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Anna M Modest - One of the best experts on this subject based on the ideXlab platform.

  • angiogenic factors and prediction for ischemic Placental Disease in future pregnancies
    Pregnancy Hypertension, 2021
    Co-Authors: Katherine M Johnson, Anna M Modest, Laura T Smith, S Z Salahuddin, S A Karumanchi, Sarosh Rana, Brett C Young
    Abstract:

    Abstract Objectives Ischemic Placental Disease (IPD), including preeclampsia, abruption, and fetal growth restriction, often recurs in subsequent pregnancies. Angiogenic factors of Placental origin have been implicated in the pathogenesis of preeclampsia, but have not been studied as predictors of IPD in subsequent pregnancies. We hypothesized that elevated angiogenic factors in an index pregnancy would be associated with recurrence of IPD. Study design We conducted a retrospective cohort study of patients undergoing evaluation for preeclampsia who had angiogenic factors measured in an index pregnancy and experienced a subsequent pregnancy at the same institution. Patients with IPD in the index pregnancy were included. A high ratio of soluble fms-like tyrosine kinase 1 (sFlt1) and Placental growth factor (PlGF) was defined as greater than or equal to 85. Main outcome measures The primary outcome was IPD in a subsequent pregnancy. Results We included 109 patients in the analysis. The sFlt1/PlGF ratio was elevated in 30% of participants. Those with an elevated ratio were more likely to be nulliparous in the index pregnancy, and less likely to have chronic hypertension. The recurrence of IPD in the study was 27%, with a non-significant difference in risk based on a high sFlt-1/P1GF ratio RR 0.58 (95% CI 0.21 – 1.6) compared to a low ratio. Conclusions A high sFlt1/P1GF ratio in an index pregnancy is not associated with a higher risk of IPD in a subsequent pregnancy. These data suggest Placental angiogenic biomarkers are specific to the pregnancy and not a reflection of maternal predisposition to IPD.

  • elevated serum progesterone during in vitro fertilization treatment and the risk of ischemic Placental Disease
    Pregnancy Hypertension, 2021
    Co-Authors: Katherine M Johnson, Anna M Modest, Ashley Aluko, Ashwini Joshi, Lauren A Wise, Matthew P Fox, Michele R Hacker
    Abstract:

    Abstract Background Elevated progesterone on the day of human chorionic gonadotropin (hCG) administration is associated with decreased live birth rates in IVF cycles. The association with adverse pregnancy outcomes is unknown. Objectives Assess the association between serum progesterone on the day of hCG administration and the risk of ischemic Placental Disease [IPD; preeclampsia, Placental abruption, and/or small for gestational age (SGA)]. Methods We conducted a retrospective cohort study of autologous fresh IVF cycles resulting in delivery between 2005 and 2018. All IVF procedures were conducted at a large, university-affiliated infertility center. Patients were divided into tertiles based on their serum progesterone level on the day of hCG administration; the lowest tertile served as the reference group. We identified pregnancies complicated by preeclampsia and Placental abruption using ICD-9/10 codes and medical record review. We defined SGA as  Results The cohort included 166 deliveries in the lowest tertile of progesterone (0.2–0.73 ng/ml), 166 deliveries in the middle (0.64–1.05 ng/ml) and 167 deliveries in the highest tertile (1.05–5.6 ng/ml). Compared with the lowest tertile, the risk of IPD was greater in the middle (RR 1.6; 95% CI 1.1–2.5) tertile after adjustment for age, parity, number of oocytes retrieved, and estradiol. The highest tertile was also not associated with an increased risk of IPD. Conclusion In an IVF population, elevated serum progesterone in the range of 0.64–1.05 ng/mL on the day of hCG administration was associated with a small increased risk of IPD.

  • association between in vitro fertilization and ischemic Placental Disease by gestational age
    Fertility and Sterility, 2020
    Co-Authors: Katherine M Johnson, Michele R Hacker, Anna M Modest, Brett C Young, Kim L Thornton
    Abstract:

    Objective To evaluate the association between in vitro fertilization (IVF) and ischemic Placental Disease (IPD), stratified by gestational age. Design We performed a secondary analysis of a retrospective cohort study of deliveries. Setting Deliveries were performed over 15 years at a single tertiary hospital. Patient(s) We included all parturients who had a live born infant or an intrauterine fetal demise (IUFD). Intervention(s) We compared pregnancies resulting from IVF cycles to non-IVF pregnancies. Main Outcome Measure(s) The primary outcomes were preterm and term IPD (preeclampsia, Placental abruption, small-for-gestational age infant [SGA], or an intrauterine fetal demise [IUFD] due to Placental insufficiency). Result(s) Of the 69,084 deliveries during the study period, 3,763 (5.4%) were conceived with IVF. The incidence of preterm delivery was 32.6% in IVF pregnancies and 10.8% in non-IVF pregnancies. Multiple gestations were more common in IVF pregnancies. Compared to non-IVF pregnancies, IVF pregnancies were more likely to develop both preterm and term IPD, even after adjustment for maternal age and parity. The risk of preterm IPD was 4 times higher (95% confidence interval, 3.7–4.4) in patients who underwent IVF compared with those who did not undergo IVF. Among parturients who delivered at ≥37 weeks of gestation, IVF pregnancies had 1.7 times the risk of term IPD (95% confidence interval, 1.6–1.9) compared with non-IVF pregnancies. Conclusion(s) IVF was strongly associated with preterm IPD. We found a similar, but attenuated, association between IVF and term IPD. The stronger association with preterm IPD suggests an association between IVF and Placental insufficiency.

