Fetal Growth Retardation Research Articles

Placental dysfunction in women at risk and threat of premature delivery

Premature birth remains one of the most urgent problems of modern obstetrics. It is not possible to reliably establish the cause in 70–80% of premature births, so the search for risk factors and markers of premature termination of pregnancy is justified. According to many authors, 25–30% of women at risk of premature birth have placental dysfunction.The objective: was to assess the prevalence of placental dysfunction in women at risk of preterm birth and with preterm birth.Materials and methods. 80 pregnant women were under observation. The criteria for inclusion in the study were the presence of risk factors for premature birth – Group I (30 women) or the threat of premature birth – Group II (30 women). The control group consisted of 20 conditionally healthy pregnant women. Transabdominal ultrasound examination with color Doppler mapping, determination of free estriol, progesterone and placental lactogen levels in blood serum was performed at 18–21+6 and 28–30 weeks of gestation.Results. The average age of the patients was 31.4±2.5 years, there was no significant difference in age, life history, social status, somatic pathology between the formed groups. Pregnant women of groups I and II probably had a history of pelvic inflammatory disease more often than in controls; colpitis; sexually transmitted infections; pathology of the cervix and operations on the uterus and appendages. The course of this pregnancy in most of the women of the studied cohort was complicated by the threat of termination of pregnancy, 36.7% of pregnant women of the I group and 46.7% of the II group had premature births. Signs of premature ripening of the placenta were detected in 13 (43.3%) pregnant women of the experimental cohort and in 1 (5.0%) of the control group (Р<0.0001), which was accompanied by changes in parameters during dopplerometry of utero-placental blood flow. Clinical manifestations of placental dysfunction occurred in 36.7% of patients in the risk group of premature birth and pregnant women with a threat of premature birth, and were manifested by a decrease in the level of progesterone, a plateau in the increase in the level of placental lactogen. Morphological signs of placental dysfunction were found in 43.3% of cases of premature birth, which correlates with the frequency of early complications of pregnancy, primarily with the formation of retrochorial hematoma.Conclusions. Clinical manifestations of placental dysfunction (fetal growth retardation, preeclampsia) occur in a third of patients of the risk group and pregnant women with a threat of premature birth, which correlates with changes in the hormone-producing function of the placenta.

Fetal growth retardation as a complication of post-COVID endotheliitis: causes, consequences, ways of prevention

The risk of fetal intrauterine growth retardation (IUGR) is increased in women who have experienced acute infections, as well as in pregnant women with gynecological pathology and endocrine diseases. A woman’s lack of nutrition also makes a negative contribution to the development of IUGR. The frequency of IUGR in the population is very variable and depends on a number of reasons. In practically healthy pregnant women, IUGR is registered in 3–5% of cases, in case of complicated obstetric and gynecological diagnosis and complicated pregnancy – in 10–25%. Morphofunctional disorders in the chorion/placenta in pregnant women with COVID-19 on the background of post-covid endotheliitis are the main pathogenetic factor in the development of preeclampsia, ectopic pregnancy, antenatal fetal death, and impaired condition of the fetus and newborns. Sufficient saturation of the pregnant woman’s body with the nitric oxide donor L-arginine and L-carnitine (main cofactor of fatty acid metabolism in cells) with the improvement of microcirculation and the correction of hypovolemic disorders in the fetoplacental complex can be considered one of the real ways to prevent IUGR in women in the post-covid period.A review of the scientific literature on pathogenesis, diagnosis, impact on the life and health of a newborn with IUGR in women after COVID-19, as well as the possibilities of medical correction of placental dysfunction during pregnancy was performed.This analysis and our own clinical experience allow us to state the fact that after a coronavirus infection during pregnancy, one of the frequent and threatening for the further development of the child is the formation of placental dysfunction and IUGR. One of the ways to prevent these conditions is to saturate the woman’s body with the nitric oxide donor L-arginine from the stage of pre-gravid preparation, which will provide the opportunity for adequate angiogenesis and development of the embryo/fetus. In the case of additional risk factors, such as coronavirus disease, complex therapy blood (Rheosorbilact), in combination with a nitric oxide donor and L-carnitine as an endothelium-protective agent (Tivor-L).

