Lower Pregnancy Research Articles

Use of tenofovir-based PrEP among pregnant women in South Africa.

We developed Healthy Families-PrEP to support perinatal women to use HIV prevention strategies. Single arm study to evaluate PrEP use among pregnant women exposed to the intervention. We offered safer conception counselling including TDF/FTC as PrEP with adherence support (Healthy Families-PrEP) for women planning for pregnancy in South Africa with a partner with HIV or unknown serostatus. Women completed pregnancy and HIV testing quarterly and were followed for one year or until pregnancy end. For those initiating PrEP, electronic pillcap data and plasma were collected. We described PrEP adherence by proportion of days with pillcap openings and proportion of women with detected (≥10ng/mL) plasma tenofovir. From November 2017 to January 2020, 326 women with median age 24 (IQR: 22-27) years enrolled. Partner HIV-serostatus was unknown by 316 (97%). Over 3,204 person-months of follow-up, 56 women became pregnant. Twenty-six women used PrEP during pregnancy and opened pillcaps on a mean of 53.1% (95% CI 46.9-59.3%) of days. Plasma tenofovir was detected among 25.0%, 15.4%, and 12.5% of women providing samples during months 0-3, 4-6, and 7-9. No HIV seroconversions were observed. We observed low pregnancy incidence. Counselling may have encouraged delayed pregnancy plans; some women may have exaggerated pregnancy plans to enroll. About half of pregnant women used PrEP and took over half of doses by pillcap. Fewer than 25% had tenofovir detected, likely reflecting pregnancy-related pharmacokinetics and adherence challenges. High interest in pregnancy PrEP use highlights the need to optimize adherence support and prevention choice.

Oocyte donation pregnancies with high fetal-maternal immunogenetic dissimilarity show alterations in the maternal peripheral immunoregulatory response

Oocyte donation (OD) pregnancies result in increased fetal-maternal immunogenetic dissimilarity due to paternal and donor-derived genes. Higher fetal-maternal HLA mismatches are correlated with preeclampsia. Therefore, this study explored the maternal immune response, focusing on regulatory T cells (Tregs), during low versus high allogeneic pregnancies, and healthy versus preeclamptic OD pregnancies. Ten healthy and five preeclamptic OD pregnancies were included. Maternal peripheral blood was collected at different stages of pregnancy. Fetal-maternal HLA mismatches were determined, and immunophenotyping of peripheral blood mononuclear cells was conducted using a 22-colour spectral flow cytometry panel. Cytokines and hormones were detected in maternal plasma using ELISA and Luminex assays. The findings show similarities, but also distinct differences between low and high allogeneic healthy OD pregnancies. Early high allogeneic OD pregnancy showed reduction in Tregs, and CD8+ T cells, alongside lower percentage of effector/memory Tregs expressing PD-1 and Helios. Additionally, high allogeneic OD pregnancies showed increased IL-6 and progesterone in the first trimester. These variations suggest a different mode of immune regulation in early high allogeneic OD pregnancies, possibly to maintain healthy pregnancy. Further comparative analyses revealed reduced CD45RO+CTLA-4+ Tregs and increased latent TGF-β1 and -β2 levels in early preeclamptic compared to healthy OD pregnancy. Late-stage preeclamptic OD pregnancies exhibited higher frequencies of CD45RO+TIGIT+ Tregs and higher levels of TNFα, indicating both a regulatory and pro-inflammatory environment. Overall, this study sheds light on the course of various immunoregulatory key players in OD pregnancy, and expands knowledge on maternal tolerance in this particular type of pregnancy.

Effect of day 3 embryo cell number on the pregnancy and neonatal outcomes of day 4 single embryo transfer from fresh cycles

