Nevin Manimala

Zhongguo Zhong Yao Za Zhi. 2024 Nov;49(22):6224-6234. doi: 10.19540/j.cnki.cjcmm.20240815.503.

ABSTRACT

This study systematically reviewed the randomized controlled trial(RCT) of traditional Chinese medicine(TCM) treatment of coronary heart disease patients with angina pectoris after percutaneous coronary intervention(PCI). The basic elements of these RCTs, including sample size and estimation method, randomizing scheme, allocation concealment, blind method implementation, data integrity, statistical method, TCM syndrome, intervention measures, treatment course, follow-up time, and outcome indicators, were analyzed to provide reference for the design of future RCT and the clinical application of TCM in treating angina pectoris after PCI. CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase, Cochrane Library, Web of Science, ClinicalTrials.gov, and Chinese Clinical Trial Registry were searched for the RCT about TCM treatment of coronary heart disease patients with angina pectoris after PCI according to pre-defined criteria, with the time interval from inception to January 31, 2024. A total of 188 RCTs were included, of which 184 were clinical research articles and 4 were clinical trial registration schemes. These RCTs involved a total of 15 521 patients, with an average sample size of 83 patients and a maximum sample size of 248 patients. Among them, 126 RCTs reported TCM syndromes, the top three of which were Qi deficiency and blood stasis(38.89%), phlegm combined with stasis(17.46%), and Qi stagnation and blood stasis(9.52%). The control group received guideline-directed medical therapy(GDMT) or GDMT combined with placebo, and the treatment group received GDMT combined with TCM. The treatment mainly lasted for 4-8 weeks, most of the RCTs did not set the follow-up period or the follow-up period was unknown. A total of 160 outcome indicators were used, with the total frequency of 1 348. According to functional attributes, the outcome indicators can be categorized into 6 groups: symptoms/signs(403, 29.90%), TCM syndromes/symptoms(182, 13.50%), physical and chemical examination(468, 34.72%), quality of life(89, 6.60%), long-term prognosis(5, 0.37%), and safety evaluation(201, 14.91%). The clinical trial design of TCM intervention in angina pectoris after PCI of coronary heart disease is becoming more and more rigorous, while it remains to be improved. It is expected that more clinical trial schemes with rigorous design and taking into account the TCM advantages can be adopted in the future to provide a basis for the TCM treatment of angina pectoris after PCI of coronary heart disease.

PMID:39701718 | DOI:10.19540/j.cnki.cjcmm.20240815.503

Zhongguo Zhong Yao Za Zhi. 2024 Nov;49(22):6198-6213. doi: 10.19540/j.cnki.cjcmm.20240815.501.

