Polycystic ovary syndrome and low-grade inflammation with special reference to YKL-40

Objective: To evaluate the plasma level of YKL-40 in a Danish polycystic ovary syndrome (PCOS) population and to investigate whether YKL-40 is associated with CVD risk factors such as waist circumference, body mass index (BMI), insulin resistance (IR), fasting glucose, fasting insulin, blood lipids and CRP.

Design: Cross-sectional study.

Setting: Gynecological clinics at three Danish University Hospitals.

Patients: One hundred seventy-one premenopausal women with PCOS recruited consecutively from April 2010 to February 2012. PCOS was diagnosed according to the Rotterdam criteria.

Main outcome measures: Plasma level of YKL-40 in four phenotypes of PCOS defined by BMI and IR.

Results: No statistically significant difference was observed in the plasma level of YKL-40 across the four BMI/IR-phenotypes. Positive associations were observed between YKL-40 and BMI, total and free testosterone, triglycerides, and CRP. Total and free testosterone were independent predictors of YKL-40.

Conclusion: YKL-40, the marker of low-grade inflammation is not increased in women with PCOS.     

Impact of oral probiotics on neurodevelopmental outcomes in preterm infants

Objective: The aim of the study was to evaluate the neurodevelopment outcomes of very low birth weight (VLBW) preterm infants supplemented with oral probiotics for the prevention of necrotizing enterocolitis (NEC).

Methods: A prospective follow-up study was performed in a cohort of VLBW preterm infants enrolled in a single center randomized controlled clinical trial to evaluate the efficacy of oral probiotics for the prevention of NEC. Cognitive and neuromotor developments were assessed by using the Bayley scales of infant development II. Sensory and neurological performance was evaluated by standard techniques. The primary outcome was neurodevelopmental impairment at 18–24 months’ corrected age.

Results: A total of 400 infants completed the trial protocol. Of the 370 infants eligible for follow-up, 249 infants (124 in the probiotics group and 125 in the control group) were evaluated. There was no significant difference in any of the neurodevelopmental and sensory outcomes between the two groups.

Conclusion: Oral probiotic given to VLBW infants to reduce the incidense and severity of NEC started with the first feed did not affect neuromotor, neurosensory and cognitive outcomes at 18–24 months’ corrected age.     

Neonatal morbidities among full-term infants born to obese mothers

Introduction: Impact of maternal obesity on full-term neonates is not known.

Objective: We hypothesized increased incidence of neonatal morbidities requiring NICU admission in full-term neonates of obese women compared to neonates of normal-weight women.

Methods: Data from full-term pregnancies collected in the Consortium of Safe Labor study were analyzed. Maternal BMI was classified using the WHO criteria. Incidence of neonatal outcomes including sepsis, PDA, NEC, respiratory distress, or their combination were compared between newborns of obese and normal-weight women.

Results: Of the 109?488 women included in the study, 17.7% were obese. Maternal co-morbidities (diabetes, gestational diabetes, hypertension, and preeclampsia) increased with increasing maternal BMI. Both maternal obesity and its related co-morbidities were associated with higher incidence of neonatal morbidities. After adjusting for maternal comorbidities, there was a higher incidence of sepsis (AOR 1.91(1.45–2.50)), and combination of any of the neonatal outcomes (AOR 1.66(1.32–2.09)) among newborns of obese women than those of normal-weight women, along with an increased trend for incidence of PDA (Cochran-Armitage Test (CA)?=?23.1, p?<?0.0001) and NEC (CA?=?7.2, p?=?0.007).

Conclusion: Maternal obesity is independently associated with increased incidence of neonatal sepsis and a combination of neonatal morbidities in full-term newborns with an increased trend for PDA and NEC.     

Maternal risk factors for neonatal necrotizing enterocolitis

Objective: This study aimed to investigate the relationship between maternal hypertensive disease and other risk factors and the neonatal development of necrotizing enterocolitis (NEC).

Methods: This was a retrospective case–control study of infants with NEC from 2008 to 2012. The primary exposure of interest was maternal hypertensive disease, which has been hypothesized to put infants at risk for NEC. Other variables collected included demographics, pregnancy complications, medications and neonatal hospital course. Data were abstracted from medical records.

