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1.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(9): 947-950, 2019 09 06.
Artigo em Chinês | MEDLINE | ID: mdl-31474080

RESUMO

From March 2015 to February 2018, 4 728 women aged 18 to 45 years old with single-pregnancy at the gestational age of 13 to 27 weeks in Hefei were recruited to analyze the trend of vitamin D status. The average levels of serum 25(OH)D in 2015, 2016 and 2017 were (43.22±18.41) nmol/L, (39.3±15.1) nmol/L and (36.6±17.0) nmol/L, and the prevalence of vitamin D deficiency were 69.5%, 77.6% and 81.4%, respectively. Compared with 2015, the levels of serum 25(OH)D in pregnant women in 2016 and 2017 decreased by 5.23 (95%CI: 4.10-6.35) nmol/L and 7.98 (95%CI: 6.77-9.19) nmol/L. The OR (95%CI) values for the risk of vitamin D deficiency were 1.88 (95%CI: 1.57-2.24) and 2.41 (95%CI: 1.98-2.93).


Assuntos
Complicações na Gravidez , Deficiência de Vitamina D , Vitamina D , Adolescente , Adulto , Feminino , Idade Gestacional , Humanos , Pessoa de Meia-Idade , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/epidemiologia , Prevalência , Fatores de Risco , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/epidemiologia , Adulto Jovem
2.
Isr Med Assoc J ; 21(8): 546-551, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31474018

RESUMO

BACKGROUND: The Bedouins living in southern Israel are a Muslim-Arab population that is transitioning from a nomadic lifestyle to life in permanent settlements. The population has unique characteristics that could affect hemoglobin A1c (HbA1c) measurements. The objective of this study was to describe the socio-demographic and unique morbidity characteristics of this community and their effect on HbA1c measurements. Consanguinity, especially among cousins in the Bedouin population, results in a high prevalence of autosomal recessive genetic diseases such as thalassemia (underestimate of HbA1c), hemoglobinopathies (underestimate and overestimate), Gilbert's disease, and glucose-6-phosphate dehydrogenase deficiency, an X-linked disorder, which can cause hyperbilirubinemia with an overestimate of HbA1c. Furthermore, nutritional deficiencies, autosomal recessive diseases, high birth rates, parasitic infections, and poverty can all cause high rates of anemia (iron and vitamin B12 deficiencies) that can raise HbA1c levels. Congenital dyserythropoietic anemia is found among Bedouin tribes in the Negev region and can lead to an underestimation of HbA1c levels. Pregnancy can also affect HbA1c levels. Medical teams working in the Bedouin community and in other Muslim populations with similar morbidity characteristics throughout the world should identify patients with medical conditions that can affect HbA1c measurements and be aware of possible measurement alternatives such as fructosamine and glycated albumin.


Assuntos
Anemia/etnologia , Hemoglobina A Glicada/análise , Hemoglobinopatias/etnologia , Desnutrição/etnologia , Complicações na Gravidez/etnologia , Anemia/sangue , Anemia/complicações , Árabes , Feminino , Hemoglobinopatias/sangue , Hemoglobinopatias/complicações , Humanos , Islamismo , Israel/etnologia , Masculino , Desnutrição/sangue , Desnutrição/complicações , Gravidez , Complicações na Gravidez/sangue , Reprodutibilidade dos Testes , Fatores Socioeconômicos
3.
Lancet ; 394(10201): 849-860, 2019 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-31378395

RESUMO

BACKGROUND: Intrahepatic cholestasis of pregnancy, characterised by maternal pruritus and increased serum bile acid concentrations, is associated with increased rates of stillbirth, preterm birth, and neonatal unit admission. Ursodeoxycholic acid is widely used as a treatment without an adequate evidence base. We aimed to evaluate whether ursodeoxycholic acid reduces adverse perinatal outcomes in women with intrahepatic cholestasis of pregnancy. METHODS: We did a double-blind, multicentre, randomised placebo-controlled trial at 33 hospital maternity units in England and Wales. We recruited women with intrahepatic cholestasis of pregnancy, who were aged 18 years or older and with a gestational age between 20 weeks and 40 weeks and 6 days, with a singleton or twin pregnancy and no known lethal fetal anomaly. Participants were randomly assigned 1:1 to ursodeoxycholic acid or placebo, given as two oral tablets a day at an equivalent dose of 500 mg twice a day. The dose could be increased or decreased at the clinician's discretion, to a maximum of four tablets and a minimum of one tablet a day. We recommended that treatment should be continued from enrolment until the infant's birth. The primary outcome was a composite of perinatal death (in-utero fetal death after randomisation or known neonatal death up to 7 days after birth), preterm delivery (<37 weeks' gestation), or neonatal unit admission for at least 4 h (from birth until hospital discharge). Each infant was counted once within this composite. All analyses were done according to the intention-to-treat principle. The trial was prospectively registered with the ISRCTN registry, number 91918806. FINDINGS: Between Dec 23, 2015, and Aug 7, 2018, 605 women were enrolled and randomly allocated to receive ursodeoxycholic acid (n=305) or placebo (n=300). The primary outcome analysis included 304 women and 322 infants in the ursodeoxycholic acid group, and 300 women and 318 infants in the placebo group (consent to use data was withdrawn for 1 woman and 2 infants). The primary composite outcome occurred in 74 (23%) of 322 infants in the ursodeoxycholic acid group and 85 (27%) of 318 infants in the placebo group (adjusted risk ratio 0·85 [95% CI 0·62-1·15]). Two serious adverse events were reported in the ursodeoxycholic acid group and six serious adverse events were reported in the placebo group; no serious adverse events were regarded as being related to treatment. INTERPRETATION: Treatment with ursodeoxycholic acid does not reduce adverse perinatal outcomes in women with intrahepatic cholestasis of pregnancy. Therefore, its routine use for this condition should be reconsidered. FUNDING: National Institute for Health Research Efficacy and Mechanism Evaluation Programme.


