Subgroups Of Pregnant Women Research Articles

Is Maternal Selenium Status Associated with Pregnancy Outcomes in Physiological and Complicated Pregnancy?

Selenium is essential for the synthesis and function of various selenoenzymes, such as glutathione peroxidases, selenoprotein P, and thioredoxin reductase. These enzymes play a critical role in both antioxidant defense and in limiting oxidative damage. Numerous studies have reported associations between serum selenium concentration, obstetric complications and pregnancy outcomes. The aim of this study was to determine whether the dietary intake of selenium, its serum concentration, and the activity of glutathione peroxidase in subsequent trimesters of pregnancy affect the birth condition of newborns. This was assessed based on the APGAR score in the 1st and 5th minute of life, birth weight, body length and head and chest circumference in both physiological and complicated pregnancy courses. Twenty-seven pregnant women, with a mean age of 29.6 ± 4.8 years from the Lower Silesia region of Poland, participated in the study. Fifty-five percent of the study group experienced pregnancy complications. The median reported selenium intake and serum selenium content for Polish pregnant women in the first trimester was 56.30 μg/day and 43.89 μg/L, respectively. These figures changed in the second trimester to 58.31 μg/day and 41.97 μg/L and in the third trimester to 55.60 μg/day and 41.90 μg/L. In the subgroup of pregnant women with a physiological pregnancy course, a weak, positive correlation was observed in the first trimester between Se intake and the length (R = 0.48, p = 0.019) and the birth weight of newborns (R = 0.472, p = 0.022). In the second trimester, a positive correlation was noted with the APGAR score at the 1st (R = 0.680, p = 0.005) and 5th minutes (R = 0.55, p = 0.033), and in the third trimester with the APGAR score at the 1st minute (R = 0.658, p = 0.019). The glutathione peroxidase activity had a strong positive correlation with the APGAR score at the 1st min (R = 0.650, p = 0.008) in the second trimester and with the birth weight of the newborns (R = 0.598, p = 0.039) in the third trimester. No correlation was found between newborns' birth measurements and serum selenium concentration. In the subgroup of pregnant women with complications, a strong, negative correlation was found between Se intake in the second trimester and gestational age (R = -0.618, p = 0.032). In the third trimester, a positive correlation was noted between Se concentration in serum and head circumference (R = 0.587, p = 0.021). The results indicate that maternal selenium status during pregnancy, including dietary intake, serum concentration, and glutathione peroxidase activity, correlates with anthropometric parameters of the newborn, such as birth weight, length, and APGAR score, especially in pregnancies with a physiological course. However, these relationships diminish in importance when pregnancy complications occur.

Plasma interferon-alpha protein levels during pregnancy are associated with lower birth weight in systemic lupus erythematosus.

Adverse pregnancy outcomes are more common in women with systemic lupus erythematosus (SLE) compared with healthy women, but we lack prognostic biomarkers. Plasma interferon alpha (IFNα) protein levels are elevated in a subgroup of pregnant women with SLE, but whether this is associated with pregnancy outcomes is unknown. We investigated the relationship between IFNα, adverse pregnancy outcomes and the presence of autoantibodies in SLE pregnancy. We followed 76 women with SLE prospectively. Protein levels of IFNα were quantified in plasma collected in the 2nd and 3rd trimester with single-molecule array. Positivity for antinuclear and antiphospholipid antibodies was assessed during late pregnancy with multiplexed bead assay. Clinical outcomes included the adverse pregnancy outcomes small for gestational age (SGA), preterm birth, and preeclampsia. During SLE pregnancy, women with SGA infants compared with those without had higher levels of plasma IFNα protein, and IFNα positivity was associated with lower birth weight of the infant. Preterm birth was associated with autoantibodies against chromatin. IFNα protein levels associated positively with autoantibodies against chromatin, Smith/ribonucleoprotein (SmRNP) and RNP, but negatively with phospholipid antibodies. Elevated IFNα protein in plasma of women with SLE is a potential risk factor for lower birth weight of their infants. The association between IFNα and lower birth weight warrants further investigation regarding the pathophysiological role of IFNα during SLE pregnancy.

