Major Complication Of Pregnancy Research Articles

Routine transabdominal cervical length screening in mid-pregnancy for the prevention of preterm birth: Is it good enough to use as a screening test?

Preterm birth (PTB) is a major pregnancy complication. There is evidence that a short cervical length in mid-pregnancy may predict women at increased risk of PTB. To evaluate the utility of population-based, transabdominal cervical length (TACL) measurement screening in mid-pregnancy for PTB prediction in women. A transabdominal approach was initially performed, with a transvaginal (TVCL) approach offered when the TACL was <35 mm, could not be accurately measured, or the pregnancy had risk factors for PTB. TACL was compared to the directly related TVCL, when both were performed at the same assessment. Women with risk factors of PTB were included when they had both TACL and TVCL measurements performed at the same visit. Data were provided for 9355 singleton pregnancies from 13 participating imaging centres. A transabdominal approach was used in 9006 (96.3%), including 682 (7.3%) TVCL combined with TACL. There were 349 (3.7%) women who had TVCL only. The median TACL was longer (40 mm) than the TVCL (38 mm). In 682 paired TACL and TVCL measurements, TACL <35 mm correctly identified 96.2% of pregnancies with TVCL <25 mm, compared with 65.4% of cases when using a TACL <30 mm. A TVCL <25 mm occurred in 59 (0.6%) women. A TACL <35 mm was associated with birth <37 weeks of gestation in 12.1% of women and birth <32 weeks of gestation in 3.9%. Universal TACL is a feasible option for population screening of cervical length in a low-risk population, progressing to TVCL if the TACL is <35 mm or the cervix cannot be transabdominally accurately measured.

O-191 Delayed fetal growth in pregnant women with polycystic ovary syndrome using serial ultrasonographic biometry

Abstract Study question To investigate the effect of maternal polycystic ovary syndrome (PCOS) on intrauterine growth and perinatal outcome of offspring. Summary answer Maternal PCOS might have an adverse impact on fetal growth, represented by serial biometric measurements, and consequently lower the birth weight. What is known already Women with PCOS often have low fertility and high risk of certain pregnancy complications, including miscarriage, gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP) and preterm birth (PTB). In addition, the offspring of PCOS mothers are susceptible to short- and long-term health consequences, such as metabolic diseases and neuropsychiatric disorders. And the suboptimal intrauterine environment caused by maternal PCOS condition might be the origin of impaired long-term health of the offspring. Study design, size, duration A total of 1153 pregnant women with pregestational diagnosis of PCOS and 1383 non-PCOS controls were included in the retrospective case-control study for clinical record and ultrasonographic database at women’s hospital, school of medicine, Zhejiang university over a 6-year period. Participants/materials, setting, methods Maternal demographic data, fetal biometric measurements with ultrasound, obstetrical and neonatal outcomes were analyzed. A meta-analysis of birth weight in PCOS offspring in the literature was performed to assess the relationship between the maternal PCOS and neonatal growth. Main results and the role of chance After adjustment for potential confounding variables, we found that biparietal diameter (BPD) and femur length (FL) were notably smaller in fetuses of women with PCOS than controls across the entire gestation. This effect still existed after excluding three major pregnancy complications of PCOS, including GDM, HDP and PTB. Although other fetal biometry including estimated fetal weight and birth weight in PCOS offspring were comparable with controls in our study, the meta-analysis of 22 studies showed that the birth weight in offspring of women with PCOS was lower than controls (WMD -37.813, 95%CL [-69.713, -5.913]), especially for offspring in South America (WMD -84.69, 95%CL [-166.69, -2.68]). Limitations, reasons for caution First, data of other fetal parameters like abdominal and head circumference was scanty. Second, neonatal anthropometric parameters apart from the birth weight were not included. Lastly, we did not have the long-term follow-up results of the offspring to explore the potential effect of delayed fetal biometry in their later life. Wider implications of the findings More attention needs to be paid to the smaller-than-average fetuses in PCOS mothers, and proper management may be needed during and after pregnancy. Further studies are needed to confirm the intrauterine growth pattern of the PCOS offspring and its clinical significance in the neonatal period and beyond. Trial registration number N/A

