Acid In Women Research Articles

Effects of the Ketogenic Diet on Microbiota Composition and Short-Chain Fatty Acids in Women with Overweight/Obesity.

Background/Objectives: The ketogenic diet (KD) is a dietary model that can impact metabolic health and microbiota and has been widely discussed in recent years. This study aimed to evaluate the effects of a 6-week KD on biochemical parameters, gut microbiota, and fecal short-chain fatty acids (SCFAs) in women with overweight/obesity. Methods: Overall, 15 women aged 26-46 years were included in this study. Blood samples, fecal samples, and anthropometric measurements were evaluated at the beginning and end of this study. Results: After KD, the mean body mass index decreased from 29.81 ± 4.74 to 27.12 ± 4.23 kg/m2, and all decreases in anthropometric measurements were significant (p < 0.05). Fasting glucose, insulin, homeostasis model assessment of insulin resistance, hemoglobin A1C, urea, and creatinine levels decreased, whereas uric acid levels increased (p < 0.05). Furthermore, increased serum zonulin levels were noted (p = 0.001), whereas fecal butyrate, propionate, acetate, and total SCFA levels decreased (p < 0.05). When the changes in microbiota composition were examined, a decrease in beta diversity (p = 0.001) was observed. After the intervention, a statistically significant increase was noted in the Firmicutes/Bacteroidetes ratio (p = 0.001). Although Oscilibacter, Blautia, and Akkermensia relative abundances increased, Prevotella relative abundance and Bifidobacter abundance, which were the dominant genera before the KD, decreased. Moreover, the abundance of some pathogenic genera, including Escherichia, Klebsilella, and Listeria, increased. Conclusions: In healthy individuals, KD may cause significant changes in microbial composition, leading to dysbiosis and long-term adverse outcomes with changes in serum zonulin and fecal SCFA levels.

Factors Affecting Visual Inspection Examination of Acetic Acid (IVA) in Couples of Childbearing Age in the Working Area of UPT. Puskesmas Mandala Medan Year 2024

Visual Inspection of Acetic Acid (IVA) is an early detection of cervical cancer, the decline in IVA Test examinations in 2022 is from 154 people to 61 people in January to June 2023, where in half a year in 2023 the achievement of IVA Test examinations does not reach 50% of IVA examinations Test in 2022. The aim of the research is to analyze the factors that influence the visual inspection of acetic acid (VIA) in couples of childbearing age in the work area of UPT.Puskesmas Mandala Medan in 2023. This research is a combination of quantitative and qualitative research. The population was 259 people and the sample was 972 people. Quantitative data analysis using the chi-square test and multiple logistic regression and qualitative data analysis. The results of this study show that 38 people did not carry out IVA examinations with the chi-square test results showing the variables age, education, employment, knowledge, attitudes, culture and husband's support. The results of the multiple logistic regression test show that the knowledge variable has the most influence on visual inspection of acetic acid in women of childbearing age. The conclusion of this research is that there is an influence of age, education, work, knowledge, attitudes, culture and husband's support with visual inspection of acetic acid (IVA) on couples of childbearing age in the working area of UPT. Mandala Health Center Medan in 2023. It is recommended that UPT Mandala Health Center increase participation in providing training to health workers and be able to promote the VIA examination program and should involve husbands so that they can be enthusiastic in the VIA examination program and it is better for door to door health workers in providing VIA education

Effect of menopause on circulating amino acid concentrations in women with fibromyalgia and healthy women.

Fibromyalgia is a complex syndrome that appears more frequently during menopause. No previous studies have investigated the effect of menopause on amino acids in women with fibromyalgia. Therefore, we have examined serum amino acid concentrations in premenopausal and postmenopausal women with fibromyalgia and healthy women. A case-control study was carried out in 28 premenopausal and 46 postmenopausal healthy women and in 16 premenopausal and 52 postmenopausal women with fibromyalgia. This study adheres to STROBE guidelines. Amino acid content was assayed using high-performance liquid chromatography. Significant differences were found in concentrations of several amino acids (aspartic acid, glutamic acid, histidine, glycine, alanine, leucine, and taurine) between healthy premenopausal women and premenopausal women with fibromyalgia and between healthy postmenopausal women and postmenopausal women with fibromyalgia. Concentrations of other amino acids (aminoadipic acid, asparagine, threonine, arginine, 5-methyl-histidine, valine, methionine, isoleucine, phenylalanine, ornithine, branched-chain amino acids, large neutral amino acids, essential amino acids, non-essential amino acids, basic amino acids, and arginine/ornithine ratio) were found to differ between healthy postmenopausal women and postmenopausal women with fibromyalgia, but not between healthy premenopausal women and premenopausal women with fibromyalgia. No significant differences were found in serum amino acid concentrations between premenopausal and postmenopausal healthy women or between premenopausal and postmenopausal women with fibromyalgia. Our results show, for the first time, that the association between menopause and fibromyalgia may increase the risk of metabolic disorders by disrupting amino acid homeostasis to a greater extent than menopause or fibromyalgia alone.

