Influence of gestational age on fetal deoxyribonucleic acid retrieval in maternal peripheral blood

OBJECTIVE: We wanted to verify whether gestational age influences the retrieval of fetal deoxyribonucleic acid in maternal blood to identify the best period for maternal blood sampling for a future noninvasive prenatal diagnoses. STUDY DESIGN: We amplified 81 deoxyribonucleic acid samples extracted from the peripheral blood of 27 pregnant women (18 bearing male fetuses and 9 bearing females) by nested polymerase chain reaction of the Y-specific sequence DYS14. We obtained three blood samples (one per gestational trimester) from each woman. Statistical evaluation was assessed by the McNemar test of symmetry. RESULTS: Polymerase chain reaction results in male-bearing pregnancies differed significantly between the first and second trimesters and between the second and third trimesters (p < 0.025) in parallel with a decrease in sensitivity in the second trimester (67%) compared with the first (94%) and third trimesters (100%). CONCLUSIONS: The drop in sensitivity from the first to the second trimester witnesses a variable concentration of fetal cells in maternal blood, with a negative balance in the second trimester. Therefore, to achieve an adequate polymerase chain reaction accuracy, the choice of gestational age is relevant and the first trimester seems to be more suitable than the second trimester.(Am J Obstet Gynecol 1997;177:22)     

妊娠期葡萄糖耐量试验2 h血糖切点的选择与母儿预后

目的　探讨 75g葡萄糖耐量试验 (OGTT)服糖后 2h的血糖切点对妊娠结局的影响。方法　回顾性分析 ,2 0 0 2年 1月～ 2 0 0 3年 12月在北京大学第一医院产科产前检查并分娩的单胎产妇共 4 6 5 2例 ,孕期均接受 5 0g葡萄糖负荷试验 (GCT)筛查。排除GDM和GIGT的病例 ,将其余 10 18例糖代谢正常产妇按OGTT服糖后 2h的血糖值 (OGTT 2hPG)分OGTT 2hPG <6 7mmol/L组 (I组 ) 4 87例、 6 7mmol/L≤OGTT 2hPG <7 8mmol/L组 (Ⅱ组 ) 32 4例和 7 8mmol/L≤OGTT 2hPG <9 2mmol/L组 (Ⅲ组 ) 2 0 7例 ,比较三组母儿预后的差异。结果　①三组孕妇的平均年龄 (2 9 7± 3 5 )岁、 (30 1± 3 7)岁和 (30 4± 3 3)岁 ,孕周 (39 4± 2 3)周、 (39 4± 1 5 )周和 (39 3± 1 4 )周 ,差异无显著性 (P >0 0 5 )。②Ⅲ组的剖宫产 (C -S)率为 6 1 8% ,显著高于Ⅰ、Ⅱ组的 4 8 3%和 4 9 1% (P <0 0 5 )。产钳术和先兆子痫的发生率各组间差异无显著性 (P >0 0 5 )。依血糖水平增加 ,三组巨大儿和早产的发生率递增 ,分别为Ⅰ组 9 7%和 4 7% ;Ⅱ组 11 7%和 5 6 % ;Ⅲ组15 5 %和 5 8% ,但差异无显著性 (P >0 0 5 )。③Ⅱ组和Ⅲ组新生儿转科率为 2 2 5 %和 2 7 5 % ,显著高于Ⅰ组的14 0 % (P <0 0 5 )。Ⅲ组新生儿低血糖、     

Effect of exercise during pregnancy to prevent gestational diabetes mellitus: a systematic review and meta-analysis

Introduction: Exercise showed some potential in preventing gestational diabetes mellitus. However, the results remained controversial. We conducted a systematic review and meta-analysis to evaluate the impact of exercise during pregnancy on gestational diabetes mellitus.

Methods: PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the influence of exercise during pregnancy on gestational diabetes mellitus were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcome was the incidence of gestational diabetes mellitus. Meta-analysis was performed using random-effect model.

