Fetal Growth Retardation Research Articles

The role of FABP4 in the development of fetal growth retardation in women with gestational diabetes mellitus and threatened late miscarriage diagnosed in the second trimester of pregnancy

The role of FABP4 in the development of fetal growth retardation in women with gestational diabetes mellitus and threatened late miscarriage diagnosed in the second trimester of pregnancy

PFAS e salute: quali rischi per l’uomo?

Perfluoroalkyl and poly-fluoroalkyl substances (PFAS) are a series of synthetic chemical compounds that can be found in the environment, potentially associated with various adverse health effects on human health, such as carcinogenicity, immune and genotoxicity, and endocrine disorders. During pregnancy, an increased risk of fetal growth retardation, low birth weight, and preterm birth has also been highlighted; possible delays in motor and cognitive development in children have also been reported, with potential effects on their learning ability and social interaction. The metabolic alterations reported in adults could also be possible in children, with an increased risk of obesity and early puberty. Through direct exposure (ingestion of contaminated substances) and indirect exposure (consumption of foods that have come into contact with PFAS through packaging, storage, and cooking), PFAS can compromise our food security with possible long-term outcomes. This problem is now of global concern and, unfortunately, also affects Italy, as shown by the “Veneto case”, particularly in the provinces of Padua and Verona, where a marked contamination of the sewer system and drinking water of the territory has been found, with very high concentrations of PFAS (>1000 ng/L). From this perspective, the medical and scientific community must be aware of the presence of PFAS in the environment and their possible interference with health to suggest ways to reduce exposure, especially for vulnerable individuals such as children.

Implications for miR-339-5p regulation of trophoblast proliferation and migration in placentas associated with porcine intrauterine growth retardation using integrated transcriptome sequencing analysis

Placental dysfunction is considered as one of the main etiologies of fetal intrauterine growth retardation (IUGR). MicroRNAs (miRNAs) have been demonstrated to be a vital epigenetic modification involved in regulating the placental function and pregnancy outcomes in mammals. However, the mechanisms underlying placenta-specific miRNAs involved in the occurrence and development of pig IUGR remain unclear. In this work, we compared the placental morphologies of piglets with IUGR and normal birth weight (NBW) by using histomorphological analysis and performed a miRNA–mRNA integrative analysis of the gene expression profiles of IUGR and NBW placentas through RNA sequencing. We also investigated the role of differentially expressed ssc-miR-339-5p/GRIK3 through an in vitro experiment on porcine trophoblast cells (PTr2). IUGR piglets had significantly lower birth weight, placental weight, placental efficiency, and placental villus and capillary densities compared with the NBW piglets (P < 0.05). A total of 81 differentially expressed miRNAs and 726 differentially expressed genes in the placentas were screened out between the IUGR and NBW groups. The miRNA–mRNA interaction networks revealed the key core miRNA (ssc-miR-339-5p) and its corresponding target genes. Subsequently, we found that upregulation of ssc-miR-339-5p significantly inhibited the migration and proliferation of PTr2 cells (P < 0.05). The dual-luciferase reporter system showed that GRIK3 was the target gene of ssc-miR-339-5p, and the transcription level of GRIK3 may be negatively regulated by ssc-miR-339-5p. Additionally, overexpression of ssc-miR-339-5p significantly increased (P < 0.05) the mRNA expression levels of genes involved in the cytokine–cytokine receptor interaction pathway. These results indicate that ssc-miR-339-5p may affect the migration and proliferation of trophoblast cells by regulating the expression of GRIK3 and altering the placental inflammatory response, resulting in a suboptimal morphology and function of the placenta and the development of pig IUGR.

Vascular growth factors of the placenta, apoptosis of blood neutrophils in pregnant women with post-COVID syndrome

