Anita C J Ravelli | University of Amsterdam (original) (raw)

Papers by Anita C J Ravelli

American Journal of Obstetrics and Gynecology

Pregnancy Hypertension, 2022

OBJECTIVES To describe the cardiovascular mortality (CVM) risk in women after twin versus singlet... more OBJECTIVES To describe the cardiovascular mortality (CVM) risk in women after twin versus singleton pregnancies complicated by hypertensive disorders of pregnancy (HDP). STUDY DESIGN Retrospective cohort study of nulliparous women with a twin or singleton pregnancy who delivered in the Netherlands between 1995 and 2015. We used data of the Perinatal Registry of the Netherlands and data of the National Death Registry to determine baseline data, the occurrence of HDP and CVM. In the two main analyses we compared twin pregnancies complicated by HDP to 1) singleton pregnancies complicated by HDP and 2) uncomplicated twin pregnancies (i.e. without HDP) of women who delivered within a hospital setting. MAIN OUTCOME MEASURES CVM risk using cox-proportional hazard models, adjusted for maternal age (aHR). RESULTS 1,243,231 nulliparous women were included, of which 30,623 (2.5%) had a twin and 1,212,608 (97.5%) had a singleton pregnancy. A total of 9,853 (32.2%) twin pregnancies were complicated by HDP, versus 249,141 (20.6%) singleton pregnancies (p < 0.0001). Within the HDP twin cohort, 14/73 (19.2%) maternal deaths were due to cardiovascular causes, versus 335/1,788 (18.7%) in the HDP singleton cohort and 10/117 (8.6%) in the uncomplicated twin cohort. The corresponding aHR was 2.85 (95% CI 1.26-6.41; p = 0.01) for the HDP twin versus the uncomplicated twin cohort, and 1.05 (95% CI 0.62-1.80; p = 0.85) for the HDP twin versus the HDP singleton cohort. CONCLUSIONS Women after both twin and singleton pregnancies complicated by HDP are at a similarly increased risk of CVM later in life.

Chronic diseases are the main public health problem in Western countries. There are indications t... more Chronic diseases are the main public health problem in Western countries. There are indications that these diseases originate in the womb. It is thought that undernutrition of the fetus during critical periods of development would lead to adaptations in the structure and physiology of the fetal body, and thereby increase the risk of diseases in later life. The Dutch famine—though a historical disaster—provides a unique opportunity to study effects of undernutrition during gestation in humans. This thesis describes the effects of prenatal exposure to the Dutch famine on health in later life. We found indications that undernutrition during gestation affects health in later life. The effects on undernutrition, however, depend upon its timing during gestation and the organs and systems developing during that critical time window. Furthermore, our findings suggest that maternal malnutrition during gestation may permanently affect adult health without affecting the size of the baby at bir...

Journal of Perinatology, 2021

To study the impact of fetal gender on the risk of spontaneous preterm birth in various ethniciti... more To study the impact of fetal gender on the risk of spontaneous preterm birth in various ethnicities. National cohort study in which all singleton live births from 25+0 weeks onwards without congenital anomalies were included of African, Asian, and Mediterranean women (1999–2010). Our primary outcome measure was preterm birth before 37 weeks. Per ethnic group, male and female neonates were compared. In each ethnic group, male fetuses were at increased risk of preterm birth (adjusted odds ratio (aOR) 1.63 for African, aOR 1.71 for Asian, and aOR 1.84 for Mediterranean males). The population-attributable risk of male gender on spontaneous preterm birth is lower in African women (3.9%) than in Asian (10.3%) and Mediterranean women (9.0%). Male fetal gender is associated with spontaneous preterm birth in African, Asian, and Mediterranean women, but the total impact of ethnicity on spontaneous preterm birth rate is different.

