Gestational Complications Research Articles

Prevalence of the practice of physical activity and its associated factors in adult Colombian pregnant women

ResumenIntroducción. La actividad física durante el embarazo puede ser útil para la prevención de complicaciones gestacionales.Objetivo. Estimar la prevalencia de actividad física en mujeres gestantes adultas en Colombia y evaluar los factores asociados con su práctica.Materiales y métodos. Se hizo un análisis secundario de la información recolectada en la Encuesta Nacional de Situación Nutricional en Colombia del 2015. La muestra incluyó 906 mujeres gestantes. La actividad física en los dominios de tiempo libre, transporte y global se evaluó con la versión larga del International Physical Activity Questionnaire. Los factores asociados se evaluaron mediante modelos de regresión binomial negativa.Resultados. La prevalencia del cumplimiento de las recomendaciones de actividad física en las participantes fue de 12,57 % (IC95% 8,41-18,38), 28,66 % (IC95% 23,29-34,70) y 36,33 % (IC95% 30,92-42,11) en los dominios de tiempo libre, transporte y global, respectivamente. Los factores asociados con el dominio de tiempo libre fueron: residir en Bogotá (razón de prevalencia, RP=2,41; IC95% 1,16-4,99), encontrarse en el tercer trimestre de la gestación (RP=2,13; IC95% 1,17-3,87), disponer de programas de actividad física dirigida (RP=1,75; IC95% 1,07-2,87), nivel educativo de secundaria (RP=0,51; IC95% 0,29-0,91), y pertenecer a los cuartiles de riqueza dos (RP=0,45; IC95% 0,24-0,81), tres y cuatro (RP=0,43; IC95% 0,23-0,80). Los factores asociados con el transporte fueron: tener, por lo menos, un hijo (RP=1,60; IC95% 1,14-2,24), residir en Bogotá (RP=1,84; IC95% 1,23-2,73), convivir con compañero sentimental (RP=0,66: IC95% 0,49-0,89) y haber asistido a entre uno y cuatro controles prenatales (RP=0,53; IC95% 0,37-0,76).Conclusiones: La prevalencia de la actividad física en mujeres gestantes colombianas es preocupantemente baja. Se requiere la implementación de programas y proyectos orientados a la promoción de la actividad física durante el embarazo.

A national study of pregnancy-related maternal and fetal outcomes in women with inflammatory bowel disease.

The incidence of inflammatory bowel disease (IBD) among women is highest during their reproductive years and current estimates suggest that therate of conception is low in female IBD patients. The aim of our study was to assess the burden of adverse maternal and perinatal outcomes among female IBD patients. Using the national inpatient sample database from 2016 to 2018, we recruited all female patients above the age of 15years admitted with a primary diagnosis of pregnancy and a secondary diagnosis of IBD. We adjusted our results for hospital and patient level variables including age, race, socioeconomic status, hypertension, diabetes mellitus, obesity, smoking, hyperlipidemia, alcohol use, and malnutrition. Multivariable regression analysis was used for analysis. Pregnant women with IBD had greater odds of gestational diabetes (adjusted odds ratio [AOR] 1.55, 95% confidence interval [CI] 1.04-2.3, p 0.02), hypertensive complications (AOR 1.35, 95% CI 1.06-1.72, p 0.01), and pre-term delivery (AOR, 1.41 95% CI 1.13-1.76, p 0.003). Pregnancies with co-existent IBD were associated with fetal growth restriction (AOR 1.27, 95% CI 1-1.63, p 0.04) and fetal death (AOR 3.21, 95% CI 1.72-6.00, p < 0.01). Odds of experiencing postpartum hemorrhage or large for gestational age infant were comparable to general population. Crohn's disease was independently associated with increased odds of worse maternal and fetal outcome. IBD patients had increased mean length of stay by 0.14days and increased mean hospital charges of $2741. Women with IBD had greater likelihood of poor maternal and fetal outcomes and increased hospital resource utilization.

