Half Of Pregnancy In Women Research Articles

Vitamin D Status and Gestational Diabetes in Russian Pregnant Women in the Period between 2012 and 2021: A Nested Case-Control Study.

Several meta-analyses found an association between low maternal serum 25-hydroxyvitamin D (25(OH)D) level and gestational diabetes mellitus (GDM). However, some of them reported significant heterogeneity. We examined the association of serum 25(OH)D concentration measured in the first and in the second halves of pregnancy with the development of GDM in Russian women surveyed in the periods of 2012–2014 and 2018–2021. We conducted a case–control study (including 318 pregnant women) nested on two previous studies. In 2012–2014, a total of 214 women (83 GDM and 131 controls) were enrolled before 15 weeks of gestation and maternal serum 25(OH)D concentrations were measured twice: at 8th–14th week of gestation and simultaneously with two-hour 75 g oral glucose tolerance test (OGTT) at 24th–32nd week of gestation. In the period of 2018–2021, 104 women (56 GDM and 48 controls) were included after OGTT and 25(OH)D concentrations were measured at 24th–32nd week of gestation. Median 25(OH)D levels were 20.0 [15.1–25.7] vs. 20.5 [14.5–27.5] ng/mL (p = 0.565) in GDM and control group in the first half of pregnancy and 25.3 [19.8–33.0] vs. 26.7 [20.8–36.8] ng/mL (p = 0.471) in the second half of pregnancy, respectively. The prevalence rates for vitamin D deficiency (25(OH)D levels < 20 ng/mL) were 49.4% and 45.8% (p = 0.608) in the first half of pregnancy and 26.2% vs. 22.1% (p = 0.516) in the second half of pregnancy in women who developed GDM and in women without GDM, respectively. The frequency of vitamin D supplements intake during pregnancy increased in 2018–2021 compared to 2012–2014 (p = 0.001). However, the third trimester 25(OH)D levels and prevalence of vitamin D deficiency (25.5 vs. 23.1, p = 0.744) did not differ in women examined in the periods of 2012–2014 and 2018–2021. To conclude, there was no association between gestational diabetes risk and maternal 25(OH)D measured both in the first and in the second halves of pregnancy. The increased prevalence of vitamin D supplements intake during pregnancy by 2018–2021 did not lead to higher levels of 25(OH)D.

Oligohydramnion in the First Half of Pregnancy in the Fetuses with Congenital Abnormalities: Ultrasound Diagnostics and Obstetric Outcomes

Background.Oligohydramnion in the first half of pregnancy, combined with congenital abnormalities in the fetus has objective difficulties in diagnosis. The morphology features and type of defects associated with oligohydramnion, which manifests in the first half of pregnancy, are not sufficiently studied at the present stage.&#x0D; Aims to evaluate the clinical significance of diagnosing oligohydramnion in the first half of pregnancy in women with congenital fetal malformations.&#x0D; Materials and methods.The analysis of the course of pregnancy and perinatal outcomes in 77 women with low water content in combination with congenital malformations of the fetus and 72 patients with a normal amount of amniotic fluid and no congenital malformations of the fetus was performed. The patients of the main group were divided into two subgroups depending on the severity of oligohydramnion: the 1st subgroup (n = 54) patients with severe oligohydramnion and the 2nd subgroup (n = 23) patients with moderate oligohydramnion. The amount of amniotic fluid was determined by 3D/4D ultrasound (1321 weeks of gestation) and the structure of fetal abnormalities associated with oligohydramnion was analyzed. We evaluated perinatal outcomes in women with congenital malformations of the fetus in combination with oligohydramnion and the effect of its severity on the outcome of pregnancy.&#x0D; Results.In the main group (n = 77), fetal abnormalities were detected in patients: urinary system 39 (50.6%), respiratory system 4 (5.2%), heart 1 (1.3%), chromosomal and genetic abnormalities 14 (18.2%), central nervous system 3 (3.9%), osseous system 3 (3.9%), multiple 13 (16.9%). In the main group (n = 77), pregnancy was terminated for medical indications in 47 (61%) cases, in 6 (7.8%) spontaneous miscarriage occurred, in 5 (6.5%) antenatal fetal death. 19 (24.7%) children were born alive, and surgical treatment in the neonatal period was required in 8 (10.4%) cases. In the 1st subgroup (n = 54) in 53 (98.1%) cases, there was a loss of the fetus, in 1 (1.9%) the newborn died on the 9th day. In the 2nd subgroup (n = 23), fetal death occurred in 5 (21.7%) cases, 18 (78.3%) children were born alive, and 8 (44.4%) newborns were operated on in the neonatal period. In the control group, all pregnancies ended with the birth of healthy children. A decrease in ultrasound imaging of internal organs in the fetus was observed when a pregnant woman was obese (BMI more than 35).&#x0D; Conclusions.Oligohydramnion in the first half of pregnancy in combination with fetal malformation should be considered an extremely unfavorable clinical sign for the prognosis of pregnancy and the health of the fetus and newborn. 3D/4D ultrasound scanning allows you to reliably determine oligohydramnion in the first half of pregnancy, and the degree of its severity to assume the nature of complications.

Features of the second half of pregnancy in women with labor abnormalities

Aim: conduct a systematic analysis of pregnancy development, investigate clinical and laboratory data affecting development of labor abnormalities in women residing in the Belgorod region. Materials and Methods. From 2014 to 2018, 484 women were examined and divided into 2 groups: main group consisted of those who had childbirth complicated with labor abnormalities (n = 344), whereas control group consisted of women lacking complications during delivery (n = 140). The following methods were used in the study: questionnaires, general clinical methods, biochemical blood tests in pregnant and postpartum women, populational statistics as well as methods of standard and multivariate statistics. Results. In the second half of pregnancy in women with labor abnormalities revealed higher rate of moderate preeclampsia (34.30 ± 2.56 % vs. 10.71 ± 2.61%; p &lt; 0.05), polyhydramnios (11.34 ± 1.71 % vs. 5.71 ± 1.96 %; p &lt; 0.05), chronic intrauterine hypoxia (29.6 ± 2.46 % vs. 12.86 ± 2.83 %; p &lt; 0.05), chronic utero-placental insufficiency (60.47 ± 2.64 % vs. 20.00 ± 3.38 %; p &lt; 0.05), sexually transmitted infections (3.78 ± 1.03 % vs. 0.71 ± 0.71 %; p &lt; 0.05), acute respiratory viral infection (8.72 ± 1.52 % vs. 3.57 ± 1.57 %; p &lt; 0.05) as well as a combination of several types of pathology (8.72 ± 1.52 % vs. 13.57 ± 2.89 %; p &lt; 0.05). Laboratory parameters in women with labor abnormalities compared with control antepartum group were noted to have significantly decreased count of red blood cells (3.89 ± 0.38×1012/L vs. 3.99 ± 0.40×1012/L; p = 0.006), eosinophils (0.95 ± 0.69×109/L vs. 1.20 ± 0.67×109/L; p = 0.026) and platelets (226.29 ± 62.71×109/L vs. 245.44 ± 60.32×109/L; p = 0.0003). Blood biochemical parameters in women with labor abnormalities vs. control group were featured with significantly decreased level of bilirubin (6.76 ± 3.16 μmol/L vs. 9.88 ± 3.60 μmol/L; p &lt; 0.05) and alanine aminotransferase (13.94 ± 10.08 U/L vs. 19.41 ± 14.40 U/L; p = 0.004). Analyzing coagulation parameters in the main group showed significantly reduced fibrinogen level (4.30 ± 1.00 g/L) compared with control group (4.71 ± 1.14 g/L; p &lt; 0.05) as well as elevated international normalized ratio (1.07 ± 0.11 vs. 1.03 ± 0.10; p = 0.001). Conclusion. Our study data found that pregnant women with labor abnormalities had altered clinical and laboratory parameters observed as early as in the second half of gestation, which may be used to calculate an individual risk of such labor complication.

