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1.
Medicine (Baltimore) ; 99(17): e19663, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332610

RESUMO

Hyperglycemia in pregnancy (HIP) is related to adverse pregnancy outcomes. However, women with hyperglycemia in the second and third trimester of pregnancy (HISTTP) were not been observed. We aim to reveal associations between HISTTP and prematurity. To confirm which risk factor is better in predicting preterm delivery.This retrospective study included 660 patients, of which 132 have HISTTP and 528 have euglycemia. Univariate analysis was used to extract risk factors and multivariates logistic regression analysis to obtain odds ratio (OR) for prematurity. Mean decrease gini (MDG) in random forest algorithm was used to rank the risk factors.HISTTP women have higher prepregnancy BMI and a higher percentage of family history of hypertension, maternal adiposity, maternal anemia, gestational diabetes mellitus (GDM), prematurity, neonatal asphyxia in 1-minute (P < .05). Univariate analysis of prematurity showed that preterm women had higher rate of HISTTP (P < .01), second births, elderly pregnancy, hypertention, family history of hypertention and multiple perinatal infant (P < .05). Multivariate logistic regression analysis indicates that HISTTP (OR = 2.984, P = .0017), maternal hypertension (OR = 5.208, P = .001) and multiple perinatal infants (OR = 59.815, P < .0001) are independent risk factors for prematurity. After ranked the MDG, the top 3 risk factors were multiple perinatal infants, maternal hypertension, HISTTP. MDG of HISTTP is higher than that of GDM.Women with HISTTP deserve to be concerned, whose prematurity rate are increased. HISTTP is an independent risk factor and a better predictor of prematurity.


Assuntos
Hiperglicemia/complicações , Adulto , Índice de Massa Corporal , Feminino , Idade Gestacional , Humanos , Hiperglicemia/sangue , Hiperglicemia/fisiopatologia , Recém-Nascido , Modelos Logísticos , Razão de Chances , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/fisiopatologia , Segundo Trimestre da Gravidez/sangue , Segundo Trimestre da Gravidez/metabolismo , Terceiro Trimestre da Gravidez/sangue , Terceiro Trimestre da Gravidez/metabolismo , Nascimento Prematuro/sangue , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Estatísticas não Paramétricas
2.
PLoS One ; 15(2): e0229002, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32059045

RESUMO

BACKGROUND: Although protective associations between dietary antioxidants and pregnancy outcomes have been reported, randomized controlled trials of supplementation have been almost uniformly negative. A possible explanation is that supplementation during pregnancy may be too late to have a beneficial effect. Therefore, we examined the relationship between antioxidant levels prior to pregnancy and birth outcomes. METHODS AND FINDINGS: Serum carotenoids and tocopherols were assayed in fasting specimens at 1985-86 (baseline) and 1992-1993 (year 7) from 1,215 participants in Coronary Artery Risk Development in Young Adults (CARDIA) study. An interviewer-administered quantitative food-frequency questionnaire assessed dietary intake of antioxidants. Pregnancy outcome was self-reported at exams every 2 to 5 years. Linear and logistic regression modeling was used to assess relationships of low birthweight (LBW; <2,500 g), continuous infant birthweight, preterm birth (PTB; <37 weeks) and length of gestation with antioxidant levels adjusted for confounders, as well as interactions with age and race. RESULTS: In adjusted models, lycopene was associated with higher odds of LBW (adjusted odds ratio for top quartile, 2.15, 95% confidence interval 1.14, 3.92) and shorter gestational age (adjusted beta coefficient -0.50 weeks). Dietary intake of antioxidants was associated with lower birthweight, while supplement use of vitamin C was associated with higher gestational age (0.41 weeks, 0.01, 0.81). CONCLUSIONS: Higher preconception antioxidant levels are not associated with better birth outcomes.


Assuntos
Afro-Americanos , Antioxidantes/metabolismo , Ácido Ascórbico/sangue , Carotenoides/sangue , Grupo com Ancestrais do Continente Europeu , Idade Gestacional , Nascimento Prematuro/sangue , Adolescente , Adulto , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Gravidez , Adulto Jovem
3.
PLoS One ; 15(1): e0227193, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31995561