Assuntos
Colagogos e Coleréticos/administração & dosagem , Colestase Intra-Hepática/tratamento farmacológico , Complicações na Gravidez/tratamento farmacológico , Ácido Ursodesoxicólico/administração & dosagem , Administração Oral , Adulto , Alanina Transaminase/sangue , Ácidos e Sais Biliares/sangue , Biomarcadores/sangue , Colestase Intra-Hepática/sangue , Método Duplo-Cego , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Nascimento Vivo/epidemiologia , Morte Perinatal/prevenção & controle , Gravidez , Complicações na Gravidez/sangue , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/prevenção & controle , Prurido/prevenção & controle , Natimorto/epidemiologia
4.
JAMA ; 322(7): 632-641, 2019 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-31429897

RESUMO

Importance: Maternal hypothyroidism and hyperthyroidism are risk factors for preterm birth. Milder thyroid function test abnormalities and thyroid autoimmunity are more prevalent, but it remains controversial if these are associated with preterm birth. Objective: To study if maternal thyroid function test abnormalities and thyroid autoimmunity are risk factors for preterm birth. Data Sources and Study Selection: Studies were identified through a search of the Ovid MEDLINE, EMBASE, Web of Science, the Cochrane Central Register of Controlled Trials, and Google Scholar databases from inception to March 18, 2018, and by publishing open invitations in relevant journals. Data sets from published and unpublished prospective cohort studies with data on thyroid function tests (thyrotropin [often referred to as thyroid-stimulating hormone or TSH] and free thyroxine [FT4] concentrations) or thyroid peroxidase (TPO) antibody measurements and gestational age at birth were screened for eligibility by 2 independent reviewers. Studies in which participants received treatment based on abnormal thyroid function tests were excluded. Data Extraction and Synthesis: The primary authors provided individual participant data that were analyzed using mixed-effects models. Main Outcomes and Measures: The primary outcome was preterm birth (<37 weeks' gestational age). Results: From 2526 published reports, 35 cohorts were invited to participate. After the addition of 5 unpublished data sets, a total of 19 cohorts were included. The study population included 47 045 pregnant women (mean age, 29 years; median gestational age at blood sampling, 12.9 weeks), of whom 1234 (3.1%) had subclinical hypothyroidism (increased thyrotropin concentration with normal FT4 concentration), 904 (2.2%) had isolated hypothyroxinemia (decreased FT4 concentration with normal thyrotropin concentration), and 3043 (7.5%) were TPO antibody positive; 2357 (5.0%) had a preterm birth. The risk of preterm birth was higher for women with subclinical hypothyroidism than euthyroid women (6.1% vs 5.0%, respectively; absolute risk difference, 1.4% [95% CI, 0%-3.2%]; odds ratio [OR], 1.29 [95% CI, 1.01-1.64]). Among women with isolated hypothyroxinemia, the risk of preterm birth was 7.1% vs 5.0% in euthyroid women (absolute risk difference, 2.3% [95% CI, 0.6%-4.5%]; OR, 1.46 [95% CI, 1.12-1.90]). In continuous analyses, each 1-SD higher maternal thyrotropin concentration was associated with a higher risk of preterm birth (absolute risk difference, 0.2% [95% CI, 0%-0.4%] per 1 SD; OR, 1.04 [95% CI, 1.00-1.09] per 1 SD). Thyroid peroxidase antibody-positive women had a higher risk of preterm birth vs TPO antibody-negative women (6.6% vs 4.9%, respectively; absolute risk difference, 1.6% [95% CI, 0.7%-2.8%]; OR, 1.33 [95% CI, 1.15-1.56]). Conclusions and Relevance: Among pregnant women without overt thyroid disease, subclinical hypothyroidism, isolated hypothyroxinemia, and TPO antibody positivity were significantly associated with higher risk of preterm birth. These results provide insights toward optimizing clinical decision-making strategies that should consider the potential harms and benefits of screening programs and levothyroxine treatment during pregnancy.


Assuntos
Doenças Autoimunes/diagnóstico , Iodeto Peroxidase/imunologia , Complicações na Gravidez/diagnóstico , Nascimento Prematuro/etiologia , Doenças da Glândula Tireoide/diagnóstico , Testes de Função Tireóidea , Adulto , Autoanticorpos/sangue , Doenças Autoimunes/sangue , Doenças Autoimunes/complicações , Feminino , Idade Gestacional , Humanos , Hipotireoidismo/complicações , Hipotireoidismo/diagnóstico , Recém-Nascido , Gravidez , Complicações na Gravidez/sangue , Doenças da Glândula Tireoide/sangue , Doenças da Glândula Tireoide/complicações , Tireotropina/sangue , Tiroxina/sangue
5.
Medicine (Baltimore) ; 98(33): e16840, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415407

RESUMO

RATIONALE: Twin pregnancy in women with chronic kidney disease (CKD) is very rare but poses a great risk to both mother and children. In developing countries like China, advanced CKD twin pregnancies are often terminated. Here, we report a successful case and reviewed related cases, hope to facilitate further study. PATIENT CONCERNS: A 29-year-old woman with a twin pregnancy showed serum creatinine (Scr) 100 µmol/L (CKD2) at conception. During her 12th week, Scr reached 263 µmol/L (CKD4) with urine protein 3+ and hypertension. DIAGNOSES: Due to her pregnancy, renal biopsy was not considered. Lab tests showed deterioration of renal function and ultrasound detections showed small kidney size. INTERVENTIONS: The patient was given basic drug therapy to control her blood pressure and supplemental nutrition without hemodialysis. OUTCOMES: The patient delivered 2 healthy babies weighting 0.9 and 0.7 kg by cesarean section at the 28th week, but has been under maintenance hemodialysis since then. LESSONS: Despite low birth weight and preterm delivery, successful twin pregnancies in some patients with CKD could be realized under early multidisciplinary intervention, but this poses great risks for mothers and twins, especially for patients with advanced CKD and those on hemodialysis.


