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Francis EC, Powe CE, Lowe WL, White SL, Scholtens DM, Yang J, Zhu Y, Zhang C, Hivert MF, Kwak SH, Sweeting A. Refining the diagnosis of gestational diabetes mellitus: a systematic review and meta-analysis. Commun Med (Lond) 2023; 3:185. [PMID: 38110524 PMCID: PMC10728189 DOI: 10.1038/s43856-023-00393-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/25/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Perinatal outcomes vary for women with gestational diabetes mellitus (GDM). The precise factors beyond glycemic status that may refine GDM diagnosis remain unclear. We conducted a systematic review and meta-analysis of potential precision markers for GDM. METHODS Systematic literature searches were performed in PubMed and EMBASE from inception to March 2022 for studies comparing perinatal outcomes among women with GDM. We searched for precision markers in the following categories: maternal anthropometrics, clinical/sociocultural factors, non-glycemic biochemical markers, genetics/genomics or other -omics, and fetal biometry. We conducted post-hoc meta-analyses of a subset of studies with data on the association of maternal body mass index (BMI, kg/m2) with offspring macrosomia or large-for-gestational age (LGA). RESULTS A total of 5905 titles/abstracts were screened, 775 full-texts reviewed, and 137 studies synthesized. Maternal anthropometrics were the most frequent risk marker. Meta-analysis demonstrated that women with GDM and overweight/obesity vs. GDM with normal range BMI are at higher risk of offspring macrosomia (13 studies [n = 28,763]; odds ratio [OR] 2.65; 95% Confidence Interval [CI] 1.91, 3.68), and LGA (10 studies [n = 20,070]; OR 2.23; 95% CI 2.00, 2.49). Lipids and insulin resistance/secretion indices were the most studied non-glycemic biochemical markers, with increased triglycerides and insulin resistance generally associated with greater risk of offspring macrosomia or LGA. Studies evaluating other markers had inconsistent findings as to whether they could be used as precision markers. CONCLUSIONS Maternal overweight/obesity is associated with greater risk of offspring macrosomia or LGA in women with GDM. Pregnancy insulin resistance or hypertriglyceridemia may be useful in GDM risk stratification. Future studies examining non-glycemic biochemical, genetic, other -omic, or sociocultural precision markers among women with GDM are warranted.
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Affiliation(s)
- Ellen C Francis
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA.
| | - Camille E Powe
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - William L Lowe
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sara L White
- Department of Women and Children's Health, King's College London, London, UK
| | - Denise M Scholtens
- Department of Preventive Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jiaxi Yang
- Global Center for Asian Women's Health (GloW), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Bia-Echo Asia Centre for Reproductive Longevity & Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yeyi Zhu
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Cuilin Zhang
- Global Center for Asian Women's Health (GloW), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Bia-Echo Asia Centre for Reproductive Longevity & Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Marie-France Hivert
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Soo Heon Kwak
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Arianne Sweeting
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Chen S, Zhou Y, Mu Q, Wang Y. The interaction effect of pre-pregnancy body mass index and maternal age on the risk of pregnancy complications in twin pregnancies after assisted reproductive technology. J Matern Fetal Neonatal Med 2023; 36:2271623. [PMID: 37884444 DOI: 10.1080/14767058.2023.2271623] [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: 04/24/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVE The widespread use of assisted reproductive technology (ART) has led to an increased twin pregnancy rate and increased risk of pregnancy complications. Pre-pregnancy body mass index (BMI) and maternal age are both risk factors for pregnancy complications. This study aimed to explore whether there is an interaction effect between pre-pregnancy BMI and maternal age on pregnancy complications in women with twin pregnancies after ART. METHODS Data of 445,750 women with twin pregnancies after ART were extracted from the National Vital Statistics System (NVSS) database in 2016-2021 in this retrospective cohort study. Univariate and multivariate logistic regression analyses were used to explore (1) the associations between pre-pregnancy BMI, maternal age, and total pregnancy complications; (2) interaction effect between pre-pregnancy BMI and maternal age on total pregnancy complications; and (3) this interaction effect in parity, race, gestational weight gain (GWG), and preterm birth subgroups. The evaluation indexes were odds ratios (ORs), relative excess risk of interaction (RERI), attributable proportions of interaction (AP), and synergy index (S) with 95% confidence intervals (CIs). RESULTS A total of 6,827 women had pregnancy complications. After adjusting for the covariates, compared with women had non-AMA and pre-pregnancy BMI <25 kg/m2, higher maternal age combined with higher pre-pregnancy BMI was associated with higher odds of total pregnancy complications [OR = 2.16, 95%CI: (1.98-2.36)]. The RERI (95% CI) was 0.22 (0.04-0.41), AP (95% CI) was 0.10 (0.02-0.19), and S (95% CI) was 1.24 (1.03-1.49). Subgroup analysis results indicated that the potential additive effect between pre-pregnancy BMI and maternal age on total pregnancy complications was also found in women with different race, multipara/unipara, GWG levels, or preterm births/non-preterm births (all p < 0.05). CONCLUSION Pre-pregnancy BMI and maternal age may have an additive effect on the odds of pregnancy-related complications in women with twin pregnancy after ART.
