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Background: To reduce neonatal mortality, it is necessary to identify neonates with fetal malnutrition at birth using the clinical assessment score (CAN score). Furthermore, comprehensive summary data that shows burden of fetal malnutrition in Africa is scarce. As a result, this systematic review and meta-analysis aimed to assess fetal malnutrition among newborns in Africa. Method: The PRISMA guidelines were used for this study. Articles were obtained from databases and websites. The outcome of the study was fetal malnutrition, as determined using the CAN score. The meta-analysis of the primary and secondary outcomes was performed using Stata version 18 statistical software. The pooled prevalence with a 95% CI was estimated using the random effect method with the Der Simonian Liard model. Results: This meta-analysis and systematic review included 5356 newborns from 13 studies. The pooled prevalence of fetal malnutrition (FM) among newborns diagnosed using the CAN score in Africa was 19% [95% CI: 17, 22]. Based on subgroup analysis by publication year, the lowest prevalence of fetal malnutrition 17% (95% CI: 9–27) was observed in the studies published in the years 2020–2023. Maternal and fetal factors were significantly associated with fetal malnutrition. Conclusion: Nearly one-fifth of neonates delivered in Africa were found to have fetal malnutrition based on the clinical evaluation of nutritional status. It has also been established that maternal malnutrition, a lack of proper treatment during pregnancy, maternal malnutrition, and newborn morbidities were associated with fetal malnutrition. To prevent fetal malnutrition, integrated efforts should be made for early maternal infection screening. Furthermore, maternal nutritional therapy should be explored for malnourished pregnant women. [ABSTRACT FROM AUTHOR]

Fetal hypoxia due to placental dysfunction is the hallmark of fetal growth restriction (FGR). Preferential perfusion of the brain (brain-sparing effect), as a part of physiological placental cardiovascular compensatory mechanisms to hypoxia, in FGR was reported. Therefore, the correlation between vascular endothelial growth factor A (VEGF-A) protein expression in the FGR placentas and newborns' early neurological outcome was examined. This study included 50 women with FGR complicated pregnancies and 30 uneventful pregnancies. Fetal hemodynamic parameters, neonatal acid–base status after delivery, placental pathohistology and VEGF-A expression were followed. Early neonatal morphological brain evaluation by ultrasound and functional evaluation of neurological status by Amiel – Tison Neurological Assessment at Term (ATNAT) were performed. VEGF-A protein expression level was significantly higher in the FGR placentas than normal term placentas (Fisher–Freeman–Halton's test, p≤0.001). No statistically significant correlation between placental VEGF-A expression and different prenatal and postnatal parameters was noticed. Whereas the alteration of an early neurological status assessed by ATNAT was found in 58 % of FGR newborns, morphological brain changes evaluated by UZV was noticed in 48 % of cases. No association between the level of placental VEGF-A expression and the early neurological deficits was found. As far as we know this is the first study of a possible connection between VEGF-A protein expression in the FGR placentas and neonates' early neurological outcomes. The lack of correlation between the FGR placental VEGF-A expression and neonates' neurological outcome could indicate that optimal early neurodevelopment may take place due to compensatory mechanism not related to placental VEGF-A expression. [ABSTRACT FROM AUTHOR]

ObjectiveMethodsResultsDiscussionPrenatal protein malnutrition produces anatomical and functional changes in the developing brain that persist despite immediate postnatal nutritional rehabilitation. Brain networks of prenatally malnourished animals show diminished activation of prefrontal areas and an increased activation of hippocampal regions during an attentional task [1]. While a reduction in cell number has been documented in hippocampal subfield CA1, nothing is known about changes in neuron numbers in the prefrontal or parahippocampal cortices.In the present study, we used unbiased stereology to investigate the effect of prenatal protein malnutrition on the neuron numbers in the medial prefrontal cortex and the cortices of the parahippocampal region that comprise the larger functional network.Results show that prenatal protein malnutrition does not cause changes in the neuronal population in the medial prefrontal cortex of adult rats, indicating that the decrease in functional activation during attentional tasks is not due to a reduction in the number of neurons. Results also show that prenatal protein malnutrition is associated with a reduction in neuron numbers in specific parahippocampal subregions: the medial entorhinal cortex and presubiculum.The affected regions along with CA1 comprise a tightly interconnected circuit, suggesting that prenatal malnutrition confers a vulnerability to specific hippocampal circuits. These findings are consistent with the idea that prenatal protein malnutrition produces a reorganization of structural and functional networks, which may underlie observed alterations in attentional processes and capabilities. [ABSTRACT FROM AUTHOR]

Abstract Background To reduce neonatal mortality, it is necessary to identify neonates with fetal malnutrition at birth using the clinical assessment score (CAN score). Furthermore, comprehensive summary data that shows burden of fetal malnutrition in Africa is scarce. As a result, this systematic review and meta-analysis aimed to assess fetal malnutrition among newborns in Africa. Method The PRISMA guidelines were used for this study. Articles were obtained from databases and websites. The outcome of the study was fetal malnutrition, as determined using the CAN score. The meta-analysis of the primary and secondary outcomes was performed using Stata version 18 statistical software. The pooled prevalence with a 95% CI was estimated using the random effect method with the Der Simonian Liard model. Results This meta-analysis and systematic review included 5356 newborns from 13 studies. The pooled prevalence of fetal malnutrition (FM) among newborns diagnosed using the CAN score in Africa was 19% [95% CI: 17, 22]. Based on subgroup analysis by publication year, the lowest prevalence of fetal malnutrition 17% (95% CI: 9–27) was observed in the studies published in the years 2020–2023. Maternal and fetal factors were significantly associated with fetal malnutrition. Conclusion Nearly one-fifth of neonates delivered in Africa were found to have fetal malnutrition based on the clinical evaluation of nutritional status. It has also been established that maternal malnutrition, a lack of proper treatment during pregnancy, maternal malnutrition, and newborn morbidities were associated with fetal malnutrition. To prevent fetal malnutrition, integrated efforts should be made for early maternal infection screening. Furthermore, maternal nutritional therapy should be explored for malnourished pregnant women.

Background: Fetal malnutrition (FM) is a clinical condition resulting from failure of the fetus to acquire adequate amounts of subcutaneous fat and muscle mass during its intrauterine life, with short and long term implications. Aim of the work: As the diagnosis of FM is essentially clinical, the aim of this study is to estimate the prevalence of FM using the Clinical Assessment of Nutritional Status (CANS) score & comparing the results with the classic anthropometric parameters and investigate FM impacts on early neonatal morbidities. subjects and methods: This is a cross-sectional study of full-term and preterm infants that was done between January 2023 and January 2024 (n = 385) at Alhussein neonatal intensive care unit & gynecology and obstetric department Early neonatal morbidities e.g hypoglycemia, polycythemia, Neonatal sepsis, RDS, feeding intolerance and hyperbilirubinemia were detected within the first week of life for the studied population who required NICU admission. The CANS score was evaluated for all infants enrolled in the study within 48 hours of birth. Moreover the standard anthropometric measure e.g. Body mass index (BMI), Ponderal Index (PI), and Mid-Upper-Arm Circumference/Head Circumference ratio (MUAC/HC) were calculated &both results were compared. Results: the FM cutoff values of CANS score <25, BMI <11.2 kg/m2, PI <2.2 g/cm3 and MUAC/HC < 0.27. that show significant difference between CANS & standard method in assessment of FM. the prevalence rate of FM for the studied population was Using the CANS score 36.4%, BMI 31.4%, MUAC/HC 23.4% and PI 22.3% Conclusions:The CANS score allows a better identification of nutritional status of infants than using the standard anthropometric parameters. [ABSTRACT FROM AUTHOR]

We aimed to analyze trends in the rate of effective antenatal corticosteroid prophylaxis (ACS) administrations across a spectrum of typical diagnoses associated with preterm birth. In this retrospective study we utilized delivery data after ACS from 2014 to 2020 at Charité Berlin, Germany. We evaluated the rate of effective ACS administrations defined as ≤10 days between last dose of ACS and delivery as well as the rate of post-ACS births on/after 37 + 0 weeks. We explored conditions associated with high rates of ineffective ACS administrations (>10 days before delivery). We analyzed the trend of ACS-effectiveness during the study period in the overall cohort and in placental dysfunction and cervical insufficiency diagnoses. The overall rate of effective ACS administrations was 42 % (709/1,672). The overall percentage of deliveries after/at 37 + 0 weeks following ACS administration was 19 % (343). Placenta previa, twin pregnancy and isthmocervical insufficiency were associated with ineffective ACS (19–34 % effective i.e. ≤10 days before delivery). The overall ratio of effective ACS applications rose over time (p=0.002). Over the course of this study ACS effectiveness increased in placental dysfunction and isthmocervical insufficiency diagnoses (p=0.028; p=0.001). Compared to a previous publication we found a decrease of post-ACS deliveries after/at 37 + 0 weeks (19 vs. 27 %). Ineffective ACS administrations are still frequent in patients with placenta previa, twin pregnancy and isthmocervical insufficiency. It remains to be investigated in future trials if the introduction of new diagnostic tools such as soluble Fms-like tyrosinkinase-1/placental growth factor (sFlt-1/PlGF) testing and placental alpha-microglobulin-1 (PAMG-1) testing directly led to an increased ACS effectiveness. [ABSTRACT FROM AUTHOR]

Doppler ultrasound is used to risk assess and monitor high-risk pregnancies to time delivery. Uterine artery (UtA) Doppler is a screening tool for placental dysfunction, as abnormal values represent an increased risk of hypertensive disorders and fetal growth restriction. Routine fetal growth assessment includes measuring the umbilical artery Doppler (UmA), as this reflects placental blood flow and can indicate placental dysfunction. In pregnancies with abnormal UmA Dopplers, assessment of the middle cerebral artery (MCA) and ductus venosus (DV) enables timely delivery by detecting developing hypoxia. In extremely preterm cases of severe growth restriction, the clinical challenge is timing birth so as not to replace the risk of stillbirth with the significant challenges of extreme preterm birth. Here, the DV Doppler is key, as this reflects cardiac function and identifies preterminal acidaemia. The use of each of these Doppler measurements will be described, illustrated and highlighted below using a case summary. [ABSTRACT FROM AUTHOR]

