Early Stages Of Pregnancy Research Articles

The effect of a coping program on mothers' grief following perinatal deaths.

Mother-child attachment is formed from early stages of pregnancy and peaks in the second trimester and continues until after childbirth. The fetal or neonatal death as a tragic event could lead to the grief experience among parents, especially mothers. The present study aimed to determine the effect of a coping program on mothers' grief following perinatal deaths. This trial study was performed on 56 women with the experience of perinatal death during the last 1-3 months with a score of Perinatal Grief Scale (PGS) ≥91, who were referred to the health centers of Tabriz, Iran, from September 2020 to June 2021. Participants were randomly assigned into the intervention and control groups through stratified blocking on the basis of the stillbirth and neonatal death using Random Allocation Software with a block size of 4 and 6 with a ratio of 1:1. The intervention group received a coping program individually during three sessions, once a week for 45-60 min. Data collection tools included the demographic and obstetric characteristic questionnaire and PGS. The data were analyzed using SPSS24. The groups were compared through t-test, and ANCOVA after adjusting the effect of baseline score. Prior to coping program, the mean standard deviation of the grief total score was 108.32 (14.31) in the intervention group and 107.92 (6.65) in the control group (P = 0.89). After coping program, the mean of the grief total score was 82.28 (16.72) in the intervention group and 101.05 (12.78) in the control group. After adjusting the effect of baseline score and stratified factors, the mean of the grief total score in the intervention group was significantly lower than that in the control group [Adjusted mean difference (AMD): -18.77, 95% confidence interval: -26.79 to - 10.75, P ≤ 0.001]. Conducting a coping program during 1-3 months after experiencing perinatal deaths is effective in reducing the mothers' grief reactions. It is recommended to evaluate the effectiveness of the same intervention after perinatal deaths for both parents with a longer follow-up period in further studies.

Effects of prenatal subjective well-being on birth outcomes and child development: A longitudinal study.

Although maternal mental illnesses have been found to influence child health and development, little is known about the impact of maternal positive well-being on child health and development. Therefore, this longitudinal study investigated the effects of prenatal subjective well-being on birth outcomes and child development by considering the potential modifier effect of parity. Pregnant women in early stages of pregnancy were recruited at five selected hospitals in Taipei, Taiwan, during their prenatal appointments since 2011. Self-reported evaluations were conducted at seven time points up to 2 years postpartum. Linear regression and generalized estimating equation models were used for examination. Higher prenatal eudaimonic well-being was associated with longer gestational length (adjusted beta [aβ] = 0.36, 95% confidence interval [CI] = 0.03, 0.68) and higher birth weight (aβ = 124.71, 95% CI = 35.75, 213.66). Higher positive and negative affect were associated with longer gestational length (aβ = 0.38, 95% CI = 0.06, 0.70) and smaller birth weight (aβ = -93.51, 95% CI = -178.35, -8.67), respectively. For child's outcomes, we found an association between higher prenatal eudaimonic well-being and decreased risks of suspected developmental delay, particularly for children of multiparous mothers (adjusted odds ratio = 0.18, 95% CI = 0.05, 0.70). Higher levels of prenatal depression and anxiety were significantly associated with increased risks of suspected developmental delay for children of primiparous mothers. Positive prenatal maternal mental health may benefit birth outcomes and child development, particularly for children of multiparous mothers. Interventions for improving prenatal mental health may be beneficial for child development.

Клинический случай неиммунной водянки у недоношенного ребенка с наличием IgG к SARS-CoV-2 при рождении