BackgroundThe aim of this retrospective cohort study was to assess the impact of day 3(D3) embryo cell number on the clinical pregnancy and neonatal outcomes of day 4(D4) single embryo transfer in fresh cycles.MethodsThe study included 431 day 4 single embryo transfer in fresh cycles conducted between December 2018 and June 2023. These cycles were divided into three groups according to the day 3 embryo cell number: 248 cycles in the 7 ~ 9-cell group, 149 cycles in the 10 ~ 13-cell group and 34 cycles in the >13-cell group, and clinical pregnancy outcomes and neonatal outcomes were compared among the three groups.ResultsThe clinical outcomes with 10 ~ 13-cell were significantly higher than those of the 7 ~ 9-cell group, regardless of whether the female age was < 30 or ≥ 30 years. The same result could be found when the insemination pattern was IVF, and when the transferred embryos were the grade of complete fusion. There were no differences in neonatal outcomes between different groups.After adjusting for confounding factors, the 7 ~ 9-cell group was associated with lower clinical pregnancy rates(CBR) and live birth rates(LBR) compared with the 10 ~ 13-cell group (CPR: aOR 0.527, 95% CI 0.317 ~ 0.874, P = 0.013; LBR: aOR 0.499, 95% CI 0.308 ~ 0.807, P = 0.005).ConclusionThe cell number of D3 embryos can be an important reference indicator for D4 embryo selection. When performing day 4 single embryo transfer in fresh cycles, embryos with 10 ~ 13-cell on D3 can be preferentially selected for transplantation to enhance clinical outcomes, especially when the insemination pattern is IVF, and when the transferred embryos are the grade of compaction stage.

Extracellular vesicle-packaged PKM2 from endometriotic stromal cells promotes endometrial collagen I deposition by inhibiting autophagy in endometriosis

Aberrant endometrial collagen I deposition during the implantation window impairs endometrial stromal cell (ESC) decidualization, which may contribute to lower pregnancy rate in endometriosis (EMs) patients with in vitro fertilization (IVF) treatment. However, the underlying mechanism of eutopic aberrant endometrium collagen I deposition in EMs remains unclear. In this study, we found increased endometrial collagen I and defective decidualization in the mid-secretory phase of EMs patients, while the level of eutopic ESCs' autophagy was decreased, which was an important mechanism of intracellular collagen degradation. Lower ESCs' autophagy level may cause the endometrial collagen I deposition in EMs. Furthermore, in vivo and in vitro studies showed that the extracellular vesicles derived from the ectopic ESCs of EMs patients (EMs-EVs) encapsulated higher PKM2 inhibited autophagy of the ESCs accompanied by an increase of collagen I. We also found that the constructed EMs-EVsAd-PKM2 with PKM2 overexpression inhibited ESCs' autophagy by activating the Akt/mTOR signaling pathway. And the expressions of PKM2, p-Akt and p-mTOR were also increased in the endometrium of EMs patients. Collectively, these data showed that EMs-EVs delivering PKM2 inhibited autophagy inducing aberrant endometrial collagen I deposition via the Akt/mTOR signaling pathway to impair decidualization, which provided a potential therapeutic target for improving the IVF pregnancy rate in EMs patients.

Knowledge and concern towards endometriosis among Lebanese women: a cross-sectional study

BackgroundEndometriosis is a prevalent disease among women worldwide, including the Middle East. Insufficient knowledge about the disease causes delayed diagnosis which could result in major complications, particularly infertility. Thus, being aware of the symptom’s aids in prompt diagnosis and treatment. Furthermore, no research has been done in Lebanon to assess the Lebanese women’s knowledge about endometriosis.AimTo determine the understanding and concerns of Lebanese women about endometriosis which aids in identifying knowledge gaps and misconceptions so that they can be addressed.MethodsA cross-sectional study was conducted between February and March 2024 among Lebanese females, who completed the authors’ online questionnaire assessing knowledge and concern about endometriosis and its associated symptoms, Multivariable logistic regression analysis was used to explore the relationship between score of knowledge and different characteristics of patients.ResultsA survey of 725 Lebanese women (mean age 32.5 years, SD = 9.5) revealed low knowledge (25.9%) about endometriosis origin, symptoms, and treatment. Over 60% were unaware of endometriosis symptoms, while 9.9% mistakenly believed menstrual cramps indicated the disease. Younger age (< 35 years), higher education (Master’s degree or above), professional occupation, lower pregnancy and live birth rates, and no history of abortion, endometriosis, pelvic inflammatory disease, uterine or ovarian conditions, and pelvic surgeries were significantly associated with greater knowledge of endometriosis.ConclusionLebanese women’s knowledge of endometriosis is limited. This highlights how crucial medical education and awareness initiatives are in addressing the issue in Lebanon. Greater awareness of endometriosis will encourage Lebanese women to seek medical advice and consultation, resulting in earlier detection and treatment.

