Pregnant Subjects Research Articles

The cytokine profile of women with severe anxiety and depression during pregnancy

BackgroundControversial findings regarding the association between pro-inflammatory cytokines and depression have been reported in pregnant subjects. Scarce data about anxiety and its relationships with cytokines are available in pregnant women. To understand the association between anxiety and cytokines during pregnancy, we conducted the present study in women with or without depression.MethodsWomen exhibiting severe depression (SD) and severe anxiety (SA) during the 3rd trimester of pregnancy (n = 139) and control subjects exhibiting neither depression nor anxiety (n = 40) were assessed through the Hamilton Depression Rating Scale (HDRS) and the Hamilton Anxiety Rating Scale (HARS). Serum cytokines were measured by a multiplex bead-based assay. Correlation tests were used to analyze the data and comparisons between groups were performed. A general linear model of analysis of variance was constructed using the group as a dependent variable, interleukin concentrations as independent variables, and HDRS/HARS scores and gestational weeks as covariables.ResultsThe highest levels of Th1- (IL-6, TNF-α, IL-2, IFN-γ), Th17- (IL-17A, IL-22), and Th2- (IL-9, IL-10, and IL-13) related cytokines were observed in women with SD + SA. The SA group showed higher concentrations of Th1- (IL-6, TNF-α, IL-2, IFN-γ) and Th2- (IL-4, and IL-10) related cytokines than the controls. Positive correlations were found between HDRS and IL-2, IL-6, and TNF-α in the SA group (p < 0.03), and between HDRS and Th1- (IL-2, IL-6, TNF-α), Th2- (IL-9, IL-10, IL-13) and Th17- (IL-17A) cytokines (p < 0.05) in the SD + SA group. After controlling the correlation analysis by gestational weeks, the correlations that remained significant were: HDRS and IL-2, IL-6, IL-9, and IL-17A in the SD + SA group (p < 0.03). HARS scores correlated with IL-17A in the SA group and with IL-17A, IL-17F, and IL-2 in the SD + SA group (p < 0.02). The linear model of analysis of variance showed that HDRS and HARS scores influenced cytokine concentrations; only IL-6 and TNF-α could be explained by the group.ConclusionsWe found that the cytokine profiles differ when comparing pregnant subjects exhibiting SA with comorbid SD against those showing only SA without depression.

The Relation between Serum C-Reactive Protein Level and Gestational Diabetes

Background: Gestational diabetes is one of the most common medical condition during pregnancy and its early detection is necessary to prevent prenatal and maternal complications. There is a link between raised CRP and development of gestational diabetes, so early detection of raised CRP may avoid serious maternal and neonatal hazards. Objective: The goal of this study was to detect the prevalence of raised high sensitivity C‑ reactive protein (hs‑ CRP) in normal pregnancy and gestational diabetes mellitus (GDM) and to compare the prevalence in both groups. Materials and methods: A case–control study was conducted between April 2018 and December 2018. A number of 60 pregnant women who were investigated for oral glucose tolerance test at 24–28 weeks of gestation were enrolled in this study. They were divided into 30 women with GDM as cases and 30 normal pregnant as control. They were investigated for the level of hs‑ CRP. Results: The prevalence of elevated hs‑ CRP in controls was 60%, whereas in cases it was 83.3%, with a P = 0.045 which is significant in this study.Conclusion: The study showed a raised level of hs‑ CRP in GDM in comparison with normal pregnant subjects.

The Relation between Serum C-Reactive Protein Level and Gestational Diabetes

Background: Gestational diabetes is one of the most common medical condition during pregnancy and its early detection is necessary to prevent prenatal and maternal complications. There is a link between raised CRP and development of gestational diabetes, so early detection of raised CRP may avoid serious maternal and neonatal hazards. Objective: The goal of this study was to detect the prevalence of raised high sensitivity C‑ reactive protein (hs‑ CRP) in normal pregnancy and gestational diabetes mellitus (GDM) and to compare the prevalence in both groups. Materials and methods: A case–control study was conducted between April 2018 and December 2018. A number of 60 pregnant women who were investigated for oral glucose tolerance test at 24–28 weeks of gestation were enrolled in this study. They were divided into 30 women with GDM as cases and 30 normal pregnant as control. They were investigated for the level of hs‑ CRP. Results: The prevalence of elevated hs‑ CRP in controls was 60%, whereas in cases it was 83.3%, with a P = 0.045 which is significant in this study.Conclusion: The study showed a raised level of hs‑ CRP in GDM in comparison with normal pregnant subjects.

