Risk Of Poor Pregnancy Outcomes Research Articles

Lower inflammatory markers in women with antenatal depression brings the M1/M2 balance into focus from a new direction

BackgroundAntenatal depression and use of serotonin reuptake inhibitors (SSRI) in pregnancy have both been associated with an increased risk of poor pregnancy outcomes, such as preterm birth and impaired fetal growth. While the underlying biological pathways for these complications are poorly understood, it has been hypothesized that inflammation may be a common physiological pathway. The aim of the present study was to assess peripheral inflammatory markers in healthy women, women with antenatal depression, and in women using SSRI during pregnancy. Methods160 healthy pregnant controls, 59 women with antenatal depression and 39 women on treatment with SSRIs were included. The relative levels of 92 inflammatory proteins were analyzed by proximity extension assay technology. ResultsOverall, 23 of the inflammatory markers were significantly lower in women with antenatal depression and in women on treatment with SSRIs in comparison with the healthy controls. No difference in any of the inflammatory markers was observed between women with antenatal depression and those who were using SSRI. Top three inflammatory markers that were down-regulated in women with antenatal depression were TNF-related apoptosis-inducing ligand (TRAIL), p=0.000001, macrophage colony-stimulating factor 1 (CSF-1), p=0.000004, and fractalkine (CX3CL1), p=0.000005. Corresponding inflammatory markers in SSRI users were CSF-1, p=0.000011, vascular endothelial growth factor A (VEGF-A), p=0.000016, and IL-15 receptor subunit alpha (IL-15RA), p=0.000027. The inflammatory markers were negatively correlated with cortisone serum concentrations in controls, but not in the cases. Differential DNA methylation of was found for seven of these inflammatory markers in an independent epigenetics cohort. ConclusionWomen with antenatal depression or on SSRI treatment have lower levels of a number of peripheral inflammatory markers than healthy pregnant controls. Hypothetically, this could be due to dysregulated switch to the pro-M2 milieu that characterizes normal third trimester pregnancy. However, longitudinal blood sampling is needed to elucidate whether the presumably dysregulated M2 shift is driving the development of antenatal depression or is a result of the depression.

Smoking, HIV, and risk of pregnancy loss.

Objective:Cigarette smoking during pregnancy increases risks of poor pregnancy outcomes including miscarriage and stillbirth (pregnancy loss), but the effect of smoking on pregnancy loss among HIV-infected women has not been explored. Here, investigated the impact of smoking on risk of pregnancy loss among HIV-positive and HIV-negative women, and estimated the potential impact of realistic smoking cessation interventions on risk of pregnancy loss among HIV-positive women.Design:We analyzed pregnancy outcomes in HIV-positive and HIV-negative participants in the Women's Interagency HIV Study between 1994 and 2014.Methods:We estimated effects of current smoking at or immediately before pregnancy on pregnancy loss; we controlled for confounding using regression approaches, and estimated potential impact of realistic smoking cessation interventions using a semiparametric g-formula approach.Results:Analysis examined 1033 pregnancies among 659 women. The effect of smoking on pregnancy loss differed dramatically by HIV status: adjusted for confounding, the risk difference comparing current smokers to current nonsmokers was 19.2% (95% confidence limit 10.9–27.5%) in HIV-positive women and 9.7% (95% confidence limit 0.0–19.4%) in HIV-negative women. These results were robust to sensitivity analyses. We estimated that we would need to offer a realistic smoking cessation intervention to 36 women to prevent one pregnancy loss.Conclusion:Smoking is a highly prevalent exposure with important consequences for pregnancy in HIV-positive pregnant women in the United States, even in the presence of potent highly active antiretroviral therapy. This evidence supports greater efforts to promote smoking cessation interventions among HIV-positive women, especially those who desire to become pregnant.

Women with Subclinical Hypothyroidism Are at Low Risk of Poor Pregnancy Outcome in Japan.

