A first look at the effects of long inter-pregnancy interval and advanced maternal age on perinatal outcomes: A retrospective cohort study.

BACKGROUND: After China's One-child Policy was replaced with the Two-child Policy in 2013, the rate of second pregnancies with a longer inter-pregnancy interval (IPI) has suddenly increased in that country; however, the effect of long IPIs (≥49 months) on perinatal outcomes remains unreported. METHODS: This was a retrospective cohort study in China from July 2015 through June 2016. We used univariate and multivariate logistic regression models to test the associations among IPI, maternal age, and perinatal outcome (preterm delivery, term low birthweight, and small-for-gestational age). We included baseline factors and variables with biological plausibility as confounders. RESULTS: Our analytic sample included 3309 second pregnancies. The mean IPI was 75.36 months. Compared with second pregnancies with a short IPI of 7-24 months, those with long IPIs had higher adjusted odds ratios (ORs) of preterm delivery (1.70-2.00 [95% CI 1.20-3.33]) and term low birthweight (2.16-2.68 [1.10-6.17]), but not small-for-gestational age. The mean maternal age at current delivery was 32.0 years. Compared with the reference group (25-29 years), second pregnancies for the oldest maternal age group (≥35 years) showed no statistically significant increased ORs for adverse perinatal outcomes. CONCLUSION: Long IPI is a significant contributor to preterm delivery and term low birthweight. Health care providers need to pay close attention to preterm delivery prevention and fetal growth during prenatal care for second pregnancies where the mothers have long IPIs.

Efficacy of temporary ligation of infrarenal abdominal aorta during cesarean section in pernicious placenta previa.

OBJECTIVE: To evaluate the efficacy and safety of temporary loop ligation of the infrarenal abdominal aorta for control of intraoperative blood loss in patients with pernicious placenta previa.
 Methods: We retrospectively analyzed the clinical data of 14 patients with pernicious placenta previa, who underwent temporary loop ligation of the infrarenal abdominal aorta for control of blood loss during cesarean section between July 2013 and December 2014.
 Results: Eight patients received conservative management to preserve the uterus and 6 patients underwent cesarean hysterectomy. The occlusion time of the abdominal aorta was (31.42±12.67) min. The average estimated intraoperative blood loss was (1 117.85±745.13) mL. The volume of packed red blood cell transfusion was (3.91±3.24) units, and the volume of fresh frozen plasma transfusion was (192.85±156.71) mL. Post-operative histologic diagnosis revealed 6 cases of placenta percreta, 4 of increta, 3 of accreta and 1 non-creta. All patients experienced an uneventful postoperative recovery.
 Conclusion: In patients with pernicious placenta previa, temporary ligation of the infrarenal abdominal aorta provide a safe and effective means for controlling intraoperative hemorrhage during cesarean section. Additionally, the procedure may provide an opportunity to preserve fertility by avoiding a cesarean hysterectomy.

[Progress in study on the correlation of polyunsaturated fatty acids, vitamin D and homocysteine with postpartum depression].

Postpartum depression(PPD) is a common emotional disorder in the puerperium, which has negative impact on women, infants and family. There is growing evidence that abnormal concentration of a number of nutrients (including polyunsaturated fatty acids, vitamin D and homocysteine) is associated with depression in postpartum population. Further studies on the mechanisms for the functions of nutrients and regulation of nutritional states in the puerperium will be of great value in the prevention, early diagnosis and treatment of PPD.

[Therapeutic effect of hemin on gestational hypertension in rats and the mechanism].

OBJECTIVE: To investigate the therapeutic effects of hemin, an inducer of heme oxygenase, in a rat model of gestational hypertension and explore the possible mechanism. METHODS: Eighteen pregnant SD rats at day 12 of gestation were randomized equally into gestational hypertension model group, hemin treatment group, and normal pregnancy (control) group. In the former two groups, the rats were subjected to daily nitro-L-arginine methyl ester (L-NAME, 80 mg/kg) gavage since gestational day 14 for 7 consecutive days to induce gestational hypertension; saline was administered in the same manner in the control rats. The rats in hemin group received daily intraperitoneal injection of hemin (30 mg/kg) starting from gestational day 16. HO activity and carboxyhemoglobin (COHb) level in rat placental tissue were detected with spectrophotometric method, and soluble vascular endothelial growth factor receptor-1 (sFlt-1) and vascular endothelial growth factor (VEGF) level in the placental tissue homogenate supernatant were detected using ELSIA. RESULTS: At gestational day 20, the blood pressure and 24-h urinary protein were significantly higher in the model group than in the other two groups (P<0.05), and were higher in hemin group than in the control group (P<0.05); HO activity and COHb content in the placenta tissue were the lowest in the model group (P<0.05), and was lower in hemin group than in the control group (P<0.05). The level of sFlt-1 was significantly higher and VEGF level significantly lower in the model group than in the other two groups (P<0.05); sFlt-1 level remained higher and VEGF lower in hemin group than in the control group (P<0.05). CONCLUSION: Hemin can reduce blood pressure and urinary protein in rats with gestational hypertension possibly by up-regulating HO activity, enhancing carbon monoxide production, reducing sFlt-1 and increasing VEGF in the placental tissue.