The objective: to determine the diagnostic value of biomarkers of placental dysfunction at different stages of gestation. Materials and methods. The research was carried out in 2015–2022 on the basis of the municipal non-commercial enterprise “Maternity House No.5” of the Odesa City Council. We analyzed the course and clinical outcomes of pregnancies in 118 women (the main group) who developed and established placental dysfunction (PD) during pregnancy at different stages of gestation. The control group included 78 healthy women whose pregnancies occurred without PD. In women of both groups the frequency of detection of risk factors for PD was assessed by analyzing the content of placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1) biomarkers in blood serum, Pregnancy-Associated Plasma Protein A (PAPP-A) and β-subunit of chorionic gonadotropin (hCG). Fetal growth retardation was determined by deviations of fetal metric indicators (abdominal circumference, head circumference, biparietal size, thigh length, estimated fetal weight) below the 10th percentile. Statistical processing of the obtained results was carried out using Statistica 14.0 software (TIBCO, USA). Results. Among the examined women of both groups, cases where the pregnancy occurred at the age of 30 years or more and was the first pregnancy that did not end in abortion prevailed. The average age of women in the main group was 33.4±2.3 years, the control group – 29.3±1.4 years. The main group had more women with a history of multiple abortions (odds ratio (OR)=5.6, 95% confidence interval (CI): 1.9–18.8). Disorders of the menstrual cycle in history were found in 39 (33.1%) women of the main group and in 18 (23%) women of the control group (OR=1.6, 95% CI: 0.9–3.2). Concomitant gynecological diseases were represented by uterine fibroids – in 16 (13.6%) pregnant women of the main group and in 8 (10.2%) women of the control group (OR=1.4, 95% CI: 0.6–3.4), benign ovarian tumors – in 13 (11.0%); OR=20.1, 95% CI: 1.2–343.1), mastopathy – in 19 (16.1%; OR=30.8, 95% CI: 1.8–517.6) women of the main group. A significant number of women in the main group had a hypertrophic nutritional status – the body mass index (BMI) at the time of pregnancy was on average 26.7±0.9 kg/m², women in the control group were represented by the normotrophic type (BMI – 22.2±0.3 kg/m² ), in 4 women the indicator was more 30 kg/m² . In the vast majority of pregnant women (68 persons – 57.6%) of the main group the signs of placental malperfusion were registered up to 34 weeks. In 12 (10.2%) cases a primary PD was established. The content of PIGF in women of the main group at the 20th week of pregnancy decreased to 83±4 pg/ml, which is significantly less than the reference values (≥100 pg/ml). On the other hand, in the control group the PIGF concentration was 147±8 pg/ ml (p<0.05). The sFlt-1 amount in the main group corresponded to the level of 3395±62 pg/ml. Therefore, the ratio of sFlt-1/ PlGF was equal to 40.8±0.4, which is prognostically unfavorable. The PAPP-A indicator, according to monitoring data at the 20th week of pregnancy, was 0.77±0.08 mU/l. In pregnant women with lower values in the future PD occurred earlier. As for the indicators of the β-subunit of hCG, the levels of this hormone in most cases corresponded to the normative values, amounting to an average of 4.7±0.1 IU/l in a pregnancy with a male fetus and 8133±21 IU/l in a pregnancy with a female fetus. Signs of preeclampsia were determined in 22 (18.6%) pregnant women of the main group. The value of the sFlt-1/PlGF ratio in these pregnant women exceeded 50.0. Conclusions. In the vast majority of pregnant women of the main group (68 – 57.6%) the signs of placental malperfusion were found up to 34 weeks. In 22 (18.6%) pregnant women with placental dysfunction (PD) the signs of preeclampsia were detected, the development of which increases when the sFlt-1/PlGF ratio exceeds 50, starting from the II trimester of pregnancy, which is an early biomarker of PD. [ABSTRACT FROM AUTHOR]

Objective Delta-like homolog 1 (DLK1) is a growth factor that is reduced in maternal sera in pregnancies with small for gestational age neonates. We sought to determine if DLK1 is associated with stillbirth (SB), with and without placental insufficiency. Study Design A nested case-control study was performed using maternal sera from a multicenter case-control study of SB and live birth (LB). SB and LB were stratified as placental insufficiency cases (small for gestational age <5% or circulatory lesions on placental histopathology) or normal placenta controls (appropriate for gestational age and no circulatory lesions). Enzyme-linked immunosorbent assay (ELISA) was used to measure DLK1. The mean difference in DLK1 was compared on the log scale in an adjusted linear regression model with pairwise differences, stratified by term/preterm deliveries among DLK1 results in the quantifiable range. In exploratory analysis, geometric means were compared among all data and the proportion of "low DLK1" (less than the median value for gestational age) was compared between groups and modeled using linear and logistic regression, respectively. Results Overall, 234 SB and 234 LB were analyzed; 246 DLK1 values were quantifiable within the standard curve. Pairwise comparisons of case and control DLK1 geometric means showed no significant differences between groups. In exploratory analysis of all data, adjusted analysis revealed a significant difference for the LB comparison only (SB: 71.9 vs. 99.1 pg/mL, p = 0.097; LB: 37.6 vs. 98.1 pg/mL, p = 0.005). In exploratory analysis of "low DLK1," there was a significant difference between the odds ratio of having "low DLK1" between preterm cases and controls for both SB and LB. There were no significant differences in geometric means nor "low DLK1" between SB and LB. Conclusion In exploratory analysis, more placental insufficiency cases in preterm SB and LB had "low DLK1." However, low DLK1 levels were not associated with SB. Key Points Maternally circulating DLK1 is correlated with placental insufficiency. Maternally circulating DLK1 is not correlated with SB. DLK1 is a promising marker for placental insufficiency. [ABSTRACT FROM AUTHOR]

The objective: development of a method of prevention of great obstetrical syndromes (GOS) from the standpoint of a single genesis determined by morphofunctional disorders in the fetoplacental system (FPS) and evaluation of its clinical effectiveness. Materials and methods. 155 women of the high-risk group for the development of GOS were examined. I group – 32 pregnant women who had GOS prophylaxis with low doses of acetylsalicylic acid (ASA) 100–150 mg per os once a day from the 12th to the 36th week of pregnancy; II group – 31 pregnant women who from the 6th to the 16th week had prophylactically progesterone according to the scheme: 200 mg once a day per vaginally every day; III group – 36 pregnant women who received prophylactic monotherapy, consisting of the use of magnesium with a complex with vitamin B6 for three courses of 6 weeks each; IV group – 56 pregnant women who refused any preventive measures. To assess the effectiveness of preventive therapy a dynamic examination of the pregnant women of the study groups, their fetuses and newborns was carried out. Statistical processing of research results was carried out using standard Microsoft Excel 5.0 and Statistica 6.0 programs. Results. The analysis of obstetrical and perinatal outcomes in women of the high-risk group for the development of GOS showed that the development of placental insufficiency (PI) in the IV group was realized in 100% (56 cases), including severe forms in 51.8% (29 cases); the frequency of PI in I, II and III groups was 12.5% (4 cases), 29.0% (9 cases) and 36.6% (11 cases), respectively, and was significantly lower (p<0.05); premature births were in 3 cases each in I and III groups, which amounted to 9.3% and 8.3%, respectively (р<0.05), in II group – 2 cases (6.5%); p<0.05. In general, the realization of GOS (preeclampsia, fetal growth retardation syndrome, premature birth) in I group was 25.0% (8 cases), including severe form – 3.1% (1 case); in the II group – 29.0% (9 cases), severe forms – 2 cases (6.3%); in the III group – 30.6% (11 cases), severe forms – 3 cases (8.3%) versus 100.0% (56 cases) realization of all clinical manifestations of GOS in the IV group of the study (р<0.05).Conclusions. A promising direction for the prevention of vasculitis in the high-risk group for their development is the consistent, early gestational appointment of low doses of ASA according to the developed method, which demonstrates the greatest effectiveness: a significant reduction in the frequency of preeclampsia, placental insufficiency with fetal growth retardation, premature birth, severe forms of preeclampsia according to optimized by the standards of evidence-based medicine: the number of pregnant women who need prophylaxis is 1.4; 95% confidence interval (CI): 1.1–1.7; odds ratio 5.3; 95% CI: 4.7–5.8. [ABSTRACT FROM AUTHOR]

This review focuses on the management of reproductive issues in women who have antiphospholipid syndrome (APS) or are carriers of antiphospholipid antibodies (aPL). The importance of aPL detection during preconception counselling relies on their pathogenic potential for placental insufficiency and related obstetric complications. The risk of adverse pregnancy outcomes can be minimized by individualized risk stratification and tailored treatment aimed at preventing placental insufficiency. Combination therapy of low-dose acetylsalicylic acid and heparin is the mainstay of prophylaxis during pregnancy; immunomodulation, especially with hydroxychloroquine, should be considered in refractory cases. Supplementary ultrasound surveillance is useful to detect fetal growth restriction and correctly tailor the time of delivery. The individual aPL profile must be considered in the stratification of thrombotic risk, such as during assisted reproduction techniques requiring hormonal ovarian stimulation or during the follow-up after pregnancy in order to prevent the first vascular event. [ABSTRACT FROM AUTHOR]

Objective: Poor intrauterine growth has negative impacts for child growth and development and disproportionately affects children living in low‐resource settings. In the present study, we investigated relationships between placental pathologies and indicators of poor intrauterine growth. Methods: We enrolled a longitudinal cohort of 279 mother–infant pairs from Leyte, the Philippines. Placental measures included characteristics, pathological findings, and immunohistochemistry. At birth, intrauterine growth was assessed using anthropometric measures, weight‐for‐gestational age, and the clinical assessment of nutritional status score (CANSCORE) for determining fetal malnutrition. Multivariate linear regression and log‐binomial regression models were applied, controlling for potential confounding factors. Results: Maternal vascular malperfusion (MVM) was related to reduced birthweight (P < 0.0001), birth length (P = 0.002), head circumference (P = 0.001), and weight‐to‐length ratio (P = 0.016). MVM increased the risk for preterm delivery (P = 0.0005) and small for gestational age (SGA) (P = 0.016). Acute chorioamnionitis (P = 0.013) and MVM (P = 0.021) both led to an increased risk for fetal malnutrition defined by CANSORE<25. Villous tissue activated caspase‐3 was associated with lower birth length (P = 0.0006), higher weight‐to‐length ratio (P = 0.004), reduced risks for SGA (P = 0.011) and low weight‐to‐length ratio for gestational age (P = 0.004). Conclusion: The present study applied comprehensive measures for intrauterine growth and demonstrates that low placental weight and placental pathology, chiefly MVM, contribute to poor intrauterine growth. A better understanding of the mechanistic role of specific placental pathologies on adverse newborn outcomes will provide opportunities for reducing incidence of poor intrauterine growth and associated long‐term morbidities. Synopsis: Among 279 mother–infant pairs from the Philippines, low placental weight and maternal vascular malperfusion were associated with increased risk for measures of poor intrauterine growth. [ABSTRACT FROM AUTHOR]

The adult diet and lifestyle are conventionally considered at the origin of cardiovascular and metabolic diseases that occur during life time. The hypothesis that supports the link between intrauterine malnutrition, prematurity, maternal stress, and the occurrence of type 2 diabetes and ischemic heart disease in adults/elderly, called Developmental Origins of Adult Disease, has been supported by numerous clinical studies. The concept of fetal phenotype programming gained consistency through epigenetic studies that showed how DNA methylation changes, histone changes, maintained over time are at the origin of chronic adult diseases. Initially demonstrated through studies on experimental animals and later through research on human subjects exposed to extreme situations, epigenetic changes were identified in severe maternal malnutrition, folic acid deficiency, smoking and maternal obesity or contact with environmental toxins. It is possible for some of the epigenetic changes to be transgenerational transmitted, their argumentation subject to objective limitations.