Association between dietary calcium and pregnancy induced hypertension

Background: Pregnancy induced hypertension (PIH) is one of the major complications of pregnancy. Inadequate calcium (Ca) intake is considered a public health problem in some vulnerable groups, especially pregnant women. A balanced diet during pregnancy with adequate Ca should be the ideal solution, and to proceed in this direction, evidence is required on the nature and extent of Ca deficiency in the diet of PIH mothers. Objectives: To assess the dietary intake of Ca in PIH (compared to non-PIH) mothers and to explore the factors affecting the intake of those nutrients. Methods: Under an observational case-control design, we recruited 300 Bangladeshi pregnant women in two groups (150 with and 150 without PIH), aged between 20-40 years (from 3 hospitals in Dhaka) at the 3rd trimester of pregnancy. A pre-tested questionnaire was used to collect the data. The first part of the questionnaire was allocated to general socio-demographic and clinical characteristics. Secondly, a food frequency questionnaire was used to estimate individual dietary Ca intake. Results: The dietary Calcium intake [(mg/day), median (range)] was significantly lower [265(111-487)] (p&lt;0.001) in the PIH compared to the non-PIH [350(201-984) ;(p&lt;0.001)] group. On bivariate analysis, the dietary Calcium intakes had a significantly negative correlation with mean blood pressure which was considered an indicator of the severity of PIH (r=-0.276; p&lt;0.001) for Ca. On regression analysis, PIH was found to be significantly associated with a lower intake of Ca (b=-0.009; p&lt;0.001) when the effects of age, family history of HTN and family income were adjusted. Conclusion: Dietary consumption of Calcium during pregnancy is much lower than those recommended in our population, PIH seems to have an association with dietary deficiency of Calcium in pregnant women. Bioresearch Commu. 10(2): 1612-1618, 2024 (July)

Child Telomere Length at 11–12 Years of Age Is Not Associated with Pregnancy Complications

Children born from pregnancy complications are at higher risk of chronic diseases in adulthood. Identifying which children born from a complicated pregnancy are likely to suffer from later chronic disease is important in order to intervene to prevent or delay the onset of disease. This study examined the associations between the major pregnancy complications (gestational diabetes, high blood pressure, small- and large for gestational age, and preterm birth) and child telomere length, a biomarker of chronic disease risk. This was a population-based longitudinal analysis using data from the Longitudinal Study of Australian Children. The primary outcome is telomere length, measured in 11–12-year-old children. Multivariable linear regression was used to estimate the association between pregnancy complications and child telomere length, adjusting for a range of a priori confounders. Data from 841 families were used. One in four pregnancies (27.1%) featured a pregnancy complication. In the adjusted analysis, there was no association between pregnancy complications and child telomere length (high blood pressure: mean difference (95% CI): 0.00 (−0.12, 0.12); gestational diabetes (0.05 (−0.10, 0.19)); small for gestational age (0.07 (−0.04, 0.19)); large for gestational age (−0.06 (−0.15, 0.03)); and preterm birth (−0.10 (−0.21, 0.01)). Our results do not support the notion that telomere length is shorter in children born to mothers after a pregnancy complication. Methodological considerations should be rigorous to improve the reproducibility of findings.

Risk Factors for Major Pregnancy Complications in Female Cardiothoracic Surgeons.

To describe the incidence of and risk factors for pregnancy complications in female cardiothoracic surgeons compared to women of similar sociodemographic profiles. Female cardiothoracic surgeons often postpone childbearing, but little is known about their pregnancy outcomes. A self-administered survey was distributed to US cardiothoracic surgeons/trainees in 2023. Surgeons with ≥1 live birth were queried on maternal work hours during pregnancy and major antenatal pregnancy complications. Male surgeons answered on behalf of non-surgeon childbearing partners (female non-surgeons). The study included 255 surgeons (63.53% male; 36.47% female). Compared to female surgeons, male surgeons more often had partners who were not employed outside the home (25.64% vs. 13.33%, P<0.001). Female surgeons were older than female non-surgeons at first live birth (34.494.41 vs. 31.454.16, P<0.001), more often worked >60 hours/week during pregnancy (70.33% vs. 14.08%, P<0.001), and more often had pregnancy complications (45.16% vs. 27.16%, P=0.003; OR 1.78, 95%CI:1.01-3.13). Among female surgeons, 18.28% reduced work hours during pregnancy. During their third trimester, 54.84% worked >6 overnight calls/month and 72.04% operated >12 hours/week. Age35yrs (OR 3.28, 95%CI 1.27-8.45) and operating >12 hours/week during the third trimester (OR 3.72, 95%CI 1.04-13.30) were associated with pregnancy complications. Female cardiothoracic surgeons are more likely to experience major pregnancy complications than non-surgeon partners of their male peers. Long operative hours during pregnancy and older maternal age are significant risk factors for pregnancy complications. To advance gender equity, policies to protect maternal-fetal health and facilitate childbearing during training and early career are needed.

