Bone densitometry status and its associated factors in peri and post menopausal females: A cross sectional study from a tertiary care centre in India

Objective

Osteoporosis is a skeletal disorder characterized by diminished bone strength that increases the risk of fracture at instances of trivial trauma. Asians have a lower bone mass than the west. The present study was designed to add data from India on women above the age of 40 years with respect to low bone mineral density (BMD) and its associated high risk factors.

Actively preparing for pregnancy is associated with healthier lifestyle of women during the preconception period

ObjectiveTo assess whether actively preparing for pregnancy by women is associated with lifestyle changes during the preconception period.Designretrospective cross-sectional study.Settingprimary care community midwifery practice in the Netherlands.Participantsconvenience sample of 283 women who received antenatal care.Measurements and findingsthe association between pregnancy preparation (defined as searching for information and/or consulting a healthcare provider) and preconception lifestyle changes (healthier diet, folic acid, alcohol and tobacco cessation) was measured and adjusted for age, body mass index and educational level. Almost 60% (n=160) of women acquired preconception information themselves and 25% (n=68) consulted a healthcare provider regarding their pregnancy wish. The former group was significantly more likely to quit drinking (adjusted OR 5.46 (95% CI 1.76–16.96)), improve their diet (adjusted OR 7.84 (95% CI 3.03–20.30)) and use folic acid (adjusted OR 3.90 (95% CI 2.00–7.62)) compared with women who did not prepare for pregnancy. Effect sizes were even larger for women who (also) consulted a healthcare provider with regard to folic acid use, healthier diet and smoking cessation.Key conclusionsgathering preconception information, either by women themselves or by means of a PCC consult, is associated with women positively changing lifestyles during the preconception period.Implications for practicewe recommend to not solely focus interventions on increasing the uptake of PCC consults, yet providing a suitable offer of preconception health information, which enables women to properly inform themselves.     

Influences on the food choices and physical activity behaviours of overweight and obese pregnant women: A qualitative study

Objectiveto qualitatively explore influences identified by overweight/obese pregnant women on food choices and physical activity (PA) behaviours; to determine the impact of pregnancy on these factors; and to inform development of future lifestyle interventions during pregnancy.Designcross-sectional interview study.Settingmaternity hospital, Ireland.Participantspregnant women (n=22), early pregnancy Body Mass Index > 25 kg/m²Measuresbarriers to and facilitators of healthy eating and PA in overweight/obese pregnancy. Interviews were transcribed verbatim and analysed using inductive thematic analysis.Findingsoverweight/obese women perceived the following factors to influence their food choices and PA behaviours: personal (e.g. age, enjoyment, health, aesthetic appearance, and response to fatigue); social (e.g. social support, food modelling, social facilitation and weight bias) and environmental (e.g. food salience and the obesogenic environment). These factors affected PA and food choice trajectories differently according to socio-economic and socio-cultural context.Conclusion and Implicationspersonal, social and environmental factors affect food choices and PA behaviours. Pregnancy is a powerful stimulus for positive changes in food choices particularly. This change is driven by desire for healthy pregnancy outcome, and is not intrinsically motivated. Healthy lifestyle interventions should aim to sustain positive changes beyond pregnancy through: empowerment, intrinsic motivation, family-centred approach, and behavioural goals.     

Bilirubin exposure is associated with neonatal sepsis in the eight days preceding symptoms: a retrospective study

Objective: To compare levels of bilirubin (using the area under the curve, AUC) in preterm infants before the onset of sepsis with healthy matched-controls.

Methods: Preterm infants born between January 2011 and December 2015 with late-onset sepsis were enrolled in our retrospective study and were matched with healthy controls (sex, birth weight and gestational age). Levels of bilirubin were registered in the eight days preceding the onset of sepsis and the AUC was calculated for both groups.

Results: Eighty-eight neonates (44 cases) were studied. GA and BW did not differ between cases and controls. In cases, we found a higher value of AUC (30.7 versus 22.5; p?=?0.021).

Conclusion: In our retrospective cohort, we found that the levels of bilirubin and the AUC in the first eight days before the onset of sepsis in preterm infants were significantly higher than the healthy controls. These data suggest that the prolonged exposition to high levels of bilirubin could increase the infection susceptibility in preterm infants.     

