Fetal Diaphragmatic Excursion Is Decreased in Hospitalized Pregnant Women Infected with COVID-19 during the Second and Third Trimesters.

OBJECTIVE: In the present study, we aimed to evaluate coronavirus disease 2019 (COVID-19) infection effects on fetal diaphragm thickness and diaphragmatic excursion, which together show the quality of diaphragmatic contractions. STUDY DESIGN: One hundred and ninety-two pregnant women were included in this prospective case-control study. Patients were divided into four groups according to their COVID-19 infection history in their second or third trimester: hospitalized COVID-19-infected pregnant women group (n = 48), outpatient COVID-19-infected pregnant women group (n = 48), common cold (COVID-19 polymerase chain reaction negative) pregnant women group (n = 48), and noninfected healthy controls (n = 48). The number of patients was determined by power analysis following the pilot study. All participants underwent an ultrasound examination to determine fetal diaphragm parameters at 32 to 37 weeks of gestation. RESULTS: Demographic characteristics were similar among the four groups. The gestational age at ultrasound examination and gestational age at delivery were similar among the groups. Neonatal intensive care unit (NICU) admission rate was significantly higher in the hospitalized COVID-19-infected pregnant women group than the other groups. The fetal diaphragm thickness during inspiration and expiration, and fetal costophrenic angles at inspiration and expiration were similar among the groups. Fetal diaphragmatic excursion was significantly decreased in the hospitalized COVID-19-infected pregnant women group compared with the other groups. CONCLUSION: Our results indicated that moderate maternal COVID-19 infection decreased fetal diaphragmatic excursion, and ultrasonographic evaluation of fetal diaphragmatic excursion before delivery can provide critical information to predict whether infants will require NICU admission. KEY POINTS: · Diaphragm ultrasound as a new technique for characterizing the diaphragm's structure and function.. · Fetal diaphragmatic excursion is decreased in the presence of moderate COVID-19 infection.. · Ultrasonographic evaluation of fetal diaphragmatic excursion provides critical information to predict NICU admission..

Severe Intrahepatic Cholestasis Pregnancy Is Associated With Maternal Endothelial Dysfunction: A Case-Control Study.

OBJECTIVE: The aim of the present study was to evaluate maternal serum endocan levels, which are markers of vascular pathologies and strongly associated with vascular inflammation and endothelial dysfunction, in pregnancies complicated by intrahepatic cholestasis of pregnancy (ICP). METHODS: The study comprised 30 pregnant women with mild ICP, 30 pregnant women with severe ICP, and 30 healthy pregnant women as a control group. The inclusion criteria were women with ICP, which was diagnosed based upon the presence of pruritus associated with elevated total bile acid (TBA) levels (> 10 µm/L), elevated aminotransferases, or both, and the absence of diseases that may produce similar laboratory findings and symptoms. Severe ICP was defined as TBA > 40 µmol/L. After diagnosis for ICP, blood samples were obtained before medication during hospitalization to analyze maternal serum endocan levels. RESULTS: Gestational age at delivery, delivery induction rates, birth weight, and newborn intensive care unit (NICU) admission rates were significantly higher in the severe ICP group than in the control group and mild ICP group. Gestational age for all groups when blood was sampled was similar. Maternal serum TBAs and aminotransferase levels were significantly higher in the severe ICP group than in the control group and mild ICP group. The mean serum endocan levels were 10.9 ± 2.6 ng/mL in the control group, 12.5 ± 2.8 ng/mL in the mild ICP group, and 24.3 ± 4.8 ng/mL in the severe ICP group (p < 0.001). CONCLUSION: Our results indicated that maternal serum endocan levels were increased in the presence of severe ICP and it can be speculated that increased bile acid levels were associated with maternal endothelial dysfunction.

The effect of steroid administration on fetal diaphragm function.

