Do Anti-Factor Xa Levels have any Impact on Pregnancy Outcome in
                    Women with Previous Adverse Outcomes?

Abstract Objective Low-molecular-weight heparin (LMWH) is used during pregnancy in women diagnosed with thrombophilia for prevention of thromboembolic events and prevention of recurrent pregnancy loss. Prophylactic dosing does not always achieve target anti-FXa levels of 0.2–0.6 IU/ml. We aimed to determine if anti-FXa levels, measured in the first trimester, have an influence on pregnancy outcome. Material and Methods Eighty-one first-trimester women with a history of adverse pregnancy outcomes under LMWH therapy during pregnancy were enrolled in this study. Anti-FXa levels were measured in the first trimester, and fetal and maternal outcomes were recorded. Results The mean age of women was 28±4 (19–40) and mean anti-FXa level 0.44±0.93 IU/ml. No bleeding or clotting complications were associated with LMWH administration. Anti-FXa levels did not have a relationship with gestational age at birth, fetal weight, type of delivery, cesarean indications, postpartum bleeding, APGAR scores, or admission to the neonatal intensive care unit (p>0.005). Anti-FXa levels were not correlated with live birth rates. Conclusion Anti-FXa levels did not have an influence on pregnancy and fetal outcomes. The effect of LMWH on pregnancy outcomes may not be due to anticoagulant activity but other mechanisms.

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FIRST TRIMESTER MATERNAL BMI AND PREGNANCY OUTCOME AT DMCH, LAHERIASARAI, BIHAR

10.36106/ijsr/6930378 ◽

2020 ◽

pp. 79-81

Author(s):

Supriya Kumari ◽

Surya Narayan ◽

Kumudini Jha ◽

Debarshi Jana

Keyword(s):

Pregnancy Outcome ◽

Pregnancy Outcomes ◽

First Trimester ◽

Normal Weight ◽

Obese Women ◽

Family History Of Diabetes ◽

Medical College ◽

Asian Indian Women ◽

Adverse Pregnancy ◽

Maternal Bmi

Aim: The aim of the study was to find out relationship of maternal BMI to pregnancy outcome. Methodology: The study carried out in Department of Obstetrics and Gynaecology, Darbhanga Medical College and Hospital, Laheriasarai, Bihar from February 2019 to January 2020 and pregnancy outcomes were analyzed in relation BMI recorded in first trimester of primigravida. Results: Mean age of pregnant women was 26.2 years. At first booking obese women were significantlyolder (28.0 years) than others. Family history of diabetes was significantly higher among obese women (8.25%) compared to others. Rates of cesarean sections were higher in obese compared to others. The macrosomia rates were higher in obese compared to other group. The preeclampsia (1.89%), were significantly higher in obese women than others. Conclusions: Obese women were at a high risk of developing adverse pregnancy outcomes in terms ofgestational diabetes, macrosomia, preeclampsia more of ceasarean section. Normal weight women have low risk for cesarean section and macrosomia. These results highlight the need for preconception counseling, especially for obese and overweight and have beneficial outcomes in Asian Indian women.

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Placental massive perivillous fibrinoid deposition is associated with adverse pregnancy outcomes: a clinicopathological study of 12 cases

Case Reports in Perinatal Medicine ◽

10.1515/crpm-2015-0087 ◽

2016 ◽

Vol 5 (1) ◽

pp. 35-39

Author(s):

Maili Qi ◽

Kenneth Tou En Chang ◽

Derrick Wen Quan Lian ◽

Chong Kiat Khoo ◽

Kok Hian Tan

Keyword(s):

