title: Helicobacter pylori colonization and pregnancies complicated by preeclampsia, spontaneous prematurity, and small for gestational age birth.
abstract: BACKGROUND
  Preeclampsia (PE), small for gestational age (SGA), and spontaneous preterm birth (PTB) each may be complications of impaired placental function in pregnancy. Although their exact pathogenesis is still unknown, certain infectious agents seem to play a role. Helicobacter pylori (H. pylori) colonization has been associated with increased risk for PE. Our aim was to assess the association between H. pylori colonization and PE, SGA, and PTB.
  
  
  METHODS
  We measured IgG anti-H. pylori and CagA antibodies in serum of pregnant women (median 20.5 weeks, range 16.5-29.4) who participated in a population-based prospective cohort study. Delivery and medical records were assessed. Information on demographics, education, and maternal risk factors was collected by questionnaire. We used multivariate logistic regression analyses to assess associations between H. pylori colonization and PE, SGA, and PTB.
  
  
  RESULTS
  In total, 6348 pregnant women were assessed. H. pylori positivity was found in 2915 (46%) women, of whom 1023 (35%) also were CagA-positive. Pregnancy was complicated by PE, SGA, or PTB in 927 (15%) women. H. pylori colonization was associated with PE (aOR 1.51; 95%CI 1.03-2.25). Differentiation according to CagA status revealed the same risk. H. pylori was positively related with SGA, mainly explained by CagA-positive strains (aOR 1.34; 1.04-1.71). No association was observed between H. pylori and PTB.
  
  
  CONCLUSIONS
  Our data suggest that H. pylori colonization may be a risk factor for PE and SGA. If these associations are confirmed by future studies and shown to be causal, H. pylori eradication may reduce related perinatal morbidity and mortality.
authors: Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.
authors: Wouter J
authors: WJ
authors: den Hollander
authors: Department of Obstetrics and Gynecology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.
authors: Sarah
authors: S
authors: Schalekamp-Timmermans
authors: Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.
authors: I Lisanne
authors: IL
authors: Holster
authors: Department of Pediatrics, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.|Department of Epidemiology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.
authors: Vincent W
authors: VW
authors: Jaddoe
authors: Department of Epidemiology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.
authors: Albert
authors: A
authors: Hofman
authors: Department of Pediatrics, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.
authors: Henriëtte A
authors: HA
authors: Moll
authors: Department of Medicine and Microbiology, New York Langone Medicine Center, New York, NY, USA.
authors: Guillermo I
authors: GI
authors: Perez-Perez
authors: Department of Medicine and Microbiology, New York Langone Medicine Center, New York, NY, USA.
authors: Martin J
authors: MJ
authors: Blaser
authors: Department of Obstetrics and Gynecology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.
authors: Eric A P
authors: EA
authors: Steegers
authors: Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.|Department of Internal Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.
authors: Ernst J
authors: EJ
authors: Kuipers
mesh_terms: D000328:Adult; D000907:Antibodies, Bacterial / Q000097:blood; D005260:Female; D016481:Helicobacter Infections / Q000150:complications*; D016480:Helicobacter pylori / Q000276:immunology; D006801:Humans; D007236:Infant, Small for Gestational Age; D011225:Pre-Eclampsia / Q000453:epidemiology*; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D000907:Antibodies, Bacterial
keywords: Helicobacter pylori colonization; preeclampsia; small for gestational age; spontaneous preterm birth; virulence factor CagA