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Kechagias KS, Triantafyllidis KK, Zouridaki G, Savvidou M. Obstetric and neonatal outcomes in pregnant women with idiopathic polyhydramnios: a systematic review and meta-analysis. Sci Rep 2024; 14:5296. [PMID: 38438422 PMCID: PMC10912321 DOI: 10.1038/s41598-024-54840-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 02/17/2024] [Indexed: 03/06/2024] Open
Abstract
Although the assessment of the amniotic fluid volume in pregnancy is part of the fetal wellbeing surveillance, the impact of idiopathic polyhydramnios (IP) on maternal and perinatal outcomes in unknown. The aim of this meta-analysis was to investigate the association of IP with different maternal and perinatal outcomes. We screened five electronic databases until December 2023 and performed data extraction and quality assessment using ROBINS-E in duplicates. Pooled risk ratios and 95% confidence intervals (95% CI) were calculated with a random effects model. 38 studies were included. Patients with IP were at increased risk of perinatal complications including preterm delivery (RR 1.96, 95% CI 1.35-2.86; I2 = 92%), placental abruption (RR 3.20, 95% CI 2.20-4.65; I2 = 2%), delivery via caesarean section (RR 1.60, 95% CI 1.39-1.84; I2 = 95%) and postpartum haemorrhage (RR 1.98, 95% CI 1.22-3.22; I2 = 84%). Similarly, IP was associated with increased risk of adverse perinatal outcomes including low APGAR score (RR 3.0, 95% CI 1.23-7.35; I2 = 95%), stillbirth (RR 4.75, 95% CI 2.54-8.86; I2 = 9%) and perinatal mortality (RR 4.75, 95% CI 2.67-8.48; I2 = 37%). This meta-analysis suggests that pregnant women with IP may be at increased risk of perinatal complications and adverse neonatal outcomes. However, data remains inconclusive considering the low quality and high heterogeneity of included studies.PROSPERO registration number: CRD42022359944.
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Affiliation(s)
- Konstantinos S Kechagias
- Department of Metabolism, Digestion and Reproduction & Department of Surgery and Cancer, Faculty of Medicine, IRDB, Imperial College London, Hammersmith Campus, Du Cane Road, 3rd Floor, London, W12 0NN, UK.
| | | | - Georgia Zouridaki
- Department of Metabolism, Digestion and Reproduction & Department of Surgery and Cancer, Faculty of Medicine, IRDB, Imperial College London, Hammersmith Campus, Du Cane Road, 3rd Floor, London, W12 0NN, UK
| | - Makrina Savvidou
- Department of Metabolism, Digestion and Reproduction & Department of Surgery and Cancer, Faculty of Medicine, IRDB, Imperial College London, Hammersmith Campus, Du Cane Road, 3rd Floor, London, W12 0NN, UK
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London, UK
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Patey O, Bartsota M, Maric T, Patel D, Savvidou M, Carvalho JS. Impact of maternal bariatric surgery on offspring perinatal cardiac function: A prospective study. BJOG 2023. [PMID: 38155109 DOI: 10.1111/1471-0528.17747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/15/2023] [Accepted: 12/13/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE To assess perinatal cardiac function in offspring of women with previous bariatric surgery and examine its association with maternal glucose control. DESIGN Prospective study. SETTING Maternity unit, UK. POPULATION Fifty-four fetuses/neonates; 29 of post-bariatric surgery women and 25 of women without surgery. METHODS Prospective, longitudinal observational study of pregnant women with and without previous bariatric surgery, matched for early pregnancy body mass index. Cardiac function of all offspring was assessed by two-dimensional conventional, spectral tissue Doppler and speckle-tracking echocardiography at 35-37 weeks of gestation and at 5-7 weeks of age. Maternal glycated haemoglobin (HbA1c) was measured at 27-30 weeks of gestation. Maternal demographics and fetal/infant cardiac function indices were compared between the groups. Correlation coefficient (r) is reported. MAIN OUTCOME MEASURES Fetal/infant cardiac function indices. RESULTS Compared with no-bariatric neonates, offspring of post-bariatric women were smaller at birth (birthweight centiles: 64.96 ± 36.41 versus 40.17 ± 27.99; p = 0.007). There were no significant differences in fetal/infant cardiac function indices and perinatal cardiac changes, between groups. There was a positive correlation between maternal HbA1c and fetal left ventricular (LV) longitudinal strain (r = 0.33) and LV longitudinal strain rate (r = 0.29), suggesting an inverse relation between HbA1c and fetal LV systolic function, but this was mainly seen in offspring of women with no previous bariatric surgery (r = 0.56 and r = 0.50, respectively). CONCLUSIONS Maternal bariatric surgery does not appear to inadvertently affect the offspring cardiac performance. We found an inverse correlation between maternal HbA1c levels and fetal LV systolic function but this was mainly seen in the no-bariatric pregnancies.
