Passive antibody transfer from pregnant women to their fetus are maximized after SARS-CoV-2 vaccination irrespective of prior infection

Background

Pregnancy is associated with a higher risk of adverse symptoms and outcomes for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection for both mother and neonate. Antibodies can provide protection against SARS-CoV-2 infection and are induced in pregnant women after vaccination or infection. Passive transfer of these antibodies from mother to fetus in utero may provide protection to the neonate against infection. However, it is unclear whether the magnitude or quality and kinetics of maternally derived fetal antibodies differs in the context of maternal infection or vaccination.

Objective

We aimed to determine whether antibodies transferred from maternal to fetus differed in quality or quantity between infection- or vaccination-induced humoral immune responses.

Methods

We evaluated 93 paired maternal and neonatal umbilical cord blood plasma samples collected between October 2020 and February 2022 from a birth cohort of pregnant women from New Orleans, Louisiana, with histories of SARS-CoV-2 infection and/or vaccination. Plasma was profiled for the levels of spike-specific antibodies and induction of antiviral humoral immune functions, including neutralization and Fc-mediated innate immune effector functions. Responses were compared between 4 groups according to maternal infection and vaccination.

Results

We found that SARS-CoV-2 vaccination or infection during pregnancy increased the levels of antiviral antibodies compared to naive subjects. Vaccinated mothers and cord samples had the highest anti-spike antibody levels and antiviral function independent of the time of vaccination during pregnancy.

Conclusions

These results show that the most effective passive transfer of functional antibodies against SARS-CoV-2 in utero is achieved through vaccination, highlighting the importance of vaccination in pregnant women.

Connecting G protein-coupled estrogen receptor biomolecular mechanisms with the pathophysiology of preeclampsia: a review

BACKGROUND

Throughout the course of pregnancy, small maternal spiral arteries that are in contact with fetal tissue undergo structural remodeling, lose smooth muscle cells, and become less responsive to vasoconstrictors. Additionally, placental extravillous trophoblasts invade the maternal decidua to establish an interaction between the fetal placental villi with the maternal blood supply. When successful, this process enables the transport of oxygen, nutrients, and signaling molecules but an insufficiency leads to placental ischemia. In response, the placenta releases vasoactive factors that enter the maternal circulation and promote maternal cardiorenal dysfunction, a hallmark of preeclampsia (PE), the leading cause of maternal and fetal death. An underexplored mechanism in the development of PE is the impact of membrane-initiated estrogen signaling via the G protein-coupled estrogen receptor (GPER). Recent evidence indicates that GPER activation is associated with normal trophoblast invasion, placental angiogenesis/hypoxia, and regulation of uteroplacental vasodilation, and these mechanisms could explain part of the estrogen-induced control of uterine remodeling and placental development in pregnancy.

CONCLUSION

Although the relevance of GPER in PE remains speculative, this review provides a summary of our current understanding on how GPER stimulation regulates some of the features of normal pregnancy and a potential link between its signaling network and uteroplacental dysfunction in PE. Synthesis of this information will facilitate the development of innovative treatment options.

Maternal and Neonatal Antibody And T Cell Responses To SARS-CoV-2 Following Maternal Infection And/Or Vaccination

Pregnant women and neonates are at risk for adverse SARS CoV-2 infection outcomes, but few studies have evaluated this population for adaptive immunity. Here, we utilized samples collected from pregnant women 18 years or older reporting two or more respiratory symptoms. Information about trimester of COVID positive test or history of vaccination was also collected. Maternal blood (MB) samples were collected at prenatal clinic visits, or at delivery together with the fetal cord blood (CB)(n=70 dyads). Groups were selected based on trimester of infection, vaccination only, or no history of vaccination or infection (n=9–24) and compared with banked samples from a non-pregnant, age-matched woman from the same time period (n=7–12). Data shows IgG transfer to baby irrespective of trimester of infection (n=9–24 per group). Highest levels of antibodies were observed with vaccinated, uninfected women. Functional antibodies are transferred from mother to fetus following infection and vaccination. CD4 and CD8 T-cell activation and cytokine secretion were detected in maternal PBMCs, with highly variable expression between subjects. In at least one dyad with a PCR-confirmed infection during second trimester, both maternal and cord blood samples had low level expression of anti-S, N, RBD antibodies at delivery and the cord blood mononuclear cells showed CD4 T cell activation (CD134+) and cytokine secretion (IL-2, IL-6, TNFalpha) to spike antigens. These results indicate the unusual immunity to SARS CoV-2 infection during pregnancy and suggest at least one case of a neonate with anti-viral cellular immunity. Ongoing analyses and surveillance for perinatal outcomes may reveal how these immune responses impact infant respiratory outcomes.

Childhood adiposity and fertility difficulties: the Bogalusa Heart Study

BACKGROUND

Adult obesity is associated with infertility; however, childhood obesity has received little consideration.

OBJECTIVES

The present study sought to evaluate the impact of childhood adiposity on fertility.

METHODS

Associations between childhood adiposity and self-reported fertility difficulties were estimated among women participating in a long-term study of cardiovascular risks and reproductive health (n = 1061).

RESULTS

Participants with obesity between ages 9 and 12 were more likely to report fertility difficulties (adjusted relative risk [aRR], 1.82, 95% CI 1.17-2.82) and inability to become pregnant when trying (aRR = 1.94, 95% CI 1.22-3.08) as were those with obesity prior to age 9 (aRR = 1.76, 95% CI 1.04-2.97). Similar associations were seen among those ever overweight or obese in childhood. High subscapular skinfold thickness (age < 12) increased risk of receiving help becoming pregnant (aRR = 2.16, 95% CI 1.15-4.06), inability to become pregnant (aRR = 1.46, 95% CI 1.05-2.04) and any fertility difficulties (aRR = 1.56, 95% CI 1.13-2.14); associations for triceps skinfold were attenuated. Participants with increased adiposity also had fewer pregnancies and live births. Effects persisted, excluding women with polycystic ovarian syndrome.

