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1.
J Korean Med Sci ; 37(12): e96, 2022 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-35347904

RESUMO

BACKGROUND: The single vitrified-warmed blastocyst transfer (SVBT) cycle has been increasingly utilized for assisted reproductive technology. Women of advanced maternal age (AMA) comprise a significant portion of patients who have undergone 'freeze-all' cycles. This study investigated the association between the post-warming extended culture duration and pregnancy outcomes in patients of AMA. METHODS: This retrospective cohort study analyzed the outcomes of 697 SVBT cycles between January 2016 and December 2017. The cycles were divided into 3 groups based on the age of the female partners: group I: < 35 years (n = 407), group II: 35-37 years (n = 176); and group III, 38-40 years (n = 114). Data are shown as the mean ± standard error of the mean. Data were analyzed using one-way ANOVA followed by Duncan's multiple range test. Statistical significance was set at P < 0.001. RESULTS: The blastocyst rate, clinical pregnancy rate, and live birth rate (LBR) was significantly lower in the AMA groups. However, there were no significant differences in LBR in the transfer between the AMA and younger groups according to blastocyst morphology and post-warming extended culture duration. CONCLUSION: Post-warming extended culture of blastocysts is not harmful to patients of AMA. It could be a useful parameter in clinical counseling and decision making for fertility treatments.


Assuntos
Blastocisto , Transferência Embrionária , Adulto , Feminino , Humanos , Idade Materna , Gravidez , Taxa de Gravidez , Estudos Retrospectivos
2.
BMC Pregnancy Childbirth ; 22(1): 681, 2022 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-36057566

RESUMO

BACKGROUND: Coexistence of molar pregnancy with living fetus represents a challenge in diagnosis and treatment. The objective of this study to present the outcome of molar pregnancy with a coexisting living fetus who were managed in our University Hospital in the last 5 years. METHODS: We performed a retrospective analysis of patients who presented with molar pregnancy with a coexisting living fetus to our Gestational Trophoblastic Clinic, Mansoura University, Egypt from September, 2015 to August, 2020. Clinical characteristics of the patients, maternal complications as well as fetal outcome were recorded. The patients and their living babies were also followed up at least 6 months after delivery. RESULTS: Twelve pregnancies were analyzed. The mean maternal age was 26.0 (SD 4.1) years and the median parity was 1.0 (range 0-3). Duration of the pregnancies ranged from 14 to 36 weeks. The median serum hCG was 165,210.0 U/L (range 7662-1,200,000). Three fetuses survived outside the uterus (25%), one of them died after 5 months because of congenital malformations. Histologic diagnosis was available for 10 of 12 cases and revealed complete mole associated with a normal placenta in 6 cases (60%) and partial mole in 4 cases (40%). Maternal complications occurred in 6 cases (50%) with the most common was severe vaginal bleeding in 4 cases (33.3%). There was no significant association between B-hCG levels and maternal complications (P = 0.3). CONCLUSION: Maternal and fetal outcomes of molar pregnancy with a living fetus are poor. Counseling the patients for termination of pregnancy may be required. TRIAL REGISTRATION: The study was approved by Institutional Research Board (IRB), Faculty of Medicine, Mansoura University (number: R.21.10.1492).


Assuntos
Mola Hidatiforme , Neoplasias Uterinas , Adulto , Feminino , Feto/patologia , Humanos , Mola Hidatiforme/complicações , Mola Hidatiforme/tratamento farmacológico , Mola Hidatiforme/patologia , Idade Materna , Gravidez , Estudos Retrospectivos , Neoplasias Uterinas/tratamento farmacológico
3.
J Glob Health ; 12: 04072, 2022 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-36112509

RESUMO

Background: Considering the public health importance of stillbirth, this study quantified the trends in stillbirths over eight decades in England and Wales. Methods: This longitudinal study utilized the publicly available aggregated data from the Office for National Statistics that captured maternity information for babies delivered in England and Wales from 1940 to 2019. We computed the trends in stillbirth with the associated incidence risk difference, incidence risk ratio, and extra lives saved per decade. Results: From 1940-2019, 56 906 273 births were reported. The stillbirth rate declined (85%) drastically up to the early 1980s. In the initial five decades, the estimated number of deaths per decade further decreased by 67 765 (9.49/1000 births) in 1940-1949, 2569 (0.08/1000 births) in 1950-1959, 9121 (3.50/1000 births) in 1960-1969, 15 262 (2.31/1000 births) in 1970-1979, and 10 284 (1.57/1000 births) in 1980-1989. However, the stillbirth rate increased by an additional 3850 (0.58/1000 births) stillbirths in 1990-1999 and 693 (0.11/1000 births) stillbirths in 2000-2009. The stillbirth rate declined again during 2010-2019, with 3714 fewer stillbirths (0.54/1000 births). The incidence of maternal age <20 years reduced over time, but pregnancy among older women (>35 years) increased. Conclusions: The stillbirth rate declined drastically, but the rate of decline slowed in the last three decades. Though teenage pregnancy (<20 years) had reduced, the prevalence of women with a higher risk of stillbirth may have risen due to an increase in advanced maternal age. Improved, more personalised care is required to reduce the stillbirth rate further.


