Search

(Abstracted from BMJ2021;374:n1857)Placental growth factor (PlGF) has been suggested as a diagnostic biomarker of preeclampsia or placental dysfunction. PIGF typically circulates in maternal plasma and increases as placenta develops.

In this paper we present observations of ηCarinae in the 1.3 mm and 7 mm radio continuum, during the 2003.5 low excitation phase. The expected minimum in the light curves was confirmed at both wavelengths and was probably due to a decrease in the number of UV photons available to ionize the gas surrounding the binary system. At 7 mm a very well defined peak was superimposed on the declining flux density. It presented maximum amplitude in 29 June 2003 and lasted for about 10 days. We show that its origin can be free-free emission from the gas at the shock formed by wind-wind collision, which is also responsible for the observed X-ray emission. Even though the shock strength is strongly enhanced as the two stars in the binary system approach each other, during periastron passage the X-ray emission is strongly absorbed and the 7 mm observations represent the only direct evidence of this event.

Human erythrocytes lacking various blood group determinants were susceptible to invasion by Plasmodium falciparum including Duffy-negative erythrocytes that are refractory to invasion by Plasmodium knowlesi. Erythrocytes treated with trypsin or neuraminidase had reduced susceptibility of P. falciparum and normal susceptibility to P. knowlesi. Chymotrypsin treatment (0.1 mg/ml) blocked invasion only by P. knowlesi. The differential effect of enzymatic cleavage of determinats from the erythrocyte surface on invasion by these parasites suggests that P. falciparum and P. knowlesi interact with different determinants on the erythrocyte surface.

ObjectiveTo determine whether the addition of placental growth factor (PlGF) measurement to current clinical assessment of women with suspected pre-eclampsia before 37 weeks' gestation would reduce maternal morbidity without increasing neonatal morbidity.DesignStepped wedge cluster randomised control trial from 29 June 2017 to 26 April 2019.SettingNational multisite trial in seven maternity hospitals throughout the island of IrelandParticipantsWomen with a singleton pregnancy between 20+0to 36+6weeks’ gestation, with signs or symptoms suggestive of evolving pre-eclampsia. Of the 5718 women screened, 2583 were eligible and 2313 elected to participate.InterventionParticipants were assigned randomly to either usual care or to usual care plus the addition of point-of-care PlGF testing based on the randomisation status of their maternity hospital at the time point of enrolment.Main outcomes measuresCo-primary outcomes of composite maternal morbidity and composite neonatal morbidity. Analysis was on an individual participant level using mixed-effects Poisson regression adjusted for time effects (with robust standard errors) by intention-to-treat.ResultsOf the 4000 anticipated recruitment target, 2313 eligible participants (57%) were enrolled, of whom 2219 (96%) were included in the primary analysis. Of these, 1202 (54%) participants were assigned to the usual care group, and 1017 (46%) were assigned the intervention of additional point-of-care PlGF testing. The results demonstrate that the integration of point-of-care PlGF testing resulted in no evidence of a difference in maternal morbidity—457/1202 (38%) of women in the control group versus 330/1017 (32%) of women in the intervention group (adjusted risk ratio (RR) 1.01 (95% CI 0.76 to 1.36), P=0.92)—or in neonatal morbidity—527/1202 (43%) of neonates in the control group versus 484/1017 (47%) in the intervention group (adjusted RR 1.03 (0.89 to 1.21), P=0.67).ConclusionsThis was a pragmatic evaluation of an interventional diagnostic test, conducted nationally across multiple sites. These results do not support the incorporation of PlGF testing into routine clinical investigations for women presenting with suspected preterm pre-eclampsia, but nor do they exclude its potential benefit.Trial registrationClinicalTrials.gov NCT02881073.

