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Dhital R, Baer RJ, Kalunian K, Chambers C. Adverse pregnancy outcomes across SLE subgroups: significance of cardiovascular events. Lupus Sci Med 2025; 12:e001507. [PMID: 40306735 PMCID: PMC12049864 DOI: 10.1136/lupus-2025-001507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2025] [Accepted: 04/11/2025] [Indexed: 05/02/2025]
Abstract
OBJECTIVE SLE is associated with increased risks of maternal cardiovascular events (CVEs) as well as adverse pregnancy outcomes. The influence of maternal CVEs on pregnancy complications in lupus is not clearly known. Our primary aim was to assess the risks of adverse pregnancy outcomes in individuals with SLE, specifically examining the influence of CVEs. METHODS Using a California population-based birth cohort from 2005 to 2020, pregnant individuals with SLE were identified via International Classification of Diseases codes on maternal discharge records and further subdivided based on whether they had lupus nephritis (LN) or antiphospholipid syndrome (APS). We analysed adjusted relative risks (aRRs) of adverse pregnancy outcomes in SLE subgroups, comparing those with and without CVEs, to the reference group of pregnant individuals without autoimmune rheumatic diseases or APS and CVEs. CVEs were broadly defined to encompass thromboembolic and cardiovascular conditions associated with SLE. RESULTS CVEs complicated 17 130/7004 334 (0.2%) of pregnancies in individuals without autoimmune rheumatic diseases or APS, and 176/8422 (2.1%) with SLE, including 52/903 (5.8%) with LN and 40/513 (7.8%) with APS. Compared with the reference group, the aRRs for maternal complications were higher in SLE subgroups: non-cardiac severe maternal morbidity (3.2-fold to 31.5-fold), intensive care admission (2.0-fold to 12.2-fold), 1 year re-admission (2.4-fold to 6.0-fold) and death (7.0-fold to 7.9-fold). Similarly, adverse infant outcomes were higher: preterm birth (2.3-fold to 6.8-fold), small-for-gestational-age infant (1.8-fold to 3.4-fold), neonatal intensive care admission (2.1-fold to 7.9-fold) and infant death (1.6-fold to 3.7-fold), with highest risk estimates for SLE with LN or APS, particularly when complicated by CVEs. CONCLUSIONS LN and APS in SLE contributed to incremental risks for adverse outcomes, with the combination of LN or APS with CVEs yielding the highest point estimates. This underscores the importance of disease severity but also the impact of CVEs, helping to individualise the risks of pregnancy complications for various SLE subpopulations.
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Affiliation(s)
- Rashmi Dhital
- Department of Medicine, Division of Rheumatology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rebecca J Baer
- Department of Pediatrics, Division of Environmental Science and Health, University of California San Diego, La Jolla, California, USA
- The California Preterm Birth Initiative, University of California San Francisco, San Francisco, California, USA
| | - Kenneth Kalunian
- Department of Medicine, Division of Rheumatology, University of California San Diego, La Jolla, California, USA
| | - Christina Chambers
- Department of Pediatrics, Division of Environmental Science and Health, University of California San Diego, La Jolla, California, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
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Etzel L, Ye Q, Apsley AT, Chiaro C, Petri LE, Kozlosky J, Propper C, Mills-Koonce R, Short SJ, Garrett-Peters P, Shalev I. Maternal telomere length and oxidative stress in pregnancy: cross-sectional analysis with an exploratory examination of systemic inflammation. BMC Pregnancy Childbirth 2025; 25:395. [PMID: 40186152 PMCID: PMC11971816 DOI: 10.1186/s12884-025-07542-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2024] [Accepted: 03/27/2025] [Indexed: 04/07/2025] Open
Abstract
BACKGROUND Telomere length (TL) is a marker of cellular aging associated with risk for age-related diseases and is known to be influenced by various factors, including oxidative stress and inflammation, in the contexts of stress and aging. The physiological demands of pregnancy may impact maternal TL, though research in this area is sparse. We tested oxidative stress and explored inflammation as predictors of maternal TL in a sample of women with normative pregnancies. METHODS Participants (N = 88, aged 18 to 46 years, 25% non-Hispanic Black, 65% non-Hispanic White) were recruited during their 2nd or 3rd trimester. TL was measured using saliva via qPCR as absolute TL. Oxidative stress was derived from principal component analysis of selected metabolites measured via urinary metabolomics. Inflammation was quantified as total IL-6 in serum. Hypotheses were tested with stepwise generalized linear models. RESULTS Longer TL was predicted by higher oxidative stress (b = 0.20 ± 0.08; P =.019), controlling for maternal age, gestational age, race/ethnicity, maternal BMI, and income-to-needs ratio. In our exploratory analysis, longer TL was also predicted by higher IL-6 (b = 0.76 ± 0.20; P =.0003) controlling for covariates. There was no significant interaction between oxidative stress and inflammation predicting TL. CONCLUSION Our findings suggest that in normative pregnancies, both oxidative stress and inflammation are independently associated with longer telomere length. Given that these associations are inconsistent with the role of oxidative stress and inflammation on telomere biology in non-pregnant samples, future work should aim to replicate these findings in both normal and high-risk pregnancies, explore mechanisms underlying these associations using longitudinal designs, and examine how these relationships influence maternal and fetal health.
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Affiliation(s)
- Laura Etzel
- Social Science Research Institute, Duke University, Durham, NC, USA
| | - Qiaofeng Ye
- Department of Biobehavioral Health, The Pennsylvania State University, 219 Biobehavioral Health Building, University Park, PA, 16802, USA
| | - Abner T Apsley
- Department of Biobehavioral Health, The Pennsylvania State University, 219 Biobehavioral Health Building, University Park, PA, 16802, USA
| | - Chris Chiaro
- Department of Biobehavioral Health, The Pennsylvania State University, 219 Biobehavioral Health Building, University Park, PA, 16802, USA
| | - Lauren E Petri
- Department of Biobehavioral Health, The Pennsylvania State University, 219 Biobehavioral Health Building, University Park, PA, 16802, USA
| | - John Kozlosky
- Department of Biobehavioral Health, The Pennsylvania State University, 219 Biobehavioral Health Building, University Park, PA, 16802, USA
| | - Cathi Propper
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Roger Mills-Koonce
- School of Education, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sarah J Short
- Department of Educational Psychology, University of Wisconsin-Madison, Madison, WI, USA
- Center for Healthy Minds, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Idan Shalev
- Department of Biobehavioral Health, The Pennsylvania State University, 219 Biobehavioral Health Building, University Park, PA, 16802, USA.
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Kaul P, Barrett O, Savu A, Liyanage V, Davidge ST, Cooke CLM. Association between adverse birth outcomes and long-term risk of premature cardiovascular disease and mortality in a contemporary population-based cohort of 502,383 pregnant women. Am Heart J 2025; 282:13-20. [PMID: 39674525 DOI: 10.1016/j.ahj.2024.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 11/27/2024] [Accepted: 12/06/2024] [Indexed: 12/16/2024]
Abstract
BACKGROUND Relatively few studies have examined the association between the entire spectrum of adverse birth outcomes [stillbirth, preterm birth (PTB), term births that are low birth weight (LBW) or high birth weight (HBW)] and long-term risk of CVD in the mother. Our objective was to examine the association between birth outcomes and risk of premature CVD or death in a contemporary cohort of pregnant women. METHODS We conducted a retrospective population-based cohort study of women in Alberta, Canada, between 01/01/2005 and 01/01/2023. The primary endpoint was a composite of CVD-related hospitalization, CVD-related emergency department visit, or death. Cox proportional hazard modelling was used to examine the independent association between birth outcomes and the risk of CVD or death in the mother, after accounting for other socio-demographic, clinical and pregnancy-related complications. RESULTS Among 502,383 mothers, 0.51% had stillbirth, 7.11% had PTB, 86.11% had normal birth weight (NBW), 2.11% had LBW, and 4.15% had HBW. During a median follow-up of 3612 days (∼10 years), compared the NBW group, the adjusted hazard ratio (aHR) and 95% confidence interval (CI) for maternal CVD or death associated with stillbirth was 1.63 (1.33, 1.99); 1.45 (1.36, 1.55) for PTB; 1.22 (1.06, 1.41) for LBW, and 1.13 (1.03, 1.23) for HBW. In addition to birth outcomes, pre-existing diabetes (aHR: 1.61, 95% CI: 1.47, 1.76), gestational hypertension (aHR: 1.47, 95% CI: 1.38, 1.57), and pre-existing hypertension (aHR: 3.28, 95% CI: 2.66, 4.04) carried a higher risk for premature CVD and death in the mother. CONCLUSIONS Adverse birth outcomes of stillbirth and preterm birth, and to a lesser degree term births that result in LBW or HBW, are markers of increased risk of premature CVD and death in the mother. Coordinated effort between obstetricians, family physicians, and cardiologists are needed to design and implement effective risk reduction programs tailored for these high-risk women.
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Affiliation(s)
- Padma Kaul
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, T6G 2R7, Canada; Canadian VIGOUR Center, Edmonton, Alberta T6G 2E1, Canada; Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, T6G 2S2, Canada.
| | - Olesya Barrett
- Maternal & Child Division, Alberta Health Services, Edmonton, Alberta T5J 3E4, Canada
| | - Anamaria Savu
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, T6G 2R7, Canada; Canadian VIGOUR Center, Edmonton, Alberta T6G 2E1, Canada
| | - Vichy Liyanage
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, T6G 2R7, Canada; Canadian VIGOUR Center, Edmonton, Alberta T6G 2E1, Canada
| | - Sandra T Davidge
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, T6G 2R7, Canada; Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, T6G 2S2, Canada
| | - Christy-Lynn M Cooke
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, T6G 2R7, Canada; Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, T6G 2S2, Canada
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Crump C, Sundquist J, Sundquist K. Adverse Pregnancy Outcomes and Long-Term Risk of Heart Failure in Women: National Cohort and Co-Sibling Study. JACC. HEART FAILURE 2025; 13:589-598. [PMID: 39846910 PMCID: PMC11981847 DOI: 10.1016/j.jchf.2024.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Revised: 11/06/2024] [Accepted: 11/20/2024] [Indexed: 01/24/2025]
Abstract
BACKGROUND Adverse pregnancy outcomes, such as preterm delivery and hypertensive disorders of pregnancy, may be associated with higher future risks of heart failure (HF). However, the comparative effects of different adverse pregnancy outcomes on long-term risk of HF, and their potential causality, are unclear. OBJECTIVES The authors sought to examine 5 major adverse pregnancy outcomes in relation to long-term risk of HF in a large population-based cohort. METHODS A national cohort study was conducted of all 2,201,638 women with a singleton delivery in Sweden in 1973-2015, followed up for HF identified from nationwide outpatient and inpatient diagnoses through 2018. Cox regression was used to compute HRs for HF associated with preterm delivery, small for gestational age, preeclampsia, other hypertensive disorders of pregnancy, and gestational diabetes, while adjusting for other adverse pregnancy outcomes and maternal factors. Co-sibling analyses assessed for potential confounding by shared familial (genetic or environmental) factors. RESULTS In 48 million person-years of follow-up, 667,774 women (30%) experienced an adverse pregnancy outcome, and 19,922 women (0.9%) were diagnosed with HF (median age, 61 years). All 5 adverse pregnancy outcomes were independently associated with long-term increased risk of HF. With up to 46 years of follow-up after delivery, adjusted HRs for HF associated with specific adverse pregnancy outcomes were: gestational diabetes, 2.19 (95% CI: 1.95-2.45); preterm delivery, 1.68 (95% CI: 1.61-1.75); other hypertensive disorders, 1.68 (95% CI: 1.48-1.90); preeclampsia, 1.59 (95% CI: 1.53-1.66); and small for gestational age, 1.35 (95% CI: 1.31-1.40). All HRs remained significantly elevated (1.3- to 3.0-fold) even 30 to 46 years after delivery. These findings were only partially explained by shared familial factors. Women with multiple adverse pregnancy outcomes had further increases in risk (eg, up to 46 years after delivery, adjusted HRs associated with 1, 2, or ≥3 adverse pregnancy outcomes were 1.51 [95% CI: 1.47-1.56], 2.31 [95% CI: 2.19-2.45], and 3.18 [95% CI: 2.85-3.56], respectively). CONCLUSIONS In this large national cohort, women who experienced any of 5 major adverse pregnancy outcomes had increased risk for HF up to 46 years later. Women with adverse pregnancy outcomes need early preventive actions and long-term clinical care to reduce the risk of HF.
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Affiliation(s)
- Casey Crump
- Departments of Family and Community Medicine and of Epidemiology, The University of Texas Health Science Center, Houston, Texas, USA.
| | - Jan Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden; University Clinic Primary Care Skåne, Region Skåne, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden; University Clinic Primary Care Skåne, Region Skåne, Sweden
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Miserachs M, Martinez-Bueno C, Castro A, Pallarés-Carratalá V, Pijuan-Domenech A, Gordon B, Farràs A, Del Barco E, Higueras T, Carreras E, Goya M. Adverse Pregnancy Outcomes and Cardiovascular Disease: A Spanish Cohort. Healthcare (Basel) 2025; 13:728. [PMID: 40218026 PMCID: PMC11989046 DOI: 10.3390/healthcare13070728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2025] [Revised: 03/14/2025] [Accepted: 03/15/2025] [Indexed: 04/14/2025] Open
Abstract
Background and Aims: Emerging evidence suggests adverse pregnancy outcomes (APOs) may increase future cardiovascular risk. This study aimed to assess in a Spanish cohort the long-term risk of cardiovascular disease in women with APOs compared to those without such complications. Methods: A retrospective longitudinal cohort study was conducted at Hospital Vall d'Hebron (Barcelona, Spain), including pregnant women delivering between January 2010 and December 2015. Women with pre-existing medical conditions were excluded. APOs included preeclampsia, gestational diabetes, preterm birth, late miscarriage, and stillbirth. Cardiovascular events were defined as acute myocardial infarction or stroke. Both APO and non-APO groups were compared for their risk of cardiovascular events in the years following delivery, using unadjusted and adjusted models. Results: Out of 12,071 pregnant women delivered at Hospital Vall d'Hebron during the study period. 10,734 met the inclusion criteria (8234 in the non-APO group and 2500 in the APO group). The adjusted model revealed a significant association between APOs and cardiovascular events post-delivery (HR 2.5; 95% CI 1.4-4.4). Furthermore, an increased number of APOs (≥2) correlated with a higher risk of post-delivery cardiovascular events (HR 8.6; 95% CI 2.8-26.8). Conclusions: Women with adverse pregnancy outcomes (APOs), particularly those experiencing preeclampsia, preterm birth, and late miscarriage, exhibit an elevated long-term risk of cardiovascular events. Our findings highlight that these associations persist even after adjusting for traditional cardiovascular risk factors, indicating that APOs may independently influence long-term cardiovascular health. This underscores the importance of recognizing pregnancy as a critical window for early cardiovascular health interventions and counseling. Addressing these risks proactively could improve long-term health outcomes for women with a history of APOs.
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Affiliation(s)
- Marta Miserachs
- Maternal-Foetal Medicine Unit, Department of Obstetrics, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
| | - Cristina Martinez-Bueno
- Sexual and Reproductive Health Services, Catalan Institute of Health, Barcelona University (UB), Gran Via de les Corts Catalanes, 587, 08007 Barcelona, Spain
| | - Almudena Castro
- Department of Cardiology, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Vicente Pallarés-Carratalá
- Health Surveillance Unit, Mutual Insurance Union, 12004 Castellon, Spain
- Department of Medicine, Jaume I University, 12006 Castellon, Spain
| | - Antonia Pijuan-Domenech
- Integrated Hospital Vall d’Hebron-Hospital Sant Pau Adult Congenital Heart Disease Unit, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
- Department of Cardiology, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, CIBER-CV, 08035 Barcelona, Spain
| | - Blanca Gordon
- Integrated Hospital Vall d’Hebron-Hospital Sant Pau Adult Congenital Heart Disease Unit, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
- Department of Cardiology, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, CIBER-CV, 08035 Barcelona, Spain
| | - Alba Farràs
- Maternal-Foetal Medicine Unit, Department of Obstetrics, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
| | - Ester Del Barco
- Maternal-Foetal Medicine Unit, Department of Obstetrics, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
| | - Teresa Higueras
- Maternal-Foetal Medicine Unit, Department of Obstetrics, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
- Obstetrics and Gynecology Department, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Spain
| | - Elena Carreras
- Maternal-Foetal Medicine Unit, Department of Obstetrics, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
- Obstetrics and Gynecology Department, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Spain
| | - Maria Goya
- Maternal-Foetal Medicine Unit, Department of Obstetrics, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
- Obstetrics and Gynecology Department, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Spain
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Countouris ME, Bello NA. Advances in Our Understanding of Cardiovascular Diseases After Preeclampsia. Circ Res 2025; 136:583-593. [PMID: 40080539 PMCID: PMC11921930 DOI: 10.1161/circresaha.124.325581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2024] [Revised: 01/21/2025] [Accepted: 01/22/2025] [Indexed: 03/15/2025]
Abstract
Preeclampsia is a syndrome of hypertension in association with target organ dysfunction, including proteinuria, which manifests during pregnancy and the immediate postpartum period. The pathophysiology of preeclampsia originates from impaired trophoblastic invasion of the placental resulting in malperfusion and involves multiple mechanistic pathways that include anti-angiogenic factors, endothelial dysfunction, and immune dysregulation. Preeclampsia caries an increased risk of subclinical cardiovascular disease including left ventricular remodeling, diastolic dysfunction, coronary artery calcification, peripheral vascular abnormalities, and microvascular dysfunction and clinical cardiovascular disease including stroke, heart failure, myocardial infarction, and death from a cardiovascular cause. This review will highlight several common mechanistic pathways shared between preeclampsia and cardiovascular diseases that provide insight into potential targets for risk reduction and disease process mitigation that can be examined in future trials.
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Affiliation(s)
- Malamo E Countouris
- Department of Medicine, Division of Cardiology, University of Pittsburgh, PA (M.E.C.)
| | - Natalie A Bello
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (N.A.B.)
- Atria Institute, New York, NY (N.A.B.)
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Zhao Z, Chang T, Liu X, Zhang X, Liu X, Zhang Y, Chen J, Zhang Y, Lu M. Association between dietary intakes and pregnancy complications: a two-sample Mendelian randomization analysis. BMC Pregnancy Childbirth 2025; 25:286. [PMID: 40087593 PMCID: PMC11908085 DOI: 10.1186/s12884-025-07385-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/26/2025] [Indexed: 03/17/2025] Open
Abstract
BACKGROUND Previous studies reported possible connections between dietary factors and pregnancy complications; however, confounders tend to confound the results. A two-sample Mendelian randomization (MR) study was carried out to explore the impact of dietary intakes on the risk of pregnancy complications. METHODS Exposure data in this study were derived from the IEU Open GWAS project, and the outcome data were from the FinnGen study. The inverse variance-weighted (IVW) method is the main analytical method used in this study. In addition, we verified the accuracy of the findings by performing sensitivity analyses using other methods. RESULTS After rigorous False Discovery Rate (FDR) correction, dried fruit intake can reduce the risk of ectopic pregnancy (OR [odds ratio]: 0.36, 95% CI [confidence interval]: 0.21-0.62). Fresh fruit intake was positively associated with pregnancy hypertension (OR: 2.26, 95% CI: 1.32-3.87), and cheese intake was negatively related to pregnancy hypertension (OR: 0.63, 95% CI: 0.47-0.85). In addition, cheese intake was negatively associated with pre-eclampsia (OR: 0.53, 95% CI: 0.38-0.72) and gestational diabetes (OR: 0.48, 95% CI: 0.36-0.64). There was no significant causality in this study for the analyses of other dietary intakes and pregnancy complications, and no heterogeneity or horizontal pleiotropy was found. CONCLUSIONS Our two-sample MR study explores the causal association between dietary intakes and pregnancy complications, and our results contribute to the primary prevention of pregnancy complications. The mechanism by which dietary intakes affects pregnancy complications can be validated by further basic observational studies.
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Affiliation(s)
- Zengle Zhao
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, 107 Wenhua West Road, Jinan, Shandong, 250012, China
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China
| | - Tongmin Chang
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China
| | - Xiaoyan Liu
- Department of Gynecology and Obstetrics, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, China
| | - Xuening Zhang
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China
| | - Xinjie Liu
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China
| | - Yuan Zhang
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China
| | - Jiaqi Chen
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China
| | - Yuan Zhang
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, 107 Wenhua West Road, Jinan, Shandong, 250012, China.
- Clinical Research Center of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China.
| | - Ming Lu
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, 107 Wenhua West Road, Jinan, Shandong, 250012, China.
- Clinical Research Center of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China.
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8
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Manthorpe T, Arstall M, Andraweera PH, Aldridge E. Patient Experiences of a Postpartum Cardiovascular Disease Intervention Clinic for Pregnancy Complications. Matern Child Health J 2025; 29:310-321. [PMID: 39918614 PMCID: PMC11926021 DOI: 10.1007/s10995-025-04047-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2025] [Indexed: 03/14/2025]
Abstract
OBJECTIVES Experiencing a maternal complication of pregnancy conveys a significantly higher risk of developing premature cardiovascular disease compared to having an uncomplicated pregnancy. Postpartum interventions that aim to improve lifestyle and modifiable risk factors for people in this cohort may reduce cardiovascular disease risk. This study will explore the experiences and barriers to attendance of patients referred to one such clinic located in South Australia. METHODS This qualitative study conducted six focus groups comprised of two-six patients who had attended at least one postpartum intervention clinic appointment (N = 19). Audio recordings were captured and transcribed and NVivo was used to perform a thematic analysis. RESULTS Participants found the clinic informative as it educated them on their greater risk of cardiovascular disease and how to reduce this risk. They reported wanting more frequent appointments and the ability to opt in for additional contact, including newsletters and social media groups. We also identified several barriers to attendance, including an unclear clinic referral and appointment booking process, and missing clinic correspondence including appointment letters and pathology forms. CONCLUSIONS FOR PRACTICE This study provides insight into the experiences of patients who attended a postpartum cardiovascular disease prevention clinic. The clinic model can be operated in different health care settings to become part of standardized care in the postpartum period for patients who have had a pregnancy complication. Refinement of the clinic model referral and booking processes could reduce potential barriers to patient attendance.
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Affiliation(s)
- Tegan Manthorpe
- Adelaide Medical School, Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia.
- Department of Cardiology, Lyell McEwin Hospital, Adelaide, South Australia, Australia.
| | - Margaret Arstall
- Adelaide Medical School, Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Cardiology, Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Prabha H Andraweera
- Adelaide Medical School, Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Cardiology, Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Emily Aldridge
- Adelaide Medical School, Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Cardiology, Lyell McEwin Hospital, Adelaide, South Australia, Australia
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Birnie K, Howe LD, Jones T, Madley-Dowd P, Martin FZ, Forbes H, Redaniel MT, Cornish R, Magnus MC, Davies NM, Tilling K, Hughes AD, Lawlor DA, Fraser A. Life course trajectories of maternal cardiovascular disease risk factors by obstetric history: a UK cohort study using electronic health records. BMC Med 2025; 23:91. [PMID: 39948598 PMCID: PMC11827161 DOI: 10.1186/s12916-025-03937-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Accepted: 02/07/2025] [Indexed: 02/16/2025] Open
Abstract
BACKGROUND Women who experience adverse pregnancy outcomes (APOs; gestational hypertension, preeclampsia (PE), gestational diabetes (GD), preterm birth (PTB), small or large for gestational age, miscarriage, multiple miscarriages, stillbirth, and offspring with major congenital anomalies) have increased risk of developing cardiovascular disease (CVD). We aimed to compare cardiometabolic health trajectories across the life course between women with and without APOs. METHODS We studied 187,186 women with a registered pregnancy in the UK Clinical Practice Research Datalink (CPRD) GOLD linked to Hospital Episode Statistics. Fractional polynomial multilevel models were used to compare trajectories of cardiometabolic risk factors (body mass index [BMI], blood pressure [BP], cholesterol, and glucose) between women with and without a history of APOs (individual APOs in any pregnancy and number of APOs). We explored two underlying time axes: (1) time relative to first pregnancy (from 10 years before first pregnancy to 15 years after) and (2) age. Models controlled for age at first pregnancy, residential area deprivation, non-singleton pregnancy, parity, smoking status, ethnicity, and medications use. RESULTS Women with a history of PE, gestational hypertension, or GD had higher BMI, BP, and glucose 10 years before first pregnancy compared to women without these APOs. These differences persisted 15 years post-first pregnancy. Women with a history of GD had a steeper post-partum rise in glucose. Women who experienced multiple (3 +) miscarriage, stillbirth, and/or medically indicated PTB had higher BP and BMI before and after pregnancy, with BP trajectories converging 15 years after first pregnancy. Women who experienced multiple APOs had the most adverse measurements across all cardiometabolic risk factors, with more unfavourable mean levels with each additional APO. There was little difference in cardiometabolic trajectories between women with and without a history of 1 or 2 miscarriages or congenital anomalies. CONCLUSIONS Women with APOs had adverse cardiometabolic profiles before first pregnancy, persisting up to 15 years post-pregnancy. Findings highlight the potential for targeted public health interventions to promote good cardiometabolic health in young adults transitioning from contraceptive use to planning pregnancies. APOs may identify young women who could benefit from monitoring CVD risk factors and interventions to improve cardiometabolic health.
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Affiliation(s)
- Kate Birnie
- MRC Integrative Epidemiology Unitat the , University of Bristol, Bristol, UK.
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK.
| | - Laura D Howe
- MRC Integrative Epidemiology Unitat the , University of Bristol, Bristol, UK
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Timothy Jones
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
- The National Institute for Health Research and Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Bristol Medical School, Translational Health Sciences, University of Bristol, Bristol, UK
| | - Paul Madley-Dowd
- MRC Integrative Epidemiology Unitat the , University of Bristol, Bristol, UK
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Florence Z Martin
- MRC Integrative Epidemiology Unitat the , University of Bristol, Bristol, UK
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Harriet Forbes
- MRC Integrative Epidemiology Unitat the , University of Bristol, Bristol, UK
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
- Faculty of Epidemiology and Population HealthandDepartment of Non-Communicable Disease EpidemiologySchool of Hygiene and Tropical Medicine, London, UK
| | - Maria Theresa Redaniel
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
- The National Institute for Health Research and Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- National Cancer Registry Ireland, Cork, Ireland
| | - Rosie Cornish
- MRC Integrative Epidemiology Unitat the , University of Bristol, Bristol, UK
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Maria C Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Neil M Davies
- Division of Psychiatry, University College London, London, UK
- Department of Statistical Sciences, University College London, London, UK
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kate Tilling
- MRC Integrative Epidemiology Unitat the , University of Bristol, Bristol, UK
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing at University College London, London, UK
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, University College London, London, UK
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unitat the , University of Bristol, Bristol, UK
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Abigail Fraser
- MRC Integrative Epidemiology Unitat the , University of Bristol, Bristol, UK
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
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McCarthy KJ, Liu SH, Kennedy J, Chan HT, Mayer VL, Vieira L, Glazer KB, Van Wye G, Janevic T. Prospective transitions in hemoglobin A1c following gestational diabetes using multistate Markov models. Am J Epidemiol 2025; 194:397-406. [PMID: 39013791 PMCID: PMC12034835 DOI: 10.1093/aje/kwae219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 05/15/2024] [Accepted: 07/12/2024] [Indexed: 07/18/2024] Open
Abstract
We characterized the state-to-state transitions in postpartum hemoglobin A1c levels after gestational diabetes, including remaining in a state of normoglycemia or transitions between prediabetes or diabetes states of varying severity. We used data from the APPLE Cohort, a postpartum population-based cohort of individuals with gestational diabetes between 2009 and 2011, and linked A1c data with up to 9 years of follow-up (n = 34 171). We examined maternal sociodemographic and perinatal characteristics as predictors of transitions in A1c progression using Markov multistate models. In the first year postpartum following gestational diabetes, 45.1% of people had no diabetes, 43.1% had prediabetes, 4.6% had controlled diabetes, and 7.2% had uncontrolled diabetes. Roughly two-thirds of individuals remained in the same state in the next year. Black individuals were more likely to transition from prediabetes to uncontrolled diabetes (adjusted hazard ratio [aHR] = 2.32; 95% CI, 1.21-4.47) than White persons. Perinatal risk factors were associated with disease progression and a lower likelihood of improvement. For example, hypertensive disorders of pregnancy were associated with a stronger transition (aHR = 2.06; 95% CI, 1.39-3.05) from prediabetes to uncontrolled diabetes. We illustrate factors associated with adverse transitions in incremental A1c stages and describe patient profiles that may warrant enhanced postpartum monitoring.
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Affiliation(s)
- Katharine J McCarthy
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, NY, United States
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY, United States
| | - Shelley H Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, NY, United States
| | - Joseph Kennedy
- Department of Health & Mental Hygiene, Bureau of Vital Statistics, New York City, NY, United States
| | - Hiu Tai Chan
- Department of Health & Mental Hygiene, Bureau of Vital Statistics, New York City, NY, United States
| | - Victoria L Mayer
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, United States
| | - Luciana Vieira
- Department of Maternal and Fetal Medicine, Stamford Hospital, Stamford, CT, United States
| | - Kimberly B Glazer
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, NY, United States
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY, United States
| | - Gretchen Van Wye
- Department of Health & Mental Hygiene, Bureau of Vital Statistics, New York City, NY, United States
| | - Teresa Janevic
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY, United States
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11
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Zhao M, Chang H, Yue Y, Zeng X, Wu S, Ren X. The association between periodontal disease and adverse pregnancy outcomes: a bibliometric analysis from 2000 to 2023. Front Med (Lausanne) 2025; 12:1526406. [PMID: 39906598 PMCID: PMC11790436 DOI: 10.3389/fmed.2025.1526406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2024] [Accepted: 01/02/2025] [Indexed: 02/06/2025] Open
Abstract
Background Periodontal disease (PD) refers to a chronic inflammatory disorder affecting the supporting tissues of the teeth triggered by bacterial infection and is recognized to promote systemic inflammation, leading to dysfunction in specific organs. Adverse pregnancy outcomes (APOs), including preterm birth, small for gestational age infants, gestational diabetes and preeclampsia, are linked to pregnancy complications. Recently, the correlation between periodontal disease and adverse pregnancy outcomes has garnered global attention. However, bibliometric studies in this area remain limited. This study aimed to visualize knowledge framework and research trends concerning the relationship between periodontal disease and adverse pregnancy outcomes from 2000 to 2023 through bibliometric approaches. Methods On September 22, 2024, articles and reviews on the connection between periodontal disease and adverse pregnancy outcomes were retrieved from the Web of Science Core Collection (WOSCC). CiteSpace [6.3.R1 (64-bit) Advanced] was used to perform knowledge mapping and bibliometric studies. Results Over the past 23 years, 932 articles from 73 countries were collected, with the U.S. contributing over one-third (355), followed by Brazil (85) and India (59). The literature in this field has experienced multiple growth phases since 2000, with particularly rapid growth observed after 2019. The University of North Carolina (n = 34, 3.65%) is the leading institution in terms of publication output, primarily representing the U.S. Notably, the Journal of Periodontology and the American Journal of Obstetrics and Gynecology are the most frequently cited journals in the fields of periodontology and obstetrics, respectively. These publications are authored by 94 researchers, with Steven Offenbacher being both the most productive and most highly cited author, making significant contributions to the field. A visual analysis of keywords identifies "oral microbiota," "oral health," "adverse pregnancy outcomes," and "global burden" as emerging research hotspots in exploring the correlation between periodontal disease and adverse pregnancy outcomes. Conclusions This first bibliometric and visual analysis of periodontal disease and adverse pregnancy outcomes offers a concise overview of the field and suggests future research should focus on risk factors, high-risk populations, oral microbiota, mechanisms, interventions, and international collaboration.
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Affiliation(s)
- Miaomiao Zhao
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, China
| | - Haoxiang Chang
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, China
| | - Yuxu Yue
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, China
| | - Xinyue Zeng
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, China
| | - Shaobang Wu
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, China
| | - Xiuyun Ren
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, China
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12
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Yi L, Rifas-Shiman S, Pescador Jimenez M, Lin PID, Suel E, Hystad P, Larkin A, Hankey S, Zhang W, Klompmaker J, Oken E, Hivert MF, Aris I, James P. Assessing greenspace and cardiovascular health through deep-learning analysis of street-view imagery in a cohort of US children. ENVIRONMENTAL RESEARCH 2025; 265:120459. [PMID: 39603586 PMCID: PMC11742899 DOI: 10.1016/j.envres.2024.120459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 10/24/2024] [Accepted: 11/24/2024] [Indexed: 11/29/2024]
Abstract
BACKGROUND Accurately capturing individuals' experiences with greenspace at ground-level can provide valuable insights into their impact on children's health. However, most previous research has relied on coarse satellite-based measurements. METHODS We utilized CVH and residential address data from Project Viva, a US-based pre-birth cohort, tracking participants from mid-childhood to late adolescence (2007-21). A deep learning segmentation algorithm was applied to street-view images across the US to estimate % street-view trees, grass, and other greenspace (flowers, field, and plants). Exposure estimates were derived by linking street-view greenspace metrics to 500m of participants' residences during mid-childhood, early and late adolescence. CVH scores (range 0-100; higher indicate better CVH) were calculated using the American Heart Association's Life's Essential 8 algorithm at these three time points, incorporating four biomedical components (body weight, blood lipids, blood glucose, blood pressure) and four behavioral components (diet, physical activity, nicotine exposure, sleep). Linear regression models were used to examine cross-sectional and cumulative associations between street-view greenspace metrics and CVH scores. Generalized estimating equations models were used to examine associations between street-view greenspace metrics and changes in CVH scores across three timepoints. All models were adjusted for individual and neighborhood-level confounders. RESULTS Adjusting for confounders, a one-SD increase in street-view trees within 500m of residence was cross-sectionally associated with a 1.92-point (95%CI: 0.50, 3.35) higher CVH score in late adolescence, but not mid-childhood or early adolescence. Longitudinally, street-view greenspace metrics at baseline (either mid-childhood or early adolescence) were not associated with changes in CVH scores at the same and all subsequent time points. Cumulative street-view greenspace metrics across the three time points were also not associated with CVH scores in late adolescence. CONCLUSION AND RELEVANCE In this US cohort of children, we observed few evidence of associations between street-level greenspace children's CVH, though the impact may vary with children's growth stage.
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Affiliation(s)
- Li Yi
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
| | - Sheryl Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | | | - Pi-I Debby Lin
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Esra Suel
- Centre for Advanced Spatial Analysis, University College London, London, UK
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Andrew Larkin
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Steve Hankey
- School of Public and International Affairs, Virginia Tech, Blacksburg, VA, USA
| | - Wenwen Zhang
- Edward J. Bloustein School of Planning and Public Policy, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Jochem Klompmaker
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Marie-France Hivert
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA; Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Izzuddin Aris
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Peter James
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Public Health Sciences, University of California, Davis School of Medicine, Sacramento, CA, USA
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13
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Alrifai N, Puttur A, Ghanem F, Dhital Y, Jabri A, Al-Abdouh A, Alhuneafat L. Maternal and fetal outcomes in those with autoimmune connective tissue disease. Clin Rheumatol 2025; 44:391-401. [PMID: 39616303 DOI: 10.1007/s10067-024-07242-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 10/31/2024] [Accepted: 11/14/2024] [Indexed: 01/14/2025]
Abstract
INTRODUCTION Autoimmune CTDs like systematic lupus erythematosus (SLE), systemic sclerosis (SSc), and rheumatoid arthritis (RA)predominantly affect women during reproductive years and are linked to maternal and fetal complications. METHODS We conducted a population-based, retrospective cohort study using the national inpatient data sample to compare maternal and fetal outcomes in patients with and without CTD delivering between October 2015 and December 2020. Regression analysis was performed and adjusted for multiple patient characteristics to compare outcomes. RESULTS Our study comprised of 18,866,050 deliveries, of which 50,450 (0.02%) had autoimmune CTD, including 25,340 with SLE, 23,945 with RA, and 1,165 with SSc. Patients with CTDs had significantly higher odds of maternal death (aOR 3.898; 95% CI: 1.462-10.389, p = 0.007), hypertensive disorders (aOR 1.554; 95% CI: 1.456-1.659, p < 0.001), acute kidney injury (aOR 4.886; 95% CI: 3.934-6.069, p < 0.001), blood transfusions (aOR 1.853; 95% CI: 1.628-2.109, p < 0.001), peripartum cardiomyopathy (aOR 2.709; 95% CI: 1.492-4.917, p = 0.001), sepsis (aOR 2.112; 95% CI: 1.430-3.119, p < 0.001), and ARDS (aOR 1.623; 95% CI: 1.076-2.449, p = 0.021). Fetal outcomes were also worse, with higher odds of small for gestational age fetuses (aOR 1.926; 95% CI: 1.779-2.086, p < 0.001), stillbirth (aOR 1.644; 95% CI: 1.352-2.000, p < 0.001), and preterm labor (aOR 1.702; 95% CI: 1.574-1.841, p < 0.001). Patients with RA, SS, and SLE experience varying degrees of complications. CONCLUSION Our study shows that pregnant patients with autoimmune CTDs have worse maternal and fetal outcomes compared to those without CTDs. The rates of adverse outcomes varies among CTD subtypes. Comprehensive preconception counseling and tailored management strategies are essential for optimizing outcomes in these patients. Key Points • Increased Maternal Complications: Patients with autoimmune CTDs had significantly higher odds of maternal death, hypertensive disorders, acute kidney injury, blood transfusions, peripartum cardiomyopathy, sepsis, and ARDS. • Adverse Fetal Outcomes: Higher odds of small for gestational age fetuses, stillbirth, and preterm labor were observed in patients with CTDs compared to those without. • CTD Subtype Variations: Complication rates varied among CTD subtypes, with SLE, RA, and SSc each presenting varying risks and outcomes.
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Affiliation(s)
- Nada Alrifai
- Department of Rheumatology, Cooper University, Camden, NJ, USA
| | - Anushree Puttur
- Department of Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Fares Ghanem
- Department of Cardiovascular Disease, Southern Illinois University, Springfield, IL, USA
| | - Yadhu Dhital
- Department of Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Ahmad Jabri
- Department of Cardiovascular Disease, Henry Ford, Detroit, MI, USA
| | - Ahmad Al-Abdouh
- Department of Medicine, University of Kentucky, Lexington, KY, USA
| | - Laith Alhuneafat
- Division of Cardiology, University of Minnesota, Minneapolis, USA.
- Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, USA.
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14
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Dhital R, Baer RJ, Bandoli G, Chambers C. Cardiovascular Events During Pregnancy: Implications for Adverse Pregnancy Outcomes in Individuals With Autoimmune and Rheumatic Diseases. J Rheumatol 2025; 52:93-99. [PMID: 38879185 PMCID: PMC11693493 DOI: 10.3899/jrheum.2024-0306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2024] [Indexed: 06/27/2024]
Abstract
OBJECTIVE This study examined maternal cardiovascular (CV) events relative to adverse pregnancy outcomes (APOs) among individuals with autoimmune rheumatic diseases (ARDs), primary antiphospholipid syndrome (APS), and those with neither. METHODS Using a California population-based birth cohort (2005-2020), we identified those with CV events (CVEs), ARDs, and APS through International Classification of Diseases, 9th and 10th revisions, Clinical Modification codes in maternal discharge records. Selected APOs identified from birth certificates were preterm birth (PTB; < 37 weeks' gestation), small-for-gestational-age infants (SGA; birth weight < 10th percentile for age and sex), and a composite of either outcome. Adjusted risk ratios (aRRs) for adverse outcomes and their 95% CIs were calculated. RESULTS CVEs occurred more frequently in individuals with ARDs (265 of 19,340 [1.4%]) and primary APS (428 of 7758 [5.5%]) than those without (17,130 of 7,004,334 [0.3%]). The presence vs absence of CVEs was associated with a greater incidence of adverse outcomes in ARD (53.2% vs 26.6%), APS (30.6% vs 20.7%), and non-ARD/APS pregnancies (28.2% vs 15.2%). CVEs were associated with increased risks of SGA in all groups (aRRs 1.2-1.5) and PTB in ARD (aRR 1.6, 95% CI 1.3-2.0) and non-ARD/APS (aRR 1.7, 95% CI 1.7-1.8) pregnancies. CONCLUSION CVEs were associated with modestly increased risks (20-70%) for PTB, SGA, or both across the groups. Notably, > 50% of ARD pregnancies with CVEs experienced APOs. Given that ARD and APS pregnancies have higher (although still low) rates of CVEs and have higher baseline risks of APOs than the general population, the additional burden conferred by CVEs is clinically important.
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Affiliation(s)
- Rashmi Dhital
- R. Dhital, MD, Department of Medicine, Division of Rheumatology, Autoimmunity and Inflammation, School of Medicine, University of California San Diego, La Jolla, California, now with Department of Medicine, Division of Rheumatology & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee;
| | - Rebecca J Baer
- R.J. Baer, MPH, Department of Pediatrics, Division of Environmental Science and Health, School of Medicine, University of California San Diego, La Jolla, and the California Preterm Birth Initiative, University of California San Francisco, San Francisco, California
| | - Gretchen Bandoli
- G. Bandoli, PhD, C. Chambers, PhD, MPH, Department of Pediatrics, Division of Environmental Science and Health, School of Medicine, and Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Christina Chambers
- G. Bandoli, PhD, C. Chambers, PhD, MPH, Department of Pediatrics, Division of Environmental Science and Health, School of Medicine, and Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
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Ferreira AF, Araújo J, Azevedo MJ, Saraiva F, Diaz SO, Sousa C, Machado AP, Sampaio-Maia B, Ramalho C, Leite-Moreira AF, Barros AS, Santos M, Falcão-Pires I. Cardiovascular remodelling and reverse remodelling during pregnancy and postpartum: Looking at the right side. Pregnancy Hypertens 2024; 38:101171. [PMID: 39579686 DOI: 10.1016/j.preghy.2024.101171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Revised: 10/29/2024] [Accepted: 11/16/2024] [Indexed: 11/25/2024]
Abstract
BACKGROUND Considering the limited information available on right cardiac remodelling during gestation, we aimed to characterise the right cardiovascular (CV) remodelling and reverse remodelling (RR) induced by pregnancy and postpartum, respectively, and the impact of perinatal CV risk (CVR) factors on these processes. METHODS This prospective cohort was recruited at two tertiary centres during 2019-2022, including 51 healthy pregnant women and 79 with perinatal CVR factors. Participants were evaluated by transthoracic echocardiography during pregnancy (1st[1T] and 3rd[3T] trimesters) and postpartum (one-month[PP1], six-months[PP2], and one-year postpartum[PP3]). Generalised linear mixed-effects models were used for statistical analysis. RESULTS Similar enlargement of the right atrium (RA) and right ventricle (RV) dimensions was observed throughout pregnancy, normalising at PP2 values similar to PT1. This anatomical postpartum recovery was accompanied by an increase of RV global longitudinal strain, being statistically significant in perinatal CVR group. Interestingly, at 3T, this group revealed lower RV and RA strain compared to healthy participants. Despite both groups maintained preserved RV systolic function from 1T to PP3, a significant reduction of TAPSE and tricuspid S' velocity was observed at PP1. Concomitantly, all participants showed a significant increase of E/A at the same time-point, suggesting the recovery of diastolic deterioration seen from 1T to 3T that was persistingly higher in the perinatal CVR group througout the postpartum. Constant pulmonary artery systolic pressure (PASP) was documented throughout follow-up time, showing consistently higher values in the perinatal CVR group. All these echocardiographic index changes were within the normality range. CONCLUSION This study described subtle right cardiac changes within the normal/physiological range, recovering six-months after delivery. Coexisting perinatal CVR factors seem to affect the magnitude of RV diastolic function changes, PASP and myocardial deformation without any impact on other RV systolic function indexes.
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Affiliation(s)
- Ana Filipa Ferreira
- RISE-Health, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Joana Araújo
- RISE-Health, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Maria João Azevedo
- Faculdade de Medicina Dentária, University of Porto, Porto, Portugal; INEB - Instituto Nacional de Engenharia Biomédica, Porto, Portugal; i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal; Academic Center for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, the Netherlands
| | - Francisca Saraiva
- RISE-Health, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Sílvia O Diaz
- RISE-Health, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Carla Sousa
- RISE-Health, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Cardiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ana Paula Machado
- Obstetrics, Gynaecology and Pediatrics Department, Faculty of Medicine of the University of Porto, Portugal
| | - Benedita Sampaio-Maia
- Faculdade de Medicina Dentária, University of Porto, Porto, Portugal; INEB - Instituto Nacional de Engenharia Biomédica, Porto, Portugal; i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - Carla Ramalho
- Obstetrics Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Obstetrics, Gynaecology and Pediatrics Department, Faculty of Medicine of the University of Porto, Portugal; RISE-Health, Portugal
| | - Adelino F Leite-Moreira
- RISE-Health, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Cardiothoracic Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - António Sousa Barros
- RISE-Health, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Mário Santos
- RISE-Health, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Inês Falcão-Pires
- RISE-Health, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal.
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Rawat A, Vyas K. Exercise Intervention to Mitigate the Cardiovascular Sequence of Pregnancy Complications. Cureus 2024; 16:e75703. [PMID: 39807464 PMCID: PMC11728208 DOI: 10.7759/cureus.75703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2024] [Indexed: 01/16/2025] Open
Abstract
Pregnancy issues such as gestational hypertension, preeclampsia, and gestational diabetes mellitus (GDM) are significant contributors to long-term cardiovascular diseases (CVDs) in women. Recent research has proved the impact of exercise on improving cardiovascular outcomes, particularly in women with pregnancy-related disorders. This review explores the outcomes of various exercise interventions on cardiovascular health in pregnant women. Among these, aerobic exercise has been widely studied, with results from observational studies and randomized controlled trials (RCTs) showing its positive outcomes on cardiovascular health in pregnant women, especially with complications. It has been found that regular aerobic exercise has been associated with reduced hypertension and improved endothelial function, particularly in women with a history of preeclampsia. Evidently, aerobic exercise results in better blood pressure regulation and enhanced vascular health that directly attends to the risk of cardiovascular diseases associated with pregnancy complications. Another form of exercise is resistance training, which despite being studied less, has shown potential benefits as well. Some advantages of resistance exercise have been found to improve muscle strength and overall enhancement in metabolic control. This is important, especially in women with GDM whereby improvement in insulin sensitivity reduces the overall risk of type 2 diabetes and future CVDs. Combined exercise that incorporates both aerobic and resistance elements has been known to offer the most comprehensive benefits. Various studies suggest that a combinatory approach maximizes the positive cardiovascular effects. Practicing women have experienced better overall heart health, with improved blood pressure regulation, enhanced endothelial function, and reduced metabolic risks. However, despite these findings, there are challenges such as small sample sizes and limited follow-up durations that hinder the generalizability of current research. Importantly, previous studies targeting exercise interventions for women experiencing complications during pregnancy have been limited in evidence by small sample sizes, short follow-ups, and lack of diversity. Such broader, more diverse populations were needed to reflect the various health risks and responses to exercise. Future research must include multi-center RCTs, diverse exercise regimens, and digital health tools for monitoring exercise adherence. This warrants future large-scale, multicenter trials that are necessary to establish more definitive evidence. Additionally, clinicians should consider including tailored exercise programs in care plans for women with pregnancy complications to mitigate long-term cardiovascular risks.
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Affiliation(s)
- Anurag Rawat
- Interventional Cardiology, Himalayan Institute of Medical Sciences, Dehradun, IND
| | - Kinnari Vyas
- Plastic Surgery, Shri Guru Ram Rai Institute of Medical & Health Sciences, Dehradun, IND
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van der Bijl MF, Al-Hassany L, Wijtzes AI, Verdonk K, Duvekot JJ, Roeters van Lennep J. FUPEC study, a prospective open-cohort on severe pre-eclampsia and cardiovascular risk factors based in the Netherlands. BMJ Open 2024; 14:e093423. [PMID: 39532369 PMCID: PMC11574419 DOI: 10.1136/bmjopen-2024-093423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2024] Open
Abstract
PURPOSE The FUPEC (Follow-Up Pre-EClampsia) study aims to investigate the presence and development of cardiovascular risk factors, cardiovascular disease, as well as cardiovascular health following a pregnancy complicated by severe pre-eclampsia. PARTICIPANTS The FUPEC study is an open-cohort study conducted within routine care at the FUPEC clinic at Erasmus Medical Center in the Netherlands. This clinic is specifically designed for the cardiovascular follow-up of patients who have experienced severe pre-eclampsia. Women with a history of severe pre-eclampsia are invited to the FUPEC clinic at 6 weeks, 3 months, 1 year and every 2 years thereafter postpartum until they are 50 years of age. Clinical and biochemical data are routinely collected, encompassing pregnancy characteristics and outcomes, anthropometric measurements, cardiovascular risk factors, cardiovascular health scores, carotid intima-media thickness-including vascular age and ambulatory blood pressure measurements. Additionally, blood and urine samples are collected and stored in a biobank. FINDINGS TO DATE The first patient was enrolled in April 2011. As of March 2024, a total number of 1268 women have been enrolled in the FUPEC study, with an annual enrolment rate of 100-150 new patients. At inclusion, women had a median age of 33.5 years (IQR 30.1-37.9). At their first FUPEC visit, women were a median of 4.9 months (1.9-29.4) after delivery. At the first visit, the median body mass index was 25.7 (IQR 23.0-29.9) kg/m2, 23.4% of participants were using antihypertensive medication and 6.4% were smoking. Preliminary analyses of 24-hour blood pressure patterns and carotid intima-media thickness have previously been conducted on a subset of the cohort, with details provided in the 'Findings to Date' section. FUTURE PLANS The FUPEC cohort serves as a robust clinical data source and biobank that can be used for future studies and collaborative research answering, for example, questions on the aetiology, risk factors and short-term and long-term complications of pregnancies complicated by severe pre-eclampsia. Since the FUPEC cohort is integrated with routine care, there is no strict completion of data collection, allowing for flexible data acquisition.
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Affiliation(s)
- Marte F van der Bijl
- Internal Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Linda Al-Hassany
- Internal Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Anne I Wijtzes
- Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Koen Verdonk
- Internal Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Johannes J Duvekot
- Department of Obstetrics and Gynecology, Erasmus MC University Medical Center Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Jeanine Roeters van Lennep
- Internal Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
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18
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Mitro SD, Sundaram R, Grandi SM, Hinkle SN, Mills JL, Mendola P, Mumford SL, Qiao Y, Cifuentes A, Zhang C, Schisterman EF, Grantz KL. Cesarean delivery, labor duration, and mothers' mortality risk over 50 years of follow-up. Am J Obstet Gynecol MFM 2024; 6:101498. [PMID: 39305994 PMCID: PMC11563887 DOI: 10.1016/j.ajogmf.2024.101498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 08/13/2024] [Accepted: 08/23/2024] [Indexed: 10/10/2024]
Abstract
BACKGROUND Pregnancy complications have been recognized as a window to future health. Though cesarean delivery is common, it is unknown whether labor duration and mode of delivery are associated with maternal long-term mortality. OBJECTIVE To examine whether labor duration and mode of delivery were associated with all-cause and cause-specific mortality. STUDY DESIGN Participants were mothers from the multisite Collaborative Perinatal Project (CPP) cohort (1959-1966; n=43,646, limited to last CPP delivery). We ascertained all-cause and specific causes of death as of 2016 via linkage to the National Death Index and Social Security Death Master File. Hazard ratios (HR) testing mode of delivery and labor duration were estimated using Cox proportional hazards models adjusted for demographic and clinical characteristics. We further stratified analyses by parity. RESULTS Among participants with a recorded delivery mode, 5.9% (2486/42,335) had a cesarean delivery. Participants who had a cesarean were older (26.9 vs 24.3 years), with higher body mass index (24.0 vs 22.7 kg/m2), were less likely to be nulliparous (21% vs 30%), and more likely to have a household income of at least $6000 (22% vs 17%), to smoke ≥1 pack/d (18% vs 15%), to have diabetes mellitus (12% vs 1%) and to have a prior medical condition (47% vs 34%), compared to participants with a vaginal delivery. Delivery mode was similar by race/ethnicity, marital status, and education. Median labor duration was 395 minutes among participants who had an intrapartum cesarean delivery and 350 minutes among participants delivered vaginally. By 2016, 52.2% of participants with a cesarean delivery and 38.5% of participants with a vaginal delivery had died. Cesarean vs vaginal delivery was significantly associated with increased risk for all-cause mortality (HR=1.16 (95% confidence interval [CI]: 1.09, 1.23); in nulliparas, HR=1.27 (95% CI: 1.09, 1.47); in multiparas, HR=1.13 (95% CI: 1.06, 1.21) as well as increased risk of death from cardiovascular disease, diabetes, respiratory disease, infection, and kidney disease. Associations with death from cardiovascular disease, infection, and kidney disease were stronger for multiparas than nulliparas, though the association with death from diabetes was stronger among nulliparas. Labor duration was not significantly related to overall mortality. CONCLUSION In a historic United States cohort with a low cesarean delivery rate, cesarean delivery was an indicator for subsequent increased mortality risk, particularly related to cardiovascular disease and diabetes. Future studies with long-term follow-up are warranted given the current high prevalence of cesarean delivery.
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Affiliation(s)
- Susanna D Mitro
- Epidemiology Branch, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (Mitro, Mills, Qiao, Cifuentes, and Grantz); Kaiser Permanente Northern California Division of Research, Oakland, CA (Mitro)
| | - Rajeshwari Sundaram
- Biostatistics and Bioinformatics Branch, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (Sundaram)
| | - Sonia M Grandi
- Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, ON, Canada (Grandi); Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada (Grandi)
| | - Stefanie N Hinkle
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (Hinkle, Mumford, and Schisterman)
| | - James L Mills
- Epidemiology Branch, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (Mitro, Mills, Qiao, Cifuentes, and Grantz); Kaiser Permanente Northern California Division of Research, Oakland, CA (Mitro)
| | - Pauline Mendola
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY (Mendola)
| | - Sunni L Mumford
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (Hinkle, Mumford, and Schisterman)
| | - Yan Qiao
- Epidemiology Branch, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (Mitro, Mills, Qiao, Cifuentes, and Grantz); The Prospective Group, Inc., Fairfax, VA (Qiao and Cifuentes)
| | - Anokhi Cifuentes
- Epidemiology Branch, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (Mitro, Mills, Qiao, Cifuentes, and Grantz); The Prospective Group, Inc., Fairfax, VA (Qiao and Cifuentes)
| | - Cuilin Zhang
- Bia-Echo Asia Centre for Reproductive Longevity & Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore (Zhang); Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore (Zhang)
| | - Enrique F Schisterman
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (Hinkle, Mumford, and Schisterman)
| | - Katherine L Grantz
- Epidemiology Branch, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (Mitro, Mills, Qiao, Cifuentes, and Grantz); Kaiser Permanente Northern California Division of Research, Oakland, CA (Mitro).
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19
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Zhang F, Xie Z, Peng S, Jiang N, Li B, Chen B, Deng S, Yuan Y, Wu Q, Wen S, Tao Y, Ma J, Li S, Lin T, Wen F, Li Z, Huang R, Feng Z, He C, Wang W, Liang X, Xu L, Shen Y, Hong N, Xu R, Liu S. The risk factor for adverse pregnancy outcomes and its impact on clinical effect in IgA nephropathy: A retrospective observational study. Nephrology (Carlton) 2024; 29:729-737. [PMID: 39254037 DOI: 10.1111/nep.14387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 08/07/2024] [Accepted: 08/28/2024] [Indexed: 09/11/2024]
Abstract
AIM IgA nephropathy (IgAN) is the most common primary glomerular disease worldwide. Pregnant IgAN patients are more susceptible to adverse pregnancy outcomes (APO). However, the risk factor for APO and its effects on the long-term renal outcome of pregnant IgAN patients remained unclear. METHODS We performed a retrospective observational study covering 2003-2019 that included 44 female IgAN patients with pregnancy history to investigate the risk factor for APO and its impact on clinical outcome in IgAN. Renal function outcome and proteinuria remission were evaluated in pregnant IgAN women with and without APO. RESULTS In this retrospective and observational study, we found that patients with APO exhibited higher levels of serum creatinine and IgM, and lower haemoglobin levels while other clinical characteristics, pathological characteristics and therapy protocol had no significant difference. We found that anaemia and a higher level of serum IgM were independent risk factors for APO. IgAN pregnant women without APO experienced a higher proportion of proteinuria remission than those with APO, but there is no difference in the renal function outcome. CONCLUSION Pregnant IgAN patients with higher risks, including lower haemoglobin levels and higher IgM levels deserve intensive monitoring, and aggressive therapy to reduce proteinuria should be carried out in pregnant IgAN patients with APO.
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Affiliation(s)
- Fengxia Zhang
- Department of Nephrology, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Zhiyong Xie
- Department of Nephrology, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Siqi Peng
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Nan Jiang
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Bohou Li
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Boxi Chen
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Shuting Deng
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Ye Yuan
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Qiong Wu
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Sichun Wen
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yiming Tao
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Jianchao Ma
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Sijia Li
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Ting Lin
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Feng Wen
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Zhuo Li
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Renwei Huang
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Zhonglin Feng
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Chaosheng He
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Wenjian Wang
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Xinling Liang
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Lixia Xu
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yue Shen
- Department of Nephrology, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Niechao Hong
- Department of Nephrology, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Ruiquan Xu
- Department of Urology, First Affifiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Shuangxin Liu
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
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Essington R, Pudwell J, Retnakaran R, Smith GN. Antenatal Glycemic Management and Postpartum Cardiovascular Disease Risk Screening. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102561. [PMID: 38844259 DOI: 10.1016/j.jogc.2024.102561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 04/22/2024] [Accepted: 04/25/2024] [Indexed: 09/29/2024]
Abstract
OBJECTIVES This study aims to evaluate the cardiovascular disease (CVD) risk profiles of patients referred to the Maternal Health Clinic (MHC) with a history of gestational diabetes mellitus (GDM). METHODS Eligible patients had their MHC appointment at 6 months postpartum between November 2011 and May 2022 and experienced GDM in their most recent pregnancy. Included participants were then divided into subgroups comparing methods of glycemic control: diet-controlled GDM and insulin-controlled GDM. Additionally, the MHC recruited 47 patients who have not experienced a complication in pregnancy to act as a comparator group in research studies. Demographics, medical and pregnancy history, and CVD risk scores were compared between the 3 groups. RESULTS In total, 344 patients with GDM were included in the analysis; 165 were insulin-controlled and 179 diet-controlled. When measuring the median 30-year Framingham risk score based on both BMI and lipids, there was a significant stepwise increase seen from the unexposed group, the diet-controlled GDM, and the insulin-controlled groups, respectively (all P < 0.05). The presence of metabolic syndrome showed a stepwise increase in prevalence when comparing the unexposed group, diet-exposure group, and the insulin-exposure group, respectively (16.7%; 21.5%-44.8%, P < 0.05). CONCLUSIONS Our findings reinforce the prevalence of maternal CVD risk among GDM-diagnosed patients in the postpartum period and the necessity for screening. More specifically, our findings show how CVD risk may differ based on required interventions for glycemic control throughout pregnancy. Future research should aim to compare a more diverse patient population to optimise the generalizability of glycemic control-specific CVD outcomes.
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Affiliation(s)
- Rylie Essington
- Queen's University School of Medicine, Kingston Health Sciences Centre, Kingston, ON
| | - Jessica Pudwell
- Department of Obstetrics and Gynaecology, Queen's University, Kingston Health Sciences Centre, Kingston, ON
| | - Ravi Retnakaran
- Department of Medicine, University of Toronto, Toronto, ON; Leadership Sinai Centre for Diabetes, Toronto, ON
| | - Graeme N Smith
- Queen's University School of Medicine, Kingston Health Sciences Centre, Kingston, ON.
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21
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Latt SM, Opondo C, Alderdice F, Kurinczuk JJ, Rowe R. Postpartum haemorrhage and risk of cardiovascular disease in later life: A population-based record linkage cohort study. BJOG 2024; 131:1705-1714. [PMID: 38946538 DOI: 10.1111/1471-0528.17896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/04/2024] [Accepted: 06/12/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVE To investigate the association between postpartum haemorrhage (PPH) and subsequent cardiovascular disease. DESIGN Population-based retrospective cohort study, using record linkage between Aberdeen Maternity and Neonatal Databank (AMND) and Scottish healthcare data sets. SETTING Grampian region, Scotland. POPULATION A cohort of 70 904 women who gave birth after 24 weeks of gestation in the period 1986-2016. METHODS We used extended Cox regression models to investigate the association between having had one or more occurrences of PPH in any (first or subsequent) births (exposure) and subsequent cardiovascular disease, adjusted for sociodemographic, medical, and pregnancy and birth-related factors. MAIN OUTCOME MEASURES Cardiovascular disease identified from the prescription of selected cardiovascular medications, hospital discharge records or death from cardiovascular disease. RESULTS In our cohort of 70 904 women (with 124 795 birth records), 25 177 women (36%) had at least one PPH. Compared with not having a PPH, having at least one PPH was associated with an increased risk of developing cardiovascular disease, as defined above, in the first year after birth (adjusted hazard ratio, aHR 1.96; 95% confidence interval, 95% CI 1.51-2.53; p < 0.001). The association was attenuated over time, but strong evidence of increased risk remained at 2-5 years (aHR 1.19, 95% CI 1.11-1.30, P < 0.001) and at 6-15 years after giving birth (aHR 1.17, 95% CI 1.05-1.30, p = 0.005). CONCLUSIONS Compared with women who have never had a PPH, women who have had at least one episode of PPH are twice as likely to develop cardiovascular disease in the first year after birth, and some increased risk persists for up to 15 years.
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Affiliation(s)
- Su Mon Latt
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Charles Opondo
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Fiona Alderdice
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rachel Rowe
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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22
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Patel M, Battarbee AN, Refuerzo JS, Zork N, Eichelberger K, Ramos GA, Olson G, Durnwald C, Landon MB, Aagaard KM, Wallace K, Scifres C, Rosen T, Mulla W, Valent A, Longo S, Boggess KA. Association Between Metformin Use in Early Gestational or Type 2 Diabetes in Pregnancy and Preterm Preeclampsia. Obstet Gynecol 2024; 144:733-739. [PMID: 39236318 PMCID: PMC11575948 DOI: 10.1097/aog.0000000000005720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 07/25/2024] [Indexed: 09/07/2024]
Abstract
OBJECTIVE To estimate the association between maternal metformin use for the treatment of early gestational or pre-existing type 2 diabetes and preterm preeclampsia. METHODS This is a planned secondary analysis of the MOMPOD study (Medical Optimization of Management of Overt Type 2 Diabetes in Pregnancy), a randomized trial comparing the effect of adding metformin with insulin treatment on composite neonatal outcome in singleton pregnancies with early gestational or type 2 diabetes. Participants were randomized at 11-23 weeks of gestation to 1,000 mg metformin twice daily or placebo until delivery. A subset of participants had maternal blood collected at 24-30 weeks of gestation, and serum soluble endoglin, apolipoprotein B, vascular cell adhesion molecule-1, soluble fms-like tyrosine kinase 1, placental growth factor, high-sensitivity C-reactive protein, adiponectin, and vascular endothelial growth factor levels were measured. Our primary outcome was preterm preeclampsia , defined as preeclampsia requiring delivery before 37 weeks of gestation. Secondary outcomes included preterm preeclampsia requiring delivery before 34 weeks of gestation and differences in serum biomarkers. Multivariable regression analysis was used to estimate the associations between metformin use and primary or secondary study outcomes. RESULTS Of 831 participants, 119 (14.3%) developed preeclampsia requiring delivery before 37 weeks of gestation: 57 of 416 (13.7%) in the placebo group and 62 of 415 (14.9%) in the metformin group. Thirty-seven (4.4%) developed preeclampsia requiring delivery before 34 weeks of gestation: 15 (3.6%) receiving placebo and 22 (5.3%) receiving metformin. Compared with placebo, metformin was not associated with a significant difference in the occurrence of preeclampsia before 37 weeks of gestation (adjusted odds ratio [aOR] 1.04, 95% CI, 0.70-1.56) or before 34 weeks (aOR 1.43, 95% CI, 0.73-2.81). Similarly, there was no association between maternal metformin use and serum biomarker levels. CONCLUSION Among parturients with early gestational or pre-existing type 2 diabetes, the addition of metformin to insulin was not associated with lower odds of preterm preeclampsia or with serum biomarkers associated with cardiovascular disease risk.
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Affiliation(s)
- Maya Patel
- University of North Carolina at Chapel Hill School of Medicine Chapel Hill, NC USA
| | - Ashley N. Battarbee
- University of Alabama at Birmingham Heersink School of Medicine Birmingham, AL USA
| | - Jerrie S. Refuerzo
- University of Texas Health Houston McGovern Medical School Houston, TX USA
| | - Noelia Zork
- Columbia University Irving Medical Center, New York, NY USA
| | - Kacey Eichelberger
- University of South Carolina School of Medicine Greenville/Prisma Health-Upstate Greenville, SC USA
| | | | - Gayle Olson
- University of Texas Medical Branch Galveston Galveston, TX USA
| | - Celeste Durnwald
- University of Pennsylvania Perelman School of Medicine Philadelphia, PA USA
| | - Mark B. Landon
- Ohio State University College of Medicine and Wexner Medical Center Columbus, OH USA
| | - Kjersti M. Aagaard
- Baylor College of Medicine and Texas Children’s Hospital Houston, TX USA
| | - Kedra Wallace
- University of Mississippi Medical Center Jackson, MS USA
| | | | - Todd Rosen
- Rutgers Health/Robert Wood Johnson Medical School New Brunswick, NJ USA
| | - Wadia Mulla
- Temple University Lewis Katz School of Medicine Philadelphia, PA USA
| | - Amy Valent
- Oregon Health & Science University Portland, OR USA
| | | | - Kim A. Boggess
- University of North Carolina at Chapel Hill School of Medicine Chapel Hill, NC USA
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23
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Unger E, Makarova N, Borof K, Schlieker P, Reinbold CV, Aarabi G, Blankenberg S, Magnussen C, Behrendt CA, Zyriax BC, Schnabel RB. Association of adverse pregnancy outcomes with cardiovascular risk profiles in later life: Current insights from the Hamburg City Health Study (HCHS). Atherosclerosis 2024; 396:118526. [PMID: 39133970 DOI: 10.1016/j.atherosclerosis.2024.118526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 05/09/2024] [Accepted: 06/18/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND AND AIMS Adverse pregnancy outcomes (APO) have been related to increased cardiovascular (CV) risk and mortality in later life. Underlying pathomechanisms for the development of CV disease in these women are not yet fully understood. In this study, we aimed to investigate the relationship between APO and individual CV risk profiles in later life. METHODS We used cross-sectional data from 10,000 participants enrolled in the Hamburg City Health Study (HCHS). We analysed self-reported APO, CV risk factors and health status, including biomarkers, electrocardiogram, echocardiography and vascular ultrasound. To examine associations, Wilcoxon rank sum test and Pearson's χ2-test were performed. Multivariable-adjusted regression models were calculated to determine associations. RESULTS N = 1970 women who reported pregnancies were included. Median age was 63 years, 8.7 % reported gestational hypertension (gHTN), 18 % excessive weight gain and 2.4 % gestational diabetes. Ten percent had delivered newborns with birth weight <2.5 kg, 14 % newborns with birth weight >4 kg. In multivariable-adjusted models, significant associations between APO, CV risk profiles and cardiac remodeling were identified. gHTN correlated with higher body mass index (BMI) (Beta 1.68, CI 95 % 0.86-2.50; p < 0.001), hypertension (OR 4.58, CI 95 % 2.79-7.86; p < 0.001), left ventricular remodeling (e.g. left ventricular mass index (Beta 4.46, CI 95 % 1.05-7.87; p = 0.010)) and myocardial infarction (OR 3.27, CI 95 % 0.94-10.07; p = 0.046). CONCLUSIONS In this population-based sample, APO were associated with CV risk profiles and cardiac remodeling in later life, suggesting early manifestations of future CV risk during pregnancy. Prospective data is needed for individual risk stratification in women with APO.
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Affiliation(s)
- Elisabeth Unger
- Department of Cardiology, University Heart & Vascular Center Hamburg-Eppendorf, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Luebeck/Kiel, Germany
| | - Nataliya Makarova
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Luebeck/Kiel, Germany; Midwifery Science - Health Services Research and Prevention, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Katrin Borof
- Department of Periodontics, Preventive and Restorative Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Patricia Schlieker
- Department of Cardiology, University Heart & Vascular Center Hamburg-Eppendorf, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Carla V Reinbold
- Department of Cardiology, University Heart & Vascular Center Hamburg-Eppendorf, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Luebeck/Kiel, Germany
| | - Ghazal Aarabi
- Department of Periodontics, Preventive and Restorative Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart & Vascular Center Hamburg-Eppendorf, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Luebeck/Kiel, Germany
| | - Christina Magnussen
- Department of Cardiology, University Heart & Vascular Center Hamburg-Eppendorf, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Luebeck/Kiel, Germany; Center for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Birgit-Christiane Zyriax
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Luebeck/Kiel, Germany; Midwifery Science - Health Services Research and Prevention, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
| | - Renate B Schnabel
- Department of Cardiology, University Heart & Vascular Center Hamburg-Eppendorf, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Luebeck/Kiel, Germany
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Oken E. Eager to improve women's cardiovascular health. Paediatr Perinat Epidemiol 2024; 38:581-582. [PMID: 39054737 PMCID: PMC11427150 DOI: 10.1111/ppe.13104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 07/06/2024] [Indexed: 07/27/2024]
Affiliation(s)
- Emily Oken
- Harvard Medical School and Harvard Pilgrim Health Care Institute
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Bodnar LM, Jin Q, Naimi AI, Simhan HN, Catov JM, Parisi SM, Kirkpatrick SI. Periconceptional Dietary Quality and Metabolic Syndrome at 3 Years Postpartum. J Am Heart Assoc 2024; 13:e035555. [PMID: 39158564 PMCID: PMC11963925 DOI: 10.1161/jaha.124.035555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 07/22/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND The period around pregnancy is a critical window in the primordial prevention of cardiovascular disease, but little is known about the role of dietary patterns in cardiometabolic health. Our objective was to determine the association between alignment of periconceptional diet with the 2020 to 2025 Dietary Guidelines for Americans and the risk of metabolic syndrome. METHODS AND RESULTS We used data from the Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-Be Heart Health Study, a pregnancy cohort study that followed pregnant participants to a median of 3 years postpartum (n=4423). Usual dietary intake in the 3 months around conception was estimated from a Food Frequency Questionnaire. Alignment with the Dietary Guidelines was measured using the Healthy Eating Index-2020, where higher scores represent greater alignment. Postpartum metabolic syndrome was defined using the American Heart Association/National Heart, Lung, and Blood Institute guideline. The prevalence of metabolic syndrome at 3 years postpartum was 20%. After adjusting for confounders, the prevalence of metabolic syndrome was flat up to a periconceptional Healthy Eating Index-2020 total score of ≈60, and then declined steeply as scores increased. Compared with a Healthy Eating Index-2020 score of 60, having scores of 70, 80, and 90 were associated with 2, 4, and 7 fewer cases of metabolic syndrome per 100 individuals, respectively (prevalence differences: -0.02 [95% CI, -0.03, 0]; -0.04 [-0.08, -0.1]; -0.07 [-0.13, -0.02]). CONCLUSIONS Dietary interventions around conception and systems-level changes to support high diet quality may be important for improving postpartum cardiometabolic health, and helping to reverse or slow the decline in women's cardiometabolic health.
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Affiliation(s)
- Lisa M. Bodnar
- Department of Epidemiology, School of Public HealthUniversity of PittsburghPittsburghPA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of MedicineUniversity of PittsburghPittsburghPA
| | - Qianhui Jin
- Department of Epidemiology, School of Public HealthUniversity of PittsburghPittsburghPA
| | - Ashley I. Naimi
- Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaGA
| | - Hyagriv N. Simhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of MedicineUniversity of PittsburghPittsburghPA
| | - Janet M. Catov
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of MedicineUniversity of PittsburghPittsburghPA
| | - Sara M. Parisi
- Department of Epidemiology, School of Public HealthUniversity of PittsburghPittsburghPA
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Stuart JJ, Skurnik G, Roche AT, Tsigas E, Rich-Edwards JW, Seely EW. Accuracy of Maternal Self-Report of Recent Preeclampsia Among Healthy Women. J Womens Health (Larchmt) 2024; 33:1072-1079. [PMID: 38551220 PMCID: PMC11564672 DOI: 10.1089/jwh.2023.0930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Abstract
Background: Preeclampsia history signals a higher risk for cardiovascular disease, but its value as a risk marker relies primarily on self-report. To identify the accuracy of maternal self-reports of recent preeclampsia, we conducted a validation study among women recruited to a web-based trial. Methods: Women with preeclampsia in the past 5 years were recruited to Heart Health 4 Moms. Preeclampsia was self-reported through an online recruitment questionnaire and affirmed via phone screen. Accuracy of maternal self-report was quantified using positive predictive value (PPV) versus medical record evidence of preeclampsia using three definitions: (1) documentation of clinician diagnosis, (2) American College of Obstetricians and Gynecologists (ACOG) 2002 diagnostic criteria (gestational hypertension and proteinuria), and (3) ACOG 2013 diagnostic criteria (gestational hypertension and proteinuria or systemic symptoms). Results: Complete medical records were received for 290 women who delivered from 2011 to 2016 and were predominantly non-Hispanic White (81.7%) with a mean age of 31.2 ± 4.8 years. Mean length of recall was 13.6 ± 14.7 months. The majority of women (92.1%) had medical record evidence of preeclampsia using ≥1 of the definitions. Maternal self-report of preeclampsia was validated for 88.3% based on clinician diagnosis, 59.0% with ACOG 2002, and 65.2% with ACOG 2013. Conclusions: In this validation study of U.S. women, the majority accurately self-reported their preeclampsia diagnosis based on medical record review. A higher proportion of self-reports validated by clinician diagnosis than ACOG criteria, suggesting women remember the diagnosis given by their provider and providers may not always follow or document criteria when making a diagnosis.
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Affiliation(s)
- Jennifer J. Stuart
- Division of Women’s Health, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Geraldine Skurnik
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Andrea T. Roche
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Eleni Tsigas
- Preeclampsia Foundation, Melbourne, Florida, USA
| | - Janet W. Rich-Edwards
- Division of Women’s Health, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ellen W. Seely
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Wu LX, Jin M, Yang J. Status, outcome, and related factors of postpartum hypertension in the Shanghai community. World J Clin Cases 2024; 12:4632-4641. [PMID: 39070825 PMCID: PMC11235491 DOI: 10.12998/wjcc.v12.i21.4632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/23/2024] [Accepted: 06/11/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Postpartum hypertension poses a considerable health risk. Despite research on gestational hypertension, comprehensive studies focusing on postpartum hy-pertension in communities are limited. Understanding its prevalence and associated risk factors is crucial for effective prevention and management. AIM To provide insights for postpartum hypertension's prevention and management. METHODS In total, 3297 women who gave birth between June 2021 and December 2022 in Xuhui District, Shanghai were selected. Blood pressure was measured thrice within one month post-delivery during home visits. Eighty-six women with hypertension were followed up for four months to analyze hypertension per-sistence and its related risk factors. A predictive model for persistent postpartum hypertension was established and verified using the Nomo diagram model. RESULTS Hypertension prevalence 1 month post-delivery was 2.61% (86/3297). Among the 86 pregnant women, 32 (37.21 %) had persistent hypertension at four months post-delivery. Multivariate logistic regression analysis revealed that older age [odds ratio (OR) = 1.212; 95% confidence interval (CI): 1.065-1.380] and higher pre-pregnancy body mass index (BMI) (OR = 1.188; 95%CI: 1.006-1.404) were associated with hypertension (OR = 10.781; 95%CI: 1.006-1.404) during pregnancy. A 95%CI of 1.243-93.480 is a risk factor for persistent postpartum hypertension. The Nomograph model accurately predicted the risk of persistent postpartum hypertension, demonstrating high precision. CONCLUSION In Xuhui, older age, higher pre-pregnancy BMI, and gestational hypertension are risk factors for persistent postpartum hypertension. Our prediction model can identify high-risk individuals, thereby improving patient quality of life.
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Affiliation(s)
- Ling-Xia Wu
- Department of Women's Health, Xuhui District Maternal and Child Health Hospital, Shanghai 200235, China
| | - Man Jin
- Department of Women's Health, Xuhui District Maternal and Child Health Hospital, Shanghai 200235, China
| | - Jian Yang
- Department of Women's Health, Xuhui District Maternal and Child Health Hospital, Shanghai 200235, China
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Root AL, Crossley NP, Heck JL, McCage S, Proulx J, Jones EJ. Effects of Mindfulness-Based Interventions on Cardiometabolic-Related Adverse Pregnancy Outcomes: A Systematic Review. J Cardiovasc Nurs 2024; 39:335-346. [PMID: 37878581 DOI: 10.1097/jcn.0000000000001054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
BACKGROUND Growing evidence suggests maternal stress contributes to the development of adverse pregnancy outcomes that are associated with cardiovascular and cardiometabolic risk in birthing persons. Mindfulness-based interventions may positively affect psychological stress in pregnancy and, in turn, reduce stress. However, few study authors have examined the effects of mindfulness-based interventions on adverse pregnancy outcomes that heighten cardiovascular risk. OBJECTIVE The aim of this study was to appraise available literature examining the effects of mindfulness-based interventions delivered during pregnancy on adverse pregnancy outcomes associated with future cardiovascular and cardiometabolic disease risk. METHODS In this systematic review, multiple electronic databases were searched using major keywords, including "mindfulness-based intervention," "pregnancy," "preterm delivery," "gestational diabetes," "small for gestational age," "preeclampsia," and "hypertension in pregnancy" during February 2023. RESULTS Six studies using mindfulness-based interventions during pregnancy were included. The review indicated that these interventions were largely effective at reducing prenatal stress; however, the overall effects of interventions were mixed concerning their impact on pregnancy complications. Study authors examining the effects on gestational diabetes-related outcomes reported significant improvements in blood glucose levels, hemoglobin A 1c , and oral glucose tolerance. Outcomes were mixed or inconclusive related to the effects of interventions on the incidence of preterm birth, birth of a small-for-gestational-age newborn, and preeclampsia. CONCLUSIONS Mitigating cardiovascular and cardiometabolic risk-associated adverse pregnancy outcomes through mindfulness-based approaches may represent an emerging field of study. The few studies and limited, mixed findings synthesized in this review indicate that high-validity studies are warranted to examine the effects of mindfulness-based interventions on pregnancy complications that contribute to cardiovascular-related maternal morbidity and suboptimal life course health for diverse birthing persons.
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Arvizu M, Wang S, Mitsunami M, Mínguez-Alarcón L, Gaskins AJ, Rosner B, Rich-Edwards JW, Chavarro JE. BMI status and weight trajectories across females' reproductive years and risk of adverse pregnancy outcomes: a prospective cohort study. Am J Clin Nutr 2024; 120:225-231. [PMID: 38777663 PMCID: PMC11251209 DOI: 10.1016/j.ajcnut.2024.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 04/08/2024] [Accepted: 04/24/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Prepregnancy body mass index (BMI) is a well-established risk factor of adverse pregnancy outcomes (APOs). The associations of long-term and short-term weight trajectories with APOs are less clear. OBJECTIVES This study aimed to determine the associations of weight trajectories during females' reproductive years, before and between pregnancies, with risk of APOs. METHODS We followed 16,241 females (25,386 singleton pregnancies) participating in a prospective cohort, the Nurses' Health Study II. Weight at age 18 y, current weight, and height were assessed at baseline (1989), and weight was updated biennially. Pregnancy history was self-reported in 2009. The primary outcome was a composite of hypertensive disorders of pregnancy (HDP), gestational diabetes (GDM), preterm birth, and stillbirth. Secondary outcomes were individual APOs. The associations of weight change with APOs were estimated using log-binomial regression, adjusting for demographic, lifestyle, reproductive factors, and baseline BMI (in kg/m2). RESULTS The mean (standard deviation [SD]) age at first in-study pregnancy was 33.7 (4.1) y. The mean (SD) time from age 18 y to pregnancy, baseline to pregnancy, and between pregnancies was 16.3 (4.0), 6.1 (3.0), and 2.9 (1.6) y, with a corresponding weight change of 6.4 (9.1), 3.1 (5.8), and 2.3 (4.8) kg, respectively. Of the pregnancies, 4628 (18.2%) were complicated by ≥1 APOs. Absolute weight change since age 18 y was most strongly associated with APOs. Compared with females whose weight remained stable (0-2 kg) since age 18, females who gained >2 kg had higher risk of APO (2.1-9.9 kg, relative risk [RR]: 1.12; 95% confidence interval [CI]: 1.02, 1.23; 10.0-14.9 kg, RR: 1.43; 95% CI: 1.29, 1.60; ≥15 kg, RR: 1.87; 95% CI: 1.69, 2.08), primarily driven by HDP and GDM. The associations of per 1 kg weight gain before and between pregnancies with HDP were nearly identical. CONCLUSIONS Weight trajectories prior to and between pregnancies were associated with the risk of APOs, particularly HDP. Longer periods of weight gain, corresponding to greater absolute weight gain, were most strongly associated with higher risk of APOs.
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Affiliation(s)
- Mariel Arvizu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Siwen Wang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Makiko Mitsunami
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Lidia Mínguez-Alarcón
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Audrey J Gaskins
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Bernard Rosner
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Janet W Rich-Edwards
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Jorge E Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
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Hill AV, Balascio P, Moore M, Blackmon B, Alston T, Anto-Ocrah M. Black Father's Influence on Adverse Pregnancy Outcomes in the United States: A Narrative Synthesis of Literature. Am J Mens Health 2024; 18:15579883241266466. [PMID: 39066606 PMCID: PMC11282517 DOI: 10.1177/15579883241266466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/12/2024] [Accepted: 06/14/2024] [Indexed: 07/28/2024] Open
Abstract
Few studies have investigated paternal characteristics in relationship with adverse pregnancy outcomes, and results are inconsistent. The purpose of this study was to review studies examining associations between characteristics of Black fathers and adverse pregnancy outcomes in the United States. A systematic narrative synthesis was conducted of research studies examining paternal characteristics of Black fathers in association with adverse pregnancy outcomes: preterm birth, hypertensive disorders of pregnancy, gestational diabetes, spontaneous abortion, and maternal mortality. Seven databases (Academic Search Premier, CINHAL, CENTRAL, ClinicalTrials.gov, Embase, PubMed, and Web of Science) were searched for original research articles from inception to February 2023. Articles were excluded if they (a) were in a language other than English, (b) did not describe original research, (c) included a geographic region outside of the United States, (d) did not include adverse maternal outcomes as a study outcome, (e) did not describe race of fathers in the study sample, and (f) did not describe a paternal characteristic of Black fathers. The search resulted in 210 articles. Six studies were included in the final review; five studies examined associations between paternal characteristics of Black fathers and preterm birth, finding significantly increased odds of preterm birth among births with Black fathers. Among births with non-Hispanic Black paternity, the odds of hypertensive disorders of pregnancy were reduced or not significantly associated. Researchers should continue to explore paternal factors that influence pregnancy outcomes in racial/ethnic-specific models to identify optimal intervention strategies to improve disparities in maternal and child health outcomes.
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Affiliation(s)
- Ashley V. Hill
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Phoebe Balascio
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mikaela Moore
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brandi Blackmon
- Department of Physician Assistant Studies, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tasha Alston
- Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Martina Anto-Ocrah
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Crump C, Sundquist J, Sundquist K. Adverse Pregnancy Outcomes and Long-Term Mortality in Women. JAMA Intern Med 2024; 184:631-640. [PMID: 38619848 PMCID: PMC11019441 DOI: 10.1001/jamainternmed.2024.0276] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/18/2024] [Indexed: 04/16/2024]
Abstract
Importance Women with adverse pregnancy outcomes, such as preterm delivery or preeclampsia, have higher future risks of cardiometabolic disorders; however, little is known about their long-term mortality risks. A better understanding of such risks is needed to facilitate early identification of high-risk women and preventive actions. Objective To determine long-term mortality risks associated with 5 major adverse pregnancy outcomes in a large population-based cohort of women. Design, Setting, and Participants This national cohort study in Sweden used the Swedish Medical Birth Register, containing prenatal and birth information for nearly all deliveries in Sweden since 1973, to identify women who had a singleton delivery during 1973 to 2015. All 2 195 667 such women with information for pregnancy duration and infant birth weight were included in the study. Data were analyzed from March to September 2023. Exposure Adverse pregnancy outcomes (preterm delivery, small for gestational age, preeclampsia, other hypertensive disorders, and gestational diabetes), identified from nationwide birth records. Main Outcome and Measures All-cause and cause-specific mortality through December 31, 2018. Cox regression was used to compute hazard ratios (HRs) for mortality associated with specific adverse pregnancy outcomes, adjusted for other maternal factors. Cosibling analyses assessed for confounding by shared familial (genetic or environmental) factors. Results In 56 million person-years of follow-up to a median (IQR) age of 52 (42-61) years, 88 055 women (4%) died (median [IQR] age at death, 59 [50-67] years). All 5 adverse pregnancy outcomes were independently associated with increased mortality. Across the entire follow-up (≤46 years after delivery), adjusted HRs for all-cause mortality associated with specific adverse pregnancy outcomes were as follows: gestational diabetes, 1.52 (95% CI, 1.46-1.58); preterm delivery, 1.41 (95% CI, 1.37-1.44); small for gestational age, 1.30 (95% CI, 1.28-1.32); other hypertensive disorders, 1.27 (95% CI, 1.19-1.37); and preeclampsia, 1.13 (95% CI, 1.10-1.16). All HRs remained significantly elevated even 30 to 46 years after delivery. These effect sizes were only partially (0%-45%) reduced after controlling for shared familial factors in cosibling analyses. Women who experienced multiple adverse pregnancy outcomes had further increases in risk. Several major causes of death were identified, including cardiovascular and respiratory disorders and diabetes. Conclusions and Relevance In this large national cohort study, women who experienced any of 5 major adverse pregnancy outcomes had increased mortality risks that remained elevated more than 40 years later. Women with adverse pregnancy outcomes need early preventive evaluation and long-term follow-up for detection and treatment of chronic disorders associated with premature mortality.
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Affiliation(s)
- Casey Crump
- Department of Family and Community Medicine, McGovern Medical School, The University of Texas Health Science Center, Houston
- Department of Epidemiology, School of Public Health, The University of Texas Health Science Center, Houston
| | - Jan Sundquist
- Department of Clinical Sciences, Lund University, Malmö, Sweden
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Ackerman-Banks CM, Palmsten K, Lipkind HS, Ahrens KA. Association between gestational diabetes and cardiovascular disease within 24 months postpartum. Am J Obstet Gynecol MFM 2024; 6:101366. [PMID: 38580094 DOI: 10.1016/j.ajogmf.2024.101366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 03/15/2024] [Accepted: 04/01/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Cardiovascular disease is the leading cause of death among women in the United States. It is well established that gestational diabetes mellitus is associated with an overall lifetime increased risk of cardiometabolic disease, even among those without intercurrent type 2 diabetes. However, the association between gestational diabetes mellitus and short-term risk of cardiovascular disease is unclear. Establishing short-term risks of cardiovascular disease for patients with gestational diabetes mellitus has significant potential to inform early screening and targeted intervention strategies to reduce premature cardiovascular morbidity among women. OBJECTIVE This study aimed to compare the risk of cardiovascular disease diagnosis in the first 24 months postpartum between patients with and without gestational diabetes mellitus. STUDY DESIGN Our longitudinal population-based study included pregnant individuals with deliveries from 2007 to 2019 in the Maine Health Data Organization's All Payer Claims Database. We excluded records with gestational age <20 weeks, non-Maine residence, multifetal gestation, no insurance in the month of delivery or the 3 months before pregnancy, an implausibly short interval until next pregnancy (<60 days), pregestational diabetes mellitus, and any prepregnancy diagnosis of the cardiovascular conditions being examined postpartum. Gestational diabetes mellitus and cardiovascular disease (heart failure, ischemic heart disease, arrhythmia/cardiac arrest, cardiomyopathy, cerebrovascular disease/stroke, and new chronic hypertension) were identified by International Classification of Diseases 9/10 diagnosis codes. Cox proportional hazards models were used to estimate hazard ratios, adjusting for potential confounding factors. We assessed whether the association between gestational diabetes mellitus and chronic hypertension was mediated by intercurrent diabetes mellitus. RESULTS Among the 84,746 pregnancies examined, the cumulative risk of cardiovascular disease within 24 months postpartum for those with vs without gestational diabetes mellitus was 0.13% vs 0.20% for heart failure, 0.16% vs 0.14% for ischemic heart disease, 0.60% vs 0.44% for cerebrovascular disease/stroke, 0.22% vs 0.16% for arrhythmia/cardiac arrest, 0.20% vs 0.20% for cardiomyopathy, and 4.19% vs 1.83% for new chronic hypertension. After adjusting for potential confounders, those with gestational diabetes had an increased risk of new chronic hypertension (adjusted hazard ratio, 1.56; 95% confidence interval, 1.32-1.86) within the first 24 months postpartum compared with those without gestational diabetes. There was no association between gestational diabetes and ischemic heart disease (adjusted hazard ratio, 0.75; 95% confidence interval, 0.34-1.65), cerebrovascular disease/stroke (adjusted hazard ratio, 1.13; 95% confidence interval, 0.78-1.66), arrhythmia/cardiac arrest (adjusted hazard ratio, 1.16; 95% confidence interval, 0.59-2.29), or cardiomyopathy (adjusted hazard ratio, 0.75; 95% confidence interval, 0.40-1.41) within the first 24 months postpartum. Those with gestational diabetes appeared to have a decreased risk of heart failure within 24 months postpartum (adjusted hazard ratio, 0.45; 95% confidence interval, 0.21-0.98). Our mediation analyses estimated that 28% of the effect of gestational diabetes on new chronic hypertension was mediated through intercurrent diabetes mellitus. CONCLUSION Patients with gestational diabetes mellitus have a significantly increased risk of new chronic hypertension as early as 24 months postpartum. Most of this effect was not due to the development of diabetes mellitus. Our findings suggest that all women with gestational diabetes need careful monitoring and screening for new chronic hypertension in the first 2 years postpartum.
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Affiliation(s)
| | - Kristin Palmsten
- Pregnancy and Child Health Research Center, HealthPartners Institute, Minneapolis, MN (Dr Palmsten)
| | - Heather S Lipkind
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York City, NY (Dr Lipkind)
| | - Katherine A Ahrens
- Muskie School of Public Service, University of Southern Maine, Portland, ME (Dr Ahrens)
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Everett BG, Philbin MM, Homan P. Structural heteropatriarchy and maternal cardiovascular morbidities. Soc Sci Med 2024; 351:116434. [PMID: 38825374 PMCID: PMC11149902 DOI: 10.1016/j.socscimed.2023.116434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 11/04/2023] [Accepted: 11/13/2023] [Indexed: 06/04/2024]
Abstract
The United States has some of the poorest maternal health outcomes of any developed nation. Existing research on maternal cardiovascular morbidities has focused predominantly on individual- and clinic-level drivers, but we know little about community- and structural-level factors that shape these outcomes. We use a composite measure of "structural heteropatriarchy" which includes measures of structural sexism and structural LGB-stigma to examine the relationship between structural heteropatriarchy and three cardiovascular-related maternal morbidities using the National Longitudinal Study of Adolescent to Adult Health (n = 3928). Results using multivariate regressions show that structural heteropatriarchy is associated with increased risk of reporting maternal morbidities. Our findings provide further evidence that sexuality- and gender-based stigma operate together to shape health disparities, including maternal health.
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Affiliation(s)
| | - Morgan M Philbin
- Division of Vulnerable Populations, Department of Medicine, University of California at San Francisco, United States
| | - Patricia Homan
- Department of Sociology, Florida State University, United States
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Janzen C, Lei MYY, Lee BR, Vangala S, DelRosario I, Meng Q, Ritz B, Liu J, Jerrett M, Chanlaw T, Choi S, Aliabadi A, Fortes PA, Sullivan PS, Murphy A, Vecchio GD, Thamotharan S, Sung K, Devaskar SU. A Description of the Imaging Innovations for Placental Assessment in Response to Environmental Pollution Study. Am J Perinatol 2024; 41:e853-e862. [PMID: 36241211 PMCID: PMC11111287 DOI: 10.1055/a-1961-2059] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/22/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The aim of Placental Assessment in Response to Environmental Pollution Study (PARENTs) was to determine whether imaging of the placenta by novel multiparametric magnetic resonance imaging (MRI) techniques in early pregnancy could help predict adverse pregnancy outcomes (APOs) due to ischemic placental disease (IPD). Additionally, we sought to determine maternal characteristics and environmental risk factors that contribute to IPD and secondary APOs. STUDY DESIGN Potential patients in their first trimester of pregnancy, who agreed to MRI of the placenta and measures of assessment of environmental pollution, were recruited into PARENTs, a prospective population-based cohort study. Participants were seen at three study visits during pregnancy and again at their delivery from 2015 to 2019. We collected data from interviews, chart abstractions, and imaging. Maternal biospecimens (serum, plasma, and urine) at antepartum study visits and delivery specimens (placenta, cord, and maternal blood) were collected, processed, and stored. The primary outcome was a composite of IPD, which included any of the following: placental abruption, hypertensive disease of pregnancy, fetal growth restriction, or a newborn of small for gestational age. RESULTS In this pilot cohort, of the 190 patients who completed pregnancy to viable delivery, 50 (26%) developed IPD. Among demographic characteristics, having a history of prior IPD in multiparous women was associated with the development of IPD. In the multiple novel perfusion measurements taken of the in vivo placenta using MRI, decreased high placental blood flow (mL/100 g/min) in early pregnancy (between 14 and 16 weeks) was found to be significantly associated with the later development of IPD. CONCLUSION Successful recruitment of the PARENTs prospective cohort demonstrated the feasibility and acceptability of the use of MRI in human pregnancy to study the placenta in vivo and at the same time collect environmental exposure data. Analysis is ongoing and we hope these methods will assist researchers in the design of prospective imaging studies of pregnancy. KEY POINTS · MRI was acceptable and feasible for the study of the human placenta in vivo.. · Functional imaging of the placenta by MRI showed a significant decrease in high placental blood flow.. · Measures of environmental exposures are further being analyzed to predict IPD..
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Affiliation(s)
- Carla Janzen
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Margarida Y. Y. Lei
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Brian R. Lee
- Department of Pediatrics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Sitaram Vangala
- Department of Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Irish DelRosario
- Department of Epidemiology, Jonathan Fielding School of Public Health at University of California Los Angeles, Los Angeles, California
| | - Qi Meng
- Department of Epidemiology, Jonathan Fielding School of Public Health at University of California Los Angeles, Los Angeles, California
| | - Beate Ritz
- Department of Epidemiology, Jonathan Fielding School of Public Health at University of California Los Angeles, Los Angeles, California
| | - Jonathan Liu
- Department of Environmental Health Sciences, Jonathan Fielding School of Public Health at University of California Los Angeles, Los Angeles, California
| | - Michael Jerrett
- Department of Environmental Health Sciences, Jonathan Fielding School of Public Health at University of California Los Angeles, Los Angeles, California
| | - Teresa Chanlaw
- Department of Pediatrics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Sarah Choi
- Department of Pediatrics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Arya Aliabadi
- Department of Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Precious Ann Fortes
- Department of Pathology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Peggy S. Sullivan
- Department of Pathology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Aisling Murphy
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Giorgia Del Vecchio
- Department of Pediatrics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Shanthie Thamotharan
- Department of Pediatrics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - KyungHyun Sung
- Department of Radiology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Sherin U. Devaskar
- Department of Pediatrics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
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Fan X, Zhang Y, Ning N, Wang Y, He Y, Ma Y, Jin L. Reproductive factors and cardiovascular health in post-menopausal women: a special focus on natural menopause. Women Health 2024; 64:440-449. [PMID: 38755523 DOI: 10.1080/03630242.2024.2349572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/24/2024] [Indexed: 05/18/2024]
Abstract
Female-specific reproductive factors might contribute to increased risk of cardiovascular disease, and the American Heart Association (AHA) recently proposed Life's Essential 8 (LE8) score to quantify cardiovascular health (CVH). The study aimed to examine the relationships between reproductive factors and the LE8 score among post-menopause women in the United States. We enrolled 3223 post-menopause women from National Health and Nutrition Examination Survey (NHANES). CVH groups based on LE8 score were low (0-49), moderate (50-79), and high good CVH levels (80-100). Multivariate ordinal logistic regressions were applied to estimate the associations between reproductive factors and the LE8 score. In multivariate model, early menarche (OR: 0.69, 95 percent CI: 0.51-0.93) and early menopause (OR: 0.57, 95 percent CI: 0.43-0.77) were associated with LE8 score compared with normal menarche and menopause; Meanwhile, ages at menarche and menopause were positively correlated with LE8 score. The number of pregnancies and full-term pregnancies were negatively associated with LE8 (OR for per pregnancy increase and 95 percent CI, 0.93 (0.88, 0.98), 0.93 (0.87, 0.99), separately). Overall, natural menopausal women with early age at menarche and menopause, and a higher number of pregnancies may have a high risk of lower CVH, and need to focus on their CVH.
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Affiliation(s)
- Xiaoting Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Yuan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Ning Ning
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning, China
| | - Yingxin Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Yue He
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Yanan Ma
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning, China
| | - Lina Jin
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
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Gan H, Xing Y, Tong J, Lu M, Yan S, Huang K, Wu X, Tao S, Gao H, Pan Y, Dai J, Tao F. Impact of Gestational Exposure to Individual and Combined Per- and Polyfluoroalkyl Substances on a Placental Structure and Efficiency: Findings from the Ma'anshan Birth Cohort. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2024; 58:6117-6127. [PMID: 38525964 DOI: 10.1021/acs.est.3c09611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Prenatal exposure to perfluoroalkyl and polyfluoroalkyl substances (PFASs) is inevitable among pregnant women. Nevertheless, there is a scarcity of research investigating the connections between prenatal PFAS exposure and the placental structure and efficiency. Based on 712 maternal-fetal dyads in the Ma'anshan Birth Cohort, we analyzed associations between individual and mixed PFAS exposure and placental measures. We repeatedly measured 12 PFAS in the maternal serum during pregnancy. Placental weight, scaling exponent, chorionic disc area, and disc eccentricity were used as the outcome variables. Upon adjusting for confounders and implementing corrections for multiple comparisons, we identified positive associations between branched perfluorohexane sulfonate (br-PFHxS) and 6:2 chlorinated polyfluorinated ether sulfonate (6:2 Cl-PFESA) with placental weight. Additionally, a positive association was observed between br-PFHxS and the scaling exponent, where a higher scaling exponent signified reduced placental efficiency. Based on neonatal sex stratification, female infants were found to be more susceptible to the adverse effects of PFAS exposure. Mixed exposure modeling revealed that mixed PFAS exposure was positively associated with placental weight and scaling exponent, particularly during the second and third trimesters. Furthermore, br-PFHxS and 6:2 Cl-PFESA played major roles in the placental measures. This study provides the first epidemiological evidence of the relationship between prenatal PFAS exposure and placental measures.
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Affiliation(s)
- Hong Gan
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032 Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei 230032 Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei 230032 Anhui, China
| | - Yanan Xing
- State Environmental Protection Key Laboratory of Environmental Health Impact Assessment of Emerging Contaminants, School of Environmental Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Juan Tong
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032 Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei 230032 Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei 230032 Anhui, China
| | - Mengjuan Lu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032 Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei 230032 Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei 230032 Anhui, China
| | - Shuangqin Yan
- Ma'anshan Maternal and Child Health Care Hospital, Ma'anshan 243011 Anhui, China
| | - Kun Huang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032 Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei 230032 Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei 230032 Anhui, China
| | - Xiaoyan Wu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032 Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei 230032 Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei 230032 Anhui, China
| | - Shuman Tao
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Hui Gao
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei 230022 Anhui, China
| | - Yitao Pan
- State Environmental Protection Key Laboratory of Environmental Health Impact Assessment of Emerging Contaminants, School of Environmental Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Jiayin Dai
- State Environmental Protection Key Laboratory of Environmental Health Impact Assessment of Emerging Contaminants, School of Environmental Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032 Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei 230032 Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei 230032 Anhui, China
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Kramer CK, Ye C, Hanley AJ, Connelly PW, Sermer M, Zinman B, Retnakaran R. Postpartum weight retention and the early evolution of cardiovascular risk over the first 5 years after pregnancy. Cardiovasc Diabetol 2024; 23:101. [PMID: 38500162 PMCID: PMC10949683 DOI: 10.1186/s12933-024-02184-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 02/29/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND The cumulative effect of postpartum weight retention from each pregnancy in a woman's life may contribute to her risk of ultimately developing type 2 diabetes and cardiovascular disease. However, there is limited direct evidence supporting this hypothesis. Thus, we sought to characterize the impact of postpartum weight retention on the trajectories of cardiovascular risk factors over the first 5-years after pregnancy. METHODS In this prospective observational cohort study, 330 women (mean age 35.7 ± 4.3 years, mean pre-pregnancy body mass index 25.2 ± 4.8 kg/m2, 50.9% primiparous) underwent serial cardiometabolic characterization (anthropometry, blood pressure, lipids, oral glucose tolerance test, insulin sensitivity/resistance (Matsuda index, HOMA-IR), C-reactive protein (CRP), adiponectin) at 1-year, 3-years, and 5-years postpartum. Based on the magnitude of weight change between pre-pregnancy and 5-years postpartum, they were stratified into the following 3 groups: weight loss (n = 100), weight gain 0-6% (n = 110), and weight gain ≥ 6% (n = 120). RESULTS At 1-year postpartum, cardiovascular risk factors did not differ between the groups. However, an adverse risk factor profile progressively emerged in the weight retention groups at 3- and 5-years. Indeed, after covariate adjustment, there was stepwise worsening (from the weight loss group to weight gain 0-6% to weight gain ≥ 6% group) of the following cardiovascular risk factors at 5-years: triglycerides (p = 0.001), HDL (p = 0.02), LDL (p = 0.01), apolipoprotein-B (p = 0.003), Matsuda index (p < 0.0001), HOMA-IR (p < 0.0001), fasting glucose (p = 0.07), and CRP (p = 0.01). Moreover, on logistic regression analyses, weight gain ≥ 6% emerged as an independent predictor of pre-diabetes/diabetes at 5-years (adjusted OR = 3.40, 95%CI: 1.63-7.09). CONCLUSION Postpartum weight retention predicts trajectories of worsening cardiovascular risk factors and glucose intolerance over the first 5-years after delivery, consistent with its postulated contribution to future vascular disease in women.
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Affiliation(s)
- Caroline K Kramer
- Leadership Sinai Centre for Diabetes, University of Toronto, Mount Sinai Hospital, 60 Murray Street, Suite L5-025, Mailbox-21, Toronto, ON, M5T 3L9, Canada
- Division of Endocrinology, University of Toronto, Toronto, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Chang Ye
- Leadership Sinai Centre for Diabetes, University of Toronto, Mount Sinai Hospital, 60 Murray Street, Suite L5-025, Mailbox-21, Toronto, ON, M5T 3L9, Canada
| | - Anthony J Hanley
- Leadership Sinai Centre for Diabetes, University of Toronto, Mount Sinai Hospital, 60 Murray Street, Suite L5-025, Mailbox-21, Toronto, ON, M5T 3L9, Canada
- Division of Endocrinology, University of Toronto, Toronto, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
| | - Philip W Connelly
- Division of Endocrinology, University of Toronto, Toronto, Canada
- Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Mathew Sermer
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Canada
| | - Bernard Zinman
- Leadership Sinai Centre for Diabetes, University of Toronto, Mount Sinai Hospital, 60 Murray Street, Suite L5-025, Mailbox-21, Toronto, ON, M5T 3L9, Canada
- Division of Endocrinology, University of Toronto, Toronto, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Ravi Retnakaran
- Leadership Sinai Centre for Diabetes, University of Toronto, Mount Sinai Hospital, 60 Murray Street, Suite L5-025, Mailbox-21, Toronto, ON, M5T 3L9, Canada.
- Division of Endocrinology, University of Toronto, Toronto, Canada.
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada.
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Skjaerven R, Kvalvik LG. Harnessing women's full reproductive history in assessing cardiovascular risk. Paediatr Perinat Epidemiol 2024; 38:268-270. [PMID: 38453261 DOI: 10.1111/ppe.13064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 02/15/2024] [Indexed: 03/09/2024]
Affiliation(s)
- Rolv Skjaerven
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Liv G Kvalvik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Zhang H, Li H, Yao J, Zhao M, Zhang C. The mutation of NSUN5 R295C promotes preeclampsia by impairing decidualization through downregulating IL-11Rα. iScience 2024; 27:108899. [PMID: 38559585 PMCID: PMC10978358 DOI: 10.1016/j.isci.2024.108899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 11/24/2023] [Accepted: 01/09/2024] [Indexed: 04/04/2024] Open
Abstract
Preeclampsia (PE) is a pregnancy-specific hypertensive disorder that severely impairs maternal and fetal health. However, its pathogenesis remains elusive. NOP2/Sun5 (NSUN5) is an RNA methyltransferase. This study discovered a significant correlation between rs77133388 of NSUN5 and PE in a cohort of 868 severe PE patients and 982 healthy controls. To further explore this association, the researchers generated single-base mutant mice (NSUN5 R295C) at rs77133388. The pregnant NSUN5 R295C mice exhibited PE symptoms. Additionally, compared to the controls, the decidual area of the placenta was significantly reduced in NSUN5 R295C mice, and their decidualization was impaired with a significantly decrease in polyploid cell numbers after artificially induced decidualization. The study also found a decrease in phosphorylated JAK2, STAT3, and IL-11Rα, Cyclin D3 expression in NSUN5 R295C mice. Overall, these findings suggest that NSUN5 mutation potentially alters decidualization through the IL-11Rα/JAK2/STAT3/Cyclin D3 pathway, ultimately impairing placental development and contributing to PE occurrence.
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Affiliation(s)
- Hongya Zhang
- Shandong Provincial Key Laboratory of Animal Resistance Biology, College of Life Sciences, Shandong Normal University, Jinan, Shandong 250014, China
| | - Huihui Li
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
| | - Jiatong Yao
- Shandong Provincial Key Laboratory of Animal Resistance Biology, College of Life Sciences, Shandong Normal University, Jinan, Shandong 250014, China
| | - Miaomiao Zhao
- Shandong Provincial Key Laboratory of Animal Resistance Biology, College of Life Sciences, Shandong Normal University, Jinan, Shandong 250014, China
| | - Cong Zhang
- Shandong Provincial Key Laboratory of Animal Resistance Biology, College of Life Sciences, Shandong Normal University, Jinan, Shandong 250014, China
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200135, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai 200135, China
- Shandong Provincial Key Laboratory of Reproductive Medicine, Jinan, Shandong 250001, China
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Zhu F, Noordermeer D, Aribas E, Bos M, Boersma E, Kavousi M. Metabolic disorders mediate the relation of miscarriage with cardiovascular diseases. Eur J Prev Cardiol 2024; 31:330-336. [PMID: 37939791 DOI: 10.1093/eurjpc/zwad347] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/18/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023]
Abstract
AIMS The extent to which the contribution of pregnancy loss to cardiovascular diseases (CVDs) can be explained by metabolic disorders is poorly elucidated but holds insights for reducing long-term cardiovascular risk. The aim of this study is to investigate the mediating effects of hypertension, diabetes mellitus (DM), and lipoprotein metabolism disorders on the association of miscarriage and stillbirth with coronary heart disease (CHD), stroke, heart failure, atrial fibrillation, and composite outcomes. METHODS AND RESULTS A total of 163 283 ever-gravid women (age 55.3 ± 7.9 years) from the UK Biobank cohort without established metabolic disorders and CVDs were included and followed from 2007 to 2010 baseline until December 2020. Causal mediation analyses were used to estimate the proportion mediated. Hypertension mediated 11.1% (95% confidence interval, 3.7-18.5%) of the association between a history of miscarriage and incident CHD. Approximately, 9.5% (4.1-14.8%) of the effect of recurrent miscarriages on incident CHD was via hypertension, 8.4% (2.5-14.3%) of the effect was via lipoprotein metabolism disorders, 1.7% (0.5-2.9%) of the effect was via DM, and 10.7% (0.2-21.1%) of the effect of recurrent miscarriages on incident stroke was via hypertension. Hypertension mediated the largest proportion of effect for the atherosclerotic cardiovascular event (15.5% for a history of miscarriage and 9.4% for recurrent miscarriages), followed by lipoprotein metabolism disorders and DM. CONCLUSION Hypertension, DM, and lipoprotein metabolism disorders mediated the association between miscarriage and various cardiovascular outcomes in later life. In particular, hypertension mediated a large proportion of the relationship between miscarriage and atherosclerotic CVD.
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Affiliation(s)
- Fang Zhu
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam 3000 CA, The Netherlands
| | - Daniëlle Noordermeer
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam 3000 CA, The Netherlands
| | - Elif Aribas
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam 3000 CA, The Netherlands
| | - Maxime Bos
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam 3000 CA, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam 3000 CA, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam 3000 CA, The Netherlands
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Wambua S, Singh M, Okoth K, Snell KIE, Riley RD, Yau C, Thangaratinam S, Nirantharakumar K, Crowe FL. Association between pregnancy-related complications and development of type 2 diabetes and hypertension in women: an umbrella review. BMC Med 2024; 22:66. [PMID: 38355631 PMCID: PMC10865714 DOI: 10.1186/s12916-024-03284-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 02/02/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Despite many systematic reviews and meta-analyses examining the associations of pregnancy complications with risk of type 2 diabetes mellitus (T2DM) and hypertension, previous umbrella reviews have only examined a single pregnancy complication. Here we have synthesised evidence from systematic reviews and meta-analyses on the associations of a wide range of pregnancy-related complications with risk of developing T2DM and hypertension. METHODS Medline, Embase and Cochrane Database of Systematic Reviews were searched from inception until 26 September 2022 for systematic reviews and meta-analysis examining the association between pregnancy complications and risk of T2DM and hypertension. Screening of articles, data extraction and quality appraisal (AMSTAR2) were conducted independently by two reviewers using Covidence software. Data were extracted for studies that examined the risk of T2DM and hypertension in pregnant women with the pregnancy complication compared to pregnant women without the pregnancy complication. Summary estimates of each review were presented using tables, forest plots and narrative synthesis and reported following Preferred Reporting Items for Overviews of Reviews (PRIOR) guidelines. RESULTS Ten systematic reviews were included. Two pregnancy complications were identified. Gestational diabetes mellitus (GDM): One review showed GDM was associated with a 10-fold higher risk of T2DM at least 1 year after pregnancy (relative risk (RR) 9.51 (95% confidence interval (CI) 7.14 to 12.67) and although the association differed by ethnicity (white: RR 16.28 (95% CI 15.01 to 17.66), non-white: RR 10.38 (95% CI 4.61 to 23.39), mixed: RR 8.31 (95% CI 5.44 to 12.69)), the between subgroups difference were not statistically significant at 5% significance level. Another review showed GDM was associated with higher mean blood pressure at least 3 months postpartum (mean difference in systolic blood pressure: 2.57 (95% CI 1.74 to 3.40) mmHg and mean difference in diastolic blood pressure: 1.89 (95% CI 1.32 to 2.46) mmHg). Hypertensive disorders of pregnancy (HDP): Three reviews showed women with a history of HDP were 3 to 6 times more likely to develop hypertension at least 6 weeks after pregnancy compared to women without HDP (meta-analysis with largest number of studies: odds ratio (OR) 4.33 (3.51 to 5.33)) and one review reported a higher rate of T2DM after HDP (hazard ratio (HR) 2.24 (1.95 to 2.58)) at least a year after pregnancy. One of the three reviews and five other reviews reported women with a history of preeclampsia were 3 to 7 times more likely to develop hypertension at least 6 weeks postpartum (meta-analysis with the largest number of studies: OR 3.90 (3.16 to 4.82) with one of these reviews reporting the association was greatest in women from Asia (Asia: OR 7.54 (95% CI 2.49 to 22.81), Europe: OR 2.19 (95% CI 0.30 to 16.02), North and South America: OR 3.32 (95% CI 1.26 to 8.74)). CONCLUSIONS GDM and HDP are associated with a greater risk of developing T2DM and hypertension. Common confounders adjusted for across the included studies in the reviews were maternal age, body mass index (BMI), socioeconomic status, smoking status, pre-pregnancy and current BMI, parity, family history of T2DM or cardiovascular disease, ethnicity, and time of delivery. Further research is needed to evaluate the value of embedding these pregnancy complications as part of assessment for future risk of T2DM and chronic hypertension.
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Affiliation(s)
- Steven Wambua
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK.
| | - Megha Singh
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Kelvin Okoth
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Kym I E Snell
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Richard D Riley
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Christopher Yau
- Big Data Institute, University of Oxford, Li Ka Shing Centre for Health Information and Discovery, Old Road Campus, Oxford, OX3 7LF, UK
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Level 3 Women's Centre, John Radcliffe Hospital, Oxford, OX3 9DU, UK
- Health Data Research, London, UK
| | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Francesca L Crowe
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
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42
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Clayton GL, Borges MC, Lawlor DA. The impact of reproductive factors on the metabolic profile of females from menarche to menopause. Nat Commun 2024; 15:1103. [PMID: 38320991 PMCID: PMC10847109 DOI: 10.1038/s41467-023-44459-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 12/14/2023] [Indexed: 02/08/2024] Open
Abstract
We explore the relation between age at menarche, parity and age at natural menopause with 249 metabolic traits in over 65,000 UK Biobank women using multivariable regression, Mendelian randomization and negative control (parity only). Older age of menarche is related to a less atherogenic metabolic profile in multivariable regression and Mendelian randomization, which is largely attenuated when accounting for adult body mass index. In multivariable regression, higher parity relates to more particles and lipids in VLDL, which are not observed in male negative controls. In multivariable regression and Mendelian randomization, older age at natural menopause is related to lower concentrations of inflammation markers, but we observe inconsistent results for LDL-related traits due to chronological age-specific effects. For example, older age at menopause is related to lower LDL-cholesterol in younger women but slightly higher in older women. Our findings support a role of reproductive traits on later life metabolic profile and provide insights into identifying novel markers for the prevention of adverse cardiometabolic outcomes in women.
