The correlation between serum total bile acid and adverse perinatal outcomes in pregnant women with intrahepatic cholestasis of pregnancy (ICP) and non-ICP hypercholanemia of pregnancy.

BACKGROUND: The association between excessive serum total bile acid (TBA) and adverse perinatal outcomes in individuals with non-intrahepatic cholestasis of pregnancy (non-ICP) hypercholanemia has not been determined, and it is unclear if this link is similar to that observed in patients with ICP. OBJECTIVE: To examine the adverse perinatal outcomes in two specific subcategories: those with ICP and those with non-ICP, including individuals with liver disease and asymptomatic hypercholanemia of pregnancy (AHP), at different levels of TBA. Investigate the correlation between TBA levels and adverse perinatal outcomes of ICP, liver disease, and AHP. METHODS: From 2013 to 2021, pregnant women with excessive TBA levels were taken from the electronic medical record database of our hospital and categorized into three groups: ICP (n = 160), liver disease (n = 164), and AHP (n = 650). This was done as part of a retrospective cohort research project. Multivariable regression and subgroup analyses were performed to examine the association between TBA levels and adverse perinatal outcomes in each group. RESULTS: The study found no significant differences in adverse perinatal outcomes between the ICP and liver disease groups at different TBA levels. However, at moderate TBA levels, both groups had a higher risk of adverse perinatal outcomes than the AHP group (p < 0.017). Among liver disease cases with TBA ≥ 100µmol/L, three cases of perinatal deaths (6.67%) associated with moderate-to-severe acute hepatitis occurred between 27 and 33 weeks of gestation. A 59% higher chance of perinatal death was found for every 10 µmol/L rise in TBA, even after significant variables and confounders were taken into account (adjusted odds ratio (aOR) = 1.59; 95% confidence interval (CI): 1.06-2.40; p = 0.03). CONCLUSIONS: If a pregnant woman has moderate-to-severe liver disease and TBA ≥ 100µmol/L, preterm termination of pregnancy (before 34 weeks) may be considered.

If someone doesn't have ICP but does have moderate-to-severe hepatitis and TBA levels of 100 µmol/L or more, they should be treated more aggressively, and their pregnancies should be terminated earlier (before 34 weeks) than what is usually done for ICP.

Outcomes of pregnancies complicated by cirrhosis: a retrospective cohort study.

BACKGROUND: Although pregnancy complicated by liver cirrhosis is rare, women with cirrhosis experience increased adverse pregnancy outcomes. This study aimed to evaluate pregnancy outcomes in women with liver cirrhosis and develop a predictive model using maternal factors for preterm birth in such pregnancies. METHODS: A retrospective analysis was conducted on pregnancy outcomes of a cirrhosis group (n = 43) and a non-cirrhosis group (n = 172) in a university hospital between 2010 and 2022. Logistic regression evaluated pregnancy outcomes, and a forward stepwise logistic regression model was designed to predict preterm birth in pregnant women with cirrhosis. The model's predictive performance was evaluated using the receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC). RESULTS: The incidence of cirrhosis during pregnancy was 0.06% (50/81,554). Pregnant women with cirrhosis faced increased risks of cesarean section, preterm birth, intrahepatic cholestasis of pregnancy, thrombocytopenia, and postpartum hemorrhage. In pregnant women with cirrhosis, preterm birth risk significantly increased at an incidence rate of 46.51% (20/43). According to the prediction model, the key predictors of preterm birth in pregnant women with cirrhosis were intrahepatic cholestasis of pregnancy and total bilirubin. The model demonstrated accurate prediction, with an AUC of 0.847, yielding a model accuracy of 81.4%. CONCLUSIONS: Pregnant women with cirrhosis face a heightened risk of adverse obstetric outcomes, particularly an increased incidence of preterm birth. The preliminary evidence shows that the regression model established in our study can use the identified key predictors to predict preterm birth in pregnant women with cirrhosis, with high accuracy.

Does a longer second stage of labor worsen umbilical artery blood gas parameters in newborns?-a retrospective cohort study of 2,140 cases.