Assuntos
Serviços de Saúde Materna , Natimorto , Adolescente , Adulto , Idoso , Feminino , Humanos , Lactente , Estudos Longitudinais , Idade Materna , Gravidez , Natimorto/epidemiologia , País de Gales/epidemiologia , Adulto Jovem
4.
J Zhejiang Univ Sci B ; 23(9): 747-759, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36111571

RESUMO

The mechanisms underlying pregnancy complications caused by advanced maternal age (AMA) remain unclear. We analyzed the cellular signature and transcriptomes of human placentas in AMA women to elucidate these mechanisms. Placental tissues from two AMA women and two controls were used for single-cell RNA-sequencing (scRNA-seq). Controls consisted of AMA women who did not experience any pregnancy complications and pregnant women below the age of 35 years without pregnancy complications. Trophoblast cells were obtained from the placentas of another six pregnant women (three AMA women and three controls), and in-vitro transwell assays were conducted to observe the cell invasion ability. Thirty additional samples (from 15 AMA women and 15 controls) were analyzed to verify the specific expression of serine protease inhibitor clade E member 1 (SERPINE1). Preliminary study of the role of SERPINE1 in cell invasion was carried out with HTR8-S/Vneo cells. High-quality transcriptomes of 27 |607 cells were detected. Three types of trophoblast cells were detected, which were further classified into eight subtypes according to differences in gene expression and Gene Ontology (GO) function. We identified 110 differentially expressed genes (DEGs) in trophoblast cells between the AMA and control groups, and the DEGs were enriched in multiple pathways related to cell invasion. In-vitro transwell assays suggested that the invading trophoblast cells in AMA women were reduced. SERPINE1 was specifically expressed in the trophoblast, and its expression was higher in AMA women (P<0.05). Transfection of human SERPINE1 (hSERPINE1) into HTR8-S/Vneo trophoblast cells showed fewer invading cells in the hSERPINE1 group. Impaired cell invasion may underlie the increased risk of adverse pregnancy outcomes in AMA women. Abnormal expression of SERPINE1 in extravillous trophoblast (EVT) cells appears to play an important role.


Assuntos
Placenta , Complicações na Gravidez , Adulto , Linhagem Celular , Movimento Celular , Feminino , Humanos , Idade Materna , Placenta/metabolismo , Gravidez , Gestantes , RNA/metabolismo , Inibidores de Serino Proteinase/metabolismo
5.
Clin Transl Med ; 12(9): e990, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36103411

RESUMO

BACKGROUND: The number of women delivering at advanced maternal age (AMA; > = 35) continuously increases in developed and high-income countries. Large cohort studies have associated AMA with increased risks of various pregnancy complications and adverse pregnancy outcomes, which raises great concerns about the adverse effect of AMA on the long-term health of offspring. Specific acquired characteristics of parents can be passed on to descendants through certain molecular mechanisms, yet the underlying connection between AMA-related alterations in parents and that in offspring remains largely uncharted. METHODS: We profiled the DNA methylomes of paired parental peripheral bloods and cord bloods from 20 nuclear families, including 10 AMA and 10 Young, and additional transcriptomes of 10 paired maternal peripheral bloods and cord bloods. RESULTS: We revealed that AMA induced aging-like changes in DNA methylome and gene expression in both parents and offspring. The expression changes in several genes, such as SLC28A3, were highly relevant to the disorder in DNA methylation. In addition, AMA-related differentially methylated regions (DMRs) identified in mother and offspring groups showed remarkable similarities in both genomic locations and biological functions, mainly involving neuron differentiation, metabolism, and histone modification pathways. AMA-related differentially expressed genes (DEGs) shared by mother and offspring groups were highly enriched in the processes of immune cell activation and mitotic nuclear division. We further uncovered developmental-dependent dynamics for the DNA methylation of intergenerationally correlated DMRs during pre-implantation embryonic development, as well as diverse gene expression patterns during gametogenesis and early embryonic development for those common AMA-related DEGs presenting intergenerational correlation, such as CD24. Moreover, some intergenerational DEGs, typified by HTRA3, also showed the same significant alterations in AMA MII oocyte or blastocyst. CONCLUSIONS: Our results reveal potential intergenerational inheritance of both AMA-related DNA methylome and transcriptome and provide new insights to understand health problems in AMA offspring.


