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1.
Obesity in pregnancy causes a volume overload in third trimester.
Vonck, S, Lanssens, D, Staelens, AS, Tomsin, K, Oben, J, Bruckers, L, Gyselaers, W
European journal of clinical investigation. 2019;(11):e13173
Abstract
BACKGROUND Obesity is a major risk factor for cardiovascular diseases. In this study, we aimed to investigate the maternal circulatory differences during pregnancy between obese and normal weight women. MATERIALS AND METHODS The functioning of the maternal circulation (arteries, veins, heart and body fluid) was assessed by ECG-Doppler ultrasound, impedance cardiography (ICG) and bio-impedance during pregnancy in obese women (BMI ≥30 kg/m2 ) and normal weight, nonobese women (BMI 20-25 kg/m2 ). In this observational study, 232 assessments were performed in the obese group, whereas 919 assessments were performed in the nonobese group. RESULTS Relative to nonobese women, the overall cardiovascular function in obese women during first and second trimester is consistent with a high volume/low-resistance circulation. In third trimester, cardiac output of obese women decreases from 9.2 (8.2-10.7) L/min to 8.5 (7.6-9.6) L/min (P = .037) whereas this is not true in the nonobese women (from 7.8 (7-8.5) L/min to 7.8 (6.8-8.9) L/min, P = .536). Simultaneously, the persistently lower peripheral vascular resistance in obese vs nonobese women disappears (880 (761-1060) dyn.sec/cm5 vs 928 (780-1067). CONCLUSIONS The circulatory gestational adaptations between nonobese and obese women were generally similar. The findings in the third trimester suggest that a pregnancy in obese women start as a state of high volume/low resistance, gradually shifting to a volume overload with decrease of cardiac output and disappearance of low vascular resistance. This evolution makes obese women vulnerable for gestational hypertensive diseases.
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2.
Comprehensive Measurements of Intrauterine and Postnatal Exposure to Lamotrigine.
Paulzen, M, Stingl, JC, Augustin, M, Saßmannshausen, H, Franz, C, Gründer, G, Schoretsanitis, G
Clinical pharmacokinetics. 2019;(4):535-543
Abstract
OBJECTIVE The aim of this study was to measure and investigate correlations of lamotrigine concentrations in maternal as well as umbilical cord blood, amniotic fluid, and breast milk to account for the distribution of the drug. METHODS Concentrations of lamotrigine were measured in 19 mother-infant pairs at the time of delivery. To account for the penetration ratio into amniotic fluid, cord blood and breast milk, the concentration of lamotrigine in the particular environment was divided by the concentration in maternal serum. A no-intercept model was applied for associations between maternal serum concentrations, amniotic fluid, umbilical cord blood, and breast milk concentrations. RESULTS The mean daily dosage of lamotrigine was 351.32 mg (range 50-650 mg). We detected associations between maternal serum and amniotic fluid (β = 0.088, p < 0.001), as well as umbilical cord (β = 0.939, p < 0.001) and breast milk (β = 0.964, p < 0.001). The median penetration ratio into amniotic fluid, cord blood, and breast milk was 0.68, 0.92, and 0.77, respectively. CONCLUSIONS Lamotrigine concentrations in amniotic fluid, cord blood, and breast milk give evidence that the fetus/newborn is constantly exposed to lamotrigine. Maternal serum concentrations predicted exposure via amniotic fluid, umbilical cord, and breast milk. Data suggest that therapeutic drug monitoring can be recommended as part of the clinical routine in psychopharmacotherapy for pregnant or breastfeeding women.
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The plasma metabolome of women in early pregnancy differs from that of non-pregnant women.
