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Hantoushzadeh S, Gargar OK, Jafarabady K, Rezaei MM, Asadi F, Eshraghi N, Panahi Z, Shirdel S, Mirzamoradi M, Ghaemi M. Diagnostic value of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio to predict recurrent pregnancy loss and abortion; a systematic review and meta-analysis. Immun Inflamm Dis 2024; 12:e1210. [PMID: 38506423 PMCID: PMC10953208 DOI: 10.1002/iid3.1210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/05/2024] [Accepted: 02/29/2024] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to evaluate the diagnostic value of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in women with a history of abortion (missed and threatened) and recurrent pregnancy loss (RPL) in comparison with healthy pregnancies. METHODS Electronic databases including MEDLINE, Scopus, Web of Science, Embase, and Cochrane Library were searched for NLR and PLR in women who experienced early pregnancy loss up to January 1, 2023 with a combination of proper keywords. Meta-analysis was done for comparison with three or more studies and summary estimates were measured. RESULTS A total of 390 citations were retrieved initially, and after screening, 16 articles were deemed eligible for the final review. Among these, 14 studies underwent meta-analysis. The meta-analysis revealed that the standard mean of the NLR was significantly higher in abortion cases compared to the control group. However, there was no significant difference in the PLR between the pregnancy loss group and the control group. CONCLUSION NLR was significantly higher among RPL patients compared to the control group, according to these data, NLR may be capable of being used in the diagnosis of RPL as an easy, cheap, and accessible modality. Further studies, which take these variables into account, will need to be undertaken to determine the diagnostic value of NLR and PLR in early pregnancy loss.
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Affiliation(s)
- Sedigheh Hantoushzadeh
- Vali‐E‐Asr Reproductive Health Research Center, Family Health Research InstituteTehran University of Medical SciencesTehranIran
| | | | - Kyana Jafarabady
- Student Research CommitteeAlborz University of Medical SciencesKarajIran
| | | | - Fatemeh Asadi
- Vali‐E‐Asr Reproductive Health Research Center, Family Health Research InstituteTehran University of Medical SciencesTehranIran
| | - Nasim Eshraghi
- Vali‐E‐Asr Reproductive Health Research Center, Family Health Research InstituteTehran University of Medical SciencesTehranIran
| | - Zahra Panahi
- Vali‐E‐Asr Reproductive Health Research Center, Family Health Research InstituteTehran University of Medical SciencesTehranIran
| | - Saeedeh Shirdel
- Vali‐E‐Asr Reproductive Health Research Center, Family Health Research InstituteTehran University of Medical SciencesTehranIran
| | - Masoumeh Mirzamoradi
- Clinical Research Development Center, Mahdiyeh Educational HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Marjan Ghaemi
- Vali‐E‐Asr Reproductive Health Research Center, Family Health Research InstituteTehran University of Medical SciencesTehranIran
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Mouliou DS. C-Reactive Protein: Pathophysiology, Diagnosis, False Test Results and a Novel Diagnostic Algorithm for Clinicians. Diseases 2023; 11:132. [PMID: 37873776 PMCID: PMC10594506 DOI: 10.3390/diseases11040132] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/25/2023] Open
Abstract
The current literature provides a body of evidence on C-Reactive Protein (CRP) and its potential role in inflammation. However, most pieces of evidence are sparse and controversial. This critical state-of-the-art monography provides all the crucial data on the potential biochemical properties of the protein, along with further evidence on its potential pathobiology, both for its pentameric and monomeric forms, including information for its ligands as well as the possible function of autoantibodies against the protein. Furthermore, the current evidence on its potential utility as a biomarker of various diseases is presented, of all cardiovascular, respiratory, hepatobiliary, gastrointestinal, pancreatic, renal, gynecological, andrological, dental, oral, otorhinolaryngological, ophthalmological, dermatological, musculoskeletal, neurological, mental, splenic, thyroid conditions, as well as infections, autoimmune-supposed conditions and neoplasms, including other possible factors that have been linked with elevated concentrations of that protein. Moreover, data on molecular diagnostics on CRP are discussed, and possible etiologies of false test results are highlighted. Additionally, this review evaluates all current pieces of evidence on CRP and systemic inflammation, and highlights future goals. Finally, a novel diagnostic algorithm to carefully assess the CRP level for a precise diagnosis of a medical condition is illustrated.
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Beernink RHJ, Schuitemaker JHN, Zwertbroek EF, Scherjon SA, Cremers TIFH. Early pregnancy biomarker discovery study for spontaneous preterm birth. Placenta 2023; 139:112-119. [PMID: 37356366 DOI: 10.1016/j.placenta.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/24/2023] [Accepted: 06/17/2023] [Indexed: 06/27/2023]
Abstract
(1) OBJECTIVE: discover new candidate biomarkers for spontaneous preterm birth in early pregnancy samples. When fully clinically validated, early pregnancy biomarkers for sPTB give the possibility to intervene or monitor high-risk pregnancies more intensively through, as example, pelvic exams, ultrasound or sonographic cervical length surveillance. (2) STUDY DESIGN: Early pregnancy serum samples of eight spontaneous extreme and very preterm birth cases (<32 weeks of gestational age) without any symptoms of preeclampsia and fetal growth restriction and eight uncomplicated pregnancies were analyzed by liquid chromatography mass spectrometry (LC-MS). Thirteen proteins, which were differentially expressed according to the LC-MS data, were subsequently selected for confirmation by enzyme-linked immunosorbent assay (ELISA). (3) RESULTS: Differential expression of four candidate biomarkers was confirmed by ELISA with decreased early pregnancy levels of gelsolin and fibulin-1 and increased levels of c-reactive protein and complement C5 in the preterm birth group. (4) CONCLUSIONS: The confirmed candidate biomarkers are all to some extent related to inflammatory pathways and/or the complement system. This supports the hypothesis that both play a role in extreme and very preterm birth without any symptoms of preeclampsia and fetal growth restriction. The predictive value of complement C5, c-reactive protein, fibulin-1 and gelsolin should, therefore, be validated in another cohort with early pregnancy samples.
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Affiliation(s)
- Rik H J Beernink
- Dept. Analytical Biochemistry, University of Groningen, Groningen, the Netherlands; Research & Development, IQ Products BV., Groningen, the Netherlands.
| | - Joost H N Schuitemaker
- Research & Development, IQ Products BV., Groningen, the Netherlands; Div. of Medical Biology, Dept. of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Eva F Zwertbroek
- Dept. of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Sicco A Scherjon
- Dept. of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Thomas I F H Cremers
- Dept. Analytical Biochemistry, University of Groningen, Groningen, the Netherlands
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Matoba N, Collins JW, Dizon MLV. Fetal Origins of Health Disparities: Transgenerational Consequences of Racism. Dev Neurosci 2023; 46:112-118. [PMID: 37290414 DOI: 10.1159/000531462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 05/24/2023] [Indexed: 06/10/2023] Open
Abstract
Despite advances in perinatal medicine, racial disparity in birth outcomes remains a public health problem in the USA. The underlying mechanisms for this long-standing racial disparity are incompletely understood. This review presents transgenerational risk factors for racial disparities in preterm birth, exploring the impact of interpersonal and structural racism, theoretical models of stress, and biological markers of racial disparities.
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Affiliation(s)
- Nana Matoba
- Department of Pediatrics, Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Pediatrics, Division of Neonatology, University of California San Diego, Rady Children's Hospital San Diego, San Diego, California, USA
| | - James W Collins
- Department of Pediatrics, Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Maria L V Dizon
- Department of Pediatrics, Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Vexø LE, Stormlund S, Landersoe SK, Jørgensen HL, Humaidan P, Bergh C, Englund ALM, Klajnbard A, Bogstad JW, Freiesleben NLC, Zedeler A, Prætorius L, Andersen AN, Løssl K, Pinborg A, Nielsen HS. Low-grade inflammation is negatively associated with live birth in women undergoing IVF. Reprod Biomed Online 2023; 46:302-311. [PMID: 36446681 DOI: 10.1016/j.rbmo.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/28/2022] [Accepted: 10/08/2022] [Indexed: 11/23/2022]
Abstract
RESEARCH QUESTION Is low-grade inflammation, detected by C-reactive protein (CRP), a marker of IVF outcome addressing both blastocyst quality and pregnancy outcome? DESIGN This sub-study of a multicentre randomized controlled trial included 440 women undergoing IVF treatment with a gonadotrophin-releasing hormone (GnRH) antagonist protocol. Serum CRP was measured on cycle day 2-3 (baseline) and on the day of ovulation triggering. The association between CRP concentrations and reproductive outcomes (number of retrieved oocytes, number of good-quality blastocysts, pregnancy, pregnancy loss and live birth), were analysed, adjusting for relevant confounders. RESULTS A negative association was found between higher baseline CRP concentrations and live birth rate (odds ratio [OR] 0.77, 95% confidence interval [CI] 0.62-0.96, P = 0.02) and higher CRP concentrations at baseline were associated with pregnancy loss among women who conceived (OR 1.37, 95% CI 1.07-1.76, P = 0.01). When testing for a specific cut-off, CRP concentrations above 2.34 (the highest quartile) were more likely to be associated with pregnancy loss (P = 0.02) and a lower chance of live birth (P = 0.04) compared with the lowest quartile. No associations were found between CRP concentrations and pregnancy outcomes on the day of ovulation triggering, and there were no associations between CRP concentrations and the number of good-quality blastocysts. CONCLUSIONS Higher CRP concentrations at cycle day 2-3, before starting ovarian stimulation, are negatively associated with chance of live birth, possibly because of an increased risk of pregnancy loss. No association was found between the number of good-quality blastocysts and CRP concentration. More studies are needed to investigate the impact of low-grade inflammation.
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Affiliation(s)
- Laura Emilie Vexø
- Fertility Department, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Obstetrics and Gynaecology, Fertility Clinic, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
| | - Sacha Stormlund
- Department of Obstetrics and Gynaecology, Fertility Clinic, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Selma Kloeve Landersoe
- Fertility Department, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Henrik Løvendahl Jørgensen
- Department of Clinical Biochemistry, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Humaidan
- Fertility Clinic, Skive Regional Hospital and Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Christina Bergh
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University; Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anne Lis Mikkelsen Englund
- Department of Obstetrics and Gynaecology, Fertility Clinic, Region Zealand University Hospital, Koege, Denmark
| | - Anna Klajnbard
- Fertility Clinic, Department of Obstetrics and Gynaecology, Herlev University Hospital, Copenhagen, Denmark
| | - Jeanette Wulff Bogstad
- Fertility Department, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Nina la Cour Freiesleben
- Department of Obstetrics and Gynaecology, Fertility Clinic, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Zedeler
- Department of Obstetrics and Gynaecology, Fertility Clinic, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Lisbeth Prætorius
- Department of Obstetrics and Gynaecology, Fertility Clinic, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Anders Nyboe Andersen
- Fertility Department, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kristine Løssl
- Fertility Department, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Anja Pinborg
- Fertility Department, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Obstetrics and Gynaecology, Fertility Clinic, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Henriette Svarre Nielsen
- Fertility Department, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Obstetrics and Gynaecology, Fertility Clinic, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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6
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Zhang H, Li X, Zhang F, Li F, Jin H, Su Y, Li G. Serum C-reactive protein levels are associated with clinical pregnancy rate after in vitro fertilization among normal-weight women. Front Endocrinol (Lausanne) 2023; 14:934766. [PMID: 36742394 PMCID: PMC9893108 DOI: 10.3389/fendo.2023.934766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 01/05/2023] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To assess whether low-grade inflammation, measured by serum high-sensitivity C-reactive protein (hsCRP) levels, is associated with in vitro fertilization (IVF) outcomes. DESIGN A retrospective study. SETTING University-affiliated IVF center. PATIENTS In the present study, 875 women of normal weight who underwent their first fresh embryo transfer (ET) cycles for IVF treatment were divided into three groups according to serum concentrations of hsCRP. INTERVENTIONS Serum from women undergoing IVF was collected on days 2-4 of a spontaneous menstrual cycle prior to the commencement of ovarian stimulation. MAIN OUTCOME MEASURES The IVF outcomes included implantation, biochemical pregnancy, clinical pregnancy, miscarriage and live birth rates. RESULTS The women were divided into three groups according to the baseline serum levels of hsCRP as follows: low hsCRP (<1 mg/L; n=517), medium hsCRP (1-3 mg/L; n= 270), high hsCRP (>3 mg/L; n=88). The maternal age was similar among the three groups. The women in the high and medium hsCRP group had significantly higher BMI compared with those in the low hsCRP group. The protocol of controlled ovarian hyperstimulation, the gonadotropin dose administered, the serum estradiol levels, progesterone levels and the endometrial thickness on the day of triggering, as well as the number of retrieved oocytes, fertilized oocytes and good quality embryos, and the oocyte maturation rate were similar among the three groups. Implantation, biochemical pregnancy and clinical miscarriage rates did not differ significantly were not significantly different among three groups. The clinical pregnancy rate was significantly lower in the high hsCRP group compared with that in the low hsCRP group (50.0% versus 63.4%; P<0.0167), which contributed to a significant decrease in birth rate (39.8% versus 53.8%; P<0.0167). High serum hsCRP levels was found to be a factor affecting live birth rate. CONCLUSIONS Among women of normal weight undergoing their first IVF treatment, it was found that low-grade inflammation was associated with reduced clinical pregnancy and live birth rates following fresh ET cycles.
