Different Trimesters Of Pregnancy Research Articles

Resolvin D1 level during different trimesters of pregnancy for predicting the risk of fetal growth retardation in elderly pregnancy

Resolvin D1 (RvD1) is potentially associated with fetal growth retardation (FGR) through alleviating maternal inflammation and its linkage with several pregnancy complications. Thus, this study detected RvD1 levels at different trimesters of pregnancy, aiming to investigate its role in predicting FGR risk of elderly pregnant women. This prospective, observational cohort study enrolled 165 elderly pregnant women aged ≥35 years. Serum RvD1 was detected at 10–13 weeks (early pregnancy), 20–23 weeks (middle pregnancy), and 30–33 weeks (late pregnancy) of gestational week by enzyme-linked immunosorbent assay. RvD1 was varied among different trimesters of pregnancy in elderly pregnant women (p < 0.001). FGR occurred in 25 (15.2%) women in this study. RvD1 at early (p = 0.009), middle (p = 0.002), and late (p = 0.003) pregnancy was decreased in women with FGR versus those without. By multivariate analysis, RvD1 at middle pregnancy (odds ratio (OR): 0.477, p < 0.001), pre-pregnancy body mass index (OR: 0.763, p = 0.025), and gestational diabetes mellitus (yes versus no) (OR: 0.071, p = 0.031) were independently correlated with declined FGR risk. While age (OR: 1.382, p = 0.009) was independently associated with elevated risk of FGR. Furthermore, the combination of these independent factors as a predictive model exhibited a good potential for assessing FGR risk (area under the curve: 0.802, 95% confidence interval: 0.711–0.894). In conclusion, RvD1 at different trimesters of pregnancy is negatively linked with the risk of FGR, whose level at middle pregnancy serves as an independent factor for FGR risk in elderly pregnant women.

Evaluation of changes in exhausted T lymphocytes and miRNAs expression in the different trimesters of pregnancy in pregnant women.

Throughout the three trimesters of a typical pregnancy, we looked at changes in the expression of miRNAs and exhausted T lymphocytes for this study. Fifty healthy subjects were included in this study. The frequency of exhausted T lymphocytes was measured in isolated PBMCs using flow cytometry. PD-1, TIM-3, and related miRNAs gene expression were assessed using qRT-PCR. The analyses revealed a significant decline in PD-1 and Tim-3 expression in PBMCs from RPL women (p = 0.0003 and p = 0.001, respectively). In addition, PD-1 and TIM-3 expression increased significantly in the 2nd trimester compared with the 1st trimester of healthy pregnant women (p < 0.0001 and p = 0.0002, respectively). PD-1 and TIM-3 expression was down-regulated in the 3rd trimester compared with the 1st and 2nd trimesters. In the present study, we demonstrated that TIM-3+/CD4+, TIM-3+/CD8+, PD-1+/CD4+, and PD-1+/CD8 + exhausted T lymphocytes increased in the circulation of women in the 2nd trimester compared to the 1st and 3rd trimester. In the 3rd trimester, the expression of miR-16-5p increased significantly (p < 0.0001). miR-125a-3p expression was down and upregulated in 2nd (p < 0.0001) and 3rd (p = 0.0007) trimesters compared to 1st trimester, respectively. This study showed a significant elevation of miR-15a-5p in 3rd trimester compared to 1st trimester of pregnant women (p = 0.0002). Expression pattern of PD-1 and TIM3 in exhausted T lymphocytes is different not only between normal pregnant and RPL women but also in different trimesters of pregnancy. So, our results showed the role of these markers in the modulation lymphocytes activity in different stages of pregnancy.

Therapeutic Drug Monitoring of Levetiracetam in Different Trimesters of Pregnant Women with Epilepsy in a Tertiary Care Center: A Prospective Study.

Levetiracetam is the most commonly used antiepileptic drug in pregnant women due to its low teratogenic risk profile, favorable pharmacokinetic characteristics, and safety profile. Serum levels of levetiracetam vary in epilepsy during pregnancy. Therefore, the aim of the study was to evaluate the serum levels of levetiracetam during different trimesters of pregnancy by using therapeutic drug monitoring (TDM). This was a single-center, prospective study. Pregnant women with epilepsy on levetiracetam were enrolled after getting written informed consent from them. Serum trough levels of levetiracetam were estimated at all trimesters by high-performance liquid chromatography (HPLC). The study included 16 participants with mean ± standard deviation (SD) age of 27.75 ± 4 years. There were nine (56.2%) participants with generalized seizure disorder and seven (43.8%) participants of focal seizure disorder. Among 16 patients, 10 (62.5%) participants were on levetiracetam alone and six (37.5%) participants were on levetiracetam combined with other antiepileptic drugs. In a total of 48 trough samples, 45 sample concentrations were below the therapeutic range of 12-46 mg/l and three sample concentrations were within the therapeutic range. There was a statistically significant difference in the concentration-dose ratio (CDR) of levetiracetam between the third and first trimesters (P-value 0.018). There was a statistically significant difference in serum levetiracetam concentration between the third and first trimesters. A well-conducted, intensive pharmacokinetic sampling study in PWWE with a control group is needed in future to evaluate the whole pharmacokinetic profile of levetiracetam and to correlate the clinical outcome.

