Evaluation of the thyroid gland vascularity during pregnancy using 2-dimensional color Superb Microvascular Imaging vascularization index technique.

PURPOSE: We aimed to investigate maternal thyroid parenchymal vascularity with 2-dimensional color superb microvascular imaging vascularization index (2D-cSMIVI) levels and thyroid gland volume in the first, second and third trimesters. METHODS: This longitudinal prospective study was carried out with participants selected from 30 healthy asymptomatic pregnant women. Ultrasonography (US) for the thyroid gland was performed in each trimester. The vascularization index (VI) values obtained by manually drawing the contours of the thyroid parenchyma in the longutidinal plane, using the free region of interest (ROI) with 2DcSMIVI mode. VI values obtained in each trimester, thyroid hormone levels (TSH, T3, T4) and thyroid volumes were compared. RESULTS: We have detected that thyroid gland vascularity increased significantly as pregnancy progresses. The mean VI values of thyroid gland in third trimester were significantly higher than first and second trimester (p < 0.001), and the mean VI values of the thyroid gland in the second trimester were significantly higher than first trimester (p < 0.001). During pregnancy, we detected the increase in VI values, TSH levels and thyroid gland volumes. CONCLUSION: Maternal thyroid gland gray scale findings, parenchymal vascularization, thyroid volumes should be evaluated routinely for the healthy fetal development. 2D-cSMIVI method allows us to evaluate vascularization with quantitative numerical values objectively. We have detected that the VI values and volume of the thyroid gland increases as pregnancy progresses. In the complex situation of pregnancy process, the thyroid gland can be evaluated quantitatively with SMI method effectively.

Are Vascular Endothelium and Angiogenesis Effective MicroRNA Biomarkers Associated with the Prediction of Early-Onset Preeclampsia (EOPE) and Adverse Perinatal Outcomes?

MicroRNA is associated with angiogenesis, invasion, proliferation, and vascular endothelial remodeling of various diseases. We aimed to investigate serum MicroRNA (miRNA) levels in preeclampsia (PE) and to determine whether any changes in miRNA levels are useful in predicting early onset preeclampsia (EOPE) and adverse perinatal outcomes. A total of 89 pregnant patients were enrolled in this prospective case-control study (55 PE and 34 healthy controls). miR-17, miR-20a, miR-20b, miR126, miR155, miR-200, miR-222, and miR-210 levels were studied in maternal serum in preeclamptic pregnant women. Multiple logistic regression analyses analyzed the risk factors which are associated with EOPE and adverse maternal outcomes. The Real-time RT-PCR method was used to determine maternal serum miRNA levels. Serum miR-17, miR-20a, miR-20b, miR126, and miR-210 levels were significantly higher in PE than the control group (p < .001, p < .001, p < .001, p < .001 and p = .047 respectively). Increased miR-17, miR-20a, and miR-20b levels were independently associated with PE (OR: 0.642, 95%Cl: 0.486-0.846, p = .002; OR: 0.899, 95%Cl: 0.811-0.996, p = .042 and OR: 0.817, 95%Cl: 0.689-0.970, p = .021). Increased miR-17 and miR-126 levels were negatively correlated with serum EOPE in PE (r = -.313, p = .020), and increased miR-210 levels were significantly positively correlated with EOPE in PE (r = .285, p = .005). Increased expression of serum miR-17, miR-20a, miR-20b, miR126, and miR-210 were found to be associated with PE, also increased expression of miR-17, miR-20a, and miR-20b were to be predicted with PE, also increased maternal serum miR-17 and miR-126 expressions were negatively correlated and increased miR-210 expression was positively correlated with EOPE in PE women.

Is the expression of placental epithelial and lymphoid markers associated with the perinatal outcomes in preeclampsia?