Assuntos
Complicações na Gravidez/fisiopatologia , Gravidez de Gêmeos , Insuficiência Renal Crônica/fisiopatologia , Adulto , Cesárea , China , Creatinina/sangue , Feminino , Glucocorticoides/uso terapêutico , Humanos , Recém-Nascido , Nifedipino/uso terapêutico , Prednisona/uso terapêutico , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/tratamento farmacológico , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/tratamento farmacológico , Vasodilatadores/uso terapêutico
6.
J Dairy Sci ; 102(9): 8367-8375, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31301839

RESUMO

The objective of our study was to identify cow-level factors associated with subclinical hypocalcemia at calving (SCH) in multiparous Jersey cows. A total of 598 Jersey and 218 Jersey × Holstein crossbreed cows from 2 commercial dairy herds were enrolled in a retrospective cohort study. Blood samples to determine total Ca concentration were collected from the coccygeal vessels at 3 h 19 min (±2 h 33 min) after calving. We used 2 serum Ca concentration thresholds to define SCH: <2.00 mmol/L (SCH-2.00) and <2.12 mmol/L (SCH-2.12). We evaluated the association of cow-level factors with SCH with multivariable Poisson regression models. Variables evaluated for association with SCH were herd; parity (2, 3, and ≥4); breed; previous lactation length and 305-d mature-equivalent milk yield; previous lactation first test milk yield and last test somatic cell count; lengths of calving interval, gestation, dry, and close-up periods; body condition and locomotion scores at calving; calving ease; and calf sex for singletons. We categorized continuous variables into quartiles (≤25th percentile, interquartile range and ≥75th percentile). The prevalence of SCH among Jersey cows was 40 (SCH-2.00) and 64% (SCH-2.12). Jersey cows of higher parity had greater risk of SCH-2.00 and SCH-2.12. The risk of SCH-2.12 was higher after birthing male calves. We also found a tendency for previous lactation length and previous lactation 305-d mature-equivalent milk yield effect to affect risk of SCH-2.12. The risk of SCH-2.12 was lower for cows that had a previous lactation length shorter than the 25th percentile compared with cows that had a previous lactation length within the interquartile range. The risk of SCH-2.12 was higher for cows that had a previous lactation 305-d mature-equivalent milk yield below the 25th percentile compared with cows that had a previous lactation 305-d mature-equivalent milk yield above the 75th percentile. Also, Jersey × Holstein crossbreed was associated with increased risk of SCH-2.00. In the multivariable analysis, we observed no association between SCH and previous lactation first test milk yield; last test somatic cell count; lengths of calving interval, gestation, dry, and close-up periods; body condition and locomotion scores at calving; and calving ease. Our study identified parity, breed, calf sex, previous lactation length, and previous lactation 305-d mature-equivalent milk yield as cow-level factors associated with SCH in multiparous Jersey cows.


Assuntos
Doenças dos Bovinos/etiologia , Hipocalcemia/veterinária , Paridade , Complicações na Gravidez/veterinária , Animais , Cálcio/sangue , Bovinos , Doenças dos Bovinos/sangue , Doenças dos Bovinos/epidemiologia , Estudos de Coortes , Feminino , Hipocalcemia/sangue , Hipocalcemia/etiologia , Lactação , Leite , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/etiologia , Estudos Retrospectivos , Fatores de Risco
7.
Medicine (Baltimore) ; 98(28): e16373, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305436

RESUMO

BACKGROUND: Prenatal exposure to depression has been considered as a risk factor for adverse childhood, while it is accompanied by unknown molecular mechanisms. The aim of this study was to identify differentially expressed genes (DEGs) and associated biological processes between cord blood samples from neonates born to mothers who exposed to major depressive disorder (MDD) and healthy mothers. METHODS: The microarray data GSE114852 were downloaded to analyze the mRNA expression profiles of umbilical cord blood with 31 samples exposed to prenatal MDD and 62 samples with healthy mothers. Kyoto Encyclopedia of Genes and Genomes pathway and Gene ontology enrichment analyses were conducted to identify associated biochemical pathways and functional categories of the DEGs. The protein-protein interaction network was constructed and the top 10 hub genes in the network were predicted. RESULTS: The results showed several immunity related processes, such as "phagosome", "Epstein-Barr virus infection", "proteasome", "positive regulation of I-kappaB kinase/NF-kappaB signaling", "interferon-gamma-mediated signaling pathway", and "tumor necrosis factor" presented significant differences between two groups. Most of the hub genes (for example PSMD2, PSMD6, PSMB8, PSMB9) were also associated with immune pathways. CONCLUSION: This bioinformatic analysis demonstrated immune-mediated mechanisms might play a fatal role in abnormalities in fetal gene expression profiles caused by prenatal MDD.


Assuntos
Transtorno Depressivo Maior , Sangue Fetal/metabolismo , Complicações na Gravidez , Biologia Computacional , Transtorno Depressivo Maior/sangue , Transtorno Depressivo Maior/genética , Feminino , Expressão Gênica , Humanos , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/genética , RNA Mensageiro/sangue
8.
Medicine (Baltimore) ; 98(27): e16214, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277130

RESUMO

Intrahepatic cholestasis of pregnancy (ICP) increases adverse perinatal outcome (APO) incidence. Whether successful treatment of severe ICP reduces APO risk is unclear.This retrospective, single-center study in China enrolled consecutive women with ICP who had term delivery (≥37 weeks, singleton) between August 2013 and June 2016. Patients were divided into the mild ICP (serum bile acids (SBA) ≤40 µmol/L throughout pregnancy) and severe ICP (SBA >40 µmol/L during pregnancy but fell after ursodeoxycholate therapy) groups. Baseline characteristics, laboratory investigations, and maternal and neonatal outcomes were assessed. Logistic regression was used to identify factors associated with meconium staining of amniotic fluid (MSAF) and APOs.Seventy-three patients were included (mild ICP group, n=47; severe ICP group, n=26). Pruritus was more common in the severe ICP group (65.4% vs 40.4%; P <.05), but other baseline characteristics were similar. Compared with the mild ICP group, the severe ICP group had higher SBA at first visit and peak value, higher direct bilirubin before delivery and 4 days postpartum, and lower gamma-glutamyltransferase at peak value, before delivery and 4 days postpartum (P <.05). Other laboratory parameters, type of delivery, hemorrhage, and liver function abnormality were similar between groups, although the severe ICP group had longer duration of hepatic dysfunction (P <.05). Birth weight was lower in the mild ICP group (P <.05), but other fetal outcomes were similar between groups. Logistic regression identified no factors (including SBA group) associated with APOs or MSAF.Women successfully treated for severe ICP do not have increased risks for APOs.


