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Background: Being obese can lead to various complications during pregnancy, such as Gestational Diabetes Mellitus (GDM), pregnancy induced hypertension (PIH), Pre-Eclampsia (PE), and Large Gestational Age (LGA). Although bariatric surgery is an effective way to treat obesity, it can also result in complications and may be linked to having small for gestational age (SGA) babies. This cohort study protocol aims to compare the maternal and fetal/neonatal outcomes of two groups of Iranian pregnant women: those who have undergone bariatric surgery and those who are obese but have not had bariatric surgery., Methods: In this study Pregnant women (< 14 weeks' gestation) (n = 38 per group) are recruited either from one of the obesity clinic (exposure group = with a history of bariatric surgery) or primary healthcare clinics in Tehran city (comparison group = pregnant women with obesity and and no history of bariatric surgery). Dietary intake and nutrient status are assessed at < 14, 28, and 36 weeks. Maternal and fetal/neonatal outcomes are compared between the two groups, including gestational diabetes, preeclampsia, preterm labor, intrauterine growth restriction, severe nausea and vomiting, abortion, placenta previa and abruption, venous thrombosis, vaginal bleeding, cesarean delivery, meconium aspiration, and respiratory distress. Maternal serum levels of ferritin, albumin, zinc, calcium, magnesium, selenium, copper, vitamins A, B9, B12, and 25-hydroxy Vit D are checked during 24th to 28th weeks. Maternal and neonatal outcomes, including height, weight, head circumference, fetal abnormality, infection, small or large fetus, low birth weight, macrosomia, NICU admission, and total weight gain during pregnancy, are measured at birth. Maternal and offspring outcomes, including weight, height, head circumference, total weight gain during pregnancy, newborn diseases, postpartum bleeding, breastfeeding, and related problems, are assessed 6 weeks after delivery. Child's weight, height, and head circumference are followed at 2, 4, 6, 8, 10, and 12 months after birth. Maternal stress, anxiety, and depression are assessed with the DASS-21 questionnaire, and physical activity is evaluated using the PPAQ questionnaire in the first and third trimesters., Discussion: By assessing the levels of micronutrients in the blood of pregnant women along with the evaluation of pregnancy outcomes, it is feasible to gain a more accurate understanding of how bariatric surgery affects the health and potential complications for both the mother and the fetus/newborn. This information can help specialists and patients make more informed decisions about the surgery. Additionally, by examining issues such as stress, anxiety, and depression in women undergoing surgery, this study can contribute to recognizing these problems, which can also affect pregnancy outcomes., (© 2024. The Author(s).)

Objectives: To compare between the two methods of magnesium sulfate administration for duration of 12 versus 24 h after delivery in patients with severe preeclampsia., Method: The study was performed as a randomized clinical trial on 182 cases of severe preeclampsia. In one group, Mg sulfate (MgSO4) was prescribed for 12 h after delivery and, in the other group, it was prescribed for 24 h after delivery. Both groups were compared for occurrence of convulsion and other adverse effects., Results: The women of the two groups did not have significant difference according to age, BMI, parity and gravidity, gestational age at the time of delivery. Also, systolic blood pressure, diastolic blood pressure, antihypertensive use, previous diabetes and renal disorders, gestational diabetes, and proteinuria were similar in both groups before treatment. One woman had convulsion in the 12-h group and MgSO4 was continued for 24 h in this case. Blood pressure, urine volume, and laboratory indexes did not show significant differences between the two groups before and after treatment. Also, adverse effects were similar in both groups. Pain of the injection site was less in the 12-h group (p = 0.048)., Conclusion: Administration of MgSO4 for a duration of 12 h after delivery should be considered somehow as effective as 24 h prescription for preventing convulsion after delivery.

