Cross-sectional study of nutritional markers in pregnancy.

OBJECTIVES: To note the value of serum Vitamin B12, folic acid, and ferritin in normal and high-risk pregnancies (HRPs) in patients attending antenatal clinic at All India Institute of Medical Sciences (AIIMS). MATERIALS AND METHODS: This is a cross-sectional study where a total of 282 patients attending Gynaecology Outpatient Department at AIIMS, New Delhi, India were recruited. Among the 282 subjects, 251 were pregnant, and 31 were controls. The serum was tested for serum Vitamin B12, serum folic acid, and serum ferritin levels using Beckman Coulter Access 2 immunoassay. RESULTS: The median value of serum folic acid level in pregnant women was 12 pg/ml with range being 2-20 pg/ml in contrast to 8 pg/ml with range being 3-20 pg/ml in nonpregnant female. This difference was statistically significant. (P = 0.05). There was no significant difference in the median level of serum Vitamin B12 and serum ferritin in pregnant and nonpregnant group. Serum Vitamin B12 level was lower in the third trimester (127 pg/ml) than in first trimester (171 pg/ml) and the difference is statistically significant (P = 0.03). Serum ferritin levels were also significantly lower in the second trimester (16.4 pg/ml) than third trimester (24.55 pg/ml). Although the median serum folic acid level was lower in the first trimester (9.84 pg/ml) than in second trimester (10.8 pg/ml) and in the third trimester (13.18 pg/ml) but the difference was not statistically significant. There was no significant difference in Vitamin B12 level in HRPs (median value 134 pg/ml) as compared to low-risk pregnancies (149.5 pg/ml). CONCLUSION: Serum folic acid levels are significantly higher during pregnancy as compared to nonpregnant state. However, there was no significant difference in the median level of serum Vitamin B12 and serum ferritin in pregnant and nonpregnant group. Serum folic acid level and ferritin level were significantly higher in HRPs compared to low-risk pregnancies.

Cross-sectional study of serum parathyroid hormone level in high-risk pregnancies as compared to nonpregnant control.

OBJECTIVES: To note the value of serum parathyroid hormone (PTH) levels in normal and high-risk pregnancies (HRP) in patients attending antenatal visits at All India Institute of Medical Sciences (AIIMS). MATERIALS AND METHODS: This is a cross-sectional study where a total of 282 patients attending Gynecology Outpatient Department at AIIMS, New Delhi were recruited. Among the 282 subjects, 251 were pregnant, and 31 were controls. The serum was tested for serum PTH levels using Beckman coulter access 2 immunoassay. RESULTS: The median value of PTH level in pregnant women was 31.6 pg/ml with range being 0.8-505.5 pg/ml in contrast to 45.9 pg/ml with range being 19-102.7 pg/ml in nonpregnant female. This difference was statistically significant (P = 0.0012). There was no significant difference in median level of PTH in different age group. Although the median PTH levels were lower in second trimester (25.25 pg/ml) than in first trimester (35.5 pg/ml) and in third trimester (32.4 pg/ml), the difference was not statistically significant. There was no significant difference in PTH level in HRP (median value - 31.6 pg/ml) as compared to low-risk pregnancies (31.5 pg/ml). CONCLUSION: Serum PTH levels are significantly lower during pregnancy as compared to nonpregnant state. However, age, parity, and HRP did not alter PTH level during pregnancy.

Three-dimensional sonography-based automated volume calculation (SonoAVC) versus two-dimensional manual follicular tracking in in vitro fertilization.

