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Croce L, Beneventi F, Ripepi F, De Maggio I, Malovini A, Bellingeri C, Coperchini F, Teliti M, Rotondi M, Spinillo A, Magri F. Relationship between maternal obesity and first-trimester TSH in women with negative anti-TPO antibodies. Eur Thyroid J 2024; 13:e230213. [PMID: 38417259 PMCID: PMC11046355 DOI: 10.1530/etj-23-0213] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/27/2024] [Indexed: 03/01/2024] Open
Abstract
Objective Obesity is associated with increased thyroid-stimulating hormone (TSH) in non-pregnant subjects, but this phenomenon has not been fully characterized during pregnancy. Our aim was to evaluate the impact of BMI on first-trimester TSH in a wide cohort of pregnant women with negative anti-thyroperoxidase antibodies (AbTPO) and its implications on uterine artery pulsatility index (UtA-PI), a marker of early placentation. Methods The study included 2268 AbTPO-negative pregnant women at their first antenatal visit. Anamnestic data, BMI, TSH, anti-nuclear antibody (ANA) and extractable nuclear antigen (ENA) positivity and mean UtA-PI were collected. Results A total of 1693 women had normal weight, 435 were overweight and 140 were obese. Maternal age, ANA/ENA positivity, history of autoimmune diseases and familiar history of thyroid diseases were similar in the three groups. TSH was significantly higher in obese women (1.8 (IQR: 1.4-2.4) mU/L) when compared to normal weight (1.6 (IQR: 1.2-2.2) mU/L) and overweight (median: 1.6 (IQR: 1.2-2.2) mU/L) ones (P < 0.001). BMI was significantly related with the risk of having a TSH level ≥4 mU/L at logistic regression, independently from non-thyroid autoimmunity, smoking or familiar predisposition for thyroid diseases (OR: 1.125, 95% CI: 1.080-1.172, P < 0.001). A restricted cubic splines regression showed a non-linear relationship between BMI and TSH. Women with a TSH ≥4 mU/L had a higher UtA-PI, independently from BMI. Conclusion Overweight/obesity is significantly related with TSH serum levels in AbTPO-negative pregnant women, independently from the other risk factors for hypothyroidism during pregnancy. The increase of TSH levels could be clinically relevant, as suggested by its association with abnormal UtA-PI, a surrogate marker of abnormal placentation.
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Affiliation(s)
- Laura Croce
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia (PV), Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Pavia (PV), Italy
| | - Fausta Beneventi
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo, University of Pavia, Pavia (PV), Italy
| | - Federica Ripepi
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia (PV), Italy
| | - Irene De Maggio
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo, University of Pavia, Pavia (PV), Italy
| | - Alberto Malovini
- Istituti Clinici Scientifici Maugeri IRCCS, Laboratory of Informatics and Systems Engineering for Clinical Research, Pavia (PV), Italy
| | - Camilla Bellingeri
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo, University of Pavia, Pavia (PV), Italy
| | - Francesca Coperchini
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia (PV), Italy
| | - Marsida Teliti
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia (PV), Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Pavia (PV), Italy
| | - Mario Rotondi
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia (PV), Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Pavia (PV), Italy
| | - Arsenio Spinillo
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo, University of Pavia, Pavia (PV), Italy
| | - Flavia Magri
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia (PV), Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Pavia (PV), Italy
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Beneventi F, Bellingeri C, De Maggio I, Cavagnoli C, Fumanelli S, Ligari E, Fiandrino G, Cesari S, Spinillo A. Placental pathologic features in obesity. Placenta 2023; 144:1-7. [PMID: 37922644 DOI: 10.1016/j.placenta.2023.10.011] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/08/2023] [Accepted: 10/22/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Obesity in pregnancy is associated with adverse long-term consequences both in the mother and in offspring. Maternal obesity induces a metabolic-inflammatory state that could impact on placental function and could mediate the adverse outcomes. The purpose of this study was to compare the major placental histological characteristics of non-diabetic obese women to lean controls, focusing on uncomplicated pregnancies. METHODS Prospective case-control study comparing placental histopathological features between 122 non-diabetic obese women and 185 non-obese controls. The analysis was performed on overall subjects, then uncomplicated pregnancies from both groups were analyzed. Placenta pathologic findings were recorded according to standard classification. RESULTS Both in overall analysis and among the subset of subjects with an uncomplicated pregnancy, obese subjects had higher risks of maternal vascular malperfusion (MVM) (respectively OR=2.2, 95%CI =1.3-3.7 and OR=4.2, 95%CI=2.1-8.5), fetal vascular malperfusion (FVM) (respectively OR=6.3, 95%CI=3.1-12.5 and OR=7.2, 95%CI=3-17.2), maternal and fetal inflammatory response placental lesions and villitis (VUE) (respectively OR=2.5, 95%CI=1.1-5.6 and OR=10.8, 95%CI=3.3-35.3) compared to controls. Among uncomplicated pregnancies and after adjustment for confounders, first trimester BMI was significantly associated with overall MVM, overall FVM, maternal inflammatory, fetal inflammatory response and VUE. DISCUSSION Placentas from obese women showed a significantly higher risk of maternal and fetal vascular and inflammatory placental lesions, both in overall population and in the subgroup with uncomplicated pregnancies. The metabolic and inflammatory dysfunctions typical of obesity could have an impact on placental development and function, which could be a mediator of the detrimental effects of obesity on pregnancy outcome and on future health of the offspring.
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Affiliation(s)
- Fausta Beneventi
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 19, 27100, Pavia, Italy; Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Corso Strada Nuova 65, 27100, Pavia, Italy.
| | - Camilla Bellingeri
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 19, 27100, Pavia, Italy.
| | - Irene De Maggio
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 19, 27100, Pavia, Italy.
| | - Chiara Cavagnoli
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 19, 27100, Pavia, Italy.
| | - Silvia Fumanelli
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 19, 27100, Pavia, Italy; Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Corso Strada Nuova 65, 27100, Pavia, Italy.
| | - Elisa Ligari
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 19, 27100, Pavia, Italy; Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Corso Strada Nuova 65, 27100, Pavia, Italy.
| | - Giacomo Fiandrino
- Anatomic Pathology Unit, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 19, 27100, Pavia, Italy.
| | - Stefania Cesari
- Anatomic Pathology Unit, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 19, 27100, Pavia, Italy.
| | - Arsenio Spinillo
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 19, 27100, Pavia, Italy; Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Corso Strada Nuova 65, 27100, Pavia, Italy.
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Beneventi F, Bellingeri C, De Maggio I, Cavagnoli C, Boschetti A, Giannico S, Pandolfi MP, Spada C, Montecucco C, Spinillo A. Impact of pregnancy on progression of preclinical autoimmune disorders: a prospective cohort study. Rheumatology (Oxford) 2023; 62:2971-2978. [PMID: 36342202 DOI: 10.1093/rheumatology/keac637] [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: 08/22/2022] [Accepted: 10/27/2022] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVES The objective of this study was to evaluate the role of pregnancies in the progression from the preclinical phase of autoimmune disorder to a definite rheumatic disease. METHODS A cohort study of women with symptoms and laboratory findings suggestive for autoimmune disorder were enrolled during the first trimester of pregnancy and followed-up for 5 years with clinical and laboratory assessment. Multinomial logistic regression was used to compute the risk of progression to definite autoimmune disease correcting for confounders. RESULTS At the end of follow-up, out of 208 subjects, 81 (38.9%) were considered negative, 53 (25.5%) had symptoms and abnormalities of autoantibody profile compatible with a non-criteria rheumatic status and 74 (35.6%) had a definite rheumatic disease (43 undifferentiated connective tissue disease, 5 systemic lupus erythematosus, 3 SS, 10 antiphospholipid syndrome, and 12 miscellaneous autoimmune disorders). The median time from enrolment to definite diagnosis was 28 months (interquartile range = 18-42). The rate of progression towards a definite autoimmune disease was 47.1% (48/102) among subjects with one or more subsequent viable pregnancies compared with 24.5% (26/106) of those with no subsequent pregnancies (adjusted odds ratio = 4.9, 95% CI: 2.4, 10). The occurrence of preeclampsia during the index pregnancy or subsequent pregnancy was an additional and independent risk factor for progression to a definite autoimmune disease (adjusted odds ratio = 4.3, 95% CI: 1.2, 14.8). CONCLUSIONS Among women with suspected autoimmune disease during pregnancy, additional viable pregnancies and diagnosis of preeclampsia were independently associated with an increased rate of progression to definite rheumatic disorder. Hormonal modifications associated with pregnancy could worsen preclinical rheumatic disorders favouring their progression to a defined autoimmune disease.
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Affiliation(s)
- Fausta Beneventi
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Camilla Bellingeri
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Irene De Maggio
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chiara Cavagnoli
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Anna Boschetti
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Serena Giannico
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Maria Paola Pandolfi
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Carolina Spada
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Carlomaurizio Montecucco
- Department of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Arsenio Spinillo
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
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Magri F, Bellingeri C, De Maggio I, Croce L, Coperchini F, Rotondi M, Chiovato L, Spinillo A, Beneventi F. A first-trimester serum TSH in the 4-10 mIU/L range is associated with obstetric complications in thyroid peroxidase antibody-negative women. J Endocrinol Invest 2022:10.1007/s40618-022-01996-z. [PMID: 36562959 DOI: 10.1007/s40618-022-01996-z] [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: 11/23/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE The impact of mild subclinical hypothyroidism on pregnancy outcomes in TPOAb-negative women is poorly explored. The aim of the present study was the evaluation in a wide cohort of TPOAb-negative pregnant women the role of subclinical hypothyroidism (SCH) on several pregnancy outcomes. METHODS The study included women aged ≥ 18 years with a singleton pregnancy without known thyroid disease with serum TSH concentration between 0.4 and 10 mIU/L and TPOAb negative. Data about clinical and demographic features were collected. A blood sample was drown to test TSH, TPOAb, ANA and ENA concentration. The mean uterine artery pulsatility index was measured. Risk of adverse obstetric and fetal outcomes was collected. RESULTS The cohort included 2135 pregnant women. Pregnant women with TSH 4-10 mUI/L had a significantly higher frequency of family history of thyroid diseases, and personal history of celiac disease diseases, type 1 diabetes mellitus, rheumatic disease, antinuclear antibody (ANA) and anti-extractable nuclear antigen (ENA) positive tests. The risk for pre-eclampsia and small for gestational age (SGA) was significantly higher in pregnant women with first-trimester TSH 4-10 mIU/L. A first-trimester TSH serum level greater than 4 mIU/L was associated with a significant increase in the occurrence of abnormal uterine artery pulsatility index, with a more than threefold increase in the risk of developing pre-eclampsia and with the risk of SGA. CONCLUSIONS In TPOAb-negative pregnant women, a first-trimester serum TSH level ranging from 4 to 10 mIU/L is significantly and independently linked to an increased uterine artery pulsatility index as well as to negative pregnancy outcomes such as pre-eclampsia, SGA and gestational diabetes.
