Dataset Information

Antimullerian hormone and pregnancy loss from the Effects of Aspirin in Gestation and Reproduction trial.

ABSTRACT: OBJECTIVE:To evaluate if antimüllerian hormone (AMH) is associated with pregnancy loss. DESIGN:Prospective cohort study within a block-randomized, double-blind, placebo-controlled trial of low-dose aspirin. SETTING:Not applicable. PATIENT(S):Women (n = 1,228) were of ages 18-40 years with a history of one to two pregnancy losses and were actively attempting pregnancy without fertility treatment. INTERVENTION(S):Not applicable. MAIN OUTCOME MEASURE(S):Pregnancy loss. RESULT(S):Relative risks (and 95% confidence interval [CIs]) of human chorionic gonadotropin (hCG)-detected and clinical pregnancy loss were assessed with the use of log binomial models with robust variance and inverse probability weights adjusted for age, race, body mass index, income, trial treatment assignment, parity, number of previous losses, and time since most recent loss. AMH levels were defined as: low (<1.00 ng/mL; n = 124), normal (referent; 1.00-3.5 ng/mL; n = 595), and high (>3.5 ng/mL; n = 483). Of the 1,202 women with baseline AMH data, 19 (17.3%) with low AMH experienced a clinical loss, compared with 61 (11.4%) with normal AMH and 50 (11.8%) with high AMH levels. Low or high AMH levels, compared with normal AMH, were not associated with clinical loss. Results for hCG-detected pregnancy loss mirrored those of clinical loss. CONCLUSION(S):AMH values were not associated with hCG-detected or clinical pregnancy loss in unassisted conceptions in women with a history of one to two previous losses. Our data do not support routine AMH testing for prediction of pregnancy loss. CLINICAL TRIAL REGISTRATION NUMBER:NCT00467363.

SUBMITTER: Zarek SM

PROVIDER: S-EPMC4821799 | biostudies-literature | 2016 Apr

REPOSITORIES: biostudies-literature

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Antimüllerian hormone and pregnancy loss from the Effects of Aspirin in Gestation and Reproduction trial.

Zarek Shvetha M SM Mitchell Emily M EM Sjaarda Lindsey A LA Mumford Sunni L SL Silver Robert M RM Stanford Joseph B JB Galai Noya N Schliep Karen C KC Radin Rose G RG Plowden Torie C TC DeCherney Alan H AH Schisterman Enrique F EF

Fertility and sterility 20151217 4

<h4>Objective</h4>To evaluate if antimüllerian hormone (AMH) is associated with pregnancy loss.<h4>Design</h4>Prospective cohort study within a block-randomized, double-blind, placebo-controlled trial of low-dose aspirin.<h4>Setting</h4>Not applicable.<h4>Patient(s)</h4>Women (n = 1,228) were of ages 18-40 years with a history of one to two pregnancy losses and were actively attempting pregnancy without fertility treatment.<h4>Intervention(s)</h4>Not applicable.<h4>Main outcome measure(s)</h4>Pr ...[more]

