Later Stages Of Pregnancy Research Articles

Influence of ursodeoxycholic acid therapy on levels of fibroblast growth factor 21, adiponectin and biochemical parameters in intrahepatic cholestasis of pregnancy

The aim was to assess whether fibroblast growth factor 21 (FGF-21) and adiponectin influence intrahepatic cholestasis of pregnancy (ICP) pathogenesis and whether ursodeoxycholic acid (UDCA) has an impact on their levels. 50 pregnant women with ICP (ICP PW), 50 with uncomplicated pregnancy (HPW) and 50 healthy nonpregnant women (HW) were included. In ICP PW the first blood sample was drawn at the time of diagnosis, while in HPW it was drawn in the 28th week of pregnancy. The next blood samples were drawn in the 32nd and 36th week of pregnancy and one day after delivery. UDCA was administered when ICP was diagnosed. In ICP PW serum FGF-21 concentration was the lowest at the time of diagnosis with an evident increase after UDCA administration. Serum FGF-21 levels were significantly higher in ICP PW than in HPW from the first to the last measurement. There was a negative association between adiponectin and bile acids (BAs) levels in the later stage of pregnancy in ICP PW. Up-regulated FGF-21 serum levels in ICP patients compared to HPW persisted after delivery, suggesting its role in disease pathophysiology. The negative association between serum adiponectin and BAs of the later stage of pregnancy may suggest its role in regulation of BAs concentration. UDCA exerts a beneficial effect on insulin sensitivity and up-regulates FGF-21 in ICP.

Occurrence of oxidative stress in sheep during different pregnancy periods

The objective of this paper was to evaluate oxidative stress during different pregnancy stages in Lohi sheep reared in Libya. Investigations were carried out on Lohi sheep between 1.5 and 5 years of age. A total of 40 sheep were sub-grouped into various stages of pregnancy along with non-pregnant controls as follows: non-pregnant (n=10), early pregnancy (n=10), mid pregnancy (n=10), and late pregnancy (n=10). Blood samples were collected from pregnant sheep and preserved at -20°C and further used for evaluating the concentrations of total antioxidant status (TAS), total oxidant status (TOS), malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT), and paraoxonase (PON-1). In pregnant sheep, TAS, TOS, MDA, SOD, CAT, and PON-1 values were significantly (P < 0.05) different. TOS and MDA increased from non-pregnant ewes to early, mid and late stages of pregnancy whereas TAS, SOD, CAT, and PON-1 significantly (P < 0.05) decreased with the progression of pregnancy. The study suggests that the use of oxidant and antioxidant markers along with the blood metabolic profile should be the recommended procedure for monitoring health status during pregnancy to evade reduced productive performance and economic losses.

Immigration and the Short- and Long-Term Impact of Improved Prenatal Conditions

This paper investigates the effects of immigration from a developing country to a developed country during pregnancy on offspring's outcomes. We focus on intermediate and long-term outcomes, using quasi-experimental variation created by the immigration of Ethiopian Jews to Israel in May 1991. Individuals conceived before immigration experienced dramatic changes in their environmental conditions at different stages of prenatal development depending on their gestational age at migration. We find that females whose mothers immigrated at an earlier gestational age have lower grade repetition and dropout rates in high school. They also show better cognitive performance during primary and middle school and in the high school matriculation study program. As adults, they have higher post-secondary schooling, employment rates, and earnings than those whose mothers migrated at a later stage of pregnancy.

Spirometric Changes during Pregnancy in Cystic Fibrosis Patients

Rationale: Survival and longevity in patients with cystic fibrosis (CF) have improved with new treatments, so that pregnancy can be safely undertaken despite physiologic limitations. Dyspnea still develops in the latter stages of pregnancy. To explain this symptom, we evaluated the effect of pregnancy on lung function before and after delivery. Methods: Records of 23 pregnant patients with CF were retrospectively reviewed for data analysis. Spirometry was recorded prior to pregnancy, at first and third trimesters, and every three months following delivery up to one year. Comparisons between time points were adjusted for age and pre-gestational BMI by analysis of variance (ANOVA). Results: Complete clinical and spirometric data were available for eleven of these patients (13 pregnancies total), obtained between 2009 and 2017. FEV1 and FVC declined significantly from baseline to third trimester (by 8.1%, p Conclusions: The changes in FEV1 and FVC occur as a result of increases in intravascular blood volume and lung water during the third trimester. At the same time, FEV1/FVC increases as there is reversal of bronchiolar constriction with elimination of extracellular fluid and lung water. Furthermore, restoration of end-expiratory lung volume post-partum counteracts reversal of air trapping with resolution of peribronchiolar edema, with FVC remaining unchanged. These changes would explain decrease in dyspnea following delivery in CF patients.