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Affiliation(s)
- F Magri
- Unit of Internal Medicine and Endocrinology, Department of Internal Medicine and Therapeutics, Istituti Clinici Scientifici Maugeri IRCCS, University of Pavia, via Maugeri 10, 27100, Pavia, Italy.
| | - C Bellingeri
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - I De Maggio
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - L Croce
- Unit of Internal Medicine and Endocrinology, Department of Internal Medicine and Therapeutics, Istituti Clinici Scientifici Maugeri IRCCS, University of Pavia, via Maugeri 10, 27100, Pavia, Italy
| | - F Coperchini
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - M Rotondi
- Unit of Internal Medicine and Endocrinology, Department of Internal Medicine and Therapeutics, Istituti Clinici Scientifici Maugeri IRCCS, University of Pavia, via Maugeri 10, 27100, Pavia, Italy
| | - L Chiovato
- Unit of Internal Medicine and Endocrinology, Department of Internal Medicine and Therapeutics, Istituti Clinici Scientifici Maugeri IRCCS, University of Pavia, via Maugeri 10, 27100, Pavia, Italy
| | - A Spinillo
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - F Beneventi
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo, University of Pavia, Pavia, Italy
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Bellis E, Codullo V, Palermo BL, Bottazzi F, Biglia A, Bellingeri C, Beneventi F, Spinillo A, Montecucco C, Zanframundo G, Cavagna L. POS0924 THE ROLE OF RAYNAUD’S PHENOMENON ON MATERNAL AND FETAL OBSTETRICAL OUTCOMES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5048] [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: 11/04/2022]
Abstract
BackgroundIt is established that Raynaud’s phenomenon (RP) may influence pregnancy outcomes when secondary to rheumatic conditions (1,2). Data on the impact of primary RP (pRP) on pregnancy are very limited.ObjectivesTo retrospectively evaluate the impact of pRP on pregnancy outcomes.MethodsWomen with pRP were included in the study. They were compared with a group of women affected by UCTD with RP, and by UCTD without RP. These women were assessed and followed at our outpatient clinic from January 2011 to October 2020 and they did not exhibit an evolution to a UCTD or to a definite CTD during at least one-year follow-up. Antiphospholipid antibody positivity, twin pregnancies and voluntary termination of pregnancy were exclusion criteria. Women with pRP were also compared with a group of healthy pregnant women enrolled by our gynaecologist during the first trimester of pregnancy. Maternal and foetal outcomes were retrospectively recorded. ANOVA or the Kruskal-Wallis test for continuous variables, and the Chi2 test or the Fischer exact test for categorical were performed (level of significance. P<0.050). In the post-hoc analysis we used the Mann-Whitney test (quantitative variables) or with the Chi2 test/Fischer exact test (qualitative variables), applying the Bonferroni correction with pRP women as a reference group (level of significance: p<0.0167).ResultsThe analysis included 188 women with a total of 375 pregnancies divided in 4 groups:-Group “pRP”: 46 women with RP without secondary causes, and a total of 106 pregnancies (reference group),-Group “RP-UCTD”: 48 UCTD women with RP and a total of 88 pregnancies,-Group “UCTD”: 37 UCTD women without RP and a total of 88 pregnancies,-Group “HC”: 57 healthy women with a total of 93 pregnancies.The reference group did not differ from the others regarding age at conception.Prophylactic acetylsalicylic acid was administered during pregnancy to 9% of patients with pRP compared to 1% in HC (p=0.010). In contrast, in the RP-UCTD this percentage was significantly higher (32%, p<0,001) than in pRP.pRP group showed an increased rate of 1st trimester miscarriages (33% vs 16%, p=0.006, OR 2.05 and 95%CI 1.05-3.98), a lower median birth weights (3038 g vs 3358 g, p=0.002), a higher rate of infants with a birth weight <10th percentile (21% vs 3%, p=<0.001, OR 8.36 and 95% CI 1.85 - 37.84) with respect to HC. There was no statistically significant difference between the reference and the UCTD groups.No statistically significant differences were observed when considering obstetrical outcomes (eg: mode of delivery, median gestation duration, gestational diabetes mellitus, hypertensive disorder of pregnancy, premature rupture of membranes, oligo-anhydramnios).ConclusionOur study shows that pRP in a retrospective cohort has an impact on pregnancy outcomes, with significantly more miscarriages and lower birth weight infants compared to HC. Importantly, pregnancy outcome in pRP women did not differ with respect to UCTD with and without RP, conditions generally associated to maternal morbidity, but in the RP-UCTD group prophylactic acetylsalicylic acid was more commonly prescribed.Further prospective studies aiming at evaluating these differences and at identifying the appropriate follow-up and the possible benefit from the use of prophylactic acetylsalicylic acid during pregnancy in RP are necessary.References[1]Liu E et al. Arch Rheumatol., 2017.[2]Al Arfaj A et al. Lupus. 2010.Table 1.Analysis of obstetrical outcomesPrimary RP (pRP)RP-UCTDUCTDHCp-valueMiscarriagesN. (%)35 (33%)17 (19%)30 (31%)15 (16%)p=0,017vs pRPreferencep=0,051p=0,750p=0,006Median weight at birth(IQR), gr3038 (2710-3500)3180 (2935 - 3465)3157 (2910 - 3610)3358 (3195 - 3583)p=0,02vs pRPreferencep=0,3473p=0,1542p=0,0002Birthweight < 10th percentileN. (%)15 (21%)7 (10%)5 (8%)2 (3%)p=0,002vs pRPreferencep=0,087p=0,03p=<0,001Disclosure of InterestsNone declared
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Beneventi F, De Maggio I, Bellingeri C, Cavagnoli C, Spada C, Boschetti A, Magri F, Spinillo A. Thyroid autoimmunity and adverse pregnancy outcomes: a prospective cohort study. Endocrine 2022; 76:198-207. [PMID: 35083637 DOI: 10.1007/s12020-021-02958-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/04/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Fausta Beneventi
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo, Piazzale Golgi n.19, 27100, Pavia, Italy
- University of Pavia, Corso Strada Nuova n.65, 27100, Pavia, Italy
| | - Irene De Maggio
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo, Piazzale Golgi n.19, 27100, Pavia, Italy.
| | - Camilla Bellingeri
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo, Piazzale Golgi n.19, 27100, Pavia, Italy
- University of Pavia, Corso Strada Nuova n.65, 27100, Pavia, Italy
| | - Chiara Cavagnoli
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo, Piazzale Golgi n.19, 27100, Pavia, Italy
| | - Carolina Spada
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo, Piazzale Golgi n.19, 27100, Pavia, Italy
- University of Pavia, Corso Strada Nuova n.65, 27100, Pavia, Italy
| | - Anna Boschetti
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo, Piazzale Golgi n.19, 27100, Pavia, Italy
- University of Pavia, Corso Strada Nuova n.65, 27100, Pavia, Italy
| | - Flavia Magri
- University of Pavia, Corso Strada Nuova n.65, 27100, Pavia, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Unit of Internal Medicine and Endocrinology and Department of Internal Medicine and Therapeutics, Via S. Maugeri, n. 10, 27100, Pavia, Italy
| | - Arsenio Spinillo
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo, Piazzale Golgi n.19, 27100, Pavia, Italy
- University of Pavia, Corso Strada Nuova n.65, 27100, Pavia, Italy
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Motta F, Codullo V, Ramoni V, Cesari S, Ferrario G, Fiandrino G, Beneventi F, Rampello S, Johnsson H, Montecucco C, Graham GJ. Role of placental inflammatory mediators and growth factors in patients with rheumatic diseases with a focus on systemic sclerosis. Rheumatology (Oxford) 2021; 60:3307-3316. [PMID: 33313931 PMCID: PMC8516508 DOI: 10.1093/rheumatology/keaa782] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/19/2020] [Indexed: 12/16/2022] Open
Abstract
Objectives Pregnancy in SSc is burdened with an increased risk of obstetric complications. Little is known about the underlying placental alterations. This study aimed to better understand pathological changes and the role of inflammation in SSc placentas. Leucocyte infiltration, inflammatory mediators and atypical chemokine receptor 2 (ACKR2) expression in SSc placentas were compared with those in other rheumatic diseases (ORD) and healthy controls (HC). Methods A case–control study was conducted on eight pregnant SSc patients compared with 16 patients with ORD and 16 HC matched for gestational age. Clinical data were collected. Placentas were obtained for histopathological analysis and immunohistochemistry (CD3, CD20, CD11c, CD68, ACKR2). Samples from four SSc, eight ORD and eight HC were analysed by qPCR for ACKR2 expression and by multiplex assay for cytokines, chemokines and growth factors involved in angiogenesis and inflammation. Results The number of placental CD3, CD68 and CD11 cells was significantly higher in patients affected by rheumatic diseases (SSc+ORD) compared with HC. Hepatocyte growth factor was significantly increased in the group of rheumatic diseases patients (SSc+ORD) compared with HC, while chemokine (C-C motif) ligand 5 (CCL5) was significantly higher in SSc patients compared with ORD and HC. CCL5 levels directly correlated with the number of all local inflammatory cells and higher levels were associated with histological villitis. Conclusions Inflammatory alterations characterize placentas from rheumatic disease patients and could predispose to obstetric complications in these subjects.
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Affiliation(s)
- Francesca Motta
- Institute of Infection, Immunity & Inflammation, College of Medical and Veterinary Life Sciences, University of Glasgow, Glasgow, UK.,Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo and University of Pavia
| | - Veronica Codullo
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo and University of Pavia
| | - Véronique Ramoni
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo and University of Pavia
| | - Stefania Cesari
- Unit of Anatomic Pathology, Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo
| | | | - Giacomo Fiandrino
- Unit of Anatomic Pathology, Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo
| | - Fausta Beneventi
- Division of Obstetrics and Gynaecology, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia
| | - Stefania Rampello
- Division of Obstetrics and Gynaecology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Hanna Johnsson
- Institute of Infection, Immunity & Inflammation, College of Medical and Veterinary Life Sciences, University of Glasgow, Glasgow, UK
| | | | - Gerard J Graham
- Institute of Infection, Immunity & Inflammation, College of Medical and Veterinary Life Sciences, University of Glasgow, Glasgow, UK
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Spinillo A, Bellingeri C, Cavagnoli C, Maggio ID, Riceputi G, Ruspini B, Cesari S, Beneventi F. Maternal and foetal placental vascular malperfusion in pregnancies with anti-phospholipid antibodies. Rheumatology (Oxford) 2021; 60:1148-1157. [PMID: 32864694 DOI: 10.1093/rheumatology/keaa499] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/27/2020] [Revised: 07/15/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The objective of the study was to evaluate the rates of pathological placental lesions among pregnant subjects positive for aPL antibodies. METHODS We performed a longitudinal case-control study including 27 subjects with primary APS, 51 with non-criteria APS, 24 with aPL antibodies associated with other well-known CTDs enrolled at the end of the first trimester of pregnancy and 107 healthy controls. RESULTS Compared with controls and after correction for multiple comparisons, primary, non-criteria APS and aPL associated to CTD, subjects had lower placental weight, volume and area. After penalized logistic regression analysis to correct for potential confounders, placental lesions suggesting severe maternal vascular malperfusion (MVM) were more common among primary [odds ratio (OR) 11.7 (95% CI 1.3, 108)] and non-criteria APS [OR 8.5 (95% CI 1.6, 45.9)] compared with controls. The risk of foetal vascular malperfusion (FVM) was higher in primary APS [OR 4.5 (95% CI 1.2, 16.4)], aPL associated with CTDs [OR 3.1 (95% CI 1.5, 6.7)] and non-criteria APS [OR 5.9 (95% CI 1.7, 20.1)] compared with controls. Among clinical and laboratory criteria of APS, first trimester aCL IgG >40 UI/ml [OR 4.4 (95% CI 1.3, 14.4)], LA positivity [OR 6.5 (95% CI 1.3, 33.3)] and a history of pre-eclampsia at <34 weeks [OR 32.4 (95% CI 6.5, 161)] were the best independent first trimester predictors of severe MVM [area under the curve 0.74 (95% CI 0.6, 0.87)]. CONCLUSION Compared with healthy controls, pregnant subjects with aPL antibodies have an increased risk of placental lesions, suggesting MVM and FVM. First-trimester variables such as aCL IgG >40 UI/ml and a history of pre-eclampsia were significant predictors of both severe MVM and FVM.