High Prevalence of Hepatitis B Virus Infection among Pregnant Women Attending Antenatal Care in Central Nigeria

A total of 200 pregnant women subjects were selected for this study to determine the sero-prevalence of hepatitis B virus (HBV) infection and assess the risk factors among pregnant women attending ante natal care at FMC, Keffi, Nigeria.

Maternal and fetal Leptin and interleukin 33 concentrations in pregnancy complicated by obesity and preeclampsia

Objectives: To evaluate maternal and fetal Leptin and IL33 concentrations in pregnancy complicated by obesity and preeclampsia.Study design: A case-control study including 35 subjects with obesity (18 normotensive and 17 preeclamptic) and 47 normal weight controls (42 normotensive and 5 preeclamptic).Main outcome measures: Leptin and IL33 concentrations in maternal serum during pregnancy and in cord blood; uterine artery and umbilical artery Doppler velocimetry.Results: Subjects with obesity who developed preeclampsia had higher first trimester maternal (41.5, interquartile range (IQR) = 15.7–65.1 ng/ml) Leptin concentrations compared to either normal weight with (25, IQR = 20.4–25.8 ng/ml) and without hypertension (14.26, IQR = 8.2–22.8) (p < .05) or normotensive subjects with obesity (30.3, IQR = 10.4–38.4) (p < .05). Subjects with obesity who developed preeclampsia (2.4, IQR = 1.7–3.2 pg/ml) or not (1.4, IQR = 0.8–2 pg/ml) had lower first trimester maternal IL33 levels when compared to controls without hypertension (4.8, IQR = 2.9–5.9 pg/ml) (p < .001). Cord blood Leptin and IL33 concentrations were significantly correlated to third trimester maternal concentrations (Spearman rho = 0.51, p < .001 and Spearman rho = 0.68, p < .001, respectively). Uterine artery pulsatility index (PI) were significantly and directly correlated with maternal Leptin levels (p < .002) and inversely and statistically correlated with maternal IL33 concentrations (p < .001).Conclusions: Compared to lean controls, pregnant subjects with obesity had higher serum Leptin and lower IL33 concentrations at first trimester and during pregnancy. This difference persisted also for those who later developed preeclampsia. The relationship between maternal serum levels of Leptin and IL33 with uterine artery Doppler pulsatility index strongly suggests a role of these two markers in early placentation.

Evaluating Performance of Invu Versus IUPC in Monitoring of Pregnant Subjects With Uterine Contractions.

Evaluating Performance of Invu Versus IUPC in Monitoring of Pregnant Subjects With Uterine Contractions.

Effects of Malaria Infection on some Haematological and Biochemical Parameters in the General Population and Pregnant Malaria Patients Attending Two District Hospitals in Niger State, Nigeria

The effects of malaria on some haematological and biochemical parameters among males, pregnant and non-pregnant female patients attending district hospitals in Bida and Kagara areas of Niger State, Nigeria was investigated. The subjects were volunteers confirmed to be positive for malaria and without other clinical symptoms. A total of 231 patients (103 males and 128 females) within the age range of 1-50 years were studied. Fifty (20 males and 30 females) apparently healthy individuals in the similar age bracket were used as controls. Haematological and biochemical parameters were analyzed using standard methods. Overall, the reduction in haemoglobin concentration and packed cell volume (PCV) in patients were significantly higher/lower from non-infected patients (p&gt;0.05), while there was no significant differences observed in the male patients. The mean cell haemoglobin concentration (MCHC) (36.03 ± 1.29g/dl) in pregnant subjects was significantly higher (p&lt;0.05) compared to the non-infected pregnant control group (32.65 ± 0.46g/dl). There was a significant reduction in neutrophils but increase in lymphocytes in all subjects irrespective of sex. Non-significant (p&gt;0.05) increase existed in serum lipid levels among pregnant and non-pregnant women. When males and females were compared, serum lipids except triglycerides varied significantly. There were apparently no variations in glucose levels between pregnant and non-pregnant subjects, whereas males had significantly higher values. Some of these parameters can thus be useful tools in the monitoring and management of malaria.

