Group Of Healthy Pregnant Women Research Articles

Optical coherence tomography angiography assessment of retinochoroidal microcirculation differences in preeclampsia

BackgroundTo investigate microvascular changes in pregnant women with preeclampsia using optical coherence tomography angiography (OCTA) and compare the results with healthy pregnant and non-pregnant subjects. MethodsSuperficial capillary plexus (SCP), deep capillary plexus (DCP) choriocapillaris (CC) vessel density (VD) and foveal avascular zone area (FAZ), retina, retinal nerve fiber layer (RNFL), the ganglion cell layer (GCL) and the choroidal thickness were examined and compared in preeclamptic pregnant (group 1), healthy pregnant women (group 2) and non-pregnant, age-matched female controls (group 3). The correlations of the parameters with each other and with blood pressure were evaluated. ResultsNo significant difference was found between the groups when retinal, RNFL and GCL thickness values (p> 0.05). The choroidal thickness values were significantly lower in group 1 than in group 2 (p = 0.029). The central foveal VD of the SCP and DCP was significantly lower in group 1 compared to groups 2 and 3 (p = 0.03, p< 0.01 respectively). The mean VD of the SCP was significantly higher in groups 1 and 2 than in group 3 (p = 0.01). The FAZ area was statistically significantly lower in group 3 than in group 2 (p = 0.032). The CC VD was lower in group 3 compared to the other groups in all measurements (p < 0.01).The FAZ area was positively correlated with systolic blood pressure in group 1. ConclusionThe use of OCTA, a non-invasive imaging technique, to assess the retinal microcirculation appears to have the potential to in the early diagnosis or follow up in preeclampsia before signs of hypertensive retinopathy.

Serum CYFRA21–1 and SCC-Ag levels in women during pregnancy and their diagnostic value for cervical cancer

ObjectivesThe incidence of cervical cancer increases every year during pregnancy. Cervical cytology in pregnant women has a unique morphology and liquid-based cytology methods are prone to cause false positives. The aim of this study was to investigate the serum cytokeratin 19 fragment antigen 21–1 (CYFRA21–1) and squamous cell carcinoma associated antigen (SCC-Ag) concentrations in healthy pregnant women during pregnancy and to assess their diagnostic value for cervical cancer in pregnancy. MethodsIn this prospective study, 165 healthy non-pregnant women, 441 healthy pregnant women and 22 patients with cervical cancer in pregnancy were recruited. The healthy pregnant women group included 143 women in the first trimester (T1), 147 in the second (T2) and 151 in the third (T3). ResultsBoth SCC-Ag and CYFRA21–1 levels were significantly different in the healthy pregnant women group compared to the control group. The CYFRA21–1 and SCC-Ag were higher in the T1 and T3 than in the control groups. However, there was no statistically significant difference in serum CYFRA21–1 and SCC-Ag levels in the T2 group compared to the control group. The AUCs of CYFRA21–1, SCC-Ag and CYFRA21–1 combined with SCC-Ag were 0.674, 0.792, and 0.805, respectively. The cut-off values of CYFRA21–1 and SCC-Ag were 6.64 ng/mL and 1.75 ng/mL, respectively. ConclusionsSerum CYFRA21–1 and SCC-Ag levels were higher in pregnant women during early and late pregnancy compared to non-pregnant individuals, while they were not statistically different from non-pregnant women during mid-trimester. CYFRA21–1 and SCC-Ag have diagnostic value for cervical cancer in pregnancy.

B-cell-activating factor (BAFF) and platelet-activating factor (PAF) in pregnancies complicated by maternal obesity and diabetes: a preliminary study

