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Khan RR, Guerrero RF, Wapner RJ, Hahn MW, Raja A, Salleb-Aouissi A, Grobman WA, Simhan H, Silver RM, Chung JH, Reddy UM, Radivojac P, Pe'er I, Haas DM. Genetic polymorphisms associated with adverse pregnancy outcomes in nulliparas. Sci Rep 2024; 14:10514. [PMID: 38714721 PMCID: PMC11076516 DOI: 10.1038/s41598-024-61218-9] [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] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 05/02/2024] [Indexed: 05/10/2024] Open
Abstract
Adverse pregnancy outcomes (APOs) affect a large proportion of pregnancies and represent an important cause of morbidity and mortality worldwide. Yet the pathophysiology of APOs is poorly understood, limiting our ability to prevent and treat these conditions. To search for genetic markers of maternal risk for four APOs, we performed multi-ancestry genome-wide association studies (GWAS) for pregnancy loss, gestational length, gestational diabetes, and preeclampsia. We clustered participants by their genetic ancestry and focused our analyses on three sub-cohorts with the largest sample sizes: European, African, and Admixed American. Association tests were carried out separately for each sub-cohort and then meta-analyzed together. Two novel loci were significantly associated with an increased risk of pregnancy loss: a cluster of SNPs located downstream of the TRMU gene (top SNP: rs142795512), and the SNP rs62021480 near RGMA. In the GWAS of gestational length we identified two new variants, rs2550487 and rs58548906 near WFDC1 and AC005052.1, respectively. Lastly, three new loci were significantly associated with gestational diabetes (top SNPs: rs72956265, rs10890563, rs79596863), located on or near ZBTB20, GUCY1A2, and RPL7P20, respectively. Fourteen loci previously correlated with preterm birth, gestational diabetes, and preeclampsia were found to be associated with these outcomes as well.
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Affiliation(s)
- Raiyan R Khan
- Department of Computer Science, Columbia University, New York, NY, USA
| | - Rafael F Guerrero
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA
- Department of Computer Science, Indiana University, Bloomington, IN, USA
| | - Ronald J Wapner
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - Matthew W Hahn
- Department of Computer Science, Indiana University, Bloomington, IN, USA
- Department of Biology, Indiana University, Bloomington, IN, USA
| | - Anita Raja
- Department of Computer Science, CUNY Hunter College, New York, NY, USA
| | | | - William A Grobman
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Hyagriv Simhan
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
| | - Judith H Chung
- Department of Obstetrics and Gynecology, University of California, Irvine, Orange, CA, USA
| | - Uma M Reddy
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - Predrag Radivojac
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, USA
| | - Itsik Pe'er
- Department of Computer Science, Columbia University, New York, NY, USA
| | - David M Haas
- Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
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Venkatesh KK, Khan SS, Yee LM, Wu J, McNeil R, Greenland P, Chung JH, Levine LD, Simhan HN, Catov J, Scifres C, Reddy UM, Pemberton VL, Saade G, Bairey Merz CN, Grobman WA. Adverse Pregnancy Outcomes and Predicted 30-Year Risk of Maternal Cardiovascular Disease 2-7 Years After Delivery. Obstet Gynecol 2024:00006250-990000000-01053. [PMID: 38574364 DOI: 10.1097/aog.0000000000005569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/22/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE To determine whether adverse pregnancy outcomes are associated with a higher predicted 30-year risk of atherosclerotic cardiovascular disease (CVD; ie, coronary artery disease or stroke). METHODS This was a secondary analysis of the prospective Nulliparous Pregnancy Outcomes Study-Monitoring Mothers-to-Be Heart Health Study longitudinal cohort. The exposures were adverse pregnancy outcomes during the first pregnancy (ie, gestational diabetes mellitus [GDM], hypertensive disorder of pregnancy, preterm birth, and small- and large-for-gestational-age [SGA, LGA] birth weight) modeled individually and secondarily as the cumulative number of adverse pregnancy outcomes (ie, none, one, two or more). The outcome was the 30-year risk of atherosclerotic CVD predicted with the Framingham Risk Score assessed at 2-7 years after delivery. Risk was measured both continuously in increments of 1% and categorically, with high predicted risk defined as a predicted risk of atherosclerotic CVD of 10% or more. Linear regression and modified Poisson models were adjusted for baseline covariates. RESULTS Among 4,273 individuals who were assessed at a median of 3.1 years after delivery (interquartile range 2.5-3.7), the median predicted 30-year atherosclerotic CVD risk was 2.2% (interquartile range 1.4-3.4), and 1.8% had high predicted risk. Individuals with GDM (least mean square 5.93 vs 4.19, adjusted β=1.45, 95% CI, 1.14-1.75), hypertensive disorder of pregnancy (4.95 vs 4.22, adjusted β=0.49, 95% CI, 0.31-0.68), and preterm birth (4.81 vs 4.27, adjusted β=0.47, 95% CI, 0.24-0.70) were more likely to have a higher absolute risk of atherosclerotic CVD. Similarly, individuals with GDM (8.7% vs 1.4%, adjusted risk ratio [RR] 2.02, 95% CI, 1.14-3.59), hypertensive disorder of pregnancy (4.4% vs 1.4%, adjusted RR 1.91, 95% CI, 1.17-3.13), and preterm birth (5.0% vs 1.5%, adjusted RR 2.26, 95% CI, 1.30-3.93) were more likely to have a high predicted risk of atherosclerotic CVD. A greater number of adverse pregnancy outcomes within the first birth was associated with progressively greater risks, including per 1% atherosclerotic CVD risk (one adverse pregnancy outcome: 4.86 vs 4.09, adjusted β=0.59, 95% CI, 0.43-0.75; two or more adverse pregnancy outcomes: 5.51 vs 4.09, adjusted β=1.16, 95% CI, 0.82-1.50), and a high predicted risk of atherosclerotic CVD (one adverse pregnancy outcome: 3.8% vs 1.0%, adjusted RR 2.33, 95% CI, 1.40-3.88; two or more adverse pregnancy outcomes: 8.7 vs 1.0%, RR 3.43, 95% CI, 1.74-6.74). Small and large for gestational age were not consistently associated with a higher atherosclerotic CVD risk. CONCLUSION Individuals who experienced adverse pregnancy outcomes in their first birth were more likely to have a higher predicted 30-year risk of CVD measured at 2-7 years after delivery. The magnitude of risk was higher with a greater number of adverse pregnancy outcomes experienced.
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Affiliation(s)
- Kartik K Venkatesh
- Departments of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio; Northwestern University, Chicago, Illinois; University of California, Irvine, Orange, California; University of Pennsylvania, Philadelphia, and University of Pittsburgh, Pittsburgh, Pennsylvania; Indiana University, Indianapolis, Indiana; Columbia University, New York, New York; and Eastern Virginia Medical College, Norfolk, Virginia; the Department of Preventive Medicine, Northwestern University, Chicago, Illinois; RTI International, Durham, North Carolina; the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; and the Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
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3
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De Zoysa MY, Westermann M, Yang T, Chung JH. The Effect of Body Mass Index on Post-Bolus Magnesium Levels in the Obstetric Patient. Am J Perinatol 2024; 41:677-683. [PMID: 37949099 DOI: 10.1055/s-0043-1776902] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
OBJECTIVE In the setting of a growing obese obstetric population, we sought to determine whether differences in body mass index (BMI) and obesity class influenced both serum magnesium levels and the likelihood of achieving therapeutic levels for eclampsia prophylaxis after standard boluses of magnesium sulfate. STUDY DESIGN This is a retrospective cohort study of patients treated with magnesium sulfate in the setting of either preeclampsia with severe features or preterm labor between 2010 and 2016. Subjects were categorized by BMI: Normal (BMI < 30 kg/m2), Class 1 (BMI 30-34.9 kg/m2), Class 2 (BMI 35-39.9 kg/m2), and Class 3 (BMI ≥ 40 kg/m2). Study participants' demographics, intrapartum characteristics, and adverse reactions were compared among the groups. Logistic regression models were used to calculate unadjusted and adjusted odds ratios comparing the likelihood of each BMI class reaching therapeutic eclamptic prophylactic levels. Linear regression models were also evaluated to determine the relationship between BMI and post-bolus serum magnesium levels. RESULTS Of the 760 people who met the inclusion criteria, 313 (41.1%) had normal BMI, 190 (25.0%) had Class 1 obesity, 135 (17.8%) had Class 2 obesity, and 122 (16.1%) had Class 3 obesity. When adjusted for confounders, those with Class 1 obesity were 54% less likely to achieve serum levels deemed therapeutic for seizure prophylaxis compared with normal BMI counterparts. Meanwhile, those with Class 2 or 3 obesity were 90% less likely. Linear regression models also demonstrated an inverse association between BMI and post-bolus serum magnesium levels. CONCLUSION Increasing BMI has a significant effect on post-bolus serum magnesium levels regardless of standard loading dose used. Immediately after bolus administration, obese gravidas are significantly less likely to reach levels effective for eclamptic seizure prophylaxis. When considering which bolus to administer in an obese gravida, it may be more beneficial to choose a 6 g load. KEY POINTS · BMI has an inverse relationship with post-bolus serum magnesium levels.. · Obese gravidas were less likely to reach eclampsia prophylaxis levels regardless of bolus type.. · Obesity class, not just the presence or absence of obesity, plays a role in serum magnesium levels..
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Affiliation(s)
- Madushka Y De Zoysa
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California Irvine, California
| | - Melissa Westermann
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California Irvine, California
| | - Tyler Yang
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California Irvine, California
| | - Judith H Chung
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California Irvine, California
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Metz TD, Allshouse AA, McMillin GA, Greene T, Chung JH, Grobman WA, Haas DM, Mercer BM, Parry S, Reddy UM, Saade GR, Simhan HN, Silver RM. Cannabis Exposure and Adverse Pregnancy Outcomes Related to Placental Function. JAMA 2023; 330:2191-2199. [PMID: 38085313 PMCID: PMC10716715 DOI: 10.1001/jama.2023.21146] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/28/2023] [Indexed: 12/18/2023]
Abstract
Importance Cannabis use is increasing among reproductive-age individuals and the risks associated with cannabis exposure during pregnancy remain uncertain. Objective To evaluate the association between maternal cannabis use and adverse pregnancy outcomes known to be related to placental function. Design, Setting, and Participants Ancillary analysis of nulliparous individuals treated at 8 US medical centers with stored urine samples and abstracted pregnancy outcome data available. Participants in the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be cohort were recruited from 2010 through 2013; the drug assays and analyses for this ancillary project were completed from June 2020 through April 2023. Exposure Cannabis exposure was ascertained by urine immunoassay for 11-nor-9-carboxy-Δ9-tetrahydrocannabinol using frozen stored urine samples from study visits during the pregnancy gestational age windows of 6 weeks and 0 days to 13 weeks and 6 days (visit 1); 16 weeks and 0 days to 21 weeks and 6 days (visit 2); and 22 weeks and 0 days to 29 weeks and 6 days (visit 3). Positive results were confirmed with liquid chromatography tandem mass spectrometry. The timing of cannabis exposure was defined as only during the first trimester or ongoing exposure beyond the first trimester. Main Outcome and Measure The dichotomous primary composite outcome included small-for-gestational-age birth, medically indicated preterm birth, stillbirth, or hypertensive disorders of pregnancy ascertained by medical record abstraction by trained perinatal research staff with adjudication of outcomes by site investigators. Results Of 10 038 participants, 9257 were eligible for this analysis. Of the 610 participants (6.6%) with cannabis use, 32.4% (n = 197) had cannabis exposure only during the first trimester and 67.6% (n = 413) had ongoing exposure beyond the first trimester. Cannabis exposure was associated with the primary composite outcome (25.9% in the cannabis exposure group vs 17.4% in the no exposure group; adjusted relative risk, 1.27 [95% CI, 1.07-1.49]) in the propensity score-weighted analyses after adjustment for sociodemographic characteristics, body mass index, medical comorbidities, and active nicotine use ascertained via urine cotinine assays. In a 3-category cannabis exposure model (no exposure, exposure only during the first trimester, or ongoing exposure), cannabis use during the first trimester only was not associated with the primary composite outcome; however, ongoing cannabis use was associated with the primary composite outcome (adjusted relative risk, 1.32 [95% CI, 1.09-1.60]). Conclusions and Relevance In this multicenter cohort, maternal cannabis use ascertained by biological sampling was associated with adverse pregnancy outcomes related to placental dysfunction.