Elevated fibrinogen, von Willebrand factor, and Factor VIII confer resistance to dilutional coagulopathy and activated protein C in normal pregnant women

BackgroundGestational changes in coagulation factor concentrations include elevations in fibrinogen, Factor VIII, and von Willebrand factor (vWF). We hypothesised that blood samples from term pregnant (TP) subjects are less prone to coagulation disturbances from haemodilution compared with those from non-pregnant (NP) females. MethodsBlood samples were collected from 15 NP and 15 TP subjects. In vitro haemodilution with normal saline was assessed by modified Clauss fibrinogen assay, factor activity, flow-chamber assay, and thromboelastometry. The impact of human fibrinogen concentrate (hFC), cryoprecipitate, and vWF/Factor VIII (FVIII) concentrate replacement in diluted TP and NP blood was compared. Thrombin generation and activated protein C sensitivity were assessed. ResultsTP blood contained twice the concentrations of fibrinogen, FVIII, and vWF relative to NP blood (P<0.0001). Platelet thrombus formation (PTF) under flow was reduced by 99.2% and 69.2% in diluted NP and TP blood, respectively. Platelet thrombus formation was partially restored by adding vWF/FVIII, but not hFC or cryoprecipitate. Fibrin clot firmness approached the threshold of 10 mm in diluted NP blood, and clot firmness was effectively restored by hFC, but not by vWF/FVIII. In the presence of thrombomodulin, peak thrombin generation was decreased by 86.7% in NP plasma, but by 31.8% in TP plasma (P<0.0001 vs NP plasma), indicating reduced activated protein C sensitivity in TP plasma. Both elevated FVIII and haemodilution contributed to activated protein C insensitivity. ConclusionsOur in vitro model showed relative resistance of TP blood to dilutional coagulation changes with respect to platelet adhesion, fibrin polymerisation, and thrombin generation. Careful therapeutic monitoring for different pro-haemostatic agents in pregnant women is warranted.

Association of vitamin D deficiency in pregnancy and risk of preterm labor

Introduction: Prematurity represents around 50-75% of the perinatal mortality causes. It is considered a challenging clinical scenario faced in every day practice. Preterm labor is clinically definedas the beginning of regular uterine contractions accompanying cervical changes before 37 gestational week’s completion with or without intact fetal membranes.Aim of the work: To assess the association between vitamin D status and preterm labor.Patients and Methods: 80 pregnant study subjects with singleton pregnancy between 20-28 gestational weeks were followed up for any sign or symptom of preterm labor. Study subjects that completed 37 gestational weeks were considered controls, others delivered before 37 gestational weeks were considered cases. A blood sample was collected from cases and controls and was frozen till reaching our target of PTBs then serum 25(OH) VD was assayed by ELISA.Results: Vitamin D levels were less in the preterm research group in statistically significant fashion (p value =0.000). GA age at delivery was statistically significantly correlated to vitamin D levels in which Pearson correlation = 0.571 (p value =0.000). Vitamin D deficiency was statistically significantly more prevalent in preterm research group ; while vitamin D sufficiency and insufficiency were more prevalent in full term research group in statistically significant manner (p value =0.000).Conclusion: A significant association between vitamin D deficiency in pregnancy and occurrence of preterm labor. Future research studies should in addition consider racial, ethnic differences between study subjects recruited in a comparative manner and seasonal variabilities that could affect vitamin D status.

High‐flow nasal therapy – modelling the mechanism

High‐flow nasal therapy – modelling the mechanism

Today's vaccination policies in Italy: The National Plan for Vaccine Prevention 2017-2019 and the Law 119/2017 on the mandatory vaccinations.