Особливості перебігу коронавірусної хвороби у вагітних та частота виникнення перинатальних ускладнень залежно від ступеня тяжкості захворювання

Purpose - to analyze clinical and laboratory changes in women with mild to moderate coronavirus disease, the frequency of gestational complications depending on the course of the disease. Materials and methods. 120 pregnant women of the main group with coronavirus disease were involved in the clinical and laboratory examination. The control group consisted of 40 women with gestational age from 22 to 41 weeks, whose pregnancy was not complicated by coronavirus disease. The course of the disease and the impact of coronavirus infection on the course of pregnancy were evaluated by the results of general - clinical, laboratory and instrumental examinations. Results. The surveyed women underwent treatment in the period from 2021 to 2022 at the Communal Non-profit Enterprise «Kyiv City Center for Reproductive and Perinatal Medicine». The mild course of disease had 48 (40%) pregnant women, the course of coronavirus disease of moderate severity had 72 (60%) pregnant women. Symptoms of coronavirus disease observed in pregnant women: hyperthermia - body t≥37.0oC (85 (70.8%) women), general weakness (103 (85.8%) women), loss of smell and taste (27 (22.5%) women), catarhal phenomena (69 (57.5%) women). Decrease in saturation to 92-94% was noted at 18 (15%) pregnant women. The following complications of pregnancy were observed: the threat of premature birth, oligohydramnios, polyhydramnios, fetal growth retardation, structural changes in the placenta according to ultrasound examination of the fetus, violation of fetal-placental blood flow I-II centuries. Conclusions. Given the data of the analysis, it is possible to identify certain features of clinical and laboratory manifestations of coronavirus disease. The most common clinical manifestations are hyperthermia and general weakness. Features of changes in laboratory blood parameters are as follows: leukopenia, lymphocytopenia, increased C-reactive protein and D-dimer, decreased activated partial thromboplastin time, increased prothrombin time, increased total fibrinogen. The most common complications in pregnant women with mild to moderate coronavirus disease: the risk of premature birth, structural changes of the placenta and oligohydramnios. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the author. Keywords: coronavirus disease, pregnant women, extragenital pathology, complications of pregnancy.

Monocytes and macrophages in pregnancy: The good, the bad, and the ugly.

A successful human pregnancy requires precisely timed adaptations by the maternal immune system to support fetal growth while simultaneously protecting mother and fetus against microbial challenges. The first trimester of pregnancy is characterized by a robust increase in innate immune activity that promotes successful implantation of the blastocyst and placental development. Moreover, early pregnancy is also a state of increased vulnerability to vertically transmitted pathogens notably, human immunodeficiency virus (HIV), Zika virus (ZIKV), SARS-CoV-2, and Listeria monocytogenes. As gestation progresses, the second trimester is marked by the establishment of an immunosuppressive environment that promotes fetal tolerance and growth while preventing preterm birth, spontaneous abortion, and other gestational complications. Finally, the period leading up to labor and parturition is characterized by the reinstatement of an inflammatory milieu triggering childbirth. These dynamic waves of carefully orchestrated changes have been dubbed the "immune clock of pregnancy." Monocytes in maternal circulation and tissue-resident macrophages at the maternal-fetal interface play a critical role in this delicate balance. This review will summarize the current data describing the longitudinal changes in the phenotype and function of monocyte and macrophage populations in healthy and complicated pregnancies.

Can the First Fasting Plasma Glucose Test in Pregnancy Predict Subsequent Gestational Complications?