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Affiliation(s)
- Huixia Zhang
- Centre for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin Li
- Centre for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fan Zhang
- Centre for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fei Li
- Centre for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Haixia Jin
- Centre for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingchun Su
- Centre for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Gang Li
- Centre for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Gang Li,
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Bernhardt GV, Shivappa P, Bernhardt K, Bhat S, Pinto JR, Jhancy M, Kumar S. Markers of inflammation in obese pregnant women: Adenosine deaminase and high sensitive C - reactive protein. Eur J Obstet Gynecol Reprod Biol X 2022; 16:100167. [PMID: 36312323 PMCID: PMC9597103 DOI: 10.1016/j.eurox.2022.100167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/27/2022] [Accepted: 10/12/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction The worldwide increase in the prevalence of obesity over the years has emerged as a global health concern. The growing rate of obesity in women of child bearing age is particularly a matter of concern. Obesity is considered a risk factor that predisposes an individual to a proinflammatory state through the release of the inflammatory mediators. Recent studies have shown a positive correlation between the severity of inflammation and an increase in adenosine deaminase (ADA) and high sensitivity C- reactive protein (hs-CRP). Obese pregnancy women are at a higher risk for developing inflammation-mediated pregnancy complications like gestational diabetes, preeclampsia, and preterm delivery. Considering the fact that pregnancy, obesity and inflammation are closely linked, this study evaluated the inflammation associated with obesity during pregnancy by estimating changes in ADA and hs-CRP. Materials and methods The current study aimed to evaluate the levels of inflammation in obese pregnant women compared to non-obese pregnant women by correlating BMI with levels of ADA / hs-CRP. The study also aimed to examine the change in ADA and hs-CRP levels with gestational age (between the 1st and the 3rd trimester) in obese pregnant women as compared to non-obese pregnant women. We also examined whether changes in the levels of ADA correlate with changes in the levels of hs-CRP particularly in obese pregnant women.Blood samples were collected from obese and non-obese pregnant women. ADA activity and hs-CRP levels were estimated by biochemical assays. BMI was evaluated in the 1st trimester and those women with BMI > 30 kg/m2were considered as obese. Thirty subjects were included in each of the two groups. Results ADA and hs-CRP levels were significantly higher in obese pregnant women in both the 1st and 3rd trimesters compared to non-obese participants (P value<0.05). Statistically significant higher values of ADA and hs-CRP were seen in obese participants in the 3rd trimester compared to the 1st trimester.A significant linear positive correlation was found between BMI and 3rd trimester ADA, and a linear positive correlation between BMI and hs-CRP both in the 1st and 3rd trimester. The relationship between ∆ ADA and ∆ hs-CRP was non- significant. Conclusions The observations of this study reveal increased inflammatory responses in obese pregnant women and suggests the importance of ADA and hs-CRP as early indicators of obesity-related complications prevailing thereafter, these markers can be useful for clinical diagnosis of impending maternal and neonatal complications.
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Affiliation(s)
- Grisilda Vidya Bernhardt
- Department of Biochemistry, RAK College of Medical Sciences, RAK Medical and Health Science University, Ras Al Khaimah, United Arab Emirates
| | - Pooja Shivappa
- Department of Basic Sciences, RAK Medical and Health Science University, Ras Al Khaimah, United Arab Emirates
| | - Kavitha Bernhardt
- Department of Physiology, Melaka Manipal Medical College, Manipal Campus, Manipal Academy of Higher Education, Manipal, Karnataka. India
- Corresponding author.
| | - Sujatha Bhat
- Department of Microbiology, Melaka Manipal Medical College, Manipal Campus, Manipal Academy of Higher Education, Manipal, Karnataka. India
| | - Janita R.T. Pinto
- Department of Biomedical Sciences, College of Medicine, Gulf Medical University, Ajman, United Arab Emirates
| | - Malay Jhancy
- Department of Pediatrics, College of Medical Sciences, RAK Medical and Health Science, University, Ras Al Khaimah, United Arab Emirates
| | - Suresh Kumar
- Department of Pharmacology, RAK College of Medical Sciences, RAK Medical and Health Science University, Ras Al Khaimah, United Arab Emirates
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Wang G, Tandon P, Rodriguez N, Ambrosio L, Sutton RT, Dieleman LA, Kroeker KI, Huang V. Impact of Disease Activity and Inflammatory Bowel Disease Subtype on Quality of Life in Preconception and Pregnant Patients. Dig Dis Sci 2022; 68:1156-1166. [PMID: 35930124 DOI: 10.1007/s10620-022-07638-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 07/19/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) and pregnancy both impact health-related quality of life (HRQoL). However, little is known about IBD-related HRQoL around pregnancy. AIMS To assess the trajectory and predictors of HRQoL in preconception and pregnant patients with Crohn's disease (CD) and ulcerative colitis (UC). METHODS Preconception and pregnant patients with IBD were followed prospectively from preconception to twelve months postpartum at a tertiary referral centre. Participants completed the Short IBD Questionnaire (SIBDQ) and were assessed for clinical disease activity (modified Harvey Bradshaw Index or partial Mayo score) and objective disease activity (C-reactive protein [CRP], fecal calprotectin [FCP]). RESULTS A total of 61 patients with IBD (25 CD, 36 UC) were included. During preconception, patients with UC had higher SIBDQ bowel and social sub-scores than those with CD, but this reversed during postpartum. Patients with CD but not UC developed a significant, sustained improvement in SIBDQ upon becoming pregnant, which persisted into 12 months postpartum. In a multivariable linear regression model, clinical disease activity negatively predicted SIBDQ at every pregnancy timepoint and up to 12 months postpartum. SIBDQ was significantly lower in patients with CRP ≥ 8.0 mg/L during trimester 1 (T1), but not later in pregnancy. SIBDQ bowel sub-scores were significantly lower in patients with FCP ≥ 250 mg/kg at T2, T3, and 6 months postpartum. CONCLUSIONS Clinical disease activity is a consistent negative predictor of HRQoL from conception to 12 months postpartum. Patients with UC experience better preconception HRQoL but suffer worse postpartum HRQoL than those with CD.
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Affiliation(s)
- Grace Wang
- Faculty of Medicine, University of Toronto, 1 King's College Cir, Toronto, M5S 1A8, Canada.
| | - Parul Tandon
- Faculty of Medicine, University of Toronto, 1 King's College Cir, Toronto, M5S 1A8, Canada.,Department of Gastroenterology, Mount Sinai Hospital, 600 University Ave, Toronto, M5G 1X5, Canada
| | - Nicole Rodriguez
- Faculty of Medicine, University of Alberta, 8440 112 St NW, Edmonton, T6G 2R7, Canada
| | - Lindsy Ambrosio
- Faculty of Medicine, University of Alberta, 8440 112 St NW, Edmonton, T6G 2R7, Canada.,Division of Gastroenterology, Zeidler Ledcor Centre, University of Alberta, 8540 112 St NW, Edmonton, T6G 2X8, Canada
| | - Reed T Sutton
- Faculty of Medicine, University of Alberta, 8440 112 St NW, Edmonton, T6G 2R7, Canada.,Division of Gastroenterology, Zeidler Ledcor Centre, University of Alberta, 8540 112 St NW, Edmonton, T6G 2X8, Canada
| | - Levinus A Dieleman
- Faculty of Medicine, University of Alberta, 8440 112 St NW, Edmonton, T6G 2R7, Canada.,Division of Gastroenterology, Zeidler Ledcor Centre, University of Alberta, 8540 112 St NW, Edmonton, T6G 2X8, Canada
| | - Karen I Kroeker
- Faculty of Medicine, University of Alberta, 8440 112 St NW, Edmonton, T6G 2R7, Canada.,Division of Gastroenterology, Zeidler Ledcor Centre, University of Alberta, 8540 112 St NW, Edmonton, T6G 2X8, Canada
| | - Vivian Huang
- Faculty of Medicine, University of Toronto, 1 King's College Cir, Toronto, M5S 1A8, Canada.,Department of Gastroenterology, Mount Sinai Hospital, 600 University Ave, Toronto, M5G 1X5, Canada
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Torres E, Zumpf KB, Ciolino JD, Clark CT, Sit DK, Miller ES, Wisner KL. C-Reactive protein concentrations in reproductive-aged women with major mood disorders. Arch Womens Ment Health 2022; 25:577-584. [PMID: 35316423 DOI: 10.1007/s00737-022-01222-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/15/2022] [Indexed: 11/30/2022]
Abstract
To examine associations between high sensitivity C-reactive protein (CRP) concentrations and depressive symptoms in reproductive-aged women with mood disorders. Women (N = 86) with major depressive or bipolar disorder in a specialized mood disorders program provided plasma samples which were analyzed for CRP concentrations and categorized by tertiles (T1, low; T2, middle; T3 high). Depressive symptoms were assessed with the Inventory of Depressive Symptoms. We hypothesized that CRP concentrations would be significantly associated with the following: (1) depressive symptoms; (2) pregnancy, (3) body mass index, and (4) counts of white blood cells and absolute neutrophils and percentage of segmented neutrophils. The distribution of CRP concentrations was highly skewed with a median of 2.45 mg/L and an interquartile range 0.90 - 8.17 mg/L. Elevated plasma levels of CRP were not associated with depressive symptoms, which did not differ by tertile group either before or after adjusting for BMI, pregnancy status, and their interactions. Women in T3 had 5 times greater odds of pregnancy compared to women in T1 (p = .021). However, women in T2 had 11% greater BMI on average (p = 0.023), and women in T3 had 47% greater BMI compared to those in T1 (p < 0.001). Women in T3 had higher mean white blood cell counts than those in T1 and T2, the percentage of neutrophils was higher in T2 and T3 compared to T1, and women in T3 had higher absolute neutrophil counts compared to T1. CRP concentrations varied widely and were significantly elevated in reproductive-aged women with high BMI and current pregnancy, but not with depressive symptoms in this sample of depressed women.
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Affiliation(s)
- Elizabeth Torres
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Katelynn B Zumpf
- Department of Preventive Medicine (Biostatistics), Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jody D Ciolino
- Department of Preventive Medicine (Biostatistics), Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Crystal T Clark
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Dorothy K Sit
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily S Miller
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Katherine L Wisner
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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10
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Wang Z, Chen Y, Wang W, Huang C, Hu Y, Johnston L, Wang F. Dietary Supplementation With Fine-Grinding Wheat Bran Improves Lipid Metabolism and Inflammatory Response via Modulating the Gut Microbiota Structure in Pregnant Sow. Front Microbiol 2022; 13:835950. [PMID: 35418966 PMCID: PMC8999112 DOI: 10.3389/fmicb.2022.835950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/08/2022] [Indexed: 12/12/2022] Open
Abstract
This study investigated the effects of fine-grinding wheat bran on pregnant sow body condition, lipid metabolism, inflammatory response, and gut microbiota. In this study, wheat bran was crushed into three particle sizes. A total of 60 Landrace × Yorkshire second parity sows were allotted to two groups: CWB (a diet containing coarse wheat bran with particle size of 605 μm) and FWB (a diet containing fine wheat bran with particle size of 438 μm). Fine-grinding wheat bran had higher soluble dietary fiber concentration, swelling capacity, water-holding capacity, and fermentability than coarse wheat bran. Pregnant sows fed FWB throughout pregnancy had lower body weight and fat deposition than sows fed CWB. And the piglet body weight at birth of the FWB group was remarkably increased. Serum concentrations of lipids (triglycerides, total cholesterol, and free fatty acid), interleukin 6, leptin, and resistin were decreased on day 90 of pregnancy by fine wheat bran supplementation. Feeding FWB significantly decreased abundance of Firmicutes and dramatically increased the abundance of Bacteroidetes at phylum level. At genus level, the abundance of Terrisporobacter was decreased in FWB feeding sows, but the abundance of Parabacteroides was increased. Fecal total short-chain fatty acids, propionate, and butyrate contents were markedly increased in the FWB group. The results suggested that the physicochemical properties of finely ground wheat bran had been improved. Dietary supplementation with fine wheat bran changed the gut microbiota structure and enhanced the short-chain fatty acids level, which improved the maternal body condition, metabolic and inflammatory status, and reproductive performance in sows.
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Affiliation(s)
- Zijie Wang
- State Key Lab of Animal Nutrition, College of Animal Science & Technology, China Agricultural University, Beijing, China
| | - Yifan Chen
- College of Animal Science and Technology, Hebei Agricultural University, Baoding, China
| | - Wenhui Wang
- State Key Lab of Animal Nutrition, College of Animal Science & Technology, China Agricultural University, Beijing, China
| | - Caiyun Huang
- College of Animal Science, Fujian Agriculture and Forestry University, Fuzhou, China
| | - Yongfei Hu
- State Key Lab of Animal Nutrition, College of Animal Science & Technology, China Agricultural University, Beijing, China
| | - Lee Johnston
- Swine Nutrition and Production, West Central Research and Outreach Center, University of Minnesota, Morris, MN, United States
| | - Fenglai Wang
- State Key Lab of Animal Nutrition, College of Animal Science & Technology, China Agricultural University, Beijing, China
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11
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Santana DD, Kac G, dos Santos PPT, da Silva TC, Benaim C, Cocate PG, Trindade de Castro MB, Heitmann BL, Adegboye ARA. Association between Pre-Pregnancy BMI and Inflammatory Profile Trajectories during Pregnancy and Postpartum in Brazilian Women with Periodontitis: The IMPROVE Trial. Int J Environ Res Public Health 2022; 19:2705. [PMID: 35270396 PMCID: PMC8909899 DOI: 10.3390/ijerph19052705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/04/2022] [Accepted: 02/23/2022] [Indexed: 11/30/2022]
Abstract
This study aimed to explore the association between pre-pregnancy BMI and longitudinal changes in inflammatory markers from the second trimester of pregnancy to 6-8 weeks postpartum in women with periodontitis. This is a secondary exploratory analysis of 68 women who took part in a feasibility clinical trial in Rio de Janeiro, Brazil. Inflammatory markers included C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-10 (IL-10), and matrix metalloproteinase-9 (MMP-9) blood concentrations at 11-22 (T0) and 30-36 gestational weeks (T1), and 6-8 weeks postpartum (T3). Longitudinal generalised linear mixed-effects models were used to identify possible associations between pre-pregnancy BMI and changes in concentrations of inflammatory markers. Pre-pregnancy excess weight (β = 4.39; 95% CI, 2.12-6.65) was significantly associated with increased CRP levels from pregnancy to postpartum. There were no significant associations between pre-pregnancy BMI and longitudinal changes in IL-6, IL-10 and MMP-9. Our findings provide evidence that a higher pre-pregnancy BMI may lead to increases in CRP levels during pregnancy in women with periodontitis, irrespective of the severity of clinical periodontal parameters. Further studies need to investigate if predictors of changes in inflammatory markers can be used as prognostic factors for gestational outcomes.