Anemia in the inpatient settings: what is left out of sight

Background. Anemia is a decrease in the number of erythrocytes and hemoglobin levels as a result of blood loss, disruption of erythropoietic cell production, and increased erythrocyte breakdown or a combination thereof. Anemia of pregnant women is divided into physiological anemia and pathological conditions. In case of latent iron deficiency clinical manifestations are absent. This condition is characterized by a decrease in iron and erythropoietin to a level sufficient to maintain hematological parameters at the lower limit of normal values. In the absence of iron supplements administrations 65 % of cases of latent deficiency end up in a manifest deficiency.
 Objective. To describe the features of the anemia treatment in inpatient settings.
 Materials and methods. Analysis of literature sources on this issue.
 Results and discussion. The normal value of hemoglobin for the 1st and 3rd trimesters is ≥110 g/l, for the 2nd – ≥105 g/l. After childbirth, anemia is determined as a decrease in hemoglobin <100 g/l. Risk factors for anemia in pregnant women include poor nutrition, chronic diseases, chronic intoxication, history of anemia, bleeding during pregnancy, multiple pregnancy, frequent childbirth with a long lactation period, and short intervals between births. Anemia in pregnant women increases the probability of premature birth by 63 %, of low birth weight – by 31 %, of perinatal mortality – by 51 %, of neonatal death – in 2.5 times. In case of maternal anemia, the newborn has a worse development of external respiratory function, a lag in the weight gain and a greater susceptibility to infectious diseases. To diagnose anemia, a general blood test and determination of additional indicators (serum iron, ferritin, ferritin saturation, transferrin, soluble ferritin receptor) are used. Patients with mild anemia do not require hospitalization; patients with moderate anemia need hospitalization in the absence of a response to oral iron supplements; patients with severe anemia need hospitalization after the mandatory consultation of hematologist. The purposes of anemia treatment include the normalization of blood tests, correction of iron deficiency, and the creation of iron stores to ensure full fetal development and lactation. Evaluation of treatment is performed on the 21st day after treatment; normally the increase in hemoglobin is about 1 g per 1 day of therapy. If hemoglobin has increased by <10 g/l, it is advisable to prescribe intravenous iron. Indications for parenteral administration also include the intolerance to oral iron supplements, peptic ulcer disease in the exacerbation phase, lack of confidence in the good adherence of the patient, hemodialysis, swallowing disorders, and the need for a more pronounced increase in hemoglobin. If it is necessary to quickly restore the level of blood hemoglobin in the late stages of pregnancy, Sufer (“Yuria-Pharm”) can be administered (10.0 ml in 200.0 ml of saline intravenously 1-3 times a week). Parenteral administration of iron supplements should be administered with caution in case of polyvalent allergies, active infections, chronic liver disease, and signs of iron overload. Parenteral administration of iron supplements is not indicated in the 1st trimester of pregnancy.
 Conclusions. 1. Anemia in pregnant women increases the likelihood of premature birth, low birth weight, perinatal mortality, and neonatal death. 2. The purposes of anemia treatment are the normalization of blood tests, correction of iron deficiency and the creation of iron stores. 3. Indications for parenteral administration of iron are lack of response and intolerance to oral iron supplements, exacerbation of the peptic ulcer disease, and the need for a more pronounced increase in hemoglobin. 4. If it is necessary to quickly restore the level of hemoglobin in the late stages of pregnancy, Sufer may be prescribed.

Maternal periodontal status, oral inflammatory load, and systemic inflammation are associated with low infant birth weight.

