Objective:The aims of this study were to determine the differences between women with single vs.recurrent episodes of preeclampsia in term of:(1)the outcome of the first pregnancy affected by preeclampsia;and(2)the pe...Objective:The aims of this study were to determine the differences between women with single vs.recurrent episodes of preeclampsia in term of:(1)the outcome of the first pregnancy affected by preeclampsia;and(2)the perinatal outcomes of subsequent pregnancies.Methods:This population based retrospective cohort study included all multiparous patients with a singleton gestation who delivered at Soroka University Medical Center(Beer Sheva,Israel)from January 1988 until December 2012,meeting the inclusion criteria,those who had fetuses with chromosomal or anatomical abnormalities were exclude.Our cohort included 213,558 deliveries that met the inclusion criteria,of them 208,017 had normotensive pregnancies and 5541 had preeclampsia.The latter group was further divided into those who had a single episode of preeclampsia followed by normotensive gestations(n=3879),and women who had recurrent preeclampsia(n=1662).We used parametric and non-parametric statistics as appropriate.Results:(1)Women with recurrent preeclampsia had an increased rate of early((130/1662)7.8%vs.(171/3879)4.4%,P<0.001)and late((268/1662)16.1%vs.(438/3879)11.3%,P<0.001)preterm deliveries than a single episode of preeclampsia;(2)of interest,the rate of chronic hypertension is higher in the first pregnancy of those with a single preeclampsia episode(P<0.001),while women with recurrent preeclampsia developed It in the subsequent gestations(P<0.001);(3)the rate of small for gestational age neonates in the index pregnancy was higher in those with recurrent rather than a single episode of preeclampsia(single episode 450/3879,11.6%,recurrent preeclampsia 244/1662,14.7%,P=0.002);(4)patients with recurrent disease had an increased rate of cesarean deliveries in the subsequent pregnancies(P<0.001);and(5)patients who developed severe preeclampsia in the subsequent gestations had lower mean birthweight(P<0.001),a higher rate of perinatal mortality(P<0.001),and a lower Apgar score at 1 and 5 minutes(P<0.001),than those who developed mild preeclampsia in subsequent pregnancies,those with a single episode of preeclampsia and the control group.Conclusion:Recurrent preeclampsia increases the rate of pregnancy complications in the following gestations.Early onset preeclampsia at the index pregnancy of women with recurrent preeclampsia,is associated with increased risk for severe preeclampsia,placental abruption and perinatal mortality in subsequent pregnancies.展开更多
Preterm delivery is a major global health problem associated with increased neonatal morbidity and mortality.To develop effective strategies to reduce preterm birth,it is important to address the causes of and risk fa...Preterm delivery is a major global health problem associated with increased neonatal morbidity and mortality.To develop effective strategies to reduce preterm birth,it is important to address the causes of and risk factors for this condition.Maternal metabolism plays a crucial role in pregnancy outcomes,as it affects the availability of nutrients,energy,and other essential factors required for fetal development and growth.Several aspects of maternal metabolism can potentially contribute to the risk of preterm delivery.Severe energy deficiency as observed in women suffering from eating disorders can affect the hypothalamic-pituitary-gonadal axis resulting in amenorrhea and infertility,suggesting that maintaining a minimum maternal weight is essential to uphold a functional reproductive system,thus ensuring a successful pregnancy.Maternal undernutrition as observed in past famine and observations and animal studies may affect fetal growth and trigger an early activation of the parturition pathway leading to preterm delivery.A correlation exists between maternal size and gestation duration.Obesity is associated with a higher likelihood of medically indicated preterm birth.Low maternal body mass index and low gestational weight gain during pregnancy have been associated with preterm birth,potentially due to fetal-maternal metabolic imbalance;however,the exact mechanism remains to be determined,thus emphasizing the importance of appropriate weight management before and during pregnancy.Addressing metabolic-related risk factors for preterm delivery requires a comprehensive approach to reduce the burden of preterm delivery and improve neonatal outcomes.This review aims to explore various aspects of fetal-maternal metabolic imbalance that could potentially contribute to preterm birth.By doing so,we suggest a novel and comprehensive approach that sheds light on the intricate connection between fetal-maternal imbalance and the susceptibility to preterm birth.展开更多