Non-immune hydrops of the fetus is a heterogeneous pathology, which is accompanied by excessive accumulation of fluid in two or more serous cavities (pericardial cavity, abdominal cavity, pleural cavity) and fetal tissues in the absence of signs of immune sensitization. This pathology in most cases leads to high mortality in both the antenatal and postnatal periods. The incidence of this disease ranges from 0.05 to 5%. Perinatal mortality in nonimmune hydrops fetalis accounts for about 80%, but with the manifestation of the disease in the early stages of pregnancy, the frequency of deaths is already about 95%. Most often, fetal death occurs due to severe heart failure and hypoxia. The most common causes of the development of nonimmune hydrops fetalis are: chromosomal abnormalities, pathology of the cardiovascular system and infectious diseases. Due to the emergence of a new coronavirus infection COVID-19, the question arises how the SARS-CoV-2 virus affects the course and outcome of pregnancy, as well as what effect it has on fetal development. And is it possible to assume that the SARS-CoV-2 virus can be attributed to the etiological factor of the occurrence of nonimmune hydrops fetalis. The article describes a clinical case of non-immune hydrops in a premature baby with a burdened obstetric and gynecological history against the background of COVID-19 during pregnancy, a severe course of the neonatal period. The review of current literature data on the pathogenesis, classification and features of clinical manifestations, diagnosis and treatment of such newborns is carried out.

Analysis of correlation between heart failure in the early stage of acute myocardial infarction and serum pregnancy associated plasma protein-A, prealbumin, C-reactive protein, and brain natriuretic peptide levels.

The study sought to analyze the predictive value of the early measurement of pregnancy associated plasma protein-A (PAPP-A), prealbumin (PAB), C-reactive protein (CRP), brain natriuretic peptide (BNP), and other indicators of heart failure (HF) after acute myocardial infarction (AMI). A total of 200 AMI patients admitted to Wuyi People's Hospital from November 1, 2019 to October 31, 2020 were continuously enrolled as the research objects and divided into a HF group (Killip class II or above, n=94) and HF-free group (Killip class I or below, n=106) according to the Killip Classification for Heart Function. The age, creatine kinase-myocardial band (CK-MB), PAPP-A, CRP, suppression of tumorigenicity 2 (ST2), BNP, aldosterone (ALD), and left ventricular end-diastolic diameter (LVEDD) of the HF group were all significantly higher than those of the HF-free group, while the PAB and left ventricular ejection fraction (LVEF) were significantly lower (P<0.05). The PAPP-A, CRP, and BNP of HF patients increased as the Killip class increased, while the PAB decreased progressively (P<0.05). After including the statistically significant single factors in a multivariate logistic regression analysis, it was found that PAPP-A, PAB, CRP, and BNP were the independent influencing factors causing HF in the early stage of AMI; and the diagnostic efficacy of HF in the early stage of AMI (from high to low) was combined test, PAPP-A, PAB, BNP and CRP. Serum PAPP-A, PAB, CRP and BNP levels are the independent influencing factors of HF after AMI, but comprehensive tests of clinical indicators, including PAPP-A, PAB, CRP, and BNP, are more accurate at predicting and evaluating HF and can be used to guide clinical decisions.

Machine learning-based evaluation of application value of the USM combined with NIPT in the diagnosis of fetal chromosomal abnormalities.

To explore the soft ultrasound marker (USM) combined with non-invasive prenatal testing (NIPT) in diagnosing fetal chromosomal abnormalities based on machine learning and data mining techniques. To analyze the data of ultrasonic examination from 856 cases with high-risk single pregnancy during early and middle pregnancy stage. NIPT was applied in 642 patients. All 856 patients accepted amniocentesis and chromosome karyotype analysis to determine the efficacy of USM, Down's syndrome screening, and NIPT in detecting fetal chromosomal abnormalities. Among the 856 fetuses, 129 fetuses (15.07%) with single positive USM and 36 fetuses (4.21%) with two or more positive USM. There were 81 fetuses (9.46%) with chromosomal abnormalities. In the group with multiple USM, chromosomal abnormalities were found in 36.11% of them. It was higher than the group without USM, which was 6.22% (P < 0.01), and the group with just a single USM (19.38%, P < 0.05). The sensitivity, specificity and accuracy were 96.72%, 98.45% and 98.29% when the combination of USM, Down's syndrome screening and NIPT was used to diagnose fetal chromosomal abnormalities further evaluating the accuracy and effectiveness of the above diagnostic criteria and methods with mainstream Classifiers based evaluation indicators of accuracy, f1 score, AUC. The combination of USM, Down's syndrome screening and NIPT is valuable for the diagnosis of fetal chromosomal abnormalities.

In Utero Exposure to Zika Virus Results in sex-Specific Memory Deficits and Neurological Alterations in Adult Mice.

