Role of the brain-sparing effect on retinopathy of prematurity in newborns with fetal growth restriction.

INTRODUCTION: This study aimed to investigate the role of the brain-sparing effect (BSE) on retinopathy of prematurity (ROP) in fetal growth restriction (FGR). METHODS: In this retrospective study, 127 pregnant women were divided into two groups considering the cerebroplacental ratio (CPR): FGR with abnormal CPR group (n = 74) and the appropriate for gestational age with normal Doppler group (n = 53). CPR was computed using the pulsatility index (PI) and resistance index (RI) to quantitate the waveforms [middle cerebral artery (MCA) PI/umbilical artery (UA) PI and MCA RI/UA RI: a result <1 was taken into account as abnormal]. ROP screening results of newborns were recorded from electronic files. RESULTS: After adjusting for co-variants, BSE was not related to ROP (adjusted odds ratio [aOR], 1.06; 95% confidence interval [CI], 0.23-4.95). Gestational age at delivery <30 weeks (aOR, 2.55; 95% CI, 1.04-6.93) and birth weight <1500 g (aOR, 5.15; 95% CI, 1.15-25.2) were independently associated with ROP. Preeclampsia, emergency cesarean section birth, or 48 h completion after the first steroid administration were not associated with ROP. CONCLUSIONS: Gestational age at delivery <30 weeks and birth weight <1500 g are independent risk factors for ROP in FGR whereas the BSE is not a risk factor.

Third-trimester persistent maternal hypotension effects on late-onset small for gestational age and adverse perinatal outcomes.

INTRODUCTION: The purpose of the current study was to examine whether third-trimester persistent maternal hypotension is related to small for gestational age (SGA) and adverse perinatal outcomes. METHODS: In this large retrospective cohort study, 6560 pregnant women were enrolled and divided into two groups according to maternal tension status: a normotensive group (n: 6290) and a persistent maternal hypotensive group (n: 270). Persistent maternal hypotension was defined as an SBP <100 mmHg and/or DBP <60 mmHg at three antenatal visits: visit 1 (260/7-296/7 gestation weeks), visit 2 (300/7-336/7 gestation weeks), and visit 3 (340/7-366/7 gestation weeks). Following the Delphi consensus criteria, a fetal growth restriction diagnosis was employed. The presence of an SGA neonate was the primary outcome of the study. SGA was defined as fetal abdominal circumference below the 10th percentile or fetal birth weight below the 10th percentile in the absence of abnormal Doppler findings. The secondary outcomes were defined as the presence of other adverse perinatal outcomes. RESULTS: The baseline characteristics of the study population were similar. We found that SGA rates were 6.3% in the control group and 7.0% in the persistent maternal hypotension group, which were statistically similar. In the present study, the secondary outcomes which prematurity, low 5-min Apgar score, and NICU admission were similarly between groups. DISCUSSION: Our results indicate that third-trimester persistent hypotension is not associated with SGA neonates or adverse perinatal outcomes. Hence, it can be concluded that third-trimester persistent hypotension is a physiological phenomenon during pregnancy that should not cause anxiety in mothers.

Effect of third trimester maternal vitamin D levels on placental weight to birth weight ratio in uncomplicated pregnancies.

OBJECTIVES: Vitamin D has critical role for the fetal and placental development. Today, placental weight (PW), fetal birth weight (BW), and the PW/BW ratio are used as markers of fetal development. The aim of this study is to evaluate the relationship between vitamin D levels and these markers in uncomplicated pregnancies. METHODS: This study included 108 women with uncomplicated pregnancies, defined as full-term and healthy pregnancies without perinatal complications. Vitamin D levels <12 ng/mL were classified as deficient, 12-20 ng/mL as insufficient, and >20 ng/mL as normal. Postnatal BW and PW were compared according to maternal serum vitamin D levels. RESULTS: Maternal age, maternal height, maternal weight, body mass index, nulliparity, gestational age at delivery, mode of delivery, and fetal gender were similar between groups. Postnatal BW, PW, fetal height at birth, and fetal head circumference parameters were similar between the groups. The PW/BW ratio was 21.77±2.20 in the vitamin D deficient group, 21.20±2.40 in the insufficient group, and 19.98±2.37 in the normal group (p=0.012). In addition, there was a significant negative correlation between vitamin D level and the PW/BW ratio (p=0.012, r=0.031). CONCLUSIONS: Our results indicated that PW/BW ratio which is the marker for prediction adverse perinatal outcomes were significantly increased in the presence of vitamin D deficiency and insufficiency.

