The effects of yoga in prevention of pregnancy complications in high-risk pregnancies: a randomized controlled trial.

OBJECTIVE: While previous studies have shown the potential effects of yoga in normal pregnancies, this randomized controlled trial investigated the effects of yoga in prevention of pregnancy complications in high-risk pregnancies for the first time. METHODS: 68 high-risk pregnant women were recruited from two maternity hospitals in Bengaluru, India and were randomized into yoga and control groups. The yoga group (n=30) received standard care plus one-hour yoga sessions, three times a week, from the 12th to the 28th week of gestation. The control group (n=38) received standard care plus conventional antenatal exercises (walking) during the same period. RESULTS: Significantly fewer pregnancy induced hypertension (PIH), preeclampsia, gestational diabetes (GDM) and intrauterine growth restriction (IUGR) cases were observed in the yoga group (p=0.018, 0.042, 0.049, 0.05 respectively). Significantly fewer Small for Gestational Age (SGA) babies and newborns with low APGAR scores (p=0.006) were born in the yoga group (p=0.033). CONCLUSION: This first randomized study of yoga in high-risk pregnancy has shown that yoga can potentially be an effective therapy in reducing hypertensive related complications of pregnancy and improving fetal outcomes. Additional data is needed to confirm these results and better explain the mechanism of action of yoga in this important area.

Antithymocyte globulin for acute-graft-versus-host-disease prophylaxis in patients undergoing allogeneic hematopoietic cell transplantation: a systematic review.

Graft-versus-host-disease (GVHD) is a major complication associated with allogeneic hematopoietic cell transplantation (allo-HCT). Antithymocyte globulin (ATG) is recommended for GVHD prophylaxis following allo-HCT, however, evidence on efficacy of ATG is conflicting. Accordingly, we undertook a systematic review. All phase III randomized controlled trials (RCTs) comparing ATG versus control for prevention of GVHD in patients undergoing allo-HCT were eligible. Medline and Cochrane databases were searched. Data on methodological quality, benefits and harms were extracted for each trial and pooled under a random effects model. Seven RCTs enrolling 733 patients met inclusion criteria. Pooled results showed no difference for overall survival with use of ATG (hazard ratio was 0.91; 95% confidence intervals (CI), 0.75-1.10; P = 0.32). There was a significant benefit for prevention of grade III/IV acute GVHD (risk ratio (RR) = 0.51; 95% CI, 0.27-0.94; P = 0.03). There was no benefit associated with ATG use for prevention of either grade II (RR = 0.79; 95% CI, 0.48-1.30; P = 0.35) or grade I acute GVHD (RR = 1.42; 95% CI, 0.75-2.69; P = 0.28). Use of ATG was not associated with significant reduction in non-relapse mortality (RR = 0.74; 95% CI, 0.53-1.03; P = 0.08). Future trials with adequate sample size are required to provide more definitive answers.

Timing of first-line cancer treatments - early versus late - a systematic review of phase III randomized trials.

PURPOSE: To conduct a systematic review and meta-analysis of all phase III randomized controlled trials comparing efficacy of early versus late first-line or initial treatments for cancer. METHODS: A comprehensive literature search of MEDLINE and Cochrane library databases was performed (1966-2008). Data was extracted and pooled as per the methods recommended by the Cochrane Collaboration. RESULTS: Of the 570 identified studies, 10 (3811 patients) met inclusion criteria: three each in prostate cancer and multiple myeloma (MM), two in chronic lymphocytic leukemia (CLL), and one each in lung cancer, and follicular lymphoma. The analyses showed no survival benefit with early treatment except in prostate cancer (hazard ratio [HR]=1.23, 95% CI 1.11-1.37 p<0.001). There was no survival difference in MM (HR=0.92, 95% CI 0.56-1.52 p=0.74), CLL (HR=0.76, 95% CI 0.56-1.04 p=0.09), lung cancer (HR=0.95, 95% CI 0.72-1.24 p=0.71), or follicular lymphoma (HR=1, 95% CI 0.55-1.83 p=0.99). No statistically significant difference in response rate between early and late treatment was detected in any cancer type. CONCLUSIONS: Data shows that delaying cancer treatments does not necessarily compromise therapeutic outcomes except possibly in locally advanced prostate cancer. These findings provide a unique window to oncologists and patients to address time-sensitive issues if desired by patients.

Glucose kinetics and pregnancy outcome in Indian women with low and normal body mass indices.

