ROC Curve Analysis of the Sensitivity and Specificity of Biochemical Detection of Intrahepatic Cholestasis during Pregnancy

Abstract Introduction Intrahepatic cholestasis of pregnancy (ICP) is associated with an increased risk of adverse pregnancy outcomes in mothers and infants. The aim was to evaluate the sensitivity and specificity of biochemical detection of ICP by ROC curve and to determine the threshold of more reliable experimental indicators. Materials and Methods 305 patients and 305 healthy pregnant women were enrolled in the study. Results The average levels of TBA, ALT, and AST in the ICP group were much higher than those in the control group (P<0. 001); the area of both CG and TBA under ROC curve was up to 0.99, the sensitivity was 97.7%, and the specificity was 99.3%. Conclusions This study did not find any single specificity and sensitivity markers that could be used to reliably diagnose ICP. In the future, we will pay more attention to the correlation between sensitive biochemical indicators and adverse pregnancy outcomes.

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Increased Risk of Stillbirth among Women whose Partner Has Tuberculosis

BioMed Research International ◽

10.1155/2021/1837881 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Qi Sun ◽

Hongguang Zhang ◽

Ya Zhang ◽

Zuoqi Peng ◽

Jianbo Lu ◽

...

Keyword(s):

Logistic Regression ◽

Birth Weight ◽

Low Birth Weight ◽

Pregnancy Outcomes ◽

Chinese Women ◽

Adverse Pregnancy Outcomes ◽

Control Group ◽

Increased Risk ◽

Significant Difference ◽

Adverse Pregnancy

Background. The relationship between tuberculosis (TB) and adverse pregnancy outcomes remains unclear. The aim of our study was to investigate whether TB is a risk factor for adverse pregnancy outcomes including premature birth, low birth weight, and stillbirth. Method. We conducted a population-based retrospective cohort study in mainland China. A total of 3,668,004 Chinese women, along with their partners, were included in this study, within the National Free Pre-Pregnancy Checkups Project, during 2015–2018. Propensity score matching was used to balance the two groups (cases: women or partners with TB; controls: women and partners without TB). Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results. Multivariate logistic regression showed that the OR of stillbirth for cases was 1.89 (95% CI: 1.09–3.16), in comparison with the control group. In the subgroup analysis, women whose partner had TB had a higher risk of stillbirth (OR: 2.13, 95% CI: 1.10–3.86) than women whose partner did not have TB. There was no significant difference in adverse pregnancy outcomes, including preterm birth, low birth weight, and stillbirth, between women with and without TB. Conclusions. Women whose partner had TB were more likely to have stillbirth than women whose partners did not have TB.

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The association between soy intake and risk of gestational diabetes mellitus: a prospective cohort study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04175-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yan Wang ◽

Biru Luo ◽

Jie Xiang

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Cesarean Section ◽

Gestational Diabetes Mellitus ◽

Pregnant Women ◽

Pregnancy Outcomes ◽

Adverse Pregnancy Outcomes ◽

Control Group ◽

Increased Risk ◽

Adverse Pregnancy

Abstract Background The association between soy intake and adverse pregnancy outcomes remains unclear. The objectives of this study were to investigate the soy consumption of pregnant women in the second trimester and explore the prospective association between soy intake and the risk of adverse pregnancy outcomes. Methods Pregnant women between 13 and 24 weeks of gestation were recruited at a women’s and children’s hospital in southwest China from June to December 2019. Dietary intakes in the middle trimester were assessed by a semi-quantitative food frequency questionnaire. Participants were divided into the insufficient group (< 40 g/day) and the control group (≥40 g/day) according to daily soy consumption. Participants were followed up until delivery. Pregnancy outcomes including gestational diabetes mellitus (GDM), cesarean section, and macrosomia were obtained. Multiple logistic regression was used to analyze the association between soy intake and risk of adverse pregnancy outcomes. Sociodemographic information, histories of diseases, and duration of physical activities were obtained and used for covariate adjustments. Results A total of 224 participants were included in this study, of which identified 36 (16.1%) cases of GDM, and 120 (53.6%) cases of cesarean section. More than half (125, 55.8%) pregnant women consumed less soy than 40 g/day. Daily soy intake less than 40 g was associated with the increased risk of GDM (OR = 2.755 95%CI 1.230-6.174, P = 0.014) and cesarean section (OR = 1.792 95%CI 1.035-3.101, P = 0.037) without adjustment for confounders such as age, pre-pregnancy body mass index, parity, daily intake of vegetables, fruits, seafood and, nuts. After adjusting for these factors, daily soy intake of less than 40 g increased 2.116-fold risk of GDM (95%CI 1.228-7.907, P = 0.017), but not with the significantly increased risk of cesarean section. Conclusion Insufficient soy intake may increase the risk of GDM, suggesting adequate soy intake may have a beneficial role in the prevention of GDM. Trial registration Registration number: ChiCTR1900023721. Date of registration: June 9, 2019.