Research objectives: to determine the activity of vascular placental growth factors, apoptosis and necrosis of neutrophils in the blood of pregnant women with post-COVID syndrome.Methods and materials. 30 pregnant women (the main group) with SARS-CoV-2, positive Ig A, M or G to SARS-CoV-2 at 30–34 weeks of pregnancy took part in the study. The control group consisted of 30 women with physiological pregnancy.Blood neutrophils were studied by flow cytofluorometry. The proportion of neutrophils that were at the stage of apoptosis and necrosis was determined. The correlation of these indicators with the uncomplicated course of the gestational process during the physiological course of pregnancy and with the development of gestational complications against the background of post-COVID syndrome was determined.In the third trimester of pregnancy, we collected blood samples to determine the effect of SARS-CoV-2 infection on placental angiogenesis. We evaluated a panel of biomarkers: vascular endothelial growth factor (VEGF), placental growth factor PlGF, and interleukin-32α (IL-32α).Results. In pregnant women of the main group with a complicated course of pregnancy accompanied by post-COVID syndrome, apoptosis was at the level of 24.30 ± 0.50% of neutrophil cells, which was significantly different from the control group (4.45 ± 0.25%) (р &lt; 0.001). The level of late apoptosis, necrosis of neutrophils increased 4 times – from 4.20 ± 0.65 to 16.80 ± 0.54% (р &lt; 0.001). The concentration of IL-32α in pregnant women of the control group was 67.27 ± 5.63 pg/ml. Post-COVID syndrome caused an increase in this indicator in the main group by 2.8 times compared to the control group (188.36 ± 25.22 pg/ml) (p &lt; 0.001). In the III trimester, the concentration of VEGF reached maximum values in the main group and was 192.20 ± 10.02 pg/ml, which is 2 times higher than in the control group at the same time (95.30 ± 5.65 pg/ml), (p &lt; 0.001). In the control group the level of PIGF at full-term pregnancy was 144.53 ± 15.55 pg/ml. In women with postpartum syndrome, PIGF significantly decreased and was 43.92 ± 4.81 pg/ml, which was only 30% of the PIGF value in women with an uncomplicated pregnancy (p &lt; 0.001).Conclusions. The development of metabolic disorders and apoptotic changes in the placental tissue are confirmed at the morphological level in the form of destructive and necrotic changes in the microcirculatory channel of the placenta. An increase in the level of annexin-positive neutrophils and activation of the degree of neutrophil necrosis is accompanied by fetoplacental dysfunction, by violation of the balance of placental growth factors and is an important marker for predicting of fetal growth retardation in pregnant women with post-COVID syndrome.

Cholestasis in neonates with fetal growth restriction

Background: Neonatal Cholestasis (NC) is a sign of hepatobiliary disorder due to various etiologies. In the neonatal intensive care unit (NICU) extensive evaluvation is done to rule out treatable causes. Neonates with fetal growth retardation (FGR) have an increased incidence of cholestasis. Aim: To determine the prevalence, management, additional healthcare cost and outcome of cholestasis in neonates born with FGR. Methods: Retrospective review of all neonates admitted to the NICU at Valley Children’s Hospital, from January 1, 2021 to December 31, 2022 was done. Data of the infants with FGR was collected. Results: Of 2850 infants admitted in the 2-year period, 42 had a birth weight of less than 10th percentile, of which 19 developed cholestasis (45%). 12 of the 19 infants were preterm infants and 7 were term infants. Average gestational age at birth was 31.6 and average direct bilirubin of 5.2 mg/dL. The average length of stay was 54 days Of the 19 infants who developed NC, 8 were discharged on ursodiol and followed up in gastroenterology clinic. 17 showed resolution of NC within 6 months of discharge. Some infants underwent extensive work-up. Costs for the work-up added up to an average of $8,920. Conclusion: Prognosis for NC in the FGR neonates appears to be good with resolution in our study population within the first year of life. Hence, it may be safe to monitor these neonates with outpatient followup with early limited evaluation until complete resolution of cholestasis.

INVESTIGATING INDICATORS OF ANXIETY, PSYCHOEMOTIONAL TENSION AND STRESS IN PREGNANT WOMEN DURING MARTIAL LAW

Introduction. Pregnancy is a vulnerable period marked by psychoemotional changes, ushering in a new stage with profound shifts in a woman's mental well-being. Elevated stress levels during pregnancy correlate with various adverse psychological and physiological outcomes for both the mother and child. In the current context, the ongoing war serves as an additional stressor for Ukrainian women. Pregnant women exposed to conflict face an increased risk of maternal mortality and a higher likelihood of delivering infants with health complications. Recognizing potential factors contributing to psychoemotional changes in pregnant women is a critical undertaking that should be initiated early in pregnancy.&#x0D; The purpose of this study is to assess indicators of anxiety, psychoemotional tension and stress in pregnant women during martial law&#x0D; Materials and methods. Psychometric testing of 50 pregnant women was performed by using three anxiety/stress scales: the Spielberger-Hanin Scale, the Psychological Stress Measure (PSM-25), and the Impact of Event Scale (IES-R). The participants were categorized into three groups: group 1 comprised pregnant women residing in areas directly impacted by the full-scale invasion, facing active hostilities or constant rocket fire without changing their residence (17 women, one experiencing occupation for &lt; 1 month); group 2 included internally displaced women (13 individuals, two in settlements occupied for &lt; 1 month); and group 3 encompassed 20 women residing in areas where active hostilities were not taking place.&#x0D; Results. According to the Spielberger-Hanin scale, the highest rate of reactive (46.2%, n=6) and personal anxiety (38.5%, n=5) was observed in the group of internally displaced women. The results of the IES-R were as follows, according to the invasion subscale: the highest level was observed in the group of women who were in settlements where there were no active hostilities (45%, n=9), avoidance was found in women who did not change their place of residence, where there was or continues to be active hostilities (58.8%, n=10), excitement – in internally displaced persons (46.2%, n=6). According to the PSM-25, no woman had a high level of stress, it was increased in women of the first group (23.5%, n=4). In the first studied group, complications were dominated by polyhydramnios (29.4%, n=5), fetal growth retardation syndrome (11.8%, n=2), umbilical cord localization pathology (5.9%, n=1), premature detachment a normally located placenta (11.8%, n=2) and one woman had surgery during pregnancy (5.9%, n=1). In the second group, there was a threat of abortion (30.8%, n=4). , preeclampsia in the first half of pregnancy (7.7%, n=1) and placenta localization pathology (7.7%, n=1). In the third group, there was a threat of premature birth (35%, n=7), preeclampsia (20% , n=4), oligohydramnios (25%, n=5), placental pathology (20%, n=4) and premature rupture of membranes (25%, n=5). Regarding the termination of pregnancies (table 4), the majority of pregnancies in all studied groups ended in term delivery, the highest percentage of premature deliveries (35%, n=7) was observed in the third group. In the group where there were women from the zone of active hostilities (group 1), one case of neonatal death was recorded, which was associated with significant fetal malformations.&#x0D; Conclusions. Stress is an adaptive process that induces changes in the body. This study revealed that each group experienced stress. It is noteworthy that stress during pregnancy is not solely attributed to war; factors such as the pregnancy itself, its parity, and the presence of somatic diseases also contribute. Consequently, there is a need to formulate measures for the psychoprophylaxis of women and to conduct further observations, assessing larger research cohorts.

