Pregnant Subjects Research Articles

Thyroid Hormones Pattern in Preeclampsia.

Objectives: To assess thyroid hormones pattern in preeclampsia in third trimester, in our Pakistani population (Punjab). Methods| It was a Comparative cross- sectional study. Thyroid hormones; namely thyrotropin (TSH), Total triiodothyronine (tT3), free triiodothyronine (fT3), Total thyroxine (tT4) and free thyroxine (fT4) were evaluated by enzyme linked immunoassay (ELISA) in 17 diagnosed preeclamptic subjects with 16 number of matched normotensive pregnant subjects. Data was entered in the form of a questionnaire and analyzed by using version SPSS 17. Results| In this study the mean TSH concentration was 100% higher in preeclamptic subjects as compared to normotensive pregnant subjects, whereas Mean of tT3, tT4, fT3 and fT4were lower when compared between healthy normotensive pregnant and preeclamptic women but no significant difference was seen between both the groups. Conclusion| This study shows statistically non-significant increase in TSH levels and decrease in total and free T3 and T4 levels of PE as compared to the normotensive pregnant subjects.

Quantitative susceptibility mapping in the human fetus to measure blood oxygenation in the superior sagittal sinus.

To present the feasibility of performing quantitative susceptibility mapping (QSM) in the human fetus to evaluate the oxygenation (SvO2) of cerebral venous blood in vivo. Susceptibility weighted imaging (SWI) data were acquired from healthy pregnant subjects (n = 21, median = 31.3 weeks, interquartile range = 8.8 weeks). The susceptibility maps were generated from the SWI-phase images using a modified QSM processing pipeline, optimised for fetal applications. The processing pipeline is as follows: (1) mild high-pass filtering followed by quadratic fitting of the phase images to eliminate background phase variations; (2) manual creation of a fetal brain mask that includes the superior sagittal sinus (SSS); (3) inverse filtering of the resultant masked phase images using a truncated k-space approach with geometric constraint. Further, the magnetic susceptibility, ∆χv and corresponding putative SvO2 of the SSS were quantified from the generated susceptibility maps. Systematic error in the measured SvO2 due to the modified pipeline was also studied through simulations. Simulations showed that the systematic error in SvO2 when using a mask that includes a minimum of 5 voxels around the SSS and five slices remains < 3% for different orientations of the vessel relative to the main magnetic field. The average ∆χv in the SSS quantified across all gestations was 0.42 ± 0.03 ppm. Based on ∆χv, the average putative SvO2 in the SSS across all fetuses was 67% ± 7%, which is in good agreement with published studies. This in vivo study demonstrates the feasibility of using QSM in the human fetal brain to estimate ∆χv and SvO2. • A modified quantitative susceptibility mapping (QSM) processing pipeline is tested and presented for the human fetus. • QSM is feasible in the human fetus for measuring magnetic susceptibility and oxygenation of venous blood in vivo. • Blood magnetic susceptibility values from MR susceptometry and QSM agree with each other in the human fetus.

A14264 Circulating Plasma DNA as Potential Markers for Pregnancy Associated Metabolic Complications

Objectives: To assess circulating plasma DNA (pDNA) as a possible predictive factor for pregnancy associated metabolic complications. Methods: Blood samples were collected from 200 subjects, in the second trimester of pregnancy from Obstetrics and Gynecology Clinic, KGMU, Lucknow, India. pDNA from all samples was quantified spectrophotometrically and in real-time quantitative PCR (qPCR), using β-actin and GAPDH housekeeping gene primers. Statistics was applied using SPSS (ver. 21.0). Results: The qPCR analysis for β-actin and GAPDH at II trimester of pregnancy demonstrated a significant increase (P = 0.001) in concentration of pDNA in pre-eclamptic cases as compared with normal healthy pregnant subjects. Similarly, significant increase (P = 0.003 and 0.002) was observed in gestational diabetes (GDM) cases for β-actin and GAPDH gene primers respectively. Conclusion: Our results confirmed that concentrations of circulating plasma DNA may be used as a possible early predictive marker for pregnancy associated metabolic complications.

