Determining Pregnancy Outcome Research Articles

Determinants of pregnancy outcomes in early-onset intrahepatic cholestasis of pregnancy.

To analyze pregnancy outcomes and factors influencing early-onset intrahepatic cholestasis of pregnancy (ICP), offering insights to improve the management, diagnosis, and treatment of ICP during pregnancy. We categorized 127 pregnant women with ICP into two groups based on a gestational age cutoff of 28weeks. The analysis centered on biochemical markers, pregnancy complications, and outcomes to identify factors influencing early-onset ICP. We found that biochemical markers including alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase (GGT), alkaline phosphatase, total bilirubin, direct bilirubin (DBIL), indirect bilirubin, and cholesterol were significantly lower in early-onset ICP compared to late-onset ICP. Importantly, premature birth rates were higher in the early-onset ICP group. Through univariate and multivariate logistic regression analyses of these biochemical markers, GGT and DBIL emerged as significant predictive factors (OR=0.84 and 0.54). Early-onset ICP is characterized by its early onset, prolonged duration, and a higher incidence of premature births compared to late-onset ICP, leading to adverse perinatal outcomes. This research underscores theprotective role of GGT and DBIL in early-onset ICP.

The vital role of the placenta in determining pregnancy outcomes and life-long health

The vital role of the placenta in determining pregnancy outcomes and life-long health

Maternal Dietary Carbohydrate and Pregnancy Outcomes: Quality over Quantity.

Dietary nutrition plays a crucial role in determining pregnancy outcomes, with poor diet being a major contributor to pregnancy metabolic syndrome and metabolic disorders in offspring. While carbohydrates are essential for fetal development, the excessive consumption of low-quality carbohydrates can increase the risk of pregnancy complications and have lasting negative effects on offspring development. Recent studies not only highlighted the link between carbohydrate intake during pregnancy, maternal health, and offspring well-being, but also suggested that the quality of carbohydrate foods consumed is more critical. This article reviews the impacts of low-carbohydrate and high-carbohydrate diets on pregnancy complications and offspring health, introduces the varied physiological effects of different types of carbohydrate consumption during pregnancy, and emphasizes the importance of both the quantity and quality of carbohydrates in nutritional interventions during pregnancy. These findings may offer valuable insights for guiding dietary interventions during pregnancy and shaping the future development of carbohydrate-rich foods.

#1715 Role of T cell profile (Th1/Th2/Th17/Treg) and podocyturia in the peripheral blood of patients with preeclampsia versus normal pregnancy

Abstract Background and Aims The concept of the balance between Th17/Treg cell immunity plays important role in determining pregnancy outcomes. Does Treg/TH17 play a role in pathogenesis of preeclampsia associated proteinuria and its implication on irreversible renal damage was the research question. Method This hospital based prospective study conducted in the Department of obstetrics and gynecology at a tertiary care medical college between October 2018 till October 2020 and assessment of T cell profiling and urinary podocyturia among all pregnancies with clinical evidence of preeclampsia and compared it with normal pregnancy monitoring for maternal and foetal outcomes. Repeat assessment of Th profiling and podocyturia was done after 3 months post partum to look for any residual effect. Results A total of 40 patients of preeclampsia and 40 control were enrolled in the study with median age group (24.58 ± 1.22 vs 25.16 ± 1.01). The percentage of Th1 and Th2 were higher for the preeclampsia group as compared to the control group with no change in the percentage of Th17 subsets while Th17 1 were found higher and percentage of Treg (8.1 ± 3.19 vs 2.3 ± 1,05, p = 0.001) lower in the peripheral blood of the preeclampsia group at time of delivery however the ratio of Th1/Treg, Th2/Treg, Th17/Treg and Th17.1/Treg were found significantly lowered after 6 weeks of delivery among those with preeclampsia nearly comparable to the normal pregnancy group The quantitative assessment of podocyte in urine using antinephrin showed increase numbers among preeclamptic pregnancies compared to normal yet it settled within 6 weeks of delivery. Conclusion Women with preeclampsia per se does not increase the risk to exacerbation of kidney disease however greater research mandates to assess the women at greatest risk of kidney disease after pre-eclampsia to have good maternal and foetal outcomes.

