Bjog-An International Journal of Obstetrics and Gynaecology最新文献_第5页

Multiple Chronic Conditions Before Pregnancy and Risk of Adverse Maternal Health Outcomes: Population-Based Cohort Study 妊娠前多种慢性疾病和不良孕产妇健康结局的风险：基于人群的队列研究

IF 4.3 1区医学 Q1 OBSTETRICS & GYNECOLOGY

Bjog-An International Journal of Obstetrics and Gynaecology

Pub Date : 2025-09-03 DOI: 10.1111/1471-0528.18347

Hilary K. Brown, Kinwah Fung, Eyal Cohen, Cindy-Lee Dennis, Sonia M. Grandi, Laura C. Rosella, Catherine Varner, Simone N. Vigod, Walter P. Wodchis, Joel G. Ray

Objective

To assess the risks of perinatal emergency department (ED) use, hospitalisation and severe maternal morbidity or mortality (SMM-M) associated with preconception MCC, according to the number of chronic conditions, complex MCC and co-occurring cardiometabolic conditions.

Design

Population-based cohort study.

Setting

Ontario, Canada.

Population

Females aged 13–54 years, with a recognised pregnancy, 2012–2021.

Methods

Modified Poisson regression was used to generate adjusted relative risks (aRRs) according to the number of chronic conditions, complex MCC (≥ 3 chronic conditions affecting ≥ 3 body systems) and co-occurring cardiometabolic conditions. aRRs were adjusted for age, parity, income quintile, rurality and immigrant/refugee status.

Main Outcome Measures

ED use, hospitalisation and SMM-M from the estimated date of conception to 42 days postpartum.

Results

In total, 894 042 individuals had no pre-pregnancy chronic condition; 357 398 had 1; 94 427 had 2; and 27 326 had ≥ 3 chronic conditions. Relative to those without a chronic condition, the aRR for ED use increased with 1 (1.26, 95% CI 1.25–1.27), 2 (1.55, 1.54–1.56) and ≥ 3 (1.86, 1.85–1.88) conditions. For hospitalisations, the corresponding aRRs were 1.45 (1.43–1.47), 2.06 (2.02–2.10) and 3.18 (3.09–3.27). For SMM-M, the corresponding aRRs were 1.38 (1.35–1.42), 1.82 (1.75–1.90) and 2.75 (2.59–2.92). SMM-M risk was even more pronounced with complex MCC (aRR 2.92, 95% CI 2.72–3.14), and ≥ 3 cardiometabolic conditions (aRR 5.45, 95% CI 4.29–6.91).

Conclusions

MCC, especially complex or cardiometabolic MCC, is associated with elevated risk of maternal morbidity. Multidisciplinary patient-centred care may mitigate these risks.

目的根据慢性疾病、复杂MCC和并发心脏代谢疾病的数量，评估围产期急诊科（ED）使用、住院和严重孕产妇发病率或死亡率（SMM-M）与孕前MCC相关的风险。设计基于人群的队列研究。SETTINGOntario,加拿大。人口：2012-2021年，年龄13-54岁，已确认怀孕的女性。方法采用改进泊松回归，根据慢性疾病、复杂MCC（≥3种慢性疾病影响≥3个身体系统）和同时发生的心脏代谢疾病的数量，生成调整后的相对风险（aRRs）。arr根据年龄、性别、收入五分位数、农村地区和移民/难民身份进行了调整。主要结局测量从估计受孕日期到产后42天的使用、住院和SMM-M。结果894 042人无孕前慢性疾病；357 398有1；94 427有2个；27 326例慢性疾病≥3种。与无慢性疾病的患者相比，1 （1.26,95% CI 1.25-1.27）、2（1.55,1.54-1.56）和≥3（1.86,1.85-1.88）患者使用ED的aRR增加。住院患者的arr分别为1.45（1.43 ~ 1.47）、2.06（2.02 ~ 2.10）和3.18（3.09 ~ 3.27）。SMM-M对应的arr分别为1.38（1.35 ~ 1.42）、1.82（1.75 ~ 1.90）和2.75（2.59 ~ 2.92）。复杂MCC （aRR 2.92, 95% CI 2.72-3.14）和≥3种心脏代谢疾病（aRR 5.45, 95% CI 4.29-6.91）的SMM-M风险更为明显。结论：smcc，尤其是复杂或心脏代谢性MCC，与孕产妇发病风险升高相关。多学科以患者为中心的护理可以减轻这些风险。

{"title":"Multiple Chronic Conditions Before Pregnancy and Risk of Adverse Maternal Health Outcomes: Population-Based Cohort Study","authors":"Hilary K. Brown, Kinwah Fung, Eyal Cohen, Cindy-Lee Dennis, Sonia M. Grandi, Laura C. Rosella, Catherine Varner, Simone N. Vigod, Walter P. Wodchis, Joel G. Ray","doi":"10.1111/1471-0528.18347","DOIUrl":"10.1111/1471-0528.18347","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess the risks of perinatal emergency department (ED) use, hospitalisation and severe maternal morbidity or mortality (SMM-M) associated with preconception MCC, according to the number of chronic conditions, complex MCC and co-occurring cardiometabolic conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Population-based cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Ontario, Canada.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Females aged 13–54 years, with a recognised pregnancy, 2012–2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Modified Poisson regression was used to generate adjusted relative risks (aRRs) according to the number of chronic conditions, complex MCC (≥ 3 chronic conditions affecting ≥ 3 body systems) and co-occurring cardiometabolic conditions. aRRs were adjusted for age, parity, income quintile, rurality and immigrant/refugee status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>ED use, hospitalisation and SMM-M from the estimated date of conception to 42 days postpartum.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 894 042 individuals had no pre-pregnancy chronic condition; 357 398 had 1; 94 427 had 2; and 27 326 had ≥ 3 chronic conditions. Relative to those without a chronic condition, the aRR for ED use increased with 1 (1.26, 95% CI 1.25–1.27), 2 (1.55, 1.54–1.56) and ≥ 3 (1.86, 1.85–1.88) conditions. For hospitalisations, the corresponding aRRs were 1.45 (1.43–1.47), 2.06 (2.02–2.10) and 3.18 (3.09–3.27). For SMM-M, the corresponding aRRs were 1.38 (1.35–1.42), 1.82 (1.75–1.90) and 2.75 (2.59–2.92). SMM-M risk was even more pronounced with complex MCC (aRR 2.92, 95% CI 2.72–3.14), and ≥ 3 cardiometabolic conditions (aRR 5.45, 95% CI 4.29–6.91).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>MCC, especially complex or cardiometabolic MCC, is associated with elevated risk of maternal morbidity. Multidisciplinary patient-centred care may mitigate these risks.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 1","pages":"142-153"},"PeriodicalIF":4.3,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18347","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144960105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Complications After Childbirth-Related Perineal Trauma up to Six-Weeks Postpartum: A Prospective Cohort Study 产后6周会阴创伤后并发症：一项前瞻性队列研究

IF 4.3 1区医学 Q1 OBSTETRICS & GYNECOLOGY

Bjog-An International Journal of Obstetrics and Gynaecology

Pub Date : 2025-09-03 DOI: 10.1111/1471-0528.18356

Rebecca Man, R. Katie Morris, Laura Magill, Terry Hughes, Rita Perry, Sue Tohill, Nyesha Henry, Bryar Kadir, Christine Macarthur, Victoria Hodgetts Morton, the CHAPTER group

Objective

To determine the prevalence of perineal wound infection after childbirth-related perineal trauma up to 6 weeks postpartum.

Design

Prospective, multi-centre cohort study.

Setting

Fifty-one UK NHS maternity services.

Population

There were 2021 women who consented to take part and 1213 women who completed their 6-week questionnaire.

Methods

All women aged 16 or over who sustained childbirth-related perineal trauma of any type after spontaneous or assisted vaginal birth were eligible. Medical record review and distribution of questionnaires took place at 6 weeks postpartum.

Main Outcome Measures

The primary outcome was perineal wound infection within 6 weeks postpartum, determined using medical record data and questionnaire response.

