Antenatal Neuroprotective Magnesium Sulfate in Very Preterm Infants and Its Association With Feeding Intolerance.

INTRODUCTION/OBJECTIVE: Magnesium sulfate (MgSO 4 ) treatment is widely used for fetal neuroprotection despite the controversy concerning the side effects. There is limited data regarding the impact of various cumulative maternal doses and neonatal serum magnesium (Mg) levels on short-term neonatal morbidity and mortality. We opted to carry out a study to determine the impact of neonatal serum Mg levels on neonatal outcomes. METHOD: We conducted this prospective observational study between 2017 and 2021. Antenatal MgSO 4 was used for neuroprotective purpose only during the study period. Inborn preterm infants delivered between 23 and 31 6/7 weeks of gestation were enrolled consecutively. Babies who underwent advanced resuscitation in the delivery room, inotropic treatment due to hemodynamic instability in the first 7 days of life, >12 hours since the discontinuation of maternal MgSO 4 treatment, severe anemia, and major congenital/chromosomal anomalies were excluded from the study. The subgroup of babies with serum Mg level at the 6th hour of life underwent an analysis. A neonatal Mg concentration of 2.5 mg/dL was used to classify MgSO 4 -exposed patients into 2 groups (<2.5 mg/dL and ≥2.5 mg/dL). Another analysis was performed between babies whose mothers were exposed to MgSO 4 and those not exposed. Finally, the groups' neonatal outcomes were compared. RESULTS: Of the 584 babies, 310 received antenatal MgSO 4 . The birth weights were significantly lower in the MgSO 4 exposed group (1113 ± 361 g vs 1202 ± 388 g, P = 0.005). Antenatal corticosteroid usage and intrauterine growth restriction were also noted to be higher. The MgSO 4 group was more likely to have bronchopulmonary dysplasia, prolonged invasive ventilation, necrotizing enterocolitis, delayed enteral nutrition, and feeding intolerance ( P < 0.05). MgSO 4 treatment was shown as an independent risk factor for feeding intolerance when corrected for confounders (odds ratio 2.13, 95% confidence interval: 1.4-3.1, P = 0.001). Furthermore, serum Mg level significantly correlated with feeding intolerance ( r = 0.21, P = 0.002). CONCLUSION: This study highlighted the effect of MgSO 4 treatment and the potential superiority of serum Mg level as a predictor of immediate neonatal outcomes, particularly delayed enteral nutrition and feeding intolerance. Further studies are warranted to ascertain the optimal serum Mg concentration of preterm infants in early life to provide maximum benefit with minimal side effects.

Maternal plasma endocan levels in intrauterine growth restriction.

OBJECTIVES: Intrauterine growth restriction (IUGR) is diagnosed when the estimated fetal weight remains below the 10th percentile of gestational age based on pathological restriction of growth and/or accompanying Doppler abnormalities. Endothelial dysfunction is a common pathogenetic pathway underlying IUGR etiology. Endocan (ESM-1) is a novel marker of endothelial dysfunction and inflammation found in the maternal circulation. This study was designed to compare plasma endocan levels between pregnancies complicated with IUGR and a control group. STUDY DESIGN: Forty-four pregnancies complicated with IUGR and 47 healthy pregnancies were included. Maternal plasma endocan levels were detected by ELISA. Parametric data was studied by Student's t-test. Mann-Whitney U-test was used in analyzing non-parametric data. Categorical variables underwent chi-square test. ROC analysis was performed to define the cutoff value of endocan in detecting IUGR. Spearman correlation test was performed. RESULTS: Maternal plasma endocan level varied significantly between IUGR and healthy pregnancies and was 1.8 fold higher in the IUGR group (793.0 (IQR:544.4-1896.0) ng/L vs. 441.8 (IQR: 408.3-512.4) ng/L, p < .001). There was a weak negative correlation between endocan level and 5th and 10th minute APGAR Scores (r = -0.256; p = .015 and r = -0.215; p = .042, respectively), a weak positive correlation with umbilical artery pulsatility index, and a moderate negative correlation with cerebroplacental ratio (r = 0.394; p < .001 and r = -0.459; p < .001, respectively). CONCLUSIONS: There was a significant difference between endocan levels of IUGR and healthy pregnancies. Further studies might be designed to investigate the performance of endocan in predicting neonatal outcomes for pregnancies complicated with IUGR.