Palmitate and group B Streptococcus synergistically and differentially induce IL-1β from human gestational membranes.

Rupture of the gestational membranes often precedes major pregnancy complications, including preterm labor and preterm birth. One major cause of inflammation in the gestational membranes, chorioamnionitis (CAM) is often a result of bacterial infection. The commensal bacterium Streptococcus agalactiae, or Group B Streptococcus (GBS) is a leading infectious cause of CAM. Obesity is on the rise worldwide and roughly 1 in 4 pregnancy complications is related to obesity, and individuals with obesity are also more likely to be colonized by GBS. The gestational membranes are comprised of several distinct cell layers which are, from outermost to innermost: maternally-derived decidual stromal cells (DSCs), fetal cytotrophoblasts (CTBs), fetal mesenchymal cells, and fetal amnion epithelial cells (AECs). In addition, the gestational membranes have several immune cell populations; macrophages are the most common phagocyte. Here we characterize the effects of palmitate, the most common long-chain saturated fatty acid, on the inflammatory response of each layer of the gestational membranes when infected with GBS, using human cell lines and primary human tissue. Palmitate itself slightly but significantly augments GBS proliferation. Palmitate and GBS co-stimulation synergized to induce many inflammatory proteins and cytokines, particularly IL-1β and matrix metalloproteinase 9 from DSCs, CTBs, and macrophages, but not from AECs. Many of these findings are recapitulated when treating cells with palmitate and a TLR2 or TLR4 agonist, suggesting broad applicability of palmitate-pathogen synergy. Co-culture of macrophages with DSCs or CTBs, upon co-stimulation with GBS and palmitate, resulted in increased inflammatory responses, contrary to previous work in the absence of palmitate. In whole gestational membrane biopsies, the amnion layer appeared to dampen immune responses from the DSC and CTB layers (the choriodecidua) to GBS and palmitate co-stimulation. Addition of the monounsaturated fatty acid oleate, the most abundant monounsaturated fatty acid in circulation, dampened the proinflammatory effect of palmitate. These studies reveal a complex interplay between the immunological response of the distinct layers of the gestational membrane to GBS infection and that such responses can be altered by exposure to long-chain saturated fatty acids. These data provide insight into how metabolic syndromes such as obesity might contribute to an increased risk for GBS disease during pregnancy.

Platelet-to-lymphocyte ratio and serum hsCRP levels in third trimester and adverse pregnancy outcomes in women with gestational diabetes mellitus

Gestational diabetes mellitus (GDM) is a major complication of pregnancy. GDM is associated with a higher risk of adverse pregnancy outcomes (APO). The purpose of this study was to assess the association between third-trimester platelet to lymphocyte ratio (PLR) and high-sensitivity C-reactive protein (hsCRP) concentration and the risk of APO in GDM pregnant women. This study selected 406 non-elderly gestational diabetes patients diagnosed in the Renmin Hospital of Wuhan University from May 2021 to February 2023 as the research objects. According to the presence or absence of APO, they were divided into an APO group (n = 171) and a non-APO group (n = 235). Logistic regression model to evaluate the correlation between PLR and hsCRP and APO in women with GDM; Restricted cubic spline analyses was used to explore nonlinear correlations between PLR or hsCRP and the risk of APO; ROC curve analysis of the diagnostic performance of PLR and hsCRP for APO in women with GDM. APO occurred in 171 of the 406 included participants. Compared with the non-APO group, patients in the APO group had higher PLR and hsCRP levels. The incidence of APO was positively associated with PLR and the hsCRP level in each logistic regression model (P < 0.05). After adjusting for all the risk factors included in this study, restricted cubic spline analyses found that the PLR and the hsCRP level were positively associated with the risk of APO. The levels of PLR and hsCRP in the third trimester are related to the occurrence of APO in women with GDM, and high levels of PLR and hsCRP may indicate the occurrence of APO.

