Health In Early Pregnancy Research Articles

Determinants of Racial and Ethnic Differences in Maternal Cardiovascular Health in Early Pregnancy.

Suboptimal cardiovascular health (CVH) in pregnancy is associated with adverse maternal and offspring outcomes. To guide public health efforts to reduce disparities in maternal CVH, we determined the contribution of individual- and neighborhood-level factors to racial and ethnic differences in early pregnancy CVH. We included nulliparous individuals with singleton pregnancies who self-identified as Hispanic, non-Hispanic Black (NHB), or non-Hispanic White (NHW) and participated in the nuMoM2b cohort study (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be). First-trimester CVH was quantified using 6 routinely assessed factors in pregnancy included in the American Heart Association Life's Essential 8 score (0-100 points), in which higher scores indicate better CVH. Oaxaca-Blinder decomposition evaluated the extent to which racial and ethnic differences in CVH were explained by differences in individual- and neighborhood-level factors (age, socioeconomic characteristics, psychosocial factors, nativity, perceived racial discrimination, and area deprivation index). Among 9104 participants, the mean age was 26.8 years, 18.7% identified as Hispanic, 15.6% identified as NHB, and 65.8% identified as NHW. Mean (SD) CVH scores were 76.7 (14.1), 69.8 (15.1), and 79.9 (14.3) in the Hispanic, NHB, and NHW groups, respectively (P<0.01). The individual- and neighborhood-level factors evaluated explained all differences in CVH between Hispanic and NHW groups and 82% of differences between NHW and NHB groups. Racial and ethnic differences in educational attainment explained the greatest proportion of differences in CVH. If mean years of education among the Hispanic (14.0 [2.5]) and NHB (13.4 [2.4]) groups were the same as the NHW (15.8 [2.4]) group, mean CVH scores would be higher by 2.98 points (95% CI, 2.59-3.37) in the Hispanic and 4.28 points (95% CI, 3.77-4.80) in NHB groups. Racial and ethnic differences in early pregnancy CVH were largely explained by differences in individual- and neighborhood-level factors.

Mental Health in Early Pregnancy and Spontaneous Abortion Risk: A Prospective Cohort Study.

This study aims to explore the relationship between maternal mental health during early pregnancy and the risk of spontaneous abortion (SA), especially in the context of the Coronavirus disease 2019 pandemic. We conducted a prospective cohort study involving 4088 pregnant women at a maternal-child health hospital in China from January to December 2022. During the first trimester, we assessed depression, anxiety, and stress levels using the Depression, Anxiety, and Stress Scale (DASS-21). Pregnancy outcomes were monitored, and univariate and multiple logistic analyses were performed to identify the risk factors. These factors were then used to develop a nomogram model. Significant differences were found in maternal age, number of embryonic arrests, history of abortion, assisted reproduction, and environmental exposure between the SA group (n = 302) and the normal pregnancy group (n = 3786). After adjusting for potential confounders, higher scores on the DASS-21 subscales were independently associated with an increased risk of SA: Depression (OR [Odds Ratio] = 1.54, 95% CI [Confidence Interval]: 1.39-1.71, P < .001), Anxiety (OR = 1.61, 95% CI: 1.44-1.80, P < .001), and Stress (OR = 1.69, 95% CI: 1.31-2.20, P < .001). The model achieved a concordance index of 0.87 (95% CI: 0.86-0.90) and demonstrated a well-fitted calibration curve, indicating its good clinical applicability. Our findings indicate that mental health conditions are significantly associated with an increased risk of SA. The nomogram model also demonstrated strong predictive accuracy, indicating its potential usefulness in clinical settings.

P-778 Exploration of maternal proteome over pregnancy based on corpus luteum number at conception

