37th Week Of Gestation Research Articles

Intrauterine maxillary development and maxillary dental arch biometry: a fetal cadaver study

IntroductionThis study's goal was to determine normal maxillary development on fetal cadavers. Materials and methodsThis study was carried out on 45 fetuses aged between the 17th - 40th weeks of gestation (24 male, 21 female). The distance between the widest left and right points of the maxillary dental arch (MDA) on the transverse plane, the distance of the papilla incisiva (PI) to the widest left and right points of the maxillary dental arch (MDAW), and the PI and posterior nasal spine (PNS) were measured. The average arch forms of the MDA were created according to trimester groups using the MATLAB program. The one-way ANOVA test was used to make a comparison between trimester groups, and ANOVA followed by post hoc analysis using the Bonferroni test was applied for comparisons. Pearson's correlation analysis was used for correlation analysis. ResultsThe data in the present study did not differ between genders. In the comparison between trimester groups, we did not find any difference between the 3rd trimester and full-term groups only in the PI-MDAW measurement. Other parameters increased with age. In the correlation analysis, the measurement values by age showed a strong positive correlation. The MDAW exhibited the best correlation with age (rweek = 0.919). When the average MDA forms created using the MATLAB program were evaluated, it was observed that the PI-MDAW of the average MDA in the 3rd trimester and full-term intersected. ConclusionsThis study provides a basis for a better understanding of fetal maxillary growth processes and can be useful to standardize the detection of malformations or intrauterine growth restrictions.

The first-trimester serum decorin levels as a potential predictor of preeclampsia.

Background Preeclampsia (PE) is a multisystem disease and is still among the leading causes of maternal and neonatal morbidity and mortality. Inadequate trophoblast invasion plays a key role in the PE pathogenesis. The proliferation, migration, and invasion of extravillous trophoblasts (EVTs) is primarily controlled by the decidua-derived transforming growth factor beta (TGF-β) and decorin. In this study, we aimed to investigate the clinical utility of serum decorin levels measured in the 11th to 14th gestational weeks to predict preeclampsia during the following weeks of gestation. Materials and Methods A total of 600 pregnant women, whose age and gestational age ranged from 18 to 40 years and 11 to 14weeks, were included. Venous blood samples were obtained and stored at-80°C. Subsequently, the patients who developed preeclampsia and healthy controls with a similar body mass index were identified and their first-trimester blood samples were analyzed for serum decorin levels. Results The mean serum decorin level was 8.76±6.88ng/mL for the PE group while 9.75±9.82ng/mL for the control group. No statistically significant difference was found between the two groups (p=0.838). Conclusion We observed that the serum decorin levels during the 11th to 14th weeks of gestation showed no predictive value for preeclampsia in pregnant women. However, more accurate conclusions about the clinical utility of decorin as a biomarker of preeclampsia would require further studies with larger samples including more patients with EOS-PE.

Is Prematurity a Protective Factor Against Developmental Dysplasia of the Hip? A Retrospective Analysis of 660 Newborns.

In Middle Europe developmental dysplasia of the hip (DDH) has an incidence of up to 5.9 %. The rate of congenital hip dislocation as the worst complication of a growth disorder of the hip is between 1.5 % and 2.5 %. Among known risk factors of DDH are breech position, multiples, foot deformities and family history. The aim of this retrospective study was to investigate prematurity as a risk factor for developmental dysplasia of the hip (DDH). The hips of 283 infants who were born before the 38th week of gestation or earlier, and those of 377 infants who were born after the 37th week of gestation, none of whom had other risk factors for DDH, were compared using the ultrasound technique according to Graf et al., within the first week after birth. Both hips of all infants were included in the study. Surprisingly, the difference in alpha angles between the two groups was statistically extremely significant, favoring the preterm infants. Moreover, we found a physiological curve of alpha angle development with a peak after the 31st week of gestation. The incidence of pathological dysplasia was not significantly different in the two groups. Our results suggest that prematurity is not a predisposing factor for DDH, but rather is protective for hip development.