The National Plan for Vaccine Prevention 2017-2019 has expanded the vaccination offer including new vaccines, enlarging the target population and introducing for the first time in Italy a life-course approach to vaccination. A "lifetime immunization schedule" is aimed to reduce the burden and the related costs of vaccine-preventable diseases through effective vaccination programs. However, to counteract the national steady downward trend in the uptake of vaccinations that caused a drop of the vaccination coverage below the 95% threshold to allow herd immunity, it was decided to make 10 vaccinations mandatory by the law 119/2017. In particular, in addition to already mandatory vaccinations against diphtheria, tetanus, hepatitis B and poliomyelitis, those against measles, mumps, rubella (MMR), varicella, pertussis and Haemophilus influenzae type b (Hib) were added to the list. According to the law, all unvaccinated children cannot attend preschool services until the age of 6 years and fines (from 100 to 500 Euros) are provided for parents. Moreover, this law provided, in its first application, a catch-up campaign for children up to the age of 16 years and the free-of-charge offer of all mandatory and recommended vaccines to each child not yet vaccinated according to the previous NPVP. The NPVP includes also several at risk categories, such as pregnant women, healthcare workers and subjects suffering from chronic diseases, to whom specific vaccinations, free of charge, are offered. The vaccinations of pregnant women have different purposes. In order to decrease the pertussis risk in newborns in the first months of life, a booster immunization of DTPa is recommended, at every pregnancy, between week 27th and 36th. Instead, the influenza vaccine administration to pregnant women during the second or third quarter is mainly aimed to avoid the risk of serious disease complications for both the mother and the fetus. Another group of at risk subjects included in the NPVP is that made up by healthcare workers. According to the plan, "an adequate immunization of the healthcare workers is essential for the prevention and control of infections (anti-hepatitis B, anti-influenza, anti-measles-mumps-rubella, anti-varicella, anti-pertussis)". Finally, almost all the vaccinations foreseen by the NPVP are offered free of charge to subjects suffering from specific diseases. These include cardiovascular, respiratory, hepatic, neoplastic, renal and metabolic disorders, in addition to immunosuppression that exposes them to an increased risk of contracting invasive infectious diseases.

Endogenous cardiotonic steroids and vascular fibrosis in preeclampsia

Background. Previous studies implicated cardiotonic steroids, including Na/K-ATPase inhibitor marinobufagenin (MBG), in the pathogenesis of preeclampsia (PE). Recently, we demonstrated that MBG induces fibrosis in cardiovascular tissues via mechanism involving inhibition of Fli1, a nuclear transcription factor and a negative regulator of collagen-1 synthesis.Objective.We hypothesized that in human and rat PE, elevated MBG level is associated with development of fibrosis of umbilical arteries and rat thoracic aortae.Design and methods.Twelve patients with PE (mean blood pressure (BP) 118 ± 4 mmHg; mean age 28 ± 2 years; mean gestation age 36 ± 1 weeks) and 12 gestational age-matched normal pregnant subjects (mean BP 92 ± 2 mmHg; mean age 26 ± 1 years; mean gestation age 37 ± 1 weeks) were enrolled in the clinical study. We tested 16 pregnant Sprague-Dawley rats. Hypertension was provoked in 8 rats by 1,8 % Na supplementation.Results.PE in humans and rats was associated with the higher plasma MBG level and was associated with five-fold decrease in Fli-1 level and four-fold increase in collagen-1 level in the PE umbilical arteries vs. those from the normal subjects (p &lt; 0,01). Isolated rings of umbilical arteries from the subjects with PE exhibited impaired response to the relaxant effect of sodium nitroprusside vs. control vessels (EC50 = 141 nmol/L vs. EC50 = 0,9 nmol/L; p &lt; 0,001). Similar results were obtained for thoracic aorta of rats with experimental PE.Conclusions. These results demonstrate that elevated MBG level is implicated in the development of fibrosis umbilical arteries in PE.

Plasma Zonulin Levels as a Non-Invasive Biomarker of Intestinal Permeability in Women with Gestational Diabetes Mellitus.

