Post-partum follow-up of women with gestational diabetes mellitus: effectiveness,determinants, and barriers

Background: Despite the recommendations for postpartum blood glucose monitoring post gestational diabetes mellitus (GDM); scientific evidence reveals that these recommendations may not be fully complied to. This study aimed to follow-up women up to 2 years post-delivery with pregnancies complicated by GDM and healthy controls to assess this fact.

Methods: Women with GDM (n?=?78) and normal glucose tolerant (n?=?89) delivered in 2014 were followed up for 2 years. They were informed and enquired via telephone about their blood glucose screening, physical activity, postpartum complications, and current weight status of mother and baby.

Results: Women with previous GDM were older and reported higher body weight 2 years post-delivery. At the 2?year follow-up, n?=?11 (14.1%) participants had developed diabetes, all with previous GDM. Both weight at birth (3.8?±?0.5?kg) and at 2-year (10.7?±?2.3?kg) for the babies born to GDM mothers was significantly higher than the NGT group babies (2.6?±?0.63 and 7.1?±?1.4?kg; p?Conclusions: The high incidence of T2DM in women with previous GDM is an alarming finding. Given this trend, systematic follow-up programs are needed to reduce obesity and diabetes risk.     

The effects of probiotic supplementation on biomarkers of inflammation,oxidative stress and pregnancy outcomes in gestational diabetes

Objective: This study was designed to evaluate the effects of probiotic supplementation on biomarkers of inflammation, oxidative stress and pregnancy outcomes among subjects with gestational diabetes (GDM).

Methods: This randomized, double-blind, placebo-controlled clinical trial was done among 60 subjects with GDM who were not on oral hypoglycemic agents. Patients were randomly allocated to intake either probiotic capsule containing Lactobacillus acidophilus, Lactobacillus casei and Bifidobacterium bifidum (2?×?10⁹ CFU/g each) (n?=?30) or placebo (n?=?30) for six?weeks.

Results: Compared with the placebo, probiotic supplementation resulted in significant decreases in fasting plasma glucose (FPG) (?5.3?±?6.7 vs.?+0.03?±?9.0?mg/dL, p?=?.01), serum high-sensitivity C-reactive protein (hs-CRP) (?2.2?±?2.7 vs.?+0.5?±?2.4?μg/mL, p?p?=?.03) and MDA/TAC ratio (?0.0003?±?0.0008 vs.?+0.0009?±?0.002, p?=?.004), and a significant increase in total antioxidant capacity (TAC) levels (+65.4?±?103.3 vs. ?37.2?±?143.7?mmol/L, p?=?.002). Probiotic supplementation did not affect pregnancy outcomes.

Conclusions: Overall, probiotic supplementation among women with GDM for six?weeks had beneficial effects on FPG, serum hs-CRP, plasma TAC, MDA and oxidative stress index, but did not affect pregnancy outcomes.     

Association between increased FVIIa-antithrombin complex/FVIIa ratio and pre-eclampsia

Abstract

Objective: Activated factor VII-antithrombin (FVIIa-AT) complexes can be used to reflect the degree of intravascular exposure of tissue factor (TF). The aim of the present case-control study was to evaluate FVIIa-AT plasma levels during normal pregnancy and in pre-eclampsia (PE).

Methods: One hundred and five pregnant women were enrolled and namely n?=?30 in the first (T1), n?=?30 in the second (T2), n?=?30 in the third (T3) trimester of pregnancy and n?=?15 with PE. FVIIa-AT complexes were determined using a specific ELISA (Diagnostica Stago, Asnieres, France).

Results: FVIIa-AT complexes were significantly higher in pregnant (119?±?24?pM) than in healthy (102?±?12?pM, p?=?0.001) women. No difference in FVIIa-AT levels between T3 women and with PE was observed. Interestingly, women with PE had significantly higher FVIIa-AT/FVIIa ratio than women during T3 (2.01?±?0.44 versus 1.50?±?0.29, p?=?0.001).

Conclusion: FVIIa-AT complexes plasma levels differed significantly between normal pregnancy and non-pregnant women. Moreover, FVIIa-AT/FVIIa ratio was higher in patients with PE than in normal pregnant women.     

