Gestational Complications Research Articles

Artificial Neural Network Modeling to Predict Neonatal Metabolic Bone Disease in the Prenatal and Postnatal Periods

Early recognition of metabolic bone disease (MBD) in infants is necessary but difficult; an appropriate tool to screen infants at risk of developing MBD is needed. To develop a predictive model for neonates at risk for MBD in the prenatal and postnatal periods and detect the pivotal exposed factors in each period. A diagnostic study was conducted from January 1, 2012, to December 31, 2021, in Shanghai, China. A total of 10 801 pregnant women (singleton pregnancy, followed up until 1 month after parturition) and their infants (n = 10 801) were included. An artificial neural network (ANN) framework was used to build 5 predictive models with different exposures from prenatal to postnatal periods. The receiver operating characteristic curve was used to evaluate the model performance. The importance of each feature was examined and ranked. Of the 10 801 Chinese women who participated in the study (mean [SD] age, 29.7 [3.9] years), 7104 (65.8%) were local residents, 1001 (9.3%) had uterine scarring, and 138 (1.3%) gave birth to an infant with MBD. Among the 5 ANN models, model 1 (significant prenatal and postnatal factors) showed the highest AUC of 0.981 (95% CI, 0.970-0.992), followed by model 5 (postnatal factors; AUC, 0.977; 95% CI, 0.966-0.988), model 4 (all prenatal factors; AUC, 0.850; 95% CI, 0.785-0.915), model 3 (gestational complications or comorbidities and medication use; AUC, 0.808; 95% CI, 0.726-0.891), and model 2 (maternal nutritional conditions; AUC, 0.647; 95% CI, 0.571-0.723). Birth weight, maternal age at pregnancy, and neonatal disorders (anemia, respiratory distress syndrome, and septicemia) were the most important model 1 characteristics for predicting infants at risk of MBD; among these characteristics, extremely low birth weight (importance, 50.5%) was the most powerful factor. The use of magnesium sulfate during pregnancy (model 4: importance, 21.2%) was the most significant predictor of MBD risk in the prenatal period. In this diagnostic study, ANN appeared to be a simple and efficient tool for identifying neonates at risk for MBD. Combining prenatal and postnatal factors or using postnatal exposures alone provided the most precise prediction. Extremely low birth weight was the most significant predictive factor, whereas magnesium sulfate use during pregnancy could be an important bellwether for MBD before delivery.

Analysis of Risk Factors for Low Birth Weight (LBW) in the Work Area of the Setu II Bekasi Health Center

The aim of the study was to analyze the risk factors for LBW events in the working area of the Setu II Bekasi Health Center in 2022. This research was an analytic survey study using a cross-sectional study design with a population of 521 people and a sample of 84 people who were selected using a random sampling technique. Data was taken using a questionnaire which was then processed using a statistical program. Results: The study found that 22.6% of babies were born with a weight < 2500 grams, 27.4% of mothers aged < 20 and > 35 years, 20.2% of mothers with gestational age < 37 weeks, 28.6% of mothers with parity ≥ 3 children, 14.3% of mothers had LILA <23.5 cm, 7.1% of mothers had HB levels <10 g/dl, 10.7% of mothers experienced pregnancy complications. The results of statistical analysis using the chi square test found that the risk factors associated with the incidence of LBW were gestational age (p value = 0.000), parity (p value = 0.019) and pregnancy complications (p value = 0.025). While the risk factors that were not related to the incidence of LBW were mother's age (p value = 0.179), upper arm circumference (p value = 0.455) and HB levels (p value = 0.126). Conclusion: the risk factors associated with the incidence of LBW are gestational age, parity and complications of pregnancy. Therefore, it is hoped that parents will always take care of their pregnancies by checking their pregnancies to health services, so as to minimize risk factors during pregnancy

Obesity and pregnancy: possible ways to overcome complications and improve reproductive outcomes