Pregnancy Outcomes ◽

Gestational Hypertension ◽

Local Population ◽

Fetal Loss ◽

Perinatal Outcomes ◽

First Trimester ◽

Adverse Outcomes ◽

Special Focus ◽

Adverse Perinatal Outcomes ◽

Adverse Pregnancy

Abstract Introduction: Massive perivillous fibrinoid deposition (MPFD) is a very rare placental condition characterized by abnormally extensive fibrinoid deposition in the placental villous parenchyma. The aim of this study is to document clinical and pathological features with special focus on pregnancy outcomes of this condition in consecutive cases of MPFD in our local population. Methods: This is a retrospective clinico-pathological study of cases affected by MPFD over the period January 2010–July 2014 in our hospital. We document clinical features (including perinatal outcome and subsequent pregnancies) and placental pathological characteristics. Results: Twelve cases of MPFD were identified among 3640 placentas (0.33%). There was no identified recurrence. The affected infants had adverse outcomes, including intrauterine growth restriction (IUGR) (75%), preterm birth (58.3%), and fetal loss (25%). A high frequency of reduced PAPP-A in the first trimester (25%), and concurrent gestational hypertension or pre-eclampsia (25%) was noted. Conclusion: MPFD is associated with adverse perinatal outcomes. Further research to better understand its pathogenesis and to improve clinical diagnosis and management is warranted.

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Does the Thyroid-Stimulating Hormone Measured Concurrently With First Trimester Biochemical Screening Tests Predict Adverse Pregnancy Outcomes Occurring After 20 Weeks Gestation?

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2014-1918 ◽

2014 ◽

Vol 99 (12) ◽

pp. E2668-E2672 ◽

Cited By ~ 19

Author(s):

Gregory S. Y. Ong ◽

Narelle C. Hadlow ◽

Suzanne J. Brown ◽

Ee Mun Lim ◽

John P. Walsh

Keyword(s):

Thyroid Function ◽

Pregnancy Outcomes ◽

First Trimester ◽

Adverse Pregnancy Outcomes ◽

Adverse Outcomes ◽

First Trimester Screening ◽

Free T4 ◽

Trimester Screening ◽

Secondary Outcomes ◽

Adverse Pregnancy

Context: Maternal hypothyroidism in early pregnancy is associated with adverse outcomes, but not consistently across studies. First trimester screening for chromosomal anomalies is routine in many centers and provides an opportunity to test thyroid function. Objective: To determine if thyroid function tests performed with first trimester screening predicts adverse pregnancy outcomes. Design, Participants and Setting: A cohort study of 2411 women in Western Australia with singleton pregnancies attending first trimester screening between 9 and 14 weeks gestation. Outcome Measures: We evaluated the association between TSH, free T4, free T3, thyroid antibodies, free beta human chorionic gonadotrophin (β-hCG) and pregnancy associated plasma protein A (PAPP-A) with a composite of adverse pregnancy events as the primary outcome. Secondary outcomes included placenta previa, placental abruption, pre-eclampsia, pregnancy loss after 20 weeks gestation, threatened preterm labor, preterm birth, small size for gestational age, neonatal death, and birth defects. Results: TSH exceeded the 97.5th percentile for the first trimester (2.15 mU/L) in 133 (5.5%) women, including 22 (1%) with TSH above the nonpregnant reference range (4 mU/L) and 5 (0.2%) above 10 mU/L. Adverse outcomes occurred in 327 women (15%). TSH and free T4 did not differ significantly between women with or without adverse pregnancy events. On the multivariate analysis, neither maternal TSH >2.15 mU/L nor TSH as a continuous variable predicted primary or secondary outcomes. Conclusion: Testing maternal TSH as part of first trimester screening does not predict adverse pregnancy outcomes. This may be because in the community setting, mainly mild abnormalities in thyroid function are detected.

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Reproductive Concerns Among Female Leukemia and Lymphoma Survivors with the History of Adverse Pregnancy Outcomes after Cancer Treatment

Blood ◽

10.1182/blood-2018-99-110590 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 5893-5893

Author(s):

Ksenya Shliakhtsitsava ◽

Emily Myers ◽

Irene Su

Keyword(s):