Nasal intermittent mandatory ventilation versus nasal continuous positive airway pressure for transient tachypnea of newborn: a randomized,prospective study

Abstract

Objective: To evaluate the efficacy of nasal intermittent mandatory ventilation (NIMV) in reducing the duration of respiratory distress compared with nasal continuous positive airway pressure (NCPAP) in transient tachypnea of the newborn (TTN).

Patient and methods: ?n this randomized-prospective study, 40 infants with a gestational age ≥37 weeks and birth weight ≥2000?g with TTN were randomized to either nonsynchronized NIMV (n?=?20) or NCPAP (n?=?20). The primary end point was the reduction of the duration of respiratory distress. Secondary end points were the duration and level of oxygen supplementation, the incidence of complications such as pneumothorax, pneumonia and respiratory failure requiring entubation.

Results: There were no significant difference in the duration of respiratory support (28.0?±?19.2?h versus 32.2?±?23.3?h, p?=?0.231), O₂ therapy (31.2?±?15.6?h versus 29.0?±?19.3?h, p?=?0.187), duration of TTN (67.6?±?36.5?h versus 63.3?±?39.1?h, p?=?0.480) and hospitalization (6.2?±?2.6?d versus 5.4?±?2.0?d, p?=?0.330) between the groups. The rate of complications were not significantly different between the groups.

Conclusion: Our study indicates that NIMV is well tolerated and as effective as NCPAP in the treatment of TTN.     

Duration of labor by gestational week in nulliparous women

Abstract

Objectives: To assess whether labor length differs by week of gestation.

Methods: In this observational cross-sectional study, we compared duration of labor by gestational age (36?+?0 through 40?+?6 weeks) in primiparous singleton parturients with vertex presentation. Data were acquired for a period of 24 months (2010–2011).

Results: In general, the rate of change in cervical dilatation decreased as gestational week at delivery advanced: 1.8?±?1.0?cm/h, 1.5?±?0.9?cm/h, 1.3?±?0.8?cm/h, 1.6?±?1.5, and 1.3?±?1.0?cm/h at 36th, 37th, 38th, 39th and 40th gestational week, respectively (p?=?0.040). Concurrently, the total labor duration (1st?+?2nd?+?3rd stages) increased as gestational age advanced: 423.6?±?180.9?min, 496.5?±?212.6?min, 545.9?±?247.1?min, 483.8?±?256.3?min, and 568.2?±?273.8?min at 36th, 37th, 38th, 39th and 40th gestational week, respectively (p?=?0.013).

Conclusions: Gestational week of pregnancy may alter the duration of labor, specifically, the length of labor increases as gestational week at delivery advances.     

P-wave and QT dispersion in hypertensive disorders of pregnancy

Abstract

Aim: To compare P-wave and QT dispersion values in hypertensive disorders of pregnancy and controls and also in preeclampsia, chronic hypertension, and gestational hypertension separately.

Material and methods: We included 140 hypertensive pregnants and 110 healthy age-matched pregnants in this study. The hypertensive pregnants were divided into three subgroups: preeclampsia (n?=?43), chronic hypertension (n?=?51), and gestational hypertension (n?=?46). P-wave and QT dispersion values were compared between groups.

Results: Hypertensive pregnants had higher P-wave (41.74?±?5.51 vs. 37.73?±?5.62, p?<?.001) and QTc dispersion (45.44?±?7.62 vs. 39.77?±?8.34, p?<?.001) values. In subgroup analysis, P-wave dispersion and QTc dispersion were different between preeclamptic, chronic hypertensive, and gestational hypertensive patients. Also, they were significantly higher in chronic hypertension as compared to gestational hypertension and they were higher in preeclampsia than in gestational hypertension. No difference was found according to these parameters between preeclampsia and chronic hypertension. In correlation analysis, both P-wave dispersion and QTc dispersion were positively correlated with systolic (r?=?0.409, p?<?.001 and r?=?0.306, p?<?.001) and diastolic blood pressure (r?=?0.390, p?<?.001 and r?=?0.287, p?<?.001) which are main clinical determinants of hypertensive disorders.

Conclusion: In clinical practice, chronic hypertensive pregnants are generally followed up in their future life for cardiovascular disorders. Also, we recommend that we must inform and follow preeclamptic patients for future cardiovascular diseases.     

