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Frontiers in Endocrinology 2024Polycystic ovary syndrome (PCOS) and thyroid disorders have both been linked to adverse pregnancy and neonatal outcomes. Even small variations in thyroid function within... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
Polycystic ovary syndrome (PCOS) and thyroid disorders have both been linked to adverse pregnancy and neonatal outcomes. Even small variations in thyroid function within the normal range may influence fetal growth. Our aim was to investigate whether maternal thyroid function is associated with newborn anthropometrics in PCOS and explore the potential modifying effect of metformin.
METHODS
analyses of two RCTs in which pregnant women with PCOS were randomized to metformin or placebo, from first trimester to delivery. Maternal serum levels of thyroid stimulating hormone (TSH) and free thyroxine (fT4) were measured at gestational weeks (gw) 5-12, 19, 32 and 36 in 309 singleton pregnancies. The mean z-scores of birthweight, birth length, and head circumference were estimated in the offspring. Associations of maternal thyroid parameters with offspring anthropometrics and the outcomes large for gestational age (LGA) and small for gestational age (SGA) were studied using linear and logistic regression models, with adjustment for body mass index (BMI) when relevant.
RESULTS
Maternal fT4 at baseline was negatively associated with birth length (b= -0.09, p=0.048). Furthermore, ΔfT4 during pregnancy correlated positively to z-score of both birth weight and length (b=0.10, p=0.017 and b=0.10, p=0.047 respectively), independently of treatment group. TSH at baseline and gw19 was inversely associated with LGA (OR 0.47, p=0.012 and OR 0.58, p=0.042), while ΔTSH was positively associated with LGA (OR 1.99, p=0.023). There were inverse associations between TSH at baseline and SGA (OR 0.32, p=0.005) and between ΔfT4 and SGA (OR 0.59, p=0.005) in the metformin group only. There were no associations between maternal thyroid function and head circumference of the newborns.
CONCLUSION
In women with PCOS, a higher maternal fT4 in early pregnancy and a greater decrease in fT4 during pregnancy was associated with a lower offspring birthweight and shorter birth length. Higher TSH by mid-gestation and smaller increase in TSH during pregnancy was associated with less risk of LGA. Subclinical variations in maternal thyroid function might play a role for birth anthropometrics of PCOS offspring.
Topics: Humans; Female; Polycystic Ovary Syndrome; Pregnancy; Adult; Infant, Newborn; Birth Weight; Metformin; Thyrotropin; Thyroid Gland; Thyroid Function Tests; Pregnancy Complications; Thyroxine; Infant, Small for Gestational Age; Pregnancy Outcome; Anthropometry; Hypoglycemic Agents; Male
PubMed: 38868742
DOI: 10.3389/fendo.2024.1388473 -
Journal of the Turkish German... Jun 2024In this study, maternal and neonatal outcomes of pregnant women with positive severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) RNA tests were evaluated...
OBJECTIVE
In this study, maternal and neonatal outcomes of pregnant women with positive severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) RNA tests were evaluated according to their symptomatic status. The clinical progression of SARS-CoV-2-positive pregnant women and the effect of coronavirus disease-2019 (COVID-19) on newborns was investigated.
MATERIAL AND METHODS
This retrospective cohort study was conducted at a tertiary pandemic hospital specializing in caring for pregnant women infected with SARS-CoV-2. We included patients with a positive SARS-CoV-2 polymerase chain reaction test at delivery, subdividing them into symptomatic and asymptomatic groups.
RESULTS
Two hundred and forty-nine patients were included in the study. The mean age of the pregnant women in the symptomatic group was higher than those in the asymptomatic group (p=0.001). The iatrogenic preterm birth rates in the symptomatic and asymptomatic groups were 43.37% and 8.43%, respectively (p<0.001). Cesarean section rate was higher in symptomatic group (p=0.01). Maternal death was significantly higher in symptomatic pregnant women (p<0.001). The neonatal intensive care unit admission rate was higher in symptomatic pregnant women (p<0.001).
CONCLUSION
The maternal and fetal outcomes for mothers with symptomatic infections tend to be worse, highlighting the importance of careful management, good follow-up and the advisability of closer monitoring.
PubMed: 38867711
DOI: 10.4274/jtgga.galenos.2024.2023-6-4 -
PLOS Global Public Health 2024Providing accurate, evidence-based information to women with Zika infection during pregnancy was problematic because of the high degree of uncertainty in the diagnosis...