OBJECTIVE: To compare the predictive value of manual two-dimensional follicular monitoring with that of sonography-based automated volume calculation (SonoAVC) in routine follicular tracking in in vitro fertilization (IVF). METHODS: A prospective study was undertaken of women undergoing IVF with controlled ovarian hyperstimulation at a center in New Delhi, India, between October and November 2013. Follicular monitoring was performed both manually and in three dimensions with SonoAVC. On the day of oocyte retrieval, the follicular count and dimensions were calculated with both techniques and correlated with the number of oocytes retrieved. RESULTS: Overall, 46 patients and 91 ovaries were studied. The mean times taken to perform manual and SonoAVC measurements were 209.2 ± 47.4 s and 156.6 ± 38.6 s, respectively (P < 0.001). The mean follicular count was significantly lower when measured manually than with SonoAVC (8.46 ± 3.35 vs 9.91 ± 4.60; P = 0.016). However, the mean leading follicle diameter measured manually (19.45 ± 2.46 mm) was similar to both the mean diameter (21.12 ± 2.65 mm) and the volume-based diameter (19.56 ± 2.16 mm) measured with SonoAVC. CONCLUSION: Three-dimensional SonoAVC could be a useful adjunct for follicular monitoring, with a significant reduction in time and a good correlation with manual counts. However, further studies with larger sample sizes are required.

A cross-sectional study of tumor markers during normal and high-risk pregnancies.

OBJECTIVE: To determine tumor marker concentrations during normal and high-risk pregnancies. METHODS: The present cross-sectional study included women attending the gynecology outpatient department at All India Institute of Medical Sciences, New Delhi, India, between November 1, 2012 and March 31, 2013. Their serum was assayed for carcinoembryonic antigen (CEA), cancer antigen 19-9 (CA19-9), and cancer antigen 15-3 (CA15-3). RESULTS: A total of 251 pregnant women and 31 nonpregnant women were included. Median CEA value was lower among pregnant women than among nonpregnant women (1.2µg/L vs 1.4µg/L; P=0.006), whereas that of CA15-3 was higher (16.7U/mL vs 12.3U/mL; P=0.03). CA19-9 concentration was higher among pregnant women aged 25-29years (7.0U/mL) or 30-34years (7.2U/mL) than among those aged 20-24years (4.2U/mL; P=0.01 for both). The CA15-3 level was increased during the second (13.0U/mL) and third (60.5U/mL) trimesters compared with the first trimester (9.5U/mL) (P≤0.01 for both comparisons). It was also raised in high-risk pregnancies (33.7U/mL), specifically pregnancies complicated by gestational diabetes mellitus (39.7U/mL), intrahepatic cholestasis of pregnancy (64.3U/mL), or heart disease (54.0U/mL) (P<0.05 for all). CONCLUSION: CA15-3 concentrations rise during pregnancy, but whether this increase can be attributed to physiological changes in breast tissue needs to be investigated further.

Quantitative evaluation of balance in patients with spinocerebellar ataxia type 1: a case control study.

OBJECTIVE: Quantitative assessment of balance in spinocerebellar ataxia type 1 (SCA1). BACKGROUND: Evaluation of balance in degenerative ataxias is often clinical and subject to bias. Quantification of balance is crucial for evaluating the efficacy of therapeutic and rehabilitative interventions. METHODS: The subjects were 20 patients (males: 14, females: 6) with genetically positive SCA1 and 20 age and gender matched healthy subjects. Ataxia was rated using the International Cooperative Ataxia Rating Scale (ICARS). Balance was assessed by dynamic posturography (Biodex, USA) which included: (a) ability to control balance in all directions (overall balance index, OBI), front to back (anterior-posterior index, API) and side-to-side (medio-lateral index, MLI); and (b) the limits of stability (LOS) in all directions. Balance index was considered abnormal if the actual value exceeded the predictive value. RESULTS: Impaired balance was found in 80% of patients (all indices in 35%, OBI+API in 25%, only OBI in 15%, and OBI+MLI in 5%). Compared to controls, SCA1 patients had significantly higher balance indices and lower LOS scores. Unlike in controls, the mean value of API was significantly higher than MLI in SCA1. LOS was found to the best predictor of balance abnormality. In patients, all balance indices had significant positive correlations with ICARS, static score of ICARS, body weight, severity and duration of illness, but not with the CAG repeat length. CONCLUSIONS: Patients with SCA1 had global impairment of balance, with greater instability in anterior-posterior than medio-lateral directions. Apart from severity and duration of illness, body weight was detriment to maintenance of balance in SCA1. This information may be useful in planning balance rehabilitation in SCA.