Fetal Hypotrophy Research Articles

Nutrition during Pregnancy: Macronutrient and Specific Needs

Pregnancy is characterized by significant metabolic changes aimed at providing the fetus a regular nutritional intake, adapted to its needs in all circumstances. The nutritional impact on the fetus is assessed by development and growth fetal and by its repercussions on fetal programming which conditions the occurrence of metabolic diseases in adulthood. Maternal weight gain during pregnancy is an important nutritional indicator. Excessive energy intake increases the risk of pregnancy-related high blood pressure, gestational diabetes, macrosomia and dystocia. Insufficient, it exposes to the risk of fetal hypotrophy, morbidity and mortality increase in neonatal and postnatal developmental disorders. Desirable nutritional intakes are close to those recommended in the general population. A debate remains concerning the benefit of systematic supplementation with iron, vitamin D and iodine. It is accepted that a diversified, sufficient and balanced diet is enough to satisfy all needs, with the exception of folic acid, the subdeficiency of which, very common among women of childbearing age, is associated with malformations which can be prevented by systematic supplementation. Others supplementation is only necessary for women at risk.

Nutrition during Pregnancy: Macronutrient and Specific Needs

Pregnancy is characterized by significant metabolic changes aimed at providing the fetus a regular nutritional intake, adapted to its needs in all circumstances. The nutritional impact on the fetus is assessed by development and growth fetal and by its repercussions on fetal programming which conditions the occurrence of metabolic diseases in adulthood. Maternal weight gain during pregnancy is an important nutritional indicator. Excessive energy intake increases the risk of pregnancy-related high blood pressure, gestational diabetes, macrosomia and dystocia. Insufficient, it exposes to the risk of fetal hypotrophy, morbidity and mortality increase in neonatal and postnatal developmental disorders. Desirable nutritional intakes are close to those recommended in the general population. A debate remains concerning the benefit of systematic supplementation with iron, vitamin D and iodine. It is accepted that a diversified, sufficient and balanced diet is enough to satisfy all needs, with the exception of folic acid, the sub-deficiency of which, very common among women of childbearing age, is associated with malformations which can be prevented by systematic supplementation. Others supplementation is only necessary for women at risk.

The Effect of Maternal Exposure to a Diet High in Fats and Cholesterol on the Placental Function and Phenotype of the Offspring in a Rabbit Model: A Summary Review of About 15 Years of Research.

The rates of obesity and being overweight are increasing all around the world, especially among women of childbearing age, in part due to overconsumption of lipids. The aim of this summary review was to present the cellular and molecular effects of a hyperlipidic high-cholesterol (H) diet on the maternal and offspring phenotype at the early embryonic, neonatal, weaning and adult stages while considering the effects of sex and to identify the window(s) of vulnerability linked to this exposure in a rabbit model. Before breeding, the H diet induced dyslipidemia and aortic atherosclerosis lesions and increased the number of atretic follicles. In the offspring, the H diet disrupted the embryonic phenotype and induced fetal hypotrophy associated with sex-specific disturbances of the feto-placental unit. In adulthood, the offspring of the H dams were heavier and hyperphagic and had increased blood pressure associated with disturbed gonadal development in both sexes. Vulnerability windows were explored via embryo transfers. The maternal gestational diet was shown to play a key role in the feto-placental phenotype, and preconception programming was unquestionably also observed. These two periods could represent windows of intervention in the context of obesity or being overweight to limit fetal and placental consequences.