Maternal irisin level in last trimester isolated intrauterine growth-restriction

Purpose Intrauterine Growth Restriction (IUGR) is the inability of the fetus to achieve the biologically accessible growth potential. Irisin is a recently discovered adipomyokine with a crucial role in energy metabolism. Our current study aimed to investigate the relationship between the isolated IUGR in the third trimester and maternal serum irisin level. Materials and methods This prospective case-control study included total 137 pregnant women who were between the 24th and 39th gestational weeks and who applied to the University of Health Sciences, Ankara Zekai Tahir Burak Women's Health Training and Research Center, between 2016 October-2017 May. The Study Group consisted of 68 pregnant women who were diagnosed with Isolated IUGR with Estimated Fetal Weight (EFW) <10th percentile. The Control Group consisted of 69 low-risk uncomplicated pregnant women, matched with the Study Group in terms of gestational week, and with EFW between 10th and 90th percentiles. Demographic data, clinical findings, fetal Doppler parameters, and obstetric-neonatal outcomes were evaluated. Maternal serum irisin levels were measured by ELISA (Enzyme-Linked Immunosorbent Assay) Method and compared between the groups. Results Maternal serum irisin level was found to be significantly lower in IUGR Group as compared to the Control (3.83 ng/ml vs. 4.78 ng/ml, p < .001, respectively). There was a positive correlation between maternal serum irisin level and duration of pregnancy, the weight gain during pregnancy, birth weight, fetal abdominal circumference measurement and cerebroplacental ratio (r = 0.18, p = .03; r = 0.17, p = .04; r = 0.37, p < .001; r = 0.35, p < .001; r = 0.27, p = .001, respectively). Binary Logistic Regression Analysis showed that maternal serum irisin level is an independent estimator of IUGR [OR %95 CI: 8.33 (3.22 − 25.01)]. AUC (Area Under the Curve) analysis of maternal irisin for IUGR estimation was 0.75 (p < .001, 95% CI = 0.67 − 0.82). The optimal cutoff value was below 3.86 ng/ml for maternal irisin level with a sensitivity of 54.41% and a specificity of 88.41%, positive predictive value of 82.22% and negative predictive value of 66.30%. Conclusion Low level of maternal serum irisin in pregnancies with isolated IUGR was consistent with the role of irisin in metabolic pathways and with the increased risk of metabolic diseases in the future life of IUGR fetuses and their mothers.

Is it suitable for DM diagnosis using an abnormal two-hour glucose value only after 24th gestational weeks in China

Objective To investigate the postnatal outcomes of diabetes mellitus (DM) women diagnosed according to two-hour glucose value ≥11.1 mmol/L after 24th gestational weeks in China, and to evaluate if it is suitable for DM diagnosis using the criteria that two-hour glucose value ≥11.1 mmol/L after 24th gestational weeks only. Research design and methods: We conducted a retrospective cohort study of the pregnant women with gestational hyperglycemia participated in gestational hyperglycemia day care and delivered in Peking University First Hospital from June 2016 to May 2018. A total of 168 women diagnosed with DM according to the criteria that two-hour glucose value ≥11.1 mmol/L after 24th gestational weeks were included, and 75 DM women did the oral glucose tolerance test (OGTT) from 6 weeks to 1 year postpartum. The general information collected and analyzed included age, prepregnancy body mass index (BMI), prepregnancy weight, gestational weight gain (GWG), OGTT value during pregnancy, OGTT value of postpartum, gestational weeks, and neonatal birth weight. Results There were 168 women diagnosed with DM according to the criteria that two-hour glucose value ≥11.1 mmol/L after 24th gestational weeks, and 75 (75/168, 44.6%) women underwent an OGTT from 6 weeks to 1 year postpartum. Among the women followed-up, 56 (56/75, 74.7%) women were diagnosed as hyperglycemia and 19 (19/75, 25.3%) women were diagnosed as normal glucose metabolism. In hyperglycemia women, there are eight (8/56, 10.7%) women diagnosed as DM, 24 (24/56, 32.0%) women diagnosed as impaired glucose tolerance (IGT), eight (8/56, 10.7%) women diagnosed as impaired fasting glucose (IFG), and 16 (16/56, 21.3%) women diagnosed as IFG and IGT. Compared with normal glucose metabolism women, the age of hyperglycemia women is higher significantly (34.8 ± 3.8 versus 32.7 ± 4.7). The incidence of IFG, pharmacy treatment, and the value of HbA1c is also higher in hyperglycemia women than the normal glucose metabolism women, in which it is not statistically significant but clinically significant. Conclusion In DM women diagnosed according to the criteria that two-hour glucose value ≥11.1 mmol/L after 24th gestational weeks, there were only eight (10.7%) women could meet DM diagnostic criteria according to the OGTT value of postpartum. Moreover, 25% women had normal OGTT value postpartum. Due to the characteristics of glucose metabolism in Asian population, an abnormal two-hour glucose value in OGTT may not be suitable to diagnose DM during pregnancy in China.

