scholarly journals Maternal lithium use and the risk of adverse pregnancy and neonatal outcomes: a Swedish population-based cohort study

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Roxanne Hastie ◽  
Stephen Tong ◽  
Richard Hiscock ◽  
Anthea Lindquist ◽  
Linda Lindström ◽  
...  
Keyword(s):  
Cohort Study ◽  
Preterm Birth ◽  
Gestational Age ◽  
Population Based ◽  
Neonatal Outcomes ◽  
Large For Gestational Age ◽  
Adjusted Relative Risk ◽  
Spontaneous Preterm Birth ◽  
Increased Risk ◽  
Adverse Pregnancy

Abstract Background Lithium is prescribed during pregnancy, but there is limited information about pregnancy and neonatal outcomes following in utero exposure. Thus, this study aimed to investigate the associations between lithium use and adverse pregnancy and neonatal outcomes. Methods This population-based cohort study examined associations between maternal lithium use and major adverse pregnancy and neonatal outcomes via inverse probability weighted propensity score regression models. Results Of 854,017 women included in this study, 434 (0.05%) used lithium during pregnancy. Among pre-specified primary outcomes, lithium use during pregnancy was associated with an increased risk of spontaneous preterm birth (8.7% vs 3.0%; adjusted relative risk [aRR] 2.64 95% CI 1.82, 3.82) and birth of a large for gestational age infant (9.0% vs 3.5%; aRR 2.64 95% CI 1.91, 3.66), but not preeclampsia nor birth of a small for gestational age infant. Among secondary outcomes, lithium use was associated with an increased risk of cardiac malformations (2.1% vs 0.8%; aRR 3.17 95% CI 1.64, 6.13). In an analysis restricted to pregnant women with a diagnosed psychiatric illness (n=9552), associations remained between lithium and spontaneous preterm birth, birth of a large for gestational age infant, and cardiovascular malformations; and a positive association with neonatal hypoglycaemia was also found. These associations were also apparent in a further analysis comparing women who continued lithium treatment during pregnancy to those who discontinued prior to pregnancy. Conclusions Lithium use during pregnancy is associated with an increased risk of spontaneous preterm birth and other adverse neonatal outcomes. These potential risks must be balanced against the important benefit of treatment and should be used to guide shared decision-making.

scholarly journals Maternal Lipidomic Signatures in Relation to Spontaneous Preterm Birth and Large-For-Gestational Age Neonates

2021 ◽  
Author(s):  
Max Aung ◽  
Pahriya Ashrap ◽  
Deborah Watkins ◽  
Bhramar Mukherjee ◽  
Zaira Rosario ◽  
...  
Keyword(s):  
Fatty Acids ◽  
Preterm Birth ◽  
Free Fatty Acids ◽  
Gestational Age ◽  
Pregnancy Outcomes ◽  
Lipid Analysis ◽  
Lipid Classes ◽  
Large For Gestational Age ◽  
Spontaneous Preterm Birth ◽  
Increased Risk

Abstract Background: Lipidome-wide metabolites may be useful biomarkers of pregnancy outcomes. We sought to characterize maternal lipidomic signatures associated with preterm birth and neonatal anthropometric parameters. Methods: Plasma samples were collected 24-28 weeks gestation, and lipidomic profiling was quantified using high-performance liquid chromatography tandem mass spectrometry. Lipid metabolites were analyzed individually and as whole lipid classes and subgroups based on degree of hydrocarbon chain saturation. Associations were estimated using linear and logistic regression.Results: After false discovery adjustment (q<0.15), four plasmenyl-phosphatidylethanolamines and three free fatty acids associated with increased risk for spontaneous preterm birth. Five phosphatidylinositols, two phosphatidylglycerols, and one phosphatidic acid were associated with large for gestational age neonates. The saturated plasmenyl-phosphatidylethanolamines held the association with increased risk for spontaneous preterm birth. Both the mono- and poly-unsaturated free fatty acids held the association for increased risk for spontaneous preterm birth. Mono- and poly-unsaturated phosphatidylinositols were associated with large for gestational age neonates. Whole lipid classes (plasmenyl-phophatidylcholines and plasmenyl-phosphatidylethanolamines) were associated with increased risk for large for gestational age at delivery.Conclusions: This study provides evidence that finer omics-scale analysis of the maternal lipidome may be more informative biomarkers of pregnancy outcomes compared to whole class level lipid analysis.