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Affiliation(s)
- Olga Patey
- Brompton Centre for Fetal Cardiology, Royal Brompton Hospital NHS Foundation Trust, London, UK
| | - Margarita Bartsota
- Brompton Centre for Fetal Cardiology, Royal Brompton Hospital NHS Foundation Trust, London, UK
| | - Tanya Maric
- Academic Department of Obstetrics and Gynaecology, Chelsea & Westminster Hospital, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College, London, UK
| | - Deesha Patel
- Academic Department of Obstetrics and Gynaecology, Chelsea & Westminster Hospital, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College, London, UK
| | - Makrina Savvidou
- Academic Department of Obstetrics and Gynaecology, Chelsea & Westminster Hospital, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College, London, UK
- Fetal Medicine Unit, Chelsea & Westminster Hospital, London, UK
| | - Julene S Carvalho
- Brompton Centre for Fetal Cardiology, Royal Brompton Hospital NHS Foundation Trust, London, UK
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
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Jindal S, Steer PJ, Savvidou M, Draycott T, Dixon‐Woods M, Wood A, Kim LG. Risk factors for a serious adverse outcome in neonates: a retrospective cohort study of vaginal births. BJOG 2023; 130:1521-1530. [PMID: 37156754 PMCID: PMC10952606 DOI: 10.1111/1471-0528.17531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 03/25/2023] [Accepted: 04/23/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To investigate the hypothesis that risk factors in addition to an abnormal fetal heart rate pattern (aFHRp) are independently associated with adverse neonatal outcomes of labour. DESIGN Observational prospective cohort study. SETTING 17 UK maternity units. SAMPLE 585 291 pregnancies between 1988 and 2000 inclusive. METHODS Adjusted odds ratios (OR) with 95% confidence intervals (95% CI) were estimated from multivariable logistic regression. MAIN OUTCOME MEASURES Adverse neonatal outcome at term (5-minute Apgar score <7, and a composite measure comprising 5-minute Apgar score <7, resuscitation by intubation and/or perinatal death). RESULTS Analysis was based on 302 137 vaginal births at 37-42 weeks inclusive. We found a higher odds of Apgar score at 5 minutes <7 with suspected fetal growth restriction (OR 1.34, 95% CI 1.16-1.53), induction of labour (OR 1.41, 95% CI 1.25-1.58), nulliparity (OR 1.48, 95% CI 1.34-1.63), booking body mass index ≥30 (OR 1.18, 95% CI 1.02-1.37), maternal age <25 (OR 1.23, 95% CI 1.10-1.39), black ethnicity (OR 1.21, 95% CI 1.03-1.43), early-term birth at 37-38 weeks (OR 1.13, 95% CI 1.02-1.25), late-term birth at 41-42 weeks (OR 1.14, 95% CI 1.01-1.28), use of oxytocin (OR 1.27, 95% CI 1.14-1.41), maternal pyrexia (OR 1.87, 95% CI 1.46-2.40), aFHRp and presence of meconium (aFHRp without meconium: OR 2.40, 95% CI 2.15-2.69; meconium without aFHRp: OR 2.20, 195% CI.94-2.49; both aFHRp and meconium: OR 4.26, 95% CI 3.74-4.87). The results were similar when the composite adverse outcome was considered. CONCLUSIONS A range of risk factors, including suspicion of fetal growth restriction, maternal pyrexia and presence of meconium, are implicated in poor birth outcomes in addition to aFHRp. Interpretation of the fetal heart rate pattern alone is insufficient as a basis for decisions about escalation and intervention.
