Previous Adverse Pregnancy Outcomes Research Articles

Cluster analysis of antiphospholipid antibodies-associated adverse pregnancy outcome patients: based on a 13-years cohort study.

Antiphospholipid antibodies (aPLs) are the leading causes of adverse pregnancy outcomes (APOs). We conducted cluster analysis to identify distinct phenotypes among aPLs-associated APOs patients. This approach aims to facilitate risk stratification and improve pregnancy outcomes for obstetric APS. This was a retrospective study of persistent aPLs positive women cohort in Peking Union Medical College Hospital. Baseline demographic characteristics, clinical manifestation, previous APOs and antibodies profiles were included for hierarchical cluster analysis. Placentae from portions of patients were collected and performed the histopathologic diagnoses. Four clusters among 209 patients with 477 pregnancies were identified. Cluster 1 comprised patients with triple aPLs positivity and demonstrates a high incidence of gestational hypertension (34.92%, P < 0.05) and preterm delivery (20.63%, P < 0.05). Patients in cluster 2 were characterized by lupus anticoagulant (LA) positivity, with high risk of whole gestational APOs. Cluster 3 included patients with isolated aPLs-IgM isotype combined with early miscarriage (60.92%, P = 0.016). Patients in cluster 4 majorly presented aPLs-IgG isotype combined with placenta insufficiency (22.73%). During the follow-up, the live birth rate in cluster 1 and 2 was only 69.20%. Placenta pathology revealed the most severe impairment within cluster 1, whereas clusters 3 and 4 exhibited relatively milder damage. By cluster analysis, we identified four clinical subtypes of aPLs-associated APOspatients. Patients with triple antibodies or high-risk lupus characteristics were prone to occurred gestational hypertension and premature delivery. Isolated LA or aCL/aβ2GPI positivity were found to be more frequently associated with early-stage fetal loss.

Comparing prenatal and postpartum stress among women with previous adverse pregnancy outcomes and normal obstetric histories: A longitudinal cohort study

ObjectiveThe aim of this study was to compare subjectively and objectively measured stress during pregnancy and the three months postpartum in women with previous adverse pregnancy outcomes and women with normal obstetric histories. MethodsWe recruited two cohorts in southwestern Finland for this longitudinal study: (1) pregnant women (n = 32) with histories of preterm births or late miscarriages January–December 2019 and (2) pregnant women (n = 30) with histories of full-term births October 2019–March 2020. We continuously measured heart rate variability (HRV) using a smartwatch from 12 to 15 weeks of pregnancy until three months postpartum, and subjective stress was assessed with a smartphone application. ResultsWe recruited the women in both cohorts at a median of 14.2 weeks of pregnancy. The women with previous adverse pregnancy outcomes delivered earlier and more often through Caesarean section compared with the women with normal obstetric histories. We found differences in subjective stress between the cohorts in pregnancy weeks 29 and 34. The cohort of women with previous adverse pregnancy outcomes had a higher root mean square of successive differences between normal heartbeats (RMSSD), a well-known HRV parameter, compared with the other cohort in pregnancy weeks 26 (64.9 vs 55.0, p = 0.04) and 32 (63.0 vs 52.3, p = 0.04). Subjective stress did not correlate with HRV parameters. ConclusionsWomen with previous adverse pregnancy outcomes do not suffer from stress in subsequent pregnancies more than women with normal obstetric histories. Healthcare professionals need to be aware that interindividual variation in stress during pregnancy is considerable.