Results: Twenty-eight cases of singleton neonates with NEC and 81 matched controls were identified and analyzed. There was no significant difference in the primary outcome. Fetuses with an antenatal diagnosis of growth restriction were more likely to develop NEC (p?=?0.008). Infants with NEC had lower median birth weight than infants without NEC (p?=?0.009). Infants with NEC had more late-onset sepsis (p?=?0.01) and mortality before discharge (p?=?0.001).

Conclusions: The factors identified by this case–control study that increased the risk of neonatal NEC included intrauterine growth restriction and lower neonatal birth weight. The primary exposure, hypertensive disease, did not show a significantly increased risk of neonatal NEC; however, there was a nearly two-fold difference observed. Our study was underpowered to detect the observed difference.     

ß-hCG and prediction of therapeutic success in ectopic pregnancies treated with methotrexate,results from a prospective observational study

Objective: To evaluate the diagnostic accuracy of different beta-human chorionic gonadotrophin (ß-hCG) levels measurement, for predicting success of medical treatment in cases diagnosed as tubal ectopic pregnancy (TEP).

Design: Five-year prospective observational study.

Setting: Prenatal Diagnosis Unit, Vall d'Hebron University Hospital – Barcelona.

Patients: TEP cases fulfilling criteria for medical treatment with Methotrexate.

Interventions: ß-hCG levels were measured on d 0, 4 and 7 of treatment. Results were compared by non-parametrical tests. A ROC curve was plotted to define cut-off points. Diagnostic accuracy of the different measurements was evaluated.

Main outcome measure: Failure of treatment defined as need for surgical treatment or persistence of high ß-HCG levels despite treatment.

Results: 126 women were diagnosed as TEP, eligible for medical treatment. There were no differences in parity, age, previous TEP, or adnexal mass size. Success rate was 88%. ß-HCG decreased significantly more, between days 0–7 and 4–7, in the successful cases. LR for success prediction was 6.2 and 7.8 for ß-HCG levels at days 4 and 7 respectively, 4.02 and 2.47 for decrement between days 0–7 (25%) and 4–7 (20%), respectively.

Conclusion: ß-hCG cutoff values have a potential for predicting a successful medical treatment of TEP.     

The influence of psychological factors on postpartum weight retention 12 months post-birth

Background

During the first postpartum year 20% of women retain excessive weight from pregnancy (postpartum weight retention; PPWR), which predicts long-term overweight/obesity.

Objective

The aim of this study was to explore the associations between psychological factors (depression, anxiety and stress symptoms and body attitudes) in late gestation and at 12-months postpartum with PPWR one-year post-birth.

Methods

Pregnant women (N = 176) completed questionnaires in early–mid pregnancy (Time 1; mean (SD) = 16.97 (1.35) weeks), late pregnancy (Time 2; mean (SD) = 33.33 (2.05) weeks), and one year postpartum (Time 3; mean (SD) = 53.12 (3.34) weeks). Women provided demographic characteristics, height and pre-pregnancy weight at Time 1. At Times 2 and 3, weight, depressive, anxiety and stress symptoms and body attitudes (salience of weight and shape, attractiveness, feeling fat, and strength and fitness) were assessed in addition to physiological, socio-contextual and lifestyle factors. Gestational weight gain and PPWR were calculated. Hierarchical linear regression models were conducted to explore variance in 12-month PPWR.

Results

Overall, models explained 26–39% variance in PPWR. Gestational weight gain in late pregnancy and low attractiveness at 12 months postpartum were the only variables associated significantly with 12-month PPWR.

Conclusion

While psychological factors did not appear to be important direct contributors to PPWR at 12 months, the overall contribution of all variables suggests that such factors may be implicated in a small and incremental way. Exploration of the interactions between variables will help unpack potential mechanisms of the development of PPWR at 12 months post-birth.     

Transcervical Foley’s catheter versus Cook balloon for cervical ripening in stillbirth with a scarred uterus: a randomized controlled trial

Objective: To compare the efficacy and safety of the use of transcervical Foley’s catheter versus Cook cervical ripening balloon in pregnant women with stillbirth, unfavorable cervix and scarred uterus.

Design: Randomized controlled study.

Setting: El Minia University Hospital, El Minia, Egypt.

