Non-pregnant Women Research Articles

The Influence of Racial/Ethnic and Gender Concordance on Care Among Non-Pregnant Women of Childbearing Age with Diabetes Mellitus: an Analysis of the Medical Expenditure Panel Survey, 2010-2019.

This study examined associations between patient-provider race/ethnicity concordance and gender concordance on overall healthcare ratings, self-efficacy, and diabetes care monitoring in non-pregnant women of childbearing age with diabetes mellitus before and after adjusting for sociodemographic factors. We analyzed longitudinal data from the 2010-2019 Medical Expenditure Panel Survey. The sample was limited to non-pregnant women of childbearing age (18-45years) diagnosed with diabetes (unweighted n = 327; weighted n = 566,504). Bivariate analysis, logistic regression, and latent variable modeling were performed. Few racially minoritized women reported racial/ethnic and gender concordance with their healthcare provider. Only 2.9% of Hispanic women reported having a Hispanic provider and 12.1% of non-Hispanic Black women reported seeing a non-Hispanic Black provider compared to 81.1% of non-Hispanic White women who reported seeing a non-Hispanic White provider (p < .0001). Among Hispanic women, 15.3% reported seeing a female provider compared to 25.2% of non-Hispanic Black and 53.5% of non-Hispanic White women. Patient-provider race/ethnicity and gender concordance were not statistically significantly associated with overall healthcare ratings, self-efficacy, or diabetes care monitoring. This study revealed a large disparity in race/ethnicity and gender concordance among minority women of reproductive age with diabetes compared to their non-Hispanic White counterparts. There is a need for larger, more robust studies to examine the influence of provider and other healthcare characteristics on diabetes-related outcomes in this understudied population.

Genome-wide methylation profiling of maternal cell-free DNA using methylated DNA sequencing (MeD-seq) indicates a placental and immune-cell signature.

Placental-originated cell-free DNA (cfDNA) provides unique opportunities to study (epi)genetic placental programming remotely, but studies investigating the cfDNA methylome are scarce and usually technologically challenging. Methylated DNA sequencing (MeD-seq) is well compatible with low cfDNA concentrations and has a high genome-wide coverage. We therefore aim to investigate the feasibility of genome-wide methylation profiling of first trimester maternal cfDNA using MeD-seq, by identifying placental-specific methylation marks in cfDNA. We collected cfDNA from nonpregnant controls (female n = 6, male n = 12) and pregnant women (n = 10), first trimester placentas (n = 10), and paired preconceptional and first trimester buffy coats (total n = 20). Differentially methylated regions (DMRs) were identified between pregnant and nonpregnant women. We investigated placental-specific markers in maternal cfDNA, including RASSF1 promoter and Y-chromosomal methylation, and studied overlap with placental and buffy coat DNA methylation. We identified 436 DMRs between cfDNA from pregnant and nonpregnant women, which were validated using male cfDNA. RASSF1 promoter methylation was higher in maternal cfDNA (fold change 2.87, unpaired t-test p < .0001). Differential methylation of Y-chromosomal sequences could determine fetal sex. DMRs in maternal cfDNA showed large overlap with DNA methylation of these regions in placentas and buffy coats. Sixteen DMRs in maternal cfDNA were specifically found only in placentas. These novel potential placental-specific DMRs were more prominent than RASSF1. MeD-seq can detect (novel) genome-wide placental DNA methylation marks and determine fetal sex in maternal cfDNA. Our results indicate a placental and immune-cell contribution to the pregnancy-specific cfDNA methylation signature. This study supports future research into maternal cfDNA methylation.

Changes in Fibrinogen and D-Dimer During Complicated and Uncomplicated Pregnancy.