Tranexamic acid for postpartum bleeding: a systematic review and individual patient data meta-analysis of randomised controlled trials

Tranexamic acid is a recommended treatment for women with a clinical diagnosis of postpartum haemorrhage, but whether it can prevent bleeding is unclear. We conducted a systematic review and individual patient data (IPD) meta-analysis of randomised controlled trials to assess the effects of tranexamic acid in women giving birth. In this systematic review and IPD meta-analysis, we searched the WHO International Clinical Trials Registry Platform from database inception to Aug 4, 2024 for randomised trials that assessed the effects of tranexamic acid in women giving birth. Trials were eligible if they were prospectively registered, placebo-controlled, included more than 500 women, and had a low risk of bias for random sequence generation and allocation concealment. IPD were requested from the trial investigators. The primary outcomes were the numbers of women with life-threatening bleeding and thromboembolic events. We used a one-stage model to analyse the data and explored whether the effect of tranexamic acid varied by the underlying risk of life-threatening bleeding, type of birth, presence of moderate or severe anaemia, or timing of administration (before or after a diagnosis of postpartum haemorrhage). This study is registered with PROSPERO, CRD42022345775. We analysed data on 54 404 women from five trials. We obtained IPD for 43 409 women from four trials and aggregate data on 10 995 women from one trial. All trials had a low risk of bias. Life-threatening bleeding occurred in 178 (0·65%) of 27 300 women in the tranexamic acid group versus 230 (0·85%) of 27 093 women in the placebo group (pooled odds ratio [OR] 0·77 [95% CI 0·63-0·93]; p=0·008). There was no evidence that the effect of tranexamic acid varied by the underlying risk of life-threatening bleeding, type of birth, presence of moderate or severe anaemia or timing of administration. No significant difference was identified between tranexamic acid and placebo groups with regard to thromboembolic events: 50 (0·2%) of 26 571 women in the tranexamic acid group had fatal or non-fatal thromboembolic events versus 52 (0·2%) of 26 373 women in the placebo group (pooled OR 0·96 [0·65-1·41]; p=0·82) with no significant heterogeneity identified in the subgroup analyses. Tranexamic acid reduces the risk of life-threatening postpartum bleeding. We found no evidence that tranexamic acid increases the risk of thrombosis. Although we do not recommend the use of tranexamic acid in all women giving birth, consideration should be given to its use before a diagnosis of postpartum haemorrhage in women at high risk of death. The Bill & Melinda Gates Foundation.

Serum Uric Acid in Women with Preeclampsia and its Relation to Perinatal and Maternal Outcomes

Background and objective: Preeclampsia is a dangerous, progressive condition that is linked to maternal and neonatal death and morbidity. The purpose of this study was to determine the association between serum uric acid levels in preeclampsia with maternal and fetal outcomes. Method: A case-control study was conducted on 300 women delivered at the labour room of Duhok Obstetrics and Gynecology Hospital, from 1st of April 2021 to 1st of April 2022. The study participants were divided into two groups, pregnant women with preeclampsia and normotensive women. The serum uric acid levels of these women were estimated with the impact on fetal and mother outcomes. Results: There was a highly significant association between preeclamptic and normotensive women in relation to mean serum uric acid (5.862 ±1.416) mg/dL and (3.570 ±0.982) mg/dL respectively. A highly significant association was seen between uric acid test levels and maternal eclamptic fit, HELLP syndrome and admission to intensive care unit. A highly significant association also seen with newborn birth weight, APGAR scores and admission to neonatal intensive care unit. Conclusion: The current study demonstrates a significant raise in serum uric acid level in preeclamptic women and associated with adverse perinatal and maternal outcomes.