Assuntos
Colestase Intra-Hepática/tratamento farmacológico , Complicações na Gravidez/tratamento farmacológico , Ácido Ursodesoxicólico/uso terapêutico , Adulto , Ácidos e Sais Biliares/sangue , Colagogos e Coleréticos/uso terapêutico , Colestase Intra-Hepática/sangue , Colestase Intra-Hepática/diagnóstico , Feminino , Seguimentos , Idade Gestacional , Humanos , Recém-Nascido , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/diagnóstico , Resultado da Gravidez , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
9.
Clin Biochem ; 71: 46-51, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31278894

RESUMO

OBJECTIVE: To investigate the association between cfDNA levels measured during non-invasive prenatal testing (NIPT) and the risk of pregnancy complications in a Chinese population. METHODS: This was a retrospective cohort study of 831 pregnant women who underwent NIPT at 12-22 weeks of gestation. Maternal plasma cfDNA levels and pregnancy outcomes were obtained from NIPT Screening System and hospitalization records, respectively. Logistic regression analysis was performed to investigate the relationship between cfDNA levels and pregnancy complications (after adjusting for confounding factors). RESULTS: Maternal cfDNA levels were significantly higher in women diagnosed with intrahepatic cholestasis of pregnancy (ICP) and preeclampsia (PE) compared to pregnant women with non-pregnancy complications (NPC) (median cfDNA 7.07, 6.42 vs. 5.99 ng/mL). Increase in cfDNA levels were associated with an increased risk for ICP (adjusted-OR = 1.20, 95% CI: 1.07-1.34) and PE (adjusted-OR = 1.14, 95% CI: 1.02-1.26). In addition, increase in cfDNA levels were associated with risk of GDM, and was dependent on maternal age (maternal age ≥ 35 years: adjusted-OR = 1.16, 95% CI: 1.04-1.29; maternal age < 35 years: adjusted-OR = 0.85, 95% CI: 0.73-0.99). CONCLUSION: Maternal plasma cfDNA levels measured during NIPT are associated with pregnancy complications (ICP, PE and GDM). Maternal age may be an important effect modifier for the association between plasma cfDNA levels and GDM.


Assuntos
Ácidos Nucleicos Livres/sangue , Complicações na Gravidez/sangue , Segundo Trimestre da Gravidez , Adulto , Feminino , Humanos , Gravidez , Estudos Retrospectivos
10.
Cochrane Database Syst Rev ; 7: CD012546, 2019 07 05.
Artigo em Inglês | MEDLINE | ID: mdl-31283001

RESUMO

BACKGROUND: Intrahepatic cholestasis of pregnancy is a pregnancy-specific liver disorder, possibly associated with an increased risk of severe fetal adverse events. Total serum bile acids (TSBA) concentration, alone or in combination with serum aminotransferases, have been the most often used biomarkers for the diagnosis of intrahepatic cholestasis of pregnancy in clinical practice. Serum bile acid profile, composed of primary or secondary, conjugated or non-conjugated bile acids, may provide more specific disease information. OBJECTIVES: To assess and compare, independently or in combination, the diagnostic accuracy of total serum bile acids or serum bile acids profile, or both, for the diagnosis of intrahepatic cholestasis of pregnancy in pregnant women, presenting with pruritus. To define the optimal cut-off values for components of serum bile acid profile; to investigate possible sources of heterogeneity. SEARCH METHODS: We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Hepato-Biliary Group Diagnostic Test Accuracy Studies Register, the Cochrane Library, MEDLINE Ovid, Embase Ovid, Science Citation Index Expanded, Conference Proceedings Citation Index - Science, BIOSIS, CINAHL, two Chinese databases (CKNI, VIP), Latin American and Caribbean Health Sciences Literature (LILACS), Scientific Electronic Library Online (SciELO), Evidence Search: Health and Social Care by the National Institute for Health and Care Excellence (NICE), the World Health Organization (WHO) Reproductive Health Library (RHL), and the Turning Research into Practice database (TRIP). The most recent date of search was 6 May 2019. We identified additional references by handsearching the references of articles, meta-analyses, and evidence-based guidelines retrieved from the computerised databases, on-line trial registries, and grey literature through OpenSIGLE, National Technical Information Service (NTIS), ProQuest Dissertations & Thesis Database, and Index to Theses in Great Britain and Ireland. SELECTION CRITERIA: Prospective or retrospective diagnostic case-control or cross-sectional studies, irrespective of publication date, format, and language, which evaluated the diagnostic accuracy of total serum bile acids (TSBA) or components of serum bile acid profile for the diagnosis of intrahepatic cholestasis of pregnancy in pregnant women of any age or ethnicity, in any clinical setting, symptomatic for pruritus. DATA COLLECTION AND ANALYSIS: We selected studies by reading titles, abstracts, or full texts, and assessing their fulfilment of our inclusion criteria. We emailed primary authors to request missing data or individual participant data. Having extracted data from each included study, we built the two-by-two tables for each primary study and for all the index tests considered. We estimated sensitivity and specificity with their 95% confidence intervals (CI). We presented data in coupled forest plots, showing sensitivities and specificities of each study, and we plotted the studies in the Receiver Operating Characteristic (ROC) space. We performed meta-analyses adopting the hierarchical summary ROC model (HSROC) or the bivariate model to meta-analyse the data. We made indirect comparisons of the considered index tests by adding the index tests as covariates to the bivariate or HSROC models. We performed heterogeneity analysis and sensitivity analysis on studies assessing TSBA accuracy. We used Review Manager 5 (RevMan 5) and SAS statistical software, release 9.4 (SAS Institute Inc., Cary, NC, USA), to perform all statistical analyses. We used QUADAS-2 domains to assess the risk of bias of the included studies. MAIN RESULTS: Our search yielded 5073 references, but at the end of our selection process, only 16 studies fulfilled the review inclusion criteria. Nine of these provided individual participant data. We analysed only data concerning TSBA, cholic acid (CA), glycocholic acid (GCA), chenodeoxycholic acid (CDCA), and CA/CDCA because the remaining planned index tests were assessed in few studies. Only one study had low risk of bias in all four QUADAS-2 domains. The most biased domains were the patient sampling and the reference standard domains. When considering all studies with a cut-off of 10 µmol/L, TSBA overall sensitivity ranged from 0.72 to 0.98 and specificity ranged from 0.81 to 0.97. After a sensitivity analysis excluding case-control studies, TSBA sensitivity ranged from 0.48 to 0.66 and specificity from 0.52 to 0.99. After a sensitivity analysis excluding studies in which TSBA was part of the reference standard, TSBA sensitivity ranged from 0.49 to 0.65 and specificity from 0.53 to 0.99. We found the estimates of the overall accuracy for some serum bile acid components (CA, GCA, CDCA, and CA/CDCA) to be imprecise, with the CI for sensitivity and specificity very wide or impossible to calculate. Indirect comparisons between serum bile acid profile components and TSBA were not statistically significant. None of the heterogeneity analysis performed was statistically significant, except for the timing of assessment of TSBA (onset of symptoms, peak value among multiple assessments, delivery) but without clinically relevant results. We could not analyse the diagnostic accuracy of combinations of index tests because none of the included studies carried them out, and because of the small number of included studies. AUTHORS' CONCLUSIONS: The overall high risk of bias, the existing concern regarding applicability of the results in clinical practice, and the great heterogeneity of the results in the included studies prevents us from making recommendations and reaching definitive conclusions at the present time. Thus, we do not find any compelling evidence to recommend or refute the routine use of any of these tests in clinical practice. So far, the diagnostic accuracy of TSBA for intrahepatic cholestasis of pregnancy might have been overestimated. There were too few studies to permit a precise estimate of the accuracy of serum bile acid profile components. Further primary clinical research is mandatory. We need both further phase II and phase III diagnostic studies.