  • risk of ischemic Placental Disease is increased following in vitro fertilization with oocyte donation a retrospective cohort study
    Journal of Assisted Reproduction and Genetics, 2019
    Co-Authors: Katherine M Johnson, Nina Resetkova, Anna M Modest, Brett C Young, Lauren A Wise, Matthew P Fox, Ananth S Karumanchi, Michele R Hacker
    Abstract:

    Assess the risk of ischemic Placental Disease (IPD) among in vitro fertilization (IVF; donor and autologous) pregnancies compared with non-IVF pregnancies. This was a retrospective cohort study of deliveries from 2000 to 2015 at a tertiary hospital. The exposures, donor, and autologous IVF, were compared with non-IVF pregnancies and donor IVF pregnancies were also compared with autologous IVF pregnancies. The outcome was IPD (preeclampsia, Placental abruption, small for gestational age (SGA), or intrauterine fetal demise due to Placental insufficiency). We defined SGA as birthweight < 10th percentiles for gestational age and sex. A secondary analysis restricted SGA to < 3rd percentile. Of 69,084 deliveries in this cohort, 262 resulted from donor IVF and 3,501 from autologous IVF. Compared with non-IVF pregnancies, IPD was more common among donor IVF pregnancies (risk ratio (RR) = 2.9; 95% CI 2.5–3.4) and autologous IVF pregnancies (RR = 2.0; 95% CI 1.9–2.1), adjusted for age and parity. IVF pregnancies were more likely to be complicated by preeclampsia (donor RR = 3.8; 95% CI 2.8–5.0 and autologous RR = 2.2; 95% CI 2.0–2.5, adjusted for age, parity, and marital status), Placental abruption (donor RR = 3.8; 95% CI 2.1–6.7 and autologous RR = 2.5; 95% CI 2.1–3.1, adjusted for age), and SGA (donor RR = 2.7; 95% CI 2.1–3.4 and autologous RR = 2.0; 95% CI 1.9–2.2, adjusted for age and parity). Results were similar when restricting SGA to < 3rd percentile. Pregnancies conceived using donor IVF and autologous IVF were at higher risk of IPD and its associated conditions than non-IVF pregnancies and associations were consistently stronger for donor IVF pregnancies.

  • risk of ischemic Placental Disease in fresh and frozen embryo transfer cycles
    Fertility and Sterility, 2019
    Co-Authors: Katherine M Johnson, Michele R Hacker, Nina Resetkova, Barbara Obrien, Anna M Modest
    Abstract:

    Objectives To evaluate the association of fresh and frozen embryo transfer with the development of ischemic Placental Disease (IPD), hypothesizing that differences in implantation environment affect placentation and thus pregnancy outcomes. Design We performed a secondary analysis of a retrospective cohort study of deliveries linked to IVF cycles. Setting Tertiary hospital and infertility treatment center. Patient(s) We included all women who underwent an autologous IVF cycle and had a live-born infant or an intrauterine fetal demise (IUFD). We excluded women less than 18 years of age. Intervention(s) We compared pregnancies resulting from frozen embryo transfer (frozen) cycles with those resulting from fresh embryo transfer (fresh) cycles. Main Outcome Measure(s) The primary outcome was a composite outcome of IPD or IUFD due to Placental insufficiency. Ischemic Placental Disease included pre-eclampsia, Placental abruption, and small for gestational age (SGA). We calculated risk ratios (RRs) and 95% confidence intervals (CIs). Result(s) Compared with fresh cycles, frozen cycles had a lower risk of IPD or IUFD from Placental insufficiency (RR 0.75, 95% CI 0.59–0.97). Frozen cycles also conferred a lower risk of SGA than fresh cycles (RR 0.58, 95% CI 0.41–0.81). Risks of pre-eclampsia (RR 1.3, 95% CI 0.84–1.9) and abruption (RR 1.2, 95% CI 0.56–2.4) were similar. Conclusion(s) There was a lower risk of IPD among frozen cycles compared with fresh cycles. This association was largely driven by lower risk of SGA among frozen cycles.

Katherine M Johnson - One of the best experts on this subject based on the ideXlab platform.

