Singleton pregnancy losses before gestational week 22 among patients with autoimmune disorders and Methylenetetrahydrofolate reductase polymorphisms

BACKGROUND: The rates of pregnancy losses (PLs) are increased by maternal risk factors such as autoimmune disorders (AD) and methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms. OBJECTIVE: To evaluate singleton PLs before gestational week (gw) 22 among patients with AD and MTHFR polymorphisms. METHODS: Totally, 1108 singleton pregnancies in 243 women were categorized as: 1) 148 pregnancies in 33 patients with AD, 2) 316 pregnancies in 66 patients with MTHFR polymorphisms, 3) 644 pregnancies in 144 patients with AD +MTHFR polymorphisms. PLs were classified into subgroups: a) Chemical Pregnancy(CP), b) Blighted Ovum(BO), c) gw ⩽ 10, d) gw11–14 e) gw15–22, f) Ectopic Pregnancy(EP), g) Trophoblastic Disease(TD). Obstetric histories were compared using Beksac Obstetrics Index (BOI): [number of living child + (π/10)]/gravida. RESULTS: PL rates before gw22 were 39.2% (58/148), 33.2% (105/316), and 36.3% (234/644) in AD, MTHFR, and AD +MTHFR groups, respectively (p= 0.421). The rate of Pre-Prenatal Screening Period fetal losses (CP + BO + gw ⩽ 10 fetal losses + EP + TD) were 84.8%, 75.9%, and 77.8% in AD, MTHFR, and AD +MTHFR, respectively (p= 0.264). Gravidity ⩽ 4 versus those with gravidity ⩾ 5 had statistically significant differences in BOI (p< 0.001). CONCLUSIONS: PL rate before gw22 among singleton pregnancies with AD and/or MTHFR polymorphisms was 35.8%. The clinical findings seem to be more complicated in patients with gravidity ⩾ 5.

The Maternal Risk Factors for Preterm Birth in Universitas Airlangga Hospital Surabaya in 2017-2018

Introduction: Preterm birth becomes a global problem due to its high rate of morbidity and mortality. In 2010, it is estimated approximately 15 premature birth cases per 100 lives birth in Indonesia. This study aimed to analyze the maternal risk factors towards preterm birth at Universitas Airlangga Hospital Surabaya in 2017-2018.Methods: This was observational analytic study using case-control approach to observe 178 medical records at Universitas Airlangga Hospital Surabaya. The population of this study was women who had preterm and aterm birth. The sample consisted of case group and control group which were convenient to exclusion and inclusion criteria. Univariate analysis was used to observe the relationship between dependent and independent variable. The significance value was p ≤ 0.05. The data were analysed using SPSS.Results: The research samples consisted of 89 case groups and 89 control groups. The case sample characteristic showed that 36% patients had overweight BMI; 62.9% patients had normal/hypotension; 69.7% patients gave birth to male baby; and 82% patients had no history of disease.There was no patient who used drugs and substance abuse (0%). Mothers aged 20 years old and older than 35 years old had OR = 2.13 (95% CI : 1.106-4.11) to become preterm birth. The primiparous women had risk for preterm birth 2.978 folds (95%, CI : 576-5.625) higher.Conclusion: There was a relationship between maternal age and parity to preterm birth. There was no relationship between maternal education, maternal occupation, hemoglobin levels, history of obstetric complications, and multiple pregnancy to preterm birth.

Maternal Risk Factors for Small-for-Gestational-Age Newborns in Mexico: Analysis of a Nationwide Representative Cohort

Background: Small for gestational age (SGA) is a key contributor to premature deaths and long-term complications in life. Improved characterization of maternal risk factors associated with this adverse outcome is needed to inform the development of interventions, track progress, and reduce the disease burden. This study aimed to identify socioeconomic, demographic, and clinical factors associated with SGA in Mexico.Methods: We analyzed administrative data from 1,841,477 singletons collected by the National Information Subsystem of Livebirths during 2017. Small-for-gestational-age was defined as being &lt;10th centiles according to the INTERGROWTH-21st standards. The comparison group was defined as being in ≥10th centiles. We fitted logistic regression models to determine odds ratios for the maternal factors associated with SGA.Results: Among the 1,841,477 singletons, 51% were male, 6.7% were SGA, 6.1% were term-SGA, and 0.5% were preterm-SGA. Maternal education presented a protective gradient of being SGA among mothers who achieved 1 to 6 years of education (adjusted odds ratio (aOR)0.95; 95% CI:0.91,0.99), 7 to 9 years (aOR 0.86; 95% CI:0.83,0.89), 10 to 12 years (aOR 0.75; 95% CI: 0.72, 0.79) and &gt; 12 years (aOR 0.63; 95% CI:0.6,0.66) compared with those without education. SGA was particularly likely to occur among primiparous (aOR 1.42; 95% CI: 1.39, 1.43), mothers living in very high deprivation localities (aOR 1.39; 95% CI: 1.36, 1.43), young (aOR 1.04; 95% CI: 1.02, 1.06), advanced age (aOR 1.14; 95% CI 1.09, 1.19), and mothers living in areas above 2,000 m (aOR 1.69; 95% CI: 1.65, 1.73). Antenatal care was associated with a reduced risk of SGA by 30% (aOR 0.7; 95% CI:0.67,0.73), 23% (OR 0.77; 95% CI:0.74,0.8), and 21% (OR 0.79; 95% CI:0.75,0.83), compared with those mothers who never received antenatal care, when women visited the clinic at the first, second and third trimester, respectively.Conclusion: Almost 7% of live births were found to be SGA. Parity, maternal age, education, place of residence, and social deprivation were significantly associated with this outcome. Antenatal care was protective. These findings imply that interventions focusing on early and adequate contact with health care facilities, reproductive health counseling, and maternal education should reduce SGA in Mexico.