Introduction. Obesity, due to its high prevalence and relevance, can be considered an epidemic of modern society. Obesity-related microcirculatory vascular disease and chronic inflammation with endothelial dysfunction are associated with adverse effects on reproductive potential. Sulodexide reduces the risk of hemostatic complications in patients planning pregnancy due to its polypotent effect, which is especially important in metabolic disorders and comorbidities. Therefore, it is promising to assess the effectiveness of integrated management of obese patients as part of pregnancy planning.
 Aim. To modify the complex treatment of obesity in patients planning pregnancy to reduce the risk of reproductive losses and gestational complications.
 Materials and methods. The prospective analysis included 92 patients with grade 1 obesity. According to the clinical protocols and guidelines of the Reproductive Health Professional Medical Association, 46 patients in the control group (group 1) were prescribed treatment to reduce the body mass index, including lifestyle correction, folic acid, and vitamin D. Patients in the comparison group (Group 2, n=46) also received endotheliotropic agent sulodexide. The treatment efficacy was analyzed based on the frequency of pregnancy, the change of laboratory markers of endothelial dysfunction, the incidence of gestational complications, and reproductive losses.
 Results. The study showed that in comparison group patients, the frequency of pregnancy (58.7% of cases in Group 1, 71.7% in Group 1), favorable course of the first trimester (39.1% in Group 1, 63.0% in Group 2), and delivery at term (30.4% in Group 1, 56.5% in Group 2) were higher compared to the control group. There was also a more significant decrease in the body mass index and endothelial dysfunction factors (homocysteine level in group 1 before treatment was 172.4 mol/L, and 141.8 mol/L after treatment; 191.7 mol/L before treatment and 91.4 mol/L after treatment in Group 2, respectively) in patients receiving complex treatment with sulodexide. Analysis of the pregnancy course showed a lower risk of gestational diabetes (33.3% in Group 1 and 13.8% in Group 2).
 Conclusion. Treatment of obesity in patients planning pregnancy requires a complex effect aimed at correcting lifestyle, reducing body weight, restoring the endothelial layer, and reducing the severity of chronic inflammation, thus improving reproductive outcomes and minimizing the risk of gestational complications.

Raised Thyroid-Stimulating Hormone in Girls with Polycystic Ovary Syndrome: Effects of Randomized Interventions

Introduction: Polycystic ovary syndrome (PCOS) in women associates with raised levels of circulating thyroid-stimulating hormone (TSH) and with high rates of gestational complications. A low range of preconception TSH is followed by low rates of gestational complications. It is unknown whether TSH levels are elevated in adolescents with PCOS and, if so, whether traditional or exploratory treatments can lower them into safe preconception range. We investigated TSH in nonobese adolescents with PCOS, including the effects of randomized interventions. Methods: Morning TSH was a safety marker in randomized pilot studies comparing the effects of an oral contraceptive (OC) versus those of a low-dose combination of spironolactone-pioglitazone-metformin (SPIOMET) in nonobese adolescents with PCOS. A post hoc analysis compared TSH levels in PCOS (N = 62) versus controls, TSH changes on treatment (for 1 year), and TSH levels posttreatment (for 1 year). Results: Mean TSH levels were higher in PCOS patients than in control girls (p < 0.01). On-treatment TSH levels diverged (p < 0.001), remaining elevated on OC, and descending swiftly on SPIOMET, well into safe preconception range. Posttreatment TSH levels were stable in both subgroups. On-treatment changes of circulating TSH associated to those of liver fat (R = 0.307, p = 0.017). Conclusion: The endocrine signature of early PCOS is herewith extended to include modestly raised levels of circulating TSH; the normalizing effects of SPIOMET intervention in nonobese adolescents with PCOS are herewith extended to include on- and posttreatment TSH.

