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Al Khalaf SY, Bodunde E, Maher G, O'Reilly ÉJ, McCarthy FP, O'Shaughnessy M, O’Neill SM, Khashan AS. Chronic Kidney Disease and Adverse Pregnancy Outcomes: A Systematic Review and Meta-analysis. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
Chronic kidney disease (CKD) has been linked with adverse pregnancy outcomes, but few studies have examined the influence of cause and severity. The aim of this meta-analysis was to synthesize the evidence on CKD and adverse pregnancy outcome, by cause and severity of CKD where reported.
Data sources
We searched PubMed, Embase, and Web of Science from inception to May 2021. Study selection and Data Extraction: Studies reporting associations between CKD and adverse pregnancy outcomes were included according to pre-defined eligibility criteria (PROSPERO protocol registration: CRD42020211925). Two reviewers independently screened titles, abstracts, and full-text articles and performed data extraction. The certainty of the evidence was assessed using the GRADE approach.
Main Outcomes and Measures: We used random-effects meta-analyses to calculate pooled estimates. Primary outcomes included pre-eclampsia, Caesarean section (CS), preterm birth (PTB <37 wk.) and small for gestational age (SGA).
Results
In total, 31 studies were included. The certainty of the evidence was deemed to be ‘very low' for all outcomes using the GRADE approach as expected given the observational study design. Pre-pregnancy CKD was associated with pre-eclampsia [pooled adjusted odds ratio (aOR)=2.58 (1.33-5.01)], CS [aOR=1.65 (1.21-2.25)], PTB [aOR=1.73 (1.31-2.27)] and SGA [aOR= 1.93 (1.06-3.52)]. Subgroup analyses suggested that different causes of CKD had differing risks for adverse pregnancy outcomes, and later stages of CKD, compared to earlier stages, were associated with higher odds of pre-eclampsia [crude OR = 2.77 (1.73-4.44)], PTB [4.21 (2.99-5.92)], and SGA [2.43 (1.33-4.46)].
Conclusions
CKD was associated with a higher risk of adverse pregnancy outcomes, and the degree of risk varied by cause and severity. These findings highlight the need for further studies of a more robust quality evaluating the effects of cause and severity of kidney disease on adverse pregnancy outcomes.
Key messages
Pre-pregnancy CKD was associated with higher risk of adverse pregnancy outcomes. The risk of adverse pregnancy outcomes varied by CKD cause and severity.
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Affiliation(s)
- SY Al Khalaf
- School of Public Health, University College Cork, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
| | - E Bodunde
- School of Public Health, University College Cork, Cork, Ireland
| | - G Maher
- School of Public Health, University College Cork, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
| | - ÉJ O'Reilly
- School of Public Health, University College Cork, Cork, Ireland
- Department of Nutrition, Harvard T.H., Chan School of Public Health, Boston, MA, USA
| | - FP McCarthy
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland
| | - M O'Shaughnessy
- Department of Renal Medicine, Cork University Hospital, Cork, Ireland
| | - SM O’Neill
- School of Public Health Alumna, University College Cork, Cork, Ireland
| | - AS Khashan
- School of Public Health, University College Cork, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
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Maher GM, Dalman C, O'Keeffe GW, Kearney PM, McCarthy FP, Kenny LC, Khashan AS. Association between preeclampsia and autism spectrum disorder and attention deficit hyperactivity disorder: an intergenerational analysis. Acta Psychiatr Scand 2020; 142:348-350. [PMID: 32337718 DOI: 10.1111/acps.13180] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/17/2020] [Accepted: 04/23/2020] [Indexed: 01/10/2023]
Affiliation(s)
- G M Maher
- INFANT Research Centre, Cork, Ireland.,School of Public Health, University College Cork, Cork, Ireland
| | - C Dalman
- Department of Public Health Sciences, Division of Public Health Epidemiology, Karolinska Institutet, Stockholm, Sweden.,Center for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - G W O'Keeffe
- INFANT Research Centre, Cork, Ireland.,Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - P M Kearney
- School of Public Health, University College Cork, Cork, Ireland
| | | | - L C Kenny
- Department of Women's and Children's Health, Institute of Translational Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - A S Khashan
- INFANT Research Centre, Cork, Ireland.,School of Public Health, University College Cork, Cork, Ireland
