Vaginal microbiome analysis of healthy women during different periods of gestation.

To assess the vaginal microbiome throughout full-term uncomplicated pregnancy, a longitudinal study was designed for 12 healthy women who had prepared to become pregnant and then delivered at term (38-42 weeks) without complications. The vaginal microbial community was studied at pre-pregnancy, 8-12, 24-28, 37-38 weeks of gestation, and puerperium, using hypervariable tag sequencing of the V3-V4 region of the 16S rRNA gene. Sequencing produced approximately 10 million reads on the Illumina MiSeq. Members of the Firmicutes phyla were prevailing before and during pregnancy periods, and the proportion was quite as Proteobacteria until puerperium. Lactobacillus genus was abundant before and during pregnancy, but post-delivery vaginal microflora variety turned diverse. The species-level analysis revealed that a healthy vaginal microbiome before or during pregnancy was prominently dominated by Lactobacillus crispatus. Furthermore, PCoA analysis revealed for differences in the bacterial community composition between the two levels of Lactobacillus species in pre-pregnancy and pregnancy period (PC1 contribution of 58.46%, PC3 contribution of 8.64%). Based on the taxonomic and PCoA analysis, we found that L. crispatus was dominant in the vaginal microflora of healthy women before or during pregnancy, but at the puerperium, the status changed leading to decreased abundance of protective Lactobacillus species that made vaginal micro-ecological barrier vulnerable to diseases. Additionally, vaginal pH was an important environmental property affecting the vaginal microbial community.

Goal-directed Fluid Therapy May Improve Hemodynamic Stability of Parturient with Hypertensive Disorders of Pregnancy Under Combined Spinal Epidural Anesthesia for Cesarean Delivery and the Well-being of Newborns.

BACKGROUND: Hypotension induced by combined spinal epidural anesthesia in parturient with hypertensive disorders of pregnancy (HDP) can easily compromise blood supply to vital organs including uteroplacental perfusion and result in fetal distress. The aim of this study was to investigate whether the goal-directed fluid therapy (GDFT) with LiDCO rapid system can improve well-being of both HDP parturient and their babies. METHODS: Fifty-two stable HDP parturient scheduled for elective cesarean delivery were recruited. After loading with 10 ml/kg lactated Ringer's solution (LR), parturient were randomized to the GDFT and control group. In the GDFT group, individualized fluid therapy was guided by increase in stroke volume (ΔSV) provided via LiDCO rapid system. The control group received the routine fluid therapy. The primary endpoints included maternal hypotension and the doses of vasopressors administered prior to fetal delivery. The secondary endpoints included umbilical blood gas abnormalities and neonatal adverse events. RESULTS: The severity of HDP was similar between two groups. The total LR infusion (P < 0.01) and urine output (P < 0.05) were higher in the GDFT group than in the control group. Following twice fluid challenge tests, the systolic blood pressure, mean blood pressure, cardiac output and SV in the GDFT group were significantly higher, and the heart rate was lower than in the control group. The incidence of maternal hypotension and doses of phenylephrine used prior to fetal delivery were significantly higher in the control group than in the GDFT group (P < 0.01). There were no differences in the Apgar scores between two groups. In the control group, the mean values of pH in umbilical artery/vein were remarkably decreased (P < 0.05), and the incidences of neonatal hypercapnia and hypoxemia were statistically increased (P < 0.05) than in the GDFT group. CONCLUSIONS: Dynamic responsiveness guided fluid therapy with the LiDCO rapid system may provide potential benefits to stable HDP parturient and their babies.

[Multicenter study on screen method for gestational diabetes].

OBJECTIVE: To investigate the feasibility of using random blood glucose to screen gestational diabetes mellitus (GDM). METHOD: The random blood glucose was determined in 1 038 pregnant women between 24 and 32 gestational weeks. Then 50 gram glucose challenge test (50 g GCT) was performed followed immediately. Finally, 75 gram oral glucose tolerance test (75 g OGTT) was done without dietary control for 3 days. If two values of four were abnormal, GDM was diagnosed. Impaired glucose tolerance (IGT) was diagnosed if only one value was abnormal or the 2nd hour value ranged from 120 to 164 mg/dl. RESULTS: (1) The determination of the three steps was completed in 948 cases. Among them, 42 cases (4.4%) were GDM, 372 cases (39.2%) were IGT and other 534 cases were normal. (2) In the normal group, the random blood glucose were different in fasting and postprandial times. No difference was found among blood glucose values determined of 50 g GCT at different times except that the value of 50 g GCT 1 hour postprandial was higher than the value at other times. There was no significant association between random blood glucose and 50 g GCT. (3) The sensitivity and specificity were 50.0% and 67.7%, when IGT was diagnosed using the cut point of 6.4 mmol/L (115 mg/dl) of random blood glucose, which was similar with 51.1% of sensitivity and 71.2% of specificity when using >or= 7.8 mmoL/L (140 mg/dl) as the cut point of 50 g GCT. If 6.4 mmol/L (115 mg/dl) was used as the cut point in GDM group the sensitivity would be 80.0%, which was much higher than that of IGT group and the specificity was 61.2%. In this study, if the value of >or= 8.3 mmoL/L (150 mg/dl) was used as the cut-point of 50 g GCT to screen the GDM, the sensitivity decreased only 2.0% while the specificity increased more than 10.0%. CONCLUSIONS: (1) The determination of random blood glucose to screen GDM couldn't replace the 50 g GCT, but it can be used as a complemental method and can be used repeatedly at any gestational age and convenience the pregnant women and the doctors. (2) The value of 8.3 mmol/L (150 mg/dl) was used as the cut-point of 50 g GCT, the specificity would be increased and the requirement for OGTT would be lowered markedly, which would reduce economic and psychological stress.

[Postpartum reclassification in women with gestational diabetes and analyzing the high risk factors associated with them].

OBJECTIVE: To follow up the 75 g oral glucose tolerance test (OGTT) in gestational diabetes mellitus (GDM) at 2 month after birth for reclassifying and analyzing the risk factors associated with the abnormal blood glucose level. METHODS: 294 cases of GDM underwent a 2 hours 75 g OGTT two months postpartum. According to the WHO diagnostic criteria, they were divided into three groups: (1) type 2 diabetic mellitus (DM), impaired glucose tolerance (IGT) and normal. The related factors during pregnancy were analysed. RESULTS: 160 cases (54.4%) were normal, 75 cases (25.5%) and 59 cases (20.1%) were IGT and DM respectively. (2) In the DM group, the gestational age at diagnosis was much earlier than those of the other two groups (P < 0.01), the glucose level of 50 gram glucose challenge test (GCT) and fasting blood glucose values in OGTT and the value of HbAlc at diagnosis were evidently higher than the other two groups (P < 0.01, P < 0.01, P < 0.01), the gestational age of use of insulin for treatment was earlier than normal group, the dosage used markedly greater than the other two groups, the fasting blood glucose and 2 hours postprandial glucose were significantly higher than other two groups (P < 0.01) within 7 days after birth. Maternal age, body weight and family history did not show difference in the three groups. CONCLUSION: Among the GDM, about 1/4 were IGT and 1/5 were type 2 DM. The DM group showed early diagnosis, high fasting blood glucose, high frequency to use insulin during pregnancy.