BACKGROUND/OBJECTIVES: Fetal energy demands are met from the oxidation of maternally supplied glucose and amino acids. During the fasted state, the glucose supply is thought to be met by gluconeogenesis. Underweight women with low body mass index (BMI) might be unable to adequately supply amino acids to satisfy the demands of gluconeogenesis. SUBJECTS/METHODS: Glucose kinetics were measured during the first and second trimesters of pregnancy in 10 low-BMI and 10 normal-BMI pregnant women at the 12th hour of an overnight fast using a primed 6 h U-(13)C glucose infusion and was correlated to maternal dietary and anthropometric variables and birth weight. RESULTS: Low-BMI mothers consumed more energy, carbohydrates and protein, had faster glucose production (R (a)) and oxidation rates in the first trimester. In the same trimester, dietary energy and carbohydrate correlated with glucose production, glycogenolysis and glucose oxidation in all women. Both groups had similar rates of gluconeogenesis in the first and second trimesters. Glucose R (a) in the second trimester was weakly correlated with the birth weight (r=0.4, P=0.07). CONCLUSIONS: Maternal energy and carbohydrate intakes, not BMI, appear to influence glucose R (a) and oxidation in early and mid pregnancy.

In vivo arginine production and nitric oxide synthesis in pregnant Indian women with normal and low body mass indices.

BACKGROUND/OBJECTIVES: Nitric oxide (NO) has been proposed as a mediator of vascular expansion during pregnancy. Inability to increase NO synthesis and/or production of its precursor, arginine, may be a contributor to pregnancy-induced hypertension or preeclampsia. Because maternal weight is associated with blood pressure and risk of preeclampsia during pregnancy, it may also influence arginine and/or NO production. The purpose of this study was to determine the in vivo arginine production and NO synthesis rate in pregnant women with normal (n=10) and low (n=10) body mass indices (BMIs). SUBJECTS/METHODS: Arginine flux and NO synthesis rate were measured in the postabsorptive state with constant infusions of 15N2-arginine and 13C,2H4-citrulline. Plasma concentrations of arginine and NO metabolites were also measured. Kinetic parameters were correlated to maternal variables, gestational age, birth weight and blood pressure. RESULTS: Endogenous arginine flux was significantly faster in the low-BMI compared with normal-BMI women in the first trimester (63.1+/-3.4 vs 50.2+/-2.0 micromol/kg per h, P<0.01), but not in the second. Plasma NO concentration was higher (44.7+/-5.3 vs 30.4+/-1.9 micromol/l, P=0.03) and its rate of synthesis trended faster in the low-BMI compared with normal-BMI group in the second trimester. Maternal weight and BMI were negatively correlated with arginine flux in both trimesters and NO synthesis in the second trimester. CONCLUSIONS: These findings suggest, but do not prove, that maternal BMI may be a factor in the ability to produce NO during pregnancy and may be one way by which BMI influences blood pressure during pregnancy.

The effect of fish and omega-3 LCPUFA intake on low birth weight in Indian pregnant women.

BACKGROUND: Inadequate consumption of fish could be a risk factor for low birth weight (LBW). This study assessed fish intake and omega-3 LCPUFA intake and status for their association with LBW in a cohort of urban, south Indian pregnant women. SUBJECTS/METHODS: In a prospective cohort study, data on maternal fish intake and omega-3 LCPUFA intake and status of 676 women were obtained at baseline (first trimester), the second and third trimesters of pregnancy. Infant birth weight was measured immediately following hospital delivery. The dropout rate was 7.6%. RESULTS: Fifty-six percent of the study women consumed fish with low daily median intakes (3.4, 4.1 and 3.8 g day(-1) at the three trimesters, respectively). Consequently, the median intakes of EPA and DHA during pregnancy were also low at 2.1 and 10.1 mg day(-1), respectively. EPA and DHA intakes were associated with their status in erythrocyte membrane phospholipids during pregnancy (r=0.40 and 0.36, r=0.34 and 0.32 and r=0.37 and 0.41, at the three trimesters, respectively, all P<0.001). Women who did not eat fish during the third trimester had a significantly higher risk of LBW (OR: 2.49, P=0.019). Similarly, low EPA intake during the third trimester had an association with a higher risk of LBW (OR: 2.75, P=0.011). CONCLUSIONS: Among low fish-eating pregnant women, fish intake in the third trimester was closely associated with birth weight. Supplementation with omega-3 LCPUFA during pregnancy may have important implications for fetal development in India.

Anthropometry and body composition of south Indian babies at birth.

