Maternal Estrogen Research Articles

Association of phthalates exposure and sex steroid hormones with late-onset preeclampsia: a case-control study

BackgroundThis study aimed to investigate the relationship between phthalates exposure and estrogen and progesterone levels, as well as their role in late-onset preeclampsia.MethodsA total of 60 pregnant women who met the inclusion and exclusion criteria were recruited. Based on the diagnosis of preeclampsia, participants were divided into two groups: normotensive pregnant women (n = 30) and pregnant women with late-onset preeclampsia (n = 30). The major metabolites of phthalates (MMP, MEP, MiBP, MBP, MEHP, MEOHP, MEHHP) and sex steroid hormones (estrogen and progesterone) were quantified in urine samples of the participants.ResultsNo significant differences were observed in the levels of MMP, MEP, MiBP, MBP, MEHP, MEOHP, and MEHHP between women with preeclampsia and normotensive pregnant women (P > 0.05). The urinary estrogen showed a negative correlation with systolic blood pressure (rs= -0.46, P < 0.001) and diastolic blood pressure (rs= -0.47, P < 0.001). Additionally, the urinary estrogen and progesterone levels were lower in women with preeclampsia compared to those in normotensive pregnant women (P < 0.05). After adjusting for confounding factors, we observed a significant association between reduced urinary estrogen levels and an increased risk of preeclampsia (aOR = 0.09, 95%CI = 0.02–0.46). Notably, in our decision tree model, urinary estrogen emerged as the most crucial variable for identifying pregnant women at a high risk of developing preeclampsia. A positive correlation was observed between urinary progesterone and MEHP (rs = 0.36, P < 0.05) in normotensive pregnant women. A negative correlation was observed between urinary estrogen and MEP in pregnant women with preeclampsia (rs= -0.42, P < 0.05).ConclusionsPhthalates exposure was similar in normotensive pregnant women and those with late-onset preeclampsia within the same region. Pregnant women with preeclampsia had lower levels of estrogen and progesterone in their urine, while maternal urinary estrogen was negatively correlated with the risk of preeclampsia and phthalate metabolites (MEP).Trial registrationRegistration ID in Clinical Trials: NCT04369313; registration date: 30/04/2020.

Maternal prolactin or estrogen signaling in hepatocytes does not regulate iron homeostasis during pregnancy.

Not available.

Clinical outcomes of fresh and frozen embryos transfer after in vitro fertilization in spouses of patients with severely low sperm concentration and motility.

To compare the pregnancy and neonatal outcomes of in vitro fertilization-embryo transfer (IVF-ET) with fresh or frozen embryos in spouses of patients with severely low sperm concentration and motility. A total of 2300 patients whose spouses have severely low sperm concentration and motility underwent IVT-ET in the Reproduction Medicine Center, Sir Run Run Shaw Hospital from April 2018 to April 2022. After applying the propensity score matching (PSM), 473 fresh embryo transferred cycles and 473 frozen embryo transferred cycles were selected for the study, and the pregnancy and neonatal outcomes were compared between the two groups. There were no significant differences in pregnancy outcomes and neonatal outcomes between fresh and frozen embryo groups (all P>0.05). In the stratification analysis, the number of retrieved oocytes in the fresh good-quality embryo transfer group was significantly increased compared with the fresh poor-quality embryo group (P<0.05), but the very early pregnancy loss rates were similar between the two groups (P>0.05), while the rate in fresh good-quality embryo transfer group was significantly higher than that in the frozen good-quality embryo transfer group (P<0.05). Among different age groups of women, the number of retrieved oocytes and the level of estrogen in the fresh embryo transfer group was significantly higher in the 20 to <30 years old group than that in the 30 to <35 years old group (both P<0.05), but the clinical pregnancy rate was lower in the 20 to <30 years old group than that in the 30 to <35 years old group (P>0.05). Additionally, the very early pregnancy loss was significantly increased in the fresh embryo group compared with the frozen embryo group in the 20 to <30 years age group (P<0.05). There were no significant differences in pregnancy and neonatal outcomes between fresh and frozen embryo transfer in spouses of patients with severely low sperm concentration and motility undergoing IVF-ET. Due to the shorter transfer times, less embryo freezing damage and reduced costs, fresh embryo transfer can be considered as the first choice. However, it is not necessary to pursue fresh embryo transfer if maternal oestrogen levels are too high and there is a tendency of overstimulation.

