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Riishede I, Ekelund CK, Sperling L, Overgaard M, Knudsen CS, Clausen TD, Pihl K, Zingenberg HJ, Wright A, Wright D, Tabor A, Rode L. Screening for pre-eclampsia with competing-risks model using placental growth factor measurement in blood samples collected before 11 weeks' gestation. Ultrasound Obstet Gynecol 2024; 63:342-349. [PMID: 37698230 DOI: 10.1002/uog.27462] [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] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/17/2023] [Accepted: 08/14/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVES To describe the distributional properties and assess the performance of placental growth factor (PlGF) measured in blood samples collected before 11 weeks' gestation in the prediction of pre-eclampsia (PE). METHODS The study population consisted of pregnant women included in the Pre-eclampsia Screening in Denmark (PRESIDE) study with a PlGF measurement from the routine combined first-trimester screening (cFTS) blood sample collected at 8-14 weeks' gestation. PRESIDE was a prospective multicenter study investigating the predictive performance of the Fetal Medicine Foundation (FMF) first-trimester screening algorithm for PE in a Danish population. In the current study, serum concentration of PlGF in the cFTS blood samples was analyzed in batches between January and June 2021. RESULTS A total of 8386 pregnant women were included. The incidence of PE was 0.7% at < 37 weeks' gestation and 3.0% at ≥ 37 weeks. In blood samples collected at 10 weeks' gestation, PlGF multiples of the median (MoM) were significantly lower in pregnancies with preterm PE < 37 weeks compared to unaffected pregnancies. However, PlGF MoM did not differ significantly between pregnancies with PE and unaffected pregnancies in samples collected before 10 weeks' gestation. CONCLUSIONS The gestational-age range for PlGF sampling may be expanded from 11-14 to 10-14 weeks when assessing the risk for PE using the FMF first-trimester screening model. There is little evidence to support the use of PlGF in blood samples collected before 10 weeks' gestation. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- I Riishede
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - C K Ekelund
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - L Sperling
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - M Overgaard
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark
| | - C S Knudsen
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - T D Clausen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics and Gynecology, Copenhagen University Hospital North Zealand, Hillerød, Denmark
| | - K Pihl
- Department of Obstetrics and Gynecology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - H J Zingenberg
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark
| | - A Wright
- Institute of Health Research, University of Exeter, Exeter, UK
| | - D Wright
- Institute of Health Research, University of Exeter, Exeter, UK
| | - A Tabor
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - L Rode
- Center of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Riishede I, Rode L, Sperling L, Overgaard M, Ravn JD, Sandager P, Skov H, Wagner SR, Nørgaard P, Clausen TD, Jensen CAJ, Pihl K, Jørgensen FS, Munk JK, Zingenberg HJ, Pedersen NG, Andersen MR, Wright A, Wright D, Tabor A, Ekelund CK. Pre-eclampsia screening in Denmark (PRESIDE): national validation study. Ultrasound Obstet Gynecol 2023; 61:682-690. [PMID: 36840981 DOI: 10.1002/uog.26183] [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] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/19/2023] [Accepted: 02/13/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVES To investigate the predictive performance of the Fetal Medicine Foundation (FMF) first-trimester screening algorithm for pre-eclampsia in a Danish population and compare screening performance with that of the current Danish strategy, which is based on maternal risk factors. METHODS This was a prospective study of women with a singleton pregnancy attending for their first-trimester ultrasound scan and screening for aneuploidies at six Danish university hospitals between May 2019 and December 2020. Prenatal data on maternal characteristics and medical history were recorded, and measurements of mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), serum pregnancy-associated plasma protein-A (PAPP-A) and serum placental growth factor (PlGF) were collected without performing a risk assessment for pre-eclampsia. Information on acetylsalicylic acid use was recorded. After delivery, pregnancy outcome, including gestational age at delivery and pre-eclampsia diagnosis, was recorded. Pre-eclampsia risk assessment for each woman was calculated blinded to outcome using the FMF screening algorithm following adjustment to the Danish population. Detection rates (DRs) of the FMF algorithm were calculated for a fixed screen-positive rate (SPR) of 10% and for the SPR achieved in the current Danish screening. RESULTS A total of 8783 pregnant women were included, with a median age of 30.8 (interquartile range (IQR), 28.1-33.9) years. The majority were white (95%), naturally conceiving (90%), non-smokers (97%) and had no family history of pre-eclampsia (96%). The median body mass index was 23.4 (IQR, 21.2-26.6) kg/m2 . A complete risk assessment including maternal characteristics, MAP, UtA-PI, PlGF and PAPP-A was available for 8156 women (92.9%). In these women, UtA-PI was measured bilaterally with a median value of 1.58 (IQR, 1.27-1.94) and the median resting MAP of 80.5 (IQR, 76.1-85.4) mmHg in two consecutive measurements. Among these, 303 (3.7%) developed pre-eclampsia, including 55 (0.7%) cases of pre-eclampsia with delivery < 37 weeks of gestation and 16 (0.2%) cases of pre-eclampsia with delivery < 34 weeks. At a SPR of 10%, combined screening using the FMF algorithm based on maternal characteristics, MAP, UtA-PI, PlGF and PAPP-A had a DR of 77.4% (95% CI, 57.6-97.2%) for pre-eclampsia with delivery < 34 weeks, 66.8% (95% CI, 54.4-79.1%) for pre-eclampsia with delivery < 37 weeks and 44.1% (95% CI, 38.5-49.7%) for pre-eclampsia with delivery at any gestational age. The current Danish screening strategy using maternal risk factors detected 25.0% of women with pre-eclampsia with delivery < 34 weeks and 19.6% of women with pre-eclampsia with delivery < 37 weeks at a SPR of 3.4%. When applying the FMF algorithm including maternal characteristics, MAP, UtA-PI and PlGF at the fixed SPR of 3.4%, the DRs were 60.5% (95% CI, 36.9-84.1%) for PE with delivery < 34 weeks and 45.2% (95% CI, 32.0-58.5%) for PE with delivery < 37 weeks. CONCLUSION In this large Danish multicenter study, the FMF algorithm based on maternal characteristics, MAP, UtA-PI, PlGF and PAPP-A predicted 77.4% of cases with pre-eclampsia with delivery < 34 weeks and 66.8% of cases with pre-eclampsia with delivery < 37 weeks of gestation at a SPR of 10%, suggesting that the performance of the algorithm in a Danish cohort matches that in other populations. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- I Riishede
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics, Center of Fetal Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - L Rode
- Department of Obstetrics, Center of Fetal Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - L Sperling
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, Odense University Hospital, Odense, Denmark
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - M Overgaard
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark
| | - J D Ravn
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, Odense University Hospital, Odense, Denmark
| | - P Sandager
- Department of Obstetrics and Gynecology, Center of Fetal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - H Skov
- Department of Obstetrics and Gynecology, Center of Fetal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - S R Wagner
- Biomedical Engineering Section, Department of Electrical and Computer Engineering, Aarhus University, Aarhus, Denmark
| | - P Nørgaard
- Department of Obstetrics and Gynecology, Copenhagen University Hospital North Zealand, Hillerød, Denmark
| | - T D Clausen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics and Gynecology, Copenhagen University Hospital North Zealand, Hillerød, Denmark
| | - C A Juel Jensen
- Department of Clinical Biochemistry, Copenhagen University Hospital North Zealand, Hillerød, Denmark
| | - K Pihl
- Department of Obstetrics and Gynecology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - F S Jørgensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - J K Munk
- Department of Clinical Biochemistry, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - H J Zingenberg
- Department of Obstetrics and Gynecology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - N G Pedersen
- Department of Obstetrics and Gynecology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - M R Andersen
- Department of Clinical Biochemistry, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark
| | - A Wright
- Institute of Health Research, University of Exeter, Exeter, UK
| | - D Wright
- Institute of Health Research, University of Exeter, Exeter, UK
| | - A Tabor
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics, Center of Fetal Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - C K Ekelund
