Browsing by Subject "Adverse pregnancy outcomes"

Now showing 1 - 6 of 6
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    Association of Adverse Pregnancy Outcomes With Hypertension 2 to 7 Years Postpartum
    (Wiley Open Access, 2019-10-01) Haas, David M.; Parker, Corette B.; Marsh, Derek J.; Grobman, William A.; Ehrenthal, Deborah B.; Greenland, Philip; Merz, C. Noel Bairey; Pemberton, Victoria L.; Silver, Robert M.; Barnes, Shannon; McNeil, Rebecca B.; Cleary, Kirsten; Reddy, Uma M.; Chung, Judith H.; Parry, Samuel; Theilen, Lauren H.; Blumenthal, Elizabeth A.; Levine, Lisa D.; Mercer, Brian M.; Simhan, Hyagriv; Polito, LuAnn; Wapner, Ronald J.; Catov, Janet; Chen, Ida; Saade, George R. Saade; NHLBI nuMoM2b Heart Health Study; Medicine, School of Medicine
    Background Identifying pregnancy-associated risk factors before the development of major cardiovascular disease events could provide opportunities for prevention. The objective of this study was to determine the association between outcomes in first pregnancies and subsequent cardiovascular health. Methods and Results The Nulliparous Pregnancy Outcomes Study Monitoring Mothers-to-be Heart Health Study is a prospective observational cohort that followed 4484 women 2 to 7 years (mean 3.2 years) after their first pregnancy. Adverse pregnancy outcomes (defined as hypertensive disorders of pregnancy, small-for-gestational-age birth, preterm birth, and stillbirth) were identified prospectively in 1017 of the women (22.7%) during this pregnancy. The primary outcome was incident hypertension (HTN). Women without adverse pregnancy outcomes served as controls. Risk ratios (RR) and 95% CIs were adjusted for age, smoking, body mass index, insurance type, and race/ethnicity at enrollment during pregnancy. The overall incidence of HTN was 5.4% (95% CI 4.7% to 6.1%). Women with adverse pregnancy outcomes had higher adjusted risk of HTN at follow-up compared with controls (RR 2.4, 95% CI 1.8-3.1). The association held for individual adverse pregnancy outcomes: any hypertensive disorders of pregnancy (RR 2.7, 95% CI 2.0-3.6), preeclampsia (RR 2.8, 95% CI 2.0-4.0), and preterm birth (RR 2.7, 95% CI 1.9-3.8). Women who had an indicated preterm birth and hypertensive disorders of pregnancy had the highest risk of HTN (RR 4.3, 95% CI 2.7-6.7). Conclusions Several pregnancy complications in the first pregnancy are associated with development of HTN 2 to 7 years later. Preventive care for women should include a detailed pregnancy history to aid in counseling about HTN risk.
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    Body Mass Index, Adverse Pregnancy Outcomes, and Cardiovascular Disease Risk
    (American Heart Association, 2023) Khan, Sadiya S.; Petito, Lucia C.; Huang, Xiaoning; Harrington, Katharine; McNeil, Rebecca B.; Bello, Natalie A.; Bairey Merz, C. N.; Miller, Eliza C.; Ravi, Rupa; Scifres, Christina; Catov, Janet; Pemberton, Victoria; Varagic, Jasmina; Zee, Phyllis C.; Yee, Lynn M.; Ray, Mitali; Kim, Jin Kyung; Lane-Cordova, Abbi; Lewey, Jennifer; Theilen, Lauren H.; Saade, George R.; Greenland, Philip; Grobman, William A.; Obstetrics and Gynecology, School of Medicine
    Background: Obesity is a well-established risk factor for both adverse pregnancy outcomes (APOs) and cardiovascular disease (CVD). However, it is not known whether APOs are mediators or markers of the obesity-CVD relationship. This study examined the association between body mass index, APOs, and postpartum CVD risk factors. Methods: The sample included adults from the nuMoM2b (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be) Heart Health Study who were enrolled in their first trimester (6 weeks-13 weeks 6 days gestation) from 8 United States sites. Participants had a follow-up visit at 3.7 years postpartum. APOs, which included hypertensive disorders of pregnancy, preterm birth, small-for-gestational-age birth, and gestational diabetes, were centrally adjudicated. Mediation analyses estimated the association between early pregnancy body mass index and postpartum CVD risk factors (hypertension, hyperlipidemia, and diabetes) and the proportion mediated by each APO adjusted for demographics and baseline health behaviors, psychosocial stressors, and CVD risk factor levels. Results: Among 4216 participants enrolled, mean±SD maternal age was 27±6 years. Early pregnancy prevalence of overweight was 25%, and obesity was 22%. Hypertensive disorders of pregnancy occurred in 15%, preterm birth in 8%, small-for-gestational-age birth in 11%, and gestational diabetes in 4%. Early pregnancy obesity, compared with normal body mass index, was associated with significantly higher incidence of postpartum hypertension (adjusted odds ratio, 1.14 [95% CI, 1.10-1.18]), hyperlipidemia (1.11 [95% CI, 1.08-1.14]), and diabetes (1.03 [95% CI, 1.01-1.04]) even after adjustment for baseline CVD risk factor levels. APOs were associated with higher incidence of postpartum hypertension (1.97 [95% CI, 1.61-2.40]) and hyperlipidemia (1.31 [95% CI, 1.03-1.67]). Hypertensive disorders of pregnancy mediated a small proportion of the association between obesity and incident hypertension (13% [11%-15%]) and did not mediate associations with incident hyperlipidemia or diabetes. There was no significant mediation by preterm birth or small-for-gestational-age birth. Conclusions: There was heterogeneity across APO subtypes in their association with postpartum CVD risk factors and mediation of the association between early pregnancy obesity and postpartum CVD risk factors. However, only a small or nonsignificant proportion of the association between obesity and CVD risk factors was mediated by any of the APOs, suggesting APOs are a marker of prepregnancy CVD risk and not a predominant cause of postpartum CVD risk.