scholarly journals Is maternal weight gain between pregnancies associated with risk of large-for-gestational age birth? Analysis of a UK population-based cohort

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e026220 ◽  
Author(s):  
Nida Ziauddeen ◽  
Sam Wilding ◽  
Paul J Roderick ◽  
Nicholas S Macklon ◽  
Nisreen A Alwan
Keyword(s):  
Weight Gain ◽  
Gestational Age ◽  
Population Based ◽  
Overweight And Obesity ◽  
Large For Gestational Age ◽  
Adjusted Relative Risk ◽  
Maternal Weight ◽  
Overweight Women ◽  
Increased Risk ◽  
Maternal Overweight

ObjectiveMaternal overweight and obesity during pregnancy increases the risk of large-for-gestational age (LGA) birth and childhood obesity. We aimed to investigate the association between maternal weight change between subsequent pregnancies and risk of having a LGA birth.DesignPopulation-based cohort.SettingRoutinely collected antenatal healthcare data between January 2003 and September 2017 at University Hospital Southampton, England.ParticipantsHealth records of women with their first two consecutive singleton live-birth pregnancies were analysed (n=15 940).Primary outcome measureRisk of LGA, recurrent LGA and new LGA births in the second pregnancy.ResultsOf the 15 940 women, 16.0% lost and 47.7% gained weight (≥1 kg/m2) between pregnancies. A lower proportion of babies born to women who lost ≥1 kg/m2(12.4%) and remained weight stable between −1 and 1 kg/m2(11.9%) between pregnancies were LGA compared with 13.5% and 15.9% in women who gained 1–3 and ≥3 kg/m2, respectively. The highest proportion was in obese women who gained ≥3 kg/m2(21.2%). Overweight women had a reduced risk of recurrent LGA in the second pregnancy if they lost ≥1 kg/m2(adjusted relative risk (aRR) 0.69, 95% CI 0.48 to 0.97) whereas overweight women who gained ≥3 kg/m2were at increased risk of new LGA after having a non-LGA birth in their first pregnancy (aRR 1.35, 95% CI 1.05 to 1.75). Normal-weight women who gained weight were also at increased risk of new LGA in the second pregnancy (aRR 1.26, 95% CI 1.06 to 1.50 with gain of 1–3 kg/m2and aRR 1.34, 95% CI 1.09 to 1.65 with gain of ≥3 kg/m2).ConclusionsLosing weight after an LGA birth was associated with a reduced LGA risk in the next pregnancy in overweight women, while interpregnancy weight gain was associated with an increased new LGA risk. Preventing weight gain between pregnancies is an important measure to achieve better maternal and offspring outcomes.

Large-for-gestational-age fetuses have an increased risk for spontaneous preterm birth

2019 ◽  
Vol 39 (8) ◽  
pp. 1050-1056
Author(s):  
Maud D. van Zijl ◽  
Martijn A. Oudijk ◽  
Anita C. J. Ravelli ◽  
Ben W. J. Mol ◽  
Eva Pajkrt ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Gestational Age ◽  
Large For Gestational Age ◽  
Spontaneous Preterm Birth ◽  
Increased Risk

Obstetrical, maternal and neonatal outcomes in pregnancies affected by muscular dystrophy

2018 ◽  
Vol 46 (7) ◽  
pp. 791-796 ◽  
Author(s):  
Adriano Petrangelo ◽  
Eman Alshehri ◽  
Nicholas Czuzoj-Shulman ◽  
Haim A. Abenhaim
Keyword(s):  
Cohort Study ◽  
Muscular Dystrophy ◽  
Large Population ◽  
The United States ◽  
Population Based ◽  
Adverse Outcomes ◽  
Neonatal Outcomes ◽  
Increased Risk ◽  
Maternal And Neonatal Outcomes ◽  
Adverse Pregnancy