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Affiliation(s)
- Arsenio Spinillo
- Department of Obstetrics and Gynecology, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Camilla Bellingeri
- Department of Obstetrics and Gynecology, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chiara Cavagnoli
- Department of Obstetrics and Gynecology, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Irene De Maggio
- Department of Obstetrics and Gynecology, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Greta Riceputi
- Department of Obstetrics and Gynecology, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Beatrice Ruspini
- Department of Obstetrics and Gynecology, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefania Cesari
- Department of Pathology, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Fausta Beneventi
- Department of Obstetrics and Gynecology, IRCCS Policlinico San Matteo, Pavia, Italy
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Spinillo A, Bellingeri C, De Maggio I, Riceputi G, Pandolfi MP, Spada C, Alpini C, Montecucco C, Beneventi F. The impact of various entities of antiphospholipid antibodies positivity on adverse pregnancy outcome. An epidemiological perspective. J Reprod Immunol 2021; 145:103304. [PMID: 33677238 DOI: 10.1016/j.jri.2021.103304] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/11/2021] [Accepted: 02/26/2021] [Indexed: 01/12/2023]
Abstract
The aim of the study was to evaluate the rate of obstetric complications and the burden of obstetric outcomes in antiphospholipid syndrome (APS), non-criteria APS and asymptomatic antiphospholipid antibodies (aPL) carriers. From 2013-2018, 163 pregnant subjects with aPL antibodies and 785 controls were enrolled. Penalized logistic regression was used to compare obstetric complications. Cases included 62 complete APS (38 %), 48 non-criteria APS (29.4 %) and 53 (32.5 %) asymptomatic aPL-carriers. Connective tissue diseases (CTDs) were diagnosed in 31.3 % of cases. The rate of high-risk aPL profile was higher (p < .01) in APS (67.7 %) compared to non-criteria (14.6 %) and aPL-carriers (9.4 %). Double/triple positivity was 33.9 % (p < .05 compared to non-criteria and aPL-carriers) in APS, 10.4 % in non-criteria and 9.4 % in aPL-carriers. The rate of adverse pregnancy outcomes were 5.6 % in controls, 41.9 % (adj.OR = 6.95 %CI = 2.7-13.5) in APS, 25 % (adj.OR = 4.4,95 %CI = 2-9.4) in non-criteria and 28.3 % (OR = 4.95 %CI = 1.8-8.8) in aPL-carriers. CTDs were independently associated with an increased risk of adverse obstetric outcomes (OR = 2.8,95 %CI = 1.36-5.89). The attributable fraction (AF) of adverse obstetric events was higher among low-risk antibodies compared to high-risk (AF = 0.27,95 %CI = 0.22-0.31 vs AF = 0.16,95 %CI = 0.16-0.2,p < .01) and among single positivity compared to double/triple positivity (AF = 0.32,95 %CI = 0.26-0.37 vs AF = 0.11,95 %CI = 0.09-0.13,p < .01) suggesting that low-risk subjects are responsible for a high burden of obstetric complications.
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Affiliation(s)
- Arsenio Spinillo
- Fondazione IRCCS Policlinico San Matteo, Obstetrics and Gynecology, Piazzale Golgi 19, 27100, Pavia, Italy; University of Pavia, Corso Strada Nuova 65, 27100, Pavia, Italy.
| | - Camilla Bellingeri
- Fondazione IRCCS Policlinico San Matteo, Obstetrics and Gynecology, Piazzale Golgi 19, 27100, Pavia, Italy; University of Pavia, Corso Strada Nuova 65, 27100, Pavia, Italy.
| | - Irene De Maggio
- Fondazione IRCCS Policlinico San Matteo, Obstetrics and Gynecology, Piazzale Golgi 19, 27100, Pavia, Italy.
| | - Greta Riceputi
- Fondazione IRCCS Policlinico San Matteo, Obstetrics and Gynecology, Piazzale Golgi 19, 27100, Pavia, Italy; University of Pavia, Corso Strada Nuova 65, 27100, Pavia, Italy.
| | - Maria Paola Pandolfi
- Fondazione IRCCS Policlinico San Matteo, Obstetrics and Gynecology, Piazzale Golgi 19, 27100, Pavia, Italy; University of Pavia, Corso Strada Nuova 65, 27100, Pavia, Italy.
| | - Carolina Spada
- Fondazione IRCCS Policlinico San Matteo, Obstetrics and Gynecology, Piazzale Golgi 19, 27100, Pavia, Italy; University of Pavia, Corso Strada Nuova 65, 27100, Pavia, Italy.
| | - Claudia Alpini
- Fondazione IRCCS Policlinico San Matteo, Diagnostic Medicine, Piazzale Golgi 19, 27100 Pavia, Italy.
| | - Carlomaurizio Montecucco
- University of Pavia, Corso Strada Nuova 65, 27100, Pavia, Italy; Fondazione IRCCS Policlinico San Matteo, Rheumatology, Piazzale Golgi 19, 27100 Pavia, Italy.
| | - Fausta Beneventi
- Fondazione IRCCS Policlinico San Matteo, Obstetrics and Gynecology, Piazzale Golgi 19, 27100, Pavia, Italy; University of Pavia, Corso Strada Nuova 65, 27100, Pavia, Italy.
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Beneventi F, Locatelli E, De Amici M, Cavagnoli C, Bellingeri C, De Maggio I, Ruspini B, Spinillo A. Maternal and fetal Leptin and interleukin 33 concentrations in pregnancy complicated by obesity and preeclampsia. J Matern Fetal Neonatal Med 2020; 33:3942-3948. [PMID: 30856361 DOI: 10.1080/14767058.2019.1593359] [Citation(s) in RCA: 4] [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] [Indexed: 12/17/2022]
Abstract
Objectives: To evaluate maternal and fetal Leptin and IL33 concentrations in pregnancy complicated by obesity and preeclampsia.Study design: A case-control study including 35 subjects with obesity (18 normotensive and 17 preeclamptic) and 47 normal weight controls (42 normotensive and 5 preeclamptic).Main outcome measures: Leptin and IL33 concentrations in maternal serum during pregnancy and in cord blood; uterine artery and umbilical artery Doppler velocimetry.Results: Subjects with obesity who developed preeclampsia had higher first trimester maternal (41.5, interquartile range (IQR) = 15.7-65.1 ng/ml) Leptin concentrations compared to either normal weight with (25, IQR = 20.4-25.8 ng/ml) and without hypertension (14.26, IQR = 8.2-22.8) (p < .05) or normotensive subjects with obesity (30.3, IQR = 10.4-38.4) (p < .05). Subjects with obesity who developed preeclampsia (2.4, IQR = 1.7-3.2 pg/ml) or not (1.4, IQR = 0.8-2 pg/ml) had lower first trimester maternal IL33 levels when compared to controls without hypertension (4.8, IQR = 2.9-5.9 pg/ml) (p < .001). Cord blood Leptin and IL33 concentrations were significantly correlated to third trimester maternal concentrations (Spearman rho = 0.51, p < .001 and Spearman rho = 0.68, p < .001, respectively). Uterine artery pulsatility index (PI) were significantly and directly correlated with maternal Leptin levels (p < .002) and inversely and statistically correlated with maternal IL33 concentrations (p < .001).Conclusions: Compared to lean controls, pregnant subjects with obesity had higher serum Leptin and lower IL33 concentrations at first trimester and during pregnancy. This difference persisted also for those who later developed preeclampsia. The relationship between maternal serum levels of Leptin and IL33 with uterine artery Doppler pulsatility index strongly suggests a role of these two markers in early placentation.
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Affiliation(s)
- Fausta Beneventi
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Elena Locatelli
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Mara De Amici
- Department of Pediatrics, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Chiara Cavagnoli
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Camilla Bellingeri
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Irene De Maggio
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Beatrice Ruspini
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Arsenio Spinillo
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy
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Sprio E, Lucotti P, Iadarola C, Bellingeri C, Beneventi F, Lovati E. Use of insulin degludec in pregnancy: two case reports and a literature review. Endocrine and Metabolic Science 2020. [DOI: 10.1016/j.endmts.2020.100064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Ramoni VL, Xoxi B, Beneventi F, Bellingeri C, Montecucco C, Spinillo A. Efficacy of a screening strategy for the detection of rheumatic diseases in early pregnancy during COVID-19 pandemic. Lupus 2020; 29:1821-1823. [PMID: 32838626 DOI: 10.1177/0961203320952848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Blerina Xoxi
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Fausta Beneventi
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Camilla Bellingeri
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | | | - Arsenio Spinillo
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
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Mallucci G, Beneventi F, Bergamaschi R, Bizzotto C, Cavagnoli C, De Maggio I, Bellingeri C, Monti C, Viarengo G, Spinillo A. Circulating endothelial progenitor cells during pregnancy in multiple sclerosis. Neurol Sci 2020; 42:1443-1451. [PMID: 32804349 PMCID: PMC7956006 DOI: 10.1007/s10072-020-04648-3] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 08/01/2020] [Indexed: 11/30/2022]
Abstract
Background Endothelial progenitor cells (EPCs) have been shown to increase during physiological pregnancy and are believed to play a fundamental role in the process of placentation. Reduced levels of EPCs during pregnancy have been associated with preeclampsia and miscarriage. Women with multiple sclerosis (MS) are not at increased risk of preeclampsia nor of general adverse obstetric outcome, in contrast with some other autoimmune diseases. Objective The aim of this study was to evaluate circulating EPCs levels in pregnant patients with MS. Methods CD34+ and CD133+ were longitudinally detected by flow cytometry in the maternal plasma of 29 healthy controls and 9 MS patients and in the cord blood of their newborns. Results EPCs were affected by pregnancy with the same trend in both groups (CD34+ p = 0.0342; CD133+ p = 0.0347). EPCs during pregnancy were increased in MS (mean ± SD: CD34+ cells 0.038 ± 0.010; CD133+ 0.024 ± 0.009) with respect to healthy controls (mean ± SD: CD34+ cells 0.022 ± 0.006; CD133+ 0.016 ± 0.004), CD34+ p = 0.0004; CD133+ p = 0.0109. EPCs levels of the cord blood of MS patients' newborns mild correlated with maternal EPC levels at delivery (CD34+: spearman’s Rho 0.658, p = 0.054; CD133+: spearman’s Rho 0.758, p = 0.018). Conclusions This work identified increased circulating EPC levels during pregnancy, following the same trend both in MS patients and healthy controls. Despite the similar trend, the levels of circulating EPCs were significantly higher in MS patients with respect to the control population. A correlation was also found in MS patients between cord blood EPCs and circulating EPCs at delivery. Electronic supplementary material The online version of this article (10.1007/s10072-020-04648-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Giulia Mallucci
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
- Multiple Sclerosis Center, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy.