Patients and methods: Two-hundred pregnant women with stillbirth, unfavorable cervix and scarred uterus were recruited into this study. They were randomized into two groups. In group I (n?=?100), cervical ripening was done using Foley’s catheter. In group II (n?=?100), cervical ripening was done using Cook cervical ripening balloon.

Main outcome measures: Balloon insertion to delivery interval, successful ripening rate, cesarean delivery rate, maternal adverse events and maternal satisfaction.

Results: Time from balloon insertion to expulsion and from balloon insertion to delivery was significantly shorter in Foley’s catheter group. However, the difference between the two groups regarding time from balloon insertion to active labor, time from balloon expulsion to delivery, cervical ripening, cesarean section, instrumental delivery, pain score, need for analgesia, hospital stay and maternal satisfaction was not statistically significant.

Conclusions: Foley’s catheter and Cook cervical ripening balloon are comparable regarding efficacy and safety profile when used to ripen the cervix in pregnant women with stillbirth, unfavorable cervix and scarred uterus. However, Foley’s catheter has a shorter induction to delivery interval and is relatively cheaper device.     

Increasing maternal percentage body fat in early second trimester: a risk factor for preeclampsia

Objective: To determine if maternal percentage body fat (PBF) or fat free mass (FFM) in the early second trimester of pregnancy influenced the development of preeclampsia.

Methods: A matched nested case-control study was conducted from a cohort study of 1668 women at Gansu provincial maternal and child care hospital from July 2007 to August 2011 in China. Maternal PBF and FFM were assessed by bioelectrical impedance analysis during 12th–16th gestational week. The demographic characteristics were all chart abstracted. After childbirth, 70 cases of preeclampsia were matched by race/age with 140 uncomplicated pregnancies women. Multivariate logistic regression analysis was performed to determine the associated risk factors.

Results: Pre-pregnancy body mass index were higher in women who subsequently developed preeclampsia compared with controls (p?<?0.001). During 12th–16th gestational week, there were nearly 7-fold increase in the odds of preeclampsia (adjusted OR: 6.84, 95% CI: 4.15–41.60) among women with PBF?≥?40% versus women with PBF?<?40%. But FFM were not at further increased risk of the development of preeclampsia (adjusted OR, 1.02; 95% CI, 0.6–3.6).

Conclusion: Maternal PBF but not FFM is a predictor of preeclampsia in the early second trimester. Excessive adipose tissue possibly played an important role in developing of preeclampsia.     

Little beneficial effect of maternal vitamin supplement on metabolic disturbances in the offspring from the obese mother mice

Objective: To examine whether vitamin supplement before and during pregnancy alters the detrimental effect of maternal obesity on the offspring.

Methods: Obese C57BL/6 female mice were randomly divided into four groups and fed with the control, vitamin D, folic acid or multivitamin supplement diet before and during pregnancy. Physiologic and biochemical variables were obtained.

Results: No significant differences were observed in glucose and lipid variables among offspring from each maternal obese group.

Conclusions: Overall, vitamin D, folic acid or multivitamin supplement cannot ameliorate the detrimental effect of maternal obesity on the metabolic disturbances in the offspring.     

Role of ultrasound in the management of diabetes in pregnancy

The purpose of this review is to discuss the established role of ultrasound (US) in the management of pregnancy complicated by diabetes mellitus (DM), as well as new developments with regard to the use of US in this situation. We choose to explore the role of US in pregnancy complicated by DM in three areas:

(1) Role of US in estimation of fetal weight.

(2) Role of US in diagnosis of congenital malformation.

(3) Role of US in monitoring diabetic pregnant patients.     

Prognostic value of funisitis and/or chorionic vasculitis compared to histologic chorioamnionitis in full-term infants

Aim: To compare pathological findings in the placenta and cord with the prognosis of full-term infants in cases of neonatal infection and microbial analyses.

Methods: The pathological findings in the placenta and cord and microbial analyses of amniotic fluid and neonatal samples based on culture or polymerase chain reaction (PCR) were observed in 1208 full-term mother–infant pairs at our center. We also collected neonatal clinical infection data, such as the occurrence of septicemia and other infectious diseases.

Results: Neonatal infection and positive identification of microorganisms were more common in the funisitis and/or chorionic vasculitis group than in the histologic chorioamnionitis group.