Risk factors and outcome of preterm births at a teaching hospital in Jos, North Central Nigeria

Background/Aim: Preterm birth is a major pregnancy complication that imposes tremendous long-term medical and financial burdens on affected children, families, and the healthcare system. The aim of this study was to find out the prevalence, risk factors, and outcome of preterm babies admitted to Bingham University Teaching Hospital's inborn Special Care Baby Unit. Methods: It was a retrospective study of the medical records of all preterm babies delivered in the hospital from January 2021 to June 2022. Results: A total of 1,160 live births occurred in the hospital during the study period out of which 196 (16.9%) were admitted. Of these, 100 (51.0%) were preterm's with gestational ages ranging from 24 to 36 weeks with a mean gestational age of 31.24 weeks (±2.78).Birth weight ranged from 650g to 2450g with a mean of 1530.22g (±414.11). There were 47 males and 53 females (M: F 0.89:1) and 63 (63.0%) were delivered via caesarean section. The duration of hospital stay ranged from 1 to 182 days with a median of 9and IQR of 11 days. Preterm premature membrane rupture and preeclampsia were the two most frequent risk factors for prematurity. Jaundice was the most prevalent morbidity seen, closely followed by anaemia. The overall mortality rate was 20%. Conclusion: Prematurity continues to be a major contributor to infant morbidity and mortality in our hospital, thus there is a need to improve the quality of health care delivery in order to improve survival rate of these newborns.

An interpretation for Chinese expert consensus on how to manage pregnant women of advanced maternal age with scarred uterus

Deferral of marriage and child-bearing age as well as high occurrence of uterine surgery history such as cesarean section and myomectomy in women who are about to have babies are challenging obstetrical health care worldwide, since pregnancy at advanced maternal age and pregnancy with scarred uterus are both high-risk pregnancy. In China, one-child policy had been implemented for three decades and contributes to high cesarean section rates. With family planning policy turning to two and three-child, there are rising pregnancy at advanced maternal age with scarred uterus. A clinical management scheme can help obstetricians a lot to assess risks, prevent pregnancy complications and manage pregnancy in an organized manner. However, there are insufficient studies on relevant clinical issues for the specific population, and there is no consensus or practice guidelines until now. We have developed Chinese expert consensus based on our pioneering research findings on the prevention and treatment strategy for major pregnancy complications in women of advanced maternal age. We formulate the consensus comprising general management scheme to standardize clinical care, practical risk scoring systems to early warn major pregnancy complications, and nationwide expert recommendations to be in accordance with evidence-based appraisal method. Consecutive supervision along with stratified management are highly emphasized. We interpret the consensus containing up-to-date literature review, research findings interpretation and most concerned questions discussion. This consensus interpretation helps standardize how to manage pregnant women of advanced maternal age with scarred uterus and improve the maternal-fetal outcomes.

Expression of inhibitory receptors on peripheral blood T cells in pregnant women with preeclampsia