OBJECTIVES: This study aimed to investigate the association of the epithelial and lymphoid immune markers with the adverse perinatal conditions such as early-onset preeclampsia (EOPE), fetal growth restriction (FGR) and intrauterine fetal death (IUFD) in preeclampsia in the placentae of preeclamptic patients. MATERIAL AND METHODS: A total of 60 pregnant patients were included in this study. The immunohistochemistry method was used to determine the expression levels of CD4, CD8, CD4 / CD8, CD68, P53, MDM2, CK18, CK19, E-cadherin, and ß-catenin. RESULTS: In our study, the increase in E-cadherin expression in the preeclamptic fetal-maternal placental region was associated with EOPE and FGR development preeclampsia and the decrease in the expression of CD4 and CD8, which are involved in the local immunomodulation, was associated with IUFD. CONCLUSIONS: Our data reveal that the increase in the expression of CK18, CK19, E-cadherin, and ß-catenin and the decrease in CD4 and CD8 play a role in the pathogenesis of preeclampsia.

The role of thyroid-stimulating hormone and thyroglobulin antibody in abnormally invasive placenta.

PURPOSE: Thyroid hormones and antibodies are known to participate in angiogenesis and invasion and also thyroid hormone receptors are expressed in the placenta. We aimed to evaluate the relationship of serum levels of thyroid-stimulating hormone (TSH), thyroid hormones (TH), and anti-thyroid antibodies with abnormally invasive placenta (AIP). We also aimed to investigate whether they are related with cesarean hysterectomy and massive blood transfusion need in AIP cases. METHODS: A total of 88 pregnant patients were enrolled in this prospective case-control study (30 with AIP, 28 with non-adherent placenta previa totalis (PPT) and 30 controls). Serum TSH, thyroid hormone [T3 (triiodothyronine) and T4 (thyroxine)] and thyroid antibodies against thyroglobulin (TgAb) and thyroid peroxidase (TPOAb) levels were studied in maternal serum at initial admission to our Perinatology Unit (at early third trimester). The factors associated with increased risk of AIP, cesarean hysterectomy, massive blood transfusion, and adverse perinatal outcomes were evaluated with multiple logistic regression analysis. Adjusted odds ratios and 95% confidence intervals were also calculated. RESULTS: Serum TSH and TgAb levels were significantly lower in the AIP group than both PPT and control groups (p = .01, p < .001 and p < .001, p < .001 respectively). Decreased serum levels of TSH (<2.16 mIU/L) and TgAb (<2.70 mIU/L) levels and high previous cesarean section rates were found to be independently associated with AIP in pregnant women with PPT (OR: 0.4, 95% CI: 0.1-0.9; p = .04, OR: 0.7, 95%CI: 0.4-1.3, p = .02 and OR: 0.1, 95% CI: 0.1-0.5, p = .01). Decreased serum TSH and TgAb levels were found to be independently associated with an increased rate of cesarean hysterectomy and massive blood transfusion in AIP cases (OR: 3.7, 95% CI: 1.4-9.8; p = .01, OR: 1.8, 95% CI: 1.1-3.1; p = .03 and OR: 2.6, 95% CI: 1.0-6.5; p = .05, OR: 2.2, 95% CI: 1.1-4.1 p = .02). Decreased TSH and TgAb serum levels were also found to be independently associated with adverse perinatal outcomes in AIP cases (OR: 3.4, 95% CI: 1.3-11.0; p = .01 and OR: 1.978, 95% CI: 2-3.6; p = .03). CONCLUSION: Decreased serum TSH and TgAb levels, and previous history of cesarean section were all found to be significantly associated with AIP in cases with PPT. We suggest that maternal serum TSH and TgAb levels can provide additional contribution to obstetric Doppler ultrasound in the diagnosis of AIP and thus can reduce the risks of unplanned cesarean hysterectomy in cases with PPT.

Are body roundness index and a body shape index in the first trimester related to foetal macrosomia?

