Increased Pregnancy Complications Research Articles

Alterations in the placental methylome with maternal obesity and evidence for metabolic regulation.

The inflammatory and metabolic derangements of obesity in pregnant women generate an adverse intrauterine environment, increase pregnancy complications and adverse fetal outcomes and program the fetus for obesity and metabolic syndrome in later life. We hypothesized that epigenetic modifications in placenta including altered DNA methylation/hydroxymethylation may mediate these effects. Term placental villous tissue was collected following cesarean section from lean (prepregnancy BMI<25) or obese (BMI>30) women. Genomic DNA was isolated, methylated and hydroxymethylated DNA immunoprecipitated and hybridized to the NimbleGen 2.1M human DNA methylation array. Intermediate metabolites in placental tissues were measured by HPLC-ESI-MS, ascorbate levels by reverse phase HPLC and gene expression by RT-PCR. Differentially methylated and hydroxymethylated regions occurred across the genome, with a 21% increase in methylated but a 31% decrease in hydroxymethylated regions in obese vs lean groups. Whereas increased methylation and decreased methylation was evident around transcription start sites of multiple genes in the GH/CSH and PSG gene clusters on chromosomes 17 and 19 in other areas there was no relationship. Increased methylation was associated with decreased expression only for some genes in these clusters. Biological pathway analysis revealed the 262 genes which showed reciprocal differential methylation/ hydroxymethylation were enriched for pregnancy, immune response and cell adhesion-linked processes. We found a negative relationship for maternal BMI but a positive relationship for ascorbate with α-ketoglutarate a metabolite that regulates ten eleven translocase (TET) which mediates DNA methylation. We provide evidence for the obese maternal metabolic milieu being linked to an altered DNA methylome that may affect placental gene expression in relation to adverse outcomes.

The pregnancy in neurofibromatosis 1: A retrospective register-based total population study.

The objective of this retrospective total population study was to form a view of the pregnancies of the patients with neurofibromatosis type 1 (NF1). A cohort of 1,410 Finnish patients with NF1 was acquired by searching NF1-related inpatient and outpatient hospital visits and confirming the diagnoses by reviewing the medical records. Ten matched control persons per patient with NF1 were collected from Population Register Centre. Study persons were linked to data from Medical Birth Register and Care Register for Health Care through the personal identity code. Cesarean deliveries, hypertension/preeclampsia, and placental abruptions were more common among mothers with NF1 with adjusted odds ratios of 2.24 (95%CI 1.63-3.07), 1.96 (95%CI 1.18-3.24), and 13.40 (95%CI 4.26-42.13), respectively. The adjusted mean pregnancy duration was 0.65 (95%CI 0.42-0.88) weeks shorter among the mothers with NF1 than in the control group consisting of non-NF1 mothers giving birth to a non-NF1 child. The pregnancies of non-NF1 mothers giving birth to a NF1 child were 0.43 (95%CI 0.24-0.62) weeks shorter than in the control group. In summary, NF1 of the mother was associated with a shortened pregnancy and increased pregnancy complications. Also, the NF1 of the fetus slightly shortened pregnancy. Since mothers with NF1 are at increased risk for pregnancy complications, careful evaluation of their pregnancies is warranted.

Pregnancy outcomes features in patients with different severity of asthma

Purpose of the study. The study of the peculiarities and outcomes of pregnancy and neonatal status in patients with bronchial asthma (BA).&#x0D; Materials and methods. Studied the course of pregnancy and delivery 1800 women suffering from BA. Patients were conducted and surveyed throughout the period of gestation simultaneously with pulmonologist and obstetrician; thus it was formed a complex of treatment and preventive measures, made recommendations for the primary prevention of allergic diseases of unborn child.&#x0D; Results. The increase in pregnancy complications in patients with asthma is directly related to the lack of control of the disease, especially in the first trimester of gestation. The lack of ade quate treatment of asthma increases the risk of different pregnancy complications, which has a direct effect on the health status of newborns.&#x0D; Conclusion. Even severe asthma, is not a contraindication to pregnancy. The main condition for the safety pregnancy and delivery is the timely appointment of a set of preventive and therapeutic measures for control of the disease that not only improve the quality of life of women during gestation, but also improve health status of newborns.