Clinical and genetic determinants of severe course of COVID-19 in pregnant women

Objectives: to determine the clinical and genetic determinants of the severe course of COVID-19 in pregnant women in order to identify a risk group and search for therapeutic targets.Materials and methods. 21 patients (group 1) with a severe course of COVID-19 who required intensive care in the Anesthesiology and Intensive Care Unit (AICU) and 126 pregnant women with moderate severity treated in the Infectious-Obstetrics Unit (IOCU) were examined (group 2). Genomic DNA for molecular genetic analysis of gene variants ACE (I/D, rs 4340), PGR (Alu insertion), ESR1 (A351G, rs 9340799), PON1 (C108T, rs 705379) was isolated from the peripheral blood of patients using a commercial Quick-DNA Miniprep Plus Kit (Zymo Research, USA). Variants of ACE and PGR genes were determined using allele-specific polymerase chain reaction; polymerase chain reaction followed by restriction analysis was used to determine ESR1 and PON1 gene variants.Results. Severe course of COVID-19 is observed in 18.2% of pregnant women, critical condition in 7.5%. A third of AICU patients are over 35 years old. Somatic anamnesis was complicated in 23.8% of patients; thyroid gland pathology (14.3%) and varicose disease (19.0%) prevailed. A significant factor in the severe course of COVID-19 is obesity of the III–IV degree in 28.5% cases. The severe course of the disease was associated with complications of pregnancy (oligohydramnios – 52.4%, ahydramnios – 14.3%, fetal growth retardation syndrome – 33.3%, circulatory disorders – 57.1%, fetal distress – 47.6%, preeclampsia – 14.3%), labor (caesarean section – 57.1%, premature birth – 28.6%), disorders of newborns state (asphyxia – 35.6%). These patients are characterized by anemia (58.7%), thrombocytopenia (23.8%), leukocytosis (33.3%), lymphopenia (90.5%), a shift of the leukocyte formula to the left (an increase of rod-nuclear leukocytes by 85.7%). There were significantly increased levels of transaminases: alanine aminotransferase in 47.6%, aspartate aminotransferase in 76.2%. Prothrombotic changes are indicated by a decrease in prothrombin time and activated partial thromboplastin time in 66.7%, which is confirmed by an increase in D-dimer in 85.7% of patients up to the maximum 15,000 ng/ml in 9.5% of women. An increase in inflammation markers (C-reactive protein and interleukin-6 in all AICU patients, procalcitonin in 66.7%) is a reflection of the destructive effect of inflammatory processes. The genetic determinants of the severe course of COVID-19 in pregnant women can be the ID genotype of the ACE I/D rs4340 polymorphism (81.0%), the T2/T2 PROGINS genotype (19.0%), the ESR1 A351G rs9340799 GG genotype (28.5%).Conclusions. The use of separate clinical, laboratory and genetic indicators in pregnant women with COVID-19 will contribute to the selection of the risk group of a coronavirus severe course and the determination of targets of therapeutic impact.

Features of retrochoir hematomas and their effect on the course of pregnancy

The aim. Study of the features of retrochoir hematomas (RHG) and their influence on the formation of the placenta, the course of pregnancy, as well as the occurrence of premature birth.
 Materials and methods. 2 groups of pregnant women were selected depending on the frequency of RHG formation: 1 group – 60 pregnant women with recurrent RHG, group 2 – 50 pregnant women with RHG, which was detected only in the early stages of pregnancy. extragenital and genital pathology did not differ reliably. All the women studied were anamnesis, examined, and ultrasound and dopplerometry were performed.
 Statistical methods included an assessment of statistical significance using Student's t-criterion and criterion X2 and were considered significant at p<0.05.
 Results. Supracervical localization of hematomas prevailed in the studied pregnant women, namely: in group 1 – 51.7 % (in 31 pregnant women) and 68 % (in 34 women) in group 2. The same pattern was observed regarding the involution of hematomas.
 Changes in the yolk sac were found in both groups with RHG (in 6.7 % of women (i.e., in 4 pregnant women) of group 1 and 4 % (in 2 pregnant women) of group 1.
 Mean values of the pulsation index (PI) of blood flow velocity curves in the uterine arteries (UA) and umbilical cord artery (UCA) in pregnant women with RHG were higher than the standard average for gestational age.
 In pregnant RHGs, a history of various types of fetal growth retardation (FGR) is detected. The number of early forms of URP was higher in group 1 (16.7 %, i.e. in 10 pregnant women) as opposed to group 2 (2.0 %, i.e. 1 case). The late form was approximately the same amount in both groups. Also, group 1 was characterized by a significantly larger number of FGR of 2-3 centuries.
 In addition, in both groups with RHG, such pathological conditions were identified during pregnancy as the threat of premature birth, premature placental maturation, placental hypoplasia, oligohydramnios, and hydramnios.
 Conclusions. Pregnant women with recurrent RHG compared to pregnant women with sporadic RHGs have a greater number of complications during pregnancy, including the threat of preterm labour, premature placental maturation, placental hypoplasia, oligohydramnios, hydramnios, FGR, impaired uterine-placental and placental-fetal blood flow.

