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Context Excessive insulin resistance, inadequate insulin compensation, or both could result in gestational diabetes mellitus (GDM). Levels of pigment epithelium-derived factor (PEDF), a novel adipokine that could induce insulin resistance, are high in patients with obesity and diabetes. However, the impact of PEDF in pregnancy remains unknown. Objective This study aimed to elucidate the role of PEDF on insulin resistance and compensatory elevation of insulin levels during normal pregnancy and in patients with GDM. Methods In this population-based and cohort study, logistic regression analysis was performed to determine the association of PEDF/adiponectin/leptin levels with the risk of developing GDM and to predict postpartum prediabetes. PEDF protein, PEDF transgenic mice, PEDF knockout mice, and PEDF-neutralized antibodies were used to observe changes in insulin resistance and insulin levels with pregnancy. Results Plasma PEDF levels were increased in normal pregnancy and higher in GDM women. Higher PEDF levels were associated with the increased risk of developing GDM and emerged as a significant independent determinant of postpartum prediabetes in GDM women. Mechanistically, in vivo and in vitro experiments revealed that PEDF induced insulin resistance by inhibiting the insulin signaling pathway. Conclusion In addition to insulin resistance and upregulated insulin levels in normal pregnancy and GDM, aberrant PEDF levels can serve as a "fingerprint" of metabolic abnormalities during pregnancy. Thus, PEDF is a valuable biomarker but could interfere with the time course for early diagnosis and prognosis of GDM. [ABSTRACT FROM AUTHOR]

Background and purpose: Placental thickness measured at the level of the umbilical cord insertion can be used as a new parameter to estimate gestational age. The present study was undertaken to evaluate the relationship between placental thickness and gestational age and to assess the growth pattern of placenta with advancing gestational age in pregnancy induced hypertension and gestational diabetes mellitus. Objectives: 1. To assess the placental thickness in normal pregnancy, Pregnancy induced hypertension and gestational diabetes mellitus 2. To compare the placental thickness in normal pregnancy with placental thickness in gestational diabetes mellitus and in pregnancy induced hypertension. Methods: The study included 120 antenatal cases of gestational age between 24-28 weeks of gestation based on each 40 cases of normal pregnancy, gestational diabetes mellitus and pregnancy induced hypertension women aged between 18-40 years, who attending Adichunchanagiri Institute of Medical Sciences and referred to the Radiodiagnosis department for antenatal Ultrasound from the period of November 2019 to May 2020 The study mainly aimed at detailed assessment of placental thickness in normal pregnancy, pregnancy induced hypertension and gestational diabetes mellitus to assess the spectrum of placental changes and to correlate these findings with severity and duration of maternal disease and with the fetal outcome. A study of 120 pregnant patients were done with the collaboration of Department of Obstetrics and Gynecology, to find out the thickness of placenta in pregnancy induced hypertension, gestational diabetes mellitus and normal pregnancy. Mean placental thickness found to be much lower in the study group of pregnancy induced hypertension and increased in gestational diabetes mellitus in comparison to placental thickness of normal pregnancy. Placental thickness of normal pregnancy corresponds to the gestational age with normal fetal outcome. Multiparous women with increasing age groups were more likely to have gestational diabetes mellitus than primi-gravida women. Conclusion: To conclude on the outcome received in our study signifies placental thickness can be used as an accurate indicator for estimating the fetal and maternal well-being. The variations in placental thickness decide whether a fetus is considered to be at risk. Also in our study the thickness of placenta did not show any variation with the location of placenta. Abnormal placental thickness in the early stages helps to detect intrauterine growth restriction (IUGR) and gestational diabetes mellitus(GDM). In normal pregnancy the placental thickness almost corresponds to the gestational age and results in healthy fetus and mother. In GDM the placenta thickness appears thickened and undergoes alterations in its formation, structure, and function. According to the review, these alterations are related to an oxygenation deficiency in the fetus, changes in the transplacental transport of nutrients and other alterations that cause fetal overgrowth by increasing their availability, and other consequences to the developing fetus. Placental thickness is reduced in pregnancy induced hypertension due to increased blood pressure. Pregnancy induced hypertension, produces accelerated maturation and rapid aging of the chorionic villi with the risk of inducing a placental abruption. In addition, placental circulation is reduced causing decrease in oxygen saturation of the fetus. [ABSTRACT FROM AUTHOR]

Gestational trophoblastic neoplasia (GTN) is a rare neoplasm and is a spectrum of proliferative disorders of placenta. Invasive mole is a subtype of GTN that almost always arises after molar pregnancy. This report presents a 35-year-old woman with an atypical presentation of invasive mole after a normal pregnancy. The patient presented with a complaint of vaginal bleeding after normal vaginal delivery. Invasive mole was diagnosed based on findings of imaging and elevated beta human chorionic gonadotropin (ß-hCG) levels. Hysterectomy was finally decided upon due to severe vaginal bleeding and the patient’s request. Although GTN occurs after normal delivery, the patient recovered without receiving chemotherapy. It is important to consider all subtypes of GTN as a differential diagnosis of patients with abnormal postpartum bleeding and elevated ß-hCG levels even after a normal pregnancy.

Background: The development of the foetal kidneys can be monitored during the entire pregnancy by measuring their length and comparing them to typical charts. The ultrasonogram is thought to be a useful tool for assessing kidney growth and anomalies in foetuses, and it can help with the early detection and treatment of some kidney-related disorders. Objectives: 1. To perform obstetric USG in healthy women with uncomplicated pregnancy between 20 weeks and term gestation to determine correlation between fetal kidney length and gestational age. 2. To derive nomogram for estimating the gestational age of fetus from ultrasonographically measured fetal kidney length. 3. To assess the accuracy of fetal kidney length measurement in determining the Material & Methods: Study Design: Hospital based observational study. Study area: Department of Obstetrics & Gynecology, Narayana medical college and hospital, tertiary care center at Nellore, Andhra Pradesh. Study Period: April 2022 - March 2023. Study population: Pregnant women with uncomplicated pregnancy more than 20 weeks Attending Antenatal Outpatient department. Sample size: Study consisted a total of 100 subjects. Sampling Technique: Simple Random technique. Study tools and Data collection procedure: All the statutory requirements under PNDT act were followed and form F was obtained from all the patients. All the relevant clinical history was obtained and the correct LMP was confirmed. Transabdominal ultrasonography was performed with patient in supine position. Good acoustics coupling was obtained using synthetic ultrasound gel. Ultrasonography is done using Siemens Sonoline or Philips HD 7 ultra sound scanner using a 3.5-12MHz transducers, images were recorded in the thermal films using the digital camera Results: The association between the fetal measurements and FK GA. The correlation was best for FK GA versus AC (r: 0.876) and least for BPD (r: 0.808). All the correlation was statistically significant. Conclusion: FKL is reasonably a precise parameter for estimating GA. Measurement of FKL will prove significant when other biometric parameters failed to be measured in certain situations like engaged/fixed head and when head is not in correct plane. Hence, FKL can be used as a reliable parameter for determination of gestational age. [ABSTRACT FROM AUTHOR]

Aim: To determine the gestational age‐related changes in cervical gland length in relation to cervical length (CL) in normal singleton pregnancies. Methods: We studied 363 women with an uncomplicated singleton pregnancy (188 nulliparous and 175 multiparous women with one or more previous transvaginal deliveries). A total of 1138 cervical gland and CLs were measured longitudinally at 17–36 weeks of gestation using transvaginal ultrasonography along the curvature from the external os to the lower uterine segment and the internal end of the cervical gland area (CGA), respectively. Gestational age‐related changes in cervical gland and CLs and their relationships were analyzed using a linear mixed model. Results: Cervical gland and CLs decreased in different ways with advancing gestation depending on parity, and their changes were related to each other. The CGAs in nulliparous women were longer than those in multiparous women at 17–25 weeks of gestation (p < 0.05), but with no differences thereafter. CLs in multiparous women were different from those in nulliparous women at 17–23 and 35–36 weeks (p < 0.05), but there were no differences at 24–34 weeks. The cervix did not shorten compared with the CGA throughout the observational periods in nulliparous and multiparous women. Conclusions: Shortening of the cervix indicates changes to the lower uterine segment in normal pregnancies. The cervical gland region can be a useful marker representing the true cervix beyond 25 weeks of gestation, irrespective of parity. [ABSTRACT FROM AUTHOR]

