Pathological Pregnancies Research Articles

Steroid metabolome and multiple pregnancy

Steroid biosynthesis occurs in adrenal, gonadal, brain, liver, and placental tissues. Depending on the location of their activity, steroids can be divided into two groups - intracellular and extracellular. Intracellular ones act as transcription factors, suppressing or activating gene expression - they have a so-called genomic effect and therefore their onset of action is slow. Steroids acting extracellularly (non-genome effect) bind to neurotransmitter receptors located on the cytoplasmic cell membrane and thus affect the permeability of the ion channels, the effect of which is much faster, and we refer to them as neuroactive steroids or neurosteroids. While neuroactive steroids can be produced in different tissues of the body, or can be administered externally, neurosteroids are synthetized in cells of the nervous system. Some neuroactive steroids whose levels are extremely elevated in pregnancy (progesterone and its metabolites) are crucial in stabilizing pregnancy and changes in their concentration may influence the onset of parturition. Steroidogenic disorders may be involved in a number of pregnancy pathologies such as premature birth, pre-eclampsia, intrahepatic cholestasis in pregnancy, etc. Our research in collaboration with the Department of Steroids and Proteofactors of the Institute of Endocrinology in Prague also focuses on the investigation of multiple pregnancies in terms of biosynthesis, transport, and the effects of steroids. Studies available in the literature so far have not provided a comprehensive analysis of the steroidome in children and mothers in multiple pregnancies. The aim of our research is therefore to clarify the relationships between fetuses and mothers and between fetuses from the point of view of steroid synthesis and transport as well as the physiology and pathophysiology of human pregnancy and childbirth.

Polycystic ovary syndrome and pregnancy - review

Introduction and purpose Polycystic Ovary Syndrome(PCOS) is one of the most common endocrinological disorders, and it affects 7-8 % of women globally. It is very heterogenous disease, which pathogenesis is complex and composed of many factors like genetics, hormonal changes, environmental factors and insulin resistance. PCOS has many symptoms, which appearance is dependent on comorbidities like obesity, diabetes mellitus, hypercholesterolemia. Due to complexity of the pathogenesis of PCOS it may have four phenotypes: A,B,C,D. The pregnancy pathologies connected to PCOS are mainly gestational diabetes mellitus, pregnancy induced hypertension. Pregnant women with PCOS have 3-4 times a higher risk of developing pregnancy induced hypertension (PIH) and preeclampsia and a three times higher risk of gestational diabetes mellitus (GDM). More than 64% of pregnancies in women with PCOS were terminated via caesarean section. Metformin, although still controversial may be a good option for the treatment of PCOS before and during pregnancy as a second-line therapy. PCOS is a disease which affects the women in childbearing age and may have negative impact on its course. Pathologies connected to PCOS during pregnancy affect not only mothers, but foetus and according to new researches also children and adults from mothers with PCOS. It is very essential to extract women with PCOS to implement treatment and prevent its complications. Moreover, due to its common association with obesity patients should be under cardiologists care due to higher cardiovascular risk.

Kharakterystyka klinichno-laboratornykh pokaznykiv vmistu mahniiu u syrovattsi krovy vahitnykh iz rannim hestozom riznoho stupenia tiazhkosty