Maternal subclinical hypothyroidism may be associated with adverse pregnancy outcomes, although not consistently across regions. Here, we sought to determine the effect of elevated thyroid-stimulating hormone (TSH) on pregnancy outcomes in Japanese women without known medical complications. TSH was determined by dried blood spots at 8-20 weeks of gestation, and 3.0-10.0 μU/mL of TSH was considered as elevated TSH (eTSH). A retrospective study involving 167 cases of eTSH was conducted. Five hundred and seventy eight of controls with normal TSH and without thyroid antibodies were selected. We compared a composite adverse maternal outcome comprised of spontaneous abortion, premature delivery, gestational diabetes mellitus (GDM), placental abruption, and pregnancy-induced hypertension, as well as composite adverse neonatal outcome including stillbirths, heavy for date, light for date, and a low Apgar score (< 7) at 5 minutes between two groups. The incidence of GDM was significantly higher in eTSH (p < 0.01); however, composite adverse maternal and neonatal outcome did not differ between groups (p = 0.19 and p = 0.50, respectively). Although 27 out of 167 cases in eTSH have antibodies, composite adverse outcome did not differ between eTSH with antibodies and controls (p = 0.64 and p = 0.50, respectively). Additionally, composite adverse maternal and neonatal outcome did not differ between the group larger than the median of TSH in eTSH (n = 81) and controls (p = 0.43 and p = 0.98, respectively). Thus, elevated TSH is not associated with overall adverse pregnancy outcomes in women without known medical complications.

Hopes and dreams: poverty, motherhood and health care

Racial and ethnic differences in health outcomes exist in all areas of health care even when factors related to income; insurance status and access to care are controlled. The importance of the social environment versus biological influences a person’s health status are explored in this study. Healthy People 2020 identified maternal health status to pregnancy-related health outcomes and African American women are at greater risk for poor pregnancy outcomes including increased rates of maternal, perinatal, neonatal, and infant mortality.Study Purpose: To understand the meaning of being and African-American woman living in poverty and their experiences with the health care system. Research Design: Exploratory qualitative, community-based participatory action research study used oral and digital storytelling. Participants and Setting: African American mothers residing in government subsidized housing.Data Collection and Analysis: Focus groups, storytelling, and photovoice for data collection. Thematic analysis the focus groups’ transcriptions and storyboard findings was conducted. Results: Common themes from the transcripts were “respect me…don’t stereotype me” and “be safe.” Themes from storyboards were “love of family,” “love of community,” and “hope for the future.” Courage, family, and community are the foundation of their lives. Limitation: Sample size does not allow generalization to larger populations.

Pregnancy wantedness, frequency and timing of antenatal care visit among women of childbearing age in Kenya.

BackgroundA woman’s health seeking behaviour during pregnancy has been found to have significant repercussions on her wellbeing and that of her unborn child. For example, the risk of poor pregnancy outcomes and maternal death is higher among women who do not receive antenatal care.MethodsThe study described the characteristics of women who reported wanted, unwanted and mistimed pregnancies from their last birth at the time of the survey; the linkage between frequency of antenatal care visits and pregnancy wantedness and the relationship between timing of the first antenatal care visit and pregnancy wantedness since maternal morbidity and mortality are higher among women who do not receive antenatal care. The 2008-09 Kenya Demographic and Health Survey data is used and multinomial logistic regression and logistic regression informed the study analysis.ResultsResults showed that women, who reported wanted pregnancy were more likely to receive antenatal care while those who reported unwanted pregnancy were less likely to receive antenatal care, but more likely to attend late the first time and have fewer than four antenatal care visits. Also, mistimed pregnancies were associated with low frequency of antenatal care visit and late timing of the first visit.ConclusionOur findings confirm an association between pregnancy wantedness, frequency of antenatal care visits and timing of the first antenatal care visit. Women whose pregnancy was reported as mistimed and unwanted were more likely not to receive any antenatal care and when they did; they went for fewer than the recommended four visits with late timing. Health policy and strategies should ensure that all pregnant women regardless of their pregnancy status at the time of conception first receive antenatal care, and receive it in a timely manner and make at least four antenatal care visits before delivery. This will help to identify health complications that may arise during and after delivery and reduce maternal, new-born and infant mortality. Information, education and communication campaigns on family planning especially for spacing and matters related to antenatal care visits, timing and frequency should be intensified nationally.