BACKGROUND: Increased renal echogenicity is a nonspecific ultrasound finding. It may be a normal variation or suggestive of various underlying conditions like renal amyloidosis, chronic kidney disease, sickle cell disease and HIV associated nephropathy (HIVAN). Objective: To study maternal renal echogenicity in normal pregnancy, and explore its relationship with maternal baseline characteristics in our subregion. METHODS: This descriptive, cross-sectional study was conducted in the Obstetrics and Radiology Units of the two tertiary health facilities, one secondary facility and one radio-diagnostic facility, all in Bayelsa State, South-South Nigeria, between March-August 2022. The relationships between maternal renal echogenicity and age, parity and gestational age were explored using Chi-square test of proportion, while with an analysis of variance (ANOVA), the mean difference of age, weight and height between the grades of renal echogenicity was investigated. Kruskal Wallis test was deployed to examine parity in the grades of renal echogenicity. The level of significance was set at p<0.05. RESULTS: The study participants that had Grade 0, 1 and 2 renal echogenicity were 160 (39.7%), 403 (58.3%) and 8 (2.0%), respectively. There were statistically significant relationships between maternal renal echogenicity and maternal age (􀀀²=36.94; p=0.001), parity (􀀀²=64.29; p=0.001), gestational age (􀀀²=16.03; p=0.003) and body mass index (BMI) (􀀀2 = 45.15; p - 0.001). CONCLUSION: Our study revealed a significant relationship between maternal renal echogenicity in normal pregnancy and maternal baseline characteristics (age, parity, gestational age and weight). [ABSTRACT FROM AUTHOR]

Abstract Background On a clinical level, preeclampsia and atherosclerotic cardiovascular disease share common risk factors. Carotid intima media thickness (CIMT) is ultrasound-based imaging, non-invasive, simple, and reproducible method of subclinical atherosclerosis evaluation. Nowadays, there were studies concerning of CIMT among preeclamptic women, although the results were different. Objective To prove that CIMT among women with histories of preeclampsia was greater compared to normal pregnancy. Methods We conducted a meta-analysis of studies that reported CIMT, in women who had preeclampsia and had normal pregnancy. Studies were identified through three databases: PubMed, Google Scholar, and SAGE Journals with publication year of 2010–2020. Heterogeneity was assessed using the I 2 statistic. Standardized mean difference was used as measured of effect size. Results Nine eligible studies were included in the meta-analysis. This meta-analysis consisted of 439 women with preeclampsia histories and 526 women with normal pregnancy histories. Women who had preeclampsia had significantly higher CIMT compared to those with normal pregnancy with standardized mean difference −0.38 and 95% confidence interval (CI) −0.68 to −0.07 (p=0.02). Conclusion CIMT was greater among women with histories of preeclampsia compared to normal pregnancy. Trial registration PROSPERO CRD42021228825

This study was aimed at investigating the adaptive changes in myocardial work (MyW) during normal pregnancy. Sequential 2D standard and speckle-tracking echocardiography was performed on 41 pregnant women in each gestational trimester and 4 to 11 mo after delivery. Thirty-eight age-matched, healthy, non-pregnant women served as controls. Four components of MyW—global myocardial work index (GWI), constructive work (GCW), wasted work (GWW) and work efficiency (GWE)—were calculated. GWI began to decline early in the first trimester and remained at a low level until delivery; GCW gradually decreased with gestational progression and reached its lowest level in the third trimester. When compared with the values for non-pregnant women and those postpartum, GWE and GWW remained unchanged in gestation. This study provides normal ranges of MyW during pregnancy. Despite the adapted decrease in GWI and GCW, the myocardium manages to work efficiently in the healthy pregnancy with drastic hemodynamic alternations. [ABSTRACT FROM AUTHOR]

BACKGROUND: Foetal kidney length (FKL) measurements and comparisons to normal charts can be used to assess the development of the foetal kidneys throughout the entire course of pregnancy. This study was designed to assess FKL between 20 - 40 weeks' gestation, establish reference ranges for FKL and determine the relationship between FKL and gestational age (GA) in normal pregnancy. METHODS: This descriptive, cross-sectional study was conducted between March-August 2022, at the Obstetric Units and Radiology Departments of the two tertiary health facilities, one secondary facility and one radiodiagnostic facility in Bayelsa State, Southern Nigeria. Transabdominal ultrasound scan was used to evaluate the foetal kidneys. The relationship between foetal kidney dimensions and GA was explored using Pearson's correlation analysis. Linear regression analysis was done to define the relationship between GA and mean kidney length (MKL). A nomogram predicting GA from MKL was constructed. Level of significance was set at p<0.05. RESULTS: There was a very strong significant correlation between foetal renal dimensions and GA. The correlation coefficient between GA and mean FKL, width and anteroposterior diameter were 0.89 (p=0.001), 0.87 (p=0.001) and 0.82 (p=0.001), respectively. A unit change in mean FKL corresponded to a 79% change in GA (?2), showing a very strong association between mean FKL and GA. The regression equation: GA = 9.87 + 5.91 x MKL, was derived for estimation of GA for a given MKL. CONCLUSION: Our study revealed a significant relationship between FKL and GA. The FKL can therefore be reliably used to estimate GA. [ABSTRACT FROM AUTHOR]

Acute pyelonephritis, a risk factor for maternal sepsis, adult respiratory distress syndrome, and preterm labor, is a frequent cause of hospitalization. This condition is characterized by excessive intravascular inflammation and endothelial cell activation and dysfunction. Syndecan-1, a major component of the glycocalyx, is a gel-like layer that covers the luminal surface of healthy endothelial cells, preserving and mediating many endothelial functions. During pregnancy, there is an additional potential source of syndecan-1, the "syncytiotrophoblast glycocalyx," which lines the intervillous space. Insults that damage the glycocalyx lead to a shedding of syndecan-1 into the circulation. Hence, syndecan-1 has been proposed as a marker of endothelial injury in conditions such as sepsis, trauma, cardiovascular disease, and diabetes mellitus. The objective of this study was to determine whether the plasma syndecan-1 concentration changes in women with acute pyelonephritis in the presence or absence of bacteremia. This cross-sectional study included three groups: (1) non-pregnant women (n = 25); (2) women with an uncomplicated pregnancy from whom samples were collected preterm (n = 61) or at term (n = 69); and (3) pregnant women diagnosed with acute pyelonephritis from whom samples were collected at the time of diagnosis during the second and third trimesters (n = 33). The diagnosis of acute pyelonephritis was based on clinical findings and a positive urine culture for bacteria. Blood culture results were available in 85% (28/33) of women with acute pyelonephritis. Plasma concentrations of syndecan-1 were determined by a validated immunoassay. (1) Women with an uncomplicated pregnancy had a higher plasma concentration of syndecan-1 than non-pregnant women. The geometric mean (95% confidence interval [CI]) of syndecan-1 concentration was 51.0 (12.1–216.1) ng/mL in non-pregnant controls; 1280 (365–4487) ng/mL in normal preterm gestations; and 1786 (546–5834) ng/mL in normal term gestations (adjusted p <.005 for all three between group comparisons); (2) plasma syndecan-1 concentrations increased with gestational age among women with a normal pregnancy (p <.001, R2 = 0.27); (3) syndecan-1 multiple of the mean (MoM) values in pregnant patients with acute pyelonephritis were higher than those in normal pregnant women based on second- and third-trimester samples (p =.048, 1.26-fold change). The increase was driven primarily by cases with a positive blood culture (p =.009, 1.74-fold change); (4) when data from third-trimester samples were compared, overall differences in syndecan-1 MoM values between cases and controls were slightly larger (p =.03, 1.36- fold change), which were especially contributed to by cases with a positive blood culture (p =.023, fold change 1.79-fold change). Plasma syndecan-1 concentration is higher in pregnant women and increases as a function of gestational age. Patients with acute pyelonephritis have a higher plasma concentration of syndecan-1, and this is particularly the case in the presence of bacteremia. [ABSTRACT FROM AUTHOR]