Limited Effects of Ultra-low Oxygen Concentration during Extended Embryo Culture on In vitro Fertilisation Outcomes in Indian Women: A Retrospective Cross-sectional Study.

Amongst various other factors, oxygen (O2) concentration in embryo culture plays an important role in determining pregnancy outcomes in women undergoing in vitro fertilisation. Some studies have reported that lowering O2 levels in embryo culture provides better results. To explore the effects of low- and ultra-low- O2 concentrations (5% and 2%, respectively) in extended embryo culture on various outcome parameters of pregnancy. This was a retrospective cross-sectional study. In this study 382 participants had their embryos cultured in varying O2 concentrations (5% or 2%), followed by either a fresh embryo transfer (ET) or frozen embryo transfer (FET). Outcomes such as pregnancy rate, implantation rate, abortion rate, twinning rate, and live birth rate were compared between the groups. Chi square test was applied to compare the primary and secondary outcomes between different groups. No significant differences were observed in pregnancy rate and implantation rate between 5% and 2% O2 groups, irrespective of their mode of ET. The abortion rate was significantly higher in 5% O2 group than in 2% group during FET (24.71% vs. 11.49%, P = 0.02). While the proportion of good-quality embryos was higher in 5% O2 group, these did not translate to better pregnancy outcomes. Additionally, embryos cultured in 2% O2 concentration had a significantly better implantation rate when they were transferred fresh rather than frozen (71.34% vs. 61.46%, P = 0.04). There were no other differences observed. Only marginal benefits were observed in switching human embryos to ultra-low O2 concentration after the initial days of culture.

Determinants of Pregnancy Outcomes After Assisted Reproductive Therapy: A Sample From the West Bank, Palestine.

Background Infertility is a public health issue with a significant impact on the well-being of affected couples. Aim This paper aims to detect the determinants of pregnancy and their outcome after assisted reproductive therapy (ART) in a sample of Palestinian society. Methods A retrospective observational study was carried out at Razan Medical Center for Infertility. Subjects were assigned into twelve categories based on the type of infertility (primary versus secondary), the cause of infertility, and the treatment modality. Age at marriage, age at presentation, duration of infertility, in addition to regularity of menstruation, were also studied. Biochemical pregnancy was considered the endpoint for the purpose of the analysis. Results We reviewed the files of 459 subjects diagnosed with infertility. 79.74% had primary infertility while 20.26% had secondary. 28.85% were found to be infertile due to anovulation, 2.86% due to endometriosis, 16.74% attributed to male factor, and 3.3% had tubal damage. 13.43% of cases were multifactorial while 34.80% were idiopathic. Four biochemical markers were assessed in our study:thyroid-stimulating hormone (TSH) (x̄=2.32±2.46), luteinizing hormone (x̄=6.71±4.90), follicle-stimulating hormone (FSH) (x̄=6.59±6.11), and human prolactin (x̄=41.88±6.50). The menstrual cycle was regular in 70.58% of subjects, in contrast to 29.41% with irregular cycles. The female mean age at presentation was 22.76±5.58, while their mean age of marriage was 22.76±4. The mean duration of infertility was 3.97±6.87 years. Patients were treated via three modalities - ovarian stimulation (2.2%), intrauterine insemination (29.58%), and intracytoplasmic sperm injection (68.21%) - with a success rate of 51.85%. Of the studied factors, only diagnosis, follicle-stimulating hormone, and treatment modality had a significant impact on the outcome, with p-values of 0.040, 0.003, and <.0.001, respectively. Conclusions There is a strong relationship between diagnosis prior to intervention, level of FSH, and treatment modality and successful outcome of ART.

Pregnancy Outcome After Selective Fetal Reduction in Dichorionic Twin Pregnancies.