Assuntos
Ácidos e Sais Biliares/sangue , Colestase Intra-Hepática/sangue , Colestase Intra-Hepática/diagnóstico , Complicações na Gravidez/sangue , Complicações na Gravidez/diagnóstico , Biomarcadores/sangue , Testes Diagnósticos de Rotina , Feminino , Humanos , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto
11.
BJOG ; 126(11): 1390-1398, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31240854

RESUMO

OBJECTIVE: To calculate the cost-effectiveness of implementing PlGF testing alongside a clinical management algorithm in maternity services in the UK, compared with current standard care. DESIGN: Cost-effectiveness analysis. SETTING: Eleven maternity units participating in the PARROT stepped-wedge cluster-randomised controlled trial. POPULATION: Women presenting with suspected pre-eclampsia between 20+0 and 36+6  weeks' gestation. METHODS: Monte Carlo simulation utilising resource use data and maternal adverse outcomes. MAIN OUTCOME MEASURES: Cost per maternal adverse outcome prevented. RESULTS: Clinical care with PlGF testing costs less than current standard practice and resulted in fewer maternal adverse outcomes. There is a total cost-saving of UK£149 per patient tested, when including the cost of the test. This represents a potential cost-saving of UK£2,891,196 each year across the NHS in England. CONCLUSIONS: Clinical care with PlGF testing is associated with the potential for cost-savings per participant tested when compared with current practice via a reduction in outpatient attendances, and improves maternal outcomes. This economic analysis supports a role for implementation of PlGF testing in antenatal services for the assessment of women with suspected pre-eclampsia. TWEETABLE ABSTRACT: Placental growth factor testing for suspected pre-eclampsia is cost-saving and improves maternal outcomes.


Assuntos
Técnicas de Diagnóstico Obstétrico e Ginecológico/economia , Fator de Crescimento Placentário/sangue , Pré-Eclâmpsia/sangue , Pré-Eclâmpsia/diagnóstico , Complicações na Gravidez/sangue , Complicações na Gravidez/diagnóstico , Adulto , Biomarcadores/sangue , Análise por Conglomerados , Análise Custo-Benefício , Feminino , Idade Gestacional , Humanos , Modelos Econômicos , Pré-Eclâmpsia/epidemiologia , Pré-Eclâmpsia/fisiopatologia , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/fisiopatologia , Resultado da Gravidez , Reino Unido/epidemiologia
12.
Environ Int ; 129: 389-399, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31150980

