Echocardiographic findings and pregnancy outcomes for fetuses with complete closure of the ductus arteriosus.

OBJECTIVE: We aimed to analyze the echocardiographic characteristics and pregnancy outcomes for fetuses with premature complete closure of the fetal ductus arteriosus. METHODS: A retrospective analysis was performed for eight cases of premature ductus arteriosus closure diagnosed by prenatal ultrasonography in the Hunan Maternal and Child Health Hospital from July 2019 to August 2022, and the characteristics of fetal echocardiography and pregnancy outcomes of the eight cases were analyzed and summarized. RESULTS: In all cases, the intima of the ductus arteriosus was thickened and occluded, the ductus arteriosus could be seen with slightly hyperechogenic, and no blood flow signal was found in the ductus arteriosus by Doppler ultrasonography. The right heart was enlarged in seven cases, and the whole heart was enlarged in one case. Tricuspid valve regurgitation was observed to different degrees, of which seven cases were severe and one case was moderate. The pulmonary arteries of eight patients had varying degrees of widening. All eight cases were delivered by cesarean section, and one newborn died after follow-up. The prognosis of the other newborns was good. CONCLUSION: The parameters of prenatal echocardiography are helpful for the prognosis of fetuses with premature closure of the ductus arteriosus. Early prenatal detection, close observation, and clinical guidance can be used to select the right time of delivery.

Effectiveness of Chromosomal Microarray Analysis for Prenatal Diagnosis of Fetal Echogenic Intracardiac Focus: A Single-Center Experience.

BACKGROUND: Echogenic intracardiac focus (EIF) is a common ultrasound finding during pregnancy. However, the correlation between fetal EIF and cardiac abnormality remains in dispute until now. The study aimed to examine the association of fetal EIF with chromosomal abnormality by means of chromosomal microarray analysis (CMA). MATERIALS AND METHODS: A total of 192 pregnant women with fetal EIF undergoing amniocentesis or umbilical cord blood puncture were recruited and assigned into groups A (8 cases with isolated EIF alone), B (75 cases with EIF and other cardiac malformations) and C (109 cases with EIF and extracardiac malformations). All fetuses underwent karyotyping analysis and CMA simultaneously. The detection of chromosomal abnormality and copy number variations (CNVs) were compared. RESULTS: Chromosomal karyotyping identified 5 fetuses with chromosomal abnormality, including 3 cases with trisomy 21, one fetus with Turner's syndrome, and one fetus with chromosome 8 mosaicism, while CMA detected 6 additional fetuses with CNVs, including 2 fetuses with pathogenic CNVs and 4 fetuses with variants of uncertain significance (VOUS). There was no significant difference among groups A (0), B (5.33%) and C (6.42%) in terms of the prevalence of chromosomal abnormality (P> 0.05). Among the 4 fetuses with VOUS, pregnancy continued in 2 fetuses, and pregnancy was terminated in other 2 fetuses. CONCLUSION: An isolated EIF may not correlate with chromosomal abnormality. However, CMA is recommended in fetuses with CMA complicated by other abnormal cardiac ultrasound findings, which facilitates the prediction of fetal outcomes during the genetic counseling and precision assessment of prognosis.

Imbalance of uterine innate lymphoid cells is involved in the abnormal pregnancy induced by Toxoplasma gondii infection.

Toxoplasma gondii (T. gondii) is a ubiquitous intracellular protozoan parasite that causes adverse pregnancy outcomes. Innate lymphoid cells (ILCs) are critical mediators of mucosal immunity, and have been reported to play an important role in uterine vascular adaptation for successful pregnancy. However, the specific role of ILCs in T. gondii-infection-induced adverse pregnancy outcomes remains elusive. In the present study, we found that T. gondii infection caused the imbalance of uterine ILC cells (uILCs). It was characterized by substantially lower expression of the transcription factor GATA-3 and RORγt and higher expression of T-bet in uILCs. Consistent with the transcription factor changes, uILCs from T. gondii-infected mice produced much less IL-5 and IL-17 and substantially more IFN-γ and TNF-α than did uILCs from uninfected mice. Notably, IL-12, IL-18, and their receptors were increased in the uterus of T. gondii-infected mice. In vitro experiments showed that IL-12 and IL-18 treatment reduced the percentages of uILC2 and uILC3 and increased the percentages of uILC1. Conclusion, our data suggest that alterations in uILC composition may disrupt the balance of immune microenvironment after T. gondii infection and contribute to the adverse pregnancy outcomes caused by T. gondii infection.

