Editorial: No abstract available
Pregnancy Hypertens.2019Oct;18:82-87. doi: 10.1016/j.preghy.2019.09.015. Epub 2019 Sep 29
Objectives
Angiogenic factors may be involved in lung development. To evaluate the relations between maternal and cordblood angiogenic factors (sflt-1, placental growth factor [plgf], soluble endogline [seng], transforming growthfactor β [TGF-beta]) and their association with moderate and severe broncho-pulmonary dysplasia (BPD) invery preterm growth-restricted infants.
Study design
Prospective mono-centric cohort study. Twenty-four mother-child dyads featuring antepartumpreeclampsia,intra-uterine growth restriction (IUGR) and birth before 30 weeks’ gestation were included. This ensured a 80%power to test whether sflt-1 maternal levels would be twice as high in cases of BPD as in the absence of BPD.
Main outcome measures
Four pro/anti-angiogenic factors from two pathways (sflt-1, plgf and seng, TGF-beta) were measured inmaternal serum before delivery (at the time of hospitalization or the day of birth) and in neonates’ cord blood.Neonatal outcome was moderate to severe BPD, defined as oxygen requirement for at least 28 days and persistent need for oxygen or ventilatory support at 36 weeks’ postmenstrual age.
Results
Sflt-1 levels were positively correlated in maternal serum and cord blood (rs = 0.83, p < .001) but levels of plgfand TGF-beta and its receptor seng were not. Among all the factors studied in cord and maternal blood, nonewas associated with BPD.
Conclusions
In IUGR preterm babies born before 30 weeks’ gestation from pre-eclamptic mothers, serum sflt-1, plgf andseng, TGF-β levels were not correlated with BPD. The increased BPD risk in preterm neonates born from pre-eclamptic mothers cannot be related to high sflt-1 levels.
JPediatr.2019 Oct;213:22-29.e4. doi: 10.1016/j.jpeds.2019.06.001. Epub 2019 Jul 4
Objectives
To investigate the relation between neonatal intensive care unit (NICU) volume and survival, and neuromotorand sensory disabilities at 2 years in very preterm infants.
Study design
The EPIPAGE-2 (Etude Epidémiologique sur les Petits Âges Gestationnels-2) national prospective population-based cohort study was used to include 2447 babies born alive in 66 level III hospitals between 24 and 30completed weeks of gestation in 2011. The outcome was survival without disabilities (levels 2-5 of the GrossMotor Function Classification System for cerebral palsy with or without unilateral or bilateral blindness ordeafness). Units were grouped in quartiles according to volume, defined as the annual admissions of verypreterm babies. Multivariate logistic regression analyses with population average models were used.
Results
Survival at discharge was lower in hospitals with lower volumes of neonatal activity (aOR 0.55, 95% CI 0.33-0.91). Survival without neuromotor and sensory disabilities at 2 years increased with hospital volume, from 75% to 80.7% in the highest volume units. After adjustment for gestational age, small for gestational age, sex, maternal age, infertility treatment, multiple pregnancy, principal cause of prematurity, parental socioeconomic status, and mother’s country of birth, survival without neuromotor or sensory disabilities was significantly lower in hospitals with a lower volume of neonatal activity (aOR 0.60, 95% CI 0.38-0.95) than in the highest quartile hospitals.
Conclusion
These results suggest that lower neonatal intensive care unit volume is associated with lower survival without an increase in disabilities at 2years. These results could be useful to generate improvements of perinatal regionalization.
Sci Rep. 2019 Sep 27;9(1):13962. doi: 10.1038/s41598-019-50417-4. PMID: 31562365; PMCID: PMC6764989.
