SERUM PROTEOME ALYSSA STEPHENSON-FAMY1, JANE HITTI1, ... OBJECTIVE: To perform comprehensive proteomic analysis of maternal serum to identify ...
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THE ASSOCIATION OF OBESITY, BODY IMAGE AND POSTPARTUM DEPRESSION D. YVETTE LACOURSIERE1, ANN HUTTON2, MICHAEL VARNER1, 1University of Utah, Salt Lake City, Utah, 2University of Utah, Nursing, Salt Lake City, Utah OBJECTIVE: In women of reproductive age, obesity has been associated with numerous medical and obstetric problems including depression. Postpartum depression (PPD) affects 10-15% of all women, especially those with a history of pre-existing depression. This series of correlations suggests an association between obesity and PPD. We set out to quantify the relationship between obesity and postpartum depression and identify potential risk factors unique to obese women. STUDY DESIGN: Using a prospective design with an over-sampling technique, women were enrolled 24-36 hours postpartum. Intake data including demographic, medical, obstetric and psychiatric history, pregnancy stressors and anthropomorphic information was collected. Eight weeks postpartum women were contacted, surveyed and completed the Edinburgh Postnatal Depression Screen (EPDS) and modified Body Shape Questionnaire (BSQ). EPDS ⬎⫽ 12 was used to define a positive PPD screen. Responses were stratified by maternal BMI and analyzed via Chi-Square, ANOVA and Multiple Logistic Regression Modeling. RESULTS: 1282 women were included in the analysis. PPD increased with extremes of BMI. The percent of women by BMI strata with PPD follows: underweight 18.7%, normal weight 12.7%, overweight 15.9%, class I obesity 17.6%, class II obesity 28.0% and class III obesity 29.4%. (p⫽0.047). Increasing weight gain during pregnancy increases the risk of PPD in normal and overweight women. Poor body image was associated with obesity and weight gain during pregnancy. After controlling for maternal age, race, parity, stressors, and education, BMI is a risk factor for PPD. At the postpartum visit, only 26.3% of providers addressed weight and 53.7% discussed mood. CONCLUSION: This is the first study to use a validated screening tool to evaluate the risk of PPD by maternal BMI. Women at the extremes of BMI and greater weight gains in pregnancy are at increased risk for PPD. Nearly 30% of women with a BMI Y 35 screen positive for PPD, warranting heightened attention to PPD among obese women.
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0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.311
ASSOCIATION OF BILE ACID CONCENTRATIONS WITH ADVERSE PREGNANCY OUTCOME IN AN ERA OF AGGRESSIVE MANAGEMENT FOR INTRAHEPATIC CHOLESTASIS OF PREGNANCY RICHARD LEE1, KAYMAY KWOK1, SUE INGLES2, MELISSA L. WILSON2, MARC INCERPI1, PATRICK MULLIN1, BHUVAN PATHAK1, T. MURPHY GOODWIN1, 1University of Southern California, Obstetrics and Gynecology, Los Angeles, California, 2University of Southern California, Preventive Medicine, Los Angeles, California OBJECTIVE: Intrahepatic cholestasis of pregnancy (ICP) is associated with preterm labor, meconium passage, and fetal death but whether these outcome vary by total bile acid concentration (TBA) is debated. Our objective was 1) to examine the association between TBA and adverse pregnancy outcomes in Latinas with ICP and 2) to determine if a TBA threshold of ⱖ40 mol/L is associated with worse obstetric outcomes during a time period when ICP patients were delivered by 37 0/7 weeks. STUDY DESIGN: A retrospective chart review of patients delivered at our institution coded with ICP between 2000-2007. ICP was defined as TBA ⱖ20 mol/L in the presence of pruritus. Subjects with TBA ⬍20 mol/L were categorized as having pruritus only. ICP was further subcategorized as mild (TBA ⱖ20 mol/L and ⬍ 40 mol/L) and severe (TBA ⱖ40 mol/L). Ethnicity was determined from charted demographic data. Statistical analysis was performed using chi-square, multivariate logistic regression, and linear regression. P ⬍ 0.05 was considered significant. RESULTS: Meconium passage was observed in no births to mothers with TBA ⬍20, but was found in 18% of deliveries of mothers with ICP. Above 20 mol/L the risk of meconium passage increased linearly, with a 14% increased risk for each 10 mol/L increase in TBA (P ⫽ 0.011). There was no association between higher TBA and abnormal fetal heart rate patterns, postpartum hemorrhage, NICU admission, fetal death, or chorioamnionitis. There was no difference in adverse outcomes between subjects with mild and severe ICP. 31% of newborns were admitted to the NICU; after adjusting for potential risk factors this was associated with maternal diabetes (P⬍ 0.001) and cesarean delivery (P⫽0.036) but not with elevated TBA (P ⫽ 0.09) or delivery by 37 0/7 weeks (P⫽ 0.12). CONCLUSION: In the Latina population in Los Angeles, there is an association between meconium passage and TBA ⱖ20 mol/L. Delivering ICP patients by 37 weeks is associated with a low risk of adverse outcomes due to ICP among all patients including those with higher TBA. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.313