Investigating the effects of a multidimensional exercise program on symptoms and antiinflammatory status in female patients with ankylosing spondylitis

ObjectiveThe purpose of this study is to investigate the effects of a multidimensional exercise program on symptoms and antiinflammatory status in female patients with ankylosing spondylitis (AS).MethodsThe BATH Indexes, Dougados Functional Index (DFI), Health Assessment Questionnaire in Spondyloarthopathies (HAQ-S), Ankylosing Spondylitis Quality of Life (ASQoL) and Beck Depression Inventory (BDI) were used to evaluate twenty-four female AS patients. ESR, CRP, TNF-α and IL-6 were also analyzed. All patients were assessed at baseline and with 3 weeks intervals till 12 week. A multidimensional exercise program was applied for three times a week.ResultsThere were significant differences in Bath Ankylosing Spondylitis Global Index (BAS-G) and Disease Activity Index (BASDAI), HAQ-S, ASQoL and BDI scores (p < 0.05). The level of the ESR, CRP and IL-6 fluctuated slightly. There was only significant difference at 3 and 12 weeks as compared to baseline levels in TNF-α values (p = 0.048, p < 0.001).ConclusionWe concluded that multidimensional exercise program should be taken into consideration for AS patients due to its positive effects on symptoms and antiinflammatory effects.     

Examining exercise intention and behaviour during pregnancy using the Theory of Planned Behaviour: a meta-analysis

Background: The efficacy and predictive utility of the Theory of Planned Behaviour (TPB) in explaining a variety of behaviours including physical activity (PA) is well documented. However, the relative contribution of the theory’s components in describing intention and behaviour may differ depending on the context, time and population being studied. Such evidence is necessary to inform PA advice and interventions aimed at special populations including pregnant women. Objective: The purpose of this study was to review the existing literature surrounding the application of the TPB in explaining exercise intentions and behaviour during pregnancy and to evaluate the magnitude of relationships between TPB constructs within this context. Method: Multiple search strategies yielded 99 potentially relevant studies of which 47 were assessed against the inclusion criteria. Finally, eight studies were subjected to a random-effects meta-analysis. Result: Results confirmed the existence of a strong relationship between intention and behaviour while perceived behavioural control (PBC) revealed a weaker correlation with behaviour. Women’s attitude towards exercise had the strongest association with their intention to be physically active while expecting. However, both PBC and subjective norm showed strong relationships with intention. Conclusion: The study supports the TPB as a relevant conceptual framework for the investigation of PA intentions and behaviours during pregnancy. Furthermore, this study supported subjective norm as a pertinent construct to investigate exercise intentions and behaviour in a pregnant population. These findings present both researchers and practitioners with an opportunity for intervention and further research.     

Evaluation of serum anti-nuclear antibody among women with PCOS: a hospital based single center cross sectional study

Abstract

Polycystic ovary syndrome (PCOS), a major endocrinopathy is associated with barrage of metabolic aberrations. Reports in literature on association of PCOS and autoimmunity are conflicting. We aim to evaluate serum levels of anti-nuclear antibody (ANA) among Indian women with PCOS. In this hospital-based single center cross-sectional study, women qualifying a diagnosis of PCOS by Rotterdam criteria 2003 were recruited. Eighty-nine eligible women who consented were enrolled. All these women along with 87 age-matched, healthy controls underwent, clinical (menstrual history, anthropometry, hirsutism scoring), biochemical, hormonal assessment and serum ANA estimation. OGTT after overnight (8–12?h) fast with 75?g oral glucose load was done for 1?h, 2?h glucose and insulin measurements. The mean age of cases and controls was comparable (22.67?±?5.53 vs. 22.84?±?3.64 years). The prevalence of ANA positivity was significantly higher among women with PCOS (18.4% vs. 2.29%; p?<?.001). Though significant correlation was observed between ANA positivity and clinical signs of hyperandrogenism and plasma glucose, no significant correlation was noted between ANA status and other hormonal parameters. Higher prevalence of ANA positivity among women with PCOS, being a marker of autoimmunity, suggests a possible role of autoimmunity in causation of PCOS and needs further elucidation.     