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Affiliation(s)
| | | | - Gwendolyn A McMillin
- University of Utah Health, Salt Lake City
- ARUP Laboratories, Salt Lake City, Utah
| | - Tom Greene
- University of Utah Health, Salt Lake City
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Chahine Z, Abel S, Hollin T, Chung JH, Barnes GL, Daub ME, Renard I, Choi JY, Pratap V, Pal A, Alba-Argomaniz M, Banks CAS, Kirkwood J, Saraf A, Camino I, Castaneda P, Cuevas MC, De Mercado-Arnanz J, Fernandez-Alvaro E, Garcia-Perez A, Ibarz N, Viera-Morilla S, Prudhomme J, Joyner CJ, Bei AK, Florens L, Ben Mamoun C, Vanderwal CD, Le Roch KG. A Potent Kalihinol Analogue Disrupts Apicoplast Function and Vesicular Trafficking in P. falciparum Malaria. bioRxiv 2023:2023.11.21.568162. [PMID: 38045341 PMCID: PMC10690269 DOI: 10.1101/2023.11.21.568162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Here we report the discovery of MED6-189, a new analogue of the kalihinol family of isocyanoterpene (ICT) natural products. MED6-189 is effective against drug-sensitive and -resistant P. falciparum strains blocking both intraerythrocytic asexual replication and sexual differentiation. This compound was also effective against P. knowlesi and P. cynomolgi. In vivo efficacy studies using a humanized mouse model of malaria confirms strong efficacy of the compound in animals with no apparent hemolytic activity or apparent toxicity. Complementary chemical biology, molecular biology, genomics and cell biological analyses revealed that MED6-189 primarily targets the parasite apicoplast and acts by inhibiting lipid biogenesis and cellular trafficking. Genetic analyses in P. falciparum revealed that a mutation in PfSec13, which encodes a component of the parasite secretory machinery, reduced susceptibility to the drug. The high potency of MED6-189 in vitro and in vivo, its broad range of efficacy, excellent therapeutic profile, and unique mode of action make it an excellent addition to the antimalarial drug pipeline.
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Affiliation(s)
- Z Chahine
- Department of Molecular, Cell and Systems Biology, University of California Riverside, CA, USA
| | - S Abel
- Department of Molecular, Cell and Systems Biology, University of California Riverside, CA, USA
| | - T Hollin
- Department of Molecular, Cell and Systems Biology, University of California Riverside, CA, USA
| | - JH Chung
- Department of Chemistry, University of California, Irvine, California, 92617, USA
| | - GL Barnes
- Department of Chemistry, University of California, Irvine, California, 92617, USA
| | - ME Daub
- Department of Chemistry, University of California, Irvine, California, 92617, USA
| | - I Renard
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, USA
| | - JY Choi
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, USA
| | - V Pratap
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, USA
| | - A Pal
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, USA
| | - M Alba-Argomaniz
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA, United States
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA, United States
- Center for Vaccines and Immunology, University of Georgia, Athens, GA, United States
| | - CAS Banks
- Stowers Institute for Medical Research, 1000 E. 50th Street, Kansas City, MO 64110, USA
| | - J Kirkwood
- Metabolomics Core Facility, University of California, Riverside, CA 92521, USA
| | - A Saraf
- Stowers Institute for Medical Research, 1000 E. 50th Street, Kansas City, MO 64110, USA
| | - I Camino
- GSK, C/ Severo Ochoa, 2 PTM, 28760 Tres Cantos (Madrid), Spain
| | - P Castaneda
- GSK, C/ Severo Ochoa, 2 PTM, 28760 Tres Cantos (Madrid), Spain
| | - MC Cuevas
- GSK, C/ Severo Ochoa, 2 PTM, 28760 Tres Cantos (Madrid), Spain
| | | | | | - A Garcia-Perez
- GSK, C/ Severo Ochoa, 2 PTM, 28760 Tres Cantos (Madrid), Spain
| | - N Ibarz
- GSK, C/ Severo Ochoa, 2 PTM, 28760 Tres Cantos (Madrid), Spain
| | - S Viera-Morilla
- GSK, C/ Severo Ochoa, 2 PTM, 28760 Tres Cantos (Madrid), Spain
| | - J Prudhomme
- Department of Molecular, Cell and Systems Biology, University of California Riverside, CA, USA
| | - CJ Joyner
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA, United States
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA, United States
- Center for Vaccines and Immunology, University of Georgia, Athens, GA, United States
| | - AK Bei
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - L Florens
- Stowers Institute for Medical Research, 1000 E. 50th Street, Kansas City, MO 64110, USA
| | - C Ben Mamoun
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, USA
| | - CD Vanderwal
- Department of Chemistry, University of California, Irvine, California, 92617, USA
| | - KG Le Roch
- Department of Molecular, Cell and Systems Biology, University of California Riverside, CA, USA
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Yan Q, Guerrero RF, Khan RR, Surujnarine AA, Wapner RJ, Hahn MW, Raja A, Salleb-Aouissi A, Grobman WA, Simhan H, Blue NR, Silver R, Chung JH, Reddy UM, Radivojac P, Pe’er I, Haas DM. Searching and visualizing genetic associations of pregnancy traits by using GnuMoM2b. Genetics 2023; 225:iyad151. [PMID: 37602697 PMCID: PMC10691790 DOI: 10.1093/genetics/iyad151] [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] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/29/2023] [Indexed: 08/22/2023] Open
Abstract
Adverse pregnancy outcomes (APOs) are major risk factors for women's health during pregnancy and even in the years after pregnancy. Due to the heterogeneity of APOs, only few genetic associations have been identified. In this report, we conducted genome-wide association studies (GWASs) of 479 traits that are possibly related to APOs using a large and racially diverse study, Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b). To display extensive results, we developed a web-based tool GnuMoM2b (https://gnumom2b.cumcobgyn.org/) for searching, visualizing, and sharing results from a GWAS of 479 pregnancy traits as well as phenome-wide association studies of more than 17 million single nucleotide polymorphisms. The genetic results from 3 ancestries (Europeans, Africans, and Admixed Americans) and meta-analyses are populated in GnuMoM2b. In conclusion, GnuMoM2b is a valuable resource for extraction of pregnancy-related genetic results and shows the potential to facilitate meaningful discoveries.
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Affiliation(s)
- Qi Yan
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Rafael F Guerrero
- Department of Computer Science, Indiana University, Bloomington, IN 47405, USA
- Department of Biological Sciences, North Carolina State University, Raleigh, NC 27695, USA
| | - Raiyan R Khan
- Department of Computer Science, Columbia University, New York, NY 10032, USA
| | - Andy A Surujnarine
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Ronald J Wapner
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Matthew W Hahn
- Department of Computer Science, Indiana University, Bloomington, IN 47405, USA
- Department of Biology, Indiana University, Bloomington, IN 47405, USA
| | - Anita Raja
- Department of Computer Science, CUNY Hunter College, New York, NY 10065, USA
| | | | - William A Grobman
- Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Hyagriv Simhan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Nathan R Blue
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT 84132, USA
| | - Robert Silver
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT 84132, USA
| | - Judith H Chung
- Department of Obstetrics and Gynecology, University of California, Irvine, Orange, CA 92697, USA
| | - Uma M Reddy
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Predrag Radivojac
- Khoury College of Computer Sciences, Northeastern University, Boston, MA 02115, USA
| | - Itsik Pe’er
- Department of Computer Science, Columbia University, New York, NY 10032, USA
| | - David M Haas
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN 46202, USA
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Post RJ, Chang J, Ziogas A, Crosland BA, Silver RM, Haas DM, Grobman WA, Saade GR, Reddy UM, Simhan H, Chung JH. Risk factors and perinatal outcomes for persistent placenta previa in nulliparas. Am J Obstet Gynecol MFM 2023; 5:101136. [PMID: 37598887 DOI: 10.1016/j.ajogmf.2023.101136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/06/2023] [Accepted: 08/15/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Placenta previa diagnosed on midtrimester ultrasound often resolves by the third trimester. Multiparity and previous cesarean delivery have been associated with persistence of placenta previa at delivery. Risk factors for persistent placenta previa in nulliparas are not well characterized. OBJECTIVE This study aimed to identify risk factors for persistent placenta previa in the nulliparous population, and evaluate differences in outcomes between persistent and resolved placenta previa. STUDY DESIGN This was a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b), a prospective cohort study that observed 10,037 nulliparous individuals throughout pregnancy. Nulliparas diagnosed with placenta previa on midtrimester ultrasound were included in this analysis. Baseline characteristics and delivery outcomes of nulliparas with persistent placenta previa were compared with those of nulliparas with resolved placenta previa. Multivariate logistic regression with stepwise model selection was used for adjusted analyses. RESULTS A total of 171 nulliparas (1.7%) in the nuMoM2b study were diagnosed with placenta previa on midtrimester ultrasound, of whom 17% (n=29) had persistent placenta previa at delivery. When compared with those with resolved placenta previa, nulliparas with persistent placenta previa were more likely to be older (median, 32 years [interquartile range, 30-37] vs 29 years [interquartile range, 25-31]; P<.01), have a previous pregnancy of <20 weeks (48.3% vs 22.5%; P=.01), have a previous dilation and curettage/evacuation procedure (27.6% vs 10.6%; P=.03), or have a pregnancy that resulted from assisted reproductive technology (31% vs 4.9%; P=.01). After adjusting for potential confounders, maternal age (adjusted odds ratio, 1.11; 95% confidence interval, 1.02-1.21), in vitro fertilization (adjusted odds ratio, 9.00; 95% confidence interval, 1.97-41.14), and previous pregnancy of <20 weeks (adjusted odds ratio, 2.77; 95% confidence interval, 1.10-6.95) remained statistically significant risk factors for persistent placenta previa. Persistent placenta previa was also associated with higher likelihood of antepartum admission (10.3% vs 0%; P<.01), preterm delivery (34.5% vs 12%; P<.01), lower neonatal birthweight (median, 2847 g [interquartile range, 2655-3310] vs 3263 g [interquartile range, 2855-3560]), and cesarean delivery (100% vs 20.4%; P<.001), but there were no differences in overall pregnancy or neonatal outcomes. CONCLUSION In nulliparous individuals diagnosed with placenta previa on midtrimester ultrasound, older maternal age, previous pregnancy of <20 weeks, and in vitro fertilization are associated with persistent placenta previa at delivery.
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Affiliation(s)
- Rebecca J Post
- Department of Obstetrics and Gynecology, University of California, Irvine, Irvine, CA (Drs Post, Crosland, and Chung).
| | - Jenny Chang
- Department of Medicine, University of California, Irvine, Irvine, CA (Ms Chang and Dr Ziogas)
| | - Argyrios Ziogas
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT (Dr Silver)
| | - Brian A Crosland
- Department of Obstetrics and Gynecology, University of California, Irvine, Irvine, CA (Drs Post, Crosland, and Chung)
| | - Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT (Dr Silver)
| | - David M Haas
- Department of Obstetrics and Gynecology, Indiana University Health, Indianapolis, IN (Dr Haas)
| | - William A Grobman
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Dr Grobman)
| | - George R Saade
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX (Dr Saade)
| | - Uma M Reddy
- Department of Obstetrics and Gynecology, Columbia University, New York City, NY (Dr Reddy)
| | - Hyagriv Simhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA (Dr Simhan)
| | - Judith H Chung
- Department of Obstetrics and Gynecology, University of California, Irvine, Irvine, CA (Drs Post, Crosland, and Chung)
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8
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Theilen LH, McNeil RB, Hunter S, Grobman WA, Parker CB, Catov JM, Pemberton VL, Ehrenthal DB, Haas DM, Hoffman MK, Chung JH, Mukhtar F, Arzumanyan Z, Mercer B, Parry S, Saade GR, Simhan HN, Wapner RJ, Silver RM. Serum Cotinine and Adverse Cardiovascular Outcomes: A Cross-sectional Secondary Analysis of the nuMoM2b Heart Health Study. Am J Perinatol 2023; 40:1311-1320. [PMID: 34359079 PMCID: PMC8818058 DOI: 10.1055/a-1580-3155] [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] [Indexed: 01/24/2023]
Abstract
OBJECTIVE We aimed to (1) compare serum cotinine with self-report for ascertaining smoking status among reproductive-aged women; (2) estimate the relative odds of adverse cardiovascular (CV) outcomes among women by smoking status; (3) assess whether the association between adverse pregnancy outcomes (APOs) and CV outcomes varies by smoking status. STUDY DESIGN We conducted a cross-sectional study of the nuMoM2b Heart Health Study. Women attended a study visit 2 to 7 years after their first pregnancy. The exposure was smoking status, determined by self-report and by serum cotinine. Outcomes included incident chronic hypertension (HTN), metabolic syndrome (MetS), and dyslipidemia. Multivariable logistic regression estimated odds ratios (ORs) for each outcome by smoking status. RESULTS Of 4,392 women with serum cotinine measured, 3,610 were categorized as nonsmokers, 62 as secondhand smoke exposure, and 720 as smokers. Of 3,144 women who denied tobacco smoke exposure, serum cotinine was consistent with secondhand smoke exposure in 48 (1.5%) and current smoking in 131 (4.2%) After adjustment for APOs, smoking defined by serum cotinine was associated with MetS (adjusted OR [aOR] = 1.52, 95% confidence interval [CI]: 1.21, 1.91) and dyslipidemia (aOR = 1.28, 95% CI: 1.01, 1.62). When stratified by nicotine exposure, nonsmokers with an APO in their index pregnancy had higher odds of stage 1 (aOR = 1.64, 95% CI: 1.32, 2.03) and stage 2 HTN (aOR = 2.92, 95% CI: 2.17, 3.93), MetS (aOR = 1.76, 95% CI: 1.42, 2.18), and dyslipidemia (aOR = 1.55, 95% CI: 1.25, 1.91) relative to women with no APO. Results were similar when smoking exposure was defined by self-report. CONCLUSION Whether determined by serum cotinine or self-report, smoking is associated with subsequent CV outcomes in reproductive-aged women. APOs are also independently associated with CV outcomes in women. KEY POINTS · Cotinine was detected in 5.7% of reported nonsmokers.. · Smoking and APOs were independently associated with CV health.. · Smoking was associated with MetS and dyslipidemia..
