Nonpregnant Individuals Research Articles

Multicomponent provider–patient intervention to improve glycaemic control in Medicaid-insured pregnant individuals with type 2 diabetes: clinical trial protocol for the ACHIEVE study

IntroductionType 2 diabetes (T2D) is one of the most frequent comorbid medical conditions in pregnancy. Glycaemic control decreases the risk of adverse pregnancy outcomes for the pregnant individual and infant....

Pregnancy-specific responses to COVID-19 revealed by high-throughput proteomics of human plasma

BackgroundPregnant women are at greater risk of adverse outcomes, including mortality, as well as obstetrical complications resulting from COVID-19. However, pregnancy-specific changes that underlie such worsened outcomes remain unclear.MethodsPlasma samples were collected from pregnant women and non-pregnant individuals (male and female) with (n = 72 pregnant, 52 non-pregnant) and without (n = 29 pregnant, 41 non-pregnant) COVID-19. COVID-19 patients were grouped as asymptomatic, mild, moderate, severe, or critically ill according to NIH classifications. Proteomic profiling of 7,288 analytes corresponding to 6,596 unique protein targets was performed using the SOMAmer platform.ResultsHerein, we profile the plasma proteome of pregnant and non-pregnant COVID-19 patients and controls and show alterations that display a dose-response relationship with disease severity; yet, such proteomic perturbations are dampened during pregnancy. In both pregnant and non-pregnant state, the proteome response induced by COVID-19 shows enrichment of mediators implicated in cytokine storm, endothelial dysfunction, and angiogenesis. Shared and pregnancy-specific proteomic changes are identified: pregnant women display a tailored response that may protect the conceptus from heightened inflammation, while non-pregnant individuals display a stronger response to repel infection. Furthermore, the plasma proteome can accurately identify COVID-19 patients, even when asymptomatic or with mild symptoms.ConclusionThis study represents the most comprehensive characterization of the plasma proteome of pregnant and non-pregnant COVID-19 patients. Our findings emphasize the distinct immune modulation between the non-pregnant and pregnant states, providing insight into the pathogenesis of COVID-19 as well as a potential explanation for the more severe outcomes observed in pregnant women.

Repeat Ivermectin Mass Drug Administrations for Malaria Control II: Protocol for a Double-blind, Cluster-Randomized, Placebo-Controlled Trial for the Integrated Control of Malaria

The gains made against malaria have stagnated since 2015, threatened further by increasing resistance to insecticides and antimalarials. Improvement in malaria control necessitates a multipronged strategy, which includes the development of novel tools. One such tool is mass drug administration (MDA) with endectocides, primarily ivermectin, which has shown promise in reducing malaria transmission through lethal and sublethal impacts on the mosquito vector. The primary objective of the study is to assess the impact of repeated ivermectin MDA on malaria incidence in children aged ≤10 years. Repeat Ivermectin MDA for Malaria Control II is a double-blind, placebo-controlled, cluster-randomized, and parallel-group trial conducted in a setting with intense seasonal malaria transmission in Southwest Burkina Faso. The study included 14 discrete villages: 7 (50%) randomized to receive standard measures (seasonal malaria chemoprevention [SMC] and bed net use for children aged 3 to 59 months) and placebo, and 7 (50%) randomized to receive standard measures and monthly ivermectin MDA at 300 μg/kg for 3 consecutive days, provided under supervision to all eligible village inhabitants, over 2 successive rainy seasons. Nonpregnant individuals >90 cm in height were eligible for ivermectin MDA, and cotreatment with ivermectin and SMC was not permitted. The primary outcome is malaria incidence in children aged ≤10 years, as assessed by active case surveillance. The secondary safety outcome of repeated ivermectin MDA was assessed through active and passive adverse event monitoring. The trial intervention was conducted from July to November in 2019 and 2020, with additional sampling of humans and mosquitoes occurring through February 2022 to assess postintervention changes in transmission patterns. Additional human and entomological assessments were performed over the 2 years in a subset of households from 6 cross-sectional villages. A subset of individuals underwent additional sampling in 2020 to characterize ivermectin pharmacokinetics and pharmacodynamics. Analysis and unblinding will commence once the database has been completed, cleaned, and locked. Our trial represents the first study to directly assess the impact of a novel approach for malaria control, ivermectin MDA as a mosquitocidal agent, layered into existing standard-of-care interventions. The study was designed to leverage the current SMC deployment infrastructure and will provide evidence regarding the additional benefit of ivermectin MDA in reducing malaria incidence in children. ClinicalTrials.gov NCT03967054; https://clinicaltrials.gov/ct2/show/NCT03967054 and Pan African Clinical Trials Registry PACT201907479787308; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=8219. DERR1-10.2196/41197.

