Bisphenol A (BPA) exposure during the perinatal and postnatal periods increases the susceptibility to disease over the life cycle. However, information on the BPA delivered to fetuses or infants via ...the placenta and breastfeeding is limited. We determined the BPA exposure levels in various bodily fluids and tissues of pregnant women and described fetus and infant exposures to BPA based on associations and BPA ratios in mother–neonate paired samples. Maternal serum, urine, placenta, breast milk, cord serum, and neonatal urine samples were collected from 318 mother–neonate pairs at six university hospitals in Korea. BPA levels were detected using liquid chromatography tandem mass spectrometry. The ratios of the BPA levels in the other sample types to the levels in maternal serum were calculated. BPA was detected in 79.5–100% of the maternal and fetal samples. The median BPA concentration in the samples decreased in the order of neonatal urine (4.75ng/mL), maternal urine (2.86ng/mL), cord serum (1.71ng/mL), maternal serum (1.56ng/mL), breast milk (0.74ng/mL), and the placenta (0.53ng/g). We estimated the ratios of BPA levels in the other sample types to those in maternal serum. The median (95th percentile) cord serum-to-maternal serum ratio was 1.12 (15.2) for 160 mother–fetal pairs, in which BPA was detected in both samples. The placenta-, maternal urine-, neonatal urine-, and breast milk-to-maternal serum ratios were 0.28 (5.31), 1.79 (29.9), 1.98 (28.2), and 0.51 (10.5), respectively. In addition, the median (95th percentile) cord serum-to-placenta ratio was 4.03 (45.8), and the neonatal urine-to-cord serum ratio was 1.95 (25.6). The 95th percentile values were 14–20-fold greater than the medians. Urine contained the highest BPA concentrations, followed by serum, breast milk, and the placenta. The variations of BPA ratio show individual differences in the amounts of BPA delivered from mother to fetus.
Display omitted
•Not enough data on tissue distribution of BPA in mother‑neonate (or fetus) pair•The order of BPA concentrations in examined tissue or bio-samples are urine in mother and neonates>cord serum>maternal serum>breast milk>placenta.•BPA in cord serum, significantly associated with in maternal serum and urine but not in others.•The variations of BPA ratio show individual differences in the amounts of BPA delivered from mother to fetus.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
The aim of this study was to evaluate the hourly fetal urine production rate (HFUPR) via three-dimensional ultrasonography in women with isolated oligohydramnios and compare with normal pregnant ...women at term. This was a prospective observational cohort study of 112 women from 34 to 40 6/7 weeks' gestation. They were classified into three groups according to the amniotic fluid index (AFI) and ultrasonographic estimated fetal weight (EFW) as isolated oligohydramnios (defined as AFI below 5% and appropriate EFW corresponding to gestational age) (n = 34) and IUGR (defined as EFW below 5% corresponding to gestational age irrespective amniotic fluid) (n = 17), and normal pregnancy (n = 61). HFUPR was measured using three-dimensional virtual organ computer-aided analysis. Adverse perinatal outcomes in all participants were examined. There was no significant difference in HFUPR between patients with isolated oligohydramnios and women with normal pregnancies (median, 40.0 mL/h interquartile range IQR 31.0-66.5 vs. 48.6 31.5-81.2, p = 0.224). HFUPR was significantly decreased in the IUGR group (13.8 mL/h IQR 10.1-24.8), compared to the normal pregnancy group (p<0.001) and the isolated oligohydramnios group (p<0.001). HFUPR was significantly decreased in neonates with adverse perinatal outcomes compared to the control (24.7 mL/h IQR 13.4-47.4 vs. 43.6 29.8-79.0, p = 0.016). HFUPR was not decreased in patients with isolated oligohydramnios but was decreased in patients with IUGR when compared to normal controls at term.