ABSTRACT

Bayesian network Meta-analysis was conducted to assess the efficacy and safety of different Chinese medicine injections for dilated cardiomyopathy(DCM). CNKI, Wanfang, VIP, SinoMed, PubMed, Web of Science, EMbase, Cochrane Library, ProQuest, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov were searched for the randomized controlled trial(RCT) from the inception to January 2024. The quality of the included RCT was evaluated using the Cochrane’s risk of bias assessment tool, and the quality of evidence for outcomes was assessed by GRADE. Stata 16.0 and RevMan 5.4 softwares were used for Meta-analysis. A total of 57 RCTs involving 4 812 subjects, 6 Chinese medicine injections and 6 outcome indicators were included. Bayesian network Meta-analysis indicated that:(1) In terms of increasing clinical total effectiveness rate, except Shenqi Fuzheng Injection + conventional western medicine, other 5 Chinese medicine injections combined with conventional western medicine outperformed conventional western medicine alone, and Xinmailong Injection + conventional western medicine had the best effect.(2) In terms of improving left ventricular ejection fraction, all of the 6 Chinese medicine injections combined with conventional western medicine were superior to conventional western medicine alone, and Shengmai Injection + conventional western medicine had the highest likelihood of being the best intervention.(3) On account of reducing left ventricular end-diastolic dimension, Shenfu Injection + conventional western medicine, Shenmai Injection + conventional western medicine, Huangqi Injection + conventional western medicine, and Xinmailong Injection + conventional western medicine outperformed conventional western medicine alone except Shengmai Injection + conventional western medicine, and Huangqi Injection + conventional western medicine had the highest probability of being the best treatment.(4) In terms of decreasing BNP, Huangqi Injection + conventional western medicine, Shenfu Injection + conventional western medicine, and Shenmai Injection + conventional western medicine were better than conventional western medicine alone, and Huangqi Injection + conventional western medicine had the highest likelihood of being the best treatment.(5) Considering the improvement in 6-min walk test, Shenmai Injection + conventional western medicine were superior to conventional western medicine alone.(6) In the case of improving cardiac output, Shenmai Injection + conventional western medicine, Shengmai Injection + conventional western medicine, Xinmailong Injection + conventional western medicine, and Shenqi Fuzheng Injection + conventional western medicine outperformed conventional western medicine alone except Shenfu Injection + conventional western medicine, thereinto, Shenmai Injection + conventional western medicine might be the optimal choice for increasing cardiac output level.(7) For safety, no statistically significant difference in adverse events was recorded between the experimental group and the control group(P=0.24). Bayesian network Meta-analysis showed that the addition of Chinese medicine injections to conventional western medicine exerted a more positive effect for DCM, and had advantages in alleviating clinical symptoms and improving cardiac function. However, due to the overall low quality of the included articles, the low inclusion of certain Chinese medicine injections, and the lack of direct comparison between different Chinese medicine injections, the results need to be further confirmed.

PMID:39701716 | DOI:10.19540/j.cnki.cjcmm.20240815.501

Zhongguo Zhong Yao Za Zhi. 2024 Nov;49(22):6138-6148. doi: 10.19540/j.cnki.cjcmm.20240809.301.

ABSTRACT

This study utilized ultra-performance liquid chromatography coupled with quadrupole-time-of-flight mass spectrometry(UPLC-Q-TOF-MS) to rapidly analyze and identify the chemical constituents in five processed products of Strychni Semen(raw, sand-roasted, fried, urine-soaked, and vinegar-processed products). Using PeakView software to extract compound information, 50 chemical components were identified based on retention time, accurate molecular ion peaks, secondary mass spectrometry data, and comparison with reference standards and relevant literature. Specifically, 41 components were identified in raw Strychni Semen, 48 in sand-roasted, 43 in fried, 41 in urine-soaked, and 40 in vinegar-processed products. Principal component analysis(PCA) and orthogonal partial least squares discriminant analysis(OPLS-DA) were employed to identify differential components among the processed products, with variable importance in projection(VIP) values>1 and a t-test with P<0.05 as criteria. PCA revealed significant differences among the five processed products, demonstrating good clustering and separation. OPLS-DA identified 13 differential components, including brucine, strychnine, loganic acid, and chlorogenic acid. The results indicated that S. nux-vomica primarily contained alkaloids, organic acids, and glycosides, with significant compositional differences among the various processed products. Notably, the content of key components such as brucine and strychnine decreased after processing, with the most significant reduction observed in vinegar-processed Strychni Semen. In conclusion, this study provides a comprehensive comparison of the effects of different processing methods on the chemical composition of Strychni Semen, exploring the differences in the material basis of the processed products and offering data to support the scientific rationale behind the processing of Strychni Semen.

PMID:39701710 | DOI:10.19540/j.cnki.cjcmm.20240809.301

Zhongguo Zhong Yao Za Zhi. 2024 Sep;49(18):5045-5054. doi: 10.19540/j.cnki.cjcmm.20240604.501.