Maternal adaptation of the immune system aimed at limiting the immune response to fetal antigens is a necessary condition for a successful pregnancy. It involves various mechanisms (Th1/Th2 switching, Treg expansion, induction of anergy and apoptosis of T lymphocytes, development of T cell depletion) that are induced through the ligation of inhibitory receptors. Accordingly, the expression of inhibitory receptors on T cells, including PD-1, CTLA-4, and Tim-3 molecules, may reflect the effectiveness of immune adaptation and its impairment in pregnancy pathology. Preeclampsia (PE), the pathogenesis of which is associated with the impairments of immunological tolerance is a major complication of pregnancy. Accordingly, changes in the expression of inhibitory receptors on T cells may be biomarkers of abnormal gestation and potential therapeutic targets. The aim of this work was to study the expression of inhibitory molecules on peripheral blood T cells in women with PE. The study recruited 29 pregnant women with PE and 36 women with uncomplicated pregnancies in the second half of pregnancy. Pregnant women of the study groups were comparable in terms of gestational age, number of pregnancies and parity of childbirth. The control group consisted of 28 fertile women with children. Relative content of CD8+PD-1+, CD8+CTLA-4+, CD8+TIM-3+, CD8+PD-1+TIM-3+, CD4+PD-1+, CD4+CTLA-4+, CD4+TIM-3+, CD4+PD-1+TIM-3+T cells in blood were analyzed by flow cytometry. It has been shown that uncomplicated pregnancy is associated with increased expression of PD-1 and Tim-3 T cells, which is manifested by an increase in the relative content of CD4+Tim-3+, CD8+PD-1+ and PD-1+Tim-3+T lymphocytes . In PE, on the contrary, there is a reduction in the expression of PD-1 and Tim-3 by T cells, in particular, a decrease in the proportion of CD4+Tim-3+ and CD8+PD-1+ cells; the absence of elevated levels in PD-1+Tim-3+ cells (compared to uncomplicated gestation) and an increase in CTLA-4+ cells within CD4+ lymphocytes. Changes in the expression of inhibitory receptors are associated with the severity of PE. A decrease in CD4+Tim-3+ and CD8+PD-1+T cells is most typical for patients with moderate PE, and an increase in CD4+CTLA-4T cells for pregnant women with severe PE. The relationship between changes in the expression of inhibitory molecules and the onset of PE has also been demonstrated. A distinctive feature of early PE is a decrease in the proportion of CD8+CTLA-4+ cells and a more pronounced increase in CD4+CTLA-4+ cells, while late PE is associated with a decrease in CD4+PD-1+ cells and a more pronounced decrease in CD4+Tim-3+ cells. The results obtained indicate a changes in the expression of CTLA-4, PD-1 and Tim-3 molecules on circulating T cells in pregnant women with PE and the association of these changes with the severity and the onset of PE manifestation.

CONCENTRATIONS OF D-DIMER, FOLIC ACID AND HOMOCYSTEIN IN PREGNANT WOMEN WITH POST-COVID SYNDROME

Introduction. The problem of decreasing birth rate is becoming the main medical and social problem of modern Ukraine. Therefore, the preservation of each pregnancy is the main task of obstetrics. The outbreak of a global pandemic caused by the SARS-CoV-2 virus, war, population migration abroad and within the country have created unprecedented medical and economic problems. The aim of the study was to investigate the relationship between D-dimer, folic acid (vitamin B9) and homocysteine levels and major pregnancy complications in the third trimester in pregnant women with post- COVID syndrome.Material and methods. 60 pregnant women (the main group) with SARS-CoV-2, positive Ig A, M or G to SARS-CoV-2 participatedin the study. The control group consisted of 25 women with normal pregnancies. The test system used for the determination of folic acid was from Monobind Inc. (USA) and Axis- Shield Diagnostics LTD (UK) for homocysteine. D-dimer studies were performed on a Coag Chrom 3003 analyzer. Statistical analysis of the study results was performed using the Statistica.10 program package for Windows. The study was approved by the Ethics Committee of the Ternopil National Medical University named after I. Ya. Gorbachevskii (protocol No. 61 dated November 13, 2020).Quantitative results for normally distributed data are presented as arithmetic mean (M) ± root mean square deviation (m). Results of qualitative measurements were presented as number (n) and percentage (%). Statistical analysis of the research results was performed using the Statistica.10 statistical package for Windows.The study was conducted within the framework of the National Development Program “Improvement of Diagnosis and Treatment of Pregnant Women with Burdened Somatic History” of the Department of Obstetrics and Gynecology, Faculty of Postgraduate Education, Ternopil State Medical University named after I. Ya. Gorbachevsky (state registration number N 0121U100153, performance period 2021-2023).Results. According to our research, patients of both groups did not diff er from each other in terms of age, body mass index (BMI), erythrocyte and hemoglobin levels (p&gt;0.05). Among the pregnant women in the main group, 25 pregnant women (41.7%) had a mild form of coronavirus disease, 14 (23.3%) pregnant women had pneumonia and were hospitalized, and 21 (35.0%) pregnant women had pneumonia and required oxygen support. The SARS-CoV-2 virus upsets the coagulation homeostasis system of pregnant women. The average value of D-dimer in healthy pregnant women was 0.56±0.16 μgFEO/ml, while in the main group this indicator was 16.48±4.25 μgFEO/ml (р&lt;0.001). In our study, the folate level in the control group was 5.88±0.08 μg/L, while in the main group this indicator signifi cantly decreased and was 2.56±0.09 μg/l (р&lt;0.05), compared with indicators in women with a physiological pregnancy, which can be considered a risk factor for the development of complications during pregnancy against the background of post- COVID syndrome. The average level of homocysteine in the control group was 7.8±2.28 μmol/l. The SARS-CoV-2 virus had a negative eff ect on homocysteine metabolism and caused moderate hyperhomocysteinemia (47.8±4.36 μmol/l, р&lt;0.05) in pregnant women in the 3rd trimester.Conclusions. Therefore, SARS-CoV-2 virus during pregnancy has a negative eff ect on the course of pregnancy and upsets thecoagulation system of homeostasis. Hyperhomocysteinemia and a decrease in folate levels can be considered a promising marker for assessing the risk of complications during pregnancy against the background of post- COVID syndrome.