Abstract Study question Does the maternal plasma proteome profile differ depending on corpus luteum (CL) number at conception? Summary answer The proteome profiles show differences depending on the number of CL at conception and some differentially regulated proteins may be linked to preeclampsia. What is known already Frozen embryo transfer (FET) in a programmed cycle is associated with a higher risk for preeclampsia. These women also experience impaired maternal vascular health in early pregnancy and differences in the endocrine environment, such as a lack of relaxin. These changes may be related to the absence of products from the CL. Study design, size, duration Prospective cohort study (N = 878) between June 2015 and December 2018 in an academic setting. Participants/materials, setting, methods Women with viable pregnancies were recruited at 6-8 weeks and compared by number of CL: no CL (programmed cycle FET), 1 CL (spontaneous pregnancy after infertility, modified natural cycle FET), and multiple CL (fresh IVF). Peripheral blood was collected, and plasma frozen at -80 °C. MS-based proteomics was used to determine proteome profiles of 4 participants in each group at 11-14 and 35-37 weeks’ gestation and 6-12 weeks postpartum. Main results and the role of chance Over 1000 protein groups were identified and 650 could be quantified in all samples. We found significant differences based on number of CL. Many of these proteins have been reportedly linked to preeclampsia. The results in the first trimester indicate the importance of aminopeptidases involved in the breakdown of angiotensin III. In addition, extracellular matrix proteins were found to be differentially regulated. Also, at the end of the third trimester certain proteins were differentially regulated among the groups. Limitations, reasons for caution This was a pilot study and unable to determine if differences are related to selection bias or could exist already pre-pregnancy independent of CL number at conception. Wider implications of the findings The findings warrant confirmation in a larger patient cohort. The detected differences in the proteome might shed light upon phenomena observed in women during pregnancy that lack a CL and as well as molecular mechanisms underlying preeclampsia. Trial registration number not applicable

Maternal cardiovascular health in early pregnancy and the risk of congenital heart defects in offspring

BackgroundCongenital heart disease (CHD) is the predominant birth defect. This study aimed to explore the association between maternal cardiovascular health (CVH) and the CHD risk in offspring.MethodsWe used the prospective data from the Fujian Birth Cohort Study, collected from March 2019 to December 2022 on pregnant women within 14 weeks of gestation. Overall maternal CVH was assessed by seven CVH metrics (including physical activity, smoking, sleep duration, body mass index, blood pressure, total cholesterol, and fasting plasma glucose), with each metric classified as ideal, intermediate or poor with specific points. Participants were further allocated into high, moderate and low CVH categories based on the cumulative CVH score. The association with offspring CHD was determined with log-binominal regression models.ResultsA total of 19810 participants aged 29.7 (SD: 3.9) years were included, with 7846 (39.6%) classified as having high CVH, 10949 (55.3%) as having moderate CVH, and 1015 (5.1%) as having low CVH. The average offspring CHD rate was 2.52%, with rates of 2.35%, 2.52% and 3.84% across the high, moderate and low CVH categories, respectively (P = 0.02). Adjusted relative risks (RRs) of having offspring CHD were 0.64 (95% CI: 0.45-0.90, P = 0.001) for high CVH and 0.67 (95% CI: 0.48-0.93, P = 0.02) for moderate CVH compared to low CVH. For individual metrics, only ideal total cholesterol was significantly associated with lower offspring CHD (RR: 0.73, 95% CI: 0.59-0.83, P = 0.002).ConclusionsPregnant women of high or moderate CVH categories in early pregnancy had reduced risks of CHD in offspring, compared to those of low CVH. It is important to monitor and improve CVH during pre-pregnancy counseling and early prenatal care.

Anxiety and Depression in Early Gestation and the Association with Subsequent Gestational Diabetes Mellitus in a Disadvantaged Population

ObjectivesEvaluate the association between poor mental health and risk of developing gestational diabetes mellitus (GDM) in a cohort of women from a socioeconomically disadvantaged community.MethodsA total of 1363 nulliparous women with singleton pregnancies recruited to the Screening Tests to Predict Poor Outcomes of Pregnancy study in Adelaide, Australia. Women were assessed for mental health in the first trimester, including likelihood of depression, high functioning anxiety, perceived stress and risk of developing a mental health disorder. GDM was diagnosed based on the International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria. Socioeconomic status was measured using the New Zealand Socioeconomic Index (NZSEI).ResultsComplete mental health data was available for 1281 participants. There was no statistically significant difference in SEI, depression, risk of mental health issues, high functioning anxiety and perceived stress between women who developed GDM and those who did not. There was no difference in history of depression nor risk of developing a high mental health disorder in first trimester after adjusting for SEI, BMI in first trimester, smoking status in first trimester and maternal age between women with a GDM pregnancy and those who did not.Conclusions for PracticeThere was no difference in markers of poor mental health in early pregnancy between women who subsequently did or did not develop GDM. Cohort participants were socioeconomically disadvantaged, potentially contributing to the lack of apparent differences in depression observed between groups. Socioeconomically disadvantaged women should be targeted in pre-conception planning to reduce risk of GDM.