This study was conducted for determining pregnancy outcome after selective fetal reduction in twin pregnancies based on the gestational age at the time of the procedure in a referral academic center between 2017 and 2021. This retrospective cohort study included all women with twin pregnancies who were diagnosed with a genetic or structural anomaly of one fetus or a desire to reduce the number of fetuses in order to reduce pregnancy complications visited in the period of 2017-2021. Reduction was performed due to an abdominal approach at 11 to 23 weeks of pregnancy. Maternal and pregnancy information were recorded. A total of 159 cases of twin dichorionic pregnancies were included. The highest frequency of reduction was performed at the gestational age of 18-20 weeks, and the most common cause of reduction was major structural anomalies in the fetus. The results showed the average gestational age (GA) at the time of delivery to be 37.6 weeks, the average birth weight of 2,999 grams, the incidence of miscarriage (loss before 22 weeks) to be 9.4% and a rate of preterm birth (delivery before 37weeks) of 33.3%. There is not a statistically significant relationship between the gestational age at the time of reduction and preterm birth, the birth weight, the incidence of RDS and the incidence of SGA. Fetal reduction of twins to singleton pregnancy is associated with lower risk of preterm birth (delivery before37 weeks reduction of twins to singleton pregnancy is associated with lower risk of preterm birth (delivery before37 weeks). It causes an increase in birth weight and perinatal outcome in remaining co-twin so we recommend fetal reduction after counselling with patients for their unique situation to improve pregnancy outcome.

To determine the incidence of normal, suspicious and pathological non-stress test (NST) in full term pregnant women in a tertiary healthcare centre

All fetuses undergo physiological stress in the process of labour. Various techniques of foetal surveillance have been developed. Non stress test at admission may be used as an effective screening technique, to detect fetuses at risk. It is a noninvasive technique that can be used to identify compromised fetal. Prior to onset of labour also some fetuses may have stress that may be identified by NST at admission. Foetal surveillance is needed to ensure fetal wellbeing with minimum intervention. Intermittent auscultations may be used in low risk, but it cannot determine accelerations, baseline FHR, decelerations, baseline variability. Thus, taking NST helps to detect the ability of fetus to respond to stress. Hence, it may be useful to prevent neurological injuries like cerebral palsy. Thus, NST at admission has been accepted widely. It is considered as first investigation for fetal surveillance in some studies to decrease perinatal mortality. In busy labour wards, with limited resources, it plays an important role for selection of patients requiring continuous monitoring. Aim and objectives: To determine the incidence of normal, suspicious and pathological NST in full-term, pregnant women. To state the role of NST at admission in determining pregnancy outcome in full-term pregnancies. Material and Method: It was a prospective cohort study conducted in Bangalore Baptist Hospital during November 2020 to September 2021in 680 women. Results: Among the studied full term pregnant women attending tertiary health care center 77.06% had normal NST, 21.77 % had suspicious NST and 1.18% had pathological NST. There was statistically significant association (p value <0.05) between NST at admission and risk factors, mode of delivery, category of LSCS and APGAR at 1 min and 5 min. Conclusion: We concluded that NST at admission can be used as a screening tool to identify patients who are at risk and need more vigorous monitoring.

Maternal Anemia and BMI as Determinants of Pregnancy Outcomes: A Hospital-Based Study.

Malnutrition is a serious underlying cause of child and maternal deaths around the world. The objective of this study evaluates maternal anemia and body mass index as determinants of pregnancy outcomes. Undernourishment during pregnancy can occurs Intra Uterine Growth Retardation. Contributing to about 80,0000 new-borns, 40,0000 infant deaths and 20% under 2 years children have stunted, 20% of maternal deaths during labor and early postpartum. This study Hospital-based cross-sectional study. The study comprised laboring women admitted for delivery in selected tertiary care hospital in South India from 10th November 2021 to 20th January 2022. Structured interview schedule for demographic information, patient's case sheet for information about the 'Body Mass Index as a determinants of pregnancy outcomes' and anthropometric measurement for body mass index (weight and height). All registered deliveries in the study period have been included, comprising of 101 sample size Bivariate logistic regressions were used to determine the factors associated with outcome variables. A significant level of 5% was used to decide the significance of statistical tests. Body Mass Index in the 1st antenatal visit of the women who came for delivery in tertiary care hospital, underweight 36.6%, normal body mass index 52.5%, and overweight 10.9%. During 1st antenatal visit 58.4% had anemia, while 53.5% had mild anemia during the last antenatal visit. Respectively 39.6% of antenatal women had normal Hb% during 1st antenatal care visit, whereas 46.5% had normal Hb%, during their last antenatal visit. The mode of delivery; spontaneous vaginal delivery 45.5%, vacuum delivery 3.0%, emergency caesarean section delivery 50.5%. Preterm delivery was statistically significant among whose first antenatal care visit was after 11th weeks of gestation. Whereas, emergency caesarean section delivery was statistically significant among underweight. Increasing maternal weight body mass index was associated with maternal and neonatal health outcomes. Which was risk of pregnancy induced hypertension, preeclampsia, eclampsia, gestational diabetes mellitus and caesarean section delivery. Every 2nd women was anemic, every 3rd pregnant women was underweight (BMI >18.5), every 2nd baby was born with caesarean section delivery. Preterm delivery was statically significant of weeks of gestation during first antenatal care visit with more than 11th weeks of gestation. Whereas, emergency cesarean section was significant with low body mass index.