Introduction. Early gestosis is a pathological pregnancy state linked to the development of a fertilized egg or its elements and is characterized by several symptoms. In today’s conditions, the frequency of early gestosis is observed in 60.0-80.0 % of pregnant women, and the need for hospitalization and special treatment occurs in 12.0-17.8 % of pregnant women. According to statistics, up to 90.0 % of pregnant women suffer from nausea and vomiting of varying severity. One of the main issues of medical care for pregnant women with early preeclampsia, in addition to the number of episodes of vomiting during the day, is the presence and severity of micronutrient and vitamin imbalance, which should be inevitable due to nutritional deficiencies due to incontinence and loss of micronutrients with vomiting. One of the key moments of vomiting in pregnant women is expressed misbalance in microelements, especially magnesium (Mg). Mg is necessary for vitamin D biosynthesis, transportation, and activation which is one of the key factors determining the effectiveness of our immune system. Mg participates in vitamin D metabolism, normalizes it, and increases the sensitivity of the target organs. Magnesium has a significant role in immune response as a cofactor for immunoglobulin synthesis and other processes associated with T- and B-cells function is a natural antistress factor that slows down excitation of the central nervous system. The prospects of magnesium insufficiency influencing the severity of early gestosis are poorly studied, which became the reasoning for this study. The aim of the study. To characterize clinical and laboratory indices of magnesium levels in blood serum in pregnant women with early gestosis of different severity grades. Materials and methods. We examined 150 women, 100 ones (the main group) with signs of early gestoses: 41 females with mild signs, 37 women with moderate signs, 22 ones with severe signs, and 50 females (the control group) with the physiologic course of the first trimester of pregnancy. We considered the patient’s complaints, information from case history, physical examination data, common laboratory tests, and ultrasound imaging. The evaluation of Mg deficit was performed according to an adapted standardized score that was used in the international medical practice according to the scale of deficit signs and the Mg levels in blood serum were tested. The reference values of normal Mg levels in blood serum were 0.80-0.85 mmol/L. The statistical analysis of the results was performed using methods of variability with the help of MS Excel and Statistica SPSS10.0 for Windows. Results. According to the results of the questionnaire, the women from the main group mostly presented the Mg deficit and only 17 (17.0%) of pregnant females had no Mg deficit; at the same time, the pregnant women presented Mg insufficiency in 7 (14.0%), and Mg deficit was observed only in 1 (2%) case. the gotten results showed that at increasing gestosis severity, Mg deficit frequency in blood serum increases as well. The analysis of Mg indices in blood serum and using the questionnaire for Mg deficit allowed the determination significant prevalence of magnesium deficit. Conclusion. Most women aged 18-40 years with single live intrauterine pregnancy at 4-12 weeks and signs of early gestosis present magnesium insufficiency and deficit and the frequency of such cases increases with higher severity of early gestosis.

Ophthalmic artery Doppler at 19–23 weeks' gestation in pregnancies that deliver small‐for‐gestational‐age neonates

ABSTRACTObjectivesFirst, to explore hemodynamic differences between pregnancies delivering a small‐for‐gestational‐age (SGA) neonate in the absence of hypertensive disorders and those that develop pre‐eclampsia (PE) or gestational hypertension (GH), by comparing the ophthalmic artery peak systolic velocity (PSV) ratio and first (PSV1) and second (PSV2) PSV at 19–23 weeks' gestation, and second, to compare these pregnancies for markers of placental perfusion and function.MethodsThis was a prospective observational study in women attending for a routine hospital visit at 19 + 1 to 23 + 3 weeks' gestation. This visit included recording of maternal demographic characteristics and medical history, ultrasound examination for assessment of fetal anatomy and growth, and measurement of maternal ophthalmic artery PSV ratio, PSV1, PSV2, mean arterial pressure (MAP), uterine artery pulsatility index (UtA‐PI) and serum placental growth factor (PlGF). The values of PSV ratio, PSV1, PSV2, MAP, UtA‐PI and PlGF were converted to multiples of the median (MoM) or deltas. Mean MoMs or deltas of these biomarkers in the SGA, PE and GH groups were compared with those in the unaffected group. The definition of SGA was birth weight below the 10th percentile in the absence of PE or GH.ResultsThe study population of 5214 pregnancies contained 4375 (83.9%) that were unaffected by SGA, PE or GH, 563 (10.8%) complicated by SGA, 157 (3.0%) with PE and 119 (2.3%) with GH. There were three main findings of the study. First, in the SGA, PE and GH groups, compared with unaffected pregnancies, the PSV ratio delta, PSV2 MoM, MAP MoM and UtA‐PI MoM were increased and PlGF MoM was decreased; however, the magnitude of most changes was smaller in the SGA group than in PE and GH groups. Second, in the PE and GH groups, but not in the SGA group, PSV1 MoM was increased. Third, in general, in the pathological pregnancies, the magnitude of deviation of biomarkers from unaffected pregnancies was greater for those delivering at < 37 than at ≥ 37 weeks' gestation.ConclusionIn mid‐gestation, pregnancies that subsequently develop hypertensive disorders and those delivering a SGA neonate, compared with unaffected pregnancies, have abnormal uteroplacental measurements and increased maternal ophthalmic artery PSV ratio. These data suggest similar pathophysiology in the two conditions, with evidence of placental dysfunction and increased peripheral vascular resistance, but the magnitude of abnormalities is greater in hypertensive disorders. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Renin-angiotensin system in normal pregnancy and in preeclampsia: A comprehensive review.