Association of HIF-1A (rs11549465) gene polymorphism with congenital malformations and intrauterine growth retardation of the fetus

Introduction. Congenital malformations have long received the status of a marker of environmental distress. Six per cent of the newborns in the world are diagnosed with congenital malformations of various etiologies, 30 million develop intrauterine growth retardation, often associated with hypoxia, while the number of these pathologies is significantly higher in environmentally unfavourable regions. The degree of resistance to hypoxia is determined by the transcription factor induced by hypoxic conditions - HIF. There is revealed polymorphism of the HIF gene, which determines the differences in the activity of the transcription factor encoded by this gene, and therefore, the differences in the level of resistance to hypoxia. Recently, HIF has also been detected in response to the activation of free radical processes. Materials and methods. The study examined fifty five women living in the South of Kuzbass, most of them in the city of Novokuznetsk. 18 women were included in the control group because they carried a healthy child, the study group consisted of 11 women who gave birth to children with intrauterine growth retardation, and 26 women who gave birth to children with congenital malformations. Genomic DNA was isolated from peripheral blood leukocytes using the phenol-chloroform extraction method. Gene typing was carried out by the Real Time method. Results. Among the studied groups, in women who gave birth to children with congenital malformations, there were no reliable differences in the occurrence of polymorphisms of mutant and wild types. In the group of women who gave birth to children with intrauterine growth retardation, a reliable association of C/T polymorphism in the mother with intrauterine fetal growth retardation was shown (χ2 = 4.54; OR = 9.71), while the ancestral form of C/C was associated with resistance to this pathology. Limitations. Since the identification of the association of the HIF-1A (rs11549465) gene polymorphism with intrauterine growth retardation was of a pilot nature, it is advisable to increase the sample. Conclusion. The results obtained may indicate the leading role of the HIF-α subunit in the body’s adaptation to hypoxia and the secondary importance of this protein in the regulation of pro- and antioxidant balance.

Соматический тканевой мозаицизм по хромосоме 16 и его связь с задержкой роста плода

Соматический тканевой мозаицизм по хромосоме 16 и его связь с задержкой роста плода

Human Chorionic Villous Differentiation and Placental Development.

In humans, the placenta provides the only fetomaternal connection and is essential for establishing a pregnancy as well as fetal well-being. Additionally, it allows maternal physiological adaptation and embryonic immunological acceptance, support, and nutrition. The placenta is derived from extra-embryonic tissues that develop rapidly and dynamically in the first weeks of pregnancy. It is primarily composed of trophoblasts that differentiate into villi, stromal cells, macrophages, and fetal endothelial cells (FEC). Placental differentiation may be closely related to perinatal diseases, including fetal growth retardation (FGR) and hypertensive disorders of pregnancy (HDP), and miscarriage. There are limited findings regarding human chorionic villous differentiation and placental development because conducting in vivo studies is extremely difficult. Placental tissue varies widely among species. Thus, experimental animal findings are difficult to apply to humans. Early villous differentiation is difficult to study due to the small tissue size; however, a detailed analysis can potentially elucidate perinatal disease causes or help develop novel therapies. Artificial induction of early villous differentiation using human embryonic stem (ES) cells/induced pluripotent stem (iPS) cells was attempted, producing normally differentiated villi that can be used for interventional/invasive research. Here, we summarized and correlated early villous differentiation findings and discussed clinical diseases.

Role of intergenic interactions among folate cycle genes in the development of fetal growth retardation

Objective: Metabolic disturbances in the folate cycle in mothers can lead to fetal growth retardation (FGR). This study was to analyze the role of intergenic interactions among maternal folate cycle genes in the development of FGR. Methods: This case-control study recruited 365 women in the third trimester of pregnancy, including 122 FGR patients and 243 controls. The women were genotyped for 5 polymorphisms of the 4 folate cycle genes: MTR (rs1805087), MTRR (rs1801394), serine hydroxymethyl transferase (SHMT1; rs1979277), and TYMS (rs699517 and rs2790). The SNP × SNP interactions in the two-, three-, and four-locus models were analyzed using the multifactor dimensionality reduction method and a modification of it (the model-based multifactor dimensionality reduction method). Results: Four loci of maternal folate cycle genes (rs1805087 MTR, rs2790 TYMS, rs1801394 MTRR, and rs1979277 SHMT1) were associated with FGR in 3 significant models of single nucleotide polymorphism (SNP) × SNP interactions (two-, three-, and four-locus models) (P <0.05). The highest contribution to FGR was made by polymorphic loci rs1979277 SHMT1 (1.70% of entropy), rs1805087 MTR (0.96%), and interactions between rs1979277 SHMT1 × rs1805087 MTR (-1.11%) and rs1801394 MTRR × rs1979277 SHMT1 (−0.64%). The four-locus maternal genotype combination AG rs1801394 MTRR × AA rs1805087 MTR × CT rs1979277 SHMT1 × AG rs2790 TYMS was associated with an increased risk of FGR (β = 2.69, P = 0.012). FGR-associated SNPs were correlated with the expression of 16 genes (MTR, MTRR, SHMT1, ALKBH5, CTD-2303H24.2, ENOSF1, FAM106A, FOXO3B, LGALS9C, LLGL1, MIEF2, NOS2P2, RP11-806L2.6, SMCR8, TOP3A, and USP32P2) in various tissues and organs related to FGR pathophysiology. Conclusion: SNP × SNP interactions of maternal folate cycle genes (MTR, MTRR, SHMT1, and TYMS) are associated with the development of FGR.

