Normal Pregnancy Research Articles

The effect and mechanism of low-molecular-weight heparin on the decidualization of stromal cells in early pregnancy

Objective This study aimed to analyze the effect of low-molecular-weight heparin (LMWH) on the decidualization of stromal cells in early pregnancy and explore the effect of LMWH on pregnancy outcomes. Methods Recurrent spontaneous abortion (RSA) mouse model (CBA/J × DBA/2) and normal pregnant mouse model (CBA/J × BALB/c) were established. The female mice were checked for a mucus plug twice daily to identify a potential pregnancy. When a mucus plug was found, conception was considered to have occurred 12 h previously. The pregnant mice were divided randomly into a normal pregnancy control group, an RSA model group, and an RSA + LMWH experimental group (n = 10 mice in each group). Halfway through the 12th day of pregnancy, the embryonic loss of the mice was observed; a real-time quantitative polymerase chain reaction was used to detect the messenger ribonucleic acid (mRNA) expressions of prolactin (PRL) and insulin-like growth factor-binding protein 1 (IGFBP1) in the decidua of the mice. Additionally, the decidual tissues of patients with RSA and those of normal women in early pregnancy who required artificial abortion were collected and divided into an RSA group and a control group. Decidual stromal cells were isolated and cultured to compare cell proliferation between the two groups, and cellular migration and invasion were detected by membrane stromal cells. Western blotting was used to detect the protein expressions of proliferating cell nuclear antigen (PCNA), cyclin D1, matrix metalloproteinase- (MMP) 2, and MMP-7 in stromal cells treated with LMWH. Results Compared with the RSA group, LMWH significantly reduced the pregnancy loss rate in the RSA mice (p < 0.05). Compared with the RSA group, the LMWH + RSA group had significantly higher expression levels of PRL and IGFBP1 mRNA (p < 0.01). LMWH promoted the proliferation, migration, and invasion of human decidual stromal cells; compared with the control group, the expression levels of MMP-2, MMP-7, cyclin D1, and PCNA proteins in the decidual stromal cells of the LMWH group increased (p < 0.05). Conclusions The use of LMWH can improve pregnancy outcomes by enhancing the proliferation and migration of stromal cells in early pregnancy and the decidualization of stromal cells.

Application value of ultrasound elastography for screening of early pregnancy cervical insufficiency: a retrospective case-control study.

This study aimed to investigate changes in the cervical strain rate (SR), cervical length (CL), and uterine artery blood flow parameters during early pregnancy in women with cervical insufficiency and evaluate the clinical efficacy of these markers for screening of cervical insufficiency in early pregnancy. This retrospective study in 60 pregnant women with cervical insufficiency and 100 normal pregnant women was conducted between September 2021 and January 2023 and measured ultrasound parameters of the cervix during early pregnancy. The cervical SR, CL, and uterine artery resistance index (RI) were measured in both groups at 11-14 weeks of gestation. Strain elastography represented by the SR was used to assess the hardness of the internal and external cervical openings. During early pregnancy, the SR at the internal and external cervical openings were significantly higher in the cervical insufficiency group than those in the normal pregnancy group (SR I: 0.19 ± 0.018% vs. 0.16 ± 0.014%; SR E: 0.26 ± 0.028% vs. 0.24 ± 0.025%; p < .001). The CL was significantly shorter in the cervical insufficiency group than that measured in the normal pregnancy group (34.3 ± 2.9 mm vs. 35.2 ± 1.99 mm; p = .036), while cervical blood perfusion was also poorer in the cervical insufficiency group than that in the normal pregnancy group (uterine artery RI: 0.76 ± 0.07 vs. 0.74 ± 0.05; p = .048). Receiver operating characteristic (ROC) curve analysis showed that the optimal critical values for diagnosing cervical insufficiency were 0.17% for SR I, 0.25% for SR E, 33.8 mm for CL, and 0.78 for uterine artery RI. Of these parameters, the ROC curve for SR I had the largest area under the curve [AUC = 0.89 (p < .001)], with the highest sensitivity (78%) and specificity (82%). Multivariate logistic regression analysis demonstrated that the SR at the internal cervical opening (OR 17.47, 95% confidence interval (CI) 5.08-60.08; p < .001) and CL (OR 5.05, 95% CI 1.66-15.32; p = .004) still showed significant differences between the two groups. Cervical elastography is an effective tool for screening early pregnancy cervical insufficiency. The SR at the internal cervical opening is a valuable indicator for screening cervical insufficiency and has superior clinical efficacy for screening for this condition compared to that of CL and the uterine artery blood flow index.

