Outside Of Pregnancy Research Articles

N-3 PUFA and Pregnancy Preserve C-Peptide in Women with Type 1 Diabetes Mellitus.

Type 1 diabetes (T1DM) is an autoimmune disease characterized by the gradual loss of β-cell function and insulin secretion. In pregnant women with T1DM, endogenous insulin production is absent or minimal, and exogenous insulin is required to control glycemia and prevent ketoacidosis. During pregnancy, there is a partial decrease in the activity of the immune system, and there is a suppression of autoimmune diseases. These changes in pregnant women with T1DM are reflected by Langerhans islet enlargement and improved function compared to pre-pregnancy conditions. N-3 polyunsaturated fatty acids (n-3 PUFA) have a protective effect, affect β-cell preservation, and increase endogenous insulin production. Increased endogenous insulin production results in reduced daily insulin doses, better metabolic control, and adverse effects of insulin therapy, primarily hypoglycemia. Hypoglycemia affects most pregnant women with T1DM and is several times more common than that outside of pregnancy. Strict glycemic control improves the outcome of pregnancy but increases the risk of hypoglycemia and causes maternal complications, including coma and convulsions. The suppression of the immune system during pregnancy increases the concentration of C-peptide in women with T1DM, and n-3 PUFA supplements serve as the additional support for a rise in C-peptide levels through its anti-inflammatory action.

A Comparison between the Effectiveness of Norethisterone and Dydrogesterone for treatment of Irregular Menstrual Cycle

Background: Abnormal uterine bleeding is defined as irregularities in the menstrual cycle involving frequency, regularity, duration, and volume of flow outside of pregnancy. Up to 1/3rd of women experience abnormal uterine bleeding in their life, with irregularities most commonly occurs at menarche and perimenopause due to disruption of the hypothalamic-pituitary-ovarian axis. Aim: To compare the effectiveness of Norethisterone and Dydrogesterone for the treatment of irregular menstrual cycles due to abnormal uterine bleeding of ovulatory or endometrial dysfunction and to check for patient satisfaction after the use of prescribed hormones by taking their feedback. Methods: This observational, comparative, cohort-prospective study was conducted on 100 nonpregnant women between the ages of 15-45 years who presented with complaints of irregular menstruation in gynae outdoor of AMTH for 6 months from April 2021 to September 2021. After excluding pelvic pathology, known thyroid disease, coagulation disorder, or use of the contraceptive method, the participants were divided into Group A and Group B, each having 50 participants. Results: The mean age±SD of the participants in Group A was 29±3.4 while Group B had mean age±SD was 29.5±3.6. In Group A, 38(76%) patients reported a regular menstrual cycle after 3 months of use while 12(24%) patients complained of persistent irregular menstrual cycle despite 3 months use of Norethisterone with compliance in Group B using Dydrogesterone, 22(44%) patients had regular menstrual cycles while 28(56%) patients had persistent irregular menstrual cycles after three months of use. Conclusion: So we concluded from our study that Norethisterone had a better cycle control than Dydrogesterone. Keywords: Abnormal uterine bleeding of ovulatory and/or endometrial dysfunction, Norethisterone, Dydrogesterone,

Analysis of the Impact of Comorbidities on Endometrial Lesions Using the Charlson Comorbidity Index in Western Romania.

Background and Objectives: This retrospective study aimed to identify the main comorbidities found in gynecological patients hospitalized for endometrial lesions and to analyze the relationships between these comorbidities and each type of endometrial lesion. The Charlson comorbidity index (CCI) was calculated, thus assessing the patient’s probability of survival in relation to the underlying disease and the existing comorbidities. Materials and Methods: During 2015–2019, 594 cases hospitalized for vaginal bleeding outside of pregnancy were included in the research. For all cases, the frequency of comorbidities was calculated, applying the Cox proportional hazard model, considering the hospitalizations (from the following year after the first outpatient or hospital assessment) as a dependent variable; age and comorbidities were considered as independent variables. Results: Analysis of variance (ANOVA) for mean age of patients enrolled after diagnosis and multiple comparisons (via the Tukey post-hoc test) indicate significant differences (p < 0.05) between the average age for endometrial cancer (EC) and that for the typical endometrial hyperplasia or other diagnoses. The most common comorbidities were hypertension (62.28%), obesity (35.01%), and diabetes (22.89%), followed by cardiovascular disease. An intensely negative correlation (r = −0.715281634) was obtained between the percentage values of comorbidities present in EC and other endometrial lesions. The lowest chances of survival were calculated for 88 (14.81% of the total) patients over 50 years (the probability of survival in the next 10 years being between 0 and 21%). The chances of survival at 10 years are moderately negatively correlated with age (sample size = 594, r = −0.6706, p < 0.0001, 95% confidence interval (CI) for r having values from −0.7126 to −0.6238) and strongly negatively correlated with the CCI (r = −0.9359, p < 0.0001, 95% CI for r being in the range −0.9452 to −0.9251). Conclusions: Using CCI in endometrial lesions is necessary to compare the estimated risk of EC mortality with other medical conditions.