Para-occupational exposure to pesticides, PON1 polymorphisms and hypothyroxinemia during the first half of pregnancy in women living in a Mexican floricultural area

BackgroundAdequate maternal thyroxine (T4) concentrations during the first half of pregnancy are fundamental to the embryo’s or fetus’ neural development. Organophosphate pesticides (OP) can act as thyroid disruptors and genetic polymorphisms for paraoxonase 1 (PON1), an enzyme that detoxifies OP, could be involved in individual’s susceptibility to them. We assessed the association between para-occupational exposure to pesticides, including OP, during pregnancy and maternal hypothyroxinemia, as well as the potential genetic susceptibility conferred by PON1 polymorphisms.MethodsWe analyzed information from 381 healthy pregnant women (< 17 gestational weeks), who lived in a floricultural region of Mexico where pesticides, including OP, are routinely used. Women who were para-occupationally exposed to pesticides were those whose partner had an occupation involving contact with these products. Thyroid-Stimulating Hormone (TSH) and free T4 concentrations were determined using ELISA, and hypothyroxinemia was defined as free T4 concentrations <0.76 ng/dL. PON1192QR, PON155LM and PON1–108CT polymorphisms were determined through Polymerase Chain Reaction (PCR). The association between para-occupational exposure and genetic polymorphisms and hypothyroxinemia was estimated using logistic regression models.ResultsOne hundred and sixty two women (42.52%) were classified as para-occupationally exposed to pesticides. Hypothyroxinemia prevalence was 54%, and it was not significantly associated with pesticide para-occupational exposure (OR: 1.21 95% CI 0.75–1.94). Independently of para-occupational exposure, the likelihood of hypothyroxinemia was higher among women who were carriers of PON155MM than in those with PON155LL genotype (OR MM vs LL: 3.03; 95%CI 1.62, 5.70). PON1192 RR (OR RR vs QQ: 1.72; 95%CI 0.93, 3.17) and PON1–108TT (OR TT vs CC: 1.60; 95%CI 0.90, 2.70) genotypes were marginally associated with hypothyroxinemia. No significant interaction was observed between pesticides para-occupational exposure and PON1 polymorphisms.ConclusionsThese results suggest that PON1 polymorphisms could affect thyroid function during pregnancy in women living in areas where pesticides, including OP, are routinely used. Low exposure variability in this population, could be a possible explanation for the lack of association between para-occupational exposure and thyroid function.

FEATURES OF LABOUR AND POSTPARTUM PERIOD IN WOMEN WITH ADENOMYOSIS

Objective: the aim of the study was to investigate features of the course of labor and postpartum period in women with adenomyosis, to improve existing and develop new methods of treatment and prevention of obstetric complications and reproductive losses in pregnant women with adenomyosis.Patients and methods: 90 pregnant women in 30-31 weeks of gestation were divided into groups: 30 healthy women (control group), a comparison group of 30 pregnant women with adenomyosis receiving traditional progesterone therapy and the main group of 30 women with adenomatosis, who received advanced prgesterne therapy, diet therapy, psychological support, sedative naturopathic therapy; the state of the blood coagulation system was studied; vaginal biota examination and treatment were performed. The data of laboratory parameters, questionnaires, ultrasound diagnostics were analyzed.Results: on the background of the proposed treatment, the study revealed a significant reduction in the occurrence of IUGR, placental dysfunction, polyhydramnion, prenatal infections, premature rupture of amniotic membranes, preterm labor and hemodynamic disorders in the main group compared to the comparison group. The index of stress resistance has increased, cortisol levels decreased. Significantly fewer injuries of soft tissues occurred in labour. Violation of the fetus condition in labour was noticed much less frequently. The level of hypogalactia in the main group comparing the comparison group is lower.Conclusions: the results of the conducted studies indicate the negative impact of adenomyosis on the state of reproductive health of women. The proposed algorithm of diagnostic, treating and preventive measures can reduce the frequency of various obstetric complications in the second half of pregnancy in women with adenomyosis and can be widely implemented.