Results

Six-week medical record check data was available for 1998 women (99%). 1213 (60%) of women completed their 6-week questionnaire. 70.6% of consented women experienced a spontaneous vaginal birth and 29.4% of women an assisted vaginal birth. Across all types of perineal trauma and all modes of birth, the overall rate of perineal wound infection was 5.5% (95% CI 4.6%–6.6%). When considering the rate of wound infection by type of tear, women with episiotomy had the highest rate of wound infection at 9.5% (95% CI 7.5%–11.9%).

Conclusion

We provide the best estimate to date of perineal wound infection after childbirth-related perineal trauma. Improvements to care to reduce perineal wound infection rates are urgently needed, particularly for groups where currently there are no targeted interventions postnatally, such as women who undergo episiotomy after spontaneous vaginal birth.

目的了解产后6周会阴外伤后会阴伤口感染的发生率。前瞻性、多中心队列研究。51 .英国国民医疗服务体系的产科服务。共有2021名妇女同意参加，1213名妇女完成了为期6周的问卷调查。方法所有在自然分娩或辅助阴道分娩后发生任何类型的会阴创伤的16岁及以上妇女均为入选对象。在产后6周进行医疗记录审查和问卷分发。主要结局指标：主要结局指标为产后6周内会阴伤口感染，通过病历资料和问卷调查结果确定。结果1998例（99%）妇女有6周病历检查资料。1213名（60%）女性完成了为期6周的问卷调查。70.6%同意顺产的妇女选择自然阴道分娩，29.4%选择辅助阴道分娩。在所有类型的会阴创伤和所有出生方式中，会阴伤口感染的总发生率为5.5% （95% CI 4.6%-6.6%）。当考虑撕裂类型的伤口感染率时，会阴切开术的女性伤口感染率最高，为9.5% （95% CI为7.5%-11.9%）。结论我们提供了迄今为止对分娩相关会阴创伤后会阴伤口感染的最佳估计。迫切需要改善护理以降低会阴伤口感染率，特别是对于目前产后没有针对性干预措施的群体，例如自然阴道分娩后接受会阴切开术的妇女。

{"title":"Complications After Childbirth-Related Perineal Trauma up to Six-Weeks Postpartum: A Prospective Cohort Study","authors":"Rebecca Man, R. Katie Morris, Laura Magill, Terry Hughes, Rita Perry, Sue Tohill, Nyesha Henry, Bryar Kadir, Christine Macarthur, Victoria Hodgetts Morton, the CHAPTER group","doi":"10.1111/1471-0528.18356","DOIUrl":"10.1111/1471-0528.18356","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine the prevalence of perineal wound infection after childbirth-related perineal trauma up to 6 weeks postpartum.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Prospective, multi-centre cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Fifty-one UK NHS maternity services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>There were 2021 women who consented to take part and 1213 women who completed their 6-week questionnaire.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All women aged 16 or over who sustained childbirth-related perineal trauma of any type after spontaneous or assisted vaginal birth were eligible. Medical record review and distribution of questionnaires took place at 6 weeks postpartum.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>The primary outcome was perineal wound infection within 6 weeks postpartum, determined using medical record data and questionnaire response.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Six-week medical record check data was available for 1998 women (99%). 1213 (60%) of women completed their 6-week questionnaire. 70.6% of consented women experienced a spontaneous vaginal birth and 29.4% of women an assisted vaginal birth. Across all types of perineal trauma and all modes of birth, the overall rate of perineal wound infection was 5.5% (95% CI 4.6%–6.6%). When considering the rate of wound infection by type of tear, women with episiotomy had the highest rate of wound infection at 9.5% (95% CI 7.5%–11.9%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We provide the best estimate to date of perineal wound infection after childbirth-related perineal trauma. Improvements to care to reduce perineal wound infection rates are urgently needed, particularly for groups where currently there are no targeted interventions postnatally, such as women who undergo episiotomy after spontaneous vaginal birth.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 2","pages":"274-282"},"PeriodicalIF":4.3,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18356","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144960107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Short-Term Outcomes of Early-Term Versus Full-Term and Late-Term Neonates: A Systematic Review and Meta-Analysis 早足月、足月和晚足月新生儿的短期预后：一项系统综述和荟萃分析。

IF 4.3 1区医学 Q1 OBSTETRICS & GYNECOLOGY

Bjog-An International Journal of Obstetrics and Gynaecology

Pub Date : 2025-09-03 DOI: 10.1111/1471-0528.18362

Siddarth Venkateswaran, Junye George Chen, Chescia Yi-Xin Lim, Mohamad Iman Bin Imran Lim, Gwyneth Kong, Zubair Amin, Yvonne Peng Mei Ng

<div> <section> <h3> Background</h3> <p>Early-term births constitute 15%–31% of global births; its impact on neonates is under-recognised.</p> </section> <section> <h3> Objectives</h3> <p>To systematically synthesise current evidence comparing short-term neonatal outcomes between early-term and full-/late-term births globally and in low- and middle-income countries (LMICs).</p> </section> <section> <h3> Search Strategy</h3> <p>PubMed and Embase databases were searched from inception to 13 March 2025.</p> </section> <section> <h3> Selection Criteria</h3> <p>Studies comparing short-term neonatal outcomes (e.g., morbidity, respiratory complications) among early-term (37–38 weeks' gestation), full-term (39–40 weeks) and late-term (41 weeks) births were included. Studies involving multiple pregnancies were excluded.</p> </section> <section> <h3> Data Collection and Analysis</h3> <p>Using PRISMA guidelines, two investigators independently screened studies, extracted data and assessed risk of bias. Meta-analyses employed a random-effects model to estimate pooled odds ratios (ORs) with 95% confidence intervals (CIs).</p> </section> <section> <h3> Main Results</h3> <p>Thirty-five studies, medium to high quality, from 15 countries (<i>n</i> = 13 784 259) were included. Eight studies (<i>n</i> = 75 081) were from LMICs. Early-term neonates had higher risks of respiratory distress syndrome (OR 2.85, 95% CI: 2.09–3.90), transient tachypnoea of the newborn (OR 2.00, 95% CI: 1.65–2.42) and composite respiratory morbidities (OR 1.75, 95% CI: 1.48–2.08) compared to full-term and late-term neonates. In LMICs, early-term neonates had an even higher risk of respiratory distress syndrome (OR 4.77, 95% CI: 1.83–12.44). However, limited data from LMICs reduced the generalisability of findings. The need for mechanical ventilation (OR 2.08, 95% CI: 1.83–2.38), continuous positive airway pressure (OR 2.41, 95% CI: 1.88–3.09) and oxygen therapy (OR 1.88, 95% CI: 1.48–2.39) was also higher in early-term neonates.</p> </section> <section> <h3> Conclusions</h3> <p>Early-term neonates face higher risks of short-term adverse consequences, underscoring the need for heightened vigilance in perinatal management strategies to optimise outcomes for this vulnerable population.</p> </section> <section> <h3> Prospero Registration</h3> <p>CRD42024556551

早产儿占全球新生儿的15%-31%；它对新生儿的影响尚未得到充分认识。目的系统地综合目前的证据，比较全球和低收入和中等收入国家（LMICs）足月和足月/晚足月新生儿的短期结局。检索STRATEGYPubMed和Embase数据库，检索时间从成立到2025年3月13日。选择标准：研究比较了早期（妊娠37-38周）、足月（39-40周）和晚期（41周）新生儿的短期结局（如发病率、呼吸系统并发症）。多胎妊娠的研究被排除在外。使用PRISMA指南，两位研究者独立筛选研究，提取数据并评估偏倚风险。meta分析采用随机效应模型估计95%置信区间（ci）的合并优势比（ORs）。主要结果纳入来自15个国家的35项中高质量研究（n = 13 784 259）。8项研究（n = 75081）来自中低收入国家。与足月和足月新生儿相比，早期新生儿出现呼吸窘迫综合征（OR 2.85, 95% CI: 2.09-3.90）、新生儿短暂性呼吸急促（OR 2.00, 95% CI: 1.65-2.42）和复合呼吸疾病（OR 1.75, 95% CI: 1.48-2.08）的风险更高。在低收入和中等收入国家，早产新生儿出现呼吸窘迫综合征的风险更高（OR 4.77, 95% CI: 1.83-12.44）。然而，来自中低收入国家的有限数据降低了研究结果的普遍性。早期新生儿对机械通气（OR 2.08, 95% CI: 1.83-2.38）、持续气道正压通气（OR 2.41, 95% CI: 1.88-3.09）和氧治疗（OR 1.88, 95% CI: 1.48-2.39）的需求也较高。结论：早产新生儿面临较高的短期不良后果风险，需要提高围产期管理策略的警惕性，以优化这一弱势群体的预后。PROSPERO REGISTRATIONCRD42024556551 （https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=556551）。

