Relationship of Iron Consumption with Anemia in Pregnant Women

The prevalence of anemia in pregnant women in Indonesia ranges from 20-80%, but in general, many studies show anemia in pregnant women is greater than 50%. In the western part of Indonesia, the area is classified as high, anemia in Aceh is 56.6%, North Sumatra 77.9%, West Sumatra 8.9%, Riau 65.6%, Jambi 74.2%, South Sumatra 58.3, Lampung 60.7%. In pregnancy, anemia can harm maternal and infant morbidity and mortality. In a pregnant state, the supply of iron from food is still not sufficient so that a supplement is needed in the form of blood/Fe added tablets. Because the benefits of Fe tablets are very large for the prevention of anemia in pregnant women. However, there are still many pregnant women who do not consume Fe tablets up to 90 tablets. So that the administration of Fe tablets has not yet reached the target where the central government has set it. The results of Riskesdas in 2013 from 89.1% of pregnant women who consumed Fe tablets, only 33.3% consumed up to 90 Fe tablets as recommended.

To Evaluate the Effect of an Educational Programme on Breast Care Attentiveness among Young Mothers after Childbirth

The postpartum period, also known as the puerperium and the "fourth trimester," refers to the time after delivery when maternal physiologic changes related to pregnancy return to the non-pregnant state. From the day of delivery to six-eight weeks after delivery is termed as the fourth trimester. A few days after birth, the mother’s breast will swell with milk and become tender swollen, firm, and painful breasts. If the breasts are severely engorged, they are very swollen, hard, shiny, warm, and slightly lumpy to the touch. This is called engorgement. Breast care is necessary postnatally since this will avoid complications such as mastitis – infection caused due to trapped milk. Post natal education on breast care is much needed for all mothers. Mastitis, for example, is an infection that causes inflammation of the breast tissue. It’s most commonly caused by milk trapped in the breast. Untreated mastitis can lead to complications such as a collection of pus in the clogged milk ducts. Often, even well educated women seem to know very less about breast care post childbirth. Hence the present study was framed to assess on how much knowledge the new mothers possess about breast care (sample size: 60). From the results obtained we conclude that all the new mothers post the awareness rendered about breast care acquired good or adequate knowledge regarding the same when compared to pre-test. This emphasizes the need for public health interventions and awareness programs to educate as well as minimize the related complications.

Changes in DNA methylation during pregnancy and after delivery

Background Gestational adaptation takes place soon after fertilization and continues throughout pregnancy, while women return to a pre-pregnancy state after delivery and lactation. However, little is known about the role of DNA methylation in the fine tuning of maternal physiology. In this study, we investigated whether and how the DNA methylation pattern changes in the three trimesters and after delivery in ten uncomplicated pregnancies. Results DNA methylation was measured using Human MethylationEPIC BeadChip. There are 14,018 CpG sites with statistically significant changes in DNA methylation over the four time periods (p < .001). Overall, DNA methylation of the non-pregnant state was higher than that of the three trimesters (p < .001), with the protein ubiquitination pathway the top canonical pathway involved. We classified these CpG sites into nine groups according to the changes in the three trimesters. During pregnancy, most CpG sites (61.63%) had subtle or no changes in DNA methylation (Group 9). There were 3,173 (22.64%) CpG sites in Group 7 and 995 (7.1%) CpG sites in Group 8, which were the two groups with DNA methylation changes between the first and second trimesters. The top systems involved in these two groups were associated with embryonic development and organ morphological changes, as shown by the IPA analysis. Conclusion The DNA methylation pattern changes between trimesters, which may be involved in maternal adaptation to pregnancy. Meanwhile, the DNA methylation patterns during pregnancy and in the postpartum period were different, implying that puerperium repair may also act through DNA methylation mechanisms.

Molecular Markers for Metabolic Adaptation in Dairy Cows: SNAI2 Gene Variations

Background: Healthy transition from non-lactating pregnant state to non-pregnant lactating state is an important in the profitability of dairying. Though feeding and managemental practices play an important role in the adaptation to transition, animals kept on similar feeding and management exhibit differences in adaptation indicating an underlying genetic cause. In the present study, the sequence of gene SNAI2, which is considered to have an effect on metabolic adaptability has been compared among animals with apparently varying adaptability, as indicated by their β-hydroxy butyric acid (BHBA) concentration. Methods: During the period from August 2018 to May 2019, blood was collected and serum was separated from 30 pregnant cross bred (belonging to Sunandini genetic group of cross bred cattle of Kerala) dairy cows at fortnightly intervals from four weeks before the predicted day of parturition until four weeks after parturition. Concentration of BHBA was determined. Based on BHBA concentration the animals were sorted into two groups (High BHBA and low BHBA) using cluster analysis. Blood was collected, DNA extracted and SNAI2 gene amplified using custom synthesised primers. Amplicons from representative animals of each group were sequenced. The sequences obtained were aligned and compared using clustal-ω. Result: The comparison of the sequence of SNAI2 gene amongst the animals having high BHBA and those with low BHBA revealed two variations between the groups, one at promoter region, 61 bp upstream to the gene and other was at exonic region at 1560 bp. In silico structural analysis revealed difference in protein structure. The changes observed in the gene SNAI2 between the sets of animals grouped based on BHBA has to be studied on a larger population to ascertain the suitability of them being used as markers of genetic selection for metabolic adaptability, which in turn can increase the profitability of dairying.

