemorrhage were determined using logistic regression. Missing data were imputed using the Multivariate Imputation by Chained Equations method. RESULTS Among 16,382 included women, the postpartum hemorrhage prevalence was 5.37%. A first-degree family history of postpartum hemorrhage (adjusted odds ratio, 1.63; 95% confidence interval, 1.24-2.14) and a personal transfusion history (adjusted odds ratio, 1.90; 95% confidence interval, 1.23-2.92) were significantly associated with postpartum hemorrhage. The use of oxytocin during labor was also a risk factor for postpartum hemorrhage (adjusted odds ratio, 1.24; 95% confidence interval, 1.06-1.44). Inversely, smoking during pregnancy and intrauterine growth restriction were associated with a reduced risk for postpartum hemorrhage (adjusted odds ratio, 0.76; 95% confidence interval, 0.63-0.91, and 0.34; 95% confidence interval, 0.13-0.87, respectively). CONCLUSION In addition to classical risk factors, this study identified a family history of postpartum hemorrhage and personal transfusion history as new characteristics associated with postpartum hemorrhage after vaginal delivery. The association of postpartum hemorrhage with a family history of postpartum hemorrhage suggests a hereditary hemorrhagic phenotype and calls for genetic studies. Identifying women at risk for postpartum hemorrhage is a key element of being prepared for this complication.
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Affiliation(s)
- François Anouilh
- Ecole Universitaire de Maïeutique de Brest, UFR Santé - Brest, Brest, France (Mr Anouilh); UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), Brest, France (Mr Anouilh, Drs de Moreuil, Trémouilhac, Morcel, Couturaud, Tromeur, Le Moigne, and Pan-Petesch)
| | - Claire de Moreuil
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), Brest, France (Mr Anouilh, Drs de Moreuil, Trémouilhac, Morcel, Couturaud, Tromeur, Le Moigne, and Pan-Petesch); Département de Médecine Interne, Médecine Vasculaire et Pneumologie, Centre Hospitalier Universitaire Brest, Brest, France (Drs Moreuil, Couturaud, Tromeur, and Le Moigne).
| | - Christophe Trémouilhac
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), Brest, France (Mr Anouilh, Drs de Moreuil, Trémouilhac, Morcel, Couturaud, Tromeur, Le Moigne, and Pan-Petesch); Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire Brest, Brest, France (Dr Trémouilhac, Ms Cornec, and Drs Dupré and Morcel)
| | - Matthieu Jacquot
- Service de Gynécologie Obstétrique, CHIC de Quimper, Quimper, France (Drs Jacquot, Bellot, and Le Joliff)
| | - Gilles Salnelle
- Service de Gynécologie Obstétrique, CH des Pays de Morlaix, Morlaix, France (Drs Salnelle and Muller)
| | - Violaine Bellec
- Service de Gynécologie Obstétrique, Centre Hospitalier Privé de Brest - Keraudren, Brest, France (Dr Bellec)
| | - Nathalie Touffet
- Service de Gynécologie Obstétrique, CH de Landerneau, Landerneau, France (Dr Touffet)
| | - Caroline Cornec
- Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire Brest, Brest, France (Dr Trémouilhac, Ms Cornec, and Drs Dupré and Morcel)
| | - Matthieu Muller
- Service de Gynécologie Obstétrique, CH des Pays de Morlaix, Morlaix, France (Drs Salnelle and Muller)
| | - Pierre-François Dupré
- Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire Brest, Brest, France (Dr Trémouilhac, Ms Cornec, and Drs Dupré and Morcel)
| | - Charles Bellot
- Service de Gynécologie Obstétrique, CHIC de Quimper, Quimper, France (Drs Jacquot, Bellot, and Le Joliff)
| | - Karine Morcel
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), Brest, France (Mr Anouilh, Drs de Moreuil, Trémouilhac, Morcel, Couturaud, Tromeur, Le Moigne, and Pan-Petesch); Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire Brest, Brest, France (Dr Trémouilhac, Ms Cornec, and Drs Dupré and Morcel)
| | - Delphine Le Joliff
- Service de Gynécologie Obstétrique, CHIC de Quimper, Quimper, France (Drs Jacquot, Bellot, and Le Joliff)
| | - Guillaume Drugmanne
- CIC1412, Institut National de la Sante et de la Recherche Medicale, Brest, France (Mr Drugmanne, Ms Gelebart, Ms Lucier, Dr Nowak, and Ms Bihan)
| | - Elodie Gelebart
- CIC1412, Institut National de la Sante et de la Recherche Medicale, Brest, France (Mr Drugmanne, Ms Gelebart, Ms Lucier, Dr Nowak, and Ms Bihan)
| | - Sandy Lucier
- CIC1412, Institut National de la Sante et de la Recherche Medicale, Brest, France (Mr Drugmanne, Ms Gelebart, Ms Lucier, Dr Nowak, and Ms Bihan)
| | - Emmanuel Nowak
- CIC1412, Institut National de la Sante et de la Recherche Medicale, Brest, France (Mr Drugmanne, Ms Gelebart, Ms Lucier, Dr Nowak, and Ms Bihan)
| | - Line Bihan
- CIC1412, Institut National de la Sante et de la Recherche Medicale, Brest, France (Mr Drugmanne, Ms Gelebart, Ms Lucier, Dr Nowak, and Ms Bihan)
| | - Francis Couturaud
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), Brest, France (Mr Anouilh, Drs de Moreuil, Trémouilhac, Morcel, Couturaud, Tromeur, Le Moigne, and Pan-Petesch); Département de Médecine Interne, Médecine Vasculaire et Pneumologie, Centre Hospitalier Universitaire Brest, Brest, France (Drs Moreuil, Couturaud, Tromeur, and Le Moigne)
| | - Cécile Tromeur
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), Brest, France (Mr Anouilh, Drs de Moreuil, Trémouilhac, Morcel, Couturaud, Tromeur, Le Moigne, and Pan-Petesch); Département de Médecine Interne, Médecine Vasculaire et Pneumologie, Centre Hospitalier Universitaire Brest, Brest, France (Drs Moreuil, Couturaud, Tromeur, and Le Moigne)
| | - Emmanuelle Le Moigne
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), Brest, France (Mr Anouilh, Drs de Moreuil, Trémouilhac, Morcel, Couturaud, Tromeur, Le Moigne, and Pan-Petesch); Département de Médecine Interne, Médecine Vasculaire et Pneumologie, Centre Hospitalier Universitaire Brest, Brest, France (Drs Moreuil, Couturaud, Tromeur, and Le Moigne)