Abstract 4136984: Low Occurence of Fetal Extranodal Findings and AV Interval Prolongation in Prospectively Followed High Titer Anti-Ro Pregnancies

. Background: Third-degree atrioventricular block (AVB) is the most common manifestation of Anti-Ro antibody associated fetal cardiac disease. Extranodal findings of isolated cardiac echogenicity, valvulitis with insufficiency and AV interval prolongation have been reported but not described in large prospective series. Aims: To report the occurrence and outcomes of extranodal findings in subjects followed prospectively since 2020 in STOP BLOQ (Surveillance and Treatment to Prevent Fetal AV block Likely to Occur Quickly) and the Registry for Neonatal Lupus (RNL). Methods: We reviewed fetal echo reports from pregnant STOP BLOQ and RNL Anti-Ro antibody subjects. Pregnancies with high (&gt;1000 EU for anti-Ro52 or 60) antibody titers measured in a core research lab underwent surveillance with home fetal heart rate monitoring (FHRM) 3x/day and weekly or bi-weekly fetal echos from 17- 26 gestational weeks. Low titer subjects underwent echo or no surveillance based on local site protocol. We evaluated cardiac function, effusions, cardiac echogenicity and its location, any tricuspid (TV) or mitral (MV) insufficiency trivial or &gt;trivial) and AV conduction times (&lt;150, 150-170 or &gt;170 ms) Results: Echo reports were available in 622 prospectively followed pregnancies (376 high (40/376 with a previously affected child) and 246 low-titer pregnancies. All had subjectively normal ventricular function and none had effusions. Seven fetuses, 2 low and 5 high titer at 19 (range 16.7-21.7) weeks demonstrated cardiac echogenicity (n=6), AV or semilunar valve insufficiency (n=2) or AV interval 150-170 ms (n=2) (Table). Subjects 1 and 2, both high titer and treated with prophylactic Plaquenil (400 mg/d before 10 gestational weeks), had prior fetal AVB. Subject #1 had normal AV conduction but MV and TV echogenicity and moderate insufficiency of both valves which resolved in days after IVIG and dexamethasone (dex) treatment, but 3° AVB developed at 19 weeks after dex wean. Subjects 2-7 received no treatment and extranodal findings did not progress to cardiac dysfunction or AVB. During the same time period, 10 high titer subjects developed 2° or 3° AVB. Conclusion: Anti-Ro associated extranodal findings are rare, occurring in 1% of pregnancies overall and in 5% of pregnancies with a previously affected child. Unlike AVB, extranodal findings can occur in low titer pregnancies. The role of treatment for isolated extranodal findings in the absence of cardiac dysfunction is unclear.

Impact of Prednisone on Vasectomy Reversal Outcomes (iPRED Study): Results from a Randomized, Controlled Clinical Trial

ObjectiveTo evaluate the safety and efficacy of prednisone on pregnancy rates and semen concentrations at 1-year post vasectomy reversal (post-VR). DesignRandomized, controlled trial (NCT04788823). SettingSingle medical center specializing in vasectomy reversals. PatientsMen undergoing vasectomy reversal. InterventionsParticipants were randomized 1:1:1:1 to Control (no prednisone), Pred High (20 mg prednisone taper, every other month x 3 months), Pred PRN (20 mg prednisone taper x 3 courses maximum if sperm counts were declining or 0) and Pred Low (5 mg/day, every other week x 6 months). Note that Pred High and Pred PRN were stopped prematurely due to interim findings demonstrating lower pregnancy rates. Main Outcome MeasuresPregnancy rates, semen concentrations, and adverse events. The current study reports outcomes at 1-year. Results75 men were enrolled, with 1-year data available in 73 (Control, n=25, Pred High, n=14, Pred PRN, n=11, Pred Low, n=23). Baseline factors were similar among cohorts. Pregnancy rates at 12-months were higher in Controls (65%) and Pred Low (67%) compared to Pred High (17%) and Pred PRN (38%), p=0.02. Overall patency at 12-months (sperm at any point) was 99%, with no statistically significant differences noted between groups for patency, median concentrations by month (range 3-42), or overall median concentrations (median of medians range 5-16). ConclusionsHigh dose (20 mg) prednisone results in decreased pregnancy rates post-VR, an effect which is independent of sperm concentration, dose dependent and persists for months after discontinuation. Prednisone does not impact sperm concentrations at doses ranging from 5-20 mg.

