News in January

High cholestrol levels increase preterm birth risk
Women with elevated cholesterol levels during early pregnancy are at increased risk for delivering a preterm infant, report US researchers. “Mechanisms that may link preterm delivery with excess maternal cardiovascular risk are not understood. Increasing evidence relates dyslipidemia, a harbinger of later life cardiovascular disease, with pre-eclampsia,” remark Janet Catov (University of Pittsburgh, USA) and team.

The investigators assessed the risk for preterm birth among 289 pregnant women. Of the women, 199 gave birth at term, 67 had moderate preterm births, delivering at between 34 and 37 weeks’ gestation, and 23 had preterm deliveries before 34 weeks. The mother’s serum levels of cholesterol, low-density lipoprotein (LDL), and triglycerides were evaluated before 15 weeks’ gestation.

Women with elevated cholesterol levels, at above 200 mg/dl, in early pregnancy were almost three times as likely as those with normal lipid profiles to experience a preterm or a moderate preterm delivery, while those with elevated triglyceride levels higher than 100 mg/dl were almost twice as likely.

Early pregnancy cholesterol concentrations and LDL levels were markedly higher among overweight women with preterm births than their normal weight peers, while lean women with moderate preterm births had only elevated triglyceride levels compared with women who delivered at term. “These findings suggest that women who deliver preterm may enter pregnancy with subtle, but detectable, elevations in atherogenic lipid components,” conclude Catov et al.

Source: American Journal of Obstetrics & Gynecology 2007; 197: 610.e1-7


Stillbirth increases subsequent pregnancy complications
Comparing obstetric outcomes between women with a history of stillbirth and normal birth.

Women with a history of stillbirth are at increased risk for subsequent pregnancy complications, UK study findings show.

Current scientific literature suggests that experiencing a previous intrauterine death could lead to adverse perinatal outcomes, but the evidence surrounding this theory is conflicting, the researchers explain. To clarify the issue, they assessed obstetric outcomes among 34,079 women giving birth in the Grampian region of Scotland, UK, between 1976 and 2002. Among these women, 364 had had a previous stillbirth and 33,175 had experienced a previous live birth.

Women who experienced a previous stillbirth were 9.4 times as likely as those who delivered a live infant to develop placental abruption in a subsequent pregnancy. Experiencing an intrauterine death also increased the subsequent risk for pre-eclampsia 3.1-fold.
Indeed, in comparison with those who experienced a live birth, women with a history of stillbirth were significantly more likely to experience any obstetric complication.

Women who had previous stillbirths were also nearly three times as likely as those who experienced live births to deliver low birth weight and premature infants, the researchers note.
“While the majority of women with a previous stillbirth have a live birth in the subsequent pregnancy, they are a high-risk group with an increased incidence of adverse neonatal outcomes,” conclude Sohinee Bhattacharya (Aberdeen Maternity Hospital, Scotland) and team.

Source: The British Journal of Obstetrics and Gynecology 2008; 115: 269-74

News in December

More on vitamins...
Assessing whether antioxidant supplementation reduces the risk for pre-eclampsia.

Taking antioxidant supplements does not reduce the risk for subsequent episodes of pre-eclampsia among pregnant women with chronic hypertension or those with a prior history of pre-eclampsia, US study findings show.

The researchers assessed the incidence of pre-eclampsia among 707 pregnant women with chronic hypertension between 12 and 19 weeks' gestation, a history of pre-eclampsia or both who were registered in four clinics in Porto Alegre and Recife, Brazil. Of these, 355 were randomly assigned to receive antioxidant supplementation comprising 1,000 mg of vitamin C and 400 International Units of vitamin E daily, while 352 received placebo.

The incidence of pre-eclampsia was comparable between women taking antioxidant supplementation and those given placebo, at 13.8 percent and 15.6 percent, respectively.
Women with a history of pre-eclampsia but no chronic hypertension were actually slightly more likely to develop severe pre-eclampsia if they took antioxidant supplements, at a rate of 6.5 percent compared with 2.4 percent among those taking placebo.

There were no significant differences in perinatal outcomes between the treatment and the placebo group, the investigators note. Joseph Spinnato (University of Cincinatti College of Medicine, Ohio, USA) and team conclude: "This study failed to demonstrate a significant effect of vitamins C and E on the rate of pre-eclampsia."

Source: Obstetrics and Gynecology 2007; 110: 1311-8

Pre-pregnancy BMI affects pre-eclampsia risk in second pregnancy
Researchers examine prepregnancy body mass index changes between a woman's first and second pregnancy and the risk for pre-eclampsia in the second pregnancy.

Women are more likely to develop pre-eclampsia in their second pregnancy if they become overweight or obese after their first, say researchers. "Chronic inflammation could be a cardinal link between prepregnancy body mass index (BMI) in earlier pregnancy and pre-eclampsia in the following pregnancy," Darios Getahun (University of Medicine and Dentistry of New Jersey, New Brunswick, USA) and colleagues suggest.

The researchers studied the risk for subsequent pre-eclampsia among 136,884 women who did not have pre-eclampsia in their first pregnancy. Women were categorized as underweight if they had a prepregnancy BMI below 18.5 kg/m2, and as normal weight, overweight, or obese if their BMIs were 18.5-24.9 kg/m2, 25-29.9 kg/m2, or 30 kg/m2 or above, respectively.
In all, 2 percent of women developed pre-eclampsia in their second pregnancy. The risk was increased 5.6 fold among women whose BMI changed from underweight to obese and 2.0 fold for women whose BMI changed from normal to overweight, compared with women whose weight remained normal in both pregnancies.

Women who went from normal weight to obese were 3.2 times more likely to develop pre-eclampsia, and women who went from overweight to obese were 3.7 times more likely to develop the condition. The researchers note that African-American women whose BMI fell from obese or overweight to normal were still at increased risk for pre-eclampsia, whereas the risk was attenuated slightly among white women.

Source: Obstetrics & Gynecology 2007; 110: 1319-25

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