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In our previous study, preterm birth after pre-pregnancy partial cervical excision demonstrated abnormal wound healing with an increased muscle-to-collagen ratio at the proximal site of the cervix. We aimed to investigate whether treatment with plasma fibronectin affects the differentiation of mouse uterine cervical fibroblasts into myofibroblasts and mediates a reduction in the incidence of preterm delivery in mice. We examined the gestational period after the administration of lipopolysaccharide in mice subjected to cervical excision and subsequently treated with fibronectin or vehicle. We confirmed that the gestational period was longer in the plasma fibronectin-treated group than in the vehicle-treated control group. In addition, the ratio of α-smooth muscle actin to collagen type I alpha 1 increased after LPS injection in mice subjected to cervical excision, and this increase was suppressed by plasma fibronectin treatment. Plasma fibronectin may serve as a potential therapeutic agent to prevent preterm delivery by inhibiting myogenic differentiation in the cervix.

Background Multiple gestations are associated with an increased incidence of preeclampsia. However, there exists no evidence for an association between multiple gestations and development of hypertension(HTN) later in life. This study aimed to determine whether multiple gestations are associated with HTN beyond the peripartum period. Methods In this retrospective nationwide population-based study, women who delivered a baby between January 1, 2007, and December 31, 2008, and underwent a national health screening examination within one year prior to their pregnancy were included. Subsequently, we tracked the occurrence of HTN during follow-up until December 31, 2015, using International Classification of Diseases-10th Revision codes. Results Among 362,821 women who gave birth during the study period, 4,944 (1.36%) women had multiple gestations. The cumulative incidence of HTN was higher in multiple gestations group compared with singleton group (5.95% vs. 3.78%, p Conclusions Multiple gestations are associated with an increased risk of HTN later in life. Therefore, guidelines for the management of high-risk patients after delivery should be established.

Objective The aim of this study was to evaluate the changes in twin pregnancy outcomes between 2007 and 2016 in a Korean population.Methods The data for this nationwide population-based study was obtained from the national birth registry of the Korean National Statistical Office and the Health Insurance Review & Assessment Service of Korea. Women with twin pregnancies who gave birth between 2007 and 2016 were included.Results From 2007 to 2016, the rate of twin pregnancies increased (1.37% vs. 1.91%, respectively, P

Preeclampsia is associated with abnormal invasion of the trophoblast through decidua and subsequently altered remodeling of the maternal spiral arteries and endothelial dysfunction. This phenomenon is explained by the dysregulation of various kinds of vascular factors and proteases. The purpose of this study was to compare the circulating levels of sFlt-1, cathepsin B, and cystatin C in preeclamptic and normotensive pregnancies. Sixty-two pregnant women were enrolled in this prospective study. Twenty women were preeclamptic and 42 were normotensive. Serum levels of sFlt-1, cathepsin B, and cystatin C were measured using an enzyme-linked immunosorbent assay kit. Circulating levels of sFlt-1, cathepsin B, and cystatin C were significantly higher in preeclamptic than in normotensive pregnant women (p

Multiple gestations are associated with an increased incidence of preeclampsia. However, there exists no evidence for an association between multiple gestations and development of hypertension(HTN) later in life. This study aimed to determine whether multiple gestations are associated with HTN beyond the peripartum period.In this retrospective nationwide population-based study, women who delivered a baby between January 1, 2007, and December 31, 2008, and underwent a national health screening examination within one year prior to their pregnancy were included. Subsequently, we tracked the occurrence of HTN during follow-up until December 31, 2015, using International Classification of Diseases-10th Revision codes.Among 362,821 women who gave birth during the study period, 4,944 (1.36%) women had multiple gestations. The cumulative incidence of HTN was higher in multiple gestations group compared with singleton group (5.95% vs. 3.78%, p 0.01, respectively). On the Cox proportional hazards models, the risk of HTN was increased in women with multiple gestations (HR 1.35, 95% CI 1.19, 1.54) compared with those with singleton after adjustment for age, primiparity, preeclampsia, atrial fibrillation, body mass index, blood pressure, diabetes mellitus, high total cholesterol, abnormal liver function test, regular exercise, and smoking status.Multiple gestations are associated with an increased risk of HTN later in life. Therefore, guidelines for the management of high-risk patients after delivery should be established.

Chemicals such as phthalates and phenolics have been associated with metabolic markers in humans. However, most studies have only looked at a limited number of chemicals, and little is known about their potential effects on adipokines in humans. In the present study, the associations between dozens of urinary chemicals, including phthalate metabolites and phenolics, and markers related to insulin resistance as well as major adipokines, were assessed among the women of reproductive age (n = 459, between 20 and 48 years of age) recruited from major cities in Korea between 2015 and 2016. Adipokines such as adiponectin and leptin, and insulin resistance related markers such as glucose and insulin, were analyzed in serum. Associations between urinary chemicals and the adipokines or insulin resistance related markers were assessed in two steps. First, ordinary least squares (OLS) regression was used to assess the association of each urinary chemical with the adipokines or insulin resistance related markers (single-pollutant model). Second, several chemicals were selected using elastic net regression and were subsequently analyzed with OLS regression model (multi-pollutant model), considering simultaneous exposure to multiple chemicals. In both single- and multi-pollutant models, several urinary chemicals consistently showed significant associations with adipokines or the insulin resistance related markers. The sum of di-(2-ethylhexyl) phthalate metabolites (ΣDEHPm) and ethyl paraben (EtP) were associated with increased serum adiponectin levels. Urinary ΣDEHPm levels also showed positive associations with fasting glucose. Moreover, urinary mono-methyl phthalate (MMP), mono-isobutyl phthalate (MiBP), and bisphenol S (BPS) levels showed positive associations with the homeostasis model assessment for insulin resistance (HOMA-IR). Interestingly, urinary propyl paraben (PrP) levels showed a negative association with HOMA-IR, in both models. Our observations show that among many consumer chemicals, phthalates may affect serum adipokines, and thus glucose, and insulin resistance in adult females. Further confirmation is warranted in other populations.