Transplacental transmission of Zika virus (ZIKV) during early pregnancy may lead to several neurological alterations, known as congenital Zika syndrome. We have previously shown that intravaginal infection of immunocompetent dams with ZIKV during the early stage of pregnancy triggers neuroinflammation in fetuses, characterized by increased brain expression of inflammatory factors, including IL-6, IL-18, CCL2, CXCL1, and CXCL10. The present study sought to understand the long-term consequences of these early cerebral alterations. For that, pregnant FVB/NJ immunocompetent females were infected intravaginally on the gestational day (GD) 4.5 and experiments were performed when offspring reached between 4 to 5 months of age. The exposure to ZIKV promoted significant neuronal cell loss detected in the CA1 region of the hippocampus of adult mice. However, only females showed reduced expression levels of brain-derived neurotrophic factor (BDNF), postsynaptic density protein 95 (PSD95), and syntaxin-1A, which are important genes related to neuronal function and synaptic plasticity. Moreover, the protein levels of the pre- and postsynaptic markers, SNAP25 and PSD95, respectively, were decreased exclusively in ZIKV-exposed female mice, indicating that ZIKV exposure in utero induces synaptic loss. Additionally, only females exposed to ZIKV showed risk-taking behavior and hippocampal-dependent spatial memory deficit. Together, these results demonstrate that intravaginal infection of mice on GD4.5 induces neurological alterations in the offspring detectable in their adulthood and that female mice, rather than male mice, are more susceptible to ZIKV-induced neurobehavioral alterations. Summary StatementIn utero exposure to ZIKV leads to decreased number of neurons in adult mice. Female mice exposed to ZIKV in utero exhibit lower levels of BDNF, a decrease in synaptic markers, memory deficits, and risk-taking behavior during adulthood.

Trends in the Prevalence and Progression of Diabetic Retinopathy Associated with Hyperglycemic Disorders during Pregnancy in Japan.

The aim of this study was to determine the prevalence and progression of diabetic retinopathy (DR) with hyperglycemic disorders during pregnancy (HDPs) in Japan between 2013 and 2018 using two cohorts. The patients with HDPs were classified as those with pre-existing DM (pexD), gestational DM (GDM), and overt DM (ODM). Cohort 1 was obtained from the health claims database whose diseases were classified by the International Classification of Diseases-10. Cohort 2 was derived from a retrospective, multicenter analysis of the medical records of 225 patients from 10 ophthalmological institutions. In Cohort 1, there were 5268 patients with an HDP prevalence of 8.4%. Among them, 73 of 1139 patients had pexD (6.4%) and 61 of 4129 patients with GDM (1.5%) had DR; the overall prevalence of DR was 2.5%. In Cohort 2, 36 of 225 patients (16.0%) had DR, and 149 patients were followed at the early and late stages of pregnancy. Moreover, 10 of the 102 patients with pexD (9.8%) and two of five patients with ODM (40.0%) had a progression of DR. In conclusion, the prevalence and progression of DR in patients with pexD is lower than previously reported. More attention should be given to pexD and ODM.

Influence of Pregnancy Stages on Thyroid Status and Blood Metabolites in Desert Ewes Raised under Range Conditions in West Kordufan State, Sudan

