Assessment of selected parameters of placental microstructure in patients with intrahepatic cholestasis of pregnancy

Objectives: Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disorder during pregnancy. Cholestasis is associated with increased risk of fetal complications: prematurity, perinatal hypoxia and meconium stained amniotic fluid, and sudden intrauterine fetal death. The exact mechanisms associated with cholestasis fetal sequelae are not fully understood. The aim of the study was the histopathological evaluation of placentas from patients with cholestasis and healthy pregnant women to establish whether cholestasis is accompanied by changes in placental microstructure.  Material and methods: The effect of cholestasis on placental microstructure was investigated using placental tissue from patients with cholestatsis treated with ursodeoxycholic acid (UDCA) and from uncomplicated pregnancies. Five placental histopathological features were analyzed: number of syncytial knots, number of capillaries per villous, structure of stroma, presence of Hofbauer cells, and villitis of unknown etiology.  Results: There were no statistically significant differences in any of the studied parameters between cholestasis-affected and healthy control groups.  Conclusions: There are no diffrences in placental microstructure in cholestasis patients treated with UDCA and in patients with uncomplicated pregnancy

Continuous subcutaneous insulin infusion reduces neonatal risk in pregnant women with type 1 diabetes mellitus

Objectives: An attempt was made to demonstrate the superiority of the treatment model using continuous subcutaneous insulin infusion (CSII) over multiple daily injections (MDI) of insulin in achieving a successful pregnancy outcome and good newborn’s condition in patients with type 1 diabetes.  Material and methods: The study included 297 infants born to type 1 diabetic patients; 175 patients were treated with MDI and 122 with CSII.  Maternal metabolic control during pregnancy, gestational weight gain, insulin requirements, pregnancy outcome and neonatal status were compared between MDI and CSII arm.  The composite adverse neonatal outcome was diagnosed if at least one of the following was found: abnormal birth weight (LGA or SGA), congenital malformation, miscarriage, intrauterine fetal death, emergency CS due to fetal risk, iatrogenic prematurity, RDS, hypoglycemia, hyperbilirubinemia, and the postpartum pH in the umbilical artery ≤ 7.1.  Results: The studied groups did not differ regarding gestational week at delivery, a proportion of births at full term, preterm births, miscarriages, or late pregnancy losses (intrauterine fetal death > 22 weeks). Newborns of mothers treated with CSII showed lower incidence of neonatal complications (composite adverse neonatal outcome) compared to those of mothers treated with MDI (60% vs 74%, respectively; p = 0.01). We did not find any association between the mode of treatment and composite adverse maternal outcome.  Conclusions: The use of CSII in the treatment of pregnant women with type 1 diabetes was associated with reduced number of neonatal complications presented as neonatal composite outcome but had no influence on maternal outcome

Inflammatory rheumatic diseases and pregnancy

Pregnancy in a patient diagnosed with systemic connective tissue disorder is a challenge that requires a close co-operation between a rheumatologist and gynaecologist. Good control over the activity of the underlying condition and the choice of appropriate time for planning a pregnancy have direct effect on the pregnancy results in these patients. Applying gynaecological supervision adequate to the increased risk of complications is also very important.The aim of this study is to present the current knowledge on the care over pregnant patients with systemic connective tissue diseases and to draw attention to the importance of pregnancy planning in this group of patients

Adropin in pregnancy complicated by hyperglycemia and obesity — a preliminary study

Objectives: According to the data, approximately 33–37% of women of reproductive age are obese. These numbers are reflected in the increasing number of complications in pregnancy, including gestational diabetes. The study aims to assess the concentrations of adropin in the course of gestational diabetes and their possible relationship with the occurrence of obstetric complications characteristic for it. Material and methods: The study included 65 obese and overweight pregnant patients (BMI > 27 kg/m2) with glycemic disorders diagnosed during pregnancy. Blood samples we collected during visits: V0 — the first half of pregnancy V1 — 28–32 weeks of gestation, and V2 — 37–39 weeks of gestation. The concentrations of adropin were measured during V1 and V2 by ELISA tests. We analyzed the studied patients' anthropometric, metabolic parameters and obstetrical results. Results: In the study group, at the visit V1, the mean level of adropin was 525.5 mmol/mL and 588.1 mmol/mL for the V2 visit. The comparison of adropin concentration between visits showed a statistically significant increase (p = 0.02). The concentration of adropin did not differ between obese and morbidly obese patients at V1, but at V2, there was a significant lover adropin level in morbidly obese patients. Conclusions: In overweight and obese pregnant patients with gestational diabetes, the levels of adropin in serum increased significantly in the last trimester of pregnancy. The increase in concentration was significantly lower in the morbidly obese patients than in the obese group. The study provides the basis for further analyses of the role of adropin in pregnancies complicated by obesity and gestational diabetes

