Oxidative stress and antioxidant status among neonates born to mothers with pre-eclampsia and their early outcome

Abstract

Objective: To study the oxidative stress and antioxidant status among neonates born to pre-eclamptic mothers and their role in the early outcome of these babies.

Study design: This case control study was conducted at a tertiary care teaching hospital in South India. We included 75 neonates born to mothers with pre-eclampsia matched against 75 neonates born to mothers with normal blood pressure. Relevant antenatal and neonatal clinical data were collected for all babies. Levels of malondialdehyde (MDA) and total antioxidant status (TAS) were estimated in cord blood and oxidative stress was correlated with early neonatal outcome.

Results: Oxidative stress was increased among cases compared to controls as evidenced by increased mean MDA levels (7.43?±?1.21 versus 3.06?±?0.69?µmol/L) and decreased mean TAS (742.15?±?27.30 versus 829.26?±?23.16?mmol/L). Level of oxidative stress correlated with poor neonatal outcome including sepsis, NEC and respiratory distress among cases. An MDA value of 8.68?µmol/L can be used as a cut-off, with sensitivity of 60% and specificity of 89.2%, to predict neonatal death among babies born to pre-eclamptic mothers.

Conclusion: Oxidative stress is increased in neonates born to mothers with pre-eclampsia and useful in predicting outcome.     

Thiol-disulfide homoestasis in pregnancies with fetal growth restriction

Abstract

Aim: To investigate the role of dynamic thiol-disulfide homeostasis in preeclamptic and idiopathic fetal growth restricted (FGR) pregnancies.

Material and method: In this prospective case-control study, a total of 110 singleton pregnancies with FGR (study group) (51 preeclamptic and 59 idiopathic FGR’s cases) were compared with 68 healthy pregnant controls at the same gestational weeks (control group). For serum disulfide-thiol homeostasis, a newly used method described by Erel and Neselioglu was used.

Results: Serum native thiol and total thiol levels were lower in FGR pregnancies (285.63?±?55.92?µmol/L, 324.41?±?44.18?µmol/L, respectively) than control group (324.41?±?44.18?µmol/L, 362.98?±?51.43?µmol/L, p?<?.001, p?=?.004, respectively). In subgroup analysis, only preeclamptic FGR’s have lower native and total thiol levels (254.41?±?59.55, 324.41?±?44.18?µmol/L, respectively) compare to both idiopathic FGR’s and control’s. There was no difference in native and total thiol levels with idiopathic FGR’s with controls. Idiopathic FGR’s have higher levels of disulfide than preeclamptic FGR’s (21.72?±?17.72 versus 16.80?±?11.20?µmol/L). The serum albumin and total protein levels were positively and spot urine protein/creatinine ratio, 24-h urine protein levels were negatively correlated with native thiol and total thiol levels.

Conclusion: The balance of thiol-disulfide homeostasis was shifted and native and total thiol levels were decreased only in preeclamptic FGR pregnancies. The serum disulfide level was increased in idiopathic FGR pregnancies compare to preeclamptic FGR pregnancies which may be a sign of oxidative stress in idiopathic FGR pregnancies with normal thiol pool.     

Thiol/disulfide homeostasis in pregnant women with obstructive sleep apnea syndrome

Background: Repetitive episodes of hypoxia and reoxygenation during sleep in patients with obstructive sleep apnea syndrome (OSAS) resemble an ischemia-reperfusion injury. We aimed to test the hypothesis that oxidative stress occurs in pregnant women with OSAS. We also aimed to compare thiol/disulfide homeostasis with ischemia-modified albumin (IMA) and total antioxidant capacity (TAC) as markers of ischemia-reperfusion injury in pregnant women with and without OSAS and healthy control.

Methods: This study included 29 pregnant women with OSAS, 30 women without OSAS in the third trimester applying for periodic examinations, and 30 healthy women. Serum IMA and TAC (using the ferric reducing power of plasma method) were measured. Serum thiol/disulfide homeostasis was determined by a novel automated method.

