Pub Date : 2025-02-01DOI: 10.1016/j.ajog.2024.04.034
Joshua F. Robinson PhD , Sayan Das MSc , Waqasuddin Khan PhD , Rasheda Khanam PhD , Joan T. Price MD, MPH , Anisur Rahman PhD , Salahuddin Ahmed MBBS , Said Mohammed Ali MSc , Saikat Deb PhD , Brian Deveale PhD , Arup Dutta MBA , Matthew Gormley BS , Steven C. Hall PhD , A.S.M. Tarik Hasan MSc , Aneeta Hotwani MSc, MBA , Mohamed Hamid Juma DPHN , Margaret P. Kasaro MBChB, MPH , Javairia Khalid PhD , Pallavi Kshetrapal PhD , Michael T. McMaster PhD , Susan J. Fisher PhD
Background
The Multi-Omics for Mothers and Infants consortium aims to improve birth outcomes. Preterm birth is a major obstetrical complication globally and causes significant infant and childhood morbidity and mortality.
Objective
We analyzed placental samples (basal plate, placenta or chorionic villi, and the chorionic plate) collected by the 5 Multi-Omics for Mothers and Infants sites, namely The Alliance for Maternal and Newborn Health Improvement Bangladesh, The Alliance for Maternal and Newborn Health Improvement Pakistan, The Alliance for Maternal and Newborn Health Improvement Tanzania, The Global Alliance to Prevent Prematurity and Stillbirth Bangladesh, and The Global Alliance to Prevent Prematurity and Stillbirth Zambia. The goal was to analyze the morphology and gene expression of samples collected from preterm and uncomplicated term births.
Study Design
The teams provided biopsies from 166 singleton preterm (<37 weeks’ gestation) and 175 term (≥37 weeks’ gestation) deliveries. The samples were fixed in formalin and paraffin embedded. Tissue sections from these samples were stained with hematoxylin and eosin and subjected to morphologic analyses. Other placental biopsies (n=35 preterm, 21 term) were flash frozen, which enabled RNA purification for bulk transcriptomics.
Results
The morphologic analyses revealed a surprisingly high rate of inflammation that involved the basal plate, placenta or chorionic villi, and the chorionic plate. The rate of inflammation in chorionic villus samples, likely attributable to chronic villitis, ranged from 25% (Pakistan site) to 60% (Zambia site) of cases. Leukocyte infiltration in this location vs in the basal plate or chorionic plate correlated with preterm birth. Our transcriptomic analyses identified 267 genes that were differentially expressed between placentas from preterm vs those from term births (123 upregulated, 144 downregulated). Mapping the differentially expressed genes onto single-cell RNA sequencing data from human placentas suggested that all the component cell types, either singly or in subsets, contributed to the observed dysregulation. Consistent with the histopathologic findings, gene ontology analyses highlighted the presence of leukocyte infiltration or activation and inflammatory responses in both the fetal and maternal compartments.
Conclusion
The relationship between placental inflammation and preterm birth is appreciated in developed countries. In this study, we showed that this link also exists in developing geographies. In addition, among the participating sites, we found geographic- and population-based differences in placental inflammation and preterm birth, suggesting the importance of local factors.
