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Placenta Aug 2023Chronic histiocytic intervillositis (CHI) is a rare histopathological lesion in the placenta characterized by an infiltrate of CD68 cells in the intervillous space. CHI...
INTRODUCTION
Chronic histiocytic intervillositis (CHI) is a rare histopathological lesion in the placenta characterized by an infiltrate of CD68 cells in the intervillous space. CHI is associated with adverse pregnancy outcomes such as miscarriage, fetal growth restriction, and (late) intrauterine fetal death. The adverse pregnancy outcomes and a variable recurrence rate of 25-100% underline its clinical relevance. The pathophysiologic mechanism of CHI is unclear, but it appears to be immunologically driven. The aim of this study was to obtain a better understanding of the phenotype of the cellular infiltrate in CHI.
METHOD
We used imaging mass cytometry to achieve in-depth visualization of the intervillous maternal immune cells and investigated their spatial orientation in situ in relation to the fetal syncytiotrophoblast.
RESULTS
We found three phenotypically distinct CD68HLA-DRCD38 cell clusters that were unique for CHI. Additionally, syncytiotrophoblast cells in the vicinity of these CD68HLA-DRCD38 cells showed decreased expression of the immunosuppressive enzyme CD39.
DISCUSSION
The current results provide novel insight into the phenotype of CD68 cells in CHI. The identification of unique CD68 cell clusters will allow more detailed analysis of their function and could result in novel therapeutic targets for CHI.
Topics: Pregnancy; Humans; Female; Placenta Diseases; Placenta; Pregnancy Outcome; Histiocytes; Abortion, Spontaneous; Chorionic Villi
PubMed: 37300938
DOI: 10.1016/j.placenta.2023.05.007 -
Clinical Infectious Diseases : An... Jan 2024Tuberculosis (TB) disease has been associated with pregnancy complications. However, the potential impact of TB infection (TBI) on pregnancy outcome is unknown. To...
BACKGROUND
Tuberculosis (TB) disease has been associated with pregnancy complications. However, the potential impact of TB infection (TBI) on pregnancy outcome is unknown. To investigate this, we conducted a register-based study in immigrant women screened with QuantiFERON assays for TBI in antenatal care in Sweden.
METHODS
Women with history of immigration from TB-endemic countries were eligible for inclusion if national identification numbers and available QuantiFERON results obtained during pregnancy from 2014 to 2018 were available. QuantiFERON results were linked to data on maternal characteristics and pregnancy outcomes from the national Pregnancy and Patient Registers. TBI was defined as nil-corrected QuantiFERON result ≥0.35 IU/mL, in the absence of TB disease. Pregnancies in women with TB disease or human immunodeficiency virus were excluded, as were multiplex pregnancies, pregnancies resulting in miscarriage, and pregnancies occurring >10 years after immigration. Odds of defined adverse pregnancy outcomes were compared by maternal TBI status using mixed effects logistic regression with adjustment for maternal age and region of origin.
RESULTS
In total, 7408 women with 12 443 pregnancies were included. In multivariable analysis, stillbirth (adjusted odds ratio [AOR], 1.90; 95% confidence interval [CI], 1.13-3.21; P = .016), severe preeclampsia (AOR, 1.62; 95% CI, 1.03-2.56; P = .036), low birthweight (<2500 g; AOR, 1.38; 95% CI, 1.01-1.88; P = .041), and emergency cesarean section (AOR, 1.28; 95% CI, 1.02-1.63; P = .033) were significantly associated with TBI.
CONCLUSIONS
Among immigrant women seeking antenatal care in Sweden, TBI was independently associated with adverse pregnancy outcomes. Further studies are needed to corroborate these findings and to explore mechanisms involved.
Topics: Pregnancy; Female; Humans; Pregnancy Outcome; Prenatal Care; Sweden; Cesarean Section; Stillbirth; Tuberculosis; Latent Tuberculosis
PubMed: 37572363
DOI: 10.1093/cid/ciad465 -
PloS One 2024There are limited population-based data on the role of mental disorders in adolescent pregnancy, despite the presence of mental disorders that may affect adolescents'...