Results: The mean age of the pregnant women with OSAS was 31.0?±?4.7 years with a mean gestational age of 36.5?±?3.0 weeks. The mean age of pregnant women without OSAS was 29.8?±?4.9 years with a mean gestational age of 36.9?±?2.7 weeks. The mean age of the nonpregnant control group was 29.7?±?6.4 years. Both native thiol (291?±?29?μmol/L versus 314?±?30?μmol/L; p?=?.018) and total thiol (325?±?32 versus 350?±?32, p?=?.025) levels were lower in pregnant women with OSAS compared to pregnant women without OSAS, respectively (p?Conclusions: This is the first study demonstrating the thiol/disulfide homeostasis in pregnant women with OSAS. Native thiol and total thiol levels were lower in pregnant women with OSAS compared to those without OSAS. However, dynamic thiol/disulfide homeostasis parameters cannot provide valuable information to discriminate OSAS in pregnant women.     

Is cord blood hepcidin influenced by the low-grade acute-phase response occurring during delivery? A small-scale longitudinal study

Aim: To measure serum hepcidin in late pregnancy and in cord blood, and to analyze relationship between hepcidin, interleukin-6, and biomarkers of fetal iron status.

Materials and methods: Data from 15 uncomplicated singleton pregnancies were analyzed longitudinally in trimester 3 (T3) and at birth.

Results: In T3, S-ferritin (median 14 µg/L) and transferrin (median 4.0?g/L) indicated low iron status, whereas the median soluble transferrin receptor (sTfR) was 4.0?mg/L, i.e. within the reference interval. Median T3?S-hepcidin was 7.8?ng/mL. Later on in cord blood, ferritin concentration (180 µg/L) were significantly higher, transferrin concentration (1.8?g/L) were significantly lower, and both sTfR (4.7?mg/L) and S-hepcidin concentrations (30.5?ng/mL) were significantly higher than maternal T3 concentrations. At the same time, cord blood interleukin-6 indicated an activated acute-phase reaction. In T3, after logarithmic transformation, there was a significant correlation between S-hepcidin and both S-ferritin (r?=?0.691) and sTfR (r?=??0.825). There was also a significant correlation between S-ferritin and both sTfR (r?=??0.729) and transferrin (r?=?0.549) in T3.

Conclusions: Although S-ferritin, S-hepcidin, and sTfR were correlated during pregnancy, these relationships were not apparent in umbilical cord blood. Further, cord blood interleukin-6 indicated an activated acute-phase response, and sTfR, which is known to be unaffected by inflammation, indicated a low iron status in cord blood. Thus, instead of representing an enhanced iron status, the data appear to suggest that hepcidin and ferritin in cord blood may be influenced by the low-grade acute-phase response that occurs during delivery.     

Higher levels of thyrotropin in pregnancy and adverse pregnancy outcomes

Objective: To determine the frequency of subclinical hypothyroidism in women with pathological pregnancies and the association between elevated thyroid-stimulating hormone (TSH) and pregnancy outcome.

Subjects and methods: A cross-sectional prospective study investigated value of TSH and free thyroxine (FT4) in (1) pregnant women with hypertension (HTA) (N?=?62) or preeclampsia (PE) (N?=?50), (2) women with gestational diabetes mellitus (GDM) (N?=?92) in pregnancy, and (3) women with normal pregnancies (control) (N?=?201). The level of statistical significance was set at p?Results: Of the total 404 respondents, the highest incidence of subclinical hypothyroidism was in the group with preeclampsia 22%, followed HTA group 9.6%; GDM group 10.9% and in the control group 9% (p?p?3?mIU/L (p?=?.003). There were no differences in the average TSH value between GDM (1.93?±?1.03?mIU/L) and control group (p?=?.962).

Conclusions: Early detection and optimal treatment of thyroid dysfunction before and in the first trimester of pregnancy reduces the risk of adverse pregnancy outcomes.     

Morbidity and mortality of very low birth weight multiples compared with singletons

Background: Previous studies comparing the neonatal outcome of very low birth weight (VLBW) multiples and singletons have suggested a worse outcome for multiples at gestational ages on the limits of viability.

Objectives: The objective of this study is to determine the neonatal mortality and morbidity of VLBW multiples compared to singletons.