Abstract P381: Sex differences in association between gut microbiome and 24-hour blood pressure variability

Background: Blood pressure (BP) variability is an independent risk factor for cardiovascular disease (CVD). BP variability has been associated with cardiovascular organ damage and is a potential therapeutic target for the prevention of CVD. Recently, the gut microbiome (GM) has been shown to have a pathological role in hypertension, however, the association between GM and BP variability is poorly understood. Methods: 241 community-dwelling individuals free of symptomatic CVD from Hong Kong (113 males and 128 females, mean age 54±6 years) underwent ambulatory BP monitoring and stool microbiota shotgun sequencing. BP variability was determined as systolic/diastolic BP (SBP/DBP) coefficient of variation (CoV), nighttime dipping, and morning BP surge (MBPS). Sleep latency was estimated using 7-day Actigraphy data. Associations of BP variability with GM, and plasma and stool short-chain fatty acids (SCFAs) were analyzed under statistical models adjusting for age, sex, serum glucose and lipids, sodium intake assessed by urine analysis, menopause status, smoking, fatty liver, BP and sleep latency. Results: Women had a significantly higher 24-hour SBP ( p =0.0005) and DBP ( p =0.002) CoV than men. 24-hour SBP CoV had a negative association with GM α-diversity (Shannon and Simpson’s index: all P &lt;0.05) and a positive association with Firmicutes/Bacteroidetes ratio ( P &lt;0.05), suggesting gut dysbiosis in participants with higher systolic BP variability. Several GM species and SCFAs were significantly associated with the indices of BP variability in both men and women. Notably, Parabacteroides merdae had a negative association with both systolic and diastolic BP CoV (all P &lt;0.05-0.01). Bacteroidetes dorei and Bacteroides intestinalis were reduced in women with higher SBP CoV ( P &lt;0.05) and nondipping status ( P&lt; 0.01), respectively. Prewaking and sleepthrough MBPS had a positive association with Faecalibacterium prausnitzii in women (all P &lt;0.001) and plasma acetic acid levels in men ( P &lt;0.05-0.001). Further analysis indicated that Bacteroidetes dorei may mediate SBP CoV via plasma iso-butyric acid in women (bootstrapping 95% CI: -3.6 to -0.19; P &lt;0.05). Conclusions: This cross-sectional study suggests sex-specific associations between GM and BP variability. Most noteworthy, higher systolic BP variability was associated with a significant reduction in potentially beneficial bacterial species, primarily in women which may be explored for therapeutic potential.

Inositols and female reproduction disorders: a consensus statement from the working group of the Club of the Italian Society of Endocrinology (SIE)-Women's Endocrinology.

To provide the latest scientific knowledge on the efficacy of inositols for improving reproductive disorders in women with and without polycystic ovary syndrome (PCOS) and to reach a consensus on their potential use through a Delphi-like process. A panel of 17 endocrinologists and 1 gynecologist discussed 4 key domains: menses irregularity and anovulation, fertility, pregnancy outcomes, and neonatal outcomes. A total of eight consensus statements were drafted. Myo-inositol (Myo) supplementation can be used to improve menses irregularities and anovulation in PCOS. Myo supplementation can be used in subfertile women with or without PCOS to reduce the dose of r-FSH for ovarian stimulation during IVF, but it should not be used to increase the clinical pregnancy rate or live birth rate. Myo supplementation can be used in the primary prevention of gestational diabetes mellitus (GDM), but should not be used to improve pregnancy outcomes in women with GDM. Myo can be preconceptionally added to folic acid in women with a previous neural tube defects (NTD)-complicated pregnancy to reduce the risk of NTDs in newborns. Myo can be used during pregnancy to reduce the risk of macrosomia and neonatal hypoglycemia in mothers at risk of GDM. This consensus statement provides recommendations aimed at guiding healthcare practitioners in the use of inositols for the treatment or prevention of female reproductive disorders. More evidence-based data are needed to definitively establish the usefulness of Myo, the appropriate dosage, and to support the use of D-chiro-inositol (DCI) or a definitive Myo/DCI ratio.

Association of Vitamin D with Perfluorinated Alkyl Acids in Women with and without Non-Obese Polycystic Ovary Syndrome.