Background: The aim of our study was to investigate the prepregnancy characteristics that are risk factors for the development of hypertension (HTN) and identify prepregnancy factors for the development of HTN in women affected by pre-eclampsia in their first pregnancy. Methods: We enrolled 1910 women who had undergone a National Health Screening Examination through the National Health Insurance Corporation between 2002 and 2003, and who had their first delivery affected by pre-eclampsia in 2004. Women were classified as having HTN if they were newly diagnosed with HTN from 2005 through 2012. Results: After 8 years of follow-up, 7.7% (148/1910) of pre-eclamptic women developed HTN. Using the Cox proportional hazards model, old age (hazard ratio [HR] 3.92, 95% confidence interval [CI] 2.47-6.23), a family history of HTN (HR 2.28, 95% CI 1.46-3.58), prepregnancy obesity (HR 3.74, 95% CI 2.50-5.59), and high blood pressure (BP) (HR 2.78, 95% CI 1.85-4.19) were independently associated with the development of HTN. Conclusions: The results show that the development of HTN in pre-eclamptic women is related to prepregnancy factors. Recognizing who subsequently develops HTN postpartum in pre-eclamptic women with these prepregnancy factors could lead to early identification and lifestyle interventions, which could reduce the burden of cardiovascular disease.

Accurate prediction of failure to progress and rapid decision making regarding the mode of delivery can improve pregnancy outcomes. We examined the value of sonographic cervical markers in the prediction of successful vaginal delivery beyond 34 weeks of gestation. A retrospective chart review was carried out. Medical information of singleton gestations delivered at a single center from 1 July 2019 to 30 August 2020 was collected. Transvaginal sonographic records of cervical length, anterior and posterior cervical angles, and cervical dilatation were obtained and re-measured. The value of these markers and clinical characteristics of mother and baby on vaginal delivery were investigated and compared to women who underwent cesarean section. A total of 90 women met the inclusion criteria. The rate of vaginal delivery was 75.6%. There were no differences found in terms of maternal age, rate of abortion, induction of labor, premature rupture of membranes, preterm labor, hypertension, diabetes, cervical length, and neonatal sex and weight. The prediction of vaginal delivery was provided by parity, maternal body mass index, and posterior cervical angle. The area under the receiver operating characteristic curve for prediction of vaginal delivery was 0.667 (95% CI 0.581–0.864, p = 0.017) for the posterior cervical angle, with a cutoff of 96.5°. Regression analysis revealed a posterior cervical angle ≥96.5° in the prediction of vaginal delivery (adjusted odds ratio: 6.24, 95% confidence interval: 1.925–20.230, p = 0.002). Posterior cervical angle ≥96.5° is associated with successful vaginal delivery. It is simple and easy to measure and can be useful in determining the mode of delivery.

This study uses machine learning and population data to analyze major determinants of preterm birth including depression and particulate matter. Retrospective cohort data came from Korea National Health Insurance Service claims data for 405,586 women who were aged 25–40 years and gave births for the first time after a singleton pregnancy during 2015–2017. The dependent variable was preterm birth during 2015–2017 and 90 independent variables were included (demographic/socioeconomic information, particulate matter, disease information, medication history, obstetric information). Random forest variable importance was used to identify major determinants of preterm birth including depression and particulate matter. Based on random forest variable importance, the top 40 determinants of preterm birth during 2015–2017 included socioeconomic status, age, proton pump inhibitor, benzodiazepine, tricyclic antidepressant, sleeping pills, progesterone, gastroesophageal reflux disease (GERD) for the years 2002–2014, particulate matter for the months January–December 2014, region, myoma uteri, diabetes for the years 2013–2014 and depression for the years 2011–2014. In conclusion, preterm birth has strong associations with depression and particulate matter. What is really needed for effective prenatal care is strong intervention for particulate matters together with active counseling and medication for common depressive symptoms (neglected by pregnant women).

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This study aims to evaluate the perinatal outcomes of preterm premature rupture of membrane (PPROM) with latency periods at 33 + 0&ndash, 36 + 6 weeks of gestation. This retrospective case-control study included women with singleton pregnancies who delivered at 33 + 0&ndash, 36 + 6 weeks at Korea University Ansan Hospital in South Korea between 2006&ndash, 2019. The maternal and neonatal characteristics were compared between different latency periods (expectant delivery &ge, 72 h vs. immediate delivery &lt, 72 h). Data were compared among 345 women (expectant, n = 39, immediate delivery, n = 306). There was no significant difference in maternal and neonatal morbidities between the groups, despite the younger gestational age in the expectant delivery group. Stratified by gestational weeks, the 34-week infants showed a statistically significant lower exposure to antenatal steroids (73.4% vs. 20.0%, p &lt, 0.001), while the incidence of respiratory distress syndrome (12.8%) and the use of any respiratory support (36.8%) was higher than those in the 33-week infants, without significance. Our study shows that a prolonged latency period (&ge, 72 h) did not increase maternal and neonatal morbidities, and a considerable number of preterm infants immediately delivered at 34 weeks experienced respiratory complications. Expectant management and antenatal corticosteroids should be considered in late preterm infants with PPROM.

