Crucial role of corticotropin-releasing hormone, corticotropin-releasing hormone -binding protein, mir-200c, and mir-181a in preterm delivery: A case-control study.

Background: Preterm birth before 37th wk of gestation is called premature birth. Corticotropin-releasing hormone (CRH) and CRH-binding protein (BP) act on various maternal and fetal tissues during pregnancy, such as the myometrium, which regulates the transition from the dormant phase of the uterus to the active phase. Studies have shown that mir-200c and mir-181a interact with CRH and CRH-BP. Objective: The present study aimed to investigate the expression of mir-200c, mir-181a, CRH, and CRH-BP in women with a history of preterm birth. Materials and Methods: In this case-control study, the gene expression level of mir-200c, mir-181a, CRH, and CRH-BP in placental tissue samples obtained from 48 women with a history of preterm labor was assessed in the Mojibian hospital of Yazd, Iran, from January to March 2023. Differences between mir-200c, mir-181a CRH, and CRH-BP gene expressions among cases and controls were assessed. Results: The outcomes indicated that the expression of CRH increased with going on to the regular parturition time (p < 0.001). While outcomes indicated, CRH-BP decreased with going on to the regular parturition time (p < 0.001). In addition, the results showed that the expression of mir-181a increased and mir-200c decreased with approaching the normal delivery time (p < 0.001). Conclusion: In conclusion, the expressions of mir-200c, mir-181a, CRH, and CRH-BP were dissimilar in different weeks of gestation. It could be proposed to use mir-200c, mir-181a, CRH, and CRH-BP as biomarkers to weigh the exact delivery time, which could minimize the side effects of preterm labor for the mother and fetus.

The relationship between postnatal hypoglycemia and umbilical artery Doppler ultrasonography in neonates with intrauterine growth restriction: A longitudinal follow-up study.

Background: Intrauterine growth restriction (IUGR) refers to fetuses with an estimated ultrasonography weight below the 10% percentile. Hypoglycemia is a major concern in neonates with IUGR. Objective: To investigate the relationship between umbilical artery (UA) Doppler ultrasonography and neonate hypoglycemia and IUGR. Materials and Methods: This was a longitudinal follow-up study consisting of 114 neonates (gestational age of 28-40 wk) born with IUGR in the third trimester of pregnancy at Shahid Sadoughi Hospital, Yazd, Iran between May 2016 and October 2017. The neonates were assigned into three subgroups of normal UA Doppler, absent end-diastolic flow (EDF) in UA Doppler, and reverse EDF in UA Doppler. The blood glucose of the neonates was checked one, two, three, six, 12, 24 and 48 hr after birth, and the neonates were placed in the hypoglycemia or euglycemia groups according to guidelines. Results: Out of the 114 neonates included in the study, 75 (65.8%) had normal UA Doppler, 29 (25.4%) had absent EDF in UA Doppler, and 10 (8.8%) had reverse EDF in UA Doppler. There was a significant difference in the mean blood glucose in the first hr between the normal UA Doppler group and the reverse EDF in UA Doppler group (p < 0.01). Conclusion: Postnatal hypoglycemia in neonates with IUGR is associated with the result of UA Doppler ultrasonography during pregnancy.

A comparative study of ranitidine and quince (Cydonia oblonga mill) sauce on gastroesophageal reflux disease (GERD) in pregnancy: a randomised, open-label, active-controlled clinical trial.

Quince (Cydonia oblonga Mill) is a popular medicinal herb in different traditional medicines. Concentrated quince fruit extract, also known as quince sauce (QS), is traditionally used for the treatment of a variety of gastrointestinal disorders. The aim of this study was to compare the efficacy of QS versus ranitidine on gastroesophageal reflux disease (GERD) in pregnant women. We compared the efficacy of 4 weeks of ranitidine (150 mg, twice daily) with the efficacy of QS (10 mg, after meals) on 137 pregnant women with GERD. Their General Symptom Score (GSS) and Major Symptom Score (MSS) were compared at the baseline, 2 weeks and 4 weeks after intervention. After 2 weeks of the study, the mean GSS score of the QS group was significantly lower compared with the ranitidine group (p = .036). Although, the GSS value at the end of the study had no difference between groups (p = .074). However, the MSS of the different symptoms of the two groups at 2 weeks and 4 weeks had no significant differences. It seems that the efficacy of QS for the management of pregnancy-related GERD is similar to ranitidine. Impact statement What is already known on this subject? Quince is a traditional gastric tonic, an appetiser, and a remedy for nausea/vomiting and epigastric pain. Also, there are several previous positive experiences about quince products for GERD treatment. What do the results of this study add? It seems that the efficacy of QS for the management of pregnancy-related GERD is similar to ranitidine. What are the implications of these findings for clinical practice and/or further research? QS can be suggested as an alternative medicine for pregnant patients with GERD.

Serum ferritin concentration in early pregnancy and risk of subsequent development of gestational diabetes: A prospective study.