The activation of the Renin Angiotensin System (RAS) is required during pregnancy and it seems that RAS dysfunction has some important effects on pathological pregnancy conditions, including preeclampsia (PE). The objective of this review is to summarize and to discuss the role of the RAS in normal pregnancy and in PE. We found evidence that the RAS is important for the evolution of pregnancy under physiological conditions and plays an important role in the pathogenesis of PE. In normal gestation, almost all circulating components of RAS are increased and there is a general state of non-reactivity to the vasoconstrictor actions of Angiotensin (Ang) II. In PE, changes in the circulating levels of RAS components occur, especially with an intense decrease in the levels of Ang I, Ang II and Ang-(1-7). Our findings endorse the idea that PE is a disease whose cornerstone relies on altered placental physiology. There are high tissue levels of Ang II type 1 receptor (AT1R) in the musculature of the blood vessels and in the placenta, generating a state of increased sensitivity to the vasoconstrictor action of Ang II. AT1R autoantibodies (AT1R-AA) might be one of the key points for the vicious cycle of PE, as these molecules are synthesized in situations of hypoxia and enhance placental vasoconstriction, causing even more hypoxia. Further studies are needed to investigate the role of circulating RAS, uteroplacental RAS and local RAS molecules from other tissues related to the pathogenesis of PE.

Compensation Possibilities of Mental Disorders — Individual Case of a Child with Severe Neurological Disorder

IntroductionNeurological diseases often lead to mental disorders in children. After the structure of disorder is identified, an important task is to examine the abilities to compensate developmental delay (Lev S. Vygotsky).ObjectivesThe goal of the study was to explore potential of children with opsoclonus-myoclonus syndrome (OMS), which is important for psychocorrection.MethodsCase study of a boy with idiopathic OMS (aged 3 years 5 months) who was patient at the Psychoneurological Department no. 2 of the Russian Children Clinical Hospital. The following methods were used: analysis of anamnestic data, analysis of patient’s medical record, pathopsychological assessment.ResultsAnamnestic data and medical records indicate the absence of pregnancy pathologies and normal early development. OMS was first detected when the child was aged 2 y. 7 m. Pathopsychological assessment gave the following results: 1) movement disorder (primary disorder) leads to secondary mental disorders; 2) locomotor activity disorders inhibit the child’s use of space and orientation of body in it; 3) secondary defects are detected in constructive activity, speech and drawing. Intact components of the mental processes: 1) the child demonstrates motivation for independent activity despite operational difficulties; 2) in certain activities, the general plan of actions remains intact, i.e., the goal set is actualized in movements and actions; 3) notions about objects, actions with them, planning and performance of movements are intact.ConclusionsThe research demonstrates disbalance between operational difficulties and integrity of semantic orientation, internal planning of actions. The data prove the importance of discussion on abilities of children with OMS to compensate mental disorders.DisclosureNo significant relationships.

Single-cell RNA sequencing reveals immunological rewiring at the maternal-fetal interface following asymptomatic/mild SARS-CoV-2 infection.