BACKGROUND: Antenatal steroid administrations lead to not only accelerated lung maturation, improved blood gas measurements but also lung dynamics and lung compliance. This study aimed to investigate structural and functional changes in diaphragm after antenatal steroid administration. METHODS: The 79 volunteers were divided into 2 groups according to presence of preterm delivery. Betamethasone (CelestoneR) 12 mg intramuscularly was routinely administered to pregnancies complicated with preterm delivery between 28th -34th weeks of gestation. Same dose was repeated 24 h later. In all patients, diaphragm thickness, diaphragmatic excursion and costophrenic angle were measured in both the inspirium and expirium stage of respiration. This is an observational cross-sectional study. RESULTS: Diaphragm thickness, diaphragmatic excursion and diaphragm thickening fraction parameters were improved but costophrenic angle was not different 7 days after steroid administration. Diaphragm thickness, diaphragmatic excursion and costophrenic angle changes during inspiration and expiration stage after 7 days of betamethasone treatment reflects the effect of steroid administration on diaphragm muscle. Comparisons of the differences that occur after steroid rescue protocol were done by subtracting the diaphragm thickness, diaphragmatic excursion and costophrenic angle parameters before the treatment from the diaphragm thickness, diaphragmatic excursion and costophrenic angle parameters 7 days after steroid treatment respectively. CONCLUSION: Diaphragm became more mobile in patients with preterm labor, 7 days after steroid administration. This situation reflects positive effect of steroid administration on diaphragm function.

Evaluation of maternal serum progesterone-induced blocking factor levels in pregnancies complicated with early- and late-onset preeclampsia.

The aim of present study was to evaluate maternal serum progesterone-induced blocking factor (PIBF) levels in pregnancies complicated with early-onset (EO-PE) and late-onset (LO-PE) preeclampsia. Patients with preeclampsia were divided in two groups according to preeclampsia onset and compared to healthy control group: EO-PE and LO-PE defined as being diagnosed before 340/7 and ≥340/7 weeks, respectively. Maternal age, nulliparity, BMI at blood sampling, smoking, history of caesarean section and ethnicity were statistically similar among the groups. Statistically significant differences were found between the eo-PE and lo-PE preeclampsia groups in terms of gestational age at delivery, mean birth-weight percentile and foetal growth restriction rates. The mean serum PIBF level was 528.6 ± 220 ng/mL in the eo-PE and 615.3 ± 269.1 ng/mL in the lo-PE preeclampsia and 782.3 ± 292.4 ng/mL in the control groups; the difference among groups was statistically significant. Our results indicated that decreased PIBF levels play an important immunologic role in preeclampsia onset. IMPACT STATEMENTWhat is already known on this subject? Maternal lymphocytes secrete PIBF that provides the immunological effects of progesterone during pregnancy by activating T-helper type 2 (Th2) cells and inhibiting any activated uterine natural killer (uNK) cells. The recent studies results have shown that there is disproportion in the Th1/Th2 rate in women with preeclampsia. This purports that Th1-mediated immunity is promoted through Th2-mediated immunity, which can be involved in the pathogenesis of preeclampsia.What do the results of this study add? In this study we found that PIBF levels in maternal serum were significantly lower in the EO-PE group than in LO-PE and control group. Our results indicated that decreased PIBF levels play an important immunologic role in preeclampsia onset.What are the implications of these findings for clinical practice and/or further research? We can speculate that first trimester maternal serum PIBF levels may be a useful biomarker for prediction of EO-PE. Using serum PIBF levels within the first trimester combined with Doppler values for the uterine artery, and some biochemical markers to predict onset and severity of preeclampsia appear to be a new screening method.

First-trimester maternal serum betatrophin levels are decreased in pregnancies complicated by gestational diabetes mellitus.

INTRODUCTION: The purpose of the present study was to compare maternal serum betatrophin levels during the first trimester from healthy pregnancies to those complicated by gestational diabetes mellitus (GDM). METHODS: In this prospective study, 320 pregnant women were evaluated in their first trimester, and 145 pregnant women who met the inclusion criteria were divided into the following two groups according to GDM screening results: GDM (n:20) and non-diabetic healthy control (n: 125). Samples of maternal serum fasting insulin, fasting blood glucose, hemoglobin (HB)A1c, and betatrophin levels obtained from the women's blood samples between 11+0/7 -13+6/7 gestational weeks during first trimester nuchal translucency screening. 75-g oral glucose tolerance test protocol was preferred for GDM scanning between 24+0/7 -28+0/7 gestational weeks. RESULTS: Maternal age and first-trimester body mass index (BMI) were higher in the GDM group than in the control group. Gestational age at blood draw was similar between the groups. First-trimester fasting insulin, fasting glucose, hemoglobin (Hb)A1c, thyroid-stimulating hormone, triiodothyronine (sT3), and thyroxine (sT4) were statistically similar between groups. First trimester Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) was 2.67 ± 1.42 in the GDM group and 2.12 ± 1.61 in the control group and not statistically different. Maternal age and BMI adjusted first-trimester maternal serum betatrophin levels were 11.58 ± 6.40 ng/mL in the GDM group and 31.11 ± 3.00 ng/mL in the control group and was statistically lower in the GDM group (p < 0.001). DISCUSSION: Our results indicated that first trimester maternal serum betatrophin levels are decreased in pregnancies complicated by GDM and first trimester betatrophin levels could be an early screening tool for GDM to allow better pregnancy management.

