Pregnant Subjects Research Articles

74 Central cortisol regulation in pregnancy

Pregnancy is characterized by changes in the regulation of the maternal hypothalamic-pituitary-adrenal (HPA) axis. Even though it is known that aberrations in this pathway could have implications for mood disorders during pregnancy, the effects of cortisol on the maternal brain in healthy women are poorly understood. Therefore, we aimed to enhance our understanding of central adaptations in cortisol metabolism in healthy pregnant women at term gestation. Plasma and CSF cortisol and cortisone were prospectively collected in 24 women at term gestation prior to scheduled cesarean section and in 24 regularly cycling non-pregnant controls matched for age and BMI. Subjects were healthy, with no history of smoking, alcoholism, psychiatric or neurological disorders. Cortisol and cortisone (inactivated form) were assayed by ELISA. Data were analyzed by two-tailed Student t test. Plasma cortisol levels were 54% higher (248.5±15.9 vs 161.7±10.7 ng/ml, p<0.001) and plasma cortisone levels were 88% higher (110.9±7.7 vs 59.1± 6.1 ng/ml, p <0.001) in pregnant vs non-pregnant women, as expected. In CSF, cortisol (7.7 ± 0.5 vs 6.1 ± 0.3 ng/mL, p = 0.01) and cortisone (8.2 ± 0.9 vs 2.7 ± 0.2 ng/mL, p < 0.001) were also significantly higher in pregnant vs non-pregnant subjects. However, interestingly, in pregnant subjects the relative increase in CSF cortisol was only ½ that observed in plasma, while the relative increase in CSF cortisone was 2.3 times greater than in plasma. Accordingly, the CSF cortisol/cortisone ratio was significantly lower in pregnancy (1.30 ± 0.3 vs 2.4 ± 0.2, p = 0.003), due to the increased concentration of the inactive metabolite cortisone. To our knowledge, this is the first study to measure CSF cortisol and cortisone concentrations in pregnancy. These data demonstrate a pregnancy-specific shift in central cortisol metabolism that favors cortisone. This adaptation may protect the maternal brain from high cortisol levels, and aberrations in this pathway could have implications for mood disorders during pregnancy and post-partum.

150 Management of diabetes in pregnancy during the COVID-19 pandemic at a New York City hospital

To compare diabetic control and maternal and neonatal outcomes in pregnant women during the Coronavirus 2019 (COVID-19) pandemic to women managed one year prior. This was a retrospective cohort study of pregnant women with diabetes managed either during the COVID-19 pandemic or one year earlier. Twenty-two gestational and pregestational diabetic subjects were identified in a city hospital clinic during the peak of the pandemic in New York City (NYC) from March 15, 2020 until May 31, 2020. Fifty-seven pregnant diabetic subjects were identified who were managed at this clinic during the same timeframe in 2019. Demographics and maternal and neonatal outcomes were collected and compared. Diabetic control was compared by measuring change in hemoglobin A1c and diabetic medication regimen at time of delivery. Outcomes documented included mode of delivery, gestational age at delivery, postpartum hemorrhage, maternal infection, birth weight, shoulder dystocia, APGAR score <7, fetal acidosis, NICU admission, neonatal glucose level and neonatal demise. Secondary outcomes included number of virtual or in person visits, COVID-19 status, and gestational age at time of the diabetes diagnosis. Patients managed during the COVID-19 pandemic had significantly more telehealth visits and fewer in person visits compared to the year prior (p<0.001). However, no significant differences in maternal or neonatal outcomes or diabetic control were noted. There was no significant change in mode of delivery (p>0.999), shoulder dystocia (p=0.075), macrosomia (p>0.999), APGARs (p=0.671) or change in hemoglobin A1c during pregnancy (p=0.342). There were no significant differences in maternal or neonatal outcomes or diabetic control for subjects managed during the COVID-19 pandemic in a NYC hospital. A decreased number of in person visits, substituted with telehealth visits, had no apparent negative effect on outcomes or diabetic control.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

78 Preeclampsia Diminishes Pregnancy-augmented Myometrial H2S Biosynthesis and Myometrial Artery Cystathionine ß-Synthase Expression in Women