RESUMO

BACKGROUND: We conducted a literature review on the studies that investigated the relationship of preterm birth, including spontaneous preterm birth (sPTB), with vitamin D status. Overall, these studies demonstrated that the incidence of sPTB was associated with maternal vitamin D insufficiency in early pregnancy. However, the potential mechanisms and biological pathways are unknown. OBJECTIVES: To investigate early pregnancy gene expression signatures associated with both vitamin D insufficiency and sPTB. We further constructed a network of these gene signatures and identified the common biological pathways involved. STUDY DESIGN: We conducted peripheral blood transcriptome profiling at 10-18 weeks of gestation in a nested case-control cohort of 24 pregnant women who participated in the Vitamin D Antenatal Asthma Reduction Trial (VDAART). In this cohort, 8 women had spontaneous preterm delivery (21-32 weeks of gestation) and 17 women had vitamin D insufficiency (25-hydroxyvitamin D < 30 ng/mL). We separately identified vitamin D-associated and sPTB gene signatures at 10 to 18 weeks and replicated the overlapping signatures in the mid-pregnancy peripheral blood of an independent cohort with sPTB cases. RESULT: At 10-18 weeks of gestation, 146 differentially expressed genes (25 upregulated) were associated with both vitamin D insufficiency and sPTB in the discovery cohort (FDR < 0.05). Of these genes, 43 (25 upregulated) were replicated in the independent cohort of sPTB cases and controls with normal pregnancies (P < 0.05). Functional enrichment and network analyses of the replicated gene signatures suggested several highly connected nodes related to inflammatory and immune responses. CONCLUSIONS: Our gene expression study and network analyses suggest that the dysregulation of immune response pathways due to early pregnancy vitamin D insufficiency may contribute to the pathobiology of sPTB.


Assuntos
Perfilação da Expressão Gênica , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/genética , Transcriptoma/genética , Vitamina D/análogos & derivados , Adulto , Estudos de Casos e Controles , Estudos de Coortes , Método Duplo-Cego , Feminino , Humanos , Incidência , Recém-Nascido , Saúde Materna , Gravidez , Nascimento Prematuro/sangue , Nascimento Prematuro/imunologia , Mapas de Interação de Proteínas/genética , Vitamina D/sangue , Vitamina D/imunologia , Vitaminas , Adulto Jovem
4.
J Matern Fetal Neonatal Med ; 33(1): 57-61, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29860925

RESUMO

Background: The Bilicare™ is a new device that measures transcutaneous bilirubin (TcB) level at the ear pinna. There are only few studies which have evaluated its accuracy in clinical practice.Objective: This study aims to determine the accuracy of Bilicare™ as a predischarge screening tool in late preterm and term neonates and to define the optimal cutoff point for determining the need to measure total serum bilirubin (TSB).Methods: The 35 weeks' gestation or more and healthy neonates who underwent predischarge TSB measurement were enrolled. Bilicare™ TcB was measured within 30 minutes of blood sampling. Paired TcB and TSB data were analyzed.Results: We collected 214 paired samples. Mean age (SD) at TcB measurement was 57.17 (7.47) hours. Mean TSB (SD) was 9.79 (2.83) mg/dL. TcB showed a significant correlation with TSB (r = 0.84, r2 = 0.7). The mean difference (SD) between TcB and TSB was 0.7 (0.21) mg/dL (95%CI 0.49-0.91). TcB tended to overestimate TSB level at the TSB values of <12 mg/dL but underestimate at the higher TSB level. The accuracy of using TcB values to detect neonates who required phototherapy was 92.5%. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 78.3, 94.2, 62.1, and 97.3%, respectively. If TcB +3 mg/dL was applied as a cutoff point, the sensitivity, specificity, PPV, and NPV were 100, 53.9, 20.7, and 100%, respectively.Conclusions: Bilicare™ TcB and TSB measurements were well correlated. The TcB level +3 mg/dL could detect all neonates who had significant hyperbilirubinemia requiring phototherapy during their birth hospitalization.


Assuntos
Bilirrubina/sangue , Hiperbilirrubinemia Neonatal/diagnóstico , Triagem Neonatal/instrumentação , Alta do Paciente , Pele/diagnóstico por imagem , Bilirrubina/análise , Estudos Transversais , Orelha , Feminino , Idade Gestacional , Humanos , Hiperbilirrubinemia Neonatal/sangue , Recém-Nascido , Doenças do Prematuro/sangue , Doenças do Prematuro/diagnóstico , Masculino , Triagem Neonatal/métodos , Triagem Neonatal/normas , Nascimento Prematuro/sangue , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Pele/metabolismo , Nascimento a Termo/sangue , Fatores de Tempo
5.
J Matern Fetal Neonatal Med ; 33(3): 359-367, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29909752