Maternal serum telomerase levels increase in pregnancies with mild and severe preeclampsia.

INTRODUCTION: Considering that preeclampsia is characterized by oxidative stress, inflammation, and endothelial dysfunction, we hypothesized that preeclampsia and preeclampsia severity may affect the telomerase levels of the mother. METHODS: This cross-sectional case control study comprised 86 participants who were separated into three groups as severe preeclampsia, non-severe preeclampsia, and healthy control group. Venous blood samples were obtained from pregnant women with severe preeclampsia just before delivery for biochemical analysis and to evaluate maternal serum telomerase levels. Since gestational age, maternal age and BMI would have an effect on maternal serum telomerase levels, serum samples were taken in the control group and non-severe preeclampsia group at similar gestational age during clinical visits in order to homogenize these parameters, and these patients were followed up. Telomerase levels in maternal serum were evaluated using the enzyme-linked immune-sorbent assay. RESULTS: Maternal age, nulliparity, body mass index (kg/m2) at blood sampling day, ethnicity, smoking and history of caesarian section were statistically similar among the groups. The mean birth weight percentiles were the lowest in the severe preeclampsia group. Fetal growth restriction rates were significantly higher in the severe preeclampsia group than in the non-severe preeclampsia group. Gestational age at blood drawn was similar among groups. Neutrophil lymphocyte ratio, platelet lymphocyte ratio, mean platelet volume, red cell distribution width and white blood cell were statistically different among groups. The serum telomerase level was 1.137 ± 0.390 ng/mL in the severe preeclampsia group, 0.763 ± 0.390 ng/mL in the non-severe preeclampsia group, and 0.425 ± 0.160 ng/mL in the control group (p < .001). DISCUSSION: This study indicated that maternal serum telomerase levels were significantly increased in both preeclampsia groups.

COVID-19 disease does not cause ovarian injury in women of reproductive age: an observational before-and-after COVID-19 study.

RESEARCH QUESTION: Can the SARS-CoV-2 virus injure the ovaries? DESIGN: An observational before-and-after COVID-19 study at an academic medical centre. A total of 132 young women aged 18-40 were enrolled; they were tested for reproductive function in the early follicular phase, and their information was obtained from hospital data between January 2019 and June 2021. Serum FSH, LH, oestradiol, the ratio of FSH to LH and anti-Müllerian hormone (AMH) concentrations were measured for each patient both before and after COVID-19 disease. RESULTS: In women with unexplained infertility, the median serum AMH concentrations (and ranges) were 2.01 ng/ml (1.09-3.78) and 1.74 ng/ml (0.88-3.41) in the pre-COVID-19 disease and post-COVID-19 disease groups, respectively. There was no statistically significant difference in terms of serum concentrations of AMH between pre- and post-illness (P = 0.097). Serum FSH, LH, FSH/LH ratio and oestradiol concentrations of the patients before COVID-19 illness were similar to the serum concentrations of the same patients after COVID-19 illness. CONCLUSION: According to these study results and recent studies investigating the effect of COVID-19 on ovarian reserve, it is suggested that the SARS-CoV-2 virus does not impact ovarian reserve; however, menstrual status changes may be related to extreme immune response and inflammation, or psychological stress and anxiety caused by the COVID-19 disease. These menstrual status changes are also not permanent and resolve within a few months following COVID-19 illness.

Evaluation of fetal diaphragm excursion and thickness in term pregnancies complicated with pre-gestational and gestational diabetes mellitus.

BACKGROUND: Both pre-gestational (PGDM) and gestational diabetes mellitus (GDM) make pregnancy complicated. Moreover in the literature GDM and PGDM have been held responsible for respiratory morbidity in newborns. Diaphragm ultrasound (DUS) is a valuable and noninvasive method that provides an opportunity to examine the diaphragmatic morphology and function. This study examined the quality of fetal diaphragmatic contractions in pregnant women complicated with GDM and PGDM. METHODS: A total of 105 volunteers who were separated into three groups; (1) A GDM group (n = 35), (2) a PGDM group (n = 35), and (3) a healthy non-diabetic control group (n = 35). All volunteers with the cephalic presentation and only male fetuses were examined in the 37th week of gestation. This cross sectional and case controlled study was performed at the perinatology clinic of the Erciyes University School of Medicine between 15.01.2020 and 01.08.2021. The thickness of fetal diaphragm (DT), diaphragmatic excursion (DE), diaphragm thickening fraction (DTF) and costodiaphragmatic angle (CDA) was measured and recorded by ultrasound and examined on the video frame during the inspiration and expiration phases of respiration. RESULTS: Especially the PGDM group represented adversely affected diaphragm function parameters. DT inspiration, DT expiration, DE, CDA inspiration and DTF values were significantly different between PGDM and the control group. Neonatal intensive care unit (NICU) admission was high among babies who were born to pregnancies complicated with PGDM or GDM. CONCLUSIONS: The quality of fetal diaphragm movements is affected in pregnancies complicated with GDM and PGDM. The prolonged duration of diabetes may have additional adverse effects on diaphragm morphology and its function.