Quality of life in Indian women with fertility problems as assessed by the FertiQoL questionnaire: a single center cross sectional study

Purpose: Infertility and its treatment can significantly impact an individual's physical and psychological health; however, this has not been well-studied in the Indian population. This study aimed to assess the quality of life in women with infertility at a teaching hospital in Hyderabad, India.

Methods: In this cross sectional study of women with infertility, the quality of life was measured using the ‘FertiQoL International’ questionnaire (English/Hindi).

Results: The age ranged from 20 to 38?years and polycystic ovary syndrome was the most common cause of infertility. Core FertiQoL scores were analyzed in 215 women and Treatment FertiQoL in 156. The mean Total FertiQoL score in the study population was 66.1 (SD 13.0) and this overall score was not influenced by socio-demographic or infertility-specific factors. However, on subscale analysis, women who had living children and were university-educated had significantly better emotional scores while obese (≥35?kg/m²) women and those on ovulation induction treatment had poorer mind body and relational scores, respectively. Women with associated co-morbidities had worse quality of life on the Treatment Environment scale than those without.

Conclusions: The results provide a baseline quality of life score in these women. Infertility had the greatest impact on the emotional domain.     

Clinical pregnancy is significantly associated with the blastocyst width and area: a time-lapse study

Journal of Assisted Reproduction and Genetics - In order to maintain pregnancy rates following single embryo transfer, optimisation of embryo culture and selection is vital. Time-lapse monitoring...     

雌二醇屈螺酮片治疗绝经后妇女绝经相关症状的多中心临床研究

目的 探讨雌二醇屈螺酮片(其他名称:安今益)用于伴有绝经相关症状的绝经后妇女的临床疗效和安全性.方法 采用多中心、双盲、随机、安慰剂对照的研究方法,将244例伴有中重度潮热症状的绝经后妇女,按3∶1比例随机分为治疗组(服用雌二醇屈螺酮片,183例)和安慰剂组(61例),连续服药16周,在服药的4、8、12、16周及服药结束后2周进行随访,观察身高、体质量、生命体征、潮热及其他绝经相关症状改善情况和阴道出血等,并在服药16周时进行临床疗效评价.结果 与治疗前比较,治疗后16周治疗组和安慰剂组总潮热平均严重程度指数下降的绝对值分别为-0.6±0.5和-0.4 ±0.4,两组比较,差异有统计学意义(P＜0.05);但治疗组和安慰剂组治疗后中重度潮热平均严重程度指数下降的绝对值分别为-0.6±0.8和-0.3±0.6,两组比较,差异无统计学意义(P＞0.05).治疗后16周时,治疗组妇女中重度出汗、阴道干涩等症状的缓解以及总体临床疗效均显著优于安慰剂组,差异有统计学意义(P＜0.01).整个治疗过程中,治疗组妇女的血压基本稳定.治疗中发生阴道出血治疗组为48.9%(87/178),安慰剂组为10.7%(6/56),尤其在治疗的第4～8周发生率最高.虽然治疗组的每个周期(28 d)累积无阴道出血率低于安慰剂组,但随着治疗时间的延长,治疗组的累积无阴道出血率逐渐升高.治疗组的不良事件主要是乳房胀痛,占12.0%(22/183).治疗组患者血钾无异常升高,无明显其他不良事件发生.整个治疗过程中发生的严重不良事件均与试验药物无关或可能无关.结论 雌二醇屈螺酮片可有效缓解绝经后妇女的绝经相关症状,是安全有效的新型激素补充治疗药物.