Maternal and Placental Zinc and Copper Status in Intra-Uterine Growth Restriction.

BACKGROUND AND AIM: Zinc and copper are essential trace elements for cell growth and proliferation. Their deficiency may contribute to intrauterine growth restriction (IUGR). We aimed to determine the zinc and copper status of maternal serum and placenta samples of pregnant women with fetal IUGR and age-matched pregnant women without IUGR. METHOD: Serum and placenta samples obtained from 37 IUGR and 21 healthy pregnant women were analyzed at delivery. RESULTS: Placenta zinc concentrations and placenta zinc/copper ratio were significantly lower in the IUGR group compared to controls (p < 0.05). Placenta zinc concentrations correlated with birth weight (p: 0.01, r: 0.31). Maternal levels of zinc and copper were similar between pregnant women with IUGR and controls. CONCLUSIONS: Lower placental zinc and zinc/copper ratio levels in pregnancies with IUGR may indicate that placenta zinc and placental zinc/copper status might be involved in IUGR.

Do fetuin-A/apha2-Heremans Schmid-glycoprotein levels have an association with recurrent pregnancy loss?

OBJECTIVE: Fetuin-A is a hepatokine which is previously found related to fertility and pregnancy outcomes. We aimed to investigate if recurrent pregnancy loss (RPL) is associated with increased fetuin-A levels. MATERIALS AND METHODS: Serum fetuin-A concentrations were measured and compared in 30 non-pregnant women with a history of unexplained recurrent miscarriage, 29 women who had a history of unexplained recurrent miscarriage and were admitted to our clinic due to miscarriage during the study period and 30 fertile women who have no history of miscarriage or any other pregnancy complications with at least two previous healthy children. RESULTS: The median serum fetuin-A levels of group I, II, and III were 59.45, 62.73, and 44.52, respectively (p=.065). Serum fetuin-A levels significantly increased in group II compared to group III (p=.011). No significant differences in the levels of fetuin-A of group I compared to either group II (p=.433) or group III (p=.268). CONCLUSIONS: The etiology of RPL is still a subject that is not clarified. Fetuin-A levels may have a relationship with RPL.

Gitelman Syndrome in Pregnancy: A Clinical Challenge.

PURPOSE: Disease progress may be affected by pregnancy-related changes, and underlying conditions may also affekt pregnancy outcomes in women with Gitelman syndrome (GS). Case presentation A 35-year-old woman with GS (gravida 2 para 1) was referred to our hospital to start routine antenatal care follow-up at 6 weeks of gestation. At the age of 31, she had been diagnosed with GS after her first uneventful pregnancy. Upon early admission, her serum Mg+level was 0.51 mmol/L and her serum K+level 2.7 mmol/L with normal kidney function tests. She was already taking oral combined potassium citrate and potassium bicarbonate supplementation once a day before pregnancy. At the eighth gestational week, the medication was changed to an oral potassium color sachet of 1.5 gram per day until labor because of the insufficient dosage to maintain optimum potassium levels. She was also taking 365 milligrams of oral magnesium oxide twice a day before and during pregnancy. In the third trimester of the pregnancy, her serum Mg+level was 0.48 mmol/L and serum K+level 2.8 mmol/L. Because of the previous uterine surgery history, she underwent an elective cesarean operation at 39 weeks' gestation under spinal anesthesia and delivered a healthy 3090-gram female infant. CONCLUSION: Increased need for potassium and magnesium supplementation should be the critical considerations when managing pregnant patients with GS.