Conclusion: Funisitis and/or chorionic vasculitis is a valuable pathological marker for assessing the comparison between intrauterine infection and neonatal inflammatory conditions in infants delivered at full-term.     

Comparison between resveratrol and cabergoline in preventing ovarian hyperstimulation syndrome in a rat model

Objective: The aim of this study is to investigate the effects of resveratrol in a rat model of ovarian hyperstimulation syndrome (OHSS) and compare with cabergoline.

Design: Randomized controlled, animal study.

Animal(s): Female Wistar rats.

Material and methods: A rat OHSS model was used to investigate the effects of resveratrol compare with cabergoline administration for preventing OHSS. Body weight, ovary weight, diameter, vascular permeability (VP), vascular endothelial growth factor (VEGF), cyclooxygenase-2 (COX-2) expression (immunohistochemistry), and serum estradiol (E2) levels were then compared.

Results: The ovarian VEGF concentration was significantly increased in the OHSS Groups (Groups 3–5) compared with the control groups (1 and 2). But vascular permeability, VEGF, and COX-2 expressions were reduced in animals treated with the resveratrol group compared with the cabergoline group (group 5) and the severe OHSS (group 3) group. Blood E2 levels were decreased in group treated with the resveratrol group compared with the cabergoline group (group 5) and severe the OHSS (group 3) group.

Conclusion(s): Our results in a rat model suggest that resveratrol has a beneficial effect on OHSS by reducing the increases in ovarian daimeter, VP, and VEGF expression associated with OHSS. These effects may be mediated by the COX-2 inhibitory capacity of resveratrol.     

Micronized progesterone reduces vasoconstriction in the placenta

Objective: To investigate if micronized progesterone (P4) has the ability to attenuate thromboxane mimetic U46619-mediated fetoplacental artery vasoconstriction.

Methods: Paired cotyledons obtained from the same placenta of five-term subjects were analyzed. The fetal artery and maternal intervillous space of one cotyledon was infused with P4 while another cotyledon was infused with control perfusate. After 30?min, a bolus dose of U44619 was administered to both cotyledons.

Results: The change in the measured fetoplacental vascular pressure caused by bolus administration of U46619 was less in the cotyledons infused with P4 (p?=?0.009).

Conclusion: Continuous treatment with P4 significantly attenuates the U46619-mediated fetoplacental vasoconstriction.     

Does preeclampsia involve the pancreas? A report of original research

Objective: To analyze the effect, if any, of pregnancy-related hypertension on the pancreas.

Methods: A database of pregnant women with hyperbilirubinemia was reviewed for cases with serum amylase values. These cases were linked to a computerized obstetric database, and women were analyzed according to the diagnosis of preeclampsia.

Results: A total of 292 consecutive women with hyperbilirubinemia during pregnancy delivered at our institution between 2005 and 2011. Of these, 52 (18%) were diagnosed with preeclampsia, and in only nine was serum amylase abnormally elevated.

Conclusion: Using serum analytes as surrogates for organ injury, it appears preeclampsia infrequently affects the pancreas.     

Fetal thigh and upper-arm volumes by three-dimensional ultrasound to predict low postnatal body mass index

Objective: To assess the usefulness of estimating fetal upper arm and thigh volumes as predictors of low postnatal body mass index (BMI) using three-dimensional ultrasonography (3DUS) with extended imaging virtual organ computer-aided analysis (XI VOCAL).

Methods: This prospective cross-sectional study analyzed 300 singleton pregnancies between 33 and 41 weeks of gestation. The Hadlock 4 formula was used to estimate fetal weight. The XI VOCAL 10 planes method was used to assess fetal upper arm and thigh volumes. After delivery, the newborns’ BMI was evaluated and considered low (≤10th percentile) or normal (>10th percentile). We determined receiver operating characteristics (ROC) curves and respective areas under the curves for the percentiles of fetal weight and fetal thigh and upper arm volumes.

Results: Of the 300 newborns, BMI was ≤10th percentile for 21 and >10th percentile for 279 newborns. The area under the ROC curve for fetal weight, obtained using the Hadlock formula, and fetal upper arm and thigh volumes, obtained by 3DUS, were 0.801, 0.930 and 0.924, respectively. We determined the sensitivity and specificity of the three parameters for predicting low postnatal BMI and found values of 85.70% and 65.60%, respectively, for fetal weight, 90.48% and 88.17%, respectively, for fetal thigh volume, and 76.19% and 92.47%, respectively, for fetal upper arm volume.