The increase in fibrinogen levels is vital for the formation of a prothrombotic state during gestation to counter-bleeding challenges at delivery. However, pregnancy complications characterized by systemic inflammatory response syndrome may consume fibrinogen, resulting in elevated D-dimer levels. Our study is based on a total of 16 768 pregnant women who delivered between December 1, 2013, and December 1, 2018, to study fibrinogen and D-dimer changes during gestation under normal and multiples of pathogenic states. Compared with nonpregnant women (3.04[3.02-3.08]), pregnant women depicted higher fibrinogen levels throughout gestation (p < 0.001). In the uncomplicated group, fibrinogen levels increased throughout the first (3.28[3.26-3.29]), second (4.04[4.01-4.07]), and third trimesters (4.40[4.38-4.41]) but dropped at delivery (4.30[4.28-4.31]), similar to the changing pattern of the pregnancy-related complication group and pre-existing disorder group. Women with pregnancy-related complications showed significantly higher mean fibrinogen levels throughout gestation (p < 0.001), except for placental abruption, where, it decreased from the third trimester and was lower than that of uncomplicated pregnancies (3.89[3.60-4.17] vs. 4.40 [4.38-4.41], p = 0.001). Among uncomplicated pregnancies, D-dimer grew rapidly throughout the first trimester (0.09[0.06-0.15]), second trimester (0.28[0.19-0.40]), third trimester (0.51[0.36-0.78]), and delivery (0.70[0.47-1.03]). Women with pregnancy-related complications and pre-existing disorders shared similar changing patterns; however, the D-dimer of women with placenta accreta presented higher levels than those with uncomplicated pregnancies since the first trimester. We concluded that fibrinogen levels are expected to increase steadily, but in patients with placental abruption, fibrinogen levels dropped during the third trimester. D-dimer levels typically rise consistently throughout pregnancy, yet in patients with placenta accreta, they show abnormal elevation since an early stage of pregnancy.

Ischemia-Modified Albumin and Antioxidant Capacity of Blood Serum in Normal Pregnancy and Preeclampsia.

A comparative study of oxidative stress markers (ischemia-modified albumin (IMA) and the blood serum antioxidant capacity) in normal pregnancy and preeclampsia was carried out. The IMA level and blood serum antioxidant capacity increased in the following order: healthy non-pregnant women→healthy pregnant women→patients with moderate preeclampsia→patients with severe preeclampsia (p<0.001). A significant positive correlation was revealed between blood serum antioxidant capacity and uric acid levels in all the examined groups. The results showed that oxidative stress in preeclampsia is more pronounced compared to normal pregnancy. The levels of IMA and the blood serum antioxidant capacity can be additional criteria for assessment of the severity of preeclampsia and predicting of its course.

High prevalence of undiagnosed iron deficiency in endometriosis patients: A cross-sectional study.

The primary objective was to evaluate the prevalence of undiagnosed iron deficiency in patients with endometriosis. We performed a multi-center, cross-sectional study at two tertiary care hospitals. We included 251 non-pregnant women (18-50 years old) presenting with a clinical or surgical diagnosis of symptomatic endometriosis. Patients who consented to the study underwent screening bloodwork (including complete blood count, ferritin, and transferrin saturation) and completed the study survey assessing demographics, medical and surgical history, and validated questionnaires to assess iron deficiency and endometriosis symptoms. The prevalence of iron deficiency in our endometriosis cohort was 53.4% (134/251), and the prevalence of iron deficiency anemia was 13.5% (34/251). Patients with iron deficiency were more likely to have heavy menstrual bleeding (HMB) compared with patients without iron deficiency (66/133, 49.6% vs. 40/115, 34.8%, p = 0.022). Nonetheless, 58% (142/251) of our study population did not endorse HMB. Despite absence of HMB, 47% (67/142) of these patients were iron-deficient. Transferrin saturation was diagnostic for iron deficiency in 63 of 176 patients (35.7%) who had a normal ferritin (≥30 ng/mL). Patients with iron deficiency had a significantly lower adjusted median Functional Assessment of Chronic Illness Therapy Fatigue Subscale score compared with those without iron deficiency (26.3. vs. 29.8, p = 0.025). This study highlights the high prevalence of iron deficiency, which remains undiagnosed in over half of patients with endometriosis presenting to a gynecologist. Future research should focus on assessing the effectiveness of iron therapy in improving symptoms and overall well-being in this population.

Transcription and Copy Number Variation of Plasmodium falciparum var2csa among Nonpregnant Malaria Patients in Thailand.