LEVEL OF KNOWLEDGE OF WOMEN ABOUT THE RISKS ASSOCIATED WITH OVERWEIGHT DURING PREGNANCY

Worldwide half of women start pregnancy with overweight/obese, which greatly increases the risk of pregnancy and birth complications. Recommendations to improve preconception care emphasize the need to ensure that women of reproductive age understand factors that increase the obstetric and perinatal risks connected with high body mass index (BMI).&#x0D; Aim. Study whether women who start pregnancy with overweight were known of the increased risks of the gestational complications associated with a high (BMI) and the barriers and limitations that women had to optimize their body weight before conception.&#x0D; Materials and methods. total of 117 pregnant were enrolled in the research. The first group included 68 overweight women (BMI 25.0-29.9 kg/m2), the second - 49 normal body weight women (BMI 18.5-24.9 kg/m2) before pregnancy. Two questionnaires were used: "Questionnaire on the assessment of the level of knowledge of women about the risks associated with overweight during pregnancy" and "Barriers and limitations that women had to optimize body weight before conception". Patients filled out the presented questionnaires individually during the first antenatal visit (9-12 weeks). The results were statistically analyzed using Statistica 10.0 program pack (StatSoft Inc., USA) and Microsoft Excel statistical analysis package. The differences between the groups were considered statistically significant at p&lt;0.05.&#x0D; Results. It was shown that the majority of women knew that overweight increased the general risk of pregnancy complications regardless of the woman's BMI. However, the chances of underestimating the high risk of operative delivery in overweight patients were (OR=3.80; 95% CI: 1.83-7.87; p&lt;0.001 and OR=3.69; 95% CI: 1.58 -8.64; p=0.004), premature birth (OR=2.96; 95% CI: 1.47-5.95; p=0.003 and OR=2.99; 95% CI: 1.31-6 .83; p=0.015), adverse neonatal outcomes (OR=2.96; 95% CI: 1.47-5.95; p=0.0031), and especially fetal congenital anomalies of development (OR=5.50; 95 % CI: 2.62-11.54; p&lt;0.001 and OR=12.38; 95% CI: 4.56-33.58; p&lt;0.001) among patients of the first and second groups, respectively. An underestimation of the risk of diabetes, caesarean section, premature birth, and negative perinatal outcomes, and especially congenital fetal abnormalities, has been confirmed if weight loss occurs before conception. The main barriers and limitations for women to optimize their weight before pregnancy were insufficient basic knowledge about the risk of gestational, especially perinatal complications during pregnancy and childbirth associated with overweight, family culture and habits, unsuccessful repeated irregular attempts to weight lose, lack of information and consulting medical professionals on this issue. Only 14.7 % of women reported that they were satisfied with their appearance and health and did not need to lose weight.&#x0D; Conclusions. Being overweight, usually caused by incorrect lifestyle, including dietary choices and lack of physical activity, has long-term negative health consequences for women and their children. The preconception, pregnancy, and postpartum periods are unique opportunities for intervention to establish sustainable healthy lifestyles. It remains relevant to develop programs aimed at improving women's knowledge about overweight as a factor of high obstetric and perinatal risks, and lifestyle modeling with the aim of optimizing body weight at the preconceptional stage.

Pre-pregnancy body mass index has greater influence on newborn weight and perinatal outcome than weight control during pregnancy in obese women

BackgroundThe pre-pregnancy weight and gestational weight gain (GWG) are closely related to perinatal maternal and infant complications, but the relationship between pre-pregnancy weight and GWG and the pattern of interaction have not been reported. This study investigated the influence of weight control during pregnancy on the perinatal maternal and infant outcomes.MethodsA total of 835 singleton pregnant women who were hospitalized between January 2018 and December 2018 were retrospectively included in this study and divided into two groups: the diet guidance (DG) group (n = 167) and the control group (n = 668). The pre-pregnancy body mass index (BMI), GWG, and perinatal outcomes of the women and infants were determined in two groups.ResultsThe dietary modification and reasonable exercise during pregnancy effectively reduced the GWG, and even some women with pre-pregnancy obesity achieved weight loss during pregnancy. The GWG in the DG group was significantly lower than in the control group, especially in the second and third trimesters. GWG was positively related to birth weight. The birth weight in the DG group was significantly lower than in the control group when their mothers had similar GWG. In women with pre-pregnancy obesity, GWG seemed to be negatively related to birth weight. However, after adjusting the mean BMI, the pre-pregnancy BMI and GWG were positively related to the birth weight. Compared with the control group, the incidences of dystocia, postpartum hemorrhage, macrosomia, small for gestational age infants and neonatal complications significantly reduced in the DG group, and the preterm birth rate was comparable between two groups. Some women with pre-pregnancy obesity lose weight during pregnancy, but there was no premature birth or small for gestational age infant. The incidences of macrosomia, postpartum hemorrhage, dystocia, cesarean section and gestational diabetes increased significantly with the increase of pre-pregnancy BMI.ConclusionFor women with increased pre-pregnancy BMI, strict weight control is required to reduce obesity-related complications of the mother and infant. The weight control in the second and third trimesters is especially important and most likely to prevent GWG. Compared with GWG, pre-pregnancy BMI has greater influence on the birth weight and maternal and infant complications, and may even compromise the benefits of weight control during pregnancy. Thus, weight control is recommended before pregnancy.