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Maher GM, Dalman C, O'Keeffe GW, Kearney PM, McCarthy FP, Kenny LC, Khashan AS. Association between preeclampsia and attention-deficit hyperactivity disorder: a population-based and sibling-matched cohort study. Acta Psychiatr Scand 2020; 142:275-283. [PMID: 32056200 DOI: 10.1111/acps.13162] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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] [Accepted: 02/11/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To examine the association between preeclampsia and attention-deficit hyperactivity disorder (ADHD), using a large Swedish-based registry cohort. METHODS This study comprised 2 047 619 children, with 114 934 (5.6%) cases of ADHD. Preeclampsia was based on two alternate definitions: (i) preeclampsia (using ICD-9/ICD-10) and (ii) preeclampsia and small for gestational age (SGA) combined. ADHD was determined in one of two ways: (i) if a diagnosis of ADHD was present in the National Patient Register or (ii) if an individual was in receipt of ADHD medication in the Prescribed Drug Register. Multivariate Cox proportional hazards regression analysis allowed adjustment for several perinatal/sociodemographic factors. Sibling-matched analysis further controlled for shared genetic and familial confounding. RESULTS In the adjusted Cox model, preeclampsia was associated with an increase in likelihood of ADHD (HR: 1.15, 95% CI: 1.12, 1.19). The HR for preeclampsia and those born SGA was 1.43 (95% CI: 1.31, 1.55) in the adjusted model, compared to those unexposed to preeclampsia/SGA. The sibling-matched analysis did not materially change these associations (HR: 1.13, 95% CI: 1.05, 1.22) and 1.55 (95% CI: 1.28, 1.88). CONCLUSIONS Exposure to preeclampsia or preeclampsia/SGA was associated with ADHD, independent of genetic/familial factors shared by siblings. However, it is important to note that sibling-matched analysis can only adjust for factors that are constant between pregnancies; therefore, residual confounding cannot be ruled out. Further research is needed to explore modifiable risk factors and identify those most-at-risk babies following delivery.
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Affiliation(s)
- G M Maher
- INFANT Research Centre, Cork, Ireland.,School of Public Health, University College Cork, Cork, Ireland
| | - C Dalman
- Department of Public Health Sciences, Division of Public Health Epidemiology, Karolinska Institutet, Stockholm, Sweden.,Center for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - G W O'Keeffe
- INFANT Research Centre, Cork, Ireland.,Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - P M Kearney
- School of Public Health, University College Cork, Cork, Ireland
| | | | - L C Kenny
- Department of Women's and Children's Health, Institute of Translational Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - A S Khashan
- INFANT Research Centre, Cork, Ireland.,School of Public Health, University College Cork, Cork, Ireland
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Barrett PM, McCarthy FP, Evans M, Kublickas M, Perry IJ, Stenvinkel P, Khashan AS, Kublickiene K. Preeclampsia and the risk of chronic kidney disease: a national registry-based cohort study. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Preeclampsia is associated with increased risk of future cardiovascular disease, but evidence for associations with chronic kidney disease (CKD) has been inconsistent to date. We aimed to measure associations between preeclampsia and long-term CKD in a population-based sample of parous women, and to identify whether the risk differs by CKD subtype.
Methods
Using data from the Swedish Medical Birth Register, singleton live births from 1973-2012 were identified and linked to data from the Swedish Renal Register and National Patient Register (up to 2013). Preeclampsia was the main exposure of interest and was treated as a time-dependent variable. The primary outcome was maternal CKD, and this was classified into 5 subtypes: hypertensive, diabetic, glomerular/proteinuric, tubulo-interstitial, other/non-specific CKD. Cox proportional hazard regression models were used for analysis. Women with pre-pregnancy comorbidities were excluded.
Results
The dataset included 1,924,591 unique women who had 3,726,819 singleton pregnancies. The median follow-up was 20.7 (interquartile range 9.9-30.0) years. Overall, 90,964 women (4.7%) experienced preeclampsia and 18,146 (0.9%) developed CKD. Women who had preeclampsia had higher risk of developing any CKD during follow-up (aHR 1.88, 95% CI 1.79-1.98). The risk differed by CKD subtype, and was higher for hypertensive CKD (aHR 3.76, aHR 3.09-4.57), diabetic CKD (aHR 3.45, 95% CI 2.83-4.21) and glomerular/proteinuric CKD (aHR 2.08, 95% CI 1.90-2.29). Women who had preterm preeclampsia, recurrent preeclampsia, or preeclampsia complicated by pre-pregnancy obesity were also at greater risk of any CKD.