SUCCESSFUL MANAGEMENT OF SEVERE CONGENITAL FACTOR X DEFICIENCY DURING PREGNANCY AND LABOR WITH PCC IN TWO SISTERS

Factor X (FX) deficiency is an autosomal recessive disorder caused by quantitative or qualitative defects in the FX protein. FX deficiency has an estimated worldwide prevalence of one in 1000000. (1) Pregnancy in women with congenital FX deficiency has been associated with adverse fetal outcomes (abortion and preterm labor) (2,11). We report two cases of successful pregnancy with factor X deficiency. A 29-year-old woman with congenital factor X deficiency and prior abortion on prophylaxis PCC every 4 weeks. She was treated with PCC 25unit/kg twice weekly during the pregnancy course. At week 32 of pregnancy, she presented with labor pain. Lab showed PT 20.7 PTT 52.5 INR1.5 Fibrinogen 3.8 Hb13.8 platelet 195 WBCs 7.6 factor X 0.15. She was given PCC 25 units/kg until a level of 0.4 was achieved. She delivered a healthy, 1.9 kg baby by normal vaginal delivery. The estimated blood loss was 150 ml. She then received FX 15 units/kg for 3 days postpartum to maintain FX level >30% and INR <1.5. No episodes of abnormal bleeding were observed during pregnancy, labor or post-partum. A 36-years-old woman with congenital factor X deficiency and two prior abortions, on prophylaxis PCC every 4 weeks. She received prophylaxis PCC 25units/kg twice weekly during the course of this pregnancy. At week 38 of pregnancy, she delivered a healthy 3.2 kg baby by cesarean section (CS) after failing labor induction. Lab showed PT 23.7 PTT 50.4 INR1.7 Fibrinogen 2.3 CBC was normal.FX 0.13. She was given PCC 25 units/kg until a level of 0.4 was achieved. The estimated blood loss was 500 ml. She then received FX 15 units/kg for 7 days postpartum to maintain FX level >30% and INR <1.5. She was discharged on tranexamixc acid. No episodes of abnormal bleeding were observed during pregnancy CS or post-partum. Although FX activity increases during normal pregnancy, levels usually remain insufficient for hemostasis at delivery in women with severe FXD (4,5,6). FX replacement therapy with PCC or FX concentrate may be required to treat or prevent bleeding in FXD.Therefore, a therapeutic dose of PCC 20–30 iu/kg is expected to increase plasma FX activity by 0.4–0.6 iu/ml. Further infusions at 1- to 2-d intervals may be required if sustained treatment is necessary (3) . There are reports of FX replacement with PCC during pregnancy in women with previous adverse pregnancy outcomes (7,8) and FX replacement during labor with PCC or FFP, but with different regimens (9) . Our patients were treated with PCC prophylaxis during pregnancy and 25 units/kg during labor. No bleeding nor thrombosis was seen in both cases. The British guidelines recommend PCC 20–40 iu/kg during the third trimester for women with history of bleeding and with FX activity <03 iu/ml with the goal of achieving FX activity >04 iu/ml. They also recommend, to consider further PCC 10–20 iu/kg once daily to maintain FX activity >03 iu/ml for at least 3 days post-partum. (10) Prophylactic PCC resulted in excellent hemostasis in two of our patients, including one that delivered by C-section.

Positive predictive value of noninvasive prenatal testing for sex chromosome abnormalities

BackgroundEarly and intermediate serological screening cannot detect sex chromosome abnormalities. Currently, noninvasive prenatal testing (NIPT) is the only procedure available for screening such disorders; however, its use is controversial.Methods and ResultsA total of 47,855 pregnant women underwent NIPT at our referral center from January 2014 to December 2020. Of the 314 patients with a positive NIPT indicating sex chromosome abnormalities, 260 were screened via karyotype analysis and single nucleotide polymorphism (SNP) array after amniotic fluid extraction; 96 cases were confirmed. Karyotype analysis and SNP array were consistent in the diagnosis of 88 out of the 96 fetuses. The positive predictive value (PPV) for sex chromosome abnormalities was found to be 36.9%. The PPV in patients aged 30–34 years was significantly higher than that in patients aged < 30 years. No statistically significant difference was observed on the PPV among patients with or without previous adverse pregnancy outcomes. Moreover, 83 women carrying fetuses were diagnosed with a sex chromosome abnormality terminated their pregnancy.ConclusionsImprovements in detection and analytical technologies are needed to increase the accuracy of sex chromosome abnormalities detection. Pregnant women with a positive NIPT for these abnormalities may require invasive diagnostic procedures such as karyotype analysis and SNP array for better genetic counseling.

Previous adverse pregnancy events as a predictor of gestational diabetes mellitus in Southern Ethiopia: a case control study

Introduction Gestational diabetes mellitus is a type of glucose intolerance that first manifests itself during pregnancy. A pregnant woman and her unborn child are at an increased risk of pregnancy complications and poor neonatal outcomes. Pregnancy diabetes affects one out of every 200 women. Therefore, this study aims to identify the determinants of gestational diabetes mellitus among pregnant women attending an antenatal care service in Gedeo Zone, Ethiopia. Methods A facility-based case-control study design was employed from 25 January 2020 through 25 April 2020. The study included 80 cases and 240 control groups of pregnant women. Face-to-face interviews with structured questionnaires were used to collect data. For analyses, data was entered into Epidata version 3.1 and exported to the Statistical Package for the Social Sciences (SPSS) version 23.0. Variables with p .25 or lower in bivariate analysis were fitted to multivariable analysis. A multivariable logistic regression model with a 95% confidence interval and a p-Value of .05 was used. Results Family history of diabetes mellitus [AOR 1.837; 95% CI (1.06–3.18)], history of spontaneous abortion [AOR 2.39; 95% CI 1.33–4.31), history of still birth [AOR 2.240 (1.222–4.105)], and history of delivery of a macrocosmic baby in the previous pregnancy [AOR 1.99 (1.157–3.43)] were found to be predictors of GDM. Conclusion Previous adverse pregnancy outcomes were found to be the main predictors of GDM. Women with gestational diabetes mellitus should be followed after delivery in order to monitor hyper-glycemic status.