Predictors of severe and critical disease in pregnant women with SARS-CoV-2

Background/Objective SARS-CoV-2 continues to spread widely in the US and worldwide. Pregnant women are more likely to develop severe or critical illness than their non-pregnant counterparts. Known risk factors for severe and critical disease outside of pregnancy, such as asthma, diabetes, and obesity have not been well-studied in pregnancy. We aimed to determine which clinical and pregnancy-related factors were associated with severe and critical COVID illness in pregnancy. Study design This was a retrospective cohort study of women with confirmed intrauterine pregnancy and positive nasopharyngeal swab for SARS-CoV-2 who presented to an academic medical center in New York City from 1 March 2020 to 1 July 2020. Severe and critical COVID-19 disease was defined by World Health Organization criteria. Women with severe/critical disease were compared to women with asymptomatic/mild disease. Continuous variables were compared with Mann–Whitney or t-test and categorical variables were compared using chi-square and Fisher’s exact. Statistical significance was set at p < .05. Multivariable logistic regression was performed including variables that were significantly different between groups. Results Two hundred and thirty-three patients were included, 186 (79.8%) with asymptomatic/mild disease and 47 (20.2%) with severe/critical disease. Women with asymptomatic/mild disease were compared to those with severe/critical disease. Women with severe/critical disease were more likely to have a history of current or former smoking (19.6 vs. 5.4%, p = .004), COVID-19 diagnosis in the 2nd trimester (42.6 vs. 11.8%, p = .001), and asthma or other respiratory condition (21.3 vs. 7.0%, p = .01). Women with severe/critical disease were more likely to have cesarean delivery (35.5 vs. 15.6%, p < .01) and preterm delivery <37 weeks (25.8 vs. 3.8%, p < .01). After adjustment, history of smoking remained significantly predictive of severe/critical disease [aOR 3.84 (95% CI, 1.25–11.82)]. Conclusion Pregnant women with a history of smoking, asthma, or other respiratory condition, and COVID-19 diagnosis in the second trimester of pregnancy were more likely to develop severe/critical disease. These findings may be useful in counseling women on their individual risk of developing the severe or critical disease in pregnancy and may help determine which women are good candidates for vaccination during pregnancy.