Predictive value of the sFlt‑1/PlGF ratio in women with suspected preeclampsia: An update (Review).

Preeclampsia (PE) is a major complication of pregnancy with an incidence rate of 2‑8% and is a leading cause of maternal mortality and morbidity. The various consequences of severe preeclampsia for the fetus, neonate and child include intrauterine growth retardation (IUGR), fetal hypoxia, oligohydramnios, intrauterine fetal demise, increased perinatal mortality and morbidity, neurodevelopmental disorders and even irreversible brain damage (cerebral palsy). A number of studies have demonstrated that differences in maternal serum concentrations of angiogenic factors between preeclampsia and normotensive pregnancies can be used as biomarkers, either alone or in combination with other markers, to predict the development of PE. The presence in the maternal circulation of two proteins of placental origin, placental growth factor (PlGF) and soluble fms‑like tyrosine kinase 1 (sFlt‑1), has been shown to be of clinical value, as the sFlt‑1/PlGF ratio appears to be the optimal predictive tool for the development of PE. The measurement of their concentration in maternal serum in screening models, serves as predictive marker for the development of PE or IUGR later in gestation. However, further research is required to improve its clinical applicability and provide guidelines for its use worldwide to achieve more consistent clinical management of women with PE.

Coping as a Mediator between Attachment and Depressive Symptomatology Either in Pregnancy or in the Early Postpartum Period: A Structural Equation Modelling Approach.

Peripartum depression (PPD) is a major complication of pregnancy, and numerous risk factors have been associated with its onset, including dysfunctional coping strategies and insecure attachment styles, both during pregnancy and postpartum. The aim of our study was to investigate the role of coping strategies in mediating the relationship between women's attachment style and depressive symptomatology in pregnancy and one week after giving birth in a large sample of women (N = 1664). Our hypothesis was that the relationship between anxious and avoidant attachment and depressive symptomatology would be mediated by use of maladaptive coping strategies. The assessment instruments were Edinburgh Postnatal Depression Scale (EPDS), Brief Coping Orientation for Problem Experiences (COPE), and Experiences in Close Relationship Scale (ECR). The results indicated that the effect of insecure attachment styles (anxious and avoidant attachment) on antepartum depressive symptomatology was partially mediated by dysfunctional coping styles. Anxious attachment also has an indirect significant effect on postpartum depressive symptomatology through emotional coping; however, avoidant attachment does not seem to be significantly related to postpartum depressive symptoms. Our findings revealed that not only is it important to consider attachment in understanding peripartum depressive symptomatology, but also that coping plays an important role in these relationships. These findings would help a preventive coping-based intervention strategy to enhance the capacity of women with insecure attachment styles to use more adaptive coping during and after pregnancy.

Effects of Xenobiotic Compounds on Preeclampsia and Potential Mechanisms.

Preeclampsia (PE) refers to a disease with new hypertension and albuminuria or other end-organ damage after 20 weeks of pregnancy. As a major complication of pregnancy, PE can increase the morbidity and mortality of pregnant women and fetuses and cause serious social burden. Recently, it has been found that exposure to xenobiotic compounds, especially endocrine disruptors in the environment, may contribute to the development of PE. However, the underlying mechanism is still unclear. It is generally believed that PE is related to placental dysplasia, spiral artery remodelling failure, oxidative stress, etc. Therefore, in order to better prevent the occurrence of PE and reduce the damage and impact on mother and fetus, this paper reviews the role and potential mechanism of PE induced by exogenous chemicals and provides an outlook on the environmental etiology of PE.