MECHANISMS OF EPIGENETIC REGULATION IN THE DEVELOPMENT OF PREECLAMPSIA

Introduction. The etiology and pathophysiology of pre-eclampsia (PE) are unclear. Effective methods of its prognosis, prevention and treatment have not still been devised. Of great interest have been the prospects for the use microRNA molecules that epigenetically control the expression of target genes at the post-transcriptional level and of key importance in proliferation, differentiation, invasion, migration, apoptosis of trophoblast cells, regulation of angiogenesis, immune response and other processes which occur during pregnancy Aim. The objective of the study is to investigate the epigenetic development mechanisms of PE based on the evaluation of the expression of pathogenetically significant microRNAs in women’s blood plasma. Materials and methods. The study include 62 female patients divided into the main study group (42 pregnant women with PE) and the control group (20 healthy women with uncomplicated pregnancy, childbirth and post-natal period). All patients have undergone a general clinical, laboratory, instrumental examination. The expression 15 micRroNAs level in blood plasma has been evaluated using a quantitative real-time polymerase chain reaction.The software DIANA miRPath v. 3.0 has been used to evaluate the effect of differentially expressed microRNAs on the signalling pathways functioning . The statistical data processing has been carried out using the licensed software package Statistica 6.0. Results. The women with PE have been detected to have multidirectional changes in the expression of 13 out of 15 plasma microRNAs compared with the control group; however, there has been a statistically significant decrease in the expression levels of 8 microRNAs: hsa-miR-146a-5p, hsa-miR-181a-5p , hsa-miR-210-3p, hsa-miR-517a-3p , hsa-miR-517c-3p, hsa-miR-574-3p, hsa-miR-574-5p, hsa-miR-1304-5p . The subgroup of pregnant women having PE proceeding with the symptoms of fetal growth retardation (FGR), has shown a significant decrease in the expression of hsa-miR-20a-5p and hsa-miR-143-3p molecules compared with the subgroup without FGR. Dysregulation of more than 40 signalling pathways has been shown. Conclusion. The development of PE proceeds alongside with significant epigenetic changes accompanied by changes in the microRNA expression profile which are associated with cardiovascular, cerebrovascular diseases, placental disorders. The detected differentially expressed microRNAs may be potential diagnostic markers of PE

What is in common between preeclampsia, HPS70 and medieval headwear? Part II. Serum HSP70 in superimposed preeclampsia: original study

The objective: to investigate serum heat shock protein 70 (HSP70) concentration in pregnant women with chronic hypertension and superimposed preeclampsia. To assess the prospects of using HSP70 as a superimposed preeclampsia predictor.Materials and methods. The original prospective cohort single-center observational study included 105 pregnant women with chronic hypertension and 34 healthy pregnant women as a control group. Serum HSP70 was measured via enzyme-linked immunosorbent assay. The first measurement point of serum HSP70 was at 28 weeks of gestation, the second measurement point was at 36 weeks in case of absence of preeclampsia or at 29-35 weeks in case of preeclampsia. If signs of preeclampsia appeared later than 36 weeks, additional HSP70 measurement was not performed. Statistical analysis was conducted using EZR 1.55 software.Results. In the study group (105 pregnant women with chronic hypertension), after delivery 30 patients had signs of superimposed preeclampsia (superimposed preeclampsia subgroup) and 75 persons had no signs of superimposed preeclampsia (chronic hypertension subgroup). In the control group (34 healthy pregnant women) 3 patients after delivery had preeclampsia signs (preeclampsia subgroup) and another 31 had no signs of preeclampsia (healthy subgroup).Serum HSP70 levels, obtained at the first measurement point (28 weeks) was statistically significantly different between three subgroups: patients with chronic hypertension vs. patients with superimposed preeclampsia (p<0.01), healthy pregnant women vs. chronic hypertension women (p<0.0001), healthy persons vs. superimposed preeclampsia persons (p<0.0001).Serum HSP70 concentrations at the second measurement point (36 weeks, or 29-35 weeks in case of preeclampsia) also had a statistically significant difference for each pair of subgroups (p<0.001). Given the small number of persons in the preeclampsia subgroup (3 women), it was not included in the calculations.No statistically significant difference between serum HSP70 levels in the first and second measurement points was found in healthy pregnant women subgroup. In the subgroup of pregnant women with chronic hypertension without superimposed preeclampsia complications, a statistically significant increased serum HSP70 concentration was found at 36 weeks compared to 28 weeks (p<0.0001). Even bigger growth of HSP70 levels compared to 28 weeks occurred in case of joining preeclampsia to chronic hypertension (p<0.0001).Conclusions. The data suggest an increased concentration of HSP70 in pregnant women with superimposed preeclampsia compared to pregnant women with chronic hypertension of the corresponding term. Thus, it is possible to assume that HSP70 plays a role in superimposed preeclampsia pathogenesis.The increased serum HSP70 levels in pregnant women with chronic hypertension, compared to healthy pregnant women of the corresponding gestational age was determined. Therefore, it can be argued that HSP70 has an influence on the course of chronic hypertension during pregnancy.No statistically significant dependance of serum HSP70 level in healthy pregnant women on gestational age was found. The increase in the level of HSP70 in pregnant women with chronic hypertension with increasing gestational age is most likely due to the progression of hypertensive disorders and/or related conditions. The highest HSP70 increase was observed in pregnant women with chronic hypertension with the addition of preeclampsia.The use of HSP70 as the only predictor of superimposed preeclampsia is not effective, given its non-specificity, but the use of this indicator in combination with other markers is promising and requires further study.