{"title":"High rates of placental inflammation among samples collected by the Multi-Omics for Mothers and Infants consortium","authors":"Joshua F. Robinson PhD , Sayan Das MSc , Waqasuddin Khan PhD , Rasheda Khanam PhD , Joan T. Price MD, MPH , Anisur Rahman PhD , Salahuddin Ahmed MBBS , Said Mohammed Ali MSc , Saikat Deb PhD , Brian Deveale PhD , Arup Dutta MBA , Matthew Gormley BS , Steven C. Hall PhD , A.S.M. Tarik Hasan MSc , Aneeta Hotwani MSc, MBA , Mohamed Hamid Juma DPHN , Margaret P. Kasaro MBChB, MPH , Javairia Khalid PhD , Pallavi Kshetrapal PhD , Michael T. McMaster PhD , Susan J. Fisher PhD","doi":"10.1016/j.ajog.2024.04.034","DOIUrl":"10.1016/j.ajog.2024.04.034","url":null,"abstract":"<div><h3>Background</h3><div>The Multi-Omics for Mothers and Infants consortium aims to improve birth outcomes. Preterm birth is a major obstetrical complication globally and causes significant infant and childhood morbidity and mortality.</div></div><div><h3>Objective</h3><div>We analyzed placental samples (basal plate, placenta or chorionic villi, and the chorionic plate) collected by the 5 Multi-Omics for Mothers and Infants sites, namely The Alliance for Maternal and Newborn Health Improvement Bangladesh, The Alliance for Maternal and Newborn Health Improvement Pakistan, The Alliance for Maternal and Newborn Health Improvement Tanzania, The Global Alliance to Prevent Prematurity and Stillbirth Bangladesh, and The Global Alliance to Prevent Prematurity and Stillbirth Zambia. The goal was to analyze the morphology and gene expression of samples collected from preterm and uncomplicated term births.</div></div><div><h3>Study Design</h3><div>The teams provided biopsies from 166 singleton preterm (<37 weeks’ gestation) and 175 term (≥37 weeks’ gestation) deliveries. The samples were fixed in formalin and paraffin embedded. Tissue sections from these samples were stained with hematoxylin and eosin and subjected to morphologic analyses. Other placental biopsies (n=35 preterm, 21 term) were flash frozen, which enabled RNA purification for bulk transcriptomics.</div></div><div><h3>Results</h3><div>The morphologic analyses revealed a surprisingly high rate of inflammation that involved the basal plate, placenta or chorionic villi, and the chorionic plate. The rate of inflammation in chorionic villus samples, likely attributable to chronic villitis, ranged from 25% (Pakistan site) to 60% (Zambia site) of cases. Leukocyte infiltration in this location vs in the basal plate or chorionic plate correlated with preterm birth. Our transcriptomic analyses identified 267 genes that were differentially expressed between placentas from preterm vs those from term births (123 upregulated, 144 downregulated). Mapping the differentially expressed genes onto single-cell RNA sequencing data from human placentas suggested that all the component cell types, either singly or in subsets, contributed to the observed dysregulation. Consistent with the histopathologic findings, gene ontology analyses highlighted the presence of leukocyte infiltration or activation and inflammatory responses in both the fetal and maternal compartments.</div></div><div><h3>Conclusion</h3><div>The relationship between placental inflammation and preterm birth is appreciated in developed countries. In this study, we showed that this link also exists in developing geographies. In addition, among the participating sites, we found geographic- and population-based differences in placental inflammation and preterm birth, suggesting the importance of local factors.</div></div>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"232 2","pages":"Pages 230.e1-230.e19"},"PeriodicalIF":8.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140850303","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}
Pub Date : 2025-02-01DOI: 10.1016/j.ajog.2024.10.005
Sarah Anne A. Mayo MS, Elissa E. Cleland BS, Alim Osman MS, Tetsuya Kawakita MD, MS
{"title":"The association between neighborhood characteristics and gynecologic oncology survival","authors":"Sarah Anne A. Mayo MS, Elissa E. Cleland BS, Alim Osman MS, Tetsuya Kawakita MD, MS","doi":"10.1016/j.ajog.2024.10.005","DOIUrl":"10.1016/j.ajog.2024.10.005","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"232 2","pages":"Pages e31-e36"},"PeriodicalIF":8.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142399119","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}