Is ProBNP a New Marker for Predicting Intrauterine Growth Restriction?

PURPOSE: To evaluate the usability of first-trimester maternal serum ProBNP levels in the prediction of intrauterine growth restriction (IUGR). Methods In this prospective study, blood samples taken from 500 women who applied to our polyclinic for routine serum aneuploidy screening between the 11-14th gestational weeks were centrifuged. The obtained plasma samples were placed in Eppendorf tubes and stored at -80+°C. For the final analysis, first-trimester maternal serum ProBNP levels of 32 women diagnosed with postpartum IUGR and 32 healthy women randomly selected as the control group were compared. FGR was defined as estimated fetal weight below the 10th percentile for the gestational age. RESULTS: The mean ProBNP levels were statistically and significantly higher in the women with intrauterine growth restriction (113.73±94.69 vs. 58.33±47.70 pg/mL, p<0.01). At a cut-off level of 50.93, ProBNP accurately predicted occurrence of IUGR (AUC+= 0.794 (95% confidence interval 0.679-0.910), p+= 0.001) with sensitivity and specificity rates of 78.1 and 69.0%, respectively. Conclusion First-trimester serum ProBNP level was significantly higher in women who developed IUGR compared to healthy controls. First-trimester ProBNP level can be used as a potential marker to predict the development of IUGR in pregnant women.

Doppler assessment of the fetus in pregnant women recovered from COVID-19.

OBJECTIVE: The aim of this study was to evaluate the maternal-fetal Doppler patterns in pregnant women recovered from COVID-19. METHODS: This prospective case-control study was conducted in Ankara City Hospital between July 1, 2020 and August 30, 2020. Thirty pregnant women who were diagnosed with COVID-19 and completed the quarantine process were compared with 40 healthy pregnant women in terms of the fetal Doppler parameters. All pregnant women diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were followed up in our clinic and their diagnoses have been confirmed in nasopharyngeal and oropharyngeal samples by quantitative real time reverse transcriptase polymerase chain reaction (RT-PCR) method. Doppler ultrasonographic assessment of the uterine arteries (UtA) and middle cerebral artery (MCA) were used in addition to umbilical artery (UA) Doppler between 23 and 40 weeks of gestation. Also, cerebroplacental ratio (CPR) was calculated according to gestational age. RESULTS: The pulsatility and resistance indices of umbilical and UtA showed a significant increase in pregnant women in the study group compared to the control group (p < 0.05). Multivariable logistic regression analysis revealed that pulsatility and resistance indices of the mean UtA were independently associated with disease (OR > 1000, 95%CI 9.77 to >1000, p = 0.009; OR 0,000 95%CI 0,000-0,944, p = 0,049), respectively. Medical treatment was given to 16/30 (53%) of pregnant women diagnosed with COVID-19. CONCLUSION: In conclusion, uterine artery Doppler indices in the third trimester may have clinical value in pregnant women recovered from COVID-19.

The Effect of Antenatal Neuroprotective Magnesium Sulfate Treatment on Cerebral Oxygenation in Preterm Infants.

OBJECTIVE: Antenatal magnesium sulfate (MgSO4) treatment is associated with reduced risk of cerebral palsy in preterm infants. We aimed to investigate whether this treatment leads to any alterations on cerebral hemodynamics which could be detected by near-infrared spectroscopy (NIRS) readings in early postnatal life. STUDY DESIGN: Infants with gestational ages (GAs) ≤ 32 weeks were divided into two groups regarding their exposure to antenatal neuroprotective MgSO4 treatment or not. NIRS monitoring was performed to all infants, and readings were recorded for 2 hours each day during the first 3 days of life. The primary aim was to compare regional cerebral oxygen saturation (rcSO2) and cerebral fractional tissue oxygen extraction (cFTOE) between the groups. RESULTS: Sixty-six infants were exposed to antenatal MgSO4, while 64 of them did not. GA and birth weight were significantly lower in the treatment group (p < 0.01). No difference was observed in rcSO2 and cFTOE levels in the first, second, and the third days of life (p > 0.05). An insignificant reduction in severe intraventricular hemorrhage rates was observed (8 vs. 15%, p = 0.24). CONCLUSION: We could not demonstrate any effect on cerebral oxygenation of preterm infants in early postnatal life that could be attributed to antenatal neuroprotective MgSO4 treatment. Future studies are warranted to clarify the exact underlying mechanisms of neuroprotection.

