Progression Of Normal Pregnancy Research Articles

A Challenging Case: Colorectal Cancer During Pregnancy

Introduction: Colorectal cancer (CRC) occurring in younger women can lead to an increased incidence of colorectal cancer during pregnancy. The estimated frequency of malignancy during pregnancy with colorectal cancer specifically estimated at 1 in 13,000 pregnancies. However, the exact causes of colorectal cancer during pregnancy are not yet fully understood. Diagnosing and managing colorectal cancer during pregnancy pose significant challenges because the symptoms can be masked by the normal signs and symptoms of pregnancy. Case Pesentation: A 42-year-old pregnant patient, Mrs. L, presented with abdominal pain, a history of dark-colored bowel movements, and a lump on the left side of her neck that had been present for a year. She had also experienced a weight loss of 5 kg both before and during pregnancy, and there was no previous history of malignancy. The patient underwent various diagnostic procedures, including pregnancy ultrasound, abdominal ultrasound, and colonoscopy biopsy. Based on the comprehensive evaluation of the patient's medical history, physical examination, and supporting tests, she was diagnosed with stage IV rectal adenocarcinoma with metastases to the liver, kidney, and lymph nodes. The patient was in her second pregnancy (G2P1Ab0) at 27-29 weeks of gestation. Conclusion: Colorectal cancer during pregnancy poses diagnostic and therapeutic challenges, as the signs and symptoms are often attributed to the normal progression of pregnancy, resulting in delayed diagnosis at an advanced stage. Early detection, evaluation, and monitoring of nonspecific symptoms are crucial, and a multidisciplinary approach is necessary for the management of colorectal cancer during pregnancy.

Setting a stage: Inflammation during preeclampsia and postpartum.

Preeclampsia (PE) is a leading cause of maternal and fetal mortality worldwide. The immune system plays a critical role in normal pregnancy progression; however, inappropriate inflammatory responses have been consistently linked with PE pathophysiology. This inflammatory phenotype consists of activation of the innate immune system, adaptive immune system, and increased inflammatory mediators in circulation. Moreover, recent studies have shown that the inflammatory profile seen in PE persists into the postpartum period. This manuscript aims to highlight recent advances in research relating to inflammation in PE as well as the inflammation that persists postpartum in women after a PE pregnancy. With the advent of the COVID-19 pandemic, there has been an increase in obstetric disorders associated with COVID-19 infection during pregnancy. This manuscript also aims to shed light on the relationship between COVID-19 infection during pregnancy and the increased incidence of PE in these women.

Expression dynamics of Crry at the implantation sites in normal pregnancy and response against miscarriage induction.

In mammals, immune tolerance against fetal tissue has been established for normal pregnancy progression. It is known that Crry regulates complemental activity to prevent injury of the mouse embryo and extra-embryonic tissue. This study aimed to examine the expression appearance and normal localization sites of Crry in the mouse placenta. Also, the emergency responses of Crry were verified at the time of experimental miscarriage induction. Moreover, we investigated an existing similar protein of Crry in animal placentas other than mice. Crry expression level showed a peak at day 8.5 of pregnancy. Trophoblast giant cells and decidual cells indicated a positive reaction to anti-Crry antibody. After treatments of interferon-γ, Crry expression was increased significantly in the survived implantation sites as compared with the controls. However, there was no significant difference in the miscarriage-initiated sites. It disclosed that Crry distributes from the early to middle periods of the placentas and involves complement regulation at the extraembryonic tissue and decidua basalis. Crry also showed an ability to respond to risk against external initiation for urgent miscarriage. Finally, we found anti-mouse Crry antibody-bound proteins in the placenta of many animals. It suggests a potency of Crry to make an environment of immune tolerance in many types of mammal placentas.

Kallistatin prevents ovarian hyperstimulation syndrome by regulating vascular leakage.

