1st Trimester Of Pregnancy Research Articles

COVID-19 PANDEMIC EFFECT ON EARLY PREGNANCY – ARE MISCARRIAGE RATES ALTERED, IN ASYMPTOMATIC WOMEN?

To evaluate the effect of the COVID-19 pandemic state on early, 1st trimester pregnancies, in light of a link described between war-induced stress and adverse pregnancy outcomes. Retrospective cohort study conducted in a University fertility center. All 1ST trimester viability scans done since the COVID-19 shut down, March13-May 6, 2020 (Study group), and between March 1-May 17, 2019 (pre-pandemic Control), were reviewed. Early 1st trimester pregnancy outcomes (Viable pregnancy, Arrested pregnancy including biochemical pregnancy loss and miscarriage, and ectopic pregnancy (EP)) were measured. A multivariate analysis was performed to control for significant confounders. Power analysis revealed that a sample size of 58 patients per group has a 90% power with a 15% difference in outcomes and α=5%. The study group denied symptoms of COVID-19. 113 women were scanned in the study, and 172 in the control periods (5-11 weeks gestational age). The groups had similar demographics, gestational history, fertility diagnosis and treatment characteristics (Table). No significant differences were noted in the rate of recurrent pregnancy loss (RPL). Viable clinical pregnancy rates were not different between the groups (76.1% vs. 80.2% in the pandemic and pre-pandemic groups p= 0.41). No significant difference was seen in number of 1st trimester miscarriage (14.2% vs 12.8% p=0.76), biochemical pregnancies (3.5% vs 1.7% p=0.34), or in total miscarriage rate (22.1% vs 16.9% p=0.32), nor in EP rates (0.9% vs 2.3% p=0.36) Mean serum TSH levels were higher in the control but fell in the normal range for both groups. Use of donor sperm was higher in the control and may have favored lower miscarriage rates in that group. The COVID-19 pandemic environment does not seem to affect early first-trimester miscarriage rates in asymptomatic patients.Tabled 1CharacteristicStudy(n=113)Pre-pandemic Control (n=172)P-valueFemale Age, Years, mean±SD36.5 ± 4.537.2 ± 5.40.28RPL History, N(%)15 (13.3)15 (8.7)0.22Fertility diagnosis, N(%)Unexplained24 (21.4)32 (19.6)0.21Male Factor36 (32.1)58 (35.6)Tubal factor5 (4.5)11 (6.8)Polycystic ovarian syndrome21 (18.8)25 (15.3)Decreased ovarian reserve23 (20.5)20 (12.3)Endometriosis1 (0.9)4 (2.5)Base line testing, median(IQR)AMH ng/ml2.5 (1.0 – 4.4)2.5 (1.2 – 5.4)0.75TSH mIU/L1.3 (0.9 – 1.8)1.7 (1.2 – 2.3)0.001Antral follicular count (AFC)16 (9 – 29)14 (9 – 25)0.27Total motile sperm count, median(IQR)18 (6 – 43)12 (5 – 47)0.23Sperm donation, N (%)2 (1.8)17 (9.9)0.01Pregnancy, N (%)Spontaneous34 (30.1)54 (31.4)0.97IUI34 (30.1)51 (29.7)IVF45 (39.8)67 (38.9)ICSI (percentage of IVF patients)31 (79.5)52 (77.6)0.82Blastocyst transferred39 (86.7)56 (83.6)0.65 Open table in a new tab

Effect of prenatal exposure to per- and polyfluoroalkyl substances on childhood allergies and common infectious diseases in children up to age 7 years: The Hokkaido study on environment and children's health

