Is there a difference in placental pathology in pregnancies complicated with gestational diabetes A2 versus gestational diabetes A1, versus one abnormal value, on 100 gr glucose tolerance test?

INTRODUCTION: The objective of the study was to investigate pregnancy outcome and placental pathology lesions among patients with gestational diabetes mellitus (GDM) versus patients with one abnormal value (OAV), in the oral glucose tolerance test (OGTT). METHODS: A prospective study was performed from 2016 to 2019. All participants performed an OGTT between 24 and 28 weeks. Included patients who delivered at term (>37 weeks) with the diagnosis of GDMA2 (treated with insulin), GDMA1 (controlled with diet) and those with OAV. Maternal characteristics, pregnancy outcomes, and placental histopathology reports were compared between the GDMA2, GDMA1, and OAV groups. Placental lesions were classified according to "Amsterdam" criteria to maternal and fetal vascular malperfusion (MVM, FVM) lesions, and inflammatory lesions. RESULTS: The GDMA2 group (n = 59) was characterized by higher maternal BMI (p < 0.001), increased rate of chronic hypertension (p < 0.01), cesarean delivery (CD) (p < 0.001), adverse neonatal outcomes (p < 0.001) and prolonged hospitalization (p < 0.001) as compared to the GDMA1 (n = 73) and the OAV group (n = 124). Average placental weight in the GDMA2 group were higher (p = 0.004). There were no between groups differences in the rate of placental MVM or inflammatory lesions. The OAV and GDMA1 groups were characterized by an increased rate of FVM lesions, as compared to the GDMA2 group (p = 0.02). DISCUSSION: GDMA2 is associated with increased rate of CD and adverse neonatal outcome. The similar rate of placental MVM lesions among the study groups, and the increased rate of FVM lesions observed among the OAV group, implies of impaired placental function among the OAV group as in GDM pregnancies.

Efficient Maternal to Neonatal transfer of SARS-CoV-2 and BNT162b2 antibodies

BackgroundThe significant risks posed to mothers and fetuses by COVID-19 in pregnancy have sparked a worldwide debate surrounding the pros and cons of antenatal SARS-CoV-2 inoculation, as we lack sufficient evidence regarding vaccine effectiveness in pregnant women and their offspring. We aimed to provide substantial evidence for the effect of BNT162b2 mRNA vaccine versus native infection on maternal humoral, as well as transplacentally acquired fetal immune response, potentially providing newborn protection. MethodsA multicenter study where parturients presenting for delivery were recruited at 8 medical centers across Israel and assigned to three study groups: vaccinated (n=86); PCR confirmed SARS-CoV-2 infected during pregnancy (n=65), and unvaccinated non-infected controls (n=62). Maternal and fetal blood samples were collected from parturients prior to delivery and from the umbilical cord following delivery, respectively. Sera IgG and IgM titers were measured using Milliplex MAP SARS-CoV-2 Antigen Panel (for S1, S2, RBD and N). ResultsBNT162b2 mRNA vaccine elicits strong maternal humoral IgG response (Anti-S and RBD) that crosses the placenta barrier and approaches maternal titers in the fetus within 15 days following the first dose. Maternal to neonatal anti-COVID-19 antibodies ratio did not differ when comparing sensitization (vaccine vs. infection). IgG transfer rate was significantly lower for third-trimester as compared to second trimester infection. Lastly, fetal IgM response was detected in 5 neonates, all in the infected group. ConclusionsAntenatal BNT162b2 mRNA vaccination induces a robust maternal humoral response that effectively transfers to the fetus, supporting the role of vaccination during pregnancy.

Survivin expression in the ureteral wall of high degree vesicoureteral reflux in children.

INTRODUCTION: Survivin is a member of inhibitor of apoptosis protein family which suppresses apoptosis and regulates cell division. Survivin was not found to be expressed in normal differentiated tissues. CD95 is a cell surface receptor, and it is believed to induce cell death in a variety of cells. The goal of this study is to evaluate the survivin and CD95 expression in bladder and uerters of children operated for vesicoureteral reflux (VUR). MATERIALS AND METHODS: Sixteen paraffine embeded ureteral units of 11 children with vecico ureterl reflux were treated immunohistochemicaly with survivin and CD95. At operation the distal margins of the ureters were send to histologic exam and a full thickness biopsy from the anterior bladder wall including muscle and mucosa were performed. The control was taken from a urologically normal 9 days old baby who died from myocarditis. The sections were stained with the antibody in the regular method and the degree of staining was graded from 0 to 3, by a single uropathologist. RESULTS: Immunohistochemistry staining with survivin was positive in all ureters. We had 13 high grade (grade 3-5) and 3 low grade (grade 1-2) vesicoureteral reflux. The average survivin degree of staining in the low grade reflux was 1.33 compared to 2.3 (P = 0.019) in the high grade refluxing ureters. The staining of the control sample was graded 1. The average degree of staining was 1.2 in the bladder wall compared to 2.125 in the ureters. CD95 stained mast cells in ureters and bladders. CONCLUSIONS: Possitive staining of survivin was found in both ureters and urinary bladders of children that underwent surgical repair of vesicoureteral reflux. The degree of survivin staining was significantly higher in the high grade refluxing ureters compared to low grade reflux and to the bladder wall in the same patients.