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Affiliation(s)
- Lauren H. Theilen
- Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Rebecca B. McNeil
- Division of Biostatistics and Epidemiology, RTI International, Research Triangle Park, North Carolina
| | - Shannon Hunter
- Division of Biostatistics, RTI International, Research Triangle Park, North Carolina
| | - William A. Grobman
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Corette B. Parker
- Division of Biostatistics, RTI International, Research Triangle Park, North Carolina
| | - Janet M. Catov
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburg, Pittsburg, Pennsylvania
| | - Victoria L. Pemberton
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLB), Bethesda, Maryland
| | - Deborah B. Ehrenthal
- Department of Obstetrics and Gynecology, School of Medicine, University of Wisconsin, Madison, Wisconsin
| | - David M. Haas
- Department of Obstetrics and Gynecology, School of Medicine, Indiana University, Indianapolis, Indiana
| | - Matthew K. Hoffman
- Department of Obstetrics and Gynecology, Christiana Care, Wilmington, Delaware
| | - Judith H. Chung
- Department of Obstetrics and Gynecology, School of Medicine, University of California-Irvine, Irvine, California
| | - Farhana Mukhtar
- Department of Obstetrics and Gynecology, School of Medicine, University of California-Irvine, Irvine, California
| | - Zorayr Arzumanyan
- Department of Biomedical Research, The Lundquist Institute, Los Angeles, California
| | - Brian Mercer
- Department of Obstetrics and Gynecology, Case Western Reserve University, Cleveland, Ohio
| | - Samuel Parry
- Department of Maternal Fetal Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - George R. Saade
- Division Chief of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
| | - Hyagriv N. Simhan
- Department of Obstetrics, Gynecology, and Reproductive Science, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ronald J. Wapner
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Robert M. Silver
- Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, Utah
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9
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Delgado A, Kendle A, Randis TM, Donda K, Salemi JL, Facco FL, Parker C, Reddy UM, Silver RM, Basner RC, Chung JH, Schubert FP, Pien GW, Redline S, Parry S, Grobman W, Zee PC, Louis JM. Association between sleep disordered breathing and neonatal outcomes in nulliparous individuals. Am J Perinatol 2023. [PMID: 37380034 DOI: 10.1055/a-2115-0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
BACKGROUND To determine whether objectively measured Sleep-Disordered Breathing (SDB) during pregnancy is associated with an increased risk of adverse neonatal outcomes in a cohort of nulliparous individuals. METHODS Secondary analysis of the nuMom2b- sleep disordered breathing substudy was performed. Individuals underwent in-home sleep studies for SDB assessment in early- (6-15 weeks' gestation) and mid-pregnancy (22-31 weeks' gestation). SDB was defined as an apnea-hypopnea index ≥5 events/hour at either time point. Primary outcome was a composite outcome of respiratory distress syndrome, transient tachypnea of the newborn, or receipt of respiratory support, treated hyperbilirubinemia or hypoglycemia, large-for-gestational age (LGA), seizures treated with medications or confirmed by electroencephalography, confirmed sepsis, or neonatal death. Individuals were categorized into 1) early pregnancy SDB (6-15 weeks' gestation), 2) new onset mid-pregnancy SDB (22-31 weeks' gestation), and 3) no SDB. Log-binomial regression was used to calculate adjusted risk ratios (RR) and 95% confidence intervals (CI) representing the association. Adjustments were made for maternal age, chronic hypertension, pregestational diabetes, progesterone use and Body Mass Index (BMI), new onset mid-pregnancy SDB to establish if a relationship was still present. RESULTS Among 2,106 participants, 3% percent (n=75) had early pregnancy SDB and 5.7% (n=119) developed new onset mid-pregnancy SDB. The incidence of the primary outcome was higher in offspring of individuals with early- (29.3%) and new onset mid- pregnancy SDB (30.3%) compared to individuals with no SDB (17.8%). After adjustment for maternal age, chronic hypertension, pregestational diabetes, progesterone use and BMI, new onset mid-pregnancy SDB conferred increased risk (RR=1.42, 95% CI: 1.05, 1.92), where there was no longer statistically significant association between early pregnancy SDB and the primary outcome. CONCLUSION New Onset, Mid- pregnancy SDB is independently associated with neonatal morbidity.
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Affiliation(s)
- Arlin Delgado
- Obstetrics and Gynecology, South University - Tampa, Tampa, United States
| | - Anthony Kendle
- Obstetrics and Gynecology, University of South Florida College of Medicine, Tampa, United States
| | - Tara M Randis
- Pediatrics and Molecular Biology, University of South Florida, Tampa, United States
| | - Keyur Donda
- Pediatrics, South University - Tampa, Tampa, United States
| | | | | | | | - Uma M Reddy
- Yale University School of Medicine, New Haven, United States
| | - Robert M Silver
- Obstetrics & Gynecology, The University of Utah School of Medicine, Salt Lake City, United States
| | - Robert C Basner
- Obstetrics and Gynecology, Columbia University, New York, United States
| | - Judith H Chung
- Department of Obstetrics and Gynecology, University of California Irvine, Irvine, United States
| | - Frank Paul Schubert
- Obstetrics and Gynecology - Division of Maternal Fetal Medicine, Indiana University School of Medicine, Indianapolis, United States
| | - Grace W Pien
- Johns Hopkins University, Baltimore, United States
| | - Susan Redline
- Beth Israel Deaconess Medical Center, Boston, United States
| | - Samuel Parry
- Maternal-Fetal Medicine, University of Pennsylvania, Philadelphia, United States
| | - William Grobman
- Obstetrics and Gynecology, The Ohio State University, Columbus, United States
| | - Phyllis C Zee
- Neurology, Northwestern University, Evanston, United States
| | - Judette M Louis
- Obstetrics & Gynecology, University of South Florida, Tampa, United States
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10
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Yan Q, Guerrero RF, Khan RR, Surujnarine AA, Wapner RJ, Hahn MW, Raja A, SallebAouissi A, Grobman WA, Simhan H, Blue NR, Silver R, Chung JH, Reddy UM, Radivojac P, Pe'er I, Haas DM. Searching and visualizing genetic associations of pregnancy traits by using GnuMoM2b. medRxiv 2023:2023.05.25.23290500. [PMID: 37333377 PMCID: PMC10274999 DOI: 10.1101/2023.05.25.23290500] [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] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Adverse pregnancy outcomes (APOs) are major risk factors for women's health during pregnancy and even in the years after pregnancy. Due to the heterogeneity of APOs, only few genetic associations have been identified. In this report, we conducted genome-wide association studies (GWAS) of 479 traits that are possibly related to APOs using a large and racially diverse study, Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b). To display the extensive results, we developed a web-based tool GnuMoM2b ( https://gnumom2b.cumcobgyn.org/ ) for searching, visualizing, and sharing results from GWAS of 479 pregnancy traits as well as phenome-wide association studies (PheWAS) of more than 17 million single nucleotide polymorphisms (SNPs). The genetic results from three ancestries (Europeans, Africans, and Admixed Americans) and meta-analyses are populated in GnuMoM2b. In conclusion, GnuMoM2b is a valuable resource for extraction of pregnancy-related genetic results and shows the potential to facilitate meaningful discoveries.
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Venkatesh KK, Yee LM, Johnson JD, McNeil RB, Chung JH, Mercer BM, Simhan H, Reddy UM, Silver RM, Parry S, Wapner RJ, Saade GR, Denning-Johnson Lynch C, Grobman WA. Neighborhood socioeconomic disadvantage and abnormal fetal growth. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.056] [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: 01/09/2023]
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12
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Licon E, Chang J, Simhan H, Grobman WA, Saade GR, Haas DM, Silver BM, Chung JH, Thiel de Bocanegra H. Birth outcomes of nulliparous immigrants in the United States. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.1075] [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: 01/09/2023]
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13
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Bank TC, Grasch JL, Chung JH, Mercer BM, McNeil RB, Parry S, Saade GR, Shanks AL, Silver BM, Simhan H, Yee LM, Grobman WA, Frey HA. The association of sodium intake with the development of hypertensive disorders of pregnancy. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.1257] [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: 01/09/2023]
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14
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Post RJ, Schmidt L, Crosland A, Chang J, Ziogas A, Silver BM, Parry S, Saade GR, Grobman WA, Mercer BM, Bernard C, Simhan H, Chung JH. Unintended pregnancy risk factors and perinatal outcomes in a nulliparous population. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.963] [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: 01/09/2023]
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15
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Grasch JL, Venkatesh KK, Silver BM, Saade GR, Mercer BM, Yee LM, Scifres C, Parry S, Simhan H, Chung JH, McNeil RB, Grobman WA, Frey HA. Association of obesity with outcomes of attempted operative vaginal delivery. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.843] [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: 01/09/2023]
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16
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Meiman JC, Grobman WA, Yee LM, Haas DM, McNeil RB, Chung JH, Mercer BM, Simhan H, Reddy UM, Silver RM, Parry S, Wapner RJ, Saade GR, Denning-Johnson Lynch C, Venkatesh KK. Association of neighborhood socioeconomic disadvantage and postpartum readmission. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.052] [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: 01/09/2023]
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17
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Milone GF, Lindsay KL, Mercer BM, Saade GR, Silver BM, Haas DM, Simhan H, Parry S, Reddy UM, Chung JH. Is periconceptional diet associated with a shortened cervix and preterm birth? Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.1084] [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: 01/09/2023]
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18
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Milone GF, Lindsay KL, Mercer BM, Saade GR, Silver BM, Haas DM, Simhan H, Parry S, Reddy UM, Chung JH. Nausea and vomiting of pregnancy beyond the first trimester and the risk of preterm birth. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.553] [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: 01/09/2023]
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19
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Parry S, Carper BA, Grobman WA, Wapner RJ, Chung JH, Haas DM, Mercer B, Silver RM, Simhan HN, Saade GR, Reddy UM, Parker CB. Placental protein levels in maternal serum are associated with adverse pregnancy outcomes in nulliparous patients. Am J Obstet Gynecol 2022; 227:497.e1-497.e13. [PMID: 35487327 PMCID: PMC9420814 DOI: 10.1016/j.ajog.2022.03.064] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND The Eunice Kennedy Shriver National Institute of Child Health and Human Development Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be was established to investigate the underlying causes and pathophysiological pathways associated with adverse pregnancy outcomes in nulliparous gravidas. OBJECTIVE This study aimed to study placental physiology and identify novel biomarkers concerning adverse pregnancy outcomes, including preterm birth (medically indicated and spontaneous), preeclampsia, small-for-gestational-age neonates, and stillbirth. We measured levels of placental proteins in the maternal circulation in the first 2 trimesters of pregnancy. STUDY DESIGN Maternal serum samples were collected at 2 study visits (6-13 weeks and 16-21 weeks), and levels of 9 analytes were measured. The analytes we measured were vascular endothelial growth factor, placental growth factor, endoglin, soluble fms-like tyrosine kinase-1, A disintegrin and metalloproteinase domain-containing protein 12, pregnancy-associated plasma protein A, free beta-human chorionic gonadotropin, inhibin A, and alpha-fetoprotein. The primary outcome was preterm birth between 20 0/7 and 36 6/7 weeks of gestation. The secondary outcomes were spontaneous preterm births, medically indicated preterm births, preeclampsia, small-for-gestational-age neonates, and stillbirth. RESULTS A total of 10,038 eligible gravidas were enrolled in the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be cohort, from which a nested case-control study was performed comparing 800 cases with preterm birth (466 spontaneous preterm births, 330 medically indicated preterm births, and 4 unclassified preterm births), 568 with preeclampsia, 406 with small-for-gestational-age birth, and 49 with stillbirth with 911 controls who delivered at term without complications. Although levels of each analyte generally differed between cases and controls at 1 or 2 visits, the odds ratios revealed a <2-fold difference between cases and controls in all comparisons. Receiver operating characteristic curves, generated to determine the relationship between analyte levels and preterm birth and the other adverse pregnancy outcomes, resulted in areas under the receiver operating characteristic curves that were relatively low (range, 0.50-0.64) for each analyte. Logistic regression modeling demonstrated that areas under the receiver operating characteristic curves for predicting adverse pregnancy outcomes were greater using baseline clinical characteristics and combinations of analytes than baseline characteristics alone, but areas under the receiver operating characteristic curves remained relatively low for each outcome (range, 0.65-0.78). CONCLUSION We have found significant associations between maternal serum levels of analytes evaluated early in pregnancy and subsequent adverse pregnancy outcomes in nulliparous gravidas. However, the test characteristics for these analytes do not support their use as clinical biomarkers to predict adverse pregnancy outcomes, either alone or in combination with maternal clinical characteristics.