Pregnancy Outcome ◽

Pregnancy Outcomes ◽

Adverse Pregnancy Outcome ◽

Adverse Pregnancy Outcomes ◽

The Future ◽

Reproductive Concerns ◽

History Of ◽

Adverse Pregnancy ◽

After Cancer ◽

Lymphoma Survivors

Abstract Introduction Due to advances in cancer treatment the majority of young adults diagnosed with leukemia or lymphoma become long-term survivors. These individuals have been shown to have higher pregnancy risks as a result of cancer and treatment exposure. Adverse pregnancy outcomes including miscarriage and premature delivery may impact survivor's reproductive concerns after cancer. We hypothesized that reproductive-aged female leukemia and lymphoma survivors who experienced miscarriage or premature birth after cancer would have higher reproductive concerns as compared to female leukemia and lymphoma survivors who did not have an adverse pregnancy outcome after cancer. Methods This is a retrospective cohort study of young adult female leukemia and lymphoma survivors with at least one pregnancy after cancer, who are participants of the Reproductive Window study. Study participants were recruited between March 2015 and December 2017 from population-based cancer registries (California and Texas), physician and advocacy group referrals. Eligible women were age 18 to 40 at enrollment, age 15-35 at cancer diagnosis, and had at least one ovary. Enrolled participants answered a questionnaire on pregnancy outcomes and reproductive concerns using the Reproductive Concerns After Cancer (RCAC) Scale. The exposure was adverse pregnancy outcome (miscarriage or premature birth). The outcomes were RCAC subscales measuring concerns regarding becoming pregnant in the future and personal and offspring health. Subscale scores were dichotomized at 3, with >3 indicating moderate to severe reproductive concerns. Logistic regression models were used to test the association between an adverse pregnancy outcome (miscarriage or preterm birth) and RCAC subscales of interest, while adjusting for confounding Results 76 participants, mean age 34.3±3.9 years and mean years since cancer diagnosis 12.0± 5.8 years were included. The majority of participants were white (80%), completed college (72%) and were partnered (87%). Thirty eight percent of participants reported an adverse pregnancy outcome after cancer (18% miscarriage, 21% premature delivery). Thirty-two percent reported moderate to severe concerns about becoming pregnant in the future, 60% regarding offspring health, and 46% over personal health. History of miscarriage after cancer, but not preterm birth, was associated with higher concerns about becoming pregnant. In a multivariable model that adjusted for Hispanic ethnicity, current age, and live birth after cancer, participants who experienced a miscarriage after cancer were more likely to have moderate to high concerns about becoming pregnant in the future (adjusted OR 4.1, 95% CI 1.05-15.5, p=0.042) compared to participants with no history of miscarriage. Neither adverse pregnancy outcomes was associated with concerns about offspring or personal health. Conclusions In the cohort of young adult female leukemia and lymphoma survivors, experiencing a miscarriage after cancer was associated with higher concerns regarding becoming pregnant in the future. Additional research is needed to determine whether interventions such as preconception counseling with consideration of prior cancer treatments may help manage these concerns and improve pregnancy outcomes. Disclosures No relevant conflicts of interest to declare.

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Effects of sanitation practices on adverse pregnancy outcomes in India: a conducive finding from recent Indian demographic health survey

BMC Pregnancy and Childbirth ◽

10.1186/s12884-019-2528-8 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Ratna Patel ◽

