Gustaaf A Dekker

• The University of Adelaide

Objectives To evaluate the relative importance of changing paternity (“primipaternity”, direct inquiry with patients) in multiparas versus prolonged birth/pregnancy interval as risk factors for preeclampsia (PE) by a logistic regression model comparing the adjusted odds ratios of both exposures. Design Assessment of all consecutive singleton deliv...

Overview of the discussions, 12th International Workshop Réunion island, Immunology and preeclampsia, December 2022.

The 2023 goal is to halve the incidence of preeclampsia worldwide to reach 3 million cases per year vs the current approximately 7 million cases. Preventive treatment by low dose aspirin only halves the incidence of early-onset preeclampsia (EOP < 34 weeks gestation) in high-risk women. However, 90% of PE cases are the late onset form (LOP, 34 week...

Objective To compare in singleton multiparous pregnancies the effect of having a new father for an index pregnancy as compared with multiparas with the same male partner and primiparas. Material and Methods 21 year data, 2001-2021, Reunion island. We compared 2233 multiparas who had a new partner NewPMP (cases) with 50,364 same partner multiparas...

Among mammalian species, human reproduction has 2 outstanding features. The human hemochorial placentation is characterized by a very deep endovascular trophoblast invasion in the spiral arteries, reaching deep into the myometrium. This requires an agonistic direct cell-cell interaction between the maternal immune system and semiallogeneic trophobl...

Citation: Robillard, P.-Y.; Boukerrou, M.; Dekker, G.; Scioscia, M.; Bonsante, F.; Boumahni, B.; Iacobelli, S. Risk

Objectives To investigate in singleton multiparous pregnancies the effect of having a new father for an index pregnancy on new-borns’ birthweights and intrauterine growth restriction. Design 20 year-observational cohort study (2001-2020) Settings Centre Hospitalier Universitaire Hospitalier Sud Reunion’s maternity (French overseas department, Ind...

Objectives: To develop a multivariate model for risk factors specific to early onset preeclampsia (EOP) and late onset preeclampsia (LOP) in our entire population (singleton and twin pregnancies). Material and methods: 20 year-observational population-based historical cohort study (2001-2020). All consecutive births delivered at the Centre Hospital...

Objectives: To develop a multivariate model for risk factors specific to early onset preeclampsia (EOP) and late onset preeclampsia (LOP) in our entire population (singleton and twin pregnancies). Material and methods: 20 year-observational population-based historical cohort study (2001-2020). All consecutive births delivered at the Centre Hospital...

Objectives: To present a comprehensive overview of different risk factors for early onset preeclampsia (<34 weeks gestation, EOP) vs. late onset (LOP). Study design: South-Reunion University’s maternity (Reunion Island, Indian Ocean). 18.5 year-observational population-based cohort study (2001–2019). Epidemiological perinatal database with informat...

Objectives To investigate in singleton term pregnancies (≥37 weeks gestation) if applying optimal gestational weight gains (optGWG) on our population could have an effect on the incidence of late-onset preeclampsia (LOP). Design 18.5-year-observational cohort study (2001–2019). Settings Centre Hospitalier Universitaire Hospitalier Sud Reunion’s m...

Introduction: Early onset preeclampsia (EOP) and late onset preeclampsia (LOP) have been differentiated with a cut point of ≤34 weeks. This classical definition has never been examined with respect to maternal characteristics by different gestational age cut points. We examined maternal characteristics in a population based cohort of 1,736 preecla...

Background To investigate the ongoing controversy on the effect of BMI (body mass index) on EOP (early onset preeclampsia) vs LOP (late onset), especially focusing on diabetes and maternal booking/pre-pregnancy BMI as possible independent variables. Methods 18 year-observational cohort study (2001–2018). The study population consisted of all conse...

The 11th workshop on Immunology of preeclampsia in Reunion 2018 celebrated its 20th candle In this paper we try to summarize the main tracks of reflections during these two decades. First, of course, the advances in immunology of reproduction in the field of preeclampsia, which was poorly developed 2 decades ago when we first started in 1998. But,...