Objective In pregnancies complicated by maternal obesity and diabetes, a disruption in inflammatory mediators occurs, resulting in endothelial microvascular dysfunction, oxidative stress, tissue damage, and maternal and feto-neonatal complications. To outline this proinflammatory status, an innovative approach is represented by the measurement of proinflammatory cytokines. Among these biomarkers, B-cell-activating factor (BAFF) and platelet-activating factor (PAF) play a key role in metabolic regulation, immune response to infections, tissue homeostasis, and “food-related inflammation.” The aim of the present study is to investigate the blood expression of BAFF and PAF in a cohort of pregnant women affected by obesity and diabetes compared with a control group of healthy pregnant women. Methods A prospective longitudinal cohort study has been conducted on pregnant women referred to Fondazione Policlinico Universitario Gemelli IRCCS in Rome. For each pregnant woman, a capillary sample was collected with a swab in three different consecutive evaluations carried out in the three trimesters of pregnancy. Results A total of 77 pregnant women have been enrolled. No significant differences in BAFF and PAF levels were longitudinally observed between groups. Focusing on the exposed group, in the third trimester of pregnancy, both PAF and BAFF levels were lower than the basal time. Among the selected group of patients who developed Gestational Diabetes, only PAF values were longitudinally lower when compared to other groups. The multivariate analysis showed that BAFF levels were positively correlated with thyroid-stimulating hormone levels. No macrosomia, no shoulder dystocia, no major perineal lacerations at birth, and no intrauterine growth restriction were observed in the whole population. Conclusions This study supports the involvement of metabolic and proinflammatory biomarkers in the mechanisms related to pregnancy complications. Improving a good metabolic environment for obese and diabetic pregnant women could break the vicious cycle connecting inflammation, oxidative stress, and metabolic disorders.

Does diabetes mellitus affect the development of fetal brain structures and spaces including corpus callosum, subarachnoid space, insula, and parieto-occipital fissure?

We investigated the impact of pregestational and gestational diabetes mellitus (PGDM and GDM) on the development of fetal intracranial structures and spaces. This prospective cross-sectional study involved singleton pregnancies between 20 and 32 weeks of gestation. The study comprised a control group (n = 65) of healthy pregnant women without diabetes mellitus (DM); a PGDM group (n = 43) of pregnant women having type 2 DM in a controlled diabetic state; and a GDM group (n = 26) of pregnant women with GDM diagnosed with 2-h 75-g oral glucose tolerance test and received intervention to reduce the diabetic impact on fetus. During neurosonographic evaluation, the simultaneous measurements of corpus callosum (CC) width and depth in the midsagittal image; and lateral craniocortical and posterior craniocortical widths of the subarachnoid space and insular and parieto-occipital fissure depths in the axial image were performed. Before statistical analysis, these values were carefully adjusted for the occipitofrontal diameter. The DM groups displayed substantially higher frequencies of family history of DM and obstetric history of GDM compared to the control group (p < 0.05). Regarding the neurosonographic parameters, the CC length and insular and parieto-occipital fissure depths were significantly increased in the GDM group but not in the PGDM group (p < 0.05). No significant difference was found among the study groups regarding other neurosonographic parameters (p > 0.05). The results of neurosonographical evaluation of fetal brain structures and spaces reveal that diabetic impact may not be seen in the presence of PGDM, especially in pregnant women receiving prenatal interventions to reduce or avoid diabetic adverse effects on fetal brain development. The effect of GDM on neurosonographically assessed fetal brain development should be evaluated in further studies with subjects matched for gestational weeks and antenatal care conditions.

Th17 / Treg ratio: A prospective study in a group of pregnant women with preeclampsia and fetal growth restriction

IntroductionDuring pregnancy, the maternal immune system is challenged to tolerate a semi-allogenic fetus. A proinflammatory profile has been linked to adverse pregnancy outcomes and poor placental development. In this study, the authors evaluated the number of circulating Tregs and Th17 cells in a group of patients diagnosed with preeclampsia(PE) and fetal growth restriction(FGR). MethodsProspective longitudinal observational study where peripheral blood lymphocyte subsets were analyzed in a cohort of pregnant patients with PE, FGR, and a control group of healthy pregnant women. ResultsThe diagnosis of PE was associated with a significative higher number of circulating Th17 cells and a significative relative reduction in the Treg cell count. This proinflammatory profile was also expressed in the evolution of the Th17/ CD4+CD25highFOXP3+ Treg ratio. In the FGR group, the Th17 cell count was significantly higher during the third trimester of pregnancy. This proinflammatory profile was also expressed in the evolution of the Th17/ CD4+CD25highFOXP3+ Treg ratio. When we compare the immunological profiles of patients with PE and FGR we observed a higher number of proinflammatory Th17 cells and a significative lower number of Treg cells in PE patients. This is particularly expressed in the differences found between the Th17/ CD4+CD25highFOXP3+ Treg ratios of these two groups.Discussion/ConclusionOur data showed a that a proinflammatory profile and a relative excess of Th17 cells was associated with the diagnosis of PE and FGR. A more exuberant systemic proinflammatory profile present in the PE patients is absent in patients with FGR without preeclampsia