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics, Center of Fetal Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Vedel C, Hjortshøj TD, Jørgensen DS, Tabor A, Rode L, Sundberg K, Ekelund CK, Petersen OB. Prevalence of chromosomal disorders in cases with congenital heart defect: registry-based study from Denmark between 2008 and 2018. Ultrasound Obstet Gynecol 2023; 61:40-48. [PMID: 36099538 PMCID: PMC10107356 DOI: 10.1002/uog.26075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 08/08/2022] [Accepted: 09/02/2022] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To estimate the prevalence of chromosomal conditions in all fetuses and children with major congenital heart defect (CHD) in Denmark between 2008 and 2018. METHODS This was a national registry-based study including all singleton pregnancies with a prenatally or postnatally diagnosed major CHD usually requiring surgery within the first year after birth and a due date between July 2008 and December 2018 in Denmark. Data were retrieved from the Danish Fetal Medicine Database (DFMD) and the Danish Cytogenetic Central Register (DCCR) in October 2020. The DCCR contains information on all prenatal and postnatal genetic analyses, including karyotyping, chromosomal microarray, polymerase chain reaction, multiplex ligation-dependent probe amplification and fluorescence in-situ hybridization. All cases were reviewed by a clinical geneticist, and genetic changes were classified as pathogenic, likely pathogenic, variant of uncertain significance, likely benign or benign. Pathogenic and likely pathogenic variants were considered to be abnormal. Cases with CHD without any registered chromosomal analysis reported were considered genetically normal. Isolated CHD was defined as a case with major CHD without any other structural malformations detected prenatally or postnatally. Results are given as n (%). Comparisons between isolated and non-isolated cases were performed using logistic regression analysis, and data are presented as odds ratios (ORs) with 95% CIs. RESULTS A total of 8482 cases with any cardiovascular diagnosis were retrieved from the DFMD. Twins (n = 112) and minor CHD cases (n = 6921) were excluded, resulting in 1449 cases with major CHD. Of the included cases, 918 (63.4%) underwent chromosomal analysis. An abnormal test result was found in 187 cases, giving a prevalence of a chromosomal condition of 12.9% (95% CI, 11.2-14.7%) among all cases with major CHD. The highest prevalence of a chromosomal condition was found in cases with pulmonary atresia with intact ventricular septum and those with truncus arteriosus (both 28.6%), while the lowest prevalence was found in cases with transposition of the great arteries (2.2%) and congenitally corrected transposition of the great arteries (0%). In isolated cases of transposition of the great arteries, the prevalence of a chromosomal condition was 0.6%. The overall OR for a chromosomal condition in non-isolated cases compared with isolated cases was 2.72 (95% CI, 1.90-3.88). CONCLUSIONS We found an overall prevalence of a chromosomal condition of 12.9% among cases with major CHD in a national cohort with a high participation rate in first- and second-trimester screening, without employing whole genome and whole exome sequencing. The prevalence of a chromosomal condition varied considerably according to CHD diagnosis and presence of associated extracardiac malformations. These findings are important for prenatal counseling. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C. Vedel
- Department of Obstetrics, Center of Fetal Medicine and PregnancyCopenhagen University Hospital RigshospitaletCopenhagenDenmark
| | - T. D. Hjortshøj
- Department of Clinical GeneticsCopenhagen University Hospital RigshospitaletCopenhagenDenmark
| | - D. S. Jørgensen
- Department of Obstetrics, Center of Fetal Medicine and PregnancyCopenhagen University Hospital RigshospitaletCopenhagenDenmark
| | - A. Tabor
- Department of Obstetrics, Center of Fetal Medicine and PregnancyCopenhagen University Hospital RigshospitaletCopenhagenDenmark
- Department of Clinical MedicineCopenhagen UniversityCopenhagenDenmark
| | - L. Rode
- Department of Clinical BiochemistryCopenhagen University Hospital RigshospitaletCopenhagenDenmark
| | - K. Sundberg
- Department of Obstetrics, Center of Fetal Medicine and PregnancyCopenhagen University Hospital RigshospitaletCopenhagenDenmark
| | - C. K. Ekelund
- Department of Obstetrics, Center of Fetal Medicine and PregnancyCopenhagen University Hospital RigshospitaletCopenhagenDenmark
- Department of Clinical MedicineCopenhagen UniversityCopenhagenDenmark
| | - O. B. Petersen
- Department of Obstetrics, Center of Fetal Medicine and PregnancyCopenhagen University Hospital RigshospitaletCopenhagenDenmark
- Department of Clinical MedicineCopenhagen UniversityCopenhagenDenmark
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Romero R, Conde-Agudelo A, Rehal A, Da Fonseca E, Brizot ML, Rode L, Serra V, Cetingoz E, Syngelaki A, Tabor A, Perales A, Hassan SS, Nicolaides KH. Vaginal progesterone for the prevention of preterm birth and adverse perinatal outcomes in twin gestations with a short cervix: an updated individual patient data meta-analysis. Ultrasound Obstet Gynecol 2022; 59:263-266. [PMID: 34941003 PMCID: PMC9333094 DOI: 10.1002/uog.24839] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/06/2021] [Accepted: 12/14/2021] [Indexed: 05/27/2023]
Affiliation(s)
- R Romero
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute for Child Health and Human Development, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA
- Detroit Medical Center, Detroit, MI, USA
| | - A Conde-Agudelo
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute for Child Health and Human Development, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
| | - A Rehal
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - E Da Fonseca
- Departamento de Obstetrícia e Ginecologia, Hospital do Servidor Publico Estadual 'Francisco Morato de Oliveira' and School of Medicine, University of São Paulo, São Paulo, Brazil
| | - M L Brizot
- Department of Obstetrics and Gynecology, Pontifical Catholic University of São Paulo School of Medical and Health Sciences, São Paulo, Brazil
| | - L Rode
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Juliane Marie Centre, Department of Obstetrics, Copenhagen, Denmark
| | - V Serra
- Maternal-Fetal Medicine Unit, Instituto Valenciano de Infertilidad, University of Valencia, Valencia, Spain
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain
| | - E Cetingoz
- Department of Obstetrics and Gynecology, Zeynep Kamil Women and Children Diseases Education and Research Hospital, Uskudar, Istanbul, Turkey
| | - A Syngelaki
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - A Tabor
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
| | - A Perales
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain
- Department of Obstetrics, University Hospital La Fe, Valencia, Spain
| | - S S Hassan
- Office of Women's Health, Integrative Biosciences Center, Wayne State University, Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Physiology, Wayne State University School of Medicine, Detroit, MI, USA
| | - K H Nicolaides
- Fetal Medicine Research Institute, King's College Hospital, London, UK
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Vedel C, Rode L, Bundgaard H, Iversen K, Jørgensen FS, Petersen OB, Sillesen AS, Sundberg K, Vejlstrup N, Zingenberg H, Tabor A, Ekelund CK. Prenatal cardiac biometry and flow assessment in fetuses with bicuspid aortic valve at 20 weeks' gestation: multicenter cohort study. Ultrasound Obstet Gynecol 2021; 58:846-852. [PMID: 33998082 DOI: 10.1002/uog.23670] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 02/10/2021] [Revised: 04/14/2021] [Accepted: 04/28/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate prenatal changes in cardiac biometric and flow parameters in fetuses with bicuspid aortic valve (BAV) diagnosed neonatally compared with controls with normal cardiac anatomy. METHODS This analysis was conducted as part of the Copenhagen Baby Heart Study, a multicenter cohort study of 25 556 neonates that underwent second-trimester anomaly scan at 18 + 0 to 22 + 6 weeks' gestation and neonatal echocardiography within 4 weeks after birth, in Copenhagen University Hospital Herlev, Hvidovre Hospital and Rigshospitalet in greater Copenhagen, between April 2016 and October 2018. From February 2017 (Rigshospitalet) and September 2017 (Herlev and Hvidovre hospitals), the protocol for second-trimester screening of the heart was extended to include evaluation of the four-chamber view, with assessment of flow across the atrioventricular valves, sagittal view of the aortic arch and midumbilical artery and ductus venosus pulsatility indices. All images were evaluated by two investigators, and cardiac biometric and flow parameters were measured and compared between cases with BAV and controls. All cases with neonatal BAV were assessed by a specialist. Maternal characteristics and first- and second-trimester biomarkers were also compared between the two groups. RESULTS Fifty-five infants with BAV and 8316 controls with normal cardiac anatomy were identified during the study period and assessed using the extended prenatal cardiac imaging protocol. There were three times as many mothers who smoked before pregnancy in the group with BAV as in the control group (9.1% vs 2.7%; P = 0.003). All other baseline characteristics were similar between the two groups. Fetuses with BAV, compared with controls, had a significantly larger diameter of the aorta at the level of the aortic valve (3.1 mm vs 3.0 mm (mean difference, 0.12 mm (95% CI, 0.03-0.21 mm))) and the pulmonary artery at the level of the pulmonary valve (4.1 mm vs 3.9 mm (mean difference, 0.15 mm (95% CI, 0.03-0.28 mm))). Following conversion of the diameter measurements of the aorta and pulmonary artery to Z-scores and Bonferroni correction, the differences between the two groups were no longer statistically significant. Pregnancy-associated plasma protein-A (PAPP-A) multiples of the median (MoM) was significantly lower in the BAV group than in the control group (0.85 vs 1.03; P = 0.04). CONCLUSIONS Our findings suggest that fetuses with BAV may have a larger aortic diameter at the level of the aortic valve, measured in the left-ventricular-outflow-tract view, and a larger pulmonary artery diameter at the level of the pulmonary valve, measured in the three-vessel view, at 20 weeks' gestation. Moreover, we found an association of maternal smoking and low PAPP-A MoM with BAV. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C Vedel
