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A population analysis examines if preeclampsia may serve as a warning sign for heart defects in the neonate. Also, do chlamydia antibodies mean reduced fertility? Plus: Can ovary removal help CVD risk in diabetic women?
According to a new population analysis published in JAMA, women who have preeclampsia may be more likely to give birth to infants with heart defects.
Researchers looked at all live births from 1989 to 2012 in the province of Quebec, which comprises a quarter of Canada’s population. Every woman who delivered an infant, with or without a heart defect, in any Quebec hospital during that period was included, covering 1,942,072 infants.
The overall prevalence of heart defects in infants born to women without preeclampsia was 8.6 per 1000, compared with 16.7 per 1000 in infants born to women with preeclampsia. No increase in prevalence of critical heart defects (123.7 per 100,000 vs 75.6 per 100,000) was seen in infants of preeclamptic mothers, but they were more likely to have noncritical heart defects (1538.9 per 100,000 vs 789.2 per 100,000) when compared to infants of non-preeclamptic mothers. Among specific defects, septal defects had the highest prevalence.
After stratifying the preeclampsia variants, the researchers found that infants of women with early-onset preeclampsia (< 34 weeks) had a greater prevalence of critical heart defects (364.4 per 100,000) and noncritical heart defects (294.6 per 100,000) than those of women with late-onset preeclampsia (≥ 34 weeks).
The authors concluded that preeclampsia was significantly associated with noncritical heart defects and that a preeclampsia diagnosis before 34 weeks was associated with critical heart defects. They stressed, however, that the absolute risk of congenital heart defects was low.
C. trachomatis antibodies and infertility
Antibodies to Chlamydia trachomatis may be a marker of reduced fertility in some women, according to results of a cohort study conducted through the National Institutes of Health’s Reproductive Medicine Network. Published in Fertility & Sterility, the research also shows that risk of ectopic pregnancy is significantly higher in women with the antibodies.
The goal of the study was to determine if seropositivity for C trachomatis predicts pregnancy and pregnancy outcome in infertile women with patent fallopian tubes. The cohort included 1250 women enrolled in the Pregnancy in Polycystic Syndrome II and the Assessment of Multiple Gestations From Ovarian Stimulation trials.
Elementary body-based enzyme-linked immunosorbent assay (EB ELISA) was used to test the women’s sera for anti-C trachomatis immunoglobulin G (IgG)1 and IgG3 antibodies. Optical density readings ≥0.35 and ≥0.1 were considered positive for IgG1 and IgG3, respectively. The researchers assessed outcomes for pregnancy, live birth, and ectopic pregnancy and used log-linear regression to determine the relative risk after adjustment for age, race, medication, smoking status, and current alcohol use.
The 243 women (19%) who tested positive for anti-C trachomatis IgG3 tended to be nonwhite and smokers. They were also significantly less likely to conceive (risk ratio [RR] 0.65, 95% confidence interval [CI] 0.52-0.83) or to have a live birth (RR 0.59, 95% CI 0.43-0.80). Adjustment for the number of hysterosalpingography-documented patent tubes weakened the relationships (RR 0.73, 95% CI 0.56-0.97 and RR 0.73, 95% CI 0.50-1.04, respectively). Risk of ectopic pregnancy was 2.7 times higher in women who were anti-C trachomatis IgG3 seropositive (95% CI 1.40-5.34).
Surgery may not cut CVD risk for type 2 diabetes
Ovarian hyperandrogenemia may not explain the high risk of cardiovascular disease (CVD) in women with type 2 diabetes mellitus, according to results from a community-based, multicenter study. The report was published in Diabetes Care.
The data are from the Study of Osteoporotic Fractures, in which 7977 women aged ≥ 65 years were monitored for an average of 15.1 years. Sex steroid hormones were measured in a random subset of 654 of the women and Cox proportional hazard regression was used to calculate adjusted hazard ratios.
A history of diabetes was reported by 6.3% of the women and 18% reported having undergone bilateral salpingo-oophorectomy (BSO). In the women whose sex steroid hormones were measured, type 2 diabetes was associated with 43.6% higher levels of free testosterone, which was partially explained by age and adiposity.
Total and free testosterone levels were lower in the women who had undergone BSO than in those with intact ovaries. Rates of death due to CVD were high in both the women with type 2 diabetes who retained their ovaries (hazard ratio = 1.95) and those with type 2 diabetes who had undergone BSO (hazard ratio = 2.56). Overall, BSO was not associated with CVD mortality.
Investigators concluded that the known association of type 2 diabetes and CVD was not reduced by BSO, suggesting that ovarian hyperandrogenemia does not explain the high risk of CVD seen in women with type 2 diabetes.