Objective::This study aimed to determine:(1)whether recurrent deliveries of a small for gestational age(SGA)neonate are associated with increased obstetrical or neonatal complications;(2)whether the risk factors that ...Objective::This study aimed to determine:(1)whether recurrent deliveries of a small for gestational age(SGA)neonate are associated with increased obstetrical or neonatal complications;(2)whether the risk factors that can predict small for gestational age(SGA)recurrence.Methods::This study was based on Soroka Medical Center's Obstetrics electronic database.The database consisted of 109022 women who had 320932 deliveries between the year 1988-2014.The study cohort included 6.8%(7368/109022)of these patients who gave birth to a singleton SGA neonate on their first delivery and had more than one delivery.The study population was divided into two groups according to the outcome of the subsequent delivery:(1)women with sporadic SGA who delivered a non-SGA neonate(n=5416);(2)women with recurrent SGA(n=1952).SGA defined as birthweight<10 th percentile.Maternal and neonatal complications were compared between the two groups.Logistic regression was used to determine independent risk factors for SGA recurrence.Results::The prevalence of birthweight<5 th percentile was higher among the recurrent SGA group in the first delivery(P<0.001).Bedouin ethnicity was more prevalent in the recurrent SGA group(P<0.001).The rate of preterm delivery was higher in the first delivery of the recurrent SGA group(P=0.015).The sporadic SGA group had a higher rate of perinatal mortality during the first pregnancy(P=0.017).The rate of severe hypertension(P=0.005),polyhydramnios,meconium-stained amniotic fluid,nonreassuring fetal heart rate and total perinatal mortality(P<0.001)were higher in the second delivery of the recurrent SGA group.In a logistic regression model,preterm delivery and birthweight<5 th percentile at the first delivery was found to be independent risk factors for recurrence of an SGA neonate in the subsequent birth(relative risks:1.530,confidence interval:1.249-1.875;relative risks:1.826,confidence interval:1.641-2.030,respectively).Conclusion::Women with recurrent SGA neonates have specific clinical characteristics.Among women who deliver an SGA neonate,preterm delivery,and birthweight<5 th percentile are independent predictors for its recurrence.展开更多
文摘Objective:The aims of this study were to determine the differences between women with single vs.recurrent episodes of preeclampsia in term of:(1)the outcome of the first pregnancy affected by preeclampsia;and(2)the perinatal outcomes of subsequent pregnancies.Methods:This population based retrospective cohort study included all multiparous patients with a singleton gestation who delivered at Soroka University Medical Center(Beer Sheva,Israel)from January 1988 until December 2012,meeting the inclusion criteria,those who had fetuses with chromosomal or anatomical abnormalities were exclude.Our cohort included 213,558 deliveries that met the inclusion criteria,of them 208,017 had normotensive pregnancies and 5541 had preeclampsia.The latter group was further divided into those who had a single episode of preeclampsia followed by normotensive gestations(n=3879),and women who had recurrent preeclampsia(n=1662).We used parametric and non-parametric statistics as appropriate.Results:(1)Women with recurrent preeclampsia had an increased rate of early((130/1662)7.8%vs.(171/3879)4.4%,P<0.001)and late((268/1662)16.1%vs.(438/3879)11.3%,P<0.001)preterm deliveries than a single episode of preeclampsia;(2)of interest,the rate of chronic hypertension is higher in the first pregnancy of those with a single preeclampsia episode(P<0.001),while women with recurrent preeclampsia developed It in the subsequent gestations(P<0.001);(3)the rate of small for gestational age neonates in the index pregnancy was higher in those with recurrent rather than a single episode of preeclampsia(single episode 450/3879,11.6%,recurrent preeclampsia 244/1662,14.7%,P=0.002);(4)patients with recurrent disease had an increased rate of cesarean deliveries in the subsequent pregnancies(P<0.001);and(5)patients who developed severe preeclampsia in the subsequent gestations had lower mean birthweight(P<0.001),a higher rate of perinatal mortality(P<0.001),and a lower Apgar score at 1 and 5 minutes(P<0.001),than those who developed mild preeclampsia in subsequent pregnancies,those with a single episode of preeclampsia and the control group.Conclusion:Recurrent preeclampsia increases the rate of pregnancy complications in the following gestations.Early onset preeclampsia at the index pregnancy of women with recurrent preeclampsia,is associated with increased risk for severe preeclampsia,placental abruption and perinatal mortality in subsequent pregnancies.
