Serum indoxyl sulphate and its relation to albumin and α1-acid  glycoprotein as a potential biomarkers of maternal intestinal metabolism  during pregnancy and postpartum

Background Serum indoxyl sulfate (IS) levels depend on the production of indole in the gut. The biological effects of IS in the vascular bed could be confirmed by changes in the levels of individual serum proteins during normal pregnancy and in the postpartum period as compared with non-pregnant controls. Albumin (Alb) and α1-acid glycoprotein (AGP, orosomucoid) are the most abundant serum carrier proteins with potential interrelationships with serum levels of IS. Methods Serum levels of IS, Alb and AGP were measured in 84 pregnant women in the first, second and third trimester of pregnancy and in the postpartum period, as well as in non-pregnant controls (n = 20), using ultra-performance liquid chromatography (UPLC) coupled to mass spectrometry (IS), colorimetric assay (Alb) and immunoturbidimetric assay (AGP). Results The postpartum serum levels [mg/L] of IS were lower (p = 0.027) than in the second trimester (mean±SD: 0.85±0.39 vs 0.58±0.32). There were no differences in the IS to ALB ratio calculated in the three trimesters of pregnancy, the postpartum period, and in the non-pregnant controls. The IS/AGP ratio increased from the first to the second trimester (p = 0.039), and decreased in the postpartum period (p<0.05), when it was lower than in the second and third trimester. Conclusions The variability of the serum IS/AGP ratio during pregnancy and in the postpartum period may reflect shared involvement in the regulation of their intravascular relationships. The link between serum levels of IS derived from the gut and AGP could serve a potential biomarkers of maternal intestinal metabolism during pregnancy and postpartum.

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Visual Acuity Changes during Pregnancy and Postpartum: A Cross-Sectional Study in Iran

Journal of Pregnancy ◽

10.1155/2014/675792 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 12

Author(s):

Khashayar Mehdizadehkashi ◽

Shahla Chaichian ◽

Abolfazl Mehdizadehkashi ◽

Ebrahim Jafarzadepour ◽

Zeinab Tamannaie ◽

...

Keyword(s):

Visual Acuity ◽

Refractive Error ◽

Postpartum Period ◽

First Trimester ◽

Cross Sectional Study ◽

Second Trimester ◽

Sectional Study ◽

Cross Sectional ◽

Pregnancy And Postpartum ◽

Myopic Shift

In this research, we represent the changes in visual acuity during pregnancy and after delivery. Changes as myopic shift start during second trimester and will be stopped after delivery; however it is obtained that women will have the same refractive error as what they had in the first trimester, after postpartum. So, any change in their spectacle prescription during this period is forbidden. As a result, not only changing in hormones can cause myopic shift in vision, but also overweight has its retributive role. What we are trying to do is to notify gynecologists and optometrists to be aware of these changes, so as to leave spectacle prescription writing to the session after postpartum period.

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Therapeutic levetiracetam monitoring during pregnancy: “mind the gap”

Therapeutic Advances in Chronic Disease ◽

10.1177/2040622319851652 ◽

2019 ◽

Vol 10 ◽

pp. 204062231985165 ◽

Cited By ~ 2

Author(s):

Maya Berlin ◽

Dana Barchel ◽

Revital Gandelman-Marton ◽

Nurit Brandriss ◽

Ilan Blatt ◽

...

Keyword(s):