OBJECTIVES: To assess the consequences on body composition of increasing birth weight in Indian babies in relation to reported values in Western babies, and to assess the relationship between maternal and neonatal anthropometry and body composition. DESIGN: Prospective observational study. SETTING: Bangalore City, India. SUBJECTS: A total of 712 women were recruited at 12.5+/-3.1 weeks of gestation (mean+/-standard deviation, SD) and followed up until delivery; 14.5% were lost to follow-up. Maternal body weight, height, mid upper-arm circumference and skinfold thicknesses were measured at recruitment. Weight and body composition of the baby (skinfold thicknesses, mid upper-arm circumference, derived arm fat index and arm muscle index; AFI and AMI, respectively) were measured at birth in hospital. RESULTS: The mean+/-SD birth weight of all newborns was 2.80+/-0.44 kg. Birth weight was significantly related to the triceps and subscapular skinfold thickness of the baby. In a small number of babies with large birth weight for gestational age, there was a relatively higher normalised AFI relative to AMI than for babies with lower or appropriate birth weight for gestational age. Maternal height and fat-free mass were significantly associated with the baby's length at birth. CONCLUSIONS: Skinfold thicknesses in Indian babies were similar to those reported in a Western population with comparable birth weights, and the relationship of AFI to birth weight appeared to be steeper in Indian babies. Thus, measures to increase birth weight in Indian babies should take into account possible adverse consequences on body composition. There were no significant relationships between maternal anthropometry and body composition at birth on multivariate analysis, except for sum of the baby's skinfold thicknesses and maternal fat-free mass (P<0.02).

Low maternal vitamin B12 status is associated with intrauterine growth retardation in urban South Indians.

OBJECTIVE: To assess the maternal sociodemographic, anthropometric, dietary and micronutrient status in apparently healthy pregnant women in order to determine their associations with intrauterine growth retardation (IUGR). DESIGN: Prospective observational study. SETTING: Bangalore City, India. SUBJECTS: A total of 478 women were recruited at 12.9+/-3.3 weeks of gestation and followed up at the first, second and third trimesters of pregnancy and at delivery. The dropout rate was 8.5%. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Birth weight was measured at hospital delivery. RESULTS: The mean birth weight was 2.85+/-0.45 kg. In all, 28.6% of newborns were IUGR. There was a strong inverse relationship between maternal educational level and risk of IUGR. A low body weight at baseline was also associated with a high risk of IUGR. Compared with women in the highest quartile for second trimester weight gain, those in the lowest quartile had a significantly higher adjusted odds ratio (AOR: 3.98; 95% CI: 1.83, 8.65) for IUGR. Women in the lowest tertile for serum vitamin B(12) concentration during each of the three trimesters of pregnancy had significantly higher risk of IUGR (AOR: 5.98, 9.28 and 2.81 for trimesters 1-3, respectively). CONCLUSIONS: The present study demonstrates associations between educational status, maternal weight and gestational weight gain with IUGR. Importantly, in a subsample, there were strong associations of vitamin B(12) status with IUGR, suggesting that better socioeconomic conditions, improved nutritional status and early detection of vitamin B(12) deficiency in pregnancy combined with appropriate interventions are likely to play an important role in reducing IUGR.

Are we increasing serious maternal morbidity by postponing termination of pregnancy in severe pre-eclampsia/eclampsia?

The objective of this study was to evaluate the impact of admission--delivery interval on maternal morbidity in patients with severe pre-eclampsia/eclampsia. This was a retrospective study, which involved review of case sheets of 188 women (admitted to St John's Medical College Hospital during the year 2000--2001 with the above diagnosis). The incidence of severe pre-eclampsia and eclampsia was 5.18% (188/3,627) with 119 primigravida and 69 multigravida. The incidence of serious maternal complications in the post partum period was 17% (11/68) in the category of women who delivered within 12 hours of admission compared with 40.6% (28/69) in the 12--48-h category and 60.8% (31/51) in the>48-h category. The incidence of serious maternal complications in the subset with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome was 33.4% (7/21) in the12-h. We concluded that termination of pregnancy within 12 hours of admission in severe pre-eclampsia/eclampsia especially in patients with HELLP syndrome helps to prevent avoidable serious maternal morbidity.

Factor XIII deficiency: a rare cause of repeated abortions.

Factor XIII deficiency is a rare cause of early abortion. The obstetrical outcome of four pregnancies in two women with factor XIII deficiency is reported. Both women were treated with substitution therapy using locally-prepared cryoprecipitate. The outcome in these two women demonstrated the need for substitution therapy in early pregnancy leading to an increased chance of obstetrical success.