This study aimed to evaluate the influence of the stages of pregnancy in two ecotypes of sheep, located in different grazing areas on thyroid status and certain blood metabolites. Eighty clinically healthy ewes (40 Hamari and 40 Kabashi ecotype) aged 2-5 years were used in the study. For each ecotype, the ewes were divided into four groups according to the reproductive status. Group (A): 10 ewes non-pregnant non-lactating (dry) served as the control. Group (B): 10 ewes in the early stage of pregnancy (first trimester). Group (C): 10 ewes in mid-stage of pregnancy (second trimester). Group (D): 10 ewes in the late stage of pregnancy (third trimester). Blood samples were used to measure serum levels of thyroid stimulating hormone (TSH), thyroxine (T4), triiodothyronine (T3), plasma glucose concentration and serum triglyceride levels. The study detected that Hamari ecotype was supplied with salt and minerals block during watering by its owners. The results showed that in both ecotypes, the serum TSH levels were significantly (P&lt;0.05) higher during the early stage of pregnancy then, it decreased significantly (P&lt;0.01) as the pregnancy advanced. While serum T4 levels were higher during the early stage of pregnancy, then it decreased significantly (P&lt;0.01) during the late pregnancy in both ecotypes. Serum T3 level was significantly (P&lt;0.001) higher in both ecotypes during early and mid-pregnancy, then declined to the lowest value during the late stage. The plasma glucose level was significantly (P&lt;0.001) lower during mid and late pregnancy in both ecotypes. There was a significant (P&lt;0.05) decrease in serum triglyceride level when pregnancy advanced in both ecotypes. Kabashi ecotype showed significantly higher serum triglyceride levels in the control group (P&lt;0.001) during early pregnancy stage (P&lt;0.01) and mid pregnancy stage (P&lt;0.05) compared to the values of serum triglyceride levels in Hamari ecotypes. This study indicated that pregnancy altered thyroid status in both ecotypes, however, the influence of pregnancy on the thyroid status was less in the Hamary ecotype which supplemented by mineral and salt blocks. Therefore, supplementation with minerals during pregnancy might enhance the metabolic profile on the natural pasture grazing.

Environmental Exposures and Congenital Heart Disease

Congenital heart disease (CHD) is the most common congenital abnormality worldwide, affecting 8 to 12 infants per 1000 births globally and causing >40% of prenatal deaths. However, its causes remain mainly unknown, with only up to 15% of CHD cases having a determined genetic cause. Exploring the complex relationship between genetics and environmental exposures is key in understanding the multifactorial nature of the development of CHD. Multiple population-level association studies have been conducted on maternal environmental exposures and their association with CHD, including evaluating the effect of maternal disease, medication exposure, environmental pollution, and tobacco and alcohol use on the incidence of CHD. However, these studies have been done in a siloed manner, with few examining the interplay between multiple environmental exposures. Here, we broadly and qualitatively review the current literature on maternal and paternal prenatal exposures and their association with CHD. We propose using the framework of the emerging field of the exposome, the environmental complement to the genome, to review all internal and external prenatal environmental exposures and identify potentiating or alleviating synergy between exposures. Finally, we propose mechanistic pathways through which susceptibility to development of CHD may be induced via the totality of prenatal environmental exposures, including the interplay between placental and cardiac development and the internal vasculature and placental morphology in early stages of pregnancy.

Second-trimester cardiovascular biometry in growth-restricted fetuses; a multicenter cohort study

Intrauterine growth restriction is associated with an increased risk of cardiovascular changes neonatally. However, the underlying pathways are poorly understood, and it is not clear whether the dysfunction is already present in the fetus. This study aimed to investigate fetal cardiac dimensions assessed from images at the second trimester anatomy scan from fetuses classified postnatally as small for gestational age and intrauterine growth restricted and compare them with appropriate for gestational age fetuses. This was a substudy from The Copenhagen Baby Heart Study, a prospective, multicenter cohort study including fetuses from the second trimester of pregnancy in Copenhagen from April 2016 to October 2018. The mothers were recruited at the second trimester anatomy scan that included extended cardiovascular image documentation followed by consecutively measured heart biometry by 2 investigators blinded for the pregnancy outcome. The fetuses were classified postnatally as small for gestational age and intrauterine growth restricted according to the International Society of Ultrasound in Obstetrics and Gynecology 2020 guidelines using birthweight and with a retrospective assessment of Doppler flow. The mean differences in the cardiovascular biometry were adjusted for gestational age at the time of the second trimester scan and the abdominal circumference. The z-scores were calculated, and the comparisons were Bonferroni corrected (significance level of P<.005). Receiver operating characteristic curves were computed after performing backward regression on several maternal characteristics and biomarkers. We included 8278 fetuses, with 625 (7.6%) of them being small for gestational age and 289 (3.5%) being intrauterine growth restricted. Both small for gestational age and intrauterine growth restricted fetuses had smaller heart biometry, including the diameter at the location of the aortic valve (P<.005), the ascending aorta in the 3-vessel view (P<.005), and at the location of the pulmonary valve (P<.005). The intrauterine growth restricted group had significantly smaller hearts with respect to length and width (P<.005) and smaller right and left ventricles (P<.005). After adjusting for the abdominal circumference, the differences in the aortic valve and the pulmonary valve remained significant in the intrauterine growth restricted group. Achievement of an optimal receiver operating characteristic curve included the following parameters: head circumference, abdominal circumference, femur length, gestational age, pregnancy associated plasma protein-A multiples of median, nullipara, spontaneous conception, smoking, body mass index <18.5, heart width, and pulmonary valve with an area under the curve of 0.91 (0.88-0.93) for intrauterine growth restricted cases. Intrauterine growth restricted fetuses had smaller prenatal cardiovascular biometry, even when adjusting for abdominal circumference. Our findings support that growth restriction is already associated with altered cardiac growth at an early stage of pregnancy. The heart biometry alone did perform well as a screening test, but combined with other factors, it increased the sensitivity and specificity for intrauterine growth restriction.

