Risk Factors for Large for Gestational age Infants in Pregnant Women with Gestational Diabetes Mellitus

Objective: To examine the risk factors for large for gestational age (LGA) infants in pregnant women with gestational diabetes mellitus (GDM). Methods: Data were extracted from antenatal records of 282 GDM women who attended the antenatal clinict and delivered at Ramathibodi Hospital, Mahidol University. Risk factors were analyzed and compared between LGA group and control group. Results:History of previous macrosomia infants, pre-pregnant BMI ≥25 kg/m2, glucosuria on delivery day, fasting plasma glucose (FPG) of oral glucose tolerance test (OGTT) ≥ 95 mg/dl and plasma glucose at 1 hr of OGTT ≥ 180 mg/dl were significant risk factors for LGA infants (P < 0.05). Using multivariate analysis, the remained significant factors were the history of prior macrosomia infants, pre-pregnant BMI ≥ 25 kg/m2 and FPG of OGTT ≥ 95 mg/dl (OR 4.86, 95%CI 1.66-14.25, OR 1.94, 95%CI 1.08-3.51 and, OR 3.05, 95%CI 1.61-5.77, respectively).Conclusion: The significant risk factors for LGA infants in GDM women were the history of prior macrosomia infants, pre-pregnant BMI ≥ 25 kg/m2 and FPG ≥ 95 mg/dl.The most important risk factor for LGA infant was the history of prior macrosomia

Effect of immediate neonatal zidovudine on prevention of vertical transmission of human immunodeficiency virus type 1

AbstractObjectives: To describe the effects of various short zidovudine (ZDV) prophylactic regimens on vertical transmission of human immunodeficiency virus type 1 (HIV-1) infection, especially the effect of immediate neonatal ZDV prophylaxis.Materials and Methods: The study included children of HIV-1-infected mothers who were born at a teaching hospital in Bangkok. The ZDV prophylaxis regimens varied by time periods that included: (1) no ZDV (1991–1996); (2) antenatal oral ZDV, 250 mg given twice a day starting at 34 to 36 weeks' gestation and continued until labor (1995–1998); (3) antenatal oral ZDV plus immediate neonatal oral ZDV, 6 mg/0.6 mL/dose started within the first 2 hours after birth and continued at 6-hour intervals for 4 to 6 weeks (1997–1998); and (4) intrapartum intravenous ZDV given in addition to regimen 3 (1998–1999). Neonatal ZDV was administered within 2 hours after birth in 95% of the neonates.Results: In a cohort of 136 children born at least 9 months before the analysis date, the HIV-1 vertical infection rates were: (1) no ZDV, 11 of 48 (22.9%, 95% confidence interval [Cl] = 12.0–37.3); (2) late antenatal ZDV, 10 of 47 (21.3%, 95% Cl = 10.7–35.7); (3) late antenatal ZDV plus immediate neonatal ZDV, 0 of 28 (0%, 95% Cl = 0–12.3); (4) late antenatal, intrapartum intravenous ZDV, plus immediate neonatal ZDV, 0 of 13 (0%, 95% Cl = 0–24.7). An estimated 0% (95% Cl = 0–8.6) of the infants who received immediate neonatal ZDV with or without intrapartum ZDV were infected, as compared with 22.1% (95% Cl = 14.2–31.8 ) of those who received no ZDV or only late antenatal ZDV (P < 0.001).Conclusion: The results of this study suggests high protective effect of immediate administration of neonatal ZDV. Perinatal components of antiretroviral prophylaxis provided the best results for protecting against vertical HIV-1 transmission

The Comparative Study of The Large for Gestational Age Prevalence in Neonate of Diabetic Pregnant Women Between The Optimal and Suboptimal Glycemic Control Groups

Objective:To compare the prevalences of LGA (large for gestational age) newborns in diabetic pregnant women between the optimal glycemic control and suboptimal glycemic control. Materials and Methods: Total of 228 women, delivered at Ramathibodi Hospital between March 2010-December 2012, 114 women in each group, were enrolled. The medical records were reviewed for necessary data. The primary outcome were the prevalences of LGA in both groups and the secondary outcome were the prevalences of neonatal hypoglycemia.Results:The prevalence of LGA newborns in suboptimal controlled group was higher than in optimal controlled group (n = 33, 28.95% and n = 7, 6.14%, respectively) with the relative risk of 4.71 (95% CI; 2.18, 10.21). The factors that found the association with LGA newborns were prepregnant BMI and types of DM. Adjusted relative risk for both factors of the LGA in suboptiamal controlled group was 3.59 (95% CI; 1.60, 8.06 ). The prevalence of neonatal hypoglycemia were not different. (7.02% in suboptimal controlled group and 3.51% in optimal controlled group)Conclusion:Suboptimal glycemic controlled pregnant women were found increase risk of LGA newborns. The prevalence of neonatal hypoglycemia was not different

Effects of probiotic supplements on insulin resistance in gestational diabetes mellitus: A double‐blind randomized controlled trial

