ADRB2 gene polymorphism and preterm labor

This article discusses issues related to the role of polymorphism of the ADRB2 gene encoding β2-adrenergic receptor in preterm labor and tocolysis. Information is provided on scientific studies related to the search for associations of the carriage of alleles and genotypes of ADRB2 with the preterm labor, as well as with the pharmacological response to tocolytic therapy using β2-adrenergic agonists. The history of the discovery of the relationship of ADRB2 gene polymorphisms with preterm labor is presented in chronological order. As scientific facts emerge, researchers are faced with the question: how can ADRB2 gene polymorphisms affect physiological processes? That is, whether they affect by changing the primary structure of the receptor or by changing the level of expression. Depending on the answer to this question, pharmacogenetics are faced with a further task: what to study - individual polymorphisms or haplotypes?

Transient hyperglycemia, impaired glucose tolerance and gestational diabetes mellitus (GDM) in preterm pregnant women receiving antenatal steroids

OBJECTIVE:To determine the frequency of transient hyperglycemia, impaired glucose tolerance and gestational diabetes mellitus(GDM) in preterm pregnant women receiving antenatal steroids. METHODOLOGY:This descriptive cross-sectional study was carried out in Maternal and Child Health Center unit 1 (MCH-1) at Pakistan Institute of Medical Sciences Islamabad Pakistan from January 2017 till August 2017. A total of 365 pregnant women presenting to emergency and outpatient department with preterm labor (alive morphologically normal babies), with preterm premature rupture of membranes (PPROM) and other conditions which require early delivery including preeclampsia, IUGR requiring preterm delivery, severe oligohydramnios, antepartum hemorrhage(APH), women receiving two doses dexamethasone and all those with BSR>126mg/dl were included in the study. Multiple pregnancies, advanced preterm labor (cervix > 5cm dilated), gestational diabetes mellitus (GDM) or type I/II diabetes mellitus (DM), chorioamnionitis and taking any medication that affects glucose metabolism were excluded from the study. After ethical approval, informed consent was taken from study participants. Blood sugar levels before the commencement of 1st dose of dexamethasone were noted. Blood sugar profile (fasting, 2 hours after lunch, 2 hours after dinner) were carried out. 2nd dose of dexamethasone was given after 12 hours of 1st dose. Profile was carried out till euglycemia or 5 days if sugars remain deranged. Patients having deranged levels for greater than 5 days were advised 75 g oral glucose tolerance test(OGTT) and labelled as having impaired glucose tolerance or gestational diabetes mellitus. RESULTS: In our study, 57.57%(n=213) were between 18-30 years, 42.43%(n=157) were between 31-40 years of age, mean age was calculated as 28.92+5.54 while mean gestational age was 31.19+1.92 weeks. Frequency of transient hyperglycemia, impaired glucose tolerance and gestational diabetes mellitus(GDM) in preterm pregnant women receiving antenatal steroids revealed 62.16%(n=230) had transient hyperglycemia, 9.46%(n=35) had impaired glucose tolerance, 2.16%(n=8) had gestational diabetes and 26.22%(n=97) had no blood glucose abnormality. CONCLUSION: We concluded that the frequency of abnormal glucose levels increases in preterm pregnant women receiving antenatal steroids. Therefore, single blood sugar level done routinely before dexamethasone therapy are insufficient to judge the glucose metabolic status and should be closely monitored during the use of antenatal corticosteroids. KEYWORDS: Preterm delivery, antenatal steroids, transient hyperglycemia, impaired glucose tolerance and gestational diabetes mellitus(GDM)

PERSALINAN PADA IBU DENGAN RIWAYAT KEKURANGAN ENERGI KRONIS

Ibu hamil yang mengalami KEK akan mengalami kekurangan gizi, tubuh mudah lelah, pucat, lemas, dan mengalami kesulitan salah satunya dalam proses persalinan. Pengaruh KEK terhadap proses persalinan dapat mengakibatkan persalinan sulit dan lama, persalinan sebelum waktunya (prematur), pendarahan setelah persalinan, serta persalinan dengan operasi. Puskesmas Sadananya data ibu hamil yang mengalami KEK sebanyak 70 orang (9,49%) dan berlanjut ke penyulit lainnya yaitu mengalami Abortus 5 0rang (3,5%), BBLR 9 bayi (6,3%). Jenis Penelitian ini merupakan penelitian deskriptif. Populasi dalam penelitian ini adalah seluruh ibu bersalin dengan riwayat KEK pada masa kehamilan di Wilayah Kerja Puskesmas Sadananya Kabupaten Ciamis Tahun 2019 sebanyak 70, Teknik pengambilan sempel mengunakan Simple Random Sampling. Analisa dalam penelitian ini adalah Univariat. Hasil penelitian menunjukan sebanyak 3 oang mengalami persalinan sebelum waktunya (4,3%), 1 orang mengalami perdarahan paska salin disebebkan atonia uteri (1,4%), dan 8 orang proses persalinan dengan Operasi (SC) (11,4%). Kesimpulan dari penelitian ini adalah Ibu hamil dengan riwayat KEK mengalami penyulit persalinan, meskipun secara jumlah tidak terlalu signifikan, namun hal ini tentunya tetap harus menjadi perhatian khususnya bagaimana bisa mencegah ibu hamil untuk tidak mengalami anemia, dan apabila sudah terjadi sebagai seorang bidan tentunya harus dapat mendeteksi penyulit yang akan terjadi denganmelakukan penapisan awal persalinanPregnant women who experience KEK will experience malnutrition, body easily tired, pale, weak, and experience difficulties, one of which is in the delivery process. The effect of KEK on the labor process can result in difficult and prolonged labor, preterm labor, bleeding after delivery, and delivery by surgery. Puskesmas Sadananya data on pregnant women who experience KEK as many as 70 people (9.49%) and continue to other complications, namely experiencing 5 0rang abortion (3.5%), LBW 9 babies (6.3%). This type of research is a descriptive study. The population in this study were all 70 women who gave birth with a history of KEK during pregnancy in the Work Area of the Sadananya Health Center, Ciamis Regency in 2019, the sampling technique used was Simple Random Sampling. The analysis in this research is Univariate.. The results showed as many as 3 people experienced premature labor (4.3%), 1 person experienced post-saline bleeding due to uterine atony (1.4%), and 8 people went into labor by surgery (11.4%). The conclusion of this study is that pregnant women with a history of KEK experience difficulty in childbirth, although the numbers are not too significant, this of course still has to be a concern, especially how to prevent pregnant women from experiencing anemia, and if it has occurred as a midwife, of course they must be able to detecting impending complications by performing an early screening of labor.