Investigation of the Prevalence of Back Pain and Related Risk Factors in Different Trimesters of Pregnancy in Pregnant Women Referring to Selected Health Centers in Shahrekord, Iran, During 2022-2023

Background and aims: Back pain is one of the most common and often neglected problems in pregnancy. This study aimed to investigate the prevalence of back pain and its associated risk factors during the trimesters of pregnancy in pregnant women referring to selected healthcare centers in Shahrekord from 2022 to 2023. Methods: This cross-sectional study was conducted on 521 eligible pregnant women referring to selected holistic healthcare centers in Shahrekord, Iran, during 2022-2023. Data were collected using a demographic characteristics checklist completed as a self-report, and the presence of back pain was evaluated based on the perception and feeling that the mother herself had of any pain in the lower back area. The data were analyzed using SPSS (version 26), and P&lt;0.05 was considered the significance level. Results: The prevalence of back pain in pregnant women was 62.7% in general, with a significant difference among trimesters of pregnancy (P&lt;0.001). Among the investigated risk factors, there was a significant association between employment (P=0.01), type of delivery (P=0.002), type of anesthesia (P&lt;0.001), history of back pain before pregnancy (P&lt;0.001), and standing break of more than three hours (P&lt;0.001) and the prevalence of back pain. In addition, increasing gestational age (P&lt;0.001, odds ratio=1.308, 95% confidence interval=1.255–1.363) was a significant predictor of back pain in pregnancy. Conclusion: The results revealed that more than half of women experience back pain during pregnancy, and the most powerful factor in the prevalence of this disorder is increasing gestational age. Considering the high prevalence and effects of pain on the quality of life of pregnant women, it is important for service providers to identify and develop policies and design effective interventions to prevent or solve this problem.

Changes in Serum Concentrations of Bone Turnover Markers in Healthy Pregnant Women.

Changes in bone metabolism during pregnancy have not received sufficient attention because of the lack of effective screening tools. Bone turnover markers (BTMs) could reflect the changes of bone metabolism. Currently, reference intervals for bone metabolism during normal pregnancy are inconclusive. This study aimed to determine reference intervals for BTMs in pregnant women taking prenatal care and to facilitate clinical research on diseases affecting bone metabolism during pregnancy. We surveyed 120 low-risk pregnant women attending routine antenatal care from January 2020 to March 2020. The serum levels of procollagen type I N-propeptide (PINP), N-terminal osteocalcin (N-MID), and C-terminal telopeptide of type I collagen (β-CTX) were measured in the first trimester (<13 weeks), second trimester (14-27 weeks), and third trimester (>28 weeks). Reference intervals for BTMs during pregnancy were analyzed. The Kruskal-Wallis test and paired t-test are used to analyze differences between groups. Spearman correlation coefficients expressed the measure of linear association. The bone resorption marker β-CTX in third trimester increases compared to the first trimester and the second trimester (P < 0.001, P < 0.001). The bone formation markers PINP and N-MID were decreased from the first trimester to the second trimester (P = 0.01, P < 0.001) and then raised from the second trimester to the third trimester (P < 0.001, P < 0.001). Two indices of bone turnover rate, β-CTX/PINP and β-CTX/N-MID, were increased from the first trimester to the second trimester (P < 0.001, P < 0.001) and then decreased from the second trimester to the third trimester (P = 0.02, P < 0.001). This study established reference intervals for BTMs in pregnant women and observed the changes in BTMs during the different trimesters of pregnancy. The present findings can help in clinical monitoring of the effects of pregnancy diseases on the bone metabolism of pregnant women.

