Relationship of serum adipocyte-derived proteins with insulin sensitivity and reproductive features in pre-pubertal and pubertal daughters of polycystic ovary syndrome women

Objective

To evaluate in a cross-sectional study adiponectin and leptin levels in prepubertal and pubertal daughters of women with PCOS and their relationship to insulin sensitivity and reproductive features.

Study design

We studied 92 daughters of PCOS women (PCOSd) and 76 daughters of control women (Cd) matched by age and body mass index SD scores and distributed according to breast Tanner stage: prepuberty (Tanner 1), early puberty (Tanner 2–3) or late puberty (Tanner 4–5). In all girls an oral glucose tolerance test was performed. Leptin, adiponectin, sex steroids, SHBG, glucose, insulin and lipid profile were determined. Leptin–adiponectin ratio, free androgen index and insulin sensitivity (HOMA-IR and ISI composite) were then calculated.

Results

Prepubertal PCOSd showed lower serum adiponectin compared to Cd (p = 0.028), whereas during puberty no differences were observed between the groups. Leptin concentrations were similar in both groups in all Tanner stages. In addition, in PCOSd during early puberty, adiponectin showed a negative correlation with testosterone and leptin showed a negative correlation with ISI composite, which were independent of BMI SDS (r = −0.39; p = 0.02 and r = −0.42; p = 0.01).

Conclusion

These observations suggest that during the prepubertal period PCOSd exhibit abnormal adiponectin levels, independently of BMI. Moreover, leptin and adiponectin may be related to metabolic and reproductive abnormalities observed in PCOSd during the early stages of sexual development.     

Fetal thyroid in two-dimensional ultrasonography: nomograms according to gestational age and biparietal diameter

Objective

To establish fetal thyroid nomograms based on gestational age and biparietal diameter and to compare obtained results with previously published data.

Study design

A cross-sectional study of 241 healthy pregnant women at 14–38 week of gestation was undertaken. Exclusion criteria were: known maternal thyroid or systemic disease, unknown date of last menstrual period, multiple pregnancy and fetal malformations. Fetal thyroid diameter (FTD), circumference (FTC) and area (FTA) were measured by two-dimensional ultrasonography and plotted against gestational age (GA) and biparietal diameter (BPD).

Results

FTD, FTC and FTA increased logarithmically to GA and BPD. Fetal thyroid measurements as a function of GA were expressed by logarithmic formulas: ln(FTD) = 3.6025–23.0315/GA, ln(FTC) = 4.6227–22.8003/GA, ln(FTA) = 6.6303–45.0831/GA. The following logarithmic formulas were obtained for fetal thyroid measurements according to BPD: ln(FTD) = 3.4068–45.4271/BPD, ln(FTC) = 4.4271–44.8359/BPD, ln(FTA) = 6.2390–88.4408/BPD. There were highly significant correlations between thyroid measurements and GA or BPD: r = 0.87–0.90, p < 0.00001.

Conclusions

We have established age-dependent and age-independent nomograms of fetal thyroid. These nomograms will enable prenatal diagnosis in fetuses at risk of thyroid disorders.     

Physiology and clinical value of glycosuria after a glucose challenge during pregnancy

Objective

Urine testing for glucose is commonly performed during pregnancy but little is known about the regulation and clinical value of glycosuria because studies are hampered by its low prevalence and intermittent nature. The aim of this study was to compare the urine and plasma response 60 min after a 50 g oral glucose challenge in the setting of gestational diabetes mellitus (GDM) screening.

Study design

Of 338 consecutively enrolled gravidas, 325 completed the study. Glycosuria was measured semi-quantitatively (0, 1, 2 or 3+) and venous plasma glucose was measured.