A mother’s diet as a predictor of her child’s current and future health

The body’s ‘nutritional programming’ scheme assumes that the influence of environmental factors during the so-called “critical periods’” of human development associated with, among other things, excessive or deficient nutrients can lead to permanent metabolic changes. The negative impact of external factors, poor nutrition, different gene expression during the fetal period with accompanying fetal growth retardation can permanently “reprogram” the metabolism and the course of many physiological processes, causing metabolic complications in adulthood. More and more researchers and theoreticians are considering and verifying the relationship between the early influence of environmental factors and the occurrence of civilisation diseases in the context of nutritional programming. Recently, many researchers have pointed out that the infant years are a critical time for metabolic programming. The impact of a pregnant woman’s nutrition on the development of obesity, cardiovascular disease, insulin resistance or metabolic syndrome in her child’s later life has been empirically proven. Similar results have been reported for the importance of breastfeeding and also of nutritional deficiencies or excesses in the first 1000 days of the child. This period is particularly susceptible to all the factors that affect the body and builds the foundations of the child’s broader health at present and in the future. The aim of this study is to show, on the basis of an analysis of research reports, that both woman’s nutrition during the pre-conceptional period and during pregnancy, as well as her child’s nutrition after birth, are of crucial importance for the child’s development and somatic health. Keywords: child health, feeding, metabolic programming, nutrition, pregnancy.

Obstetrical and perinatal consequences of childbirth in women with antenatally undiagnosed fetal growth restriction

Fetal growth restriction (FGR) is one of the most studied topics in the medicine of the mother and fetus. However, not identified antenatally FGR can have an increased risk of both perinatal morbidity and mortality, as well as adverse long-term consequences. The identification of FGR during pregnancy will contribute to the reduction of both perinatal morbidity and perinatal mortality.&#x0D; Aim. Based on a retrospective analysis, assess the obstetric and perinatal consequences of childbirth in women with antenatally undiagnosed fetal growth restriction.&#x0D; Materials and methods. An analysis of 488 cases of childbirth in women with singleton pregnancy, who gave birth to a live child, was conducted. In all cases, the gestational age was ≥22 weeks with a fetal weight less than the 10th percentile for the corresponding gestational age. Depending on the antenatally established diagnosis of FGR, two study groups were formed: group I consisted of 204 (41.8 %) cases with antenatally diagnosed FGR, group II – 284 (58.2 %) cases in which signs of FGR were identified after the birth of the child. Maternal characteristics, neonatal outcomes, and evaluation of short-term infant outcomes were analyzed.&#x0D; Results. Both groups were dominated by women with first births, the number of which was almost the same. Somatic pathology was almost 2 times more common in women of group I, 17.2 %, compared to 9.2 % of women in group II (p &lt; 0.01), this indicates that the majority of women who were not diagnosed with FGR during pregnancy belong to the low-risk group. Fetuses with impaired blood flow in the umbilical cord arteries were twice as common in group I, 49.5 % versus 23.9 % in group II (p &lt; 0.0001), and the frequency of absent/reversible end flow in the umbilical arteries in group I compared to group II, prevailed 3 times (p &lt; 0.0001), indicating more serious lesions of the placenta and, as a result, early manifestation of the fetal condition disorder. The frequency of premature abdominal delivery was 3.75 times higher in group I compared to group II. The most frequent indication for cesarean delivery in both groups was signs of fetal distress syndrome. Analysis of neonatal outcomes showed that the average birth weight was significantly lower in group I and was 2180 ± 55 g against 2420 ± 61 g in group II (p &lt; 0.0001). The need for hospitalization of newborns in the intensive care unit had no statistical difference between the groups (p &gt; 0.05). However, the complications of the early neonatal period and the total length of stay in the hospital were greater in children of the I group, compared to the II group (p &lt; 0.0001).&#x0D; Conclusions. The results of the conducted research indicate a low level of prenatal diagnosis of fetal growth restriction. Most pregnant women with antenatally undiagnosed fetal growth restriction belong to the group of low perinatal risk. The most frequent indication for cesarean section operation, regardless of the date of delivery, in both groups were signs of fetal distress, the frequency of which was 1.5 times higher in the antenatally diagnosed fetal growth retardation group. Newborns with an undetected growth anomaly before delivery have an increased risk of fetal distress, the severity of which is determined by the degree of deterioration of fetal oxygenation, and not by weight percentile, which requires more careful observation of fetuses with signs of growth restriction.