The Feto-Maternal Outcomes and Incidence of Early-and Late-Onset Preeclampsia

Hypertensive disorders in gestation are categorized as hypertension in pregnancy, chronic hypertension, eclampsia and pre-eclampsia. The World Health Organization states: “There are 529,000 maternal deaths annually worldwide due to pre-eclampsia and eclampsia. This study will help in determining pregnancy outcomes in early vs late-onset pr-eclampsia. Aim: To access the pregnancy outcomes of early and late onset pre-eclampsia. Study Design: A retrospective, descriptive and cross-sectional study Place and Duration: In the Obstetrics and Gynecology department of Allama Iqbal Memorial Teaching Hospital Sialkot and Islamic International Medical College, Rawalpindi for one-year duration form January 2021 to December 2021. Methods: A total 130 were admitted to the gynae ward with pre-diagnosis of pre-eclampsia were included. The cut-off value of the early and late onset PE was thirty-four weeks. Pre-eclampsia analysed &lt; 34 weeks was labeled as early-onset pre-eclampsia and if diagnosed after 34 weeks will be labeled as late-onset pre-eclampsia. Obstetric and perinatal outcomes were assessed with version 21 of the Social Sciences Statistical Package. Results: A total 130 were admitted to the gynae ward with pre-diagnosis of pre-eclampsia were included. The severe pre-eclampsia was observed in 48(36.9%) pregnant women and 82 women (63.1%) had no symptoms of severe pre-eclampsia. In 38 (29.2%) cases; early-onset pre-eclampsia was detected and late-onset PE in 92 (70.7%) cases. The rate of severe PE in early-onset PE has been documented in 22 (57.8%) of 38 cases, and severe PE has been reported in late-onset PE in 29 (31.5%) of 92 cases. Adverse maternal outcomes occurred in 20 cases, including 7 cases of placenta abruptio and 3 cases of eclampsia with seizure disorders. Conclusions: The results indicate that in addition to intensive fetal monitoring in women with early-onset pre-eclampsia, attention should be paid to neurological, cardiopulmonary, and haematological parameters. Keywords: late onset, early onset; pregnancy outcome and preeclampsia.

Metabolic signature of spent culture media shows lipid metabolism as a determinant of pregnancy outcomes.

In the present study, we investigated the spent culture media of in vitro produced (IVP) bovine embryos which did (group Pregnant) or did not (group Non-pregnant) establish pregnancy after transfer. For that purpose, IVP embryos on D5 were transferred to individual droplets for the last 48h of culture. Embryos at the blastocyst stage were then transferred to synchronized recipients, while respective culture media drops were collected and evaluated individually. The list of metabolites present in spent culture media was obtained by electrospray ionization mass spectrometry (ESI-MS) and analysed with Metaboanalyst® to characterize the metabolic profile of each group. The spectrometric analysis showed that pathways related to lipid metabolism, particularly fatty acids degradation via beta-oxidation, were more present in the Pregnant group whereas no significant pathway was identified in the group Non-pregnant. By using this method, we were able to identify a metabolic signature in culture media that allows for a better comprehension of preferential metabolic routes taken by the most viable embryos. These findings offer great insights into the biochemistry of embryo development and reveal a potential target for the development of better-quality IVP systems, as well as tools to identify bovine embryos with greater chances to establish and maintain pregnancy.