Angiogenesis and increased permeability are essential pathological basis for the development of ovarian hyperstimulation syndrome (OHSS). Kallistatin (KS) is an endogenous anti‐inflammatory and anti‐angiogenic factor that participates in a variety of diseases, but its role in OHSS remains unknown. In this study, treating a human ovarian granulosa‐like tumour cell line KGN and human primary granulosa cells (PGCs) with human chorionic gonadotropin (hCG) reduced the expression of KS, but increased the expression of VEGF. Furthermore, we found that KS could attenuate the protein level of VEGF in both KGN cells and human PGCs. More interestingly, we observed that exogenous supplementation of KS significantly inhibited a series of signs of OHSS in mice, including weight gain, ovarian enlargement, increased vascular permeability and up‐regulation of VEGF expression. In addition, KS was proved to be safe on mice ovulation, progression of normal pregnancy and fetus development. Collectively, these findings demonstrated that KS treatment prevented OHSS, at least partially, through down‐regulating VEGF expression. For the first time, these results highlight the potential preventive value of KS in OHSS.

Exosomes and exosomal non-coding RNAs throughout human gestation (Review).

In recent years, research on exosomes and their content has been intensive, which has revealed their important role in cell-to-cell communication, and has implicated exosomal biomolecules in a broad spectrum of physiological processes, as well as in the pathogenesis of various diseases. Pregnancy and its normal progression rely highly on the efficient communication between the mother and the fetus, mainly mediated by the placenta. Recent studies have established the placenta as an important source of circulating exosomes and have demonstrated that exosome release into the maternal circulation gradually increases during pregnancy, starting from six weeks of gestation. This orchestrates maternal-fetal crosstalk, including maternal immune tolerance and pregnancy-associated metabolic adaptations. Furthermore, an increased number of secreted exosomes, along with altered patterns of exosomal non-coding RNAs (ncRNAs), especially microRNAs and long non-coding RNAs (lncRNAs), have been observed in a number of pregnancy complications, such as gestational diabetes mellitus and preeclampsia. The early detection of exosomes and specific exosomal ncRNAs in various biological fluids during pregnancy highlights them as promising candidate biomarkers for the diagnosis, prognosis and treatment of numerous pregnancy disorders in adolescents and adults. The present review aimed to provide insight into the current knowledge regarding the potential, only partially elucidated, role of exosomes and exosomal cargo in the regulation and progression of normal pregnancy, as well as their potential dysregulation and contribution to pathological pregnancy situations.

Spatial transcriptomic profiles of mouse uterine microenvironments at pregnancy day 7.5†.

Uterine dysfunctions lead to fertility disorders and pregnancy complications. Normal uterine functions at pregnancy depend on crosstalk among multiple cell types in uterine microenvironments. Here, we performed the spatial transcriptomics and single-cell RNA-seq assays to determine local gene expression profiles at the embryo implantation site of the mouse uterus on pregnancy day 7.5 (D7.5). The spatial transcriptomic annotation identified 11 domains of distinct gene signatures, including a mesometrial myometrium, an anti-mesometrial myometrium, a mesometrial decidua enriched with natural killer cells, a vascular sinus zone for maternal vessel remodeling, a fetal-maternal interface, a primary decidual zone, a transition decidual zone, a secondary decidual zone, undifferentiated stroma, uterine glands, and the embryo. The scRNA-Seq identified 12 types of cells in the D7.5 uterus including three types of stromal fibroblasts with differentiated and undifferentiated markers, one cluster of epithelium including luminal and glandular epithelium, mesothelium, endothelia, pericytes, myelomonocytic cell, natural killer cells, and lymphocyte B. These single-cell RNA signatures were then utilized to deconvolute the cell-type compositions of each individual uterine microenvironment. Functional annotation assays on spatial transcriptomic data revealed uterine microenvironments with distinguished metabolic preferences, immune responses, and various cellular behaviors that are regulated by region-specific endocrine and paracrine signals. Global interactome among regions is also projected based on the spatial transcriptomic data. This study provides high-resolution transcriptome profiles with locality information at the embryo implantation site to facilitate further investigations on molecular mechanisms for normal pregnancy progression.