Analysis of perinatal consequences against the background of the proposed treatment complex in pregnant women after the application of assisted reproductive technologies

The course of pregnancy that occurs as a result of the application of assisted reproductive technologies is accompanied by numerous complications that affect the indicators of perinatal morbidity and mortality. Nowadays in Ukraine, there is no unified approach to the management of women whose pregnancy occurred as a result of ART application, which determined the direction of this work.The objective: to assess perinatal consequences against the background of the introduction of the proposed treatment complex in women whose pregnancy occurred as a result of the application of assisted reproductive technologies.Materials and methods. 249 pregnant women were examined, which were divided into: group I – 94 women with tubo-peritoneal, group II – 87 women with endocrine and group III – 68 women with male types of infertility. Depending on the prescribed therapy, women of groups I, II and III are divided into: subgroup IA – 49 pregnant women with tubo-peritoneal, subgroup IIA – 48 pregnant women with endocrine, subgroup IIIA – 36 pregnant women with male factor of infertility who received the proposed therapeutic and preventive complex; subgroup IB – 45 pregnant women with tubo-peritoneal, subgroup IIB – 39 pregnant women with endocrine, subgroup IIIB – 32 pregnant women with male factor of infertility, which were observed in accordance with generally accepted standards of obstetric care.Results. Against the background of prescribing the proposed complex, there was a significant decrease in the frequency of threatened miscarriage in women of Group I by 41.6%, in women of Group II by 37.1% (p&lt;0.05). In the second and third trimesters, there was a significant decrease in the number of cases of threatening late spontaneous miscarriages, threatening premature birth, placental dysfunction, preeclampsia, and fetal growth retardation syndrome (p&lt;0.05). A significant indicator of the effectiveness of the proposed treatment complex is a significant increase in the proportion of urgent labor in women of subgroups IA and IIA. Thus, 46 (93.8%) women of subgroup IA and 46 (95.8%) women of subgroup IIA had urgent labor.Assessing the pathological conditions of newborns, it should be noted that in children from women in labor of subgroups who received the proposed complex, respiratory disorders syndrome (p&lt;0.05), intraventricular hemorrhages (p&lt;0.05), hypoxic-ischemic encephalopathy (p&lt;0.05), and cases of antenatal infection (p&lt;0.05) were determined in a significantly smaller number of cases.Conclusions. The effectiveness of the proposed treatment complex and the complex of psychoemotional correction in pregnant women after the use of assisted reproductive technologies is confirmed by a reliably better course of the first, second and third trimesters of pregnancy, a reliably better course of Labor, which was reflected in an increase in cases of urgent labor and a decrease in cases of complications in childbirth, which was reflected in a significant decrease in the number of cesarean sections.Improvement of perinatal consequences against the background of the use of the proposed treatment complex and the complex of psychoemotional correction in newborns from women in labor after the use of assisted reproductive technologies is confirmed by a significantly larger mass of newborns, a significantly smaller number of newborns with low gestational weight, a significantly higher Apgar score, a significantly smaller number of cases of pathological and transient conditions, and a significantly shorter duration of stay of women in labor and newborns in an obstetric hospital, as well as the absence of cases of early neonatal and perinatal mortality among newborns.

Risk factors for preeclampsia in pregnant women at risk

Despite the large number of studies conducted on the development of preeclampsia, today, this pathology of pregnancy tends to increase the manifestations of adverse consequences. It is essential to implement early diagnosis of the risk of preeclampsia in pregnant women for timely prevention. This pathology requires the cooperation of both obstetricians and gynecologists, family doctors, and cardiologists. A comprehensive approach to the diagnosis of preeclampsia in pregnant women will allow timely detection of the risk of the occurrence of the specified pathology and will provide an opportunity to carry out preventive measures promptly.Objective: to conduct a retrospective analysis of individual charts of pregnant women and birth histories of pregnant women with preeclampsia and to analyze risk factors that may cause the occurrence of this pathology.Material and methods. A retrospective analysis of 100 individual charts of pregnant women and histories of childbirth with preeclampsia at the obstetric hospital of the Chernivtsi Regional Perinatal Center for 2018-2021 was conducted in order to determine risk factors for the development of preeclampsia during pregnancy. We used standard methods of mathematical and correlational analysis.Results. Gestational anemia, placental dysfunction, in the form of fetal distress and fetal growth retardation syndrome were observed in pregnant women with preeclampsia. It is worth noting that in pregnant women with preeclampsia, childbirth can be complicated by premature rupture of the fetal membranes, premature birth, fetal distress, as well as abnormal labor activity, which leads to an increase in the frequency of cesarean section.Conclusions. It is important when registering pregnant women at risk of developing preeclampsia to conduct a detailed collection and analysis of the obstetric history, identification of the risk group of pregnant women and timely prophylactic treatment in order to prevent the occurrence of this pathology.