Seroprevalence and associated factors of maternal cytomegalovirus in Southern Ethiopia: a cross-sectional study

ObjectivesThe aim of this study was to assess the seroprevalence and associated factors of cytomegalovirus (CMV) among pregnant women in Southern Ethiopia.DesignCross-sectional study.SettingThe study was conducted in Hawassa University comprehensive...

A longitudinal study of thyroid markers during pregnancy and the risk of gestational diabetes mellitus and post-partum glucose metabolism.

AimsTo determine the relationship between thyroid markers during pregnancy and gestational diabetes mellitus (GDM) or post‐partum glucose metabolism.Materials and MethodsBased on pregnancy 75‐g oral glucose tolerance test (OGTT) results, 1467 subjects were grouped into normal glucose tolerance (NGTp; n = 768) and GDM (n = 699) groups. Furthermore, based on post‐partum 75‐g OGTT results, 286 GDM subjects, screened for glucose metabolism after delivery, were grouped into NGTd (n = 241) and abnormal glucose tolerance (AGT; n = 45) groups.ResultsMaternal age, family history of diabetes, acanthosis nigricans, previous adverse pregnancy outcomes and caesarean section incidence, and thyroid positive antibody rates were higher in the GDM group than in the NGTp group. In the first trimester, free triiodothyronine (FT3), thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) levels were higher in the GDM group than in the NGTp group. In the second trimester, free thyroxine (FT4) levels were lower and TPOAb and TgAb levels were higher in the GDM group than in the NGTp group. After adjusting for confounding factors, FT3, TPOAb and TgAb (first trimester), and FT4, TPOAb and TgAb (second trimester) were risk factors for GDM. TPOAb and TgAb levels were higher in the AGT group than in the NGTd group and were potential predictors of abnormal post‐partum glucose tolerance.ConclusionsGDM risk significantly increased with increased FT3 (first trimester), TPOAb and TgAb (first and second trimesters) or with decreased FT4 (second trimester). Presence of thyroid antibodies predicted post‐partum glucose abnormalities in subjects with GDM.

Change of serum B-cell activating factor level in patients with positive antiphospholipid antibodies and previous adverse pregnancy outcomes and its significance.

Background:B-cell activating factor (BAFF) is vital for B cell survival. Serum BAFF levels are elevated in thrombotic antiphospholipid syndrome, but little is known about levels in patients with positive antiphospholipid antibodies (aPLs) and previous adverse pregnancy outcomes (APOs). We aimed to analyze serum BAFF concentrations of these patients in early pregnancy along with different pregnancy outcomes.Methods:Thirty-six pregnant patients positive for aPLs and previous APOs (patient group), 25 healthy pregnant females (HP group) and 35 healthy non-pregnant females (HNP group) from the Peking University Third Hospital, between October 2018 and March 2019, were enrolled in this study. Serum of HNP and serum of patients as well as HP in the first gestational trimester were collected. Enzyme-linked immunosorbent assay kits were used to measure serum BAFF and interferon-alpha (IFN-α) concentrations. Cytometric bead array analysis was used to measure serum concentrations of cytokines. The patient group was further divided into APOs and non-APOs (NAPOs) group, fetal loss and live birth group according to pregnancy outcomes. The Mann-Whitney U-test was used to assess significance between and within groups. Spearman rank-order was used to evaluate correlation coefficients between BAFF and related cytokines.Results:The serum BAFF level in HP group was significantly lower than HNP group (245.24 [218.80, 265.90] vs. 326.94 [267.31, 414.80] pg/mL, Z = −3.966, P < 0.001). The BAFF level was obviously elevated in patient group compared to that in HP group (307.77 [219.86, 415.65] vs. 245.24 [218.80, 265.90] pg/mL, Z = −2.464, P = 0.013). BAFF levels in APOs group tended to be higher than that in NAPOs group (416.52 [307.07, 511.12] vs. 259.37 [203.59, 375.81] pg/mL, Z = −2.718, P = 0.006). Compared to HP group, concentrations of IFN-α, interleukin (IL-6) and tumor necrosis factor were higher in patient group (33.37 [18.85, 48.12] vs. 13.10 [6.85, 25.47] pg/mL, Z = −2.023, P = 0.043; 39.16 [4.41, 195.87] vs. 3.37 [2.92, 3.90] pg/mL, Z = −3.650, P < 0.001; 8.23 [2.27, 64.46] vs. 1.53 [1.25, 2.31] pg/mL, Z = −3.604, P < 0.001, respectively). Serum BAFF levels had a positive correlation with the concentrations of both IL-6 and IL-10 (IL-6: r = 0.525, P = 0.002; IL-10: r = 0.438, P = 0.012).Conclusions:Serum BAFF levels are increased in patients with positive aPLs and previous APOs as compared to healthy pregnant females and tend to be higher in individuals with current APOs. The BAFF levels have a positive correlation with serum IL-6 and IL-10.