{"title":"Short-Term Outcomes of Early-Term Versus Full-Term and Late-Term Neonates: A Systematic Review and Meta-Analysis","authors":"Siddarth Venkateswaran, Junye George Chen, Chescia Yi-Xin Lim, Mohamad Iman Bin Imran Lim, Gwyneth Kong, Zubair Amin, Yvonne Peng Mei Ng","doi":"10.1111/1471-0528.18362","DOIUrl":"10.1111/1471-0528.18362","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Early-term births constitute 15%–31% of global births; its impact on neonates is under-recognised.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To systematically synthesise current evidence comparing short-term neonatal outcomes between early-term and full-/late-term births globally and in low- and middle-income countries (LMICs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Search Strategy</h3>\u0000 \u0000 <p>PubMed and Embase databases were searched from inception to 13 March 2025.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Selection Criteria</h3>\u0000 \u0000 <p>Studies comparing short-term neonatal outcomes (e.g., morbidity, respiratory complications) among early-term (37–38 weeks' gestation), full-term (39–40 weeks) and late-term (41 weeks) births were included. Studies involving multiple pregnancies were excluded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Collection and Analysis</h3>\u0000 \u0000 <p>Using PRISMA guidelines, two investigators independently screened studies, extracted data and assessed risk of bias. Meta-analyses employed a random-effects model to estimate pooled odds ratios (ORs) with 95% confidence intervals (CIs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Results</h3>\u0000 \u0000 <p>Thirty-five studies, medium to high quality, from 15 countries (<i>n</i> = 13 784 259) were included. Eight studies (<i>n</i> = 75 081) were from LMICs. Early-term neonates had higher risks of respiratory distress syndrome (OR 2.85, 95% CI: 2.09–3.90), transient tachypnoea of the newborn (OR 2.00, 95% CI: 1.65–2.42) and composite respiratory morbidities (OR 1.75, 95% CI: 1.48–2.08) compared to full-term and late-term neonates. In LMICs, early-term neonates had an even higher risk of respiratory distress syndrome (OR 4.77, 95% CI: 1.83–12.44). However, limited data from LMICs reduced the generalisability of findings. The need for mechanical ventilation (OR 2.08, 95% CI: 1.83–2.38), continuous positive airway pressure (OR 2.41, 95% CI: 1.88–3.09) and oxygen therapy (OR 1.88, 95% CI: 1.48–2.39) was also higher in early-term neonates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Early-term neonates face higher risks of short-term adverse consequences, underscoring the need for heightened vigilance in perinatal management strategies to optimise outcomes for this vulnerable population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Prospero Registration</h3>\u0000 \u0000 <p>CRD42024556551","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 2","pages":"228-242"},"PeriodicalIF":4.3,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144960104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Serum Bile Acid Composition in Women With Gestational Diabetes and Fasting Hyperglycaemia (HAPO): A Cohort Study 妊娠期糖尿病和空腹高血糖（HAPO）妇女血清胆汁酸组成：一项队列研究。

IF 4.3 1区医学 Q1 OBSTETRICS & GYNECOLOGY

Bjog-An International Journal of Obstetrics and Gynaecology

Pub Date : 2025-09-03 DOI: 10.1111/1471-0528.18363

Josca M. Schoonejans, Hanns-Ulrich Marschall, M. Martineau, David McCance, Catherine Williamson

<p>Bile acids (BAs) are produced in the liver and released into the intestine upon feeding. Primary BAs may be de-conjugated and converted to secondary bile acids by the gut microbiome, after which they are reabsorbed into the portal circulation. Serum BA composition changes in pregnancy, which may affect endocrine glucose regulation. In rodents, bile acid feeding and genetic manipulation of bile acid receptors affect gestational glucose tolerance [<span>1</span>]. We have shown that in the PRiDE study, late gestation serum BAs were increased in women with gestational diabetes mellitus (GDM) of European, but not South Asian, ethnicity, and correlated positively to fasting glucose levels [<span>2</span>]. This study aimed to confirm whether serum BA profiles were altered in an independent cohort of European women with GDM diagnosed based on fasting glucose.</p><p>This study used participants from the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study (participants gave written informed consent, approved by Northern Ireland Regional Ethics Committee, RO1-HD34242, RO1-HD34243, RD04/0002756), who had fasting glucose in the lowest quartile (≤ 4.3 mmol/L) without GDM (<i>n</i> = 79, Control) or highest quartile (≥ 5.1 mmol/L) with GDM (<i>n</i> = 70, GDM) [<span>3</span>]. GDM was diagnosed if fasting plasma glucose ≥ 5.1 mmol/L and/or 2-h plasma glucose ≥ 8.5 mmol/L during 75 g oral glucose tolerance testing. Serum BAs were measured with UPLC-MS/MS in fasted serum collected between 25 and 31 weeks gestation (median 29 weeks). Log-transformed BA data were analysed using multiple linear regression analysis testing for effects of GDM and BMI, corrected for maternal age.</p><p>Participants were well-matched for gestational age and height (not shown), but women with GDM had a higher BMI (31.3 [27.7–36.2] vs. 25.2 [23.8–27.2] kg/m [2], <i>p</i> < 0.001) and age (32.1 [30.0–35.0] vs. 29.1 [25.6–33.4] years, <i>p</i> < 0.001), and the analysis was corrected for this. Total serum BAs were elevated 1.43-fold in women with GDM (Table 1). Specifically, concentrations of individual species G-CA, G-CDCA, T-CDCA, and G-DCA were increased. Total conjugated and G-conjugated species were significantly increased (trend for T-conjugated species) but the conjugation ratio was not different. When combining unconjugated and conjugated species, we found an increased prevalence of the primary BA species CA (12α-hydroxylated) and CDCA (non-12α-hydroxylated). Both total primary (trend) and secondary (significant) BAs were increased, but the ratio between primary and secondary BAs was unchanged. There was no difference in the CA/CDCA or 12α-hydroxylation ratios as total 12α-hydroxylated and non-12α-hydroxylated BAs were both increased. The total abundance of the most prevalent secondary BA type, DCA, was decreased with increasing BMI, resulting in an association between BMI and higher primary/secondary and lower 12α-hydroxylation ratios.</p><p>This study confirmed o