| | - Fausta Beneventi
- Department of Obstetrics and Gynaecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Roberto Bergamaschi
- Multiple Sclerosis Center, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Cristina Bizzotto
- Multiple Sclerosis Center, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Chiara Cavagnoli
- Department of Obstetrics and Gynaecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Irene De Maggio
- Department of Obstetrics and Gynaecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Camilla Bellingeri
- Department of Obstetrics and Gynaecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Cristina Monti
- Department of Public Health Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
| | - Gianluca Viarengo
- Immunohaematology and Transfusion Service, IRCCS Foundation Policlinico San Matteo, Pavia, Italy
| | - Arsenio Spinillo
- Department of Obstetrics and Gynaecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy
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Motta F, Ramoni V, Codullo V, Cesari S, Beneventi F, Johnsson H, Graham G, Montecucco C. SAT0280 IMPACT OF PLACENTAL FACTORS ON PREGNANCY AND FETAL OUTCOME IN SYSTEMIC SCLEROSIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4379] [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: 11/04/2022]
Abstract
Background:Systemic Sclerosis (SSc) is one of the rheumatic diseases burdened with obstetrical complications. An Italian multicenter study showed that women with SSc have a higher-than-normal risk of intrauterine growth restriction, preterm delivery, very-low birth weight babies and pregnancy should be discouraged in patients with severe organ damage. However, with a multidisciplinary management, patients with SSc can have successful outcomes1. Little is known about the pathogenesis of obstetrical complications, as studies on placenta are case reports or description of a few cases2,3.Objectives:The aim of this study was to analyze the placental alterations with a focus on the role of inflammation in the pathogenesis of obstetrical complications in SSc, including the study of the atypical chemokine receptor 2 (ACKR2), involved in immune modulation and known to be highly expressed in circulating leucocytes in SSc patients4-6.Methods:Eight SSc pregnant patients were compared with 16 patients with other rheumatic diseases (ORD) and 16 healthy controls (HC), matched for gestational age. Clinical data were collected. Placentas biopsies were obtained for histopathological analysis and immunohistochemistry for CD3, CD20, CD11c, CD68 and ACKR2. Frozen placenta samples from 4 SSc, 8 ORD and 8 HC were analyzed by qPCR for ACKR2 gene expression and proteins were extracted for multiplex assay for cytokines, chemokines and growth factors involved in angiogenesis and inflammation. Statistical analysis was performed with parametric or non-parametric tests depending on samples distribution.Results:The number of placental CD3 (p<0.05), CD68 (p<0.001) and CD11c+ (p<0.001) cells was significantly higher considering the group of patients affected by rheumatic diseases (SSc+ORD) compared to HC. The SSc group alone did not show significance due to the lower sample size. No differences were observed between groups in terms of vascular alterations or fibrosis. The percentage of stained area for ACKR2 and the ACKR2 transcripts levels were comparable between groups. Hepatocyte growth factor (HGF), involved in angiogenesis, was significantly increased in the group of rheumatic diseases patients (SSc+ORD) compared to HC (p<0.05), while the chemokine CCL5 was significantly higher in SSc patients compared to patients affected by ORD (p<0.05) and to HC (p<0.01). CCL5 levels directly correlated with the number of all inflammatory cells considered and higher levels were associated to histological villitis (p<0.01).Conclusion:The higher number of placental inflammatory cells and the alterations in the levels of HGF and especially CCL5 could play a role in the pathogenesis of the obstetrical complications in SSc. ACKR2 does not seem involved in the obstetrical complications of SSc.References:[1]Taraborelli M, et al. Arthritis Rheum. 2012[2]Ibba-Manneschi L, et al. Ann Rheum Dis. 2010[3]Doss BJ, et al. Hum Pathol. 1998[4]Graham GJ. Eur J Immunol. 2009[5]Martinez de la Torre Y, et al. Proc Natl Acad Sci U S A. 2007[6]Codullo V, et al. Ann Rheum Dis. 2011Disclosure of Interests:None declared
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Lenti MV, Miceli E, Padula D, Colleoni R, Beneventi F, Corazza GR, Di Sabatino A. Infertility and recurrent miscarriage in a patient with autoimmune atrophic gastritis. Intern Emerg Med 2018; 13:815-816. [PMID: 29524079 DOI: 10.1007/s11739-018-1823-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 03/05/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Marco Vincenzo Lenti
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Emanuela Miceli
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Donatella Padula
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Rossella Colleoni
- Departments of Obstetrics and Gynecology, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Fausta Beneventi
- Departments of Obstetrics and Gynecology, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Gino Roberto Corazza
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Antonio Di Sabatino
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy.
- Clinica Medica I, Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Piazzale Golgi 19, 27100, Pavia, Italy.
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Spinillo A, Beneventi F, Caporali R, Ramoni V, Montecucco C. Undifferentiated connective tissue diseases and adverse pregnancy outcomes. An undervalued association? Am J Reprod Immunol 2017; 78. [PMID: 28921728 DOI: 10.1111/aji.12762] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 05/20/2017] [Accepted: 08/22/2017] [Indexed: 12/14/2022] Open
Abstract
Undifferentiated connective tissue diseases (UCTDs) are a heterogeneous group of disorders characterized by symptoms and signs suggestive of systemic autoimmune rheumatic disease (ARD), but which do not fulfill all the established criteria for definite diagnosis of a condition. Although a third of UCTDs can progress to a definite ARD within months or years, most UCTDs can remain stable for years with minimal disease activity. The annual incidence of UCTD in the general population ranges from 14 to 140 per 100 000 people. UCTDs are associated with the persistence of several circulating autoantibodies including antinuclear, antiphospholipid or antithyroid antibodies. Immunological evaluation of subjects with UCTDs suggests a proinflammatory state and dysregulation of the Th1/Th2 balance. Autoantibodies have well-known deleterious effects on placentation and have been associated with an increased risk of prematurity, fetal growth restriction (FGR), preeclampsia, and congenital atrioventricular heart block. Although epidemiological and biological data suggest a potential negative impact on reproductive outcomes, the relationship between UCTD and pregnancy outcomes has not been adequately studied. While awaiting definitive data from large studies, obstetricians should be aware that rheumatic disorders in their early, incomplete, or undifferentiated phases can adversely affect pregnancy outcomes, increasing the likelihood of pregnancy loss, FGR, preeclampsia, and prematurity.
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Affiliation(s)
- Arsenio Spinillo
- Division of Obstetrics and Gynecology, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Fausta Beneventi
- Division of Obstetrics and Gynecology, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Roberto Caporali
- Division of Rheumatology, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Veronique Ramoni
- Division of Rheumatology, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Carlomaurizio Montecucco
- Division of Rheumatology, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
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Spinillo A, Beneventi F, Locatelli E, Ramoni V, Caporali R, Alpini C, Albonico G, Cavagnoli C, Montecucco C. The impact of unrecognized autoimmune rheumatic diseases on the incidence of preeclampsia and fetal growth restriction: a longitudinal cohort study. BMC Pregnancy Childbirth 2016; 16:313. [PMID: 27756248 PMCID: PMC5069792 DOI: 10.1186/s12884-016-1076-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 12/16/2015] [Accepted: 09/13/2016] [Indexed: 12/15/2022] Open
Abstract
Background The burden of pregnancy complications associated with well defined, already established systemic rheumatic diseases preexisting pregnancy such as rheumatoid arthritis, systemic lupus erythematosus or scleroderma is well known. Systemic rheumatic diseases are characterized by a long natural history with few symptoms, an undifferentiated picture or a remitting course making difficult a timely diagnosis. It has been suggested that screening measures for these diseases could be useful but the impact of unrecognized systemic rheumatic disorders on pregnancy outcome is unknown. The objective of the study was to evaluate the impact of previously unrecognized systemic autoimmune rheumatic on the incidence of preeclampsia and fetal growth restriction (FGR). Methods A longitudinal cohort-study with enrolment during the first trimester of pregnancy of women attending routine antenatal care using a two-step approach with a self-reported questionnaire, autoantibody detection and clinical evaluation of antibody-positive subjects. The incidence of FGR and preeclampsia in subjects with newly diagnosed rheumatic diseases was compared to that of selected negative controls adjusting for potential confounders by logistic regression analysis. Results The prevalence of previously unrecognized systemic rheumatic diseases was 0.4 % for rheumatoid arthritis (19/5232), 0.25 % (13/5232) for systemic lupus erythematosus, 0.31 % (16/5232) for Sjögren’s syndrome, 0.3 % for primary antiphospholipid syndrome (14/5232) and 0.11 % (6/5232) for other miscellaneous diseases. Undifferentiated connective tissue disease was diagnosed in an additional 131 subjects (2.5 %). The incidence of either FGR or preeclampsia was 6.1 % (36/594) among controls and 25.3 % (50/198) in subjects with unrecognized rheumatic diseases (excess incidence = 3.9 % (95 % CI = 2.6–9.6) or 34 % (95 % CI = 22–44) of all cases of FGR/preeclampsia). The incidence of small for gestational age infant (SGA) was higher among subjects with unrecognized rheumatic diseases (41/198 as compared to 46/594; adjOdds Ratio = 3.1, 95 % CI =1.96–4.95) than in controls. The excess incidence associated with unrecognized rheumatic diseases was 2.7 % (95 % CI = 1.5–4) or 25 % (95 % CI = 12.8–34.8) of all SGA cases. Conclusions Unrecognized autoimmune systemic rheumatic disorders are associated with a significant proportion of preeclampsia and fetal growth failure, suggesting that their role in the etiology of adverse pregnancy outcome is probably undervalued.