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
| | - L Rode
- Department of Clinical Biochemistry, Copenhagen University Hospital Rigshospitalet, Glostrup, Denmark
| | - H Bundgaard
- University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - K Iversen
- University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - F S Jørgensen
- University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - O B Petersen
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
| | - A-S Sillesen
- Department of Cardiology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - K Sundberg
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - N Vejlstrup
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - H Zingenberg
- Department of Obstetrics and Gynecology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - A Tabor
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
| | - C K Ekelund
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
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Romero R, Conde-Agudelo A, Rode L, Brizot ML, Cetingoz E, Serra V, Da Fonseca E, Tabor A, Perales A, Hassan SS, Nicolaides KH. Vaginal progesterone in twin gestation with a short cervix: revisiting an individual patient data systematic review and meta-analysis. Ultrasound Obstet Gynecol 2021; 58:943-945. [PMID: 34516022 PMCID: PMC9335349 DOI: 10.1002/uog.24765] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/07/2021] [Indexed: 06/01/2023]
Affiliation(s)
- R Romero
- Perinatology Research Branch, Eunice Kennedy Shriver National, Institute for Child Health and Human Development, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA
- Detroit Medical Center, Detroit, MI, USA
| | - A Conde-Agudelo
- Perinatology Research Branch, Eunice Kennedy Shriver National, Institute for Child Health and Human Development, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
| | - L Rode
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Juliane Marie Centre, Department of Obstetrics, Copenhagen, Denmark
| | - M L Brizot
- Department of Obstetrics and Gynecology, Pontifical Catholic University of São Paulo School of Medical and Health Sciences, São Paulo, Brazil
| | - E Cetingoz
- Department of Obstetrics and Gynecology, Zeynep Kamil Women and Children Diseases Education and Research Hospital, Uskudar, Istanbul, Turkey
| | - V Serra
- Maternal-Fetal Medicine Unit, Instituto Valenciano de Infertilidad, University of Valencia, Valencia, Spain
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain
| | - E Da Fonseca
- Departamento de Obstetrícia e Ginecologia, Hospital do Servidor Publico Estadual 'Francisco Morato de Oliveira' and School of Medicine, University of São Paulo, São Paulo, Brazil
| | - A Tabor
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
| | - A Perales
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain
- Department of Obstetrics, University Hospital La Fe, Valencia, Spain
| | - S S Hassan
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
- Office of Women's Health, Integrative Biosciences Center, Wayne State University, Detroit, MI, USA
- Department of Physiology, Wayne State University School of Medicine, Detroit, MI, USA
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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7
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Taubel J, Hauke W, Rump S, Viereck J, Batkai S, Poetzsch J, Rode L, Weigt H, Genschel C, Lorch U, Theek C, Levin A, Bauersachs J, Solomon S, Thum T. Novel antisense therapy targeting microRNA-132 in patients with heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0920] [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: 11/14/2022] Open
Abstract
Abstract
Background
Cardiac microRNA-132-3p (miR-132) levels are increased in patients with heart failure (HF) and mechanistically drive cardiac remodelling processes. CDR132L, a specific antisense oligonucleotide, is a first-in-class miR-132 inhibitor that attenuates and even reverses HF in preclinical models.
Purpose
The aim of the current clinical Phase 1b study was to assess safety, pharmacokinetics, target engagement, and exploratory pharmacodynamic effects of CDR132L in patients on standard-of-care therapy for chronic ischaemic HF in a randomized, placebo-controlled, double-blind, dose-escalation study.
Methods
Patients had left ventricular ejection fraction between ≥30% and <50% or amino terminal fragment of pro-brain natriuretic peptide (NT-proBNP) >125 ng/L at screening. Twenty-eight patients were randomized to receive CDR132L (0.32, 1, 3, and 10 mg/kg body weight) or placebo (0.9% saline) in two intravenous infusions, 4 weeks apart in four cohorts of seven (five verum and two placebo) patients each.
Results
CDR132L was safe and well tolerated, without apparent dose-limiting toxicity. A pharmacokinetic/pharmacodynamic dose modelling approach suggested an effective dose level at ≥1 mg/kg CDR132L. CDR132L treatment resulted in a dose-dependent, sustained miR-132 reduction in plasma. Patients given CDR132L ≥1 mg/kg displayed median 23.3% NT-proBNP reduction, vs. 0.9% median increase in the control group. CDR132L treatment induced significant QRS narrowing and positive trends for cardiac fibrosis biomarkers.
Conclusions
This study is the first clinical trial of an antisense drug in HF patients. CDR132L was safe and well tolerated, confirmed linear plasma pharmacokinetics with no signs of accumulation, and suggests cardiac functional improvements. The indicative efficacy of this drug is very encouraging justifying additional clinical studies to confirm the beneficial CDR132L pharmacodynamic effects for the treatment of HF.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Cardior Pharmaceuticals GmbH
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Affiliation(s)
- J Taubel
- Richmond Pharmacology, London, United Kingdom
| | - W Hauke
- Cardior Pharmaceuticals GmbH, Hannover, Germany
| | - S Rump
- Cardior Pharmaceuticals GmbH, Hannover, Germany
| | - J Viereck
- Cardior Pharmaceuticals GmbH, Hannover, Germany
| | - S Batkai
- Cardior Pharmaceuticals GmbH, Hannover, Germany
| | - J Poetzsch
- Cardior Pharmaceuticals GmbH, Hannover, Germany
| | - L Rode
- Cardior Pharmaceuticals GmbH, Hannover, Germany
| | - H Weigt
- Fraunhofer Institute of Toxicology and Experimental Medicine, Hannover, Germany
| | - C Genschel
- Cardior Pharmaceuticals GmbH, Hannover, Germany
| | - U Lorch
- Richmond Pharmacology, London, United Kingdom
| | - C Theek
- University of Witten/Herdecke, Witten, Germany
| | - A.A Levin
- Avidity Biosciences, La Jolla, United States of America
| | - J Bauersachs
- Hannover Medical School, Department of Cardiology and Angiology, Hannover, Germany
| | - S.D Solomon
- Brigham and Women's Hospital, Cardiovascular Division, Boston, United States of America
| | - T Thum
- Institute for Molecular and Translational Therapeutic Strategies (IMTTS), Hannover, Germany
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8
