Dehydroepiandrosterone sulfate/free androgen index ratio predicts a favorable metabolic profile in patients with polycystic ovary syndrome

Potential effect of hyperandrogenemia on metabolic disturbances in polycystic ovary syndrome (PCOS) has always been a matter of interest. We analyzed the records of 125 patients with PCOS and 54 age-matched healthy women. All participants underwent biochemical and hormonal assessment and a 75?g oral glucose tolerance test was performed. PCOS and control groups were comparable in terms of age. Dehydroepiandrosterone sulfate/free androgen index (DHEAS/FAI) ratio was negatively correlated with body mass index (BMI) (p?<?.001), fasting glucose (p?=?.02), area under the curve (AUC) of glucose (p?=?.03), AUC of insulin (p?=?.001), homeostasis model assessment-estimated insulin resistance (HOMA-IR) (p?<?.001), and triglycerides (TG) (p?=?.009), and positively correlated with insulin sensitivity index (ISI) (p?<?.001) and high-density lipoprotein cholesterol (HDL-C) (p?<?.001) among PCOS patients. In logistic regression analysis, higher DHEAS/FAI ratio levels were associated with lower risk of low HDL-C [RR(95%CI); 0.97(0.95–0.98); p?<?.001] as well as atherogenic dyslipidemia (TG/HDL-C) [RR(95%CI); 0.97(0.94–0.99); p?=?.035] even after adjustment for BMI in the PCOS group. Androgens, DHEAS and FAI act differently on metabolic parameters. Our results demonstrate that high DHEA-S/FAI ratio levels are associated with a more favorable metabolic profile.     

Short-term effects of metformin and myo-inositol in women with polycystic ovarian syndrome (PCOS): a meta-analysis of randomized clinical trials

Metformin (MET), the most commonly used insulin sensitizer, is the reference off-label drug for the treatment of polycystic ovary syndrome (PCOS), worldwide. However, its use may be limited mainly by gastrointestinal adverse effects. Myo-inositol (MI), a well-recognized food supplement, also represents an evidence-based treatment for PCOS women, popular in many countries. Our aim is to provide a systematic review of the literature and a meta-analysis which compares these two treatments, for their short-term efficacy and safety in PCOS patients. Systematic review and meta-analysis of randomized clinical trials (RCTs). RCTs were identified from 1994 through 2017 using MEDLINE, Cochrane Library, PubMed, and ResearchGate. Included studies were limited to those one directly comparing MET to MI on several hormones changes. Standardized mean difference (SMD) or risk ratios (RRs) with 95% CIs were calculated. Changes in fasting insulin was the main outcome of measure. Six trials with a total of 355 patients were included. At the end of treatment, no difference between MET and MI was found on fasting insulin (SMD=0.08 µU/ml, 95% CI: ?0.31–0.46, p=.697), HOMA index (SMD =0.17, 95% CI: ?0.53–0.88, p=.635), testosterone (SMD=??0.01, 95% CI: ?0.24–0.21, p=.922), SHBG levels (SMD=??0.50?nmol/l, 95% CI: ?1.39–0.38, p=.263) and body mass index (BMI) (SMD=??0.22, 95% CI: ?0.60–0.16, p=.265). There was strong evidence of an increased risk of adverse events among women receiving MET compared to those receiving MI (RR =5.17, 95% CI: 2.91–9.17, p<.001). No differences were found in the effect of MET and MI on short-term hormone changes. The better tolerability of MI makes it more acceptable for the recovery of androgenic and metabolic profile in PCOS women.     

Maternal serum and fetal cord-blood ischemia-modified albumin concentrations in normal pregnancy and preeclampsia: a systematic review and meta-analysis

Background/aims: A meta-analysis of maternal serum ischemia-modified albumin (IMA) and fetal cord-blood IMA concentrations in normal pregnancy (NP) compared to non-pregnant healthy controls (HC) and in preeclampsia (PE) compared with normal pregnant controls were studied.

Methods: All major databases were searched for eligible studies. We included eight studies comparing serum IMA between NP and HC, 14 studies comparing serum IMA between PE and NP and five studies comparing cord-blood IMA between PE and NP groups. Meta-analyses on these included studies were performed using Review Manager 5.3. Pooled-overall effect size as standardized mean difference (SMD), publication bias, subgroup, and sensitivity analysis data were generated.

