Comparison of Diagnostic Values of Maternal Arginine Concentration for Different Pregnancy Complications: A Systematic Review and Meta-Analysis

Abnormal arginine metabolism contributes to the development of intrauterine growth restriction (IUGR), preeclampsia (PE), and gestational diabetes mellitus (GDM), which increase the health burden of mothers and induce adverse birth outcomes. However, associations between maternal arginine concentration and different pregnancy complications have not been systematically compared. The PubMed, ScienceDirect, and Web of Science databases were searched for peer-reviewed publications to evaluate the diagnostic value of plasma arginine concentration in complicated pregnancies. Standardized mean difference (SMD) of the arginine concentration was pooled by a random effects model. The results show that increased maternal arginine concentrations were observed in IUGR (SMD: 0.48; 95% CI: 0.20, 0.76; I2 = 47.0%) and GDM (SMD: 0.46; 95% CI: 0.11, 0.81; I2 = 82.3%) cases but not in PE patients (SMD: 0.21; 95% CI: −0.04, 0.47; I2 = 80.3%) compared with the normal cohorts. Subgroup analyses indicated that the non-fasting circulating arginine concentration in third trimester was increased significantly in GDM and severe IUGR pregnancies, but the change mode was dependent on ethnicity. Additionally, only severe PE persons were accompanied by higher plasma arginine concentrations. These findings suggest that maternal arginine concentration is an important reference for assessing the development of pregnancy complications.

The Role of Plasminogen Activator Inhibitor Type 1 (PAI-1) in Placenta-Mediated Pregnancy Complications: A Systematic Review

Plasminogen activator inhibitor type 1 (PAI-1) is a main inhibitor of fibrinolysis. The PAI-1 gene (SERPINE1) harbors genetic variants with the potential of modifying plasma levels of PAI-1. A delicate balance exists between the coagulation and fibrinolytic system, and changes in PAI-1 have been suggested to compromise establishment of a successful pregnancy. Therefore, this systematic review investigated the association between genetic variants and/or plasma levels of PAI-1 and placenta-mediated pregnancy complications. An extensive literature search was conducted in PubMed, Embase, and Web of Science on the 29th of April 2021. All studies underwent quality rating according to The Study Quality Assessment Tools checklist provided by National Heart, Lung and Blood Institute. A total of 71 studies were included, among which 60 studies investigated PAI-1 genotypes and 11 studies measured PAI-1 plasma levels. In 32 out of 59 studies, no association was found between the PAI-1 4G/5G polymorphism (rs1799768) and placenta-mediated pregnancy complications, which was stated as no significant difference in the genotype distribution comparing women with and without placenta-mediated pregnancy complications or no significantly increased odds of placenta-mediated pregnancy complications carrying the 4G/4G or 4G/5G genotype. Eight out of 11 studies reported significantly higher PAI-1 plasma levels in preeclamptic women than in women without preeclampsia. In conclusion, no clear evidence indicates that PAI-1 polymorphisms are associated with placenta-mediated pregnancy complications, and the possible association between high PAI-1 plasma levels and preeclampsia needs further investigations. Thus, investigation of PAI-1 genotypes and PAI-1 plasma levels does not currently seem to have a place in daily clinical practice managing placenta-mediated pregnancy complications.

Ten‐Year Cardiovascular Disease Risk Trajectories by Obstetric History: A Longitudinal Study in the Norwegian HUNT Study

Background Women with a history of obstetric complications are at increased risk of cardiovascular disease, but whether they should be specifically targeted for cardiovascular disease (CVD) risk screening is unknown. Methods and Results We used linked data from the Norwegian HUNT (Trøndelag Health) Study and the Medical Birth Registry of Norway to create a population‐based, prospective cohort of parous women. Using an established CVD risk prediction model (A Norwegian risk model for cardiovascular disease), we predicted 10‐year risk of CVD (nonfatal myocardial infarction, fatal coronary heart disease, and nonfatal or fatal stroke) based on established risk factors (age, systolic blood pressure, total and high‐density lipoprotein cholesterol, smoking, antihypertensive use, and family history of myocardial infarction). Predicted 10‐year CVD risk scores in women aged between 40 and 60 years were consistently higher in those with a history of obstetric complications. For example, when aged 40 years, women with a history of preeclampsia had a 0.06 percentage point higher mean risk score than women with all normotensive deliveries, and when aged 60 years this difference was 0.86. However, the differences in the proportion of women crossing established clinical thresholds for counseling and treatment in women with and without a complication were modest. Conclusions Findings do not support targeting parous women with a history of pregnancy complications for CVD screening. However, pregnancy complications identify women who would benefit from primordial and primary prevention efforts such as encouraging and supporting behavioral changes to reduce CVD risk in later life.

Pregnancy Complications and Risk of Cardiovascular Disease Later in Life: A Nationwide Cohort Study

Background The aim of this study was to investigate the associations between pregnancy complications and cardiovascular mortality and hospitalizations of cardiovascular disease (CVD) after adjustment for major confounding. Methods and Results In a nationwide register‐based cohort study, women with singleton births between 1973 and 2014 were included from the Swedish Medical Birth Register. Outcomes of mortality and hospitalizations of CVD were collected from the Cause of Death Register and the National Inpatient Register. The cohort was followed from the date of the first delivery until death or end of follow‐up, whichever occurred first. The pregnancy complications studied were preeclampsia or eclampsia, gestational hypertension, gestational diabetes, preterm birth, small for gestational age, and stillbirth. Among the 2 134 239 women (mean age at first pregnancy, 27.0 [SD, 5.1] and mean parity 1.96 [SD, 0.9]), 19.1% (N=407 597) had 1 of the studied pregnancy complications. All pregnancy complications were associated with all‐cause and cardiovascular mortality and hospitalization for CVD (ischemic heart disease, ischemic stroke, and peripheral artery disease) after adjustment for major confounding in a Cox proportional hazard regression model. The adjusted hazard ratio for cardiovascular mortality was 1.84 (95% CI, 1.38–2.44) for preterm birth and 3.14 (95% CI, 1.81–5.44) for stillbirth. Conclusions In this large cohort study, pregnancy complications were associated with all‐cause mortality, cardiovascular mortality, and hospitalizations for CVD, also after adjusting for confounding, including overweight, smoking, and comorbidities. The study highlights that less established pregnancy complications such as preterm birth and stillbirth are also associated with cardiovascular mortality and CVD.