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Affiliation(s)
- Samuel Parry
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | | | - William A Grobman
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL
| | - Ronald J Wapner
- Department of Obstetrics and Gynecology, Columbia University, New York, NY
| | - Judith H Chung
- Department of Obstetrics and Gynecology, University of California, Irvine, Orange, CA
| | - David M Haas
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN
| | - Brian Mercer
- Department of Obstetrics and Gynecology, MetroHealth System, Cleveland, OH
| | - Robert M Silver
- Department of Obstetrics and Gynecology, The University of Utah Health Sciences Center, Salt Lake City, UT
| | - Hyagriv N Simhan
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA
| | - George R Saade
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Uma M Reddy
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT
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20
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Metz TD, Allshouse AA, McMillin GA, Silver RM, Smid MC, Haas DM, Simhan HN, Saade GR, Grobman WA, Parry S, Chung JH, Jarlenski MP. Association of Cannabis Use With Nausea and Vomiting of Pregnancy. Obstet Gynecol 2022; 140:266-270. [PMID: 35852278 PMCID: PMC9309979 DOI: 10.1097/aog.0000000000004850] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/21/2022] [Indexed: 11/26/2022]
Abstract
Our objective was to evaluate whether cannabis use was associated with nausea and vomiting in early pregnancy. Participants from nuMoM2b (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be) enrolled from October 2010 through September 2013 with a PUQE (Pregnancy-Unique Quantification of Emesis) questionnaire and an available stored urine sample from the first study visit (median gestational age 12 weeks) were included. Cannabis exposure was ascertained by urine immunoassay for 11-nor-9-carboxy-delta-9-tetrahydrocannabinol (THC-COOH); positive results were confirmed with liquid chromatography tandem mass spectrometry. The primary outcome was moderate-to-severe nausea by the PUQE score. Overall, 9,250 participants were included, and 5.8% (95% CI 5.4-6.3%) had detectable urine THC-COOH. In adjusted analyses, higher THC-COOH levels were associated with greater odds of moderate-to-severe nausea (20.7% in the group with THC-COOH detected vs 15.5% in the group with THC-COOH not detected, adjusted odds ratio 1.6, 95% CI 1.1-2.2 for a 500 ng/mg Cr THC-COOH increment).
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Affiliation(s)
- Torri D Metz
- University of Utah Health and ARUP Laboratories, Salt Lake City, Utah; Indiana University, Indianapolis, Indiana; University of Pittsburgh, Pittsburgh, Pennsylvania; University of Texas Medical Branch, Galveston, Texas; The Ohio State University, Columbus, Ohio; University of Pennsylvania, Philadelphia, Pennsylvania; University of California Irvine, Irvine, California; and University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
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21
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Pagel KA, Chu H, Ramola R, Guerrero RF, Chung JH, Parry S, Reddy UM, Silver RM, Steller JG, Yee LM, Wapner RJ, Hahn MW, Natarajan S, Haas DM, Radivojac P. Association of Genetic Predisposition and Physical Activity With Risk of Gestational Diabetes in Nulliparous Women. JAMA Netw Open 2022; 5:e2229158. [PMID: 36040739 PMCID: PMC9428742 DOI: 10.1001/jamanetworkopen.2022.29158] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Polygenic risk scores (PRS) for type 2 diabetes (T2D) can improve risk prediction for gestational diabetes (GD), yet the strength of the association between genetic and lifestyle risk factors has not been quantified. OBJECTIVE To assess the association of PRS and physical activity in existing GD risk models and identify patient subgroups who may receive the most benefits from a PRS or physical activity intervention. DESIGN, SETTINGS, AND PARTICIPANTS The Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be cohort was established to study individuals without previous pregnancy lasting at least 20 weeks (nulliparous) and to elucidate factors associated with adverse pregnancy outcomes. A subcohort of 3533 participants with European ancestry was used for risk assessment and performance evaluation. Participants were enrolled from October 5, 2010, to December 3, 2013, and underwent genotyping between February 19, 2019, and February 28, 2020. Data were analyzed from September 15, 2020, to November 10, 2021. EXPOSURES Self-reported total physical activity in early pregnancy was quantified as metabolic equivalents of task (METs). Polygenic risk scores were calculated for T2D using contributions of 84 single nucleotide variants, weighted by their association in the Diabetes Genetics Replication and Meta-analysis Consortium data. MAIN OUTCOMES AND MEASURES Estimation of the development of GD from clinical, genetic, and environmental variables collected in early pregnancy, assessed using measures of model discrimination. Odds ratios and positive likelihood ratios were used to evaluate the association of PRS and physical activity with GD risk. RESULTS A total of 3533 women were included in this analysis (mean [SD] age, 28.6 [4.9] years). In high-risk population subgroups (body mass index ≥25 or aged ≥35 years), individuals with high PRS (top 25th percentile) or low activity levels (METs <450) had increased odds of a GD diagnosis of 25% to 75%. Compared with the general population, participants with both high PRS and low activity levels had higher odds of a GD diagnosis (odds ratio, 3.4 [95% CI, 2.3-5.3]), whereas participants with low PRS and high METs had significantly reduced risk of a GD diagnosis (odds ratio, 0.5 [95% CI, 0.3-0.9]; P = .01). CONCLUSIONS AND RELEVANCE In this cohort study, the addition of PRS was associated with the stratified risk of GD diagnosis among high-risk patient subgroups, suggesting the benefits of targeted PRS ascertainment to encourage early intervention.
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Affiliation(s)
- Kymberleigh A. Pagel
- Department of Computer Science, Indiana University, Bloomington
- Institute of Computational Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Hoyin Chu
- Khoury College of Computer Sciences, Northeastern University, Boston, Massachusetts
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Rashika Ramola
- Khoury College of Computer Sciences, Northeastern University, Boston, Massachusetts
| | - Rafael F. Guerrero
- Department of Biological Sciences, North Carolina State University, Raleigh
| | - Judith H. Chung
- Department of Obstetrics and Gynecology, University of California, Irvine
| | - Samuel Parry
- Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia
| | - Uma M. Reddy
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Robert M. Silver
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City
| | | | - Lynn M. Yee
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ronald J. Wapner
- College of Physicians and Surgeons, Columbia University, New York, New York
| | - Matthew W. Hahn
- Department of Computer Science, Indiana University, Bloomington
- Department of Biology, Indiana University, Bloomington
| | | | - David M. Haas
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis
| | - Predrag Radivojac
- Khoury College of Computer Sciences, Northeastern University, Boston, Massachusetts
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22
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Theilen LH, Greenland P, Varagic J, Catov J, Shanks A, Thorsten V, Parker CB, McNeil R, Mercer B, Hoffman M, Wapner R, Haas D, Simhan H, Grobman W, Chung JH, Levine LD, Barnes S, Bairey Merz N, Saade G, Silver RM. Association between aspirin use during pregnancy and cardiovascular risk factors 2-7 years after delivery: The nuMoM2b Heart Health Study. Pregnancy Hypertens 2022; 28:28-34. [PMID: 35158155 PMCID: PMC9133043 DOI: 10.1016/j.preghy.2022.01.012] [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] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 01/08/2022] [Accepted: 01/31/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To evaluate the association between aspirin use during first pregnancy and later maternal cardiovascular risk. STUDY DESIGN In this secondary analysis of a prospective cohort, we included participants who carried their first pregnancy to 20 + weeks, had data regarding aspirin use, and attended a study visit 2-7 years following delivery. The exposure was aspirin use during the first pregnancy. We calculated aspirin use propensity scores from logistic regression models including baseline variables associated with aspirin use in pregnancy and cardiovascular risk. Outcomes of interest were incident cardiovascular-related diagnoses 2-7 years following delivery. Robust Poisson regression calculated the risk of outcomes by aspirin exposure, adjusting for the aspirin use propensity score. MAIN OUTCOME MEASURES The primary outcome was a composite of incident cardiovascular diagnoses at the time of the study visit: cardiovascular events, chronic hypertension, metabolic syndrome, prediabetes or type 2 diabetes, dyslipidemia, and chronic kidney disease. RESULTS Of 4,480 women included, 84 (1.9%) reported taking aspirin during their first pregnancy. 52.6% of participants in the aspirin-exposed group and 43.0% in the unexposed group had the primary outcome. After adjusting for the aspirin use propensity scores, aspirin use during the first pregnancy was not associated with any of the outcomes. CONCLUSION We did not detect an association between aspirin use during the first pregnancy and cardiovascular-related diagnoses 2-7 years later. Our study was only powered to detect a large difference in relative risk, so we cannot rule out a smaller difference that may be clinically meaningful.
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Affiliation(s)
- Lauren H Theilen
- University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132, United States.
| | - Philip Greenland
- Northwestern University Feinberg School of Medicine, 680 N Lakeshore Dr, Chicago, IL 60611, United States.
| | - Jasmina Varagic
- National Heart, Lung, and Blood Institute, 31 Center Drive, Bethesda, MD 20892, United States.
| | - Janet Catov
- University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15213, United States.
| | - Anthony Shanks
- Indiana University School of Medicine, 720 Eskenazi Avenue, Indianapolis, IN 46202, United States.
| | | | | | | | - Brian Mercer
- MetroHealth, 2500 MetroHealth Drive, G267, Cleveland, OH 44109, United States.
| | - Matthew Hoffman
- Christiana Care, 4755 Ogletown Stanton Road, Newark, DE 19718, United States.
| | - Ronald Wapner
- Columbia University, 622 West 168(th) Street, New York, NY 10032, United States.
| | - David Haas
- Indiana University School of Medicine, 720 Eskenazi Avenue, Indianapolis, IN 46202, United States.
| | - Hyagriv Simhan
- University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15213, United States.
| | - William Grobman
- Northwestern University Feinberg School of Medicine, 680 N Lakeshore Dr, Chicago, IL 60611, United States.
| | - Judith H Chung
- University of California, Irvine, 333 City Tower West, Suite 1400, Orange, CA 92868, United States.
| | - Lisa D Levine
- University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, 2 Silverstein, Philadelphia, PA 19104, United States.
| | - Shannon Barnes
- Indiana University School of Medicine, 720 Eskenazi Avenue, Indianapolis, IN 46202, United States.
| | - Noel Bairey Merz
- Cedars Sinai Smidt Heart Institute, 127 S San Vicente Blvd #A3600, Los Angeles, CA 90048, United States.
| | - George Saade
- University of Texas Medical Branch, 1005 Harborside Drive, Galveston, TX 77555, United States.
| | - Robert M Silver
- University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132, United States.