ABSTRACT

Based on the latent structure model and association rule analysis, the regularity of prescription for hyperlipidemia comorbid with hypertension was explored, and traditional Chinese medicine(TCM) pattern type was speculated to provide a reference for clinical pattern differentiation and treatment, and guideline establishment. The literature on the treatment of hyperlipidemia comorbid with hypertension by TCM was systematically searched on CNKI, Wanfang, VIP, and SinoMed academic platforms. The relevant information was extracted and a database was established using Microsoft Excel 2019. The frequency and properties of high-frequency TCM were statistically analyzed using Lantern 5.0 and RStudio software. The latent structure model and association rule analysis were applied to explore the medication regularity and speculate TCM pattern type. A total of 97 TCM prescriptions involving 104 TCM were included, with a cumulative frequency of 1 189 times. The high-frequency TCM included Poria, Gastrodiae Rhizoma, Atractylodis Macrocephalae Rhizoma, Pinelliae Rhizoma, Citri Reticulatae Pericarpium. The efficacy was mainly based on tonifying deficiency drugs, activating blood circulation drugs, and calming liver wind drugs. A total of 13 latent variables, 42 latent classes, and 5 comprehensive clustering models were obtained from the latent structure analysis. A total of 17 core formulas were obtained, suggesting that there were 5 common patterns in hyperlipidemia comorbid with hypertension, namely phlegm-dampness and blood stasis pattern, phlegm-blood stasis pattern, liver-fire hyperactivity pattern, Yin deficiency and Yang hyperactivity pattern, and liver and kidney deficiency pattern. Association rule analysis obtained 26 strong association rules, among which the highest support degree was Gastrodiae Rhizoma→Poria. Hyperlipidemia comorbid with hypertension belongs to the pattern of deficiency in the root and excess in the branch, which is closely related to the dysfunction of the liver, kidney, and spleen in the body. Phlegm-dampness and blood stasis, liver and kidney Yin deficiency are the main pathogenesis of this disease. The treatment should be based on the principles of calming liver fire, resolving phlegm, and strengthening spleen function. According to the pattern, Qi and blood as well as Yin and Yang should be coordinated to eliminate phlegm, blood stasis, etc., supplemented by treatments such as calming liver fire and eliminating wind from the liver.

PMID:39701687 | DOI:10.19540/j.cnki.cjcmm.20240604.501

Hum Reprod. 2024 Dec 19:deae269. doi: 10.1093/humrep/deae269. Online ahead of print.

ABSTRACT

STUDY QUESTION: Is there an association between the somatic loss of PTEN (phosphatase and tensin homolog) and ARID1A (AT-rich interaction domain 1A) and endometriosis disease severity and worse clinical outcomes?

SUMMARY ANSWER: Somatic PTEN loss in endometriosis epithelium was associated with greater disease burden and subsequent surgical complexity.

WHAT IS KNOWN ALREADY: Somatic cancer-driver mutations including those involving the PTEN and ARID1A genes exist in endometriosis without cancer; however, their clinical impact remains unclear.

STUDY DESIGN, SIZE, DURATION: This prospective longitudinal study involved endometriosis tissue and clinical data from 126 participants who underwent surgery at a tertiary center for endometriosis (2013-2017), with a follow-up period of 5-9 years.

PARTICIPANTS/MATERIALS, SETTING, METHODS: PTEN and ARID1A loss was assessed using established immunohistochemistry (IHC) methods as proxies for somatic loss by two independent raters. PTEN and ARID1A status for each participant was defined as loss (loss in at least one sample for a participant) or retained (no loss in all samples for a participant). Primary analyses examined associations between PTEN and ARID1A loss and disease burden based on anatomic subtype (superficial peritoneal endometriosis (SUP), deep endometriosis (DE), ovarian endometrioma (OMA)) and rASRM stage (I-IV). Secondary analyses explored associations of PTEN and ARID1A loss with demographics, surgical difficulty, and pain scores (baseline and follow-up). Additionally, using previously published data on KRAS codon 12 mutations for this cohort, we investigated associations between variables in the primary and secondary analyses and acquiring two or more somatic events (PTEN loss, ARID1A loss, or KRAS mutation) in this cohort. The risk of reoperation over the 5-9 years was also examined.

