Maternal blood biomarkers and adverse pregnancy outcomes: a systematic review and meta-analysis
- DOI
- Language of the publication
- English
- Date
- 2019-09-11
- Type
- Article
- Author(s)
- Gomes, J.
- Au, F.
- Basak, A.
- Cakmak, S.
- Vincent, R.
- Kumarathasan, P.
- Publisher
- Taylor & Francis
Abstract
Background: Pregnancy is a vulnerable period for the mother and the infant and exposures to environmental chemicals in utero can influence neonatal morbidity and mortality. There is a momentum toward understanding and exploring the current maternal biological mechanisms specific to in utero effects, to improve birth outcomes. This study aims to examine the current understanding of the role of biomarkers that may be associated with term of pregnancy, infant birth weights and infant development in utero. Methods: Electronic searches were conducted in PubMed, Embase, OvidMD, and Scopus databases; and all relevant research articles in English were retrieved. Studies were selected if they evaluated maternal blood plasma/serum biomarkers proposed to influence adverse birth outcomes in the neonate. Data were extracted on characteristics, quality, and odds ratios from each study and meta-analysis was conducted. Results: A total of 54 studies (35 for meta-analysis), including 43,702 women, 50 plasma markers and six descriptors of birth outcomes were included in the present study. The random effect point estimates for risk of adverse birth outcomes were 1.61(95%CI: 1.39–1.85, p < 0.0001) for inflammation-related biomarkers and 1.65(95%CI: 1.22–2.25, p = 0.0013) for growth factor/hormone-related biomarkers. All subgroups of plasma markers showed significant associations with adverse birth outcomes with no apparent study bias. Conclusions: The two subsets of plasma markers identified in this study (inflammation-related and growth factor/hormone-related) may serve as potentially valuable tools in the investigation of maternal molecular mechanisms, especially select pathways underlying inflammatory and immunological mediation in terms of modulating adverse infant outcomes. Future large, prospective cohort studies are needed to validate the promising plasma biomarkers, and to examine other maternal biological matrices such as cervicovaginal fluid and urine.
Plain language summary
Adverse birth outcomes are linked to various factors such as maternal environmental exposures and nutritional status during pregnancy. Understanding biochemical changes in mothers during pregnancy can provide insight into mechanistic pathways related to adverse health effects in mothers and their babies. This information can be useful in identifying strategies to favour healthy pregnancies, and thus is in line with Health Canada's mandate to maintain and improve the health of Canadians. The aim of this work was to conduct a literature review on infant birth outcomes (e.g. infant birth weights, term of pregnancy) and maternal markers of biochemical status, and to conduct a meta-analysis to identify potential adverse outcome pathways. The work was conducted by University of Ottawa in collaboration with Health Canada. In order to carry out the literature search, various scientific publication databases were queried using various search terms relevant to this topic. Fifty-four articles in English were screened in, and of these studies only 35 were considered for meta-analyses. The present study, consisted of 43,702 women and 50 maternal biomarkers in blood. Statistical tests were carried out to assess the relationship between adverse infant birth outcomes and maternal markers that either were classified as inflammatory (e.g pro-inflammatory cytokines) or hormonal/growth factor-type of biomarkers (e.g. pregnancy associated plasma protein A) of which some of them were associated with small for gestational age (SGA) or preterm birth (PTB) or low birth weight. The findings of this work implied that changes in the levels of these classes of maternal plasma markers may serve as valuable tools in identifying adverse birth outcome pathways. Furthermore, these results also favour future large, prospective cohort studies to verify and validate maternal mechanisms that may contribute to specific adverse birth outcomes.
Subject
- Health,
- Health and safety