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The Need for Personalized Risk-Stratified Approaches to Treatment for Gestational Diabetes: A Narrative Review

Seminars in Reproductive Medicine ◽

10.1055/s-0041-1723778 ◽

2021 ◽

Author(s):

Shamil D. Cooray ◽

Jacqueline A. Boyle ◽

Georgia Soldatos ◽

Shakila Thangaratinam ◽

Helena J. Teede

Keyword(s):

Gestational Diabetes ◽

Pregnancy Outcomes ◽

Population Based ◽

Adverse Pregnancy Outcomes ◽

Therapeutic Interventions ◽

Clinical Prediction Model ◽

Increased Risk ◽

Adverse Pregnancy ◽

The Individual ◽

Personalized Risk

AbstractGestational diabetes mellitus (GDM) is common and is associated with an increased risk of adverse pregnancy outcomes. However, the prevailing one-size-fits-all approach that treats all women with GDM as having equivalent risk needs revision, given the clinical heterogeneity of GDM, the limitations of a population-based approach to risk, and the need to move beyond a glucocentric focus to address other intersecting risk factors. To address these challenges, we propose using a clinical prediction model for adverse pregnancy outcomes to guide risk-stratified approaches to treatment tailored to the individual needs of women with GDM. This will allow preventative and therapeutic interventions to be delivered to those who will maximally benefit, sparing expense, and harm for those at a lower risk.

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Maternal educational inequalities about adverse pregnancy outcomes observed in a rural area of a province of China during a time period (2010–2018)

Journal of Epidemiology & Community Health ◽

10.1136/jech-2021-217754 ◽

2022 ◽

pp. jech-2021-217754

Author(s):

Lixin Li ◽

Yanpeng Wu ◽

Yao Yang ◽

Ying Wu ◽

Yan Zhuang ◽

...

Keyword(s):

Pregnancy Outcomes ◽

Maternal Education ◽

Rural China ◽

Education Level ◽

Adverse Pregnancy Outcomes ◽

Secondary Outcome ◽

Health Examination ◽

Educational Inequalities ◽

Increased Risk ◽

Adverse Pregnancy

BackgroundThe relationship between maternal education and adverse pregnancy outcomes is well documented. However, limited research has investigated maternal educational disparities in adverse pregnancy outcomes in China. This study examined maternal educational inequalities associated with adverse pregnancy outcomes in rural China.MethodsWe conducted a population-based cohort study using participants enrolled in the National Free Preconception Health Examination Project in Yunnan province from 2010 to 2018. The primary outcome was stillbirth, and the secondary outcome was adverse pregnancy outcomes, defined as a composite event of stillbirth, preterm birth or low birth weight. The study was restricted to singleton births at 20–42 weeks’ gestation. Univariate and multivariate log-binomial regression models were performed to estimate crude risk ratios (RRs) and confounding-adjusted RRs (ARRs) for stillbirth and adverse pregnancy outcomes according to maternal education level.ResultsA total of 197 722 singleton births were included in the study. Compared with mid-educated women, low-educated women were at a significantly increased risk of stillbirth (ARR, 1.20; 95% CI, 1.05 to 1.38) and adverse pregnancy outcomes (ARR, 1.11; 95% CI, 1.07 to 1.16). However, the risk of stillbirth (ARR, 1.16; 95% CI, 1.01 to 1.35) was significantly higher for high-educated women compared with mid-educated women.ConclusionCompared with women with medium education level, women with lower education level were more likely to experience adverse pregnancy outcomes, including stillbirth, and women with higher education level were more likely to experience stillbirth.

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Interpregnancy Body Mass Index Changes: Distribution and Impact on Adverse Pregnancy Outcomes in the Subsequent Pregnancy

American Journal of Perinatology ◽

10.1055/s-0038-1670634 ◽

2018 ◽

Vol 36 (05) ◽

pp. 517-521 ◽

Cited By ~ 3

Author(s):

Whitney Bender ◽

Adi Hirshberg ◽

Lisa Levine

Keyword(s):