Conclusions
Women with a history of preeclampsia are at increased risk of long-term CKD. The risk is most marked for hypertensive CKD, diabetic CKD, and glomerular/proteinuric CKD. The absolute risk of CKD related to preeclampsia is substantial, and these women may warrant systematic renal monitoring in the years following delivery.
Key messages
Preeclampsia is an independent predictor of long-term risk of chronic kidney disease in otherwise healthy parous women. Women with a history of preeclampsia may warrant systematic renal monitoring through additional blood pressure, blood glucose, and proteinuria checks.
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Affiliation(s)
- P M Barrett
- School of Public Health, University College Cork, Cork, Ireland
- INFANT, University College Cork, Cork, Ireland
| | - F P McCarthy
- INFANT, University College Cork, Cork, Ireland
- Department of Obstetrics, University College Cork, Cork, Ireland
| | - M Evans
- CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - M Kublickas
- Department of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
| | - I J Perry
- School of Public Health, University College Cork, Cork, Ireland
| | - P Stenvinkel
- CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - A S Khashan
- School of Public Health, University College Cork, Cork, Ireland
- INFANT, University College Cork, Cork, Ireland
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Barrett P, McCarthy FP, Kublickiene K, Cormican S, Judge C, Evans M, Kublickas M, Perry IJ, Stenvinkel P, Khashan AS. Adverse pregnancy outcomes and long-term risk of maternal renal disease: a systematic review. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Little is known about the long-term risk of renal disease following adverse pregnancy outcomes, such as hypertensive disorders of pregnancy (HDP), gestational diabetes (GDM) or preterm delivery. We aimed to investigate associations between adverse pregnancy outcomes and maternal chronic kidney disease (CKD) and end-stage kidney disease (ESKD), by synthesising results of relevant studies.
Methods
A systematic search of PubMed, EMBASE and Web of Science was done up to July 2018. Case-control and cohort studies were eligible for inclusion if they provided original effect estimates for associations between adverse pregnancy outcomes (HDP, GDM, preterm) and maternal renal disease (primary outcomes: CKD, ESKD; secondary outcomes: renal hospitalisation, renal mortality). Two independent reviewers extracted data and assessed risk of bias. Random effects meta-analyses were conducted to determine pooled adjusted odds ratio (AOR) and 95% confidence interval (95%CI) for each association.
Results
Of 5,120 studies retrieved, 21 studies met inclusion criteria (4,483,847 participants). HDP was associated with increased odds of ESKD (AOR 6.58, 95%CI 4.06-10.65), CKD (AOR 2.08, 95%CI 1.06-4.10), renal hospitalisation (AOR 2.29, 95%CI 1.42-3.71). The magnitude of association was dependent on HDP subtype: AOR for preeclampsia and ESKD was 4.87 (95%CI 3.01-7.87); gestational hypertension and ESKD was 3.65 (95%CI 2.34-5.67); other HDP (including chronic hypertension) and ESKD was 14.67 (95%CI 3.21-66.97). Preterm delivery was associated with increased odds of ESKD (AOR 2.16, 95%CI 1.64-2.85). GDM was associated with increased odds of CKD among black women (AOR 1.78, 95%CI 1.18-2.70), but not Caucasian women (AOR 0.81, 95%CI 0.58-1.13)
Conclusions
Women who experience adverse pregnancy outcomes have increased odds of renal disease, especially after HDP. Risk stratification and preventive interventions may be needed to reduce the risk of clinically significant renal disease in mothers.
Key messages
This is the first study to summarise the long-term risk of renal disease among women who experience a range of adverse pregnancy outcomes. Women who experience hypertensive disorders in pregnancy, preterm delivery, or gestational diabetes are at increased odds of renal disease.