The model of screening for preeclampsia in the second and third trimesters of gestation

<b>Purpose:</b> Preeclampsia (PE) is a specific syndrome of multiple organ insufficiency in case of pregnancy, which is included in the panel of major obstetric syndromes and is among the main causes of maternal morbidity and mortality in the whole world.<br /> <b>Material and methods</b>: We conducted a prospective cohort study of 91 pregnant women to evaluate the effectiveness of integrated use of maternal risk factors (2019 International Federation of Gynecology and Obstetrics recommendations), placenta location (ultrasound at 18-20 weeks of gestation), and serum cystatin C (at 18-36 weeks of gestation) in screening for pe in the second and third trimesters of gestation.<br /> <b>Results: </b>In the subgroup of pregnant women with cystatin C levels greater than 1.0 mg/L (27 women), PE developed in 26 women, which is 96.29% in percentage terms. When calculating GFR for cystatin C in a group with PE there was a significant violation of the renal filtration system -52.46±2.08 (95% CI, 48.39-56.54), while in healthy group the indicator is within normal limits -97.6±1.64 (95% CI, 94.38-100.82). In the analysis of the ratio of cystatin C levels more than 1.0 mg / l and the development of PE, a sensitivity of 98.46%, specificity of 100% and accuracy of 98.9%, p<0.001.<br /> <b>Conclusions: </b>The data show that the combined model of maternal factors, ultrasound of the placenta and serum cystatin C, is prognostically effective in pregnant women in the second and third trimesters of gestation and is a reliable marker for the development of pe.

Diagnostic Accuracy of a Thick Blood Smear Compared to qPCR for Malaria Associated with Pregnancy in Colombia

This study aimed to evaluate the accuracy of the thick blood smear (TBS) versus quantitative polymerase chain reaction (qPCR) for the diagnosis of malaria associated with pregnancy (MAP) caused by P. falciparum or P. vivax in Colombia in its gestational malaria (GM), placental malaria (PM), and congenital malaria (CM) forms as well as to compare its accuracy in different subgroups of pregnant women according to the presence of fever, anemia and a history of malaria. This was a diagnostic evaluation of 829 pregnant women, 579 placentas, 381 umbilical cord samples, and 221 neonatal peripheral blood samples. Accuracy was evaluated based on the parameters of sensitivity, specificity, predictive values, likelihood ratios, and validity index, with their 95% confidence intervals. The frequency of GM was 36% (n = 297/829), PM 27% (n = 159/579), and CM 16.5% (n = 63/381) in umbilical cord samples and 2% (n = 5/221) in neonatal peripheral blood samples. For GM, the sensitivity was 55%, with higher rates in those infected with P. vivax (68%), with a history of malaria (69%), and with fever (96%). These three subgroups presented the best results in terms of the negative likelihood ratio and validity index. For PM, sensitivity was 8%; in subgroup analyses in terms of species, symptomatology (anemia and fever), and history of malaria, it was 1-18%, and the negative likelihood ratio was >0.80 in all subgroups. No false positives were recorded in any of the subgroups. The TBS did not detect any cases of CM. This study found the TBS yielded satisfactory results in terms of diagnosing GM for P. vivax, pregnant women with previous malaria and febrile. It also showed that the TBS is not useful for diagnosing PM and CM. It is necessary to conduct surveillance of MAP with molecular methods in in groups where TBS is deficient (asymptomatic GM, P. falciparum, and pregnant women without history of malaria) to optimize the timely treatment of PM and CM, avoid the deleterious effects of MAP and achieve the malaria elimination goals in Colombia.

Differential effectiveness of a practice change intervention to improve antenatal care addressing alcohol consumption during pregnancy: Exploratory subgroup analyses within a randomised stepped-wedge controlled trial

ObjectiveA practice change intervention demonstrated improvements in the provision of antenatal care addressing alcohol consumption. The aim of this study was to explore whether the effectiveness of the intervention differed between subgroups of pregnant women and types and location of maternity services. Design and SettingPost-hoc exploratory subgroup analyses of the outcomes from a randomised stepped-wedge controlled trial conducted with all public maternity services within three sectors of a local health district in Australia. MeasurementsTwo outcomes (receipt of alcohol assessment and complete care) measured at two visit types (initial and subsequent) were included in analyses. Logistic regression models explored interactions between pre-post differences and subgroups of women (age, Aboriginal origin, education level, disadvantage, gravidity and alcohol consumption in pregnancy) and services (geographic remoteness, service and provider type/s) that have been reported to be associated with variation in guideline implementation. FindingsSurveys from 5694 women were included in the analyses. For the initial visit, no significant differential intervention effects between subgroups of women or type/location of services were found for either outcome. For subsequent visits, the intervention effect differed significantly only between Aboriginal origin subgroups (Aboriginal OR: 1.95; 95% CI: 0.99-3.85; non-Aboriginal OR: 5.34; 95% CI: 4.17-6.83; p<0.01) and women's alcohol consumption in pregnancy subgroups (consumed alcohol OR: 1.28; 95% CI: 0.59-2.78; not consumed alcohol OR: 5.22; 95% CI: 4.11-6.65; p<0.001) for assessment of alcohol consumption. Key conclusionsThese exploratory results suggest that the intervention may have had similar effects between different subgroups of women and types and location of services, with the exception of women who were non-Aboriginal and women who had not consumed alcohol, for whom the intervention was potentially more effective. Implications for practiceThe practice change intervention could be implemented with different maternity service and provider types to effectively support improvements in antenatal care addressing alcohol consumption. These exploratory results provide further data for hypothesis generation regarding targeted areas for the testing of additional strategies that enable Aboriginal women to benefit equally from the intervention, and to ensure those women most in need of care, those consuming alcohol during pregnancy, have their care needs met.