Objective To determine the best cut-off level of pregnant women's first fasting plasma glucose (FFPG) test results for the prediction of subsequent onset of gestational diabetes mellitus (GDM) and to examine the association between FFPG and maternal and neonatal outcomes in a large Caucasian population. Methods 1437 medical records of women with singleton pregnancies followed up between 2015 and 2018 were retrospectively analyzed. Data on FFPG tested in the first trimester and 75 g oral glucose tolerance test (OGTT) findings performed according to IADPSG criteria and Italian guidelines were collected and evaluated. The women's clinical and metabolic characteristics (age, prepregnancy body mass index (BMI), previous pregnancies complicated by GDM, timing of delivery, and gestational hypertension) were also recorded. The fetal variables considered were being large for gestational age (LGA) or small for gestational age (SGA), macrosomia, and hypoglycemia. Results Among the 1437 pregnant women studied, 684 had a normal glucose tolerance (NGT) and 753 developed GDM. In a univariate analysis FFPG ≥92 mg/dl predicts the risk of GDM with an OR = 2.36 (95% CI 1.930–3.186; p < 0.001). In multivariate analysis, after adjusting for principal risk factors of GDM (BMI, previous GDM, age >35 years, family history of diabetes) FFPG ≥92 mg/dl was associated with the risk of GDM (OR = 1.92; 95% CI 1.488–2.492; p < 0.001). In univariate analysis, FFPG ≥92 mg/dl predict the risk of insulin therapy in GDM women with a OR = 1.88 (95% CI 1.230–2.066; p < 0.001). As regards LGA, in a multivariate analysis, after adjusting for BMI, FFPG ≥92 mg/dl was associated with the risk of LGA only in NGT women (OR = 2.34; 95% CI 1.173–4.574; p=0.014), but not in GDM women. FFPG was not associated with other maternal or neonatal outcomes. Conclusions FFPG ≥92 mg/dl is related to GDM diagnosis and to the need of insulin therapy if GDM is diagnosed. An early diagnosis and a prompt start of insulin therapy are essential to prevent maternal and fetal complications.

Protocol of the Fit-For-Fertility study: a multicentre randomised controlled trial assessing a lifestyle programme targeting women with obesity and infertility

IntroductionWomen with obesity are at a higher risk of infertility as well as gestational and neonatal complications. Lifestyle changes are universally recommended for women with obesity seeking fertility treatments, but...

The effect of fetal hypoxia on myeloperoxidase levels in cord blood: a prospective study.

We aimed to compare myeloperoxidase (MPO) levels in cord blood samples of mothers with and without perinatal hypoxia, since fetal hypoxia results in decreased pH, base excess, and an increase in pCO<inf>2</inf> and lactate levels. We enrolled 42 pregnant women to this cross-sectional analytic study if they had met following criteria: uneventful gestational follow-ups, no known chronic or pregnancy-associated diseases, a BMI of <29.9, a singleton pregnancy, those with pregnancy over 34 weeks. The exclusion criteria for the study and control groups were as follows: presence of multiple pregnancies, fetal abnormality, any disease diagnosed before or during antenatal follow-up e.g., diabetes, hypertension, thyroid dysfunction, uncontrolled endocrine disease or abnormal kidney function, autoimmune disease, chronic inflammatory diseases, IUGR, preeclampsia), maternal age below 18 or above 35, intrauterine exitus, pregnancy with assisted reproductive technique, alcohol or smoking addiction, and any chronic drug use. The subjects were 1:1 randomized to either hypoxic newborns (N.=21) and those in the control group (N.=21) and their myeloperoxidase levels were measured from cord blood samples. Results were expressed as U/L. Patient data regarding age, gestation, parity, birth weight, birth length, APGAR scores, and neonatal complications were collected. All the women signed written informed consent forms and accepted verbal consent before being included in the study. The mean age of the study population was 26.9±5.3 years. The mean BMI was 28.3±3.5 kg/m2. For the hypoxic group, 21 newborns with cord blood below 7.25 were included in the study group. The bloods with pH above 7.25 formed the control group. Mean pH and five (5) minute APGAR scores were found to be significantly lower in the study group, while base excess (BE) was found to be significantly higher. In this study, we compared the MPO levels of hypoxic newborns and those in the control group, and we did not find a significant difference between the two groups (P=0.147). Pearson Correlation Analysis is at -0.566 with P value (0.008) showing significant negative correlation between MPO and pH in the study group. We found that MPO values are negatively correlated with cord blood pH among newborns diagnosed with fetal hypoxia.