The percentage of pre-gestational diabetes mellitus (PGDM) in pregnancy is 13­21% and the remaining part of diabetes is gestational diabetes mellitus (GDM). Both of the complications are related to respiratory problems at birth.Until now, it was known that this situation was due to the lack of surfactant, which has a facilitating effect on the participation of the lungs in respiration. However, in this study, the diaphragm of the babies of patients with PGDM and GDM was examined. The thickness of fetal diaphragm, movements and function were evaluated via using ultrasound. As a result, it was determined that the diaphragm movements were impaired and the babies born from these patients needed more pediatric care.This study will open horizon on new studies examining the functional capacity of the diaphragm in the future. In the future, it may be possible to decide which baby will need intensive care by examining the diaphragm.

New ultrasonographic midtrimester scoring method for predicting spontaneous preterm birth in uncomplicated asymptomatic twin pregnancies.

OBJECTIVES: The aim of the present study was to evaluate a new ultrasonographic scoring method that could predict spontaneous preterm birth (sPTB) in uncomplicated twin pregnancies during routine anomaly screening in the midtrimester. METHODS: This prospective study included women with a monochorionic diamniotic (MCDA) or dichorionic diamniotic (DCDA) twin pregnancy gestational ages from 170/7 through 226/7. A new ultrasonographic score between 0 and 5 points was calculated using cervical length (CL), uterocervical angle (UCA), and cervical dilatation status during routine anomaly screening in the midtrimester. The primary outcome of the study was the prediction of sPTB < 32 and <34 gestational weeks. RESULTS: A total of 118 pregnant women with twins were evaluated, 31 of whom delivered before 34 gestational weeks an 87 of whom delivered after 34 gestational weeks. The sensitivity and specificity values were separately calculated for scores of 3.5 and 2.5 for predicting sPTB < 32 gestational weeks. The cut-off value of 3.5 provided a sensitivity of 80% and a specificity of 82%. When the score was 2.5, the sensitivity and specificity were 86 and 71%, respectively. To determine a score for predicting sPTB < 34 gestational week cut-off value of 3.5 provided a sensitivity of 80% and a specificity of 90%. When the score value was 2.5, the sensitivity and specificity of the method were 83 and 81%, respectively. CONCLUSIONS: Our results indicated that the midtrimester new scoring is a simple technique that can be easily used as an improved tool for predicting the risk of sPTB in women with a twin pregnancy.

Evaluation of midtrimester ductus venosus diameter and peak systolic velocity to predict late onset small for gestational age fetuses.