Full text
Available for:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract
Birthweight is a strong determinant of a neonate’s health. The SARS-CoV-2 pandemic’s impact on birthweight has not been investigated in-depth, with inconsistent conclusions from initial ...studies. To assess changes in preterm birth and inappropriate birthweight between the SARS-CoV-2 pandemic and pre-pandemic periods. A nationwide birth micro-data consisted with exhaustive census of all births in 2011–2020 in South Korea was accessed to examine whether the mean birthweight and rates of under/overweight births changed significantly during the SARS-CoV-2 pandemic year (2020) compared to those of the pre-pandemic period (2011–2019). A total of 3,736,447 singleton births were analyzed. Preterm birth was defined as < 37 weeks of gestation. Low birthweight (LBW) and macrosomia were defined as birthweights < 2.5 kg and ≥ 4.0 kg, respectively. Small for gestational age (SGA) and large for gestational age (LGA) were defined as birthweights below the 10th and above 90th percentiles for sex and gestational age, respectively. Inappropriate birthweight was defined as one or more LBW, macrosomia, SGA, or LGA. Generalized linear models predicted birth outcomes and were adjusted for parental age and education level, marital status, parity, gestational age, and months from January 2011. There were 3,481,423 and 255,024 singleton births during the pre-pandemic and pandemic periods, respectively. Multivariable generalized linear models estimated negative associations between the pandemic and preterm birth (odds ratio OR, 0.968; 95% confidence interval CI 0.958–0.978), LBW (OR: 0.967, 95% CI 0.956–0.979), macrosomia (OR: 0.899, 95% CI 0.886–0.912), SGA (OR: 0.974, 95% CI 0.964–0.983), LGA (OR: 0.952, 95% CI 0.945–0.959), and inappropriate birthweight (OR: 0.958, 95% CI 0.952–0.963), indicating a decline during the pandemic compared to pre-pandemic period. An 8.98 g decrease in birthweight (95% CI 7.98–9.99) was estimated during the pandemic. This is the largest and comprehensive nationwide study to date on the impact of the SARS-CoV-2 pandemic on preterm birth and inappropriate birthweight. Birth during the pandemic was associated with lower odds of being preterm, underweight, and overweight. Further studies are required to understand the dynamics underlying this phenomenon.
Full text
Available for:
IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Although there is a high rate of pregnant immigrant women in Korea, little is known regarding their pregnancy outcomes. The aim of this study was to evaluate the pregnancy outcomes of immigrant women ...in Korea. Data for all pregnant women who gave birth between January 1, 2007 and December 31, 2016 were obtained using the Health Insurance Review and Assessment Service Database. Pregnant women were divided into two groups: Korean and immigrant women. The main outcome measures were adverse pregnancy outcomes including gestational diabetes of mellitus, preeclampsia, cesarean section, placental abrnomalities, and postpartum hemorrhage. The odds of gestational diabetes mellitus, preeclampsia, cesarean section, placental previa, placental abruptio, and postpartum hemorrhage was compared between the two groups. Among 4,439,778 pregnant women who gave birth during the study period, 168,940 (3.8%) were immigrant women. The odds of gestational diabetes mellitus (adjusted OR: 1.24; 95% CI: 1.21, 1.28), and cesarean section (adjusted OR: 1.26; 95% CI: 1.25-1.28)were higher in immigrant women than in Korean women, but the odds of preeclampsia (adjusted OR: 0.84; 95% CI: 0.81-0.86) and postpartum hemorrhage (adjusted OR 0.96, 95% CI 0.94-0.97) was lower in immigrant women than in Korean women. Immigrant women had different pregnancy outcomes. Pregnancy and postpartum management that reflects these characteristics will be necessary for immigrant women.