Per- and polyfluoroalkyl substances (PFAS) are widely used bio-accumulative chemicals in many industrial and household products. Experimental studies reported that exposure to PFAS results in immunotoxicity. We have previously reported that prenatal exposure to PFAS decreased the risk of allergies, while it increased the risk of infectious diseases at ages 2 and 4 years. However, it remains unclear whether the adverse effects of PFAS on allergies and infectious diseases continue until a reliable age of diagnosing allergies. This study aimed at investigating the effects of prenatal exposure to PFAS on the prevalence of allergies and infectious diseases in children up to age 7, from the Hokkaido Study.Among mother-child pairs enrolled in the Hokkaido study and followed up until the age of 7 years, 2689 participants with maternal PFAS, 1st trimester of pregnancy and 7-year-old questionnaire survey data were included in this study. Eleven PFAS in the 3rd-trimester plasma were measured using ultra-performance liquid chromatography coupled to triple quadrupole tandem mass spectrometry. Wheeze, rhino-conjunctivitis, and eczema were defined using the International Study of Asthma and Allergies on Childhood (ISAAC) questionnaire. History childhood infectious diseases diagnosed by a doctor was assessed by a mother-reported questionnaire at child’s age 7. The relative risk of childhood allergies was calculated by generalized estimating equation models. The odds ratio of an episode of infectious diseases was calculated by logistic regression analysis, adjusted for potential confounders.The prevalence of various allergies and infectious diseases was: wheeze, 11.9%; rhino-conjunctivitis, 11.3%; eczema, 21.0%; chickenpox, 61.5%; otitis media, 55.7%; pneumonia, 30.6%; and respiratory syncytial virus infection, 16.8%. Prenatal exposure to perfluorooctanoic acid, perfluorodecanoic acid (PFDA), and perfluoroundecanoic acid (PFUnDA) was inversely associated with rhino-conjunctivitis, while that for perfluorooctanoate (PFOA), perfluorooctane sulfonate, PFUnDA, perfluorododecanoic acid (PFDoDA), and perfluorotridecanoic acid was inversely associated with eczema. For infectious diseases, PFDA and PFDoDA were associated with increased risk of pneumonia and PFOA was associated with increased risk of RSV infection among children not having any siblings (only-one-child).Our results corroborate the hypothesis on immunosuppressive and immunomodulating effects of PFAS on allergies and infectious diseases in children. These effects observed previously at 2 and 4 years continued until the age of 7 years. However, additional studies assessing inflammatory biomarkers along with ISAAC questionnaires, doctor-diagnosed allergies, and longer follow-ups are necessary to better assess the effects of exposure to chemicals on human immune outcomes.

Sleep Problems in Pregnancy—A Cross-Sectional Study in over 7000 Pregnant Women in Poland

The aim was to characterize sleep patterns in pregnant women in Poland and to analyze the relation between sociodemographic factors, pregnancy-related physical symptoms and sleep problems. A self-composed questionnaire, containing questions in Polish language, was distributed online via web pages and Facebook groups designed for pregnant women. The questionnaire included questions regarding sociodemographic data and information on the current pregnancy and sleep patterns over the past four weeks. Exactly 7207 respondents were included to the study. 77.09% reported sleep problems: nocturnal awakening (52.77%), sleep onset insomnia (20.23%), awakening too early (18.56%) and believed their sleep was too shallow (9.82%). Sleep onset insomnia (26.38%) and frequent awakening (62.88%) were most often reported in 3rd trimester, while daytime drowsiness (86.35%) and naps impeding daytime function (27.18%) in the 1st trimester of pregnancy. The analyzed demographic, socioeconomic and psychological issues had a small but significant influence on sleep problems occurrence (aOR 0.81–1.24). Time to conceive from 6 to 12 months of trying increased the risk of developing sleep problems during pregnancy (aOR 1.31). Pregnancy ailments increased the risk of sleep disturbances (aOR 1.53–2.59). Sleep disorders are prevalent among pregnant women in Poland. The evaluation of risk factors is essential in proper screening for sleep disorders in pregnant women.

Про можливість таргетної профілактики кальцитріол-асоційованих ускладнень вагітності на доклінічному етапі

According to recent studies, in the vitamin D deficiency state (VDD), pregnancy can be complicated and the optimal level of VD in the blood is one of the conditions for the realization of reproductive potential. The objective: the possibility to preventing calcitriol-associated pregnancy complications by the correcting VD deficiency at the preconception period. Materials and methods. 57 women with VDD were examined. A history of all women had a pregnancy complicated by placental dysfunction (PD); 27 of them were observed from the preconception period (main group – IA) and 30 – from the 1st trimester of pregnancy (comparison group – IB). The VD status by the blood level of the 25-hydroxyvitamin D by ELISA was determined. Women of both groups, in addition to the vitamin-mineral complex (VMC) were prescribed supplementation colecalciferol at a dose of 4.000 IU per day. Pregnant women of both groups received VMCs up to 16 weeks. After optimizing the level (3–4 months), women continued to take VD at a dose of 2.000 IU per day throughout pregnancy. Results. At the initial study, the VD level was 15.72±2.59 ng/ml in ІА and 16.1±1.99 ng/ml in ІВ group (U=883; p>0.05); after treatment increased to 38.31±3.29 ng/ml and 36.13±2.99 ng/ml (U=900; p>0.05). In group IA, the course of pregnancy was characterized by a lower frequency of complications: PD was diagnosed in 22.2% in group IA and 50% in group IB (F=0.0001; p<0.01); fetal distress in 3.7% and 10% (F=0.16; p<0.05): signs of amnionitis – in 18.5% and 33.3% (F=0.035; p<0.05); placental hypertrophy or hypotrophy – in 7.4% and 36.7% (F=0.00001; p<0.01), preeclampsia in 3.7% and 6.7% of women (F=0,54; p<0.05). The frequency of cesarean section in the comparison group was significantly higher (40% VS 25.9%, F=0.034; p<0.05). Conclusions. During pregnancy, which occurred in conditions of VDD, the frequency of some pregnancy complications, including preeclampsia, the threat of miscarriage, placental dysfunction was in 2–4 times higher than in women with optimized VD status. One of the directions of the individual management plan for women with a negative obstetric history can be the determination of the level of VD in the blood and correction of the VDD at the preconception period. This approach is a pathogenetically substantiated and promising direction for the prevention of some pregnancy complications and improvement of perinatal outcomes. Keywords: pregnancy, deficiency vitamin D, placental dysfunction, preconception period.