胆汁酸（BAs）在肝脏中产生，在进食时释放到肠道中。初级胆汁酸可被肠道微生物解偶联并转化为次级胆汁酸，之后它们被重新吸收到门静脉循环中。妊娠期血清BA组成改变，可能影响内分泌葡萄糖调节。在啮齿动物中，胆汁酸喂养和胆汁酸受体的基因操纵影响妊娠期葡萄糖耐量[1]。在PRiDE研究中，我们发现欧洲人妊娠期糖尿病（GDM）女性妊娠晚期血清BAs升高，而南亚人则没有，并且与空腹血糖水平bb0呈正相关。本研究旨在确认基于空腹血糖诊断为GDM的欧洲女性独立队列中血清BA谱是否发生改变。本研究使用来自高血糖和不良妊娠结局（HAPO）研究的参与者（参与者给予书面知情同意，经北爱尔兰地区伦理委员会批准，RO1-HD34242, RO1-HD34243, rd4 /0002756），空腹血糖在最低四分位数（≤4.3 mmol/L），无GDM （n = 79，对照组）或最高四分位数（≥5.1 mmol/L），有GDM (n = 70， GDM)[3]。75 g口服葡萄糖耐量试验中空腹血糖≥5.1 mmol/L和/或2小时血糖≥8.5 mmol/L诊断为GDM。采用UPLC-MS/MS对妊娠25 ~ 31周（中位29周）的空腹血清进行血清BAs测定。对经对数变换的BA数据进行多元线性回归分析，检验GDM和BMI的影响，并对产妇年龄进行校正。参与者的胎龄和身高匹配良好（未显示），但GDM女性的BMI（31.3[27.7-36.2]对25.2 [23.8-27.2]kg/m b[2], p < 0.001）和年龄（32.1[30.0-35.0]对29.1[25.6-33.4]岁，p < 0.001）更高，并且分析对此进行了修正。GDM患者血清总BAs升高1.43倍（表1）。其中G-CA、G-CDCA、T-CDCA和G-DCA的浓度升高。总共轭种和g共轭种显著增加（以t共轭种为趋势），但共轭比无显著差异。当结合非共轭和共轭物种时，我们发现主要BA物种CA （12α-羟基化）和CDCA（非12α-羟基化）的患病率增加。初级（趋势）和次级（显著）BAs总数均有所增加，但初级和次级BAs之间的比例不变。12α-羟基化和非12α-羟基化的BAs总量均增加，CA/CDCA和12α-羟基化的比值无显著差异。最常见的继发BA类型DCA的总丰度随着BMI的增加而降低，从而导致BMI与较高的初级/次级和较低的12α-羟基化比率相关。该研究证实了我们之前的发现，在一个独立的队列中，欧洲GDM女性血清BAs升高，与BMI无关。这一发现轻度（在无并发症妊娠的正常范围内）[4]但伴有GDM和空腹高血糖的BAs显著升高表明，对于一些欧洲妇女来说，改变的BA稳态可能与GDM的发病机制有关，或者是该人群中GDM的结果。我们之前的研究显示，GDM患者[2]中C4 （BA合成标志物）水平升高，表明肝生成增加可能是本研究结果的基础。超过一半的HAPO女性根据空腹血糖被诊断为GDM，但更广泛的空腹血糖研究将证实我们的研究结果对所有GDM女性的普遍性。与先前的研究一致，BMI增加与原发性BAs多于继发性BAs相关，这一发现通常与肠道微生物组变化与肥胖有关。在这个队列中，观察到共轭BAs在GDM女性中的优势，这是新颖的。这可能反映了母体微生物群在大肠中脱偶联的减少。需要进一步的工作来确定这种成分变化的原因。概念化：C.W.数据管理：M.M.， J.M.S.正式分析：J.M.S.资金获取：C.W.项目管理：C.W.， J.M.S.调查：H.U.M.资源：C.W.， H.U.M.， D.M.C.监督：C.W.可视化：J.M.S.写作-原稿：J.M.S.写作-审查和编辑：C.W.， D.M.C.， J.M.S.， M.M.所有符合作者资格的人都被包括在内，所有被包括的人都有资格获得作者资格。本研究使用了北爱尔兰地区伦理委员会（RO1-HD34242、RO1-HD34243和RD04/0002756）批准的高血糖和不良妊娠结局研究的一部分参与者。参与者给予书面知情同意。作者声明无利益冲突。支持本研究结果的数据可根据通讯作者的合理要求提供。

{"title":"Serum Bile Acid Composition in Women With Gestational Diabetes and Fasting Hyperglycaemia (HAPO): A Cohort Study","authors":"Josca M. Schoonejans, Hanns-Ulrich Marschall, M. Martineau, David McCance, Catherine Williamson","doi":"10.1111/1471-0528.18363","DOIUrl":"10.1111/1471-0528.18363","url":null,"abstract":"<p>Bile acids (BAs) are produced in the liver and released into the intestine upon feeding. Primary BAs may be de-conjugated and converted to secondary bile acids by the gut microbiome, after which they are reabsorbed into the portal circulation. Serum BA composition changes in pregnancy, which may affect endocrine glucose regulation. In rodents, bile acid feeding and genetic manipulation of bile acid receptors affect gestational glucose tolerance [<span>1</span>]. We have shown that in the PRiDE study, late gestation serum BAs were increased in women with gestational diabetes mellitus (GDM) of European, but not South Asian, ethnicity, and correlated positively to fasting glucose levels [<span>2</span>]. This study aimed to confirm whether serum BA profiles were altered in an independent cohort of European women with GDM diagnosed based on fasting glucose.</p><p>This study used participants from the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study (participants gave written informed consent, approved by Northern Ireland Regional Ethics Committee, RO1-HD34242, RO1-HD34243, RD04/0002756), who had fasting glucose in the lowest quartile (≤ 4.3 mmol/L) without GDM (<i>n</i> = 79, Control) or highest quartile (≥ 5.1 mmol/L) with GDM (<i>n</i> = 70, GDM) [<span>3</span>]. GDM was diagnosed if fasting plasma glucose ≥ 5.1 mmol/L and/or 2-h plasma glucose ≥ 8.5 mmol/L during 75 g oral glucose tolerance testing. Serum BAs were measured with UPLC-MS/MS in fasted serum collected between 25 and 31 weeks gestation (median 29 weeks). Log-transformed BA data were analysed using multiple linear regression analysis testing for effects of GDM and BMI, corrected for maternal age.</p><p>Participants were well-matched for gestational age and height (not shown), but women with GDM had a higher BMI (31.3 [27.7–36.2] vs. 25.2 [23.8–27.2] kg/m [2], <i>p</i> < 0.001) and age (32.1 [30.0–35.0] vs. 29.1 [25.6–33.4] years, <i>p</i> < 0.001), and the analysis was corrected for this. Total serum BAs were elevated 1.43-fold in women with GDM (Table 1). Specifically, concentrations of individual species G-CA, G-CDCA, T-CDCA, and G-DCA were increased. Total conjugated and G-conjugated species were significantly increased (trend for T-conjugated species) but the conjugation ratio was not different. When combining unconjugated and conjugated species, we found an increased prevalence of the primary BA species CA (12α-hydroxylated) and CDCA (non-12α-hydroxylated). Both total primary (trend) and secondary (significant) BAs were increased, but the ratio between primary and secondary BAs was unchanged. There was no difference in the CA/CDCA or 12α-hydroxylation ratios as total 12α-hydroxylated and non-12α-hydroxylated BAs were both increased. The total abundance of the most prevalent secondary BA type, DCA, was decreased with increasing BMI, resulting in an association between BMI and higher primary/secondary and lower 12α-hydroxylation ratios.</p><p>This study confirmed o","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 2","pages":"348-350"},"PeriodicalIF":4.3,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18363","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Duration of Intrauterine Balloon Tamponade in Post-Partum Haemorrhage Management After Vaginal Delivery: A Secondary Cohort Analysis From the French TUB Trial 宫内球囊填塞在阴道分娩后出血处理中的持续时间：来自法国TUB试验的二次队列分析

IF 4.3 1区医学 Q1 OBSTETRICS & GYNECOLOGY

Bjog-An International Journal of Obstetrics and Gynaecology

Pub Date : 2025-09-01 DOI: 10.1111/1471-0528.18345

Charles Garabedian, Charlotte Prats, Aurélien Seco, Catherine Deneux-Tharaux, Patrick Rozenberg, Paul Berveiller

Objective

To compare the rates of bleeding recurrence and other post-partum haemorrhage (PPH)-related clinical outcomes in women with PPH initially controlled by intrauterine balloon tamponade (IUBT) according to its duration.

Design

Exploratory cohort study from a randomised trial.

Setting

Eighteen hospitals in France.

Population

All women included in the randomised trial and managed with IUBT. Those whose balloon was removed within the first 2 h of placement because of spontaneous expulsion and those who underwent invasive procedures before the planned IUBT removal were excluded.

Methods

The first quartile of the distribution of the IUBT duration was 6.9 h, and we divided the population into two groups according to the duration: ≤ 7 h vs.> 7 h. To control for confounding factors, we used a propensity score adjustment approach.

Main Outcome Measures

Need for an invasive procedure, rate of recurrence of bleeding after removal of the IUBT, and mean quantified peri-partum blood loss.

Results

Totally, 199 women were included. No invasive procedures were performed, and there was no recurrence of bleeding in either group. There were no significant differences in mean (±SD) quantified total blood loss (1126 ± 383 mL vs. 1240 ± 505 mL, p = 0.1) or the need for transfusion (9 [18%] vs. 40 [27%], p = 0.2) between groups, even after adjustment.