Prenatal Exposure to PFAS, Associations with Preterm Birth and Modification by Maternal Estrogen Levels: The Maoming Birth Study.

Estrogens play a critical role in parturition, and poly- and perfluoroalkyl substances (PFAS), which have estrogenic effects, have been associated with preterm birth. However, the impact of estrogens on the association between PFAS and preterm birth is unknown. The objective of this study is to investigate if estrogens modified the association between PFAS and preterm birth, using a nested case-control study design. A total of 371 preterm births and 508 controls were selected from a birth cohort study in China between 2016 and 2018. Perfluorobutanoic acid (PFBA), perfluorohexanesulfonic acid (PFHxS) and its branched isomer, perfluorooctanoic acid (PFOA), perfluorooctanesulfonic acid (PFOS) and its branched isomer, and perfluorononanoic acid (PFNA) were quantified in maternal serum (mean gestational age of 32 wk). Estradiol and estriol were quantified in cord serum. Preterm birth was defined as live delivery at gestational weeks. Causal mediation analysis was used to estimate the mediation and interaction effects of estrogen on the association between PFAS and preterm birth. Latent profile analysis was used to identify important estrogen profiles. Multiple linear regression was used to estimate associations between PFAS and preterm birth and interactions between PFAS and estrogens on preterm birth. Overall, higher odds ratios (ORs) of preterm birth were associated with each 1 ln-unit PFAS increase: PFBA [1.20, 95% confidence interval (CI): 1.14, 1.26], PFNA (1.30, 95% CI: 1.21, 1.39), PFOA (1.98, 95% CI: 1.54, 2.55), and PFOS (1.91, 95% CI: 1.76, 2.07) and its branched isomer (1.91, 95% CI: 1.90, 1.92). We detected statistically significant interactions between cord estradiol and PFAS on preterm birth, while no mediation effects of cord estrogen were observed. The ORs of PFOS (4.29, 95% CI: 1.31, 8.25), its branched isomer (6.71, 95% CI: 1.06, 11.91), and preterm birth were greater for participants with high cord estrogen levels than for participants with low cord estrogen levels. Our findings suggest that estrogen modified the association between maternal PFAS exposure and preterm birth. Further studies on maternal PFAS exposure and preterm birth, taking interaction effects of cord estrogens into account, are warranted. https://doi.org/10.1289/EHP11377.

OR04-05 Prenatal Phthalate Exposure Alters The Pattern Of Fetal And Neonatal Endocrine Puberty In A Sex-specific Manner

Abstract Disclosure: M.A. Bunnell: None. P. Lin: None. S. Zhou: None. C. Park: None. S. Wang: None. Q. Hu: None. B. Marzbanabbasabadi: None. J. Oh: None. B. Wang: None. M. Laws: None. E. Fletcher: None. Z. Liu: None. E. Joo: None. H. Qiao: None. J. Flaws: None. C. Ko: None. Endocrine puberties (EP) are sex-specific transient elevations of gonadotropins and testosterone (T) in males and estradiol (E2) in females. Fetal EP occurs mid-gestation, neonatal EP is stimulated by the clearance of maternal estrogen after birth, and finally, reproductive function arises during classical puberty. EPs are critical for normal development and the sexual dimorphism of reproductive and some somatic organs. Disrupted T or E2 levels during fetal or neonatal EP lead to reproductive abnormalities in adults. The endocrine disrupting effects of phthalates have been well-documented in humans and animal models. Prepubescent children are highly susceptible to phthalate toxicity. In utero, exposure to phthalates causes gender-specific reproductive abnormalities. In this study, we tested the working hypothesis that in utero exposure to phthalates alters T and E2 levels in fetal and newborn mice in a gender-specific manner. Pregnant CD-1 dams (n=5-6/treatment/time point) were orally administered an environmentally relevant phthalate mixture (20 μg/Kg/day) or vehicle daily from embryonic day (ED) 10.5 until birth. On ED16.5, and postnatal hours (h) 1, 3, and 6, fetal tissues and neonatal sera and tissues were sampled for hormonal assays. Fetal and neonatal gonads were collected for testicular T and ovarian E2 measurements. The amount of serum per embryo was insufficient for determining circulating hormone levels in the fetus. Hence, at ED16.5, hormonal content of the full-body (excluding gonads) was used to assess the impact of phthalate exposure. Hormone levels were quantified by ELISA. At ED16.5, full-body T level was lower in exposed females (2.93 vs. 12.23 pg/body in control, P&amp;lt;0.0001), but higher in exposed males (277 vs. 216 pg/body in control, P=0.022). However, there was no difference in fetal testicular T (871 vs. 1027 pg/2 testes in control, P=0.089), indicating that testicular steroidogenesis was unaltered. A rapid decline in serum T levels occurred in both newborn control (h1= 623 pg/mL, h6= 249 pg/mL, P=0.009) and exposed males (h1= 600 pg/mL, h6= 224 pg/mL, P=0.0015), but serum LH remained constant (Control: h1= 0.83 ng/mL, h6= 0.63 ng/mL, P=0.36; exposed: h1= 0.69 ng/mL, h6= 0.82 ng/mL, P=0.43). Phthalate exposure did not impact neonatal serum T or LH in males. However, at h6, exposed females had lower serum E2 than controls (0.7 vs. 8.51 pg/mL in control, P=0.001). This study found that prenatal phthalate exposure altered T and E2 levels of males and females distinctly, without disrupting LH secretion and gonadal steroidogenesis. The results indicate that T and E2 levels were likely disrupted by altered steroid clearance due to a sex-dependent impact on hepatic T and E2 metabolism, rather than pituitary or gonadal hormone production. In conclusion, prenatal exposure to a phthalate mixture alters the levels of T and E2 during fetal and neonatal EP in a gender-specific manner. Presentation: Thursday, June 15, 2023