BACKGROUND
There are limited population-based data on the role of mental disorders in adolescent pregnancy, despite the presence of mental disorders that may affect adolescents' desires and decisions to become pregnant.
OBJECTIVE
This study aimed to examine the relationship between specific types of mental disorders and pregnancy rates and outcome types among adolescents aged 13-19 years, using single-year age groups.
METHODS
We conducted a retrospective cohort study using data from the Merative™ MarketScan Research Databases. The study population consisted of females aged 13-19 years with continuous insurance enrollment for three consecutive calendar years between 2005 and 2015. Pregnancy incidence rates were calculated both overall and within the different categories of mental disorders. The presence of mental disorders, identified through diagnosis codes, was classified into 15 categories. Pregnancy and pregnancy outcome types were determined using diagnosis and procedure codes indicating the pregnancy status or outcome. To address potential over- or underestimations of mental disorder-specific pregnancy rates resulting from variations in age distribution across different mental disorder types, we applied age standardization using 2010 U.S. Census data. Finally, multivariable logistic regression models were used to examine the relationships between 15 specific types of mental disorders and pregnancy incidence rates, stratified by age.
RESULTS
The age-standardized pregnancy rate among adolescents diagnosed with at least one mental disorder was 15.4 per 1,000 person-years, compared to 8.5 per 1,000 person-years among adolescents without a mental disorder diagnosis. Compared to pregnant adolescents without a mental disorder diagnosis, those with a mental disorder diagnosis had a slightly but significantly higher abortion rate (26.7% vs 23.8%, P-value < 0.001). Multivariable logistic regression models showed that substance use-related disorders had the highest odds ratios (ORs) for pregnancy incidence, ranging from 2.4 [95% confidence interval (CI): 2.1-2.7] to 4.5 [95% CI:2.1-9.5] across different age groups. Overall, bipolar disorders (OR range: 1.6 [95% CI:1.4-1.9]- 1.8 [95% CI: 1.7-2.0]), depressive disorders (OR range: 1.4 [95% CI: 1.3-1.5]- 2.7 [95% CI: 2.3-3.1]), alcohol-related disorders (OR range: 1.2 [95% CI: 1.1-1.4]- 14.5 [95% CI: 1.2-178.6]), and attention-deficit/conduct/disruptive behavior disorders (OR range: 1.1 [95% CI: 1.0-1.1]- 1.8 [95% CI: 1.1-3.0]) were also significantly associated with adolescent pregnancy, compared to adolescents without diagnosed mental disorders of the same age.
CONCLUSION
This study emphasizes the elevated rates of pregnancy and pregnancy ending in abortion among adolescents diagnosed with mental disorders, and identifies the particular mental disorders associated with higher pregnancy rates.
Topics: Female; Humans; Adolescent; Pregnancy; Pregnancy Rate; Retrospective Studies; Pregnancy Outcome; Mental Disorders; Substance-Related Disorders; Attention Deficit Disorder with Hyperactivity
PubMed: 38483946
DOI: 10.1371/journal.pone.0296425 -
Medicine Oct 2023Being overweight or obese is closely related to adverse pregnancy outcomes and harms both pregnant women and neonates, increasing complications during pregnancy and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Being overweight or obese is closely related to adverse pregnancy outcomes and harms both pregnant women and neonates, increasing complications during pregnancy and leading to adverse pregnancy outcomes. Consequently, a meta-analysis was done to investigate exercise therapy impact on the complications and outcomes of pregnant women who are obese or overweight.
MATERIALS AND METHODS
The computer system searched PubMed, Cochrane Library, Wanfang, EMBASE, and CNKI databases. The search duration extended from the database establishment until October 2022. A thorough search was carried out for pertinent studies investigating exercise therapy impact on pregnancy complications and outcomes in obese or overweight pregnant women. The heterogeneity test was carried out using Cochrane Q and Chi-square tests. The combined findings from the meta-analysis were examined for reliability and robustness using sensitivity and publication bias analyses. All statistics used RevMan 5.3 software.