A Retrospective Study of Maternal and Fetal Outcomes of Twin Pregnancy

Objective: This study was aimed to study the prevalence of twin pregnancy in a tertiary care hospital in Karad and to evaluate the various factors that influence maternal, fetal, and neonatal outcomes of twin gestation. Methods: This retrospective study was conducted at a tertiary care hospital in Karad, Maharashtra, for a period of two years. All women admitted with twin pregnancy (&gt;28 weeks gestation) were considered for study. Maternal data including age, gestational age, parity, mode of conception, maternal interventions, mode of delivery, fetal death, intrauterine fetal growth restriction (IUGR), twin to twin transfusion, neonatal intensive care unit (NICU) admissions, birth asphyxia, low birth weight (LBW) and respiratory distress were recorded and analyzed Results: Incidence rate of twin pregnancy was 1.9%. Most women (56.48%) were aged 21-30 years and have completed 34-36 weeks of gestation (48.15%) with average gestational age of 34.97±2.35 weeks. Malpresentations (37.96%) followed by preterm labour (35.1%) was most common maternal complication. Cesarean section (62.04%) was most frequent mode of delivery. Most neonates had LBW (92.34%) and required NICU admissions (19.6%). Total rate of neonatal mortality is 3.34%. Birth asphyxia (42.85%) was the most frequent cause of neonatal mortality. Conclusion: Twin gestation necessitates special attention as there is increased risk of maternal and perinatal morbidity and mortality. Early detection and anticipation of complications of twin gestation can greatly improve the maternal and fetal outcomes.

Hepatic Epigenetic Reprogramming After Liver Resection in Offspring Alleviates the Effects of Maternal Obesity.

Obesity has become a public health problem in recent decades, and during pregnancy, it can lead to an increased risk of gestational complications and permanent changes in the offspring resulting from a process known as metabolic programming. The offspring of obese dams are at increased risk of developing non-alcoholic fatty liver disease (NAFLD), even in the absence of high-fat diet consumption. NAFLD is a chronic fatty liver disease that can progress to extremely severe conditions that require surgical intervention with the removal of the injured tissue. Liver regeneration is necessary to preserve organ function. A range of pathways is activated in the liver regeneration process, including the Hippo, TGFβ, and AMPK signaling pathways that are under epigenetic control. We investigated whether microRNA modulation in the liver of the offspring of obese dams would impact gene expression of Hippo, TGFβ, and AMPK pathways and tissue regeneration after partial hepatectomy (PHx). Female Swiss mice fed a standard chow or a high-fat diet (HFD) before and during pregnancy and lactation were mated with male control mice. The offspring from control (CT-O) and obese (HF-O) dams weaned to standard chow diet until day 56 were submitted to PHx surgery. Prior to the surgery, HF-O presented alterations in miR-122, miR-370, and Let-7a expression in the liver compared to CT-O, as previously shown, as well as in its target genes involved in liver regeneration. However, after the PHx (4 h or 48 h post-surgery), differences in gene expression between CT-O and HF-O were suppressed, as well as in microRNA expression in the liver. Furthermore, both CT-O and HF-O presented a similar regenerative capacity of the liver within 48 h after PHx. Our results suggest that survival and regenerative mechanisms induced by the partial hepatectomy may overcome the epigenetic changes in the liver of offspring programmed by maternal obesity.

Акушерські та перинатальні наслідки розродження після ДРТ в жінок з інфекціями, що передаються статевим шляхом, в анамнезі