RESUMO

Objectives: To evaluate if midtrimester maternal serum contains microbial DNA and whether it differs between women with spontaneous preterm birth (SPTB) and those delivering at term.Study design: In this retrospective case-control study, we identified 20 healthy nulliparas with SPTB at 24-33 weeks of a nonanomalous singleton in 2014. Each case was matched by race/ethnicity to a control delivering at 39-40 weeks. Serum samples, collected at 15-20 weeks and stored at -80 C, were thawed and DNA extracted. PCR with primers targeting the 16S rDNA V4 region were used to prepare an amplicon library, sequenced using Illumina MiSeq, and analyzed using quantitative insight into microbial ecology (QIIME). Taxonomy was assigned using Ribosomal Database program (RDP) Classifier (threshold 0.8) against a modified Greengenes database. Differences in number of observed species, microbial alpha-diversity and beta-diversity, and taxa level analyses were undertaken.Results: All 40 samples were included. Women with SPTB had more unique observed species (p = .046) and higher mean alpha-diversity by Shannon index (but not Chao1 or Simpson) (p = .024). Microbial composition was different between groups by Bray-Curtis clustering (p = .03) but not by weighted (p = .13) or unweighted Unifrac (p = .11). Numerous taxa in the Firmicutes, Proteobacteria, and Actinobacteria phyla differed between groups (p < .05).Conclusions: SPTB is associated with distinct microbial DNA changes detected in midtrimester maternal serum.


Assuntos
DNA Bacteriano/sangue , Microbiota , Nascimento Prematuro/microbiologia , Adulto , Feminino , Humanos , Gravidez , Segundo Trimestre da Gravidez , Nascimento Prematuro/sangue , Estudos Retrospectivos , Adulto Jovem
6.
Nutrients ; 11(12)2019 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-31847068

RESUMO

Maternal 25-hydroxyvitamin D (25-OHD) deficiency during pregnancy may increase the risk of preterm and small-for-gestational age (SGA) birth, but studies report conflicting results. We used a multicenter prospective cohort of 2813 pregnant women assessed for 25-OHD levels in the first trimester of pregnancy to investigate the association between maternal 25-OHD concentrations and risks of preterm birth (<37 weeks) and SGA (birthweight <10th percentile). Odds ratios were adjusted (aOR) for potential cofounders overall and among women with light and dark skin separately, based on the Fitzpatrick scale. 25-OHD concentrations were <20 ng/mL for 45.1% of the cohort. A total of 6.7% of women had a preterm birth. The aOR for preterm birth associated with the 1st quartile of 25-OHD concentrations compared to the 4th quartile was 1.53 (95% confidence interval (CI): 0.97-2.43). In stratified analyses, an association was observed for women with darker skin (aOR = 2.89 (95% CI: 1.02-8.18)), and no association with lighter skin. A total of 11.9% of births were SGA and there was no association overall or by skin color. Our results do not provide support for an association between maternal first trimester 25-OHD deficiency and risk of preterm or SGA birth overall; the association with preterm birth risk among women with darker skin requires further investigation.


Assuntos
Recém-Nascido Pequeno para a Idade Gestacional/sangue , Primeiro Trimestre da Gravidez/sangue , Nascimento Prematuro , Vitamina D/sangue , Adolescente , Adulto , Feminino , Humanos , Gravidez , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/sangue , Nascimento Prematuro/epidemiologia , Estudos Prospectivos , Pigmentação da Pele/fisiologia , Deficiência de Vitamina D/epidemiologia , Adulto Jovem
7.
Medicina (Kaunas) ; 55(11)2019 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-31671553

RESUMO

Background and objectives: Premature newborns have a number of oxidative stress-inducing disorders. Antioxidant defense is deficient in premature newborns. Hydrogen donors can be used to evaluate the non-enzymatic antioxidant defense. By measuring hydrogen donors, a group of antioxidants can be assessed: tocopherol, ascorbic acid, and glutathione. These represent the most relevant group of non-enzymatic antioxidants. The main aim of this study was to evaluate the non-enzymatic antioxidant defense capacity of premature newborns by measuring hydrogen donors. Materials and Methods: We evaluated the non-enzymatic antioxidant capacity by hydrogen donor measurement in 24 premature newborns with various oxidative stress-inducing disorders and in 14 premature newborns without oxidative stress-inducing conditions. Statistical analysis was performed using the Statistica program (v. 8, StatSoft, Round Rock, TX, USA). Differences between groups were tested with Wilcoxon matched test for quantitative paired data or Mann-Whitney test for quantitative independent data. The Z test for proportions was used to compare qualitative data among subgroups. Results: Hydrogen donors in the study group had a significantly lower value on the first day of life compared to the value of the control group. Also, the hydrogen donor value in the study group was significantly lower on the first day compared to the third day of life (p < 0.05). Neonates with mild respiratory distress (14 cases) had increased hydrogen donor values on their third day of life compared to the first day of life. Conclusions: The antioxidant capacity is influenced by oxidative stress-inducing disorders. Respiratory distress influenced the hydrogen donor value and antioxidant defense. Antioxidant defense gradually improves after birth according to gestational age.