RESULTS
This meta-analysis included data from 8026 patients from 22 randomized controlled trials. The results demonstrated that exercise therapy might successfully decrease the incidence of gestational diabetes mellitus (GDM) (odds ratio [OR] = 0.85, 95% confidence interval [CI]: 0.74-0.96, P = .01) and macrosomia (OR = 0.78, 95% CI: 0.68-0.89, P < .001), and control weight gain during pregnancy (SMD = -0.2, 95% CI: -0.31 to -0.08, P < .001).
CONCLUSIONS
Exercise therapy can control weight gain during pregnancy, lower the incidence of GDM and the macrosomia rate, and improve adverse pregnancy outcomes.
Topics: Infant, Newborn; Female; Humans; Pregnancy; Overweight; Pregnancy Outcome; Pregnant Women; Fetal Macrosomia; Reproducibility of Results; Exercise; Obesity; Weight Gain; Diabetes, Gestational; Pregnancy Complications; Exercise Therapy
PubMed: 37800765
DOI: 10.1097/MD.0000000000034804 -
Acta Obstetricia Et Gynecologica... Nov 2023This meta-analysis aimed to evaluate the efficacy and safety of low-molecular-weight heparin (LMWH) on pregnancy outcomes in thrombophilic women receiving in vitro... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
This meta-analysis aimed to evaluate the efficacy and safety of low-molecular-weight heparin (LMWH) on pregnancy outcomes in thrombophilic women receiving in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI).
MATERIAL AND METHODS
A systematic literature search of PubMed, EMBASE, the Cochrane Library, and China National Knowledge Infrastructure was performed to identify randomized controlled trials (RCTs) comparing LMWH with no treatment or placebo published from database inception until February 19, 2023. Primary outcomes were the clinical pregnancy rate and implantation rate, and secondary outcomes were the live birth rate, miscarriage rate, and the risk of bleeding events. The certainty of the evidence was rated using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system. Meta-analysis was conducted using STATA 14.0.
RESULTS
Five RCTs involving 1094 thrombophilic women receiving IVF/ICSI were finally included. Administration of LMWH was associated with statistically higher clinical pregnancy rate (4 RCTs, risk ratio [RR] 1.50, 95% confidence interval [CI] 1.23-1.82, p < 0.001, low certainty evidence), implantation rate (5 RCTs, RR 1.49, 95% CI 1.25-1.78, p < 0.001, very low certainty evidence), and live birth rate (2 RCTs, RR 2.15, 95% CI 1.60-2.89, p < 0.001, very low certainty evidence), but with statistically lower miscarriage rate (2 RCTs, RR 0.36, 95% CI 0.15-0.86, p = 0.021, very low certainty evidence). However, using LMWH was linked to a higher risk of bleeding events (2 RCTs, RR 2.36, 95% CI 1.49-3.74, p < 0.001, very low certainty evidence).
CONCLUSIONS
Very low certainty evidence suggests that administration of LMWH may benefit pregnancy outcomes in thrombophilic women receiving IVF/ICSI treatment, although it may also increase the risk of bleeding events. However, before putting our findings into practice, healthcare professionals should conduct an in-depth evaluation of the available evidence and specific patient situations. Furthermore, due to the low methodological quality of the included studies, more high-quality studies are needed to validate our findings in the future.
Topics: Pregnancy; Female; Humans; Sperm Injections, Intracytoplasmic; Heparin, Low-Molecular-Weight; Abortion, Spontaneous; Fertilization in Vitro; Pregnancy Outcome; Pregnancy Rate; Hemorrhage; Live Birth
PubMed: 37475190
DOI: 10.1111/aogs.14634 -
Nutrients Nov 2023There has been a dramatic worldwide increase in the prevalence of obesity or overweight and physical inactivity in women of reproductive age. Growing evidence suggests...