Results

Post-challenge glycosuria occurred in 26.2% of gravidas. Women with 2 or 3+ glycosuria showed higher plasma glucose (p < 0.001), lower height (p = 0.004) and lower body weight throughout pregnancy (p = 0.014); however, glycosuria was not related to age, parity, body mass index (BMI), highest blood pressure or newborn size at birth. The sensitivity for a GDM diagnosis was 8.2%. Comparison of pure “urine” responders (i.e., any glycosuria but glucose <130 mg/dl, n = 50) with “plasma” responders (no glycosuria but plasma glucose ≥140 mg/dl, n = 29) showed that urine responders were younger and had a lower body weight and BMI than plasma responders.

Conclusion

Glycosuria after an oral glucose challenge depends on the plasma glucose excursion, and is more pronounced in gravidas with lower height and body weight, who presumably have a smaller plasma distribution volume. Post-load glycosuria is a poor predictor of GDM, pre-eclampsia and newborn size at birth, and therefore has limited clinical benefit.     

Offspring birth weight and maternal fasting lipids in women screened for gestational diabetes mellitus (GDM)

Objectives

Maternal lipid metabolism is altered during pregnancy but little is known about the influence of these alterations on either intrauterine fetal development or maternal wellbeing. The purpose of this study was to examine the relationship between both fasting cholesterol and triglycerides and offspring birth weight in women screened selectively for gestational diabetes mellitus (GDM).

Study design

In a prospective observational study in a University Maternity Hospital, women were recruited at their convenience when they were screened for GDM with a diagnostic 75 g oral glucose tolerance test (OGTT). An additional sample was taken for a lipid profile at the time the fasting glucose was obtained. Clinical and socio-demographic details were recorded.

Results

Of the 189 women recruited, the mean age was 32 years, 35.4% (n = 67) were primigravidas, 44.1% (n = 82) were obese and 11.6% (n = 22) had an abnormal OGTT. On univariate analysis, increasing birth weight was correlated positively with multiparity, first trimester body mass index (BMI), GDM and hypertriglyceridaemia but not with cholesterol levels. On multivariate analysis, increased birth weight correlated positively only with hypertriglyceridaemia.

Conclusions

This study provides further evidence that maternal hypertriglyceridaemia is important in programming intrauterine fetal growth and raises questions about whether women should be screened selectively for dyslipidaemia before, during and after pregnancy.     

Are plasma levels of visfatin and retinol-binding protein 4 (RBP4) associated with body mass,metabolic and hormonal disturbances in women with polycystic ovary syndrome?

Objective

To analyze potential interactions of visfatin and retinol-binding protein 4 (RBP4) levels with body mass, metabolic, and hormonal status in normal weight and obese women with PCOS.

Study design

Body composition was determined by bioimpedance in 83 women (44 obese) diagnosed with PCOS and in 67 women (36 obese) without PCOS. In addition, serum glucose, lipids, androgens, FSH, LH, SHBG, insulin, visfatin, and RBP4 were measured in a fasting state and the free androgen index (FAI) was calculated, as was insulin resistance using the HOMA-IR assessment.

Results

Plasma RBP4 levels were significantly higher in women of normal weight compared to obese subjects when both were diagnosed with PCOS (14.1 ± 4.6 vs.10.9 ± 4.5 ng/mL, p < 0.001); while in non-PCOS subjects the opposite was found (10.8 ± 4.5 vs. 18.4 ± 11.6 ng/mL, p < 0.01; respectively). Plasma visfatin levels were similar in PCOS and non-PCOS subjects. In non-PCOS subjects, positive correlations between RBP4 level and anthropometric parameters were observed. In PCOS, RBP4 levels inversely correlated with serum insulin levels and HOMA-IR values. No correlation was found between plasma visfatin levels and anthropometric parameters in all study groups. Similarly, no correlation was found in PCOS and non-PCOS subgroups. Additionally, there was an inverse correlation between RBP4 and LH concentrations and LH/FSH ratio in all study subjects.

Conclusions

Plasma visfatin level is not a useful biomarker of insulin resistance and hyperandrogenism. RBP4 level reflects visceral body fat content in non-PCOS women. Decreasing RBP4 release along with increasing insulin resistance and hormonal disturbances may be a compensatory mechanism preventing deterioration in obese PCOS.     