Assessment of placental complex function and miscarriage prevention in pregnant women with uterine fibroid

The objective: to reduce the frequency of the threat of pregnancy interruption and loss in women with uterine fibroid through treatment prediction and improvement.Materials and methods. A complex examination of 70 pregnant women with uterine fibroid at 15-16 weeks of pregnancy (main group) and 50 pregnant women without uterine fibroid at the same gestational term (control group) was carried out at 4 clinical bases of the Department of Obstetrics and Gynecology N1 of the Shupyk National Healthcare University of Ukraine in the time period of 2020-2022. Pregnant women in the main group were divided into 2 subgroups depending on the type of the nodes: Ia – 39 pregnant women with subserous type of fibroid nodes (type 5-6 according to FIGO) and Ib – 31 pregnant women with intramural fibroid (type 3-4 according to FIGO). The pregnant women in the main group received the complex of developed therapy for pregnancy interruption (micronized progesterone, magnesium preparations, vitamin B6, acetylsalicylic acid), in the control one – the common therapy (bed rest, abstinence from sexual life, micronized progesterone preparations, tranexamic acid).The concentrations of estradiol, progesterone, human chorionic gonadotropin (hCG) were determined in the blood plasma of all persons at 15–16 weeks and 24 weeks of pregnancy.Results. In the II trimester the concentration of estradiol in the blood of pregnant women with intramural uterine fibroid, especially with multiple forms, was significantly higher than in the control group (p&lt;0.05). At the same time, in pregnant women with intramural fibroid node(s) the mean concentration of estradiol exceeded the similar indicator in the group with the subserosal type (p&lt;0.05). These changes indicated the stress of the hormonal function of the placenta and were considered by us as one of the signs of the initial stage of placental dysfunction.With an increase in estradiol concentration, a significant decrease in progesterone amount was noted. Progesterone deficiency was significantly more common in the subgroup of pregnant women with multiple intramural uterine fibroid and nodes in contact with the uterine cavity, especially at the place of placenta attachment (type 3) – 165.24±14.71nmol/l compared to the control group – 219.96±16.63 nmol/l, and with pregnant women with subserosal node(s) – 210.61±18.57 nmol/l (р&lt;0.01), which confirms the threat of abortion and indicates the development of placental dysfunction. In the II trimester of pregnancy the concentration of hCG in women with uterine fibroid was significantly lower than in women without uterine fibroid and especially lower in multiple uterine fibroid. In the women of the main group progesterone and hCG concentrations in the blood plasma normalized (p&gt;0.05) after the treatment, but the level of estradiol in the group of pregnant women with multiple intramural uterine leiomyoma remained significantly higher (p&lt;0.05).Conclusions. Pregnant women with uterine fibroid have an increased risk of placental dysfunction with a disbalance of the main placental hormones: an increase in estradiol concentration and a relative decrease in progesterone and human chorionic gonadotropin, a shift in the estrogen-progesterone balance towards relative hyperestrogenia.The use of medical measures with long-term support with progesterone, magnesium and low doses of acetylsalicylic acid for the prevention of miscarriage in persons with the clinical manifestations of the threat of gestation is quite effective.

ELEVATED ANION GAP AS A MARKER OF SEVERE SARS-COV-2 INFECTION IN PREGNANT PATIENTS WITHOUT DIABETES: A CASE SERIES

ELEVATED ANION GAP AS A MARKER OF SEVERE SARS-COV-2 INFECTION IN PREGNANT PATIENTS WITHOUT DIABETES: A CASE SERIES

Diet quality during pregnancy and its association with social factors: 3D Cohort Study (Design, Develop, Discover).

Good diet quality during pregnancy provides adequate nutrition to support both the mothers and the fetus. The objective of this study is to describe the distribution of diet quality during pregnancy and to study the association between social factors and diet quality during pregnancy in a Canadian population. This study was based on 1535 pregnant women who provided dietary information in the 3D Cohort Study in Quebec, Canada. A 3‐day food record was used to collect dietary intake in the second trimester of pregnancy. A Canadian adaption of the Healthy Eating Index (HEI‐C) 2010 was used to quantify diet quality. Univariate and multiple linear regression models were used to calculate unadjusted and adjusted effect estimates and confidence intervals for the association between social factors and HEI‐C. The mean HEI‐C 2010 score in this study was 62.9 (SD: 11.2). Only 4.5% and 8.3% of the pregnant women consumed the recommended amounts of whole grains and ‘greens and beans’, respectively. Diet quality was lower in some subgroups of pregnant women. After multivariable adjustment, lower diet quality was observed in participants who were less educated, younger, overweight or obese before pregnancy, or parous. There was an interaction between ethnicity and immigration status on diet quality in pregnancy. These findings could be useful for health practitioners and policymakers in developing strategies to improve the diet quality of pregnant women.

Screening of group B Streptococcus infection in pregnancy and neonatal outcomes in the province of Trento, Italy.