Abstract
First-trimester placenta (<10 gestational weeks (GW)) develops in a low oxygen environment (≈2%). Early oxygen exposure can cause oxidative damage leading to pregnancy disorders. The aim of this work was to determine the major sources of placental superoxide during early pregnancy – more specifically before 10 GW – and to study redox adaptation to increased oxygen pressure after 12 GW. Our results show that NADPH oxidase (Nox) is the main source of superoxide in first-trimester chorionic villi. Its activity is higher before 10 GW and concomitant with the location on the syncytiotrophoblast apical pole of p47phox, the Nox organizer subunit. After the increase in pO2 pressure (12-14 GW), the activities of the antioxidant enzymes SOD1, catalase and GPX1 are increased. The redox-sensitive MAPK pathways show increased phosphorylated-p38 expression, but no variation in the phosphorylation of stress-activated protein kinase/c-Jun NH2-terminal kinase (SAPK/JNK) during first trimester, suggesting a physiological redox adaptation, whilst ERK1/2 phosphorylation is higher after 12 GW. Nox is the major superoxide source in early pregnancy (<10 GW). Increased superoxide production at 7-9 GW is associated with p38 MAPK pathway activation, suggesting that it is involved in physiological placental function and healthy early development of the placenta, through MAPK pathways.
Clin Infect Dis. 2019 Sep 27;69(8):1385-1393. doi: 10.1093/cid/ciy1073.
BACKGROUND:
In sub-Saharan Africa, malaria in the first half of pregnancy is harmful for both the mother and her fetus. However, malaria in the first trimester of pregnancy, when women are usually not protected against malaria, has been little investigated. For the first time, we assessed the effects of malaria in the first trimester on maternal and birth outcomes using a preconceptional study design.
METHODS:
From June 2014 to March 2017, 1214 women of reproductive age were recruited and followed monthly until 411 became pregnant. The pregnant women were then followed from 5-6 weeks of gestation until delivery. Path analysis was used to assess the direct effect (ie, not mediated by malaria in the second or third trimester) of malaria in the first trimester on maternal anemia and poor birth outcomes. The cumulative effect of infections during pregnancy on the same outcomes was also evaluated.
RESULTS:
The prevalence of malaria infections in the first trimester was 21.8%. Malaria in the first trimester was significantly associated with maternal anemia in the third trimester (adjusted odds ratio 2.25, 95% confidence interval 1.11-4.55). While we did not find evidence of any direct effect of first trimester malaria infections on birth outcomes, their association with infections later in pregnancy tended to increase the risk of low birth weights.
CONCLUSIONS:
Malaria infections in the first trimester were highly prevalent and have deleterious effects on maternal anemia. They highlight the need for additional preventive measures, starting in early pregnancy or even before conception.
PLoS One. 2019 Sep 19;14(9):e0222864. doi: 10.1371/journal.pone.0222864. eCollection 2019.
BACKGROUND:
Malaria and schistosomiasis represent two of the most prevalent and disabling parasitic infections in developing countries. Few studies have evaluated the effect of maternal schistosomiasis and malaria in the peri-conceptional period on infant’s risk of infection.
METHODS:
In Benin, women were followed from the preconception period until delivery. Subsequently, their children were followed from birth to 3 months of age. Pre-pregnancy malaria, malaria in pregnancy (MiP)-determined monthly using a thick blood smear-and urinary schistosomiasis-determined once before pregnancy and once at delivery using urine filtration-were the main maternal exposures. Infant’s febrile infection (fever with respiratory, gastrointestinal and/or cutaneous clinical signs anytime during follow-up) was the main outcome. In a secondary analysis, we checked the relation of malaria and schistosomiasis with infant’s hemoglobin (Hb) concentration. Both effects were separately assessed using logistic/mixed linear regression models.
RESULTS:
The prevalence of MiP was 35.7% with 10.8% occurring during the 1st trimester, and the prevalence of schistosomiasis was 21.8%. From birth to 3 months, 25.3% of infants had at least one episode of febrile infection. In multivariate analysis, MiP, particularly malaria in the 1st trimester, was significantly associated with a higher risk of infant’s febrile infection (aOR = 4.99 [1.1; 22.6], p = 0.03). In secondary results, pre-pregnancy malaria and schistosomiasis were significantly associated with a lower infant’s Hb concentration during the first 3 months.
CONCLUSION:
We evidenced the deleterious effect of maternal parasitic infections on infant’s health. Our results argue in favor of the implementation of preventive strategies as early as in the peri-conception.
Pan Afr Med J. 2019 Sep 16;34:30. doi: 10.11604/pamj.2019.34.30.20013. eCollection 2019.