An inadequate rise in uterine blood flow in pregnancy can lead to preeclampsia. Endogenous hydrogen sulfide (H2S) is a potent vasodilator that is synthesized from L-cysteine by cystathionine-β synthase (CBS) and cystathionine-γ lyase (CSE). Enhanced H2S production by selective upregulation of CBS, but not CSE, has been recognized as a uterine artery vasodilator in pregnancy. This study using human myometrial biopsies tests a hypothesis that preeclampsia diminishes pregnancy-augmented uterine artery H2S biosynthesis. Human myometrial biopsies were collected from normal pregnant, severe preeclamptic women, and hysterectomies of nonpregnant women (n = 3-5/group) with IRB approval and written consent. Levels of CBS and CSE mRNAs were assessed by qRT-PCR and their proteins were assessed by immunoblotting and immunofluorescence microscopy. H2S production was determined by methylene blue assay with or without specific inhibitors of CBS (CHH, 1 mM) and CSE (BCA, 1 mM). Myometrial CBS mRNA and protein were greater (p < 0.01) in normal pregnant (P) compared to nonpregnant women (NP). Pregnancy did not change myometrial CSE mRNA and protein. Myometrial H2S production was greater (p<0.05) in P vs. NP women, which was blocked by incubation with CHH or its combination with BCA, but not BCA alone. Compared to normal pregnant subjects, preeclampsia reduced myometrial CBS mRNA, protein, and H2S production to levels comparable to that of nonpregnant women. Immunofluorescence microscopy identified CBS and CSE protein localization in the myocytes, endothelium, and smooth muscle of myometrial arteries. Quantitation of the immunoreactive CBS and CSE signals showed greater CBS, but not CSE protein in P vs. NP myocytes and myometrial artery endothelium and smooth muscle, while preeclampsia reduced CBS protein levels to that in nonpregnant controls, without changing CSE protein in these cells. Pregnancy augments myometrial myocyte and myometrial artery endothelial and smooth muscle CBS expression. CBS expression and H2S production are significantly downregulated in severe preeclampsia.

Sero-epidemiological assessment of toxoplasmosis among antenatal attendees of university of Port Harcourt teaching hospital, rivers state, Nigeria

Toxoplasmosis is a disease that can infect pregnant mothers and women of child bearing age and is transmitted to the unborn baby. The sero-prevalence of toxoplasmosis with its associated risk factors in two hundred and seventy-seven pregnant subjects attending University of Port Harcourt Teaching Hospital was investigated to ascertain the current sero-prevalence status of toxoplasmosis in River State. Blood samples were collected from the subjects through a veno-puncture and the blood tests were performed using the rapid test kits for Toxoplasma gondii IgG and IgM antibodies following manufactures instructions. Commercial pregnancy test kits and HIV test kits were used to confirm their pregnancy and HIV status. Out of the 277 pregnant subjects examined, the overall prevalence was 1.8% (5/277) positive for T. gondii IgG antibody and 6.9% (19/277) positive for HIV. None of the HIV pregnant subjects were positive for toxoplasmosis. All data were presented in frequency and percentages. The chi-square analysis was used to assess the distribution of toxoplasmosis and other variables. All the analysis was done with the Statistical Package for Social Sciences (SPSS) version 25 and a p-value of less than 0.05 was considered significant. The age group of 20 -29 years and 30-39 years had the highest sero- prevalence rates of 3(60%) and 2(40%) respectively for IgG while age group 40-49 years recorded no sero-prevalence. Exposure related sero-prevalence showed that eating of raw vegetables, undercooked meat, and exposure to contaminated soil through farming were more sensitive risk factors associated with toxoplasmosis than others. There was no statistical significance using cat as pets at P&gt;0.05. A Statistical significance difference of toxoplasmosis was higher among the subjects that ate raw vegetables and drank contaminated water (P&lt;0.05) compared to those who ate cooked vegetables and drank treated water. The need for health campaign to enlighten the society and pregnant mothers on the dangers of acquiring toxoplasmosis and how to avoid it is advocated.

