What women can do to optimise their health during pregnancy and that of their baby Claire Roberts

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1 Periconception Planning to Protect Pregnancy and Infant Health 2015 What women can do to optimise their health during pregnancy and that of their baby Claire Roberts

2 Pregnancy Complications Preterm Birth Preeclampsia Intrauterine Growth Restriction Gestational Diabetes

3 Preeclampsia, PTB, IUGR, GDM Together these complications affect about 25% of first pregnancies and can be life-threatening to mother and/or baby affecting many millions of women and babies each year Good screening tests during early stages of pregnancy are required High risk women could benefit from intensive monitoring and preventative treatments

4 Incidence % Gestation at Preterm Birth SA % % 0.42% <74% <19% <7.5% wks wks wks Gestation at PTB Verburg et al. Submitted N= 574,358 SA Perinatal Statistics Collection

5 Incidence % Pregnancy Induced Hypertensive Disorders South Australia Year Verburg et al. submitted N= 574,358 SA Perinatal Statistics Collection

6 Incidence % Gestational Diabetes in SA Year Verburg et al. submitted N= 460,749 SA Perinatal Statistics Collection

7 Maternal risk factors for adverse outcomes Chronic disease Poor nutrition (Furness et al. in preparation) A, T, C & G Elevated BMI (McCowan et al. 2010) Age (Lee et al. 2012) Family history (Dekker et al. 2012) Ethnicity Genetics (Andraweera et al. 2011a, 2011b, 2012a, 2012b, 2012c, 2012d, 2012e, 2014; Zhou et al. 2012, 2013) Paternal Obesity (McCowan et al. 2010) Smoking (McCowan et al. 2008; Dekker et al. 2012) Alcohol (McCarthy et al. 2013), Illicit Drugs (Leemaqz et al. submitted) Low folate (Furness et al. 2012) Vitamin D (Wilson et al. submitted; Laurence et al. submitted) Short period of sexual cohabitation (Kho et al. 2009) Fetal Sex (Buckberry et al. 2014; Verburg et al. submitted)

8 Parental genes interact with the environment to influence outcome Egg Sperm Maternal genes Conceptus genome Paternal genes Fetal gene expression Placental gene expression Embryo/Fetal signalling to the mother Age Ethnicity Family History Chronic disease Maternal adaptation to pregnancy Placental invasion & Function Maternal, fetal and postnatal health Folate, Vitamins B12, C, D, Ca, Zn, Se, Diet, Obesity, Stress, Smoking, Alcohol, Illicit drugs, Socioeconomic Status, Ethnicity Modified after Roberts Placenta 2010

9 Parental genes interact with the environment to influence outcome Egg Sperm Maternal genes Conceptus genome Paternal genes Fetal gene expression Placental gene expression Embryo/Fetal signalling to the mother Age Ethnicity Family History Chronic disease Maternal adaptation to pregnancy Placental invasion & Function Maternal, fetal and postnatal health Folate, Vitamins B12, C, D, Ca, Zn, Se, Diet, Obesity, Stress, Smoking, Alcohol, Illicit drugs, Socioeconomic Status, Ethnicity Modified after Roberts Placenta 2010

10 Parental genes interact with the environment to influence outcome Egg Sperm Maternal genes Conceptus genome Paternal genes Fetal gene expression Placental gene expression Embryo/Fetal signalling to the mother Age Ethnicity Family History Chronic disease Maternal adaptation to pregnancy Placental invasion & Function Maternal, fetal and postnatal health Folate, Vitamins B12, C, D, Ca, Zn, Se, Diet, Obesity, Stress, Smoking, Alcohol, Illicit drugs, Socioeconomic Status, Ethnicity Modified after Roberts Placenta 2010

11 Maternal BMI Maternal BMI in SCOPE Pregnancy Outcomes Non-cases PE GHTN GDM SGA SPTB Obese Overweight Normal Underweight N=5628 Leemaqz et al. Submitted All pregnancy complications groups P<0.05

12 Tiered Prediction Pre-pregnancy Higher Sensitivity Aim at identifying all women at risk Weeks of gestation Higher PPV Aim at identifying true positives First Trimester weeks Patient Tier 1 Tier 2 Clinical & Lifestyle Factors, SNPs, Family History At Risk Low Risk Clinical & Lifestyle Factors, SNPs, Cervical Length High Risk Moderate Risk

13 Red Blood Cell Folate and Pregnancy Outcome Normal ( nmol/L) Deficient (<220nmol/L) Insufficient ( nmol/L) High ( nmol/L) Furness et al. J Mat Fetal Neonatal Med (8):

14 Red Blood Cell Folate and Pregnancy Outcome All P<0.003 * Normal ( ) Deficient (<220) Insufficient ( ) High ( ) nmol/l Furness et al. J Mat Fetal Neonatal Med (8): All P<0.05

15 Red Blood Cell Folate and Pregnancy Outcome * All P<0.003 * Normal ( ) Deficient (<220) Insufficient ( ) High ( ) Furness et al. J Mat Fetal Neonatal Med (8): All P<0.05

16 Red Blood Cell Folate and Pregnancy Outcome * All P<0.003 * Normal ( ) Deficient (<220) Insufficient ( ) High ( ) * * Furness et al. J Mat Fetal Neonatal Med (8): *All P<0.05

17 Number of women 25(OH)D 3 in SCOPE Women 150 IMVS Endocrine Society of Australia 100 Mean = Std. Dev = N = % <60 nmol/l 68.6% <80 nmol/l 25(OH)D 3 (nmol/l)

18 Vitamin D nmol/l 25(OH)D 3 and BMI in SCOPE Women * * < >30 BMI Categories N=2,787 Leviton et al. unpublished *P<0.05

19 What can women do to modify risk Normalise weight before pregnancy including that of your partner Eat a good quality diet Supplement with recommended micronutrients Have regular exercise Avoid smoking, alcohol and illicit drugs

20 What can women do to modify risk Normalise weight before pregnancy including that of your partner Eat a good quality diet Supplement with recommended micronutrients Avoid smoking, alcohol and illicit drugs But best to start before conception

21 Placental Development Group SCOPE Families SCOPE Consortium

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