Reference Range ◽

Serum Levels ◽

First Trimester ◽

Second Trimester ◽

Serum Concentrations ◽

Third Trimester ◽

The Third ◽

Antiepileptic Medication ◽

Apparent Clearance ◽

Neurological Conditions

Background: Epilepsy is one of the most common chronic neurological conditions and its treatment during pregnancy is challenging. Levetiracetam (LEV) is an antiepileptic medication frequently used during pregnancy. Only a few small studies have been published on LEV monitoring during pregnancy, demonstrating decreased serum LEV levels during the first and second trimester; however, the most significant decrease was observed during the third trimester of pregnancy. In this study we aimed to evaluate LEV pharmacokinetics during different stages of pregnancy. Methods: We followed up and monitored serum levels of pregnant women treated with LEV for epilepsy. Results: Fifty-nine women with 66 pregnancies during the study period were included. The lowest raw LEV serum concentrations were observed during the first trimester. Compared with the pre-pregnancy period, raw serum concentration was lower by 5.76 mg/L [95% confidence interval (CI) (2.78, 8.75), p = 0.039] during the first trimester. Comparing the decrease in the first trimester with either the second or the third, no significant changes were observed ( p = 0.945, p = 0.866). Compared with pre-pregnancy measurements, apparent clearance was increased by 71.08 L/day [95%CI (16.34, 125.83), p = 0.011] during the first trimester. About 30% of LEV serum levels during pregnancy were below the laboratory quoted reference range. Conclusions: Raw LEV serum levels tend to decrease during pregnancy, mainly during the first trimester contrary to previous reports. Monitoring of LEV serum levels is essential upon planning pregnancy and thereafter if pre-pregnancy LEV levels are to be maintained. However, more studies are needed to assess the correlation with clinical outcome.

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Hypothyroidism incidence in and around pregnancy: a Danish nationwide study

Acta Endocrinologica ◽

10.1530/eje-16-0446 ◽

2016 ◽

Vol 175 (5) ◽

pp. 387-393 ◽

Cited By ~ 7

Author(s):

S L Andersen ◽

A Carlé ◽

J Olsen ◽

P Laurberg

Keyword(s):

Incidence Rate ◽

Early Pregnancy ◽

Incidence Rate Ratio ◽

First Trimester ◽

Population Based ◽

Second Trimester ◽

Third Trimester ◽

First Child ◽

Born Child ◽

Pregnancy And Postpartum

Objective Immunological changes in and after a pregnancy may influence the onset of autoimmune diseases. An increased incidence of hyperthyroidism has been observed both in early pregnancy and postpartum, but it remains to be studied if the incidence of hypothyroidism varies in a similar way. Design Population-based cohort study using Danish nationwide registers. Method All women who gave birth to a singleton live-born child in Denmark from 1999 to 2008 (n = 403 958) were identified, and data on hospital diagnosis of hypothyroidism and redeemed prescriptions of thyroid hormone were extracted. The overall incidence rate (IR) of hypothyroidism during 1997–2010 and the IR in three-month intervals before, during and after the woman’s first pregnancy in the study period were calculated and compared with the IR of hyperthyroidism. Results Altogether 5220 women were identified with onset of hypothyroidism from 1997 to 2010 (overall IR 92.3/100 000/year) and 1572 women developed hypothyroidism in the period from 2 years before to 2 years after birth of the first child in the study period. The incidence of hypothyroidism decreased during the pregnancy (incidence rate ratio (IRR) vs overall IR in the rest of the study period: first trimester: 0.89 (95% CI: 0.66–1.19), second trimester: 0.71 (0.52–0.97), third trimester: 0.29 (0.19–0.45)) and increased after birth with the highest level at 4–6 months postpartum (IRR 3.62 (2.85–4.60)). Conclusion These are the first population-based data on the incidence of hypothyroidism in and around pregnancy. The incidence declined during pregnancy followed by a sharp increase postpartum. Notably, hypothyroidism as opposed to hyperthyroidism showed no early pregnancy increase.

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Continuous 7-Month Internet of Things–Based Monitoring of Health Parameters of Pregnant and Postpartum Women: Prospective Observational Feasibility Study (Preprint)

10.2196/preprints.12417 ◽

2019 ◽

Author(s):

Johanna Saarikko ◽

Hannakaisa Niela-Vilen ◽

Eeva Ekholm ◽

Lotta Hamari ◽

Iman Azimi ◽

...

