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Journal of Cellular and Molecular... Apr 2023The ratio between circulating levels of leptin and soluble leptin receptor (sOB-R), the free leptin index (FLI), is used as a marker of leptin resistance. Therefore, the... (Observational Study)
Observational Study
The ratio between circulating levels of leptin and soluble leptin receptor (sOB-R), the free leptin index (FLI), is used as a marker of leptin resistance. Therefore, the aim of our study was to investigate the FLI in mild pre-eclamptic pregnancies in a nested case-control study within a prospective observational study. Circulating levels of leptin and sOB-R levels rise significantly during pregnancy in healthy (p < 0.05) (n = 46) and pre-eclamptic pregnancies (p < 0.05) (n = 20). Serum levels of leptin were significantly higher in pre-eclamptic compared to healthy pregnancies at second and third trimesters of pregnancy (p < 0.05). Additionally, serum levels of sOB-R were significantly lower in pre-eclamptic pregnancies during the second and third trimesters of pregnancy compared to healthy pregnancies (p < 0.05). Moreover, we found that FLI did not vary significantly during pregnancy in healthy women (p > 0.05), while it increases in pre-eclamptic pregnancies (p < 0.05). Indeed, FLI was significantly higher at second and third trimesters of pregnancy in pre-eclamptic compared to healthy pregnancies (p < 0.05). In addition, FLI was significantly higher in the luteal phase compared with the follicular phase of the menstrual cycle in eumenorrheic women (p < 0.05). Receiver operating characteristic (ROC) curve analysis revealed the ability of leptin (AUC = 0.72) and FLI (AUC = 0.67) as a reliable predictor for mild pre-eclampsia during the second trimester of pregnancy. In conclusion, our findings show that FLI were significantly increased in mild pre-eclamptic pregnancies and allowed us to hypothesize that this rise might alter leptin bioavailability and bioactivity which might lead to the sympathetic hyperactivity and the hypertensive disorders during pregnancy.
Topics: Pregnancy; Female; Humans; Leptin; Pre-Eclampsia; Longitudinal Studies; Case-Control Studies; Pregnancy Trimester, Third; Receptors, Leptin
PubMed: 36950780
DOI: 10.1111/jcmm.17707 -
Journal of Clinical Laboratory Analysis May 2021The reference intervals of thyroid hormone will change at different stages of pregnancy because of physiological alterations. On the other hand, the reference intervals...
BACKGROUND
The reference intervals of thyroid hormone will change at different stages of pregnancy because of physiological alterations. On the other hand, the reference intervals of thyroid hormone will also change in different detection systems due to the manufacturer's methodology as well as a different race. The objective of this study was to establish the assay method- and trimester-specific reference intervals for thyroid-stimulating hormone, free thyroxine and free triiodothyronine for pregnant women in Chengdu.
METHODS
A prospective, population-based cohort study involved 23,701 reference samples of pregnant women during the three trimesters and 8646 non-pregnant women with pre-pregnancy clinical and laboratory tests. The 2.5th and 97.5th percentiles were calculated as the reference intervals for thyroid-stimulating hormone, free thyroxine and free triiodothyronine at each trimester of pregnant women according to ATA Guidelines.
RESULTS
The reference interval of thyroid-stimulating hormone in the 2.5th and 97.5th percentiles has a significant increasing trend from the first trimester, to second trimester and to third trimester, which was 0.08-3.79 mIU/L for the first trimester, and 0.12-3.95 mIU/L for the second trimester and 0.38-4.18 mIU/L for the third trimester, respectively (p < 0.001). However, the reference intervals of free thyroxine and free triiodothyronine in the 2.5th and 97.5th percentiles have significant decreasing trends from the first trimester, to second trimester and to third trimester, which were 11.87-18.83 pmol/L and 3.77-5.50 pmol/L for the first trimester, and 11.22-18.19 pmol/L and 3.60-5.41 pmol/L for the second trimester, and 10.19-17.42 pmol/L and 3.37-4.79 pmol/L for the third trimester, respectively (both p < 0.001).
CONCLUSION
It is necessary to establish assay method- and trimester-specific reference intervals for thyroid-stimulating hormone, free thyroxine, and free triiodothyronine because the reference intervals of these thyroid hormones are significantly different at different stages of pregnancy.