Handelman, SK, Romero, R, Tarca, AL, Pacora, P, Ingram, B, Maymon, E, Chaiworapongsa, T, Hassan, SS, Erez, O
PloS one. 2019;(11):e0224682
Abstract
BACKGROUND In comparison to the non-pregnant state, the first trimester of pregnancy is characterized by systemic adaptation of the mother. The extent to which these adaptive processes are reflected in the maternal blood metabolome is not well characterized. OBJECTIVE To determine the differences between the plasma metabolome of non-pregnant and pregnant women before 16 weeks gestation. STUDY DESIGN This study included plasma samples from 21 non-pregnant women and 50 women with a normal pregnancy (8-16 weeks of gestation). Combined measurements by ultrahigh performance liquid chromatography/tandem mass spectrometry and by gas chromatography/mass spectrometry generated molecular abundance measurements for each sample. Molecular species detected in at least 10 samples were included in the analysis. Differential abundance was inferred based on false discovery adjusted p-values (FDR) from Mann-Whitney-Wilcoxon U tests <0.1 and a minimum median abundance ratio (fold change) of 1.5. Alternatively, metabolic data were quantile normalized to remove sample-to-sample differences in the overall metabolite abundance (adjusted analysis). RESULTS Overall, 637 small molecules met the inclusion criteria and were tested for association with pregnancy; 44% (281/637) of small molecules had significantly different abundance, of which 81% (229/281) were less abundant in pregnant than in non-pregnant women. Eight percent (14/169) of the metabolites that remained significant in the adjusted analysis also changed as a function of gestational age. A pathway analysis revealed enrichment in steroid metabolites related to sex hormones, caffeine metabolites, lysolipids, dipeptides, and polypeptide bradykinin derivatives (all, FDR < 0.1). CONCLUSIONS This high-throughput mass spectrometry study identified: 1) differences between pregnant vs. non-pregnant women in the abundance of 44% of the profiled plasma metabolites, including known and novel molecules and pathways; and 2) specific metabolites that changed with gestational age.
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Maternal hemoglobin concentrations across pregnancy and maternal and child health: a systematic review and meta-analysis.
Young, MF, Oaks, BM, Tandon, S, Martorell, R, Dewey, KG, Wendt, AS
Annals of the New York Academy of Sciences. 2019;(1):47-68
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Abstract
Maternal anemia is a well-recognized global health problem; however, there remain questions on specific hemoglobin (Hb) thresholds that predict health risk or protection for mother and child. We conducted a systematic review and meta-analysis to examine the associations of maternal Hb concentrations with a range of maternal and infant health outcomes, accounting for the timing of measurement (preconception, and first, second, and third trimesters), etiology of anemia, and cutoff category. The systematic review included 272 studies and the meta-analysis included 95 studies. Low maternal Hb (<110 g/L) was associated with poor birth outcomes (low birth weight, preterm birth, small-for-gestational-age (SGA), stillbirth, and perinatal and neonatal mortality) and adverse maternal outcomes (postpartum hemorrhage, preeclampsia, and blood transfusion). High maternal Hb (>130 g/L) was associated with increased odds of SGA, stillbirth, preeclampsia, and gestational diabetes. Relationships varied by the timing of measurement and cutoff category (stronger associations with lower cutoffs); limited data were available on anemia etiology. There were insufficient data for other maternal outcomes and long-term child health outcomes. Current data are insufficient for determining if revisions to current Hb cutoffs are required. Pooled high-quality individual-level data analyses, as well as prospective cohort studies, would be valuable to inform the reevaluation of Hb cutoffs.
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Maternal and Fetal Thyroid Physiology.
Sterrett, M
Clinical obstetrics and gynecology. 2019;(2):302-307
Abstract
This study was a brief review of maternal and fetal thyroid function and pathology during pregnancy.
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Prenatal maternal docosahexaenoic acid intake and infant information processing at 4.5mo and 9mo: A longitudinal study.