Results: Random-effects meta-analysis indicated a significant increase in serum IMA in the NP group (SMD?=?0.98, p?=?.01) and the PE group (SMD?=?0.94, p?p?Conclusions: This meta-analysis, the first of its kind showed that the increased serum IMA concentrations were indicative of increased oxidative stress in NP and PE. Measurement of maternal serum IMA and fetal cord-blood IMA concentrations were useful as simple, novel, and inexpensive markers of oxidative stress (OS) status in PE patients. Future large-scale studies are needed to explore IMA in relationship to the disease severity in PE.     

Improved pregnancy outcome following earlier splenectomy in women with immune thrombocytopenia: a 5-year observational study

Objective: To assess prospectively the maternal and fetal outcome in women with immune thrombocytopenic purpura (ITP) who undergone earlier splenectomy compared to women on medical therapy.

Methods: A 5-year observational study included pregnant women in the first trimester previously diagnosed with primary ITP with 74 patients underwent splenectomy before pregnancy and 86 patients on medical therapy. Patients were followed throughout pregnancy and labour to record their obstetric outcome. Data were collected and tabulated.

Results: There was a higher platelet count in the splenectomy group at enrollment (p?p?p?p?p?p?p?p?p?Conclusion: Earlier splenectomy in patients with ITP may have a beneficial impact on obstetric outcome and should be explained to patients wishing to get pregnant. Further larger multicenter studies are warranted to confirm or refute our findings.     

Sociodemographic characteristics associated with the use of effective and less effective contraceptive methods: findings from the Understanding Fertility Management in Contemporary Australia survey

Objective: Unintended pregnancy and abortion may, in part, result from suboptimal use of effective contraception. This study aimed to identify sociodemographic factors associated with the use of effective and less effective methods among women and men of reproductive age living in Australia.

Methods: In a cross-sectional national survey, 1544 women and men aged 18–51 were identified as being at risk of pregnancy. Chi-square and logistic regression analyses were used to assess the sociodemographic factors related to contraceptive use.

Results: Most respondents (n?=?1307, 84.7%) reported using a method of contraception. Use of any contraceptive was associated with being born in Australia (Odds Ratio [OR] 1.89; 95% Confidence Interval [CI]1.186, 3.01; p?=?.008), having English as a first language (OR 1.81; 95% CI: 1.07, 3.04; p?=?.026), having private health insurance (OR 2.25; 95% CI 1.66, 3.04; p?p?n?=?534, 34.6%; permanent methods: 23.1%, and long-acting reversible contraception (LARC): 11.4%). Permanent methods were more likely to be used in rural areas (OR 0.62; 95%CI 0.46, 0.84; p?=?.002). Use of the least effective, short-term methods was reported by nearly half (condoms: 25.6%, withdrawal: 12.5%, and fertility-awareness-based methods: 2.8%). Those who relied on withdrawal were more likely to live in a metropolitan area (OR 2.85; 95% CI 1.95, 4.18; p?p?Conclusions: Targeted promotion of the broad range of available contraceptives may raise awareness and uptake of more effective methods and improve reproductive autonomy in certain population groups.     

Misconceptions and current use of contraception among women of reproductive age in six major cities in Nigeria

Abstract

Objectives: The aims of this study were to assess the determinants of family planning misconceptions and modern contraceptive use, and the influence of misconceptions on the use of modern contraceptive methods.

Methods: We reviewed and analysed data collected between October 2010 and March 2011 among a representative household sample of 13,575 women of reproductive age (15–49 years) in six urban cities in Nigeria. Multiple linear and logistic regression models were used to examine the predictors of misconceptions and current use of contraception and the association between misconceptions and modern contraceptive use.

Results: Catholic women were significantly more likely to have misconceptions compared with Muslim women (β?=?1.09; 95% confidence interval [CI] 0.58, 1.60; p?<?.001); women with higher education were significantly less likely to have misconceptions about contraception compared with women with no formal education (β=??0.06; 95% CI ?0.96, ?0.29; p?<?.001). Unmarried women living with a partner were not significantly different from those who were not cohabiting (single, separated or widowed) in their current contraceptive use (adjusted odds ratio [OR] 0.91; 95% CI 0.79, 1.04; p?>?.05). Women with lower misconception scores were significantly more likely to adopt and use modern contraception compared with those with high misconception scores (adjusted OR 0.93; 95% CI 0.92, 0.94; p?<?.001).

Conclusion: These findings suggest that programmatic efforts should be geared towards dispelling misconceptions by providing simple factual information related to the benefits of contraception and family planning.     

The association between maternal race and adverse outcomes in twin pregnancies with similar healthcare access

Objective: To compare twin pregnancy outcomes between white and nonwhite women with similar access to health care.