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Cho GJ, Cho KD, Kim HY, Ha S, Oh MJ, Won HS, Chung JH. Short-term neonatal and long-term infant outcome of late-preterm twins: nationwide population-based study. Ultrasound Obstet Gynecol 2022; 59:763-770. [PMID: 34931725 DOI: 10.1002/uog.24838] [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] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 11/04/2021] [Accepted: 12/02/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To evaluate the short- and long-term outcome of late-preterm compared with term birth in twin pregnancy. METHODS This retrospective observational cohort study included all women who had a twin delivery between 1 January 2007 and 31 December 2010 recorded in the claims database of the Korea National Health Insurance, with at least one follow-up recorded in the database of the National Health Screening Program for Infants and Children. Outcomes were analyzed at the pregnancy level, with adverse outcome being defined as an adverse outcome in one or both twins, identified by a diagnosis according to the International Classification of Diseases 10th Revision. The primary short-term outcome was composite morbidity, which included any of the following: transient tachypnea, respiratory distress syndrome, necrotizing enterocolitis, intraventricular hemorrhage and bronchopulmonary dysplasia. Long-term adverse outcome included any neurological or neurodevelopmental outcome, defined by prespecified neurological and developmental diagnoses; these were assessed by following up all neonates until the end of 2018, by which time they were 8-11 years of age. Outcomes were compared between twins delivered late preterm (34 + 0 to 36 + 6 weeks) and those delivered at term (≥ 37 weeks). RESULTS Among 17 189 women who delivered twins at ≥ 34 weeks of gestation during the study period, 5032 (29.27%) women delivered in the late-preterm period. On multivariate analysis, compared with the twins delivered at term, the late-preterm twins had an increased risk for the primary short-term outcome of composite morbidity (adjusted odds ratio (aOR), 2.09; 95% CI, 1.90-2.30), including transient tachypnea (aOR, 1.85; 95% CI, 1.64-2.09), respiratory distress syndrome (aOR, 2.31; 95% CI, 2.04-2.62), necrotizing enterocolitis (aOR, 2.10; 95% CI, 1.20-3.69) and intraventricular hemorrhage (aOR, 2.13; 95% CI, 1.46-3.11). For the long-term outcome, the late-preterm twins also had an increased risk for any neurological or neurodevelopmental outcome (adjusted hazard ratio, 1.14; 95% CI, 1.07-1.21). CONCLUSIONS Twins delivered in the late-preterm period have an increased risk for short- and long-term morbidity compared with twins delivered at term. These results should be considered when determining the timing of delivery in uncomplicated twin pregnancy. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- G J Cho
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - K-D Cho
- Big Data Department, National Health Insurance Service, Gangwon-do, Korea
| | - H Y Kim
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - S Ha
- Graduate School of Statistics, Sungkyunkwan University, Seoul, Korea
| | - M-J Oh
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - H-S Won
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - J H Chung
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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24
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Facco FL, Redline S, Hunter SM, Zee PC, Grobman WA, Silver RM, Louis JM, Pien GW, Mercer B, Chung JH, Bairey Merz CN, Haas DM, Nhan-Chang CL, Simhan HN, Schubert FP, Parry S, Reddy U, Saade GR, Hoffman MK, Levine LD, Wapner RJ, Catov JM, Parker CB. Sleep-disordered Breathing in Pregnancy and after Delivery: Associations with Cardiometabolic Health. Am J Respir Crit Care Med 2022; 205:1202-1213. [PMID: 35144521 PMCID: PMC9872809 DOI: 10.1164/rccm.202104-0971oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Rationale: Knowledge gaps exist regarding health implications of sleep-disordered breathing (SDB) identified in pregnancy and/or after delivery. Objectives: To determine whether SDB in pregnancy and/or after delivery is associated with hypertension (HTN) and metabolic syndrome (MS). Methods: nuMoM2b-HHS (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be Heart Health Study) (N = 4,508) followed participants initially recruited during their first pregnancy. Participants returned for a visit 2-7 years after pregnancy. This study examined a subgroup who underwent SDB assessments during their first pregnancy (n = 1,964) and a repeat SDB assessment after delivery (n = 1,222). Two SDB definitions were considered: 1) apnea-hypopnea index (AHI) ⩾ 5 and 2) oxygen desaturation index (ODI) ⩾ 5. Associations between SDB and incident HTN and MS were evaluated with adjusted risk ratios (aRRs). Measurements and Main Results: The aRR for MS given an AHI ⩾ 5 during pregnancy was 1.44 (95% confidence interval [CI], 1.08-1.93), but no association with HTN was found. ODI ⩾ 5 in pregnancy was associated with both an increased risk for HTN (aRR, 2.02; 95% CI, 1.30-3.14) and MS (aRR, 1.53; 95% CI, 1.19-1.97). Participants with an AHI ⩾ 5 in pregnancy that persisted after delivery were at higher risk for both HTN (aRR, 3.77; 95% CI, 1.84-7.73) and MS (aRR, 2.46; 95% CI, 1.59-3.76). Similar associations were observed for persistent ODI ⩾ 5 after delivery. Conclusions: An AHI ⩾ 5 in pregnancy was associated with an increased risk of MS. An ODI ⩾ 5 in pregnancy was significantly associated with both HTN and MS. Participants with persistent elevations in AHI and ODI during pregnancy and at 2-7 years after delivery were at the highest risk for HTN and MS. Clinical trial registered with www.clinicaltrials.gov (NCT02231398).
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Affiliation(s)
- Francesca L. Facco
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Susan Redline
- Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts
| | | | | | - William A. Grobman
- Department of Obstetrics, Gynecology-Maternal Fetal Medicine and Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Robert M. Silver
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
| | - Judette M. Louis
- University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Grace W. Pien
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Brian Mercer
- Department of Obstetrics and Gynecology, Case Western Reserve, MetroHealth, Cleveland, Ohio
| | - Judith H. Chung
- Department of Obstetrics and Gynecology, University of California, Irvine, Irvine, California
| | - C. Noel Bairey Merz
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - David M. Haas
- Department of Obstetrics and Gynecology, School of Medicine, Indiana University, Indianapolis, Indiana
| | - Chia-Ling Nhan-Chang
- Department of Obstetrics and Gynecology, Columbia University, New York, New York
| | - Hyagriv N. Simhan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Frank P. Schubert
- Department of Obstetrics and Gynecology, School of Medicine, Indiana University, Indianapolis, Indiana
| | - Samuel Parry
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Uma Reddy
- Department of Obstetrics, Gynecology & Reproductive Services, Yale University, New Haven, Connecticut
| | - George R. Saade
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, University of Texas, Galveston, Texas; and
| | - Matthew K. Hoffman
- Department of Obstetrics and Gynecology, Christiana Care Health System, Wilmington, Delaware
| | - Lisa D. Levine
- Department of Obstetrics and Gynecology, School of Medicine, Indiana University, Indianapolis, Indiana
| | - Ronald J. Wapner
- Department of Obstetrics and Gynecology, Columbia University, New York, New York
| | - Janet M. Catov
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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25
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Kim H, Jang J, Song MJ, Kim G, Park CH, Lee DH, Lee SH, Chung JH. Attenuation of intrinsic aging of the skin via elimination of senescent dermal fibroblasts with senolytic drugs. J Eur Acad Dermatol Venereol 2022; 36:1125-1135. [PMID: 35274377 DOI: 10.1111/jdv.18051] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 11/02/2021] [Accepted: 02/15/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Skin aging is caused by numerous factors that result in structural and functional changes in cutaneous components. Research has shown that senescent cells are known to accumulate in skin aging, however, the role of senescent cells in skin aging has not been defined. OBJECTIVES To elucidate the role of senescent cell in skin aging, we evaluated the effect of known senolytic drugs on senescent dermal fibroblasts. METHODS Primary human dermal fibroblasts (HDFs) were induced to senescence by long-term passaging, UV irradiation, and H2O2 treatment. Cell viability was measured after treatment of ABT-263 and ABT-737 on HDFs. Young and aged hairless mice were intradermally injected with drugs or vehicle on the dorsal skin for 10 days. Skin specimens were obtained and reverse-transcription quantitative PCR, western blotting, and histological analysis were performed. RESULTS We found that ABT-263 and ABT-737 induced selective clearance of senescent dermal fibroblasts, regardless of the method of senescence induction. Aged mouse skin treated with ABT-263 or ABT-737 showed increased collagen density, epidermal thickness, and proliferation of keratinocytes, as well as decreased senescence-associated secretory phenotypes, such as MMP-1 and IL-6. CONCLUSIONS Taken together, our results indicate that selective clearance of senescent skin cells can attenuate and improve skin aging phenotypes and that senolytic drugs may be of potential use as new therapeutic agents for treating aging of the skin.
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Affiliation(s)
- H Kim
- Department of Dermatology, Seoul National University College of Medicine.,Department of Biomedical Sciences, Seoul National University Graduate School.,Institute of Human-Environmental Interface Biology, Medical Research Center, Seoul National University
| | - J Jang
- Department of Dermatology, Seoul National University College of Medicine.,Institute of Human-Environmental Interface Biology, Medical Research Center, Seoul National University
| | - M J Song
- Department of Dermatology, Seoul National University College of Medicine.,Department of Biomedical Sciences, Seoul National University Graduate School.,Institute of Human-Environmental Interface Biology, Medical Research Center, Seoul National University
| | - G Kim
- Department of Dermatology, Seoul National University College of Medicine.,Department of Biomedical Sciences, Seoul National University Graduate School.,Institute of Human-Environmental Interface Biology, Medical Research Center, Seoul National University
| | - C-H Park
- Department of Dermatology, Seoul National University College of Medicine.,Institute of Human-Environmental Interface Biology, Medical Research Center, Seoul National University
| | - D H Lee
- Department of Dermatology, Seoul National University College of Medicine.,Institute of Human-Environmental Interface Biology, Medical Research Center, Seoul National University
| | - S-H Lee
- Department of Dermatology, Seoul National University College of Medicine.,Institute of Human-Environmental Interface Biology, Medical Research Center, Seoul National University
| | - J H Chung
- Department of Dermatology, Seoul National University College of Medicine.,Department of Biomedical Sciences, Seoul National University Graduate School.,Institute of Human-Environmental Interface Biology, Medical Research Center, Seoul National University.,Institute on Aging, Seoul National University, Seoul, Republic of Korea
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26
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Lindsay KL, Milone GF, Grobman WA, Haas DM, Mercer BM, Simhan HN, Saade G, Silver RM, Chung JH. Periconceptional diet quality is associated with gestational diabetes risk and glucose concentrations among nulliparous gravidas. Front Endocrinol (Lausanne) 2022; 13:940870. [PMID: 36133312 PMCID: PMC9483841 DOI: 10.3389/fendo.2022.940870] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/18/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) and elevated glucose concentrations below the threshold for GDM diagnosis have been associated with adverse pregnancy and offspring outcomes. Dietary interventions initiated during pregnancy have demonstrated inconsistent beneficial effects. Limited data exist regarding the effects of periconceptional diet on gestational glycemia. OBJECTIVE To evaluate independent associations between periconceptional diet quality with GDM frequency and glucose concentrations from GDM screening and diagnostic tests among nulliparous gravidas. DESIGN This is a secondary analysis of N=7997 participants from the NuMoM2b multicenter, prospective, observational cohort study of first pregnancies. The Alternative Healthy Eating Index (AHEI)-2010 was computed from food frequency questionnaires completed in early pregnancy (6-13 weeks), reporting usual dietary intake over the preceding 3 months. GDM screening was performed either by non-fasting 1-hour 50g glucose load (N=6845), followed by 3-hour 100g glucose tolerance test (GTT) for those with raised glucose concentrations (N=1116; at risk for GDM), or by a single 2-hour 75g GTT (N=569; all GDM risk levels). Logistic and linear regression were used to estimate the associations between the AHEI-2010 score with odds of GDM, having raised blood glucose on the 1-hour screening test, and continuous glucose concentrations on screening and diagnostic tests. All models were adjusted for a priori covariates: maternal age, race/ethnicity, early-pregnancy body mass index, smoking habits, rate of gestational weight gain, energy intake, nausea and vomiting in early pregnancy, study site. RESULTS Poorer periconceptional diet quality was observed among participants who were younger, with higher BMI, lower income levels, and of non-Hispanic Black or Hispanic ethnicity. The GDM rate was 4%. Each 1-point increase in AHEI-2010 score was associated with a 1% decrease in the odds of being diagnosed with GDM (beta=-0.015, p=0.022, OR=0.986, 95% CI 0.973 to 0.998). Diet quality was inversely associated with each post glucose load concentration on the non-fasting screening test and the 2-hour and 3-hour GTT. CONCLUSION Poor periconceptional diet quality is independently associated with an increased risk of GDM and with minor elevations in serum glucose concentrations on GDM screening and diagnostic tests, in a diverse cohort of nulliparas. Periconception intervention studies targeting diet quality are warranted.
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Affiliation(s)
- Karen L. Lindsay
- Susan Samueli Integrative Health Institute, Susan & Henry Samueli College of Health Sciences, University of California, Irvine, CA, United States
- Division of Endocrinology, Department of Pediatrics, University of California, Irvine, School of Medicine, Orange, CA, United States
- *Correspondence: Karen L. Lindsay,
| | - Gina F. Milone
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of California, Irvine, School of Medicine, Orange, CA, United States
| | - William A. Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - David M. Haas
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Brian M. Mercer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Cleveland, OH, United States
| | - Hyagriv N. Simhan
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - George R. Saade
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, United States
| | - Robert M. Silver
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, UT, United States
| | - Judith H. Chung
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of California, Irvine, School of Medicine, Orange, CA, United States
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27
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Milone G, Chung JH, Haas DM, Silver RM, Grobman WA, Simhan H, Saade GR, Reddy UM, Lindsay K. Periconceptional diet quality predicts glycemic control and gestational diabetes risk in nulliparous women. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.106] [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: 11/25/2022]
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28
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Heerboth S, Allshouse AA, Nourse SE, Silver BM, Grobman WA, Chung JH, Simhan H, Reddy UM, Saade GR, Shanks A, Blue N. Deriving a sex-specific fetal growth standard. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.872] [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: 11/25/2022]
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29
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Melber DJ, Pantham P, Adami RR, Fratto V, De Hoff P, Vuppala A, Srinivasan S, Afshar Y, Makhoul JA, Westermann M, Cassidy AG, Meads M, Liu TN, Magallanes CG, Martinez-King C, Fernando AN, Tran VH, To C, Jacobs MB, Murphy AM, Chung JH, Norton ME, Parast MM, Laurent LC. Maternal Serum miRNAs as Biomarkers for Abnormal Placentation. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.744] [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]
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30
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Westermann M, De Zoysa M, Yang T, Chung JH. Comparison of magnesium sulfate loading dose on ability to achieve a therapeutic level. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.1223] [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: 11/01/2022]
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31
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Post RJ, Chang J, Ziogas A, Crosland A, Silver BM, Haas DM, Grobman WA, Saade GR, Reddy UM, Simhan H, Chung JH. Risk factors and perinatal outcomes for persistent placenta previa in nulliparous women. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.563] [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: 11/01/2022]
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32
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De Zoysa M, Chung JH, Adkins K, Steller J. Factors associated with postpartum readmission for hypertensive disorders of pregnancy. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.767] [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: 11/01/2022]
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33
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Coakley KE, Yang TB, Chung JH. Periviable delivery of a pregnancy in a rudimentary uterine horn: A case report. Case Rep Womens Health 2021; 32:e00346. [PMID: 34381697 PMCID: PMC8339228 DOI: 10.1016/j.crwh.2021.e00346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 12/03/2022] Open
Abstract
Pregnancy in a rudimentary uterine horn is an extremely rare form of ectopic pregnancy, with an incidence of 1 in 76,000-140,000 pregnancies. Given its high-risk nature, the standard of care is to terminate such pregnancies at the time of diagnosis. This is a case of a nulliparous patient at 23 5/7 weeks of gestation with a new diagnosis of a rudimentary horn pregnancy. She elected to proceed with full intervention for her fetus and was delivered at 24 0/7 weeks after administration of antenatal corticosteroid therapy. While the infant did have some adverse effects related to prematurity, she met developmental milestones and was alive and well at the age of two. Although the standard of care is to manage these cases as ectopic pregnancies, when diagnosed at a periviable gestational age, optimization of fetal status prior to delivery may be an alternative approach to immediate delivery.