Centering Prenatal Care

INTRODUCTION: The Centering Pregnancy prenatal care model is a group care model which incorporates standard prenatal assessment and education into a series of sessions in which patients are encouraged to participate in their own healthcare and learn from their peers. The aim of this study was to compare outcomes for traditional care patients at one high volume health center with the institution's Centering Pregnancy patients, focusing on preterm birth. METHODS: This study is a retrospective cohort analysis of 5,003 traditional care and 444 Centering Pregnancy deliveries at Christiana Care Health Services from 2009 until 2014. Eligible patients initiated care in the first trimester with the resident hospital service. Parity, race, and prior preterm birth were controlled for. RESULTS: Mean gestational age at delivery was significantly higher in the Centering Pregnancy cohort (38.67 vs 38.15, P=.0004). After correction for parity, race, and prior preterm delivery, Centering Pregnancy was protective for preterm delivery before 34 weeks (OR: .43, P=.006). There also was a nonsignificant trend towards lower rates of preterm delivery before 37 weeks in the Centering Pregnancy cohort (OR: .73, P=.062). NICU admission was higher in the traditional care group (18.31% vs 12.61%). Birthweight and five minute APGAR of 9 were similar between groups. CONCLUSION: This large retrospective study shows decreased preterm birth rates with Centering Pregnancy in an at risk population. The clinician should be open to providing prenatal care outside of the traditional framework, especially for disadvantaged patients at high risk of poor pregnancy outcome.

Predictors of Poor Pregnancy Outcomes Among Antenatal Care Attendees in Primary Health Care Facilities in Cross River State, Nigeria: A Multilevel Model.

Objectives Pregnancy carries a high risk for millions of women and varies by urban–rural location in Nigeria, a country with the second highest maternal deaths in the world. Addressing multilevel predictors of poor pregnancy outcomes among antenatal care (ANC) attendees in primary health care (PHC) facilities could reduce the high maternal mortality rate in Nigeria. This study utilised the “Risk Approach” strategy to (1) compare the risks of poor pregnancy outcomes among ANC attendees by urban–rural location; and (2) determine predictors of poor pregnancy outcomes among ANC attendees in urban–rural PHC facilities in Cross River State, Nigeria. Methods A cross-sectional survey was conducted in 2011 among 400 ANC attendees aged 15–49 years recruited through multistage sampling. Data on risk factors of poor pregnancy outcomes were collected using interviewer-administered questionnaires and clinic records. Respondents were categorised into low, medium or high risk of poor pregnancy outcomes, based on their overall risk scores. Predictors of poor pregnancy outcomes were determined by multilevel ordinal logistic regression. Results A greater proportion of the women in the rural areas were below the middle socio-economic quintile (75 vs. 4 %, p < 0.001), had no education (12 vs. 2 %, p < 0.001), and were in the 15–24 age group (58 vs. 35 %, p < 0.001) whereas women in the urban areas were older than 35 years (10 vs. 5 %, p < 0.001). The women attending antenatal care in the urban PHC facilities had a low overall risk of poor pregnancy outcomes than those in the rural facilities (64 vs. 50 %, p = 0.034). Pregnant women in the urban areas had decreased odds of being at high risk of poor pregnancy outcomes versus the combined medium and low risks compared with those in the rural areas (OR 0.55, 95 % CI 0.09–0.65). Conclusions for Practice Pregnant women attending antenatal care in rural PHC facilities are more at risk of poor pregnancy outcomes than those receiving care in the urban facilities. Health programmes that promote safe pregnancy should target pregnant women in rural settings.

Type 1 and Type 2 Diabetes Preconception and in Pregnancy: Health Impacts, Influence of Obesity and Lifestyle, and Principles of Management.