MO427SAFE USE OF ALLOPURINOL TO TREAT ACUTE URIC ACID NEPHROPATHY IN PREGNANCY: A CASE REPORT

Abstract Introduction Acute uric acid nephropathy (UAN) is characterized by acute kidney injury (AKI) due to uric acid crystal precipitation within the distal tubules and collecting ducts. We present a young woman, with a history of hyperuricaemia, who was treated with allopurinol for acute UAN during her first pregnancy. She also continued allopurinol treatment during her second pregnancy for prevention of further acute UAN. To the author’s knowledge, this is the first case report of biopsy-confirmed acute UAN during pregnancy. Case report A 20 year old woman, who was 13 weeks pregnant, was admitted with AKI. Past medical history included chronic kidney disease (CKD) and gout since the age of 17. She had an extensive family history of CKD and gout (without diagnosis, despite genetic testing). She had been on daily allopurinol 300mg, but this was stopped 8 weeks prior by her rheumatology team due to concerns about teratogenicity. At that time serum creatinine was at her baseline of 100 μmol/L (normal range 50-120 μmol/L) and serum uric acid had been 740 μmol/L (normal range 140-360 μmol/L). On admission, she felt well and was euvolemic. Serum creatinine was now 352 μmol/L and her serum uric acid level was 1720 μmol/L, with an elevated urine uric acid to creatinine ratio of 1.1. She underwent renal biopsy, which showed significant deposition of uric acid crystals in the renal tubules, confirming a diagnosis of acute UAN. She was given intravenous fluids. The uncertainties of allopurinol use in pregnancy were discussed with her, and she was restarted on allopurinol 200 mg daily. Over the next 3 weeks, serum uric acid decreased to 470 μmol/L and serum creatinine to 116 μmol/L. She was maintained on allopurinol during her pregnancy and delivered a healthy baby girl. She was advised against further pregnancies due to increased risk of maternal and fetal complications. However, three years later she presented at 15 weeks’ gestation. After a discussion regarding the potential teratogenic effects of allopurinol versus the risk of recurrent severe AKI due to acute UAN if it was again discontinued, she chose to continue allopurinol. The pregnancy proceeded without complication. Her daughters are now 8 and 5 years old. They do not have any congenital malformations, though both have mild to moderate learning difficulties. Discussion Allopurinol is approved for the treatment of hyperuricaemia outside of pregnancy, but given it interrupts purine synthesis there is a biologically plausible concern regarding teratogenicity. However, in our patient with long-standing hyperuricaemia it was the discontinuation of allopurinol that precipitated AKI due to the resultant crystal formation when serum uric acid reached very high levels. Biopsy confirmation of acute UAN was vital in this case, given the possibility of missing an alternative diagnosis and the risks of giving empirical allopurinol therapy. Once the diagnosis for her severe AKI was confirmed, it was clear our patient would benefit from uric acid lowering therapy. Our patient had two healthy girls despite using allopurinol from week 16 in her first pregnancy and throughout her second pregnancy. Unfortunately, both girls have mild to moderate learning needs, though it is unprovable whether allopurinol was causative as no study has followed up long term outcomes after foetal exposure during pregnancy.

ANALYSIS OF NIDANAS ON ASRIGDHARA WITH SPECIAL REFERENCE TO PATHOPHYSIOLOGY OF ABNORMAL UTERINE BLEEDING

Asrigdhara/ Raktapradara is one among the Artavavyapath mentioned by our Acharyas. It can be a symptom in any disease or a disease in itself. The Tridoshakara nidanas mentioned in our classics leads to the manifestation of the disease, the pre-existing Srotodushti in the Garbhashaya and Artavavaha srotas. Any uterine bleeding outside the normal volume, duration, regularity or frequency outside of pregnancy is considered abnormal uterine bleeding (AUB). Heavy menstrual bleeding defines prolonged or heavy cyclic menstruation. Objectively menstruation last- ing longer than 7 days or exceeding 80mL of blood loss are determining values. The causes of AUB can either be structural (PALM- Polyp, Adenomyosis, Leiomyoma, Malignancy) or non- structural (COEIN- Coagulopathy, Ov- ulatory dysfunction, Endometrial, Iatrogenic and Not yet classified). Abnormal uterine bleeding among women has a global prevalence of between 3-30% accounting for about one third of outpatient gynecology visits. This condition affects the quality life of women with socioeconomic and psychological well-being. The Nidanas, Samprapti of Asrigdhara and pathophysiology of abnormal uterine bleeding has been elaborately discussed in the present article which is need of the hour. Keywords: Asrigdhara, Artavavyapath, Tridoshakara nidanas, Artavavaha srotas, Abnormal uterine bleeding.

Maternal and child genetic liability for smoking and caffeine consumption and child mental health: an intergenerational genetic risk score analysis in the ALSPAC cohort.