Placental malaria is an important cause of fetomaternal morbidity and mortality among pregnant women infected with Plasmodium falciparum. The pathogenesis involves the binding of VAR2CSA on the surface of infected erythrocytes to chondroitin sulfate proteoglycans on syncytiotrophoblasts in the intervillous space of the placenta. Anti-VAR2CSA antibodies confer protection from adverse pregnancy outcomes in falciparum malaria; therefore, VAR2CSA is a strong vaccine candidate against placental malaria. To date, little is known about transcription of var2csa among isolates from male and nonpregnant patients in low transmission areas. In this study, transcription and copy number variation of var2csa were analyzed in 55 P. falciparum isolates from nonpregnant women, men and children with symptomatic malaria in five endemic provinces of Thailand. Reverse transcription polymerase chain reaction (PCR) detected var2csa transcripts in 43 (78.2%) blood samples. Multiple copies of var2csa were identified in 16 of 55 (29.1%) isolates by quantitative real-time PCR. Copy number variation of var2csa was not associated with the patients' gender, age group, ethnicity, parasite genotypes, parasite density, and geographic origins. These data suggest that P. falciparum carrying multicopy var2csa had a wide geographic distribution in Thailand with a prevalence rate comparable to those observed in high transmission areas of Africa. The high prevalence of isolates from male and nonpregnant patients with var2csa transcription suggests that the transcription of this gene occurs naturally during blood stage infection. Whether VAR2CSA is expressed and immunogenic among nonpregnant falciparum malaria patients requires further study.

Analysis of Circulating Catestatin in Early Pregnancy: A Preliminary Investigation.

Background: During pregnancy, significant cardiovascular changes occur to accommodate fetal growth, and catestatin may play a role in these changes. Evidence suggests that catestatin, a pleiotropic sympathoinhibitory peptide, is involved in multiple cardiovascular pathologies, including hypertensive disorders. The objective of this study was to compare serum catestatin levels between first-trimester pregnant women and non-pregnant women, aiming to investigate catestatin's role in blood pressure regulation during early pregnancy. Methods: This cross-sectional study included 72 first-trimester pregnant women and 57 age-matched non-pregnant controls, all without known cardiovascular or metabolic disorders. Results: Serum catestatin concentrations were significantly higher in pregnant women compared to controls (12.4 (9.9-21.2) ng/mL vs. 7.1 (4.5-10.9) ng/mL, p < 0.001). However, there was no significant difference in serum catestatin levels between those with a normal and abnormal uterine artery pulsatility index (17.8 (8.3-22.3) ng/mL vs. 12.5 (9.9-22.4) ng/mL, p = 0.962). Similarly, catestatin concentrations did not significantly differ between primiparous and multiparous women (14.0 (11.5-22.4) ng/mL vs. 10.7 (8.8-19.0) ng/mL). A positive correlation was observed between systolic blood pressure and serum catestatin levels in the control group (r = 0.335, p = 0.011) but not in pregnant women. Conclusions: Research on catestatin in pregnancy is still in its early stages, necessitating further studies to fully elucidate its roles and potential therapeutic applications.

Molecular Exploration of Mycoplasma fermentans and Mycoplasma genitalium in Mexican Women with Cervicitis.

Genital Mycoplasmas are implicated in adverse pregnancy outcomes and the development of infertility. However, the role of Mycoplasma fermentans in these outcomes has not been adequately studied; therefore, its participation in these sufferings requires further investigation. This study aimed to evaluate the prevalence of M. fermentans in pregnant and non-pregnant women. End-point PCR was used to analyze two hundred and twenty-eight endocervical samples for M. hominis, M. genitalium, M. fermentans, M. pirum, Ureaplasma urealyticum, and U. parvum diagnoses. The prevalence of Mycoplasma spp. was as follows: U. parvum was found in 83 samples (36.4%), U. urealyticum in 39 instances (17.1%), M. hominis in 36 (15.7%), M. fermentans in 32 (14%), M. genitalium in 15 (6.6%), and M. pirum in 0 samples. No association was found between the Mycoplasma spp. and some infertility conditions or adverse pregnancy. However, M. fermentans and M. hominis were found to be associated with bacterial vaginosis (RR = 3.4 CI 95% 1.85-6.3, p < 0.005). In conclusion, M. fermentans and M. hominis were isolated more often in women with bacterial vaginosis, which suggests that these bacteria could contribute to the development of this pathology.