On the distinct differences in autonomic regulation between pregnant and non-pregnant women - a heart rate variability analysis

Objective. Appropriate adaptation of the maternal autonomic nervous system to progressing gestation is essential to a healthy pregnancy. This is partly evidenced by the association between pregnancy complications and autonomic dysfunction. Therefore, assessing maternal heart rate variability (HRV)—a proxy measure for autonomic activity—may offer insights into maternal health, potentially enabling the early detection of complications. However, identifying abnormal maternal HRV requires a thorough understanding of normal maternal HRV. While HRV in women of childbearing age has been extensively investigated, less is known concerning HRV during pregnancy. Subsequently, we investigate the differences in HRV between healthy pregnant women and their non-pregnant counterparts. Approach. We use a comprehensive suite of HRV features (assessing sympathetic and parasympathetic activity, heart rate (HR) complexity, HR fragmentation, and autonomic responsiveness) to quantify HRV in large groups of healthy pregnant (n = 258) and non-pregnant women (n = 252). We compare the statistical significance and effect size of the potential differences between the groups. Main results. We find significantly increased sympathetic and decreased parasympathetic activity during healthy pregnancy, along with significantly attenuated autonomic responsiveness, which we hypothesize serves as a protective mechanism against sympathetic overactivity. HRV differences between these groups typically had a large effect size (Cohen’s d > 0.8), with the largest effect accompanying the significantly reduced HR complexity and altered sympathovagal balance observed in pregnancy (Cohen’s d > 1.2). Significance. Healthy pregnant women are autonomically distinct from their non-pregnant counterparts. Subsequently, assumptions based on HRV research in non-pregnant women cannot be readily translated to pregnant women.

279. Maternal Infection by SARS CoV2 and Clinical Repercussion of the Newborn.

Abstract Background Pregnancy confers a higher risk of complications in SARS CoV2 disease as well as in the neonatal stage. Physiological and immunological changes during pregnancy predispose women to have complications in all the respiratory variations and increase maternal-fetal mortality and morbidity; The role of SARS CoV2 infection in newborns of mothers positive for COVID-19 was evaluated, analyzing the clinical consequences in the pregnant patient and the impact on the newborn. Methods Descriptive, observational, retrospective study. All pregnant patients with a positive PCR test for SARS CoV2 and newborns treated at the Spanish Hospital, in the period from March 2020 to March 2021, were included, the information provided was collected from the medical history. Results We recorded the cases of pregnant patients treated at the Spanish Hospital in the period from March 2020 to March 2021. The population was divided into those with a positive and negative PCR test for SARS Cov2. A total of 561 cases were registered, 35 positive cases for SARS Cov2; positive patients reported a higher presentation of Preeclampsia than patients without infection (p 0.009). The percentage of preterm products in mothers with infection was higher by 20% vs 12%; with the highest number of advanced neonatal resuscitation events. SARS Cov2 infection conditions the presentation of pathologies such as preeclampsia in pregnant women and an increase in preterm birth. Conclusion In this study we conclude, comparing with the group of healthy pregnant women with no history of COVID-19, that the products of mothers with a history of SARS CoV2 infection represent a higher risk of prematurity coupled with the risk of other pathologies such as preeclampsia, also in the period neonatal patients required greater support with oxygen, however the rate of severe complications in the newborn is unlikely. The role of maternal protection such as isolation, hygiene and vaccination measures are priority tools to reduce these perinatal pathologies and the risk of contagion. Disclosures All Authors: No reported disclosures.

