Impact of maternal obesity on preterm delivery in patients with cervical cerclage.

BACKGROUND: Maternal obesity has risen in the United States in recent decades. OBJECTIVE: This study aimed to evaluate the impact of maternal obesity on the risk for spontaneous preterm delivery and the risk for overall preterm delivery among patients with cervical cerclage placement. STUDY DESIGN: This was a retrospective study in which data from the California Office of Statewide Health Planning and Development linked birth file from 2007 to 2012 were used, yielding a total of 3654 patients with and 2,804,671 patients without cervical cerclage placement. Exclusion criteria included patients with missing information on body mass index, multiple gestation, anomalous pregnancies, and gestations <20 weeks or >42 weeks. Patients in each group were identified and were further categorized based on body mass index with the nonobese group defined as having a body mass index of <30 kg/m2, the obese group defined as having a body mass index of 30 to 40 kg/m2, and the morbidly obese group defined as having a body mass index >40 kg/m2. The risks for overall and spontaneous preterm delivery were compared between patients without obesity and those with obesity or those with morbid obesity patients. The analysis was stratified by cerclage placement. RESULTS: Among patients who underwent cerclage placement, the risk for spontaneous preterm delivery was not significantly different in the obese and morbidly obese group when compared with the nonobese group (24.2% vs 20.6%; adjusted odds ratio, 1.18; 95% confidence interval, 0.97-1.43; and 24.5% vs 20.6%; adjusted odds ratio, 1.12; 0.78-1.62, respectively). However, among patients without cerclage placement, the obese and morbidly obese groups had a higher risk for spontaneous preterm delivery than the nonobese group (5.1% vs 4.4%; adjusted odds ratio, 1.04; 1.02-1.05; and 5.9% vs 4.4%; adjusted odds ratio, 1.03; 1.00-1.07, respectively). The risks for overall preterm delivery at <37 weeks' gestation were higher for the obese and morbidly obese groups than for the nonobese group among patients with cerclage (33.7% vs 28.2%; adjusted odds ratio, 1.23; 1.03-1.46; and 32.1% vs 28.2%; adjusted odds ratio, 1.01; 0.72-1.43, respectively). Similarly, among patients without cerclage placement, the risks for preterm delivery at <37 weeks' gestation were higher for the obese and morbidly obese groups than for the nonobese group (7.9% vs 6.8%; adjusted odds ratio, 1.05; 1.04-1.06; and 9.3% vs 6.8%; adjusted odds ratio, 1.10; 1.08-1.13, respectively). CONCLUSION: Among patients who received a cervical cerclage for the prevention of preterm birth, obesity was not associated with an increased risk for spontaneous preterm delivery. However, it was associated with an overall increased risk for preterm delivery.

Severe maternal morbidity associated with endometriosis: a population-based, retrospective cohort study.

OBJECTIVE: To evaluate the association between endometriosis and the risk of severe maternal morbidity (SMM) as defined by the Centers for Disease Control and Prevention. DESIGN: This was a population-based, retrospective cohort study using the California Office of Statewide Health Planning and Development Linked Birth File with hospital discharge International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnoses between 2007 and 2012. SETTING: Population-based. PATIENT(S): A total of 3,098,578 pregnancies from 2007 to 2012. INTERVENTION(S): Prior diagnosis of endometriosis identified using the ICD-9-CM codes 617.0-617.9. MAIN OUTCOME MEASURE(S): The primary outcome of interest was SMM, which was defined as having been diagnosed with any of the ICD-9-CM codes corresponding to 25 peripartum conditions listed by the Centers for Disease Control and Prevention. The secondary outcomes of interest were each individual condition. RESULT(S): Of the 3,098,578 pregnancies analyzed, 2,910 pregnancies were among women with a prior diagnosis of endometriosis. There were 45,655 pregnancies complicated by at least 1 SMM; 158 pregnancies (54.3 per 1,000 pregnancies) were in women with endometriosis and 45,497 (14.7 per 1,000 pregnancies) were in women without endometriosis. Women with pregnancies complicated by endometriosis were 2.41 times more likely to develop SMM than women who did not have endometriosis (adjusted odds ratio [aOR], 2.41; 95% confidence interval [CI], 2.03-2.87). There was an increased risk of disseminated intravascular coagulation (aOR, 2.46; 95% CI, 1.65-3.66), heart failure during a procedure or surgery (aOR, 2.58; 95% CI, 1.69-3.94), pulmonary edema (aOR, 3.02; 95% CI, 1.11-8.17), blood transfusion (aOR, 2.17; 95% CI, 1.75-2.68), and hysterectomy (aOR, 2.46; 95% CI, 1.58-3.85). When the association was stratified by delivery mode, the risk of SMM was higher for vaginal delivery (aOR, 4.59; 95% CI, 2.73-7.71) than for cesarean delivery (aOR, 1.64; 95% CI, 1.37-1.97) (P-interaction<.0001). CONCLUSION(S): This study demonstrated that endometriosis is a major risk factor for SMM, especially among those who deliver vaginally. Furthermore, precautions should be taken before delivery in anticipation of potential complications.

