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JAMA Network Open Apr 2024
Topics: Female; Humans; Pregnancy; Neoplasms; Pregnancy Complications, Neoplastic
PubMed: 38630480
DOI: 10.1001/jamanetworkopen.2024.6486 -
Brain, Behavior, and Immunity Oct 2023Pre-pregnancy obesity is an emerging risk factor for perinatal depression. However, the underlying mechanisms remain unclear. We investigated the association between...
BACKGROUND
Pre-pregnancy obesity is an emerging risk factor for perinatal depression. However, the underlying mechanisms remain unclear. We investigated the association between pre-pregnancy body mass index (BMI) and perinatal depressive symptoms in a large population-based pre-birth cohort, the Barwon Infant Study. We also assessed whether the levels of circulating inflammatory markers during pregnancy mediated this relationship.
METHODS
Depressive symptoms were assessed in 883 women using the Edinburgh Postnatal Depression Scale (EPDS) and psychological stress using the Perceived Stress Scale (PSS) at 28 weeks gestation and 4 weeks postpartum. Glycoprotein acetyls (GlycA), high-sensitivity C-reactive protein (hsCRP) and cytokines were assessed at 28 weeks gestation. We performed regression analyses, adjusted for potential confounders, and investigated mediation using nested counterfactual models.
RESULTS
The estimated effect of pre-pregnancy obesity (BMI ≥ 30 kg/m) on antenatal EPDS scores was 1.05 points per kg/m increase in BMI (95% CI: 0.20, 1.90; p = 0.02). GlycA, hsCRP, interleukin (IL) -1ra and IL-6 were higher in women with obesity, compared to healthy weight women, while eotaxin and IL-4 were lower. Higher GlycA was associated with higher EPDS and PSS scores and partially mediated the association between pre-pregnancy obesity and EPDS/PSS scores in unadjusted models, but this association attenuated upon adjustment for socioeconomic adversity. IL-6 and eotaxin were negatively associated with EPDS/PSS scores, however there was no evidence for mediation.
CONCLUSIONS
Pre-pregnancy obesity increases the risk of antenatal depressive symptoms and is also associated with systemic inflammation during pregnancy. While discrete inflammatory markers are associated with antenatal depressive symptoms and perceived stress, their role in mediating the effects of pre-pregnancy obesity on antenatal depression requires further investigation.
Topics: Infant; Female; Pregnancy; Humans; Depression; Depression, Postpartum; C-Reactive Protein; Interleukin-6; Obesity; Risk Factors; Inflammation; Pregnancy Complications
PubMed: 37437818
DOI: 10.1016/j.bbi.2023.07.005 -
American Journal of Obstetrics &... Aug 2023With increasing cancer incidence and survival rates, the prevalence of maternal cancer and its effect on adverse birth outcomes are important for prenatal care and...
BACKGROUND
With increasing cancer incidence and survival rates, the prevalence of maternal cancer and its effect on adverse birth outcomes are important for prenatal care and oncology management. However, the effects of different types of cancer at different gestational stages have not been widely reported.
OBJECTIVE
This study aimed to describe the epidemiologic characteristics of pregnancy-associated cancers (during and 1 year after pregnancy) and evaluate the association between adverse birth outcomes and maternal cancers.
METHODS
Of 983,162 cases, a history of maternal cancer, including pregestational cancer, pregnancy-associated cancer, and subsequent cancer, was identified in 16,475 cases using a health information network. The incidence and 95% confidence interval of pregnancy-associated cancer were calculated with the Poisson distribution. The adjusted risk ratio with 95% confidence interval of the association between adverse birth outcomes and maternal cancer were estimated using the multilevel log-binomial model.