Niveles de tirotrofina y anticuerpos antitiroperoxidasa en el primer trimestre de gestación asociados a complicaciones del embarazo en la mujer eutiroidea

IntroductionPregnancy is a physiological state presenting with endocrine and immunological changes. The thyroid gland modifies its output in order to provide enough hormones to the mother and foetus. Thyroid autoimmunity and thyroid dysfunction are prevalent in women of childbearing age and may affect the course of gestation and having maternal and foetal clinical consequences. The purpose of the present study was to establish the relationship between euthyroid pregnant women with thyrotropin (TSH) at two levels of the reference range (< 1.2 and between 1.2 and 2.5 mIU/L), and positive or negative anti-thyroid peroxidase autoantibodies (TPO Ab) with the frequency of pregnancy complications and the development of thyroid dysfunction. MethodsA retrospective study of euthyroid women in their first trimester of pregnancy was performed. TSH, free thyroxine (FT4), total thyroxine (T4), and TPOAb values were analysed. A total of 580 women had positive TPOAb (EP group), and 533 women had negative TPOAb (EN group). The EP and EN groups were subdivided according to TSH levels into EP1: positive TPOAb and TSH<1.2, and EP2: positive TPOAb and TSH between 1.2 and 2.5 mIU/L. Maternal and foetal complications, such as miscarriage, intrauterine death, preterm delivery, and thyroid dysfunction during pregnancy and postpartum were taken into account. ResultsTSH values were higher in EP group vs EN group (X¯±SD; 1.57±0.82 vs 1.16±0.54 mIU/L, P=.01). FT4 and T4 values were similar in both groups. Out of the pregnant women in the EP group, 63% were included in EP1, and 37% in EP2. In the EN group, 80% of women were included in EN1 and 20% in EN2. A significant (P=.001) increase in pregnancy complications in EP group (22%) vs EN (10%) was observed. In the EP group, TSH levels were: 1.65±0.67 vs 0.99± 0.77 (X¯±SD) mIU/L (P=.014) respectively, in women with and without miscarriage. TSH levels were 1.63±0.70 vs 1.15±0.53 (X¯±SD) mIU/L (P=.012), respectively, in women with and without preterm delivery. In the EN group TSH levels were: 1.45±0.61 vs 0.85± 0.66 (X¯±SD) mIU/L (P=.001), respectively, in women with and without miscarriage. TSH levels were 1.59±0.71 vs 0.83±0.64 (X¯±SD) mIU/L (P=.001), respectively, in women with and without preterm delivery. However, TSH levels in miscarriage and preterm delivery were similar. Thirty-two EP, and 19 EN women developed hypothyroidism in pregnancy (ns), and 29 EP and 10 EN women developed post-partum thyroiditis (P=.005). ConclusionThyroid autoimmunity and higher TSH levels within the reference range during the first trimester of pregnancy were associated with pregnancy complications and with the development of thyroid postpartum dysfunction.

Perinatal Outcomes in Advanced Age Pregnancies

Objective: The aim of this study is to evaluate the impact of advanced maternal age on pregnancy outcomes Methods: A retrospective analysis of 951 birth registry records of Zeynep Kamil Hospital, were analyzed between Janu­ary 2003 and December 2007. Study group was made up of women ≥40 years old and control group was made up of women younger than 40 years. Results: Mean maternal age was 41.48 years in the study group and 26.41 years in the control group. Mean gesta­tional age at the time of delivery is 37.73 weeks in study group and 38.10 weeks in the control group. There was no statistical difference in terms of preterm delivery, multiple pregnancy, fetal anomaly, IUGR, superimpose preeclampsia oligohidramnios, presentation anomaly and placenta previa rates between the study and control groups. Incidence of preeclampsia (p=0.041), Chronic hypertension (p=0.001), GDM (p= 0.003),is found to be higher in study group. Cesar­ean birth rate is higher (p<0.05) and hospitalization time is longer in study group (p=0.001). 1st minute and 5th minute APGAR scores of the study group (6.99±2, 8.27±2) was lower than the 1st minute and 5th Minutes APGAR scores of the control group (7.38±1.6, 8.58±1.7). Neonatal intensive care unit administration rate is seen also higher in study group (p<0.01). Conclusion: Advanced maternal age was related to increased pregnancy complications and poor perinatal outcome. Preeclampsia, GDM, chronic hypertension is seen more common in advanced age pregnancies. Neonatal intensive care administration is higher and APGAR scores are lower; cesarean delivery was performed more common, and hospitaliza­tion time was longer in advanced age pregnancies.

