Risk factors associated with adverse pregnancy outcomes in patients with new-onset systemic lupus erythematosus during pregnancy

Lupus ◽  
2021 ◽  
pp. 096120332098053
Author(s):  
Jian Chen ◽  
Zi-Zi Xiao ◽  
Qing Shi ◽  
Hui-Min Wang ◽  
Fang He ◽  
...  
Keyword(s):  
Risk Factors ◽  
Preterm Birth ◽  
Fetal Growth ◽  
Pregnancy Outcomes ◽  
Fetal Growth Restriction ◽  
Pregnancy Loss ◽  
Renal Involvement ◽  
Growth Restriction ◽  
Adverse Pregnancy ◽  
New Onset

Objective To investigate the risk factors for Adverse pregnancy outcome (APOs) in patients with new-onset SLE during pregnancy. Methods Eighty-five patients with new-onset SLE during pregnancy were analyzed retrospectively. Univariate and multivariate logistic regression were used to identify risk factors for different APOs (pregnancy loss, preterm birth, fetal growth restriction, and eclampsia/preeclampsia). A two-sided p-value below 0.05 was considered significant, and two-sided 95% confidence intervals (CIs) are reported. Results Multivariate analysis indicated that renal involvement (aOR: 7.356; 95%CI:1.516,35.692) and greater SLE disease activity index (SLEDAI) grade (aOR:5.947;95%CI: 1.586,22.294) increased the risk for composite APO, and that use of heparin therapy (aOR: 0.081; 95%CI: 0.012, 0.532) was a protective factor. Advanced gestational age at disease onset (aOR: 0.879; 95%CI: 0.819,0.943) and high serum albumin level (aOR: 0.908,95%CI: 0.831,0.992) protected against pregnancy loss. Renal involvement increased the risk for preterm birth (aOR: 2.272; 95%CI: 1.030,7.222) and fetal growth restriction (aOR: 9.070; 95%CI: 1.131,72.743). Hypertension (aOR: 19.185; 95%CI: 3.921,93.868), renal involvement (aOR: 8.380, 95%CI: 1.944,74.376) increased the risk for eclampsia/preeclampsia. Conclusion New onset SLE during pregnancy increased the risk for multiple APOs. Timely management of the risk factors identified here may help to improve pregnancy outcomes in these patients.

scholarly journals Effect of Endogenic and Exogenic Oxidative Stress Triggers on Adverse Pregnancy Outcomes: Preeclampsia, Fetal Growth Restriction, Gestational Diabetes Mellitus and Preterm Birth

2021 ◽  
Vol 22 (18) ◽  
pp. 10122
Author(s):  
Eun Hui Joo ◽  
Young Ran Kim ◽  
Nari Kim ◽  
Jae Eun Jung ◽  
Seon Ha Han ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Diabetes Mellitus ◽  
Preterm Birth ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Fetal Growth ◽  
Pregnancy Outcomes ◽  
Fetal Growth Restriction ◽  
Growth Restriction ◽  
Adverse Pregnancy

Oxidative stress is caused by an imbalance between the production of reactive oxygen species (ROS) in cells and tissues and the ability of a biological system to detoxify them. During a normal pregnancy, oxidative stress increases the normal systemic inflammatory response and is usually well-controlled by the balanced body mechanism of the detoxification of anti-oxidative products. However, pregnancy is also a condition in which this adaptation and balance can be easily disrupted. Excessive ROS is detrimental and associated with many pregnancy complications, such as preeclampsia (PE), fetal growth restriction (FGR), gestational diabetes mellitus (GDM), and preterm birth (PTB), by damaging placentation. The placenta is a tissue rich in mitochondria that produces the majority of ROS, so it is important to maintain normal placental function and properly develop its vascular network to ensure a safe and healthy pregnancy. Antioxidants may ameliorate these diseases, and related research is progressing. This review aimed to determine the association between oxidative stress and adverse pregnancy outcomes, especially PE, FGR, GDM, and PTB, and explore how to overcome this oxidative stress in these unfavorable conditions.

scholarly journals Association between neighbourhood deprivation, fetal growth, small-for-gestational age and preterm birth: a population-based prospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e049075
Author(s):  
Dionne V Gootjes ◽  
Anke G Posthumus ◽  
Vincent W V Jaddoe ◽  
Eric A P Steegers
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Preterm Birth ◽  
Fetal Growth ◽  
Gestational Age ◽  
Pregnancy Outcomes ◽  
First Trimester ◽  
Adverse Pregnancy Outcomes ◽  
Neighbourhood Deprivation ◽  
Adverse Pregnancy