Spontaneous Abortion in Pregnancies Having COVID-19 Infection in Bangladesh: A Series of Cases

Background: Coronavirus Disease (COVID-19) is a highly contagious disease and spreading all over the world. Pregnant women are particularly vulnerable to this infectious disease. There are not many reports on missed-abortion or stillbirths in COVID-19 that affected pregnant women. Twelve cases are presented here among a few cases of spontaneous abortion or fetal demise without having remarkable cause other than laboratory-confirmed COVID-19 (RT-PCR) from March 2020 to July 2020 in a single medical university hospital in Bangladesh.Cases: Enrolled 12 pregnant subjects of fetal demise ≥11 weeks of gestation had COVID-19 infection (RT-PCR) and the specimen was nasal swab. 10 patients were admitted to the hospital and 2 patients were managed in their home under the supervision of Bangabandhu Sheikh Mujib Medical University (BSMMU). We excluded all the possible causes of clinical and obstetric causes of abortion other than COVID-19 infection. However, most of them were asymptomatic COVID-19 infection carriers, and only had a history of low-grade fever. 5 cases had a history of medical disorder which were controlled before pregnancy. Conclusion: All the 12 cases did not have any clinical and obstetric disorder during pregnancy, but they all had COVID-19 infection. This clearly suggests COVID-19 infection might induce fetal death through possible inflammation in the placenta.

Plasma level of brain-derived neurotrophic factor (BDNF) in patients with postpartum depression

Postpartum depression occurs in 10–15% of mothers. Brain-derived neurotrophic factor (BDNF) is a nerve growth factor that plays a role in neuroplasticity. We hypothesized that the concentration of BDNF is related to reproduction and childbirth, and that women with postpartum depression show alteration in BDNF level. A total of 104 pregnant women was selected as subjects, and 60 non-pregnant women were selected as normal controls. Symptoms of depression were evaluated in the pregnant study subjects using the diagnostic criteria outlined in the Edinburgh Postnatal Depression Scale (EPDS). The pregnant subjects were divided into three groups of perinatal non-depressed controls (n = 61), postpartum depression-recovery (n = 18), and postpartum depression (n = 25). The plasma concentration of BDNF was higher in the pregnant group than in non-pregnant controls and lower in the postpartum depression group at 6 weeks after delivery than in the perinatal non-depressed group. In the postpartum depression-recovery group, the BDNF concentration increased at 6 weeks after delivery compared to that at 24 weeks of gestation. This study found significant changes in plasma BDNF concentration in depressed pregnant women.

Relationship of Circulating Copper Level with Gestational Diabetes Mellitus: a Meta-Analysis and Systemic Review.

Gestational diabetes mellitus (GDM) represents the frequently occurring medical disorder beginning in the process of pregnancy. No consensus has been reached about the relationship of circulating copper content with the risk of GDM. Therefore, the present work carried out a meta-analysis for summarizing epidemiological research regarding the copper level with the GDM risk. Furthermore, studies using categories of copper concentration as exposure were combined by dose-response meta-analysis. Related studies were retrieved against the PubMed, Web of Science, and Scopus databases from inception till August 2020. The overall effects were expressed as standard mean difference (SMD). A dose-response meta-analysis was conducted to assess whether the higher copper concentration was associated with higher risks of GDM. Stata 16.0 and Review Manager 5.3 were utilized for data analysis. A total of fourteen articles involving were retrieved for meta-analysis; in the meantime, 2670 pregnant subjects including 910 GDM cases were enrolled for quantitative analysis. Based on the integrated findings, GDM cases showed increased circulating copper contents relative to those in normal pregnant subjects (SMD = 0.65, 95% CI 0.19 to 1.11; P = 0.005). There was no obvious evidence of publication bias among the studies enrolled. Subgroup analysis showed that such trend was consistent in the third trimester (SMD = 1.21, 95% CI 0.35 to 2.08; P = 0.006) but not second trimester. Meanwhile, circulating copper concentration was significantly higher in women with GDM than those without GDM within the Asian population but not within the Caucasian population (Asia: SMD = 0.73; 95% CI 0.12 to 1.34, P = 0.02; Europe: SMD = 0.49; 95% CI: - 0.23 to 1.20, P = 0.18). Further, serum copper analysis together with subgroup analysis was conducted, and the same result was obtained. For dose-response analysis, the linear associations between circulating copper and risks of GDM were revealed, that higher circulating copper concentration during pregnancy is closely associated with GDM. According to existing evidence, the serum copper concentration increased among GDM cases compared with subjects with normality in glucose tolerance pregnant subject, in particular among the Asians and during the third trimester. The finding from dose-response analysis suggested that increased copper level is associated with an increased risk of GDM. Nonetheless, more specially designed prospective articles should be carried out for understanding the dynamic relationship of copper concentration with the GDM risk.

