Impact of inherited thrombophilias on first and second trimester maternal serum markers for aneuploidy.

OBJECTIVE: To evaluate first and second-trimester maternal serum markers in pregnancies complicated with inherited thrombophilias. METHODS: A case-control study was conducted in 50 pregnancies complicated with hereditary thrombophilia and 100 control pregnancies. RESULTS: Each woman with inherited thrombophilia received low molecular weight heparin (LMWH) throughout her pregnancy. Gravidity, parity, number of first-trimester and second-trimester abortions, and rate of adverse pregnancy outcomes (APO) were significantly higher in the thrombophilia group compared to the control group (P < 0.001 for all). Among the thrombophilia group median values of pregnancy associated placental protein-A (PAPP-A) (0.6 vs. 0.9; P < 0.001) and free ß-human chorionic gonadotropin (ß-hCG) (0.9 vs. 1.1; P = 0.001) in the first trimester; median values of α-fetoprotein (AFP) (0.7 vs. 1.1; P = 0.027), unconjugated estriol 3 (uE3) (0.9 vs. 1.1; P < 0.001), and hCG (0.7 vs. 1.2; P < 0.001) in the second trimester were significantly lower with respect to control pregnancies. Multivariate analysis revealed that low uE3 and hCG levels were independently associated with APO. CONCLUSION: Pregnant women with hereditary thrombophilias, all of whom were treated with LMWH, had decreased levels of all first and second trimester serum markers. In addition, levels of hCG and uE3 in the second trimester could independently predict placenta-related disorders and adverse outcomes in these patients.

Second trimester fetal nasal bone length in a low-risk Turkish population.

OBJECTIVE: To define normal values of second trimester fetal nasal bone length (NBL) in a low-risk Turkish population. METHOD: Prenatal records of singleton fetuses who underwent second trimester ultrasonographic examination in the 16 to 23 weeks of pregnancy were retrospectively analyzed for NBL and biometric measurements (BPD, FL and HL). The relationship among NBL and gestational age (GA), biparietal diameter (BPD), femur length (FL) and humerus length (HL) was determined. Additionally, percentile values of NBL for each gestational week were provided. RESULTS: A total of 1467 fetuses were included in this study. There was a significant linear association among NBL and GA (R(2) = 0.709), BPD (R(2) = 0.752), FL (R(2) = 0.742) and HL (R(2) = 0.747). Fifth percentile values of fetal NBL were 3.11 mm for 16th, 3.50 mm for 17th, 3.70 mm for 18th, 4.10 mm for 19th, 4.50 mm for 20th, 4.62 mm for 21st, 5.24 mm for 22nd and 5.37 mm for 23rd gestational weeks. CONCLUSION: The study provides normal ranges of NBL between 16 and 23 weeks of pregnancy in a low-risk Turkish population. Future studies with larger sample sizes including pregnancies carrying high risk for aneuploidy are needed to define cut-off values for NBL.

First trimester maternal serum PAPP-A and free ß-HCG levels in hyperemesis gravidarum.

OBJECTIVE: To evaluate whether hyperemesis gravidarum (HG) affects first-trimester maternal serum PAPP-A and free ß-hCG levels. METHOD: An observational study was conducted in 115 cases of HG and 110 control pregnancies who attended the first-trimester prenatal screening program between January 2006 and July 2010. RESULTS: Maternal serum TSH levels were lower and free T4, and transaminases (ALT, AST) levels were higher in pregnancies complicated with HG compared with controls (p < 0.05 for all). In HG cases, median values of maternal serum PAPP-A were significantly higher with respect to normal pregnancies (1.2 vs 1.0 MoM; p = 0.009). Similarly, median values of free ß-hCG were 1.3 MoM in HG pregnancies and 1.0 MoM in controls (p = 0.006). Multivariate analysis revealed that PAPP-A and hCG were independently associated with HG after controlling for TSH, free T4, AST, and ALT. CONCLUSION: HG is associated with elevated levels of PAPP-A and free ß-hCG, and such changes are independent of serum indicators of thyroid and liver function.

Are CD57+ natural killer cells really important in early pregnancy failure?

OBJECTIVE: The aim of this study was to compare the CD57+ Natural Killer (NK) cell counts in normal pregnancies and in cases grouped according to different types of early pregnancy failure. MATERIALS AND METHODS: A prospective case control study which was set in Baskent University Faculty of Medicine, Obstetrics and Gynecology Department. A total of 119 women whose pregnancies ended in the first trimester were divided into elective pregnancy termination, incomplete miscarriage, intrauterine demise, ectopic pregnancy and recurrent pregnancy loss groups. CD57+ NK cells were stained and counted in the histologic preparations of the decidua in all of these groups. RESULTS: CD57+ NK cell counts were 2.14+/-1.42 in control, 2.24+/-1.92 in incomplete miscarriage, 1.82+/-1.34 in intrauterine demise, 2.54+/-1.80 in ectopic pregnancy and 3.42+/-2.15 in recurrent pregnancy failure group. There were no statistically significant differences between the control group and the other four groups with respect to the CD57+ NK cell counts. CONCLUSION: This study suggests that CD57+ NK cell count is not associated with early pregnancy failure.

Diagnosis of gestational diabetes mellitus by use of the homeostasis model assessment-insulin resistance index in the first trimester.

OBJECTIVE: Gestational diabetes mellitus (GDM) affects 2-10% of all pregnant women, causing increased morbidity and mortality, and is tested for in the second trimester of pregnancy. The purpose of the present study was to predict GDM in the first trimester. DESIGN AND METHODS: The study included 271 patients who were between the 10th and 14th week of gestation. Fasting glucose and insulin were measured in the first trimester and the homeostasis model assessment-insulin resistance index (HOMA-IR) was calculated for each patient. These values were compared with the results of the second-trimester glucose tolerance test. RESULTS: HOMA-IR values were higher in women with GDM. A cut-off value of 2.60 for HOMA-IR was calculated at the end of the study. CONCLUSION: Accepting patients whose HOMA-IR value is higher than 2.60 in the first trimester seems to be a good method to predict GDM.