Levels of neopterin and C-reactive protein in pregnant women with fetal growth restriction

Budak

J of Obstet and Gynaecol

et al. 2016

Section: Discussioncontrasting

confidence: 46%

Section: Discussionmentioning

confidence: 97%

Serum levels of neopterin, inflammatory markers and oxidative stress indicators in hyperemesis gravidarum

Budak

J of Obstet and Gynaecol

et al. 2016

“…Serum CRP may predict preeclampsia [35], and may be a risk marker for preterm birth, perhaps by reflecting intrauterine infection [36]. But as a predictor of FGR, only inconsistent associations have been found [37, 38]. A recent prospective study documented that high maternal CRP predicted lower birth weight, but did not adjust for gestational age at birth [39].…”

Section: Discussionmentioning

confidence: 99%

Inflammation throughout pregnancy and fetal growth restriction in rural Nepal

et al. 2019

Maternal systemic inflammation during pregnancy may restrict embryo−fetal growth, but the extent of this effect remains poorly established in undernourished populations. In a cohort of 653 maternal−newborn dyads participating in a multi-armed, micronutrient supplementation trial in southern Nepal, we investigated associations between maternal inflammation, assessed by serum α1-acid glycoprotein and C-reactive protein, in the first and third trimesters of pregnancy, and newborn weight, length and head and chest circumferences. Median (IQR) maternal concentrations in α1-acid glycoprotein and C-reactive protein in the first and third trimesters were 0.65 (0.53–0.76) and 0.40 (0.33–0.50) g/l, and 0.56 (0.25–1.54) and 1.07 (0.43–2.32) mg/l, respectively. α1-acid glycoprotein was inversely associated with birth size: weight, length, head circumference and chest circumference were lower by 116 g (P = 2.3 × 10−6), and 0.45 (P = 3.1 × 10−5), 0.18 (P = 0.0191) and 0.48 (P = 1.7 × 10−7) cm, respectively, per 50% increase in α1-acid glycoprotein averaged across both trimesters. Adjustment for maternal age, parity, gestational age, nutritional and socio-economic status and daily micronutrient supplementation failed to alter any association. Serum C-reactive protein concentration was largely unassociated with newborn size. In rural Nepal, birth size was inversely associated with low-grade, chronic inflammation during pregnancy as indicated by serum α1-acid glycoprotein.

“…SGA birth was not associated with raised CRP concentrations, and raised values were actually lower at ANC1 for this outcome. Previous studies in non-malaria endemic areas have reported a positive association with fetal growth restriction but only when CRP levels were very high (> 25 mg/l) [42], a weak positive association in late pregnancy [43], or no association [44]. In Papua New Guinea, CRP at enrolment and at delivery in women receiving sulphadoxine-pyrimethamine plus chloroquine (compared to sulphadoxine-pyrimethamine plus azithromycin), was positively associated with PTB, but not SGA [45].…”

Section: Discussionmentioning

confidence: 99%

Excess risk of preterm birth with periconceptional iron supplementation in a malaria endemic area: analysis of secondary data on birth outcomes in a double blind randomized controlled safety trial in Burkina Faso

Brabin

Gies

Roberts

et al. 2019

Malar J

Background Iron supplementation before a first pregnancy may improve the future health of mother and baby by reducing maternal anaemia. Iron supplementation could, however, increase malaria infections, notably in primigravidae who are most susceptible. The pathogenicity of other iron-utilizing pathogens could also increase, causing inflammation leading to increased risk of adverse birth outcomes. This paper reports pre-specified secondary birth outcomes from a safety trial in Burkina Faso in an area of high malaria endemicity. Primary outcomes from that trial had investigated effects of long-term weekly iron supplementation on malaria and genital tract infections in non-pregnant and pregnant women. Methods A double-blind, randomized controlled trial. Nulliparous, mainly adolescent women, were individually randomized periconceptionally to receive weekly either 60 mg elemental iron and 2.8 mg folic acid, or 2.8 mg folic acid alone, continuing up to the first antenatal visit for those becoming pregnant. Secondary outcomes were ultrasound-dated gestational age, fetal growth, placental malaria, chorioamnionitis and iron biomarkers. Seasonal effects were assessed. Analysis was by intention to treat. Results 478 pregnancies occurred to 1959 women: 258/980 women assigned iron and folic acid and 220/979 women assigned folic acid alone. Malaria prevalence at the first antenatal visit was 53% (iron) and 55% (controls). Mean birthweight was 111 g lower in the iron group (95% CI 9:213 g, P = 0.033). Mean gestational ages were 264 days (iron) and 269 days (controls) (P = 0.012), with 27.5% under 37 weeks compared to 13.9% in controls (adjRR = 2.22; 95% CI 1.39–3.61) P < 0.001). One-third of babies were growth restricted, but incidence did not differ by trial arm. Half of placentae had evidence of past malaria infection. C–reactive protein > 5 mg/l was more common prior to births < 37 weeks (adjRR = 2.06, 95% CI 1.04–4.10, P = 0.034). Preterm birth incidence during the rainy season was ~ 50% in the iron arm and < 20% in controls (P = 0.001). Chorioamnionitis prevalence peaked in the dry season (P = 0.046), with no difference by trial arm (P = 0.14). Conclusion Long-term weekly iron supplementation given to nulliparous women in a malaria endemic area was associated with higher risk of preterm birth in their first pregnancy. Trial Registration NCT01210040. Registered with Clinicaltrials.gov on 27th September 2010 Electronic supplementary material The online version of this article (10.1186/s12936-019-2797-8) contains supplementary material, which is available to authorized users.