Assuntos
Epigenoma , Transcriptoma , Metilação de DNA/genética , Epigenoma/genética , Feminino , Humanos , Padrões de Herança , Idade Materna , Gravidez , Serina Endopeptidases/genética , Transcriptoma/genética
6.
Sci Rep ; 12(1): 14506, 2022 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-36008507

RESUMO

Differential maternal allocation theory states that mothers will invest more heavily in the offspring sex that will secure higher reproductive output. Senescence theory is concerned with the gradual deterioration of physiological function with age. We analysed the offspring sex-dependent response of calf growth and milk traits to mother age in an Iberian population of captive red deer (Cervus elaphus) using a 22 year time series longitudinal data set. Previous studies revealed that there was little evidence for the differential allocation theory on milk traits and that most studies lacked proper control for confounding factors. Our results indicated that (i) calf growth was offspring male-biased, negatively affected by mother age and positively influenced by mother weight and parity, and (ii) there was no support for differential allocation offspring sex-dependence in milk traits (yield, energy density, fat, protein and lactose content). Our findings suggest that maternal allocation responds to offspring energy requirements, which are mainly driven by offspring body weight, and contingent on mother age and weight and previous maternal reproductive effort.


Assuntos
Cervos , Leite , Animais , Cervos/fisiologia , Feminino , Lactação/fisiologia , Lactose/metabolismo , Masculino , Idade Materna , Leite/metabolismo , Gravidez
7.
Int J Mol Sci ; 23(16)2022 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-36012456

RESUMO

Advanced maternal age (≥35 years) is associated with pregnancy complications. Aging impairs vascular reactivity and increases vascular stiffness. We hypothesized that uterine artery adaptations to pregnancy are impaired with advanced age. Uterine arteries of nonpregnant and pregnant (gestational day 20) young (4 months) and aged (9 months; ~35 years in humans) Sprague-Dawley rats were isolated. Functional (myogenic tone, n = 6-10/group) and mechanical (circumferential stress-strain, n = 10-24/group) properties were assessed using pressure myography and further assessment of elastin and collagen (histology, n = 4-6/group), and matrix metalloproteinase-2 (MMP-2, zymography, n = 6/group). Aged dams had worse pregnancy outcomes, including smaller litters and fetal weights (both p < 0.0001). Only in arteries of pregnant young dams did higher pressures (>100 mmHg) cause forced vasodilation. Across the whole pressure range (4-160 mmHg), myogenic behavior was enhanced in aged vs. young pregnant dams (p = 0.0010). Circumferential stress and strain increased with pregnancy in young and aged dams (p < 0.0001), but strain remained lower in aged vs. young dams (p < 0.05). Arteries from young nonpregnant rats had greater collagen:elastin ratios than the other groups (p < 0.05). In aged rats only, pregnancy increased MMP-2 active capacity. Altered functional and structural vascular adaptations to pregnancy may impair fetal growth and development with advanced maternal age.


Assuntos
Metaloproteinase 2 da Matriz , Artéria Uterina , Animais , Colágeno , Elastina , Feminino , Humanos , Idade Materna , Gravidez , Ratos , Ratos Sprague-Dawley
8.
J Prev Med Public Health ; 55(4): 371-378, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35940192

RESUMO

OBJECTIVES: No studies have examined the association between preterm birth rates and socioeconomic factors in Japan using nationwide statistical data. We analyzed the association between preterm birth rates and household occupation using Vital Statistics data. METHODS: Aggregated Vital Statistics data from Japan from 2007 to 2019 were obtained from the Ministry of Health, Labour and Welfare. From the data, the number of births according to year, age group, gestational period, number of pregnancies, and household occupation were used in this study. Crude preterm birth rates and preterm birth rates adjusted by maternal age according to household occupation were calculated for each year. Poisson regression analysis was conducted to evaluate the association between household occupation and preterm births. RESULTS: Unemployed households had the highest preterm birth rate, and households with an occupation classification of "full-time worker 2" (an employee at a large company, civil servant, or board member) had the lowest preterm birth rate throughout each period. Poisson regression analysis revealed that unemployed households were statistically significantly associated with a high preterm birth risk. In contrast, the preterm birth rate adjusted by maternal age remained stable throughout each period regardless of household occupation, and preterm birth rates were found not to have increased in recent years in Japan. CONCLUSIONS: Unemployed households had higher preterm birth rates than other household occupations. Further studies investigating the characteristics of unemployed households are needed to identify the reasons for this disparity.