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Affiliation(s)
- Arsenio Spinillo
- Department of Obstetrics and Gynecology, University of Pavia, IRCCS Policlinico San Matteo Foundation, P.le Golgi 19, 27100, Pavia, Italy. @smatteo.pv.it
| | - Fausta Beneventi
- Department of Obstetrics and Gynecology, University of Pavia, IRCCS Policlinico San Matteo Foundation, P.le Golgi 19, 27100, Pavia, Italy
| | - Elena Locatelli
- Department of Obstetrics and Gynecology, University of Pavia, IRCCS Policlinico San Matteo Foundation, P.le Golgi 19, 27100, Pavia, Italy
| | - Vèronique Ramoni
- Department of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Roberto Caporali
- Department of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Claudia Alpini
- Laboratory Medicine, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Giulia Albonico
- Laboratory Medicine, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Chiara Cavagnoli
- Department of Obstetrics and Gynecology, University of Pavia, IRCCS Policlinico San Matteo Foundation, P.le Golgi 19, 27100, Pavia, Italy
| | - Carlomaurizio Montecucco
- Department of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
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Spinillo A, Beneventi F, Locatelli E, Ramoni V, Caporali R, Alpini C, Albonico G, Cavagnoli C, Montecucco C. Early, Incomplete, or Preclinical Autoimmune Systemic Rheumatic Diseases and Pregnancy Outcome. Arthritis Rheumatol 2016; 68:2555-62. [DOI: 10.1002/art.39737] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 04/26/2016] [Indexed: 01/10/2023]
Affiliation(s)
- Arsenio Spinillo
- University of Pavia and IRCCS Policlinico San Matteo Foundation; Pavia Italy
| | - Fausta Beneventi
- University of Pavia and IRCCS Policlinico San Matteo Foundation; Pavia Italy
| | - Elena Locatelli
- University of Pavia and IRCCS Policlinico San Matteo Foundation; Pavia Italy
| | - Vèronique Ramoni
- University of Pavia and IRCCS Policlinico San Matteo Foundation; Pavia Italy
| | - Roberto Caporali
- University of Pavia and IRCCS Policlinico San Matteo Foundation; Pavia Italy
| | - Claudia Alpini
- University of Pavia and IRCCS Policlinico San Matteo Foundation; Pavia Italy
| | - Giulia Albonico
- University of Pavia and IRCCS Policlinico San Matteo Foundation; Pavia Italy
| | - Chiara Cavagnoli
- University of Pavia and IRCCS Policlinico San Matteo Foundation; Pavia Italy
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Betelli M, Ramoni V, Meroni M, Allanore Y, Baresic M, Beneventi F, Caramaschi P, Cutolo M, Favaro M, Govoni M, Hachulla E, Limonta M, Matucci Cerinic M, Riccieri V, Rosato E, Salsano F, Scolack M, Smith V, Taraborelli M, Tincani A, Valentini G, Vonk M, Brucato A. SAT0196 Impress 2 (International Multicentric Prospective Study on Pregnancy in Systemic Sclerosis). Prospective, Case-Control Study of Pregnancy in Systemic Sclerosis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3875] [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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Ramoni V, Romano M, Rocchetti C, Vitolo B, Beneventi F, Cavagnoli C, Locatelli E, Simonetta M, Klersy C, Caporali R, Montecucco C. FRI0510 Long-Term Post Partum Follow-Up of Undifferentiated Connective Tissue Diseases Newly Diagnosed during Pregnancy. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5437] [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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21
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Beneventi F, Locatelli E, De Amici M, Simonetta M, Cavagnoli C, Bellingeri C, Scancarello C, Ierullo A, Martinetti M, Spinillo A. Soluble HLA-G concentrations in maternal blood and cervical vaginal fluid of pregnant women with preterm premature rupture of membranes. J Reprod Immunol 2016; 116:76-80. [PMID: 27232355 DOI: 10.1016/j.jri.2016.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 01/21/2016] [Revised: 05/03/2016] [Accepted: 05/11/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate soluble HLA-G (sHLA-G) concentrations in maternal blood serum and cervical vaginal fluid in pregnancies complicated by preterm premature rupture of membranes (PPROM) compared to controls. STUDY DESIGN Case-control study of 24 women with PPROM and 40 controls. MAIN OUTCOME MEASURES Vaginal and serum sHLA-G and IL-6 concentrations. FINDINGS Women with PPROM had significantly higher serum and vaginal sHLA-G concentrations compared to controls (respectively median 31.48U\ml versus 13.9U\ml p<0.001 and 1.7U\ml versus 0.1U\ml p<0.001). Vaginal expression of IL-6 was higher in PPROM cases compared to controls (respectively, median 31.19pg\ml versus 6.67pg\ml; p<0.001). Higher serum and vaginal sHLA-G were associated with both a shorter length of pregnancy and histological chorioamnionitis in the PPROM group. CONCLUSIONS Higher vaginal and serum sHLA-G in PPROM cases may be a sign of local and systemic inflammation.
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Affiliation(s)
- Fausta Beneventi
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, 27100 Pavia, Italy
| | - Elena Locatelli
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, 27100 Pavia, Italy.
| | - Mara De Amici
- Department of Pediatrics, University of Pavia, IRCCS Foundation Policlinico San Matteo and University of Pavia, 27100 Pavia, Italy
| | - Margherita Simonetta
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, 27100 Pavia, Italy
| | - Chiara Cavagnoli
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, 27100 Pavia, Italy
| | - Camilla Bellingeri
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, 27100 Pavia, Italy
| | - Chiara Scancarello
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, 27100 Pavia, Italy
| | - AntonioMaria Ierullo
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, 27100 Pavia, Italy
| | - Miryam Martinetti
- Immunogenetics Laboratory, Immunohematology and Transfusion Center, IRCCS Foundation Policlinico San Matteo and University of Pavia, 27100 Pavia, Italy
| | - Arsenio Spinillo
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, 27100 Pavia, Italy
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Beneventi F, Locatelli E, Alpini C, Lovati E, Ramoni V, Simonetta M, Cavagnoli C, Spinillo A. Association between previously unknown connective tissue disease and subclinical hypothyroidism diagnosed during first trimester of pregnancy. Fertil Steril 2015; 104:1195-201. [DOI: 10.1016/j.fertnstert.2015.07.1158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 07/23/2015] [Accepted: 07/29/2015] [Indexed: 12/13/2022]
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Beneventi F, Badulli C, Locatelli E, Caporali R, Ramoni V, Cavagnoli C, Simonetta M, Garbin G, Tinelli C, Alpini C, Montecucco C, Martinetti M, Spinillo A. Soluble HLA-G in pregnancies complicated by autoimmune rheumatic diseases. J Reprod Immunol 2015; 110:67-73. [PMID: 26042897 DOI: 10.1016/j.jri.2015.04.005] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 04/16/2015] [Accepted: 04/27/2015] [Indexed: 11/30/2022]
Abstract
Autoimmune rheumatic diseases in pregnancies are associated with increased adverse obstetric outcomes. We compared maternal soluble human leucocyte antigen-G (sHLA-G) blood levels in subjects with a rheumatic disease preexisting pregnancy and unaffected controls. Third-trimester blood maternal sHLA-G concentrations were significantly higher in subjects with rheumatic diseases than in controls (mean 93.1ng/ml [SD 42.1] vs 58.1ng/ml [SD 96.3], p=0.003). Cord blood sHLA-G concentrations were significantly higher in rheumatic disease than in those born to control mothers (median 41.2ng/ml [IQR: 3.3-44.0] vs 17.9ng/ml [IQR: 17.2-88.1], p=0.007). A strict positive correlation (r=0.88, p<0.001) was found between the maternal and fetal titers of ANA autoantibodies as well as between maternal and fetal sHLAG circulating levels (r=0.58 and r=0.67, respectively, for controls and cases, p<0.001). Maternal s-HLA-G blood concentrations were significantly higher in subjects with rheumatic disease DEL/DEL homozygous for a polymorphism of the 3' untranslated regulatory region of HLA-G (HLA-G 14bp) than in the corresponding healthy controls (mean values 141.5ng/ml [SD: 166] vs 54.2ng/ml [SD: 35], p=0.009). Increasing maternal and cord blood levels of s-HLA-G concentrations among pregnant subjects with rheumatic diseases compared with controls suggest that autoimmune diseases prompt a maternal and fetal immune response that favors pregnancy immune tolerance.
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Affiliation(s)
- Fausta Beneventi
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Carla Badulli
- Immunogenetics Laboratory, Immunohematology and Transfusion Center, IRCCS Foundation Policlinico San Matteo, Pavia, Italy
| | - Elena Locatelli
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy.
| | - Roberto Caporali
- Division of Rheumatology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Véronique Ramoni
- Division of Rheumatology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Chiara Cavagnoli
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Margherita Simonetta
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Giulia Garbin
- Immunogenetics Laboratory, Immunohematology and Transfusion Center, IRCCS Foundation Policlinico San Matteo, Pavia, Italy
| | - Carmine Tinelli
- Clinical Epidemiology and Biometric Unit, IRCCS Foundation Policlinico San Matteo, Pavia, Italy
| | - Claudia Alpini
- Clinical Chemistry Laboratory, IRCCS Foundation Policlinico San Matteo, Pavia, Italy
| | - CarloMaurizio Montecucco
- Division of Rheumatology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Miryam Martinetti
- Immunogenetics Laboratory, Immunohematology and Transfusion Center, IRCCS Foundation Policlinico San Matteo, Pavia, Italy
| | - Arsenio Spinillo
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy
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Grosjean F, Beneventi F, Scaramuzzi L, Manini A, Simonetta M, Marchi G, Sileno G, Esposito C, Fasoli G, Spinillo A, Dal Canton A. SaO044LOW PREGNANCY NITRIC OXYDE (NO) CIRCULATING LEVELS ARE ASSOCIATED WITH HYPERTENSION PERSISTENCE AFTER THE DELIVERY. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv154.02] [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: 11/13/2022] Open
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Beneventi F, Locatelli E, Giorgiani G, Zecca M, Mina T, Simonetta M, Cavagnoli C, Albanese M, Spinillo A. Adolescent and adult uterine volume and uterine artery Doppler blood flow among subjects treated with bone marrow transplantation or chemotherapy in pediatric age: a case-control study. Fertil Steril 2015; 103:455-61. [DOI: 10.1016/j.fertnstert.2014.10.043] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 10/23/2014] [Accepted: 10/29/2014] [Indexed: 11/25/2022]
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Beneventi F, Simonetta M, Locatelli E, Cavagnoli C, Badulli C, Lovati E, Garbin G, Genini E, Albertini R, Tinelli C, Martinetti M, Spinillo A. Temporal Variation in Soluble Human Leukocyte Antigen-G (sHLA-G) and Pregnancy-Associated Plasma Protein A (PAPP-A) in Pregnancies Complicated by Gestational Diabetes Mellitus and in Controls. Am J Reprod Immunol 2014; 72:413-21. [DOI: 10.1111/aji.12270] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 04/18/2014] [Indexed: 12/30/2022] Open
Affiliation(s)
- Fausta Beneventi
- Department of Obstetrics and Gynecology; IRCCS Foundation Policlinico San Matteo and University of Pavia; Pavia Italy
| | - Margherita Simonetta
- Department of Obstetrics and Gynecology; IRCCS Foundation Policlinico San Matteo and University of Pavia; Pavia Italy
| | - Elena Locatelli
- Department of Obstetrics and Gynecology; IRCCS Foundation Policlinico San Matteo and University of Pavia; Pavia Italy
| | - Chiara Cavagnoli
- Department of Obstetrics and Gynecology; IRCCS Foundation Policlinico San Matteo and University of Pavia; Pavia Italy
| | - Carla Badulli
- Immunogenetics Laboratory; Immunohematology and Transfusion Center; IRCCS Foundation Policlinico San Matteo; Pavia Italy
| | - Elisabetta Lovati
- First Department of Medicine; IRCCS Foundation Policlinico San Matteo; Pavia Italy
| | - Giulia Garbin
- Immunogenetics Laboratory; Immunohematology and Transfusion Center; IRCCS Foundation Policlinico San Matteo; Pavia Italy
| | - Emilia Genini
- Clinical Chemistry Laboratory; IRCCS Foundation Policlinico San Matteo; Pavia Italy
| | - Riccardo Albertini
- Clinical Chemistry Laboratory; IRCCS Foundation Policlinico San Matteo; Pavia Italy
| | - Carmine Tinelli
- Clinical Epidemiology and Biometric Unit; IRCCS Foundation Policlinico San Matteo; Pavia Italy
| | - Miryam Martinetti
- Immunogenetics Laboratory; Immunohematology and Transfusion Center; IRCCS Foundation Policlinico San Matteo; Pavia Italy
| | - Arsenio Spinillo
- Department of Obstetrics and Gynecology; IRCCS Foundation Policlinico San Matteo and University of Pavia; Pavia Italy
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Beneventi F, Locatelli E, Giorgiani G, Zecca M, Locatelli F, Cavagnoli C, Simonetta M, Bariselli S, Negri B, Spinillo A. Gonadal and uterine function in female survivors treated by chemotherapy, radiotherapy, and/or bone marrow transplantation for childhood malignant and non-malignant diseases. BJOG 2014; 121:856-65; discussion 865. [PMID: 24655331 DOI: 10.1111/1471-0528.12715] [Citation(s) in RCA: 10] [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] [Accepted: 01/15/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate gonadal function and uterine volume in a cohort of female survivors treated by chemotherapy, radiotherapy, and/or stem cell transplantation (SCT) for childhood malignant and non-malignant diseases. DESIGN An observational study. SETTING S. Matteo Hospital, Pavia, Italy. POPULATION A cohort of 135 female survivors. METHODS A clinical, hormonal, and ultrasonographic evaluation. Thirty-three patients (24%) had non-malignant haematologic diseases (thalassaemia or sickle cell anaemia), 68 (50%) had leukaemia, 23 (17%) had lymphomas, and 11 (8%) had solid tumours. In total, 106 patients had received SCT, preceded by a conditioning regimen. MAIN OUTCOME MEASURES Anti-Müllerian hormone (AMH) and Inhibin-B, and uterine volume. RESULTS The median concentrations of AMH and Inhibin-B in the entire cohort were 0.12 ng/ml (interquartile range, IQR, 0.1-0.5 ng/ml) and 3.5 pg/ml (IQR 0.1-13.2 pg/ml), respectively. In a stepwise ordered logistic regression analysis, conventional chemotherapy for the treatment of malignancies, as opposed to total body irradiation (TBI), was the only oncologically significant predictor of increased AMH levels (OR 4.8, 95% CI 1.9-12, P < 0.001). Conditioning treatment before or after menarche did not influence AMH concentrations (P = 0.24). The best predictor of reduced uterine volume was TBI during the preparation for the allograft (OR 3.5, 95% CI 1.4-8.4, P = 0.006). Increasing age at treatment (OR 0.86, 95% CI 0.77-0.95, P = 0.04), chemotherapy, as opposed to other treatments (OR 0.09, 95% CI 0.03-0.28, P < 0.001), and solid tumours as opposed to either leukaemia/lymphomas or non-malignant diseases (OR 0.2, 95% CI 0.07-0.56, P = 0.002) were associated with larger uterine volumes. CONCLUSIONS Conditioning therapies for SCT, including TBI, had the worst effects on uterine volume and gonadal reserve. Increasing age at treatment and conventional chemotherapy were associated with less detrimental effects on uterine volume.
