Women with endometriosis at first pregnancy have an increased risk of adverse obstetric outcome

Objective: To evaluate pregnancy, delivery and neonatal outcome in singleton primiparous versus multiparous women with/without endometriosis.

Methods: Multicentric, observational and cohort study on a group of Caucasian pregnant women (n?=?2239) interviewed during their hospitalization for delivery in five Italian Gynecologic and Obstetric Units (Siena, Rome, Padua, Varese and Florence).

Results: Primiparous women with endometriosis (n?=?219) showed significantly higher risk of small for gestational age fetuses (OR: 2.72, 95% CI 1.46–5.06), gestational diabetes (OR: 2.13, 95% CI 1.32–3.44), preterm premature rupture of membranes (OR: 2.93, 95% CI 1.24–6.87) and preterm birth (OR: 2.24, 95% CI 1.46–3.44), and were hospitalized for a longer period of time (p?n?=?1331). Multiparous women with endometriosis (n?=?97) delivered significantly more often small for gestational age fetuses (OR: 2.93, 95% CI 1.28–6.67) than control group (n?=?592). Newborns of primiparous women with endometriosis needed more frequently intensive care (p?=?0.05) and were hospitalized for a longer period of time (p?Conclusions: Women with endometriosis at first pregnancy have an increased risk of impaired obstetric outcome, while a reduced number of complications occur in the successive gestation. Therefore, it is worthy for obstetricians to increase the surveillance in nulliparous women with endometriosis during pregnancy.     

Predictors of twin pregnancy after ovarian stimulation and intrauterine insemination in women with unexplained infertility

Multi-foetal gestation is a well-known, adverse outcome of infertility treatment. Maternal and obstetrical complications are more frequent in multiple pregnancies compared to singletons. The aim of this study was to determine parameters that affect the risk for multiple pregnancies after ovarian stimulation (OS) with intrauterine insemination (IUI). We retrospectively evaluated all cases of OS with IUI cycles that ended with successful clinical pregnancy. A total of 259 pregnancies were analysed (175 singletons, 63 twins and 21 triplets). Significant parameters predicting multiple pregnancies were gravidity and number of follicles at least 15?mm in diameter on day of hCG. A previous pregnancy increased the risk for multiple gestation by a factor of 1.86 (95% CI 1.03–3.37, p?=?0.04). Each follicle ≥15?mm increased the odds ratio for multiple gestation by 1.3 (95% CI 1.03–1.65, p?=?0.027). In conclusion, women with more than one previous pregnancy and three or more than three follicles ≥15?mm at hCG are at risk for multi-foetal pregnancy after OS and IUI.     

Association of common variations of the E-cadherin with endometriosis

Abstract

Endometriosis is a polygenic and multifactorial disease. E-cadherin (CDH1) gene encodes an epithelial cell–cell adhesion glycoprotein that modulates a wide variety of processes, including cell polarization, migration and cancer metastasis. Decreased expression of CDH1 in epithelial cells in peritoneal endometriosis has been reported in advanced stages of endometriotic lesions. We investigated the CDH1 ?160C/A and +54C/T variations with susceptibility to endometriosis in an Iranian population. In this case-control study, 149 patients with endometriosis (stages I–IV) and 151 healthy women as controls were included. Genotyping was performed using PCR-RFLP method. A p value of <0.05 was considered statistically significant. The CDH1?+?54TT genotype was significantly lower (p?=?0.012; OR?=?0.30, 95% CI: 0.12–0.77) in the patients (11.6%) than the control group (26.7%). The CDH1?+?54T allele was significantly lower (p?=?0.001; OR?=?0.55, 95% CI: 0.38–0.77) in the cases (35.7%) compared with the control group (50.3%). No association was found between CDH1???160C/A polymorphism and endometriosis. The CDH1 +54C/T was associated with susceptibility to endometriosis in Iranian population, and +54T allele may have a protective role in progression of endometriosis.     

