Objective: Increased rates of pro-inflammatory and metabolic-related disorders, plus perinatal death and other pregnancy complications such as gestational diabetes (GDM), are consistently reported among women of Indian ethnicity. This study compares lipid profiles and early pregnancy biomarkers associated with metabolic dysfunction between healthy nulliparous pregnant women of Indian and European ethnicity. Design: a prospective cohort study. Setting: Australia, Ireland, New Zealand and the United Kingdom; 2004-2011. Population: 138 and 5,240 women of Indian and European ethnicity were included from the prospective Screening for Pregnancy Endpoints cohort study. Methods: Early pregnancy biomarkers were selected a priori on the basis of a potential association with the metabolic syndrome, diabetes/GDM or obesity, and compared between ethnic groups. Biomarkers that differed significantly between ethnic groups were adjusted for maternal age, body mass index, smoking, alcohol use and socioeconomic status. Main outcome measures: Mean values for 21 placental, metabolic, inflammatory and cardiovascular biomarkers, plus blood lipids, measured at 15±1 weeks gestation. Results: Ten biomarkers were significantly different by ethnicity, mostly consistent with a pro-inflammatory and less favourable metabolic profile in Indian women: PlGF (p=0.02), adiponectin (p<0.01), NGAL (p<0.01), TNFR1A (p<0.01), CXCL10 (p=0.01), ICAM-1 (p<0.01), ST2 (p<0.01), angiogenin (p<0.01), and proANP (p<0.01). We additionally found increased triglycerides (1.6±0.6 vs 1.5±0.6, p<0.01) and reduced HDL cholesterol (1.7±0.4 vs 1.9±04, p<0.01) in Indian mothers, compared with European. Conclusions: Low-risk mothers of Indian ethnicity have an overall less favourable metabolic health profile at early gestation compared with European women. Future research should investigate the association with pregnancy outcomes.

Background: Offspring size at birth is known to be associated with maternal cardiovascular disease (CVD) risk. Low birthweight (LBW), small for gestational age (SGA) and intrauterine growth restriction (IUGR) are all used to define infants considered small at birth. Objectives: To determine whether women who give birth to SGA/LBW/IUGR infants have higher levels of cardio-metabolic risk factors compared to women who give birth to average for gestational age infants or women. Search strategy: We performed a systematic literature search using PubMed, Embase and CINAHL. Selection criteria: Studies that compared cardio-metabolic risk factors in women who gave birth to SGA/LBW/IUGR infants compared to a control group. Data collection and analysis: Two independent authors screened and extracted data. Meta-analysis was performed on Review Manager 5.3. Main results: The meta-analysis showed a significantly increased CVD mortality among women who gave birth to SGA infants compared to AGA infants (relative risk 1.45, 95% confidence interval (CI) 1.40 to 1.52; 2,584,533 participants, three studies; heterogeneity: Chi2 P=0.48; I2=0%). Women who gave birth to growth restricted infants had significantly higher mean BMI (1.72kg/m2, 95% CI 0.97 to 2.47; 77 participants, two studies; heterogeneity: Chi2 P=0.35; I2=0%), and higher total mean cholesterol levels (0.32mmol/l, 95% CI 0.13 to 0.50; 77 participants, two studies; heterogeneity: Chi2 P=0.69; I2=0%) compared to women who had uncomplicated pregnancies. Conclusions: Women who give birth to small infants are at increased risk of CVD. Postpartum screening for CVD risk factors will help identify those at risk.

Abstract Objective To evaluate the safety of maternal pertussis vaccination on pregnancy and birth outcomes. Design Prospective, multicentre cohort study. Setting Two major materiality hospitals in South Australia. Population A total of 1364 low-risk nulliparous women with a singleton pregnancy recruited at 9–16 weeks’ gestation between 2015 to 2018. Methods Participants were followed prospectively, with vaccination (confirmed by medical records), extensive amounts of pregnancy and birth outcome data collected by research midwives. Adjusted relative risks (aRRs) and hazard ratios (aHRs) were estimated accounting for time-varying vaccine exposure and the temporal nature of each outcome. Main Outcome Measures Pregnancy and birth outcomes. Results Of the 1272 women included in this study, 80.1% (n=1019) received maternal pertussis vaccination. Vaccinated women had an average 0.22 weeks (95% CI 0.001, 0.44) longer gestation at delivery compared to unvaccinated women. Maternal pertussis vaccination was not associated with chorioamnionitis (aRR 0.71, 95% CI 0.27,1.82), gestational hypertension (aHR 1.24, 95% CI, 0.66, 2.30), preeclampsia (aHR 0.75, 95% CI 0.47, 1.18) nor preterm birth (aHR 0.99, 95% CI 0.47, 2.07). Neither risk of low birth weight (aHR 0.72, 95% CI 0.41, 1.27) nor small for gestational age infants (aHR 0.67,95% CI 0.29, 1.55) were increased following maternal pertussis vaccination. No associations between pertussis vaccination during pregnancy and adverse birth outcomes including admission to the neonatal care unit, low Apgar scores, and mechanical ventilation were observed. Conclusions Our study provides reassuring evidence of the safety of maternal pertussis vaccination with no increased risk of adverse pregnancy and birth outcomes.