Factores que influyen en la inseminación artificial con semen fresco en alpacas (&lt;i&gt;Vicugna pacos&lt;/i&gt;)

The aim of the study was to evaluate factors that affect the fertility of artificial insemination (AI) with fresh diluted semen in alpacas. In Exp. 1, females with preovulatory follicles with diameters ≥7-≤ 9 or ≥10-≤12 mm were inseminated; in Exp. 2 the females were inseminated at 24, 26, 28 and 30 h after ovulation induction; In Exp. 3, alpacas were inseminated with semen at four concentrations: 15, 25, 35 and 45x106 sperm/ml; and in Exp. 4, using the best results from the previous experiments, 350 alpacas were inseminated in two peasant communities. Semen was collected by the post-copulatory method, using ejaculates with motility ≥60%, diluted in Tris-glucose-citric acid and egg yolk. Alpacas with preovulatory follicles ≥7 mm were selected for AI. Ovulation induction was done with a GnRH analogue and pregnancy diagnosis was made 30 days after service. Pregnancy rate was not affected by follicular size. AI 24 to 26 h after ovulation induction obtained a higher pregnancy rate (50 and 55%, respectively; p&lt;0.05) compared to those inseminated at 28 and 30 h (35 and 30%). AI with 15x106 sperm/ml resulted in low pregnancy rates (30%) compared to 35 and 45x106 sperm/ml (50 and 55%, respectively). In the peasant communities, 55% pregnancy rate was obtained. The results suggest that the success of AI with fresh semen in alpacas is highly dependent on sperm dose and timing of insemination.

Study of placenta histopathology in low birth weight deliveries: A prospective cross-sectional study at Nobel Medical College Teaching Hospital

Background: Placenta is the most important organ that represents the status of the mother and fetus. Its examination on gross and microscopy can reveal varied pregnancy-related diseases, decreasing future adverse pregnancy outcomes. This study aims to examine the placenta histopathologically among low birth weight pregnancies. Materials and methods: A prospective case-control study was conducted in the Department of Pathology over one year. The placenta of low birth weight (weight &lt; 2.5 kg) term pregnancies were histopathologically examined. The maternal demographics, co-morbidity, gravida, and hemoglobin levels were recorded. Descriptive statistics, and student t-test or Chi-square test were used for two-group analysis. Results: Thirty-two consecutive patients enrolled in each group. A significant proportion of the patients in the study group were anemic (9.2 vs. 11.5 gm/dl; p=0.03). Pregnancy-induced hypertension rate was significantly higher in the study group (31% vs. 9%; p = 0.042). Gross observations in low birth weight pregnancies were sub-chorionic fibrin deposition (75%), calcification (37%) and infarction (31%). On microscopy, chorionic vessel thrombosis was significantly higher in the study group (56% vs. 6%; p= 0.003). Furthermore, chorioamnionitis (34%) and placental floor infarction (12%) were also observed in a significantly higher number of placentas in the study group. Conclusions: Anemia and pregnancy-induced hypertension are important associated factors for low birth weight pregnancies. Pathological examinations reveal higher fibrin deposition, infarction, calcification, sub-chronic vessel thrombosis, and chorioamnionitis in low birth weight placenta.

Management considerations of moose life‐history characteristics in Colorado, USA

Wildlife management agencies are obliged to provide evidence‐based management recommendations to stakeholders. However, allocation of resources towards the management of species is rarely uniform. The consideration of life‐history characteristics of moose offers wildlife managers a more robust understanding of population ecology, while also providing insight into potential limiting factors for long‐term management. From 2014–2020 we simultaneously measured survival of adult female moose, as well as calf productivity, in relation to the nutritional condition of adult females, in Colorado. Mean annual adult survival was high (93% and 95% confidence interval: 91–95%). Human hunter harvest was the leading source of mortality and lowered annual adult survival to 88%. Malnutrition was the leading source of natural mortality. Mean annual pregnancy rates were relatively low (77%) and highly variable (95% confidence interval: 65–88%). However, low pregnancy rates were compensated for by high apparent calf survival. The best predictor of moose pregnancy was nutritional condition. Our data suggest that bottom‐up ecological processes were affecting moose population growth, but populations were likely increasing during our study, with a simulated population growth rate of 1.04 (95% confidence interval: 0.94–1.17).