Oestrogens and progesterone in human milk and their effects on infant health outcomes: A narrative review.

Human milk (HM) is a complex biological system that contains a wide range of bioactive components including oestrogens and progesterone. Whilst maternal oestrogens and progesterone concentrations drop rapidly after birth, they remain detectable in HM across lactation. Phytoestrogens and mycoestrogens, which are produced by plants and fungi, are also present in HM and can interact with oestrogen receptors to interfere with normal hormone functions. Despite the potential impact of HM oestrogens and progesterone on the infant, limited research has addressed their impact on the growth and health of breastfed infants. Furthermore, it is important to comprehensively understand the factors that contribute to these hormone levels in HM, in order to establish effective intervention strategies. In this review, we have summarized the concentrations of naturally occurring oestrogens and progesterone in HM from both endogenous and exogenous sources and discussed both maternal factors impacting HM levels and relationships with infant growth.

Maternal steroids during pregnancy and their associations with exposure to lifetime stressful life events, prenatal stress appraisal and psychological functioning

BackgroundDuring pregnancy, steroids enable physiological adaptations in response to many factors, including maternal stress or psychological functioning. While stress and psychological dysfunction can have endocrine-disrupting effects beyond cortisol disruption, associations between prenatal maternal stress or related psychological dysfunction and the broader steroid milieu remain understudied. AimTo assess associations between independent and joint maternal stress and psychological functioning measures and steroid profiles in pregnancy (22–40 gestational weeks) in the Programming of Intergenerational Stress Mechanisms (PRISM) birth cohort (n = 334). MethodsSerum metabolomics detected 42 steroids and their metabolites, which were grouped into five classes (pregnenolone, androgens, estrogens, progestin, and corticosteroids). The Perceived Stress Scale, Life Stressor Checklist-Revised, and Edinburgh Postnatal Depression Scale indexed lifetime traumatic/non-traumatic stressors, global prenatal stress appraisal, and depressive symptoms during pregnancy, respectively. Exposures were categorized as high-low using the corresponding 3rd quartiles. We assessed associations between both individual and joint stress exposures with steroid classes using linear mixed effect models and with individual steroids using linear regressions. We also examined fetal sex-specific effects. ResultsHigh prenatal perceived stress was independently associated with lower levels of androgens and estrogens in the overall sample [β (95%CI): androgens: −0.13 (−0.25;−0.01); estrogens: −0.16 (−0.31;−0.01)], particularly among women carrying males [androgens: −0.22 (−0.39;−0.05); estrogens: −0.28 (−0.50;−0.07)]. Results on estrogens were consistent when considering joint exposure to both greater lifetime stressors and higher prenatal perceived stress. We also found a single testosterone metabolite—5alpha-androstan-3alpha,17alpha-diol disulfate—negatively associated with both individual high perceived stress and joint exposure to high lifetime stressors and high perceived stress among women carrying males. ConclusionsIncreased maternal perceived stress experienced in pregnancy was independently associated with lower maternal androgen and estrogen levels during pregnancy in the overall sample, particularly among women carrying males. Results on estrogens were consistent when we considered the joint exposure of increased lifetime stressors and higher prenatal perceived stress.