Clinical features and pregnancy outcomes of women with abnormal cell-free fetal DNA test results.

BACKGROUND: This study was performed to examine the factors affecting attitudes regarding prenatal diagnosis and clinical treatment by analyzing the clinical data of women with positive noninvasive prenatal testing (NIPT) results. METHODS: We collected clinical data for women with positive NIPT results. The women received prenatal genetic consultation. The women with true positive results received prenatal genetic counseling again, and decided whether to continue or terminate their pregnancy. RESULTS: A total of 228 women received positive NIPT results. The prenatal diagnosis was accepted in 174 cases (76.3%), and 124 women were confirmed to have true positive NIPT results. The positive predictive values (PPV) of T21/T18/T13 and fetal sex chromosome aneuploidy were 88.4% and 42.9%, respectively. All (99/99, 100%) of the women with T21/T18/T13 terminated their pregnancies, while 25.0% (6/24) of women with fetal SCA continued their pregnancies. An NIPT result of Chr(9) microduplication was obtained in one woman, which was confirmed by chromosomal microarray analysis (CMA). CONCLUSIONS: NIPT exhibited good detection accuracy for T21/T18/T13, and also contributed to identifying fetal SCA and substructural chromosomal abnormalities. With a positive NIPT result, the attitudes of pregnant women regarding prenatal diagnosis and clinical treatment are related to the severity of disease, cognitive ability, and the level of prenatal genetic counseling.

[The Role of Soluble HLA-G in the Vertical Transmission of Toxoplasma gondii].

Soluble human leukocyte antigen G (sHLA-G) plays a key role in pregnancy through interaction with decidual natural killer (dNK) cell inhibitory receptors at the maternal-fetal interface. To demonstrate the possible role of sHLA-G during the pregnancy with Toxoplasma gondii infection, we compared the concentration of a murine functional homolog of sHLA-G, Qa-2, in T. gondii infected and non-infected pregnant C57BL/6 mice, and that of sHLA-G in BeWo culture supernatant. In addition, the levels of KIR2DL4 expressed on human dNK cells and NKG2A in pregnant mice were evaluated. We showed that T. gondii infection result in significant increase in the level of Qa-2 and NKG2A in pregnant mice. sHLA-G and KIR2DL4 in human samples were also significantly upregulated under the condition of T. gondii infection. The further treatment with sHLA-G antibody could reduce the expression level of KIR2DL4 which was upregulated by T. gondii infection. In summary, sHLA-G could upregulate the expression level of KIR2DL4 which lead to excessive immunological tolerance, and further contributed to T. gondii immunity escaping and affecting fetus via vertical transmission which may lead to adverse outcomes.

Toxoplasma gondii ROP16I Deletion: The Exacerbated Impact on Adverse Pregnant Outcomes in Mice.

Imbalance of Th1 and Th2 response at the maternal-fetal interface is considered as a radical event in the pathogenesis of immunity-related pregnant diseases. It has been demonstrated that the ROP16I, a rhoptry protein of Toxoplasma gondii, and the viable parasite with ROP16I may induce M2 macrophage polarization in host innate immunity and may be involved in the adverse pregnant outcomes. However, the mechanisms by which T. gondii-derived effectors subvert the immune tolerance in the pathology of pregnancy remain unclear. Here, we constructed the RH strain with ROP16I deletion (RHΔrop16) to explore the pathogenesis of abnormal pregnancy. We found that C57BL/6 mice infected with RHΔrop16 exhibited the increased resorption of fetuses and more severe adverse pathology of placentae at the early phase of gestation, as compared to the mice infected with RH wild type (RH WT) parasite. Additionally, RHΔrop16 strain infection significantly promoted M1 macrophage phenotypes of CD80 and CD86, and decreased CD206 expression of M2 macrophages, with upregulation of the iNOS and downregulation of the Arg-1 expression in placental homogenates. Simultaneously, the pro-inflammatory cytokines of IL-12 and TNF-α were elevated whereas the anti-inflammatory cytokine of TGF-ß1 was dampened. Moreover, the p38α mitogen-activated protein kinase (p38α MAPK) was notably phosphorylated in placental macrophages infected with both RHΔrop16 and RH WT strains compared with the control. Taken together, our findings indicated that ROP16I deletion of type I RH strain may cause exacerbated adverse pregnant outcomes, which is attributable to subversion of the maternal immune tolerance due to the increased pro-inflammatory cytokines in the pregnant animals. The results also suggest that ROP16I might be a protective factor and other T. gondii-derived molecules might be involved in the M1-Th1 biased pathological process in aberrant pregnancy at the early phase of gestation.