Severe Intrahepatic Cholestasis Pregnancy Is Associated With Maternal Endothelial Dysfunction: A Case-Control Study.

OBJECTIVE: The aim of the present study was to evaluate maternal serum endocan levels, which are markers of vascular pathologies and strongly associated with vascular inflammation and endothelial dysfunction, in pregnancies complicated by intrahepatic cholestasis of pregnancy (ICP). METHODS: The study comprised 30 pregnant women with mild ICP, 30 pregnant women with severe ICP, and 30 healthy pregnant women as a control group. The inclusion criteria were women with ICP, which was diagnosed based upon the presence of pruritus associated with elevated total bile acid (TBA) levels (> 10 µm/L), elevated aminotransferases, or both, and the absence of diseases that may produce similar laboratory findings and symptoms. Severe ICP was defined as TBA > 40 µmol/L. After diagnosis for ICP, blood samples were obtained before medication during hospitalization to analyze maternal serum endocan levels. RESULTS: Gestational age at delivery, delivery induction rates, birth weight, and newborn intensive care unit (NICU) admission rates were significantly higher in the severe ICP group than in the control group and mild ICP group. Gestational age for all groups when blood was sampled was similar. Maternal serum TBAs and aminotransferase levels were significantly higher in the severe ICP group than in the control group and mild ICP group. The mean serum endocan levels were 10.9 ± 2.6 ng/mL in the control group, 12.5 ± 2.8 ng/mL in the mild ICP group, and 24.3 ± 4.8 ng/mL in the severe ICP group (p < 0.001). CONCLUSION: Our results indicated that maternal serum endocan levels were increased in the presence of severe ICP and it can be speculated that increased bile acid levels were associated with maternal endothelial dysfunction.

Evaluation of Altmetric Analysis Scores of the Top 100 Articles on Polycystic Ovary Syndrome Published in the Last 10 Years.

OBJECTIVE: In the current study, we analyzed the 100 most cited articles with the topic, title, and keywords of polycystic ovary syndrome (PCOS) published in all journals in terms of traditional metrics and the altmetric score (AS). METHODS: The term "polycystic ovary syndrome (PCOS)" was searched in the Web of Science (WoS) database and filtered for articles published in all journals. Bibliographic data and AS were obtained for 100 highly cited papers from January 2012 to July 2022. Descriptive statistics were reported and correlation analysis between traditional bibliographies and the AS was performed. RESULTS: The Journal of Clinical Endocrinology & Metabolism, with 14 articles, had the most publications on the Top 100 list. When the studies were classified according to subtypes, 56 papers were original scientific papers with mean AS of 32.5 (15.3-52.7), whereas 44 papers were reviews and meta-analyses with AS of 16.0 (8.6-43.2). The AS was positively correlated with H-index, total WoS citation number of article and Q category. There were no correlations with impact factor (IF), five-year IF, journal impact factor (JIF) percentile and journal citation indicator (JCI) value. CONCLUSION: Our results suggest that the AS is related with article total WoS citation number, journal Q category, and journal H-index. Effective communication on social media can promote scientific productivity and have a positive impact on society.

Evaluation of maternal serum progesterone-induced blocking factor levels in pregnancies complicated with early- and late-onset preeclampsia.