Abstract：

Objective To study the efficacy and safety of estradiol and drospirenone tablets (Angeliq)in treatment of menopausal symptoms among postmenopausal Chinese healthy women.Methods Total 244 postmenopausal Chinese healthy women who had moderate to severe hot flushes were randomly assigned for 16 weeks in this randomized multi-center double-blind placebo-controlled study.During the trial.the follow-up visits were conducted at week 4,8,12,16 of treatment and 2 weeks after treatment respectively.Height,weight,vital signs,hot flushes,other relevant menopausal symptoms and vaginal bleeding were observed in each follow-up visit,while the clinical global impression scale Was assessed at 16 weeks as well.Results It showed that hot flushes were reduced significantly more in observation group than that in placebo group ( P＜0.01 ), although both treatments were effective. The absolute values of mean severity index of total hot flushes decreased by - 0. 6± 0. 5 in observation group and - 0. 4 ± 0. 4 in placebo group from baseline respectively, which reached significant difference ( P ＜ 0. 05 ). However, the absolute values of mean severity index of moderate to severe hot flushes decreased by - 0. 6± 0. 8 in observation group and -0. 3± 0.6 in placebo group from baseline respectively, which had no significant difference (P ＞ 0. 05 ).After 16 weeks treatment, it also showed that estradiol and drospirenone had significant better efficacy than placebo on moderate to severe sweating, vaginal dryness and clinical global impression scale (P ＜0. 01 ).During the trial, blood pressure in observation group was stable. The rate of vaginal bleeding in observation group was higher than that in the placebo group, especially during the week 4 to week 8 when 48. 9% (87/178) in observation group and 10. 7% (6/56) in placebo group of patients bled. Although the cumulative amenorrhea rate of observation group was lower than that of placebo group in each cycle (28 days), it increased gradually along with duration of the treatment. The commonest adverse event in observation group was breast tenderness which accounted for 12.0% (22/183 ). The level of serum potassium was in the normal range in observation group mostly. Meanwhile, the other adverse events rate was low. Serious adverse events reported in this trial were assessed as not study drug related or as unlikely study drug related. Conclusion Estradiol and drospirenone tablets which could effectively alleviate menopausal symptoms in postmeuopausal Chinese healthy women is a novel hormone replacement therapy regimen with high safety and efficacy.     

Raloxifene therapy in postmenopausal women is associated with a significant reduction in the concentration of serum vascular endothelial growth factor

OBJECTIVE: To determine whether raloxifene has an effect on serum vascular endothelial growth factor (VEGF) concentration in postmenopausal women. DESIGN: A randomized, placebo-controlled trial. SETTING: University-based obstetrics and gynecology unit. PATIENT(S): Fifty postmenopausal women who did not receive any hormone therapy in the 6 months preceding the study. INTERVENTION(S): The participants were randomly assigned on a one-to-one basis to receive either raloxifene (60 mg daily) or placebo for 36 weeks. MAIN OUTCOME MEASURE(S): Serum VEGF concentrations at baseline and at 12 weeks and 36 weeks after the commencement of intervention. RESULT(S): The serum VEGF concentrations in the raloxifene group were significantly reduced from 247 +/- 16 pg/mL at baseline to 195 +/- 11 pg/mL at 36 weeks after starting raloxifene. The placebo group showed no significant change in the serum VEGF concentrations throughout the intervention period. CONCLUSION(S): Raloxifene therapy in postmenopausal women is associated with a significant reduction in serum VEGF concentration.     

Prevalence and frequency of severity of urinary incontinence symptoms in late pregnancy: a prospective study in the north of Jordan

Objective  To determine the frequency of urinary urge, stress incontinence and bothersome urinary symptoms in late pregnancy in Jordan. Method  Women admitted in spontaneous labor to labor suite at three covering hospitals in the north of Jordan and at least 36 weeks gestational age were eligible for survey to ascertain data on current pregnancies and past pregnancy. Data analyzed for 181 women. Result  Mean gestational age was 39.5 weeks. 85% had normal vaginal delivery. 35% of women reported symptoms of urgency, 30% of whom described symptoms frequency as moderate or severe, and 45% reported stress incontinence, 29% of whom described symptoms frequency as moderate or severe during the current pregnancy. Symptoms in previous pregnancies were reported by 20 and 30% of women for urge and stress incontinence, respectively. Urgency and urge incontinence increased in relation to parity. Conclusion  The frequency of urinary incontinence and bothersome symptoms was relatively similar compared to other countries.     

Length of use and symptoms associated with premature removal of the levonorgestrel intrauterine system: a nation-wide study of 17,360 users