ObjectiveTo study the associations between neighbourhood deprivation and fetal growth, including growth in the first trimester, and adverse pregnancy outcomes.DesignProspective cohort study.SettingThe Netherlands, Rotterdam.Participants8617 live singleton births from the Generation R cohort study.ExpositionLiving in a deprived neighbourhood.Main outcome measuresFetal growth trajectories of head circumference, weight and length.Secondary outcomes measuresSmall-for-gestational age (SGA) and preterm birth (PTB).ResultsNeighbourhood deprivation was not associated with first trimester growth. However, a higher neighbourhood status score (less deprivation) was associated with increased fetal growth in the second and third trimesters (eg, estimated fetal weight; adjusted regression coefficient 0.04, 95% CI 0.02 to 0.06). Less deprivation was also associated with decreased odds of SGA (adjusted OR 0.91, 95% CI 0.86 to 0.97, p=0.01) and PTB (adjusted OR 0.89, 95% CI 0.82 to 0.96, p=0.01).ConclusionsWe found an association between neighbourhood deprivation and fetal growth in the second and third trimester pregnancy, but not with first trimester growth. Less neighbourhood deprivation is associated with lower odds of adverse pregnancy outcomes. The associations remained after adjustment for individual-level risk factors. This supports the hypothesis that living in a deprived neighbourhood acts as an independent risk factor for fetal growth and adverse pregnancy outcomes, above and beyond individual risk factors.

Preterm Preeclampsia with Severe Features: Composite Maternal and Neonatal Morbidities Associated with Fetal Growth Restriction

2018 ◽  
Vol 35 (08) ◽  
pp. 785-790 ◽  
Author(s):  
Raminder Khanagura ◽  
Heather Kregel ◽  
Farah Amro ◽  
Baha Sibai ◽  
Suneet Chauhan ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Gestational Age ◽  
Pregnancy Outcomes ◽  
Fetal Growth Restriction ◽  
Multivariable Analysis ◽  
Growth Restriction ◽  
Tertiary Center ◽  
Appropriate For Gestational Age ◽  
Adverse Pregnancy ◽  
Estimated Fetal Weight

Objective The objective of this study was to compare adverse pregnancy outcomes between fetuses with estimated fetal weight (EFW) < 10 to > 10% in women with preterm preeclampsia (PE) with severe features. Materials and Methods All women with preterm PE with severe features and nonanomalous singletons with EFW were identified at a tertiary center. Women with oligohydramnios or absent/reversed umbilical Doppler velocimetry were excluded. Using multivariable analysis, we compared the composite maternal and neonatal morbidities (CMM and CNM) between those with appropriate for gestational age (AGA) fetal growth, defined as EFW at 10 to 90th versus those with fetal growth restriction (FGR), defined as EFW < 10th percentile for gestational age (GA). Results In this study, 165 patients were included; 112 had EFW at 10th to 90th percentile, and 53 had FGR. Of the 53 with FGR, 33 (62%) had EFW at 5 to 9% for GA and 20 (38%) had EFW < fifth percentile for GA. The CMM was significantly higher among women with FGR versus AGA (29 vs. 7%; p < 0.001). The CNM was significantly higher with FGR versus AGA (20 vs. 6%; p = 0.01). Conclusion Women with preterm PE with severe features and FGR, when compared with those with AGA, have significantly higher risk of CMM and CNM.

scholarly journals Fetal growth restriction as the initial finding of preeclampsia is a clinical predictor of maternal and neonatal prognoses: a single-center retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Masaya Takahashi ◽  
Shintaro Makino ◽  
Kyoko Oguma ◽  
Haruka Imai ◽  
Ai Takamizu ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Fetal Growth ◽  
Pregnancy Outcomes ◽  
Pregnancy Complications ◽  
Fetal Growth Restriction ◽  
Premature Birth ◽  
Adverse Pregnancy Outcomes ◽  
Growth Restriction ◽  
Hypertensive Disorder ◽  
Adverse Pregnancy