Maternal Cardiovascular Health in Early Pregnancy and Childhood Brain Structure.

Background Poor cardiovascular health during pregnancy has been associated with adverse neurocognitive outcomes in the offspring. We examined the associations of maternal cardiovascular health factors with brain structure in 10-year-old children. Methods and Results We included 2797 mother-offspring pairs from the Generation R Study. Maternal body mass index, gestational weight gain, blood pressure, insulin, glucose, and lipid blood concentrations were obtained in early pregnancy. Childhood structural brain measures, including global metrics of brain tissue volumes and white matter microstructure, were quantified by magnetic resonance imaging at 10 years. As compared with offspring of mothers with normal weight, those of mothers with underweight had smaller total brain volume (difference, -28.99 [95% CI -56.55 to -1.45] cm3). Similarly, as compared with offspring of mothers with gestational weight gain between the 25th and 75th percentile, those of mothers with gestational weight loss or no gestational weight gain (<25th percentile), had smaller total brain volume (difference, -13.07 [95% CI, -23.82 to -2.32] cm3). Also, higher maternal diastolic blood pressure in early pregnancy was associated with lower offspring white matter mean diffusivity (difference, -0.07 [95% CI, -0.11 to -0.02] SD score). After multiple testing correction, only the association of maternal diastolic blood pressure with lower offspring white matter mean diffusivity remained statistically significant. No associations were observed of maternal insulin, glucose, and lipid concentrations with childhood brain outcomes. Conclusions Our findings suggest that maternal cardiovascular health during pregnancy might be related to offspring brain development in the long term. Future studies are needed to replicate our findings and to explore the causal nature of the associations.

Sexual function in primiparous women: a prospective study

Introduction and hypothesisThe aim of this prospective study was to examine the impact of sociodemographic, pregnancy and obstetric characteristics on sexual function 12 months postpartum in primiparous women. We hypothesized that sexual function would decrease after childbirth.MethodsBetween 1 October 2014 and 1 October 2017, all nulliparous women in early pregnancy registering for maternity health care in Region Örebro County, Sweden, were invited to participate in this prospective study. A total of 958 women were included. Sexual activity and function were measured at early pregnancy, 8 weeks postpartum and 12 months postpartum using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). The associations between sociodemographic, pregnancy and obstetric characteristics and sexual activity and function from early pregnancy to 12 months postpartum were examined using linear and logistic models based on generalized estimating equations.ResultsWe found that the prevalence of sexually active women decreased from 98.0% in early pregnancy to 66.7% at 8 weeks postpartum, but increased to 90.0% at 12 months postpartum. Age ≥ 35 years, second-degree perineal tear and current breastfeeding were statistically significant risk factors for sexual inactivity at 12 months postpartum. Poor self-reported health in early pregnancy was statistically significantly associated with decreased sexual function at 12 months postpartum.ConclusionsA majority of women resumed sexual activity at 8 weeks postpartum and most women at 12 months postpartum; the decrease in sexual function at 12 months postpartum was small and few risk factors were observed.

Green space, neighborhood walkability and cardiometabolic health in early pregnancy: The Healthy Start study

