Prolonged Gestation Research Articles

Impact of fetal growth restriction on pregnancy outcome in women undergoing expectant management for preterm pre-eclampsia.

To assess whether coexisting fetal growth restriction (FGR) influences pregnancy latency among women with preterm pre-eclampsia undergoing expectant management. Secondary outcomes assessed were indication for delivery, mode of delivery and rate of serious adverse maternal and perinatal outcomes. We conducted a secondary analysis of the Pre-eclampsia Intervention (PIE) and the Pre-eclampsia Intervention 2 (PI2) trial data. These randomized controlled trials evaluated whether esomeprazole and metformin could prolong gestation of women diagnosed with pre-eclampsia between 26 and 32 weeks of gestation undergoing expectant management. Delivery indications were deteriorating maternal or fetal status, or reaching 34 weeks' gestation. FGR (defined by Delphi consensus) at the time of pre-eclampsia diagnosis was examined as a predictor of outcome. Only placebo data from PI2 were included, as the trial showed that metformin use was associated with prolonged gestation. All outcome data were collected prospectively from diagnosis of pre-eclampsia to 6 weeks after the expected due date. Of the 202 women included, 92 (45.5%) had FGR at the time of pre-eclampsia diagnosis. Median pregnancy latency was 6.8 days in the FGR group and 15.3 days in the control group (difference 8.5 days; adjusted 0.49-fold change (95% CI, 0.33-0.74); P < 0.001). FGR pregnancies were less likely to reach 34 weeks' gestation (12.0% vs 30.9%; adjusted relative risk (aRR), 0.44 (95% CI, 0.23-0.83)) and more likely to be delivered for suspected fetal compromise (64.1% vs 36.4%; aRR, 1.84 (95% CI, 1.36-2.47)). More women with FGR underwent a prelabor emergency Cesarean section (66.3% vs 43.6%; aRR, 1.56 (95% CI, 1.20-2.03)) and were less likely to have a successful induction of labor (4.3% vs 14.5%; aRR, 0.32 (95% CI, 0.10-1.00)), compared to those without FGR. The rate of maternal complications did not differ significantly between the two groups. FGR was associated with a higher rate of infant death (14.1% vs 4.5%; aRR, 3.26 (95% CI, 1.08-9.81)) and need for intubation and mechanical ventilation (15.2% vs 5.5%; aRR, 2.97 (95% CI, 1.11-7.90)). FGR is commonly present in women with early preterm pre-eclampsia and outcome is poorer. FGR is associated with shorter pregnancy latency, more emergency Cesarean deliveries, fewer successful inductions and increased rates of neonatal morbidity and mortality. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Gestation outcomes in various options of help for pregnant women with Rh-immunization

BACKGROUND: To date, several options for helping pregnant women with rhesus immunization are known: (a) active tactics in carrying out methods of efferent therapy in the form of basic operations (plasmapheresis, hemosorption) in combination with adjuvant methods (immunoglobulin, blood photomodification with ultraviolet, laser beams, ozone therapy) to pregnant women; (b) wait-and-see active tactics with observation of the pregnant woman, followed by intrauterine intravascular transfusions of washed donor red blood cells; (c) mixed active tactics with a sequential combination, alternation of these methods. In Russia, only option 2 with fetal transfusions of washed donor red blood cells is accepted as the basis and paid for. The objective of the study is to conduct a comparative analysis of pregnancy outcomes in women with rhesus immunization using different management options.&#x0D; MATERIALS AND METHODS: A total of 392 women were followed up at seven different institutions in Russia and at the Donetsk Center for Maternal and Child Health (DNR), of whom 345 pregnant women (Group 1) received efferent therapy, 33 women (Group 2) had fetuses intrauterine bypass surgery, and 14 pregnant women (Group 3) had mixed efferent therapy and fetal PEEP bypass surgery.&#x0D; RESULTS: The analysis showed that the most favorable results for the main clinical indicators (premature, operative delivery, fetal hypoxia at birth, etc.) were in Group 1 and 3 women, in which the perinatal mortality was 14.5/1000 and 0/1000, respectively, which was significantly lower than in Group 2 (176.5/1000). It was also found that in Groups 2 and 3 women, the mean intervals between repeated transfusions of washed donor red blood cells were 8.8 0.2 and 21.4 3.8 days (p 0.01), which may be explained by the detoxifying effect of efferent therapy methods, preservation of fetal red blood cells and transfused donor red blood cells to the fetus with prolonged gestation and obtaining healthier and more viable progeny.&#x0D; CONCLUSIONS: 1. Severe Rh conflict is a manifestation of a syndrome of systemic effects of aggressive metabolites of specific and nonspecific nature. 2. The etiopathogenetic measure in the prevention and treatment of HDF/HDN in rhesus conflict is efferent therapy methods for the mother, and transfusion of washed donor rhesus-negative red blood cells to the fetus is effective, but a temporary, palliative measure, as is the case in multiple organ failure. 3. In the treatment protocols, efferent therapy methods must be present to prevent fetal red cell destruction and, equally importantly, to prevent destruction of Rh-negative donor red cells transfused to the fetus.

