Relationship between Restless legs syndrome associated symptoms and presence of depression during pregnancy.

Restless legs syndrome (RLS) is associated with depression in the general population. Although depression can lead to adverse events during the perinatal period, the association between RLS and depression remains under debate. Thus, we examined the association between depression and RLS, including RLS-associated symptoms, in pregnant women. We evaluated the presence of RLS and RLS-associated symptoms in 135 pregnant women using questionnaires on RLS symptoms based on Allen's symptoms and the International Restless Legs Syndrome Rating Scale (IRLS), respectively. We defined RLS as 4/4 on Allen's symptoms. Depressive status was evaluated using the Edinburgh Postnatal Depression Scale. The mean±SD of age was 31.8 ± 4.3 years, and none of the participants had a family history of RLS. Ten percent of women had depression during their pregnancy and demonstrated higher IRLS scores than those without depression (6.1 ± 10.5 vs. 0.7 ± 3.8 points, P = 0.001). A significant association between IRLS score, including its subscales, and depression was observed, even after adjusting for confounders. It was concluded that RLS-associated symptoms may be indicators of depression during pregnancy. Comprehensive sleep evaluations and examinations of RLS-associated symptoms are needed to improve psychiatric health during pregnancy.

Idiopathic and secondary restless legs syndrome during pregnancy in Japan: Prevalence, clinical features and delivery-related outcomes.

OBJECTIVE: The aim of this study was to investigate prevalence of idiopathic and secondary restless legs syndrome (RLS) according to pregnancy trimester, and its effects on delivery-related outcomes among pregnant women in Japan. METHODS: This was a single-center, prospective observational study. One hundred eighty-two consecutive pregnant women participated in the study from June 2014 to March 2016. Participants were interviewed and examined in the second and third trimesters of pregnancy and 1 month after delivery. At each term, RLS was identified by a research assistant and then specialist in sleep medicine based on the diagnostic criteria of the International Restless Legs Syndrome Study Group. Delivery-related data was collected from medical charts. RLS was classified as idiopathic RLS, which originally existed before the index pregnancy, or secondary RLS, which newly appeared during the index pregnancy. RESULTS: The prevalence of RLS was 4.9% (idiopathic 3.3%, secondary 1.6%) in the second trimester, 5.0% (idiopathic 0.0%, secondary 5.0%) in the third trimester, and 0.6% (idiopathic 0.0%, secondary 0.6%) after delivery. Prolonged labor, emergency Cesarean section, and arrest of labor tended to be more frequent in idiopathic and/or second RLS (all p<0.05). CONCLUSIONS: The prevalence of RLS during pregnancy was 4-5% and decreases after delivery in current Japan. The presence of RLS was associated with an increase in some delivery-related outcomes. Early detection and treatment of RLS during pregnancy may be beneficial to safe delivery for pregnant women.

Separation efficiency of a microfluidic sperm sorter to minimize sperm DNA damage.

OBJECTIVE: To evaluate whether microfluidic sperm sorters (MFSSs) allow effective recovery of sorted motile sperm without DNA damage compared with the centrifugation and swim-up procedure. DESIGN: Experimental laboratory study. All participants completed questionnaires regarding previous and/or current diseases, surgery, reproductive experiences, lifestyle factors, and date of the preceding ejaculation. SETTING: University research laboratory. PATIENT(S): Male volunteers were recruited without setting conditions. Semen samples from healthy volunteers (n = 37) were collected in sterile containers by masturbation. INTERVENTION(S): Flow cytometric measurement and sperm chromatin structure assay analysis of DNA damage after sperm preparation using MFSS and the centrifugation and swim-up procedure. MAIN OUTCOME MEASURE(S): Efficacy and efficiency of sperm preparation, correlation between sperm DNA fragmentation index (DFI) and semen parameters, and relationship between basic characteristics and DFI after the centrifugation and swim-up procedure. RESULT(S): Final sperm concentration and motility were significantly different between the centrifugation and swim-up procedure and MFSS sperm preparations. A significantly lower sperm DNA fragmentation rate was detected with MFSS compared with the centrifugation and swim-up procedure use. No correlation was observed between DFI and smoking or drinking, but significant correlations were observed between DFI and medication use and sexual abstinence duration. CONCLUSION(S): MFSSs can be used to efficiently and reliably prepare sperm compared with the centrifugation and swim-up procedure. Further research on the clinical use of MFSSs is required to evaluate the safety and usefulness of this device.