262. A pharmacokinetic assessment of aspirin through timed analysis of plasma salicylate acid level: An analysis of difference in gender, dose and preparation of aspirin

Introduction The benefit of aspirin in preventing preeclampsia is well established. Recent data, however, suggest variability in outcomes with its use. Two potential contributing factors are the dose and preparation of aspirin. Objective/hypothesis To determine the: pharmacokinetics of 100 mg coated (Coated100) vs 100 mg non-coated (NonCoated100) vs 150 mg non-coated (NonCoated150) aspirin. Pharmacokinetics of the above in male vs non-pregnant vs gestation-matched pregnant female subjects. Methods Three subjects from each group were given Coated100, NonCoated100 or NonCoated150 aspirin at different times. Blood samples were collected pre-ingestion, 1-h post, 2-h post, 4-h post, 6-h post, 12-h post and 24-h post-ingestion of aspirin. Samples were analysed for plasma salicylate acid (SA) utilising a validated liquid chromatography mass-spectrometry (LCMS) methodology. The differences in the area under the curves (AUC) were analysed using Kruskal-Wallis and Mann-Whitney-U (SPSS). Results The AUCs of Coated100, NonCoated100 and NonCoated150 were different across all three groups of subjects (p Discussion The pharmacokinetics of aspirin between male, non-pregnant and pregnant female differs, with lower AUCs in pregnant females. There is no difference in the dose-matched AUCs between coated and non-coated aspirin but a difference was noted in AUCs between preparation-matched 100 mg and 150 mg of Aspirin. The clinical significance of this in the high-risk pregnant women is yet to be examined, however, potentially supports the need for a higher dose of aspirin in pregnant women.

Screening extremely obese pregnant women for obstructive sleep apnea

Obesity is prevalent among pregnant women in the United States; obstructive sleep apnea is highly comorbid with obesity and is associated with adverse pregnancy outcomes. Screening for obstructive sleep apnea in pregnant women has remained a challenge because of a lack of validated screening tools. The purpose of this study was to evaluate established obstructive sleep apnea screening tools, a sleepiness scale, and individual component items in a cohort of pregnant women with extreme obesity in mid pregnancy with the use of objective testing to determine obstructive sleep apnea status and to describe the prevalence of obstructive sleep apnea among women with extreme obesity. Adult pregnant subjects, between 24 and 35 weeks gestation, with a body mass index ≥40 kg/m2 at the time of enrollment completed obstructive sleep apnea screening tools (Berlin Questionnaire, American Society of Anesthesiologists checklist, and STOP-BANG questionnaire) and the Epworth Sleepiness Scale; they also underwent physical examination of the neck, mouth, and airway. The published obstructive sleep apnea in pregnancy prediction score was calculated for each subject. Obstructive sleep apnea status for each subject was determined by the results of an overnight, unattended type III home sleep apnea test. Twenty-four percent of pregnant women with extreme obesity had obstructive sleep apnea on home sleep apnea testing in mid pregnancy (Apnea-Hypopnea Index, ≥5 events per hour]. Established obstructive sleep apnea screening tools performed very poorly to screen for obstructive sleep apnea in this cohort. Age, body mass index, neck circumference, frequently witnessed apneas, and highly likely to fall asleep while driving were associated most strongly with obstructive sleep apnea status in this cohort. We found that 24% of pregnant women with body mass index ≥40 kg/m2 between 24 and 35 weeks gestation have obstructive sleep apnea, defined as Apnea-Hypopnea Index ≥5 events per hour on an overnight type III home sleep apnea test. We found the Berlin Questionnaire, American Society of Anesthesiologists checklist, STOP-BANG, obstructive sleep apnea in pregnancy score by Facco etal, and the Epworth Sleepiness Scale were not useful screening tools for obstructive sleep apnea in a cohort of obese pregnant women. However, age, body mass index, neck circumference, frequently witnessed apneas, and likely to fall asleep while driving were associated with obstructive sleep apnea in this cohort. Further studies are needed to adjust the criteria and thresholds within the available screening tools to better predict obstructive sleep apnea in pregnant women with obesity.