COVID-19 and pregnancy: a comprehensive study of comorbidities and outcomes

ObjectivesThis study aimed to investigate the impact of pregnancy and pre-existing comorbidities on COVID-19 infections and associated complications of hospitalisation and mortality in women of reproductive age (WRA). The study also compared the risk of severe COVID-19 complications between pregnant women (PW) and non-pregnant women (NPW) with and without pre-existing comorbidities. Special focus was placed on some understudied comorbidities of immunosuppression, chronic renal disease and chronic obstructive pulmonary disease (COPD).MethodsThe study utilized anonymized patient-related information for a population of 7,342,869 WRA from the Mexican Ministry of Health data repository on COVID-19. Descriptive variables were characterized using frequencies, percentages, means, and standard deviations. Adjusted odds ratios (aORs) were used to assess the associations between risk factors and outcomes of hospitalisation and mortality. The study covered the entire COVID-19 pandemic period from January 30, 2020, to May 5, 2023.ResultsThe findings revealed that PW were not more likely to get COVID-19 infections than NPW. PW with COVID-19 infections were more likely to require hospital admission, intubation treatments, and ICU admission compared to NPW with COVID-19. PW with immunosuppression had an increased odds ratio (aOR) of getting COVID-19 infections compared to NPW (PW: aOR = 1.0396; NPW: aOR = 0.8373). NPW with immunosuppression had higher risk of mortality (all-cause death: aOR = 1.7084; COVID-19-associated death: aOR = 1.4079) and hospitalisation (all-cause hospitalisation: aOR = 4.1328; COVID-19-associated hospitalisation: aOR = 3.0451) than NPW without immunosuppression. Renal disease was identified as a concerning pre-existing condition that increased the risks of COVID-19 associated mortality/hospitalizations and all-cause mortality/hospitalizations for both PW and NPW. NPW with renal disease had much higher odds ratio (aOR) of either COVID-19-associated-hospitalisations (NPW: aOR = 8.639; PW: aOR = 1.7603) or all-cause hospitalisations (NPW: aOR = 8.8594; PW: aOR = 1.786) than PW with renal disease.ConclusionsThis study provides valuable insights into the impact of pregnancy and pre-existing comorbidities on COVID-19 outcomes in WRA. The findings underscore the importance of considering demographic factors and pre-existing comorbidities in the management of PW with COVID-19. The study also highlights the need for further research to understand the unique impacts of different comorbidities, particularly immunosuppression and renal disease, on COVID-19 outcomes in WRA.

Possible rapid reduction of anti-RBD antibody titre after SARS-CoV-2 mRNA vaccination in pregnant women: Multicentre prospective study.

Pregnant women are at increased risk for severe illness associated with coronavirus disease 2019 (COVID-19) compared to nonpregnant women. The aim of this multicenter prospective study was to assess the current COVID-19 vaccination status of pregnant women in the southern Osaka district and to compare their antibody titers with those of nonpregnant women. Serum antibody titers of anti-NCP antibodies (antibodies against the SARS-CoV-2 nucleocapsid) and anti-RBD antibodies (the receptor binding domain of the S1 subunit of the spike protein) were evaluated in 753 pregnant women at 34-35 weeks of gestation from October 2021 to March 2022. Anti-RBD antibody titre was also investigated in 1003 health care workers at Kindai University hospital 3 and 6 months after a second dose of the vaccine from March 2021 to April 2021. 519 (68.9%) pregnant women were vaccinated during pregnancy, of whom 497 (95.8%) received two doses. The COVID-19 infection rate calculated from the number of pregnant women with a positive anti-NCP antibody titre or with confirmed diagnosis was 5.1% (12/234) in the unvaccinated and 3.5% (18/519) in the vaccinated. The estimated half-life calculated from anti-RBD antibody titers and the number of days between vaccination and antibody testing was 39.9 days. The antibody titre and half-life in pregnant women were significantly lower and shorter than in nonpregnant women aged 20-39 years (109.4 days). Our study showed that pregnant women may have lower vaccine-acquired COVID-19 immunity than nonpregnant women.

