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Frontiers in Endocrinology 2023Insufficient thyroid hormone levels during pregnancy, especially in the first trimester, adversely affect maternal and fetal health. However, the impact of isolated...
OBJECTIVE
Insufficient thyroid hormone levels during pregnancy, especially in the first trimester, adversely affect maternal and fetal health. However, the impact of isolated hypothyroxinemia (IH) on adverse pregnancy outcomes remains controversial. Therefore, this study aimed to investigate the association between IH during the first trimester and adverse pregnancy outcomes.
METHODS
This prospective cohort study included 1236 pregnant women. Thyroid-stimulating hormone and free thyroxine levels were measured before 13 weeks of gestation. Logistic regression analysis and the Cochran-Armitage trend test were used to assess the association between IH in the first trimester and adverse pregnancy outcomes.
RESULTS
IH during the first trimester was associated with an increased risk of macrosomia. After adjusting for confounding factors, including age, body mass index, parity, abnormal pregnancy history, fasting blood glucose, and total cholesterol, multivariate logistic regression analysis showed that IH in the first trimester remained an independent risk factor for macrosomia. In addition, the risk of macrosomia increased with IH severity. However, no significant relationship was found between IH during the first trimester and gestational diabetes mellitus, hypertensive disorders of pregnancy, spontaneous abortion, premature rupture of membranes, placental abruption, oligohydramnios, premature delivery, fetal distress, or low birth weight.
CONCLUSION
IH during the first trimester did not increase the risk of adverse pregnancy outcomes, except for macrosomia.
Topics: Pregnancy; Female; Humans; Pregnancy Outcome; Fetal Macrosomia; Pregnancy Trimester, First; Prospective Studies; Placenta; Weight Gain; Premature Birth
PubMed: 38161973
DOI: 10.3389/fendo.2023.1309787 -
International Journal of Molecular... Dec 2023This study highlights the importance of a combined diagnostic approach in the diagnosis of rare diseases, such as adult-onset genetic FSGS. We present three adult...
This study highlights the importance of a combined diagnostic approach in the diagnosis of rare diseases, such as adult-onset genetic FSGS. We present three adult patient cases evaluated with kidney biopsy for proteinuria, chronic kidney disease, and hypertension, which were suggestive of adult-onset genetic FSGS. Renal biopsy samples and formalin-fixed, paraffin-embedded fetal kidneys were evaluated using standard light microscopical stainings, direct immunofluorescence on cryostat sections, and electron microscopy. Clinical exome sequencing was performed for each case, and 45 FSGS-related genes were analyzed. Identifying mutations in the , , and genes have prompted a re-evaluation of the previous histopathological examinations. The mutation led to a thinner nephrogenic zone and decreased number of glomeruli, resulting in oligohydramnios during fetal development and oligomeganephronia and adaptive focal-segmental glomerulosclerosis in adulthood. The mutation caused distinct electron-dense aggregates in podocyte cell bodies, while the mutation led to segmental sclerosis of glomeruli with marked interstitial fibrosis and tubular atrophy. The identification of specific mutations and their histopathological consequences can lead to a better understanding of the disease and its progression, as well as potential treatment options.
Topics: Adult; Humans; Glomerulosclerosis, Focal Segmental; Kidney Glomerulus; Mutation; Phenotype; Genotype
PubMed: 38139322
DOI: 10.3390/ijms242417489 -
Cureus Nov 2023Preeclampsia is associated with the incidence of common fetal problems including intra-uterine growth restriction (IUGR), premature delivery oligohydramnios, placental...
BACKGROUND
Preeclampsia is associated with the incidence of common fetal problems including intra-uterine growth restriction (IUGR), premature delivery oligohydramnios, placental abruption, fetal discomfort, and intrauterine fetal death. Pregnant women are not well-informed about preeclampsia, including its symptoms, risk factors, and consequences. The aim of the current study is to evaluate the awareness of preeclampsia and its associated factors among women in the Al Baha region, Saudi Arabia.
METHODOLOGY
An observational cross-sectional design was employed to assess the awareness of preeclampsia and its associated factors among women in the Al Baha region of Saudi Arabia. Data was collected from April 2023 to September 2023. A questionnaire was designed to gather information on participants' sociodemographic characteristics (such as age, educational level, and residency) and their awareness of preeclampsia, including knowledge about signs/symptoms, risk factors, and complications.
