Systemic sclerosis and pregnancy outcomes. A retrospective study from a single center

Background: Pregnancy in systemic sclerosis (SSc) patients is no more an infrequent event as it used to be, but literature data on pregnancy outcomes in women with SSc are scarce. The rate of preterm deliveries and intrauterine growth restriction (IUGR) seems to be increased, while the risk of miscarriages is controversial. Moreover, no study compared pregnancy outcomes in SSc with antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE). We performed a retrospective study to compare the pregnancy and disease outcomes of women with SSc with a cohort of age-matched women with systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), and healthy controls (HC). Methods: A total of 154 pregnancies from SSc, SLE, APS patients, and HC were prospectively followed at the High-Risk Pregnancy Unit of our center from 2008 to 2019. The primary outcome was a composite endpoint of miscarriages, fetal deaths, intrauterine growth restriction (IUGR), preeclampsia, neonatal deaths, preterm birth, and small-for-gestational-age (SGA) newborns. Single adverse pregnancy outcomes (APO) represented secondary endpoints. SSc activity variations in relation to pregnancy were assessed. Results: The risk of APO was significantly higher in SSc patients compared to HC (60.6% vs 10.0%; OR = 14.42; 95% CI 3.70-56.18, p = 0.001) and SLE patients (60.6% vs 37.5%; OR = 3.56; 95% CI 1.29-9.83, p = 0.014). Compared to HC, women with SSc had an increased frequency of first trimester miscarriage (15% vs 0 %; p = 0.016), preeclampsia (12% vs 0%, p = 0.038), and SGA newborns (21.2% vs 0%; p = 0.003). Preterm deliveries were more frequent in SSc pregnancies in comparison with HC (24.2% vs 5%; OR = 6.08; 95% CI 1.19-31.02, p = 0.036) and SLE patients (24.2% vs 7.5%, OR = 5.68; 95% CI 1.1-29.38, p = 0.038). Disease remained stable in all SSc patients during pregnancy and up to 1 year after delivery. Conclusions: We found an increased risk of APO in our SSc cohort in comparison with HC (with higher rates of miscarriages, preeclampsia, SGA newborns, and preterm deliveries) and SLE patients (presenting a higher rate of preterm deliveries). High-risk multidisciplinary management of SSc pregnant women is highly recommended

DBI Inflation in the Tip Region of a Warped Throat

Previous work on DBI inflation, which achieves inflation through the motion of a $D3$ brane as it moves through a warped throat compactification, has focused on the region far from the tip of the throat. Since reheating and other observable effects typically occur near the tip, a more detailed study of this region is required. To investigate these effects we consider a generalized warp throat where the warp factor becomes nearly constant near the tip. We find that it is possible to obtain 60 or more e-folds in the constant region, however large non-gaussianities are typically produced due to the small sound speed of fluctuations. For a particular well-studied throat, the Klebanov-Strassler solution, we find that inflation near the tip may be generic and it is difficult to satisfy current bounds on non-gaussianity, but other throat solutions may evade these difficulties.Comment: 26 pages, 1 figure. v1. references added, typos corrected v2. clarifications mad

Metastable SUSY Breaking, de Sitter Moduli Stabilisation and K\"ahler Moduli Inflation

We study the influence of anomalous U(1) symmetries and their associated D-terms on the vacuum structure of global field theories once they are coupled to N=1 supergravity and in the context of string compactifications with moduli stabilisation. In particular, we focus on a IIB string motivated construction of the ISS scenario and examine the influence of one additional U(1) symmetry on the vacuum structure. We point out that in the simplest one-Kahler modulus compactification, the original ISS vacuum gets generically destabilised by a runaway behaviour of the potential in the modulus direction. In more general compactifications with several Kahler moduli, we find a novel realisation of the LARGE volume scenario with D-term uplifting to de Sitter space and both D-term and F-term supersymmetry breaking. The structure of soft supersymmetry breaking terms is determined in the preferred scenario where the standard model cycle is not stabilised non-perturbatively and found to be flavour universal. Our scenario also provides a purely supersymmetric realisation of Kahler moduli (blow-up and fibre) inflation, with similar observational properties as the original proposals but without the need to include an extra (non-SUSY) uplifting term.Comment: 38 pages, 8 figures. v2: references added, minor correction

Accidental Inflation in the Landscape

We study some aspects of fine tuning in inflationary scenarios within string theory flux compactifications and, in particular, in models of accidental inflation. We investigate the possibility that the apparent fine-tuning of the low energy parameters of the theory needed to have inflation can be generically obtained by scanning the values of the fluxes over the landscape. Furthermore, we find that the existence of a landscape of eternal inflation in this model provides us with a natural theory of initial conditions for the inflationary period in our vacuum. We demonstrate how these two effects work in a small corner of the landscape associated with the complex structure of the Calabi-Yau manifold P^4_[1,1,1,6,9] by numerically investigating the flux vacua of a reduced moduli space. This allows us to obtain the distribution of observable parameters for inflation in this mini-landscape directly from the fluxes.Comment: 40 pages, 11 figure

de Sitter String Vacua from Kahler Uplifting

We present a new way to construct de Sitter vacua in type IIB flux compactifications, in which the interplay of the leading perturbative and non-perturbative effects stabilize all moduli in dS vacua at parametrically large volume. Here, the closed string fluxes fix the dilaton and the complex structure moduli while the universal leading perturbative quantum correction to the Kahler potential together with non-perturbative effects stabilize the volume Kahler modulus in a dS_4-vacuum. Since the quantum correction is known exactly and can be kept parametrically small, this construction leads to calculable and explicitly realized de Sitter vacua of string theory with spontaneously broken supersymmetry.Comment: 1+21 pages, 5 figures, LaTeX, uses JHEP3 class, v3: conforms with published versio