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Affiliation(s)
- Sita Jindal
- Academic Department of Obstetrics and GynaecologyImperial College London, Chelsea and Westminster HospitalLondonUK
| | - Philip J. Steer
- Academic Department of Obstetrics and GynaecologyImperial College London, Chelsea and Westminster HospitalLondonUK
| | - Makrina Savvidou
- Academic Department of Obstetrics and GynaecologyImperial College London, Chelsea and Westminster HospitalLondonUK
| | - Tim Draycott
- The Royal College of Obstetricians and GynaecologistsLondonUK
- Department of Women's HealthNorth Bristol NHS TrustWestbury on TrymUK
| | - Mary Dixon‐Woods
- Department of Public Health and Primary CareUniversity of Cambridge, Strangeways Research LaboratoryCambridgeUK
| | - Angela Wood
- Department of Public Health and Primary Care / Cardiovascular Epidemiology Unit, Victor Phillip Dahdaleh Heart and Lung Research InstituteUniversity of CambridgeCambridgeUK
- Health Data Research UK CambridgeWellcome Genome Campus and University of CambridgeCambridgeUK
| | - Lois G. Kim
- Department of Public Health and Primary Care / Cardiovascular Epidemiology Unit, Victor Phillip Dahdaleh Heart and Lung Research InstituteUniversity of CambridgeCambridgeUK
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Savvidou M. Postpartum haemorrhage; prevention and perception. BJOG 2023; 130:997-998. [PMID: 37430432 DOI: 10.1111/1471-0528.17590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
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Iacovou C, Maric T, Bourke M, Patel D, Savvidou M. Gestational Weight Gain in Pregnancies Following Bariatric Surgery. Obes Surg 2023; 33:1004-1011. [PMID: 36811750 PMCID: PMC10079746 DOI: 10.1007/s11695-023-06496-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION To compare the gestational weight gain (GWG) between women with previous bariatric surgery and those without and investigate whether GWG correlates with birthweight (BW) or delivery of a small-for-gestational-age (SGA) neonate. MATERIALS AND METHODS Prospective, longitudinal study, include 100 pregnant women with previous bariatric surgery and 100 without weight loss surgery, but with similar early-pregnancy body mass index (BMI). In a sub-study, 50 of the post-bariatric women were also matched to 50 women without surgery, but early-pregnancy BMI similar to the pre-surgery BMI of the post-bariatric ones. All women had their weight/BMI measured at 11-14 and 35-37 weeks of gestation, and the difference in maternal weight/BMI between the two time points was expressed as GWG/BMI gain. Associations between maternal GWG/BMI gain and birthweight (BW) were examined. RESULTS Compared to no bariatric women with similar early-pregnancy BMI, post-bariatric women had similar GWG (p = 0.46), and the number of women with appropriate, insufficient, and excessive weight gain was comparable between groups (p = 0.76). However, post-bariatric women delivered smaller babies (p < 0.001), and GWG was not a significant predictor of BW or of delivering a SGA neonate. Compared to no bariatric women with similar pre-surgery BMI, post-bariatric ones had higher GWG (p < 0.01) but still delivered smaller neonates (p = 0.001). CONCLUSIONS Post-bariatric women seem to have similar or greater GWG compared to women without surgery matched for early-pregnancy or pre-surgery BMI, respectively. Maternal GWG was not associated with BW or higher prevalence of SGA neonates seen in women with previous bariatric surgery.
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Affiliation(s)
- Christos Iacovou
- Academic Department of Obstetrics and Gynaecology, Department of Metabolism, Digestion and Reproduction, Imperial College London, Chelsea & Westminster Hospital, 369 Fulham Road, SW10 9NH, London, UK
| | - Tanya Maric
- Fetal Medicine Unit, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK
| | - Miriam Bourke
- Academic Department of Obstetrics and Gynaecology, Department of Metabolism, Digestion and Reproduction, Imperial College London, Chelsea & Westminster Hospital, 369 Fulham Road, SW10 9NH, London, UK
| | - Deesha Patel
- Fetal Medicine Unit, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK
| | - Makrina Savvidou
- Academic Department of Obstetrics and Gynaecology, Department of Metabolism, Digestion and Reproduction, Imperial College London, Chelsea & Westminster Hospital, 369 Fulham Road, SW10 9NH, London, UK. .,Fetal Medicine Unit, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK.