Results: Six RCTs involving 2164 patients were included in the meta-analysis. Compared with control intervention, exercise intervention was associated with significantly decreased incidence of gestational diabetes mellitus (Std. mean difference?=?0.59; 95%CI?=?0.39–.88; p?=?.01), but had no effect on gestational age at birth (Std. mean difference?=??0.03; 95%CI?=??0.12 to 0.07; p?=?.60), the number of preterm birth (OR?=?0.85; 95%CI?=?0.43–1.66; p?=?.63), glucose 2-h post-OGTT (Std. mean difference?=??1.02; 95%CI?=??2.75 to 0.71; p?=?.25), birth weight (Std. mean difference?=??0.13; 95%CI?=??0.26 to 0.01; p?=?.06), and Apgar score less than 7 (OR?=?.78; 95%CI?=?0.21–2.91; p?=?.71).

Conclusions: Compared to control intervention, exercise intervention could significantly decrease the risk of gestational diabetes mellitus, but showed no impact on gestational age at birth, preterm birth, glucose 2-h post-OGTT, birth weight, and Apgar score less than 7.     

A comparative analysis of maternal and fetal 25-hydroxyvitamin D in pregnant women with and without gestational diabetes mellitus

Objective: This study aimed to compare maternal 25-hydroxyvitamin D (25(OH)D) serum levels during pregnancy in women with and without gestational diabetes mellitus (GDM) with neonatal 25(OH)D serum levels and to evaluate the relationship between maternal and fetal 25(OH)D in the two groups.

Methods: Between May 2014 and March 2015, 87 pregnant women were enrolled. The study population was divided into two groups, those with and without GDM (n?=?32 and 55). All participants were surveyed about lifestyle and behavior. Maternal and umbilical venous blood samples were obtained. Serum from maternal blood was analyzed for 25(OH)D₂ and 25(OH)D₃, and umbilical venous blood for 25(OH)D₂, 25(OH)D₃, and 3-epi-25(OH)D₃.

Results: The maternal serum level of 25(OH)D₃ and the 25(OH)D₃ and 3-epi-25(OH)D₃ levels in umbilical venous blood were significantly lower in women with GDM (p?2, 25(OH)D₃, and total 25(OH)D were positively correlated with their levels in umbilical venous blood in the total, normal, and GDM groups.

Conclusions: The serum 25(OH)D₃ and 3-epi-25(OH)D₃ levels of babies from mothers with GDM are lower than in pregnant women without GDM.     

Arachidonic and docosahexaenoic acid in the blood of a mother and umbilical vein in diabetic pregnant women

Abstract

Objective: The aim of the study was to determine the total concentration of fatty acids (FAs) in the maternal vein serum and in the umbilical vein serum in pregnant women suffering from Type 1 diabetes compared to healthy women. Additional goal was to determine the percentages of arachidonic (AA) and docosahexaenoic acid (DHA) in comparison to the total concentration of FAs.

Methods: The study included 63 pregnant women, 32 suffering from Type 1 diabetes and 31 healthy pregnant women. Extraction of total lipids was performed using gas chromatography.

Results: There was statistically significant difference in the total FAs concentration in the maternal vein serum and the umbilical vein serum between the two groups. There was a statistically significant higher concentration of total FAs in the maternal and umbilical vein serum of the diabetic group. Higher AA and DHA concentrations were found in the maternal vein serum compared to an umbilical vein serum of the diabetic group.

Conclusion: No difference was found in AA and DHA percentages in the maternal or in the umbilical vein serum of diabetic pregnant women. Despite of T1DM, a good metabolic control leads to insignificant changes in the AA and DHA levels in diabetic pregnancy.     

Investigation of possible maternal and fetal factors which affect umbilical coiling index

Aim: The aim of this study was to investigate the possible maternal and fetal factors, which affect the Umbilical Coiling Index (UCI).

Methods: This prospective, observational, analytic study was conducted using the data of 380 women with term pregnancy and newborns who presented at a University Hospital. Hemoglobin (Hb), ferritin, iron, and the total iron binding capacity (TIBC) of the maternal blood were measured, and transferrin saturation was estimated based on the ratio between serum iron and TIBC. Blood gases, ferritin, iron, and TIBC of the umbilical cord were also measured, and the transferrin saturation was calculated. The length and thickness of the umbilical cord, numbers of coilings, weight of placenta, neonatal weight were registered. The UCI was calculated dividing the total number of coils by the length of the umbilical cord (in cm).