Assuntos
Antioxidantes/fisiologia , Hidrogênio/análise , Estresse Oxidativo/fisiologia , Nascimento Prematuro/fisiopatologia , Antioxidantes/análise , Feminino , Idade Gestacional , Humanos , Hidrogênio/sangue , Recém-Nascido , Masculino , Nascimento Prematuro/sangue , Nascimento Prematuro/classificação , Estudos Prospectivos
8.
Lupus ; 28(14): 1640-1647, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31684818

RESUMO

BACKGROUND: Women with lupus have an increased risk of preeclampsia and preterm birth, and aspirin 81 mg/day is recommended as a preventative measure for preeclampsia. This pilot study quantified the association between a 60-gene aspirin response signature (ARS) gene expression with preterm birth and preeclampsia risk among women with lupus taking aspirin. METHODS: The analysis included 48 RNA samples from 23 pregnancies in the Duke Autoimmunity Pregnancy Registry. RNA was isolated from peripheral blood, and quantitative polymerase chain reaction was performed for ARS genes. The primary outcome was poor pregnancy outcome (preeclampsia or preterm birth). Gene expression was modeled as a response to presence or absence of a poor pregnancy outcome using linear regression models, stratified by trimester. RESULTS: Of the 23 pregnancies, nine delivered preterm and four had preeclampsia. Expression of PBX1 and MMD was higher in the second trimester among patients who experienced a poor pregnancy outcome compared to those who did not. However, in a global test of all ARS genes, we identified no association between expression of ARS genes and poor pregnancy outcomes. CONCLUSION: Our pilot study identified two candidate genes that are reflective of the platelet function response to aspirin. Further work is needed to determine the role of these genes in identifying women with lupus at high risk for preeclampsia and preterm delivery despite aspirin therapy.


Assuntos
Aspirina/administração & dosagem , Lúpus Eritematoso Sistêmico/complicações , Inibidores da Agregação de Plaquetas/administração & dosagem , Pré-Eclâmpsia/genética , Nascimento Prematuro/genética , Adulto , Feminino , Expressão Gênica , Humanos , Peptídeos e Proteínas de Sinalização Intracelular/genética , Proteínas de Membrana/genética , Projetos Piloto , Fator de Transcrição 1 de Leucemia de Células Pré-B/genética , Pré-Eclâmpsia/sangue , Pré-Eclâmpsia/prevenção & controle , Gravidez , Complicações na Gravidez/prevenção & controle , Resultado da Gravidez , Nascimento Prematuro/sangue , Nascimento Prematuro/prevenção & controle , Estudos Prospectivos , Medição de Risco , Fatores de Risco
9.
Gynecol Obstet Fertil Senol ; 47(11): 790-796, 2019 11.
Artigo em Francês | MEDLINE | ID: mdl-31593819

RESUMO

OBJECTIVE: The aim of the study was to evaluate if fetal cell-free DNA (cfDNA) fraction circulating in maternal blood at the beginning of the second trimester is associated with obstetrical complications. METHODS: This is a retrospective unicentric study conducted at the hospital of Poissy Saint Germain between the 1st January 2015, and the 31st. December 2016, Each woman who had a genetic counseling in order to realize a non-invasive prenatal test (NIPT) was included. Only singleton pregnancies with a documented-issue were analysed. The primary criteria was a composite criteria, defined as the occurrence of preeclampsia, in utero fetal growth, or a spontaneous preterm delivery. A descriptive analyse was first conducted, secondly completed by a sub-group one: "high fetal fraction" (>90th percentile) group, "low fetal-fraction" group (<10th percentile) and "medium fetal-fraction" (control group) group. RESULTS: A total of 417 women had a cfDNA test, which was performed at a mean gestational age of 17.1 weeks of gestation. A total of 17% of pregnancies met the primary criteria. Among them, there were 8 (1.9%) pre-eclampsia, 49 (11.8%) intra-uterine growth restriction and 14 (3.4%) preterm births. There was no significant difference for the occurrence of the primary criteria (P>0.99) and of each obstetrical complication between each group. CONCLUSION: Fetal cf-DNA fraction measured at the beginning of the second trimester is not associated with common obstetrical complications.


Assuntos
Ácidos Nucleicos Livres/sangue , Retardo do Crescimento Fetal/diagnóstico , Pré-Eclâmpsia/diagnóstico , Nascimento Prematuro/diagnóstico , Medição de Risco , Adulto , Biomarcadores/sangue , Feminino , Retardo do Crescimento Fetal/sangue , Humanos , Pré-Eclâmpsia/sangue , Gravidez , Segundo Trimestre da Gravidez/sangue , Nascimento Prematuro/sangue , Estudos Retrospectivos , Adulto Jovem
10.
Med Sci Monit ; 25: 7755-7762, 2019 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-31617502