Proposal of a new parameter for diagnosing a low-lying placenta in the third trimester: The distance between the external os and placental edge.

OBJECTIVE: To validate a new parameter of the distance between the external os (EO) and placental edge (PE) to diagnose a low-lying placenta in the third trimester. MATERIALS AND METHODS: The study participants included 94 uncomplicated singleton pregnant women with cephalic presentation. These women were cared for in our hospital in 1998-2011, with a posterior low-lying placenta, which was diagnosed as the distance between the internal os (IO) and a PE of 0-3.0 cm at 34-36 weeks' gestation. Measurements of cervical length (CL) and the distances of IO-PE and EO-PE were performed using transvaginal ultrasonography at least twice at 28-30 weeks, 31-33 weeks, and 34-36 weeks. Changes in CL, and the IO-PE and EO-PE distances were analyzed. RESULTS: CL and the IO-PE and EO-PE distances did not change prior to 31-33 weeks. CL was shortened and the IO-PE distance was increased after 31-33 weeks (p = 0.0001), but the EO-PE distance was unchanged. CONCLUSION: The EO-PE distance is a promising parameter for diagnosis of low-lying placenta in the third trimester up to 36 weeks' gestation.

Clinical significance of amphiregulin and epidermal growth factor in colostrum.

BACKGROUND: Colostrum contains a wide variety of crucial nutritional elements including growth factors for newborn infants to adapt to the extrauterine environment. OBJECTIVE: To investigate the clinical significance of epidermal growth factor receptor ligands in milk during the first month of lactation. METHODS: The concentrations of epidermal growth factor (EGF), amphiregulin (AR) and transforming growth factor-α (TGF-α) in milk sampled from a total of 31 normal mothers at days 1-3, 5, and 30 postpartum were examined using ELISA. RESULTS: At days 1-3, the concentration of EGF was extremely high [131.6 ± 20.4 (mean ± SEM) ng/ml] compared to that of AR (4,197.2 ± 1,055.2 pg/ml) or TGF-α (261.7 ± 33.6 pg/ml), while the concentration of AR was significantly elevated compared to that of TGF-α. At days 5 and 30, the concentration of EGF was significantly elevated compared to that of AR or TGF-α. In 16 mothers among the same 31 subjects, samples were longitudinally obtained on days 1, 2, 5, and 30 postpartum. Concentrations of AR were higher on days 1 and 2 and rapidly declined to below 1 ng/ml on day 5, and were maintained at lower levels on day 30. Concentrations of EGF were high on day 1 (greater than 10 ng/ml) but gradually declined by days 2, 5, and 30. Concentrations of TGF-α remained at lower levels of below 1 ng/ml throughout the lactation period from days 1 to 30. CONCLUSION: These results suggested that EGF and amphiregulin in colostrum might contribute to the early stage of development of neonatal gastrointestinal function.

Four-year experience with prenatal diagnosis of congenital heart defects at a single referral center in Japan with focus on inaccurately diagnosed cases.