Purpose - to analyze the clinical course of pregnancy, childbirth and the condition of newborns in women with sexually transmitted infections (STIs) in the anamnesis after pre-pregnancy training before assisted reproduction technology (ART) cycles. Materials and methods. A clinical analysis of pregnancy, childbirth and newborns in 100 pregnant women after ART, with a history of STIs. This women were randomly divided into two groups: Group I (main) - 50 pregnant women subject to pre-pregnancy training, obstetric and perinatal support and delivery according to our developed medical and organizational algorithms, prognostic methods and treatment and prevention schemes; Group II - 50 pregnant women who received conventional prognostic and treatment and prevention measures. The Group III (control) was included 50 practically healthy pregnant women with a successful reproductive history and uncomplicated course of this pregnancy. Statistical processing of research results was performed using standard programs Microsoft Excel 5.0 and Statistica 8.0. Results. The main complication in pregnant women of group I was placental dysfunction, which due to our proposed pre-pregnancy training and management of pregnancy, was reduced from 38.0% in the Group II to 22.0% in women of the Group I (p&lt;0.05), the structure of which was dominated by compensated (72.7%) and subcompensated (27.3%) and no decompensated forms, recurrence of STIs (the Group I - 6.0% and the Group II - 16.0%, p&lt;0.05) and colpitis (the Group I - 16.0% and the Group II - 26.0%, p&lt;0.05). In addition, it is important to reduce the level of preeclampsia (the Group I - 6.0% and the Group II - 10%). In addition, gestational anemia (48.0%) was quite common in the Group II, the level of which we managed to reduce to 24.0% (p&lt;0.05). The analysis of the clinical course of childbirth showed a significant reduction in all complications of childbirth: premature birth (the Group I - 12.0% and the Group II - 26.0%, p&lt;0,05); premature rupture of fetal membranes (the Group I - 12.0% and the Group II - 36.0%, p&lt;0.05); fetal distress (the Group I - 8.0% and the Group II - 20.0%, p&lt;0.05) and obstetric bleeding (the Group I - 10.0% and the Group II - 18.0%), which is associated with severe decrease of the main complications of the gestational period). Condition of newborns after childbirth: in the Group I in 86.07% of cases the condition of children was satisfactory, 13.59% of children were born with signs of asphyxia (mild and moderate), and the overall level of children born with asphyxia decreased 2.5 times. The rate of fetal developmental delay decreased from 14.4% in the Group II to 3.03% in the Group I. Comprehensive dynamic monitoring and pathogenetic therapy were effective for the onset of pregnancy by ART and a favorable pregnancy outcome in 81.0% of women; reduction of reproductive losses by 4.4 times and perinatal mortality by 8.5 times. Conclusions. Early diagnosis, prevention and treatment of infectious diseases in women before pregnancy, pre-pregnancy preparation and planning of pregnancy in women with a history of STIs, effectively restores reproductive function, reduce the frequency of complications of gestation, severity (frequency and duration of relapses) infectious process during pregnancy, prevent severe forms of neonatal infection, reduce perinatal morbidity and mortality. The study was conducted 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. Informed consent of women was obtained for the study. No conflict of interests was declared by the author. Key words: sexually transmitted infections, pre-pregnancy training, pregnancy, obstetric and perinatal complications.

Current views on the assessment of vascular wall elasticity in pregnant women with arterial hypertension

Introduction. Arterial hypertension is the most common somatic pathology in pregnant women. Arterial hypertension is a factor of high risk for the development of severe preeclampsia, placental insufficiency, intrauterine growth restriction, premature birth, maternal and perinatal mortality, nervous disorder and vascular heart disease of newborns and women’s distant cardiovascular disorders. The pathogenesis of gestational complications is associated with pathology of placentation, endothelial dysfunction and a decrease in vascular elasticity. The pathogenesis has not studied yet. Nowadays there are no tests with enough sensitivity and specificity ensuring early diagnostics and risk identification at development of great obstetric syndromes. Aim of the study was to improve our understanding about a clinical and prognostic role of vascular wall elasticity in pregnant women with arterial hypertension. Materials and Methods. We searched publications and analyzed literature using various scientific databases, including Index Medicus, PubMed/MEDLINE, Embase, Cochrane Library and Russian scholarly journals related to obstetrics, gynecology, cardiology for the last 9 years. Results and Discussion. Today changes in the elastic properties of arteries is a modern marker of a high risk of cardiovascular events in patients with essentialhypertension. Endothelial dysfunction develops already in the early stages of arterial hypertension and initiates structural changes in the vascular wall and an increase in arterial stiffness. High activity of the sympathetic nervous system is the cause of changes in the elastic properties of arteries in pregnant women with arterial hypertension. Conclusion. The role of vascular wall elasticity in pregnant women with arterial hypertension is of tremendous importance and deserves close attention. The study of elastic properties of vessels is relevant for assessing the risk of gestational complications in pregnant women with arterial hypertension.