There has been a dramatic worldwide increase in the prevalence of obesity or overweight and physical inactivity in women of reproductive age. Growing evidence suggests that pre-pregnancy maternal abnormal body mass index (BMI) and lower physical activity level are associated with poor maternal health and perinatal outcomes. The aim of this study was to assess how self-perceived exercise and pre-pregnancy BMI are associated with preterm birth, low birth weight, and type of birth. We conducted a retrospective cross-sectional study of 394 Polish women in the postpartum period. We used a questionnaire with the structure of the medical interview. To analyze factors related to birth outcomes, we used the Pearson's Chi-squared test of independence and odds ratio (OR), with a corresponding 95% confidence interval (CI), followed by a multiple logistic regression. Women who reported being physically active before pregnancy ( = 0.00) and during pregnancy ( = 0.03) were more likely to give birth on time and had a lower incidence of very-premature and extremely premature births compared to inactive women. Importantly, they were more likely to have vaginal birth ( = 0.03). Pre-pregnancy BMI influenced the week of delivery, i.e., inadequate, too-high BMI contributed to an increase in the percentage of premature births [OR (95% CI) = 1.19 (1.06; 1.34)]. The findings indicate that promoting physical activity and weight management remains a priority in public health policy, and women of childbearing age should be encouraged to adopt or maintain an active and healthy lifestyle during pregnancy in order to avoid sedentary- and obesity-associated risks affecting birth and newborns' health.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Pregnancy Outcome; Cross-Sectional Studies; Body Mass Index; Premature Birth; Retrospective Studies; Pregnancy Complications; Obesity; Exercise
PubMed: 38068752
DOI: 10.3390/nu15234894 -
American Journal of Obstetrics and... Feb 2024This study aimed to assess the risk of adverse maternal and perinatal complications between twin and singleton pregnancies affected by gestational diabetes mellitus and... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This study aimed to assess the risk of adverse maternal and perinatal complications between twin and singleton pregnancies affected by gestational diabetes mellitus and the respective group without gestational diabetes mellitus (controls).
DATA SOURCES
A literature search was performed using MEDLINE, Embase, and Cochrane from January 1980 to May 2023.
STUDY ELIGIBILITY CRITERIA
Observational studies reporting maternal and perinatal outcomes in singleton and/or twin pregnancies with gestational diabetes mellitus vs controls were included.
METHODS
This was a systematic review and meta-analysis. Pooled estimate risk ratios with 95% confidence intervals were generated to determine the likelihood of adverse pregnancy outcomes between twin and singleton pregnancies with and without gestational diabetes mellitus. Heterogeneity among studies was evaluated in the model and expressed using the I statistic. A P value of <.05 was considered statistically significant. The meta-analyses were performed using Review Manager (RevMan Web). Version 5.4. The Cochrane Collaboration, 2020. Meta-regression was used to compare relative risks between singleton and twin pregnancies. The addition of multiple covariates into the models was used to address the lack of adjustments.