Methods: This is a retrospective study including all infants registered in the Spanish network for infants under 1500?g (SEN1500), over a 12-year period (from 2002 to 2013). Mortality and major morbidities were compared between singletons and multiples.

Results: About 32,770 infants were included: 21,123 singletons (64.5%) and 11,647 multiples (35.5%), with a mean gestational age of 29.5 weeks (22–38), and mean birth weight of 1115?g (340–1500). When adjusted by other perinatal factors, multiple pregnancy has a significantly higher risk of mortality than singleton pregnancy (odds ratio (OR) 1.15; IC 95% 1.05–1.26, p?=?.002), but not a higher risk of major morbidity or composite adverse outcome. In the subgroup of infants born before 26 weeks, multiples showed a higher risk of mortality (63.9% versus 51%, OR 1.7; 95% CI 1.47–1.96) and a higher risk of composite adverse outcome (88.9% versus 81.5%, OR 1.82, 95% CI 1.28–2.24).

Conclusions: In preterm infants born with less than 1500?g, multiple pregnancy is a prognostic factor that can slightly increase mortality. Extremely preterm infants born before 26 weeks have a greater risk of mortality and major morbidity if they come from a multiple pregnancy.     

Management of hypertriglyceridaemia-induced acute pancreatitis in pregnancy

Introduction: Acute pancreatitis is a recognised rare complication in pregnancy. The reported incidence varies between 3 and 7 in 10?000 pregnancies and is higher in the third trimester. The commonest causes in pregnancy include gallstones, alcohol and hypertriglyceridaemia. Non-gallstone pancreatitis is associated with more complications and poorer outcome with hypertriglyceridaemia-induced acute pancreatitis having mortality rates ranging from 7.5 to 9.0% and 10.0 to 17.5% for mother and foetus, respectively.

Case history: A 40-year-old para 4 woman, who presented at 15⁺⁴ weeks’ gestation, was diagnosed with acute pancreatitis. Past medical history included Graves’ disease and hypertriglyceridaemia. Fenofibrate was discontinued immediately after discovery of the pregnancy. Initial investigations showed elevated amylase (475.0?µ/L) and triglycerides (46.6?mmol/L). Imaging revealed an inflamed pancreas without evidence of biliary obstruction/gallstones hence confirming the diagnosis of hypertriglyceridaemia-induced acute pancreatitis. Laboratory tests gradually improved (triglyceride 5.2?mmol/L on day 17). On day 18, ultrasound confirmed foetal demise (18⁺¹ weeks) and a hysterotomy was performed as she had had four previous caesarean sections.

Conclusion: Management of acute pancreatitis in pregnancy requires a multi-disciplinary approach. Hypertriglyceridaemia-induced acute pancreatitis has poor outcomes when diagnosed in early pregnancy. Identifying those at risk pre-pregnancy and antenatally can allow close monitoring through pregnancy to optimise care.     

Adiponectin as serum biomarker of insulin resistance in patients with polycystic ovarian syndrome

Abstract

Objective: To examine the role of adiponectin as a biomarker of insulin resistance in polycystic ovary syndrome (PCOS).

Background: PCOS is associated with metabolic syndrome, which correlates to increased cardiovascular risk in these patients. Adiponectin is decreased in obese individuals.

Methods: Ninety women with PCOS (45 with and 45 without metabolic syndrome) were enrolled in this study. Anthropometric variables, serum concentrations of fasting glucose, insulin, triglycerides, lipoproteins, cholesterol, testosterone and adiponectin were measured in all patients. Insulin sensitivity was examined in all patients. Numerical values were analyzed by t-tests and categorical data were analyzed by Chi-square test. Multiple regression analyses were performed to detect the factors that contributed to insulin resistance.

Results: Metabolic syndrome predicted insulin resistance in PCOS patients. Serum adiponectin levels were suppressed in insulin resistant compared to insulin sensitive patients (10.7?±?4.3?µg/mL, p?<?0.001). Multiple linear regression analysis revealed for every 1?µg increase in adiponectin, insulin sensitivity index increases by 0.1 (p?=?0.016). Serum testosterone failed to correlate with insulin sensitivity.

