Placental histopathology associated with preeclampsia: A systematic review and Meta-Analysis.

OBJECTIVES: Preeclampsia is associated with impaired trophoblast invasion and typical villous and vascular placental lesions. The primary aim was to conduct a systematic review in order to quantify the prevalence of placental histopathological lesions in pregnancies complicated by preeclampsia. METHODS: MEDLINE, EMBASE and CINAHL were searched electronically and relevant articles reporting placental histopathological lesions were assessed according to the following criteria: study design, number of pregnancies, type of preeclampsia and whether the pathologist was blinded to the clinical information. Prospective and retrospective case-control studies, including 100 pregnancies or more in total, were included. The number of the most prevalent histological lesions according to the Perinatal Section of the Society for Pediatric Pathology classification was extracted and categorized in two main groups, "villous lesions" and "vascular lesions". Random-effect meta-analysis of proportions was used for analysis. Between-study heterogeneity was assessed using the I(2) statistic. RESULTS: The search yielded 717 citations and a total of 8 studies were included in the review. In unblinded studies, the pooled prevalence of villous lesions was 11.6% (95% CI 6.4-18.1%) and 48.2% (95% CI 19.1-77.9%) in normal and preeclamptic pregnancies, giving a pooled odds ratio (OR) of 7.59 (95% CI 2.16-26.62). In blinded studies, the pooled prevalence of villous lesions was 18.5% (95% CI 1.4-48.7%) and 42.0% (95% CI 13.3-74.2%) in normal and preeclamptic pregnancies, giving a pooled OR of 4.28 (95% CI 1.16-15.76). In unblinded studies, the pooled prevalence of vascular lesions was 8.1% (95% CI 4.5-13.2%) and 37.3% (CI 3.1-82.4%), giving a pooled OR of 20.34 (95% CI 11.53-35.89). In blinded studies, the pooled prevalence of vascular lesions was 9.8% (95% CI 0.7-27.8%) and 38.9% (24.1-54.8%), giving a pooled OR of 7.08 (95% CI 2.55-19.61). CONCLUSIONS: The prevalence of both placental villous and vascular histopathological lesions is higher, by a factor of four to seven-fold, in preeclampsia compared to normal pregnancies in blinded studies. Greater differences are reported in unblinded studies. Despite the fact that the probability (point prevalence) of finding abnormal placenta pathology is higher in preeclampsia, placental lesions are not specific to the diagnosis of preeclampsia

The importance of maternal nutrition for health

Nutrition plays a major role in maternal and child health and it is widely recognized that optimum nutrition in early life is the foundation for long-term health. A healthy maternal dietary pattern, along with adequate maternal body composition, metabolism and placental nutrient supply, reduces the risk of maternal, fetal and long-term effects in the offspring. While undernutrition is mainly an issue of low-income countries, malnutrition, due to poor quality diet, is becoming a global health problem. Preconceptional counseling of women of childbearing age should spread awareness of the importance of maternal nutrition before and during pregnancy and should promote a cultural lifestyle change, in favor of a healthy weight before conceiving and balanced healthy diet with high-quality foods consumption. Supplementation and/or fortification can make a contribution when recommended micronutrient intakes are difficult to be met through food alone. In industrialized countries, although a balanced diet is generally accessible, a switch to a high-fat and low-quality diet has led to inadequate vitamin and mineral intake during pregnancy. Evidence do not support a routine multiple micronutrient supplementation but highlights the importance of an individualized approach, in order to recognize nutritional deficiencies of individuals, thus leading to healthful dietary practices prior to conception and eventually to tailored supplementation

Lower uterine segment placental thickness in women with abnormally invasive placenta.

Introduction Ultrasound signs of abnormal placental invasion are subjective in nature. We tested the hypothesis that placental thickness in the lower uterine segment is increased when there is abnormally invasive placenta (AIP) in women with a low‐lying placenta. Material and methods Retrospective analysis of data of placental thickness in women with ultrasound evidence of major placenta previa or a low‐lying anterior placenta was done. The diagnosis of AIP was confirmed both intraoperatively and on histopathology for those managed by partial myometrial excision with uterine conservation or by hysterectomy. Results In all, 131 records were available for analysis after exclusion of 33 cases due to unsuitable images and eight cases without pregnancy outcomes. The diagnosis of AIP was confirmed in 28 (21.4%) of the 131 cases. The lower segment placental thickness was significantly higher in women with AIP (median = 50.3 mm, IQR: 42.7‐64.3) than in those with normal placentation (median = 30.9 mm, IQR: 22.9‐42.2, P < 0.001). Logistic regression analysis showed that previous cesarean section and placental thickness on ultrasound were independent predictors for AIP. Conclusions Lower uterine segment placental thickness is increased in women with AIP compared with those with noninvasive placentation. This association constitutes a pragmatic objective sign and may be of clinical value in improving prenatal detection of AIP in women with placental implantation in the lower uterine segment. Prospective studies are necessary to ascertain lower segment placental thickness as a predictor for AIP