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Affiliation(s)
- Shenglan Chen
- College of Nursing, Jiangsu Vocational College of Medicine, Yancheng, Jiangsu, P.R. China
| | - Yu Zhou
- College of Nursing, Jiangsu Vocational College of Medicine, Yancheng, Jiangsu, P.R. China
| | - Qin Mu
- Department of Paediatrics, Yancheng Third People's Hospital, Yancheng, Jiangsu, P.R. China
| | - Yina Wang
- Department of Obstetrics and Gynecology, Yancheng Third People's Hospital, Yancheng, Jiangsu, P.R. China
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Lee S, Seow CH, Nerenberg K, Bertazzon S, Leung Y, Huang V, Whitten T, Coward S, Panaccione R, Kaplan GG, Metcalfe A. Despite Increased Disease Activity, Women who Attended a Dedicated Inflammatory Bowel Disease and Pregnancy Clinic Had Infants With Higher Apgar Scores: A Population-Based Study. Inflamm Bowel Dis 2023:izad147. [PMID: 37499061 DOI: 10.1093/ibd/izad147] [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: 01/16/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Attendance at a subspecialty pregnancy clinic for women with inflammatory bowel disease (IBD) improves disease-specific pregnancy knowledge. We examined the impact of attendance at a dedicated IBD-pregnancy clinic on IBD and perinatal outcomes. METHODS Using linked administrative databases in Alberta, Canada (2012-2019), we identified 1061 pregnant women with IBD who delivered singleton liveborn infants in-hospital who did (n = 314) and did not attend (n = 747) the clinic. Propensity score weighted multivariable log-binomial and multinomial logistic regression models were used to determine the risk of IBD and perinatal outcomes. RESULTS The median number of clinic visits was 3 (Q1-Q3, 3-5), with 34.7% completing a preconception consultation. A greater proportion of women who attended lived near the clinic, were nulliparous, had a disease flare prior to pregnancy, and were on maintenance IBD medication (P < .05). Women who attended had increased risks of a disease flare during pregnancy (adjusted risk ratio [aRR], 2.02; 95% CI, 1.45-2.82), an IBD-related emergency department visit during pregnancy (aRR, 2.66; 95% CI, 1.92-3.68), and cesarean delivery (aRR, 1.78; 95% CI, 1.23-2.57). Despite this, clinic attendees had a decreased risk of delivering an infant with a low Apgar score at 1 minute (risk ratio [RR], 0.49; 95% CI, 0.32-0.76) and 5 minutes (RR, 0.32; 95% CI, 0.12-0.87). CONCLUSIONS Women who attended a dedicated IBD-pregnancy clinic were more likely to have a disease flare prior to pregnancy, reflecting a more severe disease phenotype, but had similar perinatal outcomes and infants with better Apgar scores at birth. Our study suggests the value of these subspecialty clinics in providing enhanced IBD-specific prenatal care.
