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1.
West Afr J Med ; 36(3): 199-204, 2019.
Artigo em Inglês, Francês | MEDLINE | ID: mdl-31622480

RESUMO

BACKGROUND: HIV infection in pregnant women is a known cause of low birth weight (LBW) and small for gestational age (SGA). This study compared the birth weight for gestational age (GA) of HIV exposed and non-exposed babies in Nnamdi Azikiwe University Teaching Hospital, (NAUTH) Nnewi, Nigeria. SUBJECTS AND METHODS: A retrospective comparative appraisal of birth weights for GA of babies born to HIV- positive and negative women, over a 7-year period (January 2009-December 2015), was conducted. Data were abstracted from PMTCT database, ANC and Labor ward registers of NAUTH. RESULTS: A total of 3459 babies (1782 males, 1677 females) were enrolled, out of which 1829 were HIV- exposed and 1630 were not. GA spanned from 26-42 weeks (mean 38.7 ± 2.2 weeks) and birth weights (BW) from 400-5300g (mean 3072.5 ± 630g). The mean BW of exposed babies was significantly lower than the unexposed babies (p=0.048). LBW occurred in 12.0% of exposed and 13.5% of non-exposed babies (p<0.001). Using either percentile or Z-score cut-offs, HIV-exposed babies had twice the proportion of SGA compared to their non-exposed counterparts. Using Z-score, maternal antiretroviral use for >5 years was significantly associated with the lowest proportion of SGA compared to shorter duration of use. CONCLUSION: Maternal HIV infection is associated with SGA. However, maternal ARV use in excess of 5 years is associated with better BW outcome. Targeted enhancement of maternal nutrition and strict adherence to ARV therapy prior to and during pregnancy will improve birth outcome.


Assuntos
Peso ao Nascer , Retardo do Crescimento Fetal/etiologia , Infecções por HIV/complicações , Soronegatividade para HIV , Transmissão Vertical de Doença Infecciosa , Complicações Infecciosas na Gravidez/epidemiologia , Adulto , Feminino , Retardo do Crescimento Fetal/epidemiologia , Idade Gestacional , Infecções por HIV/epidemiologia , Soropositividade para HIV , Humanos , Recém-Nascido , Masculino , Mães , Nigéria/epidemiologia , Gravidez , Estudos Retrospectivos , Centros de Atenção Terciária
2.
Medicine (Baltimore) ; 98(26): e16069, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261515

RESUMO

The aim of this study was to check whether the sFlt-1/PIGF ratio, established as the biomarker for preeclampsia, reduces the false positive rate of late fetal growth restriction (FGR) detection by ultrasound biometry.This was a prospective case-control study, conducted at one regional maternity hospital in Romania. Study participants included singleton pregnancy women for whom the estimated fetal weight (EFW) at 28 to 35 weeks was < 10 percentiles and as controls, pregnant women with EFW >10 percentiles. All pregnancies were dated in the first trimester by crown-rump-length. We also recorded maternal characteristics, pregnancy and neonatal outcomes.The primary outcome measures were the relation between the sFlt-1/PIGF ratio and incidence of FGR. Secondary outcome was establishing a threshold for statistical significance of the marker and influence of other conditions (e.g., pre-eclampsia) on the accuracy of the marker in FGR prediction.Included in the study were 37 pregnant women and 37 controls.When we used ultrasound (US) biometry and maternal risk factors to estimate EFW <10 percentiles, the sensitivity was 44.4% with a specificity of 89% for an FPR (false positive result) of 10%. When we combined the US biometry and maternal risk factors with sFlt1/PIGF ratio, for a cut off of 38, the sensitivity was 84.21%, and the specificity was 84.31% for an FPR of 10%. The cut off value (36) did not change if we considered all cases of SGA, including those with associated preeclampsia or if we considered only FGR cases without associated preeclampsia.When associated with maternal factors and US biometry, the sFlt1/PIGF ratio enhanced the sensitivity for detecting late FGR.


Assuntos
Retardo do Crescimento Fetal/diagnóstico , Fator de Crescimento Placentário/sangue , Ultrassonografia Pré-Natal , Receptor 1 de Fatores de Crescimento do Endotélio Vascular/sangue , Adulto , Biomarcadores/sangue , Biometria , Estudos de Casos e Controles , Reações Falso-Positivas , Feminino , Retardo do Crescimento Fetal/epidemiologia , Humanos , Incidência , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Fatores de Risco , Sensibilidade e Especificidade , Adulto Jovem
3.
Int J Gynaecol Obstet ; 146(1): 110-117, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31055833

RESUMO

OBJECTIVE: To explore a conceptual framework of clinical conditions associated with preterm birth (PTB) by cluster analysis, assessing determinants for different PTB subtypes and related maternal and neonatal outcomes. METHODS: Secondary analysis of the Brazilian Multicentre Study on Preterm Birth of 33 740 births in 20 maternity hospitals between April 2011 and July 2012. In accordance with a prototype concept based on maternal, fetal, and placental conditions, an adapted k-means model and fuzzy algorithm were used to identify clusters using predefined conditions. The mains outcomes were phenotype clusters and maternal and neonatal outcomes. RESULTS: Among 4150 PTBs, three clusters of PTB phenotypes were identified: women who had PTB without any predefined conditions; women with mixed conditions; and women who had pre-eclampsia, eclampsia, HELLP syndrome and fetal growth restriction. The prevalence of different preterm subtypes differed significantly in the three clusters, varying from 80.95% of provider-initiated PTBs in cluster 3-6.62% in cluster 1 (P<0.001). Although some maternal characteristics differed among the clusters, maternal and neonatal outcomes did not. CONCLUSIONS: The analysis identified three clusters with distinct phenotypes. Women from the different clusters had different subtypes of PTB and maternal and pregnancy characteristics.