Conclusion: Serum adiponectin levels were suppressed in patients with both metabolic syndrome and insulin resistance. This protein could be used as a biomarker to distinguish the patients at a higher risk of diabetes and cardiovascular morbidity.     

Neuroleptic malignant syndrome in pregnancy: case report and literature review

Background: Neuroleptic malignant syndrome (NMS) is a serious complication associated with the use of drugs that affect dopaminergic system neurotransmission. The occurrence of NMS during pregnancy or gestation is considered a life-threatening obstetric emergency.

Case: We are reporting the first case in Latin America of NMS in one pregnant women with acute psychotic episode. One day after starting with antipsychotic therapy, she developed a fever higher than 39.0?°C with tachycardia, tachypnea, generalized muscle rigidity and somnolence, with creatine kinase (CPK) levels evidencing a result of 2800?U/L. She was treated successfully with levetiracetam, biperiden and quetiapine.

Discussion: A search in PubMed, Embase and Ovid from 1988 to 2016 resulted in seven cases reported in either pregnant or puerperal women. In general, NMS resolves within 3–14 days; most NMS cases reported during pregnancy have involved the use of haloperidol (5 case reports) which is concordant with this report. The obstetric results were good in cases reported, only two women showed signs, among them: hyperemesis gravidarum and preterm delivery. Most of the pregnant women who had NMS presented other associated comorbidities, being mostly of infectious origin. In other investigations, it has been affirmed that NMS can become lethal in adults; however, in our search for pregnant women with this disease, no associated mortality was found.

Conclusions: NMS is seen infrequently during pregnancy. The clinical diagnosis requires high suspicion by the examiner. It is important that obstetricians timely recognize the condition.     

Second trimester amniotic fluid myo-inositol concentrations in women later developing gestational diabetes mellitus or pregnancy-induced hypertension

Objective: To evaluate myo-inositol concentrations in amniotic fluid in women later developing gestational diabetes and hypertension.

Methods: A retrospective study was carried out with three groups of amniotic fluid samples (15–18 gestational weeks): 30 gestational hypertension pregnancies, 30 gestational diabetes pregnancies, and 30 normal pregnancy.

Results: A significant difference was observed in myo-inositol concentrations between the median gestational diabetes values (124.0?µmol/L, IQR 90.0–162.5) and the control group values (79.0?µmol/L, IQR 62.0–107.5), but also with gestational hypertension median values (79.0?µmol/L, IQR 67.75–92.0) (p?<?0.001).

Conclusions: This study has shown that myo-inositol concentrations in amniotic fluid increased significantly in women later developing gestational diabetes compared to the control group.     

Effectiveness and safety of late midtrimester cervical cerclage

Objectives: To evaluate the safety and effectiveness of late cervical cerclage performed beyond 17 weeks of gestation. The outcomes of interest were effectiveness of late cerclage in prolongation of pregnancy and evaluation of pregnancy outcome including maternal and fetal complications.

Study design: A total of 30 patients underwent late cervical cerclage during the study period. Of them, two were twin pregnancies. A late cerclage was performed after the diagnosis of cervical shortening or dilatation in 20 patients. We performed a retrospective case series review. One case was lost to follow up (delivery in another medical center). Medical information was retrieved from all cases of patients who underwent a late cervical cerclage between the years 2010 and 2016 at the Soroka University Medical Center, a tertiary medical center. Continuous variables were expressed as mean?±?standard deviation. Categorical variables were expressed as proportions.

Results: The average gestational age at birth was 35?±?5.1 weeks of gestation. The mean interval between cerclage and delivery in the study population was 17?±?5.62 weeks. Nine cases (32.1%) resulted in preterm deliveries, three of them below 34 weeks of gestation (one twin pregnancy and two pregnancies diagnosed with cervical dilation prior to cerclage). Among all the preterm deliveries, there were four cases of preterm prelabor rupture of membranes (13.3%). Of the 28 deliveries, 24 women (85.7%) had a vaginal delivery, while four women (14.3%) underwent a cesarean section. No cases of cervical tear were described. The cerclage was sent to bacteriology after removal, showing positive cultures for Candida species in nine cases (31%).