Modeling spatially varying compliance effects of PM2.5 exposure reductions on gestational diabetes mellitus in southern California: Results from electronic health record data of a large pregnancy cohort

Gestational diabetes mellitus (GDM) is a major pregnancy complication affecting approximately 14.0% of pregnancies around the world. Air pollution exposure, particularly exposure to PM2.5, has become a major environmental issue affecting health, especially for vulnerable pregnant women. Associations between PM2.5 exposure and adverse birth outcomes are generally assumed to be the same throughout a large geographical area. However, the effects of air pollution on health can very spatially in subpopulations. Such spatially varying effects are likely due to a wide range of contextual neighborhood and individual factors that are spatially correlated, including SES, demographics, exposure to housing characteristics and due to different composition of particulate matter from different emission sources. This combination of elevated environmental hazards in conjunction with socioeconomic-based disparities forms what has been described as a “double jeopardy” for marginalized sub-populations. In this manuscript our analysis combines both an examination of spatially varying effects of a) unit-changes in exposure and examines effects of b) changes from current exposure levels down to a fixed compliance level, where compliance levels correspond to the Air Quality Standards (AQS) set by the U.S. Environmental Protection Agency (EPA) and World Health Organization (WHO) air quality guideline values. Results suggest that exposure reduction policies should target certain “hotspot” areas where size and effects of potential reductions will reap the greatest rewards in terms of health benefits, such as areas of southeast Los Angeles County which experiences high levels of PM2.5 exposures and consist of individuals who may be particularly vulnerable to the effects of air pollution on the risk of GDM.

Experimental treatment of induced fetal retardation in model animals

Intrauterine retardation is one of the major complications of pregnancy. This pathology occurs in approximately 10% of all pregnancies in developed countries and 20% in developing countries. Moreover, intrauterine retardation is more frequently associated with stillbirths than other pathologies. Despite studies conducted in the past 50 years, no generally accepted therapeutic regimen has yet been developed. Numerous drugs have been used for treatment; however, none of them has been proven effective. Moreover, after years of testing, new data are emerging about the side effects of the drugs previously used.&#x0D; Various models of fetal retardation have been developed throughout the study of this problem. The main model animals are rats, pigs, and sheep. Numerous techniques and drug options have been proposed for the treatment of simulated intrauterine developmental delays in these animals. The main amino acids used for treatment were arginine, glutamine, taurine, and citrulline. Thus, the literature review aimed to analyze which model animals and experimental models of intrauterine retardation treatment most adequately reflect the effectiveness of these drugs.

Predictive Biochemical Factors for Pre-eclampsia in Early Pregnancy

Abstract: Pre-eclampsia (PE) is one of the major pregnancy complications, affecting up to 10 % of all pregnancies in some regions of the world. The clinical diagnosis, characterised by hypertension and proteinuria often late during pregnancy, with the added inability to treat (other than delivery), can lead to significant morbidity and mortality in both mother and unborn foetus. Moreover, as yet, only low dose aspirin administration is accepted as a preventive measure for PE. This puts more pressure to identify diagnostic and prognostic biomarkers of PE from blood or urine for the non-invasive screening of pregnant women before pregnancy becomes complicated. Over the years, a number of DNA and protein molecules, such as cell-free DNA, VEGF, sFLT1, PlGF, PP-13, ADMA, and several other biomarkers, have been linked to specific pathophysiological observations and proposed as predictive markers for PE. However, their reliability and reproducibility have been put to the test by numerous studies. The aim of this review is to cover the key clinical and biochemical features of pregnancies complicated by PE and evaluate the robustness of data gathered from various studies in order to better understand the link between the proposed biomarkers and the development of PE so as to better quantify their relevance in diagnostic or prognostic applications. The overall goal is to use such biomarkers for earlier detection, better molecular monitoring, and, where possible, lessening of symptoms, hopefully leading to a reduction in the yearly PE-related deaths worldwide.

