The Hyperglycemia and Adverse Pregnancy Outcome Study: Associations of GDM and obesity with pregnancy outcomes

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

Associations of gestational cardiovascular health with pregnancy outcomes: the Hyperglycemia and Adverse Pregnancy Outcome study

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2020.07.053 ◽

2020 ◽

Author(s):

Amanda M. Perak ◽

Nicola Lancki ◽

Alan Kuang ◽

Darwin R. Labarthe ◽

Norrina B. Allen ◽

...

Keyword(s):

Pregnancy Outcome ◽

Pregnancy Outcomes ◽

Cardiovascular Health ◽

Adverse Pregnancy Outcome ◽

Outcome Study ◽

Adverse Pregnancy

Download Full-text

Hyperglycemia and Adverse Pregnancy Outcome Study: Neonatal Glycemia

PEDIATRICS ◽

10.1542/peds.2009-2257d ◽

2010 ◽

Vol 127 (2) ◽

pp. peds.2009-2257d-peds.2009-2257d ◽

Cited By ~ 1

Keyword(s):

Pregnancy Outcome ◽

Adverse Pregnancy Outcome ◽

Outcome Study ◽

Adverse Pregnancy

Download Full-text

Neonatal outcome in pregnant patients with antiphospholipid syndrome

Journal of Perinatal Medicine ◽

10.1515/jpm-2014-0118 ◽

2015 ◽

Vol 43 (6) ◽

Cited By ~ 13

Author(s):

Katarina Jeremic ◽

Aleksandar Stefanovic ◽

Jelena Dotlic ◽

Jelena Stojnic ◽

Sasa Kadija ◽

...

Keyword(s):

Risk Factors ◽

Respiratory Distress Syndrome ◽

Pregnancy Outcome ◽

Pregnancy Outcomes ◽

Distress Syndrome ◽

Adverse Pregnancy Outcome ◽

Perinatal Asphyxia ◽

Premature Delivery ◽

Control Group ◽

Adverse Pregnancy

AbstractThe study aim was to evaluate pregnancy outcomes in patients with antiphospholipid syndrome (APS) and to determine which clinical parameters present risk factors for adverse pregnancy outcomes in these patients.The study included 55 patients with APS treated at the Clinic for Ob/Gyn, Clinical Center of Serbia, from 2006 to 2012. The control group consisted of 55 healthy pregnant women. Data regarding previous pregnancies and conception method were registered. Immunological and laboratory tests were performed. Pregnancy outcomes, including miscarriage, intrauterine fetal death, hypertensive disorders, diabetes mellitus, phlebothrombosis, fetal growth restriction, premature delivery, delivery method, perinatal asphyxia, respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis were followed.The premature delivery rate in APS patients was 31.8%, and pregnancy loss was 18.2%. Significantly more patients with APS had thrombocytopenia, pregnancy losses, intrauterine growth restriction, and perinatal asphyxia compared with the control group. More miscarriages, preterm delivery, lower birth weight, preeclampsia, and IgM anticardiolipin antibody levels significantly correlated with adverse pregnancy outcomes. Although rare, respiratory distress syndrome can also worsen neonatal health status. According to ROC analysis, previous miscarriages correctly explained 66.3% of adverse pregnancy outcome cases. We generated four equations of adverse pregnancy outcome risk factors.The most important prognostic factor for pregnancy outcome in APS patients is the number of previous miscarriages. Using appropriate current therapeutic protocol can enable live birth of a healthy newborn in most cases.

Download Full-text

Abstract 33: Associations of Gestational Cardiovascular Health With Pregnancy Outcomes: The Hyperglycemia and Adverse Pregnancy Outcome Study

Circulation ◽

10.1161/circ.141.suppl_1.33 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Cited By ~ 1

Author(s):

Amanda M Perak ◽

Nicola Lancki ◽

Alan Kuang ◽

Darwin R Labarthe ◽

Svati H Shah ◽

...