Gestational diabetes mellitus: current screening problems

Gestational diabetes mellitus (GDM) is characterized as hyperglycemia, first detected during pregnancy, yet not meeting the criteria for “manifest” diabetes mellitus. GDM is one of the most common gestational complications. This pathology is associated with many adverse pregnancy outcomes, both on the part of the mother and the fetus. The problem of identifying GDM has acquired particular relevance and significance for the healthcare system at the moment due to the steady increase in the prevalence of such risk factors of GDM as obesity and late pregnancy. The history of screening and diagnosis of GDM has undergone a number of significant changes in a short time. Currently, different clinical guidelines offer different approaches to GDM screening, thus, a unified approach to identifying this pathology has not yet been formulated and adopted. The purpose of this review was to discover the current clinical guidelines for the detection of GDM at 24–28 weeks of pregnancy, including historical context of their origin and development, to describe these approaches, as well as to critically evaluate them with a discussion of the main advantages and disadvantages of each of them.

Autoimmune hepatitis in pregnancy: Pearls and pitfalls.

Autoimmune hepatitis (AIH) in pregnancy has many unique considerations. Evidence provided from single center studies with patient level data and nationwide population studies provide valuable insight into this complex situation. Because a planned pregnancy is a safer pregnancy, preconception counseling is a crucial opportunity to optimize care and risk stratify women with AIH. Women with chronic liver disease who receive preconception advice and counseling are more likely to achieve stable liver disease at conception and undergo appropriate variceal surveillance. Loss of biochemical response in pregnancy is associated with adverse outcomes in unstable disease. New onset AIH in pregnancy should be managed with classical treatment regimens. The continued use of immunosuppression in pregnancy, with the exception of mycophenolate mofetil, has not shown to adversely affect the rates of stillbirth or congenital malformation. Previously adopted immunosuppression withdrawal paradigms in pregnancy should no longer be considered advantageous, because remission loss postdelivery is likely (12%-86%). Population studies, report improved outcomes with preterm birth rates falling from 20% to 9%-13% in AIH pregnancies over a 20-year period. Newer data have also demonstrated an increased risk of gestational diabetes and hypertensive complications in AIH pregnancy, which has implications for management and preeclampsia prevention with aspirin use. This review aims to provide the framework to guide and manage pregnancy in AIH outlining pearls and pitfalls to ensure optimal outcomes for mother, baby and to reduce variation in practice.

Periodontal Inflamed Surface Area Is Associated With Increased Gestational Blood Pressure and Uric Acid Levels Among Pregnant Women From Rural North China

BackgroundPeriodontal disease has been associated with gestational complications and both conditions have a high prevalence in rural populations from developing regions. A cross-sectional study was carried out to explore the relationship between periodontal inflamed surface area (PISA), blood pressure (BP), and, serum uric acid levels (UA) in a group of rural North Chinese pregnant women in the third trimester of pregnancy.MethodsThree hundred and thirty-five rural women aged 20–34 years, with normal body mass index (BMI) were examined in a cross-sectional study during their third trimester of gestation. Exclusion criteria were history of pregnancy complications, multiple pregnancy, smoking habits, diabetes, hypertension or any known infectious disease. Socio-demographic variables, including age and socioeconomic status (SES), systolic blood pressure (SBP) and diastolic blood pressure (DBP) readings, serum UA levels, and PISA values were recorded. A structural equation model was implemented with two constructed latent variables including “Dem” (comprising of age and SES category to represent unobserved demographic variables) and, “BP” (comprising of SBP and DBP to account for measurement error and lack of multiple BP readings). The model accounted for co-variance of BP and UA, and implemented simultaneous regressions for BP and UA as outcomes, upon Dem and PISA values as exogenous variables.ResultsThe median PISA score was 1,081.7 (IQR = 835.01), reflecting high levels of periodontal inflammation in the sample. SEM showed a significant association of PISA with BP (estimate = 0.011, 95% CI = 0.009–0.012 p < 0.001) and UA (estimate = 0.001, 95% CI = 0.001–0.001, p < 0.001).ConclusionHigher PISA values were significantly associated with higher blood pressure and uric acid levels among rural pregnant women in a cross-sectional sample from a center in North China after accounting for a latent demographic construct derived from age and SES.

Blood pressure adjustments throughout healthy and hypertensive pregnancy: A systematic review and meta-analysis.