The Journal of Maternal-Fetal & Neonatal Medicine, 2019

Objective Studies on the optimal mode of delivery in women with a twin pregnancy < 32 weeks are s... more Objective Studies on the optimal mode of delivery in women with a twin pregnancy < 32 weeks are scarce. We studied the effects of the mode of delivery on perinatal and maternal outcomes in very preterm twin pregnancy. Design and Setting Population-based cohort study including all women with twin pregnancy who delivered very preterm (26-32 weeks of gestation) in the Netherlands between January 2000 and December 2010. Methods We compared perinatal mortality and neonatal and maternal morbidity according to the intended mode of delivery as well as to the actual mode of delivery. Perinatal outcomes were paired taking into account the dependency between the children of the same twin pregnancy and were also analysed for each child separately. We used logistic regression to correct for possible confounding factors. Results Perinatal mortality was significantly higher in planned caesarean section 22/212 (10.4%) as compared to planned vaginal delivery 94/1443 (6.5%) (aOR 2.5; 95% CI 1.5-4.2) in the whole study population. The same applied for perinatal morbidity 140/212 (66.0%) versus 905/1443 (62.7%) (aOR 1.5; 95% CI 1.1-2.0),maternal morbidity 36/212 (17.0%) versus 71/1443 (4.9%), (aOR 4.0; 95% CI 2.6-6.3) and for perinatal mortality for the second twin 15/212 (7.1%) versus51/1443 (3.5%) (aOR 2.9; 95% CI 1.7-5.2). Conclusion In very preterm delivery of twins a policy of planned caesarean section increases perinatal mortality and neonatal and maternal morbidity.

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Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health, 2015

Current literature suggests that early and late onset preeclampsia should be treated as distinct ... more Current literature suggests that early and late onset preeclampsia should be treated as distinct entities and that early onset preeclampsia shares pathophysiology aspects with intrauterine growth restriction. Our objective was to investigate whether 5th percentile small for gestational age (SGA) in a 1st pregnancy increases 2nd pregnancy risk of early and late onset preeclampsia, and vice versa. We studied a cohort of 1st and 2nd singleton pregnancies of 262.934 women from the Dutch Perinatal Registry who gave birth between 2000 and 2007. We analyzed 2nd pregnancy risk of SGA, early and late onset preeclampsia using logistic regression considering in each case the absence of the outcome in the first pregnancy. Gestational age, maternal age, iatrogenic preterm birth, chronic hypertension, max diastolic pressure, diabetes, ethnicity and socioeconomic status were adjusted for. In women without 1st pregnancy preeclampsia, prevalences of early and late onset preeclampsia in the 2nd pregnancy were 0.05% and 0.6%, respectively. SGA in the 1st pregnancy increased these prevalences to 0.1% and 1.1%. After adjustment for confounders, 2nd pregnancy late onset preeclampsia risk was increased (aOR 1.3; 95% CI 1.1-1.6) due to SGA in the 1st pregnancy but early onset preeclampsia did not increase (aOR 1.3; 95% 0.7-2.3). In women that did not present SGA in the 1st pregnancy, SGA prevalence in term 2nd pregnancies was 3.3%. Prevalence was higher in women who presented 1st pregnancy late and early preeclampsia: 5.4% (aOR 1.6; 95% CI 1.4-1.9) and 10.2% (aOR 3.2; 95% CI 2.5-4.0), respectively. In the absence of preeclampsia in the 1st pregnancy, SGA increased late but not early onset 2nd pregnancy preeclampsia risks. Second pregnancy SGA risk was increased by preeclampsia in the 1st pregnancy, especially in early onset cases. T.P. Bernardes: None. B.W. Mol: None. A.C. Ravelli: None. P.P. van den Berg: None. R.P. Stolk: None. H. Groen: None.