Prevalence of hepatitis E virus infection among pregnant women in Zhenjiang, China

BackgroundMost hepatitis E virus (HEV) infections are mild or subclinical, however, the infections are characteristically associated with a high incidence of symptomatic presentation among pregnant women. ObjectivesThe aim of this study was to assess the HEV prevalence among pregnant women in Zhenjiang, China. Materials and methods225 and 208 of serum samples collected from pregnant and healthy nonpregnant women, respectively, were used to detect anti-HEV IgG and IgM levels. IgM positive samples were further tested for HEV RNA by using RT-nested PCR (nPCR) method. Positive PCR products were sequenced and subjected to phylogenetic analysis. Results21.8% (49/225) of samples were anti-HEV IgG positive in pregnant women, whereas 7.7% (16/208) of samples were anti-HEV IgG positive in control subjects (P < 0.001). With respect to anti-HEV IgM testing, 3.6% (8/225) and 0.0% (0/208) were positive in pregnant women and control subjects, respectively (P = 0.006 < 0.01). 4 out of 8 IgM positive samples were positive for HEV RNA. Phylogenetic analysis indicated that four HEV strains had distinct nucleotide sequences and clustered into two different sub-genotypes in genotype 4. ConclusionsIn the current study, the prevalence of HEV infection with respect to IgG and IgM levels among pregnant women was significantly higher than that in the healthy nonpregnant group. Additionally, all four HEV strains belonged to genotype 4 implying that genotype 4 is the predominant genotype in the area.

Pregnant versus non-pregnant healthy subjects – a prospective longitudinal musculoskeletal ultrasound study concerning the spectrum of normality

The main objective was to establish the presence, frequency and distribution of articular and peri-articular abnormal findings in healthy women, pregnant and non-pregnant, using clinical examination (CE) and musculoskeletal ultrasound (MSUS). Second objective was to identify which joint/tendon set would show fewer modifications in both groups of healthy subjects and would remain stable throughout pregnancy. A prospective cross-sectional and longitudinal study on healthy pregnant (case group, 5 evaluations - 1st, 2nd, and 3rd trimester of pregnancy and 2 postpartum visits) and non-pregnant female volunteers (control group, one evaluation), consisting in CE vs MSUS joint and tendon evaluation, was conducted. MSUS elementary lesions such as synovial hypertrophy, effusion, Power Doppler (PD) signal, erosions and osteophytes were quantified. The case group (20 pregnant women) and 75 age- matched controls were evaluated on 46 joints and 24 tendon units. The highest frequency of grey scale pathologic-like imaging abnormalities was detected at metatarsophalangeal joints and wrist level in both groups. No pathologic-like abnormalities throughout pregnancy and postpartum were detected on flexor tendons (F1-F5), metacarpophalangeal joints (MCPj), extensor carpi ulnaris tendon (EUC) and large joints (glenohumeral, elbow, tibiotalar). Very low frequency of PD signal, erosions and osteophytes was identified in both groups. The highest longitudinal change was detected in the effusion on joint and tendon level only. MSUS inflammation-like abnormalities can be detected in healthy subjects and pregnancy may modify baseline findings. The identification of a joint/tendon set with less abnormalities (hand flexor tendons F1-F5, MCPj 2-5 and EUC) in healthy subjects would help in selecting target structures, important for identifying the disease onset and for further monitoring.

Term pregnant patients have similar gastric volume to non-pregnant females: a single-centre cohort study

BackgroundThe physiological changes of pregnancy can increase the risk of peri-partum pulmonary aspiration. There is limited objective information regarding gastric volumes in pregnant patients. The aim of this cohort study was to characterise prospectively the range of gastric-fluid volume in term non-labouring pregnant patients compared with a historical cohort of non-pregnant females. MethodsFasted non-labouring term pregnant patients scheduled for elective Caesarean delivery underwent a standardised gastric ultrasound examination. Gastric content was evaluated qualitatively (type of content), semi-quantitatively (Perlas grades), and quantitatively (volume). The antral cross-sectional area and volume were compared with those of a retrospective cohort of non-pregnant females from the same institution. Descriptive statistics were used to describe the central tendency through mean and median values. Dispersion was evaluated with standard deviation and inter-quartile range, and the higher end of the distribution as 95th percentile. ResultsNon-labouring pregnant (59) and non-pregnant (81) subjects were studied. The range of estimated total gastric-fluid volume (P=0.96) and volume per body weight (P=0.78) was not significantly different between cohorts. An estimated volume of 115 ml (102–143) vs 136 ml (106–149) and volume per body weight of 1.4 ml kg−1 (1.2–2.8) vs 2.0 ml kg−1 (1.5–2.7) corresponded to the 95th percentile (95% confidence interval) values in the pregnant and non-pregnant cohort, respectively. ConclusionsBaseline gastric volume of non-labouring pregnant patients at term is not significantly different from that of non-pregnant females. This information will be helpful to interpreting findings of gastric point-of-care ultrasound in obstetric patients.

