Extravillous trophoblast cell lineage development is associated with active remodeling of the chromatin landscape.

The extravillous trophoblast cell lineage is a key feature of placentation and successful pregnancy. Knowledge of transcriptional regulation driving extravillous trophoblast cell development is limited. Here, we map the transcriptome and epigenome landscape as well as chromatin interactions of human trophoblast stem cells and their transition into extravillous trophoblast cells. We show that integrating chromatin accessibility, long-range chromatin interactions, transcriptomic, and transcription factor binding motif enrichment enables identification of transcription factors and regulatory mechanisms critical for extravillous trophoblast cell development. We elucidate functional roles for TFAP2C, SNAI1, and EPAS1 in the regulation of extravillous trophoblast cell development. EPAS1 is identified as an upstream regulator of key extravillous trophoblast cell transcription factors, including ASCL2 and SNAI1 and together with its target genes, is linked to pregnancy loss and birth weight. Collectively, we reveal activation of a dynamic regulatory network and provide a framework for understanding extravillous trophoblast cell specification in trophoblast cell lineage development and human placentation.

Attitudes toward Rubella and Varicella Vaccination during Preconception Care.

INTRODUCTION: Studies of anti-vaccine attitudes in the perinatal time period previously have not paid special attention to the MMR and varicella vaccines. Because both contain live attenuated virus, a contraindication during pregnancy, it is important to assess barriers to vaccination clinically during preconception to avoid the known fetal morbidity associated with congenital rubella or varicella infection. METHODS: The primary outcome of this study was to determine prevalence of patients with nonimmune status for rubella and varicella in the setting of advanced reproductive care. Secondary outcomes of interest included further understanding nonimmune reproductive-aged women's attitudes toward MMR and varicella vaccination during preconception. Patient records with laboratory orders for rubella or varicella immunoglobulin titers, placed at the KU Advanced Reproductive Care clinic between January 2017 and June 2020, were reviewed (n = 2,217). A cross-sectional survey was administered to patients with a laboratory reported negative titer result. RESULTS: Prevalence of nonimmunity to either rubella or varicella represented 6.0% (n = 134) and 3.8% (n = 85) of records, respectively; nineteen records (0.6%) demonstrated nonimmunity to both. The women who did not receive recommended vaccines following a non-immune titer result (n = 19) most commonly cited their rationale was to not delay fertility treatment further (n = 8), a requirement when receiving live attenuated virus vaccines. CONCLUSIONS: The prevalence of nonimmune persons in the study population fell within the range recognized to be sufficient for herd immunity. The majority of survey respondents indicated that CDC recommended vaccinations were of high personal importance, with strong congruence of thought among those who answered in favor of vaccines when posed with several true or false statements about personal beliefs and vaccine efficacy. The risk/benefit analysis of postponing fertility treatment to achieve adequate levels of immunity should be a focused discussion when establishing fertility treatment goals with patients in the setting of advanced reproductive care.

Chromium picolinate improves insulin sensitivity in obese subjects with polycystic ovary syndrome.

Trivalent chromium (1000 microg), as chromium picolinate, given without change in diet or activity level, caused a 38% mean improvement in glucose disposal rate in five obese subjects with polycystic ovary syndrome who were tested with a euglycemic hyperinsulinemic clamp technique. This suggests that chromium picolinate, an over-the-counter dietary product, may be useful as an insulin sensitizer in the treatment of polycystic ovary syndrome.