RESUMO

Serum perfluoroalkyl acids (PFAAs) have been linked to disruption of maternal thyroid hormone homeostasis, but results have varied between studies which we hypothesized was due to timing of the thyroid hormone measurements, variability in PFAA isomer patterns, or presence of other stressors. In a longitudinal study design, we investigated the time-dependency of associations between PFAA isomers and thyroid hormones during pregnancy and post-partum while considering thyroid peroxidase antibody (TPOAb) status and mercury (Hg) co-exposure. In participants of a prospective Canadian birth cohort (n = 494), free thyroxine (FT4), free triiodothyronine (FT3), thyroid stimulating hormone (TSH) and TPOAb were quantified in maternal plasma collected in each trimester and 3-months postpartum, and 25 PFAAs (15 linear and 10 branched) and Hg were quantified in samples collected during the second trimester. Perfluorohexane sulfonate (PFHxS) and total branched isomers of perfluorooctane sulfonate (PFOS) were positively associated with TSH in mixed-effect models, with strongest associations early in gestation. Throughout pregnancy and post-partum, PFHxS was inversely associated with FT4, consistent with elevated TSH, while Hg was inversely associated with FT3. In TPOAb-positive women, negative associations were found between PFUnA and FT4, and 1m-PFOS and TSH, supporting previous studies that thyroid disorder could increase susceptibility to PFAA-mediated hormone dysregulation. Hg did not confound associations but was a significant interaction term, revealing further positive associations between PFOS isomers (∑3m+4m-PFOS) and TSH. Higher perfluoroalkyl sulfonate exposures were associated with higher TSH and/or lower FT4, strongly suggestive that PFHxS and branched PFOS isomers are risk factors for subclinical maternal hypothyroidism. Isomer-specific analysis is important in future studies, as crude measures of 'total-PFOS' masked the associations of branched isomers. A concerning result was for PFHxS which had consistent negative associations with FT4 at all time points and a positive association with TSH in early pregnancy when fetal development is most sensitive to disruption.


Assuntos
Alcanossulfonatos/sangue , Poluentes Ambientais/sangue , Hipotireoidismo/induzido quimicamente , Complicações na Gravidez/induzido quimicamente , Hormônios Tireóideos/sangue , Adulto , Ácidos Alcanossulfônicos/sangue , Autoanticorpos/sangue , Canadá , Poluentes Ambientais/toxicidade , Feminino , Fluorcarbonetos/sangue , Humanos , Hipotireoidismo/sangue , Estudos Longitudinais , Gravidez , Complicações na Gravidez/sangue , Segundo Trimestre da Gravidez , Estudos Prospectivos , Tireotropina/sangue , Tiroxina/sangue , Tri-Iodotironina/sangue
13.
Medicine (Baltimore) ; 98(23): e15903, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169703

RESUMO

D-Dimer (DD) is the smallest fragment of plasmin-mediated cleavage of fibrin. There is a progressive increase in DD concentration with advancing gestation in normal pregnancies, making the upper limit of 0.5 µg/ml used in non-pregnant population an unfavorable marker during pregnancy. Coagulation and fibrinolysis parameters are also markedly disturbed in pregnancies complicated by various pathologies.We designed this retrospective observational cohort study to investigate the trimester specific reference range for DD throughout normal pregnancy, and to compare the distribution of DD in third trimester healthy pregnancies and those complicated by preeclampsia (PE), severe preeclampsia (SPE), gestational diabetes mellitus (GDM), premature rupture of membranes (PROM) and preterm premature rupture of membranes (PPROM). In addition, we aimed to determine the diagnostic value of DD in PE and SPE.In this retrospective observational cohort study, 250 normal and 178 complicated pregnancies were included. Normal pregnancies included 88-first trimester, 101-second trimester and 61-third trimester pregnancies. Complicated pregnancy included 34 PE, 44 SPE, 32 GDM, 33 PROM, and 35 PPROM cases during the third trimester. Predefined exclusion criteria were used.The period of gestation (POG) accounted for 41.9% of the variance in DD, with strong correlation between the POG and DD. The trimester specific reference intervals were computed. The distribution for severe preeclampsia was statistically different compared to other categories in the third trimester. This exceptional distribution led to the generation of a receiver operating characteristic (ROC) curve with an area under curve of 0.828, attesting its possible role in predicting severe preeclampsia.We determined trimester specific reference intervals of DD. The role of DD has been explored, and it may be of diagnostic value in severe preeclampsia.


Assuntos
Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Complicações na Gravidez/sangue , Trimestres da Gravidez/fisiologia , Adulto , Biomarcadores , Diabetes Gestacional/sangue , Feminino , Ruptura Prematura de Membranas Fetais/sangue , Idade Gestacional , Humanos , Pessoa de Meia-Idade , Pré-Eclâmpsia/sangue , Gravidez , Valores de Referência , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto Jovem
14.
Int J Mol Sci ; 20(12)2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31200554

RESUMO

Despite a large number of studies, the etiology of pregnancy complications remains unknown. The involvement of cell-free DNA or fetal cell-free DNA in the pathogenesis of pregnancy complications is currently being hypothesized. Cell-free DNA occurs in different forms-free; part of neutrophil extracellular traps; or as recently discovered, carried by extracellular vesicles. Cell-free DNA is believed to activate an inflammatory pathway, which could possibly cause pregnancy complications. It could be hypothesized that DNA in its free form could be easily degraded by nucleases to prevent the inflammatory activation. However, recently, there has been a growing interest in the role of exosomes, potential protectors of cell-free DNA, in pregnancy complications. Most of the interest from recent years is directed towards the micro RNA carried by exosomes. However, exosome-associated DNA in relation to pregnancy complications has not been truly studied yet. DNA, as an important cargo of exosomes, has been so far studied mostly in cancer research. This review collects all the known information on the topic of not only exosome-associated DNA but also some information on vesicles-associated DNA and the studies regarding the role of exosomes in pregnancy complications from recent years. It also suggests possible analysis of exosome-associated DNA in pregnancy from plasma and emphasizes the importance of such analysis for future investigations of pregnancy complications. A major obstacle to the advancement in this field is the proper uniformed technique for exosomes isolation. Similarly, the sensitivity of methods analyzing a small fraction of DNA, potentially fetal DNA, carried by exosomes is variable.