Introduction This study aimed to explore the spontaneous healing of ruptured fetal membranes experimentally in the prelabor rupture of membrane model using the amnion pore culture technique. Methods The human amniotic membrane was separated from the post-delivery term placenta in women with normal pregnancies who delivered by scheduled unlabored cesarean section and stained immunohistochemically with primary antibodies against SSEA-4, OCT-3/4, and TRA-1-60. The characteristics of the cultured amniotic epithelial cells were examined by fluorescence-activated cell sorting analysis. Amniotic membranes with perforations that were 1, 2, and 3 mm in diameter were cultured in αMEM containing 10% heat-inactivated FBS, 1% penicillin-streptomycin, and 10 ng/mL EGF at 37 °C in a humidified incubator with 5% CO2. Next, the pore sizes were calculated to evaluate the healing process. Results The amniotic membrane stained positive for CD49d and pluripotent stem cell markers such as SSEA-4, TRA 1-60, and OCT-4 in the stromal and epithelial cell layers. In the flow cytometry analyses, the extracted amniotic epithelial stem cells were observed to express indicator markers for stem cells such as SSEA-4, OCT-4, SOX-2, and Nanog. In the amnion pore culture technique model, the 1-mm pores healed completely, whereas the 2- and 3-mm pores did not heal substantially. Discussion The amnion pore culture technique was useful for demonstrating the natural healing process of the human amniotic membrane. Stem cells in the human amnion might facilitate the resealing of small pores in the amniotic membrane, as observed in this model.

Progesterone and oestrogen play important roles during parturition; however, their roles in the uterine cervix during preterm labour and delivery are unknown. We evaluated the serum progesterone and oestrogen levels and changes in their receptors (PR and ER) in the cervix in a cervical excision-associated preterm delivery mouse model. Adult female C57BL/6 mice were divided into four groups: sham, cervical excision (Ex), lipopolysaccharide (LPS) and Ex + LPS. Mating was permitted at 3 weeks post-Ex. On gestation day 16, mice were administered LPS intrauterine (100 µg/100 µL/mouse) or physiological saline (100 µL)

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.

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.

Exposure of the developing fetus and infants to toxic substances can cause serious lifelong health consequences. Several chemicals have been associated with adverse neurodevelopmental disorders in the early life stages of humans. However, most epidemiological studies have focused on a limited number of chemicals, and hence may exclude important chemicals from consideration or result in conclusions built on associations by chance. In the present study, we investigated the chemical exposure profile of the women, and associated these with the early neurodevelopmental performance of their offspring at 13-24months of age. The chemicals assessed include four phthalates, bisphenol A, three heavy metals, 19 polychlorinated biphenyls (PCBs), 19 organochlorine pesticides, and 19 polybrominated diphenyl ethers, which were measured from urine, whole blood, serum, and/or breastmilk of the pregnant or lactating women. For neurodevelopmental performance, the Bayley Scales of Infant Development-II (BSID-II), Social Maturity Scale (SMS), and Child Behavior Checklist (CBCL) were measured from a total of 140 toddlers. Among the measured chemicals, monoethyl phthalate (MEP) in maternal urine was significantly associated with early mental, psychomotor, and social development. In addition, breast milk di-ethylhexyl phthalate (DEHP) metabolite and blood lead concentrations were inversely associated with mental and psychomotor development indices, respectively. Maternal blood PCB153, heavy metals, and urinary MEP levels were also higher among the children with behavioral problems, as indicated by the CBCL range. Taken together, maternal exposure to several EDCs such as PCBs and DEHP was associated with adverse neurodevelopmental performances among the children aged 1-2years. Confirmation of these association in larger populations, as well as longer-term consequences of such exposure warrant further investigation.

Many scientists made estimates of the body burden of PBDEs from breastmilk and house dust. Interestingly, they have not included the prenatal contribution to the body burden in young children after birth. In order to address how the prenatal contribution is important in the risk assessment of PBDEs in infants up to five years old, we used the median measurements of BDE-47 as a model chemical in 108 neonates in Korea, and made simulations of its disposition out of body from birth to five years. During the simulation periods, the environmental exposure was considered for house dust, babyfood, breastmilk consumption, etc., with assumption of typical exposure scenario applicable to general infants in Korea. About 22% of the total amounts of BDE-47 in newborn remained up to 5 years after birth. The relative amounts of BDE-47 from the prenatal source were 20%, 14%, 10%, 8%, 6%, and 4% of the total body burden for 1-, 2-, 3-, 4- and 5-year after birth, respectively. The contribution from breastfeeding was 95.2% and 92.2% of the total postnatal exposure amounts at 6-month and 1-year after birth, respectively. After cease of breastfeeding at 1-yr, house dust and food were the important sources of exposure up to 5-yr; however, their contributions to the bodyburden were negligible with consideration of the remaining amounts of the analytes from the breastmilk and prenatal exposure. Suggestively, the innate amounts and pharmacokinetics should be counted in estimating bodyburden of BDE-47.

Breastfeeding is an important exposure pathway to perfluoroalkyl substances (PFASs) for newborn infants. Nevertheless, reports are limited on the occurrence and time-course of PFASs in breast milk, and most studies have focused on the analysis of perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA). In this study, 16 PFASs were analyzed in breast milk samples (n=293) collected from 128 mothers in Korea during various lactation periods to assess maternal exposure levels, contamination profiles, time-course variations, and infant health risks. The total concentrations of PFASs (ΣPFAS) ranged from 31.7 to 1004 (median: 188) ng/L, which was within the ranges recently reported for Asian and European populations. After a month of nursing, the concentrations of PFOS, PFOA, perfluorononanoic acid (PFNA), and ΣPFAS significantly increased. This could be due to changes in the dietary and behavior patterns of the mothers after the first month of lactation. The concentrations of PFOS and PFOA were significantly correlated with maternal age, body mass index, and parity. Certain types of diet (e.g. consuming snacks and milk) and eating-out frequency were significantly associated with increasing levels of PFAS. Significant correlations and similar time-course trends were found between PFASs and PCBs/DDTs, implying similar exposure sources and biokinetics for these contaminants. The estimated daily intakes of PFOS and PFOA via the consumption of breast milk were below the tolerable daily intakes for infants suggested by the European Food Safety Authority (EFSA).