Placental Volume and Uterine Artery Doppler in Pregnancy Following In Vitro Fertilization: A Comprehensive Literature Review.

The number of pregnancies achieved using in vitro fertilization (IVF) is rapidly increasing around the world. The chance of obtaining a successful pregnancy is also significantly improved due to technological advances and improvement in infertility treatment. Despite this success, there is evidence that pregnancy conceived by IVF has an increased risk of adverse maternal and perinatal outcome mainly represented by the development of hypertensive diseases, pre-eclampsia, and fetal growth restriction. Although different cofactors may play a role in the genesis of these diseases, the development of the placenta has a pivotal function in determining pregnancy outcomes. Advances in ultrasound technology already allows for evaluation in the first trimester, the impedance to flow in the uterine artery, and the placental volume using Doppler and three-dimensional techniques. This review article aims to describe the modification occurring in placental volume and hemodynamics after IVF and to summarize the differences present according to the type of IVF (fresh vs. frozen-thawed embryos).

Ultrasound assessment of twin reversed arterial perfusion sequence for the prediction of adverse pregnancy outcomes in the first trimester.

To investigate twin reversed arterial perfusion (TRAP) sequence for the prediction of TRAP-related adverse pregnancy outcomes at the gestational age of 11-14weeks. Pregnant women in the first trimester diagnosed with TRAP were recruited at West China Second University Hospital from January 2015 to June 2018. Systematic screening for the pump twin's crown-rump length (CRL) and acardiac twin's upper pole-rump length (URL) was conducted using ultrasonic detection. The (CRL- URL)/CRL and URL/CRL ratios were used to assess the pregnancy outcomes for the pump twin. Twenty-one pregnant women aged 21-39years with a gestation of 11-14weeks were recruited. TRAP was diagnosed on average(±standard deviation (SD)) at pregnancy week 13.1±0.18. The pump twins' mean(±SD) CRL was 6.65±1.1cm. The incidence of intrauterine death for the pump twins was 19.0% (n=4), the miscarriage rate was 14.3% (n=3), and the live birth rate was 66.7% (n=14). The (CRL- URL)/CRL ratios between the nonsurvival (intrauterine death and miscarriage) and survival groups significantly differed (0.33±0.08vs. 0.58±0.08, p<0.05). Similarly, the URL/CRL ratios between the nonsurvival and survival groups significantly differed (0.67±0.08vs. 0.42±0.08, p<0.05). The (CRL- URL)/CRL and URL/CRL ratios were valuable indicators for determining pregnancy outcomes of pump twins with TRAP at an early gestational age.

Sanitation and Multiple Micronutrient Supplementation in Pregnancy Outcomes: Literature Review

BACKGROUND: Around 2.6 billion people lack proper sanitation. In addition, nutritional problems such as multiple micronutrient (MMN) deficiency can increase morbidity, mortality, and impaired neurocognitive growth at later stages of life. In addition to the need for a sanitary approach, a globally applicable strategy to prevent micronutrient deficiencies in pregnant women, UNICEF recommends the use of MMN for prenatal supplementation as an initial program in developing countries, to reduce the risk of poor birth outcomes. AIM: The aim of this literature study was to analyze the relationship between sanitation and the multimicronutrient (MMN) approach in pregnancy and birth outcomes. METHODS: This research was conducted using literature review method. Various references were collected from online database including reports, journals, and books. The journals were mostly from the scholarly journals. The articles were screened according to the research objectives. The keywords used are sanitation, pregnancy, and multiple micronutrient approach. RESULTS: Several studies have shown that sanitation and the multi micronutrient (MMN) approach play a role in determining pregnancy outcomes. We conclude that the importance of sanitation on pregnancy outcome is to reduce the chance of infection. The importance of MMN in pregnancy outcomes is that mothers who consume MMN during pregnancy can reduce the risk of poor birth output. The role of stakeholders is needed in the future. CONCLUSIONS: Several studies have shown that sanitation and multi micronutrient (MMN) play a role in determining pregnancy outcome.