Expression and clinical significance of short-chain fatty acids in pregnancy complications.

To investigate the expression of short-chain fatty acids (SCFAs)-metabolites of intestinal flora-in gestational complications of gestational diabetes mellitus (GDM), preeclampsia (PE), and intrahepatic cholestasis of pregnancy (ICP), and its clinical significance. Targeted metabonomics was used to detect SCFAs in the serum of 28 GDM pregnant women, 28 PE pregnant women, 29 ICP pregnant women, and 27 healthy pregnant women (NP); their expression changes were observed; the correlation between SCFAs and clinical characteristics was studied; and their potential as biomarkers for clinical diagnosis was evaluated. There were significant differences in the SCFA metabolic spectrum between the GDM, PE, ICP, and NP groups. Quantitative analysis showed that the content of isobutyric acid in the three pregnancy complications groups (the GDM, PE, and ICP groups) was significantly higher than that in the NP group (p < 0.05), and other SCFAs also showed significant differences in the three pregnancy complications groups compared with the NP group (p < 0.05). Receiver operating characteristic (ROC) curve analysis of the generalized linear model showed that multiple SCFAs were highly sensitive and specific as diagnostic markers in the pregnancy complications groups, where isobutyric acid was highly predictive in GDM (area under the ROC curve (AUC) = 0.764) and PE (AUC = 1), and caproic acid was highly predictive in ICP (AUC = 0.968), with potential clinical application. The metabolic products of intestinal flora, SCFAs, during pregnancy are closely related to pregnancy complications (GDM, PE, and ICP), and SCFAs can be used as potential markers of pregnancy complications.

Obstetric-Neonatal Complications of Gestational Diabetes: A Systematic Review

Analyse the evidence provided regarding neonatal and obstetric complications derived from gestational diabetes. A systematic search of the scientific literature, PUBMED, ScienceDirect was carried out with various search strategies guaranteeing the completeness and reproducibility of the phases of the PRISMA guide. 13 studies were included, 10 simultaneously evaluated obstetric and neonatal complications, the rest (3) evaluated only neonatal complications. The prevalence of GDM (gestational diabetes mellitus) was 12.5% (65,852 of 527,351) Obstetric complications include: emergency caesarean section (OR 1.1 to 2.37), preeclampsia with an OR range of 1.1 to 2.96, and prematurity (OR 1.1 to 2.3). The most frequent neonatal complications are: macrosomia with an OR range of 1.2 to 5.2, with a prevalence of 10.3%; while hypoglycaemia is the one with the highest risk (OR 3.19-11.97), other complications include greater height for gestational age OR 1.3 to 3.43; perinatal asphyxia (OR 1.2-3.4); shoulder dystocia (OR 1.3-2.56); respiratory distress (OR 1.3-2) and hyperbilirubinemia (OR 1.02-1.39). No increased risk of perinatal death was found, the reported OR range is 0.7-0.8. Both obstetric and neonatal gestational diabetes complications are very prevalent and may require intensive care, being a highly relevant public health problem. Although an efficient screen for the early detection of gestational diabetes has been established, greater efforts are required to comply with it and to avoid these complications.&#x0D; &#x0D; &#x0D;