Conclusions: In our study population, late cervical cerclage was found to be a safe procedure resulting in almost 90% of successful vaginal deliveries without maternal or fetal complications. This procedure might be effective in the prolongation of pregnancy in women with cervical dynamics in the late second trimester.     

Vitamin D status in pregnant women with asthma and its association with adverse respiratory outcomes during infancy

Background: Vitamin D may influence pregnancy and infant outcomes, especially infant respiratory health. This study aimed to examine vitamin D status in pregnant women with asthma, and whether higher vitamin D levels are associated with fewer adverse respiratory outcomes in their infants.

Methods: Pregnant women with asthma, recruited from John Hunter Hospital Newcastle Australia (latitude 33°S), had serum total 25-hydroxyvitamin-D (25(OH)D) measured at 16 and 35 weeks gestation. Infant respiratory outcomes were collected at 12 months by parent-report questionnaire. Mother–infant dyads were grouped by serum 25(OH)D during pregnancy: 25(OH)D?Results: In 52 pregnant women with asthma, mean serum 25(OH)D levels were 61 (range 26–110) nmol/L at 16 weeks, and 65 (range 32–116) nmol/L at 35 weeks, gestation. Thirty-one (60%) women had 25(OH)D?p?=?.04). Infant acute-care presentations (45 versus 13%, p?=?.02) and oral corticosteroid use (26 versus 4%, p?=?.03) due to “asthma/wheezing” were higher in the maternal group with 25(OH)D?Conclusions: Most pregnant women with asthma had low vitamin D status, which persisted across gestation. Low maternal vitamin D status was associated with greater risk of adverse respiratory outcomes in their infants, a group at high risk of developing childhood asthma.     

Casting doubt on the value of assessing the cardiac index in pregnancy

Objectives: The objective of this study is to assess the reliability of the cardiac index (CI) in healthy pregnant women at term by investigating the correlation between the cardiac output (CO) and the body surface area (BSA) using a novel non-invasive cardiography technique (NICaS?).

Methods: Sixty-one healthy, normotensive women with a singleton pregnancy at term (≥37 gestational weeks) participated in this prospective observational study between 1/2015 and 6/2015?L. Each woman was assessed for CO by the NICaS?, an impedance device that non-invasively measures the CO and its derivatives. The NICaS? demonstrated a very good correlation with the gold standard Swan–Ganz catheter. BSA was determined by the Dubois nomogram.

Results: The mean?±?standard deviation maternal age was 34.2?±?5.3 years, mean height 166?±?6?cm, and mean body mass index 23.9?±?4.9?kg/m². The mean gestational age was 38.8?±?0.7 weeks. The correlation between the CO and the BSA was poor (Pearson r?=?0.254, p?Conclusions: The current study demonstrated poor correlation between the CO and the BSA in pregnant women, therefore, making the CI a non-reliable variable for assessing CO in pregnant women. We, therefore, suggest that the CO rather than the CI is the preferred parameter for hemodynamic measurements in this population.     

Estimation of birth population-based perinatal-neonatal mortality and preterm rate in China from a regional survey in 2010

Abstract

Objective: To estimate birth population-based perinatal-neonatal mortality and preterm rate in China from a regional survey in 2010.

Study design: Data of total births in 2010 obtained from 151 level I–III hospitals in Huai’an, Jiangsu, were prospectively collected and analyzed.

Results: From 61?227 birth registries (including 60?986 live births and 241 stillbirths), we derive a birth rate of 11.3‰ (of 5.4 million regional population), a male-to-female ratio of 116:100 and valid data from 60?615 newborns. Mean birth weight (BW) was 3441?±?491?g with 13.6% macrosomia. Low BW was 2.8% (1691/60?372) with 8.83% mortality. Preterm rate was 3.72% (2239/60?264) with 7.61% mortality. Cesarean section rate was 52.9% (31?964/60?445), multiple pregnancy 1.8% (1088/60?567) and birth defects 6.7‰ (411/61?227). There were 97.4% healthy newborns and 2.2% (1298) requiring hospitalized after birth. The perinatal mortality was 7.7‰ (471/61?227, including 241 stillbirths, 230 early neonatal deaths). The neonatal mortality was 4.4‰ (269/60?986). The main causes of neonatal death were birth asphyxia (24.5%), respiratory diseases (21.5%), prematurity related organ dysfunction (18.5%) and congenital anomalies (7.7%), whereas incidence of congenital heart disease and respiratory distress syndrome was 8.6‰ and 6.1‰, respectively.