RESULTS
Overall, 85 studies in singleton pregnancies and 27 in twin pregnancies were included. In singleton pregnancies with gestational diabetes mellitus, compared with controls, there were increased risks of hypertensive disorders of pregnancy (relative risk, 1.85; 95% confidence interval, 1.69-2.01), induction of labor (relative risk, 1.36; 95% confidence interval, 1.05-1.77), cesarean delivery (relative risk, 1.31; 95% confidence interval, 1.24-1.38), large-for-gestational-age neonate (relative risk, 1.61; 95% confidence interval, 1.46-1.77), preterm birth (relative risk, 1.36; 95% confidence interval, 1.27-1.46), and admission to the neonatal intensive care unit (relative risk, 1.43; 95% confidence interval, 1.38-1.49). In twin pregnancies with gestational diabetes mellitus, compared with controls, there were increased risks of hypertensive disorders of pregnancy (relative risk, 1.69; 95% confidence interval, 1.51-1.90), cesarean delivery (relative risk, 1.10; 95% confidence interval, 1.06-1.13), large-for-gestational-age neonate (relative risk, 1.29; 95% confidence interval, 1.03-1.60), preterm birth (relative risk, 1.19; 95% confidence interval, 1.07-1.32), and admission to the neonatal intensive care unit (relative risk, 1.20; 95% confidence interval, 1.09-1.32) and reduced risks of small-for-gestational-age neonate (relative risk, 0.89; 95% confidence interval, 0.81-0.97) and neonatal death (relative risk, 0.50; 95% confidence interval, 0.39-0.65). When comparing relative risks in singleton vs twin pregnancies, there was sufficient evidence to suggest that twin pregnancies have a lower relative risk of cesarean delivery (P=.003), have sufficient adjustment for confounders, and have lower relative risks of admission to the neonatal intensive care unit (P=.005), stillbirths (P=.002), and neonatal death (P=.001) than singleton pregnancies.
CONCLUSION
In both singleton and twin pregnancies, gestational diabetes mellitus was associated with an increased risk of adverse maternal and perinatal outcomes. In twin pregnancies, gestational diabetes mellitus may have a milder effect on some adverse perinatal outcomes and may be associated with a lower risk of neonatal death.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Diabetes, Gestational; Hypertension, Pregnancy-Induced; Perinatal Death; Pregnancy Outcome; Pregnancy, Twin; Premature Birth; Retrospective Studies; Observational Studies as Topic
PubMed: 37595821
DOI: 10.1016/j.ajog.2023.08.011 -
JAMA Network Open Apr 2024The safety of exogenous gonadotropin treatment, based on its effect on embryos and pregnancy outcomes, remains inconclusive. (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
The safety of exogenous gonadotropin treatment, based on its effect on embryos and pregnancy outcomes, remains inconclusive.
OBJECTIVE
To evaluate the associations of different doses and durations of gonadotropins with embryonic genetic status and pregnancy outcomes after euploid embryo transfer in couples with infertility.
DESIGN, SETTING, AND PARTICIPANTS
This study was a post hoc analysis of a multicenter randomized clinical trial (RCT) conducted at 14 reproductive centers throughout China from July 2017 to June 2018 that evaluated the cumulative live birth rate with or without preimplantation genetic testing for aneuploidy (PGT-A) among couples with infertility and good prognosis. The PGT-A group from the original RCT was selected for secondary analysis. Patients were divided into 4 groups according to the total dosage of exogenous gonadotropins and treatment duration: group 1 (≤1500 IU and <10 days), group 2 (≤1500 IU and ≥10 days), group 3 (>1500 IU and <10 days), and group 4 (>1 500 IU and ≥10 days). Group 1 served as the control group. Data were analyzed from June through August 2023.
INTERVENTIONS
Blastocyst biopsy and PGT-A.
MAIN OUTCOMES AND MEASURES
The primary outcomes were embryonic aneuploidy, embryonic mosaicism, and cumulative live birth rates after euploid embryo transfer.
RESULTS
A total of 603 couples (mean [SD] age of prospective mothers, 29.13 [3.61] years) who underwent PGT-A were included, and 1809 embryos were screened using next-generation sequencing. The embryo mosaicism rate was significantly higher in groups 2 (44 of 339 embryos [13.0%]; adjusted odds ratio [aOR], 1.69 [95% CI, 1.09-2.64]), 3 (27 of 186 embryos [14.5%]; aOR, 1.98 [95% CI, 1.15-3.40]), and 4 (82 of 651 embryos [12.6%]; aOR, 1.60 [95% CI, 1.07-2.38]) than in group 1 (56 of 633 embryos [8.8%]). There were no associations between gonadotropin dosage or duration and the embryo aneuploidy rate. The cumulative live birth rate was significantly lower in groups 2 (83 of 113 couples [73.5%]; aOR, 0.49 [95% CI, 0.27-0.88]), 3 (42 of 62 couples [67.7%]; aOR, 0.41 [95% CI, 0.21-0.82]), and 4 (161 of 217 couples [74.2%]; aOR, 0.53 [95% CI, 0.31-0.89]) than in group 1 (180 of 211 couples [85.3%]).
CONCLUSIONS AND RELEVANCE
In this study, excessive exogenous gonadotropin administration was associated with increased embryonic mosaicism and decreased cumulative live birth rate after euploid embryo transfer in couples with a good prognosis. These findings suggest that consideration should be given to minimizing exogenous gonadotropin dosage and limiting treatment duration to improve embryo outcomes and increase the live birth rate.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT03118141.
Topics: Female; Pregnancy; Humans; Child, Preschool; Pregnancy Outcome; Aneuploidy; Embryo Transfer; Gonadotropins; Infertility
PubMed: 38564220
DOI: 10.1001/jamanetworkopen.2024.4438 -
Environmental Health Perspectives Aug 2023Exposures to ambient air pollution during pregnancy have been linked to adverse pregnancy outcomes such as preeclampsia and fetal growth restriction. Although evidence...
BACKGROUND
Exposures to ambient air pollution during pregnancy have been linked to adverse pregnancy outcomes such as preeclampsia and fetal growth restriction. Although evidence has shown that women with preeclampsia have higher ratio of soluble fms-like tyrosine kinase 1 to placental growth factor (sFlt-1/PlGF ratio), the potential impact of air pollution on markers of placental growth and function has not been well studied.
OBJECTIVES
We aimed to examine longitudinal associations between ambient air pollution exposure and angiogenic factors among pregnant women in LIFECODES, a prospective birth cohort and biorepository in Massachusetts in the United States.
METHODS
PlGF and sFlt-1 were measured among pregnant women using plasma samples collected around 10, 18, 26, and 35 wk' gestation. Women's exposures to ozone (), fine particulate matter with aerodynamic diameter (), and nitrogen dioxide () within 1, 2, 4, and 8 wk prior to each plasma sample collection were estimated based on geocoded residential addresses, and mixed effect linear regression models were fitted to assess their associations with sFlt-1/PlGF ratio, sFlt-1 (ng/mL), and PlGF (pg/mL). Percent changes in outcomes associated with each interquartile range increase in exposures were reported, along with their 95% confidence intervals.
RESULTS
A total of 1,066 pregnant women were included. In the multipollutant models, significant associations were observed for increased sFlt-1/PlGF ratio ( 3-8 wk' gestation, : 35-39 wk' gestation), elevated sFlt-1 (: 26-34 wk' gestation, : 3-8 wk' gestation), decreased sFlt-1 (: 4-8 wk' gestation), and decreased PlGF (: 34-39 wk' gestation) after adjusting for sociodemographic status, smoking, drinking, body mass index, parity, history of chronic hypertension, and conception time.
DISCUSSION
Exposures to during early pregnancy and exposures to and during late pregnancy were associated with increased sFlt-1/PlGF ratio, elevated sFlt-1 and with decreased PlGF, which may be a potential mechanism underlying ambient air pollution's impacts on adverse pregnancy and birth outcomes. https://doi.org/10.1289/EHP11909.
Topics: Pregnancy; Female; Humans; Pregnant Women; Placenta Growth Factor; Prospective Studies; Pre-Eclampsia; Placenta; Pregnancy Outcome; Air Pollution; Biomarkers; Vascular Endothelial Growth Factor Receptor-1
PubMed: 37556304
DOI: 10.1289/EHP11909 -
Chinese Medical Journal Aug 2023
Topics: Pregnancy; Female; Humans; COVID-19; SARS-CoV-2; Risk Factors; Risk Assessment; Pregnancy Complications, Infectious; Pregnancy Outcome
PubMed: 37468986
DOI: 10.1097/CM9.0000000000002762