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Affiliation(s)
- Gemma L Clayton
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Maria Carolina Borges
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
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Whitaker KM, Jones MA, Smith K, Catov J, Feghali M, Kline CE, Santillan M, Santillan D, Zimmerman B, Gibbs BB. Study Design and Protocol of the Multisite Pregnancy 24/7 Cohort Study. Am J Epidemiol 2024; 193:415-425. [PMID: 37939072 PMCID: PMC11484610 DOI: 10.1093/aje/kwad208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 05/29/2023] [Accepted: 10/26/2023] [Indexed: 11/10/2023] Open
Abstract
Hypertensive disorders of pregnancy and other adverse pregnancy outcomes (APOs) are associated with an increased risk of future maternal cardiovascular disease. Physical activity during pregnancy reduces the risk of these APOs, yet few meet physical activity guidelines during pregnancy. Little is known about the role of sedentary behavior or sleep in APOs, a critical gap in knowledge given these behaviors comprise the majority of a 24-hour day. To address this knowledge gap, the Pregnancy 24/7 cohort study (2020-2025) uses 2 devices for 24-hour activity assessment in each trimester of pregnancy to examine associations of sedentary behavior, sleep, and the 24-hour activity cycle (composition of sedentary behavior, physical activity, and sleep) with hypertensive disorders and other APOs. Participants (n = 500) are recruited from the University of Iowa, University of Pittsburgh, and West Virginia University in early pregnancy and followed through delivery. The activPAL3 micro and Actiwatch Spectrum Plus are worn in each trimester for 7 days of 24-hour wear to assess the 24-hour activity cycle. APOs are abstracted from medical charts. This study will provide critical data to fuel future research examining how modifying the 24-hour activity cycle in pregnancy can improve maternal health.
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Affiliation(s)
- Kara M Whitaker
- Correspondence to Dr. Kara M. Whitaker, Department of Health and Human Physiology, 225 S. Grand Avenue, Iowa City, IA 52242 (e-mail: )
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Nix KM, Lee-Ann Hawkins T, Vlasschaert M, Ma IW, Nerenberg KA. Understanding Patient Perspectives on Specialized, Longitudinal, Postpartum, Cardiovascular Risk-Reduction Clinics. CJC Open 2024; 6:165-173. [PMID: 38487052 PMCID: PMC10935677 DOI: 10.1016/j.cjco.2023.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/27/2023] [Indexed: 03/17/2024] Open
Abstract
Background Females who experience hypertensive disorders of pregnancy (HDP) have an increased lifelong risk of cardiovascular disease. Thus, Canadian clinical practice guidelines recommend cardiovascular risk reduction follow-up after a patient has HDP. This study examined the experiences of patients with HDP who attended a specialized, longitudinal general internal medicine postpartum cardiovascular risk reduction clinic called PreVASC. PreVASC focuses on comprehensive cardiovascular risk reduction through cardiovascular risk factor screening and management tailored specifically for female patients after they have HDP. Methods This multimethod study examined the experiences of female patients with HDP via the following: (i) a quantitative survey (summarized with descriptive statistics); (ii) semistructured qualitative patient phone interviews (results grouped thematically); and (iii) triangulation of qualitative themes with quantitative survey results. Results Overall, 37% of eligible clinic patients (42 of 115) participated; 79% of participants (n = 33) reported being "very satisfied" with the PreVASC clinic's specialized longitudinal model of care, and 95% (n = 40) reported making at least one preventive health behaviour change after receiving individualized counselling on cardiovascular risk reduction. Qualitative results found improvements in patient-reported cardiovascular health knowledge, health behaviours, and health-related anxiety. A preference for in-person vs phone clinic visits was reported by participants. Conclusions An in-person, general internal medicine specialist-led, longitudinal model of cardiovascular disease preventive care focused specifically on cardiovascular risk reduction after HDP had positive impacts on patient experience, health knowledge, and preventive health behaviours. This novel knowledge on patient preferences for a longitudinal, specialized model of care advances cardiovascular risk reduction tailored specifically for high-risk people after HDP.
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Affiliation(s)
- Kimberley M. Nix
- Division of General Internal Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - T. Lee-Ann Hawkins
- Division of General Internal Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Meghan Vlasschaert
- Division of General Internal Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Irene W.Y. Ma
- Division of General Internal Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kara A. Nerenberg
- Division of General Internal Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Mikkola TS, Ylikorkala O. Pregnancy-associated risk factors for future cardiovascular disease - early prevention strategies warranted. Climacteric 2024; 27:41-46. [PMID: 38174425 DOI: 10.1080/13697137.2023.2287628] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/20/2023] [Indexed: 01/05/2024]
Abstract
We summarize convincing evidence that future cardiovascular disease (CVD) risk increases one-fold to four-fold for women with a history of pregnancy complicated by hypertensive disorders, gestational diabetes, fetal growth restriction, placental abruption and preterm birth. A concomitant occurrence of two or more complications in the same pregnancy further potentiates the risk. These women should be informed of their future CVD risks during the postpartum check-up taking place after delivery, and also, if needed, treated, for example, for persisting high blood pressure. In these women with high blood pressure, check-up should take place within 7-10 days, and if severe hypertension, within 72 h. Women without diagnostic signs and symptoms should be examined for the first time 1-2 years postpartum and then at intervals of 2-3 years for a complete CVD risk profile including clinical and laboratory assessments. Women should be informed for future CVD risks and their effective prevention with healthy lifestyle factors. Combined oral contraceptives should be avoided or used with caution. If laboratory or other clinical findings indicate, then vigorous treatments consisting of non-medical and medical (antihypertensives, statins, antidiabetic and anti-obesity therapies) interventions should be initiated early with liberal indications and with ambitious therapeutic goals. Low-dose aspirin and menopausal hormone therapy should be used in selected cases. Active control and treatment policies of these women with pregnancy-related risks will likely result in decreases of CVD occurrence in later life.
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Affiliation(s)
- T S Mikkola
- Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - O Ylikorkala
- Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki University, Helsinki, Finland
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Niazi E, Dumanski SM. Change of HeART: Cardiovascular Implications of Assisted Reproductive Technology. CJC Open 2024; 6:142-152. [PMID: 38487072 PMCID: PMC10935705 DOI: 10.1016/j.cjco.2023.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/10/2023] [Indexed: 03/17/2024] Open
Abstract
Cardiovascular (CV) disease is the leading cause of death in women, and it may manifest differently than in men, in part related to sex-specific CV risk factors. In females, assisted reproductive technologies (ARTs) are commonly used to treat infertility, and they utilize controlled ovarian stimulation involving the administration of exogenous sex hormones. ARTs, and especially controlled ovarian stimulation, have been associated with an increased pregnancy and short-term CV risk, although the long-term CV implications of these treatments in individuals treated with ARTs and their offspring remain unclear. This review endeavors to provide a comprehensive examination of what is known about the relationship between ART and CV outcomes for females treated with ARTs, as well as their offspring, and recommendations for future research. Novel insights into female-specific CV risk factors are critical to reduce the disproportionate burden of CV disease in Canadian women. ART has revolutionized reproductive medicine, offering hope to millions of individuals with infertility worldwide, and a further understanding of the CV implications of this important sex-specific CV risk factor is warranted urgently.
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Affiliation(s)
- Elaha Niazi
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Sandra M. Dumanski
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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d'Errico A, Fontana D, Sacerdote C, Ardito C. Child rearing or childbearing? Risk of cardiovascular diseases associated to parity and number of children. BMC Public Health 2024; 24:272. [PMID: 38263016 PMCID: PMC10804732 DOI: 10.1186/s12889-023-17119-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/31/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND An increased risk of cardiovascular diseases (CVD) has been associated with women's parity, but whether or not this association reflects a direct pregnancy effect, or exposure to factors related to childrearing, still appears unclear. We assessed the CVD risk associated with number of children separately by gender and tested effect modification by socioeconomic position (SEP) and employment status, in order to elucidate the possible mechanisms underlying this association. METHODS The study population was composed of 20,904 men and 25,246 women who were interviewed in one of two National Health Surveys conducted in 2000 and 2005 in Italy. These subjects were followed for CVD incidence up to 2014 through record-linkage with national archives of mortality and hospitalisations. CVD risk was estimated by Cox regression models that were adjusted for socio-demographics, perceived health, lifestyles, biological CVD risk factors and for other potential confounders. RESULTS CVD incidence was significantly increased among men with 3 or more children (HR = 1.26, 95% CI: 1.02-1.56) and among women with 2 and with 3 or more children (HR = 1.42, 95% CI: 1.10-1.83; and HR = 1.39, 95% CI: 1.03-1.87, respectively) compared to subjects without children and no significant gender differences were observed. Subjects with lower SEP displayed stronger associations with parity and a higher number of children for both genders; by contrast, no modifying effect of employment status was observed. CONCLUSIONS Taken together, the significant association between higher parity and CVD risk in both genders, and the higher risk of CVD associated with higher parity among lower SEP parents, suggests that childrearing has a potential effect on the development of CVD that is more pronounced among disadvantaged families, although a concurrent effect of childbearing cannot be completely excluded.
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Affiliation(s)
- Angelo d'Errico
- Epidemiology Unit Piedmont Region ASL TO3, Grugliasco (TO), Italy
| | - Dario Fontana
- Epidemiology Unit Piedmont Region ASL TO3, Grugliasco (TO), Italy
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, University of Turin, Turin, Italy
- Centre for Cancer Epidemiology and Prevention (CPO Piemonte), Turin, Italy
| | - Chiara Ardito
- Competence Centre On Microeconomic Evaluation (CC-ME), European Commission, Joint Research Centre (JRC), Ispra, Italy.
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Nicklas JM, Pyle L, Soares A, Leiferman JA, Bull SS, Tong S, Caldwell AE, Santoro N, Barbour LA. The Fit After Baby randomized controlled trial: An mHealth postpartum lifestyle intervention for women with elevated cardiometabolic risk. PLoS One 2024; 19:e0296244. [PMID: 38194421 PMCID: PMC10775990 DOI: 10.1371/journal.pone.0296244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 12/03/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Postpartum women with overweight/obesity and a history of adverse pregnancy outcomes are at elevated risk for cardiometabolic disease. Postpartum weight loss and lifestyle changes can decrease these risks, yet traditional face-to-face interventions often fail. We adapted the Diabetes Prevention Program into a theory-based mobile health (mHealth) program called Fit After Baby (FAB) and tested FAB in a randomized controlled trial. METHODS The FAB program provided 12 weeks of daily evidence-based content, facilitated tracking of weight, diet, and activity, and included weekly coaching and gamification with points and rewards. We randomized women at 6 weeks postpartum 2:1 to FAB or to the publicly available Text4baby (T4B) app (active control). We measured weight and administered behavioral questionnaires at 6 weeks, and 6 and 12 months postpartum, and collected app user data. RESULTS 81 eligible women participated (77% White, 2% Asian, 15% Black, with 23% Hispanic), mean baseline BMI 32±5 kg/m2 and age 31±5 years. FAB participants logged into the app a median of 51/84 (IQR 25,71) days, wore activity trackers 66/84 (IQR 43,84) days, logged weight 17 times (IQR 11,24), and did coach check-ins 5.5/12 (IQR 4,9) weeks. The COVID-19 pandemic interrupted data collection for the primary 12-month endpoint, and impacted diet, physical activity, and body weight for many participants. At 12 months postpartum women in the FAB group lost 2.8 kg [95% CI -4.2,-1.4] from baseline compared to a loss of 1.8 kg [95% CI -3.8,+0.3] in the T4B group (p = 0.42 for the difference between groups). In 60 women who reached 12 months postpartum before the onset of the COVID-19 pandemic, women randomized to FAB lost 4.3 kg [95% CI -6.0,-2.6] compared to loss in the control group of 1.3 kg [95% CI -3.7,+1.1] (p = 0.0451 for the difference between groups). CONCLUSIONS There were no significant differences between groups for postpartum weight loss for the entire study population. Among those unaffected by the COVID pandemic, women randomized to the FAB program lost significantly more weight than those randomized to the T4B program. The mHealth FAB program demonstrated a substantial level of engagement. Given the scalability and potential public health impact of the FAB program, the efficacy for decreasing cardiometabolic risk by increasing postpartum weight loss should be tested in a larger trial.
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Affiliation(s)
- Jacinda M. Nicklas
- Department of Medicine, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Laura Pyle
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, United States of America
- Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, Colorado, United States of America
| | - Andrey Soares
- Department of Medicine, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Jennifer A. Leiferman
- Department of Community and Behavioral Health, University of Colorado School of Public Health, Aurora, Colorado, United States of America
| | - Sheana S. Bull
- Department of Community and Behavioral Health, University of Colorado School of Public Health, Aurora, Colorado, United States of America
| | - Suhong Tong
- Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, Colorado, United States of America
| | - Ann E. Caldwell
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado School of Medicine, Aurora, Colorado, United States of America
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility & Reproductive Sciences, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Linda A. Barbour
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado School of Medicine, Aurora, Colorado, United States of America
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America
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Stanhope KK, Michopoulos V, Powers A, Boulet SL, Kramer MR, Suglia SF. Types and timing of trauma exposure across the life course and maternal hypertension. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.13.23299937. [PMID: 38168444 PMCID: PMC10760284 DOI: 10.1101/2023.12.13.23299937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Objective To estimate associations between types and timing (first occurrence and time since) of trauma exposure and hypertension experienced during pregnancy in a safety-net hospital in Atlanta, Georgia. Methods Participants completed a 14-item trauma screener. We linked that information to data from the medical record on hypertension (inclusive of chronic hypertension, gestational hypertension, or preeclampsia). We fit logistic regression models and used the estimates to calculate risk ratios for each trauma type and each critical window (0-9 years, 10-19, and 20+). We fit unadjusted models and adjusted for age, parity, and education. Results We included 704 individuals with a delivery within 12 months of screening. The majority (94%, 661) reported at least one traumatic event, most commonly witnessing violence (79.4%). Overall, 18% experienced gestational hypertension, 10.8% chronic hypertension, and 11.9% preeclampsia. Among individuals who reported trauma, 31.5% screened positive for probable posttraumatic stress disorder and 30.9% for probable depression compared to 0 and 2.3% among those without reported trauma. No trauma type (violence, witnessing violence, non-interpersonal, or sexual assault) was associated with increased hypertensive risk, regardless of timing. Similarly, time between trauma and delivery (0-3 years, 3-10 years, 10+ years) was not associated with increased hypertensive risk. Conclusions In this sample with a high trauma and hypertension burden, trauma was not associated with elevated risk of hypertension during pregnancy, despite a high burden of PTSD and depressive symptoms among people with trauma exposure. Future research should consider how community-level exposure may modify the impact of trauma on adverse pregnancy outcomes.
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Arntzen E, Jøsendal R, Sandsæter HL, Horn J. Postpartum follow-up of women with preeclampsia: facilitators and barriers - A qualitative study. BMC Pregnancy Childbirth 2023; 23:833. [PMID: 38049716 PMCID: PMC10694896 DOI: 10.1186/s12884-023-06146-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/20/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Pregnancy causes physiological changes to the maternal organ systems that can be regarded as a cardiometabolic stress test for women. Preeclampsia, a pregnancy complication characterized by new onset of hypertension in combination with proteinuria or end-organ dysfunction, affects approximately 2-8% of pregnancies. Adverse pregnancy outcomes, including preeclampsia, have been described as a failed stress test and have been consistently linked with increased risk of cardiovascular disease later in life. The postpartum period is therefore often regarded as a window of opportunity for cardiovascular disease prevention. However, we lack knowledge about how women with preeclampsia experience current postpartum care in the Norwegian health system. The aim of this qualitative study is to uncover women's perspectives and preferences regarding postpartum follow-up. METHODS Semi-structured telephone interviews were conducted with 17 women following a six-month lifestyle intervention study. Participants were 9-20 months postpartum, following a pregnancy complicated by preeclampsia. Data were analyzed using Malterud's systematic text condensation. RESULTS We identified five themes, each with 2-3 subthemes, that demonstrate how women with recent preeclampsia experience postpartum follow-up: (1) fear and uncertainty (a body out of balance and facing an uncertain future), (2) a conversation on lifestyle - not really that difficult (preeclampsia as a gateway, a respectful approach, and a desire for more constructive feedback), (3) when your own health is not a priority (a new everyday life, out of focus, and lack of support), (4) motivation for lifestyle changes (an eye opener, lack of intrinsic motivation, and a helping hand), and (5) lack of structured and organized follow-up (there should be a proper system, a one-sided follow-up care, and individual variation in follow-up care). CONCLUSIONS Findings from this study highlight the need for more systematic postpartum follow-up for women after a pregnancy complicated by preeclampsia. Further research is required to explore the potential use of standardized guidelines and routine invitations to postpartum care. Furthermore, exploring health care professionals' experiences is crucial to ensure their engagement in postpartum care after complicated pregnancies.
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Affiliation(s)
- Eirin Arntzen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postbox 8905, NO-7491, Trondheim, Norway
| | - Ranveig Jøsendal
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postbox 8905, NO-7491, Trondheim, Norway
| | - Heidi Linn Sandsæter
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postbox 8905, NO-7491, Trondheim, Norway
- Department of Obstetrics and Gynecology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Julie Horn
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postbox 8905, NO-7491, Trondheim, Norway.
- Department of Obstetrics and Gynecology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.
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