OBJECTIVE: The ductus venosus, a small blood vessel in the fetal venous system, has extraordinary physiologic significance because it connects the umbilical vein to the inferior vena cava in the fetus circulation system and transports highly oxygenated blood from the placenta to the fetus' heart. Hence, assessment of ductus venosus flows is helpful in evaluating fetal hemodynamics. Considering the critical function of the ductus venosus, we hypothesized that the diameter of the midtrimester ductus venosus and its peak velocity index can be related to adequate fetal growth; therefore, the aim of this study was to evaluate the role of the midtrimester umbilical venous blood flow, ductus venosus diameter, and ductus venosus peak systolic velocity to help predict uncomplicated deliveries of late onset small for gestational age (SGA) fetuses. METHODS: In this prospective study we analyzed the pregnancies and deliveries of 398 pregnant women who met the inclusion criteria and divided them into three groups according to fetal birth weight as follows: birth weight <3 percentile SGA group (n = 16), birth weight 3-10 percentile SGA group (n = 42), and appropriate for the gestational age (AGA) group (n = 340). The midtrimester ductus venosus diameter and peak sistolic velocity, umbilical venous blood flow, and umbilical artery pulsatility index (PI) were recorded. In the absence of congenital anomalies, the diagnosis of fetal growth restriction (FGR) is made according to Delphi consensus criteria. In the absence of abnormal Doppler findings, late FGR was defined as occurring ≥32 weeks. RESULTS: Maternal age, nulliparity, mean gestational age at ultrasound evaluation, ethnicity, body mass index, and previous cesarean delivery rates were similar among the groups. In addition, mid-trimester fetal biometric measurements and amniotic fluid volume were similar among the groups. The gestational age at delivery, prematurity, fetal birth weight, vaginal delivery rates, and rate of admission to the neonatal intensive care unit were significantly different among the groups. The mean mid-trimester umbilical vein blood flow to abdominal circumference ratio (UVBF/AC) was similar among the groups (p=.740). In the <3 group, the mean peak systolic velocity of the ductus venosus was significantly lower and the mean diameter of the ductus venosus significantly higher than those in the 3-10 and AGA groups (both p<.001). Although the values are below the 95th percentile mid-trimester umbilical artery PI was significantly higher in the <3 percentile SGA group than in the 3-10 percentile SGA and AGA groups. CONCLUSION: Our results suggest that the diameter and peak systolic velocity of the mid-trimester ductus venosus are useful noninvasive measurements that provide prediction of late onset SGA fetuses.

Assessment of intrahepatic cholestasis in pregnancy and the effect of disease severity on transient tachypnea in the newborn in uncomplicated fetuses.

OBJECTIVES: Considering the effects of bile-acid levels on fetal lungs and pulmonary surfactants, we hypothesized that in the presence of intrahepatic pregnancy cholestasis (ICP), poor neonatal respiratory problems are observed in relation to the severity of the disease. Delivery timing with the presence of ICP is scheduled during late-preterm and early term gestational weeks. The aim of this study was to assess ICP and disease severity effects on transient tachypnea of the newborn (TTN) in uncomplicated fetuses. METHODS: This study comprised 1,097 singleton pregnant women who were separated into three groups-control, mild ICP, and severe ICP. The pregnant women diagnosed with ICP between January 2010 and September 2020 was investigated using the hospital's database. For the control group, healthy pregnant women who met the same exclusion criteria and were similar in terms of maternal age, gestational age at delivery, and mode of delivery were analyzed. RESULTS: The TTN rate was 14.5% in the severe ICP group, 6.5% in the mild ICP group, and 6.2% in the control group. The TTN rate in the severe ICP group was significantly higher than that in the other groups (p<0.001). Similarly, the rate of admission to the neonatal intensive care unit was significantly higher in the severe ICP group than in the other groups (p<0.001). According to Pearson correlation analyses, maternal serum bile-acid levels were positively correlated with TTN (r=0.082; p=0.002). CONCLUSIONS: Severe ICP, but not mild ICP, and serum bile-acid levels were positively correlated with increased TTN risk and reduced pulmonary surfactant levels.

The role of the brain-sparing effect of growth-restricted fetuses in newborn germinal matrix/intraventricular hemorrhage.

OBJECTIVES: The aim of the study was to evaluate the effect of the brain-sparing effect (BSE) of fetal growth restriction (FGR) in newborn germinal matrix/intraventricular hemorrhage (GM/IVH). METHODS: A total of 320 patients who delivered prior to the 34th gestational week were analyzed from data records. 201 patients were divided into two groups according to cerebro-placental ratio (CPR): early fetal growth restriction (FGR) with abnormal CPR group (n=104) and appropriate for gestational age with normal Doppler group (control) (n=97). Using the normal middle cerebral artery (MCA) Doppler as a reference, multivariate logistic regression analysis was used to assess the association between the BSE and the primary outcome. RESULTS: The rate of Grade I-II germinal matrix/intraventricular hemorrhage (GM/IVH) was 31(29.8%) in the group possessing early FGR with abnormal CPR and 7(7.2%) in the control group, showing a statistically significant difference. The rate of grade III-IV GM/IVH was 7(6.7%) in the group possessing early FGR with abnormal CPR and 2 (2.1%) in the control group, showing no statistically significant difference. We found that gestational age at delivery <32 weeks was an independent risk factor for GM/IVH. In addition, we found that other variables such as the presence of preeclampsia, fetal weight percentile <10, emergency CS delivery, 48-h completion after the first steroid administration and 24-h completion rate after MgSO4 administration were not independently associated with the primary outcome. CONCLUSIONS: Our results indicate that the rate of GM-IVH was increased in the group possessing early FGR with abnormal CPR; however, multivariate logistic regression analysis showed that BSE was not an independent risk factor for GM/IVH.

