Sexual Dimorphism in Adverse Pregnancy Outcomes - A Retrospective Australian Population Study 1981-2011

Objectives Sexual inequality starts in utero. The contribution of biological sex to the developmental origins of health and disease is increasingly recognized. The aim of this study was to assess and interpret sexual dimorphisms for three major adverse pregnancy outcomes which affect the health of the neonate, child and potentially adult. Methods Retrospective population-based study of 574,358 South Australian singleton live births during 1981-2011. The incidence of three major adverse pregnancy outcomes [preterm birth (PTB), pregnancy induced hypertensive disorders (PIHD) and gestational diabetes mellitus (GDM)] in relation to fetal sex was compared according to traditional and fetus-at-risk (FAR) approaches. Results The traditional approach showed male predominance for PTB [20-24 weeks: Relative Risk (RR) M/F 1.351, 95%-CI 1.274-1.445], spontaneous PTB [25-29 weeks: RR M/F 1.118, 95%-CI 1.044-1.197%], GDM [RR M/F 1.042, 95%-CI 1.011-1.074], overall PIHD [RR M/F 1.053, 95%-CI 1.034-1.072] and PIHD with term birth [RR M/F 1.074, 95%-CI 1.044-1.105]. The FAR approach showed that males were at increased risk for PTB [20-24 weeks: RR M/F 1.273, 95%-CI 1.087-1.490], for spontaneous PTB [25-29 weeks: RR M/F 1.269, 95%-CI 1.143-1.410] and PIHD with term birth [RR M/F 1.074, 95%-CI 1.044-1.105%]. The traditional approach demonstrated female predominance for iatrogenic PTB [25-29 weeks: RR M/F 0.857, 95%-CI 0.780-0.941] and PIHD associated with PTB [25-29 weeks: RR M/F 0.686, 95%-CI 0.581-0.811]. The FAR approach showed that females were at increased risk for PIHD with PTB [25-29 weeks: RR M/F 0.779, 95%-CI 0.648-0.937]. Conclusions This study confirms the presence of sexual dimorphisms and presents a coherent framework based on two analytical approaches to assess and interpret the sexual dimorphisms for major adverse pregnancy outcomes. The mechanisms by which these occur remain elusive, but sex differences in placental gene expression and function are likely to play a key role. Further research on sex differences in placental function and maternal adaptation to pregnancy is required to delineate the causal molecular mechanisms in sex-specific pregnancy outcome. Identifying these mechanisms may inform fetal sex specific tailored antenatal and neonatal care

A Prospective Cohort Study Investigating Associations between Hyperemesis Gravidarum and Cognitive, Behavioural and Emotional Well-Being in Pregnancy

Objectives: To investigate the association between hyperemesis gravidarum and altered cognitive, behavioural and emotional well-being in pregnancy. Methods: The study cohort consisted of 3423 nulliparous women recruited in the Screening for Pregnancy Endpoints (SCOPE) study performed in Auckland, New Zealand; Adelaide, Australia; Cork, Ireland; Manchester and London, United Kingdom between November 2004 and August 2008. Women were interviewed at 15±1 weeks' gestation and at 20±1weeks' gestation. Women with a diagnosis of hyperemesis gravidarum (HG) were compared with women who did not have a diagnosis of HG. Main outcome measures included the Short form State- Trait Anxiety Inventory (STAI) score (range 6–24), Perceived Stress Scale score (PSS, range 0–30), Edinburgh Postnatal Depression Scale (EPDS) score (range 0–30 or categories a–c) and behavioural responses to pregnancy score (limiting/resting [range 0–20] and all-or-nothing [range 0–28]). Results: During the study period 164 women suffered from HG prior to their 15 week interview. Women with HG had significantly higher mean STAI, PSS, EPDS and limiting response to pregnancy scores compared to women without HG. These differences were observed at both 15±1 and 20±1 weeks' of gestation. The magnitude of these differences was greater in women with severe HG compared to all women with HG. Women with severe HG had an increased risk of having a spontaneous preterm birth compared with women without HG (adjusted OR 2.6 [95% C.I. 1.2, 5.7]). Conclusion: This is the first large prospective study on women with HG. Women with HG, particularly severe HG, are at increased risk of cognitive, behavioural and emotional dysfunction in pregnancy. Women with severe HG had a higher rate of spontaneous preterm birth compared to women without HG. Further research is required to determine whether the provision of emotional support for women with HG is beneficial.Fergus P. McCarthy, Ali S. Khashan, Robyn A. North, Rona Moss-Morris, Philip N. Baker, Gus Dekker, Lucilla Poston, Louise C. Kenny on behalf of the SCOPE consortiu