Placental dysfunction (PD) is one of the actual topics of research in the modern scientific world. Fetal growth retardation (FGR) is the leading clinical manifestation of chronic PD. Assessment of fetal growth is one of the key tasks in prenatal care. FGR is associated with an increased risk of perinatal morbidity and mortality, with long-term adverse outcomes for the child. Prenatal diagnosis of FGR is an important task for stillbirth prevention, up to 30% of cases of which are associated with this pathology or with a small-for-gestational-age fetus at the end of the III trimester. The objective: to study the influence of acetylsalicylic acid on the development of compensatory abilities of the fetus by PD. Materials and methods. 118 pregnancies with FGR and/or PD were analyzed. The women were divided into two groups: I group (67 persons) – patients with FGR and/or PD who used acetylsalicylic acid during pregnancy; II group (51 women) – pregnant women with FGR and/or PD who did not use acetylsalicylic acid during pregnancy. In all cases, the method of delivery was cesarean section due to fetal distress. Fetal distress was diagnosed using ultrasound examinations based on the following criteria: abnormal blood flow according to Doppler data (Volusun S10 ultrasound device), fetal biophysical profile indicators (Volusun S10 ultrasound device, Sonicaid Team fetal monitor) and cardiotocographic assessment of short-term variability (STV) fetal heart rate; STV > 4.5 according to the Sonicaid Team fetal monitor. Exclusion criteria: multiple pregnancy, antenatally confirmed fetal malformations. Results. The use of acetylsalicylic acid through placental regulation allows to achieve a longer gestation period before the development of fetal distress. The average gestational age before the appearance of this pathology in 50.75% of patients of the I group (34 persons) was larger – 33–36 weeks. On the other hand, 54.9% of women (28 individuals) in the II group had fetal distress earlier – at 28–32 weeks of gestation (p<0.05). Pathological blood flow in the umbilical artery or fetal biophysical profile <4 points was determined in 83.6% of cases in the I group (56 pregnant women) and in 23.5% in the II group (12 women). In women who used acetylsalicylic acid (I group) acute fetal distress diagnosed by STV was detected in 11 (16.4%) cases. In women who did not use acetylsalicylic acid (II group), distress manifested itself sharply – due to acidosis – in 39 (76.5%) cases (p<0.05). Conclusions. 1. In women who did not use acetylsalicylic acid, fetal distress manifested itself sharply – due to acidosis (STV<4.5 was recorded in 39 (76.5%) patients of the II group, while in women who used acetylsalicylic acid – in 11 pregnant women of the I group (16.4%; p<0.05). 2. Prophylactic use of acetylsalicylic acid allows to slow down the growth of placental dysfunction, which lets to the development of compensatory mechanisms and adaptation. 3. By use of acetylsalicylic acid the gestational period delivery closer to full term pregnancy. In women who used acetylsalicylic acid, most cases of fetal distress occurred at 33–36 weeks – 50.75%, while in the group that did not use acetylsalicylic acid most cases of fetal distress occurred at 28–32 weeks – in 54.9% (р<0.05). [ABSTRACT FROM AUTHOR]

Introduction: The fundamental tenet of human development is nutrition, which is also one of the risk factors for rising new born morbidity and mortality. Fetal malnutrition is a serious condition marked by evident intrauterine loss or failure to acquire a typical amount of subcutaneous fat or muscle. It is a vital state that sets the stage for proper growth and neurodevelopment throughout life. India has received a score of 101 out of 116 on the global hunger index for 2021 in developing nations. Materials and Methods: Live born, singleton neonates with a gestational age of ≥34 weeks who were brought for a regular checkup immediately after birth in the outpatient department and neonates whose hospital stay exceeded 24 hours of birth in Government General Hospital were enrolled. A total of 50 neonates brought to Government General Hospital from January 2021 to December 2021 were studied. Interviews were conducted with the parents of the children who met the criteria for selection and who agreed to take part in the study, and information regarding the baby's sex, gestational age, time of delivery, and the mother's history of multiple pregnancies was gathered. The latest menstrual period (LMP) date was used to calculate the gestational age in accordance with clinical evaluation using New Ballard's Scoring and first trimester ultrasonography. Within 48 hours of the birth, all the infants underwent a protocol-required systematic examination. Results: The CANSCORE ranged from 18 to 36, and the mean and median CANSCORE was 27.84±4.61 and 28 (IQR 4.5), respectively. The PI ranged from 2 to 3, and the mean and median PI was 2.44±0.26 and 2.36 (IQR 0.40), respectively. The MAC/HC ratio ranged from 0.23 to 0.33, and the mean and median MAC/HC ratio was 0.29±0.02 and 0.28 (IQR 0.03), respectively. In the present study, 76% of the neonates had CANSCORE of ≥25, and 24% had CANSCORE of <25. In the present study, 80% of the neonates had MAC/HC ratio of ≥0.27, and 20% had MAC/HC ratio of <0.27. In the present study, 68% of the neonates were boys, and 32% were girls. However, 66.67% of the boys had CANSCORE of <25 compared to 33.33% of the girls, and the difference was statistically not significant (p=0.586). Conclusion: The present study reemphasizes that FM is a significant problem in the study area as the incidence of FM in the study area is as high as one in four newborns are likely to have FM based on CANSCORE. Further, the present study also reemphasizes that CANSCORE is a simple systematic method to identify fetal malnutrition. It does not require any sophisticated equipment or time-consuming calculations. Hence it is the method preferred for or ideal for screening malnourished babies. At the same time, MAC/HC ratio seems to be a more accurate index than PI as the diagnostic accuracy of PI is slightly less than MAC/HC ratio. This tool is very helpful in the periphery where the availability of qualified personnel is less and will help the health workers to identify FM easily in developing nations where the incidence of FM is high. However, these observations require further validation due to the potential limitations of the study. [ABSTRACT FROM AUTHOR]

Background: This study investigated the effect of uteroplacental insufficiency (UPI) on renal development by detecting metabolic alterations in the kidneys of rats with intrauterine growth restriction (IUGR). Methods: On gestational day 17, pregnant Sprague Dawley rats were selected and allocated randomly to either the IUGR group or the control group. The IUGR group received a protocol involving the closure of bilateral uterine vessels, while the control group underwent a sham surgery. The rat pups were delivered on gestational day 22 by natural means. Pups were randomly recruited from both the control and IUGR groups on the seventh day after birth. The kidneys were surgically removed to conduct Western blot and metabolomic analyses. Results: IUGR was produced by UPI, as evidenced by the significantly lower body weights of the pups with IUGR compared to the control pups on postnatal day 7. UPI significantly increased the levels of cleaved caspase-3 (p < 0.05) and BAX/Bcl-2 (p < 0.01) in the pups with IUGR. Ten metabolites exhibited statistically significant differences between the groups (q < 0.05). Metabolic pathway enrichment analysis demonstrated statistically significant variations between the groups in the metabolism related to fructose and mannose, amino and nucleotide sugars, and inositol phosphate. Conclusions: UPI alters kidney metabolism in growth-restricted newborn rats and induces renal apoptosis. The results of our study have the potential to provide new insights into biomarkers and metabolic pathways that are involved in the kidney changes generated by IUGR. [ABSTRACT FROM AUTHOR]

Simple Summary: This study was carried out to evaluate the effect of enzymes of microbiological origin with pancreatic profiles added to the feed of pregnant sows on fetal size in order to minimize IUGR caused by fetal malnutrition. IUGR, understood as impaired growth and development of mammalian feti or their organs during pregnancy, is a serious problem in pig production. Restriction of fetal growth reduces the piglet survival rate, inhibits postnatal development, permanently weakens health, and also reduces pig production performance, negatively affecting meat quality. The research hypothesis was that the administration of PLEMs to sows would increase the uptake of nutrients by the feti, contributing to an increase in the piglets' birth weight and survival rate, ensuring the proper growth and development of pigs. The development of effective strategies to reduce the incidence of IUGR and its effects will therefore improve the profitability of pig production. In conclusion, we can conclude that the use of fungal enzymes with pancreatic profiles has beneficial effects on piglets' rearing rates, the development of their digestive tracts, and the activity of brush edge enzymes. It can be further concluded that the IUGR syndrome can be induced in pigs via the mother's diet during pregnancy. The present study aimed to develop a feeding strategy for pregnant sows that involved the prenatal administration of a mixture of pancreatic-like fungal enzymes, such as lipase, amylase, and protease, at (1) 1–115 days of gestation (group D1) and (2) 80–115 days of gestation (group D2) and to carry out a comparison with groups of sows that were not receiving such supplementation (negative control (NC) and positive control (PC)). It was found that the administration of the enzyme supplement resulted in a significant shortening of gestation (p ≤ 0.01). The pancreatic enzymes administered to sows had a significant effect on the number of liveborn piglets and weaned piglets, which was higher compared with the control groups that did not receive supplementation: D1—12.1 ± 1.1 and 11.12 ± 1.1 and D2—12.8 ± 1.3 and 11.75 ± 0.07 vs. the control groups KN—10.7 ± 1.0 and 9.62 ± 0.95 and KP—10.9 ± 1.2 and 10.15 ± 1.0 (p < 0.006), respectively. Significant changes in piglet growth were observed after weaning up to 70 days of age. During this period, the most favorable growth parameters were observed in groups D2 (420 ± 91 g) and PC (407 ± 103 g), in which piglets obtained a mixture of pancreatic enzymes (lipase, amylase, and protease) at 3 weeks of age, and significantly higher weight gain and feed intake were observed compared with groups NC (378 ± 114 g) and D1 (381 ± 96 g) (p ≤ 0.007). In contrast, insulin levels were significantly lower in groups D1 and D2, with values of 6.8 IU/mL and 6.7 IU/mL, respectively, compared with groups NC (14.6 IU/mL) and PC (16.6 IU/mL) (p ≤ 0.01). Piglets in group D2 had a significantly better feed conversion ratio (FCR) of 1.604 ± 0.10 compared with the other dietary groups: KN—1.986 ± 0.14; KP—1.704 ± 0.11; and D1—1.932 ± 0.15 (p ≤ 0.03). Histological imaging confirmed a significantly thicker intestinal epithelium and intestinal mesenteron in animals from groups D2 and PC (p ≤ 0.03). Animals from the groups KP, D1, and D2 receiving enzymes showed a highly significant increase in the surface area of pancreatic follicles and pancreatic surface area compared with the group without KN supplementation (p < 0.01). Furthermore, significantly higher activity of the brush border enzyme lactase was observed in groups D1, D2, and PC, with values of 32.90 ± 3.99, 30.00 ± 6.83, and 29.60 ± 29.60, respectively, compared with group NC, with a value of 21.80 ± 3.27 (p ≤ 0.01). [ABSTRACT FROM AUTHOR]