Assuntos
Ácidos Nucleicos Livres/sangue , Exossomos/metabolismo , Complicações na Gravidez/sangue , Biomarcadores/sangue , Ácidos Nucleicos Livres/genética , Exossomos/genética , Feminino , Humanos , Placenta/metabolismo , Gravidez , Complicações na Gravidez/genética , Complicações na Gravidez/metabolismo
15.
J Trace Elem Med Biol ; 54: 110-117, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31109600

RESUMO

Selenium (Se) is a trace element essential for the appropriate course of vital processes in the human body. It is also a constituent of the active center of glutathione peroxidase and other antioxidant compounds which play an important role in red-ox processes. Associations between lower blood selenium concentration and obstetric complications has been reported in many studies. The aim of this study was to determine the dietary selenium intake and serum selenium content in pregnant Polish women and relate this to antioxidant status as whole blood glutathione peroxidase (GPX) activity, serum uric acid (UA) content and serum total antioxidant status (TAS) and pregnancy complications occurrence. Ninety-four pregnant women at a mean age 30.6 ± 5.4 years from the Lower Silesia region of Poland were recruited to the study, 37% of studied group had pregnancy complications. The mean reported Se intake and serum selenium content for Polish pregnant women was in the first trimester - 53.99 µg/day and 44.36 µg/l, the second trimester - 58.93 µg/day and 43.16 µg/l and the third trimester - 62.89 µg/day and 40.97 µg/l, respectively. Selenium intake below or above recommended value hadn't significant effect on GPX activity, TAS and UA levels. There were no statistical differences in selenium intake, serum selenium content, GPX activity and TAS and UA level between physiological and complicated pregnancy, but a positive correlation between Se intake and serum selenium content was observed during all period of gestation as well as in the second trimester of pregnancy between Se intake and GPX activity in group with physiological pregnancy where selenium intake was below the recommended level. Selenium intake above the recommended level was positively correlated also with serum UA level in first and second trimester of pregnancy. Despite weak, positive correlations in the first two trimesters of pregnancy between selenium supply and GPX activity and UA concentration we concluded that selenium intake does not significantly affect during pregnancy, both: markers of the antioxidant status of pregnant women and the occurrence of pregnancy complications.


Assuntos
Antioxidantes/metabolismo , Complicações na Gravidez/sangue , Selênio/sangue , Adulto , Feminino , Glutationa Peroxidase/sangue , Humanos , Gravidez , Selênio/administração & dosagem , Ácido Úrico/sangue
16.
BMJ Case Rep ; 12(4)2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31040142

RESUMO

We report a potential association between an abnormally raised pregnancy level of alkaline phosphatase (ALP) and intrauterine growth restriction (IUGR). There are few reports of women with abnormally high ALP during pregnancy. However, there is work to suggest an association with placental insufficiency, low birth weight and preterm delivery. In conjunction with a rising ALP, fetal IUGR and intermittent absence of umbilical artery end diastolic flow had evolved. A greatly elevated ALP may be a marker for placental insufficiency and IUGR.


Assuntos
Fosfatase Alcalina/sangue , Retardo do Crescimento Fetal/sangue , Placenta/irrigação sanguínea , Insuficiência Placentária/sangue , Complicações na Gravidez/sangue , Adulto , Biomarcadores/sangue , Cesárea , Feminino , Retardo do Crescimento Fetal/fisiopatologia , Humanos , Recém-Nascido de Baixo Peso , Insuficiência Placentária/fisiopatologia , Gravidez , Resultado do Tratamento
17.
Eur J Endocrinol ; 180(6): 373-380, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30991360

RESUMO

Objective To explore whether gestational prolactin and breast increase are markers of metabolic health in pregnancy and on long-term, in PCOS. Design Follow-up study. Women with PCOS, according to the Rotterdam criteria (n = 239), former participants of the randomized controlled trial (RCT) PregMet were invited, 131 participated in the current follow-up study, at mean 8 years after pregnancy. Methods Metformin 2000 mg/day or placebo from first trimester to delivery in the original RCT. No intervention in the current study. Prolactin was analyzed in the first trimester and at gestational week 32 and metabolic characteristics which are part of the metabolic syndrome and measures of glucose homeostasis were examined. Metabolic health was also evaluated according to breast increase versus lack of breast increase during pregnancy. Results Prolactin increase in pregnancy was negatively correlated to BMI (P = 0.007) and systolic blood pressure (P ≤ 0.001) in gestational week 32. Prolactin at gestational week 32 was negatively correlated to BMI (P = 0.044) and visceral fat area (P = 0.028) at 8-year follow-up in an unadjusted model. Prolactin at gestational week 32 showed no associations to metabolic health at follow-up when baseline BMI was adjusted for. Women who reported lack of breast increase during pregnancy, had higher BMI (P = 0.034), waist-hip ratio (P = 0.004), visceral fat area (P = 0.050), total cholesterol (P = 0.022), systolic (P = 0.027) and diastolic blood pressure (P = 0.011) at 8-year follow-up. Conclusion High prolactin levels and breast increase in pregnancy were associated with a more favorable long-term metabolic health in women with PCOS. Both prolactin and breast increase may be mediated by gestational BMI.


Assuntos
Mama/crescimento & desenvolvimento , Síndrome do Ovário Policístico/sangue , Síndrome do Ovário Policístico/fisiopatologia , Complicações na Gravidez/fisiopatologia , Prolactina/sangue , Adolescente , Adulto , Pressão Sanguínea , Índice de Massa Corporal , Feminino , Seguimentos , Idade Gestacional , Humanos , Hipoglicemiantes , Resistência à Insulina , Gordura Intra-Abdominal/patologia , Metformina/administração & dosagem , Pessoa de Meia-Idade , Síndrome do Ovário Policístico/patologia , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/patologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Relação Cintura-Quadril , Adulto Jovem
18.
Pak J Biol Sci ; 22(3): 148-153, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30972985