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Affiliation(s)
- Danilo Dias Santana
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (D.D.S.); (G.K.); (P.P.T.d.S.); (T.C.d.S.); (C.B.); (M.B.T.d.C.)
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (D.D.S.); (G.K.); (P.P.T.d.S.); (T.C.d.S.); (C.B.); (M.B.T.d.C.)
| | - Pedro Paulo Teixeira dos Santos
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (D.D.S.); (G.K.); (P.P.T.d.S.); (T.C.d.S.); (C.B.); (M.B.T.d.C.)
| | - Thainá Castro da Silva
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (D.D.S.); (G.K.); (P.P.T.d.S.); (T.C.d.S.); (C.B.); (M.B.T.d.C.)
| | - Camila Benaim
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (D.D.S.); (G.K.); (P.P.T.d.S.); (T.C.d.S.); (C.B.); (M.B.T.d.C.)
| | - Paula Guedes Cocate
- School of Physical Education and Sports, Federal University of Rio de Janeiro, Rio de Janeiro 21941-599, Brazil;
| | - Maria Beatriz Trindade de Castro
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (D.D.S.); (G.K.); (P.P.T.d.S.); (T.C.d.S.); (C.B.); (M.B.T.d.C.)
| | - Berit Lilienthal Heitmann
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark;
- Section for General Practise, Department of Public Health, University of Copenhagen, 1353 Copenhagen, Denmark
| | - Amanda Rodrigues Amorim Adegboye
- Centre for Healthcare Research, Faculty of Health and Life Sciences, School of Nursing, Midwifery and Health, Coventry University, Priory Street, Coventry CV1 5FB, UK
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12
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Chen PS, Tang LY, Chang HH. Roles of C-reactive protein polymorphisms and life event changes on cognitive function in bipolar patients receiving valproate. Int J Immunopathol Pharmacol 2022; 36:3946320221084835. [PMID: 35377256 PMCID: PMC8984865 DOI: 10.1177/03946320221084835] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Patients with bipolar disorder (BD) exhibit an inflamed condition that is
associated with metabolic disturbance and cognitive impairment. Whether
inflammation, represented by C-reactive protein (CRP), is causally
associated with BD and influences treatment outcome has not been
established. Methods We examined whether CRP is a causal factor for the risk of BD in drug-naïve,
depressed BD patients and investigated whether polymorphisms in
CRP and life event changes influence cognitive function
in BD patients receiving valproate (VPA) treatment. Results Our results showed that BD patients had significantly higher CRP levels and
worse cognitive function than the controls, while the frequencies of
CRP single nucleotide polymorphisms in BD patients and
in controls were not different. In addition, the life event scale score was
higher for BD patients than for controls. Furthermore, the genotypes of
CRP polymorphisms and the interactions between
polymorphisms of CRP and life event scale score had a
significant influence on cognitive performance in BD patients after 12 weeks
of VPA treatment. Conclusion Our study demonstrated the clinical utility of the application of functional
genetics in clarifying the interactions among CRP, life event stress, and BD
and suggested the important roles of CRP gene–environment
interactions in developing treatment strategies for BD.
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Affiliation(s)
- Po See Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, 38026National Cheng Kung University, Tainan, Taiwan.,Institute of Behavioral Medicine, College of Medicine, 38026National Cheng Kung University, Tainan, Taiwan
| | - Li-Yi Tang
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, 38026National Cheng Kung University, Tainan, Taiwan
| | - Hui Hua Chang
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, 38026National Cheng Kung University, Tainan, Taiwan.,School of Pharmacy, College of Medicine, 38026National Cheng Kung University, Tainan, Taiwan.,Department of Pharmacy, National Cheng Kung University Hospital, College of Medicine, 38026National Cheng Kung University, Tainan, Taiwan.,Department of Pharmacy, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan
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13
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Satué K, Calvo A, Muñoz A, Fazio E, Medica P. Interrelationship between reproductive hormones and acute phase proteins during estrous cycle and pregnancy in Spanish purebred broodmares. Vet Anim Sci 2021; 14:100212. [PMID: 34765800 PMCID: PMC8573188 DOI: 10.1016/j.vas.2021.100212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/22/2021] [Accepted: 10/23/2021] [Indexed: 11/22/2022] Open
Abstract
In some species, female steroid hormones modify the profile of acute phase proteins (APPs) during the estrous cycle and pregnancy, according to the ovulation, embryonic implantation and placental development; however, nowadays there's no experimental evidence for equine species. Objectives of this study were: to compare the serum amyloid A (SAA), haptoglobin (Hp) and C-reactive protein (CRP) concentrations between cyclic and pregnant mares, and to analyze the influence of estradiol-17β (E2) during estrous cycle or estrone sulfate (E1) during pregnancy, and progesterone (P4) on these proteins to assess their potential role to identify the cyclicity or pregnancy in Spanish mares. Blood samples were taken from 20 Purebred Spanish mares on the day of ovulation (day 0), on days +5 and +16 post-ovulation, and then, monthly during the whole pregnancy. SAA, Hp and CRP did not change between day 0, +5 and +16 post-ovulation days. P4 concentrations were significantly higher on day +16 than on days +5 and 0; and E2 concentrations were significantly higher on day 0 than day +5. On the other hand, pregnancy was characterized by a progressive increase in the Hp, variable modifications of E1 and P4 concentrations, without changes in SAA and CRP. The absence of significant differences in the APPs between days 0, +5 and +16, suggested that these proteins cannot be used as biomarkers of diagnosis of heat or pregnancy in Spanish mares, at least early, since the Hp later increases during the gestation. Nevertheless, it is possible to use them for comparative purposes with other equine breeds, as supervisor instrument of health status in breeding females as diagnostic tools to monitor pregnancy's development and/or subclinical reproductive inflammations, that could lead to the early embryonic death.
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Affiliation(s)
- Katiuska Satué
- Department of Animal Medicine and Surgery, Faculty of Veterinary Medicine, CEU‐Cardenal Herrera University, Avd. Seminari CEU, s/n, Valencia, 46113 Spain
| | - Antonio Calvo
- Department of Animal Medicine and Surgery, School of Veterinary and Experimental Sciences, Catholic University of Valencia San Vicente Mártir, Valencia, Spain
| | - Ana Muñoz
- Department of Animal Medicine and Surgery, School of Veterinary Medicine, University of Córdoba, Spain
| | - Esterina Fazio
- Department of Veterinary Sciences, Veterinary Physiology Unit, Messina University, Italy
| | - Pietro Medica
- Department of Veterinary Sciences, Veterinary Physiology Unit, Messina University, Italy
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14
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Ozgu-Erdinc AS, Gozukara I, Kahyaoglu S, Yilmaz S, Yumusak OH, Yilmaz N, Erkaya S, Engin-Ustun Y. Is there any role of interleukin-6 and high sensitive C-reactive protein in predicting IVF/ICSI success? A prospective cohort study. Horm Mol Biol Clin Investig 2021; 43:35-40. [PMID: 34837488 DOI: 10.1515/hmbci-2021-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 11/10/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Studies have established a relationship between proinflammatory factors and implantation failure in IVF/ICSI cycles. Likewise, low-grade chronic inflammation is generally blamed for predisposing infertility. In the present study, we aimed to find a relationship between serum IL-6 and hs-CRP levels and IVF/ICSI cycle outcomes. METHODS A total of 129 patients who consented to participate and attended the IVF unit of our department for the treatment of infertility have been enrolled in this prospective cohort study. Serum levels of high sensitive C-reactive protein and interleukin 6 have been detected at the beginning of the IVF/ICSI ovulation induction cycle. Cycle outcomes have been compared between patients with and without clinical pregnancy achievement following ART treatments. IVF/ICSI cycle outcomes of these two groups were also comparable except the number of >14 mm follicles, retrieved oocytes, metaphase II oocytes, and fertilized oocytes (2 pronuclei) which were in favor of the clinical pregnancy group. RESULTS Mean serum hs-CRP levels were 3.08 mg/L (0.12-35.04) and 2.28 mg/L (0.09-22.52) patients with and without clinical pregnancy respectively. Mean serum IL-6 levels were 2 pg/mL (1-10.2) and 2 pg/mL (1-76.9) patients with and without clinical pregnancy respectively. Both tests were found to be statistically insignificant in predicting the success of the ART cycle in terms of implantation, clinical pregnancy, miscarriage, and live birth. CONCLUSIONS In the present study, we have not found any significant effect of hs-CRP and IL-6 levels in the IVF cycle. However, in the light of this and previous studies, large-scale research may prove the exact influence of these markers on IVF success.
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Affiliation(s)
| | - Ilay Gozukara
- University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Serkan Kahyaoglu
- University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Saynur Yilmaz
- University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | | | - Nafiye Yilmaz
- University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Salim Erkaya
- University of Health Sciences, Ankara City Hospital, Ankara, Turkey
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15
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Bohn MK, Adeli K. Physiological and metabolic adaptations in pregnancy: importance of trimester-specific reference intervals to investigate maternal health and complications. Crit Rev Clin Lab Sci 2021; 59:76-92. [PMID: 34587857 DOI: 10.1080/10408363.2021.1978923] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Diagnosis, prognostication, and monitoring of maternal health throughout pregnancy relies on laboratory testing, including but not limited to key markers of thyroid, hepatic, cardiac, hematology, and renal function. Dynamic physiological processes during gestation significantly influence the maternal biochemistry that supports both the mother and fetus. Resultant changes in blood biochemistry alter the expected values of common laboratory tests. However, the importance of pregnancy-specific reference intervals for laboratory test result interpretation and appropriate monitoring of maternal health and complications is underappreciated. Most clinical laboratories continue to use non-pregnant adult reference intervals for laboratory test interpretation in pregnancy. The current review summarizes and critically evaluates the available literature regarding physiological and metabolic adaptations in pregnancy and their influence on common biomarkers of health and disease. The main laboratory parameters discussed include thyroid, hepatic, metabolic, renal, hematology, inflammatory, and cardiac markers. Considering the available data, further studies are urgently needed to establish trimester-specific reference intervals in healthy pregnant women on updated analytical platforms. Without such data, the standard of clinical laboratory service in pregnancy remains compromised and affects the quality of maternal-fetal healthcare.
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Affiliation(s)
- Mary Kathryn Bohn
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Khosrow Adeli
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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16
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Wirestam L, Pihl S, Saleh M, Wetterö J, Sjöwall C. Plasma C-Reactive Protein and Pentraxin-3 Reference Intervals During Normal Pregnancy. Front Immunol 2021; 12:722118. [PMID: 34408755 PMCID: PMC8366313 DOI: 10.3389/fimmu.2021.722118] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/16/2021] [Indexed: 11/13/2022] Open
Abstract
Although several biomarkers are available to monitor the acute phase response, the short pentraxin C-reactive protein (CRP) is dominating in clinical practice. The long pentraxin 3 (PTX3) is structurally and functionally related to CRP, but not liver-derived. In addition, increased levels of PTX3 have been linked to preeclampsia. Reference intervals are usually based on healthy blood donors. Several physiological and immunological alterations occur during normal pregnancy with subsequent potential effects on blood analytes. Hence, this study aims to determine pregnancy-specific reference intervals for CRP and PTX3. Longitudinal clinical data and blood plasma samples from the 1st, 2nd and 3rd trimester of 100 healthy, non-medicating, females aged 18–40 at the time-point of conception were available to us. High‐sensitivity CRP measurements were performed by turbidimetry and enzyme-linked immunosorbent assay (ELISA) was used to quantify PTX3. CRP and PTX3 levels followed each other during the first two trimesters and both increased during the third trimester. CRP showed a median of 4.12 mg/L in the third trimester, and were significantly higher compared to the first (median 2.39 mg/L, p<0.0001) and the second (median 2.44 mg/L, p=0.0006) trimesters. In the third trimester PTX3 levels reached a median of 7.70 µg/L, and were significantly higher compared to the first (median 3.33 µg/L, p<0.0001) and the second (median 3.70 µg/L, p<0.0001) trimesters. Plasma albumin was inversely correlated with CRP (rho=-0.27, p<0.0001), but not with PTX3. In conclusion, it is important to consider pregnancy-specific reference values as elevations of CRP and PTX3 during the later phase may occur in absence of infection.
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Affiliation(s)
- Lina Wirestam
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection/Rheumatology, Linköping University, Linköping, Sweden
| | - Sofia Pihl
- Department of Obstetrics and Gynaecology, Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Muna Saleh
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection/Rheumatology, Linköping University, Linköping, Sweden
| | - Jonas Wetterö
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection/Rheumatology, Linköping University, Linköping, Sweden
| | - Christopher Sjöwall
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection/Rheumatology, Linköping University, Linköping, Sweden
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17
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Foyle KL, Sharkey DJ, Moldenhauer LM, Green ES, Wilson JJ, Roccisano CJ, Hull ML, Tremellen KP, Robertson SA. Effect of Intralipid infusion on peripheral blood T cells and plasma cytokines in women undergoing assisted reproduction treatment. Clin Transl Immunology 2021; 10:e1328. [PMID: 34408876 PMCID: PMC8358997 DOI: 10.1002/cti2.1328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/26/2021] [Accepted: 07/27/2021] [Indexed: 12/12/2022] Open
Abstract
Objectives Intravenous infusion of Intralipid is an adjunct therapy in assisted reproduction treatment (ART) when immune‐associated infertility is suspected. Here, we evaluated the effect of Intralipid infusion on regulatory T cells (Treg cells), effector T cells and plasma cytokines in peripheral blood of women undertaking IVF. Methods This prospective, observational pilot study assessed Intralipid infusion in 14 women exhibiting recurrent implantation failure, a clinical sign of immune‐associated infertility. Peripheral blood was collected immediately prior to and 7 days after intravenous administration of Intralipid. Plasma cytokines were measured by Luminex, and T‐cell subsets were analysed by flow cytometry. Results A small increase in conventional CD8+ T cells occurred after Intralipid infusion, but no change was seen in CD4+ Treg cells, or naïve, memory or effector memory T cells. Proliferation marker Ki67, transcription factors Tbet and RORγt, and markers of suppressive capacity CTLA4 and HLA‐DR were unchanged. Dimensionality‐reduction analysis using the tSNE algorithm confirmed no phenotype shift within Treg cells or other T cells. Intralipid infusion increased plasma CCL2, CCL3, CXCL8, GM‐CSF, G‐CSF, IL‐6, IL‐21, TNF and VEGF. Conclusion Intralipid infusion elicited elevated pro‐inflammatory cytokines, and a minor increase in CD8+ T cells, but no change in pro‐tolerogenic Treg cells. Notwithstanding the limitation of no placebo control, the results do not support Intralipid as a candidate intervention to attenuate the Treg cell response in women undergoing ART. Future placebo‐controlled studies are needed to confirm the potential efficacy and clinical significance of Intralipid in attenuating cytokine induction and circulating CD8+ T cells.