In resource limited areas complete enteral feed in stable very low birth weight infants (1000–1500 g) started within 24 h of life can improve nutritional outcome

Objective: To evaluate feasibility of complete enteral feed (CEF) in stable very low birth weight neonates weighing 1000–1500?g.

Subjects and interventions: One hundred and three stable very low birth weight (vlbw) neonates (1000–1500?g) irrespective of gestational age (GA) were randomized to receive either CEF with expressed breast milk (EBM) (n?=?51) or minimal enteral feed (MEF) supplemented with intravenous fluid (IVF). (MEF) (n?=?52). Feed volume was increased progressively. Primary outcome measures were feed intolerance (FI) and necrotizing enterocolitis (NEC) in first 21 days of life or discharge from NICU, whichever was earlier. Secondary outcome measures were the time taken to reach calorie intake of 110?kcal/kg/D and regain of birthweight.

Results: FI was observed in n?=?12 (23.53%) in CEF group versus n?=?6 (11.53%) in MEF group (p?=?0.1264). NEC was observed in 4 (7.8%) in CEF group versus 1(1.9%) in MEF group (p?=?0.16) and results were comparable in both groups. Birthweight regain (10.6?±?1.6 days versus 11.8?±?1.6 days, p?=?0.038), NICU discharge (11.7?±?2.6 days versus 13.0?±?3.45 days, p?=?0.038) and time to reach 110?kcal/kg/day (9.571?±?1.458 days versus 10.833?±?1.655 days, p?=?0.001) were significantly earlier in CEF compared to MEF group.

Conclusion: Complete enteral feeds started within 24?h of life is feasible in vlbw neonates.     

Evaluation of maternal serum progranulin levels in normotensive pregnancies,and pregnancies with early- and late-onset preeclampsia

Aims: To investigate the possible pathophysiological associations between progranulin (PGRN) and preeclampsia (PE), early-onset PE (EOPE) and late-onset PE (LOPE).

Study design: A cross-sectional study was designed to include consecutive patients with uncomplicated pregnancy (n?=?28), EOPE (n?=?30) and LOPE (n?=?22). Maternal levels of serum PGRN were measured with the use of an enzyme-linked immunosorbent assay kit.

Results: The mean serum PGRN level was significantly higher in women with PE compared to the control group (54.17?±?4.20?pg/ml versus 42.37?±?5.64?pg/ml, p?<?0.001), in the LOPE group compared to the control group (51.63?±?4.61?pg/ml versus 42.37?±?5.64?pg/ml, p?<?0.001) and also in women with EOPE compared to women with LOPE (56.03?±?2.68?pg/ml versus 51.63?±?4.61?pg/ml, p?<?0.001). Serum PGRN was negatively correlated with gestational age at birth (r?= ?0.669, p?=?0.001) and birth weight (r?= ?0.653, p?=?0.001); and positively correlated with systolic (r?=?0.653, p?=?0.001) and diastolic blood pressure (r?=?0.601, p?=?0.001), C-reactive protein (r?=?0.519, p?=?0.001), uterine artery pulsatility (r?=?0.441, p?=?0.001) and resistance indices (r?=?0.441, p?=?0.001).

Conclusions: Serum PGRN levels increase significantly in women with PE as an indirect sign of placental dysfunction. This increase is even more prominent in women with EOPE. The serum PGRN in the third trimester is positively correlated with gestational age at birth and birth weight.     

Low gestational weight gain improves infant and maternal pregnancy outcomes in overweight and obese Korean women with gestational diabetes mellitus

Objective.?The aim of the study was to retrospectively assess what was the optimal gestational weight gain to have better maternal and neonatal outcomes in overweight and obese Korean women with gestational diabetes mellitus (GDM) who maintained normoglycemia throughout pregnancy by dietary modification, exercise, and/or insulin treatment.

Study design.?We performed a hospital-based study of 215 GDM women with prepregnancy BMI?≥?25 kg/m². Body weight, glucose homeostasis, lipid profiles, insulin treatment, and maternal outcomes were collected as predictors of neonatal birth weight. We divided the subjects into three groups according to modified Institute of Medicine (IOM) guidelines for weight gain during pregnancy: inadequate (n?=?42), normal (n?=?96), and excessive (n?=?77) groups.