Objective: We aimed to compare the levels of plasma zonulin, a non-invasive biomarker of increased intestinal permeability, between pregnant subjects, with and without gestational diabetes mellitus (GDM), at 24–28 gestational weeks. The eighty-five consecutive pregnant subjects that presented to our hospital’s obstetrics outpatient clinic and were diagnosed with GDM, for the first time by an oral glucose tolerance test (OGTT), formed the GDM group; 90 consecutive subjects that were not diagnosed with GDM by OGTT, formed the control group. The diagnosis of GDM was made by an OGTT performed between the 24th and 28th weeks of gestation, and in compliance with the American Diabetes Association (ADA) criteria. Plasma zonulin levels were measured by the enzyme-linked immunosorbent assay (ELISA) methods. The Plasma zonulin level was significantly higher in the GDM group than the control group (p < 0.001). A correlation analysis showed that plasma zonulin level was positively correlated to body mass index (BMI), creatinine, fasting plasma glucose, baseline, first hour, and two hours glucose levels and the OGTT, hemoglobin A1C (HbA1C), homeostatic model assessment for insulin resistance (HOMA-IR), and alanine aminotransferase (ALT) levels. Our findings suggest that zonulin may be a non-invasive biomarker involved in the pathogenesis of GDM. Further large-scale studies are needed on this subject.

Analysis of amino acid and acyl carnitine profiles in maternal and fetal serum from preeclampsia patients

Objectives: To analyze and compare concentrations of amino acids (AAs) and acylcarnitine (AC) profiles in maternal–fetal serum from women with preeclampsia (PE) and to assess their use as possible predictors of PE.Methods: This is a retrospective study in which we enrolled a total of 38 pregnant women and their offspring. Pregnant women with PE (n = 14) and healthy pregnant control subjects (n = 24) participated voluntarily in the study. Maternal blood and cord blood were tested using dry blood spot (DBS) specimens, and we detected concentrations of 18 types of AAs and 31 types of AC by using high-performance liquid chromatography tandem mass spectrometry (HPLC-MS), and compared metabolites between the groups. We used logistic regression modeling to estimate the association of each metabolite with development of PE.Results: Concentrations of most AAs and AC in PE mothers were significantly higher than those in the group of control mothers. Cord plasma concentrations of AC in most PE mothers were significantly higher than those in controls; however, in PE, levels of cord plasma concentrations of most AAs were significantly lower, except for Gly, compared with controls. Levels of most AAs and AC were lower in the control and PE groups, with a tendency for lower levels in maternal blood compared to cord blood. Receiver operating characteristics (ROC) and areas under the curves (AUC) analyses using these metabolites did not predict PE individually.Conclusions: Maternal–fetal levels of AAs and AC were associated with PE. But the use of metabolites did not constitute a reliable method for use as a biomarker in the diagnosis of PE. Further prospective studies are needed to clarify the roles of different metabolites involved in the mechanism underlying the development of PE.

Asymptomatic Uropathogenic Bacteriuria Among Pregnant and Non-pregnant Women at St Luke’s Hospital Anua, Offot Ukwa District Uyo: A Reassessment Case-Control Approach

Asymptomatic bacteriuria is the presence of multiplying bacteria in the absence of any symptoms. The relevance of ASB lies in the insight it provides into symptomatic infections. Physiological and anatomical alterations during pregnancy make women more predisposed to urinary tract infection. This study seeks to determine the prevalence, risk factors, and bacteria profile among pregnant and non-pregnant women. A total of 230 pregnant women and 100 age-matched non-pregnant women were recruited. All pregnant women were recruited from individuals attending antenatal clinic and the controls recruited within the same hospital. Clean catch mid-stream urines ample was collected and microbial analysis done immediately. Significant ASB was identified and antibiotic sensitivity determined by conventional protocols. The overall prevalence of ASB in this study was 29.1% and 15% among pregnant and non-pregnant women respectively. The mean age was 25.3±5.2 and 24.2±5.6years for pregnant and non-pregnant women. Based on their parity among pregnant women, 112 (48.7%), 61(26.5%) and 57 (24.8%) were nulliparous, monoparous and multiparous respectively. Also, 37(16.1%), 70(30.4%) and 123(53.5%) of the pregnant women were in the 1^st, 2^nd and 3^rd trimester. Sixty-seven (29.1%), 125 (54.3%) and 37 (16.1%) pregnant subjects were housewives, self-employed and civil servants in their occupation. Trimester was a risk factor for asymptomatic bacteriuria in the 2nd and 3rd trimester. There was association between age, parity, trimester and ASB. The most common isolate in this study was <i>Escherichia coli</i> (28.4%), followed by <i>Klebsiella pneumonia</i> (23.9%). The <i>Escherichia coli</i> and other uropathogens isolates were multiple drug sensitive between 50-100%. Previous bacteriuria treatment seeking pattern among the pregnant women was 138(60%), 42(18.3%), 32(13.9%) and 1(0.4%) for individuals who had sought treatments in hospitals, patent drug dealers (chemists), multi-centres and traditionally respectively. It is recommended that routine urine culture screening be conducted for all pregnant women at least in the second and third trimesters and positive ASB promptly treated.

