Maternal Serum Antioxidants in Mid Pregnancy and Risk of Preterm Delivery and Small for Gestational Age Birth: Results from a Prospective Pregnancy Cohort.

Background: Preterm delivery (PTD) and poor fetal growth are major contributors to neonatal mortality and morbidity that can extend from birth onward. Although overt maternal nutrient deficiencies are associated with adverse pregnancy outcomes, such deficiencies are rare in developed countries. However, some evidence suggests that even within the normal range, higher levels of antioxidant nutrients are protective against adverse pregnancy outcomes. Materials and Methods: Using data from the prospective Pregnancy Outcomes and Community Health (POUCH) Study (n = 301 preterm; n = 246 term), we examined associations between maternal blood levels of selected antioxidants and pregnancy outcomes. Serum collected at 16-27 weeks' gestation was analyzed for carotenoids, retinol, and α- and γ-tocopherol. Using weighted polytomous regression, these nutrient concentrations were assessed in relation to (1) PTD (<37 weeks gestation) overall and grouped as spontaneous or medically indicated; and (2) small for gestational age (SGA) defined as birthweight-for-gestational age <10th percentile of a national reference population. Results: Women with total serum carotenoids in the upper quartile (Q4) had significantly lower odds of medically indicated PTD compared with women in the lower quartiles (Q1-Q3) even after adjustment for maternal characteristics (aOR = 0.4; 95% CI: 0.2-0.9). Odds ratios for SGA were consistently ≤0.5 among women with any of the serum nutrients in Q4 as compared with Q1-Q3, but final models did not reach statistical significance. Conclusion: Results support the possibility that high maternal serum antioxidants and/or the larger dietary or lifestyle pattern they represent may play a protective role in preventing adverse pregnancy outcomes.

Women with Preterm Birth Have Evidence of Subclinical Atherosclerosis a Decade After Delivery.

Background: Women with preterm birth (PTB) have excess risk of cardiovascular disease (CVD) and metabolic dysregulation after delivery, but vascular mechanisms are poorly understood. We considered that women with PTB may have evidence of subclinical atherosclerosis after delivery, perhaps related to cardiometabolic risk factors. Materials and Methods: The Pregnancy Outcomes and Community Health Moms (POUCHmoms) study followed women from pregnancy through 7 to 15 years after delivery (n = 678). Women underwent B-mode ultrasound to measure the average intima-media thickness (IMT) across the common carotid, bulb, and internal carotid artery segments at follow-up (n = 605). Linear regression estimated the overall and segment-specific difference in IMT between women with preterm and term births. Results: Women were, on average, 38 years old (SD 5.7) at the follow-up visit. Those with a prior preterm versus term birth had thicker mean IMT (average of eight segments, 0.592 mm vs. 0.575, p = 0.04). Differences persisted after accounting for age, race, smoking, and body mass index (difference = +0.018 mm, p = 0.019) and were attenuated after adjustment for blood pressure, medication use, and total cholesterol (difference = +0.014, p = 0.052). Thicker mean bulb IMT in women with PTB was robust to cardiovascular risk factor adjustments (fully adjusted difference = +0.033, p = 0.029). Excluding cases of prepregnancy hypertension or preeclampsia did not change results. Conclusions: Mechanisms leading to subclinical atherosclerosis may link PTB with future CVD. PTB differences in maternal vessel remodeling in the carotid bulb, an arterial segment more prone to early development of atherosclerosis, were independent of traditional risk factors suggesting that novel processes may be involved.

C-reactive protein and preterm delivery: clues from placental findings and maternal weight.

To study the association between maternal C-reactive protein (CRP) and preterm delivery (PTD) pathways, CRP was measured in maternal plasma collected at mid-pregnancy (n = 1310). PTD was subdivided into spontaneous (sPTD) or medically indicated (MI-PTD). Histologic chorioamnionitis (HCA) was determined by placental histopathology (n = 1076). Adjusted CRP levels were elevated for sPTD (5.5 µg/mL) versus term deliveries (4.8 µg/mL) and higher in sPTD with HCA (6.3 µg/mL). After removing HCA, an interaction between body mass index (BMI) and sPTD in relation to CRP was noted. In BMI-stratified models, an association between CRP and sPTD among women with prepregnancy BMI >25 (8.9 µg/mL for sPTD; 7.2 µg/mL for term) was absent among women with lower BMI. We propose that this remaining association in overweight/obese women suggests that CRP may mark an obesity/inflammation PTD pathway that is distinct from the pathway indicated by HCA.

Discrimination and symptoms of depression in pregnancy among African American and White women.

PURPOSE: Depressive symptomatology during pregnancy has been associated with negative health outcomes for both the mother and child. This study examines the potential associations between depression and depressive symptoms in poor women and African-American women and their lifelong experiences of discrimination. METHODS: Data from 2,731 African-American and White participants in the Pregnancy Outcomes and Community Health Study were analyzed. Multiple regression analyses were used to investigate relations between depressive symptoms and total discrimination, and between depressive symptoms and 3 discrimination types (gender, race, and socioeconomic). MAIN FINDINGS: Initial results showed that African-American women had higher levels of depressive symptoms than White women. Self-reported total discrimination and discrimination types were each positively associated with depressive symptomatology in all women. After adjusting for sociodemographic characteristics (maternal age, education, employment status, partner status, and Medicaid status) and examining significant interactions, the race difference in depressive symptomatology was evident only in employed women. The addition of total discrimination to the multicovariate model eliminated race differences in the adjusted mean level of depressive symptoms. When the 3 discrimination types were modeled simultaneously with all other covariates, only gender and economic discrimination remained positively associated with depressive symptoms in African-American and White women. CONCLUSIONS: These results should be cautiously interpreted because of 1) the study design--namely, ascertainment of maternal discrimination and depressive symptoms at a single time point; and 2) limitations of the discrimination measure. Despite these limitations, the study points to potential links between lifetime discrimination and depressive symptoms in pregnancy.