Conclusions: This regional birth population-based data file contains low perinatal-neonatal mortality rates, associated with low proportion of LBW and preterm births, and incidences of major neonatal disease, by which we estimate, in a nationwide perspective, in 16 million annual births, preterm births should be around 800?000, perinatal and neonatal mortality may be 128?000–144?000 and 80?000–96?000, respectively, along with 100?000 respiratory distress syndrome.     

Maternal risk factors associated with lead,mercury and cadmium levels in umbilical cord blood,breast milk and newborn hair

Objective: Lead (Pb), mercury (Hg) and cadmium (Cd) are environmental pollutants that are wide spread throughout the world. The present study aimed to investigate the level of exposure to Pb, Hg and Cd during the prenatal period, and the possible routes of maternal exposure to these toxic heavy metals.

Participants: The study included 123 mothers and their newborns. Umbilical cord blood samples were collected immediately after delivery, and breast milk and newborn hair samples were collected between postpartum d 3 and 10.

Results: Among the 121 cord blood samples that were analyzed, Pb was present in 120 (99.2%) and the mean level was 1.66?±?1.60?µg?dL^?1 (range: <detection limit–12.50?µg?dL^?1), whereas Hg was noted in only 2 (1.7%) (15.74 and 33.20?µgL^?1) and Cd was detected in 24 (19.8%) (range: <?detection limit–6.71?µgL^?1). The level of Pb in cord blood was ≥2?µg?dL^?1 in 29% of the samples. Pb, Hg and Cd were detectable in all the newborn hair samples.

Discussion: Among the 107 breast milk samples analyzed, 89 (83.2%) had a detectable level of Pb and the mean level was 14.56?±?12.13?µgL^?1. Detection rate of Cd in breast milk was higher in women who resided near to city waste disposal site. Detection rate of Cd in cord blood was significantly higher in the women who consumed ≥2 servings of fish weekly. Maternal exposure to environmental tobacco smoke (ETS) resulted in elevated levels of Pb and Cd in newborn hair samples.

Conclusion: Most of the study samples had detectable levels of Pb, Hg and Cd, indicating that there was long-term maternal exposure prior to and during pregnancy, and a considerable number of the cord and breast milk samples had levels that exceeded the present accepted safety level.     

Thyroid function in pregnant women: iodine deficiency after iodine enrichment program

Abstract

Objective: Significant changes in thyroid function occur during pregnancy which can complicate the interpretation of thyroid function tests. Therefore, normative gestational related reference ranges for thyroid hormones tests are required. The aim of this study was to determine the reference ranges for free triiodothyronine (FT3), free thyroxin (FT4) and thyroid stimulating hormone (TSH) in Iranian pregnant women.

Methods: This study was a cross-sectional observational study conducted in the Obstetrics and Gynecology department, Akbarabadi University Hospital. A single blood sample from 584 pregnant women was analyzed for thyroid function. Serum levels of TSH, FT4, FT3, total T4 (TT4), T3 resin uptake (T3RU) and anti-thyroid peroxidase antibody (TPO Ab) were measured. Urinary iodine was determined in some cases. Reference intervals based on 2.5th and 97.5th percentiles were calculated.

Results: The composition of reference population comprising 584 women included 162 in first trimester and 422 in the third trimester. The 2.5th and 97.5th percentiles values were used to determine the reference ranges for FT3, FT4, TT4, T3RU and TSH. These values were T3 1.4 and 2.9?pmol/L, FT4 7.1 and 18?pmol/L, TT4 7.2 and 13.5?µg/dL and TSH 0.5 and 3.9?µg/L, respectively. The level of urinary iodine in 80.5% of the subjects was less than normal.

Conclusions: Serum levels of thyroid hormones are different in Iranian population that could be due to racial differences or differences in iodine intake.     