Background & objectives: To investigate the potential association between maternal age and obstructed labour or fetal distress in primiparas, defined as requiring active ob-sterical intervention (caesarean sections, vaginal operative procedures).

The 11th workshop on Immunology of preeclampsia in Reunion 2018 celebrated its 20th candle In this paper we try to summarize the main tracks of reflections during these two decades. First, of course, the advances in immunology of reproduction in the field of preeclampsia, which was poorly developed 2 decades ago when we first started in 1998. But,...

Objectives : Adolescent pregnancies being well-known to deliver better than older counterparts, we sought to investigate the potential association between maternal age and birthing needing active medical intervention in primiparas. Design: 14 year-observational cohort study (2001-2014). The study population consisted of all consecutive primiparous...

Background There is a peculiar phenomenon: two separate individuals (mother and foetus) have a mutually interactive dependency concerning their respective weight. Very thin mothers have a higher risk of small for gestational age (SGA) infants, and rarely give birth to a large for gestational age (LGA) infant. While morbidly obese women often give b...

The authors delineate seven quantum leap forward and, or revolutions having occurred during the 20th century in the understanding of the physiopathology of preeclampsia. First the discovery of the inflatable arm band permitting to measure blood pressure in 1896. Second, the discovery that eclamptic (convulsions), and later “pre”eclamptic (proteinur...

Eclampsia (together with epilepsy) being the first disease ever written down since the beginning of writings in mankind 5000 years ago, we will make a brief presentation of the different major steps in comprehension of Pre-eclampsia. 1) 1840. Rayer, description of proteinuria in eclampsia, 2) 1897 Vaquez, discovery of gestational hypertension in ec...

Objectives: We sought to investigate the potential association between maternal age and the need for active obstetrical intervention intrapartum in primiparas. Study design: Observational study over 14 years (2001-2014) of all consecutive primiparous singleton births having delivered at the Centre Hospitalier Universitaire Hospitalier Sud Reunio...

Purpose: To investigate the association between maternal age and spontaneous breech presentation. Material and methods: 15 year-observational study over (2001-2015). All consecutive singleton births delivered at the Centre Hospitalier Universitaire Hospitalier Sud Reunion's maternity. The only single exclusion criterion was uterine malformations...

Supplementary material

Background: Obesity has been associated with increased risk of antenatal depression, but little is known about this relationship. This study tested whether socio-economic status (SES) influences the relationship between obesity and antenatal depression. Methods: Data were taken from the Screening for Pregnancy Endpoints (SCOPE) cohort. BMI was c...

Widespread legalisation of marijuana raises safety concerns for its use in pregnancy. This study investigated the association of marijuana use prior to and during pregnancy with pregnancy outcomes in a prospective cohort of 5588 nulliparous women from the international SCOPE study. Women were assessed at 15±1 and 20±1 weeks’ gestation. Cases [278 P...

There exists a paucity of data for socially disadvantaged populations describing patterns and predictors of asthma control status and exacerbations during pregnancy, and their relationship to adverse perinatal outcomes. Asthmatic women (n=189) were followed prospectively during pregnancy, with visits at 12, 20, 28 and 36 weeks gestation. Data on lo...

Introduction: During pregnancy approximately 40% of women develop anaemia, with a compensatory decrease in peripheral vascular resistance. However, the effect of anaemia on skin microvascular function is unknown. This study used laser Doppler flowmetry to determine skin microvascular reactivity in women during the third trimester of pregnancy. Meth...

Objective To investigate the association between antidepressant use in late gestation and postpartum haemorrhage (PPH).DesignRetrospective cohort study.SettingTertiary teaching hospital in Adelaide, Australia.PopulationA total of 30 198 women delivering between 2002 and 2008.Methods Relative risks adjusted for maternal sociodemographics and comorbi...