Abstract Aims/Introduction To evaluate the effect of probiotic supplements on insulin resistance in pregnant women with diet‐controlled gestational diabetes mellitus. Materials and Methods A randomized, double‐blind, placebo‐controlled trial was carried out between June 2016 and February 2017. Pregnant women with diet‐controlled gestational diabetes mellitus were enrolled in the study at 24–28 weeks‐of‐gestation and randomized to receive either probiotic supplements containing Bifidobacterium and Lactobacillus or a placebo daily for four consecutive weeks. Primary outcomes were mean differences in insulin resistance (homeostatic model assessment for insulin resistance), fasting insulin and fasting plasma glucose between the two groups. Secondary outcomes were changes in maternal weight after the intervention. Results Data from 28 patients in the probiotic group and 29 in the placebo group were analyzed. The changes in metabolic parameters after randomization showed significant improvement in glucose metabolism in the probiotic group compared with the placebo group, including fasting plasma glucose (0.68 ± 5.88 vs 4.620 ± 7.78 mg/dL, mean difference −3.94 mg/dL, 95% confidence interval −7.62, −0.27, P = 0.034), fasting plasma insulin (1.11 ± 1.71 vs 3.77 ± 1.70 mIU/L, mean difference −2.67 mIU/L, 95% confidence interval −3.57, −1.76, P = 0.001) and homeostatic model assessment for insulin resistance (0.25 ± 0.37 vs 0.89 ± 0.46, mean difference −0.63, 95% confidence interval −0.86, −0.41, P = 0.001). Weight gain during randomization was similar between the two groups. Conclusions Four weeks of probiotic supplements in women with diet‐controlled gestational diabetes in the late second and early third trimester lowered fasting glucose and increased insulin sensitivity. Probiotic supplements may be considered as an adjunct treatment for glycemic control in these patients

A novel in vitro model reveals distinctive modulatory roles of Plasmodium falciparum and Plasmodium vivax on naïve cell-mediated immunity

Abstract Background To date, human peripheral blood mononuclear cells (PBMCs) have been used mainly in immune stimulation assays and the interpretation of data can be influenced by the previous immunological history of donors and cross reactivity with other infectious agents. Resolving these limitations requires an alternative in vitro model to uncover the primary response profiles. Methods A novel in vitro model of mononuclear cells (MNCs) generated from haematopoietic stem cells (HSCs) was developed and these cells were then co-cultured with various antigens from Plasmodium falciparum and Plasmodium vivax to investigate the response of naïve immune cells to malaria antigens by flow cytometry. Results In vitro stimulation of naïve lymphocytes showed that CD4+ and CD8+ T lymphocytes were significantly reduced (P < 0.01) by exposure to lysates of infected erythrocytes or intact erythrocytes infected with P. falciparum. The depletion was associated with the expression of CD95 (Fas receptor) on the surface of T lymphocytes. Maturation of T lymphocytes was affected differently, showing elevated CD3+CD4+CD8+ and CD3+CD4−CD8− T lymphocytes after stimulation with cell lysates of P. falciparum and P. vivax, respectively. In addition, antigen presenting monocytes and dendritic cells derived from haematopoietic stem cells showed impaired HLA-DR expression as a consequence of exposure to different species of malaria parasites. Conclusion These results suggest that naïve mononuclear cells differentiated in vitro from HSCs could provide a valid model for the assessment of immunity. P. falciparum and P. vivax malaria parasites could modulate various populations of immune cells starting from newly differentiated mononuclear cells

MOESM4 of A novel in vitro model reveals distinctive modulatory roles of Plasmodium falciparum and Plasmodium vivax on naĂŻve cell-mediated immunity

Additional file 4. Malaria parasites induced the expression of CD95 on T lymphocytes

Suppression of erythroid development <it>in vitro</it> by <it>Plasmodium vivax</it>

<p>Abstract</p> <p>Background</p> <p>Severe anaemia due to dyserythropoiesis has been documented in patients infected with <it>Plasmodium vivax,</it> however the mechanism responsible for anaemia in vivax malaria is poorly understood. In order to better understand the role of <it>P. vivax</it> infection in anaemia the inhibition of erythropoiesis using haematopoietic stem cells was investigated.</p> <p>Methods</p> <p>Haematopoietic stem cells/CD34⁺ cells, isolated from normal human cord blood were used to generate growing erythroid cells. Exposure of CD34⁺ cells and growing erythroid cells to <it>P. vivax</it> parasites either from intact or lysed infected erythrocytes (IE) was examined for the effect on inhibition of cell development compared with untreated controls.</p> <p>Results</p> <p>Both lysed and intact infected erythrocytes significantly inhibited erythroid growth. The reduction of erythroid growth did not differ significantly between exposure to intact and lysed IE and the mean growth relative to unexposed controls was 59.4 ± 5.2 for lysed IE and 57 ± 8.5% for intact IE. Interestingly, CD34⁺ cells/erythroid progenitor cells were susceptible to the inhibitory effect of <it>P. vivax</it> on cell expansion. Exposure to <it>P. vivax</it> also inhibited erythroid development, as determined by the reduced expression of glycophorin A (28.1%) and CD 71 (43.9%). Moreover, vivax parasites perturbed the division of erythroid cells, as measured by the Cytokinesis Block Proliferation Index, which was reduced to 1.35 ± 0.05 (<it>P</it>-value < 0.01) from a value of 2.08 ± 0.07 in controls. Neither TNF-a nor IFN-g was detected in the culture medium of erythroid cells treated with <it>P. vivax,</it> indicating that impaired erythropoiesis was independent of these cytokines.</p> <p>Conclusions</p> <p>This study shows for the first time that <it>P. vivax</it> parasites inhibit erythroid development leading to ineffective erythropoiesis and highlights the potential of <it>P. vivax</it> to cause severe anaemia.</p