Impact of Prematurity on the Buccal Epithelial Cells of the Neonates via Wnt/Beta-Catenin Signaling Pathway and Apoptosis

Objective Understanding the reflections of prematurity is necessary for the management of neonatal complications. We focused on the impact of prematurity and related “maternal risk factors/obstetric complications” on buccal cells of the neonates via evaluation of the Wnt/β-catenin signaling pathway and apoptosis. Study Design This study consisted of “early preterm neonates (EPN) (≤34th gestational week [gw]) (n = 36),” “late preterm neonates (LPN) (34th– < 37th gw) (n = 46),” and “term neonates (control) (≥37th gw) (n = 56).” Cohort was also subclassified according to the presence of maternal risk factors, obstetric complications, and neonatal complications. Wnt/β-catenin signaling and caspase-3 activation pathways were studied immunocytochemically. Results Wnt/β-catenin signaling positivity was statistically more frequent at buccal smears of the EPN and LPN groups compared with controls (p < 0.001). The cutoff for gestational age at delivery in receiver operating characteristic curve with the best balance of sensitivity (67.4%) and specificity (67.3%) was 35.8th gw for determining the reduction of Wnt/β-catenin signaling positivity (p < 0.001). The study demonstrated that obstetric complications significantly affected the activity of signaling, while maternal risk factors do not have any effect on Wnt/β-catenin signaling pathway (p = 0.003 and p = 0.828, respectively). This study also demonstrated a significant relationship between Wnt/β-catenin signaling pathway and the presence of neonatal complications (p = 0.015). Conclusion Dynamic characteristics of buccal cells are influenced by prematurity and related obstetric and neonatal problems. Buccal smear is a good tool to investigate the impact of prematurity and obstetric problems on perinatal outcome. Key Points

Frequency of Maternal Factors in Patients of Stillbirth in Pakhtoon Families Visiting Public Hospitals of Peshawar

Aim: To determine the frequency of maternal factors in patients of still birth in Pakhtoon families visiting hospitals of Peshawar. Study design: Cross-sectional study Place and duration of study: Department of Community & Preventive Medicine, Kabir Medical College Gandhara University Peshawar from 1stJanuary 2020 to 31stDecember 2020 Methodology: Five hundred pregnant women were enrolled. All multiparous pregnant women of Pakhtoon families with still birth admitted in Gynaecology wards in public hospitals of Peshawar were included. All multiparous pregnant women of Pakhtoon families with still births with renal diseases, accidental trauma, respiratory diseases and history of physical violence visiting public hospitals of Peshawar were excluded. Results: 65% of respondents were from 31-45 years. Maternal risk factors were education below matric 64.4%, 7% respondents were working, 78% respondents with total income less than 30 thousand. 59.8% with last birth interval less than 2 years. 44% respondents had haemoglobin less than 7g/dl. 40.2% respondents had comorbidity with stillbirth i.e. hypertension. Conclusion: Maternal risk factors were low socioeconomic status, birth interval less than 2 years, severe anemia and hypertension in current study. Keywords: Still birth, Socioeconomic, Ante-partum hemorrhage

Predictors of preeclampsia. Screening and prophylaxis in the I trimester of pregnancy

Aim. To examine the current state of the problem of the prediction of preeclampsia in early pregnancy. Materials and methods. The article provides an overview of publications based on search results in electronic resources PubMed, Elibrary, EMBASE and Google Scholar. Results. The currently known predictors of preeclampsia can be divided into biochemical and hemodynamic. A number of markers demonstrate prognostic value already in the early stages of gestation. To predict preeclampsia, algorithms are created. They include various combinations of its predictors and maternal risk factors. Conclusion. Prediction of preeclampsia is gradually moving from theory to practice. The instruments of its early forecasting before the gestational age of 14 weeks 6 days are becoming available. That opens up opportunities for targeted and timely prevention of preeclampsia.