RELATIONSHIP OF MATERNAL VITAMIN B12 STATUS IN PREGNANCY WITH PRETERM BIRTH AND MATERNAL HEALTH RISKS

Vitamin B12 is known to be vital for cell growth and population during pregnancy. This retrospective and prospective case−control study was aimed to disclose a health risk for pregnant women with vitamin B12 deficiency, as well as the one of the preterm birth. The main tasks set and performed in this research were as follows: to compare the obstetrics anamnesis between the women who gave birth on term and women who gave birth before term; to find the prevalence of vitamin B12 insufficiency in pregnancy; to determine its association with preterm birth and low birth weight; to examine its association with spontaneous abortions, and to investigate its relationship with obesity and hemoglobin levels in pregnant women. The conducted investigation involved 107 women who gave birth before the 37th week of gestation and 101 women who gave birth after the 37th week of gestation at the outpatient clinic of the University Hospital "Maichin Dom" in Bulgaria. Our study revealed a correlation between maternal vitamin B12 deficiency, overweight and low hemoglobin level. Our results showed no significant correlation between serum vitamin B12 level and the risk of preterm birth. However, we found an inverse association between vitamin B12 level and overweight before pregnancy and at the time of giving birth. As well there was confirmed the strong connection between meat consumption and vitamin B12 level. The paper emphasizes that the deficiency of the vitamin occurs most likely in the women with inadequate diets. Such a deficiency is actually confirmed to have serious health consequences for pregnant women and their offspring. Therefore further profound and numerous studies should be performed to properly assess the correlation between vitamin B12 and preterm birth, as well as to understand better the impact of vitamin B12 over pregnant women. Key words: vitamin B12, preterm birth, pregnancy, overweight, hemoglobin.

Gebelikte Feokromositoma

Pheochromocytoma is a neuro-endocrine tumor which secretes catecholamine. It is rare in pregnancy. Misdiagnosis as gestational hypertension or preeclampsia may cause delays in diagnosis. We aimed to discuss a case of pheochromocytoma during pregnancy presenting with hypertension. A 27-year-old female patient with 15-weeks of pregnancy was found to have a 45x55 millimeter mass on the left adrenal gland while she was complaining left side pain. Physical examination revealed hypertension. 24-hour urine catecholamine levels were elevated. Abdominal MRI was consistent with pheochromocytoma. After appropriate preparation, laparoscopic adrenalectomy was performed for the left adrenal gland in second trimester. Catecholamine levels decreased after the operation. The pathology was consistent with pheochromocytoma. The patient delivered a baby by cesarean section at 37th gestational week. Pheochromocytoma during pregnancy is a rare but important cause of morbidity and mortality for mother and fetus. Therefore, it should be considered in the differential diagnosis especially in pregnant women presenting with hypertension in first trimester.

The Influence of Various Cerebral and Extracerebral Pathologies on Apparent Diffusion Coefficient Values in the Fetal Brain.

ABSTRACTBACKGROUND AND PURPOSEThe changing MRI signal accompanying brain maturation in fetal brains can be quantified on apparent diffusion coefficient (ADC) maps. Deviations from the natural course of ADC values may reflect structural pathology. The purpose of this study was to determine the influence of fetal pathologies on the ADC values in different regions of the fetal brain and their evolution with increasing gestational age.METHODSThis was a retrospective study of 291 fetuses evaluated between the 14th and the 40th week of gestation using diffusion‐weighted imaging (DWI). Fetuses with normal MRI findings but sonographically suspected pathology or fetuses with abnormalities not affecting the brain were analyzed in the control group and compared to fetuses suffering from different pathologies like hydrocephalus/ventriculomegaly, brain malformations, infections, ischemia/hemorrhage, diaphragmatic hernias, and congenital heart disease. Pairwise ADC measurements in each side of the white matter (WM) of the frontal, parietal, and occipital lobes, in the basal ganglia and the cerebellum, as well as a single measurement in the pons were performed and were plotted against gestational age.RESULTSIn the control group, brain maturation followed a defined gradient, resulting in lower ADC values in the most mature regions. Each disorder group experienced abnormal patterns of evolution of the ADC values over time deviating from the expected course.CONCLUSIONSThe ADC values in different regions of the fetal brain and their evolution with increasing gestational age are influenced by pathologies compromising the cerebral maturation.