The aim of present study was to evaluate maternal serum progesterone-induced blocking factor (PIBF) levels in pregnancies complicated with early-onset (EO-PE) and late-onset (LO-PE) preeclampsia. Patients with preeclampsia were divided in two groups according to preeclampsia onset and compared to healthy control group: EO-PE and LO-PE defined as being diagnosed before 340/7 and ≥340/7 weeks, respectively. Maternal age, nulliparity, BMI at blood sampling, smoking, history of caesarean section and ethnicity were statistically similar among the groups. Statistically significant differences were found between the eo-PE and lo-PE preeclampsia groups in terms of gestational age at delivery, mean birth-weight percentile and foetal growth restriction rates. The mean serum PIBF level was 528.6 ± 220 ng/mL in the eo-PE and 615.3 ± 269.1 ng/mL in the lo-PE preeclampsia and 782.3 ± 292.4 ng/mL in the control groups; the difference among groups was statistically significant. Our results indicated that decreased PIBF levels play an important immunologic role in preeclampsia onset. IMPACT STATEMENTWhat is already known on this subject? Maternal lymphocytes secrete PIBF that provides the immunological effects of progesterone during pregnancy by activating T-helper type 2 (Th2) cells and inhibiting any activated uterine natural killer (uNK) cells. The recent studies results have shown that there is disproportion in the Th1/Th2 rate in women with preeclampsia. This purports that Th1-mediated immunity is promoted through Th2-mediated immunity, which can be involved in the pathogenesis of preeclampsia.What do the results of this study add? In this study we found that PIBF levels in maternal serum were significantly lower in the EO-PE group than in LO-PE and control group. Our results indicated that decreased PIBF levels play an important immunologic role in preeclampsia onset.What are the implications of these findings for clinical practice and/or further research? We can speculate that first trimester maternal serum PIBF levels may be a useful biomarker for prediction of EO-PE. Using serum PIBF levels within the first trimester combined with Doppler values for the uterine artery, and some biochemical markers to predict onset and severity of preeclampsia appear to be a new screening method.

First-trimester maternal serum betatrophin levels are decreased in pregnancies complicated by gestational diabetes mellitus.

INTRODUCTION: The purpose of the present study was to compare maternal serum betatrophin levels during the first trimester from healthy pregnancies to those complicated by gestational diabetes mellitus (GDM). METHODS: In this prospective study, 320 pregnant women were evaluated in their first trimester, and 145 pregnant women who met the inclusion criteria were divided into the following two groups according to GDM screening results: GDM (n:20) and non-diabetic healthy control (n: 125). Samples of maternal serum fasting insulin, fasting blood glucose, hemoglobin (HB)A1c, and betatrophin levels obtained from the women's blood samples between 11+0/7 -13+6/7 gestational weeks during first trimester nuchal translucency screening. 75-g oral glucose tolerance test protocol was preferred for GDM scanning between 24+0/7 -28+0/7 gestational weeks. RESULTS: Maternal age and first-trimester body mass index (BMI) were higher in the GDM group than in the control group. Gestational age at blood draw was similar between the groups. First-trimester fasting insulin, fasting glucose, hemoglobin (Hb)A1c, thyroid-stimulating hormone, triiodothyronine (sT3), and thyroxine (sT4) were statistically similar between groups. First trimester Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) was 2.67 ± 1.42 in the GDM group and 2.12 ± 1.61 in the control group and not statistically different. Maternal age and BMI adjusted first-trimester maternal serum betatrophin levels were 11.58 ± 6.40 ng/mL in the GDM group and 31.11 ± 3.00 ng/mL in the control group and was statistically lower in the GDM group (p < 0.001). DISCUSSION: Our results indicated that first trimester maternal serum betatrophin levels are decreased in pregnancies complicated by GDM and first trimester betatrophin levels could be an early screening tool for GDM to allow better pregnancy management.

Maternal serum telomerase levels increase in pregnancies with mild and severe preeclampsia.

INTRODUCTION: Considering that preeclampsia is characterized by oxidative stress, inflammation, and endothelial dysfunction, we hypothesized that preeclampsia and preeclampsia severity may affect the telomerase levels of the mother. METHODS: This cross-sectional case control study comprised 86 participants who were separated into three groups as severe preeclampsia, non-severe preeclampsia, and healthy control group. Venous blood samples were obtained from pregnant women with severe preeclampsia just before delivery for biochemical analysis and to evaluate maternal serum telomerase levels. Since gestational age, maternal age and BMI would have an effect on maternal serum telomerase levels, serum samples were taken in the control group and non-severe preeclampsia group at similar gestational age during clinical visits in order to homogenize these parameters, and these patients were followed up. Telomerase levels in maternal serum were evaluated using the enzyme-linked immune-sorbent assay. RESULTS: Maternal age, nulliparity, body mass index (kg/m2) at blood sampling day, ethnicity, smoking and history of caesarian section were statistically similar among the groups. The mean birth weight percentiles were the lowest in the severe preeclampsia group. Fetal growth restriction rates were significantly higher in the severe preeclampsia group than in the non-severe preeclampsia group. Gestational age at blood drawn was similar among groups. Neutrophil lymphocyte ratio, platelet lymphocyte ratio, mean platelet volume, red cell distribution width and white blood cell were statistically different among groups. The serum telomerase level was 1.137 ± 0.390 ng/mL in the severe preeclampsia group, 0.763 ± 0.390 ng/mL in the non-severe preeclampsia group, and 0.425 ± 0.160 ng/mL in the control group (p < .001). DISCUSSION: This study indicated that maternal serum telomerase levels were significantly increased in both preeclampsia groups.