  • angiogenic factors and prediction for ischemic Placental Disease in future pregnancies
    Pregnancy Hypertension, 2021
    Co-Authors: Katherine M Johnson, Anna M Modest, Laura T Smith, S Z Salahuddin, S A Karumanchi, Sarosh Rana, Brett C Young
    Abstract:

    Abstract Objectives Ischemic Placental Disease (IPD), including preeclampsia, abruption, and fetal growth restriction, often recurs in subsequent pregnancies. Angiogenic factors of Placental origin have been implicated in the pathogenesis of preeclampsia, but have not been studied as predictors of IPD in subsequent pregnancies. We hypothesized that elevated angiogenic factors in an index pregnancy would be associated with recurrence of IPD. Study design We conducted a retrospective cohort study of patients undergoing evaluation for preeclampsia who had angiogenic factors measured in an index pregnancy and experienced a subsequent pregnancy at the same institution. Patients with IPD in the index pregnancy were included. A high ratio of soluble fms-like tyrosine kinase 1 (sFlt1) and Placental growth factor (PlGF) was defined as greater than or equal to 85. Main outcome measures The primary outcome was IPD in a subsequent pregnancy. Results We included 109 patients in the analysis. The sFlt1/PlGF ratio was elevated in 30% of participants. Those with an elevated ratio were more likely to be nulliparous in the index pregnancy, and less likely to have chronic hypertension. The recurrence of IPD in the study was 27%, with a non-significant difference in risk based on a high sFlt-1/P1GF ratio RR 0.58 (95% CI 0.21 – 1.6) compared to a low ratio. Conclusions A high sFlt1/P1GF ratio in an index pregnancy is not associated with a higher risk of IPD in a subsequent pregnancy. These data suggest Placental angiogenic biomarkers are specific to the pregnancy and not a reflection of maternal predisposition to IPD.

  • elevated serum progesterone during in vitro fertilization treatment and the risk of ischemic Placental Disease
    Pregnancy Hypertension, 2021
    Co-Authors: Katherine M Johnson, Anna M Modest, Ashley Aluko, Ashwini Joshi, Lauren A Wise, Matthew P Fox, Michele R Hacker
    Abstract:

    Abstract Background Elevated progesterone on the day of human chorionic gonadotropin (hCG) administration is associated with decreased live birth rates in IVF cycles. The association with adverse pregnancy outcomes is unknown. Objectives Assess the association between serum progesterone on the day of hCG administration and the risk of ischemic Placental Disease [IPD; preeclampsia, Placental abruption, and/or small for gestational age (SGA)]. Methods We conducted a retrospective cohort study of autologous fresh IVF cycles resulting in delivery between 2005 and 2018. All IVF procedures were conducted at a large, university-affiliated infertility center. Patients were divided into tertiles based on their serum progesterone level on the day of hCG administration; the lowest tertile served as the reference group. We identified pregnancies complicated by preeclampsia and Placental abruption using ICD-9/10 codes and medical record review. We defined SGA as  Results The cohort included 166 deliveries in the lowest tertile of progesterone (0.2–0.73 ng/ml), 166 deliveries in the middle (0.64–1.05 ng/ml) and 167 deliveries in the highest tertile (1.05–5.6 ng/ml). Compared with the lowest tertile, the risk of IPD was greater in the middle (RR 1.6; 95% CI 1.1–2.5) tertile after adjustment for age, parity, number of oocytes retrieved, and estradiol. The highest tertile was also not associated with an increased risk of IPD. Conclusion In an IVF population, elevated serum progesterone in the range of 0.64–1.05 ng/mL on the day of hCG administration was associated with a small increased risk of IPD.

  • association between in vitro fertilization and ischemic Placental Disease by gestational age
    Fertility and Sterility, 2020
    Co-Authors: Katherine M Johnson, Michele R Hacker, Anna M Modest, Brett C Young, Kim L Thornton
    Abstract:

    Objective To evaluate the association between in vitro fertilization (IVF) and ischemic Placental Disease (IPD), stratified by gestational age. Design We performed a secondary analysis of a retrospective cohort study of deliveries. Setting Deliveries were performed over 15 years at a single tertiary hospital. Patient(s) We included all parturients who had a live born infant or an intrauterine fetal demise (IUFD). Intervention(s) We compared pregnancies resulting from IVF cycles to non-IVF pregnancies. Main Outcome Measure(s) The primary outcomes were preterm and term IPD (preeclampsia, Placental abruption, small-for-gestational age infant [SGA], or an intrauterine fetal demise [IUFD] due to Placental insufficiency). Result(s) Of the 69,084 deliveries during the study period, 3,763 (5.4%) were conceived with IVF. The incidence of preterm delivery was 32.6% in IVF pregnancies and 10.8% in non-IVF pregnancies. Multiple gestations were more common in IVF pregnancies. Compared to non-IVF pregnancies, IVF pregnancies were more likely to develop both preterm and term IPD, even after adjustment for maternal age and parity. The risk of preterm IPD was 4 times higher (95% confidence interval, 3.7–4.4) in patients who underwent IVF compared with those who did not undergo IVF. Among parturients who delivered at ≥37 weeks of gestation, IVF pregnancies had 1.7 times the risk of term IPD (95% confidence interval, 1.6–1.9) compared with non-IVF pregnancies. Conclusion(s) IVF was strongly associated with preterm IPD. We found a similar, but attenuated, association between IVF and term IPD. The stronger association with preterm IPD suggests an association between IVF and Placental insufficiency.