SPONTANEOUS PNEUMOTHORAX DURING PREGNANCY: A RARE CHALLENGE

TYPE: Abstract Publication TOPIC: Disorders of the Pleura PURPOSE: Primary spontaneous pneumothorax (PSP) during pregnancy is a rare condition with serious risks to the mother and the fetus, so rapid recognition and treatment are essential. Since few cases has been described, symptoms of dyspnea and chest pain can be easily misdiagnosed. The aim is to describe a case of a pregnant patient with PSP, managed with chest tube drainage. METHODS: A 30-year-old woman on 28th gestational week (gravida 1/ parity 0), non-smoker, presented at urgency department with sudden pleuritic chest pain and dyspnea. No history of respiratory pathology or trauma. On physical examination, hemodynamically stable, no fever, tachypneic with oxygen saturation 97% on ambient air. Pulmonary auscultation with decreased vesicular murmur on the left hemithorax. No analytic alterations. No fetal distress. The chest radiography showed findings of large left pneumothorax, without mediastinum deviation. A chest drain was placed with reduction of pneumothorax. Given the absence of pulmonary re-expansion, suction treatment was made. RESULTS: The patient had progressive recovering and was hospital discharged asymptomatic. A caesarean section was performed on 39th gestational week, under epidural anesthesia, without complications. The patient maintains a pulmonology follow-up, without new episodes of pneumothorax. CONCLUSIONS: PSP during pregnancy should be part of chest pain and dyspnea differential diagnosis and promptly recognized to prevent severe complications. CLINICAL IMPLICATIONS: Given the symptomatic large pneumothorax, a chest tube was placed. Since the high risk of recurrence during delivery, it is recommended elective assisted delivery with forceps or ventouse extraction to lessen maternal efforts, despite some authors consider the caesarean section a safe option. DISCLOSURE: No significant relationships. KEYWORDS: pneumothorax, pregnancy

Impact of cell-free fetal DNA on early invasive prenatal diagnosis at a Chinese reference maternal medicine center

Purpose The aim of this study is to evaluate the impact of the utility of maternal cell-free DNA (cfDNA) on the number of chorionic villus sampling (CVS) at a mainland Chinese maternal hospital. Methods This was a retrospective cohort study conducted in consecutive singleton pregnancies that underwent CVS between the 11th and 14th gestational weeks at a Chinese maternal hospital during a nine-year period. The indications, complications and prenatal diagnosis results were evaluated. Results This study consisted of 5108 CVS procedures, including 2000 performed for fetal karyotyping, and 3108 performed for fetal single-gene genotyping. During the period with the introduction of cfDNA, the proportion of the number of CVS procedures for the indication of positive serum screening declined significantly, and abnormal ultrasound was the main indication for CVS performed for fetal karyotyping. Thalassemia was always the main indication for CVS, accounting for 50.5% of all CVS cases. Conclusions cfDNA has changed the spectrum of CVS indications. CVS is now the invasive procedure performed for patients with a fetus having a very high risk of fetal genetic defects, including fetuses having major abnormal ultrasound or having a risk of single-gene disorder inherited from their parents.

Near-term pregnant women’s attitude toward, concern about and knowledge of the COVID-19 pandemic