Conclusions

A shorter IUBT duration (7 h) is not associated with unfavourable PPH outcomes and may therefore be a reasonable option if ongoing haemorrhage has abated. However, these findings should be interpreted with caution due to the imbalance in clinical indication between groups.

目的比较经宫内球囊填塞（IUBT）控制产后出血（PPH）的妇女出血复发率和其他与产后出血相关的临床结局。设计：来自随机试验的探索性队列研究。法国有18家医院。所有女性均纳入随机试验，并采用IUBT进行管理。排除在放置后2小时内因自然排出而将球囊取出的患者，以及在计划的IUBT取出前接受侵入性手术的患者。方法IUBT持续时间分布的第一四分位数为6.9 h，将人群按持续时间分为≤7 h和≤7 h两组。为了控制混杂因素，我们采用倾向评分调整方法。主要观察指标：是否需要进行有创手术，取出IUBT后出血复发率，以及平均量化的围产期出血量。结果共纳入199名妇女。两组患者均未进行侵入性手术，无出血复发。即使在调整后，两组之间的平均（±SD）量化总失血量（1126±383 mL对1240±505 mL， p = 0.1）或输血需求（9[18%]对40 [27%]，p = 0.2）也无显著差异。结论：较短的IUBT持续时间（7小时）与不利的PPH结果无关，因此如果持续出血减少，可能是一个合理的选择。然而，由于组间临床适应症的不平衡，这些发现应谨慎解释。

{"title":"Duration of Intrauterine Balloon Tamponade in Post-Partum Haemorrhage Management After Vaginal Delivery: A Secondary Cohort Analysis From the French TUB Trial","authors":"Charles Garabedian, Charlotte Prats, Aurélien Seco, Catherine Deneux-Tharaux, Patrick Rozenberg, Paul Berveiller","doi":"10.1111/1471-0528.18345","DOIUrl":"10.1111/1471-0528.18345","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare the rates of bleeding recurrence and other post-partum haemorrhage (PPH)-related clinical outcomes in women with PPH initially controlled by intrauterine balloon tamponade (IUBT) according to its duration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Exploratory cohort study from a randomised trial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Eighteen hospitals in France.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>All women included in the randomised trial and managed with IUBT. Those whose balloon was removed within the first 2 h of placement because of spontaneous expulsion and those who underwent invasive procedures before the planned IUBT removal were excluded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The first quartile of the distribution of the IUBT duration was 6.9 h, and we divided the population into two groups according to the duration: ≤ 7 h vs.> 7 h. To control for confounding factors, we used a propensity score adjustment approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Need for an invasive procedure, rate of recurrence of bleeding after removal of the IUBT, and mean quantified peri-partum blood loss.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Totally, 199 women were included. No invasive procedures were performed, and there was no recurrence of bleeding in either group. There were no significant differences in mean (±SD) quantified total blood loss (1126 ± 383 mL vs. 1240 ± 505 mL, <i>p</i> = 0.1) or the need for transfusion (9 [18%] vs. 40 [27%], <i>p</i> = 0.2) between groups, even after adjustment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A shorter IUBT duration (7 h) is not associated with unfavourable PPH outcomes and may therefore be a reasonable option if ongoing haemorrhage has abated. However, these findings should be interpreted with caution due to the imbalance in clinical indication between groups.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 1","pages":"123-131"},"PeriodicalIF":4.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18345","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144923880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Maternal and Interpregnancy Factors and Risks of First-Time Preeclampsia in Second Pregnancy: A Swedish National Cohort Study 第二次妊娠首次子痫前期的母体和妊娠因素和风险：瑞典国家队列研究

IF 4.3 1区医学 Q1 OBSTETRICS & GYNECOLOGY

Bjog-An International Journal of Obstetrics and Gynaecology

Pub Date : 2025-09-01 DOI: 10.1111/1471-0528.18348

Hanna Carr, Kari Johansson, Jonathan M. Snowden, Abigail Newby-Kew, Sven Cnattingius, Jonas F. Ludvigsson, Olof Stephansson, Anna-Karin Wikström, Anna Sandström

<div> <section> <h3> Objective</h3> <p>To investigate factors associated with first-time preeclampsia in second pregnancies.</p> </section> <section> <h3> Design</h3> <p>Population-based cohort study using Swedish national registers.</p> </section> <section> <h3> Setting</h3> <p>Sweden 1992–2019.</p> </section> <section> <h3> Population</h3> <p>A group of 808 107 women with second singleton deliveries, who did not have preeclampsia in first pregnancy.</p> </section> <section> <h3> Methods</h3> <p>Information in the Swedish Medical Birth Register, relating to (1) first pregnancy complications, (2) maternal characteristics in early second pregnancy, and (3) interpregnancy changes in risk factor status, was examined for association with first-time preeclampsia occurring in second pregnancy using modified Poisson regression analysis.</p> </section> <section> <h3> Main Outcome Measures</h3> <p>First-time preeclampsia, and first-time preeclampsia with preterm delivery (< 37 gestational weeks) in second pregnancy.</p> </section> <section> <h3> Results</h3> <p>Adjusted relative risks (aRRs; 95% confidence interval) for first-time preeclampsia in second pregnancy increased after first pregnancy complications, including: gestational hypertension (4.61; 4.20, 5.05) and preterm delivery (1.99; 1.87, 2.12). There was a dose-dependent association between interpregnancy weight change and risk of first-time preeclampsia in second pregnancy. Compared to stable weight (BMI −1 to 1 unit) a 2 to 4 BMI unit increase was associated with a 50% increase in risk of first-time preeclampsia (1.57; 1.47, 1.67), and weight loss equivalent to > 2 BMI units was associated with a reduced risk (0.63, 0.55, 0.72). This pattern of association was consistent also when stratifying by first pregnancy BMI (18.5 to < 25, 25 to < 30, 30 or above).</p> </section> <section> <h3> Conclusions</h3> <p>In addition to maternal disease and complication in first pregnancy, interpregnancy weight change was also associated with increased risks of first-time preeclampsia in second pregnancy, even in women with normal weight in first pregnancy.</p> </section> </d

目的探讨第二次妊娠首次子痫前期的相关因素。设计：基于人口的队列研究，使用瑞典国家登记册。SettingSweden 1992 - 2019。一组808107例第二次单胎分娩的妇女，她们在第一次怀孕时没有子痫前期。方法采用修正泊松回归分析，对瑞典出生登记中有关(1)首次妊娠并发症、(2)二胎早期产妇特征、(3)危险因素状态的解释性变化等信息进行分析，以确定二胎发生首次先兆子痫的相关性。主要结局指标：首次子痫前期，以及第二次妊娠首次子痫前期伴早产（37孕周）。结果首次妊娠并发症(妊娠高血压（4.61;4.20,5.05）和早产（1.99;1.87,2.12）后，第二次妊娠首次先兆子痫的调整相对危险度（aRRs； 95%可信区间）增加。妊娠体重变化与第二次妊娠发生子痫前期风险之间存在剂量依赖关系。与稳定体重（BMI - 1至1单位）相比，BMI增加2至4单位与首次子痫前期风险增加50%相关（1.57;1.47,1.67），体重减少相当于BMI减少2单位与风险降低相关（0.63,0.55,0.72）。这种关联模式在按首次妊娠BMI（18.5至25,25至30,30或更高）分层时也是一致的。结论除了首次妊娠的母体疾病和并发症外，妊娠体重变化也与第二次妊娠发生首次先兆子痫的风险增加有关，即使在首次妊娠体重正常的妇女中也是如此。