Background and aimsPrevious studies suggest an association between maternal tobacco and caffeine consumption during and outside of pregnancy and offspring mental health. We aimed to separate effects of the maternal environment (intrauterine or postnatal) from pleiotropic genetic effects.DesignSecondary analysis of a longitudinal study. We (i) validated smoking and caffeine genetic risk scores (GRS) derived from published genome‐wide association study (GWAS) for use during pregnancy, (ii) compared estimated effects of maternal and offspring GRS on childhood mental health outcomes and (iii) tested associations between maternal and offspring GRS on their respective outcomes.SettingWe used data from a longitudinal birth cohort study from England, the Avon Longitudinal Study of Parents and Children (ALSPAC).ParticipantsOur sample included 7921 mothers and 7964 offspring.MeasurementsMental health and non‐mental health phenotypes were derived from questionnaires and clinical assessments: 79 maternal phenotypes assessed during and outside of pregnancy and 71 offspring phenotypes assessed in childhood (<10 years) and adolescence (11–18 years).FindingsThe maternal smoking and caffeine GRS were associated with maternal smoking and caffeine consumption during pregnancy (2nd trimester: Psmoking = 3.0 × 10−7, Pcaffeine = 3.28 × 10−5). Both the maternal and offspring smoking GRS showed evidence of association with reduced childhood anxiety symptoms (βmaternal = −0.033; βoffspring = −0.031) and increased conduct disorder symptoms (βmaternal = 0.024; βoffspring = 0.030), after correcting for multiple testing. Finally, the maternal and offspring smoking GRS were associated with phenotypes related to sensation seeking behaviours in mothers and adolescence (e.g. increased symptoms of externalising disorders, extraversion and monotony avoidance). The caffeine GRS showed weaker evidence for associations with mental health outcomes.ConclusionsWe did not find strong evidence that maternal smoking and caffeine genetic risk scores have a causal effect on offspring mental health outcomes. Our results confirm that the smoking genetic risk scores also captures liability for sensation seeking personality traits.

Third-trimester repeat HIV testing: it is time we make it universal

Since the 1990s, perinatal transmission of HIV has decreased substantially, largely as a result of improved detection secondary to routine HIV screening in pregnancy and the use of antiretroviral therapy. However, despite reductions in HIV transmission, elimination of perinatal transmission, defined as an incidence of perinatal HIV infection of <1 per 100,000 live births and a transmission rate of <1%, remains elusive. An estimated 80% of perinatal transmissions occur after 36 weeks' gestation, which highlights the importance of diagnosis and treatment of maternal HIV infection before the highest-risk period for perinatal transmission. With timely identification of seroconversion, intrapartum and neonatal interventions can lower the risk of perinatal transmission from 25% to 10%, substantially reducing perinatal transmission events. The American College of Obstetricians and Gynecologists and the Centers for Disease Control and Prevention recommend that routine HIV testing be performed in all pregnancies, as early in the prenatal course as possible. Third-trimester repeat testing is only recommended for individuals known to be at high risk of acquiring HIV (ie, those who are incarcerated; who reside in jurisdictions with elevated HIV incidence; who are receiving care in facilities that have an HIV incidence in pregnant women > 1 per 1000 per year; or have signs or symptoms of acute HIV). However, among reproductive-age women, heterosexual intercourse is the most common mode of HIV transmission, and the risk of HIV seroconversion is greater during pregnancy than outside of pregnancy. Furthermore, state statutes for HIV testing in pregnancy are largely lacking. In this clinical opinion, we reviewed the evidence in support of universal third-trimester repeat HIV testing in pregnancy using a successful state-mandated testing program in Illinois. In addition, we provided clinical recommendations to further reduce missed perinatal transmission cases by implementing universal third-trimester repeat testing, obtaining hospital buy-in, monitoring testing adherence, bridging communications across multidisciplinary teams, and engaging clinicians in advocacy work.