Role of oxidative stress after routine Iron supplementation in normal and anemic women during pregnancy: Central Indian scenario

Iron deficiency anemia (IDA) is one of the most common nutritional disorders worldwide, affecting people of all ages in developed and developing countries. causes dimunition of various antioxidant enzymes like superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase. The objective of the study was to detect impact of iron supplementation in anaemic & non- anaemic pregnant subjects on oxidative stress. Patients are divided into two groups, Control groups (60 non-anemic pregnant women) & Study groups (60 anemic pregnant women). The blood sample (5 ml) was collected from different groups of subjects. In controls groups, a fall in catalase, superoxide dismutase, glutathione peroxidase and glutathione reductase were seen while lipid peroxidase was found to have increased significantly after iron therapy. In study group, and increment in all markers except lipid peroxidase was seen and the level of lipid peroxidase was decreased following iron supplementation which was statistically significant (p<0.001). it may be concluded that iron deficiency anaemia is associated with free radical generation and peroxidation of vital body molecules which implies increased risk for pregnant women.

Impact of Maternal Obesity on Perinatal Complications

ntroduction Obesity during pregnancy is one of the important risk factors for development of complications. This study is conducted to assess the association of body mass index with maternal complications in pregnancy. Method This was an observational study conducted retrospectively over a year comprised 300 pregnant subjects in second trimester. Incidence of gestational diabetes mellitus (GDM), pregnancy induced hypertension (PIH), Caesarean section and postoperative wound infection were compared in women with various Body Mass index (BMI). Analysis of the data was done using SPSS version 13 using chi square test and p ≤ 0.05 was considered statistically significant. Results Out of 300 participants, 62(20.7%) subjects developed GDM out of which 88.7% were overweight/obese. 61(20.3%) subjects developed PIH, out of which about 91.8% were overweight/obese. 162 (54%) subjects underwent C-section out of which 67(41.4%) were in overweight/obese category. 82 subjects developed post-operative wound infection in which 41 (50%)cases were in overweight/obese category Conclusion Normal body mass index at the time of incidence of pregnancy and proper antenatal care and careful monitoring of the maternal body weight can minimize the complications to a large extent. Obstetrician-gynaecologists could play a prime position to prevent it.

Prenatal thallium exposure and poor growth in early childhood: A prospective birth cohort study

BackgroundThallium (Tl) exposure remains a public health problem with potential impacts on humans. Studies have suggested that prenatal exposure to thallium may be associated with fetal growth, but no studies are known have explored its association with early childhood anthropometry. ObjectiveTo investigate the effects of prenatal Tl exposures on early child growth and development aged 0–2 years in a prospective birth cohort study. Methods3080 pregnant women and their children participated in the study, which were recruited from a birth cohort in China. Serum samples collected in the first and second trimester of pregnant subjects and umbilical cord blood of infants were analyzed for Tl exposure assessment. Infant length or standing height and weight were obtained from medical records and 2 years planned visits. We used length/height and weight to calculate z-scores for weight-for-age (WAZ), height-for-age (HAZ), weight-for-height (WHZ), and body mass index-for-age (zBMI) based on World Health Organization standards. Linear mixed model was used to investigate the association between serum concentrations of Tl and the children's anthropometric characteristics (WAZ, HAZ, WHZ, and zBMI), and stratification analysis by sex was also examined. ResultsThe median (P25-P75) of Tl levels in the first trimester, second trimester and umbilical cord serum were 61.7 (50.7–77.0), 60.1 (50.9–74.8) and 38.4 (33.6–43.9) ng/L, respectively. Paired Mann-Whitney tests found Tl concentrations in umbilical cord serum were significantly less than that in maternal serum during the first and second trimesters (all p < 0.01). Using adjusted linear mixed model, no significant relationships were observed between maternal Tl exposure and child growth parameters. However, the umbilical cord serum Tl levels may contributed to decreased WAZ (β = −0.382, 95% confidence interval (CI): −0.670, −0.095) and HAZ (β = −0.427, 95% CI: −0.702, −0.152). When stratified by sex, the umbilical cord serum Tl levels were negatively related to WAZ (β = −0.450, 95% CI: −0.853, −0.048) and HAZ (β = −0.775, 95% CI: −1.160, −0.391) for girls. Among boys, overall Tl exposures were not significantly associated with early children anthropometric outcomes. ConclusionsIn the present study, our results suggested that prenatal Tl exposures may have a sex specific effect on child anthropometric measurements in the first 2 years of life. Umbilical cord serum Tl levels tended to be reduced child's stature and weight in young girls.

