Maternal Vascular Lesions in the Placenta Predict Vascular Impairments a Decade After Delivery

Women with adverse pregnancy outcomes later experience excess hypertension and cardiovascular disease, but how the events are linked is unknown. Examination of the placenta may provide clues to vascular impairments after delivery. Maternal vascular malperfusion lesions (MVMs) were abstracted from clinical reports, validated and characterized using clinical guidelines and severity score. A total of 492 women (170 with MVMs and 322 without MVMs) participated in a study visit 8 to 10 years after delivery to assess blood pressure, cardiometabolic factors, and sublingual microvascular features using sidestream dark field imaging. Covariates included age, race, adverse pregnancy outcomes (preeclampsia, small for gestational age, and preterm birth), and health behaviors. Women with versus without MVM had a distinct sublingual microvascular profile comprised of (1) lower microvascular density (−410 μm/mm 2 , P =0.015), (2) higher red blood cell filling as a marker of perfusion (2%, P =0.004), and (3) smaller perfused boundary region (−0.07 µm, P =0.025) as a measure of glycocalyx integrity, adjusted for covariates including adverse pregnancy outcomes. Women with MVM also had higher adjusted diastolic blood pressure (+2.6 mm Hg, P =0.021), total and LDL (low-density lipoprotein)-cholesterol (+11.2 mg/dL, P =0.016; +8.7 mg/dL, P =0.031). MVM associations with subsequent cardiovascular measures did not vary by type of adverse pregnancy outcome, except among women with preterm births where blood pressure was higher only among those with MVM. Results were similar when evaluated as MVM severity. A decade after delivery, women with placental vascular lesions had an adverse cardiovascular profile comprised of microvascular rarefaction, higher blood pressure and more atherogenic lipids. Placental histopathology may reveal a woman’s early trajectory toward subsequent vascular disease.

Download Full-text

Adverse pregnancy outcomes associated with moderate elevations in blood pressure or blood glucose in Ugandan women; a prospective cohort study

AJOG Global Reports ◽

10.1016/j.xagr.2021.100007 ◽

2021 ◽

Vol 1 (2) ◽

pp. 100007

Author(s):

Jack Milln ◽

Betty Nakabuye ◽

Barnabas Natamba ◽

Isaac Sekitoleko ◽

Michael Mubiru ◽

...

Keyword(s):

Blood Pressure ◽

Cohort Study ◽

Blood Glucose ◽

Prospective Cohort Study ◽

Pregnancy Outcomes ◽

Prospective Cohort ◽

Adverse Pregnancy Outcomes ◽

Adverse Pregnancy

Download Full-text

Abstract P176: Associations of Gestational Lipids and Apolipoproteins With Pregnancy Outcomes: The Hyperglycemia and Adverse Pregnancy Outcome Study

Circulation ◽

10.1161/circ.141.suppl_1.p176 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Amanda M Perak ◽

Alan Kuang ◽

Nicola Lancki ◽

Darwin R Labarthe ◽

Svati H Shah ◽

...

Keyword(s):

Blood Pressure ◽

Pregnancy Outcome ◽

Gestational Age ◽

Pregnancy Outcomes ◽

Adverse Pregnancy Outcome ◽

Late Pregnancy ◽

Large For Gestational Age ◽

Obstetric Outcomes ◽

Outcome Study ◽

Adverse Pregnancy

Introduction: Gestational hyperlipidemia has traditionally been considered physiologic and benign, but the significance of inter-individual variation in lipid levels for maternal-fetal health are poorly understood. We examined associations of gestational lipids and apolipoproteins with adverse obstetric and neonatal outcomes. Methods: Data from the Hyperglycemia and Adverse Pregnancy Outcome Study were analyzed, including 1,813 mother-child dyads from 9 field centers in 6 countries: US (25%), Barbados (24%), UK (20%), China (16%), Thailand (8%), and Canada (7%). Fasting lipids and apolipoproteins were directly measured at a mean of 28 (range 23-34) weeks’ gestation. Cord blood was collected at delivery, neonatal anthropometrics were measured within 72 hours, and medical records were abstracted for obstetric outcomes. Logistic regression was utilized to test associations of lipids and apolipoproteins (per +1 SD; log-transformed if skewed) with pregnancy outcomes, adjusted for center, demographics, and maternal covariates such as BMI, blood pressure, and glycemia. Results: See Table for lipid and apolipoprotein levels in pregnant mothers. In fully adjusted models ( Table ), 1 SD higher log-triglycerides (i.e., ~2.7-fold higher triglyceride level) in late pregnancy was significantly associated with higher odds for preeclampsia (OR 1.53 [95% CI, 1.15-2.05]), large for gestational age infant (1.42 [1.21-1.67]), and infant insulin sensitivity <10 th percentile (1.25 [1.03-1.50]), but not with unplanned primary cesarean section or infant sum of skinfolds >90 th percentile. There were no significant associations of maternal HDL-C, LDL-C, or log-ApoB/A1 ratio with any outcome. Conclusion: Triglyceride levels in the latter half of pregnancy were uniquely associated with both maternal risks (preeclampsia) and neonatal risks (large for gestational age and insulin resistance), even after adjustment for maternal BMI, blood pressure, and glycemia.

