Factors affecting cord blood leptin levels in a consecutive birth cohort.

INTRODUCTION: The fetus that fails to meet its ideal growth trajectory has increased risks of poor health outcomes throughout life. "Gold standard" methods of anthropometric assessment such as measurement of percentage body fat can be difficult to apply across populations and other biomarkers such as serum concentration of umbilical cord blood leptin may be more effective for screening. This study reports cord blood leptin levels in a large prospective consecutive birth cohort and assesses the relationship between leptin and neonatal and maternal factors. METHODS: Venous umbilical cord blood samples were collected from a prospective consecutive cohort of pregnancies at the time of delivery. Maternal and neonatal characteristics and details of delivery were collated. Serum leptin levels were measured, associations with demographic features were identified, and a normal range was established. The association between cord leptin level and neonatal outcome was tested. RESULTS: Umbilical cord leptin and maternal and neonatal characteristics were collected at 1275 births. The median leptin value was 10.8 ng/ml (IQR: 6.4, 17.8 ng/ml). Log10 leptin was significantly associated with gestation at delivery, birthweight (BWt), infant sex, plurality, and maternal body mass index (BMI) (p < .001). Observed leptin values were expressed as multiples of the median (MoM). The mean leptin MoM was significantly lower in infants admitted to NICU following delivery (0.85; 95% confidence interval [CI]: 0.78-0.91 versus 1.05; 95% CI: 1.03-1.06 (controls), p < .001). There was no significant association between leptin MoM values and 5-min Apgar scores. CONCLUSIONS: Neonatal cord leptin levels are influenced by a number of maternal and fetal characteristics. Absolute levels can be adjusted to account for normal population variation. Infants requiring admission to NICU have lower mean leptin MoM levels. Further studies are needed to see whether the identification of fetuses with polarized leptin levels (<5th or >95th centile) will benefit from further surveillance or intervention in infancy.

Experiences of non-invasive prenatal screening: A survey study.

BACKGROUND: In Australia, using non-invasive prenatal testing (NIPT) to screen for fetal abnormalities is becoming more commonplace. However, there is a lack of standardised procedures surrounding pre-test counselling. This holds the potential for variability in pregnant people's experiences when undergoing NIPT, which subsequently may impact their ability to make informed decisions surrounding NIPT results. AIM: This study sought to characterise the experiences of Australian women undergoing NIPT, including perceptions of informed choice, counselling experiences and decision to undergo NIPT. MATERIALS AND METHODS: Australian women who had been recently pregnant (n = 94) completed an online survey which assessed: their knowledge of and attitude toward NIPT; satisfaction with counselling; satisfaction with their decision; and decisional conflict to undergo NIPT. The survey also allowed participants to provide qualitative information about their counselling experience and reasons for undergoing NIPT. RESULTS: Overall, participants had good knowledge of and positive attitudes toward NIPT, experienced low decisional conflict and were overall satisfied with their counselling experience and decision to undergo NIPT. However, some participants expressed dissatisfaction with the lack of information provided, and biased language, by counselling providers. The desire to be informed was the most frequent reason for undergoing NIPT. CONCLUSION: The provision of accurate and objective information in pre-test counselling is important to reduce decisional conflict and improve satisfaction with the decision to undergo NIPT. It is recommended counselling providers present pregnant people with neutral, objective, and accurate information at the time of pre-test counselling.

Combination therapy with mifepristone and misoprostol for the management of first trimester miscarriage: Improved success.

BACKGROUND: First trimester miscarriage affects 20% of pregnancies. Medical management has a high degree of patient acceptance and does not increase the risk of infection. Mifepristone is an anti-progesterone shown to improve outcomes when used in conjunction with misoprostol for first trimester abortion. However, there have been conflicting results when it has been added to treatment regimens for miscarriage. METHODS: We performed a retrospective cohort analysis of women presenting to the Acute Gynaecology Service of our tertiary referral centre for miscarriage management from December 2010 until December 2013. Patients given misoprostol alone were compared to those who received combination treatment with mifepristone and misoprostol. Primary outcome was failure of treatment determined by the need for repeat medical management or surgical curettage. Secondary outcome was need for hospital admission. RESULTS: A total of 281 women were treated from December 2010 to December 2013: 179 received combined mifepristone and misoprostol and 102 received misoprostol only. The primary outcome was significantly different between the two groups; 73% of women in the mifepristone and misoprostol group required no further treatment compared to only 56% of women in the misoprostol only group (P = 0.012). There were fewer hospital admissions, with 24% in the combined therapy group being admitted compared to 42% in the misoprostol only group (P < 0.001). CONCLUSION: The addition of mifepristone to medical treatment regimens for first trimester miscarriage significantly decreased the need for repeat medical dosing and surgical curettage. Hospital admissions were also significantly decreased.

First trimester prediction and prevention of adverse pregnancy outcomes related to poor placentation.

PURPOSE OF REVIEW: To summarize recent research findings related to first trimester prediction and prevention of adverse pregnancy outcomes associated with poor placentation. Recent publications related to prediction and prevention of preeclampsia, intrauterine growth restriction (IUGR) and stillbirth were reviewed. RECENT FINDINGS: Researchers continue to identify markers that will help predict pregnancies that go on to develop preeclampsia through screening at 11-13 weeks. A number of multivariate algorithms describing risks for preeclampsia have been published and some of these have been validated in independent populations. A large randomized controlled trial has proven the efficacy of a first trimester prediction - prevention programme for preeclampsia with an 80% reduction in prevalence of disease leading to delivery less than 34 weeks. Screening tools for IUGR and stillbirth are less advanced and require further validation in other populations. The value of these models in preventing disease still needs to be demonstrated. SUMMARY: Significant progress has been made in developing predictive and preventive strategies which can affect the prevalence of severe early-onset preeclampsia. This approach could be adopted for population-based screening aiming to prevent this disease.

Comparison of induction of labour regimes for termination of pregnancy, with and without mifepristone, from 20 to 41 weeks gestation.

AIM: To investigate the efficacy of mifepristone for induction of labour in pregnancies at 20-41 weeks' gestation, by comparing the outcomes of length of labour and duration of admission in women with and without mifepristone pretreatment. METHOD: In this retrospective cohort study, all women who underwent a medical termination of a singleton pregnancy between 20 and 41 weeks gestation for either a fetal abnormality or fetal death in utero between 1 January, 2009 and 1 January, 2014 were identified. Women who went into spontaneous labour, required a primary surgical delivery or had a multiple pregnancy were not included. RESULTS: The total number of women included in the study was 147: 63 in the mifepristone treatment and 84 in the no mifepristone treatment. In the group of women induced after mifepristone pre-treatment there was a 38% reduction in the median duration of labour, with 2.5 h in the group treated with mifepristone versus 4.0 h in women induced without (P = 0.001). We also found a 50% reduction in the number of days admitted to hospital with the length of admission being 1 day versus 2 days (P = 0.005). CONCLUSION: This study supports the hypothesis that in pregnancies greater than 20 weeks, the duration of labour and length of admission are reduced when induction of labour for termination of pregnancy is preceded by treatment with mifepristone.