Intrauterine insemination with husband semen: an evaluation of pregnancy rate and factors affecting outcome

Purpose  The aim was to determine pregnancy rate following intrauterine insemination (IUI) and its associated factors in a university assisted reproductive technique center in Tehran, Iran. Methods  A retrospective analysis of 350 IUI cycles with ovarian stimulation by clomiphene citrate and/or gonadotropins was performed. Results  The overall pregnancy rate was 22% (77/350). Of the 77 pregnancies, 88.3% resulted in live birth, 7.8% in spontaneous abortion, 2.6% in blighted ovum and 1.3% were ectopic. Logistic regression analysis revealed three predictive variables as regards pregnancy: number of the treatment cycle (OR:3.5 CI:1.9 – 6.4 p:0.006), duration of infertility (OR:2.1 CI:1.2 – 3.7 p = 0.001) and age (OR:2.15 CI:1.1 – 4.4 p = 0.04). Pregnancy rate did not have any independent relation to sperm count, type of infertility, number and size of follicle and side of ovulatory ovary. Conclusion  Our results indicate that clomiphene citrate and/or gonadotropins IUI is a convenient and useful treatment option in women with younger age ( <30 years) and fewer treatment cycles and fewer infertility duration (4 years). Capsule Best results for intrauterine insemination with ovarian stimulation is obtained in women with younger age, fewer treatment cycles and fewer infertility duration. This study was conducted in Human Reproduction Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.     

Luteal phase support after mild ovulation induction with intrauterine insemination: an on-going debate

Objective: To evaluate the effect of luteal phase support (LPS) using progesterone vaginal gel on pregnancy rate (PR) and live birth rate (LBR) during cycles in which controlled ovarian stimulation (COH) was performed using gonadotropins with intrauterine insemination (IUI) cycles in patients with unexplained infertility and polycystic ovarian syndrome.

Materials and methods: From 2010 to 2015, all IUI cycles in which COH was performed using gonadotropins were evaluated retrospectively. LPS was not used until July 2013, after which vaginal progesterone gel was applied in the luteal phase of IUI cycles. Both groups of patients were evaluated in terms of the effect of LPS on PR and LBR.

Results: In total, 1578 IUI cycles were evaluated, of which 481 were LPS (+) and 1097 LPS (?). PR and LBR per cycle were 10.6% and 7.4%, respectively, in the LPS (+) group, and 11.6% and 7.7%, respectively, in the LPS (?) group (p?=?0.31 and p?=?0.25). PR and LBR per patient were 17% and 12%, respectively, in the LPS (+) group, and 17.4% and 12.3%, respectively, in the LPS (?) group (p?=?0.48 and p?=?0.82).

Conclusions: We found no difference in PR and LBR per cycle and per patient according to the use of LPS in IUI cycles in which COH was performed using gonadotropins. Thus, routine use of LPS in gonadotropin-stimulated cycles requires further research involving larger numbers of patients.     

A 12-year cohort study on adverse pregnancy outcomes in Eastern Townships of Canada: impact of endometriosis

The aim of this study was to provide a temporal-spatial reference of adverse pregnancy outcomes (APO) and examine whether endometriosis promotes APO in the same population. Among the 31?068 women who had a pregnancy between 1997 and 2008 in Eastern Townships of Canada, 6749 (21.7%) had APO. These APO increased significantly with maternal age and over time (r^2?=?0.522, p?=?0.008); and were dominated by preterm birth (9.3%), pregnancy-induced hypertension (8.3%) including gestational hypertension (6.5%), low birth weight (6.3%), gestational diabetes (3.4%), pregnancy loss (2.2%) including spontaneous abortion (1.5%) and stillbirth (0.6%), intrauterine growth restriction (2.1%) and preeclampsia (1.8%). Among the 31?068 pregnancies, 784 (2.5%) had endometriosis and 183 (23.3%) had both endometriosis and APO. Endometriosis has been shown to increase the incidence of fetal loss (OR?=?2.03; 95% CI?=?1.42–2.90, p?p?=?0.005) and stillbirth (OR?=?2.29; 95% CI?=?1.24–5.22, p?=?0.012). This study provides a temporal-spatial reference on APO, which is a valuable tool for monitoring, comparing and correcting. It is also the first study to highlight an impact of endometriosis on the incidence of spontaneous abortion and stillbirth.     