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Rode L, Ekelund CK, Riishede I, Rasmussen S, Lidegaard Ø, Tabor A. Prediction of preterm pre-eclampsia according to NICE and ACOG criteria: descriptive study of 597 492 Danish births from 2008 to 2017. Ultrasound Obstet Gynecol 2021; 58:561-567. [PMID: 34021947 DOI: 10.1002/uog.23693] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/31/2021] [Accepted: 05/10/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The aim of this national study was to examine the incidence of preterm pre-eclampsia (PE) and the proportion of women with risk factors for PE, according to the criteria suggested by the National Institute for Health and Care Excellence (NICE) and the American College of Obstetricians and Gynecologists (ACOG), during a 10-year period in Denmark. METHODS Data from The Danish National Patient Registry and the Danish Medical Birth Registry were used to obtain the incidence of preterm PE with delivery < 37 weeks' gestation and risk factors for PE for all deliveries in Denmark from 1 January 2008 to 31 December 2017. The proportion of women with at least one high-risk factor and/or at least two moderate-risk factors for PE, according to the NICE and ACOG criteria, and the detection rate for preterm PE were examined. Race, socioeconomic status and the woman's weight at birth were not available from the registries used, and information on Type-2 diabetes was found to be invalid. RESULTS Of the 597 492 deliveries during the study period, any PE was registered in 3.2%, preterm PE < 37 weeks in 0.7% and early-onset PE < 34 weeks' gestation in 0.3%. These proportions remained largely unchanged from 2008 to 2017. Overall, the NICE criteria were fulfilled in 7.5% of deliveries and the ACOG criteria in 17.3%. In the total population, the NICE criteria identified 47.6% of those with preterm PE and the ACOG criteria identified 60.5%. The current criteria for offering aspirin treatment in Denmark largely correspond to having at least one NICE high-risk factor. In 2017, a total of 3.5% of deliveries had at least one NICE high-risk factor, which identified 28.4% of cases that later developed preterm PE. CONCLUSIONS The incidence of preterm PE remained largely unchanged in Denmark from 2008 to 2017. Prediction of PE according to high-risk maternal factors could be improved by addition of moderate-risk factors. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- L Rode
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital Rigshospitalet, Glostrup, Denmark
| | - C K Ekelund
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - I Riishede
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - S Rasmussen
- Department of Gynecology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ø Lidegaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Gynecology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - A Tabor
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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9
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Vedel C, Tabor A, Jørgensen FS, Rode L, Sundberg K, Vejlstrup N, Zingenberg H, Ekelund CK. Prenatal detection rate of major congenital heart defects in Copenhagen from 2015 to 2018. Ultrasound Obstet Gynecol 2021; 58:324-325. [PMID: 32770678 DOI: 10.1002/uog.22167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/28/2020] [Accepted: 07/31/2020] [Indexed: 06/11/2023]
Affiliation(s)
- C Vedel
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - A Tabor
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - F S Jørgensen
- Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - L Rode
- Department of Clinical Biochemistry, Copenhagen University Hospital Rigshospitalet, Glostrup, Denmark
| | - K Sundberg
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - N Vejlstrup
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - H Zingenberg
- Department of Obstetrics and Gynecology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - C K Ekelund
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
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10
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Vedel C, Rode L. Long-term consequences of prenatal progesterone exposure. BJOG 2020; 128:975. [PMID: 33245821 DOI: 10.1111/1471-0528.16608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 11/28/2022]
Affiliation(s)
- C Vedel
- Centre of Fetal Medicine and Pregnancy, Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
| | - L Rode
- Department of Clinical Biochemistry, Rigshospitalet Glostrup, Glostrup, Denmark
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11
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Nielsen S, Rasmussen I, Strandkjær N, Kamstrup P, Gøtze JP, Rode L, Iversen K, Bundgaard H, Frikke-Schmidt R. Thrombosis and hemostasis parameters in early life – the copenhagen baby heart and compare studies. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.097] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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12
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Andreasen LA, Tabor A, Nørgaard LN, Rode L, Gerds TA, Tolsgaard MG. Detection of growth-restricted fetuses during pregnancy is associated with fewer intrauterine deaths but increased adverse childhood outcomes: an observational study. BJOG 2020; 128:77-85. [PMID: 32588532 DOI: 10.1111/1471-0528.16380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Exploring associations between antenatal detection of fetal growth restriction (FGR) and adverse outcome. DESIGN Retrospective, observational, register-based study. SETTING Zealand, Denmark. POPULATION OR SAMPLE Children born from 1 September 2012 to 31 August 2015. METHODS Diagnoses from birth until 1 January 2018 were retrieved from The National Patient Registry. Detection was defined as estimated fetal weight less than the 2.3rd centile. Cox regression was used to associate detection status with the hazard rate of adverse outcome, adjusted for fetal weight deviation, maternal age, ethnicity, body mass index and smoking. MAIN OUTCOME MEASURES Adverse neonatal outcome, adverse neuropsychiatric outcome, respiratory disorders, endocrine disorders, gastrointestinal/urogenital disorders. RESULTS A total of 2425 FGR children were included. An association was found for gastrointestinal/urogenital disorders (hazard ratio [HR] 1.68, 95% CI 1.26-2.23, P < 0.001) and respiratory disorders (HR 1.22, 95% CI 1.02-1.46, P = 0.03) in detected versus undetected infants. For adverse neuropsychiatric outcome, HR was 1.32 (95% CI 1.00-1.75, P = 0.05). There was no evidence of an association between detection and adverse neonatal outcome (HR 1.00, 95% CI 0.62-1.61, P = 0.99) and endocrine disorders (HR 1.39, 95% CI 0.88-2.19, P = 0.16). Detected infants were smaller (median -28% versus -25%, P < 0.0001), more often born preterm (odds ratio [OR] 4.15, 3.12-5.52, P < 0.0001) and more often born after induction or caesarean section (OR 5.19, 95% CI 4.13-6.51, P < 0.0001). Stillbirth risk was increased in undetected FGR fetuses (OR 2.63, 95% CI 1.37-5.04, P = 0.004). CONCLUSIONS We found an association between detection of FGR and risk of adverse childhood conditions, possibly caused by prematurity. Iatrogenic prematurity may be inevitable in stillbirth prevention, but is accompanied by a risk of long-term childhood conditions. TWEETABLE ABSTRACT Antenatal detection of growth-restricted fetuses is associated with adverse childhood outcomes but fewer intrauterine deaths.
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Affiliation(s)
- L A Andreasen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark
| | - A Tabor
- Department of Obstetrics, Centre of Fetal Medicine and Ultrasound, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - L N Nørgaard
- Department of Obstetrics, Centre of Fetal Medicine and Ultrasound, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - L Rode
- Department of Clinical Biochemistry, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - T A Gerds
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - M G Tolsgaard
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark.,Department of Obstetrics, Centre of Fetal Medicine and Ultrasound, Copenhagen University Hospital, Rigshospitalet, Denmark
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13
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Yelland LN, Schuit E, Zamora J, Middleton PF, Lim AC, Nassar AH, Rode L, Serra V, Thom EA, Vayssière C, Mol B, Gates S. Correlation between neonatal outcomes of twins depends on the outcome: secondary analysis of twelve randomised controlled trials. BJOG 2018; 125:1406-1413. [PMID: 29790271 DOI: 10.1111/1471-0528.15292] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To estimate the magnitude of the correlation between neonatal outcomes of twins and demonstrate how this information can be used in the design of randomised controlled trials (RCTs) in women with twin pregnancies. DESIGN Secondary analysis of data from 12 RCTs. SETTING Obstetric care in multiple countries, 2004-2012. POPULATION OR SAMPLE 4504 twin pairs born to women who participated in RCTs to assess treatments given during pregnancy. METHODS Intraclass correlation coefficients (ICCs) were estimated using log-binomial and linear models. MAIN OUTCOME MEASURES Perinatal death, respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular haemorrhage, necrotising enterocolitis, sepsis, neonatal intensive care unit admission, birthweight, low birthweight and two composite measures of adverse neonatal outcome. RESULTS ICCs for the composite measures of adverse neonatal outcome were all above 0.5, indicating moderate to strong correlation between adverse outcomes of twins. For individual neonatal outcomes, median ICCs across trials ranged from 0.13 to 0.79 depending on the outcome. An example illustrates how ICCs can be used in sample size calculations for RCTs in women with twin pregnancies. CONCLUSIONS The correlation between neonatal outcomes of twins varies considerably between outcomes and may be lower than expected. Our ICC estimates can be used for designing and analysing RCTs that recruit women with twin pregnancies and for performing meta-analyses that include such RCTs. Researchers are encouraged to report ICCs for neonatal outcomes in twins in their own RCTs. TWEETABLE ABSTRACT Correlation between neonatal outcomes of twins depends on the outcome and may be lower than expected.