This study investigated the effectiveness of maternal Body Roundness Index (BRI), Body Shape Index (ASBI), and Visceral Adiposity Index (VAI) in predicting foetal macrosomia and small for gestational age (SFGA) babies in obese and non-obese pregnant women. This prospective trial included 168 pregnant women (99 obese and 69 non-obese). A logistic regression model was used to identify the independent risk factors of foetal macrosomia and SFGA. BRI, waist/hip ratio, HbA1c and HOMA-IR were found to be significantly associated with increased macrosomia risk in obese women (OR = 1.469, % CI: 1.126-1.917, p = .005; OR = 4.289, % CI: 0.178-1.030, p = .012, OR = 6.277, %Cl: 1.233-31.948, p = .027, and OR = 1.393, %Cl: 1.060-1.832, p = .017). The present study indicates that first-trimester BRI and waist/hip ratio may be powerful determinants in predicting foetal macrosomia in obese pregnant women.Impact statementWhat is already known on this subject? Obesity is a major risk factor for maternal and foetal morbidity and mortality. The rate of obesity continues to increase rapidly around the world. The accuracy of ultrasound in estimated foetal weight is reduced in obese pregnant women. The Body Roundness Index (BRI) is a new anthropometric index that shows body fat distribution.What do the results of this study add? Our results show that the BRI was an independent risk factor associated with foetal macrosomia in obese pregnant women.What are the implications of these findings for future clinical practice and/or further research? BRI measurements should be taken before pregnancy to help predict shoulder dystocia, GDM, FGR and foetal macrosomia in obese women.

Increased levels of serum IL-33 is associated with adverse maternal outcomes in placenta previa accreta.

PURPOSE: IL-33 is associated with invasion, proliferation, and metastasis of various cancers. The trophoblastic cells of placenta previa accreta (PPA) invade into the myometrium in a similar way to the invasion of cancers. We studied the role of IL-33 in PPA and also aimed to investigate its relation with adverse maternal outcome in this placental disorder. METHODS: A total of 87 pregnant patients were enrolled in this prospective case-control study [27 with PPA, 30 with placenta previa totalis (PPT; nonadherent placenta previa), and 30 controls]. IL-33 and IL-6 levels were studied in maternal serum at late preterm gestation weeks. Multiple logistic regression analyses analyzed the risk factors which are associated with PPA and adverse maternal outcomes. Adjusted odds ratios and 95% confidence intervals were also calculated. Enzyme-linked immunosorbent assay (ELISA) method was used to determine maternal serum IL-33 and IL-6 levels. RESULTS: Serum IL-33 levels were significantly higher in PPA patients when compared with both nonadherent PPT and the control groups (p = .011, p = .010). Serum IL-6 and neutrophil/lymphocyte ratio levels were significantly higher than the control group's (p = .045, p = .028). IL-33 levels and history of previous cesarean section were found to be significantly associated with PPA (OR: 1.039, 95% CI: 1.004-1.075; p = .030 and OR: 0.067, 95% CI: 0.014-0.309, p = .001, respectively). Serum IL-33 levels were positively correlated with previous cesarean section history in PPA. Increased maternal serum IL-33 levels were found to be independently associated with a cesarean hysterectomy and massive transfusion in PPA patients (OR: 1.098, 95% CI: 0.998-1.207; p = .049 and OR: 1.162 95% CI: 1.010-1.337; p = .036). CONCLUSION: Increased levels of maternal serum IL-33 and history of previous cesarean section were found to be significantly associated with PPA, and also increased maternal serum IL-33 levels were related to cesarean hysterectomy and massive blood transfusion in PPA. We suggest that IL-33 may have a role in abnormal placental invasion.

Association of adverse outcomes of intrahepatic cholestasis of pregnancy with zonulin levels.

Our aim was to investigate serum zonulin levels in intrahepatic cholestasis of pregnancy (ICP) and to determine the usefulness of zonulin in ICP follow-up. A prospective case-control study was carried out which included 88 pregnant women (44 patients with ICP and 44 controls). Maternal serum samples obtained from all participants and zonulin levels were determined by enzyme-linked immunosorbent assay (ELISA). Compared with controls, women with ICP had significantly higher zonulin levels (mean 0.728 ± 0.520 ng/mL vs. 1.303 ± 0.63 ng/mL, p <.001). According to the receiver operating characteristic (ROC) analysis performed for the predictive value of zonulin levels for ICP, the area under the curve (AUC) was 0.761 (95% CI: 0.661-0.860). Multivariable logistic regression analysis revealed serum zonulin levels was independently associated with adverse perinatal outcomes (OR = 1.278, 95% CI: 0.232-7.041), severity ICP (OR: 7.535, 95% CI: 1.597-13.553) and also unresponsiveness to treatment in ICP (OR: 4.178, 95% CI: 0.929-8.784).IMPACT STATEMENTWhat is already known on this subject? Zonulin is a regulator protein that increases the intestinal permeability by modulating the intercellular tight junctions (TJ). It is the only physiological protein known to control intestinal permeability and damage of the intestinal barrier is one of the causes of absorption disorders, inflammation and autoimmunity. ICP is a relatively non-threatening condition to women but is linked with a higher risk of preterm delivery, foetal distress and foetal death.What do the results of this study add? This study showed that increased levels of zonulin are associated with adverse perinatal outcomes, severity of ICP and unresponsiveness to treatment in ICP.What are the implications of these findings for clinical practice and/or further research? Focussing on preservation of intestinal permeability may be an alternative preventive strategy to reduce the adverse perinatal outcomes and severity of ICP. Further longitudinal studies are needed to verify the relationships among zonulin levels and pregnancy-related diseases.