Antibody to Marinobufagenin Reverses Placenta-Induced Fibrosis of Umbilical Arteries in Preeclampsia.

Background: Previous studies implicated cardiotonic steroids, including Na/K-ATPase inhibitor marinobufagenin (MBG), in the pathogenesis of preeclampsia (PE). Immunoneutralization of heightened MBG by Digibind, a digoxin antibody, reduces blood pressure (BP) in patients with PE, and anti-MBG monoclonal antibody lessens BP in a rat model of PE. Recently, we demonstrated that MBG induces fibrosis in cardiovascular tissues via a mechanism involving inhibition of Fli-1, a nuclear transcription factor and a negative regulator of collagen-1 synthesis. Objectives and Methods: We hypothesized that in PE, elevated placental MBG levels are associated with development of fibrosis in umbilical arteries. Eleven patients with PE (mean BP 124 ± 4 mmHg; age 29 ± 2 years; 39 weeks gest. age) and 10 gestational age-matched normal pregnant subjects (mean BP 92 ± 2 mmHg; controls) were enrolled in the clinical study. Results: PE was associated with a higher placental (0.04 ± 0.01 vs. 0.49 ± 0.11 pmol/g; p < 0.01) and plasma MBG (0.5 ± 0.1 vs. 1.6 ± 0.5 nmol/L; p < 0.01), lower Na/K-ATPase activity in erythrocytes (2.7 ± 0.2 vs. 1.5 ± 0.2 µmol Pi/mL/hr; p < 0.01), 9-fold decrease of Fli-1 level and 2.5-fold increase of collagen-1 in placentae (p < 0.01) vs. control. Incubation of umbilical arteries from control patients with 1 nmol/L MBG was associated with four-fold decrease in Fli-1 level and two-fold increase in collagen-1 level vs. those incubated with placebo (p < 0.01), i.e., physiological concentration of MBG mimicked effect of PE in vitro. Collagen-1 abundance in umbilical arteries from PE patients was 4-fold higher than in control arteries, and this PE-associated fibrosis was reversed by monoclonal anti-MBG antibody ex vivo. Conclusion: These results demonstrate that elevated placental MBG level is implicated in the development of fibrosis of the placenta and umbilical arteries in PE.

Abstract 565: Coxsackievirus Infection During the First Trimester of Pregnancy Suppresses Cardiomyocyte Proliferation Leading to Congenital Heart Defects

Purpose: Coxsackievirus B (CVB), known to be the most common cause of myocarditis, target cardiomyocytes through Coxsackie and Adenovirus Receptor, which is highly expressed in the fetal heart. We hypothesized that CVB infection during early pregnancy may play a role in the pathogenesis of congenital heart disease (CHD). Methods: Pregnant C57Bl/6J mice were infected with varying doses of CVB3 (Nancy strain), 1x10 6 , 2.5x10 6 , and 5x10 6 TCID50, between embryonic days (E) 5-11. Presence of the virus was confirmed by RT-PCR and infectivity assay. Fetal heart phenotype was assessed by histology. RNA collected from fetal hearts using laser microdissection was analyzed by RNA-Seq to understand changes at the molecular level after infection. Results were confirmed by immunohistochemistry and qPCR. To determine if virus serotype alters the outcome, CVB1, CVB4, and a combination of CVB3 and CVB4 were used for infection. To assess the clinical significance serum from pregnant human subjects, grouped based on outcome of pregnancy (healthy baby vs babies with CHD), was checked for the presence of CVB serotypes. Results: Fetuses developed spectrum of CHD (38.2%, n=78/204): ventricular septal defect, double outlet right ventricle, and non-compaction of ventricular myocardium after CVB3 infection. Approximately one third of the fetuses were resorbed (38.7%, n=129/333). Infection at E9 led to the highest incidence of VSD with female fetuses being more susceptible to the phenotype. Transcripts found to be differentially expressed in hearts with VSDs were mediators of the Transforming growth factor β and Extracellular matrix signaling pathways. Consistent with the former, expression levels of BMP2 and Smad1/5/9 mRNA were elevated in fetal hearts with VSDs. This correlated with suppressed proliferation of cardiomyocytes in these mice. In pregnant human subjects who had babies with CHD elevated titers of antibodies against CVB3, CVB4, and CVB3+CVB4 were seen. In mice, infection with CVB1, CVB4, or CVB3+4 showed that CVB3 in combination with CVB4 induces more VSDs than infection with any one serotype. Conclusion: There is a critical window during pregnancy where CVB infection leads to abnormal cardiac development likely through reduction of cardiomyocyte proliferation.