Effect of luteal phase support after ovulation induction and intrauterine insemination

Objective: This study aimed to evaluate the effect of luteal phase support on clinical pregnancy and live birth rates after ovulation induction and intrauterine insemination (IUI).

Methods: 579 cycles from 2010 to 2013 were retrospectively evaluated. Ovarian stimulation was performed with gonadotropins, and rHCG was used for ovulation triggering. All patients received IUI. 451 cycles were supported by receiving vaginal micronized progesterone capsules (142 cycles) or vaginal progesterone gel (309 cycles) whereas 128 cycles were not supported.

Results: Clinical pregnancy (20.6 versus 9.4%; p?=?0.004) and live birth rates (14 versus 7%; p?=?0.036) were higher for supported group than for unsupported group. Progesterone gel and micronized progesterone subgroups achieved similar clinical pregnancy and live birth rates (21.4 versus 19%, p?=?0.567 and 14.2 versus 13.4%, p?=?0.807; respectively).

Conclusions: Luteal phase support improved the success of IUI cycles affecting both clinical pregnancy and live birth rates when gonadotropins were used for ovulation induction. The use of vaginal progesterone gel or micronized progesterone significantly improves clinical pregnancy rates. The live birth rates were higher in the progesterone gel group, but were similar in the micronized progesterone group compared to the unsupported group.     

Asian ethnicity is associated with decreased pregnancy rates following intrauterine insemination

Asian ethnicity has been associated with decreased pregnancy outcomes in patients undergoing IVF. The objective of this study was to determine if a difference exists in pregnancy rates between Asian and Caucasian patients undergoing intrauterine insemination (IUI). A retrospective cohort of Asian and Caucasian patients treated with IUI between December 2002 and 2006 was analysed, including 2327 IUI cycles among 814 patients. Baseline characteristics were similar between Asian and Caucasian women. A significantly greater proportion of Asians (43.9%) presented for treatment after more than 2 years of infertility compared with Caucasians (24.6%) (P < 0.0001). Unadjusted analysis showed a trend towards decreased pregnancy rates associated with Asian ethnicity (odds ratio (OR) 0.71, 95% CI 0.50–1.01, not statistically significant). Age, stimulation protocol, differences in gravity and parity, and duration of infertility did not account for this difference (adjusted OR 0.68, 95% CI 0.47–0.98, P = 0.039). Asian ethnicity is associated with lower pregnancy rates in IUI treatment. The increased duration of infertility in Asians does not explain the reduced pregnancy rates.     

Pregnancy rates following three different timings of intrauterine insemination for women with unexplained infertility: A randomised controlled trial

ObjectiveTo compare pregnancy rates following three different timings of intrauterine insemination after human chorionic gonadotrophin administration at 24, 34 and 48h in women with unexplained infertility.SettingKasr El-Aini Hospital.DesignRandomized controlled trial.Participants and methodsCouples with unexplained infertility had 125 cycles of IUI divided in three groups: Group (1): 24h after hCG administration, Group (2): 34h after hCG administration and Group (3): 48h after hCG administration.ResultsThere was no significant difference in pregnancy rates between all groups, Group 1 vs. Group 2 OR=0.61, 95% [CI] 0.15–2.36, Group 1 vs. Group 3 OR=0.42, 95% CI 0.12–1.53 and Group 2 vs. Group 3 OR=0.729, CI 0.23–2.32.ConclusionIUI can be done any time between 24 and 48h after hCG injection without significant differences in pregnancy rates.     

Automated auditory brainstem response in preterm newborns with histological chorioamnionitis

Objective: We investigated whether histological chorioamnionitis is associated with an adverse neonatal hearing outcome.

Methods: Two cohorts of very preterm newborns (n?=?548, gestational age ≤ 32.0 weeks) were linked to placental histology and automated auditory brainstem response (AABR) outcome.