Vitamin D deficiency during pregnancy

Vitamin D plays a crucual role during pregnancy. Its active form calcitriol is of utmost importance for placental physiology, for the synthesis of estradiol, progesterone, human chorionic gonadotropin, embryogenesis, and normal progression of pregnancy. Taking in mind the beneficial role of calcitriol on pregnancy, it could be supposed that its inadequacy may lead to deleterious consequences for the mother and fetus. Several studies reveal a correlation between low vitamin D levels during pregnancy and the development of unfavorable consequences for the mother as well as for the fetus: risk of preterm birth, preeclampsia, gestational diabetes mellitus, low birth weight, and postpartum complications. Evaluation of vitamin D status during pregnancy is of utmost importance to overcome the adverse outcomes for the mother and newborn. To achieve maximum protection from pregnancy complications, a serum levels of at least 40 ng/mL for the circulating 25-hydroxy vitamin D3 during the earliest time points of pregnancy are recommended. Control of vitamin D status during pregnancy would present an opportunity for initiating timely and thorough supplementation with harmless and inexpensive vitamin D pharmaceuticals, which in turn would decrease the risk of adverse pregnancy outcomes.

RNA profiles reveal signatures of future health and disease in pregnancy

Maternal morbidity and mortality continue to rise, and pre-eclampsia is a major driver of this burden1. Yet the ability to assess underlying pathophysiology before clinical presentation to enable identification of pregnancies at risk remains elusive. Here we demonstrate the ability of plasma cell-free RNA (cfRNA) to reveal patterns of normal pregnancy progression and determine the risk of developing pre-eclampsia months before clinical presentation. Our results centre on comprehensive transcriptome data from eight independent prospectively collected cohorts comprising 1,840 racially diverse pregnancies and retrospective analysis of 2,539 banked plasma samples. The pre-eclampsia data include 524 samples (72 cases and 452 non-cases) from two diverse independent cohorts collected 14.5 weeks (s.d., 4.5 weeks) before delivery. We show that cfRNA signatures from a single blood draw can track pregnancy progression at the placental, maternal and fetal levels and can robustly predict pre-eclampsia, with a sensitivity of 75% and a positive predictive value of 32.3% (s.d., 3%), which is superior to the state-of-the-art method2. cfRNA signatures of normal pregnancy progression and pre-eclampsia are independent of clinical factors, such as maternal age, body mass index and race, which cumulatively account for less than 1% of model variance. Further, the cfRNA signature for pre-eclampsia contains gene features linked to biological processes implicated in the underlying pathophysiology of pre-eclampsia.

COVID-19, Pre-Eclampsia, and Complement System

COVID-19 is characterized by virus-induced injury leading to multi-organ failure, together with inflammatory reaction, endothelial cell (EC) injury, and prothrombotic coagulopathy with thrombotic events. Complement system (C) via its cross-talk with the contact and coagulation systems contributes significantly to the severity and pathological consequences due to SARS-CoV-2 infection. These immunopathological mechanisms overlap in COVID-19 and pre-eclampsia (PE). Thus, mothers contracting SARS-CoV-2 infection during pregnancy are more vulnerable to developing PE. SARS-CoV-2 infection of ECs, via its receptor ACE2 and co-receptor TMPRSS2, can provoke endothelial dysfunction and disruption of vascular integrity, causing hyperinflammation and hypercoagulability. This is aggravated by bradykinin increase due to inhibition of ACE2 activity by the virus. C is important for the progression of normal pregnancy, and its dysregulation can impact in the form of PE-like syndrome as a consequence of SARS-CoV-2 infection. Thus, there is also an overlap between treatment regimens of COVID-19 and PE. C inhibitors, especially those targeting C3 or MASP-2, are exciting options for treating COVID-19 and consequent PE. In this review, we examine the role of C, contact and coagulation systems as well as endothelial hyperactivation with respect to SARS-CoV-2 infection during pregnancy and likely development of PE.