  • risk of ischemic Placental Disease is increased following in vitro fertilization with oocyte donation a retrospective cohort study
    Journal of Assisted Reproduction and Genetics, 2019
    Co-Authors: Katherine M Johnson, Nina Resetkova, Anna M Modest, Brett C Young, Lauren A Wise, Matthew P Fox, Ananth S Karumanchi, Michele R Hacker
    Abstract:

    Assess the risk of ischemic Placental Disease (IPD) among in vitro fertilization (IVF; donor and autologous) pregnancies compared with non-IVF pregnancies. This was a retrospective cohort study of deliveries from 2000 to 2015 at a tertiary hospital. The exposures, donor, and autologous IVF, were compared with non-IVF pregnancies and donor IVF pregnancies were also compared with autologous IVF pregnancies. The outcome was IPD (preeclampsia, Placental abruption, small for gestational age (SGA), or intrauterine fetal demise due to Placental insufficiency). We defined SGA as birthweight < 10th percentiles for gestational age and sex. A secondary analysis restricted SGA to < 3rd percentile. Of 69,084 deliveries in this cohort, 262 resulted from donor IVF and 3,501 from autologous IVF. Compared with non-IVF pregnancies, IPD was more common among donor IVF pregnancies (risk ratio (RR) = 2.9; 95% CI 2.5–3.4) and autologous IVF pregnancies (RR = 2.0; 95% CI 1.9–2.1), adjusted for age and parity. IVF pregnancies were more likely to be complicated by preeclampsia (donor RR = 3.8; 95% CI 2.8–5.0 and autologous RR = 2.2; 95% CI 2.0–2.5, adjusted for age, parity, and marital status), Placental abruption (donor RR = 3.8; 95% CI 2.1–6.7 and autologous RR = 2.5; 95% CI 2.1–3.1, adjusted for age), and SGA (donor RR = 2.7; 95% CI 2.1–3.4 and autologous RR = 2.0; 95% CI 1.9–2.2, adjusted for age and parity). Results were similar when restricting SGA to < 3rd percentile. Pregnancies conceived using donor IVF and autologous IVF were at higher risk of IPD and its associated conditions than non-IVF pregnancies and associations were consistently stronger for donor IVF pregnancies.

  • risk of ischemic Placental Disease in fresh and frozen embryo transfer cycles
    Fertility and Sterility, 2019
    Co-Authors: Katherine M Johnson, Michele R Hacker, Nina Resetkova, Barbara Obrien, Anna M Modest
    Abstract:

    Objectives To evaluate the association of fresh and frozen embryo transfer with the development of ischemic Placental Disease (IPD), hypothesizing that differences in implantation environment affect placentation and thus pregnancy outcomes. Design We performed a secondary analysis of a retrospective cohort study of deliveries linked to IVF cycles. Setting Tertiary hospital and infertility treatment center. Patient(s) We included all women who underwent an autologous IVF cycle and had a live-born infant or an intrauterine fetal demise (IUFD). We excluded women less than 18 years of age. Intervention(s) We compared pregnancies resulting from frozen embryo transfer (frozen) cycles with those resulting from fresh embryo transfer (fresh) cycles. Main Outcome Measure(s) The primary outcome was a composite outcome of IPD or IUFD due to Placental insufficiency. Ischemic Placental Disease included pre-eclampsia, Placental abruption, and small for gestational age (SGA). We calculated risk ratios (RRs) and 95% confidence intervals (CIs). Result(s) Compared with fresh cycles, frozen cycles had a lower risk of IPD or IUFD from Placental insufficiency (RR 0.75, 95% CI 0.59–0.97). Frozen cycles also conferred a lower risk of SGA than fresh cycles (RR 0.58, 95% CI 0.41–0.81). Risks of pre-eclampsia (RR 1.3, 95% CI 0.84–1.9) and abruption (RR 1.2, 95% CI 0.56–2.4) were similar. Conclusion(s) There was a lower risk of IPD among frozen cycles compared with fresh cycles. This association was largely driven by lower risk of SGA among frozen cycles.

Michele R Hacker - One of the best experts on this subject based on the ideXlab platform.

  • elevated serum progesterone during in vitro fertilization treatment and the risk of ischemic Placental Disease
    Pregnancy Hypertension, 2021
    Co-Authors: Katherine M Johnson, Anna M Modest, Ashley Aluko, Ashwini Joshi, Lauren A Wise, Matthew P Fox, Michele R Hacker
    Abstract:

    Abstract Background Elevated progesterone on the day of human chorionic gonadotropin (hCG) administration is associated with decreased live birth rates in IVF cycles. The association with adverse pregnancy outcomes is unknown. Objectives Assess the association between serum progesterone on the day of hCG administration and the risk of ischemic Placental Disease [IPD; preeclampsia, Placental abruption, and/or small for gestational age (SGA)]. Methods We conducted a retrospective cohort study of autologous fresh IVF cycles resulting in delivery between 2005 and 2018. All IVF procedures were conducted at a large, university-affiliated infertility center. Patients were divided into tertiles based on their serum progesterone level on the day of hCG administration; the lowest tertile served as the reference group. We identified pregnancies complicated by preeclampsia and Placental abruption using ICD-9/10 codes and medical record review. We defined SGA as  Results The cohort included 166 deliveries in the lowest tertile of progesterone (0.2–0.73 ng/ml), 166 deliveries in the middle (0.64–1.05 ng/ml) and 167 deliveries in the highest tertile (1.05–5.6 ng/ml). Compared with the lowest tertile, the risk of IPD was greater in the middle (RR 1.6; 95% CI 1.1–2.5) tertile after adjustment for age, parity, number of oocytes retrieved, and estradiol. The highest tertile was also not associated with an increased risk of IPD. Conclusion In an IVF population, elevated serum progesterone in the range of 0.64–1.05 ng/mL on the day of hCG administration was associated with a small increased risk of IPD.

  • association between in vitro fertilization and ischemic Placental Disease by gestational age
    Fertility and Sterility, 2020
    Co-Authors: Katherine M Johnson, Michele R Hacker, Anna M Modest, Brett C Young, Kim L Thornton
    Abstract:

    Objective To evaluate the association between in vitro fertilization (IVF) and ischemic Placental Disease (IPD), stratified by gestational age. Design We performed a secondary analysis of a retrospective cohort study of deliveries. Setting Deliveries were performed over 15 years at a single tertiary hospital. Patient(s) We included all parturients who had a live born infant or an intrauterine fetal demise (IUFD). Intervention(s) We compared pregnancies resulting from IVF cycles to non-IVF pregnancies. Main Outcome Measure(s) The primary outcomes were preterm and term IPD (preeclampsia, Placental abruption, small-for-gestational age infant [SGA], or an intrauterine fetal demise [IUFD] due to Placental insufficiency). Result(s) Of the 69,084 deliveries during the study period, 3,763 (5.4%) were conceived with IVF. The incidence of preterm delivery was 32.6% in IVF pregnancies and 10.8% in non-IVF pregnancies. Multiple gestations were more common in IVF pregnancies. Compared to non-IVF pregnancies, IVF pregnancies were more likely to develop both preterm and term IPD, even after adjustment for maternal age and parity. The risk of preterm IPD was 4 times higher (95% confidence interval, 3.7–4.4) in patients who underwent IVF compared with those who did not undergo IVF. Among parturients who delivered at ≥37 weeks of gestation, IVF pregnancies had 1.7 times the risk of term IPD (95% confidence interval, 1.6–1.9) compared with non-IVF pregnancies. Conclusion(s) IVF was strongly associated with preterm IPD. We found a similar, but attenuated, association between IVF and term IPD. The stronger association with preterm IPD suggests an association between IVF and Placental insufficiency.

  • risk of ischemic Placental Disease is increased following in vitro fertilization with oocyte donation a retrospective cohort study
    Journal of Assisted Reproduction and Genetics, 2019
    Co-Authors: Katherine M Johnson, Nina Resetkova, Anna M Modest, Brett C Young, Lauren A Wise, Matthew P Fox, Ananth S Karumanchi, Michele R Hacker
    Abstract:

    Assess the risk of ischemic Placental Disease (IPD) among in vitro fertilization (IVF; donor and autologous) pregnancies compared with non-IVF pregnancies. This was a retrospective cohort study of deliveries from 2000 to 2015 at a tertiary hospital. The exposures, donor, and autologous IVF, were compared with non-IVF pregnancies and donor IVF pregnancies were also compared with autologous IVF pregnancies. The outcome was IPD (preeclampsia, Placental abruption, small for gestational age (SGA), or intrauterine fetal demise due to Placental insufficiency). We defined SGA as birthweight < 10th percentiles for gestational age and sex. A secondary analysis restricted SGA to < 3rd percentile. Of 69,084 deliveries in this cohort, 262 resulted from donor IVF and 3,501 from autologous IVF. Compared with non-IVF pregnancies, IPD was more common among donor IVF pregnancies (risk ratio (RR) = 2.9; 95% CI 2.5–3.4) and autologous IVF pregnancies (RR = 2.0; 95% CI 1.9–2.1), adjusted for age and parity. IVF pregnancies were more likely to be complicated by preeclampsia (donor RR = 3.8; 95% CI 2.8–5.0 and autologous RR = 2.2; 95% CI 2.0–2.5, adjusted for age, parity, and marital status), Placental abruption (donor RR = 3.8; 95% CI 2.1–6.7 and autologous RR = 2.5; 95% CI 2.1–3.1, adjusted for age), and SGA (donor RR = 2.7; 95% CI 2.1–3.4 and autologous RR = 2.0; 95% CI 1.9–2.2, adjusted for age and parity). Results were similar when restricting SGA to < 3rd percentile. Pregnancies conceived using donor IVF and autologous IVF were at higher risk of IPD and its associated conditions than non-IVF pregnancies and associations were consistently stronger for donor IVF pregnancies.