Objective To establish the continuation rates of the levonorgestrel intrauterine system (LNG IUS) and symptoms associated with its premature removal.
Sample and Setting All women in Finland who had a LNG IUS inserted between April 1990 and December 1993 and whose doctor had filled in and returned a form at the insertion visit. This study population consists of 46% of all the LNG IUSs sold in Finland between 1990 and 1993.
Design A questionnaire on reproductive and contraceptive history, gynaecological problems and symptoms experienced during the use of the LNG IUS was sent to 23,885 LNG IUS users. A total of 17,914 questionnaires were returned (response rate 75%). The results cover experience from 58,600 woman years. A log-rank-test was used to test differences in continuation rates. Multivariate analyse were performed using Cox's proportional hazard model.
Results The LNG IUS was prematurely removed from 5175 women. The one, two, three, four and five year continuation rates were 93%, 87%, 81%, 75% and 65%, respectively. The symptoms during the use of the LNG IUS most strongly associated with its premature removal were excessive bleeding and spotting, and infections and pain. The risk of premature removal was markedly lower among women who had occasional or total absence of menstruation. Premature removal was less likely in the oldest age group.
Conclusions The continuation rate of the LNG IUS compares favourably with other long-acting contraceptive systems. Totally or occasionally absent menstruation was strongly associated with prolonged continuation.     

Fetal placental inflammation is associated with poor neonatal growth of preterm infants: a case-control study

Abstract

Objective: To determine whether there is an association between histological chorioamnionitis (HCA) and postnatal growth of preterm infants in the neonatal period.

Method: This case–control study is part of a larger prospective histological study on placentas performed in all deliveries prior to 32 weeks of gestation. Eligible cases involved all placentas with a diagnosis of HCA. Control subjects were those without HCA, matched 1:1 with case subjects according to gestational age (±1 week). Placental inflammatory status and serial weight gain were analyzed for all infants during the first four postnatal weeks. Based on placental inflammation extension, HCA was defined as maternal HCA (MHCA) or fetal HCA (FHCA).

Results: Of the 320 mother–infant pairs, 71 (22.1%) presented with HCA (27 MHCA and 44 FHCA). Decreases in weight gain at 21 and 28 days were associated with the presence of FHCA (β coefficient?±?SE?=??4.40?±?2.21, p?=?0.05 and ?6.92?±?2.96, p?=?0.02, respectively), whereas no significant differences were found between MHCA and no-HCA groups. FHCA and MHCA were not identified as risk factors of weekly weight gain, after adjusting for possible confounders (maternal ethnicity, parity, smoking during pregnancy, infant gender, IUGR status, SGA status, antenatal steroids, total fluid intake, late-onset sepsis, BPD).

Conclusions: We found an association between fetal placental inflammation and poor neonatal growth but we were not able to identify a specific week wherein weight gain could be mostly affected. Placental findings may be used to identify preterm infants at risk of postnatal growth failure.     

HPV vaccination coverage in French girls attending middle and high schools: a declarative cross sectional study in the department of Côte d’Or

Objectives

To assess human papillomavirus prophylactic vaccine coverage among a representative population of French girls, aged 14 years and above, attending middle and high schools, and to determine factors associated with the initiation and completion of the vaccination protocol.

Study design

This cross-sectional study, designed with cluster sampling, was conducted from October 2010 to May 2011, in 29 schools in the department of Côte d’Or, France. The schools were randomized according to their status (public or private) and location (rural or urban). Two classes per level were then included. All analyses were stratified on age.

Results

948 questionnaires were collected (87.9% participation). Mean age was 15.2 years (SD = 1.3), ranging between 14 and 19. Only 31.7% of 14-year-old girls and 61.4% of girls aged 15 and above initiated vaccination (one dose), and 7.8% of 14-year-old girls and 48.5% of girls aged 15 and above completed it (three doses). An urban school location and a physician's recommendation were independently associated with vaccination initiation in girls aged 14. In girls aged 15 and above, the parents’ socioeconomic status, the family composition and a recommendation by a physician were independently associated with vaccination initiation. Once vaccination had been initiated, girls who attended private school, who belonged to families with higher outcomes, who lived with a single parent or who smoked were less likely to complete the vaccination protocol.

Conclusion

HPV prophylactic vaccine coverage in girls attending school in Côte d’Or appears to be low. Physicians play a major role in vaccine acceptance.     