BACKGROUND: Elevated serum ferritin concentration is associated with insulin resistance and diabetes. Recently it has also been described in gestational diabetes mellitus (GDM). OBJECTIVE: A prospective study was done to determine whether there was a relationship between serum ferritin concentration in early pregnancy and the risk of GDM. MATERIALS AND METHODS: A study was performed on 1,384 pregnant women with gestational age of 12-16 weeks. A blood sample was obtained for measurement of ferritin in the first trimester. Diagnosis of GDM was done by 75 gr oral glucose tolerance test between 24-28 wk. RESULTS: Women who developed GDM had a higher concentration of serum ferritin than women who did not develop GDM (p=0.01). A ferritin concentration of 45 ng/ml was calculated to be the 75th percentile for healthy pregnant women. Considering this level 32% in the GDM group and 25.2%of normal subjects exhibited high ferritin levels (p=0.01). The risk of GDM with these high levels of ferritin was 1.4-fold higher than that for subjects with lower concentrations. The Odds Ratio was 1.4 (95% CI= 1-1.87) (p=0.01). After adjusted for age Odds Ratio was 1.38 (95% CI=1.02-1.86) (p=0.03) and after adjustment for pre-pregnancy Body Mass index, the adjusted odds ratio was 1.31 (CI= 0.96-1.79) (p=0.08). After multivariable adjustment (age and body mass index), the adjusted odds ratio was 1.3 (0.95-1.8) (p=0.09). CONCLUSION: High serum ferritin can be regarded as a significant risk factor for the development of gestational diabetes.

The effects of vitamin D supplementation on maternal and neonatal outcome: A randomized clinical trial.

BACKGROUND: Vitamin D supplementation during pregnancy has been supposed to defend against adverse gestational outcomes. OBJECTIVE: This randomized clinical trial study was conducted to assess the effects of 50,000 IU of vitamin D every two weeks supplementation on the incidence of gestational diabetes (GDM), gestational hypertension, preeclampsia and preterm labor, vitamin D status at term and neonatal outcomes contrasted with pregnant women that received 400 IU vitamin D daily. MATERIALS AND METHODS: 500 women with gestational age 12-16 weeks and serum 25 hydroxy vitamin D (25 (OH) D ) less than 30 ng/ml randomly categorized in two groups. Group A received 400 IU vitamin D daily and group B 50,000 IU vitamin D every 2 weeks orally until delivery. Maternal and Neonatal outcomes were assessed in two groups. RESULTS: The incidence of GDM in group B was significantly lower than group A (6.7% versus 13.4%) and odds ratio (95% Confidence interval) was 0.46 (0.24-0.87) (P=0.01). The mean ± SD level of 25 (OH) D at the time of delivery in mothers in group B was significantly higher than A (37.9 ± 19.8 versus 27.2 ± 18.8 ng/ml, respectively) (P=0.001). There were no differences in the incidence of preeclampsia, gestational hypertension, preterm labor, and low birth weight between two groups. The mean level of 25 (OH) D in cord blood of group B was significantly higher than group A (37.9 ± 18 versus 29.7 ± 19ng/ml, respectively). Anthropometric measures between neonates were not significantly different. CONCLUSION: Our study showed 50,000 IU vitamin D every 2 weeks decreased the incidence of GDM.

The effect of different doses of vitamin D supplementation on insulin resistance during pregnancy.

Low serum vitamin D levels are correlated with insulin resistance during pregnancy. We have assessed the effects of different doses of vitamin D on insulin resistance during pregnancy. A randomized clinical trial was done on 120 women with a gestational age of less than 12 weeks. The women were divided into three groups randomly. Group A received 200 IU vitamin D daily, group B 50,000 IU vitamin D monthly and group C 50,000 IU vitamin D every 2 weeks from 12 weeks of pregnancy until delivery. The serum levels of fasting blood sugar (FBS), insulin, calcium and 25-hydroxyvitamin D were measured before and after intervention. We used the homeostatic model assessment of insulin resistance (HOMA-IR) as a surrogate measure of insulin resistance. The mean ± standard deviation of serum 25-hydroxyvitamin D increased in group C from 7.3 ± 5.9 to 34.1 ± 11.5 ng/ml and in group B it increased from 7.3 ± 5.3 to 27.23 ± 10.7 ng/ml, but the level of vitamin D in group A increased from 8.3 ± 7.8 to 17.7 ± 9.3 ng/ml (p < 0.001). The mean differences of insulin and HOMA-IR before and after intervention in groups A and C were significant (p = 0.01, p = 0.02). This study has shown that supplementation of pregnant women with 50 000 IU vitamin D every 2 weeks improved insulin resistance significantly.

Maternal serum leptin concentration in gestational diabetes.

