276 research outputs found
One step versus two step approach for gestational diabetes screening: systematic review and meta-analysis of the randomized trials
No full textINTRODUCTION:
To compare both the prevalence of gestational diabetes mellitus (GDM) as well as maternal and neonatal outcomes by either the one-step or the two-step approaches.
MATERIAL AND METHODS:
Electronic databases were searched from their inception until June 2017. We included all randomized controlled trials (RCTs) comparing the one-step with the two-step approaches for the screening and diagnosis of GDM. The primary outcome was the incidence of GDM.
RESULTS:
Three RCTs (n = 2333 participants) were included in the meta-analysis. 910 were randomized to the one step approach (75 g, 2 hrs), and 1423 to the two step approach. No significant difference in the incidence of GDM was found comparing the one step versus the two step approaches (8.4 versus 4.3%; relative risk (RR) 1.64, 95%CI 0.77-3.48). Women screened with the one step approach had a significantly lower risk of preterm birth (PTB) (3.7 versus 7.6%; RR 0.49, 95%CI 0.27-0.88), cesarean delivery (16.3 versus 22.0%; RR 0.74, 95%CI 0.56-0.99), macrosomia (2.9 versus 6.9%; RR 0.43, 95%CI 0.22-0.82), neonatal hypoglycemia (1.7 versus 4.5%; RR 0.38, 95%CI 0.16-0.90), and admission to neonatal intensive care unit (NICU) (4.4 versus 9.0%; RR 0.49, 95%CI 0.29-0.84), compared to those randomized to screening with the two step approach.
CONCLUSIONS:
The one and the two step approaches were not associated with a significant difference in the incidence of GDM. However, the one step approach was associated with better maternal and perinatal outcomes
Obstet Gynecol
No full textObjectiveTo estimate the association between maternal hydroxyvitamin D (25-hydroxyvitamin D) concentrations and risk of preterm birth subtypes.MethodsWe performed a case-cohort study using data and banked samples from patients at a teaching hospital in Pittsburgh, Pennsylvania. Eligible participants were women with a prenatal aneuploidy screening serum sample at or before 20 weeks of gestation who subsequently delivered a singleton, live-born infant. Of the n=12,861 eligible women, we selected n=2327 at random as well as all remaining preterm birth cases for a total of n=1126 cases. Serum 25-hydroxyvitamin D was measured using liquid chromatography\u2013tandem mass spectrometry. Multivariable log-binomial regression models were used to estimate associations between maternal vitamin D status and preterm birth <37 weeks (separately by spontaneous or indicated) and preterm birth <34 weeks.ResultsThe incidence of preterm birth <37 weeks was 8.6% overall and 11.3%, 8.6%, and 7.3% among mothers with serum 25-hydroxyvitamin D<50, 50\u201374.9, and 6575nmol/L, respectively (p<0.01). After adjustment for maternal race and ethnicity, prepregnancy BMI, season, smoking, and other confounders, the risk of preterm birth <37 weeks significantly decreased as 25-hydroxyvitamin D increased to approximately 90 nmol/L and then plateaued (test of nonlinearity p<0.01). Results were similar when limiting to cases that were medically indicated or occurred spontaneously and cases occurring at <34 weeks of gestation.ConclusionsOur data support a protective association maternal vitamin D sufficiency and preterm birth that combined with extant epidemiologic data may provide justification for a randomized clinical trial of maternal vitamin D replacement or supplementation to prevent preterm birth.R01 HD056999/HD/NICHD NIH HHSUnited States/U01 DP003177/DP/NCCDPHP CDC HHSUnited States
Ann Epidemiol
No full textPurpose:The objective of this case-cohort study was to evaluate the relationship between maternal 25-hydroxyvitamin D (25(OH)D) concentration and preeclampsia overall and by severity.Methods:From an eligible cohort of 12,861 women who had serum banked from aneuploidy screening in Pittsburgh, Pennsylvania from 1999 to 2010, we randomly sampled a subcohort of 2327 pregnancies and all remaining preeclampsia cases (n = 650 cases). Preeclampsia (defined as new-onset hypertension and proteinuria) and its mild and severe forms were identified using ICD-9 codes. Maternal serum collected at 20 weeks or less gestation was measured for 25(OH)D. We used log-binomial regression with restricted cubic splines to estimate the association between 25(OH)D and preeclampsia after adjusting for confounders.Results:Approximately 21% of the randomly selected sample had 25(OH)D less than 50 nmol per L. We found that the adjusted risk of preeclampsia declined as serum 25(OH)D increased to 50 nmol per L and then plateaued (test of nonlinearity P < .05). The adjusted preeclampsia risk ratios (95% confidence intervals) for 25(OH)D less than 25 nmol per L, 25 to 49.9 nmol per L, and 50 to 74.9 nmol per L were 2.4 (1.2\u20134.8), 1.1 (0.69\u20131.7), and 1.3 (0.89\u20131.8), respectively, compared with those with 25(OH)D 75 nmol per L and over. Similar associations were observed with severe and mild preeclampsia.Conclusions:Vitamin D deficiency increases risks of severe and mild forms of preeclampsia.U01 DP003177/DP/NCCDPHP CDC HHSUnited States