Treatment status of maternal syphilis infection and factors associated with their adverse pregnant outcomes in Shanghai during 2013-2015 / 中华传染病杂志

Objective To analyze the factors associated with syphilis treatment compliance and adverse pregnant outcomes among pregnant women with syphilis in Shanghai.Methods The prospective cohort was established based on maternal syphilis monitoring system of Shanghai,which included all the pregnant women diagnosed with syphilis during Jan 2013 to Dec 2015.A total of 1 717 pregnant women with syphilis were recruited at the baseline,and 1 147 of them were followed up during treatment and their pregnancy,and the delivery outcomes were recorded.The information of testing/treatment of pregnant women with syphilis and health outcomes of infants were collected.Chi-square test was used for univariate analysis and logistic regression model was used to identify the factors associated with syphilis treatment and adverse pregnant outcomes.Results A total of 685 participants received syphilis treatment during pregnancy,with the treatment rate of 59.7％.Among them,397 (34.6％) patients underwent two courses of complete treatment.The poor educated,unemployed/job-waiting or multipara population had poor compliance to treatment.Only 34.9％ (142/407) of cases diagnosed at last trimester received syphilis treatment and 10.1％ (41/407) completed the treatment.The proportion of non-treponemal conversion were higher in subjects who received syphilis treatment during pregnancy than those who did not (39.1％ [268/285] vs 3.7％ [17/462]).Complete syphilis treatment during pregnancy was protective factor to decrease neonatal death adjusted relative risk ([aRR] =0.05,95％ CI:0.01-0.37,P =0.003) and prematurity/low birth weight (aRR =0.44,95％ CI:0.27-0.70,P =0.001).Strong positive non-treponemal result before delivery increased the risks of neonatal death (aRR =12.89,95％ CI:1.70-100.43,P =0.014) and prematurity/low birth weight (aRR =12.78,95％ CI:152-5.06,P =0.001).Conclusions Factors such as educational level,employment status,and maternal history will affect the compliance of syphilis treatment during pregnancy.Early diagnosis and complete treatment course of syphilis could improve the pregnant outcomes and the health status of infants.

Prevalence of Vitamin D Deficiency during Second Trimester of Pregnancy in Shanghai China, Risk Factors and Effects on Pregnancy Outcomes.

BACKGROUND: Vitamin D plays important roles in various physiological processes. Vitamin D deficiency is common among pregnant women in some regions, such as China. Our study aimed to determine the prevalence of Vitamin D deficiency during second trimester of pregnancy in Shanghai China, and explore its risk factors and effects on pregnant outcomes. METHODS: Overall, 23100 pregnant women (2013 to 2017, Shanghai, China) were included and vitamin D concentrations were measured at 16 weeks of gestation. Correlations between vitamin D concentrations and participants' general data and maternal and infant outcomes were analyzed by chi square test. Non-conditional multivariate logistic regression analysis was used to screen the independent risk factors for vitamin D deficiency. RESULTS: Vitamin D deficiency was significantly correlated with aging, education level, smoking, dirking, BMI before pregnancy, body weight gain during pregnancy (P<0.01), the use of vitamin D supplement and milk consumption, and older than 30 years, drinking, smoking, BMI before pregnancy> 36, body weight gain during pregnancy< 40g per day, no daily milk consumption, no vitamin D supplement, and education lever below college were independent risk factors for vitamin D deficiency in second trimester of pregnancy. In addition, vitamin D deficiency in second trimester of pregnancy was closely correlated with the occurrence of a serious of adverse maternal and infant outcomes. CONCLUSION: Vitamin D deficiency was still common among women in second trimester of pregnancy in Shanghai China. Vitamin D deficiency was closely correlated with the occurrence of a serious of adverse maternal and infant outcomes.

Toxoplasma Chinese 1 Strain of WH3Δrop16I/III /gra15II Genetic Background Contributes to Abnormal Pregnant Outcomes in Murine Model.

