森山 佳則

The growing recognition of the importance of interpregnancy weight management in reducing hypertensive disorders of pregnancy (HDP) underscores the importance of effective preventive strategies. However, developing effective systems remains a challenge. We aimed to bridge this gap by constructing a prediction model. This study retrospectively analyzed the data of 1746 women who underwent two childbirths across 14 medical facilities, including both tertiary and primary facilities. Data from 2009 to 2019 were used to create a derivation cohort (n = 1746). A separate temporal-validation cohort was constructed by adding data between 2020 and 2024 (n = 365). Furthermore, the external-validation cohort was constructed using the data from another tertiary center between 2017 and 2023 (n = 340). We constructed a prediction model for HDP development in the second pregnancy by applying logistic regression analysis using 5 primary clinical information: maternal age, pre-pregnancy body mass index, and HDP history; and pregnancy interval and weight change velocity between pregnancies. Model performance was assessed across all three cohorts. HDP in the second pregnancy occurred 7.3% in the derivation, 10.1% in the temporal-validation, and 7.9% in the external-validation cohorts. This model demonstrated strong discrimination, with c-statistics of 0.86, 0.88, and 0.86 for the respective cohorts. Precision-recall area under the curve values were 0.90, 0.85, and 0.91, respectively. Calibration showed favorable intercepts (-0.02 to -0.00) and slopes (0.96-1.02) for all cohorts. In conclusion, this externally validated model offers a robust basis for personalized interpregnancy weight management goals for women planning future pregnancies.

AIM: Prenatal maternal depression is known to affect the neurodevelopment of offspring. This study aimed to investigate the profile of umbilical cord serum in mothers with major depressive disorder (MDD). METHODS: Liquid chromatography-tandem mass spectrometry (LC-MS) was conducted using umbilical cord serum from mothers with MDD (n = 5) and controls (control, n = 5). The levels of several differentially expressed proteins in umbilical cord serum were compared between the MDD (n = 10) and control groups (n = 10) by enzyme-linked immunosorbent assay. RESULTS: The proteomic profiles in the umbilical cord serum were different between the MDD and control groups, including the pathways of regulation of plasma lipoprotein particle levels, and synapse organization. Only apolipoprotein A4 (APOA4) was significantly higher in the cord blood of MDD group. APOA4 levels in maternal serum were also significantly higher in the MDD group than those in the control group. The APOA4 levels in the umbilical cord serum were higher than that in the maternal serum. CONCLUSIONS: The levels of APOA4, a biomarker of depression, in the umbilical cord serum at birth were elevated in the neonates of MDD mothers. It is, therefore, likely that fetuses of MDD mothers were exposed to higher APOA4 levels in utero and this could have developmental and mental health implications for the offspring.