| | - Brigitte Pan-Petesch
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), Brest, France (Mr Anouilh, Drs de Moreuil, Trémouilhac, Morcel, Couturaud, Tromeur, Le Moigne, and Pan-Petesch); Centre de Ressources et de Compétence des Maladies Hémorragiques, Centre de Ressources et de Compétence des Maladies Hémorragiques, Hémostase, Service Hématologie, Centre Hospitalier Universitaire Brest, Brest, France (Dr Pan-Petesch)
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Than NG, Romero R, Györffy D, Posta M, Bhatti G, Done B, Chaemsaithong P, Jung E, Suksai M, Gotsch F, Gallo DM, Bosco M, Kim B, Kim YM, Chaiworapongsa T, Rossi SW, Szilágyi A, Erez O, Tarca AL, Papp Z. Molecular subclasses of preeclampsia characterized by a longitudinal maternal proteomics study: distinct biomarkers, disease pathways and options for prevention. J Perinat Med 2023; 51:51-68. [PMID: 36253935 PMCID: PMC9837387 DOI: 10.1515/jpm-2022-0433] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/09/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The heterogeneous nature of preeclampsia is a major obstacle to early screening and prevention, and a molecular taxonomy of disease is needed. We have previously identified four subclasses of preeclampsia based on first-trimester plasma proteomic profiles. Herein, we expanded this approach by using a more comprehensive panel of proteins profiled in longitudinal samples. METHODS Proteomic data collected longitudinally from plasma samples of women who developed preeclampsia (n=109) and of controls (n=90) were available from our previous report on 1,125 proteins. Consensus clustering was performed to identify subgroups of patients with preeclampsia based on data from five gestational-age intervals by using select interval-specific features. Demographic, clinical, and proteomic differences among clusters were determined. Differentially abundant proteins were used to identify cluster-specific perturbed KEGG pathways. RESULTS Four molecular clusters with different clinical phenotypes were discovered by longitudinal proteomic profiling. Cluster 1 involves metabolic and prothrombotic changes with high rates of early-onset preeclampsia and small-for-gestational-age neonates; Cluster 2 includes maternal anti-fetal rejection mechanisms and recurrent preeclampsia cases; Cluster 3 is associated with extracellular matrix regulation and comprises cases of mostly mild, late-onset preeclampsia; and Cluster 4 is characterized by angiogenic imbalance and a high prevalence of early-onset disease. CONCLUSIONS This study is an independent validation and further refining of molecular subclasses of preeclampsia identified by a different proteomic platform and study population. The results lay the groundwork for novel diagnostic and personalized tools of prevention.
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Affiliation(s)
- Nándor Gábor Than
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Systems Biology of Reproduction Research Group, Institute of Enzymology, Research Centre for Natural Sciences, Budapest, Hungary
- Maternity Private Clinic of Obstetrics and Gynecology, Budapest, Hungary
- Genesis Theranostix Group, Budapest, Hungary
- First Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA
- Detroit Medical Center, Detroit, Michigan, USA
| | - Dániel Györffy
- Systems Biology of Reproduction Research Group, Institute of Enzymology, Research Centre for Natural Sciences, Budapest, Hungary
- Genesis Theranostix Group, Budapest, Hungary
- Faculty of Information Technology and Bionics, Pázmány Péter Catholic University, Budapest, Hungary
| | - Máté Posta
- Systems Biology of Reproduction Research Group, Institute of Enzymology, Research Centre for Natural Sciences, Budapest, Hungary
- Genesis Theranostix Group, Budapest, Hungary
- Károly Rácz Doctoral School of Clinical Medicine, Semmelweis University, Budapest, Hungary
| | - Gaurav Bhatti
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Bogdan Done
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Piya Chaemsaithong
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Eunjung Jung
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Manaphat Suksai
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Francesca Gotsch
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Dahiana M. Gallo
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Universidad Del Valle, Cali, Colombia
| | - Mariachiara Bosco
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Bomi Kim
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Pathology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Department of Pathology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Yeon Mee Kim
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Pathology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Department of Pathology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Tinnakorn Chaiworapongsa
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | | | - András Szilágyi
- Systems Biology of Reproduction Research Group, Institute of Enzymology, Research Centre for Natural Sciences, Budapest, Hungary
| | - Offer Erez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Genesis Theranostix Group, Budapest, Hungary
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, HaEmek Medical Center, Afula, Israel
| | - Adi L. Tarca
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Genesis Theranostix Group, Budapest, Hungary
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Department of Computer Science, Wayne State University College of Engineering, Detroit, Michigan, USA
| | - Zoltán Papp
- Maternity Private Clinic of Obstetrics and Gynecology, Budapest, Hungary
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
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