Plasma Endocan Levels in Early and Late-Onset Preeclampsia.

BACKGROUND: Preeclampsia (PE) may represent an inflammatory process. Endocan (ESM-1) is a marker of endothelial inflammation. We compared plasma endocan levels between PE and control groups and between early and late-onset PE. Study design: Maternal plasma endocan levels were measured in 41 preeclampsia (PE) pregnancies - 25 early-onset (<34 weeks); 16 late-onset (≥34 weeks), and 37 non-complicated pregnancies (22 matched with early-onset PE, 15 with late onset). Results: There was no significant differences between plasma endocan levels of patients with PE and control group (468.8(IQR: 169.7)ng/L vs 462.4(IQR: 321.1)ng/L, p > 0.05), between early and late-onset PE (458.8(221.8)ng/L vs 469.8(122.6)ng/L, p > 0.05), between early-onset PE and corresponding control group (458.8(221.8)ng/L vs 506.2(1481.9)ng/L, p > 0.05), or late-onset PE and corresponding control group (469.8(122.6)ng/L vs 451.0(85.1)ng/L, p > 0.05). Conclusion: There was no significant difference between endocan levels of early or late-onset PE compared with their corresponding control groups, nor between early and late-onset preeclampsia groups.

Evaluation of the Effects of Delayed Cord Clamping in Infants of Diabetic Mothers.

OBJECTIVE: This study aimed to investigate the effect of delayed cord clamping (DCC) in infants of diabetic mothers. STUDY DESIGN: Women who had diabetes throughout their pregnancy and gave birth at 37 weeks of gestation or later were included in the study along with their babies. Early cord clamping was performed as soon as possible after birth, while DCC was performed by clamping 60 second after birth. The two groups were compared in terms of venous hematocrit (htc) levels and rates of hypoglycemia, jaundice requiring phototherapy, and respiratory distress. RESULTS: Venous htc levels at postnatal 6 and 24 hours were significantly higher in the DCC group (p = 0.0001). Polycythemia rates were higher in the DCC group at both 6 and 24 hours, but partial exchange transfusion (PET) was not needed in either group. There were no differences between the groups with regard to the rates of hypoglycemia or jaundice requiring phototherapy. Rate of admission to the neonatal intensive care unit (NICU) was lower in the DCC group. CONCLUSION: Although DCC increased the rate of polycythemia, it did not result in PET requirement. Moreover, DCC reduced the severity of respiratory distress and the rate of admission to NICU due to respiratory distress.

Do Anti-Factor Xa Levels have any Impact on Pregnancy Outcome in Women with Previous Adverse Outcomes?

OBJECTIVE: Low-molecular-weight heparin (LMWH) is used during pregnancy in women diagnosed with thrombophilia for prevention of thromboembolic events and prevention of recurrent pregnancy loss. Prophylactic dosing does not always achieve target anti-FXa levels of 0.2-0.6 IU/ml. We aimed to determine if anti-FXa levels, measured in the first trimester, have an influence on pregnancy outcome. MATERIAL AND METHODS: Eighty-one first-trimester women with a history of adverse pregnancy outcomes under LMWH therapy during pregnancy were enrolled in this study. Anti-FXa levels were measured in the first trimester, and fetal and maternal outcomes were recorded. RESULTS: The mean age of women was 28±4 (19-40) and mean anti-FXa level 0.44±0.93 IU/ml. No bleeding or clotting complications were associated with LMWH administration. Anti-FXa levels did not have a relationship with gestational age at birth, fetal weight, type of delivery, cesarean indications, postpartum bleeding, APGAR scores, or admission to the neonatal intensive care unit (p>0.005). Anti-FXa levels were not correlated with live birth rates. CONCLUSION: Anti-FXa levels did not have an influence on pregnancy and fetal outcomes. The effect of LMWH on pregnancy outcomes may not be due to anticoagulant activity but other mechanisms.

