The effect of glucose tolerance test on fetoplacental circulation

OBJECTIVE

Acute hyperglycemia affects the fetoplacental circulation. This study aims to investigate the possible effect of acute hyperglycemia induced by 50 g oral glucose tolerance test (OGTT) on fetoplacental circulation in women between 24 and 28 weeks of gestation.

MATERIALS AND METHODS

Between January 2019 and April 2019, a total of 29 women who were between 24 and 28 weeks of gestation with a singleton gestation and were in low-risk group were included in this prospective study. All patients underwent fetal biometric measurements using ultrasonography (USG) and were administered 50 g OGTT. Before and 1 h after the test, Doppler USG was used to measure uterine artery, umbilical artery (UA), middle cerebral artery (MCA), pulsatility index (PI), resistance index (RI), and systolic/diastolic (S/D) ratio. The cerebroplacental ratio (CPR) was calculated as the ratio of the MCA-PI/UA-PI.

RESULTS

There was a decline in the MCA-RI (p = 0.008) and UA-PI (p = 0.021) at 1 h after the administration of 50 g OGTT. Z-scores of the mean UA-PI, MCA-PI, and CPR were calculated and a statistically significant increase in the Z-scores of the mean UA-PI was observed (p = 0.028).

CONCLUSION

Our study results show that acute hyperglycemia induced by OGTT significantly increases the Z-scores of the UA-PI, affecting the fetoplacental circulation.

The role of genetic mutations in intrahepatic cholestasis of pregnancy

OBJECTIVE

Intrahepatic cholestasis of pregnancy (ICP) is a liver disorder of pregnancy characterized by pruritus, elevated liver enzymes and fasting serum bile acids. Genetic predisposition has been suggested to play a role in its etiology and mutations in the ATP8B1(OMIM ∗602397) (FIC1), ABCB11(OMIM ∗603201) (BSEP), and ABCB4(OMIM ∗171060) (MDR3) genes have been implicated. In the present study, we aimed to investigate the possible role of ATP8B1, ABCB11, and ABCB4 gene mutations in the patients with ICP.

MATERIALS AND METHODS

A total of 25 patients who were diagnosed with ICP were included in the study. Genetic test results and mutation status of the patients as assessed by the next-generation sequencing technology were retrospectively retrieved from the hospital database.

RESULTS

Of all patients, significant alterations in the ATP8B1 (n = 2), ABCB11 (n = 1), and ABCB4 (n = 7) genes were observed in 10 patients using the molecular analysis testing. All these alterations were heterozygous. Of these alterations, four were reported in the literature previously, while six were not. Using the in-silico parameters, there was a pathogenic alteration in the ABCB4 gene in one patient, while there was no clinically relevant alteration in the other gene mutations in the remaining nine patients.

CONCLUSION

Considering the fact that the alterations were compatible with clinical presentations of the ICP patients and the incidence of these mutations is low in the general population, we believe that our study results are clinically relevant. Further molecular genetic tests in ICP patients and functional studies supporting the results would shed light into the clinical importance of these alterations.

The predictive value of first-trimester anthropometric and ultrasonographic adipose tissue measurements in gestational diabetes mellitus

AIM

Previous studies in pregnant women reported a strong correlation between first-trimester ultrasonographic visceral adipose tissue (VAT) measurements and gestational diabetes mellitus (GDM) during the following weeks. In this study, we aimed to evaluate the clinical utility of ultrasonographic subcutaneous and visceral adipose tissue measurements between 11th and 14th weeks of gestation to predict GDM during the 24th to 28th gestational weeks.

MATERIALS AND METHODS

This prospective study included a total of 142 pregnant women. Between 11th and 14th gestational weeks, we performed blinded measurements of intraperitoneal, perirenal, and subcutaneous adipose tissue thicknesses using ultrasonography. Between 24th and 28th gestational weeks, each participant underwent one-step GDM screening, and the measurement data were assessed for prognostic significance.

RESULTS

Of the 142 women included, 19 (8.8%) were diagnosed with GDM. The mean intraperitoneal and maximum subcutaneous fat thickness were 51.59 ± 22.49 and 19.79 ± 12.52 mm, respectively for the GDM group and 39.88 ± 13.73 and 13.24 ± 5.70 mm, respectively for the non-GDM group. Although we observed statistically significant differences between the GDM and non-GDM groups in terms of current body mass index (BMI), subcutaneous and intraperitoneal fat thicknesses, and waist and hip circumference values, the logistic regression model showed that only current BMI had a significant association with the increasing GDM frequency.