Evaluation of Serum Selenium Level, Quality of Sleep, and Life in Pregnant Women With Restless Legs Syndrome.

Restless legs syndrome (RLS) is a multifactorial disease that patients describe as restlessness in their legs, which creates a desire to move their legs, especially in the evening and at rest. This study aims to investigate serum selenium levels in RLS and document the quality of sleep and life in pregnant women with RLS according to International Restless Legs Syndrome Study Group (IRLSSG) diagnostic criteria. Thirty-eight moderate to severe RLS patients with pregnancy at 38-41weeks of gestation were determined as the case group, and 38 women with healthy gestational age-matched pregnancies were determined as the control group. Maternal serum selenium levels were compared between the RLS case group and the group of healthy pregnant women at the time of hospitalization for delivery. The Pittsburgh Sleep Quality Index (PSQI) and The Quality of Life Scale (SF-36) were applied to the patients. The mean selenium level (µg/L) was statistically significantly lower in the RLS group (53.24 ± 10.28), compared to the healthy pregnant population (58.95 ± 11.29) (P = 0.024). The PSQI score was significantly higher in the RLS case group (P = 0.033). Especially sleep efficiency (P = 0.018) and daytime dysfunction (P = 0.032) sub-parameters were affected. The SF-36 questionnaire was examined and a significant difference was detected between the two groups in role emotional (P = 0.026), social functioning (P = 0.023), and body pain (P = 0.044) sub-parameters. Serum selenium level was significantly lower, the sleep quality of the RLS group was impaired and their quality of life was affected in pregnant women with RLS. Further studies are needed to determine whether selenium replacement in pregnant women with RLS is feasible or not.

THE ROLE OF OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN PATIENTS WITH PREECLAMPSIA.

To investigate the changes in the microvascular structure of the retina and optic disk by comparing the optical coherence tomography angiography findings in preeclamptic patients with those in healthy pregnant women and healthy nonpregnant women and also to evaluate the preeclamptic patients after delivery by showing whether the changes are permanent or not. Fifty preeclamptic, 50 healthy pregnant, and 50 healthy nonpregnant women enrolled in three groups (preeclamptic pregnant women group, healthy pregnant women group, and nonpregnant women group; respectively). Patients in the preeclamptic pregnant women group were evaluated at three different time points including up to 3 hours before delivery (Group 1), 2, or 3 days after delivery (Group 2), and 6 weeks after delivery (Group 3), and compared with each other. All patients underwent a comprehensive ophthalmologic examination including optical coherence tomography angiography. Choriocapillaris blood flow area, deep foveal density, deep temporal density, deep nasal density, and radial peripapillary capillary inside disk density values were significantly lower in the preeclamptic pregnant women group than in the healthy pregnant women group. Deep foveal density and deep nasal density values were significantly higher in Group 3 than in Group 1 and 2, and deep temporal density was significantly higher in Group 3 than in Group 1. Optical coherence tomography angiography diagnosed decreased deep retinal capillary density values in the macula of patients with preeclampsia, but these results improved after delivery.

Construction of machine learning tools to predict threatened miscarriage in the first trimester based on AEA, progesterone and β-hCG in China: a multicentre, observational, case-control study

BackgroundEndocannabinoid anandamide (AEA), progesterone (P4) and β-human chorionic gonadotrophin (β-hCG) are associated with the threatened miscarriage in the early stage. However, no study has investigated whether combing these three hormones could predict threatened miscarriage. Thus, we aim to establish machine learning models utilizing these three hormones to predict threatened miscarriage risk.MethodsThis is a multicentre, observational, case-control study involving 215 pregnant women. We recruited 119 normal pregnant women and 96 threatened miscarriage pregnant women including 58 women with ongoing pregnancy and 38 women with inevitable miscarriage. P4 and β-hCG levels were detected by chemiluminescence immunoassay assay. The level of AEA was tested by ultra-high-performance liquid chromatography-tandem mass spectrometry. Six predictive machine learning models were established and evaluated by the confusion matrix, area under the receiver operating characteristic (ROC) curve (AUC), accuracy and precision.ResultsThe median concentration of AEA was significantly lower in the healthy pregnant women group than that in the threatened miscarriage group, while the median concentration of P4 was significantly higher in the normal pregnancy group than that in the threatened miscarriage group. Only the median level of P4 was significantly lower in the inevitable miscarriage group than that in the ongoing pregnancy group. Moreover, AEA is strongly positively correlated with threatened miscarriage, while P4 is negatively correlated with both threatened miscarriage and inevitable miscarriage. Interestingly, AEA and P4 are negatively correlated with each other. Among six models, logistic regression (LR), support vector machine (SVM) and multilayer perceptron (MLP) models obtained the AUC values of 0.75, 0.70 and 0.70, respectively; and their accuracy and precision were all above 0.60. Among these three models, the LR model showed the highest accuracy (0.65) and precision (0.70) to predict threatened miscarriage.ConclusionsThe LR model showed the highest overall predictive power, thus machine learning combined with the level of AEA, P4 and β-hCG might be a new approach to predict the threatened miscarriage risk in the near feature.