Studi LCPUFA dan variant genetik enzim Fatty Acid Desaturase pada masa kehamilan di Asia masih langka

Enourmos body of literatures reported that inadequacy of LCPUFAS (long chain polyunsaturated fatty acids) during pregnancy is associated with premature birth and newborn low birth weight. LCPUFAs may modified pregnancy outcome by modulating blood fatty acid, lipid profile and apo-lipoprotein. Current study reviewed literatures that investigate the association between maternal LCPUFAS and genetic variant of FADS (fatty acid desaturares), which act on endogenous synthesis of omega 3 precursors, and birth outcome in Asian countries particularly Indonesia. Using accessed PUBMED and Google Scholar database during January 2015 to December 2022 with a query of LCPUFAs, FADS, pregnancy and birth outcome, there were nine peer-reviewed literatures in English and two local literatures. Current finding confirmed the scarcity of literatures that associating LCPUFAS, FADS during pregnancy and birth outcome in Asian countries particularly in Indonesia. The finding also highlighted the role of LCPUFAS in prolonged gestation and desirable birth outcome. Genetic variant of FADS was indicated to modify the association of maternal LCPUFAs and birth ouctome. The scarcity of literaturs encourages other researcher to conduct further investigatation on this topic

Hydroxychloroquine improves pregnancy outcomes of women with positive antinuclear antibody spectrum test results.

Empirical use of Hydroxychloroquine (HCQ) in patients with positive antinuclear antibody spectrum (ANAs) test result is controversial regarding its impact on improving perinatal outcomes. This study aimed to investigate the effect of HCQ on adverse pregnancy outcomes associated with placental dysfunction in ANAs-positive patients. The study included pregnant women with positive ANAs test result from 2016 to 2020 in our center, and divided into a weakly positive and a positive group in just ANA positive patients among them. Univariate and multivariate analyses were conducted to determine the effect of HCQ on pregnancy outcomes in each subgroup. Stratified and interactive analyses were performed to assess the value of HCQ in improving pregnancy outcomes. (i) A total of 261 cases were included, accounting for 30.60% of pregnancy complicated with autoimmune abnormalities, and 65.12% of them used HCQ during pregnancy. (ii) The application of HCQ significantly reduced the incidence of early-onset preeclampsia (1.18% vs. 12.09%, p = 0.040) and small-for-gestational-age infants (10.06% vs. 25.84%, p = 0.003) in the ANAs-positive population, increased birth weight (3075.87 ± 603.91 g vs. 2847.53 ± 773.73 g, p = 0.025), and prolonged gestation (38.43 ± 2.31 vs. 36.34 ± 5.45 weeks, p < 0.001). (iii) A total of 185 just ANA-positive patients were stratified according to titers. Among them, the rate of HCQ usage was significantly higher than that in the weakly positive group (81.03% vs. 58.27%, p = 0.003). (vi) Stratified univariate analysis showed that HCQ usage in the ANA-positive group could reduce the incidence of preeclampsia (2.13% vs. 27.27%, p = 0.019) and prolong gestation (38.29 ± 2.54 vs. 34.48 ± 7.68 weeks, p = 0.006). In the ANA-weakly positive group, HCQ significantly reduced the incidence of preeclampsia (6.76% vs. 28.30%, p = 0.002), early-onset preeclampsia (1.35% vs. 13.21%, p = 0.027), and small-for-gestational-age infants (7.89% vs. 35.19%, p < 0.001). Multivariate regression analysis showed that HCQ significantly reduced the incidence of preeclampsia in both groups. Intergroup interaction analysis showed no significant difference in the value of HCQ in reducing the incidence of preeclampsia between the two groups. ANAs positivity is an important abnormal autoimmunity type in pregnancy. HCQ can be considered as a choice for improving adverse pregnancy outcomes related to placental dysfunction, such as preeclampsia, in this population.