文摘Preterm delivery is a major global health problem associated with increased neonatal morbidity and mortality.To develop effective strategies to reduce preterm birth,it is important to address the causes of and risk factors for this condition.Maternal metabolism plays a crucial role in pregnancy outcomes,as it affects the availability of nutrients,energy,and other essential factors required for fetal development and growth.Several aspects of maternal metabolism can potentially contribute to the risk of preterm delivery.Severe energy deficiency as observed in women suffering from eating disorders can affect the hypothalamic-pituitary-gonadal axis resulting in amenorrhea and infertility,suggesting that maintaining a minimum maternal weight is essential to uphold a functional reproductive system,thus ensuring a successful pregnancy.Maternal undernutrition as observed in past famine and observations and animal studies may affect fetal growth and trigger an early activation of the parturition pathway leading to preterm delivery.A correlation exists between maternal size and gestation duration.Obesity is associated with a higher likelihood of medically indicated preterm birth.Low maternal body mass index and low gestational weight gain during pregnancy have been associated with preterm birth,potentially due to fetal-maternal metabolic imbalance;however,the exact mechanism remains to be determined,thus emphasizing the importance of appropriate weight management before and during pregnancy.Addressing metabolic-related risk factors for preterm delivery requires a comprehensive approach to reduce the burden of preterm delivery and improve neonatal outcomes.This review aims to explore various aspects of fetal-maternal metabolic imbalance that could potentially contribute to preterm birth.By doing so,we suggest a novel and comprehensive approach that sheds light on the intricate connection between fetal-maternal imbalance and the susceptibility to preterm birth.
文摘Objective::This study aimed to determine:(1)whether recurrent deliveries of a small for gestational age(SGA)neonate are associated with increased obstetrical or neonatal complications;(2)whether the risk factors that can predict small for gestational age(SGA)recurrence.Methods::This study was based on Soroka Medical Center's Obstetrics electronic database.The database consisted of 109022 women who had 320932 deliveries between the year 1988-2014.The study cohort included 6.8%(7368/109022)of these patients who gave birth to a singleton SGA neonate on their first delivery and had more than one delivery.The study population was divided into two groups according to the outcome of the subsequent delivery:(1)women with sporadic SGA who delivered a non-SGA neonate(n=5416);(2)women with recurrent SGA(n=1952).SGA defined as birthweight<10 th percentile.Maternal and neonatal complications were compared between the two groups.Logistic regression was used to determine independent risk factors for SGA recurrence.Results::The prevalence of birthweight<5 th percentile was higher among the recurrent SGA group in the first delivery(P<0.001).Bedouin ethnicity was more prevalent in the recurrent SGA group(P<0.001).The rate of preterm delivery was higher in the first delivery of the recurrent SGA group(P=0.015).The sporadic SGA group had a higher rate of perinatal mortality during the first pregnancy(P=0.017).The rate of severe hypertension(P=0.005),polyhydramnios,meconium-stained amniotic fluid,nonreassuring fetal heart rate and total perinatal mortality(P<0.001)were higher in the second delivery of the recurrent SGA group.In a logistic regression model,preterm delivery and birthweight<5 th percentile at the first delivery was found to be independent risk factors for recurrence of an SGA neonate in the subsequent birth(relative risks:1.530,confidence interval:1.249-1.875;relative risks:1.826,confidence interval:1.641-2.030,respectively).Conclusion::Women with recurrent SGA neonates have specific clinical characteristics.Among women who deliver an SGA neonate,preterm delivery,and birthweight<5 th percentile are independent predictors for its recurrence.