RESULTS
A total of 38,295 offspring were born to mothers with a cancer history. Of these, 2583 (6.75%) were exposed to pregnancy-associated cancer, 30,706 (80.18%) had a subsequent cancer diagnosis, and 5006 (13.07%) were exposed to pregestational cancer. The incidence of pregnancy-associated cancer was 2.63 per 1000 pregnancies (95% confidence interval, 2.53‰-2.73‰), with cancer of the thyroid (1.15‰), breast (0.25‰), and female reproductive organs (0.23‰) being the most common cancer types. The increased risks of preterm birth and low birthweight were significantly associated with cancer diagnosed during the second and third trimester of pregnancy, whereas increased risks of birth defects (adjusted risk ratio, 1.48; 95% confidence interval, 1.08-2.04) were associated with cancer diagnosed in the first trimester. Increased risks of preterm birth (adjusted risk ratio, 1.16; 95% confidence interval, 1.02-1.32), low birthweight (adjusted risk ratio, 1.24; 95% confidence interval, 1.07-1.44), and birth defects (adjusted risk ratio, 1.22; 95% confidence interval, 1.10-1.35) were observed in thyroid cancer survivors.
CONCLUSION
Careful monitoring of fetal growth should be implemented for women diagnosed with cancer in the second and third trimester to ensure timely delivery and balance the benefits of neonatal health and cancer treatment. The higher incidence of thyroid cancer and increased risk of adverse birth outcomes among thyroid cancer survivors suggested that the regular thyroid function monitoring and regulation of thyroid hormone levels are important in maintaining pregnancy and promoting fetal development among thyroid cancer survivors before and during pregnancy.
Topics: Pregnancy; Humans; Infant, Newborn; Female; Birth Weight; Cohort Studies; Premature Birth; Pregnancy Complications; Infant, Low Birth Weight; Neoplasms
PubMed: 37245606
DOI: 10.1016/j.ajogmf.2023.101036 -
BMJ Open Aug 2023Adverse childhood experiences (ACEs) have a profound negative impact on health. However, the strength of the association between ACEs and pregnancy complications and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Adverse childhood experiences (ACEs) have a profound negative impact on health. However, the strength of the association between ACEs and pregnancy complications and adverse pregnancy outcomes is not well quantified or understood.
OBJECTIVE
To conduct a systematic review and meta-analysis of the association between ACEs and risk of pregnancy complications and adverse pregnancy outcomes.
SEARCH STRATEGY
A comprehensive search was conducted using PubMed, Embase, CINAHL, PsycINFO, ClinicalTrials.gov and Google scholar up to July 2022.
DATA COLLECTION AND ANALYSIS
Two reviewers independently conducted the screening and quality appraisal using a validated tool. Meta-analysis using the quality-effects model on the reported odds ratio (OR) was conducted. Heterogeneity and inconsistency were examined using the I statistics.
RESULTS
32 studies from 1508 met a priori inclusion criteria for systematic review, with 21 included in the meta-analysis. Pooled analyses showed that exposure to ACEs increased the risk of pregnancy complications (OR 1.37, 95% CI 1.20 to 1.57) and adverse pregnancy outcomes (OR 1.31, 95% CI 1.17 to 1.47). In sub-group analysis, maternal ACEs were associated with gestational diabetes mellitus (OR 1.39, 95% CI 1.11 to 1.74), antenatal depression (OR 1.59, 95% CI 1.15 to 2.20), low offspring birth weight (OR 1.27, 95% CI 1.02 to 1.47), and preterm delivery (OR 1.41, 95% CI 1.16 to 1.71).
CONCLUSION
The results suggest that exposure to ACEs increases the risk of pregnancy complications and adverse pregnancy outcomes. Preventive strategies, screening and trauma-informed care need to be examined to improve maternal and child health.