Fertility outcomes in cows with subclinical endometritis after clinical cure of clinical endometritis

Clinical endometritis (CE) is common in post-partum dairy cows and is associated with impaired reproductive performance. The aim of the study was to evaluate the effect of subclinical endometritis (SE) in cows clinically cured of CE on their fertility. The study was performed on 215 Holstein Friesian cows with CE diagnosed by vaginoscopy and ultrasound between 21 and 28 days after parturition. All cows were clinically examined three times at an interval of 2 weeks. Cows without signs of CE were considered cured, and endometrial samples from the uteri were collected by cytobrush to diagnose SE using cytological evaluation of polymorphonuclear neutrophils (PMNs) percentage. The threshold for SE was set at ≥ 5% PMNs. Intervals calving to oestrus and calving to conception, first AI pregnancy rate, pregnancy rate 200 days after artificial insemination (AI), the number of AI per pregnancy (AI/P), pregnancy loss, and culling rate were calculated. SE was diagnosed in 40.9% of cows clinically cured of CE. There were significant differences in the AI/P (3.2 vs. 2.6; p < 0.027) and the pregnancy loss (18.2% vs. 4.7%; p < 0.002) between cows with SE and without SE. Cows with SE showed a tendency towards longer interval calving to conception, lower pregnancy rate 200 days after AI, and higher culling rate. In conclusion, SE after a clinical cure of CE may reduce fertility in dairy cows.

Higher serum progesterone level has no negative impact on live birth rate in frozen embryo transfer

Optimal synchronisation between the endometrium and the embryo is key to the success of frozen embryo transfers (FET). It is achieved by administering different doses of exogenous oestrogen and progesterone (P4). The negative impact of low levels of P4 on FET has been reported, but there is a lack of knowledge about which levels are most appropriate. We aimed to evaluate whether high serum P4 levels measured on FET day affect the probability of having a baby at home. This retrospective cohort study includes 7546 FET cycles performed with hormone replacement therapy (HRT) for artificial endometrial preparation. Patients were divided into three groups according to P level on FET day (ng/mL): P4 < 20(n = 6623), P4 ≥ 20–40 (n = 770) and P > 40 (n = 146). Female age was per group P4 < 20 = 38.7 ± 3.1, P ≥ 20–40 = 39.0 ± 3.0, and P4 > 40 = 38.1 ± 2.9 years old (p = 0.53). The group with the highest progesterone levels found lower ongoing pregnancy rates without statistical significance (56.3 % (P4 < 20) vs 56.8 % (P4 ≥ 20-<40) vs 51.4 % (P4 > 40); p = 0.5). Miscarriage rate was also higher, although not significantly: 16.2 % (P4 < 20) vs 15.0 % (P4 ≥ 20-<40) vs 18.0 % (P4 > 40) (p = 0.6). These findings were explored with an adjusted analysis. A higher, but not significant, odds of miscarriage was observed when P4 > 40 ng/ml, aOR = 1.14 (0.75–1.74) (p = 0.55) whereas no such association was found with P4 ≥ 20–40 ng/ml (aOR = 0.92 (0.74–1.15) (p = 0.46)). The probability of livebirth is similar when the patient was P4 > 40 (aOR = 0.77 (0.51–1.15) (p = 0.20)) than when P4 ≥ 20-<40 (aOR = 0.94 (0.79–1.11) (p = 0.47). In conclusion, women with elevated serum P4 levels on the day of FET after HRT do not find their probability of live birth impaired.

Is lifestyle different in male partners experiencing recurrent pregnancy loss compared to men fathering a live birth?

Recurrent pregnancy loss is characterized by three or more consecutive pregnancy losses. Although the causes of recurrent pregnancy loss are often unknown, chromosomal defects and fetal anomalies account for a significant proportion of cases. Previous research has primarily focused on maternal factors, but recent attention has shifted to the role of male lifestyle factors. This study examined how male lifestyle factors and chronic illnesses affect recurrent pregnancy loss in a Danish cohort. Objectives included analyzing demographic and clinical features, as well as assessing lifestyle factors and pregnancy outcomes. We included 741 males referred to the Danish recurrent pregnancy loss unit between 2009 and 2021, alongside a control group of 1173 males from the PREGCO study. Data on demography, clinical features, lifestyle factors, and pregnancy outcomes were collected and analyzed. The recurrent pregnancy loss group had a higher mean age compared to the controls. Although there was a trend suggesting a higher prevalence of obesity in the recurrent pregnancy loss group, statistical significance was not reached. The prevalence of chronic illnesses was similar in both groups. In the recurrent pregnancy loss group, a higher body mass index and history of previous or current smoking were associated with a lower pregnancy rate, and men who never smoked had an increased likelihood of achieving pregnancy. However, these associations lost significance after adjusting for potential confounders. The study suggests an association between male obesity and smoking, and decreased pregnancy rates after referral for recurrent pregnancy loss. However, further research is needed to understand the underlying mechanisms and establish causality in this association. The study reveals potential associations between male smoking, male obesity, and reduced pregnancy rates in individuals referred for recurrent pregnancy loss. These findings emphasize the importance of considering male lifestyle factors in the evaluation and management of recurrent pregnancy loss.