Association of IL-18 genotype with impaired glucose regulation in Korean women with polycystic ovary syndrome

Objective

Polycystic ovary syndrome (PCOS) is a common endocrine disorder among women of reproductive age. The pro-inflammatory cytokine, interleukin (IL)-18, is associated with metabolic syndrome, and elevated serum IL-18 levels are related to obesity and insulin resistance in PCOS patients. However, the role of IL-18 in the PCOS remains unclear. So we examined whether or not two functional polymorphisms in the IL-18 gene, −137G > C and +183A > G, are associated with PCOS itself or glucose intolerance in Korean women with PCOS.

Study design

The IL-18 genotypes of 126 women with PCOS and 113 controls were determined and their serum levels of lipid and hormone profiles measured. The insulin resistance index was calculated from the glucose and insulin concentrations obtained by oral glucose tolerance tests.

Results

There were no statistically significant differences in the distribution of −137 G > C polymorphisms among the women classified according to presence or absence of PCOS and obesity. However, the −137G/G allele was more frequent in the PCOS + impaired glucose regulation (IGR) group than PCOS + normal glucose tolerance group (X² = 7.637, p_Bonf = 0.022). The PCOS group with only the −137G allele had a significantly increased risk of IGR compared to the PCOS group with the −137C allele (92 vs. 8%, odds ratio = 6.325, 95% confidence interval = 1.403–28.519). In the PCOS patients, the mean fasting and 2-h post-prandial plasma glucose level of patients with only the −137G allele was significantly higher than those of the patients with the −137C allele (88.87 ± 9.49 vs. 84.37 ± 6.19, p = 0.002 and 120.07 ± 34.53 vs. 107.54 ± 27.13, p = 0.038). Only one woman was heterozygous for the +183A > G polymorphism and the other 224 subjects were homozygous for the polymorphism (A/A).

Conclusion

The IL-18 −137G allele could play a role in the predisposition to glucose intolerance in Korean women with PCOS, and the +183G allele of IL-18 is not associated with the Korean population.     

Neonatal outcome and birth defects in 6623 singletons born following minimal ovarian stimulation and vitrified versus fresh single embryo transfer

Objective

To compare neonatal outcome between children born after vitrified versus fresh single-embryo transfer (SET).

Study design

Retrospective, single-centre cohort study of 6623 delivered singletons following 29,944 single-embryo transfers. Patients underwent minimal ovarian stimulation/natural cycle IVF followed by SET of fresh or vitrified-warmed (using Cryotop, Kitazato) cleavage-stage embryos or blastocysts. Outcome measures were gestational age at delivery, birth weight, birth length, low birth weight (LBW), small for gestational age (SGA) and large for gestational age (LGA) infants, perinatal mortality and minor/major birth defects (evaluated by parent questionnaire).

Results

Gestational age (38.6 ± 2 versus 38.7 ± 1.9 weeks) and preterm delivery rate (6.9% versus 6.9%, aOR: 0.96 95%CI: 0.76–1.22) in singletons born after the transfer of vitrified embryos were comparable to those born after the transfer of fresh embryos. Children born after the transfer of vitrified embryos had a higher birth weight (3028 ± 465 versus 2943 ± 470 g, p < 0.0001) and lower LBW (8.5% versus 11.9%, aOR: 0.65 95%CI: 0.53–0.79) and SGA (3.6% versus 7.6% aOR: 0.43 95%CI: 0.33–0.56) rates. Total birth defect rates (including minor anomalies) (2.4% versus 1.9%, aOR: 1.41 95%CI: 0.96–2.10) and perinatal mortality rates (0.6% versus 0.5%, aOR: 1.02 95%CI: 0.21–4.85) were comparable between the vitrified and fresh groups.

Conclusions

Vitrification of embryos/blastocysts did not increase the incidence of adverse neonatal outcomes or birth defects following single embryo transfer.     