RESUMO

BACKGROUND The influence of maternal vitamin D on pregnancy outcomes, including preterm birth (PTB), is unclear due to different experimental designs and study populations (patient race and sample size) of previous studies. We aimed to investigate the relationship between 25-hydroxyvitamin D (25[OH] D) levels and PTB among pregnant women in southern China. MATERIAL AND METHODS A total of 11 641 pregnant women were retrospectively enrolled between January 2016 and April 2019. Vitamin D concentrations were evaluated by electrochemiluminescence immunoassay. Logistic regression analysis was used to analyze the association between vitamin D and PTB. RESULTS The average 25(OH) D concentration was 59.3±21.5 nmol/L; 34.8% of patients were vitamin D deficient, 43.0% were vitamin D insufficient (25[OH] D <50 nmol/L and 50-74.9 nmol/L, respectively). In total, 3.6% of newborns were born prematurely. Comparing the pre-term and full-term groups, 45.7% versus 42.9% and 29.8% versus 35% were vitamin D deficient and insufficient, respectively These differences were not significant (P>0.05). However, the mean vitamin D status was significantly different between the pre-term and full-term groups (61.3±21.3 and 59.1±21.5 nmol/L, respectively). No association was found between vitamin D deficiency/insufficiency and PTB in unadjusted or adjusted models, compared with vitamin D sufficiency (adjusted odds ratio, 1.016; 95% confidence interval, 0.794-1.301 and 0.842; 0.641-1.106, respectively). CONCLUSIONS Low maternal 25(OH) D levels are common in southern China. However, low vitamin D status in pregnant women appears to be unrelated to PTB. Measuring vitamin D level alone is therefore not sufficient to predict PTB.


Assuntos
Nascimento Prematuro/sangue , Vitamina D/sangue , Adulto , China , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Razão de Chances , Gravidez , Complicações na Gravidez/sangue , Resultado da Gravidez , Estudos Retrospectivos , Fatores de Risco , Vitamina D/análogos & derivados , Deficiência de Vitamina D/sangue , Vitaminas
11.
Artigo em Inglês | MEDLINE | ID: mdl-31618675

RESUMO

OBJECTIVE: To determine if plasma concentrations of the N-acylethanolamines (NAEs) N-arachidonoylethanolamine (AEA), N-oleoylethanolamide (OEA) and N-palmitoylethanolamide (PEA) increase in women at high risk for preterm birth (PTB) and whether these could be used to predict preterm delivery and if so, how they compare with current methods. DESIGN: Prospective cohort study. SETTING: A large UK teaching hospital. POPULATION: 217 pregnant women were recruited between 24 and 34 gestational weeks at 'high-risk' for PTB, recruited from a prematurity prevention clinic or antenatal wards. METHODS: Plasma AEA, OEA, and PEA concentrations were measured using ultra-high performance liquid chromatography-tandem mass spectrometry whilst FAAH enzyme activity was measured by fluorometric radiometric assay and CL by ultrasound scan. The clinical usefulness of these measurements were determined by ROC and multivariate analyses. RESULTS: AEA and PEA concentrations were significantly higher in women who delivered prematurely. An AEA concentration >1.095 nM predicted PTB, the gestational age at delivery and the recruitment to delivery interval (RTDI). A PEA concentration >17.50 nM only predicted PTB; FAAH enzyme activity was not related to these changes. Multivariate analysis (all variables) generated an equation to accurately predict the RTDI. CONCLUSIONS: A single plasma AEA or PEA measurement can predict PTB. A single AEA measurement predicts the gestational age of delivery and the remaining period of pregnancy with reasonable accuracy and better than existing conventional tests thus offering a better window for primary prevention of PTB.


Assuntos
Endocanabinoides/sangue , Etanolaminas/sangue , Idade Gestacional , Trabalho de Parto Prematuro/sangue , Ácidos Oleicos/sangue , Ácidos Palmíticos/sangue , Nascimento Prematuro/sangue , Amidoidrolases/sangue , Estudos de Coortes , Feminino , Humanos , Trabalho de Parto Prematuro/epidemiologia , Gravidez , Nascimento Prematuro/epidemiologia , Estudos Prospectivos , Medição de Risco , Reino Unido
12.
Metabolomics ; 15(9): 124, 2019 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-31506796

RESUMO

INTRODUCTION: Most known risk factors for preterm birth, a leading cause of infant morbidity and mortality, are not modifiable. Advanced molecular techniques are increasingly being applied to identify biomarkers and pathways important in disease development and progression. OBJECTIVES: We review the state of the literature and assess it from an epidemiologic perspective. METHODS: PubMed, Embase, CINAHL, and Cochrane Central were searched on January 31, 2019 for original articles published after 1998 that utilized an untargeted metabolomic approach to identify markers of preterm birth. Eligible manuscripts were peer-reviewed and included original data from untargeted metabolomics analyses of maternal tissue derived from human studies designed to determine mechanisms and predictors of preterm birth. RESULTS: Of 2823 results, 14 articles met the inclusion requirements. There was little consistency in study design, outcome definition, type of biospecimen, or the inclusion of covariates and confounding factors, and few consistent associations with metabolites were identified in this review. CONCLUSION: Studies to date on metabolomic predictors of preterm birth are highly heterogeneous in both methodology and resulting metabolite identification. There is an urgent need for larger studies in well-defined populations, to determine biomarkers predictive of preterm birth, and to reveal mechanisms and targets for development of intervention strategies.