Aim: Growth restriction in the fetal period may affect the development of metabolic diseases in later ages. In this study, it was aimed to compare the growth of the first two years of age and the glucose, insulin and lipid profiles in the second year of term newborn babies with and without fetal malnutrition. Materials and Methods: Term infants born in our hospital between May 2019 and October 2019, with and without fetal malnutrition detected using the CANSCORE method were included in the study. Insulin, glucose, total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), very low-density lipoprotein (VLDL) cholesterol, triglyceride values were measured in the umbilical cord blood. The growth of these babies was followed up to the age of two. At the end of the second year, the same parameters were looked at again. Results: 26 out of 40 babies with fetal malnutrition and 22 out of 40 babies without fetal malnutrition were followed for two years. It was observed that body weight, height and head circumference of babies with fetal malnutrition were higher at 6 months compared to babies without fetal malnutrition, but this difference regressed at 12 and 24 months. While there was no significant difference between the two groups in terms of glucose, insulin, total cholesterol, LDL cholesterol, and HDL cholesterol levels in the second year of life, VLDL cholesterol and triglyceride levels were found to be significantly higher in the group with fetal malnutrition. Conclusion: Rapid weight gain in the first 6 months of life in infants with fetal malnutrition may affect the lipid profile in early childhood. [ABSTRACT FROM AUTHOR]

We have previously demonstrated that pre- and early postnatal malnutrition in sheep induced depot- and sex-specific changes in adipose morphological features, metabolic outcomes, and transcriptome in adulthood, with perirenal (PER) as the major target followed by subcutaneous (SUB) adipose tissue. We aimed to identify coexpressed and hub genes in SUB and PER to identify the underlying molecular mechanisms contributing to the early nutritional programming of adipose-related phenotypic outcomes. Transcriptomes of SUB and PER of male and female adult sheep with different pre- and early postnatal nutrition histories were used to construct networks of coexpressed genes likely to be functionally associated with pre- and early postnatal nutrition histories and phenotypic traits using weighted gene coexpression network analysis. The modules from PER showed enrichment of cell cycle regulation, gene expression, transmembrane transport, and metabolic processes associated with both sexes' prenatal nutrition. In SUB (only males), a module of enriched adenosine diphosphate metabolism and development correlated with prenatal nutrition. Sex-specific module enrichments were found in PER, such as chromatin modification in the male network but histone modification and mitochondria- and oxidative phosphorylation-related functions in the female network. These sex-specific modules correlated with prenatal nutrition and adipocyte size distribution patterns. Our results point to PER as a primary target of prenatal malnutrition compared to SUB, which played only a minor role. The prenatal programming of gene expression and cell cycle, potentially through epigenetic modifications, might be underlying mechanisms responsible for observed changes in PER expandability and adipocyte-size distribution patterns in adulthood in both sexes. [ABSTRACT FROM AUTHOR]

Premature birth, despite the significant achievements of perinatal medicine in recent decades, remains an urgent global and national medical and social problem, as it is the leading cause of perinatal morbidity and mortality. According to modern views, placental dysfunction can be one of the causes of premature birth, and its frequency, according to randomized studies, can be from 78 to 91%, depending on the gestational age. At the same time, the research conducted to date does not provide a clear understanding of the role of timely diagnosis and prevention of placental dysfunction in preventing premature birth. The objective: to perform clinical evaluation of the prevalence of placental dysfunction in women at risk of preterm birth and with threat of preterm birth. Materials and methods. 180 pregnant women were took part in the study. To achieve the research aim, three research groups were formed. I group – 73 pregnant women with threat of premature birth; II group – 77 pregnant women with risk factors for premature birth. Women with risk factors for premature birth were included in the study at the stage of pregnancy planning (IIA subgroup, 39 women) or from the moment of applying to a women’s outpatient clinic to monitor the course of pregnancy (IIB subgroup, 38 pregnant women). The control group included 30 pregnant women with an uncomplicated course of pregnancy. Transabdominal ultrasound examination with color Doppler mapping, determination of free estriol, progesterone and placental lactogen levels in blood serum were performed at 18–21+6 and 28–30 weeks of gestation. Results. Analysis of the prevalence of risk factors for placental dysfunction and preterm birth in patients of the studied cohort showed that in pregnant women with preterm birth (I group), the combination of risk factors was 5.2; in pregnant women who received pre-gravid training (IIA subgroup) – 3.2; in pregnant women who were included in the study in the I trimester of pregnancy (IIB subgroup) – 4.7, while in pregnant women of the control group – only 0.8 (p<0.05). The threat of early spontaneous miscarriage with the formation of a retrochorial hematoma as a clinical manifestation of primary placental dysfunction was determined in 43.8% of pregnant women whose premature delivery was carried out for medical reasons. Placenta abruption in these patients can be considered as decompensation of the primary dysfunction of the placenta with the transition to acute placental insufficiency. The formation of chronic placental dysfunction, clinically manifested by the syndrome of fetal growth retardation, was most often observed in patients whose pregnancy ended in spontaneous premature birth at 34–36+6 weeks in the presence of an untouched amnion, – 68.6% compared to births at 28–33+6 weeks of gestation – 25.9% and with childbirth at 22–37+6 weeks – 13.3%. Conclusions. Clinical manifestations of placental dysfunction were detected in 30.6% of patients with premature birth, with morphological signs in 60.4% of cases, which indicates the hidden course of placental insufficiency before the development of premature birth. Morphological signs of placental dysfunction were determined in 87.5% of cases of premature births for medical reasons and in 100.0% of cases of spontaneous births at 22–27+6 weeks of gestation (with a combination of risk factors from 2.1 to 3.0), in 66.7% – with premature births at 28–33+6 weeks of pregnancy, in 40.0% – with premature births at 34–36+6 weeks of pregnancy and only in one (5.6%) case – with term births. The frequency of fixation of morphological characteristics of placental dysfunction correlates with the frequency of early pregnancy complications, primarily with the formation of retrochorial hematomas in the first half of pregnancy. [ABSTRACT FROM AUTHOR]

The article discusses the use of modern technology, such as ultrasound and cardiotocography, to gain insights into fetal behavior and movement. Topics include the significance of maternal perception of reduced fetal movement (RFM) as a potential indicator of stillbirth risk, the need for improved management strategies, challenges and recommendations related to monitoring fetal movements and addressing deficiencies in prenatal care delivery.

The objective: to evaluate the clinical effectiveness of L-arginine in the prevention of preeclampsia and reduction of other perinatal risks in patients with preclinical gestational endotheliopathy (GE). Materials and methods. A comparative clinical study was performed at the clinical base of the Department of Obstetrics and Gynecology N. 1 of the Vinnytsya National Pirogov Memorial Medical University. 116 pregnant women with preclinical GE (main group), which was diagnosed by laboratory and instrumental research (microalbuminuria and endothelium-dependent vasodilatation), took part in the study. The patients of the main group were divided into clinical subgroups: 31 pregnant women with GE in subgroup A received acetylsalicylic acid (ASA) at a dose of 75 mg per or per day; 33 patients with preclinical GE from subgroup B received L-arginine at a dose of 4-4.2 g per or per day; 52 pregnant women with preclinical GE who refused prophylactic treatment were included in the subgroup C. The control group involved 58 pregnant women with a physiological gestation and without GE. The clinical effectiveness of the therapy was assessed by comparing the number of cases of perinatal pathology in the I, II and III trimesters. Results. The use of L-arginine as an alternative preventive therapy for the development of preeclampsia and other perinatal pathology made possible to reduce the rate of preeclampsia significantly (RR 0.19, 95% CI: 0.05-0.77; p=0.02) and placental hyperplasia/hypoplasia (RR 0.17, 95% CI: 0.04-0.68; p=0.01), compared to patients who did not receive any preventive treatment. In pregnant women with early-onset gestational endotheliopathy who received L-arginine, placental dysfunction was not diagnosed in the II and III trimesters of pregnancy and there were no cases of fetal growth retardation. The use of L-arginine was not associated with side effects and/or adverse reactions in the proposed dose and frequency of administration and can be considered beneficial for the mother and the fetus. Conclusions. Prescribing ASA and L-arginine drugs for pregnant women with a moderate degree of perinatal risk (preclinical GE) made possible not only to prolong pregnancy, but also to prevent the development of severe perinatal pathology. A more pronounced clinical effectiveness of the course prescription of solution of L-arginine per or (daily dose of L-arginine - 4.0-4.2 g) in pregnant women with preclinical form of GE may be associated with the endotheliotropic protective effect of the drug. The appropriateness of using L-arginine during pregnancy is still debated, and further researches are needed to determine the optimal dosage, initial period for using and duration for the best prophylactic or therapeutic effect. [ABSTRACT FROM AUTHOR]

Objective This study aimed to evaluate the association of induction method on delivery mode in pregnancies complicated by oligohydramnios with and without fetal growth restriction (FGR). Study Design This was a secondary analysis of a National Institutes of Health funded retrospective cohort study of singleton deliveries at a tertiary-care hospital between 2002 and 2013 with diabetes, mild hypertension, and/or FGR. Chart abstraction was performed by trained research nurses. Patients with a diagnosis of fetal oligohydramnios with and without FGR were identified. Our analytic cohort was further stratified into three groups per initial induction agent: prostaglandins (PGEs) alone, PGE plus mechanical ripening, or oxytocin only. Primary outcome was mode of delivery. Secondary outcomes included indications for cesarean delivery and neonatal morbidity. Results Out of 4,929 patients in the original database, 546 subjects with fetal oligohydramnios were identified; of these, 270 were induced and included for analysis. Outcomes were compared between 171 patients who had fetuses with isolated oligohydramnios and 99 patients who had fetuses with oligohydramnios and FGR. There were no significant differences in demographic characteristics between the groups. Patients with fetuses with isolated oligohydramnios had similar rates of spontaneous vaginal delivery (SVD) when PGEs were used (n = 44/79, 55.7% PGE alone, n = 44/76, 57.9% PGE with mechanical ripening) and when they were not used (n = 5/13, 38.5% oxytocin alone; p = 0.43). Similarly, the majority of patients in both cohorts underwent SVD regardless of induction method (n = 30/44, 68.2% PGE alone, n = 30/44, 68.2% PGE with mechanical ripening, and n = 6/10, 60% oxytocin alone; p = 0.90). There was no significant difference in composite neonatal morbidity. Conclusion In patients with fetuses with oligohydramnios with and without FGR, most patients delivered by SVD regardless of induction method. In this population, PGE use was associated with a high chance of SVD in patients with fetuses with suspected placental insufficiency regardless of the presence of absence of FGR. Key Points The majority of fetuses with oligohydramnios with or without FGR deliver vaginally. The use of prostaglandins did not increase rates of cesarean for fetal distress in oligohydramnios. Prostaglandin use did not increase rate of neonatal intensive care unit admission among pregnancies with oligohydramnios. [ABSTRACT FROM AUTHOR]