Periodontal disease and pregnancy outcomes have been claimed to be associated with conflicting reports. The purpose of this study was to prospectively examine the association between maternal periodontal status, oral inflammatory load and serum C- reactive protein (CRP) level, and infant birth weight. A total of 156 pregnant women (age 26.62 ± 3.93 years) within the gestational age group of 13 to 32weeks participated in this cross-sectional study. Oral inflammatory load (OIL) was assessed in a salivary rinse sample using fluorescence microscopy. Clinical periodontal parameters were recorded and serum C-reactive protein level (CRP) was assessed. Participants were followed till delivery, details of parturition and infant birth weight (IBW) was recorded. OIL was significantly more in participants with mild and moderate periodontitis as compared to those with gingivitis in mid and late stages of pregnancy. Periodontal and systemic inflammatory parameters were positively correlated. A significant negative correlation was found between IBW and OIL (P=0.006) and serum CRP (P<0.001). The GI score (P=0.039), BOP% (P=0.023), serum CRP level (P<0.001) and oral polymorphonuclear neutrophil (oPMN) count (P<0.001) was significantly more in mothers delivering babies with low IBW. A multiple linear regression analysis showed that only oPMN (β=- 0.244, P=0.021) and serum CRP (β=- 0.226, P=0.019) were included in the best model (R2 =0.12, F(3,152)=7.15, P<0.001) for significantly predicting the infant birth weight. Poor maternal periodontal status, increased oral inflammatory load and increased systemic inflammation have an adverse effect on infant birth weight.

Pregnancy-related plasticity of gastric vagal afferent signals in mice.

Gastric vagal afferents (GVAs) sense food-related mechanical stimuli and signal to the central nervous system, to integrate control of meal termination. Pregnancy is characterized by increased maternal food intake, which is essential for normal fetal growth and to maximize progeny survival and health. However, it is unknown whether GVA function is altered during pregnancy to promote food intake. This study aimed to determine the mechanosensitivity of GVAs and food intake during early, mid-, and late stages of pregnancy in mice. Pregnant mice consumed more food compared with nonpregnant mice, notably in the light phase during mid- and late pregnancy. The increased food intake was predominantly due to light-phase increases in meal size across all stages of pregnancy. The sensitivity of GVA tension receptors to gastric distension was significantly attenuated in mid- and late pregnancy, whereas the sensitivity of GVA mucosal receptors to mucosal stroking was unchanged during pregnancy. To determine whether pregnancy-associated hormonal changes drive these adaptations, the effects of estradiol, progesterone, prolactin, and growth hormone on GVA tension receptor mechanosensitivity were determined in nonpregnant female mice. The sensitivity of GVA tension receptors to gastric distension was augmented by estradiol, attenuated by growth hormone, and unaffected by progesterone or prolactin. Together, the data indicate that the sensitivity of GVA tension receptors to tension is reduced during pregnancy, which may attenuate the perception of gastric fullness and explain increased food intake. Further, these adaptations may be driven by increases in maternal circulating growth hormone levels during pregnancy.NEW & NOTEWORTHY This study provides first evidence that gastric vagal afferent signaling is attenuated during pregnancy and inversely associated with meal size. Growth hormone attenuated mechanosensitivity of gastric vagal afferents, adding support that increases in maternal growth hormone may mediate adaptations in gastric vagal afferent signaling during pregnancy. These findings have important implications for the peripheral control of food intake during pregnancy.

Clinical characteristics and pregnancy outcome of 14 pregnant women with history of atherosclerotic cardiovascular disease

Objective: To summarize the clinical characters and pregnancy outcome in pregnant women with history of atherosclerotic cardiovascular disease (ASCVD). Methods: A total of 14 pregnant women with pre-existing ASCVD admitted to Beijing Anzhen Hospital from October 2013 to May 2020 were enrolled as subjects, whose ASCVD disease status, clinical manifestations, treatment and pregnancy outcomes were collected and retrospectively analyzed. Results: The age of subjects at diagnosis of ASCVD was (31±7) years old. The main intervention before pregnancy was revascularization (10 cases), and the rest 4 cases were treated with medicine. The age of subjects at pregnancy was (36±5) years old. A total of 12 cases had risk factors of ASCVD. In early stages of pregnancy, there were 1 case with cardiac function level Ⅲ and 1 with cardiac function level Ⅳ. Abnormal ventricular wall motion and ventricular aneurysm formation were determined in 3 cases by echocardiography, one of which was complicated with moderate left ventricular ejection fraction impairment. Abnormal ST segment in 4 cases and sinus tachycardia in 1 case were found by electrocardiogram. Troponin (TNI) increased in 1 case. The serum low density lipoprotein cholesterol level (LDL-C) of these pregnant women at early stages of pregnancy was (2.3±1.0) mmol/L. A total of 9 pregnant women entered later stages of pregnancy, 1 of whom had chest tightness after slight activity. There were 4 cases with excessive weight gain and 2 cases with insufficient weight gain during pregnancy, and there were 1 case with cardiac function level Ⅲ and 1 case with mild impaired left heart function. The average level of LDL-C was (2.6±0.6) mmol/L in 5 pregnant women at their later stages of pregnancy. The main treat measures included anti-platelet therapy (aspirin, 75-100 mg/d) and healthy lifestyle interventions. Five pregnant women terminated their pregnancy at the early stage of pregnancy, and 9 full-term pregnant women underwent hysterotomy with intraoperative blood loss of 180-800 ml. Adverse cardiac events occurred in 2 cases and gestational diabetes was diagnosed in 3 cases during pregnancy, among which 2 cases were complicated with chronic hypertension and preeclampsia. The weight of 9 live newborns was (3 102±647) g, among which 2 were smaller than gestational age and 1 was of low birth weight. Conclusions: Women with established ASCVD before preynancy have risk of adverse cardiac events in pregnancy. Strengthening the management of high risk factors in pregnancy is conducive to achieving a good pregnancy outcome.