{"title":"Maternal and Interpregnancy Factors and Risks of First-Time Preeclampsia in Second Pregnancy: A Swedish National Cohort Study","authors":"Hanna Carr, Kari Johansson, Jonathan M. Snowden, Abigail Newby-Kew, Sven Cnattingius, Jonas F. Ludvigsson, Olof Stephansson, Anna-Karin Wikström, Anna Sandström","doi":"10.1111/1471-0528.18348","DOIUrl":"10.1111/1471-0528.18348","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate factors associated with first-time preeclampsia in second pregnancies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Population-based cohort study using Swedish national registers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Sweden 1992–2019.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>A group of 808 107 women with second singleton deliveries, who did not have preeclampsia in first pregnancy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Information in the Swedish Medical Birth Register, relating to (1) first pregnancy complications, (2) maternal characteristics in early second pregnancy, and (3) interpregnancy changes in risk factor status, was examined for association with first-time preeclampsia occurring in second pregnancy using modified Poisson regression analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>First-time preeclampsia, and first-time preeclampsia with preterm delivery (< 37 gestational weeks) in second pregnancy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Adjusted relative risks (aRRs; 95% confidence interval) for first-time preeclampsia in second pregnancy increased after first pregnancy complications, including: gestational hypertension (4.61; 4.20, 5.05) and preterm delivery (1.99; 1.87, 2.12). There was a dose-dependent association between interpregnancy weight change and risk of first-time preeclampsia in second pregnancy. Compared to stable weight (BMI −1 to 1 unit) a 2 to 4 BMI unit increase was associated with a 50% increase in risk of first-time preeclampsia (1.57; 1.47, 1.67), and weight loss equivalent to > 2 BMI units was associated with a reduced risk (0.63, 0.55, 0.72). This pattern of association was consistent also when stratifying by first pregnancy BMI (18.5 to < 25, 25 to < 30, 30 or above).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In addition to maternal disease and complication in first pregnancy, interpregnancy weight change was also associated with increased risks of first-time preeclampsia in second pregnancy, even in women with normal weight in first pregnancy.</p>\u0000 </section>\u0000 </d","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 1","pages":"154-164"},"PeriodicalIF":4.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18348","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144923881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

NASHUS: A Novel Surgical Approach for Apical Prolapse Repair Using Harvested Internal Ligaments 纳什：一种利用切除的内韧带修复根尖脱垂的新手术方法

IF 4.3 1区医学 Q1 OBSTETRICS & GYNECOLOGY

Bjog-An International Journal of Obstetrics and Gynaecology

Pub Date : 2025-09-01 DOI: 10.1111/1471-0528.18349

Salwan Al-Salihi, Ruth Cameron-Jeffs, Mooska Raoofi

Introduction

Pelvic organ prolapse (POP) surgery aims to restore apical support while minimizing complications. The Novel Apical Suspension Harvesting UteroSacral tissue (NASHUS) procedure is a minimally invasive technique utilizing the uterosacral ligament (USL) for apical suspension.

Methods

Developed through pre-clinical cadaver work and in-vivo evaluation, NASHUS restores anatomy via precise USL mobilization, division, and suturing to apical tissue. Applicable to both hysteropexy and colpopexy, it offers laparoscopic, robotic, and open approaches. This article details surgical methodology, early clinical outcomes, and future innovative studies.

Results

This article details surgical methodology, early clinical outcomes, and future innovative studies. Additionally, an accompanying video abstract demonstrates in-vivo laparoscopic NASHUS hysteropexy.

Conclusion

NASHUS presents a native tissue surgical alternative addressing apical prolapse with safety and durability in short term follow up.

盆腔器官脱垂（POP）手术旨在恢复根尖支持，同时尽量减少并发症。新型子宫骶组织根尖悬吊（NASHUS）手术是一种利用子宫骶韧带（USL）进行根尖悬吊的微创技术。方法：通过临床前的尸体工作和体内评估，NASHUS通过精确的USL移动、分裂和缝合到根尖组织来恢复解剖。适用于子宫切除术和阴道切除术，它提供腹腔镜，机器人和开放的方法。本文详细介绍了手术方法、早期临床结果和未来的创新研究。本文详细介绍了手术方法、早期临床结果和未来的创新研究。此外，随附的视频摘要演示了体内腹腔镜nash子宫切除术。结论nash为根尖脱垂的治疗提供了一种安全、持久的短期随访方法。

{"title":"NASHUS: A Novel Surgical Approach for Apical Prolapse Repair Using Harvested Internal Ligaments","authors":"Salwan Al-Salihi, Ruth Cameron-Jeffs, Mooska Raoofi","doi":"10.1111/1471-0528.18349","DOIUrl":"10.1111/1471-0528.18349","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Pelvic organ prolapse (POP) surgery aims to restore apical support while minimizing complications. The Novel Apical Suspension Harvesting UteroSacral tissue (NASHUS) procedure is a minimally invasive technique utilizing the uterosacral ligament (USL) for apical suspension.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Developed through pre-clinical cadaver work and in-vivo evaluation, NASHUS restores anatomy via precise USL mobilization, division, and suturing to apical tissue. Applicable to both hysteropexy and colpopexy, it offers laparoscopic, robotic, and open approaches. This article details surgical methodology, early clinical outcomes, and future innovative studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This article details surgical methodology, early clinical outcomes, and future innovative studies. Additionally, an accompanying video abstract demonstrates in-vivo laparoscopic NASHUS hysteropexy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>NASHUS presents a native tissue surgical alternative addressing apical prolapse with safety and durability in short term follow up.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 1","pages":"18-23"},"PeriodicalIF":4.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144923878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Reproductive Outcomes in Women Born With Low Birth Weight, Preterm or Small for Gestational Age: A Population-Based Register Study 低出生体重、早产或小于胎龄妇女的生殖结局：一项基于人口的登记研究

IF 4.3 1区医学 Q1 OBSTETRICS & GYNECOLOGY

Bjog-An International Journal of Obstetrics and Gynaecology

Pub Date : 2025-09-01 DOI: 10.1111/1471-0528.18350

Susanne Liffner, Louise Möller, Marie Bladh, Elizabeth Nedstrand

Objective

To evaluate if the reduced likelihood of reproducing among women born small for gestational age (SGA), preterm (PT) or with low birth weight (LBW) persists towards the end of their reproductive era and to evaluate their use of medically assisted reproduction (MAR).

Design

Population-based register study.

Setting

Sweden.

Population/Sample

Women born in Sweden between 1973 and 1993 (n = 1 000 148).

Methods

Data was retrieved from registers, among others the Swedish Medical Birth Register. The study population was stratified into two cohorts, born 1973 to 1983 and 1984 to 1993. The likelihood of giving birth was analysed using a Cox Proportional Hazards model.

Main Outcome Measures

Giving birth to at least one child.

Results

Women born SGA, PT or LBW had a lower probability of giving birth (presented as HR), adjusted for sociodemographic factors, with 95% CI: SGA: HR 0.94 (0.93–0.96); PT: HR 0.95 (0.94–0.96); and LBW: HR 0.90 (0.88–0.92) but no reduction was seen for women in the younger cohort born SGA (HR 0.98 [0.95–1.01]). Women born SGA or LBW had a lower chance of childbirth after MAR (SGA 80.3%, LBW 80.0%) compared to women born with normal weight (84.6%, p < 0.001) as well as an increased risk of being treated with oocyte donation (SGA 5.5% vs. 2.5%, p < 0.001; LBW 5.0% vs. 2.5%, p < 0.001).

Conclusion

The decreased probability of parenthood for women born LBW, SGA, or preterm was even more evident after a longer follow-up time. When pursuing MAR with their own oocytes, they had a lower chance of conceiving.