Cervical Collagen Network Porosity Assessed by SHG Endomicroscopy Distinguishes Preterm and Normal Pregnancy - a Pilot Study.

Preterm birth (PTB) remains a pressing global health concern associated with premature cervical ripening and weakened cervical mechanical strength. Second harmonic generation (SHG) microscopy has proved instrumental in tracking progressive changes in cervical collagen morphology during pregnancy. To translate this imaging modality into clinical practice, we have developed a flexible SHG endomicroscope for label-free visualization of cervical collagen architecture. This study aims to assess the feasibility of our SHG endomicroscope for non-invasive differentiation of normal and PTB mouse models, with the ultimate goal of enabling early diagnosis and risk assessment of PTB in vivo. in this pilot investigation, we conducted endomicroscopic SHG imaging on frozen cervical tissue sections and intact cervices resected from both normal pregnant mice and mifepristone-induced PTB mouse models, and then analyzed the acquired images to identify collagen morphology characteristics associated with abnormal cervical collagen remodeling. quantitative image analysis revealed significantly altered collage spatial distribution, larger collagen fiber diameter and pore size, along with reduced pore numbers in SHG endomicroscopy images from PTB mouse models compared to normal pregnant mice. Similar trends were consistent across SHG endomicroscopy images of subepithelial collagen fibers acquired directly from intact cervices. overall, the experiment results underscore the potential of SHG endomicroscopy, coupled with quantitative image analysis, for clinically evaluating cervical collagen remodeling and PTB risk.

Cytokines in normal pregnancy and miscarriage

Cytokines in normal pregnancy and miscarriage

Fetal Aortic and Umbilical Doppler Flow Velocity Waveforms in Pregnancy: The Concept of Aortoumbilical Column.

Low impedance within the uteroplacental circulation is crucial for fetal development. Flow velocity waveforms (FVW) have been established for the aortic and umbilical arteries in low-risk pregnancies during the second half of pregnancy, but data regarding early gestation is limited. Both vascular territories exhibit higher impedance patterns in pregnancies complicated by fetal growth restriction (FGR), hypertensive disorders, fetal anemia, and chromosomal abnormalities. Early identification of these complications is critical in obstetric practice, to reduce perinatal morbidity and mortality through prevention and close antenatal surveillance. Available data suggest that aortic and umbilical impedances follow the same variation pattern as pregnancy progresses. This observation implies that both vessels may be considered as a single artery, referred to as the "aortoumbilical column". Our hypothesis posits that changes in the hemodynamic pattern of this column could identify high-risk pregnancies, particularly those complicated by preeclampsia, FGR, intrauterine fetal demise, fetal aneuploidies, and fetal anemia. Understanding vascular embryogenesis and the FVWs of the aortic and umbilical arteries enables comprehension of impedance changes throughout normal pregnancies. The continuous variation in impedance along a single vessel supports our concept of the aortoumbilical column. Deviations from the regular pattern could assist in identifying compromised fetuses during early pregnancy. Further research on normal aortoumbilical column FVW and the development of reference charts is necessary to consider this arterial column as a screening tool in clinical practice.

Serum Macrophage Colony-Stimulating Factor Relates to the Severity and the Pregnancy Outcomes in Hypertensive Disorders Complicating Pregnancy