532 Comparison of N-terminal pro-brain natriuretic peptide levels in healthy obese and non-obese pregnant women

NT-proBNP, a marker of ventricular dysfunction, varies by BMI outside of pregnancy with a lower threshold proposed for obesity. We sought to compare NT-proBNP levels between healthy obese and non-obese pregnant women. Prospective observational study of healthy pregnant women in the 3rd and 4th trimesters. Subjects were excluded if they had significant medical comorbidities or if their fetus had anomalies, growth restriction or aneuploidy. NT-proBNP was measured at 28 weeks(3TM), prior to delivery(PD), 1-2 days postpartum(IP), and 4-6 weeks postpartum(PP). LogNT-proBNP at these time points was analyzed using linear mixed effects models, including BMI< or ≥30, time, and time-by-BMI interactions with adjustment for hypertensive disorders of pregnancy (PIH) and race. 55 pregnant women (28 BMI≥30 and 27 BMI<30) enrolled. Obese women were more likely to develop PIH (50% vs 15%, p=0.010), be black (75% vs 29.6%, p=0.002), and have higher systolic blood pressure at all time points (p <0.05). Median NT-proBNP in pg/mL was 18 vs 26 at 3TM, 16 vs 43 at PD, 58 vs 63 at IP, and 33 vs 23 at PP for obese vs non-obese women (Figure 1). In linear mixed effects models, logNT-proBNP was significantly lower in obese women at 3TM (β=-0.89, 95%CI -1.51, -0.26) and PD (β=-1.05, 95%CI -1.72, -0.38) and trended lower IP (β=-0.52, 95%CI -1.16, 0.13; Table 1). The logNT-proBNP trends over time differed by BMI category, with higher values in obese women at both postpartum time points compared to the 3TM (IP β=1.24, 95% CI 0.75, 1.73); PP β=1.08, 95%CI 0.52, 1.63), but only IP for non-obese women (β=0.87, 95%CI 0.36, 1.38). Obese women have significantly lower NT-proBNP than non-obese women during pregnancy, but not postpartum. While NT-proBNP increases in the immediate postpartum period in obese and non-obese women, this increase persists to 4-6 weeks postpartum for obese women. These findings suggest that healthy obese pregnant women have lower baseline NT-proBNP levels than non-obese women, but that their cardiac recovery postpartum may be more prolonged.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

1104 B-Type natriuretic peptide as a predictor of hypertensive disease of pregnancy in maternal cardiac disease

To investigate changes in B-type natriuretic peptide (BNP) during pregnancy in women with congenital heart disease (CHD) and evaluate its utility as a predictor of adverse outcomes. Retrospective cohort study of singleton gestations with maternal CHD that delivered at a tertiary care center from March 2013 to August 2020 with at least one pregnancy BNP value. The primary outcomes were development of a composite adverse cardiovascular (CV) outcome, diagnosis of hypertensive (HTN) disease of pregnancy, and endorsement of CV symptoms. BNP values were categorized as less than or equal to or greater than 100 pg/mL, the threshold predictive of heart failure outside of pregnancy. Given lack of an established diagnostic threshold value in pregnancy, median, maximum, and trend of BNP values were obtained. Only BNP measurements collected prior to the development of an adverse outcome were evaluated. BNP values were compared with Chi-squared and Wilcoxon rank sum tests among those who did and did not develop an adverse outcome. 81 pregnancies with maternal CHD had at least one BNP measurement. 30 (37.0%) had a composite adverse CV outcome, 16 (19.8%) developed HTN disease of pregnancy, and 52 (64.2%) endorsed CV symptoms. BNP was not different for those who developed an adverse CV outcome (p=0.76) or endorsed CV symptoms (p=0.40). A BNP measurement above 100 pg/mL was associated with the development of HTN disease of pregnancy (p=0.01). The difference between minimum and maximum BNP values throughout pregnancy was higher with the development of HTN disease of pregnancy (p=0.03). A BNP less than or equal to 100 pg/mL has a negative predictive value of 96.1% for HTN disease of pregnancy in participants. In pregnancies complicated by maternal CHD, BNP greater than 100 pg/ml and increasing BNP over gestation is associated with the development of HTN disease of pregnancy but not adverse CV outcomes. Evaluation of BNP may be of clinical utility in the antepartum surveillance of pregnant women with cardiac disease, specifically when evaluating for HTN disease of pregnancy.

Update on the Use of Intravenous Immunoglobulin in Pregnancy.