Some Specific Garbhavyapad Related with Placenta Previa and Fetal Growth Retardation in Modern Science

Ayurveda, one of the oldest systems of medicine, is momentous in audience of worldwide on virtue of its holistic approach of life. Ayurveda has its origin back to the 'Vedic-era'. It has its mentioning in the Atharva Veda. Many historians claim that it is a part of Atharva Veda Ayurveda is also known as the Upveda of Atharva Veda. The Ayurveda term Sharir Rachana deals with anatomical and physiological consideration of the human body right from intrauterine life (before birth) till death. Ayurveda is one of the traditional sciences of pregnancy and foetal care management. The ancient anatomical knowledge like Masanumasika garbha vridhi and Garbhaa vyapad provides great understanding about the foetal growth and various structural and functional anomalies. The understanding of abnormalities is very important for the treatment of various diseases. According to Ayurvedic principles, pre-conception care is a set of interventions which are essential prerequisite for a healthy progeny. Maximum of Ayurvedic principles have proved true in today’s scientific research. Many of classical factors have accepted by modern medical science. Here in this article, a try has made to show the similarity between some of the Garbha vyapad described in ancient Ayurvedic texts and placenta previa and fetal growth retardation described in modern texts. The term Garbha vyapad refers to the calamity of the foetus. Under some conditions like too much fasting, eating stale food, not consuming fats as required, consumption of Vata vitiating objects in access, etc. leads to the foetus does remains in the uterus for a long time and doesn’t quiver.

PSV-16 Different Late Gestation Heat Stress Time-Windows and Their Effects on Newborn Holstein Calves from Northwest México

Abstract Exposure to heat stress (HS) during the dry period not only exerts negative effects on the welfare of pregnant cows, but also impairs the development of the fetus in the utero. When dams are subjected to late-gestation HS, affectations to their placental function and blood placental flow occur, generating fetal hypoxia and growth retardation of their calves. Since on the last 60 d of gestation bovine fetuses undergo through a phase of accelerated growth where they accrue around 60% of their birth weight, the number of days that their dams become exposed to HS during this period could affect differently their body weight and oxygenation status at birth. Therefore, the objective of this study was to determine the effects of different late-gestation HS time-windows on the birth weight and oxygen saturation of newborn Holstein calves. The study was conducted at the Yaqui valley in northwest México, a semiarid zone where the temperature and humidity index (THI) exceeds the dairy cattle thermal threshold from mid-March to mid-October (~7 months). Under such environmental dynamic, all cows within this geographical zone experience HS at some point during their gestation; nonetheless, depending on the conception date of the cow, different late-gestation HS time-windows arise. To assess the influence of the number of days of intrauterine HS exposure during late gestation (e.g., days with an average THI &amp;gt; 72 units), three intrauterine heat-stressed groups of calves were formed: G1 = calves born to dams exposed to HS less than 20 d within the last 60 d of gestation (n = 30), G2 = calves born to dams exposed to HS between 21 and 40 d within the last 60 d of gestation (n = 20), and G3 = calves born to dams exposed to HS for more than 40 d within the last 60 d of gestation (n = 16). Upon calving, variables such as sex, birth weight (BW, kg) and oxygen saturation (SpO2, %) were recorded. A general linear model that included the effects of sex of the calf and intrauterine HS calves’ group was implemented to analyze BW and SpO2. Harmonic means were compared via the Tukey-Kramer test. Harmonic means (±SE) for BW and SpO2 among groups were 42.42 ± 0.92, 40.84 ± 1.11, and 34.73 ± 1.24 kg, and 78.16 ± 2.71, 82.52 ± 3.28, and 82.29 ± 3.68 %, for G1, G2 and G3, respectively. Significant differences (P &amp;lt; 0.001) were found only for BW, with calves of G3 exhibiting the lowest BW in comparison to calves within G1 and G2, which were not statistically different among themselves (P &amp;gt; 0.05). Results of this study indicated that intrauterine HS exposures of &amp;gt;40 d strive deleterious effects on fetal growth and reduce the BW of newborn Holstein calves from northwest México.