  • risk of ischemic Placental Disease in fresh and frozen embryo transfer cycles
    Fertility and Sterility, 2019
    Co-Authors: Katherine M Johnson, Michele R Hacker, Nina Resetkova, Barbara Obrien, Anna M Modest
    Abstract:

    Objectives To evaluate the association of fresh and frozen embryo transfer with the development of ischemic Placental Disease (IPD), hypothesizing that differences in implantation environment affect placentation and thus pregnancy outcomes. Design We performed a secondary analysis of a retrospective cohort study of deliveries linked to IVF cycles. Setting Tertiary hospital and infertility treatment center. Patient(s) We included all women who underwent an autologous IVF cycle and had a live-born infant or an intrauterine fetal demise (IUFD). We excluded women less than 18 years of age. Intervention(s) We compared pregnancies resulting from frozen embryo transfer (frozen) cycles with those resulting from fresh embryo transfer (fresh) cycles. Main Outcome Measure(s) The primary outcome was a composite outcome of IPD or IUFD due to Placental insufficiency. Ischemic Placental Disease included pre-eclampsia, Placental abruption, and small for gestational age (SGA). We calculated risk ratios (RRs) and 95% confidence intervals (CIs). Result(s) Compared with fresh cycles, frozen cycles had a lower risk of IPD or IUFD from Placental insufficiency (RR 0.75, 95% CI 0.59–0.97). Frozen cycles also conferred a lower risk of SGA than fresh cycles (RR 0.58, 95% CI 0.41–0.81). Risks of pre-eclampsia (RR 1.3, 95% CI 0.84–1.9) and abruption (RR 1.2, 95% CI 0.56–2.4) were similar. Conclusion(s) There was a lower risk of IPD among frozen cycles compared with fresh cycles. This association was largely driven by lower risk of SGA among frozen cycles.

Cande V Ananth - One of the best experts on this subject based on the ideXlab platform.

  • risk of ischemic Placental Disease in relation to family history of preeclampsia
    American Journal of Perinatology, 2019
    Co-Authors: Cande V Ananth, Uma M Reddy, Kathleen A Jablonski, Leslie Myatt, James M Roberts, Alan T N Tita, Kenneth J Leveno, Michael W Varner, John M Thorp, Brian M Mercer
    Abstract:

    Objective To assess the risk of ischemic Placental Disease (IPD) including preeclampsia, small for gestational age (SGA), and abruption, in relation to preeclampsia in maternal grandmother, mother, and sister(s). Study Design We performed a secondary analysis of data from a randomized trial of vitamins C and E for preeclampsia prevention. Data on family history of preeclampsia were based on recall by the proband. The associations between family history of preeclampsia and the odds of IPD were evaluated from alternating logistic regressions. Results Of the 9,686 women who delivered nonmalformed, singleton live births, 17.1% had IPD. Probands provided data on preeclampsia in 55.5% (n = 5,374) on all three family members, 26.5% (n = 2,562) in mother and sister(s) only, and 11.6% (n = 1,125) in sister(s) only. The pairwise odds ratio (pOR) of IPD was 1.16 (95% confidence interval [CI]: 1.00–1.36) if one or more of the female relatives had preeclampsia. The pORs of preeclampsia were 1.54 (95% CI: 1.12–2.13) and 1.35 (95% CI: 1.03–1.77) if the proband's mother or sister(s) had a preeclamptic pregnancy, respectively, but no associations were seen for SGA infant or abruption. Conclusion This study suggests that IPD may share a predisposition with preeclampsia, suggesting a familial inheritance.

  • first trimester prediction of ischemic Placental Disease
    Seminars in Perinatology, 2014
    Co-Authors: Anthony M Vintzileos, Cande V Ananth
    Abstract:

    Ischemic Placental Disease is characterized by one or more of the clinical manifestations of preeclampsia, fetal growth restriction, and/or Placental abruption, resulting in indicated preterm delivery. Since over half of the indicated preterm deliveries are due to ischemic Placental Disease, accurate early prediction of the Disease is of paramount importance in developing prevention strategies. This review article focuses on studies that have used the first trimester aneuploidy screening timing window to predict those patients who later develop ischemic Placental Disease. Emphasis was given to studies originating from the Fetal Medicine Foundation because of their uniformity in definitions and expertise of the personnel who performed the ultrasound screening exams.

  • ischemic Placental Disease and risks of perinatal mortality and morbidity and neurodevelopmental outcomes
    Seminars in Perinatology, 2014
    Co-Authors: Cande V Ananth, Alexander M Friedman
    Abstract:

    Preeclampsia, intrauterine growth restriction, and Placental abruption are serious obstetrical complications that constitute the syndrome of ischemic Placental Disease and account for a disproportionate degree of perinatal morbidity and mortality. We review the risks of stillbirth and neonatal and infant mortality in relation to ischemic Placental Disease, focusing on population-based studies. We also review the risks of neonatal morbidity and neurodevelopmental outcomes in relation to ischemic Placental Disease. A synthesis of the findings of the relevant studies relating ischemic Placental Disease to adverse perinatal outcomes underscores two important observations. First, despite the low prevalence of each of the three obstetrical complications, all are associated with increased risks of adverse perinatal and infant outcomes, as well as neurodevelopmental deficits. Second, the burden of increased perinatal risks appears strongest during the preterm period. Efforts to reduce the risks of ischemic Placental Disease remain critically important and developing effective clinical interventions will be a target worthy for consideration.