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Affiliation(s)
- Kerrie L Foyle
- Robinson Research Institute Adelaide Medical School University of Adelaide Adelaide SA Australia
| | - David J Sharkey
- Robinson Research Institute Adelaide Medical School University of Adelaide Adelaide SA Australia
| | - Lachlan M Moldenhauer
- Robinson Research Institute Adelaide Medical School University of Adelaide Adelaide SA Australia
| | - Ella S Green
- Robinson Research Institute Adelaide Medical School University of Adelaide Adelaide SA Australia
| | - Jasmine J Wilson
- Robinson Research Institute Adelaide Medical School University of Adelaide Adelaide SA Australia
| | - Cassandra J Roccisano
- School of Pharmacy and Medical Sciences University of South Australia Adelaide SA Australia
| | - M Louise Hull
- Robinson Research Institute Adelaide Medical School University of Adelaide Adelaide SA Australia
| | - Kelton P Tremellen
- School of Medicine Flinders University Adelaide SA Australia.,Repromed Pty Ltd Dulwich SA Australia
| | - Sarah A Robertson
- Robinson Research Institute Adelaide Medical School University of Adelaide Adelaide SA Australia
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18
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Rodrigues Amorim Adegboye A, Dias Santana D, Teixeira dos Santos PP, Guedes Cocate P, Benaim C, Trindade de Castro MB, Maia Schlüssel M, Kac G, Lilienthal Heitmann B. Exploratory Efficacy of Calcium-Vitamin D Milk Fortification and Periodontal Therapy on Maternal Oral Health and Metabolic and Inflammatory Profile. Nutrients 2021; 13:783. [PMID: 33673568 PMCID: PMC7997467 DOI: 10.3390/nu13030783] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/21/2021] [Accepted: 02/24/2021] [Indexed: 12/16/2022] Open
Abstract
In this 2 × 2 factorial, outcome-assessor blinded, feasibility randomised trial we explored the effect of a non-pharmaceutical multi-component intervention on periodontal health and metabolic and inflammatory profiles among pregnant women with periodontitis receiving prenatal care in a Brazilian public health centre. 69 pregnant women (gestational age ≤20 weeks, T0) were randomly allocated into four groups: (1) fortified sachet (vitamin D and calcium) and powdered milk plus periodontal therapy during pregnancy (early PT) (n = 17); (2) placebo sachet and powdered milk plus early PT (n = 15); (3) fortified sachet and powdered milk plus late PT (after delivery) (n = 19); (4) placebo sachet and powdered milk plus late PT (n = 18). Third trimester (T1) and 6-8 weeks postpartum (T2) exploratory outcomes included periodontal health (% sites with bleeding on probing (BOP)), glucose, insulin, C-Reactive Protein, serum calcium and vitamin D. The mean BOP was significantly reduced in the early PT groups, while BOP worsened in the late PT groups. No significant effect of fortification on BOP was observed. Changes in glucose levels and variation on birthweight did not differ among groups This feasibility trial provides preliminary evidence for estimating the minimum clinically important differences for selected maternal outcomes. A large-scale trial to evaluate the interventions' clinical benefits and cost-effectiveness is warranted.
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Affiliation(s)
- Amanda Rodrigues Amorim Adegboye
- Faculty of Health and Life Sciences, School of Nursing, Midwifery and Health, Coventry University, Priory Street, Coventry CV1 5FB, UK
| | - Danilo Dias Santana
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (D.D.S.); (P.P.T.d.S.); (C.B.); (M.B.T.d.C.); (G.K.)
| | - Pedro Paulo Teixeira dos Santos
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (D.D.S.); (P.P.T.d.S.); (C.B.); (M.B.T.d.C.); (G.K.)
| | - Paula Guedes Cocate
- Department of Bioscience and Physical Activity, School of Physical Education and Sports, Federal University of Rio de Janeiro, Rio de Janeiro 21941-599, Brazil;
| | - Camila Benaim
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (D.D.S.); (P.P.T.d.S.); (C.B.); (M.B.T.d.C.); (G.K.)
| | - Maria Beatriz Trindade de Castro
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (D.D.S.); (P.P.T.d.S.); (C.B.); (M.B.T.d.C.); (G.K.)
| | - Michael Maia Schlüssel
- The EQUATOR Network—UK Centre, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Old Road, Oxford OX3 7LD, UK;
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (D.D.S.); (P.P.T.d.S.); (C.B.); (M.B.T.d.C.); (G.K.)
| | - Berit Lilienthal Heitmann
- Research Unit for Dietary Studies at the Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, 2000 Frederiksberg, Denmark;
- Section for General Practice, Institute of Public Health, Copenhagen University, 1014 Copenhagen, Denmark
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19
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Dockree S, Brook J, James T, Shine B, Impey L, Vatish M. Pregnancy-specific reference intervals for C-reactive protein improve diagnostic accuracy for infection: A longitudinal study. Clin Chim Acta 2021; 517:81-85. [PMID: 33647266 DOI: 10.1016/j.cca.2021.02.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/16/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Infections are a major cause of maternal mortality. C-reactive protein (CRP), a commonly-used inflammatory marker, is widely used to inform diagnosis, but the upper limit of normal in pregnancy is uncertain. We have defined trimester-specific reference intervals for CRP and evaluated their diagnostic accuracy for infection. MATERIALS AND METHODS Development cohort: longitudinal study of pregnant women to determine 95% reference intervals. Evaluation cohort: diagnostic accuracy study to evaluate these intervals in 50 women with suspected intrauterine infection. RESULTS In these 322 healthy pregnant women, CRP was substantially higher than in most non-pregnant populations. CRP was similar in each trimester, with an upper reference limit of 19 mg/L. CRP increased linearly with body mass index (p < 0.0001). The sensitivity and specificity of CRP for diagnosing chorioamnionitis were 73% and 86%, respectively. The overall diagnostic accuracy using the pregnancy-specific reference interval was significantly better than that of the existing standard (p = 0.03). CONCLUSIONS CRP is a widely-used clinical tool in pregnancy, and a pregnancy-specific reference interval should be used to optimise diagnostic accuracy. Chorioamnionitis was used as an example of a localised infection with well-defined outcomes, but pregnancy-specific RIs for CRP should be considered in any clinical setting including pregnant women.
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Affiliation(s)
| | - Jennifer Brook
- Department of Clinical Biochemistry, John Radcliffe Hospital, Oxford, UK.
| | - Tim James
- Department of Clinical Biochemistry, John Radcliffe Hospital, Oxford, UK.
| | - Brian Shine
- Department of Clinical Biochemistry, John Radcliffe Hospital, Oxford, UK.
| | | | - Manu Vatish
- Nuffield Department of Women's and Reproductive Health, University of Oxford, UK.
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20
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Dockree S, Brook J, James T, Shine B, Vatish M. A pregnancy-specific reference interval for procalcitonin. Clin Chim Acta 2021; 513:13-6. [PMID: 33307062 DOI: 10.1016/j.cca.2020.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/13/2020] [Accepted: 12/03/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Sepsis is a leading cause of maternal death, and developing diagnostic tests for infection is increasingly important to reduce maternal mortality. The existing inflammatory markers, like C-reactive protein, are not specific for infection, which introduces diagnostic uncertainty. Procalcitonin (PCT) is used to accurately diagnose bacterial sepsis and differentiate it from other conditions, which is now particularly important given the vulnerability to COVID-19 in pregnancy. There are few studies of PCT in pregnancy as the reference interval for pregnant women is unknown. This study aimed to define the pregnancy-specific reference interval for PCT. MATERIALS AND METHODS Cross-sectional study of 323 healthy pregnant women, with longitudinal sampling in each trimester. RESULTS The upper reference limit for PCT was 0.05 ng/mL and did not vary materially between any observed group of gestational age, body mass index, maternal age, mean arterial blood pressure or fetal sex. CONCLUSION Our study has shown that levels of PCT are similar in pregnant and non-pregnant populations despite the physiological changes of normal pregnancy. Therefore, pregnancy should not preclude the use of PCT in pregnant women with suspected sepsis, or for guiding antibiotic therapy in women with a diagnosed bacterial infection at any stage of pregnancy.
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21
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García-Ricobaraza M, García-Bermúdez M, Torres-Espinola FJ, Segura Moreno MT, Bleyere MN, Díaz-Prieto LE, Nova E, Marcos A, Campoy C. Association study of rs1801282 PPARG gene polymorphism and immune cells and cytokine levels in a Spanish pregnant women cohort and their offspring. J Biomed Sci 2020; 27:101. [PMID: 33250050 PMCID: PMC7702670 DOI: 10.1186/s12929-020-00694-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 11/12/2020] [Indexed: 12/20/2022] Open
Abstract
Background Peroxisome proliferator activated receptor gamma (PPARG) belongs to the nuclear receptor superfamily functioning as transcription factors to regulate cellular differentiation, development and metabolism. Moreover, it has been implicated in the regulation of lipid metabolism, as well as the maturation of monocytes/macrophages and the control of inflammatory reactions. The aim of this study was to evaluate the relationship between the Pro12Ala (rs1808212) PPARG gene polymorphism on immune molecular and cellular components in mothers and their offspring participating in the PREOBE study. Methods DNA from maternal venous blood samples at 24, 34 and 40 gestational weeks, plus cord blood samples was extracted. Pro12Ala PPARG polymorphism genotyping was performed, and immune system markers were analyzed by flow cytometry. Results Study findings revealed no effect of rs1808212 PPARG genotypes on innate immune parameters in mothers and their offspring; however, CD4 + /CD8 + ratio were decreased at 24 and 34 weeks in pregnant women carrying the CG (Pro12Ala) rs1808212 polymorphism, (p = 0,012 and p = 0,030; respectively). Only CD19 levels in peripheral blood were significantly higher at delivery in pregnant women carrying the CC (Pro12Pro) genotype (p ≤ 0.001). Moreover, there were statistically significant differences in leukocytes and neutrophils maternal levels at 34 weeks of gestation, being lower in carriers of Pro12Ala genotype (p = 0.028 and p = 0.031, respectively). Conclusions Results suggest that Pro12Ala PPARG polymorphism may have an effect on some cell and immune parameters in pregnant women during pregnancy and at time of delivery. However, newborn innate immune system does not seems to be influenced by PPARG Pro12Ala polymorphism in cord blood.
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Affiliation(s)
- Maria García-Ricobaraza
- Department of Paediatrics, School of Medicine, Universidad de Granada, Granada, Spain.,Instituto de Investigación Biosanitaria ibsGRANADA, Health Sciences Technological Park, Granada, Spain
| | - Mercedes García-Bermúdez
- Department of Paediatrics, School of Medicine, Universidad de Granada, Granada, Spain. .,Instituto de Investigación Biosanitaria ibsGRANADA, Health Sciences Technological Park, Granada, Spain.
| | - Francisco J Torres-Espinola
- Department of Paediatrics, School of Medicine, Universidad de Granada, Granada, Spain.,EURISTIKOS Excellence Centre for Paediatric Research, Universidad de Granada, Granada, Spain
| | - M Teresa Segura Moreno
- Department of Paediatrics, School of Medicine, Universidad de Granada, Granada, Spain.,Instituto de Investigación Biosanitaria ibsGRANADA, Health Sciences Technological Park, Granada, Spain
| | - Mathieu N Bleyere
- Department of Physiology, Haematology and Immunology, Nangui Abrogoua University, Abidjan, Côte d'Ivoire
| | - Ligia E Díaz-Prieto
- Institute of Food Science, Technology and Nutrition (ICTAN), CSIC, Madrid, Spain
| | - Esther Nova
- Institute of Food Science, Technology and Nutrition (ICTAN), CSIC, Madrid, Spain
| | - Ascensión Marcos
- Institute of Food Science, Technology and Nutrition (ICTAN), CSIC, Madrid, Spain
| | - Cristina Campoy
- Department of Paediatrics, School of Medicine, Universidad de Granada, Granada, Spain. .,Instituto de Investigación Biosanitaria ibsGRANADA, Health Sciences Technological Park, Granada, Spain. .,EURISTIKOS Excellence Centre for Paediatric Research, Universidad de Granada, Granada, Spain.
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22
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Nakamura E, Kotani T, Hiramatsu Y, Hata K, Yoshikawa A, Matsumura Y, Tokai N, Wada Y, Fujita D, Takeuchi T. Simplified disease activity index and clinical disease activity index before and during pregnancy correlate with those at postpartum in patients with rheumatoid arthritis. Mod Rheumatol 2020; 31:809-816. [PMID: 32990114 DOI: 10.1080/14397595.2020.1829342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES We explored rheumatoid arthritis (RA) disease activity before, during, and after pregnancy in patients treated with tight control and investigated the association between disease activity in the postpartum period and those before and during pregnancy. METHODS We retrospectively reviewed disease activity and medications of 27 patients before pregnancy, at every trimester, and in the postpartum period. RESULTS Prednisolone was administered to 33% of patients with a median dose of 0 (0-2.5) mg/day and biologic agents was 78% in the third trimester. The median remission rates during all periods were the Disease Activity Score-28-C-reactive Protein assessed with three variables (DAS28-CRP-3) 85%, Simplified Disease Activity Index (SDAI) 55%, and Clinical Disease Activity Index (CDAI) 54%. Although SDAI and CDAI decreased significantly from before pregnancy to the first trimester and increased from the third trimester to the postpartum period, DAS28-CRP-3 did not change during all periods. Although SDAI and CDAI before and during pregnancy were significantly correlated with those in the postpartum period, DAS28-CRP-3 was not. CONCLUSIONS Tight control before pregnancy suppressed RA disease activity during pregnancy and in the postpartum period. SDAI/CDAI before and during pregnancy were predictive for disease activity in the postpartum period.