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Affiliation(s)
- Sangmin Lee
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Cynthia H Seow
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, Alberta, Canada
| | - Kara Nerenberg
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Stefania Bertazzon
- Department of Geography, University of Calgary, Calgary, Alberta, Canada
| | - Yvette Leung
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vivian Huang
- Division of Gastroenterology, Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Tara Whitten
- Provincial Research Data Services, Alberta Health Services, Alberta, Canada
- Alberta Strategy for Patient Oriented Research Support Unit Data and Research Services Platform, Alberta, Canada
| | - Stephanie Coward
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Remo Panaccione
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, Alberta, Canada
| | - Gilaad G Kaplan
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, Alberta, Canada
| | - Amy Metcalfe
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
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Orovou E, Eskitzis P, Mrvoljak-Theodoropoulou I, Tzitiridou-Hatzopoulou M, Dagla M, Arampatzi C, Iliadou M, Antoniou E. The Relation between Neonatal Intensive Care Units and Postpartum Post-Traumatic Stress Disorder after Cesarean Section. Healthcare (Basel) 2023; 11:1877. [PMID: 37444711 DOI: 10.3390/healthcare11131877] [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: 05/28/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The experience of a neonate hospitalized in the NICU is an understandably traumatic experience for parents, especially for the mothers of neonates. This mental distress resulting from preterm birth and/or NICU hospitalization can be understood as post-traumatic symptomatology, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5 version). The aim of this study is to investigate the impact of the admission of a neonate to the NICU (forany reason) on the development of postpartum PTSD in a sample of women after cesarean section. METHODS A total of 469 women who gave birth with cesarean section from July 2019 to June 2020 participated in this study out of the original sample of 490 women who consented to participate. Data were obtained from the researcher's socio-demographic questionnaire and the post-traumatic stress checklist (PCL-5) from the Diagnostic and Statistical Manual of Mental Disorders DCM-5 version. RESULTS In total,11.7% of the sample experienced postpartum PTSD. There is a strong relationship between the inclusion of a neonate to the NICU due to perinatal stress, breathing difficulties, infections, and IUGR with postpartum PTSD (37.7%) in relation to the perinatal stress Criterion A (fear for the life of the neonate), the first criterion of postpartum PTSD. CONCLUSIONS Additional measures must be taken for mothers of children who have been admitted to the neonatal intensive care unit with psychological support interventions and a reassessment of their mental state.
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Affiliation(s)
- Eirini Orovou
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
- Department of Midwifery, University of Western Macedonia, Keptse, 50200 Ptolemaida, Greece
| | - Panagiotis Eskitzis
- Department of Midwifery, University of Western Macedonia, Keptse, 50200 Ptolemaida, Greece
| | | | | | - Maria Dagla
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
| | - Christiana Arampatzi
- Department of Midwifery, University of Western Macedonia, Keptse, 50200 Ptolemaida, Greece
| | - Maria Iliadou
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
| | - Evangelia Antoniou
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
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Gantt A, Metz TD, Kuller JA, Louis JM, Cahill AG, Turrentine MA. Obstetric Care Consensus #11, Pregnancy at age 35 years or older. Am J Obstet Gynecol 2023; 228:B25-B40. [PMID: 35850202 DOI: 10.1016/j.ajog.2022.07.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Centers for Disease Control and Prevention data from 2020 demonstrate the continued upward trend in the mean age of pregnant individuals in the United States. Observational studies demonstrate that pregnancy in older individuals is associated with increased risks of adverse pregnancy outcomes-for both the pregnant patient and the fetus-that might differ from those found in younger pregnant populations, even in healthy individuals with no other comorbidities. There are several studies that suggest that advancing age at the time of pregnancy is associated with greater disparities in severe maternal morbidity and mortality. This document seeks to provide evidence-based clinical recommendations for minimizing adverse outcomes associated with pregnancy with anticipated delivery at an advanced maternal age. The importance and benefits of accessible health care from prepregnancy through postpartum care for all pregnant individuals cannot be overstated. However, this document focuses on and addresses the unique differences in pregnancy-related care for women and all those seeking obstetrical care with anticipated delivery at the age of 35 years or older within the framework of routine pregnancy care. This Obstetric Care Consensus document was developed using an a priori protocol in conjunction with the authors listed above.