MAIN RESULTS AND THE ROLE OF CHANCE: PTEN loss (68.3%; 86 participants) exceeded ARID1A loss (24.6%; 31 participants). Inter-rater reliability was substantial for PTEN (k = 0.69; 95% CI: 0.62-0.77) and ARID1A (k = 0.64; 95% CI: 0.51-0.77). PTEN loss was significantly associated with more severe anatomic subtypes (P < 0.001; participants with SUP only = 46.4%; participants with DE only or OMA only = 72.7%; participants with mixed subtypes = 85.1%), and higher stages (P = 0.024; Stage I = 47.8%; Stage II = 73.7%; Stage III = 80.8%; Stage IV = 81.0%). Results were similar for ARID1A loss, albeit with smaller sample size limiting power. PTEN loss was further associated with non-White ethnicities (P = 0.017) and greater surgical difficulty (more frequent need for ureterolysis) (P = 0.02). There were no differences in pain scores (baseline or follow-up) based on PTEN or ARID1A status. Reoperation was uncommon (13.5% of the cohort), and patterns in reoperation rates based on the presence of somatic alterations did not reach statistical significance.

LIMITATIONS, REASONS FOR CAUTION: Sequencing was not performed to determine the type of PTEN and ARID1A somatic mutations resulting in loss of expression.

WIDER IMPLICATIONS OF THE FINDINGS: These results demonstrate a link between PTEN somatic loss and greater endometriosis disease burden. These findings underscore the potential relevance of PTEN loss and other somatic driver mutations in a future molecular classification of endometriosis.

STUDY FUNDING/COMPETING INTEREST(S): This study was funded by Canadian Institutes of Health Research (CIHR) project grant (MOP-142273 and PJT-156084). P.J.Y. was supported by a Health Professional Investigator award from Michael Smith Health Research BC, Canada, and a Canada Research Chair (Tier 2) in Endometriosis and Pelvic Pain. M.S.A. was supported by a Michael Smith Health Research BC Scholar award, and CIHR project grants (369990, 462997, and 456767). The sponsors did not play any role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. C.A. declares receiving payment from Pfizer for a symposium; being on advisory boards for AbbVie and Pfizer; being President and past President of the Canadian Society for the Advancement of Gynecologic Excellence (CanSAGE), co-lead of EndoAct Canada, and a board member of IPPS. M.A.B. has received consulting fees from AbbVie and Pfizer and grants from Ferring outside the scope of this work. D.G.H. is the founder of Canxeia Health but has no current affiliation. M.K. has received consulting fees from Helix Biopharma outside the scope of this work. M.S.A. received reimbursement of travel and registration fees to attend and present at the 2023 and 2024 annual meetings for the Society for Reproductive Investigation (SRI). P.J.Y. declares receiving: payment for a lecture from the International Society for the Study of Women’s Sexual Health (ISSWSH); honoraria from the CIHR; support to attend meetings from CanSAGE, ISSWSH, the International Pelvic Pain Society, the World Endometriosis Society (WES), the Society for the Study of Reproduction, and the Vulvodynia Summit; and discounted devices from Ohnut Wearable for a clinical trial. P.J.Y. is a data safety monitoring board member of a clinical trial funded by CIHR; and a strategic advisory board member for the Women’s Health Research Institute. P.J.Y. served as a board of directors member for CanSAGE and ISSWSH; was a junior board of directors member for WES; is a current board of directors member for WES; and was a committee chair for the Society of Obstetricians and Gynaecologists of Canada. A subset of these results was presented by the first author at the 71st Society for Reproductive Investigation Annual Scientific Meeting on 15 March 2024. Other authors have nothing to declare.

TRIAL REGISTRATION NUMBER: N/A.

PMID:39701665 | DOI:10.1093/humrep/deae269

Vet Comp Oncol. 2024 Dec 19. doi: 10.1111/vco.13036. Online ahead of print.

