Ratio In Pregnant Women Research Articles

Exploring the Impact of Folic Acid Supplementation and Vitamin B12 Deficiency on Maternal and Fetal Outcomes in Pregnant Women with Celiac Disease.

Background: Celiac disease is a chronic small intestinal immune-mediated enteropathy precipitated by exposure to dietary gluten, affecting approximately 1% of the global population and two million Americans. An increasing number of studies have identified a link between celiac disease and adverse maternal and fetal outcomes during pregnancy and after birth. Additionally, both celiac disease and pregnancy are associated with an increased risk for nutrient deficiencies, specifically vitamin B12 and folate. Methods: This review examines the current literature related to the folate trap and vitamin B12 deficiency in patients with celiac disease and pregnant women independently and provides rationale for future research to explore the relationship between the folate-to-12 ratio in pregnant women with celiac disease. Results: Deficiencies in vitamin B12 are linked with several negative maternal and fetal health outcomes including pre-eclampsia, gestational diabetes, spontaneous abortion/miscarriage, preterm birth, neural tube defects, intrauterine growth restriction, and low gestational age and birthweight. Conclusions: Folic acid supplementation is widely recommended during pregnancy, but complementary vitamin B12 supplementation is not standard. Physicians should consider celiac disease screening during pregnancy as well as vitamin B12 supplementation.

Assessment of the fetal thymic-thoracic ratio in pregnant women with intrahepatic cholestasis: a prospective case-control study.

To examine the fetal thymic-thoracic ratio (TTR) in intrahepatic cholestasis of pregnancy (ICP). This prospective case-control study was conducted in a single tertiary center. The sample consisted of 86 pregnant women at 28-37 weeks of gestation, including 43 women with ICP and 43 healthy controls. TTR was calculated for each patient using the anterior-posterior measurements of the thymus and intrathoracic mediastinal measurements. The median TTR value was found to be smaller in the ICP group compared to the control group (0.32 vs. 0.36, p<0.001). The ICP group had a greater rate of admission to the neonatal intensive care unit (NICU) (p<0.001). Univariate regression analysis revealed that lower TTR values increased the possibility of NICU admission six times (95 % confidence interval: 0.26-0.39, p=0.01). A statistically significant negative correlation was detected between TTR and the NICU requirement (r:-0.435, p=0.004). As a result of the receiver operating characteristic analysis, in predicting NICU admission, the optimal cut-off value of TTR was determined to be 0.31 with 78 % sensitivity and 67 % specificity (area under the curve=0.819; p<0.001). We determined that the fetal TTR may be affected by the inflammatory process caused by the maternal-fetal immune system and increased serum bile acid levels in fetal organs in the presence of ICP. We consider that TTR can be used to predict adverse pregnancy outcomes in patients with ICP.

The correlation between neutrophil lymphocyte ratio in pregnant women with COVID-19 and neonatal outcome

Background and objectives. Coronavirus Disease 2019 (COVID-19) in pregnancy periods can adversely affect the neonatal outcomes. Neutrophil Lymphocyte Ratio (NLR) were reported as sensitive markers and good predictor of COVID-19 progression in symptomatic pregnant women. The aim of this study to find correlation on NLR value of the pregnant women with COVID-19 to the neonatal outcome. Materials and methods. We retrospectively included neonates who was delivered from pregnant women with COVID-19 at Dr. Soetomo Hospital from June 2021 to July 2022. NLR value of the pregnant women were calculated. Demographic data and clinical characteristic were taken from medical records. The diagnosis of COVID-19 in pregnant women is confirmed by PCR nasopharyngeal swab, as well as in the neonates who undergo nasopharyngeal swab a maximum of 24 hours after birth. Results. Total of 1058 births delivered between June 2021- July 2022, 224 neonates (21.17%) met inclusion criteria. We analyzed the severity of maternal factors described by NLR and correlated with neonate outcomes, such as mortality, Apgar Score (AS), birth weight, gestational age, type of delivery and Polymerase Chain Reaction (PCR) swab of the neonates. the results of our analysis, the maternal NLR was correlated with the birth weight (p=0.005). However, NLR of the pregnant women are not correlated with mortality of the neonates (p=0.681), type of delivery (p= 1), AS at 1 minute (p= 0.158), AS at 5 minutes (p= 0.158), gestational age (p= 0.110) length of stay (LOS) (p=0,258) and PCR swab of the neonates (p= 1). Conclusions. NLR value in the majority of pregnant women with COVID-19 was found to be increasing, but these results are not related for the neonatal outcome except the birth weight.