As males and females share highly similar genomes, the regulation of many sexually dimorphic traits is constrained to occur through sex-biased gene regulation. There is strong evidence that human males and females differ in terms of growth and development in utero and that these divergent growth strategies appear to place males at increased risk wh...

To compare the prevalence and predictors of alcohol use in multiple cohorts. Cross-cohort comparison of retrospective and prospective studies. Population-based studies in Ireland, the UK, Australia and New Zealand. 17 244 women of predominantly Caucasian origin from two Irish retrospective studies (Growing up in Ireland (GUI) and Pregnancy Risk Ass...

Objective: To present the outcome of expectant management of preterm preeclampsia in Indonesia, and the effect of ongoing treatment with methylprednisolone (MP) on maternal and perinatal outcome. Material and methods: Prospective RCT on 48 patients with early-onset preeclampsia. Following the administration of dexamethasone for fetal lung matura...

Introduction Preeclampsia is associated with cardiac dysfunction and long-term cardiovascular disease. A novel echocardiography technique measuring cardiac strain using speckle tracking myocardial deformation is closely related to the functional state of the myocardium and is more sensitive in the early detection of subtle left ventricular changes....

Being born small for gestational age (SGA) increases the risk for adverse perinatal outcomes and later life vascular and metabolic disorders. The insulin family plays a vital role in intrauterine growth. We investigated the association of functional SNPs in insulin (INS), insulin receptor (INSR) and insulin receptor substrate 2 (IRS2) with small fo...

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Elevated pro-inflammatory cytokines play an important role in the pathogenesis of preeclampsia. We investigated the prevalence of functional polymorphisms in genes regulating inflammation in preeclamptic women. One hundred seventy-five nulliparous Sinhalese women with preeclampsia (cases) and 171 normotensive women matched for age, ethnicity, parit...

Objective To investigate the association of the fat mass and obesity associated gene (FTO) rs9939609 single nucleotide polymorphism (SNP) with recurrent miscarriage (RM).DesignCandidate gene association study. Setting: Human Genetics Unit, Colombo, Sri Lanka.Population202 Sinhalese women with two or more first trimester miscarriages and no living c...

Background: Takotsubo Cardiomyopathy (TCM) is a rarely identified cause of acute heart failure in pregnancy. We describe the demographic characteristics, clinical features and outcomes in reported cases of peripartum TCM.

Venous thromboembolism (VTE) remains a leading cause of maternal mortality. An effective predictive test would be very clinically important. Measurements of Calibrated Automated Thrombogram (CAT) parameters in the presence and absence of thrombomodulin have been correlated with risk of recurrent VTE. D-Dimers and soluble P-selectin are markers of t...

To assess the degree of sexual dimorphism for Preterm Birth (PTB), Pregnancy Induced Hypertensive Disorders (PIHD) and Gestational Diabetes Mellitus (GDM) in an Australian population. Retrospective population-based study of 574,358 South Australian singleton live births during 1981-2011 in the South Australian Perinatal Statistics Collection of thr...

To assess the seasonal variation of pregnancy induced hypertensive disorders (PIHD) in an Australian population. Retrospective study of 59,993 South Australian singleton live born births, for whom a body mass index (BMI) of the mother and sex of the baby were recorded, during 2007-2011 in the South Australian Perinatal Statistics Collection. The in...

Objective To investigate whether women with previous miscarriages or terminations have higher levels of anxiety, depression, stress, and altered behaviours in a subsequent pregnancy. DesignA retrospective analysis of 5575 women recruited into the Screening for Pregnancy Endpoints (SCOPE) study, a prospective cohort study. SettingAuckland, New Zeala...

To investigate the clinical usefulness of Placental growth factor (PlGF) testing, prior to 35weeks and at all gestations, as a marker of subsequent disease and harm in placental insufficiency conditions (specifically pre-eclampsia and intrauterine growth restriction). A prospective cohort study was conducted, blinded to treating clinicians, analyzi...