BACKGROUND AND AIM: Green space and neighborhood walkability have been associated with cardiometabolic health, but relationships with cardiometabolic markers during pregnancy are unclear. We estimated associations of residential green space and neighborhood walkability with cardiometabolic health in early pregnancy. METHODS: We included 1208 pregnant women enrolled in the Colorado-based Healthy Start study (2009-2014). During a study visit in early pregnancy (median 17 weeks of gestation), we measured systolic and diastolic blood pressure and collected fasting blood samples. We measured serum glucose and insulin and calculated the Homeostatic Model for Assessment of Insulin Resistance (HOMA-IR). We used the average Normalized Difference Vegetation Index (NDVI) in circular buffers of 250m, 500m and 1000m surrounding the participants’ homes to estimate exposure to green space. The walkability of the Census block group of the maternal residence was assessed by the National Walkability Index of 2010. Associations of green space and neighborhood walkability with cardiometabolic markers in early pregnancy were assessed by linear regression, adjusting for covariates. RESULTS:A higher average NDVI in all buffer sizes was associated with a lower diastolic blood pressure and (non-significantly) lower systolic blood pressure in early pregnancy. For example, women in the highest tertile of green space in a buffer of 500m (NDVI ≥0.21) had a 1.21mmHg [95%CI -2.23, -0.20] lower diastolic blood pressure than women in the lowest tertile. Additionally, pregnant women who lived in the most walkable neighborhoods had a 3.41mmHg [95%CI -5.31, -1.51] lower systolic and 2.18mmHg [95%CI -3.73, -0.63] lower diastolic blood pressure than women residing in the least walkable neighborhoods. We found no associations of green space or neighborhood walkability with glucose, insulin or HOMA-IR. CONCLUSIONS:In this racially and ethnically diverse population, higher exposure to residential green space and higher neighborhood walkability were associated with lower systolic and diastolic blood pressure in early pregnancy. KEYWORDS: Green space, Walkability, Female, Obesity and metabolic disorders

Prevalence and predictors of poor mental health among pregnant women in Wales using a cross-sectional survey

ObjectivesTo assess the prevalence of self-reported mental health problems in a cohort of women in early pregnancy.To describe the relationship between poor mental health and sociodemographic characteristics, self-efficacy and support networks.To assess if participants were representative of the local antenatal population. Research design and settingThe UK government has pledged money to provide more support for women with perinatal mental health issues. Understanding the prevalence and predicting women who may need support will inform clinical practice. This paper reports part of the larger ‘Mothers Mood Study’, which explored women's and midwives’ experience of mild to moderate perinatal mental health issues and service provision. Routinely collected population level data were analysed and a smaller cross-sectional survey design used to assess predictors of poor mental health in early pregnancy in one health board in Wales. ParticipantsRoutinely collected data were extracted for all women who registered for maternity care between May 2017 and May 2018 (n = 6312) from the electronic maternity information system (pregnant population). Over a three month period 302 of these women completed a questionnaire at the antenatal clinic after an ultrasound scan (participants). Eligible women were aged ≥18 years, with sufficient spoken and written English to complete the questionnaire and a viable pregnancy of ≤18 weeks’ gestation. The questionnaire collected data on sociodemographic status, self-efficacy and support networks, self-reported mental health problems. Current anxiety and depression were assessed using the General Anxiety Disorders Assessment and Edinburgh Postnatal Depression Scale. FindingsAmong the pregnant population 23% (n = 1490) disclosed a mental health problem during routine questioning with anxiety and depression being the most common conditions. Participants completing the detailed questionnaire were similar in age and parity to the pregnant population with similar levels of depression (15.6%; n = 15.6 v 17.3%, n = 1092). Edinburgh Postnatal Depression Scale and General Anxiety Disorder 7 scores identified 8% with symptoms of anxiety (n = 25) or depression (n = 26) and a further 24.2% (n = 73) with symptoms of mild anxiety and 25.2% (n = 76) with mild depression. Low self-efficacy (OR 1.27, 95% CI 1.12–1.45), a previous mental health problem (OR 3.95, 95% CI 1.37–11.33) and low support from family (OR 1.13, 95% CI 1.00–1.27) were found to be associated with early pregnancy anxiety and/or depression. Key conclusions and implications for practiceAround one in five women who register for maternity care may have a mental health problem. Mild to moderate anxiety and depression are common in early pregnancy. Services need to improve for women who do not currently meet the threshold for referral to perinatal mental health services. Assessment and active monitoring of mental health is recommended, in particular for pregnant women with risk factors including a history of previous mental health difficulties, poor family support or low self-efficacy.