Mercury and lead are naturally occurring toxicants and are responsible for various health issues including neurobehavioral and developmental disorders. Because of crucial synchronized developmental processes occurring at the early stage of life, infancy and childhood are considered as among the most susceptible windows to the exposure to these metals. Breastmilk is often the only source of nutrition during the first months of life. As breastmilk can be contaminated with these metals, breastfeeding may serve as a significant route of heavy metal exposure among infants. In order to understand current levels of exposure to mercury and lead through breastfeeding, and their associated risks, a total of 157 lactating mothers were recruited from Children's Health and Environmental Chemicals of Korea (CHECK) cohort, and breastmilk samples were collected at 15 and 30days after delivery (n=207). Mercury was detected from 100% of breastmilk with a median concentration of 0.59μg/L, and lead was detected in 77% of the samples with a median at 4.71μg/L. Higher concentrations of lead were found in the 30- day breastmilk than in the 15-day. Up to 45% of the breastmilk samples exceeded the normal range of the breastmilk lead suggested by WHO. Based on Monte Carlo simulation, about 71% of 15days old infants and 56% of 30days old infants were estimated at risk due to lead exposure through breastfeeding. Considering vulnerability of infants and well-known neurological toxicity of these metals, further studies to identify major exposure sources that contribute the lead concentration in breastmilk and health implication of early life stage exposure to lead among the breastfed infants are warranted.

Background & Aims Preeclampsia is a serious multi-systemic disorder leading to maternal and neonatal adverse outcomes. However, little is known about the early markers of this disease. The aim of this study was to investigate the association between pre-pregnancy liver function and the development of preeclampsia. Methods We enrolled 192,571 Korean women who had their first delivery between January 1, 2008, and December 31, 2014, and had undergone a national health screening examination through the National Health Insurance Corporation during 1–2 years before delivery. Results Preeclampsia developed in 3,973 (2.0%) women. The rate of development of preeclampsia was higher in women with abnormal pre-pregnancy liver enzyme levels than in those with normal liver enzyme levels before pregnancy. On multivariate analysis, women with abnormal alanine aminotransferase level before pregnancy had a 1.21-fold increased risk of developing preeclampsia than those with normal alanine aminotransferase level before pregnancy, after adjusting for age, family history of hypertension, hepatitis B virus carrier status, smoking, alcohol status, pre-pregnancy body mass index, and blood pressure. Pre-pregnancy γ-glutamyltransferase and aspartate aminotransferase levels were not associated with the risk of preeclampsia development. Conclusion Abnormal pre-pregnancy alanine aminotransferase level was associated with the development of preeclampsia in a subsequent pregnancy. Further studies are needed to evaluate whether early intervention for liver function before pregnancy can decrease the risk of preeclampsia. This article is protected by copyright. All rights reserved.

This study aimed to determine the correlation between the placental thickness-to-estimated foetal weight ratio on midterm ultrasonography and small-for-gestational-age (SGA) infants. In this retrospective study, the placental thickness at the umbilical cord insertion site was measured and adjusted for foetal body weight at 18-24 weeks gestation. Investigators compared the data of women who delivered SGA infants (birth weight

Phthalates and environmental phenols might be associated with some benign diseases that have been found to be hormone-sensitive. Current knowledge on adverse effects of these chemicals among reproductive women is limited and often controversial. Therefore, the purpose of this study was to investigate the association between the urinary concentration of phthalates and environmental phenols and gynecological disorders from 512 women of reproductive age. The association between chemical concentration and disease in the control and case groups was statistically determined with the questionnaire survey data and measurements using the LC–MS/MS. The results have shown that DEHP metabolites, ethyl paraben and 3,4-DHB showed significant direct associations with leiomyoma and benign ovarian tumors (p < 0.05). We found statistically significant positive relationships between exposure to chemicals (some DEHP metabolites, DHB) and prevalence of gynecologic disorders (p < 0.05). Furthermore, the ORs for leiomyoma associated with these compounds in always user for personal care products (PCPs) was higher than those of sometimes user. High levels of urinary concentrations of these compounds such as DEHP metabolites and parabens and their metabolites showed significant associations with leiomyoma and benign ovarian tumors.