Prenatal Dietary Intake and Blood Metal Concentrations During the 1st Trimester of Pregnancy in Project Viva

Abstract Objectives To identify foods associated with blood metal concentrations during the 1st trimester of pregnancy. Methods In early pregnancy (11.3 ± 2.8 gestational week), 1206 women from Project Viva completed food frequency questionnaire and provided a blood sample to measure essential and non-essential metals. This analysis included 135 food items and 14 metals (As, Cd, Hg, Pb, Co, Cu, Mg, Mn, Se, Zn, Ba, Cs, Sb, Sn) in red blood cells (RBC). We perform a diet-wide association study (DWAS) of all bivariate relationships between each food-metal combination. Additionally, we used machine learning models with elastic-net regularization to estimate the % variation in metal concentrations explained by diet. Results Mean (standard deviation [SD]) age was 32.5 (4.5) years and pre-pregnancy BMI was 24.8 (5.4) kg/m2. Most participants were white (76.0%), not current smokers (88.5%), completed a college degree (75.5%), and had a household income >$70 K/year (66.8%). Compared to other US-based cohorts, the overall diet quality of participants was higher, and levels of toxic metals were lower. DWAS identified significant associations between several food items with As, Hg, Pb, Cs and Se; among the positives associations, for example, each SD increase in fresh fruit, white rice, and seafood was associated with 4%, 8%, and 18% higher median concentrations of As, respectively; and fresh fruits (12%), eggs (12%), white rice (15%), green vegetables (17%), and seafood (64%) was associated with Hg. Elastic net models identified significant positive and negative dietary predictors of As, Cs, and Hg, but not other metals. The % variation explained by the selected dietary variables was 21% for As, 7% for Cs, and 11% for Hg. Conclusions DWAS provides systematic evaluation of diet-metal relationship and can uncover potential dietary sources of prenatal metal exposure. In this population, we found positive associations between fruit, green vegetable, white rice and seafood consumption with As and Hg. Prenatal diet may be an important source of metals exposures, including As, Hg, and Cs. Funding Sources This work was supported by the US National Institutes of Health grants R01HD034568, UH3OD023286, U2CES026561and U2CES026555, and metal analysis was conducted by the Children's Health Exposure Analysis Resource (CHEAR award #2017–1740).

Economic Status, Nutrition and Pregnancy Cost; A Vicious Cycle in Pregnancy

Abstract Objectives Despite been in a positive pathway to achieve maternal and child healthcare targets in sustainable development goals, maternal nutrition is a leading public health problem in Sri Lanka. We studied the economic status, pregnancy expenditure and nutritional status of the pregnant mother to explore these associations. Methods The study was carried out in Anuradhapura District, Sri Lanka. Consecutive pregnant women registered in the public health clinics and who was in the 1st trimester of pregnancy were recruited as a part of a large cohort study. Detail evaluation of household income, expenditure and pregnancy costs were assessed together with anthropometric measurements. Results The mean age of the pregnant women (n = 750) was 28.3 years (SD 5.7) and 84.6% of them have not engaged in any income-generating activities. Among the employed group, the majority (58.6%) were in the government sector. Of the 750 pregnant women, 17.3% were underweight (BMI < 18.5). The average household income of the underweight group (USD 237.56) was significantly lower (t = −2.718, P = 0.007) than the others (USD 311.59). There was a significant difference in monthly food cost between underweight and normal mothers (t = −1.774, P = 0.076). The average cost for food of underweight and normal mothers was USD 53.33 (SD 40.07) and USD 60.05 (SD 39.13). In addition, the pregnancy cost of underweight mothers as a fraction of the money available for food was 23.05%. Conclusions Despite having significantly low income and low resources for food, the additional burden of pregnancy cost may be leading to a vicious cycle of undernutrition. More details and context-specific approaches are required to combat nutrition in pregnancy. Funding Sources Accelerating Higher Education Expansion and Development (AHEAD), World Bank.