Preexisting diabetes in pregnancy results in increased risks to the mother, fetus, and neonate. Preconception care is vital to reduce risk of miscarriage, congenital malformations, and perinatal mortality. Preconception care should empower women with realistic goal setting, healthy lifestyle, and diabetes self-management skills, to ensure a positive experience of the pregnancy and to reduce diabetes-related distress. In high-risk women without known diabetes, preconception and early antenatal screening is crucial to enable prompt treatment of hyperglycemia and any complications. The prevalence of obesity in reproductive age women is rising, further increasing risk of poor pregnancy outcomes in women with diabetes. Adverse lifestyle factors should be addressed preconception and in the antenatal period, allowing opportunity to improve physical health, manage weight, and improve neonatal outcomes. Management of diabetes in pregnancy involves individualized and intensified insulin therapy, accounting for expected changes in insulin sensitivity, and minimizing glucose variability and hypoglycemia. Diabetes complications must be screened for and managed as necessary. Delivery timing will depend on fetal surveillance and obstetric considerations. It is important to maintain engagement and motivation of these women in the postpartum period, encouraging breastfeeding and postpartum weight management and supporting diabetes management.

Treatment With Diet and Exercise for Women With Gestational Diabetes Mellitus Diagnosed Using IADPSG Criteria.

Prevalence of gestational diabetes mellitus (GDM) and obesity continue to increase. This study aimed to ascertain whether diet and exercise is a successful intervention for women with GDM and whether a subset of these women have comparable outcomes to those with normal glucose tolerance (NGT). This was a retrospective cohort study of five antenatal centers along the Irish Atlantic seaboard of 567 women diagnosed with GDM and 2499 women with NGT during pregnancy. Diet and exercise therapy on diagnosis of GDM were prescribed and multiple maternal and neonatal outcomes were examined. Infants of women with GDM were more likely to be hypoglycemic (adjusted odds ratio [aOR], 7.25; 95% confidence interval [CI], 2.94-17.9) at birth. They were more likely to be admitted to the neonatal intensive care unit (aOR, 2.16; 95% CI, 1.60-2.91). Macrosomia and large-for-gestational-age rates were lower in the GDM group (aOR, 0.48; 95% CI, 0.37-0.64 and aOR, 0.61; 95% CI, 0.46-0.82, respectively). There was no increase in small for gestational age among offspring of women with GDM (aOR, 0.81; 95% CI, 0.49-1.34). Women with diet-treated GDM and body mass index (BMI) < 25 kg/m(2) had similar outcomes to those with NGT of the same BMI group. Obesity increased risk for poor pregnancy outcomes regardless of diabetes status. Medical nutritional therapy and exercise for women with GDM may be successful in lowering rates of large for gestational age and macrosomia without increasing small-for-gestational-age rates. Women with GDM and a BMI less than 25 kg/m(2) had outcomes similar to those with NGT suggesting that these women could potentially be treated in a less resource intensive setting.

Systemic lupus erythematosus: Specific features of its course and therapy options

The prevalence of systemic lupus erythematosus (SLE) varies greatly in different regions of the world. The disease is encountered in different age groups; however it is most common in young and adolescent women (its peak incidence is in the range of 15–25 years). Familial SLE cases are known. The course of SLE in pregnant women is noted to have features due to an increased risk for complications and to pharmacotherapeutic peculiarities. Risk factors for poor pregnancy outcomes, such as high disease activity at the time of conception, active lupus nephritis, and the presence of antiphospholipid antibodies (APA), are identified in patients with SLE. The paper presents antenatal fetal death predictors: proteinuria, thrombocytopenia, APA, and hypertension. When SLE is concurrent with secondary antiphospholipid syndrome (APS), the risk of poor pregnancy outcome is 30%. Management tactics for pregnant women with APS and a dosage regimen are shown to largely depend on history data (the presence (absence) of nonplacental thromboses, the number of spontaneous abortions, prior therapy, etc.). There are four patient groups: 1) patients who have only anticardiolipin antibodies without previous pregnancy or one episode of unexplained abortion at less than 10 weeks’ gestation with no history of thrombosis; 2) those who have APS with no history of nonplacental thrombosis and have anticardiolipin antibodies and a history of two or more unexplained spontaneous abortions at less than 10 weeks’ gestation; 3) those who have APS and a history of nonplacental thromboses (who have taken warfarin prior to pregnancy); 4) those in whom standard therapy is ineffective during their next pregnancy. The paper presents therapy options for each patient group. It is concluded that effective therapeutic strategy for SLE, including that in pregnant women, implies patient monitoring to long maintain remission (low disease activity).