The Effectiveness of Virgin Coconut Oil on the Decrease of Blood Glucose Levels on Gestational Diabetes Mellitus

Gestational Diabetes Mellitus (GDM) was medical complication that occurs during pregnancy and caused preterm labor. Efforts reduce blood glucose levels and improve pancreatic performance must be safe both for mother and fetus. The research aimed to prove VCO can reduce blood glucose levels in GDM. The research design was quasi-experimental with one group pre-test and post-test. The research started on March to September 2020. The population was pregnant mother with GDM from two hospitals in Mojokerto East Java. The sample was 46 respondents with purposive sampling. The treatment given was VCO at a dose of 5 ml, 6 times a day and lowcarb diet. The instrument used to measure the fasting blood glucose was glucose stick. The data was analyzed with paired t-test. The result showed blood glucose levels before intervention average of 155.19 mg/dL and after 153.50 mg/dL. The t-test value 14.442 and p value 0.000 which meant that VCO and low carb diet was more effective in reducing blood glucose levels on GDM. The administration of VCO with a low carb diet is an effort to restrict glucose intake in the body without hypoglycemia. It is safe to use for both mother and fetus as an alternative non-pharmacological therapy on GDM and prevent preterm labor

Prenatal and Postnatal Manifestations of Congenital Chloride Diarrhea Due to a Heterozygote Variant of the SLC26A3 Gene: A Case Report

Congenital chloride diarrhea (CCD) is caused by a recessive mutation in the SLC26A3 gene and characterized mainly by watery diarrhea, hypochloremia and metabolic alkalosis. Various different mutations in SLC26A3 are responsible for the disease. In the prenatal period, the symptoms of CCD may include polyhydramnios, preterm labor and abdominal distension. The main feature of CCD is chloride-rich diarrhea, which leads to excessive loss of fluid and salt immediately after birth and is followed by weight loss and dehydration. Hyponatremia and hypochloremia are soon accompanied by hypokalemia and metabolic alkalosis. Untreated CCD is fatal even in the first weeks of life. Diagnosis is made by high fecal chloride concentrations in patients with serum electrolytes corrected by salt substitution and confirmed using genetic testing of peripheral blood samples. Here, we detail prenatal and postnatal manifestations of a preterm infant, born via Caesarian section, who was suspected to suffer intrauterine bowel obstruction. Upper median laparotomy was performed and no intestinal abnormalities found. The course of the neonatal period was complicated by severe diarrhea with hypochloremia, hyponatremia and metabolic alkalosis. Based on the patient's clinical picture and stool examination, a diagnosis of CCD was established. Mutation of the SLC26A3 gene was confirmed using genetic testing.

Relationship of Notch Signal, Surfactant Protein A, and Indomethacin in Cervix During Preterm Birth: Mast Cell and Jagged-2 May Be Key in Understanding Infection-mediated Preterm Birth

Although it is thought that there is a close relationship between Notch signal and preterm birth, the functioning of this mechanism in the cervix is unknown. The efficacy of surfactants and prostaglandin inhibitors in preterm labor is also still unclear. In this study, 48 female CD-1 mice were distributed to pregnant control (PC), Sham, PBS, indomethacin (2 mg/kg; intraperitoneally), lipopolysaccharides (LPS) (25 μg/100 μl; intrauterine), LPS + IND, and Surfactant Protein A Block (SP-A Block: SP-A B; the anti-SP-A antibody was applied 20 µg/100μl; intrauterine) groups. Tissues were examined by immunohistochemistry, immunofluorescence, and Western blot analysis. LPS administration increased the expression of N1 Dll-1 and Jagged-2 (Jag-2). Although Toll-like receptor (Tlr)-2 significantly increased in the LPS-treated and SP-A-blocked groups, Tlr-4 significantly increased only in the LPS-exposed groups. It was observed that Jag-2 is specifically expressed by mast cells. Overall, this experimental model shows that some protein responses increase throughout the uterus, starting at a specific point on the cervix epithelium. Surfactant Protein A, which we observed to be significantly reduced by LPS, may be associated with the regulation of the epithelial response, especially during preterm delivery due to infection. On the contrary, prostaglandin inhibitors can be considered an option to delay infection-related preterm labor with their dose-dependent effects. Finally, the link between mast cells and Jag-2 could potentially be a control switch for preterm birth: