Temperature and preeclampsia: Epidemiological evidence that perturbation in maternal heat homeostasis affects pregnancy outcome.
- 作者列表："Shashar S","Kloog I","Erez O","Shtein A","Yitshak-Sade M","Sarov B","Novack L
INTRODUCTION:This study aims to determine the association between temperature and preeclampsia and whether it is affected by seasonality and rural/urban lifestyle. METHODS:This cohort study included women who delivered at our medical center from 2004 to 2013 (31,101 women, 64,566 deliveries). Temperature values were obtained from a spatiotemporally resolved estimation model performing predictions at a 1×1km spatial resolution. In "Warm" pregnancies >50% of gestation occurred during the spring-summer period. In cold pregnancies >50% of gestation occurred during the fall and winter. Generalized estimating equation multivariable models were used to estimate the association between temperature and incidence of preeclampsia. RESULTS:1) The incidence of preeclampsia in at least one pregnancy was 7% (2173/64,566); 2) during "warm" pregnancies, an elevation of one IQR of the average temperature in the 1st or the 3rd trimesters was associated with an increased risk to develop preeclampsia [patients with Jewish ethnicity: 1st trimester: relative risk (RR) of 2.38(95%CI 1.50; 3.80), 3rd trimester 1.94(95%CI 1.34;2.81); Bedouins: 1st trimester: RR = 2.91(95%CI 1.98;4.28), 3rd trimester: RR = 2.37(95%CI 1.75;3.20)]; 3) In "cold" pregnancies, an elevation of one IQR of average temperature was associated with a lower risk to develop preeclampsia among patients with Bedouin-Arab ethnicity RR = 0.68 (95% CI 0.49-0.94) for 1st trimester and RR = 0.62 (95% CI 0.44-0.87) for 3rd trimester. CONCLUSIONS:1) Elevated averaged temperature during the 1st or 3rd trimesters in "warm" pregnancies confer an increased risk for the development of preeclampsia, especially in nomadic patients; 2) Of interest, during cold pregnancies, elevated averaged temperature was associated with a lower risk to develop preeclampsia for nomadic patients. 3) These findings suggest temperature might be associated with perturbations in maternal heat homeostasis resulting in reallocation of energy resources and their availability to the fetus that may increase the risk for preeclampsia. This observation is especially relevant in the context of global warming and its effects on maternal/fetal reproductive health.
引言: 本研究旨在确定温度与先兆子痫之间的关联，以及是否受季节性和农村/城市生活方式的影响。 方法: 本队列研究包括2004年至2013年在我们医疗中心分娩的妇女 (31,101名妇女，64,566名分娩)。温度值是从一个时空分辨的估计模型获得的，该模型以1 × 1千米的空间分辨率进行预测。在 “温暖” 妊娠中，> 50% 的妊娠发生在春夏期间。在寒冷妊娠中，> 50% 的妊娠发生在秋季和冬季。广义估计方程多变量模型用于估计温度与子痫前期发病率之间的关联。 结果: 1) 至少一次妊娠中先兆子痫的发生率为7% (2173/64，566); 2) 在 “温暖” 妊娠期间，第1或第3个月内平均温度的一个IQR升高与发生先兆子痫的风险增加相关 [犹太人种族患者: 第1三个月:相对危险度 (RR) 为2.38(95% CI 1.50; 3.80)，第3妊娠1.94(95% CI 1.34;2.81); 贝都因: 第1妊娠: RR = 2.91(95% CI 1.98;4.28)，第3妊娠: RR = 2.37(95% CI 1.75;3.20)]; 3) 在 “冷” 怀孕中，在患有贝都因阿拉伯种族的患者中，平均体温升高1 IQR与发生先兆子痫的风险较低相关，0.68个月的RR = 95% (0.49 CI 0.94-第1)，0.62个月的RR = 95% (0.44 CI 0.87-第3)。 结论: 1) 在 “温暖” 妊娠的第1或第3个三个月期间，平均温度升高导致先兆子痫发生的风险增加，特别是在游牧患者中; 2) 值得注意的是，在寒冷妊娠期间，平均温度升高与游牧患者发生先兆子痫的风险降低相关。3) 这些发现表明，温度可能与母体热量稳态的扰动有关，导致能量资源的重新分配及其对胎儿的可用性，这可能增加先兆子痫的风险。这一观察结果尤其与全球变暖及其对母亲/胎儿生殖健康的影响有关。