CONCLUSION

In this study investigating the clinical utility of first-trimester ultrasonographic VAT measurements during the 24th to 28th gestational weeks for the diagnosis of GDM, BMI seems to be a more useful predictor than the other anthropometric tools. However, further large-scale studies are needed to confirm these findings.

The role of oligohydramnios and fetal growth restriction in adverse pregnancy outcomes in preeclamptic patients

OBJECTIVES

We aimed to compare perinatal outcomes of oligohydramnios or fetal growth restriction with normal amniotic fluid index and fetal growth in preeclampsia and to compare the outcomes of only oligohydramnios, only fetal growth restriction and oligohydramnios with fetal growth restriction preeclamptic groups.

MATERIAL AND METHODS

A total of 743 preeclamptic patients were evaluated between June 2016 and 2020. Patients were divided into two groups: preeclampsia with oligohydramnios or fetal growth restriction (n = 237) and preeclampsia with normal amniotic fluid index and fetal growth (n = 506). Then, the first group was divided subgroups as only oligohydramnios (n = 55), only fetal growth restriction (n = 125) and oligohydramnios with fetal growth restriction (n = 57). Demographic characteristics and perinatal outcomes were recorded.

RESULTS

Gestational age at delivery (p < 0.001), birth weight (p < 0.001), Apgar scores (p < 0.001) and eclampsia (p < 0.001) were lower whereas impaired doppler findings (p < 0.001), cesarean rates (p < 0.001), preterm delivery (p < 0.001), abruptio placenta (p < 0.001), acute fetal distress (p < 0.001), RDS (p < 0.001), NICU requirement (p < 0.001) and neonatal death (p < 0.001) were higher in oligohydramnios or fetal growth restriction preeclamptic group. In subgroup analysis, there were differences between three groups according to the gestational age (p < 0.001), cesarean rates (p = 0.002), preterm delivery (p < 0.001), intensive care unit requirement (p = 0.039), birth weight (p < 0.001), Apgar scores (p < 0.001), RDS (p < 0.001) and NICU requirement (p < 0.001). In pairwise comparison, there was significant difference between only oligohydramnios and only fetal growth restriction group and between only oligohydramnios and oligohydramnios with fetal growth restriction group according to birth weight, Apgar scores, preterm delivery and cesarean rates, presence of RDS, maternal and neonatal intensive care unit requirement. No significant difference was detected between only fetal growth restriction group and oligohydramnios with fetal growth restriction group in terms of all parameters.

CONCLUSIONS

We suggest that patients with only oligohydramniosis have more favorable pregnancy outcomes than pregnants with only fetal growth restriction and coexistence of two conditions in preeclamptic patients. We claim that it could be appropriate to recommend close monitorization in preeclamptic patients with only fetal growth restriction and oligohydramniosis and fetal growth restriction.

The association of dynamic thiol-disulfide homeostasis and inflammatory markers in patients with polycystic ovary syndrome

OBJECTIVE

Polycystic ovary syndrome (PCOS) is a common hormonal disorder among women of reproductive age characterized by irregular menstruation and hirsutism and is associated with an increased risk for cardiovascular diseases. Increased inflammatory response and oxidative stress may also present in these patients. In this study, we aimed to compare the neutrophil-to-lymphocyte ratio (NLR), mean platelet volume (MPV), and dynamic thiol-disulphide homeostasis (dTDH) between the patients with PCOS and healthy individuals and to investigate the correlation between these parameters and cardiovascular risk factors in patients with PCOS.

MATERIALS AND METHODS

A total of 60 participants were included in this study. The patient group consisted of 36 patients who were diagnosed with PCOS and the control group consisted of 24 healthy individuals without PCOS. Complete blood count and hormonal tests were performed using blood samples. The NLR, MPV, and dTDH were compared between the patient and control groups.

RESULTS

There was no statistically significant difference in the native thiol, total thiol, disulphide levels and disulfide/native, disulfide/total and native/total thiol ratios between the patient and control groups (p = 0.494, p = 0.446, p = 0.338, p = 0.717, p = 0.723, and p = 0.717, respectively). In addition, there was no statistically significant difference in NLR and MPV between the groups (p = 0.531 and p = 0.196).

CONCLUSION

Our study results showed no significant difference in the NLR, MPV, dTDH levels, and inflammatory biomarkers including leukocyte count between the PCOS patients and healthy controls. Based on these findings, we conclude that the diagnosis of PCOS alone in overweight patients has no considerable effect on these biomarkers.