Seasonality of gestational diabetes mellitus:a South Australian population study

Objective: To investigate whether there is a seasonal variation in the incidence of gestational diabetes mellitus (GDM). Research design and methods: This retrospective cohort study of 60 306 eligible South Australian live-born singletons during 2007-2011 recorded in the South Australian Perinatal Statistics Collection (SAPSC) examined the incidence of GDM in relation to estimated date of conception (eDoC). Fourier series analysis was used to model seasonal trends. Results: During the study period, 3632 (6.0%) women were diagnosed with GDM. Seasonal modeling showed a strong relation between GDM and eDoC (p Conclusions: This study is the first population-based study to demonstrate a seasonal variation for GDM. Several maternal lifestyle and psychosocial factors associated with seasonality and GDM may be influential in the pathophysiologic mechanisms of GDM. Ambient temperature, physical activity, nutrient intake, and vitamin D levels may affect maternal physiology, and fetal and placental development at the cellular level and contribute to the development of GDM. The mechanisms underlying these possible associations are not fully understood and warrant further investigation

Use of metabolomics for the identification and validation of clinical biomarkers for preterm birth:Preterm SAMBA

Made available in DSpace on 2018-12-11T17:29:12Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-08-08Background: Spontaneous preterm birth is a complex syndrome with multiple pathways interactions determining its occurrence, including genetic, immunological, physiologic, biochemical and environmental factors. Despite great worldwide efforts in preterm birth prevention, there are no recent effective therapeutic strategies able to decrease spontaneous preterm birth rates or their consequent neonatal morbidity/mortality. The Preterm SAMBA study will associate metabolomics technologies to identify clinical and metabolite predictors for preterm birth. These innovative and unbiased techniques might be a strategic key to advance spontaneous preterm birth prediction. Methods/design: Preterm SAMBA study consists of a discovery phase to identify biophysical and untargeted metabolomics from blood and hair samples associated with preterm birth, plus a validation phase to evaluate the performance of the predictive modelling. The first phase, a case-control study, will randomly select 100 women who had a spontaneous preterm birth (before 37 weeks) and 100 women who had term birth in the Cork Ireland and Auckland New Zealand cohorts within the SCOPE study, an international consortium aimed to identify potential metabolomic predictors using biophysical data and blood samples collected at 20 weeks of gestation. The validation phase will recruit 1150 Brazilian pregnant women from five participant centres and will collect blood and hair samples at 20 weeks of gestation to evaluate the performance of the algorithm model (sensitivity, specificity, predictive values and likelihood ratios) in predicting spontaneous preterm birth (before 34 weeks, with a secondary analysis of delivery before 37 weeks). Discussion: The Preterm SAMBA study intends to step forward on preterm birth prediction using metabolomics techniques, and accurate protocols for sample collection among multi-ethnic populations. The use of metabolomics in medical science research is innovative and promises to provide solutions for disorders with multiple complex underlying determinants such as spontaneous preterm birth.University of Campinas (UNICAMP) School of Medical Sciences Department of Obstetrics and Gynecology, R. Alexander Fleming, 101University of Auckland Gravida: National Centre for Growth and Development Liggins InstituteUniversity College Cork Irish Centre for Fetal and Neonatal Translational Research (INFANT) Department of Obstetrics and GynaecologyUniversity of Auckland South Auckland Clinical School Faculty of Medical and Health SciencesUniversity of Auckland School of Biological SciencesUniversity of Campinas (UNICAMP) LNBio-Brazilian Biosciences National Laboratory and School of Medical SciencesSchool of Medical Sciences University of CampinasLNBioSchool of Medicine of Botucatu UNESPSchool of Medicine Federal University of Rio Grande do SulSchool of Medicine Federal University of PernambucoSchool of Medicine Federal University of CearáKing's College London and King's Health PartnersMaternal and Fetal Health Research Centre University of ManchesterUniversity of LeedsUniversity of AdelaideSchool of Medicine of Botucatu UNES

Seasonality of hypertensive disorders of pregnancy - A South Australian population study