Methods: Retrospective cohort study of all twin pregnancies delivered by a single maternal–fetal medicine practice from 2005–2016. All patients had private health insurance and equal access to physician care. Outcomes were compared between white and nonwhite women using logistic regression to adjust for differences at baseline.

Results: Of the 858 women included, 730 (85.1%) were white and 128 (14.9%) were nonwhite. Univariate analysis demonstrated that nonwhite women had higher rates of preterm birth <32 weeks (12.5 versus 6.7%, p?=?.022), cesarean delivery (78.1% versus 61.4% of all women, p?p?p?=?.029) and gestational diabetes (23.2% versus 7.3%, p?Conclusions: Nonwhite women with twin pregnancies have an increased risk of adverse outcomes that cannot be explained by access to care. Although improving access to care is an important goal for health care systems, our data suggest that this alone will not eliminate all disparities in health care outcomes between women of different races.     

Vaginal delivery among women who underwent labor induction with vaginal dinoprostone (PGE2) insert: a retrospective study of 1656 women in China

Objective: This study aimed to qualify relevant factors for vaginal delivery among women who underwent labor induction with vaginal dinoprostone (PGE2) insert in a Chinese tertiary maternity hospital.

Material and methods: A retrospective study was conducted in Hubei Maternal and Child Health Hospital. A total of 1656 pregnancies that underwent labor induction with vaginal dinoprostone insert between January and August 2016 were finally included in this study. Data were analyzed using univariate and multivariable regression modeling.

Results: Of 1656 women with PGE2-induced labor at term, 396 (23.91%) gave birth by cesarean section, 1260 (76.09%) had a vaginal delivery among which 921 (55.61%) delivered vaginally within 24?h. Multivariable regression analysis showed that maternal age (p?p?p?=?.009, OR = 0.98, 95%CI 0.96–0.99), and birth weight (p?p?p?p?=?.004, OR = 0.96, 95%CI 0.94–0.99), and birth weight (p?Conclusions: Our findings suggested a vaginal delivery rate of 76.09% when dinoprostone vaginal insert was used for labor induction, which was markedly higher than the overall annual vaginal delivery rate of 65.1% in China during 2014. Maternal age, parity, baseline fetal heart rate, and birth weight were significant factors for vaginal delivery. This study enables us to better understand the efficiency of dinoprostone and the potential predictors of vaginal delivery in dinoprostone-induced labor, which may be helpful to guide the clinical use of dinoprostone and therefore provide better service clinically.     

An alternative method for measuring oxidative stress in intrahepatic cholestasis of pregnancy: thiol/disulphide homeostasis

Purpose: The aim of our study was to evaluate the oxidative stress (OS) in pregnant women with intrahepatic cholestasis of pregnancy (ICP) by evaluating thiol/disulphide homeostasis using an alternative technique.

Methods: A total of 57 pregnant women with ICP were compared with 50 gestational age and body mass index matched controls. A recently defined method was used for the measurement of plasma native-total thiol and disulphide levels. The independent two-sample t test, Mann–Whitney-U test, Chi-square test, binary logistic regression with backward elimination and receiver operating characteristic (ROC) curve was performed for statistical analyses.

Results: Pregnant women with ICP (n?=?57) versus controls (n?=?50) had significantly lower serum levels of native thiol (233.8?±?47.4?μmol/L vs. 308.5?±?51.7?μmol/L, p?p?p?p?p?Conclusions: To our knowledge, this is the first study in the literature exploring thiol/disulphide balance in ICP. We found that thiol/disulphide balance indicate OS in pregnant woman with ICP.     

Is there a role for kisspeptin in pathogenesis of polycystic ovary syndrome?

Aim: To investigate association of kisspeptin levels in infertile women with different ovarian reserve patterns.

Materials and methods: In this prospective cross-sectional study, 157 participants were recruited. The women were divided into three groups: (i) adequate ovarian reserve (AOR) (n?=?57), (ii) high ovarian reserve (PCOS) (n?=?60), (iii) diminished ovarian reserve (DOR) (n?=?40). Weight, height, waist circumference (WC), hip circumference (HC), body mass index (BMI), waist/hip ratio (WHR) were measured. The blood samples were analyzed for estradiol (E2), follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone (TT), 17-hydroxy progesterone (17OHP), dehydroepiandrosterone sulfate (DHEAS), antimullerian hormone (AMH), kisspeptin measurements.