Epidemiology, lung mechanics and outcomes of ARDS: A comparison between pregnant and non-pregnant subjects

PurposeWe describe the epidemiology, lung mechanics and outcomes of acute respiratory distress syndrome (ARDS) complicating pregnancy. We also compare the outcomes of ARDS in pregnant and non-pregnant females. MethodsRetrospective observational study of all women admitted with ARDS. Results211 women with ARDS were admitted, which included 27 (12.8%) pregnant subjects. All were ventilated with a low tidal volume strategy. Most pregnant females presented during the third trimester. There was no difference in the lung compliance, the applied PEEP and the plateau pressures across trimesters. The pregnant females had a lower median age (25 [22-28] vs. 32 [22–42] years, p = 0.003), higher proportion of severe ARDS (40.8% vs. 10.3%, p < 0.0001), and higher driving pressure (18.2 vs. 15.5 cm H2O, p = 0.03) compared to non-pregnant females. The maternal (18.5%) and perinatal (37%) mortality was high. However, the mortality was not different between pregnant and non-pregnant subjects with ARDS. On a multivariate logistic regression analysis, the baseline APACHE II score, driving pressure and the delta SOFA score were independent predictors of mortality. ConclusionsARDS complicating pregnancy is severe and is associated with high perinatal mortality. However, the outcomes of ARDS in pregnant females were similar to non-pregnant females.

Assessment of uterine artery geometry and hemodynamics in human pregnancy with 4d flow mri and its correlation with doppler ultrasound.

Uterine artery (UtA) hemodynamics might be used to predict risk of hypertensive pregnancy disorders, including preeclampsia and intrauterine growth restriction. To determine the feasibility of 4D flow MRI in pregnant subjects by characterizing UtA anatomy, computing UtA flow, and comparing UtA velocity, and pulsatility and resistivity indices (PI, RI) with transabdominal Doppler ultrasound (US). Prospective cross-sectional study from June 6, 2016, to May 2, 2018. Forty-one singleton pregnant subjects (age [range] = 27.0 ± 5.9 [18-41] years) in their second or third trimester. We additionally scanned three subjects who had prepregnancy diabetes or chronic hypertension. The subjects underwent UtA and placenta MRI using noncontrast angiography and 4D flow at 1.5T. UtA anatomy was described based on 4D flow-derived noncontrast angiography, while UtA flow properties were characterized by net flow, systolic/mean/diastolic velocity, PI and RI through examination of 4D flow data. PI and RI are standard hemodynamic parameters routinely reported on Doppler US. Spearman's rank correlation, Wilcoxon signed rank tests, and Bland-Altman plots were used to preliminarily investigate the relationships between flow parameters, gestational age, and Doppler US. or RESULTS: 4D flow MRI and UtA flow quantification was feasible in all subjects. There was considerable heterogeneity in UtA geometry in each subject between left and right UtAs and between subjects. Mean 4D flow-based parameters were: mean bilateral flow rate = 605.6 ± 220.5 mL/min, PI = 0.72 ± 0.2, and RI = 0.47 ± 0.1. Bilateral flow did not change with gestational age. We found that MRI differed from US in terms of lower PI (mean difference -0.1) and RI (mean difference < -0.1) with Wilcoxon signed rank test P = 0.05 and P = 0.13, respectively. 4D flow MRI is a feasible approach for describing UtA anatomy and flow in pregnant subjects. Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;49:59-68.