Maternal serum insulin-like growth factor (IGF-I) and binding proteins IGFBP-1 and IGFBP-3 at 11-13 weeks' gestation in pregnancies delivering small for gestational age neonates

Objective

To investigate the possible value of maternal serum concentration of insulin-like growth factor-I (IGF-I), IGF binding protein-1 (IGFBP-1) and IGFBP-3 at 11–13 weeks’ gestation in the prediction of small-for-gestational age (SGA) neonates.

Study design

Maternal serum concentrations of IGF-I, IGFBP-1 and IGFBP-3 at 11–13 weeks were measured in 60 cases that subsequently delivered SGA neonates in the absence of pre-eclampsia, and compared to 120 non-SGA controls.

Results

In the SGA group, compared to the non-SGA group, there was significantly lower median IGF-I (61.8, IQR 43.4–93.4 ng/mL vs 94.9, IQR 56.7–131.2 ng/mL, p = 0.002) and IGFBP-1 (58.2, IGR 39.8–84.9 ng/mL vs 81.4, IGR 57.3–105.5 ng/mL, p = 0.002) but not IGFBP-3 (54.5, IGR 45.6–61.5 ng/mL vs 55.4, IGR 47.4–64.9 ng/mL, p = 0.402). However, after multiple regression analysis and adjustment for maternal characteristics, these biomarkers were not useful in predicting SGA.

Conclusion

Maternal serum IGF-I, IGFBP-1 and IGFBP-3 at 11–13 weeks are unlikely to be useful biochemical markers for early prediction of SGA.     

Effectiveness of local anaesthetics with and without vasoconstrictors for perineal repair during spontaneous delivery: double-blind randomised controlled trial

Objective

to investigate the use of local anaesthetics, in the presence or absence of vasoconstrictors, for perineal repair during spontaneous delivery.

Design

double-blind, randomised-controlled trial.

Setting

a birth centre, in the city of Sao Paulo, Brazil.

Participants

from June to December 2004, a total of 96 women were allocated into three groups (first-degree perineal lacerations, second-degree perineal lacerations or episiotomy), and treated with local anaesthesia (1% lidocaine or 1% lidocaine with epinephrine) (n=16 per treatment per group).

Interventions

an initial local infiltration of the anaesthetic solution was given so that episiotomy could be carried out (5 ml) and to suture spontaneous lacerations (1 ml), followed by repeated doses (1 ml) until pain was completely inhibited.

Measurements and findings

the main outcome measurement was the volume of anaesthetic used during episiotomy and perineal suture. Our data suggest that the concomitant use of the vasoconstrictor resulted in a significantly lower average volume used in the treatment of first-degree (1 ml, 95% confidence interval (CI) 0.4–1.6) and second-degree (3.7 ml, 95% CI 1.6–5.8) lacerations (p=0.002 and 0.001, respectively). A 0.3 ml (95% CI 1.5–2.1) average decrease in anaesthetic volume was observed with episiotomy (p=0.724). The maximum volume of anaesthetic used with and without vasoconstrictor was 1–2 ml in 95% and 3–4 ml in 50% of first-degree lacerations, respectively, and 1–6 ml in 88% and 7–15 ml in 81% of second-degree lacerations, respectively. For episiotomy, the maximum dose was 15 ml, regardless of anaesthetic solution used.

Key conclusions

our data confirm the hypothesis that the use of anaesthetics in conjunction with vasoconstrictors is more effective than anaesthetics alone in the repair of perineal lacerations, but not for episiotomy.     

Twin pregnancies in Cardiff and Vale of Glamorgan over four decades: natural twinning is on the increase

Objective

To assess trends in twinning over four decades using a population-based registry.

Design

Ecological study to conduct trend analysis of twin pregnancies in a geographically defined area over 40 years.

Setting

All pregnancies in the Cardiff and Vale of Glamorgan area of South Wales from 1965 to 2004, as recorded in the Cardiff Birth Survey (CBS) database.