How do maternal androgens and estrogens affect sex determination in reptiles with temperature-dependent sex?

Temperature sex determination (TSD) in reptiles has been studied to elucidate the mechanisms by which temperature is transformed into a biological signal that determines the sex of the embryo. Temperature is thought to trigger signals that alter gene expression and hormone metabolism, which will determine the development of female or male gonads. In this review, we focus on collecting and discussing important and recent information on the role of maternal steroid hormones in sex determination in oviparous reptiles such as crocodiles, turtles, and lizards that possess TSD. In particular, we focus on maternal androgens and estrogens deposited in the egg yolk and their metabolites that could also influence the sex of offspring. Finally, we suggest guidelines for future research to help clarify the link between maternal steroid hormones and offspring sex.

Neonatal Single-Stage Surgical Management of Complicated Distal Vaginal Atresia: Revisiting an Appropriate and Feasible Technique

Hydrometrocolpos is distension of the vagina and uterus with fluid other than pus or blood. It is due to distal vaginal obstruction, and one of its possible causes is agenesis of the distal vagina. Patients with distal vaginal atresia may present in the neonatal period due to stimulation of uterine and cervical glands by maternal estrogen. In this study, we presented our results in managing neonates with complicated hydrometrocolpos due to distal vaginal atresia through a single-stage abdomino-perineal pull-through vaginoplasty. During the period from July 2003 to June 2018, neonates presented to the Department of Pediatric Surgery, Faculty of Medicine, Ain Shams University with complicated hydrometrocolpos (complicated with obstructive uropathy, intestinal obstruction, urinary tract infection, or systemic sepsis) due to distal vaginal atresia were included in the study. All the patients underwent single-stage abdomino-perineal pull-through vaginoplasty with drainage of the accumulated fluid. The patients were followed up for re-accumulation of fluid or vaginal stenosis for at least 4 years after the procedure. During the specified period, 14 neonates with complicated hydrometrocolpos due to distal vaginal atresia (complicated with obstructive uropathy, intestinal obstruction, urinary tract infection, or systemic sepsis) presented to the Department of Pediatric Surgery, Faculty of Medicine, Ain Shams University and underwent single-stage abdomino-perineal pull-through vaginoplasty with drainage of the accumulated fluid. Their age ranged between 4 and 18 days (mean 10, median 8). Two patients (14%) developed vaginal stenosis, which responded well to dilatation, and none of the patients had re-accumulation of the fluid during the follow-up period. Single-stage abdomino-perineal pull-through vaginoplasty in neonates with complicated distal vaginal atresia (complicated with obstructive uropathy, intestinal obstruction, urinary tract infection, or systemic sepsis) is an appropriate and feasible technique with a satisfactory outcome. Treatment study. IV.

Neonatal giant mastauxe: a case report.

A 13-day-term male neonate presented with bilateral breast enlargement and milky nipple discharge, which worsened upon breast massage. The mother had an uneventful pregnancy, and neither the mother nor the baby had a history of drug intake. The examination revealed soft, non-tender, non-erythematous bilateral breast swellings measuring 3.6×3.8cm on the right side and 3.2×3.4cm on the left side. Ultrasonography confirmed their hypoechoic nature with minimum vascularization. The white blood cell count, C-reactive protein levels, and culture of nipple discharge yielded normal results. The baby was discharged, and upon follow-up after 2 weeks, it was observed that breast swellings had spontaneously reduced in size. Neonatal breast enlargement can occur as a result of either the transplacental transfer of maternal estrogens or declining levels of estrogens toward the end of pregnancy, leading to hyperprolactinemia. However, the exact reasons behind the occurrence of giant mastauxe in some newborns remain incompletely understood. It may be due to increased sensitivity of the breast tissue to estrogens. Proper clinical examination, along with the use of ultrasonography and/or laboratory investigations if required, is essential to differentiate giant mastauxe from neonatal mastitis or breast abscess. Treatment primarily involves observation and providing reassurance to parents.