Azithromycin treatment for short cervix with or without amniotic fluid sludge: A matched cohort study.

Preterm birth (PTB) is one of the leading causes of neonatal mortality and morbidity worldwide. A shortened cervix is a recognised risk factor for PTB, and amniotic fluid sludge (AFS) diagnosed on ultrasound may be suggestive of underlying inflammation or infection. The aim is to determine if azithromycin, administered in cases of a shortened cervix, results in prolongation of gestation with improvements in neonatal outcomes. We performed a retrospective cohort study at three tertiary maternity services in Melbourne, Australia, between 2015 and 2020. Women with a singleton pregnancy were included if they had a cervical length of 15 mm or less at 13-24 weeks' gestation, with or without AFS. Exclusion criteria comprised multiple pregnancy, major fetal congenital anomaly, placenta praevia, prelabour premature rupture of membranes, vaginal bleeding and/or clinical signs suggestive of chorioamnionitis at the time of diagnosis of the short cervix. The results of antibiotic treatment with azithromycin were compared to those of no antibiotic treatment. The outcomes of interest were PTB, prelabour premature rupture of membranes (PPROM), chorioamnionitis and neonatal morbidity. A total of 374 women were included in the study, of whom 129 received azithromycin and 245 received no antibiotics. When adjusting for potential confounders, the adjusted risk of PTB overall was higher in the treatment group (adjusted hazard ratio 1.36 (95% confidence interval 1.04-1.77) P= 0.023) with no differences found for PPROM, chorioamnionitis or neonatal morbidity. These data do not support the routine use of azithromycin in women with a short cervix, including those with AFS detected on ultrasound.

Nicotine ameliorates inflammatory mediators in RU486 induced preterm labor model through activating cholinergic anti-inflammatory pathway.

Preterm birth is a global public health threat. Inflammatory reaction is thought to mediate preterm birth. The role of nicotine, an anti-inflammatory agent that is mediated by cholinergic anti-inflammatory pathways (CAP), remains unclear in the pathogenesis. Pregnant rats were randomly divided into four groups (20 rats each): pregnant control group (P), RU486-treated group (PTL), RU486 and nicotine-treated group (PTL+N), RU486, nicotine and α-BGT treated group (PTL+N+A). Rats were administered RU486 (1.0mg/kg) by subcutaneous injection on gestational day (GD) 18 to establish PTL model. Subcutaneous injection of nicotine (1mg/kg) was administered daily from GD 16 to 18. α-BGT (1µg/kg) was administrated subcutaneously in two sessions and each session was 30min prior to nicotine. TNF-α, IL-1β, IL-4, IL-6, IL-10 in myometrium and serum were detected by Luminex. Macrophage infiltration and α7nAChR were detected by IHC. We established a RU486-induced preterm labor rat model. Preterm labor was associated with a striking upregulation inflammatory mediators and increased macrophage infiltration. Nicotine significantly prolonged gestation (P&lt;0.05) and α-BGT treatment reversed the prolonged interval (P&lt;0.05). The cytokines all markedly elevated at 12h, but deceased after delivery (P&lt;0.05). The IL-1β and TNF-α in serum were significantly increased in PTL group vs P group (P&lt;0.05), and decreased after nicotine treatment (P&lt;0.05). The cytokines IL-1β, IL-4, IL-6, IL-10 and TNF-α in myometrium increased as the same trend as in serum. Nicotine treatment also downregulated the expression of α7nAChR in pregnant tissue. We confirmed the increased inflammation in preterm birth. Nicotine was able to down-regulate the inflammatory mediates and prolong the pregnant duration in PTL model, which might be induced by activating α7nAChR through CAP. This study provides a novel evidence supporting the future development of therapeutic target for preterm birth.