Keyword(s):

Physical Activity ◽

Heart Rate ◽

Postpartum Period ◽

Continuous Monitoring ◽

Second Trimester ◽

Third Trimester ◽

Activity Data ◽

The Third ◽

Nulliparous Women ◽

Health Parameters

BACKGROUND Monitoring during pregnancy is vital to ensure the mother’s and infant’s health. Remote continuous monitoring provides health care professionals with significant opportunities to observe health-related parameters in their patients and to detect any pathological signs at an early stage of pregnancy, and may thus partially replace traditional appointments. OBJECTIVE This study aimed to evaluate the feasibility of continuously monitoring the health parameters (physical activity, sleep, and heart rate) of nulliparous women throughout pregnancy and until 1 month postpartum, with a smart wristband and an Internet of Things (IoT)–based monitoring system. METHODS This prospective observational feasibility study used a convenience sample of 20 nulliparous women from the Hospital District of Southwest Finland. Continuous monitoring of physical activity/step counts, sleep, and heart rate was performed with a smart wristband for 24 hours a day, 7 days a week over 7 months (6 months during pregnancy and 1 month postpartum). The smart wristband was connected to a cloud server. The total number of possible monitoring days during pregnancy weeks 13 to 42 was 203 days and 28 days in the postpartum period. RESULTS Valid physical activity data were available for a median of 144 (range 13-188) days (75% of possible monitoring days), and valid sleep data were available for a median of 137 (range 0-184) days (72% of possible monitoring days) per participant during pregnancy. During the postpartum period, a median of 15 (range 0-25) days (54% of possible monitoring days) of valid physical activity data and 16 (range 0-27) days (57% of possible monitoring days) of valid sleep data were available. Physical activity decreased from the second trimester to the third trimester by a mean of 1793 (95% CI 1039-2548) steps per day (P<.001). The decrease continued by a mean of 1339 (95% CI 474-2205) steps to the postpartum period (P=.004). Sleep during pregnancy also decreased from the second trimester to the third trimester by a mean of 20 minutes (95% CI –0.7 to 42 minutes; P=.06) and sleep time shortened an additional 1 hour (95% CI 39 minutes to 1.5 hours) after delivery (P<.001). The mean resting heart rate increased toward the third trimester and returned to the early pregnancy level during the postpartum period. CONCLUSIONS The smart wristband with IoT technology was a feasible system for collecting representative data on continuous variables of health parameters during pregnancy. Continuous monitoring provides real-time information between scheduled appointments and thus may help target and tailor pregnancy follow-up.

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Second-trimester maternal serum markers in the prediction of preeclampsia

Journal of Perinatal Medicine ◽

10.1515/jpm-2016-0249 ◽

2017 ◽

Vol 45 (7) ◽

Cited By ~ 3

Author(s):

Qiong Luo ◽

Xiujun Han

Keyword(s):

Detection Rate ◽

Late Onset ◽

Serum Levels ◽

Serum Markers ◽

Maternal Serum ◽

Second Trimester ◽

Third Trimester ◽

Roc Curve Analysis ◽

The Third ◽

Significant Difference

AbstractAim:To determine whether late second-trimester maternal serum biomarkers are useful for the prediction of preeclampsia during the third trimester, a case-control study including 33 preeclamptic and 71 healthy pregnancies was conducted. Maternal serum concentrations of placental protein 13 (PP13), pregnancy-associated plasma protein (PAPP-A), pentraxin3 (PTX3), soluble FMS-like tyrosine kinase-1 (sFlt-1), myostatin and follistatin-like-3 (FSLT-3) were measured at 24–28 weeks’ gestation. All the concentrations of these markers were compared between the preeclamptic and control groups. Receiver operating characteristic (ROC) curve analysis was applied to assess sensitivity and specificity of serum markers with significant difference.Results:The levels of PP13 and sFlt-1 were significantly increased and FSLT3 was significantly decreased in patients with preeclampsia. However, the concentration of PAPPA, PTX3 and myostatin did not differ significantly. In screening for preeclampsia during the third trimester by PP13, sFlt-1 and FSLT3, the detection rate was 61.3%, 48.1% and 39.1%, respectively, at 80% specificity, and the detection rate increased to 69.8% by combination of these three markers.Conclusion:Maternal serum levels of PP13, sFlt-1 and FSLT3 play an important role in predicting late-onset preeclampsia, and the combination of these three markers significantly increases the detection rate for prediction.