Fetomaternal outcomes in pregnant women with congenital heart disease: a comparative analysis from an apex institute.

With advancements in cardiac surgical interventions during infancy and childhood, the incidence of maternal congenital heart disease (CHD) is increasing. This retrospective study compared fetal and cardiac outcomes in women with and without CHD, along with a sub-analysis between cyanotic versus non-cyanotic defects and operated versus non-operated cases. A 10-year data were retrospectively collected from pregnant women with CHD and a 1:1 ratio of pregnant women without any heart disease. Adverse fetal and cardiac outcomes were noted in both groups. Statistical significance was set at P<0.05. A total of 86 pregnant women with CHD were studied, with atrial septal defects (29.06%) being the most common. Out of 86 participants, 27 (31.39%) had cyanotic CHD. Around 55% of cases were already operated on for their cardiac defects. Among cardiovascular complications, 5.8% suffered from heart failure, 7.0% had pulmonary arterial hypertension, 8.1% presented in New York Heart Association functional class IV, 9.3% had a need for intensive care unit admission, and one experienced maternal mortality. Adverse fetal outcomes, including operative vaginal delivery, mean duration of hospital stay, fetal growth restriction, preterm birth (<37 weeks), low birth weight (<2,500 g), 5-minute APGAR score <7, and neonatal intensive care unit admissions, were significantly higher in women with CHD than in women without heart disease. Women with CHD have a higher risk of adverse fetal and cardiac outcomes. The outcome can be improved with proper pre-conceptional optimization of the cardiac condition, good antenatal care, and multidisciplinary team management.

Subclinical hypothyroidism in pregnancy – assessment of offspring thyroid status and mitochondrial robustness to stress

Subclinical hypothyroidism’s clinical implications on pregnancy are controversial. Consequently, thyrotropin (TSH) cutoff-values for pregnancy are continuously a subject for debate. In subclinical hypothyroidism, altered levels of thyroid hormones may affect mitochondrial function. Objectives were i) to analyze thyroid hormone levels in offspring of women with and without subclinical hypothyroidism ii) to analyze mitochondrial “robustness” in terms of MTG/TMRM ratio in pregnant women and their offspring in relation to thyroid function and iii) to perform differentiate analyses on different TSH thresholds to determine the importance of cutoff-values to results. Pregnant women were included by blood collections prior to a planned cesarean section, and cord samples were collected after delivery. Thyroid status (analyzed by Siemens Healthcare Diagnostics by an electrochemical luminescent immunoassay based on LOCI-technology) grouped the women and their offspring in euthyroid or subclinical hypothyroid, with groups established from previous recommended third-trimester cutoff-value (TSH > 3.0 mIU/L) and the recently recommended cutoff-value in Denmark (TSH > 3.7 mIU/L). Flow cytometric measurements of mitochondrial function in mononuclear blood cells with the fluorophores TetraMethylRhodamine Methyl Ester (TMRM) and Mitotracker Green (MTG) were used to evaluate mitochondrial robustness as the MTG/TMRM ratio. No significant differences in mitochondrial robustness between euthyroid and subclinical hypothyroid cohorts were observed, irrespective of TSH-cutoff applied. Maternal and cord MTG/TMRM ratios were positively correlated. Cord-TSH was elevated in subclinical hypothyroid offspring, independent of TSH cutoff applied. Cord-TSH was associated with maternal TSH-level, maternal smoking and cord arterial-pH.

Docosahexaenoic Acid Supplementation in Lactating Women Increases Breast Milk and Erythrocyte Membrane Docosahexaenoic Acid Concentrations and Alters Infant n–6:n–3 Fatty Acid Ratio