Factors and consequences of early marriage among women in Jumla

Background: In Nepal, child marriage is seen as a significant obstacle to the country's social and economic growth as well as a significant threat to the health of women. Despite a steady decline in this harmful practice over the past decade, child marriage remains widespread, with approximately one in five girls married in childhood across the globe. The objective of the study was to find out the factors and consequences of early marriage among women in Jumla. Methods: The cross-sectional study was conducted among the residents of Jumla District where 280 married reproductive age group women were taken as subjects. Simple random sampling technique was used. Data was collected by using semi-structured interview schedule. Analysis was done by using descriptive and inferential statistics. Results: Study findings showed that majority (77.9%) of the respondents got early marriage. Early marriage was statistically association with educational status at the time of marriage (p=0.000), occupational status (p=0.000), type of marriage ((p=0.014), educational status of father (p=0.009), occupational status of father (p=0.016), parental income (p=0.000), decision making (p=0.003), husband´s education and occupation (p=0.000). Inadequate education (70.7%) and economic resources (83.9%), customs (66.8%) and unemployment (63.2%) are the main reasons of early marriage. Likewise, increasing responsibility (80.7%), lower abdominal pain (67.5%), uterine prolapse (65.4%), early pregnancy (71.1%), unplanned pregnancy (58.9%) and prolonged labor (51.8%) are the main consequences of early marriage. Therefore, it is concluded that more than three fourth of the respondents were married early which lead to many consequences. Conclusion: The study concluded that more than three fourth of the respondents got early marriage. Early marriage had significant association with educational status at the time of marriage, occupational status, type of marriage, occupational status of father, parental income, decision making at time of marriage, husband´s education and occupation. Inadequate education and economic resources, customs and unemployment are the main reasons of early marriage. Likewise, early pregnancy, unplanned pregnancy, prolonged labor, lower abdominal pain, uterine prolapse, and increasing responsibility are the main consequences of early marriage. Hence, the efforts have to be made to prevent the early marriage through awareness and various educational programs.

Folate and cobalamin status, indicators, modulators, interactions, and reference ranges from early pregnancy until birth: the Reus–Tarragona birth cohort study

BackgroundFolate and cobalamin status, although essential for pregnancy, are not routinely monitored in prenatal care. ObjectivesTo investigate folate and cobalamin status and determinants throughout pregnancy, in the absence of mandatory folic acid (FA) fortification. MethodsIn a cohort study of 831 mothers recruited at <12 gestational weeks (GW), plasma folate, total homocysteine (tHcy), cobalamin, holotranscobalamin (holoTC), methylmalonic acid (MMA), red blood cell folate (RBCF), and the combined cobalamin status indicator (cB12) were determined at ≤12, 15, 24–27, 34 GW, labor and in the cord. Single nucleotide polymorphisms affecting folate and cobalamin status were determined. FA, cobalamin, micronutrient supplement use, and dietary folate and cobalamin intake (food frequency questionnaire) were recorded. Folate and cobalamin status predictors were assessed by multiple linear regression analysis. ResultsOnly 36.1% of the participants took FA preconceptionally and 47.4% and 7.3% had suboptimal RBCF (<906 nmol/L) and plasma cobalamin status (≤221 pmol/L), respectively, at ≤12 GW. RBCF determinants included planned pregnancy, FA supplementation, plasma cobalamin, and methylenetetrahydrofolate (MTHFR) 677C>T genotype. Cobalamin supplementation was positively associated with plasma cobalamin and early holoTC. Smoking and BMI were inversely associated with plasma cobalamin and early holoTC, but none were associated with MMA. Only participants with the MTHFR 677TT genotype, exceeding FA supplement recommendations, improved their folate status (interaction term: B (95% CI):0.15 (0.01, 0.29), P = 0.032). Smoking was inversely associated with plasma cobalamin status in participants with the methionine synthase reductase (MTRR) 524CC genotype only (interaction term:0.07 (0.01, 0.04), P = 0.014). Mothers with low early pregnancy cobalamin status and also those with bigger newborns, had lower cobalamin status at labor. ConclusionsSuboptimal early pregnancy folate or cobalamin status affected 47.4% and 7.3% of the participants, respectively. The MTHFR 677TT genotype predicted folate status throughout pregnancy. Smoking and BMI were negatively associated with cobalamin status throughout pregnancy.Clinical Trial Registry number and website where it was obtained: NCT01778205. www.clinicaltrials.gov