Vitamin D Deficiency Is Associated With Poor Ovarian Stimulation Outcome in PCOS but Not Unexplained Infertility.

The impact of vitamin D deficiency on the success of ovarian stimulation according to underlying infertility diagnosis has not been investigated. To evaluate the relationship between vitamin D deficiency and reproductive outcomes after ovarian stimulation in women with either polycystic ovary syndrome (PCOS) or unexplained infertility. Retrospective cohort study. Analysis of randomized controlled trial (RCT) data. Participants from the Pregnancy in Polycystic Ovary Syndrome II (PPCOS II) RCT (n = 607); participants from the Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS) RCT of unexplained infertility (n = 647). Serum 25(OH)D levels measured in banked sera. Primary: live birth; secondary: ovulation (PPCOS II), pregnancy, and early pregnancy loss. In PPCOS II, subjects with vitamin D deficiency [25(OH)D < 20 ng/mL or 50 nmol/L] were less likely to ovulate (adjusted OR, 0.82; 95% CI, 0.68 to 0.99; P = 0.04) and experienced a 40% lower chance of live birth (adjusted OR, 0.63; 95% CI, 0.41 to 0.98; P = 0.04) than those not deficient. In AMIGOS, no significant association between vitamin D deficiency and live birth was noted. In pregnant subjects from both studies, vitamin D deficiency was associated with elevated risk of early pregnancy loss (OR, 1.6; 95% CI, 1.0 to 2.6; P = 0.05). In this investigation of women pursuing ovarian stimulation, the association between vitamin D deficiency and diminished live birth relied on carrying the diagnosis of PCOS and was not observed in unexplained infertility. Given the generally modest success of ovarian stimulation, addressing vitamin D deficiency may prove an important treatment adjunct for many infertile women.

Effect of posture on pulmonary function in the third trimester of pregnancy of primigravid, nulliparous and multiparous women in Benin City

BACKGROUND: the advancing gravid uterus poses a limited lying down posture options in the third trimester. The supine position has been documented to have deleterious cardiovascular effect. This study is aimed at measuring pulmonary function of pregnant women in the third trimester of pregnancy with some lying down positions viz a viz parity.MATERIALS AND METHOD: It was a cross sectional study carried out at St Philomena's Catholic Hospital. A total of 150 third trimester pregnant subjects in 5 groups of parities with 30 in each group and in different lying down were studied. Spirometric measurements of forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were performed in sitting position which served as the control, and the test positions were supine, left lateral and right lateral.RESULT: FVC and FEV1 values of all subjects in all positions studied were significantly lower than the sitting position. However, the FVC and FEV1 of subjects in the lateral positions were significantly higher (p &lt; 0.05) than the supine position across parities. There was no significant difference (p &gt; 0.05) between the left lateral position and the right lateral positions. Furthermore there was an increase in FVC and FEV1 of subjects as the parity increases across all lying down position.CONCLUSION: Supine position in the third trimester of pregnancy has a negative effect on pulmonary function and should be discouraged; parity however has a cumulative positive effect on pulmonary function across the postures studied.

Expression of urotensin II is\xa0associated with placental autophagy in patients with severe preeclampsia