Ajay Gupta ◽

Shekhar Chauhan ◽

Dhananjay W. Bansod

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Pregnancy Outcome ◽

Health Survey ◽

Pregnancy Outcomes ◽

Adverse Pregnancy Outcome ◽

Wealth Index ◽

Adverse Pregnancy Outcomes ◽

Adverse Outcomes ◽

Adverse Pregnancy

Abstract Background Several risk factors predisposing women and their live-borns to adverse outcomes during pregnancy have been documented. Little is known about sanitation being a factor contributing to adverse pregnancy outcomes in India. The role of sanitation in adverse pregnancy outcomes remains largely unexplored in the Indian context. This study is an attempt to bring the focus on sanitation as a factor in adverse pregnancy outcome. Along with the sanitation factors, few confounder variables have also been studied in order to understand the adverse pregnancy outcomes. Methods The study is based on the fourth round of National Family Health Survey (NFHS-IV) covering 26,972 married women in the age-group 15–49. The study variables include the mother’s age, Body Mass Index (BMI), education, anemia, and Antenatal care (ANC) visits during their last pregnancy. The household level variable includes place of residence, religion, caste, wealth index, access to toilet, type of toilet, availability of water within toilet premises, and facility of hand wash near the toilet. Children study variables include Low Birth Weight (LBW), the order of birth (Parity), and the death of the children of the women in the last 5 years. The target variable Adverse Pregnancy Outcome (APO) was constructed using children born with low birth weight or died during the last pregnancy. Results We calculated both adjusted as well as unadjusted odds ratios for a better understanding of the association between sanitation and adverse pregnancy outcomes. Findings from the study showed that women who did not have access to a toilet within the house had a higher risk of adverse pregnancy outcome. In the multivariable model, no association was observed for adverse pregnancy outcome among women who did not have access to toilet and women who used shared toilet. Teenage (15–19 years), uneducated, underweight and anemic mothers were more likely to face APO as compare to other mothers in similar characteristics group. Conclusions Our findings contribute to the decidedly less available literature on maternal sanitation behaviour and adverse pregnancy outcomes. Our results support that sanitation is a very significant aspect for women who are about to deliver a baby as there was an association between sanitation and adverse pregnancy outcome. Education on sanitation practices is the need of the hour as much as it needs to follow.

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Adverse Pregnancy Outcomes of Patients with History of First-Trimester Recurrent Spontaneous Abortion

BioMed Research International ◽

10.1155/2017/4359424 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

Jing Yang ◽

Yan Wang ◽

Xiao-ye Wang ◽

Yan-yu Zhao ◽

Jing Wang ◽

...

Keyword(s):

Risk Factor ◽

Cesarean Section ◽

Spontaneous Abortion ◽

Pregnancy Outcomes ◽

Pregnancy Complications ◽

First Trimester ◽

Recurrent Spontaneous Abortion ◽

Study Group ◽

History Of ◽

Adverse Pregnancy

Although a history of first-trimester recurrent spontaneous abortion (FRSA) is regarded as a risk factor in antenatal care, the characteristic of subsequent pregnancy outcome is not clearly elucidated. Here, a retrospective analysis was performed on the clinical data of 492 singleton pregnant women. 164 of them with the history of FRSA were enrolled in study group, compared to 328 deliveries without the history of FRSA. For maternal outcomes, patients in the study group delivered earlier with mean gestational age and the incidences of cesarean section and postpartum hemorrhage were higher compared to the control group. For placental outcomes, the incidence of placenta-mediated pregnancy complications (PMPC) in the study group increased in terms of late-onset preeclampsia, oligohydramnios, early-onset fetal growth restriction, and second-trimester abortion. Patients in the study group were more likely to suffer from placenta accreta, placenta increta, and placenta percreta. For perinatal outcomes, the proportion of birth defects of newborns in the study group was greater. At last, logistic regression analyses showed that the history of FRSA was an independent risk factor for cesarean section and pregnancy complications. In conclusion, women with the history of FRSA are often exposed to an elevated incidence of maternal-placental-perinatal adverse pregnancy outcomes.

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Placental Growth Factor and Adverse Obstetric Outcomes in a Mixed-Risk Cohort of Women Screened for Preeclampsia in the First Trimester of Pregnancy

Fetal Diagnosis and Therapy ◽

10.1159/000514201 ◽

2021 ◽

pp. 1-9

Author(s):

Charlotte Kvist Ekelund ◽

Line Rode ◽

Ann Tabor ◽

Jon Hyett ◽

Andrew McLennan

Keyword(s):