The effectiveness of assisted reproductive technologies immunological prediction

The high frequency of infertility is a significant medical and social problem in many countries of the world; assisted reproductive technologies (ART) are actively used to solve it. Given that immune responses play an important role in the development and maintenance of pregnancy, the study of changes in immune parameters is relevant in different trimesters of pregnancy, as well as at the stage of preconception preparation. It is believed that the maternal-fetal relationship is not limited to the development of maternal tolerance to fetal antigens, but is complemented by complex cytokine interactions that control selective immune regulation, control of adhesion and vascularization processes during embryo implantation and pregnancy. The purpose of the review was to analyze the available scientific data on the use of immune parameters to predict the effectiveness of ART. A review of Russian and foreign scientific papers on prevalence, immunopathogenetic mechanisms, and infertility diagnostics was carried out. A multi-criteria search was carried out for inventions, abstracts of patent documents on immunological prediction of the effectiveness of ART. As predictors, immunocompetent cells (CD3+-, CD4+-, CD3-CD16+56+-venous blood lymphocytes, CD95+ macrophages of endometrial biopsy), cytokines, pregnancy glycoproteins, autoantibodies, immunogenetic markers are presented. The study of the quantitative level of cytokines in blood serum, ovarian follicular fluid and endometrium as mediators of intercellular and intertissue interactions is of undoubted scientific and practical interest in terms of establishing their discriminatory levels specific to different trimesters of a normal pregnancy, the threat of miscarriage, and infertility. There was an association with non-occurrence of pregnancy due to in vitro fertilization of an increased content of interleukin (IL)-2 and interferon (IFN)-γ in the follicular fluid, and a soluble receptor IL-2-α, IL-8 and lactoferrin in the blood serum. The immunosuppressive effects of pregnancy-associated α2-glycoprotein, trophoblastic β1-glycoprotein, α-fetoprotein, α2-macroglobulin contribute to the development and maintenance of pregnancy, but their prognostic value is not unambiguous. The study of the content of immunoglobulins G to α2-macroglobulin, lactoferrin, progesterone, estradiol, cardiolipin in the follicular fluid and blood serum makes it possible to predict the result of ART. Conclusion. The study of immune parameters, especially in combination with sex hormones and characteristics of the state of the embryo, in infertile women has diagnostic value and prognostic significance, and can contribute to the timely correction of therapy and the ART program.

The effect of hormone-modulating therapy during pregravid preparation on the course of pregnancy and childbirth in patients with a history of endometriosis

BACKGROUND: Endometriosis is a benign proliferation of tissue similar in morphological and functional characteristics with endometrium outside the uterine. In the structure of gynecological diseases, it ranks on the third place and its prevalence is growing steadily every year.&#x0D; AIM: The aim of this study was to analyze the features of pregnancy and childbirth in patients with endometriosis who received hormone-modulating therapy during pregravid preparation.&#x0D; MATERIALS AND METHODS: This retrospective analysis of the course of pregnancy and childbirth in patients with a surgically confirmed diagnosis of varying severity endometriosis (n = 140) in history was carried out at the Center for Diagnosis and Treatment of Endometriosis, The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott, Saint Petersburg, Russia. The control group consisted of pregnant women without endometriosis (n = 50).&#x0D; RESULTS: Before pregnancy, 82.1% (n = 115) of patients with endometriosis used hormone-modulating therapy, while 17.9% (n = 15) of patients did not comply with the given therapy. During therapy, 70% (n = 98) of patients mentioned decreasing in the severity of pain. In patients with a history of endometriosis, threatened miscarriage took the leading place and was identified in 24.3% of cases in the first and second trimesters and in 33.6% of cases in the third trimester of pregnancy, which was consistently higher than in the control group. Miscarriage was observed in 38.5% of patients and recurrent pregnancy loss in 18.6% of women. Preeclampsia was diagnosed in 23.8% (n = 33) of patients with endometriosis. The use of hormone-modulating therapy during pregravid preparation was shown to reduce the risk of developing preeclampsia among patients with endometriosis by 4.1 times, and the use of dienogest 2 mg as the therapy of endometriosis to reduce the frequency of preeclampsia by ten times in comparison with patients who did not receive any treatment. Fetal growth restriction was observed in 18.6% (n = 26) of patients with endometriosis. The presence of endometriosis increased the likelihood of developing fetal growth restriction by 3.6 times and reduced the likelihood of having a large fetus by 2.7 times. Preterm birth was observed in 20% (n = 28) of patients with endometriosis, which is four times higher than in the control group (p = 0.019). Most pregnant women with a history of endometriosis – 64.3 % (n = 90) of patients – were delivered by cesarean section, while 35.7% (n = 50) of women had vaginal birth, which was 3.34 times higher than the frequency of cesarean section in the control group.&#x0D; CONCLUSIONS: Patients with a history of endometriosis are at high risk for the development of obstetric complications associated with the pathogenesis of the disease. An integrated approach to the treatment of endometriosis with the use of hormone-modulating therapy during pregravid preparation and personalized management of patients in different trimesters of pregnancy can reduce the risk of complications of pregnancy and childbirth.