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Affiliation(s)
- Katherine E. Coakley
- University of California, Irvine Medical Center, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, 333 City Boulevard West, Suite 1400, Orange, CA 92868, United States of America
| | - Tyler B. Yang
- University of California, Irvine Medical Center, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, 333 City Boulevard West, Suite 1400, Orange, CA 92868, United States of America
| | - Judith H. Chung
- University of California, Irvine Medical Center, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, 333 City Boulevard West, Suite 1400, Orange, CA 92868, United States of America
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34
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Son SL, Allshouse AA, Heinrichs GA, Garite TJ, Silver RM, Wapner RJ, Grobman WA, Chung JH, Mercer BM, Metz TD. Is Exposure to Intrapartum Prostaglandins for Labor Induction Associated with a Lower Incidence of Neonatal Respiratory Distress Syndrome? Am J Perinatol 2021; 38:993-998. [PMID: 33934327 DOI: 10.1055/s-0041-1728820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Respiratory distress syndrome (RDS) is implicated in 30% of neonatal deaths. Since prostaglandins promote surfactant secretion and labor is associated with a lower risk of RDS in term neonates, it is plausible that synthetic prostaglandin (sPG) exposure is associated with a lower risk of RDS. Thus, we evaluated the association between sPG exposure and RDS in neonates born after the induction of labor (IOL). STUDY DESIGN Secondary analysis of women with singleton pregnancies undergoing IOL at 340/7 to 420/7 weeks in the nuMoM2b study, a multicenter prospective cohort of nulliparous women. RDS rates and secondary neonatal outcomes in neonates with intrapartum sPG exposure were compared with those who had IOL with non-sPG methods (e.g., balloon catheter, amniotomy, oxytocin, and laminaria). Logistic regression models estimated the association of sPG with RDS and with secondary outcomes after adjustment for clinical and demographic factors (including gestational age). A sensitivity analysis was performed in which analysis was restricted to those with an admission cervical dilation ≤2 cm. RESULTS Of 10,038 women in the total cohort, 3,071 met inclusion criteria; 1,444 were exposed and 1,627 were unexposed to sPGs. Antenatal corticosteroid exposure rates were low (3.0%) and similar between groups. In univariable analysis, neonates with sPG exposure had higher rates of RDS (3.2 vs. 2.0%, odds ratio [OR]: 1.59, 95% confidence interval [CI]: 1.01-2.50). This relationship was similar by gestational age at delivery (term vs. preterm, interaction p = 0.14). After adjustment, the association between sPG and RDS was no longer significant (adjusted odds ratio: 1.4, 95% CI: 0.9-2.3). When analysis was restricted to subjects with admission cervical dilation of ≤2 cm, there was also no association between sPG exposure and RDS. CONCLUSION In pregnancies between 34 and 42 weeks of gestation, exposure to sPG for cervical ripening or labor induction was not associated with newborn RDS. KEY POINTS · RDS is implicated in 30% of neonatal deaths.. · sPG exposure was not associated with RDS.. · Avoiding preterm birth remains crucial in RDS prevention..
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Affiliation(s)
- Shannon L Son
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah.,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Intermountain Healthcare, Salt Lake City, Utah
| | - Amanda A Allshouse
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
| | - Gretchen A Heinrichs
- Department of Obstetrics and Gynecology, Denver Health and Hospital Authority, Denver, Colorado
| | - Thomas J Garite
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California Irvine, Orange, California
| | - Robert M Silver
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah.,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Intermountain Healthcare, Salt Lake City, Utah
| | - Ronald J Wapner
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York City, New York
| | - William A Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Judith H Chung
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California Irvine, Orange, California
| | - Brian M Mercer
- Department of Obstetrics & Gynecology, The MetroHealth System, Case Western Reserve University, Clevelend, Ohio
| | - Torri D Metz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah.,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Intermountain Healthcare, Salt Lake City, Utah
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Blue NR, Hoffman M, Allshouse AA, Grobman WA, Simhan HN, Turan OM, Parry S, Chung JH, Reddy U, Haas DM, Myers S, Mercer B, Saade GR, Silver RM. Antenatal Fetal Adrenal Measurements at 22 to 30 Weeks' Gestation, Fetal Growth Restriction, and Perinatal Morbidity. Am J Perinatol 2021; 38:676-682. [PMID: 31756754 PMCID: PMC7708295 DOI: 10.1055/s-0039-3400308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Our objective was to test the association of fetal adrenal size with perinatal morbidity among fetuses with fetal growth restriction (FGR; estimated fetal weight [EFW] < 10th percentile). STUDY DESIGN This was a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b) adrenal study, which measured fetal adrenal gland size at 22 to 30 weeks' gestation. We analyzed the transverse adrenal area (TAA) and fetal zone area (absolute measurements and corrected for fetal size) and the ratio of the fetal zone area to the total transverse area using a composite perinatal outcome of stillbirth, neonatal intensive care unit admission, respiratory distress syndrome, necrotizing enterocolitis, retinopathy of prematurity, sepsis, mechanical ventilation, seizure, or death. Among fetuses with FGR, adrenal measurements were compared between those that did and did not experience the composite perinatal outcome. RESULTS There were 1,709 eligible neonates. Seven percent (n = 120) were diagnosed with FGR at the time of adrenal measurement, and 14.7% (n = 251) experienced perinatal morbidity. EFW-corrected and absolute adrenal measurements were similar among fetuses with and without FGR as well as among those who did and did not experience morbidity. The area under the curve for corrected TAA was 0.52 (95% confidence interval 0.38-0.67). CONCLUSION In our cohort, adrenal size was not associated with risk of morbidity among fetuses with FGR.
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Affiliation(s)
- Nathan R Blue
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
| | - Matthew Hoffman
- Department of Obstetrics and Gynecology, Christiana Care Health System, Wilmington, Delaware
| | - Amanda A Allshouse
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
| | - William A Grobman
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Hyagriv N Simhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital of UPMC, Pittsburgh, Pennsylvania
| | - Ozhan M Turan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Samuel Parry
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Judith H Chung
- Department of Obstetrics and Gynecology, University of California, Irvine, Orange, California
| | - Uma Reddy
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - David M Haas
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Stephen Myers
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, Kansas
| | - Brian Mercer
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, Ohio
| | - George R Saade
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
| | - Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
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Hawkins M, Parker CB, Redline S, Larkin JC, Zee PP, Grobman WA, Silver RM, Louis JM, Pien GW, Basner RC, Chung JH, Haas DM, Nhan-Chang CL, Simhan HN, Blue NR, Parry S, Reddy U, Facco F. Objectively assessed sleep-disordered breathing during pregnancy and infant birthweight. Sleep Med 2021; 81:312-318. [PMID: 33756281 DOI: 10.1016/j.sleep.2021.02.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 02/16/2021] [Accepted: 02/19/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Sleep-disordered breathing (SDB) in pregnancy is associated with adverse maternal outcomes. The relationship between SDB and infant birthweight is unclear. This study's primary aim is to determine if objectively measured SDB in pregnancy is associated with infant birthweight. METHODS We measured SDB objectively in early (6-15 weeks' gestation) and mid (22-31 weeks' gestation) pregnancy in a large cohort of nulliparous women. SDB was defined as an Apnea-Hypopnea Index ≥5 and in secondary analyses we also examined measures of nocturnal hypoxemia. We used a modified Poisson regression approach to estimate relative risks (RR) of large-for-gestational-age (LGA: >90th percentile for gestational age) and small-for-gestational-age (SGA: <10th percentile for gestational age) birthweights. RESULTS The prevalence of early-pregnancy SDB was nearly 4%. The incidence of mid-pregnancy SDB was nearly 6.0%. The prevalence of LGA and SGA was 7.4% and 11.9%, respectively. Early-pregnancy SDB was associated with a higher risk of LGA in unadjusted models (RR 2.2, 95% CI 1.3-3.5) but not BMI-adjusted models (aRR 1.0, 95% CI 0.6-1.8). Mid-pregnancy SDB was not associated with SGA or LGA. Mid-pregnancy nocturnal hypoxemia (% of sleep time <90% oxygen saturation) and increasing nocturnal hypoxemia from early to mid-pregnancy were associated with a higher risk of LGA in BMI-adjusted models. SDB and nocturnal hypoxemia were not associated with SGA. CONCLUSIONS SDB in pregnancy was not associated with an increased risk of LGA or SGA birthweight, independent of BMI. Some measures nocturnal hypoxemia were associated with an increase in LGA risk, independent of BMI. ClinicalTrials.gov Registration number NCT02231398.
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Affiliation(s)
- Marquis Hawkins
- University of Pittsburgh, Department of Epidemiology, Pittsburgh, PA, USA.
| | | | - Susan Redline
- Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
| | - Jacob C Larkin
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Phyllis P Zee
- Department of Neurology, Northwestern University, Chicago, IL, USA
| | - William A Grobman
- Department of Obstetrics, Gynecology-Maternal Fetal Medicine & Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
| | - Judette M Louis
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Grace W Pien
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Robert C Basner
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - Judith H Chung
- Department of Obstetrics and Gynecology, University of California, Irvine, CA, USA
| | - David M Haas
- Department of Obstetrics and Gynecology, School of Medicine, Indiana University, Indianapolis, IN11, USA
| | | | - Hyagriv N Simhan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nathan R Blue
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
| | - Samuel Parry
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA
| | - Uma Reddy
- Department of Obstetrics, Gynecology & Reproductive Services, Yale University, New Haven, CT, USA
| | - Francesca Facco
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Catov JM, McNeil RB, Marsh DJ, Mercer BM, Bairey Merz CN, Parker CB, Pemberton VL, Saade GR, Chen YDI, Chung JH, Ehrenthal DB, Grobman WA, Haas DM, Parry S, Polito L, Reddy UM, Silver RM, Simhan HN, Wapner RJ, Kominiarek M, Kreutz R, Levine LD, Greenland P. Early Pregnancy Atherogenic Profile in a First Pregnancy and Hypertension Risk 2 to 7 Years After Delivery. J Am Heart Assoc 2021; 10:e017216. [PMID: 33619977 PMCID: PMC8174276 DOI: 10.1161/jaha.120.017216] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Cardiovascular risk in young adulthood is an important determinant of lifetime cardiovascular disease risk. Women with adverse pregnancy outcomes (APOs) have increased cardiovascular risk, but the relationship of other factors is unknown. Methods and Results Among 4471 primiparous women, we related first‐trimester atherogenic markers to risk of APO (hypertensive disorders of pregnancy, preterm birth, small for gestational age), gestational diabetes mellitus (GDM) and hypertension (130/80 mm Hg or antihypertensive use) 2 to 7 years after delivery. Women with an APO/GDM (n=1102) had more atherogenic characteristics (obesity [34.2 versus 19.5%], higher blood pressure [systolic blood pressure 112.2 versus 108.4, diastolic blood pressure 69.2 versus 66.6 mm Hg], glucose [5.0 versus 4.8 mmol/L], insulin [77.6 versus 60.1 pmol/L], triglycerides [1.4 versus 1.3 mmol/L], and high‐sensitivity C‐reactive protein [5.6 versus 4.0 nmol/L], and lower high‐density lipoprotein cholesterol [1.8 versus 1.9 mmol/L]; P<0.05) than women without an APO/GDM. They were also more likely to develop hypertension after delivery (32.8% versus 18.1%, P<0.05). Accounting for confounders and factors routinely assessed antepartum, higher glucose (relative risk [RR] 1.03 [95% CI, 1.00–1.06] per 0.6 mmol/L), high‐sensitivity C‐reactive protein (RR, 1.06 [95% CI, 1.02–1.11] per 2‐fold higher), and triglycerides (RR, 1.27 [95% CI, 1.14–1.41] per 2‐fold higher) were associated with later hypertension. Higher physical activity was protective (RR, 0.93 [95% CI, 0.87‐0.99] per 3 h/week). When evaluated as latent profiles, the nonobese group with higher lipids, high‐sensitivity C‐reactive protein, and insulin values (6.9% of the cohort) had increased risk of an APO/GDM and later hypertension. Among these factors, 7% to 15% of excess RR was related to APO/GDM. Conclusions Individual and combined first‐trimester atherogenic characteristics are associated with APO/GDM occurrence and hypertension 2 to 7 years later. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02231398.