Are serum levels of ADAMTS5, TAS and TOS at 24-28 gestational weeks associated with adverse perinatal outcomes in gestational diabetic women?

We aimed to determine the role of placental A Disintegrin and Metalloproteinase with thrombospondin motifs 5 (ADAMTS5), and maternal serum ADAMTS5, total antioxidant status (TAS), total oxidant status (TOS) and oxidative stress index (OSI) levels at 24-28th gestational weeks in GDM. This study included 57 patients, who had been diagnosed as having GDM at their 24-28th gestational week, and 29 controls. The maternal blood samples were collected at the 24-28th gestational week and ADAMTS5 was studied with the enzyme-linked immunosorbent assay (ELISA) method, whereas an automated colorimetric method was used to study TAS, TOS, and OSI. The level of ADAMTS5 in maternal serum of patients with GDM were significantly lower than the controls (p = .017); whereas TOS and OSI levels were significantly higher (p = .003 and p = .008). Multivariable logistic regression analysis revealed ADAMTS5 and TOS levels were independently associated with adverse perinatal outcomes (p = .004 and p = .018). We found that serum ADAMTS5 levels decreased and TOS level increased in GDM pregnant at 24-28th gestational weeks. In addition, we found that increased levels of serum ADAMTS5 and decreased TOS levels at 24-28th weeks were associated with adverse perinatal outcomes independent of the mode of treatment in GDM.Impact statementWhat is already known on this subject? Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy. The insulin resistance, which starts at the 24-28th gestational weeks, increases during gestation. GDM increases maternal complications like preeclampsia, cesarean rate, cardiovascular disease, obesity, and diabetes after pregnancy; and neonatal complications like macrosomia, hypoglycemia, hyperbilirubinemia, delivery trauma, shoulder dystocia, and adult-onset obesity, and diabetes.What the results of this study add? A significant relationship between ADAMTS5, TOS levels and adverse perinatal outcome. insulin resistance and was observed.What the implications are of these findings for clinical practice and/or further research? Based on this finding, we concluded that increased levels of oxidative stress and decreased ADAMTS5 levels are associated with GDM and predictive for adverse perinatal outcomes. The results of the present study were consistent with the previous reports and indicated that increased oxidative stress in GDM patients are related to adverse perinatal outcomes.

Metabolomic identification of novel diagnostic biomarkers in ectopic pregnancy.

INTRODUCTION: Ectopic pregnancy (EP) is a potentially life-threatening condition and early diagnosis still remains a challenge, causing a delay in management leading to tubal rupture. OBJECTIVES: To identify putative plasma biomarkers for the detection of tubal EP and elucidate altered biochemical pathways in EP compared to intrauterine pregnancies. METHODS: This case-control study included prospective recruitment of 39 tubal EP cases and 89 early intrauterine pregnancy controls. Plasma samples were biochemically profiled using proton nuclear magnetic resonance spectroscopy (1H NMR). To avoid over-fitting, datasets were randomly divided into a discovery group (26 cases vs 60 controls) and a test group (13 cases and 29 controls). Logistic regression models were developed in the discovery group and validated in the independent test group. Area under the receiver operating characteristics curve (AUC), 95% confidence interval (CI), sensitivity, and specificity values were calculated. RESULTS: In total 13 of 43 (30.3%) metabolite concentrations were significantly altered in EP plasma (p < 0.05). Metabolomic profiling yielded significant separation between EP and controls (p < 0.05). Independent validation of a two-metabolite model consisting of lactate and acetate, achieved an AUC (95% CI) = 0.935 (0.843-1.000) with a sensitivity of 92.3% and specificity of 96.6%. The second metabolite model (D-glucose, pyruvate, acetoacetate) performed well with an AUC (95% CI) = 0.822 (0.657-0.988) and a sensitivity of 84.6% and specificity of 86.2%. CONCLUSION: We report novel metabolomic biomarkers with a high accuracy for the detection of EP. Accurate biomarkers could potentially result in improved early diagnosis of tubal EP cases.