  • ischemic Placental Disease epidemiology and risk factors
    European Journal of Obstetrics & Gynecology and Reproductive Biology, 2011
    Co-Authors: Cande V Ananth, Anthony M Vintzileos
    Abstract:

    Abstract Objective Preeclampsia, small for gestational age (SGA) and Placental abruption – conditions that constitute the syndrome of “ischemic Placental Disease” (IPD) – may portend different clinical manifestations of a common underlying pathophysiology. We examined if (i) preeclampsia, SGA and abruption share similar risk profiles; and (ii) if there are any differences in these profiles between patients with IPD that delivered at term and preterm gestations. Study design We utilized data from the US Collaborative Perinatal Project, a multicenter, prospective cohort study (1959–1966), restricted to women that delivered singleton births at ≥20 weeks ( n  = 47,495.) We compared risk factors between women with and without IPD as well as preeclampsia, SGA and abruption. Results A strong overlap in risk factors for all 3 conditions was evident. Socio-economic class, income, age, parity, education, race, BMI, marital status, and history of preterm birth were different between preterm and term gestations in women with IPD. Although rates of preeclampsia only, SGA only and preeclampsia with SGA were similar between term and preterm birth, rates of other conditions were higher at preterm gestations, with abruption being the driving condition behind these associations. Conclusions The similar risk profiles for preeclampsia, SGA, and abruption provide compelling evidence to suggest that these conditions may share common pathophysiological mechanisms—ischemic Placental Disease. Greater homogeneity in risk profiles within preterm than term births suggests that IPD may be a syndrome that has strong underpinnings at preterm gestations.

  • ischemic Placental Disease maternal versus fetal clinical presentations by gestational age
    Journal of Maternal-fetal & Neonatal Medicine, 2010
    Co-Authors: Cande V Ananth, John C Smulian, Anthony M Vintzileos
    Abstract:

    Objective. Preeclampsia, small for gestational age (SGA), and abruption are considered ischemic Placental Diseases (IPD), and are major contributors to both maternal and fetal morbidity and mortality. Although the placenta is considered a fetal organ, these conditions can present clinically with either maternal or fetal manifestations, but their relationship to preterm births is largely unexplored.Methods. We designed a population-based study to assess the origins of IPD. IPD was classified as maternal (preeclampsia only), fetal (SGA only), or both (abruption only, preeclampsia with either SGA or abruption, or all 3). The study was based on 90,500 women that delivered singleton live births at 22–44 weeks gestation.Results. Among 77,275 term births with IPD, 23.2% presented as maternal Disease only, 68.9% as fetal Disease, and 7.9% as both. In contrast, among 12,906 preterm births with IPD, the proportions were roughly equal (maternal 32.9%, fetal 36.5%, and both 30.6%). Among spontaneous preterm births wi...

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  • customized birth weight centiles and placenta related fetal growth restriction
    Ultrasound in Obstetrics & Gynecology, 2021
    Co-Authors: John Kingdom, Nir Melamed, Liran Hiersch, Amir Aviram, Sheila M Keating
    Abstract:

    OBJECTIVE The value of using customized birth-weight centiles to improve the diagnostic accuracy for fetal growth restriction (FGR), in comparison with using population-based charts, remains a matter of debate. One potential explanation for the conflicting data is that most studies used measures of perinatal mortality and morbidity as proxies for placenta-mediated FGR, many of which are not specific and may be confounded by other factors such as prematurity. The aim of this study was to compare the diagnostic accuracy of small-for-gestational age (SGA) at birth, defined according to customized vs population-based charts, for associated abnormal Placental pathology. METHODS This was a secondary analysis of data from a prospective cohort study on risk factors for placenta-mediated complications and abnormal Placental pathology in low-risk nulliparous women. All placentae were sent for detailed histopathological examination by two perinatal pathologists. The primary exposure was SGA, defined as birth weight < 10th centile for gestational age using either a customized (SGAcust ) or a population-based (SGApop ) birth-weight reference. The outcomes of interest were one of three types of abnormal Placental pathology associated with FGR: maternal vascular malperfusion (MVM), chronic villitis and fetal vascular malperfusion (FVM). Adjusted relative risks (aRR) with 95% CIs were estimated using modified Poisson regression analysis, with adjustment for smoking, body mass index and aspirin treatment. RESULTS A total of 857 nulliparous women met the study criteria. The proportions of infants identified as SGA based on the customized and population-based charts were 12.6% (108/857) and 11.4% (98/857), respectively. A diagnosis of SGA using either customized or population-based charts was associated with an increased risk of any Placental pathology (aRR, 3.04 (95% CI, 2.29-4.04) and 1.60 (95% CI, 1.10-2.31), respectively) and MVM pathology (aRR, 12.33 (95% CI, 6.60-23.03) and 5.29 (95% CI, 2.87-9.76), respectively). SGAcust , but not SGApop , was also associated with an increased risk for chronic villitis (aRR, 1.85 (95% CI, 1.07-3.18)) and FVM pathology (aRR, 2.48 (95% CI, 1.25-4.93)). SGAcust had a higher detection rate for any Placental pathology (30.3% vs 17.1%; P < 0.001), MVM pathology (63.2% vs 39.5%; P = 0.003) and chronic villitis (20.8% vs 8.3%; P = 0.007) than did SGApop , for a similar false-positive rate. This was mainly the result of a higher detection rate for abnormal pathology in the white and East-Asian subgroups and a lower false-positive rate for abnormal pathology in the South-Asian subgroup by SGAcust than by SGApop . In addition, pregnancies in the SGAcust group, but not those in the SGApop group, were more likely to be complicated by preterm birth and a low 5-min Apgar score than were the corresponding non-SGA group. CONCLUSION These findings suggest that customized birth-weight centiles may be superior to population-based birth-weight centiles in detecting FGR that is due to underlying Placental Disease. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