Assuntos
Resultado da Gravidez/epidemiologia , Nascimento Prematuro/etiologia , Adulto , Brasil/epidemiologia , Análise por Conglomerados , Feminino , Retardo do Crescimento Fetal/epidemiologia , Lógica Fuzzy , Humanos , Recém-Nascido , Fenótipo , Pré-Eclâmpsia/epidemiologia , Gravidez , Nascimento Prematuro/epidemiologia , Prevalência , Fatores de Risco
4.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(4): 471-474, 2019 Apr 10.
Artigo em Chinês | MEDLINE | ID: mdl-31006211

RESUMO

Objective: To investigate the dose-response relationship between hemoglobin concentration and preterm birth, during pregnancy. Methods: With Zhuang ethnicity, a total of 12 780 pregnant women and their infants that admitted to Wuming、Pingguo、Jingxi、Debao、Longan and Tiandong hospitals, were recruited, in Guangxi Zhuang Autonomous Region, from January 2015 to December 2017. Non-conditional logistic regression method was used to analyze the effect of anemia on preterm birth during pregnancy. Dose-response relationship between hemoglobin concentration and preterm birth was explored, using the restrictive cubic spline model. Results: After excluding 2 053 pregnant women with hypertension or aged 35 years and over, results from the non-conditional logistic regression analysis showed that the risk of preterm birth in the anemia group was 1.29 times (OR=1.29, 95%CI: 1.04-1.59, P=0.019) of the non-anemia group in the first trimester. Data from the restricted cubic sample showed that there appeared nonlinear "L" dose-response relationship between hemoglobin concentration and preterm birth in the first trimester and "U" shape in the third trimester (non-linearity test P<0.001). Conclusion: There appeared nonlinear dose-response relationship between the hemoglobin concentration and preterm birth, both in the first and third trimesters.


Assuntos
Anemia/complicações , Retardo do Crescimento Fetal/epidemiologia , Hemoglobinas/metabolismo , Trabalho de Parto Prematuro/epidemiologia , Nascimento Prematuro/epidemiologia , Adulto , China/epidemiologia , Feminino , Retardo do Crescimento Fetal/etiologia , Humanos , Recém-Nascido , Trabalho de Parto Prematuro/etiologia , Gravidez , Complicações Hematológicas na Gravidez , Resultado da Gravidez , Gestantes , Fatores de Risco
5.
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
6.
PLoS One ; 14(2): e0212116, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30735555

RESUMO

OBJECTIVE: To estimate the effect of inadequate maternal weight gain in the third trimester on the risk of intrauterine growth restriction (IUGR) in rural Bangladesh. METHODS: This study analyzed data from 1,463 mother-infant pairs in Matlab, Bangladesh which were available through the electronic databases of Matlab Health and Demographic Surveillance System and Matlab hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). All the mothers were admitted to Matlab hospital for childbirth from January 2012 to December 2014, and they had singleton live births at term. Third-trimester weight gain (kg) was calculated by subtracting the estimated weight at the end of the second trimester from the weight taken before childbirth. Inadequate third-trimester weight gain was defined as 4 kg or less irrespective of pre-gravid nutritional status. IUGR was defined as a birth weight below 2500 g in full-term newborns (LBW-Term), and a birth weight for gestational age and infant sex less than the 10th percentile (SGA-10th) and 2 standard deviations below the mean birth weight (SGA-2SD) based on the international newborn standards from the INTERGROWTH-21st project. Multivariable logistic regression models were fitted to determine the independent effect of inadequate weight gain in the third trimester on the risk of IUGR. RESULTS: A total of 824 (56.3%) women experienced inadequate weight gain in the third trimester of pregnancy. In this study, 215 (14.7%), 573 (39.2%) and 220 (15.0%) infants were born as LBW-Term, SGA-10th and SGA-2SD, respectively. In the multivariable logistic regression models, compared to adequate weight gain in the third-trimester, the odds ratios (OR) for LBW-Term, SGA-10th and SGA-2SD for inadequate weight gain were 1.8 (95% CI: 1.3, 2.5; p < 0.001), 1.4 (95% CI: 1.1, 1.8; p = 0.002) and 1.8 (95% CI: 1.3, 2.4; p = 0.001), respectively. CONCLUSIONS: Both inadequate third-trimester weight gain and IUGR are prevailing public health concerns in rural Bangladesh. Inadequate weight gain in the third trimester substantially increased the risk of IUGR. Public health programs focusing on the promotion of adequate weight gain in the third trimester of pregnancy with an ultimate aim to decrease IUGR should be implemented.