Associations of body composition and physical fitness with gestational diabetes and cardiovascular health in pregnancy: Results from the HealthyMoms trial

The aim of this study was to examine associations of body composition (fat mass index, % fat mass, fat-free mass index, body mass index) and physical fitness (cardiorespiratory fitness and handgrip strength) with gestational diabetes and cardiovascular health in early pregnancy. This cross-sectional study utilized baseline data (n = 303) collected in early pregnancy from the HealthyMoms trial. Body composition was measured using air-displacement plethysmography, cardiorespiratory fitness was assessed by means of the 6-min walk test and handgrip strength using a dynamometer. Logistic regression was used to estimate odds ratios (ORs) for gestational diabetes as well as high (defined as 1 SD above the mean) blood pressure, homeostatic model assessment for insulin resistance (HOMA-IR), and metabolic syndrome score (MetS score) per 1 SD increase in body composition and fitness variables. Fat mass index, % fat mass and body mass index were all strongly associated with gestational diabetes (ORs: 1.72–2.14, P ≤ 0.003), HOMA-IR (ORs: 3.01–3.80, P < 0.001), blood pressure (ORs: 1.81–2.05, P < 0.001) and MetS score (ORs: 3.29–3.71, P < 0.001). Associations with fat-free mass index were considerably weaker (ORs: 1.26–1.82, P = 0.001–0.15) and were strongly attenuated after adjustments for fat mass index (ORs: 0.88–1.54, P = 0.039–0.68). Finally, greater cardiorespiratory fitness was associated with lower risk of high HOMA-IR and MetS score (ORs: 0.57–0.63, P ≤ 0.004) although these associations were attenuated when accounting for fat mass index (ORs: 1.08-1.11, P ≥ 0.61). In conclusion, accurately measured fat mass index or % fat mass were strongly associated with gestational diabetes risk and markers of cardiovascular health although associations were not stronger than the corresponding ones for body mass index. Fat-free mass index had only weak associations with gestational diabetes and cardiovascular health which support that the focus during clinical care would be on excess fat mass and not fat-free mass.

Study on Maternal SNPs of MTHFR Gene and HCY Level Related to Congenital Heart Diseases

The aim of this study is to evaluate the relationship between maternal single nucleotide polymorphisms (SNPs) of methylenetetrahydrofolate reductase (MTHFR) gene with plasma homocysteine (HCY) level and offspring congenital heart diseases (CHDs). 338 mothers with offspring CHDs as case group and 306 mothers of normal children as control group were recruited. Their pregnant histories were interviewed by questionnaire and the MTHFR rsl801133 and rsl801131 were genotyped. The case–control analysis was used to find out the relationship between maternal SNPs of MTHFR gene and offspring CHDs. And the plasma HCY concentration of the mothers of CHDs children was detected. This case–case study was intended to find out the relevance between maternal HCY level and SNPs of MTHFR gene. There were significant differences in the gender of children, occupation of mothers, family history with CHDs, history of abortion, history of adverse pregnancy, early pregnancy health, fetus during pregnancy, pesticide exposure and drug exposure in CHDs group and control group (P < 0.05). MTHFR rs1801133 was significantly associated with their offspring CHDs in mothers. The polymorphism of maternal MTHFR rs1801133 increased plasma HCY level, especially the homozygous mutation. Besides the environmental factors, our results suggested that the maternal MTHFR rs1801133 polymorphism might be a risk factor of their offspring CHDs, which may be due to the hyperhomocysteinemia by abnormal metabolism of HCY.

Serum Angiopoietin-1 &amp; Angiopoietin-2 as Serum Biomarkers for Ectopic Pregnancy and Missed Miscarriage

Background: The angiopoietins are proteins which belong to the family of angiogenic proteins,Angiopoietin-1 (Ang-1) and (Ang -2) are two critical regulators with different functions of vasculardevelopment and angiogenesis indicators for placental growth and maternal vascular health in earlypregnancy and miscarriage .Objective: To evaluate whether a single serum measurement of angiopoietin-1 and angiopoietin-2 at 6-8weeks gestation can differentiate failed pregnancies, whether ectopic pregnancies or missed miscarriages,from healthy intrauterine pregnancies.Methods: This study was a case control study conducted at Obstetric & Gynecological Department ofBaghdad Teaching hospital /Medical city through the period from 1 st of March to end of August, 2017Patient and method: the study included 93 pregnant women as following:a- 33 women with intrauterine viable pregnancyb- 30 pregnant women diagnosed as first trimester miscarriage.c- 30 women with ectopic pregnancy( proved by histopathology)Full history was taken and clinical examination was done blood sampling was performed ,full routineinvestigation ( complete blood picture , renal and liver indices ,blood group ) and measurement of angiopoietin1 and 2 levels and B.HCG were taken.Results: Mean angiopoitin-1 and angiopoitin-2 levels was significantly lower among women withectopic pregnancy (p<;0.001), in same way, there was a highly significant reduction in angiopoitin-1 andangiopoitin-2 mean among women with miscarriage than healthy women (p<0.001).Angiopoietin ratio was significantly lower among women with ectopicPregnancy (p<0.001). Validity results of angiopoitin-2 in prediction of ectopic pregnancy and miscarriage inearly pregnancy were better than angiopoitin-1 and human chorionic gonadotropins ratio titre. Angioepoitin1&2was not significant in differentiation between ectopic pregnancy and missed miscarriages (p=0.5).