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Affiliation(s)
- L N Yelland
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | - E Schuit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J Zamora
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,CIBER Epidemiology and Public Health and IRYCIS, Madrid, Spain
| | - P F Middleton
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,Robinson Research Institute, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - A C Lim
- Department of Obstetrics & Gynecology and GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - A H Nassar
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - L Rode
- Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - V Serra
- Maternal-Fetal Medicine Unit, Valencia Infertility Institute, University of Valencia, Valencia, Spain
| | - E A Thom
- George Washington University Biostatistics Center, Washington, DC, USA
| | - C Vayssière
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, Toulouse, France.,UMR 1027 INSERM, University of Paul Sabatier Toulouse III, Toulouse, France
| | - Bwj Mol
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash Health and Monash University, Clayton, Vic., Australia
| | - S Gates
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
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14
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Romero R, Conde‐Agudelo A, El‐Refaie W, Rode L, Brizot ML, Cetingoz E, Serra V, Da Fonseca E, Abdelhafez MS, Tabor A, Perales A, Hassan SS, Nicolaides KH. Vaginal progesterone decreases preterm birth and neonatal morbidity and mortality in women with a twin gestation and a short cervix: an updated meta-analysis of individual patient data. Ultrasound Obstet Gynecol 2017; 49:303-314. [PMID: 28067007 PMCID: PMC5396280 DOI: 10.1002/uog.17397] [Citation(s) in RCA: 129] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 12/23/2016] [Accepted: 12/29/2016] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To assess the efficacy of vaginal progesterone for the prevention of preterm birth and neonatal morbidity and mortality in asymptomatic women with a twin gestation and a sonographic short cervix (cervical length ≤ 25 mm) in the mid-trimester. METHODS This was an updated systematic review and meta-analysis of individual patient data (IPD) from randomized controlled trials comparing vaginal progesterone with placebo/no treatment in women with a twin gestation and a mid-trimester sonographic cervical length ≤ 25 mm. MEDLINE, EMBASE, POPLINE, CINAHL and LILACS (all from inception to 31 December 2016), the Cochrane Central Register of Controlled Trials, Research Registers of ongoing trials, Google Scholar, conference proceedings and reference lists of identified studies were searched. The primary outcome measure was preterm birth < 33 weeks' gestation. Two reviewers independently selected studies, assessed the risk of bias and extracted the data. Pooled relative risks (RRs) with 95% confidence intervals (CI) were calculated. RESULTS IPD were available for 303 women (159 assigned to vaginal progesterone and 144 assigned to placebo/no treatment) and their 606 fetuses/infants from six randomized controlled trials. One study, which included women with a cervical length between 20 and 25 mm, provided 74% of the total sample size of the IPD meta-analysis. Vaginal progesterone, compared with placebo/no treatment, was associated with a statistically significant reduction in the risk of preterm birth < 33 weeks' gestation (31.4% vs 43.1%; RR, 0.69 (95% CI, 0.51-0.93); moderate-quality evidence). Moreover, vaginal progesterone administration was associated with a significant decrease in the risk of preterm birth < 35, < 34, < 32 and < 30 weeks' gestation (RRs ranging from 0.47 to 0.83), neonatal death (RR, 0.53 (95% CI, 0.35-0.81)), respiratory distress syndrome (RR, 0.70 (95% CI, 0.56-0.89)), composite neonatal morbidity and mortality (RR, 0.61 (95% CI, 0.34-0.98)), use of mechanical ventilation (RR, 0.54 (95% CI, 0.36-0.81)) and birth weight < 1500 g (RR, 0.53 (95% CI, 0.35-0.80)) (all moderate-quality evidence). There were no significant differences in neurodevelopmental outcomes at 4-5 years of age between the vaginal progesterone and placebo groups. CONCLUSION Administration of vaginal progesterone to asymptomatic women with a twin gestation and a sonographic short cervix in the mid-trimester reduces the risk of preterm birth occurring at < 30 to < 35 gestational weeks, neonatal mortality and some measures of neonatal morbidity, without any demonstrable deleterious effects on childhood neurodevelopment. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.
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Affiliation(s)
- R. Romero
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentNational Institutes of Health, Department of Health and Human ServicesBethesda, MD and DetroitMIUSA
- Department of Obstetrics and GynecologyUniversity of MichiganAnn ArborMIUSA
- Department of Epidemiology and BiostatisticsMichigan State UniversityEast LansingMIUSA
- Center for Molecular Medicine and GeneticsWayne State UniversityDetroitMIUSA
| | - A. Conde‐Agudelo
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentNational Institutes of Health, Department of Health and Human ServicesBethesda, MD and DetroitMIUSA
- Department of Obstetrics and GynecologyWayne State University School of MedicineDetroitMIUSA
| | - W. El‐Refaie
- Department of Obstetrics and Gynecology, Mansoura University HospitalsMansoura UniversityMansouraEgypt
| | - L. Rode
- Center of Fetal Medicine and Pregnancy, Department of ObstetricsCopenhagen University HospitalRigshospitaletCopenhagenDenmark
- Department of Clinical BiochemistryHerlev and Gentofte HospitalHerlevDenmark
| | - M. L. Brizot
- Department of Obstetrics and GynecologySão Paulo University Medical SchoolSão PauloBrazil
| | - E. Cetingoz
- Department of Obstetrics and GynecologyZeynep Kamil Women and Children Diseases Education and Research HospitalUskudarIstanbulTurkey
| | - V. Serra
- Maternal‐Fetal Medicine Unit, Instituto Valenciano de InfertilidadUniversity of ValenciaValenciaSpain
- Department of Pediatrics, Obstetrics and GynecologyUniversity of ValenciaValenciaSpain
| | - E. Da Fonseca
- Departamento de Obstetrícia e Ginecologia, Hospital do Servidor Publico Estadual ‘Francisco Morato de Oliveira’ and School of MedicineUniversity of São PauloSão PauloBrazil
| | - M. S. Abdelhafez
- Department of Obstetrics and Gynecology, Mansoura University HospitalsMansoura UniversityMansouraEgypt
| | - A. Tabor
- Center of Fetal Medicine and Pregnancy, Department of ObstetricsCopenhagen University HospitalRigshospitaletCopenhagenDenmark
- University of CopenhagenFaculty of Health SciencesCopenhagenDenmark
| | - A. Perales
- Department of Pediatrics, Obstetrics and GynecologyUniversity of ValenciaValenciaSpain
- Department of ObstetricsUniversity Hospital La FeValenciaSpain
| | - S. S. Hassan
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentNational Institutes of Health, Department of Health and Human ServicesBethesda, MD and DetroitMIUSA
- Department of Obstetrics and GynecologyWayne State University School of MedicineDetroitMIUSA
| | - K. H. Nicolaides
- Harris Birthright Research Centre for Fetal MedicineKing's College HospitalLondonUK
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15
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Vedel C, Larsen H, Holmskov A, Andreasen KR, Uldbjerg N, Ramb J, Bødker B, Skibsted L, Sperling L, Krebs L, Zingenberg H, Laursen L, Christensen JT, Tabor A, Rode L. Long-term effects of prenatal progesterone exposure: neurophysiological development and hospital admissions in twins up to 8 years of age. Ultrasound Obstet Gynecol 2016; 48:382-389. [PMID: 27106105 DOI: 10.1002/uog.15948] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 04/13/2016] [Accepted: 04/18/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To perform a neurophysiological follow-up at 48 or 60 months of age in children exposed prenatally to progesterone compared with a placebo and evaluate their medical histories up to 8 years of age. METHODS In this study, Danish participants of the PREDICT study, including 989 surviving children from 498 twin pregnancies, were followed-up. PREDICT was a placebo-controlled randomized clinical trial examining the effect of progesterone for prevention of preterm delivery in unselected twin pregnancies. Medical histories of the children were reviewed and neurophysiological development was evaluated by the parent-completed Ages and Stages Questionnaire (ASQ) at either 48 or 60 months after the estimated date of delivery. We used the method of generalized estimating equation to account for the correlation within twins. RESULTS A total of 492 children had been exposed prenatally to progesterone and 497 to placebo. There was no difference in the number of admissions to or length of stay in hospital between the treatment groups, and we found no overall difference in the rates of diagnoses made. However, the odds ratios (ORs) for a diagnosis concerning the heart was 1.66 (95% CI, 0.81-3.37), favoring placebo, among all children, 2.38 (95% CI, 1.07-5.30) in dichorionic twins and 8.19 (95% CI, 1.02-65.6) in all children when excluding diagnoses made at outpatient clinic visits. ASQ scores were available for 437 children (progesterone, n = 225; placebo, n = 212). Mean ASQ score was slightly higher in the progesterone group compared with the placebo group (P = 0.03). In dichorionic twins, the risk of having a low ASQ score (< 10(th) centile) was decreased in the progesterone group (OR, 0.34 (95% CI, 0.14-0.86)). CONCLUSION Second- and third-trimester exposure of the fetus to progesterone does not seem to have long-term harmful effects during childhood, but future studies should focus on cardiac disease in the child. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- C Vedel