High rate of abnormal findings in Prenatal Exome Trio in low risk pregnancies and apparently normal fetuses.

Data on the value of exome sequencing in fetuses with no structural anomalies are limited, especially in the early stages of pregnancy and in low risk pregnancies. We investigated the yield of targeted clinical prenatal trio exome sequencing (pES) in pregnancies with and without fetal structural anomalies. We performed pES in 353 pregnancies: Group 1 included 143 pregnancies with high clinical suspicion for a genetic disease: pregnancies with increased nuchal translucency, ultrasound structural defects, intrauterine growth restriction, polyhydramnios, or effusion/nuchal edema. Group 2 included 210 pregnancies with no notable abnormal fetal ultrasound findings. 2a. Low risk pregnancies with minor ultrasound findings, referred to the geneticist due to mildly increased risk for genetic disease (50); and 2b. Normal pregnancy surveillance (160). Overall, 26 (7.36%) fetal analyses had pathogenic (P)/likely pathogenic (LP) variants. In group 1, 20/143 (13.99%) cases had P/LP variants. In group 2, 6/210 (2.86%) cases were found to have P/LP variants [5/50 in (2a) and 1/160 in (2b)]. These results show a high rate of abnormal findings on pES even in apparently normal pregnancies.

Maternal serum-derived exosomal lactoferrin as a marker in detecting and predicting ventricular septal defect in fetuses.

Among different types of congenital heart diseases, ventricular septal defect is the most frequently diagnosed type and is frequently missed in early prenatal screening programs. Herein, we explored the role of maternal serum-derived exosomes in detecting and predicting ventricular septal defect in fetuses in the early stage of pregnancy. A total of 104 pregnant women consisting of 52 ventricular septal defect cases and 52 healthy controls were recruited. TMT/iTRAQ proteomic analysis uncovered 15 maternal serum exosomal proteins, which showed differential expression between ventricular septal defect and control groups. Among these, four down-regulated proteins, lactoferrin, SBSN, DCD, and MBD3, were validated by Western blot. The protein lactoferrin was additionally verified by ELISA which was able to distinguish ventricular septal defects from controls with area under the ROC curve (AUC) 0.804 (p < 0.001). Our findings reveal that lactoferrin in maternal serum-derived exosomes may be a potential biomarker for non-invasive prenatal diagnosis of fetal ventricular septal defects.

Clinical application of non-invasive prenatal diagnosis of phenylketonuria based on haplotypes via paired-end molecular tags and weighting algorithm

BackgroundPhenylketonuria (PKU) is a metabolic disease that can cause severe and irreversible brain damage without treatment.MethodsHere we developed a non-invasive prenatal diagnosis (NIPD) technique based on haplotypes via paired-end molecular tags and weighting algorithm and applied it to the NIPD of PKU to evaluate its accuracy and feasibility in the early pregnancy. A custom-designed hybridization probes containing regions in phenylalanine hydroxylase (PAH) gene and its 1 Mb flanking region were used for target sequencing on genomic and maternal plasma DNA (7–13 weeks of gestation) to construct the parental haplotypes and the proband’s haplotype. Fetal haplotype was then inferred combined with the parental haplotypes and the proband’s haplotype. The presence of haplotypes linked to both the maternal and paternal mutant alleles indicated affected fetuses. The fetal genotypes were further validated by invasive prenatal diagnosis in a blinded fashion.ResultsThis technique has been successfully applied in twenty-one cases. Six fetuses were diagnosed as patients carrying both of the mutated haplotypes inherited from their parents. Eleven fetuses were carriers of one heterozygous PAH variants, six of which were paternal and five of which were maternal. Four fetuses were absence of pathogenic alleles. All results were consistent with the prenatal diagnosis through amniotic fluid.ConclusionsThe results showed that our new technique applied to the genotyping of fetuses with high risk for PKU achieves an accurate detection at an early stage of pregnancy with low fetal fraction in cell free DNA.