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Affiliation(s)
- F Beneventi
- Department of Obstetrics and Gynaecology, IRCSS S. Matteo Hospital, Pavia, Italy
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Beneventi F, Locatelli E, Cavagnoli C, Simonetta M, Lovati E, Lucotti P, Aresi P, Decembrino L, Albertini R, Negri B, Cavallo A, Spinillo A. Effects of uncomplicated vaginal delivery and epidural analgesia on fetal arterial acid-base parameters at birth in gestational diabetes. Diabetes Res Clin Pract 2014; 103:444-51. [PMID: 24529563 DOI: 10.1016/j.diabres.2013.12.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 10/07/2013] [Accepted: 12/20/2013] [Indexed: 11/18/2022]
Abstract
AIM To investigate the effects of uncomplicated vaginal delivery and epidural analgesia on fetal acid-base parameters in women with gestational diabetes (GDM) compared with controls. METHODS A retrospective case-control study of 142 women with gestational diabetes and 284 controls. To evaluate the effect of diabetes and analgesia on acid-base status correcting for potential confounders we used ordered logistic equations including quartiles of fetal arterial acid-base parameters collected at birth as outcomes and categories of diabetes and epidural analgesia as explanatory variables. RESULTS In the GDM group cord base deficit (-2.63 mmol/l, interquartile range [IQR]=4.2 to -0.65 mmol/l vs. -1.9 mmol/l, IQR=-3.3 to -0.2 mmol/l, p=0.009, odds ratio (OR)=1.51, 95% confidence interval (CI)=1.04-2.18) was lower and concentration of calcium higher (1.49 mmol/l, IQR=1.42-1.56 mmol/l vs. 1.47 mmol/l, IQR=1.41-1.51 mmol/l, p=0.009, OR=1.69, 95% CI=1.12-2.56) compared with controls. Epidural analgesia in the GDM group was associated with reduced cord concentration of glucose (84.0mg/dl [4.7 mmol/l], IQR=70-103.3mg/dl vs. 92.5mg/dl [5.1 mmol/l], IQR=76.5-121.8 mg/dl, p=0.004), lactate (2.65 mmol/l (IQR=1.80-4.20) vs. 3.70 mmol/l (IQR=2.90-5.55 mmol/l), p=0.002) and less pronounced base deficit (-2.05 mmol/l, IQR=-3.90 to -0.17 mmol/l vs. -2.8, IQR=-5.57 to -1.05 mmol/l, p=0.01, OR=0.7, 95% CI=0.49-0.99). CONCLUSIONS In uncomplicated pregnancies and deliveries, well-controlled gestational diabetes mellitus has potentially significant detrimental effects on fetal acid-base status at birth. Epidural analgesia reduces cord arterial glucose and lactates.
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Affiliation(s)
- F Beneventi
- Department of Obstetrics and Gynecology, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy
| | - E Locatelli
- Department of Obstetrics and Gynecology, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy
| | - C Cavagnoli
- Department of Obstetrics and Gynecology, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy.
| | - M Simonetta
- Department of Obstetrics and Gynecology, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy
| | - E Lovati
- Department of General Medicine Diabetologic Unit, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy
| | - P Lucotti
- Department of General Medicine Diabetologic Unit, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy
| | - P Aresi
- Department of Obstetrics and Gynecology, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy
| | - L Decembrino
- Department of Pediatrics and Neonatology, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy
| | - R Albertini
- Department of Clinical Laboratory, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy
| | - B Negri
- Department of Obstetrics and Gynecology, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy
| | - A Cavallo
- Department of Obstetrics and Gynecology, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy
| | - A Spinillo
- Department of Obstetrics and Gynecology, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy
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Lovati E, Beneventi F, Simonetta M, Laneri M, Quarleri L, Scudeller L, Albonico G, Locatelli E, Cavagnoli C, Tinelli C, Spinillo A, Corazza GR. Gestational diabetes mellitus: including serum pregnancy-associated plasma protein-A testing in the clinical management of primiparous women? A case-control study. Diabetes Res Clin Pract 2013; 100:340-7. [PMID: 23642968 DOI: 10.1016/j.diabres.2013.04.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 02/18/2013] [Accepted: 04/08/2013] [Indexed: 12/13/2022]
Abstract
AIMS To assess pregnancy-associated plasma protein A (PAPP-A) correlation with GDM and its usefulness in predicting GDM in primiparous women. METHODS First trimester data related to 307 pregnant women affected by GDM and 366 control pregnant women were retrieved from a computer data base and integrated with ad hoc data. Clinical data were recorded at delivery. A logistic model was used to analyze the association between first trimester data and subsequent clinical outcomes. We derived a risk score using both classical risk factors for GDM and PAPP-A. RESULTS Diabetic and control women were significantly different in terms of age (p<0.001), BMI (p<0.001), weight (p<0.001), family history of diabetes (p<0.001), PAPP-A concentration and PAPP-A corrected multiple of the median (MoM) (p<0.001). The ROC-AUC of the clinical risk score was 0.60 (95%CI 0.56-0.64), the adjusted score including PAPP-A MoM was 0.70 (95%CI 0.66-0.74). CONCLUSIONS Low PAPP-A was strongly associated with GDM and lower values were found in diabetic women needing insulin therapy. Adding PAPP-A to first trimester screening could improve the prediction of women at high risk who will develop GDM. Further studies are needed to validate the applicability of our findings in different populations and settings.
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Affiliation(s)
- Elisabetta Lovati
- First Department of Medicine, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy.
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Beneventi F, Locatelli E, Ramoni V, Caporali R, Montecucco CM, Simonetta M, Cavagnoli C, Ferrari M, Spinillo A. Uterine artery Doppler velocimetry and obstetric outcomes in connective tissue diseases diagnosed during the first trimester of pregnancy. Prenat Diagn 2012; 32:1094-101. [PMID: 22961285 DOI: 10.1002/pd.3964] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the effect of connective tissue disease (CTD) diagnosed during the first trimester on uterine arteries (UtA) Doppler velocities and on pregnancy outcomes. METHOD Pregnant women were screened for CTDs during the first trimester, using a questionnaire, testing for autoantibodies, rheumatologic examination and UtA Doppler evaluations. RESULTS Out of 3932 women screened, 491 (12.5%) were screened positive at the questionnaire; of them, 165(33.6%) tested positive for autoantibodies, including 66 eventually diagnosed with undifferentiated connective tissue disease (UCTD), 28 with a definite CTD and 71 with insufficient criteria for a diagnosis. Controls were 326 women screened negative for autoantibodies. In logistic analysis, women diagnosed with either UCTD (OR = 7.9, 95% CI = 2.3-27.3) or overt CTD (OR = 24.9, 95% CI = 6.7-92.4), had increased rates of first trimester bilateral UtA notches compared with controls. The rates of bilateral UtA notches persisting in the second (15/94 vs 0/326, p < 0.001) and third trimesters (7/94 vs 0/326, p < .001) were higher among women with CTDs than in controls. The risk of complications (preeclampsia, fetal growth restriction, prematurity, diabetes, fetal loss) was higher (OR = 7.8, 95% CI = 3.6-17.0) among women with CTDs than in controls. CONCLUSION Women with undiagnosed CTDs have higher rates of bilateral UtA Doppler notches throughout pregnancy and increased rates of adverse pregnancy outcomes than controls.