Rees, A, Sirois, S, Wearden, A
PloS one. 2019;(2):e0210984
Abstract
Previous research suggesting an association between maternal prenatal docosahexaenoic acid (DHA) intake and infant cognition has yet to assess whether there is a critical trimester for the observed effects. We used a comprehensive Food Frequency Questionnaire to estimate DHA levels during both the second and third trimesters of pregnancy, in a sample of 125 pregnant women. Infants were assessed at 4.5 months and 9 months post-partum using specific tests of visual acuity, habituation, and visual attention. Based on maternal DHA levels during pregnancy, mothers were subdivided into high, medium, and low groups, and their infants compared for task performance using one-way ANOVAs with maternal DHA groups. On the 9 month visual acuity test, infants whose mothers were in the medium DHA group performed significantly better than those with mothers in the low or high DHA groups (p = 0.008). However, no significant finding was found for any of the other cognitive assessment measures. Despite a number of studies reporting a positive effect of higher DHA levels on cognitive development, this study fails to support those conclusions. We can, however, conclude that it appears to be DHA intake in the third trimester specifically, which is influencing the development of visual acuity towards the end of the first postnatal year.
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Maternal Thyroid Function in Early Pregnancy and Child Attention-Deficit Hyperactivity Disorder: An Individual-Participant Meta-Analysis.
Levie, D, Korevaar, TIM, Mulder, TA, Bath, SC, Dineva, M, Lopez-Espinosa, MJ, Basterrechea, M, Santa-Marina, L, Rebagliato, M, Sunyer, J, et al
Thyroid : official journal of the American Thyroid Association. 2019;(9):1316-1326
Abstract
Background: Thyroid hormone is essential for optimal fetal brain development. Evidence suggests that both low and high maternal thyroid hormone availability may have adverse effects on child neurodevelopmental outcomes, but the effect on behavioral problems remains unclear. We studied the association of maternal thyrotropin (TSH) and free thyroxine (fT4) concentrations during the first 18 weeks of pregnancy with child attention-deficit hyperactivity disorder (ADHD). Methods: A total of 7669 mother-child pairs with data on maternal thyroid function and child ADHD were selected from three prospective population-based birth cohorts: INfancia y Medio Ambiente (INMA; N = 1073, Spain), Generation R (N = 3812, The Netherlands), and Avon Longitudinal Study of Parents and Children (ALSPAC; N = 2784, United Kingdom). Exclusion criteria were multiple pregnancy, fertility treatment, usage of medication affecting the thyroid, and pre-existing thyroid disease. We used logistic regression models to study the association of maternal thyroid function with the primary outcome, ADHD, assessed via the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria by parents and/or teachers at a median child age of 4.5 to 7.6 years, and with the secondary outcome, an ADHD symptom score above the 90th percentile. Effect modification by gestational age and sex was tested with interaction terms and stratified analyses. Results: Overall, 233 (3%) children met the criteria for ADHD. When analyzed continuously, neither fT4 nor TSH was associated with a higher risk of ADHD (odds ratio [OR] 1.1, 95% confidence interval [CI 1.0-1.3], p = 0.060 and OR 0.9 [CI 0.9-1.1], p = 0.385, respectively) or with high symptom scores. When investigating effect modification by gestational age, a higher fT4 was associated with symptoms above the 90th percentile but only in the first trimester (for fT4 per 1 SD: OR 1.2 [CI 1.0-1.4], p = 0.027). However, these differential effects by gestational age were not consistent. No significant effect modification by sex was observed. Conclusions: We found no clear evidence of an association between maternal thyroid function and child ADHD.
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Relationship Between Psychosocial Factors, Dietary Intake and Gestational Weight Gain: A Narrative Review.