ABSTRACT

Mast cell tumours (MCTs) are the most frequent cutaneous neoplasia of the dog, and they have very variable biological behaviour and survival times. Surgery is still the best treatment, and despite the several adjuvant therapies described, many cases are very aggressive and resistant to these treatments making it urgent to find new therapeutic targets. Nowadays, immunotherapy targeting immune checkpoints has been described as a complementary treatment for several human cancers, but it is still very scarcely studied in veterinary medicine. Therefore, this study aimed to investigate the expression of the checkpoint proteins programmed death-ligand 1 (PD-L1) and cytotoxic T-lymphocyte antigen-4 (CTLA-4) to evaluate their potential as therapeutic targets for MCT. Through immunohistochemical study, it was analysed the expression of PD-L1 and CTLA-4 in 74 MCT cases from the archive of the Veterinary Pathology Laboratory of the University of Porto (LabPatVet). Tumour size, histological grade, ki-67 proliferation index, mitotic count and presence of metastatic disease were also assessed. Most of the cases expressed both immune checkpoints in neoplastic cells. There was a statistically significant inverse association between the expression of CTLA-4 and MCT grade (p < 0,001) and mitotic count (p < 0.001). PD-L1 was significantly and negatively related to HG (p = 0.004), and tumour size (р = 0.014). Tumour size, histological grade and mitotic count were positively associated with metastatic disease. Additionally, it was observed that the expression of PD-L1 and CTLA-4 was interrelated (p < 0.001). This study demonstrated that MCT cells express both PD-L1 and CTLA-4 and that their expression was associated with MCT prognostic factors.

PMID:39701664 | DOI:10.1111/vco.13036

Lancet Child Adolesc Health. 2025 Jan;9(1):37-46. doi: 10.1016/S2352-4642(24)00296-7.

ABSTRACT

BACKGROUND: The number of children requiring prolonged mechanical ventilation (PMV) has increased with the advancement of medical care. We aimed to estimate the prevalence of PMV worldwide, document demographic and clinical characteristics of children requiring PMV in paediatric intensive care units (PICUs), and to understand variation in clinical practice and health-care burden.

METHODS: This international, multicentre, cross-sectional cohort study screened participating PICUs in 28 countries for children aged >37 postgestational weeks to 17 years who had been receiving mechanical ventilation (MV; invasive or non-invasive) for at least 14 consecutive days. Screening days took place every 90 days for 3 years. Patients were eligible for inclusion in the analysis if they had been receiving MV (invasive or non-invasive) for at least 14 consecutive days by their first day of screening. Eligible patients were followed up on the subsequent screening day 90 days later or at time of hospital discharge, whichever came first. Outcome data were recorded in a validated web-based case report file. The primary outcome was the prevalence of PMV. Secondary outcomes were mortality, duration of MV, tracheostomy, and number of complications. All outcomes were assessed at 90 days post-screening. The study was registered with ClinicalTrials.gov, NCT04112459.

FINDINGS: Between Sept 4, 2019 and Dec 7, 2022, 14 595 children were screened on four separate screening days in 158 PICUs, and 2773 patients had been receiving MV for at least 14 days and were included in the analysis. The point prevalence of PMV was 25·8% (IQR 24·1-28·5). Median age was 0·4 years (IQR 0·2-5·3) and median weight was 8·1 kg (IQR 4·7-19·1). 625 (24·0%) of 2610 patients had a history of prematurity (<37 weeks gestational age at birth). 90-day outcome data were collected for 2430 patients. 441 (18·2%) of 2430 patients had died within 90 days. 649 (29·8%) of 2176 patients who initiated ventilation support upon hospital admission had a tracheostomy placed after the first 14 days of MV. The median time to tracheostomy placement after MV initiation was 26 days (IQR 18-52). 462 (21·2%) of 2176 patients had at least one failed extubation between MV initiation and their first screening date. 556 (25·6%) of 2174 patients who started MV upon hospital admission required MV for 21 days or less, whereas 1618 (74·4%) patients required MV for 22 days or more; 90-day mortality did not differ between these groups (18·2% vs 20·30%, p=0·288). Complications were recorded for 810 (38·4%) 2109 patients who initiated MV upon hospital admission; of these 539 (67%) had ventilator-associated pneumonia, and 212 (39%) of 539 patients had multiple episodes of ventilator-associated pneumonia.