Topics: Adult; Biological Assay; China; Female; Humans; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Pregnancy Trimesters; Reference Values; Thyroid Hormones
PubMed: 33942380
DOI: 10.1002/jcla.23763 -
Journal of Obstetric, Gynecologic, and... Mar 2023To evaluate the feasibility of using electronic health records (EHRs) and wearable data to describe patterns of longitudinal change in day-level heart rate before,...
OBJECTIVE
To evaluate the feasibility of using electronic health records (EHRs) and wearable data to describe patterns of longitudinal change in day-level heart rate before, during, and after pregnancy and how these patterns differ by age and body mass index.
DESIGN
Descriptive secondary analysis feasibility study using data from the National Institutes of Health All of Us Research Program.
SETTING
United States.
PARTICIPANTS
Women (N = 89) who had a birth or length of gestation code in the EHR and at least 60 days of Fitbit heart rate data during pregnancy.
METHODS
We estimated pregnancy-related episodes using EHR codes. Time consisted of five 3-month periods: before pregnancy, first trimester, second trimester, third trimester, and after birth. We analyzed data using descriptive statistics and locally estimated scatterplot smoothing.
RESULTS
An average of 330 days (SD = 112) of Fitbit heart rate data (29,392 days) were available from participants. During pregnancy, distinct peaks in heart rate occurred during the first trimester (6% increase) and third trimester (15% increase).
CONCLUSION
Future researchers can examine whether longitudinal timing and patterns of heart rate from wearable devices could be leveraged to detect health problems early in pregnancy.
Topics: Pregnancy; Humans; Female; United States; Electronic Health Records; Population Health; Pregnancy Trimester, Third; Pregnancy Trimester, Second; Wearable Electronic Devices
PubMed: 36702164
DOI: 10.1016/j.jogn.2022.12.003 -
Gynecological Endocrinology : the... Dec 2023To investigate the physiological changes of serum homocysteine (Hcy) levels and to establish trimester-specific reference intervals of serum Hcy levels for Chinese...
OBJECTIVE
To investigate the physiological changes of serum homocysteine (Hcy) levels and to establish trimester-specific reference intervals of serum Hcy levels for Chinese pregnant women.
METHOD
According to the guideline of the Clinical and Laboratory Standards Institute (CLSI) C28-A3 document, 476 healthy women were recruited in West China Second University Hospital, Sichuan University from January 2021 to October 2021. Among them, 120 were non-pregnant, 118 were in the first trimester, 120 were in the second and 118 were in the third trimester of gestation. The enzymatic cycling method was performed to detect serum Hcy levels. Non-parametric percentiles (2.5th percentile and 97.5th percentile) were calculated to establish the reference intervals for non-pregnant women and pregnant women in different trimester of gestation.
RESULTS
There was a significant statistical difference for serum Hcy levels between non-pregnant women and pregnant women ( < 0.05), and serum Hcy levels in the first, second, and third trimesters of gestation were statistically different ( < 0.05). The trimester-specific reference intervals of serum Hcy levels were 4.35 ∼ 10.16 μmol/L, 3.38 ∼ 8.60 μmol/L, and 3.75 ∼ 11.17 μmol/L for pregnant women in the first, second, and third trimester of gestation, respectively.
CONCLUSIONS
Compared to non-pregnant women, serum Hcy levels physiologically decreased after pregnancy, and the physiological changes in serum Hcy levels during pregnancy were also found. Establishing trimester-specific reference intervals of serum Hcy levels for pregnant women was valuable for clinical practice.
Topics: Pregnancy; Female; Humans; Longitudinal Studies; Reference Values; Pregnancy Trimesters; China; Homocysteine
PubMed: 37553809
DOI: 10.1080/09513590.2023.2242974 -
Economics and Human Biology Dec 2020This paper investigates the hidden yet persistent cost of conflict to birth weight outcomes for 53 developing countries experiencing conflict in the past three decades...
This paper investigates the hidden yet persistent cost of conflict to birth weight outcomes for 53 developing countries experiencing conflict in the past three decades (1990-2018). Exploiting the variation across districts and conception months-years, we find that intrauterine exposure to armed conflict in the first trimester of pregnancy reduces child's weight at birth by 2.8% and raises the incidence of low birth weight by 3.2 percentage points. Infants born to poor and low educated mothers are especially vulnerable to the adverse repercussions of armed conflict. Given the long-lasting consequences of poor infant health over the life cycle, our findings call for global efforts in the prevention and mitigation of conflict. Extra attention should be directed to children and women from disadvantaged backgrounds.