Деквалиния хлорид в терапии вагинальных инфекций

The most common inflammatory and infectious diseases of the lower genital tract include bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), aerobic vaginitis, and mixed infections. Standard modern therapies show acceptable but short-term efficacy in most cases, and high recurrence rates and increased antimicrobial resistance remain an unresolved issue. Moreover, vaginal infections are associated with different adverse outcomes both in terms of higher incidence of infertility among couples and gestational complications, having a serious impact on patients’ quality of life. The determination of appropriate management tactics for these women, especially in mixed infections, is quite a challenge for clinicians. This metaanalysis evaluates the efficacy of topical therapy with antimicrobial antiseptics containing dequalinium chloride for various types of vaginal infections. Objective. To analyze the clinical and microbiological efficacy and safety of dequalinium chloride in the treatment of vaginal infections of different etiologies. Materials and methods. A review of selected scientific publications over the past 40 years on the use of dequalinium chloride in the treatment of vaginal infections with assessing the efficacy and safety of its topical use in women was conducted. A total of 4,783 patients (from 26 studies) were included. Results. Dequalinium chloride is an antimicrobial antiseptic agent with broad bactericidal and fungicidal activity and low systemic absorption after vaginal administration. At the same time, dequalinium chloride has similar clinical efficacy to clindamycin when used topically in the treatment of bacterial vaginosis, and its broad antimicrobial activity appears to be most suitable for the treatment of mixed vaginal infections. In addition, the development of microbial resistance to this drug is unlikely due to its pluripotent mechanism of action and local application. Conclusion. The analysis showed that the current formulation of dequalinium chloride (10 mg vaginal tablets) as 6-day therapy with its broad spectrum of antimicrobial activity and good tolerability offers a safe and effective option for empiric therapy of various vaginal infections in daily practice. Key words: vaginal infections, bacterial vaginosis, vulvovaginal candidiasis, anaerobic vaginitis, dequalinium chloride

Dietary intake patterns during pregnancy and excessive gestational weight gain: a systematic review and meta-analysis.

Excessive gestational weight gain (EGWG) is associated with gestational complications and adverse birth outcomes. Dietary intake is closely related to EGWG; however, evidence of the association between different dietary patterns and EGWG is inconsistent. We conducted a meta-analysis to systematically evaluate this association using articles from PubMed, Embase, and Web of Science databases published up to March 1st 2023 and included observational studies revealing an association between EGWG and dietary patterns during pregnancy. Dietary patterns were categorized into three groups: healthy, unhealthy, and mixed. Summary odds ratio (OR) and 95% confidence interval (CI) were calculated using the fixed-effects (I2 < 50%) or random-effects model (I2 ≥ 50%). Fourteen studies from eleven countries, including a total of 77,550 participants, met the inclusion criteria. The overall effect of healthy dietary patterns on EGWG was non-significant. After excluding one result in overweight participants, a significant negative association between healthy dietary patterns and EGWG was found in studies with a priori defined healthy dietary patterns (OR = 0.97, 95% CI: 0.94-1.00, P = 0.047), with sample size <1000 (OR = 0.68, 95% CI: 0.48-0.97, P = 0.031), and cohort studies (OR = 0.97, 95% CI: 0.95-1.00, P = 0.043). Overall analysis revealed a significant association between unhealthy dietary patterns and EGWG (OR = 1.22, 95% CI: 1.02-1.45, P = 0.031), and the results were similar in sub-groups of cohort studies (OR = 1.23, 95% CI: 1.02-1.49, P = 0.009) and those with a sample size < 1000 (OR = 1.31, 95% CI: 1.07-1.61, P = 0.03). A healthy dietary pattern instead of an unhealthy dietary pattern is recommended for pregnant women to prevent EGWG. This meta-analysis was registered in PROSPERO as CRD42023404179.

Hapless Foetal Outcome in Twin-Twin transfusion syndrome: A case report

Twin-Twin transfusion syndrome (TTTS), a complication of Monochorionic twin gestation is a worldwide cause of perinatal mortality, with a high incidence of impairment in surviving twins. We report a recent case of TTTS at 28 weeks resulting in poor outcomes after birth.