CONCLUSIONS

This study supports an association between childhood adiposity and infertility, not solely driven by polycystic ovarian syndrome.

Use of Intracytoplasmic Sperm Injection and Birth Outcomes in Women Conceiving through In Vitro Fertilization

BACKGROUND

Despite questionable evidence of benefits over conventional in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI) use has markedly increased in recent decades among couples without male factor infertility. We assessed the frequency of ICSI use and its effect on birth outcomes.

METHODS

A retrospective cohort study was conducted in 141 030 women conceiving through IVF using 2006-2010 data from the Society for Assisted Reproductive Technology (SART).

RESULTS

Between 2006 and 2010, overall ICSI use in women conceiving through IVF increased from 68.9% to 73.1%. This increase was greater among women without male factor infertility (53.0-59.2%) than in women with male factor infertility (92.0-93.4%). Women conceiving through IVF with and without ICSI had similar rates of multiple pregnancy, preterm delivery, stillbirth, and neonatal death. However, ICSI pregnancies were associated with an increased risk of birth defects over conventional IVF (3.0% for ICSI vs. 2.5% for conventional IVF; adjusted odds ratio (OR) 1.2, 95% confidence interval (CI) 1.2, 1.3). These increases were observed in both women conceiving through ICSI with male factor infertility (3.2% vs. 2.5%; OR 1.4, 95% CI 1.3, 1.5) and without male factor infertility (2.7% vs. 2.5%; OR 1.1, 95% CI 1.1, 1.2).

CONCLUSIONS

Higher rates of birth defects were observed among women conceiving through ICSI. Since approximately half of all ICSI procedures are performed in couples without male factor infertility, ICSI may be overused in practice.

Birth Weight by Gestational Age for 76,710 Twins Born in the United States as a Result of In Vitro Fertilization: 2006 to 2010

Objective The objective of this study was to establish twin-specific birth weight percentiles by gestational age using U.S. twin births resulting from in vitro fertilization (IVF). Study Design A retrospective analysis of birth weight by completed weeks of gestation for 76,710 twin IVF births reported to the Society for Assisted Reproductive Technologies from 2006 to 2010. Mean and median birth weights and 3rd, 5th, 10th, 25th, 50th, 75th, 90th, and 97th percentiles were calculated by completed week of gestation and infant sex. Results IVF twin birth weight accelerates until term and then declines. The deceleration in twin birth weight occurs at 39 completed weeks of gestation for larger twins, those at or above the 50th percentile in weight. For smaller twins, the growth deceleration occurs earlier, at 38 weeks of gestation. IVF female and male twin birth weights for gestational age were similar to all IVF twins, showing similar decelerations near term. Conclusion Using U.S. IVF twin-specific growth charts, with known date of conception, twins demonstrate a deceleration in birth weight near term. Larger twins demonstrate a deceleration in birth weight by 39 completed weeks of gestation; smaller twins show a deceleration at 38 weeks. These data may assist in the clinical management of twins near term.

Prospective study of pregnancy and newborn outcomes in mothers with West nile illness during pregnancy

BACKGROUND

A previous case report of West Nile virus (WNV) illness during pregnancy suggested that WNV could be a cause of congenital defects. We performed a prospective, longitudinal cohort study of pregnant women with WNV illness to increase our knowledge of the effects of WNV illness during pregnancy.

METHODS

Participants were enrolled in 2005 to 2008 from pregnant women with serologically confirmed WNV illness reported to the Centers for Disease Control and Prevention. Comparison was made to WNV-uninfected women, matched on maternal age and enrollment month. Pregnancy and newborn data were collected; cord blood WNV serology was obtained. Pediatric exams and the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III) were performed.

RESULTS

Twenty-eight WNV-infected mothers and 25 WNV-uninfected mothers participated. Maternal demographics were similar except for a higher rate of planned pregnancies, education, and household income in the WNV-uninfected mothers. There were no differences in pregnancy and delivery characteristics except that infected mothers had a higher incidence of febrile illnesses and used more medications. Birth weight, length, head circumference, and rate of congenital malformations were similar in babies born to WNV-infected and -uninfected mothers. Follow-up physical exams were generally normal. The Bayley-III assessments, available for 17 children born to mothers with WNV illness, showed performance at or above age level across domains.

CONCLUSION

The risk for adverse pregnancy and newborn outcomes in women experiencing WNV illness in pregnancy appears to be low, but future studies with larger numbers are needed to rule out a small risk. Birth Defects Research (Part A) 106:716-723, 2016. © 2016 Wiley Periodicals, Inc.

Singleton birthweight by gestational age following in vitro fertilization in the United States

BACKGROUND

Assisted reproductive technology has been reported to account for a disproportionate higher number of low birthweight infants, even in singleton births. Low birthweight infants occur from preterm birth, decreased intrauterine growth, or both. It is unclear whether infants conceived by in vitro fertilization (IVF) have a reduced intrauterine growth rate or intrauterine growth restriction. Growth-restricted newborns have higher perinatal morbidity and are at increased risk for adult-onset illnesses. To date, there are no national standards for birthweight percentiles by gestational week, allowing for fetal growth assessment of singletons conceived by assisted reproductive technology in the United States.

OBJECTIVE

The objective of the study was to establish US singleton IVF reference standards using birthweight percentiles by gestational age for singleton live births resulting from IVF in the United States.

STUDY DESIGN

We studied birthweight by completed weeks of gestation for 93,443 singleton IVF births reported to the Society for Assisted Reproductive Technologies, 2006-2010. The third to 97th birthweight percentiles per completed week of gestation for weeks between 24 and 42 were calculated and were compared with recently published birthweight percentiles by gestational age for 3,812,730 US singleton births in 2011.

