Sex-specific effect of first-trimester maternal progesterone on birthweight.
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Sex-specific effect of first-trimester maternal progesterone on birthweight. / Hartwig, Isabel R V; Pincus, Maike K; Diemert, Anke; Hecher, Kurt; Arck, Petra C.
In: HUM REPROD, Vol. 28, No. 1, 1, 2013, p. 77-86.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Sex-specific effect of first-trimester maternal progesterone on birthweight.
AU - Hartwig, Isabel R V
AU - Pincus, Maike K
AU - Diemert, Anke
AU - Hecher, Kurt
AU - Arck, Petra C
PY - 2013
Y1 - 2013
N2 - STUDY QUESTION: Are maternal progesterone levels in early pregnancy associated with fetal birthweight?SUMMARY ANSWER: Low levels of first-trimester maternal progesterone are significantly associated with a reduction in birthweight in girls, but not boys.WHAT IS ALREADY KNOWN: Progesterone in the third trimester of pregnancy has previously been related to birthweight in humans.STUDY DESIGN, SIZE, DURATION: Pregnant women between gestational weeks 4 and 12 were recruited by 99 obstetricians in private practice and enrolled in a prospective cohort study. A follow-up took place at birth. Women younger than 18 years, who had undergone fertility treatments or were diagnosed with infectious diseases, were excluded from the study. A subgroup of 906 participants in whom progesterone had been measured was then selected retrospectively based on the following criteria: no miscarriages, elective abortions or pregnancy complications, infections or multiple births. Data from the follow-up were available for 623 women, who were included in the analyses.PARTICIPANTS/MATERIALS, SETTING, METHODS: The study was coordinated at the Charité University Medicine in Berlin, Germany. Anthropometric, medical and psychosocial information were collected and serum progesterone and estradiol levels were measured in women during the first trimester of pregnancy, followed by the documentation of the pregnancy outcome at birth. Univariable and multivariable regression analyses were performed to identify maternal markers, among them progesterone, affecting birthweight and to determine environmental and maternal factors that are associated with maternal progesterone levels during pregnancy.MAIN RESULTS AND THE ROLE OF CHANCE: In the multivariable regression model, each increase in maternal progesterone by 1 ng/ml during the first trimester increased girls' birthweight by 10.17 g (95% CI: 2.03-18.31 g). If the mother carried a boy, maternal smoking and perceived worries during early pregnancy predicted a reduced birthweight, irrespective of progesterone levels. Maternal body mass index over 25 and maternal age <21 years significantly correlated with the reduced levels of progesterone. Correlations between environmental challenges and maternal progesterone did not reach levels of significance. Since the analyses were exploratory, the likelihood that results may be due to chance is increased.LIMITATIONS, REASONS FOR CAUTION: Due to the exploratory nature of the analyses, results need to be independently confirmed in a larger sample. Furthermore, our findings pertain to pregnant women without pregnancy complications or fertility treatments.WIDER IMPLICATIONS OF THE FINDINGS: Maternal progesterone during early pregnancy is an indicator of subsequent fetal development in female children. Future studies should confirm this relationship and determine whether maternal progesterone is a useful tool in predicting pregnancies at risk resulting in the birth of a girl with low birthweight. Detailed identification of environmental factors modulating maternal progesterone levels should be addressed in future studies.STUDY FUNDING/POTENTIAL COMPETING INTERESTS: Financial support was provided by the Alexander von Humboldt Foundation, Excellence Initiative of the Hamburg Foundation for Research and the Association for Prevention and Information for Allergy and Asthma (Pina e.V.). The authors have no conflict of interest.