Hypoxic trophoblast HMGB1 induces endothelial cell hyperpermeability via the TRL-4/caveolin-1 pathway.

High mobility group box 1 (HMGB1) plays an important role in the pathologic processes of endothelial permeability under oxidative stress. Trophoblast oxidative stress has been implicated in the pathophysiology of preeclampsia (PE). HMGB1 serum levels are increased in PE. However, the potential roles of HMGB1 in endothelial permeability in PE remain unclear. We assessed the effects of the hypoxic trophoblast on the permeability of the endothelial monolayer. Our results showed that the hypoxic trophoblast displayed higher HMGB1 mRNA, intracellular HMGB1 protein, and HMGB1 in conditioned medium than those of the normoxic trophoblast did. The hypoxic trophoblast conditioned medium increased the endothelial monolayer permeability and increased TLR 4 and caveolin-1 (CAV-1) protein expression in endothelial cells, which was inhibited by glycyrrhizic acid and HMGB1 small interfering RNA transfection to trophoblasts before hypoxia. The increased endothelial permeability induced by hypoxic trophoblast conditioned medium could be inhibited with TLR4 or CAV-1 gene silencing in endothelial cells. Immunoprecipitation showed that CAV-1 and TLR4 are colocalized in HUVECs and C57BL/6 mouse kidney. TLR4 small interfering RNA suppressed CAV-1 protein expression in endothelial cells upon stimulation of hypoxic trophoblast conditioned medium or HMGB1. We conclude that hypoxic trophoblasts play an important role in the mechanism of general edema (including protein urine) in PE via increasing endothelial monolayer permeability through the HMGB1/TLR4/CAV-1 pathway.

Study on changes of IGF-I and leptin levels in serum and placental tissue of prceclampsia patients and their associativity.

AIM: To explore the changes of IGF-I and leptin levels in serum and placental tissue of prceclampsia patients, and to study the associativity of IGF-I and leptin at the onset and in the development of prceclampsia further. METHODS: The levels of IGF-I and leptin in serum and placental tissue of 80 patients with prceclampsia and 50 normal pregnancy were detected with ELISA and immunohistochemistry. RESULTS: The serum IGF-I level of mild and severe prceclampsia was significantly lower than that of normal pregnancy group (P<0.05), and the serum leptin level of mild and severe prceclampsia was significantly lower than that of normal pregnancy group (P<0.05). The serum IGF-I level in severe prceclampsia group was lower than that in mild prceclampasia and the serum leptin level in severe prceclampsia was higher than that in mild prceclampsia ( P<0.05). There were significantly difference in the expression of IGF-I and leptin among normal pregnancy group, mild and severe prceclampsia group (P<0.05). CONCLUSION: The level of IGF-I and leptin may be involved in the pathogenesis and development of prceclampsia and can be a index to test the prognosis of prceclampsia patient.

[DRD2/ANKK1 Taq IA polymorphism and early infant temperament].

OBJECTIVE: To investigate whether there is an association between DRD2/ANKK1 Taq IA polymorphism and early infant temperament. METHODS: DRD2/ANKK1 Taq IA polymorphism (rs1800497) was determined using polymerase chain reaction-ligase detection reaction (PCR-LDR) techniques in 149 Chinese Han infants from Changsha City. Their mothers were asked to complete the Early Infant Temperament Questionnaires (EITQ) when the infants were 1 to 4 months old (mean: 2.75 months). There were three genotypes found in these infants: C/C, T/T and C/T. The subjects were subdivided into T-carrier (CT, TT) and non-T-carrier (CC) groups for statistical analysis. RESULTS: There were no differences in the temperament style distribution between the T-carrier and non-T carrier groups. There were also no statistically significant differences between the two groups in the score of the nine temperament dimensions. CONCLUSIONS: DRD2/ANKK1 Taq IA polymorphism is not associated with early infant temperament.