Maternal plasma fetuin-A levels in fetal growth restriction: A case-control study.

BACKGROUND: Higher Fetuin-A (FA) concentrations were found to be associated with obesity and there is an interest to the relation between maternal FA and pregnancy outcomes. OBJECTIVE: In this study, our aim was to evaluate the association of maternal plasma levels of FA with fetal growth restriction (FGR). MATERIALS AND METHODS: 41 pregnant women with FGR and 40 controls were recruited in this case-control study between July and November 2015. At the diagnosis of FGR, venous blood samples (10 cc) were obtained for FA analysis. RESULTS: Maternal plasma FA levels were significantly higher in fetal growth-restricted pregnant women compared with controls (19.3 ± 3.0 ng/ml vs 25.9 ± 6.8 ng/ml, p = 0.001). Area under receiver operating characteristic curve analysis of FA in FGR was 0.815 (95% confidence interval (CI): 0.718-0.912, p < 0.001). The maternal FA levels with values more than 22.5 ng/ml had a sensitivity of about 73.17% (95% CI: 56.79-85.25) and a specificity of about 82.5% (95% CI: 66.64-92.11) with positive and negative predictive values of about 81.08% (95% CI: 64.29-91.45) and 75% (95% CI: 59.35-86.30), respectively. Therefore, the diagnostic accuracy was obtained about 77.78%. CONCLUSION: The results of this study show higher maternal plasma levels of FA in FGR. Further studies are needed in order to demonstrate the long-term effects of FA in pregnancies complicated with FGR and early prediction of FGR.

There is No Association between Premature Ovarian Insufficiency and Levels of Fetuin-A/α2-Heremans-Schmid Glycoprotein.

OBJECTIVE: Fetuin-A is a well-known negative acute-phase protein and has been used liberally to predict vascular disease. The aim of this study was to evaluate the association between serum human fetuin-A/alpha2-Heremans-Schmid glycoprotein levels and idiopathic premature ovarian insufficiency (POI). METHODS: A total of 75 women were included in this case-control study between January 2013 and December 2013. Serum fetuin-A concentrations were measured in 36 women with idiopathic POI and 39 healthy women with regular cycles. Blood samples were drawn after a 12-h overnight fast and were kept at -80°C for subsequent assay. The serum levels of fetuin-A were assessed by commercial ELISA kits (BioVendor Laboratory Medicine Inc., Brno, Czech Republic) and serum concentration values were expressed as µg/ml. RESULTS: The mean serum fetuin-A levels of idiopathic POI and control women were 229.02 ± 27.79 and 232.37 ± 65.56, respectively, with P = 0.771 (independent samples t-test). Our results showed no statistically significant difference between serum fetuin-A levels of idiopathic POI women and controls. CONCLUSION: The mean values of serum fetuin-A in idiopathic POI women were not significantly different from controls, which implies that there is no significant association between serum fetuin-A levels and idiopathic POI.

Association of Higher Maternal Serum Levels of Plac1 Protein with Intrauterine Growth Restriction.