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Psichoudaki M, Mina T, Savvidou M, Mina C, Michael C, Fatta-Kassinos D. Wastewater-based monitoring of illicit drugs in Cyprus by UPLC-MS/MS: The impact of the COVID-19 pandemic. Sci Total Environ 2023; 854:158747. [PMID: 36108831 PMCID: PMC9467927 DOI: 10.1016/j.scitotenv.2022.158747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/09/2022] [Accepted: 09/09/2022] [Indexed: 05/14/2023]
Abstract
The outbreak and spread of COVID-19 impacted through various ways the lives of millions of humans globally. In this work, wastewater-based epidemiology (WBE) was applied to investigate the effect of the actions taken by the Republic of Cyprus to confine COVID-19 on the use of illicit stimulant drugs. Daily influent samples were collected from the six main wastewater treatment plants (WWTPs) of the country i) before lockdown (3-9 April 2019), ii) during lockdown (21-27 April 2020), iii) during the post-lockdown period (14-20 July 2020), and, iv) during each season of the following year (20-26 April 2021, 19-25 July 2021, 11-17 October 2021, 25 December 2021-2 January 2022), and analyzed for amphetamine, methamphetamine, MDMA and cocaine. In most areas, amphetamine and methamphetamine use was not affected during the confinement period, but as availability of the substances decreased with time, a drop in their use was observed when most restriction measures were eased (up to 9- and 22-fold decrease, respectively). The limitations on social interactions and events during the quarantine period seem to have led to the reduction of MDMA and cocaine and driven a sharp decrease of their use in most areas studied (up to 11 and 6 times lower, respectively). However, the re-opening of activities led to a pronounced consumption increase, reaching maximum daily values of 800 and 2691 mg/1000 inhabitants/day, respectively. In 2021, drug use was re-established to lower levels. The examination of weekly patterns during this year revealed higher weekend use of methamphetamine, MDMA and cocaine. Our results suggest that both the implementation and the easing of COVID-19 related measures affected the availability and the use of drugs. This study also provides the first insight on the consumption of illicit drugs in the Republic of Cyprus during pre-, post- and pandemic times and demonstrates the importance of WBE.
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Affiliation(s)
- M Psichoudaki
- Nireas-International Water Research Centre, University of Cyprus, P.O. Box 20537, 1678 Nicosia, Cyprus
| | - T Mina
- Nireas-International Water Research Centre, University of Cyprus, P.O. Box 20537, 1678 Nicosia, Cyprus; Department of Civil and Environmental Engineering, School of Engineering, University of Cyprus, P.O. Box 20537, 1678, Nicosia, Cyprus
| | - M Savvidou
- Cyprus National Addictions Authority, 2027 Nicosia, Cyprus
| | - C Mina
- Cyprus National Addictions Authority, 2027 Nicosia, Cyprus
| | - C Michael
- Nireas-International Water Research Centre, University of Cyprus, P.O. Box 20537, 1678 Nicosia, Cyprus
| | - D Fatta-Kassinos
- Nireas-International Water Research Centre, University of Cyprus, P.O. Box 20537, 1678 Nicosia, Cyprus; Department of Civil and Environmental Engineering, School of Engineering, University of Cyprus, P.O. Box 20537, 1678, Nicosia, Cyprus.