Selective Inhibition of Coxiella burnetii Replication by the Steroid Hormone Progesterone.

Coxiella burnetii is a zoonotic bacterial obligate intracellular parasite and the cause of query (Q) fever. During natural infection of female animals, C. burnetii shows tropism for the placenta and is associated with late-term abortion, at which time the pathogen titer in placental tissue can exceed one billion bacteria per gram. During later stages of pregnancy, placental trophoblasts serve as the major source of progesterone, a steroid hormone known to affect the replication of some pathogens. During infection of placenta-derived JEG-3 cells, C. burnetii showed sensitivity to progesterone but not the immediate precursor pregnenolone or estrogen, another major mammalian steroid hormone. Using host cell-free culture, progesterone was determined to have a direct inhibitory effect on C. burnetii replication. Synergy between the inhibitory effect of progesterone and the efflux pump inhibitors verapamil and 1-(1-naphthylmethyl)-piperazine is consistent with a role for efflux pumps in preventing progesterone-mediated inhibition of C. burnetii activity. The sensitivity of C. burnetii to progesterone, but not structurally related molecules, is consistent with the ability of progesterone to influence pathogen replication in progesterone-producing tissues.

Effect of season and pregnancy on minerals serum variations of local rabbits in Tiaret, Algeria

Abstract The present study aimed to assess the season and pregnancy influence on minerals serum of local rabbits raised in semi-arid climate type. Fifty-nine multiparous does was used in this study during 2019. The semi-intensive rhythm of reproduction was used. All pregnant does were at the late stage of pregnancy at the sampling date. Serum samples were collected in two seasons: winter and summer. In this study, biochemical parameters concentrations of pregnant rabbits were significantly higher (p&lt;0,05) compared with non-pregnant rabbit. The value of biochemical parameters total protein, albumin, triglyceride, cholesterol, calcium, and phosphorusus changed significantly. In this study, most parameters were influenced by pregnancy.

Preeclampsia for the Nephrologist: Current Understanding in Diagnosis, Management, and Long-term Outcomes.

Preeclampsia is a multisystem progressive disorder of pregnancy that can be potentially catastrophic for the mother and the fetus. It involves complex perturbations of the kidney and systemic physiology, along with long-term effects on vascular and kidney health. Thus, the nephrologist plays a key role in the peripartum and long-term management of preeclampsia. Recent translational research has improved our understanding of its pathophysiology, and there is hope for novel therapies. In this review, we discuss the evolution of diagnostic criteria and dilemmas in the diagnosis of hypertensive disorders in pregnancy. We summarize the advances in the pathogenesis and prediction of preeclampsia. We describe the management and prevention of preeclampsia focusing specially on the forthcoming strategies from the nephrologist's perspective. We address the evidence regarding long-term outcomes for the mother and the child. We end with exploring areas warranting future research.

Dilemma for appeals to the moral significance of birth

Giubilini and Minerva argue that the permissibility of abortion entails the permissibility of infanticide. Proponents of what we refer to as the Birth Strategy claim that there is a morally...