A5149 - Fertility outcomes after bariatric surgery: fifth-year follow up data

Maternal morbid obesity has been associated with higher infertility rates, increase in pregnancy complications and fetal growth abnormalities. Bariatric surgery is currently the mainstay treatment of morbid obesity. It has been proven to achieve long term weight loss with improvement in all obesity related morbidities.

Pregnancy outcomes in women with osteogenesis imperfecta

Objective: To assess the relationship between osteogenesis imperfecta (OI) type, mode of delivery and outcomes as self-reported by women in the International Osteogenesis Imperfecta (OI) Registry. Methods: A cross-sectional study using data from 274 women with OI who reported their experience with pregnancy practices, including mode of delivery, number of children, genetic counseling, assisted conception techniques, mean ages at menarche and at menopause, and pregnancy complications. Chi-square analyses were performed to compare pregnancy outcomes, number of children and OI type. Prevalence ratios and 95% confidence intervals were obtained to quantify exposure–outcome relationships. Results: The most common mode of delivery was the sole use of cesarean section (C-section) reported by 55% of the participants. Approximately two-thirds had at least two children. Twenty-nine percent (n = 80) reported pregnancy complications. There was a significant relationship between the mode of delivery and OI type (p < 0.001), genetic counseling (p = 0.010), and number of children (p < 0.0001). There was neither evidence of an association between pregnancy complications and number of children (p = 0.16), OI type (p = 0.27), nor mode of delivery (p = 0.11). Conclusions: These findings suggested that clinical OI type, pre-natal genetic counseling, and number of children were strong predictors for choosing the mode of delivery. Severity of OI, multiparity, and vaginal delivery were not associated with increased pregnancy complications in this cohort of women with OI.

Asthma Attacks During Pregnancy in the ICU: Just Be Alert

Background Asthma represents one of the most common medical conditions encountered during pregnancy, which occurs in 3 to 8 % of pregnant women [11. Namazy JA, Schatz M (2005) Pregnancy and asthma: recent developments. Curr Opin Pulm Med 11: 56-60. ]. Pregnancy may be associated with changes in the course of asthma, and asthma may affect the outcome of pregnancy. Although the incidence of severe asthma during pregnancy is low (0.4%-1.3%), its consequences on mother and fetus can be disastrous [22. Tan KS, Thompson NC (2000) Asthma in pregnancy. Am J Med 109: 727-733.]. Albeit small, significant increase in complications of pregnancy in asthmatic women such as perinatal mortality, pre-eclampsia, preterm deliveries or low birth weight infants are being registered [33. Grewal P, Mulla ZD, Simon MR (2008) Effect of Maternal Asthma on Pregnancy Outcomes: An Analysis of Texas Hospital Data. AEP 18: 735-736. ].

Maternal Obesity and Pregnancy Outcomes

Obesity in pregnancy is associated with increased pregnancy complications such as congenital malformations, stillbirths, macrosomia, neonates with low Apgar scores, pre-eclampsia, and gestational diabetes. In addition to these adverse outcomes, obese women face additional challenges due to longer labor progression, increased cesarean deliveries and postoperative complications, difficulties in administering anesthesia, and increased risk of thromboembolic disease. The purpose of this review is to provide an evidence-based guide to obstetric providers when caring for obese women in the intrapartum and postpartum period.

Polarization of macrophages induced by Toxoplasma gondii and its impact on abnormal pregnancy in rats

Toxoplasma gondii infection is the leading cause of fetal intrauterine growth retardation among the five kinds of pathogens termed as TORCH, including Toxoplasma, Rubella virus, Cytomegalo virus, herpes virus and others during pregnancy. Pathogens infect the fetus through the placenta. T. gondii infection may result in congenital toxoplasmosis, miscarriage, stillbirth, and preemie, and increase pregnancy complications. Adaptive immune response induced by T. gondii infection stimulates T cells and macrophages to produce high levels of cytokines. Physiologically, the microenvironment of pregnancy was Th2-dominant. Here we set up a pregnant Sprague-Dawley rat model, and reported the polarization of macrophages induced by genotype Chinese 1 strain (Wh6) of Toxoplasma, and its adverse impact on pregnancy. The results showed that Wh6 infection pre- or in-gestation both led to abnormal pregnancy outcomes. Peritoneal macrophages in pre-gestation infection were polarized toward classically activated macrophages (M1), while in-gestation infection drove macrophages to polarize toward M2 activation. The Th2-dominant immune response in pregnant rat somewhat inhibits the excessive bias of the macrophages toward M1, and partially, toward M2. Infection of pre- and in-gestation may alter the physiological immune microenvironment in pregnant rats, giving rise to abnormal pregnancy outcomes.