Machine learning approaches to predict gestational age in normal and complicated pregnancies via urinary metabolomics analysis

The elucidation of dynamic metabolomic changes during gestation is particularly important for the development of methods to evaluate pregnancy status or achieve earlier detection of pregnancy-related complications. Some studies have constructed models to evaluate pregnancy status and predict gestational age using omics data from blood biospecimens; however, less invasive methods are desired. Here we propose a model to predict gestational age, using urinary metabolite information. In our prospective cohort study, we collected 2741 urine samples from 187 healthy pregnant women, 23 patients with hypertensive disorders of pregnancy, and 14 patients with spontaneous preterm birth. Using gas chromatography-tandem mass spectrometry, we identified 184 urinary metabolites that showed dynamic systematic changes in healthy pregnant women according to gestational age. A model to predict gestational age during normal pregnancy progression was constructed; the correlation coefficient between actual and predicted weeks of gestation was 0.86. The predicted gestational ages of cases with hypertensive disorders of pregnancy exhibited significant progression, compared with actual gestational ages. This is the first study to predict gestational age in normal and complicated pregnancies by using urinary metabolite information. Minimally invasive urinary metabolomics might facilitate changes in the prediction of gestational age in various clinical settings.

Maternal Neutrophil Depletion Fails to Avert Systemic Lipopolysaccharide-Induced Early Pregnancy Defects in Mice.

Maternal infection-induced early pregnancy complications arise from perturbation of the immune environment at the uterine early blastocyst implantation site (EBIS), yet the underlying mechanisms remain unclear. Here, we demonstrated in a mouse model that the progression of normal pregnancy from days 4 to 6 induced steady migration of leukocytes away from the uterine decidual stromal zone (DSZ) that surrounds the implanted blastocyst. Uterine macrophages were found to be CD206+ M2-polarized. While monocytes were nearly absent in the DSZ, DSZ cells were found to express monocyte marker protein Ly6C. Systemic endotoxic lipopolysaccharide (LPS) exposure on day 5 of pregnancy led to: (1) rapid (at 2 h) induction of neutrophil chemoattractants that promoted huge neutrophil infiltrations at the EBISs by 24 h; (2) rapid (at 2 h) elevation of mRNA levels of MyD88, but not Trif, modulated cytokines at the EBISs; and (3) dose-dependent EBIS defects by day 7 of pregnancy. Yet, elimination of maternal neutrophils using anti-Ly6G antibody prior to LPS exposure failed to avert LPS-induced EBIS defects allowing us to suggest that activation of Tlr4-MyD88 dependent inflammatory pathway is involved in LPS-induced defects at EBISs. Thus, blocking the activation of the Tlr4-MyD88 signaling pathway may be an interesting approach to prevent infection-induced pathology at EBISs.

Endometrial CD56+ natural killer cells in women with recurrent implantation failure: An immunohistochemical study.

Objective:Implantation failure is a multifactorial problem of reproductive medicine. However, the mechanism of this process is still not fully understood. There is increasing evidence that these cases of recurrent implantation failure might have an immunologic background. Uterine natural killer (NK) cells provide immune-modulation at the interface between maternal decidua and the trophoblast. The aim of this study to evaluate whether there was a significant difference in the number of endometrial CD56+ NK between women with a history of recurrent implantation failure and women who had a live birth.Materials and Methods:Patients with a history of recurrent implantation failure were included in the study. Twenty-five women with a history of recurrent implantation failure were assigned to the case group, and 25 women who had one or more live births were assigned to the control group. Endometrial biopsies were obtained during the luteal phase on the 21st-24th day of the menstrual cycle.Results:There was a statistically significant difference between the groups concerning the number of deliveries (p<0.001) and miscarriages (p<0.001). The mean number of uNK was 10.5±10.5 cells/mm2 in the case group and 19.2±11.2 cells/mm2 in the control group. There was a statistically significant difference between the two groups (p=0.003).Conclusion:Implantation failure is a multifactorial problem of reproductive medicine. The results of our study suggest that uterine NK play a role in the progress of normal pregnancy and reduced uterine NK cell numbers were associated with implantation failure.

The Role of B7 Family Molecules in Maternal-Fetal Immunity.