Assuntos
Retardo do Crescimento Fetal/epidemiologia , Ganho de Peso na Gestação , Terceiro Trimestre da Gravidez/fisiologia , População Rural/estatística & dados numéricos , Adolescente , Adulto , Bangladesh/epidemiologia , Feminino , Humanos , Gravidez , Risco , Adulto Jovem
7.
Early Hum Dev ; 130: 33-37, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30660016

RESUMO

INTRODUCTION: Children born from pregnancies that were complicated by hypertensive disorders of pregnancy (HDP, i.e. pre-eclampsia or HELLP syndrome) are at risk for elevated systolic and diastolic blood pressure (SBP/DBP) in childhood. AIM: To examine which neonatal, life style, and family characteristics are associated with SBP/DBP. METHODS: Study design: Prospective cohort. SUBJECTS: 12-years-old preterm and growth restricted children born to women with severe early-onset HDP. OUTCOME MEASURES: SBP/DBP standard deviation scores (SDS), corrected for age, gender and height. RESULTS: Ninety-two of the 174 mother-child pairs participated at age 12 years (mean gestational age 32 weeks, range 27 to 38 weeks, mean birth weight ratio (BWR) 0.68, range 0.33 to 0.99). Mean SBP SDS was 0.70 ±â€¯0.81 and mean DBP SDS was 0.14 ±â€¯0.78. SBP SDS was positively associated with very preterm birth (beta 0.53, p = .002), with child BMI SDS (beta 0.25, p = .035), and maternal BMI ≥ 25 kg/m2 at 12 years (beta 0.49, p = .003), and not with pre-pregnancy maternal BMI ≥ 25 kg/m2. DBP SDS was positively associated with maternal BMI ≥ 25 kg/m2 (beta 0.35, p 0.002). BWR was not associated with blood pressure. CONCLUSIONS: In 12-years old children born to women with HDP, higher systolic blood pressure values were associated with very preterm birth and child BMI. Higher blood pressure values were also associated with current maternal BMI ≥ 25 kg/m2. Life style adaptations may benefit long-term cardio vascular health in mother and child.


Assuntos
Pressão Sanguínea , Retardo do Crescimento Fetal/fisiopatologia , Hipertensão Induzida pela Gravidez/fisiopatologia , Recém-Nascido de Baixo Peso/crescimento & desenvolvimento , Recém-Nascido Prematuro/crescimento & desenvolvimento , Criança , Características da Família , Feminino , Retardo do Crescimento Fetal/epidemiologia , Retardo do Crescimento Fetal/etiologia , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Recém-Nascido , Estilo de Vida , Masculino , Gravidez
8.
Med Glas (Zenica) ; 16(1): 53-59, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30680983

RESUMO

Aim To investigate a potential of the clinical use of the soluble fms-like tyrosine kinase 1 (sFLT-1) to placental growth factor (PlGF) ratio from the perspective of a small hospital centre. Methods Maternal serum samples were analysed at 241/7-28 0/7, and 281/7-320/7 weeks of gestation. The level of sFLT-1 and PIGF was determined by immunoassay platform and used to calculate the sFLT-1/PIGF ratio in 35 pregnant women, and divided into subgroups according to preeclampsia occurrence at the time of delivery: preterm (≤37 weeks) or term (37-42 weeks'), and matched a control group. Results Patients in the preterm delivery group had a significantly higher incidence of intrauterine growth restriction, lower gestational age at the time of delivery, and lower infant birth weight compared to the other two groups. There was a negative correlation between the sFLT-1/PlGF ratio and GA and between the sFLT-1/ PlGF ratio and birth weight at the time of delivery. The value of the sFLT-1/PlGF ratio was significantly higher in the preterm delivery PE group. All the PE group pregnancies ended with caesarean delivery compared to 25% in the control group. However, none of the patients from the PE group had any of the possible complications of preeclampsia nor did they require additional therapy such as blood transfusion or additional non-standard hypertensive therapy. Conclusion The sFLT-1/PlGF ratio could be used as an indicator for the development and estimation of the severity of PE to provide objective evidence for the management of preeclampsia patients, and as a predictive marker of preeclampsia at low cost.


Assuntos
Fator de Crescimento Placentário/sangue , Pré-Eclâmpsia/sangue , Índice de Gravidade de Doença , Receptor 1 de Fatores de Crescimento do Endotélio Vascular/sangue , Adulto , Biomarcadores/sangue , Feminino , Retardo do Crescimento Fetal/sangue , Retardo do Crescimento Fetal/epidemiologia , Retardo do Crescimento Fetal/etiologia , Idade Gestacional , Humanos , Incidência , Recém-Nascido de Baixo Peso , Recém-Nascido , Gravidez , Nascimento Prematuro/sangue , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Adulto Jovem
9.
Eur J Obstet Gynecol Reprod Biol ; 234: 63-70, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30660941

RESUMO

OBJECTIVE: The objective of this study is to explore developmental outcomes at five years after early-onset fetal growth restriction (FGR). STUDY DESIGN: Retrospective data analysis of prospective follow-up of patients of three Dutch centres, who participated in a twenty centre European randomized controlled trial on timing of delivery in early-onset FGR. Developmental outcome of very preterm infants born after extreme FGR is assessed at (corrected) age of five. RESULTS: Seventy-four very preterm FGR children underwent follow-up at the age of five. Mean gestational age at birth was 30 weeks and birth weight was 910 g, 7% had a Bayley score <85 at two years. Median five years' FSIQ was 97, 16% had a FSIQ < 85, and 35% had one or more IQ scores <85. Motor score ≤ 7 on movement ABC-II (M-ABC-II-NL) was seen in 38%. Absent or reversed end-diastolic flow, gestational age at delivery, birthweight and neonatal morbidity were related to an FSIQ < 85. Any abnormal IQ scale score was related to birthweight, male sex and severity of FGR, and abnormal motor score to male sex and bronchopulmonary dysplasia (BPD). CONCLUSIONS: Overall, median cognitive outcome at five years was within normal range, but 35% of the children had any abnormal IQ score at age five, depending on the IQ measure, and motor impairment was seen in 38% of the children. GA at delivery, birthweight, EDF prior to delivery and neonatal morbidity were the most important risk factors for cognitive outcomes.