Abstract Objective: Pregnancies in women affected by a muscular dystrophy are at an increased risk of adverse maternal and neonatal outcomes due to the effect of the disease on the muscular, cardiac and respiratory systems. We sought to evaluate the risk of adverse outcomes within a large population-based cohort study. Methods: We used the data extracted from the Nationwide Inpatient Sample (NIS) to conduct a retrospective population-based cohort study consisting of over 12 million births that occurred in the United States between 1999 and 2013. Births to mothers with muscular dystrophy were identified using the International Classification of Diseases, Ninth Revision (ICD-9) codes and were compared with births to mothers with no maternal muscular dystrophy. Unconditional logistic regression analysis was used to evaluate the adjusted effect of muscular dystrophy on maternal and neonatal outcomes. Results: During the 14-year study period, there was an increasing trend in the incidence of muscular dystrophy, with a cumulative incidence of 7.26 in 100,000 births. Women with muscular dystrophy and their neonates were at a significantly increased risk of adverse pregnancy outcomes: specifically, an increased risk of preeclampsia, preterm premature rupture of membranes, preterm labor, venous thromboembolism, cardiac dysrhythmia, requiring a blood transfusion and giving birth by cesarean section. Neonates born to affected mothers were at a significantly higher risk of being born preterm, with a congenital malformation and suffering intrauterine growth restriction. Conclusion: The risk of several adverse maternal and neonatal outcomes is increased in pregnant women with muscular dystrophy. As such, additional surveillance in order to mitigate the risk of adverse outcomes is warranted in these pregnancies.

scholarly journals COVID-19 Lockdown Increased the Risk of Preterm Birth

2021 ◽  
Vol 8 ◽  
Author(s):  
Ting-ting Lin ◽  
Chen Zhang ◽  
Lei Chen ◽  
Li Jin ◽  
Xian-hua Lin ◽  
...  
Keyword(s):  
Cohort Study ◽  
Preterm Birth ◽  
Pregnant Women ◽  
Population Based ◽  
Second Trimester ◽  
Spontaneous Preterm Birth ◽  
Third Trimester ◽  
Very Preterm ◽  
Increased Risk ◽  
The City

Purpose: To estimate whether the city-specific lockdown in Shanghai induced by the COVID-19 pandemic affected preterm birth rates among uninfected pregnant women in different trimesters.Methods: The population-based retrospective cohort study was conducted in the International Peace Maternity and Child Health Hospital (IPMCH) in Shanghai, China. Pregnant women without COVID-19 received perinatal healthcare during lockdown (from January 24, 2020 to March 24, 2020) and non-lockdown (from January 24, 2019 to March 24, 2019) period and giving birth to a live infant at IPMCH were enrolled. 1:1 propensity score matching and Inverse probability of treatment weighting were used to evaluate preterm birth (&lt;37 weeks), very preterm birth (&lt;34 weeks), preterm birth with premature rupture of membranes (PROM-PTB), spontaneous preterm birth with intact membranes (S-PTB), and medically induced preterm birth (MI-PTB) between two groups.Results: 8,270 pregnant women were in the lockdown group, and 9,815 were in the non-lockdown group. Pregnant women in second trimester during lockdown had a higher risk of PTB than those during the non-lockdown period [OR: 1.43 (CI 1.01–2.02), ARD: 1.7% (CI 0.04–3.4%), p = 0.045]. Furthermore, pregnant women in third trimester during lockdown had a higher risk of PROM-PTB than those during the non-lockdown period [OR: 1.64 (CI 1.09–2.47), ARD: 0.9% (CI 0.2–1.6%), p = 0.02]; no group differences were found related to rates of VPTB, S-PTB or MI-PTB.Conclusion: In this cohort study in China, we found that there was an increased risk in preterm birth for non-infected women in COVID-19 lockdown who were in their second trimester.