Intravenous immunoglobulin (IVIG) was first administered to humans in the 1980s. The mechanism of action of IVIG is still a subject of debate but the pharmacokinetics have been well characterized, albeit outside of pregnancy. IVIG has been used in pregnancy to treat several nonobstetrical and obstetrical-related conditions. However, current evidence suggests that IVIG use during pregnancy can be recommended for 1) in utero diagnosis of neonatal alloimmune thrombocytopenia; 2) gestational alloimmune liver disease; 3) hemolytic disease of the fetus and newborn for early-onset severe intrauterine disease; 4) antiphospholipid syndrome (APS) when refractory to or contraindicated to standard treatment, or in catastrophic antiphospholipid syndrome; and 5) immune thrombocytopenia when standard treatment is ineffective or rapid increase of platelet counts is needed. All recommendations are based on case series and cohort studies without randomized trials usually because of the rare prevalence of the conditions, the high incidence of adverse outcomes if left untreated, and ethical concerns. In contrast, IVIG therapy cannot be recommended for recurrent pregnancy loss, and the use of IVIG in subgroups of those with recurrent pregnancy loss requires further investigations. For non-obstetrical-related conditions, we recommend using IVIG as indicated for nonpregnant patients. In conclusion, the use of IVIG during pregnancy is an effective treatment in some obstetrical-related conditions with rare serious maternal side effects. However, the precise mechanisms of action and the long-term immunologic effects on the fetus and neonate are poorly understood and merit further investigations.

Diabesity and Pregnancy: How Do We Get Our Patients Moving?

Obesity and diabetes are 2 commonly encountered complications in pregnancy that adversely affect pregnancy outcomes, maternal health, and the health of the offspring, both short-term and long-term. It is well established that physical activity provides numerous health benefits, both during and outside of pregnancy. By participating in physical activity, many of the negative consequences of both obesity and diabetes may be mitigated. Physical activity guidelines recommend that all adults, including pregnant women, perform at least 150 minutes of moderate-intensity exercise weekly in order to obtain health benefits. More physical activity may be needed to achieve weight management goals.

Prognosis of HER2-positive pregnancy-associated breast cancer: Analysis from the French CALG (Cancer Associé à La Grossesse) network

IntroductionThe prevalence of pregnancy-associated breast cancer is increasing. HER2-positive breast cancers typically have a poor prognosis. The objective of our study was to compare the prognosis of patients with HER2-positive breast cancer diagnosed during pregnancy (HER2-positive BCP) to young women diagnosed with HER2-positive breast cancer outside of pregnancy (HER2 non-BCP). MethodsData of patients managed for invasive breast carcinoma between January 2005 and 2020 were retrospectively collected from the database of Tenon University Hospital (Paris, France), part of the “Cancer lié à la Grossesse” network. ResultsFifty-one patients with HER2-positive BCP were matched on age at diagnosis with 51 HER2-positive non-BCP patients. Locally advanced disease with axillary lymph node involvement were frequent. Tumors were frequently aggressive with high grade (p = 0.57) and high Ki67 (p = 0.15). Among the HER2-positive BCP patients, the mean term at diagnosis was 19.3 week of gestation (WG). Eighty-four percent of the patients continued their pregnancy with a mean term at delivery of 34.2WG. Chemotherapy modalities differed between the two groups: neoadjuvant chemotherapy was more frequent in the HER2-positive BCP group (p = 0.03) and adjuvant chemotherapy more frequent in the HER2 non-BCP group (p = 0.009). The recurrence rate was 10% (n = 5) and 18% (n = 9) in the HER2-positive BCP and HER2 non-BCP groups, respectively, p = 0.25. Breast cancer-free survival was poorer in the HER2-positive BCP group with earlier recurrence, p = 0.008. No difference in type of recurrence was found between the groups (p = 0.58). ConclusionThis matched case-control study implies that patients with HER2-positive BCP still have a poorer prognosis than non-pregnant HER-positive patients.

Chikungunya infection in pregnancy - reassuring maternal and perinatal outcomes: a retrospective observational study.