Background: COVID-19 is a novel type of the coronavirus family with an incompletely described clinical course. Little is known about the psychological aspects, particularly for vulnerable populations including pregnant women.Objectives: To understand the attitude, concerns, and knowledge of the non-infected pregnant women toward the COVID-19 outbreak in order to constitute base data for detailed counseling and to develop targeted messages.Patients and methods: This cross-sectional survey research presented analysis of prospectively collected data yielded at a single tertiary “Coronavirus Pandemic Hospital” referral center for a ten days period following the first confirmed death due to the COVID-19 pandemic in Turkey. Non-infected women with a confirmed pregnancy over 30th gestational week were consecutively included. A patient-reported non-validated questionnaire formed by the expert committee that includes 15 specific questions was used. Non-infected, pregnant women over 30th gestational week who applied to the outpatient clinic were consecutively included. A total of 213 women were enrolled, 37 were excluded: 7 for being in the first trimester, 3 were illiterate, and 27 were Syrian refugees having difficulties in translation.Results: A total of 172 pregnant women were included. Overall, four women refused to participate to the survey (1.9%). The mean age was 27.5 ± 5.3 years. Median gestational week and parity were 35 ± 11 weeks and 1 ± 2, respectively. Pregnant women were observed to trust the authorities (65%) and the healthcare staff (92.4%), and their respect was increased (82.5%) during the outbreak. Majority of the women (87.2%) comply with the self-quarantine rules. Half of the women (52%) reported that they felt vulnerable and predominantly were concerned (80%). Approximately one-third of the women constantly keep thinking that they may get infected (35.5%) or they might get infected during/following the delivery or their baby might get infected after being born (42%). Half of the women (50%) were reported that they either had no idea about or think the breastfeeding is not safe during the outbreak. About 45% of the women were confused or had doubts about if the mode of delivery may be affected by the pandemic. Greater part of the participants does not know if COVID-19 might cause birth defects (76%) or preterm birth (64.5%). Counseling flow keys helping pregnant women to overcome misleads, regarding the COVID-19 outbreak is proposed.Conclusions: Non-infected pregnant women with a viable pregnancy at near term were observed to have positive attitude and compliance toward the COVID-19 outbreak and frontline healthcare staff; increased concern and vulnerability; and restricted knowledge about the pregnancy-related outcomes. While the clinical evidence was growing rapidly, this data may guide obstetricians and midwives to perceive what accurate information should be provided to the pregnant women.

Benefits of Adhering to a Mediterranean Diet Supplemented with Extra Virgin Olive Oil and Pistachios in Pregnancy on the Health of Offspring at 2 Years of Age. Results of the San Carlos Gestational Diabetes Mellitus Prevention Study.

The intrauterine environment may be related to the future development of chronic diseases in the offspring. The St. Carlos gestational diabetes mellitus (GDM) prevention study, is a randomized controlled trial that evaluated the influence of the early (before 12th gestational week) Mediterranean diet (MedDiet) on the onset of GDM and adverse gestational outcomes. Out of 874 women assessed after delivery (440 control group (CG)/434 intervention group (IG)), 703 children were followed (365/338; CG/IG), with the aim to assess whether the adherence to a MedDiet during pregnancy induces health benefits for the offspring during the first two years of life. Logistic regression analysis showed that the IG in children of mothers with pre-gestational body mass index (BMI) < 25 kg/m2 and normal glucose tolerance (NGT), was associated with a lower risk (RR(95% CI)) of suffering from severe events requiring hospitalization due to bronchiolitis/asthma (0.75(0.58–0.98) and 0.77(0.59–0.99), respectively) or other diseases that required either antibiotic (0.80(0.65–0.98) and 0.80(0.65–0.99), respectively), corticosteroid treatment (0.73(0.59–0.90) and 0.79(0.62–1.00) respectively) or both (all p < 0.05). A nutritional intervention based on the MedDiet during pregnancy is associated with a reduction in offspring’s hospital admissions, especially in women with pre-gestational BMI < 25 kg/m2 and NGT.

The evaluation of ventricular functions by speckle tracking echocardiography in preeclamptic patients.

Preeclampsia is a maternal disorder of pregnancy characterized by concomitant increase in preload and afterload with end organ dysfunction. The aim of our study is to evaluate left ventricular (LV) and right ventricular (RV) functions with speckle tracking echocardiography in preeclamptic patients. Fifty-five preeclamptic (mean age: 30.7 ± 5.9 years) and 35 healthy pregnant women (mean age: 28.8 ± 5.7 years) of the same race, similar age and gestational week were consecutively included. The diagnosis of preeclampsia was based on the criteria proposed by the American College of Obstetricians and Gynecologists. LV and RV functions were assessed by both conventional and speckle tracking echocardiography after the 30th gestational week and at the postpartum 6th months. The preeclamptic patients had significantly larger left atrium, thicker interventricular septum, higher systolic pulmonary artery pressure and mitral E/e' ratio compared to controls during pregnancy while LV ejection fraction was similar. Preeclamptic patients had significantly lower LV and RV global longitudinal strain (GLS) during pregnancy compared to controls (- 18.0 ± 2.6% vs. - 19.8 ± 2.1% p = 0.001 and - 26.7 ± 3.3% vs. 28.9 ± 3.3% p = 0.002, respectively). In the postpartum period, while LVGLS values of preeclamptic patients increased significantly (- 18.0 ± 2.6% vs. - 20.4 ± 2.4% p < 0.001) and became similar to those of controls at the sixth month, the RVGLS decreased significantly (- 26.7 ± 3.3% vs. - 25.8 ± 2.7% p = 0.003) making the difference in RVGLS between the preeclamptic patients and controls more prominent. Preeclampsia may impair LV and RV function. Long-term follow up with larger sample is needed to determine the clinical relevance of the observed changes in strain.