Severe Preeclampsia Epidemiological, Diagnostic, Therapeutic and Prognostic Aspects at the Thies Regional Hospital Center about 443 Cases

Objectives: Are to study the epidemiological, diagnostic, therapeutic and prognostic aspects of severe pre-eclampsia in the Obstetrics Gynecology Department of the Regional Hospital of THIES. Materials and Methods: This were a prospective, descriptive and analytical study of patients received for PES at the Maternity Department of the Regional Hospital of Thies between June 20, 2015 and June 20, 2017. We studied the diagnostic, epidemiological, therapeutic and prognostic aspects. The data were entered and analyzed by the EPINFO software version 6.04dfr. In order to study the influence of certain prognostic factors, we used the comparison of proportions and the Chi-square test with a significance level of 0.05. Results: We recorded 443 cases of Severe Peclampsia (SEP) out of 15,744 pregnant women, i.e. a frequency of 2.81%. It represented 52.05% of all hypertensive states associated with pregnancy during the study and a frequency of 3.12% of deliveries. The typical epidemiological profile found was that of a young woman aged 20-24 (25.05%), married (91.19%), housewife (80.8%) from the commune of Thies (50.56 %), primiparous (52.37%), carrier of a single pregnancy (96.4%), followed in a health post (97.21%) and evacuated in 89.4% of cases. The time between admission and delivery was on average 3.85 ± 3.91 days with extremities ranging from 0 to 42 days. The main signs found were: headache (96.61%), hypertension with SBP ≥160/110mmHg (93.90%), edematous syndrome (90.29%), proteinuria on the test strip ≥ ++ (95.48%), hyper uricemia >60mg/l (66.13%). Therapeutically, calcium channel blockers were the main antihypertensive agent used (99.32%). Magnesium sulfate was administered to almost all patients (97.29%). Corticosteroids were administered to 223 patients (50.23%). The blood transfusion had been done in 45 patients or 10.08%, and 05 of our patients had presented an acute renal failure requiring a transfer to Dakar for dialysis. Fetal evacuation was performed by Caesarean section in 49.88% of cases. Maternal complications were dominated by: eclampsia (24.78%), retro-placental hematoma (3.61%) and Hellp syndrome (3.61%). We recorded 18 cases of maternal death, i.e. a specific lethality of 4.06% and 69 cases of neonatal death, or a perinatal mortality rate of 4.87 per 1000 live births. On the fetal side, the main complications were fetal hypotrophy (51.46%) and prematurity (41.08%). The main factors of poor maternal prognosis were young age (20-24 years), primi gestity and primiparity. The fetal risk factors included prematurity and the low Apgar score.

Вплив дифузного нетоксичного зоба на розвиток плацентарної недостатності, перебіг гестації та пологів

Актуальність. При захворюваннях щитоподібної залози (ЩЗ), особливо за умов хронічного дефіциту йоду, спостерігаються суттєві порушення у функціонуванні системи «мати — плацента — плід», що призводить до ускладнень вагітності, пологів із загрозою здоров’ю потомства. Мета. Вивчення впливу йодиду калію в поєднанні з натрію селенітом і цитофлавіном у жінок із дифузним нетоксичним зобом (ДНЗ) для корекції порушень у системі «мати — плацента — плід» під час вагітності. Матеріали та методи. Для оцінки стану вагітних за період 2012–2017 рр. обстежено 159 вагітних жінок і їхніх новонароджених, які сформували дві групи. До першої групи увійшло 79 вагітних із ДНЗ, які через різні причини не отримували йодиду калію та інші препарати. Другу групу сформували 80 жінок із ДНЗ, які отримували йодид калію (200 мкг/добу) в поєднанні з натрію селенітом і цитофлавіном. Результати. Хронічна фетоплацентарна недостатність зареєстрована в 21,1 % випадків, причому встановлено вірогідну відмінність у її частоті в обох групах обстежуваних жінок: 27,9 % у першій групі та 14,3 % у другій групі. Рівень тиреотропного гормону (ТТГ) новонароджених, які народилися від жінок першої і другої груп, вірогідно не відрізнявся та не перевищував нормальних показників (4,72 ± 1,22 мМО/л і 2,73 ± 1,01 мМО/л відповідно). Концентрація ТТГ у крові новонароджених другої групи була на 42,2 % нижчою, ніж у новонароджених першої групи. Висновки. Про сприятливий вплив прийому йодиду калію в поєднанні з натрію селенітом і цитофлавіном під час гестації на розвиток плода свідчить статистично значуще зменшення частоти внутрішньоутробних ускладнень у другій групі в порівнянні з першою групою дослідження: хронічної фетоплацентарної недостатності (14,3 і 27,9 % відповідно; р < 0,05) і хронічної внутрішньоутробної гіпотрофії плода (13,8 і 28,6 % відповідно; р < 0,05).