Analysis of Clinical Differences Between Preterm Delivery and Full-Term Delivery among Pregnant Women with Gestational Diabetes Mellitus

Objective: To investigate the clinical characteristics of preterm delivery and full-term delivery in pregnant women with gestational diabetes mellitus (GDM). Methods: Women who were diagnosed with GDM by 75 g glucose tolerance test (OGTT) between 24 and 28 weeks of gestation were selected as the subjects of the study. According to the delivery time, they were divided into full-term group (n = 61) and preterm group (n = 42). Results: There was no statistical difference in the puerpera between preterm group and full-term group (P &gt; 0.05). The incidence of hyperhydramnios and oligohydramnios in the term group was 16.19% and 2.38%, respectively. The number of hyperhydramnios and oligohydramnios in the full-term group was lower than that in the preterm group, and the difference was statistically significant (P &lt; 0.05). Conclusion: Prolonged gestation period can effectively reduce the incidence of polyhydramnios and oligohydramnios, and prevent premature delivery, improve the quality of blood glucose management in diabetic patients, avoid hypoglycemia and other complications, and reduce the threat to the life of pregnant women and the fetus.

ВЛИЯНИЕ ПРОЛОНГАЦИИ НЕДОНОШЕННОЙ БЕРЕМЕННОСТИ, ОСЛОЖНЕННОЙ ПРЕЖДЕВРЕМЕННЫМ РАЗРЫВОМ ПЛОДНЫХ МЕМБРАН, НА ФУНКЦИОНАЛЬНОЕ СОСТОЯНИЕ ФЕТОПЛАЦЕНТАРНОГО КОМПЛЕКСА

At present, in obstetric hospitals of the Russian Federation, in accordance with a number of guidance documents, in preterm pregnancy complicated by premature rupture of the membranes, expectant management is recommended, i.e. prolongation of gestation, the main purpose of which is to achieve a more morphofunctionally mature fetus. However, this tactic is associated with a high risk of developing a systemic inflammatory response and critical conditions in the mother and fetus, requiring emergency delivery. At the same time, it is of scientific interest to assess dynamic changes in the mother-placenta-fetus system in the process of pregnancy prolongation. Establishing patterns of changes in the functional state of the fetus may allow you to determine the optimal timing of the completion of gestation and reduce the percentage of urgent situations. For this purpose, on the basis of the “Perinatal Center of the Saratov Region”, an assessment was made of the functional state of the fetoplacental complex in 147 patients whose premature pregnancy was complicated by premature rupture of the membranes, with prolongation of gestation in the periods: admission to the hospital, on days 5-7 of prolongation and the moment of completion of gestation . The indicators of cardiotocography, dopplerometry (resistance indices of the uterine arteries, umbilical artery, fetal middle cerebral artery), placental thickness and amniotic fluid index were assessed. The comparison group consisted of 140 patients with a physiological pregnancy with similar gestation periods, in whom similar studies were performed. It was established that this pathology of gestation develops against the background of feto-placental insufficiency, as evidenced by a decrease in fetal rhythm variability, a decrease in the thickness of the placenta compared to the control group. In the process of pregnancy prolongation, the most significant indicators for assessing the functional state of the fetus were cardiotocography data, resistance indices of the uterine and umbilical arteries, and the amniotic fluid index.

Impact of prolonged use of adjuvant tocolytics after cervical cerclage on late abortion and premature delivery

We evaluated the impact of cervical cerclage combined with one or more uterine contraction inhibitors in persistent inhibition of uterine contraction for the treatment of late abortion and premature delivery. This retrospective case series study analysed the medical data of 58 patients who underwent cervical cerclage for cervical insufficiency and simultaneously received one or more uterine contraction inhibitors (indomethacin, ritodrine, and atosiban) and magnesium sulphate at the Zibo Maternal and Child Health Hospital between January 2019 and December 2020. Patients are normal pregnancy who received cervical cerclage without complications. The rate of successful treatment was 74.14% (43/58). The prolonged gestation duration was 16.42 ± 7.84 weeks, and the average delivery gestational age was 35.91 ± 5.16 weeks. The longest duration of treatment with a uterine contraction inhibitor or inhibitors in combination or with magnesium sulphate alone was 15.34 ± 13.16 days, and nine cases developed adverse reactions. Persistent uterine contraction inhibition after cervical cerclage could prolong pregnancy and improve pregnancy outcomes. Impact statement What is already known on this subject? A crucial reason for treatment failure of cervical cerclage is that uterine contraction was not effectively inhibited. What do the results of this study add? Persistent inhibition of uterine contraction after cervical cerclage prolonged pregnancy duration, increased gestational age at delivery, and improved pregnancy outcomes. What are the implications of these findings for clinical practice and/or further research? This study may provide a clinical basis for prolonging gestational age, preventing late abortion and premature delivery, and improving the survival rate and quality of life of premature infants.