Increased mtDNA mutation frequency in oocytes causes epigenetic alterations and embryonic defects.

Mitochondria are essential for female reproductive processes, yet the function of mitochondrial DNA (mtDNA) mutation in oocytes remains elusive. By employing an mtDNA mutator (Polgm) mouse model, we found the fetal growth retardation and placental dysfunction in post-implantation embryos derived from Polgm oocytes. Remarkably, Polgm oocytes displayed the global loss of DNA methylation; following fertilization, zygotic genome experienced insufficient demethylation, along with dysregulation of gene expression. Spindle-chromosome exchange experiment revealed that cytoplasmic factors in Polgm oocytes are responsible for such a deficient epigenetic remodeling. Moreover, metabolomic profiling identified a significant reduction in the α-ketoglutarate (αKG) level in oocytes from Polgm mice. Importantly, αKG supplement restored both DNA methylation state and transcriptional activity in Polgm embryos, consequently preventing the developmental defects. Our findings uncover the important role of oocyte mtDNA mutation in controlling epigenetic reprogramming and gene expression during embryogenesis. αKG deserves further evaluation as a potential drug for treating mitochondrial dysfunction-related fertility decline.

A retrospective cohort study on the effects of Down’s screening markers and maternal characteristics on pregnancy outcomes in preeclampsia

ABSTRACT Background To investigate the effects of down’s screening markers and maternal characteristics on preeclampsia (PE) pregnancy outcome during early and middle pregnancy. Methods A retrospective study of a cohort of 246 PE and 18,709 No-PE pregnant women who participated in Down’s screening during early and middle pregnancy was performed. Clinical data of pregnancy-related were collected. Multivariate binary logistic regression was used to analyze the adjusted odds ratio (aOR) and 95% confidence interval (CI) of Down’s screening markers, maternal characteristics, pregnancy outcome, and other related variables, and to evaluate the influencing factors of each indicator on PE. P < .05 was considered to be statistically significant. Results Compared with the non-PE group, the concentration and median multiple (MoM) of pregnancy-associated plasma protein-A (PAPP-A) and free beta subunit of human chorionic gonadotropin (free β-hCG) in PE group were both lower (P < .001). Multivariate binary logistic regression analysis showed that low birth weight, hydronephrosis, premature delivery, fetal growth retardation, cesarean section, live birth, hyperlipemia, infection, decreased free β-hCG and first trimester maternal weight were risk factors for PE (aOR were: 7.552, 6.684, 4.154, 3.762, 3.612, 2.454, 1.757, 1.562, 1.270, and 1.077, respectively), while uterine scar, premature rupture of membranes and elevated PAPP-A were protective factors of PE (aOR were: 0.222, 0.328 and 0.612, respectively). Conclusion Decreased maternal serum PAPP-A level, increased free β-hCG, hyperlipemia, premature delivery, cesarean section, live birth, hydronephrosis, fetal growth retardation, low birth weight, and infection are risk factors for PE, while uterine scar and premature rupture of membrane are protective factors for PE.