Maternal intravenous immunoglobulin: A non-invasive treatment option for Rhesus D-sensitised women with previous adverse pregnancy outcomes

Background. Maternal intravenous immunoglobulin (IVIG) may delay the onset and severity of fetal anaemia in Rhesus D (RhD)- sensitised pregnancies, thereby minimising the need for intrauterine transfusion and its associated complications. Objective. To compare the pregnancy outcomes of RhD-sensitised women who received antenatal IVIG with those who did not receive antenatal IVIG. Methods. This was a retrospective cross-sectional analysis of RhD-sensitised women who attended the Wits Fetal Medicine Centre (Johannesburg) from 1 January 2008 to 31 May 2018. Criteria for maternal IVIG administration were: (i) previous adverse pregnancy outcome (early neonatal death, intrauterine fetal death or miscarriage related to RhD sensitisation), ( ii ) women with high antibody titre levels (≥1:64) in the absence of fetal anaemia; and ( iii ) rising antibody titre levels. Maternal antibody titre levels, pregnancy and neonatal outcomes were compared in women who received IVIG v. those who did not receive IVIG. Results. Of the 42 RhD-sensitised women, 14 received IVIG. A greater proportion of women experienced a decrease in antibody titres in the IVIG v. no-IVIG group (43% v. 11%, respectively; p =0.04). Nine of the 10 women in the IVIG group with a previous adverse pregnancy outcome had a successful pregnancy outcome following IVIG treatment. Conclusion. Maternal IVIG may provide a successful pregnancy outcome in RhD-sensitised women with previous adverse pregnancy outcomes related to Rh disease, or women with raised or increasing maternal antibody titre levels who present in the first or early second trimester.

Clinical features associated with pregnancy outcomes in women with positive antiphospholipid antibodies and previous adverse pregnancy outcomes: a real-world prospective study.

This study aims to analyze factors related to pregnancy outcomes in women with positive antiphospholipid antibodies and previous adverse pregnancy outcomes (APOs) prospectively. Patients' characteristics were described. Factors associated with obstetric complications were analyzed using logistic regression analysis. A total of 128 females with 73.4% non-criteria obstetric antiphospholipid syndrome (NC-OAPS) were included. APOs accounted for 38.3%, of which 65.3% were fetal losses. Live birth rates in criteria OAPS and NC-OAPS were similar (76.5% and 74.5%). For the whole patients, antinuclear antibody (ANA) titer ≥ 1:160 (OR 5.064, 95% CI (1.509, 16.995), P = 0.009) was a risk factor for APOs and low molecular weight heparin (LMWH) use (OR 0.149, 95% CI (0.029, 0.775), P = 0.024)) was a protective factor. Age (OR 1.159, 95% CI (1.011, 1.329), P = 0.034) and previous APOs ≥ 3 times (OR 3.772, 95% CI (1.14, 12.435), P = 0.029) were risk factors for fetal loss, and LMWH use (OR 0.068, 95% CI (0.009, 0.486), P = 0.007) was a protective factor. Regular rheumatology visits was a protective factor for APOs and fetal loss (OR 0.085, 95% CI (0.024, 0.306), P< 0.001; OR 0.019, 95% CI (0.004, 0.104), P< 0.001). The proportion of it decreased in APOs and fetal loss groups (53.1% and 28.1%). Glucocorticoid use was a risk factor for APOs in NC-OAPS and higher serum C3 levels in the first gestational trimester was a protective factor for fetal loss (OR 3.703, 95% CI (1.402, 9.777), P = 0.008; OR 0.041, 95% CI (0.002, 0.947), P = 0.046). Age, APO history, ANA titer, LWMH and glucocorticoid use, serum C3 levels, and regular rheumatology visits were related to obstetric complications. Key Points • This was one of the few prospective studies focused on patients with positive antiphospholipid antibodies and previous adverse pregnancy outcomes. The majority were NC-OAPS patients. • The study first evaluated the impact of rheumatologists' monitoring based on individual disease assessments on pregnancy outcomes. The live birth proportion was similar in patients with criteria OAPS and NC-OAPS when treated. • Age, APO history (≥ 3 times), ANA titer (≥ 1:160), LMWH use, glucocorticoid use, and serum C3 were factors related to obstetric complications.