Mitochondrial Dysfunction in the Pathogenesis of Preeclampsia.

Preeclampsia complicates 5-10% of all pregnancies and is a leading cause of maternal and perinatal mortality and morbidity. The placenta plays a pivotal role in determining pregnancy outcome by supplying the fetus with oxygen and nutrients and by synthesizing hormones. Placental function is highly dependent on energy supplied by mitochondria. It is well-known that preeclampsia is originated from placental dysfunction, although the etiology of it remains elusive. During the last three decades, substantial evidence suggests that mitochondrial abnormality is a major contributor to placental dysfunction. In addition, mitochondrial damage caused by circulating bioactive factors released from the placenta may cause endothelial dysfunction and subsequent elevation in maternal blood pressure. In this review, we summarize the current knowledge of mitochondrial abnormality in the pathogenesis of preeclampsia and discuss therapeutic approaches targeting mitochondria for treatment of preeclampsia.

Prevalence and Determinants of Pregnancy Outcomes among Mothers with Hypertensive Disorders at Woliso Saint Luke Hospital, Southwest Ethiopia

Objective: The study aimed to determine the prevalence of hypertensive disorders of pregnancy and determinants of its maternal and neonatal outcomes among pregnant mothers admitted to maternity wards of Woliso Saint Luke hospital, Ethiopia. Materials and Methods: Retrospective, institution-based cross-sectional study was conducted by reviewing records of pregnant mothers admitted to the maternity ward of the hospital between January 01, 2018, and December 31, 2020. The data were extracted using a structured checklist and analyzed using SPSS v. 24. Descriptive statistics of findings, univariate and multivariate logistic regression analysis were performed to identify the independent effect of predictor variables on the maternal and perinatal clinical outcomes. Results: During a three-year period, 15,097 pregnant mothers were admitted to the hospital's maternity ward. The prevalence of hypertensive disorders of pregnancy was 197(1.3%); more than half 121(61%) attributed to preeclampsia. From the total cases 37(18.8%) of mothers encountered adverse pregnancy outcomes of which 5(2.5%) of them died of its complications. Over half (51.8%) of neonates encountered adverse pregnancy outcomes; 17(20%) were born extremely LBW and 32(16.2%) died. Mothers who had blood pressure level of ˂ 160/110 mmHg during admission were 63% less likely to have adverse maternal outcomes compared to higher levels (AOR = 0.37, 95% CI = 0.14-0.94). The earlier gestational age at admission for hypertensive disorder associated to higher odd of adverse pregnancy outcome of neonates (AOR = 18.272, 95% CI = 6.330-52.742). Conclusion: The magnitude of hypertensive disorders of pregnancy showed significant rate. Besides, the complications or adverse pregnancy outcomes were higher compared to other previous studies. Earlier diagnosis during gestation, prompt management of complications and effective antenatal care are crucial in minimizing adverse outcomes for both mothers and newborns. Provision of focused and better quality care for high-risk mothers from pregnancy to post-partum period is highly recommended.

Validating Claims-Based Algorithms Determining Pregnancy Outcomes and Gestational Age Using a Linked Claims-Electronic Medical Record Database.

IntroductionPregnancy outcome identification and precise estimates of gestational age (GA) are critical in drug safety studies of pregnant women. Validated pregnancy outcome algorithms based on the International Classification of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) have not previously been published.MethodsWe developed algorithms to classify pregnancy outcomes and estimate GA using ICD-10-CM/PCS and service codes on claims in the 2016–2018 IBM® MarketScan® Explorys® Claims-EMR Data Set and compared the results with ob-gyn adjudication of electronic medical records (EMRs). Obstetric services were grouped into episodes using hierarchical and spacing requirements. GA was based on evidence with the highest clinical accuracy. Among pregnancies with obstetric EMRs, 100 full-term live births (FTBs), 100 preterm live births (PTBs), 100 spontaneous abortions (SAs), and 24 stillbirths were selected for review. Physicians adjudicated cases using Global Alignment of Immunization safety Assessment in pregnancy (GAIA) definitions applied to structured EMRs.ResultsThe claims-based algorithms identified 34,204 pregnancies, of which 9.9% had obstetric EMRs. Of sampled pregnancies, 92 FTBs, 93 PTBs, 75 SAs, and 24 stillbirths were adjudicated. Among these pregnancies, the percent agreement was 97.8%, 62.4%, 100.0%, and 70.8% for FTBs, PTBs, SAs, and stillbirths, respectively. The percent agreement on GA within 7 and 28 days, respectively, was 85.9% and 100.0% for FTBs, 81.7% and 98.9% for PTBs, 61.3% and 94.7% for SAs, and 66.7% and 79.2% for stillbirths.ConclusionsThe pregnancy outcome algorithms had high agreement with physician adjudication of EMRs and may inform post-market maternal safety surveillance.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40264-021-01113-8.