Association between serum hypovitaminosis D and preeclampsia: A nested case-control study

Background: Preeclampsia is a major complication of pregnancy and a major cause of perinatal and maternal morbidity and mortality. Vitamin D deficiency has been implicated in the aetiology and pathophysiology of preeclampsia. However, there is no uniformity in the findings of previous studies on the association between vitamin D and preeclampsia. Aims and Objectives: The study is aimed at determining the association between preeclampsia and maternal vitamin D deficiency. Materials and Methods: This nested case-control study was conducted among 158 pregnant women (78 preeclamptic women and 80 controls) with singleton pregnancies. Case participants were women with preeclampsia. The controls were matched pregnant women without preeclampsia. Their serum vitamin D levels were determined. Statistics: Continuous data was analysed using T-test. The statistical significance was inferred at p- value ≤0.05. Results: The prevalence of hypovitaminosis D in our study was 7.0% overall. The proportion of women with hypovitaminosis D was not significantly different between preeclampsia group and control group (7.7% vs 6.3% respectively; p=0.76). The mean serum concentration of vitamin D in the preeclamptic group was lower than that in the control group, however, the difference was not statistically significant (118.8±17.4nmol/L vs 129.0±19.7nmol/L, p=0.17). There was a weak association between gestational age and the level of serum vitamin D in both groups (r= 0.062 and r= -0.13 respectively). Conclusions: Hypovitaminosis D is not significantly associated with preeclampsia when compared with control. However, there was a weak association between gestational age and the level of serum vitamin D in both groups.

Maternal Factors for Intrauterine Growth Retardation: Systematic Review and Meta-Analysis of Observational Studies.

Intrauterine growth retardation (IUGR) is a major complication of pregnancy and is the second leading cause of perinatal morbidity and mortality. The etiology of IUGR is multifactorial and the maternal factors are easily identifiable and modifiable. The present study aimed to perform a meta-analysis to identify the association between various maternal factors and IUGR. Eight electronic databases (PubMed, Cochrane, Embase, CIHNAL Plus, CNKI, VIP database, CBM, and WanFang database) were searched from their inception until July 2020. Eligibility screening, data extraction, and quality assessment of the retrieved articles were conducted independently by two reviewers. The Newcastle-Ottawa Quality Assessment Form and the Joanna Briggs Institute critical appraisal tool were used to evaluate the quality of included studies. The outcomes of study were calculated by OR with 95%CI. The study protocol was registered with PROSPERO (No. CRD42020210615). A total of 15 studies were included, with a sample size range from 152 to 9372. The quality of included studies ranged from moderate to high. The pooled results identified seven factors: smoking (OR = 1.62, 95%CI 1.38-1.90), primiparity (OR = 1.64, 95%CI 1.20-2.24), and prepregnancy.BMI < 18.5 (OR = 1.98, 95%CI 1.29-3.03), anemia (OR = 2.01, 95%CI 1.44-2.82), hypoproteinemia (OR = 2.91, 95%CI 1.94-4.36), pregnancy-induced hypertension (OR = 3.45, 95%CI 1.80-6.58), and maternal gestational weight gain (OR = 2.51, 95%CI 1.88-3.35). The present study identified several maternal factors for IUGR: smoking, primiparity, prepregnancy BMI < 18.5, poor gestational weight gain, PIH, anemia, and hypoproteinemia. The result could serve to generate risk factors prediction models, improve the management and education for child-bearing or early pregnant women.

Association between maternal selenium levels and pregnancy outcome among human immunodeficiency virus-positive and human immunodeficiency virus-negative pregnant women in a tertiary health-care center in Owerri, Nigeria: A comparative cross-sectional study.

Human immunodeficiency virus (HIV) infection constitutes a major medical complication of pregnancy and is associated with adverse feto-maternal outcomes. However, the relationship between maternal serum selenium levels and pregnancy outcomes has been inconsistent. This study aimed to determine the relationship between maternal serum selenium status and pregnancy outcome in HIV-positive and HIV-negative women in a tertiary health facility. A. HIV-positive pregnant women had significantly lower mean serum selenium concentration compared with HIV-negative pregnant women (64.3 ± 19.6 μg/L vs. 100.1 ± 30.9 μg/L; P < 0.001). There was a statistically significant association between serum selenium concentration and birth weight among both HIV-positive and HIV-negative pregnant women (P < 0.001). Similarly, a statistically significant association was seen between serum selenium and maternal PCV in HIV-positive and HIV-negative pregnant women (P = 0.024 and P < 0.001, respectively). However, there was no association found between serum selenium and other pregnancy outcomes. HIV-positive pregnant women had a lower mean serum selenium level compared to HIV-negative pregnant women. There was a significant association between low maternal serum selenium level and maternal anemia, as well as low birth weight, especially in HIV-positive pregnant women.