Nant Women Research Articles

Preeclampsia and Preterm Delivery Risk: The Significance of Obesity in Pregnancy

<p><strong>Introduction.</strong> A significant proportion of women globally, consti tuting 38%, are obese, among whom 24.5% reside in Europe. Obe sity elevates the risk of premature birth due to associated maternal conditions, such as preeclampsia. The objectives were to assess: variations in demographic and clinical characteristics among preg nant women across groups; the impact of obesity on the incidence of preeclampsia and preterm delivery; and the influence of obesity on newborn characteristics.</p> <p><strong>Methods. </strong>One-year prospective study included 133 pregnant wom en gestational age 11-14 gestational week (GW), divided into two groups: OB (41.35%) and CG (58.65%). The data were analyzed using IBM SPSS version 23.</p> <p><strong>Results. </strong>There is statistically significant difference in average body mass index (BMI) (22.01 ± 1.83 vs. 30.26 ± 4.52; p < 0.001) and de livery time (37.94 ± 2.05 vs. 36.87 ± 2.45; p = 0.003) between CG and OB. Obese pregnant women developed preeclampsia significantly more often than normal weight (61.82% vs. 28.21%; p < 0.001). Body mass index has significant moderate predictive ability to predict preeclampsia (AUC 0.696 (95% CI: [0.601; 0.79]). Higher BMI (OR = 1.19, [1.09; 1.29], p < 0.0001) was associated with higher rates of pre eclampsia. Overweight (OR = 2.41, [1.07; 5.43], p = 0.0335), obesity class I, II and III (OR = 20.36, [4.32; 95.99], p = 0.0001) were associated with higher rates of preeclampsia. A poor negative correlation was found between BMI and GW of pregnancy outcome (p = -0.24; r2 = 0.104; p = 0.006). Higher BMI (β = -0.14, [-0.21; -0.07], p = 0.0002) was associated with lower values of GW of pregnancy outcome.</p> <p><strong>Conclusions.</strong> Presence of obesity or overweightness in the first tri mester of pregnancy poses a significant risk factor for preeclampsia and preterm delivery.</p>

Did advice on the prescription of sodium valproate reduce prescriptions to women? An observational study in three European countries between 2007 and 2016.

In November 2014, the CMDh (a regulatory body representing EU Member States) advised doctors not to prescribe sodium valproate for epilepsy or bipolar disorder in preg nant women, in women who can become pregnant, or in girls unless other treatments are ineffective or not tolerated. This study aimed to determine if this warning led to changes in prescription patterns. Cohort of 5.4 million women aged between 10 and 50 years identified in electronic health care data from United Kingdom, France, and Italy (2007-2016). Anti-epileptic drug (AED) prescriptions. The prevalence of women receiving AED prescriptions in 2016 varied from 12.2 per 1000 to 29 per 1000 in the four regions. The incidence of prescribing any AED (excluding clonazepam, gabapentin, and pregabalin) fell each year on average by 7.5% (95% CI, 7.0%-8.0%; Emilia Romagna), 9.6% (8.3%-11.0%; France), 7.1% (6.7%-7.6%; Tuscany), and 0.4% (0.2%-1.0%; United Kingdom). The relative odds of prescribing sodium valproate rather than any other AED decreased more after 2014 compared with before the end of 2014 in France (OR = 0.77; 95% CI, 0.60-0.98), Tuscany (0.81; 0.76-0.86), Emilia Romagna (0.83; 0.76-0.90), and the United Kingdom (0.92; 0.80-1.06; not statistically significant). There is evidence that the CMDh warning did lead to changes in prescription patterns of sodium valproate in women of childbearing age. There were considerable differences in prescribing practice amongst regions of Europe.