Antenatal screening of small for gestational age: Impact on obstetrical management and neonatal outcomes in case of trial of labor after 37 weeks

ObjectiveAntenatal screening of small fetuses for gestational age (SGA) is a public health challenge. The aim of this study is to assess the obstetrical management and the immediate neonatal outcomes, according to the antenatal screening of the SGA fetuses. MethodsWe performed a retrospective study in a French tertiary care hospital between January 1, 2016 and December 31, 2018. Women were eligible if they had a monofetal pregnancy with a fetus in head presentation and a trial of labor after 37 weeks. A fetus was considered SGA when the estimated fetal weight was less than the 10th percentile at the third trimester ultrasound. A newborn was considered hypotrophic when the birthweight was less than the 10th percentile. Results8 153 newborns were included and 948 of the newborns were hypotrophic (308 were suspected for SGA, 640 were not suspected for SGA) and 7205 were eutrophic. Among the hypotrophic neonates, we observed no significant difference regarding the immediate neonatal outcomes between the two groups of fetuses suspected and not suspected for SGA. Among the fetuses not suspected for SGA, the rate of arterial umbilical cord pH below 7.10 was significantly higher in the hypotrophic newborns compared to the non hypotrophic newborns (4.7% vs 3.1%, p = 0.041). ConclusionIn our population, unsuspected fetal hypotrophy may be associated with an increased risk of neonatal acidosis. These results emphasize the benefit of improving prenatal screening to identify the SGA fetuses.

Health-related quality of life (Nottingham Health Profile) of women with normal and pathological pregnancy and during delivery: correlation with clinical variables and self-reported limitations

Objective Pregnancy is often associated with changes in the psychological functioning of women. The present study aimed to analyze the incidence of health problems in pregnant mothers and the influence of these problems on their daily functioning using a survey. Material and methods The study included a total of 232 women aged 19–42 years. The tools used in the study were a self-developed questionnaire and the NHP questionnaire. The study was performed among women with pathological pregnancies and healthy pregnancies who delivered. Women with pathological pregnancies had pregnancy-induced hypertension, fetal hypotrophy, cholestasis, or gestational diabetes mellitus. Women with healthy pregnancies were recruited from the hospital ambulatory and cooperating private practices or during admission for delivery. Results Group K had significantly lowest “TOTAL” intensity in relation to the other groups. For variable “PROBLEMS,” a statistically significant difference was found between group K and group P (p=.001) and between group D and group P Conclusions Every woman may experience a different level of satisfaction with life during pregnancy. This is typically determined by the personality of the given individual, as well as by pregnancy-associated emotions. It is important that health care personnel should provide psychological support and follow individual approach for each pregnant woman.

Nutritional status of Moroccan pregnant women and the birth weight of their newborn: a case-control study in the province of El Jadida