Placental secretome characterization identifies candidates for pregnancy complications

Alterations in maternal physiological adaptation during pregnancy lead to complications, including abnormal birthweight and gestational diabetes. Maternal adaptations are driven by placental hormones, although the full identity of these is lacking. This study unbiasedly characterized the secretory output of mouse placental endocrine cells and examined whether these data could identify placental hormones important for determining pregnancy outcome in humans. Secretome and cell peptidome analyses were performed on cultured primary trophoblast and fluorescence-activated sorted endocrine trophoblasts from mice and a placental secretome map was generated. Proteins secreted from the placenta were detectable in the circulation of mice and showed a higher relative abundance in pregnancy. Bioinformatic analyses showed that placental secretome proteins are involved in metabolic, immune and growth modulation, are largely expressed by human placenta and several are dysregulated in pregnancy complications. Moreover, proof-of-concept studies found that secreted placental proteins (sFLT1/MIF and ANGPT2/MIF ratios) were increased in women prior to diagnosis of gestational diabetes. Thus, placental secretome analysis could lead to the identification of new placental biomarkers of pregnancy complications.

Placental mitochondrial function in response to gestational exposures

Poor environmental conditions, including malnutrition, hypoxia and obesity in the mother increase the risk of pregnancy complications, such as pre-eclampsia and gestational diabetes mellitus, which impacts the lifelong health of the mother and her offspring. The placenta plays an important role in determining pregnancy outcome by acting as an exchange interface and endocrine hub to support fetal growth. Mitochondria are energy powerhouses of cells that fuel placental physiology throughout pregnancy, including placental development, substrate exchange and hormone secretion. They are responsive to environmental cues and changes in mitochondrial function may serve to mediate or mitigate the impacts of poor gestational environments on placental physiology and hence, the risks of pregnancy complications. Thus, a more integrated understanding about the role of placental mitochondria in orchestrating changes in relation to environmental conditions and pregnancy outcome is paramount. This review summarises the functions of mitochondria in the placenta and findings from humans and experimental animals that demonstrate how mitochondrial structure and function are altered in different gestational environments (namely complicated pregnancies and adverse environmental conditions). Together the available data suggest that mitochondria in the placenta play a major role in determining placental physiology, fetal growth and pregnancy outcome.

A Pregnancy Decision-Making Model: Psychological, Relational, and Cultural Factors Affecting Unintended Pregnancy

Empirical data from the past 50 years have illuminated some of the factors that influence pregnancy decision-making. Yet, formal models of pregnancy decision-making are uncommon and rarely incorporate cultural perspectives. In order to address this gap in the literature, we propose the Pregnancy Decision-Making Model (PDMM), a comprehensive model of the factors that are likely to affect pregnancy decisions in the context of unintended pregnancy, with special attention to relational and intersectional components of pregnancy decisions. The PDMM begins with three primary Evaluation factors: Evaluation of Capital, Evaluation of Values, and Evaluation of Narratives. Barriers to Access are proposed to be a key factor in limiting agency and autonomy and determining pregnancy outcomes. Social Influences are also hypothesized to influence Evaluation factors and their relationship with outcome variables, which include the Pregnancy Outcome, Decisional Certainty, and Decisional Satisfaction. As the PDMM is designed to be flexible in its prediction of a variety of outcomes, we consider a number of possible permutations of the model. Finally, we discuss the utility of the PDMM for inspiring future research, as well as the practical implications of the model.