Keyword(s):

Pregnancy Outcome ◽

Cardiovascular Health ◽

Adverse Pregnancy Outcome ◽

Neonatal Outcomes ◽

Large For Gestational Age ◽

Obstetric Outcomes ◽

Sensitivity Index ◽

Outcome Study ◽

Odds Ratios ◽

Adverse Pregnancy

Introduction: Combinations of risk factor levels typically contribute more to population burdens of disease than single adverse risk factors. CVH (as defined by the AHA) characterizes a range of health levels, but its significance in pregnancy for obstetric and neonatal outcomes is unknown. Methods: Data from the Hyperglycemia and Adverse Pregnancy Outcome Study were analyzed, including 1,754 mother-child dyads from 9 field centers in 6 countries: US (26%), Barbados (24%), UK (20%), China (15%), Thailand (8%), and Canada (7%). Maternal CVH was scored (0-10 points, with 10 most favorable) at a mean of 28 (range 23-34) weeks’ gestation using 5 metrics ( Table ). 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 gestational CVH with obstetric and neonatal outcomes, adjusted for center and maternal and infant characteristics ( Table footnote). Results: The mean gestational CVH score was 8.2 (SD 1.5) out of 10; 18% of mothers had all ideal, 37% had 1+ intermediate, 34% had 1 poor, and 9% had 2+ poor metrics. In fully adjusted models ( Table ), odds ratios per 1 point higher (better) CVH score were 0.65 (95% CI, 0.56-0.76) for preeclampsia, 0.89 (0.78-1.00) for unplanned primary cesarean section (among primiparous mothers), 0.84 (0.77-0.93) for large for gestational age infant, 0.87 (0.79-0.97) for infant sum of skinfolds >90 th percentile, and 0.77 (0.69-0.86) for infant insulin sensitivity index (20/[C-peptide*glucose]) <10 th percentile. CVH categories were also associated with outcomes; for example, compared with mothers with all metrics ideal, odds ratios for preeclampsia were 2.00 (0.71-7.14) for mothers with 1+ intermediate, 4.34 (1.63-15.09) for mothers with 1 poor, and 9.40 (3.22-34.52) for mothers with 2+ poor metrics. Conclusion: More favorable levels of gestational CVH were associated with healthier obstetric and neonatal outcomes in this multinational cohort.

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

Hyperglycemia and Adverse Pregnancy Outcome Study

Der Diabetologe ◽

10.1007/s11428-012-0933-y ◽

2012 ◽

Vol 8 (8) ◽

pp. 652-656

Author(s):

H. Kleinwechter ◽

U. Schäfer-Graf

Keyword(s):

Pregnancy Outcome ◽

Adverse Pregnancy Outcome ◽

Outcome Study ◽

Adverse Pregnancy

Download Full-text

Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study: Associations of maternal A1C and glucose with pregnancy outcomes

Diabetes Care ◽

10.2337/dc11-1687 ◽

2012 ◽

Vol 35 (3) ◽

pp. 574-580 ◽

Cited By ~ 124

Author(s):

L. P. Lowe ◽

B. E. Metzger ◽

A. R. Dyer ◽

J. Lowe ◽

D. R. McCance ◽

...

Keyword(s):

Pregnancy Outcome ◽

Pregnancy Outcomes ◽

Adverse Pregnancy Outcome ◽

Adverse Pregnancy

Download Full-text

Gestational weight gain and neonatal adiposity in the hyperglycemia and adverse pregnancy outcome study-North American region

Obesity ◽

10.1002/oby.20742 ◽

2014 ◽

Vol 22 (7) ◽

pp. 1731-1738 ◽

Cited By ~ 29

Author(s):

Sylvia E. Badon ◽

Alan R. Dyer ◽

Jami L. Josefson ◽

Keyword(s):

Weight Gain ◽

Pregnancy Outcome ◽

Gestational Weight Gain ◽

North American ◽

Adverse Pregnancy Outcome ◽

Outcome Study ◽

Gestational Weight ◽

Neonatal Adiposity ◽

Adverse Pregnancy ◽

American Region

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