OBJECTIVE: The aim of this study was to evaluate fasting serum leptin concentration and its relation to insulin resistance in women with gestational diabetes mellitus (GDM) and gestational impaired glucose tolerance (IGT). MATERIALS AND METHODS: This case-control study, at 28 weeks of gestation, measured serum concentration of fasting leptin, insulin, and homeostatic model assessment index in three groups, GDM, IGT, and normal control, and compared them with each other. RESULTS: The serum leptin level was significantly higher in women with GDM than in the two other groups (p=0.03). In women with GDM and IGT, leptin was significantly positively related with insulin and homeostatic model assessment index (r=0.221, p=0.03) and (r=0.246, p=0.03), respectively. In all of the participants, there was a significant correlation between leptin and body mass index before pregnancy (r=0.416, p=0.001). CONCLUSION: Our data showed that serum leptin level was higher in GDM and had a positive correlation with insulin resistance. Our findings suggest that high leptin levels might be a risk factor for GDM and IGT in pregnant women.

An appropriate test for diagnosis of gestational diabetes mellitus.

Early diagnosis of GDM is necessary to reduce maternal and fetal morbidity and mortality. As all approaches to diagnosis of GDM are costly and difficult, we meant to find an appropriate and simple way to perform this test. One-thousand six-hundred and fifty-three pregnant women were screened for GDM at 24-28 weeks of gestation. Initial screening was done by a glucose challenge test with 50 g glucose. If the 1-h blood glucose level exceeded 130 mg/dl, then a 3-h oral glucose tolerance test (OGTT) with 100 g glucose was performed, and diagnosis was established according to ADA criteria. For determining which plasma glucose level is the best test for diagnosis of GDM, we used receiver operative characteristic cures (ROC) by plotting sensitivity versus one minus specificity at different times of plasma glucose levels in OGTT. In 732 pregnant women with a positive GCT, a 2-h plasma glucose level above 150 mg/dl was the most powerful test for detecting GDM, which revealed a sensitivity and specificity of 0.84 (0.81-0.86) and 0.94 (CI: 0.92-0.96), respectively. The results of this study suggest that 2-h 100 g OGTT could be an appropriate approach to diagnose GDM, which is cost-effective and could reduce laboratory workload.

Maternal vitamin D status in gestational diabetes mellitus.

BACKGROUND: Vitamin D deficiency has long been suspected as a risk factor for glucose intolerance. This study compared serum levels of 25-hydroxy vitamin D(3) in pregnant women with gestational diabetes mellitus (GDM), impaired glucose tolerance (IGT), and non-GDM control subjects. METHODS: In this case-control study, 54 women with diagnosed GDM and 39 women with IGT (1 abnormal oral glucose tolerance test) were compared with 111 non-GDM control women in whom GDM were excluded by glucose challenge test. Controls were matched in gestational age, age, and body mass index with IGT and GDM groups. RESULTS: Maternal serum 25-hydroxy vitamin D(3) concentration in GDM and IGT groups at 24-28 weeks of gestation were significantly lower than non-GDM controls (P = .001). A total of 83.3% of GDM compared with 71.2% of the control group had plasma 25-hydroxy vitamin D(3) concentrations consistent with a diagnosis of vitamin D deficiency (<20 ng/mL; P = .03). Women with GDM had a 2.66-fold increased risk of deficient status (25-hydroxy vitamin D(3) <15 ng/mL) compared with control group. CONCLUSIONS: These results suggested that rates of vitamin D deficiency are higher among women with IGT/GDM, and the relationship between vitamin D status and glucose tolerance in pregnancy needs further study.

Maternal serum adiponectin concentration in gestational diabetes.

AIM: Adiponectin is an insulin sensitizing protein. Because gestational diabetes mellitus is associated with insulin resistance, we compared serum adiponectin levels in women with gestational diabetes mellitus and healthy pregnant women. STUDY DESIGN: Twenty-nine women with gestational diabetes and 26 women with impaired glucose tolerance were compared with 27 normal pregnant women in control group. Controls were matched for gestational age, age and body mass index (BMI) before pregnancy with two other groups. At 28 weeks of gestation serum concentration of adiponectin, insulin and insulin resistance (calculated by the homeostasis model assessment) were measured in three groups. MAIN FINDINGS: The serum adiponectin level in gestational diabetes (6379.31 + or - 1934.90 ng/ml), was significantly lower than the impaired glucose tolerance test (7384.61 + or - 1626.70 ng/ml) and control groups (7962.96 + or - 2667.20 ng/ml),(p = 0.02). Serum level of insulin and HOMA index in gestational diabetes were higher than the normal group (p > 0.05). In patients with gestational diabetes, there was a significant correlation between serum adiponectin level and BMI before pregnancy (r = -0.531, p = 0.013). Also, the correlation between maternal serum adiponectin levels and neonatal birth weight was not significant (r = -0.07, p value = 0.73). CONCLUSION: Our data show that serum adiponectin level was significantly lower in gestational diabetes in comparison with healthy pregnant women.