Increased syndecan-1 and glypican-3 predict poor perinatal outcome and treatment resistance in intrahepatic cholestasis.

BACKGROUND: Intrahepatic cholestasis of pregnancy (ICP) increases the risk of adverse pregnancy outcomes. This study aimed to explore the association between serum syndecan-1 and glypican-3 levels and the adverse perinatal outcome as well as the responses to the treatment of ursodeoxycholic acid (UDCA). METHODS: This prospective, case control study included 88 pregnant women (44 women with ICP and 44 healthy controls). The primary end points were the perinatal outcome and the response to UDCA therapy. A logistic regression model was used to identify the independent risk factors of adverse pregnancy outcomes and reduced response to UDCA therapy. RESULTS: Women with ICP had significantly higher serum syndecan-1 (1.27 ± 0.36 ng/mL vs. 0.98 ± 0.50 ng/mL; P = 0.003), glypican-3 (1.78 ± 0.13 ng/mL vs.1.69 ± 0.16 ng/mL; P = 0.004), AST (128.59 ± 1.44 vs. 13.29 ± 1.32 U/L; P < 0.001), and ALT (129.84 ± 1.53 vs. 8.00 ± 3.67 U/L; P < 0.001) levels compared with the controls. The increased levels of syndecan-1 (OR = 4.715, 95% CI: 1.554-14.310; P = 0.006), glypican-3 (OR = 8.465, 95% CI: 3.372-21.248; P = 0.007), ALT (OR = 1.382, 95% CI: 1.131-1.690; P = 0.002), and postprandial bile acid (PBA) (OR = 3.392, 95% CI: 1.003-12.869; P = 0.026) were correlated to ICP. The adverse neonatal outcome was related to increased glypican-3 (OR = 4.275, 95% CI: 2.726-5.635; P = 0.039), and PBA (OR = 3.026, 95% CI: 1.069-13.569; P = 0.037). Increases of syndecan-1 (OR = 7.464, 95% CI: 2.130-26.153, P = 0.017) and glypican-3 (OR = 6.194, 95% CI: 2.951-13.002; P = 0.025) were the risk factors of decreased response to UDCA treatment. CONCLUSION: Syndecan-1 and glypican-3 might be powerful determinants in predicting adverse perinatal outcome in patients with ICP, and they can be used to predict the response to the UDCA treatment.

Are serum levels of ADAMTS5, TAS and TOS at 24-28 gestational weeks associated with adverse perinatal outcomes in gestational diabetic women?