RESUMO

BACKGROUND AND OBJECTIVE: Preeclampsia(PE) is adisordercharacterized byhypertensionandproteinuria. There is accumulating evidence that this is a disease of the endothelium. Angiogenic factors may be responsible for the regulation of placental vascular development. Clinicians cannot predict pre-eclampsia prior to the onset symptoms. An ideal bio-marker for pre-eclampsia prediction is during the first trimester. This study investigated the serum levels of tumor necrosis factor-α (TNF-α), C-reactive protein (CRP) and the gene expressions of vascular endothelial growth factor (VEGF), endothelial nitric oxide synthase (eNOS) and p53 in PE trying to find out potential bio-markers for prediction and diagnosis of PE. MATERIAL AND METHODS: A total of 100 female volunteers were involved in this study and their ages were ranged from 25-35 years. They were divided into three groups: Group (1) was 20 healthy non-pregnant women, group (2) was 20 pregnant women normal pregnancies and group (3) was 60 preeclamptic patients. The study participants were enrolled at the Department of Obstetrics and Gynaecology at Mansoura University Hospital, Mansoura, Egypt. The study was approved by the Research Ethics Committee (Faculty of Science, Al Azhar University, Egypt) approved on the March 15, 2014) all women gave written informed consent. Serum levels of CRP, IL-10 and TNF-α were evaluated, in addition to the gene expression of VEGF, eNOS and p53. RESULTS: Significant elevations in the serum levels of blood pressure, TNF-α and CRP were observed in PE patients. Additionally, the gene expression of VEGF, eNOS and P53 were down-regulated in preeclampsia. CONCLUSION: Elevated serum levels of TNFα and CRP, in addition to the down-regulation of eNOS may be used as good predictors for preeclampsia. The TNF-α and VEGF gene were recommended used as markers for PE to be added to routine testes of pregnant women.


Assuntos
Citocinas/sangue , Perfilação da Expressão Gênica , Pré-Eclâmpsia/sangue , Complicações na Gravidez/sangue , Adulto , Biomarcadores/sangue , Proteína C-Reativa/análise , Estudos de Casos e Controles , Egito , Feminino , Humanos , Interleucina-10/sangue , Óxido Nítrico Sintase Tipo III/sangue , Pré-Eclâmpsia/diagnóstico , Gravidez , Reação em Cadeia da Polimerase em Tempo Real , Fator de Necrose Tumoral alfa/sangue , Proteína Supressora de Tumor p53/sangue , Fator A de Crescimento do Endotélio Vascular/sangue
19.
BMC Pregnancy Childbirth ; 19(1): 112, 2019 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-30940099

RESUMO

INTRODUCTION: The role of vitamin D in placental functions and fetal growth had been addressed in many reports with conflicting results. However, such report is limited for Indonesian population. The aim of this study was to explore the association between maternal vitamin D level in the first trimester and fetal biometry in the later stage of pregnancy with adjusted OR for other determinants like hemoglobin and ferritin level. METHODS: From July 2016 a prospective cohort study of pregnant women had begun in four cities in West Java, Indonesia. Data on maternal vitamin D, ferritin, hemoglobin level, maternal demography and fetal biometry were analyzed with linear regression. RESULTS: Among 203 recruited women, 195 (96.06%) had hypovitaminosis D. One hundred fifty two (75%) were in deficient state and 43 women (21%) were in insufficient state. Women with insufficient vitamin D had the highest proportion of anemia, while women with normal vitamin D level had the highest proportion of low ferritin level. Maternal serum vitamin D showed significant associations with biparietal diameter (ß = 0.141, p = 0.042) and abdominal circumference (ß = 0.819, p = 0.001) after adjustment with maternal age, pre-pregnancy body mass index, parity, serum ferritin level, and hemoglobin level. CONCLUSION: Our study suggested that sufficient maternal vitamin D level was an important factor to improve fetal growth and development.


Assuntos
Ferritinas/sangue , Hemoglobinas/metabolismo , Primeiro Trimestre da Gravidez/sangue , Terceiro Trimestre da Gravidez/sangue , Vitamina D/sangue , Adulto , Biometria , Feminino , Desenvolvimento Fetal , Feto/fisiopatologia , Humanos , Indonésia/epidemiologia , Modelos Lineares , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/epidemiologia , Estudos Prospectivos , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/epidemiologia , Adulto Jovem
20.
BMC Pregnancy Childbirth ; 19(1): 124, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30971214

RESUMO

BACKGROUND: To compare the rates of adverse pregnancy outcomes between women with normal and abnormal inhibin-A levels. METHODS: Based on a prospective database of Down syndrome screening program, the consecutive records were comprehensively reviewed. Pregnancies were classified into three groups: normal, high (> 2 MoM) and low (< 0.5 MoM) inhibin-A levels. The pregnancies with medical diseases, chromosome abnormalities and fetal anomalies were excluded. The primary outcomes were the rates of preterm birth, preeclampsia, and fetal growth restriction (FGR). RESULTS: Of 6679 recruited pregnancies, 5080 met the inclusion criteria, including 4600, 205 and 275 pregnancies in the group of normal, high, and low inhibin-A levels respectively. The rates of preterm birth, preeclampsia and FGR were significantly higher in the group of high levels; (RR, 1.51, 95%CI: 1.01-2.26; 3.47, 95% CI: 2.13-5.65; 3.04, 95% CI: 1.99-4.65 respectively), whereas the rates of other adverse outcomes were comparable. However, the rate of spontaneous preterm birth among women with high inhibin-A was not significantly increased. Based on multivariate analysis, the preterm birth rate was not significantly associated with inhibin-A levels, but it was rather a consequence of preeclampsia and FGR. Low levels of serum inhibin-A were not significantly associated with any adverse outcomes. CONCLUSIONS: High levels of maternal serum inhibin-A in the second trimester are significantly associated with abnormal placentation, which increases the risk of preeclampsia and FGR with a consequence of indicated preterm birth but not a risk of spontaneous preterm birth. In contrast, low inhibin-A levels were not associated with any common adverse pregnancy outcomes.


Assuntos
Retardo do Crescimento Fetal/epidemiologia , Inibinas/sangue , Pré-Eclâmpsia/epidemiologia , Segundo Trimestre da Gravidez/sangue , Nascimento Prematuro/epidemiologia , Adulto , Bases de Dados Factuais , Feminino , Retardo do Crescimento Fetal/sangue , Humanos , Pré-Eclâmpsia/sangue , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/epidemiologia , Resultado da Gravidez , Nascimento Prematuro/sangue , Estudos Prospectivos
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