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Affiliation(s)
- Janet M Catov
- University of Pittsburgh School of Medicine Pittsburgh PA
| | | | | | - Brian M Mercer
- Case Western Reserve University-The MetroHealth System Cleveland OH
| | | | | | | | | | | | | | | | | | - David M Haas
- Indiana University School of Medicine Indianapolis IN
| | - Samuel Parry
- University of Pennsylvania School of Medicine Philadelphia PA
| | - LuAnn Polito
- Case Western Reserve University-The MetroHealth System Cleveland OH
| | - Uma M Reddy
- Eunice Kennedy Shriver National Institute of Child Health and Human Development Bethesda MD
| | | | | | | | | | - Rolf Kreutz
- Indiana University School of Medicine Indianapolis IN
| | - Lisa D Levine
- University of Pennsylvania School of Medicine Philadelphia PA
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Chung JM, Lee SG, Nam JS, Ha JG, Chung JH, Cho HJ, Kim CH, Lee SN, Lee H, Yoon JH. Compressive stress induces collective migration through cytoskeletal remodelling in nasal polyp epithelium. Rhinology 2021; 59:49-58. [PMID: 32666957 DOI: 10.4193/rhin19.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Nasal polyps in the nasal cavity and mucous discharge inside the maxillary sinus exhibit compressive stress on the nasal mucosal epithelium. However, there have been only a few studies on how compressive stress impacts the human nasal mucosal epithelium. METHODOLOGY We investigated the effect of compressive stress on collective migration, junctional proteins, transepithelial electri- cal resistance, epithelial permeability, and gene expression in well-differentiated normal human nasal epithelial (NHNE) cells and human nasal polyp epithelial (HNPE) cells. RESULTS NHNE cells barely showed collective migration at compressive stress up to 150 mmH20. However, HNPE cells showed much greater degree of collective migration at a lower compressive stress of 100 mmH20. The cell migration of HNPE cells sub- jected to 100 mmH2O compression was significantly decreased at day 3 and was recovered to the status prior to the compressive stress by day 7, indicating that HNPE cells are relatively more sensitive to mechanical pressure than NHNE cells. Compressive stress also increased transepithelial electrical resistance and decreased epithelial permeability, indicating that the compressive stress disturbed the structural organization rather than physical interactions between cells. In addition, we found that compressive stress induced gene expressions relevant to airway inflammation and tissue remodelling in HNPE cells. CONCLUSION Taken together, these findings demonstrate that compressive stress on nasal polyp epithelium is capable of inducing collective migration and induce increased expression of genes related to airway inflammation, innate immunity, and polyp remo- delling, even in the absence of inflammatory mediators.
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Affiliation(s)
- J M Chung
- Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea
| | - S G Lee
- School of Mechanical Engineering, Yonsei University, Seoul, Korea
| | - J-S Nam
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - J-G Ha
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - J H Chung
- Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea
| | - H-J Cho
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - C-H Kim
- Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea; Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - S-N Lee
- Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea
| | - H Lee
- School of Mechanical Engineering, Yonsei University, Seoul, Korea
| | - J-H Yoon
- Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea; Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
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Theilen L, Greenland P, Varagic J, Catov J, Shanks AL, Thorsten VR, Parker C, McNeil RB, Mercer BM, Hoffman M, Wapner RJ, Haas DM, Simhan H, Grobman WA, Chung JH, Levine LD, Merz NB, Saade GR, Silver BM. 222 Association between aspirin use during pregnancy and cardiovascular risk factors 2-7 years after delivery. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.244] [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: 10/22/2022]
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Monk C, Webster RS, McNeil RB, Parker CB, Catov JM, Greenland P, Bairey-Merz CN, Silver RM, Simhan HN, Ehrenthal DB, Chung JH, Haas DM, Mercer BM, Parry S, Polito L, Reddy UM, Saade GR, Grobman WA. Associations of perceived prenatal stress and adverse pregnancy outcomes with perceived stress years after delivery. Arch Womens Ment Health 2020; 23:361-369. [PMID: 31256258 PMCID: PMC6935433 DOI: 10.1007/s00737-019-00970-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 12/06/2018] [Accepted: 04/22/2019] [Indexed: 02/07/2023]
Abstract
Maternal stress is a risk factor for adverse pregnancy outcomes (APOs). This study evaluates the associations of prenatal stress and APOs with maternal stress years after pregnancy. The 10-item Perceived Stress Scale (PSS) (0-40 range) was completed in the first and third trimesters, and 2-7 years after delivery among a subsample (n = 4161) of nulliparous women enrolled at eight US medical centers between 2010 and 2013 in a prospective, observational cohort study. Demographics, medical history, and presence of APOs (gestational diabetes (GDM), hypertensive disorders of pregnancy (HDP), preeclampsia (PE), and medically indicated or spontaneous preterm birth (miPTB, sPTB)) were obtained. The associations of prenatal PSS and the presence of APOs with PSS scores years after delivery were estimated using multivariable linear regression. Mean PSS scores were 12.5 (95% CI 12.3, 12.7) and 11.3 (95% CI 11.1, 11.5) in the first and third trimesters respectively and 14.9 (95% CI 14.7, 15.1) 2-7 years later, an average increase of 2.4 points (95% CI 2.2, 2.6) from the start of pregnancy. Regressing PSS scores after delivery on first-trimester PSS and PSS increase through pregnancy showed positive associations, with coefficients (95% CI) of 2.8 (2.7, 3.0) and 1.5 (1.3, 1.7) per 5-point change, respectively. Adding APO indicator variables separately showed higher PSS scores for women with HDP (0.7 [0.1, 1.3]), PE (1.3 [0.6, 2.1]), and miPTB (1.3 [0.2, 2.4]), but not those with GDM or sPTB. In this geographically and demographically diverse sample, prenatal stress and some APOs were positively associated with stress levels 2-7 years after pregnancy.ClinicalTrials.gov Registration number NCT02231398.
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Affiliation(s)
- Catherine Monk
- Departments of Psychiatry and Obstetrics and Gynecology, Columbia University, 630 West 168th Street, PH1540H, New York, NY, 10032, USA.
| | - Rachel S. Webster
- Columbia University Vagelos College of Physicians and
Surgeons, New York, New York
| | | | | | - Janet M. Catov
- Department of Obstetrics and Gynecology, University of
Pittsburgh, Pittsburgh, Pennsylvania
| | - Philip Greenland
- Division of Cardiology, Department of Medicine,
Northwestern University, Chicago, Illinois
| | - C. Noel Bairey-Merz
- Division of Cardiology, Department of Medicine,
Cedars-Sinai Medical Center, Los Angeles, California
| | - Robert M. Silver
- Department of Obstetrics and Gynecology, University of Utah
and Intermountain Healthcare, Salt Lake City, Utah
| | - Hyagriv N. Simhan
- Department of Obstetrics and Gynecology, University of
Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Judith H. Chung
- Department of Obstetrics and Gynecology, University of
California, Irvine, California
| | - David M. Haas
- Department of Obstetrics and Gynecology, School of
Medicine, Indiana University, Indianapolis, Indiana
| | - Brian M. Mercer
- Department of Obstetrics and Gynecology, Case Western
Reserve University, Cleveland, Ohio
| | - Samuel Parry
- Department of Obstetrics and Gynecology, University of
Pennsylvania, Philadelphia, Pennsylvania
| | - LuAnn Polito
- Department of Obstetrics and Gynecology, Case Western
Reserve University, Cleveland, Ohio
| | - Uma M. Reddy
- Eunice Kennedy Shriver National Institute of Child Health
and Human Development, Bethesda, Maryland
| | - George R. Saade
- Department of Obstetrics and Gynecology, University of
Texas Medical Branch, University of Texas, Galveston, Texas
| | - William A. Grobman
- Department of Obstetrics and Gynecology, Northwestern
University, Chicago, Illinois
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Moon KC, Yeo HD, Yoon ES, Lee BI, Park SH, Chung JH, Lee HC. Robotic-assisted latissimus dorsi muscle flap for autologous chest reconstruction in poland syndrome. J Plast Reconstr Aesthet Surg 2020; 73:1506-1513. [PMID: 32461033 DOI: 10.1016/j.bjps.2020.01.030] [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] [Received: 04/15/2019] [Revised: 12/15/2019] [Accepted: 01/05/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND As chest reconstructions in Poland syndrome are performed for patients at young ages, patients are generally concerned about conspicuous scars. Meanwhile, a robotic-assisted latissimus dorsi (LD) muscle harvest with inconspicuous scars has been performed for autologous breast reconstruction. As our experience with robotic-assisted LD flap harvest has increased over the years, we have made improvements in surgical techniques to optimize results. The purpose of this study was to introduce and identify the role of the refined robotic-assisted LD muscle flap harvest technique in autologous chest reconstruction in patients with Poland syndrome. METHODS Autologous chest reconstruction using a robotic-assisted LD muscle flap harvest was performed for 21 patients with Poland syndrome. Subjective assessments were performed to evaluate improvement in chest deformity, patient satisfaction with overall outcomes, chest symmetry, and scars. Assessments by the operator and two independent evaluating investigators were carried out with patients' photographs. The complication rates and the time for robotic surgery were also evaluated. RESULTS At the last visit, the average patient grades for improvement in chest deformity, satisfaction with overall outcomes, chest symmetry, and scars were 4.80, 4.72, 4.18, and 4.87, respectively. Assessments by the operator and two independent evaluating investigators demonstrated that improvement in chest deformity was achieved in all patients. No serious complications such as flap loss were recorded for any patient. The time for robotic surgery markedly decreased as experience accumulated. CONCLUSIONS Surgical refinements for robotic-assisted LD flap harvest might be effective and reduce operative times for patients with Poland syndrome.
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Affiliation(s)
- K C Moon
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, South Korea
| | - H D Yeo
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, South Korea
| | - E S Yoon
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, South Korea.
| | - B I Lee
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, South Korea
| | - S H Park
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, South Korea
| | - J H Chung
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, South Korea
| | - H C Lee
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, South Korea
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Sokol ES, Feng YX, Jin DX, Basudan A, Lee AV, Atkinson JM, Chen J, Stephens PJ, Frampton GM, Gupta PB, Ross JS, Chung JH, Oesterreich S, Ali SM, Hartmaier RJ. Loss of function of NF1 is a mechanism of acquired resistance to endocrine therapy in lobular breast cancer. Ann Oncol 2020; 30:115-123. [PMID: 30423024 PMCID: PMC6336006 DOI: 10.1093/annonc/mdy497] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background Invasive lobular carcinoma (ILC) as a disease entity distinct from invasive ductal carcinoma (IDC) has merited focused studies of the genomic landscape, but those to date are largely limited to the assessment of early-stage cancers. Given that genomic alterations develop as acquired resistance to endocrine therapy, studies on refractory ILC are needed. Patients and methods Tissue from 336 primary-enriched, breast-biopsied ILC and 485 estrogen receptor (ER)-positive IDC and metastatic biopsy specimens from 180 ILC and 191 ER-positive IDC patients was assayed with hybrid-capture-based comprehensive genomic profiling for short variant, indel, copy number variants, and rearrangements in up to 395 cancer-related genes. Results Whereas ESR1 alterations are enriched in the metastases of both ILC and IDC compared with breast specimens, NF1 alterations are enriched only in ILC metastases (mILC). NF1 alterations are predominantly under loss of heterozygosity (11/14, 79%), are mutually exclusive with ESR1 mutations [odds ratio = 0.24, P < 0.027] and are frequently polyclonal in ctDNA assays. Assessment of paired specimens shows that NF1 alterations arise in the setting of acquired resistance. An in vitro model of CDH1 mutated ER-positive breast cancer demonstrates that NF1 knockdown confers a growth advantage in the presence of 4-hydroxy tamoxifen. Our study further identified a significant increase in tumor mutational burden (TMB) in mILCs relative to breast ILCs or metastatic IDCs (8.9% >20 mutations/mb; P < 0.001). Most TMB-high mILCs harbor an APOBEC trinucleotide signature (14/16; 88%). Conclusions This study identifies alteration of NF1 as enriched specifically in mILC. Mutual exclusivity with ESR1 alterations, polyclonality in relapsed ctDNA, and de novo acquisition suggest a role for NF1 loss in endocrine therapy resistance. Since NF1 loss leads to RAS/RAF kinase activation, patients may benefit from a matched inhibitor. Moreover, for an independent subset of mILC, TMB was elevated relative to breast ILC, suggesting possible benefit from immune checkpoint inhibitors.