Expectant Fathers' Social Determinants of Health in Early Pregnancy.

This cross-sectional, descriptive study examined unmet social and economic needs and health information requests of low-income, expecting fathers who participated in the First 1000 Days program. The First 1000 Days is a systems-level intervention aiming to prevent obesity among low-income mothers and infants across 3 community health centers in Greater Boston, MA, USA. Fathers who attended their partner’s first prenatal care visit were invited to complete a program survey during early pregnancy. Among 131 fathers surveyed, 45% were white, 21% were Hispanic/Latino, 55% were foreign-born, and 69% reported an annual income under $50 000. Fathers reported elevated levels of food insecurity (18%) and 33% were unaware of someone that could provide a $50 loan; however, over 85% of fathers knew someone that could provide non-financial social support. Fathers requested information about pregnancy, birth preparation, and fatherhood. Findings support addressing fathers’ unmet needs during pregnancy and providing father-specific perinatal information.

Hypertension Editors' Picks Preeclampsia.

Hypertension Editors' Picks Preeclampsia.

Preconceptional factors associated with haemoglobin concentration in early pregnancy: a community-based cohort study in rural northeastern Tanzania.

Maternal anaemia in early pregnancy is associated with poor pregnancy outcomes. Furthermore, preconceptional health can influence the health during pregnancy. The aim of this study was to investigate which preconceptional factors were associated with haemoglobin (Hb) concentration in early pregnancy. In Tanzania, 226 women were followed at preconception and during early pregnancy. Red blood cell (RBC) morphology, serum micronutrient concentration, demographic characteristics and health status were assessed in preconception and in early pregnancy. The association between preconceptional factors and Hb concentration in early pregnancy was investigated using simple and multiple linear regression analyses stratified by preconceptional anaemia status. Mean Hb was 123 and 119g/l before conception and during early pregnancy (median gestational age 53days) respectively. Preconceptional mid-upper arm circumference (MUAC) (adjusted coefficient (AC) 0.35 95% CI 0.9-0.61) and preconceptional Hb concentration (AC 0.45 95% CI 0.36-0.54) were positively associated with early pregnancy Hb concentration, whereas preconceptional microcytic hypochromic RBC morphology (AC -6.00 95% CI -9.56 to -2.44) was negatively associated with early pregnancy Hb concentration. In addition, treatment of preconceptional malaria was positively associated with early pregnancy Hb concentration (AC 6.45 95% CI 0.74-12.2) among women with preconceptional anaemia. In contrast, among preconceptional non-anaemic women, only preconceptional Hb concentration and medium socio-economic status was positively associated with early pregnancy Hb concentration. Mid-upper arm circumference (MUAC) and Hb measurements in preconception can help to detect women at increased risk of low Hb concentration in early pregnancy.

Absent or Excessive Corpus Luteum Number Is Associated With Altered Maternal Vascular Health in Early Pregnancy.

Identifying modifiable factors that contribute to preeclampsia risk associated with assisted reproduction can improve maternal health. Vascular dysfunction predates clinical presentation of preeclampsia. Therefore, we examined if a nonphysiological hormonal milieu, a modifiable state, affects maternal vascular health in early pregnancy. Blood pressure, endothelial function, circulating endothelial progenitor cell numbers, lipid levels, and corpus luteum (CL) hormones were compared in a prospective cohort of women with infertility history based on number of CL: 0 CL (programmed frozen embryo transfer [FET], N=18); 1 CL (spontaneous conception [N=16] and natural cycle FET [N=12]); or >3 CL associated with in vitro fertilization [N=11]. Women with 0 or >3 CL lacked the drop in mean arterial blood pressure compared with those with 1 CL (both P=0.05). Reactive hyperemia index was impaired in women with 0 CL compared with 1 CL ( P=0.04) while baseline pulse wave amplitude was higher with > 3 CL compared with 1 CL ( P=0.01) or 0 CL ( P=0.01). Comparing only FET cycles, a lower reactive hyperemia index and a higher augmentation index is noted in FETs with suppressed CL compared with FETs in a natural cycle (both P=0.03). The number of angiogenic and nonangiogenic circulating endothelial progenitor cell numbers was lower in the absence of a CL in FETs ( P=0.01 and P=0.03). Vascular health in early pregnancy is altered in women with aberrant numbers of CL (0 or >3) and might represent insufficient cardiovascular adaptation contributing to an increased risk of preeclampsia.