Integration of multiomics with precision nutrition for gestational diabetes: Study protocol for the Westlake Precision Birth Cohort

Integration of multiomics with precision nutrition for gestational diabetes: Study protocol for the Westlake Precision Birth Cohort

Muscle sympathetic nerve activity during pregnancy: A systematic review and meta-analysis.

We conducted a systematic review and meta-analysis to quantify the impact of healthy and complex pregnancy on muscle sympathetic nerve activity (MSNA) at rest, and in response to stress. Structured searches of electronic databases were performed until February 23, 2022. All study designs (except reviews) were included: population (pregnant individuals); exposures (healthy and complicated pregnancy with direct measures of MSNA); comparator (individuals who were not pregnant, or with uncomplicated pregnancy); and outcomes (MSNA, BP, and heart rate). Twenty-seven studies (N=807) were included. MSNA burst frequency was higher in pregnancy (n=201) versus non-pregnant controls (n=194) (Mean Differences [MD], MD: 10.6 bursts/min; 95% CI: 7.2, 14.0; I2 =72%). Accounting for the normative increase in heart rate with gestation, burst incidence was also higher during pregnancy (Pregnant N=189, non-pregnant N=173; MD: 11 bpm; 95% CI: 8, 13 bpm; I2 =47%; p < 0.0001). Meta-regression analyses confirmed that although sympathetic burst frequency and incidence are augmented during pregnancy, this was not significantly associated with gestational age. Compared to uncomplicated pregnancy, individuals with obesity, obstructive sleep apnea, and gestational hypertension exhibited sympathetic hyperactivity, while individuals with gestational diabetes mellitus or preeclampsia did not. Uncomplicated pregnancies exhibited a lesser response to head-up tilt, but an exaggerated sympathetic responsiveness to cold pressor stress compared to non-pregnant individuals. MSNA is higher in pregnant individuals and further increased with some, but not all pregnancy complications. PROSPERO registration number: CRD42022311590.

Variation in diet of desert bighorn sheep (Ovis canadensis nelsoni): Tradeoffs associated with parturition

Selection of forage and habitats is driven by nutritional needs of individuals. Some species may sacrifice nutritional quality of forage for the mother in favor of safety of offspring (risk-averse strategy), immediately following parturition. We studied diet quality and forage selection by bighorn sheep before and following parturition to determine how nutritional demands associated with rearing offspring influenced forage acquisition. We used desert bighorn sheep, Ovis canadensis nelsoni, to investigate that potential tradeoff. We captured and radio-collared female bighorn sheep from 2016 to 2018. We used vaginal implant transmitters (VIT)s in pregnant females to identify parturition and to capture and radio-collar neonates to monitor survival of young. We collected fecal samples throughout the breeding season and throughout the year to understand diet quality and composition throughout those temporal periods. We determined diet quality and composition for pre-parturient females, females provisioning offspring, females that lost offspring, and non-pregnant individuals using fecal nitrogen and DNA metabarcoding analyses. Additionally, we compared the diet quality and composition of offspring and adult females during the spring, as well as summer and winter months. Our results indicated differences in diet quality between individuals provisioning offspring and those whose offspring had died. Females that were provisioning dependent young had lower quality diets than those that lost their offspring. Diet composition among those groups was also markedly different; females that had lost an offspring had a more diverse diet than did females with dependent young. Diet quality differed among seasons, wherein offspring and adult females had higher quality diets during the spring months, with decreasing quality as the year progressed. Diet diversity was similar across seasons, although spring months tended to be most diverse. Our results support tradeoffs associated with risk-averse strategies made by adult females associated with parturition. Nutritional quality of forage was linked to provisioning status, indicating that females were trading diet quality for safety of offspring, but those females whose offspring had died selected high quality forages. Those results help explain habitat selection observed in mountain ungulates around parturition and provide further insight into the evolutionary processes and adaptive significance exhibited by those specialized artiodactyls.