Pattern of Anemia during Pregnancy among Patients in Selected Hospital in Bangladesh

Background: Anemia in pregnancy is a common health problem. In developing countries, nearly half of all women and children are anemic. Anemia reduces work productivity and places at risk for poor pregnancy outcomes including increased risk of maternal mortality, perinatal mortality, premature births, spontaneous abortions and low birth weight. Objective: The aim of this study was to assess pattern of anemia during pregnancy. Methods: A cross sectional observational study was conducted among purposively selected 200 women attending in the outpatient department (OPD) of Obstetrics and Gynecology and Clinical Pathology department, BSMMU. Hemoglobin was measured by appropriate method. Descriptive statistics were used to analyze data. Results: About 55%, 33% and 12% women suffered from anemia at 2 nd trimester, 3rd trimester and 1st trimester of gestational period respectively. About 12% respondents had mean hemoglobin percentage of 55.83 in 1 st trimester. In 2 nd trimester 55% respondents had mean hemoglobin percentage 55.40 and remaining 33% had mean hemoglobin percentage 53.25 in 3 rd trimester. About 49%, 44% and 7% of the women were multipara, primipara and grand multipara respectively. Mean hemoglobin level was lower in multipara than in primipara. Mild, moderate and severe anemic was 70%, 27% and 3%. Conclusion: The mean hemoglobin level declines with the number of pregnancies of the respondents.

Association Between Insurance and Adequacy of Prenatal Care [257

INTRODUCTION: Obese women and Medicaid recipients have an increased risk of poor pregnancy outcomes, which has been thought to be the result of inadequate prenatal care. However, our prior work demonstrated that maternal obesity is associated with an improved adequacy of prenatal care in our population. Although obesity was associated with increased use of ultrasound services, this alone did not explain the improvement in prenatal care adequacy associated with obesity. We sought to further examine whether payer status influences prenatal care adequacy. METHODS: From a University of Rochester database of deliveries from January 2009 to December 2011, participants were categorized by body mass index (BMI, calculated as weight (kg)/[height (m)]2) as normal weight (BMI 18.5–24.9), overweight (BMI 25–29.9), and obese (BMI 30, subdivided as class I, II, III). Prenatal care adequacy was evaluated using the Kotelchuck Index. Payer status was defined as private, Medicaid, and other (tricare, self-pay). χ2 was used for univariate comparisons and logistic regression for multivariable testing. RESULTS: Of 7,090 deliveries, inadequate prenatal care was more common in both Medicaid (32.7%; odds ratio [OR] 1.24, 95% confidence interval [CI] 1.11–1.38) and other insurance groups (43.4%; OR 1.95, 95% CI 1.13–3.37) compared with private insurance (28.2% inadequate). After adjusting for age, race, education, obesity class, diabetes, and hypertension, payer status remained a significant predictor of inadequate prenatal care (Medicaid OR 1.18, 95% CI 1.03–1.35; “other” OR 1.85, 95% CI 1.05–3.24). CONCLUSION: Medicaid and other nonprivate insurance payer statuses are associated with higher rates of inadequate prenatal care compared with private insurance regardless of obesity status and potential confounders. The reason for less adequate care in these groups is unclear.

Prenatal food insecurity: how is it related to pregnancy and birth outcomes among low‐income women