Effects of highly active antiretroviral therapy on semen parameters of a cohort of 770 HIV-1 infected men

Background HIV-1 infected patients show impaired semen parameters. Currently, it is not clear whether HIV-1 infection itself or antiretroviral therapy have an effect on semen parameters. We aim evaluate semen quality in a large cohort of fertile HIV-1 infected men under stable highly active antiretroviral therapy (HAART) and to assess the effect of HAART type and duration on semen parameters. Materials and methods Between January 2010 and June 2014, we enrolled in a retrospective case-control study 770 HIV-1 patients under stable HAART asking a reproductive counselling with their HIV negative partner. Co-infections with HBV or HCV, genital tract infections and known causes of infertility represented exclusion criteria. Semen samples were analysed and compared with the WHO reference values. A multivariate analysis including HAART type and duration, age, viral load and CD4 count, was performed on 600 patients out of 770. Results The median values of all semen parameters were significantly lower among HIV-1 infected patients compared to the WHO reference group, with a significant proportion of patients having values below the 5th percentile of the WHO reference value. In a multivariate analysis, only age and viral load negatively impacted progressive motility (\u3b2 -0.3 (95% CI: -0.5; -0.0) %, p&lt;0.05) and semen morphology (\u3b2 -0.00 (95% CI: -0.00; -0.00) %, p0.01), while no associations were detected as regards HAART type and duration. Conclusions HIV-1 infected patients showed a significant impairment of semen parameters compared to the reference values. HAART type and duration showed no associations with semen quality. Further research is needed to investigate implications for clinical care of HIV infected men desiring a child

Placental thickness in the lower uterine segment and invasive placentation: Will the promise live up?

We thank Takahashi and Matsubara for the interest in our article in which it was demonstrated that the placental thickness in the lower uterine segment is increased in women with abnormally invasive, compared to those with normal placentation. Takahashi & Matsubara argue that measurement of the placental thickness can be difficult in cases of central placenta previa. To support their argument, they show MRI images of central placenta previa. This article is protected by copyright. All rights reserved

Effects of Antiretroviral Therapy on Sperm DNA Integrity of HIV-1-Infected Men

HIV-1-affected couples\u2019 desire to have children and free sexual intercourses with the use of pre-exposure prophylaxis for the negative partner has emerged as an alternative option to assisted reproduction in aviremic patients under highly active antiretroviral therapy (HAART). It is already known that sperm quality may be impaired in HIV-infected men. The underlying physiopathological mechanism is still debated. The aim of this study was to evaluate the effects of HAART on sperm DNA fragmentation, comparing HIV-1-infected patients taking HAART versus na\uefve HIV-1-infected patients. This is a prospective case-control study. Sperm nuclear DNA fragmentation rate was evaluated by the sperm chromatin dispersion test in 77 HIV-infected men: 53 HIV-1 patients receiving HAART (Group 1) versus 24 na\uefve HIV-1 patients not receiving HAART (Group 2). Complete semen analysis was performed according to WHO 2010 recommendations. Patients with HBV infection or HCV infection coinfections and genital tract infections wre excluded. All the patients did not present any clinical signs of their disease. Seminal parameters were examined in the two groups, showing no significant differences. Increased sperm DNA fragmentation > 30% was demonstrated in 67.9% of patients in Group 1 and 37.5% of patients in Group 2, respectively (p =.02). A positive but nonsignificant trend toward increased fragmentation was reported with advancing patients\u2019 age. In conclusion, sperm nuclear fragmentation rate is increased in HIV-1-infected patients taking HAART compared to HIV-1 patients not receiving HAART

Prevention of congenital malformations and other adverse pregnancy outcomes with 4.0 mg of folic acid : community-based randomized clinical trial in Italy and the Netherlands