Biochemical Markers for Prediction of Hypertensive Disorders of Pregnancy

SummaryBackground: Gestational hypertension (GH) and pre eclam p - sia (PE) are the most common gestational complications. Several placental biochemical markers are used to predict GH/PE, but with conflicting results. Methods: The study aim was to estimate the biochemical markers’ ability to predict hypertensive disorders in pregnancy. On the first ultrasonographic examination, 104 healthy preg nant women were recruited. At the regular pregnancy check-ups, BMI, blood pressure, occurrence of gestational hypertension (early or late onset), preeclampsia, eclampsia and other complications were recorded. Serum concentrations (in multiples of median - MoM) of human chorionic gonadotropin (HCG) and pregnancyassociated plasma protein A (PAPPA) were measured from the 11th to 14th gestational week, while HCG, alpha feto protein (AFP), estriol and inhibin were determined between the 16th and 19th gestational week. Results: Hypertensive disorders throughout pregnancy were diagnosed in 20.2% women. Early-onset GH was registered in 7 and PE in 6 patients, while 14 had late-onset GH and 10 additional women PE. There were no significant differences (p≥0.05) in biochemical markers concentrations between women with and without GH/PE. PAPPA levels in the first and HCG in the second trimester correlated with early and late GH/PE. Moreover, higher AFP concentra tions were registered in women with preeclampsia signs/symptoms. According to ROC analysis, AFP>1.05 MoM properly identified 80% of GH/PE cases. Obtained models imply that HCG, PAPPA and AFP should be used for GH/PE prediction. Conclusion: Biochemical markers HCG, PAPPA and AFP could be useful in predicting gestational hypertension and preeclampsia. However, different markers should be used for early and late onset GH/PE.

A guide to magnetic resonance imaging in clinical practice

British Journal of Hospital MedicineVol. 76, No. 4 Core TrainingA guide to magnetic resonance imaging in clinical practiceD McKean, P Yoong, CL McCarthyD McKeanSearch for more papers by this author, P YoongSearch for more papers by this author, CL McCarthySearch for more papers by this authorD McKean; P Yoong; CL McCarthyPublished Online:8 Apr 2015https://doi.org/10.12968/hmed.2015.76.4.C55AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Armstrong P, Keevil SF (1991) Magnetic resonance imaging: Basic principles of image production. BMJ 303(6793): 35–40 Crossref, Medline, Google ScholarCowper SE, Robin HS, Steinberg SM, Su LD, Gupta S, LeBoit PE (2000) Scleromyxoedema-like cutaneous diseases in renal-dialysis patients. Lancet 356(9234): 1000–1 Crossref, Medline, Google ScholarLi A, Wong CS, Wong MK, Lee CM, Au Yeung MC (2006) Acute adverse reactions to magnetic resonance contrast media–gadolinium chelates. Br J Radiol 79(941): 368–71 Crossref, Medline, Google ScholarMansfield P, Maudsley AA (1977) Medical imaging by NMR. Br J Radiol 50(591): 188–94 Crossref, Medline, Google ScholarPrice DL, De Wilde JP, Papadaki AM, Curran JS, Kitney RI (2001) Investigation of acoustic noise on 15 MRI scanners from 0.2 T to 3 T. J Magn Reson Imaging 13(2): 288–93 Crossref, Medline, Google ScholarShellock FG, Schaefer DJ, Kanal E (1994) Physiologic responses to an MR imaging procedure performed at a specific absorption rate of 6.0 W/kg. Radiology 192(3): 865–8 Crossref, Medline, Google Scholar FiguresReferencesRelatedDetails 2 April 2015Volume 76Issue 4ISSN (print): 1750-8460ISSN (online): 1759-7390 Metrics History Published online 8 April 2015 Published in print 2 April 2015 Information© MA Healthcare LimitedPDF download

Prevalence of Herpes Simplex Virus in Pregnant Women from Gangetic Plain Region of Allahabad, India

Herpes Simplex Virus (HSV) is a common pathogen that leads to lifelong latent infection and may be associated with transmission from mother to their fetus. A total of 191 blood samples of preg- nant women were collected to check the prevalence of Herpes Simplex Virus (HSV). It was ob- served that 124 (64.9%) and 04 (2.1%) samples were positive for HSV IgG and HSV IgM, respec- tively. Seropositivity of HSV IgG was the highest for third trimester and it was followed by second and first trimester; while it was the highest for first trimester for HSV IgM and it was followed by third and second trimester. Seroprevalence of HSV IgG and IgM was statistically insignificant (P > 0.05) according to gestation age. A significant correlation was observed between HSV IgG and age groups of pregnant women; while it was insignificant for HSV IgM. Seroprevalence of HSV IgG+ IgM- was 32 (53.3%), 61 (66.3%), and 27 (69.2%) for first, second and third trimester, respectively. Seroprevalence of HSV IgG+ IgM+ group was 02 (3.3%), 01 (1.1%) and 01 (2.6%) for first, second and third trimester, respectively. Seroprevalence of HSV IgG- IgM- group was 26 (43.3%), 30 (32.6%), and 11 (28.2%) for first, second and third trimester, respectively.