Sero-Epidemiological Assessment of Toxoplasmosis Among Antenatal Attendees of University of Port Harcourt Teaching Hospital, Rivers State, Nigeria

Toxoplasmosis is a disease that can infect pregnant mothers, women of child bearing age and it can be transmitted to the unborn baby. The sero-prevalence of toxoplasmosis with its associated risk factors in two hundred and seventy-seven pregnant attending University of Port Harcourt Teaching Hospital was investigated to ascertain the current status of toxoplasmosis in River State. Blood samples were collected from the subjects through a veno-puncture and the blood tests were performed using the rapid test kits for Toxoplasma gondii IgG and IgM antibodies following manufactures instructions. Commercial pregnancy test kits and HIV test kits were used to confirm their pregnancy and HIV status. Out of the 277 pregnant subjects examined, the overall prevalence was 5(1.8%) for T. gondii IgG antibody and 14(6.9%) positive for HIV. None of the HIV pregnant subjects were positive for toxoplasmosis. All data were presented in frequency and percentages. The chi-square analysis was used to assess the distribution of toxoplasmosis and other variables. All the analysis was done with the Statistical Package for Social Sciences (SPSS) version 25 and a p-value of less than 0.05 was considered significant. The age group of 20 -29 years and 30-39 years had the highest sero- prevalence rates of 3(60%) and 2(40%) respectively for IgG while age group 40-49 years recorded no sero-prevalence. Exposure related sero-prevalence showed that eating of raw vegetables, undercooked meat, and exposure to contaminated soil through farming were more sensitive risk factors associated with toxoplasmosis than others. There was no statistical significance using cat as pets at P>0.05. A Statistical significance difference of toxoplasmosis was higher among the subjects that ate raw vegetables and drank contaminated water (P<0.05) compared to those who ate cooked vegetables and drank treated water. The need for health campaign to enlighten the society and pregnant mothers on the dangers of acquiring toxoplasmosis and how to avoid it is advocated. Funding Statement: This study was self funded by the authors. Declaration of Interests: The authors declare that there are no conflicts of interest. Ethics Approval Statement: Ethical approval was obtained from University of Port Harcourt Teaching Hospital (UPTH) Ethical Committee. After the approval, the proposal was further presented to the Department of Obstetrics and Gynecology (O&G), thereafter, informed and written consents were obtained from the volunteers after due consultation.

Asymptomatic Bacteriuria (ASB) in diabetic patients: Treat or not to treat: A prospective, observational study conducted at a tertiary care hospital.

Background:The term asymptomatic bacteriuria (ASB) refers to the isolation of bacteria in a urine specimen of individuals who denied symptoms of urinary tract infection. Diabetes mellitus (DM) is a disease involving multiple organ systems, hallmarked for its chronicity and thus-forth endless complications including asymptomatic bacteriuria.Objectives:This study aimed to determine the characteristics of asymptomatic bacteriuria and antibiotic susceptibility pattern amongst patients with diabetes.Settings and Design:A prospective observational study was conducted at a tertiary care hospital in Karachi, Pakistan.Methods and Material:The study included all those patients with a diagnosis of diabetes with no signs and symptoms of urinary tract infection but showing the growth of an organism in urine culture. Pregnant females and subjects who used antibiotics in last two weeks were excluded. A total of 222 urine cultures were observed prospectively who met the inclusion criteria through non-probability consecutive sampling.Results:Out of 222 urine cultures observed, mean age of subjects were 62.89 ± 13.77 out of which 76% were females, and 61% had a family history of diabetes. The most frequent organisms isolated were Escherichia. Coli (E. Coli), Enterococcus, Klebsiella, Pseudomonas, and Enterobacter species. A total of 20 subjects got dual bacterial growth in their cultures among which 17 subjects had a growth of Enterococcus with any other pathogen causing UTI. Gender, family history of diabetes, levels of HBA1c, and older age groups all were found significantly associated with ASB.Conclusions:Our study is the first to analyze and study the associated risk factors amongst ASB in DM patients, and to identify the pathogens involved along with assessing their antibiotic resistance profiles. Also, due to the increase resistance to antibiotics we would recommend to use antibiotics in ASB patients only if they have any two or more comorbidities.