Prognosis of pregnancy and perinatal outcomes in the presence of polycystic ovary syndrome

Aim. To determine prognostic criteria for pregnancy complications and perinatal pathology in women with polycystic ovary syndrome.Materials and methods. A prospective study of 100 pregnant women with polycystic ovary syndrome at the St. Joasaph Belgorod Regional Clinical Hospital. Depending on the type of ART method, 2 groups were formed. The first group (n=50) of women – pregnancy occurred by induction of ovulation with chlorthyanisene clomiphene citrate (CC). The second group (n=50) – with the help of In vitro fertilisation (IVF). Research methods – clinical, laboratory, instrumental.Result. It was revealed that the main conditions for the probability of the formation of polycystic ovary syndrome and infertility are: the presence of childhood infections in the anamnesis, low birth weight of mothers. Disorders of the reproductive system in polycystic ovary syndrome (PCOS) are detected by menstrual cycle disorders, late menarche, inflammatory diseases of the genitals, primary and secondary infertility. Extragenital pathology is diagnosed in 100 % of women with PCOS and appears in the form of obesity, infectious and inflammatory diseases, infectious and inflammatory pathologies. With PCOS, miscarriage, preeclampsia, isthmic-cervical insufficiency, gestational diabetes mellitus, fetal growth retardation, chronic placental insufficiency are noted. The onset of pregnancy by stimulating ovulation of CC has an unfavorable course relative to IVF: the risk of miscarriage and isthmic-cervical insufficiency is higher. The average weight of full-term babies, the method of their birth turned out to be IVF, is greater than ovulation stimulation. The probability of perinatal damage against the background of ovulation stimulation exceeds IVF by about 1.5 times. In the early period of gestation and in conditions of PCOS, there is a hormonal imbalance: a fascination with TBG and a decrease in the secretion of PAMG in peripheral blood at 7–8 and 10–12 weeks. In women with polycystic ovary syndrome, the probability of termination of pregnancy in the first trimester is characterized by the presence of chorionitis, a decrease in the volume of the amniotic cavity, tachycardia of the embryo. Signs of placental insufficiency were detected in the II and III trimesters. In pregnant women with PCOS, hemostatic disorders are observed – a shortening of the activated recalcification time and blood clotting time and an increase in fibrinogen and prothrombin index. Pregnancy on the background of PCOS is accompanied by activation of free radical oxidation and the development of oxidative stress.Conclusion. To predict placental insufficiency, the risk of miscarriage, perinatal pathology of the nervous system in pregnant women with PCOS, it is necessary to assess the level of glycodelin, TBG, PAMG‑1, β-HCG.

Review of short-term and long-term adverse effects of covid-19 vaccination during pregnancy

BackgroundThe covid-19 pandemic sparked a debate about the safety of vaccines during pregnancy. However, pregnant women were excluded from the Pfizer-BioNTech vaccine phase 3 trials. As two years have passed since the first Covid-19 vaccine and more studies have been conducted, we want to evaluate the scientific literature to determine any actual risks in taking the vaccine during pregnancy. MethodsWe conducted literature research using PubMed and Google Scholar databases from January to April 2023. As the review considers short- and long-term adverse effects it was divided into two parts. The first part was conducted as a systematic review. The second concerning long-term negative effects due to lack of research is a literature review. The inclusion criteria for the systematic review part were singleton pregnancies, women vaccinated during pregnancy, and studies from 2020 and later. The most common short-term pregnancy adverse effects were included in the search: preterm delivery, small gestation age, intrauterine death, congenital defects, stillborn, fetal growth retardation, spontaneous abortion. Maternal immune activation was the primary concern for the long-term adverse effects and whether vaccination could cause it. The search terms included maternal immune activation, fetal neurodevelopment, neuropsychiatric disorders and the studies used were from 2019. ResultsMost studies showed no significant difference in short-term adverse effects between vaccinated and non-vaccinated women and their fetuses. However, the literature is insufficient to evaluate possible long-term adverse effects. ConclusionAvailable evidence supports the safety of administering SARS-CoV-2 vaccines to pregnant women, but further systematic reviews and meta-analyses are essential. Maternal immune activation caused by vaccination may impact a child's neurodevelopment and should be a concern for future studies.

Clinical assessment of the placenta function in women at risk and threat of premature delivery