Aim:Fetal malnutrition is a condition characterized clinically by the inability of subcutaneous adipose tissue and muscle mass to reach the normal amount or by significant intrauterine loss. The major hormones regulating fetal growth, fetal energy metabolism and adipogenesis are insulin, leptin, ghrelin and adiponectin. Cholesterol and triglycerides are very important in fetal growth in the last period of pregnancy. In this study, it was aimed to compare the glucose, insulin, leptin, ghrelin, adiponectin, cholesterol and triglyceride levels in the cord blood of newborn babies with and without fetal malnutrition.Materials and Methods:Term babies born in our hospital were included in this study. Babies with a Clinical Assessment of Nutritional Status of 24 or below were considered as cases with fetal malnutrition, and those over 24 were considered as cases without fetal malnutrition. Glucose, insulin, leptin, ghrelin, adiponectin, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, very-low-density lipoprotein cholesterol and triglyceride levels were studied from blood samples taken from the umbilical cord after delivery.Results:A total of 80 term newborn babies (40 babies with fetal malnutrition and 40 babies without fetal malnutrition) were included in this study. Birth weight, glucose and insulin values were found to be significantly lower in the group with fetal malnutrition (p

The objective: to determine the pathomorphological changes in the placenta by antenatal asphyxia of the fetus associated with the coronavirus disease (COVID-19) in pregnant women. Materials and methods. 21 placentas by fetal antenatal asphyxia which occurred at different terms of pregnancy in women with COVID-19 were examined. COVID-19 was diagnosed by a positive PCR test – detection of SARS-CoV-2 RNA. The study groups were defined depending on the duration of the post-covid interval (time from the diagnosis of COVID-19 to delivery). I group (n=12) included placentas of women with antenatal fetal asphyxia, in whom the postpartum interval was 1–4 weeks; II group (n=9) – placentas of women with fetal death, in whom the postpartum interval was 5–14 weeks. In the I group, antenatal asphyxia of the fetus occurred in the term from the 13th to 36th weeks of gestation, in the II group – in period from the 29th to the 41st week. Macroscopic, organometric, microscopic methods of placenta research and a statistical method were applied. Fetal-placental index (FPI) was calculated Results. In the studied cases, antenatal fetal death occurred in different terms of pregnancy, namely, from the 14th to the 41st week of gestation (median is 32 weeks). Pregnant women had COVID-19 from the 13th to the 35th week of gestation (median is 25 weeks); when the mother was diagnosed with COVID-19 after the 35th week, there was no case of antenatal fetal death. The severity of the course of the coronavirus disease was mild in 7 pregnant women, moderate – 12 persons, and a severe course with pneumonia was diagnosed in 2 women. The severity of morphological changes in the placenta did not depend on the severity of the course of COVID-19 in the pregnant woman (chorioamnionitis, p=1.0; intervillositis, p=0.63; obliteration of arterioles, p=0.32). In the I group, a slight increase in FPI was found up to 0.19 [0.12; 0.34], in the II group – a similar indicator was 0.16 [0.13; 0.24]. However, the absolute values of the weight of the fetus and placenta in both groups were lower than those for the given gestational age. The I group of placentas there were the pronounced inflammatory changes – placentitis: chorioamnionitis – 100% (95%CI: 85.4– 100) and basal deciduitis – 91.7% (95%CI: 67.1–100). In the II group the inflammatory changes of the chorioamniotic membranes and basal plate were focal and were found in 6 placentas – 66.7% (95% CI: 29.2–94.8). Intervillositis was detected in 11 placentas – 91.7% (95%CI: 67.1–100) in the I group versus 2 placentas – 22.2% (95%CI: 1.1–58.9; p=0.006) in the II group. Villositis in the I group was determined in 8 cases – 66.7% (95%CI: 35.4–91.4) and in only one placenta in the II group – 11.1% (95%CI: 0.0–43.91; p=0.034). In the placentas of both groups the fibrinoid necrosis of the arteriole wall, proliferative changes in the vessel wall and necrosis of the endothelium were detected – 100% (95%CI: 85.4–100), dyscirculatory disorders (stasis, thrombosis, hemorrhages) were found in 75% (95% CI: 44.4–95.8) of cases in the I group and in 66.7% (95% CI: 29.2–94.8) – in the II group. An increased number of syncytial nodules was observed as a manifestation of compensatory mechanisms: in the I group – 83.3% (95%CI: 54.7–98.9), in the II group – 88.9% (95%CI: 56.1–100). All studied cases in the II group were accompanied by obliteration of the lumen of the arterioles of trunk and semi-trunk villi – 100% (95%CI: 80.9–100; p=0.0006), versus the I group – 16.7% (95%CI: 1.1–45.3). At the same time, in 6 cases in the II group the morphological manifestations of restoration of the lumen (revascularization) were detected – the formation of intravascular septa – 66.7% (95% CI: 29.2–94.8), which were not found in the I group (р=0.0093). In 100% (95%CI: 80.9–100) of placentas of the II group and in 66.7% (95%CI: 35.4–91.4) of the I group the stroma fibrosis of stem and semi-stem villi, obliteration intervillous space, and hypoplasia of terminal villi were determined. Conclusions. Statistically significant differences of placentas in antenatal asphyxia of the fetus depended on the length of the postcovid interval: in the postcovid interval of 1–4 weeks (I group) the inflammatory changes prevailed – placentitis: chorioamnionitis – 100% (95%CI: 85.4–100), intervillositis – 91.7% (95% CI: 67.1–100), p=0.006; villositis – 66.7% (95%CI: 35.4–91.4), p=0.034. When the duration of the postcovid interval increased to 5–14 weeks (II group), arteriosclerosis prevailed – 100% (95% CI: 80.9–100); p=0.0006. The cause of antenatal fetal death in the women with COVID-19 in the I group is acute placental insufficiency associated with the exudative phase of inflammation (chorioamnionitis, villositis, intervillositis). In the II group, the cause of antenatal fetal asphyxia is the formation of chronic placental dysfunction caused by the proliferation phase, which was manifested by proliferative changes in the muscular layer of arterioles and their subsequent fibrosis with obliteration of the lumen of arterioles (arteriosclerosis). [ABSTRACT FROM AUTHOR]

Background: It remains unclear whether goblet cell numbers in offspring are altered by maternal nutritional status and/or early weaning. Herein, using a murine model, we clarified whether a low-protein (LP) diet during pregnancy and/or early weaning changes villus structures, goblet cell numbers, mucin intensity, and mucin mRNA expression in the mucosal layer throughout the intestines in mice offspring. Methods: We examined villus-crypt structures and goblet cell numbers using hematoxylin-eosin staining. By performing alcian blue-PAS staining and RT-qPCR, we investigated mucin intensity in the mucosal layer and mRNA expressions of Muc2 and Muc4, respectively, in 17 (early weaning)-, 21 (normal weaning)- and 28-day old mice born from LP diet-fed mothers or those born from control diet-fed mothers during pregnancy. Results: Dietary protein restriction reduced goblet cell numbers in throughout the intestine, particularly in the duodenum and jejunum, and mucin intensity in the mucosal layer at the border of the jejunum and colon. The LP diet increased villus height and decreased villus thickness throughout the small intestine and crypt depth and width in the cecum and colon. Conclusions: Dietary protein restriction during pregnancy and/or early weaning decreased the number of goblet cells, mucin intensity in the mucosal layer, and the Muc2 and Muc4 mRNA expressions in the small and large intestines, and affected the villus and crypt structures in the small and large intestines in female offspring mice during and after weaning. General significance: Dietary abnormalities in fetal and weaning periods affects intestinal function.

The article focuses on the challenges neonatologists and healthcare providers face in correctly coding with the International Classification of Diseases, 10 Revision (ICD-10), emphasizing the importance of accurate coding for billing and reimbursement. It addresses common coding errors related to prenatal consultations, attendance at delivery, and NICU admissions.

Background: Women with antiphospholipid syndrome (APS) or antiphospholipid antibodies (aPLs) are at high risk for obstetric complications, including recurrent pregnancy loss (RPL). However, effective treatments for RPL are lacking. Objective: This study aimed to reveal the function and underlying mechanism of hyperoside (Hyp) in RPL associated with antiphospholipid antibodies (aCLs). Methods: The pregnant rats (N = 24) were divided randomly into four groups: normal human-IgG (NH-IgG); aCL-pregnancy loss (aCL-PL); aCL-PL + Hyp (40 mg/kg/day); aCL-PL + low molecular weight heparin (LMWH, 525 μg/kg/day). HTR‐8 cells were treated with 80 μg/mL aCL to establish the cell models of miscarriage. Results: In pregnant rats, aCL-IgG injection raised the abortion rate of embryos, while Hyp treatment inhibited the effects. Additionally, Hyp inhibited the platelet activation and uteroplacental insufficiency caused by aCL. In vivo and in vitro experiments further suggested that Hyp suppressed aCL-induced inflammation and apoptosis by downregulating NOD-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome-related factors and decreasing apoptotic rates. After aCL administration, Hyp therapy downregulated the expression of purinergic ligand-gated ion channel 7 (P2X7), which is reported to induce cytokine release and apoptosis. Furthermore, we found that the treatment of 3′-O-(4-Benzoyl) benzoyl-ATP (BzATP, an agonist of the P2X7 receptor) reversed the inhibitory effects of Hyp on cell function. Conclusions: Hyp exerts protective effects on aCL-induced pregnancy loss by preventing platelet activation-mediated P2X7/NLRP3 pathway. Therefore, Hyp may provide a feasible pharmaceutical strategy for the treatment of RPL. Graphical Abstract [ABSTRACT FROM AUTHOR]