Clinical comparison of antioxidant for pregnant women with iron deficiency anemia

The aim of this study was to study the evaluation of serum antioxidation in pregnant women with iron deficiency anemia by measuring to measure some antioxidant parameters including: ceruloplasmin (Cp), copper (Cu) and transferrin (Tf) levels in pregnant women with iron deficiency anemia. Blood samples were obtained from (80) pregnant women with anemia divided according to the stage of pregnancy and iron deficiency as follows: 1) Twenty patients in the second trimester with anemia without iron deficiency; 2) Twenty patients in the second trimester with anemia with iron deficiency; 3) Twenty patients In the third trimester with anemia without iron deficiency; 4) Twenty patients in the third trimester have anemia with iron deficiency. In addition, a control group of (40) healthy pregnant women was used. Twenty pregnant in the second trimester and 20 pregnant in the third trimester were divided into two groups. Results: The results show a presence of a significant increase in Cp, Cu and Tf in all groups of patients with Iron deficiency in comparison with control group.

Features of the treatment of bacterial vaginosis during pregnancy

Introduction. The prevalence of bacterial vaginosis (BV) in the population ranges from 12 to 80% and depends on the cohort of examined women. Of the total confirmed cases, 37-40% are pregnant women.Aim. To assess the effectiveness of the treatment of bacterial vaginosis (BV) in pregnant women.Materials and methods. The study included 43 women at 22 to 30 weeks' gestation, divided into two groups: the treatment group consisted of 30 pregnant women diagnosed with BV, the control group comprised 13 pregnant women with normal vaginal microbiocenosis. To determine the antimicrobial activity of vaginal epithelium, samples of vaginal discharge were examined. The treatment was carried out using clindamycin according to the following regimen: 100 mg intravaginally per day at bedtime for 3 days.Results. The study results showed that the highest activity of antimicrobial peptides (AMP) was found in the group of healthy pregnant women, which accounted for 79.1%. In pregnant women with BV, the level of antimicrobial activity significantly decreased as compared with the group of healthy pregnant women as the severity of the disease increased, amounting to 44.5% in women with mild BV, 36.4% in women with moderate BV and 33.6% in women with severe BV. The level of antimicrobial activity in the group of pregnant women with BV, who received treatment with clindamycin significantly increased by almost two times from the baseline values and amounted to 86.1% in women with mild BV, 78.5% in women with moderate BV and 76.9% in women with severe BV.Conclusion. The production of endogenous antibiotics, AMP, provides adequate protection against infectious agents. After a course of therapy with clindamycin 100 mg intravaginally at bedtime for 3 days, the AMP level normalized 2 weeks after treatment.