AB - STUDY QUESTION: Are maternal progesterone levels in early pregnancy associated with fetal birthweight?SUMMARY ANSWER: Low levels of first-trimester maternal progesterone are significantly associated with a reduction in birthweight in girls, but not boys.WHAT IS ALREADY KNOWN: Progesterone in the third trimester of pregnancy has previously been related to birthweight in humans.STUDY DESIGN, SIZE, DURATION: Pregnant women between gestational weeks 4 and 12 were recruited by 99 obstetricians in private practice and enrolled in a prospective cohort study. A follow-up took place at birth. Women younger than 18 years, who had undergone fertility treatments or were diagnosed with infectious diseases, were excluded from the study. A subgroup of 906 participants in whom progesterone had been measured was then selected retrospectively based on the following criteria: no miscarriages, elective abortions or pregnancy complications, infections or multiple births. Data from the follow-up were available for 623 women, who were included in the analyses.PARTICIPANTS/MATERIALS, SETTING, METHODS: The study was coordinated at the Charité University Medicine in Berlin, Germany. Anthropometric, medical and psychosocial information were collected and serum progesterone and estradiol levels were measured in women during the first trimester of pregnancy, followed by the documentation of the pregnancy outcome at birth. Univariable and multivariable regression analyses were performed to identify maternal markers, among them progesterone, affecting birthweight and to determine environmental and maternal factors that are associated with maternal progesterone levels during pregnancy.MAIN RESULTS AND THE ROLE OF CHANCE: In the multivariable regression model, each increase in maternal progesterone by 1 ng/ml during the first trimester increased girls' birthweight by 10.17 g (95% CI: 2.03-18.31 g). If the mother carried a boy, maternal smoking and perceived worries during early pregnancy predicted a reduced birthweight, irrespective of progesterone levels. Maternal body mass index over 25 and maternal age <21 years significantly correlated with the reduced levels of progesterone. Correlations between environmental challenges and maternal progesterone did not reach levels of significance. Since the analyses were exploratory, the likelihood that results may be due to chance is increased.LIMITATIONS, REASONS FOR CAUTION: Due to the exploratory nature of the analyses, results need to be independently confirmed in a larger sample. Furthermore, our findings pertain to pregnant women without pregnancy complications or fertility treatments.WIDER IMPLICATIONS OF THE FINDINGS: Maternal progesterone during early pregnancy is an indicator of subsequent fetal development in female children. Future studies should confirm this relationship and determine whether maternal progesterone is a useful tool in predicting pregnancies at risk resulting in the birth of a girl with low birthweight. Detailed identification of environmental factors modulating maternal progesterone levels should be addressed in future studies.STUDY FUNDING/POTENTIAL COMPETING INTERESTS: Financial support was provided by the Alexander von Humboldt Foundation, Excellence Initiative of the Hamburg Foundation for Research and the Association for Prevention and Information for Allergy and Asthma (Pina e.V.). The authors have no conflict of interest.
KW - Adult
KW - Germany
KW - Humans
KW - Male
KW - Female
KW - Adolescent
KW - Young Adult
KW - Prospective Studies
KW - Cohort Studies
KW - Follow-Up Studies
KW - Retrospective Studies
KW - Pregnancy
KW - Models, Biological
KW - Biological Markers/blood
KW - Pregnancy Trimester, First
KW - Birth Weight
KW - Down-Regulation
KW - Embryonic Development
KW - Progesterone/blood
KW - Sex Determination Processes
KW - Adult
KW - Germany
KW - Humans
KW - Male
KW - Female
KW - Adolescent
KW - Young Adult
KW - Prospective Studies
KW - Cohort Studies
KW - Follow-Up Studies
KW - Retrospective Studies
KW - Pregnancy
KW - Models, Biological
KW - Biological Markers/blood
KW - Pregnancy Trimester, First
KW - Birth Weight
KW - Down-Regulation
KW - Embryonic Development
KW - Progesterone/blood
KW - Sex Determination Processes
U2 - 10.1093/humrep/des367
DO - 10.1093/humrep/des367
M3 - SCORING: Journal article
C2 - 23049076
VL - 28
SP - 77
EP - 86
JO - HUM REPROD
JF - HUM REPROD
SN - 0268-1161
IS - 1
M1 - 1
ER -