Pub Date : 2025-02-01DOI: 10.1016/j.ajog.2024.04.049
Lara Slesnick MD , Mary Nienow-Birch MD , Calla Holmgren MD , Rachel Harrison MD
<div><h3>Background</h3><div><span>Preterm preeclampsia<span>, a product of vascular dysfunction, is associated with prolonged hospital admission and proteinuria, significant risk factors for </span></span>thromboembolism<span><span> in pregnancy. The risk of thromboembolism in preterm </span>preeclampsia warrants further investigation.</span></div></div><div><h3>Objective</h3><div>To determine the relationship between preterm preeclampsia and thromboembolic risk. We hypothesize that preterm preeclampsia is an independent risk factor for thromboembolism in pregnancy.</div></div><div><h3>Study Design</h3><div><span><span><span><span><span>This is a retrospective cohort study using the National Inpatient Sample database via Healthcare Cost and Utilization Project-Agency for Healthcare Cost and Utilization Project from 2017–2019. All subjects with an International Classification of Diseases, Tenth Revision code for pregnancy or peripartum encounter were included. Subjects were excluded if the gestational age at delivery was <20 weeks or if they had a history of thromboembolism, inherited </span>thrombophilia, or </span>antiphospholipid syndrome<span>. Patients with preterm (delivered <37 weeks) preeclampsia and term (delivered ≥37 weeks) preeclampsia were compared with those without preeclampsia. The primary outcome was a composite of any thromboembolic event, including pulmonary embolism, </span></span>deep vein thrombosis<span>, cerebral thrombosis or </span></span>transient ischemic attack<span>, or other thromboses. The secondary outcomes were rates of each type of thromboembolic event. The groups were compared via variance analysis, chi-square, and logistic regression analyses. The logistic regression included those variables that differed between groups with </span></span><em>P</em><.05.</div></div><div><h3>Results</h3><div><span>Of individuals in the database, >2.2 million met the inclusion criteria. A total of 56,446 (2.7%) had preterm preeclampsia, and 86,152 (6.7%) had term preeclampsia. Those with preterm preeclampsia were more likely to be older, identify as non-Hispanic black, have obesity, have chronic hypertension among other chronic diseases, and be in the lowest quartile of income (</span><em>P</em><.001). Among patients with preterm preeclampsia, 0.32% experienced thromboembolism, whereas those with term preeclampsia and without preeclampsia experienced thromboembolism at 0.10% and 0.09%, respectively. After controlling for confounders that differed between groups with <em>P</em><.05, preterm preeclampsia remained independently associated with any thromboembolic event (adjusted odds ratio, 2.21 [95% confidence interval, 1.84–2.65]), and each type of thromboembolism. Term preeclampsia was not associated with an increased risk of thromboembolism (adjusted odds ratio, 1.18 [95% confidence interval, 0.94–1.48]).</div></div><div><h3>Conclusion</h3><div>Preterm preeclampsia is independently associated with an increased
{"title":"Preterm preeclampsia as an independent risk factor for thromboembolism in a large national cohort","authors":"Lara Slesnick MD , Mary Nienow-Birch MD , Calla Holmgren MD , Rachel Harrison MD","doi":"10.1016/j.ajog.2024.04.049","DOIUrl":"10.1016/j.ajog.2024.04.049","url":null,"abstract":"<div><h3>Background</h3><div><span>Preterm preeclampsia<span>, a product of vascular dysfunction, is associated with prolonged hospital admission and proteinuria, significant risk factors for </span></span>thromboembolism<span><span> in pregnancy. The risk of thromboembolism in preterm </span>preeclampsia warrants further investigation.</span></div></div><div><h3>Objective</h3><div>To determine the relationship between preterm preeclampsia and thromboembolic risk. We hypothesize that preterm preeclampsia is an independent risk factor for thromboembolism in pregnancy.