Symptoms associated with severe acute respiratory syndrome coronavirus-2 infection in vaccinated pregnant and non-pregnant individuals during the omicron surge

Given limited data on the symptoms and severity of the predominant SARS-CoV-2 variant in pregnant persons, this study aims to investigate symptoms associated with infection in vaccinated pregnant individuals during the Omicron variant surge.

An analysis of changing practice advisory guidelines on COVID-19 vaccine uptake in pregnancy

Pregnant individuals face increased risk of severe illness with SARS-CoV-2 compared to non-pregnant individuals. On July 30, 2021, the American College of Obstetricians and Gynecologists (ACOG) updated the COVID-19 Vaccination Considerations for Obstetric-Gynecologic Care Practice Advisory to recommend COVID-19 immunization for all pregnant persons. Prior to this date, there was no clear guidance regarding COVID-19 vaccination in pregnancy. This study aims to explore the potential impact of this Advisory on vaccine uptake and knowledge of current recommendations among pregnant individuals.

Previous Trauma Exposure and Its Associations with Fear of Childbirth and Quality of Life among Pregnant Lesbian, Bisexual, Transgender, and Queer People and Their Partners

The primary aim of this study was to determine the prevalence of previous trauma exposure among expectant birth-giving parents and their partners within a LBTQ population. The secondary aims were to compare fear of childbirth (FOC) and quality of life (QoL) in relation to previous trauma exposure in pregnant LBTQ people and their partners. A further aim was to analyze associations between severe FOC and clinical and demographic factors in this population. Data was collected from a Swedish LGBTQ competent antenatal clinic. Trauma-exposed pregnant (n = 32) and non-pregnant (n = 21) individuals and pregnant (n = 48) and non-pregnant (n = 30) individuals without previous trauma experiences responded to instruments measuring FOC (Wijma Delivery Expectancy Questionnaire) and QoL (EuroQol 5 D-index/-visual analogue scale, VAS). Differences between groups were assessed using non-parametric tests. The proportion of trauma exposure was similar among pregnant responders and their partners (40.0% vs. 41.2%). Trauma-exposed pregnant respondents had a significantly higher prevalence of severe FOC compared to the pregnant respondents without previous trauma. Pregnant trauma-exposed respondents scored lower on EQ5D-VAS than pregnant respondents without trauma, as did non-pregnant trauma exposed respondents compared with non-pregnant ­respondents without trauma. Furthermore, trauma-exposed non-pregnant respondents scored lower on the EQ5D-index compared to non-pregnant respondents without trauma. Previous trauma was the only clinical and demographic factor that had any significant association withto severe FOC in the regression analysis. In conclusion, our results suggest that previous trauma exposure may contribute to the risk of suffering from severe FOC and lower QoL among LBTQ-identifying prospective parents.