Purpose: This study aimed to assess the predictive value of macrophage colony-stimulating factor (M-CSF) in the first trimester for hypertensive disorders complicating pregnancy (HDCP) and its association with disease severity and adverse pregnancy outcomes. HDCP pose significant risks to both maternal health and fetal health. M-CSF is implicated in the pathogenesis of HDCP by promoting inflammation and endothelial damage. Methods: Serum levels of M-CSF were measured using an enzyme-linked immunosorbent assay, and clinical characteristics and pregnancy outcomes were compared between groups. Results: Pregnant women with HDCP had significantly higher levels of proteinuria, systolic blood pressure, and diastolic blood pressure compared to those with normal pregnancy. Among patients with HDCP, the severity of disease correlated positively with serum levels of M-CSF. Furthermore, M-CSF levels in the first trimester were significantly associated with adverse pregnancy outcomes. The findings suggest that M-CSF may serve as a potential biomarker for predicting HDCP and its severity, as well as adverse pregnancy outcomes. Conclusions: Early detection and monitoring of M-CSF levels could aid in identifying high-risk pregnancies and implementing appropriate interventions to improve maternal and fetal outcomes.

Some results of perinatal complications in pregnant women with polycystic ovary syndrome

Purpose. Evaluation of the results of complications in the perinatal period in pregnant women with (PCOS) polycystic ovary syndrome. Material and methods. The research carried out for the accumulation, processing and analysis of data was a retrospective study that was carried out during the years 2020-2022 within IMSP SCM no. 1, the patients were divided into 2 groups: Group I – 60 patients with polycystic ovary syndrome and pregnancy achieved. Group II – 60 patients with normal pregnancy. According to its character, the study carried out is descriptive observational. The method of accumulating and extracting data from the medical documentation did not allow the determination of anamnestic-clinical peculiarities, clinical and paraclinical investigations (laboratory and instrumental), the evolution of the pregnancy and the birth of the pregnant women included in the study, including the assessment of the status of the newborn at birth. Results. From the results of the study, it can be confirmed that there were no statistically significant differences (&gt;0.05) between the 2 groups included in the study. Live children were born - 50 (94.34±0.32) in group I compared to 58 (96.7±0.63) in group II. Neonatal death was registered only in group I – 3 (5.66±0.32) cases and neonatal death only in group II – 2 (3.3±0.63) cases. Conclusion. The results of the comparative study show that pregnancy in pregnant women with PCOS ends with macrosomicfetuses - 26.43%; with an Apgar score of 7-8 in – 38.3%; who did not require transfer to the neonatal intensive care unit – 64%. Strict antenatal monitoring of pregnancy remains the gold standard for favorable perinatal outcomes.

Иммунологические предикторы преждевременных родов при истмико-цервикальной недостаточности

Aim. To identify immunological predictors of premature birth in women with isthmic-cervical insufficiency (ICN). Design. A prospective comparative cohort study. Materials and methods. The study included 58 pregnant women with ICN and 20 women without ICN. After completion of pregnancy, all women were divided into three groups: group 1 (main) — 23 patients with premature birth, group 2 (comparison) — 35 patients with timely delivery and group 3 (control) — 20 women with normal pregnancy without ICN. Indicators of innate immunity in cervical mucus were studied in all pregnant women. In patients with ICN, an immunological study was conducted at the time of this diagnosis. In participants without ICN, cervical mucus was collected 18–20 weeks after receiving the results of cervicometry. Results. In the main group, the average number of leukocytes and neutrophil extracellular traps (NET), lysosomal activity of neutrophils, levels of macrophage inflammation protein-1β (MIP1β) and BOX1 protein of the high mobility protein group (HMGB1) in cervical mucus were statistically significantly higher than in the comparison group and the control group. Using ROC analysis, the prognostic value of these markers in relation to premature birth in women with ICN was studied. It was found that the amount of NET &gt; 18%, the levels of MIP1β &gt; 13.5 pg/ml and HMGB1 &gt; 10 ng/ml in cervical mucus can be considered as predictors of premature birth in patients with ICN. At the same time, the HMGB1 index has the highest sensitivity (78.3%) and specificity (80%) as a prognostic marker of premature birth in ICN. Conclusion. The proposed new approach to the prediction of premature birth in ICN is non-invasive and can be applied in the routine clinical practice of obstetricians and gynecologists. Keywords: isthmic-cervical insufficiency, premature birth, prognosis, innate immunity, HMGB1.

Proteomics profiling reveals lipid metabolism abnormalities during oogenesis in unexplained recurrent pregnancy loss.