Increased risk of stillbirth in older mothers--a rationale for induction of labour before term?

The average age of childbearing has risen markedly in Germany and other high-income countries during the past 2 decades. Women aged 35 years or older have an increase in pregnancy complications and in preexisting medical conditions including obesity, diabetes and hypertension as well as a significant increase in the gestational age-related rate of stillbirth compared to younger mothers. Additional individual risk factors for stillbirth are primiparity, body mass index>30 and smoking. After exclusion of risk factors the absolute risk of stillbirth in women aged≥40 years old is 2-fold higher (1 in 503 maternities) at 39/40 weeks of gestation compared to women aged<35 years (1 in 1 020 maternities) at the same gestational age. Women aged 40 years or older have a similar stillbirth risk at 39 weeks of gestation to 25-29-year-olds at 41 weeks gestation. The underlying mechanism for the excess risk of stillbirth in women of advanced maternal age after exclusion of congenital anomalies is unknown. Independent of maternal age the cumulative probability of perinatal death increases from 1.8/1 000 deliveries at 38 weeks of gestation to 9.3/1 000 deliveries at 42 weeks of gestation. Whether on the basis of these data induction of labour at 39 weeks of gestation should be recommended in women of advanced maternal age has recently been discussed in a Scientific Impact Paper of the Royal College of Obstetricians and Gynaecologists. In this context it should be taken into account that the rate of Caesarean sections in women aged 40 years or over is 40%, and, in particular, older nulliparous may request elective Caesaran section rather than elective induction of labour. Recent metaanalyses have shown that elective induction of labour before or after term is not associated with an increase of the Caesarean section rate compared to expectant management. Up to now no randomised controlled trials exist and consequently no -recommendations from current guidelines regarding induction of labour in women of advanced maternal age can be given. In any case, a careful consultation and an individual risk-benefit analysis regarding the obstetric management is mandatory, and the final decision should be made in agreement between the pregnant women and the obstetrician. Currently a randomised controlled trial in the U.K. comparing induction of labour at 39 weeks of gestation with expectant management in nulliparous women aged over 35 years is recruiting, with the aim to determine intrapartum complications and perinatal morbidity and mortality in both managements.

Occupational hazards for pregnant or lactating women in the orthopaedic operating room.

Pregnant or lactating staff working in the orthopaedic operating room may be at risk of occupational exposure to several hazards, including blood-borne pathogens, anesthetic gases, methylmethacrylate, physical stress, and radiation. Because the use of proper personal protective equipment is mandatory, the risk of contamination with blood-borne pathogens such as hepatitis B, hepatitis C, and HIV is low. Moreover, effective postexposure prophylactic regimens are available for hepatitis B and HIV. In the 1960s, concerns were raised about occupational exposure to harmful chemicals in the operating room such as anesthetic gases and methylmethacrylate. Guidelines on safe levels of exposure to these chemicals and the use of personal protective equipment have helped to minimize the risks to pregnant or lactating staff. Short periods of moderate physical activity are beneficial for pregnant women, but prolonged strenuous activity can lead to increased pregnancy complications. The risk of prenatal radiation exposure during orthopaedic procedures is of concern, as well. However, proper lead protection and contamination control can minimize the risk of occupational exposure to radiation.

A Retrospective Survey Studying the Impact of Fabry Disease on Pregnancy.

