Lack of nitric oxide bioavailability in early pregnancy predisposes to dyslipidemia and surges preeclampsia and fetal growth retardation

Background: Hyperlipidemia has been reported in preeclampsia (PrE) and is linked to poor pregnancy outcome and long-term cardiovascular complications. This study aimed to elucidate the relationship between nitric oxide (NO) and blood lipids levels during normal pregnancy and in NG-nitro-l-arginine methyl ester (L-NAME) - induced preeclampsia before and after magnesium sulphate (MgSO4) therapy and its effect on the pregnancy outcome.Methods: Forty female Wistar rats were divided into four groups: non pregnant (NP) group - non pregnant healthy rats receiving no treatment, control pregnant (Con-P) group - control pregnant rats receiving no treatment, pregnant (PE) group - pregnant animals with untreated PrE, and the pregnant MgSO4 (PE-Mg) group - pregnant animals with PrE- treated with MgSO4. The nitric oxide synthase inhibitor L-NAME was used to induce experimental model of PrE in the PE and the PE-Mg groups. The changes in total NO production, total cholesterol (TC), triglycerides (TG), low density lipoproteins (LDL-C), high density lipoproteins (HDL), LDL-C/HDL-C ratio, soluble vascular endothelial growth factor receptor-1 (sVEGFR1) also known as sFlt-1, blood pressure, kidney functions, body weight, and pregnancy outcome were assessed.Results: Decreased NO production in the PE group was associated with elevated TC, TG, LDL-C/HDL-C ratio, hypertension, proteinuria, increased urea, creatinine, and sFlt-1 levels, and poor pregnancy outcome demonstrated by high pup mortality rate and low birth weight. Increased NO production in the PE-Mg group treated with MgSO4 therapy was associated with decreased signs of preeclampsia and hypolipidemia and increased pup viability and birth weight.Conclusions: NO bioavailability is crucial for the homeostasis of the lipid profile in normal pregnancy and the prevention of preeclampsia. Routine periodic assessments of the blood lipid profile and the NO production in the pregnant females may be a helpful tool in early prediction of preeclampsia.

Study of iron deficiency anemia in pregnant women attending antenatal care clinic in tertiary care hospital in northern India

Background: Anemia is major health problem in developing countries with many underlying etiologies, particularly nutritional deficiencies. Pregnant women are prone to become anemic, and anemia leads to increased morbidity and mortality in mother along with poor pregnancy outcome. This study focused on evaluation of anemia in pregnant women attending antenatal clinic in northern India.Methods: Total 1000 pregnant women attended antenatal clinic were enrolled and were evaluated for anemia, and various red blood cell indices were studied.Results: Prevalance of anemia in this study population was 80%, while relative prevalance of mild, moderate and severe anemia was 33.5%, 48.5% and 20% respectively. Majority of cases were because of iron deficiency anemia.Conclusions: Prevalance of anemia is very high in pregnant women which is a major cause for poor pregnancy outcome. Measures need to be taken at various level to improve nutritional status of pregnant women.

Pregnancy in unicornuate uterus without rudimentary horn: a case report

A unicornuate uterus is associated with numerous obstetric and gynaecological complications such as infertility, endometriosis, miscarriage, malpresentations, and intrauterine growth restriction. Around 2.3-13% of Mullerian duct anomalies present as unicornuate uterus. Management of unicornuate uterus is still uncertain and it leads to poorer pregnancy outcome. We present here a case of 26-year-old primigravida who presented to us with 40-weeks pregnancy associated with breech presentation. She was taken for elective caesarean section and intra-operatively she was found to have unicornuate uterus without rudimentary horn. Unicornuate uterus is associated with poor pregnancy outcome but a successful pregnancy is possible. Usual presentation of patients with unicornuate uterus is near their menarche and they have higher than usual gynaecological complications. Pregnancies in unicornuate uterus are prone to intra uterine growth restriction hence serial ultrasound should be done for regular fetal growth monitoring.