Comparative Study on Gender Selection: Persian Medicine and Modern Medicine

Gender selection has emerged as a controversial issue in different countries and in this respect, a wide range of studies and international symposiums have been dedicated to this subject. A comprehensive literature review was performed without restriction on publication date. Also, the credible Persian Medicine (PM) resources such as "Exir-e-Azam" (The Great Elixir), "Qarabadin-e-Kabir" (Great Pharmacopoeia), and "al-Qānūn fīl-tibb” (The Canon of Medicine) were completely studied. It was found that both nutritional factors such as glucose and electrolytes and non-nutritional factors including female tract, sperm, age, the timing of sexual intercourse, maternal body mass, stress, pH, estrogen, temperature, and testosterone can be used as important indicators in the gender selection. Most recommendations provided by PM for gender selection were found to be in good agreement with those reported by modern medicine.

The pathophysiological role of estrogens in the initial stages of pregnancy: molecular mechanisms and clinical implications for pregnancy outcome from the periconceptional period to end of the first trimester.

Estrogens regulate disparate female physiological processes, thus ensuring reproduction. Altered estrogen levels and signaling have been associated with increased risks of pregnancy failure and complications, including hypertensive disorders and low birthweight babies. However, the role of estrogens in the periconceptional period and early pregnancy is still understudied. This review aims to summarize the current evidence on the role of maternal estrogens during the periconceptional period and the first trimester of pregnancies conceived naturally and following ART. Detailed molecular mechanisms and related clinical impacts are extensively described. Data for this narrative review were independently identified by seven researchers on Pubmed and Embase databases. The following keywords were selected: 'estrogens' OR 'estrogen level(s)' OR 'serum estradiol' OR 'estradiol/estrogen concentration', AND 'early pregnancy' OR 'first trimester of pregnancy' OR 'preconceptional period' OR 'ART' OR 'In Vitro Fertilization (IVF)' OR 'Embryo Transfer' OR 'Frozen Embryo Transfer' OR 'oocyte donation' OR 'egg donation' OR 'miscarriage' OR 'pregnancy outcome' OR 'endometrium'. During the periconceptional period (defined here as the critical time window starting 1 month before conception), estrogens play a crucial role in endometrial receptivity, through the activation of paracrine/autocrine signaling. A derailed estrogenic milieu within this period seems to be detrimental both in natural and ART-conceived pregnancies. Low estrogen levels are associated with non-conception cycles in natural pregnancies. On the other hand, excessive supraphysiologic estrogen concentrations at time of the LH peak correlate with lower live birth rates and higher risks of pregnancy complications. In early pregnancy, estrogen plays a massive role in placentation mainly by modulating angiogenic factor expression-and in the development of an immune-tolerant uterine micro-environment by remodeling the function of uterine natural killer and T-helper cells. Lower estrogen levels are thought to trigger abnormal placentation in naturally conceived pregnancies, whereas an estrogen excess seems to worsen pregnancy development and outcomes. Most current evidence available endorses a relation between periconceptional and first trimester estrogen levels and pregnancy outcomes, further depicting an optimal concentration range to optimize pregnancy success. However, how estrogens co-operate with other factors in order to maintain a fine balance between local tolerance towards the developing fetus and immune responses to pathogens remains elusive. Further studies are highly warranted, also aiming to identify the determinants of estrogen response and biomarkers for personalized estrogen administration regimens in ART.

Vitamin C supplementation modulates crude oil contaminated water induced gravid uterine impaired contractile mechanism and foetal outcomes in Wistar rats.

Crude oil is a common environmental contaminant that impacts the reproductive functions of women. Understanding the contractile mechanism of the gravid uterus and how it impacts fetal outcomes during crude oil-contaminated water (CCW) exposure is still evolving. This study investigates the effect of vitamin C supplementation during the ingestion of CCW from Bayelsa, Nigeria, on the contractile mechanism of the gravid uterus and fetal outcomes. Fifteen nulliparous pregnant rats were randomly divided into 3 groups of 5 rats each and treated with normal saline (control), CCW (2.5 mL), and CCW + vitamin C (10 mg/kg bwt), respectively. Treatments were via oral gavage from gestation days 1-19. Gas chromatography-mass spectrometry of CCW, uterine oxidative biomarkers, and invitro contractile activity of excised uterine tissue to acetylcholine, oxytocin, magnesium, and potassium were determined. Furthermore, uterine responses to acetylcholine after incubation with nifedipine, indomethacin, and N-nitro-L-arginine methyl ester were also recorded using the Ugo Basile data capsule acquisition system. Fetal weights, morphometric indices, and anogenital distance were also determined. Acetylcholine, oxytocin, magnesium, diclofenac, and indomethacin-mediated contractile mechanisms were significantly impaired with CCW exposure; however, vitamin C supplementation significantly attenuated the impaired uterine contractile activity. Maternal serum estrogen, weight, uterine superoxide dismutase, fetal weight, and anogenital distance were significantly reduced in the CCW group compared to the vitamin C supplemented group. Ingestion of CCW impaired the uterine contractile mechanism, fetal developmental indices, oxidative biomarkers, and estrogen. Vitamin C supplementation modulated these by elevating uterine antioxidant enzymes and reducing free radicals.