American Journal of Perinatology, 2009

Progesterone treatment has proven to be effective in preventing recurrent preterm birth. The use ... more Progesterone treatment has proven to be effective in preventing recurrent preterm birth. The use of progesterone varies widely between different obstetric clinics in the Netherlands. The study aimed to identify factors that hamper or facilitate the use of progesterone to create an implementation strategy. A Web-based survey was developed containing questions on socio-political factors, organizational factors, knowledge, and attitude. This survey was spread among 212 gynecologists, 203 midwives, and 130 women with a recent preterm birth. Response rates were 46% for gynecologists, 57% for midwives, and 78% for patients. Twenty-five percent of gynecologists were prescribing progesterone, 21% of midwives would recommend progesterone, and 54% of patients were willing to undergo treatment in future pregnancies. Specific factors hampering implementation for gynecologists were working in nonteaching hospitals and absence of progesterone treatment in local protocols. For midwives and patients, unfamiliarity with progesterone was the most notable finding. The major reason for failure of implementation of progesterone treatment to prevent recurrent preterm birth is absence of this treatment in protocols and lack of familiarity with this treatment in midwives and patients. This may be overcome through adjustment of clinical protocols on regional and national levels.

American Journal of Obstetrics and Gynecology, 2013

To evaluate whether racial/ethnic disparities exist in adverse obstetric outcomes and in the prov... more To evaluate whether racial/ethnic disparities exist in adverse obstetric outcomes and in the provision of obstetric care, and if so, whether these disparities are explained by differences in patient or hospital characteristics. STUDY DESIGN: We analyzed data abstracted concurrently from deliveries on 365 randomly selected days at 25 hospitals over a 3-year period. Race/ethnicity was categorized as Non-Hispanic White (NHW), Non-Hispanic Black (NHB), Hispanic, or Asian. Associations between race/ethnicity and postpartum hemorrhage (PPH), peripartum infection (INF), and severe perineal laceration (LAC) at SVD were estimated by univariable analysis, and after controlling for demographic differences among racial/ethnic groups and for hospital of delivery in fixed effects logistic regressions. Similarly, associations between race/ethnicity and types of obstetric care (eg, episiotomy) relevant to the adverse outcomes were compared in both univariable and multivariable analyses. RESULTS: Of 115,502 studied women, 95% were classified according to one of the defined race/ethnicity categories. Disparities for all outcomes were observed, with NHW women least likely to experience PPH or INF, and NHB women least likely to experience LAC (Table, P Ͻ 0.001 for all). These disparities persisted after controlling for differences in demographic characteristics as well as hospital of delivery. Every aspect of obstetric care that was examined also was significantly different according to race/ethnicity (Table, P Ͻ .001 for all), even after controlling for demographic characteristics and hospital of delivery. There were no significant interactions between race/ethnicity and hospital of delivery. CONCLUSION: Racial/ethnic disparities exist for adverse obstetric outcomes and in the provision of obstetric care, and do not appear to be explained by differences in demographic characteristics or by delivery hospital.

American Journal of Obstetrics and Gynecology, 2016

non-discordant (n¼49), with gestational age at delivery of 35w (p¼N.S.). No BW discordancy was se... more non-discordant (n¼49), with gestational age at delivery of 35w (p¼N.S.). No BW discordancy was seen in group II. No significant differences in NRBCs, Platelets, or S/D ratios were found in group II. See table for group I results. CONCLUSION: Our results indicate that birth weight discordance in NICU admitted DiDi twins is not a normal variant. When BW discordance is as low as 15%, the smaller twin faces a significant increased placental impedance (reflected by an increased S/D ratio) and its compensatory mechanisms include a significant increase in NRBCs combined with a significant decrease in platelets. Non Discordant Discordant Small Large P-value Small Large P-value S/D %tile (median) 53 52 .288 60 46 .008 NRBC/100WBC

International Journal of Environmental Health Research, 2021

This paper describes the findings of a historical cohort study of men and women born around the t... more This paper describes the findings of a historical cohort study of men and women born around the time of the Dutch famine 1944-45. It provided the first direct evidence in humans of the lasting consequences of prenatal undernutrition. The effects of undernutrition depended on its timing during gestation, and the organs and tissues undergoing periods of rapid development at that time. Early gestation appeared to be particularly critical, with the effects of undernutrition being most apparent, even without reductions in size at birth. Undernutrition during gestation affected the structure and function of organs and tissues, altered behaviour and increased risks of chronic degenerative diseases. This demonstrates the fundamental importance of maternal nutrition during gestation as the building blocks for future health.

American Journal of Obstetrics and Gynecology, 2021