Psychiatric Variables in <i>Cytomegalovirus</i> or <i>Toxoplasma gondii</i>—Infected Pregnants: Prospects for Cure with a Program of “Counseling about Behavioral Change”

TORCH complex, one of the potential infections that may occur during pregnancy, may contribute also to prenatal pregnant women's anxiety and depression. The aim of this study was to explore the presence of psychiatric symptoms, in relation with infection of TORCH agents, specifically the Toxoplasma gondii (T. gondii) and Cytomegalovirus (CMV). The study was conducted on 58 preg- nant women recruited from the Clinical Virology Unit, A.O.U. Policlinico-Vittorio Emanuele, P.O. Gaspare Rodolico, from September 2012 to March 2014. Psychiatric symptoms were evaluated through the Symptom Checklist-90 Revised (SCL-90 R) in pregnant women with CMV or T. gondii infection. Moreover, pregnant women were invited to participate in a program of Counseling about behavioral change, an effective psychotherapeutic training for the development of new motivational strategies to the infection acceptance, the greater self-confidence and greater adhe- rence to treatment. The age of the subjects was positively correlated with Depression (r = 0.119, p < 0.05) and negatively correlated with Phobic Anxiety (r = −0.178, p < 0.05). The same variables were also negatively correlated with the level of education (r = −0.231, r = −0.320, p < 0.05) and with the dimension Somatization (r = −0.208, p < 0.05). Somatization was positively correlated with unmarried patients (r = 0.141, p < 0.05), while Phobic Anxiety was negatively correlated with unmarried patients (r = −0.105, p < 0.05). Somatization, Phobic Anxiety and Depression were po- * Corresponding author.

Design and development of a combined calcium-iron-folic acid prenatal supplement to support implementation of the new World Health Organization recommendations for calcium supplementation during pregnancy.

Hypertensive diseases of pregnancy are important causes of maternal and perinatal mortality. Based on meta-analyses of efficacy trials of prenatal calcium supplementation to reduce the risk of hypertensive diseases of pregnancy, the World Health Organization recommends 1.5 to 2.0 g of elemental calcium per day for pregnant women with low dietary calcium intakes (as well as 60 mg of iron and 400 microg of folic acid). However, implementation of this recommendation is challenged by the size and number of calcium tablets required and the need to avoid concurrent ingestion of calcium and iron due to intraintestinal interactions. We developed a novel micronutrient powder containing microencapsulated pH-sensitive calcium in addition to iron and folic acid, designed to facilitate early intestinal iron release and delayed calcium release. Two pharmaceutical companies were contracted to develop a prototype, one of which was chosen for clinical testing. Calcium carbonate granules were coated with a trilayer pH-sensitive enteric coating using a fluid-bed spray coater. Iron and folic acid granules were encapsulated with a time-release coating. Iron and calcium dissolution profiles were assessed during exposure to acidic (pH 1.2) and/or basic (pH 5.8) media using a modified USP apparatus 1 (basket) method. At pH 1.2, calcium and iron release was < or = 10% and > 90% after 120 minutes, respectively. At pH 5.8, > 80% of total calcium was released after 90 minutes. Based on in vitro criteria, the supplement may be a promising approach for delivering calcium, iron, and folic acid as a single daily dose to pregnant women in settings of low dietary intake of calcium.

