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Article: Maternal age and adverse pregnancy outcomes: a cohort study.
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ABSTRACT: OBJECTIVE: The aim of this study was to examine the association between maternal age and a wide range of adverse pregnancy outcomes after adjustment for confounding factors in obstetric history and maternal characteristics. METHODS: This was a retrospective study in women with singleton pregnancies attending the first routine hospital visit at 11(+0) -13(+6) weeks of gestation. Data on maternal characteristics, medical and obstetric history were collected and pregnancy outcomes ascertained. Maternal age was studied, both as a continuous and as a categorical variable. Regression analysis was performed to examine the association between maternal age and adverse pregnancy outcomes including preeclampsia (PE), gestational hypertension (GH), gestational diabetes mellitus (GDM), preterm delivery (PTD), small for gestational age (SGA), large for gestational age (LGA), miscarriage, stillbirth, elective and emergency cesarean section (CS). RESULTS: The study population included 76,158 singleton pregnancies with a live fetus at 11(+0) -13(+6) weeks. After adjusting for maternal and pregnancy potential confounding variables, advanced maternal age (defined as ≥40 years) was associated with increased risk of miscarriage [OR (95% CI): 2.32 (1.83-2.93), p < 0.001], PE [1.49 (1.22-1.82), p < 0.001], GDM [1.88 (1.55-2.29) p < 0.001], SGA [1.46 (1.27-1.69) p < 0.001] and CS [1.95 (1.77-2.14) p < 0.001], but not for stillbirth, GH, spontaneous PTD or LGA. CONCLUSION: Maternal age should be combined with other maternal characteristics and obstetric history when calculating an individualised adjusted risk for adverse pregnancy complications. Advanced maternal age is a risk factor for miscarriage, PE, SGA, GDM and CS, but not for stillbirth, GH, spontaneous PTD or LGA.Ultrasound in Obstetrics and Gynecology 04/2013; · 3.01 Impact Factor -
Article: First-trimester uterine Doppler examination in pregnancies complicated by gestational diabetes mellitus with or without pre-eclampsia.
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ABSTRACT: OBJECTIVES: To assess first trimester placental perfusion, reflected in uterine artery pulsatility index (PI), in pregnancies complicated by gestational diabetes mellitus (GDM), with or without pre-eclampsia (PE), compared to those that remain unaffected by GDM. METHODS: Uterine artery PI was measured at 11(+0) -13(+6) weeks' gestation in 1,037 singleton pregnancies that subsequently developed GDM and 56,649 normoglycaemic controls. The measured mean uterine artery PI was converted to multiple of the expected normal median (MoM), corrected for maternal weight, racial origin and gestational age, and the median MoM values in the two groups were compared. RESULTS: The incidence of PE was higher in GDM than in controls (4.0% vs 2.3%; p=0.001). However, there were no significant differences in the median uterine artery PI MoM between the groups (1.00, interquartile range (IQR):0.82-1.21 MoM vs 1.00, IQR: 0.81-1.21 MoM; p=0.73). The median uterine artery PI in patients that developed PE was higher than in those that did not develop PE, regardless of development of GDM. CONCLUSIONS: First trimester placental perfusion, as assessed by uterine artery Doppler examination, is not impaired in women who subsequently develop GDM. The increased prevalence of PE in women with GDM cannot be attributed to impaired placentation.Ultrasound in Obstetrics and Gynecology 02/2013; · 3.01 Impact Factor -
Article: Quantitative ELISAs for serum soluble LHCGR and hCG-LHCGR complex: potential diagnostics in first trimester pregnancy screening for stillbirth, down's syndrome, preterm delivery and preeclampsia.