Aim: The purpose of the present study was to evaluate the diagnostic value of maternal serum high-sensitivity C-reactive protein (hs-CRP) measurement during the first trimester of pregnancy for predicting pre-eclampsia., Material and Methods: A prospective cohort study was performed on 394 pregnant women who were at the gestational age of 8-13 weeks. In all women, serum hs-CRP was measured by latex agglutination test. The women were then monitored to delivery. We compared the hs-CRP of the two groups, those with and without pre-eclampsia. We used the receiver-operator curve for finding the optimum cut-off points., Results: Out of 394 women, 42 cases (10.7%) were complicated by pre-eclampsia, of whom 23 women (56.1%) had severe pre-eclampsia. Mean serum hs-CRP of the pre-eclamptic group was higher than that of the normotensive group (7.06 ± 2.6 mg/L vs 3.6 ± 2.3 mg/L, P = 0.001). The receiver-operator curve showed a significant difference between the under-curve zone for the hs-CRP level with the reference line. Serum hs-CRP of 4 mg/L showed sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy as 78.1%, 72.1%, 25%, 96.5% and 72.8%, respectively. Hs-CRP of more than 7 mg/L was found in 26 (61.9%) cases of pre-eclampsia and 22 (6.25%) normotensive pregnancies, which showed a significant difference (P = 0.001, relative risk = 12.1, 95% confidence interval: 6.91-21.15). Hs-CRP of more than 7 mg/L was found in 17 (73.91%) cases of severe pre-eclampsia and 22 (6.25%) normotensive pregnancies, which showed a significant difference (P = 0.001, relative risk = 9.35, 95% confidence interval: 4.48-19.52)., Conclusion: Hs-CRP measurements during the first trimester of pregnancy are helpful in predicting pre-eclampsia., (© 2013 The Authors. Journal of Obstetrics and Gynaecology Research © 2013 Japan Society of Obstetrics and Gynecology.)

Objective: To compare the cerebro vascular reactivity (CVR) of middle cerebral artery (MCA) in response to CO2 5% inhalation between preeclamptic and normotensive pregnant women, also, between mild and severe preeclampsia., Study Design: A comparative study was performed on 61 women with preeclampsia and 65 normotensive pregnant women who were in the third trimester of gestation. MCA transcranial Doppler ultrasound was used to measure CVR in response to CO2 5% inhalation. Pulsatility index (PI), resistance index (RI), blood pressure, maternal age, gestational age and gravidity were also recorded., Results: Baseline PI and RI were lower in the preeclamptic group (p < 0.05). Inhalation of CO2 5% caused significant increase in CVR among normotensive pregnant women in comparison with preeclamptic group (1.006 ± 0.229 versus 0.503 ± 0.209, p = 0.0001). Significantly, more cerebral vasodilatation was found among mild preeclamptic women in comparison with severe preeclamptic women (0.583 ± 0.193 versus 0.383 ± 0.173, p = 0.0001). The receiver operating characteristics curve analysis revealed acceptable difference between CO2 stimulation test of preeclamptic and normotensive women (Area under curve = 0.973, p = 0.0001)., Conclusion: CVR in response to CO2 5% is less in preeclamptic pregnant women than normotensives, also, in severe preeclampsia, it is less than mild preeclampsia.

Background: Apolipoprotein E (ApoE) polymorphism plays a significant role in the development of several diseases, but its role in the preeclampsia disease incidence is not clear. Therefore, the purpose of this study was to investigate the susceptibility of some pregnant women to preeclampsia., Methods: In a comparative cross-sectional study, the ApoE polymorphism genotypes were investigated in 100 patients with preeclampcia and 100 normal pregnant, using the polymerase chain reactions (PCR) analysis. Serum lipids and lipoproteins concentrations were also evaluated using the commercially available kits., Results: The difference in distribution of the epsilon2/epsilon2, epsilon2/epsilon3, epsilon2/epsilon4, epsilon3/epsilon3, epsilon3/epsilon4 and epsilon4/epsilon4 genotypes between patient subjects and controls was not significantly (p = 0.266). The data obtained for Apo epsilon4, epsilon2 and epsilon3 alleles in the patient group was not different significantly from those obtained for the control group (p = 0.220). The VLDL and TG levels of the patient group were higher significantly than controls (p < 0.01, p < 0.01 respectively). The data obtained for HDL concentration (52.2 +/- 16.1 g/dL) of the patient group was not different significantly from controls (49.4 +/- 12.5 g/dL). The difference between LDL concentration of patients with preeclampsia and controls was not significant. The cholesterol concentration of control subjects was not different significantly from patient subjects., Conclusions: The observed profiles of ApoE alleles and genotypes frequencies suggest that Apo E polymorphism does not play a major role in the development of preeclampsia. Nonetheless, the abnormal lipid profiles that we found in patients with preeclampsia may have a genetic explanation and/or contribution.