Controlled Internal Drug Release (CIDR) Based Hormonal Protocols Effect upon Estrus Response and Pregnancy Outcome in Anestrous Cows

Controlled internal drug release (CIDR) based hormonal protocols CoSynch + CIDR, OvSynch + CIDR and CIDR + PGF2α were applied to 25 crossbred anestrous Holstein and Jersey cows to improve the fertility at the farm of National Cattle Research Programme, Rampur, Chitwan. All three protocols were found equally effective (P>0.05) with 100% estrus expression rate, out of which, 80% (8/10), 85.7% (6/7) and 75% (6/8) had estrus expression with well cervix open at fixed time artificial insemination in CoSynch + CIDR, OvSynch + CIDR and CIDR + PGF2α protocols respectively and rest had estrus expression with partial cervix open. Statistically non-significant (P>0.05) pregnancy outcome that is 14.3 % (1/7) in CIDR+PGF2α group and 12.5 % (1/8) in OvSynch group while none in CoSynch + CIDR group were pregnant following fixed time artificial insemination. Poor pregnancy outcome of the anestrous cows in all protocols might not only have hormonal problem but also could have various other reasons which was beyond the objective of this research findings. Hence, study concludes anestrous cows respond well to the CIDR based hormonal protocols to revive the estrus.

Risk Factors of Poor Pregnancy Outcome in Living Kidney Donors in UK

Despite thousands of kidney donations every year across the world, there is a decline in donations particularly within the BAME (Black Asian Minority and Ethnic community). Young female faces a dilemma of future pregnancy when considering the decision to donate a kidney. The study aims to describe the risk in pregnancy based on ethnicity, gender and regional variations.

Effect of aspirin response signature gene expression on preterm birth and preeclampsia among women with lupus: a pilot study

Background Women with lupus have an increased risk of preeclampsia and preterm birth, and aspirin 81 mg/day is recommended as a preventative measure for preeclampsia. This pilot study quantified the association between a 60-gene aspirin response signature (ARS) gene expression with preterm birth and preeclampsia risk among women with lupus taking aspirin. Methods The analysis included 48 RNA samples from 23 pregnancies in the Duke Autoimmunity Pregnancy Registry. RNA was isolated from peripheral blood, and quantitative polymerase chain reaction was performed for ARS genes. The primary outcome was poor pregnancy outcome (preeclampsia or preterm birth). Gene expression was modeled as a response to presence or absence of a poor pregnancy outcome using linear regression models, stratified by trimester. Results Of the 23 pregnancies, nine delivered preterm and four had preeclampsia. Expression of PBX1 and MMD was higher in the second trimester among patients who experienced a poor pregnancy outcome compared to those who did not. However, in a global test of all ARS genes, we identified no association between expression of ARS genes and poor pregnancy outcomes. Conclusion Our pilot study identified two candidate genes that are reflective of the platelet function response to aspirin. Further work is needed to determine the role of these genes in identifying women with lupus at high risk for preeclampsia and preterm delivery despite aspirin therapy.

Variation in C-reactive protein at 1 month post-partum by etiology of preterm birth: selective identification of those at risk for both poor pregnancy outcome and future health complications

Objective To assess post-partum inflammation for patients delivering prior to 34 6/7 weeks by birth etiology. Methods This was an observational study of early preterm birth (PTB) occurring between 20 0/7 and 34 6/7 weeks of gestation. Serum C-reactive protein (CRP) levels were measured 1 month post-partum. CRP measurements were compared by birth etiology. Results A total of 399 women were analyzed. Distribution of birth etiology was 35% (n = 138) preterm labor (PTL), 28% (n = 115) preterm premature rupture of membranes (pPROM), and 37% (n = 141) indicated preterm birth (IPTB). Serum CRP varied by birth etiology (P = 0.036). Women with pPROM had elevated median CRP levels compared to women with PTL (P = 0.037). IPTB demonstrated elevated CRP levels when compared to PTL (P = 0.019). Pre-eclamptic/eclamptic subjects exhibited increased median CRP levels compared to PTL (P = 0.04). Conclusion Post-partum inflammation varies by birth etiology. Such variation may serve as identification of subjects whose future pregnancies and, ultimately, overall health status may benefit from inter-pregnancy interventions aimed at reducing inflammatory-associated risk factors.