<abstract><sec> <title>Background</title> <p>Maternal malnutrition is a global concern whose consequences for newborns are intrauterine growth retardation, fetal hypotrophy and exposure to risks of pathologies in adulthood.</p> </sec><sec> <title>Objective</title> <p>The aim of this study was to assess and compare the diet quality and nutritional status of pregnant women at the time of childbirth while assessing their newborn's weight at birth.</p> </sec><sec> <title>Materials and methods</title> <p>The study involved 400 parturient, divided into two groups of 200 each, the controls who have just given birth to newborns of normal weight and the cases who have just given birth to babies of low birth weight (LBW). Information on food intakes and dietary habits were collected using questionnaires and anthropometric parameters were measured.</p> </sec><sec> <title>Results</title> <p>The mean body mass index (BMI) of the cases was 25.93 ± 2.64 kg/m<sup>2</sup> vs. 28.25 ± 2.75 kg/m<sup>2</sup> in the controls. The dietary diversity and variety scores were higher in the controls than in the cases. Indeed means were 6.87 ± 1.30 vs. 8.88 ± 1.35 food groups for the diversity scores and 11.77 ± 1.57 vs. 15.90 ± 2.09 food items for the variety scores in the cases and the controls respectively. The average daily intakes of folates, calcium, iron and zinc were lower than the Recommended Daily Allowances (RDA) for both groups. The daily calcium intake represents only 1/5th of the RDI for the cases and 1/3 for the controls. Average dietary iron intake was insufficient at only 49% of the daily requirement for cases vs. 66.88% for controls while folates accounts for 64.33% of the RDA for the cases.</p> </sec><sec> <title>Conclusion</title> <p>Data from this study shows that the diets of women who have given birth to low birth weight infants are poorly diversified, poorly varied, and poor in certain nutrients essential for a successful pregnancy and childbirth.</p> </sec></abstract>

Pregnant woman with circumvallate placenta and suspected fetal hypotrophy caused by placental insufficiency: a case report

Background: The circumvallate placenta is a rare pathology of the human placenta that occurs in 1–2% of pregnancies. It is characterized by extrachorial placental development, resulting in a ring formation along the edges of the placenta, which leads to efficiency impairment. As a consequence, it causes an intrauterine fetal hypotrophy. The fetal hypotrophic pregnancies are classified as high-risk pregnancies, requiring not only intensive monitoring of fetal development but also maternal and fetal care by the highest reference clinical center. Aim of the study: The aim of this study was to analyze the case of a patient with circumvallate placenta and fetal hypotrophy suspicion. Material and methods: The study was based on the case study method. The data was obtained by analyzing medical documentation collected during hospitalization. The patient was interviewed and observed. All of the selected parameters were measured and scaled. Case study: A 30-year-old primiparous woman at 38+1 weeks gestation, with diagnosed circumvallate placenta and suspected fetal hypotrophy. The pregnancy had several complications, including gestational hypothyroidism. There was spotting and imminent abortion in the first trimester and in the second and third trimester, the patient was treated for vaginal mycosis. There was a risk of preterm labor in the third trimester. The patient was admitted to the delivery room in the first stage of labor. The course of first stage of labor was normal however the second stage of labor was complicated. Obstructed labor with ace presentation, mentoposterior position. A lower uterine segment cesarean section (LUSCS) was performed and a live full-term female infant was delivered, which was found to be small for gestational age (SGA). The course of the early puerperium was uncomplicated with an expected duration of stay in the neonatology department. Both mother and baby were discharged from hospital on postpartum day 3. Conclusions: Circumvallate placenta is not a contraindication to natural delivery however is associated with an increased risk of many perinatal complications. Holistic care during delivery and the early puerperium requires specialized knowledge and skills of medical staff in taking care of both of the mother and the child.

Современные подходы к диагностике раннего маловодия

Objective. To compare the methods of oligohydramnios (OHA) diagnosis using 2D- and 3D-ultrasound and to determine clinical significance of OHA in women with intrauterine infection. Patients and methods. We evaluated the amount of amniotic fluid in 130 pregnant women (at weeks 13–21) aged between 17 and 45 years by measuring the largest vertical pocket and calculating the volume of the largest pocket. Seventy patients were found to have reduced amount of amniotic fluid (Group 1). Sixty women comprised the control group (Group 2). Results. The method for measuring the largest vertical diameter of a fluid pocket demonstrated the following performance characteristics: 84% sensitivity, 94% specificity, 87.9% accuracy, and 0.5 AUC. The performance of measurement of the largest pocket volume was as follows: 92.5% sensitivity, 97.3% specificity, 96.1% accuracy, and 0.8 AUC. Perinatal losses were observed only in Group 1 (n = 2; 28.6%). Women in Group 1 were more likely to have fetal hypotrophy than women in Group 2 (54 (77.1%) vs 5 (8.3%)). Hypoxic-ischemic brain injury and intrauterine infections were also more common among patients with OH than in controls (65 (92.8%) vs 4 (6.6%) and 59 (84.3%) vs 7 (11.6%), respectively) (p < 0.001). Conclusion. Early OH is a marker of severe obstetric and perinatal complications in patients with signs of intrauterine infections. Measurement of the largest pocket volume demonstrated better performance characteristics for the detection of early OH than calculation of the largest vertical diameter of a fluid pocket. Key words: intrauterine infection, oligohydramnios, amniotic fluid, three-dimensional ultrasound