STUDY QUESTION Which variables at 15 and 20 weeks’ gestation, particularly those amenable to modification before pregnancy, are associated with a subsequent uncomplicated pregnancy? SUMMARY ANSWER Normalising body mass index, increasing fruit intake before pregnancy, reducing blood pressure, stopping misuse of drugs, and being in paid employment ar...

Impaired fibrinolytic activity is implicated in the pathogenesis of recurrent spontaneous abortion (RSA). This case-control study assessed the prevalence of polymorphisms in fibrinolytic system genes in RSA. Cases comprised 202 Sinhalese women who had experienced at least two first-trimester spontaneous abortions and had no living children; control...

Maternal death from obstetric haemorrhage remains a common cause of maternal mortality worldwide1. Iron deficiency and iron-deficiency anaemia (IDA) in pregnancy is a global health problem affecting around 20% of women in the western world and increasing to 56% in developing countries2. It is associated with adverse physiological and psychological...

Objectives To compare the prevalence and predictors of alcohol use in multiple cohorts. Design Cross-cohort comparison of retrospective and prospective studies. Setting Population-based studies in Ireland, the UK, Australia and New Zealand. Participants 17 244 women of predominantly Caucasian origin from two Irish retrospective studies (Growing up...

More than half of all cases of preeclampsia occur in healthy first-time pregnant women. Our aim was to develop a method to predict those at risk by combining clinical factors and measurements of biomarkers in women recruited to the Screening for Pregnancy Endpoints (SCOPE) study of low-risk nulliparous women. Forty-seven biomarkers identified on th...

Circulating IGFs are important regulators of prenatal and postnatal growth, and of metabolism and pregnancy, and change with sex, age and pregnancy. Single nucleotide polymorphisms (SNPs) in genes for these hormones associate with circulating abundance of IGF1 and IGF2 in non-pregnant adults and children, but whether this occurs in pregnancy is unk...

Preeclampsia still ranks as one of obstetrics major problems. Clinicians typically encounter preeclampsia as maternal disease with variable degrees of fetal involvement. More and more the unique immunogenetic maternal-paternal relationship is appreciated, and as such also the specific 'genetic conflict' that is characteristic of haemochorial placen...

Most patients with a pregnancy-induced hypertensive disorder have no clinical symptoms. So it can only be reliably detected by repetitive searches (screening) for the early signs and symptoms in the 2nd half of pregnancy. Adequate and proper prenatal care is the most important part of management of preeclampsia. Maternal antenatal monitoring includ...

Objective: Excessive gestational weight gain (GWG) is associated with adverse maternal and child outcomes and contributes to obesity in women. Our aim was to identify early pregnancy factors associated with excessive GWG, in a contemporary nulliparous cohort. Methods: Participants in the SCOPE study were classified into GWG categories ("not exce...

As males and females share highly similar genomes, the regulation of many sexually dimorphic traits is constrained to occur through sex-biased gene regulation. There is strong evidence that human males and females differ in terms of growth and development in utero and that these divergent growth strategies appear to place males at increased risk wh...

Iron deficiency is a common nutritional deficiency amongst women of childbearing age. Peri-partum iron deficiency anaemia (IDA) is associated with significant maternal, fetal and infant morbidity. Current options for treatment are limited: these include oral iron supplementation, which can be ineffective and poorly tolerated, and red blood cell tra...

Background The effect of prenatal distress on the risk of a small for gestational age (SGA) infant is uncertain. We have addressed the influences of prenatal stress, anxiety and depression on the risk of SGA. We also examined the effects of infant sex and timing of distress during pregnancy on any observed associations. Method The study population...

Background: Pregnancy presents a unique situation for the management of asthma as it can alter the course of asthma severity and its treatment, which in turn can affect pregnancy outcomes. Despite awareness of the substantial adverse effects associated with asthma during pregnancy, little has been done to improve its management and reduce associat...

STUDY QUESTION Do women with a previous miscarriage or termination of pregnancy have an increased risk of spontaneous preterm birth and is this related to previous cervical dilatation and curettage? SUMMARY ANSWER A single previous pregnancy loss (termination or miscarriage) managed by cervical dilatation and curettage is associated with a greater...