Marijuana Use during Pregnancy and Preterm Birth: A Prospective Cohort Study

2020 ◽  
Author(s):  
Mark A. Klebanoff ◽  
Diana G. Wilkins ◽  
Sarah A. Keim
Keyword(s):  
Cohort Study ◽  
Preterm Birth ◽  
Relative Risk ◽  
High Risk ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Marijuana Use ◽  
Adjusted Relative Risk ◽  
Spontaneous Preterm Birth ◽  
Increased Risk

Objective The aim of this study is to estimate the association between marijuana use during pregnancy and total, spontaneous and indicated preterm birth. Study Design Prospective cohort study of women receiving antenatal care at The Ohio State University from 2010 to 2015. Marijuana use was assessed by questionnaire, record abstraction, and urine toxicology. Women were followed through the end of pregnancy. Relative risks were assessed with Poisson regression and time to delivery with proportional hazard models. Results Of 363 eligible women, 119 (33%) used marijuana in pregnancy by at least one measure. In this high-risk cohort, preterm birth occurred to 36.0% of users and 34.6% of nonusers (p = 0.81). The unadjusted relative risk of all preterm birth was 1.06 (95% confidence interval [CI]: 0.76–1.47); the adjusted relative risk was similar 1.04 (95% CI: 0.72–1.50). Spontaneous preterm birth was nonsignificantly elevated among users before 1.32 (95% CI: 0.89–1.96), and after 1.21 (95% CI: 0.76–1.94) adjustment. Indicated preterm birth was nonsignificantly reduced before 0.52 (95% CI: 0.22–1.23) and after 0.75 (95% CI: 0.29–2.15) adjustment. The unadjusted hazard ratio (HR) for time to preterm birth was 1.26 (95% CI: 0.84–2.00); the adjusted HR was 1.32 (95% CI: 0.80–2.07). Both unadjusted 1.77 (95% CI: 1.06–2.93) and adjusted 2.16 (95% CI: 1.16–4.02) HRs for spontaneous preterm birth were significantly elevated, primarily due to an increased risk of spontaneous birth <28 weeks among users. The unadjusted and adjusted HRs for time to indicated preterm birth were 0.69 (95% CI: 0.33–1.43) and 0.58 (95% CI: 0.23–1.46). Conclusion Marijuana use was not associated with total preterm birth in this cohort, suggesting that among women already at high risk of preterm birth, marijuana does not increase risk further. However, there was a suggestion that pregnant women who use marijuana may deliver earlier, particularly from spontaneous preterm birth, than women who do not use marijuana.

Juvenile onset arthritis and pregnancy outcome: a population-based cohort study

2017 ◽  
Vol 76 (11) ◽  
pp. 1809-1814 ◽  
Author(s):  
Katarina Remaeus ◽  
Kari Johansson ◽  
Johan Askling ◽  
Olof Stephansson
Keyword(s):  
Cohort Study ◽  
Preterm Birth ◽  
Pregnancy Outcomes ◽  
Late Onset ◽  
Population Based ◽  
Spontaneous Preterm Birth ◽  
Juvenile Onset ◽  
Swedish Population ◽  
Increased Risk ◽  
Pregnancy And Delivery

ObjectivesReports on pregnancy outcomes among women with juvenile onset arthritis (JIA) have been few and small. The aim of this study was to assess pregnancy outcomes in a large and contemporary cohort of women diagnosed with JIA.MethodsIn a nationwide Swedish population-based cohort study between 1992 and 2011, we identified 1807 births among women with JIA and 1 949 202 control births. Since JIA is a heterogenic condition, births to women with JIA was divided into JIA paediatric only (n=1169) and JIA persisting into adulthood (n=638). ORs and 95% CIs were estimated with generalised estimating equations.ResultsWomen with JIA were at increased risk of preterm birth, especially medically indicated, in both subgroups: adjusted OR (aOR) 1.74 (1.35–2.67) for JIA paediatric and aOR 4.12 (2.76–6.15) for JIA persisting into adulthood. JIA persisting into adulthood was associated with very preterm birth (aOR 3.14, 1.58–6.24), spontaneous preterm birth (aOR 1.63, 1.11–2.39), small for gestational age birth (aOR 1.84, 1.19–2.85), early-onset pre-eclampsia (aOR 6.28, 2.68–13.81) and late-onset pre-eclampsia (aOR 1.96, 1.31–2.91). Women with JIA paediatric only were at increased risk of delivery by caesarean section (aOR 1.42, 1.66–1.73) and induction of labour (aOR 1.45, 1.18–1.77).ConclusionsWe found increased risks of both maternal and infant complications among women with JIA confined to childhood and in women with JIA persistent into adulthood as compared with population controls. Pregnancies in women with JIA should thus be subject to increased surveillance during pregnancy and delivery.

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