</div></div><div><h3>Study Design</h3><div><span><span><span><span><span>This is a retrospective cohort study using the National Inpatient Sample database via Healthcare Cost and Utilization Project-Agency for Healthcare Cost and Utilization Project from 2017–2019. All subjects with an International Classification of Diseases, Tenth Revision code for pregnancy or peripartum encounter were included. Subjects were excluded if the gestational age at delivery was <20 weeks or if they had a history of thromboembolism, inherited </span>thrombophilia, or </span>antiphospholipid syndrome<span>. Patients with preterm (delivered <37 weeks) preeclampsia and term (delivered ≥37 weeks) preeclampsia were compared with those without preeclampsia. The primary outcome was a composite of any thromboembolic event, including pulmonary embolism, </span></span>deep vein thrombosis<span>, cerebral thrombosis or </span></span>transient ischemic attack<span>, or other thromboses. The secondary outcomes were rates of each type of thromboembolic event. The groups were compared via variance analysis, chi-square, and logistic regression analyses. The logistic regression included those variables that differed between groups with </span></span><em>P</em><.05.</div></div><div><h3>Results</h3><div><span>Of individuals in the database, >2.2 million met the inclusion criteria. A total of 56,446 (2.7%) had preterm preeclampsia, and 86,152 (6.7%) had term preeclampsia. Those with preterm preeclampsia were more likely to be older, identify as non-Hispanic black, have obesity, have chronic hypertension among other chronic diseases, and be in the lowest quartile of income (</span><em>P</em><.001). Among patients with preterm preeclampsia, 0.32% experienced thromboembolism, whereas those with term preeclampsia and without preeclampsia experienced thromboembolism at 0.10% and 0.09%, respectively. After controlling for confounders that differed between groups with <em>P</em><.05, preterm preeclampsia remained independently associated with any thromboembolic event (adjusted odds ratio, 2.21 [95% confidence interval, 1.84–2.65]), and each type of thromboembolism. Term preeclampsia was not associated with an increased risk of thromboembolism (adjusted odds ratio, 1.18 [95% confidence interval, 0.94–1.48]).</div></div><div><h3>Conclusion</h3><div>Preterm preeclampsia is independently associated with an increased ","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"232 2","pages":"Pages 216.e1-216.e8"},"PeriodicalIF":8.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140848813","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}
Pub Date : 2025-02-01DOI: 10.1016/j.ajog.2024.09.012
Mingzhuo Pei BA, Carolyn J. Gibson PhD, Deborah Grady MD, MPH, Alison J. Huang MD, MAS
{"title":"Addressing the impact of high placebo response in hot flash treatment trials","authors":"Mingzhuo Pei BA, Carolyn J. Gibson PhD, Deborah Grady MD, MPH, Alison J. Huang MD, MAS","doi":"10.1016/j.ajog.2024.09.012","DOIUrl":"10.1016/j.ajog.2024.09.012","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"232 2","pages":"Page e78"},"PeriodicalIF":8.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279067","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}
Pub Date : 2025-02-01DOI: 10.1016/j.ajog.2024.08.011
Luyang Su, Shixia Zhao, Cuiqiao Meng
{"title":"Addressing racial disparities in maternal health: the imperative for integrated women's health management programs","authors":"Luyang Su, Shixia Zhao, Cuiqiao Meng","doi":"10.1016/j.ajog.2024.08.011","DOIUrl":"10.1016/j.ajog.2024.08.011","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"232 2","pages":"Page e68"},"PeriodicalIF":8.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141987233","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}