Full text
Available for:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Although there is a high rate of pregnant immigrant women in Korea, little is known regarding their pregnancy outcomes. The aim of this study was to evaluate the pregnancy outcomes of immigrant women ...in Korea. Data for all pregnant women who gave birth between January 1, 2007 and December 31, 2016 were obtained using the Health Insurance Review and Assessment Service Database. Pregnant women were divided into two groups: Korean and immigrant women. The main outcome measures were adverse pregnancy outcomes including gestational diabetes of mellitus, preeclampsia, cesarean section, placental abrnomalities, and postpartum hemorrhage. The odds of gestational diabetes mellitus, preeclampsia, cesarean section, placental previa, placental abruptio, and postpartum hemorrhage was compared between the two groups. Among 4,439,778 pregnant women who gave birth during the study period, 168,940 (3.8%) were immigrant women. The odds of gestational diabetes mellitus (adjusted OR: 1.24; 95% CI: 1.21, 1.28), and cesarean section (adjusted OR: 1.26; 95% CI: 1.25-1.28)were higher in immigrant women than in Korean women, but the odds of preeclampsia (adjusted OR: 0.84; 95% CI: 0.81-0.86) and postpartum hemorrhage (adjusted OR 0.96, 95% CI 0.94-0.97) was lower in immigrant women than in Korean women. Immigrant women had different pregnancy outcomes. Pregnancy and postpartum management that reflects these characteristics will be necessary for immigrant women.
Full text
Available for:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Presuming that the incidence of cerebral palsy (CP) in Korea is decreasing due to medical advances, we analyzed the trends and risk factors of CP in changing circumstances. We identified all women ...who delivered a singleton between 2007 and 2015 using the Korea National Health Insurance (KNHI). Information on pregnancy and birth was obtained by linking the KNHI claims database and data from the national health-screening program for infants and children. The 4-years incidence of CP decreased significantly from 4.77 to 2.52 per 1000 babies during the study period. The multivariate analysis revealed that the risk of developing CP was 29.5 times higher in preterm infants born before 28 weeks of gestational age, 24.5 times higher in infants born between 28 and 34 weeks, and 4.5 times higher in infants born between 34 and 36 weeks, compared to full-term appropriate for age (2.5 ~ 4 kg of body weight) infants. 5.6 times higher in those with birth weight < 2500 g, and 3.8 times higher in pregnancies with polyhydramnios. Additionally, respiratory distress syndrome increased the risk of developing CP by 2.04 times, while necrotizing enterocolitis was associated with a 2.80-fold increased risk of CP. In Korea, the incidence of CP in singleton decreased from 2007 to 2015. We need to continue to focus on developing medical technologies for the early detection of high-risk neonates and minimizing brain damage to reduce the incidence rate of CP effectively.
Full text
Available for:
IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Smoking cigarettes is known to lower the risk of preeclampsia. The objective of this study is to evaluate the effect of smoking on the expression of soluble FMS-like tyrosine kinase-1 (sFlt-1), ...vascular endothelial growth factor (VEGF), and endoglin (sEng)-1 and the role of the aryl hydrocarbon receptor (AhR) in pregnant mice. We developed a smoking mouse model using a gas-filling system. One or two cigarettes per day were exposed to each of the five pregnant mice for five days a week throughout pregnancy. AhR agonist and antagonist were injected. Serum levels and expression in the placenta of sFlt-1, VEGF, and sEng-1 were analyzed and compared among the cigarette smoke and no-exposure groups after delivery. Compared to the no-smoke exposure group, the serum level of sFlt-1 was significantly decreased in the two-cigarette-exposed group (
< 0.001). When the AhR antagonist was added to the two-cigarette-exposed group, sFlt-1 levels were significantly increased compared to the two-cigarette group (
= 0.002). The levels of sFlt-1 in the AhR antagonist group did not change regardless of two-cigarette exposure (
= 0.064). With the AhR agonist, sFlt-1 decreased significantly compared to the control (
= 0.001) and AhR antagonist group (
= 0.002). The sFlt-1 level was significantly decreased after the injection of the AhR agonist compared to the control group (
= 0.001). Serum levels of VEGF were significantly decreased in the one-cigarette-exposed group compared to the control group; however, there was no difference between the control and the two-cigarette-exposed groups. The placental expression of sFlt-1, VEGF, and sEng were inconsistent. This study offers insights into the potential role of AhR on antiangiogenic sFlt-1 associated with preeclampsia. It may support the invention of a new treatment strategy for preeclampsia using AhR activation.