Toxoplasma gondii infection evokes a strong Th1-type response with interleukin (IL)-12 and interferon (IFN)-γ secretion. Recent studies suggest that the infection of pregnant mice with T. gondii may lead to adverse pregnancy results caused by subversion of physiological immune tolerance at maternofetal interface rather than direct invasion of the parasite. Genotype-associated dense granule protein GRA15II tends to induce classically activated macrophage (M1) differentiation and subsequently activating NK, Th1, and Th17 cells whereas rhoptry protein ROP16I/III drives macrophages to alternatively activated macrophage (M2) polarization and elicits Th2 immune response. Unlike the archetypal strains of types I, II, and III, type Chinese 1 strains possess both GRA15II and ROP16I/III, suggesting a distinct pathogenesis of Toxoplasma-involved adverse pregnancies. We constructed T. gondii type Chinese 1 strain of WH3Δrop16 based on CRISPR/Cas9 technology to explore the ROP16I/III-deficient/GRA15II-dominant parasites in induction of trophoblast apoptosis in vitro and abnormal pregnant outcomes of mice in vivo. Our study showed that Toxoplasma WH3Δrop16 remarkably induced apoptosis of trophoblasts. C57BL/6 pregnant mice injected with the tachyzoites of WH3Δrop16 presented increased absorptivity of fetuses in comparison with the mice infected with WH3 wild type (WH3 WT) parasites although no remarkable difference of virulence to mice was seen between the two strains. Additionally, the mice inoculated with WH3Δrop16 tachyzoites exhibited a notable expression of both IL-17A and IFN-γ, while the percentage of CD4+CD25+FoxP3 [T regulatory cells (Tregs)] were diminished in splenocytes and placenta tissues compared to those infected with WH3 WT parasites. Accordingly, expressions of IL-4, IL-10, and transforming growth factor beta 1, the pivotal cytokines of Th2 and Tregs response, were significantly dampened whereas IFN-γ and IL-12 expressions were upregulated in WH3Δrop16-infected mice, which gave rise to more prominent outcomes of abnormal pregnancies. Our results indicated that the WH3Δrop16 parasites with gra15II background of T. gondii type Chinese 1 strains may cause miscarriage and stillbirth due to subversion of the maternal immune tolerance and system immunity of the animals and the GRA15II effector contributes to the process of adverse pregnant consequences.

[Study on weight gain in different stages of pregnancy and pregnancy outcomes].

Objective: By investigating the relationship of pregestational body mass index(BMI), trimester-specific gestational weight gain (rate) during the first, second, third and total trimesters of pregnancy with adverse pregnant outcomes, to evaluate the effects of different pregestational BMI, trimester-specific gestational weight gain on pregnant outcomes, and to provide evidences for gestational weight control. Methods: From April 2015 to January 2016, 964 pregnant women in Zhejiang Taizhou First People's Hospital and Taizhou Huangyan Maternal & Child Care Service Center were enrolled in random for prospective study and were divided into groups according to the Institute of Medicine 2009 guidelines[IOM2009]. (1)They were divided into four groups according to pregestational BMI: low body mass, normal body mass, over body mass and obese group.(2)They were divided into three groups according to trimester-specific gestational weight gain (rate): normal gestational weight gain, insufficient gestational weight gain and excessive gestational weight gain.(3)The gestational weight gain and pregnant outcomes were recorded by using self-made information table, including the incidence rates of gestational diabetes mellitus (GDM), neonatal birth weight (BW), hypertensive disorders complicating pregnancy (HDCP), cesarean section, pliers delivery, shoulder dystocia, fetal macrosomia, small for gestational age (SGA), premature rupture of membranes, neonatal asphyxia, and neonatal hypoglycemia. Results: (1)In this study, 964 pregnant women were enrolled, no significant differences were found in terms of age, culture level, pregnancy times and delivery times of the different pregestational BMI groups (P>0.05). (2)The incidences of GDM, HDCP, premature rupture of membranes, cesarean section, pliers delivery, shoulder dystocia, fetal macrosomia, SGA, neonatal asphyxia and neonatal hypoglycemia were as dependent variables and trimester-specific gestational weight gain (rate) was as independent variable.Multivariate Logistic regression analysis showed that the pregnancy obesity was associated with increased risks of GDM and HDCP, the OR values were 6.63 and 2.60 (P<0.05). The excessive gestational weight gain (rate) of the total trimester of pregnancy was associated with increased risks of GDM, fetal macrosomia and cesarean section, the OR values were 2.05, 1.36 and 1.60, (P<0.05). There was no statistical significance in other groups (P>0.05). (3)Compared to the normal groups, the pregnancy obesity and excessive gestational weight gain of the first, second, third and total trimesters of pregnancy were all associated with an increased risk of GDM, the OR values were 7.36, 1.61, 1.81, 2.20 and 2.4 (P<0.05), respectively.The incidences of HDCP, cesarean section and neonatal hypoglycemia in pregnant women with GDM were higher than those in normal pregnant women (P<0.05). Conclusion: There is a significant correlation among pregestational BMI, gestational weight gain (rate) during the first, second, third and total trimesters of pregnancy with adverse pregnant outcomes, and it suggested that we could reduce the incidence of adverse pregnant outcomes by pre-pregnancy BMI and gestational weight control, and the focus should be placed on pre-pregnancy BMI control.