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Affiliation(s)
- P Barrett
- School of Public Health, University College Cork, Cork, Ireland
- INFANT, University College Cork, Cork, Ireland
| | | | | | - S Cormican
- Department of Nephrology, University Hospital Galway, Galway, Ireland
| | - C Judge
- Department of Nephrology, University Hospital Galway, Galway, Ireland
| | - M Evans
- CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - M Kublickas
- Department of Obstetrics, Karolinska Institutet, Stockholm, Sweden
| | - I J Perry
- School of Public Health, University College Cork, Cork, Ireland
| | - P Stenvinkel
- CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - A S Khashan
- School of Public Health, University College Cork, Cork, Ireland
- INFANT, University College Cork, Cork, Ireland
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Barrett P, McCarthy FP, Evans M, Kublickas M, Perry IJ, Stenvinkel P, Kublickiene K, Khashan AS. Preterm delivery is associated with long-term risk of maternal renal disease. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz187.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Preterm delivery is an independent risk factor for maternal cardiovascular disease. Little is known about the association between preterm delivery and maternal renal function, and whether any association is independent of preeclampsia or intra-uterine growth restriction. This study aimed to examine the association between gestational age and long-term maternal chronic kidney disease (CKD) and end-stage kidney disease (ESKD).
Methods
Using data from the Swedish Medical Birth Register, singleton live births from 1973-2012 were identified and linked to data from the Swedish Renal Register and National Patient Register (up to 2013). Women with pre-pregnancy CKD/ESKD, cardiovascular disease, diabetes, hypertension, systemic lupus erythematosus were excluded. Gestational age at delivery was the main exposure, treated as a time-dependent variable. Primary outcomes were maternal CKD or ESKD. Cox regression was used, adjusting for maternal age, year of delivery, country of origin, education, parity, interpregnancy interval, smoking, BMI, gestational diabetes. Models were stratified by exposure to preeclampsia or small for gestational age (SGA).
Results
There were 3,847,694 pregnancies among 1,990,273 unique women. Nine percent of women (n = 172,915) had at least one preterm delivery (<37 weeks). Exposure to preterm delivery was associated with higher risk of CKD (aHR 1.48, 95%CI 1.41-1.54) and ESKD (aHR 2.52, 95%CI 2.17-2.92). Earlier gestational age at delivery was associated with increasing risk of CKD and ESKD. Women with spontaneous preterm delivery were at higher risk of CKD (vs. normal term, aHR 1.33, 95% CI 1.26-1.40) and ESKD (aHR 2.02, 95%CI 1.69-2.40) independently of preeclampsia/SGA. Associations persisted after excluding women who developed postpartum cardiovascular disease, hypertension or diabetes.
Conclusions
Women who gave birth at earlier gestation were at higher risk of later CKD and ESKD. This association persisted independently of preeclampsia and SGA.
Key messages
Preterm delivery is an independent predictor of long-term maternal renal disease. Obstetric history should be considered as part of overall risk stratification for chronic kidney disease in women.
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Affiliation(s)
- P Barrett
- School of Public Health, University College Cork, Cork, Ireland
- INFANT, University College Cork, Cork, Ireland
| | | | - M Evans
- CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - M Kublickas
- Department of Obstetrics, Karolinska Institutet, Stockholm, Sweden
| | - I J Perry
- School of Public Health, University College Cork, Cork, Ireland
| | - P Stenvinkel
- CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | | | - A S Khashan
- School of Public Health, University College Cork, Cork, Ireland
- INFANT, University College Cork, Cork, Ireland
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7