Results: FSH concentration was higher and AMH concentration was lower in DOR group (p?p?p?=?.001, p?p?=?.003, respectively). The 17OHP level did not differ among the groups (p?=?.15). Women with PCOS possessed the highest kisspeptin level (p?=?.01). The kisspeptin level was negatively correlated with FSH level (r?=??0.18, p?=?.02) and positively correlated with TT and DHEAS levels (r?=?0.17, p?=?.02 and r?=?0.23, p?=?.003, respectively).

Conclusions: Women with PCOS had increased serum kisspeptin levels. Kisspeptin concentrations were negatively correlated with serum FSH and positively correlated with serum TT and DHEAS levels.     

The influence of massage on neonatal hyperbilirubinemia: a meta-analysis of randomized controlled trials

Introduction: The efficacy of massage to treat neonatal hyperbilirubinemia remains controversial. We conducted a systematic review and meta-analysis to explore the influence of massage on the neonatal hyperbilirubinemia.

Methods: We search PubMed, Embase, Web of science, EBSCO, and Cochrane Library databases through November 2017 for randomized controlled trials (RCTs) assessing the effect of massage on neonatal hyperbilirubinemia. This meta-analysis is performed using the random-effect model.

Results: Six RCTs involving 357 patients are included in the meta-analysis. Overall, compared with the control group in neonatal hyperbilirubinemia, massage therapy is associated with substantially reduced serum bilirubin level within 4?d (mean difference (MD)?=??2.31; 95% CI?=??2.92 to ?1.70; p?p?p?=?.23), transcutaneous bilirubin level on 2?d (MD?=??0.17; 95% CI?=??1.34 to 1.00; p?=?.77), frequency of defecation daily on 2?d (MD?=?0.57; 95% CI?=??0.03 to 1.16; p?=?.06), and frequency of defecation daily within 4?d (MD?=?0.83; 95% CI?=??0.11 to 1.76; p?=?.08).

Conclusions: Massage therapy can significantly reduce serum bilirubin level and transcutaneous bilirubin level within 4?d, but demonstrates no influence on serum bilirubin level and transcutaneous bilirubin level on 2?d, frequency of defecation daily on 2 and 4?d for neonatal hyperbilirubinemia.     

High-visfatin levels in women with polycystic ovary syndrome: evidence from a meta-analysis

Abstract

Objective: Previous studies regarding visfatin levels in women with polycystic ovary syndrome (PCOS) showed conflicting results. To evaluate the visfatin levels in PCOS, a meta-analysis was performed. Methods: A comprehensive literature search of eligible studies in Embase, Pubmed and the Cochrane Library was undertaken through November 2014. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated to estimate the strength of the association. Results: A total of 1341 subjects (695 cases and 646 controls) were included in this meta-analysis. The pooled analysis results indicated that the visfatin levels were significantly higher in PCOS patients than that of controls (SMD?=?1.19, 95% CI 0.77–1.60, p?=?0.000). The results from stratified analysis and univariate analysis suggested that high-visfatin levels were not related to body mass index (BMI), insulin resistance (IR) and total testosterone ratio. Significant heterogeneity was observed in all analysis. Conclusion: Our results indicate that high-circulating visfatin level is an intrinsic characteristic of PCOS, which suggests visfatin could be a potential biomarker for PCOS.     

A systematic review and meta-analysis of lifestyle and body mass index predictors of successful assisted reproductive technologies

Objective: Lifestyle (smoking, drinking alcohol) and body mass index (BMI) predictors of successful outcomes in assisted reproductive technology (ART) treatments were examined in this meta-analysis.

Method: A bibliographic search was undertaken using six databases. The review was informed by PRISMA/MOOSE guidelines. Meta-analytic data were analysed using random effects models.

Results: We included 77 studies examining effects of BMI, smoking and drinking alcohol. Patients with a BMI<?=24.9 were significantly more likely to achieve LB/pregnancy than with BMI>?=25 OR?=?1.219 (95% CI:1.128–1.319, z?=?4.971, p?<?.001; I²?=?53.779%, p?=?.001). Non-smokers were significantly more likely to achieve a LB or pregnancy than smokers OR?=?1.457 (95% CI:1.228–1.727, z?=?4.324, p?<?.001; I²?=?51.883; p?=?.001). Meta-regression revealed the number of embryos transferred significantly moderated the effects of smoking on ART outcomes, and there was a trend indicating primary infertility and high BMI were also significant moderators. The evidence for drinking alcohol was inconclusive due to the small number of studies.