Are neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and/or mean platelet volume (MPV) clinically useful as predictive parameters for preeclampsia?

Objective: Preeclampsia (PE) is a severe pregnancy complication with significant maternal and neonatal morbi–mortality resulting in high health care costs. Prevention, mainly based on the administration of acetylsalicylic acid, is only possible if timely identification of high-risk patients can be realized in an easy, nonexpensive, and widely available method. This paper explores the clinical usability of neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and/or mean platelet volume (MPV) in discriminating between women that will and those that will not develop PE.Study design: Demographic data and laboratory results were retrospectively collected and compared in 2050 pregnant women (164 PE and 1886 controls) between 1 January 2014 and 31 January 2016.Results: In the PE group, gravidity, parity, gestational age, and birth weight were significantly lower compared to the control group. Before the 20th pregnancy week, MPV was significantly elevated in the PE group compared to the controls (p = .006), hence analysis revealed an optimal cut-off point of 8.15 (sensitivity 66.7%, specificity 56.3%) for predicting PE. At the end of pregnancy, NLR and MPV appeared to be higher and PLR lower in the PE group compared to the controls, which strengthens the current knowledge on the pathogenesis of PE.Conclusions: MPV is significantly elevated in the first half of pregnancy in women who later develop PE and might therefore be implemented in combination with other parameters in a PE prediction model.

Intra-individual variability in TSH levels of healthy women during the first half of pregnancy

ObjectiveTSH is the parameter most widely accepted to assess thyroid function, especially in pregnant women. The aim of this current study was to analyze intra-individual changes in TSH during the first half of pregnancy in women with TSH levels higher than 2.5mIU/L in early pregnancy. MethodsAn observational, prospective study was conducted on 243 healthy pregnant women in the first trimester of pregnancy. Thyroid function was assessed by testing TSH and free T4 levels. A subgroup of women with TSH levels >2.5mIU/L underwent additional tests (TSH, free T4, peroxidase antibodies). Information on dietary iodine intake and/or iodine supplements was also recorded. ResultsMean TSH level was 1.89mIU/L (range 0.024–6.48mIU/L), and mean FT4 level was 1.19ng/dL (range 0.80–1.90ng/dL). Fifty-eight women (23.8%) had TSH levels>2.5mIU/L in the first trimester of pregnancy, and additional thyroid function tests were performed in 27 women. TSH levels significantly decreased from the first to the second test (3.59±0.92mIU/L vs 2.81±1.06mIU/L respectively; p<0.01), and the decrease was significantly greater in pregnant women who used iodized salt as compared to those who did not (1.16±0.65mIU/L vs 0.19±0.93mIUI/L respectively; p<0.01). A positive correlation was found between the time elapsed to the second measurement (24.3±17.2 days; range 8–58) and the decrease in TSH levels (r=0.40; p=0.038). ConclusionTSH levels showed a continuous, uniform decrease during the first half of pregnancy in women with values slightly above the normal range. Pregnant women who used iodized salt were more likely to have decreased TSH levels in a second test.

Intra-individual variability in TSH levels of healthy women during the first half of pregnancy

ObjectiveTSH is the parameter most widely accepted to assess thyroid function, especially in pregnant women. The aim of this current study was to analyze intra-individual changes in TSH during the first half of pregnancy in women with TSH levels higher than 2.5mIU/L in early pregnancy. MethodsAn observational, prospective study was conducted on 243 healthy pregnant women in the first trimester of pregnancy. Thyroid function was assessed by testing TSH and free T4 levels. A subgroup of women with TSH levels >2.5mIU/L underwent additional tests (TSH, free T4, peroxidase antibodies). Information on dietary iodine intake and/or iodine supplements was also recorded. ResultsMean TSH level was 1.89mIU/L (range 0.024–6.48mIU/L), and mean FT4 level was 1.19ng/dL (range 0.80–1.90ng/dL). Fifty-eight women (23.8%) had TSH levels>2.5mIU/L in the first trimester of pregnancy, and additional thyroid function tests were performed in 27 women. TSH levels significantly decreased from the first to the second test (3.59±0.92mIU/L vs 2.81±1.06mIU/L respectively; p<0.01), and the decrease was significantly greater in pregnant women who used iodized salt as compared to those who did not (1.16±0.65mIU/L vs 0.19±0.93mIUI/L respectively; p<0.01). A positive correlation was found between the time elapsed to the second measurement (24.3±17.2 days; range 8–58) and the decrease in TSH levels (r=0.40; p=0.038). ConclusionTSH levels showed a continuous, uniform decrease during the first half of pregnancy in women with values slightly above the normal range. Pregnant women who used iodized salt were more likely to have decreased TSH levels in a second test.