<div><h3>Objective</h3><div>This study aimed to investigate the diagnostic role of antimüllerian hormone in polycystic ovary syndrome using an advanced marginal beta-binomial statistical model, and present the optimal cutoff by different age groups, geographical locations, body mass indexes, and other relevant factors.</div></div><div><h3>Data Sources</h3><div>A comprehensive and systematic literature search was conducted in Web of Science, PubMed/Medline, Scopus, Cochrane Library, Embase, and ProQuest until August 2024.</div></div><div><h3>Study Eligibility Criteria</h3><div>Epidemiologic studies that used the Androgen Excess and Polycystic Ovary Syndrome Society, National Institutes of Health, or Rotterdam diagnostic criteria for polycystic ovary syndrome were included in this meta-analysis. Studies were eligible for inclusion if they provided information on the sensitivity and specificity of antimüllerian hormone or related data that allowed for the calculation of these parameters, and/or data on odds ratios and means.</div></div><div><h3>Methods</h3><div>The diagnostic efficacy of antimüllerian hormone was assessed using the marginal beta-binomial statistical model and the summary receiver operating characteristic method in terms of pooled sensitivity, specificity, and diagnostic odds ratio with 95% confidence interval. Pooled weighted mean difference and pooled odds ratios with 95% confidence interval were estimated using a random effects model.</div></div><div><h3>Results</h3><div>A total of 202 observational studies were included in the pooled analysis, of which 106 studies (including 19,465 cases and 29,318 controls) were used for meta-analysis of sensitivity/specificity and 186 studies (including 30,656 cases and 34,360 controls) for meta-analysis of mean difference. The pooled sensitivity, specificity, and diagnostic odds ratio for antimüllerian hormone were 0.79 (95% confidence interval, 0.52–0.97), 0.82 (95% confidence interval, 0.64–0.99), and 17.12 (95% confidence interval, 14.37–20.32), respectively. The area under the curve based on the summary receiver operating characteristic model was 0.90 (95% confidence interval, 0.87–0.93). Antimüllerian hormone levels were significantly higher in women with polycystic ovary syndrome than in control women (weighted mean difference, 4.91; 95% confidence interval, 4.57–5.27). In addition, individuals with higher antimüllerian hormone levels were more likely to be affected by polycystic ovary syndrome (odds ratio, 23.17; 95% confidence interval, 18.74–28.66; I<sup>2</sup>=94%; <em>P</em><.001). A serum antimüllerian hormone concentration of >5.39 ng/mL was associated with polycystic ovary syndrome (sensitivity, 88.6%; specificity, 92.75%; likelihood ratio for a positive test result, 12.21; likelihood ratio for a negative test result, 0.12).</div></div><div><h3>Conclusion</h3><div>According to the results of this meta-analysis, serum antimüllerian hormone concentration is a valuable biomar
{"title":"New insights into the relationship of antimüllerian hormone with polycystic ovary syndrome and its diagnostic accuracy: an updated and extended meta-analysis using a marginal beta-binomial model","authors":"Mostafa Barghi MSc , Zahra Heidari PhD , Fahimeh Haghighatdoost PhD , Awat Feizi PhD , Mahin Hashemipour MD","doi":"10.1016/j.ajog.2024.10.004","DOIUrl":"10.1016/j.ajog.2024.10.004","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to investigate the diagnostic role of antimüllerian hormone in polycystic ovary syndrome using an advanced marginal beta-binomial statistical model, and present the optimal cutoff by different age groups, geographical locations, body mass indexes, and other relevant factors.</div></div><div><h3>Data Sources</h3><div>A comprehensive and systematic literature search was conducted in Web of Science, PubMed/Medline, Scopus, Cochrane Library, Embase, and ProQuest until August 2024.</div></div><div><h3>Study Eligibility Criteria</h3><div>Epidemiologic studies that used the Androgen Excess and Polycystic Ovary Syndrome Society, National Institutes of Health, or Rotterdam diagnostic criteria for polycystic ovary syndrome were included in this meta-analysis. Studies were eligible for inclusion if they provided information on the sensitivity and specificity of antimüllerian hormone or related data that allowed for the calculation of these parameters, and/or data on odds ratios and means.