目的评估出生时小于胎龄（SGA）、早产（PT）或低出生体重（LBW）的妇女生育能力降低的情况是否持续到生育年龄末期，并评估她们对医学辅助生殖（MAR）的使用情况。设计：基于人口的登记研究。人口/样本1973年至1993年在瑞典出生的妇女（n = 1 000 148）。方法从登记册中检索数据，其中包括瑞典医疗出生登记册。研究人群分为两组，分别出生于1973年至1983年和1984年至1993年。使用Cox比例风险模型分析分娩的可能性。主要结局指标：至少生育一个孩子。结果经社会人口因素调整后，SGA、PT或LBW出生的女性分娩的概率（以HR表示）较低，95% CI: SGA: HR 0.94 (0.93-0.96)；Pt: hr 0.95 (0.94-0.96)；LBW：风险比0.90(0.88-0.92)，但SGA出生的年轻队列女性的风险比没有降低（风险比0.98[0.95-1.01]）。与体重正常的女性（84.6%,p < 0.001）相比，SGA或LBW出生的女性在MAR后分娩的机会较低（SGA 80.3%, LBW 80.0%），并且接受卵母细胞捐赠治疗的风险增加（SGA 5.5%对2.5%,p < 0.001; LBW 5.0%对2.5%,p < 0.001）。结论低体重、低体重、早产妇女的生育能力下降趋势在随访时间较长后更为明显。当她们用自己的卵母细胞进行MAR时，她们怀孕的几率较低。

{"title":"Reproductive Outcomes in Women Born With Low Birth Weight, Preterm or Small for Gestational Age: A Population-Based Register Study","authors":"Susanne Liffner, Louise Möller, Marie Bladh, Elizabeth Nedstrand","doi":"10.1111/1471-0528.18350","DOIUrl":"10.1111/1471-0528.18350","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate if the reduced likelihood of reproducing among women born small for gestational age (SGA), preterm (PT) or with low birth weight (LBW) persists towards the end of their reproductive era and to evaluate their use of medically assisted reproduction (MAR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Population-based register study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Sweden.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population/Sample</h3>\u0000 \u0000 <p>Women born in Sweden between 1973 and 1993 (<i>n</i> = 1 000 148).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data was retrieved from registers, among others the Swedish Medical Birth Register. The study population was stratified into two cohorts, born 1973 to 1983 and 1984 to 1993. The likelihood of giving birth was analysed using a Cox Proportional Hazards model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Giving birth to at least one child.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Women born SGA, PT or LBW had a lower probability of giving birth (presented as HR), adjusted for sociodemographic factors, with 95% CI: SGA: HR 0.94 (0.93–0.96); PT: HR 0.95 (0.94–0.96); and LBW: HR 0.90 (0.88–0.92) but no reduction was seen for women in the younger cohort born SGA (HR 0.98 [0.95–1.01]). Women born SGA or LBW had a lower chance of childbirth after MAR (SGA 80.3%, LBW 80.0%) compared to women born with normal weight (84.6%, <i>p</i> < 0.001) as well as an increased risk of being treated with oocyte donation (SGA 5.5% vs. 2.5%, <i>p</i> < 0.001; LBW 5.0% vs. 2.5%, <i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The decreased probability of parenthood for women born LBW, SGA, or preterm was even more evident after a longer follow-up time. When pursuing MAR with their own oocytes, they had a lower chance of conceiving.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 1","pages":"165-177"},"PeriodicalIF":4.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18350","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144923879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Carbetocin for Postpartum Haemorrhage Prophylaxis in All Births: A Retrospective Cohort Study Following Policy Change in Routine Uterotonic Use 卡贝菌素用于预防所有新生儿产后出血：一项常规子宫扩张使用政策改变后的回顾性队列研究

IF 4.3 1区医学 Q1 OBSTETRICS & GYNECOLOGY

Bjog-An International Journal of Obstetrics and Gynaecology

Pub Date : 2025-09-01 DOI: 10.1111/1471-0528.18358

Megan McKimmie-Doherty, Vidanka Vasilevski, Lauren De Luca, Elisa McDonald, Tracey Grainger, Lucy Nash, Linda Sweet

Objective

To compare postpartum haemorrhage (PPH) outcomes following a change in routine prophylactic uterotonic from Oxytocin to Carbetocin.

Design

A retrospective cohort study with a before-after design.

Setting

A large tertiary maternity service in Melbourne, Australia.

Sample

All births that met the inclusion criteria (n = 6235) from January to June 2020 and 2021.

Methods

Clinical outcome data for all births in the two 6-month periods were retrieved from the electronic medical records and manually checked for accuracy. Data were statistically analysed using univariate tests and binary logistic regression.

Main Outcome Measure

Weighed blood loss (mL) and prevalence of moderate (≥ 500 mL) and severe (≥ 1000 mL) PPH. Secondary outcomes included use of additional uterotonics, blood transfusions, admission to the high-dependency care unit, and length of stay.

Results

Carbetocin was associated with significantly lower average blood loss (p < 0.001), including rates of moderate and severe PPH (p < 0.001). There were no significant differences in the use of additional uterotonics or blood transfusions following the implementation of Carbetocin. There were significant reductions in admissions to the high-dependence care unit and length of hospital stay. Secondary analyses identified that Carbetocin was associated with reduced odds of PPH for both vaginal and caesarean birth after adjusting for a range of factors that increase the risk of PPH.

Conclusion

Carbetocin is associated with reduced blood loss and the rate of PPH compared to Oxytocin. Associated reductions in admissions to high dependency care and length of hospital stay are likely to result in reduced maternal morbidity and lower hospital costs.

目的比较产后出血（PPH）在常规预防性子宫强张剂由催产素改为卡贝菌素后的预后。设计：采用前后设计的回顾性队列研究。背景：澳大利亚墨尔本的大型三级产科服务。样本：2020年1月至2021年6月期间所有符合纳入标准的新生儿（n = 6235）。方法从电子病历中检索两个6个月期间所有新生儿的临床结局数据，并人工检查其准确性。采用单因素检验和二元逻辑回归对数据进行统计分析。称重失血量（mL）和中度（≥500 mL）和重度（≥1000 mL） PPH的患病率。次要结果包括使用额外的子宫强直术、输血、进入高依赖护理单位和住院时间。结果催产素与较低的平均失血量（p < 0.001）相关，包括中度和重度PPH的发生率（p < 0.001）。在使用卡贝菌素后，在使用额外的子宫强张剂或输血方面没有显著差异。高依赖性护理病房的入院率和住院时间显著减少。二次分析发现，在调整了一系列增加PPH风险的因素后，卡贝菌素与阴道分娩和剖宫产PPH的几率降低有关。结论与催产素相比，卡贝菌素可降低出血量和PPH发生率。接受高依赖性护理和住院时间的相关减少可能导致产妇发病率降低和住院费用降低。

{"title":"Carbetocin for Postpartum Haemorrhage Prophylaxis in All Births: A Retrospective Cohort Study Following Policy Change in Routine Uterotonic Use","authors":"Megan McKimmie-Doherty, Vidanka Vasilevski, Lauren De Luca, Elisa McDonald, Tracey Grainger, Lucy Nash, Linda Sweet","doi":"10.1111/1471-0528.18358","DOIUrl":"10.1111/1471-0528.18358","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare postpartum haemorrhage (PPH) outcomes following a change in routine prophylactic uterotonic from Oxytocin to Carbetocin.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A retrospective cohort study with a before-after design.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>A large tertiary maternity service in Melbourne, Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Sample</h3>\u0000 \u0000 <p>All births that met the inclusion criteria (<i>n</i> = 6235) from January to June 2020 and 2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Clinical outcome data for all births in the two 6-month periods were retrieved from the electronic medical records and manually checked for accuracy. Data were statistically analysed using univariate tests and binary logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measure</h3>\u0000 \u0000 <p>Weighed blood loss (mL) and prevalence of moderate (≥ 500 mL) and severe (≥ 1000 mL) PPH. Secondary outcomes included use of additional uterotonics, blood transfusions, admission to the high-dependency care unit, and length of stay.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Carbetocin was associated with significantly lower average blood loss (<i>p</i> < 0.001), including rates of moderate and severe PPH (<i>p</i> < 0.001). There were no significant differences in the use of additional uterotonics or blood transfusions following the implementation of Carbetocin. There were significant reductions in admissions to the high-dependence care unit and length of hospital stay. Secondary analyses identified that Carbetocin was associated with reduced odds of PPH for both vaginal and caesarean birth after adjusting for a range of factors that increase the risk of PPH.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Carbetocin is associated with reduced blood loss and the rate of PPH compared to Oxytocin. Associated reductions in admissions to high dependency care and length of hospital stay are likely to result in reduced maternal morbidity and lower hospital costs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 2","pages":"293-301"},"PeriodicalIF":4.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18358","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144928047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Differences in Risk Factors for Severe Preeclampsia and HELLP Syndrome in Singleton Versus Twin Pregnancies: A Population-Based Cohort Study. 单胎与双胎妊娠中严重子痫前期和HELLP综合征危险因素的差异：一项基于人群的队列研究

IF 4.3 1区医学 Q1 OBSTETRICS & GYNECOLOGY

Bjog-An International Journal of Obstetrics and Gynaecology

Pub Date : 2025-08-31 DOI: 10.1111/1471-0528.18351

Mackenzie Campbell, Johanna Koegl, Jeffrey N Bone, Sofia Nicolls, Janet Lyons, Chantal Mayer, Kenneth I Lim, Julie Van Schalkwyk, K S Joseph, Sarka Lisonkova

Objective: To examine whether the associations between pre-pregnancy risk factors and severe preeclampsia/eclampsia (SPE) and/or HELLP syndrome differ between singleton and twin pregnancies.