Objective: To compare the features of the functioning of the ADAMTS-13 /vWF system in pregnant women with physiologically occurring pregnancy in the I, II, III trimester and in pregnant women with a physiological course in the I and II trimester, who developed late preeclampsia in the III trimester. Methods: At the first stage, we prospectively examined 167 women with a physiological course of pregnancy in the I, II, III trimester, however, 104 women (n=63; the main group) were excluded from the study (acute respiratory infections, premature birth, acute pyelonephritis, gestational diabetes mellitus, preeclampsia). In these women, we examined the levels of ADAMTS-13 antigen, vWF antigen and the ADAMTS-13/vWF axis and performed a comparative analysis of the indicators between pregnant women with a physiological course of pregnancy (n=63; the main group) in the I, II and III trimesters of gestation and healthy non-pregnant women (n=45; the control group). At the second stage of the study, a comparative analysis of ADAMTS-13 indicators was carried out ADAMTS-13:Ag, vWF:Ag and axis АDAMTS-13:Ag/vWF:Ag between patients with a physiological course of pregnancy in the I, II, III trimester (n= 63) and in patients with a physiological course of pregnancy in the I, II, trimester who developed preeclampsia after 34 weeks of gestation (n=15; the comparison group). Results: The average age in women with physiological pregnancy was 28.5±4.64 years (the main group), in patients with advanced late preeclampsia 29.2±6.24 years (comparison group)., in the control group 28.3±5.83 years. At the first stage of the study, we found out that starting from the second trimester of physiological pregnancy in the normal, the level of ADAMTS-13:Ag decreases and the level of vWF:Ag increases. The decrease in the level of ADAMTS-13:Ag in the second trimester was by 13% (0.855 [0.726; 0.92] U/ml), compared with the control group (0.909 [0.886; 1.00] U/ml) and by 17% in the third trimester (0.787 [0.72; 0.89]U/ml). We also revealed a decrease in the axis ADAMTS-13:Ag/vWF:Ag by 50% in the second trimester and by 59% in the third trimester. At the second stage of the study, when examining the ADAMTS-13:Ag/vWF:Ag, it was found that in the main group, the median of this indicator was 0.976 [0.895;1.09], and in the comparison group 0.573 [0.486;0.696] (p<0.01). A 13.3% decrease in the ADAMTS-13:Ag axis was revealed/vWF:Ag in the first trimester in patients who developed preeclampsia in the future. The area under the ROC curve corresponding to the relationship between the development of preeclampsia and the level of ADAMTS13:Ag/vWF:Ag was 0.952. The threshold value of ADAMTS-13:Ag/vWF:Ag at the cut-off point equal to 0.587 U/ml. If the ADAMTS 13:Ag/vWF:Ag level is equal to or lower than this value, a high risk of developing preeclampsia is predicted in the first trimester. Median ADAMTS-13:Ag/vWF:Ag in patients with preeclampsia in the second trimester was 0.269 [0.218-0.356], and in the third trimester 0.154 [0.131-0.200], compared with pregnant women whose pregnancy was physiologically 0.557 [0.475-0.631] (II trimester) and 0.447[0.394-0.48] (III trimester). Conclusion: Our study shows the normal functioning of the ADAMTS-13:Ag/vWF:Ag in healthy pregnant women in the I, II, and III trimesters. This is important to know, since a violation of this axis may indicate the development of possible pregnancy complications. Further research on this subject should be a priority for the obstetrics. [ABSTRACT FROM AUTHOR]

• The reference range of PA in normal pregnancy was evaluated. • PA increased more significantly in normal pregnancy than that in the controls. • Linear correlations were found between PA and Alb, PDW. It was recently shown that abnormal platelet aggregation (PA) had played a critical role in some adverse pregnancies. Till now reference range for PA in normal pregnancy has not been determined. Furthermore, few study has been conducted to explore the factors related to PA. Our study was performed to assess the reference range of PA in normal pregnancy (150 participants in the second trimester), and to determine whether it differs from that of the controls (38 nonpregnant participants). In addition, this study explored the factors related to PA. The results showed that PA was significantly higher in normal pregnancy than that in the controls (84.40% vs. 80.7%, respectively, P = 0.013). The reference interval for PA in normal pregnancy was 74.75%-94.77%. Hemoglobin (Hb), platelet counts (PLT) and albumin (Alb) were significant lower in normal pregnancy than those in the control group. Moreover, it was found that PA was positively correlated with PLT (r = 0.263, P < 0.001), and negatively correlated with platelet distribution width (PDW) (r = -0.342, P < 0.001) and mean platelet volume (r = -0.296, P < 0.001). Linear correlations between PA and Alb, PDW were proved by linear regression model (LRM). In conclusion, PA was enhanced in normal pregnancy, and Alb and PDW might be the possible contributing factors to PA. [ABSTRACT FROM AUTHOR]

Background and Objective: In pregnancies complicated by preeclampsia, it seems that failure of trophoblast invasion and induction of placental inflammation can lead to the production of biomarkers, one of which is CA-125. The aim of this study is to investigate serum CA-125 levels in non-severe and severe preeclampsia and compare it with normal pregnancy. Methods: This retrospective case-control study was conducted on 30 women with normal pregnancy, 27 women with mild preeclampsia and 30 women with severe preeclampsia referring to the midwifery clinic of Shahid Motahari Hospital in Urmia who met the inclusion criteria. The data evaluated in this study included gestational age, systolic and diastolic blood pressure, platelet, AST, ALT, serum creatinine, serum uric acid, serum CA-125 levels, urinary protein level and birth weight. Venous blood samples were collected at delivery for complete blood count, creatinine, uric acid and CA-125 concentration from all participants. Then the results were compared. Findings: The results of the present study showed that the mean CA-125 of women in the control group was 17.83±5.37 u/ml, in the mild preeclampsia group was 40.64±12.40 and in the severe preeclampsia group was 71.73±48.90, which indicates that this value is high in mild preeclampsia compared to the control group as well as severe preeclampsia compared to the other two groups. Statistical comparisons showed that there is a significant relationship between serum CA-125 levels in women with normal pregnancy and non-severe and severe preeclampsia (p

In this post hoc study, arachidonic acid (AA)-induced platelet aggregation during pregnancy with and without acetylsalicylic acid (ASA) treatment was studied in 323 women with unexplained recurrent first-trimester miscarriage and in 59 healthy women with normal pregnancies. All women had normal AA-induced platelet aggregation in the non-pregnant state. Women with recurrent miscarriage were treated with 75 mg ASA or placebo daily. AA-induced platelet aggregation was measured with multiple electrode impedance aggregometry and presented in units (U), where 1 U = 10 aggregation units x minutes. There were no significant differences in platelet aggregation between placebo-treated women with recurrent miscarriage and healthy women. The mean differences were -0.7 (95%CI; −7.0; 5.6) U in the non-pregnant state, 3.8 (95%CI; −4.6; 12.2) U during the late first trimester and 1.7 (95%CI; −6.7; 10.3) U and 4.1 (95%CI; −3.9; 12.0) U during the early and late third trimester, respectively. ASA reduced platelet aggregation by median −84.0% (Q1; Q3; −89.8; −76.3), −79.9% (−84.7; −69.2) and −75.7% (−83.5; −49.5), respectively, during pregnancy. The degree of inhibition by ASA decreased during the third trimester (p

Background: With the invention of more sophisticated ultrasonography techniques, there is room to explore and better comprehend the link between gestational age (GA), fetal weight (FW), and the diameter of the umbilical vein (UV). Aim: To explore the relationship between umbilical vein diameter (UVD) and GA as well as FW in normal pregnancy. Materials and Methods: This descriptive, cross-sectional study was conducted between February and August 2022 at the obstetric units and radiology departments of two tertiary health facilities: one secondary facility and one radiodiagnostic facility in the state. A transabdominal ultrasound scan was used to assess the UV. The relationship between UVD and GA and between UVD and estimated fetal weight (EFW) was explored using Pearson's correlation analysis. A nomogram was constructed, and the level of significance was set at P < 0.05. Results: There was a very strong, positive and significant relationship between UVD and GA (r =0.63; P = 0.001) and between UVD and EFW (r = 0.57; P = 0.001). For every unit change in GA, there was a 39% change in UVD (r2 = 0.39), while every unit change in FW was associated with a corresponding 33% change in UVD (r2 = 0.33). The regression coefficients for GA were 0.257 (β0) and 0.015 (β1), while β0 and β1 for FW were 0.590 and 0.069, respectively. Conclusion: Our study revealed a very strong, positive and significant relationship between UVD and GA and between UVD and EFW.