Providing accurate, evidence-based information to women with Zika infection during pregnancy was problematic because of the high degree of uncertainty in the diagnosis of the infection and the associated risk. The 2015-17 Zika virus epidemic overwhelmingly affected women in countries with limited access to safe abortion. Understanding women's perspectives on risk communication during pregnancy in the context of an emerging pathogen can help inform risk communication in response to future outbreaks that affect fetal or child development. We conducted a cross-sectional qualitative interview study with 73 women from 7 locations in Brazil, Colombia, and Puerto Rico to understand women's experiences of Zika virus (ZIKV) test and outcome-related communication during the ZIKV pandemic. We used thematic analysis to analyze the in-depth interviews. Participants in Brazil and Colombia reported that the healthcare system's lack of preparation and organization in communicating ZIKV test results and associated adverse outcomes led to their feeling abandoned and alone in confronting the challenges of a ZIKV-affected pregnancy. In contrast, participants in Puerto Rico reported that the regular testing schedules and clear, well-planned communication between the care team and between providers and pregnant women helped them to feel they could prepare for a ZIKV-affected pregnancy. Communication of the risk associated with an emerging pathogen suspected to affect pregnancy and developmental outcomes is a fraught issue. Public health authorities and healthcare providers should work together in the interpandemic period to understand families' preferences for risk communication during pregnancy in the presence of uncertainty and develop a community-informed plan for risk communication.
PubMed: 38865420
DOI: 10.1371/journal.pgph.0002808 -
PloS One 2024In low-resource settings, magnesium sulphate (MgSO4) for preeclampsia is administered majorly through an injection into the gluteal muscles 4-hourly for 24 hours. The... (Randomized Controlled Trial)
Randomized Controlled Trial Comparative Study
INTRODUCTION
In low-resource settings, magnesium sulphate (MgSO4) for preeclampsia is administered majorly through an injection into the gluteal muscles 4-hourly for 24 hours. The repeated injections are very painful and may lead to infection, abscess formation, and reduced compliance.
OBJECTIVE
To determine the acceptability of Springfusor® pump for the administration of Magnesium Sulphate in preeclampsia and eclampsia.
DESIGN
Randomized Open Label Clinical Trial.
METHODS
The study was conducted at Kawempe National Referral Hospital. Eligible women had a systolic blood pressure of ≥140mmHg and or diastolic blood pressure >90mmHg, proteinuria ≥+1, and the physician's decision to start on MgSO4. Four-hundred-ninety-six participants were randomized to a Springfusor® pump group (n = 248) or control (standard of care) (n = 248) administration of MgSO4. Intervention group had a loading dose (4gm of 50% MgSO4 intravenously over 20 minutes) and maintenance therapy (1gm of 50% MgSO4 intravenously per hour for 24 hours) administered using the Springfusor®. The standard of care (SOC) group received a loading dose of 4gm of 20% MgSO4 IV over 15-20 minutes, followed by 10gm of 50% MgSO4 intramuscular (5gm in each buttock) and a maintenance dose of 5gm of 50% MgSO4 was administered IM every 4 hours for 24 hours. Both arms received the rest of the care for preeclampsia/eclampsia as per the hospital guidelines. Acceptability of the method of administration was assessed using a Likert scale (1-5; 1 and 2: acceptable and 3-5: unacceptable). Pain at the site of MgSO4 administration was assessed using a Visual Analogue Scale 1-7, (1 minimal pain and 7 worst pain). Comparisons were assessed with the Chi-square test, Mann Whitney-Wilcoxon test, and Students' t-test.
RESULTS
Intervention arm; was more acceptable than the standard of care arm, (95.3% vs70.3%; p<0.001), had a lower median pain score, (2(CI: 2-2), vs 4(CI: 4-5) p<0.001), and fewer side effects. Maternal mortality was comparable between groups (0.8% in the intervention arm vs 1.2% in the IM arm).
TRIAL REGISTRATION
Trial No PACTR201712002887266 (https://pactr.samrc.ac.za/).
Topics: Humans; Magnesium Sulfate; Female; Pre-Eclampsia; Pregnancy; Eclampsia; Adult; Standard of Care; Young Adult; Injections, Intramuscular
PubMed: 38865319
DOI: 10.1371/journal.pone.0286361 -
Hypertension in Pregnancy Dec 2024This study aimed to establish in vitro hemodilution and resupplementation assays for obstetric hemorrhage in pregnancy-induced hypertension (PIH) and to monitor the...