Design: A population-based retrospective cohort study.

Setting: British Columbia (BC), Canada.

Population: All pregnancies with singletons or twins that resulted in a stillbirth or live birth at ≥ 20 weeks' gestation from 2008/09 to 2020/21.

Methods: Data were obtained from the BC Perinatal Database Registry. Logistic regression was used to estimate the association between each risk factor for SPE/HELLP (e.g., body-mass-index (BMI), in vitro-fertilisation (IVF), chronic hypertension, and diabetes) and the modifying effect of plurality by including interaction terms between these risk factors and plurality in the model.

Main outcome measures: Severe preeclampsia, eclampsia, and/or HELLP syndrome.

Results: Among 563 252 pregnancies (8841 twin, 554 411 singleton), the rate of SPE/HELLP was 4.7 per 1000 singleton pregnancies and 31.1 per 1000 twin pregnancies (relative risk 6.61; 95% confidence interval (CI) 5.84-7.49). Older maternal age (≥ 35 years), nulliparity, pre-pregnancy and gestational diabetes, chronic hypertension, prior mental health problems, substance use during pregnancy, and prior stillbirth increased the odds, while smoking decreased the odds of SPE/HELLP among both singleton and twin pregnancies. However, the adjusted associations between BMI, IVF, prior abortions, and SPE/HELLP differed by plurality (interaction p-values 0.002, < 0.0001, and 0.04, respectively). IVF was associated with increased odds of SPE/HELLP in singleton pregnancies (adjusted odds ratio (aOR) 1.93; 95% CI 1.64-2.27) but not in twins (aOR 0.85; CI 0.65-1.11). Similarly, overweight BMI was associated with elevated odds in singleton pregnancies (aOR 1.47; CI 1.32-1.64) but not in twins (aOR 0.86; CI 0.59-1.25), as was obese BMI (singleton aOR 1.88; CI 1.67-2.12; twin aOR 0.80; CI 0.51-1.24). Conversely, a history of prior abortions was associated with decreased odds in twin pregnancies (aOR 0.70; CI 0.54-0.92) but not singleton pregnancies (aOR 0.95; CI 0.88-1.04).

Conclusions: High BMI and IVF are associated with elevated risk of SPE/HELLP syndrome in singleton pregnancies, but not in twin pregnancies. This study provides insights regarding SPE/HELLP syndrome among singleton and twin pregnancies, and useful information for pre-pregnancy counselling.

目的：探讨妊娠前危险因素与严重子痫前期/子痫（SPE）和/或HELLP综合征之间的关系在单胎和双胎妊娠中是否存在差异。设计：以人群为基础的回顾性队列研究。地理位置：加拿大不列颠哥伦比亚省。人群：2008/09年至2020/21年期间，所有妊娠≥20周导致死产或活产的单胎或双胞胎妊娠。方法：数据来自BC省围产期数据库登记处。通过在模型中包括这些危险因素和多元性之间的相互作用项，使用Logistic回归来估计SPE/ help的每个危险因素（例如，身体质量指数（BMI）、体外受精（IVF）、慢性高血压和糖尿病）与多元性的修正效应之间的关联。主要结局指标：重度先兆子痫、子痫和/或HELLP综合征。结果：563 252例妊娠（双胎8841例，单胎554 411例）中，SPE/HELLP发生率为每1000例单胎4.7例，每1000例双胎31.1例（相对危险度6.61；95%可信区间（CI） 5.84 ~ 7.49）。高龄产妇（≥35岁）、无产、孕前和妊娠期糖尿病、慢性高血压、既往精神健康问题、妊娠期间药物使用和既往死产增加了SPE/ help的几率，而吸烟降低了单胎和双胎妊娠发生SPE/ help的几率。然而，BMI、体外受精、既往流产和SPE/ help之间的校正相关性存在较大差异（相互作用p值为0.002）。结论：高BMI和体外受精与单胎妊娠发生SPE/ help综合征的风险升高相关，而与双胎妊娠无关。本研究提供了关于单胎和双胎妊娠SPE/ help综合征的见解，并为孕前咨询提供了有用的信息。

{"title":"Differences in Risk Factors for Severe Preeclampsia and HELLP Syndrome in Singleton Versus Twin Pregnancies: A Population-Based Cohort Study.","authors":"Mackenzie Campbell, Johanna Koegl, Jeffrey N Bone, Sofia Nicolls, Janet Lyons, Chantal Mayer, Kenneth I Lim, Julie Van Schalkwyk, K S Joseph, Sarka Lisonkova","doi":"10.1111/1471-0528.18351","DOIUrl":"https://doi.org/10.1111/1471-0528.18351","url":null,"abstract":"<p><strong>Objective: </strong>To examine whether the associations between pre-pregnancy risk factors and severe preeclampsia/eclampsia (SPE) and/or HELLP syndrome differ between singleton and twin pregnancies.</p><p><strong>Design: </strong>A population-based retrospective cohort study.</p><p><strong>Setting: </strong>British Columbia (BC), Canada.</p><p><strong>Population: </strong>All pregnancies with singletons or twins that resulted in a stillbirth or live birth at ≥ 20 weeks' gestation from 2008/09 to 2020/21.</p><p><strong>Methods: </strong>Data were obtained from the BC Perinatal Database Registry. Logistic regression was used to estimate the association between each risk factor for SPE/HELLP (e.g., body-mass-index (BMI), in vitro-fertilisation (IVF), chronic hypertension, and diabetes) and the modifying effect of plurality by including interaction terms between these risk factors and plurality in the model.</p><p><strong>Main outcome measures: </strong>Severe preeclampsia, eclampsia, and/or HELLP syndrome.</p><p><strong>Results: </strong>Among 563 252 pregnancies (8841 twin, 554 411 singleton), the rate of SPE/HELLP was 4.7 per 1000 singleton pregnancies and 31.1 per 1000 twin pregnancies (relative risk 6.61; 95% confidence interval (CI) 5.84-7.49). Older maternal age (≥ 35 years), nulliparity, pre-pregnancy and gestational diabetes, chronic hypertension, prior mental health problems, substance use during pregnancy, and prior stillbirth increased the odds, while smoking decreased the odds of SPE/HELLP among both singleton and twin pregnancies. However, the adjusted associations between BMI, IVF, prior abortions, and SPE/HELLP differed by plurality (interaction p-values 0.002, < 0.0001, and 0.04, respectively). IVF was associated with increased odds of SPE/HELLP in singleton pregnancies (adjusted odds ratio (aOR) 1.93; 95% CI 1.64-2.27) but not in twins (aOR 0.85; CI 0.65-1.11). Similarly, overweight BMI was associated with elevated odds in singleton pregnancies (aOR 1.47; CI 1.32-1.64) but not in twins (aOR 0.86; CI 0.59-1.25), as was obese BMI (singleton aOR 1.88; CI 1.67-2.12; twin aOR 0.80; CI 0.51-1.24). Conversely, a history of prior abortions was associated with decreased odds in twin pregnancies (aOR 0.70; CI 0.54-0.92) but not singleton pregnancies (aOR 0.95; CI 0.88-1.04).</p><p><strong>Conclusions: </strong>High BMI and IVF are associated with elevated risk of SPE/HELLP syndrome in singleton pregnancies, but not in twin pregnancies. This study provides insights regarding SPE/HELLP syndrome among singleton and twin pregnancies, and useful information for pre-pregnancy counselling.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0