Prenatal origins of suicide mortality: A prospective cohort study in the United States

Most suicide research focuses on acute precipitants and is conducted in high-risk populations. Yet, vulnerability to suicide is likely established years prior to its occurrence. In this study, we aimed to investigate the risk of suicide mortality conferred by prenatal sociodemographic and pregnancy-related factors. Offspring of participants (N = 49,853) of the Collaborative Perinatal Project, a U.S. population-based cohort of pregnancies enrolled between 1959 and 1966, were linked to the U.S. National Death Index to determine their vital status by the end 2016. We examined associations between sociodemographic factors during pregnancy, pregnancy complications, labor and delivery complications, and neonatal complications with suicide death coded according to ICD-9/10 criteria. By the end of 2016, 3,555 participants had died. Of these, 288 (214 males, 74 females) died by suicide (incidence rate = 15.6 per 100,000 person-years, 95% Confidence Interval [CI] = 13.9–17.5). In adjusted models, male sex (Hazard Ratio [HR] = 2.98, CI: 2.26–3.93), White race (HR = 2.14, CI = 1.63–2.83), low parental education (HR = 2.23, CI = 1.38–3.62), manual parental occupation (HR = 1.38, CI = 1.05–1.82), being a younger sibling (HR = 1.52, CI = 1.10–2.11), higher rates of pregnancy complications (HR = 2.36, CI = 1.08–5.16), and smoking during pregnancy (HR = 1,28, CI = 0.99–1.66) were independently associated with suicide risk, whereas birth and neonatal complications were not. Consistent with the developmental origins of psychiatric disorders, vulnerability to suicide mortality is established early in development. Both sociodemographic and pregnancy factors play a role in this risk, which underscores the importance of considering life course approaches to suicide prevention, possibly including provision of high-quality prenatal care, and alleviating the socioeconomic burdens of mothers and families.

FACTORES ASOCIADOS A LA FALTA DE CONTROL PRENATAL EN AMÉRICA LATINA Y SU RELACIÓN CON LAS COMPLICACIONES OBSTÉTRICAS.

Introducción: El control prenatal es un conjunto de actividades y procedimientos que el equipo de salud ofrece a la embarazada, para la prevención de complicaciones, por medio del diagnóstico precoz de factores de riesgo en la gestante y enfermedades que puedan afectar el curso normal del embarazo y la salud del recién nacido. Objetivo: Identificar los factores asociados a la falta de control prenatal en América latina y su relación con las complicaciones obstétricas. Métodos: investigación de diseño documental con revisión bibliográfica en las bases de datos: PubMed, BVS, Scielo, Latindex, Lilacs y Google académico, con los descriptores de ciencias de la salud (DeCS) de Bireme y los Medical Subject Headings (MesH) de la National Library of Medicine: atención prenatal, embarazo, complicaciones del embarazo, salud materno-infantil, en idioma español e inglés durante el periodo 2015-2021. Resultados: La búsqueda inicial de información reportó un total de 1718 registros, de los cuales 86 eran elegibles, de estos 56 no fueron relevantes, por lo que quedan incluidos 30 que permitieron dar cumplimiento al objetivo de estudio con los cuales se procedió al meta-análisis. Conclusiones: Los factores asociados a la falta de control prenatal son: el bajo nivel de instrucción, ocupaciones del hogar y crianza, falta de empleo, escasos recursos económicos, ubicación geográfica, falta de afiliación, creencias y costumbres, estos factores se relacionan con complicaciones obstétricas como: infecciones, anemia, preeclampsia, hemorragias, desgarros perineales, alumbramiento incompleto, bajo peso y prematuridad. Palabras claves: atención prenatal, embarazo, complicaciones del embarazo, salud materno-infantil ABSTRACT Introduction: Prenatal control is a set of activities and procedures that the health team offers to the pregnant woman, for the prevention of complications, through the early diagnosis of risk factors in the pregnant woman and diseases that may affect the normal course of pregnancy. and the health of the newborn. Objective: To identify the factors associated with the lack of prenatal control in Latin America and its relationship with obstetric complications. Methods: documentary design research with bibliographic review in databases: PubMed, BVS, Scielo, Latindex, Lilacs and academic Google, with the descriptors of health sciences (DeCS) from Bireme and the Medical Subject Headings (MeSH) from the National Library of Medicine: prenatal care, pregnancy, pregnancy complications, maternal and child health, in Spanish and English during the period 2015-2021. Results: The initial search for information reported a total of 1718 records, of which 86 were eligible, of these 56 were not relevant, so 30 are included that allowed the fulfillment of the study objective with which the goal was carried out. analysis. Conclusions: The factors associated with the lack of prenatal control are: low level of education, home occupations and upbringing, lack of employment, scarce economic resources, geographic location, lack of affiliation, beliefs and customs, these factors are related to complications obstetrics such as: infections, anemia, preeclampsia, hemorrhages, perineal tears, incomplete delivery, low weight and prematurity.Keywords: prenatal care, pregnancy, pregnancy complications, maternal and child health