INTERPRETATION: Timing of tracheostomy was variable, and duration of MV was longer than previously reported. The large variability in patients requiring MV and the associated health-care burden and outcomes across PICUs suggest that further investigation of the factors influencing the care of children with MV is warranted.

FUNDING: Réseau en Santé Respiratoire du Québec (Respiratory Research Network of Quebec), Fonds de la recherche en santé du Québec, Women and Children Health Research Institute-Clinical/Community Research Integration and Support Program, Réseau mère-enfant de la francophonie.

TRANSLATIONS: For the French and Spanish translations of the abstract see Supplementary Materials section.

PMID:39701660 | DOI:10.1016/S2352-4642(24)00296-7

Lancet Child Adolesc Health. 2025 Jan;9(1):16-24. doi: 10.1016/S2352-4642(24)00294-3.

ABSTRACT

BACKGROUND: Peripheral oxygen saturation (SpO₂) above 94% is typical in children in paediatric intensive critical care units (PICUs) who are receiving invasive ventilation and supplemental oxygen. In a previous report from the Oxy-PICU trial, we showed that lower (conservative) oxygenation targets (SpO₂ 88-92%) are beneficial, showing small but statistically significant differences in duration of organ support and large but non-significant cost reductions at 30 days. In this pre-specified analysis of the Oxy-PICU trial, we compare longer-term outcomes and cost-effectiveness of conservative versus liberal (SpO₂ >94%) oxygenation targets in children with emergency PICU admission.

METHODS: Oxy-PICU was a pragmatic, multicentre, open-label, randomised controlled trial in England and Scotland. Eligible children were older than 38 weeks and younger than 16 years and had been admitted for emergency care in one of 15 participating PICUs, where they received invasive respiratory support for abnormal gas exchange. Participants were randomly assigned (1:1) to either a conservative oxygenation target (SpO₂ 88-92%) or liberal oxygenation target (SpO₂ >94%). Survival status was assessed at 90 days and 1 year, and health-related quality of life (HRQoL), quality-adjusted life-years (QALYs), health-care costs, and incremental net monetary benefit were assessed at 1 year after the index hospital admission and randomisation. HRQoL was measured with age-appropriate Paediatric Quality of Life Generic Core Scales and mapped onto the Child Health Utility 9D index score. HRQoL and survival data were combined to construct QALYs. Costs at 1 year were derived from use of hospital, outpatient, and community health services. The trial was registered in the ISRCTN registry (ISRCTN92103439).

FINDINGS: 2040 children were enrolled between Sept 1, 2020 and May 15, 2022. 1868 (91·6%) children were included in the 90-day survival analysis; of these 930 (49·8%) had been assigned liberal oxygen and 938 (50·2%) conservative oxygen. 1867 (91·5%) children were included in the 1-year survival analysis; 930 (49·8%) had been assigned liberal oxygenation and 937 (50·2%) conservative oxygen. At 90 days, 35 (3·7%) patients in the conservative oxygenation group and 45 (4·8%) patients in the liberal oxygenation group had died (adjusted hazard ratio [aHR] 0·75 [95% CI 0·48 to 1·17]). By 1 year, 52 (5·5%) patients in the conservative oxygenation group and 66 (7·1%) patients in the liberal oxygenation group had died (aHR 0·77 [95%CI 0·53 to 1·10]). Overall, mean HRQoL, life-years, and QALYs at 1 year were similar in the two groups. The adjusted incremental effect on cost of conservative oxygenation versus liberal oxygenation was -£879 (95% CI -9036 to 7278), whereas the incremental difference in QALYs was estimated at 0·001 (-0·010 to 0·011), leading to an incremental net monetary benefit of £894 (-7290 to 9078) associated with conservative oxygenation relative to liberal oxygenation. These results did not vary by age (<12 months vs ≥12 months), comorbidity at baseline, age-adjusted heart rate, or haemoglobin level at admission and were robust to alternative assumptions.