The Genetics and Epidemiology of Reproductive Disorders
No full textEach year in the United States about one million (17%) of all pregnancies experience complications that result in fetal loss. Of the five million pregnancies that end in a live birth approximately 12% are born prematurely. Vaginal disorders and infections during pregnancy, particularly bacterial vaginosis (BV), are known risk factors for both miscarriage and preterm birth (PTB). Identifying the environmental and genetic risk factors for these complex reproductive disorders is important for improving health through better diagnostic methods and treatments.
The purpose of this project is to examine the genetics and epidemiology of BV and PTB as examples of complex reproductive disorders. Cervical immunity clearly plays an important role in the pathogenesis and progression of BV. Therefore, cervical cytokine concentrations were measured during the first trimester of pregnancy in BV positive (BV+) and BV negative (BV-) women. Genetic associations between cytokine receptor genes and cervical cytokine concentrations were identified and discovered to differ by both BV status and race.
The genetics of PTB was examined by genotyping approximately 1500 single nucleotide polymorphisms (SNPs) from 160 genes involved in preterm pathways, including decidual hemorrhage, infection and inflammation, activation of the hypothalamic-pituitary-adrenal axis, and uterine distention. SNPs in both the decidual hemorrhage and infection/inflammation pathways were associated with PTB. Additionally, many of these associations corroborate results from a previous association study
Eur J Obstet Gynecol Reprod Biol
No full textBackgroundSeveral candidate genes and genome wide association studies have reported significant associations between vitamin D metabolism genes and 25-hydroxyvitamin D. Few studies have examined these relationships in pregnancy.ObjectiveWe evaluated the relationship between maternal allelic variants in three vitamin D metabolism genes and 25-hydroxyvitamin D (25(OH)D) concentration in pregnancy.Study designIn two case-control studies, samples were drawn from women who delivered at Magee Womens Hospital in Pittsburgh, PA from 1999 to 2010 and twelve recruiting sites across the United States from 1959 to 65. For 882 Black and 1796 White pregnant women from these studies, 25(OH)D concentration was measured and single nucleotide polymorphisms (SNPs) were genotyped 50 kilobases up- and down-stream in three genes (VDR, GC, and CYP27B1). Using multivariable linear regression, we estimated the associations between allelic variation of each locus and log-transformed 25(OH)D concentration separately by race and study group. Meta-analysis was used to estimate the association across the four groups for each SNP.ResultsMinor alleles of several variants in VDR, GC, and CYP27B1 were associated with differences in log-transformed 25(OH)D concentration compared to the corresponding major alleles [beta, 95% confidence intervals (CI)]. The meta-analysis confirmed the associations for differences in log-transformed 25(OH)D by allelic loci for one intron VDR variant [rs2853559 0.08 (0.02, 0.13), p < 0.01] and a variant in the GC flanking region [rs13150174: 0.04 (0.02, 0.07), p < 0.01], and a GC missense mutation [rs7041 0.05 (0.01, 0.09), p < 0.01]. The meta-analysis also revealed possible associations for SNPs in linkage disequilibrium with variants in the VDR 3-prime untranslated region, another GC missense variant (rs4588), and a variant of the 3-prime untranslated region of CYP27B1.ConclusionWe observed associations between VDR, GC, and CYP27B1 variants and maternal 25-hydroxyvitamin D concentration. Our results provide additional support for a possible role of genetic variation in vitamin D metabolism genes on vitamin D status during pregnancy.U01 DP003177/DP/NCCDPHP CDC HHS/United State
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