Clinical features of new-onset systemic lupus erythematosus in pregnant patients.

AIM: This study was conducted to examine the clinical characteristics of new-onset systemic lupus erythematosus (SLE) during pregnancy. METHODS: We performed a retrospective study of all pregnancies in patients with SLE managed at The People's Hospital of Peking University from 2008 to 2015. In total, 97 pregnancies were identified and studied, 22 of which were first diagnosed with SLE during pregnancy or puerperium. RESULTS: New-onset SLE mainly occurred during the first and second pregnancy trimesters. Blood and multi-organ involvement were detected in 95.45% and 45.45% of new-onset patients, respectively, and both had a higher incidence than in active patients. Thrombocytopenia was the most common blood involvement in new-onset patients. All three maternal deaths occurred in new-onset patients. There were nine (40.91%) fetal losses, three (13.64%) low birth weight infants, one (4.54%) fetal malformation and two (9.09%) cases of neonatal lupus in new-onset patients. CONCLUSION: New-onset pregnant SLE patients were characterized with blood system involvement and generally experienced more adverse maternal outcomes than active patients with SLE history. However, adverse fetal outcomes in new-onset patients were the same as those of active patients with an SLE history.

Echocardiographic characteristics and pregnant outcome in fetuses with complete closure of the ductus arteriosus / 中华超声影像学杂志

Objective To explore the echocardiographic features and pregnant outcomes in fetuses with complete closure of the ductus arteriosus ( DA) . Methods The echocardiographic data and follow-up materials were retrospectively reviewed in 28605 fetuses . Of all the fetuses ,6 fetuses had complete closure of the DA . The echocardiographic features and pregnant outcomes of the 6 fetuses with complete closure of the DA were summarized . Results Of all the 6 fetuses ,4 cases were found in the third trimester and 2 cases in the second trimester . There was no the lumen of the DA in the three vessel view on the two dimensional echocardiography ,demonstrating the line-like low echogenicity in the DA area . No DA flow signal was found on the color and spectral Doppler imaging . Four cases had dilated right heart .Six cases had thickened wall of the right ventricle ( WRV ) ,and hypokinetic motion of the WRV . Moderate to severe tricuspid regurgitation were found in 5 cases and disappeared or reversal a-wave of the ductus venosus were found in 5 cases . The mild pericardial effusion was found in 2 cases . Of all the 6 cases ,4 cases were delivered by cesarean section and the echocardiographic findings were unremarkable at the follow -up of six months . Conclusions Intrauterine complete closure of the DA can be accurately diagnosed by fetal echocardiograph in the 2-3 trimesters . If indicated ,elective delivery results in good outcome .

Idiopathic polyhydramnios at term and pregnancy outcomes: a multicenter observational study.