INTERPRETATION: Compared with usual care (SpO₂ >94%) for invasively ventilated children who are admitted as an emergency to a PICU, conservative oxygenation (SpO₂ 88-92%) was not associated with differences in longer-term survival, costs, or cost-effectiveness. Taken together with previous findings of Oxy-PICU that conservative oxygenation compared with liberal oxygenation leads to better patient-centred and parent-centred outcomes at 30 days, these findings support the use of conservative oxygenation targets for this population.

FUNDING: UK National Institute for Health and Social Care Research Health Technology Assessment Programme.

PMID:39701658 | DOI:10.1016/S2352-4642(24)00294-3

Chaos. 2024 Dec 1;34(12):123161. doi: 10.1063/5.0230848.

ABSTRACT

The development of robust Early Warning Signals (EWSs) is necessary to quantify the risk of crossing tipping points in the present-day climate change. Classically, EWSs are statistical measures based on time series of climate state variables, without exploiting their spatial distribution. However, spatial information is crucial to identify the starting location of a transition process and can be directly inferred by satellite observations. By using complex networks constructed from several climate variables on the numerical grid of climate simulations, we seek for network properties that can serve as EWSs when approaching a state transition. We show that network indicators such as the normalized degree, the average length distance, and the betweenness centrality are capable of detecting tipping points at the global scale, as obtained by the MIT general circulation model in a coupled-aquaplanet configuration for CO2 concentration-driven simulations. The applicability of such indicators as EWSs is assessed and compared to traditional methods. We also analyze the ability of climate networks to identify nonlinear dynamical patterns.

PMID:39700522 | DOI:10.1063/5.0230848

Obstet Gynecol. 2024 Dec 19. doi: 10.1097/AOG.0000000000005808. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare odds of maternal morbidity by mode of becoming pregnant and type of medically assisted reproduction treatments: fertility-enhancing drugs, intrauterine insemination (IUI), and assisted reproductive technology (ART) with autologous or donor oocytes.

METHODS: Birth certificates were used to study maternal morbidity among the birthing population in Utah between 2009 and 2017 (N=469,919 deliveries); 22,543 pregnancies occurred through medically assisted reproduction (4.8%). Maternal morbidity was identified as a binary variable, indicating the presence of any of the following: blood transfusion, unplanned operating room procedure, admission to intensive care unit, eclampsia, unplanned hysterectomy, and ruptured uterus. Using logistic regression, we assessed maternal morbidity among medically assisted reproduction pregnancies (overall and by type of treatment) compared with unassisted pregnancies in the overall sample before and after adjustment for individual sociodemographics (age at birth, family structure, level of education, Hispanic origin, parity), and pre-existing comorbidities (ie, chronic hypertension, heart disease, asthma), multifetal gestation, and obstetric comorbidities (ie, placenta previa, placental abruption, cesarean delivery).

RESULTS: Individuals becoming pregnant through medically assisted reproduction had higher risk of maternal morbidity, with odds ratios (ORs) increasing as medically assisted reproduction treatments become more invasive. Associations were largely attenuated when accounting for multifetal gestation and further reduced after controlling for obstetric comorbidities. However, ART with autologous oocytes (OR 1.46, 95% CI, 1.20-1.78) maintained higher coefficients compared with unassisted pregnancies. In models including only singletons, after controlling for obstetric comorbidities, the OR differences in maternal morbidity between all medically assisted reproduction groups and unassisted pregnancies were no longer statistically significant.

CONCLUSION: More invasive medically assisted reproduction treatments (ART and IUI) are associated with higher odds of maternal morbidity, whereas less invasive treatments are not. This relationship is partially explained by higher prevalence of multifetal gestation and obstetric comorbidities in people undergoing more invasive treatment, but the persistent association suggests subfertility itself may contribute to maternal morbidity.

PMID:39700505 | DOI:10.1097/AOG.0000000000005808