The association of prenatal exposure to benzophenones with gestational age and offspring size at birth.

In recent decades, emerging environmental pollutants such as endocrine-disrupting chemicals (EDCs) have become a particular concern. This study examined the association of maternal exposure to benzophenones as one of the EDCs with gestational age and evaluated their effects on birth outcomes including birth weight, birth length, head circumference, and Ponderal Index. We assessed 166 pregnant mothers of the PERSIAN cohort population of Isfahan, Iran, in the 1st and 3rd trimesters of pregnancy and their infants at birth. Four common benzophenones (BPs) including 2,4-dihydroxy benzophenone (BP-1), 2-hydroxy-4-methoxy benzophenone (BP-3), 4-hydroxy benzophenone (4-OH-BP), and 2,2′-dihydroxy-4-methoxy benzophenone (BP-8) were measured in maternal urine samples. The median urinary concentrations of 4-OH-BP, BP-3, BP-1, and BP-8 in the 1st trimester were 6.62, 7.5, 4.39, and 1.32 µg/g creatinine and those in the 3rd trimester were 3.15, 16.98, 9.95, and 1.04 µg/g creatinine, respectively. BP-3 was the predominant metabolite in both trimesters. There was a significant correlation between BP-3, BP-1, and 4-OH-BP levels (p < 0.05) but not BP-8. BP-1 showed a significant positive association with gestational age (GA) in all infants in the 1st trimester, but a negative association was observed between BP-3 and BP-1 levels and GA in girls. Classification of infants’ birth weight for different GAs represented that the majority of them were appropriate for GA. However, boys’ weights were heavier than girls. Also, birth outcomes of preterm (< 37 weeks) infants were noticeably lower than term infants (37–42 weeks). This study demonstrated that benzophenone derivatives especially BP-3 can affect the duration of pregnancy and consequently fetal growth in the early and late stages of pregnancy. This is more pronounced in girls; however, more investigations in a different population are needed to prove the results. Therefore, the application of these compounds as a UV protector requires precise regulation to reduce exposure, especially in pregnant women.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11356-021-17634-9.

Peptide Charge Derivatization as a Tool for Early Detection of Preeclampsia by Mass Spectrometry-A Comparison with the ELISA Test.

Early detection of any preeclampsia biomarkers may lower the risk of mortality, both for a mother and a child. Our study focuses on techniques for preeclampsia biomarker identification by comparing the results of a method using liquid chromatography mass spectrometry in multiple reaction monitoring mode (LC-MS/MS) with those by the enzyme-linked immunosorbent assay (ELISA) test, as well as by comparing the obtained results with clinical data. In the proposed LC-MS/MS method a tryptic digest peptide charge derivatization strategy was used as a tool for sensitive detection of podocin, i.e., a previously discovered preeclampsia biomarker present in urine samples from pregnant women. Urine samples from pregnant women with diagnosed preeclampsia were collected at different stages of pregnancy and from healthy subjects, and then were analyzed by ELISA test and the proposed method with LC-MS/MS. Charge derivatization of the ε amino group of C-terminal lysine residues in tryptic digests by 2,4,6-triphenylpyrylium salt was performed to increase the ionization efficiency in the LC-MS/MS mode. Podocin was identified at the early stage of pregnancy, while its detection using an ELISA test was not possible. The protocol for urine sample preparation was optimized. Our results show that the proposed method by LC-MS/MS in combination with peptide charge derivatization, provides an ultrasensitive tool for diagnosis of preeclampsia, and provides earlier detection than a clinical diagnosis or ELISA test. The proposed solution may revolutionize medical diagnostics.