Fabry disease (FD) is a lysosomal storage disorder resulting from a deficiency of lysosomal enzyme α-galactosidase A (α-gal A). Reduced or missing α-gal A enzyme results in the storage of globotriaosylceramide (GL3) and related glycosphingolipids in the cellular lysosomes throughout the body. The majority of GL3 buildup occurs in the body's vasculature resulting in narrowed blood vessels and an increased risk for strokes, transient ischemic attacks, and deep vein thrombosis. Theoretical concerns have been raised about increased pregnancy complications in women affected by FD as glycosphingolipid storage has been found in both maternal- and fetal-derived placental tissues. This retrospective study was conducted to better understand risks for women with FD during pregnancy. Survey questions included queries about prenatal medications, teratogenic exposures, prenatal testing, common pregnancy complications, Fabry symptoms during pregnancy, obstetrical history, and immediate neonatal history. In total, 41 affected women completed the survey. Results indicate several Fabry-related symptoms and features may worsen during pregnancy, including gastrointestinal symptoms, acroparesthesias, proteinuria, headaches, and postpartum depression. Although no life-threatening complications were reported, a statistically significant increased frequency of hypertension was observed when comparing data from this study to the general population (p < 0.05) and previous publications (p < 0.001). Limitations include sample size and recall bias. Though this survey sampling of women was small and required women to recall their past pregnancy experiences, the findings suggest that when pregnant, women with FD should be aware of potential worsening of FD symptoms and may benefit from consulting with a maternal-fetal medicine specialist.

Investigation on the effect of intrauterine devices contraception for subsequent fertility

Intrauterine devices contraception (IUD) offers users highly effective and safe contraception. But some people think that IUDs may cause pelvic inflammatory disease and infertility, etc. The aim of our study was to examine time to pregnancy and pregnancy outcome after the removal of IUD. Retrospective analysis. From January 2012 to January 2013,562 women were identified eligible, who removed IUD for more than one year and for the purposes of planning to become pregnant. Data were collected through questionnaires. All analyses were done using SPSS. The questionnaires revealed that 73.30% (412/562) became pregnant following IUD removal and the intervals of becoming pregnant after discontinuing contraception was average 11.16 months. Among women with different durations of IUD use, pregnancy rates were statistically different (P<0.05). Most of IUDs were copper intrauterine devices (72.6%), pregnancy rates following cessation of copper IUDs were 78.40%. For the levonorgestrel-releasing intrauterine system,the pregnancy rate was 74.36%, there was no statistically difference from the copper IUDs. And the incidence of pelvic inflammatory disease was 11.19%. Twelve women (2.14%) had ectopic pregnancies, and there were no increased pregnancy complications or adverse fetal outcomes.Table 1The relationship between the duration of use IUDs and pregnancy rate after discontinuing contraceptionDuration of use IUD (months)No of womenMean age (years)Pregnancy rate after discontining contraception＜12 months11831.3481.36%12-23 months11232.6476.79%24-35 months9834.9659.18%36-47 months7338.4454.79%48-60 months5737.3382.46%≥60 months10436.9281.73%χ2=16.257 P=0.006. Open table in a new tab χ2=16.257 P=0.006. After the removal of IUD, the results showed relatively high pregnancy rates and normal pregnancy outcomes. While during of IUD use seemed to influence conception rate independently.

Racial and Ethnic Differences in Physiology and Clinical Symptoms of Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders and affects approximately 5 to 10% of women of reproductive age. There exists substantial variation of physical stigmata and clinical symptoms among women, but PCOS has been known to be associated with irregular periods, infertility, increased pregnancy complications, as well as nonreproductive health problems arising from its association with the metabolic syndrome. Over the years, there have been various consensus statements regarding the diagnostic criteria, but the varying pronouncements suggest that the underlying cause is still not well understood and may be multifaceted. Importantly, the interaction of genetic predisposition and local environment is possibly responsible for the heterogeneity of phenotypes seen; it has been demonstrated that there is substantial ethnic and racial variation in the clinical presentations among PCOS patients and related individuals may vary in appearance based on nutritional and other aspects of locale. The differences in phenotype and clinical symptoms of PCOS related to the clinical, hormonal, and metabolic characteristics among various ethnic backgrounds, including Hispanics, African Americans, Asians, and Indians, need to be considered when assessing and treating these individuals. Future research must address the importance of interactions between genotype and the environment.