Sperm DNA Fragmentation: Unraveling Its Imperative Impact on Male Infertility Based on Recent Evidence.

Male factors may be present in up to 50-70% of infertile couples and the prevalence of male infertility accounts for 20-30% of infertility cases. Understanding the mechanisms and causes behind male infertility remains a challenge, but new diagnostic tools such as DNA fragmentation might aid in cases where the routine semen analysis is insufficient. DNA fragmentation, which refers to damages or breaks of the genetic material of the spermatozoa, is considered one of the main causes of male infertility due to impaired functional capability of sperm. The aim of the present narrative review is to investigate and enlighten the potential correlation between DNA fragmentation and male infertility parameters such as the seminal profile and the reproductive outcomes. Comprehensive research in PubMed/Medline and Scopus databases was conducted and 28 studies were included in the present review. Fourteen studies provided data regarding the impact of DNA fragmentation and seminal parameters and showed a correlation of significantly lower sperm count, lower concentration, motility, and abnormal morphology with an increased DNA fragmentation index (DFI). Similarly, 15 studies provided data regarding the impact of DFI on reproductive outcomes. Two studies showed higher aneuploidy rates with higher DFI values, and seven studies showed significantly lower pregnancy rates and live birth rates with higher DFI values. Ultimately, the studies included in this review highlight, collectively, the importance of measuring sperm DFI in the assessment of male infertility. Further studies are needed to explore the effectiveness of interventions aiming to reduce DFI levels.

Dietary Sugar and Saturated Fat Consumption Associated with the Gastrointestinal Microbiome during Pregnancy

BackgroundGrowing evidence supports changes in the gastrointestinal microbiome over the course of pregnancy may have an impact on the short- and long-term health of both the mother and the child. ObjectiveOur objective was to explore the association of diet quality, as measured by the Healthy Eating Index (HEI), with the composition and gene ontology (GO) representation of microbial function in the maternal gastrointestinal microbiome during pregnancy. MethodsWe conducted a retrospective, observational analysis of n = 185 pregnant participants in the Pregnancy Eating Attributes Study. Maternal dietary intake was assessed in the first trimester using the automated self-administered 24-h recall method, from which the HEI 2015 was calculated. Rectal swabs were obtained in the second trimester and sequenced using the NovaSeq 6000 system shotgun platform. We used unsupervised clustering to identify microbial enterotypes representative of maternal taxa and GO functional term composition. Multivariable linear models were used to identify associations between taxa, functional terms, and food components while controlling for relevant covariates. Multinomial regression was then used to predict enterotype membership based on a participant’s HEI food component score. ResultsThose in the high diet quality tertile had a lower early pregnancy BMI [mean (M) = 23.48 kg/m2, SD = 3.38] compared with the middle (M = 27.35, SD = 6.01) and low (M = 27.49, SD = 6.99) diet quality tertiles (P < 0.01). There were no statistically significant associations between the HEI components or the total HEI score and the 4 alpha diversity measures. Differences in taxa and GO term enterotypes were found in participants with, but not limited to, a higher saturated fat component score (β = 1.35, P = 0.01), added sugar HEI component (β = 0.07, P < 0.001), and higher total dairy score (β = 1.58, P = 0.01). ConclusionsSpecific dietary components are associated with microbial composition and function in the second trimester of pregnancy. These findings provide a foundation for future testable hypotheses.

Cumulative live birth rate of a blastocyst versus cleavage stage embryo transfer policy during in vitro fertilisation in women with a good prognosis: multicentre randomised controlled trial

ObjectivesTo evaluate whether embryo transfers at blastocyst stage improve the cumulative live birth rate after oocyte retrieval, including both fresh and frozen-thawed transfers, and whether the risk of obstetric and...