S-Nitrosation of Arabidopsis thaliana Protein Tyrosine Phosphatase 1 Prevents Its Irreversible Oxidation by Hydrogen Peroxide.

Tyrosine-specific protein tyrosine phosphatases (Tyr-specific PTPases) are key signaling enzymes catalyzing the removal of the phosphate group from phosphorylated tyrosine residues on target proteins. This post-translational modification notably allows the regulation of mitogen-activated protein kinase (MAPK) cascades during defense reactions. Arabidopsis thaliana protein tyrosine phosphatase 1 (AtPTP1), the only Tyr-specific PTPase present in this plant, acts as a repressor of H2O2 production and regulates the activity of MPK3/MPK6 MAPKs by direct dephosphorylation. Here, we report that recombinant histidine (His)-AtPTP1 protein activity is directly inhibited by H2O2 and nitric oxide (NO) exogenous treatments. The effects of NO are exerted by S-nitrosation, i.e., the formation of a covalent bond between NO and a reduced cysteine residue. This post-translational modification targets the catalytic cysteine C265 and could protect the AtPTP1 protein from its irreversible oxidation by H2O2. This mechanism of protection could be a conserved mechanism in plant PTPases.

Impact of labor induction at 39 weeks gestation compared with expectant management on maternal and perinatal morbidity among a cohort of low-risk women.

OBJECTIVE: To determine maternal and perinatal outcomes after induction of labor (IOL) at 39 weeks compared with expectant management. METHODS: This is a retrospective national cohort study from the National Center for Health Statistics birth database. The study included singleton, low-risk pregnancies with a non-anomalous fetus delivered at 39-42 weeks gestation between 2015 and 2018. Maternal outcomes available included chorioamnionitis (Triple I), blood transfusion, intensive care unit (ICU) admission, uterine rupture, cesarean delivery (CD), and cesarean hysterectomy. Fetal and infant outcomes included stillbirth, 5-min Apgar ≤3, prolonged ventilation, seizures, ICU admission, and death within 28 days. We compared women undergoing IOL at 39 weeks to those managed expectantly. Non-adjusted and adjusted relative risks (aRRs) were estimated using multivariate log-binomial regression analysis. RESULTS: There were 15,900,956 births available for review of which 5,017,524 met inclusion and exclusion criteria. For the maternal outcomes, the IOL group was less likely to require a CD (aRR 0.880; 95% CI [0.874-0.886]; p value < .01) or develop Triple I (aRR 0.714; 95% CI [0.698-0.730]; p value < .01) but demonstrated a small increase in the cesarean hysterectomy rate (aRR 1.231; 95% CI [1.029-1.472]; p value < .01). Among perinatal outcomes, the stillbirth rate (aRR 0.195; 95% CI [0.153-0.249]; p value < .01), 5-min Apgar ≤3 (aRR 0.684; 95% CI [0.647-0.723]; p value < .01), prolonged ventilation (aRR 0.840; 95% CI [0.800-0.883]; p value < .01), neonatal intensive care (NICU) admission (aRR 0.862; 95% CI [0.849-0.875]; p value < .01) were lower after 39 week IOL compared with expectant management. There were no differences in risk for neonatal seizures (aRR 0.848; 95% CI [0.718-1.003]; p value 0.011) or death (aRR 1.070; 95% CI [0.722-1.586]; p value 0.660). CONCLUSIONS: IOL at 39 weeks of gestation in a low-risk cohort is associated with a lower risk of CD and maternal infection, stillbirth, and lower neonatal morbidity. There was no effect on the risk for neonatal seizures or death.

Nitric oxide production and signalling in algae.

Nitric oxide (NO) was the first identified gaseous messenger and is now well established as a major ubiquitous signalling molecule. The rapid development of our understanding of NO biology in embryophytes came with the partial characterization of the pathways underlying its production and with the decrypting of signalling networks mediating its effects. Notably, the identification of proteins regulated by NO through nitrosation greatly enhanced our perception of NO functions. In comparison, the role of NO in algae has been less investigated. Yet, studies in Chlamydomonas reinhardtii have produced key insights into NO production through the identification of NO-forming nitrite reductase and of S-nitrosated proteins. More intriguingly, in contrast to embryophytes, a few algal species possess a conserved nitric oxide synthase, the main enzyme catalysing NO synthesis in metazoans. This latter finding paves the way for a deeper characterization of novel members of the NO synthase family. Nevertheless, the typical NO-cyclic GMP signalling module transducing NO effects in metazoans is not conserved in algae, nor in embryophytes, highlighting a divergent acquisition of NO signalling between the green and the animal lineages.