New ultrasonographic midtrimester scoring method for predicting spontaneous preterm birth in uncomplicated asymptomatic twin pregnancies.

OBJECTIVES: The aim of the present study was to evaluate a new ultrasonographic scoring method that could predict spontaneous preterm birth (sPTB) in uncomplicated twin pregnancies during routine anomaly screening in the midtrimester. METHODS: This prospective study included women with a monochorionic diamniotic (MCDA) or dichorionic diamniotic (DCDA) twin pregnancy gestational ages from 170/7 through 226/7. A new ultrasonographic score between 0 and 5 points was calculated using cervical length (CL), uterocervical angle (UCA), and cervical dilatation status during routine anomaly screening in the midtrimester. The primary outcome of the study was the prediction of sPTB < 32 and <34 gestational weeks. RESULTS: A total of 118 pregnant women with twins were evaluated, 31 of whom delivered before 34 gestational weeks an 87 of whom delivered after 34 gestational weeks. The sensitivity and specificity values were separately calculated for scores of 3.5 and 2.5 for predicting sPTB < 32 gestational weeks. The cut-off value of 3.5 provided a sensitivity of 80% and a specificity of 82%. When the score was 2.5, the sensitivity and specificity were 86 and 71%, respectively. To determine a score for predicting sPTB < 34 gestational week cut-off value of 3.5 provided a sensitivity of 80% and a specificity of 90%. When the score value was 2.5, the sensitivity and specificity of the method were 83 and 81%, respectively. CONCLUSIONS: Our results indicated that the midtrimester new scoring is a simple technique that can be easily used as an improved tool for predicting the risk of sPTB in women with a twin pregnancy.

Evaluation of midtrimester ductus venosus diameter and peak systolic velocity to predict late onset small for gestational age fetuses.

OBJECTIVE: The ductus venosus, a small blood vessel in the fetal venous system, has extraordinary physiologic significance because it connects the umbilical vein to the inferior vena cava in the fetus circulation system and transports highly oxygenated blood from the placenta to the fetus' heart. Hence, assessment of ductus venosus flows is helpful in evaluating fetal hemodynamics. Considering the critical function of the ductus venosus, we hypothesized that the diameter of the midtrimester ductus venosus and its peak velocity index can be related to adequate fetal growth; therefore, the aim of this study was to evaluate the role of the midtrimester umbilical venous blood flow, ductus venosus diameter, and ductus venosus peak systolic velocity to help predict uncomplicated deliveries of late onset small for gestational age (SGA) fetuses. METHODS: In this prospective study we analyzed the pregnancies and deliveries of 398 pregnant women who met the inclusion criteria and divided them into three groups according to fetal birth weight as follows: birth weight <3 percentile SGA group (n = 16), birth weight 3-10 percentile SGA group (n = 42), and appropriate for the gestational age (AGA) group (n = 340). The midtrimester ductus venosus diameter and peak sistolic velocity, umbilical venous blood flow, and umbilical artery pulsatility index (PI) were recorded. In the absence of congenital anomalies, the diagnosis of fetal growth restriction (FGR) is made according to Delphi consensus criteria. In the absence of abnormal Doppler findings, late FGR was defined as occurring ≥32 weeks. RESULTS: Maternal age, nulliparity, mean gestational age at ultrasound evaluation, ethnicity, body mass index, and previous cesarean delivery rates were similar among the groups. In addition, mid-trimester fetal biometric measurements and amniotic fluid volume were similar among the groups. The gestational age at delivery, prematurity, fetal birth weight, vaginal delivery rates, and rate of admission to the neonatal intensive care unit were significantly different among the groups. The mean mid-trimester umbilical vein blood flow to abdominal circumference ratio (UVBF/AC) was similar among the groups (p=.740). In the <3 group, the mean peak systolic velocity of the ductus venosus was significantly lower and the mean diameter of the ductus venosus significantly higher than those in the 3-10 and AGA groups (both p<.001). Although the values are below the 95th percentile mid-trimester umbilical artery PI was significantly higher in the <3 percentile SGA group than in the 3-10 percentile SGA and AGA groups. CONCLUSION: Our results suggest that the diameter and peak systolic velocity of the mid-trimester ductus venosus are useful noninvasive measurements that provide prediction of late onset SGA fetuses.