While severe coronavirus 2019 (COVID-19) is associated with immune activation at the maternal-fetal interface, responses to asymptomatic/mild severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy remain unknown. Here, we assess immunological adaptations in blood and term decidua in response to asymptomatic/mild disease in pregnant women. We report attenuated antigen presentation and type I interferon (IFN) signaling pathways, loss of tissue-resident decidual macrophages, and upregulated cytokine/chemokine signaling in monocyte-derived decidual macrophages. Furthermore, we describe increased frequencies of activated tissue-resident T cells and decreased abundance of regulatory T cells with infection while frequencies of cytotoxic CD4/CD8 T cells are increased in the blood. In contrast to decidual macrophages, type I IFN signaling is higher in decidual T cells. Finally, infection leads to a narrowing of T cell receptor diversity in both blood and decidua. Collectively, these observations indicate that asymptomatic/mild COVID-19 during pregnancy results in remodeling of the immunological landscape of the maternal-fetal interface, with a potential for long-term adverse outcomes for the offspring.

Association between maternal thyroid function and risk of gestational hypertension and preeclampsia.

To investigate the influence of maternal level of thyroid-stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4) one by one or in combination on incidence of gestational hypertension and preeclampsia. The study included pregnant women (n=107) hospitalized in the period from July 1, 2020 to October 10, 2021at the Department of Pathology of Pregnancy of the University Clinic of Obstetrics and Gynecology, University Clinical Center Sarajevo (UCCS) (Bosnia and Herzegovina), due to hypertensive disorder in pregnancy without symptoms of impaired thyroid function. In all patients fulfilling inclusion criteria TSH, FT3, and FT4 using electrochemiluminescence immunoassay (ECLIA, Roche Diagnostics, Basel, Switzerland) were checked. There were two groups of patients: one with gestational hypertension (G1) and the other with preeclampsia (G2). The programs SPSS for Windows 25.0, SPSS Inc, Chicago, IL, USA and Microsoft Excel 11, Microsoft Corporation, Redmond, WA, USA were used for statistical analysis using nonparametric Mann-Whitney U test because the distribution of the data was not normal. The result was considered statistically significant if p<0.05. Gestational age at delivery (G2 36.86±3.79 vs. G1 38.94±2.15; p=0.002) and birth weight (G2 2,841.36±1,006.39 vs. G2 3,290.73±745.6; p=0,032) were significantly different between the investigated groups. The difference between the peak systolic (p=0.002), peak diastolic blood pressure (p=0.007), TSH (p=0.044), and FT3 (p=0.045) were statistically significant. Impaired thyroid function was observed more often in G2 than in G1. Thyroid function was more often affected adversely in pregnancies complicated with preeclampsia than with gestational hypertension. Based on the results of our study it might be prudent to check thyroid hormones inall asymptomatic pregnancies with preeclampsia or gestational hypertension. These findings need confirmation in larger better designed prospective studies.