Pregnancy is a complex but well-arranged process, and a healthy fetus requires immune privilege and surveillance in the presence of paternally derived antigens. Maternal and fetal cells interact at the maternal–fetal interface. The upregulation and downregulation of maternal immunity executed by the leukocyte population predominantly depend on the activity of decidual natural killer cells and trophoblasts and are further modulated by a series of duplex signals. The B7 family, which consists of B7-1, B7-2, B7-H1, B7-DC, B7-H2, B7-H3, B7-H4, B7-H5, BTNL2, B7-H6, and B7-H7, is one of the most characterized and widely distributed signaling molecule superfamilies and conducts both stimulatory and inhibitory signals through separate interactions. In particular, the roles of B7-1, B7-2, B7-H1, and their corresponding receptors in the progression of normal pregnancy and some pregnancy complications have been extensively studied. Together with the TCR–MHC complex, B7 and its receptors play a critical role in cell proliferation and cytokine secretion. Depending on this ligand–receptor crosstalk, the balance between the tolerance and rejection of the fetus is perfectly maintained. This review aims to provide an overview of the current knowledge of the B7 family and its functions in regulating maternal–fetal immunity through individual interactions.

Human Miscarriage Is Associated With Dysregulations in Peripheral Blood-Derived Myeloid Dendritic Cell Subsets.

Dendritic cells (DC) are critically involved in decisions related to the acceptance or rejection of the foreign fetal antigens by the maternal immune system. However, particularly for human peripheral blood DCs (PBDC), available literature is rather inconsistent and the factors regulating these cells are ill-defined. Here, we investigated the phenotype and functionality of different human PBDC subsets during normal and pathologic pregnancies and studied an involvement of human chorionic gonadotropin (hCG) in PBDC regulation. Peripheral blood samples were obtained from normal pregnant women in all three trimesters, from first trimester miscarriage patients and from healthy non-pregnant women. Samples were analyzed for plasma hCG levels, for regulatory T (Treg) cell numbers, for frequencies of total and mature plasmacytoid (PDC) and myeloid (MDC1 and MDC2) PBDC subsets and for their cytokine secretion. In vitro assays, culturing PDC, MDC1 or MDC2 in the presence of two trophoblast cell lines, placenta explant supernatants or two hCG preparations were performed. The Treg-inducing capability of hCG- or non-hCG-treated stimulated MDC1 was assessed. Total and mature MDC1 and MDC2 frequencies increased during the first and second trimester of normal pregnancy, respectively. Miscarriage was associated with a reduced MDC1 and an increased MDC2 activation profile. PDC were not altered neither during normal pregnancy progression nor during miscarriage. In vitro, the culture of isolated PBDC subsets in the presence of placenta-derived factors impaired the maturation of MDC1 and differentially affected PDC maturation. An inhibitory effect on MDC1 and PDC maturation was also proven for the urine-derived hCG preparation. Finally, we observed a Treg cell elevation during early normal pregnancy that was not present in miscarriages. Stimulated MDC1 induced Treg cells in vitro, however, hCG was not involved in this process. Our findings suggest that during normal pregnancy PBDC subsets are differentially regulated dependent on gestational age. Miscarriage seems to be associated with dysregulations in the myeloid PBDC subsets and with disturbances in Treg cell frequencies. Moreover, our results propose an interdependency between MDC1 and Treg cells during early pregnancy. hCG, although shown to impair MDC1 maturation, does not seem to be a key regulator of PBDC alterations during pregnancy.