Follow-up of children with antenatally diagnosed idiopathic polyhydramnios

Objectives: The aim of our work was to assess the development of children with antenatally diagnosed idiopathic poly- hydramnios, over 12 months from the end of pregnancy.  Material and methods: The study included 91 healthy pregnant patients with idiopathic polyhydramnios. Diagnostic tests results and perinatal medical history were obtained retrospectively. Parents of children were contacted by phone and by mail. The answers were obtained from 64 (70%) parents. For statistical analysis SigmaStat3.5 software was used.  Results: Ninety six percent of parents declared that in their opinion the development of children was normal. Abnormali- ties were found in 44% of the children. Thirty percent of neonates demonstrated mild abnormalities which may be due to organic or functional neuromuscular disorders: abnormal muscle tone, speech apparatus and development disorders, swallowing and breathing problems (manifested as vomiting, excessive regurgitation, idiopathic apnoeas).  Isolated small malformations were diagnosed in 12 (19%) children. Two children (3%) with SGA were diagnosed with genetic syndromes. More than one of the abnormalities described above were diagnosed in 14% of children. Gestational age at the time of polyhydramnios diagnosis and its severity were not prognostic factors for abnormalities. Seventy percent of newborns were male.  Conclusions: Despite the subjectively positive assessment of the development of children by the majority of parents, groups of common disorders requiring long-term follow-up have been identified. Functional disorders of the gastrointestinal tract, CNS and the group of neuromuscular disorders may be responsible for idiopathic polyhydramnios. SGA with co-existing idiopathic polyhydramnios is associated with the risk of genetic diseases. The more frequent incidence of idiopathic poly- hydramnios in male fetuses requires further research.

Evaluation of predictive value of biochemical markers for adverse obstetrics outcomes in pregnancies complicated by cholestasis

Objectives: Intrahepatic cholestasis of pregnancy (ICP) is significantly more often associated with an abnormal perinataloutcome compared to a group of healthy pregnant women.The aim of the study was to analyse the correlation between the adverse perinatal outcome and the biochemical parametersin pregnancy complicated by cholestasis, and to assess their predictive value for neonatal complications.Material and methods: Eighty-six patients with ICP were divided into 3 groups according to their fasting serum bile acidlevel [group I n = 60, 10–39.90 μmol/L; group II n = 20, 40–99.90 μmol /L; group III n = 6, TBA (total bile acids) ≥ 100.00 μmol/L].Linear regression models were created to determine the relation of serum TBA, ALT, and AST concentration with total adverseperinatal outcome, defined as an occurrence of at least one perinatal outcome: stillbirth, preterm birth, spontaneous andiatrogenic preterm birth, presence of meconium in amniotic fluid, Apgar score (< 7 in 5th min), pH from umbilical artery(< 7.1), necessity for NICU admission, the presence of breathing disorders, and the need to perform phototherapy.Results: TBA ≥ 40.00 μmol/L is connected to an elevated risk of the occurrence of total adverse perinatal outcome (OR = 4.17,p = 0.0037, AUC = 0.62, p = 0.046). TBA ≥ 40.00 μmol/L is a predictor of preterm birth (OR 2.3, p = 0.0117), iatrogenic pretermbirth (OR 2.5, p = 0.006), admission to NICU (OR 2.38, p = 0.0094), intubation or assisted ventilation (OR 2.16, p = 0.0301), andphototherapy (OR 2.0, p = 0.0438). The threshold value of TBA for the need for phototherapy was 52.7 μmol/L (AUC = 0.67,p = 0.0089) and for preterm birth, 32.1 μmol/L (AUC = 0.62, p = 0.0251).Conclusions: Pregnant women with ICP and TBA serum level over 40.00 μmol/L have a worse prognosis regarding obstetricoutcomes. The concentration of bile acids is a predictor of the occurrence of adverse perinatal outcomes, although theconcentration of ALT and AST failed to show such a connection

Endometriosis is associated with an increased whole-blood thrombogenicity detected by a novel automated microchip flow-chamber system (T-TAS®)