POS1336 BEHCET’S DISEASE AND PREGNANCY OUTCOMES

BackgroundBehcet’s disease (BD) is multisystemic disease of unknown cause. The relationship between BD and pregnancy is reported in limited number of studies.ObjectivesTo evaluate outcomes of pregnancies in BD patients (pts).MethodsWe retrospectively collected data of 45 women with BD diagnosis (according to ISGBD 1990 and ICBD 2014) and their 118 pregnancies. Pts’ mean age was 31,3 [27;35] years., disease duration 6,0 [3;8] years. 11,1% pts had severe BD according to Ch.Zouboulis classification (due to generalized uveitis, retinal vasculitis and parenchymatous CNS lesions), 31,1% pts had a moderate disease, 57,8% pts had a mild disease with mainly dermal-mucous manifestations.Results118 pregnancies in 35 pts resulted in 75 live birth (6 cesarean section in 3 pts). Thirty-nine incomplete pregnancies were observed in 26 patients. Ten patients had 20 medical abortions on request before 12 weeks of gestation, one patient had an abortion due to medical reasons (rubella on the 7 th week of gestation), two patients had premature birth at 28 and 32 weeks with subsequent perinatal death of the baby. Fifteen out of 35 pts had 20 adverse pregnancy outcomes: 8 spontaneous abortion, 12 missed miscarriage. Nine patients had 12 Missed miscarriage at 6-11 weeks of gestation, one patient had 3 missed miscarriage, two had 2, and the others had 1 missed miscarriage. Six patients had 8 spontaneous abortions (early miscarriage). In the control group of 15 women, 7 had 15 pregnancies, 13 live birth of healthy children on time. Table 1 presents a comparison of pregnancy outcomes in patients with BD and healthy control.Table 1.Pregnancy outcomesPregnancy, nBD, n=118 (%)Control, n=15 (%)pBirth77 (65)13 (87)0,01Abortion21 (18)00,00Unfavorable pregnancy outcome20 (17)2 (13)nsMissed miscarriage12 (10)0nsSpontaneous abortion8 (7)2 (13)nsPatients with BD were more likely to terminate pregnancy of their own volition compared to control group. All women with unfavorable pregnancy outcomes are re-pregnant, have healthy children born on time, all had a second or subsequent pregnancy with an unfavorable outcome. Immunosuppressive therapy of BD was not received by any of the pregnant women, which makes it possible to exclude the connection of the outcome of pregnancy with BD therapy.The manifestation of BD with skin-mucous lesion of the patient in the first and third trimester of pregnancy was noted by 3 patients. In one patient, the appearance of a recurrent ulcer on the vulva was an indication for cesarean section.Only three women had one favorably completed pregnancy, all the others had from 2 to 7 pregnancies. Out of 45 patients, 10 patients did not have pregnancies, 9 of them are not married, 1 patient is planning a pregnancy.Table 2 shows the frequency of pregnancy pathology with varying degrees of severity of BD.ConclusionPatients with BD were more to terminate pregnancy compared to control group. Unfavorable outcomes of pregnancy were documented in pts regardless (with all grades of) BD severity.

Prediction of gestational age using urinary metabolites in term and preterm pregnancies

Assessment of gestational age (GA) is key to provide optimal care during pregnancy. However, its accurate determination remains challenging in low- and middle-income countries, where access to obstetric ultrasound is limited. Hence, there is an urgent need to develop clinical approaches that allow accurate and inexpensive estimations of GA. We investigated the ability of urinary metabolites to predict GA at time of collection in a diverse multi-site cohort of healthy and pathological pregnancies (n = 99) using a broad-spectrum liquid chromatography coupled with mass spectrometry (LC–MS) platform. Our approach detected a myriad of steroid hormones and their derivatives including estrogens, progesterones, corticosteroids, and androgens which were associated with pregnancy progression. We developed a restricted model that predicted GA with high accuracy using three metabolites (rho = 0.87, RMSE = 1.58 weeks) that was validated in an independent cohort (n = 20). The predictions were more robust in pregnancies that went to term in comparison to pregnancies that ended prematurely. Overall, we demonstrated the feasibility of implementing urine metabolomics analysis in large-scale multi-site studies and report a predictive model of GA with a potential clinical value.

Deletion of ACLY Disrupts Histone Acetylation and IL-10 Secretion in Trophoblasts, Which Inhibits M2 Polarization of Macrophages: A Possible Role in Recurrent Spontaneous Abortion.

Changes to macrophage polarization affect the local microenvironment of the placenta, resulting in pathological pregnancy diseases such as recurrent spontaneous abortion (RSA). Macrophages are in close contact with trophoblasts during placental development, and trophoblast-derived cytokines are important regulators of macrophage polarization and function. Histone acetylation can affect the expression and secretion of cytokines, and ATP citrate lyase (ACLY) is an important factor that regulates histone acetylation. The aim of this study was to investigate the effect of ACLY expression differences in trophoblast on macrophage polarization and its mechanism. Our data demonstrate that ACLY level in placental villi of patients with RSA is decreased, which may lead to the inhibition of histone acetylation in trophoblasts, thereby reducing the secretion of IL-10. Reduced IL-10 secretion activates endoplasmic reticulum stress in macrophages, thus inhibiting their M2 polarization.