Methods

Trends of the incidence of all twin pregnancies (≥18 weeks of gestation) were calculated in 5-year increments, beginning with 1965–1969 and ending in 2000–2004. Natural twinning rates could only be calculated for the terminal five time periods (i.e., 1980–1984, 1985–1989, 1990–1994, 1995–1999, and 2000–2004), when information regarding non-spontaneous (iatrogenic) twinning was first collected in the database. All results were adjusted for maternal age.

Results

The total twinning rate was 13.1 per 1000 pregnancies in the 1st time period (1965–1969). Subsequently, there was a gradual reduction in twinning, reaching a nadir of 10.3 per 1000 for the time period 1980–1985 (Z = 3.15, P value < 0.001). This was followed by a gradual increase in twinning, reaching a maximum of 15.7 per 1000 for both 1995–1999 and 2000–2004 (Z = −5.18, P value < 0.0001). After exclusion of the cases of iatrogenic pregnancies, the natural twinning rate showed a continuous and gradual increase from 10 per 1000 spontaneous pregnancies in 1980–1984 to 13.3 per 1000 in 2000–2004 (Z = −5.08, P value < 0.0001).

Conclusion

The data showed a gradual, continuous increase in natural twinning rates over the last two decades. Such an increase cannot be attributed to the rise in maternal age alone.     

Diabetes pregestacional: resultados metabolicoperinatales según la terapia empleada

Aim

To evaluate the treatment of pregestational diabetes mellitus (PDM) and the metabolicperinatal results according to the treatment used.

Material and method

We reviewed 42 women with PDM with intensive insulin treatment under clinical supervision from the first three months of their pregnancy.

Results

The average age was 30 ± 5 years and the time for the average development of diabetes was14,2 ± 9.5 years. The Body Mass Index and the need for insulin passed from 26 ± 4.85 kg/m² and 0,56 ± 0.32 U/kg at the beginning to 30 ± 4.5 kg/m² and 0.70 ± 0.28 U/kg at the end. Prior HbA_1c was 7.71 ± 1.85% and a gestational average HbA_1c of 6.81 ± 1.33%. Four types of insulin therapy were used: NPH-lispro 26.2%, pre-programmed mixtures 26.2%, glargina-lispro 21.4% and ISCI 26,2%. Significant differences were not found among the types of insulin and the variables analyzed.

Conclusions

The type of insulin doesn’t affect perinatal results. High HbA1c are related to greater abdominal circumference at 32 weeks and with a greater.     

Urbanization and the likelihood of a cesarean section

Objective

This study examines the association between the likelihood of cesarean section (CS) and the degree of urbanization in Taiwan, exploring possible explanations for the difference.

Study design

The database used in this study was the Taiwan 2004 National Health Insurance Research Database. A total of 200,207 singleton deliveries fulfilled our criteria and were included in our study. The urbanization level of cities/towns where parturients resided at the time of delivery was stratified into seven categories. A multilevel logistic regression model was applied to examine the relative likelihood of CS by urbanization level after adjusting for parturient, physician and hospital characteristics.

Results

There was an upward trend in the CS rate with advancing urbanization level; the CS rates for urbanization level 1 (most urbanized) through 7 (least urbanized) were 33.7, 32.3, 30.4, 30.2 29.7, 29.5, and 28.6%, respectively. Compared with participants living at the highest urbanization level, the adjusted odds of a CS were 0.91 (95% CI = 0.85–0.98, p = 0.014), 0.84 (95% CI = 0.78–0.91, p < 0.001), 0.83 (95% CI = 0.68–0.88, p < 0.001), 0.79 (95% CI = 0.72–0.86, p < 0.001), and 0.70 (95% CI = 0.62–0.80, p < 0.001) times, respectively, for those living in cities/towns ranked from the third highest to the lowest levels of urbanization.

Conclusions

We conclude that higher urbanization levels were associated with higher odds of CS. Highly urbanized communities could therefore be targeted for policy intervention aimed at reducing the unnecessary CS rate.     