Post-warming embryo morphology is associated with live birth: a cohort study of single vitrified-warmed blastocyst transfer cycles

PurposeThis study aims to examine whether blastocyst morphology post-warming correlates with live birth.MethodsIn this cohort study, morphological characteristics post-warming were reviewed in all single vitrified-warmed blastocyst transfer cycles performed between November 2016 and May 2017. Immediately before transfer, the degree of blastocoel re-expansion was graded as A, fully expanded; B, partially expanded ≥ 50%; C, partially expanded < 50%; and D, collapsed. The degree of post-warming cell survival was graded on a scale of 50 to 100% and was then classified into 4 groups: very low 50–70%, low 71–80%, moderate 81–90%, and high 91–100%.ResultsOverall, 612 cycles were reviewed, of which 196 included PGT-A tested embryos. The live birth rate (LBR) increased from 11.4% in the collapsed blastocysts group to 38.9% in the post-warming full re-expansion group (p < 0.001) and from 6.5% for blastocysts with a very low cell survival rate to 34.7% for blastocysts with high cell survival rate (p = 0.001). LBR was 6.7% for blastocysts with the worst post-warming morphological characteristics, namely, collapsed with very low cell survival rate. On multivariate analyses, partial blastocyst re-expansion ≥ 50%, full re-expansion, and high cell survival rate remained significantly associated with live birth, after controlling for female age, pre-vitrification morphological grading, and PGT-A. A sub-analysis of cycles using PGT-A tested embryos showed similar results.ConclusionPost-warming re-expansion and high cell survival rate are associated with higher LBR in euploid and untested blastocysts. However, embryos with poor post-warming morphology still demonstrate a considerable probability of live birth, and they should not be discarded.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10815-021-02390-z.     

Butyrylcholinesterase (BChE) activity is associated with the risk of preeclampsia: influence on lipid and lipoprotein metabolism and oxidative stress

Abstract

Objective: To determine the butyrylcholinesterase (BChE) activity and phenotypes in preeclampsia and its possible association with lipid and lipoprotein metabolism and oxidative stress in preeclamptic women.

Methods: In a case–control study, 101 pregnant women with normal pregnancy and 198 women with preeclampsia from Western Iran were studied. The serum BChE activity and phenotypes were measured using spectrophotometric method. The apolipoprotein E (APOE) genotypes were identified using PCR-RFLP. The serum malondialdehyde (MDA) level and total antioxidant capacity (TAC) were determined by HPLC and commercial kits, respectively.

Results: The BChE activity and the frequency of non-usual BChE phenotype in preeclamptic women were significantly lower and higher, respectively compared to controls. There was a higher BChE activity in the presence of APOE ε3ε4 compared to ε3ε3 genotype in preeclamptic women. In addition, there were significant positive correlations between BChE activity and the levels of low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, total cholesterol (TC) and TAC. However, there was a negative but significant correlation between BChE activity and MDA level.

Conclusions: Our study for the first time indicated that BChE activity might be involved in the pathogenesis of preeclampsia through influence on lipid and lipoprotein metabolism and oxidative stress.     

Diagnosis and management of symptoms associated with vulvovaginal atrophy: expert opinion on behalf of the Italian VVA study group*

Vulvovaginal atrophy (VVA) is a chronic disorder that commonly occurs in postmenopausal women, whose symptoms are recognized among the most frequent and bothersome symptoms associated with menopause. The principal therapeutic goal in managing VVA is to relieve symptoms as well as to restore the vaginal environment to a healthy state. However, despite its high prevalence and negative impact on quality of life, VVA is underreported by women, underrecognized by gynecologists, and therefore, undertreated. In the light of the new development of treatment options for VVA, we here provide an updated expert opinion on the management of VVA. In particular, we strongly recommend that HCPs proactively start an open discussion with their postmenopausal patients about urogenital symptoms. Treatment should be started as early as the first symptoms of VVA occur and should be maintained over time, due to the chronicity of the conditions. Many treatment options are now available and therapy should be individualized, taking the woman’s preference in consideration.     

The reduction of melatonin levels is associated with the development of preeclampsia: a meta-analysis

Objective: The aim of this analysis was to demonstrate the association between melatonin levels and the development of preeclampsia.

Methods: Standardized mean difference (SMD) with 95% confidence interval (CI) was calculated using a random effects model.

Results: The pooled SMD between case and control was 1.40 (95% CI: 0.26, 2.55; P = 0.02). And the pooled SMD between mild PE and severe PE was 5.25 (95% CI: 1.5, 9.01; P = 0.006).

Conclusion: The meta-analysis illustrated that melatonin concentration was significantly lower in women with preeclampsia, and correlated with the severity of the disease.