Growth Factor ◽

Pregnancy Outcomes ◽

Gestational Hypertension ◽

Adverse Pregnancy Outcome ◽

First Trimester ◽

Placental Growth Factor ◽

Adverse Pregnancy Outcomes ◽

Adverse Outcomes ◽

Obstetric Outcomes ◽

Adverse Pregnancy

Objective: The study aimed to investigate the association between placental growth factor (PlGF) and adverse obstetric outcomes in a mixed-risk cohort of pregnant women screened for preeclampsia (PE) in the first trimester. Methods: We included women with singleton pregnancies screened for PE between April 2014 and September 2016. Outcome data were retrieved from the New South Wales Perinatal Data Collection (NSW PDC) by linkage to the prenatal cohort. Adverse outcomes were defined as spontaneous preterm birth (sPTB) before 37-week gestation, birth weight (BW) below the 3rd centile, PE, gestational hypertension (GH), stillbirth, and neonatal death. Results: The cohort consisted of 11,758 women. PlGF multiple of the median (MoM) was significantly associated with maternal sociodemographic characteristics (particularly smoking status and parity) and all biomarkers used in the PE first trimester screening model (notably pregnancy-associated plasma protein A MoM and uterine artery pulsatility index [PI] MoM). Low levels of PlGF (<0.3 MoM and <0.5 MoM) were independently associated with sPTB, low BW, PE, GH, and a composite adverse pregnancy outcome score, with odds ratios between 1.81 and 4.44 on multivariable logistic regression analyses. Conclusions: Low PlGF MoM levels are independently associated with PE and a range of other adverse pregnancy outcomes. Inclusion of PlGF should be considered in future models screening for adverse pregnancy outcomes in the first trimester.

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A comparative study of pregnancy outcomes among women with and without threatened miscarriage in the first trimester in Abakaliki Southeast Nigeria

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20193789 ◽

2019 ◽

Vol 8 (9) ◽

pp. 3639

Author(s):

Johnbosco Ifunanya Nwafor ◽

Victor Jude Uchenna Onuchukwu ◽

Vitus Okwuchukwu Obi ◽

Darlinghton-Peter Chibuzor Ugoji ◽

Blessing Idzuinya Onwe ◽

...

Keyword(s):

Pregnancy Outcomes ◽

Neonatal Intensive Care ◽

First Trimester ◽

Adverse Pregnancy Outcomes ◽

University Teaching ◽

Retrospective Case ◽

Threatened Miscarriage ◽

Increased Risk ◽

Adverse Pregnancy ◽

Control Study

Background:Threatened miscarriage is the commonest complication of pregnancy and has been aBackground: Threatened miscarriage is the commonest complication of pregnancy and has been associated with adverse pregnancy outcomes. Therefore, the aim of this study is to determine the association between threatened miscarriage and adverse maternal and perinatal outcomes.Methods: This was a retrospective case-control study undertaken at the Alex Ekwueme Federal University Teaching Hospital, Abakaliki. The study involved 228 women presenting with threatened miscarriage in the first trimester and 228 asymptomatic matched controls. The statistical analysis was done using Epi info version 7.1.5, March 2015 (CDC, Atlanta, Georgia, USA).Results: Women with threatened miscarriage were more likely to have preterm delivery (OR = 7.1, 95% CI = 3.51-14.32, P <0.0001), placenta praevia (OR = 2.4, 95% CI = 1.13 - 5.26, P = 0.03), placental abruption (OR = 3.6, 95% CI = 1.40 - 9.03, P = 0.01) and retained placenta (OR = 2.9, 95% CI = 1.18 - 6.97, P = 0.02). Similarly, women with first trimester threatened miscarriage were more likely to develop postpartum haemorrhage (OR = 2.4, 95% CI = 1.17 - 5.06, P = 0.02). There was no significant differences in the stillbirth rate, Apgar scores at 5 minutes less than 7, admission into neonatal intensive care unit and early neonatal death. Threatened miscarriage was associated with intrauterine growth restriction (OR = 3.5, 95% CI = 1.77 - 6.88, P <0.0001) and low birth weight <2.kg (OR = 3.2, 95% CI = 1.33 - 7.69, P = 0.01).Conclusions: Women with threatened miscarriage in the first trimester are at increased risk of adverse pregnancy outcomes and the risk factors should be taken into consideration when deciding upon antenatal surveillance and management of their pregnancies.