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The objective: to study the activity of the p65 subunit of the nuclear factor – NF-κB and effector caspase-3, as well as the presence of a single nucleotide polymorphism of the VEGF gene (936C/T) in pregnant women with placental disorders and various clinical types of the course of premature labor (with premature rupture of the membranes and without it). Materials and methods. At the clinical base of the Department of Obstetrics and Gynecology No. 1 of O. O. Bogomolets National Medical University, which is located in the non-commercial enterprise “Perinatal Center of Kyiv”, during 2019– 2022, a case-control study was conducted with the involvement of 90 pregnant women: 60 women of the main group with placental disorders and the development of spontaneous premature labor in the period of 24–34 weeks of gestation (I group – 30 women with premature labor and premature rupture of membranes, II group – 30 women with premature rupture of the membranes) and 30 women of control group (CG) with term normal delivery and the physiological course of the pregnancy. In pregnant women, the number of total and activated fractions of the p65 subunit of nuclear factor NF-κB and caspase-3 was determined by enzyme-linked immunosorbent assay (ELISA) in placenta lysates with further calculation of their activity based on these data, as well as the presence of a single nucleotide polymorphism of the VEGF gene (936C/T) using the polymerase chain reaction. Results. In women with placental disorders and preterm birth a significantly higher values of fraction content and activity of p65 NF-κB and caspase-3 were found, with some peculiarities within the groups compared to the control group. Women of the I group were characterized by a higher activity of p65-subunit of nuclear factor (I group — 61.6% with 95% CI 59.7–64.2; II group — 33.8 pg/ml with 95% CI 31.2-35.2; CG — 27.3 pg/ml, 95% CI 26.4–28.6; p<0.05). Pregnant women of the II group had higher values of caspase-3 activity (II group — 59.2% with 95% CI 57.4–59.8, I group — 39.5% with 95% CI 38.5–40.5, CG — 31.2%, 95% CI 30.4–31.9; p<0.01). It was established that the presence of the T allele at position 936 of VEGF gene polymorphism is a risk factor for the development of placental disorders with the development of premature labor, the rate of this allele in the main group was 11.7% versus 1.7% – in the control cohort (p<0.05). Conclusions. Pregnant women with placental disorders and the development of premature birth are characterized by an increased activity of the p65 subunit of nuclear factor κB and caspase-3 compared to the control group: in women without premature rupture of the fetal membranes, a significant 2.2-fold increase in p65 NF-κB activity was found, and caspase-3 activity – by 1.3 times; in the group of pregnant women with preterm premature rupture of membranes the level of caspase-3 activity exceeded the control group by 1.9 times, and the level of p65-subunit of nuclear factor activity — by 1.2 times (p<0.01 for all groups). 936(C/T) single nucleotide polymorphism of the vascular endothelial growth factor gene was determined significantly more often in women with placental disorders and preterm birth (11.7 % in the study group versus 1.7 % in CG, p<0.05), the T-allele on the VEGF gene carriers may be associated with the development of these pregnancy complications. However, a study on a larger sample of women is needed to obtain definitive results. [ABSTRACT FROM AUTHOR]

In recent years, scientific views on perinatal protection of fetus have shifted to earlier periods of pregnancy – to the I trimester, because from this stage the formation of the fetoplacental complex and laying of organs and tissues take place, which in most cases determines the further course of pregnancy. The objective: to clarify the role of the imbalance of angiogenic growth factors as one of the pathogenetic mechanisms in the development of placental dysfunction, and to conduct a postnatal macromorphometric study of placenta and umbilical cord in women with pathology of the fetal environment. Materials and methods. The object of the study were 80 pregnant women (the main group) with a singleton pregnancy, selected from the cohort of patients from the risk group for the development of preeclampsia and miscarriage. Among them, at 30–32 weeks of gestation oligohydramnios was diagnosed in 40 patients (the first group) and polyhydramnios – in 40 women (the second group). The control group included 30 somatically healthy pregnant women with a normal volume of amniotic fluid and a physiological course of pregnancy. The concentrations of placental growth factor (PlGF), vascular endothelial growth factor-1 (VEGF-1), and an antiangiogenic marker of neovasculogenesis, soluble fms-like tyrosine kinase (sFlt-1), were performed at 12–16 and 28–32 weeks of pregnancy by enzyme immunoassay method. The study of the structural and functional features of the placenta and umbilical cord included sonographic and organometric methods. The variational statistical method of analysis of the obtained results was carried out using the «STATISTICA for Windows®-6.0» package. Results. In the women of the main group in the I trimester the ultrasound signs of pathology of the embryo and extraembryonic structures were significantly more often observed: low placement of the fertilized egg (33.8 %), its deformation (27.5 %), and partial detachment of the chorion (28.5 %). At 12–16 weeks of pregnancy, a pronounced vascular imbalance was established with a 2.5-fold decrease in the concentration of PlGF in the case of oligohydramnios compared to control data, a 1.8-fold decrease in the level of free VEGF-1 (in the case of oligohydramnios), and an increased level of antiangiogenic growth factors (sFlt-1). The postnatal examination of the placenta and umbilical cord showed that in the pregnant women of the main group a predominance of abnormal forms of placenta (16.3 %), a predominance of eccentric and marginal types of attachment of the umbilical cord (53.8 %), main and intermediate types of vascular branching (63.7 %), changes in the diameter of the umbilical cord (17.5 %), a combination of these features in a third of cases (31.3 %) were found. In the women of the main group, there was a decrease of the placental-fetal coefficient compared to the individuals of the control group, which was especially pronounced in pregnant women with oligohydramnios (up to 0.11±0.01 units compared to control data - 0.16±0.01 units). Conclusions. In the period of 12–16 weeks of pregnancy a vascular imbalance was established at the stage of placentation in patients who were diagnosed pathology of the perinatal environment at 30–32 weeks. In particular, by oligohydramnios there is a 2.5-fold decrease in the concentration of PlGF compared to the control data, a 1.8-fold decrease in the level of VEGF-1, and an increased antiangiogenic growth factor (sFlt-1), which became a prerequisite for the development of placental dysfunction. The results of the postnatal examination of the placenta and umbilical cord became an indirect reflection of placentation conditions. They demonstrated the predominance of abnormal forms, the predominance of the eccentric and marginal type of attachment of the umbilical cord, the main and intermediate type of vascular branching, an increased rate of umbilical cord pathology (Warton’s jelly deficiency, anomalies of the umbilical cord vessels) and a decreased placental-fetal ratio in women with amniotic fluid pathology, which was it is especially pronounced with oligohydramnios. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate the impact of Corona Virus Disease 19 (COVID-19) infection on pregnancy outcomes. STUDY DESIGN: This retrospective study was conducted at a tertiary university hospital between the years of October 2020-October 2021. All the pregnant women with COVID-19 diagnoses were enrolled in the study during this period. Demographic parameters, a history of Favipiravir use, COVID-19 symptoms, treatment approaches, hospitalization, intensive care unit admission, and obstetric and neonatal outcomes were recorded. RESULTS: A total of 92 patients were enrolled in the study. The mean age was 30+5 years. Forty-seven of the patients were asymptomatic (51%). The most common symptoms were respectively; fatigue (37.8%), fever (27.6%), dyspnea (22%), cough (17.8%), headache (11%), anosmia (4.4%), hyperemesis (4.4%), diarrhea (2.2%). There were 20 patients (21.7%) who were hospitalized. Eight of these women (8.6%) required intensive care unit admission due to COVID pneumonia-related acute respiratory distress syndrome. Five of the patients treated in the intensive care unit died due to respiratory failure. Two patients had a miscarriage before the 20th week. There were four stillbirths. The gestational weeks at which fetal death occurred were 24, 26, 28, and 38 weeks of gestation. There were 19 patients with a history of favipiravir use. There was not any other congenital abnormality due to Favipiravir usage. CONCLUSION: Our study showed that COVID-19 disease has similar symptoms in pregnant women to non-pregnant women, according to the literature data. However, COVID-19 infection increases the rates of pregnancy complications and maternal mortality. [ABSTRACT FROM AUTHOR]

Previous studies have shown that low birth weight (LBW) individuals are at higher risk of glucose metabolism disorders compared with normal birth weight (NBW) individuals under overnutrition conditions, but the mechanism remains unclear. To explore the underlying mechanism of glucose metabolism disorders induced by LBW under overnutrition in adulthood, the prenatal malnutrition method was applied to ICR mice to establish the LBW mice model and high-fat diets were used to mimic overnutrition conditions. Then the mechanism was further explored on Hepg2 cells treated with nutritional deprivation plus palmitic acid. The results showed that LBW plus high-fat interventions will cause glucose metabolism disorders and inhibit autophagy flux in adulthood. Moreover, the expression of TRPC5-regulated AMPK/mTOR autophagy pathway was downregulated by LBW with high-fat interventions. Collectively, LBW plus high-fat intervention increased the risk of glucose metabolism disorders, which may be related to the alteration of TRPC5 expression level and its regulation of the AMPKα/mTOR autophagy pathway. This study may provide a fundamental basis for the molecular mechanism of glucose metabolism disorders induced by LBW with high-fat diets in adulthood and a new target for the treatment of metabolic diseases in LBW individuals. • LBW mice induced by a high-fat diet are more prone to glucose metabolic disorders in adulthood. • The LBW mice model was established by the prenatal malnutrition method with a high-fat diet to explore the possible mechanism of metabolic disorders induced by LBW. • The mechanism was further explored on Hepg2 cells treated with nutritional deprivation plus palmitic acid. • Glucose metabolic disorders induced by LBW may be related to the alteration of TRPC5 expression level and its regulation of the CaMKKβ/AMPKα/mTOR autophagy pathway. [ABSTRACT FROM AUTHOR]

Placental insufficiency affects about 10% of pregnancies and can lead to pre-eclampsia, fetal growth restriction, and preterm birth. Despite significant advances in early prediction and prevention of preterm pre-eclampsia with aspirin, the effects of prophylaxis on fetal growth restriction are less certain, and the rates of late-onset pre-eclampsia are not influenced by aspirin treatment. Pregnancies complicated by placental insufficiency are characterized by increased oxidative stress, and recent studies suggest that melatonin has antioxidant properties and contributes to maintaining placental homeostasis. We aimed to systematically review the available literature about melatonin in pregnancies complicated by placental insufficiency, specifically preeclampsia and fetal growth restriction, exploring three different aspects: 1) maternal melatonin levels; 2) expression and activity of melatonin placental receptors; 3) effects of maternal melatonin administration. PubMed (Medline) and Scopus were searched until December 2020. Identified studies were screened and assessed independently by two authors. Data were extracted and compiled in qualitative evidence synthesis. The circadian pattern of melatonin secretion seems to be altered in pregnancies complicated by placental insufficiency reflected by lower production of melatonin, with consequent lower systemic and placental concentrations and lower expression of melatonin receptors, thus reducing the local release of the indole and its autocrine function. Small intervention studies also suggest that treatment is safe and may lead to prolongation of pregnancy and better outcomes, but double-blind, randomized placebo-controlled trials are lacking. [ABSTRACT FROM AUTHOR]

Introduction: To prevent the adverse effects of fetal malnutrition (FM), its management and early diagnosis by reliable tools are essential. The present study aimed to identify the rate of malnutrition in a referral maternity center in Iran using different systems for evaluating the nutritional status and determining a better index for FM. Methods: This cross-sectional study was performed on the neonates born in the maternity ward of Hajar Hospital in Shahrekord, Iran in 2020. FM was evaluated based on different parameters, including the CANSCORE index, body mass index (BMI), Ponderal index, and mid-arm circumference/head circumference (MAC/HC) index. After recording the measurements, birth weight and height were plotted on the intrauterine growth chart, and the infants were classified into groups of appropriate for gestational age (AGA), small for gestational age (SGA), and large for gestational age (LGA). Results: Based on the fetal growth status index, 14.7% of the neonates were in the AGA group, and 95.3% were in the LGA group. Malnourishment was detected in 40.5% of the neonates based on the CANSCORE index, 8.3% based on the MAC/HC index, 6.9% based on the BMI, and 5.2% based on the Ponderal index. In addition, the CANSCORE index had a significant positive correlation with all the growth indices (except the MAC/HC index), and the Ponderal index was also significantly correlated with all the growth indices except height. Conclusion: According to the results, the CANSCORE index could show growth status and FM more accurately compared to other anthropometric parameters that may underestimate FM. Furthermore, BMI is a highly sensitive indicator, and infants malnourished in terms of BMI should be examined based on the CANSCORE index to accurately identify FM.