PURPOSE: The aim of this study was to achieve a control model of cardiac and respiratory function through key indicators established in a comparative analysis between the results of the initial and final pulse tests for women with normal pregnancies. METHODS: The research was done among 111 women, all Bulgarians. We used: functional tests for assessing the effects of our own original Recreational Wellness program with a specific focus on pregnant women. We measured the intensity of the tool branded under the name of the co-author Nesheva. RESULTS: During our own original Recreational Wellness program was established data by specific tests and the analysis has shown that the average values (Mean ± SD) of the measured indicators, in the six lessons are statistically different (p

The human placenta is a critical structure with multiple roles in pregnancy, including fetal nutrition and support, immunological, mechanical and chemical barrier as well as an endocrine activity. Besides, a growing body of evidence highlight the relevance of this organ on the maternofetal wellbeing not only during gestation, but also from birth onwards. Extracellular vesicles (EVs) are complex macromolecular structures of different size and content, acting as carriers of a diverse set of molecules and information from donor to recipient cells. Since its early development, the production and function of placental-derived EVs are essential to ensure an adequate progress of pregnancy. In turn, the fetus receives and produce their own EVs, highlighting the importance of these components in the maternofetal communication. Moreover, several studies have shown the clinical relevance of EVs in different obstetric pathologies such as preeclampsia, infectious diseases or gestational diabetes, among others, suggesting that they could be used as pathophysiological biomarkers of these diseases. Overall, the aim of this article is to present an updated review of the published basic and translational knowledge focusing on the role of placental-derived EVs in normal and pathological pregnancies. We suggest as well future lines of research to take in this novel and promising field.

Background: Studies on the electrocardiogram findings in African pregnant women are limited. There is no information available in the literature on the electrocardiographic parameters of pregnant Angolan women.Objectives: The aim of this study was to describe electrocardiographic findings in women with normal pregnancies in Bengo Province, Angola.Methods: This is a community-based study with a cross-sectional design conducted between September 2013 and March 2014 in Bengo. The study involved 114 black pregnant women, compared with a paired control group comprising of 120 black non-pregnant women, aged 15 to 42 years. A 12-lead electrocardiogram and a rhythm strip were recorded for all participants.Results: In this study, the mean age was 26.2 ± 7.3 years. Comparing pregnant women vs. non-pregnant, we found the following mean values: Heart rate (83 bpm vs. 74 bpm, p < .001), PR interval (146 ms vs. 151 ms, p = .034), QT interval (360 ms vs. 378 ms, p < .001), QTIc Fridericia (398 ms vs. 403, p = .017), QTIc Framingham (399 ms vs. 404 ms, p = .013) and T-wave axis (340 vs. 410 , p = .001).The main electrocardiographic changes found were: Sinus tachycardia (4.4% vs. 2.5%), T-wave inversion (14.9% vs. 1.7%), Minor ST segment depression (4.5% vs. 0%) and left ventricular hypertrophy (11.4% vs. 11.7%, p = .726).Conclusions: Pregnant Angolan women compared with controls, had several significantly higher values for heart rate, and significantly lower values of systolic blood pressure and diastolic blood pressure, PR interval, QT interval, QTc interval by Fridericia and Framingham and T-wave axis. Sinus tachycardia, T-wave inversion, and left ventricular hypertrophy, were the main electrocardiographic changes found. [ABSTRACT FROM AUTHOR]

Background: On a clinical level, preeclampsia and atherosclerotic cardiovascular disease share common risk factors. Carotid intima media thickness (CIMT) is ultrasound-based imaging, non-invasive, simple, and reproducible method of subclinical atherosclerosis evaluation. Nowadays, there were studies concerning of CIMT among preeclamptic women, although the results were different. Objective: To prove that CIMT among women with histories of preeclampsia was greater compared to normal pregnancy. Methods: We conducted a meta-analysis of studies that reported CIMT, in women who had preeclampsia and had normal pregnancy. Studies were identified through three databases: PubMed, Google Scholar, and SAGE Journals with publication year of 2010–2020. Heterogeneity was assessed using the I2 statistic. Standardized mean difference was used as measured of effect size. Results: Nine eligible studies were included in the meta-analysis. This meta-analysis consisted of 439 women with preeclampsia histories and 526 women with normal pregnancy histories. Women who had preeclampsia had significantly higher CIMT compared to those with normal pregnancy with standardized mean difference −0.38 and 95% confidence interval (CI) −0.68 to −0.07 (p=0.02). Conclusion: CIMT was greater among women with histories of preeclampsia compared to normal pregnancy. Trial registration: PROSPERO CRD42021228825 [ABSTRACT FROM AUTHOR]

The purpose of the study is to investigate the effects of delayed cord clamping on bilirubin levels and phototherapy rates in neonates of diabetic mothers. This was a prospective study that enrolled pregnant women without pregnancy complications and those with diabetes. Their neonates were randomized in a 1:1 ratio to delayed cord clamping. The main outcomes were the neonatal transcutaneous bilirubin values on 2–4 days postpartum and the rate of requiring phototherapy in infants. A total of 261 pregnant women were included in the final analysis (132 women with diabetic pregnancies and 129 women with normal pregnancies). In diabetic pregnancies, neonatal bilirubin levels on the 2–4 days postpartum and phototherapy rates were significantly higher in the delayed cord clamping group than in the immediate cord clamping group (7.65 ± 1.83 vs 8.25 ± 1.96, P = 0.039; 10.35 ± 2.23 vs 11.54 ± 2.56, P = 0.002; 11.54 ± 2.94 vs 12.83 ± 3.07 P = 0.024, 18.2% vs 6.3%, P = 0.042), while in normal pregnancies, there was no statistical difference in bilirubin values and phototherapy rates between the delayed cord clamping group and the immediate cord clamping group (P > 0.05). After receiving delayed cord clamping, bilirubin levels on the third postnatal day and the rate of requiring phototherapy in infants were higher in the diabetic pregnancy group than in the normal pregnancy group (10.35 ± 2.23 vs 11.54 ± 2.56, P = 0.013). Conclusion: Delayed cord clamping increased the risk of jaundice in newborns born to diabetic mothers, but had no effect in newborns from mothers with normal pregnancies. DCC may be a risk factor for increased bilirubin in infants of diabetic mothers. Trial registration: ClinicalTrials.gov: NCT04369313; date of registration: April 27, 2020 (retrospectively registered). What is Known: • Delayed cord clamping had significant benefits for newborns by increasing neonatal hemoglobin levels and reducing the risk of neonatal anemia, etc. • Delayed cord clamping may lead to neonatal hyperemia, erythrocytosis, and hyperbilirubinemia, which increases the risk of neonatal jaundice. What is New: • Our trial focused on the differential effects of delayed cord clamping on jaundice in full-term newborns between diabetic pregnancies and normal pregnancies. And newborns of diabetic mothers who received delayed cord clamping had a significantly increased risk of jaundice compared to newborns with normal pregnancy. • Delayed cord clamping may be a risk factor for increased bilirubin levels in neonates of diabetic mothers. [ABSTRACT FROM AUTHOR]