Adequacy of glycemic control in early pregnancy with type 2 diabetes and perinatal outcomes

In non-pregnant individuals with type 2 DM (T2DM), an HbA1c target < 7% is recommended. We sought to assess if an HbA1c < 7% in early pregnancy is associated with a lower risk for adverse pregnancy outcomes. We conducted a retrospective cohort study of individuals with T2DM and a singleton gestation who delivered at 2 health systems between 2018-2020. Demographics, markers of health care utilization, and perinatal outcomes were abstracted from the medical record. Race and ethnicity were self-reported. The primary exposure was levels of glycemic control at less than 20 weeks’ gestation using recommended HbA1c targets in non-pregnant individuals (HbA1c < 7% vs. HbA1c ≥7%). Patients without documentation of HbA1c prior to 20 weeks were excluded. Perinatal outcomes were abstracted from the medical record, and logistic regression was used to adjust for covariates. Of the individuals who had a documented HbA1c < 20 weeks of gestation, 128/281 (46%) had a HbA1c < 7%, and 153/281 (54%) had a HbA1c ≥7%. Patients with HbA1c < 7% were more likely to be of White race and have private insurance. They also had the first HbA1c measured earlier in pregnancy, a lower mean HbA1c across gestation, less overall weight gain, and were less likely to require insulin at the time of delivery. There were no significant differences in other demographics or markers of healthcare utilization (Table 1). Outcomes are shown in Table 2. After adjusting for covariates, those with a HbA1c ≥7% were more likely to have a preterm birth < 37 weeks (aOR 2.3, 95% CI 1.3-4.0), cesarean delivery (aOR 1.9, 95% CI 1.1-3.3), and a neonate requiring NICU admission (aOR 2.9, 95% CI 1.7-4.9). Adverse perinatal outcomes are common among individuals with T2DM even when early pregnancy HbA1c values are within recommended targets for non-pregnant individuals. Those who present with a HbA1c ≥7% are at even higher risk for several outcomes. We observed important disparities in HbA1c values in early pregnancy that likely represent barriers in accessing medical care prior to pregnancy.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Considerações éticas sobre estudos de vacina controlada com placebo em gestantes

Abstract Placebo use in clinical trials, whenever a proven effective treatment exists, is one of the most debated topics in contemporary research ethics. This article addresses the ethical framework for placebo use in clinical trials assessing vaccine efficacy in pregnant women. Vaccine trial participants are healthy at the outset and some must be infected during the study to demonstrate the product’s efficacy, meaning that placebo-treated participants are under risk of serious and irreversible harm. If effective vaccines exist, such risk precludes placebo use. This interdiction should be extended to any clinical trial of vaccine efficacy in pregnant women, because a demonstration of clinical efficacy in nonpregnant individuals and comparable immunogenic responses in pregnant women are predictors of efficacy in pregnancy as well. Moreover, product effectiveness in real-world use scenarios can be ascertained by observational studies conducted after its inclusion in vaccination campaigns.

Method Validation Study for SARS-CoV-2 Viral RNA Detection in Cervical, Rectal, Amniotic Fluid, Placental, Umbilical Cord Blood, and Breastmilk Specimens in a Cohort of Unvaccinated Women in Manila, Philippines.

To validate a method in detecting SARS-CoV-2 via RT-qPCR in pregnant and non-pregnant samples other than nasopharyngeal swabs and/or oropharyngeal swabs such as cervical, rectal, amniotic fluid, placental, umbilical cord blood, and breastmilk. We performed a validation experiment using MGI easy extraction kits and BGI PCR kits on non-conventional specimens, including cervical, rectal, amniotic fluid, placental, umbilical cord blood, and breastmilk to detect and confirm the presence of SARS-CoV-2. In addition, we tested the validated method on 572 purposively sampled field-collected non-conventional specimens from a cohort of 109 unvaccinated pregnant and 47 unvaccinated non-pregnant women to assess which candidate non-conventional maternal- and fetal-associated specimens may contribute to maternal-fetal viral vertical transmission. Positive detection of SARS-CoV-2 viral RNA in non-conventional specimens was demonstrated and verified. Of the 572 non-conventional samples tested, 1.8% (10/572) were positively validated by RT-qPCR for SARS-CoV-2 in the maternal-associated specimens particularly the rectal (5), placental (1), and cervical (4) swabs among six pregnant and four non-pregnant individuals. In contrast, no SARS-CoV-2 viral RNA was detected in fetal-associated specimens. The results of the validation study may serve as an additional diagnostic screening layer to support maternal-child care. Furthermore, viral detection in these non-conventional maternal specimens may also be utilized to provide guidance in the clinical management of neonates, and pregnant women during delivery.