Perfluorinated alkyl acids (PFAAs) are persistent organic pollutants affected by BMI and ethnicity, with contradictory reports of association with vitamin D deficiency. Twenty-nine Caucasian women with non-obese polycystic ovary syndrome (PCOS) and age- and BMI-matched Caucasian control women (n = 30) were recruited. Paired serum samples were analyzed for PFAAs (n = 13) using high-performance liquid chromatography-tandem mass spectrometry. Tandem mass spectrometry determined levels of 25(OH)D3 and the active 1,25(OH)2D3. Women with and without PCOS did not differ in age, weight, insulin resistance, or systemic inflammation (C-reactive protein did not differ), but the free androgen index was increased. Four PFAAs were detected in all serum samples: perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), and perfluorohexane sulfonic acid (PFHxS). Serum PFOS was higher in PCOS versus controls (geometric mean [GM] 3.9 vs. 3.1 ng/mL, p < 0.05). Linear regression modeling showed that elevated PFHxS had higher odds of a lower 25(OH)D3 (OR: 2.919, 95% CI 0.82-5.75, p = 0.04). Vitamin D did not differ between cohorts and did not correlate with any PFAAs, either alone or when the groups were combined. When vitamin D was stratified into sufficiency (>20 ng/mL) and deficiency (<20 ng/mL), no correlation with any PFAAs was seen. While the analyses and findings here are exploratory in light of relatively small recruitment numbers, when age, BMI, and insulin resistance are accounted for, the PFAAs do not appear to be related to 25(OH)D3 or the active 1,25(OH)2D3 in this Caucasian population, nor do they appear to be associated with vitamin D deficiency, suggesting that future studies must account for these factors in the analysis.

Changes in the consumption of isoflavones, omega-6, and omega-3 fatty acids in women with metastatic breast cancer adopting a whole-food, plant-based diet: post-hoc analysis of nutrient intake data from an 8-week randomized controlled trial.

Diets rich in minimally processed plant-based foods are recommended to breast cancer patients, and some may have an interest in whole-food, plant-based (WFPB) diets that avoid animal-based foods, added fats, and refined sugars. Within WFPB diets, the intakes of isoflavones, omega-6 polyunsaturated fatty acids (n-6 PUFAs), and omega-3 polyunsaturated FAs (n-3 PUFAs), which have been discussed in reference to breast cancer outcomes, have not been well characterized. Women with stage IV breast cancer on stable therapy were randomized 2:1 into (1) a WFPB intervention (N = 21) or (2) usual care (N = 11) for 8 weeks. Three meals per day were provided. Outcomes presented here include dietary intake of isoflavones, n-3 and n-6- PUFAs, which were assessed using three-day food records at baseline and 8 weeks. Baseline and 8-week mean intake within groups were compared using the Wilcoxon signed-rank test and between control and intervention groups by a two-sample t-test. The WFPB intervention participants increased their daily consumption of total isoflavones from a mean of 0.8 mg/day to 14.5 mg/day (p < 0.0001) and decreased the n-6:n-3 ratio of their diet from a mean of 9.3 to 3.7 (p < 0.0001). Within the WFPB group, linoleic acid (n-6 PUFA) consumption decreased by a mean of 3.8 g (p = 0.0095), from 12.8 g/day to 9.0 g/day; total n-3 PUFA consumption increased by a mean of 1.1 g (p = 0.0005), from 1.6 g/day to 2.7 g/day. Transitioning to a WFPB diet resulted in significantly increased isoflavone intake and decreased n-6:n-3 ratio in women with breast cancer.

Phosphorus modifies the association between body mass index and uric acid: Results from NHANES 2007-2018.

Studies in recent years have shown that high uric acid causes harm to the human body, which has become a serious public health problem. Elevated serum uric acid has been shown to be associated with obesity, but the relationship between BMI and uric acid (UA) remains controversial. Although the association between BMI and UA has been well studied, the effect of phosphorus levels in vivo on this association remains unclear. This study aimed to determine the relationship between BMI and serum uric acid and the effect of phosphorus on the relationship between the two. The present study analyzed data from the National Health and Nutrition Examination Survey (NHANES) continuous 2007-2018 cycle. We included 10786 participants aged 20 years and over. Multivariable linear regression was performed to assess the association between BMI and serum uric acid. phosphorus was stratified into low phosphorus (<3.3 mg/dl), middle phosphorus (3.3-3.9 mg/dl) and high phosphorus (>3.9 mg/dl). Correction of the effect of phosphorus was assessed by testing the interaction between BMI and UA in multivariate linear regression. In this cross-sectional study, we found that BMI was positively associated with UA in the female population but not significantly in the male population or in the total population. In multiple regression analysis, UA was 0.51 higher in the highest female BMI group than in the lowest group (p = 0.0001). The relationship between BMI and UA differed significantly by gender under the influence of phosphorus, with men and women in Model II having a greater elevation of UA in men than in women within most groups. (BMI >30, phosphorus >3.9 mg/dl, β:0.83 95% CI: 0.43, 1.23 vs β: 0.79 95% CI: 0.30, 1.29). In addition, phosphorus significantly altered the positive association between BMI and UA in most models. Our results indicate significant associations between BMI and uric acid in women, with higher BMI values likely to be associated with a higher risk of hyperuricemia, suggesting that uric acid levels in obese people should be closely monitored in clinical practice. Phosphorus and BMI have an interactive effect in elevating UA and should be noted as indicators of phosphorus in clinical practice.