Topics: Infant, Newborn; Child; Pregnancy; Female; Humans; Adverse Childhood Experiences; Pregnancy Complications; Pregnancy Outcome; Diabetes, Gestational; Premature Birth
PubMed: 37536966
DOI: 10.1136/bmjopen-2022-063826 -
Pregnancy Hypertension Dec 2023Human chorionic gonadotropin (hCG), a glycoprotein produced in the placenta, is crucial for a healthy pregnancy. We investigated the relationship between hCG levels and... (Meta-Analysis)
Meta-Analysis Review
Human chorionic gonadotropin (hCG), a glycoprotein produced in the placenta, is crucial for a healthy pregnancy. We investigated the relationship between hCG levels and adverse pregnancy outcomes. We conducted a systematic review including studies measuring hCG blood levels in the first or second trimester, reporting on any of the 12 predefined adverse pregnancy outcomes with logistic regression-adjusted association estimates. The primary outcomes were placenta-associated complications, such as miscarriage, preeclampsia, intrauterine growth restriction, and preterm delivery. We searched PubMed, Embase and CINAHL Complete. The hCG levels were analysed as multiple of the median (MoM). Odds ratio (OR) and 95% confidence interval (CI) were used. Risk of bias and the certainty of evidence were assessed using ROBINS-I and GRADE, respectively. Meta-analysis also showed that hCG levels, reported as MoM ≥2/2.31/2.5, might be associated with an increased risk of preeclampsia (OR 2.08, 95% CI 1.26 to 3.44) and preterm delivery (OR 1.29, 95% CI 1.12 to 1.47), but the evidence is very uncertain. High second trimester hCG levels may be associated with preeclampsia and preterm delivery but confidence in evidence is low.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Premature Birth; Pre-Eclampsia; Pregnancy Outcome; Chorionic Gonadotropin; Abortion, Spontaneous; Pregnancy Trimester, Second
PubMed: 37951184
DOI: 10.1016/j.preghy.2023.11.003 -
Scientific Reports Jul 2023To compare pregnancy rates and complications in women with and without a history of optic neuritis (ON). A nationwide, population-based, retrospective study using data...
To compare pregnancy rates and complications in women with and without a history of optic neuritis (ON). A nationwide, population-based, retrospective study using data from the Korean National Health Claims from January 2011, to December 2017 was done. ON cohort (ON group) consisting of women aged 18 to 50 with a history of ON and 1:3 age-matched controls (control group) were compared for pregnancy and delivery rates using logistic regression after adjusting for possible confounders. Pregnancy-ON cohort (pregnancy-ON group), women aged 18 to 55 with a history of ON and pregnancy, and 1:3 age at pregnancy matched controls (pregnancy-control group) were analyzed for pregnancy complications using logistic regression after adjusting for covariates. ON group (n = 2516) showed decreased odds ratio (OR) for pregnancy [Adjusted OR2: 0.716, 95% confidence interval (CI): 0.626-0.820] and delivery (adjusted OR2: 0.647, 95% CI: 0.554-0.756) compared to controls (n = 7548). Pregnancy-ON group (n = 550) showed increased risk of delayed fetal growth (adjusted OR2: 9.867, 95% CI: 1.224-79.564), pre-eclampsia (adjusted OR2: 8.327, 95% CI: 2.911-23.819), preterm delivery (adjusted OR2: 3.914, 95% CI: 2.667-5.742), pregnancy and postpartum infection (adjusted OR1: 1.671, 95% CI: 1.296-2.154), diabetes in pregnancy (adjusted OR2: 1.365, 95% CI: 1.062-1.754) compared to pregnancy-control group (n = 1650). Our population-based cohort study suggests that history of ON is associated with decreased pregnancy and delivery rates. It may be a risk factor for various pregnancy complications.
Topics: Pregnancy; Infant, Newborn; Humans; Female; Retrospective Studies; Cohort Studies; Prevalence; Pregnancy Complications; Premature Birth; Optic Neuritis; Pregnancy Outcome
PubMed: 37500694
DOI: 10.1038/s41598-023-38851-x -
Acta Obstetricia Et Gynecologica... Oct 2023Pain during pregnancy affects women's well-being, causes worry and is a risk factor for the child and the mother during labor. The aim was to investigate the relative...