Gestational age-specific serum creatinine can predict adverse pregnancy outcomes

Serum creatinine level (SCr) typically decreases during pregnancy due to physiologic glomerular hyperfiltration. Therefore, the clinical practice of estimated glomerular filtration rate (eGFR) based on SCr concentrations might be inapplicable to pregnant women with kidney disease since it does not take into account of the pregnancy-related biological changes. We integrated the Wonju Severance Christian Hospital (WSCH)-based findings and prior knowledge from big data to reveal the relationship between the abnormal but hidden SCr level and adverse pregnancy outcomes. We analyzed 4004 pregnant women who visited in WSCH. Adverse pregnancy outcomes included preterm birth, preeclampsia, fetal growth retardation, and intrauterine fetal demise. We categorized the pregnant women into four groups based on the gestational age (GA)-unadjusted raw distribution (Q1–4raw), and then GA-specific (Q1–4adj) SCr distribution. Linear regression analysis revealed that Q1-4adj groups had better predictive outcomes than the Q1–4raw groups. In logistic regression model, the Q1–4adj groups exhibited a robust non-linear U-shaped relationship with the risk of adverse pregnancy outcomes, compared to the Q1–4raw groups. The integrative analysis on SCr with respect to GA-specific distribution could be used to screen out pregnant women with a normal SCr coupled with a decreased renal function.

Abnormal growth and morphogenesis of placenta at term is linked to adverse fetal development after perigestational alcohol consumption up to early gestation in mouse.

Gestation alcohol consumption produces fetal growth restriction and malformations by affecting the embryo-fetal development. Recently a relationship between abnormal placentation and fetal malformation and intrauterine growth retardation has been suggested. However, the effects of perigestational alcohol ingestion up to early pregnancy on the placenta at term and its association with fetal abnormalities are little known. In female mice, ethanol 10% in water was administered for 15 days previous and up to days 4 (D4), 8 (D8), or 10 (D10) of gestation (TF), and gestation continues without ethanol exposure. Control females (CF) received ethanol-free water. At day 18, feto-placental units and implantation sites were studied. TF had increased resorptions and only fetuses from D8-TF and D10-TF had significantly increased weights versus CF. D4 and D10-TF-placentas had significantly reduced weights. All TF had increased junctional zone (JZ) and reduced labyrinth (Lab) areas (PAS-histology and morphometry) compared with CF. Fetuses with mainly with craniofacial abnormalities and skeletal defects (Alizarin red staining), significantly increase; while the fetal bone density (alizarin color intensity, ImageJ) was reduced in D4, D8 and D10-TF versus CF. Although all TF-placentas were histo-structural affected, TF-abnormal fetuses had the most severe placental anomalies, with junctional abundant glycogenic cells into the labyrinth, disorganized labyrinthine vascularization with signs of leukocyte infiltrates and feto-maternal blood mix. Perigestational alcohol consumption up to early gestation induces at term fetal growth alterations, dysmorphology and defective skeleton, linked to deficient growth and abnormal morphogenesis of placenta, highlighting insight into the prenatal etiology of FASD.

Prenatal diagnosis and molecular cytogenetic characterization of inherited chromosome 2q11.1q11.2 microduplication with fetal intrauterine growth retardation

Prenatal diagnosis and molecular cytogenetic characterization of inherited chromosome 2q11.1q11.2 microduplication with fetal intrauterine growth retardation

Комбінований пренатальний скринінг І триместру вагітності як прогностичний маркер розвитку «великих акушерських синдромів»

Purpose - to conduct an analysis of the combined prenatal screening of the trimester I of pregnancy in women who had complications from the group of great obstetric syndromes. Materials and methods. A retrospective statistical analysis of the combined prenatal screening of the trimester I was carried out. Of the 239 pregnant women (Group I - main) who had complications from the group of great obstetric syndromes, according to the data of the pregnancy monitoring exchange cards, combined prenatal screening of the trimester I was carried out in 65.3% of pregnant women, which amounted to 156 pregnant women who were divided into three subgroups: Ia (n=74) pregnant women with severe preeclampsia, Ib (n=40) pregnant women with placental insufficiency, clinically verified fetal growth retardation; Ic (n=42) of pregnant women with spontaneous premature birth in the gestation period of 22-36 weeks. The control group (CG) was 56 practically healthy pregnant women with a healthy reproductive history and an uncomplicated course of this pregnancy. Statistical processing of the research results was carried out using standard Microsoft Excel 5.0 and Statistica 6.0 programs. Results. In the Group I, the average term of trimester I screening was 12 weeks 3±4 days, in the CG - 12 weeks 1±3 days, the difference in the gestational term of the trimester I combined screening was statistically insignificant. The lowest level of PAPP-A was determined in subgroups Ia and subgroup Ic. In the Group I, the level of PAPP-A was on average 2.16 (1.35-3.24) IU/l and 0.836 (0.571-1.14) MoM, and in CG - 2.62 (1.82-4, 12) MO/l and 1.16 (0.786-1.7) MoM. According to the relative number of patients with a level of PAPP-A &lt;0.5 MoM, no significant differences were found between the Group I and CG, but in subgroup Ib the percent of such patients was the highest, which is significantly more than in CG. More significant differences were found at the level of PAPP-A &lt;0.3 MoM: in Group I there were 11 (7.05%) patients with a level of PAPP-A &lt;0.3 MoM, in CG - 1 (1.78%). The number of patients with a level of PAPP-A &gt;1.5 MoM, on the contrary, turned out to be the largest in CG - 15 (26.8%) compared to 23 (14.7%) in the Group I and with subgroup Ia - 9 (12.2%). The level of β-hCG in the studied groups was not statistically significant. There was no statistically significant difference in the thickness of the nuchal translucency, but in the Group I this indicator was slightly higher. The largest nuchal translucency value was in subgroup 1b. There were no statistically significant differences in the frequency of the absence of imaging of the nasal bone during ultrasound screening. According to the frequency of detection of reverse blood flow in the ductus venosus, it was not possible to detect statistically significant differences. This sign occurred only in 3 (1.92%) patients of the Group 1 (1 patient in each subgroup) and in 1 (1.78%) patient of CG. Conclusions. In patients who later developed pregnancy complications belonging to the group of great obstetric syndromes, in the trimester I, a number of prenatal screening indicators differ from those in patients with a physiological course of pregnancy. When conducting a standard set of prenatal diagnostics, the most significant differences were found in the level of PAPP-A (MoM). The results obtained during the analysis of PAPP-A are promising from the point of view of using this parameter as an element of the prognostic model of great obstetric syndromes for the successful course of pregnancy and the birth of a child with a normal body weight. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Women’s informed consent was obtained for the study. No conflict of interests was declared by the author.

