Does advancing male age influence the expression levels and localisation patterns of phospholipase C zeta (PLCζ) in human sperm?

Socio-economic factors have led to an increasing trend for couples to delay parenthood. However, advancing age exerts detrimental effects upon gametes which can have serious consequences upon embryo viability. While such effects are well documented for the oocyte, relatively little is known with regard to the sperm. One fundamental role of sperm is to activate the oocyte at fertilisation, a process initiated by phospholipase C zeta (PLCζ), a sperm-specific protein. While PLCζ deficiency can lead to oocyte activation deficiency and infertility, it is currently unknown whether the expression or function of PLCζ is compromised by advancing male age. Here, we evaluate sperm motility and the proportion of sperm expressing PLCζ in 71 males (22–54 years; 44 fertile controls and 27 infertile patients), along with total levels and localisation patterns of PLCζ within the sperm head. Three different statistical approaches were deployed with male age considered both as a categorical and a continuous factor. While progressive motility was negatively correlated with male age, all three statistical models concurred that no PLCζ–related parameter was associated with male age, suggesting that advancing male age is unlikely to cause problems in terms of the sperm’s fundamental ability to activate an oocyt

Dysglycemias in pregnancy: from diagnosis to treatment. Brazilian consensus statement

There is an urgent need to find consensus on screening, diagnosing and treating all degrees of DYSGLYCEMIA that may occur during pregnancies in Brazil, considering that many cases of DYSGLYCEMIA in pregnant women are currently not diagnosed, leading to maternal and fetal complications. For this reason the Brazilian Diabetes Society (SBD) and the Brazilian Federation of Gynecology and Obstetrics Societies (FEBRASGO), got together to introduce this proposal. We present here a joint consensus regarding the standardization of clinical management for pregnant women with any degree of Dysglycemia, on the basis of current information, to improve medical assistance and to avoid related complications of Dysglycemia in pregnancy to the mother and the fetus. This consensus aims to standardize the diagnosis among general practitioners, endocrinologists and obstetricians allowing the dissemination of information in basic health units, public and private services, that are responsible for screening, diagnosing and treating disglycemic pregnant patients

Association Between Advanced Maternal Age and Maternal and Neonatal Morbidity: A Cross-Sectional Study on a Spanish Population

Background and objective: Over recent decades, a progressive increase in the maternal age at childbirth has been observed in developed countries, posing a health risk for both women and infants. The aim of this study was to analyze the association between advanced maternal age (AMA) and maternal and neonatal morbidity. Material and methods: A cross-sectional study of 3,315 births was conducted in the north of Spain in 2014. We compared childbirth between women aged 35 years or older, with a reference group of women aged between 24 and 27 years. AMA was categorized based on ordinal ranking into 35-38 years, 39-42 years, and >42 years to estimate a dose-response pattern (the older the age, the greater the risk). As an association measure, crude and adjusted Odds Ratios (OR) were estimated by non-conditional logistic regression and 95% Confidence Intervals (95%CI) were calculated. Results: Repeated abortions were more common among women of AMA in comparison to pregnant women aged 24-27 years (reference group): adjusted OR = 2.68; 95%CI (1.52-4.73). A higher prevalence of gestational diabetes was also observed among women of AMA, reaching statistical significance when restricted to first time mothers: adjusted OR = 8.55; 95%CI (1.12-65.43). In addition, the possibility of an instrumental delivery was multiplied by 1.6 and the possibility of a cesarean by 1.5 among women of AMA, with these results reaching statistical significance, and observing a dose-response pattern. Lastly, there were associations between preeclampsia, preterm birth (<37 weeks) and low birthweight, however without reaching statistical significance. Conclusion: Our results support the association between AMA and suffering repeated abortions. Likewise, being of AMA was associated with a greater risk of suffering from gestational diabetes, especially among primiparous women, as well as being associated with both instrumental deliveries and cesareans among both primiparous and multiparous women

"The next-generation": Long-term reproductive outcome of adults born at a very low birth weight

Background Preterm birth at very low birth weight (VLBW, Aims To evaluate the reproductive outcome of VLBW infants who survive to adulthood (next-generation). Study design Retrospective cohort Subjects Infants born at a single tertiary center between the years 1982–1997 who survived to 18 years of age (first-generation). Outcome measures The number and the birth weight of offspring from adults born with VLBW were compared to those of other birth weight groups born in the same epoch: 1500–2499g, 2500–3799g (reference group) and ≥3800g. We calculated the ratio of actual compared to expected number of children in the next-generation for extreme birth weight parents, using the reference group as a control group and adjusting for birth year. Thereafter, we measured whether first-generation VLBW had an increased risk for a VLBW in the next-generation. Results After exclusions, we identified first-generation 67,183 births, including 618 (9.2%) VLBW. There were 193 males and 184 female VLBW infants who survived to adulthood. Both female and male first-generation patients from the VLBW group had half the reproductive rate relative for the normal birth weight group. After adjusting for parental age, male and female VLBW survivors had no significant risk for a VLBW neonate in the next-generation, however, the overall number of are small and may limit any conclusion. Conclusions VLBW children who reach adulthood may be at a significantly lower reproductive capacity.</p

"The next-generation": Long-term reproductive outcome of adults born at a very low birth weight