Metabolism regulates the phenotype and function of macrophages. After recruitment to local tissues, monocytes are influenced by the local microenvironment and differentiate into various macrophages depending on different metabolic pathways. However, the metabolic mechanisms underlying decidual macrophage differentiation remain unknown. Interleukin-10 (IL-10) is an important decidual macrophage inducer and promotes oxidative phosphorylation (OXPHOS) of bone marrow-derived macrophages. In this study, we mainly investigate the metabolic changes involved in IL-10-generated macrophages from monocytes using in vitro models. We demonstrate that exposure of monocytes (either peripheral or THP-1) to IL-10 altered the phenotype and function of resultant macrophages that are linked with OXPHOS changes. Interleukin-10 enhanced the mitochondrial complex I and III activity of THP-1 cell-differentiated macrophages and increased the mitochondrial membrane potential, intracellular adenosine triphosphate, and reactive oxygen species levels. Oxidative phosphorylation blockage with oligomycin changed the cell morphology of IL-10-generated macrophages and the expression levels of cytokines, such as transforming growth factor beta, tumor necrosis factor-alpha, interferon gamma, and IL-10, apart from changes in the expression level of the surface markers CD206, CD209, and CD163. Moreover, in vivo IL-10 administration reduced the lipopolysaccharide (LPS)-induced embryo resorption rate, and this effect was diminished when OXPHOS was inhibited, demonstrating that OXPHOS is important for the improved pregnancy outcomes of IL-10 in LPS-induced abortion-prone mice. Our findings provide deep insights into the roles of IL-10 in macrophage biology and pregnancy maintenance. Nevertheless, the direct evidence that OXPHOS is involved in decidual macrophage differentiation needs further investigations., (© The Author(s) 2024. Published by Oxford University Press on behalf of Society for the Study of Reproduction. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Abstract Background Studies on the electrocardiogram findings in African pregnant women are limited. There is no information available in the literature on the electrocardiographic parameters of pregnant Angolan women. Objectives The aim of this study was to describe electrocardiographic findings in women with normal pregnancies in Bengo Province, Angola. Methods This is a community‐based study with a cross‐sectional design conducted between September 2013 and March 2014 in Bengo. The study involved 114 black pregnant women, compared with a paired control group comprising of 120 black non‐pregnant women, aged 15 to 42 years. A 12‐lead electrocardiogram and a rhythm strip were recorded for all participants. Results In this study, the mean age was 26.2 ± 7.3 years. Comparing pregnant women vs. non‐pregnant, we found the following mean values: Heart rate (83 bpm vs. 74 bpm, p

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In this post hoc study, arachidonic acid (AA)-induced platelet aggregation during pregnancy with and without acetylsalicylic acid (ASA) treatment was studied in 323 women with unexplained recurrent first-trimester miscarriage and in 59 healthy women with normal pregnancies. All women had normal AA-induced platelet aggregation in the non-pregnant state. Women with recurrent miscarriage were treated with 75 mg ASA or placebo daily. AA-induced platelet aggregation was measured with multiple electrode impedance aggregometry and presented in units (U), where 1 U = 10 aggregation units x minutes. There were no significant differences in platelet aggregation between placebo-treated women with recurrent miscarriage and healthy women. The mean differences were -0.7 (95%CI; −7.0; 5.6) U in the non-pregnant state, 3.8 (95%CI; −4.6; 12.2) U during the late first trimester and 1.7 (95%CI; −6.7; 10.3) U and 4.1 (95%CI; −3.9; 12.0) U during the early and late third trimester, respectively. ASA reduced platelet aggregation by median −84.0% (Q1; Q3; −89.8; −76.3), −79.9% (−84.7; −69.2) and −75.7% (−83.5; −49.5), respectively, during pregnancy. The degree of inhibition by ASA decreased during the third trimester (p <.0001). There were two (1.9%) complete non-responders to ASA and 32.1% with a partial response. The rate of subsequent miscarriage was not affected by ASA, which did not seem to influence the rate of early miscarriage if treatment was initiated when a viable pregnancy was detectable by ultrasound. [ABSTRACT FROM AUTHOR]

Background and Objective: In pregnancies complicated by preeclampsia, it seems that failure of trophoblast invasion and induction of placental inflammation can lead to the production of biomarkers, one of which is CA-125. The aim of this study is to investigate serum CA-125 levels in non-severe and severe preeclampsia and compare it with normal pregnancy. Methods: This retrospective case-control study was conducted on 30 women with normal pregnancy, 27 women with mild preeclampsia and 30 women with severe preeclampsia referring to the midwifery clinic of Shahid Motahari Hospital in Urmia who met the inclusion criteria. The data evaluated in this study included gestational age, systolic and diastolic blood pressure, platelet, AST, ALT, serum creatinine, serum uric acid, serum CA-125 levels, urinary protein level and birth weight. Venous blood samples were collected at delivery for complete blood count, creatinine, uric acid and CA-125 concentration from all participants. Then the results were compared. Findings: The results of the present study showed that the mean CA-125 of women in the control group was 17.83±5.37 u/ml, in the mild preeclampsia group was 40.64±12.40 and in the severe preeclampsia group was 71.73±48.90, which indicates that this value is high in mild preeclampsia compared to the control group as well as severe preeclampsia compared to the other two groups. Statistical comparisons showed that there is a significant relationship between serum CA-125 levels in women with normal pregnancy and non-severe and severe preeclampsia (p<0.001). Conclusion: The results of the present study showed that CA-125 is associated with the occurrence of preeclampsia (mild and severe) and can be helpful as a marker in the diagnosis of preeclampsia, especially its severe type. Moreover, due to the relationship between this marker and a wide range of other variables, paying attention to its serum level along with other paraclinical variables can be helpful in better diagnosis and management of patients. [ABSTRACT FROM AUTHOR]

Pregnancy is a dynamic process, which induces a multitude of anatomic, physiological, biochemical, and psychological changes. Physiological changes during pregnancy allow the body to meet the increased metabolic demands of the mother and fetus by maintaining adequate uteroplacental circulation, and ensure fetal growth and development. These changes begin early in the first trimester and are brought on by the increased circulating levels of progesterone and estrogen, which are produced by the ovary in the first 12 weeks of pregnancy and thereafter by the placenta. While some of these cause a change in biochemical values, others may mimic symptoms of medical disease. For instance, cardiac changes such as sinus tachycardia, systolic heart murmurs, and cardiac enlargement could be interpreted as signs of heart disease. It is thus crucial, to differentiate between normal physiological changes and pathological changes, particularly for clinicians involved in the care of pregnant patient. [ABSTRACT FROM AUTHOR]

PURPOSE: The aim of this study was to achieve a control model of cardiac and respiratory function through key indicators established in a comparative analysis between the results of the initial and final pulse tests for women with normal pregnancies. METHODS: The research was done among 111 women, all Bulgarians. We used: functional tests for assessing the effects of our own original Recreational Wellness program with a specific focus on pregnant women. We measured the intensity of the tool branded under the name of the co-author Nesheva. RESULTS: During our own original Recreational Wellness program was established data by specific tests and the analysis has shown that the average values (Mean ± SD) of the measured indicators, in the six lessons are statistically different (p <0.05). These indicators are interpreted as optimal prenatal improvement of health care, but probably our Recreational Wellness program also favours the maintenance of Wellness lifestyle during all period of pregnancy. CONCLUSIONS: The results in our study are in support of establishing a system for assessing information to improve health care during the period of a normal pregnancy. This specific instrument is a reliable basis for validating standards for regulated inclusion in Recreational Wellness activity programs. [ABSTRACT FROM AUTHOR]

Polyhydramnios is a common feature diagnosed by ultrasound in the second half of pregnancy. Biochemical analysis of amniotic fluid can be useful when suspecting Bartter syndrome or digestive atresia but in most of cases, no etiology of polyhydramnios is found because of the complex regulation of amniotic fluid. Aquaporins (AQP) are transmembrane channel proteins contributing to water transfers. Some of them are expressed in fetal membranes and placenta. Their expression has been shown to be disrupted in some pathological conditions such as maternal diabetes, often associated with polyhydramnios. AQP-1, 3 and 8 levels in amniotic fluid were retrospectively measured in patients suffering from polyhydramnios (n=21) from 23 weeks of gestation (WG). They were compared to the levels observed in control subjects (n=96) and their relationship with maternal factors and neonatal issues was analyzed. AQP-1, 3, 8 levels were physiologically fluctuating, AQP-1 levels always being the lowest and AQP-3 the highest, with a significant decrease at the end of pregnancy. AQPs/AFP ratios increased about 8 folds during pregnancy, their kinetic profiles reflecting physiological dynamic evolution of amniotic fluid volume. In polyhydramnios, AQP-3 level tended to be decreased whereas AQP-8 level was decreased from mid-gestation whatever the etiology of polyhydramnios. No significant relationship was found between AQPs levels and either the fetal prematurity degree or macrosomia. No specific pattern was observed in idiopathic polyhydramnios, limiting the interest of AQPs dosage in amniotic fluid in the management of those complicated pregnancies. [ABSTRACT FROM AUTHOR]