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Protein Z, an anticoagulant protein with expanding role in reproductive biology

Reproduction ◽

10.1530/rep-13-0072 ◽

2013 ◽

Vol 146 (2) ◽

pp. R73-R80 ◽

Cited By ~ 11

Author(s):

Wassim Y Almawi ◽

Fatima S Al-Shaikh ◽

Ohannes K Melemedjian ◽

Ahmad W Almawi

Keyword(s):

Vitamin K ◽

Pregnancy Outcomes ◽

Recurrent Miscarriage ◽

Factor Xa ◽

Protein S ◽

First Trimester ◽

Adverse Pregnancy Outcomes ◽

Protein Z ◽

Venous Thromboembolic ◽

Adverse Pregnancy

Protein Z (PZ) is a vitamin K-dependent factor characterized by its homology to other vitamin K-dependent factors (factors VII, IX, and X, protein C and protein S), but lacks any enzymatic activity. Instead, PZ acts as a cofactor for the inhibition of factor Xa through the serpin PZ-dependent protease inhibitor (ZPI). PZ deficiency is associated with a procoagulant state, highlighted by excessive FXa secretion and thrombin production, and is linked with several thrombotic disorders, including arterial vascular and venous thromboembolic diseases. A role for the PZ–ZPI complex in the regulation of physiological pregnancy has been demonstrated, highlighted by the progressive elevation in PZ levels in the first trimester of gestation, which then steadily decline toward delivery. An association between altered plasma PZ concentrations and adverse pregnancy outcomes (recurrent miscarriage, stillbirth, preeclampsia, intrauterine growth restriction, and placental abruption) has been reported. The mechanism by which PZ deficiency leads to adverse pregnancy outcomes is not clear, but it is multifactorial. It may be attributed to the anti-PZ IgG and IgM autoantibodies, which apparently act independently of classical antiphospholipid antibodies (lupus anticoagulant, anticardiolipin, and anti-β2-glycoprotein I antibodies). PZ deficiency has also been reported to be constitutional, and a number of variants in thePROZ(PZ) gene andSERPINA10(ZPI) gene are linked with specific adverse pregnancy complications. This review summarizes the relationship between adverse pregnancy outcomes and acquired and constitutional PZ–ZPI deficiency, in order to understand whether or not PZ deficiency could be considered as a risk factor for poor pregnancy outcomes.

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Differences in First-Trimester Maternal Metabolomic Profiles in Pregnancies Conceived From Fertility Treatments

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2018-01118 ◽

2018 ◽

Vol 104 (4) ◽

pp. 1005-1019 ◽

Cited By ~ 4

Author(s):

Tianyanxin Sun ◽

Bora Lee ◽

Jason Kinchen ◽

Erica T Wang ◽

Tania L Gonzalez ◽

...

Keyword(s):

In Vitro Fertilization ◽

Pregnancy Outcomes ◽

First Trimester ◽

Maternal Plasma ◽

Adverse Outcomes ◽

Hormone Production ◽

Vitro Fertilization ◽

Fertility Treatments ◽

Adverse Pregnancy

Abstract Context Maternal metabolic status reflects underlying physiological changes in the maternal-placental-fetal unit that may help identify contributors to adverse pregnancy outcomes associated with infertility and treatments used. Objective To determine if maternal metabolomic profiles differ between spontaneous pregnancies and pregnancies conceived with fertility treatments that may explain the differences in pregnancy outcomes. Design Metabolon metabolomic analysis and ELISAs for 17-β-estradiol and progesterone were performed during the late first trimester of pregnancy. Setting Academic institution. Subjects Women in the Spontaneous/Medically Assisted/Assisted Reproductive Technology cohort (N = 409), 208 of whom conceived spontaneously and 201 with infertility [non in vitro fertilization treatments (NIFT), n=90; in vitro fertilization (IVF), n=111]. Intervention Mode of conception. Main Outcome Measures Levels of of 806 metabolites within eight superpathways, 17-β-estradiol, and progesterone in maternal plasma in the late first trimester. Results Metabolomic differences in the lipid superpathway (i.e., steroid metabolites, lipids with docosahexaenoyl acyl chains, acyl cholines), and xanthine and benzoate metabolites (P < 0.05) were significant among the spontaneous and two infertility groups, with greatest differences between the spontaneous and IVF groups. 17-β-estradiol and progesterone levels were significantly elevated in the infertility groups, with greatest differences between the spontaneous and IVF groups. Conclusion Metabolomic profiles differ between spontaneous and infertility pregnancies, likely driven by IVF. Higher levels of steroids and their metabolites are likely due to increased hormone production from placenta reprogrammed from fertility treatments, which may contribute to adverse outcomes associated with infertility and the treatments used.

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