Myocardial oxygen consumption in pregnancies complicated by hypertensive disorders of pregnancy

Rate-Pressure Product (RPP) has been used as a surrogate for myocardial oxygen consumption (MOC), a dynamic non-invasive index of changes in cardiovascular (CV) demand. We sought to describe pre-conceptional (PC), antepartum (AP), and postpartum (PP) RPP among pregnancies complicated by hypertensive disorders of pregnancy (HDP). Retrospective longitudinal study of women aged 18-34 who became pregnant during the study period (2013-2022). We included pregnancies complicated by HDP, defined as gestational hypertension (HTN), pre-eclampsia with or without severe features, eclampsia, and/or HELLP. Individuals with chronic medical conditions including chronic HTN, multifetal gestation, and/or other complications were excluded. Authors searched the electronic medical record for demographic characteristics, as well as PC, AP, and PP heart rate (HR) and systolic blood pressure (SBP) values. RPP was defined as the product of HR and SBP (HR X SBP) at each visit. RPP % change from the PC (baseline) value at each visit was obtained using the following formula: [(RPP value– PP RPP)/PC RPP) x 100)]. Mean and standard deviation for absolute and % change from baseline were calculated for RPP at PC, by trimester, and PP. Mixed linear model was used to ascertain differences over time. A p-value < .05 was deemed statistically significant. 549 patients were included in our study. Data were normally distributed. Mean maternal age, BMI (kg/m2), and gestational age at delivery was 27, 33.3, and 37 weeks, respectively. 65% of the cohort was multiparous. Number of months at PC visit and weeks at PP visit was 6 and 2.5, respectively. The mean RPP value at baseline was 10178. Absolute RPP increased significantly from PC values at all time points (Figure 1). The RPP increased from PC to 2nd trimester by 9% (p< .001) and by 17% in the 3rd trimester (p < .001), while RPP PP values remained 9% higher than PC (p< . 001) (Figure 2). MOC as measured by RPP increases progressively with each trimester of pregnancy and remains higher than PC values following delivery among pregnancies complicated by HDP.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Тяжелая преэклампсия как одно из критических акушерских состояний: основные факторы возникновения (данные по Ивановской области)

Aim: To analyse the clinical and anamnestic data of patients in Ivanovo Oblast who underwent such a critical obstetric condition (CAC) as severe pre-eclampsia, and to clarify the risk factors for its occurrence. Design: A retrospective study. Materials and methods. A retrospective analysis of 73 delivery histories of patients with severe pre-eclampsia delivered at the Ivanovo Scientific-Research Institute named after V.N. Gorodkov in 2021-2022 was performed. For this purpose, data were extracted from medical records — individual charts of pregnant and labouring women (Form No. 111/u) and delivery histories (Form No. 096/u). Risk factors for severe pre-eclampsia — the most frequent form of CAC in Ivanovo region were assessed in the patients. Then groups of CAC risk factors were formed: medical, organisational and methodological, socio-demographic, and patient responsibility. Results. Risk factors of severe pre-eclampsia as one of the forms of CAC were analysed and ranked. The most common were medical risk factors (72.6%), second place was occupied by socio-demographic factors (64.4%), third — organisational and methodological (53.4%, p = 0.02 for difference from medical factors). The frequency of factors related to patient responsibility was the lowest at 23.3% (p = 0.001 for difference from medical and socio-demographic factors). Conclusion. Annual analysis of risk factors for the occurrence of CAC makes it possible to develop measures to prevent severe complications of gestation, improve the quality of medical care for pregnant women at the outpatient stage, and improve perinatal outcomes, which should have a positive impact on the demographic situation in the country. Keywords: preeclampsia, pregnancy, risk factors, critical obstetric conditions.

ОСОБЕННОСТИ ФОРМИРОВАНИЯ ОСЛОЖНЕНИЙ ГЕСТАЦИИ И РОДОВ У ПАЦИЕНТОК С ОЖИРЕНИЕМ И ГЕСТАЦИОННЫМ САХАРНЫМ ДИАБЕТОМ, ПРОЖИВАЮЩИХ НА ТЕРРИТОРИИ ХМАО-ЮГРЫ

The article is devoted to the peculiarities of the formation of complications of gestation and childbirth in patients with obesity and gestational diabetes mellitus (GDM) in pregnant women living on the territory of KHMAO-Ugra. Purpose: to study the features of the course of gestation in pregnant women with obesity and GDM and to assess the impact of this pathology on pregnancy outcomes and the condition of the newborn.