Beta-2 adrenergic receptor (B2AR) agonists, used as asthma treatments and tocolytics during pregnancy, have recently been reported to be associated with autism in their offspring. However, the ...particular link between autism and ritodrine, a common type of B2AR agonist used solely as tocolytics, has never been substantiated with any nationwide database. Thus, we aimed to examine the association between in utero exposure of ritodrine and the risk of autism in their offspring using a national database. This population-based cohort study was conducted by merging the Korea National Health Insurance claims database and National Health Screening Program for Infants and Children database. These databases included all women who had delivered singleton between January 2007 and December 2008 in Korea. Out of the total 770,016 mothers, 30,959 (4.02%) were exposed to ritodrine during pregnancy, and 5583 (0.73%) of their children were identified as having autism, defined until 8 years of age. According to our analysis, the overall cumulative incidence of autism up to 8 years was 1.37% in ritodrine exposure group and 0.70% in ritodrine non-exposure group (p < 0.05, log-rank test). By Cox proportional hazard analysis, use of ritodrine in preterm birth was associated with significantly higher hazard of autism adjusted hazard ratio: 1.23, 95% CI 1.04-1.47, after adjusting for confounding variables including maternal age, parity, cesarean section, preterm labor, steroid use, birth weight, gender, and preeclampsia. Thus, in utero exposure to ritodrine was associated with an increased risk of autism in their offspring.
Full text
Available for:
IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Postpartum depression is related to many adverse effects in both mothers and their children; therefore, proper screening and early interventions are needed. This study aims to identify the risk ...factors of postpartum depression. Our primary focus is on obstetric risk factors.
This study is a cross-sectional study which we extracted the data of women who gave birth between January 1st, 2010 and December 31st, 2012 from the Health Insurance Review and Assessment service (HIRA) database. We analyzed the data using multivariable logistic regression models.
A total of 17,483 (1.4%) women suffered from depression during the postpartum period. Younger (<20years) and advanced maternal age (≥35years), primiparity, previous depression, peripartum hysterectomy, uterine artery embolization, preterm delivery, placental abruption, cesarean delivery, induced labor, and preeclampsia were found to increase the likelihood of having depression after delivery.
Our findings suggest that there are several risk factors that lead women to postpartum depression. Therefore, early detection and well-management of the symptoms and risk factors for postpartum depression along with social support can help both physical and psychological conditions of women after childbirth.
•Women with postpartum depression do not seek treatment immediately.•Obstetric complications and comorbidity during pregnancy increase depression prevalence rate.•Previous depression is the strongest risk factor in our study.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Objective
To evaluate the clinical significance of various vital signs in women referred for postpartum hemorrhage (PPH).
Methods
This retrospective study included patients with primary PPH who were ...referred to Korea University Medical Center, Ansan, between January 1, 2004, and December 31, 2016. We analyzed data for systolic and diastolic blood pressure, heart rate, and shock index (heart rate divided by systolic blood pressure) at time of arrival. Significant morbidity, such as massive transfusion, invasive procedures, and admission to the intensive care unit were reviewed. We used the area under the receiver operating characteristic curve (AUROC) for each vital sign to predict adverse maternal outcomes. Sensitivity, specificity, and negative and positive predictive values were assessed.
Results
118 women with PPH were identified. The shock index had the highest AUROC to predict massive transfusion (0.815, 95% confidence interval CI 0.727–0.883). A shock index greater than 0.9 had 93.8% (95% CI 69.8–99.8) sensitivity and 51.2% (35.1–67.1) specificity for prediction of massive transfusion, and 93.6% (78.6–99.2) sensitivity and 31.0% (15.3–50.8) specificity for prediction of invasive procedures.
Conclusion
The shock index has significant ability to predict adverse outcomes of PPH compared with other initial vital signs when patients are referred.
Initial elevated shock index can predict massive transfusion and invasive procedures when women are referred for primary postpartum hemorrhage.
Full text
Available for:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
PDF