17. Aberrant corpus luteum number as a contributor to altered maternal vascular health in early pregnancy and preeclampsia risk after assisted reproduction

Introduction Pregnancies conceived after utilization of assisted reproductive technologies (ART) are associated with an increased risk for preeclampsia. The pathophysiologic reasons are mainly unknown. Objective We sought to determine if a non-physiologic hormonal milieu influenced by the number of corpora lutea (CL) and the mode of conception affects maternal vascular health in early pregnancy. Methods Blood pressure, endothelial function, circulating endothelial progenitor cell numbers (CPCs), lipid levels, and CL hormones were compared in a prospective cohort of women at 11 to 14 weeks’ gestation by number of CL and mode of conception (N = 57): 0 CL (programmed frozen embryo transfer (FET), N = 18); 1 CL (spontaneous pregnancy after infertility [N = 16] and modified natural cycle FET [N = 12]); or >3 CL associated with in vitro fertilization [N = 11]. Results Women with 0 or >3 CL lacked the drop in mean arterial blood pressure compared to women with 1 CL (P = 0.05; P = 0.05). Reactive Hyperemia Index (RHI) was impaired in patients lacking a CL compared to women with 1 CL (P = 0.04). Baseline pulse wave amplitude (BPWA) was higher in subjects with >3 CL compared to 1 CL (P = 0.01) or zero (P = 0.01). Suppression of CL development in FET cycles was associated with a lower RHI compared with FETs in a natural cycle (P = 0.03). The number of angiogenic and non-angiogenic CPCs was lower in the absence of a CL in FETs (P = 0.02 and P = 0.04). Relaxin levels correlated with the number of angiogenic CPCs (r = 0.31; P = 0.03). Discussion Maternal vascular health in early pregnancy is altered in women with aberrant numbers of CL (0 or >3), and might represent insufficient cardiovascular adaption leading to an increased risk of preeclampsia.

50. Cardiovascular health in early pregnancy and hypertensive disorders of pregnancy

Background Women with a hypertensive disorder of pregnancy (HDP) have an increased risk for cardiovascular disease (CVD). It remains unknown whether this results from the HDP itself or suboptimal cardiovascular health (CVH) before the onset of a HDP. Objective To determine the association between early pregnancy CVH and the risk for a HDP. Secondly, whether early pregnancy CVH is associated with CVH and carotid intima-media thickness (CIMT) after pregnancy, irrespective of a HDP. Methods Women (normotensive [n = 7008]/HDP [n = 240]) participated in the Generation R Study. We determined CVH in early pregnancy and nine years after according to the American Heart Association criteria. CVH comprised of seven metrics (blood pressure, BMI, smoking, physical activity, diet, total-cholesterol and glucose concentrations), which were categorized and weighted as poor, intermediate or ideal (zero, one or two points). All seven metrics combined created the CVH score, ranging from 0 to 14 points. CIMT nine years after pregnancy was used as a preclinical CVD marker. Results Women with higher CVH in early pregnancy had a 22% lower risk of developing a HDP than women with lower CVH. Higher blood pressure, BMI and glucose in early pregnancy were the strongest risk factors for developing a HDP. Higher CVH in early pregnancy was associated with higher CVH after pregnancy, especially after a HDP. Also, women with higher CVH in early pregnancy had a smaller CIMT, irrespective of having had a HDP. Discussion Higher CVH in early pregnancy reduces the risk of developing a HDP and CIMT thickening after pregnancy. Also, women with higher CVH in early pregnancy have higher CVH after pregnancy, especially those with a previous HDP. Remarkably, early pregnancy CVH was a better predictor of CIMT thickening than HDP. Early pregnancy CVH could be used to predict the risk of HDP and optimize CVH both in pregnancy and afterwards.

