Genome-wide association identifies seven loci for pelvic organ prolapse in Iceland and the UK Biobank.

Pelvic organ prolapse (POP) is a downward descent of one or more of the pelvic organs, resulting in a protrusion of the vaginal wall and/or uterus. We performed a genome-wide association study of POP using data from Iceland and the UK Biobank, a total of 15,010 cases with hospital-based diagnosis code and 340,734 female controls, and found eight sequence variants at seven loci associating with POP (P < 5 × 10-8); seven common (minor allele frequency >5%) and one with minor allele frequency of 4.87%. Some of the variants associating with POP also associated with traits of similar pathophysiology. Of these, rs3820282, which may alter the estrogen-based regulation of WNT4, also associates with leiomyoma of uterus, gestational duration and endometriosis. Rs3791675 at EFEMP1, a gene involved in connective tissue homeostasis, also associates with hernias and carpal tunnel syndrome. Our results highlight the role of connective tissue metabolism and estrogen exposure in the etiology of POP.

[Diet and nutrient intake of pregnant women in the capital area in Iceland].

INTRODUCTION: Nutrition in pregnancy may affect growth, development and health of the child in the short and long term. We aimed to assess diet and nutrient intake among pregnant women in the capital area and evaluate differences in dietary intake between women who were overweight/obese and normal weight before pregnancy. MATERIAL AND METHODS: Pregnant women aged 18-40 years (n=183) living in the capital area kept four day weighed food records to assess diet and nutrient intake in the 19th-24th week of pregnancy (n=98 with body mass index (BMI) <25 kg/m2; n=46 with BMI 25-29.9 kg/m2 and n=39 with BMI ≥30 kg/m2). RESULTS: Only 20% of the women consumed the minimum recommended 25 g/day of dietary fibers. The contribution of added sugar to the total energy intake was on average 12% (SD ± 5%). About one-fourth appeared not to meet requirements for iodine, vitamin D and DHA (docosahexaenoic acid). No overconsumption of vitamins and minerals from food or supplements was observed. Higher median intake of milk and dairy products (346 g/day vs. 258 g/day, p<0.05), soft drinks (200 g/day vs. 122 g/day, p<0.05), as well as chips and popcorn (13 g/day vs. 0 g/day, p<0,05) was observed among women with BMI ≥30 kg/m2 compared with women of normal weight before pregnancy (BMI <25 kg/m2). CONCLUSION: Dietary habits and choices among women require enhanced consideration both before and in pregnancy, particularly among those who are obese. Sub-optimal consumption of iodine, vitamin D and DHA, was seen among up to a quarter of the pregnant women. KEY WORDS: pregnancy, nutrition, dietary intake, essential fatty acids, iodine, vitamin D, folic acid. Correspondence: Ingibjorg Gunnarsdottir, ingigun@hi.is.

Physical activity of relatively high intensity in mid-pregnancy predicts lower glucose tolerance levels.

INTRODUCTION: Physical activity (PA) is recommended as part of therapy for patients with impaired glucose tolerance. Whether such recommendations are also justified for pregnant women is less well established. We investigated the association between PA and glucose tolerance in pregnancy. MATERIAL AND METHODS: A non-selective sample of 217 pregnant women was recruited at a routine 20 week ultrasound examination. Participants answered the International Physical Activity Questionnaire (IPAQ) about frequency, intensity and duration of daily physical activity in the past 7 days and underwent oral glucose tolerance testing (OGTT) between 24 and 28 weeks. A subset of 72 overweight/obese pregnant women wore a pedometer for 1 week with assessment of IPAQ score and pedometric correlations to this. RESULTS: Of the sample, 177 attended for OGTT; 51% were overweight or obese. The mean (SD) fasting glucose was 4.5 (0.4) mmol/L, and 12% had gestational diabetes mellitus. Only one-third engaged in vigorous PA. After adjustment for pre-pregnancy BMI, age and parity, those engaging in vigorous PA had significantly lower fasting glucose levels (by 0.15 mmol/L, 95% CI 0.03-0.27) compared with those not vigorously active. This decrease was similar in both normal and overweight/obese women. There were fewer cases of gestational diabetes (p = 0.03) among the vigorously active women (3/56; 5%) than among those who were not active (19/121; 16%). No association with glucose tolerance was observed for physical activity of moderate intensity. CONCLUSIONS: Only vigorous physical activity appears beneficial with respect to maternal glucose tolerance, both among normal, overweight and obese women.

Monochorionic diamniotic twin pregnancies: natural history and risk stratification.

About 30% of monochorionic twin pregnancies are complicated by twin-to-twin transfusion syndrome (TTTS), isolated discordant growth, twin anemia-polycythemia sequence, congenital defects or intrauterine demise. About 15% will be eligible for invasive fetal therapy, either fetoscopic laser treatment for TTTS or fetoscopic or ultrasound-guided umbilical cord coagulation for a severe congenital defect in one twin or severe discordant growth with imminent demise of the growth-restricted twin. Ultrasound examination in the first and early second trimester can differentiate the monochorionic twins at high risk for adverse outcome from those likely to be uneventful, which may be useful for patient counselling and planning of care.