Gestational Diabetes: Physical Activity Before Pregnancy and Its Influence on the Cardiovascular System

Objectives:Gestational diabetes mellitus (GDM) is a common complication in pregnancy, affecting around 14% of all pregnancies each year. It will likely further increase, as obesity becomes more prevalent. The impact of GDM on cardiovascular changes in pregnant women and her child is still unclear. The aim of the study was to measure the effects of physical activity before pregnancy on the cardiovascular system in patients with GDM in pregnancy. Methods:Two hundred and six pregnant women were included in this observational study. All participants were recruited at the tertiary level teaching University Hospital "Klinikum rechts der Isar" between 28 and 32 weeks gestation. Questionnaires dealing with pre-pregnancy daily and physical activity (PA) were evaluated. The cardiovascular status of the mothers included measurements of the intima-media thickness (IMT) of the carotid arteries. PA level was performed with a standardized 6-min-walking-test. Results:Ninety-nine women with GDM with a mean age of 33.84 (+/- 4.7) years were examined. One hundred seven healthy pregnant women aged 32.6 (+/- 4.2) years served as controls. The mean weight in the study group was 73.0 (+/- 20.3) kg and 61.7 (+/- 9.5) kg in the control group. Based on the higher weight in the study group, the Body Mass Index (BMI) was also significantly higher than in the control group (26.3 +/- 7.1 vs. 21.6 +/- 3;p< 0.001). The frequency of PA was significantly higher in the control group (p< 0.001). The objective fitness level was worse in pregnant women with GDM compared to healthy controls (472 vs. 523 m,p< 0.001). PA before and during pregnancy was less performed in the study group (86 vs. 64.5%,p= 0.002;69 vs. 45.7%,p= 0.003). Women who were physically inactive before pregnancy had a 3-times higher risk to develop GDM compared to active women (OR = 2.67). The IMT was significantly thicker in the study group (0.48 +/- 0.042 mm vs. 0.45 +/- 0.042) mm;p= 0.006). Conclusion:Physical activity before pregnancy and a lower initial weight reduces the risk of developing GDM and cardiovascular risk factors in pregnancy. The development of prevention programs is certainly necessary

Исследование изотопной селективности процесса кристаллизации NaCl из водного раствора, находящегося в магнитном поле

Объектом исследования являются кристаллы NaCl, выращенные под воздействием постоянного магнитного поля из водного раствора. В данной работе приведены теоретическое обоснование и результаты исследований по изменению изотопного эффекта в постоянном магнитном поле при кристаллизации NaCl из водных растворов.The object of study are NaCl crystals grown under the influence of a constant magnetic field from an aqueous solution. This paper presents the theoretical justification and research results on the change in the isotope effect in a constant magnetic field during crystallization of NaCl from aqueous solutions

Qualitative and quantitative evaluation of computed tomography changes in adults with cystic fibrosis treated with elexacaftor-tezacaftor-ivacaftor: a retrospective observational study

Introduction: The availability of highly effective triple cystic fibrosis transmembrane conductance regulator (CFTR) modulator combination therapy with elexacaftor–tezacaftor–ivacaftor (ETI) has improved pulmonary outcomes and quality of life of people with cystic fibrosis (pwCF). The aim of this study was to assess computed tomography (CT) changes under ETI visually with the Brody score and quantitatively with dedicated software, and to correlate CT measures with parameters of clinical response.Methods: Twenty two adult pwCF with two consecutive CT scans before and after ETI treatment initiation were retrospectively included. CT was assessed visually employing the Brody score and quantitatively by YACTA, a well-evaluated scientific software computing airway dimensions and lung parenchyma with wall percentage (WP), wall thickness (WT), lumen area (LA), bronchiectasis index (BI), lung volume and mean lung density (MLD) as parameters. Changes in CT metrics were evaluated and the visual and quantitative parameters were correlated with each other and with clinical changes in sweat chloride concentration, spirometry [percent predicted of forced expiratory volume in one second (ppFEV1)] and body mass index (BMI).Results: The mean (SD) Brody score improved with ETI [55 (12) vs. 38 (15); p &lt; 0.001], incl. sub-scores for mucus plugging, peribronchial thickening, and parenchymal changes (all p &lt; 0.001), but not for bronchiectasis (p = 0.281). Quantitatve WP (p &lt; 0.001) and WT (p = 0.004) were reduced, conversely LA increased (p = 0.003), and BI improved (p = 0.012). Lung volume increased (p &lt; 0.001), and MLD decreased (p &lt; 0.001) through a reduction of ground glass opacity areas (p &lt; 0.001). Changes of the Brody score correlated with those of quantitative parameters, exemplarily WT with the sub-score for mucus plugging (r = 0.730, p &lt; 0.001) and peribronchial thickening (r = 0.552, p = 0.008). Changes of CT parameters correlated with those of clinical response parameters, in particular ppFEV1 with the Brody score (r = −0.606, p = 0.003) and with WT (r = −0.538, p = 0.010).Discussion: Morphological treatment response to ETI can be assessed using the Brody score as well as quantitative CT parameters. Changes in CT correlated with clinical improvements. The quantitative analysis with YACTA proved to be an objective, reproducible and simple method for monitoring lung disease, particularly with regard to future interventional clinical trials