Evaluation of Hursitism for Polycystic Ovary Syndrome Women At Al- Ramadi City

The hyper-androgen and huritism in face and body in women is important diseases. It can be used as a possible marker in patients with ovary polycystic syndrome (PCOS). This study was carried out to evaluate DHEA and Testosterone levels associated with huritism and PCOS was studied in serum samples from pregnant, and non-pregnant patients and controls attending clinic Specialized. The study included 38 samples divided into three groups: 21 patients subjects, 6 pregnant women, 15 non-pregnant women with PCOS syndrome, and 17 normal subjects as control of the same age group. The target was selecting pregnant women due to changes in hormonal levels and physiological changes, as well as comparing them with non-pregnant women and control samples. The level of DHEAS was considerably higher in the median among pregnant women than in the control group and between non-pregnant and control groups without statistically significant differences between pregnant and non-pregnant values. Similarly, testosterone shows a statistically significant higher median among pregnant than control and also between non-pregnant and control groups without statistically significant difference between pregnant and non-pregnant values. In conclusion, this study detected a significant increase in testosterone and DHEA in non-pregnant women and then followed by pregnant women compared to the control, and age and the rise of these hormones are factors that cause the appearance of thick hair and thus cause polycystic ovary, which may lead to infertility.

Pregnancy detection based on blood serum sample Raman spectroscopy.

In this research, women were diagnosed as pregnant based on blood serum samples Raman spectroscopy. Raman spectroscopy is a vibrational technique that provides information on the chemical composition of samples. The Raman techniques have significantly impacted the study of various degenerative diseases, particularly cancer detection, using less invasive methods such as the analysis of blood serum samples. Additionally, these techniques have been used to study the health status of patients, which is often difficult to monitor using conventional techniques. This study obtained serum samples from 12 women diagnosed as pregnant and 11 non-pregnant volunteers (controls). Spectra were collected using a LabRAM HR800 Raman Spectrometer (Horiba Jobin-Yvon) with an 830 nm wavelength laser. For each serum sample, 10 Raman spectra were obtained by focusing the laser, using a microscope objective, on different points of the sample with an exposure time of 40 seconds and an irradiation power of 17 mW. The raw spectra were processed using baseline correction and smoothing to remove noise, fluorescence, and shot noise. Subsequently, the spectra were normalized and analyzed using the multivariate statistical method of Principal Component Analysis (PCA). In these spectra, the characteristic bands of main blood serum biomolecules such as phenylalanine (Phe), tyrosine (Tyr), glutathione, amide III, phospholipid, carotene, and tryptophan (Trp) can be observed. Nevertheless, when analyzing the average spectra of pregnant and non-pregnant women, the main spectral differences were associated with variations in molecules like glutathione, tryptophan (Trp), tyrosine, and phenylalanine, which occur during the first trimesters of pregnancy. This aligns with findings previously reported by other studies. Furthermore, the serum samples from pregnant and non-pregnant patients can be effectively discriminated using PCA applied to the Raman spectra, revealing two distinct clusters in the PCA plot corresponding to each group's status. The results demonstrate that pregnancy can be determined based on blood serum samples Raman spectroscopy with sensitivity and specificity. Although there are very effective devices on the market to determine pregnancy based on the Human Chorionic Gonadotropin (HCG) hormone detection in urine samples, these preliminary results indicate an alternative method known as Raman spectroscopy. On the other hand, the results could also suggest the possibility of carrying out other gynecological or fetal-related studies in women using these Raman techniques.

Case of delayed diagnosis of combined urogenita and pulmonary tuberculosis in a patient with abnormal uterine bleeding

According to the World Health Organization tuberculosis remains a global health issue for both adult and pediatric populations worldwide. Among women the peak incidence occurs during the active reproductive age, with pregnant women being 1.5–2 times more likely to be affected and experience more severe symptoms than non-pregnant women. In the Altai Region, the epidemiological situation of tuberculosis is characterized by instability, with the incidence rate among women reaching30.5 per 100 000 of the corresponding population in 2022. Delayed diagnosis and treatment can lead to serious complications, including fatal outcomes for both mother and fetus. This article describes a clinical observation of a case of urogenital and pulmonary tuberculosis diagnosed three months after premature abdominal delivery. The course of pregnancy was complicated by acute pleuritis at 13–14 weeks, however, negative results of bacteriological culture of pleural fluid led to the absence of specific tuberculosis treatment and the development of chronic subcompensated placental dysfunction. Three months after delivery, a 34-year-old patient was admitted to the gynecological department of the emergency hospital with abnormal uterine bleeding. The diagnosis was confirmed by histopathology of an endometrial sample revealing tuberculous granulomas without caseous necrosis with epithelioid giant cells of Pirogov – Langhans. Subsequently, generalized tuberculosis was diagnosed in the preterm infant. The negative impact of undiagnosed combined urogenital and pulmonary tuberculosis on the course and outcome of pregnancy is demonstrated, including the development of anemia, placental dysfunction, preterm delivery, puerperal complications, and adverse perinatal outcomes.