METHODS::Objectives: Serial measurements of sonographic fetal abdominal circumference (AC) are useful for monitoring fetal growth during pregnancy and are essential for predicting macrosomia. The study was aiming to compare the AC profiles of infants born to mothers with or without hyperglycemia in Chinese population.Subjects and methods: The "GDM Prevalence Study (GPS)" was a large study conducted in 22 hospitals in three large cities in China, which included 34,085 NGT (normal glucose tolerant) women, 8272 GDM (gestational diabetes mellitus) women and 729 DM (diabetes mellitus) women. A total of 116,740 scans and 103,377 valid AC measurements were performed for the NGT, GDM and DM groups at different gestational age. AC profiles and fetal growth rates at different stages of pregnancy were compared between different groups.Results: The overall AC growth rate (β) was higher in the macrosomia group than in the no macrosomia group in NGT (β =10.250 versus 9.541, p < .001), GDM (β = 10.572 versus 9.705, p < .001) and DM (β = 11.363 versus 9.924, p < .001) pregnancies. Significant differences were observed between NGT-macrosomia, GDM-macrosomia and DM-macrosomia. Significant differences were also noted between NGT-no macrosomia, GDM-no macrosomia and DM-no macrosomia women. Participants in NGT-macrosomia group exhibited larger AC values than NGT-no macrosomia group beginning at 21 gestational weeks, and GDM-macrosomia group exhibited larger AC values than GDM-no macrosomia group beginning at 22 gestational weeks. AC growth rate was higher in NGT-macrosomia and GDM-macrosomia groups than in the corresponding no macrosomia groups between 22 and 30 gestational weeks.Conclusions: The overall AC growth rates are higher in macrosomia group compared to the no macrosomia group in NGT, GDM as well as DM participants. The significant difference of AC growth rates in NGT-macrosomia and GDM-macrosomia indicate the possible differential underlying mechanisms in developing macrosomia with or without hyperglycemia exposure. Our study demonstrate that larger fetal AC measurements around 21-22 weeks are associated with subsequent diagnosis of macrosomia, suggesting that macrosomia management should be initiated much earlier than we thought.
METHODS::Background: Pregnancy outcomes are affected by many different factors. One of the influential factors on pregnancy outcomes is the male partner as an important person to mother's wellbeing.Objective: The aim of the present study was to investigate the effects of male partner's role including socioeconomic support, emotional support, accompanying pregnant women during prenatal care visits (PNC) and labor, and the level of pregnant women's satisfaction from their partners' support and involvement during pregnancy on pregnancy outcomes.Method: Two hundred first gravid pregnant women with mean age of 23.2 ± 4.3 were studied. Primary outcomes were total maternal and neonatal adverse outcome (TMNAO), total maternal adverse end result (TMAE), and total neonatal adverse outcome (TNAO), regardless of the type of outcomes. Preterm labor and delivery; premature rupture of membrane (PROM) and preterm premature rupture of membrane (PPROM); preeclampsia and eclampsia; placental abruption; chorioamnionitis; stillbirth; meconium passage; maternal death; postpartum hemorrhage; poor progression labor; abnormal vaginal bleeding in third trimester of pregnancy; low birth weight and neonatal need for CPR or intubation, neonatal anomaly, NICU admission, and neonatal mortality were also analyzed as subgroup outcomes.Results: One hundred twenty-seven (63.5%) participants showed a kind of total maternal and neonatal adverse outcome (TMNAO), 72 (36%) deliveries resulted in a kind of neonatal adverse outcome (TNAO), and 104 (52%) of participants had a kind of maternal adverse end result (TMAE). Iranian fathers showed a significantly higher rate of TMNAO than Afghan fathers did (82 versus 69%, odds ratio: 2.9, 95% CI 1.0-7.8, p: .01). Mother's nationality showed the same result (82 versus 64%, odds ratio: 2.6, 95% CI 0.9-6.8, p: .03). Iranian fathers showed