Introduction:
Placental malaria (PM) is an important predictor of infant morbidity and mortality in sub-Saharan Africa. Although placental histology is the gold standard test to diagnose PM, the placenta impression smears remains widely used in epidemiological studies. This study is set to evaluate the performance of placental impression smears to detect PM in pregnant women in southern Benin.
Methods:
A cross-sectional analysis was performed on data collected in the framework a multicenter randomized clinical trial (Malaria in Pregnancy Preventive and Alternative Drugs). Samples from 491 pregnant women were examined in the district of Allada, Southern Benin. Plasmodium falciparum infections have been assessed in placental blood and placental biopsy.
Results:
Placental malaria detected by placenta impression smears and histology were prevalent in 11.4% and 10.8%, respectively. Sensitivity and specificity of placental impression smears were 90.6% and 98.4%. Among 55 pregnant women tested positive by placenta impression smears, 48 were positive by the histology, while 7 were negative (positive predictive value: 87.3%). Four hundred and twenty four (424) of the 429 tested negative by the placenta impression smears, were also negative according to histology whereas the rest (5 of 429) of the women were positive (negative predictive value: 98.8%).
Conclusion:
Placenta impression smear is an accurate and easy method for the diagnosis of placental malaria.
Abstract
Objective: To describe obstetrical care and in-hospital outcomes in very preterm triplet pregnancies in a European multiregional cohort.
Methods: Data from a prospective population-based study of very preterm births between 22 + 0 and 31 + 6 weeks of gestation in 19 regions from 11 European countries participating in the EPICE project in 2011/2012 were used to describe triplet pregnancies and compare them with twins and singletons.
Results: Triplets constituted 1.1% of very preterm pregnancies (97/8851) and 3.3% of very preterm live births (258/7900); these percentages varied from 0% to 2.6% and 0% to 6% respectively across the regions. In-hospital mortality after live birth was 12.4% and did not differ significantly from singletons or twins or by birth order. However, 28.9% of mothers with a triplet pregnancy experienced at least one neonatal death. Ninety percent of live-born triplets were delivered by cesarean. Vaginal delivery was associated with an Apgar score of less than 7, but not with in-hospital mortality.
Conclusions: The prevalence of very preterm triplets varies across European regions. Most triplets were born by cesarean and those born vaginally had lower Apgar scores. Overall, in-hospital mortality after live birth was similar to singletons and twins.
Clin Infect Dis. 2019 Sep 12. pii: ciz748. doi: 10.1093/cid/ciz748. [Epub ahead of print]
BACKGROUND:
In the context of global malaria elimination efforts, special attention is being paid to submicroscopic Plasmodium falciparum infections. In pregnant, sub-Saharan African women, such infections are more prevalent than microscopic infections, and are thought to have adverse effects on both mothers’ and newborns’ health. However, no study has studied the dynamics and determinants of these infections throughout pregnancy. Retard de Croissance Intra-uterin et Paludisme (RECIPAL), a preconception cohort study carried out in Benin between 2014 and 2017, represented a unique opportunity to assess this issue.
METHODS:
We used data from 273 pregnant Beninese women who were followed-up from preconception to delivery. We studied the dynamics of and factors influencing submicroscopic (and microscopic) P. falciparum infections during the 3 trimesters of pregnancy, using an ordinal logistic mixed model.
RESULTS:
The incidence rate of submicroscopic P. falciparum infections during pregnancy was 12.7 per 100 person-months (95% confidence interval [CI] 10.8-14.9), compared to 6.7 per 100 person-months (95% CI 5.5-8.1) for microscopic infections. The prevalences were highest in the first trimester for both submicroscopic and microscopic infections. After adjustment for potential confounding factors, we found that those of young age and those with a submicroscopic P. falciparum infection prior to pregnancy were at significantly higher risks of submicroscopic and microscopic infections throughout pregnancy, with a more pronounced effect in the first trimester of pregnancy.
CONCLUSIONS:
The first trimester of pregnancy is a particularly high-risk period for P. falciparum infection during pregnancy, especially for the youngest women. Malaria prevention tools covering the preconception period and early pregnancy are urgently needed to better protect pregnant women and their newborns.