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McCarthy FP, Gill C, Seed PT, Bramham K, Chappell LC, Shennan AH. Comparison of three commercially available placental growth factor-based tests in women with suspected preterm pre-eclampsia: the COMPARE study. Ultrasound Obstet Gynecol 2019; 53:62-67. [PMID: 29575304 PMCID: PMC6588004 DOI: 10.1002/uog.19051] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/25/2018] [Accepted: 03/03/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To compare the performance of three placental growth factor (PlGF)-based tests in predicting delivery within 14 days from testing in women with suspected preterm pre-eclampsia before 35 weeks' gestation. METHODS This was a retrospective analysis of samples collected from three prospective pregnancy cohort studies. Participants were pregnant women with suspected preterm pre-eclampsia recruited in tertiary maternity units in the UK and Ireland. Samples were analyzed simultaneously according to the manufacturers' directions. The tests compared were the DELFIA Xpress PlGF 1-2-3 test, the Triage PlGF test and the Elecsys immunoassay soluble fms-like tyrosine kinase-1 (sFlt-1)/PlGF ratio. Areas under receiver-operating characteristics curves (AUCs) were compared. The main outcome measure was detection of a difference of 0.05 in AUC between tests for delivery within 14 days of testing. RESULTS Plasma samples from 396 women and serum samples from 244 women were assayed. In predicting delivery within 14 days secondary to suspected pre-eclampsia prior to 35 weeks' gestation, no significant differences were observed in AUCs (P = 0.795), sensitivities (P = 0.249), positive predictive values (P = 0.765) or negative predictive values (P = 0.920) between the three tests. The specificity of the Elecsys sFlt-1/PlGF ratio test was higher than that of the other two tests (P < 0.001). CONCLUSIONS The tests perform similarly in their prediction of need for delivery within 14 days in women with suspected pre-eclampsia. The high negative predictive values support the role of PlGF-based tests as 'rule-out' tests for pre-eclampsia. © 2018 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- F. P. McCarthy
- Department of Women and Children's HealthKing's College LondonSt Thomas' Hospital, LondonUK
- The Irish Centre for Fetal and Neonatal Translational Research, Department of Obstetrics and GynaecologyCork University Maternity HospitalWilton, CorkIreland
| | - C. Gill
- Department of Women and Children's HealthKing's College LondonSt Thomas' Hospital, LondonUK
| | - P. T. Seed
- Department of Women and Children's HealthKing's College LondonSt Thomas' Hospital, LondonUK
| | - K. Bramham
- Department of Women and Children's HealthKing's College LondonSt Thomas' Hospital, LondonUK
| | - L. C. Chappell
- Department of Women and Children's HealthKing's College LondonSt Thomas' Hospital, LondonUK
| | - A. H. Shennan
- Department of Women and Children's HealthKing's College LondonSt Thomas' Hospital, LondonUK
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McCarthy FP, Khashan AS, Murray D, Kiely M, Hourihane JO, Pasupathy D, Kenny LC. Parental physical and lifestyle factors and their association with newborn body composition. BJOG 2016; 123:1824-9. [PMID: 27102226 DOI: 10.1111/1471-0528.14042] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2016] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To investigate the parental physical and lifestyle determinants of newborn body composition. DESIGN Prospective cohort study. SETTING Cork University Maternity Hospital, a tertiary referral hospital in Cork, Ireland. POPULATION All babies were recruited as part of a prospective birth cohort, Babies After SCOPE Evaluating the Longitudinal Impact Using Neurological and Nutritional Endpoints (BASELINE). These babies were recruited from women who had participated in the Screening of Pregnancy Endpoints (SCOPE) study Ireland, a prospective, multicentre cohort study METHODS Multivariate linear regression was used to analyse the effect of a range of maternal and paternal physical and lifestyle features on neonatal body fat percentage (BF%). MAIN OUTCOME MEASURES Neonatal BF%. Neonatal adiposity was assessed within 48 hours of birth using air displacement plethysmography (PEAPOD(®) ). RESULTS In all, 1243 infants were enrolled in the study. Increasing maternal body mass index (adjusted mean difference 0.09; 0.04, 0.15) and waist height ratio (adjusted mean difference 6.59; 0.27, 12.92) were significantly associated with increased neonatal BF%. In contrast, maternal smoking was associated with reduced neonatal BF% compared with non smokers (adjusted mean difference -0.55; -1.07, -0.03). Infant sex significantly altered neonatal BF%, with female infants having higher neonatal BF% compared with male infants (adjusted mean difference 1.98; 1.54, 2.53). No association was observed between paternal body mass index (BMI), paternal age or paternal smoking and neonatal BF%. CONCLUSIONS Maternal smoking, BMI, waist height ratio and infant sex were associated with altered BF%. TWEETABLE ABSTRACT Maternal smoking, BMI, waist height ratio and infant sex are associated with altered neonatal body fat percentage.