BackgroundLow concentrations of docosahexaenoic acid (DHA) or high n–6 (ω-6):n–3 ratio in pregnant women is associated with poor fetal growth velocity and suboptimal neurodevelopment. However, there is a lack of data on levels of important n–6 and n–3 fatty acids (FAs) at different time points during pregnancy and lactation from India. Data on how much DHA is transferred during actual supplementation are also scarce. ObjectivesWe report the concentrations of n–6 and n–3 FAs in maternal and infant blood and in breast milk following maternal supplementation with DHA or placebo. MethodsA total of 957 pregnant women (≤20 wk) from Belagavi, Karnataka, were randomly assigned to receive either 400 mg/d of algal DHA or placebo through 6 mo postpartum. Blood samples were collected from the mother at recruitment/baseline, delivery, and 6 mo postpartum and from the infant at birth (cord) and 12 mo (venous). Breast milk samples were collected from a subsample at delivery, 1 mo and 6 mo postpartum. The FA profile was analyzed using gas chromatography. ResultsThe concentration of DHA appeared to be higher in erythrocyte and breast milk samples of the DHA-supplemented group at all subsequent time points. The n–6:n–3 ratio was lower among women in the DHA group at delivery [DHA: 4.08 (1.79); placebo: 5.84 (3.57); P < 0.001] and at 6 mo postpartum [DHA: 5.34 (2.64); placebo: 7.69 (2.9); P < 0.001]. Infants of DHA-supplemented mothers also had a lower n–6:n–3 ratio at delivery and 12 mo. The n–6:n–3 ratio of breast milk increased from delivery through 1 to 6 mo but remained lower in the DHA-supplemented group than in the placebo. ConclusionsMaternal DHA supplementation with 400 mg/d from early pregnancy through 6 mo postpartum significantly increased circulating DHA in breast milk and infant erythrocyte, whereas decreased erythrocyte and breast milk n–6:n–3 ratio. However, maternal supplementation did not get the ratio to the recommended levels.

CHROMagarTM Strep B for detecting group B Streptococcus in pregnant women at 35th to 37th of gestation

Group B Streptococcus (GBS) is one of the common causes of neonatal sepsis spreading from mothers to newborns. A common method to isolate and identify GBS is using Blood agar which delivers results in at least 48 hours. Although chromogenic culture media including CHROMagarTM StrepB, can develop colored colonies for detecting pathogenic bacteria easily, there has not been approached GBS isolation in Vietnam. This study was conducted to find out the GBS infection ratio in pregnant women at the 35th – 37th week of gestation. Furthermore, this research evaluates the efficacy of CHROMagarTM StrepB media and Blood agar in GBS detection as well. In a cross-sectional survey, a total of 258 pregnant women at 35th to 37th of gestation screened for GBS at Thuan Kieu General Clinic from 04/2021 to 12/2021 were recruited. Rectovaginal swabs from these patients were cultured on Blood agar and CHROMagarTM StrepB. We performed data analysis using SPSS ver 20, p&lt;0.05 was statistically significant. Overall, out of 258 participants, 52 (20.16%) were GBS carriers. CHROMagarTM StrepB has significantly higher sensitivity than blood agar if spending a similar time (1.52 fold, p-value &lt; 0.001), or event training a shortened time (18 hours and 48 hours), CHROMagarTM StrepB media is still more sensitive than blood agar (1.16 fold, p-value 0.044). In this study, the GBS infection ratio in pregnant women at 35-37 weeks of gestation at Thuan Kieu General Clinic is 20.16%. Culturing vaginal-rectal specimens on CHROMagarTM StrepB medium is higher sensitivity and rapidly than blood agar for GBS detection. CHROMagarTM StrepB should be used to get more effective in identifying GBS carriers in near-term pregnant women.

NF-KB P65-subunit activity and T-helpers 1 / T-helpers 2 ratio in pregnant women with placental disorders and premature labor

Objectives: to study the levels of the total, phosphorylated p65-subunit of the nuclear factor NF-kB, activity of p65 and the relation with the level and ratio of T-helpers type I and II in pregnant women with placental dysfunction and different clinical types of the course of preterm labor (with preterm premature rupture of membranes (pPROM) and without it).Materials and methods. The case-control study included 60 pregnant women: 40 women with placental disorders and spontaneous premature labor in the period of 24–34 weeks (group I – 20 women with premature labor and timely discharge of amniotic fluid, group II – 20 women with pPROM) and 20 women of the control group (CG) with normal timely delivery in the head position of a fetus without complications.The value of the total NF-kB p65 subunit and its phosphorylated fraction was determined in all women using ELISA in placenta lysates. On this basis the p65 subunit activity was calculated; number of T-helper I (Th1) and T-helper II (Th2) was determined using flow cytometry in a whole blood sample, with afterward calculation of the Th1/Th2 ratio.Results. Elevated levels of total p65 and its phosphorylated fraction were found in women with placental dysfunction (p &lt; 0.01 in groups I and II compared with CG), as well as the activity p65 (p &lt; 0.01 in group I, p = 0.04 in group II compared with CG). The difference in the Th1 value and the Th1/Th2 ratio was significantly higher in both groups (p &lt; 0.01 in group I, p = 0.03 in group II for Th1; p &lt; 0.01 in both groups for Th1/Th2), the number of Th2 differed significantly only in group I (p &lt; 0.01 compared with CG). A strong positive correlation between p65 activity and Th1/Th2 was also established (r = 0.8).Conclusions. Obtained data indicates the increased NF-kB p65-subunit activity in women with placental disorders and spontaneous premature labor without pPROM, which is impact on the increase of the Th1/Th2 ratio due to the Th1 increase. This mechanism might be considered to be the leading cause of the premature birth in this group of pregnant women. However, for women with the preterm labor activity with pPROM, the difference with GC has a lower level of significance, which may indicate the existence of another leading mechanism for the initiation of premature labor in this group.