Exposure to persistent organic pollutants in Danish pregnant women: Hormone levels and fetal growth indices

This study examines possible associations of maternal Persistent Organic Pollutants (POP) exposure during pregnancy, maternal hormone levels and fetal growth indices (FGI). During 1st trimester, we measured maternal thyroids, androgens and estrogens, lipophilic POP and perfluorinated-alkyl-acid (PFAA) levels in serum from nulliparous women. Adjusted multivariate-linear regression models assessed associations between exposure and outcomes. Maternal characteristics and POP exposures associated with maternal hormone levels. Lipophilic POP elicited inverse association with androgen and estrogen levels but no strong association with thyroids. Higher level of PFAA was associated with higher thyroid and androgen levels. The PFAA did not associate with estrogens. Higher thyroid-peroxidase-antibody (TPO-Ab) and estradiol level associated with higher birth weight and length in sons. For daughters, the TPO-Ab associations were the opposite being inversely associated with birth weight and length, and higher TPO-Ab and estradiol associated with lower gestational age. Mediation analyses suggested that TPO-Ab mediates the association of PFAA with FGI.

A Case Report On Imperforated Hymen

At pubescence, a patient with a flawless hymen commonly gives a vaginal lump of flimsy hymeneal tissue with a dim or somewhat blue tone brought about by the hematocolpos behind it. Different discoveries that might be available incorporate stomach bulk, incontinence of urine, obstruction, and dysphasia. The objective of evaluation is to distinguish a perfect hymen from other blocking anatomical causes; such are the distal vaginal artesian, urogenital sinus, cross-over vaginal septum, and labial connections. Careful mediation is fundamental just in suggestive pre adolescent client. Following the declaration of the conclusion, Most of the time, careful intervening is permitted prior to pubertal estrogenization because the flawless hymen might open precipitously at pubescence. Finishing a stomach and a perinea examination is significant. Further imaging is not necessary if an ultrasound reveals hematocolpos and a genuine assessment shows a swollen hymen. Nonetheless, on the off chance that the results are uncertain or alternatively, A cross-over or longitudinal vaginal septum, immaculate or cervical arteriosclerosis, an obstructed uterine horn, or any of these conditions may be present, according to attractive reverberation imaging. The ideal time for careful mediation on hymnal tissue is before the beginning of agony and after the beginning of the pubertal turn of events when the vaginal tissue is nitrogenised. Careful administration of clinically critical hymnal varieties includes extraction of the hymeneal tissue and seldom is related to long-haul squeal. If the patient is concerned for whatever reason a cross-over vaginal septum or a distal vaginal artesian, the patient should have skilfully alluded to the middle in the treatment of these illnesses. A thin strip of stratified squamous epithelium called the hymen surrounds the vaginal introits. An imperforate hymen is one that does not spontaneously rupture throughout a new-born’s growth. The female genital and urinary systems may become obstructed during pregnancy, childhood, or adolescence due to an imperforate hymen, an uncommon reason for primary amenorrhea. When endogenous maternal oestrogen is stimulated in infants with the virginal membrane, a mucosal. The Müllerian duct and the urogenital sinus make up the transverse vaginal septum. Which is a remnant of the vaginal plate? The failure of the membrane among the urogenital sinuses and the vaginal cavity to perforate leads to an imperforate hymen. We describe a rare instance of these two situations coexisting. A 16-year-old woman was referred to our hospital after receiving multiple puncture therapies for hematomata and hematocolpos when she was 16 years old owing to her monthly incidence of lower abdomen discomfort without menstrual flow. The growth of the vaginal fornix, hematomata, and hematocolpos were seen on magnetic resonance imaging. The imperforate hymen was cut, and there was a little adhesion that could be detached at the lower vaginal cavity. After that, a 5 mm thick full transverse vaginal septum was found. After a puncture that was guided by ultrasonography, it was removed. Melamine persisted although there were two cycles of menstrual flow. Six months after the initial procedure, a second operation was carried out; when it was observed that there was once again adhesion in the lower vaginal cavity. She was given a silicon dilator but was unable to use it at home, so she substituted a tampon. Four months following the second operation, cyclical menstrual bleeding is seen.