RESULTS
In the current study, we included 485 pregnant women. The majority of participants were aged 40 years or older (37.5%), followed by those aged 35-39 (20.4%). Among the participants, 70.9% confirmed that they had heard about pre-eclampsia before. The most common signs and symptoms were high blood pressure (47.4%), increased protein in urine (40.2%), continuous headache (39.2%), and vomiting/nausea (40.0%). Participants demonstrated awareness of obesity (29.7%), diabetes mellitus (35.5%), chronic hypertension (47.0%), and chronic kidney disease (31.3%) as major risk factors. Participants were aware of potential risks such as kidney disorders (34.6%), heart disorders (23.7%), and preterm delivery (50.9%). The analysis reveals that younger participants below 20 years old (3.3%) and lower educational levels (5.6%) had lower awareness of preeclampsia compared to older age groups.
CONCLUSION
The findings of this study highlight a reasonable level of preeclampsia awareness and knowledge among Saudi Arabian women residing in the Al Baha region. While the majority of participants were familiar with preeclampsia, there were significant knowledge gaps regarding the precise symptoms, risk factors, and consequences of the condition.
PubMed: 38116365
DOI: 10.7759/cureus.49038 -
The Journal of Maternal-fetal &... Dec 2023The aim of this review is to evaluate the relationship between the use of non-steroidal anti-inflammatory drugs (NSAIDs) during last trimesters of the pregnancy and the... (Review)
Review
OBJECTIVE
The aim of this review is to evaluate the relationship between the use of non-steroidal anti-inflammatory drugs (NSAIDs) during last trimesters of the pregnancy and the reduction of amniotic fluid.
METHODS
Electronic databases were searched (PubMed, Medline, and Scopus). Selection criteria included studies reporting the relationship between oligohydramnios and use of NSAID during pregnancy. We analyzed the median age of women, weeks of pregnancy at the beginning of the drug administration, kind of medication, period of exposure and dosage, deepest vertical pocket (DVP), and amniotic fluid index (AFI).
RESULTS
Of the 68 records identified, we analyzed 29 studies investigating the administration of NSAIDs, including 11 studies examined the administration of the Indomethacin, four articles have focused on the use of Nimesulide, and only two manuscripts considered the use of Diclofenac. We found a strict correlation between the development of oligohydramnios and the use of NSAIDs. The oligohydramnios is reversible, and the normal amount of amniotic fluid is restored after the interruption of the treatment.
CONCLUSIONS
The use of NSAIDs should be considered when maternal benefits outweigh the potential fetal risk, at the lowest effective dose for shortest duration. Beyond 48 h of NSAIDs treatment, we consider ultrasound monitoring of amniotic fluid, and we suggest stopping therapy if a decline AFI is present.
Topics: Pregnancy; Female; Humans; Oligohydramnios; Amniotic Fluid; Anti-Inflammatory Agents, Non-Steroidal; Pregnancy Trimester, Third; Ultrasonography; Pregnancy Outcome
PubMed: 38092425
DOI: 10.1080/14767058.2023.2253956 -
Cureus Nov 2023Background Pre-eclampsia is a multisystem progressive disorder associated with significant maternal and neonatal morbidity and mortality. It is essential to identify the...