Background: In 2010 a Cochrane review confirmed that folic acid (FA) supplementation prevents the first- and second-time occurrence of neural tube defects (NTDs). At present some evidence from observational studies supports the hypothesis that FA supplementation can reduce the risk of all congenital malformations (CMs) or the risk of a specific and selected group of them, namely cardiac defects and oral clefts. Furthermore, the effects on the prevention of prematurity, foetal growth retardation and pre-eclampsia are unclear.Although the most common recommendation is to take 0.4 mg/day, the problem of the most appropriate dose of FA is still open.The aim of this project is to assess the effect a higher dose of peri-conceptional FA supplementation on reducing the occurrence of all CMs. Other aims include the promotion of pre-conceptional counselling, comparing rates of selected CMs, miscarriage, pre-eclampsia, preterm birth, small for gestational age, abruptio placentae.Methods/Design: This project is a joint effort by research groups in Italy and the Netherlands. Women of childbearing age, who intend to become pregnant within 12 months are eligible for the studies. Women are randomly assigned to receive 4 mg of FA (treatment in study) or 0.4 mg of FA (referent treatment) daily. Information on pregnancy outcomes are derived from women-and-physician information.We foresee to analyze the data considering all the adverse outcomes of pregnancy taken together in a global end point (e.g.: CMs, miscarriage, pre-eclampsia, preterm birth, small for gestational age). A total of about 1,000 pregnancies need to be evaluated to detect an absolute reduction of the frequency of 8%. Since the sample size needed for studying outcomes separately is large, this project also promotes an international prospective meta-analysis.Discussion: The rationale of these randomized clinical trials (RCTs) is the hypothesis that a higher intake of FA is related to a higher risk reduction of NTDs, other CMs and other adverse pregnancy outcomes. Our hope is that these trials will act as catalysers, and lead to other large RCTs studying the effects of this supplementation on CMs and other infant and maternal outcomes.Trial registration: Italian trial: ClinicalTrials.gov Identifier: NCT01244347.Dutch trial: Dutch Trial Register ID: NTR3161

Role of Ultrasound Scan in Diabetic Pregnancy

Diabetes is one of the most common disorders complicating pregnancy, associated with negative outcomes for the fetus and newborn, including fetal congenital anomalies, stillbirth, and growth disorders. Ultrasonography (US) represents a noninvasive, readily available method to assess and monitor the fetus. US use in diabetic pregnancy is now widely consolidated, allowing early detection of congenital anomalies and assessment of fetal growth, in order to optimize timing and mode of delivery. More recently, the use of fetal ultrasound evaluations and measurements of growth has been encouraged in addition to maternal glycemic control in order to identify which fetuses are at increased or decreased risk for complications, so as to guide maternal therapy. The present chapter reviews the role of the ultrasound scan in the diabetic pregnancy, focusing on the use of US for the identification of congenital abnormalities, the estimation of fetal growth, and the possible benefit of modulating management of pregnant women with diabetes based on sonographic results. Future studies comparing management strategies that address optimal timing, frequency of ultrasound examinations, and glycemic targets are needed. Most importantly, future trials involving GDM pregnancies should examine the effects of in utero different managements and therapies on childhood and lifetime risks for developing obesity or impaired glucose tolerance

Multiple micronutrient needs in pregnancy in industrialized countries

BACKGROUND: As nutritional deficiencies are known to lead to adverse pregnancy outcomes, a woman's nutritional status should be assessed preconceptionally with the goal of optimizing maternal, fetal and infant health. Worldwide micronutrient intakes do not fit pregnancy requirements, so that their supplementation is recommended from the beginning of pregnancy in most of the low- and middle-income countries. Conversely, data on multiple supplementation in developed countries appear few and controversial. Key Message: Although a balanced diet is generally accessible in industrialized countries, a switch to a high-fat and low-quality diet has led to an inadequate vitamin and mineral intake during pregnancy, so that recent data show the micronutrient intake and supplementation to be lower than recommended even in high-income countries, particularly for iron, folic acid, calcium and vitamin D. CONCLUSIONS: Currently, even if there is insufficient evidence to support routine supplementation at the population level, except for periconceptional folate supplementation, these results need to be evaluated at an individual level in order to avoid nutritional deficiencies and to encourage women to establish healthful dietary practices prior to conception. The new goal in industrialized countries needs to be an individualized approach that takes account of the phenotypic, genotypic and metabolic differences among individuals of the same population