The aim of this study was to determine the maternal PLAC1 protein levels in infants with IUGR. A total of 40 pregnant women with IUGR and 40 controls were recruited in this case control study between June 2014 and November 2014. Maternal serum PLAC1 levels were established as significantly higher in IUGR cases compared to the control groups (8.42±3.59 ng/ml vs. 6.27±4.04 ng/ml, p<0.001). Area under ROC curve (AUC) analysis of PLAC1 in IUGR was 0.708, (95% confidence interval (CI): 0.593-0.823, p=0.001) (Figure 1). Maternal PLAC1 levels above 7.41 ng/ml had a sensitivity of 62.5% (95% C1: 45.81-76.83), a specificity of 77.5% (95% CI: 61.15-88.6); positive and negative predictive values (PPV and NPV) were 73.53% (95% CI: 55.35-86.49) and 67.39% (95% CI: 51.86-80.03), respectively, with a diagnostic accuracy of 70%. In conclusion, we were able to demonstrate a significantly important link between IUGR and higher maternal serum levels of the PLAC1 protein.

A view of maternal mortalities in women conceiving through assisted reproductive techniques: A nation-based study of Turkey.

BACKGROUND: Our aim was to evaluate maternal mortality causes among Turkish women giving birth after assisted reproductive techniques (ARTs). METHODS: All maternal deaths following conception with ART pregnancies were identified through the National Maternal Mortality Surveillance System. We analyzed the system data collected between 2007 and 2014. During this period, there were 10,369,064 live births and 1788 maternal deaths resulting from both direct and indirect causes. We identified 28 maternal death cases following ART procedures. The age, gestational age at birth, number of antenatal visits, delivery route, time of death, cause of death, and neonatal outcomes were recorded. Also, any existing delay (phase 1, 2, or 3) and preventability of maternal death were assessed. RESULTS: Hypertensive disorders, pulmonary embolism, and cardiovascular disease were the leading causes of maternal death. Twelve (40%) women were over 35 years of age. Of the deaths, 15 (54%) were attributed to indirect causes. The number of unpreventable maternal deaths was 19 (67.9%), and 9 (36%) were classified as preventable after being assessed by the review commission of maternal mortality. CONCLUSION: Pregnancies conceived with ARTs should undergo a careful assessment of risk factors for hypertensive disorders, pulmonary embolism and cardiovascular diseases. Those women require closer antenatal surveillance because 1/3 of these deaths were preventable.

Low serum vitamin D level is associated with intrahepatic cholestasis of pregnancy.

AIM: Intrahepatic cholestasis of pregnancy (ICP) is a unique hepatic disorder of pregnancy and is related to adverse maternal and perinatal outcomes. The pathogenesis of the disease is not clear and appears to be multifactorial. There is increasing evidence that vitamin D (Vit D) plays a role in hepatobiliary homeostasis and in various liver diseases. We aimed to investigate the association between serum Vit D level and ICP. METHODS: A total of 40 pregnant women with ICP and 40 healthy pregnant women were included in this controlled cross-sectional study. Their demographic characteristics, including age, body mass index (BMI), gestational week, gravidity and parity, and laboratory parameters, including 25(OH) Vit D3 levels, liver function tests, fasting and postprandial bile acid concentrations, were recorded. Gestational age at delivery, birth weight (BW), neonatal intensive care unit (NICU) admission, meconium staining of amniotic fluid and appearance pulse grimace activity respiration (APGAR) score at 5 min were obtained from medical records for assessment of perinatal outcomes. RESULTS: There was no significant difference between groups in terms of demographic characteristics. The mean serum 25(OH) Vit D3 level was significantly lower in pregnant women with ICP compared to control pregnant women (8.6 ± 4.9, 11.3 ± 6.1; P =0.033), and it was significantly lower in severe disease than mild disease (6.9 ± 2.1, 10.3 ± 6.2, respectively; P =0.029). We also found that lower serum 25(OH) Vit D3 levels were significantly and inversely correlated with fasting and postprandial bile acid levels. However, in subgroup analyses in ICP pregnant women, there was no difference in mean 25(OH) Vit D3 levels for women with or without perinatal complications. CONCLUSION: Our study suggests that low levels of 25(OH) Vit D3 were associated with ICP disease and its severity. However, further larger studies are needed to evaluate the effect of Vit D in the pathogenesis and outcome of the disease.