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Bourke M, Patel D, Rocca A, Maric T, Savvidou M. Effect of postbariatric maternal weight loss and surgery to conception interval on perinatal outcomes of nulliparous women. Surg Obes Relat Dis 2021; 17:1473-1479. [PMID: 34031009 DOI: 10.1016/j.soard.2021.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 04/02/2021] [Accepted: 04/21/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Bariatric surgery is associated with an increased risk of delivering a small neonate. The role of maternal weight loss and surgery to conception interval is unclear. OBJECTIVES To investigate the effect of maternal weight loss, as a result of bariatric surgery, and surgery to conception interval on fetal growth and birthweight (BW). SETTING Inner London Teaching Hospital METHODS: We studied prospectively nulliparous women with previous bariatric surgery. Information on type, time, and presurgery weight was obtained. Surgery-to-conception interval was calculated as the time between surgery and conception, defined as the fourteenth day of the pregnancy dated by first trimester ultrasound scan. In the first trimester, maternal weight was measured. Assessment of maternal weight change between presurgery and first trimester of pregnancy was defined as total weight loss (TWL) (%). Fetal ultrasound scans were performed twice; 30-32 and 35-37 weeks' gestation and estimated fetal weight (EFW) was calculated. Fetal growth rate was calculated as the ratio of EFW increase (in grams) between 30-32 and 35-37 weeks divided by the time interval (in days) between the 2 examinations. BW was recorded. RESULTS The study included 54 pregnant women, 26 with a restrictive procedure (gastric band or vertical sleeve gastrectomy) and 28 with a gastric bypass. Surgery to conception interval was not a significant predictor of the offspring's growth. Maternal TWL was a significant predictor of fetal growth rate (P = .04) and predictor of BW (P = .005), even after adjustment for confounders. CONCLUSIONS Maternal weight loss, as a result of bariatric surgery, has an inverse correlation with fetal growth rate and BW.
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Affiliation(s)
- Miriam Bourke
- Department of Research & Development, Chelsea & Westminster Hospital, London, United Kingdom
| | - Deesha Patel
- Academic Department of Obstetrics and Gynaecology, Department of Metabolism, Digestion and Reproduction, Imperial College London, Chelsea & Westminster Hospital, London, United Kingdom
| | - Alessandra Rocca
- Department of Research & Development, Chelsea & Westminster Hospital, London, United Kingdom
| | - Tanya Maric
- Fetal Medicine Unit, Chelsea & Westminster Hospital, London, United Kingdom
| | - Makrina Savvidou
- Academic Department of Obstetrics and Gynaecology, Department of Metabolism, Digestion and Reproduction, Imperial College London, Chelsea & Westminster Hospital, London, United Kingdom; Fetal Medicine Unit, Chelsea & Westminster Hospital, London, United Kingdom.
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Rehal A, Benkő Z, De Paco Matallana C, Syngelaki A, Janga D, Cicero S, Akolekar R, Singh M, Chaveeva P, Burgos J, Molina FS, Savvidou M, De La Calle M, Persico N, Quezada Rojas MS, Sau A, Greco E, O’Gorman N, Plasencia W, Pereira S, Jani JC, Valino N, del Mar Gil M, Maclagan K, Wright A, Wright D, Nicolaides KH. Early vaginal progesterone versus placebo in twin pregnancies for the prevention of spontaneous preterm birth: a randomized, double-blind trial. Am J Obstet Gynecol 2021; 224:86.e1-86.e19. [PMID: 32598909 DOI: 10.1016/j.ajog.2020.06.050] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND In women with a singleton pregnancy and sonographic short cervix in midgestation, vaginal administration of progesterone reduces the risk of early preterm birth and improves neonatal outcomes without any demonstrable deleterious effects on childhood neurodevelopment. In women with twin pregnancies, the rate of spontaneous early preterm birth is 10 times higher than that in singletons, and in this respect, all twins are at an increased risk of preterm birth. However, 6 trials in unselected twin pregnancies reported that vaginal administration of progesterone from midgestation had no significant effect on the incidence of early preterm birth. Such apparent lack of effectiveness of progesterone in twins may be due to inadequate dosage or treatment that is started too late in pregnancy. OBJECTIVE The early vaginal progesterone for the prevention of spontaneous preterm birth in twins, a randomized, placebo-controlled, double-blind trial, was designed to test the hypothesis that among women with twin pregnancies, vaginal progesterone at a dose of 600 mg per day from 11 to 14 until 34 weeks' gestation, as compared with placebo, would result in a significant reduction in the incidence of spontaneous preterm birth between 24+0 and 33+6 weeks. STUDY DESIGN The trial was conducted at 22 hospitals in England, Spain, Bulgaria, Italy, Belgium, and France. Women were randomly assigned in a 1:1 ratio to receive either progesterone or placebo, and in the random-sequence generation, there was stratification according to the participating center. The primary outcome was spontaneous birth between 24+0 and 33+6 weeks' gestation. Statistical analyses were performed on an intention-to-treat basis. Logistic regression analysis was used to determine the significance of difference in the incidence of spontaneous birth between 