Impact of HIV infection on cervical intraepithelial neoplasia detection in pregnant and non-pregnant women in Germany: a cross-sectional study.

Women living with HIV (WLWH) are frequently affected by cervical dysplasia caused by Human Papillomavirus (HPV) and invasive cervical cancer (CxCa). CxCa screening programs can include colposcopy, cytology, and HPV testing. These methods, however, have limitations in effectively stratifying cervical dysplasia. This study aimed to evaluate the applicability of an innovative mRNA-based multiplexed expression-quantifying assay in the detection and assessment of cervical dysplasia in WLWH. The QuantiGene-Molecular-Profiling-Histology Assay (QG-MPH) was used to detect and quantify HPV oncogene and cellular biomarker mRNA expression. These results were included in the Risk Score (QG-MPH RS) calculations that inform about the presence and severity of dysplasia. QG-MPH RS results were compared to the highly sensitive Multiplexed Papillomavirus Genotyping (MPG) Assay and clinical results obtained by cytology, colposcopy and histology. For a standardized nomenclature of clinical results, the clinical ASSIST Score was used. Of 241 WLWH, including 96 pregnant women, a concordance between the QG-MPH RS and the ASSIST Score was found to 36.3% (49/135) in non-pregnant WLWH and 67.1% (57/85) in pregnant WLWH. The QG-MPH method demonstrated high specificity for detecting high-risk HPV (HR-HPV) genotypes and high-grade cervical dysplasia, achieving 89.6% and 82.4%, respectively, including pregnant and non-pregnant WLWH. The QG-MPH assay shows potential for improving the detection and management of HPV-related cervical dysplasia in WLWH, including pregnant women. Its high specificity, however, is tempered by its tendency to overestimate dysplasia severity in certain cases, indicating that further research is needed to refine its use as a reliable diagnostic tool for this high-risk population.

Seroprevalence and Risk Factors for Toxoplasma gondii Infection in Women of Reproductive Age in Nigeria in 2018.

Congenital transmission of Toxoplasma gondii can occur when a woman becomes infected for the first time during or just before pregnancy. Toxoplasma gondii in the fetus can lead to miscarriage, stillbirth, ocular or neurological abnormalities at birth, or progressive visual, hearing, motor, and cognitive deficiencies. The national seroprevalence of T. gondii infection in Nigeria was previously unknown. The 2018 Nigeria HIV/AIDS Indicator and Impact Survey collected demographic, socioeconomic, and HIV-related data and stored blood specimens with consent for future analysis for other pathogens of public health importance. We evaluated toxoplasmosis seropositivity and risk factors in a sample of 44,269 women of reproductive age (WRA) between 15 and 44 years. The national T. gondii seroprevalence among WRA was 26.8% (95% CI: 25.8-27.7%). We found that WRA from all 36 states and the Federal Capital Territory had T. gondii exposure. Seroprevalence was higher in 25- to 44-year-olds than in 15- to 24-year-olds. A similar proportion of pregnant and nonpregnant women were seropositive. Increased odds of seropositivity were associated with unimproved toilet facilities and drinking water sources, being in a higher wealth quintile, and primary and secondary education compared with no education. Decreased odds of seropositivity were associated with living in an urban area and owning livestock. This study provides the first-ever national seroprevalence estimate for WRA in Nigeria. Although information on known risk factors for toxoplasmosis (e.g., consumption of undercooked meat, cat ownership) was not collected, future studies could further investigate potential risk factors to inform the development of effective toxoplasmosis prevention measures.