Lactate levels increase significantly in the second stage of spontaneous and induced labor

Lactate is frequently observed as a component of sepsis bundles, however, there is a paucity of data for normal ranges in labor. Because of this, our aim was to survey maternal lactate levels in uncomplicated labor. This was a prospective convenience sampling of patients at term presenting with spontaneous labor and for induction at a single academic center. Blood was collected at admission, complete cervical dilation, and every 30 minutes during the second stage of labor for up to 3 hours or until delivery. Samples were processed and transported on ice to an on-site laboratory within 30 minutes for analysis of plasma lactate using enzymatic oxidation and colorimetric assay (Roche Lactate Gen.2). The primary outcome was change in lactate level over time during the second stage of labor. Statistical analysis included a mixed effects repeated measures model, with chorioamnionitis as a fixed effect and time as a random effect with p < 0.05 considered significant. From January 7, 2021, through December 30, 2021, 38 patients were enrolled. Eight patients withdrew after the baseline level was drawn. Lactate was obtained for 23 patients at complete dilation, and for 14 patients during maternal pushing. Beginning at the second stage, mean lactate was 2.76 mmol/L (95% CI 2.01, 3.51). Lactate significantly increased with time (p < 0.001) with mean change in lactate level 1.9 mmol/L over 30 minutes of observation (Figure 1a). Lactate level was increased in patients with chorioamnionitis compared to uninfected laboring patients, but this difference was not statistically significant (p = 0.67) (Figure 1b). Lactate increases significantly in the second stage of uncomplicated spontaneous or induced labor from a baseline considered outside the normal range in nonpregnant individuals. Obstetricians should use caution in interpreting abnormal lactate levels in otherwise uncomplicated laboring patients with or without chorioamnionitis.

Exposure of reproductive-aged pregnant and nonpregnant women to common environmental pollutants and endocrine-disrupting chemicals: A cross-sectional survey at the University of the Philippines-Philippine General Hospital

CONTEXT: Exposure to environmental pollutants (EP) and Endocrine-disrupting chemicals (EDCs) is associated with several general negative health effects which compromise women's reproductive health, maternal, and neonatal outcomes. Unfortunately, many nonpregnant and pregnant women are unaware of their active exposure to these potentially slow-acting toxic substances, EPs, and EDCs. At any stage of life, and in the long-term minute exposures, there is no established safe level of exposure to these substances. Due to the potentially harmful effects on women in general, and to the pregnant and her unborn child in particular, it is important to establish the prevalence of their exposure.AIMS: The aim of this study was to determine the magnitude (prevalence) of exposure among nonpregnant and pregnant women aged 18–49 years to common EPs/EDCs such as bisphenol A, pesticides, phthalates, and perfluorinated compounds among others.SETTINGS AND DESIGN: This study was conducted at the Philippine General Hospital, University of the Philippines Manila.SUBJECTS AND METHODS: The study participants were nonpregnant and pregnant women, with low-risk singleton pregnancy, and had a prenatal checkup and eventual delivery at the Philippine General Hospital. After consent, women were asked to answer a survey focused on their sociodemographics and frequency of exposure to EP- and EDC-containing items.STATISTICAL ANALYSIS USED: Descriptive statistics were used to summarize the demographic and clinical characteristics of the patients. Null hypotheses were rejected at 0.05 α-level of significance. The computer software STATA 13.1 was used for data analysis.RESULTS: One hundred and fifty-nine survey responses by women were analyzed. Possible EDC-containing household items (carpets, linoleum, upholstered, and stain-resistant furniture) are more prevalent in the homes of pregnant women compared to nonpregnant women. Pregnant women are also exposed to wallpapers compared to nonpregnant individuals. Nonpregnant women were 1.5 times more exposed to lotions. Unexposure to hand sanitizers is 1.3 times higher among pregnant individuals.CONCLUSIONS: There are differences in the prevalence of exposure to household EDC-containing items between pregnant and nonpregnant women, with pregnant women having a higher prevalence of exposure.