The objectives were 1) To assess the occurrence/severity of food insecurity; and 2) Examine total weight gain, birth weight, and associations with prenatal food insecurity among low‐income pregnant women.Women meeting the following criteria: 1) receiving WIC, 2) 蠅 18 years, and 3) in 2nd trimester, were recruited.Women were interviewed at the WIC clinic to collect socio‐demographic data, food security status and pre‐pregnancy BMI. Food security was measured using USDA Food Security scale. Upon delivery, review of pre/post natal records was conducted to collect maternal weight gain, gestational age and birth weight of infants.In total, 198 pregnant women were recruited. On average participant's monthly income was $576. Half of participants were African American, 21% white and remaining were Hispanic and other origins. Low/very low food security was reported by 51%. A majority of participants (63%) had pre‐pregnancy BMIs in overweight/obese categories. Depression during pregnancy was significantly higher among participants experiencing low/very low food security (p = 0.02). Of the 60 women who delivered babies, only 27% met the IOM recommendations for pregnancy weight gain. Almost 1/3 of newborns had non‐normal birth‐weight (&lt;5.8 lb or &gt;8.0 lb). Though not significant, an overweight/obese pre‐pregnancy BMI was more common among food secure/marginally secure women.In conclusion, food insecurity appears to be common among low‐income women. They may also be at higher risk of poor pregnancy outcomes as this sample indicates that they are gaining above IOM recommendations and starting pregnancy with higher BMIs. This highlights a need to further examine the role prenatal food insecurity plays in predicting pediatric obesity by mediating weight gain and birth weight. Funded by: NCATS‐NIH, grant #1UL1TR001111.

Placental STAT3 signaling is activated in women with polycystic ovary syndrome.

Does polycystic ovary syndrome (PCOS) in women without pregnancy complications affect placental signal transducer and activator of transcription 3 (STAT3) and mechanistic target of rapamycin (mTOR) signaling? Placental STAT3 signaling is activated but mTOR signaling is unaffected in PCOS. Women with PCOS have increased risk of poor pregnancy outcomes (e.g. restricted or accelerated fetal growth), indicating placental dysfunction. Placental STAT3 and mTOR pathways regulate placental function and indirectly affect fetal growth. In a case-control study, placental tissue and maternal blood were collected at delivery from 40 control pregnant women and 38 PCOS women with uncomplicated pregnancy. Women with PCOS were recruited at two medical centers and pregnant controls were recruited at one of these centers. Placental mRNA expression of genes encoding proteins related to steroid action, metabolic pathways and cytokines was analyzed by quantitative RT-PCR. Phosphorylated placental STAT3 (P-STAT3) and mTOR targets was measured by western blot. Levels of sex steroids in serum were determined by mass spectrometry. Placental P-STAT3 (Tyr-705) was increased in women with PCOS (P < 0.05) versus controls. Placental mTOR signaling was not affected in PCOS women when compared with controls. Circulating levels of androstenedione, androst-5-ene-3β, 17β-diol, testosterone, 5α-dihydrotestosterone and etiocholanolone glucuronide were higher and estradiol lower in women with PCOS than in controls (all P < 0.05). No correlation between sex steroid levels in serum and P-STAT3 was observed. Women with PCOS and pregnancy complications were excluded to avoid the confounding effects of placental pathologies, which could modify STAT3 and mTOR signaling. Moreover, 97.4% of women with PCOS in the study displayed oligoamenorrhea at diagnosis. Thus, the current findings could be restricted to PCOS women with the oligo-anovulatory phenotype without pregnancy complications. Phosphorylation of STAT3 is increased in the placenta from women with PCOS and uncomplicated pregnancies, indicating that specific metabolic placental pathways are activated in the absence of obstetric and perinatal complications. The work was supported by the Swedish Medical Research Council (Project No. 2011-2732 and 2014-2775); Jane and Dan Olsson Foundation, Wilhelm and Martina Lundgrens's Science Fund; Hjalmar Svensson Foundation (E.S.-V and M.M.); Adlerbert Research Foundation; Swedish federal government under the LUA/ALF agreement ALFFGBG-136481 and 429501 and the Regional Research and Development agreement (VGFOUREG-5171, -11296 and -7861). MM thanks the Becas Chile Programme (Chile) and University of Chile for financial support through a postdoctoral fellowship. There are no competing interests.

Diabetes in Socioeconomically Vulnerable Populations.

Diabetes in Socioeconomically Vulnerable Populations.

Provision of family planning to women with cardiovascular risk factors.