This document is a correction notice for an article titled "Fetal malnutrition among neonates in African countries: a CAN score systematic review and meta-analysis." The correction addresses an error in one of the authors' name and affiliation. The correct name and affiliation for the author is Hamdi Fekredin Zakaria from the School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia. The original article has been updated to reflect this correction. The publisher, Springer Nature, remains neutral in terms of jurisdictional claims and institutional affiliations. [Extracted from the article]

A recent study published in Science has found that prenatal exposure to famine, particularly in the early stages of gestation, may increase the risk of developing type 2 diabetes. The researchers analyzed data from over 10 million individuals born in Ukraine between 1930 and 1938, comparing birth records in regions affected by the Holodomor famine with a registry of type 2 diabetes cases diagnosed between 2000 and 2008. They discovered that individuals born in the hardest-hit regions during the first half of 1934 had more than double the risk of developing type 2 diabetes compared to those born in unaffected provinces. These findings support previous research linking prenatal malnutrition during famine to an increased risk of type 2 diabetes. The study highlights the importance of developing policies to address long-term health challenges following national disasters. [Extracted from the article]

Objectives: To assess the prevalence of fetal malnutrition and associated factors among newborn babies delivered at the Debre Markos Compressive Specialized Hospital, Ethiopia. Methods: This hospital-based cross-sectional study was conducted among newborn babies delivered at Debre Markos Compressive Specialized Hospital, from August, 10 to November 30, 2021. Maternal sociodemographic characteristics, reproductive, nutrition and behavioral factors were collected using interviewer based questionnaire. Nutritional status of the newborn babies were assessed using the Metcof’s CAN score within 24 h after birth. Multiple logistic regression using Hosmer and Lemeshow goodness of fit was conducted to determine the predictors of fetal malnutrition among the study variables. Results: A total of 414 newborn babies (178 males and 236 females) participated in the study. The prevalence of fetal malnutrition was 12.32 % (95 % CI: 10.68–15.79, p-value = 0.01). Within 95 % CI, ANC follow up (AOR: 3.47, 1.96–8.43, p-value = 0.02), IFA provision (AOR:4.61, 1.23–10.63, p-value = 0.01), dietary counseling (AOR: 6.01, 1.56–13.11, p-value = 0.03), maternal MUAC42 weeks (AOR: 2.34,2.03–7.73, p-value = 0.03), birth weight greater than 2.5 kg (AOR: 3.32, (1.52–7.44, p-value = 0.01) and placental weight less than 519 g (AOR: 2.22,1.89–5.16, p-value = 0.01) were significantly associated with fetal malnutrition. Conclusions: In this study, one eighth of the newborn babies had fetal malnutrition. Maternal ANC visit, dietary counseling and placental weight were noted to be as predisposing factors for fetal malnutrition. Improving maternal ANC visit and dietary counseling during pregnancy is essential to prevent fetal malnutrition.

The objective: to conduct a retrospective clinical and statistical analysis of the pregnancy course, childbirth and the condition of newborns in women with HCV infection. Materials and methods. A retrospective clinical and statistical analysis of the pregnancy course, childbirth and the condition of newborns was carried out according to the data of 351 birth histories of women with HCV infection based on the materials of the archive of the communal non-commercial enterprise “Kyiv Municipal Center of Reproductive and Perinatal Medicine” for the period from 2016 to 2021. The control group (CG) included 50 healthy pregnant women. Statistical processing of research results was carried out using standard programs “Microsoft Excel 5.0” and “Statistica 8.0”. Results. In women with HCV infection compared to the group of healthy pregnant women a significantly high frequency (p<0.001) of such pregnancy complications was found: threat of pregnancy interruption - 64 (18.2 %) patients versus 2 (4.0 %) persons, edema of pregnant women - 72 (20.5 %) and 4 (8.0 %), respectively; preeclampsia - 45 (12.8 %) versus 2 (4.0 %), gestational anemia - 131 (37.3 %) versus 6 (12.0 %), as well as placental insufficiency with fetal growth retardation syndrome (FGR) - 69 (19.6 %) versus 3 (6.0 %; p<0.05) and intrahepatic cholestasis of pregnant women - 42 (11.9 %) versus 1 (2.0 %; p<0.05). In 73 (20.8 %) pregnant women with HCV infection the childbirth was complicated by premature rupture of the membranes, of which almost half of the cases (42 (11.9 %) of the patients) finished with premature birth, while in CG only some women had such complications. Fetal distress during childbirth was reliably detected more often in pregnant women with HCV infection than in CG women (χ2 =4.76; p=0.024). Caesarean section was performed in 86 (24.5 %) patients with HCV infection versus 2 (4.0 %) persons in CG (p<0.001). The newborns from mothers with HCV infection had lower indicators of physical development and decreased Apgar score assessment, increased frequency of conjugation jaundice. Conclusions. Pregnant women with HCV infection are characterized by a significant increase in the number of pregnancy complications, such as the threat of pregnancy interruption, the threat of premature birth, gestational anemia, placental dysfunction, fetal growth retardation syndrome, and preeclampsia; during childbirth - premature and antepartum rupture of amniotic membranes, premature birth, weakness of uterine activity in labor, increased blood loss. The condition of newborns from women with HCV infection is characterized by a significant increase in the frequency of asphyxia during childbirth, CNS hypoxic-ischemic damage, prematurity and conjugation jaundice. [ABSTRACT FROM AUTHOR]

The objective: to develop a method for predicting the individual risk for great obstetric syndromes (GOS). Materials and methods. An analysis of the somatic, reproductive, and obstetric anamnesis was conducted in 572 pregnant women with clinical manifestations of GOS, in 81 of them (prediction group) signs of placental dysfunction were detected based on clinical, functional, laboratory, and ultrasound data. Control group (CG) – 50 practically healthy pregnant women with a favorable reproductive history and an uncomplicated course of this pregnancy. Functional, biophysical, hormonal, immunological and hemocoagulation indicators were calculated to determine the informative (prognostic) significance. Quantitative signs were divided into diagnostic intervals, and qualitative signs were assigned a code. The following indicators were included in the standard protocol: age, data on somatic and gynecological history, data on the pregnancy course, results of functional and laboratory examinations. Statistical processing of research results was carried out using standard Microsoft Excel 5.0 and Statistica 6.0 programs. Results. In the I trimester of pregnancy the concentration of placental lactogen (PL) in the prediction group was 29.4 % lower than the CG indicator, estradiol (E2 ) amount – by 27.4 %, estriol (E3 ) – by 28.6 %, progesterone (PG) – by 34.4%, human chorionic gonadotropin (hCG) – by 28.3 % lower, and cortisol (CR) – by 36.1 % higher. At the beginning of the II trimester of pregnancy in the prediction group the level of PL was already reduced by 33.8 %, E2 – by 26.2 %, E3 – by 32.3 %, PG – by 37.4 %, hCG – by 30.6 %, and CR – increased by 43.6 % compared to CG. The indicators of placenta hormonal activity in the early stages of pregnancy and at the beginning of the II trimester can be prognostic signs of further disruption of the adaptive compensatory and adaptive reactions of the fetal placental complex (FPC) in the II and III trimesters of pregnancy. Among a wide range of hemostasiological indicators in the I trimester of pregnancy in the prediction group the most informative were: activated partial thromboplastin time (-23 %) and activated recalcification time (+16.2 %), the changes of which remained at the beginning of the II trimester (-40% and - 11.7% respectively). During the evaluation of thromboelastogram data, the value of “r+k” was fixed by 33.3 % lower in the I trimester and by 36 % – at the beginning of the II trimester of pregnancy. As a result of the analysis the indicators with a high information value (more than 3.0 c.u.) were selected for quantitative assessment of the degree of individual risk for the development of maladaptive disorders in the FPC. The clinical trial of the scoring method of prediction proved its high sensitivity (91.8 %) and specificity (85.6 %). Conclusions. A multi-faceted analysis of anamnestic data, features of the pregnancy course, basic clinical, laboratory and functional indicators in women with clinical manifestations of GOS made possible to develop an effective methodology for predicting the risk for GOS development with high levels of sensitivity and specificity. [ABSTRACT FROM AUTHOR]

Aim: Fetal malnutrition is a condition characterized clinically by the inability of subcutaneous adipose tissue and muscle mass to reach the normal amount or by significant intrauterine loss. The major hormones regulating fetal growth, fetal energy metabolism and adipogenesis are insulin, leptin, ghrelin and adiponectin. Cholesterol and triglycerides are very important in fetal growth in the last period of pregnancy. In this study, it was aimed to compare the glucose, insulin, leptin, ghrelin, adiponectin, cholesterol and triglyceride levels in the cord blood of newborn babies with and without fetal malnutrition. Materials and Methods: Term babies born in our hospital were included in this study. Babies with a Clinical Assessment of Nutritional Status of 24 or below were considered as cases with fetal malnutrition, and those over 24 were considered as cases without fetal malnutrition. Glucose, insulin, leptin, ghrelin, adiponectin, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, very-lowdensity lipoprotein cholesterol and triglyceride levels were studied from blood samples taken from the umbilical cord after delivery. Results: A total of 80 term newborn babies (40 babies with fetal malnutrition and 40 babies without fetal malnutrition) were included in this study. Birth weight, glucose and insulin values were found to be significantly lower in the group with fetal malnutrition (p<0.001; p<0.001; p=0.047, respectively), and adiponectin levels were found to be significantly higher (p<0.001). Conclusion: In our study, adiponectin levels in cord blood were found to be high in infants with fetal malnutrition. Considering the antiinflammatory role of adiponectin, high adiponectin levels in infants with fetal malnutrition may directly or indirectly reflect a protective mechanism. [ABSTRACT FROM AUTHOR]