Expression and significance of STOX1 in villi and placenta at different stages of normal gestation

Objective: To investigate the expression and significance of STOX1 in different stages of gestation villi and placenta. Methods: Totally 137 cases of normal villi and placenta of pregnant women were collected from the Department of Obstetrics of Shanghai Pudong Hospital from October 1(st) 2015 to February 28(th) 2018, including 64 cases of early pregnancy (early pregnancy group) which consists of 32 cases of 5-7(+6) weeks gestation (early pregnancy group A) and 32 cases of 8-11(+3) weeks gestation (early pregnancy group B), 28 cases of 14-26 weeks gestation(middle pregnancy group) and 45 cases of 37-41 weeks gestation (late pregnancy group). The expression and localization of STOX1 mRNA and protein in placenta were evaluated by RT-qPCR, Western blotting and immunohistochemistry. Results: (1)STOX1 was positively expressed in the cytotrophoblasts and syncytiotrophoblasts as well as interstitial and vascular endothelial cells of all groups. (2)STOX1 mRNA expression in each group was significantly different (P<0.05), the lowest was in the early pregnancy group A(0.007 8±0.000 4), which increased along with the progression of gestational age(P<0.05),and reached the highest level in the third trimester(0.064 4±0.001 3). (3)The protein level of STOX1 in different stages of normal pregnancy was 0.53±0.20 in early pregnancy group A;0.62±0.37 in early pregnancy group B;0.70±0.03 in middle pregnancy group and 0.81±0.04 in late pregnancy group respectively; which was positively related with the progression of gestational age (P<0.05). Conclusion: The expressions of STOX1 is gradually increasing along with the normal pregnancy progression, suggesting that it might be involved in proliferation, differentiation and infiltration and (or) apoptosis of trophoblast cells and the development of the placenta.

Urinary metabolic variation analysis during pregnancy and application in Gestational Diabetes Mellitus and spontaneous abortion biomarker discovery

Pregnancy is associated with the onset of many adaptation processes that are likely to change over the course of gestation. Understanding normal metabolites’ variation with pregnancy progression is crucial for gaining insights of the key nutrients for normal fetal growth, and for comparative research of pregnancy-related complications. This work presents liquid chromatography-mass spectrum-based urine metabolomics study of 50 health pregnant women at three time points during pregnancy. The influence of maternal physiological factors, including age, BMI, parity and gravity to urine metabolome was explored. Additionally, urine metabolomics was applied for early prediction of two pregnancy complications, gestational diabetes mellitus and spontaneous abortion. Our results suggested that during normal pregnancy progression, pathways of steroid hormone biosynthesis and tyrosine metabolism were significantly regulated. BMI is a factor that should be considered during cross-section analysis. Application analysis discovered potential biomarkers for GDM in the first trimester with AUC of 0.89, and potential biomarkers for SA in the first trimester with AUC of 0.90. In conclusion, our study indicated that urine metabolome could reflect variations during pregnancy progression, and has potential value for pregnancy complications early prediction. The clinical trial number for this study is NCT03246295.

Assessment of the fetal-placental unit using clinical and ultrasound evaluation and inherited thrombophilia in pregnant patients

A normal pregnancy progression leads towards a pro­throm­botic phenotype in order to prepare the mother for delivery. When the physiological adaptation overlaps to abnormal changes, such as thrombophilic factor mu­ta­tions, the risk for adverse pregnancy outcome becomes in­crea­singly higher. Doppler ultrasound velocimetry of utero-placental and fetal vessels represents a method of antenatal monitoring, thus being a noninvasive evaluation method. We analyzed 145 pregnant women, recruited over a period of 6 months, from January 2016 to June 2016, in the Obstetrics and Gynecology Department of the Bucharest University Emergency Hospital, who underwent clinical and ultrasound evaluation according to their gestational age. We encountered five cases with middle cerebral artery/umbilical artery pulsatility indices ratio smaller than 1, representing the population at risk for a higher maternal and fetal morbidity and mortality. Also, intrauterine growth restriction was more frequent in the aforementioned group (60%) versus the rest of the patients (7.9%). An extensive literature review highlights the role of inherited thrombophilic disorders and obstetric complications affecting the normal placental vascular function; however, appropriate treatment can improve pregnancy outcome. Future research regarding thrombophilic pregnant patients should focus on close clinical and ultrasound monitoring for the best maternal and fetal results.