Combination of uterine artery Doppler velocimetry and maternal serum placental growth factor estimation in predicting occurrence of pre-eclampsia in early second trimester pregnancy: a prospective cohort study

Objective

To determine the effectiveness of the combined use of uterine artery Doppler velocimetry (UADV) and estimation of maternal serum placental growth factor (PlGF) levels in early second trimester (20–22 weeks of gestation) in identifying pregnant women at risk of developing pre-eclampsia.

Study design

Prospective cohort study on 1104 pregnant women with singleton pregnancies between May 2009 and December 2010. UADV and maternal serum PlGF estimation were done at 20–22 weeks’ gestation. Association between the two variables and the occurrence of pre-eclampsia was analyzed by logistic regression analysis and odds ratio was computed. The results were considered significant when p was <0.05.

Results

Logistic regression analysis showed that both abnormal UADV (odds ratio (OR) 4.1; 95% CI 2.3–7.2; p = 0.000) and serum PlGF < 188 pg/ml (OR 3.6; 95% CI 1.95–6.5; p = 0.000) are independent variables in the occurrence of pre-eclampsia, and the difference between the association of these two variables with pre-eclampsia was statistically insignificant as 95% CI values overlap. Multivariate logistic regression analysis showed that a combination of abnormal UADV and serum PlGF < 188 pg/ml at 20–22 weeks had a very poor association (OR 1.1; 95% CI 0.3–3.8; p = 0.938) with the occurrence of pre-eclampsia, as the 95% CI values encompass 1 and p is >0.05.

Conclusion

UADV and maternal serum PlGF estimation at 20–22 weeks of gestation are strong predictors of the occurrence of pre-eclampsia when used individually but in combination their association with pre-eclampsia is not significant.     

Markers of visceral obesity and cardiovascular risk in patients with polycystic ovarian syndrome

Background

Polycystic ovarian syndrome (PCOS) is one of most common endocrine disturbances in women of reproductive age. Besides its well known effects on reproductive health, it is also linked to increased cardiovascular risk in later life.

Objectives

The aim of this study was to investigate the link between some anthropometric indices of visceral obesity and surrogate markers of cardiovascular risk according to the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society consensus.

Study design

The study included 36 normal weight (BMI < 25 kg/m²) and 19 obese PCOS subjects (BMI ≥ 30 kg/m²), aged between 18 and 40 years. Different anthropometric markers were compared as predictors for an adverse cardiometabolic profile and composite cardiovascular risk factors as defined by the AE-PCOS consensus.

Results

Both waist-to-stature ratio (WSR) (area under the curve 0.75, p = 0.002) and waist circumference (WC) (area under the curve 0.77, p = 0.001) but not waist-to-hip ratio (WHR) (area under the curve 0.62, p = 0.143) were shown to be good markers of increased cardiovascular risk, insulin resistance and dislipidemia in PCOS patients. The cut-off point for WSR of 0.50 is useful and the cut-off of 80 cm for WC is more appropriate than 88 cm in detecting cardiovascular risk in PCOS patients. Androgen levels and immunoreactive insulin during an oral glucose tolerance test had lower power for predicting increased cardiovascular risk than WC and WSR.

Conclusion

The study indicates that WSR and WC are better associated with composite cardiovascular risk factors as defined by the AE-PCOS consensus than WHR, and that the commonly used cut-off for WSR of 0.5 is useful for detecting cardiovascular risk in PCOS patients.     

Carbon dioxide pneumoperitoneum induces systemic oxidative stress: a clinical study

Objective

To investigate the effect of carbon dioxide pneumoperitoneum on systemic oxidative stress by using serum oxidative stress markers (ischemia modified albumin (IMA), malondialdehyde (MDA), total oxidant status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI)) and to compare their effectiveness at clinically accepted safe intra-abdominal pressure levels (<12 mmHg).

Study design

A total of 33 consecutive patients who had a unilateral ovarian cyst were enrolled for this prospective clinical study. All women underwent a laparoscopic ovarian cystectomy procedure. Venous blood was collected from patients preoperatively, 10 min after induction of anesthesia and 30 min after insufflation. Preoperative, 10_min, and 30_min serum IMA, MDA, TOS, OSI and TAS levels were compared.