Relationship between TSH and pregnancy outcomes during the first half of pregnancy in women

A total of 352 pregnant women were selected in Affiliated Hospital of Qingdao University. Serum levels of TSH and FT4 were determined and pregnancy outcome were observed in all subjects. According to the standard of American Thyroid Association(ATA)published in 2011 and the Chinese Guideline of Gestation Thyroid Disease published in 2012, the subjects were grouped into control(0.1≤TSH≤2.5 mIU/L), observation(2.5 5.17 mIU/L)during first-trimester(T1)and control(0.2≤TSH≤3.0 mIU/L), observation(3.0 5.22 mIU/L)during second-trimester(T2). The results showed that the rupture of membranes, preterm labor, and total obstetrical adverse events in the observation group were significantly higher than those in control group during T1(all P<0.05), no statistical significance between control group and treatment group. The rupture of membrances in the observation group was significantly higher compared with control group during T2(P<0.05), no significant difference in other adverse pregnancy outcomes between these two groups. Compared with control group during T1, the proportion of adverse pregnancy outcomes in observation group during T1 was significantly increased(P<0.05). The elevated TSH is one of the risk factors for the increased incidence of adverse pregnancy outcomes at the first half of pregnancy, especially during T1. L-T4 treatment reduces the incidence of adverse pregnancy outcomes. (Chin J Endocrinol Metab, 2017, 33: 52-55) Key words: The first half of pregnancy; TSH; Pregnancy outcomes

Implementation of the sFlt-1/PlGF ratio for prediction and diagnosis of pre-eclampsia in singleton pregnancy: implications for clinical practice.

Implementation of the sFlt-1/PlGF ratio for prediction and diagnosis of pre-eclampsia in singleton pregnancy: implications for clinical practice.

Second‐trimester fetal aberrant right subclavian artery: original study, systematic review and meta‐analysis of performance in detection of Down syndrome

First, to estimate the prevalence of fetal aberrant right subclavian artery (ARSA) in our population and its association with Down syndrome. Second, to determine the feasibility of ultrasound to visualize ARSA in the three planes. Finally, to carry out a systematic review of the literature on the performance of second-trimester ARSA to identify fetuses with Down syndrome. ARSA was assessed by ultrasound in the axial plane and confirmed in the longitudinal and coronal planes during the second half of pregnancy in women attending our unit (from February 2011 to December 2012). A search of diagnostic tests for the assessment of ARSA was carried out in international databases. Relevant studies were subjected to a critical reading, and meta-analysis was performed with Meta-DiSc. Of the 8781 fetuses in our population (mean gestational age: 24 ± 5.4 weeks), 22 had Down syndrome. ARSA was detected in the axial view in 60 cases (0.7%) and confirmed in the coronal view in 96.7% and in the longitudinal view in 6.7% (P < 0.001). Seven cases with ARSA had Down syndrome and all were in the non-isolated-ARSA group. The estimates of positive likelihood ratio (LR) were 0 for isolated ARSA and 199 (95% CI, 88.9-445.2) for non-isolated ARSA. In the systematic review, six studies were selected for quantitative synthesis. The pooled estimates of positive and negative LRs for global ARSA were, respectively, 35.3 (95% CI, 24.4-51.1) and 0.75 (95% CI, 0.64-0.87). For isolated ARSA, the positive and negative LRs were 0 (95% CI, 0.0-14.7) and 0.98 (95% CI, 0.94-1.02), respectively. The prevalence of ARSA seems close to 1%. The coronal plane is the most suitable for its confirmation after detection in the axial plane. Detection of isolated or non-isolated ARSA should guide decisions about karyotyping given that isolated ARSA shows a weak association with Down syndrome.