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Comparison of uterine fibroids’ growth pattern during pregnancy according to fetal sex: an observational study

Biology of Sex Differences ◽

10.1186/s13293-019-0266-2 ◽

2019 ◽

Vol 10 (1) ◽

Author(s):

Giovanni Delli Carpini ◽

Valeria Verdecchia ◽

Maria Papiccio ◽

Camilla Grelloni ◽

Andrea Ciavattini

Keyword(s):

Observational Study ◽

Uterine Fibroids ◽

Serum Levels ◽

First Trimester ◽

Obstetric Outcomes ◽

Second Trimester ◽

Third Trimester ◽

Fetal Sex ◽

Female Fetus ◽

The Mean

Abstract Background To investigate the effect of fetal sex on fibroids’ growth during pregnancy according to the hCG serum levels Methods Observational study conducted from January 2007 to December 2016 on women with ultrasound identification of uterine fibroids who had a pregnancy within 1 year from diagnosis. The fibroids diameter was determined during the pre-pregnancy ultrasound, early first trimester (5–7 weeks), late first trimester (11–13 weeks), second trimester (19–21 weeks), and third trimester (31–33 weeks). The diameter growth was calculated in each interval between two ultrasounds. The hCG serum levels were determined both in early and late first trimester. The correlation between hCG levels and fibroid diameter was evaluated. Obstetric outcomes collected were gestational weeks at birth and the rate of cesarean section. Neonatal outcomes were birthweight and Apgar score at 1 min. Results Eighty-seven of the included women had a male fetus, and 70 had a female fetus. A progressive increase of fibroid diameter was observed from pre-pregnancy to second trimester for both fetal sexes. In third trimester, the mean ± SD fibroid diameter of female fetuses showed a slowdown, while the mean ± SD fibroid diameter of male fetuses continued to grow. Women carrying a female fetus presented a higher fibroid diameter in early first trimester (33.5 ± 13.3 mm vs 27.4 ± 11.0 mm, p < 0.01), late first trimester (40.2 ± 13.9 mm vs 34.6 ± 11.7 mm, p < 0.01), and second trimester (40.5 ± 14.9 mm vs 34.7 ± 10.3 mm, p < 0.01). The hCG serum levels resulted higher in women with a female fetus: 61406 (50554-71760) mU/ml vs 46016 (37160-56744) mU/ml (p < 0.01). A positive correlation between hCG levels and fibroid diameter was found both for male and female fetuses (male r = 0.77, 95% CI 0.71–0.82, p < 0.01 and female r = 0.82, 95% CI 0.76–0.86, p < 0.01). Conclusion Women with female fetus seem to have a higher growth of fibroids up to second trimester of pregnancy. This process may be mediated by the higher serum hCG levels found in women expecting a female fetus.

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Down-regulation of PM20D1 is associated with clinics outcomes and prognosis of gestational patients with diabetes mellitus

Archives of Medical Science ◽

10.5114/aoms/136284 ◽

2021 ◽

Author(s):

Lieming Zhang

Keyword(s):