Background: With the application of the new labor management model in China, the normal length of the second stage of labor is significantly longer than that of the old model. It is unclear whether a longer stage of labor worsens umbilical artery blood gas analysis (UABGA) in newborns. The aim of this study was to investigate the correlation between the second stage of labor length, UABGA results, and neonatal intensive care unit (NICU) transfer rates under the new labor management model. Methods: This is a retrospective cohort study including full-term, cephalic, vaginal deliveries. Exclusion criteria were preterm deliveries or deliveries by cesarean section during labor. The pH, base excess (BE), and lactate results of UABGA in newborns clearly reflect neonatal metabolic acidosis and intrauterine oxygenation of the fetus. The correlation between the length of the second stage of labor and the results of UABGA and NICU transfer rate was analyzed using linear or logistic regression and curve fitting. Results: Of the total 2,140 cases, after adjusting for maternal age, gestational week, high-risk pregnancy factors, body mass index (BMI) before pregnancy, induced delivery, oxytocin during labor stage, labor analgesia, abnormal fetal position in labor stage, vaginal device delivery, length of first labor stage, and weight of the newborn, every 1 hour increase in the length of the second stage of labor decreased the UABGA pH by 0.01 [95% confidence interval (CI): -0.02 to -0.01, P<0.001], decreased the UABGA BE by 0.66 mmol/L (95% CI: -0.84 to -0.48, P<0.001), increased the UABGA lactate level by 0.39 mmol/L (95% CI: 0.29 to 0.50, P<0.001), and increased the NICU transfer rate by 26% (95% CI: 1.07 to 1.48, P=0.005). In the stratified analysis, when the length of the second stage of labor increased from 3 to 4 or more hours, there was no significant change in UABGA pH, BE, lactate, or NICU transfer rates. Conclusions: Under the new criteria for the management of labor stage, the length of the second stage increasing from 3 to 4 or more hours did not negatively impact newborns. Therefore, clinician should not be too worried about the longer second stage of labor worsening adverse outcomes in newborns.

The Role of Amnioreduction in Emergency Cervical Cerclage with Bulging Membranes: A Retrospective Comparative Study.

The purpose of this study was to investigate the role of amnioreduction in patients who underwent emergency cervical cerclage (ECC) with bulging membranes during the second trimester. This retrospective comparative study included 46 singleton pregnant women who had cervical dilation at least 1 cm with bulging membranes beyond the external cervical os and underwent ECC at the Third Affiliated Hospital of Sun Yat-sen University between December 2016 and December 2021. Cases were categorized as amnioreduction group (n = 16) and non-amnioreduction group (n = 30) according to whether amnioreduction was performed prior to ECC. The gestational age and cervical dilation at cerclage, operative time, prolongation of pregnancy, and outcomes of pregnancy were compared between the two groups. All 46 patients underwent successful ECC excepted one case with intraoperative rupture of membrane in non-amnioreduction group. In the amnioreduction group, the cervical dilation at cerclage was larger than that in the non-amnioreduction group (4.5 ± 2.2 vs. 2.2 ± 1.2 cm, P < 0.001), and had more patients with cervical dilation ≥4 cm (50.0% vs. 10.0%, P = 0.004). However, the gestational age at cerclage, operative time, prolongation of pregnancy, gestational age at delivery were not significantly different between the two groups (22.9 ± 2.8 vs. 22.9 ± 3.2 weeks, 31.1 ± 9.2 vs. 27.9 ± 11.4 min, 21.3 ± 21.5 vs. 38.7 ± 40.2 days, 25.9 ± 4.5 vs. 28.4 ± 6.1 weeks; P > 0.05). The rates of delivery ≥28 weeks, ≥32 weeks, and live birth were 20.0% vs. 80.0%, 12.5% vs. 26.7%, 56.3% vs. 66.7% (P > 0.05) in amnioreduction group and non-amnioreduction group, respectively. In conclusion, even in cases with larger cervical dilation, the application of amnioreduction with ECC is possible to get the acceptable pregnancy outcomes. These findings suggested that amnioreduction may be a safe and feasible option to be applied before ECC, especially for those with advanced cervical dilation and bulging membranes.

A five-gene signature is a prognostic biomarker in pan-cancer and related with immunologically associated extracellular matrix.