24+0 and 33+6 weeks' gestation between the progesterone and placebo groups, adjusting for the effect of participating center, chorionicity, parity, and method of conception. Prespecified tests of treatment interaction effects with chorionicity, parity, method of conception, compliance, and cervical length at recruitment were performed. A post hoc analysis using mixed-effects Cox regression was used for further exploration of the effect of progesterone on preterm birth. RESULTS We recruited 1194 women between May 2017 and April 2019; 21 withdrew consent and 4 were lost to follow-up, which left 582 in the progesterone group and 587 in the placebo group. Adherence was good, with reported intake of ≥80% of the required number of capsules in 81.4% of the participants. After excluding births before 24 weeks and indicated deliveries before 34 weeks, spontaneous birth between 24+0 and 33+6 weeks occurred in 10.4% (56/541) of participants in the progesterone group and in 8.2% (44/538) in the placebo group (odds ratio in the progesterone group, adjusting for the effect of participating center, chorionicity, parity, and method of conception, 1.35; 95% confidence interval, 0.88-2.05; P=.17). There was no evidence of interaction between the effects of treatment and chorionicity (P=.28), parity (P=.35), method of conception (P=.56), and adherence (P=.34); however, there was weak evidence of an interaction with cervical length (P=.08) suggestive of harm to those with a cervical length of ≥30 mm (odds ratio, 1.61; 95% confidence interval, 1.01-2.59) and potential benefit for those with a cervical length of <30 mm (odds ratio, 0.56; 95% confidence interval, 0.20-1.60). There was no evidence of difference between the 2 treatment groups for stillbirth or neonatal death, neonatal complications, neonatal therapy, and poor fetal growth. In the progesterone group, 1.4% (8/582) of women and 1.9% (22/1164) of fetuses experienced at least 1 serious adverse event; the respective numbers for the placebo group were 1.2% (7/587) and 3.2% (37/1174) (P=.80 and P=.06, respectively). In the post hoc time-to-event analysis, miscarriage or spontaneous preterm birth between randomization and 31+6 weeks' gestation was reduced in the progesterone group relative to the placebo group (hazard ratio, 0.23; 95% confidence interval, 0.08-0.69). CONCLUSION In women with twin pregnancies, universal treatment with vaginal progesterone did not reduce the incidence of spontaneous birth between 24+0 and 33+6 weeks' gestation. Post hoc time-to-event analysis led to the suggestion that progesterone may reduce the risk of spontaneous birth before 32 weeks' gestation in women with a cervical length of <30 mm, and it may increase the risk for those with a cervical length of ≥30 mm.
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Affiliation(s)
- E. Boli
- Laboratory of Thermodynamics and Transport Phenomena, School of Chemical Engineering, National Technical University of Athens, Athens, Greece
| | - M. Savvidou
- Biotechnology Laboratory, School of Chemical Engineering, National Technical University of Athens, Athens, Greece
| | - D. Logothetis
- Laboratory of Thermodynamics and Transport Phenomena, School of Chemical Engineering, National Technical University of Athens, Athens, Greece
| | - V. Louli
- Laboratory of Thermodynamics and Transport Phenomena, School of Chemical Engineering, National Technical University of Athens, Athens, Greece
| | - G. Pappa
- Laboratory of Thermodynamics and Transport Phenomena, School of Chemical Engineering, National Technical University of Athens, Athens, Greece
| | - E. Voutsas
- Laboratory of Thermodynamics and Transport Phenomena, School of Chemical Engineering, National Technical University of Athens, Athens, Greece
| | - F. Kolisis
- Biotechnology Laboratory, School of Chemical Engineering, National Technical University of Athens, Athens, Greece
| | - K. Magoulas
- Laboratory of Thermodynamics and Transport Phenomena, School of Chemical Engineering, National Technical University of Athens, Athens, Greece
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Makgoba M, Nelson SM, Savvidou M, Messow CM, Nicolaides K, Sattar N. First-trimester circulating 25-hydroxyvitamin D levels and development of gestational diabetes mellitus. Diabetes Care 2011; 34:1091-3. [PMID: 21454797 PMCID: PMC3114479 DOI: 10.2337/dc10-2264] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the association between first-trimester maternal serum levels of 25-hydroxyvitamin D (25-OH-D) as measured by liquid chromatography-tandem mass spectrometry and development of gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS We conducted a case-control study involving 248 women in the first-trimester of pregnancy, 90 of whom developed GDM and 158 remained normoglycemic. RESULTS Although booking 25-OH-D levels correlated negatively with 2-h glucose post-oral glucose tolerance test and positively with HDL cholesterol, as well as with ethnicity, obesity, and smoking (all P < 0.05), there were no statistically significant differences in baseline maternal mean 25-OH-D levels between those who subsequently developed GDM, 18.9 ng/mL (SD 10.7) and those who remained normoglycemic, 19.0 ng/mL (10.7) (P = 0.874), even after adjustment for possible confounders including sampling month (P = 0.784). CONCLUSIONS Our large and well-phenotyped prospective study did not find evidence of an association between first-trimester maternal levels of 25-OH-D and subsequent development of GDM.