RESULTS

Smoothed birthweight for gestational age charts and curves were created for all US IVF singletons and female-male singletons from 24 to 42 weeks. Over the span of 31-41 weeks of gestation, the 10th, 50th, and 90th birthweight percentile values of IVF singletons were comparable with recently published birthweight percentile values of US singletons. At 40 completed weeks of gestation, the 10th, 50th, and 90th birthweight percentiles of all IVF singletons were 3078, 3506, and 4053 g, as compared with corresponding 3005, 3499, and 4057 g of US singletons. The 10th, 50th, and 90th birthweight percentile values for female and male IVF singletons were also comparable with US female and male singletons.

CONCLUSION

Birthweight percentiles per completed week of gestation of IVF and US singletons are approximately equal from 31 until 41 completed weeks, suggesting that intrauterine growth is not reduced in IVF singleton infants.

Long-term safety and efficacy of sapropterin: the PKUDOS registry experience

The Phenylketonuria (PKU) Demographics, Outcomes and Safety (PKUDOS) registry is designed to provide longitudinal safety and efficacy data on subjects with PKU who are (or have been) treated with sapropterin dihydrochloride. The PKUDOS population consists of 1189 subjects with PKU: N = 504 who were continuously exposed to sapropterin from date of registry enrollment, N = 211 who had intermittent exposure to the drug, and N = 474 with some other duration of exposure. Subjects continuously exposed to sapropterin showed an average 34% decrease in blood phenylalanine (Phe)--from 591 ± 382 μmol/L at baseline to 392 ± 239 μmol/L (p = 0.0009) after 5 years. This drop in blood Phe was associated with an increase in dietary Phe tolerance [from 1000 ± 959 mg/day (pre-sapropterin baseline) to 1539 ± 840 mg/day after 6 years]. Drug-related adverse events (AEs) were reported in 6% of subjects, were mostly considered non-serious, and were identified in the gastrointestinal, respiratory, and nervous systems. Serious drug-related AEs were reported in ≤ 1% of subjects. Similar safety and efficacy data were observed for children<4 years. Long-term data from the PKUDOS registry suggest that sapropterin has a tolerable safety profile and that continuous use is associated with a significant and persistent decrease in blood Phe and improvements in dietary Phe tolerance.

Maternal age and preterm births in singleton and twin pregnancies conceived by in vitro fertilisation in the United States

BACKGROUND

Among natural conceptions, advanced maternal age (≥ 35 years) is associated with an increased risk of preterm birth. However, few studies have specifically examined this association in births resulting from in vitro fertilisation (IVF).

METHODS

A retrospective cohort study was conducted in 97288 singleton and 40961 twin pregnancies resulting from fresh non-donor IVF cycles using 2006-10 data from the Society for Assisted Reproductive Technology Clinic Online Reporting System.

RESULTS

Rates of very early preterm (<28), early preterm (<32), and preterm birth (<37 completed weeks) decreased with increasing maternal age in both singleton and twin births (PTrend <0.01). With women aged 30-34 years as the reference, those aged <30 years were at an increased risk of all types of preterm births. The adjusted odd ratio (95% confidence interval [CI]) for very early preterm birth, early preterm birth, and preterm birth in women aged 25-29 years were 1.3 [95% CI 1.1, 1.5], 1.2 [95% CI 1.1, 1.4], and 1.1 [95% CI 1.02, 1.2] in singletons. This increased risk of preterm births among younger women was even more significant in twin births. However, women aged ≥ 35 years were not at an increased risk of any type of preterm births in both singleton and twin births.

CONCLUSIONS

In contrast to natural conception, advanced maternal age is not associated with an increased risk of preterm births in pregnancies conceived by IVF. Women who seek IVF treatments before 30 years old are at higher risk of all stages of preterm births.

Kaposi's sarcoma-associated herpesvirus G-protein coupled receptor activates the canonical Wnt/β-catenin signaling pathway

Background

KSHV is a tumorigenic γ-herpesvirus that has been identified as the etiologic agent of Kaposi’s sarcoma (KS), a multifocal highly vascularized neoplasm that is the most common malignancy associated with acquired immunodeficiency syndrome (AIDS). The virus encodes a constitutively active chemokine receptor homologue, vGPCR that possesses potent angiogenic and tumorigenic properties, and is critical for KSHV pathobiology. To date, a number of signaling pathways have been identified as key in mediating vGPCR oncogenic potential.

Findings

In this study, we identify a novel pathway, the Wnt/β-catenin pathway, which is dysregulated by vGPCR expression in endothelial cells. Expression of vGPCR in endothelial cells enhances the nuclear accumulation of β-catenin, that correlates with an increase in β-catenin transcriptional activity. Activation of β-catenin signaling by vGPCR is dependent on the PI3K/Akt pathway, as treatment of vGPCR-expressing cells with a pharmacological inhibitor of PI3K, leads to a decreased activation of a β-catenin-driven reporter, a significant decrease in expression of β-catenin target genes, and reduced endothelial tube formation.

Conclusions

Given the critical role of Wnt/β-catenin signaling in angiogenesis and tumorigenesis, the findings from this study suggest a novel mechanism in KSHV-induced malignancies.

Electronic supplementary material

The online version of this article (doi:10.1186/s12985-014-0218-8) contains supplementary material, which is available to authorized users.

Developmental outcomes in young children born to mothers with West Nile illness during pregnancy

BACKGROUND

West Nile virus (WNV) infection is associated with acute morbidity and mortality in adults and children. Information on the effects of maternal WNV illness during pregnancy on early childhood development is limited. This study was designed to examine the relationship between maternal WNV illness during pregnancy and birth and developmental outcomes at age 3 years.