The Role of Non-Coding RNAs in the Human Placenta.

Non-coding RNAs (ncRNAs) play a central and regulatory role in almost all cells, organs, and species, which has been broadly recognized since the human ENCODE project and several other genome projects. Nevertheless, a small fraction of ncRNAs have been identified, and in the placenta they have been investigated very marginally. To date, most examples of ncRNAs which have been identified to be specific for fetal tissues, including placenta, are members of the group of microRNAs (miRNAs). Due to their quantity, it can be expected that the fairly larger group of other ncRNAs exerts far stronger effects than miRNAs. The syncytiotrophoblast of fetal origin forms the interface between fetus and mother, and releases permanently extracellular vesicles (EVs) into the maternal circulation which contain fetal proteins and RNA, including ncRNA, for communication with neighboring and distant maternal cells. Disorders of ncRNA in placental tissue, especially in trophoblast cells, and in EVs seem to be involved in pregnancy disorders, potentially as a cause or consequence. This review summarizes the current knowledge on placental ncRNA, their transport in EVs, and their involvement and pregnancy pathologies, as well as their potential for novel diagnostic tools.

EZH2 enhances proliferation and migration of trophoblast cell lines by blocking GADD45A-mediated p38/MAPK signaling pathway

ABSTRACT Impaired activity of the trophoblasts is a major contributor to the progression of pregnancy pathologies including preeclampsia (PE). This research probed the function of enhancer of zeste homolog 2 (EZH2) in activity of trophoblast cells and its correlation with growth arrest and DNA damage inducible alpha (GADD45A). EZH2 was predicted to be downregulated in placental tissues in PE according to a gene chip analysis, and reduced expression of EZH2 was detected in the placental tissues of patients with PE. Overexpression of EZH2 augmented proliferation and invasiveness of two trophoblast cell lines HTR-8/SVneo and JEG3 cells. EZH2 catalyzed trimethylation of lysine 27 on histone 3 (H3K27me3) in GADD45A promoter to suppress its transcription. GADD45A silencing increased the activity of the trophoblast cell lines and inactivated the p38/mitogen-activated protein kinase (MAPK) signaling pathway. Rescue experiments confirmed that either inhibition of GADD45A or p38 restored the proliferation, migration, and invasiveness of the trophoblast cell lines suppressed by EZH2 silencing. In conclusion, this work suggests that EZH2 enhances activity of trophoblast cell lines by suppressing GADD45A-mediated p38/MAPK signaling pathway.

Clinical Confusion Concerning Increased D-Dimer Value during Pregnancy

Plasma D-dimer, a special cross-linked fibrin derivative, is produced when fibrin is degraded by plasminase. During pregnancy, D-dimer increases along with the increase of gestational age, and the reference value of plasma D-dimer (≤0.5 mg/L) traditionally used for the screening of venous thrombosis in the normal population is not applicable to the pregnant population. Due to the lack of uniform D-dimer detection methods or measurement units, there is currently no unified D-dimer reference values for pregnancy or puerperium. Each region or laboratory should establish its own pregnancy D-dimer reference value for different gestational weeks through blood coagulation function testing of large numbers of samples of different gestational periods. More and more studies have been conducted to investigate the association between D-dimer and venous thromboembolism (VTE) during pregnancy, gestational hypertensive disorders (GHD) and pregnancy outcome. We reviewed, herein, the generation and measurement of D-dimer, the reference values of D-dimer during normal pregnancy, and the association between D-dimer and some pathological pregnancies, intending to help clinicians develop a more thorough understanding of D-dimer during pregnancy.

Homeostatic cytokines regulate the emergence of human prenatal effector T cells.