The effect of covid 19 pandemic on women of childbearing age

The Covid 19 pandemic changed people's lifestyles. Decreased social interactions have led to a wide range of emotions in the general public, especially women of childbearing age. A range of emotions including: stress, loneliness, panic attacks, anxiety and depression, variables have been reported. Depression, which is by far the most common and second-ranked disease in the world, is now on the rise. In girls around puberty, if not correctly identified; It can increase the risk of suicide. In pregnant women, it can cause low birth weight, preterm birth, and fetal growth retardation. If a pregnant woman is not properly identified and treated, it can lead to postpartum depression and cause abrupt cessation of breastfeeding and subsequent consequences. In postmenopausal women, it can also destroy their interpersonal relationships and social interactions. Therefore, it is necessary for reproductive health professionals and health care providers, using the public education system, to promote the knowledge of the general public, especially women of childbearing age.

Effect of Hyperthyroidism Control During Pregnancy on Maternal and Fetal Outcome: A Systematic Review and Meta-Analysis.

ContextAlthough the overt hyperthyroidism treatment during pregnancy is mandatory, unfortunately, few studies have evaluated the impact of treatment on reducing maternal and fetal outcomes.ObjectiveThis study aimed to demonstrate whether treatment to control hyperthyroidism manifested during pregnancy can potentially reduce maternal-fetal effects compared with euthyroid pregnancies through a systematic review with meta-analysis.Data SourceMEDLINE (PubMed), Embase, Cochrane Library Central, LILACS/BIREME until May 2021.Study SelectionStudies that compared, during the gestational period, treated women with hyperthyroidism versus euthyroid women. The following outcomes of this comparison were: pre-eclampsia, abruptio placentae, fetal growth retardation, gestational diabetes, postpartum hemorrhage, low birth weight, stillbirth, spontaneous abortions, premature birth.Data ExtractionTwo independent reviewers extracted data and performed quality assessments. Dichotomous data were analyzed by calculating risk differences (DR) with fixed and random effect models according to the level of heterogeneity.Data SynthesisSeven cohort studies were included. The results of the meta-analysis indicated that there was a lower incidence of preeclampsia (p=0.01), low birth weight (p=0.03), spontaneous abortion (p<0.00001) and preterm birth (p=0.001) favouring the euthyroid pregnant group when compared to those who treated hyperthyroidism during pregnancy. However, no statistically significant differences were observed in the outcomes: abruptio placentae, fetal growth retardation, gestational diabetes mellitus, postpartum hemorrhage, and stillbirth.ConclusionsOur findings demonstrated that treating overt hyperthyroidism in pregnancy is mandatory and appears to reduce some potential maternal-fetal complications, despite there still being a residual risk of negative outcomes.