COVID-19 in third trimester of pregnancy.

The COVID-19 pandemic disease, which affects the respiratory system and produces flu-like symptoms, is caused by the SARS-CoV-2 virus. It is transmitted by close contact, oronasal secretions, or droplets. In general, pregnant individuals are at increased risk than nonpregnant individuals for developing serious SARS-CoV-2 virus-related illnesses, particularly during the third trimester. Despite the lack of research on COVID-19-infected pregnant mothers, this review article has discussed the clinical and laboratory characteristics and impact of COVID-19 on delivery, management, and vaccination of pregnant individuals with COVID-19 infection.

PS-BPC03-7: ARE OSCILLOMETRIC WAVEFORMS DIFFERENT IN PREGNANCY?

Objective: Hypertensive disorders of pregnancy are leading causes of maternal and perinatal morbidity and mortality. Automated blood pressure (BP) measurements are being used in clinical practice; however, understanding of how oscillometric waveform vary between pregnant and non-pregnant individuals remains low. Design and Methods: Pregnant individuals over 20 weeks gestational age and healthy, non-pregnant women were recruited. Healthy, non-pregnant women (HNP) were matched to healthy pregnant women (HP), and pregnant women with a hypertensive disorder of pregnancy (HDP) by age (± 10 years), arm circumference (± 6 cm), and BMI at the time of BP measurement (± 13 kg/m2). There were seven individuals in each group for a total of 21 participants. BP measurements were done per the International Organization for Standardization (ISO) protocol using a custom-built oscillometric device as the test device and 2-observer mercury auscultation as the reference measurement. Four pairs of auscultatory measurements and four oscillometric measurements were obtained for each participant. Baseline demographics, auscultatory BP and BP derived from slope-based and fixed ratio algorithms were determined. Oscillometric waveform and envelope features were compared among groups. Results: In HNP, HP, and HDP groups respectively: mean age was 31.3 ± 4.8; 32.1 ± 3.6; 32.0 ± 4.4 years; arm circumference 31.9 ± 3.3; 32.3 ± 4.9; 34.0 ± 3.3 cm; BMI 26.8 ± 3.8; 32.0 ± 7.2; 32.4 ± 3.7 kg/m2; mean auscultatory BP (systolic/diastolic) 103.3 ± 11.1/66.5 ± 7.4; 110.6 ± 4.0/56.9 ± 6.5; 132.6 ± 19.0/83.9 ± 13.3 mmHg. HDP had significantly higher auscultatory systolic (P &lt; 0.05) and diastolic (p &lt; 0.01) BP than the other groups. The pregnant groups (HP, HDP) had significantly higher heart rate (p &lt; 0.01); higher pulses (p &lt; 0.05) in the oscillometric waveform (OMV); lower average width in the pulses (p &lt; 0.01); higher pressure amplitude at which the OMW peaks (p &lt; 0.05) with longer time to reach this maximum pressure amplitude (p &lt; 0.05); greater area under the curve (p &lt; 0.01). Compared to HNP, the HDP showed significantly skewed OMW to the right (p &lt; 0.01); greater spread in the OMW envelope (p &lt; 0.05) and lesser random variation in the OMW envelope (p &lt; 0.01). A typical OMV with the 3 groups superimposed is demonstrated in Figure 1. Conclusion: Significant differences in the oscillometric waveform morphology and parameters were found in pregnancy and in hypertensive disorders of pregnancy compared to healthy controls. These results suggest that pregnancy-specific algorithms may be required to optimize accuracy for oscillometric BP measurement.