Serum mannose-binding lectin (MBL) concentrations are reduced in non-pregnant women with previous adverse pregnancy outcomes.

Mannose-binding lectin (MBL) is an important component of the innate immunity, and it is responsible not only for opsonization of micro-organisms, but also for efferocytosis. The aim of this study was to investigate whether MBL concentrations and lectin complement pathway activity are altered in non-pregnant women with previous adverse pregnancy outcomes. Patients were divided into four groups on the basis of their history of pregnancy complications, including control patients who had uncomplicated pregnancies and term deliveries (control, n=33), and three groups of patients with a history of pregnancy complications, including preterm labour (n=29), recurrent miscarriage (n=19) or unexplained intrauterine foetal death (IUFD; n=17). All women enrolled in the study had an interval of three to six months following their previous pregnancy, and they agreed to have a blood sample taken. We found significantly higher MBL concentrations and functional activity of the lectin complement pathway in healthy controls who had previous uneventful term pregnancies (1341ng/mL; activity 100% (IQR: 62%-100%)), compared to women with the history of IUFD (684ng/mL, P=.008; activity 8.5% (IQR: 0%-97.8%), P=.011), recurrent miscarriage (524ng/mL, P=.022; activity 44% (IQR: 4%-83%), P=.011) or preterm labour (799ng/mL, P=.022; activity 62.5% (IQR: 0%-83%), P=.003). Our results suggest that inadequate function of the complement lectin pathway is associated with a higher risk of preterm labour, recurrent miscarriage and unexplained intrauterine foetal death.

Adverse pregnancy outcomes and subsequent development of connective tissue disease in the UK: an epidemiological study.

This study assessed prevalence of connective tissue disease (CTDs), systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS) and antiphospholipid antibodies (aPL) in women with previous adverse pregnancy outcome compared with uncomplicated livebirths. Retrospective case-control study. UK Primary Care. Records of women, 18years and older, within the Clinical Practice Research Datalink (CPRD) (1January 2000-31 December 2013). Clinical Practice Research Datalink was searched for pregnancy terms to identify adverse pregnancy outcome. Each identified case was matched to five livebirths. Diagnosis of SLE, CTD, APS or autoimmune antibodies. Poisson regression was performed to calculate relative risk ratios (RR), comparing adverse pregnancy outcome with livebirth cohorts. Clinical Practice Research Datalink identified 20123 adverse pregnancy outcomes matched to 97323 livebirths, with a total of 875590 person-years follow up. Median follow up from study entry was 7.29years (SD 4.39). Compared with women with an uncomplicated livebirth, women with adverse pregnancy outcome had an increased risk of developing CTD or autoimmune antibodies (RR 3.20, 95%CI 2.90-3.51). Risk was greatest following a stillbirth (RR 5.82, 95% CI 4.97-6.81). For CTD and SLE, the risk was greatest within the first 5years of adverse pregnancy outcome. Risk for aPL and APS diagnosis was highest≥5years from adverse pregnancy outcome. Adverse pregnancy outcome is associated with increased risk of developing maternal CTD, including SLE. Either immunological factors predispose women to adverse pregnancy outcome and subsequent CTD diagnosis or, alternatively, adverse pregnancy outcome initiates autoimmune events which culminate in CTD in later life. Stillbirth is associated with increased maternal risk of developing systemic lupus erythematosus (SLE).

Comparison of 2 approaches in management of pregnant women with inherited trombophilias: Prospective analytical cohort study.