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6
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Oaks BM, Adu-Afarwuah S, Ashorn P, Lartey A, Laugero KD, Okronipa H, Stewart CP, Dewey KG. Increased risk of preterm delivery with high cortisol during pregnancy is modified by fetal sex: a cohort study. BMC Pregnancy Childbirth 2022; 22:727. [PMID: 36151538 PMCID: PMC9502964 DOI: 10.1186/s12884-022-05061-8] [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] [Received: 02/24/2022] [Accepted: 09/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Previous studies show an association between maternal plasma and salivary cortisol and preterm birth but have been primarily conducted in high-income countries. It is unknown whether salivary cortisol is a risk factor for preterm birth in Ghana. Our objective was to determine whether maternal salivary cortisol during pregnancy was associated with pregnancy duration and preterm delivery in Ghana. Methods We conducted a cohort study of 783 pregnant women in Ghana. We measured salivary cortisol at baseline (mean 16 wk), 28 wk., and 36 wk. gestation. Pregnancy duration was determined primarily by ultrasound. We used adjusted linear regression models to examine the association between cortisol and pregnancy duration and Poisson regression models to determine the risk of preterm delivery among women with high cortisol at baseline or 28 wk. gestation. Results Mean pregnancy duration was 39.4 ± 1.8 wk. and 6.6% had a preterm delivery. Mean maternal cortisol increased throughout pregnancy, from 4.9 ± 2.7 nmol/L at baseline (16 wk) to 6.4 ± 3.2 nmol/L at 28 wk. and 7.9 ± 3.0 nmol/L at 36 wk. gestation. In adjusted analyses, higher cortisol concentrations at baseline (β = − 0.39, p = .002) and 28 wk. (β = − 0.49, p = .001), but not 36 wk. (β = − 0.23, p = .084) were associated with a shorter pregnancy duration. Women with high cortisol at baseline (> 6.3 nmol/L) had an increased relative risk of preterm delivery (RR (95% CI): 1.96 (1.13, 3.40)), but the association between high cortisol at 28 wk. and preterm delivery was not significant. There was a significant interaction with fetal sex (p-for-interaction = 0.037): among women carrying male fetuses, high cortisol at baseline increased the risk of preterm delivery threefold (3.18 (1.51, 6.71)) while there was no association (1.17 (0.50, 2.74)) among women carrying female fetuses. Conclusion Higher maternal cortisol is associated with a shorter pregnancy duration and an increased risk of preterm delivery. Subgroup analysis by fetal sex revealed that this association is evident primarily among women carrying male fetuses. Future studies of cortisol and preterm delivery should include consideration of fetal sex as a potential effect modifier. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05061-8.
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Affiliation(s)
- Brietta M Oaks
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, 02881, USA.
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
| | - Per Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health, Technology, Tampere University, Tampere, Finland.,Department of Pediatrics, Tampere University Hospital, Tampere, Finland
| | - Anna Lartey
- Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
| | - Kevin D Laugero
- USDA Western Human Nutrition Research Center, Davis, CA, USA.,Department of Nutrition, University of California, Davis, CA, USA
| | - Harriet Okronipa
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, USA
| | | | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, CA, USA
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Abstract
SUMMARY Centers for Disease Control and Prevention data from 2020 demonstrate the continued upward trend in the mean age of pregnant individuals in the United States. Observational studies demonstrate that pregnancy in older individuals is associated with increased risks of adverse pregnancy outcomes-for both the pregnant patient and the fetus-that might differ from those in a younger pregnant population, even in healthy individuals with no other comorbidities. There are several studies that suggest advancing age at the time of pregnancy is associated with greater disparities in severe maternal morbidity and mortality. This document seeks to provide evidence-based clinical recommendations for minimizing adverse outcomes associated with pregnancy with anticipated delivery at an advanced maternal age. The importance and benefits of accessible health care from prepregnancy through postpartum care for all pregnant individuals cannot be overstated. However, this document focuses on and addresses the unique differences in pregnancy-related care for women and all those seeking obstetric care with anticipated delivery at age 35 years or older within the framework of routine pregnancy care. This Obstetric Care Consensus document was developed using an a priori protocol in conjunction with the authors listed above.