The Impact of Gestational Diabetes Mellitus on Maternal and Fetal Outcome

Objective: Gestational diabetes mellitus (GDM) is one of the major public health issues in developing countries. It occurs in 2-9 percent of all pregnancies [4-6]. The present study is aimed to determine whether maternal and neonatal outcomes in GDM women are different from those in the general obstetric population. Methods: This descriptive Observational study was conducted jointly in the departments of Obstetrics Gynecology and Medicine, Nightingale Medical College, Ashulia from 1st January 2014 to 31st December 2016 (3 years). Fifty pregnant woman diagnosed by OGTT as GDM and fifty healthy pregnant women were enrolled as study subjects. They were followed regularly at the outpatient departments until delivery for detection of maternal and fetal outcome. Results: Women with GDM were significantly older (mean age 31.5) than healthy pregnant women group (mean age 25.3). Multiparty, increased BMI and positive family history of DM were found commonly in GDM women than control group. GDM women were more prone to develop pregnancy induced hypertension (36% vs 20%), premature rupture of membrane (30% vs 14%), preterm labour (30% vs 10%) as compared to non GDM group. Rate of cesarean section was not significantly higher in GDM women than healthy women (64% vs 56%). Regarding neonatal complications there was increased risk of hyperbilirubinemia (46% vs 16%), hypoglycemia (20% vs 0) and macrosomia (30% vs 10%) in neonates of GDM women than those of non GDM women. Conclusion: Our study indicates that maternal and neonatal complications are more in GDM women than healthy population. So early detection of GDM and multidisciplinary approach of treatment in the form of dietary advice, lifestyle modification, and insulin therapy can reduce adverse outcomes without increasing the rate of cesarean section.

Doppler ultrasound findings in symptomatic pregnant women diagnosed with COVID-19

The primary aim of this study was to investigate the potential impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on maternal and foetal Doppler findings. Doppler ultrasound findings were compared in 40 pregnant women diagnosed with COVID-19 disease who required hospitalisation (group 1) and 30 healthy pregnant women (group 2). Maternal characteristics and birth histories were recorded. Body mass index, gestational week at birth, type of delivery, oligihydroamnios, pre-term birth (<37 weeks), low birth weight (<10 percentile), perinatal death and f1st and 5th minute Apgar scores were recorded. Birth weights and foetal biophysical profile (BPP) scores in group 1 were significantly lower than those in group 2. There was a statistically significant between-group difference in the umbilical artery pulsatility index (PI), umbilical artery resistive index (RI), middle cerebral artery (MCA) PI, MCA RI, mean uterine artery (UtA) PI, mean UtA RI and cerebroplacental ratio (CPR), the parameters used to evaluate foetal-maternal blood flow. In the pregnant group diagnosed with COVID-19 and hospitalised, all foetal-maternal Doppler indicators of foetal-maternal blood flow were impaired, and birth weights and BPP scores in these patients were statistically significantly lower than those in the healthy controls. Impact statement What is already known on this subject? Foetal and maternal vascular malperfusion characterised by decidual arteriopathy have been reported in pathologies of placentas from pregnant women with SARS-CoV-2 infection. What the results of this study add? It was determined that COVID-19 disrupted foetal and maternal blood flow. What the implications are of these findings for clinical practice and/or further research? Foetal biometric measurements and foetal Doppler may be useful in the follow-up of perinatal outcomes in pregnant women with COVID-19

GESTATIONAL DIABETES AS A POSSIBLE PREDICTOR OF LATE PREECLAMPSIA

Abstract. Purpose of the study - We assessed the impact of gestational diabetes on the development of preeсlampsia. Material and methods of research: We conducted a retrospective case-control study. Group I included 34 patients with preeclampsia, group II included 66 patients without preeclampsia. We analyzed the course of pregnancy and the development of gestational diabetes. Research results. In the group of patients with late preeclampsia (after 34 weeks of pregnancy), we found a high incidence of gestational diabetes mellitus. The frequency of gestational diabetes was noted in 56% of cases, while in the group of healthy pregnant women, the incidence of this pathology is 4.55% as the average in the population. Conclusions. Gestational diabetes mellitus can be considered one of the predictors of late preeclampsia. The course of diabetes is associated with progressive endothelial dysfunction, which can aggravate the existing compensated placental ischemia, which is one of the important pathogenetic links in the implementation of preeclampsia. We recommend explaining not only the risks of the underlying disease, but also careful self-monitoring of blood pressure at home in patients with diabetes. We also recommend testing for preeclampsia after detection of gestational diabetes mellitus (placental growth factor/fms-like soluble tyrosine kinase-1), which provides information on the likely debut of a hypertensive disorder within 4 weeks ahead.