Assuntos
Nascimento Prematuro , Feminino , Humanos , Recém-Nascido , Japão/epidemiologia , Idade Materna , Ocupações , Gravidez , Nascimento Prematuro/epidemiologia , Fatores Socioeconômicos
9.
Zhongguo Dang Dai Er Ke Za Zhi ; 24(8): 863-868, 2022 Aug 15.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-36036123

RESUMO

OBJECTIVES: To study the association between paternal age at childbirth and the risk of autism spectrum disorder (ASD) in offspring. METHODS: In this cross-sectional study, 71 children with ASD who were diagnosed in the Department of Child Healthcare in six hospitals in Guangzhou, Foshan, Beijing, Wuhan, Hangzhou, and Chongqing of China from August 2016 to March 2017 were enrolled as subjects, and 284 typically developing children matched for age, sex, and maternal age at childbirth with the ASD children served as controls. A self-design questionnaire was used to collect the data on social demography, maternal pregnancy, and delivery. The association between paternal age at childbirth and the development of ASD in offspring was evaluated by the logistic regression analysis. RESULTS: After control for demographic factors and pregnancy- and delivery-related factors, the logistic regression analysis showed that a relatively high paternal age at childbirth was significantly associated with the increased risk of ASD in offspring (OR=1.12, 95%CI: 1.02-1.23, P<0.05). After grouping based on the paternal age, the logistic regression analysis showed that paternal age at childbirth of ≥40 years was significantly associated with the risk of ASD in offspring (before adjustment: OR=7.08, 95%CI: 1.77-28.32, P<0.05; after adjustment: OR=8.50, 95%CI: 1.71-42.25, P<0.05). CONCLUSIONS: High paternal age at childbirth is significantly associated with the increased risk of ASD in offspring, and paternal age at childbirth ≥40 years may be the high-risk age group for ASD in offspring.


Assuntos
Transtorno do Espectro Autista , Idade Paterna , Adulto , Criança , China , Estudos Transversais , Feminino , Humanos , Idade Materna , Gravidez , Fatores de Risco
10.
Front Public Health ; 10: 933654, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35910867

RESUMO

Background: Spontaneous abortion is one of the prevalent adverse reproductive outcomes, which seriously threatens maternal health around the world. Objective: The current study is aimed to evaluate the association between maternal age and risk for spontaneous abortion among pregnant women in China. Methods: This was a case-control study based on the China Birth Cohort, we compared 338 cases ending in spontaneous abortion with 1,352 controls resulting in normal live births. The main exposure indicator and outcome indicator were maternal age and spontaneous abortion, respectively. We used both a generalized additive model and a two-piece-wise linear model to determine the association. We further performed stratified analyses to test the robustness of the association between maternal age and spontaneous abortion in different subgroups. Results: We observed a J-shaped relationship between maternal age and spontaneous abortion risk, after adjusting for multiple covariates. Further, we found that the optimal threshold age was 29.68 years old. The adjusted odds ratio (95% confidence interval) of spontaneous abortion per 1 year increase in maternal age were 0.97 (0.90-1.06) on the left side of the turning point and 1.25 (1.28-1.31) on the right side. Additionally, none of the covariates studied modified the association between maternal age and spontaneous abortion (P > 0.05). Conclusions: Advanced maternal age (>30 years old) was significantly associated with increased prevalence of spontaneous abortion, supporting a J-shaped association between maternal age and spontaneous abortion.


Assuntos
Aborto Espontâneo , Aborto Espontâneo/epidemiologia , Adulto , Coorte de Nascimento , Estudos de Casos e Controles , China/epidemiologia , Feminino , Humanos , Idade Materna , Gravidez
11.
BMC Pediatr ; 22(1): 504, 2022 08 25.
Artigo em Inglês | MEDLINE | ID: mdl-36008798

RESUMO

BACKGROUND: Human birthweight is a complex, multifactorial trait. Maternal characteristics contribute to birthweight variation by influencing the intrauterine environment. Variation explained by genetic effects is also important, but their contributions have not been assessed alongside other key determinants. We aimed to investigate variance in birthweight explained by genetic scores in addition to easily-measurable clinical and anthropometric variables. METHODS: We analysed 549 European-ancestry parent-offspring trios from a UK community-based birth cohort. We investigated variance explained in birthweight (adjusted for sex and gestational age) in multivariable linear regression models including genetic scores, routinely-measured maternal characteristics, and parental anthropometric variables. We used R-Squared (R2) to estimate variance explained, adjusted R-squared (Adj-R2) to assess improvement in model fit from added predictors, and F-tests to compare nested models. RESULTS: Maternal and fetal genetic scores together explained 6.0% variance in birthweight. A model containing maternal age, weight, smoking, parity and 28-week fasting glucose explained 21.7% variance. Maternal genetic score explained additional variance when added to maternal characteristics (Adj-R2 = 0.233 vs Adj-R2 = 0.210, p < 0.001). Fetal genetic score improved variance explained (Adj-R2 = 0.264 vs 0.248, p < 0.001) when added to maternal characteristics and parental heights. CONCLUSIONS: Genetic scores account for variance explained in birthweight in addition to easily measurable clinical variables. Parental heights partially capture fetal genotype and its contribution to birthweight, but genetic scores explain additional variance. While the genetic contribution is modest, it is comparable to that of individual clinical characteristics such as parity, which suggests that genetics could be included in tools aiming to predict risk of high or low birthweights.