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Affiliation(s)
- Eri Nakamura
- Division of Rheumatology, Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Takuya Kotani
- Division of Rheumatology, Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Yuri Hiramatsu
- Division of Rheumatology, Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Kenichiro Hata
- Division of Rheumatology, Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Ayaka Yoshikawa
- Division of Rheumatology, Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Yoko Matsumura
- Division of Rheumatology, Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Nao Tokai
- Division of Rheumatology, Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Yumiko Wada
- Division of Rheumatology, Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Daisuke Fujita
- Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan
| | - Tohru Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Osaka Medical College, Osaka, Japan
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23
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Witteveen AB, Henrichs J, Bellers M, van Oenen E, Verhoeven CJ, Vrijkotte TGM. Mediating role of C-reactive protein in associations between pre-pregnancy BMI and adverse maternal and neonatal outcomes: the ABCD-study cohort. J Matern Fetal Neonatal Med 2020; 35:2867-2875. [PMID: 32838637 DOI: 10.1080/14767058.2020.1807510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Increased body mass index (BMI) is associated with several adverse pregnancy outcomes, though the underlying mechanism of this association has not been fully elucidated. A mediating role of low-grade systemic inflammation in these associations is suspected but has been understudied. Our objective was to examine the effect of pre-pregnancy BMI (pBMI) on maternal and neonatal pregnancy outcomes and to explore potential mediation of these effects by C-reactive protein (CRP), a first trimester peripheral marker of inflammation. METHODS Data from the prospective community-based ABCD-study cohort (n = 3547) was used to assess associations between self-reported continuous and categorized pBMI and outcome measures gestational hypertension (GH) and preeclampsia (PE), preterm birth (PTB) and small for gestational age (SGA) based on national perinatal registration linkage data. High-sensitivity CRP concentrations determined in serum were used to explore potential mediation of these associations by inflammation. RESULTS Multivariable logistic regression analyses, adjusted for confounders, showed that pBMI was significantly related to gestational hypertensive disorders (odds ratio (OR) per standard deviation (SD) 1.66, 95% confidence interval (CI) 1.51-1.83) and PTB (OR 1.20, 95% CI 1.05-1.37). Dose-response relationships between categorical pBMI and gestational hypertensive disorders (overweight OR 2.37, 95% CI 1.85-3.03 and obese OR 4.45, 95% CI 2.93-6.72) and PTB (obese OR 2.12, 95% CI 1.16-3.87) were found as well. SGA was only significantly more prevalent in the underweight BMI category (OR 2.06, 95% CI 1.33-3.19). Mediation analyses revealed small but significant indirect effects of pBMI on overall PTB (0.037, bootstrapped 95% CI 0.005-0.065) and spontaneous PTB (0.038, bootstrapped 95% CI 0.002-0.069) through higher CRP. CRP was not a significant mediator of associations between BMI and gestational hypertensive disorders although larger mediation was found for GH than for PE. CONCLUSION Our findings provide additional evidence that high(er) pBMI increases the risk of adverse maternal and neonatal outcomes and that systemic inflammation mediates some of these risks. Further research in large cohorts including (morbidly) obese women is warranted to identify pathways that may be incorporated in future interventions to reduce the risk of adverse pregnancy outcomes due to maternal obesity.
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Affiliation(s)
- Anke B Witteveen
- Department of Midwifery Science and AVAG, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,AVAG Amsterdam Groningen Midwifery Academy, University of Applied Sciences Inholland, Amsterdam, The Netherlands
| | - Jens Henrichs
- Department of Midwifery Science and AVAG, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Mirthe Bellers
- AVAG Amsterdam Groningen Midwifery Academy, University of Applied Sciences Inholland, Amsterdam, The Netherlands
| | - Esmée van Oenen
- AVAG Amsterdam Groningen Midwifery Academy, University of Applied Sciences Inholland, Amsterdam, The Netherlands
| | - Corine J Verhoeven
- Department of Midwifery Science and AVAG, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, The Netherlands
| | - Tanja G M Vrijkotte
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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24
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Brouillet S, Boursier G, Anav M, Du Boulet De La Boissière B, Gala A, Ferrieres-Hoa A, Touitou I, Hamamah S. C-reactive protein and ART outcomes: a systematic review. Hum Reprod Update 2020; 26:753-773. [DOI: 10.1093/humupd/dmaa012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/17/2020] [Indexed: 12/23/2022] Open
Abstract
Abstract
BACKGROUND
A dynamic balance between pro- and anti-inflammatory factors contributes to regulating human female reproduction. Chronic low-grade inflammation has been detected in several female reproductive conditions, from anovulation to embryo implantation failure. C-reactive protein (CRP) is a reliable marker of inflammation that is extensively used in clinical practice. Recent studies quantified CRP in the serum of infertile women undergoing ART and suggested its potential for the prediction of ART reproductive outcomes.
OBJECTIVE AND RATIONALE
The first objective of this systematic review of the available literature was to evaluate the association between pre-implantation circulating CRP concentration and pregnancy rates in women undergoing ART. The second objective was to describe serum CRP concentration changes after early embryo implantation. The changes in circulating CRP throughout the ART cycle, clinical implications of CRP quantification for the management of women undergoing ART, and future therapeutic options will also be discussed.
SEARCH METHODS
The MEDLINE database was systematically searched from inception to March 2019 using the following key words: (C-reactive protein) AND (assisted reproductive techniques OR ovulation induction OR insemination OR in vitro fertilization). Only articles in English were considered. Studies were selected based on title and abstract. The full text of potentially relevant articles was retrieved and assessed for inclusion by two reviewers (S.B. and S.H.). The protocol was registered in the International prospective register of systematic reviews (PROSPERO; registration number: CRD148687).
OUTCOMES
In total, 10 studies were included in this systematic review. Most of these studies reported lower circulating CRP values before the window of implantation and higher circulating CRP values during the peri-implantation period in women with successful ART outcome (biochemical or clinical pregnancy) compared to women without a successful outcome. Several lifestyle factors and/or drugs that reduce the concentration of circulating CRP significantly improve ART outcomes. Subgroup analyses according to female BMI and baseline circulating CRP concentration are highly recommended in future analyses.
WIDER IMPLICATIONS
These findings highlight a possible detrimental impact of preconception high circulating CRP concentration on ART outcomes. However, the biochemical or clinical pregnancy rate endpoints used in the studies examined here are insufficient (there were no data on live birth outcome), and the impact of major variables that can influence CRP and/or ART, for example maternal age, BMI, number of transferred embryos, and use of anti-inflammatory drugs, were not considered in the analyses. CRP quantification may be a potential marker of ART outcome, but its predictive value still needs to be investigated in large prospective studies. In future, the quantification of circulating CRP before starting ART could help to identify patients with a poor ART prognosis, leading to ART cycle cancellation or to preconception treatment to minimize the medical risks and costs.
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Affiliation(s)
- Sophie Brouillet
- Université Grenoble-Alpes, Inserm 1036, Commissariat à l'Énergie Atomique et aux Énergies Alternatives (CEA), Institut de Biosciences et Biotechnologies de Grenoble (BIG), Laboratoire Biologie du Cancer et de l’Infection (BCI), 38000 Grenoble, France
- Centre Hospitalier Universitaire de Grenoble, Hôpital Couple-Enfant, Centre Clinique et Biologique d’Assistance Médicale à la Procréation-Centre d'Étude et de Conservation des Oeufs et du Sperme Humains (CECOS), La Tronche, France
- Univ Montpellier, Développement Embryonnaire Précoce Humain et Pluripotence, INSERM 1203, Montpellier, France
- CHU Montpellier, Univ Montpellier, Département de Biologie de la Reproduction, Biologie de la Reproduction et Diagnostic Pre-Implantatoire, Montpellier, France
| | - Guilaine Boursier
- CHU Montpellier, Univ Montpellier, Département de Génétique Médicale, Maladies Rares et Médecine Personnalisée, Génétique des Maladies Rares et Autoinflammatoires, Montpellier, France
| | - Margaux Anav
- CHU Montpellier, Univ Montpellier, Département de Biologie de la Reproduction, Biologie de la Reproduction et Diagnostic Pre-Implantatoire, Montpellier, France
| | - Bertille Du Boulet De La Boissière
- CHU Montpellier, Univ Montpellier, Département de Biologie de la Reproduction, Biologie de la Reproduction et Diagnostic Pre-Implantatoire, Montpellier, France
| | - Anna Gala
- CHU Montpellier, Univ Montpellier, Département de Biologie de la Reproduction, Biologie de la Reproduction et Diagnostic Pre-Implantatoire, Montpellier, France
| | - Alice Ferrieres-Hoa
- CHU Montpellier, Univ Montpellier, Département de Biologie de la Reproduction, Biologie de la Reproduction et Diagnostic Pre-Implantatoire, Montpellier, France
| | - Isabelle Touitou
- CHU Montpellier, Univ Montpellier, Département de Génétique Médicale, Maladies Rares et Médecine Personnalisée, Génétique des Maladies Rares et Autoinflammatoires, Montpellier, France
- Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies, INSERM, Univ de Montpellier, Montpellier, France
| | - Samir Hamamah
- Univ Montpellier, Développement Embryonnaire Précoce Humain et Pluripotence, INSERM 1203, Montpellier, France
- CHU Montpellier, Univ Montpellier, Département de Biologie de la Reproduction, Biologie de la Reproduction et Diagnostic Pre-Implantatoire, Montpellier, France
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25
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St-Germain LE, Castellana B, Baltayeva J, Beristain AG. Maternal Obesity and the Uterine Immune Cell Landscape: The Shaping Role of Inflammation. Int J Mol Sci 2020; 21:E3776. [PMID: 32471078 DOI: 10.3390/ijms21113776] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 05/26/2020] [Accepted: 05/26/2020] [Indexed: 12/14/2022] Open
Abstract
Inflammation is often equated to the physiological response to injury or infection. Inflammatory responses defined by cytokine storms control cellular mechanisms that can either resolve quickly (i.e., acute inflammation) or remain prolonged and unabated (i.e., chronic inflammation). Perhaps less well-appreciated is the importance of inflammatory processes central to healthy pregnancy, including implantation, early stages of placentation, and parturition. Pregnancy juxtaposed with disease can lead to the perpetuation of aberrant inflammation that likely contributes to or potentiates maternal morbidity and poor fetal outcome. Maternal obesity, a prevalent condition within women of reproductive age, associates with increased risk of developing multiple pregnancy disorders. Importantly, chronic low-grade inflammation is thought to underlie the development of obesity-related obstetric and perinatal complications. While diverse subsets of uterine immune cells play central roles in initiating and maintaining healthy pregnancy, uterine leukocyte dysfunction as a result of maternal obesity may underpin the development of pregnancy disorders. In this review we discuss the current knowledge related to the impact of maternal obesity and obesity-associated inflammation on uterine immune cell function, utero-placental establishment, and pregnancy health.
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26
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Brodowski L, Büter W, Kohls F, Hillemanns P, von Kaisenberg C, Dammann O. Maternal Overweight, Inflammation and Neurological Consequences for the Preterm Child: Results of the ELGAN Study. Geburtshilfe Frauenheilkd 2019; 79:1176-1182. [PMID: 31736506 PMCID: PMC6846733 DOI: 10.1055/a-0960-0939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/25/2019] [Accepted: 06/21/2019] [Indexed: 12/16/2022] Open
Abstract
Maternal overweight and obesity are prenatal risk factors for obstetrical complications, preterm birth, neonatal morbidity as well as cognitive and behavioural developmental disorders in children. Paediatric morbidity and mortality as well as child development disorders are significantly associated with maternal obesity. Particularly in the neurodevelopmental and psychiatric area, it is becoming increasingly clear that, in children of mothers with an increased body mass index (BMI), there is a high correlation with childhood cognitive disabilities, attention disorders, and diseases on the autistic spectrum. The ELGAN (Extremely Low Gestational Age Newborn) study is a multicentre study which has been supported since 2000 by the National Institutes of Health (NIH) and whose objective is to research predictors for neonatal brain damage and neurological-cognitive sequelae in premature infants. The areas of focus are the connection between maternal overweight and obesity and pregnancy complications, APGAR scores and systemic inflammatory markers. In this overview, our aim is to summarise the work in this area and discuss it critically on the basis of current literature. We will examine the hypothesis whether maternal overweight and obesity in terms of a chronic inflammatory state is associated with neonatal inflammation which in turn is associated with an unfavourable development prognosis.