Assuntos
Metaboloma , Nascimento Prematuro/metabolismo , Biomarcadores/sangue , Feminino , Humanos , Metabolômica/métodos , Gravidez , Nascimento Prematuro/sangue , Nascimento Prematuro/diagnóstico , Nascimento Prematuro/epidemiologia
13.
J Perinat Med ; 47(8): 804-810, 2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31494638

RESUMO

Objective To assess post-partum inflammation for patients delivering prior to 34 6/7 weeks by birth etiology. Methods This was an observational study of early preterm birth (PTB) occurring between 20 0/7 and 34 6/7 weeks of gestation. Serum C-reactive protein (CRP) levels were measured 1 month post-partum. CRP measurements were compared by birth etiology. Results A total of 399 women were analyzed. Distribution of birth etiology was 35% (n = 138) preterm labor (PTL), 28% (n = 115) preterm premature rupture of membranes (pPROM), and 37% (n = 141) indicated preterm birth (IPTB). Serum CRP varied by birth etiology (P = 0.036). Women with pPROM had elevated median CRP levels compared to women with PTL (P = 0.037). IPTB demonstrated elevated CRP levels when compared to PTL (P = 0.019). Pre-eclamptic/eclamptic subjects exhibited increased median CRP levels compared to PTL (P = 0.04). Conclusion Post-partum inflammation varies by birth etiology. Such variation may serve as identification of subjects whose future pregnancies and, ultimately, overall health status may benefit from inter-pregnancy interventions aimed at reducing inflammatory-associated risk factors.


Assuntos
Proteína C-Reativa/metabolismo , Ruptura Prematura de Membranas Fetais/sangue , Período Pós-Parto/sangue , Nascimento Prematuro/sangue , Adulto , Feminino , Humanos , Gravidez , Nascimento Prematuro/etiologia , Estudos Retrospectivos , Adulto Jovem
14.
Int J Obes (Lond) ; 43(10): 1967-1977, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31332276

RESUMO

BACKGROUND/OBJECTIVES: Acylcarnitines, intermediates of fatty acid oxidation, are known to be involved in obesity and insulin resistance. Since maternal prepregnancy overweight or obesity (OWO) is a recognized major risk factor for offspring OWO, we hypothesized that maternal plasma acylcarnitines may play a role in inter-generational OWO. SUBJECTS/METHODS: This study included 1402 mother-child pairs (1043 term, 359 preterm) recruited at birth from 1998-2013 and followed prospectively up to age 18 years at the Boston Medical Center. The primary outcomes were child OWO defined as BMI ≥ 85th percentile for age and sex. The primary exposures were maternal prepregnancy OWO defined as BMI ≥ 25 kg/m2 and maternal acylcarnitine levels measured in plasma samples collected soon after delivery using liquid chromatography-tandem mass spectrometry (LC-MS) in a targeted manner. RESULTS: Approximately 40% of the children in this study were OWO by age 5. Maternal OWO had a significant association with childhood OWO, both in term and preterm births. ß-hydroxybutyryl-carnitine (C4-OH) levels were significantly and positively associated with child OWO among term births after adjustment for potential confounders and multiple-comparisons. Children born to OWO mothers in the top tertile C4-OH levels were at the highest risk of OWO: OR = 3.78 (95%CI: 2.47, 5.79) as compared with those born to non-OWO mothers in the lowest tertile (P for interaction of maternal OWO and C4-OH = 0.035). In a four-way decomposition of mediation/interaction analysis, we estimated that C4-OH levels explained about 27% (se = 0.08) of inter-generational OWO risk (P = 0.001). In contrast, these associations were not observed in preterm births. CONCLUSIONS: In this U.S. urban low-income birth cohort, we provide further evidence of the inter-generational link of OWO and reveal the differential role of C4-OH in explaining the inter-generational obesity between term and preterm births. Further investigations are warranted to better understand and prevent the inter-generational transmission of OWO.