Assuntos
Recém-Nascido de Baixo Peso , Peso ao Nascer/genética , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Idade Materna , Paridade , Gravidez
12.
Reprod Health ; 19(1): 177, 2022 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-35964088

RESUMO

BACKGROUND: Even though several severe maternal morbidity (SMM) indicators exist globally, indicators that can serve as international standards are needed. Therefore, this study aimed to compare the SMM risk assessment using four international indicators and identify the factors underlying the differences among the risk assessments obtained by the various indicators. METHODS: This study used the National Health Insurance delivery cohort in South Korea from 2003 to 2018. SMM was estimated using four indicators: the United States Centers for Disease Control and Prevention (US-CDC) SMM algorithm, the American College of Obstetricians and Gynecologists (ACOG) gold standard guidelines, Zwart et al.'s indicators for the Netherlands, and the European Network on Severe Acute Maternal Morbidity (EURONET-SAMM) index. Generalized estimating equations models were used to identify the relationships between SMM indicators and risk factors. RESULTS: The SMM incidence rates in 6,421,091 deliveries, were 2.36%, 3.12%, 0.31%, and 1.36% using the US-CDC, ACOG, Zwart et al.'s, and EURONET SAMM indicators, respectively. In sub indicators, hemorrhage-related codes constituted the highest proportion of all SMM indicators. Advanced maternal age was related to high risk in all four SMM indicators (US-CDC: 40-44 years, RR 1.67, 95% CI 1.63-1.71; ACOG's guidelines: 40-44 years, RR 1.52, 95% CI 1.49-1.56; Zwart's indicators: RR 2.72, 95% CI 2.55-2.90; EURONET-SAMM: RR 2.04, 95% CI 1.97-2.11) compared to those aged 25-29 years. In residential area, women who lived in rural area had approximately 1.2- to 1.5-fold higher risk of SMM compared to those who lived in Seoul. Additionally, inadequate prenatal care was associated with a 1.1- to 1.4-fold higher risk of SMM compared to adequate prenatal care. CONCLUSIONS: SMM was associated with maternal age, socioeconomic status, and adverse obstetric factors using various international SMM indicators. Further studies are needed to further determine risk and preventable factors for SMM and to identify more specific causes associated with the frequent sub-indicators of SMM.


There are several indicators of severe maternal morbidity (SMM) globally, but indicators that can serve as international standards are not exist yet. This study compared the SMM risk assessment using four international indicators such as US-CDC's SMM, ACOG's gold standard guidelines, Zwart et al.'s SMM, and EURONET-SAMM, and identify the factors underlying the differences among the risk assessments obtained by the various indicators.This study extracted women who were aged 15­49 years, those who had childbirth in the healthcare institute during 2003 to 2018 in South Korea using the National Health Insurance database.Of the 6,421,091 childbirth cases, the incidence of each SMM indicators were as follow: the US-CDC's SMM: 2.4%; the ACOG's gold standard guidelines: 3.1%; Zwart et al.'s SMM: 0.3%; the EURONET-SAMM: 1.4% indicators. In addition, the highest incidence of each sub-indicators was blood transfusion or obstetric hemorrhage which recorded more than 70% of total SMM cases. In particular, the risk factor on SMM were: advanced maternal age; living rural area; inadequate prenatal care.In conclusion, SMM was associated with maternal age, socioeconomic status, and adverse obstetric factors using various global SMM indicators. Therefore, further studies are needed to identify more specific causes associated with the frequent sub-indicators of SMM and to determine risk and preventable factors for SMM.


Assuntos
Complicações na Gravidez , Cuidado Pré-Natal , Estudos de Coortes , Feminino , Humanos , Idade Materna , Gravidez , Complicações na Gravidez/epidemiologia , Estudos Retrospectivos
13.
Artigo em Inglês | MEDLINE | ID: mdl-35805738

RESUMO

Congenital anomalies (CA) contribute to disabilities and health conditions throughout life. Furthermore, they can cause emotional distress to the mothers and children, who may also experience limitations in individual and social development. This study investigated the prevalence of CA and the relationship with maternal education and age according to local development in the extreme south of Brazil. This is a retrospective observational study with birth data from the Live Birth Information System from 2000 to 2017. The association between age and maternal education with the presence of CA was verified using multiple Poisson regression for robust variances in models adjusted for those variables with a preliminary significant association. A total of 5131 (1.5%) had some CA identified at birth between 2000 and 2017. Only advanced age (≥36 years) was associated with CA regardless of macro-region development (p ≤ 0.001). The highest risk was observed in regions with medium development (RR = 1.60; 95% CI 1.30-1.97). Maternal education (<8 years of study) was associated with CA only in mothers from macro-regions with very high development (RR = 1.27; 95% CI 1.03-1.54). These analyses confirmed that women of advanced age are at greater risk of having children with a CA regardless of maternal education and local development, but social characteristics can also have an influence, as regions with higher development had lower prevalence of CA.