We aimed to determine the role of placental A Disintegrin and Metalloproteinase with thrombospondin motifs 5 (ADAMTS5), and maternal serum ADAMTS5, total antioxidant status (TAS), total oxidant status (TOS) and oxidative stress index (OSI) levels at 24-28th gestational weeks in GDM. This study included 57 patients, who had been diagnosed as having GDM at their 24-28th gestational week, and 29 controls. The maternal blood samples were collected at the 24-28th gestational week and ADAMTS5 was studied with the enzyme-linked immunosorbent assay (ELISA) method, whereas an automated colorimetric method was used to study TAS, TOS, and OSI. The level of ADAMTS5 in maternal serum of patients with GDM were significantly lower than the controls (p = .017); whereas TOS and OSI levels were significantly higher (p = .003 and p = .008). Multivariable logistic regression analysis revealed ADAMTS5 and TOS levels were independently associated with adverse perinatal outcomes (p = .004 and p = .018). We found that serum ADAMTS5 levels decreased and TOS level increased in GDM pregnant at 24-28th gestational weeks. In addition, we found that increased levels of serum ADAMTS5 and decreased TOS levels at 24-28th weeks were associated with adverse perinatal outcomes independent of the mode of treatment in GDM.Impact statementWhat is already known on this subject? Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy. The insulin resistance, which starts at the 24-28th gestational weeks, increases during gestation. GDM increases maternal complications like preeclampsia, cesarean rate, cardiovascular disease, obesity, and diabetes after pregnancy; and neonatal complications like macrosomia, hypoglycemia, hyperbilirubinemia, delivery trauma, shoulder dystocia, and adult-onset obesity, and diabetes.What the results of this study add? A significant relationship between ADAMTS5, TOS levels and adverse perinatal outcome. insulin resistance and was observed.What the implications are of these findings for clinical practice and/or further research? Based on this finding, we concluded that increased levels of oxidative stress and decreased ADAMTS5 levels are associated with GDM and predictive for adverse perinatal outcomes. The results of the present study were consistent with the previous reports and indicated that increased oxidative stress in GDM patients are related to adverse perinatal outcomes.

Dynamic Thiol/Disulfide Homeostasis in Predicting Adverse Neonatal Outcomes in Fetal Growth Restriction.

Aim: The main aim of this study was to investigate thiol/disulfide homeostasis associated with fetal growth restriction (FGR) and to evaluate whether alterations are predictive for adverse neonatal outcomes. Methods: 273 pregnant women (77 with FGR and 196 with normal fetal growth) were enrolled in this prospective case-control study. Results: Native thiol and total thiol were decreased in FGR compared to the control group (p < .001; p < .001). Decreased levels of maternal serum native and total thiol were significantly associated with adverse neonatal outcomes in FGR (OR: 0.983, 95% CI 0.976-0.991, p < .001; OR: 0.983, 95% CI 0.976-0.991, p < .001). Decreased maternal serum total thiol levels were the only significantly associated risk factor with adverse neonatal outcomes in FGR (OR: 0.981, 95% CI 0.963-1.000, p = .046). Conclusion: The decrease in the antioxidants of thiol/disulfide mechanism may be related to the development of both FGR and adverse neonatal outcome in FGR.

The influence of Body Roundness Index on sensorial block level of spinal anaesthesia for elective caesarean section: an observational study.

In this prospective trial, we investigate the effectiveness of maternal Body Roundness Index in predicting the spread of spinal anaesthesia and vasopressor requirement in parturients receiving spinal anaesthesia during the elective caesarean section. We prospectively enrolled 175 parturients. Spinal anaesthesia performed with 10 mg 0.5% hyperbaric bupivacaine at the L3-L4 intervertebral space and the optimal cut-off points of the BRI evaluated as 6.59 by receiver operating characteristic analysis calculating area under the curve. Parturients were divided into two groups with BRI <6.59 and BRI ≥6.59 for analyses. Multivariate logistic regression analysis was used to test for a relationship between variables and maximum sensory block level and vasopressor requirement. BRI was found as an independent risk factor associated with maximum sensory block level (OR = 1.378, 95% CI: 1.125-1.687, p = 0.002). Hypotension and bradycardia events after spinal anaesthesia was not associated with BRI and other variables. The present study indicates that BRI was a practical tool to predict spinal drug distribution in term parturients undergoing caesarean delivery.Impact statementWhat is already known on this subject? Spinal anaesthesia is a commonly used anaesthetic technique for the caesarean section. However, the spinal drug distribution is highly unpredictable. Anthropometric variables may predict the intrathecal drug distribution in parturients. Body Roundness Index (BRI) captures body circumference regarding height to predict body fat percentage, consider the shape of the human body as an ellipse. An ellipsoid body shape might affect the spread of spinal anaesthesia.What do the results of this study add? Our results show that the BRI was as an independent risk factor associated with maximum sensory block level in term parturients undergoing caesarean delivery.What are the implications of these findings for future clinical practice and/or further research? A future study would present the possibility to design a formula for the exact amount of local anaesthetic to be used in spinal anaesthesia with the aid of maternal BRI.