Prenatal factors associated with fetal visceral adiposity

ObjectiveTo assess fetal visceral adiposity and associated factors during pregnancy. MethodsSecondary analysis of prospective cohort data with 172 pairs (pregnant woman/fetus) treated at public health units. Anthropometric data, metabolic (glucose, glycated hemoglobin, insulin, insulin resistance, total cholesterol and fractions, triglycerides) measures, fetal biometry, and visceral and subcutaneous adiposity in the binomial (pregnant woman/fetus) were evaluated at the 16th, 28th and 36th gestational weeks by ultrasonography. Pearson's correlation coefficient and multiple linear regression were used, with a significance level of 5%. ResultsAt the 16th week, the mean age of the pregnant women was 26.6±5.8 years and mean weight was 62.7±11.5kg; 47.0% had normal weight, 28.3% were overweight, 13.3% were underweight, and 11.2% were obese. At 36 weeks, 44.1% had inadequate gestational weight gain, 32.5% had adequate gestational weight gain, and 23.3% had excessive gestational weight gain. Fetal visceral adiposity at week 36 showed a positive correlation with maternal variables: weight (r=0.15) and body mass index (r=0.21) at the 16th; with weight (r=0.19), body mass index (r=0.24), and gestational weight gain (r=0.21) at the 28th; and with weight (r=0.22), body mass index (r=0.26), and gestational weight gain (r=0.21) at the 36th week. After multiple linear regression, adiposity at the 28th week remained associated with fetal variables: abdominal circumference (p<0.0001), head circumference (p=0.01), area (p<0.0001), and thigh circumference (p<0.001). At the 36th week, adiposity remained associated with the abdominal circumference of the 28th (p=0.02) and 36th weeks (p<0.001). ConclusionAdiposity was positively correlated with the measurements of the pregnant woman. After the multivariate analysis, the persistence of the association occurred with the abdominal circumference, a central adiposity measurement with a higher metabolic risk.

The usefulness of MRI Classification System (MRICS) in a cerebral palsy cohort

Our aim was to investigate perinatal and clinical factors associated with children with cerebral palsy (CP) using magnetic resonance imaging (MRI). The distribution of MRI patterns was based on the MRI classification system (MRICS). Associations between perinatal/clinical characteristics and MRI patterns were also investigated. A population-based cohort study was performed; those 257 children (58.0% male) were enrolled from our CP database who born between 1990 and 2015 in Southwest Hungary and had at least one MRI scan. Brain maldevelopments were found in 18.7% of our patients, 83.7% of those born at term. Grey matter lesions were found in 19.8% of our patients, and 80.0% of those children were born at term. The rate of white matter injuries was the highest (35.4%); 69.0% of these patients were born before 37th week of gestation. MRI revealed no abnormalities in 13.6% of children with CP. The best values of gross/fine motor and cognitive function tests were found in children with normal MRI and with grey matter injuries. The prevalence of epilepsy was above 60% in every group with an abnormal MRI. MRI results were conclusive in 86.4% of children with CP. It is highly encouraged to perform cranial MRI in every patient with CP.

Metabolic infrastructure of pregnant women with methylenetetrahydrofolate reductase polymorphisms: A metabolomic analysis.