Assuntos
Carnitina/análogos & derivados , Mães , Obesidade/sangue , Nascimento Prematuro/sangue , Efeitos Tardios da Exposição Pré-Natal/sangue , Adolescente , Adulto , Biomarcadores/sangue , Índice de Massa Corporal , Boston/epidemiologia , Carnitina/sangue , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Mães/educação , Mães/estatística & dados numéricos , Obesidade/complicações , Obesidade/epidemiologia , Obesidade/fisiopatologia , Obesidade Pediátrica/sangue , Obesidade Pediátrica/epidemiologia , Obesidade Pediátrica/etiologia , Gravidez , Estudos Prospectivos
15.
Ann N Y Acad Sci ; 1450(1): 69-82, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31148191

RESUMO

Maternal anemia affects approximately 56 million women worldwide and increases the risk of adverse pregnancy outcomes. Our study aimed to summarize the evidence for the association between maternal hemoglobin (Hb) concentrations and maternal or infant outcomes, evaluating it in a continuous manner. In this systematic review and meta-analysis, we conducted an electronic search on PubMed, Embase, CINAHL, and Web of Science from inception to April 19, 2017, and further updated to November 21, 2018, applying subject heading terms related to pregnant women with anemia. We included 117 studies with 4,127,430 pregnancies. Maternal anemia increased the risk of low birth weight (odds ratio (OR), 1.65; 95% confidence interval (CI): 1.45-1.87), preterm birth (PTB) (OR, 2.11; 95% CI: 1.76-2.53), perinatal mortality (PNM) (OR, 3.01; 95% CI: 1.92-4.73), stillbirth (OR, 1.95; 95% CI: 1.15-3.31), and maternal mortality (OR, 3.20; 95% CI: 1.16-8.85). A nonlinear relationship was found between maternal Hb and adverse maternal and infant outcomes. The OR of outcomes such as PTB, small-for-gestational age, PNM, preeclampsia, gestational hypertension, and postpartum hemorrhage was increased by two to three times. Assessing Hb as a continuous variable is important to determine the associated risk of adverse outcomes with decreasing or increasing levels.


Assuntos
Anemia/sangue , Recém-Nascido de Baixo Peso/sangue , Complicações Hematológicas na Gravidez/sangue , Nascimento Prematuro/sangue , Feminino , Humanos , Mortalidade Materna , Gravidez , Resultado da Gravidez , Fatores de Risco , Natimorto
16.
Medicina (Kaunas) ; 55(6)2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31185683

RESUMO

BACKGROUND AND OBJECTIVES: The ACE gene encodes the angiotensin-converting enzyme (ACE), a component of the renin-angiotensin system. Increased ACE activity may cause abnormal regulation of placental circulation and angiogenesis, resulting in adverse pregnancy outcomes. Previous studies have reported that the insertion/deletion (I/D) polymorphism of the ACE gene is associated with the development of preterm birth (PTB). However, results of the association between ACE gene I/D and PTB are inconsistent in various populations. Therefore, we performed a case-control study and a meta-analysis to evaluate the association between ACE I/D polymorphism and PTB. Materials and Methods: We analyzed a total of 254 subjects (111 patients with PTB and 143 women at ≥38 weeks gestation) for the case-control study. For the meta-analysis, we searched Google Scholar, PubMed, and NCBI databases with the terms "ACE," "angiotensin-converting enzyme," "preterm birth," "preterm delivery," and their combinations. Results: Our results of the case-control study indicated that ACE I/D polymorphism is significantly associated with PTBs in the overdominant genetic model (odds ratio (OR) 0.57, 95% confidence interval (CI) 0.347-0.949, p = 0.029) and that the ID genotype of ACE I/D polymorphism has a protective effect for PTB (OR 0.57, 95% CI 0.333-0.986, p = 0.043). Similarly, the meta-analysis showed that the OR for the ACE gene ID genotype was 0.66 (95% CI 0.490-0.900, p < 0.01). Conclusion: The ACE gene ID genotype has a significant association with PTB and is a protective factor for PTB. A larger sample set and functional studies are required to further elucidate of our findings.


Assuntos
Peptidil Dipeptidase A/análise , Nascimento Prematuro/sangue , Adulto , Estudos de Casos e Controles , Feminino , Predisposição Genética para Doença/epidemiologia , Humanos , Recém-Nascido , Razão de Chances , Peptidil Dipeptidase A/sangue , Peptidil Dipeptidase A/genética , Polimorfismo Genético/fisiologia , Nascimento Prematuro/epidemiologia , República da Coreia/epidemiologia
17.
J Obstet Gynaecol ; 39(7): 903-906, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31064297

RESUMO

The purpose of this study was to analyse the relationship between preterm delivery and maternal anaemia. This retrospective cohort study was completed with 483 women; 294 of them had a normal delivery and 189 had a preterm delivery. The haemoglobin (Hb) values of all the women participating in the study were measured in the first and second trimesters, and the average Hb values were calculated. The pregnant women participating in the study were divided into three groups, according to their Hb level: those with Hb level <10 g/dl, those with Hb level between 10 and 11 g/dl and those with Hb level >11 g/dl. In crude analysis, women with low Hb levels had an increased rate of preterm delivery (odds ratio, 2.42; 95% CI, 1.07-5.49). Our study provides data that low Hb level is effective in preterm delivery. Impact statement What is already known on this subject? Serum Hb levels have inconsistent associations with a risk of preterm delivery. What the results of this study add? Compared with term delivery Hb levels are lower in preterm delivery. It is necessary to take into account the Hb levels of both the first and second trimester of the pregnancy when describing the pregnancy anaemia. What the implications are of these findings for clinical practice and/or further research? Given these results, physicians should take into account anaemia in pregnancy when considering the risk of a preterm delivery.