The tumor microenvironment (TME) is related to extracellular matrix (ECM) dynamics and has a broad fundamental and mechanistic role in tumorigenesis and cancer progression. We hypothesized that ECM regulators might play an essential role in pan-cancer attribution by causing a generic effect through its regulation of the dynamics of ECM alteration. By analyzing data from TCGA using GSEA and univariate Cox regression analysis, we found that ECM regulator genes were significantly enriched and contributed to mortality in various cancer types. Notably, UMAP analysis revealed that ECM regulator genes dominated the differences between tumor and adjacent normal tissues based on 59 or 31 pan-survival-related ECM gene sets. Subsequently, a five-gene signature consisting of the predominant ECM regulators ADAM12, MMP1, SERPINE1, PLOD3, and P4HA3 was identified. We found that this five-gene signature was pro-mortality in 18 types of cancer in TCGA, and validated eleven other cancer types in TCGA and seven types in the TARGET and CoMMpass databases using overall survival analysis. KEGG pathway enrichment and Pearson correlation analysis indicated that these five component genes that were correlated with specific ECM proteins involved in tumorigenesis from the ECM receptor interaction gene set. Additionally, the fitted results of a linear model were applied to strengthen the discovery, demonstrating that the five genes were correlated with immune infiltration score and especially associated with typically immunologically "cold" tumors. We thus conclude that the ADAM12, MMP1, SERPINE1, PLOD3, and P4HA3 signature showed a close association with a pan-cancer effect on prognosis and is related to ECM proteins in the TME which corresponding with immunologically "cold" cancer types.

Investigation Into the Predictive Potential of Three-Dimensional Ultrasonographic Placental Volume and Vascular Indices in Gestational Diabetes Mellitus.

Background: The use of ultrasonography in pregnancies complicated with gestational diabetes mellitus (GDM) can vary according to clinical practice. This study aims to compare the changes of placental volume (PV) and vascular indices measured by three-dimensional (3D) Power Doppler between pregnant women with and without GDM. Materials and Methods: This was a prospective study of singleton pregnancies who took the early nuchal translucency examination from January 2018 to September 2019. Data on PV and vascular indices including vascularization index (VI), flow index (FI), and vascularization flow index (VFI) between pregnant women with and without GDM were measured by 3D Power Doppler ultrasound machine. Univariate and multivariate logistic regression determined the association between risk factors and GDM. Receiver operating characteristic (ROC) and area under the ROC curve (AUC) were applied to evaluate the diagnostic value of different parameters for GDM. Results: Of the 141 pregnant women enrolled, 35 developed GDM and 106 did not. The maternal age and gravida in the GDM group were significantly higher than that in the non-GDM group. The PV, VI, FI, and VFI in the GDM group were significantly lower than that in the non-GDM group. There were no significant differences in other clinical parameters between the two groups. After adjustments in multivariate logistic regression analysis, significant differences were observed in VI [odds ratio (OR) = 0.98, 95% confidence interval (CI) = 0.951-1.002], FI (OR = 0.93, 955 CI: 0.86-1.00), and VFI (OR = 0.67, 95% CI = 0.52-0.87). ROC analysis indicated that the combination of maternal age, gravida, PV, and VFI was more accurate as a marker for detecting GDM than the PV, VI, FI, or VFI alone. Conclusions: The 3D ultrasonography results suggest that PV and vascular indices (VI, FI, and VFI) during the first trimester may serve as potential markers for GDM diagnosis. The combination of maternal age, gravida, and sonographic markers may have good diagnostic values for GDM, which should be confirmed by further investigations.

Mother-to-child transmission of hepatitis B virus after amniocentesis: A retrospective matched cohort study.

OBJECTIVE: The objective of this study is to determine whether amniocentesis increases the risk of mother-to-child transmission (MTCT) of hepatitis B virus (HBV) and evaluate risk factors for MTCT. METHODS: One hundred forty-three hepatitis B surface antigen (HBsAg)-positive women with amniocentesis were enrolled into the amniocentesis group. Six hundred five nonamniocentesis cases were matched with amniocentesis cases based on maternal viral loads, antiviral therapy regimens, and delivery dates. MTCT of HBV was defined as HBsAg and/or DNA positivity in infants from birth to age 7 to 12 months. RESULTS: Mother-to-child transmission rate was significantly higher in HBsAg-positive women with amniocentesis than in those without amniocentesis (2.80% vs 0.50%; relative risk [RR], 5.64; 95% CI, 1.28-24.93). In the amniocentesis group, maternal HBV DNA more than or equal to 7.0 log10 IU/mL and hepatitis B e-antigen (HBeAg) positivity were associated with higher MTCT rates than maternal HBV DNA less than 7.0 log10 IU/mL (10.81% vs 0%, p = .004) and HBeAg negativity (8.16% vs 0%, p = .013), and antiviral therapy reduced MTCT rate from 14.3% to 0% (p = .554) when maternal HBV DNA was more than or equal to 7.0 log10 IU/mL. CONCLUSIONS: Amniocentesis increases the risk of MTCT in women with hepatitis B, and maternal HBV DNA more than or equal to 7.0 log10 IU/mL and HBeAg positivity are risk factors for MTCT. Antiviral therapy may be effective to prevent MTCT after amniocentesis in highly viremic mothers.