</div></div><div><h3>Methods</h3><div>The diagnostic efficacy of antimüllerian hormone was assessed using the marginal beta-binomial statistical model and the summary receiver operating characteristic method in terms of pooled sensitivity, specificity, and diagnostic odds ratio with 95% confidence interval. Pooled weighted mean difference and pooled odds ratios with 95% confidence interval were estimated using a random effects model.</div></div><div><h3>Results</h3><div>A total of 202 observational studies were included in the pooled analysis, of which 106 studies (including 19,465 cases and 29,318 controls) were used for meta-analysis of sensitivity/specificity and 186 studies (including 30,656 cases and 34,360 controls) for meta-analysis of mean difference. The pooled sensitivity, specificity, and diagnostic odds ratio for antimüllerian hormone were 0.79 (95% confidence interval, 0.52–0.97), 0.82 (95% confidence interval, 0.64–0.99), and 17.12 (95% confidence interval, 14.37–20.32), respectively. The area under the curve based on the summary receiver operating characteristic model was 0.90 (95% confidence interval, 0.87–0.93). Antimüllerian hormone levels were significantly higher in women with polycystic ovary syndrome than in control women (weighted mean difference, 4.91; 95% confidence interval, 4.57–5.27). In addition, individuals with higher antimüllerian hormone levels were more likely to be affected by polycystic ovary syndrome (odds ratio, 23.17; 95% confidence interval, 18.74–28.66; I<sup>2</sup>=94%; <em>P</em><.001). A serum antimüllerian hormone concentration of >5.39 ng/mL was associated with polycystic ovary syndrome (sensitivity, 88.6%; specificity, 92.75%; likelihood ratio for a positive test result, 12.21; likelihood ratio for a negative test result, 0.12).</div></div><div><h3>Conclusion</h3><div>According to the results of this meta-analysis, serum antimüllerian hormone concentration is a valuable biomar","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"232 2","pages":"Pages 164-187.e31"},"PeriodicalIF":8.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142405814","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}
Pub Date : 2025-02-01DOI: 10.1016/j.ajog.2024.07.033
Stéphanie E. Reitsma PhD, Homa K. Ahmadzia MD, MPH, Alisa S. Wolberg PhD
{"title":"Agnostic proteomic profiling of maternal plasma for identifying postpartum hemorrhage risk","authors":"Stéphanie E. Reitsma PhD, Homa K. Ahmadzia MD, MPH, Alisa S. Wolberg PhD","doi":"10.1016/j.ajog.2024.07.033","DOIUrl":"10.1016/j.ajog.2024.07.033","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"232 2","pages":"Page e50"},"PeriodicalIF":8.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141791667","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}
Pub Date : 2025-02-01DOI: 10.1016/j.ajog.2024.07.042
Sonya S. Brady PhD , Shayna D. Cunningham PhD , Linda Brubaker MD , Chloe Falke BA , Aimee S. James PhD, MPH , Kimberly S. Kenton MD , Lisa Kane Low PhD, CNM, FACNM, FAAN , Alayne D. Markland DO, MSc , Gerald Mcgwin MS, PhD , Diane K. Newman DNP, APRN, BCB-PMD, FAAN , Jenna M. Norton PhD, MPH , Katlin Nuscis MSW , Dulce P. Rodriguez-Ponciano BS , Kyle D. Rudser PhD , Abigail R. Smith PhD , Ann Stapleton MD , Siobhan Sutcliffe PhD, ScM, MHS , Heather A. Klusaritz PhD, MSW
<div><h3>Objective</h3><div>Financial strain and unmet social needs are associated with greater risk for lower urinary tract symptoms. Little research has examined financial strain and unmet social needs in relation to the more holistic concept of bladder health. This study utilizes baseline data from RISE FOR HEALTH: A U.S. Study of Bladder Health to examine whether financial strain, unmet social needs, and meeting specific federal poverty level threshold levels are associated with lower urinary tract symptoms and poorer perceived bladder health, well-being, and function.</div></div><div><h3>Study Design</h3><div>Participants were 18 years or older, born female or currently identified as a woman, and from the civilian, noninstitutionalized population residing in 50 counties in the United States that included or surrounded 9 recruitment centers. Data were collected through mailed or internet-based surveys. To address research questions, the 10-item Lower Urinary Tract Dysfunction Research Network - Symptom Index and selected Prevention of Lower Urinary Tract Symptoms Research Consortium bladder health scores were separately regressed on each financial strain, unmet social need, and federal poverty level variable, using linear regression adjusting for covariates (age, race/ethnicity, education, and vaginal parity) and robust variance estimation for confidence intervals (CI). Participants with no missing data for a given analysis were included (range of n=2564–3170). In separate sensitivity analyses, body mass index, hypertension, and diabetes were added as covariates and missing data were imputed.