BackgroundObstetric hemorrhage is one of the most common causes of obstetrical morbidity and mortality, and transfusion is the most important management for hemorrhage. The aim of our study was to investigate the pre-pregnancy and pregnancy risk factors for peripartum transfusion.MethodsWomen who delivered a baby from 2010 to 2014 in Korea and participated in the Korean National Health Screening Program for Infants and Children were included. To analyze pre-pregnant risk factors for peripartum transfusion, an additional analysis was done for women who underwent a National Health Screening Examination within 1 year before pregnancy, including maternal waist circumference, body mass index, blood pressure, laboratory tests and history of smoking. Multivariable logistic regression analysis was used to estimate the risk factors for peripartum transfusion.ResultsOf the total 1,980,126 women who met the inclusion criteria, 36,868 (1.86%) were transfused at peripartum. In a multivariable regression model, the pregnancy risk factors for peripartum transfusion included maternal age above 35 years [odds ratio (OR): 1.41; 95% confidence interval (CI): 1.32–1.50], preterm birth (OR: 2.39; 95% CI: 2.15–2.65), and maternal hypertension (OR: 2.49; 95% CI: 2.24–2.77). Pre-pregnancy risk factors including fasting glucose level of more than 126 mg/dL (OR: 1.11; 95% CI: 1.02–1.20), current-smoker status (OR: 1.20; 95% CI: 1.06–1.37), and waist-circumference less than 80 cm (OR: 1.18; 95% CI: 1.06–1.30) were independently associated with peripartum blood transfusion.ConclusionsSeveral pre-pregnancy and pregnancy risk factors were associated with peripartum blood transfusion. Some identified factors are modifiable before conception, and our study validated peripartum blood transfusion as a form of triage.

OBJECTIVE This study aimed to investigate trends in the rate of cesarean sections (CSs) in South Korea from 2006 to 2015 and identify the risk factors associated with these changes. METHODS Using the National Health Insurance Corporation dataset, all women who gave birth between 2006 and 2015 were included in the study. We investigated 1) the mode of delivery, 2) the complication rates during pregnancy (i.e., preeclampsia and placenta previa), and 3) pre-pregnancy factors (body mass index, hypertension [HTN], diabetes mellitus [DM], and other pre-existing medical conditions), and their trends during the study period. RESULTS Over 10 years, the rate of CS increased from 36.3% in 2006 to 40.6% in 2015 (P

We investigated changes in gene expression of cervical collagens, matrix metalloproteinases (MMPs), and tissue inhibitors of metalloproteinases (TIMPs) during pre-gestational uterine cervical excision and/or inflammation-induced preterm labor in mice. Forty sexually mature female mice were uniformly divided into four groups: sham, cervical excision, lipopolysaccharide (LPS) injection, and cervical excision plus LPS injection. Partial cervical tissue excision was performed at five weeks of age before mating. LPS was injected into the lower right uterine horn near the cervix on gestational day 16. Mice were sacrificed immediately postpartum. Uterine cervices were collected and subjected to quantitative real-time PCR. Col4α1 and Col5α1 expression increased significantly in the cervical excision plus LPS injection group compared to the sham group (p < 0.01 and p = 0.024, respectively). MMP-14 expression levels increased in the cervical excision plus LPS injection group compared to the sham group (p < 0.01). TIMP-1 expression was not significantly decreased in this group. Increased expression levels of Col4α1, Col5α1, and MMP-14 were associated with cervical excision plus inflammation-induced preterm labor. Thus, pre-gestational cervical remodeling through specific collagen metabolism and MMP activation may involve the pathogenesis of spontaneous preterm labor.

Background: The safety of preventive progestogen therapy for preterm birth remains to be established. This meta-analysis aimed to evaluate the effects of preventive progestogen therapy on neonatal mortality. Methods: Randomized controlled trials (RCTs) on the preventive use of progestogen therapy, published between October 1971 and November 2015, were identified by searching MEDLINE/PubMed, EMBASE, Scopus, ClinicalTrials.gov, Cochrane Library databases, CINAHL, POPLINE, and LILACS using “progesterone” and “preterm birth” as key terms. We conducted separate analyses according to the type of progestogen administered and plurality of the pregnancy. Results: Twenty-two RCTs provided data on 11,188 neonates. Preventive progestogen treatment in women with a history of preterm birth or short cervical length was not associated with increased risk of neonatal death compared to placebo in all analyzed progestogen types and pregnancy conditions. The pooled relative risks (95% confidence interval) of neonatal mortality were 0.69 (0.31–1.54) for vaginal progestogen in singleton pregnancies, 0.6 (0.33–1.09) for intramuscular progestogen in singleton pregnancies, 0.96 (0.51–1.8) for vaginal progestogen in multiple pregnancies, and 0.96 (0.49–1.9) for intramuscular progestogen in multiple pregnancies. Conclusions: The results of this meta-analysis suggest that administration of preventive progestogen treatment to women at risk for preterm birth does not appear to negatively affect neonatal mortality in single or multiple pregnancies regardless of the route of administration.

To identify the influence of prepregnancy hemoglobin levels on gestational diabetes mellitus.Korean women who had given birth between January 1st, 2006 and December 31st, 2015 and who had undergone a biannual national health screening examination within 6 months prior to pregnancy were enrolled. Subjects were divided into three groups according to their hemoglobin levels. Multivariate logistic regression analysis was used to estimate the adjusted odds ratio and 95% confidence interval for GDM.Of the 366,122 participants, GDM developed in 14,799 (4%) women. More specifically, GDM developed in 3.6% of women with prepregnancy anemia (hemoglobin 11 g/dL), 3.57% with normal hemoglobin levels, and 4.47% with hemoglobin levels higher than 13 g/dL. We did not find any association between prepregnancy anemia and the risk of developing GDM (OR 1.002 [95% CI 0.90-1.11]). After adjusting for potential confounding factors (adjusted odds ratio 1.41; 95% CI 1.29-1.54), high hemoglobin levels were associated with insulin requiring GDM.Our study identified an association between high prepregnancy hemoglobin levels and GDM risk.