Abstract Background Probiotic supplementation has been shown to be beneficial and is now widely promoted as an auxiliary medicine for maternal health, but the underlying mechanism is still unclear. Thus, this study aimed to explore the effects of probiotic supplementation on the placental autophagy-related proteins LC3 and Beclin1. Method A population-based cohort of specimens was collected under sterile conditions from 37 healthy nulliparous pregnant women who underwent systemic examination and delivered at the First Affiliated Hospital of Jinan University (Guangzhou, China). At 32 weeks of gestation, the pregnant women in the probiotic group were orally supplemented with golden bifid, and the pregnant women in the control group received no probiotic. Pregnant women with pregnancy-associated complications were excluded in the follow-up period, and 25 pregnant women undergoing spontaneous delivery were enrolled. The placental tissue specimens were collected at term. Western blotting was used to detect the protein expression, and qRT-PCR was used to detect the mRNA expression of the placental autophagy-related proteins LC3 and Beclin1. Results ①There was no significant difference in the expression levels of either LC3 or Beclin1 protein between the two groups (P > 0.05). ②Probiotic supplementation induced a modest but not significant decrease in the content of LC3-mRNA with a significant decrease in the content of Beclin1-mRNA (P

CONTEXT: The diagnosis of an ectopic pregnancy (EP) requires the usage of serial beta-human chorionic gonadotropin (hCG) measurements and ultrasonography to locate the gestational sac. With the rising trends in its incidence, a rapid, noninvasive biomarker to detect this condition at the earliest can aid in decreasing the morbidity and mortality linked with EP. AIMS: This study was performed to determine the serum level of soluble FMS-like tyrosine kinase-1 (sFLT-1) at 4–10-week gestation in EP and normal pregnancy and to identify whether it can be used as a biomarker to distinguish an EP from a normal intrauterine pregnancy. SETTINGS AND DESIGN: This was a prospective case–control study conducted over 2 years from 2015 to 2017 in 280 women between the age groups of 19 and 38 years at a tertiary level hospital. SUBJECTS AND METHODS: Levels of sFLT-1 in sera of 140 women with EP and 140 women with normal pregnancy were assayed by a sandwich enzyme-linked immunosorbent assay at Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India. STATISTICAL ANALYSIS USED: Statistical analyses were performed with SPSS software version 16.0, and P ≤ 0.05 was considered statistically significant. RESULTS: The median sFLT-1 level in EP was 419 pg/ml. This was significantly lower than the value of 898 pg/ml in normal pregnancy. Receiver operating characteristic curve analysis showed that at a cutoff of 623 pg/ml, sFLT-1 was able to distinguish an EP from a normal intrauterine pregnancy with a sensitivity of 98.6% and a specificity of 90.7%. CONCLUSIONS: The present study showed the significant early lowering of sFLT-1 in EP and may be considered as an effective biomarker compared to beta-hCG.

Introduction: Maternal metabolism undergoes dynamic changes during pregnancy. A deviation from this physiological metabolic status might be involved in the pathogenesis of pregnancy complications, such as recurrent pregnancy loss (RPL). Decidua is an important uterine tissue, which provides immunological protection as well as nutritional support to the developing embryo during early pregnancy. Previous studies have shown that aberrant metabolism of the decidua is related to the etiology of RPL. However, the metabolic profile of the decidua in RPL has not yet been fully elucidated.Methods: In the current study, decidual samples from RPL patients (n = 23) and normal pregnancy (NP) women (n = 30) were collected, and hydrophilic and hydrophobic metabolites were extracted and measured using a liquid chromatography electrospray ionization tandem mass spectrometry system. Besides, the mRNA expression of several critical enzymes involved in sphingolipid metabolism and glycerophospholipid metabolism was detected.Results: The OSC-PLS-DA scores plot illustrates that metabolic differences are present in the decidual tissue of RPL patients compared with that of NP women. Combining multivariate analysis with univariate statistical analysis, a total of 62 metabolites related to RPL were selected, including carnitine, glycerophospholipids, sphingomyelin (SM), ceramide, organic acids and their derivatives, and amino acid metabolomics. KEGG analysis showed that abnormalities in multiple metabolic pathways occurred in RPL decidua, including vitamin digestion and absorption, tryptophan metabolism, citrate cycle, arginine biosynthesis, glycerophospholipid metabolism, sphingolipid metabolism, and sphingolipid signaling pathway. Increased SM synthase and decreased Phospholipase A2 Group IIE mRNA levels were detected in RPL compared with NP group.Discussion: Disruption of decidual metabolism, especially glycerophospholipid metabolism and sphingolipid metabolism, might be involved in the occurrence of RPL. [ABSTRACT FROM AUTHOR]

Purpose: There is still controversy regarding the changes of ventricular-arterial coupling (VAC) during normal pregnancy. The possible influence of chest shape on VAC during normal pregnancy has never been investigated.Methods: Between October 2019 and June 2020, 59 healthy pregnant women (33.7 ± 4.4 years/old) were consecutively included. They underwent obstetric visit, modified Haller index (MHI) assessment, and complete echocardiographic evaluation with blood pressure measurement to assess arterial elastance (Ea), end-systolic elastance (Ees), and Ea/Ees as an index of VAC, at 12-14 weeks and 36-38 weeks gestation, then 6-9 weeks after delivery.Results: VAC progressively increased from the first to the third trimester of pregnancy, then decreased in the postpartum (P < 0.0001) in the whole study population. Women with concave-shaped chest wall (MHI >2.5, n = 31) but not women with normal chest shape (MHI ≤2.5, n = 28) showed a progressive increase in VAC during normal pregnancy. Women with MHI >2.5 showed a significantly less pronounced increase in stroke volume index (SVi) from the first to the third trimester of pregnancy. There was a strong linear correlation between third trimester MHI and VAC (r = 0.93).Conclusions: Anatomical and/or extrinsic mechanical factors rather than impaired arterial elastance or reduced left ventricular contractility may contribute to changes in VAC during normal pregnancy in women with concave-shaped chest wall. [ABSTRACT FROM AUTHOR]

Obesity is prevalent among women of reproductive age and is associated with increased risk of developing multiple pregnancy disorders. Pregnancy must induce immune tolerance to avoid fetal rejection, while obesity can cause chronic inflammation through activating the immune system. Impaired maternal immuno-tolerance leads to pregnancy failure, such as recurrent spontaneous abortion (RSA), one of the most common complications during early pregnancy. How does maternal immune response change under obesity stress in normal pregnancy and RSA? In turn, is obesity affected by different gestational statuses? Limited information is presently available now. Our study investigated pregnancy outcomes and maternal immune responses in two murine models (normal pregnancy and spontaneous abortion models) after obesity challenge with a high-fat diet (HFD). Abortion-prone mice fed HFD had significantly higher weight gains during pregnancy than normal pregnant mice with HFD feeding. Nonetheless, the embryo implantation and resorption rates were comparable between HFD and normal chow diet (NCD)-fed mice in each model. Evaluation of immune cell subsets showed HFD-induced obesity drove the upregulation of activated NK cell-activating receptor (NKp46)+ NK cells and pro-inflammatory macrophages (MHCIIhigh Mφ) as well as CD4+ and CD8+ T cells in the normal pregnancy group. However, in the abortion-prone group, relative more immature NK cells with decreased activity phenotypes were found in obese mice. Moreover, there were increased DCreg (CD11bhigh DC) cells and decreased CD4+ and CD8+ T cells detected in the HFD abortion-prone mice relative to those fed the NCD diet. Our findings reveal how pregnancy obesity and maternal immune regulation are mutually influenced. It is worth noting that the abortion-prone model where active maternal immune status was intensified by obesity, in turn stimulated an overcompensation response, leading to an over-tolerized immune status, and predisposing to potential risks of perinatal complications.