Abstract In a healthy pregnancy, prenatal immunity promotes tolerance in utero and transitions to provide protective immunity after birth. In pathologic pregnancies, in utero immune activation and the ensuing fetal inflammatory response are predictive of severe neonatal morbidity and mortality. We previously demonstrated that the majority of prenatal intestinal memory CD4 T cells express the transcription factor PLZF and possess a heightened Th1 effector potential. These PLZF+ CD4+ T cells specifically accumulate in the intestine, are absent from the adult, and are enriched in the cord blood of infants exposed to in utero inflammatory pathology. However, the signals that drive their intestinal accumulation and maturation are not well understood. We show that PLZF+ CD4+ T cells are MHC Class II restricted and display tissue specific functional heterogeneity, including Th2-, Th22- and Th17-like capacities. We provide evidence that differences in homeostatic cytokines between the small intestine and mesenteric lymph node support the preferential accumulation and functional compartmentalization of prenatal PLZF+ CD4+ T cells. Specifically, we show that IL-7 and TGFβ reciprocally modulate the preferential expansion and functional maturation of PLZF+ CD4+ T cells. We provide evidence for the generation of both virtual memory T cells as well as classic antigen driven differentiation of Th1- and Th17-like effector PLZF+ CD4+ T cells. This work identifies critical mechanisms of human prenatal immune maturation and regulation and could inform the development of novel therapeutic strategies to address perinatal inflammatory pathologies. Supported by K08 Mentored Clinical Scientist Development Award (AI128007) to Joanna Halkias and the Burroughs Wellcome Fund Preterm Birth Initiative (1019828)

Full longitudinal nailfold videocapillaroscopy analysis of microvascular changes during normal pregnancy.

Microvascular remodeling is one major responsible for vascular adaptation in pregnancy, still it is not routinely evaluated in the obstetric field. This pilot study aimed to explore the role of nailfold capillaroscopy (NCV) in detecting microvascular changes during normal pregnancy. A population of 30 healthy pregnant women was longitudinally followed performing clinical assessment and NVC evaluation at each trimester and post-partum. Thirty non-pregnant age-matched healthy women having received at least two NVCs with a minimum 9 to 12-month interval were selected as controls. All NVC images were evaluated by a qualitative and semi-quantitative assessment using current standardised approach. Statistical analyses were conducted to assess NVC trend throughout gestation and its possible association with pregnancy course. A progressive significant increase of NVC neoangiogenesis and a specular reduction in capillary dilations was observed during pregnancy (p<0.05). These variations were not found in age-matched controls, who showed stable NVC parameters over a similar time frame (p<0.05). Additionally, a significant inverse correlation was found between NVC neoangiogenesis rate and maternal systemic BP (rho= -0.72, p<0.005). This first comprehensive longitudinal NVC evaluation during normal pregnancy reports significant but physiological microvascular variations throughout gestation, suggesting NVC as a safe and promising technique for further investigate and define patterns of microvascular changes also in pathological pregnancies.

Optimalisasi Gerakan Yoga untuk Mengurangi Ketidaknyamanan pada Kehamilan

Pregnancy conditions in TM 1 to TM III will tone many problems that occur even though it is in physiological pregnancy let alone pathological pregnancy. The approach used to overcome problems in pregnancy is still widely done conventionally, therefore the management of midwifery care must be considered to reduce the discomfort of pregnant women so that pregnancy feels more comfortable, so that pregnancy becomes more pleasant and pregnant women become more productive during pregnancy. This community service aims to empower pregnant women in overcoming problems during pregnancy. The process carried out in community service is to provide information education during pregnancy and teach yoga movements

Interferon Lambda Signals in Maternal Tissues to Exert Protective and Pathogenic Effects in a Gestational Stage-Dependent Manner.