Premature birth, despite the significant achievements of perinatal medicine in recent decades, remains an urgent global and national medical and social problem, as it is the leading cause of perinatal morbidity and mortality. According to modern views, placental dysfunction can be one of the causes of premature birth, and its frequency, according to randomized studies, can be from 78 to 91%, depending on the gestational age. At the same time, the research conducted to date does not provide a clear understanding of the role of timely diagnosis and prevention of placental dysfunction in preventing premature birth.The objective: to perform clinical evaluation of the prevalence of placental dysfunction in women at risk of preterm birth and with threat of preterm birth.Materials and methods. 180 pregnant women were took part in the study. To achieve the research aim, three research groups were formed. I group – 73 pregnant women with threat of premature birth; II group – 77 pregnant women with risk factors for premature birth. Women with risk factors for premature birth were included in the study at the stage of pregnancy planning (IIA subgroup, 39 women) or from the moment of applying to a women’s outpatient clinic to monitor the course of pregnancy (IIB subgroup, 38 pregnant women). The control group included 30 pregnant women with an uncomplicated course of pregnancy.Transabdominal ultrasound examination with color Doppler mapping, determination of free estriol, progesterone and placental lactogen levels in blood serum were performed at 18–21+6 and 28–30 weeks of gestation.Results. Analysis of the prevalence of risk factors for placental dysfunction and preterm birth in patients of the studied cohort showed that in pregnant women with preterm birth (I group), the combination of risk factors was 5.2; in pregnant women who received pre-gravid training (IIA subgroup) – 3.2; in pregnant women who were included in the study in the I trimester of pregnancy (IIB subgroup) – 4.7, while in pregnant women of the control group – only 0.8 (p&lt;0.05).The threat of early spontaneous miscarriage with the formation of a retrochorial hematoma as a clinical manifestation of primary placental dysfunction was determined in 43.8% of pregnant women whose premature delivery was carried out for medical reasons. Placenta abruption in these patients can be considered as decompensation of the primary dysfunction of the placenta with the transition to acute placental insufficiency.The formation of chronic placental dysfunction, clinically manifested by the syndrome of fetal growth retardation, was most often observed in patients whose pregnancy ended in spontaneous premature birth at 34–36+6 weeks in the presence of an untouched amnion, – 68.6% compared to births at 28–33+6 weeks of gestation – 25.9% and with childbirth at 22–37+6 weeks – 13.3%.Conclusions. Clinical manifestations of placental dysfunction were detected in 30.6% of patients with premature birth, with morphological signs in 60.4% of cases, which indicates the hidden course of placental insufficiency before the development of premature birth.Morphological signs of placental dysfunction were determined in 87.5% of cases of premature births for medical reasons and in 100.0% of cases of spontaneous births at 22–27+6 weeks of gestation (with a combination of risk factors from 2.1 to 3.0), in 66.7% – with premature births at 28–33+6 weeks of pregnancy, in 40.0% – with premature births at 34–36+6 weeks of pregnancy and only in one (5.6%) case – with term births.The frequency of fixation of morphological characteristics of placental dysfunction correlates with the frequency of early pregnancy complications, primarily with the formation of retrochorial hematomas in the first half of pregnancy.

Giant Chorioangioma in a Patient with 36 Weeks of Pregnancy: A Case Report

Abstract Present report relates to a 40-year-old patient with 36 weeks of pregnancy and non-trophoblastic benign placental neoplasm chorioangioma (placental hemangioma). The incidence of chorioangioma has been described as 0.5 to 1.0 % of all pregnancies. Tumors may be &gt;4 cm in diameter; such tumors are called giant tumors. Smaller tumors are generally asymptomatic. However, clinically-significant chorioangioma occur less frequently; incidence varying from 1 in 3500 to 1 in 9000 pregnancies. Giant chorioangiomas are very rare tumors; only a few cases have been reported. Feto-maternal complications like fetal growth retardation, anemia and hydrops may develop in a patient with chorioangioma. Further, fetal loss may be as high as ~ 40 %. Increased incidence of chorioangiomas may occur at high-altitude pregnancies, suggesting role of hypobaric hypoxia in pathogenesis of chorioangioma. Keywords: Well-circumscribed benign placental neoplasm.

Innate Immunity in Autoimmune Thyroid Disease during Pregnancy.

Autoimmune thyroid disease (AITD) is the most common organ-specific autoimmune disorder clinically presented as Hashimoto thyroiditis (HT) and Graves' disease (GD). The pathogenesis of AITD is caused by an inappropriate immune response related to genetic, non-genetic, and environmental factors. Pregnancy is one of the factors that have a great influence on the function of the thyroid gland because of the increased metabolic demand and the effects of hormones related to pregnancy. During pregnancy, an adaptation of the maternal immune system occurs, especially of the innate immune system engaged in maintaining adaptive immunity in the tolerant state, preventing the rejection of the fetus. Pregnancy-related hormonal changes (estrogen, progesterone, hCG) may modulate the activity of innate immune cells, potentially worsening the course of AITD during pregnancy. This especially applies to NK cells, which are associated with exacerbation of HD and GD. On the other hand, previous thyroid disorders can affect fertility and cause adverse outcomes of pregnancy, such as placental abruption, spontaneous abortion, and premature delivery. Additionally, it can cause fetal growth retardation and may contribute to impaired neuropsychological development of the fetus. Therefore, maintaining the thyroid equilibrium in women of reproductive age and in pregnant women is of the highest importance.

Nutritional Implications of Bariatric Surgery on Pregnancy Management-A Narrative Review of the Literature.