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Affiliation(s)
- F P McCarthy
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity Hospital, University College Cork, Wilton, Cork, Ireland. .,Division of Women's Health KCL, Women's Health Academic Centre KHP, St Thomas's Hospital, London, UK.
| | - A S Khashan
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity Hospital, University College Cork, Wilton, Cork, Ireland.,Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - D Murray
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity Hospital, University College Cork, Wilton, Cork, Ireland.,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - M Kiely
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity Hospital, University College Cork, Wilton, Cork, Ireland.,Department of Food Science and Nutrition, University College Cork, Cork, Ireland
| | - J O'B Hourihane
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - D Pasupathy
- Division of Women's Health KCL, Women's Health Academic Centre KHP, St Thomas's Hospital, London, UK
| | - L C Kenny
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity Hospital, University College Cork, Wilton, Cork, Ireland
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McCarthy FP, Moss-Morris R, Khashan AS, North RA, Baker PN, Dekker G, Poston L, McCowan L, Walker JJ, Kenny LC, O'Donoghue K. Previous pregnancy loss has an adverse impact on distress and behaviour in subsequent pregnancy. BJOG 2015; 122:1757-64. [PMID: 25565431 DOI: 10.1111/1471-0528.13233] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate whether women with previous miscarriages or terminations have higher levels of anxiety, depression, stress, and altered behaviours in a subsequent pregnancy. DESIGN A retrospective analysis of 5575 women recruited into the Screening for Pregnancy Endpoints (SCOPE) study, a prospective cohort study. SETTING Auckland, New Zealand, Adelaide, Australia, Cork, Ireland, and Manchester, Leeds, and London, UK. POPULATION Healthy nulliparous women with singleton pregnancies. METHODS Outcomes were recorded at 15 and 20 weeks of gestation. MAIN OUTCOME MEASURES Short-form State-Trait Anxiety Inventory (STAI) score, Perceived Stress Scale score, Edinburgh Postnatal Depression Scale score, and pregnancy-related behaviour measured using behavioural responses to pregnancy score. RESULTS Of the 5465 women included in the final analysis, 559 (10%) had one and 94 (2%) had two previous miscarriages, and 415 (8%) had one and 66 (1%) had two previous terminations of pregnancy. Women with one previous miscarriage had increased anxiety (adjusted mean difference 1.85; 95% confidence interval, 95% CI 0.61-3.09), perceived stress (adjusted mean difference 0.76; 95% CI 0.48-1.03), depression (adjusted odds ratio, aOR 1.26; 95% CI 1.08-1.45), and limiting/resting behaviour in pregnancy (adjusted mean difference 0.80; 95% CI 0.62-0.97). In women with two miscarriages, depression was more common (aOR 1.65; 95% CI 1.01-2.70) and they had higher scores for limiting/resting behaviour in pregnancy (adjusted mean difference 1.70; 95% CI 0.90-2.53) at 15 weeks of gestation. Women with one previous termination displayed elevated perceived stress (adjusted mean difference 0.65; 95% CI 0.08-1.23) and depression (aOR 1.25; 95% 1.08-1.45) at 15 weeks of gestation. Women with two previous terminations displayed increased perceived stress (adjusted mean difference 1.43; 95% CI 0.00-2.87) and depression (aOR 1.67; 95% 1.28-2.18). CONCLUSIONS This study highlights the psychological implications of miscarriage and termination of pregnancy.
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Affiliation(s)
- F P McCarthy
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland.,Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, London, UK
| | - R Moss-Morris
- King's College London, Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - A S Khashan
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland
| | - R A North
- Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, London, UK
| | - P N Baker
- Liggins Institute, University of Auckland, Auckland, New Zealand.,University of Manchester, Department of Obstetrics and Gynaecology, Manchester, UK
| | - G Dekker
- Women's and Children's Division, Lyell McEwin Hospital, University of Adelaide, Adelaide, Australia
| | - L Poston
- Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, London, UK
| | - Lme McCowan
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - J J Walker
- St James University Hospital, Leeds, UK, on behalf of the SCOPE consortium
| | - L C Kenny
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland
| | - K O'Donoghue
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland
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Ni Bhuinneain GM, McCarthy FP. A systematic review of essential obstetric and newborn care capacity building in rural sub-Saharan Africa. BJOG 2014; 122:174-82. [DOI: 10.1111/1471-0528.13218] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2014] [Indexed: 11/30/2022]
Affiliation(s)
- GM Ni Bhuinneain