Objective: We aimed to investigate whether mouse mothers born prematurely give birth to preterm pups. Methods: Sexually mature female C57BL/6 mice were used. To create the pPROM model, the fetal membranes of the right uterus were pierced using sterile 21- or 26-gauge needles on gestational day 15.5. Results: The mean gestational duration of the first-generation pPROM model was 17.5 days. The mean gestational duration for the second-generation female mice born prematurely from the pPROM model was 19.8 days. The gestational duration between the first and second generations was significantly different (P

Hyperemesis gravidarum is known to be associated with poor perinatal outcomes. This study aimed to identify pre-pregnancy risk factors for hospital admission in women with hyperemesis gravidarum. We enrolled women who had delivered between 1 January 2013 and 31 December 2015, and had undergone a national health screening examination through the National Health Insurance Corporation 1&ndash, 2 years before their first delivery. Multiple logistic regression analysis was performed to estimate the risk factors for hospital admission due to hyperemesis gravidarum. Of the 216,373 study participants with hyperemesis gravidarum, 2210 (1.02%) pregnant women were hospitalized. These women had lower waist circumference and were underweight based on body mass index compared to pregnant women who did not require hospitalization due to hyperemesis gravidarum. On multivariate analysis, primiparity, multiple pregnancies, female fetus, alcohol consumption, and pre-pregnancy underweight status were associated with an increased risk of hospitalization due to the condition. In this population-based cohort study, we found that hospitalization due to hyperemesis gravidarum was associated with pre-pregnancy lifestyle characteristics. Early recognition and management of these pre-pregnancy factors may help control the need for hospitalization in women with the condition in subsequent pregnancies.

Metals have been reported for possible associations with metabolic symptoms, but existing information remains contradictory. In the present study, the association between metal exposure and the met...

Objective This study aimed to determine the association between preeclampsia and the postpartum development of metabolic syndrome based on the pre-pregnancy status. Methods Korean women who delivered their first child between January 1, 2011, and December 31, 2012, were enrolled. All subjects underwent a national health screening examination conducted by the National Health Insurance Corporation 1 or 2 years prior to their first delivery and within 2 years after their first delivery. Results Among the 49,065 participants, preeclampsia developed in 3,391 participants (6.9%). The prevalence of metabolic syndrome was higher postpartum in women with preeclampsia than in those without preeclampsia (4.9% vs. 2.7%, respectively, P

Background Several studies have suggested potential links of phthalates to obesity in children and adults. Limited evidence, however, has been available for the relations between diethylhexyl phthalate (DEHP) and obesity-related markers or body mass change in early life. Methods 128 healthy pregnant women were recruited and, after delivery, their newborns’ first urine and umbilical cord blood samples were collected. We measured urinary levels of two DEHP metabolites, mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) and mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP). We also measured the levels of leptin, total cholesterol and triglyceride (TG) in cord serum, and used them along with weight, length, head circumference and ponderal index (PI, 100 g/cm 3 ) at birth, as obesity-related markers, and estimated the relations between DEHP metabolites and obesity-related markers using generalised linear models. For the evaluation of body mass increase by early life DEHP exposure, body mass index (BMI) z-score change during 3 months after birth by DEHP metabolites in the first urine samples of the newborns were evaluated using logistic regression. Results DEHP exposure was associated with decrease of PI and increase of TG (PI, β=−0.11, p=0.070 and TG, β=0.14, p=0.027), especially for boys (PI, β=−0.13, p=0.021; and TG, β=0.19, p=0.025). Moreover, DEHP exposure was positively associated with body mass increase during 3 months after birth (change of BMI z-scores, OR=4.35, p=0.025). Conclusions Our findings suggest that DEHP exposure may affect body mass change in early life through changes of obesity-related markers.

Synthetic musk compounds (SMCs) and benzotriazole ultraviolet stabilizers (BUVSs) are used as additives in many consumer products. Limited data are available on the accumulation of SMCs in human fluids, and no data are available on BUVSs. In this study, 208 human breast milk samples were collected from 87 participants during the lactation period at

Background Although preterm delivery is the most common cause of infant morbidity and mortality, an obvious cause cannot be found in most cases. Preterm delivery is known to be the most important risk factor for preterm birth in a subsequent pregnancy. We aimed to evaluate the recurrence rate of premature births for subsequent pregnancies in women with a history of a preterm birth. Methods Study data were collected from the Korea National Health Insurance (KNHI) claims database and data from a national health-screening program for infants and children. We enrolled women who had their first delivery between January 1, 2007 and December 31, 2007 and a subsequent delivery before 2014. Results Preterm delivery had a significant higher risk of preterm birth in a subsequent singleton pregnancy. The risk of preterm birth at second pregnancy was 2.2% in women whose first delivery at ≥ 37 weeks and 18.6% in women whose first delivery at < 37 weeks (relative risks [RR], 8.64; 95% confidence interval [CI], 7.94–9.40). In the analysis of the third pregnancy, we compared women with an initial term birth followed by preterm birth and women with an initial preterm birth followed by a subsequent term birth. A history of a just preceding preterm birth at < 37 weeks was the most relevant factor for recurrence of preterm delivery in a subsequent pregnancy (26.6%, RR, 4.01; 95% CI, 2.45–6.58). Conclusion We found that the prognosis of a third pregnancy was more closely related to the outcome of the second pregnancy to that of the first pregnancy., Graphical Abstract