Effects of gestational age on blood cortisol and prolactin levels during pregnancy in malaria endemic area.

The hormonal shift occurring in pregnant women is crucial for the outcome of pregnancy. We conducted a study in pregnant women living in a malaria endemic area to determine the potential effect of gestational age on the modulation of the endocrine system by cortisol and prolactin production during pregnancy. Primigravidae and multigravidae with a gestational age between 16-20 weeks were included in the study and followed up to delivery and 6-7 weeks thereafter. Venous blood was collected at scheduled visit: Visit 1 (V1; 16-20 weeks of amenorrhea), Visit 2 (V2; 28 ±1 weeks of pregnancy), Visit 3 (V3; 32 ±1 weeks of pregnancy), Visit4 (V4; delivery) and Visit5 (V5; 6-7 weeks after delivery). In addition, a cord blood sample was also collected during labour at delivery. Nulliparous and primiparous/multiparous non-pregnant women were enrolled in the control group. Cortisol and prolactin plasma concentrations were measured using ichroma II and i-chamber apparatus. Light microscopy was used to detect Plasmodium falciparum infections. A linear mixed-effects regression (LMER) model was used to assess the association between the variation of cortisol titres and prolactin levels during the pregnancy and the post-partum. Results showed that cortisol and prolactin levels in the peripheral blood were globally up-regulated during pregnancy. Concentrations of cortisol during follow-up was significantly higher in primigravidae than in multigravidae during the whole pregnancy (p<0.024). Moreover, the level of prolactin which was higher before delivery in primigravidae reversed at delivery and postpartum visit, but the difference was not statistically significant during the follow-up (V1 to V5) (p = 0.60). The cortisol level in peripheral blood at delivery was higher than that in the cord blood, and conversely for prolactin. Cortisol and prolactin levels decreased after delivery, though the level of prolactin was still higher than that at enrolment. An increase of one unit of prolactin was associated with the decrease of the average concentration of cortisol by 0.04 ng/ml (p = 0.009). However, when cortisol increases with one unit, the average concentration of prolactin decreases by 1.16 ng/ml (p = 0.013). These results showed that the up-regulation effects of cortisol and prolactin are related to gestational age. A The downward regulation effect that both hormones have on each other during the pregnancy when each increase to 1 unit (1.0 ng/ml) was also reported.

CLINICAL COURSE OF SEVERE AND CRITICAL CORONAVIRUS INFECTION COVID-19 AMONG PREGNANT WOMEN

Background. The COVID-19 pandemic, which spread in 2020, is a global problem that humanity has faced. Women during gestation are 3 times more likely to be admitted to the intensive care unit, 2.9 times more likely to need invasive ventilation, 2.4 times more likely to need extracorporeal membrane oxygenation, and 1.7 times more likely to have fatal outcomes than non-pregnant women Materials and methods. We conducted a retrospective analysis of the birth histories of 92 pregnant women and postpartum women with COVID-19 coronavirus infection at the clinical sites of the Scientific Center for Obstetrics, Gynecology and Perinatology, perinatal centers in the space of 2020. Results. All patients with coronavirus infection COVID-19 were young pregnant women from the age of 20 to 42 years, at a gestational age of 12 to 41 weeks, of which at full term (38-41 weeks) — 17 (18.5%), at a period of 30-37 weeks — 45 (48.9%), 21-29 weeks — 25 (27.2%), at 12-17 weeks — 5 (5.4%). One-way analysis of variance (ANOVA) has shown that there are statistically relevant differences in the days of hospitalization among the patients, depending on the parity of births (p&lt;0.05). Complications during pregnancy on the part of the fetus were: a threatening state of the fetus was observed among 5 (5.4%), intrauterine fetal death - in 22 (23.9%), premature separation of the normally located placenta (PSNLP) was observed among 3 (3.3%), miscarriage among 2 (2.2%), therapeutic abortion - 1 (1.1%); 28 children (34.2%) were born prematurely, with birth weight from 510g (at 22 weeks) to 3100g (at 37 weeks). Conclusions. Thus, pregnant women with severe and critically severe forms of COVID-19 were predominantly urban residents, at a gestational age of 30 to 37 weeks, and were multiparous. The risk of complications did not depend on the number of previous births, highlighting the need for special attention to this patient category regardless of their obstetric history.