Results.?Excessive weight gain resulted in increased macrosomia, HbA_1c at delivery, and postprandial blood glucose levels, but fasting blood glucose levels were not significantly different among the groups. The inadequate weight gain group (2.4?kg weight gain during pregnancy) had better neonatal outcomes and better maternal glycemic control with fewer requiring insulin treatment.

Conclusion.?Minimal weight gain, well below IOM recommendations, and tight control of blood glucose levels during pregnancy with proper medical management and dietary modification may eliminate most of the adverse pregnancy outcomes experienced by obese GDM Asian women.     

Polycystic ovary syndrome: a biopsychosocial understanding in young women to improve knowledge and treatment options

Aim.?To assess psychological features in young women with and without PCOS.

Methods.?Observational, cross-sectional pilot study in young women aged 18–25 with (n?=?24) or without (n?=?22) PCOS (age: 22.41?±?0.39 vs. 21.95?±?0.47 years, p?=?0.46; BMI: 29.17?±?1.54 vs. 22.05?±?0.83?kg/m², p?=?0.0003). The main outcome measures were quality of life, anxiety, depression, risk perception and fears on future health.

Results.?Women with PCOS demonstrated worsened quality of life (p?=?0.033) and greater anxiety (p?=?0.01) and depression (p?=?0.023) than women without PCOS related to BMI status. Women with PCOS were more likely to perceive themselves as at risk of obesity (p?=?0.012) and infertility (p?<?0.0001), and perceived greater importance in reducing future risk of prediabetes (p?=?0.027), gestational diabetes (p?=?0.039), type 2 diabetes (p?=?0.01), heart disease (p?=?0.005), obesity (p?=?0.0007) and infertility (p?=?0.023) than women without PCOS. Women with PCOS were more likely to have fears about future health related to weight gain (p?=?0.045), loss of femininity (p?=?0.035), loss of sexuality (p?=?0.003) and infertility (p?=?0.019) than women without PCOS.

Conclusions.?Worsened quality of life, anxiety and depression in young women with PCOS is related to BMI. Risk perception is appropriately high in PCOS, yet perceived risks of future metabolic complications are less common than those related to weight gain and infertility.     

Effects of androgen on vascular and inflammatory biomarkers in a female hypertensive population

Abstract

Background: Androgen is a steroid hormone associated with high blood pressure (BP). The effect of androgen on BP in females is unknown.

Methods: Androgen, vascular endothelial growth factor (VEGF), interleukin (IL)-6 and matrix metalloproteinase (MMP)-9 were evaluated in females with menstruation disorders (n?=?135, 28?±?5 years old) and normal BP, pre-hypertension, stage 1 hypertension, and stage 2 hypertension.

Results: Normal-BP (n?=?57), pre-hypertension (n?=?44), stage-1-hypertension (n?=?21), and stage-2-hypertension (n?=?13) females had similar androgen (3.3?±?1.5, 2.7?±?1.2, 3.1?±?1.4, and 3.5?±?1.3?ng/ml, p?>?0.05) and IL-6 levels (1.7?±?2.2, 1.9?±?2.6, 1.3?±?1.2 and 2.4?±?3.3?pg/ml, p?>?0.05). However, normal BP females had lower MMP-9 (609?±?307 versus 891?±?385?ng/ml, p?<?0.05) than stage-1-hypertension females. In addition, normal BP females had lower VEGF (166?±?103 versus 255?±?139, 272?±?128 and 301?±?216?pg/ml, p?<?0.05) than the other three groups. In normal-androgen females, VEGF levels were similar among the four groups. However, in high-androgen females, normal BP groups had lower VEGF levels than pre-hypertension, stage-1, and stage-2 hypertension groups (166?±?94 versus 294?±?153, 281?±?160 and 357?±?253?p?<?0.05).

Conclusions: Androgen can modulate growth factors and extracellular matrix proteins, which may contribute to the pathophysiology of hypertension in young females.     