Gestational hypertensive complications are preceded by deviant hemodynamic adjustments affecting blood pressure. Our objective was to determine the timing and magnitude of changes in blood pressure during singleton normotensive and hypertensive pregnancies. PubMed (NCBI) and Embase (Ovid) databases were searched for relevant studies up to November 2019. Studies reporting original blood pressure measurements during pregnancy together with a non-pregnant reference measurement were included. Studies including women with a history of cardiovascular or metabolic disease, or women using antihypertensive drugs were excluded. Pooled mean differences between pregnant and non-pregnant women, and absolute blood pressure values were calculated for predefined gestational intervals in normotensive and hypertensive pregnancy, using a random-effects model. Meta-regression analysis was used to analyze group differences in adjustments. In early normotensive pregnancy, both systolic and diastolic blood pressure decreased, reaching their maximum reduction of -4 mmHg (95%CI -6 to -1 mmHg) and -4 mmHg (95%CI, -5 to -3 mmHg), respectively in the second trimester. Thereafter, blood pressure gradually increased towards non-pregnant values. All absolute blood pressure measurements throughout normotensive pregnancy were below 130/80mmHg. In hypertensive pregnancies, only diastolic blood pressure decreased early in pregnancy. In conclusion, this meta-analysis showed a clinically moderate, but significant mid-pregnancy drop in blood pressure during normotensive pregnancy. Reference curves with absolute values underscore the current liberal cut-off limit for gestational hypertension. A lack of a mid-pregnancy systolic blood pressure drop might reflect increased vascular resistance in women destined to develop hypertensive pregnancy complications.

MANAGEMENT OF PREGNANT WOMEN WITH THYROID DISEASE

The course of pregnancy, thyroid status, hormonal levels were studied in 96 women with autoimmune thyroiditis (AIT). It was found that pregnant women have a number of complications (54.8%) from the mother and the fetus, AIT has an unfavorable effect on the course of pregnancy, there is a high risk of miscarriage and termination of pregnancy, there is a decrease in the level of thyroid hormones and an increase in the level of TSH in comparison with similar indicators of healthy pregnant women. For the prevention of complications of gestation and prematurity of pregnancy in women with AIT, a planned determination of TSH blood from early gestation is recommended.

A high-protein low–glycemic index diet attenuates gestational weight gain in pregnant women with obesity: the “An optimized programming of healthy children” (APPROACH) randomized controlled trial

Prepregnancy overweight and excessive gestational weight gain (GWG) increase the risk of complications and offspring obesity. We aimed to investigate the effect of a high-protein low-glycemic index (HPLGI) diet on GWG, birth weight, and risk of gestational complications in pregnant women with obesity. A total of 279 women with prepregnancy overweight or obesity (BMI: 28-45kg/m2), between 18 and 45 y old, and in their late first trimester with singleton pregnancies, were randomly assigned to 1 of 2 ad libitum diets: a high-protein low-glycemic index diet (HPLGI: 25%-28% of energy from protein and glycemic index≤55) and a moderate-protein moderate-glycemic index diet (MPMGI: 15%-18% of energy from protein and glycemic index ∼60). Diets were consumed from gestational week 15 and throughout pregnancy. Participants received dietary guidance by a clinical dietician 9 times to facilitate adherence. Out of 141 and 138 women randomly assigned to the HPLGI and MPMGI diets, 105 and 104 completed the intervention, respectively (75%). In the available case analyses, GWG was 6.8±1.3kg among women assigned the HPLGI diet and this was significantly lower, by -1.7kg (95% CI: -2.8, -0.5kg; P = 0.004), than the GWG of 8.5±1.3kg among women assigned the MPMGI diet. There were no significant differences between diets on major neonatal outcomes (birth weight and other anthropometric measures). The incidence of composite pregnancy complications was lower for the HPLGI than for the MPMGI diet (35.4% compared with 53.7%, respectively; P = 0.009), including cesarean delivery (15.4% compared with 28.8%, respectively; P = 0.03). There were no reported maternal, fetal, or neonatal deaths. Incidence of miscarriages (1%-2%) did not differ between groups. A moderate increase in dietary protein in conjunction with a reduction in glycemic index during the last 2 trimesters of pregnancy reduced GWG and limited complications and cesarean deliveries among women with overweight or obesity.