The essential and toxic effects of trace elements in the biological tissues of pregnant women and newborn babies (an ecologically unfavourable region)

Ecological conditions in the Urals are unfavorable. In the Sverdlovsk region, every second pregnancy and in Y ekaterinburg every third pregnancy burdened of obstetric and gynecologic pathology. It makes us pay a special attention to the reasons of the increased perinatal morbidity and mortality. The aim of the research was to estimate the levels of macro and trace elements: Fe, Ca, Mn, Cu, Zn, Cd, Pb, Cr, Ni of 156 pregnant women and their newborn babies inhabiting an industrial city, where the environment is polluted with heavy metal compounds. It was found that the women had low indices of ecological valency, pregnancy complication and break of reproductive functions (hestoses, anemia, threat pregnancy interruption). Inspection of cases revealed chronic hypoxia (81.2%), Fe-defi ciency anemia (50.4%), gestosis (29.9%), extragenital diseases of infectious infl ammatory character (65%), chronic pyelonephritis (18.8%), hypertension (13.7%). All inspected women (megacity) had higher levels of trace elements: Cu, Zn, Cd, Pb, Cr, Ni in the placenta tissue (p < 0.05) and the defi ciency of the essential elements Mn, Mg and Fe (p < 0.01). Higher levels of Cu, Cd, Pb were observed in the blood serum. The newborn babies had higher levels of Cu and Pb in the blood serum. Direct correlations were marked between Cd in the megacity environment and in placenta of pregnant women (R = 0.86, p = 0.041). Average correlation was marked between Pb in the megacity environment and placenta of pregnant women (R = 0.34; p = 0.038). A strong reverse correlation was observed between heavy metals in the city environment (Cu, Zn, Pb) and body mass of newborn (R = ‐0.98; R = ‐0.98; R = ‐0.80 respectively, p = 0.034). Reverse correlation was marked between Cd and the fetal growth (R = ‐0.79; p = 0.037). We marked absence of signifi cant distinctions between the basic and the control group in Cd levels in the blood of healthy newborn babies (0.003 ± 0.001 and 0.002 ± 0.001 mkg/mL, respectively). This evidenced about active barrier function of placenta of healthy women. Signifi cant quantities of Pb were marked in the blood serum of newborn. Barrier function of placenta for Pb was not noted. The placenta passes Cu and Zn to the blood of newborn. The combined effect of macro- and microelements through the system mother‐placenta‐newborn is unfavorable for the fetus. Preg nant women (megacity) ‐ a group of high risk by the prenatal development (intra-uterine hypoxia and the fetal growth restriction) ‐ and their newborn babies were at risk of developing pathologies provoked by the tran splacental ability of toxic elements.

E31 Outcomes of ureteroscopy for stone disease in pregnancy: Results from a systematic review of the literature

Introduction: Our aim was to evaluate the clinical efficacy and safety of ureteroscopy as a primary treatment for preg- nant women with symptomatic ureteric stones who have failed conservative management. Materials and Methods: A systematic review of the literature from January 1990 to June 2011 was performed, including all English language ar- ticles. Outcome measures were clinical efficacy, in terms of stone clearance and need for additional procedures, and safety in terms of complications. Results: A total of 239 ab- stracts were screened and 15 studies were identified report- ing on 116 procedures. The surgical methods of stone man- agement employed were stone extraction with basket only (n = 55, 47%), laser fragmentation (n = 27, 23%; holmium, n = 20, pulse dye, n = 7), impact lithotripsy (n = 21, 18%), uretero- scopic lithotripsy (n = 6, 5%) and a combination of methods (n = 6, 5%). A post-operative stent was inserted in 64 of 116 procedures (55%). Complete stone clearance was seen in 100 of the 116 procedures (86%). There were 2 major complica- tions (1 ureteral perforation and 1 case of premature uterine contraction) and 7 minor complications (5 urinary tract infec- tions and 2 cases of post-operative pain). Conclusion: This review suggests that stone clearance using ureteroscopy is a relatively safe option in pregnancy with a high success rate.

Effect of ritodrine hydrochloride combined with radix salviae miltiorrhizae on fetal growth restriction