Weight gain regardless of pre-pregnancy BMI and influence of fetal gender in response to labor induction in postdate pregnancy

Abstract

Objective: To evaluate whether maternal weight and body mass index (BMI) and their increase throughout pregnancy are associated with the response to labor induction in postdate pregnancies.

Methods: A total of 376 nulliparous women carrying singleton postdate pregnancies with unfavorable cervix were enrolled. We considered as primary outcome vaginal delivery within 24?h after induction, and outcomes were divided into responders (n?=?258) and non-responders (n?=?107) to the induction of labor to perform the statistical analyses.

Results: In the total population of study, women who successfully delivered within 24?h differed significantly from the remaining patients in terms of maternal weight gain (p?=?0.009) and BMI increase (p?=?0.02) during pregnancy. In addition, males were significantly more (p?=?0.005) than females among newborns of women not responding to induction of labor. In the multivariate analysis, maternal weight gain and fetal sex significantly influenced the induction response. The occurrence of a failed induction of labor was more likely in patients presenting a greater maternal weight gain (cut-off 12?kg) and male fetus.

Conclusion: Weight gain over 12?kg regardless of pre-pregnancy weight and male fetal gender are two novel potential risk factors for the prediction of failure to induction of labor in postdate pregnancy.     

Higher levels of thyrotropin in pregnancy and adverse pregnancy outcomes

Objective: To determine the frequency of subclinical hypothyroidism in women with pathological pregnancies and the association between elevated thyroid-stimulating hormone (TSH) and pregnancy outcome.

Subjects and methods: A cross-sectional prospective study investigated value of TSH and free thyroxine (FT4) in (1) pregnant women with hypertension (HTA) (N?=?62) or preeclampsia (PE) (N?=?50), (2) women with gestational diabetes mellitus (GDM) (N?=?92) in pregnancy, and (3) women with normal pregnancies (control) (N?=?201). The level of statistical significance was set at p?Results: Of the total 404 respondents, the highest incidence of subclinical hypothyroidism was in the group with preeclampsia 22%, followed HTA group 9.6%; GDM group 10.9% and in the control group 9% (p?p?3?mIU/L (p?=?.003). There were no differences in the average TSH value between GDM (1.93?±?1.03?mIU/L) and control group (p?=?.962).

Conclusions: Early detection and optimal treatment of thyroid dysfunction before and in the first trimester of pregnancy reduces the risk of adverse pregnancy outcomes.     

Total energy intake accounts for postnatal anthropometric growth in moderately/late preterm infants

Objective: Moderately preterm (MP) (32–33 weeks) and late preterm (LP) (34–36 weeks) infants have higher risks of mortality and growth and developmental problems. We, herein present a new concept of nutritional assessment, total energy intake (TEI), which is the sum total of kilocalories administered in all nutrient forms.

Methods: Fifty-two preterm infants were classified as MP (n?=?12), LP/appropriate for gestational age (LP/AGA) (n?=?33), or LP/small for gestational age (LP/SGA) (n?=?7). All groups received nutrient therapy by the same protocol. The sum of the daily energy intake at 14 and 28 days after birth was determined.

Results: TEI was 2822.1?±?162.1?kcal/kg/28 days in the MP group, 3187.2?±?265.0?kcal/kg/28 days in the LP/AGA group and 3424.6?±?210.4?kcal/kg/28 days in the LP/SGA group. In all groups, TEI for 28 days was significantly correlated with body weight gain (r?=?0.465, p?=?0.006). TEI for 14 days after birth was inversely correlated with the body weight loss rate after birth (r?=??0.491, p?=?0.0002).

Conclusion: TEI was well correlated with anthropometric changes after birth. TEI may be used to effectively assess preterm infants’ nutritional needs.     

Weight gain in gestational diabetes: the effect of treatment modality

Objective: To evaluate treatment effectiveness (diet alone, insulin or glyburide) on maternal weight gain in gestational diabetes (GDM).

Methods: GDM patients were treated with diet alone, insulin or glyburide. Weight gain was stratified into: prior to GDM diagnosis, from diagnosis to delivery and total pregnancy weight gain. Good glycemic control was defined as mean blood glucose ≤105?mg/dl and obesity as Body Mass Index (BMI)?≥?30?kg/m², overweight BMI 25–29?kg/m² and normal <?25?kg/m².