Operative vs Nonoperative Management of Acute Cholecystitis During the Different Trimesters of Pregnancy

Acute cholecystitis (AC) management during pregnancy requires balancing the risk of pregnancy loss or preterm delivery (adverse pregnancy outcomes [APOs]) with or without surgery. Guidelines recommend cholecystectomy across trimesters; however, trimester-specific evidence on the risks of AC and its management is lacking. To assess cholecystectomy frequency in pregnant people with AC, compare the rates of APOs in pregnant people with or without AC, and compare the rates of APOs in people with AC who did or did not undergo cholecystectomy. This retrospective, population-based cohort study used data for pregnant people with AC from the IBM MarketScan Commercial Claims and Encounters Database from January 1, 2007, to December 31, 2019, and a propensity score-matched cohort of pregnant people without AC. Trimester status (first [T1], second [T2], and third [T3]), APOs, and cholecystectomy were defined by administrative claims. Data were analyzed from October 2021 to July 2022. Pregnant patients with or without AC. Pregnant patients with AC who did or did not receive cholecystectomy. The main outcomes were cholecystectomy during pregnancy and APOs (ie, preterm delivery and pregnancy loss). Pregnant patients with and without AC were compared to assess the association of AC with risk of APOs. Propensity score inverse-probability weighting was used to calculate treatment-associated APO risk among patients with 1-year follow-up. The study included 5759 pregnant patients with AC (mean [SD] age, 30.1 [6.6] years) and 23 036 controls (mean [SD] age, 29.9 [6.7] years) after propensity score matching. Among 3426 pregnant patients with AC and 1-year follow-up, 1182 (34.5%) underwent cholecystectomy during the pregnancy (684 [41.7%] presenting with AC in T1, 404 [40.4%] in T2, and 94 [12.0%] in T3). Acute cholecystitis during pregnancy, irrespective of treatment, was associated with higher odds of APO compared with no AC during pregnancy across all trimesters (odds ratio [OR], 1.69 [95% CI, 1.54-1.85]). Compared with nonoperative management, receipt of surgery was associated with lower odds of APOs across all trimesters (OR, 0.75 [95% CI, 0.63-0.87]), in T1 (OR, 0.81 [95% CI, 0.66-1.00]), in T2 (OR, 0.71 [95% CI, 0.50-1.00]), and in T3 (OR, 0.45 [95% CI, 0.28-0.70]). In this study, cholecystectomy was associated with lower risk of APO in patients with AC across all trimesters, with the greatest benefit in T3. However, only 34.5% overall and 12.0% of patients in T3 had a cholecystectomy. These findings support guidelines recommending cholecystectomy during pregnancy and should inform decision-making discussions. Greater guideline adherence and surgery use, especially in T3, may represent an opportunity to improve outcomes for pregnant people with AC.

The impact of socio-demographic and obstetric characteristics on the prevalence of major depression in the antenatal population in the core Niger delta

Background: Antepartum depression (APD) is also of immense concern because of its grave consequences on the mother, pregnancy outcomes, child development and the family. Its prevalence is under the influence of several factors. Aim: To determine the impact of patients’ socio-demographic and obstetric characteristics on the prevalence of major antenatal depression in Rivers State University Teaching hospital, Nigeria. Methods: This was a cross-sectional study of 163 pregnant women who were recruited via systematic random sampling in the antenatal clinic of Rivers State University Teaching Hospital over a period of 4 months. Data on socio-demographic and obstetrics characteristics of the patients were obtained with the aid of semi-structured interviewer-administered questionnaire. Screening for and diagnosis of depression was done using the Edinburgh Postnatal Depression Scale (EPDS). Data collected was analyzed using the Statistical Package for Social Sciences (SPSS) version 20 statistical software. Descriptive analysis of all the variables in the study was carried out using frequency tables and bar charts. The associations between depression during pregnancy and the independent variables (socio-demographic, gestational and obstetric characteristics) were assessed using Chi-square test or a Fisher’s exact test when the expected cell count was less than five in at least twenty percent of the cells. Level of significance was set at p&lt;0.05. Results: The mean age of the participants was 29.1±4.53 years with an age range of 20-40 years. Majority of the participants were married (87.1%) from monogamous families (73.6%) and had tertiary level of education (67.5%), Majority were within high social class (56.4%), and did not experience intimate partner violence (92.6%). The prevalence of depression was 44.8%. Educational level showed significant statistical relationship with antepartum depression (X2=9.773, p&lt;0.009). APD was not shown to have significant association with the age of the mothers (X2=4.60, P&lt;0.203) and marital status (X2=0.847, p &lt;0.738). Furthermore, there were no statistically significant differences in the prevalence of major depression among women in the three different trimesters of pregnancy. Conclusion: The prevalence of antepartum major depression at the RSUTH, Port Harcourt in Nigeria was high. There was statistically significant differences in the prevalence of major depression among different educational categories.

Prospective Association between Total and Trimester-Specific Gestational Weight Gain Rate and Physical Growth Status in Children within 24 Months after Birth.