Pregnancy is a complicated and insidious state with various aspects to consider, including the well-being of the mother and child. Developing better non-invasive tests that cover a broader range of disorders with lower false-positive rates is a fundamental necessity in the prenatal medicine field, and, in this sense, the application of metabolomics could be extremely useful. Metabolomics measures and analyses the products of cellular biochemistry. As a biomarker discovery tool, the integrated holistic approach of metabolomics can yield new diagnostic or therapeutic approaches. In this review, we identify and summarize prenatal metabolomics studies and identify themes and controversies. We conducted a comprehensive search of PubMed and Google Scholar for all publications through January 2020 using combinations of the following keywords: nuclear magnetic resonance, mass spectrometry, metabolic profiling, prenatal diagnosis, pregnancy, chromosomal or aneuploidy, pre-eclampsia, fetal growth restriction, pre-term labor, and congenital defect. Metabolite detection with high throughput systems aided by advanced bioinformatics and network analysis allowed for the identification of new potential prenatal biomarkers and therapeutic targets. We took into consideration the scientific papers issued between the years 2000–2020, thus observing that the larger number of them were mainly published in the last 10 years. Initial small metabolomics studies in perinatology suggest that previously unidentified biochemical pathways and predictive biomarkers may be clinically useful. Although the scientific community is considering metabolomics with increasing attention for the study of prenatal medicine as well, more in-depth studies would be useful in order to advance toward the clinic world as the obtained results appear to be still preliminary. Employing metabolomics approaches to understand fetal and perinatal pathophysiology requires further research with larger sample sizes and rigorous testing of pilot studies using various omics and traditional hypothesis-driven experimental approaches.

Obesity is prevalent among women of reproductive age and is associated with increased risk of developing multiple pregnancy disorders. Pregnancy must induce immune tolerance to avoid fetal rejection, while obesity can cause chronic inflammation through activating the immune system. Impaired maternal immuno-tolerance leads to pregnancy failure, such as recurrent spontaneous abortion (RSA), one of the most common complications during early pregnancy. How does maternal immune response change under obesity stress in normal pregnancy and RSA? In turn, is obesity affected by different gestational statuses? Limited information is presently available now. Our study investigated pregnancy outcomes and maternal immune responses in two murine models (normal pregnancy and spontaneous abortion models) after obesity challenge with a high-fat diet (HFD). Abortion-prone mice fed HFD had significantly higher weight gains during pregnancy than normal pregnant mice with HFD feeding. Nonetheless, the embryo implantation and resorption rates were comparable between HFD and normal chow diet (NCD)-fed mice in each model. Evaluation of immune cell subsets showed HFD-induced obesity drove the upregulation of activated NK cell-activating receptor (NKp46)+ NK cells and pro-inflammatory macrophages (MHCIIhigh M φ) as well as CD4+ and CD8+ T cells in the normal pregnancy group. However, in the abortion-prone group, relative more immature NK cells with decreased activity phenotypes were found in obese mice. Moreover, there were increased DCreg (CD11bhigh DC) cells and decreased CD4+ and CD8+ T cells detected in the HFD abortion-prone mice relative to those fed the NCD diet. Our findings reveal how pregnancy obesity and maternal immune regulation are mutually influenced. It is worth noting that the abortion-prone model where active maternal immune status was intensified by obesity, in turn stimulated an overcompensation response, leading to an over-tolerized immune status, and predisposing to potential risks of perinatal complications. [ABSTRACT FROM AUTHOR]

Objective To assess the level of aldosterone hormone in preeclamptic pregnant woman and comparing it with normal pregnancy. Patients and methods A prospective case–control study that was conducted on 80 pregnant women with gestational age from 28 to 40 weeks and attended Al Zahraa University Hospital, Al Azhar University, in the period from December 2019 to December 2020. The selected participants were divided into two groups: group I (control group) (n=40), which included 40 normal pregnant women, and group II (n=40) (cases group), which is further subdivided into two subgroups: subgroup A (n=20): cases with mild preeclampsia, and subgroup B (n=20) cases with severe preeclampsia. Approximately 5 ml of venous blood was collected once from both study group and control group by antecubital venipuncture, using a sterile disposable syringe, without using elastic band tourniquet. Half of the amount collected was transferred immediately into commercially prepared concentration of ethylene diamine tetra-acetic acid containers. The remaining half was allowed to clot and the serum was obtained by centrifugation at 3000 rpm for 10 min or the remaining investigations including serum aldosterone concentration estimation by enzyme immunoassay. Results Regarding the serum aldosterone levels, there was a highly statistically significant difference among control, mild preeclampsia, and severe preeclampsia groups (P=0.003). The mean aldosterone of the study participants was 0.76, with SD of 0.27, and ranged from 0.2 to 1.39 in control group; 0.83, with SD of 0.13, and ranged from 0.59 to 1.06 weeks in mild preeclampsia group; and 1.10, with SD of 0.59, and ranged from 0.65 to 2.88 in severe preeclampsia group. Conclusion The aldosterone hormone may play an important role in the pathogenesis of elevated blood pressure in this pathological state and may be used in the prediction of the severity of preeclampsia. [ABSTRACT FROM AUTHOR]

Background: Maternal thyroid dysfunction has been associated with ad¬verse pregnancy outcomes. Objectives: The present study was conducted to determine trimester-specific reference intervals (TRIs) for serum thyroid stimulating hormone (TSH), total circulating thyroxine (TT4), total circulating triiodothyronine (TT3), free triiodothyronine (FT3) and free thyroxine (FT4) on healthy pregnant women in Mumbai region. Materials and Methods: A case-control study designed with 50 normal pregnant women that randomly selected from the first (20 samples), the second (13 samples), and the third (17 samples) trimesters and 50 randomly selected non-pregnant healthy controls. Thyroid function tests were estimated by chemiluminescent immunoassay method. Results: TRIs of TSH, TT3, TT4, FT3 and FT4 for first trimester pregnancies were 0.45-3.11µIU/mL, 139-222 ng/dL, 9.24-19.2µg/dL, 1.87-5.40 pg/mL, and 1.06-1.66 ng/dL respectively. TRIs for second trimester pregnancies were 0.63-3.88 µIU/mL, 150-231 ng/dL, 8.75-18.0 µg/dL, 2.40-3.58 pg/mL, and 0.79-1.41 ng/dL. TRIs for third trimester pregnancies were 0.75-3.92 µIU/mL, 162-252 ng/dL, 7.91-14.3 µg/dL, 2.10-2.98 pg/mL, and 0.72-1.34 ng/dL. TRIs for TSH, TT3, TT4, FT4 and FT3 were different from non-pregnant normal reference intervals. Conclusions: The reference intervals of thyroid function tests in pregnant women differ among trimesters.

A healthy pregnancy requires the development of maternal-fetal immune tolerance against the semi-allogeneic fetus. The interactions between the trophoblastic cells and the maternal immune cells (p.e., natural killer cells, T cells, macrophages, dendritic cells and B-cells) are important for the development of the maternal-fetal immune tolerance and the placental growth and function. These interactions are mediated by cell to cell contact and secreted molecules such as cytokines, chemokines, angiogenic factors and growth factors. The maternal immune cells are present in normal non-pregnant and pregnant endometrium and there are several lines of evidence based on immunohistochemical and RNA sequencing data that the decidual immune cells and immune-related pathways display alterations in GTD, which may have pathogenetic and clinical significance. The present review focuses on the usefulness of the immunohistochemical analysis which provides multiparametric in situ information regarding the numbers, the immunophenotypes and the immunotopographical distributions of the decidual immune cells in tissue sections from normal pregnancy and GTD. We also discuss the significance of the immunohistochemical information in order to gain insight in the putative mechanisms explaining the alterations of the decidual immune cells in GTD and the potential implications of these alterations in the pathogenesis and the clinical behavior of GTD. [ABSTRACT FROM AUTHOR]

The anatomical and physiological changes that accompany normal pregnancy are profound. It is therefore not surprising that, as the various systems adapt, changes result that overlap with those seen in disease. Additionally, sub-clinical disease can be unmasked during pregnancy, when the physiological adaptation to pregnancy provides an additional stress test. Common symptoms may include palpitations, dyspnoea, peripheral oedema, nausea, vomiting and pruritus. Underlying alterations in major organs can explain a large number of benign symptoms and signs. It is prudent that clinicians are aware of symptoms and signs that warrant further investigation and that may be associated with disease. Furthermore, biochemical and haematological variables may also be altered in pregnancy, and this should be taken into account when interpreting blood results. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate the importance of serum concentration of magnesium (Mg) in the first trimester of pregnancy for predicting pre-eclampsia (PE). Methods: This prospective study included 403 pregnant women over 18, with singleton pregnancy (from 11 to 14 weeks of pregnancy). The subjects were divided into a group who subsequently developed PE (PEKT) (n = 61), and a group of healthy pregnancies with no complications and with normal outcomes (TNT) (n = 342). In the first trimester, urea, creatinine, uric acid, Mg, free beta subunit of human chorionic gonadotrophin, plasma protein A related to pregnancy, and C-reactive protein were determined. We followed all subjects until the end of pregnancy. Results: Serum Mg is significantly lower in PEKT than in TNT group (p