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Affiliation(s)
- Fausta Beneventi
- Department of Obstetrics and Gynecology, San Matteo Hospital, Pavia, Italy
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Shin SJ, Rhee MY, Lim C, Lavoz C, Rodrigues-Di;ez R, Rayego-Mateos S, Benito-Martin A, Rodrigues-Diez R, Alique M, Ortiz A, Mezzano S, Ruiz-Ortega M, Axelsson J, Axelsson J, Rippe A, Sverrisson K, Rippe B, Calo L, Dal Maso L, Pagnin E, Caielli P, Calo L, Pagnin E, Dal Maso L, Caielli P, Spanos G, Spanos G, Kalaitzidis R, Karasavvidou D, Pappas K, Balafa O, Siamopoulos K, Fang TC, Lee TJF, Spanos G, Spanos G, Kalaitzidis R, Pappas E, Ermeidi E, Tatsioni A, Siamopoulos K, Blazquez-Medela A, Garcia-Sanchez O, Quiros Y, Lopez-Hernandez FJ, Lopez-Novoa JM, Martinez-Salgado C, Wu HY, Peng YS, Hung KY, Tsai TJ, Tu YK, Chien KL, Larsen T, Mose FH, Hansen AB, Pedersen EB, Quiroz Y, Rivero M, Yaguas K, Rodriguez-Iturbe B, Xydakis D, Sfakianaki M, Petra C, Maragaki E, Antonaki E, Krasoudaki E, Kostakis K, Stylianou K, Papadogiannakis A, Sagliker Y, Paylar N, Heidland A, Keck A, Erek R, Kolasin P, S Ozkaynak P, Sagliker HS, Gokcay I, Ritz E, Koleganova N, Gross-Weissmann ML, Piecha G, Reinecke N, Marquez Cunha T, M . S. Higa E, Pfeferman Heilberg I, Neder JA, Nishiura JL, Silva Almeida W, Schor N, Tapia E, Sanchez-Lozada LG, Cristobal M, Soto V, Garci;a-Arroyo F, Monroy-Sanchez F, Madero M, Johnson R, Kim SM, Yang SH, Kim YS, Karanovic S, Fistrek M, Kos J, Pecin I, Premuzic V, Abramovic M, Matijevic V, Cvoriscec D, Cvitkovic A, Knezevic M, Bitunjac M, Laganovic M, Jelakovic B, Liu F, Wu M, Fu P, Klok Matthesen S, Klok Matthesen S, Larsen T, Guldager Lauridsen T, Vase H, Gjorup Holland P, Nykjaer KM, Nielsen S, Bjerregaard Pedersen E, Blazquez-Medela A, Lopez-Hernandez FJ, Garcia-Sanchez O, Quiros Y, Montero MJ, Lopez-Novoa JM, Martinez-Salgado C, Vink E, Willemien V, Michiel V, Wilko S, Evert-Jan V, Blankestijn P, Zerbi S, Pedrini LA, Zbroch E, Zbroch E, Malyszko J, Malyszko J, Koc-Zorawska E, Mysliwiec M, Quelhas-Santos J, Quelhas-Santos J, Serrao P, Soares-Silva I, Tang L, Sampaio-Maia B, Desir G, Pestana M, Elsurer R, Demir T, Celik G, Yavas M, Yavas O, Murphy M, Jacquillet G, Unwin RJ, Chichger H, Shirley DG, Caraba A, Andreea M, Corina S, Ioan R, Nowicki M, Bobik M, Pawelec A, Lacisz J, Zapala A, Bryc K, Esposito C, Scaramuzzi ML, Manini A, Torreggiani M, Beneventi F, Spinillo A, Grosjean F, Fasoli G, Dal Canton A, Christos C, Christos C, Bernhard M.W. S, Martin N, Jan K, Claus M, Leyla R, Jan B, Ulrich K, Hermann H, Menne J, Pavicevic M, Pavicevic M, Markovic S, Igrutinovic Z. Hypertension. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs214] [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: 11/15/2022] Open
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Spinillo A, Beneventi F, Ramoni V, Caporali R, Locatelli E, Simonetta M, Cavagnoli C, Alpini C, Albonico G, Prisco E, Montecucco C. Prevalence and significance of previously undiagnosed rheumatic diseases in pregnancy. Ann Rheum Dis 2012; 71:918-23. [PMID: 22294629 DOI: 10.1136/annrheumdis-2011-154146] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate the rates of previously undiagnosed rheumatic diseases during the first trimester of pregnancy and their impact on the pregnancy outcome. METHODS Pregnant women in their first trimester were screened using a two-step approach using a self-administered 10-item questionnaire and subsequent testing for rheumatic autoantibodies (antinuclear antibody, anti-double-stranded DNA, anti-extractable nuclear antigen, anticardiolipin antibodies, anti-β2-glycoprotein I antibodies and lupus anticoagulant) and evaluation by a rheumatologist. Overall, the complications of pregnancy evaluated included fetal loss, pre-eclampsia, gestational diabetes, fetal growth restriction, delivery at less than 34 weeks, neonatal resuscitation and admission to the neonatal intensive care unit. RESULTS Out of the 2458 women screened, the authors identified 62 (2.5%) women with previously undiagnosed undifferentiated connective tissue disease (UCTD) and 24 (0.98%) women with previously undiagnosed definite systemic rheumatic disease. The prevalences were seven (0.28%) for systemic lupus erythematosus and Sjogren's syndrome, six (0.24%) for rheumatoid arthritis, three (0.12%) for antiphospholipid syndrome and one (0.04%) for systemic sclerosis. In multiple exact logistic regression, after adjustment for potential confounders, the OR of overall complications of pregnancy were 2.81 (95% CI 1.29 to 6.18) in women with UCTD and 4.57 (95% CI 1.57 to 13.57) in those with definite diseases, respectively, compared with asymptomatic controls. CONCLUSIONS In our population approximately 2.5% and 1% of first trimester pregnant women had a previously undiagnosed UCTD and definite systemic rheumatic disease, respectively. These conditions were associated with significant negative effects on the outcome of pregnancy.
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Affiliation(s)
- Arsenio Spinillo
- Department of Obstetrics and Gynecology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
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Beneventi F, Simonetta M, Lovati E, Albonico G, Tinelli C, Locatelli E, Spinillo A. First trimester pregnancy-associated plasma protein-A in pregnancies complicated by subsequent gestational diabetes. Prenat Diagn 2011; 31:523-8. [DOI: 10.1002/pd.2733] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2010] [Revised: 02/03/2011] [Accepted: 02/07/2011] [Indexed: 11/11/2022]
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Montanari L, Alfei A, Albonico G, Moratti R, Arossa A, Beneventi F, Spinillo A. The Impact of First-Trimester Serum Free β-Human Chorionic Gonadotropin and Pregnancy-Associated Plasma Protein A on the Diagnosis of Fetal Growth Restriction and Small for Gestational Age Infant. Fetal Diagn Ther 2009; 25:130-5. [DOI: 10.1159/000207554] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Accepted: 04/28/2008] [Indexed: 11/19/2022]
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Calcaterra V, Sampaolo P, Klersy C, Larizza D, Alfei A, Brizzi V, Beneventi F, Cisternino M. Utility of breast ultrasonography in the diagnostic work-up of precocious puberty and proposal of a prognostic index for identifying girls with rapidly progressive central precocious puberty. Ultrasound Obstet Gynecol 2009; 33:85-91. [PMID: 19086040 DOI: 10.1002/uog.6271] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To determine the utility of breast ultrasono- graphy in the diagnostic work-up of precocious puberty and to create a prognostic index for early differentiation between non/slowly progressive or transient forms of precocious puberty and rapidly progressive central precocious puberty. METHODS We recruited consecutively 60 girls with precocious pubertal development. In all the girls we evaluated Tanner stage, basal and gonadotropin-releasing hormone (GnRH)-stimulated follicle stimulating hormone (FSH) and luteinizing hormone (LH) levels, estradiol (E2) levels, and bone age, and performed pelvis and breast ultrasound examinations. Logistic regression models were fitted to identify possible diagnostic factors for rapidly progressive central precocious puberty and non/slowly progressive or transient forms. RESULTS Ultrasound breast volume>or=0.85 cm3 was associated with rapidly progressive central precocious puberty (P=0.01). Uterine volume>or=5 cm3, LH peak>or=7 IU/L, presence of an endometrial echo, E2 levels>or=50 pmol/L and bone age>2 SD above expected were significantly associated with rapidly progressive central precocious puberty. A multivariate model including uterine volume, E2 level, bone age, presence of an endometrial echo and ultrasound breast volume revealed a strong ability to classify rapidly progressive forms. From this multivariate analysis a prognostic index for rapidly progressive central precocious puberty was defined. CONCLUSIONS Ultrasound imaging allows better definition of the breast and the maturation stage than does use of Tanner's stages. Ultrasound breast volume>or=0.85 cm3 is an independent predicting factor of rapidly progressive central precocious puberty. A prognostic index that was created from a multivariate model including uterine volume, E2 level, presence of an endometrial echo, bone age and ultrasonographically determined breast volume, may help in the early differentiation between rapidly progressive central precocious puberty and non/slowly progressive or transient forms.
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Affiliation(s)
- V Calcaterra
- Department of Pediatrics, University of Pavia and IRCCS Policlinico San Matteo, Pavia, Italy.
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Spinillo A, Beneventi F, Epis OM, Montanari L, Mammoliti D, Ramoni V, Di Silverio E, Alpini C, Caporali R, Montecucco C. The effect of newly diagnosed undifferentiated connective tissue disease on pregnancy outcome. Am J Obstet Gynecol 2008; 199:632.e1-6. [PMID: 18667193 DOI: 10.1016/j.ajog.2008.05.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Revised: 04/06/2008] [Accepted: 05/19/2008] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate pregnancy outcome in a cohort of patients with newly diagnosed undifferentiated connective tissue disease (UCTD). STUDY DESIGN We conducted a nested case-control study that compared 41 patients who had early UCTD that was diagnosed at 11-14 weeks of pregnancy with 82 healthy control subjects. RESULTS During pregnancy, UCTD progressed to a definite connective tissue disease in 2 of 41 patients (4.9%). Sixteen of the 41 patients (39%) with UCTD tested positive for anti-Ro (SSA) antibodies. Compared with the control subjects, the women with UCTD had higher rates of small for gestational age (SGA; 12/40 vs 11/80; P = .05). The rate of complications of pregnancy (preterm delivery at </= 37 weeks of gestation, SGA, preeclampsia, late fetal loss) was 39% (16/41) among cases and 13.4% (11/82) in control subjects (adjusted odds ratio, 3.98; 95% CI, 1.59-9.49). CONCLUSION Pregnant patients with UCTD are at increased risk of SGA and complications of pregnancy.
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Affiliation(s)
- Arsenio Spinillo
- Department of Obstetrics and Gynecology, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
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Spinillo A, Beneventi F, Epis OM, Montanari L, Mammoliti D, Ramoni V, Di Silverio E, Alpini C, Caporali R, Montecucco C. Prevalence of undiagnosed autoimmune rheumatic diseases in the first trimester of pregnancy. Results of a two-steps strategy using a self-administered questionnaire and autoantibody testing. BJOG 2007; 115:51-7. [PMID: 17970796 DOI: 10.1111/j.1471-0528.2007.01530.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the prevalence of undiagnosed rheumatic diseases in the first trimester of pregnancy. DESIGN We screened for rheumatic diseases in 1210 consecutive pregnant women during the first trimester of pregnancy using a 10-item questionnaire. SETTING A university hospital in northern Italy. POPULATION One hundred and thirty-seven (11.3%) women who answered positively to at least one question constituted the cases and were compared with 107 negative controls. METHODS Cases and controls were tested for rheumatic autoantibodies (antinuclear antibody, anti-double-stranded DNA, anti-extractable nuclear antigen, anticardiolipin antibody, anti-beta2-glycoprotein I antibodies and lupus anticoagulant) and were evaluated by a rheumatologist for a definite diagnosis of rheumatic disease. MAIN OUTCOME MEASURES Prevalence of undiagnosed rheumatic disease in the first trimester of pregnancy. RESULTS The overall rate of positivity to the antibodies tested was 43.1% (59/137) among cases and 9.3% (10/107) in the controls (P < 0.001). A definitive diagnosis of rheumatic disease was made in 35 cases (25.5%) and in none of the controls (P <0.001). In stepwise logistic regression analysis, photosensitivity (adjusted OR 5.72; 95% CI 2.38-13.8), erythema or malar rash (adjusted OR 3.91; 95% CI 1.53-10) and history of two or more miscarriages (adjusted OR 5.6; 95% CI 1.55-20.6) were independent predictors of a definitive diagnosis of rheumatic disease (area under receiving operator curve = 0.814; 95% CI 0.76-0.86). Birthweight was lower (3180 g +/- 475 compared with 3340 g +/- 452, P= 0.008), and overall serious pregnancy complications (miscarriage, fetal growth restriction, delivery before 34 weeks of pregnancy and severe pre-eclampsia) were higher among cases (12/137) than controls (2/107) (adjusted OR 5.60; 95% CI 1.29-24.3; P= 0.021). CONCLUSIONS A two-step screening process with a self-administered questionnaire proved to be a useful method to screen for undiagnosed rheumatic diseases during the first trimester of pregnancy.