Assuntos
Mães , Adulto , Brasil/epidemiologia , Criança , Escolaridade , Feminino , Humanos , Recém-Nascido , Idade Materna , Prevalência , Estudos Retrospectivos
14.
JAMA Netw Open ; 5(7): e2222966, 2022 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-35900764

RESUMO

Importance: Surveillance of severe maternal morbidity (SMM) is critical for monitoring maternal health and evaluating clinical quality improvement efforts. Objective: To evaluate national and state trends in SMM rates from 2012 to 2019 and potential disruptions associated with the transition to International Classification of Diseases, 10th Revision, Clinical Modification and Procedure Coding System (ICD-10-CM/PCS) in October 2015. Design, Setting, and Participants: This repeated cross-sectional analysis examined delivery hospitalizations from 2012 through 2019 in the Healthcare Cost and Utilization Project's National Inpatient Sample and State Inpatient Databases, an all-payer compendium of hospital discharge records from community, nonrehabilitation hospitals. Trends were evaluated using segmented linear binomial regression models that allowed for discontinuities across the ICD-10-CM/PCS transition. Analyses were completed from April 2021 through March 2022. Exposures: Time, ICD-10-CM/PCS coding system, and state. Main Outcomes and Measures: SMM rates, excluding blood transfusion, per 10 000 delivery hospitalizations, overall and by indicator. Results: From 2012 to 2019, there were 5 964 315 delivery hospitalizations in the national sample representing a weighted total of 29.8 million deliveries with a mean (SD) maternal age of 28.6 (5.9) years. SMM rates increased from 69.5 per 10 000 in 2012 to 79.7 per 10 000 in 2019 (rate difference [RD], 10.2; 95% CI, 5.8 to 14.6) without a significant change across the ICD-10-CM/PCS transition (RD, -3.2; 95% CI, -6.9 to 0.6). Of 20 SMM indicators, rates for 10 indicators significantly increased while 3 significantly decreased; 5 of these changes were associated with ICD-10-CM/PCS transition. Acute kidney failure had the largest increase, from 6.4 to 15.3 per 10 000 delivery hospitalizations (RD, 8.9; 95% CI, 7.5 to 10.3) with no change associated with ICD transition (RD, -0.1; 95% CI, -1.2 to 1.1). Disseminated intravascular coagulation had the largest decrease from 31.3 to 21.2 per 10 000 (RD, 10.2; 95% CI, -12.8 to -7.5), with a significant drop associated with ICD transition (RD, -7.9; 95% CI, -10.2 to -5.6). State SMM rates significantly decreased for 1 state and significantly increased for 21 states from 2012 to 2019 and associations with ICD transition varied. Conclusions and Relevance: In this cross-sectional study, overall US SMM rates increased from 2012 to 2019, which was not associated with the ICD-10-CM/PCS transition. However, data for certain indicators and states may not be comparable across coding systems; efforts are needed to understand SMM increases and state variation.


Assuntos
Hospitalização , Classificação Internacional de Doenças , Adulto , Estudos Transversais , Bases de Dados Factuais , Feminino , Humanos , Idade Materna , Gravidez
15.
Contrast Media Mol Imaging ; 2022: 4332006, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35854775

RESUMO

We aimed to explore the association of BMI in pre-pregnant women with metabolic syndrome in pregnancy in advanced maternal age. A total of 229 maternal women and 536 maternal women participated in this study. Pregnancy women underwent a 75 g-oral glucose tolerance test and maternal lipid profile test between 24 and 28 weeks. Data about biological and sociodemographic characteristics were recorded for each case. The metabolic equivalent (Met) was 9.6% in the maternal age ≥35 group, 5.4% in the age 20-34 group (P = 0.027), and 6.7% in all pregnant women. Results also demonstrated that gestational diabetes mellitus (GDM) and MetS were more likely to appear in the maternal age ≥35 years group than the maternal age 20-34 years group (41.5% vs. 30.6%; P = 0.001, 9.6% vs. 5.4%, P = 0.027). Risk for preterm delivery and eclampsia were increased with raised MetS (RR 3.434 and RR 1.800); MetS in women aged ≥35 years had the largest area under the curve (AUC) (AUC 0.925, 95% CI 0.885-0.965), and its optimal cutoff point was ≥24.998 kg/m2, and the optimal cutoff point for total cholesterol (TC) (AUC 0.686, 95% CI 0.571-.802) predicting MetS was ≥4.955 mmol/l. MetS in pregnancy are associated with the occurrence of preterm delivery and eclampsia, and pre-BMI and TC can predict MetS in the maternal age ≥35 group.