In this study, our aim was to investigate the potential correlation between the mother's total gestational weight gain (GWG) rate and the trimester-specific GWG rate (GWGR) with the physical development status of the child within 24 months of age. We utilized linear regression models and linear mixed effects models to explore both time point and longitudinal relationships between GWGR and children's anthropometric outcome z-scores at 0, 1, 2, 4, 6, 9, 12, 18, and 24 months. To examine the critical exposure windows, we employed multiple informant models. We also conducted a stratified analysis considering pre-pregnancy BMI and the gender of the children. Our findings revealed notable positive associations between total GWGR and z-scores for body mass index for age (BMIZ), head circumference for age (HCZ), weight for age (WAZ), length for age (LAZ), and weight for length (WHZ) across different trimesters of pregnancy (pint < 0.05). The GWGR during the first two trimesters mainly influenced the relationship between total GWGR and BMIZ, WAZ, and LAZ, while the GWGR during the first trimester had a significant impact on the correlation with HCZ (0.206, 95% CI 0.090 to 0.322). Notably, the associations of GWGR and children's BMIZ were pronounced in male children and pre-pregnancy normal-weight women. In conclusion, our study findings indicated that a higher GWGR during each trimester was associated with greater physical growth during the first 24 months of life, especially GWGR in the first and second trimesters.

Increased Demand of Obese Women for Protectins, Maresin, and Resolvin D1 in the Last Trimester of Pregnancy.

Pregnancy is a physiological state during which inflammation occurs. This complex biological response is necessary for the implantation process as well as delivery. In turn, its suppression during gestation favors the normal course of the pregnancy. Therefore, the presence of pro-resolving mediators, EPA and DHA derivatives, The aim of this study was to investigate the changes in the levels of anti-inflammatory resolvins and their precursors in different trimesters of pregnancy with consideration of the women's weight, including overweight and obese women before pregnancy. A total of 78 women participated in this study; the mean age and BMI before pregnancy were 32.3 ± 5.52 and 27.73 ± 6.13, respectively. The patients were divided into two groups, considering their BMI before pregnancy. The extraction of eicosanoids was performed by high-performance liquid chromatography. The results obtained were subjected to statistical analysis. The levels of all studied parameters showed statistically significant differences between the study group (SG) and the control group (CG) in the different trimesters of pregnancy. Over the course of pregnancy, the levels of protection (PDX), maresin, resolvins (RvD1, RvE1), and their precursors differed in relation to the trimester of pregnancy and the division into groups considering the correct body weight before pregnancy. Overweight or obese women had significantly lower levels of RvE1 in the third trimester and their precursors compared to normal-weight women. While the levels of PDX and RvD1 were significantly higher, this may be due to both a lower intake of products rich in omega-3 fatty acids by obese women and an increased need of obese women's bodies to quench chronic inflammatory processes associated with obesity. Both EPA and DHA derivatives are involved in calming down inflammation during pregnancy, which was observed.

Environmental tobacco smoke increased risk of gestational diabetes mellitus: A birth cohort study in Sichuan, China.

Studies on the relationship between environmental tobacco smoke (ETS) and gestational diabetes mellitus (GDM) are limited. In this study, we aimed to clarify the association between ETS at different trimesters of pregnancy and the risk of GDM among non-smoking pregnant women. A total of 16,893 non-smoking mothers from the Southwest Birth Cohort, China, were included in the final analyses. Exposure and outcome measures included self-reported ETS status at different trimesters of pregnancy and GDM diagnosis. Multivariable logistic regression models were constructed to estimate the association between ETS and GDM. The prevalence of ETS exposure was 25.7%. Compared with no ETS, ever ETS had an increased risk of GDM, with an adjusted odds ratio (95% confidence intervals) of 1.21 (1.09, 1.33). The association remained consistent at different trimesters of pregnancy ETS exposure. In the last trimester and with continuous ETS exposure, the risk of GDM increased significantly with the increase in the duration of the exposure. The risk of GDM associated with ever ETS during pregnancy significantly increased in mothers over 30years old and pre-pregnancy overweight (P for interaction <0.05). ETS exposure at different trimesters of pregnancy was associated with an increased risk of GDM among non-smoking pregnant women. These findings emphasise the importance of preventing ETS exposure during pregnancy.

Preliminary study on the relationship between biological rhythm changes and pregnancy complications during pregnancy