Plante, AS, Lemieux, S, Labrecque, M, Morisset, AS
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC. 2019;(4):495-504
Abstract
Inadequate gestational weight gain (GWG), which has reached almost two-thirds of Canadian pregnant women, is associated with several adverse effects both in the mother and her child. The aim of this review was to establish how psychosocial factors, diet and GWG are interrelated during pregnancy. More specifically, it aimed to evaluate how psychosocial factors can impact on diet and, thus, influence GWG. Studies published through May 2017 that examined factors related to GWG were included. Of 3268 non-duplicate titles and abstract, 77 articles underwent full-text review. Regarding dietary intakes, the majority of the included studies demonstrated that a higher caloric intake was associated with an elevated GWG. Also, a negative body image and attitude toward weight gain as well as a poor knowledge of GWG recommendations and inadequate prenatal care is associated with an increased GWG. Only few studies examined altogether the factors included and conclusions about how psychosocial factors can impact on diet and, thus, influence GWG cannot be drawn at this point. In the few studies that evaluated the interrelationships between psychosocial factors, diet and GWG, energy intake was not identified as a mediator of the association between psychosocial factors and GWG. This review highlights the scarcity of findings regarding psychosocial and dietary factors in relation to GWG and the need for high quality prospective cohort studies that will include all these factors to provide a better understanding of how they are interrelated to influence short- and long-term health.
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Vitamin D status in pregnant women with asthma and its association with adverse respiratory outcomes during infancy.
Jensen, ME, Murphy, VE, Gibson, PG, Mattes, J, Camargo, CA
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. 2019;(11):1820-1825
Abstract
BACKGROUND Vitamin D may influence pregnancy and infant outcomes, especially infant respiratory health. This study aimed to examine vitamin D status in pregnant women with asthma, and whether higher vitamin D levels are associated with fewer adverse respiratory outcomes in their infants. METHODS Pregnant women with asthma, recruited from John Hunter Hospital Newcastle Australia (latitude 33°S), had serum total 25-hydroxyvitamin-D (25(OH)D) measured at 16 and 35 weeks gestation. Infant respiratory outcomes were collected at 12 months by parent-report questionnaire. Mother-infant dyads were grouped by serum 25(OH)D during pregnancy: 25(OH)D < 75 nmol/L (at both time-points) versus 25(OH)D ≥ 75 nmol/L (at one or both time-points). RESULTS In 52 pregnant women with asthma, mean serum 25(OH)D levels were 61 (range 26-110) nmol/L at 16 weeks, and 65 (range 32-116) nmol/L at 35 weeks, gestation. Thirty-one (60%) women had 25(OH)D < 75 nmol/L at both time-points; 21 (40%) had 25(OH)D ≥ 75 nmol/L at one or both time-points. Maternal 25(OH)D < 75 nmol/L during pregnancy was associated with a higher proportion of infants with "wheeze ever" at 12 months, compared with 25(OH)D ≥ 75 nmol/L (71 versus 43%, p = .04). Infant acute-care presentations (45 versus 13%, p = .02) and oral corticosteroid use (26 versus 4%, p = .03) due to "asthma/wheezing" were higher in the maternal group with 25(OH)D < 75 nmol/L, versus ≥75 nmol/L. CONCLUSIONS Most pregnant women with asthma had low vitamin D status, which persisted across gestation. Low maternal vitamin D status was associated with greater risk of adverse respiratory outcomes in their infants, a group at high risk of developing childhood asthma.
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Gestational age and maternal status of DHA and other polyunsaturated fatty acids in pregnancy: A systematic review.
Wilson, NA, Mantzioris, E, Middleton, PT, Muhlhausler, BS
Prostaglandins, leukotrienes, and essential fatty acids. 2019;:16-31
Abstract
INTRODUCTION Maternal diet is important in determining omega-3 DHA status however there is limited knowledge of other factors influencing maternal omega-3 concentrations during pregnancy. The primary objective of this systematic review and meta-analysis was to evaluate whether maternal DHA status changed across gestation. Changes in levels of other key polyunsaturated fatty acids were also investigated. MATERIALS AND METHODS The Medline, Embase, Amed, and CINAHL databases were searched. Included studies reported measures of maternal omega-3 status in at least two pregnancy trimesters. RESULTS Thirteen studies were included in the final analyses. Absolute omega-3 DHA concentrations increased across gestation, but decreased as a proportion of total lipids. DISCUSSION Our findings are consistent with previous observations of increases in lipid mobilisation, coupled with preferential transfer of DHA to the fetus, with advancing gestation. However the number of eligible studies was small and further investigations are required.