Inflation with improved D3-brane potential and the fine tunings associated with the model

We investigate brane-antibrane inflation in a warped deformed conifold background that includes contributions to the potential arising from imaginary anti-self-dual (IASD) fluxes including the term with irrational scaling dimension discovered recently. We find that the model can give rise to required number of e-foldings; observational constraint on COBE normalization is easily satisfied and low value of the tensor to scalar ratio of perturbations is achieved. We observe that these corrections to the effective potential help in relaxing the severe fine tunings associated with the earlier analysis.Comment: 8 pages, 4 figures; typos corrected, minor clarifications and new refs added, to appear in epj

Multiple Inflation, Cosmic String Networks and the String Landscape

Motivated by the string landscape we examine scenarios for which inflation is a two-step process, with a comparatively short inflationary epoch near the string scale and a longer period at a much lower energy (like the TeV scale). We quantify the number of $e$-foldings of inflation which are required to yield successful inflation within this picture. The constraints are very sensitive to the equation of state during the epoch between the two inflationary periods, as the extra-horizon modes can come back inside the horizon and become reprocessed. We find that the number of $e$-foldings during the first inflationary epoch can be as small as 12, but only if the inter-inflationary period is dominated by a network of cosmic strings (such as might be produced if the initial inflationary period is due to the brane-antibrane mechanism). In this case a further 20 $e$-foldings of inflation would be required at lower energies to solve the late universe's flatness and horizon problems.Comment: 27 pages, 6 figures; v2: refences adde

Uplifting and Inflation with D3 Branes

Back-reaction effects can modify the dynamics of mobile D3 branes moving within type IIB vacua, in a way which has recently become calculable. We identify some of the ways these effects can alter inflationary scenarios, with the following three results: (1) By examining how the forces on the brane due to moduli-stabilizing interactions modify the angular motion of D3 branes moving in Klebanov-Strassler type throats, we show how previous slow-roll analyses can remain unchanged for some brane trajectories, while being modified for other trajectories. These forces cause the D3 brane to sink to the bottom of the throat except in a narrow region close to the D7 brane, and do not ameliorate the \eta-problem of slow roll inflation in these throats; (2) We argue that a recently-proposed back-reaction on the dilaton field can be used to provide an alternative way of uplifting these compactifications to Minkowski or De Sitter vacua, without the need for a supersymmetry-breaking anti-D3 brane; and (3) by including also the D-term forces which arise when supersymmetry-breaking fluxes are included on D7 branes we identify the 4D supergravity interactions which capture the dynamics of D3 motion in D3/D7 inflationary scenarios. The form of these potentials sheds some light on recent discussions of how symmetries constrain D term interactions in the low-energy theory.Comment: JHEP.cls, 35 pages, 3 .eps figure

Warped Tachyonic Inflation in Type IIB Flux Compactifications and the Open-String Completeness Conjecture

We consider a cosmological scenario within the KKLT framework for moduli stabilization in string theory. The universal open string tachyon of decaying non-BPS D-brane configurations is proposed to drive eternal topological inflation. Flux-induced `warping' can provide the small slow-roll parameters needed for successful inflation. Constraints on the parameter space leading to sufficient number of e-folds, exit from inflation, density perturbations and stabilization of the Kahler modulus are investigated. The conditions are difficult to satisfy in Klebanov-Strassler throats but can be satisfied in T^3 fibrations and other generic Calabi-Yau manifolds. This requires large volume and magnetic fluxes on the D-brane. The end of inflation may or may not lead to cosmic strings depending on the original non-BPS configuration. A careful investigation of initial conditions leading to a phenomenologically viable model for inflation is carried out. The initial conditions are chosen on the basis of Sen's open string completeness conjecture. We find time symmetrical bounce solutions without initial singularities for k=1 FRW models which are correlated with an inflationary period. Singular big-bang/big-crunch solutions also exist but do not lead to inflation. There is an intriguing correlation between having an inflationary universe in 4 dimensions and 6 compact dimensions or a big-crunch singularity and decompactification.Comment: 43 pages, 9 figures. v3: Typos correcte

Inflating in a Better Racetrack

We present a new version of our racetrack inflation scenario which, unlike our original proposal, is based on an explicit compactification of type IIB string theory: the Calabi-Yau manifold P^4_[1,1,1,6,9]. The axion-dilaton and all complex structure moduli are stabilized by fluxes. The remaining 2 Kahler moduli are stabilized by a nonperturbative superpotential, which has been explicitly computed. For this model we identify situations for which a linear combination of the axionic parts of the two Kahler moduli acts as an inflaton. As in our previous scenario, inflation begins at a saddle point of the scalar potential and proceeds as an eternal topological inflation. For a certain range of inflationary parameters, we obtain the COBE-normalized spectrum of metric perturbations and an inflationary scale of M = 3 x 10^{14} GeV. We discuss possible changes of parameters of our model and argue that anthropic considerations favor those parameters that lead to a nearly flat spectrum of inflationary perturbations, which in our case is characterized by the spectral index n_s = 0.95.Comment: 20 pages, 7 figures. Brief discussion on the non-gaussianity of this model, one more figure of the field trajectories added as well as other minor changes to the tex