METHODS

Mother-child participants were identified using a national surveillance registry for women with WNV illness during pregnancy. Maternal and infant health data and relevant family characteristics were obtained through medical record reviews and maternal questionnaires. All infants received ophthalmologic examinations. Child development was evaluated at age 3 years using the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III).

RESULTS

As a group, the children's (N = 11) birth weight, head circumference, and infant ophthalmologic examination results were within age expectations; one child was born preterm (gestational age 36 weeks). Mean (SD) age at the time of Bayley-III testing was 36.7 (3.8) months. The group's mean performance on the Bayley-III was at or above age level in all domains, but one child showed a mild delay in the Adaptive domain. The variability observed in this sample (1/53 [1.9%] Domain scores < -2.0 SDs) was consistent with expectations based upon the distribution of Bayley-III Domain scores in the general population.

CONCLUSION

Maternal WNV infection does not appear to be associated with global developmental delays in young children. These results are preliminary, however, and require confirmation in future research.

Phenylketonuria Scientific Review Conference: state of the science and future research needs

New developments in the treatment and management of phenylketonuria (PKU) as well as advances in molecular testing have emerged since the National Institutes of Health 2000 PKU Consensus Statement was released. An NIH State-of-the-Science Conference was convened in 2012 to address new findings, particularly the use of the medication sapropterin to treat some individuals with PKU, and to develop a research agenda. Prior to the 2012 conference, five working groups of experts and public members met over a 1-year period. The working groups addressed the following: long-term outcomes and management across the lifespan; PKU and pregnancy; diet control and management; pharmacologic interventions; and molecular testing, new technologies, and epidemiologic considerations. In a parallel and independent activity, an Evidence-based Practice Center supported by the Agency for Healthcare Research and Quality conducted a systematic review of adjuvant treatments for PKU; its conclusions were presented at the conference. The conference included the findings of the working groups, panel discussions from industry and international perspectives, and presentations on topics such as emerging treatments for PKU, transitioning to adult care, and the U.S. Food and Drug Administration regulatory perspective. Over 85 experts participated in the conference through information gathering and/or as presenters during the conference, and they reached several important conclusions. The most serious neurological impairments in PKU are preventable with current dietary treatment approaches. However, a variety of more subtle physical, cognitive, and behavioral consequences of even well-controlled PKU are now recognized. The best outcomes in maternal PKU occur when blood phenylalanine (Phe) concentrations are maintained between 120 and 360 μmol/L before and during pregnancy. The dietary management treatment goal for individuals with PKU is a blood Phe concentration between 120 and 360 μmol/L. The use of genotype information in the newborn period may yield valuable insights about the severity of the condition for infants diagnosed before maximal Phe levels are achieved. While emerging and established genotype-phenotype correlations may transform our understanding of PKU, establishing correlations with intellectual outcomes is more challenging. Regarding the use of sapropterin in PKU, there are significant gaps in predicting response to treatment; at least half of those with PKU will have either minimal or no response. A coordinated approach to PKU treatment improves long-term outcomes for those with PKU and facilitates the conduct of research to improve diagnosis and treatment. New drugs that are safe, efficacious, and impact a larger proportion of individuals with PKU are needed. However, it is imperative that treatment guidelines and the decision processes for determining access to treatments be tied to a solid evidence base with rigorous standards for robust and consistent data collection. The process that preceded the PKU State-of-the-Science Conference, the conference itself, and the identification of a research agenda have facilitated the development of clinical practice guidelines by professional organizations and serve as a model for other inborn errors of metabolism.

What is new in patient safety?: best articles from the past year

This month, we focus on current research in patient safety. Dr. Pridjian discusses four recent publications, and each is concluded with a "bottom line" that is the take-home message. The complete reference for each can be found in on this page, along with direct links to the abstracts.

Impact of monozygotic twinning on multiple births resulting from in vitro fertilization in the United States, 2006-2010

OBJECTIVE

To determine the contribution of monozygotic twining to in vitro fertilization multiple births.

STUDY DESIGN

We performed a retrospective analysis of the incidence of monozygotic twining in multiple births resulting from fresh embryo transfers using 2006-2010 data from the Society for Reproductive Technology Clinic Outcome Reporting System.

RESULTS

The number of embryos transferred were fewer than the number of births in 0.5% (223/40950) of twin, 29% (659/2289) of triplet, and 64% (43/67) of quadruplet births resulting from transfer of fresh embryos from 2006 to 2010. In 2010, 37% of triplets and 100% of quadruplet births occurred when fewer than 3 and fewer than 4 embryos respectively were transferred.

CONCLUSION

Monozygotic twinning plays a key role in the development of triplet and quadruplet pregnancies achieved through in vitro fertilization.

Racial and ethnic disparities in preterm births in infants conceived by in vitro fertilization in the United States

OBJECTIVE

The objective of the study was to examine racial and ethnic differences in preterm births in infants conceived by in vitro fertilization (IVF).

STUDY DESIGN

A retrospective cohort study was conducted of 97,288 singleton and 40,961 twin pregnancies resulting from fresh, nondonor IVF cycles using 2006-2010 data from the Society for Assisted Reproductive Technology Clinic Online Reporting System.

RESULTS

Rates of very early preterm (<28 weeks), early preterm (<32 weeks), and preterm birth (<37 completed weeks) varied across racial and ethnic groups in both singleton and twin pregnancies. In singletons, with white women as the referent, after adjustment of confounding variables, the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of very early preterm birth, early preterm birth, and preterm birth in black women were 4.8 (95% CI, 4.1-5.7), 3.9 (95% CI, 3.4-4.4), and 2.1 (95% CI, 1.9-2.3). Hispanic women had a significantly lower rate of preterm births as compared with black women and similar or slightly higher rates as compared with white women. Native American women were not at an increased risk of any types of preterm births; Asian women were at a reduced risk of preterm twin births (adjusted OR, 0.8; 95% CI, 0.7-0.9).