Alterations of the gut microbiota and fecal short-chain fatty acids in women undergoing assisted reproduction.

The community structure of gut microbiota changes during pregnancy, which also affects the synthesis of short-chain fatty acids (SCFAs). However, the distribution of gut microbiota composition and metabolite SCFA levels are poorly understood in women undergoing assisted reproductive technology (ART). To evaluate the changes in gut microbiota composition and metabolic SCFAs in women who received assisted reproduction treatment. Sixty-three pregnant women with spontaneous pregnancy (SP) and nine with ART pregnancy were recruited to provide fecal samples. Gut microbiota abundance and SCFA levels were determined by 16S ribosomal RNA (rRNA) gene amplicon sequencing and gas chromatography-mass spectrometry (GC-MS). The ART group showed decreased alpha diversity (the species richness or evenness in a sample). The principal coordinates analysis (a method of analysing beta diversity) showed significant difference in gut microbiota between the ART group versus the SP group (unweighted UniFrac distance, R2=0.04, P=0.003). Proteobacteria, Blautia and Escherichia-Shigella were enriched in the ART group, whereas the relative abundance of beneficial intestinal bacteria Faecalibacterium was lower than in the SP group. Different modes of conception were associated with several SCFAs (valeric acid (r=-0.280; P=0.017); isocaproic acid (r=-0.330; P=0.005); caproic acid (r=-0.336; P=0.004)). Significantly different SCFAs between the two groups were synchronously associated with the differential gut microbiota. The diversity and abundance of gut microbiota and the levels of SCFAs in women undergoing ART decreased. The application of ART shaped the microbial composition and metabolism, which may provide critical information for understanding the biological changes that occur in women with assisted reproduction.

Breastfeeding initation after Postpartum Haemorrhage: Associated factors and potential implications

Abstract Background Breastfeeding has been recognised as a significant driver of neonatal and infant outcomes, particularly in LMIC settings. Postpartum haemorrhage (PPH) is an increasingly common complication of childbirth, with multiple effects on mothers and their babies. This study aimed to explore the association between aspects of PPH care and outcomes and the rates of breastfeeding among this cohort of women. Methods This was a secondary analysis of data from the WOMAN trial, an international, randomised, double-blind, placebo-controlled trial, investigating the effect of tranexamic acid in women who have experienced PPH. A binary logistic regression model was developed to examine the associations between the rates of any breastfeeding during the study period and the occurrence of specific factors within the peripartum period. Results 16,285 mothers of healthy singleton babies were included in the current study. Factors that may result in maternal-infant separation in the immediate postpartum period were significantly associated with lower rates of breastfeeding. These included: the mother requiring transfer between hospitals following PPH (Odds Ratio 0.47 [95%CI 0.41-0.54]) and the mother being admitted to ICU postpartum (OR 0.65 [95%CI 0.54-0.78]). Transfusion of any blood product was associated with a lower rate of breastfeeding (OR 0.82 [95%CI 0.73-0.93]), as was the use of Ergometrine (OR 0.69 [95%CI 0.62-0.77]). Maternal pain (OR 0.65 [95%CI 0.58-0.75]) and maternal anxiety or depression (OR 0.63 [95% CI 0.53-0.75]) were also associated with lower rates of breastfeeding. Conclusions Identifying women at higher risk of experiencing difficulties in initiating or sustaining breastfeeding following a PPH may allow for targeted information and support to be provided to those women. Specific prospective research should be carried out to ascertain the true implications of the identified associations. Key messages • Identifying women at higher risk of experiencing difficulties in initiating or sustaining breastfeeding following a PPH may allow for targeted information and support to be provided to those women. • Certain environments, interventions and aspects associated with PPH care are associated with lower rates of breastfeeding initiation prior to hospital discharge.