ROLE OF ULTRASOUND IN PREDICTION OF PREGNANCY OUT COME IN THREATENED ABORTION

Background: Threatened miscarriage constitutes 15–20% of pregnancies and is one of the commonest gynecological emergencies. Previously, the volume of an intrauterine hematoma (IUH) or on the presence of vaginal bleeding was considered but not the location of the hemorrhage. Objective: To predicted pregnancy outcome through sonographic finding in women presenting with symptoms of threatened abortion. Subjects and methods: This was a prospective study held on 300 patients who attended the out-patient clinic or the causality department of Obstetrics &Gynecology, in Tahta general hospital. Patients were with clinical diagnosis of threatened abortion in their 1st trimester of pregnancy, attended to outpatient clinic or causality department, giving a history of bloody vaginal discharge or vaginal bleeding. Results: there were statistically significant difference of mean values of sub trophoblastic arteries RI for the continued group and aborted group in all gestational age. There were statistically significant difference of mean values of sub trophoblastic arteries PI for the continued group and aborted group in all gestational age. Conclusion: CRL and FHR are good sonographic indicators for the prediction of outcome in women with threatened miscarriage. Color Doppler of subtrophoblastic arteries is useful in prediction of pregnancy outcome in threatened abortion .The incidence of maternal and fetal complications increased in cases with threatened miscarriage that completed the pregnancy.

Congenital Zika syndrome: association between the gestational trimester of maternal infection, severity of brain computed tomography findings and microcephaly at birth.

ABSTRACTThis study analyzed possible associations between the trimester of maternal Zika virus infection (ZIKV) in pregnancy, severity of brain computed tomography (CT) findings and the presence of microcephaly at birth in children with Congenital Zika Syndrome (CZS). It was an analytical study in a cohort of children with CZS. Symptoms of maternal infection were dichotomized into the 1st trimester of pregnancy and other trimesters. Head circumference (HC) at birth was used to calculate the z-score. Mild microcephaly was defined as HC between 2 and ≥3 standard deviations (SD) below the mean for each gestational age and sex, and severe microcephaly when HC <3 SD below average. Brain CT images were evaluated by two radiologists and classified, according to the severity, into mild, moderate and severe. Fisher’s exact, Mann-Whitney and Kruskal-Wallis tests were used to verify the associations between variables. In 108 children, maternal infection in the 1st trimester of pregnancy was associated with more severe brain CT abnormalities (p=0.038), greater severity of microcephaly at birth (p=0.013) and lower HC z-scores at birth (p=0.021). The severity of brain CT lesions was also associated with lower HC z-scores at birth (p<0.001). Maternal ZIKV infection during the first trimester of pregnancy proved to be an important risk factor for a more severe spectrum of CZS, as it is associated with more severe brain CT abnormalities and, consequently, with lower HC z-scores at birth.

Status of maternal health care services: An assessment study in slums of Kolkata.

Background and Aims:Mothers constitute an important and priority group in any community due to their high pregnancy related morbidities and mortality. The prevention of pregnancy related complications was possible with proper utilisation of maternal health care services. This study was conducted with the aim of assessing the utilisation of maternal health care services among mothers with younger child aged ≤3 years in slums of Kolkata, West Bengal and to find out the factors associated with it.Methodology:It was a community-based, observational study with cross-sectional design conducted in slums of Kolkata from June 2017 to May 2018. 30 slums [under Kolkata municipal corporation] were selected by cluster sampling technique using probability proportionate to size method. 10 mothers were selected from each slum and a total of 300 mothers were selected for the study. A pre-designed, pre-tested, structured schedule was used for data collection.Results:The mean age of the mothers was 23.83 (±3.64) years with the age ranging from 18 to 35 years. 75.7% mothers were registered in 1st trimester of pregnancy and 100% mothers received ≥4 antenatal check-ups. But only 78% mothers consumed ≥100 IFA tablets and only 23.3% mothers consumed ≥360 calcium tablets in antenatal period. 80.3% of the mothers had unsatisfactory utilisation of maternal health care services. Unsatisfactory utilisation of maternal care services was significantly associated with the younger age of the mothers, a smaller number of pregnancies and teenage marriage.Conclusion:Utilisation maternal health care services was not satisfactory among mothers in slums of Kolkata. Awareness generation and behaviour change communication among mothers is necessary for proper utilisation of the services.