The aim of this study was to demonstrate the altered metabolic infrastructure of pregnant women with methylenetetrahydrofolate reductase (MTHFR) polymorphisms at first trimester and during delivery. Eight singleton pregnant women with MTHFR polymorphisms were compared with 10 normal pregnant women. Maternal blood samples were obtained twice during their pregnancy period (between the 11th and 14th gestational weeks and during delivery). Metabolomic analysis was performed using GC-MS. The GC-MS based metabolomic profile helped identify 95 metabolites in the plasma samples. In the MTHFR group, the levels of 1-monohexadecanoylglycerol, pyrophosphate, benzoin, and linoleic acid significantly decreased (P ˂ 0.05 for all), whereas the levels of glyceric acid, l-tryptophan, l-alanine, l-proline, norvaline, l-threonine, and myo-inositol significantly increased (P ˂ 0.01 for the first two metabolites, P ˂ 0.05 for the others) at 11-14 gestational weeks. Conversely, the levels of benzoin, 1-monohexadecanoylglycerol, pyruvic acid, l-proline, phosphoric acid, epsilon-caprolactam, and pipecolic acid significantly decreased in the MTHFR group, whereas metabolites such as hexadecanoic acid and 2-hydroxybutyric acid increased significantly in the study group during delivery. An impaired energy metabolism pathway, vitamin B complex disorders, tendency for metabolic acidosis (oxidative stress), and the need for cell/tissue support seem prevalent in pregnancies with MTHFR polymorphisms.

Associations between prenatal exposure to fine particulate matter and birth weight and modifying effects of birth order related to a new baby boom: A prospective birth cohort study in Guangzhou, China

Abstract Although studies have assessed the associations between prenatal exposure with fine particulate matter (PM) with birth weight, few have investigated the effect of PM1 exposure and identified the susceptible exposure window. Additionally, a baby boom occurred after China implemented the universal two-child policy, but whether the effects of PM are modified by birth order remains unknown. The objective of this study was to estimate the effects of prenatal exposure to PM (PM2.5 and PM1) on birth weight, identify the susceptible exposure windows, and assess the modifying effect of birth order on the effects of PM exposure. All participants were selected from the Prenatal Environment and Offspring Health (PEOH) cohort conducted since 2016 in Guangzhou, China. A spatiotemporal land–use-regression (STLUR) model was used to estimate a pregnant woman's weekly PM2.5 exposure, and a generalized additive model (GAM) was used to estimate each PM1 exposure. A distributed lag non-linear model (DLNM) was applied to assess the exposure–lag-response associations between weekly PM exposure and birth weight. The sample included 4086 pregnant women. The results showed that maternal exposure to PM2.5 and PM1 during the 15th to 24th and 16th to 24th gestational weeks were associated with lower birth weight, the strongest association was observed in the 19th week, during which each 10 μg/m3 increment in PM2.5 and PM1 was associated with a 1.47 g (95% CI: 2.49 g, 0.44 g) and 1.58 g (95%CI: 2.74 g, 0.41 g) decrease in birth weight, respectively. Compared with the first-born neonates, greater effects of PM2.5 and PM1 exposure on birth weight were observed among the second-born neonates in the 15th to 21st and 15 h to 22nd gestational weeks. Further studies tracking the health of the second-born children are warranted because they may be more sensitive to environmental factors than the first-born children.

Impact of some social and clinical factors on the development of postpartum depression in Chinese women

BackgroundPostpartum depression (PPD) is prevalent and may present major adverse impacts on mother and child health. According to previous studies, mostly from the western society, PPD may have complicated etiologies, such as genetic, social and psychological factors. The aim of this study was to explore the associations of some social and clinical factors, particularly those unique in Chinese, with significant PPD symptoms.MethodsA sample of 556 pregnant women in their 36th to 40th gestational week were randomly recruited in a cross-sectional study using a self-reported questionnaire, which collected maternal sociodemographic and clinical information. During their 2nd to 4th postpartum months, 522 participants responded to our screening of significant PPD symptoms, based on a score of Edinburgh Postnatal Depression Scale ≥9.ResultsA total of 90 (17.3%) participants were identified with significant PPD symptoms, and the following factors were observed more frequently in women with significant PPD symptoms (PPD+) than with fewer symptoms (PPD−): intensive involvement of parents-in-law in a participant’s life (living together with her, taking care of her, or discriminating against a female baby), lack of support from husband, cesarean delivery, and breast milk insufficiency (supplemented with formula). After multiple logistic regression analysis, parents-in-law’s preference to baby boy while devaluing baby girl, dissatisfaction with husband’s support, cesarean delivery, and mixed feeding were strongly associated with significant PPD symptoms.ConclusionThe potential risk factors for significant PPD symptoms, i.e., “son preference” custom, cesarean delivery and mixed feeding, deserve confirmation in continued, especially clinical diagnosis-based longitudinal studies.