Evaluation of the efficacy and safety of bempedoic acid in women and men: Pooled analyses from phase 3 trials

Background and aimsSex-specific differences in the response to lipid-lowering therapies have been reported. Here, we assessed the effect of bempedoic acid in women and men using pooled, patient-level data from four phase 3 clinical trials of bempedoic acid. MethodsPatients were grouped into two pools: 1) atherosclerotic cardiovascular disease (ASCVD) and/or heterozygous familial hypercholesterolemia (HeFH) “on statins” and 2) “low-dose or no statin”. Percent changes from baseline to at least week 12 in low-density lipoprotein cholesterol (LDL-C), non–high-density lipoprotein cholesterol (non–HDL-C), total cholesterol (TC), apolipoprotein B (Apo B), and high-sensitivity C-reactive protein (hsCRP), as well as safety, were analyzed by statin pool and sex. ResultsOverall, 3623 patients were included (bempedoic acid, 2425; placebo, 1198). Significant reductions in lipid parameters and hsCRP were observed with bempedoic acid vs. placebo in both sexes in the ASCVD and/or HeFH on statins (n = 3009) and the low-dose or no statin (n = 614) pools (p ≤ 0.002). Compared with men, women had significantly greater placebo-corrected reductions in LDL-C (−21.2% vs. −17.4%; p = 0.044), non–HDL-C (−17.3% vs. −12.1%; p = 0.003), TC (−13.8% vs. −10.5%; p = 0.012), and Apo B (−16.0% vs. −11.3%; p = 0.004) in the ASCVD and/or HeFH on statins pool. Women had similar reductions to men in lipid parameters in the low-dose or no statin pool and hsCRP in both pools. The safety of bempedoic acid was comparable between sexes. ConclusionsIn this pooled analysis, women experienced significant improvements in levels of LDL-C and other lipid parameters with bempedoic acid.

YouTube as a source of information on preventing the use of valproic acid in women during pregnancy

BackgroundYouTube™ (http://www.youtube.com), as a very popular video site worldwide, is increasingly being used as a platform to disseminate health information. The purposes of this review were to assess the overall usefulness of the information on the prevention of valproic acid use in women during pregnancy on YouTube™ for patients.MethodsThe YouTube™ website was systematically using 8 keywords. One hundred and fifty four videos meet the selection criteria. The researcher evaluated the video duration, days since upload, views and the likes. These videos are categorized as Education, News & Politics and People & Blogs. We designed a usefulness scoring scheme to assess videos quality and classified them as “slightly useful”, “useful” and “very useful”. The Kruskal-Wallis test was used to determine whether differences existed between total usefulness scores and categories and Pearson chi-square test for categorical variables.ResultsThe majority of videos were educational (62.8%). The "People & Blogs" and "News & Politics" videos scored significantly higher, but had no significant difference in days since upload, views, views/day or likes. More than half of the videos (91/154) were categorized as “useful”. The mean posted days (p = 0.045) was significantly different in the useful group compared with the slightly useful group. There were no correlation between usefulness and the number of days since upload, duration, views, views/day, or likes.ConclusionYouTube™ is a promising source of information regarding the use of valproic acid during pregnancy. "News & Politics" videos are the most usefulness. Considering the presence of more slightly useful information, publishers need to improve more comprehensive video content that includes replacement medications, diagnoses and treatments. In the healthcare information space, consumers need to be directed to reliable video.

Evaluating the hemostatic effects of tranexamic acid in women with pre-eclampsia.

To evaluate the hemostatic effects of tranexamic acid (TXA) ex vivo in women with pre-eclampsia. This was an ex vivo study involving 45 normal pregnant women and 45 women with pre-eclampsia (nine with mild and 36 with severe features) matched for age, gestational age, and body mass index. Blood samples were collected and divided into two parts. The first served as the pre-TXA sample, while the second was spiked with TXA and served as the post-TXA sample. Plasma levels of D-dimer and plasmin-antiplasmin complex (PAP) were determined using enzyme-linked immunosorbent assay. The mean D-dimer and PAP values in the pre-TXA samples differed significantly between groups. Following spiking with TXA, the mean D-dimer and PAP levels did not differ significantly in the pre-TXA and post-TXA samples (P = 0.560 and P = 0.500, respectively) in the pre-eclampsia cohort. In normal pregnancy, the mean D-dimer and PAP levels in the post-TXA samples did not differ significantly (P = 0.070 and P = 0.050, respectively) from the pre-TXA samples following TXA spiking. TXA did not significantly affect D-dimer and PAP levels in pre-eclampsia, suggesting that TXA may not increase the thrombotic risks in patients with pre-eclampsia.