Molecular hydrogen has a positive impact on pregnancy maintenance through enhancement of mitochondrial function and immunomodulatory effects on T cells

AimsMolecular hydrogen (H2) has attracted growing interest because of its implications in various diseases. However, the molecular mechanisms underlying the remarkable effect of a small amount of H2 remain elusive. No knowledge has been available on the role of H2 in the etiology of pregnancy disorders or its direct influence on human immune cells. Since maternal immunity, T cells in particular, plays a critical role in pregnancy maintenance. We investigated the effects of H2 on T cells and its relation to preterm birth (PTB). Main methodsExhaled H2 concentrations in pregnant women were measured and correlated with cytokine concentrations in maternal and umbilical cord blood. H2 was added to T cells collected from healthy donors, and differentiation and proliferation were examined. Energy metabolism was also examined. H2 was administered to mice and cytokine expression was compared. Key findingsOur prospective observational study revealed that maternal production of H2 is significantly lower in pregnant women with PTB, suggesting its potential as a biomarker for predicting PTB. We found that H2 has clear associations with several maternal cytokines, and acts as an immunomodulator by exerting mitochondrial function in human T cells. Moreover, in vivo administration of H2 to pregnant mice regulated inflammatory responses and reduced PTB caused by T cell activation, which further supports the notion that H2 may contribute to prolonged gestation through its immunomodulatory effect. SignificanceMeasuring maternal H2-production could be a potential clinical tool in the management of PTB, and H2 may have positive impact on pregnancy maintenance.

EP38.05: The accuracy of ultrasound estimated fetal weight at 41 weeks of gestation prior to induction of labour: prospective study

To evaluate the accuracy of ultrasound estimated fetal weight (EFW) shortly before induction of labour in primiparous women induced by prologued gestation comparing accuracy of this measurement with third trimester ultrasound. Prospective study of 50 primiparous woman singleton pregnancies and cephalic presentation who were admitted to our unit for induction of labour due to prolonged gestation between April 2021 and December 2021. An ultrasound to estimated fetal weight 24h before induction was performed in all of them. Information of estimated fetal weight in third trimester was obtained from history records retrospectively. Both EFW were calculated using Hadlock formula and compared with birthweights. There was a high correlation between EFW at 41 weeks prior to labour induction and birthweight (R2 = 0.737, P < 0.001). EFW at third trimester ultrasound have not a good correlation with birthweight (R2 = 0.210, P > 0,143). The mean birthweight was 3469 ± 392 g. The mean EFW at 41 weeks was 4482 ± 414 g and mean absolute weight difference was −160 ± 293 g. The mean EFW in third trimester ultrasound was 2658 ± 262 g and mean absolute weight difference was 810 ± 423 g. Ultrasound EFW before induction of labour at 41 weeks is highly correlated with birthweight. Although, this trend used to overestimate fetal weight, their accuracy is superior than third trimester measurement. EFW should modified the way of delivery or monitorisation under labour (suspected fetal growth restriction), for that reason, we must look for the major accuracy.

Caesarean Section of a Dog Using Propofol and Isoflurane to Achieve Anesthesia: A Case Report

A pregnant German Shepherd bitch was brought to the University of Nairobi Veterinary Teaching Hospital with a history of prolonged gestation period. On radiography, I found an oversized puppy in the abdomen. Cesarean section to deliver the puppy was recommended as the bitch could not deliver the puppy per-vaginally. Surgery was done under general anesthesia using 1% propofol at 5mg/kg body weight and 2.5% isoflurane for maintenance. One oversized puppy was removed but died soon after delivery. Also removed was another small, mummified puppy. Following the delivery of the puppies, closure of the uterus and abdominal wall incisions was done routinely. In conclusion, this was a case of dystocia where the bitch could not normally deliver due to an oversized puppy, and a cesarean section was deemed the most appropriate management method. The anesthesia protocol used in this case has been proven to be ideal for use in cases of canine cesarean section. In this case, the puppy that died soon after delivery could have been caused by asphyxia (fetal hypoxia) caused by inhalation of fetal fluids occurring due to delayed delivery.

Size at Birth, Postnatal Growth, and Reproductive Timing in an Australian Microbat.

SynopsisReproductive phenology, size at birth, and postnatal growth are important life history traits that reflect parental investment. The ability to document detailed changes in these traits can be a valuable tool in the identification and management of at-risk wildlife populations. We examined reproductive traits in a common, widespread Australian microbat, Chalinolobus gouldii, at two sites over two years and derived growth curves and age estimation equations which will be useful in the study of how intrinsic and extrinsic factors alter parental investment strategies. We found that male and female offspring did not differ significantly in their size at birth or their postnatal growth rates. Bats born in 2018 were smaller at birth but grew at a faster rate than those born in 2017. When date of birth was compared across sites and years, we found bats born in 2018 had a later median birthdate (by 18 days) and births were more widespread than those born in 2017. Cooler and wetter weather during late gestation (Nov) in 2018 may have prolonged gestation and delayed births. With many bats facing threatening processes it is important to study reproductive plasticity in common and widespread “model” species, which may assist in the conservation and management of threatened microbats with similar reproductive traits.

Multituberculate Mammals Show Evidence of a Life History Strategy Similar to That of Placentals, Not Marsupials.

AbstractThe remarkable evolutionary success of placental mammals has been partly attributed to their reproductive strategy of prolonged gestation and birthing of relatively precocial, quickly weaned neonates. Although this strategy was conventionally considered derived relative to that of marsupials with highly altricial neonates and long lactation periods, mounting evidence has challenged this view. Until now the fossil record has been relatively silent on this debate, but here we find that proportions of different bone tissue microstructures in the femoral cortices of small extant marsupials and placentals correlate with length of lactation period, allowing us to apply this histological correlate of reproductive strategies to Late Cretaceous and Paleocene members of Multituberculata, an extinct mammalian clade that is phylogenetically stemward of Theria. Multituberculate bone histology closely resembles that of placentals, suggesting that they had similar life history strategies. A stem-therian clade exhibiting evidence of placental-like life histories supports the hypothesis that intense maternal-fetal contact characteristic of placentals is ancestral for therians. Alternatively, multituberculates and placentals may have independently evolved prolonged gestation and abbreviated lactation periods. Our results challenge the hypothesis that the rise of placental mammals was driven by unique life history innovations and shed new light on early mammalian diversification.

Japanese encephalitis virus outbreak in Australian pigs

An incursion of Japanese encephalitis virus disease has been identified as commencing in north-eastern Australia in April 2021, resulting in prolonged gestation length, mummified and stillborn piglets, often with severe fetal abnormalities and congenital tremors. The disease has been recognised to have occurred on nearly 80 farms over an 18-month period with some seasonal impacts and large mosquito numbers afflicting farms. There have been no obvious clinical problems in piglets, weaners, grow/finishing or adult pigs. The organism is zoonotic and caused clinical infection in nearly 40 people and sadly resulted in the death of five people. None of the people showing clinical signs had contact with the pig industry. No one involved in the pig industry or students handling potentially infected tissues showed any clinical signs of disease.

Hydrops amnion in a Belgian blue cow combined with prolonged gestation and anencephaly of the calf

AbstractIn cattle, hydrops amnion is a rare pathological condition. In the present study, we report such a case in a Belgian blue cow suffering from prolonged gestation. A presumptive diagnosis was based on clinical examination, including transrectal ultrasonography. Management included inducing parturition with dinoprost and dexamethasone, where 36 hours later, a left flank recumbent caesarean section was performed. A live, oversized, male calf (76 kg) with a frontal cephalocele/meningocele was delivered. Postmortem examination revealed anencephaly, characterised by the absence of the cerebrum. Intravenous fluid therapy was administered during surgery to prevent hypovolemic shock, and postoperative treatment consisted of intramuscular injections of 100 IU of oxytocin and antibiotics (procaine benzylpenicillin) for 3 consecutive days. After 5 days, the patient was discharged from the clinic.