Topics: Armed Conflicts; Birth Weight; Developing Countries; Female; Humans; Infant, Low Birth Weight; Infant, Newborn; Male; Mothers; Pregnancy; Pregnancy Trimesters; Socioeconomic Factors
PubMed: 32846273
DOI: 10.1016/j.ehb.2020.100921 -
Scandinavian Journal of Clinical and... Oct 2023Physiological changes in hemostasis during pregnancy have been reported by several authors. This study aimed at establishing reference intervals for the hemostasis...
Physiological changes in hemostasis during pregnancy have been reported by several authors. This study aimed at establishing reference intervals for the hemostasis biomarkers thrombin-antithrombin complex (TAT), α2-plasmininhibitor-plasmin complex (PIC), thrombomodulin (TM) and tissue plasminogen activator-inhibitor complex (tPAI-C), in healthy pregnancies. After excluding outliers, a total of 496 healthy pregnant women (128 first-trimester, 142 second-trimester, 107 third-trimester and 119 pre-labor) and 103 healthy nonpregnant women were enrolled from Shenzhen Bao'an Women's and Children's Hospital. Hemostasis biomarkers, TAT, PIC, TM and tPAI-C, were measured by using a quantitative chemiluminescence enzyme immunoassay performed on HISCL automated analysers. The median and reference intervals (the 2.5th and 97.5th percentiles) were calculated to establish trimester-specific reference intervals for healthy pregnant women. The reference intervals for TAT, PIC, TM and tPAI-C in the first trimester were 0.7-7.6 1 µg/L, 0.2-0.9 mg/L, 2.8-11.0 TU/ml, and 1.2-6.5 1 µg/L, respectively. The reference intervals in the second trimester were 1.7-12.0 1 µg/L, 0.2-1.0 mg/L, 3.7-11.6 TU/ml, and 2.8-8.8 1 µg/L, respectively. The reference intervals in the third trimester were 2.7-16.1 1 µg/L, 0.1-1.4 mg/L, 2.9-12.9 TU/ml, and 1.9-8.0 1 µg/L, respectively. At pre-labor, the reference intervals were 4.8-32.9 1 µg/L, 0.2-1.9 mg/L, 4.2-12.6 TU/ml, and 2.8-15.4 1 µg/L, respectively. Gestational reference intervals for TAT, PIC, TM and tPAI-C in healthy pregnancies are provided, but only for TAT with increasing concentrations throughout pregnancy, the reference intervals for non-pregnant were not applicable.
Topics: Child; Pregnancy; Female; Humans; Tissue Plasminogen Activator; Pregnancy Trimesters; Labor, Obstetric; Hemostasis; Biomarkers; Reference Values
PubMed: 37491076
DOI: 10.1080/00365513.2023.2233903 -
Archives of Women's Mental Health Aug 2022Rapid screening tools are useful for identifying at-risk patients and referring them for further assessment and treatment, but none exist that consider the unique...
Rapid screening tools are useful for identifying at-risk patients and referring them for further assessment and treatment, but none exist that consider the unique medical needs of pregnant women with eating disorders (EDs). There is a need for a rapid, sensitive, and specific screening tool that can be used to identify a potential ED in pregnancy. We started with a set of 25 questions, developed from our qualitative work along with other ED screening tools, and tested on a development (n = 190) and validation sample (n = 167). Statistical analysis included factor analysis and logistic regressions with ROC curves. Development and validation samples were combined for trimester analysis (n = 357). Refining the tool to 12 items demonstrated strong internal reliability (development alpha = 0.95, validation alpha = 0.91). With correlated errors, questions demonstrated acceptable CFA fit (development: GFI: 0.91, RMSEA: 0.10, NNFI: 0.95; validation: GFI: 0.85, RMSEA: 0.14, NNFI: 0.86). Similar fits were seen by trimester: first trimester n = 127, GFI: 0.89, RMSEA: 0.12, NNFI: 0.94; second trimester n = 150, GFI: 0.83, RMSEA: 0.14, NNFI: 0.88; third trimester n = 80, GFI: 0.99, NNFI: 0.99. Validation against current ED diagnosis demonstrated acceptable sensitivity and specificity using a cutoff of 39 (development sensitivity = 80.7%, specificity = 79.7%, OR = 16.42, 95% CI: 7.51, 35.88; validation sensitivity = 69.2%, specificity = 86.5%, OR: 17.43, 95% CI: 6.46, 47.01). Findings suggest the PEBS tool can reliably and sensitively detect EDs across pregnancy trimesters with 12 questions. A further implication of this work is to reduce health and mental health treatment disparities through this standard and rapid screening measure to ensure early identification and treatment.