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8
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McHale P, Maudsley G, Pennington A, Schlüter DK, Barr B, Paranjothy S, Taylor-Robinson D. Mediators of socioeconomic inequalities in preterm birth: a systematic review. BMC Public Health 2022; 22:1134. [PMID: 35668387 PMCID: PMC9172189 DOI: 10.1186/s12889-022-13438-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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] [Received: 03/15/2022] [Accepted: 05/16/2022] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Rates of preterm birth are substantial with significant inequalities. Understanding the role of risk factors on the pathway from maternal socioeconomic status (SES) to preterm birth can help inform interventions and policy. This study therefore aimed to identify mediators of the relationship between maternal SES and preterm birth, assess the strength of evidence, and evaluate the quality of methods used to assess mediation. METHODS Using Scopus, Medline OVID, "Medline In Process & Other Non-Indexed Citation", PsycINFO, and Social Science Citation Index (via Web of Science), search terms combined variations on mediation, socioeconomic status, and preterm birth. Citation and advanced Google searches supplemented this. Inclusion criteria guided screening and selection of observational studies Jan-2000 to July-2020. The metric extracted was the proportion of socioeconomic inequality in preterm birth explained by each mediator (e.g. 'proportion eliminated'). Included studies were narratively synthesised. RESULTS Of 22 studies included, over one-half used cohort design. Most studies had potential measurement bias for mediators, and only two studies fully adjusted for key confounders. Eighteen studies found significant socioeconomic inequalities in preterm birth. Studies assessed six groups of potential mediators: maternal smoking; maternal mental health; maternal physical health (including body mass index (BMI)); maternal lifestyle (including alcohol consumption); healthcare; and working and environmental conditions. There was high confidence of smoking during pregnancy (most frequently examined mediator) and maternal physical health mediating inequalities in preterm birth. Significant residual inequalities frequently remained. Difference-of-coefficients between models was the most common mediation analysis approach, only six studies assessed exposure-mediator interaction, and only two considered causal assumptions. CONCLUSIONS The substantial socioeconomic inequalities in preterm birth are only partly explained by six groups of mediators that have been studied, particularly maternal smoking in pregnancy. There is, however, a large residual direct effect of SES evident in most studies. Despite the mediation analysis approaches used limiting our ability to make causal inference, these findings highlight potential ways of intervening to reduce such inequalities. A focus on modifiable socioeconomic determinants, such as reducing poverty and educational inequality, is probably necessary to address inequalities in preterm birth, alongside action on mediating pathways.
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Affiliation(s)
- Philip McHale
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, England.
| | - Gillian Maudsley
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, England
| | - Andy Pennington
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, England
| | - Daniela K Schlüter
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, England
| | - Ben Barr
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, England
| | - Shantini Paranjothy
- School of Medicine, Medical Sciences and Nutrition, Aberdeen Health Data Science Research Centre, University of Aberdeen, Aberdeen, Scotland
| | - David Taylor-Robinson
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, England
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Okui T, Nakashima N. Differences in Rates of Low Birth Weight among Prefectures in Japan: An Ecological Study Using Government Statistics Data. Children (Basel) 2022; 9:children9030305. [PMID: 35327677 PMCID: PMC8947009 DOI: 10.3390/children9030305] [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] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/12/2022] [Accepted: 02/21/2022] [Indexed: 11/24/2022]
Abstract
The differences in the rates and trends of the overall low birth weight and term low birth weight in recent years are unknown for the Japanese prefectures. In this ecological study, we revealed the rates for each prefecture and investigated the factors affecting the regional differences in these outcomes. Aggregated vital statistics data from 2007 to 2019 were obtained from the Ministry of Health, Labour, and Welfare in Japan. The association between the outcomes and the variables, including the infants’ birth characteristics, medical characteristics, and socioeconomic characteristics of the prefectures, were analyzed. An analysis of repeated-measures data was conducted using the data from 2013 and 2018 for each prefecture. The trend for the rates of overall low birth weight and term low birth weight over the years differed among the prefectures. Moreover, the proportions of multiple births and lean (body mass index <18.5 kg/m2) and obese (body mass index ≥25.0 kg/m2) women had a statistically significant positive association with both the overall low birth weight rate and the term low birth weight rate among the prefectures. It was suggested that to resolve the difference in these outcomes among the prefectures, being obese or underweight needs to be addressed in mothers.