Cardiovascular risk factors (CVRFs) in reproductive-aged women can lead to pregnancy complications and fetal anomalies. We performed a cross-sectional analysis using data from the National Ambulatory Medical Care Survey, 2009-2010. The study sample included visits by reproductive-aged women with CVRFs diabetes, hypertension, hyperlipidemia, obesity, or tobacco use. The comparison group was visits by reproductive-aged women with no chronic disease. Family planning action was defined as counseling, medication, or procedure. Among an estimated 223,407,070 ambulatory visits, 30.8% were associated with at least 1 CVRF, and 17.2% had at least 1 family planning action. There was no increased frequency of family planning for visits by women with CVRFs compared with those with no chronic disease (17.4% vs 17.1%, respectively). In the multivariable model, the odds ratio (OR) of a woman with a CVRF receiving family planning was 1.2 (95% confidence interval [CI], 0.9-1.5). Visits for preventive care (OR, 2.3; 95% CI, 1.8-3.1), as well as gynecologic and sexual health care (OR, 2.6; 95% CI, 1.9-3.7), were significantly associated with increased odds of family planning. There are low rates of family planning during visits by reproductive-aged women overall, with no significant difference for visits by women with CVRFs. Comprehensive preventive visits in primary care may especially benefit women of reproductive age with CVRFs, reducing the risk of poor pregnancy outcomes.

Maternal obesity is associated with a reduction in placental taurine transporter activity.

Background/Objectives:Maternal obesity increases the risk of poor pregnancy outcome including stillbirth, pre-eclampsia, fetal growth restriction and fetal overgrowth. These pregnancy complications are associated with dysfunctional syncytiotrophoblast, the transporting epithelium of the human placenta. Taurine, a β-amino acid with antioxidant and cytoprotective properties, has a role in syncytiotrophoblast development and function and is required for fetal growth and organ development. Taurine is conditionally essential in pregnancy and fetal tissues depend on uptake of taurine from maternal blood. We tested the hypothesis that taurine uptake into placental syncytiotrophoblast by the taurine transporter protein (TauT) is lower in obese women (body mass index (BMI)⩾30 kg m−2) than in women of ideal weight (BMI 18.5–24.9 kg m−2) and explored potential regulatory factors.Subjects/Methods:Placentas were collected from term (37–42-week gestation), uncomplicated, singleton pregnancies from women with BMI 19–49 kg m−2. TauT activity was measured as the Na+-dependent uptake of 3H-taurine into placental villous fragments. TauT expression in membrane-enriched placental samples was investigated by western blot. In vitro studies using placental villous explants examined whether leptin or IL-6, adipokines/cytokines that are elevated in maternal obesity, regulates TauT activity.Results:Placental TauT activity was significantly lower in obese women (BMI⩾30) than women of ideal weight (P<0.03) and inversely related to maternal BMI (19–49 kg m−2; P<0.05; n=61). There was no difference in TauT expression between placentas of ideal weight and obese class III (BMI⩾40) subjects. Long-term exposure (48 h) of placental villous explants to leptin or IL-6 did not affect TauT activity.Conclusions:Placental TauT activity at term is negatively related to maternal BMI. We propose that the reduction in placental TauT activity in maternal obesity could lower syncytiotrophoblast taurine concentration, compromise placental development and function, and reduce the driving force for taurine efflux to the fetus, thereby increasing the risk of poor pregnancy outcome.

Associations between pregnancy outcomes and unexplained high and low maternal serum alpha-fetoprotein levels.

To determine the relationship between adverse pregnancy outcomes and maternal serum alpha-fetoprotein (MSAFP) levels. A retrospective cohort study was conducted on consecutive singleton pregnancies, screened for fetal Down syndrome, in the northern part of Thailand. The prospective database of our fetal Down screening program was assessed to recruit all consecutive records. Pregnancies with medical complication and fetal abnormality were excluded. The recruited women were categorized into three groups: normal (≥0.76 to ≤2.0 MoM), low (<0.76 MoM) and high (>2.0 MoM) MSAFP levels. Of 7,110 screened women, 5,486 met inclusion criteria, including 240; 5,016 and 230 in the group of high, normal and low MSAFP levels, respectively. The rates of preterm birth, pregnancy-induced hypertension (PIH), fetal growth restriction (FGR), fetal death, low birth weight (LBW) and low APGAR scores were significantly higher in women with high MSAFP levels (11.7 vs. 6.6 %, 7.5 vs. 3.3 %, 7.5 vs. 3.3 %, 2.1 vs. 0.3 %, 15.8 vs. 6.7 %, and 2.9 vs. 0.5 % respectively), with relative risk of 1.76, 2.28, 2.27, 7.46, 2.35 and 6.09, respectively. The rates of preterm birth, FGR and LBW were significantly lower in low MSAFP levels with relative risk of 0.39, 0.26 and 0.26, respectively, whereas the rates of PIH and fetal death and low Apgar scores were not significantly different. Pregnant women with high MSAFP levels had an increased risk of poor pregnancy outcomes, while those with low MSAFP levels had a significantly lower risk of such outcomes.