The role of the brain-sparing effect of growth-restricted fetuses in newborn germinal matrix/intraventricular hemorrhage.

OBJECTIVES: The aim of the study was to evaluate the effect of the brain-sparing effect (BSE) of fetal growth restriction (FGR) in newborn germinal matrix/intraventricular hemorrhage (GM/IVH). METHODS: A total of 320 patients who delivered prior to the 34th gestational week were analyzed from data records. 201 patients were divided into two groups according to cerebro-placental ratio (CPR): early fetal growth restriction (FGR) with abnormal CPR group (n=104) and appropriate for gestational age with normal Doppler group (control) (n=97). Using the normal middle cerebral artery (MCA) Doppler as a reference, multivariate logistic regression analysis was used to assess the association between the BSE and the primary outcome. RESULTS: The rate of Grade I-II germinal matrix/intraventricular hemorrhage (GM/IVH) was 31(29.8%) in the group possessing early FGR with abnormal CPR and 7(7.2%) in the control group, showing a statistically significant difference. The rate of grade III-IV GM/IVH was 7(6.7%) in the group possessing early FGR with abnormal CPR and 2 (2.1%) in the control group, showing no statistically significant difference. We found that gestational age at delivery <32 weeks was an independent risk factor for GM/IVH. In addition, we found that other variables such as the presence of preeclampsia, fetal weight percentile <10, emergency CS delivery, 48-h completion after the first steroid administration and 24-h completion rate after MgSO4 administration were not independently associated with the primary outcome. CONCLUSIONS: Our results indicate that the rate of GM-IVH was increased in the group possessing early FGR with abnormal CPR; however, multivariate logistic regression analysis showed that BSE was not an independent risk factor for GM/IVH.

Evaluation of the diagnostic accuracy of a combination of first-trimester ultrasound and maternal demographic characteristics for detecting abnormally invasive placenta.

OBJECTIVE: The aim of present study was to evaluate the diagnostic accuracy of using a combination of a first-trimester ultrasound and the maternal demographic characteristics in detecting abnormally invasive placenta (AIP). STUDY DESIGN: This prospective case-control study comprised 540 women who meet the inclusion criteria and who were included in the final analysis. Patients scored points based on a range between 0 and 13 for the ultrasonographic and clinical findings within first trimester. The primary outcome of the study was whether placenta accreta, increta, and percreta could be predicted early in pregnancy. RESULTS: The cutoff value of 5.5 provided a sensitivity of 100% and a specificity of 88% and the diagnostic odds ratio (DOR at 95% confidence interval [CI]) was 208 (12-3543), at 95%CI) was 0, and the positive likelihood ratio (LR + at 95%CI) was 8.25 for placenta percreta. The cutoff value of 6.5 provided a sensitivity of 92% and a specificity of 93% and DOR at 95%CI was 201.5 (25.5-1583.1), LR- at 95%CI was 0.08, and LR + at 95%CI was 15.32 for placenta percreta. The cutoff value of 4.5 provided a sensitivity of 100% and a specificity of 90% and DOR at 95%CI was 615 (37-10207), LR- at 95%CI was 0, and LR + at 95%CI was 11.7 for accreta and increta, respectively. The cutoff value of 5.5 provided a sensitivity of 87% and a specificity of 92% and DOR at 95%CI was 86.8 (28.9-260.8), LR- at 95%CI was 0.14, and LR + at 95%CI was 11.7 for placenta accreta and increta, respectively. CONCLUSION: The results of the present study indicated that this novel scoring provided high diagnostic accuracy for detecting all types of AIP during the first trimester.