To study the characteristics of heart rate rhythm in pregnant women at different trimester of pregnancy, and to explore the relationship between the basic rhythm of heart rate and pregnancy complications. Thirteen pregnant women who were diagnosed with normal early pregnancy in the Reproductive Center of the Second Affiliated Hospital of Soochow University from June 2018 to December 2019 were prospectively selected. Personal files were created and the heart rate data of pregnancy women was collected 24 hours a day by wearable devices until delivery. Prenatal examination and pregnancy outcomes were surveyed at follow-up. The cosine analysis method and the designed statistical module were used to analyze the long-term rhythm of pregnant women's heart rate. The heart rate of pregnant women showed a significant rhythm at different gestational weeks. Compared with the gestational week of 12, the midline-estimating statistic of rhythm(MESOR) increased significantly at the gestational week of 28 and 32 (t=-2.751,P=0.013;t=-2.314,P=0.032).The phase of rhythm shifted from 14∶00 pm in the first trimester of pregnancy (12 weeks) to 16∶00 pm in the second trimester (24 weeks) (t=2.613,P=0.018) and returned to 14∶00 pm at the third trimester (32 weeks) (t=-2.176,P=0.046). Season had no significant effect on the changes of MESOR, amplitude and phase of maternal heart rate in the first trimester (t=-0.356,P=0.729;t=-0.777,P=0.464;t=-0.434,P=0.673), while season had no significant effect on the changes of MESOR, amplitude and phase in the third trimester (t=-0.663,P=0.532;t=-0.209,P=0.841;t=0.625,P=0.592). The heart rate of one pregnant woman with natural delivery had rhythm disorder from the start of labor to delivery. The heart rate of one pregnant woman with premature rupture of membranes showed rhythm disorder before and after the rupture of membranes, and smaller amplitude. Rhythm disturbance may play a suggestive role in preterm delivery and labor initiation. In conclusion, pregnancy may cause changes in the internal heart rate rhythm. Maternal internal rhythm disturbance may occur when delivery or premature rupture of membranes occurs. The heart rate rhythm of pregnant women may be related to some common complications of pregnancy such as premature rupture of membranes.

Extreme Temperature Exposure and Risks of Preterm Birth Subtypes Based on a Nationwide Survey in China.

Previous studies have reported that ambient temperature may affect perinatal outcomes. However, whether extreme temperature affects the risk of preterm birth (PTB) remains controversial. Studies on the associations of extreme temperature with PTB subtypes are lacking. We aimed to investigate the associations of extreme climate events with the risks of PTB and its subtypes, discerning possible modifiers. Data on all singleton deliveries were obtained from the China Labor and Delivery Survey (CLDS), a nationwide investigation implemented in 2015 and 2016. PTB was defined as gestational weeks and then categorized as early (24-34 wk) and late PTBs (35-36 wk), and clinical subtypes [spontaneous PTB, preterm premature rupture of the fetal membranes (PPROM), iatrogenic PTB]. Ambient temperature data were provided by the China National Weather Data Sharing System. Five heat indexes and five cold indexes were used to define heat waves and cold spells. Generalized linear mixed models with a random term by hospital unit were used to assess the associations of short-term prenatal extreme temperature exposure. The Cox proportional hazard regression model was applied to assess the nonlinear associations of low- or high-temperature exposure at the whole and different trimesters of pregnancy with the risk of PTB. Stratified analyses were conducted to assess the possible modification by geographic region and fetal sex. A total of 70,818 singleton births from 96 hospitals in China were included, among which 4,965 (7.01%) were PTBs. Exposure to extreme cold events 1 wk before delivery was associated with an increased PTB risk, with an adjusted odds ratio (aOR) [95% confidence intervals (CIs)] of 1.07 (95% CI: 1.04, 1.10) and 1.06 (1.04, 1.09) for the total days when the daily average temperature below the fifth percentile (fifth-days) and the 10th percentile (10th-days), 1.18 (1.04, 1.34) for the cold spells when the daily average temperature below the fifth percentile for two consecutive days (fifth-2D), 1.09 (1.03, 1.16) and 1.12 (1.06, 1.19) for the cold spells when the daily average temperature below the 10th percentile for three and two consecutive days (10th-3D and 10th-2D), respectively. Results of extreme temperature exposure during 2 weeks before delivery showed similarly significant associations. The association between cold spells and PTB tended to be stronger for late PTB than for early PTB. Cold spells were mainly associated with spontaneous PTB and late PPROM. A stratified analysis indicated that pregnant women in western and northern regions tended to be more sensitive to cold spells, and pregnant women with a female fetus appeared to be at a higher risk of PTB when exposed to cold spells. Pregnant women in late pregnancy were more susceptible to extreme temperatures. No significant or stable association was found between heat waves and preterm birth. Exposure to cold spells was associated with an increased risk of PTB, especially late, spontaneous PTB and PPROM. The associations appeared to be more pronounced in the north and west regions and in pregnancies with female fetuses. https://doi.org/10.1289/EHP10831.