Assuntos
Retardo do Crescimento Fetal/epidemiologia , Transtornos do Neurodesenvolvimento/epidemiologia , Adulto , Pré-Escolar , Feminino , Seguimentos , Idade Gestacional , Humanos , Recém-Nascido de muito Baixo Peso , Testes de Inteligência , Masculino , Países Baixos , Transtornos do Neurodesenvolvimento/etiologia , Gravidez , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
10.
Early Hum Dev ; 129: 33-37, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30639463

RESUMO

BACKGROUND: Uterine fibroids are a common morbidity in women and its prevalence is increasing with age. As maternal age rises, fibroids become more prevalent during pregnancy. AIM: To assess perinatal outcome and long-term health of children to mothers with uterine fibroids during pregnancy. STUDY DESIGN: A population-based cohort analysis assessing long-term hospitalizations of offspring, up to the age of 18 years, due to gastrointestinal, neurological, cardiovascular, endocrine, and respiratory morbidity, following pregnancies diagnosed with and without a fibroid uterus. Multivariable generalized estimating equation (GEE) analysis adjusted for maternal clusters and other possible confounders was performed. Kaplan-Meier survival curves and Cox survival regression models were used to compare cumulative morbidity incidence and control for confounders. SUBJECTS: All singleton deliveries occurring between 1991 and 2014. OUTCOME MEASURES: Perinatal outcome and long-term pediatric morbidity. RESULTS: A total of 242,445 singleton deliveries were included; 0.5% of which were diagnosed with uterine fibroids (n = 1237). In the GEE multivariable analyses, advanced maternal age, hypertensive disorder and diabetes mellitus, fetal growth restriction, low birthweight (<2500 g), and small for gestational age newborns, were all independently associated with uterine fibroids during pregnancy. Hospitalizations up to the age of 18 years in the different health categories were comparable between the groups, using Cox regression models, controlled for clinically significant confounders in the long-term outcomes. CONCLUSION: Maternal uterine fibroids appear to negatively impact perinatal outcome, mainly fetal growth. However, no independent major impact on future health of the offspring can be detected.


Assuntos
Deficiências do Desenvolvimento/epidemiologia , Retardo do Crescimento Fetal/epidemiologia , Leiomioma/epidemiologia , Complicações na Gravidez/epidemiologia , Adulto , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez
11.
PLoS One ; 14(1): e0211683, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30699205

RESUMO

BACKGROUND: Twins with discordant growth have increased risks of perinatal mortality and morbidity. Previous studies have identified a number of risk factors for inter-twin birth weight discordance, yet no study has examined the effect of maternal hepatitis C infection. METHODS: We used the twin birth records extracted from the 2011 to 2015 United States birth records created by the Centers for Disease Control and Prevention. The outcome variable of this study was inter-twin birth weight discordance, defined as [(birth weight of larger twin-birth weight of smaller twin) / birth weight of larger twin]. The independent association of hepatitis C infection with birth weight discordance was examined using the gamma regression or log binomial regression, adjusted by potential confounders. RESULTS: Of the 270,256 twin pairs included in the final analysis, 850 (0.31%) had positive hepatitis C. Compared to mothers without hepatitis C, mothers with hepatitis C positive tended to have higher risk of birth weight discordance, but with no statistical significance. After adjustment for potential confounding factors, hepatitis C positive became a significant risk factor for birth weight discordance >25% (relative risk 1.14, 95% confidence interval 1.02-1.29). Sensitivity analyses (by treating birth weight discordance as a continuous outcome or dichotomizing into by different cutoffs) yielded similar results, with relative risks ranging from 1.07 to 1.12 (all P<0.05). CONCLUSION: Maternal hepatitis C positive is associated with inter-twin birth weight discordance, an important adverse infant outcome in twin pregnancies, although the effect size is small.


Assuntos
Peso ao Nascer , Retardo do Crescimento Fetal/epidemiologia , Hepacivirus/isolamento & purificação , Hepatite C/complicações , Gêmeos/estatística & dados numéricos , Adulto , Feminino , Retardo do Crescimento Fetal/etiologia , Idade Gestacional , Humanos , Incidência , Recém-Nascido , Registros Médicos , Gravidez , Resultado da Gravidez , Gravidez de Gêmeos , Fatores de Risco , Fatores de Tempo , Estados Unidos/epidemiologia
12.
J Matern Fetal Neonatal Med ; 32(2): 279-285, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28889772