Topics: Factor Analysis, Statistical; Feeding Behavior; Feeding and Eating Disorders; Female; Humans; Pregnancy; Pregnancy Trimesters; Psychometrics; Reproducibility of Results
PubMed: 35499780
DOI: 10.1007/s00737-022-01230-y -
Revista Da Associacao Medica Brasileira... 2023
Topics: Humans; Female; Pregnancy; Pregnancy Trimester, First; Ultrasonography, Prenatal; Ultrasonography; Pregnancy Trimester, Second
PubMed: 37585999
DOI: 10.1590/1806-9282.20230567 -
Current Opinion in Obstetrics &... Dec 2022This review focuses on patients who are most likely to experience morbidity associated with second trimester abortion care and risk mitigation strategies. (Review)
Review
PURPOSE OF THE REVIEW
This review focuses on patients who are most likely to experience morbidity associated with second trimester abortion care and risk mitigation strategies.
RECENT FINDINGS
Prior cesarean birth, particularly multiple prior cesarean births, is the most significant risk factor associated with complications during second trimester abortion because of increased risks of hemorrhage, with or without placenta accreta spectrum (PAS), and distorted anatomy, which increases the risk of uterine perforation. Recent data suggests that first trimester ultrasound findings may be predictive of PAS, including multiple lacunae, abnormal uteroplacental interface, and hypervascularity. Multiple common medications interact with mifepristone and are therefore contraindicated; ulipristal shares mifepristone's selective progesterone receptor modulator activity but does not share the same metabolic pathway. Recent data suggests ulipristal may be an effective adjunct for cervical preparation, avoiding potentially mifepristone's drug-drug interactions. Those ending a pregnancy due to severe early-onset hypertensive disorders have a high rate of clinically significant thrombocytopenia: platelet transfusion is recommended for those with platelets <50 000 per cubic millimeter.
SUMMARY
Pregnant people presenting for care in the second trimester may have conditions that make an abortion more technically or medically complex. Clinicians can mitigate much of this increased risk with preprocedural planning, and appropriate intra-operative preparedness.
Topics: Pregnancy; Female; Humans; Pregnancy Trimester, Second; Mifepristone; Placenta Accreta; Pregnancy Trimester, First; Abortion, Induced
PubMed: 36036465
DOI: 10.1097/GCO.0000000000000817 -
Revista Brasileira de Ginecologia E... Apr 2022To assess homocysteine (Hcy) levels in the three trimesters of pregnancy in women with fetal growth restriction (FGR) and to evaluate the role of Hcy as a possible...
OBJECTIVE
To assess homocysteine (Hcy) levels in the three trimesters of pregnancy in women with fetal growth restriction (FGR) and to evaluate the role of Hcy as a possible predictor of FGR.
METHODS
A total of 315 singleton pregnant women were included in the present prospective cohort study and were monitored since the 1 trimester of pregnancy before delivery. Newborns were monitored for the first 7 days of life. Patients who had risk factors for FGR were excluded. Fetal growth restriction was defined according to uterine fundal height (< 10 percentile), ultrasound fetometry (< 5 percentile), and anthropometry of newborns (< 5 percentile). The concentrations of Hcy were detected at between 10 and 14, between 20 and 24, and between 30 and 34 weeks of pregnancy by enzyme-linked immunosorbent assay (ELISA). Receiver operating characteristics (ROC) curve test and diagnostic odds ratio (DOR) were performed to evaluate the results of ELISA.
RESULTS
The concentration of Hcy in patients with FGR was 19.65 umol/L at between 10 and 14 weeks, compared with 9.28 umol/L in patients with normal fetal growth ( < 0.0001). The optimal cut-off level for Hcy in the 1 trimester of pregnancy was > 13.9 umol/L with AUC 0.788, sensitivity of 75%, specificity of 83.6%, and DOR of 15.2.
CONCLUSION
Assessment of serum Hcy concentration may be used as a predictor of FGR, with the highest diagnostic utility in the 1 trimester of pregnancy.
Topics: Female; Fetal Growth Retardation; Homocysteine; Humans; Infant, Newborn; Pregnancy; Pregnancy Trimester, Third; Prospective Studies; ROC Curve; Ultrasonography, Prenatal
PubMed: 35176778
DOI: 10.1055/s-0042-1743093