The sFlt-1/PlGF Ratio in Pregnant Patients Affected by COVID-19.

COVID-19 in pregnant women increases the risk of adverse pregnancy outcomes, including preeclampsia. This meta-analysis aimed to examine the effect of SARS-CoV-2 infection on sFlt-1/PIGF ratio during pregnancy. The study was designed as a systematic review and meta-analysis. PubMed, Web of Science, Embase and Cochrane Library were searched for relevant studies reporting the sFlt-1/PlGF ratio in pregnant women with COVID-19. Results were compared using meta-analysis by the Mantel-Haenszel method. A total of 7 studies were included in the analysis. sFlt-1/PlGF ratios between COVID-19 positive vs. negative women were 45.8 ± 50.3 vs. 37.4 ± 22.5, respectively (SMD = 1.76; 95% CI: 0.43 to 3.09; p = 0.01). sFlt-1/PlGF ratios between asymptomatic vs. symptomatic patients were 49.3 ± 35.7 vs. 37.1 ± 25.6 (SMD = 0.30; 95% CI: -0.35 to 0.95; p = 0.36). sFlt-1/PlGF ratio in non-severe group was 30.7 ± 56.5, compared to 64.7 ± 53.5 for severe patients (SMD = -1.88; 95% CI: -3.77 to 0.01; p = 0.05). sFlt-1/PlGF ratios in COVID-19 patients, with and without hypertensive disease of pregnancy, were 187.0 ± 121.8 vs. 21.6 ± 8.6, respectively (SMD = 2.46; 95% CI: 0.99 to 3.93; p = 0.001). Conclusions: Patients with COVID-19, as compared to patients without COVID-19, were characterized by higher sFlt-1/PlGF ratio. Moreover, severe COVID-19 and SARS-CoV-2 infection in hypertensive pregnant women was related to significantly higher sFlt-1/PlGF ratio.

Utility of sFtl-1 and Placental Growth Factor Ratio for Adequate Preeclampsia Management.

Introduction: The pathophysiology of preeclampsia is represented by placental ischemia and the release of angiogenic factors. Recent research suggests that using the value of the sFtl-1/PIGF ratio is more accurate for monitoring angiogenic activity. The aim of this study consists in assessing the clinical utility of the sFtl-1/PIGF ratio in determining the diagnosis and severity of preeclampsia. Material and Methods: In our study a descriptive and prospective plan was used for analyzing the specific value of the sFtl-1/PIGF ratio in women with preeclampsia and in women with gestational hypertension, depending on the gestational age and severity. Results: The study included 59 women with preeclampsia and 25 women with gestational hypertension. The mean value of the sFtl-1/PIGF ratio of pregnant women with preeclampsia was 209.2 pg/mL, while in the gestational hypertension group, the mean value of the sFtl-1/PIGF ratio was 46.08 pg/mL. The difference between the value of the sFtl-1/PIGF ratio of the group with preeclampsia and the gestational hypertension group was > 67 (pg/mL), with a sensitivity of 86.44% and a specificity of 92.00%. Significant differences were found between the median values of the sFtl-1/PIGF ratio in pregnant women with severe preeclampsia in the early-onset subgroup compared to those in the late-onset subgroup (307 pg/mL, and 98 pg/mL, respectively, p = 0.009 < α = 0.05). Conclusions: The sFtl-1/PIGF ratio may be an alternative method for diagnosing preeclampsia and it can provide data about this condition's severity.

Vitamin D Deficiency is Associated With Increased Plasminogen Activator Inhibitor 1/Plasminogen Activator Inhibitor 2 Ratio in Pregnancy.