Results: A positive, linear, and statistically significant relationship was found between the UCI scores and the umbilical cord blood transferrin saturation, umbilical cord thickness, and the first- and fifth-min APGAR scores (p?=?.044, p?p?=?.008, p?=?.022, respectively). No statistically significant relationship was found between the maternal Hb values and the UCI scores (p?=?.472). In addition, there was no statistically significant relationship between the UCI scores and maternal ferritin, maternal transferrin saturation and umbilical cordon ferritin levels (p?=?.940, p?=?.681, and p?=?.975, respectively).

Conclusions: A positive correlation was found between the UCI and umbilical cord transferrin saturation and between the newborn APGAR scores. However, this finding is not sufficient to explain the relationship of the umbilical cord dynamics with the newborn wellbeing and coiling.     

Concentration of free vascular endothelial growth factor and its soluble receptor,sFlt-1 in the maternal and fetal circulations of normal term pregnancies at high and low altitudes

Objective: Vascular endothelial growth factor (VEGF) is regulated by hypoxia that is essential for placental development. It is antagonized by a soluble form of its receptor (sFlt-1). The purpose of this study was to measure these factors in the maternal and the cord bloods, at low and high altitude. Methods: Samples were collected from full term births normal pregnant women. Free (unbound) VEGF and sFlt-1 levels were measured in plasma samples from cord and maternal blood for each subject by enzyme-linked immunosorbent assay (ELISA) using commercially available kits from R&D systems, UK (Cat # DVE00 and Cat # SVR100B, respectively). Results: At high altitude, the average maternal free VEGF in pg/ml was significantly (p < 0.001) lower than that of the cord level (71.30 ± 282.14 and 431.35 ± 424.31, respectively). On the other hand, the average maternal sFlt-1 was significantly (p < 0.001) higher than that of the cord level (8205.41 ± 6244.72 and 1811.74 + 3469.30, respectively). At low altitude, the average maternal free VEGF was significantly lower than that of the cord level (0.47 ± 0.89 and 483.44 ± 457.31, respectively, p < 0.001). On the other hand, the average maternal sFlt-1 was significantly higher than that of the cord level (9267.82 ± 6345.68 and 958.66 ± 1359.92, respectively, p < 0.001). There were no significant differences by altitude. Conclusion: Secretion of sFlt-1 appears to be polarized, in that concentrations are higher in the maternal compartment than on the fetal side at both high and low altitudes. This may be a normal physiological phenomenon to permit angiogenesis in the placenta and fetus while protecting the mother. Chronic exposure to hypobaric hypoxia at high altitude does not affect these distributions.     

The impact of maternal age,body mass index and maternal weight gain on the glucose challenge test in pregnancy

Objective. The aim of this study was to determine whether maternal age, prepregnancy and mid-trimester body mass index (BMI), or excessive mid-pregnancy weight gain predict abnormal glucose challenge test (GCT) results.

Methods. A retrospective chart review of 75 consecutive singleton pregnancies was performed. Patients were screened at 24–28 weeks of gestation with a 50-g oral GCT. Prepregnancy BMI and pregnancy weight gain up to the time of GCT testing, as well as other demographic data, were recorded. Statistical analysis included regression analysis and Student's t-test, receiver–operator characteristic curve and multivariate logistic regression.

Results. Maternal age and prepregnancy and mid-trimester BMI were significantly higher in women with an abnormal GCT (p < 0.05). A direct correlation was found between these parameters and GCT results (R² = 0.08, R² = 0.102 and R² = 0.116, respectively; p < 0.05). Mid-trimester maternal BMI of ≥30 kg/m² and maternal age ≥32 years are the optimal predictors of abnormal GCT results.

Conclusions. Mid-trimester maternal BMI of ≥30 kg/m² and maternal age ≥32 years are useful predictors of abnormal GCT results. We suggest that these factors should also be considered when selective screening for gestational diabetes mellitus is practiced.     

Aplastic anemia associated with pregnancy: maternal and fetal complications

Objective: To analyze obstetric complications associated with aplastic anemia (AA) among pregnant women and analyze the underlying factors.

Methods: A retrospective analysis of 60 pregnancies with AA. Thirty four of these patients were grouped as complicated group having obstetric complications and the rest 26 without complications as the control group. Comparative analysis was conducted to access the related risk factors, which may affect the maternal and fetal complications.