The first-trimester serum decorin levels as a potential predictor of preeclampsia

Background Preeclampsia (PE) is a multisystem disease and is still among the leading causes of maternal and neonatal morbidity and mortality. Inadequate trophoblast invasion plays a key role in the PE pathogenesis. The proliferation, migration, and invasion of extravillous trophoblasts (EVTs) is primarily controlled by the decidua-derived transforming growth factor beta (TGF-β) and decorin. In this study, we aimed to investigate the clinical utility of serum decorin levels measured in the 11th to 14th gestational weeks to predict preeclampsia during the following weeks of gestation. Materials and Methods A total of 600 pregnant women, whose age and gestational age ranged from 18 to 40 years and 11 to 14 weeks, were included. Venous blood samples were obtained and stored at -80 °C. Subsequently, the patients who developed preeclampsia and healthy controls with a similar body mass index were identified and their first-trimester blood samples were analyzed for serum decorin levels. Results The mean serum decorin level was 8.76 ± 6.88 ng/mL for the PE group while 9.75 ± 9.82 ng/mL for the control group. No statistically significant difference was found between the two groups (p=0.838). Conclusion We observed that the serum decorin levels during the 11th to 14th weeks of gestation showed no predictive value for preeclampsia in pregnant women. However, more accurate conclusions about the clinical utility of decorin as a biomarker of preeclampsia would require further studies with larger samples including more patients with EOS-PE.

Decorin levels in early- and late-onset preeclampsia

OBJECTIVES

Preeclampsia (PE) is a pregnancy complication caused by typically limited proliferation, apoptosis, migration, and invasion of extra-trophoblast cells. Decorin (DCN) is a decidua-derived transforming growth factor (TGF)-binding proteoglycan which exerts multiple physiological functions such as collagen fibrillogenesis, myogenesis, angiostasis, and restraining placental invasiveness by adversely regulate proliferation, migration, and invasiveness of human extravillous trophoblast cells. Preeclampsia is mainly classified as early- and late-onset PE according to the timing of the disease onset. In the present study, we aimed to investigate the DCN levels in early-onset PE (EOPE, < 34 weeks) and late-onset severe PE (LOPE, ≥ 34 weeks) and uncomplicated pregnancies.

MATERIAL AND METHODS

In this case-control study, serum samples were obtained from 21 pregnant women with EOPE and 29 pregnant women with LOPE, as well as from 38 healthy controls (n = 12 early-onset controls and n = 26 late-onset controls) with uncomplicated pregnancies.

RESULTS

The mean DCN level was statistically significantly higher in the early-onset PE controls than late-onset PE controls (p = 0.040). Although the mean DCN level was higher in the early-onset PE controls than EOPE and LOPE groups, it did not reach statistical significance (p = 0.119 and p = 0.117, respectively).

CONCLUSIONS

Although DCN has been thought to play a role in the pathophysiology of PE, our study results show that DCN is not a useful predictive marker of EOPE and LOPE. Further large-scale studies are needed to draw a definitive conclusion.

Comparative study of low-dose versus standard single-dose methotrexate: A novel approach for medical treatment of ectopic pregnancy

AIM

Methotrexate (MTX) treatment at a dose of 50 mg/m² of body surface area (BSA) is an effective and widely used treatment method in ectopic pregnancy. However, there is a limited number of studies investigating lower MTX doses. In this study, we aimed to investigate the efficacy of lower MTX doses in the treatment of ectopic pregnancy.

METHODS

This retrospective study included a total of 112 patients who were hospitalized due to ectopic pregnancy and administered single-dose MTX. The patients were divided into three groups according to the dose given as 22-40 mg/m² of BSA (n = 17), 41-49 mg/m² of BSA (n = 81) and ≥ 50 mg/m² of BSA (n = 14). Data including demographic characteristics of the patients, previous history of ectopic pregnancy, previous gynecological surgeries, the use of in vitro fertilization techniques, ultrasonographic findings, beta-human chorionic gonadotropin hormone (β-hCG) levels, pre-treatment endometrial sampling, MTX doses applied, and the need for a surgical intervention during follow-up were retrieved from the hospital records.

RESULTS

Of the patients, 16.96% (n = 19) were operated at the end of treatment, irrespective of the pre-treatment β-hCG levels with a success rate of 83% (n = 93). Fourteen (12.5%) of the patients received the second dose of MTX. The overall success rate was 89.2% in patients with a β-hCG level of ≤5000 mIU/mL.

CONCLUSION

This study shows that lower MTX doses than 50 mg/m² , which has been considered standard treatment and widely used in the treatment of ectopic pregnancy for nearly three decades, are effective with similar success rates.