Vitamin D deficiency has recently been suggested as an independent risk factor for thrombosis. Notably, vitamin D deficiency is common in pregnant populations, whom already have an increased thrombotic risk. However, pregnant women are commonly excluded from studies investigating the hemostatic system, and knowledge on the impact of vitamin D on hemostasis in pregnancy is therefore limited. A cross-sectional study comparing the hemostatic profile of pregnant women (gestational week 12.9 ± 0.7) with vitamin D deficiency (≤50 nmol/L) (n = 70) and high adequate vitamin D status (≥100 nmol/L) (n = 59). Vitamin D deficient women displayed increased plasminogen activator inhibitor 1 levels and an increased plasminogen activator inhibitor 1/plasminogen activator inhibitor 2 ratio, even after adjusting for factors with potential influence on hemostasis (body mass index, smoking and use of fish oil supplements). Vitamin D deficiency is associated with increased plasminogen activator inhibitor 1/plasminogen activator inhibitor 2 ratio in pregnant women. As an increased plasminogen activator inhibitor 1/plasminogen activator inhibitor 2 ratio with high plasminogen activator inhibitor 1 levels may increase thrombotic risk and is associated with the development of pregnancy complications, further research is needed to determine the optimal vitamin D supplementation in pregnancy.

Pregnancy Increases CYP3A Enzymes Activity as Measured by the 4β-Hydroxycholesterol/Cholesterol Ratio.

Changes in cortisol and other hormones during pregnancy may alter CYP3A enzymes activity, but data from sub-Saharan Africa are sparse. We investigated the effect of pregnancy and CYP3A5 genotypes on CYP3A enzymes activity using the plasma 4β-hydroxycholesterol (4β-OHC)/cholesterol (Chol) ratio, a known endogenous biomarker. Tanzanian pregnant women (n = 110) and non-pregnant women (n = 59) controls were enrolled. Plasma 4β-OHC and Chol were determined in the second and third trimesters for pregnant women and once for non-pregnant women using gas chromatography−mass spectrometry. Genotyping for CYP3A5 (*3, *6, *7) was performed. Wilcoxon Signed-Rank Test and Mann−Whitney U test were used to compare the median 4β-OHC/Chol ratio between trimesters in pregnant women and between pregnant and non-pregnant women. Repeated-measure ANOVA was used to evaluate the effect of the CYP3A5 genotypes on the 4β-OHC/Chol ratio in pregnant women. No significant effect of the pregnancy status or the CYP3A5 genotype on the cholesterol level was observed. The plasma 4β-OHC/Chol ratio significantly increased by 7.3% from the second trimester to the third trimester (p = 0.02). Pregnant women had a significantly higher mean 4β-OHC/Chol ratio than non-pregnant women, (p < 0.001). In non-pregnant women, the mean 4β-OHC/Chol ratio was significantly lower in carriers of defective CYP3A5 alleles (*3, *6 or *7) as compared to women with the CYP3A5*1/*1 genotypes (p = 0.002). Pregnancy increases CYP3A enzymes activity in a gestational-stage manner. The CYP3A5 genotype predicts CYP3A enzymes activity in the black Tanzanian population, but not during pregnancy-mediated CYP3A enzyme induction.

Quantification of cervical stiffness changes in single and twin pregnancies using the E-Cervix technique