Determination of four trihalomethanes in ship ballast water by gas chromatography-negative chemical ionization-mass spectrometry

我国每年的船舶压载水排放量巨大,压载水中含有浮游生物、病原体及其幼虫或孢子等,若处理不当,会对排放水域的生态环境造成严重影响。排放压载水前常使用电解法对其进行处理,电解产生的次氯酸钠溶液,能有效杀灭残余的微生物。但电解后会产生副产物三卤甲烷(THMs),其对人体有一定的健康风险,建立船舶压载水中三卤甲烷的测定方法具有重要意义。该研究建立了采用气相色谱-负化学源质谱(GC-NCI-MS)测定船舶压载水中4种三卤甲烷(包括三氯甲烷、二氯一溴甲烷、一氯二溴甲烷、三溴甲烷)的分析方法。船舶压载水样品经过顶空进样技术处理后,通过DB-5MS UI毛细管色谱柱(30 m×0.25 mm×1.0 μm)分离,气相色谱-负化学源质谱仪测定,在选择离子扫描(SIM)模式下分析,采用外标法进行定量。4种三卤甲烷在0.2~50 μg/L范围内线性关系良好,相关系数(r)≥0.995,定量限(S/N=10)为0.1~0.2 μg/L,在0.2、0.5、2.0 μg/L 3个加标水平下,4种THMs的平均回收率为90.3%~106.8%,相对标准偏差(RSD)为1.4%~6.2%。该方法准确、稳定、可靠,可用于测定船舶压载水中4种THMs的含量。使用建立的测定方法对36个船舶压载水进行测定,三溴甲烷、二溴一氯甲烷、一溴二氯甲烷与三氯甲烷的检出率分别为83.3%、69.4%、22.2%和19.4%,检出值分别为34.25~221.5 μg/L、3.52~41.87 μg/L、1.52~8.56 μg/L和0.02~5.46 μg/L。

FAKTOR DOMINAN PENYEBAB KEJADIAN KEKURANGAN ENERGI KRONIK PADA IBU HAMIL

CED during pregnancy triggers cases of hypertension pregnancy, pre-eclampsia, bleeding, and premature rupture of membranes and causes fetal growth retardation during pregnancy. Many factors cause KEK. Therefore cases of KEK need to be considered so that they can be managed properly before and during pregnancy. Objective: to obtain the dominant factor causing SEZ in pregnant women. Methods: This research is an observational analytic study with an explanative quantitative method, using a case-control design. The sample in this study was divided into two groups, namely the case group of 36 pregnant women and the control group of 73 pregnant women. The research was conducted at the Independent Midwife Practice in Jatidatar, Central Lampung. Bivariate analysis using chi-square test. Multivariate analysis using multiple logistic regression test. The significance level was set at 95%. Results: Of the 6 variables that were tested by bivariate, only 3 variables were associated with the incidence of SEZ. Age (ρ=0.750), education (ρ=0.541), and occupation (ρ=0.132) were concluded to be unrelated to the incidence of SEZ, where each of these variables -value &gt;0.05. Variables related to the incidence of SEZ in the statistical test results, namely; income (ρ=0.001, 95% CI: 1.911–13.821, OR = 5.139), parity (ρ=0.037, 95% CI: 1.137–5.903, OR = 2.591), anemia (ρ=0.001, 95% CI: 2.354– 13,454, OR = 5,628). In the final modeling, anemia was the dominant variable (POR/Exp(B) = 4.312, 95% CI = 1.741 – 10.683). Conclusion: Family income, maternal parity, and anemia are factors that play a role in triggering SEZ in pregnant women. Anemia after being controlled by the family income variable became the dominant factor causing KEK in pregnant women.

Dynamics of mother–placenta–fetus system functioning in pregnant women with a history of sexually transmitted infections