The placenta is a crucial organ for the supply of oxygen and nutritional elements from mother to fetus. Several studies have reported evidence of the placental transfer of persistent organic pollutants (POPs). Despite the importance of prenatal exposure to POPs, the transport process of POPs via the human placenta is not well understood. To investigate the transport processes of these contaminants and to assess the feasibility of the placenta as a non-invasive biological matrix, we measured 19 polychlorinated biphenyls (PCBs), 18 organochlorine pesticides (OCPs), and 24 polybrominated diphenyl ethers (PBDEs) in placenta tissues. The total concentrations of PCBs, OCPs, and PBDEs in placental tissues ranged from 0.36 to 75.2 (median: 5.85) ng/g lipid wt, 1.37 to 250 (63.5) ng/g lipid wt, and 1.21 to 427 (11.7) ng/g lipid wt, respectively. The BDE 209 concentrations were higher than those reported in previous studies presumably because of the high consumption of deca-BDE technical mixtures in Korea. The concentrations of all of the POPs in placental tissues correlated significantly with each other, but BDE 209 concentration did not correlate with that of any other contaminants possibly because of different exposure sources and kinetics. Maternal age, body mass index, and parity were contributors to the accumulation of several POPs in the placenta. Partitioning ratios between maternal blood-placenta-cord blood showed that lower molecular-weight and hydrophobic POPs were preferentially transported from maternal blood to the placenta and that higher molecular-weight and hydrophobic contaminants tended to remain in placental tissues. Regression analysis showed significant relationships between the POP concentrations in multiple biological matrices such as maternal blood, placenta, cord blood, and meconium. These relationships suggest that the placenta can be used as a non-invasive matrix for biomonitoring prenatal exposure to several POPs. (C) 2017 Elsevier B.V. All rights reserved.

This study investigated whether anterior placenta previa in the second trimester is associated with neonatal respiratory distress syndrome (RDS). The neonates delivered by 2067 women between 2007 and 2015 were evaluated for the presence of RDS through birth records. The location of the placenta and the presence of placenta previa during the second and third trimesters were assessed and recorded. Demographic, prenatal, and perinatal records were reviewed. Anterior placenta previa in the second and third trimesters was correlated with RDS. Infants with lower gestational ages and birth weights had higher rates of RDS. Multivariate logistic regression analysis identified a significant association between anterior placenta previa in the second trimester and neonatal RDS. Anterior placenta previa in the second trimester is associated with neonatal RDS. Obstetricians should be aware that anterior placenta previa detected during the second trimester, irrespective of whether the placenta will migrate in the third trimester, may be an independent risk factor for neonatal RDS.

Objective To investigate whether the uterine cervix excision is associated with preterm birth in female mice. Study Design Sexually mature female C57BL/6 mice (n = 40) were randomly divided into four groups (A, sham; B, cervical excision; C, lipopolysaccharide, 100 µg intrauterine injection; and D, cervical excision + lipopolysaccharide injection), with 10 mice per group. Three weeks after cervical excision, timed mating was performed. On gestational day 16, lipopolysaccharide was injected between the first and second horns of the right uterus near the cervix. The uterine cervix was obtained after delivery and was histologically analyzed. Results The mean gestational period in group D was significantly lower than those in the other groups (17, 19.5, 19, and 18.2 days in groups D, A, B, and C, respectively; p = 0.034). The cervical length was shorter in the cervical excision groups (p = 0.004). The muscle-to-collagen ratio in the proximal cervix was higher in group D (p = 0.037). Conclusion Prepregnancy cervical excision and subsequent lipopolysaccharide injection showed a high rate of preterm birth, which was higher than the known lipopolysaccharide injection related preterm birth rate. Prepregnancy cervical excision appears to have additive effects with inflammation in inducing preterm birth, which are associated with the relative muscular component amount.

Despite the global ban, organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCBs) have been a persistent and significant environmental health issue worldwide. Prenatal exposure to these persistent organic pollutants (POPs) has been identified as a major route of exposure among developing fetuses and newborn infants. Among Children's Health and Environmental Health of Korea (CHECK) cohort population, pregnant females (n=148) and their matching newborn infants (n=117) recruited from four cities of Korea in 2011 were investigated. The blood serum and cord blood serum were sampled at delivery, and measured for 19 OCPs and 19 PCBs. In addition, a questionnaire regarding demographic characteristics, and dietary habits were conducted. The most frequently detected POPs in both maternal blood and cord blood were p,p'-dichlorodiphenyl dichloroethylene (DDE) (99% detection in maternal, and 98% in cord blood serum) and PCB153 (95% in maternal, 74% in cord blood serum). The levels of dichlorodiphenyl trichloroethanes (DDTs) in both maternal (average 82.5ng/g lw) and cord blood serum (average 77.5ng/g lw) were comparable to or greater than those reported in Japan about a decade ago. Approximately two thirds of the pregnant women and newborn infants showed the p,p'-DDE concentrations exceeding the biological equivalent (BE) corresponding to 10-6 excess cancer risk. In addition, less chlorinated PCBs were detected higher in both maternal and cord serum. Less chlorinated PCBs also showed greater transplacental ratio. Dairy consumption among the subjects was positively associated, and tea consumption was negatively associated with serum levels of several POPs. Our results show that the exposure to legacy POPs, especially DDTs, among pregnant women and newborn infants is still prevailing, thus warrants measures for exposure mitigation among these vulnerable populations.