Previous adverse pregnancy outcomes (APO) in women with hereditary thrombophilia have emerged as new indications for prophylactic use of low-molecular-weight heparin (LMWH) during pregnancy. Recent meta-analysis conducted to establish if LMWH may prevent recurrent placenta-mediated pregnancy complications point to important therapeutic effect but these findings are absolutely not universal. Furthermore, previous studies regarding LMWH prophylaxis for APO in women with inherited thrombophilia were performed in high risk patients with previous adverse health outcomes in medical, family and/or obstetric history. Therefore, the aim of this study was to investigate the effects of LMWH prophylaxis on pregnancy outcomes in women with inherited thrombophilias regardless of the presence of previous adverse health outcomes in medical, family, and obstetric history.Prospective analytical cohort study included all referred women with inherited thrombophilia between 11 and 15 weeks of gestation and followed-up to delivery. Patients were allocated in group with LWMH prophylaxis (study group) and control group without LWMH prophylaxis. The groups were compared for laboratory parameters and Doppler flows of umbilical artery at 28th to 30th, 32nd to 34th and 36th to 38th gestational weeks (gw), and for obstetric and perinatal outcomes.The study group included 221 women and control group included 137 women. Mean resistance index of the umbilical artery Ri in 28 to 30, 32 to 34, and 36 to 38 gw were significantly higher in the control group compared to study group (0.71 ± 0.02 vs 0.69 ± 0.02; 0.67 ± 0.03 vs 0.64 ± 0.02; and 0.67 ± 0.05 vs 0.54 ± 0.08, respectively). Intrauterine fetal death (IUFD) and miscarriages were statistically significantly more frequent in control group compared to the patients in study (P < .001). The frequencies of fetal growth restriction (FGR) and APO were significantly higher in the control group compared to the study group (P = .008 and P < .001, respectively). In a multivariate regression model with APO as a dependent variable, only Ri was detected as a significant protective factor for APO, after adjusting for age and LMWH prophylaxis (P < .001).We have demonstrated better perinatal outcomes in women with LMWH prophylaxis for APO compared to untreated women.

The Effect of Training Pregnant Women and Their Husband’s on the Anxiety in Pregnant Women with Previous Adverse Pregnancy Outcomes: A Controlled Randomized Clinical Trial

AbstractPregnant women with previous adverse pregnancy outcomes have a higher level of anxiety, which creates several problems for the mother and the fetus/infant. Decreasing the anxiety in these pregnant women is therefore of great importance. The present study was conducted to evaluate the effect of training on the anxiety in women with previous adverse pregnancy outcomes. This randomized, controlled, clinical trial was conducted on 132 pregnant women with previous adverse pregnancy outcomes. The women were randomly assigned to training (n≤=≤66) and control (n≤=≤66) group. In the training group, women and their husbands received training sessions once a week, an instructional booklet and counseling on phone in the intervals between the sessions. The control group received routine treatment. Spielberger anxiety questionnaires were completed by the pregnant women before and 1 month after the intervention. Compared to the control group, significant reductions were observed in the state anxiety (adjusted mean difference -≤19.6, 95% CI -≤21.9 to -≤17.3, P≤ &gt; 0.001) and trait anxiety (adjusted mean difference: - 20.1, 95% CI - 22.2 to - 17.9, P &gt; 0.001) in the training group. Training pregnant women and their husbands with previous adverse pregnancy outcomes helps. This training should be added to the prenatal health care system.

Isolated effect of maternal thyroid-stimulating hormone, free thyroxine and antithyroid peroxidase antibodies in early pregnancy on gestational diabetes mellitus: a birth cohort study in China.

This article aims to understand the isolated effect of maternal thyroid-stimulating hormone (TSH), free thyroxine (FT4) and antithyroid peroxidase antibodies (TPOAb) in early pregnancy on gestational diabetes mellitus (GDM). Based on a birth cohort, pregnant women presented to maternity hospitals for the first antenatal care from Nov 2008 to Oct 2010 were invited to participate in the study. A self-administered questionnaire was asked to complete to collect data on socio-economic variables, previous adverse pregnancy outcomes, method of conception, previous endocrinic and metabolic diseases, and pregnancy-related anxiety in 1st trimester of the index pregnancy. Pre-pregnancy BMI was measured. Serum samples were collected, and TSH, FT4 and TPOAb were assayed. GDM was confirmed from medical records screened on 24-28 gestational weeks by using oral glucose tolerance test (OGTT). The prevalence of isolated subclinical hypothyroidism, hypothyroidemia and positive TPOAb in early pregnancy was 2.0%, 2.0% and 12.8%. Prevalence of GDM in women with the isolated sub-clinical hypothyroidism, hypothyroxinemia and positive TPOAb was 2.9%, 2.8% and 3.1%, respectively, which were all higher than that detected in euthyroidism women (1.2%). Women with isolated positive TPOAb had significantly higher TSH and lower FT4 level compared with euthyroidism women. It was found that isolated positive TPOAb in early pregnancy increased the risk of GDM, adjusted RR and 95%CI being 2.541(1.037-6.226). No significant relationships were identified between isolated sub-clinical hypothyroidism or hypothyroxinemia with GDM. In conclusion, isolated thyroid autoimmunity, represented by positive TPOAb, in early pregnancy were associated with GDM independent of TSH and FT4.