Conclusion: Fetal upper arm and thigh volumes estimated using 3DUS with XI VOCAL were effective predictors of low postnatal BMI.     

Influence of storage time on vitrified human cleavage-stage embryos froze in open system

Background: During in vitro fertilization, rapid growth of vitrification and liquid nitrogen storage of embryos have been well characterized. However, the effect of storage time on vitrified cleavage-stage embryos in an open system is poorly understood.

Aims: To investigate the influence of storage time on the survival and pregnancy outcomes of vitrified human cleavage-stage embryos froze and stored in an open system.

Methods: A retrospective study of 786 vitrified-warmed cycles of 735 patients was performed from January 2013 to October 2013. The cycles were divided into five groups according to storage time: 1–3 months, 4–6 months, 7–12 months, 13–24 and 25–60 months. The clinical outcomes of cycles with different storage time were analyzed.

Results: There were no significant differences of the survival rate, clinical pregnancy outcomes, birth rate, gestational weeks and singleton birthweights at various storage times.

Conclusion: For vitrified embryos froze and stored in an open system, the storage time would not influence the survival rate and pregnancy outcomes by storage time up to 5 years.     

Increase of neuronal injury markers Tau and neurofilament light proteins in umbilical blood after intrapartum asphyxia

Aim: Compare the levels of the brain injury biomarkers Tau and neurofilament light protein (NFL) in cases of asphyxia with those in controls.

Materials and methods: We analyzed the neuronal proteins Tau and NFL in umbilical blood of 10 cases of severe-moderate intrapartum asphyxia and in 18 control cases.

Results: The levels of both Tau and neurofilament were significantly higher after asphyxia and it appeared to be a correlation between the levels of the biomarkers and the severity of the insult.

Discussion: Future studies are warranted to support or refute the value of Tau/NFLin clinical practice.

Conclusion: Fetal asphyxia remains a clinical problem resulting in life-long neurological disabilities. We urgently need more accurate early predictive markers to direct the clinician when to provide neuroprotective therapy.     

Anti-Mullerian hormone and insulin resistance in polycystic ovary syndrome

Introduction: Polycystic ovary syndrome (PCOS) is a prevalent disease affecting women of reproductive age. It may be associated with metabolic disorders such as insulin resistance (IR) and obesity. The anti-Mullerian hormone (AMH) levels seem to be higher in patients with PCOS.

Objective: The present study was designed to evaluate the association between AMH and insulin in women with PCOS with and without IR.

Methods: Cross-sectional study, including 86 patients, selected and divided into three groups: Group A: 26 women with PCOS and IR; Group B: 30 women with PCOS and without IR; and Group C: 30 controls without PCOS.

Results: We found significant difference between serum AMH levels in the group of women with PCOS and without IR when compared to the control group, thus showing that PCOS and IR play an important role in elevating the levels of this hormone. When the groups were compared with each other following adjustment for BMI, serum AMH levels were significantly higher in the group of women with PCOS and IR.

Conclusion: AMH levels are significantly higher in patients with PCOS, particularly in those women with PCOS and IR. Nevertheless, larger samples are required to confirm these findings.     

The role of narrative medicine in pregnancy after liver transplantation

Narrative medicine allows professionals from all fields of medical sciences to understand the patient’s total experience of illness, and meet his/her needs in an empathetic environment. Narrative medicine helps spread holistic knowledge of a multitude of complex clinical conditions, including transplantation.

Objective: To underline the role of narrative medicine in women who become pregnant after a liver transplant by using their narrations of this very special experience.

Methods: We describe our study with narration and listening to the stories of three women expecting their first child after a liver transplant, by analysing the structure and role of narration in the context of relationships between patients and caregivers. The narrations were transcribed verbatim with the main plot analysed in order to address all the aspects of this rare clinical condition and the transition to parenthood.

Results: The women narrated this experience in three phases: transplantation, pregnancy and delivery, and post-partum. They described all phases of pregnancy as stressful but satisfying, whereas the fact of becoming a mother was perceived as a victory both as a woman and as a transplant patient.

Conclusions: Our results suggest that narrative medicine represents a significant professional tool for caring for transplant patients during pregnancy.