Trophoblastic hyperthyroidism.

Hyperthyroidism can occur secondary to gestational trophoblastic disease. The clinical and biochemical data of four women who had hyperthyroidism secondary to gestational trophoblastic disease was analyzed. The parity ranged from primi to gravida four and the period of amenorrhoea from six weeks to sixteen weeks. Three women had vomiting, two had bleeding per vaginum and two had tachycardia and minimal thyromegaly. The betahCG was more than 5,00,000 mlu/ml in all the cases. Three women required treatment for the hypermetabolic status and one woman had biochemical hyperthyroidism. Two of them had molar pregnancy, one had partial mole and one had persistent trophoblastic disease.

Methemoglobinemia following chromopertubation in treated pelvic tuberculosis.

Methylene blue administered through cervix is used to check tubal patency at laparoscopy. Although methylene blue is used to treat methemoglobinemia it can also produce methemoglobinemia in susceptible individuals. A case of methemoglobinemia induced by methylene blue in a patient with treated pelvic tuberculosis is presented.

Enzyme-linked immunosorbent determination of autoantibodies to zona pellucida as a possible cause of infertility in women.

An enzyme-linked immunosorbent assay (ELISA) for determination of antibodies against the zona pellucida was developed and compared with the already available indirect immunofluorescence (IIF) technique. Sera from 100 women with explained and unexplained infertility were screened for the presence of autoantibodies to the zona pellucida by ELISA and IIF techniques. Porcine/goat zonae immobilized on activated microtitre plates or solubilized zona pellucida antigens adsorbed on poly-L-lysine-coated microtitre plates were used as a solid phase in an ELISA. Assay of anti-zona pellucida antibodies in xenogeneic and allogeneic sera was performed by incubation of test samples with the solid phase against human serum supplied by WHO as a reference positive control, followed by incubation with staphylococcal protein A conjugated to horseradish peroxidase. The ELISA was effectively used to screen the production of monoclonal antibodies from mouse myeloma X mouse splenocyte hybridomas. The sensitivity of the ELISA was more than 2500-fold greater than that of the IIF technique. Significantly high titres of autoantibodies to zona pellucida were found in patients with unexplained infertility as compared with patients with a known cause of infertility, and their normal counterparts.

Status of autoantibodies to zona pellucida in human reproduction.

The sera of 80 patients were tested by the indirect immunofluorescence technique to evaluate the presence of autoantibodies to zona pellucida in human reproduction. The incidence of positive anti-zona activity was 71.4% (25/35) in the infertile women, 40.0% (6/15) in the normal, nonpregnant fertile women, 20.0% (3/15) in the normal pregnant women and 26.7% (4/15) in the normal fertile men, when unabsorbed sera were tested. To overcome false positive reactions due to nonspecific serum components, all the positive sera were absorbed with formalinized porcine red blood cells and retested. However, after absorption, anti-zona activity was lost in all the positive sera from non-pregnant fertile women, pregnant women and fertile men; but it was retained in 51.4% (18/35) of the infertile women. These positive sera (18) were further absorbed with zona-coated eggs and retested. Fluorescence was lost in all the positive sera, thus demonstrating the presence of antibodies specific to zona antigen in the infertile women. The study also revealed that autoantibodies to zona were seen more often in patients of greater age (26 to 40 years) and in those who had been infertile for a greater period of time (greater than 6 years).

Autoantibodies to zona pellucida in tubectomized women.

khe study was conducted to detect autoantibodies to zona pellucida by indirect immunofluorescence technique. A total of 60 human sera was examined, which included 15 tubectomized , 15 pregnant, 15 nonpregnant fertile women, and 15 fertile men. In the unabsorbed sera, anti-zona activity was observed in 53.3% of the tubectomized women and in 40.0% of the nonpregnant fertile women, 20.0% of the pregnant women and 26.7% of the fertile men. All the positive sera were then absorbed with porcine red blood cells and retested to exclude the false positive reaction due to nonspecific serum components. After absorption, immunological response was retained in 26.7% of the tubectomized women and lost in all the other women and men. The positive sera were further absorbed with zona-coated eggs and were retested. Fluorescence was lost in all the positive sera. This observation demonstrates the presence of antibodies, specific to zona antigens, in tubectomized women. To date, however, antibodies to zona antigen have not been demonstrated in the tubectomized women. Presence of anti-zona activity in tubectomized women may be an autoimmune response, possibly due to absorption and degradation of the ova into the peritoneal cavity or in the reproductive tract and the subsequent exposure of the degradation products to the immune system.