Comparison of Salivary Alpha-Amylase, Sialic Acid, and pH in Pregnant and Nonpregnant Subjects

AbstractObjectives During pregnancy, systemic physiological alterations lead to some changes in the oral cavity, which could prepare the mouth environment for oral and dental problems. This study was aimed to investigate salivary α-amylase, sialic acid levels, and pH levels in pregnant and nonpregnant females.Materials and Methods In this analytical, case–control study, unstimulated saliva samples were collected with spiting method from 35 pregnant women (case group) and 35 nonpregnant women (control group) and transferred to the laboratory to assess salivary α-amylase, sialic acid, and pH levels. Data were analyzed by SPSS (version: 19) software through statistical methods of independent t-test and analysis of variance.Results The mean sialic acid levels were 2.285 ± 1.230 mg/dL in pregnant and 2.744 ± 1.326 in nonpregnant women without any significant difference (p = 0.138). The mean salivary α-amylase concentrations were 2.461 ± 1.869 U/L and 2.439 ± 2.058 U/L, respectively, in pregnant and nonpregnant women, with no significant difference (p = 0.963).The mean salivary pH in nonpregnant women was significantly more than that in pregnant women (7.845 ± 0.430 and 6.868 ± 0.413, respectively) (p &lt; 0.001). Also, the mean salivary pH levels in pregnant women were 7.474 ± 0.420 in the first trimester, 6.868 ± 0.413 in the second trimester, and 6.568 ± 0.387 in the third trimester, which were significantly different (p &lt; 0.001).Conclusion Salivary sialic acid and α-amylase levels among pregnant women were no different from those of other subjects. During pregnancy, the salivary pH significantly reduced, and the mean salivary pH during pregnancy had a decreasing trend from the first trimester to the third trimester.

The Variants in &lt;i&gt;ADIPOQ&lt;/i&gt; Are Associated with Maternal Circulating Adipokine Profile in Gestational Diabetes Mellitus

Background: Gestational diabetes mellitus (GDM) is the most common association with hyperglycemia and glucose intolerance during pregnancy. The role of adipokines plays importantly to control insulin secretion and glucose. This study aimed to investigate the association between maternal circulating adipokine levels and ADIPOQ gene polymorphism among pregnant women subjects with gestational diabetes mellitus (GDM) and normal glucose tolerance (NGT). Methods: Participants including 229 normal pregnant women and 197 GDM pregnant women were enrolled from 2015 to 2018 at Siriraj hospital. Serum adipokine levels including adiponectin, adipsin/factor D, NGAL/Lipocalin-2, total PAI-1, and resistin were measured by immunoassay. ADIPOQ variations (-11377C/G, +45T/G and +276G/T) were investigated. Results: Serum adiponectin concentration was also significantly decreased among the GDM who had age less than 35 years old whereas adipsin levels were significantly lower among the GDM who had aged more than 35 years old. Also, adiponectin, and total PAI-1 levels were significantly lower among the GDM who had a BMI of less than 30 kg/m2. Variants of ADIPOQ +45T/G were significantly associated with disease status (p=0.03). The -11377C/G was affected by the level of adiponectin (p=0.04). The C allele of -11377C/G SNP was declined serum adiponectin levels and may be a risk factor for GDM. Conclusion: This study revealed that genetic play important roles in circulating adipokines among pregnant women. ADIPOQ polymorphisms had significant associations with adiponectin levels in GDM patients. Funding Information: This research project was supported by Siriraj Research Grant for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University to WT (grant no. R015934014) and TN. Declaration of Interests: The authors declare no conflict of interest. Ethics Approval Statement: This cross-sectional study was approved by the Faculty of Medicine Siriraj hospital ethics review board, Mahidol University, Thailand (Si 577/2015). The written informed consent was obtained from all subjects.