Results: In multivariable analyses, an abnormal AABR was not predicted by the presence of histological chorioamnionitis, either with or without fetal involvement (OR 1.4, 95% CI 0.5 – 3.8, p?=?0.54 and OR 1.1, 95% CI 0.4–3.0, p?=?0.79, respectively). Significant predictors of abnormal AABR included, e.g. birth weight (per kg increase: OR 0.2, 95% CI 0.0–0.6, p?=?0.006), umbilical cord artery pH (per 0.1 increase: OR 0.7, 95% CI 0.5–0.9, p?=?0.005) and mechanical ventilation (OR 3.7, 95% CI 1.2–11.6, p?=?0.03).

Conclusions: Histological chorioamnionitis was not associated with an adverse neonatal hearing outcome in two cohorts of very preterm newborns. Indicators of a complicated neonatal clinical course were the most important predictors of an abnormal hearing screening.     

Abnormal vaginal colonization by gram-negative bacteria is significantly higher in pregnancy conceived through infertility treatment compared to natural pregnancy

Objective: To compare abnormal vaginal colonization between natural pregnancy and pregnancy by infertility treatment in high-risk parturient women and to examine the association between abnormal vaginal colonization and early-onset neonatal sepsis (EONS).

Methods: The clinical characteristics, vaginal culture result, and delivery outcome of patients who admitted to our high-risk unit between 2005 and 2014 were retrospectively reviewed and compared. We investigated the prevalence of EONS according to maternal vaginal colonization and examined the concordance between maternal vaginal bacteria and etiologic microorganism causing EONS.

Results: Among 1096 pregnancies, the rate of vaginal colonization by gram-negative bacteria, especially Escherichia coli was significantly higher in pregnancies by infertility treatment after adjustment of confounding variables (E. coli, OR [95% CI]: 2.47 [1.33–4.57], p?=?0.004). The rate of EONS was significantly higher in neonates with maternal abnormal vaginal bacteria colonization (OR [95% CI]: 3.38 [1.44–7.93], p?=?0.005) after adjusting for confounding variables. Notably, among microorganisms isolated from maternal vagina, E. coli and Staphylococcus aureus were consistent with the results from neonatal blood culture in EONS.

Conclusions: Our data implicate a possible association between gram-negative bacteria colonization and infertility treatment and suggest that maternal vaginal colonization may be associated with EONS of neonates in high-risk pregnancy.     

Thiol/disulfide homeostasis in predicting adverse perinatal outcomes at 24–28 weeks of pregnancy in gestational diabetes

Objective: The main aim of this study was to investigate thiol/disulfide homeostasis at 24–28 weeks of pregnancy and to evaluate whether it is predictive for adverse perinatal outcomes or not in gestational diabetes mellitus (GDM).

Methods: A total of 110 pregnant women at 24–28 weeks of pregnancy (74 GDM patients and 36 age- and BMI-matched healthy pregnant women) were enrolled in this prospective case–control study. Thiol/disulfide homeostasis was evaluated with a novel spectrophotometric method to determine if there is an association with adverse perinatal outcomes in GDM, by using logistic regression analysis.

Results: GDM patients, with decreased native thiol levels at 24–28 weeks (OR: 4.890, 95% CI: 1.355–5.764, p?=?0.015) and with higher pre-pregnancy BMI (OR: 1.280, 95% CI: 1.072–1.528, p?=?0.006), were found to be at increased risk of adverse perinatal outcomes in GDM. There were no statistically significant differences in thiol/disulfide homeostasis between diet- and insulin-treated GDM subgroups. Additionally, 1-h and 2-h glucose levels on 100?g OGTT were found to be predictive for the insulin need in achieving good glycemic control in GDM (OR: 1.022, 95% CI: 1.005–1.038, p?=?0.010 and OR: 1.019, 95% CI: 1.004–1.035, p?=?0.015).

Conclusions: GDM patients, with decreased native thiol levels at 24–28 weeks of pregnancy and with higher pre-pregnancy BMI, have an increased risk of possible adverse perinatal outcomes. Also, increased 1-h and 2-h glucose levels on 100?g OGTT can predict the need for insulin treatment for GDM.     