</div></div><div><h3>Results</h3><div>The mean age of participants was 51.5 years (standard deviation=18.4). Not having enough money to make ends meet, housing insecurity, food insecurity, unreliable transportation, and percent federal poverty levels of 300% or less were consistently associated with more reported lower urinary tract symptoms and poorer perceived bladder health. For example, compared to food secure participants, women who worried that their food would run out at the end of the month had a Lower Urinary Tract Dysfunction Research Network - Symptom Index score that was 3.4 points higher (95% CI: 2.5, 4.3), on average. They also had lower mean scores across different bladder health measures, each assessed using a 100-point scale: global bladder health (−8.2, 95% CI: −10.8, −5.7), frequency (−10.2, 95% CI: −13.8, −6.7), sensation (−11.6, 95% CI: −15.1, −8.2), continence (−13.3, 95% CI: −16.7, −9.9), and emotional impact of bladder health status (−13.2, 95% CI: −16.5, −9.9). Across analyses, associations largely remained significant after additional adjustment for body mass index, hypertension, and diabetes. The pattern of results when imputing missing data was similar to that observed with complete case analysis; all significant associations remained significant with imputation.</div></div><div><h3>Conclusion</h3><div>Financial strain and unme
目的：经济压力和未满足的社会需求与下尿路症状的高风险相关。很少有研究将经济压力和未满足的社会需求与更全面的膀胱健康概念联系起来。本研究利用了 RISE FOR HEALTH 的基线数据：美国膀胱健康研究》（RISE FOR HEALTH: A U.S. Study of Bladder Health）的基线数据，研究经济压力、未满足的社会需求以及达到特定的联邦贫困线水平是否与尿路症状较轻以及膀胱健康、幸福感和功能较差有关：参与者年龄在 18 岁或以上，出生时为女性或目前被认定为女性，来自居住在美国 50 个县的非住院平民，这些县包括或环绕着 9 个招募中心。数据通过邮寄或互联网调查的方式收集。为了解决研究问题，我们使用线性回归法对每个经济压力、未满足的社会需求和联邦贫困水平变量分别进行了 10 项下尿路功能障碍研究网络症状指数和选定的预防下尿路症状研究联合会膀胱健康评分的回归，并对共变量（年龄、种族/民族、教育程度和阴道奇偶性）进行了调整，同时对置信区间进行了稳健的方差估计。在特定分析中没有缺失数据的参与者均被纳入分析范围（范围为 n=2,564 至 3,170）。在单独的敏感性分析中，加入了体重指数、高血压和糖尿病作为协变量，并对缺失数据进行了估算：参与者的平均年龄为 51.5 岁（标准差=18.4）。没有足够的钱维持生计、住房不安全、食品不安全、交通不可靠以及联邦贫困线为 300% 或更低等因素始终与报告的下尿路症状较多和膀胱健康状况较差有关。例如，与有食物保障的参与者相比，担心月底食物会吃完的妇女的下尿路功能障碍研究网络--症状指数得分平均高出 3.4 分（95% CI：2.5, 4.3）。他们在不同膀胱健康指标上的平均得分也较低，每项指标均采用 100 分制进行评估：总体膀胱健康（-8.2，95% CI：-10.8,-5.7）、尿频（-10.2，95% CI：-13.8,-6.7）、感觉（-11.6，95% CI：-15.1,-8.2）、持续性（-13.3，95% CI：-16.7,-9.9）和膀胱健康状况对情绪的影响（-13.2，95% CI：-16.5,-9.9）。在所有分析中，对体重指数、高血压和糖尿病进行额外调整后，相关性在很大程度上仍然显著。对缺失数据进行估算后的结果模式与完整病例分析中观察到的结果类似；所有显著关联在估算后仍然显著：结论：经济压力和未满足的社会需求与更严重的LUTS和更差的膀胱健康有关。需要进行纵向研究，以探讨经济压力和未满足的社会需求是否会影响下尿路症状的发展、维持和恶化；经济压力和未满足的社会需求可能影响症状的不同机制；以及症状对经济压力的影响程度。如果得到病因学研究的支持，就可以开展预防研究，以确定改善经济压力和社会需求（包括增加获得预防性护理的机会）是否可以促进整个生命过程中的膀胱健康。
{"title":"Associations of financial strain and unmet social needs with women’s bladder health","authors":"Sonya S. Brady PhD , Shayna D. Cunningham PhD , Linda Brubaker MD , Chloe Falke BA , Aimee S. James PhD, MPH , Kimberly S. Kenton MD , Lisa Kane Low PhD, CNM, FACNM, FAAN , Alayne D. Markland DO, MSc , Gerald Mcgwin MS, PhD , Diane K. Newman DNP, APRN, BCB-PMD, FAAN , Jenna M. Norton PhD, MPH , Katlin Nuscis MSW , Dulce P. Rodriguez-Ponciano BS , Kyle D. Rudser PhD , Abigail R. Smith PhD , Ann Stapleton MD , Siobhan Sutcliffe PhD, ScM, MHS , Heather A. Klusaritz PhD, MSW","doi":"10.1016/j.ajog.2024.07.042","DOIUrl":"10.1016/j.ajog.2024.07.042","url":null,"abstract":"<div><h3>Objective</h3><div>Financial strain and unmet social needs are associated with greater risk for lower urinary tract symptoms. Little research has examined financial strain and unmet social needs in relation to the more holistic concept of bladder health. This study utilizes baseline data from RISE FOR HEALTH: A U.S. Study of Bladder Health to examine whether financial strain, unmet social needs, and meeting specific federal poverty level threshold levels are associated with lower urinary tract symptoms and poorer perceived bladder health, well-being, and function.