Comparative characteristics of the fetoplacental complex in women with type 1 diabetes and in pregnant women with gestational diabetes

Annotation. In the structure of causes of maternal mortality, extragenital pathology accounts for 25%. Among them, endocrine pathology is 6%, diabetes accounts for 31.9%. 1% of women of childbearing age suffer from type 1 diabetes, and 2–17% has gestational diabetes (GD). The aim is to compare the condition of the fetoplacental complex in the third trimester of pregnancy in 9 pregnant women with type 1 diabetes (group 1) and in 12 women with GD (group 2) who were observed at “Vinnitsa City Clinical Hospital and child” for 2016–2019. The control group included 10 patients with physiological pregnancy. Women with diabetes had a history of gynecological diseases: colpitis (8 patients (88.8%)), cervical erosion (2 (22.2%)), chronic adnexitis (5 (55.5%)). Among the complications of previous pregnancies in the group of patients with diabetes mellitus (5 births) were unauthorized miscarriages (1 (11.1%)), the risk of termination of pregnancy (5 (55%)). In women with a history of GD, colpitis was observed in 3 (24.9%), which is significantly less than in women with type 1 diabetes. There were 2 pregnant women with GD: preterm births (16.6%). Among the complications of pregnancy in 1 patient was the threat of abortion in previous cases. Changes in the indexes of hemodynamics of the uterine-placental complex were evaluated on the basis of cardiotocography, ultrasound on ultrasound machine “Logic-5” with 2D measurement, Doppler, evaluation of the biophysical profile of the fetus (BPF). Statistical data processing was performed by calculating Student coefficients (+) using the Microsoft Excel program. It was established that in the 1st trimester of pregnancy, 5 (55.5%) women with type 1 diabetes were diagnosed with a threat of termination of pregnancy (TTP), and in the 1st (11.1%), they had a retroplacental hematoma. Two (22.2%) women with GD were diagnosed with TTF. In the 2nd trimester, 2 women with GD remained symptomatic of TTF. Six (66.7%) women with type 1 diabetes have symptoms of TTF. In the 1 pregnant woman developed pyelonephritis. Childbirth in 8 (88.8%) women with type 1 diabetes ended through natural birth canal, in 1 woman — a caesarean section. The weight of the child was 4435±2 g. In women with GD the weight of the child was 3756±12. In 7 (77.8%) patients, fetal weight exceeded 4000 g. BPF in the group of patients with diabetes was significantly different from the group with GD at 37–38 weeks of pregnancy. BPF in the 1st group — 7.6±0.2, in the 2nd group — 8.7±0.2, resistance index (RI): 1st group — 0.61±0.01, 2-ha group — 0.57±0.01, CO/K: in the 1st group — 3.2±0.1, in the 2nd group — 3.1±0.1. The correlation between the level of GD compensation and pathological changes in the fetoplacental complex has been established. The data obtained indicate that early screening of this pathology and appropriate compensation for carbohydrate metabolism in the presence of diabetes mellitus should be noted as one of the methods for the prevention of the development of complications in GD.

Comparative assessment of serum level of selenium and iron in 1st trimester of pregnancy with non-pregnant women

Introduction: Pregnancy is dynamic anabolic state in women’s life. During pregnancy women undergo profound hormonal, metabolic and physical changes. Aim of the present study was to compare the serum level of selenium and iron between pregnant and non-pregnant women. Materials and Methods: The present study was carried out in 50 first trimester pregnant women and 50 non pregnant women at tertiary care hospital in Surat, in age group of 30 years and in BMI groups of Blood was collected and serum was analyzed for selenium and iron concentration in atomic absorption spectrophotometry (AAS).We have also measured anthropological parameter like height, weight and based on this BMI calculated. SPSS software used for statistical analysis. Result: There was a significant lower level of serum selenium (p found in 1st trimester pregnant women compared to non-pregnant women. There was a significant decreased in selenium level in all BMI group in pregnant women except in 30 kg/m2 group and there was a decreased in serum iron level in all BMI group in pregnant women compared to non-pregnant women. Conclusion: There was a significant decrease in serum selenium and iron level in 1st trimester of pregnant women com pared to non- pregnant women, which indicate that during pregnancy requirement of trace elements increase to meet demand for fetus growth. A reduction in maternal selenium concentration during pregnancy can lead to various disorders such as miscarriage, premature birth, preeclampsia, pregnancy include hypertension, low birth weight, retinopathy of prematurity etc. Keywords: Selenium, Iron, Atomic absorption spectrophotometry.

Human biomonitoring to evaluate exposure to toxic and essential trace elements during pregnancy. Part A. concentrations in maternal blood, urine and cord blood.

Exposures to toxic elements or deficiencies of essential elements during pregnancy may be associated to various birth complications or even diseases in early life. The aim of this paper was to assess the concentrations of selected toxic (As, Cd, Cr, Hg, Ni, Pb) and essential trace elements (Co, Cu, Mn, Se and Zn) in blood and urine samples of delivering women at different periods of gestation and cord blood, as well as to evaluate the placental permeability for these elements. A total of 53 women participating in the HEALS-EXHES study were enrolled. In particular, 48 blood samples from 1st trimester of pregnancy, 40 blood samples at delivery, and 31 cord blood at delivery were collected. Moreover, mothers’ urine were sampled at the 1st (53 samples), 2nd (53 samples) and 3rd trimester (49 samples) of pregnancy. Results showed that Hg and Mn levels in cord blood were about 2.0 times higher than in maternal blood, suggesting that these elements may be transferred from mother to fetus. The cord blood levels of As and Pb were lower (ca. the 65%) than those in maternal blood, showing that the placenta modulates the rate of transfer for these elements. Essential elements as Cu and Zn showed significantly lower levels in cord than in maternal blood suggesting that the transplacental transfer of these nutrients was very limited. In addition, correlation between paired maternal and cord blood samples for As, Hg and Pb was statistically significant indicating that the fetal body burden may reflect the maternal exposure. Cadmium, Co, Cr, Ni and Se levels did not show significant correlations between maternal and cord blood. Maternal urinary concentrations of trace elements, including As, Cr, Cu, Hg, Se and Zn decreased along pregnancy, which may cause variations in fetal exposure. The levels of toxic and essential elements in maternal blood and urine, as well as in cord blood, were for most elements at the lower end of the ranges found in the scientific literature not being of special concern for pregnant women and the unborn.

Growth pattern of uterine leiomyoma along pregnancy

BackgroundUterine leiomyomas are often discovered during early pregnancy and in most cases will have no effect on pregnancy outcomes. However, in rare cases uterine leiomyomas may lead to obstetric complications. The aim of the study was to evaluate rate of uterine leiomyoma growth in the 3 trimesters of pregnancy.MethodsWe conducted a retrospective cohort study. Included were women who were diagnosed with uterine leiomyoma during pregnancy and had at least two sonographic measurements in different trimesters. Data regarding leiomyoma growth, recorded by ultrasound examination, during 1st 2nd and 3rd trimesters were collected from electronic patient records.ResultsTwo-hundred forty-eight uterine leiomyomas were included in the study. Leiomyoma area increased substantially in size between the 1st and 2nd trimesters (54.5% ± 75.9%, p = .007) and to a lesser degree between the 2nd and 3rd trimesters (17.9% ± 59.7%, NS). Evaluation of the change in size throughout the pregnancy – between 1st and 3rd trimesters revealed a significant increase of 95.9% ± 191.3% (p < .001). There was no significant growth of the leiomyomas between the 2nd and 3rd trimesters.ConclusionsUterine leiomyomas tend to grow substantially during the 1st trimester of pregnancy. This trend is attenuated later with minimal growth towards the end of gestation.

Prenatal exposure to perfluoroalkyl substances, immune-related outcomes, and lung function in children from a Spanish birth cohort study.

Prenatal exposure to perfluoroalkyl substances (PFASs) has been associated with impaired immune and respiratory health during childhood but the evidence is inconsistent and limited for lung function. We studied the association between prenatal PFASs exposure and immune and respiratory health, including lung function, up to age 7 years in the Spanish INMA birth cohort study. We assessed four PFASs in maternal plasma samples collected during the 1st trimester of pregnancy (years: 2003-2008): perfluorohexane sulfonate (PFHxS), perfluorooctane sulfonate (PFOS), perfluorooctanoate (PFOA), and perfluorononanoate (PFNA). Mothers reported the occurrence (yes/no) of lower respiratory tract infections, wheezing, asthma, and eczema in the previous 12 months at 1.5 and 4 years of the child (n = 1188) and at 7 years (n = 1071). At ages 4 (n = 503) and 7 (n = 992) years lung function was assessed using spirometry tests. The most abundant PFASs were PFOS and PFOA (geometric means: 5.80 and 2.31 ng/mL, respectively). The relative risk of asthma during childhood per each doubling in PFNA concentration was 0.74 (95 CI%: 0.57, 0.96). The relative risk of eczema during childhood per every doubling in PFOS concentration was 0.86 (95 CI%: 0.75, 0.98). Higher PFOA concentrations were associated with lower forced vital capacity and lower forced expiratory volume in 1 s z-scores at 4 years [β (95 CI %): -0.17 (-0.34, -0.01) and -0.13 (-0.29, 0.03), respectively], but not at 7 years. This longitudinal study suggests that different PFASs may affect the developing immune and respiratory systems differently. Prenatal exposure to PFNA and PFOS may be associated with reduced risk of respiratory and immune outcomes, particularly asthma and eczema whereas exposure to PFOA may be associated with reduced lung function in young children. These mixed results need to be replicated in follow-up studies at later ages.

Pregnancy-specific anxiety and elective cesarean section in primiparas: A cohort study in China.

The purpose of this study was to investigate the association between pregnancy-specific anxiety and elective cesarean section, and identify the critical period in which pregnancy-specific anxiety will affect the elective cesarean section. Primiparous women in the 1st trimester of pregnancy were invited to participate in the cohort. General information on maternal socio-demographic characteristics and environmental exposure were collected using questionnaires. Pregnancy-specific anxiety was assessed by using pregnancy-specific anxiety questionnaire in the 1st, 2nd and 3rd trimester, respectively. Delivery modes and pregnancy complications were abstracted from medical notes. Structural equation modeling (SEM) was adopted to examine the relationship between pregnancy-specific anxiety and elective cesarean section. Results indicated the overall elective cesarean section rate in this study was 45%. Among 1 874 pregnant women, 30.9% women experienced anxiety at least once during pregnancy, and 6.9% women suffered from anxiety in all three trimesters. Anxiety in the 2nd trimester was a significant predictor for elective cesarean section. Young maternal age and low educational level had indirect effects on women’s choice of elective caesarean section through affecting pregnancy-specific anxiety. More attention should be paid to maternal psychological problems, and professional counseling needs to be strengthened to protect women from pregnancy-specific anxiety.

EARLY FETAL HYDROPIC CHANGES ARE ASSOCIATED WITH MODERATE DILATATION OF THE BRAIN VENTRICULAR SYSTEM: A CLUE TO A POSSIBLE LINK BETWEEN CERVICAL LYMPHATIC ENGORGEMENT AND VENTRICULAR DILATATION?

The aim of this study is to assess whether early cervical lymphatic obstruction is associated with a sonographically detectable dilatation of the ventricular system in the 1st trimester of pregnancy. In particular, the objective is to assess whether fetuses with non-immune hydrops fetalis (NIHF), cystic hygroma, or enlarged nuchal translucency (NT) have a greater atrial width/biparietal diameter (AW/BPD) ratio than normal at time of the combined first trimester screening scan. This retrospective study included 96 first trimester fetuses (33 normal and 63 with various degree of cervical lymphatic engorgement). Inclusion criteria were CRL in the 45-84 mm range and availability of one or more three-dimensional volume datasets of the fetal head, acquired from the BPD plane. Each three-dimensional volume dataset was opened and multiplanar correlation employed to align the three orthogonal planes. The ratio between the atrial width and the BPD (AW/BPD ratio) was used to evaluate the possible presence of increased amount of cerebrospinal fluid. Abnormal cases were placed into 4 categories: 1) enlarged non-septated NT 2.5-3.9 mm, no hydrops; 2) grossly enlarged non-septated NT / edema >3.9 mm; 3) cystic hygroma and/ or NIHF; 4) major anomalies with NT <2.5 mm. Presence of dilatation of the laterocervical jugular lymphatic sacs, karyotype and presence of congenital anomalies were also recorded. The One-way ANOVA test was used to compare means. Intra- and inter-observer variability were also assessed. The AW/BPD ratio was found to be significantly higher in fetuses with grossly enlarged NT/nuchal edema and NIHF/septated cystic hygroma than in normal (p <0.05 and p <0.01, respectively). Also, the AW/BPD ratio was significantly higher in NIHF/septated cystic hygroma than in enlarged NT 2.5-3.9 mm (p <0.05). In case of enlarged NT (2.5-3.9 mm), the AW/BPD ratio is significantly higher in presence of JLS (p <0.01). At the end of the first trimester, presence of cervical lymphatic engorgement, in terms of grossly enlarged NT, nuchal edema, septated cystic hygroma, and NIHF, is statistically associated with a moderate dilatation of the ventricular system. Of note, among fetuses with moderately enlarged NT, those with evidence of dilatation of the JLS show a statistically significant increase in the AW/BPD ratio.

Sexual satisfaction in pregnancy: a cross section study in Japan

Sexuality is one of the most important quality of life issues for both men and women. Sexual dysfunction is a highly prevalent women's sexual response is characterized as highly variable and influenced by a wide range of determinants, including physiologic, psychosocial, and contextual factors. The aim of this study was to assess the sexual satisfaction in pregnant women. This was a cross-sectional study involving 685 Japanese pregnant women aging between17-43 years, who were recruited from January 01, 2012 – January 01, 2014 at the antenatal clinic of Jichi Medical University Hospital. The Female Sexual Function Index (FSFI) questionnaire was used to assess sexual function. Overall, 284/685, 41.45% of the 685 pregnant women were at risk for sexual dysfunction symptoms (FSFI scores ≤26); this rate was significantly higher among pregnant women in 3rd trimester (187/254, 73%; P&lt;0.05). Furthermore, our present study showed that the 3rd trimester of pregnancy had lower mean scores in sexual satisfaction, desire, lubrication, orgasm, arousal and dyspareunia than 1st and 2nd trimester. According to these results, pregnant women in the third trimester of pregnancy have lower female sexual function scores than 2nd and 1st trimester of pregnancy.