PMID: 26707905

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Project description:ObjectiveTo estimate the association between physical activity and risk of subclinical and clinical pregnancy loss among women with a history of pregnancy loss.DesignProspective cohort study as a secondary analysis of the Effects of Aspirin in Gestation and Reproduction randomized controlled trial of preconception-initiated low-dose aspirin among women with one or two prior pregnancy losses.SettingFour U.S. clinical centers, 2007-2011.Patient(s)Women with confirmed pregnancy (n = 785) as determined from hCG testing in longitudinally collected biospecimens.Main outcome measure(s)Subclinical loss of pregnancy detected only by hCG testing and clinically recognized loss.Result(s)Among 785 women (mean [SD] age, 28.7 [4.6] years) with an hCG-confirmed pregnancy, 188 (23.9%) experienced pregnancy loss. In multivariable models adjusted for confounders, compared with the first tertile of physical activity (median = 7.7 metabolic equivalent of task hours/week), there was a roughly twofold higher risk of subclinical loss in the second (risk ratio = 2.06; 95% confidence interval, 1.03-4.14) and third tertiles (risk ratio = 1.92; 95% confidence interval, 0.94-3.90), with median metabolic equivalent of task hours/week of 27.8 and 95.7, respectively. No relations were observed between physical activity and clinically recognized loss.Conclusion(s)Risk related to physical activity is different for pregnancy failure close to the time of implantation compared with that for later, clinical pregnancy loss. Higher physical activity levels were associated with an elevated risk of subclinical loss (i.e., pregnancies detected only by hCG, n = 55); however, no relationship was observed with clinically recognized loss. Further work is required to confirm these findings, assess generalizability to women without prior losses, and evaluate mechanisms.Ethical approvalEach participating center's Institutional Review Board approved the study, and participants provided written informed consent. The trial was registered on ClinicalTrials.gov (NCT00467363), and a Data Safety and Monitoring Board provided oversight.

Project description:BackgroundPlatelet activation may play a role in the pathophysiology of placenta-mediated obstetrical complications, as evidenced by the efficacy of aspirin in preventing preeclampsia, but published data regarding the relationship between biomarkers for platelet activation and adverse obstetrical outcomes are sparse. In particular, it is unknown whether prepregnancy biomarkers of platelet activation are associated with adverse pregnancy outcomes.ObjectiveThis study aimed to determine the following: (1) whether maternal plasma concentrations of platelet factor 4 are associated with risk of placenta-mediated adverse obstetrical outcomes, and (2) whether these associations are modified by low-dose aspirin.Study designThis ancillary study included measurement of platelet factor 4 among 1185 of 1228 women of reproductive age enrolled in the Effects of Aspirin in Gestation and Reproduction trial with available plasma samples, with relevant outcomes assessed among 584 women with pregnancies lasting at least 20 weeks' gestation. We measured platelet factor 4 in plasma samples obtained at the prepregnancy study visit (before randomization to low-dose aspirin or placebo), 12 weeks' gestation, and 28 weeks' gestation. The primary outcome was a composite of hypertensive disorders of pregnancy, placental abruption, and small-for-gestational-age infant. We estimated the relative risks (RRs) and 95% confidence intervals (CIs) for the association between platelet factor 4 and the composite and individual outcomes at each time point using log-binomial regression that was weighted to account for potential selection bias and adjusted for age, body mass index, education, income, and smoking. To evaluate the potential effect modification of aspirin, we stratified the analyses by aspirin treatment assignment.ResultsDuring follow-up, 95 women experienced the composite adverse obstetrical outcome, with 57 cases of hypertensive disorders of pregnancy, 35 of small for gestational age, and 6 of placental abruption. Overall, prepregnancy platelet factor 4 was positively associated with the composite outcome (third tertile vs first tertile; relative risk, 2.36; 95% confidence interval, 1.38-4.03) and with hypertensive disorders of pregnancy (third tertile vs first tertile; relative risk, 2.14; 95% confidence interval, 1.08-4.23). In analyses stratified by treatment group, associations were stronger in the placebo group (third tertile vs first tertile; relative risk, 3.36; 95% confidence interval, 1.42-7.93) than in the aspirin group (third tertile vs first tertile; relative risk, 1.78; 95% confidence interval, 0.90-3.50).ConclusionHigh concentrations of platelet factor 4 before pregnancy are associated with increased risk of placenta-mediated adverse pregnancy outcomes, particularly for hypertensive disorders of pregnancy. Aspirin may mitigate the increased risk of these outcomes among women with higher plasma concentrations of preconception platelet factor 4, but low-dose aspirin nonresponders may require higher doses of aspirin or alternate therapies to achieve obstetrical risk reduction.

Dataset Information

Antimullerian hormone and pregnancy loss from the Effects of Aspirin in Gestation and Reproduction trial.

Publications

Antimüllerian hormone and pregnancy loss from the Effects of Aspirin in Gestation and Reproduction trial.

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