STUDY QUESTION: Do women with a previous miscarriage or termination of pregnancy have an increased risk of spontaneous preterm birth and is this related to previous cervical dilatation and curettage? SUMMARY ANSWER: A single previous pregnancy loss (termination or miscarriage) managed by cervical dilatation and curettage is associated with a greate...

To identify factors at 15 and 20 weeks' gestation associated with a subsequent uncomplicated pregnancy. Prospective international multicentre observational cohort study. Auckland, New Zealand and Adelaide, Australia (exploration and local replication dataset) and Manchester, Leeds, and London, United Kingdom, and Cork, Republic of Ireland (external...

Pre-eclampsia is a significant health issue in pregnancy, complicating between 2-8% of pregnancies. L-arginine is an important mediator of vasodilation with a potential preventative role in pregnancy related hypertensive diseases. We aimed to systematically review randomised trials in the literature assessing the role of L-arginine in prevention an...

To investigate the association between alcohol consumption and binge drinking before and during early pregnancy and adverse pregnancy outcomes. We used data from 5,628 nulliparous pregnant participants recruited to the Screening for Pregnancy Endpoints (SCOPE) study, a prospective cohort study. Participants were interviewed at 15 weeks of gestation...

STROBE Statement - Checklist of items that should be included in reports of cohort studies. (DOCX)

Variables available to SGA, Normotensive SGA or Hypertensive SGA models. (DOCX)

This paper depicts an overview of debates that have taken place during the 14 years of the International Workshops on Reproductive Immunology/Immunological Tolerance and Immunology of Preeclampsia. This 8th event in 2012 (Reunion island, overseas department of France in the Indian Ocean) witnessed a consensus among immunologists on the key role of...

Small for gestational age (SGA) infants comprise up to 50% of all stillbirths and a minority are detected before birth. We aimed to develop and validate early pregnancy predictive models for SGA infants.5628 participants from SCOPE, a prospective study of nulliparous pregnant women, were interviewed at 15 ± 1 weeks' gestation. Fetal anthropometry,...

Maternal overweight and obesity are associated with slower labour progress and increased caesarean delivery for failure to progress. Obesity is also associated with hyperlipidaemia and cholesterol inhibits myometrial contractility in vitro. Our aim was, among overweight and obese nulliparous women, to investigate 1. the role of early pregnancy seru...

Background: The aim of this study was to replicate single-nucleotide polymorphism (SNP) associations with preterm birth (PTB; birth at <37 completed weeks of gestation) and synthesize currently available evidence using meta-analysis. Methods: Spontaneous PTB cases and controls were selected from an existing cohort. Candidate SNPs were taken from...

There are fetal sex-specific differences in the balance between angiotensin (Ang) II and Ang-(1-7) in the maternal circulation during pregnancy. To determine whether at 15 weeks' gestation plasma levels of Ang II and Ang-(1-7), as well as levels of prorenin and Ang-converting enzyme (ACE), predicted the development of gestational hypertension (GH)...

Aim: This study aims to examine single nucleotide polymorphism (SNP) associations with cerebral palsy in a multi-variable analysis adjusting for potential clinical confounders and to assess SNP-SNP and SNP-maternal infection interactions as contributors to cerebral palsy. Methods: A case control study including 587 children with cerebral palsy a...

We aimed to determine whether the ACE A11860G genotype is associated with small for gestational age babies (SGA) and to determine whether the association is affected by environmental factors and fetal sex. Overall, 3234 healthy nulliparous women with singleton pregnancies, their partners and babies were prospectively recruited in Adelaide, Australi...

Objective The aim of this study was to identify and verify plasma protein markers which may add to predictive algorithms for pre-eclampsia (PE) in asymptomatic nulliparous women. Methods We used a quantitative mass spectrometry (MS) approach to identify proteins with abundance changes in plasma (15 weeks) taken from women who subsequently develop P...