RESUMO

OBJECTIVE: Using unbiased population data, to examine whether having a positive Pap smear, and thus a high probability of Human Papilloma Virus (HPV) infection, is a significant risk factor for intrauterine growth restriction (IUGR) in a subsequent pregnancy. STUDY DESIGN AND METHODS: Two independent population-based databases, namely the South Australian Perinatal Statistics Collection and the South Australian Cervical Screening Database, were deidentified and linked by the SANT Datalinkage Service. Analyses were performed on cases where Pap smear screening data was available for up to 2 years prior to a singleton live birth. Population characteristics and pregnancy related data were compared statistically by normal birth weight versus IUGR (10th percentile - known as small for gestational age (SGA), small for gestational age) and (3rd percentile birth weight - known as VLBW, very low birth weight). The association between cervical screening results and IUGR was assessed using generalized linear log binomial regression models. RESULTS: A total of 31,827 women met the criteria. Of these, 1311 women (4.1%) had a positive Pap smear within 2 years of the current pregnancy. Those having a positive Pap smear were more likely to have a baby with IUGR than those with negative smear results. For SGA, 5.8% babies were from mothers with positive Pap smears compared to 4.0% with negative smears indicating a 40% higher risk of having an SGA baby (95%CI 20-70%) among women with positive Pap smears. For VLBW, 7.6% mothers had positive Pap smears compared with 4.0% with negative smears (p < .001), which reflects a 90% increased risk (95%CI 40-150%). These associations reduced to 20% (95%CI 1-40%) and 50% (95%CI 10-100%) for SGA and VLBW, respectively, after adjusting for all other significant covariates including maternal age, ethnicity, marital status, occupation, smoking, pregnancy history, and maternal health during pregnancy. CONCLUSIONS: Mothers with a positive Pap smear have an increased risk of IUGR, especially for VLBW, which is independent of other risk factors. The results confirm previous findings in a small study and emphasise the need to consider the risks of both cancer and IUGR in all HPV vaccination programs.


Assuntos
Retardo do Crescimento Fetal/epidemiologia , Infecções por Papillomavirus/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Adulto , Feminino , Retardo do Crescimento Fetal/virologia , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Masculino , Registro Médico Coordenado , Gravidez , Fatores de Risco
13.
Eur J Obstet Gynecol Reprod Biol ; 233: 12-18, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30544027

RESUMO

OBJECTIVE: To estimate the prevalence and indications of terminations of pregnancy (TOP) between 22+0 and 31+6 weeks of gestational age in France and to examine the characteristics of women by indication of TOP. STUDY DESIGN: From the EPIPAGE 2 population-based cohort study of preterm births in France in 2011, we selected 5009 singleton live births, stillbirths and TOP that occurred between 22 and 31 weeks. We estimated the proportion of TOP by gestational age. We then classified terminations by indications into 4 categories: fetal anomalies (TOPFA), preterm premature rupture of the membranes (PPROM), maternal conditions and fetal growth restriction (FGR). We also classified TOPFA by type of anomaly. Maternal characteristics were compared between TOPFA and TOP for maternal or fetal conditions without congenital anomaly. RESULTS: 23.1% of all births and 54.3% of stillbirths were terminations. The proportion of terminations was 36.9% of all births at 22 weeks, 50.2% at 24 weeks and <10% at 30-31 weeks. 85.8% of terminations were for fetal anomaly, 4.4% for PPROM, 6.1% for maternal complications and 3.7% for severe FGR. Compared to women with a TOPFA, those with a termination for maternal or fetal conditions were more often nulliparous, single, African, obese, smokers and covered by non-standard insurance for women in socially deprived circumstances. CONCLUSION: In France, there is a high proportion of TOP of which 14% are for indications other than congenital anomalies. Because rates of terminations have an impact on very preterm birth and perinatal mortality rates, studies on pregnancy outcome should report all terminations, not only those for congenital anomalies.


Assuntos
Aborto Induzido/estatística & dados numéricos , Nascimento Vivo/epidemiologia , Mortalidade Perinatal , Natimorto/epidemiologia , Adulto , Feminino , Retardo do Crescimento Fetal/epidemiologia , Ruptura Prematura de Membranas Fetais/epidemiologia , França/epidemiologia , Idade Gestacional , Humanos , Recém-Nascido , Gravidez , Complicações na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Estudos Prospectivos , Adulto Jovem
14.
Midwifery ; 70: 71-75, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30584971

RESUMO

OBJECTIVE: Pregnancies complicated with intrauterine growth restriction (IUGR) may require hospitalization in a high-risk pregnancy unit (HRPU). A complicated pregnancy and hospital admission may negatively affect the pregnant woman's mental health. Several factors have been identified as possible risk factors for depression, which is proven to lead to several adverse perinatal outcomes. The purpose of this study was to screen for depression in women admitted to an HRPU due to IUGR pregnancy and also to identify associated risk factors. STUDY DESIGN: All pregnant women admitted at ≥ 24 gestational weeks with the diagnosis of IUGR were eligible for the study. The Greek version of the Edinburgh Postnatal Depression Scale was used as screening tool on admission. A cut-off score ≥ 13 was used to identify depression, while possible risk factors were also investigated. RESULTS: Overall, 73 women were eligible for the study and agreed to complete the questionnaire. The mean age of the pregnant women was 31.4 ±â€¯6.7 years and the mean gestational week at admission was 33.6 ±â€¯2.9 weeks. The prevalence of depressive symptoms (score ≥ 13) was 32.9% (24/73). In the multivariable model, depressive symptoms were significantly correlated with lower gestational age (OR: 3.459 95%CI: 1.124-10.648) and smoking during pregnancy (OR: 3.926 95% CI: 1.141-13.507). CONCLUSIONS: About one third of pregnant women hospitalized in the HRPU with IUGR pregnancies showed signs of depression at the time of admission. Early-IUGR and smoking were found to be associated with antenatal depressive symptoms.