</div></div><div><h3>Study Design</h3><div>Participants were 18 years or older, born female or currently identified as a woman, and from the civilian, noninstitutionalized population residing in 50 counties in the United States that included or surrounded 9 recruitment centers. Data were collected through mailed or internet-based surveys. To address research questions, the 10-item Lower Urinary Tract Dysfunction Research Network - Symptom Index and selected Prevention of Lower Urinary Tract Symptoms Research Consortium bladder health scores were separately regressed on each financial strain, unmet social need, and federal poverty level variable, using linear regression adjusting for covariates (age, race/ethnicity, education, and vaginal parity) and robust variance estimation for confidence intervals (CI). Participants with no missing data for a given analysis were included (range of n=2564–3170). In separate sensitivity analyses, body mass index, hypertension, and diabetes were added as covariates and missing data were imputed.</div></div><div><h3>Results</h3><div>The mean age of participants was 51.5 years (standard deviation=18.4). Not having enough money to make ends meet, housing insecurity, food insecurity, unreliable transportation, and percent federal poverty levels of 300% or less were consistently associated with more reported lower urinary tract symptoms and poorer perceived bladder health. For example, compared to food secure participants, women who worried that their food would run out at the end of the month had a Lower Urinary Tract Dysfunction Research Network - Symptom Index score that was 3.4 points higher (95% CI: 2.5, 4.3), on average. They also had lower mean scores across different bladder health measures, each assessed using a 100-point scale: global bladder health (−8.2, 95% CI: −10.8, −5.7), frequency (−10.2, 95% CI: −13.8, −6.7), sensation (−11.6, 95% CI: −15.1, −8.2), continence (−13.3, 95% CI: −16.7, −9.9), and emotional impact of bladder health status (−13.2, 95% CI: −16.5, −9.9). Across analyses, associations largely remained significant after additional adjustment for body mass index, hypertension, and diabetes. The pattern of results when imputing missing data was similar to that observed with complete case analysis; all significant associations remained significant with imputation.</div></div><div><h3>Conclusion</h3><div>Financial strain and unme","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"232 2","pages":"Pages 200.e1-200.e20"},"PeriodicalIF":8.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141900625","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}
Pub Date : 2025-02-01DOI: 10.1016/j.ajog.2024.07.025
Nicholas B. Lolli MD , Amanda M. McWhirter MD , Karen B. Lesser MD , Demaretta S. Rush MD , Ahmed G. Aboul-Nasr MD , Lynn M. Coppola MD
{"title":"Zebras in a snowstorm: ultrasound guidance for differentiating placental mesenchymal dysplasia from hydatidiform mole","authors":"Nicholas B. Lolli MD , Amanda M. McWhirter MD , Karen B. Lesser MD , Demaretta S. Rush MD , Ahmed G. Aboul-Nasr MD , Lynn M. Coppola MD","doi":"10.1016/j.ajog.2024.07.025","DOIUrl":"10.1016/j.ajog.2024.07.025","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"232 2","pages":"Pages 235-238"},"PeriodicalIF":8.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141786991","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}
Pub Date : 2025-02-01DOI: 10.1016/j.ajog.2024.08.004
Liang Peng MD, Baodi Cao MB, Xiaohui Wang MB
{"title":"Evaluating soluble fms-like tyrosine kinase 1/placental growth factor (sFlt-1/PlGF) testing: technological innovation suggestions and public health application prospects","authors":"Liang Peng MD, Baodi Cao MB, Xiaohui Wang MB","doi":"10.1016/j.ajog.2024.08.004","DOIUrl":"10.1016/j.ajog.2024.08.004","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"232 2","pages":"Page e66"},"PeriodicalIF":8.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141911338","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}
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