CONCLUSION

There exist notable racial and ethnic disparities in preterm births in infants conceived by IVF, suggesting that mechanisms other than socioeconomic disparities contribute to this difference.

Possible association between maternal lithium therapy and premature closure of the arterial duct. A case report

BACKGROUND

Frequent causes of premature ductal closure include spontaneous idiopathic closure in utero and maternal use of nonsteroidal anti-inflammatory drugs late in pregnancy.

CASE

We describe a case of a preterm infant born to a mother treated with lithium throughout pregnancy who presented with right-sided cardiac enlargement at 18 weeks' gestation. Immediately following delivery, echocardiography demonstrated a small closing patent arterial duct.

CONCLUSION

We recommend that serial fetal echocardiography with emphasis on Doppler interrogation of the patent arterial duct be performed whenever a pregnant woman is taking lithium. The interrogation of the patent arterial duct is particularly important if right-sided chamber enlargement is noted at fetal sonography as this finding can be an early manifestation of premature ductal constriction.

Periodontal disease as a potential risk factor for the development of diabetes in women with a prior history of gestational diabetes mellitus

OBJECTIVE

To examine if periodontal disease is associated with later development of impaired glucose metabolism in women with a recent history of gestational diabetes (GDM).

METHODS

Women with (n = 19) and without (n = 20) a history of GDM were prospectively followed at 22 months postpartum. All subjects underwent: a) a 75-gram oral glucose tolerance test (OGTT); and b) an oral examination for measuring periodontal disease. Insulin sensitivity and pancreatic β-cell secretory capacity derived from fasting (HOMA-IR) and glucose-stimulated measures (SI(OGTT) and IGI/HOMA-IR) were determined. Periodontitis was defined as the presence of any site with a probing depth ≥ 4 mm or a clinical attachment loss ≥ 4 mm.

RESULTS

Compared to women without a history of GDM, prior GDM women had significantly higher fasting glucose and insulin concentrations, increased insulin resistance and decreased β-cell function. Although not statistically significant, prior GDM women had a higher prevalence of periodontal disease (42.1%) than women without a history of GDM (25.0%). Women with periodontal disease showed greater insulin resistance and lower β-cell function. Women with both prior GDM and periodontal disease had the most impaired glucose metabolism; the insulin secretion-sensitivity index was significantly lower in women with both prior GDM and periodontal disease (208.20 ± 2.60) than in women without prior GDM and periodontal disease (742.93 ± 1.78) (P < 0.05).

CONCLUSIONS

Women with prior GDM show reduced insulin sensitivity and inadequate β-cell secretory function at 22 months postpartum. Periodontal disease may contribute to their impaired glucose metabolism and future risk of developing diabetes.

Human cytomegalovirus infection inhibits CXCL12- mediated migration and invasion of human extravillous cytotrophoblasts

Background

During the first trimester of pregnancy, a series of tightly regulated interactions govern the formation of a highly invasive population of fetal-derived extravillous cytotrophoblasts (EVT). Successful pregnancy is dependent on efficient invasion of the uterine wall and maternal spiral arteries by EVT. Dysregulated trophoblast invasion is associated with intrauterine growth restriction, birth defects, spontaneous abortion and preeclampsia. A number of soluble growth factors, cytokines, and chemokines modulate this process, fine-tuning the temporal and spatial aspects of cytotrophoblast invasion. In particular, the CXCL12/CXCR4 axis has been shown to specifically modulate cytotrophoblast differentiation, invasion, and survival throughout early pregnancy. Infection with human cytomegalovirus (HCMV) has been associated with impaired differentiation of cytotrophoblasts down the invasive pathway, specifically dysregulating the response to mitogens including epidermal growth factor (EGF) and hepatocyte growth factor (HGF). In this study, the effect of HCMV infection on the CXCL12-mediated migration and invasion of the EVT cell line SGHPL-4 was investigated.

Results

Infection with HCMV significantly decreased secretion of CXCL12 by SGHPL-4 cells, and induced a striking perinuclear accumulation of the chemokine. HCMV infection significantly increased mRNA and total cell surface expression of the two known receptors for CXCL12: CXCR4 and CXCR7. Functionally, HCMV-infected SGHPL-4 cells were unable to migrate or invade in response to a gradient of soluble CXCL12 in transwell assays.

Conclusions

Collectively, these studies demonstrate that HCMV impairs EVT migration and invasion induced by CXCL12. As HCMV has the ability to inhibit EVT migration and invasion through dysregulation of other relevant signaling pathways, it is likely that the virus affects multiple signaling pathways to impair placentation and contribute to some of the placental defects seen in HCMV-positive pregnancies.

Change of periodontal disease status during and after pregnancy

BACKGROUND

This study explored whether there is any change of periodontal disease status during and after pregnancy. We also examined whether the change is different between females with a history of gestational diabetes mellitus (GDM) and females without GDM during pregnancy.

METHODS

A follow-up study was conducted at Woman's Hospital, Baton Rouge, Louisiana. Thirty-nine females who were previously enrolled in a case-control study during pregnancy were followed an average of 22 months postpartum. Periodontal status was assessed through dental examinations performed both during and after pregnancy. Clinical periodontal parameters included bleeding on probing (BOP), mean probing depth (PD), and mean clinical attachment level (CAL). Periodontitis was defined as the presence of ≥1 sites exhibiting PD ≥4 mm or CAL ≥4 mm. We used generalized estimating equation analysis to examine the change of periodontal status.

RESULTS

Mean number and percentage of sites with BOP decreased from 10.7 ± 11.6 (mean ± SD) and 6.5% ± 7.0% during pregnancy to 7.1 ± 8.8 and 4.3% ± 5.3% at 22 months postpartum (P <0.05), respectively. Mean levels of PD and CAL decreased from 1.8 ± 0.4 mm and 1.9 ± 0.3 mm to 1.6 ± 0.3 mm and 1.6 ± 0.3 mm (P <0.01), respectively. The prevalence of periodontitis decreased from 66.7% to 33.3% (P <0.01, adjusted risk ratio = 2.1, 95% confidence interval = 1.3 to 3.4). There was no difference in the change of periodontal status between females with GDM and females without GDM during pregnancy.