- Department of Obstetrics and Gynaecology; Mayo Medical Academy; National University of Ireland Galway at Mayo General Hospital; Castlebar Ireland
- Friends of Londiani; Londiani Kenya
| | - FP McCarthy
- Women's Health Academic Centre; King's Health Partners; St Thomas’ Hospital; London UK
- Department of Obstetrics and Gynaecology; Irish Centre for Fetal and Neonatal Translational Research; Cork University Maternity Hospital; University College Cork; Cork Ireland
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O’Keeffe LM, Kearney PM, McCarthy FP, Khashan AS, Greene RA, North RA, Poston L, McCowan LME, Baker PN, Dekker GA, Walker JJ, Taylor R, Kenny LC. OP06 Prevalence and predictors of alcohol use during pregnancy: findings from international multi-centre cohort studies. Br J Soc Med 2014. [DOI: 10.1136/jech-2014-204726.9] [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: 11/04/2022]
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12
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McCarthy FP, Khashan AS, North RA, Rahma MB, Walker JJ, Baker PN, Dekker G, Poston L, McCowan LME, O'Donoghue K, Kenny LC. Pregnancy loss managed by cervical dilatation and curettage increases the risk of spontaneous preterm birth. Hum Reprod 2013; 28:3197-206. [DOI: 10.1093/humrep/det332] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Coeliac disease is a gluten-sensitive enteropathy affecting up to 1% of the population. An accumulating body of evidence supports the association of coeliac disease with adverse pregnancy outcomes, including increased risk of miscarriage and intrauterine growth restriction. Reports differ regarding the extent and severity of these associations, in addition to the exact pathophysiology underlying these associations. Overall, coeliac disease is believed to be a significant condition in pregnancy and reproductive medicine with some advocating the screening of coeliac disease in all pregnant women or some specific high-risk groups.
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Affiliation(s)
- M M Butler
- Anu Research Center, Department of Obstetrics and Gynaecology, University College Cork , Cork , Ireland
| | - L C Kenny
- Anu Research Center, Department of Obstetrics and Gynaecology, University College Cork , Cork , Ireland
| | - F P McCarthy
- Anu Research Center, Department of Obstetrics and Gynaecology, University College Cork , Cork , Ireland
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14
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McCarthy FP, Magee CN, Plant WD, Kenny LC. Gitelman's syndrome in pregnancy: case report and review of the literature. Nephrol Dial Transplant 2010; 25:1338-40. [DOI: 10.1093/ndt/gfp688] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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15
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Khashan AS, Henriksen TB, Mortensen PB, McNamee R, McCarthy FP, Pedersen MG, Kenny LC. The impact of maternal celiac disease on birthweight and preterm birth: a Danish population-based cohort study. Hum Reprod 2009; 25:528-34. [PMID: 19939833 DOI: 10.1093/humrep/dep409] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Adverse pregnancy outcomes have been associated with maternal celiac disease (CD). In this study, we investigate the effect of treated and untreated maternal CD on infant birthweight and preterm birth. METHODS A population-based cohort study consisted of all singleton live births in Denmark between 1 January 1979 and 31 December 2004 was used. A total of 1,504,342 babies were born to 836,241 mothers during the study period. Of those, 1105 babies were born to women with diagnosed CD and 346 were born to women with undiagnosed CD. Women with diagnosed CD were considered as treated with a gluten free diet while women with undiagnosed CD were considered as untreated. The outcome measures were: birthweight, small for gestational age (SGA: birthweight <10th centile), very small for gestational age (VSGA: birthweight <5th centile) and preterm birth. We compared these measures in treated and untreated women with those of a reference group (no history of CD). RESULTS Women with untreated CD delivered smaller babies [difference = -98 g (95% CI: -130, -67)], with a higher risk of SGA infants [OR = 1.31 (95% CI: 1.06, 1.63)], VSGA infants [OR = 1.54 (95% CI: 1.17, 2.03)] and preterm birth [OR = 1.33 (95% CI: 1.02, 1.72)] compared with women without CD. Women with treated CD had no increased risk of reduced mean birthweight, risk of delivering SGA and VSGA infants or preterm birth compared with women without CD. CONCLUSION Untreated maternal CD increases the risk of reduced birthweight, the risk of delivering SGA and VSGA infants and preterm birth. Diagnosis and presumed treatment of maternal CD with a gluten-free diet appeared to result in a birthweight and preterm birth rate similar to those in women without CD.
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Affiliation(s)
- A S Khashan
- Anu Research Centre, Department of Obstetrics and Gynecology, University College Cork, Cork University Maternity Hospital, Cork, Ireland.
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