Особенности метаболизма у женщин с преэклампсией, сочетающейся с гестационным сахарным диабетом

Objective of the Review: To summarize the proven prognostic and diagnostic criteria for gestational complications caused by a combination of gestational diabetes mellitus (GDM) and preeclampsia (PE). Key points. There is an analytical review of the modern paradigm of GDM and PE, their complications, as well as perinatal and long-term outcomes for mother and child. The data on clinical, anamnestic and laboratory risk factors of PE in GDM are systematized. A close relationship between the mechanisms of PE and GDM development — angiogenic imbalance and metabolic disorders in the placenta is described. Conclusion. GDM is recognized as an independent risk factor for the development of PE, and this risk is the greater the less GDM is compensated. Polycystic ovary syndrome and an increased body mass index as concomitant factors of metabolic disorders also increase the risk of developing PE. The supposed pathogenetic commonality of GDM and PE is the presence of oxidative stress and metaflammation, which increase insulin resistance and cause endothelial dysfunction. Keywords: preeclampsia, gestational diabetes mellitus, metabolism, risk factors, pathogenetic commonality.

Ранняя и поздняя формы задержки роста плода. Факторы риска и осложнения раннего неонатального периода

Objective. To study clinical and anamnestic risk factors for the development of complications during the early neonatal period in early- and late-onset fetal growth restriction (FGR). Patients and methods. This study included 92 patients: 40 with early-onset FGR and 52 with late-onset FGR. The age aspect, medical records, pregnancy and delivery characteristics, complications in the early neonatal period were examined in all patients. Results. Most patients with FGR had complicated somatic and obstetric/gynecological histories. Patients with early-onset FGR were more likely to have chronic arterial hypertension, spontaneous abortion, missed miscarriage, and uterine surgeries. In the first and second trimesters of pregnancy, only patients with early-onset FGR had elevated blood pressure. In the third trimester, patients with early-onset FGR were significantly more likely to develop pre-eclampsia and its complications than patients with late-onset FGR. Patients with early-onset FGR delivered earlier than patients with late-onset FGR, which affected the early neonatal period. Conclusion. The presence of hypertensive complications starting early in pregnancy and the results of biochemical screening tests should be considered as part of the prediction of FGR. Timely diagnosis, treatment and prevention of gestational complications will improve maternal and perinatal outcomes. Key words: gestational arterial hypertension, fetal growth restriction, late-onset fetal growth restriction, pre-eclampsia, earlyonset fetal growth restriction, chronic arterial hypertension

ВЛИЯНИЕ НОВОЙ КОРОНАВИРУСНОЙ ИНФЕКЦИИ НА ТЕЧЕНИЕ БЕРЕМЕННОСТИ И РОДОВ, А ТАКЖЕ ИХ ИСХОДЫ ДЛЯ МАТЕРИ И НОВОРОЖДЕННОГО (СИСТЕМАТИЧЕСКИЙ ОБЗОР)

Significance. COVID-19 is a potentially fatal infection, however data on its progression in pregnant women is currently limited. The most important issues remain the features of the COVID-19 progression in pregnant women, the impact of COVID-19 on the course of pregnancy, approaches to the treatment of pregnant women and their delivery, as well as the impact of a new coronavirus infection on the fetus, the study of which is an urgent task. Purpose: to summarize data on the impact of a new coronavirus infection on pregnancy and delivery, as well as its outcomes for the mother and newborn according to scientific publications by Russian and foreign authors. Material and methods. Relevant publications on COVID-19 progression in pregnant women, the COVID-19 impact on pregnancy, delivery and its outcomes for the mother and newborn were analyzed. The systematic review was conducted according to PRISMA guidelines using PICO(S) criteria. Results. According to data from early research, pregnant women with COVID-19 had a more severe course of the disease, higher risk of gestational complications, higher demand for intensive care in intensive care unit - 1.5% versus 0.9% in non-pregnant women, as well as artificial lung ventilation (1.7 times), although mortality in the groups of pregnant and non-pregnant did not differ equaling to 0.2%. Among possible risks of complications after COVID-19 infection the domestic and foreign literature names spontaneous miscarriages in the first and second trimesters of pregnancy, premature rupture of membranes, premature birth, birth of newborns of low weight for gestational age and prematurity, development of fetoplacental insufficiency, delayed fetal development due to lower utero-placental blood flow during COVID-19, exacerbation of chronic somatic conditions (diseases of the cardiovascular system, respiratory system, autoimmune processes, endocrine disorders), and postpartum bleeding. The COVID-19 effect on fetus is still the subject of numerous discussions and studies, there is evidence that women with COVID-19 have a higher risk of premature birth with all the consequences for the newborn. Conclusion. Physiological changes associated with pregnancy increase maternal susceptibility to infections in general, so the course of the disease may have its own characteristics during pregnancy. The new coronavirus infection is more severe in pregnant women with chronic diseases, obesity, arterial hypertension, and in older age groups. According to the data obtained, adverse outcomes include early and late spontaneous miscarriages, hemostasiological disorders in pregnant women and parturient women, fetoplacental insufficiency with fetal growth retardation, preterm delivery of newborns who are small for gestational age, and their prematurity with all the consequences.