CONCLUSIONS

Pregnancy may be associated with an increased risk of periodontal disease. The association is not different between females with GDM and females without GDM during pregnancy.

Loss of resources and hurricane experience as predictors of postpartum depression among women in southern Louisiana

BACKGROUND

After a natural disaster, mental disorders often become a long-term public health concern. Previous studies under smaller-scale natural disaster conditions suggest loss of psychosocial resources is associated with psychological distress.

METHODS

We examined the occurrence of depression 6 and 12 months postpartum among 208 women residing in New Orleans and Baton Rouge, Louisiana, who were pregnant during or immediately after Hurricane Katrina's landfall. Based on the Conservation of Resources (COR) theory, we explored the contribution of both tangible/financial and nontangible (psychosocial) loss of resources (LOR) on the outcome of depression, measured using the Edinburgh Postnatal Depression Scale (EPDS). We also investigated the influence on depression of individuals' hurricane experience through a Hurricane Experience Score (HES) that includes such factors as witnessing death, contact with flood waters, and injury to self or family members.

RESULTS

Both tangible and nontangible LOR were associated with depression cross-sectionally and prospectively. Severe hurricane exposure (high HES) was also associated with depression. Regression analysis showed LOR-associated depression was explained almost entirely by nontangible rather than tangible factors. Consistent with COR theory, however, nontangible LOR explained some of the association between severe hurricane exposure and depression in our models. A similar result was seen prospectively for depression at 12 months, even controlling for depression symptoms at 6 months.

CONCLUSIONS

These results suggest the need for preventive measures aimed at preserving psychosocial resources to reduce the long-term effects of disasters.

What is new in diabetes?: best articles from the past year

This month, we focus on current research in diabetes. Dr. Pridjian discusses six recent publications, and each is concluded with a "bottom line" that is the take-home message. The complete reference for each can be found in Box 1 on this page, along with direct links to the abstracts.

Performance of estimated glomerular filtration rate prediction equations in preeclamptic patients

Accurate estimation of the glomerular filtration rate (GFR) in patients with preeclampsia requires the collection of a 24-hour urine and can have important therapeutic and diagnostic implications. This procedure is often difficult or impossible to accomplish in this patient group. In this study, the Cockcroft-Gault, the Modification of Diet in Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas were evaluated for their accuracy in determining GFR in the setting of preeclampsia. The estimated GFRs calculated from the above formulas were compared with the creatinine clearance values obtained from a 24-hour urine collections in 543 preeclamptic patients recruited from several large hospitals. Additionally, a set of new equations, preeclampsia GFR (PGFR), based on ethnicity, was created. The Cockcroft-Gault, MDRD, and CKD-EPI formulas were inaccurate in predicting GFR and both were significantly less accurate than PGFR. The latter formula provided an estimated GFR that was much closer to the creatinine clearance. Current GFR estimation equations based on serum creatinine values in nonpregnant patients are not reliable measures of renal function in patients with preeclampsia. The use of a new formula (PGFR) is recommended.

Combined effects of Hurricane Katrina and Hurricane Gustav on the mental health of mothers of small children

Few studies have assessed the results of multiple exposures to disaster. Our objective was to examine the effect of experiencing Hurricane Gustav on mental health of women previously exposed to Hurricane Katrina. A total of 102 women from Southern Louisiana were interviewed by telephone. Experience of the hurricanes was assessed with questions about injury, danger and damage, while depression was assessed with the Edinburgh Depression Scale and post-traumatic stress disorder using the Post-Traumatic Checklist. Minor stressors, social support, trait resilience and perceived benefit had been measured previously. Mental health was examined with linear and log-linear models. Women who had a severe experience of both Gustav and Katrina scored higher on the mental health scales, but finding new ways to cope after Katrina or feeling more prepared was not protective. About half the population had better mental health scores after Gustav than at previous measures. Improvement was more likely among those who reported high social support or low levels of minor stressors, or were younger. Trait resilience mitigated the effect of hurricane exposure. Multiple disaster experiences are associated with worse mental health overall, although many women are resilient. Perceiving benefit after the first disaster was not protective.

Pregestational diabetes

The prevalence of preexisting diabetes in pregnancy is increasing largely because of an increase in type 2 diabetes. Outcomes of diabetic pregnancies for mother and newborn have improved greatly in recent decades from advances in understanding the disease process, improved education, and new treatment modalities delivered in a team approach. Nausea and vomiting from pregnancy and pregnancy-associated insulin resistance can make glycemic control a challenge. Care of women with preexisting diabetes demands careful monitoring in the preconception, prenatal, and peripartum periods.

Hurricane Katrina experience and the risk of post-traumatic stress disorder and depression among pregnant women

OBJECTIVE

Little is known about the effects of disaster exposure and intensity on the development of mental disorders among pregnant women. The aim of this study was to examine the effect of exposure to Hurricane Katrina on mental health in pregnant women.

DESIGN

Prospective cohort epidemiological study.

SETTING

Tertiary hospitals in New Orleans and Baton Rouge, U.S.A.

PARTICIPANTS

Women who were pregnant during Hurricane Katrina or became pregnant immediately after the hurricane.

MAIN OUTCOME MEASURES

Post-traumatic stress disorder (PTSD) and depression.