Evaluation of the diagnostic accuracy of a combination of first-trimester ultrasound and maternal demographic characteristics for detecting abnormally invasive placenta.

OBJECTIVE: The aim of present study was to evaluate the diagnostic accuracy of using a combination of a first-trimester ultrasound and the maternal demographic characteristics in detecting abnormally invasive placenta (AIP). STUDY DESIGN: This prospective case-control study comprised 540 women who meet the inclusion criteria and who were included in the final analysis. Patients scored points based on a range between 0 and 13 for the ultrasonographic and clinical findings within first trimester. The primary outcome of the study was whether placenta accreta, increta, and percreta could be predicted early in pregnancy. RESULTS: The cutoff value of 5.5 provided a sensitivity of 100% and a specificity of 88% and the diagnostic odds ratio (DOR at 95% confidence interval [CI]) was 208 (12-3543), at 95%CI) was 0, and the positive likelihood ratio (LR + at 95%CI) was 8.25 for placenta percreta. The cutoff value of 6.5 provided a sensitivity of 92% and a specificity of 93% and DOR at 95%CI was 201.5 (25.5-1583.1), LR- at 95%CI was 0.08, and LR + at 95%CI was 15.32 for placenta percreta. The cutoff value of 4.5 provided a sensitivity of 100% and a specificity of 90% and DOR at 95%CI was 615 (37-10207), LR- at 95%CI was 0, and LR + at 95%CI was 11.7 for accreta and increta, respectively. The cutoff value of 5.5 provided a sensitivity of 87% and a specificity of 92% and DOR at 95%CI was 86.8 (28.9-260.8), LR- at 95%CI was 0.14, and LR + at 95%CI was 11.7 for placenta accreta and increta, respectively. CONCLUSION: The results of the present study indicated that this novel scoring provided high diagnostic accuracy for detecting all types of AIP during the first trimester.

Effect of preeclampsia and its severity on maternal serum NGAL and KIM-1 levels during pregnancy and the post-pregnancy period.

OBJECTIVE: The purpose of this trial was to appraise the effects of preeclampsia and its intensity on maternal serum neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) levels during pregnancy and the post-pregnancy period. STUDY DESIGN: Firstly pregnant participants (n = 156) were separated into three groups, as control, mild, and severe preeclampsia. Secondly women in post-pregnancy period (n = 368) were separated into three groups according to history of pregnancy, as healthy control, mild, and severe preeclampsia. These women were identified through the hospital data system and contacted by telephone to participate in the study. RESULTS: Our study comprised 147 patients, 77 of whom were pregnant and 70 of whom were in their post-pregnancy period after the exclusion criteria had been applied. In terms of maternal serum NGAL levels, there is a significant increase in the severe preeclampsia group compared with that in the mild preeclampsia and normal pregnancy groups (p < 0.001). During the post-pregnancy period, the maternal serum NGAL levels were found significantly higher in the severe preeclampsia group than in the mild preeclampsia group and non-hypertension control group (p < 0.001). Maternal serum KIM-1 levels were found as significantly higher in the severe and mild preeclampsia groups than in the non-hypertension pregnancy group (p = 0.004). During the post-pregnancy period, maternal serum KIM-1 levels were found as similar among all post pregnant groups (p = 0.792). CONCLUSIONS: Our results indicated that as the severity of preeclampsia increases, kidney damage as assessed using NGAL levels continues for a long period of time, even during the post-pregnancy period.

Umbilical cord N-terminal procollagen of type l collagen (P1NP) and beta C-terminal telopeptide (ßCTX) levels in term pregnancies with vitamin D deficiency.

AIMS: The aim of the present study was to evaluate umbilical cord N-terminal procollagen of type l collagen (P1NP) and beta C-terminal telopeptide (ßCTX) levels in term pregnancies with vitamin D deficiency. MATERIALS AND METHODS: Ninety-two pregnant women between 19 and 35-years-old who delivered at term gestational age were included in the study and divided into deficient (n = 32), insufficient (n = 30), and normal (control) vitamin D levels (n = 30). RESULTS: Maternal demographic characteristics and biochemical parameters were similar among groups. The mean umbilical cord P1NP level was 221.4 (211.7-231.0, 95%CI) pg/mL in the vitamin D deficiency group, 282.5 (271.2-293.8, 95%CI) pg/mL in the vitamin D insufficiency group, and 280.9 (270.9-290.8, 95%CI) pg/mL in the control group and significantly lower in vitamin D deficiency group than others (p < .001). Umbilical cord P1NP level was similar in the vitamin D insufficiency group and control group (p = .971). The mean umbilical cord ßCTX level was 5530, 9 (5511.5-5550.3, 95%CI) pg/mL in the vitamin D deficiency group, 5516.3 (5498.4-5534.2, 95%CI) pg/mL in the vitamin D insufficiency group, and 5510 (5491.4-5528.5, 95%CI) pg/mL in the control group, which was statistically similar among the groups (p = .251). CONCLUSION: Our results indicated that vitamin D deficiency during pregnancy affects fetal bone osteoblast activity.