Effect of duration of the GnRH agonists in the luteal phase in the outcome of assisted reproduction cycles

Abstract

The effect of long-acting GnRHa, in the luteal phase, during ART cycles varies from one patient to another. The aim of this study was to evaluate whether the effect of long-acting GnRHa in the luteal phase, in ART cycles, affects pregnancy rates according to the duration of its action in such phase. This is a retrospective study of 367 patients submitted to ovulation induction for in vitro fertilization/intracytoplasmic sperm injection procedures that used long-acting depot GnRHa for pituitary suppression. Patients were stratified according to the period of action of the agonist in the luteal phase: group 1, ≤6 days; group 2, 7 to 12 days; and group 3, >12 days. The following variables were analyzed: ovarian response, age, infertility causes and pregnancy rates. Group 1 (n?=?53) had a mean age of 33.8?±?4.55 years (23–44 years) and a pregnancy rate of 45.2%. In group 2 (n?=?118), mean age was 33.7?±?4.5 years (24–44 years) and the pregnancy rate was 38.9%. In group 3 (n?=?196), mean age was 33.7?±?4.4 years (23–43 years) and the pregnancy rate was 47.4%. Regardless of the duration of depot GnRHa action in the luteal phase, no significant association with pregnancy rates was found.     

Homeostatic indices of insulin resistance among gestational diabetics in anticipating pregnancy complications

Abstract

Objective: This was to determine HOMA-IR score as well as to assess its association in fetal and maternal outcomes among pregnant women with diabetes risks.

Methods: A prospective cohort study of pregnant women with diabetes risks was done. GDM was diagnosed using modified glucose tolerance test. Serum insulin was taken and measured by an electrochemiluminescence immunoassay method. Plasma glucose was measured by enzymatic reference method with hexokinase. HOMA-IR score was calculated for each patient. Maternal and fetal outcomes were analyzed.

Results: From 279 women recruited, 22.6% had GDM with higher HOMA-IR score (4.07?±?2.44 versus 2.08?±?1.12; p?=?0.001) and fasting insulin (16.76?±?8.63?µIU/L versus 10.15?±?5.07?µIU/L; p?=?0.001). Area under ROC curve for HOMA-IR score was 0.79 (95% confidence interval, 0.74–0.84) with optimum cut-off value of 2.92 (sensitivity?=?63.5%; specificity?=?89.8%), higher than recommended by IDF (2.38). This point showed significant association with neonatal hypoglycemia (p?=?0.02) and Cesarean section (p?=?0.04) in GDM mothers.

Conclusions: HOMA-IR score and insulin resistance levels were higher in GDM women in our population. With the cut-off HOMA-IR value of 2.92, neonatal hypoglycemia and Cesarean section were significant complications in GDM mothers. This can be used in anticipation of maternal and fetal morbidities.     

Relationship between advanced glycation end products and gestational diabetes mellitus

Objective: To investigate the levels of and dynamic changes of advanced glycation end products (AGEs) in maternal plasma during pregnancy and explore the association between these levels and gestational diabetes mellitus (GDM).

Methods: This study recruited 90 GDM women and 90 healthy pregnant controls. The women received prenatal care and were hospitalized for delivery in Peking University First Hospital in China between October 2015 and April 2016. The patients were recruited and provided blood samples during gestational weeks 24–29. The levels of AGEs, TNF-α, hs-CRP, plasma glucose, and FINS and lipid profiles were measured, and HOMA-IR was calculated. New blood samples were collected and AGE was measured again in the two groups at 33–41 weeks of gestation to identify its dynamic changes.

Results: The levels of AGEs were significantly higher in the GDM group than in the NGT group at both 24–29 weeks (473.65?±?105.32 versus 324.36?±?57.86?ng/L; p?p?p?p?=?.003), TNF-α (p?=?.005), and hs-CRP (p?p?=?.001). In the NGT group, there was no significant change in the concentration of AGEs between the two gestational periods (p?=?.388).

Conclusions: Plasma levels of AGEs are associated with GDM. During pregnancy, the changes observed in the levels of AGEs were different between GDM and normal pregnancies.