Results: Total weight gain was similar in all the treatment groups. Two-thirds of weight gain occurred prior to diagnosis (diet 85%, insulin 67% and glyburide 78%). Post-diagnosis, patients on diet alone gained less weight than those on insulin or glyburide (p?<?0.001); insulin-treated patients showed greater weight gain than glyburide-treated patients (p?<?0.001). Patients on diet with good glycemic control showed less weight gain after diagnosis than patients on insulin or glyburide (2.8?±?13, 6.6?±?10, 5.2?±?7.9 lbs, respectively, p?<?0.02). Poorly-controlled patients, regardless of treatment, had similar patterns of weight gain throughout pregnancy.

Conclusion: Patterns of maternal weight gain in GDM pregnancies are associated with treatment modality and level of glycemic control.     

Evaluation of point-of-care maternal venous lactate testing in normal pregnancy

Objective: There is little information about whether the established non-pregnant adult venous lactate reference range is appropriate for pregnancy. This prospective observational study examined whether the non-pregnant adult reference range is appropriate during pregnancy.

Methods: Women attending for routine prenatal appointments or elective cesarean delivery in a tertiary hospital were recruited. Clinical details were recorded and venous lactate concentration was measured using a point-of-care (POC) device.

Results: Of the 246 women, 199 were 6–18 weeks’ gestation and 47 were 36–42 weeks’ gestation. Mean lactate concentration was within the non-pregnant reference range in early and late pregnancy (0.86 SD?±?0.46?mmol/L and 1.15 SD?±?0.40?mmol/L, respectively). The mean time between phlebotomy and result was 6.1 SD?±?1.7?min. There was no correlation between lactate levels and either maternal age or time interval from tourniquet placement to lactate measurement. In women of 6–18 weeks’ gestation positive bivariate relationships were found between lactate and BMI (p?=?0.03, r?=?0.158), earlier gestational age (p?=?0.04, r=??0.145), and smoking (p?=?0.01, r?=?0.183), but these were not found in late pregnancy.

Conclusions: The venous lactate reference range for the non-pregnant adult may be applied in pregnancy. Further studies should examine lactate dynamics in labor and postpartum.     

The association between maternal weight gain and spontaneous preterm birth in twin pregnancies

Abstract

Objective: To estimate the association between maternal weight gain and SPTB in twin pregnancies.

Methods: A case-control study of patients with twin pregnancies and a normal prepregnancy BMI (18.5–24.9?kg/m²) in one maternal-fetal medicine practice from 2005 to 2013. We reviewed maternal weight in six time periods: prepregnancy, 12–15 6/7 weeks, 16–19 6/7 weeks, 20–23 6/7 weeks, 24–27 6/7 weeks and 28–31 6/7 weeks. We compared maternal weight gain patterns across pregnancy between patients who did and did not have SPTB <32 weeks. Student’s t-test and chi-square were used for analysis.

Results: In total, 382 patients were included, 29 (7.6%) of whom had SPTB <32 weeks. The baseline height, weight and BMI did not differ between the groups, nor did maternal age, IVF status, race or chorionicity. Patients with SPTB <32 weeks had significantly less weight gain as early as 15 6/7 weeks (2.9?±?4.6 versus 7.3?±?6.6?lb, p?<?0.001), and this continued until 31 6/7 weeks (25.3?±?8.7 versus 30.8?±?10.9?lb, p?=?0.037).

Conclusions: In twin pregnancies with a normal prepregnancy BMI, there is a significant association between SPTB <32 weeks and lower maternal weight gain, particularly prior to 16 weeks. Future studies are needed to test if prepregnancy or early nutritional interventions in twin pregnancies can reduce the risk of preterm birth and improve neonatal outcomes in this high-risk population.     

Gestational weight gain in overweight and obese women enrolled in a healthy lifestyle and eating habits program

Abstract

Objectives: To determine whether changes in lifestyle in women with BMI?>?25 could decrease gestational weight gain and unfavorable pregnancy outcomes.