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10
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De la Calle M, Bartha JL, García L, Cuerva MJ, Ramiro-Cortijo D. Women Aged over 40 with Twin Pregnancies Have a Higher Risk of Adverse Obstetrical Outcomes. Int J Environ Res Public Health 2021; 18:ijerph182413117. [PMID: 34948726 PMCID: PMC8701912 DOI: 10.3390/ijerph182413117] [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: 11/08/2021] [Revised: 12/08/2021] [Accepted: 12/11/2021] [Indexed: 11/16/2022]
Abstract
Maternal age is related to a higher risk of adverse maternal, fetal, and neonatal outcomes in twin pregnancies. However, whether this increase in adverse outcomes is due solely to age or due to risk factors that are more common in women over 40 remains unknown. The aim of this study is to assess if maternal age over 40 years old is an independent risk factor for obstetric adverse outcomes in dichorionic diamniotic twin gestations. In this single-center retrospective cohort study, we compared the obstetric outcomes of women with dichorionic diamniotic twin pregnancies below and over 40 years of age. A twin pregnancy cohort enrolled between 2013 and 2019 was included in the study. Maternal, fetal, and labor complications were recorded. A total of 510 women were analyzed in two groups: 266 women below 40 years old and 244 women over 40 years old. Maternal age over 40 increased the odds of maternal (aOR = 1.9 (1.3; 2.9); p-value = 0.002), fetal (aOR = 1.8 (1.0; 3.0); p-value = 0.037), and labor complications (aOR = 2.5 (1.3; 4.6); p-value = 0.004). Maternal age over 40 years was the most important factor increasing the odds of having a caesarean section (C-section). Over 40 years old was an independent risk factor for complications in dichorionic diamniotic twin pregnancies.
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Affiliation(s)
- María De la Calle
- Department of Obstetrics and Gynecology, Hospital Universitario La Paz, 28046 Madrid, Spain; (M.D.l.C.); (J.L.B.); (M.J.C.)
| | - Jose L. Bartha
- Department of Obstetrics and Gynecology, Hospital Universitario La Paz, 28046 Madrid, Spain; (M.D.l.C.); (J.L.B.); (M.J.C.)
| | - Laura García
- Department of Pediatrics, Hospital Universitario Gregorio Marañón, 28007 Madrid, Spain;
| | - Marcos J. Cuerva
- Department of Obstetrics and Gynecology, Hospital Universitario La Paz, 28046 Madrid, Spain; (M.D.l.C.); (J.L.B.); (M.J.C.)
| | - David Ramiro-Cortijo
- Department of Physiology, Faculty of Medicine, Universidad Autonoma de Madrid, 28029 Madrid, Spain
- Correspondence:
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11
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Scime NV, Metcalfe A, Nettel-Aguirre A, Tough SC, Chaput KH. Association of prenatal medical risk with breastfeeding outcomes up to 12 months in the All Our Families community-based birth cohort. Int Breastfeed J 2021; 16:69. [PMID: 34526043 PMCID: PMC8442292 DOI: 10.1186/s13006-021-00413-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/23/2021] [Indexed: 11/25/2022] Open
Abstract
Background Prenatal medical risk describes physical health issues or biological factors that predate or arise during pregnancy which heighten the risk of adverse outcomes, and often warrant specialized obstetric care. The influence of the nature and magnitude of prenatal risk on breastfeeding outcomes remains poorly understood. The objective of this study was to determine the association between prenatal medical risk and breastfeeding initiation and duration up to 1 year postpartum. Methods We analysed a subset of data from the All Our Families longitudinal cohort (n = 2706) of women in Calgary, Canada who delivered a liveborn infant between 2008 and 2010. Data were collected from self-report questionnaires and medical records. Women with complete data on prenatal medical risk factors and breastfeeding outcomes were included in this analysis. Prenatal medical risk was operationalized as one integer score of risk severity and four binary risk types capturing pre-pregnancy characteristics, past obstetric problems, current obstetric problems, and substance use. Outcomes were breastfeeding initiation defined as the infant ever receiving breast milk, and duration operationalized as still breastfeeding at 4 months, at 12 months, and time to breastfeeding cessation in weeks. We used logistic regression and Cox regression with right censoring at 52 weeks or attrition to calculate odds ratios (OR) and hazard ratios (HR), respectively, adjusting for sociodemographic vulnerability, parity, mode of delivery, and gestational age. Results Prenatal medical risk severity and type were not significantly associated with breastfeeding initiation, with the exception of pre-pregnancy risk type (OR 0.45; 95% CI 0.26, 0.77). Risk severity was associated with lower odds of breastfeeding to 4 months (OR 0.94; 95% CI 0.90, 0.99), 12 months (OR 0.93; 95% CI 0.87, 0.98), and earlier breastfeeding cessation (HR 1.05; 95% CI 1.02, 1.08). Associations with shorter breastfeeding length across the first postpartum year were observed for pre-pregnancy, current obstetric, and substance use risk types, but not past obstetric problems. Conclusion Prenatal medical risk is associated with shortened duration of breastfeeding. Women with prenatal medical risk may benefit from the proactive arrangement of lactation support before and following delivery to promote continued breastfeeding. Supplementary Information The online version contains supplementary material available at 10.1186/s13006-021-00413-0.