Maternal placi protein levels in early- and late-onset preeclampsia.

OBJECTIVES: The objective of this study was to determine the maternal PLAC1 protein levels in early and late onset preec-lampsia. MATERIAL AND METHODS: A total of 135 pregnant women were included in the study, of which 55 were at < 34 weeks of gesta-tion and 80 were at ≥ 34 weeks of gestation, between June and November 2014 were recruited in this case control study. RESULTS: Analysis of maternal serum PLAC1 levels did not reveal any significant differences between early onset PE and controls (p = 0.422). However, late onset PE patients exhibited significantly elevated levels of PLAC1, in comparison with healthy controls (p = 0.026). The difference in PLAC1 levels between early onset PE and late onset PE was also significant (p = 0.001). Area under ROC curve of PLAC1 for early and late onset PE was 0.563 and 0.646 with p values of 0.422 and 0.026 respectively. Area under ROC curve of PLAC1 in PE was 0.613 with p value = 0.024. The cutoff value for PLAC1 was 6.19 ng/mL with sensitivity: 56% (95% CI 44.1-67.3) and specificity: 63 %; (95% CI 49.9-75.1) and diagnostic odds ratio: 2.2 (95% CI 1.1-4.4) (p value = 0.037). The cutoff value for PLAC1 was 7.2 ng/mL with sensitivity: 43% (95% CI 31.5-54.6) and specificity: 78% (95% CI 65.5-87.5) and diagnostic odds ratio: 2.69 (95% CI 1.25-5.79) (p value = 0.016) CONCLUSION: In conclusion, the results of the current study showed that PLAC1 protein levels were significantly elevated in pregnant women with late onset PE in comparison with healthy control group.

Maternal and perinatal outcomes of dichorionic diamniotic twin pregnancies diagnosed with vanishing twin syndrome: a retrospective analysis from a single clinical center.

OBJECTIVES: Multiple pregnancies are known to be associated with adverse maternal and perinatal complications. How-ever, data regarding the outcomes of spontaneously reduced twin pregnancies are limited. In the current study we aimed to evaluate the consequences of the vanishing twin syndrome (VTS) in dichorionic diamniotic twin pregnancies for both mother and baby in our perinatal center. MATERIAL AND METHODS: A total of 711 pregnancies were included into the study. 51 cases of vanishing twin syndrome constituted Group 1, 235 cases of normal twins constituted Group 2, and 425 singleton pregnancies formed Group 3. The pregnancies that had multifetal reduction and monochorionic twinning were excluded from both study group and twin control group. The collected data were as follows: age, gravidity, parity, gestational week at birth, delivery route, birth weight, obstetric complications, and maternal and perinatal outcomes. RESULTS: No significant difference was observed between the groups regarding mean maternal age (p > 0.05). Mean birth weight, gestational age at birth and preterm birth ratio were significantly lower in the Group 2 when compared with Group 1 and Group 3 (all p < 0.001). Adverse perinatal outcomes including very low birth weight (VLBV) and low Apgar scores were more common in Group 1 (p < 0.05), but no significant difference was found between the groups in terms of neona-tal intensive care unit admission and perinatal mortality ratios (p > 0.05). Obstetric complications such as preeclampsia, gestational diabetes and intrauterine growth restriction were significantly higher in Group 2 than in Group 1 and Group 3 (all p < 0.05). However, severe maternal morbidities were similar among three groups (p = 0.141). CONCLUSIONS: VTS is seems to be associated with VLBV and low Apgar scores. However, the incidence of severe maternal and perinatal morbidity and mortality in pregnancies with VTS is similar to other pregnancies.