Reply To: Caring for Reproductive-aged Women with Spinal Cord Injuries: A Case Report. Obstet Med 2012;5: 133-4.

I thank Doctors Ward and Walker for their case report and review on ‘Caring for reproductive-aged women with spinal cord injuries (SCI)’ (Obstet Med 2012;5:133-4). One element of impaired pulmonary function in subjects with SCI which merits particular consideration in pregnancy is the high prevalence of obstructive sleep apnoea (OSA) and nocturnal hypoxia. A short-term longitudinal study of subjects with an acute SCI level T12 and above found a 75% prevalence of OSA on polysomnography six months post SCI.1 There was no correlation between the severity of OSA and the level and completeness of SCI, and importantly subjects were relatively asymptomatic. Several studies have demonstrated a similarly high prevalence of OSA chronically after SCI.2, 3 In addition subjects with cervical SCI may develop hypoventilation with hypoxia and hypercapnia, especially during sleep, due to restrictive ventilatory impairment.4 OSA in pregnancy is associated with significantly increased risks of low birthweight, preterm birth, small for gestational age infants, caesarean section and pre-eclampsia.5 Overnight pulse oximetry and polysomnography should be considered in all women with SCI prior to conception. In addition overnight oximetry should be performed in the second half of pregnancy in women with cervical SCI given the effect of the gravid uterus on lung function and the possibility of pre-existing impairment of ventilatory reserve.

245: Can a hemoglobin A1C value obtained in the first half of pregnancy in women with gestational diabetes mellitus predict the postpartum diagnosis of overt diabetes mellitus?

245: Can a hemoglobin A1C value obtained in the first half of pregnancy in women with gestational diabetes mellitus predict the postpartum diagnosis of overt diabetes mellitus?

EXPOSURE TO BISPHENOL A DURING PREGNANCY AND MATERNAL AND NEONATAL THYROID HORMONE LEVELS

Background and Aims: Bisphenol A (BPA) is widely used in the manufacture of polycarbonate bottles, food packaging, can linings, and dental sealants. High detection frequencies in numerous environmental and human specimens indicate that BPA is a widespread contaminant. Animal and in vitro studies suggest that BPA may disrupt thyroid hormone (TH) but little human data are available, particularly in pregnant women and neonates. Normal thyroid function during these critical developmental periods is essential for normal brain development. Our aim was thus to determine whether maternal exposure to BPA is related to thyroid hormone levels in pregnant women and neonates. Methods: We measured BPA in urine samples collected during the first and second half of pregnancy in women participating in the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS). Pregnant women who were &gt;=18 years, &lt;20 weeks gestation, English or Spanish speaking, and qualified for Medicaid (health insurance for low-income families) were eligible for participation in the study. Free thyroxine (T4), total T4 and thyroid-stimulating hormone (TSH) was measured in 339 maternal serum samples obtained at ~27 weeks’ gestation. Neonatal TSH levels were abstracted from medical records (n=371). Results: The median BPA urinary concentration was lower in CHAMACOS women (1.1 µg/L) than in the general U.S. population (2.8 µg/L). Preliminary analyses suggest that every 10-fold increase in maternal BPA urinary concentration in the second, but not the first, half of pregnancy was associated with a 0.5 µg/dL decrease in total T4 (95%CI=-1.0, -0.1) after controlling for confounders. Associations were stronger when BPA was measured closer in time to total T4. BPA urinary concentrations were not associated with maternal free T4 or TSH, or with neonatal TSH. Conclusion: Maternal exposure to BPA was inversely associated with total T4 during pregnancy. Findings may have implications for fetal brain development.