The role of work factors in determining premature birth and fetal hypotrophy

The role of work factors in determining premature birth and fetal hypotrophy

Contemporary placentography: harm or benefit?

Currently, pediatricians, neonatologists of maternity hospitals often take part in perinatal consultations. One of the indications for early delivery may be chronic placental insufficiency diagnosed during an ultrasound examination.
 Objective: to evaluate the effectiveness of the main method of diagnosis of placental insufficiency at the present time – ultrasound evaluation of the placenta.
 Materials and methods. An analysis was made of 357 birth histories, exchange cards, protocols for screening ultrasound in the third trimester of pregnancy and conclusions of pathoanatomical investigation.
 Results. To substantiate the need for prenatal diagnosis of chronic kidney disease, a comparison was made of the evaluation of newborn babies on the Apgar scale and the state of the placenta according to histological data. With compensated chronic placental insufficiency, there was no difference in Apgar scores at the first and fifth minutes, whereas in the subcompensated stage, Apgar score on the Apgar scale was significantly lower in the first and fifth minutes than in the control group. To identify possible in practical use of the objective parameters of diagnosis of chronic kidney disease, the thickness of the placenta was measured during the screening ultrasound in the third trimester of pregnancy, as well as the thickness of the placenta after its separation. Significant differences in the thickness of the placenta or in the screening ultrasound, or when measuring the placenta after separation in patients with and without chronic placental insufficiency was not detected. When assessing a violation of the rate of maturation of the placenta in the third trimester of pregnancy, no significant differences were found in the presence and absence of placental insufficiency. An analysis of the amniotic index was carried out to determine the amount of amniotic fluid in patients of the main and control groups, which revealed no significant differences between the groups.
 Conclusions. The authors believe that the main indicators currently used for diagnosis of chronic placental insufficiency (thickness of the placenta, degree of maturity of the placenta, appearance of structural changes in the placenta, change in the amount of amniotic fluid) are uninformative and modern placenography does more harm than benefit. The only parameter determined during the screening study in the third trimester of pregnancy and having significant differences in the main and control groups is fetal hypotrophy.

Pathoanatomical Lesions in Placentas With Excessively Hypercoiled Umbilical Cords: Frequent Detection of Massive Perivillous Fibrin Deposition.

This study focused to investigate a possible association of extensive umbilical hypercoiling (displaying an umbilical coiling index [UCI] of at least 1.0 coils/cm), clinical outcome, and associated pathoanatomical placental lesions. Of the 771 singleton placentas from the second and third trimesters submitted for pathoanatomical evaluation, 15 cases (2%) displayed extensive hypercoiling. There was an association of excessive hypercoiling with hypotrophy of fetuses and children (11 cases) and fetal demise (12 cases). Thin cord syndrome and umbilical stricture were observed in 9 cases and 4 cases, respectively. Seven of the 15 cases with excessive umbilical hypercoiling showed increased placental fibrin deposition (47% of the cases with hypercoiling), in 4 cases sufficient for rendering the diagnosis of massive perivillous fibrin deposition. Signs of maternal vascular malperfusion (n = 6) and chorangiosis (n = 2) were also detected in cases with hypercoiling. Recurrence of excessive umbilical hypercoiling was observed in 2 families, suggesting a genetic predisposition for the development of this lesion. Extensive hypercoiling could be a hitherto underrecognized pathogenetic factor for the development of massive perivillous fibrin deposition. A high UCI measured in the second trimester by ultrasound may be predictive of fetal hypotrophy, and intensified fetal monitoring is warranted, particularly if there is a history of hypercoiling and adverse fetal outcome.