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Affiliation(s)
- Mahlatse Makgoba
- Department of Maternal Fetal Medicine, Imperial College School of Medicine, Chelsea and Westminster Hospital, London, UK
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Savvidou M, Nelson SM, Makgoba M, Messow CM, Sattar N, Nicolaides K. First-trimester prediction of gestational diabetes mellitus: examining the potential of combining maternal characteristics and laboratory measures. Diabetes 2010; 59:3017-22. [PMID: 20876721 PMCID: PMC2992761 DOI: 10.2337/db10-0688] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Predictors of gestational diabetes mellitus (GDM) have been widely studied, but few studies have considered multiple measures. Our objective was to integrate several potential GDM predictors with consideration to both simple and novel measures and to determine the extent to which GDM can be predicted in the first trimester. RESEARCH DESIGN AND METHODS We identified first-trimester maternal samples from 124 women who developed GDM and 248 control subjects who did not. We gathered data on age, BMI, parity, race, smoking, prior GDM, family history of diabetes, and blood pressure. Using retrieved samples, we measured routine (lipids, high-sensitivity C-reactive protein, and γ-glutamyltransferase) and novel (adiponectin, E-selectin, and tissue plasminogen activator [t-PA]) parameters. We determined independent predictors from stepwise regression analyses, calculated areas under the receiver-operating characteristic curves (AUC-ROC), and integrated discrimination improvement (IDI) for relevant models. RESULTS Compared with control subjects, women who subsequently developed GDM were older, had higher BMIs, were more likely to be of Asian origin, had a history of GDM or family history of type 2 diabetes, and had higher systolic blood pressure (P < 0.05 for all). With regard biochemical measures, stepwise analyses identified only elevated t-PA and low HDL cholesterol levels as significant (P ≤ 0.015) independent predictors of GDM beyond simple non-laboratory-based maternal measures. Their inclusion improved the AUC-ROC from 0.824 to 0.861 and IDI by 0.052 (0.017-0.115). CONCLUSIONS GDM can be usefully estimated from a mix of simple questions with potential for further improvement by specific blood measures (lipids and t-PA).