RESULTS

The frequency of PTSD was higher in women with high hurricane exposure (13.8 percent) than women without high hurricane exposure (1.3 percent), with an adjusted odds ratio (aOR) of 16.8 (95% confidence interval: 2.6-106.6) after adjustment for maternal race, age, education, smoking and alcohol use, family income, parity, and other confounders. The frequency of depression was higher in women with high hurricane exposure (32.3 percent) than women without high hurricane exposure (12.3 percent), with an aOR of 3.3 (1.6-7.1). Moreover, the risk of PTSD and depression increased with an increasing number of severe experiences of the hurricane.

CONCLUSIONS

Pregnant women who had severe hurricane experiences were at a significantly increased risk for PTSD and depression. This information should be useful for screening pregnant women who are at higher risk of developing mental disorders after a disaster.

Hurricane Katrina experience and the risk of post-traumatic stress disorder and depression among pregnant women

OBJECTIVE

Little is known about the effects of disaster exposure and intensity on the development of mental disorders among pregnant women. The aim of this study was to examine the effect of exposure to Hurricane Katrina on mental health in pregnant women.

DESIGN

Prospective cohort epidemiological study.

SETTING

Tertiary hospitals in New Orleans and Baton Rouge, U.S.A.

PARTICIPANTS

Women who were pregnant during Hurricane Katrina or became pregnant immediately after the hurricane.

MAIN OUTCOME MEASURES

Post-traumatic stress disorder (PTSD) and depression.

RESULTS

The frequency of PTSD was higher in women with high hurricane exposure (13.8 percent) than women without high hurricane exposure (1.3 percent), with an adjusted odds ratio (aOR) of 16.8 (95% confidence interval: 2.6-106.6) after adjustment for maternal race, age, education, smoking and alcohol use, family income, parity, and other confounders. The frequency of depression was higher in women with high hurricane exposure (32.3 percent) than women without high hurricane exposure (12.3 percent), with an aOR of 3.3 (1.6-7.1). Moreover, the risk of PTSD and depression increased with an increasing number of severe experiences of the hurricane.

CONCLUSIONS

Pregnant women who had severe hurricane experiences were at a significantly increased risk for PTSD and depression. This information should be useful for screening pregnant women who are at higher risk of developing mental disorders after a disaster.

Resilience after hurricane Katrina among pregnant and postpartum women

BACKGROUND

Although disaster causes distress, many disaster victims do not develop long-term psychopathology. Others report benefits after traumatic experiences (posttraumatic growth). The objective of this study was to examine demographic and hurricane-related predictors of resilience and posttraumatic growth.

METHODS

We interviewed 222 pregnant southern Louisiana women and 292 postpartum women completed interviews at delivery and 8 weeks later. Resilience was measured by scores lower than a nonaffected population, using the Edinburgh Depression Scale and the Post-Traumatic Stress Checklist. Posttraumatic growth was measured by questions about perceived benefits of the storm. Women were asked about their experience of the hurricane, addressing danger, illness/injury, and damage. Chi-square tests and log-Poisson models were used to calculate associations and relative risks for demographics, hurricane experience, and mental health resilience and perceived benefit.

FINDINGS

Thirty-five percent of pregnant and 34% of the postpartum women were resilient from depression, whereas 56% and 49% were resilient from posttraumatic stress disorder. Resilience was most likely among White women, older women, and women who had a partner. A greater experience of the storm, particularly injury/illness or danger, was associated with lower resilience. Experiencing damage because of the storm was associated with increased report of some perceived benefits.

CONCLUSION

Many pregnant and postpartum women are resilient from the mental health consequences of disaster, and perceive benefits after a traumatic experience. Certain aspects of experiencing disaster reduce resilience, but may increase perceived benefit.

Periodontal disease is associated with gestational diabetes mellitus: a case-control study

BACKGROUND

Few studies have specifically examined the relationship between periodontal disease and gestational diabetes mellitus (GDM). The objective of this study was to examine whether maternal periodontal disease is associated with GDM.

METHODS

A case-control study was conducted of 53 pregnant women with GDM and 106 pregnant women without GDM at Woman's Hospital, Baton Rouge, Louisiana. The periodontal examinations were performed by a calibrated dentist who was masked to the diabetic status of the pregnant women. Periodontitis was defined as the presence of any site with a probing depth (PD) >or=4 mm or a clinical attachment loss (AL) >or=4 mm. The severity of periodontal disease was measured in quartiles of PD and clinical AL. Univariable analysis and multivariable logistic regression were used to examine the relationships between periodontal disease and GDM.

RESULTS

The percentage of periodontitis was 77.4% in women with GDM and 57.5% in women without GDM, with an odds ratio (OR) of 2.5 and a 95% confidence interval (CI) of 1.2 to 5.3. After adjusting for confounding variables of maternal age, parity, race, marital status, education, family income, smoking, alcohol consumption, systemic antibiotics during pregnancy, family history of diabetes, income, dental insurance coverage, and body mass index, the adjusted OR (95% CI) was 2.6 (1.1 to 6.1). The adjusted ORs (95% CIs) of GDM comparing the highest-to-lowest quartiles of PD and clinical AL were 3.8 (1.0 to 14.0) and 4.5 (1.2 to 16.9).

CONCLUSION

This study supports the hypothesis of an association between periodontal disease and GDM.

A Rat Model of Preeclampsia

Preeclampsia/eclampsia is a disorder of human pregnancy that continues to exact significant maternal morbidity and mortality and fetal wastage. Therapy of these disorders has not changed in over 50 years and there are no proven preventive measures. We describe a model of the development of a syndrome in the pregnant rat that resembles preeclampsia, which results from the imposition of excessive volume expansion early in gestation. We administered desoxycorticosterone acetate (DOCA) to pregnant animals whose drinking water had been replaced with saline. We compared the results obtained in these animals with those resulting from the study of control, virgin animals, virgin animals receiving DOCA and saline, and normal pregnant (NP) animals. The virgin animals given DOCA and saline did not become hypertensive. The experimental paradigm in the DOCA plus saline pregnant (PDS) animals provides many of the phenotypic characteristics of the human disorder including the development of hypertension, proteinuria, and intrauterine growth restriction. In addition, the mean blood nitrite/nitrate concentration was reduced in the PDS rats compared with their NP counterparts. We propose that this model may prove to be useful in the study of the human condition.