Fetal Prognostics in Relation to Uricemia and Maternal Proteinuria of Arterial High Blood Pressure Types during Pregnancy at the Maternity of Donka, National Hospital Donka, CHU of Conakry, Guinea

Objectives: The objectives of this work were to calculate the frequency of arterial hypertension during pregnancy, describe the epidemiological profile, and identify the most common type of hypertension and to establish fetal prognosis based on uricemia and maternal proteinuria. Methodology: This was a six (6) month descriptive prospective study performed in the Obstetrics and Gynecology Department of Donka National Hospital-CHU Conakry. The study took place from july 1 st to December 31st, 2015. Results: The frequency of arterial hypertension during pregnancy was 8.82% in the service. The epidemiological profile was that of teenagers (32.8%), nulliparous (56%), coming from home (69.2%), not having performed CPN (52%), not schooled (68%) and housewives. The primary factor was the risk factor (52.4%). Gestational age greater than 37 was the most concerned (62%). The reasons for consultation are dominated by headache (76%) and vertigo (68%). The main type of hypertension was pre-eclampsia (48%) followed by Transient HTA (28%). The predominant clinical form during the admission was pre-eclampsia (47.2%) followed by eclampsia (23%). At the first minute, 35.68% of newborns had an APGAR score of less than 7 and the fifth 25.5% had a score of less than 7. Fetal morbidity was dominated by fetal hypotrophy (30.19%), followed by prematurity (23.92%). In 90.90% of hypotrophy, there are 85.24% of premature babies, 95.55% of SFA, and 80% of MIU; the serum uric acid was greater than 350 mmol. We recorded 204 children born with mothgers with proteinuria greater than or equal to 30 mg/dl, or 80% of children. 30 cases of MFIU and 7 cases of neonatal death out of 255 births, that is 14.50% were noted. Conclusion: The detection of risk factors by a good prenatal follow-up and the regular training of the care providers for adequate and multidisciplinary care (obstetrician, intensive care nephrologist and pediatrician) of hypertensive pregnant women and their newborns can improve the maternal prognosis and fetal.

Prognostic Materno-Fetal Types of Arterille Hypertension during Pregnancy at the Maternity of Donka, National Hospital Donka, Chu of Conakry, Guinea

Objectives: The objectives of this work were to calculate the frequency of arterial hypertension during pregnancy, describe the epidemiological profile, and identify the most common type of hypertension and establish the maternal and fetal prognosis. Methodology: This was a six-month descriptive prospective study performed in the Obstetrics and Gynecology Department of Donka National Hospital, CHU, Conakry. The study took place from July 1st to December 31st, 2015. Results: The frequency of arterial hypertension during pregnancy was 8.82% in the service. The epidemiological profile was that of a teenager (32.8%), nulliparous (56%), coming from home (69.2%), not having performed CPN (52%), no schooling (68%) and housewives. The primary factor was the risk factor (52.4%). Gestational age greater than 37 was the most concerned (62%). The reasons for consultation are dominated by headache (76%) and vertigo (68%). The main type of hypertension was pre-eclampsia (48%) followed by Transient HTA (28%). The predominant clinical form at admission was pre-eclampsia (47.2%) followed by eclampsia (23%). Eclampsia was the major complication (48%), with 6 deaths, or 2.4%. At the first minute, 35.68% of newborns had an APGAR score of less than 7 and 25.5% had a score of less than 7. Fetal morbidity was dominated by fetal hypotrophy (30.19%) followed by prematurity (23.92%). We recorded 30 cases of MFIU and 7 cases of neonatal death out of 255 births, i.e. 14.50%. Conclusion: The detection of risk factors by a good prenatal follow-up and the regular training of the care providers for an adequate and multidisciplinary care (obstetrician, intensive care nephrologist and pediatrician) of hypertensive pregnant women and their newborns can improve the maternal and fetal prognosis.