Роль полиморфизмов генов-регуляторов артериального давления в патогенезе преэклампсии

Aim: To analyze the information presented in scientific publications on the role of polymorphic variants of genes responsible for the regulation of blood pressure (BP) in the pathogenesis of preeclampsia (PE). Key points. Genome-wide association studies conducted for PE confirms the multifactorial nature of its pathogenesis and demonstrates a number of BP regulator genes, polymorphic variants of which are associated with its development. A review of the literature showed that PE and diseases of the cardiovascular system have similar mechanisms of inheritance. Conclusion. The use of molecular genetic markers of PE opens up new opportunities for personalized prediction of this gestational complication and increase the effectiveness of preventive measures. Keywords: preeclampsia, blood pressure regulation genes, genetic polymorphisms, prognosis.

Obstetrics and perinatal outcomes between elective single versus double blastocyst transfer in women younger than 35 years: A cross-sectional study

IntroductionClinicians have a positive attitude towards multiple embryo transfer in in vitro fertilization (IVF) cycles, considering increased live birth rates compared to single embryo transfer. We aimed to evaluate obstetric and perinatal outcomes among young women who became clinically pregnant after single & double blastocyst transfer. Material-method545 women under 35 years who became clinically pregnant after fresh blastocyst transfer was evaluated retrospectively. The participants were divided11The participants divided into two groups according to.according to the transferred embryo number - the elective single blastocyst transfer group (eSBT) (n=112) and the double blastocyst transfer group (DBT group) (n=433). Obstetric and perinatal outcomes were recorded. ResultsLive birth and abortion rates per pregnancy and per gestational sac, having a fetus with congenital anomaly per pregnancy and per neonate, and gestational complications were comparable between the groups. Multiple pregnancy, Cesarean section, and admission to neonatal intensive care unit (NICU) and hospitalization day in NICU per neonate were higher in the DBT group than in the eSBT group. Mean gestational week, birth weight, birth height decreased with the embryo transfer number. ConclusionDBT transfer appears to be associated with increased multiple pregnancies, Cesarean section, prematurity, decreased fetal anthropometric measurements, and admission to NICU without an increase in live birth and abortion rates. Therefore, it will be easier for clinicians to choose eSBT by providing young couples undergoing IVF treatment with detailed information about multiple pregnancies and prematurity.

JMM Profile: Japanese encephalitis virus: an emerging threat.

Japanese encephalitis (JE) is an infection that occurs predominantly in Asia and the Pacific Islands. It is transmitted by mosquito bites, with the main vector being Culex tritaeniorhynchus, and is maintained in enzootic cycles involving pigs, wild birds and mosquitoes. JE is caused by infection with Japanese encephalitis virus (JEV), a zoonotic pathogen that also causes disease in mammals such as pigs and horses. In humans, most symptoms are mild or flu-like but can progress to encephalitis. Pigs are considered amplification hosts, and sows may have gestational complications. Horses may exhibit neurological signs. Detection of the virus can be confirmed by serological or molecular laboratory tests. Vaccination offers protection against JEV infection in humans, pigs and horses. Whilst there is no effective treatment of JE, human cases may require hospitalization for supportive therapy, which may include administration of fluids, oxygen and medication to treat symptoms.