Pregnancy and heart disease: what Internists should know

Pregnant women with heart disease are increasing due to medical and surgical progress and, nowadays, congenital heart disease is the most frequent heart disease affecting these women. Pregnancy represents a considerable effort for an altered heart with negative consequences for life quality, disease progression and mortality. Risk differs a lot among patients and depends not only on the type of heart disease. Clinician should stratify risk and offer patients a correct pre-counselling and accurate follow- up. At the same time Clinician should be able to diagnose rapidly heart failure as some cardiopathies, such as peripartum cardiomyopathy, are related to pregnancy and produce symptoms that can be confused with normal pregnancy progression. This brief review gives the opportunity to Internists to revise the most important aspects of management according to the recent literature. After having analyzed the pathophysiological mechanism of pregnancy, risk stratification and the salient elements of counselling, this review depicts the most important features of different heart diseases during pregnancy, giving warnings to Clinician about the fragile aspects to consider. Finally, it offers suggestions on therapy. General recommendations do not change during pregnancy, but some drugs are prohibited and dosage can sometimes be greater.

Correlation of Body Mass Index (BMI) with Thyroid Function in Euthyroid Pregnant Women in Manipur, India.

Body Mass Index (BMI) is significantly increased during pregnancy due to gain of weight with normal progression of pregnancy. The exact influence of thyroid function on BMI are ill defined in euthyroid pregnant women. To correlate serum levels of Free Triiodothyronine (FT3), Free Thyroxine (FT4) and Thyroid Stimulating Hormone (TSH) level with BMI of participant normal pregnant women in all the three trimesters. In this cross-sectional comparative study, total of 210 healthy pregnant women comprising of 70 participants in each trimester, attending Obstetrics Outpatient Department (OPD) for antenatal check-up were consecutively selected. Estimation of serum FT3, FT4 and TSH level was done by ELISA based methods. The correlation of BMI with serum levels of FT3, FT4 and TSH was done using Pearson correlation test (r) by SPSS version 21.0 software. TSH level of participant normal pregnant women showed significant positive correlation with BMI during first (r=0.254 and p=0.034) and second trimester (r=0.263 and p=0.028) of pregnancy. FT4 level showed significant negative correlation in second (r= -0.454 and p<0.001) and third trimester (r= -0.351 and p=0.003) of pregnancy. Correlation between BMI and FT3 level showed no significant association in any of the trimesters. BMI correlates positively with TSH level in first and second trimesters while it correlates negatively with FT4 level in second and third trimesters, but, failed to demonstrate significant association with FT3 level in any of trimesters in euthyroid pregnant women. Serum TSH along with FT4 level appears more useful modality compared to serum TSH alone for targeted thyroid screening particularly in obese pregnant women.

Quantitative evaluation of longitudinal strain in layer-specific myocardium during normal pregnancy in China.

BackgroundThe myocardial wall of the left ventricle is a complex, multilayered structure and is not homogenous. The aim of this study was to determine longitudinal strain (LS) in the three myocardial layers in normal pregnant women according to gestation proceedings.MethodsThe advanced two-dimensional speckle tracking echocardiography (2D STE) was performed on 62 women during each pregnancy trimester and 6 to 9 weeks after delivery, while 30 age-matched, healthy, nonpregnant women served as controls. LS on endocardial, mid-myocardial and epicardial layers at 18 cardiac segments were measured.ResultsAs gestation proceeded, all of layer-specific LS and global LS progressively decreased, which subsequently recovered postpartum (P < 0.05), and the LS gradient between inner and outer myocardium became greater, which reached its maximum in the late pregnancy. Peak systolic LS was the highest at endocardium and the lowest at epicardium, while the highest at the apical level and the lowest at the base (P < 0.05). In the early pregnancy and postpartum, LS at basal level was homogenous, meanwhile layer-specific LS showed significant differences at mid-ventricular and apical level throughout the progress of normal pregnancy (P < 0.05).ConclusionsUsing 2D STE, three-layer assessment of LS can be performed in pregnant women and shall give us new insights into the quantitative analysis of global and regional LV function during pregnancy. Future studies on the detection of pregnancy related heart disease would require these parameters as reference values for each time point of a normal pregnancy.