Сlinical features of newborn children in patients with perinatal losses

The article presents the data of a complex analysis of the course of the early period of the newborn in children born to 456 women who were delivered in the maternity hospitals of St. Petersburg and the Leningrad Region in 2009-2016. These patients were divided into the main group (99 women who gave birth to live children who died in the first 7 days of life) and a comparison group (357 women who gave birth to live children who survived the first 7 days). Estimated the duration of pregnancy at the time of delivery, clinical features of newborn children in the group of patients with perinatal losses, in comparison with the control group, were analyzed. The article compares the anthropometric data of newborns (weight and height at birth), Apgar scores, and the frequency of fetal hypotrophy. The results of the clinical analysis of the blood of newborn children of the patients of the main and control groups (hemoglobin, erythrocytes, leukocytes, platelets and venous blood glucose) were also evaluated. A number of significant differences in the main group and comparison group that can be regarded as predictors of perinatal fetal death have been identified. Thus, the risk group for perinatal fetal death includes preterm newborns with hypotrophy, low body weight, smaller body length, a low Apgar score, changes in the clinical analysis of blood (lowering of hemoglobin, erythrocytes and platelets, and an increase in the level of venous blood glucose). The level of leukocytes in peripheral blood in newborns in both groups is not significantly different.

Demographic factors determining folic acid supplementation in pregnant and childbearing age women.

Adequate folate intake constitutes a significant problem in the periconceptional period and early pregnancy but can be achieved by folic acid (FA) supplementation. Low intake of folate may cause numerous negative effects on the pregnancy outcome, including recurrent miscarriage, preeclampsia, fetal hypotrophy, premature delivery, premature placental abruption, and intrauterine fetal death. The aim of the study was to evaluate factors determining FA supplementation in the population of Polish women before and during pregnancy. The study group consisted of 257 women hospitalized postpartum at the Division of Perinatology and Women's Diseases, Poznan University of Medical Sciences, Poland. We evaluated folic acid intake considering selected demographic data. A structured questionnaire was used to evaluate folic acid intake before and during pregnancy of the investigated women. The vast majority of the investigated women (89.1%) took FA during pregnancy. During the pre-pregnancy period, a statistically significantly higher supplementation of folic acid was observed among women with the monthly income level of > 5000 PLN (p = 0.03), and among women who planned their pregnancy as compared to women who did not plan their pregnancy (p < 0.001). During pregnancy, these differences disappeared. A statistically significantly higher number of secundi- and multiparas did not take FA during pregnancy as compared to primiparas (p = 0.008). No correlation between cigarette smoking and FA intake was observed. Our analysis showed that FA intake increased (by 36.2%) during pregnancy as compared to the pre-pregnancy period, and depended on income, parity, and pregnancy planning.

Характеристика перебігу пубертатного періоду у дівчаток-підлітків Прикарпатського регіону та основні чинники зниження репродуктивного потенціалу