Results: The major maternal complications in this study were premature labor, gestational diabetes, pre-eclampsia, acute heart failure, postpartum hemorrhage, and severe postpartum infection. Premature birth, fetal growth restriction and stillbirths accounted for 27.3%, 5.0% and 6.7% of prenatal mortality. Twenty six of patients had uncomplicated pregnancies. Patients without complications had higher mean hemoglobin concentration (75.38?±?16.19?g/L) and platelet counts (23.92?±?14.82?×?10⁹ cells/L) than did women with complications (mean hemoglobin concentration, 61.47?±?15.15?g/L, p?=?0.001; mean platelet counts, 12.11?±?7.87?×?10⁹ cells/L, p?<?0.001).

Conclusion: Pregnancies associated with AA can carry the risk of multiple maternal and fetal complications. Low hemoglobin concentration and platelet counts may be the primary risk factors for obstetric complications in pregnancies associated with AA.     

ADAMTS 1, 4, 12, and 13 levels in maternal blood,cord blood,and placenta in preeclampsia

The aim of this study is to compare ADAMTS (A Disintegrin and Metalloprotease Domains with Thrombospondins motifs) 1, 4, 12, and 13 levels in maternal and cord blood and placental tissue between preeclampsia and uncomplicated pregnancies. The enzyme-linked immunosorbent assay (ELISA) results showed that ADAMTS 1, 4, 12, and 13 levels in the maternal and cord blood were lower in the preeclampsia group than in the control group. Based on the immunohistochemistry (IHC) results, ADAMTS 1, 4, and 12 levels in placental tissues were higher in the preeclampsia group. According to the polymerase chain reaction (PCR) results, ADAMTS 1, 4, and 12 were higher, whereas ADAMTS 13 was lower in the preeclampsia group than in the control group.     

Effect of dietary myo-inositol supplementation in pregnancy on the incidence of maternal gestational diabetes mellitus and fetal outcomes: a randomized controlled trial

Abstract

Objective: To test the hypothesis that dietary myo-inositol may improve insulin resistance and the development of gestational diabetes mellitus (GDM) in women at high risk of this disorder.

Design: A prospective, randomized, double-blind, placebo controlled clinical trial, pilot study.

Participants: Non-obese singleton pregnant women with an elevated fasting glucose in the first or early second trimester were studied throughout pregnancy.

Intervention: Supplementation with myo-inositol or placebo during pregnancy.

Main outcome measure: Development of GDM on a 75?g oral glucose tolerance test at 24–28 weeks’ gestation. Secondary outcome measures were increased in BMI, need for maternal insulin therapy, macrosomia, polyhydramnios, neonatal birthweight and hypoglycemia.

Results: Thirty-six women were allocated to receive myo-inositol and 39 placebo. The incidence of GDM in mid-pregnancy was significantly reduced (p?=?0.001) in women randomized to receive myo-inositol compared to placebo (relative risk 0.127). Women randomized to receive myo-inositol also required less insulin therapy, delivered at a later gestational age, had significantly smaller babies with fewer episodes of neonatal hypoglycemia.

Conclusions: Myo-inositol supplementation in pregnancy reduced the incidence of GDM in women at high risk of this disorder. The reduction in incidence of GDM in the treatment arm was accompanied by improved outcomes.     

Trace elements profiles of maternal blood,umbilical cord blood,and placenta in Beijing,China

Aim: Profiles of heavy metals such as chromium (Cr), manganese (Mn), arsenic (As), lead (Pb), and cadmium (Cd), and micronutrients such as ferrum (Fe), copper (Cu), zinc (Zn), and selenium (Se) in maternal and umbilical cord blood clots were investigated for assessing placenta function in the transport of micronutrients or heavy metal pollutants.

Methods: Correlations between contents of elements in the two tissues were also analyzed.

Results: Significantly lower levels of Cr, Pb, and Cd in umbilical cord blood clots than in maternal blood clots, and negative relationship between lead levels in maternal and umbilical cord blood (r?=??.334, p?=?.016). Concentration of Mn in cord blood was significantly higher than that in maternal blood clots and positively related to the maternal level. The data also show that the placenta may work most strongly as a barrier against Cd and protects fetus from its harmful effect, while plays almost no role in preventing the transportation of As, Mn, and Pb.

Conclusions: In conclusion, pregnant women should avoid exposure to environment polluted with heavy metals, particularly with As, Mn, and Pb.     