A Single-institution, Retrospective Chart Review of Outcomes and Complications Following Infant Ear Molding with the EarWell System

PURPOSE: Approximately one-third of infants are born with ear anomalies, more than two-thirds of which do not self-correct.1 Ear molding is the mainstay of nonsurgical correction and is commonly initiated as soon as possible after birth while cartilage remains malleable due to high concentrations of circulating maternal estrogens in the infant bloodstream.1 The purpose of this study was to examine the outcomes and complications associated with infant ear molding using the EarWell system at a single institution. METHOD: We conducted a retrospective chart review of all infants who underwent ear molding with pediatric plastic surgery from October 2010 to March 2021. Ear anomalies were classified as deformations, malformations, or multiple anomalies. Age at initiation, duration of treatment, temporal gaps in treatment, comorbidities, and details regarding any complications were also extracted for included patients. The primary outcomes assessed were degree of ear anomaly correction, incidence of skin complications, and unanticipated cessation of treatment. Parents of included patients were also sent a questionnaire regarding their children’s experiences with the ear molding process in which four outcomes regarding ear appearance (overall appearance, ‘natural’ look, symmetry, prominence) were rated on a 4-point Likert scale and cumulatively scored out of 16. RESULTS: A total of 184 ears of 113 patients were treated during the 11-year study period. Mean age at treatment initiation was 21 days, and average duration of treatment was 40 days. Helical rim deformities (N=50 ears) and lop ear (N=40 ears) were the most common anomalies present. Nine ears possessed characteristics consistent with two different anomalies. A total of 181 ears (98.4%) achieved either a complete (N=125 ears, 67.9%) or partial correction (N= 56 ears, 30.4%) upon treatment completion. There was no statistically significant association between age at initiation (p = 0.314), duration of application (p = 0.198), or type of anomaly (p = 0.192) and partial vs. complete correction. The most common complications were eczematous flares (N=27 occurrences among 25 ears, 13.6%) and pressure ulcers (N=23 occurrences among 21 ears, 12.5%). Incidence of complications was not significantly associated with age at application (p = 0.269), duration of application (p = 0.238), or type of anomaly (p = 0.106). Infants who experienced a complication were 3.36 times more likely to achieve partial correction (p < 0.001; 95% CI 1.66-6.81) relative to complete correction. Questionnaire responses were received for 24 out of 113 patients (21.2%) and were categorized into ‘Successful’ (N=21, 87.5%) and ‘Unsuccessful’ groups (N=3, 12.5%) depending on whether respondents denoted the ear molding process as successful or unsuccessful, respectively. The average cumulative appearance score for the ‘Unsuccessful’ and ‘Successful’ groups was 11 ± 2.6 and 15.4 ± 1.6, respectively, with a statistically significant difference between groups (p = 0.002). CONCLUSION: The EarWell system is an effective treatment strategy for infant ear anomalies, with most patients achieving complete correction. Addressing complications early may help providers optimize outcomes. REFERENCES: 1. Byrd HS, Langevin CJ, Ghidoni LA. Ear Molding in Newborn Infants with Auricular Deformities. Plastic and Reconstructive Surgery. 2010;126(4):1191-1200. doi:10.1097/PRS.0b013e3181e617bb

Loss of function of the maternal membrane oestrogen receptor ERα alters expansion of trophoblast cells and impacts mouse fertility.