The study analyzes the trend of group B streptococcal (GBS) infection in pregnancy in the province of Trento, Italy, where a universal screening of GBS infection in pregnancy has been active for some time. Data from pregnant women who gave birth at local maternity units between 2015-2019 were obtained from birth attendance certificates (BAC), the main - and mandatory - source of information for monitoring pregnancies, births and neonatal health in Italy. The BAC used in the province of Trento acquires the results of a vast range of infections in pregnancy. The data collected from the BAC were integrated with those provided by the Hospital Information System (SIO). The occurrence of neonatal GBS infection was investigated on 2019 birth cohort, using the hospital discharge archive as an ancillary information source. Between 2015-2019, 20,905 pregnant women received care at maternity units of the province of Trento, Italy, of whom 25.5% were foreigners. The average coverage of GBS testing in pregnancy was 91.8% (95% CI 91.25-92.35) without significant variations from one year to the next. Test coverage varies in relation to maternity units and some socio-demographic characteristics of mothers. The average proportion of GBS positive cases over the study period was 21.0% (95% CI 20.7-21.3), a value that does not show statistically significant changes from one year to the next. The proportion of positive cases appears uneven among the subgroups of pregnant women considered, even if the differences are not statistically significant. In the 2019 birth cohort, newborns to GBS-positive mothers had an excess of stillbirths, of those born with Apgar at 5 minutes <7 and hospitalized at birth. However, these excesses were not statistically significant. Intravenous Antibiotic Prophylaxis (IAP) was performed in 86.8% of births from GBS positive mothers who had an indication for IAP. IAP was inadequate in 7.4% of the GBS positive mothers. Postnatal evaluation of 783 live births to GBS positive mothers identified 3 cases of early neonatal GBS infection. The incidence of neonatal GBS infection over the whole series of live births is 0.71/1,000 (95% CI 0.56-0.86), 0.68/1000 (CI 95% 0.55-0.79) in Italians and 1.07/1000 (95% CI 0.45-1.65) in foreigners. Data collection on infections in pregnancy through BAC allows area-based assessment. The quality of the data recorded in the BAC can be considered satisfactory but it was necessary to access to other information sources. The local availability of various information sources should allow periodic audits and closer monitoring of neonatal GBS infection.

Genetic assessment of hyperuricemia and gout in Asian, Native Hawaiian, and Pacific Islander subgroups of pregnant women: biospecimens repository cross-sectional study

BackgroundGout, an inflammatory condition, is characterized by the precipitation of monosodium urate crystals (MSU) in or around distal joints. The latter is caused by chronic hyperuricemia (HU)—high urate levels in the blood. Genetic variations in urate transporters play a significant role in determining urate levels within the human body, rendering some racial and ethnic groups more or less susceptible to developing either HU or gout. This study aims to estimate the frequencies of HU and gout risk alleles in Asian, Native Hawaiian, and Pacific Islander subgroups, using biorepository DNA samples.MethodsThe biospecimens repository at the University of Hawai’i provided DNA samples of consented post-partum women of Japanese, Filipino, Korean, Native Hawaiian, Samoan, and Marshallese descent. The DNA was previously extracted from maternal blood and genotyped at the Genomics and Bioinformatics Shared Resource, Cancer Center (Honolulu, HI). Nine urate genes: ABCG2, SLC2A9, SLC16A9, GCKR, SLC22A11, SLC22A12, LRR16A, PDZK1, and SLC17A1, were selected due to their significant association with HU and gout risk. Hardy–Weinberg Equilibrium (HWE) for genotype frequencies was assessed, using the Chi-Square test with p < 0.006 for statistical significance. Allele frequencies in our study were then compared to EUR from the 1000 Genomes Project Database Phase III, using Chi-square or Fisher's exact test, when appropriate. Bonferroni correction for multiple comparisons was used, with p < 0.006 for statistical significance.ResultsOur study involved 1059 post-partum women 18-year-old or older who self-reported their respective race and ethnicity, including Asian, Native Hawaiian, and Pacific Islander ancestry. The Asian subgroups included Japanese, Filipino, and Korean. The Pacific Islander subgroups included Marshallese and Samoan. None of the study participants had a history of gout. We excluded the PDZK1 gene from the final analysis due to its deviation from HWE (p < 0.006) across all the population subgroups, with eight loci remaining for cross-subgroup comparisons. Compared to EUR, the genetic polymorphism frequencies were significantly different-8/8 in Japanese, 6/8 in Korean, 6/8 in Filipino, 8/8 in Samoan, 6/8 in Native Hawaiian, and 6/8 in Marshallese. HU and gout risk alleles indices were 8, 6, 5, 5, 4, and 4 in Japanese, Filipino, Korean, Samoan, Marshallese, and Native Hawaiian, respectively. The percentage of cumulative risk alleles was 100% in both Japanese and Filipino, followed by 83.5% in Korean.ConclusionsCompared to EUR, Asian subgroups, particularly Japanese, Filipino, and Korean, had the highest percentage of the cumulative uric acid risk alleles. These results could partly explain the increased risk of developing gout among some Asian ancestral subgroups compared to EUR.