AIM: To assess pregnancy outcomes in pregnancies with idiopathic polyhydramnios at term. METHODS: We conducted a retrospective cohort study of 106 225 term pregnancies from 37 hospitals in China. Maternal and fetal outcomes in pregnancies with idiopathic polyhydramnios were compared with pregnancies with normal amniotic fluid. The primary outcome was intra-uterine fetal death (IUFD). RESULTS: In all, 307 out of 106 225 (0.3%) had idiopathic polyhydramnios at term, 276 of which were mild and 31 of which were moderate-severe. Compared to term pregnancies with normal amniotic fluid, pregnancies idiopathic polyhydramnios was associated with over 24-fold higher risk for IUFD (adjusted odds ratio [aOR] 24.4, 95% confidence interval (CI) 7.3-82.0), macrosomia (aOR 2.8, 95%CI 2.0-3.8), malpresentation (aOR 2.5, 95%CI 1.7-3.7), cesarean delivery (aOR 2.5, 95%CI 1.7-3.7) and low APGAR scores at 5 min (aOR 4.3, 95%CI 2.4-7.8), which increased with severity of idiopathic polyhydramnios. CONCLUSION: Term pregnancies with idiopathic polyhydramnios, especially moderate-severe ones are at a significantly increased rate for adverse pregnancy outcome. Increased antepartum surveillance of fetal well-being and timed delivery are warranted.

Clinical analysis of 350 pregnant women with epilepsy / 中华神经科杂志

Objective To investigate the usage of antiepileptic drugs (AEDs),epileptic seizures,pregnancy outcomes and infant feeding practices among pregnant women with epilepsy,and provide scientific evidence for eugenics.Methods The clinical characteristics of 350 pregnant women with epilepsy from Shaanxi Provincial Epilepsy & Pregnancy Register from October 2012 to July 2016 were analyzed retrospectively.Results A total of 350 patients with 376 pregnancies were included in the final analysis.Among 376 pregnancies,272 pregnancies (72.3％) were under the treatment of AEDs.Of them,246 pregnancies (90.4％) were on monotherapy,26 (9.6％) on polytherapy.Only patients during 179 pregnancies (47.6％) took folic acid in the first trimester.Seizure frequency increased in patients during 123 pregnancies (32.7％),of whom patients during 43 pregnancies (35.0％) did not use AEDs.Although other patients during 80 pregnancies (65.0％) took AEDs,regular pharmacokinetic monitoring was absent.A total of 170 pregnancies (45.2％) attained seizure-free.Seizure frequency decreased in 42 pregnancies (11.2％) and remained unchanged in 24 pregnancies (6.4％).The rates of cesarean section and natural delivery were 43.8％ (158/361) and 56.2％ (203/361),respectively.Totally 4.5％ (17/376) pregnancies had adverse pregnancy outcome,and 1.9％ (7/376) had fetal malformations.The most common congenital malformation was heart malformation,which was observed in two offspring.One offspring developed dysostosis,one developed chromosome abnormality,and another developed cerebellum deformity.In addition,one twin developed conjoined deformities.Breastfeeding rate was 52.6％ (190/361).Conclusions In Shaanxi province,AEDs compliance,pharmacokinetic monitoring and usage rate of folic acid still need to be improved in pregnant women with epilepsy.Clinical trial registration Chinese Clinical Trial Registry,ChiCTR-OOC-16009277

[Investigation on Toxoplasma gondii infection and awareness of toxoplasmosis-related knowledge in women with poor pregnant outcomes in Wuxi City].

OBJECTIVE: To investigate the prevalence of Toxoplasma gondii infection and awareness of toxoplasmosis-related knowledge among women with poor pregnant outcomes in Wuxi City. METHODS: A total of 217 women with poor pregnant outcomes from Wuxi City during the period of January 2011 to December 2015 were randomly selected as the study subjects (a study group), while 250 women with normal pregnancy were served as controls (a control group). The sero-prevalence of T. gondii infection was detected by using ELISA and compared between the study and control groups. The awareness of toxoplasmosis-related knowledge was investigated by using a self-designed questionnaire and compared between the study and control groups. RESULTS: The positive rate of anti-Toxoplasma antibody was 30.88% in the study group, which was significantly higher than that (8.8%) in the control group (χ2 = 36.7, P < 0.01). The positive rates of anti-Toxoplasma IgG and IgM antibodies were 20.74% and 10.14% in the study group respectively, which were significantly higher than those (6% and 2.8%) in the control group (χ2 = 22.53 and 10.74, both P values < 0.01). In addition, the positive rates of anti-Toxoplasma, anti-Toxoplasma IgG and IgM antibodies were significantly higher in the women with missed miscarriage, natural abortion, stillbirth and birth defect than those in the women with normal pregnancy (all P values < 0.05). The awareness rates of "Do you hear about Toxoplasma or toxoplasmosis?" (P < 0.01), "Do you know that breeding pet cats or dogs may cause Toxoplasma infection?" (P < 0.05) and "Do you know that pregnancy women require the detection of Toxoplasma infection?" (P < 0.01) were significantly lower in the study group than those in the control group, while no significant differences were seen in the awareness rates of "Do you know that eating hot pot may cause Toxoplasma infection?", "Do you know that the use of chopping block in regardless of cooked and uncooked food may cause Toxoplasma infection?", "Do you know that Toxoplasma infection may transfer from mother to fetus?", "Do you know that Toxoplasma infection may cause adverse pregnant outcomes like abortion, stillbirth or fetal abnormalities ?", and "Do you know that the women infected with T. gondii during pregnancy require treatment?" between the two groups (all P values > 0.05). CONCLUSIONS: This study demonstrates higher prevalence of T. gondii infection in women with poor pregnant outcomes than in those with normal pregnancy in Wuxi City. Considering the harm of T. gondii infection during pregnancy and the low awareness of toxoplasmosis-related knowledge in pregnant women, the health education of toxoplasmosis-related knowledge should be strengthened, especially for pregnant women, so as to reduce the prevalence of T. gondii infection among pregnant women to improve the better child-bearing and rearing level.