Abstract 12779: Up-Regulation of the Renal Sodium Transporters is Associated With Increased CD81 in Preeclampsia Rats and Patients

Introduction: the abnormalities of placental CD81 play an important role in preeclampsia (PE), a disorder that links to the impaired placentation in the early stages of pregnancy and the subsequent systemic endothelial cell activation. Hypothesis: up-regulation of the renal sodium transporters is associated with increased CD81 in preeclampsia rats and patients Methods: we examined the renal protein abundance of CD81 and sodium transporters, channels and pump along nephron in rat model with lipopolysaccharide (LPS) -induced PE. A single ultra-low dose of LPS (0.5ug/kg) (PE) or vehicle(control group,CTL) were applied to female SD rats( age: 8-12 wks, n=4/group) on gestational day 5 (GD5) by intraperitoneal injection. Results: The SBP (101±1.6 vs 116±0.8 mmHg, p&lt;0.001, tail-cuff, BP-98A, Softron, Japan) and urine albumin (1885±35 vs 3550±157.8 ug, p&lt;0.001) were higher in PE than CTL while there were no differences in BW, fetus number/weight and serum creatinine and cholesterol concentrations (GD18) between the 2 groups. The renal protein abundances of NKCC2 (168±14 vs 100±13, % of control,P=0.02,immunoblotting) and NCC (161±16 vs 100±13, P=0.04) , among the 8 sodium transport proteins checked, were greater in PE group than in CTL group along with the increase in renal protein abundances of CD81 in PE group relative to CTL group. The protein expressions of MCP-1, IL-6, TNF-a were similar between the 2 groups. CD81 were located in thick ascending limbs of Henle’s loop and distal convoluted tubules and co-immunoprecipitated with NKCC2 and NCC in rat homogenates. CD81 was not altered in placenta, serum, liver in the LPS-PE model indicated that the increase of CD81 is kidney-specific. In PE patients , urinary exosome CD81 was also increased along with increases of NKCC2 and NCC. Furthermore, the increases of CD81 and NCC were confirmed in cultured mouse distal convoluted tubule cells (DCT) stimulated by LPS for 24 hrs at different concentrations. The knockdown of CD81 by siRNA for 48 hrs had no effects on NCC but blocked the increase of NCC induced by LPS for 24 hr. Conclusions: inhibition and decrease of renal CD81 may reverse the increases of renal sodium transporters, therefore improve the hypertension in preeclampsia.

Association of glycated hemoglobin at an early stage of pregnancy with the risk of gestational diabetes mellitus among non-diabetic women in Japan: The Japan Environment and Children's Study.

Aims/IntroductionGestational diabetes mellitus (GDM) is one of the most common complications of pregnancy and is associated with adverse pregnancy outcomes. This study aimed to explore the associations between glycated hemoglobin (HbA1c) levels at the early stage of pregnancy and the GDM risk among non‐diabetic women in a nationwide study in Japan. In addition, the relationship between GDM and adverse pregnancy outcomes was also analyzed.Materials and MethodsThis cohort study (n = 89,799) used data from the Japan Environment and Children’s Study. We stratified the participants into four groups according to HbA1c levels at an early stage of pregnancy. We investigated the association of HbA1c at an early stage of pregnancy with the risk of GDM, and of GDM with the risk of some representative adverse pregnancy outcomes, using the multiple logistic regression model with adjustment for potential confounders.ResultsThe adjusted odds ratio for GDM per 0.1 percentage point increase in HbA1c (%) was 1.20. The adjusted odds ratio for developing GDM was significantly increased in women from the HbA1c 5.0–5.4% category. GDM significantly increased the adjusted odds ratio for adverse pregnancy outcomes, such as hypertensive disorders of pregnancy, polyhydramnios and premature birth.ConclusionsHigh‐normal HbA1c levels at the early stage of pregnancy are significantly associated with GDM risk in women in Japan. GDM was significantly associated with adverse pregnancy outcomes.