This study aimed to establish in vitro hemodilution and resupplementation assays for obstetric hemorrhage in pregnancy-induced hypertension (PIH) and to monitor the coagulation function dynamically using a coagulation and platelet function analyzer. Forty-seven singleton pregnant women were divided into normal ( = 24) and PIH ( = 23) groups. Peripheral blood samples were used to construct the assays, and the activated clotting time (ACT), clotting rate (CR), and platelet function index (PF) were measured. The results showed that the baseline ACT was higher in the PIH group ( < 0.01). Hemodilution assays showed decreased ACT and increased CR and PF, with ACT changes significantly lower in the PIH group ( < 0.05). CR changed most in both groups at lower dilution ratios (35% to 50%), while ACT changed most at a higher dilution ratio (75%). In the resupplementation assay, ACT exhibited the most significant response. The analyzer effectively detected differences between pregnant women with and without PIH. Thus, we need to pay more attention to the changes of ACT in the actual clinical application to assess the coagulation status of parturients.
Topics: Humans; Female; Pregnancy; Adult; Hypertension, Pregnancy-Induced; Blood Coagulation; Platelet Function Tests; Blood Coagulation Tests; Postpartum Hemorrhage; Young Adult
PubMed: 38864450
DOI: 10.1080/10641955.2024.2366824 -
Beijing Da Xue Xue Bao. Yi Xue Ban =... Jun 2024To explore the association between polymorphisms of transforming growth factor-β (TGF-β) signaling pathway and non-syndromic cleft lip with or without cleft palate...
OBJECTIVE
To explore the association between polymorphisms of transforming growth factor-β (TGF-β) signaling pathway and non-syndromic cleft lip with or without cleft palate (NSCL/P) among Asian populations, while considering gene-gene interaction and gene-environment interaction.
METHODS
A total of 1 038 Asian NSCL/P case-parent trios were ascertained from an international consortium, which conducted a genome-wide association study using a case-parent trio design to investigate the genes affec-ting risk to NSCL/P. After stringent quality control measures, 343 single nucleotide polymorphism (SNP) spanning across 10 pivotal genes in the TGF-β signaling pathway were selected from the original genome-wide association study(GWAS) dataset for further analysis. The transmission disequilibrium test (TDT) was used to test for SNP effects. The conditional Logistic regression models were used to test for gene-gene interaction and gene-environment interaction. Environmental factors collected for the study included smoking during pregnancy, passive smoking during pregnancy, alcohol intake during pregnancy, and vitamin use during pregnancy. Due to the low rates of exposure to smoking during pregnancy and alcohol consumption during pregnancy (<3%), only the interaction between maternal smoking during pregnancy and multivitamin supplementation during pregnancy was analyzed. The threshold for statistical significance was rigorously set at =1.46×10, applying Bonferroni correction to account for multiple testing.
RESULTS
A total of 23 SNPs in 4 genes yielded nominal association with NSCL/P (<0.05), but none of these associations was statistically significant after Bonferroni' s multiple test correction. However, there were 6 pairs of SNPs rs4939874 () and rs1864615 (), rs2796813 () and rs2132298 (), rs4147358 () and rs1346907 (), rs4939874 () and rs1019855 (), rs4939874 () and rs12490466 (), rs2009112 () and rs4075748 () showed statistically significant SNP-SNP interaction (<1.46×10). In contrast, the analysis of gene-environment interactions did not yield any significant results after being corrected by multiple testing.
CONCLUSION
The comprehensive evaluation of SNP associations and interactions within the TGF-β signaling pathway did not yield any direct associations with NSCL/P risk in Asian populations. However, the significant gene-gene interactions identified suggest that the genetic architecture influencing NSCL/P risk may involve interactions between genes within the TGF-β signaling pathway. These findings underscore the necessity for further investigations to unravel these results and further explore the underlying biological mechanisms.
Topics: Humans; Cleft Palate; Cleft Lip; Gene-Environment Interaction; Polymorphism, Single Nucleotide; Signal Transduction; Transforming Growth Factor beta; Female; Genome-Wide Association Study; Asian People; Pregnancy; Male; Genetic Predisposition to Disease; Smad3 Protein; Risk Factors; Smad2 Protein; Epistasis, Genetic; Tobacco Smoke Pollution; Alcohol Drinking
PubMed: 38864121
DOI: 10.19723/j.issn.1671-167X.2024.03.002 -
Frontiers in Pharmacology 2024This study aimed to assess the impact of gestational diabetes mellitus (GDM) on fetal heart structure and function using a technique called fetal heart quantification...