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
| | - H Larsen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
| | - A Holmskov
- Department of Obstetrics and Gynecology, Viborg Hospital, Viborg, Denmark
| | - K R Andreasen
- Department of Obstetrics and Gynecology, Hvidovre Hospital, Hvidovre, Denmark
| | - N Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Skejby, Denmark
| | - J Ramb
- Department of Obstetrics and Gynecology, Sønderborg Hospital, Sønderborg, Denmark
| | - B Bødker
- Department of Obstetrics and Gynecology, Nordsjaellands Hospital, Hillerød, Denmark
| | - L Skibsted
- University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
- Department of Obstetrics and Gynecology, University Hospital Roskilde, Roskilde, Denmark
| | - L Sperling
- University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
- Department of Obstetrics and Gynecology, Herlev Hospital, Herlev, Denmark
| | - L Krebs
- Department of Obstetrics and Gynecology, Holbaek Hospital, Holbaek, Denmark
| | - H Zingenberg
- Department of Obstetrics and Gynecology, Glostrup Hospital, Glostrup, Denmark
| | - L Laursen
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - J T Christensen
- Department of Obstetrics and Gynecology, Gentofte Hospital, Hellerup, Denmark
| | - A Tabor
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
| | - L Rode
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Herlev, Denmark
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16
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Wulff CB, Gerds TA, Rode L, Ekelund CK, Petersen OB, Tabor A. Risk of fetal loss associated with invasive testing following combined first-trimester screening for Down syndrome: a national cohort of 147,987 singleton pregnancies. Ultrasound Obstet Gynecol 2016; 47:38-44. [PMID: 26581188 DOI: 10.1002/uog.15820] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [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: 10/06/2015] [Revised: 11/16/2015] [Accepted: 11/16/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To assess prospectively the risk of fetal loss associated with chorionic villus sampling (CVS) and amniocentesis (AC) following combined first-trimester screening (cFTS) for Down syndrome. METHODS This was a nationwide population-based study (Danish Fetal Medicine Database, 2008-2010) including 147,987 women with singleton pregnancy who underwent cFTS. Propensity score stratification was used to assess the risk of fetal loss with and without invasive testing. Analyses were performed between 3 and 21 days after cFTS for CVS and between 28 and 42 days after cFTS for AC. Results are reported as average risk differences with 95% CIs. RESULTS The risks of miscarriage and stillbirth were not higher in women exposed to CVS or AC compared with unexposed women, independent of the analysis time-point. The average effect of CVS on risk of miscarriage was -0.08% (95% CI, -0.64; 0.47) at 3 days and -0.21% (95% CI, -0.58; 0.15) at 21 days after cFTS, while the effect on risk of stillbirth was -0.18% (95% CI, -0.50; 0.13) at 3 days and -0.27% (95% CI, -0.58; 0.04) at 21 days after cFTS. Regarding the effect of AC on risk of miscarriage, the analysis at 28 days after cFTS showed an average effect of 0.56% (95% CI, -0.21; 1.33), while the effect on risk of stillbirth was 0.09% (95% CI, -0.39; 0.58) at 42 days after cFTS. CONCLUSION Neither CVS nor AC was associated with increased risk of miscarriage or stillbirth. These findings indicate that the procedure-related risk of CVS and AC is very low.
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Affiliation(s)
- C B Wulff
- Center of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Faculty of Medicine and Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - T A Gerds
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - L Rode
- Center of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - C K Ekelund
- Center of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - O B Petersen
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Aarhus University Hospital, Skejby, Denmark
| | - A Tabor
- Center of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Faculty of Medicine and Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Schuit E, Stock S, Rode L, Rouse DJ, Lim AC, Norman JE, Nassar AH, Serra V, Combs CA, Vayssiere C, Aboulghar MM, Wood S, Çetingöz E, Briery CM, Fonseca EB, Worda K, Tabor A, Thom EA, Caritis SN, Awwad J, Usta IM, Perales A, Meseguer J, Maurel K, Garite T, Aboulghar MA, Amin YM, Ross S, Cam C, Karateke A, Morrison JC, Magann EF, Nicolaides KH, Zuithoff NPA, Groenwold RHH, Moons KGM, Kwee A, Mol BWJ. Effectiveness of progestogens to improve perinatal outcome in twin pregnancies: an individual participant data meta-analysis. BJOG 2014; 122:27-37. [PMID: 25145491 DOI: 10.1111/1471-0528.13032] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND In twin pregnancies, the rates of adverse perinatal outcome and subsequent long-term morbidity are substantial, and mainly result from preterm birth (PTB). OBJECTIVES To assess the effectiveness of progestogen treatment in the prevention of neonatal morbidity or PTB in twin pregnancies using individual participant data meta-analysis (IPDMA). SEARCH STRATEGY We searched international scientific databases, trial registration websites, and references of identified articles. SELECTION CRITERIA Randomised clinical trials (RCTs) of 17-hydroxyprogesterone caproate (17Pc) or vaginally administered natural progesterone, compared with placebo or no treatment. DATA COLLECTION AND ANALYSIS Investigators of identified RCTs were asked to share their IPD. The primary outcome was a composite of perinatal mortality and severe neonatal morbidity. Prespecified subgroup analyses were performed for chorionicity, cervical length, and prior spontaneous PTB. MAIN RESULTS Thirteen trials included 3768 women and their 7536 babies. Neither 17Pc nor vaginal progesterone reduced the incidence of adverse perinatal outcome (17Pc relative risk, RR 1.1; 95% confidence interval, 95% CI 0.97-1.4, vaginal progesterone RR 0.97; 95% CI 0.77-1.2). In a subgroup of women with a cervical length of ≤25 mm, vaginal progesterone reduced adverse perinatal outcome when cervical length was measured at randomisation (15/56 versus 22/60; RR 0.57; 95% CI 0.47-0.70) or before 24 weeks of gestation (14/52 versus 21/56; RR 0.56; 95% CI 0.42-0.75). AUTHOR'S CONCLUSIONS In unselected women with an uncomplicated twin gestation, treatment with progestogens (intramuscular 17Pc or vaginal natural progesterone) does not improve perinatal outcome. Vaginal progesterone may be effective in the reduction of adverse perinatal outcome in women with a cervical length of ≤25 mm; however, further research is warranted to confirm this finding.
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Affiliation(s)
- E Schuit
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands; Department of Obstetrics and Gynaecology, Academic Medical Centre Amsterdam, Amsterdam, the Netherlands
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18
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Johansen ML, Oldenburg A, Rosthøj S, Cohn Maxild J, Rode L, Tabor A. Crown-rump length discordance in the first trimester: a predictor of adverse outcome in twin pregnancies? Ultrasound Obstet Gynecol 2014; 43:277-283. [PMID: 23754823 DOI: 10.1002/uog.12534] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [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: 03/04/2013] [Revised: 05/23/2013] [Accepted: 05/29/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To evaluate the usefulness of first-trimester crown-rump length (CRL) discordance in predicting adverse outcome in twin pregnancies. METHODS This retrospective study included a large cohort retrieved from local ultrasound databases at 14 obstetric departments in Denmark, comprising all twin pregnancies with two live fetuses scanned between 11 and 14 weeks' gestation during the period 1 January 2004 to 31 December 2006. The association between CRL discordance ≥ 10 % and adverse outcome was evaluated. RESULTS Among 1993 twin pregnancies, 1733 were dichorionic (156 (9%) discordant; 1577 (91%) concordant) and 260 were monochorionic (32 (12%) discordant; 228 (88%) concordant). In dichorionic twin pregnancies we found an association between CRL discordance ≥ 10% and preterm delivery before 34 weeks' gestation (P=0.007), birth weight discordance (P=0.001) and mean birth weight (P=0.033). In monochorionic twin pregnancies we found an association between CRL discordance ≥ 10% and birth weight discordance (P=0.02) and mean birth weight (P=0.03). To evaluate CRL discordance as a predictor of fetal loss and preterm delivery before 34 weeks' gestation, receiver-operating characteristics curves were created for each outcome. For CRL discordance ≥ 10% as a predictor of fetal loss and preterm delivery in dichorionic twin pregnancies, sensitivity was 0.17 (95% CI, 0.06-0.28) and 0.14 (95% CI, 0.10-0.18), respectively, and in monochorionic twin pregnancies it was 0.10 (95% CI, 0.03-0.22) and 0.16 (95% CI, 0.06-0.26), respectively. CONCLUSIONS CRL discordance in twin pregnancies is associated with, but is not a strong predictor of, adverse outcome.