Abstract Background Preeclampsia (PE) is a hypertensive disorder specific to pregnancy that can cause severe maternal-neonatal complications. The International Society for the Study of Hypertension in Pregnancy revised the PE criteria in 2018; a PE diagnosis can be established in the absence of proteinuria when organ or uteroplacental dysfunction occurs. The initial findings of PE (IFsPE) at the first diagnosis can vary considerably across patients. However, the impacts of different IFsPE on patient prognoses have not been reported. Thus, we investigate the predictors of pregnancy complications and adverse pregnancy outcomes based on IFsPE according to the new criteria. Methods This retrospective study included 3729 women who delivered at our hospital between 2015 and 2019. All women were reclassified based on the new PE criteria and divided into three groups based on the IFsPE: Classification 1 (C-1), proteinuria (classical criteria); Classification 2 (C-2), damage to other maternal organs; and Classification 3 (C-3), uteroplacental dysfunction. Pregnancy complications and adverse pregnancy outcomes were assessed and compared among the three groups. Results In total, 104 women with PE were included. Of those, 42 (40.4%), 28 (26.9%), and 34 (32.7%) were assigned to C-1, C-2, and C-3 groups, respectively. No significant differences in maternal characteristics were detected among the three groups, except for gestational age at PE diagnosis (C-1, 35.5 ± 3.0 weeks; C-2, 35.2 ± 3.6 weeks; C-3, 31.6 ± 4.6 weeks, p <  0.01). The rates of premature birth at < 37 weeks of gestation, fetal growth restriction (FGR), and neonatal acidosis were significantly higher in the C-3 group compared to the C-1 and C-2 groups. Additionally, the composite adverse pregnancy outcomes of the C-3 group compared with C-1 and C-2 represented a significantly higher number of patients. Conclusions PE patients with uteroplacental dysfunction as IFsPE had the most unfavorable prognoses for premature birth, FGR, acidosis, and composite adverse pregnancy outcomes.

scholarly journals First trimester uterine artery Doppler screening in the prediction of adverse pregnancy outcomes

2021 ◽  
Vol 10 (10) ◽  
pp. 3933
Author(s):  
Jacqueline A. Jayson ◽  
Kavita Mandrelle ◽  
Tapasya Dhar ◽  
Subhash Singla
Keyword(s):  
Fetal Growth ◽  
Pregnancy Outcomes ◽  
Fetal Growth Restriction ◽  
Pulsatility Index ◽  
Uterine Artery ◽  
First Trimester ◽  
Adverse Pregnancy Outcomes ◽  
Growth Restriction ◽  
Uterine Artery Doppler ◽  
Adverse Pregnancy

Background: Uterine artery Doppler waveform has been extensively studied as a predictive marker for the later development of preeclampsia and fetal growth restriction. Therefore, uterine artery doppler has emerged as a good test for the prediction of preeclampsia, being simple to perform, reproducible and non-invasive. The present study was done to evaluate the first trimester uterine artery Doppler in the prediction of adverse pregnancy outcome.Methods: This was a prospective cohort study for all pregnant women attending antenatal clinic during 11-14 weeks of gestation at Christian medical college and hospital, Ludhiana, during a period of 18 months. Study population of (n~270) was taken. A pre-designed case record was filled at the time of registration. After taking informed consent, these women underwent ultrasound for uterine artery Doppler pulsatility index along with nuchal translucency & nasal bone scan by transabdominal ultrasound. Patients were followed up throughout the gestation to find out the development of any adverse pregnancy outcomes (early onset preeclampsia, early onset fetal growth restriction, late onset preeclampsia, late onset fetal growth restriction, oligohydramnios, placental abruption and stillbirth).Results: In our study, about 75% of antenatal women were found to have normal first trimester uterine artery pulsatility index and the rest 25% had abnormal pulsatility index. About 40% of women with abnormal dopplers developed complications associated to hypertensive disorders and adverse pregnancy outcomes, while 60% went on to have a normal pregnancy. It was observed that 13.2% developed gestational hypertension, 10.29% developed pulmonary embolism, 1.47% developed eclampsia, 22.05% developed oligohydramnios, 42.64% developed fetal growth restriction, 4.41 % developed placental abruption and 5.88% delivered stillbirth neonates.Conclusions: As hypertensive disorders of pregnancy pose a great risk of maternal and fetal morbidity and mortality, an evolution of Doppler studies have proven to be beneficial. Doppler ultrasound was found to be a valuable modality in the evaluation of fetal and placental circulation as well as in the prediction of pregnancy outcomes. According to the receiver operating characteristic curve obtained in our study, sensitivity and specificity of first trimester uterine artery pulsatility index was predictive for pregnancy complications and adverse outcomes.

Sign in / Sign up

Export Citation Format

Share Document