Postpartum mental health after Hurricane Katrina: a cohort study

BACKGROUND

Natural disaster is often a cause of psychopathology, and women are vulnerable to post-traumatic stress disorder (PTSD) and depression. Depression is also common after a woman gives birth. However, no research has addressed postpartum women's mental health after natural disaster.

METHODS

Interviews were conducted in 2006-2007 with women who had been pregnant during or shortly after Hurricane Katrina. 292 New Orleans and Baton Rouge women were interviewed at delivery and 2 months postpartum. Depression was assessed using the Edinburgh Depression Scale and PTSD using the Post-Traumatic Stress Checklist. Women were asked about their experience of the hurricane with questions addressing threat, illness, loss, and damage. Chi-square tests and log-binomial/Poisson models were used to calculate associations and relative risks (RR).

RESULTS

Black women and women with less education were more likely to have had a serious experience of the hurricane. 18% of the sample met the criteria for depression and 13% for PTSD at two months postpartum. Feeling that one's life was in danger was associated with depression and PTSD, as were injury to a family member and severe impact on property. Overall, two or more severe experiences of the storm was associated with an increased risk for both depression (relative risk (RR) 1.77, 95% confidence interval (CI) 1.08-2.89) and PTSD (RR 3.68, 95% CI 1.80-7.52).

CONCLUSION

Postpartum women who experience natural disaster severely are at increased risk for mental health problems, but overall rates of depression and PTSD do not seem to be higher than in studies of the general population.

Estimation of glomerular filtration rate in preeclamptic patients

Accurate estimation of the glomerular filtration rate (GFR) in patients with preeclampsia is often difficult or impossible to accomplish. In this study, the Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD), and MDRD2 formulas were evaluated for their accuracy in determining GFR in the setting of preeclampsia. The estimated GFR calculated from these formulas was compared with the creatinine clearance values obtained from a 24-hour urine collection in 209 preeclamptic patients recruited from five large hospitals. Additionally, a set of new equations that more accurately estimate GFR in preeclamptic patients based on ethnicity, preeclampsia GFR (PGFR), was created. Both the CG and MDRD formulas were inaccurate in predicting GFR in preeclamptic patients, and both were significantly less accurate than PGFR. In conclusion, current GFR estimation equations based on serum creatinine values in nonpregnant patients are not reliable measures of renal function in patients with preeclampsia. The use of a new (PGFR) formula is recommended.

A multi-institutional effort for temporary training of residents displaced by disaster: lessons from Katrina

OBJECTIVE

This study was undertaken to describe a comprehensive, collaborative temporary residency training curriculum after disaster.

STUDY DESIGN

The Texas Southeast Alliance was created in response to the Katrina Disaster by regional obstetric/gynecology programs. Principles were devised to guide development of a temporary training curriculum. Learning opportunities were identified and pooled. Affected program directors were contacted who expressed interest in the curriculum which had been approved by institutional officials and appropriate regulatory bodies.

RESULTS

In total, 41 different training opportunities were made available to the Tulane residents. Twenty-four residents completed 92 rotations in total. Residents met weekly with their program director. Free psychiatric consultative services were provided through resident counseling services. Housing was facilitated wherever possible.

CONCLUSION

Consolidation of resources by the Texas Southeast Alliance provided temporary training experiences for Tulane obstetric and gynecology residents displaced by Hurricane Katrina. Effective training can be maintained after disaster by coordinating institutional efforts and establishing governing principles.

Pregnancy-induced hypertension and perinatal mortality

OBJECTIVE

To examine the association between pregnancy-induced hypertension (PIH) and perinatal mortality.

STUDY DESIGN

A population-based, retrospective, cohort study was conducted based on 16,936 pregnancies delivered between January 1, 1989, and December 31, an infant 1990, in Suzhou, China. PIH growth was classified as gestational hypertension, preeclampsia or severe preeclampsia.

RESULTS

The perinatal mortality was 10.2 per thousand in normotensive women, 10.3 per thousand in women with gestational hypertension, 17.8 per thousand in women with preeclampsia and 37.0 per thousand in women with severe preeclampsia. Severe preeclampsia was associated with 3.4-fold increased perinatal mortality. After stratifying by intrauterine growth restriction status, if infants were not intrauterine growth restricted, all types of PIH were not associated with increased perinatal mortality. However, when infants were intrauterine growth restricted, all types of PIH were associated with markedly increased perinatal mortality (e.g., 15-fold increased mortality for severe preeclampsia).

CONCLUSION

Intrauterine growth restriction secondary to PIH is associated with significantly increased perinatal mortality.

Eighty hour work reform: faculty and resident perceptions

OBJECTIVE

The purpose of the study was to describe resident and faculty perceptions on the impact of the 80 hour work reform on residency training.

STUDY DESIGN

Surveys were distributed to resident and faculty at a major university-based teaching institution. All responses were anonymous. Information abstracted from the survey included: demographic characteristics and resident and faculty perceptions on resident education, patient care, resident work environment, and quality of life after the institution of new regulations on resident duty hours. Descriptive and comparison analyses were performed.

RESULTS

Ninety-four residents and 56 faculty members responded. Significant differences were detected in resident and faculty perceptions that work reform improved resident education (52.3% vs 20.8%, respectively, P < .01), and worsened quality of patient care (8.8% vs 45.3%, respectively, P < .01). Both residents (84.4%) and faculty (90.7%) agreed that work reform improved resident quality of life.

CONCLUSION

Faculty and resident perceptions differed on the impact of the work reform on patient care and resident education but agreed that it improved resident quality of life.