Состояние микробиома нижних отделов репродуктивного тракта у беременных, инфицированных уреаплазмами Ureaplasma urealyticum, в зависимости от степени колонизации

Assessment of the microbiome state of the lower parts of the reproductive tract in pregnant women infected with various concentrations of Ureaplasma urealyticum. Bacterioscopic and bacteriological tests of the vaginal secretions of 112 pregnant women infected with Ureaplasma urealyticum were performed using traditional methods. Isolated microorganisms were identified mainly up to the genus level. Ureaplasma urealyticum was isolated by the generally accepted quantitative variant of the bacteriological test. In 85.7% of pregnant women infected with U. urealyticum, coccoid and mixed morphotypes of bacteria prevailed in smears, whereas in conditionally healthy ones they were detected in 12.5% of samples. They were most often found to have an inflammatory reaction, key cells and a positive amine test. Changes in the qualitative and quantitative composition of the microbiome of the vaginal biotope—a decrease in the titer of resident microorganisms and an increase in the spectrum and number of opportunistic pathogens—were recorded in more than 80% of infected pregnant women. These disorders were more significant in the subgroup of pregnant women with high genital colonization with U. urealyticum. As a result, bacterial vaginosis and vaginitis were statistically significantly more common in infected women. Normocenosis was registered in 47.6% of cases, compared to 77.5% in the comparison group. U. urealyticum infection of the lower parts of the reproductive tract in pregnant women leads to significant violations of the microbiome of the vaginal biotope accompanied by the development of bacterial vaginosis (BV) and vaginitis. The probability of their development increases with a rise in the titer of ureaplasmas.

Magnetic resonance imaging (MRI) for diagnosis of acute appendicitis.

Appendicitis remains a difficult disease to diagnose, and imaging adjuncts are commonly employed. Magnetic resonance imaging (MRI) is an imaging test that can be used to diagnose appendicitis. It is not commonly regarded as a first-line imaging test for appendicitis, but the reported diagnostic accuracy in some studies is equivalent to computed tomography (CT) scans. As it does not expose patients to radiation, it is an attractive imaging modality, particularly in women and children. The primary objective was to determine the diagnostic accuracy of MRI for detecting appendicitis in all patients. Secondary objectives: To investigate the accuracy of MRI in subgroups of pregnant women, children, and adults. To investigate the potential influence of MRI scanning variables such as sequences, slice thickness, or field of view. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase until February 2021. We searched the references of included studies and other systematic reviews to identify further studies. We did not exclude studies that were unpublished, published in another language, or retrospective. We included studies that compared the outcome of an MRI scan for suspected appendicitis with a reference standard of histology, intraoperative findings, or clinical follow-up. Three study team members independently filtered search results for eligible studies. We independently extracted study data and assessed study quality using the Quality Assessment of Studies of Diagnostic Accuracy - Revised (QUADAS-2) tool. We used the bivariate model to calculate pooled estimates of sensitivity and specificity. We identified 58 studies with sufficient data for meta-analysis including a total of 7462 participants (1980 with and 5482 without acute appendicitis). Estimates of sensitivity ranged from 0.18 to 1.0; estimates of specificity ranged from 0.4 to 1.0. Summary sensitivity was 0.95 (95% confidence interval (CI) 0.94 to 0.97); summary specificity was 0.96 (95% CI 0.95 to 0.97). Sensitivity and specificity remained high on subgroup analysis for pregnant women (sensitivity 0.96 (95% CI 0.88 to 0.99); specificity 0.97 (95% CI 0.95 to 0.98); 21 studies, 2282 women); children (sensitivity 0.96 (95% CI 0.95 to 0.97); specificity 0.96 (95% CI 0.92 to 0.98); 17 studies, 2794 children); and adults (sensitivity 0.96 (95% CI 0.93 to 0.97); specificity 0.93 (95% CI 0.80 to 0.98); 9 studies, 1088 participants), as well as different scanning techniques. In a hypothetical cohort of 1000 patients, there would be 12 false-positive results and 30 false-negative results. Methodological quality of the included studies was poor, and the risk of bias was high or unclear in 53% to 83% of the QUADAS-2 domains. MRI appears to be highly accurate in confirming and excluding acute appendicitis in adults, children, and pregnant women regardless of protocol. The methodological quality of the included studies was generally low due to incomplete and low standards of follow-up, so summary estimates of sensitivity and specificity may be biased. We could not assess the impact and direction of potential bias given the very low number of high-quality studies. Studies comparing MRI protocols were few, and although we found no influence of MRI protocol variables on the summary estimates of accuracy, our results do not rule out that some MRI protocols are more accurate than others.