Accuracy of self-reported sleep position in late pregnancy.

BackgroundThere is emerging research to suggest that supine maternal sleep position in late pregnancy may adversely affect fetal wellbeing. However, these studies have all been based on maternal report of sleeping position. Before recommendations to change sleep position can be made it is important to determine the validity of these studies by investigating how accurate pregnant women are in reporting their sleep position. If avoiding the supine sleeping position reduces risk of poor pregnancy outcome, it is also important to know how well women can comply with the instruction to avoid this position and sleep on their left.MethodThirty women in late pregnancy participated in a three-night observational study and were asked to report their sleeping position. This was compared to sleep position as recorded by a night capable video recording. The participants were instructed to settle to sleep on their left side and if they woke overnight to settle back to sleep on their left.ResultsThere was a moderate correlation between reported and video-determined left-side sleep time (r = 0.48), mean difference = 3 min (SD = 3.5 h). Participants spent an average of 59.60% (SD = 16.73%) of time in bed on their left side (ICC across multiple nights = 0.67). Those who included left side among their typical sleep positions reported significantly longer sleep during the study (p<0.01).ConclusionsOn average participant reports of sleep position were relatively accurate but there were large individual differences in reporting accuracy and in objectively-determined time on left side. Night-to-night consistency was substantial. For those who do not ordinarily sleep on that side, asking participants to sleep on their left may result in reduced sleep duration. This is an important consideration during a sleep-critical time such as late pregnancy.

Management of pregnant and postnatal women with pre-existing diabetes or cardiac disease using multi-disciplinary team models of care: a systematic review.

BackgroundMore women with an increased risk of poor pregnancy outcome due to pre-existing medical conditions are becoming pregnant. Although clinical care provided through multi-disciplinary team (MDT) working is recommended, little is known about the structure or working practices of different MDT models, their impact on maternal and infant outcomes or healthcare resources. The objectives of this review were to consider relevant international evidence to determine the most appropriate MDT models of care to manage complex medical conditions during and after pregnancy, with a specific focus on pre-existing diabetes or cardiac disease in high income country settings.MethodsQuantitative and qualitative evidence of MDT models of care for the management of pregnant/postnatal women with pre-existing diabetes and cardiac disease was considered. A search of the literature published between January 2002 - January 2014 was undertaken. Methodological quality was assessed using checklists developed by the Joanna Briggs Institute. Given limited primary and secondary research evidence, guidelines and opinion papers were included. Two independent reviewers conducted critical appraisal of included papers.ResultsNineteen papers were included from UK, Canada, USA, the Netherlands and Singapore. No studies were found which had compared MDT models for pregnant/postnatal women with pre-existing diabetes or cardiac disease. Two small retrospective studies reported better outcomes for women with cardiac disease if an MDT approach was used, although evidence to support this was limited. Due to study heterogeneity it was not possible to meta-analyse data. No evidence was identified of MDT management in the postnatal period or impacts of MDT working on healthcare resources.ConclusionsDespite widespread promotion of MDT models of care for pregnant and postnatal women with pre-existing diabetes or cardiac disease, there is a dearth of primary evidence to inform structure or working practices or beneficial impact on maternal and infant outcomes or healthcare resources. Primary research into if or how MDT models of care improve outcomes for women with complex pregnancies is urgently needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-014-0428-5) contains supplementary material, which is available to authorized users.