The objective: to analyze the dynamics of functional and laboratory indicators of the mother-placenta-fetus system in pregnant women with a history of sexually transmitted infections (STIs) after pregravid preparation before cycles of assisted reproductive technologies (ART). Materials and methods. An analysis of the mother–placenta–fetus system functioning was performed in 200 pregnant women with a history of STIs after the use of ART. The I (main) group included 100 pregnant women with pregravid preparation before the ART cycle, obstetric and perinatal support and childbirth in accordance with the medical and organizational algorithms, prognostic methods and treatment and prevention schemes developed by us; II group – 100 pregnant women who received generally accepted prognostic and treatment-prophylactic drugs. The control group included 100 practically healthy pregnant women with a normal reproductive history and uncomplicated course of this pregnancy. Statistical processing of research results was carried out using standard Microsoft Excel 5.0 and Statistica 8.0 programs. Results. In the I trimester of pregnancy, pregnant women in the I group were diagnosed hypoplasia of the chorion (23.0%) and thickening of the decidua basalis (32.0%) less often (p&lt;0.05), compared to 39.0% and 51.0% persons, respectively, in the II group. The increased myometrium tone (especially in the location of the chorion) was found in 16.0% of women of the I group versus 26.0% – in the II group (p&lt;0.05). During the II trimester, the moderate thickening of the placenta with increased diffuse hyperechogenicity was determined in 35.0% of pregnant women in the I group and in 48.0% – II group; hypertrophy of the placenta was accompanied by signs of polyhydramnio in 14.0% and 18.0% of cases, respectively. The probable decrease in the number of cases of placental hypoplasia was established among women of the I group (17.0%) versus 26.0% in the II group (p&lt;0.05). In the III trimester of pregnancy, a significant decrease in the number of cases of hypoplasia and destructive changes in the placenta was found (by 3 times) among women of group I compared to pregnant women of group II (p&lt;0.05).In 14.0% of the pregnant women in the I group oligohydramnios was detected, and in 15.0% – ultrasound signs of late fetal growth retardation (FGR) compared to 34.0% and 39.0% individuals, respectively, in the II group. The Ponderal index (ip) in the presence of late FGR in the I group was within the range of 1.9–2.0, and in the II group – 1.6–1.8. In the dynamics of the III trimester of pregnancy (33–34 weeks, 37–38 weeks) during the indirect cardiotocography, the fetal distress index in the It group of pregnant women was within the range of 0.98–1.02 and almost did not exceed the control standards (р&gt;0.05), in the II group at the beginning of the III trimester it was 1.7 times higher, which indicated the presence of subcompensated fetal distress. At 37–38 weeks of pregnancy, the fetal distress index in the I group was 1.02 and it was 2.5 times lower than in women in the ІІ group (2.58; p&lt;0.05). The hormonal activity of the fetoplacental complex during the III trimester of pregnancy in the II group indicates the changes which were typical for depletion of the placenta’s hormone synthetic and metabolic functions. Thus, the progesterone level in the II group was 501.6±51.6 nmol/l versus 596.4±56.4 nmol/l in the I group (p&lt;0.05); cortisol and estriol levels – 546.8±24.3 nmol/l and 77.6±5.4 nmol/l versus 655.5±31.3 nmol/l and 98.5±6.9 nmol/l, respectively (p&lt;0.05). Conclusions. According to the obtained data, in pregnant women who received our proposed complex pregravid training (I group), a state of unstable tension of hormonal regulation of the placenta was revealed until the end of pregnancy, and in the II group the exhaustion of placental and fetal hormones synthesis was observed. Our proposed pregravid preparation before ART cycles in women with a history of sexually transmitted infections leads to stabilization of the hormonal and metabolic functions of the placenta.

Prevention of recurrent fetal growth retardation in patients with circulating antiphospholipid antibodies and genetic thrombophilia

Aim: to evaluate the effectiveness of using low molecular weight heparin (LMWH) and low-dose acetylsalicylic acid (ASA) in preventing recurrence of early and late fetal growth retardation (FGR) in patients with antiphospholipid syndrome (APS) and/or genetic thrombophilia.Materials and Methods. A prospective randomized controlled study was conducted by examining 32 patients aged 23 to 43 years with a history of early and late II and III FGR as well as thrombophilia. Prevention protocol using LMWH and ASA was carried out from the pregravid period or early pregnancy. The control group included 35 women with uncomplicated pregnancy. Antiphospholipid antibodies (APA) were measured according to the Sydney antiphospholipid syndrome (APS) criteria by using enzyme immunoassay (ELISA): cardiolipin, β2-glycoprotein 1 and additionally antibodies to annexin V, prothrombin, etc. (IgG/IgM isotypes); lupus anticoagulant – by a three-stage method with Russell's viper venom; antithrombin III and protein C levels – by chromogenic method; prothrombin gene polymorphisms G20210A as well as factor V Leiden polymorphism – by chain reaction; homocysteine – by ELISA.Results. It was found that prevention protocol was effective in 78.1 % cases. FGR re-developed in 7 (21.9 %) pregnant women: in 2 (6.3 %) at 20 and 22 weeks, in 3 (9.4 %) at 30–32 weeks, in 2 (6.3 %) after 34 weeks of pregnancy. All these patients were found to have APA exceeding 40 U/ml with low dynamics of decline, 3 (9.4 %) were older than 35 years, 2 (6.3 %) had chronic kidney pathology and 1 (3.1 %) had a hypertension in the anamnesis.Conclusion. The use of LMWH and low-dose ASA starting from the pre-pregnancy period and early pregnancy as a part of complex therapy allows to effectively prevent re-development of FGR in patients with thrombophilia. In case of high APA titers, the use of LMWH and low-dose ASA may be ineffective, and alternative treatment methods in addition to anticoagulant therapy should be used to improve obstetric results.