Background Pre-eclampsia is a multisystem progressive disorder associated with significant maternal and neonatal morbidity and mortality. It is essential to identify the potential indicators of associated complications in pre-eclampsia to improve pregnancy outcomes. Serum uric acid (UA) levels are increased in pregnancies complicated by pre-eclampsia. This study was performed to validate salivary UA as an alternative non-invasive biomarker to serum UA in pre-eclampsia. Methodology A total of 150 pregnant women were enrolled in the study. They were divided equally into three groups with 50 participants in each group. Group 1 included healthy normotensive pregnant women as control, group 2 included participants with non-severe pre-eclampsia and group 3 included participants with severe pre-eclampsia. Both salivary and serum UA were estimated in all the study participants and comparative analyses were done. Results Serum UA was elevated in 33(66%) and 48(96%) of participants in groups 2 and 3 respectively while saliva uric acid in 30(60%) and 43(86%) as compared with healthy controls who had serum UA raised in 14(28%) and salivary UA in 12(24%) with a significant p-value of 0.0001. The mean values of serum and salivary UA in group 1 were 4.5 ±1.16 mg/dl and 4.11±1.74 mg/dl respectively whereas in group 2 these were 6.12±1.86mg/dl and 5.96±1.90mg/dl and in group 3 these were 8.24±2.31mg/dl and 8.17±3.31mg/dl respectively. There was a significant correlation between serum and salivary UA values in groups 1 and 2, groups 1 and 3, and groups 2 and 3 with a p-value of 0. 001. The serum and salivary UA levels showed an increasing trend from healthy controls (group 1) to non-severe pre-eclampsia (group 2) with the highest values in severe pre-eclampsia (group 3). Oligohydramnios was present in 10(20%) cases in group 1 whereas 24(48%) cases in group 3. The appearance, pulse, grimace, activity, respiration (APGAR) score at 1 and 5 minutes was abnormal in 5(1.23%) and 7(1.33%) cases in group 1, 6(1.26%) and 7(1.29%) cases in group 2 and 5(1.73%) and 6(1.53%) cases in group 3. The area under curve (AUC) in group 2 was 0.778 for serum UA and 0.779 for salivary UA. In group 3, the AUC for serum UA values was 0.938 and for salivary UA 0.882. A statistically significant correlation between serum and salivary UA values in group 2 (non-severe pre-eclampsia) was found with a p-value of 0.001 and Pearson's correlation coefficient r of 0.738. Conclusions Serum and salivary UA levels correlate with the severity of pre-eclampsia with maximum levels in severe pre-eclampsia (group 3) followed by group 2 (non-severe pre-eclampsia) with the lowest levels in group 1 (healthy controls). The authors are of the opinion that a non-invasive salivary UA test can replace the serum UA test and can be a useful supplementation for conventional pre-eclampsia prediction.
PubMed: 38073934
DOI: 10.7759/cureus.48457 -
BMC Musculoskeletal Disorders Dec 2023Established associated factors for DDH include female sex, breech presentation, family history, congenital malformations, oligohydramnios, and maternal hyperthyroidism.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Established associated factors for DDH include female sex, breech presentation, family history, congenital malformations, oligohydramnios, and maternal hyperthyroidism. However, evidence for environmental factors that may contribute to DDH is limited and inconsistent.
METHODS
A systematic review of medical literature was conducted to collect data on environmental factors, including latitude, longitude, average yearly precipitation, average yearly temperature, minimum monthly temperature, and maximum monthly temperature, from all institutions that published articles on DDH. Univariate linear regression analysis was used to examine the correlation between environmental factors and DDH incidence, while multiple regression analysis was conducted to identify significant associated factors for DDH incidence.
RESULTS
Data from a total of 93 unique manuscripts were analyzed, revealing a significant negative correlation between DDH incidence and temperature, including average yearly temperature (r = -0.27, p = 0.008), minimum monthly temperature (r = -0.28, p = 0.006), and maximum monthly temperature (r = -0.23, p = 0.029). Additionally, there was a significant positive correlation between DDH incidence and latitude (r = 0.27, p = 0.009), and a significant negative correlation between DDH incidence and average yearly precipitation (r = -0.29, p = 0.004). In the final multiple regression analysis, temperature, including average yearly temperature, minimum monthly temperature, and maximum monthly temperature, were identified as significant associated factors for DDH incidence.
CONCLUSION
The findings of this study suggest an association between cold weather and DDH incidence. Further research should explore the link between cold weather and DDH incidence, offering insights into potential interventions for cold climates.
Topics: Pregnancy; Humans; Female; Hip Dislocation, Congenital; Incidence; Developmental Dysplasia of the Hip; Breech Presentation; Regression Analysis; Risk Factors
PubMed: 38053132
DOI: 10.1186/s12891-023-07073-7 -
JAMA Dec 2023Early anhydramnios during pregnancy, resulting from fetal bilateral renal agenesis, causes lethal pulmonary hypoplasia in neonates. Restoring amniotic fluid via serial... (Clinical Trial)
Clinical Trial
IMPORTANCE
Early anhydramnios during pregnancy, resulting from fetal bilateral renal agenesis, causes lethal pulmonary hypoplasia in neonates. Restoring amniotic fluid via serial amnioinfusions may promote lung development, enabling survival.