The aims of this study are to explore the correlation between the expressions of urotensin II (UII) and autophagic markers (LC3 and P62) in patients with severe preeclampsia (SPE). A total of 64 pregnant subjects were recruited, including 29 healthy pregnancies and 35 preeclamptic patients (7 mild preeclamptic (MPE) patients and 28 SPE patients). UII and autophagic markers expression in placenta specimens was investigated by immunohistochemistry (IHC), RT-qPCR, and western blot. IHC analysis manifested that the expressions of UII and autophagic markers were mainly located in the placental cytotrophoblast and syncytiotrophoblast. Western blot and IHC analysis both indicated that the expression of UII was significantly correlated with autophagic marker LC3II (by western blot) or LC3 (by IHC) (r = 0.495, P = 0.010; r = 0.816, P = 0.007). Moreover, SPE group had higher expression of UII and LC3II, lower expression of P62 than that of normal controls. The expression of LC3II was positively related with systolic blood pressure (SBP) and urinary protein level (SBP (r = 0.501, P = 0.003) and urine protein quantitation (r = 0.509, P = 0.022)), whereas P62 had negative correlation with SBP. We first verify that UII has positive correlation with autophagic marker LC3 in placentas of preeclampsia patients; besides, autophagic levels are positively correlated with SBP and urine protein in patients with SPE.

Should We Perform an OGTT in All Latino Pregnant Women? The Negative Predictive Value of a Fasting Blood Glucose

Background: Latino women are considered a high-risk group, prone to develop GDM. Currently, according to the ADA Standard of Care Recommendations, these subjects should undergo screening with an OGTT, which is a time and resource consuming procedure. A better selection of the individual would favor a cost-effective diagnostic approach. Our hypothesis is that we could find a fasting blood glucose threshold able to predict a normal OGTT response. Methods: We analyzed the results of 363 one-step, 75-g OGTT performed in our clinic during 2017. Patients with a previously known glucose tolerance abnormality were excluded from the study. Results: The fasting glucose value was diagnostic of GDM in 83/363 cases. After selecting only those cases with fasting value lower than 92 mg/dL, 22 additional subjects were diagnosed with GDM. The one-hour post-load value criteria was met in 16/280 (5.71%) whilst the 2 hour value diagnosed 6 additional subjects (2.86%). Two patients had both one and two hour positive criteria. The area under the curve was 0.75, for fasting blood glucose as a predictor of an abnormal glucose response. Conclusions: In our population from a Mexican University Hospital, the fasting blood glucose detected fourfold the cases of GDM vs. the OGTT. It might be cost effective to perform a fasting glucose prior to prescribe an OGTT in pregnant subjects. Disclosure L.G. Mancillas-Adame: None. C.D. Gonzalez: None. J.A. Villarreal: None. D. Saldivar-Rodriguez: None. F.J. Lavalle-Gonzalez: None. R. Rodriguez-Gutierrez: None. J.G. Gonzalez-Gonzalez: None.

Medical complications of puerperium: a single center observational study

Background: Puerperium is of 6 weeks after delivery, when body reverts back to its original non pregnant state. This period holds its own set of medical issues with frequent occurrence of gynaecological complaints like hematoma, bleeding, painful discharge and many medical issues like pyrexia, mastalgia, coagulation disorders and depression. The management of all these problems is further complicated by consideration of lactation which prohibits use of many drugs. There are many studies available in international communities that analysed women in puerperium but the data from Indian subpopulation where most deliveries are conducted in government funded institutes is lacking. The current study was an observational single center study carried out at gynaecology department along with medicine and surgery department of a tertiary care hospital associated with a medical teaching institute for defining the epidemiological parameters of the puerperal maladies.Methods: 150 randomly selected pregnant subjects with otherwise uncomplicated pregnancies, both booked at our institute or referred at the time of delivery between January to July 2016 were included in the study. Both normal vaginal or assisted deliveries were considered irrespective of booking status. Patient not willing for consent, and patients reporting beyond 2 weeks of delivery were excluded. All patients were observed while in hospital and weekly thereafter till 6th week and detailed gynaecological, medical and psychiatric evaluation was carried out by a multidisciplinary team. Detailed evaluation of cause was carried out in all cases of pyrexia, pain or other objective symptoms and analysis of depression was done. All data were collected and analysed by spss 22.0 at the end of 6 weeks.Results: Of the 150 patients studied, 40% had caesarean delivery while 60% had normal vaginal delivery with or without episiotomy. The most common complications noted during puerperium were wound discharge (10.67%), perineal pain (10%), fever (15%) and Mastalgia &amp; Mastitis (13%). Depression was diagnosed in 6% of the studied cases. Cause of fever was mastitis/breast abscess in 30%, Urinary tract infection in 24%, Malaria in 7% and puerperal sepsis in 12% cases, in rest of the cases the cause of fever could not be found. The puerperal complication rate was more in LSCS 22.95% as compared with vaginal deliveries 14.6%.Conclusions: Puerperium remains an important aspect of pregnancy where the nature of complications differs totally from those seen during antenatal period. Our study suggests that most important complications in puerperium are purulent discharge, perineal pain and pyrexia. Depression is a frequent occurrence in post-partum period and its early identification can benefit both maternal and child health. Fever in puerperium is fairly common Perineal infection, Breast infection, Urinary tract infection and Malaria being common causes. A vigilant multidisciplinary approach is required to optimally manage all these complications.