O19Experiences of racial/ethnic discrimination and contraceptive use: A longitudinal study

<h3>Objectives</h3> Racism is associated with undesired pregnancy, but no studies examine how experiencing discrimination might shape pregnancy preferences or contraceptive use. <h3>Methods</h3> We recruited n=1,790 non-pregnant individuals, with the capacity for pregnancy, aged 15–34 from 20 health facilities in West Texas, Nevada, Arizona, New Mexico, and Southern California and followed them for a year (2019–2022). At baseline, participants completed the everyday discrimination measure (poor daily treatment based on race/ethnicity, sometimes/often vs. rarely/never). At baseline and at quarterly intervals, they completed the Desire to Avoid Pregnancy (DAP) scale (range: 0–4, higher score=greater desire to avoid pregnancy) and reported contraceptive method use. Using adjusted multivariable mixed-effects models, we examined associations between discrimination, pregnancy preferences, contraceptive method, and method satisfaction over one year. <h3>Results</h3> Of the sample (55% Latinx, 22% White, 14% multiracial/other, 8% Black), 25% reported sometimes or often experiencing discrimination. Discrimination was more common among Black (50%), multiracial/other (30%) and Latinx (25%) participants (vs. 11% White; adjusted ORs (aORs), 8.5, 3.5 and 3.1, respectively). Those who reported discrimination had higher preference to avoid pregnancy, on average, adjusting for race/ethnicity and covariables (marginal mean, 2.51 vs. 2.30; adjusted Coefficient=0.20 [0.10, 0.32]). Contrary to hypotheses, among those preferring to avoid pregnancy, discrimination was positively associated with condom (aOR, 1.83 [1.31, 2.57]) and prescription method use (aOR, 1.66 [1.26, 2.20]) vs. no method, but marginally negatively associated with method satisfaction (aOR, 0.74 [0.52, 1.04]). <h3>Conclusions</h3> Experiencing discrimination may influence feelings about becoming pregnant and method satisfaction. Women's pregnancy preferences and contraceptive choices are not immune from the impact of racism or xenophobia.

Pregnancy rates and clinical outcomes among women living with HIV enrolled in HPTN 052

ABSTRACT HPTN 052 was a multi-country clinical trial of cART for preventing heterosexual HIV-1 transmission. The study allowed participation of pregnant women and provided access to cART and contraceptives. We explored associations between pregnancy and clinical measures of HIV disease stage and progression. Of 869 women followed for 5.70 (SD = 1.62) years, 94.7% were married/cohabitating, 96% initiated cART, and 76.3% had >2 past pregnancies. Of 337 women who experienced pregnancy, 89.3% were from countries with lower contraceptive coverage, 56.1% first started cART with PI-based regimens and 57.6% were 25–34 years old. Mean cART duration and condom use were similar among pregnant and nonpregnant individuals. Adjusting for confounders, viral load suppression (VLS) was not (aHR(CI) = 0.82(0.61, 1.08)) and CD4 was slightly associated with decreased rates of first pregnancy over time (aHR(CI) = 0.9(0.84, 0.95)); baseline VLS was associated with increased (aRR(CI) = 2.48(1.71, 3.59)) and baseline CD4 was slightly associated with decreased number of pregnancies (aRR(CI) = 0.9(0.85,0.96)) over study duration. Partner seroconversion was univariably associated with higher rates of first pregnancy (HR(CI) = 2.02(1.32,3.07)). Despite a background of higher maternal morbidity and mortality rates, our findings suggest that becoming pregnant does not pose a threat to maternal health in women with HIV when there is access to medical care and antiretroviral treatment.