Pregnancy at high altitude is associated with maternal hypoxaemic hypoxia with resultant intervillus blood hypoxia. Maternal haemoglobin concentration and blood gases were measured in pregnant women in two cities in Peru; Lima at sea level (n=18) and Cerro de Pasco at 4300 metres above sea level (n=12). Following delivery, placental sections from both groups were examined histomorphometrically using an image analysis system. Villus diameter, villus cross-sectional area, capillary diameter, capillary cross-sectional area and the percentage of villus cross-sectional area occupied by villus capillaries were calculated and parameters were compared between the two altitude groups. Maternal haemoglobin concentration and maternal blood pH were significantly higher, and maternal pO2, pCO2and O2saturation were significantly lower in the high altitude group compared to those at sea level. The villus vessel area as a percentage of villus cross-sectional area and capillary diameter were significantly greater in the cases from the high altitude group and villus vessel area as a percentage of the villus cross-sectional area was significantly related to maternal pO2(r=−0.7, P=0.01), and maternal pCO2(r=0.7,P=0.02), but multiple regression analysis demonstrated that only pO2remained significantly independently associated with these villus histological findings (P=0.03). Placental terminal villi from term pregnancies at high altitude show different morphological features from pregnancies at sea level, and these changes are primarily related to maternal pO2. The predominant morphological alteration is an increase in villus capillary diameter and therefore of the proportion of villus cross-sectional area occupied by capillary lumens.

Previously, the risk of intrauterine death in term infants of diabetic mothers led to elective delivery at 38 weeks, after confirmation that the lungs were mature. This study looked at perinatal outcomes in 148 women with well-controlled insulin-dependent diabetes who were allowed to enter labor spontaneously. All of them had reached 38 weeks with a live fetus, no obstetrical complications, and fasting blood glucose levels of 3 to 5 mM/liter (with 2-hour postprandial levels <7 mM/liter) through most of the pregnancy. One-third of the group were primigravidas. Half of the women delivered between 38 and 39 weeks’ gestation, and the rest delivered at 40 to 42 weeks’ gestation. Instrumental delivery was performed in 9 percent of cases, and cesarean delivery was performed in 7 percent.

BackgroundMobile apps offer a potentially effective approach to support healthier food behaviours if adequately designed and informed by behaviour change theory. Individuals from a lower socioeconomic background often report unhealthier dietary patterns and consequently may benefit from a mobile app intervention supporting healthier food behaviours. However, there is limited evidence available on the use of mobile health apps in this group. Previous work suggests that a reasonable standard of health and nutrition literacy is required for effective use of existing healthy eating mobile apps but this knowledge is often low in those from a lower socioeconomic background. Consequently, it is unclear if existing mobile apps are appropriate for this population group. The aim of this study is to explore the experiences of women from a lower socioeconomic background when using healthy eating mobile apps and the individual-level and mobile-specific factors that influence their experiences.MethodsA purposive sample of 15 women from a lower socioeconomic background and aged between 18–50 years were selected to participate. Participants completed a questionnaire assessing nutrition knowledge before using the assigned mobile apps. A total of three mobile apps were assessed in this study and were of varying quality in relation to nutrition content, behaviour change and user quality. Each participant was assigned to use two different mobile apps and used each for one week only. Assignment order was randomised. After the two-week period, semi-structured interviews were conducted with participants to discuss their experiences. Interviews were audio-recorded, transcribed verbatim, and analysed using a thematic analysis approach.ResultsPreliminary analysis suggests that overall mobile app quality is adequate but there is a need to improve the customisability of mobile apps to ensure they fit users’ needs. The food lives of participants vary and mobile apps need to be flexible to reflect this variety for integration of mobile apps into everyday life. The language used in a mobile app was a reason for discontinuing use as it was not clearly understood by users or was viewed as irrelevant.ConclusionExisting mobile apps may support healthier food behaviours in women from a lower socioeconomic background but changes in design may be required. A user-centred approach is recommended where users from a lower socioeconomic background are engaged at all stages of the design process. This may improve their relevance to this population group and increase their effectiveness in supporting healthier food behaviours.