Association between late pregnancy prehypertension and adverse outcomes among newborns of women delivered at a tertiary hospital in Eastern Uganda: a prospective cohort study

BackgroundPrehypertension during pregnancy is currently not considered as a high-risk pregnancy state in existing guidelines despite recent research correlating it with higher rates of morbidity and mortality in both the mother and the fetus. Studies on prehypertension have not been conducted in Africa despite high rates of poor neonatal outcomes.AimsThe study aimed to determine the association between late pregnancy prehypertension and adverse outcomes in newborns of women with late pregnancy prehypertension at Jinja Regional Referral Hospital.Methods and materialsBetween September 2022 and January 2023, a hospital-based prospective cohort study including 300 pregnant women was conducted. Participants were divided according to third-trimester blood pressure, as determined by the JNC-8 criteria. Following hospital admission for labor and delivery, 150 normotensive women and 150 prehypertensive women were identified and followed until delivery, and their neonates were followed until death or hospital discharge. A p value of ≤ 0.05 was the threshold for statistical significance when comparing the groups using the relative risk, X2, and Mantel-Haenszel adjustment.ResultsComposite adverse neonatal outcomes were more common in prehypertensive women compared to normotensive women (48.67% versus 32.67%), particularly Small-for-Gestation Age (SGA), stillbirth, and composite adverse neonatal outcomes had significantly higher likelihood, with aRRs of 1.63 (95% CI 1.10–2.42, p = 0.037), 9.0 (95% CI 1.15–70.16, p = 0.010), and 1.55 (95% CI 1.16–2.08, p < 0.001), respectively. By a linear model, birthweight decreased by 45.1 g for every 10 mmHg rise in systolic blood pressure (p = 0.041, Pearson correlation of -0.118).Conclusion and recommendationsPrehypertension in late pregnancy increased risks for adverse neonatal outcomes, thus a need to potentially lower pregnancy hypertension cut-off levels possibly through adopting the ACC/AHA blood pressure definitions for pregnant women.

Clinical Phenotypes and Etiological Risk Factors in Children with Cerebral Palsy: A Retrospective Study

Background: Cerebral palsy is a motor impairment syndrome that arises from a lesion in the developing brain. The condition varies based on the timing of the lesion, as well as differences in clinical presentation, location, and severity. Objectives: The aim of this study is to determine the clinical features of patients with cerebral palsy, identify the associated risk factors, and analyze cranial MRI findings in relation to the different types of cerebral palsy. Methods: This study retrospectively evaluated the medical records of children diagnosed with cerebral palsy. Data collected included demographic information, details of potential relevant abnormalities during pregnancy, birth, and the neonatal period, comorbidities, types of cerebral palsy, cranial MRI findings, and classifications of motor impairments. Results: The mean age of the 202 patients with cerebral palsy in the study was 8.02 years, with a male predominance (60.4%). The most common type of cerebral palsy observed was spastic cerebral palsy, accounting for 81.6% of the cases. The most frequent cranial MRI finding was white matter damage of immaturity, present in 36.1% of the patients, while 8.4% of the cases had normal cranial MRI results. Epilepsy was the most common comorbidity, affecting 50.5% of the patients. White matter damage of immaturity was most commonly associated with spastic diparesis, and the identified risk factors for these patients included prematurity, low birth weight, oligohydramnios, multiple pregnancy, and neonatal sepsis/meningitis. Spastic tetraparesis was most frequently linked to miscellaneous MRI findings, with risk factors such as term birth, normal birth weight, polyhydramnios, asphyxia/resuscitation, and a history of neonatal convulsions. Focal infarction/hemorrhage was most often associated with spastic hemiparesis, while basal ganglia-thalamus damage was frequently seen in patients with choreoathetotic and dystonic cerebral palsy. In patients with dystonic cerebral palsy, vaginal delivery and a history of hyperbilirubinemia were identified as common risk factors. Cerebellar damage and malformations were most frequently associated with ataxic cerebral palsy. Conclusions: In this study, it was determined that MRI findings can serve as a valuable guide for identifying different types of cerebral palsy. Additionally, the risk factors, disease severity, and accompanying comorbidities were found to vary according to the specific type of cerebral palsy.