Assuntos
Eclampsia , Síndrome Metabólica , Nascimento Prematuro , Índice de Massa Corporal , Feminino , Humanos , Recém-Nascido , Lipídeos , Idade Materna , Síndrome Metabólica/epidemiologia , Gravidez
16.
Aging (Albany NY) ; 14(13): 5294-5295, 2022 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-35853249
17.
Ital J Pediatr ; 48(1): 121, 2022 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-35870983

RESUMO

BACKGROUND: Prader-Willi syndrome (PWS) is a complex disorder caused by impaired paternally expressed genes on chromosome 15q11-q13. Variable findings have been reported about the phenotypic differences among PWS genetic subtypes. METHODS: A total of 110 PWS patients were diagnosed from 8,572 pediatric patients included from July 2013 to December 2021 by MLPA and MS-MLPA assays. Atypical deletions were defined by genomic CNV-sequencing. Maternal uniparental disomy (UPD) was subgrouped by microsatellite genotyping. Clinical data were collected for phenotype-genotype associations. Twenty-one patients received growth hormone (GH) treatment, and the anthropometric and laboratory parameters were evaluated and compared. RESULTS: Genetically, the 110 patients with PWS included 29 type I deletion, 56 type II deletion, 6 atypical deletion, 11 heterodisomy UPD, and 8 isodisomy UPD. The UPD group had significantly higher maternal age (31.4 ± 3.4 vs 27.8 ± 3.8 years), more anxiety (64.29% vs 26.09%) and autistic traits (57.14% vs 26.09%), and less hypopigmentation (42.11% vs 68.24%) and skin picking (42.86% vs 71.01%) than the deletion group. The type I deletion group was diagnosed at earlier age (3.7 ± 3.3 vs 6.2 ± 3.2 years) and more common in speech delay (95.45% vs 63.83%) than the type II. The isodisomy UPD group showed a higher tendency of anxiety (83.33% vs 50%) than the heterodisomy. GH treatment for 1 year significantly improved the SDS of height (- 0.43 ± 0.68 vs - 1.32 ± 1.19) and IGF-I (- 0.45 ± 0.48 vs - 1.97 ± 1.12). No significant changes were found in thyroid function or glucose/lipid metabolism. CONCLUSION: We explored the physical, psychological and behavioral phenotype-genotype associations as well as the GH treatment effect on PWS from a large cohort of Chinese pediatric patients. Our data might promote pediatricians' recognition and early diagnosis of PWS.


Assuntos
Síndrome de Prader-Willi , Estatura , Humanos , Idade Materna , Fenótipo , Síndrome de Prader-Willi/diagnóstico , Síndrome de Prader-Willi/tratamento farmacológico , Síndrome de Prader-Willi/genética , Dissomia Uniparental/genética
18.
Cien Saude Colet ; 27(8): 3261-3271, 2022 Aug.
Artigo em Português, Inglês | MEDLINE | ID: mdl-35894336

RESUMO

The present study aims to analyze the socioeconomic and demographic factors associated with the recurrence of teenage pregnancy, as well as to verify the association with unfavorable maternal and neonatal outcomes. It is a cross-sectional study, based on data from "Nascer no Brasil", comprised of adolescent mothers and their newborns. Univariate and multiple logistic regression were used to indicate the factors associated with this recurrence. Recurrence of teenage pregnancy was associated with a maternal age of 17-19 years (OR=3.35; 95%CI=2.45-4.59); an inadequate education for their age (OR=4.34; 95%CI=3.50-5.39), with no intention of becoming pregnant; residency in the state capital; and the fact that the partner is the head of the family. However, as independent primiparous teenagers, there is a greater chance of hypertension and restricted intrauterine growth. It can therefore be concluded that there is a high percentage of teenage pregnancies in Brazil. Teenagers with a partner, inadequate education, and no reproductive planning are more likely to have two or more pregnancies before the age of 20, demonstrating difficulties in postponing the first pregnancy. However, as primiparous teenagers, they are more likely to have complications than multiparous teenagers.