Previous Adverse Outcome of Term Pregnancy and Risk of Preterm Birth in Subsequent Pregnancy.

Objective Evaluate risk of preterm birth (PTB, < 37 completed weeks' gestation) among a population of women in their second pregnancy with previous full term birth but other adverse pregnancy outcome. Methods The sample included singleton live born infants between 2007 and 2012 in a birth cohort file maintained by the California Office of Statewide Health Planning and Development. The sample was restricted to women with two pregnancies resulting in live born infants and first birth between 39 and 42weeks' gestation. Logistic regression was used to calculate the risk of PTB in the second birth for women with previous adverse pregnancy outcome including: small for gestational age (SGA) infant, preeclampsia, placental abruption, or neonatal death (≤ 28 days). Risks were adjusted for maternal factors recorded for second birth. Results The sample included 133,622 women. Of the women with any previous adverse outcome, 4.7% had a PTB while just 3.0% of the women without a previous adverse outcome delivered early (relative risk adjusted for maternal factors known at delivery 1.4, 95% CI 1.3-1.5). History of an SGA infant, placental abruption, or neonatal death increased the adjusted risk of PTB in their second birth by 1.5-3.7-fold. History of preeclampsia did not elevate the risk of a preterm birth in the subsequent birth. Conclusions for Practice The findings indicate that women with previous SGA infant, placental abruption, or neonatal death, despite a term delivery, may be at increased risk of PTB in the subsequent birth. These women may be appropriate participates for future interventions aimed at reduction in PTB.

Congenital heart disease: factor affecting it and role of RBSK in dealing with situation

Background: Congenital heart diseases (CHD) is the second leading cause of death in infancy and childhood. So the purpose of this study to know socio-demographic profile and the maternal risk factors affecting CHD, and the role of RBSK in screening with respect to CHD.Methods: A cross-sectional study was conducted during June to October 2016 in Ahmedabad city. Parents of 169 children with CHD who were beneficiaries of RBSK during the previous 3 months were interviewed.Results: The majority of children were in the age group of 0-3 years 49.7% (mean±SD= 4.26±4). Majority of families belonged to the lower middle class IV (41.4%). 44% of mothers had primary education. Mothers with age &gt;30 yrs were 55.6%. Only 30.9% of mothers had taken folic acid during the periconceptional period. Mothers with previous adverse pregnancy outcome were 40.2%. Maternal stress and high blood pressure were present in 33.7% and 24.8% of the mothers respectively. 48% of children were diagnosed through Rashtriya Bal Swasthya Karyakram (RBSK).Conclusions: Lower middle class, lower maternal education, advanced maternal age, low folic acid intake, previous adverse pregnancy outcome, maternal stress and high blood pressure were the leading risk factors for CHD. RBSK is playing important role in screening and diagnosing of patients.

166. Multiple pregnancy significantly impairs maternal vascular function postpartum

Introduction Cardiovascular disease (CVD) is significantly increased among women with previous adverse pregnancy outcomes, particularly preeclampsia. Data suggest that the increased risk of CVD among women with pregnancy hypertension such as preeclampsia is driven primarily by shared common risk factors that precede pregnancy. However, paradoxically data also indicate that a history of multiple uncomplicated pregnancies alone is associated with an increased risk of future CVD compared to never pregnant women. Objective The focus of this project was to begin to investigate the effect of pregnancy itself on future maternal vascular function. Methods Female apoE - / - mice were bred 1, 2 or 3 times and compared to age matched (10 months of age) female virgin apoE - / - mice (n = 8–9/group). Blood pressure was measured by tail cuff. Endothelial-dependent and independent vascular function of mesenteric arteries was assessed using an isometric myograph. Results Plasma cholesterol levels were similarly elevated in all apoE - / - mice. Blood pressure was significantly elevated in the mice bred 3× (138 ± 29/94 ± 13) compared to virgin mice (118 ± 12/83 ± 10 mmHg, p 0.01). Contractile response and tension to phenylephrine was not different between arteries from virgin and 1, 2, or 3× prior pregnant apoE - / - mice. Methacholine-induced endothelial-dependent relaxation was significantly blunted in arteries from 2 and 3× prior pregnant mice (62 ± 5 and 60 ± 7%, respectively) compared to 1× prior pregnant (77 ± 8%) and virgin mice (83 ± 9%, p 0.001). Endothelial-dependent relaxation was not different between arteries in the presence of the nitric oxide synthase inhibitor L-NAME. Similarly, endothelial-independent relaxation in response to nitroprusside was not different between virgin and prior pregnant mice. Discussion Compared to virgin apoE - / - female mice, similarly aged mice with multiple previous pregnancies have higher blood pressure and blunted endothelial-dependent relaxation. These data support epidemiologic data identifying an association between prior pregnancy (multiple) and increased risk of future maternal heart disease. Funded by the AHA 16SFRN27810001.