a significantly higher rate of TMAE than Afghan fathers did (79 versus 58%, odds ratio: 2.7, 95% CI 1.1-6.3, p: .01). Mother's nationality showed the same result (78 versus 60%, odds ratio: 2.4, 95% CI 1.0-5.6, p: 0.02). Neonates with Iranian fathers showed significantly more TNAO than those with Afghan fathers (50 versus 31%, odds ratio: 2.21, 95% CI 0.9-5.5, p: .04). The same trend was observed among Iranian mothers in comparison to Afghan mothers (50 versus 32%, odds ratio: 2.11, 95% CI 0.9-4.6, p: .06). Of mother's age, mother's BMI, father's age, father's BMI, and mother's nationality, only father's BMI contributed significantly to the binary logistic regression model (n = 116, R2: 9%, p: .028). It was found that for each decreased unit in BMI, the risk of TNAO was increased by 16%, p: .03. Moreover, Father's family history of preeclampsia resulted in a higher prevalence of total neonatal adverse outcome (TNAO) in comparison with lack of such family history (87 versus 43%, odds ratio: 8.9, 95% CI 1.1-74.5, p: .02). Besides, mothers' participation in prenatal care (PNC) visits, assessed by caregivers, was significantly more satisfactory in neonates without any adverse outcome than those with neonatal adverse outcomes (median (IQR) = 2 (1-2) versus 2 (2-3), p: .04). PROM, pre-eclampsia, NICU admission, neonatal intubation, low Apgar score minute 0, and low Apgar score minute 5 were significantly more prevalent in participants revealing positive father's family history of pre-eclampsia. Regarding psychosocial exposures, placental abruption was more prevalent in mothers with exposure to verbal aggression versus non-exposed ones (9 versus 2%, odds ratio: 4.0, 95% CI 0.9-24.6, p: .04). Moreover, a weak positive association between neonatal gestational age at birth and quality of mother's participation in PNC visits (r: +0.3, p: .01) as well as mother's satisfaction from father's commitment to PNC visits was found (r: +0.1, p: .03).Conclusion: Male partners may play a key role in pregnant women and fetus's heath.
METHODS::Objective: To compare maternal and neonatal outcomes by forceps vaginal delivery versus cesarean delivery during the second stage of labor.Methods: We conducted a retrospective cohort study in a large tertiary maternity center in Shanghai, China through 2007-2016. A total of 7046 women carrying a singleton term nonanomalous fetus with vertex presentation who underwent forceps vaginal delivery, or cesarean delivery from a low station in the second stage of labor were included.Results: Of the 7046 women, 6265 underwent forceps and 781 underwent second stage cesarean delivery. Forceps were associated with lower frequency of maternal infection (2.2 versus 4.7%), but higher incidence of mild postpartum hemorrhage (PPH) (4.3 versus 0.6%). When the procedures were performed for fetal indication, forceps were associated with lower frequency of the composite of perinatal mortality and/or hypoxic ischemic encephalopathy (HIE) (0.5 versus 1.9%; adjusted odds ratio (aOR), 0.24; 95% CI: 0.08-0.75), and also shorter decision to delivery interval (12.3 ± 3.5 versus 19.1 ± 5.0 min). The neonatal infection rate was higher in the forceps group (3.9 versus 2.0%). There were no differences in other neonatal outcomes including birth trauma.Conclusions: In women who had a need for intervention during the second stage with a station of +2 or below, forceps were associated with a lower frequency of maternal infection but a higher rate of PPH. Deliveries performed for nonreassuring status were accomplished faster by forceps and were associated with a lower frequency of the composite of perinatal mortality and HIE.