Role of USG in assessment of umbilical cord thickness

Background: For many years, evaluation of umbilical cord morphology was restricted to the post-partum period and was performed by pathologists who demonstrated that a thin umbilical cord was associated with adverse pregnancy outcome. Hence; the present study was undertaken for assessing the role of USG in assessment of umbilical cord thickness. Materials and methods: A total of 100 pregnancy subjects were included in the present study that was schedule to undergo USG. Ethical approval was obtained before the starting of the study. Written consent was obtained from all the patients after explaining in detail the entire research protocol. Only those patients were included in the present study that had gestational age of more than 20 weeks at the time of USG. Umbilical cord thickness, cross-sectional area, and coiling index were measured in a free-floating loop of umbilical cord using the software in the USG unit. The newborns were considered as low birth weight (LBW) when the birth weight was below 2500 g. All the results were recorded in Microsoft excel sheet and were analysed by SPSS software. Results: Mean gestational age of the patients was 37.9 weeks. Mean birth weight was 3569.1 grams. 20 patients were found to be with low birth weight. Mean umbilical cord thickness was 1.59 while mean umbilical cord area was 108. Mean coiling index was found to be 0.52. Conclusion: In uterine examination of pregnant subjects, ultrasonography is a useful tool. However; further studies are recommended.

A Comparative Study on Prevalence of Anaemia among Rural &amp; Urban Pregnant Women in a Selected Hospital of Kashmir with a View to Prepare Information Module on Prevention of Anaemia

Anaemia in pregnancy exists worldwide. In Jammu and Kashmir 58.7% of women are anemic compared to national average of 51.8%. 17.6% suffer from moderate anaemia compared to national average of 14.8%. The present study was aimed to compare the prevalence of anaemia among rural (50) and urban (50) pregnant subjects using descriptive comparative survey design. Purposive sampling technique was used for data collection. The study found mild anaemia (98%) among rural and (100%) among urban subjects. Moderate anaemia was found (2%) only among rural subjects. Both urban and rural pregnant subjects had significant association of nutritional status with socioeconomic status.

Expression of urotensin II is positively correlated with pyroptosis-related molecules in patients with severe preeclampsia

ABSTRACT Purpose: We studied the expression of urotensin II (UII) and its relationships with markers of pyroptosis in preeclampsia. Methods: 48 pregnant subjects were recruited consisting of 28 severe preeclampsia pregnancies (SPE) and 20 healthy pregnancies. We detected expressions of UII and markers of pyroptosis such as NLR-family pyrin domain (PYD)-containing 3 (NLRP-3), caspase-1/4/5, interleukin-1β (IL-1β), and gasdermin D (GSDMD) in placentas of patients with SPE and healthy pregnancies. Results: SPE group have higher expression of UII and NLRP-3, caspase-1, interleukin-1β (IL-1β), and GSDMD than that normal controls by IHC, real-time PCR, and western blot. IHC analysis manifests that the expressions of UII and pyroptosis-related molecules are mainly located in the placental cytotrophoblasts. Expressions of UII mRNA and protein are significantly positively correlated with pyroptosis marker such as NLRP3, caspase-1, GSDMD mRNA and protein by Pearson correlation analysis. Moreover, UII, NLRP-3, caspase-1, interleukin-1β (IL-1β), and GSDMD are positively related with systolic blood pressure, meanwhile caspase-1 and GSDMD are positively correlated with urine protein in SPE patients. We firstly verify that UII has a positive correlation with pyroptosis markers in placentas of preeclampsia patients; besides, pyroptosis-related proteins are positively correlated with systolic blood pressure and urine protein in patients with severe preeclampsia.

Study of iodine nutrition level in pregnant south Indian subjects in third trimester

Objective: Aim of the present study is to analyse the nutritional status of iodine among pregnant women by measuring urinary excretion and do the correlation with thyroid hormone and auto antibodies. Materials and Methods: one hundred pregnant women with third trimester gestation and one hundred age-matched non-pregnant were included in study. Results: Urinary Iodine excretion and serum TSH, fT4, fT3, AMA and ATG were estimated were estimated for case and control groups. The mean urinary iodine excretion concentration (UIC) in pregnant women was 290.17±91.71 µg/L. Excess urinary iodine excretion was found in 69%. There were elevated serum AMA levels in 36 pregnant women and that positive correlated with excess iodine. Conclusion: The pregnant women had no iodine deficiency, rather had high urinary iodine concentrations indicating more than adequate iodine intake. The excess urinary iodine level may tiger the thyroid auto antibody. Keywords: Urinary iodine excretion (UIE), thyroid stimulating hormone (TSH), free thyroxine (fT4), free tri-iodothyronine (fT3), anti-microsomal antibody (AMA), anti-thyroglobulin antibody (ATA), pregnancy, iodine excess.