Assuntos
Depressão Pós-Parto/etiologia , Retardo do Crescimento Fetal/psicologia , Adulto , Distribuição de Qui-Quadrado , Estudos Transversais , Depressão Pós-Parto/epidemiologia , Depressão Pós-Parto/psicologia , Feminino , Retardo do Crescimento Fetal/epidemiologia , Grécia/epidemiologia , Hospitalização , Humanos , Gravidez , Complicações na Gravidez/psicologia , Prevalência , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Psicometria/instrumentação , Psicometria/métodos , Fatores de Risco
15.
Environ Pollut ; 244: 915-925, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30469286

RESUMO

BACKGROUND: Little is known about the impacts of maternal exposure to acute episodes of outdoor air pollution, such as that resulting from wildfires, on obstetric and neonatal outcomes. This systematic review aims to synthesise the existing literature exploring the relationship between maternal exposure to short-to medium-term changes in outdoor air quality and obstetric and neonatal outcomes. METHODS: A systematic search of peer-reviewed articles using PubMed, Cochrane Library, EMBASE, ScienceDirect, Web of Science, ProQuest, GreenFILE and Scopus was conducted in January 2018 using selected search terms. Quality of included studies were assessed using the Newcastle Ottawa Scale. RESULTS: Eleven studies were included; eight assessed the impact of maternal exposure to air pollution exacerbation events, such as wildfires, oil well fires and volcanic eruptions, and three assessed the impact of improvement events, such as the 2018 Beijing Olympics and closure of industrial activities, on obstetric and neonatal outcomes. Studies were highly heterogenous in methodology. Six studies found a significant association between acute changes in air quality and markers of fetal growth restriction, while two did not. Three studies found an adverse association between acute changes in air quality and markers of gestational maturity, and one did not. CONCLUSION: Overall, there is some evidence that maternal exposure to acute changes in air quality of short-to medium-term duration increases the risk of fetal growth restriction and preterm birth. The relationship for other adverse obstetric or neonatal outcomes is less clear.


Assuntos
Poluição do Ar/efeitos adversos , Retardo do Crescimento Fetal/epidemiologia , Exposição Materna/efeitos adversos , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Poluição do Ar/análise , Pequim , Feminino , Fogo , Humanos , Indústrias , Recém-Nascido , Gravidez , Erupções Vulcânicas
16.
BMC Pregnancy Childbirth ; 18(1): 495, 2018 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-30547777

RESUMO

BACKGROUND: Growing evidence indicates that the risk of obstetric and perinatal outcomes is higher in women with assisted reproductive technology (ART). However, there is little known about pregnancy related complications and co-morbidity in gestational diabetes mellitus (GDM) following singleton pregnancies achieved by ART in comparison with spontaneous conception (SC). METHODS: Two hundred sixty singleton pregnant women conceived by ART and 314 pregnant women conceived by spontaneous conception (SC) were participated in this prospective cohort study. All participants were enrolled after GDM screening through one-step oral glucose tolerance test (OGTT) and then grouped into GDM and non-GDM groups. Women were followed for pregnancy outcomes including pregnancy-induced hypertension (PIH), preeclampsia, antepartum hemorrhage (APH), cesarean section (CS), preterm birth (PTB), intrauterine growth restriction (IUGR), being small or large for gestational age (SGA or LGA), macrosomia, low birth weight (LBW), respiratory distress, neonatal hypoglycemia, NICU admission and perinatal mortality from antenatal visits to delivery. Confounding factors were adjusted in logistic regression model in order to estimate adjusted odds ratios (aORs). RESULTS: Among 260 ART and 314 SC, 135 and 152 women were GDM women, respectively. Higher maternal age and pre-gravid BMI, shorter duration of gestation and lower gestational weight gain were observed in GDM groups (ART-GDM and SC-GDM) compared to those of the SC group. ART-GDM group had a higher risk (95% confidence interval) of obstetric complications including PIH [aOR:7.04 (2.24-22.15)], preeclampsia [aOR:7.78 (1.62-37.47)], APH [aOR:3.46 (1.28-9.33)], emergency CS [aOR:2.64 (1.43-4.88)], and perinatal outcomes such as PTB [aOR:3.89 (1.51-10.10)], LBW [aOR:3.11 (1.04-9.30)] and NICU admission [aOR:4.36 (1.82-10.45)], as well as neonatal hypoglycemia [aOR: 4.91 (1.50-16.07)], compared to SC group. SC-GDM group showed a higher risk of PIH [aOR: 4.12 (1.31-12.89)], emergency CS [aOR: 2.01 (1.09-3.73] and LGA [aOR: 5.20 (1.07-25.20)], compared to SC group. Additionally, ART group had a higher risk of PIH [aOR: 3.46(1.02-11.68), preeclampsia 5.29 (1.03-27.09), and NICU admission [aOR: 2.53 (1.05-6.09)] compared to SC. Insulin requirement (41.8% vs. 25.7%) was significantly higher in ART-GDM group compared to SC-GDM group. CONCLUSION: The findings of this study suggest that GDM occurring after ART conception increases the risk of adverse obstetric and perinatal outcomes.