Diabetes Mellitus ◽

Gestational Age ◽

Pregnancy Outcomes ◽

Serum Levels ◽

Inflammatory Factors ◽

Second Trimester ◽

Third Trimester ◽

Tnf Α ◽

Patients With Diabetes ◽

Healthy Control

IntroductionTo investigate clinic role of PM20D1 in gestational diabetes mellitus (GDM).Material and methodsThis observational study included 189 cases of GDM patients who came to our department during March 2018 to December 2019. Additionally, 100 healthy pregnant individuals who came to physical examination were included as healthy control during the same period. Western blotting was used to determine the expression of PM20D1 at gestational age 24-28 weeks, as well as gestational age 37-40 weeks. Serum inflammatory factors of C reactive protein (CRP), interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α.ResultsThe expression of PM20D1 was markedly decreased in GDM patients compared with the healthy control. Besides, patients of third trimester of pregnancy (gestational age 37-40 weeks) showed significantlylower expression of PM20D1 than patients of second trimester of pregnancy (gestational age 24-28 weeks). Serum levels of CRP, IL-1β, IL-6, TNF-α and leptin were remarkably higher and levels of adiponectin were markedly lower in GDM patients at both second and third trimester of pregnancy, which were the highest at third trimester of pregnancy. Pearson’s analysis showed PM20D1 was negatively correlated with IL-1β, IL-6 and leptin and positively correlated with adiponectin. At second trimester of pregnancy, patients with lower expression of PM20D1 showed remarkably higher levels of HOMA-IR, fasting insulin, FBG, OGTT-1hPG, OGTT-2hPG, as well as TG and LDL-ch, as well as markedly lower levels of HDL-ch. Down-regulated PM20D1 predicted poor pregnancy outcomes.ConclusionsReduced was PM20D1 associated with patients’ clinics outcomes and pregnancy outcomes in GDM.

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Clinical course of pregnancy and postpartum in a multidrug-resistant tuberculosis/HIV co-infected patient receiving bedaquiline-containing regimen as antimycobacterial therapy

Infusion & Chemotherapy ◽

10.32902/2663-0338-2019-4-23-30 ◽

2019 ◽

pp. 23-30

Author(s):

О.М. Raznatovska ◽

S.I. Tertishniy ◽

V.G. Syusyuka ◽

A.V. Fedorec ◽

T.K. Sahaidak ◽

...

Keyword(s):

Growth Retardation ◽

Postpartum Period ◽

Intrauterine Growth Retardation ◽

Clinical Case ◽

Sputum Smear ◽

Third Trimester ◽

Intrauterine Growth ◽

The Third ◽

Pregnancy And Postpartum ◽

Mdr Tb

Background. According to World Health Organization (WHO), experimental studies performed in rats and rabbits have revealed no evidence of harmful side effects of bedaquiline to the fetus. WHO points out that, given the lack of adequate and controlled studies on the effects of bedaquiline on the fetus in pregnant women, and the fact that drug data regarding teratogenicity are limited to nonclinical animal data, this drug may be used when an effective treatment regimen cannot otherwise be provided. However, WHO recommends thorough registering treatment, pregnancy, and postpartum bedaquiline-related outcomes to provide data on appropriate dosing for multidrug-resistant tuberculosis (MDR-TB) treatment during pregnancy and postpartum. However, in the modern literature, there are no data about attributable to bedaquiline adverse events in MDR-TB/HIV co-infected pregnant women and their fetus as well as during the postpartum period. Objective. To update the literature data with the clinical features of pregnancy and postpartum period in a MDR-TB/HIV co-infected patient receiving a bedaquiline-containing regimen as antimycobacterial therapy in the third trimester based on an example from own clinical experience. Methods. We report the clinical case of pregnancy course in the MDR-TB/HIV co-infected woman treated with the bedaquiline-containing regimen as antimycobacterial therapy in the third trimester. Results. In the clinical case presented, the patient demonstrated an initial poor adherence to treatment for both MDR-TB and HIV infection resulting in tuberculous process and HIV rapid progression. Since the patient refused the option of undergoing the therapeutic abortion prior to 22 gestational weeks as the pregnancy was intended, the antimycobacterial therapy regimen was modified by bedaquiline inclusion at 30 weeks’ gestation (the third trimester) for the maternal and neonatal mortality prevention. However, there was no sputum smear conversion on the antimycobacterial therapy regimen including bedaquiline, the patient presented with the signs of endogenous intoxication and nephropathy. Relatedly, neonatal transabdominal ultrasound revealed intrauterine growth retardation, worsening fetoplacental insufficiency (reverse flow) and intrauterine dystrophy. There was abundant placental calcification. Taking into account breech presentation, II degree intrauterine growth retardation, III degree fetoplacental insufficiency (reverse flow), oligohydramnios, fetal distress syndrome and bilateral pyelectasis, the patient was transferred to the Perinatal Centre for planned caesarean section at the 32nd week of gestation. The premature female infant was declared dead some hours later. In the postpartum period, the patient continued the initiated bedaquilinebased antimycobacterial therapy and antiretroviral therapy. However, positive clinical-radiological dynamics and sputum smear conversion have not been achieved. Conclusions. The clinical case presented confirms the literature data that the features of pregnancy and postpartum period in patients with MDR-TB/HIV co-infection are characterized by such complications development as preterm delivery, early neonatal mortality, intrauterine growth retardation, distress syndrome, etc.