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Affiliation(s)
- M L Johansen
- Center for Fetal Medicine, Department of Obstetrics and Gynecology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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19
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Oldenburg A, Rode L, Bødker B, Ersbak V, Holmskov A, Jørgensen FS, Larsen H, Larsen T, Laursen L, Mogensen H, Petersen OB, Rasmussen S, Skibsted L, Sperling L, Stornes I, Zingenberg H, Tabor A. Influence of chorionicity on perinatal outcome in a large cohort of Danish twin pregnancies. Ultrasound Obstet Gynecol 2012; 39:69-74. [PMID: 21830245 DOI: 10.1002/uog.10057] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/13/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To assess outcome in twin pregnancies according to chorionicity. METHODS A cohort was retrieved from local ultrasound databases at 14 obstetric departments in Denmark, comprising all twin pregnancies with two live fetuses scanned between weeks 11 and 14 in the period 1 January 2004 to 31 December 2006. Outcome data were retrieved from the National Board of Health. RESULTS Among 2038 twin pregnancies, 1757 (86.2%) were dichorionic (DC) and 281 (13.8%) were monochorionic diamniotic (MC). In MC pregnancies, the rate of spontaneous fetal loss in both second and third trimesters was more than threefold higher than the comparable rate in DC pregnancies: 6.0% vs. 1.9% for at least one fetus in the second trimester (P < 0.001) and 2.1% vs. 0.7% in the third trimester (P = 0.03). In 98.4% of DC pregnancies and in 91.1% of MC pregnancies, at least one infant was liveborn. Amongst pregnancies with two live fetuses at 24 weeks, the proportion with two live infants at 28 days after delivery was 97.5% and 95.1%, respectively. CONCLUSIONS The increased incidence of fetal loss in MC pregnancies compared with DC pregnancies predominantly occurs before 24 weeks' gestation. After this stage, although the risk of intrauterine fetal death is still higher in MC than in DC pregnancies, if both fetuses are alive at 24 weeks, the chance of a woman having two live infants 1 month after delivery is similar in MC and DC pregnancies.
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Affiliation(s)
- A Oldenburg
- Department of Fetal Medicine, Copenhagen University Hospital, Copenhagen, Denmark.
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20
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Rode L, Klein K, Nicolaides KH, Krampl-Bettelheim E, Tabor A. Prevention of preterm delivery in twin gestations (PREDICT): a multicenter, randomized, placebo-controlled trial on the effect of vaginal micronized progesterone. Ultrasound Obstet Gynecol 2011; 38:272-280. [PMID: 21739497 DOI: 10.1002/uog.9093] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Studies on high-risk singleton gestations have shown a preventive effect of progesterone treatment on preterm delivery. This study was conducted to investigate the preventive effect of vaginal micronized progesterone in a large population of twin gestations. METHODS This was a double-blind, placebo-controlled randomized trial performed in 17 centers in Denmark and Austria. Women with twin gestations were randomized to daily treatment with progesterone pessaries or apparently identical placebo pessaries, starting from 20-24 weeks until 34 weeks' gestation. Primary outcome was incidence of delivery before 34 weeks' gestation. Secondary outcomes were maternal and neonatal complications and long-term infant follow-up, by Ages and Stages Questionnaire (ASQ), 6 months and 18 months after the expected date of delivery. We also updated a published meta-analysis to include our data and those of another recently published twin trial. RESULTS A total of 677 women were randomized to the two treatments. Two women in the placebo group were lost to follow-up. Baseline characteristics for the groups were similar. Incidence of delivery before 34 weeks was 15.3% in the progesterone group vs 18.5% in the placebo group (odds ratio, 0.8 (95% CI, 0.5-1.2)). Risks of maternal and neonatal complications were comparable for the two groups. Mean ASQ scores at 6 months and 18 months were not significantly different between the two groups (215 for infants in the progesterone group and 218 for infants in the placebo group at 6 months (P = 0.45) and 193 and 194, respectively, at 18 months (P = 0.89)). The meta-analysis gave a pooled odds ratio of 1.06 (95% CI, 0.86-1.31). CONCLUSION Progesterone treatment did not prevent preterm delivery in twin gestations. There were no harmful effects to fetuses and infants of maternal progesterone treatment.
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Affiliation(s)
- L Rode
- Department of Fetal Medicine and Ultrasound 4002, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
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21
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Klein K, Rode L, Nicolaides KH, Krampl-Bettelheim E, Tabor A. Vaginal micronized progesterone and risk of preterm delivery in high-risk twin pregnancies: secondary analysis of a placebo-controlled randomized trial and meta-analysis. Ultrasound Obstet Gynecol 2011; 38:281-287. [PMID: 21739499 DOI: 10.1002/uog.9092] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Progesterone treatment reduces the risk of preterm delivery in high-risk singleton pregnancies. Our aim was to evaluate the preventive effect of vaginal progesterone in high-risk twins. METHODS This was a subanalysis of a Danish-Austrian, double-blind, placebo-controlled, randomized trial (PREDICT study), in which women with twin pregnancies were randomized to daily treatment with progesterone or placebo pessaries from 20-24 weeks until 34 weeks' gestation. This subpopulation consisted of high-risk pregnancies, defined by the finding of cervical length ≤ 10th centile at 20-24 weeks' gestation or history of either spontaneous delivery before 34 weeks or miscarriage after 12 weeks. Primary outcome was delivery before 34 weeks. Secondary outcomes were complications for infants including long-term follow-up by Ages and Stages Questionnaire (ASQ) at 6 and 18 months of age. RESULTS In 72 (10.6%) of the 677 women participating in the PREDICT study, the pregnancy was considered to be high-risk, including 47 with cervical length ≤ 10th centile, 28 with a history of preterm delivery or late miscarriage and three fulfilling both criteria. Baseline characteristics for progesterone and placebo groups were similar. Mean gestational age at delivery did not differ significantly between the two groups either in patients with a short cervix (34.3 ± 4.1 vs. 34.5 ± 3.0 weeks, P = 0.87) or in those with a history of preterm delivery or late miscarriage (34.6 ± 4.2 vs. 35.2 ± 2.7 weeks, P = 0.62). Similarly, there were no significant differences between the treatment groups in maternal or neonatal complications and mean ASQ score at 6 and 18 months of age. CONCLUSION In high-risk twin pregnancies, progesterone treatment does not significantly improve outcome.
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Affiliation(s)
- K Klein
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria.