Methods: Women with BMI?>?25 were randomized at 1st trimester to no intervention or a Therapeutic Lifestyle Changes (TLC) Program including diet (overweight: 1700?kcal/day, obese: 1800?kcal/day) and mild physical activity (30?min/day, 3 times/week). At baseline and at the 36th week women filled-in a Food Frequency Questionnaire. Outcomes: gestational weight gain, gestational diabetes mellitus, gestational hypertension, preterm delivery. Data stratified by BMI categories.

Results: Socio-demographic features were similar between groups (TLC: 33 cases, Controls: 28 cases). At term, gestational weight gain in obese women randomized to TLC group was lower (6.7?±?4.3?kg) versus controls (10.1?±?5.6?kg, p?=?0.047). Gestational diabetes mellitus, gestational hypertension and preterm delivery were also significantly lower. TLC was an independent factor in preventing gestational weight gain, gestational diabetes mellitus, gestational hypertension. Significant changes in eating habits occurred in the TLC group, which increased the number of snacks, the intake of fruits–vegetables and decreased the consumption of sugar.

Conclusions: A caloric restriction associated to changes in eating behavior and constant physical activity, is able to reduce gestational weight gain and related pregnancy complications in obese women.     

Maternal cardiovascular profiling in the first trimester of pregnancies complicated with gestation-induced hypertension or fetal growth retardation: a pilot study

Abstract

Objective: In this study, we determine whether maternal cardiovascular (CV) profiling can detect first trimester differences between women with uncomplicated pregnancies (UP) and those who will develop gestational hypertensive disorders (GHD) or normotensive fetal growth retardation (FGR).

Methods: Cardiac, arterial, and venous function were evaluated in 242 pregnant women around 12 weeks of gestation, using impedance cardiography (ICG) and combined electrocardiogram – Doppler ultrasonography. After postnatal determination of gestational outcome, first trimester measurements were compared between groups using Mann–Whitney U test for continuous data or Fisher’s Exact test for categorical variables (SPSS 20.0).

Results: Compared to UP, first trimester aortic flow velocity index [71?±?0.96 versus 61?±?4.91 1/1000/s (p?=?0.016)], acceleration index [133?±?2.25 versus 106?±?11.26 1/100/s² (p?=?0.023)] and Heather index [23.1?±?0.35 versus 19.2?±?1.70?Ω/s² (p?=?0.019)] were lower in GHD pregnancies, and first trimester stroke volume [77?±?1.16 versus 67?±?3.97?ml (p?=?0.033)] and cardiac output [7.3?±?0.10 versus 6.2?±?0.31?l/min (p?=?0.025)] were lower in FGR pregnancies.

Conclusions: Maternal CV function in the first trimester of pregnancy differs between UP and those destined to develop GHD or FGR. This can be assessed with non-invasive maternal CV profiling, opening perspectives for the application of this technique in early gestational screening for GHD and FGR.     

Tenascin C levels in patients with mild and severe preeclampsia

Objective: To determine the serum tenascin-C (TN-C) levels in cases with mild and severe preeclampsia.

Methods: Pregnant women were divided into three groups, namely healthy pregnants (Group 1, n?=?20), pregnants with mild preeclampsia (Group 2, n?=?20) and pregnants with severe preeclampsia (Group 3, n?=?20). The groups were formed so as to match each other in terms of gestational week. From each pregnant woman, pre- and post-delivery blood samples were obtained to measure serum TN-C levels. The data were evaluated using the Kruskall–Wallis variance analysis. For the obtained values of p?<?0.05, the groups were compared in pairs. A p value of <?0.017 was accepted as significant.

Results: In Groups 1, 2 and 3, the prepartum TN-C levels were 5.02?±?0.4?µg/ml, 12.8?±?2.9?µg/ml and 33.8?±?11.7?µg/ml, and in the postpartum TN-C levels were 4.7?±?0.1?µg/ml, 11.7?±?1.8?µg/ml and 50.6?±?33.8?µg/ml, respectively. There was a significant difference between the groups in terms of the prepartum and postpartum TN-C levels (p?<?0.017, Mann–Whitney U [MWU] test). There was also a significant difference in the prepartum TN-C levels between Groups 2 and 3 (p?<?0.017, MWU test).

Conclusions: The prepartum and postpartum TN-C levels were significantly higher in mild and severe preeclampsia than those in healthy pregnants.