INTRODUCTION
Pain during pregnancy affects women's well-being, causes worry and is a risk factor for the child and the mother during labor. The aim was to investigate the relative importance of an extensive set of pregnancy-related physiological symptoms and psychosocial factors assessed in the first trimester compared with the occurrence of pregnancy-related pain symptoms later in the pregnancy.
MATERIAL AND METHODS
Included were all women who booked an appointment for a first prenatal visit in one of 125 randomly selected general practitioner practices in Eastern Denmark from April 2015 to August 2016. These women answered an electronic questionnaire containing questions on the occurrence of five pregnancy-related pain symptoms: back pain, leg cramps, pelvic cavity pain, pelvic girdle pain and uterine contractions. The questionnaire also included sociodemographic questions and questions on chronic diseases, physical symptoms, mental health symptoms, lifestyle and reproductive background. The questionnaire was repeated in each trimester. The relative importance of this set of factors from the first trimester on the five pregnancy-related pain symptoms compared with the second and third trimesters was assessed in a dominance analysis.
RESULTS
A total of 1491 women were included. The most important factor for pregnancy-related pain in the second trimester and third trimester is the presence of the corresponding pain in the first trimester. Parity was associated with pelvic cavity pain and uterine contractions in the following pregnancies. For back pain and pelvic cavity pain, the odds increased as the women's estimated low self-assessed fitness decreased and had low WHO-5 wellbeing scores.
CONCLUSIONS
When including physical risk factors, sociodemographic factors, psychological factors and clinical risk factors, women's experiences of pregnancy-related pain in the first trimester are the most important predictors for pain later in pregnancy. Beyond the expected positive effects of pregnancy-related pain, notably self-assessed fitness, age and parity were predictive for pain later in pregnancy.
Topics: Pregnancy; Child; Female; Humans; Pregnancy Trimester, Third; Pregnancy Complications; Pregnancy Trimester, First; Pregnancy Trimester, Second; Pelvic Pain
PubMed: 37771202
DOI: 10.1111/aogs.14670 -
Medicina (Kaunas, Lithuania) Oct 2023One in three women of reproductive age is obese. The mainstay treatment for obesity is bariatric surgery, and the following weight reduction results in a decrease in... (Review)
Review
One in three women of reproductive age is obese. The mainstay treatment for obesity is bariatric surgery, and the following weight reduction results in a decrease in pregnancy adverse effects, including gestational diabetes mellitus, pregnancy-induced hypertension, and macrosomia. However, nutritional and vitamin deficiencies due to changes in the gastrointestinal tract after bariatric surgery are associated with an increase in the risk of fetal growth retardation and small for gestational-age neonates. The purpose of this review was to analyze the available recent literature on the subject of the management of pregnancy after bariatric surgery. We searched for available articles from 2007 to 2023 and chose articles of the greatest scientific and clinical value. Micronutrient, vitamin, and protein supplementation is recommended in the prenatal period and throughout the pregnancy. It is advised that pregnant women with a history of bariatric surgery should be provided with regular specialist dietary care. There is still a lack of recommendations about the optimum gestational weight gain after different types of bariatric surgery and for patients of different metabolic statuses. Women of reproductive age undergoing bariatric procedures should be provided with appropriate counseling about adequate contraception, the recommended time-to-conception interval, and the positive and negative influence of bariatric surgery on perinatal outcomes.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Pregnancy Complications; Bariatric Surgery; Obesity; Diabetes, Gestational; Hypertension, Pregnancy-Induced; Fetal Growth Retardation
PubMed: 37893582
DOI: 10.3390/medicina59101864 -
European Respiratory Review : An... Dec 2023Asthma is the most common chronic medical condition in pregnancy. Asthma exacerbations in pregnancy are unpredictable, and are associated with adverse maternal and fetal... (Review)
Review
Asthma is the most common chronic medical condition in pregnancy. Asthma exacerbations in pregnancy are unpredictable, and are associated with adverse maternal and fetal perinatal outcomes such as preterm birth and low birthweight. Goals of asthma management in pregnancy are to establish effective asthma control and prevent exacerbations. Optimising the management of asthma in pregnancy is an important goal of practice and future research.Treatable traits is a precision medicine paradigm proposed for the management of airways diseases, which holistically addresses the complexity and heterogeneity of airways disease. It is an individualised treatment approach that aims to improve outcomes. This makes treatable traits well suited for pregnant women with asthma, who have a high prevalence of obesity, mental health conditions, poor symptom perception and suboptimal asthma management skills including low treatment adherence. These traits are measurable and treatable. In this review, we explore current knowledge on the burden of asthma, maternal and perinatal consequences of asthma during pregnancy, the treatable traits paradigm, the prevalence of treatable traits in pregnant women with asthma, and consider how the treatable traits paradigm can be integrated into the management of asthma in pregnancy.