Cervical length is a commonly used clinical indicator for evaluating preterm birth. However, some studies have shown that cervical length does not change in patients with cervical insufficiency. This study aimed to use the transvaginal ultrasound E-Cervix to quantitatively evaluate the cervical stiffness in women with singleton and twin pregnancies to provide a reference for the clinical prediction of preterm birth. We collected the cervical length, cervical hardness ratio, mean internal os strain, and mean external os strain using transvaginal ultrasonographic E-Cervix assessments in pregnant women undergoing routine examinations in the obstetrics department of our hospital from January 2020 to December 2020. We summarized the range of cervical elasticity parameters at different gestational ages and compared the cervical elasticity parameters between singleton and twin pregnancies and between preterm births and full-term births. A total of 988 pregnant women were enrolled in this study, and after exclusion, 770 pregnant women were enlisted; the interrater and internal consistency for various elasticity parameters were favorable; and cervical elasticity changes in women at full term showed some particular patterns. The declines in cervical length and hardness ratio were commensurate with gestational age, whereas the internal os strain and external os strain rose with increasing gestational age. The cervical hardness ratio in women with twin pregnancies was lower than in women with singleton pregnancies at the same gestational age, although the internal os strain in women with twin pregnancies was higher than in women with singleton pregnancies at the same gestational age (P<.05). The cervical length of women with twin pregnancies was shorter than that of women with singleton pregnancies at the same gestational age when the gestational age was ≥28 weeks of gestation (all P<.05), and the hardness ratio was linearly correlated with gestational age (r=0.68 and r=0.71). The regression model for the cervical hardness ratio in women with singleton pregnancies was hardness ratio = -0.8764×gestational age+100.99, whereas the regression model for the cervical hardness ratio in women with twin pregnancies was hardness ratio = -1.3037×gestational age+103.03. When we compared cervical elasticity parameters between preterm and full-term births, we noted that the cervical hardness ratio in pregnant women who exhibited preterm births was lower regardless of whether they carried singleton or twin pregnancies (P=.000 and P=.000), although their internal os strain was higher (P=.023 and P=.000). We observed no significant difference when we compared the cervical length and external os strain of pregnant women manifesting preterm births vs women with full-term births (P=.216 and P=.345 vs P=.475 and P=.363). When used for the quantification of cervical hardness, the E-Cervix cervical elasticity changes in pregnant women at full term showed some particular patterns. Cervical length and hardness ratio diminished as gestational age increased, whereas internal os strain and external os strain rose as gestational age increased; moreover, the degree of these changes was greater in women with twin pregnancies than in women with singleton pregnancies. Pregnant women experiencing preterm births exhibited a reduced cervical hardness ratio and augmented internal os strain relative to women experiencing full-term births.

Angiogenic factors (sFlt-1, PlGF) in twin pregnancy with placentaassociated complications

Aim : to determine reference values of angiogenic factors dynamics in pregnancy for female patients with twins and different types of placentation for early diagnostics and assessment of preeclampsia (PE) severity. Materials and Methods . There was conducted 2020–2021 prospective study enrolling 93 females with twin pregnancy to examine 68 with dichorionic diamniotic (DCDA) twins and 25 with monochorionic diamniotic (MCDA) twins. All patients were divided into 2 groups: group I consisted of 65 women with twin pregnancy without PE, group II included 28 women with twin pregnancy complicated by PE. In blood serum of pregnant women the level of soluble fms-like tyrosine kinase 1 (sFlt-1), placental growth factor (PlGF) and their ratio were studied for diagnosing and predicting PE severity at 4 time points of gestation (20.0–23.6 weeks, 24.0–28.6 weeks, 29.0–33.6 weeks, 34.0–36.6 weeks). Results . No significant difference was found in angiogenic factors level and their ratio in pregnant women with uncomplicated DCDA and MCDA twins. Regardless of placentation type, sFlt-1/PlGF ratio in women with twin pregnancy and PE at 24 weeks of gestation was 103.3, by 20-fold exceeding this level than in uncomplicated twin pregnancy. Cut-off values for sFlt-1/PlGF ratio were determined allowing highly reliable to rule out diagnosis PE (sFlt-1/PlGF &lt; 21.85; sensitivity 100 %, specificity 85 %) and to diagnose PE (sFlt-1/PlGF &gt; 49.4; sensitivity 71.1 %, specificity 100 %). The sFlt-1/PlGF ratio was higher in pregnant women with severe PE compared with the moderate degree of the disease throughout pregnancy (р &lt; 0.05). In pregnant women with early PE, the angiogenic factors ratio exceeded the upper threshold value from 24 weeks of gestation, with late PE – from 34.0–36.6 weeks. Significantly higher sFlt-1 level (18359 ± 8656 pg/ml vs. 5526 ± 2808 pg/ml; р &lt; 0.001) and the sFlt-1/PlGF ratio (118,0 ± 65,2 vs. 32,8 ± 18,6; р &lt; 0.03) as well as severe degree of PE were noted in patients with induced twin pregnancy from 24.0–28.6 weeks of gestation compared with spontaneous multiple pregnancy (42,2 and 22,2 % respectively; p &lt; 0,05). Conclusion . The developed reference values of the sFlt-1/PlGF ratio in pregnant women with twins and different types of placentation can be used not only to diagnose PE, but also to assess the severity and timing of the disease manifestation.