754: Post-cesarean maternal complications in patients with extreme obesity

754 Post-cesarean maternal complications in patients with extreme obesity David Stamilio, Molly Stout, George Macones, Christina Scifres Washington University School of Medicine, Obstetrics and Gynecology, St. Louis, MO, University of Pittsburgh School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Pittsburgh, PA OBJECTIVE: Obesity is epidemic, representing a substantial disease burden. Although obesity is known to increase pregnancy complications, maternal post-operative risks among obese patients that require cesarean delivery are not well characterized. STUDY DESIGN: We performed a secondary analysis of a randomized controlled trial to estimate the effect of obesity on post-cesarean complications. The parent study was designed to estimate the effect of supplemental oxygen on post-cesarean infectious morbidity. Since study intervention had no effect, study groups were combined as a cohort. Exposure is obesity, stratified as normal/overweight (BMI 30 kg/m2), obese (BMI 30-45 kg/m2) or extremely obese (BMI 45 kg/m2). The primary outcome is a composite of wound infection and endometritis. Secondary outcomes include the composite components and wound opening, hematoma or seroma, and emergency department visit. We performed unadjusted and multinomial logistic regression analyses. Adjusted relative risk ratios (RRR) and 95% confidence intervals (CI) are reported. RESULTS: 585 women were included in the analysis. Infectious morbidity occurred in 10.4% of all patients. Rates of normal/overweight and obesity class I, II, and III were 25.1%, 30.1%, 14.9% and 29.9% respectively. Eighty-five patients (14.5%) had a BMI 45 kg/m2. Rates of black race, chronic hypertension, diabetes and gestational diabetes increased and operative duration increased with increasing obesity severity. Obese patients were more likely to undergo cesarean after labor and require a vertical skin incision or classical uterine incision. After controlling for relevant confounders, extremely obese patients had a 2-4 fold increase in postoperative complications. CONCLUSION: Maternal obesity is associated with a significant increase in post-cesarean wound complications. Risk is concentrated among class III obesity patients with BMI 45 kg/m2. These data can be used to counsel obese patients on operative risks and to target methods to reduce the risk of cesarean in extremely obese patients. 755 Impact of maternal obesity on perinatal infectious morbidity Michael Fassett, Deborah Wing, Darios Getahun Kaiser Permanente West Los Angeles Medical Center, Obstetrics and Gynecology, Los Angeles, CA, University of California Irvine, Obstetrics and Gynecology, Irvine, CA, Kaiser Permanente Southern California, Research and Evaluation, Pasadena, CA OBJECTIVE: Maternal obesity is an increasing public health problem. Studies have suggested that obesity increases placental inflammation. The aim of this study was to examine whether obesity is associated with increased risk of perinatal infectious morbidity. STUDY DESIGN: We conducted a retrospective cohort study using the 2006-2010 Kaiser Permanente Southern California medical record (n 154,275). ICD-9-CM codes from the maternally-linked hospitalizations and birth certificate data were used to examine the associations. Prepregnancy Body Mass Index (BMI, kg/m2) was defined as normal-weight (18.5-24.9), overweight (25-29.9), and obese ( 30).Odds ratio (OR) and 95% confidence interval (CI) were used to estimate the magnitude of associations after adjusting for potential confounders. RESULTS: Of the women in the study, 29 percent were overweight and 27 percent were obese. When compared to women of normal weight, overweight and obese women had a 1.31 -fold (95% CI 1.14, 1.51) and 2.11-fold (95% CI 1.86, 2.40) increased risk of surgical site infection and a 1.11-fold (95% CI 1.06, 1.16) and 1.28-fold (95% CI 1.22, 1.34) increased risk of urinary tract infection, respectively. Obesity was associated with increased risk of endometritis (OR 1.18, 95% CI 1.00, 1.41), GBS infection (OR 1.21, 95% CI 1.15, 1.27) and acute cystitis (OR 1.17, 95% CI 1.02, 1.33). CONCLUSION: The findings suggest that obese women are at increased risk for perinatal infectious morbidity and may benefit from interventions targeted at reducing infectious morbidity.

Maternal serum analytes as markers of adverse obstetric outcome

Key content Screening for Down syndrome is available in the first or second trimester. In the absence of aneuploidy and structural anomalies, abnormal maternal serum levels of first and second trimester markers are associated with adverse obstetric outcome. As the number of markers increases and their value becomes more extreme the likelihood of adverse obstetric outcome increases. Although many of the associations between maternal serum markers for adverse maternity outcome are statistically significant, the positive predictive value for individual outcomes are too low for them to be clinically useful as screening tests. Potential management strategies for care of women with abnormal serum markers are yet to be established. Pregnancies complicated by pre‐eclampsia, fetal growth restriction, pre‐term delivery, fetal demise and spontaneous miscarriage have been associated with abnormal deviations in either one or several components of these markers. Learning objectives To review the relationship between abnormal first and second trimester maternal markers and adverse obstetric outcomes. Ethical issues Despite evidence of increased pregnancy complications with unexplained abnormal quadruple screen, the optimal method to manage them is unclear. The cost of screening and emotional anxiety caused to patients must be outweighed by the benefits of early detection and the ability to reduce the overall risk. It is a great dilemma for obstetricians on how to proceed when confronted with an unexplained abnormal serum screen.