Correlates of poor mental health in early pregnancy in obese European women

BackgroundDepression during pregnancy is associated with higher maternal morbidity and mortality, and subsequent possible adverse effects on the cognitive, emotional and behavioral development of the child. The aim of the study was to identify maternal characteristics associated with poor mental health, in a group of overweight/obese pregnant women in nine European countries, and thus, to contribute to better recognition and intervention for maternal depression.MethodsIn this cross-sectional observational study, baseline data from early pregnancy (< 20 weeks) of the DALI (Vitamin D and Lifestyle Intervention for gestational diabetes mellitus prevention) study were analyzed. Maternal mental health was assessed with the World Health Organization Well-Being Index (WHO–5). Women were classified as having a low (WHO–5 ≤ 50) or high wellbeing.Results.A total of 735 pregnant women were included. The prevalence of having a low wellbeing was 27.2%, 95% CI [24.0, 30.4]. Multivariate analysis showed independent associations between low wellbeing and European ethnicity, OR = .44, 95% CI [.25, .77], shift work, OR = 1.81, 95% CI [1.11, 2.93], insufficient sleep, OR = 3.30, 95% CI [1.96, 5.55], self-efficacy, OR = .95, 95% CI [.92, .98], social support, OR = .94, 95% CI [.90, .99], and pregnancy-related worries (socioeconomic: OR = 1.08, 95% CI [1.02, 1.15]; health: OR = 1.06, 95% CI [1.01, 1.11]; relationship: OR = 1.17, 95% CI [1.05, 1.31]).ConclusionsMental health problems are common in European overweight/obese pregnant women. The identified correlates might help in early recognition and subsequent treatment of poor mental health problems during pregnancy. This is important to reduce the unfavorable effects of poor mental health on pregnancy outcomes.Trial registrationISRCTN70595832, 02.12.2011.

OP 21 Absence of corpus luteum impairs maternal endothelial health in early pregnancy – A contributor to the increased risk for hypertensive disease after assisted reproduction?

Introduction Assisted reproduction is associated with an increased risk for hypertensive disease in pregnancy. The underlying pathophysiology is still debated. Endothelial dysfunction is a central component of hypertensive disease and can be determined non-invasively by Pulse-Amplitude-Tonometry (PAT). Objectives We hypothesized that a non-physiologic maternal environment in early pregnancy, specifically the absence of a corpus luteum (CL), negatively impacts maternal endothelial health. Patients and methods For this ongoing study women with spontaneous conceptions and conceptions after assisted reproduction were recruited at an academic infertility clinic after confirmation of a viable intrauterine pregnancy between 7 and 10 weeks gestation. Exclusion criteria were multiples, chronic hypertension, chronic kidney disease, diabetes mellitus, autoimmune disease, age >50 years or BMI >30. Endothelial function was determined using the Endo-PAT2000 system by calculating the reactive hyperemia index (RHI) at 11–14 weeks gestation. RHI ⩽1.67 is associated with a higher cardiovascular risk. A fasting lipid panel was obtained for each participant. Statistical analysis was performed using Kruskal–Wallis-test with post hoc analysis. Results are shown as means and standard errors. Results 47 women participated in the research visit. We found a significant difference in endothelial function with lower RHI in pregnant women with no CL (N = 10, RHI = 1.65 ± 0.08; p = 0.04) compared to women with 1 CL (N = 21; RHI = 1.99 ± 0.11). This difference was also evident between frozen-thawed ET in programmed (N = 10; RHI = 1.65 ± 0.03, p = 0.03) compared to natural cycles (N = 9; RHI = 1.95 ± 0.08). There was no difference when comparing the data to the group of women with fresh ET and supraphysiologic numbers of CL. Age, blood pressure and lipid levels were not different between groups. Conclusions A non-physiologic maternal environment, which is generated by suppression of CL in programmed cycles, negatively impacts maternal endothelial health in early pregnancy. The cause could be the absence of CL products. Specifically, relaxin, a potent vasodilator, might play a crucial role. A deficiency in relaxin could therefore contribute to an increased risk of hypertensive disease in pregnancy after assisted reproduction.