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COMPREHENSIVE PROTEOMIC ANALYSIS OF FIRST, SECOND AND THIRD TRIMESTER MATERNAL SERUM: GESTATIONAL AGE-DEPENDENT CHANGES IN THE MATERNAL SERUM PROTEOME ALYSSA STEPHENSON-FAMY1, JANE HITTI1, XINFANG LU2, JODI LAPIDUS2, ANNA GIRSEN3, JUHA RASANEN3, MICHAEL GRAVETT1, SRINIVASA NAGALLA4, 1 University of Washington, Obstetrics and Gynecology, Seattle, Washington, 2Oregon Health & Sciences University, Portland, Oregon, 3University of Oulu, Oulu, Finland, 4Proteogenix, Inc, Beaverton, Oregon OBJECTIVE: To perform comprehensive proteomic analysis of maternal serum to identify biomarkers of gestational age (GA)-dependent changes in normal pregnancy. STUDY DESIGN: Maternal serum samples were collected longitudinally (mean GA 9.7, 22.1 and 33.6 weeks) from a prospective cohort of 123 healthy Finnish women. 17 women developed preeclampsia and were excluded. Sera were immunodepleted for high abundance proteins and analyzed using fluorescence 2-dimensional gel electrophoresis (2D-DIGE). Multidimensional liquid chromatography tandem mass spectrometry (LC-MS/MS) and label-free quantification (spectral counting) were used for protein identification. Pair-wise comparisons and trend analysis were used to monitor GA-dependent changes. Statistical significance was determined after adjusting for multiple comparisons. Immunoassays were used to confirm potential candidate biomarkers. RESULTS: 106 women with normal pregnanacies were included in the analysis. Protein identification revealed 372 unique proteins in maternal serum. Trend analysis showed that 36 proteins significantly change with advancing GA. Pair-wise comparisons demonstrated greatest change in the maternal serum proteome between the first and second trimesters. Proteins with GA-dependent changes in expression included several placental proteins, chorionic somatomammotrophin and pregnancy specific glycoproteins. CONCLUSION: Comprehensive analysis of maternal serum identified GA-dependent biomarkers that will contribute to our understanding of the physiology of normal pregnancy in each trimester. Characterization of the maternal serum proteome in a larger cohort may define biomarkers to predict and screen for pregnancy-related disorders. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.312
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FIRST EVIDENCE THAT THE HUMAN AMNION IS FUNCTIONALLY HETEROGENEOUS: A STUDY OF THE AMNION TRANSCRIPTOME CHONG JAI KIM1, YU MI HAN2, JUNG-SUN KIM1, SUN KWON KIM2, ADI L TARCA3, SORIN DRAGHICI3, JUAN PEDRO KUSANOVIC2, FRANCESCA GOTSCH2, POOJA MITTAL4, SONIA HASSAN4, ROBERTO ROMERO2, 1Wayne State University School of Medicine, Department of Pathology, Detroit, Michigan, 2 Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, 3Wayne State University, Department of Computer Science, Detroit, Michigan, 4Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan OBJECTIVE: The amnion plays a central role in the physiology of pregnancy and parturition. Though referred to as a single structure, this fetal tissue is anatomically heterogeneous. We propose that it is also physiologically heterogeneous. The objective of this study was to determine the global gene expression profile of placental and extraplacental amnion. STUDY DESIGN: Paired placental amnion (PA) and extraplacental amnion (EA) were obtained from term not in labor (n⫽10) and in labor (n⫽10) cases. The transcriptome was examined using the Affymetrix GeneChip HG-U133 Plus 2.0 Array. Genes with p⬍0.05 on a moderated t-test were considered significant provided that the fold changes were larger than 2. Simultaneous screening of 84 genes in the NF-B signaling pathway was also conducted using RT2 Profiler™ PCR Array. RESULTS: 1) Labor at term was characterized by differential expression of 17 unique genes, including seven cytokines/chemokines (IL1/IL1B/IL6/TNF/CXCL1/ CXCL2/CXCL3); 2) Gene Ontology (GO) analysis revealed 74 biological processes associated with labor, including immune response; 3) Pathway analysis identified 8 pathways associated with labor, including cytokine-cytokine receptor interaction; 4) A comparison of PA and EA revealed 839 unique differentially expressed genes. GO analysis revealed 56 enriched biological processes, including development and biological adhesion; 5) Pathway analysis identified 4 pathways associated with regional differences, including ECM-receptor interaction and JAK/STAT signaling; 6) PCR array also revealed differential expression of cytokines, and higher expressions of IRAK2 and TLR4 with labor. CONCLUSION: 1) The transcriptional program of amnion differs between women in labor and those not in labor, especially for genes involved in cytokinecytokine receptor interaction; 2) We report, for the first time, that regional differences in amnion have a profound effect on the transcriptome. We propose that the seemingly uniform amnion is divided into two functional compartments with implications for the physiology of pregnancy and parturition. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.314
Supplement to DECEMBER 2007 American Journal of Obstetrics & Gynecology
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