Psychoemotional state and filaggrin level in pregnant women with atopic dermatitis

Purpose of the study: to assess the psycho-emotional state and the level of filaggrin in the blood serum of pregnant women with exacerbation of atopic dermatitis (AtD). Materials and methods. The study included 70 pregnant women with AtD, 20 non-pregnant women with AtD, 20 healthy pregnant women. A survey was conducted on the Beck Depression and Anxiety Scale. The filaggrin level in the blood serum was assessed by ELISA. Research results. Serum filaggrin levels in pregnant women with AtD were significantly higher than in non-pregnant women with AD (p=0.007) and healthy pregnant women (p=0.001). The level of anxiety was increased in the groups with AtD compared with the group of healthy pregnant women (p=0.001). The level of depression in pregnant women with AtD was higher than in healthy pregnant women (p=0.002) and non-pregnant women with AtD (p=0.021). Conclusions. It was found that pregnant women with AtD have more pronounced disorders of the psycho-emotional state and a higher level of filaggrin in the blood serum than non-pregnant women with AtD and healthy pregnant women.

Th17/Regulatory T cells ratio evolution: A prospective study in a group of healthy pregnant women

During pregnancy, the maternal immune system is challenged to tolerate a semi-allogenic fetus. A shift toward a tolerogenic profile is essential to ensure a healthy fetal and placental development. One of the most important mechanisms involved in the maternal immune tolerance towards the fetal antigens is expressed in the activity of the regulatory T (Treg) and Th17 cells. The behavior and equilibrium of these two T lymphocyte populations were rarely studied in normal healthy pregnancies through the beginning of gestation to the postpartum period. We conducted a prospective longitudinal observational study where peripheral blood lymphocyte subsets were analyzed in each trimester of pregnancy and postpartum period in a group of healthy pregnant women. Our study observed a consistent reduction in peripheric Treg cell count through all pregnancy while the Th17 cell count remained stable. The Th17/Treg ratio increases significantly throughout pregnancy to the postpartum period. These changes could be justified by the migration of the immunotolerant Treg cells to the maternal decidua and lead to the establishment of a systemic pro-inflammatory profile by the end of pregnancy. This data could explain why systemic syndromes like preeclampsia develop in susceptible women during the second half of pregnancy or why many autoimmune disorders flourish in the first weeks postpartum.

Evaluation of thrombin generation assay in factor XI deficiency

IntroductionFactor XI (FXI) deficiency is characterized by a lack of correlation between FXI plasma levels and the occurrence of hemorrhagic events. The main objective of our study was to determine whether thrombin generation assay (TGA) could be used to assess the hemorrhagic phenotype of patients with FXI deficiency. Material and methodsAll patients had confirmed laboratory measurement of FXI < 50% in two plasma samples. Relevant bleeding history was evaluated by a senior physician. TGA was performed with Calibrated Automated Thrombography, in platelet poor plasma, from patients and healthy controls. The assay was performed with PPP low reagent (1 pM of human tissue factor). ResultsSeventy-six patients with FXI deficiency were included between 2011 and 2020. Among them, eight patients had severe deficiency (FXI < 15%). Mean age was 34 years [range: 9–77]. Endogenous thrombin potential (ETP) was significantly lower in patients with FXI deficiency and bleeding (573 nM·min [225–1214]) or no bleeding (732 nM·min [222–1435]), compared to healthy controls (1184 nM·min [933–1518]). No difference was observed for ETP and peak between patients with FXI deficiency and bleeding and patients with FXI deficiency and no bleeding. No difference was observed for ETP (923 nM·min [377–1497] vs 1063 nM·min [252–2529]), peak (82 nM [28–154] vs 131 nM [20–330]) or velocity (13.7 nM/min [3.6–29.6] vs 26.5 nM/min [2.5–90]) in women with (n = 4) and without history (n = 17) of post-partum bleeding. No difference of thrombin generation was observed in pregnant women with FXI deficiency (ETP: 1395 nM·min [351–2529]; peak: 154 nM [26–330]; velocity: 29.6 nM/min [4.1–90.0]), compared to healthy controls and a control group of healthy pregnant women. ConclusionIn conclusion, under our experimental condition, a non-significant decrease of thrombin generation was observed in plasma samples of patients with FXI deficiency and bleeding. Our results suggest an increase of coagulation parameters during pregnancy in women with FXI deficiency. A larger sample size or other experimental conditions are required to evaluate the use of TGA in FXI deficiency.