Objective Ritodrine hydrochloride(RH) combined with radix salviae mihiorrhisa(RSM) is ap- plied to treat fetal growth ristriction(FGR). Curative effect was recorded during observation. Methods 62 pregnant women with slowly growing fetuses were divided into two groups randomly. Group A(test group) :including 31 preg- nant women who received RH combined with RSM treatment. Group B(control group) :including the other 31 preg- nant women who only received RSM treatment. Group B received 250ml of fat emulsion injection. One time every three days within one week. At the same time,gronp B also received injection of 500ml 10 % dextrose, coenzyme A 100U ,ATP 40mg,vitamin C 2g,dextran-40 and compound salvia injection 10ml one time a day,ten days in all. Be- sides the above-mentioned medicament for group B, group A received RH 100ml injection every day. Ten days was a period of treatment. After the treatment, uterine height, abdominal circumference, weight were measured and bipari- etal diameter, head circumference, abdominal circumference were checked by B-type ultrasonic inspection. After birth,weight of the baby and weight of placenta were measured too. Results Measurement indexes from group A, weight of the new-born baby and weight of placenta are obviously higher than those from group B. Conclusion RH combined with RSM can obviously extend blood vessel, loose placenta, improve blood circulation, accelerate cell metabolism, make microeirculation better, reduce permeability of capillary vessel, keep placenta's function and help foetus' growth. Key words: Fetal growth retardation; Ritodrine; Salviae miltiorrhiza; Drug therapy, combination

Extracellular matrix proteins dependent apoptosis of T Cells in women with a history of recurrent spontaneous abortion

INTRODUCTION: The purpose of the study was to determine the role of T cell apoptosis in ECM environment in pregnancy maintenance in women with a history of recurrent spontaneous abortion (RSA).MATERIALS AND METHODS: Thirty nonpreg‐ nant women with the history of RSA and 10 normal healthy women with the previous successful pregnancy outcome were studied. In addition, 15 pregnant women with the history of RSA were studied. We studied apoptosis of peripheral blood T cells after culture with mAb OKT‐3 alone and with mAb OKT‐3 and the following ECM: fibronectin and collagen IV. We used Cell Death Detection ELISA. In addition, apoptotic peripheral blood T cells were identified by annexin V‐PE staining protocol using flow cytometry. CD29, CD95 T cells' surface receptors were studied.RESULTS: The highest values of enrichment factor: mU of the sample (dying/dead cells) per mU of the corresponding control (viable cells) were observed after peripheral T cells' culture with fibronectin or collagen IV in samples of women with the history of RSA. However, percentage of apoptotic T cells stained by annexin V was significantly lower in RSA women compared to control (P &lt; 0.05). CD95 expression was significantly lower in RSA women compared to control (P &lt; 0.05).CONCLUSIONS: Apoptosis of activated cytotoxic T cells might be an interesting possible explanation of successful pregnancy outcome in women with the history of RSA.

HIV Screening and Treatment of Pregnant Women and Their Newborns: A Simulation-Based Analysis

Clinical trials have shown that HIV-positive preg nant women treated with zidovudine during preg nancy and delivery have a much lower rate of HIV transmission to their newborns. Recent studies have also shown the effectiveness of antiretroviral therapy combined with elective cesarean delivery and a short- term antiretroviral therapy. In this study a dynamic computer model was built. The model was used to estimate economic consequences of testing pregnant women for HIV virus and treating the HIV-positive women and their newborns with three different reg imens. Outcomes of data analysis included costs and the number of avoided cases of perinatal transmission of the HIV virus. The study found that while the over all costs of the three treatment programs were simi lar, the short-term antiretroviral program was the least cost-effective and prevented fewer cases of peri natal transmission of the virus. Sensitivity analysis found that the cost-effectiveness of the treatment pro grams were differentially sensitive to screening and treatment rates. Cost-effectiveness of all regimens is highly sensitive to the HIV infection rate among preg nant women. When the rate reaches four to five per 1,000, treatment cost savings from the reduction in pediatric HIVcases exceed the costs of screening and treatment. The model presented provides a useful tool to be used to evaluate treatment programs designed to pre vent mother-to-infant transmission of the HIV virus.

Varicella infection contracted in utero: Sex incidence and incubation period

in normal pregnant group. It may be pointed out that ordinarily a fall in total protein levels to 5.3 Gm. per cent is usually accompanied by edema. But in the present study of normal preg nant women the fall to this level was not associated with clinical evidence of edema. How the fall in oncotic pressure of the proteins is compensated for and how the manifestation of edema is prevented needs further study. Further, the present data are from women of a low socioeconomic level consuming small amounts of vegetable protein, in whom the element of undernutrition or difference in the quality of protein cannot be ignored especially under the stress of pregnancy. Probably the undernourished mater-