Body Mass Index ◽

Preterm Birth ◽

Body Mass ◽

Pregnancy Outcomes ◽

Subsequent Pregnancy ◽

Adverse Pregnancy Outcomes ◽

Increased Risk ◽

History Of ◽

Index Changes ◽

Adverse Pregnancy

Objective To examine the change in body mass index (BMI) categories between pregnancies and its effect on adverse pregnancy outcomes. Study Design We performed a retrospective cohort study of women with two consecutive deliveries from 2005 to 2010. Analysis was limited to women with BMI recorded at <24 weeks for both pregnancies. Standard BMI categories were used. Adverse pregnancy outcomes included preterm birth at <37 weeks, intrauterine growth restriction (IUGR), pregnancy-related hypertension, and gestational diabetes mellitus (GDM). Women with increased BMI category between pregnancies were compared with those who remained in the same BMI category. Results In total, 537 women were included, of whom 125 (23%) increased BMI category. There was no association between increase in BMI category and risk of preterm birth, IUGR, or pregnancy-related hypertension. Women who increased BMI category had an increased odds of GDM compared with women who remained in the same BMI category (6.4 vs. 2.2%; p = 0.018). The increased risk remained after controlling for age, history of GDM, and starting BMI (adjusted odds ratio: 8.2; 95% confidence interval: 2.1–32.7; p = 0.003). Conclusion Almost one-quarter of women increased BMI categories between pregnancies. This modifiable risk factor has a significant impact on the risk of GDM.

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Risks of Selected Fetal Adverse Pregnancy Outcomes at Advance Maternal Age

10.53350/pjmhs211582468 ◽

2021 ◽

Vol 15 (8) ◽

pp. 2468-2471

Author(s):

Saadia Yasmeen ◽

Sumayya . ◽

Javeria Saleem ◽

Jawairiah Liaqat ◽

Nadia Pervaiz ◽

...

Keyword(s):

Birth Weight ◽

Preterm Birth ◽

Low Birth Weight ◽

Pregnancy Outcomes ◽

Maternal Age ◽

Advanced Maternal Age ◽

Adverse Pregnancy Outcomes ◽

Control Group ◽

Postpartum Women ◽

Adverse Pregnancy

Background and Aim: Advanced maternal age pregnancy could be referred to as pregnancy after 35 years or older. The prevalence of postponing pregnancies is increasing day by day worldwide. However, limited evidence was found on advanced maternal age pregnancy association with fetal adverse outcomes. The present study aimed to evaluate the frequency of advanced maternal age selected fetal adverse pregnancy outcomes. Place and Duration: Obstetrics & Gynaecology department of Alkhidmat Hospital Kohat and Qazi Hussain Ahmad Medical Complex, Nowshera for duration of six months from November 2020 to April 2021. Materials and Methods: This single-centered retrospective study was conducted on 220 postpartum women in the study group (≥35 years) and 170 control group postpartum women (20-34 years) who delivered at Obstetrics & Gynaecology department of Alkhidmat Hospital Kohat and Qazi Hussain Ahmad Medical Complex, Nowshera after 28 gestational weeks. Individuals who met the inclusion criteria were enrolled and sampled based on randomized control sampling technique for both control and study groups. Data extraction checklist and pretested questionnaire were used for data collection from the maternal charts. Adverse pregnancy outcome and advanced maternal age was correlated adjusted relative risks and strength with a 95% confidence interval. SPSS version 20 was used for data analysis and considered p-value >0.05 as a statistical standard. Results: The adverse neonatal outcomes include low birth weight, preterm birth, and stillbirth with a prevalence 38 (17.4%), 46 (20.8%), and 31 (14.2%) respectively in the study group. In the control group, the incidence of low birth weight, preterm birth, and stillbirth was 21 (12.6%), 15 (14.6%) and 6 (3.5%) respectively. The stillbirth (ARR=3.16 95% CI (1.29–6.03) and preterm deliveries (ARR=2.71 95% CI (1.79–3.86) risk had significantly higher prevalence compared to control group advanced age pregnancy. Insignificance association was found between low birth weight and advanced maternal age. Conclusion: Stillbirth and preterm birth was the adverse fetal outcome significantly related with advanced maternal age pregnancy. There was no significant association between low birth weight and advanced maternal age. Keywords: Maternal age, Fetal Adverse Pregnancy Outcomes

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Predicting pregnancy outcomes from homocysteine level: an evidence from a North Indian study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20201212 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1487

Author(s):

Shaina Chamotra ◽

Kushla Pathania ◽

S. K. Verma ◽

Ankit Chaudhary

Keyword(s):