Results

The mean age was 29.3 ± 6.4 and the range of operation time was 45–80 min. The mean serum IMA levels showed a significant increase 30 min later from CO₂ insufflation (p < 0.05). Significant alterations were not observed in serum MDA, TOS, OSI or TAS levels.

Conclusions

Laparoscopic surgery causes systemic ischemia and this ischemic effect can be revealed by measuring serum ischemia modified albumin. IMA is more sensitive than MDA, TOS, OSI and TAS in early detection of systemic oxidative stress.     

A randomised controlled trial evaluating the effect of immersion bath on labour pain

Objective

to evaluate the effect of an immersion bath on pain magnitude during the first stage of labour.

Design

a randomised controlled trial comparing the pain scores of bathing and non-bathing nulliparous women during birth was employed.

Setting

the study was conducted at the Normal Birth Center of Amparo Maternal, São Paulo, Brazil.

Participants

108 birthing women, with 54 women randomly assigned to each group.

Interventions

when the birthing women presented at 6–7 cm of cervical dilation, they were placed in an immersion bath for 60 mins.

Outcome measures

pain scores, using a behavioural pain scale and a numeric scale, were recorded at two evaluation time points: at 6–7 cm of cervical dilation and 1 h after the first pain score evaluation.

Findings

at the first evaluation, on the behavioural scale, the means were 2.1 for both groups (p=0.914; 95% confidence intervals (CI) 1.9–2.3 for the control group and 2.0–2.2 for the experimental group). On the numeric scale, the means were 8.7 and 8.5 for the control and experimental groups, respectively (p=0.235; 95% CI 8.2–9.2 for the control group and 8.1–8.9 for the experimental group). At the second evaluation, the pain score means for both scales were statistically higher in the control group than in the experimental group. On the behavioural scale, the scores were 2.4 vs. 1.9, respectively, for the control and experimental groups (p<0.001; 95% CI 2.2–2.6 for the control group and 1.7–2.1 for the experimental group). On the numeric scale, the scores were 9.3 vs. 8.5, respectively, for the control and experimental groups (p<0.05; 95% CI 8.9–9.7 for the control group and 8.1–8.9 for the experimental group).

Conclusions

mean labour pain scores in the control group were significantly higher than those in the experimental group. The present findings suggest that use of an immersion bath is a suitable alternative form of pain relief for women during labour.     

Predictors of spontaneous reduction in multiple pregnancies conceived following assisted reproductive technology

Objective

To identify patient and cycle parameters that relate to spontaneous reduction in multiple pregnancies following in vitro fertilization (IVF) and embryo transfer (ET).

Study design

A retrospective cohort study was conducted in an academic infertility center. All IVF cycles between January 2007 and June 2008 were evaluated and 69 infertile women were diagnosed with multiple gestation following IVF. Multiple pregnancy was diagnosed by transvaginal sonography at 6–7 weeks gestation following embryo transfer (ET). Repeat ultrasonography undertaken in late first trimester assessed ongoing multiple pregnancy versus occurrence of spontaneous reduction. Patient and IVF cycle parameters were compared between patients experiencing spontaneous reduction (n = 26, cases) compared to those where the multiple pregnancy proceeded uneventfully (n = 43, controls).

Results

Spontaneous reduction (SR) was observed in almost 38% of the studied multiple gestations (n = 69). Women experiencing SR were significantly older (p = .047), of a leaner body mass (p = .049), and exhibited significantly higher serum estradiol (E₂) levels in the early follicular phase (p = .016) compared to the controls. Endometrial thickness (EMT) on the day of hCG administration related inversely (p = .017), whereas the number of embryos transferred (ET) related positively with the likelihood of SR (p = .027). On multivariate analyses, EMT and the number of ET were identified as independent predictors of SR following IVF–ET; EMT of less than 10 mm was associated with a fourfold increased likelihood of SR (OR 4.18; 95% CI 1.02–17.01) whereas each additional embryo transferred doubled the risk of SR in multiple pregnancies resulting from IVF (OR 2.39; CI 1.02–5.58).