Investigation on Toxoplasma gondii infection and awareness of toxoplasmosis-related knowledge in women with poor pregnant outcomes in Wuxi City / 中国血吸虫病防治杂志

Objective To investigate the prevalence of Toxoplasma gondii infection and awareness of toxoplasmosis?related knowledge among women with poor pregnant outcomes in Wuxi City. Methods A total of 217 women with poor pregnant out?comes from Wuxi City during the period of January 2011 to December 2015 were randomly selected as the study subjects( a study group),while 250 women with normal pregnancy were served as controls(a control group). The sero?prevalence of T. gon?dii infection was detected by using ELISA and compared between the study and control groups. The awareness of toxoplasmosis?related knowledge was investigated by using a self?designed questionnaire and compared between the study and control groups. Results The positive rate of anti?Toxoplasma antibody was 30.88%in the study group,which was significantly higher than that (8.8%)in the control group(χ2 =36.7,P0.05). Conclusions This study demonstrates higher prevalence of T. gondii infection in women with poor pregnant out?comes than in those with normal pregnancy in Wuxi City. Considering the harm of T. gondii infection during pregnancy and the low awareness of toxoplasmosis?related knowledge in pregnant women,the health education of toxoplasmosis?related knowledge should be strengthened,especially for pregnant women,so as to reduce the prevalence of T. gondii infection among pregnant women to improve the better child?bearing and rearing level.

Metabolism alteration in follicular niche: The nexus among intermediary metabolism, mitochondrial function, and classic polycystic ovary syndrome.

Classic polycystic ovary syndrome (PCOS) is a high-risk phenotype accompanied by increased risks of reproductive and metabolic abnormalities; however, the local metabolism characteristics of the ovaries and their effects on germ cell development are unclear. The present study used targeted metabolomics to detect alterations in the intermediate metabolites of follicular fluid from classic PCOS patients, and the results indicated that hyperandrogenism but not obesity induced the changed intermediate metabolites in classic PCOS patients. Regarding the direct contact, we identified mitochondrial function, redox potential, and oxidative stress in cumulus cells which were necessary to support oocyte growth before fertilization, and suggested dysfunction of mitochondria, imbalanced redox potential, and increased oxidative stress in cumulus cells of classic PCOS patients. Follicular fluid intermediary metabolic profiles provide signatures of classic PCOS ovary local metabolism and establish a close link with mitochondria dysfunction of cumulus cells, highlighting the role of metabolic signal and mitochondrial cross talk involved in the pathogenesis of classic PCOS.