PMON253 The Ghrelin/Leap-2 ratio might be associated with physiologic changes in maternal weight during different stages of pregnancy

Abstract Ghrelin is an orexigenic gastric peptide hormone implicated in pleiotropic functions, playing an important role in the regulation of food intake and homeostatic body weight regulation mediated through the growth hormone secretagogue receptor (GHSR). Recently, the liver and small intestine–derived peptide liver enriched antimicrobial peptide-2 (LEAP-2) was characterized to acts as an endogenous GHSR antagonist and blunts the orexigenic action of ghrelin. On the other hand, physiologic maternal weight gain during each trimester of pregnancy might be associated primarily with the developing fetus and the maternal energy requirements. This study aimed to determine serum LEAP-2 levels and Ghrelin/Leap-2 ratio in pregnant women at each trimester of gestation and three months postpartum. We conducted a nested study within an observational prospective cohort study. Twenty five healthy women were longitudinally studied during the first, second and third trimester of pregnancy and three months postpartum. Additionally, twenty healthy non – pregnant women were studied during the follicular a luteal phase of the menstrual cycle. Biochemical and hormonal laboratory measurements were performed during the early morning hours (07: 00-08: 00 hours) following an overnight fast (9: 00-10: 00 hours). Human serum Ghrelin (MBS283919) and LEAP-2 (MBS917663) levels were determined using the commercially available ELISA kits and the ratio between circulating Ghrelin and Leap-2 (Ghrelin/Leap-2) levels was calculated. The clinical and biochemical parameters in the studied population of pregnant women and non – pregnant women were described. In healthy pregnant women, circulating Ghrelin levels decreased significantly in the third trimester of gestation (p&amp;lt;0.05). Also, serum Ghrelin levels are markedly increased after delivery and reaching the levels from first trimester of pregnancy (p&amp;gt;0.05). Additionally, in healthy pregnant women, a significant decrease was observed in serum LEAP-2 concentrations from second to third trimesters of pregnancy (p&amp;lt;0.05). In addition, serum LEAP-2 levels were significantly increased after delivery and returned to the levels of the first trimester of gestation. The Ghrelin/Leap-2 ratio increases significantly during pregnancy and reaches its peak in the second and third trimester of gestation in healthy pregnant women (p&amp;lt;0.05). In conclusion, this study provides the first evidence that Ghrelin/Leap-2 ratio increase steadily during pregnancy reaching their peak in the second and third trimester of pregnancy. Additionally, the findings of this study suggest that Ghrelin/Leap-2 ratio might play an important role in maternal physiology adaptation of weight gain during pregnancy. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

DETERMINING SPOT URINE PROTEIN / CREATININE RATIO SENSITIVITY IN THE DIAGNOSIS OF PREECLAMPSIA WITH VARIABLES SUCH AS URINE SAMPLING TIME AND WAITING TIME

OBJECTIVE: The present study aims to compare the success of spot urine protein/creatinine ratio in predicting 24-h proteinuria with different variables such as urine sampling time and urine wait time before analysis.MATERIAL AND METHODS: The study included 100 pregnant women who were tested for their 24-h urine protein levels and simultaneously checked for spot urine protein/creatinine ratio upon admission to our clinic with a complaint of high blood pressure between March 2014 and December 2017. The pregnant women included in the study were divided into two groups: those with a normal range for the level of 24-h proteinuria and those with an abnormal range for 24-h proteinuria. The success of spot urine protein/creatinine level in predicting 24-h urine proteinuria was assessed in relation to spot urine sampling time, wait time, and patients’ demographic data.RESULTS: The optimal cut-off value of spot urine protein / creatinine ratio for groups with and without proteinuria in 24-h urine was determined to be 0.315 (cut-off). Urine sampling time and wait time before analysis were compared but no statistically significant difference was found.CONCLUSIONS: The spot urine protein/creatinine ratio in pregnant women with suspected preeclampsia may replace testing patients for proteinuria in their 24-h urine. However, according to our study, urine sampling time and wait time before analysis did not affect the sensitivity of the test.