Study of iodine nutrition level in pregnant south Indian subjects in third trimester

Objective: Aim of the present study is to analyse the nutritional status of iodine among pregnant women by measuring urinary excretion and do the correlation with thyroid hormone and auto antibodies Materials and Methods:one hundred pregnant women with third trimester gestation and one hundred age-matched non-pregnant were included in study. Results:Urinary Iodine excretion and serum TSH, fT4, fT3, AMA and ATG were estimated were estimated for case and control groups. The mean urinary iodine excretion concentration (UIC) in pregnant women was 290.17±91.71 µg/L. Excess urinary iodine excretion was found in 69%. There were elevated serum AMA levels in 36 pregnant women and that positive correlated with excess iodine. Conclusion:The pregnant women had no iodine deficiency, rather had high urinary iodine concentrations indicating more than adequate iodine intake. The excess urinary iodine level may tiger the thyroid auto antibody. Keywords: Urinary iodine excretion (UIE), Thyroid stimulating hormone (TSH), Free thyroxine (fT4), Free tri-iodothyronine (fT3), Anti-microsomal antibody (AMA), Anti-thyroglobulin antibody (ATA), pregnancy, Iodine excess

Attitudes about marijuana use, potential risks, and legalization: a single-center survey of pregnant women

Objective There is an association between recreational marijuana use in pregnancy and legalization. As more states legalize marijuana, its use in pregnancy may increase. The objective of this study was to evaluate pregnant women’s knowledge and opinions about marijuana use, potential risks, and legalization. Methods A cross-sectional survey of pregnant women at a regional perinatal center in New Jersey was performed from January-December 2019. Pregnant subjects were invited to complete a voluntary, anonymous 23-question survey about marijuana use in pregnancy, potential risks, and legalization. Subjects were excluded if they could not read in English or Spanish. Survey questions were based on a 5-point Likert scale (1 = strongly agree, 2 = agree, 3 = neutral, 4 = disagree, and 5 = strongly disagree). Likelihood of agreeing or disagreeing with potential risks, with neutral responses as the reference, were estimated based on the relative risk (RR) (95% confidence interval [CI]). Associations were examined with prior tobacco/marijuana use and education level. Results During the study period, approximately 1133 consecutive patients were approached and 843 completed the study (74.4% response rate). The majority of participants were English-speaking, college educated, and employed. 204 (25.2%) reported prior marijuana use and 36 (4.5%) reported marijuana use during pregnancy. Overall, pregnant women had poor knowledge about potential risks of marijuana use in pregnancy. Although 234 (29.0%) patients were opposed to legalization, more than 90% of pregnant subjects indicated that they would be more likely to use marijuana in pregnancy if it were legalized. Associations of marijuana risks by prior tobacco use showed that nonsmokers had more awareness about risks. Nonsmokers had higher likelihood of agreeing that marijuana use may be harmful to a pregnancy (RR 1.41, 95% CI 1.12–1.76), may hurt the growth of a baby (RR 1.36, 95% CI 1.07–1.74), may cause preterm birth (RR 1.18, 95% CI 1.00–1.40), and may hurt a child’s ability to learn (RR 1.20, 95% CI 0.95–1.51). Similar trends were observed for subjects who reported no prior marijuana use and for subjects with more than high school education. Conclusions The majority of surveyed pregnant women demonstrated poor knowledge about the possible risks of marijuana in pregnancy and indicated that they would be more likely to use marijuana in pregnancy if it were legalized. As the use of marijuana increases, providers should focus on educating their patients about potential risks associated with marijuana use in pregnancy while additional research is needed to clarify associated risks.