ABSTRACTInterferon lambda (IFN-λ) (type III IFN) is constitutively secreted from human placental cells in culture and reduces Zika virus (ZIKV) transplacental transmission in mice. However, the roles of IFN-λ during healthy pregnancy and in restricting congenital infection remain unclear. Here, we used mice lacking the IFN-λ receptor (Ifnlr1−/−) to generate pregnancies lacking either maternal or fetal IFN-λ responsiveness and found that the antiviral effect of IFN-λ resulted from signaling exclusively in maternal tissues. This protective effect depended on gestational stage, as infection earlier in pregnancy (E7 rather than E9) resulted in enhanced transplacental transmission of ZIKV. In Ifnar1−/− dams, which sustain robust ZIKV infection, maternal IFN-λ signaling caused fetal resorption and intrauterine growth restriction. Pregnancy pathology elicited by poly(I·C) treatment also was mediated by maternal IFN-λ signaling, specifically in maternal leukocytes, and also occurred in a gestational stage-dependent manner. These findings identify an unexpected effect of IFN-λ signaling, specifically in maternal (rather than placental or fetal) tissues, which is distinct from the pathogenic effects of IFN-αβ (type I IFN) during pregnancy. These results highlight the complexity of immune signaling at the maternal-fetal interface, where disparate outcomes can result from signaling at different gestational stages.

Immunological Aspects of Normal and Pathological Pregnancy

This article presents an overview of foreign and domestic data (Web of Science, e-LIBRARY, Scopus, PubMed) for the period 19982021, devoted to the system of immune protection of the mother and fetus during normal and pathologically occurring pregnancy. According to the results of the analysis of the literature data, changes occurring at the level of cellular and humoral immunity were revealed, and the mechanisms of innate and adaptive immunity, complement systems in such pathologies of pregnancy as miscarriage, threat of termination, preeclampsia, infectious complications were described. A complex system of protection against fetal rejection is a certain regulatory factor in maintaining the immunological balance during the entire gestation period, and a violation in its work underlies the formation of complications of the early and late postpartum period, as well as neonatal pathologies.

Obstetric and gynecological history and arterial stiffness in women of different age groups

Aim. To study the correlation between the features of obstetric and gynecological anamnesis with indicators of arterial stiffness in women of different age groups to assess additional risk factors for the development of cardiovascular diseases.&#x0D; Materials and methods. The single centre study involved women aged 18 to 65 years. The surveyed 161 women were divided into three groups: 1st group 52 young women from 18 to 30 years old; 2nd group 54 women from 31 years old to the onset of menopause; 3rd group 55 postmenopausal women. The 1 and 2nd groups included women with preserved reproductive function. All women underwent a questionnaire survey, clinical examination, determination of anthropometric data, measurement of cfPWV, determination of arterial stiffness by volume sphygmography, 24-hour blood pressure monitoring with assessment of aortic stiffness and characteristics of the central pulse wave.&#x0D; Results. In group 1, the early age of menarche was associated with an increase in the rate of morning rise in SBP (r=-0.46, p=0.002) and a decrease in SEVR (r=0.33, p=0.03); the use of combined oral contraceptives correlates with an increase in the Weissler coefficient PEP/ET (R=0.3, p=0.03) and amplification of pulse pressure PPA (R=0.29, p=0.04). A history of 1 or 2 pregnancies is associated with a decrease in arterial stiffness. At the same time, 3 or more pregnancies in the anamnesis create the prerequisites for the formation of arterial stiffness. The early onset of pregnancy pathologies, namely, starting from the 1st or 2nd trimester of pregnancy, is associated with a violation of the characteristics of the reflected wave at a young age and the formation of arterial stiffness in the menopausal period. History of abortions was associated with PWVao (R=0.45, p=0.002), ASI (R=0.43, p=0.002) in group 2. History of miscarriages is associated with SEVR (R=0.52, p=0.00005) and SEVR to HR75 (R=0.27, p=0.04) in the menopausal period.&#x0D; Conclusion. Pathology of pregnancy, three or more pregnancies in history, early age of menarche, taking combined oral contraceptives, abortions and miscarriages in history are associated with an increase in arterial stiffness in the future, which predisposes women to the development of CVD and should be taken into account for preventive purposes.