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Affiliation(s)
- A Spinillo
- Department of Obstetrics and Gynecology, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy.
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Beneventi F, Sampaolo P, Polatti F, Filoni GM, Masanti ML, Persiani P, Zara C. Ultrasonography endometrial patterns in different hormonal treatments to induce ovulation. Radiol Med 1995; 90:278-83. [PMID: 7501834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
As several studies report that transvaginal ultrasound of endometrial thickness may help distinguish fertile from infertile cycles, we assessed endometrial growth and morphology in 124 infertile women. The patients underwent different ovulation induction treatments: clomiphene citrate (CC), human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG), analogous Gn-RH and hMG (aGn-RH+hMG). CC administration is followed by a slackening of endometrial maturation. The US pattern H (typical of the ovulatory phase) appears on day 13 (76.9% of the cases) in spontaneous cycles and on day 16 (75% of the cases) in CC-induced cycles. The H pattern on day 20 in CC-induced cycles persisted in the patients who did not conceive. In aGn-RH-stimulated cycles the endometrial pattern H appears on days 13 (41.66%) and 16 (83.33%), not preceded by a Hi image. The endometrial pattern Hi was always observed in the patients who did not conceive. Our retrospective study of endometrial US morphology shows that the different ovulation induction treatments may affect the day of appearance of the various endometrial patterns. These results, which need further confirmation, can allow the changes of conceiving to be investigated during the stimulation protocol of every single stimulated cycle.
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Affiliation(s)
- F Beneventi
- Clinica Ostetrica e Ginecologia, Policlinico San Matteo IRCSS, Università degli Studi di Pavia
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Beneventi F, Persiani P, Filoni G, Masanti ML, Ravagni Probizer MF, Polatti F, Zara C. [Combined use of goserelin acetate and human menopausal gonadotropin in the induction of follicular growth in a program of fertilization in vitro and embryo transfer]. Minerva Ginecol 1994; 46:645-50. [PMID: 7885608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE to investigate the efficacy of a gonadotropin-releasing hormone analogue (GN-RH-a) in combination with human menopausal menotropin (hMG) for in-vitro fertilization. METHODS 30 infertile women aged 32 to 37 years received a combined treatment with a long-acting slow-releasing Gn-RH-a and hMG to perform ovarian stimulation in a program of in-vitro fertilization. Serum levels of Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), 17-beta-estradiol (E2), Progesterone (P), were evaluated and transvaginal ultrasonographic examinations were performed during the treatment to assess the ovarian volume, the mean number and diameter of growing follicles and the endometrial morphology and thickness. Oocyte retrieval was performed by transvaginal-ultrasound-guided approach, 24-36 hours after the administration of human chorionic gonadotropin (hCG). RESULTS our data suggest that the combined use of Gn-RH-a and exogenous gonadotropins is associated with a more uniform ovarian response and with the absence of premature LH discharge. Moreover, the Gn-RH-a as polymer implant provides a controlled delivery per day over a one-month period and avoids the inconvenience of a daily administration. CONCLUSIONS this kind of Gn-RH-a formulation, in in-vitro fertilization programs, appears very effective in inducing a reversible hypogonadic state, easy to manage and well tolerated by the patient. Its association with exogenous gonadotropins appears to be effective in increasing the success rate of good quality oocyte retrieval.
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Affiliation(s)
- F Beneventi
- Clinica Ostetrica e Ginecologica, Università degli Studi di Pavia, Policlinico S. Matteo IRCCS
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Melis GB, Mais V, Paoletti AM, Beneventi F, Gambacciani M, Fioretti P. Prevention of puerperal lactation by a single oral administration of the new prolactin-inhibiting drug, cabergoline. Obstet Gynecol 1988; 71:311-4. [PMID: 3279351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
To evaluate the efficacy of a single oral administration of the new ergot derivative Cabergoline in the prevention of post-partum lactation, we compared the effects of three different doses of the drug with those of placebo in 32 puerperal women. In a controlled, double-blind trial, the subjects were randomly allocated to four treatment groups receiving either placebo or 400, 600, or 800 micrograms Cabergoline (N = 8 in each group) within 24 hours after delivery. Treatment efficacy was assessed clinically by physical examination before (day 0) and at one, two, three, four, and 14 days after treatment. Plasma prolactin (PRL) concentrations were measured in blood samples collected before and at one, two, three, and four days after treatment. Lactation was prevented in four of the eight subjects (50%) who received 400 micrograms Cabergoline and in all subjects who received 600 or 800 micrograms Cabergoline. By contrast, only one of the eight subjects (12.5%) receiving placebo showed no signs of spontaneous lactation within the 14 days after delivery. No effects of placebo administration on plasma PRL levels were observed. Plasma PRL concentrations were significantly reduced starting from one day after Cabergoline administration, however, and the amount of inhibition of PRL secretion induced by different doses of the drug was not statistically different. These preliminary data demonstrate that Cabergoline has a dose-related effect in the prevention of postpartum lactation, and milk secretion can be prevented completely by a single oral administration of 600 or 800 micrograms of the drug.
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Affiliation(s)
- G B Melis
- Department of Obstetrics and Gynecology, School of Medicine, University of Pisa, Italy
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Melis GB, Gambacciani M, Paoletti AM, Beneventi F, Mais V, Baroldi P, Fioretti P. Dose-related prolactin inhibitory effect of the new long-acting dopamine receptor agonist cabergoline in normal cycling, puerperal, and hyperprolactinemic women. J Clin Endocrinol Metab 1987; 65:541-5. [PMID: 3624413 DOI: 10.1210/jcem-65-3-541] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Two different single doses (400 and 600 micrograms) of the new long-acting dopamine agonist cabergoline (CBG) were given to 12 normal cycling women, 17 puerperal women, and 24 hyperprolactinemic women (12 with idiopathic hyperprolactinemia and 12 with pituitary adenoma). Plasma PRL was determined in blood samples collected before and at frequent intervals for 5 days after CBG administration. Both CBG doses induced marked inhibition of PRL secretion in all women. A decrease in plasma PRL levels was evident 1-2 h after CBG administration and persisted for up to 5 days. The 600-micrograms CBG dose had a more potent (P less than 0.05) PRL inhibitory effect than the 400-micrograms dose in normal, puerperal, and hyperprolactinemic women. Moreover, while 400 micrograms CBG prevented lactation in 3 of 7 puerperal women, 600 micrograms CBG prevented lactation in 5 of 5 puerperal women. A moderate blood pressure decrease occurred 3-6 h after CBG treatment, but no other side-effects occurred. These results demonstrate that CBG induces a dose-related inhibition of PRL secretion in normal women as well as in puerperal and hyperprolactinemic women. The potent long-lasting PRL inhibitory effect of CBG in conjunction with the absence of side-effects typical of dopaminergic compounds suggest that this drug is an advance in the medical treatment of hyperprolactinemia.
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Melis GB, Mais V, Paoletti AM, Beneventi F, Petacchi FD, Fioretti P. Involvement of endogenous gabaergic system in the modulation of gonadotropin secretion in normal cycling women. J Endocrinol Invest 1986; 9:71-6. [PMID: 3084617 DOI: 10.1007/bf03348068] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
To investigate whether endogenous GABA participates in the control of gonadotropin secretion during the menstrual cycle, placebo or sodium valproate (DPA), an anticonvulsant drug which enhances endogenous GABA content by blocking GABA degradation, were administered to regularly cycling women both during early follicular and midluteal phase. In a first set of experiments, the effect of DPA administration (400 mg, orally) on basal gonadotropin secretion was evaluated in 13 subjects. During early follicular phase (n = 6), no significant changes in plasma gonadotropin levels were observed after DPA or placebo administration. Conversely, during midluteal phase (n = 7), DPA administration resulted in a significant fall (p less than 0.01) in plasma LH concentrations, with a maximal percent decrease of 41.8 +/- 6.7% after 120 min. No changes in plasma FSH levels were observed. In a second set of experiments, the effect of DPA pretreatment (400 mg, orally) on gonadotropin release stimulated by a pulse of exogenous GnRH (10 micrograms, iv bolus) was studied in 11 subjects. During both follicular (n = 4) and luteal phase (n = 7), DPA did not modify gonadotropin response to GnRH injected 1h after pretreatment. Finally, 8 subjects were submitted to iv injection with 10 micrograms GnRH 2h after pretreatment with DPA (400 mg, orally) or placebo. During both follicular (n = 4) and luteal phase (n = 4), no statistical differences in gonadotropin response to GnRH were found between DPA and placebo pretreatment. These findings demonstrated that during the estrogen-progesterone (midluteal) phase of menstrual cycle, endogenous GABA is involved in the inhibitory regulation of LH secretion at a central level.
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Melis GB, Fruzzetti F, Paoletti AM, Mais V, Beneventi F, Trimarchi G, Fioretti P. Effects of the GABAergic drug, sodium valproate, on the prolactin release evoked by pharmacological stimuli in normal women. Clin Endocrinol (Oxf) 1984; 20:245-52. [PMID: 6426828 DOI: 10.1111/j.1365-2265.1984.tb00080.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Sodium valproate (DPA or Na-dipropylacetate), an anticonvulsant drug activating the endogenous GABAergic system, was administered orally at the dose of 400 mg to seventeen normal women 1 h before intravenous injections with three drugs which stimulate prolactin (PRL) release: TRH (200 micrograms bolus; six subjects); domperidone (5 mg bolus; six subjects); and sulpiride (5 mg bolus; five subjects). DPA pretreatment significantly blunted PRL response to both domperidone and sulpiride injections without affecting the PRL response to TRH. In particular, the quantitative PRL secretion (areas under curves) following domperidone and sulpiride tests appeared significantly reduced after DPA treatment in comparison to placebo (P less than 0.02 and P less than 0.01 for domperidone and sulpiride respectively). These results indicate that the pharmacological enhancement of the endogenous GABAergic system by DPA may blunt PRL response to both central and peripheral dopamine receptor blockade. These observations suggest that a GABAergic pathway inhibiting PRL secretion at the hypothalamic level competes, at least in part, with the dopaminergic system. Conversely, the lack of any effect of DPA on PRL response to TRH seems to suggest that pituitary TRH receptors are independent of any GABAergic control.
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