CURRENT APPROACH TO PREGNANT WOMEN WITH THYROID ABNORMALITIES

The course of pregnancy, thyroid status, and hormonal background were studied in 96 women with autoimmune thyroiditis (AIT). It was established that pregnant women have a number of maternal and fetal complications (54.8%); AIT has an adverse effect on the course of pregnancy; a high risk of miscarriage and termination of pregnancy is observed; and the thyroid hormone level is reduced and the TSH level is increased in comparison with that in healthy pregnant women. To prevent gestational complications and prematurity in women with AIT, routine blood TSH testing from early gestation is recommended.

Presence of Streptococcus mutans and interleukin-6 and -10 in amniotic fluid

Aim To evaluate the presence of Streptococcus mutans (SM), main pathogen of dental caries, interleukin-6 and -10 in samples of amniotic fluid (AF) and clinical and oral data of the healthy pregnancy, to investigate the SM exposition in intrauterine life and to elucidate the presence of antibodies to SM in newborns’ saliva (SA) with undetectable levels of this microorganism described in the previous study. Methods The study involved the participation of 26 women with term deliveries and without gestational complications. General health data were collected through a questionnaire applied to the participants. The volunteers were examined orally, the caries experience (decayed, missing, and filled teeth (DMFT) scores) was calculated and unstimulated SA was collected. The acquisition of AF was performed during cesarean sections and stocked on ice. The analysis of the presence of SM-DNA was performed by real-time PCR assays with specific primers. Levels of IL-6 and IL-10 were performed by ELISA with specific kits for these interleukins in the AF samples. Results 69.2% of the AF samples had detectable SM, and 65% of the women had the bacteria in the AF and SA at the same time. There was a positive association between the presence of SM in AF and a report of not going to the dentist frequently (p<.05). There was no statistically significant difference between the frequency of AF with or without detection of MS and active caries (p>.05). However, the DMFT scores of women with positive AF for SM were higher than that of women without detectable MS (p<.05). IL-6 levels were higher than IL-10 in AF (p<.05). There were no significant differences in the levels of interleukins between samples with detectable SM or in AF and even with clinical data analysis (p>.05). Conclusions The AF samples have SM in quantifiable levels, probably associated with the greatest caries experience, and seen by the highest DMFT index. Interleukin levels were not related to the presence of MS. The presence of SM in AF may explain the mucosal immune stimulation of newborn children by the previous detection of salivary antibodies against SM.

Antimicrobial Resistance Pattern in E. coli Isolated from Placental Tissues of Pregnant Women in Low-Socioeconomic Setting of Pakistan.

Infections during pregnancy can culminate in adverse pregnancy outcomes, including preterm birth (PTB). Pakistan is among the top ten nations with high PTB-associated neonatal mortality rates, where access to prenatal as well as neonatal care is only afforded by the privileged few. Societal stigma further discourages women seeking healthcare for minor infections. Microbial pathogens associated with genitourinary infections can lead to gestational complications culminating in earlier onset of labor. In this study, association of Escherichia coli (E. coli) with PTB in Pakistani women of low-socioeconomic status is examined. 57 paired vaginal swabs and placenta samples from mothers with full term and preterm deliveries were collected and processed for isolation and molecular characterization of extraintestinal pathogenic E. coli (ExPEC). ExPEC isolated from vaginal swabs and placenta showed phylotype B2 being most prevalent (Vagina n = 3 (9), 33%) (Placenta n = 4 (12), 33%) in preterm cases followed by phylotype B1 (Vagina n = 2 (9), 22%) (Placenta n = 3 (12), 25%) and untypeable strains. Antibiotic susceptibility profiling showed a large percentage of resistant isolates to multiple antibiotics, including carbapenem and included extended-spectrum beta-lactamase (ESBL) producers. Our study is the first to report different phylotypes of E. coli from placental tissues in preterm deliveries which may be a cause for concern for maternal and neonatal health. ExPEC from vaginal swabs and placental of females delivering preterm shows the pathogenic phylotype B2 dominance with a large percentage of isolates resistant to multiple antibiotics, including carbapenem and included ESBL producers. The placental isolates may indicate ascending infection from vagina or urinary tract which may lead to preterm birth.