Effect of preeclampsia and preeclampsia severity on insulin, HOMA-IR, and betatrophin levels in non-diabetic pregnant women.

BACKGROUND: The aim of the study was to evaluate the effect of preeclampsia and its severity on insulin, the homeostatic model assessment of insulin resistance (HOMA-IR), and betatrophin levels in non-diabetic pregnant women. METHODS: Our study comprised 102 pregnant women who were divided into the following three groups: (1) control, (2) severe preeclampsia, and (3) mild preeclampsia. The women were screened with the single-stage 75-g oral glucose tolerance test (OGTT), and the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria were used for diagnosis. Those women with type 2 diabetes (T2D) mellitus or gestational diabetes mellitus (GDM) were excluded from the study. RESULTS: Maternal demographic characteristics were similar among the groups. Fasting plasma glucose and postprandial 2-h plasma glucose levels were significantly increased in the severe-preeclampsia group compared to that in the other groups. Fasting insulin levels were 14.3 ± 8.7uU/mL in the severe-preeclampsia group, 19.1 ± 6.0uU/mL in the mild-preeclampsia group, and 20.5 ± 12.5uU/mL in the control group and significantly lower in the severe-preeclampsia group than in the mild-preeclampsia and control groups. The serum betatrophin level was 7.8 ± 2.6 ng/mL in the severe-preeclampsia group, 6.1 ± 1.8 ng/mL in the mild-preeclampsia group, and 5.8 ± 1.3 ng/mL in the control group and significantly increased in the severe-preeclampsia group compared to other groups. HOMA-IR was similar among the groups. Maternal serum insulin levels were negatively (r = -0,255; P = 0.010) and serum betatrophin levels were positively (r = 0.368; P ≤ 0.001) correlated with preeclampsia severity. CONCLUSION: Our results indicated that severe preeclampsia effect maternal serum glucose, insulin and betatrophin levels. Histhopatholical and immunohistochemical demostrations on pancreatic cells in new preeclampsia rat models will expand the information on the current situation.

The role of serum progesterone induced blocking factor on unexplained infertility.

OBJECTIVE: The aim of this study was to determine whether the progesterone-induced blocking factor (PIBF) level in women with unexplained infertility differed from that in fertile women. STUDY DESIGN: Volunteers between 18 and 35 years old were included in this cross-sectional study and were divided into two groups-the unexplained-infertility group and the control group. Demographic data on all the women were collected using a detailed questionnaire. The infertile participants and their male partners received complete infertility examinations according to the protocol. Blood samples were taken from all participants after the examinations during regular clinic visits. Serum PIBF levels were measured using an enzyme-linked immunosorbent assay. RESULTS: Of the 46 healthy participants in the study, 22 had unexplained infertility. Age, body mass index, ethnicity, education level, age at first menarche, and length of menstrual cycles, serum follicle stimulating hormone, luteinizing hormone, estradiol, prolactin, thyroid stimulating hormone, and progesterone were similar between two groups. The mean right antral follicle count (AFC) was 6.6 ± 1.8 in the unexplained-infertility group and 6.5 ± 2.0 in the control group. The mean left AFC was 6.6 ± 2.0 in the unexplained-infertility group and 6.9 ± 1.5 in control group. The mean serum PIBF level was 6.92 ± 3.41 ng/mL in the unexplained-infertility group and 12.10 ± 10.47 ng/mL in the control group, which was a significant difference (p = 0.02). CONCLUSION: The present study showed that serum PIBF levels were significantly lower in unexplained-infertility group than in the fertile control group.

Effect of coffee consumption on fetal renal artery blood flow and amniotic fluid volume in third trimester of pregnancy.