Background Preterm birth at very low birth weight (VLBW, &lt;1500g) has a multitude of consequences that extend to various aspects of adult life. Little is known about the long-term reproductive outcome of VLBW that survive to adulthood. Aims To evaluate the reproductive outcome of VLBW infants who survive to adulthood (next-generation). Study design Retrospective cohort Subjects Infants born at a single tertiary center between the years 1982–1997 who survived to 18 years of age (first-generation). Outcome measures The number and the birth weight of offspring from adults born with VLBW were compared to those of other birth weight groups born in the same epoch: 1500–2499g, 2500–3799g (reference group) and ≥3800g. We calculated the ratio of actual compared to expected number of children in the next-generation for extreme birth weight parents, using the reference group as a control group and adjusting for birth year. Thereafter, we measured whether first-generation VLBW had an increased risk for a VLBW in the next-generation. Results After exclusions, we identified first-generation 67,183 births, including 618 (9.2%) VLBW. There were 193 males and 184 female VLBW infants who survived to adulthood. Both female and male first-generation patients from the VLBW group had half the reproductive rate relative for the normal birth weight group. After adjusting for parental age, male and female VLBW survivors had no significant risk for a VLBW neonate in the next-generation, however, the overall number of are small and may limit any conclusion. Conclusions VLBW children who reach adulthood may be at a significantly lower reproductive capacity.</p

Universal antenatal group B streptococcus screening? The opinions of obstetricians and neonatologists within Australia

Group B streptococcus (GBS) is the leading infectious cause of morbidity and mortality in Australian newborns. Although intrapartum chemoprophylaxis is recommended to reduce the risk of neonatal GBS transmission and disease, controversy exists as to the best method to select women 'at risk' for this treatment. Our study aimed to survey the opinions of obstetricians and neonatologists currently in practice in Australia on GBS screening and treatment. Of the 488 obstetricians and 68 neonatologists currently in practice who responded to the survey, 271 obstetricians (56%) and 40 neonatologists (61%) supported universal antenatal screening. Of those respondents who did not support a universal antenatal screening policy, 196 (93%) and 24 (92%) of the obstetricians and neonatologists respectively, supported antenatal screening based on risk factors. This diversity in practitioner opinion highlights the lack of certainty in the literature as to the best management strategy to prevent neonatal GBS sepsis

Fetal urine production rate in preterm premature rupture of membranes is associated with adverse neonatal outcome: A pilot study.

Introduction In this study we evaluated the associations between fetal urinary production rate (FUPR), measured by ultrasound, and adverse neonatal outcome in women with preterm premature rupture of membranes (PPROM). Material and Methods We conducted a prospective cohort of singleton pregnancies complicated by PPROM occurring at gestational week 24 or later in a single center. Women with PPROM and conservative management until spontaneous labor (after 48 hours of admission), chorioamnionitis, or induction by protocol at 35+0 weeks. FUPR was evaluated by 2D sonography at admission, and corrected for gestational age. Attending physicians were blinded to FUPR results. The main neonatal outcome measures were chorioamnionitis, placental inflammatory grading, first neonatal creatinine value, first neonatal dextrose value, length of neonatal intensive care unit (NICU) stay, necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH) (grades I-IV), blood transfusions, reduced neonatal urine production rate ( Results The study included 38 women. Low FUPR was associated with chorioamnionitis, longer NICU hospitalization (p=0.01), and higher rates of NEC or IVH (p=0.008), and blood transfusion (p=0.004). There were no significant associations between antenatal FUPR and placental histologic inflammation grading, neonatal creatinine, neonatal dextrose, or early neonatal sepsis. IL-6 levels did not correlate with chorioamnionitis, FUPR, or early sepsis. Conclusion A finding of FUPR on in utero ultrasound examination in pregnancies complicated by PPROM may be indicative of an inflammatory process and predictive of adverse neonatal outcome.</p

Fetal urine production rate in preterm premature rupture of membranes is associated with adverse neonatal outcome: A pilot study.

Introduction In this study we evaluated the associations between fetal urinary production rate (FUPR), measured by ultrasound, and adverse neonatal outcome in women with preterm premature rupture of membranes (PPROM). Material and Methods We conducted a prospective cohort of singleton pregnancies complicated by PPROM occurring at gestational week 24 or later in a single center. Women with PPROM and conservative management until spontaneous labor (after 48 hours of admission), chorioamnionitis, or induction by protocol at 35+0 weeks. FUPR was evaluated by 2D sonography at admission, and corrected for gestational age. Attending physicians were blinded to FUPR results. The main neonatal outcome measures were chorioamnionitis, placental inflammatory grading, first neonatal creatinine value, first neonatal dextrose value, length of neonatal intensive care unit (NICU) stay, necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH) (grades I-IV), blood transfusions, reduced neonatal urine production rate (&lt;4mL/kg/h), and early neonatal sepsis. Samples of maternal (at admission) and umbilical cord blood were analyzed for interleukin-6 (IL-6) level. Results The study included 38 women. Low FUPR was associated with chorioamnionitis, longer NICU hospitalization (p=0.01), and higher rates of NEC or IVH (p=0.008), and blood transfusion (p=0.004). There were no significant associations between antenatal FUPR and placental histologic inflammation grading, neonatal creatinine, neonatal dextrose, or early neonatal sepsis. IL-6 levels did not correlate with chorioamnionitis, FUPR, or early sepsis. Conclusion A finding of FUPR on in utero ultrasound examination in pregnancies complicated by PPROM may be indicative of an inflammatory process and predictive of adverse neonatal outcome.</p