Nanopolystyrene translocation and fetal deposition after acute lung exposure during late-stage pregnancy

BackgroundPlastic is everywhere. It is used in food packaging, storage containers, electronics, furniture, clothing, and common single-use disposable items. Microplastic and nanoplastic particulates are formed from bulk fragmentation and disintegration of plastic pollution. Plastic particulates have recently been detected in indoor air and remote atmospheric fallout. Due to their small size, microplastic and nanoplastic particulate in the atmosphere can be inhaled and may pose a risk for human health, specifically in susceptible populations. When inhaled, nanosized particles have been shown to translocate across pulmonary cell barriers to secondary organs, including the placenta. However, the potential for maternal-to-fetal translocation of nanosized-plastic particles and the impact of nanoplastic deposition or accumulation on fetal health remain unknown. In this study we investigated whether nanopolystyrene particles can cross the placental barrier and deposit in fetal tissues after maternal pulmonary exposure.ResultsPregnant Sprague Dawley rats were exposed to 20 nm rhodamine-labeled nanopolystyrene beads (2.64 × 1014 particles) via intratracheal instillation on gestational day (GD) 19. Twenty-four hours later on GD 20, maternal and fetal tissues were evaluated using fluorescent optical imaging. Fetal tissues were fixed for particle visualization with hyperspectral microscopy. Using isolated placental perfusion, a known concentration of nanopolystyrene was injected into the uterine artery. Maternal and fetal effluents were collected for 180 min and assessed for polystyrene particle concentration. Twenty-four hours after maternal exposure, fetal and placental weights were significantly lower (7 and 8%, respectively) compared with controls. Nanopolystyrene particles were detected in the maternal lung, heart, and spleen. Polystyrene nanoparticles were also observed in the placenta, fetal liver, lungs, heart, kidney, and brain suggesting maternal lung-to-fetal tissue nanoparticle translocation in late stage pregnancy.ConclusionThese studies confirm that maternal pulmonary exposure to nanopolystyrene results in the translocation of plastic particles to placental and fetal tissues and renders the fetoplacental unit vulnerable to adverse effects. These data are vital to the understanding of plastic particulate toxicology and the developmental origins of health and disease.

CONCEPT ANALYSIS OF MATERNAL-FETAL ATTACHMENT

Background: Knowing about prenatal attachment is crucial because it plays a significant role in pregnant women and their babies' health. Healthcare providers, particularly midwives, need to understand the concept of attachment between mother and unborn baby. However, surrogate terms to apply the concept of maternal-fetal attachment are found, and ambiguity on the definition remains.&#x0D; Objective: To provide a more precise definition of the concept of maternal-fetal attachment&#x0D; Method: The Walker and Avant's concept analysis approach was applied.&#x0D; Results: The attributes of maternal-fetal attachment include (i) having a positive emotion, (ii) paying attention to the physical progress of the fetus and mothers themselves, (iii) having a reciprocal interaction with the baby, (iv) monitoring and imaging the unborn baby, and (v) having a desire to protect her unborn baby from harm and increase her health practices. Maternal-fetal attachment is the affection relationship, desire for protection, building the interaction, and the emotional tie between the mother and her unborn baby during the pregnancy. This personal connection is developed, mainly when the quickening is present during the late stage of pregnancy. Maternal-fetal attachment creates an emotional relationship with the unborn baby and leads the mother to express it with behavior.&#x0D; Conclusion: This concept analysis provides new insight into the maternal-fetal attachment concept used for nurses and midwives in their practice.&#x0D;

Comparison of Decidual Vasculopathy in Central and Peripheral Regions of Placenta with Implication of Lateral Growth and Spiral Artery Remodeling

Decidual vasculopathy at late gestation was shown to be associated with spiral artery remodeling at implantation. Dramatic decidual vascular transformation from early to late stage pregnancy suggests a dynamic spatiotemporal relationship between the various vascular components in spiral artery remodeling and decidual vasculopathy. The central and peripheral portions of 105 placentas with decidual vasculopathy at term were examined with or without preeclampsia to see if temporal vascular regeneration was present. Central and peripheral vasculopathy and central and peripheral regeneration were compared. The peripheral portion showed more decidual vasculopathy (88 of total 105, 83.8%) than central portion (72 of total 105, 68.6%, p &lt; 0.0001). However, central portion showed more vascular regeneration (51 of total 105, 48.6%) than the peripheral portion (23 of total 105, 21.9%, p &lt; 0.0001). There was no difference in vasculopathy or regeneration with or without preeclampsia. Spiral artery remodeling is non-synchronous during placental growth and vascular regeneration. This spatiotemporal sequence may help interpretation of morphologic changes of decidual vasculopathy.

Inflammasome signaling in human placental trophoblasts regulates immune defense against Listeria monocytogenes infection.