Algorithm for acute pancreatitis diagnostics and treatment in pregnant women

Introduction. The problem of early diagnostics and treatment of pregnant women with acute pancreatitis (AP) remains far from being solved despite a significant number of clinical trials [1, 2, 3]. There are still no AP specific recommendations with regard to early diagnostics and treatment. Recently, some sporadic reports on the determination of serum pancreatic elastase levels in pregnant women diagnosed with acute pancreatitis were recorded. At present, there are no available guidelines for the treatment of acute pancreatitis and its complications during pregnancy, emphasizing the role of minimally invasive surgical interventions.&#x0D; Objective of the study: improve the efficiency of acute pancreatitis diagnostics and treatment in pregnant women.&#x0D; Materials and methods. The analysis of diagnostic results and complex treatment of 123 pregnant women was carried out. The treatment group consisted of 61 pregnant women with acute pancreatitis for the period from 2012-2018, using the developed diagnostic and treatment algorithm and the experimental group included 62 pregnant women, from 2006 to 2012, using traditional methods of treatment and diagnosis.&#x0D; Results of the study. According to the results of the study, it can be noted that traditional ways of acute pancreatitis treatment do not take into account the limitations in the use of a number of diagnostic methods in pregnant women, as well as the peculiarities of treatment tactics in different trimesters of pregnancy. Meanwhile, the developed diagnostic and treatment algorithm has significant advantages, i.e.&#x0D; - early diagnostics based on the determination of elastase 1 at all stages of patient management. It allows detecting acute pancreatitis at an early stage of the disease in 100% of patients in the main group, compared to 48.4% in the comparison group.&#x0D; - Early use of conservative therapy due to early diagnostics. A positive effect in conservative therapy was achieved in 44.3% of patients in the main group, compared to 33.9% in the comparison group.&#x0D; - 50.8% of patients in the study group managed to limit themselves to minimally invasive methods of treatment, such as punctures and drainage of fluid formations, endovideoscopic methods of sequestrectomy compared to 46.8% in the comparison group.&#x0D; - The widespread use of minimally invasive treatment methods allowed to reduce the number of open surgical interventions in the main group up to 4.9% vs. 38.7% in the comparison group, and to avoid mortality vs. 3.2% in the comparison group.&#x0D; Conclusion. The developed diagnostic and therapeutic algorithm for acute pancreatitis in pregnant women in comparison with traditional methods of diagnostics and treatment allows to detect acute pancreatitis at an early stage of the disease. Ensure the effect of conservative therapy in 44.3% versus 33.9%, and to achieve the effect of minimally invasive surgical interventions in 50.8% against 46.8%, open surgical interventions in 4.9% against 38.7% of the comparison group, and to avoid mortality against 3.2% of the comparison group.

Assessment of Thyroid Dysfunction During Different Trimester of Pregnancy.

Thyroid dysfunction is frequently seen in pregnant women and is associated with complications like miscarriage, gestational hypertension, placental abruption, pre mature delivery and fetal growth retardation and even causes impaired neuropsychological development of fetus. This study is carried out to assess the prevalence of thyroid disorder during different trimester of pregnancy. Serum samples were collected from 124pregnant women attending Patan Academy of Health Science for ante natal visit. Free thyroxine free triiodothyronine and thyroid stimulating hormone were performed by chemiluminescent assay. Out of 124 pregnant women, euthyroidism was seen in 79% (n =98) followed by subclinical hypothyroidism (10%, n=13) and primary hypothyroidism (8%, n=10). Subclinical hyperthyroidism and primary hyperthyroidism accounts for 1% (n=1), and 2% (n=2) respectively. Although, thyroid disorder was found to be more prevalent in third trimester (38.4%, n=10) but the distribution in first and second trimester (34.6%, n= 9, 27%, n= 7 respectively) were also significant. Mean fT3 and fT4 level were found to be negatively correlated with trimester (r=-0.19, p=0.027 and r=-0.29, p=0.001 respectively) whereas positive correlation of trimester was seen with TSH (r=0.08, p=0.35). Hypothyroidism is more common in pregnant women visiting tertiary care hospital. Different complication can be minimized if diagnosis is done early.

Evaluation of Demographic, Clinic and Laboratory data of COVID-19 (+) Pregnants in their First Admission to Hospital

Aim: To investigate the clinical course of COVID-19 in different trimesters of pregnancy by evaluating the demographic, clinical and laboratory data of pregnant women who applied to the Emergency Service.&#x0D; Materials and method: Cases were examined in 3 groups as asymptomatic, mild symptomatic and severe disease according to symptoms and oxygen saturation. High levels of CRP, ferritin, D-dimer and lymphopenia in blood tests were considered as poor prognostic factors. &#x0D; Results: Of 678 pregnant women with COVİD-19 , 118 (17.4%) were in the first trimester, 261 (38.5%) were in the second trimester and 299 (44.1%) were in the third trimester. A total of 257 (37.9%) COVID-19 (+) pregnant women were hospitalized and 120 of them were due to COVID-19 infection without any obstetric indication. Severe disease was detected in 57 (8.4%) of the cases; 29 of them (50.9%) were in the 2nd trimester and 26 (45.6%) were in the 3rd trimester. The incidence of severe disease was statistically significantly higher in the later weeks of pregnancy compared to the first trimester (p=0.004). When the distribution of the poor prognostic laboratory criteria according to trimesters was examined, 22.9% of pregnant women with COVID-19 had at least one poor prognostic laboratory criterion in the first trimester, while this rate was 41.7% and 63.9% in the second and third trimesters, respectively (p