Is Assisted Reproduction Associated with Abnormal Placentation?

Artificial reproductive technologies (ART) and conception following a period of untreated infertility (>1 year) are independently associated with increased pregnancy complications in both singleton and multiple pregnancies. It is unknown if placental dysfunction associated with macroscopic and/or microscopic histological discrepancies might explain some of these variances. Our aim was to compare the histopathology of placentae from singleton pregnancies belonging to 3 groups, as follows: conception as a result of ART; spontaneous conception (<1 year of trying); and conception following untreated infertility (>1 year). Pathological examination of placentae from singleton pregnancies of nonsmoking, age-matched primiparous women with no significant medical history and no known uterine congenital anomalies was performed by a single pathologist blinded to the groups. Features were compared using analysis of variance and chi-square tests. A total of 89 placental pathology reports were available (control = 39, infertility = 17, ART = 33). The mean placental thickness was significantly higher in the ART group when compared to the spontaneous conception group (P = 0.02). There were significantly more placental hematomas in the ART group (P = 0.04) compared to the other groups. There were no significant differences in rates of abnormal placental shapes or abnormal cord insertions. There were no statistically significant differences in the incidence of microscopic placental lesions, nor were there any statistically significant differences in the incidence of macroscopic and microscopic placental lesions between the infertility group and the other groups. Placentae of ART pregnancies show significantly increased thickness and a higher incidence of hematomas. Increased placental thickness has previously been linked to increased perinatal risk.

Pregnancy complications in patients with epilepsy

Epilepsy is a common neurological disorder affecting 0.4-0.8% of pregnant women. Preeclampsia, gestational hypertension, bleeding in pregnancy, induction of labour, caesarean delivery and major congenital malformations of the children occur more frequently in this group. The objective of this review is to evaluate the pregnancy and delivery complications including congenital abnormalities in women with epilepsy. This review comments on results of recently published studies including the Medical Birth Registry of Norway. A second aim of the review is to examine the effect of antiepileptic-drug treatment on pregnancy complications, and also their association with congenital abnormalities associated with these medications. Women with epilepsy have a higher risk of preeclampsia, gestational hypertension, bleeding in pregnancy and excessive bleeding postpartum. They also have higher incidence of congenital anomalies and delayed cognitive development in their children. It has been unclear whether the increased risk of complications is due to the epilepsy per se, the use of antiepileptic drugs, or the combination of both factors. Recent studies strongly indicate an association to the medications and the dose used in pregnancy. Several drugs commonly used in treatment of epilepsy are associated with increased pregnancy complications, as well as an increased risk of congenital abnormalities.

Prevalence and predictors of proteinuria in HIV-infected and uninfected pregnant women in Cameroon

Proteinuria during pregnancy has been associated with increased pregnancy complications. Furthermore, even low-grade proteinuria has been associated with increased mortality in the general population and in non-pregnant HIV-infected women. Urine dipstick protein was measured prospectively on HIV-infected and trace protein or more and quantified by urine protein:creatinine measurement (P:C). Logistic regression modeling was used to identify factors associated with proteinuria. About 199 human immunodeficiency virus (HIV)-infected and 190 HIV-uninfected normotensive pregnant women were evaluated. The median age was 27 years in both groups and 37% presented in the third trimester. Among HIV-infected women, median CD4 cell count was 417 cells/mm(3); 27% were on combination antiretroviral therapy (cART). Proteinuria was present in 39.2% of HIV-infected and 20.9% of uninfected women (P < 0.001). HIV infection was independently associated with proteinuria [adjusted odds ratio (OR) = 2.45; confidence interval (CI) = 1.56-3.85]. Among HIV-infected pregnant women, cART was protective (adjusted OR = 0.39; CI = 0.19-0.82). Results were qualitatively similar when urine P:C was evaluated as a continuous outcome variable. The prevalence of low-grade proteinuria in both HIV-infected and -uninfected Cameroonian pregnant women is high. HIV-infected pregnant women are at increased risk for proteinuria, and cART appears to exert a protective effect. Further studies are needed to elucidate the causes of increased proteinuria in African pregnant women, both HIV-infected and -uninfected.