Reproductive capacity significantly depends on the period of puberty of a woman-to-be, as well as on the so-called «intrauterine childhood». The objective: to determine the peculiarities of the development of a girl during her puberty, to evaluate the causes of the menstrual function disturbances and to identify the main factors of the reproductive potential decline. Patients and methods. The medical and social audit was conducted by interviewing, questioning and studying the medical documentation (clinical symptoms of extragenital pathology, duration of the disease, state of menstrual function, heredity, lifestyle and bad habits) in 264 girls in order to evaluate the probable factors of the development of menstrual function disturbance and ovarian-menstrual cycle disorders. Results. The period of «intrauterine childhood» was in the context of a complicated gestation period: the threat of abortion, preeclampsia of varying degrees of severity, perinatal infections, preterm labour, fetal hypotrophy, harmful parenting habits, fetal distress during childbirth. More than two thirds of girls have chronic diseases of the internal organs, 24.2% of patients have the comorbidity of gynaecological pathology and extragenital diseases. Menstrual disorders predominate by type of algodismenorrhea, premenstrual syndrome and juvenile uterine bleeding. In sexually active adolescents the inflammatory processes of the genitals have been revealed in 46.2% of cases, undoubtedly the number of girls with absolute or relative risk of infertility is increasing. Dyshormonal diseases of the mammary glands were noted in 16.7% of cases, in girls with gynaecological pathology – twice as often, and in patients with menstrual function disturbances – 53.4%. The comparative analysis indicated the most obvious negative effect on the reproductive capacity, ovarian reserve of ovarian operations and hereditary predisposition to the disturbed reproductive function (OR=19.3; 95%: 3.1–92.6). Conclusion. The obtained results help in classifying the risk factors of reduced reproductive potential for female adolescents and girls, which allows to optimize the formation of risk groups, to predict and monitor the reduction of the ovarian reserve and to develop preventive measures for improvement of the reproductive capacity. The most significant causes that reduce the reproductive potential of girls in the period of «intrauterine childhood» are: complicated pregnancy (severe gestosis, complicated childbirth), maternal perinatal infections (especially in the early stages), and in the adolescence – ovarian surgery, childhood infections, hypothyroidism and bad habits (smoking). Key words: puberty, main causes of menstrual disturbances, reproductive potential.

Fetal Hypotrophy Is an Important Marker in Diagnosis of Preeclampsia in Pregnant Patients After Solid Organ Transplantation.

BACKGROUND The purpose of this study was to use a multidisciplinary approach to define the importance of fetal growth disturbances in pregnant patients after renal or liver transplantation in diagnosis and treatment of preeclampsia. MATERIAL AND METHODS We assessed 108 pregnancies in patients with renal or liver transplants. Statistical analysis included Pearson's chi-square test and Fisher's exact test. RESULTS In the renal transplant (RTR) group, preeclampsia was diagnosed in 40% according to ISSHP. In the liver transplant (LTR) group, ISSHP guidelines allow this diagnose in 14.6% of patients. Intrauterine fetal hypotrophy occurred in 53.3% of RTR patients with clinical symptoms of preeclampsia and in none of stabile patients. Premature delivery rate was 40% in patients with hypotrophy and only in 15.5% without. For LTR patients, hypotrophy was diagnosed in 16.4% patients with clinical symptoms of preeclampsia and in 12.7% of stabile patients. Premature delivery rate was 14.5% in patients with hypotrophy and in 14.5% without. CONCLUSIONS Fetal hypotrophy is strongly associated with premature delivery and risk of preeclampsia in pregnancies after renal transplantation. There is a need for including ultrasound findings in diagnostic criteria of preeclampsia. Fetal growth monitoring may help in prediction of premature delivery in these group.

Treatment of diffuse toxic goiter during pregnancy

We have studied an influence of diffuse toxic goiter on the flow and outcome pregnancy. 67 pregnant women with diffuse toxic goiter were examined. The group of comparison consisted of 38 pregnant women without thyroid pathology. The levels of free thyroxin, TSH, autoantibodies to TSH-receptors and autoantibodies to thyreoperoxidasis in the blood of pregnant women and umbilical cord blood and ultrasound of the thyroid gland of newborns were analyze. Pregnancy and childbirth of the women with unresolved thyrotoxicosis were more complicated by the threat of termination of pregnancy, preeclampsia, chronic placental insufficiency, preterm rupture of membranes, fetal hypotrophy and hypoxia. A high incidence of subclinical hypothyroidism (more 50%) in newborns is associated with the transplacental pass thyreostatic drugs. Subclinical hyperthyroidism in 17% of newborns should be associated with the transplacental transition from the mother to the fetus of autoantibodies to TSH-receptors.