Assuntos
Anemia/complicações , Nascimento Prematuro/etiologia , Adulto , Anemia/sangue , Feminino , Hemoglobinas/metabolismo , Humanos , Gravidez , Nascimento Prematuro/sangue , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos , Turquia/epidemiologia , Adulto Jovem
18.
Eur J Obstet Gynecol Reprod Biol ; 238: 44-48, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31082743

RESUMO

OBJECTIVE: To test whether maternal hemoglobin during pregnancy associates with offspring perinatal outcomes in a developed country. Changes in maternal hemoglobin concentration during pregnancy are partly physiological phenomena reflecting alterations of maternal blood volume. Especially hemoglobin measures outside the physiological range may influence maternal health and fetal growth with long-lasting consequences. STUDY DESIGN: We studied an unselected sample drawn from two regional birth cohorts born 20 years apart: The Northern Finland Birth Cohorts 1966 and 1986. These are two mother-and-child population-based birth cohorts together comprising 21,710 mothers and their children. After exclusions, the sample size of the current study was 20,554. Concentrations of maternal hemoglobin at first and last antenatal visits were categorized as low (lowest 10%), medium (reference) or high (highest 10%). Multinomial logistic regression analyses for categories of maternal hemoglobin and perinatal outcomes such as preterm delivery and full-term small and large for gestational age were conducted with adjustments for maternal cofactors. RESULTS: Low maternal hemoglobin at early pregnancy associated with decreased risk of full-term small for gestational age (adjusted OR 0.73, 95% CI [0.58, 0.93], p = 0.010). At late pregnancy, low maternal hemoglobin associated with increased risk of preterm delivery (adjusted OR 1.60, 95% CI [1.26, 2.02], p < 0.0005) whereas high maternal hemoglobin associated with increased risk of full-term small for gestational age (adjusted OR 1.29, 95% CI [1.07, 1.56], p = 0.009). Maternal hemoglobin did not show constant association with risk of large for gestational age. CONCLUSION: The results from this study support evidence that both low and high maternal hemoglobin associate with adverse perinatal outcomes. Low maternal hemoglobin associated with preterm delivery and high with full-term small for gestational age. Association was mainly present when maternal hemoglobin was measured during the third trimester. These results indicate that it is important to monitor both extremes of maternal hemoglobin throughout the pregnancy.


Assuntos
Hemoglobinas/metabolismo , Recém-Nascido Pequeno para a Idade Gestacional , Nascimento Prematuro/sangue , Adulto , Estudos de Coortes , Feminino , Finlândia/epidemiologia , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Gravidez , Nascimento Prematuro/epidemiologia , Adulto Jovem
19.
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
20.
Indian Pediatr ; 56(3): 202-204, 2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30954991

RESUMO

OBJECTIVE: To assess the association of TLR4 (rs4986790 and rs4986791) and TNF-a (rs1800629) genes polymorphisms and TLR4mRNA levels with preterm birth. METHODS: Hospital-based case-control study on women of Caucasoid morphological subtype ethnicity in Northern India. Inclusion criteria for cases: women aged between 18-40 years with preterm birth (<37 weeks gestation), and for controls: women who delivered a term neonate consecutive to an enrolled case. Three polymorphisms TLR4 (Asp299 Gly, Thr399 Ill) and TNF-á (-308G/A) and TLR4 mRNA levels were compared between cases and controls. RESULTS: From 2012-2015, 559 cases and 559 controls were recruited. TLR4 mRNA levels were found to be higher (P<0.001) in cases [(0.7 (0.04)] than in controls [(0.5 (0.04)]. No association was found between TLR4 Asp299 Gly, TLR4 Thr399 Ill and TNF-a (-308G/A) with preterm birth. CONCLUSIONS: Increased TLR4 mRNA levels seem to be associated with preterm birth, and can be investigated further as a potential biomarker for identifying women at risk.


Assuntos
Nascimento Prematuro , RNA Mensageiro/sangue , Receptor 4 Toll-Like/sangue , Receptor 4 Toll-Like/genética , Fator de Necrose Tumoral alfa/genética , Estudos de Casos e Controles , Feminino , Humanos , Índia/epidemiologia , Recém-Nascido , Inflamação , Polimorfismo de Nucleotídeo Único , Gravidez , Nascimento Prematuro/sangue , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/genética , RNA Mensageiro/genética
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