Is the low AMH level associated with the risk of cardiovascular disease in obese pregnants?

Our aim was to investigate whether Antimullerian Hormone (AMH), complete blood count (CBC), Homeostasis model assessment (HOMA-IR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and weight gain have any diagnostic value for the prediction of cardiovascular disease (CVD) in obese and non-obese pregnant patients. A prospective, case-control study was carried out, including 187 patients (93 obese, and 94 non-obese). CVD risk for each patient was evaluated according to the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA). A multivariate logistic regression model was used to identify the independent risk factors of CVD in obese and non-obese patients. The obese patients had significantly lower levels of AMH when compared to the non-obese ones (p = .002). Insulin, HOMA-IR, HbA1c, and SBP were significantly higher in obese patients than non-obese ones (p < .001, p < .001 and p = .001, respectively). Age, SBP, and decreased AMH levels had significantly associated with risk factors of CVD in the obese group (p = .001, p = .002, and p = .049, respectively). Our study suggests that decreased AMH levels, increased age, and SBP are associated with CVD in obese patients. AMH may be used to evaluate CVD risk in advanced aged, obese patients.IMPACT STATEMENTWhat is already known on this subject? Obesity is one of the most common medical complications of pregnancy. Obesity increases maternal complications such as preeclampsia, caesarean rate, cardiovascular disease, obesity, and diabetes after pregnancy; and neonatal complications including macrosomia, hypoglycaemia, hyperbilirubinemia, delivery trauma, shoulder dystocia, and adult-onset obesity, and diabetes. Obese patients have lower serum AMH levels.What the results of this study add? A significant relationship between AMH levels and CVD risk in obese pregnant women was observed.What are the implications of these findings for clinical practice and/or further research? Based on this finding, we concluded that decreased AMH levels are predictive for CVD in obese pregnant women.

Associations between night eating syndrome and metabolic parameters in pregnant women.

OBJECTIVE: In this study, we aimed to evaluate the incidence of night eating in pregnancy and the relationship between night eating scores and nutritional status, insulin resistance, and lipid profile in pregnant women. MATERIALS AND METHODS: In this study, 148 pregnant women who presented to the Gynecology and Obstetrics Clinics at Konya Training and Research Hospital in Konya were divided into two groups according to their night eating scores. These two groups were compared in terms of their nutritional attitudes and metabolic parameters. RESULTS: Comparisons of participants meeting night eating syndrome (NES) scores versus women without NES indicated that patients with NES exhibited fever hunger at breakfast time, more breakfast skipping (p<0.05) than those without NES. Also homeostatic model assessment insulin resistance, insulin, and high-density lipoprotein cholesterol parameters were significantly higher in pregnant women in the NES group (p<0.05). Also, correlations were found between higher night eating questionnaire total scores and higher HbA1c, insulin resistance, insulin, and more breakfast skipping. CONCLUSION: The results of this study suggest that night eating symptoms during pregnancy may increase and this is able to effect glucose metabolism.

Increased levels of serum serglycin and agrin is associated with adverse perinatal outcome in early onset preeclampsia.

Goal: Our aim was to determine whether alterations in serum serglycin and agrin levels in early-onset preeclampsia (EOPE) are useful in predicting adverse perinatal outcomes such as fetal growth restriction (FGR), intrauterine fetal demise (IUFD), preterm delivery and/or neonatal unit admission. Materials and Methods: A prospective case-controlled study enrolled 88 pregnant patients (44 EOPE and 44 controls). Maternal serum serglycin and agrin levels were determined before the 34th gestational week by enzyme-linked immunosorbent assay. Results: Compared with controls, women with EOPE had significantly higher serglycin and agrin levels (p = .018; p = .048). Multivariable logistic regression analysis revealed serglycin was independently associated with FGR in EOPE (OR 0.866; 95% CI 0.779-0.953). Agrin was independently associated with IUFD in EOPE (OR 0.757, 95% CI 0.636-0.879). Conclusions: The current study suggests that increased maternal serum serglycin is associated with FGR, and increased maternal serum agrin is associated with IUFD in EOPE.