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Continuous 7-Month Internet of Things–Based Monitoring of Health Parameters of Pregnant and Postpartum Women: Prospective Observational Feasibility Study

JMIR Formative Research ◽

10.2196/12417 ◽

2020 ◽

Vol 4 (7) ◽

pp. e12417

Author(s):

Johanna Saarikko ◽

Hannakaisa Niela-Vilen ◽

Eeva Ekholm ◽

Lotta Hamari ◽

Iman Azimi ◽

...

Keyword(s):

Physical Activity ◽

Heart Rate ◽

Postpartum Period ◽

Continuous Monitoring ◽

Second Trimester ◽

Third Trimester ◽

Activity Data ◽

The Third ◽

Nulliparous Women ◽

Health Parameters

Background Monitoring during pregnancy is vital to ensure the mother’s and infant’s health. Remote continuous monitoring provides health care professionals with significant opportunities to observe health-related parameters in their patients and to detect any pathological signs at an early stage of pregnancy, and may thus partially replace traditional appointments. Objective This study aimed to evaluate the feasibility of continuously monitoring the health parameters (physical activity, sleep, and heart rate) of nulliparous women throughout pregnancy and until 1 month postpartum, with a smart wristband and an Internet of Things (IoT)–based monitoring system. Methods This prospective observational feasibility study used a convenience sample of 20 nulliparous women from the Hospital District of Southwest Finland. Continuous monitoring of physical activity/step counts, sleep, and heart rate was performed with a smart wristband for 24 hours a day, 7 days a week over 7 months (6 months during pregnancy and 1 month postpartum). The smart wristband was connected to a cloud server. The total number of possible monitoring days during pregnancy weeks 13 to 42 was 203 days and 28 days in the postpartum period. Results Valid physical activity data were available for a median of 144 (range 13-188) days (75% of possible monitoring days), and valid sleep data were available for a median of 137 (range 0-184) days (72% of possible monitoring days) per participant during pregnancy. During the postpartum period, a median of 15 (range 0-25) days (54% of possible monitoring days) of valid physical activity data and 16 (range 0-27) days (57% of possible monitoring days) of valid sleep data were available. Physical activity decreased from the second trimester to the third trimester by a mean of 1793 (95% CI 1039-2548) steps per day (P<.001). The decrease continued by a mean of 1339 (95% CI 474-2205) steps to the postpartum period (P=.004). Sleep during pregnancy also decreased from the second trimester to the third trimester by a mean of 20 minutes (95% CI –0.7 to 42 minutes; P=.06) and sleep time shortened an additional 1 hour (95% CI 39 minutes to 1.5 hours) after delivery (P<.001). The mean resting heart rate increased toward the third trimester and returned to the early pregnancy level during the postpartum period. Conclusions The smart wristband with IoT technology was a feasible system for collecting representative data on continuous variables of health parameters during pregnancy. Continuous monitoring provides real-time information between scheduled appointments and thus may help target and tailor pregnancy follow-up.

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