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Affiliation(s)
- Lars Brodowski
- Frauenklinik, Medizinische Hochschule Hannover, Hannover, Germany
| | - Wolfgang Büter
- Kinderklinik, Medizinische Hochschule Hannover, Hannover, Germany
| | - Fabian Kohls
- Frauenklinik, Medizinische Hochschule Hannover, Hannover, Germany
| | - Peter Hillemanns
- Frauenklinik, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Olaf Dammann
- Frauenklinik, Medizinische Hochschule Hannover, Hannover, Germany.,Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA
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Schäfer-Somi S, Aksoy OA, Ergene O, Darbaz I, Herkner KR, Aslan S. First detection of heat shock protein 60 and 70 in the serum of early pregnant bitches. Acta Vet Hung 2019; 67:445-455. [PMID: 31549545 DOI: 10.1556/004.2019.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Heat shock proteins (HSPs) belong to a group of cellular stress proteins. Heat shock protein 10 immunoregulates and promotes growth during early gestation in humans, while HSP70 is considered to regulate autophagy and apoptosis during pregnancy and parturition. Both HSPs are detectable in the serum and placentas of early pregnant women and considered to contribute to the establishment of pregnancy. Within this pilot study we aimed (1) to assess whether HSPs 10, 60 and 70 are measurable in the serum of healthy early pregnant and non-pregnant bitches, and (2) to explore whether measurable differences between groups indicate pregnancy. Blood was collected from 31 bitches on days 7, 14 and 21 after mating. At 21 days post mating, all bitches were examined for pregnancy by ultrasonography; 23 were pregnant, and the eight non-pregnant bitches served as controls. Pregnant bitches had normal parturitions and gave birth to healthy puppies. The serum concentrations of HSPs 10, 60 and 70 were measured by electrophoresis and western blot. Serum HSP10 was not detectable. Average serum HSP70 concentration was significantly (d7, P = 0.030; d14, P = 0.023; d21, P = 0.030) lower in pregnant animals at all days investigated, while serum HSP60 was significantly lower at day 21 of gestation (P = 0.024) when compared to the controls. HSP 60 and HSP70 concentrations correlated positively (d7, r = +0.386, P = 0.021; d14, r = 0.450, P = 0.008; d21, r = +0.472, P = 0.006). We conclude that in pregnant bitches, serum concentrations of HSP60 and HSP70 are significantly decreased between days 7 and 21 of gestation, in comparison to non-pregnant bitches in early dioestrus, raising the question about intrauterine functions during the peri-implantation period.
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Affiliation(s)
- Sabine Schäfer-Somi
- 1Centre for Artificial Insemination and Embryo Transfer, University of Veterinary Medicine Vienna, Veterinärplatz 1, A-1210 Vienna, Austria
| | - Okan Ali Aksoy
- 2Department of Animal Experiment and Research Centre, Gülhane Institute of Health Sciences, University of Health Sciences, Turkey, Ankara
| | - Osman Ergene
- 3Department of Paediatrics and Adolescent Medicine, Medical University Vienna, Austria
| | - Isfendiyar Darbaz
- 3Department of Paediatrics and Adolescent Medicine, Medical University Vienna, Austria
| | - Kurt R. Herkner
- 3Department of Paediatrics and Adolescent Medicine, Medical University Vienna, Austria
| | - Selim Aslan
- 4Department of Obstetrics and Gynaecology, Veterinary Faculty, Near East University, Nicosia, Mersin-10, Turkey
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Sauder MW, Lee SE, Schulze KJ, Christian P, Wu LSF, Khatry SK, LeClerq SC, Adhikari RK, Groopman JD, West KP. Inflammation throughout pregnancy and fetal growth restriction in rural Nepal. Epidemiol Infect 2019; 147:e258. [PMID: 31469064 DOI: 10.1017/S0950268819001493] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Maternal systemic inflammation during pregnancy may restrict embryo−fetal growth, but the extent of this effect remains poorly established in undernourished populations. In a cohort of 653 maternal−newborn dyads participating in a multi-armed, micronutrient supplementation trial in southern Nepal, we investigated associations between maternal inflammation, assessed by serum α1-acid glycoprotein and C-reactive protein, in the first and third trimesters of pregnancy, and newborn weight, length and head and chest circumferences. Median (IQR) maternal concentrations in α1-acid glycoprotein and C-reactive protein in the first and third trimesters were 0.65 (0.53–0.76) and 0.40 (0.33–0.50) g/l, and 0.56 (0.25–1.54) and 1.07 (0.43–2.32) mg/l, respectively. α1-acid glycoprotein was inversely associated with birth size: weight, length, head circumference and chest circumference were lower by 116 g (P = 2.3 × 10−6), and 0.45 (P = 3.1 × 10−5), 0.18 (P = 0.0191) and 0.48 (P = 1.7 × 10−7) cm, respectively, per 50% increase in α1-acid glycoprotein averaged across both trimesters. Adjustment for maternal age, parity, gestational age, nutritional and socio-economic status and daily micronutrient supplementation failed to alter any association. Serum C-reactive protein concentration was largely unassociated with newborn size. In rural Nepal, birth size was inversely associated with low-grade, chronic inflammation during pregnancy as indicated by serum α1-acid glycoprotein.
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Matoba N, Yallapragada S, Davis MM, Ernst LM, Collins JW, Mestan KK. Racial differences in placental pathology among very preterm births. Placenta 2019; 83:37-42. [PMID: 31477205 DOI: 10.1016/j.placenta.2019.06.385] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 04/15/2019] [Accepted: 06/25/2019] [Indexed: 01/12/2023]
Abstract
INTRODUCTION African American women are at higher risk for preterm birth compared to white women, but no placental pathology has characterized this disparity. The objective of this study was to examine the association of race with placental pathology among very preterm births. METHODS We conducted an eight-year retrospective cohort study of very preterm infants born at ≤32 weeks at Northwestern Prentice Women's Hospital in Chicago, Illinois. Archived placental slides underwent standardized masked histopathologic review. Logistic regression was performed for placental pathology, adjusting for available relevant covariates and stratified by infant sex and gestational age. RESULTS Placentas were available for 296 white and 224 African American mother-infant pairs among births at ≤32 weeks gestation. Compared to placentas from white births, the adjusted OR (aOR) for acute inflammation in placentas from African American births was 1.95 (95% CI 0.87-4.37), the aOR for chronic inflammation was 3.35 (1.49-7.54), the aOR for fetal vascular pathology was 0.82 (0.29-2.32), and the aOR for maternal vascular pathology was 1.01 (0.51-1.99). Stratified analysis showed associations between all placental pathologies and race among male births. Across gestational age groups (<28 and ≥ 28 weeks), the association between race and placental pathology was present for chronic inflammation and fetal vascular pathology. DISCUSSION Race is associated with placental pathology, and in particular, with chronic inflammation among very preterm births. The effect is modified by infant sex and gestational age. Placental histopathology may be useful markers for understanding the biological processes that shape disparities in pregnancy outcomes.
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Affiliation(s)
- Nana Matoba
- Division of Neonatology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, 225 E. Chicago Ave., Chicago, IL, 60611, United States.
| | - Sushmita Yallapragada
- Division of Neonatology, Department of Pediatrics, University of Texas Southwestern Medical Center, 5323, Harry Hines Blvd., Dallas, TX, United States
| | - Matthew M Davis
- Division of Academic General Pediatrics and Primary Care, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, 225 E. Chicago Ave., Chicago, IL, United States
| | - Linda M Ernst
- Department of Pathology and Laboratory Medicine, Northshore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, United States
| | - James W Collins
- Division of Neonatology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, 225 E. Chicago Ave., Chicago, IL, 60611, United States
| | - Karen K Mestan
- Division of Neonatology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, 225 E. Chicago Ave., Chicago, IL, 60611, United States
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Haikin Herzberger E, Miller N, Ghetler Y, Tamir Yaniv R, Neumark E, Shulman A, Wiser A. A prospective study of C-reactive protein in patients with obesity during IVF. HUM FERTIL 2019; 24:182-187. [DOI: 10.1080/14647273.2019.1605459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Einat Haikin Herzberger
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Netanella Miller
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yehudith Ghetler
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rina Tamir Yaniv
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Neumark
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adrian Shulman
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Wiser
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Diallo S, Roberts SA, Gies S, Rouamba T, Swinkels DW, Geurts-Moespot AJ, Ouedraogo S, Ouedraogo GA, Tinto H, Brabin BJ. Malaria early in the first pregnancy: Potential impact of iron status. Clin Nutr 2019; 39:204-214. [PMID: 30737046 DOI: 10.1016/j.clnu.2019.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/11/2019] [Accepted: 01/12/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Low iron stores may protect from malaria infection, therefore improving iron stores in early pregnancy in line with current recommendations could increase malaria susceptibility. To test this hypothesis we compared iron biomarkers and red cell indices in nulliparae and primigravidae who participated in a randomized controlled trial of long-term weekly iron supplementation. METHODS Cross-sectional and longitudinal data analysis from a randomized controlled trial of long-term weekly iron supplementation in rural Burkina Faso. Malaria parasitaemia was monitored and biomarkers and red cell indices measured at study end-points: plasma ferritin, transferrin receptor (sTfR), zinc protoporphyrin, hepcidin, sTfR/log10 ferritin ratio, body iron, haemoglobin, red cell distribution width; mean corpuscular haemoglobin concentration/volume, and C-reactive protein. Correlation coefficients between biomarkers and red cell indices were determined. A regression correction approach based on ferritin was used to estimate iron body stores, allowing for inflammation. Body iron differences were compared between nulliparae and primigravidae, and the association determined of iron biomarkers and body iron stores with malaria. RESULTS Iron and haematological indices of 972 nulliparae (mean age 16.5 years) and 314 primigravidae (median gestation 18 weeks) were available. Malaria prevalence was 54.0% in primigravidae and 41.8% in nulliparae (relative risk 1.28, 95% CI 1.13-1.45, P < 0.001), anaemia prevalence 69.7% and 43.4% (P < 0.001), and iron deficient erythropoiesis (low body iron) 8.0% and 11.7% (P = 0.088) respectively. Unlike other biomarkers the sTfR/log10 ferritin ratio showed no correlation with inflammation as measured by CRP. Most biomarkers indicated reduced iron deficiency in early pregnancy, with the exception of haemoglobin. Body iron increased by 0.6-1.2 mg/kg in early gestation, did not differ by malaria status in nulliparae, but was higher in primigravidae with malaria (6.5 mg/kg versus 5.0 mg/kg; relative risk 1.53, 95% CI 0.67-2.38, P < 0.001). CONCLUSION In primigravidae, early pregnancy haemoglobin was not a good indicator of requirement for iron supplementation, which could be detrimental given the association of better iron status with increased malaria infection. TRIAL REGISTRATION clinicaltrials.gov:NCT01210040. Until placed in a public repository, data relating to the current study can be requested from the corresponding author and will be made available following an end user data agreement and sponsor approval.
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Affiliation(s)
- Salou Diallo
- Clinical Research Unit of Nanoro (URCN/IRSS), Nanoro, Burkina Faso.
| | - Stephen A Roberts
- Centre for Biostatistics, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), Oxford Road, University of Manchester, Manchester, M139PL, UK.
| | - Sabine Gies
- Department of Biomedical Sciences, Prince Leopold Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium; Medical Mission Institute, Würzburg, Germany.
| | | | - Dorine W Swinkels
- Department of Laboratory Medicine (TLM 830), Radboud University Nijmegen Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands; Hepcidinanalysis.com, Geert Grooteplein 10 (830), 6525 GA, Nijmegen, the Netherlands.
| | | | | | | | - Halidou Tinto
- Clinical Research Unit of Nanoro (URCN/IRSS), Nanoro, Burkina Faso.
| | - Bernard J Brabin
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L35QA, England, UK; Institute of Infection and Global Health, University of Liverpool, UK; Global Child Health Group, Academic Medical Centre, University of Amsterdam, the Netherlands.
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Vecchié A, Bonaventura A, Carbone F, Maggi D, Ferraiolo A, Carloni B, Andraghetti G, Affinito Bonabello L, Liberale L, Dallegri F, Montecucco F, Cordera R. C-Reactive Protein Levels at the Midpregnancy Can Predict Gestational Complications. Biomed Res Int 2018; 2018:1070151. [PMID: 30533423 DOI: 10.1155/2018/1070151] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/16/2018] [Accepted: 10/25/2018] [Indexed: 12/18/2022]
Abstract
Although essential for a successful pregnancy, a growing body of evidence suggests that maternal inflammation, when dysregulated, may represent a risk factor for both maternal and neonatal outcomes. Here, we assessed the accuracy of maternal C-reactive protein (CRP) concentrations at the middle phase of pregnancy in the identification of maternal adverse outcomes (MAO) until delivery. A correlation between CRP and a complicated pregnancy including both maternal and neonatal adverse outcomes has been investigated, too. In this retrospective study, conducted at the Diabetology Unit of IRCCS Ospedale Policlinico San Martino, Genoa (Italy), 380 outpatient pregnant women have been enrolled at the prenatal visit before performing a 75 g oral glucose tolerance test at 24th-26th gestational week for gestational diabetes mellitus (GDM) screening. Demographic, medical, and reproductive history has been obtained by verbal interview. Data about pregnancy and delivery have been retrieved from medical records. The median value of maternal baseline serum CRP was 3.25 μg/mL. Women experiencing MAO were older, more frequently suffering from hypertension, and showed higher CRP concentrations, with a cutoff value >1.86 μg/mL found by a ROC curve analysis to be accurately predictive for MAO. By a logistic regression analysis, serum CRP levels >1.86 μg/mL have been found to predict MAO also considering maternal age, hypertension, and GDM. Maternal CRP levels have been positively associated with overall pregnancy adverse outcomes (maternal and neonatal), too. In conclusion, in pregnant women serum levels of CRP can early recognize subjects at higher risk for maternal and neonatal complications needing a more stringent follow-up.
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Bondarenko N. EVALUATION OF SERUM HIGH-SENSITIVITY C-REACTIVE PROTEIN LEVELS DURING VARIOUS PERIODS OF PREGNANCY IN WOMAN, INFECTED WITH PARVOVIRUS - B19 INFECTION. EUREKA: Health Sciences 2018; 2:3-8. [DOI: 10.21303/2504-5679.2018.00604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aim of the research was analyze of C-reactive protein levels in serum blood samples during various periods of pregnancy in women, infected with parvovirus B19 and in case of presence of clinical complications.
129 pregnant women, infected with parvovirus B19 infection and 16 women with physiological pregnancy during first, second and third trimesters of pregnancy were examined. Depending on the presence or absence of clinical complications each group of pregnant women (I, II, III) was divided into two subgroups. The concentration of C-reactive protein in blood serum was determined by the method of immunoassay analysis using diagnostic sets of reagents (ELISA kits, USA). Statistical processing of data was carried out using the package of applied programs Microsoft Office Excel 2010 and StatSoft Statistica 6.1.
The mean age of pregnant woman in our study was 26±6 years. In the Iand II groups of infected B19 parvovirus pregnant women were identified a significant increasing of C-reactive protein levels compared to controls by 62.5 % and 50.0 % (p<0.05). The largest increasing of C-reactive protein level relative to control values was observed in women with clinical complications in different pregnancy periods (p<0.05).
An increase levels of the marker of systemic inflammation the C-reactive protein in the blood testifies to its active participation in the launch of a complex mechanism for the development of labor activity and the occurrence of fetal disorders, which was confirmed in groups of pregnant women with clinical complications in different periods of pregnancy.
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Mitchell AM, Porter K, Christian LM. Examination of the role of obesity in the association between childhood trauma and inflammation during pregnancy. Health Psychol 2017; 37:114-124. [PMID: 28967771 DOI: 10.1037/hea0000559] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Childhood trauma is associated with negative perinatal health outcomes including mood disorders and shorter gestation. However, effects of early life exposures on maternal biology are poorly delineated. This study examined associations between childhood trauma and inflammation, as well as the mediating role of obesity in this relationship. METHOD This study examined a racially diverse sample of 77 pregnant women assessed in early, mid, and late pregnancy. Assessments included the Childhood Trauma Questionnaire, Center for Epidemiologic Studies-Depression Scale, serum CRP, IL-6, and TNF-α, and prepregnancy BMI. RESULTS Per linear mixed models, while no direct relationships were observed between childhood trauma with IL-6 or TNF-α, physical (95% CI: 0.007, 0.080) and emotional (95% CI: 0.005, 0.046) abuse as well as emotional neglect (95% CI: 0.010, 0.051) predicted elevated CRP. Effects remained after adjustment for race, income, education, smoking status, medical conditions, and depressive symptoms. PROCESS analyses showed BMI mediated the relationship between physical abuse and both serum CRP (95% CI: 0.014, 0.062) and IL-6 (95% CI: 0.009, 0.034). CONCLUSIONS Exposure to childhood trauma, particularly emotional abuse, physical abuse, and emotional neglect, is associated with inflammation in pregnant women. Obesity served as 1 pathway by which physical abuse contributed to elevations in serum CRP and IL-6. Interventions targeting maternal obesity prior to pregnancy may help mitigate the effects of childhood trauma on perinatal health. These findings have relevance for understanding biological and behavioral pathways by which early life exposures contribute to maternal health. (PsycINFO Database Record
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Affiliation(s)
- Amanda M Mitchell
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center
| | - Kyle Porter
- Center for Biostatistics, The Ohio State University
| | - Lisa M Christian
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center
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Kuzawa CW, Fried RL, Borja JB, McDade TW. Maternal pregnancy C-reactive protein predicts offspring birth size and body composition in metropolitan Cebu, Philippines. J Dev Orig Health Dis 2017; 8:674-81. [PMID: 28720162 DOI: 10.1017/S2040174417000502] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The gestational milieu is an important influence on fetal development and long-term disease risk. Here we assess relationships between maternal pregnancy inflammation, indicated by C-reactive protein (CRP), and offspring anthropometric outcomes measured soon after birth. Data come from female participants (n=327, age 24.4-30.2 years) in a longitudinal study located in Metropolitan Cebu, Philippines. Between 2009 and 2014, pregnancy interviews (n=429) were conducted during which questionnaire and anthropometric data were obtained along with dried blood spot cards for CRP measurement. Offspring body weight, length, head circumference and five skinfold thickness measures were obtained soon after birth. Maternal pregnancy CRP was borderline (-1.11±0.64 days/log-mg/l; P<0.1) inversely related to gestational age at delivery, but did not increase the likelihood of preterm delivery. After adjusting for maternal pre-pregnancy body mass index, height, pregnancy adiposity, age, parity and other covariates, CRP was significantly, inversely related to offspring body weight (-0.047±0.017 kg/log-mg/l), length (-0.259±0.092 cm/log-mg/l) and sum of skinfolds (-0.520±0.190 mm/log-mg/l) (all P<0.05), and borderline inversely related to offspring head circumference (-0.102±0.068 cm/log-mg/l; P<0.1). Notably, relationships were continuous across the full CRP range, and not limited to unusually high levels of inflammation. These findings point to an important role of maternal non-specific immune activation as a predictor of offspring birth outcomes. In light of evidence that early life microbial, nutritional and stress experiences influence adult inflammatory regulation, these findings point to inflammation as a potential pathway for the intergenerational transmission of maternal experience to offspring health.
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Sjaarda LA, Radin RG, Silver RM, Mitchell E, Mumford SL, Wilcox B, Galai N, Perkins NJ, Wactawski-Wende J, Stanford JB, Schisterman EF. Preconception Low-Dose Aspirin Restores Diminished Pregnancy and Live Birth Rates in Women With Low-Grade Inflammation: A Secondary Analysis of a Randomized Trial. J Clin Endocrinol Metab 2017; 102:1495-1504. [PMID: 28323989 PMCID: PMC5443323 DOI: 10.1210/jc.2016-2917] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 01/11/2017] [Indexed: 12/19/2022]
Abstract
Context Inflammation is linked to causes of infertility. Low-dose aspirin (LDA) may improve reproductive success in women with chronic, low-grade inflammation. Objective To investigate the effect of preconception-initiated LDA on pregnancy rate, pregnancy loss, live birth rate, and inflammation during pregnancy. Design Stratified secondary analysis of a multicenter, block-randomized, double-blind, placebo-controlled trial. Setting Four US academic medical centers, 2007 to 2012. Participants Healthy women aged 18 to 40 years (N = 1228) with one to two prior pregnancy losses actively attempting to conceive. Intervention Preconception-initiated, daily LDA (81 mg) or matching placebo taken up to six menstrual cycles attempting pregnancy and through 36 weeks' gestation in women who conceived. Main Outcome Measures Confirmed pregnancy, live birth, and pregnancy loss were compared between LDA and placebo, stratified by tertile of preconception, preintervention serum high-sensitivity C-reactive protein (hsCRP) (low, <0.70 mg/L; middle, 0.70 to <1.95 mg/L; high, ≥1.95 mg/L). Results Live birth occurred in 55% of women overall. The lowest pregnancy and live birth rates occurred among the highest hsCRP tertile receiving placebo (44% live birth). LDA increased live birth among high-hsCRP women to 59% (relative risk, 1.35; 95% confidence interval, 1.08 to 1.67), similar to rates in the lower and mid-CRP tertiles. LDA did not affect clinical pregnancy or live birth in the low (live birth: 59% LDA, 54% placebo) or midlevel hsCRP tertiles (live birth: 59% LDA, 59% placebo). Conclusions In women attempting conception with elevated hsCRP and prior pregnancy loss, LDA may increase clinical pregnancy and live birth rates compared with women without inflammation and reduce hsCRP elevation during pregnancy.
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Affiliation(s)
- Lindsey A. Sjaarda
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland 20892
| | - Rose G. Radin
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland 20892
| | - Robert M. Silver
- Department of Obstetrics and Gynecology, University of Utah and Intermountain Healthcare, Salt Lake City, Utah 84132-2209
| | - Emily Mitchell
- Centers for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland 20857
| | - Sunni L. Mumford
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland 20892
| | - Brian Wilcox
- Department of Clinical Sciences, Obstetrics and Gynecology, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania 18509
| | - Noya Galai
- Department of Statistics, University of Haifa, Haifa 3498838, Israel
| | - Neil J. Perkins
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland 20892
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York 14214-8001
| | - Joseph B. Stanford
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah 84108
| | - Enrique F. Schisterman
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland 20892
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Abstract
Objective Gestational diabetes mellitus (GDM) increases the foetal morbidity and mortality and there is also risk of development of type II diabetes for the mother. In pregnancy iron supplementations are given to all the females in India. Data are not available on the relationship between serum ferritin and GDM in Indian populations. Material & Methods Case control study was done on 90 women (30 GDM patients approx 28 weeks of gestation and 60 control subjects without GDM) referred to the tertiary care hospital at New Delhi. Ferritin was analysed by ELISA kit. They were analyzed for the correlation of ferritin with blood glucose in GDM patients. Results On comparison with blood glucose the levels of ferritin were statistically significantly high in GDM cases as compared to controls (p value 0.008). There was a negative correlation of ferritin with blood glucose level (r value -0.039, p value 0.794). Discussion Pregnancy is an equivalent of an inflammatory state and the high levels of ferritin can help in determining the need of iron supplementation given in pregnant females. Women who had high serum ferritin had the greatest risk of GDM. Conclusion This study suggests a possible link between elevated serum ferritin and low-grade inflammation. Further studies in larger populations are required to establish this study.
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Affiliation(s)
- A Yadav
- Lady Hardinge Medical College, Department of Biochemistry, New Delhi, India
| | - V Saini
- Vardhaman Mahavir Medical College, Department of Biochemistry, New Delhi, India
| | - M Kataria
- Vardhaman Mahavir Medical College, Department of Biochemistry, New Delhi, India
| | - A Jain
- Lady Hardinge Medical College, Department of Biochemistry, New Delhi, India
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Korhonen KV, Savolainen-Peltonen HM, Mikkola TS, Tiitinen AE, Unkila-Kallio LS. C-reactive protein response is higher in early than in late ovarian hyperstimulation syndrome. Eur J Obstet Gynecol Reprod Biol 2016; 207:162-8. [PMID: 27865939 DOI: 10.1016/j.ejogrb.2016.10.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 10/16/2016] [Accepted: 10/24/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Many in vitro fertilization (IVF) complications are inflammatory by nature, some of which are even life-threatening. We evaluated the response of C-reactive protein (CRP) in IVF complications, especially in early and late ovarian hyperstimulation syndrome (OHSS), to support clinical decision making in gynecological emergency policlinics. STUDY DESIGN In a prospective two-year study at Helsinki University Hospital, Finland, we recruited patients with IVF complications including moderate or severe OHSS (n=47 patients: 36 early and 14 late OHSS cases), or other IVF complications (n=13). As controls, we recruited women in an uncomplicated IVF cycle (n=27). Serial blood samples (CRP, blood count, platelets, albumin, estradiol, creatinine, and electrolytes) were collected from patients upon admission to the emergency polyclinic and during and after treatment on the ward, and from the controls prior, during, and after the IVF protocol. All samples were categorized according to oocyte pick-up (OPU). The statistics included comparisons between and within the study groups, and receiver-operating characteristic (ROC) curve analysis for diagnostic accuracy of CRP for early OHSS at emergency polyclinics. RESULTS On admission, CRP did not differentiate OHSS from other IVF complications, but CRP was higher in early (median 21; IQR 8-33mg/L) than in late (6; 3-9mg/L, p=0.001) OHSS. In ROC analysis for CRP (12mg/L), the area under the curve (AUC) was 0.74 (p=0.001) with sensitivity of 69% and specificity of 71% for early OHSS. CRP was significantly higher (28; 10-46mg/L) in patients with early OHSS two days after oocyte pick-up (OPU) than in the controls (5; <3-9mg/L, p<0.001). The level normalized by 12 days, similarly to the controls. On the ward, the peak CRP was higher if early OHSS was complicated with infection (108; 49-166mg/L) than without infection (20; 8-32mg/L, p=0.001). Late OHSS was associated with hypoalbuminemia (19.6; 16.2-23.1g/L, p<0.001) and thrombocytosis (494; 427-561 E9/L, p=0.004; comparisons to early OHSS). CONCLUSIONS Early OHSS associates with a distinct rise in CRP level beyond that induced by uncomplicated oocyte pick-up, whereas the CRP levels in late OHSS are comparable to those in the control cycles. CRP identifies, but cannot distinguish IVF complications.
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Abstract
OBJECTIVE Controlled ovarian hyperstimulation (COH) is apparently a key factor in the success of in vitro fertilization-embryo transfer. One of the major complications of COH is severe ovarian hyperstimulation syndrome (OHSS), which may be attributable to a massive increase in systemic inflammatory cytokines or to neutrophil activation. The aim of the present review was to investigate the role of COH in the induction of an inflammatory response. METHODS Major studies that have reported on the association between COH and inflammation were identified through MEDLINE searches and the published literature. RESULTS Several inflammatory mediators, namely, C-reactive protein and leukocyte and endothelial selectins, showed a significant increase after human chorionic gonadotropin (hCG) administration in vivo, reflecting an inflammatory state, and neutrophil and endothelial activation, respectively. On the other hand, hCG showed a direct depressive effect on mononuclear cells in vitro. Because the development of OHSS almost always follows hCG administration, the negative effect of hCG on peripheral mononuclear cells indicates that it probably causes OHSS by an indirect mechanism. CONCLUSION We suspect that hCG stimulates the ovaries to produce and secrete a still unknown intermediate factor, which in turn activates inflammatory processes that may lead to an increase in capillary permeability.
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Affiliation(s)
- Raoul Orvieto
- Department of Obstetrics and Gynecology, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Zerbo O, Traglia M, Yoshida C, Heuer LS, Ashwood P, Delorenze GN, Hansen RL, Kharrazi M, Van de Water J, Yolken RH, Weiss LA, Croen LA. Maternal mid-pregnancy C-reactive protein and risk of autism spectrum disorders: the early markers for autism study. Transl Psychiatry 2016; 6:e783. [PMID: 27093065 DOI: 10.1038/tp.2016.46] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 01/28/2016] [Accepted: 01/31/2016] [Indexed: 12/31/2022] Open
Abstract
Maternal pregnancy levels of the inflammatory marker C-reactive protein (CRP) has been previously associated with autism spectrum disorder (ASD) in the offspring. We conducted a population-based nested case-control study with 500 children with ASD, 235 with developmental delay (DD) and 580 general population (GP) controls to further investigate whether elevated CRP during pregnancy increases the risk of ASD. Maternal CRP concentration was measured in archived serum collected during 15-19 weeks of pregnancy and genome-wide single-nucleotide polymorphism (SNP) data were generated. The levels of CRP were compared between ASD vs GP and DD vs GP. The genetic associations with CRP were assessed via linear regression. Maternal CRP levels in mid-pregnancy were lower in mothers of ASD compared with controls. The maternal CRP levels in the upper third and fourth quartiles were associated with a 45 and 44% decreased risk of ASD, respectively. Two SNPs at the CRP locus showed strong association with CRP levels but they were not associated with ASD. No difference was found between maternal CRP levels of DD and controls. The reasons for the lower levels of CRP in mothers of ASD are not known with certainty but may be related to alterations in the immune response to infectious agents. The biological mechanisms underlying this association remain to be clarified.
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Koks N, Ghassabian A, Greaves-Lord K, Hofman A, Jaddoe VW, Verhulst FC, Tiemeier H. Maternal C-Reactive Protein Concentration in Early Pregnancy and Child Autistic Traits in the General Population. Paediatr Perinat Epidemiol 2016; 30:181-9. [PMID: 26860445 PMCID: PMC4751036 DOI: 10.1111/ppe.12261] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Exposure to elevated levels of inflammatory markers during pregnancy has been suggested as possible aetiologic factor in the occurrence of autism spectrum disorder (ASD). In this study, we investigated the prospective relation between maternal C-reactive protein (CRP) during early pregnancy and children's autistic traits in the general population. METHODS In a large population-based cohort in the Netherlands, we measured maternal CRP levels before 18 weeks of gestation (N = 4165). Parents reported on their children's autistic traits at age 6 years using the Social Responsiveness Scale, and the Pervasive Developmental Problem scale. Regression models were used to examine the relation between maternal CRP levels and autistic traits in children. RESULTS Compared with the reference group (CRP < 2.3 mg/L), elevated levels of CRP (>7.8 mg/L) in pregnant women were associated with higher Social Responsiveness Scale scores in children [β = 0.055, 95% confidence interval (CI) 0.033, 0.078]; however, the effect was strongly attenuated after adjustment for several socioeconomic factors and in particular by maternal health-related factors including body mass index (fully adjusted model β = 0.018, 95% CI -0.005, 0.042). We found no relation between maternal CRP levels and pervasive developmental problem. CONCLUSIONS Our results suggest that the association between elevated levels of maternal CRP in pregnancy and autistic traits in children is confounded by maternal health-related and socioeconomic factors. Further studies are needed to explore whether other maternal inflammatory markers during pregnancy, as a response to maternal inflammation, are associated with the development of autistic traits in the offspring.
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Affiliation(s)
- Natasja Koks
- The Generation R Study Group, Erasmus University Medical Center, 3000 CB Rotterdam, the Netherlands.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center-Sophia Children's Hospital, 3000 CB Rotterdam, the Netherlands
| | - Akhgar Ghassabian
- The Generation R Study Group, Erasmus University Medical Center, 3000 CB Rotterdam, the Netherlands.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center-Sophia Children's Hospital, 3000 CB Rotterdam, the Netherlands.,Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD 20852, USA
| | - Kirstin Greaves-Lord
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center-Sophia Children's Hospital, 3000 CB Rotterdam, the Netherlands.,Yulius Academy, Yulius, Organization of Mental Health, Dordrecht, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus University Medical Center, 3000 CB Rotterdam, the Netherlands
| | - Vincent W.V. Jaddoe
- The Generation R Study Group, Erasmus University Medical Center, 3000 CB Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus University Medical Center, 3000 CB Rotterdam, the Netherlands.,Department of Pediatrics, Erasmus University Medical Center-Sophia Children's Hospital, 3000 CB Rotterdam, the Netherlands
| | - Frank C. Verhulst
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center-Sophia Children's Hospital, 3000 CB Rotterdam, the Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center-Sophia Children's Hospital, 3000 CB Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus University Medical Center, 3000 CB Rotterdam, the Netherlands.,Department of Psychiatry, Erasmus University Medical Center, 3000 CB Rotterdam, the Netherlands
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Mei Z, Li H, Serdula MK, Flores-Ayala RC, Wang L, Liu JM, Grummer-Strawn LM. C-reactive protein increases with gestational age during pregnancy among Chinese women. Am J Hum Biol 2016; 28:574-9. [PMID: 26865074 DOI: 10.1002/ajhb.22837] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 09/09/2015] [Accepted: 01/06/2016] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To examine the concentration of C-reactive protein (CRP) in relation to gestational weeks during pregnancy among Chinese women. METHODS From a randomized control trial of prenatal supplementation with folic acid, iron-folic acid, and multiple micronutrients in China, we examined 834 pregnant women with CRP measured initially between 5 and 20 weeks and at follow-up between 28 and 32 weeks gestation. We calculated and plotted CRP geometric means by gestational weeks. The same analysis was repeated for women who had normal pregnancies (624 women) by excluding women with stillbirth, preterm, small for gestational age, body mass index <18.5 kg/m(2) or >30 kg/m(2) at enrollment, and hypertension or anemia during pregnancy. RESULTS We observed a significant positive trend between log-transformed CRP and gestational age from 5 to 20 weeks and from 28 to 32 weeks both in the full sample and in the subset of women who had normal pregnancies. CRP geometric mean was 0.81 mg/l at 5-7 weeks of gestation, 2.85 mg/l at 19-20 weeks of gestation, and 3.89 mg/l at 32 weeks of gestation. A similar increasing trend in the CRP median or percentage of elevated CRP were also observed. CONCLUSION We concluded that CRP increased with gestational age among healthy Chinese women who delivered healthy infants. Am. J. Hum. Biol. 28:574-579, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Zuguo Mei
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Hongtian Li
- Peking University Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China
| | - Mary K Serdula
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Rafael C Flores-Ayala
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Linlin Wang
- Peking University Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China
| | - Jian-Meng Liu
- Peking University Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China
| | - Laurence M Grummer-Strawn
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
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Abstract
OBJECTIVE To evaluate the systemic inflammatory response in preeclampsia compared to normal pregnancy. MATERIALS AND METHODS The following serum parameters were determined in three groups of patients: leukocytes, neutrophils, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP), and certain markers of oxidative stress. Fetal status was assessed based on the gestational age at which birth occurred, on the Apgar score, and on fetal weight. RESULTS In preeclampsia, a higher systemic inflammatory status was found compared to normal pregnancy. Gestational age at birth, fetal weight, and Apgar score were significantly lower in the group with preeclampsia compared to normal pregnancy. CONCLUSION In preeclampsia, there is an increased systemic inflammatory response compared to normal pregnancy, which can influence fetal status at birth.
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Affiliation(s)
- Dan Mihu
- 2nd Department of Obstetrics and Gynecology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012, Cluj-Napoca, Romania
| | - Ciortea Razvan
- 2nd Department of Obstetrics and Gynecology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012, Cluj-Napoca, Romania
| | - Andrei Malutan
- 2nd Department of Obstetrics and Gynecology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012, Cluj-Napoca, Romania.
| | - Carmen Mihaela
- Department of Histology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012, Cluj-Napoca, Romania
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van der Burg JW, Sen S, Chomitz VR, Seidell JC, Leviton A, Dammann O. The role of systemic inflammation linking maternal BMI to neurodevelopment in children. Pediatr Res 2016; 79:3-12. [PMID: 26375474 PMCID: PMC4888781 DOI: 10.1038/pr.2015.179] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 07/01/2015] [Indexed: 11/09/2022]
Abstract
Children of obese mothers are at increased risk of developmental adversities. Maternal obesity is linked to an inflammatory in utero environment, which, in turn, is associated with neurodevelopmental impairments in the offspring. This is an integrated mechanism review of animal and human literature related to the hypothesis that maternal obesity causes maternal and fetal inflammation, and that this inflammation adversely affects the neurodevelopment of children. We propose integrative models in which several aspects of inflammation are considered along the causative pathway linking maternal obesity with neurodevelopmental limitations.
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Affiliation(s)
- Jelske W. van der Burg
- Department of Health and Life Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Sarbattama Sen
- Department of Pediatrics and Mother Infant Research Institute, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts, USA
- Jean Mayer Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts, USA
| | - Virginia R. Chomitz
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Jaap C. Seidell
- Department of Health and Life Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Alan Leviton
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Olaf Dammann
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Perinatal Epidemiology Unit, Hannover Medical School, Hannover, Germany
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Peña-paredes E, Reyna-villasmil E, Mejia-montilla J, Reyna-villasmil N, Torres-cepeda D, Santos-bolívar J. Proteína C reactiva en pacientes con preeclampsia y gestantes normotensas sanas. Clínica e Investigación en Ginecología y Obstetricia 2016; 43:7-11. [DOI: 10.1016/j.gine.2014.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
In the United States, approximately 64% of women of childbearing age are either overweight or obese. Maternal obesity during pregnancy is associated with a greater risk for adverse maternal-fetal outcomes. Adverse health outcomes for the offspring can persist into adulthood, increasing the incidence of several chronic conditions including cardiovascular disease, diabetes, and asthma. Since these diseases have a significant inflammatory component, these observations are indicative of perturbation of the normal development and maturation of the immune system of the offspring in utero. This hypothesis is strongly supported by data from several rodent studies. Although the mechanisms of these perturbations are not fully understood, it is thought that increased placental inflammation due to obesity may directly affect neonatal development through alterations in nutrient transport. In this review we examine the impact of maternal obesity on the neonatal immune system, and potential mechanisms for the changes observed.
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Affiliation(s)
- Randall M Wilson
- Graduate Program in Cell, Molecular, and Developmental Biology, University of California, Riverside, USA
| | - Ilhem Messaoudi
- Graduate Program in Cell, Molecular, and Developmental Biology, University of California, Riverside, USA; Division of Biomedical Sciences, School of Medicine, University of California, Riverside, USA.
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Maguire PJ, Power KA, O’Higgins AC, Jackson S, Harley R, le Roux CW, Turner MJ. Maternal C-reactive protein in early pregnancy. Eur J Obstet Gynecol Reprod Biol 2015; 193:79-82. [DOI: 10.1016/j.ejogrb.2015.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/07/2015] [Accepted: 07/14/2015] [Indexed: 12/31/2022]
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Palomba S, de Wilde MA, Falbo A, Koster MP, La Sala GB, Fauser BC. Pregnancy complications in women with polycystic ovary syndrome. Hum Reprod Update 2015; 21:575-592. [DOI: 10.1093/humupd/dmv029] [Citation(s) in RCA: 352] [Impact Index Per Article: 39.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Lapin B, Ownby D, Turyk M, Piorkowski J, Freels S, Chavez N, Wagner-Cassanova C, Hernandez E, Pelzel D, Vergara C, Persky V. Relationship between in utero C-reactive protein levels and asthma in at-risk children. Ann Allergy Asthma Immunol 2015; 115:282-7. [PMID: 26272280 DOI: 10.1016/j.anai.2015.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 07/16/2015] [Accepted: 07/17/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Asthma research has focused on postnatal exposures, but there is recent evidence to indicate atopic immune responses might be initiated in utero. Systemic inflammation during pregnancy might indicate an environment that could increase propensity in the child to develop allergic disease. OBJECTIVE To investigate the association of systemic inflammation, as measured by C-reactive protein (CRP) levels, with asthma and wheezing in offspring within an at-risk, mostly Mexican, cohort. METHODS Using data from a randomized education intervention of families at risk for asthma from 1998 followed through 2009 in urban Chicago, asthma was defined as ever having a physician diagnosis of asthma by 3 years of age and wheezing before the third year. Logistic regression models controlling for confounders investigated the effect of prenatal CRP levels on these outcomes. RESULTS There were 244 mother-child pairs included in the study analysis with median prenatal CRP levels of 4.9 mg/L (interquartile range 3.2-7.7). Continuous prenatal CRP levels were predictive of asthma by year 3 (relative risk 2.4, 95% confidence interval 1.3, 3.6) and wheezing in year 3 (relative risk 1.7, 95% confidence interval 1.1, 2.4) after adjustment. Associations remained significant in mothers who were of Mexican ethnicity and were nonsmokers, suggesting that effects might be stronger in children at lower risk of disease. CONCLUSION Prenatal CRP levels are associated with asthma by year 3 and wheezing in year 3 within a high-risk, urban, mostly Mexican, cohort. Maternal systemic inflammation might reflect a prenatal environment that could increase offspring susceptibility to develop wheezing and asthma young in life.
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Affiliation(s)
- Brittany Lapin
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois.
| | - Dennis Ownby
- Section of Allergy and Immunology, Georgia Regents University, Augusta, Georgia
| | - Mary Turyk
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Julie Piorkowski
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Sally Freels
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Noel Chavez
- Community Health Sciences Division, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Cynthia Wagner-Cassanova
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Eva Hernandez
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | | | | | - Victoria Persky
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
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Borders AE, Wolfe K, Qadir S, Kim KY, Holl J, Grobman W. Racial/ethnic differences in self-reported and biologic measures of chronic stress in pregnancy. J Perinatol 2015; 35:580-4. [PMID: 25789817 DOI: 10.1038/jp.2015.18] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 01/01/2015] [Accepted: 01/30/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Racial differences in chronic maternal stress may contribute to disparities in pregnancy outcomes. The objective is to identify racial and ethnic differences in self-reported and biologic measures of stress between non-Hispanic black (NHB) and non-Hispanic white (NHW) pregnant women. STUDY DESIGN NHB and NHW pregnant women were enrolled before 23 weeks of gestation in this prospective cohort study. Equal numbers of women were recruited with public vs private insurance in each racial group. Self-reported stress was measured and blood samples collected in the second and third trimesters were analyzed for serum Epstein-Barr virus antibody, C-reactive protein (CRP), corticotropin-releasing hormone (CRH) and adenocorticotropic hormone (ACTH). RESULTS One hundred and twelve women were enrolled. NHW women reported more buffers against stress (P=0.04) and neighborhood satisfaction (P=0.02). NHB women reported more discrimination (P<0.001), food insecurity (P=0.04) and had significantly higher mean CRP levels and mean ACTH levels in the second and third trimesters. CONCLUSION Significant differences in self-reported and biologic measures of chronic stress were identified between NHB and NHW pregnant women with similar economic characteristics. Future studies should investigate mechanisms underlying these differences and their relationship to pregnancy outcomes.
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