Comparison of Serum A Disintegrin and Metalloproteinase with Thrombospondin Motifs-19 Levels in Different Fertility Situations: Could It Be a Serum Marker of Ovarian Function and Oocyte Pool?

BACKGROUND/AIMS: A disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS) enzymes take part in extracellular matrix (ECM) remodeling which has been shown to contribute to the ovulation and follicular functions. We aimed to compare serum levels of ADAMTS-19 in patients with different fertility situations. METHODS: A total of 86 women were enrolled to this cross sectional and case-control study. Four groups were constituted with respect to women's clinical and hormonal status: group 1, women with premature ovarian failure (POF; n = 21); group 2, women with natural menopause (n = 21); group 3, women with polycystic ovary syndrome (PCOS; n = 22); and group 4, healthy fertile controls. Serum ADAMTS-19 levels and individual characteristics were compared among groups. RESULTS: -ADAMTS-19 levels were found as 36.7 ± 10.2, 40.1 ± 12.6, 46.7 ± 16.1, and 51.0 ± 18.8 ng/mL in POF, fertile, natural menopause, and PCOS groups, respectively (p = 0.012). Especially, ADAMTS-19 levels in the PCOS group were significantly higher than the POF group, as found in dual comparisons (p = 0.010). CONCLUSIONS: ADAMTS-19 was found to be higher in PCOS patients than in POF patients. This work provides a novel vantage point for function of ECM within the ovary. ADAMTS-19 may have a potential for being an important marker of ovarian function and oocyte pool.

Serum 25-Hydroxy Vitamin D Levels in Turkish Adolescent Girls with Polycystic Ovary Syndrome and the Correlation with Clinical/Biochemical Parameters.

STUDY OBJECTIVE: Polycystic ovary syndrome (PCOS) is a common endocrinopathy among female adolescents and young women. The aim of this study was to investigate the relationship between serum 25-hydroxy vitamin D (25[OH] D) levels and metabolic parameters and other characteristics of PCOS and non-PCOS adolescents. DESIGN: Case-control study. SETTING AND PARTICIPANTS: We analyzed 31 girls with PCOS as defined using the Rotterdam criteria and 35 girls were non-PCOS control participants. INTERVENTIONS AND MAIN OUTCOME MEASURES: The serum 25(OH) D level was measured. Anthropometric, clinical, endocrine, and metabolic components were determined in both groups. RESULTS: The group with PCOS showed no difference in the level of serum 25(OH) D (14.58 ± 6.15 vs 16.02 ± 7.87; P = .414). In addition to this, no significant correlations were found between serum 25(OH) D levels and endocrine or metabolic parameters in either PCOS patients or control participants. CONCLUSION: There was no difference in the level of serum 25(OH) D between PCOS patients and matched control participants. Vitamin D deficiency was common among the patients as well as in the control participants. Also, we did not find any relationship between serum 25(OH) D levels and clinical or metabolic profiles in the 2 groups.

Decreased oxidative stress may contribute to the disease process in placenta accreta

Background/aim: The main aim of this study was to investigate serum total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), and arylesterase levels in pregnant women with placenta accreta and to compare those with age-matched healthy pregnant women. Materials and methods: A total of 27 pregnant women who had clinically and pathologically proven placenta accreta and 30 age- and BMI- matched healthy pregnant women were enrolled in this case control study. Maternal serum TOS, TAS, OSI, and arylesterase levels were evaluated using logistic regression analysis to determine if there was an association with abnormal placental invasion or not. Results: Decreased OSI (OR= 0.999, 95%CI: 0.998-1.000, P = 0.035) and increased arylesterase levels (OR= 0.981, 95%CI: 0.970-0.993, P = 0.001) were significantly associated with the presence of placenta accreta. Maternal serum TOS, TAS, OSI, and arylesterase levels were not predictive for adverse perinatal outcomes (P > 0.05). Conclusions: Decreased OSI and increased arylesterase levels are significantly associated with placenta accreta and may contribute to the abnormal invasion process.

The investigation of the role of proteoglycans and ADAMTS levels in fetal membranes in physiopathological process of gestational diabetes.