Unexplained recurrent pregnancy loss (URPL) is a clinical dilemma in reproductive fields. Its diagnosis is mainly exclusionary after extensive clinical examination, and some of the patients may still face the risk of miscarriage. We analyzed follicular fluid (FF) from in vitro fertilization (IVF) in eight patients with URPL without endocrine abnormalities or verifiable causes of abortion and eight secondary infertility controls with no history of pregnancy loss who had experienced at least one normal pregnancy and delivery by direct data-independent acquisition (dDIA) quantitative proteomics to identify differentially expressed proteins (DEPs). In this study, bioinformatics analysis was performed using online software including g:profiler, String, and ToppGene. Cytoscape was used to construct the protein-protein interaction (PPI) network, and ELISA was used for validation. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis showed that the DEPs are involved in the biological processes (BP) of complement and coagulation cascades. Apolipoproteins (APOs) are key proteins in the PPI network. ELISA confirmed that APOB was low-expressed in both the FF and peripheral blood of URPL patients. Dysregulation of the immune network intersecting coagulation and inflammatory response is an essential feature of URPL, and this disequilibrium exists as early as the oogenesis stage. Therefore, earlier intervention is necessary to prevent the development of URPL. Moreover, aberrant lipoprotein regulation appears to be a key factor contributing to URPL. The mechanism by which these factors are involved in the complement and coagulation cascade pathways remains to be further investigated, which also provides new candidate targets for URPL treatment.

Doppler Waveform Indices of Foetal Middle Cerebral Artery in Normal Pregnancies: Correlation with Gestational Age of 20 to 40 Weeks

Doppler Waveform Indices of Foetal Middle Cerebral Artery in Normal Pregnancies: Correlation with Gestational Age of 20 to 40 Weeks

Sex education as part of the valeological discipline "Health Pedagogy"

The valeological discipline "Health Pedagogy" was developed and implemented in the educational process of Ukrainian higher non-medical education institutions in 2019. The discipline is intended for the formation of valeological competence, which consists in the ability to lead a healthy lifestyle, practice safe behavior and provide emergency assistance in critical situations. The medical component of the topic of sex education and family planning of the valeological discipline "Health Pedagogy" includes issues of safe and unsafe sex, fertility, prevention of unwanted pregnancies, infection with sexually transmitted diseases, abortion, anatomy and physiology of male and female genital organs, physiology of intercourse, contraception, normal and pathological pregnancy, childbirth, genetic aspects of fertilization and development of the embryo and fetus) and ethical issues of its teaching, which corresponds to the recommendations of the Ministry of Health of Ukraine and a number of authoritative international organizations. Retrospective evaluation of archival learning materials (tests and questionnaires) for the topic "Sex education and family planning" of valeological disciplines "Basics of Medical Knowledge and Health-Saving" and "Health Pedagogy" of 180 students of three Kharkiv non-medical higher education institutions, bachelor's and master's degrees, who studied during 2004–2024 and formed valeological competence at a high level according to the quartile evaluation system (Q4[75÷100]%). It was found that 148 (82.2%) students formed the component of competence related to sex education and family planning at a high level (Q4[75÷100]%), 32 (17.8%) – at the average level (Q3[50÷75]%) (p&lt;0.05%). It was concluded that the content, form of teaching, medical and psychological-pedagogical components of the topic on sex education and family planning of the valeological discipline "Health Pedagogy" allow forming the appropriate component of valeological competence at a high level. Keywords: valeological education, valeological competence, qualimetry, abortion, contraception, obstetrics and gynecology.

Role of continuing regular follow-up of serial B-human chorionic gonadotropin measurements with health education following initial surgical management of complete molar pregnancy cases

Objective: Our goal to confirm complete cure, early detection of persistent gestational trophoblastic disease and more effective and less complex treatment. Methods: Fifty-one patients from 12,960 were admitted to the Department of Obstetrics and Gynecology at Tobruk Medical Center between August 2018 and July 2021 with complete molar pregnancy, the diagnosis was confirmed with histopathology after initial surgical management. Following identification of these patients, due to lack of registration centers, the patient's telephone was required to complete the data for continuing regular follow-ups over a period of time these patients were evaluated prospectively according to their age, number of deliveries, history of normal and abnormal pregnancy, the quantity of beta-human chorionic gonadotropin (B-HCG) at the time of diagnosis and follow-up and treatment type. Persistent gestational trophoblast disease was diagnosed on the basis of a rise of B-HCG after initial evacuation, and just one patient in our study diagnosed with invasive mole and underwent second evacuation and none of these patients developed choriocarcinoma during the follow-up period. Analysis was conducted by using the social package of statistical science (SPSS) version 25 software. Results: 51 patients (0.39%) were diagnosed with complete molar pregnancy (CMP), the mean age was 31.90 (8.169) years range (17-47 years). Among 51 patients with CMP over three years, seventeen patients (33.3%) were diagnosed with persistent gestational trophoblast disease (PGTD), the incidence is about 1.3 per 1000 per deliveries, thirty-four patients (66.7%) reached spontaneous remission of molar gestation in a median time of 61 days and had a total follow-up time of 24 months. Conclusion: Follow-up women with complete molar pregnancy especially after initial management is challenging task as the incidence of molar pregnancy increasing and exposed to the risk of developing persistent gestational trophoblastic disease, and there are no specialist centres for documentation and surveillance programme. And due to wide geographical area in Libya and difficulty in the follow-up patients with molar pregnancies, especially after initial treatment has been performed. Therefore, we must create multiple centers throughout the country to cover all cases as much as possible and the communication between the patients and centers via internet, to ensure early detection of pregnancy complications.

Generation of Knockout Mouse Trophoblast Stem Cells by CRISPR/Cas9.

The placenta is the organ that dictates the reproductive outcome of mammalian pregnancy by supplying nutrients and oxygen to the developing fetus to sustain its normal growth. During early mammalian development, trophoblast cells are the earliest cell type to differentiate with multipotent capacity to generate the trophoblast components of the placenta. The isolation and use of mouse trophoblast stem cells (mTSCs) to model in vitro trophoblast differentiation, in combination with CRISPR/Cas9 genome editing technology, has provided tremendous insight into the molecular mechanisms governing early mouse placentation. By knocking out a specific gene of interest in mTSCs, researchers are shedding light onto the molecular pathways involved in normal placental development and pregnancy disorders associated with abnormal placentation. In this chapter, we provide a detailed protocol for the genetic modification of mTSCs by using CRISPR/Cas9 genome editing system.

Assessment of Nailfold Capillaroscopy Findings in Pregnant Women having Preeclampsia: A Research Protocol

Introduction: Pregnancy causes significant vascular and cutaneous changes in a woman’s body. Preeclampsia is one of the life-threatening conditions associated with high blood pressure and proteinuria after the 20th week of pregnancy. It can cause placental hypoperfusion and placental insufficiency, leading to foetal defects or, in severe cases, foetal loss, which can be prevented by early diagnosis and treatment. There are many ways to observe and study the microcirculation non invasively the safest and most accessible method is nailfold capillaroscopy. Nail-fold Video Capillaroscopy (NVC) is a handheld digital microscope used to observe the microcirculation at the nailfold of the hands. Thus, comparing the capillary status with healthy subjects will help establish an early diagnosis and manage cases to prevent further complications in the mother and newborn. Need of the Study: The pathophysiology states that preeclampsia is related to systemic endothelial dysfunction, causing the release of Tumour Necrosis Factor (TNF) alpha, a proinflammatory mediator, leading to hypoxia of the placenta and the loss of endothelial cell-lined capillaries. Thus, there is a need to find if there is an established correlation in association of decreased Capillary Density (CD) in individuals with preeclampsia. Although evidence supporting a link between decreased CD and preeclampsia is limited, timely assessment and prevention are crucial. Nailfold capillaroscopy, an accessible and non invasive imaging method, holds promising calibre for understanding microvascular changes in preeclampsia. This could facilitate post-conception monitoring and early interventions to identify and address circulatory issues in affected women with preeclampsia. Aim: To study and compare the nailfold capillary changes in women diagnosed with preeclampsia and women having normal and uneventful pregnancies. Materials and Methods: A comparative cross-sectional study will be done in the Outpatient Department (OPD) and Inpatient Department (IPD) of Obstetrics and Gynaecology and the Outpatient Department of Dermatology at AVBRH Sawangi Meghe, Wardha, Maharashtra, India, from March 2023 to March 2025. A total of 150 pregnant women will be considered in the study, with 75 women being normal pregnant women (controls) and 75 pregnant women diagnosed with preeclampsia (cases). In order to confirm the gestational age of the patients, fundal height and abdominal circumference measurements will be taken. Demographic data, Basal Metabolic Index (BMI), weight gain during pregnancy, laboratory reports including Complete Blood Count (CBC), coagulation profile (Prothrombin Time, International Normalised Ratio, Activated Partial Thromboplastin Time), liver function tests, kidney function tests, urine examinations, and serial ultrasonography reports available for the patients will be noted. Pre-examination blood pressure will be recorded and compared with the baseline to confirm the status of preeclampsia after obtaining written consent from the patients. Nailfold capillaroscopy will be performed using a (Dinolite -AF4115ZT) dermoscope equipped with a 200X magnification, high-resolution lens in a non polarised light setting with oil immersion as a fluid coupling. The observations will be used to interpret the results of the study. Results will be calculated for finding differences between the two comparative groups of cases and controls at a p-value of ≤0.05.