Objectives: Potential thrombotic and antifibrinolytic influence of endometriosis on haemostasis has been recently reported in the literature, as well as increased cardiovascular morbidity in women suffering from the disease. We performed a pilot study to assess the influence of endometriosis on the thrombus formation process under in vitro flow conditions. Material and methods: This study compared women with confirmed endometriosis (n = 23) surgically and control healthy subjects (n = 10). In both groups, the same exclusion criteria were used: a prior episode of thrombosis diagnosed as acquired or inherited thrombophilia, neoplasm, and an uncertain family history of thrombosis. We evaluated the whole blood thrombogenicity using T-TAS® at a shear rate of 240 s-1 (Total-Thrombus Analysis System, Zacros, Japan).  Results: The blood clot formation initiation time (T10) and occlusion time (OT) were significantly shortened in the endometriosis group (p < 0.05). The area under the curve (AUC30) of blood clot time formation values (BCTF) was substantially higher in the patients suffering from a disease (p = 0.03). An increase in AUC (TTAS) values by 100 increases the risk of developing endometriosis by 1.56-fold [adjusted OR = 1.56 (p = 0.01);(95% CI: 1.10–2.18)]. Inflammatory markers (neutrophil-to-lymphocyte ratio (NLR), and the leucocyte, neutrophil, basophil, and neutrophil concentrations) were also substantially higher in the endometriosis group (p < 0.05).  Conclusions: The alteration of the T-TAS and NLR values supports the thesis of a shift of the equilibrium towards thrombosis in women who have endometriosis. This phenomenon links to a state of chronic inflammation. It is detectable using a novel system for the quantitative assessment of the platelet thrombus formation process under flow conditions in vitro

Comparison of Polish and international guidelines on diet supplements in pregnancy — review

Proper nutrition is an important element that determines the course of pregnancy. Unfortunately, the everyday diet is notalways able to cover the increased in pregnancy essential vitamins and minerals requirements. Therefore, pregnant womenoften use dietary supplements. This study aimed to compare Polish and international recommendations regarding dietarysupplementation during pregnancy. The Polish Society of Gynaecologists and Obstetricians (PSGO) recommends in everypregnant woman the dietary supplementation of folates, vitamin D and iodine.Additionally, the benefits of iron supplementation in pregnant women with anemia or at high risk of developing anemiaare also highlighted. In the light of Polish guidelines, the magnesium supplementation is recommended in the conditionof its reduced level in blood. In the case of limited consumption of DHA (docosahexaenoic acid), Polish guidelines recommendin pregnant women’s diet, at least 600 mg of DHA every day. Still, in case of the high risk of premature birth — atleast 1000 mg DHA a day during the entire pregnancy period should be taken

An observational study of the risk of neonatal macrosomia, and early gestational diabetes associated with selected candidate genes for type 2 diabetes mellitus polymorphisms in women with gestational diabetes mellitus

Objectives: 1) to analyse the prevalence of selected candidate genes for type 2 diabetes mellitus polymorphisms (IRS1 G972R; ENPP1 K121Q; ADRB3 W64R) among women with gestational diabetes; and 2) to investigate any association between variants of these genes and risk of neonatal macrosomia.Material and methods: We conducted a prospective observational study of a group of women (N = 140) in singleton pregnancies who delivered at term. Characteristics of the study group at enrolment: age: 32.0 ± 4.9 years; GA: 26.6 ± 7.5 weeks; HbA1c: 5.6 ± 0.6%; fasting blood glucose: 102.3 ± 16.3 mg/dL; insulin treatment (G2DM): 65.7%; chronic hypertension: 11.4%; gestational hypertension: 17.9%; preeclampsia: 1.4%; birth weight: 3590 ± 540 g; birth weight ≥ 4000 g (macrosomia): 18.6%; caesarean section: 44.3%; and female newborns: 57.1%.Results: The maternal metabolic characteristics at the time of booking did not differ between polymorphisms. Macrosomia was insignificantly more frequent in females (22.5%) than in males (13.3%) (p = 0.193). Only maternal height and body weight at the time of booking significantly predicted birth weight (R = 0.27, p = 0.007; R = 0.25, p = 0.005, respectively). IRS1 G972R GR and ENPP1 K121Q KQ polymorphisms were associated with an insignificantly increased risk for macrosomia. Carriers of the heterozygotic variant of the IRS 1 gene were significantly more likely to be diagnosed with GDM/DiP in the first trimester: OR 5.2, 95% CI: 1.4; 19.2; p = 0.014.Conclusions: 1) having similar metabolic characteristics, carriers of specific variants of T2DM candidate genes might be at increased risk of delivery of macrosomic newborns; 2) any association between genetic variants and macrosomia in this population might be gender-specific; and 3) allelic variation in the IRS1 gene is associated with early GDM/DiP

Perinatal and cardiovascular outcomes in a pregnant patient with Marfan syndrome

A 25-year-old primigravida with Marfan syndrome (MFS) was admitted at 36 weeks of gestation (WOG)