MALIGNANT MELANOMA AND PREGNANCY

Malignant melanoma is one of the most frequent cancers diagnosed during pregnancy. Any pigmented skin lesions that change the color should be examined by an experienced dermatologist and if suspected, should be biopsied. Recent studies showed that malignant melanoma in pregnancy has not a worse outcome compared with non-pregnant state. Diagnosis of melanoma does not require an early delivery excepted pregnant patients with poor prognosis that need more aggressive treatment. Diagnosis and treatment need to be established in specialized centers with a multidisciplinary team. Pregnancy monitoring should be performed by team consisting of an obstetrician, a neonatologist and a specialist in fetal medicine.

Growth differentiation factor 15 increases in both cerebrospinal fluid and serum during pregnancy

Aim Growth differentiation factor 15 (GDF15) increases in serum during pregnancy to levels not seen in any other physiological state and is suggested to be involved in pregnancy-induced nausea, weight regulation and glucose metabolism. The main action of GDF15 is regulated through a receptor of the brainstem, i.e., through exposure of GDF15 in both blood and cerebrospinal fluid (CSF). The aim of the current study was to measure GDF15 in both CSF and serum during pregnancy, and to compare it longitudinally to non-pregnant levels. Methods Women were sampled at elective caesarean section (n = 45, BMI = 28.1±5.0) and were followed up 5 years after pregnancy (n = 25). GDF15, insulin and leptin were measured in CSF and serum. Additional measurements included plasma glucose, and serum adiponectin and Hs-CRP. Results GDF15 levels were higher during pregnancy compared with follow-up in both CSF (385±128 vs. 115±32 ng/l, P<0.001) and serum (73789±29198 vs. 404±102 ng/l, P<0.001). CSF levels correlated with serum levels during pregnancy (P<0.001), but not in the non-pregnant state (P = 0.98). Both CSF and serum GDF15 were highest in women carrying a female fetus (P<0.001). Serum GDF15 correlated with the homeostatic model assessment for beta-cell function and placental weight, and CSF GDF15 correlated inversely with CSF insulin levels. Conclusion This, the first study to measure CSF GDF15 during pregnancy, demonstrated increased GDF15 levels in both serum and CSF during pregnancy. The results suggest that effects of GDF15 during pregnancy can be mediated by increases in both CSF and serum levels.

POS0997 PERFORMANCE OF ASDAS VERSUS BASDAI DURING PREGNANCY

Background:Disease activity in patients with axial spondyloarthritis (axSpA) can be measured by BASDAI and ASDAS. Both instruments were validated in non-pregnant patients with cutoff values for active diseases. In pregnant women with axSpA, however, BASDAI and ASDAS scores might be biased by signs and symptoms of pregnancy itself.Objectives:To compare the performance of ASDAS and BASDAI during pregnancyMethods:Patients with axSpA were prospectively followed before pregnancy, at each trimester and 6 to 12 weeks postpartum. Disease activity was assessed by BASDAI, ASDAS, patient global assessment (PGA) and physician global assessment (PhGA). We analysed the disease course throughout pregnancy and postpartum, the correlation between BASDAI and ASDAS and the agreement in the classification of active disease. We applied receiver operating curves (ROC) to evaluate the cut-off points in pregnant patients.Results:The study involved 40 women with axSpA. Disease activity scores were higher during pregnancy (median ASDAS score: 2.5, median BASDAI score 3.1) than during a non-pregnant state (median ASDAS score 2.3, median BASDAI score 2.1). Median BASDAI scores were highest at the first trimester, median ASDAS scores were highest at the second trimester. ASDAS strongly correlated with BASDAI, both in the pregnant and in the non-pregnant state (r=0.796, r=0.727). However, there was a discordance when analysing the proportion of patients with high disease activity using the common cut-off values (ASDAS >2.1, BASDAS >4). More patients had high disease activity when measured by ASDAS (1st trimester (T): 63%, 2nd T: 76%, 3rd T: 61%) compared to those measured by BASDAI (1st T 43%, 2nd T: 39%, 3rd T: 34%). The κ coefficient showed only fair agreement (κ=0.39). ROC analysis among pregnant patients showed that the cut-off point estimation for high disease activity using ASDAS >2.75 corresponded to a BASDAI >4. The ASDAS >2.75 cut-off for high disease activity had a good agreement with BASDAI >4 (κ=0.657). When ASDAS >2.75 was applied in pregnant women with axSpA, about 40% experienced high disease activity.Conclusion:During pregnancy, the majority of women with axSpA experience ongoing disease activity. However, the cut-off values defining low and high disease activity might differ between pregnant and non-pregnant individuals since BASDAI and ASDAS are biased by pregnancy related symptoms like fatigue and mechanical back pain.Disclosure of Interests:None declared.