Methylparaben in meconium and risk of maternal thyroid dysfunction, adverse birth outcomes, and Attention-Deficit Hyperactivity Disorder (ADHD)

BackgroundParabens, which are used as a preservative in foods and personal care products, are detected in nearly 100% of human urine samples. Exposure to parabens is associated with DNA damage, male infertility, and endocrine disruption in adults, but the effects of prenatal exposure are unclear. In part, this is due to inadequate assessment of exposure in maternal urine, which may only reflect maternal rather than fetal exposure. To address this gap, we examined the association of prenatal methylparaben measured in meconium with preterm birth, gestational age, birthweight, maternal thyroid hormones, and child Attention-Deficit Hyperactivity Disorder (ADHD) at 6–7 years. DesignData come from the GESTation and the Environment (GESTE) prospective observational pregnancy cohort in Sherbrooke, Quebec, Canada. Participants were 345 children with data on ADHD among 394 eligible pregnancies in women age ≥18 years with no known thyroid disease before pregnancy and meconium collected at delivery. Methylparaben was measured in meconium. Birthweight, gestational age, and maternal thyroid hormones at <20 weeks gestation were measured at the Centre Hospitalier Universitaire de Sherbrooke. Preterm birth was defined as vaginal birth before the 37th week of gestation. Physician diagnosis of ADHD was determined at a scheduled cohort follow-up when children were 6–7 years old or from medical records. Associations between meconium methylparaben and outcomes were estimated with logistic and linear regressions weighted on the inverse probability of exposure to account for potential confounders, including child sex, familial income, maternal education, pre-pregnancy body mass index, age, and smoking and alcohol consumption during pregnancy. ResultsMethylparaben was detected in 65 meconium samples (19%), 33 children were diagnosed with ADHD (10%), and 13 children were born preterm (4%). Meconium methylparaben was associated with preterm birth (odds ratio [OR] = 4.81; 95% CI [2.29, 10.10]), decreased gestational age (beta [β] = −0.61 weeks; 95% CI [−0.93, −0.29]) and birthweight (β = −0.12 kg; 95% CI [−0.21, −0.03]), altered maternal TSH (relative concentration [RC] = 0.76; 95% CI [0.58, 0.99]), total T3 (RC = 0.84; 95% CI [0.75, 0.96]) and total T4 (RC = 1.10; 95% CI [1.01, 1.19]), maternal hypothyroxinemia (OR = 2.50, 95% CI [1.01, 6.22]), and child ADHD at age of 6–7 (OR = 2.33, 95% CI [1.45, 3.76]). The effect of meconium methylparaben on ADHD was partially mediated by preterm birth (20% mediation) and birthweight (13% mediation). ConclusionsMeconium methylparaben was associated with preterm birth, decreased gestational age and birthweight, maternal thyroid hormone dysfunction, and child ADHD. Parabens are a substantial health concern if causally related to these adverse outcomes.

First trimester fetal echocardiography limitations and its expected clinical values

BackgroundFetal cardiac activity could be observed between 6th and 7th gestational weeks, early performance of fetal echocardiography could be implemented to screen for fetal heart disease. The effectiveness of early first trimester fetal echocardiography has not been adequately investigated, especially with modern sonographic technological advances. The purpose of the study is to evaluate the capability to visualize fetal cardiac structures within the first trimester as early as 10th gestational weeks and to elucidate the value of using color Doppler in visualization of cardiac structures within early gestation. A prospective clinical trial conducted on 150 study subjects, 44 of them were twin gestations. Cases were fully assessed by fetal echocardiographic examination from 10th gestational week to 13 gestational weeks in a sequential manner weekly. The research study was conducted at cardiology department fetal unit in one of the tertiary hospitals.ResultsFour chamber view was mostly visualized from 12 gestational weeks, whereas cardiac axis was fully visualized in all cases from 12 gestational weeks; on the other hand, IVC assessment by 2D was satisfactorily visualized in 78.26% of cases and by color Doppler in 82.61% of cases at 13 gestational weeks, pulmonary veins were visualized in 21.74% of cases by 2D and 43.5% of cases by color Doppler at 13 gestational weeks, and interestingly, ventricular inflows were satisfactorily visualized in almost all cases from 10th gestational weeks.ConclusionsFirst trimester fetal echo is an outstanding enhancement in management pathways of cases susceptible to have fetal cardiac abnormalities permitting early detection of structural cardiac anomalies triggering a cascade of scanning for extra cardiac anomalies to aid in evaluation and assessment of the best management course for those affected cases.