One in three women of reproductive age is obese. The mainstay treatment for obesity is bariatric surgery, and the following weight reduction results in a decrease in pregnancy adverse effects, including gestational diabetes mellitus, pregnancy-induced hypertension, and macrosomia. However, nutritional and vitamin deficiencies due to changes in the gastrointestinal tract after bariatric surgery are associated with an increase in the risk of fetal growth retardation and small for gestational-age neonates. The purpose of this review was to analyze the available recent literature on the subject of the management of pregnancy after bariatric surgery. We searched for available articles from 2007 to 2023 and chose articles of the greatest scientific and clinical value. Micronutrient, vitamin, and protein supplementation is recommended in the prenatal period and throughout the pregnancy. It is advised that pregnant women with a history of bariatric surgery should be provided with regular specialist dietary care. There is still a lack of recommendations about the optimum gestational weight gain after different types of bariatric surgery and for patients of different metabolic statuses. Women of reproductive age undergoing bariatric procedures should be provided with appropriate counseling about adequate contraception, the recommended time-to-conception interval, and the positive and negative influence of bariatric surgery on perinatal outcomes.

Formation of contractility of the left ventricle in prematurely born children treated in neonatal intensive care and intensive care units, pathology of newborns

Aim: To study contractility of the left ventricle (LV) in prematurely born children of early and preschool age who received treatment in intensive care units, neonatal intensive care units and pathology of newborns in the neonatal period.Material and Methods. The study included 155 children, of which 108 children aged from one to five years old, born with very low body weight and extremely low body weight; and 47 children of the same age, born full-term and healthy. Study design: pilot, cross-sectional, retrospective, case-control study. EchoCG was performed using the Vivid E9 ultrasound system (GE, Healthcare) with M5S matrix probe (1.5–4.6 MHz). The LV global circumferential (GCSMV, GCSPM, GCSApex), and longitudinal strain, as well as the global strain of the endocardial, middle and epicardial layers of the LV were assessed. in the systole “clockwise”) was found in 33.33% of children with a history of bronchopulmonary dysplasia, and in 28.13% of children who received mechanical ventilation during the neonatal period. In 25 (69.44%) of 36 children with signs of anemia in the neonatal period, there was a decrease in deformation along the circumference of the LV epicardial layer. In 13 (86.67%) of 15 clinical observations with signs of transient hypothyroidism in the anamnesis, a decrease in deformation along the circumference of the epicardial layer was revealed.Conclusion. Factors “body weight at birth”, “fetal growth retardation”, “anemia, use of mechanical ventilation in the neonatal period”, “transient hypothyroidism”, “development of bronchopulmonary dysplasia” in children of early and preschool age born prematurely with very low and extremely low body weight, adversely affect the formation of LV contractility and rotational mechanics in the postnatal period, exacerbating the disorders caused by the immaturity of the child’s heart tissue and the implementation of other pathogenetic mechanisms in prematurity, which requires medical supervision of this clinical group in polyclinic conditions.

EARLY FETAL GROWTH RETARDATION IN PREGNANT WOMEN WITH HYPERTENSIVE DISORDERS

Fetal growth retardation (FGR) is a complication of pregnancy that develops due to placental insufficiency and leads to the birth of a child with mass and growth parameters below the 10th percentile for a given gestational age. Newborns with FGR are at high risk of developing motor, neurological, cognitive and learning disorders, as well as cerebral palsy. Purpose. To determine the frequency, risk factors and perinatal outcomes in case of early fetal growth retardation (up to 32 weeks of gestation) in pregnant women with hypertensive disorders. Materials and methods. A retrospective analysis of delivery histories was performed in 116 (8.95%) cases in pregnant women with hypertensive disorders. Hypertensive disorders included: gestational hypertension - 27 (23.2%), chronic arterial hypertension combined with preeclampsia - 18 (15.5%), severe preeclampsia - 35 (30.2%), moderate preeclampsia - 36 (31.1%) cases. Early fetal growth retardation (up to 32 weeks of gestation) was in 32 (26.8%) cases, late fetal growth retardation - in 84 (73.2%) cases. Perinatal losses occurred in 4 (34.4%o) cases in pregnant women with early FGR. Results. Pregnant women with hypertensive disorders most often had concomitant kidney disease, hypertension, obesity of II-III degree, and varicose veins. The highest percentage of newborns with FGR as in pregnant women with chronic arterial hypertension of 2-3 grades (38.9%) and in women with severe preeclampsia (31.4%). The lowest average body weight (1260±52 g) was in newborns whose mothers had blood pressure above 200/130 mm Hg. The highest average body weight (1485±85 g) was in newborns whose mothers had blood pressure up to 160/100 mm Hg. Conclusions. Thus, pregnant women with hypertensive disorders are at high risk of developing a serious complication - early fetal growth retardation. The highest risk of uteroplacental circulation disorders is in pregnant women with chronic hypertension of 2-3 grades and severe preeclampsia.