A 39-year-old nulliparous woman was referred at 36+6 weeks gestational age, and a prenatal fetal ultrasonography examination found fetal growth restriction (2,190 g

Limited data are available on the residue levels of polybrominated diphenyl ethers (PBDEs) in baby food. In this study, 24 PBDE congeners were determined in 147 homemade baby food samples collected from 97 households for 6-, 9-; 12-, 15-, and from 24 to 27-month-old infant groups during the period of 2012-2013. The concentrations of total PBDEs (Sigma PBDE) ranged from 24.5 to 6000 (mean: 263) pg/g fresh weight, higher than those found in commercial formulae from the United States. The predominant congeners were BDEs 209 and 47, accounting for 92% of the Sigma PBDE concentrations, reflected by high deca-BDE consumption in Korea. The residue levels and detection rates of BDE 47 in the baby food samples showed a gradual increasing trend with an increase in infant ages, due to changes in the food ingredients from hypoallergenic to greasy. The daily intakes of BDEs 47 and 209 via baby food consumption ranged from 0.04 to 0.58, 0.80 to 20.3, and 1.06 to 22.3 ng/kg body weight/day for 6-, 9-, 12-, 15-, and 24-27-month-old infant groups, respectively; these intakes were lower than the oral reference doses proposed by the US EPA. Together with three exposure sources, baby food, breast milk and dust ingestion for 6-month-old infants, the daily intake of Sigma PBDE was 25.5 ng/kg body weight/day, which was similar to the intake via baby food consumption only for over 24-month-old infants in our study. This indicates that baby food is an important exposure pathway of PBDEs for over 24-month-old infants. This is the first study regarding the occurrence and exposure assessment of PBDEs via homemade baby food. (C) 2014 Elsevier Inc. All rights reserved.

Polybrominated diphenyl ethers (PBDEs) are of growing public health concern because of their potential toxicities which range from endocrine disruption to neurodevelopment. However, information on their exposure among sensitive human populations is limited. The objectives of this study were to determine the levels of major PBDEs in blood sera of pregnant women and their matching newborn infants. For this purpose, a total of 198 maternal blood samples and 118 matching umbilical cord blood samples were collected from four regions of South Korea in 2011, and were determined for 19 PBDE congeners. Various demographic, dietary, and behavioral characteristics were asked in a questionnaire survey. Average concentration of total PBDEs in maternal blood serum was 3.34 ± 8.42 ng/g lipid weight (lw) at delivery and 3.14 ± 7.46 ng/g lw at 6 months of pregnancy, respectively. In cord blood serum, an average of 9.37 ± 12.60 ng/g lw was detected. Among the measured PBDE congeners, BDE-47, BDE-99 and BDE-153 were most dominant in both maternal and cord blood sera. Relatively higher levels of BDE-99 were detected in cord blood serum. Strong positive correlations were detected between maternal and cord blood serum samples, indicating the importance of maternal transfer. Health consequences of transplacental exposure to PBDEs among fetuses and newborn infants warrant further investigation.

PURPOSE: Administration of antiretroviral drugs to mothers and infants significantly decreases mother-to-child human immunodeficiency virus (HIV) transmission; cesarean sections and discouraging breastfeeding further decreases this risk. The present study confirmed the HIV status of babies born to mothers infected with HIV and describes the characteristics of babies and mothers who received preventive treatment. METHODS: This study retrospectively analyzed medical records of nine infants and their mothers positive for HIV who gave birth at Korea University Ansan Hospital, between June 1, 2003, and May 31, 2013. Maternal parameters, including HIV diagnosis date, CD4+ count, and HIV ribonucleic acid (RNA) copy number, were analyzed. Infant growth and development, HIV RNA copy number, and HIV antigen/antibody test results were analyzed. RESULTS: Eight HIV-positive mothers delivered nine babies; all the infants received antiretroviral therapy. Three (37.5%) and five mothers (62.5%) were administered single- and multidrug therapy, respectively. Intravenous zidovudine was administered to four infants (50%) at birth. Breastfeeding was discouraged for all the infants. All the infants were negative for HIV, although two were lost to follow-up. Third trimester maternal viral copy numbers were less than 1,000 copies/mL with a median CD4+ count of 325/µL (92-729/µL). Among the nine infants, two were preterm (22.2%) and three had low birth weights (33.3%). CONCLUSION: This study concludes that prophylactic antiretroviral therapy, scheduled cesarean section, and prohibition of breastfeeding considerably decrease mother-to-child HIV transmission. Because the number of infants infected via mother-to-child transmission may be increasing, studies in additional regions using more variables are necessary.

Diet is the predominant source of bisphenol A (BPA) intake, but limited data are available on BPA levels in the diet of younger infants. This study investigated BPA levels in baby-food and urine samples collected from young infants (under 2 years old). Samples of homemade baby food (n = 210) and urine (n = 187) were collected at 9, 12, and 15 months after birth from a panel of Korean infants (n = 173). BPA levels in urine and food were measured using HPLC-MS/MS and GC-MS, respectively. BPA was above the limit of detection (LOD) in 85.5-85.7% of the urine samples and 32.5-76.3% of the baby-food samples. The median levels of BPA were 0.45 ng/g wet weight (IQR: not detectable to 5.16 ng/g wet weight) in homemade baby food, 0.93 μg/L (IQR:LOD to 2.66 μg/L) in unadjusted urine samples, and 0.94 μg/L (IQR:LOD to 2.80 μg/L) in urine samples adjusted for specific gravity. The BPA levels detected in this study were comparable or lower compared to previously reported levels of BPA in baby-food and infant urine samples. The BPA concentrations in the baby food of 15-month-old children (median: 5.09 ng/g) were significantly greater than those detected at 9 or 12 months of age (median:LOD and 0.47 ng/g, respectively). Considering that the dietary changes from solid food with high water content to solid food as infants grew were accompanied by greater exposure to BPA, it is noteworthy that urinary BPA levels did not significantly differ according to infants' age. These results suggest that solid food with high water content did not drive the internal dose in younger infants, implying that there may have been other sources of exposure in their baby-food (other than weaning-food) and the environment, although further study would be needed to confirm this possibility.

Breast milk is a valuable biological specimen to assess maternal and infant exposure to polybrominated diphenyl ethers (PBDEs). In this study, 208 breast milk samples were collected from 89 participants during lactation period, at