The binding of 17β-oestradiol to oestrogen receptor alpha (ERα) plays a crucial role in the control of reproduction, acting through both nuclear and membrane-initiated signalling. To study the physiological role of membrane ERα in the reproductive system, we used the C451A-ERα mouse model with selective loss of function of membrane ERα. Despite C451A-ERα mice being described as sterile, daily weighing and ultrasound imaging revealed that homozygous females do become pregnant, allowing the investigation of the role of ERα during pregnancy for the first time. All neonatal deaths of the mutant offspring mice resulted from delayed parturition associated with failure in pre-term progesterone withdrawal. Moreover, pregnant C451A-ERα females exhibited partial intrauterine embryo arrest at about E9.5. The observed embryonic lethality resulted from altered expansion of Tpbpa-positive spiral artery-associated trophoblast giant cells into the utero-placental unit, which is associated with an imbalance in expression of angiogenic factors. Together, these processes control the trophoblast-mediated spiral arterial remodelling. Hence, loss of membrane ERα within maternal tissues clearly alters the activity of invasive trophoblast cells during placentogenesis. This previously unreported function of membrane ERα could open new avenues towards a better understanding of human pregnancy-associated pathologies.

Prenatal Mycoestrogen Concentrations in Relation to Placental and Birth Weights

Background and Aim: Zearalenone (ZEN) is an estrogenic mycotoxin or ‘mycoestrogen’ that contaminates global grain crops. Worldwide consumption has resulted in detectable concentrations of ZEN and its metabolites, including the synthetic version alpha-zearalanol (ZER), in human populations. Despite in vivo and in vitro evidence of endocrine disruption by ZEN, there is limited investigation of how mycoestrogens impact human health. The aim of this study was to examine markers of fetal growth following prenatal exposure to ZEN. Methods: Placental samples were collected from participants (n= 240) in the UPSIDE cohort (Rochester, NY, USA). ZEN and its metabolites were analyzed using high performance liquid chromatography and tandem mass spectrometry and values were log-transformed. Birth and placental weights were obtained from medical records and direct measurement, respectively; fetoplacental ratio (FPR) was calculated by dividing birthweight by placental weight. Generalized linear regression models were used to examine ZEN, ZER, and total mycoestrogens (sum of ZEN, ZER and their metabolites) in relation to fetal and placental size, adjusting for covariates. Results: ZEN and its metabolites were detected in 82% of placentas (median ZEN: 0.013 ng/g). Lower fetoplacental ratios were associated with placental concentrations of ZER (-0.45, 95%CI: -0.74,-0.16) and total mycoestrogens (-0.26, 95%CI: -0.42, -0.10). Although not statistically significant, placental ZEN (-31g, 95%CI: -115, 53) and ZER (-83g, 95%CI: -205, 40) were associated with lower birthweight and ZEN was associated with lower fetoplacental ratio (-0.19, 95%CI: -0.47, 0.08). No associations with placental weight were observed. Conclusions: Results from this first epidemiological study of prenatal mycoestrogen exposure and child health suggest that ZEN and its metabolites may alter placental efficiency, resulting in lower birthweight. Ongoing work in this cohort will additionally quantify urinary mycoestrogens across pregnancy and evaluate maternal estrogens in relation to ZEN exposure.

Genital Examination of the Prepubertal Female: Essentials for Pediatric Nurse Practitioners.

Genital Examination of the Prepubertal Female: Essentials for Pediatric Nurse Practitioners.

Changes of Oral Microbes during Pregnancy and Its Effect on Premature Birth

Premature birth, stillbirth, low birth weight babies, hypertension, and other negative pregnancy outcomes are all associated with women's dental health during pregnancy, according to several studies. Premature birth is a common complication of pregnancy. Premature birth refers to the birth of the fetus before 37 weeks of pregnancy, which is the main cause of death of children under 5 years old. Therefore, it is critical to comprehend the mechanism of premature birth and prevent it effectively. Existing studies have shown that pregnancy, especially in the early stage, promotes the proliferation of microbes in the mouth and promotes the colonization of periodontal pathogens. Gingivitis and periodontitis are more common in pregnant women than in non-pregnant women. The reasons for the changes of oral microbes during pregnancy may be the increase of maternal progesterone and estrogen, as well as the changes of immune system. The pH value of saliva will also decrease during pregnancy, which is related to oral diseases. At present, there are two mechanisms of premature birth caused by oral microbes. One is that oral bacteria reach the uterus through blood borne transmission, and intrauterine infection leads to premature birth. The other is that endotoxin released by bacteria will increase inflammatory mediators and trigger the release of inflammatory factors (such as interleukin and tumor necrosis factor) and prostaglandins in the uterus, leading to premature birth. This paper summarizes the changes and causes of oral microbes in women during pregnancy and the two mechanisms of oral bacteria leading to premature birth and puts forward some measures to prevent and treat oral diseases during pregnancy, so as to provide new ideas for the prevention and treatment of premature birth.