Pregnancy Outcomes ◽

Homocysteine Level ◽

Perinatal Outcomes ◽

Normal Subjects ◽

Adverse Pregnancy Outcomes ◽

Intrauterine Death ◽

Increased Risk ◽

Causal Pathway ◽

Mother And Child ◽

Adverse Pregnancy

Background: Hypertensive disorders of pregnancy are a major cause of adverse pregnancy outcomes. Though the etiology of spectrum of vascular disorders of pregnancy is still not understood completely, yet abnormally elevated homocysteine level has been implicated in the causal pathway and pathogenesis. Hyperhomocysteinemia has been significantly associated with increased risk of poor maternal and foetal outcomes in terms of PIH, abruption, IUGR, recurrent pregnancy loss, intrauterine death and prematurity.Methods: The present prospective study was conducted among 180 pregnant women (57 exposed and 123 non exposed) in Kamla Nehru State Hospital for Mother and Child, IGMC Shimla, Himachal Pradesh with an objective of determining association of abnormally elevated homocysteine level in pregnancy and adverse pregnancy outcomes. Socio-demographic, clinical, biochemical including homocysteine level, laboratory, ultrasonographic parameters and foeto-maternal outcomes of pregnancy of all the participants were documented.Results: The mean homocysteine level of exposed group (23.26±10.77 µmol/L) was significantly higher than the unexposed group (8.99±2.47 µmol/L). Among hyperhomocysteinemic subjects, 10.5% had abruption, 15.8% had PRES and 8.7% PPH which was significantly higher than normal subjects. Similarly, patients with homocysteinemia had significantly higher proportion (21.3%) of poor Apgar score, more (41.9%) NICU admissions and higher frequency (4.7%) of meconium aspiration syndrome.Conclusions: The present study generates necessary evidence for associating abnormally elevated homocysteine levels with pregnancy related hypertensive ailments and adverse pregnancy outcomes. It further demands the need of robustly designed studies and trials to further explore the phenomenon. Moreover, it emphasizes on a simple and timely intervention like estimating the much-neglected homocysteine levels during pregnancy which can definitely contribute in predicting and preventing adverse perinatal outcomes.

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The IADPSG diagnostic criteria identify women with increased risk of adverse pregnancy outcomes in Victoria

Australian and New Zealand Journal of Obstetrics and Gynaecology ◽

10.1111/ajo.12676 ◽

2017 ◽

Vol 57 (5) ◽

pp. 564-568 ◽

Cited By ~ 6

Author(s):

Sally K. Abell ◽

Helena J. Teede

Keyword(s):

Diagnostic Criteria ◽

Pregnancy Outcomes ◽

Adverse Pregnancy Outcomes ◽

Increased Risk ◽

Adverse Pregnancy

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Chlorination by-products (CBPs) in drinking water and adverse pregnancy outcomes in Italy

Journal of Water and Health ◽

10.2166/wh.2004.0021 ◽

2004 ◽

Vol 2 (4) ◽

pp. 233-247 ◽

Cited By ~ 48

Author(s):

Gabriella Aggazzotti ◽

Elena Righi ◽

Guglielmina Fantuzzi ◽

Barbara Biasotti ◽

Gianbattista Ravera ◽

...

Keyword(s):

Drinking Water ◽

Pregnancy Outcomes ◽

Inhalation Exposure ◽

Preterm Births ◽

Adverse Pregnancy Outcomes ◽

High Exposure ◽

Increased Risk ◽

Adverse Pregnancy ◽

Incident Cases ◽

By Products

Chlorination by-products (CBPs) in drinking water have been associated with an increased risk of adverse pregnancy outcomes, including small for gestational age at term (term-SGA) and preterm delivery. Epidemiological evidence is weakened by a generally inaccurate exposure assessment, often at an ecological level. A case control study with incident cases was performed in nine Italian towns between October 1999 and September 2000. A total of 1,194 subjects were enrolled: 343 preterm births (26th–37th not completed week of pregnancy), 239 term-SGA (from 37th completed week, and weight less than the lowest 10th percentile) and 612 controls. Exposure was assessed both by applying a questionnaire on mothers' personal habits during pregnancy and by water sampling directly at mothers' homes. Levels of trihalomethanes (THMs) were low (median: 1.10 µg l−1), while chlorite and chlorate concentrations were relatively high (median: 216.5 µg l−1 for chlorites and 76.5 µg l−1 for chlorates). Preterm birth showed no association with CBPs, while term-SGA, when chlorite levels ≥200 µg l−1 combined with low and high levels of inhalation exposure are considered, suggested a dose-response relationship (adjusted-Odds Ratios (ORs): 1.52, 95%CI: 0.91–2.54 and 1.70, 95%CI: 0.97–3.0, respectively). A weak association with high exposure levels of either THMs (≥30 µg l−1), or chlorite or chlorate (≥200 µg l−1) was also found (adjusted-OR: 1.38, 95%CI: 0.92–2.07). Chlorine dioxide treatment is widespread in Italy; therefore, chlorite levels should be regularly and carefully monitored and their potential effects on pregnancy further evaluated and better understood.

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