Factors predictive of clinical pregnancy in the first intrauterine insemination cycle of 306 couples with favourable female patient characteristics

Abstract

The objective of this study was to evaluate the factors predictive of clinical pregnancy in the first superovulation/intrauterine insemination (SO/IUI) cycle of couples with favourable female characteristics. We analyzed retrospectively the first SO/IUI cycle of 306 infertile couples with mild male factor infertility and unexplained infertility. The women had a favourable prognosis in terms of ovarian reserve.

Univariate logistic regression analyses identified body mass index (BMI) [odds ratio (OR) = 0.9, P = 0.014], sperm concentration [OR = 1.007, P = 0.007] and inseminating motile sperm count (IMC) [OR = 1.007, P = 0.032] as significant predictive factors of clinical pregnancy. Multivariate logistic regression analysis identified BMI [OR = 0.87, P = 0.008] and sperm concentration [OR = 1.008, P = 0.011] as significant factors. Pregnant and non-pregnant groups did not differ significantly in terms of the age and smoking status of the woman, duration and type of infertility, length of the stimulation, total gonadotropin dosage or antral follicle count. Of the female characteristics investigated, BMI was the most significant predictive factor of clinical pregnancy in the first SO/IUI cycle of couples with unexplained or mild male factor infertility and favourable female characteristics. In overweight women, weight loss should be advised before starting SO/IUI. Sperm concentration and IMC were significant male predictive factors for clinical pregnancy in the first SO/IUI.     

Optimal lead follicle size in letrozole human menopausal gonadotrophin intrauterine insemination cycles with and without spontaneous LH surge

Research questionWhat is the optimal lead follicle size in letrozole, human menopausal gonadotrophin and intrauterine insemination (IUI) cycles with and without spontaneous LH surges?DesignThis retrospective cohort study included 3797 letrozole HMG IUI cycles between January 2010 and May 2021. All cycles were divided into two groups: the HCG trigger group (trigger day LH ≤15 mIU/ml) and the spontaneous LH surge group (trigger day LH >15 mIU/ml). These two groups were subdivided into smaller groups based on the diameter of the follicles. The primary outcome measure was clinical pregnancy rate. Logistic regression analysis was conducted to explore other risk factors.ResultsIn the HCG trigger group, the clinical pregnancy rate varied significantly, with rates of 20.8%, 14.9% and 11.8% for the 16.1–18.0, 18.1–20.0 and 20.1–22.0 mm groups, respectively (P = 0.005). In the spontaneous LH surge group, the pregnancy rate of follicles within 14.1–16.0 mm was significantly higher than that of follicles within 20.1–22.0 mm (adjusted OR 0.533, 95% CI 0.308 to 0.923, P = 0.025). Also, patients with two lead follicles were 2.569 times more likely to achieve a clinical pregnancy than those with only one lead follicle (adjusted OR 2.569, 95% CI 1.258 to 5.246, P = 0.010). The duration of infertility was also found to be a common influencing factor in both groups.ConclusionsThe optimal lead follicle size was between 16.1 and 18.0 mm in HCG-triggered letrozole HMG IUI cycles. If the lead follicle size is relatively small (14.1–18.0 mm) when a spontaneous LH surge occurs, there is no need to cancel the IUI cycle.     

Interleukin 1 alpha (IL1A) polymorphisms and risk of endometriosis in Iranian population: a case-control study