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    Prospective Evaluation of Placental Abruption in Nulliparous Women
    (Taylor & Francis, 2022) Lueth, Amir; Blue, Nathan; Silver, Robert M.; Allshouse, Amanda; Hoffman, Matthew; Grobman, William A.; Simhan, Hyagriv N.; Reddy, Uma; Haas, David M.; Obstetrics and Gynecology, School of Medicine
    Introduction: Because most data on placental abruption are derived from retrospective studies, multiple sources of bias may have affected the results. Thus, we aimed to characterize risk factors and outcomes for placental abruption in a large prospective cohort of nulliparous women. Methods: This was a secondary analysis of women enrolled in the Nulliparous Pregnancy Outcomes Study Monitoring-to-be (nuMom2b) study, a prospective observational cohort. Participants were recruited in their first trimester of pregnancy from 8 sites and had 4 study visits, including at delivery. Placental abruption was defined by confirmed clinical criteria. The primary analysis was restricted to abruption identified antepartum and intrapartum. As a secondary analysis, we examined antepartum and intrapartum abruptions separately. We compared risk factors (maternal demographic and clinical characteristics) and outcomes in women with and without placental abruption using univariable and multivariable analyses as appropriate. Results: 9450 women were included in the primary analysis. Abruption was identified in 0.66% (n = 62), of which 35 (56%) were antepartum and 27 (44%) intrapartum. For women with abruption, the mean gestational age at delivery was 35.6 ± 4.4 weeks and 38.8 ± 2.2 weeks for women without abruption. Gravidity was associated with abruption (OR 3.1, 95% CI: 1.6-6.0). In univariate analysis, abruption was associated with cesarean delivery (OR 3.7, 95% CI: 2.2-6.0), blood transfusion (OR 3.8, 95% CI: 1.4-10.7), PPROM (OR 9.0, 95% CI: 5.4-15.1), preterm birth (OR 8.5, 95% CI: 5.1-14.2), SGA (OR 4.0, 95% CI: 2.3-6.95), RDS (OR 5.5, 95% CI: 2.6-11.2), IVH 20.2 (OR 20.2, 95% CI: 5.9-68.8) and ROP (OR 12.2, 95% CI: 2.8-52.6). However, after adjustment for confounders including gestational age, abruption was only associated with increased odds of cesarean delivery and blood transfusion. Results were similar when restricted to antepartum and intrapartum abruptions. Conclusion: Abruption was identified in <1% of nulliparous women. However, few maternal risk factors were identified. Neonatal morbidities were associated with an abruption and were primarily driven by gestational age due to preterm birth.