  • vascular dysfunction in women with a history of preeclampsia and intrauterine growth restriction insights into future vascular risk
    Circulation, 2010
    Co-Authors: Yoav Yinon, John Kingdom, Ayodele Odutayo, Rahim Moineddin, Sascha Drewlo, David Z I Cherney, Michelle Hladunewich
    Abstract:

    Background—Women with a history of Placental Disease are at increased risk for the future development of vascular Disease. It is unknown whether preexisting endothelial dysfunction underlies both the predisposition to Placental Disease and the later development of vascular Disease. The aim of this study was to assess vascular function in postpartum women and to determine whether differences emerged depending on the presentation of Placental Disease. Methods and Results—Women with a history of early-onset preeclampsia (n15), late-onset preeclampsia (n9), intrauterine growth restriction without preeclampsia (n9), and prior normal pregnancy (n16) were studied 6 to 24 months postpartum. Flow-mediated vasodilatation and flow-independent (glyceryl trinitrate–induced) vasodilatation were studied through the use of high-resolution vascular ultrasound examination of the brachial artery. Arterial stiffness was assessed by pulse-wave analysis (augmentation index). Laboratory assessment included circulating angiogenic factors (vascular endothelial growth factor, soluble fms-like tyrosine kinase 1, Placental growth factor, and soluble endoglin). Flow-mediated vasodilatation was significantly reduced in women with previous early-onset preeclampsia and intrauterine growth restriction compared with women with previous late-onset preeclampsia and control subjects (3.22.7% and 2.11.2% versus 7.93.8% and 9.13.5%, respectively; P0.0001). Flow-independent vasodilatation was similar among all groups. Similarly, the radial augmentation index was significantly increased among women with previous early-onset preeclampsia and intrauterine growth restriction, but not among late preeclamptic women and control subjects (P0.0105). Circulating angiogenic factors were similar in all groups. Conclusion—Only women with a history of early-onset preeclampsia or intrauterine growth restriction without preeclampsia exhibit impaired vascular function, which might explain their predisposition to Placental Disease and their higher risk of future vascular Disease. (Circulation. 2010;122:1846-1853.)

  • usefulness of a Placental profile in high risk pregnancies
    American Journal of Obstetrics and Gynecology, 2007
    Co-Authors: Meghana Toal, Cynthia Chan, Shafagh Fallah, Fawaz Alkazaleh, Vandana Chaddha, Rory Windrim, John Kingdom
    Abstract:

    Objective Test the hypothesis that a Placental function profile can reassure most high-risk women with normal test results yet accurately can identify a subset of women who are destined for major complications that will be attributable to Placental Disease. Study Design This was a prospective study of 212 high-risk pregnancies that used the Placental profile (16- to 18-week maternal serum screening, 18- to 23-week uterine artery Doppler imaging, and Placental morphologic condition). Odds ratios (95% CI) were derived for intrauterine fetal death (IUFD), preterm delivery at Results The odds of the development of adverse outcomes were significantly less in women with all normal test results (preeclampsia/HELLP [odds ratio, 0.2; 95% CI, 0.1-0.4]), preterm delivery (odds ratio, 0.1; 95% CI, 0.06-0.3), small for gestational age delivery (odds ratio, 0.2; 95% CI, 0.09-0.3), early-onset IUGR (0), and IUFD (odds ratio, 0.05 [0.01 – 0.2]). Combining those women with two (n = 21) of 3 (n = 15) abnormal test results together predicted 14 of 19 severe IUGR and 15 of 22 IUFD cases. Conclusion This Placental function profile at 16-23 weeks of gestation can reassure women with normal test results by identifying a smaller subset of women who are at reduced risk of perinatal morbidity or death from severe IUGR.