Neck circumference may be a valuable tool for screening individuals with obesity: findings from a young Chinese population and a meta-analysis

BackgroundCentral obesity and overweight/obesity can result in various chronic non-communicable diseases, such as cardiovascular disease, metabolic syndrome, and diabetes mellitus. Waist circumference (WC) and body mass index (BMI) are widely used to measure obesity despite their limitations. For example, WC and BMI cannot be measured in pregnant women and subjects with abdominal ascites or masses. Therefore, this study aims to determine the efficacy of neck circumference (NC) as a tool for screening central obesity and overweight/obesity.MethodsA total of 1169 undergraduates aged 18–25 years were studied by a cross-sectional survey in China, 2016. Questionnaires and physical examinations were used to collect data. Receiver operator characteristic (ROC) curve was performed to determine the best threshold of NC for screening central obesity and overweight/obesity. Meanwhile, a meta-analysis was conducted to estimate the efficacy of NC for screening central obesity and overweight/obesity synthetically.ResultsNC was moderately correlated with WC and BMI. The ROC analysis showed that 37.1 cm for male and 32.6 cm for female were the best thresholds for central obesity, and 37.4 cm and 32.2 cm for overweight/obesity, respectively. The sensitivity, specificity, area under receiver operating curve (AUC) of central obesity and overweight/obesity were higher. In the meta-analysis, the pooled sensitivity, specificity, AUC and their 95%CI of NC for screening central obesity were 0.72 (0.68~ 0.75), 0.87 (0.74~ 0.94), 0.77 (0.73~ 0.80) for male and 0.73 (0.65~ 0.80), 0.80 (0.71~ 0.86), 0.82 (0.79~ 0.86) for female. For overweight/obesity, the pooled sensitivity, specificity, AUC and corresponding 95%CI were 0.83 (0.70~ 0.91), 0.77 (0.66~ 0.85), 0.86 (0.83~ 0.89) for male and 0.82 (0.71~ 0.90), 0.84 (0.61~ 0.95), 0.89 (0.86~ 0.92) for female.ConclusionNC may not be a good tool for screening individuals with central obesity. But it may be a simple and valuable tool for screening individuals with overweight/obesity, especially in females.

Colostrum and mature breast milk analysis of serum irisin and sterol regulatory element-binding proteins-1c in gestational diabetes mellitus

Background: We aimed to evaluate irisin and SREBP-1c levels in serum, colostrum and mature breast milk in women with and without gestational diabetes (GDM); and to relate them with maternal glucose, lipid profile and weight status of babies.Methods: GDM positive women (n = 33) and normal glucose tolerant women (NGT) (n = 33) were recruited. Maternal blood samples were collected at 28th week of gestation and later at 6-week post-partum while breast milk samples of the lactating mothers were collected within 72 hours of birth (colostrum) and at 6 weeks post-partum (mature milk). Irisin and SREBP-1c levels were analyzed by commercially available ELISA kits for all maternal samples.Results: Lower levels of irisin were seen in serum, colostrum and mature breast milk of GDM females (p < .01). SREBP-1c profile showed a similar trend of low serum levels in GDM, however, they were undetectable in colostrum and mature breast milk. Weak to moderate correlations of serum irisin with BMI (r = 0.439; p < .001), GTT 0 hours (r = 0.403; p = .01), HbA1c (r = −0.312; p = .011), Fasting blood glucose (r = 0.992; p = .008), and baby weight at birth (r = 0.486; p < .001). Colostrum and mature breast milk irisin showed positive associations with baby weight at 6 weeks (r = 0.325; p = .017; r = 0.296; p = .022, respectively). Serum SREBP-1c at 6 weeks correlated with random blood glucose (r = 0.318; p = .009), and HbA1c (r= −0.292; p = .011). All correlations were lost once we adjusted for maternal BMI.Conclusions: Low irisin and SREBP1-c levels may favor development of GDM in pregnant subjects. Further, low mature breast milk levels may act as a continued stressor from fetal to infant life as long as breast-feeding is continued. Further studies are required to identify the mechanistic relationship between these biomarkers and GDM.