G protein-coupled receptor 1 participating in the mechanism of mediating gestational diabetes mellitus by phosphorylating the AKT pathway.

Gestational diabetes mellitus (GDM) is a metabolic disease that occurs during pregnancy. Herein, we investigate G protein-coupled receptor 1 (GPR1) in mediating GDM through the phosphorylation of serine/threonine kinase (AKT) pathway. Thirty pregnant SD rats were grouped into: normal pregnancy control group (NC), GDM model group, and GDM model + high-dose GPR1 antagonist treatment (GDM + Ari) group. GDM model was established, and the GDM + Ari group adopted GPR1 antagonist aripiprazole. The blood glucose level, insulin level, and insulin resistance (IR) were detected. The expression and phosphorylation of GPR1, AKT, and extracellular signal-regulated kinase (ERK) in placental tissue were detected using reverse transcription-polymerase chain reaction (RT-PCR) and western blotting (WB). The serum insulin concentration, glucose concentration, and glycated hemoglobin concentration during pregnancy in GDM group SD rats were significantly higher than those in the NC group (P < 0.05). The expression and phosphorylation levels of GPR1, AKT, and ERK in the placental tissue of SD pregnant rats in the GDM group were significantly lower than those in the NC group. Furthermore, compared with the GDM group, the expression of GPR1, AKT, and ERK in placental tissue was significantly reduced in the GDM + Ari group, while simultaneously enhancing the blood glucose level and IR level. In addition, the survival number, body weight, and malformation rate of the offspring of the GDM + Ari group were significantly improved, and there was no significant effect on the number of offspring. The expressions of GPR1, AKT, and ERK in placental tissue exhibited a significant decrease, while the glucose level and IR were observed to increase in the GDM + Ari group. Enhancing the expression of GPR1 may activate AKT phosphorylation to alleviate GDM. GPR1 could potentially serve as a novel target for diabetes treatment, offering new insights into managing GDM.

Childbirth in adolescents - features and outcomes

Introduction. Adolescent pregnancies significantly impact the welfare of young mothers, their infants, and the general population. These pregnancies represent a public healthcare concern associated with numerous consequences. Aim: To investigate the prevalence of adolescent pregnancies and their outcomes. Material and Methods. This retrospective descriptive study included adolescents who gave birth at the Gynecology and Obstetrics Clinic between January 1, 2020 and December 31, 2020. Data on anthropometric measurements, number and mode of deliveries, newborn birth weights, and complications were collected from medical records and statistically analyzed. Results. A total of 174 adolescents (aged 13-19) were included in the study. Most were first-time mothers living in common-law unions. Four spontaneous twin pregnancies were documented. No significant differences were found in the anthropometric measures between younger (&lt;15 years old) and older (16-19 years old) adolescents. Pelvic measurements did not affect the mode of delivery. Younger adolescents and those with smaller pelvic measurements experienced longer hospitalizations. Vaginal delivery was the prominent mode of birth. Newborns delivered by caesarian section had significantly lower birth weights and lengths. While no significant complications during labor and delivery were observed, there was notable postpartum blood loss and higher rates of anemia in the puerperium. Conclusion. Although the number of adolescent pregnancies and births is declining, it still remains a significant concern. Welldeveloped perinatal care and the promotion of reproductive health within educational and health systems could not only further reduce pregnancy rates but also ensure optimal conditions for normal pregnancies and deliveries in adolescents.