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Affiliation(s)
- Makrina Savvidou
- Department of Maternal Fetal Medicine, Imperial College School of Medicine, Chelsea and Westminster Hospital, London, U.K
- Corresponding authors: Naveed Sattar, , and Makrina Savvidou,
| | - Scott M. Nelson
- Faculty of Medicine, University of Glasgow, Glasgow, Scotland
| | - Mahlatse Makgoba
- Department of Maternal Fetal Medicine, Imperial College School of Medicine, Chelsea and Westminster Hospital, London, U.K
| | | | - Naveed Sattar
- Faculty of Medicine, University of Glasgow, Glasgow, Scotland
- Corresponding authors: Naveed Sattar, , and Makrina Savvidou,
| | - Kypros Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, U.K
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Anderson J, Savvidou M, Nicolaides K. 274: Maternal arterial stiffness in pregnancies complicated by gestational and type 2 diabetes mellitus. Am J Obstet Gynecol 2009. [DOI: 10.1016/j.ajog.2009.10.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Michopoulou A, Goula V, Belesioti B, Savvidou M. Commorbidity between ADHD and sleep disorders in school children. Eur Psychiatry 2008. [DOI: 10.1016/j.eurpsy.2008.01.1246] [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] Open
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Spencer K, Yu CKH, Savvidou M, Papageorghiou AT, Nicolaides KH. Prediction of pre-eclampsia by uterine artery Doppler ultrasonography and maternal serum pregnancy-associated plasma protein-A, free beta-human chorionic gonadotropin, activin A and inhibin A at 22 + 0 to 24 + 6 weeks' gestation. Ultrasound Obstet Gynecol 2006; 27:658-63. [PMID: 16493628 DOI: 10.1002/uog.2676] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To investigate the potential value of combining uterine artery Doppler ultrasonography with the measurement of maternal serum pregnancy-associated plasma protein-A (PAPP-A), free beta-human chorionic gonadotropin (beta-hCG), activin A and inhibin A at 22 + 0 to 24 + 6 weeks' gestation, in the prediction of pregnancies that subsequently develop pre-eclampsia. METHODS The maternal serum PAPP-A, free beta-hCG, activin A and inhibin A concentrations at 22 + 0 to 24 + 6 weeks' gestation were measured in samples obtained from women with singleton pregnancies who participated in a screening study for pre-eclampsia by transvaginal color flow Doppler measurement of the uterine artery pulsatility index (PI). A search was made of the database to identify those who subsequently developed pre-eclampsia (n = 24) and a group of controls with normal outcome (n = 144). Regression analysis was performed to establish any relationship between the biochemical markers themselves and between the biochemical markers and uterine artery mean PI. A multivariate Gaussian model combining various biochemical markers with uterine artery mean PI was developed using standard statistical modeling techniques and the performance of such models in discriminating cases with pre-eclampsia was evaluated by receiver-operating characteristics curve (ROC) analysis. RESULTS In the pre-eclampsia group, compared to the controls, the uterine artery mean PI and the maternal serum levels of PAPP-A, free beta-hCG, activin A and inhibin A were significantly increased. The predicted detection rates of pre-eclampsia, for a false positive rate of 5%, was 50% by uterine artery mean PI, 5% by PAPP-A, 10% by free beta-hCG, 35% by inhibin A and 44% by activin A. Screening by a combination of uterine artery mean PI and maternal serum activin A and inhibin A could detect 75% and 92% of patients who subsequently developed pre-eclampsia, for false positive rates of 5% and 10%, respectively. CONCLUSION Screening for pre-eclampsia by uterine artery PI at 22 + 0 to 24 + 6 weeks' gestation can be improved by measurement of activin A and inhibin A levels.
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Affiliation(s)
- K Spencer
- Prenatal Screening Unit, Clinical Biochemistry Department, Harold Wood Hospital, Romford, UK.
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Savvidou M, Edwards G, Davies N. Use of steroids, tocolytics and antibiotics in the management of preterm labour in Wales. J OBSTET GYNAECOL 2004; 18:315-7. [PMID: 15512098 DOI: 10.1080/01443619867010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
The management of preterm labour (PTL) remains contentious. Many regimes are used for the management of this common condition and in utero transfer of pregnant women to another unit is not unusual in British practice. Medical staff in the accepting unit may have little or no experience with one or more drug regimes used in this condition which used in isolation and in combination with others may have disastrous consequences for the mother. We have assessed the variation in practice for the management of preterm labour in all consultant-led obstetric units in Wales using a postal questionnaire. The percentage of units with written guidelines for the management of PTL was 40%. All units used corticosteroids although the regimes used varied. Fourteen of the 15 units used tocolytics. Ritodrine and nifedipine were the most frequently used tocolytics but there was much variation in practice. Only seven (46.7%) units used antibiotics and five of these were randomising women in PTL to the ORACLE study. Postal surveys may not reflect accurately what actually happens in clinical practice. These data demonstrate that there is no common policy for the management of PTL even in a relatively small region such as Wales. We would suggest that the development of a regional policy for the management of preterm labour would be a significant step forward in the management of this controversial, but important cause of neonatal morbidity and mortality.
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Affiliation(s)
- M Savvidou
- Department of Obstetrics and Gynaecology, University Hospital of Wales Healthcare Trust, Cardiff, UK
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