MODERN DIAGNOSIS OF PLACENTAL DYSFUNCTION AND ITS COMPLICATIONS

The aim of the study was to improve the modern diagnosis of placental dysfunction and its complications. Materials and methods. The study involved a prospective survey of 70 pregnant women divided into the main group (pregnant women with placental dysfunction) (n = 50) and the control group (n = 20). The main group was divided into subgroups of pregnant women with placental dysfunction and fetal growth retardation (n = 30) and pregnant women with placental dysfunction without fetal growth retardation (n = 20). The control group comprised 20 pregnant women with physiological gestation. Apart from history taking, the study comprised obstetric and general clinical examination, evaluation of endothelium- dependent vasodilation, serum concentrations of soluble forms of vascular and platelet- endothelial molecules of cell adhesion 1, indicators of athrombogenicity of the vascular growth wall, uterine-placental-fetal blood circulation, pathomorphological and histometric examination of the placenta. Results. Based on the obtained clinical-morphological and endotheliotropic criteria, a personalized clinical algorithm for managing pregnant women with placental dysfunction was developed and implemented. Conclusions. Assessment of pregnancy results in a prospective clinical study showed that the proposed algorithm for personalization of the risk of perinatal abnormalities not only helped to avoid antenatal mortality, but also to prevent intranatal and early neonatal losses in patients with placental dysfunction and fetal growth retardation.

Gestational Diabetes Mellitus (GDM) Risk for Declared Family History of Diabetes, in Combination with BMI Categories

Whether categories of family history of diabetes can act as independent risk factors for gestational diabetes mellitus (GDM-1, -2) has not yet been established, and neither has it been established how categories of body mass index (BMI) affect these relationships. A group of 912 women without chronic diseases, recruited in the first trimester, was investigated: 125 (13.7%) women developed GDM-1 (treated with diet); 21 (2.3%) women developed GDM-2 (treated with insulin); and a control group consisted of 766 non-diabetic women. A multiple logistic regression was used to evaluate adjusted odds ratios (AOR (95% confidence intervals)) of GDM-1 and GDM-2 for declared diabetes in the parents or grandparents (separately). These relationships were investigated in the whole cohort and subgroups of pre-pregnancy BMI. (1) Some categories of the family history were independent risk factors of GDM-1 or GDM-2. Compared to ‘absence of diabetes in the family’, women with diabetes in the father had a 3.68-fold increase in GDM-1 risk (AOR-b = 3.68 (2.23–6.07)), and women with diabetes in the mother had a 2.13-fold increase in GDM-1 risk (AOR-b = 2.13 (1.1–4.14)) and a 4.73-fold increase in GDM-2 risk (AOR-b = 4.73 (1.26–17.77)). Women with diabetes in the grandmother had a 2.34-fold increase in GDM-1 risk (AOR-b = 2.34 (1.29–4.24)). (2) The cumulative assessment of diabetes in the parents and/or grandparents was not related to the intensification of the risk of GDM, except for the increased risk of GDM-1 for diabetes in both mother and grandmothers simultaneously (AOR-b = 8.80 (1.16–66.57)), however, this group was very small. (3) The analyses in the subgroups of BMI categories showed that diabetes in the father was also an independent risk factor of GDM in the subgroup of pregnant women with normal BMI. In the subgroups of overweight and/or obesity, the risk of GDM for paternal and maternal diabetes was approximately twice as high as compared to the results of pregnant women with normal BMIs. Additionally, apart from the maternal influence of diabetes, the results suggest a significant influence of diabetes in the father on the risk of GDM, even (interestingly) in lean pregnant women.

Изучение ретинального кровотока у беременных с сахарным диабетом

Purpose. To investigate changes in retinal blood flow in pregnant women with diabetes mellitus (DM) using optical coherence tomography in angiography (OCTA) mode. Material and methods. 60 pregnant women were examined. The main group consisted of 24 women with DM type 1 and type 2. The control group was represented by 36 healthy women with physiological pregnancy. Women underwent OCTA on an Optovue RTVue XR Avanti device (Optovue Inc., USA) using the HD Angio Retina 6.0 mm scanning protocol. The total vascular density (TVD), foveal vascular density (FVD), and the area of the foveal avascular zone (AFAZ) in the superficial retinal plexus were studied. The survey was carried out in all trimesters of pregnancy in the main group, in the control group – in the third trimester. Results. When conducting a comparative analysis, no significant differences in the values of TDV and AFAZ were found between the main group and the control group. FVD values in pregnant women with diabetes were statistically significantly lower relative to the control group (p=0.001). There were no significant differences in FVD values in the subgroups of pregnant women with diabetic retinopathy (DR) and with diabetes and the absence of DR in the third trimester (p=0.114). However, AFAZ indices in patients with DR were significantly higher (p=0.039), and TDV – significantly lower in comparison with pregnant women with diabetes and no DR (p=0.035). Conclusions. 1. In pregnant women with diabetes in the third trimester, a statistically significant decrease in FPS in the superficial retinal plexus was revealed in comparison with healthy women with physiological pregnancy, in the absence of significant differences in TDV and AFAZ. 2. In pregnant women with DR in the third trimester, a statistically significant expansion of AFAZ with a decrease in TDV in the superficial plexus was revealed in comparison with pregnant women with DM and no DR. Key words: diabetes mellitus, diabetic retinopathy, optical coherence tomography in angiography mode, retinal blood flow.