Abstract

Endometriosis is one of the most common gynecological diseases and a major cause of pain and infertility. It is influenced by genetic, epigenetic, and environmental factors. Recently, genome-wide association studies have revealed a strong association between IL1A single nucleotide polymorphisms (SNPs) and increased risk of endometriosis in Japanese women. The aim of the present study was to evaluate the association of three IL1A SNPs, rs17561, rs1304037, and rs2856836 with the risk of endometriosis in Iranian population. Totally, 105 women with diagnosis of endometriosis and 102 healthy women as control group were included. Three SNPs of the IL1A, rs17561?G/T, rs1304037 A/G, and rs2856836 T/C, were genotyped by PCR and RFLP. The rs2856836?TC genotype was significantly higher (p?=?.002; OR?=?3.1, 95% CI: 1.5–6.5) in the patients (28.1%) than the control group (12.7%). The rs2856836?CC genotype was significantly higher (p?=?.047; OR?=?2.3, 95% CI: 1.0–5.3) in the patients (17.5%) than the control group (10.8%). The rs2856836 C allele was significantly higher (p?=?.001; OR?=?2.2, 95% CI: 1.4–3.6) in the patients (31.6%) than the control group (17.2%). The IL1A rs2856836 T/C SNP was associated with susceptibility to endometriosis and the rs2856836 C allele may increase the risk of endometriosis in Iranian women.     

Polymorphisms in the inflammatory pathway genes and the risk of preeclampsia in Sinhalese women

Objective: Elevated pro-inflammatory cytokines play an important role in the pathogenesis of preeclampsia. We investigated the prevalence of functional polymorphisms in genes regulating inflammation in preeclamptic women.

Methods: One hundred seventy-five nulliparous Sinhalese women with preeclampsia (cases) and 171 normotensive women matched for age, ethnicity, parity and body mass index (BMI) (controls) were recruited. Preeclampsia was diagnosed using international guidelines. Genotyping was performed on DNA extracted from peripheral blood using the Sequenom MassARRAY system.

Results: The prevalence of the CT genotype of IL1A rs17561 polymorphism was increased in preeclamptic women compared with controls {p?=?0.04, odds ratio (OR) [95% class interval (CI)]?=?1.6 (1.0–2.5)}. The prevalence of the CT genotype [p?=?0.01, OR (95% CI)?=?1.8 (1.1–2.8)] and the dominant model (CT?+?TT) [p?=?0.03, OR (95% CI)?=?1.6 (1.1–2.5)] of the IL1A rs1800587 polymorphism were increased in preeclamptic women compared with controls. The prevalence of the GA genotype [p?=?0.04, OR (95% CI)?=?0.6 (0.4–0.9)] and the dominant model (GA?+?AA) [p?=?0.03, OR (95% CI)?=?0.6 (0.4–0.9)] of the MBL1 rs1800450 polymorphism were reduced in preeclamptic women compared to controls.

Conclusion: Genotypes conferring a pro-inflammatory phenotype are increased in preeclamptic women.     

Peripartum cesarean hysterectomy: critical analysis of risk factors and trends over the years

Objective.?To investigate time trends and risk factors for peripartum cesarean hysterectomy.

Methods.?A population-based study comparing all deliveries that were complicated with peripartum hysterectomy to deliveries without this complication was conducted. Deliveries occurred during the years 1988–2007 at a tertiary medical center. A multiple logistic regression model was constructed to find independent risk factors associated with peripartum hysterectomy.

Results.?Emergency peripartum cesarean hysterectomy complicated 0.06% (n?=?125) of all deliveries in the study period (n?=?211,815). The incidence of peripartum hysterectomy increased over time (1988–1994, 0.04%; 1995–2000, 0.05%; 2001–2007, 0.095%). Independent risk factors for emergency peripratum hysterectomy from a backward, stepwise, multivariable logistic regression model were: uterine rupture (OR?=?487; 95% CI 257.8–919.8, p?<?0.001), placenta previa (OR?=?66.4; 95% CI 39.8–111, p?<?0.001), postpartum hemorrhage (PPH) (OR?=?40.8; 95% CI 22.4–74.6, p?<?0.001), cervical tears (OR?=?22.3; 95% CI 10.4–48.1, p?<?0.001), second trimester bleeding (OR?=?6; 95% CI 1.8–20, p?=?0.003), previous cesarean delivery (OR?=?5.4; 95% CI 3.5–8.4, p?<?0.001), placenta accreta (OR?=?4.7; 95% CI 1.9–11.7, p?=?0.001), and grand multiparity (above five deliveries, OR?=?4.1; 95% CI 2.5–6.6, p?<?0.001). Newborns of these women had lower Apgar scores (<7) at 1 and 5?min (32.7% vs.4.4%; p?<?0.001, and 10.5% vs. 0.6%; p?<?0.001, respectively), and higher rates of perinatal mortality (18.4% vs. 1.4%; p?<?0.001) as compared to the comparison group.