Assuntos
Diabetes Gestacional , Hipertensão Induzida pela Gravidez , Complicações do Trabalho de Parto , Pré-Eclâmpsia/epidemiologia , Complicações na Gravidez , Técnicas de Reprodução Assistida/estatística & dados numéricos , Adulto , Estudos de Coortes , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Feminino , Retardo do Crescimento Fetal/epidemiologia , Retardo do Crescimento Fetal/etiologia , Humanos , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/epidemiologia , Recém-Nascido , Irã (Geográfico)/epidemiologia , Idade Materna , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/etiologia , Mortalidade Perinatal , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Estudos Prospectivos , Fatores de Risco
17.
Medicine (Baltimore) ; 97(31): e11739, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30075587

RESUMO

The utero-placental ischemia induced by pregnancy-induced hypertension (PIH) could lead to fetal hypoxia and proinflammatory cytokine release, which are associated with the development of neonatal necrotizing enterocolitis (NEC). However, a few studies have investigated the relationship between PIH and neonatal NEC and have produced controversial results. Therefore, we attempted to assess the relationship between PIH and the subsequent neonatal NEC risk and identify predictive risk factors.Patients with newly diagnosed PIH were recruited from the Taiwan National Health Insurance Research Database (NHIRD). For each participant, 4 age- and delivery-year-matched participants without PIH were randomly selected. A multivariable logistic regression was performed for the identification of the predictive risk factors for neonatal NEC.Among the 23.3 million individuals registered in the NHIRD, 29,013 patients with PIH and 116,052 matched controls were identified. For the multivariable analysis, maternal PIH was associated with an increased risk of subsequent neonatal NEC development (odds ratio [OR] 1.86, 95% confidence interval [CI] 1.08-3.21, P = .026). Furthermore, single parity (OR 2.06, 95% CI 1.12-3.77, P = .019), preterm birth (OR 5.97, 95% CI 3.49-10.20, P < .001), multiple gestations (OR 2.25, 95% CI 1.22-4.14, P = .010), and intrauterine growth restriction (IUGR) (OR 3.59, 95% CI 2.06-6.24, P < .001) were independent risk factors for the development of subsequent neonatal NEC.Maternal PIH increases the risk for developing neonatal NEC. Furthermore, primiparity, preterm birth, multiple gestations, and IUGR were independent risk factors for neonatal NEC.


Assuntos
Enterocolite Necrosante/epidemiologia , Hipertensão Induzida pela Gravidez/epidemiologia , Doenças do Recém-Nascido/epidemiologia , Adulto , Comorbidade , Feminino , Retardo do Crescimento Fetal/epidemiologia , Humanos , Recém-Nascido , Modelos Logísticos , Pessoa de Meia-Idade , Razão de Chances , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fatores Socioeconômicos , Taiwan , Adulto Jovem
18.
J Obstet Gynaecol Res ; 44(5): 861-872, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29392826

RESUMO

AIM: To localize, quantify and compare angiogenic factors, vascular endothelial growth factor (VEGF), placental growth factor (PlGF), as well as their receptors fms-like tyrosine kinase receptor (Flt-1) and kinase insert domain receptor (KDR) in the placentas of normal pregnancy and complications of preeclampsia (PE), intrauterine fetal growth restriction (IUGR) and PE + IUGR. METHODS: In a prospective cross-sectional case-control study, 30 pregnant women between 24-40 weeks of gestation, were recruited into four clinical groups. Representative placental samples were stained for VEGF, PlGF, Flt-1 and KDR. Analysis was performed using semiquantitative methods and digital image analysis. RESULTS: The overall VEGF and Flt-1 were strongly expressed and did not show any conclusive difference in the expression between study groups. PlGF and KDR were significantly reduced in expression in the placentas from pregnancies complicated by IUGR compared with normal and preeclamptic pregnancies. CONCLUSION: The lack of PlGF and KDR may be a cause for the development of IUGR and may explain the loss of vasculature and villous architecture in IUGR. Automated digital image analysis software is a viable alternative method to the manual reading of placental immunohistochemical staining.


Assuntos
Retardo do Crescimento Fetal/metabolismo , Fator de Crescimento Placentário/metabolismo , Placenta/diagnóstico por imagem , Placenta/metabolismo , Pré-Eclâmpsia/metabolismo , Fator A de Crescimento do Endotélio Vascular/metabolismo , Receptor 1 de Fatores de Crescimento do Endotélio Vascular/metabolismo , Receptor 2 de Fatores de Crescimento do Endotélio Vascular/metabolismo , Adulto , Estudos de Casos e Controles , Comorbidade , Estudos Transversais , Feminino , Retardo do Crescimento Fetal/epidemiologia , Humanos , Imuno-Histoquímica , Pré-Eclâmpsia/epidemiologia , Gravidez , Estudos Prospectivos , Adulto Jovem
19.
BMC Public Health ; 18(1): 132, 2018 01 12.
Artigo em Inglês | MEDLINE | ID: mdl-29329571