Maternal Low Volume Circulation Relates to Normotensive and Preeclamptic Fetal Growth Restriction.

This narrative review summarizes current evidence on the association between maternal low volume circulation and poor fetal growth. Though much work has been devoted to the study of cardiac output and peripheral vascular resistance, a low intravascular volume may explain why high vascular resistance causes hypertension in women with preeclampsia (PE) that is associated with fetal growth restriction (FGR) and, at the same time, presents with normotension in FGR itself. Normotensive women with small for gestational age babies show normal gestational blood volume expansion superimposed upon a constitutionally low intravascular volume. Early onset preeclampsia (EPE; occurring before 32 weeks) is commonly associated with FGR, and poor plasma volume expandability may already be present before conception, thus preceding gestational volume expansion. Experimentally induced low plasma volume in rodents predisposes to poor fetal growth and interventions that enhance plasma volume expansion in FGR have shown beneficial effects on intrauterine fetal condition, prolongation of gestation and birth weight. This review makes the case for elevating the maternal intravascular volume with physical exercise with or without Nitric Oxide Donors in FGR and EPE, and evaluating its role as a potential target for prevention and/or management of these conditions.

Bulk and amino acid nitrogen isotopes suggest shifting nitrogen balance of pregnant sharks across gestation.

Nitrogen isotope (δ15N) analysis of bulk tissues and individual amino acids (AA) can be used to assess how consumers maintain nitrogen balance with broad implications for predicting individual fitness. For elasmobranchs, a ureotelic taxa thought to be constantly nitrogen limited, the isotopic effects associated with nitrogen-demanding events such as prolonged gestation remain unknown. Given the linkages between nitrogen isotope variation and consumer nitrogen balance, we used AA δ15N analysis of muscle and liver tissue collected from female bonnethead sharks (Sphyrna tiburo, n = 16) and their embryos (n = 14) to explore how nitrogen balance may vary across gestation. Gestational stage was a strong predictor of bulk tissue and AA δ15N values in pregnant shark tissues, decreasing as individuals neared parturition. This trend was observed in trophic (e.g., Glx, Ala, Val), source (e.g., Lys), and physiological (e.g., Gly) AAs. Several potential mechanisms may explain these results including nitrogen conservation, scavenging, and bacterially mediated breakdown of urea to free ammonia that is used to synthesize AAs. We observed contrasting patterns of isotopic discrimination in embryo tissues, which generally became enriched in 15N throughout development. This was attributed to greater excretion of nitrogenous waste in more developed embryos, and the role of physiologically sensitive AAs (i.e., Gly and Ser) to molecular processes such as nucleotide synthesis. These findings underscore how AA isotopes can quantify shifts in nitrogen balance, providing unequivocal evidence for the role of physiological condition in driving δ15N variation in both bulk tissues and individual AAs.

Maternal and Infant Mortality in Physicians' Families in 1922.

Maternal and Infant Mortality in Physicians' Families in 1922.

Outcome of Pregnancy and Maternal Weight in Women Living in Coastal and Continental Croatia

Pregnancy outcomes are under the influence of maternal characteristics and environmental factors, diet being the most important. The benefits of the Mediterranean diet on all health indicators, including pregnancy, are well documented, placing at the top of the world’s healthiest diets. The aim was to investigate whether pregnant women living in the Mediterranean part of Croatia have better pregnancy outcomes in comparison to women living in the continental region. Observational longitudinal study was conducted in two Croatia’s regions: continental (city of Osijek and surrounding area) and coastal (city of Split and surrounding area). Even though women for the coastal region gained more weight during pregnancy (p=0.048) and prolonged gestation (p&amp;lt;0.001), maternal nutritional status has a higher influence on offspring’s nutritional status at delivery among women from the continental region. The incidence of pregnancy disorders (p&amp;lt;0.001) is higher among women from the continental region. Maternal weight prior to delivery was associated with caesarean section in both regions. Despite an unfavorable maternal nutritional status, both prior and during gestation and prolonged gestation, offspring’s nutritional status is better in the Mediterranean part of Croatia.