Assessment of the role of hematological inflammatory markers in the severity of intrahepatic cholestasis of pregnancy

Introduction. Hematological inflammatory markers may be promising diagnostic markers for assessing the severity of intrahepatic cholestasis of pregnancy. The aim of the study was to evaluate and compare the levels of hematological inflammatory markers in intrahepatic cholestasis of pregnancy. Material and methods. A prospective cohort study of 142 clinical cases, divided into two groups depending on the presence of cholestasis gravidarum, was carried out. The research was conducted by assessing the level of bile acids and hematological inflammatory markers in the mother’s blood, as well as by studying medical records. The IBM Statistics SPSS 21 program was used to process the statistical data. To compare categorical variables, the χ² without the Yates’ continuity correction test was applied. Results. There was an increase in platelet-to-lymphocyte ratio in pregnant women with intrahepatic cholestasis of pregnancy compared to the control group (146.0±6.8 versus 135.2±7.3, respectively). The values of neutrophil-to-lymphocyte ratio and the average volume of platelets were similar in both groups. At the same time, the study found a decrease in the values of erythrocyte distribution among women whose pregnancy was complicated by cholestasis gravidarum. Conclusions. The study showed a significant increase in platelet-to-lymphocyte ratio in women whose pregnancy was complicated by cholestasis gravidarum, as well as an increase in this indicator with increasing levels of bile acids. Thus, this ratio may be a promising diagnostic marker in assessing the severity of intrahepatic cholestasis of pregnancy.

Attention-Deficit/Hyperactivity Disorder, Autism Spectrum Disorder, and Other Neurodevelopmental Outcomes Associated With Antipsychotic Drug Exposure During Pregnancy.

Between 0.3%-4.6% of women use antipsychotic (AP) drugs during pregnancy. Two large, retrospective, population-based cohort studies, conducted in Nordic countries and in the US, examined the risk of neurodevelopmental disorders (NDDs) following gestational exposure to APs. The Nordic study found that, in unadjusted analyses, exposure to APs during pregnancy was associated with increased risk of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in offspring; that the risk all but disappeared after adjusting for covariates; and that the risk appeared to be related to maternal major mental illness rather than to gestational exposure to APs. The US study also found that, in unadjusted analyses, gestational exposure to APs was associated with an increased risk of almost all of the study-specified NDDs in offspring; however, after adjusting for covariates, the risks were no longer meaningfully increased and, importantly, were no longer statistically significant for ADHD and ASD. Thus, these 2 studies suggest that gestational exposure to APs is a marker of NDD risk in offspring rather than a potential cause. Whereas a small but significantly increased risk was identified for aripiprazole in the US study, the signal was inconsistent across analyses, and confounding due to maternal mental illness was not ruled out. Previous studies have suggested that the use of APs during pregnancy is not associated with an increased risk of major congenital malformations and other adverse gestational outcomes. Considering the potential harm and suffering associated with major mental illness and the very low risks associated with AP use during pregnancy, initiation or continuation of APs appears to carry a favorable risk-benefit ratio in pregnant women who need these drugs; however, decision-making should be shared between patients, their caregivers, and the treating team.

Vitamin D Metabolite Ratio in Pregnant Women with Low Blood Vitamin D Concentrations Is Associated with Neonatal Anthropometric Data.

Existing evidence on the correlation between maternal vitamin D concentrations and birth outcomes is conflicting. Investigation of these associations requires accurate assessment of vitamin D status, especially in individuals with low 25-hydroxyvitamin D (25(OH)D) concentrations. This study examined the correlations between birth outcomes and the maternal vitamin D metabolite ratio (VMR) 1 (defined as the ratio of 24,25(OH)2D3 to 25(OH)D) and VMR2 (defined as the ratio of 3-epi-25(OH)D3 to 25(OH)D) using data from the Japan Environment and Children’s Study at Chiba Regional Center. A total of 297 mother–neonate pairs were analyzed. Using liquid chromatography–tandem mass spectrometry, we measured 25(OH)D2, 25(OH)D3, 24,25(OH)2D3, and 3-epi-25(OH)D3 concentrations in maternal serum samples. These data were analyzed in relation to birth anthropometric data using multivariable linear regression. Of the study participants, 85.2% showed insufficient vitamin D concentrations. VMR1 was strongly correlated with 25(OH)D concentrations, whereas VMR2 showed a weak correlation. Only VMR2 was associated with all anthropometric data. VMR2 in pregnant women with low vitamin D blood concentrations is a useful marker for neonatal anthropometric data and is independent of 25(OH)D. Accurate measurement of vitamin D metabolites could help better understand the effects of vitamin D on birth outcomes.

Comment on: The sFlt-1 to PlGF ratio in pregnant women with rheumatoid arthritis: impact of disease activity and sulfasalazine use

Comment on: The sFlt-1 to PlGF ratio in pregnant women with rheumatoid arthritis: impact of disease activity and sulfasalazine use