RESUMO

BACKGROUND: The developing fetus is susceptible to environmental insults. Studying the effects of environmental exposures on fetal growth is essential for understanding the causal pathway between prenatal exposures and pregnancy outcomes. Here we describe the Haifa Pregnancy Cohort Study (HPCS) and discuss challenges and opportunities in applying "big data" paradigm. METHODS: Maccabi Healthcare Services (MHS), is the second largest Israeli health maintenance organization (HMO) providing care services to two million beneficiaries. The HPCS cohort potentially includes ~750,000 newborns born between 1998 and 2017. We will estimate daily exposures to air pollutants, temperature and greenness, using satellite-based data and models. We hypothesize that residents of Haifa have higher exposures to environmental pollutants and that in pregnant women this higher exposure is associated with poorer fetal growth. We will evaluate outcomes such as birth-weight, head-circumference and gestational age at birth. We will adjust for pregnancy complications such as pre-eclampsia and gestational diabetes and parental variables, such as maternal weight, age and smoking habits as potential confounders. In addition, we will conduct a multi-tiered field study, nested within this population, among 150 pregnant women residing in two geographical regions-one in the polluted Haifa area, and one in a relatively unpolluted area in central Israel. Blood and urinary samples will be collected, as well as personal and indoor exposure to air pollution. DISCUSSION: Evaluating environmental exposures of pregnant women and assessing in utero growth over the course of the pregnancy during different exposure windows, is of great scientific and public health interest. Recent advances in data collection and analysis pose great promise to provide insights into contribution of environment to the health of the developing fetus, but also pose major challenges and pitfalls, such as data management, proper statistical framework and integration of data in the population-based study and selectiveness in the nested field study. Yet the continuing follow-up of the study cohort, integrating data from different services, health-promotion, and eventually, application later in real life of our main promises. Our study aims to meet these challenges and to provide evidence of the environmental exposures associated with fetal growth.


Assuntos
Poluição do Ar em Ambientes Fechados/efeitos adversos , Poluição do Ar/efeitos adversos , Exposição Ambiental/efeitos adversos , Retardo do Crescimento Fetal/epidemiologia , Exposição Materna/efeitos adversos , Adolescente , Adulto , Poluição do Ar/análise , Poluição do Ar em Ambientes Fechados/análise , Estudos de Coortes , Exposição Ambiental/análise , Feminino , Humanos , Recém-Nascido , Israel/epidemiologia , Gravidez , Resultado da Gravidez , Adulto Jovem
20.
Placenta ; 61: 72-79, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29277274

RESUMO

INTRODUCTION: The increased maternal estradiol (E2) concentrations induced by assisted reproductive technology (ART) result in lower birth weight of offspring, which is associated with increased risk of adult diseases. However, the exact mechanism remains unknown. The present study investigated the effect of high E2 exposure on the expression of imprinted genes CDKN1C and IGF2 in human placentas and the DNA methylation status of their differential methylation regions (DMRs). METHODS: The mRNA expression of CDKN1C and IGF2 in human placentas and the human trophoblast cells (HTR8) treated with E2 were investigated by reverse transcription-real time polymerase chain reaction (PCR). The DNA methylation of their DMRs were investigated by sodium bisulfite sequencing. RESULTS: CDKN1C and IGF2 were significantly up-regulated in ART conceived placentas. The mean birth weight of ART singletons was significantly lower than that of naturally conceived (NC) ones, with the increased percentage of small-for-gestational-age (SGA) birth. The DNA methylation was significantly down-regulated in the DMR of CDKN1C (KvDMR1) and up-regulated in the DMR of IGF2 (H19 DMR) in ART placentas. The treatment of E2 altered the expression of the two genes and the DNA methylation of their DMRs in HTR8 to a similar tendency as in vivo. DISCUSSION: The maternal high E2 levels after ART up-regulate the expression of imprinted genes in human placentas through epigenetic modifications, which influences the growth potential of the offspring. Further studies are needed to follow up the growth and development of the ART offspring.


Assuntos
Inibidor de Quinase Dependente de Ciclina p57/agonistas , Metilação de DNA/efeitos dos fármacos , Estradiol/efeitos adversos , Regulação da Expressão Gênica no Desenvolvimento/efeitos dos fármacos , Fator de Crescimento Insulin-Like II/agonistas , Indução da Ovulação/efeitos adversos , Placenta/efeitos dos fármacos , Adulto , Linhagem Celular , China/epidemiologia , Inibidor de Quinase Dependente de Ciclina p57/química , Inibidor de Quinase Dependente de Ciclina p57/genética , Inibidor de Quinase Dependente de Ciclina p57/metabolismo , Transferência Embrionária/efeitos adversos , Estradiol/sangue , Estradiol/farmacocinética , Estradiol/farmacologia , Estrogênios/efeitos adversos , Estrogênios/sangue , Estrogênios/farmacocinética , Estrogênios/farmacologia , Feminino , Fármacos para a Fertilidade Feminina/efeitos adversos , Fármacos para a Fertilidade Feminina/sangue , Fármacos para a Fertilidade Feminina/farmacocinética , Fármacos para a Fertilidade Feminina/farmacologia , Desenvolvimento Fetal/efeitos dos fármacos , Retardo do Crescimento Fetal/induzido quimicamente , Retardo do Crescimento Fetal/epidemiologia , Retardo do Crescimento Fetal/etiologia , Humanos , Infertilidade Feminina/sangue , Infertilidade Feminina/metabolismo , Infertilidade Feminina/terapia , Fator de Crescimento Insulin-Like II/química , Fator de Crescimento Insulin-Like II/genética , Fator de Crescimento Insulin-Like II/metabolismo , Placenta/metabolismo , Gravidez , Risco , Trofoblastos/efeitos dos fármacos , Trofoblastos/metabolismo
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