The survival of allogeneic fetuses during pregnancy is a rather paradoxical phenomenon with a complex mechanism. Chemokine ligand12 (CXCL12) and its receptors CXC chemokine receptor (CXCR)4 and 7 are extensively found in placenta tissues and cells, including trophoblast cells, vascular endothelial cells, and decidual stromal and decidual immune cells (eg, NK cells and regulatory T cells). Evidence has illustrated that the CXClL12/CXCR4/CXCR7 axis could enhance the cross talk at the maternal‐fetal interface through multiple processes, such as invasion and placental angiogenesis, which appears to be critical signaling components in placentation and fetal outcome. In addition, an increasing number of studies have demonstrated that the CXCL12/CXCR4/CXCR7 axis also stands out for its pleiotropic roles in several pregnancy‐associated diseases (eg, recurrent spontaneous abortion (RSA), pre‐eclampsia (PE), and preterm labor). In the present review, the different biological properties and signaling in physiological and pathological pregnancy conditions of CXCL12/CXCR4/CXCR7 axis were discussed, with the aim of obtaining a further understanding of the regulatory mechanisms and highlighting their potential as a target for therapeutic approaches. [ABSTRACT FROM AUTHOR]

Background: Probiotic supplementation has been shown to be beneficial and is now widely promoted as an auxiliary medicine for maternal health, but the underlying mechanism is still unclear. Thus, this study aimed to explore the effects of probiotic supplementation on the placental autophagy-related proteins LC3 and Beclin1.Method: A population-based cohort of specimens was collected under sterile conditions from 37 healthy nulliparous pregnant women who underwent systemic examination and delivered at the First Affiliated Hospital of Jinan University (Guangzhou, China). At 32 weeks of gestation, the pregnant women in the probiotic group were orally supplemented with golden bifid, and the pregnant women in the control group received no probiotic. Pregnant women with pregnancy-associated complications were excluded in the follow-up period, and 25 pregnant women undergoing spontaneous delivery were enrolled. The placental tissue specimens were collected at term. Western blotting was used to detect the protein expression, and qRT-PCR was used to detect the mRNA expression of the placental autophagy-related proteins LC3 and Beclin1.Results: ①There was no significant difference in the expression levels of either LC3 or Beclin1 protein between the two groups (P > 0.05). ②Probiotic supplementation induced a modest but not significant decrease in the content of LC3-mRNA with a significant decrease in the content of Beclin1-mRNA (P < 0.05).Conclusion: Our study indicates that probiotic supplementation may reduce Beclin1-mRNA levels. [ABSTRACT FROM AUTHOR]

Aim: The objective of the study is to evaluate the normal physiological changes in values of major hematological parameters occur during the normal pregnancy Method: Blood samples (5ml EDTA) were taken voluntarily after consent obtained from from 50 healthy pregnant women from 20 to 40 year s old who presented themselves at Khartoum teaching during their regularly follow-up. Questionnaires and direct interview were used to collect demographic and clinical data. CBC and part differential (WBC, RBC, Hb, PCV, and platelets), were measured by Sysmex and the plasma clotting time PT and PTT were measured by coagulometer. Results: W'BCs mean value was 7.580 cell/mm, RBCs mean value was 4.1 × l012/L, Hb mean value was 11.79 g/dL, Platelets mean value was 256 × 109/L, PT mean value of the study group was 13.40 seconds and PTT mean value was 36.20 seconds. Conclusion: It can be concluded that no statistical significance in RBCs, HB, platelets. PT and PTT between pregnant women in the three different trimesters while white WBCs count showed different decreased but not statistical significant among the three groups, the highest value was round in the second group followed by the third group and the lowest value found in the first group. [ABSTRACT FROM AUTHOR]

CONTEXT: The diagnosis of an ectopic pregnancy (EP) requires the usage of serial beta-human chorionic gonadotropin (hCG) measurements and ultrasonography to locate the gestational sac. With the rising trends in its incidence, a rapid, noninvasive biomarker to detect this condition at the earliest can aid in decreasing the morbidity and mortality linked with EP. AIMS: This study was performed to determine the serum level of soluble FMS-like tyrosine kinase-1 (sFLT-1) at 4–10-week gestation in EP and normal pregnancy and to identify whether it can be used as a biomarker to distinguish an EP from a normal intrauterine pregnancy. SETTINGS AND DESIGN: This was a prospective case–control study conducted over 2 years from 2015 to 2017 in 280 women between the age groups of 19 and 38 years at a tertiary level hospital. SUBJECTS AND METHODS: Levels of sFLT-1 in sera of 140 women with EP and 140 women with normal pregnancy were assayed by a sandwich enzyme-linked immunosorbent assay at Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India. STATISTICAL ANALYSIS USED: Statistical analyses were performed with SPSS software version 16.0, andP ≤ 0.05 was considered statistically significant. RESULTS: The median sFLT-1 level in EP was 419 pg/ml. This was significantly lower than the value of 898 pg/ml in normal pregnancy. Receiver operating characteristic curve analysis showed that at a cutoff of 623 pg/ml, sFLT-1 was able to distinguish an EP from a normal intrauterine pregnancy with a sensitivity of 98.6% and a specificity of 90.7%. CONCLUSIONS: The present study showed the significant early lowering of sFLT-1 in EP and may be considered as an effective biomarker compared to beta-hCG. [ABSTRACT FROM AUTHOR]

Objective: To assess and to look at serum levels of calcium, magnesium, uric acid and C-reactive protein in mild, extreme preeclamptic ladies and ordinary pregnant ladies and to connect these levels with seriousness of the ailment. Methods: This investigation was a planned observational case-control study that was led at the division of Obstetrics and Gynecology, Al-Azhar University, Maternity Hospital on 90 pregnant ladies in the third trimester of pregnancy (gestational age from 28 to 40 weeks of pregnancy) chosen from the individuals who had gone to the antenatal facility and the banquet hall in the period from January 2018 to June 2019. They were divided into 3 groups: 30 patients with serious preeclampsia, 30 patients with gentle preeclampsia and 30 normotensive ladies free of any medicinal issue (control group). The study was approved by the medical ethics committee of Al-Azhar University Hospitals and a written informed consent is obtained from all participants. Results: The mean estimations of CRP and serum uric acid were fundamentally higher in the pregnant ladies with preeclampsia than in the sound control ladies (p<0.05), while the mean estimations of serum calcium were altogether lower in the pregnant ladies with preeclampsia than in the solid control ladies (p<0.05). The mean serum magnesium didn't demonstrate critical contrasts among preeclampsia and solid ladies (p>0.05). Conclusion: These discoveries bolster the speculation that hypocalcaemia, hyperuricemia and expanded C-reactive protein could be potential etiologies of preeclampsia and that they relate to the seriousness of the illness. [ABSTRACT FROM AUTHOR]

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Introduction: Newborn birth weight is a major indicator of health. Although it is influenced by many conditions that affect maternal and feto-placental units, several sociocultural, religious, and geographical factors cannot be ignored. Considering this, the present study was conducted in a tertiary hospital in Khammam, Telangana to determine the average birth weight in normal pregnancy at term. Materials and Methods: All the babies, born following normal pregnancy from January 2013 to June 2015, were included in this study to establish their birth weight. Babies born without being affected by any factor influencing fetal weight were considered for the study. Some exclusion criteria such as short maternal height and teenage pregnancy were considered in this study. Results: There were 633 cases in the study group, out of which 226 were primipara and 407 were multipara. Average birth weight for all cases was 2790 g. Average birth weight for the first born babies was 2770 g, whereas in later born, it was 2800 g. Average birth weight of male newborn babies was 2860 g, whereas it was 2710 g for female newborn babies. Conclusion: Abnormal birth weight leads to many complications, both immediate and remote. However, to predict and manage such complications, one must know the average newborn birth weight. This study is the first of its kind in rural Telangana.