Download Full-text

Applying deep learning for adverse pregnancy outcome detection with pre-pregnancy health data

MATEC Web of Conferences ◽

10.1051/matecconf/201818910014 ◽

2018 ◽

Vol 189 ◽

pp. 10014 ◽

Cited By ~ 2

Author(s):

Yu Mu ◽

Kai Feng ◽

Ying Yang ◽

Jingyuan Wang

Keyword(s):

Deep Learning ◽

Pregnancy Outcome ◽

Pregnancy Outcomes ◽

Learning Algorithm ◽

Adverse Pregnancy Outcome ◽

Health Data ◽

Adverse Pregnancy Outcomes ◽

Deep Learning Algorithm ◽

Adverse Pregnancy

Adverse pregnancy outcomes can bring enormous losses to both families and the society. Thus, pregnancy outcome prediction stays a crucial research topic as it may help reducing birth defect and improving the quality of population. However, recent advances in adverse pregnancy outcome detection are driven by data collected after mothers having been pregnant. In this situation, if a bad pregnancy outcome is diagnosed, the parents will suffer both physically and emotionally. In this paper, we develop a deep learning algorithm which is able to detect and classify adverse pregnancy outcomes before parents getting pregnant. We train a multi-layer neural network by using a dataset of 75542 couples’ multidimension pre-pregnancy health data. Our model outperforms some of algorithms in accuracy, recall and F1 score.

Download Full-text

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.

Download Full-text

Assessment of HCMV-encoded microRNAs in Plasma as Potential Biomarkers in Pregnant Women with Adverse Pregnancy Outcomes

10.21203/rs.3.rs-95116/v1 ◽

2020 ◽

Author(s):

Zhiying Gao ◽

Likun Zhou ◽

Jing Bai ◽

Meng Ding ◽

Deshui Liu ◽

...

Keyword(s):

Pregnant Women ◽

Pregnancy Outcomes ◽

Adverse Pregnancy Outcome ◽

Expression Profiles ◽

Plasma Concentrations ◽

Adverse Pregnancy Outcomes ◽

Immunoglobulin M ◽

Validation Data ◽

Adverse Pregnancy ◽

Normal Controls

Abstract Background: Human cytomegalovirus (HCMV) is the most frequent cause of congenital infections and can lead to adverse pregnancy outcomes (APO). HCMV encodes multiple microRNAs (miRNAs) that have been reported to be partially related to host immune responses, cell cycle regulation, viral replication and viral latency, and can be detected in human plasma. However, the relevance of HCMV-encoded miRNAs in maternal plasma as an indicator for APO has never been evaluated.Methods: The expression profiles of 25 HCMV-encoded miRNAs were first measured in plasma samples from 20 pregnant women with APO and 28 normal controls by quantitative reverse-transcription polymerase chain reaction (RT-qPCR) technology. Next, markedly changed miRNAs were validated in another independent validation set consisting of 20 pregnant women with APO and 27 control subjects. HCMV DNA in peripheral blood leukocytes (PBLs) and anti-HCMV immunoglobulin M (IgM) and anti-HCMV immunoglobulin G (IgG) in plasma were also examined in both the training and validation sets. Diagnostic value and risk factors were compared between adverse pregnancy outcome cohorts and normal controls.Results: The analysis of training and validation data sets revealed that plasma concentrations of hcmv-miR-UL148D, hcmv-miR-US25-1-5p and hcmv-miR-US5-1 were obviously increased in pregnant women with APO compared with normal controls. Hcmv-miR-US25-1-5p presented the largest area under the receiver-operating characteristic (ROC) curve (0.735; 95% CI, 0.635–0.836), with a sensitivity of 68% and specificity of 71%. Furthermore, the plasma levels of hcmv-miR-US25-1-5p and hcmv-miR-US5-1 were obviously positively correlated with APO (P = 0.029 and 0.035, respectively). Nevertheless, neither the concentration of HCMV DNA in PBLs nor the positivity rates of anti-HCMV IgM and IgG in plasma showed statistically significant correlation with APO.Conclusion: We identified a unique signature of HCMV-encoded miRNAs in pregnant women with APO, which may be useful as a potential noninvasive biomarker for predicting and monitoring APO during HCMV infection.