Are Past Adverse Pregnancy Outcomes Associated with Maternal Anxiety and Depressive Symptoms in a Sample of Currently Pregnant Women?

There has been a great deal of concern about the mental health of women whose pregnancies involve miscarriage, termination of a pregnancy (ToP), child death or where a child has been given up for adoption. Despite this concern there has been remarkably little population-based research which has addressed the long-term consequences of pregnancy loss and child death. This study investigated the maternal mental health consequences of women whose pregnancies involve miscarriage, ToP, child death or where a child has been given up for adoption at two different time points, adjusting for socio-demographic characteristics and baseline mental health. The Mater-University of Queensland Study of Pregnancy is a prospective pre-birth cohort study. Women were recruited early in pregnancy over the period 1981 to 1983 at their first antenatal clinic visit (FCV). Women were interviewed again at the 14-year follow-up. Data from 4403 mothers were analysed using maternal reports of a prior history of giving a child up for adoption, miscarriage, ToP, and neonatal, infant and/or child deaths. Symptoms of maternal anxiety and depression were measured at FCV and the 14-year follow-up using the Delusions-Symptoms-States Inventory. We carried out logistic regression analysis using Stata 13. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to display the findings. A prior miscarriage was associated with anxiety (adjusted OR (AOR) = 1.30; 95% CI: 1.10-1.66) and depressive (AOR = 1.70; 95% CI: 1.21-2.39) symptoms at the 14-year follow-up. Having had a neonatal, infant and/or child deaths was associated with symptoms of depression at 14-year follow-up (AOR = 2.12; 95% CI: 1.06-4.25). The period after a child loss which involves a new pregnancy may be associated with relatively good mental health despite the fact that some mothers have experienced previous adverse pregnancy outcomes.

Intimate partner violence during pregnancy and its association with preterm birth and low birth weight in Tanzania: A prospective cohort study.

IntroductionIntimate partner violence (IPV) is a public health problem that affects millions of women worldwide. The role of violence as an underlying factor in poor birth outcomes remains an area where strong evidence is lacking. The aim of this study was to determine the association between intimate partner violence (IPV) and preterm delivery (PTB) and low birth weight (LBW).Materials and methodsA prospective cohort study was conducted among 1112 pregnant women attending antenatal care in Moshi–Tanzania. The women were enrolled before 24 weeks gestation, followed-up at week 34 to determine exposure to violence during pregnancy, and after delivery to estimate gestation age at delivery and birth weight. Logistic regression analysis was performed to assess the association between exposure to IPV during pregnancy and PTB and LBW while adjusting for possible confounders. In addition, stratified analysis based on previous history of adverse pregnancy outcome was performed.ResultsOne-third of the women experienced IPV during pregnancy, 22.3% reported emotional, 15.4% sexual and 6.3% physical violence. Women exposed to physical IPV were three times more likely to experience PTB (AOR = 2.9; CI 95%: 1.3–6.5) and LBW (AOR = 3.2; CI 95%: 1.3–7.7). Women with previous adverse pregnancy outcomes and exposure to physical IPV had a further increased risk of PTB (AOR = 4.5; CI 95%: 1.5–13.7) and LBW (AOR = 4.8; CI 95%: 1.6–14.8) compared to those without previous history of adverse outcome.ConclusionWomen who are exposed to IPV during pregnancy are at increased risk of PTB and LBW. The risk is even stronger if the women additionally have suffered a previous adverse pregnancy outcome. Interventions addressing IPV are urgently needed to prevent occurrence and reoccurrence of PTB and LBW.