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Affiliation(s)
- E S Sokol
- Foundation Medicine Inc., Cambridge.
| | - Y X Feng
- Department of Biology, Massachusetts Institute of Technology, Cambridge
| | - D X Jin
- Foundation Medicine Inc., Cambridge; Department of Biology, Massachusetts Institute of Technology, Cambridge
| | - A Basudan
- University of Pittsburgh, Pittsburgh; Womens Cancer Research Center, Department of Genetics, University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh
| | - A V Lee
- University of Pittsburgh, Pittsburgh; Womens Cancer Research Center, Department of Pharmacology and Chemical Biology, University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh
| | - J M Atkinson
- University of Pittsburgh, Pittsburgh; Womens Cancer Research Center, Department of Pharmacology and Chemical Biology, University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh
| | - J Chen
- University of Pittsburgh, Pittsburgh; Womens Cancer Research Center, Department of Pharmacology and Chemical Biology, University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh
| | | | | | - P B Gupta
- Department of Biology, Massachusetts Institute of Technology, Cambridge
| | - J S Ross
- Foundation Medicine Inc., Cambridge; Upstate Medical University, Syracuse, USA
| | | | - S Oesterreich
- University of Pittsburgh, Pittsburgh; Womens Cancer Research Center, Department of Pharmacology and Chemical Biology, University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh
| | - S M Ali
- Foundation Medicine Inc., Cambridge
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Page JM, Allshouse AA, Simhan H, Grobman WA, Reddy UM, Mercer BM, Wapner RJ, Chung JH, Saade GR, Haas DM, Silver RM. 181: Risk factors for stillbirth in a prospective, nulliparous cohort. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.197] [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: 11/25/2022]
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Lauder JR, Theilen L, Allshouse AA, Simhan H, Grobman WA, Mercer BM, Wapner RJ, Parry S, Haas DM, Chung JH, Reddy UM, Saade GR, Silver RM. 1102: Adverse pregnancy outcomes and adherence to diet and exercise recommendations for cardiovascular health. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.1114] [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: 10/25/2022]
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Scifres C, Grobman WA, Simhan H, Reddy UM, Mercer BM, Silver RM, Chung JH, Bhamidipalli SS, Guise D, Haas DM. 1215: The impact of early pregnancy weight gain on ultrasound growth parameters and birth weight category. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.1227] [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: 11/26/2022]
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Son SL, Allshouse AA, Heinrichs GA, Garite TJ, Silver RM, Wapner RJ, Grobman WA, Chung JH, Mercer BM, Metz TD. 439: Association between intrapartum prostaglandin exposure and neonatal respiratory distress syndrome (RDS). Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.455] [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: 11/28/2022]
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Yee LM, Silver RM, Reddy UM, Chung JH, Mercer BM, Haas DM, Grobman WA. 970: Factors associated with postpartum hospital readmission. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.981] [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: 11/25/2022]
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Greenberg VR, Lundsberg LS, Reddy UM, Grobman WA, Silver RM, Simhan H, Chung JH, Haas DM, Mercer BM, Wapner RJ, Merriam AA. 547: Perinatal outcomes in obese women with 1 abnormal value on 3-hour glucose tolerance test. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.563] [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: 11/27/2022]
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Hartmaier RJ, Trabucco SE, Priedigkeit N, Chung JH, Parachoniak CA, Vanden Borre P, Morley S, Rosenzweig M, Gay LM, Goldberg ME, Suh J, Ali SM, Ross J, Leyland-Jones B, Young B, Williams C, Park B, Tsai M, Haley B, Peguero J, Callahan RD, Sachelarie I, Cho J, Atkinson JM, Bahreini A, Nagle AM, Puhalla SL, Watters RJ, Erdogan-Yildirim Z, Cao L, Oesterreich S, Mathew A, Lucas PC, Davidson NE, Brufsky AM, Frampton GM, Stephens PJ, Chmielecki J, Lee AV. Recurrent hyperactive ESR1 fusion proteins in endocrine therapy-resistant breast cancer. Ann Oncol 2019; 29:872-880. [PMID: 29360925 PMCID: PMC5913625 DOI: 10.1093/annonc/mdy025] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Estrogen receptor-positive (ER-positive) metastatic breast cancer is often intractable due to endocrine therapy resistance. Although ESR1 promoter switching events have been associated with endocrine-therapy resistance, recurrent ESR1 fusion proteins have yet to be identified in advanced breast cancer. Patients and methods To identify genomic structural rearrangements (REs) including gene fusions in acquired resistance, we undertook a multimodal sequencing effort in three breast cancer patient cohorts: (i) mate-pair and/or RNAseq in 6 patient-matched primary-metastatic tumors and 51 metastases, (ii) high coverage (>500×) comprehensive genomic profiling of 287-395 cancer-related genes across 9542 solid tumors (5216 from metastatic disease), and (iii) ultra-high coverage (>5000×) genomic profiling of 62 cancer-related genes in 254 ctDNA samples. In addition to traditional gene fusion detection methods (i.e. discordant reads, split reads), ESR1 REs were detected from targeted sequencing data by applying a novel algorithm (copyshift) that identifies major copy number shifts at rearrangement hotspots. Results We identify 88 ESR1 REs across 83 unique patients with direct confirmation of 9 ESR1 fusion proteins (including 2 via immunoblot). ESR1 REs are highly enriched in ER-positive, metastatic disease and co-occur with known ESR1 missense alterations, suggestive of polyclonal resistance. Importantly, all fusions result from a breakpoint in or near ESR1 intron 6 and therefore lack an intact ligand binding domain (LBD). In vitro characterization of three fusions reveals ligand-independence and hyperactivity dependent upon the 3' partner gene. Our lower-bound estimate of ESR1 fusions is at least 1% of metastatic solid breast cancers, the prevalence in ctDNA is at least 10× enriched. We postulate this enrichment may represent secondary resistance to more aggressive endocrine therapies applied to patients with ESR1 LBD missense alterations. Conclusions Collectively, these data indicate that N-terminal ESR1 fusions involving exons 6-7 are a recurrent driver of endocrine therapy resistance and are impervious to ER-targeted therapies.
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Affiliation(s)
- R J Hartmaier
- Foundation Medicine Inc., Cambridge; Department of Pharmacology and Chemical Biolog, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, USA; Women's Cancer Research Center, Magee-Women's Research Institute, Pittsburgh, USA.
| | | | - N Priedigkeit
- Department of Pharmacology and Chemical Biolog, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, USA; Women's Cancer Research Center, Magee-Women's Research Institute, Pittsburgh, USA
| | | | | | | | - S Morley
- Foundation Medicine Inc., Cambridge
| | | | - L M Gay
- Foundation Medicine Inc., Cambridge
| | | | - J Suh
- Foundation Medicine Inc., Cambridge
| | - S M Ali
- Foundation Medicine Inc., Cambridge
| | - J Ross
- Foundation Medicine Inc., Cambridge
| | - B Leyland-Jones
- Department of Molecular and Experimental Medicine, Avera Cancer Institute, Sioux Falls, USA
| | - B Young
- Department of Molecular and Experimental Medicine, Avera Cancer Institute, Sioux Falls, USA
| | - C Williams
- Department of Molecular and Experimental Medicine, Avera Cancer Institute, Sioux Falls, USA
| | - B Park
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, USA
| | - M Tsai
- Minnesota Oncology, Minneapolis, USA
| | - B Haley
- UT Southwestern Medical Center, Dallas, USA
| | - J Peguero
- Oncology Consultants Research Department, Houston, USA
| | | | | | - J Cho
- New Bern Cancer Care, New Bern, USA
| | - J M Atkinson
- Women's Cancer Research Center, Magee-Women's Research Institute, Pittsburgh, USA
| | - A Bahreini
- Women's Cancer Research Center, Magee-Women's Research Institute, Pittsburgh, USA; Department of Human Genetics, University of Pittsburgh, Pittsburgh, USA; Department of Genetics and Molecular Biology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - A M Nagle
- Department of Pharmacology and Chemical Biolog, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, USA; Women's Cancer Research Center, Magee-Women's Research Institute, Pittsburgh, USA
| | - S L Puhalla
- Women's Cancer Research Center, Magee-Women's Research Institute, Pittsburgh, USA; Foundation Medicine Inc., Cambridge; Department of Molecular and Experimental Medicine, Avera Cancer Institute, Sioux Falls, USA
| | - R J Watters
- Department of Pharmacology and Chemical Biolog, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, USA; Women's Cancer Research Center, Magee-Women's Research Institute, Pittsburgh, USA; Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, USA
| | - Z Erdogan-Yildirim
- Women's Cancer Research Center, Magee-Women's Research Institute, Pittsburgh, USA; Department of Human Genetics, University of Pittsburgh, Pittsburgh, USA
| | - L Cao
- Women's Cancer Research Center, Magee-Women's Research Institute, Pittsburgh, USA; Central South University Xiangya School of Medicine, China
| | - S Oesterreich
- Department of Pharmacology and Chemical Biolog, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, USA; Women's Cancer Research Center, Magee-Women's Research Institute, Pittsburgh, USA
| | - A Mathew
- Department of Medicine, University of Pittsburgh, Pittsburgh, USA
| | - P C Lucas
- Department of Pathology, University of Pittsburgh, Pittsburgh, USA
| | - N E Davidson
- Foundation Medicine Inc., Cambridge; Department of Molecular and Experimental Medicine, Avera Cancer Institute, Sioux Falls, USA
| | - A M Brufsky
- Foundation Medicine Inc., Cambridge; Department of Molecular and Experimental Medicine, Avera Cancer Institute, Sioux Falls, USA
| | | | | | | | - A V Lee
- Department of Pharmacology and Chemical Biolog, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, USA; Women's Cancer Research Center, Magee-Women's Research Institute, Pittsburgh, USA
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Cho SI, Sun S, Mun JH, Kim C, Kim SY, Cho S, Youn SW, Kim HC, Chung JH. Dermatologist-level classification of malignant lip diseases using a deep convolutional neural network. Br J Dermatol 2019; 182:1388-1394. [PMID: 31449661 DOI: 10.1111/bjd.18459] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Deep convolutional neural networks (DCNNs) can classify skin diseases at a level equivalent to a dermatologist, but their performance in specific areas requires further research. OBJECTIVE To evaluate the performance of a trained DCNN-based algorithm in classifying benign and malignant lip diseases. METHODS A training set of 1629 images (743 malignant, 886 benign) was used with Inception-Resnet-V2. Performance was evaluated using another set of 344 images and 281 images from other hospitals. Classifications by 44 participants (six board-certified dermatologists, 12 dermatology residents, nine medical doctors not specialized in dermatology and 17 medical students) were used for comparison. RESULTS The outcomes based on the area under curve, sensitivity and specificity were 0·827 [95% confidence interval (CI) 0·782-0·873], 0·755 (95% CI 0·673-0·827) and 0·803 (95% CI 0·752-0·855), respectively, for the set of 344 images; and 0·774 (95% CI 0·699-0·849), 0·702 (95% CI 0·579-0·808) and 0·759 (95% CI 0·701-0·813), respectively, for the set of 281 images. The DCNN was equivalent to the dermatologists and superior to the nondermatologists in classifying malignancy. After referencing the DCNN result, the mean ± SD Youden index increased significantly for nondermatologists, from 0·201 ± 0·156 to 0·322 ± 0·141 (P < 0·001). CONCLUSIONS DCNNs can classify lip diseases at a level similar to dermatologists. This will help unskilled physicians discriminate between benign and malignant lip diseases. What's already known about this topic? Deep convolutional neural networks (DCNNs) can classify malignant and benign skin diseases at a level equivalent to dermatologists. The lips are a unique feature in terms of histology and morphology. Previous studies of DCNNs have not investigated tumours on specific locations. What does this study add? This study shows that DCNNs can distinguish rare malignant and benign lip disorders at the same rate as dermatologists. DCNNs can help nondermatologists to distinguish malignant lip diseases. What are the clinical implications of this work? DCNNs can distinguish malignant and benign skin diseases even at specific locations such as the lips, as well as board-certified dermatologists. Malignant lip diseases are rare and difficult for less trained doctors to differentiate them from benign lesions. This study shows that in dermatology, DCNN can help improve decision-making processes for rare skin diseases in specific areas of the body.
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Affiliation(s)
- S I Cho
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - S Sun
- Interdisciplinary Program, Bioengineering Major, Graduate School, Seoul National University, Seoul, Korea
| | - J-H Mun
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - C Kim
- Seoul National University College of Medicine, Seoul, Korea
| | - S Y Kim
- Seoul National University College of Medicine, Seoul, Korea
| | - S Cho
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - S W Youn
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - H C Kim
- Interdisciplinary Program, Bioengineering Major, Graduate School, Seoul National University, Seoul, Korea.,Department of Biomedical Engineering, and Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - J H Chung
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
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