Childbirth Educators’ Role Regarding Pregnant Women and Cervical Cancer Prevention

Childbirth educators play an important role in educating pregnant women regarding their health. They bridge the gap between pregnant women and healthcare providers. A paucity of information exists on the benefits that pregnant women derive from interactions with childbirth educators regarding early cervical cancer detection. The purpose of our cross-sectional study was to investigate the association among education during early pregnancy offered by the childbirth educators, access to childbirth educators, availability of childbirth educators in the United States and survival from cervical cancer. Secondary data from the Surveillance, Epidemiology, and End Results (SEER) on 520,153 women were analyzed using logistic regression. Childbirth education delivered by childbirth educators during early pregnancy was associated with significantly fewer cervical cancer deaths (odds ratio = .917, &lt;em&gt;CI&lt;/em&gt; = .896–.939, &lt;em&gt;P&lt;/em&gt; = .000). Women with late-stage diagnosis had an increased likelihood of dying when diagnosed with cervical cancer (odds ratio = 1.043, &lt;em&gt;CI &lt;/em&gt;= 1.042– 1.044, &lt;em&gt;P&lt;/em&gt; = .000). Childbirth educators are effective at increasing awareness of cervical cancer among women in the early stages of pregnancy; this can improve survival and lead to positive social change.

The Role of Routine Ultrasonography in the First Trimester of Pregnancy

Introduction: In the early stages of pregnancy, ultrasound is an extremely specific method for examination. This article reviews how the normal development of a baby in the first trimester of pregnancy relates to ultrasound findings.&#x0D; Aim: To highlight the importance of routine ultrasonography in the first trimester of pregnancy in detecting and dating gestation, its viability and early detection of anomalies and complications&#x0D; Methods: This descriptive study involved 100 pregnant women within 12 weeks of gestation attending antenatal clinic at Saveetha Medical college, during the study period&#x0D; Inclusion Criteria: Pregnant women with history of amenorrhea &lt;12 weeks of gestation.&#x0D; Exclusion criteria: Individuals with history of pain abdomen and bleeding per vaginum&#x0D; Results: A total of 99 pregnancies were intrauterine of which 1 was anembryonic and 2 had early pregnancy failure, 15 pregnancies were redated. One ectopic and one fibroid complicating pregnancy were aslo found.&#x0D; Conclusion: Ultrasonography is an effective method to detect and date pregnancy, identify nonviable pregnancies, fetal abnormalities and early trimester complications. Hence it is ideal to use it routinely as screening tool during the first trimester of pregnancy.

Successful pregnancy and term delivery after treatment of unicornuate uterus with non-communicating rudimentary horn pregnancy with local methotrexate injection followed by laparoscopic resection: a case report and literature review

BackgroundPregnancy in a rudimentary horn is an extremely rare type of ectopic pregnancy. A rudimentary uterine horn pregnancy is associated with a risk of spontaneous rupture and bleeding during surgery due to the increased uterine blood flow. Recent advances in imaging modalities have enabled laparoscopic surgery to be performed in cases without rupture in the early stages of pregnancy. However, there are few reports of successful pregnancies and deliveries after treatment of rudimentary horn pregnancies. We report the successful management of a case of non-communicating rudimentary horn pregnancy by local injection of methotrexate followed by complete laparoscopic excision along with a review of the literature.Case presentationThe patient was a 29-year-old Japanese woman, gravida 2, nullipara. She was diagnosed with a left unicornuate uterus with a right non-communicating rudimentary horn on hysterosalpingography and magnetic resonance imaging. A gestational sac with a heartbeat was observed in the right rudimentary uterine horn at 6 weeks of gestation. A diagnosis of ectopic pregnancy in a non-communicating rudimentary horn was made. Color Doppler detected multiple blood flow signals around the gestational sac, which were clearly increased compared to the left unicornuate uterus. Her serum human chorionic gonadotropin level was 104,619 mIU/ml. A 100 mg methotrexate injection into the gestational sac was administered, and laparoscopic surgery was performed on day 48 after the methotrexate treatment. The right rudimentary horn and fallopian tube were successfully excised with minimal bleeding. A spontaneous normal pregnancy was established 6 months after the surgery. The pregnancy was uneventful, and a baby girl was born by elective cesarean section at 38w0d.ConclusionCombined local methotrexate injection and laparoscopic surgery are safe treatment options for patients with a unicornuate uterus with a non-communicating rudimentary horn pregnancy.