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SCOPUS: no.j, info:eu-repo/semantics/published

Objective: Pregnant women with autoimmune (subclinical) hypothyroidism have an increased risk of developing gestational diabetes mellitus (GDM). However, this association remains controversial in euthyroid women with thyroid autoimmunity (TAI). Therefore, the aim of the study was to determine the association between TAI and GDM in euthyroid women in a logistic regression analysis with adjustments for baseline/ demographic parameters. Methods: Cross-sectional study in 1447 euthyroid women who performed their entire clinical/biological workup and oral glucose tolerance test (OGTT) in our center. At median 13 (11–17) weeks of gestation, thyroid-stimulating hormone, free T4, and thyroid peroxidase antibodies (TPOAb) were measured, baseline characteristics were recorded, and an OGTT was performed between 24 and 28 weeks of pregnancy. Exclusion criteria were pre-pregnancy diabetes, assisted pregnancies, and women with (treated) thyroid dysfunction before or after screening. The diagnosis of GDM was based on 2013 World Health Organization criteria, and TAI was defined as TPOAb levels ≥60 kIU/L. Results: Two hundred eighty women were diagnosed with GDM (19.4%), 26.1% in women with TAI, and 18.9% in women without TAI (P = 0.096). In the logistic regression analysis, TAI was associated with GDM in women older than 30 years (adjusted odds ratio 1.68 (95% CI, 1.01–2.78); P = 0.048). Maternal age >30 years, pre-pregnancy BMI ≥30 kg/m2, and other than Caucasian background were also associated with GDM; aOR 1.93 (95% CI, 1.46–2.56); P < 0.001, 2.03 (95% CI, 1.46–2.81); P < 0.001 and 1.46 (95% CI, 1.03–2.06); P = 0.034, respectively. Conclusions: In older pregnant women, the presence of TAI in euthyroid women was associated with GDM. In line with the literature data, (higher) age and BMI were strongly associated with GDM. Future investigations should focus on treatments that might prevent the development of GDM in euthyroid women with TAI., SCOPUS: ar.j, info:eu-repo/semantics/published

Objective: It is unknown if foetal gender influences maternal thyroid function during pregnancy. We therefore investigated the prevalence of thyroid disorders and determined first-trimester TSH reference ranges according to gender. Methods: A cross-sectional study involving 1663 women with an ongoing pregnancy was conducted. Twin and assisted pregnancies and l-thyroxine or antithyroid treatment before pregnancy were exclusion criteria. Serum TSH, free T4 (FT4) and thyroid peroxidase antibodies (TPOAb) were measured at median (interquartile range; IQR) 13 (11–17) weeks of gestation. Subclinical hypothyroidism (SCH) was present when serum TSH levels were >3.74 mIU/L with normal FT4 levels (10.29–18.02 pmol/L), and thyroid autoimmunity (TAI) was present when TPOAb were ≥60 kIU/L. Results: Eight hundred and forty-seven women were pregnant with a female foetus (FF) and 816 with a male foetus (MF). In women without TAI and during the gestational age period between 9 and 13 weeks (with presumed high-serum hCG levels), median (IQR range) serum TSH in the FF group was lower than that in the MF group: 1.13 (0.72–1.74) vs 1.24 (0.71–1.98) mIU/L; P = 0.021. First-trimester gender-specific TSH reference range was 0.03–3.53 mIU/L in the FF group and 0.03–3.89 mIU/L in the MF group. The prevalence of SCH and TAI was comparable between the FF and MF group: 4.4% vs 5.4%; P = 0.345 and 4.9% vs 7.5%; P = 0.079, respectively. Conclusions: Women pregnant with an MF have slightly but significantly higher TSH levels and a higher upper limit of the first-trimester TSH reference range, compared with pregnancies with a FF. We hypothesise that this difference may be related to higher hCG levels in women pregnant with a FF, although we were unable to measure hCG in this study. Further studies are required to investigate if this difference has any clinical relevance., SCOPUS: ar.j, info:eu-repo/semantics/published