About 2-5% of all pregnant women develop gestational diabetes mellitus (GDM) during pregnancy and its prevalence has increased markedly within the last decade. GDM is a metabolic syndrome produced by various degrees of carbohydrate intolerance during pregnancy. Various risk factors such as obesity, genetics, environmental factors, and hypertension have been described previously. Maternal and fetal complications occur in around 7% of pregnant women with GDM. In these patients, a relation between proteoglycans and ADAMTS proteases located in extracellular matrix in fetal membranes (placenta, cord, amnion) and complicated pregnancies has already been determined by various animal experiments. Changes in expression, structure and function of ADAMTS proteases and proteoglycans in fetal membranes lead to alteration in the structure of extracellular matrix. If we can establish a balance between these proteoglycans and ADMTS proteases or determine the changes in their structure and functions, it will be possible to predict the risk in high risk pregnancies at early weeks and to initiate treatment early or to follow the target population regularly. In addition, prevention or reduction of maternal and fetal complications may be possible. For this purpose, ADAMTS and proteoglycans the synthesis of which is too much or less, may be targeted and if we would be able to determine and prevent the changes in their levels in the early period of pregnancy, the development of GDM and its complications may be prevented or decreased. Thus, we may identify a marker for early diagnosis and treatment and reduce prematurity, which is the most common cause of fetal death. Fetal and maternal complications, and especially treatment and care costs of prematurity, may also be decreased.

Influenza infections in the 2014-2015 season and pregnancy outcomes.

INTRODUCTION: The most recent influenza season saw a prominent infectious burden over a period of six months in the Turkish capital, reminding observers of the pandemic in 2009 year. The aim of the present study was to investigate the consequences of seasonal outbreaks in pregnant women during the 2014-2015 influenza season. METHODOLOGY: Forty-seven pregnant female patients with symptoms of influenza-like illness who were admitted to tertiary perinatal care center in Ankara, Tukrey, between October 2014 and May 2015 were included in this case-control study. The subtype determination of influenza was performed with real-time reverse transcriptase-polymerase chain reaction (RT-PCR) testing. Clinical observations and pregnancy outcomes were compared with respect to subtypes. RESULTS: Classifications were available for 35 patients, of whom 12 were determined to have influenza A infection, while 10 had influenza B infection. The remaining 13 patients were influenza-negative. Eight of the 22 (36.4%) influenza-positive patients delivered their babies in the preterm period (< 37 weeks). The corresponding rate was 8.3% (1/12) in the influenza-negative group. This difference was not statistically significant (p = 0.077). CONCLUSIONS: Preterm deliveries in pregnant women did not differ significantly among influenza-postive and influenza-negative pregnant women in non-vaccinated study population. Further studies with larger sample sizes may provide more supporting results.

Role of Versican and ADAMTS-1 in Polycystic Ovary Syndrome.

OBJECTIVE: ADAMTS-1 is a matrix metalloproteinase which cleaves versican in the cumulus oocyte complex under the effect of luteinizing hormone surge in the periovulatory period. Altered levels may have a role in the pathogenesis of polycystic ovary syndrome (PCOS). We aimed to determine the serum versican and ADAMTS-1 (a disintegrin and metalloproteinase with thrombospondin motif-1) levels in PCOS patients and compare the results with healthy controls. METHODS: Thirty-eight patients with PCOS and forty healthy controls aged between 15 and 22 years were included in the study. They were sampled according to their basal hormone, serum versican, and ADAMTS-1 levels. Serum versican and ADAMTS-1 levels were measured by enzyme-linked immunosorbent assay. A multivariate logistic regression model was used to identify the independent risk factors of PCOS. RESULTS: Serum versican levels were significantly decreased in the PCOS group when compared with the controls. The best versican cut-off value for PCOS was calculated to be 33.65 with 76.74% sensitivity and 52.94% specificity. Serum versican levels, homeostasis model assessment of insulin resistance index, a Ferriman-Gallwey score higher than 8, and oligomenorrhea were the strongest predictors of PCOS. Serum versican levels were significantly decreased in PCOS patients. Besides, serum ADAMTS-1 and versican levels were significantly and positively correlated with each other. CONCLUSION: Serum versican levels were significantly decreased in patients with PCOS. This suggests a possible role of versican in ovulatory dysfunction and in the pathogenesis of PCOS.