The clinical usefulness of biochemical (free β-hCg, PaPP-a) and ultrasound (nuchal translucency) parameters in prenatal screening of trisomy 21 in the first trimester of pregnancy.

The aim of the study was to analyze the correlation of multiples of the normal median of PAPP-A, free β-hCG levels and nuchal translucency values in prenatal, first trimester screening of trisomy 21 in pregnant women. 251 pregnant women underwent antenatal screening at 11-13+6 weeks of pregnancy which was composed of the measurement of free β-human chorionic gonadotropin (β-hCG) and pregnancy-associated plasma protein (PAPP-A) levels in the maternal serum and an ultrasound assessment of nuchal translucency (NT). The pregnant women with a high risk of trisomy 21 (≥ 1:300) were given amniocentesis to verify fetal defects. There were 217 cases of normal fetal karyotype and 34 cases of trisomy 21. PAPP-A, β-hCGMoM and NT values were analyzed for the predefined ranges. 85% cases of trisomy 21 had elevated free β-hCGMoM (> 1.5) and only 53% of these had a PAPP-AMoM result below 0.5 (p < 0.05). Analysis of NT in selected ranges of β-hCG (> 1.5) and PAPP-AMoM (< 0.05), which are typical for Down Syndrome values, showed that not all fetuses with Down Syndrome presented with an increased NT. Respectively 44.15% and 26.5% of fetuses presented with increased NT. Characteristic for trisomy 21, a correlation with all 1st trimester screening tests' parameters occurred in only 23.5% of cases. In 53% of cases the results were atypical. The PAPP-A and β-hCG values in the selected MoM ranges did not shown a correlation to the NT measurement, therefore they are independent factors in the diagnosis of trisomy 21. Simultaneous biochemical and ultrasound testing is an indispensable condition for prenatal diagnosis of trisomy 21 in the 1st trimester of pregnancy.

Hypovitaminosis D in Healthy Pregnant Women and their Newborns in Greece.

The aim of this work was to evaluate the current vitamin D status in healthy pregnant women and their newborns living in Greece and assess possible associations between 25(OH)D and anthropometric features of their fetuses and newborns. 81 healthy women were monitored during pregnancy. Biochemical markers related to bone metabolism, 25(OH)D and PTH levels were measured in serum samples of mothernewborn pairs at 1st trimester of pregnancy and at delivery in mothers, in cord blood and at the 3rd day of life of newborns. Maternal 25(OH)D levels at the 1st trimester of pregnancy (22.6±9.2ng/ml) were significantly higher than those at delivery (19.2±9.2ng/ml) (p<0.001). Furthermore, umbilical 25(OH)D levels (21.3±9.3ng/ml) were higher than maternal at delivery (p=0.005) and neonatal levels (19.4±10.4 ng/ml) (p=0.021). Only 57.3% of the mothers at the first trimester and 46.7% at delivery as well as 55.8% of the fetuses and 38.5% of the neonates had adequate vitamin D levels (25(OH)D≥30ng/ml). A significant positive correlation was found between fetal femur length at the 22nd week of gestation and maternal 25(ΟΗ)D at the 1st trimester of pregnancy (r=0.36, p=0.048) while body length was significantly higher in newborns whose mothers had sufficient 25(OH)D levels (51.5±2.1cm) compared with those whose mothers had insufficient or deficient 25(OH)D levels at delivery (50.6±2.0cm) (p=0.047). The study confirms inadequate levels of vitamin D in pregnant women in Greece associated with inadequate vitamin D levels of their fetuses and newborns.

The case for partitioning of 1st trimester-specific TSH reference intervals

There is growing concern that a universal 1st trimester TSH cut-off of 2.5 mIU/L may cause overdiagnosis and overtreatment of subclinical hypothyroidism in pregnancy.1 New guidelines2 promote the establishment of local population-based trimester-specific reference intervals and a focus on higher upper reference limits in all trimesters. We reviewed 1st trimester TSH Results measured on the Abbott ARCHITECT i4000SR in our population partitioned into two subgroups. Patients with evidence of thyroid peroxidase, thyroglobulin and TSH receptor autoantibodies were excluded. Partitions were decided based on hCG physiology and the literature. Reference intervals were calculated using nonparametric statistics as per CLSI guidelines3 and groups were compared with Analyse-it software applying the Mann-Whitney test. The TSH reference intervals were as follows: weeks 3 to 13, 0.13–3.9 mIU/L; two subgroups: weeks 3 to 6, 0.46–4.4 mIU/L, and weeks 7 to 13, 0.03–3.2 mIU/L. The two subgroups were statistically different (p<0.0001). The most significant decrease in TSH is known to occur in the latter part of the 1st trimester and in view of this we recommend either partitioning the 1st trimester or setting a specific time frame for screening patients for thyroid disease in the 1st trimester of pregnancy.