Cross-sectional Study of Glucose Disturbances of Pregnant Women in Bulgaria

Hyperglycemia is one of the most common conditions during pregnancy. The International Diabetes Federation (IDF) estimates that one in six live births (16.8%) are in women with some form of Hyperglycemia during pregnancy. The aim is to analyze the frequency of Hyperglycemia during pregnancy through a cross-sectional multicenter population-based study in 84 settlements in Bulgaria, as well as to study the dynamics of this frequency during pregnancy. Material: We studied 547 pregnant women with a mean age of 30±5 years, divided into two groups - up to 24 gestational week – g.w. (n-386, 70.6%) and after 24 g.w. (n-161, 29.4%). Methods: BMI before pregnancy and the current one at the time of the study were calculated. A two-hour, 75 g oral glucose tolerance test (OGTT) was performed. Plasma glucose was quantitatively determined using enzymatic reference method with hexokinase (Roche reagent) on Cobas е501 analyzer, in one Central laboratory on the day of the blood sampling. The results were in mmol / l. The statistical analysis was performed using standard SPSS 13.0 for Windows. Results: Hyperglycemia was observed in 79 (14.4%) pregnant women after fasting state or in the course of classic OGTT, according to the criteria of WHO’2019, FIGO’2015, NICE’2015, and in the remaining 468 (85.6%) pregnant women - Normoglycemia. There was no significant difference in the level of glycemia between the three trimesters for each of the points of OGTT (0, 60, 120 minutes) in the subgroups of pregnant women with Hyperglycemia (up to 12 g.w, 13-24 g.w, after 24 g.w.). It turned out that the number and frequency of pregnant women with Hyperglycemia in the period up to 24 g.w. is 7.5% (29/386) and increases in the period after 24 g.w. reaching 31% (50/161), P < 0.01. According to the generally accepted population diagnostic criteria for diabetes in non-pregnant women, we found that 8.9% (7/79) of pregnant women with Hyperglycemia had Diabetes in Pregnancy (DIP), all of whom had a risk factor for Diabetes (two of them even 3 risk factors). Conclusion: As soon as pregnancy is established, verbal screening for diabetes risk factors should be performed as a first step in selecting pregnant women for glucose tolerance screening with classic OGTT to determine the glucose status of the pregnant woman.

Effects of low-molecular-weight heparin and aspirin in recurrent pre-eclampsia: A stratified cohort study.

To evaluate the effects of low-molecular-weight heparin (LMWH) combined with low-dose aspirin (LDA) in pregnant women with a history of pregnancy-related hypertensive disorders. In the current retrospective stratified cohort study, 33 women with previous hypertensive disorders of pregnancy treated with LMWH and LDA were compared with 37 control women who did not undergo LMWH or LDA treatment. Rates of pre-eclampsia recurrence, placental abruption, and other adverse outcomes for the fetuses and pregnant women were compared in the two groups. The pre-eclampsia recurrence rates were 12/33 (36.4%) in the LMWH+LDA group and 28/37 (75.7%) in the control group (P<0.01). In stratified cohort analysis, pregnant women with a history of early-onset pre-eclampsia, a body mass index of at least 24 (calculated as weight in kilograms divided by the square of height in meters), and aged less than 35years benefited from LMWH+LDA treatment. In women with chronic hypertension or a history of placental abruption there was no protective effect. There were no significant differences in other adverse outcomes such as placental abruption and small size for gestational age in fetuses or pregnant women in the two groups. Administration of LMWH+LDA only lowered the risk of pre-eclampsia recurrence in subgroups of pregnant women with a history of pregnancy-associated hypertensive disorders.

Prevention of Alcohol-Exposed Pregnancies and Fetal Alcohol Spectrum Disorder Among Pregnant and Postpartum Women: A Systematic Review.

Prenatal alcohol exposure can result in a wide range of adverse health outcomes, including in some cases fetal alcohol spectrum disorder (FASD), a lifelong neurodevelopmental disorder. Thus, there is pressing need for effective interventions to prevent alcohol-exposed pregnancies (AEPs). A systematic review was undertaken to provide an up-to-date analysis of the current prevention literature. PubMed, Embase, CINAHL, and PsycINFO were searched for relevant English-language articles published from 1970 onward. Studies were eligible for the current systematic review if the interventions included pregnant and postpartum women and/or their support networks to prevent AEPs and FASD. Outcomes of interest included alcohol consumption, knowledge, contraceptive use, neonatal outcomes, family well-being or functioning, economics, and healthcare utilization outcomes. Thirty-four peer-reviewed studies met the inclusion criteria. Fifteen studies employed brief intervention (BI) methods, 6 used long-term/intensive strategies, and 5 were educational interventions. A further 3 studies assessed counseling approaches, 2 evaluated multicomponent interventions, and 3 assessed nutritional supplementation interventions. The current review identified variable results from available interventions to prevent alcohol use among pregnant and postpartum women. Preliminary evidence demonstrated that BIs may be effective among subgroups of pregnant women with higher initial alcohol consumption, those with partner involvement, and those who used alcohol and other substances concurrently. Some preliminary evidence relating to long-term interventions with pregnant women with polysubstance use emerged, specifically case management that not only focused on reduction in substance use, but also on addressing the complex interplay between health and social well-being of families. Overall, additional research is required to improve the effectiveness of preventative approaches during pregnancy and the postpartum period.