Objectives: To investigate the seasonal variation of hypertensive disorders of pregnancy (HDP) in South Australia. Study design: Retrospective population study including all 107,846 liveborn singletons during 2007-2014 in South Australia. Seasonality in incidence of HDP in relation to estimated date of conception (eDoC) and date of birth (DoB) were examined using Fourier series analysis. Main outcome measures: Seasonality of HDP in relation to eDoC and DoB. Results: During 2007-2014, the incidence of HDP was 7.1% (n = 7,612). Seasonal modeling showed a strong relationship between HDP and eDoC (p <.001) and DoB (p <.001). Unadjusted and adjusted models (adjusted for maternal age, body mass index, ethnicity, parity, type of health care, smoking and gestational diabetes mellitus) demonstrated the presence of a peak incidence (7.8%, 7.9% respectively) occurring among pregnancies with eDoC in late Spring (November) and a trough (6.4% and 6.3% respectively) among pregnancies with eDoC in late Autumn (May). Both unadjusted and adjusted seasonal modelling showed a peak incidence of HDP for pregnancies with DoB in August (8.0%, 8.1% respectively) and a nadir among pregnancies with eDoB in February (6.2%). Conclusion: The highest incidence of HDP was associated with pregnancies with eDoC during late spring and summer and birth in winter, while the lowest incidence of HDP was associated with pregnancies with eDoC during late autumn and early winter and birth in summer. Nutrient intake, in particular vitamin D, sunlight exposure and physical activity may affect maternal, fetal and placental adaptation to pregnancy and are potential contributors to the seasonal variation of HDP

Peripheral maternal haemodynamics across pregnancy in hypertensive disorders of pregnancy

Objectives: Evaluating maternal haemodynamics across pregnancy in uncomplicated pregnancies and those complicated by hypertensive disorders of pregnancy (HDP). Study design: Prospective cohort study from 2015 to 2018 of healthy, nulliparous, singleton-bearing women. Maternal haemodynamics assessed by Uscom BP+ at 9-16 and 32-36 weeks' gestation in pregnancies complicated by HDP [preeclampsia with severe (sPE n=12) and without severe clinical features (nsPE n=49), gestational hypertension (GH n=25), transient gestational hypertension (TGH n=33)] were compared to uncomplicated pregnancies (n=286) using mixed-effects linear modelling. Main outcome measures: Maternal haemodynamic adaptation in uncomplicated pregnancies and those complicated by HDP. Results: Between the two measurements, haemodynamic adaptation in women with sPE and nsPE was significantly different compared to those with uncomplicated pregnancies. An additional increase was observed for peripheral systolic blood pressure [SBP; 14.3 mmHg, 8.6-20.1 (sPE)], peripheral diastolic blood pressure [DBP; 7.7 mmHg, 3.3-12.1 (sPE); 2.6 mmHg, 3.3-12.1 (nsPE)] peripheral mean arterial pressure [MAP; 10.6 mmHg, 5.8-15.5 (sPE); 3.4 mmHg, 0.8-6.0 (nsPE)], peripheral pulse pressure [PP; 6.6 mmHg, 2.1-11.1 (sPE)], central SBP [15.8 mmHg, 10.4-21.2 (sPE); 2.9 mmHg, 0.1-5.8 (nsPE)], central DBP [8.3 mmHg, 3.9-12.6 (sPE); 2.5 mmHg, 0.2-4.8 (nsPE), central MAP [10.8 mmHg, 6.4-15.2 (sPE); 2.6 mmHg, 0.3-5.0 (nsPE)] and central PP [7.6 mmHg, 3.9-11.3 (sPE)]. Augmentation index (AIx) decreased less (15.5%, 6.3-24.6 (sPE); 9.0%, 4.2-13.6 (nsPE)] compared to uncomplicated pregnancies. Haemodynamic adaptation across pregnancy in women with GH and TGH was not different from those with uncomplicated pregnancies. Conclusion: Women who develop preeclampsia show an altered, while those who develop GH or TGH demonstrate a comparable haemodynamic adaptation compared to uncomplicated pregnancies. TGH is not a benign condition

Early pregnancy cardio metabolic risk factors and the prevalence of metabolic syndrome 10 years after the first pregnancy.

BackgroundWe aimed to compare risk factors for CVD 10 years postpartum among women who had ≥ 1 compared to no cardio metabolic risk factor in early first pregnancy.MethodsWomen of the SCOPE (Screening fOr Pregnancy Endpoints) study from Adelaide, South Australia were invited to participate in a cardiovascular risk assessment 10 years after the delivery of the first child. Data from 141 women who completed all the assessments are included in the analyses.ResultCompared to women who did not have any cardio metabolic risk factor at 15 ± 1 weeks' gestation during the first pregnancy, those who had ≥ 1 risk factor were 5.5 times more likely to have metabolic syndrome 10 years postpartum (aOR = 5.5, 95% CI 1.8-17.3, p = 0.004). Women who had ≥ 1cardio metabolic risk factor during the first pregnancy were more likely to be obese (p = 0.001), have high total cholesterol levels (p ConclusionCardio metabolic risk factors at the booking visit in the first pregnancy may be useful in identifying young women at risk of future CVD

Sexual dimorphism for length of gestation in categories.

<p>Births in South Australia 1981–2011. Marked points represent significant RR M/F.</p