The human placenta is a dynamic organ that modulates physiological adaptations to pregnancy. To define the immunological signature of the human placenta, we performed unbiased profiling of secreted immune factors from human chorionic villi isolated from placentas at mid and late stages of pregnancy. We show that placental trophoblasts constitutively secrete the inflammasome-associated cytokines IL-1β and IL-18, which is blocked by NLRP3 inflammasome inhibitors and occurs without detectable gasdermin D cleavage. We further show that placenta-derived IL-1β primes monocytes for inflammasome induction to protect against Listeria monocytogenes infection. Last, we show that the human placenta responds to L. monocytogenes infection through additional inflammasome activation and that inhibition of this pathway sensitizes villi to infection. Our results thus identify the inflammasome as an important mechanism by which the human placenta regulates systemic and local immunity during pregnancy to defend against L. monocytogenes infection.

The Discovery of Insulin-Regulated Aminopeptidase (IRAP) Inhibitors: A Literature Review.

Insulin-Regulated Aminopeptidase (IRAP, EC 3.4.11.3) is a multi-tasking member of the M1 family of zinc aminopeptidases. Among its diverse biological functions, IRAP is a regulator of oxytocin levels during late stages of pregnancy, it affects cellular glucose uptake by trafficking of the glucose transporter type 4 and it mediates antigen cross-presentation by dendritic cells. Accumulating evidence show that pharmacological inhibition of IRAP may hold promise as a valid approach for the treatment of several pathological states such as memory disorders, neurodegenerative diseases, etc. Aiming to the investigation of physiological roles of IRAP and therapeutic potential of its regulation, intense research efforts have been dedicated to the discovery of small-molecule inhibitors. Moreover, reliable structure-activity relationships have been largely facilitated by recent crystal structures of IRAP and detailed computational studies. This review aims to summarize efforts of medicinal chemists toward the design and development of IRAP inhibitors, with special emphasis to factors affecting inhibitor selectivity.

Pregnancy in congenital central hypoventilation syndrome

Congenital central hypoventilation syndrome is a rare genetic disorder of autonomic regulation of breathing resulting from mutations in the paired-like homeobox gene. Individuals with congenital central hypoventilation syndrome demonstrate an absent or diminished physiological response to hypercapnia and hypoxia that is most severe during sleep and depend on mechanical ventilation to maintain normal gas exchange. Increased disease awareness and availability of paired-like homeobox gene testing has improved congenital central hypoventilation syndrome morbidity and mortality, and patients are now living into adulthood. During pregnancy, delivery, and the postpartum period, women with congenital central hypoventilation syndrome are vulnerable to developing respiratory insufficiency. Currently, there is no standardized approach to monitoring ventilatory status and anticipating the need for changes to existing ventilatory support for women with congenital central hypoventilation syndrome during pregnancy, labor, and delivery. This study aimed to characterize current practices for monitoring ventilatory status and managing ventilatory needs in women with congenital central hypoventilation syndrome during pregnancy; identify specific circumstances through which ventilation may be compromised during pregnancy, delivery, and postpartum; evaluate utilization of prenatal congenital central hypoventilation syndrome testing; and report any adverse pregnancy outcomes. We conducted an anonymous cross-sectional survey of women with congenital central hypoventilation syndrome with current or prior pregnancy. The 26-item electronic questionnaire included questions on congenital central hypoventilation syndrome genotype; number and outcome of pregnancies; use of mechanical ventilation; and issues with or adjustments made to ventilation during pregnancy, delivery, and the postpartum period. We received 10 responses. Three patients were not diagnosed with congenital central hypoventilation syndrome until after pregnancy and delivery. The 7 patients with a preexisting congenital central hypoventilation syndrome diagnosis reported information on 10 total pregnancies. At baseline, patients relied on various types of ventilatory support including positive pressure ventilation via tracheostomy, bilevel noninvasive positive pressure ventilation, and diaphragm pacing by phrenic nerve stimulation. Polysomnography for objective assessment of nocturnal ventilation was not consistently utilized. Changes to baseline ventilatory support were required during 3 out of 10 pregnancies. In addition, 2 patients using diaphragm pacing reported discomfort with pacing during the third trimester or after cesarean delivery, prompting discontinuation of diaphragm pacing. In 1 instance, discontinuation of diaphragm pacing and lack of recognition of need for an alternative support method led to respiratory arrest and need for emergent resuscitation. All patients who were offered prenatal congenital central hypoventilation syndrome testing chose to undergo testing. Of note, 9 out of 10 pregnancies were carried successfully to term and 5 infants were diagnosed with congenital central hypoventilation syndrome. Women with congenital central hypoventilation syndrome may experience issues maintaining adequate ventilation during pregnancy, necessitating an adjustment of ventilator settings or use of an alternative type of ventilation. Objective assessment of nocturnal ventilation by means of polysomnography is an important part of congenital central hypoventilation syndrome pregnancy care to optimize maintenance of adequate gas exchange. Patients who rely on diaphragm pacing may experience discomfort with pacing during the later stages of pregnancy and after cesarean delivery. Anticipatory guidance and contingency planning for changing ventilatory needs should be discussed early in pregnancy. Prenatal congenital central hypoventilation syndrome testing should be offered to pregnant patients with congenital central hypoventilation syndrome to inform delivery decisions and prepare for the provision of advanced neonatal care.