Detection of giant umbilical cord prenatally should lead to vigilant monitoring particularly at term as fetal demise is a possibility, as noted in the present case because of altered hemodynamics and related vascular complications such as compromised fetal circulation. A case of prenatally diagnosed, giant umbilical cord with fetoplacental insufficiency and impending heart failure is reported. An 18‐year‐old primigravida, presented at 34 weeks of gestational age with complaints of acute onset abdominal pain. Fetal umbilical artery obstetric Doppler examination demonstrated reversal of diastolic flow. 2D echocardiography demonstrated dilated all 4 chambers of the heart with reduced contractility suggesting impending heart failure. Subsequently, fetal demise was noted after 2 days, and labour was induced followed by vaginal delivery of the dead fetus. A giant umbilical cord was seen at delivery with absent knots or strictures. This case report deserves a special mention as there were no earlier reported cases of giant umbilical cord in literature presenting with impending heart failure and fetal demise. We have presented the detailed clinical course of the fetus with giant umbilical cord along with a review of the related literature. [ABSTRACT FROM AUTHOR]

The objective: to study the state of the platelet link of hemostasis in pregnant women with placental dysfunction. Materials and methods. A clinical and laboratory analysis of 54 patients with placental dysfunction was carried out. The control group included 30 practically healthy women with a physiological course of pregnancy. Venous blood of the patients was collected for testing using vacuum systems in tubes with 3.8% sodium citrate. The functional activity of platelets was studied on a photooptical aggregometer AP2110 (Solar, Belarus), thrombocytogram was performed on a hematological analyzer H18 LIGHT (SFRI SAS, France), thromboelastometric tests were determined on the ROTEM delta system (Tem Innovations GmbH, Germany). Results. Platelet hemostasis has a significant effect on maximum clot firmness (MCF) according to ROTEM results in patients with placental dysfunction. This indicator can be effective in determination of the hyperreactivity of the platelet unit in patients with placental dysfunction. Although no statically significant difference was found in the optical aggregometry indicators induced by ADP and collagen between the patients with placental dysfunction and the control group, a clear tendency to a sharp reduction in the lag-period of collagen-induced platelet aggregation in patients with placental dysfunction should be mentioned. Conclusions. Disorders in the platelet chain of hemostasis can play a significant role in the formation of a thrombophilic state in patients with placental dysfunction, as well as the damage of the endothelium and coagulation changes. The use of a test based on collagen-induced platelet aggregation may be a perspective method for effective diagnosis of platelet hyperreactivity. The study of the platelet link should become an additional element of the laboratory examination in order to resolve the issue of the need to prescribe antiplatelet agents to prevent the development of placental dysfunction. [ABSTRACT FROM AUTHOR]

Maternal report of reduced fetal movements (RFM) is a means of identifying fetal compromise in pregnancy. In live births RFM is associated with altered placental structure and function. Here, we explored associations between RFM, pregnancy characteristics, and the presence of placental abnormalities and fetal growth restriction (FGR) in cases of stillbirth. A retrospective cohort study was carried out in a single UK tertiary maternity unit. Cases were divided into three groups: 109 women reporting RFM, 33 women with absent fetal movements (AFM) and 159 who did not report RFM before the diagnosis of stillbirth. Univariate and multivariate logistic regression was used to determine associations between RFM/AFM, pregnancy characteristics, placental insufficiency and the classification of the stillbirth. AFM or RFM were reported prior to diagnosis of stillbirth in 142 (47.2%) of cases. Pregnancies with RFM prior to diagnosis of stillbirth were independently associated with placental insufficiency (Odds Ratio (OR) 2.79, 95% Confidence Interval (CI) 1.84, 5.04) and were less frequently associated with maternal proteinuria (OR 0.16, 95% CI 0.07, 0.62) and previous pregnancy loss <24 weeks (OR 0.20, 95% CI 0.07, 0.70). When combined, AFM and RFM were less frequently reported in twin pregnancies ending in stillbirth and in intrapartum stillbirths. The association between RFM and placental insufficiency was confirmed in cases of stillbirth. This provides further evidence that RFM is a symptom of placental insufficiency. Therefore, investigation after RFM should aim to identify placental dysfunction. [ABSTRACT FROM AUTHOR]

Although various perinatal outcomes in coronavirus disease 2019 (COVID‐19) pregnancies have been reported, the fetal and neonatal consequences of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection remain unclear. Several reports of miscarriages and stillbirths have been recorded, but vertical transmission by SARS‐CoV‐2 is considered very rare, and the cause remains unknown. We report a case of a 22‐year‐old uncomplicated Japanese woman infected with SARS‐CoV‐2 during the second trimester, resulting in intrauterine fetal death due to placental insufficiency associated with COVID‐19 placentitis. This report emphasizes the importance of longitudinal assessment of fetal well‐being by fetal heart rate monitoring and early detection of maternal coagulation dysfunction representing SARS‐CoV‐2 inflammation to manage COVID‐19 in pregnancy. [ABSTRACT FROM AUTHOR]

There is increasing evidence that the maternal environment exerts enduring influences on the fetal brain. In response to certain environmental stimuli such as reduced protein content, the fetus changes the course of its brain development, which leads to specific and programed changes in brain anatomy and physiology. These alterations produce a brain with a fundamentally altered organization, which then translates to alterations in adult cognitive function. The effects on brain and behavior may be linked, such that a prenatal stimulus relays a signal to alter brain development and encourage the selection and development of brain circuits and behaviors that would be beneficial for the environment in which the animal was anticipated to emerge. At the same time, the signal would deselect behaviors unlikely to be adaptive. We draw on evidence from rodent models to suggest that the brain that develops after a reduction in protein during the prenatal phase is not uniformly dysfunctional, but simply different. This perspective has implications for the role of prenatal factors in the production and expression of behavior, and may account for the elevation of risk factors for neurological and psychiatric illnesses. [ABSTRACT FROM AUTHOR]

The objective: to determine the peculiarities of hormonal support, liver enzymatic function and the state of the fetal-placental complex (FPC) in unvaccinated women with fetal growth retardation (FGR) and placental dysfunction (PD) who was ill with the coronavirus disease during the current pregnancy, on the background of the proposed correction scheme of the disorders and evaluation of its effectiveness. Materials and methods. The study included 22 pregnant women with FGR and PD who were being treated and delivered in the Department of Pregnancy and Childbirth Pathology of the State Institution «Institute of Pediatrics, Obstetrics and Gynecology named after Academician O.M. Lukyanova National Academy of Sciences of Ukraine» in 2021–2022 and suffered a coronavirus disease during the current pregnancy. All pregnant women had a general clinical examination and the following parameters were additionally determined: the level of placental lactogen (PL) in blood serum, indicators of liver enzyme activity (alanine aminotransferase – ALT, aspartate aminotransferase – AST, gamma-glutamyl transpeptidase – GHTP), the level of estriol in urine (after the 22d week of pregnancy). The examination was carried out before the start of treatment and preventive measures and 12–14 days after a 10-day course of therapy with simultaneous ultrasound (US) monitoring of the condition of the FPC. In the case of diagnosis of FGR and PD, a course of therapy was carried out, which included daily consecutive intravenous infusions of a balanced crystalloid infusion preparation with lactate and sorbitol in the amount of 200 ml and a solution of levocarnitine and arginine hydrochloride in the amount of 100 ml for 10 days, followed by ultrasound control of the condition of the fetus and FPC. The evaluation of the effectiveness of the treatment was carried out based on a combination of clinical, laboratory and instrumental indicators after 10 days of therapy. Results. All pregnant women had a moderate or mild course of the coronavirus disease at different terms of the current pregnancy. There were 9 (40.9 %) women who were infected with SARS-CoV-2 in the early terms of pregnancy (up to 12 weeks), and they were diagnosed the 2nd and 2nd-3rd degrees of FGR. The majority of pregnant women had gestational complications. Before treatment, 10 (45.5 %) women had oligohydramnios. FGR was diagnosed in 14 (63.6 %) pregnant women, among them: in 3 (13.6 %) persons – fetal growth retardation of the 2nd3rd degree, in 6 (27.3 %) – of the 2nd degree, in 5 (22.7 %) – 1st degree. The analysis of laboratory indicators demonstrated the increase in the levels of ALT, AST and GHTP, and a decrease in the levels of estriol in urine. After the proposed course of treatment, oligohydramnios was found only in 2 (9.1 %) women. The average amniotic index before treatment was 10.1, after treatment – 15.3. 4 (18.2 %) women were diagnosed FGR after the treatment. As a result of the treatment, the improvement of all determined laboratory parameters and perinatal consequences were determined. Conclusions. The proposed scheme for correcting the identified disorders with the inclusion of balanced crystalloid infusion preparation with lactate and sorbitol and balanced crystalloid infusion preparation with lactate and sorbitol drugs made possible to improve microcirculation, metabolic processes, and to normalize the consequences of postcovid endotheliitis in the vascular system of pregnant women in general and in the FPC, in particular. This was manifested in the improvement of clinical, laboratory and instrumental indicators of conducted studies and had a positive effect on perinatal results. [ABSTRACT FROM AUTHOR]

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

Background: Prenatal alcohol exposure (PAE) has been shown to alter fetal blood flow in utero and is also associated with placental insufficiency and intrauterine growth restriction (IUGR), suggesting an underlying connection between perturbed circulation and pregnancy outcomes. Methods: Timed‐pregnant C57/BL6NHsd mice, bred in‐house, were exposed by gavage on gestational day 10 (GD10) to ethanol (3 g/kg) or purified water, as a control. Pulse‐wave Doppler ultrasound measurements for umbilical arteries and ascending aorta were obtained post‐gavage (GD12, GD14, GD18) on 2 fetuses/litter. RNA from the non‐decidual (labyrinthine and junctional zone) portion of placentas was isolated and processed for RNA‐seq and subsequent bioinformatic analyses, and the association between transcriptomic changes and fetal phenotypes assessed. Results: Exposure to ethanol in pregnant mice on GD10 attenuates umbilical cord blood flow transiently during gestation, and is associated with indices of IUGR, specifically decreased fetal weight and morphometric indices of cranial growth. Moreover, RNA‐seq of the fetal portion of the placenta demonstrated that this single exposure has lasting transcriptomic changes, including upregulation of Tet3, which is associated with spontaneous abortion. Weighted gene co‐expression network analysis (WGCNA) identified erythrocyte differentiation and homeostasis as important pathways associated with improved umbilical cord blood flow as gestation progresses. WGCNA also identified sensory perception of chemical stimulus/odorant and receptor activity as important pathways associated with cranial growth. Conclusion: Our data suggest that PAE perturbs the expression of placental genes relevant for placental hematopoiesis and environmental sensing, resulting in transient impairment of umbilical cord blood flow and, subsequently, IUGR. [ABSTRACT FROM AUTHOR]