Conclusion.?Significant risk factors for peripartum hysterectomy are uterine rupture, placenta previa, PPH, cervical tears, previous cesarean delivery, placenta accreta, and grand multiparity. Since the incidence rates are increasing over time, careful surveillance is warranted. Cesarean deliveries in patients with placenta previa-accreta, specifically those performed in women with a previous cesarean delivery, should involve specially trained obstetricians, following informed consent regarding the possibility of peripartum hysterectomy.     

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.     

Maternal hyperglycemia according to IADPSG criteria as a predictor of perinatal complications in women with gestational diabetes: a retrospective observational study

Abstract

Objective: We investigated the association between abnormal maternal glucose levels according to International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria and perinatal complications.

Materials and methods: Retrospective observational study of data of 492 women in singleton pregnancy and gestational diabetes (GDM) diagnosed according to WHO criteria. Perinatal outcome and maternal characteristics were compared between normo- and hyperglycemic patients using IADPSG criteria and odds ratios calculated for particular outcomes.

Results: Maternal fasting hyperglycemia (≥5.1?mmol/L) was associated with significantly higher proportion of birth weight ≥ 4000?g (19.3% versus 9.7%, p?=?0.004, OR: 2.2; 95% CI: 1.3–3.8), gestational insulin therapy (27.7% versus 9.1%, p?<?0.001, OR: 3.8; 95% CI: 2.3–6.5), poor long-term metabolic control (HbA_1c at diagnosis?≥?6.5% [48?mmol/mol]: 19.9% versus 4.6%, p?<?0.001, OR: 5.2; 95% CI: 2.5–10.9). Pre-pregnancy obesity (BMI?≥?30?kg/m², 26.0% versus 11.9%, p?<?0.001, OR: 2.6; 95% CI: 1.6–4.3) and positive family history of diabetes (45.2% versus 30.8%, p?<?0.002, OR: 1.8; 95% CI: 1.3–2.7) was more frequent in women with fasting hyperglycemia. Two-hour post-load hyperglycemia was only associated with increased prevalence of gestational hypertension (5.1% versus 11.4%, p?=?0.046).

Conclusions: Women with fasting but not 2-h hyperglycemia according to IADPSG criteria are at significantly elevated risk of perinatal complications.     

The ultrasonographic detection of follicular rupture at the time of intrauterine insemination: is it really decisive?

Abstract

Our aim is to assess the impact of the ultrasonographic detection of follicular rupture on the intrauterine insemination success. A total of 313 women undergoing ovarian stimulation for intrauterine insemination were enrolled. Transvaginal ultrasonography was performed to check whether the dominant follicle had ruptured and according to that the patients were divided into two groups. The ultrasound detection of follicular rupture was observed in 156 patients (54%). The independent variables favoring follicular rupture were: Age (t: 7.646, p?<?0.0005), FSH value (t: ?5.637, p?<?0.0005), duration of infertility (t: ?4.265, p?<?0.0005), menstrual cycle length (t: ?4.927, p?<?0.0005). Moreover, the logistic regression analysis demonstrated that the predictive variables for follicular rupture were: FSH value (OR 1.7, CI 95% 1.3–2.3, p?<?0.0005), duration of infertility (OR 2.6, CI 95% 1.6–4.2, p?<?0.0005) and menstrual cycle length (OR 2.4, CI 95% 1.7–3.4, p?<?0.0005). Pregnancy occurred in 23 patients of the group A (14.7%) and in 22 patients of the group B (16.5%) without a significant difference (p?=?0.6). The logistic regression analysis confirmed that neither the evidence of follicular rupture nor any other variables influenced the pregnancy rate.