OBJECTIVE: Coffee is frequently (one or two cups/day) consumed throughout pregnancy. Although there are a few studies evaluating caffeine effects on pregnancy; however, a diuretic effect of caffeine on fetal kidneys has not been reported. Therefore, after drinking coffee whether changing of amniotic fluid index (AFI) and fetal renal artery blood flow (FRABF, RI, Resistive index; PI, Pulsatility index) were evaluated in this study. METHODS: This clinical study was performed with two groups. For the study group, 63 participants with isolated borderline oligohydramnios who agreed to drink one cup of instant coffee were included in this study while 63 participants with isolated borderline oligohydramnios who did not drink one cup of instant coffee formed the control group. AFI, RI and PI were evaluated both before and after coffee intake. RESULTS: Maternal characteristics of all study population were homogenous. FRABF indices were similar in both before and after coffee consumption. AFI was increased significantly six hours after drinking coffee (p<0.001). CONCLUSIONS: The coffee consumption increased the amniotic fluid volume. However it does not seem to affect on FRABF. According to our study findings, coffee consumption may offer a new opportunity to improve amniotic fluid volume for pregnant women with oligohydramnios.

Evaluation of the levels of secretory leukocyte protease inhibitor in the cervical mucus of women with unexplained infertility.

AIM: Secretory leukocyte protease inhibitor (SLPI) has specific effects on the immune system. SLPI is overexpressed in inflammation triggered by immune responses, which could have significant effects on the local immune responses in cervical mucosa. This over expression may be greater in women with unexplained infertility, which would increase the immune reaction in the cervical region against sperm. The aim of our study was to assess the levels of SLPI in cervical mucus in women with unexplained infertility. METHODS: This prospective cross-sectional study was conducted using 50 Caucasian volunteers between 20 and 40 years old. The 50 participants were divided into two groups as unexplained infertility (n = 20) and control (n = 30). The control group comprised healthy fertile women with demographic characteristics similar to those of the infertility group. The enzyme-linked immunosorbent assay method was used to assess SLPI levels in the cervical mucus of all participants. RESULTS: The median SLPI level in cervical mucus was 3767 (3541-4594, 95% CI) pg/mL (25th percentile; 3139 pg/mL, 75th percentile; 5047 pg/mL) in the unexplained-infertility group and 3204 (2602-3539, 95% CI) pg/mL (the 25th percentile = 2615 pg/mL; 75th percentile = 3990 pg/mL) in the control group, which was a significant difference (P = 0.013). CONCLUSION: Our results indicated that SLPI levels in cervical mucus were remarkably higher in patients with unexplained infertility than in the control group.

Fetal Pulmonary Artery Acceleration/Ejection Ratio for Transient Tachypnea of the Newborn in Uncomplicated Term Small for Gestational Age Fetuses.

OBJECTIVE: Transient tachypnea of the newborn (TTN) is the leading cause of neonatal morbidity in preterm deliveries and has been reported in term small-for-gestational-age (SGA) fetuses; therefore, determination of fetal lung maturity before delivery is extremely important. Our present study aimed to evaluate the ratio of fetal pulmonary artery acceleration time to ejection time (At/Et) in uncomplicated term SGA fetuses and whether this ratio changes with TTN. STUDY DESIGN: One hundred seventy-five pregnant women with uncomplicated pregnancies who delivered after 37 gestational weeks were included in this cross-sectional study. Participants were divided by birth weight percentiles into SGA (n = 86) and healthy control groups (n = 89). All participants underwent ultrasound examination to determine fetal pulmonary artery At/Et. After delivery, the neonates were grouped according to diagnosis of TTN (i.e., TTN-positive SGA group [n = 14], TTN-negative SGA group [n = 72], and TTN-negative control group [n = 86]), and the fetal pulmonary artery At/Et was compared between the two. RESULTS: Maternal demographic characterizes were similar between groups. At/Et was 0.309 ± 0.181 in the SGA group and 0.348 ± 0.213 in the control group and was significantly lower in the SGA group. At/Et was 0.290 ± 0.007 in the TTN-positive SGA group, 0.313 ± 0.017 in the TTN-negative SGA group, and 0.351 ± 0.186 in the TTN-negative control group, a significant difference. Additionally fetal pulmonary artery At/Et was found to be inverse correlated with TTN. (-0,464 P = 0.000). The cut-off value of 0.298 provided optimal specificity of 93.0 % and sensitivity of 81.0 % for subsequent diagnosis of TTN in term SGA newborns in the neonatal period. CONCLUSION: The risk for TTN increases in uncomplicated term SGA fetuses. The fetal pulmonary artery At/Et appears to be a noninvasive useful method by which to predict TTN in these fetuses.