PURPOSE: To evaluate the accuracy of prenatal diagnosis of congenital heart defect at the referral level in our institution. METHODS: One hundred and thirty-two cases were referred for prenatal diagnosis of congenital heart defect (CHD). Cases having CHDs were divided into isolated and complex CHDs, and the prenatal and postnatal diagnoses were compared. RESULTS: Thirty-nine cases were diagnosed with CHDs. The remaining 93 cases were diagnosed as normal. Postnatal diagnosis confirmed that 39 cases had CHDs; there were 19 cases of isolated CHD and 20 cases of complex CHD. Among the 19 cases of isolated CHD, all four cases with a false negative diagnosis had ventricular septal defects of an outlet or muscular type with a small defect. Cases with a false positive diagnosis had coarctation of the aorta (3 cases) or total anomalous pulmonary venous connection (1 case). Among the 20 cases of complex CHD, the prenatal diagnoses in two cases were not the same as the postnatal diagnosis and the prognosis was worse than expected. In one case with a single ventricle, pulmonary stenosis, and pulmonary venous atresia, the prenatal diagnosis was hypoplastic left heart syndrome with a suboptimal study at 38 weeks' gestation. In the other case, the diagnosis of corrected transposition of the great arteries had been missed because of misinterpretation of the anatomically right and left ventricles in utero. CONCLUSIONS: There were three possible causes of misdiagnosis or overdiagnosis of CHD: disease orientation, timing of diagnosis, and skill of the examiners. This information may be helpful for the improvement of diagnosis.

Change in cervical length in cases resulting in threatened preterm labor.

PURPOSE: To determine the predisposing changes in cervical length (CL) and the critical range of CL in which significant uterine contractions emerge resulting in threatened preterm labor (TPL). METHODS: Sixty-eight uncomplicated singleton pregnancies where the CL was <25 mm before 31 weeks were divided into cases with TPL (n = 23) or without (n = 45). CL and uterine contractions were monitored sequentially starting between 16 and 20 weeks. The gestational ages when a CL of <25 or <15 mm was first observed, the interval between these two measurements, and the CL value at TPL diagnosis were analyzed retrospectively. RESULTS: (1) The gestational ages when a CL of <25 and <15 mm was first detected were lower in the TPL group (25 (median); 18-30 (range) and 28; 25-33 weeks, respectively) than in the non-TPL group (27; 20-30 and 33; 26-35 weeks; P = 0.030 and P < 0.001). (2) The interval between the two measurements was shorter in the TPL group (2.5; 0-15 weeks) than in the non-TPL group (5.5; 0-13 weeks, P = 0.034). (3) The CL value at TPL diagnosis was 13 mm (median), ranging from 7 to 18 mm. CONCLUSION: Cases with early onset and subsequent rapid CL shortening before 31 weeks resulted in TPL when CL decreased below the range 7-18 mm.

Clinical significance of cervical length shortening before 31 weeks' gestation assessed by longitudinal observation using transvaginal ultrasonography.

AIM: To elucidate the clinical significance of progressive cervical length (CL) shortening before 31 weeks' gestation. METHODS: Transvaginal ultrasonography was used for longitudinal measurements of CL in 114 singletons. CL shortening groups were defined as having a CL of <25 mm at <26 weeks (early shortening group, 20 cases) and <31 weeks (late shortening group, 19 cases). The control group (75 cases) was defined as having a CL of >or=25 mm at <31 weeks. The CL values at 16-20, 21-25, 26-30 and 31-35 weeks, the age-related CL changes, the treatments for preterm labor, and the outcomes were compared between groups. In 78 cases with spontaneous delivery at >or=36 weeks, we investigated cervical dilatation velocity in the active phase of labor. RESULTS: At 16-20 weeks, CL values for the early group were smaller than those of the late and control groups. Rapid CL shortening occurred between 16-20 and 21-25 weeks in the early group and between 21-25 and 26-30 weeks in the late group. In the early group, all cases received cerclage and/or tocolysis or bedrest, and one case delivered prematurely. In the late group, 10 cases required tocolysis or bedrest, and one case delivered prematurely. In nulliparous women, cervical dilatation velocity in the early and late groups was more rapid than in the controls. CONCLUSIONS: CL shortening to <25 mm before 31 weeks is a risk factor for preterm delivery, as well as for preterm labor in cases who had tocolysis and bedrest, and precipitate delivery.