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22
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Rode L, Ekelund C, Pedersen N, Wøjdemann K, Christiansen M, Sundberg K, Tabor A. Maternal Smoking, Obesity and Male Fetal Sex Predispose to a Large Nuchal Translucency Thickness in Healthy Fetuses. Fetal Diagn Ther 2011; 29:201-7. [DOI: 10.1159/000319343] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Accepted: 07/08/2010] [Indexed: 11/19/2022]
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23
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Wøjdemann KR, Larsen SO, Rode L, Shalmi A, Sundberg K, Christiansen M, Tabor A. First trimester Down syndrome screening: Distribution of markers and comparison of assays for quantification of pregnancy‐associated plasma protein‐A. Scandinavian Journal of Clinical and Laboratory Investigation 2009; 66:101-11. [PMID: 16537243 DOI: 10.1080/00365510500406902] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE First trimester screening for fetal chromosomal disease is now possible using the maternal serological markers pregnancy-associated plasma protein-A (PAPP-A) and the free ss-form of human chorionic gonadotrophin (sshCG) in combination with the ultrasound marker nuchal translucency (NT) thickness. The availability of well-defined analytical methods and reference ranges for the involved parameters, and knowledge of the correlation between markers and clinical parameters, e.g. maternal weight, parity and age, are important for the design of efficient screening programs. MATERIAL AND METHODS Women (n = 2702), with singleton pregnancies, participating in the Copenhagen First Trimester Screening Study had PAPP-A and sshCG values determined and NT measured at a gestational age of 11 to 14 weeks, as determined from crown rump length (CRL). The distribution of gestational age-independent multiples of the median (MoM) of the parameters was defined and reference intervals established. Three methods for determination of PAPP-A, one manual in-house poly-monoclonal ELISA and two commercial semi-automatic double-monoclonal methods, i.e. PAPP-A for the AutoDelfia platform and PAPP-A for the Kryptor platform, were compared in 260 women. RESULTS All markers had log-normally distributed MoMs. Gestational age independent reference intervals were established. Maternal weight should be included in risk algorithms. The semi-automated PAPP-A assays (AutoDelfia and Kryptor) gave similar values, mean difference 10.5 %, whereas the manual assay gave higher values, mean differences 50.4 % and 41.0 %, respectively, CONCLUSIONS This calls for better standardization and a uniform quality control scheme that is focused on discriminatory ability rather than adherence to mean values from a large number of laboratories.
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Affiliation(s)
- K R Wøjdemann
- Copenhagen University Hospital, Department of Obstetrics and Gynaecology, Hvidovre Hospital, Denmark
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24
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Selset Aandahl G, Jacobsen CD, Rode L, Rathe Oedegaard E. Preliminary experience with plasma exchange in patients with ulcerative colitis. Transfus Sci 2000; 22:155-60. [PMID: 10831917 DOI: 10.1016/s0955-3886(00)00039-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We decided to test the effect of plasma exchange (PE) in selected patients with inflammatory bowel disease in which conventional medical treatment proved insufficient. Twenty-six patients with ulcerative colitis (UC) were treated with PE, six patients with fulminant colitis and 20 with long lasting severe colitis. After very promising results initially, 17 patients with long lasting severe colitis were selected in a careful prospective study. Twelve patients completed the treatment protocol. Two litres of plasma were exchanged every second or third day, 5-6 times in two weeks. The replacement fluid was fresh frozen plasma. The activity indices and histological evaluation were used as criteriae for treatment response. A reduction of 35% in the activity index is considered a significant improvement. In all but three patients (out of 12), the activity indices were reduced two weeks after end of treatment. Six patients had a reduction of more than 35%, three patients had a reduction between 22-28% and three had a reduction less than 10%. None became worse. In this carefully studied group, the immediate beneficial effects of PE was only demonstrable by the activity indices and not evident by blind evaluation of biopsies from the mucosa. In two of the six patients with fulminant colitis, PE was followed by an immediate dramatic clinical improvement. In the follow up period (2-14 years) 14 of the 26 patients reported marked and long lasting improvement of inflammatory bowel disease. We conclude that PE might be beneficial in subsets of patients with UC.
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Affiliation(s)
- G Selset Aandahl
- Department of Immunology, Central Hospital of Akershus, 1474, Nordbyhagen, Norway
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25
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Chikunya S, Newbold C, Rode L, Chen X, Wallace R. Influence of dietary rumen-degradable protein on bacterial growth in the rumen of sheep receiving different energy sources. Anim Feed Sci Technol 1996. [DOI: 10.1016/s0377-8401(96)00999-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.5] [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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Loraas A, Fosså SD, Franzen S, Saeter G, Rode L. Skin lesions and G-CSF in patients with malignant diseases. Malignancy or cutaneous side-effect? Eur J Cancer 1996; 32A:554-5. [PMID: 8814708 DOI: 10.1016/0959-8049(95)00595-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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27
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Stavem K, Larmo A, Rode L, Weber-Laumann JA. [Benign fibrous mesothelioma of the pleura]. Tidsskr Nor Laegeforen 1993; 113:2696-7. [PMID: 8266292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Benign fibrous mesothelioma of the pleura is rare. The tumour may present in several ways, as shown in our two patients, one with an elevated diaphragm and the other with slowly growing intrathoracic tumour. The tumour may reach a considerable size, is localized, is normally benign, and is curable by surgical resection.
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Affiliation(s)
- K Stavem
- Medisinsk avdeling, Sentralsykehuset i Akershus, Nordbyhagen
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Abstract
Recently, three young individuals died unexpectedly outside hospital. Their past medical histories revealed complaints of weakness, anorexia and nausea, none of which had led to adequate medical examination. The present paper calls for vigilance when patients present with non-specific manifestations such as anorexia and weakness. Autopsies confirmed that the deaths were caused by adrenalitis, a diagnosis unsuspected at the time of death. The value of different post-mortem laboratory findings is discussed.
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Affiliation(s)
- J Ringstad
- Medical Department, Ostfold Central Hospital, Sarpsborg, Norway
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29
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Bjørnland K, Rode L, Jørstad SO. Acute abdominal pain as presenting symptom in lymphangiomyomatosis. Case report. Eur J Surg 1991; 157:367-8. [PMID: 1678654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A case of lymphangiomyomatosis presenting with acute abdominal pain is described. Laparotomy revealed a multiloculated cystic mass on the posterior abdominal wall with typical histological pattern. In the ensuing 3 years the respiratory manifestations of this rare disorder have slowly progressed. Possible causal factors and management are discussed.
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Affiliation(s)
- K Bjørnland
- Department of Surgery, Sarpsborg Hospital, Norway
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30
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Abstract
Emery-Dreifuss syndrome is characterized by early contractures, slowly progressing muscle wasting and cardiomyopathy, often presenting as heart block. The syndrome is usually inherited as an X-linked recessive. We present a family with four affected females in three generations, including a pair of identical twins. All patients developed elbow contractures, scoliosis, and stiffness of the spine and neck from the age of about 10, with little progression in later years. The proband developed cardiomyopathy at the age of 45, whereas her mother died at 41 without a confirmed diagnosis of cardiomyopathy. The twin daughters of the proband had no unequivocal signs of cardiomyopathy at the age of 21 years. Early recognition of this syndrome is important because of the possible development of heart block.
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Affiliation(s)
- K H Orstavik
- Department of Medical Genetics, Ullevål Hospital, Oslo, Norway
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31
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Svendsen L, Kolmannskog F, Rode L, Efskind PS, Bø O. [Ultrasound guided fine-needle aspiration biopsy in cytological diagnosis]. Tidsskr Nor Laegeforen 1987; 107:1672-3, 1675. [PMID: 3307018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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32
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Svendsen L, Kolmannskog F, Rode L, Skjeldal S. [Renal oncocytoma]. Tidsskr Nor Laegeforen 1986; 106:2050-2, 2049. [PMID: 3535166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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33
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Hatlinghus S, Rode L, Christensen I, Vaage S. Sarcoma following irradiation for breast cancer. Report of three unusual cases including one malignant mesenchymoma of bone. Acta Radiol Oncol 1986; 25:239-42. [PMID: 3030050 DOI: 10.3109/02841868609136412] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Three cases of sarcoma developing after irradiation for breast cancer are reported. A malignant mesenchymoma in the sternum--a combination of osteogenic sarcoma and rhabdomyosarcoma--is the first documented case of its kind occurring after radiation therapy. Of the other two tumors one was an extraskeletal osteogenic sarcoma in the soft tissues of the thoracic wall and one a rhabdomyosarcoma in the axilla.
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Melsom H, Rode L, Kaalhus O, Elgjo RF, Langholm R, Marton P. [Non-Hodgkin lymphoma localized in the gastrointestinal tract]. Tidsskr Nor Laegeforen 1982; 102:374-7. [PMID: 7157291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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36
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Irsai E, Bély M, Rode L. [A case of solitary plasmacytoma]. Morphol Igazsagugyi Orv Sz 1981; 21:48-50. [PMID: 7266534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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