Eotaxin-2 and eotaxin-3 in malaria exposure and pregnancy

BackgroundEotaxin-1 concentrations in plasma have been inversely associated with malaria exposure, malaria infection and pregnancy, but the effect of these conditions on the levels of the related chemokines eotaxin-2 and eotaxin-3 remains unknown.MethodsEotaxin-2 and -3 concentrations were measured in 310 peripheral or placental plasma samples from pregnant and non-pregnant individuals from Papua New Guinea (malaria-endemic country) and Spain (malaria-naïve individuals) with previous data on eotaxin-1 concentrations. Correlations between eotaxin concentrations were examined with the Spearman’s test. Differences in eotaxin concentrations among groups were evaluated with the Kruskal–Wallis or Mann Whitney tests. The pairwise Wilcoxon test was performed to compare eotaxin-2 concentration between peripheral and placental matched plasmas. Univariable and multivariable linear regression models were estimated to assess the association between eotaxins and Plasmodium infection or gestational age.ResultsEotaxin-2 concentrations in plasma showed a weak positive correlation with eotaxin-3 (rho = 0.35, p < 0.05) concentrations. Eotaxin-2 concentrations in the malaria-exposed non-pregnant group were significantly lower than the in the malaria-naive non-pregnant and the malaria-exposed pregnant groups. Eotaxin-3 plasma concentrations were lower in malaria-exposed than in non-exposed groups (p < 0.05), but no differences were found associated to pregnancy. Eotaxin-2 and eotaxin-3 plasma concentrations were negatively correlated with anti-Plasmodium IgG levels: PfDBL5ε-IgG (rhoEo2 = − 0.35, p = 0.005; rhoEo3 =− 0.37, p = 0.011), and eotaxin-3 was negatively correlated with PfDBL3x-IgG levels (rhoEo3 =− 0.36; p = 0.011). Negative correlations of eotaxin-2 and 3 in plasma were also observed with atypical memory B cells (rhoEo2 = − 0.37, p < 0.001; rhoEo3= − 0.28, p = 0.006), a B cell subset expanded in malaria-exposed individuals. In addition, a borderline negative association was observed between eotaxin-3 concentrations and Plasmodium infection (adjusted effect estimate, β = − 0.279, 95% CI − 0.605; 0.047, p = 0.091). Moreover, eotaxin-2 placental concentrations were significantly increased compared to peripheral concentrations in the malaria-exposed pregnant group whereas the contrary was observed in the non-exposed pregnant group (p < 0.005).ConclusionAlthough a clear epidemiological negative association is observed between eotaxins concentrations and malaria exposure and/or infection, pregnancy may alter this association for eotaxin-2. Further research is required to understand the role of these chemokines in this disease and in combination with pregnancy.

Abstract 10617: Non-Alcoholic Fatty Liver Disease, Heart Failure, and Long-Term Mortality: Insights From the National Health and Nutrition Examination Survey

Objective: To evaluate the association between non-alcoholic fatty liver disease (NAFLD), heart failure (HF), and all-cause mortality. Background: Both NAFLD and HF are increasing in prevalence due to shared risk factors. Methods: We used data from the National Health and Nutrition Examination Survey (NHANES) 2005-2018 to identify non-pregnant individuals aged ≥20 years with HF and NAFLD and linked with the cause of death data from the National Center for Health Statistics. The associations between NAFLD, HF, and all-cause mortality were assessed using logistic regression and Cox proportional hazard modeling as appropriate. Results: There were 82,358,893 weighted eligible participants of whom 3,833,667 (4.7%) had NAFLD. The mean (SE) age was 51.5 (0.35) years, 45.1% women, 63.0% Non-Hispanic White and 11.8% Non-Hispanic Black. Cardiovascular comorbidities were more common in participants with NAFLD; they were more likely to have hypertension (81.7% vs 53.5%), diabetes (65.1% vs 17.1%), stroke (7.3% vs 4.1%), coronary artery disease (14.9% vs 8.4%), or HF (10.5% v s 3.5%) compared with participants without NAFLD. In multivariate logistic regression models adjusting for age, race/ethnicity and sex, participants with NAFLD were 3.5 times more likely to have HF [aOR, 95% CI: 3.47 (1.98-6.06)]. Older age, male sex, presence of diabetes and coronary artery disease were associated with higher odds of HF in participants with established NAFLD. At the end of the follow-up period, participants with NAFLD had higher all-cause mortality compared with participants without NAFLD [HR(95% CI): 1.93 (1.24-2.99), p&lt;0.001]. Conclusion: In this analysis of US adults, ambulatory participants with NAFLD were ~3.5 times more likely to have HF, and twice as likely to experience mortality compared with participants without NAFLD. Further studies are needed to identify the possible linkage between NAFLD and HF beyond the shared risk factor pathogenesis.