Prenatal Nondiscrimination Laws: Disability, Social Conservatism, and the Political Economy of Genetic Screening

This article analyzes recent state laws and legislative debates in the United States concerning the prohibition of abortions performed because of a diagnosis of fetal disability. The article brings together critical theories to analyze the legislative records—including floor debates and committee hearings—in the four states that enacted disability PRENDAs before 2019. This analysis shows how social conservatives use disability PRENDAs to present themselves as the protector of the oppressed, while advancing their views about family and gender. Furthermore, I argue that PRENDAs place the burden for structural economic and political concerns on the shoulders of individuals, especially pregnant persons, while largely ignoring the medical-industrial complex as well as the government's own poor funding of social services for people with disabilities. Critical attention thus needs to be paid to how factors such as the ascendancy of genetics, the privatization of medicine, and the state's facilitation of capital accumulation for biotechnology corporations help constitute the ideal self-regulating risk-averse pregnant neoliberal subject. To bring attention to these factors, the article examines the political economy of non-invasive prenatal tests (NIPTs).

Characterization of gut microbiota associated with clinical parameters in intrahepatic cholestasis of pregnancy

BackgroundIntrahepatic cholestasis of pregnancy (ICP) is a liver disorder that specifically occurs in pregnancy. Elevated levels of liver transaminases aspartate aminotransferase, alanine aminotransferase and serum bilirubin levels are common biochemical characteristics in ICP. The disorder is associated with an increased risk of premature delivery and stillbirth. The characterization of the potential microbiota in ICP could go a long way in the prevention and treatment of this pregnancy disease.MethodsA total of 58 patients were recruited for our study: 27 ICP patients and 31 healthy pregnant subjects with no ICP. The V3 and V4 regions of the 16S rDNA collected from fecal samples of both diseased and control groups were amplified. 16S rRNA gene amplicon sequencing was then performed on gut microbiota. Sequencing data were analyzed and the correlation between components of microbiota and patient ICP status was found. Related metabolic pathways, relative abundance and significantly different operational taxonomic units (OTUs) between ICP and controls were also identified.ResultsElevated levels of total bile acid, ALT, AST, Dbil and Tbil were recorded or observed in ICP subjects as compared to the control. Gut microbiota in pregnant women was dominated by four major phyla and 27 core genera. PCoA analysis results indicated that there was no significant clustering in Bray–Curtis distance matrices. Our results showed that there was a correlation between specific OTUs and measured clinical parameters of pregnant women. Comparison at the different taxonomy levels revealed high levels of abundance of Blautia and Citrobacter in ICP patients. At the family level, Enterobacteriaceae and Leuconostocaceae were higher in ICP patients. 638 KEGG Orthologs and 138 pathways significantly differed in the two groups. PLS-DA model with VIP plots indicated a total of eight genera and seven species were key taxa in ICP and control groups.ConclusionsOur research indicated that although there was no significant clustering by PCoA analysis, patients with ICP have increased rare bacteria at different phylogenetic levels. Our results also illustrated that all 638 KEGG Orthologs and 136 in 138 KEGG pathways were less abundant in ICP patients compared to the controls.

A study of serum growth differentiation factor 15 in Indian women with and without gestational diabetes mellitus in the third trimester of pregnancy and its association with pro-inflammatory markers and glucose metabolism

The pathogenesis of gestational diabetes mellitus (GDM) is multifactorial and it shares many features with type 2 diabetes mellitus. Growth differentiation factor 15 (GDF-15), a member of transforming growth factor-β superfamily, is expressed in a high amount in the placenta in addition to other organs. This cross-sectional study was performed to assess the difference of GDF-15 and pro-inflammatory cytokines between pregnant women with or without GDM, and to explore the possible association of GDF-15 with the parameters of dysglycemia (Serum insulin, HOMA-IR, fasting, 60min, and 120min post-75 gm oral glucose plasma glucose levels) and inflammation (IL-6 and TNF-α) in women with GDM at 24-28weeks of gestation. Thirty-five women with GDM and 30 age-matched non-diabetic pregnant control (NDPC) subjects were recruited for the study. Mean serum GDF-15, IL-6, and TNF-α levels were significantly higher in GDM in comparison to the NDPC population. These differences persisted even after adjusting for the possible confounders like maternal age and BMI. GDF-15 level showed a positive correlation with parameters of dysglycemia (Serum insulin, HOMA-IR, fasting, 60min, and 120min post-75 gm oral glucose plasma glucose levels) but a variable correlation with the markers of inflammation. In conclusion, our study provides evidence that, in Indian women, serum GDF-15 level is higher in GDM in comparison to age-matched pregnant subjects without GDM in the early third trimester pregnancy. Moreover, in third trimester, GDF-15 level increases with increase in plasma glucose and insulin resistance.