Conclusions

In multiple pregnancies conceived following IVF, occurrence of SR is relatively common. Increasing number of ET and EMT measuring <10 mm are identified as independent predictors of likelihood of SR. While advancing age, body mass and baseline E₂ levels were associated with likelihood of SR, these associations disappeared on adjusted analyses. The observed relationship between EMT and SR is novel: the underlying mechanisms are unclear and merit further investigation.     

Classical and non-classical HLA molecules and p16(INK4a) expression in precursors lesions and invasive cervical cancer

Objectives

Viruses and tumour cells may regulate the expression of HLA molecules on the cell surface to escape immune system surveillance. Absence of classical HLA class I molecules may impair the action of specific cytotoxic cells, whereas non-classical HLA class I molecules may regulate innate and adaptive immune cells. We assess here the possible associations between classical/non-classical class I HLA and p16^INK4a molecule expression in cervical biopsies of women infected with HPV, stratified according to grade of the lesion and HPV type.

Study design

Cervical biopsies (N = 74) presenting cervical intraepithelial neoplasia grade 1 (CIN1) (n = 31), CIN2–3 (n = 19), and invasive cancer (n = 14) were evaluated alongside 10 normal cervical specimens.

Results

HLA-A/B/C/G staining was observed in the early stages of HPV infection. A significant association was detected between HLA-A/B/C staining and HPV16/18 infection (OR = 0.12, 95%CI: 0.0163–0.7899; p = 0.04). HLA-E expression increased with the progression of the lesion (χ²-test for trend = 4.01; p = 0.05), and a significant association was found between HLA-E staining and HPV16/18 infection (OR = 11.25, 95%CI: 2.324–54.465; p = 0.003). Irrespective of the grade of the lesion, HLA-A/B/C staining and p16^INK4a presented a good concordance (Kappa: 0.67).

Conclusions

HLA-E overexpression seemed to be associated with invasive cancer and HPV16/18 infection.     

The insulin resistant subphenotype of polycystic ovary syndrome: clinical parameters and pathogenesis

Objective

This study was undertaken to compare clinical and biochemical characteristics of the insulin resistant (IR) and non-IR subphenotypes of polycystic ovary syndrome (PCOS).

Study design

Infertile PCOS women were classified as IR (n = 32) or non-IR (n = 46) on the basis of fasting glucose and insulin levels. The incidence of acanthosis nigricans (AN), hirsutism, and ovulation in response to clomiphene citrate (CC) was compared between the 2 groups, along with serum levels of gonadotropins, and sex steroids. Blood samples from 28 PCOS patients and 8 controls were analyzed by enzymatic immunoassay for autophosphorylated insulin receptor (APIR) and total insulin receptor (TIR) content.

Results

Insulin resistance was associated with obesity (odds ratio [OR] = 3.5, P < .05), AN (OR = 6.0, P < .05), hirsutism (OR = 3.1, P < .05), and resistance to CC (OR = 5.0, P < .05). Mean levels of LH, LH/FSH ratios, and testosterone were lower in women with IR (11.5 ± 6.8 mIU/mL, 2.0 ± 1.0, and 56.6 ± 29.0 ng/dL, respectively) compared with women without IR (15.0 ± 13.4 mIU/mL, 2.4 ± 1.5, and 72.5 ± 29.8 ng/dL, respectively) (P < .05). Mean APIR/TIR ratios in IR women were lower than in non-IR women (P < .05 at 100 nmol/L of insulin) and controls (P < .01 at 1, 10 and 100 nmol/L insulin).

Conclusion

Patients with IR are more likely to be obese and have AN, hirsutism, resistance to CC, and lower LH, LH/FSH ratios, and testosterone levels. Furthermore, IR patients appear to have defective autophosphorylation of the insulin receptor, a key element in insulin action, and a possible mechanism for IR in PCOS.