Changes in Spexin Levels are influenced by the Presence or Absence of Gestational Diabetes in Pregnant Subjects

ObjectiveThe study aimed to determine whether circulating spexin (SPX) is modified during the course of pregnancy and whether it is affected by the presence of glucose intolerance.MethodsThis prospective follow up study involved 47 pregnant women (26 non‐GDM and 21 GDM; mean age 31.0 ± 5.4 years; mean BMI 28.2 ± 5.8 kg/m2). Anthropometrics, glycemic and lipid profile as well adipocytokines and spexin were measured at baseline and after 3 and 6 months.ResultsIn GDM patients, SPX levels increased significantly after 6‐months, along with the significant increase in glucose during the same time (p=0.04). In non‐GDM patients, median SPX level decreased significantly from baseline to 6‐months (p&lt;0.01) but no such significant change in glucose was observed. Change in glucose from baseline to 6‐months was significantly and positively associated with change in SPX in GDM patients only (R= 0.45; p&lt;0.05).ConclusionsChanges in SPX levels seem to be influenced by the presence of glucose intolerance (GDM) among pregnant women, with decreasing levels among those without GDM, and increasing among those with GDM.Support or Funding InformationThe study was funded by Prince Mutaib Chair for Biomarkers of Osteoporosis (PMCO), Deanship of Research Chairs in King Saud University, Riyadh, Saudi ArabiaThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Relation of locus 1p13 rs646776 polymorphism with the risk of preeclampsia

ABSTRACTObjective: This study aimed to assess the relation of locus 1p13 rs646776 (T/C) polymorphism with preeclampsia in Egyptian women. Methods: The study included 100 healthy pregnant female subjects and 100 preeclampsia patients. The genotypes of the polymorphisms were assessed. Endothelin-1 level was determined in plasma. Results: The major T allele of the 1p13.3 genomic region rs646776 polymorphism had a higher frequency in preeclampsia patients. Carriers of C allele had significantly lower endothelin-1 levels, lower systolic and diastolic blood pressure, decreased proteinuria, and increased HDL-C in the patients. Conclusion: The rare C allele of rs646776 polymorphism in chromosomal locus 1p13.3 is associated with decreased risk of preeclampsia.

Assessing Exposome Effects on Pregnancy through Urine Metabolomics of a Portuguese (Estarreja) Cohort.

This nuclear magnetic resonance metabolomics study compared the influence of two different central Portugal exposomes, one of which comprised an important source of pollutants (the Estarreja Chemical Complex, ECC), on the urinary metabolic trajectory of a cohort of healthy pregnant women (total n = 107). An exposome-independent description of pregnancy metabolism was found to comprise a set of 18 metabolites reflecting expected changes in branched-chain amino acid catabolism and hormone and lipid metabolisms. In addition, a set of small changes in some metabolites was suggested to be exposome-dependent and characteristic of pregnant subjects from the Estarreja region. These results suggested that the Estarreja exposome may impact to a very low extent pregnancy metabolism, inducing slight changes in amino acid metabolism (alanine, glycine, and 3-hydroxyisobutyrate, possibly involved in valine metabolism), tricarboxylic acid (TCA) cycle (cis-aconitate), diet, or gut microflora (furoylglycine) as well as allantoin, 2-hydroxyisobutyrate, and an unassigned resonance at δ 8.45. Furthermore, the urine of Estarreja subjects was found to generally contain higher levels of 4-hydroxyphenylacetate and lower levels of citrate. However, out of the above metabolites, only glycine and citrate seemed to correlate with the proximity to the ECC, with slightly relative higher levels of these compounds found for subjects living closer to the ECC. This suggested possible small effects of local pollutants on energy metabolism, with the remaining exposome-dependent metabolite changes most probably originating from other aspects of the local exposome such as diet and lifestyle. Despite the limitation of this study regarding the unavailability of objective environmental parameters for the period under study, our results confirm the usefulness of metabolomics of human urine to gauge exposome effects on human health and, particularly, during pregnancy.