Glucocorticoids are effective immunomodulatory drugs used for many inflammatory disorders as well as in transplant recipients. However, both iatrogenic and endogenous glucocorticoid excess are also associated with several side effects including an increased risk of osteoporosis and fractures. Glucocorticoid-induced osteoporosis (GIOP) is a common secondary cause of osteoporosis in adults. Despite availability of clear evidence and international guidelines for the prevention of GIOP, a large treatment gap remains. In this narrative review, the Belgian Bone Club (BBC) updates its 2006 consensus recommendations for the prevention and treatment of GIOP in adults. The pathophysiology of GIOP is multifactorial. The BBC strongly advises non-pharmacological measures including physical exercise, smoking cessation and avoidance of alcohol abuse in all adults at risk for osteoporosis. Glucocorticoids are associated with impaired intestinal calcium absorption; the BBC therefore strongly recommend sufficient calcium intake and avoidance of vitamin D deficiency. We recommend assessment of fracture risk, taking age, sex, menopausal status, prior fractures, glucocorticoid dose, other clinical risk factors and bone mineral density into account. Placebo-controlled randomized controlled trials have demonstrated the efficacy of alendronate, risedronate, zoledronate, denosumab and teriparatide in GIOP. We suggest monitoring by dual-energy X-ray absorptiometry (DXA) and vertebral fracture identification one year after glucocorticoid initiation. The trabecular bone score might be considered during DXA monitoring. Extended femur scans might be considered at the time of DXA imaging in glucocorticoid users on long-term (≥ 3 years) antiresorptive therapy. Bone turnover markers may be considered for monitoring treatment with anti-resorptive or osteoanabolic drugs in GIOP. Although the pathophysiology of solid organ and hematopoietic stem cell transplantation-induced osteoporosis extends beyond, SCOPUS: re.j, info:eu-repo/semantics/published

Les femmes infectées par le Virus de l’Immunodéficience Humaine (VIH) sont plus à risque d’être infectées par le Papillomavirus Humain (HPV), et en conséquence de développer des lésions précancéreuses et un cancer invasif du col. Nous avons étudié la prise en charge des lésions précancéreuses du col utérin chez les femmes VIH + et l’avons comparée à celle des femmes VIH négatives. Nous avons mis en évidence que les taux de récidives après traitement chirurgical était plus élevé chez les femmes VIH + et surtout quand un traitement ablatif était utilisé. Par ailleurs, un mauvais contrôle de l’infection par VIH était associé à un plus haut taux d’échec de traitement. De plus, nous avons évalué la prévalence de l’infection par HPV en relation avec le mode d’acquisition du VIH (périnatal versus non périnatal). La prévalence d’infection par HPV était la même dans les deux groupes et nous avons observé une haute prévalence d’HPV haut risque autre que 16/18 parmi les deux groupes de femmes, ce qui soutient l’usage d’une vaccination par le vaccin HPV nonavalent chez toutes les femmes VIH+. Enfin, nous avons réalisé une étude recherchant l’HPV au sein de lésions précancéreuses de haut grade et de cancers du col invasifs chez 170 femmes VIH + généralement originaires d’Afrique mais vivant en Europe. Les génotypes les plus fréquemment détectés au sein des lésions précancéreuses de haut grade et des cancers invasifs étaient HPV 16 (30 %), HPV 35 (16%), HPV 58 (15%), HPV 31 (14%), and HPV 52 (12%). Les infections par multiples HPV étaient fréquentes et corrélées à un âge plus jeune, une immunité faible et une charge virale non contrôlée. Nous avons estimé que l’usage du vaccin nonavalent dans cette population pourrait prévenir jusqu’à 85 % des lésions précancéreuses et ajouter l’HPV 35 dans le panel vaccinal augmenterait l’efficacité vaccinale surtout chez les femmes originaires d’Afrique sub-saharienne. Une revue sur l’histoire naturelle d’infection par HPV chez les femmes VIH +, Doctorat en Sciences médicales (Médecine), info:eu-repo/semantics/nonPublished