Study on the high risk value of TSH in pregestational women / 中华内分泌代谢杂志

Objective To analyze the relationship of the serum concentration of TSH in pregestational women with pregnancy and pregnant outcome,and to investigate the high risk value of TSH in eugenic and healthy examination before pregnancy.Methods The distribution of TSH in fertile woman and the relationship of serum TSH level with sex hormone levels,rate of pregnancy,and adverse pregnant outcomes (no healthy infants were born,abortion,premature delivery,and malformation) were investigated in national-free pregestational eugenic and healthy examination during 2013.The high risk level of TSH in pregestational women was determined.Results The average level of TSH in 5 798 prepregnant women was 2.36 mIU/L with the median of 2.01 mIU/L,and the serum level of TSH showed abnormal distribution with long tail.The pregnant rate of fertile women within one year was 76.1％.The beneficial range of TSH levels for pregnancy was 0.35-3.5 mIU/L,while the pregnant rate in other ranges of TSH level was decreased with statistically significant difference (P＜0.01).When the concentration of TSH was below 0.35 mIU/L or above 5.5 mIU/L,abnormal pregnant outcomes were significantly increased (P＜0.01).Logistic regression analysis indicated that the relative risks of infertility and abnormal pregnant outcomes were significantly increased.Compared with TSH 0.35-2.5 mIU/L group,there were significantly differences in FSH,LH,and estradiol (E2) in TSH＞4.5 mIU/L or＜0.35 mIU/L group (P＜0.01).TSH was related with LH,E2,progesterone,and prolactin (r=0.29,-0.28,-0.37,0.36).Conclusion The high risk value of serum TSH in prepregnant women should be below 0.35 mIU/L or above 5.5 mIU/L.

Impact of subclinical hypothyroidism on the outcome of pregnancy / 中华内分泌代谢杂志

Objective To evaluate the impact of subclinical hypothyroidism (SCH) on the outcome of pregnancy and the therapeutic effect of L-T4.Methods A total of 1 786 pregnant women during the first, second, and third trimesters were enrolled for thyroid screening by determining serum free thyroxine (FT4), total thyroxine (TT4), thyrotropin (TSH), and thyroid peroxidase antibody;123 pregnant women with SCH were successfully divided into treated group (n =42) and untreated group (n =81).The treated group was treated by L-T4 based on American Thyroid Association (ATA) 2011 guideline.Collected items include obstetric outcomes and complications.Results (1) Compared to control group, the rate of spontaneous abortion in pregnant women during first trimesters was increased in SCH group (20.99％ vs 8.45％, x2 =12.96, P =0.00), with higher incidence of diabetes during second trimester (24.69％ vs 10.45％, x2 =14.11, P =0.00).The incidences of hypertension during pregnancy, premature delivery, ablatio placentae, placenta praevia, fetus growth restriction, and low birth weight showed no difference between two groups (all P ＞ 0.05).(2) Compared with the untreated group, the incidences of spontaneous abortion and diabetes were decreased in the treated group (7.14％ vs 20.99％, x2 =3.89, P =0.05;9.52％ vs 24.69％, x2 =4.05, P =0.04), while the incidences of hypertension, premature delivery, ablatio placentae, placenta praevia, fetus growth restriction, and low birth weight infant accident rate were not different between two groups (all P ＞ 0.05).Conclusions SCH during the frist trimester is a risk factor of spontaneous abortion;SCH during the middle stage of pregnancy is a risk factor of gestational diabetes mellitus.Treatment of SCH with L-T4 may be beneficial.

The effects of elderly pregnancy complicated with hypertensive disorder complicating pregnancy on the pregnant outcome / 中国基层医药

Objective To investigcte the effects of elderly pregnancy complicated by hypeaensive disorder on the pregnant outcome.Methods The analysis on the ultimate outcomes of pregnancy with HDCP and their neo nates is conducted.among which 51 cases with the pregnancy at the age of 35 or above were chosen as the observation group,while 143 cases whose ages are below 35 were chosen as the control group and their 217 neonates.The process of two groups of pregnancy complications:The rate of heart failure,abnormal liver function,kidney damage,HELLP syndrome,premature,placenta abruption,severe preeclampsia and eclampsia.The rate of fetal distress,neonatal as phyxia,perinatal mortality rate,FGR were observed.Results The rate of kidney damage,abnormal liver function, HELLP syndrome or premature in the observation group is remarkably higher than that in the contrl group(P＜ 0.05).There is no significant difference between the two groups on the rate of severe preeclampsia and eclampsia, heart failure,placenta abruption(P＞0.05).The rate of FGR,fetal distress,neonatal asphyxia,perinatal mortality rate is signicartly higher in the observation group than that in the control group(P＜0.05).Conclusion Elderly pregnancy complicated by HDCP is harmful for pregnant women and neonatal.It is necessary to reinforce the prevention measures and clinical treatment.