O objetivo é analisar os fatores socioeconômicos e demográficos associados à reincidência de gravidez na adolescência, assim como verificar a associação com desfechos maternos e neonatais desfavoráveis. É um estudo transversal, a partir dos dados do "Nascer no Brasil", composto por puérperas adolescentes e seus recém-nascidos. Utilizou-se regressão logística univariada e múltipla para indicar os fatores associados à essa reincidência. A reincidência da gravidez na adolescência esteve associada à idade materna de 17-19 anos (OR=3,35; IC95%=2,45-4,59), à escolaridade inadequada para a idade (OR=4,34; IC95%=3,50-5,39), à intenção de engravidar, à residência na capital do estado e ao fato do companheiro ser chefe da família. No entanto, as adolescentes primíparas apresentaram maior chance de doença hipertensiva e crescimento intrauterino restrito. Conclui-se que há um elevado percentual de reincidência de gravidez na adolescência no Brasil. Adolescentes com companheiro, pouca escolaridade e sem planejamento reprodutivo são as mais expostas a ter duas ou mais gestações antes dos 20 anos, demostrando dificuldades em postergar a primeira gestação. Todavia as adolescentes primíparas apresentam maior chance de intercorrências do que as multíparas.


Assuntos
Gravidez na Adolescência , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Idade Materna , Gravidez , Resultado da Gravidez , Reprodução , Problemas Sociais , Adulto Jovem
19.
Mymensingh Med J ; 31(3): 656-665, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35780347

RESUMO

Congenital anomalies are one of the four leading causes of neonatal mortality in Bangladesh. The risk factors which are predictive of congenital anomaly in babies vary from country to country. In a developing country like Bangladesh many possible factors are present which should be identified & frequency needs to be assessed to understand the burden. The aim of this study was to determine the patterns and related maternal factors of fetal congenital anomaly. This cross-sectional type of comparative study was conducted at Department of Obstetrics & Gynecology in Mymensingh Medical College Hospital, Mymensingh, Bangladesh from September 2019 to August 2020. All the births occurring in the labor room were recorded. All newborn babies born with congenital anomalies were identified & included in this study. The rate of congenital anomalies was estimated and common types of congenital anomalies were noted. This study was conducted involving all women who had babies with congenital anomalies and the same number whose babies had no congenital anomalies. A structured questionnaire was used during data collection. Data was analyzed by Chi square test, bivariate analysis & multivariate logistic regression using statistical package for social sciences (SPSS) version 26.0. During the study period, 11479 deliveries were conducted. Among them 87 cases with congenital anomalies were identified. Frequency of congenital anomaly was 0.8%. Central nervous system was the predominant system involved (49.4%). Regarding risk assessment, Maternal age >30 years (OR 2.96, 95% CI 1.10-7.93, p value 0.032), consanguinity (OR 7.73, 95% CI 1.79-33.39, p value 0.006), first degree relative with history of congenital anomaly (OR 35.52, 95% CI 4.31-292.86, p value 0.001) and no intake of folic acid (OR 15.99, 95% CI 5.28-48.52, p value <0.001), passive smoking (OR 6.45, 95% CI 1.66-25.09, p value 0.007) were independent risk factors for congenital anomalies.


Assuntos
Mortalidade Infantil , Cuidado Pré-Natal , Adulto , Consanguinidade , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Idade Materna , Gravidez
20.
Sci Rep ; 12(1): 10377, 2022 06 20.
Artigo em Inglês | MEDLINE | ID: mdl-35726008

RESUMO

Gestational diabetes mellitus (GDM) increases the risk of early-onset type 2 diabetes, which further exacerbates the risk of developing diabetic complications such as kidney, circulatory, and neurological complications. Yet, existing models have solely focused on the prediction of type 2 diabetes, and not of its complications, which are arguably the most clinically relevant outcomes. Our aim was to develop a prediction model for type 2 diabetic complications in patients with GDM. Using provincial administrative data from Quebec, Canada, we developed a model to predict type 2 diabetic complications within 10 years among 90,143 women with GDM. The model was internally validated and assessed for discrimination, calibration, and risk stratification accuracy. The incidence of diabetic complications was 3.8 (95% confidence interval (CI) 3.4-4.3) per 10,000 person-years. The final prediction model included maternal age, socioeconomic deprivation, substance use disorder, gestational age at delivery, severe maternal morbidity, previous pregnancy complications, and hypertensive disorders of pregnancy. The model had good discrimination [area under the curve (AUROC) 0.72 (95% CI 0.69-0.74)] and calibration (slope ≥ 0.9) to predict diabetic complications. In the highest category of the risk stratification table, the positive likelihood ratio was 8.68 (95% CI 4.14-18.23), thereby showing a moderate ability to identify women at highest risk of developing type 2 diabetic complications. Our model predicts the risk of type 2 diabetic complications with moderate accuracy and, once externally validated, may prove to be a useful tool in the management of women after GDM.


Assuntos
Complicações do Diabetes , Diabetes Mellitus Tipo 2 , Diabetes Gestacional , Complicações na Gravidez , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Idade Materna , Gravidez , Fatores de Risco
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