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ABSTRACT: BACKGROUND: Soluble LH/hCG receptor (sLHCGR) released from placental explants and transfected cells can be detected in sera from pregnant women. To determine whether sLHCGR has diagnostic potential, quantitative ELISAs were developed and tested to examine the correlation between pregnancy outcome and levels of serum sLHCGR and hCG-sLHCGR complex. METHODS: Anti-LHCGR poly- and monoclonal antibodies recognizing defined LHCGR epitopes, commerical anti-hCGbeta antibody, together with recombinant LHCGR and yoked hCGbeta-LHCGR standard calibrators were used to develop two ELISAs. These assays were employed to quantify serum sLHCGR and hCG-sLHCGR at first trimester human pregnancy. RESULTS: Two ELISAs were developed and validated. Unlike any known biomarker, sLHCGR and hCG-sLHCGR are unique because Down's syndrome (DS), preeclampsia and preterm delivery are linked to both low (lower or equal 5 pmol/mL), and high (equal or higher 170 pmol/mL) concentrations. At these cut-off values, serum hCG-sLHCGR together with PAPP-A detected additional DS pregnancies (21%) which were negative by free hCGbeta plus PAPP-A screening procedure. Therefore, sLHCGR/hCG-sLHCGR has an additive effect on the current primary biochemical screening of aneuploid pregnancies. More than 88% of pregnancies destined to end in fetal demise (stillbirth) exhibited very low serum hCG-sLHCGR(lower or equal 5 pmol/mL) compared to controls (median 16.15 pmol/mL, n = 390). The frequency of high hCG-sLHCGR concentrations (equal or higher 170 pmol/mL) in pathological pregnancies was at least 3-6-fold higher than that of the control, suggesting possible modulation of the thyrotropic effect of hCG by sLHCGR. CONCLUSIONS: Serum sLHCGR/hCG-sLHCGR together with PAPP-A, have significant potential as first trimester screening markers for predicting pathological outcomes in pregnancy.Reproductive Biology and Endocrinology 12/2012; 10(1):113. · 2.05 Impact Factor -
Article: Maternal serum activin-A at 30-33 weeks in the prediction of preeclampsia.
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ABSTRACT: Abstract Objective: To investigate the potential value of maternal serum concentration of activin-A at 30-33 weeks' gestation in the prediction of preeclampsia (PE) developing at or after 34 weeks. Methods: Serum concentrations of activin-A were measured at 11-13 and at 30-33 weeks' gestation in a case-control study of 50 cases that developed PE and 250 unaffected controls. The measured values of activin-A were converted into multiples of the unaffected median (MoM), after adjustment for maternal characteristics, and the MoM values in the PE and controls were compared. Results: The median activin-A MoM at 30-33 weeks was higher in the PE group (1.47, IQR 1.14-2.38 vs. 0.99, IQR 0.72-1.42), but at 11-13 weeks there was no significant difference between the groups. In screening by a combination of maternal characteristics and activin-A at 30-33 weeks the detection rate of PE was 50.0%, at a false positive rate of 10%. Conclusion: Screening by maternal characteristics and activin-A at 30-33 weeks could identify half of the pregnancies that will subsequently develop PE.The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 12/2012; · 1.36 Impact Factor -
Article: Maternal Serum Soluble Endoglin at 30-33 Weeks in the Prediction of Preeclampsia.
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ABSTRACT: Objective: To investigate the potential value of maternal serum concentration of soluble endoglin (sEng) at 30-33 weeks' gestation in the prediction of preeclampsia (PE) developing at or after 34 weeks. Methods: Serum sEng was measured at 11-13 and at 30-33 weeks' gestation in a case-control study of 50 cases that developed PE at or after 34 weeks and 250 unaffected controls. Regression analysis was used to determine which of the factors amongst the maternal characteristics were significant predictors of first- and third-trimester log(10) sEng in the control group. The measured values of sEng were converted into multiples of the unaffected median (MoM) and the MoM values in the PE and controls were compared. Results: The median sEng MoM at 30-33 weeks was significantly higher in the PE group (1.39, IQR 0.94-2.18) than in the controls (0.95, IQR 0.77-1.19), but at 11-13 weeks there was no significant difference between the groups. In screening by a combination of maternal characteristics and third-trimester sEng, the detection rates of intermediate- and late-PE, at a false-positive rate of 10%, were 64.3 and 50.0%, respectively. Conclusion: Screening by maternal characteristics and sEng at 30-33 weeks could identify most pregnancies that will subsequently develop PE.Fetal Diagnosis and Therapy 11/2012; · 1.05 Impact Factor