The diagnostic role of hemogram parameters in pregnant appendicitis.

Acute appendicitis is the most frequently encountered non-obstetric disease requiring surgical intervention during pregnancy. Early diagnosis reduces maternal and fetal morbidity / mortality rates. This study aims to investigate hemogram parameters in the diagnosis of acute appendicitis in pregnant women. A retrospective case-controlled study was conducted in three groups. Thirty-nine pregnant patients with acute appendicitis (Group A), 39 fertile nonpregnant patients with acute appendicitis (Group B), and 39 healthy pregnant women (Group C) were included in the study. WBC, neutrophil count, lymphocyte count, NLR, PLR, MPV and RDW values were compared. The mean NLR values in group A, group B and group C were 7.39 (1.58-46.6), 5.66 (1-20) and 4.23 (1.54-10.77) respectively, and there was a significant difference in NLR values between the groups (P= 0.002). The mean PLR values in group A, group B and group C were 159.09 (69.1-574), 134.28 (21.5-360) and 120 (68.7-334) and difference was statistically significant (P= 0.019). Cutoff points for WBC count was 14155 106/μL (51,3% sensitivity, 82,1% specificity), for neutrophil count is 10955 106/μL (53,8% sensitivity, 84,6% specificity), for NLR is 9.23 (46,2% sensitivity, 92,3% specificity) and PLR is 157,6 (51,3% sensitivity and 82,1% specificity) NLR had largest area under the curve with 0.667 NLR. Neutrophil count, WBC and PLR were found to be the most valuable inflammatory parameters however, RDW, Lymphocyte count, and MPV levels are not found valuable markers in terms of sensitivity and specificity in the diagnosis of acute appendicitis in pregnant patients by this study.

Systemic Lupus Erythematosus and Pregnancy: a Portuguese Case-Control Study.

Pregnancy in systemic lupus erythematosus (SLE) patients is associated with an increased risk of adverse outcomes. During pregnancy, SLE patients have a higher rate of miscarriage, stillbirth, preterm delivery, fetal growth restriction, or hypertensive disorders of pregnancy. To date, only a few case-control studies were published with the purpose to evaluate the magnitude of risk associated with pregnancy in lupus patients. The aim of our study was to evaluate the maternal and fetal outcomes in a cohort of Portuguese SLE patients and to compare it with a group of healthy pregnant women. We conducted a retrospective case-control study that included all pregnant women with SLE managed at a Portuguese tertiary center, between 2010 and 2019. Pregnancy outcomes were compared between SLE patients and a group of matched healthy pregnant women. Baseline maternal data was collected, and maternal-fetal and neonatal outcomes were evaluated. One hundred twenty-four SLE pregnancies were included. Of the patients, 95.2% were in remission at conception. In 13.7% of cases, a lupus flare was diagnosed during gestation and in 17.9% in the postpartum period. The live birth rate was 84.6%, and the incidence of adverse outcomes was 40.3% (OR 2.64, 95% CI 1.67-4.18). Considering only patients in remission at conception, the presence of adverse outcomes remained significantly higher (36.8% vs. 20.3%, P< 0.01). Miscarriage rate was 15.3% (OR 5.85, 95% CI 2.57-13.34) and preterm delivery occurred in 12.4% of the patients (OR 1.72, 95% CI 0.83-3.57). Preeclampsia prevalence was higher in SLE patients (OR 3.92, 95% CI 1.32-11.57). In the SLE group, the newborn admission to an intensive care unit rate was increased (OR 4.99, 95% CI 1.47-16.90). No neonatal or maternal deaths were reported. In our study, pregnancy with SLE was associated with an increased incidence of adverse outcomes, even in a population of SLE patients with well-controlled disease.