The Association between Antiphospholipid and Coagulation in Pregnant Women with Blood Clotting

Abstract Background: Antiphospholipid syndrome is a systemic hematological autoimmune disease characterized by a hypercoagulable state, which is associated with vascular thrombosis and/or obstetric morbidity characterized by miscarriage, fetal death, and/or premature birth. Objective: This research study aimed to estimate anticardiolipin [ACL; immunoglobulin (Ig)G and IgM] and lupus anticoagulant (LA) in pregnant women who have blood clots or who have previously miscarried and fetal intrauterine mortality. Materials and Methods: This study included 90 women, 60 of whom were pregnant women who had blood clots or had previously miscarried, as well as 30 nonpregnant women as a control group, aged from 20 to 41 years, from October 2022 to April 2023. The patients were referred to the Department of Gynecology and Obstetrics at a Teaching Hospital, Salahuddin. LA, ACL IgM, and ACL IgG were detected in serum by the enzyme-linked immunosorbent assay. Results: This study found that pregnant women have higher ACL IgM and IgG levels than nonpregnant women. The mean concentration (mean ±standard error) for ACL IgM was 23.43 ± 1.4, whereas ACL IgG was 33.11 ± 1.28, which is in contrast with the control group of ACL IgM (2.99 ± 0.22) and ACL IgG (3.51 ± 0.29). The differences were statistically significant (P = 0.0001). A significant increase in LA in pregnant women was 37.77 ± 1.14, whereas the control group had a lower mean amount of LA was 334.42 ± 1.05. Statistically significant differences were observed (P ≤ 0.05). Conclusion: Elevated levels of ACL and LA are the main cause of spontaneous recurrent abortions in women.

SARS-CoV-2 infection elucidates features of pregnancy-specific immunity

Pregnancy is a risk factor for increased severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other respiratory infections, but the mechanisms underlying this risk are poorly understood. To gain insight into the role of pregnancy in modulating immune responses at baseline and upon SARS-CoV-2 infection, we collected peripheral blood mononuclear cells and plasma from 226 women, including 152 pregnant individuals and 74 non-pregnant women. We find that SARS-CoV-2 infection is associated with altered Tcell responses in pregnant women, including a clonal expansion of CD4-expressing CD8+ Tcells, diminished interferon responses, and profound suppression of monocyte function. We also identify shifts in cytokine and chemokine levels in the sera of pregnant individuals, including a robust increase of interleukin-27, known to drive Tcell exhaustion. Our findings reveal nuanced pregnancy-associated immune responses, which may contribute to the increased susceptibility of pregnant individuals to viral respiratory infection.

Diminished retinal microcirculation in mild preeclampsia without obvious retinopathy in high-altitude native Tibetans by OCTA

BackgroundTo investigate the retinal microcirculation in mild preeclampsia (PE) without obvious retinopathy in high-altitude native Tibetans by optical coherence tomography angiography (OCTA). MethodsThis study enrolled 64 mild preeclamptic pregnant women without retinopathy (group PPW), 63 healthy pregnant women (group HPW), and 61 healthy non-pregnant women (group HNPW). All participants were high-altitude native Tibetans who underwent OCTA, retinal thickness (RT), vascular density (VD), perfusion density (PD) and foveal avascular zone (FAZ) parameters were measured in the macula. Differences in these parameters among the groups were compared, and the correlations of these parameters with blood pressure were evaluated. ResultsIn the entire macula, VD and PD were significantly lower in group PPW than in group HPW and HNPW (p < 0.05). In the subregions, VD was significantly different in fovea, parafovea and perifovea, PD was significantly different in parafovea and perifovea among the three groups (p < 0.05), the further pairwise comparisons showed VD and PD in parafovea and perifovea were lower in group PPW than in group HPW, and VD and PD in perifovea were lower in group PPW than in group HNPW (p < 0.05). RT and FAZ parameters did not differ among the groups (P > 0.05). VD and PD exhibited negative correlations with SBP and DBP (p < 0.05). ConclusionOCTA can objectively evaluate diminished microcirculation in mild PE without obvious retinopathy among high-altitude native Tibetans, and provide a crucial time window for early screening of PE-induced retinopathy.