Conclusions: This meta-analysis confirms that ART treatment success can be predicted with lifestyle factors. Further, non-smokers’ relative odds of pregnancy/live birth increase as more embryos were transferred but there was a trend that the odds of pregnancy/live birth decrease with primary infertility and high BMI.     

Follicle-stimulating hormone associates with metabolic factors in postmenopausal women

Abstract

Current studies have focused more on the relationships among estrogen, androgen, and metabolic syndrome (MetS). The main aim of the study was to investigate whether the variation of FSH is associated with metabolic factors in postmenopausal women. A total of 561 postmenopausal women aged 39–69 years were selected. FSH, estradiol, fasting blood glucose, and lipid profiles were analyzed. Compared with women in the highest FSH quartile, women in the lowest quartile had higher body mass index (BMI), fast blood glucose (FBG), triglyceride (TG), blood pressure, and serum estradiol (E₂) but lower high-density lipoprotein (HDL) (all p?<?.05). Compared with women in the groups of normal levels of MetS biomarkers, women in the abnormal groups had lower FSH (all p?<?.01). Increased quartiles of FSH were associated with significantly decreased rates of abnormal levels of metabolic factors (all p?<?.05). High FSH levels had protective effects regarding SBP, DBP, and FBG, with odds ratios (ORs) of 0.84 (95% CI 0.76–0.92, p?<?.001), 0.85 (95% CI 0.78–0.94, p?<?.01), 0.90 (95% CI 0.83–0.98, p?<?.01), respectively. Low FSH appears to be a risk factor of all domains of MetS in postmenopausal women, which merits further study.     

Inducible nitric oxide inhibitor aminoguanidine,ameliorated oxidative stress,interleukin-6 concentration and improved brain-derived neurotrophic factor in the brain tissues of neonates born from titanium dioxide nanoparticles exposed rats

Abstract

Introduction: An interaction between oxidative stress, neuroinflammation, and nitric oxide (NO) has been suggested to have a role neurotoxicity. The aim of current research was to investigate the effect of aminoguanidine (AG) as an inducible NO synthase (iNOS) inhibitor, on brain-derived neurotrophic factor (BDNF), oxidative stress, and interleukin-6 (IL-6) concentrations in the brain tissues of neonates born from the rats exposed to titanium dioxide nanoparticles (TiO2 NPs) during gestation.

Methods: The pregnant rats were grouped into three and received: (1) saline, (2) TiO2 (200?mg/kg, gavage), and (3) TiO2-AG [200?mg/kg intraperitoneal (IP)]. The treatment was started since the second gestation day up to the delivery time. The neonates born from the rats were deeply anesthetized, sacrificed, and the brains were collected for biochemical evaluations.

Results: The neonates born from the rats exposed to TiO₂ showed a lower BDNF (p?<?.001) but a higher IL-6 (p?<?.01) concentrations in their hippocampal tissue. TiO₂ exposure also increased malondialdehyde (MDA) (p?<?.001) and NO metabolites (p?<?.001), while diminished thiol (p?<?.001), superoxide (SOD) (p?<?.001), and catalase (CAT) (p?<?.001) in all hippocampal, cortical, and cerebellar tissues. Administration of AG improved BDNF (p?<?.01) but attenuated IL-6 (p?<?.01) concentrations in the hippocampal tissue. AG also decreased MDA (p?<?.001) and NO metabolites (p?<?.01–p?<?.001), while increased thiol (p?<?.01–p?<?.001), SOD (p?<?.001), and CAT (p?<?.05–p?<?.001) in all cerebellar, hippocampal, cortical, and tissues.

Conclusion: The results of the current research revealed that iNOS inhibitor AG, ameliorated oxidative stress, IL-6 concentration, and improved BDNF in the brain tissues of neonates born from TiO₂ NPs exposed rats.     

Association of luteinizing hormone/choriogonadotropin receptor gene polymorphisms with polycystic ovary syndrome risk: a meta-analysis