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Affiliation(s)
- Natalie V Scime
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Amy Metcalfe
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Alberto Nettel-Aguirre
- Centre for Health and Social Analytics, National Institute for Applied Statistical Research, School of Mathematics and Statistics, University of Wollongong, Wollongong, NSW, Australia
| | - Suzanne C Tough
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kathleen H Chaput
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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12
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Glick I, Kadish E, Rottenstreich M. Management of Pregnancy in Women of Advanced Maternal Age: Improving Outcomes for Mother and Baby. Int J Womens Health 2021; 13:751-759. [PMID: 34408501 PMCID: PMC8364335 DOI: 10.2147/ijwh.s283216] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/03/2021] [Indexed: 12/13/2022] Open
Abstract
Pregnancy at advanced maternal age (age >35 years old) is considered a risk factor for adverse maternal and perinatal outcomes. Yet, pregnancies of advanced maternal age have become more prevalent over the last few decades. Possible maternal complications of pregnancy at age 35 or older include increased risk of spontaneous miscarriage, preterm labor, gestational diabetes mellitus, pre-eclampsia, stillbirth, chromosomal abnormalities, and cesarean delivery. Possible adverse fetal outcomes include infants small for gestational age and intrauterine growth restrictions, low Apgar score, admission to neonatal intensive care units, and an autism spectrum disorder. This paper aims to present an up-to-date review of the literature, summarizing the most current studies and implications for the management of pregnancy of advanced maternal age.
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Affiliation(s)
- Itamar Glick
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ela Kadish
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Misgav Rottenstreich
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel
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13
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Kajdy A, Feduniw S, Modzelewski J, Sys D, Filipecka-Tyczka D, Muzyka-Placzyńska K, Kiczmer P, Grabowski B, Rabijewski M. Growth Abnormalities as a Risk Factor of Adverse Neonatal Outcome in Hypertensive Pregnancies-A Single-Center Retrospective Cohort Study. Children (Basel) 2021; 8:children8060522. [PMID: 34205263 PMCID: PMC8234699 DOI: 10.3390/children8060522] [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] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/07/2021] [Accepted: 06/17/2021] [Indexed: 11/23/2022]
Abstract
(1) Background: Hypertensive disorders of pregnancy (HDP) include gestational hypertension (GH), chronic hypertension (CH), preeclampsia (PE), and preeclampsia superimposed on chronic hypertension (CH with PE). HDP is associated with several short and long-term perinatal and neonatal complications, such as newborn growth restriction and death. This study aimed to establish the association between HDP, newborn growth abnormalities, and neonatal outcome. (2) Methods: This is a single-center retrospective cohort study of 63651 singleton deliveries. (3) Results: Univariate analysis showed a significantly increased risk of intrauterine and neonatal death associated with maternal hypertension and growth disorders. There were differences between growth charts used, with the highest risk of stillbirth for SGA defined by the Intergrowth chart (OR 17.2) and neonatal death for newborn growth restriction (NGR) based on Intergrowth (OR 19.1). Multivariate analysis showed that NGR is a stronger risk factor of neonatal death than SGA only. (4) Conclusions: HDP is significantly associated with growth abnormalities and is an independent risk factor of adverse outcomes. The presence of newborn growth restriction is strongly associated with the risk of neonatal death. The choice of growth chart has a substantial effect on the percentage of diagnosis of SGA and NGR.
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Affiliation(s)
- Anna Kajdy
- Department of Reproductive Health, Centre of Postgraduate Medical Education, 01-004 Warsaw, Poland; (S.F.); (J.M.); (D.S.); (D.F.-T.); (K.M.-P.); (M.R.)