Download Full-text

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.

Download Full-text

Pregnancy Outcomes and Blood Pressure Visit-to-Visit Variability and Level in Three Less-Developed Countries

Hypertension ◽

10.1161/hypertensionaha.120.16851 ◽

2021 ◽

Vol 77 (5) ◽

pp. 1714-1722

Author(s):

Laura A. Magee ◽

Jeffrey Bone ◽

Salwa Banoo Owasil ◽

Joel Singer ◽

Terry Lee ◽

...

Keyword(s):

Blood Pressure ◽

Pregnancy Outcomes ◽

Developed Countries ◽

Adverse Pregnancy Outcomes ◽

Less Developed Countries ◽

Composite Outcome ◽

High Definition ◽

Mortality And Morbidity ◽

Adverse Pregnancy ◽

Cluster Randomized

In pregnancy in well-resourced settings, limited data suggest that higher blood pressure (BP) visit-to-visit variability may be associated with adverse pregnancy outcomes. Included were pregnant women in 22 intervention clusters of the CLIP (Community-Level Interventions for Preeclampsia) cluster randomized trials, who had received at least 2 prenatal contacts from a community health worker, including standardized BP measurement. Mixed-effects adjusted logistic regression assessed relationships between pregnancy outcomes and both BP level (median [interquartile range]) and visit-to-visit variability (SD and average real variability [ARV], adjusted for BP level), among all women and those who became hypertensive. The primary outcome was the CLIP composite of maternal and perinatal mortality and morbidity. Among 17 770 pregnancies, higher systolic and diastolic BP levels were associated with increased odds of the composite outcome per 5 mm Hg increase in BP (odds ratio [OR], 1.05 [95% CI, 1.03–1.07] and OR, 1.08 [1.06–1.11], respectively). Higher BP visit-to-visit variability was associated with increased odds, per a SD increase in BP variability measure, of (1) hypertension (systolic: OR, 2.09 [1.98–2.21] for SD and 1.52 [1.45–1.60] for ARV; diastolic: OR, 2.70 [2.54–2.87] for SD and 1.86 [1.76–1.96] for ARV); and (2) the composite outcome (systolic: OR, 1.10 [1.06–1.14] for SD and 1.06 [1.02–1.10] for ARV; diastolic: OR, 1.07 [1.03–1.11] for SD and 1.06 [1.02–1.09] for ARV). In 3 less-developed countries, higher BP level and visit-to-visit variability predicted adverse pregnancy outcomes, providing an opportunity for high-definition medicine.

Download Full-text

Does Multiparity Affect Periodontitis Associated Adverse Pregnancy Outcomes' Awareness?

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i60a34496 ◽

2021 ◽

pp. 359-370

Author(s):

Mohamed Abdelrasoul ◽

Bashayer Bahamdain ◽

Raghad Hasanain ◽

Renad Barayan ◽

Nada Bugis ◽

...

Keyword(s):

Saudi Arabia ◽

Pregnancy Outcomes ◽

Adverse Pregnancy Outcome ◽

Oral Bacteria ◽

Adverse Pregnancy Outcomes ◽

University Education ◽

Cross Sectional ◽

Convenience Sample ◽

Validated Questionnaire ◽

Adverse Pregnancy

Background: Periodontal disease is a very common, undesirable, and neglected bacterial infection causing destruction of the connective tissue and dental bone support. During pregnancy, the oral bacteria could lead to tissue damage and mediate immune response which can impair the development and fetal growth in the placenta that it may be a risk factor for pre-term birth (before 37 weeks of gestation). The goal of this study to measure the knowledge and awareness of women in Jeddah, Saudi Arabia toward the relation between periodontitis and adverse pregnancy outcome. Methodology: A cross-sectional study was done in Jeddah, Saudi Arabia from January 2020 until November 2021. based on a validated questionnaire developed by the authors. A convenience sample size of 966 women, aged 20-50 years, with a confidence level of 95%, and a 5% margin of error was selected. The questionnaire was divided into three main sections: demographics, knowledge and attitude. Results: The study showed a mean score of awareness of 3.801.26 (54.35 ± 17.98%) while the mean score of attitudes was 1.60 ± 0.98 (39.91 ± 24.42%). There was no statistically significant relationship to age group, nationality, or parity, however, scores were significant to university education level. Conclusion: Learning from previous multigravidas did not influence knowledge and awareness towards adverse pregnancy outcomes associated with PD.

Download Full-text

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.

Download Full-text