To evaluate pregnancy and neonatal outcomes, disease severity, and mother-to-child transmission of pregnant women with Chikungunya infection (CHIKV). Retrospective observational study. Grenada. Women who gave birth during a Chikungunya outbreak between January 2014 and September 2015 were eligible. This descriptive study investigated 731 mother-infant pairs who gave birth during a CHIKV outbreak. Women and infants underwent serological testing for CHIKV by ELISA. Primary outcomes: composite pregnancy complication (abruption, vaginal bleeding, preterm labour/cervical incompetence, cesarean delivery for fetal distress/abruption/placental abnormality or delivery for fetal distress) and composite neonatal morbidity. Of 416 mother-infant pairs, 150 (36%) had CHIKV during pregnancy, 135 (33%) had never had CHIKV, and 131 (31%) had CHIKV outside of pregnancy. Mean duration of joint pain was shorter among women infected during pregnancy (μ=898days, σ=277days) compared with infections outside of pregnancy (μ=1064days, σ=244days) (P<0.0001). Rates of pregnancy complications (RR=0.76, P=0.599), intrapartum complications (RR=1.50, P=0.633), and neonatal outcomes were otherwise similar. Possible mother-to-child transmission occurred in two (1.3%) mother-infant pairs and two of eight intrapartum infections (25%). CHIKV infection during pregnancy may be protective against long-term joint pain sequelae that are often associated with acute CHIKV infection. Infection during pregnancy did not appear to pose a risk for pregnancy complications or neonatal health, but maternal infection just prior to delivery might have increased risk of mother-to-child transmission of CHIKV. Chikungunya infection did not increase risk of pregnancy complications or adverse neonatal outcomes, unless infection was just prior to delivery.

Genetic Loci and Physiologic Pathways Involved in Gestational Diabetes Mellitus Implicated Through Clustering.

Hundreds of common genetic variants acting through distinguishable physiologic pathways influence the risk of type 2 diabetes (T2D). It is unknown to what extent the physiology underlying gestational diabetes mellitus (GDM) is distinct from that underlying T2D. In this study of >5,000 pregnant women from three cohorts, we aimed to identify physiologically related groups of maternal variants associated with GDM using two complementary approaches that were based on Bayesian nonnegative matrix factorization (bNMF) clustering. First, we tested five bNMF clusters of maternal T2D-associated variants grouped on the basis of physiology outside of pregnancy for association with GDM. We found that cluster polygenic scores representing genetic determinants of reduced β-cell function and abnormal hepatic lipid metabolism were associated with GDM; these clusters were not associated with infant birth weight. Second, we derived bNMF clusters of maternal variants on the basis of pregnancy physiology and tested these clusters for association with GDM. We identified a cluster that was strongly associated with GDM as well as associated with higher infant birth weight. The effect size for this cluster’s association with GDM appeared greater than that for T2D. Our findings imply that the genetic and physiologic pathways that lead to GDM differ, at least in part, from those that lead to T2D.

Lower Urinary Pathogens: Do More Pathogenic Bacteria Increase the Risk of Pyelonephritis?

Outside of pregnancy, urinary pathogens such as Proteus and Klebsiella are considered more pathogenic than E. coli. During pregnancy, the implications of lower urinary tract infection (LUTI) with more pathogenic bacteria are unclear. Thus, we sought to compare the risk of progression from LUTI to pyelonephritis among women infected with these more pathogenic urinary bacteria to those infected with E. coli. Retrospective cohort of pregnant women with LUTI at single tertiary center from July 2013 to May 2019. Pathogenic infections (PI) were defined as asymptomatic bacteriuria or acute cystitis urinary cultures positive for Proteus, Klebsiella, Enterobacter, Citrobacter, Acinetobacter, Staphylococcus, or Raoultella species. Demographic, infectious, antepartum, and postpartum data abstracted. Pregnant women with PI compared with those with E. coli. Primary outcome was progression to pyelonephritis. Secondary outcomes included pyelonephritis length of stay (LOS) >6 days, preterm birth (PTB), low birthweight (LBW), and measures of pyelonephritis-related morbidity. Of 686 pregnant women with LUTIs, 313 had urine culture growing out either PI or E. coli, with 59 (12%) growing PI and 254 (54%) growing E. coli. Women with PI were more likely to be African American, have chronic hypertension, and have history of preeclampsia. The primary species causing PI were Klebsiella (n = 29) and Proteus (n = 11). PI were not more likely to progress to pyelonephritis than E. coli LUTIs (10.9 vs. 14.5%; p = 0.67). Median LOS for pyelonephritis and other measures of pyelonephritis-related morbidity did not differ nor did PTB or LBW rates. After controlling for race, body mass index, history of preeclampsia, and history of pyelonephritis, PI were not associated with increased odds of progression to pyelonephritis (adjusted odds ratio: 0.69, 95% confidence interval: 0.27-1.80). Bacteria traditionally considered to be more pathogenic outside of pregnancy do not progress to pyelonephritis at higher rates than E. coli in pregnancy, and are associated with similar pyelonephritis-related morbidity. Larger studies are needed to confirm these findings. · Little is known about impact of uropathogen on progression to pyelonephritis and obstetric outcomes.. · Rates of progression to pyelonephritis from UTI did not vary by uropathogen.. · Pyelonephritis-related morbidities and preterm birth rates were also similar among uropathogens..