Introduction: Pre-eclampsia is one of the most serious complications in pregnancy and is one of the major causes of maternal death. Therefore, its prediction has special importance and many studies have been performed on different materials, which may be useful for its prediction., Objective: The purpose of the present study is to evaluate the calcium to creatinine ratio for the prediction of pre-eclampsia., Method: A prospective cohort study was performed on 150 pregnant women, who were aged from 15 to 35 years. A single urine sample was obtained at 20-24 weeks of gestation for measurement of urine calcium to creatinine ratio. The women were then monitored for delivery and this ratio was compared between the women with and without pre-eclampsia., Results: Mean urine calcium of pre-eclamptic women was significantly lower than normotensive women (179 ± 35 mg/dl vs 272 ± 59 mg/dl, P < 0.001). Mean calcium to creatinine ratio was significantly lower in pre-eclamptic women (0.07 ± 0.007 vs 0.16 ± 0.006, P < 0.001). The optimal cut off point for calcium to creatinine ratio was calculated to be 0.071 with a sensitivity of 77% and specificity of 78%., Conclusion: Urine calcium and calcium to creatinine ratio are lower in pre-eclamptic women and may be used as a screening test for the prediction of pre-eclampsia.

Objective: To compare the serum androgens level during the third trimester of pregnancy between normotensive and pre-eclamptic women., Method: A case-control study was performed on 64 pregnant women with the gestational age of 28-34 weeks. 32 women were pre-eclamptic (case group), and 32 women were normotensive till term gestation (control group). The serum level of androgens including sex hormone binding globulin (SHBG), total and free testosterone, androstenedione (ADD), and dehydroepiandrosterone sulfate (DHEA-S), were compared between the two groups., Results: The women of the two groups had no statistically significant difference according to age, gestational age, BMI (body mass index), parity and fetal sex. Serum level of SHBG (90.86 ± 9.30 vs. 55.86 ± 8.02 nmol/l, p = 0.02), total testosterone (3.70 ± 0.57 vs. 2.06 ± 0.24 ng/ml, p = 0.01), free testosterone (1.28 ± 0. 17 vs. 0. 74 ± 0.07 pg/ml, p = 0.01), and ADD (2.47 ± 0.10 vs. 2.17 ± 0.10 ng/ml, p = 0.04), was higher in the pre-eclamptic women. However, there was no difference between the two groups for DHEA-S (0.75 ± 0.18 vs. 0.51 ± 0.08 μg/ml, p = 0.19)., Conclusion: Serum androgen levels during third trimester of pregnancy are higher in pre-eclamptic women and this may propose an effect of androgens in the pathogenesis of pre-eclampsia.

This study evaluated some risk factors for pre-eclampsia, which is one of the most problematic complications of pregnancy. This was a retrospective case control study conducted on 318 pre-eclamptic women (case group) and 318 women who were normotensive at the time of delivery as the control group. Evaluated factors were: maternal age, gestational age, nuliparity, mother's educational status, maternal body mass index (BMI), maternal hemoglobin and blood Rh, familial history of pre-eclampsia, history of pre-eclampsia in a previous pregnancy, marital relations, urinary infection (UTI) during the present pregnancy, season of delivery, and method of contraception. Risk factors for pre-eclampsia were: UTI (P=0.04); history of pre-eclampsia during previous pregnancy (P=0.003), and winter season (P=0.001). Maternal age of more than 20 years, high educational status of mother, parity more than one, and oral contraceptive pills were protective for pre-eclampsia. After adjusting for all possible confounding factors using multiple logistic regression, only preexisting pre-eclampsia (P=0.004) was a risk factor, whereas parity more than three (P=0.007) and anemia (P=0.01) were protective for pre-eclampsia. The rate of cesarean delivery was more common in the pre-eclamptic group (245 cases, 77%) than the control group (85 cases, 26.7%). The one minute Apgar score of neonates less than 8 was more common in the case group (28.6% vs. 47.4%, P<0.001). Gestational age at the time of delivery was lower in the case group (36.48±3.4 weeks vs. 37.12±3.3 weeks, P<0.001). Awareness of risk factors of pre-eclampsia can help to monitor patients, ensure earlier diagnosis and predict which patients are more likely to develop pre-eclampsia.