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1.
Hum Reprod ; 28(1): 77-86, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23049076

RESUMO

STUDY QUESTION: Are maternal progesterone levels in early pregnancy associated with fetal birthweight? SUMMARY ANSWER: Low levels of first-trimester maternal progesterone are significantly associated with a reduction in birthweight in girls, but not boys. WHAT IS ALREADY KNOWN: Progesterone in the third trimester of pregnancy has previously been related to birthweight in humans. STUDY DESIGN, SIZE, DURATION: Pregnant women between gestational weeks 4 and 12 were recruited by 99 obstetricians in private practice and enrolled in a prospective cohort study. A follow-up took place at birth. Women younger than 18 years, who had undergone fertility treatments or were diagnosed with infectious diseases, were excluded from the study. A subgroup of 906 participants in whom progesterone had been measured was then selected retrospectively based on the following criteria: no miscarriages, elective abortions or pregnancy complications, infections or multiple births. Data from the follow-up were available for 623 women, who were included in the analyses. PARTICIPANTS/MATERIALS, SETTING, METHODS: The study was coordinated at the Charité University Medicine in Berlin, Germany. Anthropometric, medical and psychosocial information were collected and serum progesterone and estradiol levels were measured in women during the first trimester of pregnancy, followed by the documentation of the pregnancy outcome at birth. Univariable and multivariable regression analyses were performed to identify maternal markers, among them progesterone, affecting birthweight and to determine environmental and maternal factors that are associated with maternal progesterone levels during pregnancy. MAIN RESULTS AND THE ROLE OF CHANCE: In the multivariable regression model, each increase in maternal progesterone by 1 ng/ml during the first trimester increased girls' birthweight by 10.17 g (95% CI: 2.03-18.31 g). If the mother carried a boy, maternal smoking and perceived worries during early pregnancy predicted a reduced birthweight, irrespective of progesterone levels. Maternal body mass index over 25 and maternal age <21 years significantly correlated with the reduced levels of progesterone. Correlations between environmental challenges and maternal progesterone did not reach levels of significance. Since the analyses were exploratory, the likelihood that results may be due to chance is increased. LIMITATIONS, REASONS FOR CAUTION: Due to the exploratory nature of the analyses, results need to be independently confirmed in a larger sample. Furthermore, our findings pertain to pregnant women without pregnancy complications or fertility treatments. WIDER IMPLICATIONS OF THE FINDINGS: Maternal progesterone during early pregnancy is an indicator of subsequent fetal development in female children. Future studies should confirm this relationship and determine whether maternal progesterone is a useful tool in predicting pregnancies at risk resulting in the birth of a girl with low birthweight. Detailed identification of environmental factors modulating maternal progesterone levels should be addressed in future studies. STUDY FUNDING/POTENTIAL COMPETING INTERESTS: Financial support was provided by the Alexander von Humboldt Foundation, Excellence Initiative of the Hamburg Foundation for Research and the Association for Prevention and Information for Allergy and Asthma (Pina e.V.). The authors have no conflict of interest.


Assuntos
Peso ao Nascer , Regulação para Baixo , Desenvolvimento Embrionário , Modelos Biológicos , Progesterona/sangue , Processos de Determinação Sexual , Adolescente , Adulto , Biomarcadores/sangue , Estudos de Coortes , Feminino , Seguimentos , Alemanha , Humanos , Masculino , Gravidez , Primeiro Trimestre da Gravidez , Estudos Prospectivos , Estudos Retrospectivos , Adulto Jovem
2.
J Reprod Immunol ; 90(1): 3-8, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21641655

RESUMO

Fetal development is largely dependent on the mother. However, pregnancy maintenance and consequently fetal development are highly vulnerable and sensitive to disruption, triggered by, for example, prenatal stress challenge. Such prenatal stress challenge modulates the maternal endocrine and immune responses during pregnancy e.g. by decreasing levels of progesterone. Prenatal stress also has negative repercussions for the child's health later in life. It has been reported that prenatal stress increases the risk of the child to develop chronic immune diseases such as allergies and asthma. We therefore propose that prenatal stress challenge - associated with a decrease in maternal progesterone - impairs fetal immune development (immune ontogeny). Such impaired immune ontogeny carries over into postnatal life, rendering the child more prone to developing chronic immune diseases. This purported association urgently requires a fresh evaluation in order to identify biomarkers and cascades of events. In the present review, we outline candidate biomarkers involved in fetal immune ontogeny, which may be targets of prenatal stress challenge and subsequently determine offspring disease risk. Identification of these stress-sensitive biomarkers may allow detection of pregnant women at risk to deliver chronic immune disease-prone offspring. The creation of therapeutic interventions designed to prevent negative consequences of prenatal stress would then be within reach.


Assuntos
Manutenção da Gravidez , Progesterona/sangue , Estresse Fisiológico , Suscetibilidade a Doenças , Feminino , Humanos , Gravidez , Cuidado Pré-Natal , Progesterona/biossíntese , Fatores de Risco
3.
Reprod Biomed Online ; 17(1): 101-13, 2008 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-18616898

RESUMO

Many pregnancies are lost during early gestation, but clinicians still lack tools to recognize risk factors for miscarriage. Thus, the identification of risk factors for miscarriage during the first trimester in women with no obvious risk for a pregnancy loss was the aim of this prospective cohort trial. A total of 1098 women between gestation weeks 4 and 12 in whom no apparent signs of a threatened pregnancy could be diagnosed were recruited. Demographic, anamnestic, psychometric and biological data were documented at recruitment and pregnancy outcomes were registered subsequently. Among the cases with sufficiently available data, 809 successfully progressing pregnancies and 55 subsequent miscarriages were reported. In this cohort, risk of miscarriage was significantly increased in women at higher age (>33 years), lower body mass index (< or =20 kg/ m(2)) and lower serum progesterone concentrations (< or =12 ng/ml) prior to the onset of the miscarriage. Women with subsequent miscarriage also perceived higher levels of stress/demands (supported by higher concentrations of corticotrophin-releasing hormone) and revealed reduced concentrations of progesterone-induced blocking factor. These risk factors were even more pronounced in the subcohort of women (n = 335) recruited between gestation weeks 4 and 7. The identification of these risk factors and development of an interaction model of these factors, as introduced in this article, will help clinicians to recognize pregnant women who require extra monitoring and who might benefit from therapeutic interventions such as progestogen supplementation, especially during the first weeks of pregnancy, to prevent a miscarriage.


Assuntos
Aborto Espontâneo/etiologia , Adulto , Índice de Massa Corporal , Estudos de Coortes , Hormônio Liberador da Corticotropina/metabolismo , Feminino , Humanos , Análise Multivariada , Gravidez , Resultado da Gravidez , Primeiro Trimestre da Gravidez , Progesterona/metabolismo , Estudos Prospectivos , Fatores de Risco , Estresse Psicológico
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