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    Searching and visualizing genetic associations of pregnancy traits by using GnuMoM2b
    (Oxford University Press, 2023) Yan, Qi; Guerrero, Rafael F.; Khan, Raiyan R.; Surujnarine, Andy A.; Wapner, Ronald J.; Hahn, Matthew W.; Raja, Anita; Salleb-Aouissi, Ansaf; Grobman, William A.; Simhan, Hyagriv; Blue, Nathan R.; Silver, Robert; Chung, Judith H.; Reddy, Uma M.; Radivojac, Predrag; Pe’er, Itsik; Haas, David M.; Obstetrics and Gynecology, School of Medicine
    Adverse pregnancy outcomes (APOs) are major risk factors for women's health during pregnancy and even in the years after pregnancy. Due to the heterogeneity of APOs, only few genetic associations have been identified. In this report, we conducted genome-wide association studies (GWASs) of 479 traits that are possibly related to APOs using a large and racially diverse study, Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b). To display extensive results, we developed a web-based tool GnuMoM2b (https://gnumom2b.cumcobgyn.org/) for searching, visualizing, and sharing results from a GWAS of 479 pregnancy traits as well as phenome-wide association studies of more than 17 million single nucleotide polymorphisms. The genetic results from 3 ancestries (Europeans, Africans, and Admixed Americans) and meta-analyses are populated in GnuMoM2b. In conclusion, GnuMoM2b is a valuable resource for extraction of pregnancy-related genetic results and shows the potential to facilitate meaningful discoveries.
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    Trajectories of antenatal depression and adverse pregnancy outcomes
    (Elsevier, 2022) Miller, Emily S.; Saade, George R.; Simhan, Hyagriv N.; Monk, Catherine; Haas, David M.; Silver, Robert M.; Mercer, Brian M.; Parry, Samuel; Wing, Deborah A.; Reddy, Uma M.; Grobman, William A.; Obstetrics and Gynecology, School of Medicine
    Background: Antenatal depression affects approximately 1 of 7 pregnancies, with an increasing prevalence across gestation. Data regarding the associations between antenatal depression and adverse pregnancy outcomes yielded conflicting results. However, previous studies evaluated the cross-sectional prevalence of depression at various time points and not the depressive symptom trajectory across gestation. Objective: This study aimed to identify whether the trajectory of antenatal depressive symptoms is associated with different risks of adverse pregnancy outcomes. Study design: This was a secondary analysis of a large multisite prospective cohort of nulliparous women across the United States. The Edinburgh Postpartum Depression Scale was administered at 2 study visits: between 6 and 14 weeks' gestation and between 22 and 30 weeks' gestation. The Edinburgh Postpartum Depression Scale score trajectories were categorized as improved, stable, or worsened based on whether the scores changed by at least 1 standard deviation between the 2 visits. The frequencies of adverse pregnancy outcomes (hypertensive disorders of pregnancy, abruption, cesarean delivery, preterm birth [ie, <37 weeks' gestation], small for gestational age neonates, neonatal intensive care unit admission, and maternal readmission) were compared with depression trajectories across gestation in bivariable and multivariable analyses. Secondary analyses evaluated the frequencies of spontaneous and medically indicated preterm births and frequencies of spontaneous and medically indicated preterm births before 35, 32, and 28 weeks' gestation. Results: Of the 8784 women who completed the 2 antenatal Edinburgh Postpartum Depression Scale screens, 1141 (13.0%) had improved, 6663 (75.9%) had stable, and 980 (11.2%) had worsened depressive symptom trajectories across gestation. Compared with women with improved or stable depressive symptoms, those with worsened symptoms were more likely to experience preterm birth (8.3% vs 7.4% vs 9.9%, respectively; P=.018). After controlling for potential confounders, worsened depressive symptoms remained associated with more frequent preterm birth (adjusted odds ratio, 1.68; 95% confidence interval, 1.10-2.57). Conclusion: Women with depression symptoms that worsen as pregnancy progresses have increased odds of preterm birth. Future research is warranted to optimize and implement effective prevention, screening, and treatment protocols for antenatal depressive symptoms as a strategy to prevent preterm birth.
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    Using Association Rules to Understand the Risk of Adverse Pregnancy Outcomes in a Diverse Population
    (World Scientific, 2023) Chu, Hoyin; Ramola, Rashika; Jain, Shantanu; Haas, David M.; Natarajan, Sriraam; Radivojac, Predrag; Obstetrics and Gynecology, School of Medicine
    Racial and ethnic disparities in adverse pregnancy outcomes (APOs) have been well-documented in the United States, but the extent to which the disparities are present in high-risk subgroups have not been studied. To address this problem, we first applied association rule mining to the clinical data derived from the prospective nuMoM2b study cohort to identify subgroups at increased risk of developing four APOs (gestational diabetes, hypertension acquired during pregnancy, preeclampsia, and preterm birth). We then quantified racial/ethnic disparities within the cohort as well as within high-risk subgroups to assess potential effects of risk-reduction strategies. We identify significant differences in distributions of major risk factors across racial/ethnic groups and find surprising heterogeneity in APO prevalence across these populations, both in the cohort and in its high-risk subgroups. Our results suggest that risk-reducing strategies that simultaneously reduce disparities may require targeting of high-risk subgroups with considerations for the population context.