Topics: Humans; Infant, Newborn; Female; Pregnancy; Premature Birth; Asthma; Chronic Disease; Phenotype; Precision Medicine; Pregnancy Complications
PubMed: 38123232
DOI: 10.1183/16000617.0105-2023 -
BMC Pregnancy and Childbirth Aug 2023The purpose of this study was to investigate the relationship between the size and duration of asymptomatic subchorionic hematoma and pregnancy outcomes in women with... (Observational Study)
Observational Study
BACKGROUND
The purpose of this study was to investigate the relationship between the size and duration of asymptomatic subchorionic hematoma and pregnancy outcomes in women with singleton pregnancies.
METHODS
This was a retrospective study that enrolled 701 singleton pregnant women who were diagnosed with asymptomatic subchorionic hematoma by ultrasound at 5-10 gestational weeks. The control group recruited 640 normal pregnant women without subchorionic hematoma who were matched with subchorionic hematoma group on baseline characteristics. The pregnancy outcomes were compared between the two groups, and the associations of the size and duration of subchorionic hematoma with pregnancy outcomes were analyzed by logistic regression model.
RESULTS
Compared with the normal pregnancy group, the incidence of, gestational diabetes mellitus, gestational thrombocytopenia, placenta adhesion, fetal growth restriction, macrosomia in subchorionic hematoma group were higher (all P < 0.05). After adjusting for confounding factors, the hematoma size was positively associated with the occurrence of gestational hypothyroidism (adjusted OR[95%CI]: 1.029[1.004-1.054]), intrahepatic cholestasis of pregnancy (adjusted OR[95%CI]: 1.095[1.047-1.146]), term premature rupture of membranes (adjusted OR[95%CI]: 1.044[1.005-1.085]), hypertensive disorders of pregnancy (adjusted OR[95%CI]: 1.030[1.0004-1.060]), gestational thrombocytopenia (adjusted OR[95%CI]: 1.078 [1.045-1.113]), placenta adhesion (adjusted OR[95%CI]: 1.054 [1.027-1.082]), and the duration of hematoma was positively associated with the incidence of term premature rupture of membranes (adjusted OR[95%CI]: 1.070[1.027-1.115]), gestational diabetes mellitus (adjusted OR[95%CI]: 1.938 [1.886-1.993]) and fetal growth restriction (adjusted OR[95%CI]: 1.194 [1.124-1.268]).
CONCLUSIONS
The presence, size and duration of a first-trimester asymptomatic subchorionic hematoma may be associated with adverse pregnancy outcomes at later gestations such as term premature rupture of membranes and fetal growth restriction.
Topics: Female; Humans; Pregnancy; Fetal Growth Retardation; Hematoma; Pregnancy Complications; Pregnancy Outcome; Premature Birth; Retrospective Studies; Case-Control Studies; Ultrasonography, Prenatal
PubMed: 37532977
DOI: 10.1186/s12884-023-05831-y