Increased fetal adiposity: a very sensitive marker of abnormal in utero development

OBJECTIVE: Because offspring of women with gestational diabetes mellitus have an increased risk of obesity and diabetes mellitus as young adults, our purpose was to characterize body composition at birth in infants of women with gestational diabetes mellitus and normal glucose tolerance. STUDY DESIGN: One hundred ninety-five infants of women with gestational diabetes mellitus and 220 infants of women with normal glucose tolerance had anthropometric measurements and total body electrical conductivity body composition evaluations at birth. Parental demographic, anthropometric, medical and family history data, and diagnostic glucose values were used to develop a stepwise regression model that related to fetal growth and body composition. RESULTS: There was no significant difference in birth weight (gestational diabetes mellitus [3398+/-550 g] vs normal glucose tolerance [3337+/-549 g], P=.26) or fat-free mass (gestational diabetes mellitus [2962+/-405 g] vs normal glucose tolerance [2975+/-408 g], P=.74) between groups. However, infants of women with gestational diabetes mellitus had significantly greater skinfold measures (P=.0001) and fat mass (gestational diabetes mellitus [436+/-206 g] vs normal glucose tolerance [362+/-198 g], P=.0002) compared with infants of women with normal glucose tolerance. In the gestational diabetes mellitus group, although gestational age had the strongest correlation with birth weight and fat-free mass, fasting glucose level had the strongest correlation with neonatal adiposity. CONCLUSION: Infants of women with gestational diabetes mellitus, even when they are average weight for gestational age, have increased body fat compared with infants of women with normal glucose tolerance. Maternal fasting glucose level was the strongest predictor of fat mass in infants of women with gestational diabetes mellitus. This increase in body fat may be a significant risk factor for obesity in early childhood and possibly in later life.     

产妇血清脐血及乳汁中叶酸和维生素B_(12)水平测定及意义

为了解产妇叶酸和维生素Ｂ１２缺乏状况以及胎盘和乳腺在两者代谢中的作用。对１００名住院产妇采用放射免疫分析法测定产妇血清、脐血及乳汁中叶酸和维生素Ｂ１２水平并进行比较分析。结果：叶酸水平为乳汁＞脐血＞血清＜对照；维生素Ｂ１２水平为脐血＞血清≈乳汁＜对照。结论：胎盘在叶酸和维生素Ｂ１２代谢中有主动运输功能；乳腺在叶酸代谢中有主动运输功能，而在维生素Ｂ１２代谢中只起被动扩散作用；孕期补充维生素Ｂ１２与补充叶酸同等重要。     

Measuring the rate of fetal urine production using three-dimensional ultrasound during normal pregnancy and pregnancy-associated diabetes

Abstract

Objective: To establish a nomogram of fetal urine production according to gestational age as a predictor for fetal well-being in normal and diabetic women.

Study design: Prospective observational study included 180 pregnant women classified into two groups: Group I (120 women) without any medical complications and Group II (60 women) with gestational diabetes mellitus (GDM). The fetal bladder is measured by the virtual organ computer-aided analysis VOCAL 3D ultrasound scanner.

Results: There was a significant positive correlation between gestational age and fetal urine production rate (UPR) (the mean UPR rate in normal pregnancy at 25, 30, 35, 40 weeks were 12.3, 14.38, 56.13 and 90.73?ml/h, respectively). There was no significant difference regarding UPR ml/h between women with normal pregnancy and those with controlled GDM (p?=?0.9). There was a statistically significant difference regarding UPR ml/h between women with normal pregnancy and those with uncontrolled GDM (p?=?0.012) and a statistically significant difference between women with controlled GDM and those with uncontrolled GDM (p?=?0.03).

Conclusion: Fetal UPR is considered to be more reliable as an assessment method for fetal well-being and shows significant increase in patients with uncontrolled gestational DM.     

Making pregnancy safer in Australia: the importance of maternal death review

Australia is one of the safest countries in the world to birth. Because maternal deaths are rare, often the focus during pregnancy is on the well-being of the fetus. The relative safety of birth has fostered a shift in the focus of maternal health, from survival, to the model of care or the birth experience. Yet women still die in Australia as a result of child bearing and many of these deaths are associated with avoidable factors. The purpose of this paper is to outline the maternal death monitoring and review process in Australia and to present to clinicians the salient features of the most recently published Australian maternal death report. The notion of preventability and the potential for practice to have an effect on reducing maternal mortality are also discussed.