Temperature and preeclampsia: Epidemiological evidence that perturbation in maternal heat homeostasis affects pregnancy outcome.

体温与先兆子痫: 母体热量稳态扰动影响妊娠结局的流行病学证据。

  • 影响因子:3.02
  • DOI:10.1371/journal.pone.0232877
  • 作者列表:"Shashar S","Kloog I","Erez O","Shtein A","Yitshak-Sade M","Sarov B","Novack L
  • 发表时间:2020-05-18

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::Background: The exact cause of preeclampsia remains unknown. The past decade has seen an ongoing debate on the relative importance of primipaternity versus prolonged birth/pregnancy interval.Aims: The aim of the current study was to analyze these two major potential risk factors in a high risk population in the Northern suburbs of Adelaide; a socioeconomically disadvantaged area characterized by instable relationships and overall poor health and lifestyle.Methods: A retrospective cohort study was performed on all multigravid women birthing at the Lyell McEwin Hospital, Adelaide, from July 2011 to August 2012; 2003 patients were included in this analysis. Basic demographic data, previous pregnancy outcomes, paternity, and birth and pregnancy intervals were recorded.Results: Women with a previously normal pregnancy had a significantly increased risk of developing preeclampsia in subsequent pregnancy with a new paternity (OR: 2.27 [p = .015]). Increasing birth and pregnancy intervals were associated with a significantly increased risk of developing preeclampsia in later pregnancies, with OR 1.39 at 3 years (p = .042) and OR 2.05 at 4 years (p = .002).Conclusions: The results of this study indicate that both prolonged birth interval and primipaternity are independent risk factors for preeclampsia in multigravidae.

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作者列表:["Lapoirie J","Contis A","Guy A","Lifermann F","Viallard JF","Sentilhes L","James C","Duffau P"]

METHODS::Introduction: Philadelphia-negative myeloproliferative neoplasms (MPNs) greatly increase the risk of maternal and fetal complications during pregnancy. Currently, international agreements regarding the management of these women are lacking.Patients and methods: Our study aimed to assess the current management and outcomes of MPN pregnancies in a French cohort. We retrospectively analyzed 27 pregnancies in women with MPNs that were associated with a specific mutation. Nineteen pregnancies in nine women with essential thrombocythemia and eight pregnancies in five women with polycythemia vera were identified.Results: Our study showed 70% live births, but only 30% uneventful pregnancies. Fetal complications were mainly early spontaneous abortions (22%), fetal growth restriction (15%), and premature delivery (15%). Maternal issues were divided between thrombosis (15%) and hemorrhages (11%). High rates of preeclampsia and hemolysis, elevated liver enzymes, and low platelet count syndrome (15%) were reported. Uterine artery Doppler was performed in 70% pregnancies. Abnormal Doppler results were found in 43% pregnancies. Pregnancies with high platelet counts and packed cell volume remaining static or increasing ended with fetal death and utero-placental dysfunction. According to expert consensus, most of the pregnancies (67%) could be stratified in the high risk group and had a bad obstetrical outcome, with 50% standard-risk pregnancies versus 22% high-risk pregnancies that were uneventful. Higher risk pregnancies were prescribed heparin and/or interferon α in 72%.Conclusions: The prognosis of these pregnancies remains very bad and may be improved by a more effective collaboration between specialists as well as a therapeutic intensification including heparin and interferon α.

作者列表:["Capriglione S","Plotti F","Terranova C","Gulino FA","Di Guardo F","Lopez S","Scaletta G","Angioli R"]

METHODS::Purpose: The challenge to obtain improved predictive tools, able to identify women destined to develop preeclampsia (PE), is raising the interest of researchers for the attractive chance to allow for timely initiation of prophylactic therapy, appropriate antenatal surveillance, and better-targeted research into preventive interventions. We aimed to gather all the evidence reported up to now in scientific literature relating to all prediction tests for PE.Materials and methods: We searched articles on conventional literature platforms from January 1952 to August 2016, using the terms "preeclampsia," "gestational preeclampsia," and "gestational hypertensive disorders" combined with "predictive test" and "risk assessment." Abstracts/titles identified by the search were screened by three investigators.Results: The search identified 203 citations, of which 154 potentially relevant after the initial evaluation. Among these studies, 20 full articles were excluded, therefore, 134 primary studies met the criteria for inclusion and were analyzed.Conclusions: Current evidence suggests that a combination of several features may provide the best predictive accuracy for the identification of PE. Large-scale, multicenter, multiethnic, prospective trials are required to propose an ideal combination of markers for routine screening.

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