Growth differentiation factor 15 increases in both cerebrospinal fluid and serum during pregnancy

AimGrowth differentiation factor 15 (GDF15) increases in serum during pregnancy to levels not seen in any other physiological state and is suggested to be involved in pregnancy-induced nausea, weight regulation and glucose metabolism. The main action of GDF15 is regulated through a receptor of the brainstem, i.e., through exposure of GDF15 in both blood and cerebrospinal fluid (CSF). The aim of the current study was to measure GDF15 in both CSF and serum during pregnancy, and to compare it longitudinally to non-pregnant levels.MethodsWomen were sampled at elective caesarean section (n=45, BMI=28.1±5.0) and were followed up 5 years after pregnancy (n=25). GDF15, insulin and leptin were measured in CSF and serum. In addition, glucose, adiponectin and Hs-CRP were measured in blood.ResultsGDF15 levels were higher during pregnancy compared with follow-up in both CSF (385±128 vs. 115±32 ng/l, p<0.001) and serum (73789±29198 vs. 404±102 ng/l, p<0.001). CSF levels correlated with serum levels during pregnancy (p<0.001), but not in the non-pregnant state (p=0.98). Both CSF and serum GDF15 were highest in women carrying a female fetus (p<0.001), previously linked to pregnancy-induced nausea. Serum GDF15 correlated with the homeostatic model assessment for beta-cell function and placental weight, and CSF GDF15 correlated inversely with CSF insulin levels.ConclusionThis, the first study to measure CSF GDF15 during pregnancy, demonstrated increased GDF15 levels in both serum and CSF during pregnancy. The results suggest that effects of GDF15 during pregnancy can be mediated by increases in both CSF and serum levels.

CONCEPTUAL STUDY OF THE EFFICACY OF LODHRA WITH HONEY GEL IN UPAPLUTA YONIYAPAD (VAGINAL CANDIDIASIS IN PREGNANCY)

Introduction: The pregnant women are more prone to vaginal infection like vulvovaginitis, which presents a challenge for doctor today. Pregnant state produces several normal and expected changes in all the ma-ternal organ systems, from which vaginal candidiasis is one. Vaginal secretion changes during pregnancy mainly vaginal PH. Vaginal secretions during pregnancy falls from a pH of greater than 7 (an alkaline pH) to 4 or 5 (an acid pH). Due to this change in vaginal pH candida albicans growth occurs. In pregnancy, there is higher oestrogen level and higher glycogen level which helps in growth of candida. According to Ayurveda if woman during pregnancy take Kapha aggravating Ahar and Vihar excessively and suppresses the urges of vomiting and respiration, the vitiated Vayu carries Kapha to genital tract affect the same and vaginal white discharge is seen in pregnant woman due to Kapha and Vata; This is known as "Upapluta Yonivyapad". Lodhra has Kashay Ras which help in decreasing Kapha Dosha and Madhu has Tridoshahar property which cures Upapluta Yonivyapad. Aim: The present study is aimed to assess the efficacy of Lodhra with Madhu gel in Upapluta Yonivyapad. Material and Methods: The present study is done, to analyze the effect of Lodhra and Madhu gel in Upapluta Yonivyapad. Study is performed with help of var-ious previous research paper published, from various authentic Ayurvedic and Modern books as well as Samhitas. Conclusion: In pregnancy, due to Kapha and Vata there is a change in vaginal pH and vaginal white discharge; Also, there is high estrogen level which cause vaginal candida. Lodhra has property of Kaphahar, analgesic, anti-inflammatory, antibacterial, antihelminthic. Madhu is one of the five elixirs of immortality (panchamrut) and has properties like: Tridoshahar, antiseptic, antimicrobial, antiallergic, anti-inflammatory. Thus, it balances the Dosha and result in decrease (vaginal candida) Upapluta Yonivyapad. Thus, Lodhra and Madhu gel can work effectively in Upapluta Yonivyapad.

Physiology of Pregnancy

Pregnancy is associated with profound anatomical, physiological, biochemical, and endocrine changes that affect multiple organs and systems. One fertilized egg cell implanted in the lining of uterus initiates countless bodily changes. Secretion of ovarian hormones increases greatly. The bone marrow produces more RBCs and blood volume increases. The heart enlarges slightly to handle an extra supply of blood and shifts its position as uterus enlarges with the growing fetus. Such changes are necessary to help women adapt to the pregnant state and to support the growth and survival of the fetus. Such anatomical and physiological changes can also create confusion during a pregnant woman's clinical review. Likewise, changes in the biochemistry of blood during pregnancy may cause difficulties in interpreting tests. Hence, there is need to understand the deviation from normal anatomical, physiological, biochemical, and endocrine changes occurring during pregnancy so as to plan appropriate strategies for better maternal and fetal health.