Mental health, Reproductive health and contraception: pharmacological interaction, current evidence and challenges

IntroductionMental pathology is relatively prevalent in the women, and there is often a need for treatment with psychotropic drugs, with an impact on women’s reproductive health. The use of contraception is widely spread among this population and the choice between these methods must be considered carefully.ObjectivesThis review aims to present the main interactions between contraceptive methods and psychotropic therapy and its impact on psychiatric disorders, in addition to the precautions to be taken in their choice.MethodsLiterature review of relevant articles on Pubmed. Query: Contraceptive+(psychiatric disorder, depression, anxiety, schizophrenia, bipolar disorder, psychotropic drugs).ResultsBased on current evidence, no statistically significant differences regarding unplanned pregnancy rates or the psychotropic treatment outcomes were found when using combined oral contraceptives and antidepressants, benzodiazepines or atypical antipsychotics (being clozapine the exception). The impact of contraceptive methods on mood was unclear, as some articles showed an association between contraceptive use and a higher risk of beginning antidepressants and others showing no differences or even as a protective factor. Although the interactions of the aforementioned drugs are infrequent, there are cases where important interactions occur, such as clozapine, valproic acid, lamotrigine and carbamazepine, as some herbal products as the St.John’s wort. With clozapine, there is an increased serum concentrations, while the opposite occurs in the case of valproate and lamotrigine with a decrease of 32.6% and 23.4%, respectively. Treatment with valproic acid in women of childbearing age has been discouraged because of its association with polycystic ovary syndrome, elevated testosterone concentrations and menstrual irregularities, in addition to the risk of fetal malformations. In cases where this drug is prescribed, it is recommended to use highly effective methods such as subcutaneous implants or intrauterine devices. Lamotrigine and carbamazepine reduce the effectiveness of some contraceptive methods, such as oral contraceptives, transdermal patch and vaginal ring, in which case the placement of a subcutaneous implant or intrauterine device is indicated.ConclusionsThe magnitude of the impact between contraceptives, regarding depressive disorders, is unclear. The evidence shows that some women report the appearance and recrudescence of depressive symptoms, evidencing the need of further studies to identify the risk factors in these cases. The importance of clear and simple information and a shared decision on which contraception to choose is crucial, as clarification about their interactions with psychiatric treatment. The clinician must also be aware of the implications for reproductive health, in order to reduce the risks and side effects associated with some drugs.Disclosure of InterestNone Declared

Impact of regulatory restrictions on the use of valproic acid in women of childbearing age: An Italian study.

Due to significant risks to the offspring after intrauterine exposure, the European Medicines Agency issued recommendations in 2014 and 2018 restricting the use of valproate (VPA) in women of childbearing age (WOCA). We aimed to evaluate their impact in the Emilia-Romagna region (ERR) of Northern Italy. Using administrative databases, we identified all the ERR residents who received antiseizure medication (ASM) prescriptions from 2010 to 2020. Time series of incidence rates by sex and age group were evaluated for all ASMs. Focusing on VPA, an interrupted time series analysis was applied to assess the impact of the restrictions in WOCA with epilepsy (WOCA-E) and WOCA with psychiatric disorders (WOCA-P). We then evaluated the chronological order of ASM prescriptions with regard to the position of VPA. Incidence rates of VPA prescriptions overall decreased over time. A significant decrease was observed only for females. The effect was stronger for WOCA, after both the first (incidence rate ratio [IRR]=.85, 95% confidence interval [CI]=.75-.96) and the second restriction (IRR=.67, 95% CI=.55-.82). The decrease was significant after the second restriction both for WOCA-E (IRR=.43, 95% CI=.27-.68) and for WOCA-P (IRR=.49, 95% CI=.35-.70), as well as VPA as a first prescription in both populations. VPA prescriptions as further choice did not show the same trend. After the regulatory restrictions, an overall significant decline in the use of VPA in WOCA was observed in ERR. The second restriction has been effective in consolidating the prescription trend. However, VPA appears still to be a commonly used drug in WOCA when other ASMs have failed.

Behavior during aging of bone-marrow fatty-acids profile in women's calcaneus to search for early potential osteoporotic biomarkers: a 1H-MR Spectroscopy study.