To investigate the association between Luteinizing hormone/choriogonadotropin receptor (LHCGR) gene polymorphisms and polycystic ovary syndrome (PCOS). A systematic literature search and meta-analysis using STATA software for included studies. Fourteen case-control studies containing rs13405728, rs4539842, and rs2293275 of LHCGR gene were included, which was comprised of 11,738 PCOS cases and 35,329 controls. Results of the meta-analysis showed a significant association between PCOS and rs13405728 (for G vs. A: OR?=?0.735, 95% CI?=?0.699–0.773, p<.001; For GG vs. AG?+?AA: OR?=?0.578, 95% CI?=?0.436–0.767, p<.001; For GG?+?AG vs. AA: OR?=?0.817, 95% CI?=?0.741–0.901, p<.001) in Asian populations, and rs4539842 (for ins/ins vs. ins/non?+?non/non: OR?=?0.686, 95% CI?=?0.483–0.974, p=.035) and rs2293275 (for AA vs. AG?+?GG: OR?=?4.115, 95% CI?=?1.033–16.38, p=.045) in Caucasian populations, respectively. LHCGR gene variations are population specifically associated with PCOS, which indicated these SNPs in LHCGR may contribute to the pathogenesis of PCOS and could be used as potential biomarkers to predict the risk of PCOS.     

Serum Kisspeptin levels in unexplained infertility,polycystic ovary syndrome,and male factor infertility

Kisspeptin (KP), a hypothalamic peptide, is known as an important marker for neuroendocrine regulation during the human reproduction process. The unexplained infertility (UI) group comprised 30 patients, polycystic ovary syndrome (PCOS) group comprised 29 patients and the male factor infertility (MFI) group comprised 27 patients. An observational cohort study was conducted. The basic characteristics of the study population, BMI, and serum FSH, LH, E2, AMH, KP, TSH, and PRL levels and antral follicle count (AFC) on the 3rd menstruation day were evaluated. The mean KP level was 281.98?±?73.9?ng/ml in the UI group, 525.49?±?164.17?ng/ml in the PCOS group, and 354.313?±?111.38?ng/ml in the MFI group (p?<?.001). KP levels were significantly higher in the PCOS group than in the UI and MFI groups (p?<?.001 for both). AUC was 83% (95% CI: 73%–93%), with 375.15 (pg/ml) as the cutoff value in the PCOS group with 83% sensitivity and 79% specificity. UI may be treated by KP injection therapies and higher levels of KP may be a reliable marker for AFC and diagnosis of PCOS. Clinical Trials registration number: NCT03018314     

Efficacy of probiotic supplement for gestational diabetes mellitus: a systematic review and meta-analysis

Background: Probiotic supplement might be beneficial for gestational diabetes mellitus. However, the results remained controversial. We conducted a systematic review and meta-analysis to explore the efficacy of probiotic supplement in gestational diabetes mellitus.

Methods: PubMed, Embase, Web of science, EBSCO, and Cochrane Library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of probiotic supplement in gestational diabetes mellitus were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcome were fasting serum insulin and fasting plasma glucose. Meta-analysis was performed using the fixed-effect or random-effect model.

Results: Six RCTs involving 830 patients were included in the meta-analysis. Overall, compared with control intervention in gestational diabetes mellitus, probiotic supplementation intervention was found to significantly reduce fasting serum insulin (Std. mean difference?=??0.95; 95% CI?=??1.73 to ?0.17; p?p?=?.02), but showed no substantial impact on fasting plasma glucose (Std. mean difference =??0.49; 95% CI?=??1.05–0.08; p?=?.09), gestational age (Std. mean difference?=?0.07; 95% CI?=??0.20–0.34; p?=?.63), and gestational weight (Std. mean difference?=??0.11; 95% CI?=??0.38–0.16; p?=?.43).

Conclusions: Compared with control intervention in gestational diabetes mellitus, probiotic supplementation was found to significantly reduce insulin resistance (HOMA-IR) and fasting serum insulin, but had no substantial influence on fasting plasma glucose, gestational age and gestational weight.     

Maternal and neonatal outcomes of placenta increta and percreta from a multicenter study in China

Objective: The objective of this study is to identify the maternal and neonatal outcomes in women with placenta increta or placenta percreta in China.

Materials and methods: We retrospectively analyzed 2219 cases from 20 tertiary care centers in China between January 2011 and December 2015. All cases were diagnosed of placenta increta or placenta percreta, based on either intraoperative findings or histopathological findings.

Results: The incidence of placenta increta and placenta percreta progressively increased from 0.18% in 2011 to 0.78% in 2015. Compared with the placenta increta, placenta percreta was strongly related to serious adverse outcomes: postpartum hemorrhage (65.9% versus 38.6%, p?=?.003), blood transfusion (86.2% versus 46.5%, p?p?p?p?Conclusion: The incidence of placenta increta and placenta percreta is likely to increase in China. The depth of placenta implantation is associated with the severity of outcomes. Placenta percreta tends to have worse maternal and neonatal outcomes.