Normal pregnancy outcome after first-trimester exposure to semaglutide in an overweight woman: a case report

Normal pregnancy outcome after first-trimester exposure to semaglutide in an overweight woman: a case report

Comparison of Doppler Flow Parameters of Foetal Middle Cerebral Artery in Pregnancy with Gestational Diabetes versus Normal Pregnancy: A Cohort Study

Comparison of Doppler Flow Parameters of Foetal Middle Cerebral Artery in Pregnancy with Gestational Diabetes versus Normal Pregnancy: A Cohort Study

Thyroid-stimulating hormone and total bile acids can predict adverse pregnancy outcome among patients with gestational hypertension.

To investigate the correlation between serum thyroid-stimulating hormone (TSH) and total bile acid (TBA) levels in gestational hypertension and their combined predictive value for pregnancy outcome. A total of 194 patients with gestational hypertension (GH), treated from June 2020 to May 2022, were included in this study. The patients were divided into two subgroups based on pregnancy outcome: an adverse pregnancy outcome group (77 cases) and a normal pregnancy outcome group (117 cases). Additionally, 50 healthy pregnant women undergoing routine prenatal checkups during the same period served as the control group. In this study, serum TBA and TSH levels were measured and compared between the control and GH groups as well as between adverse pregnancy outcome and normal pregnancy outcome groups. The independent risk factors for adverse pregnancy outcome were screened using logistic regression, and their predictive value for pregnancy outcome in patients with GH was analyzed using receiver operating characteristic (ROC) curves. Serum TSH and TBA levels were significantly higher in the GH group compared to the normal group (both P < 0.001). Logistic regression analysis revealed that age, body mass index (BMI), TSH, and TBA were independent risk factors for adverse pregnancy outcome. ROC curve analysis showed that combined TSH and TBA for predicting adverse pregnancy outcome had an Area Under the Curve (AUC) of 0.896, surpassing the AUCs of each individual index (0.843 for TSH and 0.765 for TBA), which indicates a stronger predictive value (P < 0.001). The combined measurement of serum TBA and TSH can serve as a valuable predictive tool for pregnancy outcome in patients with gestational hypertension.

Determinant Role of Toll-like Receptor 4 (TLR4) on Angiotensin II in Isolated Umbilical Arteries from Normal and Gestational Diabetes Pregnant Women.

Gestational diabetes mellitus (GDM) is a common condition that occurs during pregnancy and results in cesarean section, pre-eclampsia, and neonatal morbidity. Angiotensin II is a potent vasoconstrictor and an important determinant of uteroplacental perfusion. Toll-like receptor 4 (TLR4) was found to contribute to diabetes progression. This study aimed to determine how TLR4 activation affects the contraction mediated by angiotensin II type 1 receptor in the isolated umbilical arteries of normal and GDM women. Angiotensin II was applied with either a TLR4 agonist or TLR4 antagonists to isolated arteries from normal and GDM umbilical cords. The changes in the angiotensin II response were expressed as the maximal contraction percentage and pD2 values. The mRNA expression levels of TLR4 and angiotensin II type 1 receptor gene were measured via quantitative real-time polymerase chain reaction analysis. This study displayed an increased sensitivity to angiotensin II in the arteries of the GDM group compared with the normal group. The TLR4 agonist showed a synergistic effect with angiotensin II, while the TLR4 antagonists were not strongly determinant. In the GDM group, the TLR4 mRNA level is slightly higher than in the normal pregnancy group; however, no statistical difference was noted. Toll-like receptor 4 may determine the vasoconstrictive effect of angiotensin II in normal and GDM umbilical arteries. Some studies showed a similar interaction as supportive. However, comprehensive animal and/or human studies are promising.