- Correspondence: ; Tel.: +48-22-2559-918
| | - Stepan Feduniw
- Department of Reproductive Health, Centre of Postgraduate Medical Education, 01-004 Warsaw, Poland; (S.F.); (J.M.); (D.S.); (D.F.-T.); (K.M.-P.); (M.R.)
| | - Jan Modzelewski
- Department of Reproductive Health, Centre of Postgraduate Medical Education, 01-004 Warsaw, Poland; (S.F.); (J.M.); (D.S.); (D.F.-T.); (K.M.-P.); (M.R.)
| | - Dorota Sys
- Department of Reproductive Health, Centre of Postgraduate Medical Education, 01-004 Warsaw, Poland; (S.F.); (J.M.); (D.S.); (D.F.-T.); (K.M.-P.); (M.R.)
| | - Dagmara Filipecka-Tyczka
- Department of Reproductive Health, Centre of Postgraduate Medical Education, 01-004 Warsaw, Poland; (S.F.); (J.M.); (D.S.); (D.F.-T.); (K.M.-P.); (M.R.)
| | - Katarzyna Muzyka-Placzyńska
- Department of Reproductive Health, Centre of Postgraduate Medical Education, 01-004 Warsaw, Poland; (S.F.); (J.M.); (D.S.); (D.F.-T.); (K.M.-P.); (M.R.)
| | - Paweł Kiczmer
- Department and Chair of Pathomorphology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland;
| | | | - Michał Rabijewski
- Department of Reproductive Health, Centre of Postgraduate Medical Education, 01-004 Warsaw, Poland; (S.F.); (J.M.); (D.S.); (D.F.-T.); (K.M.-P.); (M.R.)
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Ross KM, Carroll JE, Horvath S, Hobel CJ, Coussons-Read ME, Dunkel Schetter C. Epigenetic age and pregnancy outcomes: GrimAge acceleration is associated with shorter gestational length and lower birthweight. Clin Epigenetics 2020; 12:120. [PMID: 32762768 PMCID: PMC7409637 DOI: 10.1186/s13148-020-00909-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 02/27/2020] [Accepted: 07/20/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Advanced biological aging, as measured by epigenetic aging indices, is associated with early mortality and morbidity. Associations between maternal epigenetic aging indices in pregnancy and pregnancy outcomes, namely gestational length and birthweight, have not been assessed. The purpose of this study was to examine whether epigenetic age during pregnancy was associated with gestational length and birthweight. RESULTS The sample consisted of 77 women from the Los Angeles, CA, area enrolled in the Healthy Babies Before Birth study. Whole blood samples for DNA methylation assay were obtained during the second trimester (15.6 ± 2.15 weeks gestation). Epigenetic age indices GrimAge acceleration (GrimAgeAccel), DNAm PAI-1, DNAm ADM, and DNAm cystatin C were calculated. Gestational length and birthweight were obtained from medical chart review. Covariates were maternal sociodemographic variables, gestational age at blood sample collection, and pre-pregnancy body mass index. In separate covariate-adjusted linear regression models, higher early second trimester GrimAgeAccel, b(SE) = - .171 (.056), p = .004; DNAm PAI-1, b(SE) = - 1.95 × 10-4 (8.5 × 10-5), p = .004; DNAm ADM, b(SE) = - .033 (.011), p = .003; and DNAm cystatin C, b(SE) = 2.10 × 10-5 (8.0 × 10-5), p = .012, were each associated with shorter gestational length. Higher GrimAgeAccel, b(SE) = - 75.2 (19.7), p < .001; DNAm PAI-1, b(SE) = - .079(.031), p = .013; DNAm ADM, b(SE) = - 13.8 (3.87), p = .001; and DNAm cystatin C, b(SE) = - .010 (.003), p = .001, were also associated with lower birthweight, independent of gestational length. DISCUSSION Higher maternal prenatal GrimAgeAccel, DNAm PAI-1, DNAm ADM, and DNAm cystatin C were associated with shorter gestational length and lower birthweight. These findings suggest that biological age, as measured by these epigenetic indices, could indicate risk for adverse pregnancy outcomes.
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Affiliation(s)
- Kharah M. Ross
- Centre for Social Sciences, Athabasca University, 1 University Drive, Athabasca, AB T9S 3A3 Canada
- Department of Psychology, University of Calgary, Calgary, AB Canada
| | - Judith E. Carroll
- Cousins Center for Psychoneuroimmunology, David Geffen School of Medicine, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California – Los Angeles, Los Angeles, CA USA
| | - Steve Horvath
- Department of Biostatistics, University of California – Los Angeles, Los Angeles, CA USA
| | - Calvin J. Hobel
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Mary E. Coussons-Read
- Psychology Department, University of Colorado – Colorado Springs, Colorado Springs, CO USA
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