Assessment of D-dimer levels in pregnant women diagnosed with COVID-19: A case-control study

Objective We aimed to evaluate D-dimer levels in pregnant women diagnosed with COVID-19. Methods This single-center study was carried out in a tertiary center hospital serving as a pandemic hospital. 151 pregnant women with COVID-19 diagnosis were included as the study group, and 70 healthy pregnant women as the control group. The data were analyzed separately in 3 different trimesters of pregnancy. Results Of the 221 pregnant women included in the study, 151 had a diagnosis of COVID-19. 70 healthy pregnant women were taken as the control group. It was observed that D-dimer values in pregnancy increased as the trimesters progressed. No significant difference was observed when this was compared with pregnant women with COVID-19 (p = .428, .75, .927 according to the 1st, 2nd and 3rd trimesters, respectively). Conclusion The diagnosis of pulmonary embolism is difficult due to the lack of reliable alternative D-dimer thresholds for pregnant patients. On the other hand, D-dimer elevation continues to be a sign of poor prognosis in patients with COVID-19. The situation remains uncertain in patients who are pregnant and have COVID-19. Maybe D-dimer value should be removed from being a poor prognosis criterion in pregnant women.

Low back pain, ultrasonographic muscle thickness measurements and biopsychosocial factors at different trimesters of pregnancy

BackgroundPregnancy-related low back pain is a multifactorial problem and its assosiation with pain intensity and biopsycosocial factors can not be fully explained. This study aimed to determine the psychosocial as well as biological/physical risk factors associated with self-reported low back pain (LBP) intensity during different trimesters of pregnancy. MethodsThis cross-sectional study comprised 107 pregnant women. An introductory information form for physical and medical characteristics, Visual Analog Scale (VAS) for low back pain intensity and Oswestry Disability Index (ODI) for degree of loss of functionality, Short Form-36 (SF-36) for quality of life and Pregnancy Physical Activity Questionnaire (PPAQ) for physical activity were applied. Abdominal muscle thicknesses and diastasis recti were measured by ultrasonography. Univariate regression was used to analyse associations between each plausible independent variable and low back pain intensity. ResultsMean LBP intensity during 1st, 2nd ve 3rd trimesters were 26.8 ± 20.9, 27.3 ± 19.8, 21.6 ± 20.1 mm, respectively. ODI scores were associated with LBP intensity, explaining 11%, 13% and 26% of LBP severity during the 1st, 2nd ve 3rd trimesters, respectively. Other biological/physical variables like age, body mass index, muscle thickness and diastasis recti were not associated with pain intensity. SF-36 emotional role limitation (coef = −0.03, R2 = 0.20, p = 0.01) in the 3rd trimester and SF-36 pain score in the 1st (coef = −0.04, R2 = 0.12, p = 0.02) and 3rd (coef = −0.05, R2 = 0.26, p = 0.004) trimesters and PPAQ-sedentary was associated during the 2nd trimester (coef = 0.17, R2 = 0.17, p = 0.02) with pain intensity. ConclusionODI scores were associated with LBP intensity in all three trimesters, with SF-36 pain domain in the 1st and 3rd trimesters, with SF-36 emotional role limitation only in the 3rd trimester and with sedentary activity level only in the 2nd trimester. İncreased pain intensity was surprisingly associated with a small number of biopsychosocial factors in all the trimesters. There is need for further large-sample studies.

Influence of pregnancy and lactation on vitamin D serum levels and antioxidant status in randomized women in Zaria.

Pregnancy and lactation are normal physiological conditions that tend to influence numerous biological processes. The aim of this study was to identify the impact of pregnancy and lactation on serum vitamin D level and antioxidant status in some women in Zaria, Nigeria. A cross‑sectional descriptive study conducted at Ahmadu Bello University Teaching Hospital, Zaria for a period of three (3) months. Blood samples were collected, serum catalase, superoxide dismutase, lipid peroxidation and vitamin D, were determined using standard methods. Data were presented as mean ± SD, analysis was performed using one-way ANOVA and Pearson's correlation analysis. Values were considered significant at p ≤ 0.05. There was a significant difference (p < 0.01) serum malondialdehyde level, superoxide dismutase activity and glutathione peroxidase activity during the various trimesters of pregnancy and lactating group. However, the levels of these markers were highest in the lactating group. Furthermore, serum level of vitamin D and catalase activity was highest in the 2nd trimester and lowest in the control and lactating group respectively. Pregnancy and lactation altered serum level of Vitamin D, CAT, SOD, MDA and GPx suggesting a variation in oxidative stress at different trimester of pregnancy and lactation. Key words: Pregnancy, lactation, oxidative stress, vitamin D.