OBJECTIVE
To assess neonatal outcomes of serial amnioinfusions initiated before 26 weeks' gestation to mitigate lethal pulmonary hypoplasia.
DESIGN, SETTING, AND PARTICIPANTS
Prospective, nonrandomized clinical trial conducted at 9 US fetal therapy centers between December 2018 and July 2022. Outcomes are reported for 21 maternal-fetal pairs with confirmed anhydramnios due to isolated fetal bilateral renal agenesis without other identified congenital anomalies.
EXPOSURE
Enrolled participants initiated ultrasound-guided percutaneous amnioinfusions of isotonic fluid before 26 weeks' gestation, with frequency of infusions individualized to maintain normal amniotic fluid levels for gestational age.
MAIN OUTCOMES AND MEASURES
The primary end point was postnatal infant survival to 14 days of life or longer with dialysis access placement.
RESULTS
The trial was stopped early based on an interim analysis of 18 maternal-fetal pairs given concern about neonatal morbidity and mortality beyond the primary end point despite demonstration of the efficacy of the intervention. There were 17 live births (94%), with a median gestational age at delivery of 32 weeks, 4 days (IQR, 32-34 weeks). All participants delivered prior to 37 weeks' gestation. The primary outcome was achieved in 14 (82%) of 17 live-born infants (95% CI, 44%-99%). Factors associated with survival to the primary outcome included a higher number of amnioinfusions (P = .01), gestational age greater than 32 weeks (P = .005), and higher birth weight (P = .03). Only 6 (35%) of the 17 neonates born alive survived to hospital discharge while receiving peritoneal dialysis at a median age of 24 weeks of life (range, 12-32 weeks).
CONCLUSIONS AND RELEVANCE
Serial amnioinfusions mitigated lethal pulmonary hypoplasia but were associated with preterm delivery. The lower rate of survival to discharge highlights the additional mortality burden independent of lung function. Additional long-term data are needed to fully characterize the outcomes in surviving neonates and assess the morbidity and mortality burden.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT03101891.
Topics: Female; Humans; Infant; Infant, Newborn; Pregnancy; Fetal Therapies; Gestational Age; Kidney; Kidney Diseases; Prospective Studies; Infusions, Parenteral; Oligohydramnios; Fetal Diseases; Lung Diseases; Isotonic Solutions; Ultrasonography, Interventional; Pregnancy Outcome; Treatment Outcome; Premature Birth
PubMed: 38051327
DOI: 10.1001/jama.2023.21153 -
Gynecology and Minimally Invasive... 2023The objective of this study was to observe the influence of laparoscopic adenomyomectomy on perinatal outcomes.
OBJECTIVES
The objective of this study was to observe the influence of laparoscopic adenomyomectomy on perinatal outcomes.
MATERIALS AND METHODS
The retrospective cohort study included 43 pregnant cases with adenomyosis who did not undergo laparoscopic surgery before pregnancy (nonsurgery group; 26 cases) and did (surgery group; 17 cases). To evaluate the impact of surgery on perinatal outcomes, nine obstetric complications including preterm delivery, hypertensive disorder of pregnancy, placental malposition, oligohydramnios, gestational diabetes mellitus, uterine rupture, abruptio placentae, and postpartum hemorrhage were selected. One obstetric complication was counted as one point (Maximum 9 points for one person). The obstetrical morbidity was compared by adding up the number of relevant events (0-9) between the two groups. Apgar score, umbilical artery pH (UApH), neonatal intensive care unit (NICU) admission, and neonatal death were also examined.
RESULTS
The surgery group had a significantly lower prevalence of fetal growth restriction compared to the nonsurgery group (nonsurgery vs. surgery; 26.9%, 7/26 vs. 0%, 0/17: = 0.031). No differences were found in the morbidity of the nine obstetric complications (19.2%, 45/234 vs. 13.7%, 21/153), gestational weeks (mean ± standard deviation, 37.2 ± 2.4 vs. 36.4 ± 3.2), birth weight (2573.6 ± 557.9 vs. 2555.4 ± 680.8 g), Apgar score (1, 5 min; 8.0 ± 0.7 vs. 7.7 ± 1.2, 8.9 ± 0.6 vs. 8.5 ± 1.8), UApH (7.28 ± 0.08 vs. 7.28 ± 0.06), NICU admission (26.9%, 7/26 vs. 41.2%, 7/17), and neonatal death (0%, 0%) between both groups.