Comparison of risk factors, management and outcome between early and lately detected gestational diabetes mellitus patients

Aim: The aim of this study is to compare the risk factors, management and pregnancy outcome between the Gestational Diabetes Mellitus (GDM) patients who were diagnosed at early and late stage of pregnancy. Methods: We randomly selected 250 newly detected GDM patients and examined them. They were divided into two groups considering the gestational age at the time of diagnosis: early group (13 to 28 weeks) and late group (after 28 weeks). Results: Data of 150 cases from early group and 100 cases from late group were analyzed. Incidence of nulliparous GDM patient (24% vs 36%, P – 0.04),weight at the time of GDM diagnosis (66.0 ± 11.067 vs 69.93 ± 9.865, P - 0.004) were significantly higher in late group and so was the excess body weight from ideal body weight (14.13 ± 10.147 vs 17.94 ± 8.535, P - 0.002). Prevalence of pre pregnancy obese/ overweight patients (68.7% vs 80.0%, P - 0.047), maternal H/O of DM (45.3% vs 32%, p - 0.035) and H/O unexplained fetal loss (24% vs 10%, p - 0.005) were higher in early group. There were no significant differences of blood sugar values (SMBG) between the groups except fasting blood sugar at 2nd visit (F2) (5.557 ± 1.045 vs 5.167 ± 0.960, P - 0.01). Conclusion: This study suggests that range of screening should be broader to detect high risk and undiagnosed GDM mothers. Beside that it has also showed that only early diagnosis and intervention will not be enough to prevent the complications if the patients fails to understand and participate in GDM management.

Abstract P226: The Analysis Of Regional Placental Hemodynamics Using Combined Photoacoustic Imaging And Contrast-enhanced Ultrasound

Placental insufficiency is often associated with pregnancies at risk for fetal growth restriction or preeclampsia. We have previously demonstrated that three-dimensional ultrasound-guided photoacoustic imaging (PAI) is a sensitive tool for assessing regional variations in placental oxygenation in mice. However, whether changes in placental oxygenation determined by the PAI correlate with changes in placental perfusion is unknown and was tested in this study. PAI combines optical contrast of photoacoustic laser technology with a high spatial resolution of ultrasound. Placental vascular oxygen saturation (sO2) was quantified in C57Bl/6 mice by the PAI using Vevo 2100 LAZR instrument (Fujifilm, VisualSonics). 50 microliters of Vevo MicroMarker contrast agent was delivered via a bolus tail-vein injection. Placental perfusion parameters were determined at day 15 of gestation in C57Bl/6 mice. Our data demonstrated significantly greater oxygenation in the placental labyrinth versus maternal triangle area (53.01±1.7 vs. 42.7±4.2 % sO2; n=6, p&lt;0.05). No regional differences were detected in relative blood flow in these mice (dB or a.u.). However “time-to-peak” (perfusion kinetics parameter) was greater in the labyrinth compared with maternal triangle area (2.3 times, p&lt;0.05, n=5). Our data show that the overall blood flow is similar throughout the placenta at mid-late gestation, while the perfusion is greater in the labyrinth (fetal) side of the placenta consistent with greater vascularization of this area. Our data suggest that placental sO2 measured by the PAI is associated with coordinated changes in placental perfusion during late stages of mouse pregnancy. This approach provides a novel tool for non-invasively investigating placental environment and pregnancy outcomes particularly in pregnancies complicated by IUGR or preeclampsia.