Contribution of Fetal Magnetocardiography to Diagnosis, Risk Assessment, and Treatment of Fetal Arrhythmia

Background Fetal echocardiography has been the mainstay of fetal arrhythmia diagnosis; however, fetal magnetocardiography (fMCG) has recently become clinically available. We sought to determine to what extent fMCG contributed to the precision and accuracy of fetal arrhythmia diagnosis and risk assessment, and in turn, how this altered pregnancy management. Methods and Results We reviewed fMCG tracings and medical records of 215 pregnancies referred to the Biomagnetism Laboratory, UW‐Madison, over the last 10 years, because of fetal arrhythmia or risk of arrhythmia. We compared referral diagnosis and treatment with fMCG diagnosis using a rating scale and restricted our review to the 144 subjects from the tachycardia, bradycardia/AV block, and familial long QT syndrome categories. Additional fMCG findings beyond those of the referring echocardiogram, or an alternative diagnosis were seen in 117/144 (81%), and 81 (56%) were critical changes. Eight (5.5%) had resolution of arrhythmia before fMCG. At least moderate changes in management were seen in 109/144 (76%) fetuses, of which 35/144 (24%) were major. The most diverse fMCG presentation was long QT syndrome, present in all 3 referral categories. Four of 5 stillbirths were seen with long QT syndrome. Nine fetuses showed torsades de pointes ventricular tachycardia, of which only 2 were recognized before fMCG. Conclusions FMCG has a significant impact on prenatal diagnosis and management of arrhythmias or familial arrhythmia risk, which cannot be fully met by existing technology. The combination of fMCG and fetal echocardiography in fetal care centers will be needed in the future to optimize care

Physical Activity in High-Risk Pregnancies

It is known that physical activity before and during pregnancy is associated with health benefits for both the mother and fetus. The WHO recommends a minimum of 150 min per week of moderate-intensity aerobic physical activity for pregnant women. However, the majority of pregnant woman seem not to be physically active in pregnancy as recommended. In addition, the WHO recommendations do not include information on physical activity (PA) for specific target groups. This might be particularly problematic in women with assisted reproduction technologies (ART) or those who have received the fetal diagnosis of congenital heart defects (CHD). The aim of our study was to elaborate on whether assisted reproduction technologies (ART) and/or the diagnosis of fetal congenital heart defects (CHD) influence the level of PA in pregnant women, and to determine if there is a difference between PA behavior before and during pregnancy. In addition, we will evaluate whether high-risk pregnant women also reach the WHO recommendations. A non-interventional, cross-sectional, monocentric study based on two standardized questionnaires on physical activity was conducted. In total, n = 158 pregnant women were included. All of the participants were recruited from the outpatient clinics of the German Heart Center, Munich, and the Klinikverbund Kempten-Oberallg&auml;u, Germany. Pregnant women after ART (n = 18), with fetal CHD (n = 25) and with both ART and CHD (n = 8) could be included. A total of 107 pregnant women served as healthy controls. Women, after ART, showed a significantly reduced level of physical activity (p = 0.014) during pregnancy compared to women who became pregnant naturally. Additionally, less (p &lt; 0.001) and lighter (p = 0.002) physical activity was observed in all groups during pregnancy compared to those before pregnancy. An increase in maternal age increases the likelihood of CHD (p &lt; 0.001) and decreases the level of physical activity before pregnancy (p = 0.012). The overall level of physical activity decreased in healthy and high-risk pregnancies, and only a quarter (26.49%) of all pregnant women reached the WHO recommendations. Further research for the specific target groups is highly recommended in order to promote and increase physical activity in ART and CHD pregnancies