OBJECTIVE
This study aimed to assess the impact of gestational diabetes mellitus (GDM) on fetal heart structure and function using a technique called fetal heart quantification (Fetal HQ), with a focus on mitochondrial dynamics, which employs advanced imaging technology for comprehensive analysis.
METHODS
A total of 180 fetuses with normal heart structures, aged 24-40 weeks of gestation, were examined. A 2-3 s cine loop in the standard four-chamber oblique view was captured and analyzed using the speckle-tracking technique with Fetal HQ. Various echocardiographic parameters were evaluated, including four-chamber view (4CV), global spherical index (GSI), global longitudinal strain (GLS), 24-segment spherical index (SI), ventricular fractional area change (FAC), cardiac output (CO), and stroke volume (SV). These parameters were compared between the GDM group and the control group during two gestational periods: 24 to 28 weeks and 28 to 40 weeks. Statistical analysis was performed using independent samples -tests and Mann-Whitney U tests to identify significant differences.
RESULTS
Twenty fetuses from mothers with GDM and 40 from the control group were recruited at 24 to 28 weeks. At 28 to 40 weeks, 40 fetuses from mothers with GDM and 80 from the control group were recruited. The fetal left ventricular global longitudinal function was similar between the GDM and control groups. However, compared to the controls, right ventricular function in the GDM group was lower only at 28 to 40 weeks. In the GDM group, the global spherical index (GSI) was lower than in the control group at 28 to 40 weeks (1.175 vs. 1.22; = 0.001). There were significant decreases in ventricular FAC (38.74% vs. 42.83%; < 0.0001) and 4CV GLS for the right ventricle (-22.27% vs. -26.31%; = 0.005) at 28 to 40 weeks.
CONCLUSION
Our findings suggest that GDM is associated with decreased right ventricular function in the fetal heart, particularly during the later stages of pregnancy (28 to 40 weeks), compared to fetuses from healthy pregnancies. The Fetal HQ technique represents a valuable tool for evaluating the structure and function of fetal hearts affected by GDM during the advanced stages of pregnancy.
PubMed: 38863981
DOI: 10.3389/fphar.2024.1394885 -
Journal of the ASEAN Federation of... 2024Gestational diabetes mellitus (GDM) is a common pregnancy complication with adverse fetal and maternal outcomes. Currently, there are only a few validated tools...
OBJECTIVES
Gestational diabetes mellitus (GDM) is a common pregnancy complication with adverse fetal and maternal outcomes. Currently, there are only a few validated tools available that address knowledge in GDM. Recognition of the inconsistencies will provide an effective learning program to achieve optimal results. This study aimed at validating the "Gestational Diabetes Mellitus Knowledge Questionnaire" (GDMKQ).
METHODOLOGY
A cross-sectional validation study on GDMKQ among 51 GDM patients aged at least 18 years was conducted in the outpatient clinics of a tertiary hospital. Excluded were those with pre-existing diabetes. The questionnaire was submitted for peer review for translation to Filipino and back-translation. Concurrent validity, internal consistency and test-retest reliability of the questionnaire were undertaken as part of the validation process. Descriptive analysis was used for data elaboration by using SPSS v23.
RESULTS
The Filipino version of GDMKQ demonstrated sensible content and face validity. As measured, respondents obtained higher total and domain scores with better knowledge levels of GDM compared to its English version. Overall adequate knowledge was observed among those married and college subgroups as compared to single women and those with secondary levels of education. The reliability of the questionnaire was calculated at 0.632 using the Kuder-Richardson 20. The test-retest scores using the Filipino-translated questionnaire have a Pearson correlation coefficient of 0.853 with moderate to good level of agreement with each other, and Cohen's kappa of 0.564 with an intra-class correlation coefficient of 0.828.
CONCLUSION
The Filipino-translated version of GDMKQ is a valid screening tool that assesses a patient's knowledge on gestational diabetes. Identifying the level of their understanding will enable clinicians to develop an individualized, effective learning program to improve pregnancy outcomes.
Topics: Humans; Female; Diabetes, Gestational; Pregnancy; Surveys and Questionnaires; Adult; Health Knowledge, Attitudes, Practice; Cross-Sectional Studies; Tertiary Care Centers; Philippines; Reproducibility of Results; Young Adult
PubMed: 38863908
DOI: 10.15605/jafes.039.01.10