Management of prepregnancy, pregnancy, and postpartum obesity from the FIGO Pregnancy and Non‐Communicable Diseases Committee: A FIGO (International Federation of Gynecology and Obstetrics) guideline

Management of prepregnancy, pregnancy, and postpartum obesity from the FIGO Pregnancy and Non‐Communicable Diseases Committee: A FIGO (International Federation of Gynecology and Obstetrics) guideline

A case of indomitable vomiting outside of pregnancy

Mrs. M. began to menstruate at the age of 13, the regulations are incorrect, - after 11/2-2 weeks for 7 days, profuse, clots, with severe pain in the lower abdomen during the 1st day. She got married at the age of 21: the regulations appeared after 28 days, lasted only 4-5 days, but were still abundant and accompanied by the same severe pain.

Pregnancy hypertension diagnosis and care in COVID-19 era and beyond.

Pregnancy hypertension diagnosis and care in COVID-19 era and beyond.

193-OR: Physiology-Informed Type 2 Diabetes Genetic Clusters and Gestational Diabetes

Background: We previously described physiology-informed genetically-anchored type 2 diabetes (T2D) clusters based on associations between glycemic traits and T2D-associated variants discovered in prior GWAS. Cluster polygenic scores (PSs) delineate T2D subtypes with distinct features (e.g., reduced beta-cell function, obesity, lipodystrophy-like). These PSs have not been tested for association with gestational diabetes (GDM). Methods: We tested for associations between PSs (beta-cell, proinsulin, lipodystrophy, obesity, liver/lipid) and traits at 24-30 weeks gestation in the Gen3G cohort (N=582, 97% white non-Hispanic) with linear regression (β=change per 1 SD increase in PS). In 3 cohorts [Gen3G, HAPO (N=1369, 100% white non-Hispanic) MGH2(N=621, 62% white non-Hispanic)], we tested for associations between PSs and GDM using logistic regression and conducted fixed effects meta-analyses. Results: The beta-cell PS was associated with higher 1-hr OGTT glucose (β=4.5 mg/dl, P&amp;lt;0.001) and lower insulin secretory response (β=-45.7 Stumvoll 1st phase index, P=0.02). The obesity PS was associated with higher BMI (β=0.5 kg/m2, P=0.03) and HbA1c (β=0.03%, P=0.02). The lipodystrophy PS was associated with higher 1-hr OGTT glucose (β=2.6 mg/dl, P=0.03), higher fasting triglycerides (TGs) (β=6 mg/dl, P=0.01), and lower insulin sensitivity (β=-0.6 Matsuda index, P=0.005). The liver/lipid PS was associated with lower fasting TGs (β=-11 mg/dl, P&amp;lt;0.001). In 3-cohort meta-analyses (297 cases), only the beta-cell PS was associated with GDM (OR 1.19, P=0.009). There was heterogeneity across cohorts for the liver/lipid PS-GDM association. No PS was associated with birth weight. Adjustment for maternal age and genetic principal components did not alter results. Conclusion: Clusters of T2D-associated genetic variants derived based on physiology outside of pregnancy are associated with expected traits in pregnancy. A cluster representing reduced beta-cell function is associated with GDM. Disclosure C.E. Powe: None. M. Udler: None. S. Hsu: None. A. Kuang: None. C. Allard: None. A. Manning: None. L. Bouchard: None. P. Perron: None. J.C. Florez: Advisory Panel; Self; Doris Duke Charitable Foundation. Other Relationship; Self; Novo Nordisk Inc., Park Street School. W. Lowe: None. D. Scholtens: None. M. Hivert: None. Funding American Diabetes Association (1-15-ACE-26 to M-F.H.); National Institutes of Health (K23DK113218); Robert Wood Johnson Foundation; Harold Amos Medical Faculty Development Award (72456)