CONCLUSION
Laparoscopic adenomyomectomy may not increase obstetric complications, although attention must be paid to uterine rupture during pregnancy.
PubMed: 38034106
DOI: 10.4103/gmit.gmit_45_22 -
The Journal of Maternal-fetal &... Dec 2023To compare neonatal outcomes in pregnancies with fetal growth restriction (FGR) by intended delivery mode. This is a retrospective cohort study of singleton pregnancies...
To compare neonatal outcomes in pregnancies with fetal growth restriction (FGR) by intended delivery mode. This is a retrospective cohort study of singleton pregnancies with FGR that were delivered ≥34.0 weeks gestation. Neonatal outcomes were compared according to the intended delivery mode, which the attending obstetrician determined. Of note, none of the subjects had a contraindication to labor. Crude and adjusted odds ratios (ORs) and corresponding confidence intervals (CIs) were calculated logistic regression models to assess the potential association between intended delivery mode and neonatal morbidity defined as a composite outcome (i.e. umbilical artery pH ≤7.1, 5-min Apgar score ≤7, admission to the neonatal intensive care unit, hypoglycemia, intrapartum fetal distress requiring expedited delivery, and perinatal death). A sensitivity analysis excluded intrapartum fetal distress requiring emergency cesarean delivery from the composite outcome since only patients with spontaneous labor or labor induction could meet this criterion. Potential confounders in the adjusted effects models included maternal age, body mass index, hypertensive disorders, diabetes, FGR type (i.e. early or late), and oligohydramnios. Seventy-two (34%) patients had an elective cesarean delivery, 73 (34%) had spontaneous labor and were expected to deliver vaginally, and 67 (32%) underwent labor induction. The composite outcome was observed in 65.3%, 89%, and 88.1% of the groups mentioned above, respectively ( < 0.001). Among patients with spontaneous labor and those scheduled for labor induction, 63% and 47.8% required an emergency cesarean delivery for intrapartum fetal distress. Compared to elective cesarean delivery, spontaneous labor (OR 4.32 [95% CI 1.79, 10.42], = 0.001; aOR 4.85 [95% CI 1.85, 12.66], = 0.001), and labor induction (OR 3.92 [95% CI 1.62, 9.49] = 0.002; aOR 5.29 [95% CI 2.01, 13.87], = 0.001) had higher odds of adverse neonatal outcomes. In this cohort of FGR, delivering at ≥34 weeks of gestation, pregnancies with spontaneous labor, and those that underwent labor induction had higher odds of neonatal morbidity than elective cesarean delivery.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Fetal Growth Retardation; Retrospective Studies; Fetal Distress; Cesarean Section; Labor, Obstetric; Labor, Induced; Gestational Age
PubMed: 38010351
DOI: 10.1080/14767058.2023.2286433 -
Clinical Imaging Dec 2023Although 60.5 % of clinically unexplained stillbirths can be attributed to placental insufficiency and/or fetal growth restriction, clinicians rarely calculate...
Although 60.5 % of clinically unexplained stillbirths can be attributed to placental insufficiency and/or fetal growth restriction, clinicians rarely calculate estimated placental volume (EPV). We present a scenario in which EPV was used to inform patient care of a 28-year-old with decreased fetal movement at 32 weeks and 1 day gestation. Although estimated fetal weight (EFW), amniotic fluid index (AFI), and nonstress test (NST) were normal, EPV was low (<0.1st percentile), which prompted more frequent patient follow-up. Oligohydramnios was detected at 38 weeks and 1 day, and labor was induced. An infant with birthweight in the 12th percentile for gestational age was born. We learned that EPV can precede intrauterine growth restriction (IUGR), oligohydramnios, and low birthweight.
Topics: Pregnancy; Female; Humans; Adult; Placenta; Birth Weight; Oligohydramnios; Fetal Movement; Fetal Growth Retardation; Gestational Age; Ultrasonography, Prenatal
PubMed: 37984265
DOI: 10.1016/j.clinimag.2023.110027