Identify new potential biomarkers of osteoporosis at an early stage, by magnetic resonance spectroscopy (MRS), studying early changes in the metabolic profile of bone-marrow fatty acids in women's calcanei during healthy aging and osteoporosis status. Single voxel MRS was performed by using a point resolved spectroscopy (PRESS) sequence at 3T. Thirty-four Caucasian women (age range: 22-59years) were recruited to investigate calcaneus bone marrow. The cohort was constituted of four groups according to age, menopausal status, and T-score evaluated after a DXA examination on the femoral neck. Women were classified in young control (n=11, mean age=26.5±3.8 y, age range: 22-34years), perimenopausal groups (n=11, mean age=42.0±3.6 y, age range: 37-47years), postmenopausal group (n=9, mean age=55.4±2.9 y, age range: 50-59years, mean T-score=-1.70±0.50) and osteoporotic group (n=6, mean age=53.0±2.8 y, age range: 50-58years, mean T-score=-2.54±0.10). The total lipid content (TL), the Unsaturation Index (UI), and the fraction of unsaturated/polyunsaturated fatty acid (fUFA and fPUFA) were calculated. TL was significantly correlated with age (r=0.73, p<0.001). TL increases linearly with age in the young + perimenopausal population (r=0.92, p<0.001) but this trend is not significant in the postmenopausal subject (r=0.48, p=0.07). No significant correlation was found between T-Score and TL in postmenopausal and osteoporotic women, whereas a significant correlation was found between TL and time interval (tp) between the age at menopause and the age of the subject at the MRS examination. Conversely, no correlation was found between T-score and tp. The unsaturation index (UI) does not significantly discriminate between osteoporotic, peri- and postmenopausal women. On the other hand, fUFA is significantly different in peri-menopausal and osteoporotic subjects (p=0.02), while fPUFA is significantly different both between peri- and postmenopausal women (p=0.05) and postmenopausal and osteoporotic subjects (p=0.03). Both fUFA and fPUFA did not correlate with subjects' age. In the female calcaneus, fUFA and fPUFA are promising measurable quantities for the characterization of bone marrow's composition potentially correlated with the development of osteoporosis, whereas UI does not differentiate between subjects of varying osteoporotic status. The fact that the TL in the calcaneus is correlated with tp, indicates that active metabolic changes are still occurring in these subjects, giving complementary information to the DXA about the changes in bone marrow's composition which may affect the whole bone health.

Branched-chain and aromatic amino acid levels response to an oral glucose load associated with gestational diabetes mellitus

Serum branched chain amino acids (BCAAs) and aromatic amino acids (AAAs) are associated with obesity, insulin resistance and type 2 diabetes mellitus (T2DM). We investigated the levels of these amino acids in women with gestational diabetes mellitus (GDM) and examined their changes in response to an oral glucose tolerance test (OGTT). 110 women were enrolled and underwent a 75-g OGTT during their second trimester; 43 women were diagnosed with GDM and 67 women did not have GDM (non-GDM women). During the OGTT, fasting, 1-h, and 2-h blood samples were obtained. BCAA and AAA levels were measured by liquid chromatography-tandem mass spectrometry. The differences in BCAA and AAA levels between GDM and non-GDM women were not evident during fasting but became significant after glucose loading. Glucose ingestion decreased the levels of BCAAs and AAAs in both groups. Notably, GDM women showed a delayed and blunted decrease in these amino acids compared to non-GDM women. The risks of 2-h changes in BCAAs and AAAs for GDM women were significant. We identified that the differences in BCAA and AAA levels between GDM women and controls, which were not evident during fasting, could be provoked by performing an OGTT.

Level of Uric Acid in Women Suffering from Pre-Eclampsia and its Comparison with Normal Pregnancy

Objective: Current study is conducted to explore the variations in uric acid level in pre-eclamptic and normal healthy pregnancy in its third trimester in pregnant females. Methods: This descriptive cross sectional study was conducted to measure the serum uric acid level in mg/dl by kit method. The cutoff value was kept at 5mg/dl. The 10 ml of midstream urine was collected for estimation of urinary protein by dipstick method and graded from +1 to +3. For comparison between two groups in terms of levels of uric acid, independent sample t-test was used. Pearson Chi Square test was used to compare qualitative variables. Results: Raised levels of uric acid were obtained in 81.6% preeclampsia samples, and 13.1% found among normal samples, p&lt;0.01 showed that level of serum uric acid has a significant relationship with preeclampsia. Independent sample t-test showed a significant mean difference for SBP, DBP, and SUA between two groups, (p&lt;0.01) Conclusion: Significant high level of serum uric acid level was found in pre-eclamptic females than normotensive women. The findings suggest that measurement of serum uric acid may be a suitable marker in diagnosis of pre-eclampsia. Keywords: Pregnancy, Pre-eclampsia, Serum Uric Acid, Hypertension