Why Chinese mothers stop breastfeeding: Mothers' self-reported reasons for stopping during the first six months.

The reasons why mothers in mainland China stop breastfeeding before their infants were six months old was investigated. Five hundred sixty-two mothers within two to three days after delivery in a hospital in Guangzhou, China, were followed up via telephone interview at one, four, and six months postpartum between January and August 2015 to assess their infant's feeding patterns and mother's reasons for breastfeeding cessation. Measures included the questionnaire about sociodemographic, psychosocial, and perinatal characteristics, the Breastfeeding Outcome Questionnaire and the Breastfeeding Self-efficacy Scale-Short Form. Compared with mothers who continued breastfeeding for at least six months, the mothers who stopped breastfeeding were less likely to have attended the perinatal classes, used more inhospital formula, and were less self-efficacious regarding breastfeeding and less intention to exclusive breastfeeding. The reasons that 180 mothers stopped breastfeeding before their infants were six months old were analyzed with content analysis. The reasons given for breastfeeding cessation were insufficient milk supply, medical reasons, lactational factors, and return to work. Lactational factors were nipple soreness and mastitis. In order to prolong breastfeeding, pregnant women should be encouraged to attend more prenatal classes. Attendance would enhance self-efficacy and intention to breastfeed longer. Strategies helping working mothers to continue breastfeeding are also needed.

Knowledge of and attitudes towards hepatitis B and its transmission from mother to child among pregnant women in Guangdong Province, China.

BACKGROUND: Hepatitis B virus (HBV) infection remains a serious public health problem worldwide. Mother-to-child transmission (MTCT) of HBV is the major mode of transmission in HBV-endemic areas, including China, where little is known about pregnant women's knowledge of and attitudes towards HBV infection and MTCT. METHODS: A cross-sectional survey, conducted in pregnant women in Guangdong Province, China, measured HBV knowledge and attitudes using a questionnaire, at one tertiary and two rural hospitals. RESULTS: The total response rate was 94.5% (737/780). Of the 11 knowledge questions, the mean score was 6.73 ± 3.04 (mean ± SD). Most pertinent to preventing MTCT, 53.3% of the respondents did not know that HBV can be transmitted through unprotected sexual intercourse and nearly 20% did not know that HBV can be transmitted from mother to infant. The results of the four attitude questions was better with 83% and 85% being willing to be screened for HBV and let their baby receive HBV vaccine and HBIg, respectively. However, only 16.5% of respondents agreed that they would be willing to take drugs that are known not to harm the fetus to prevent MTCT of HBV. In multivariable analysis, higher education level was associated with better knowledge and attitude scores. CONCLUSIONS: Knowledge about HBV among pregnant women was poor and needs to be improved to prevent MTCT of HBV. Health education needs to be directed towards pregnant mothers, particularly less educated mothers, in high HBV endemicity settings.

Intestinal obstruction due to congenital malrotation complicating a multiple pregnancy: A rare case report.

Intestinal obstruction due to congenital intestinal malrotation is usually diagnosed in neonates but may, in rare cases, occur during pregnancy. The absence of specific symptoms in combination with its low incidence makes timely detection of intestinal malrotation-related obstruction difficult in expectant mothers. We present a rare case of a 23-year-old woman with a twin pregnancy following in vitro fertilization-embryo transfer (IVF-ET) who presented with symptoms of intestinal obstruction at 22+4 weeks of gestation. This diagnosis was not confirmed by imaging and the patient was managed conservatively. Following caesarean section, she gave birth to two healthy full-term infants. During the operation, malposition of the bowel and the typical Ladd's band confirmed intestinal malrotation. This is the first report of a congential malrotation complicating a multiple pregnancy, and highlights that malrotation without volvulus can be managed conservatively.

Effectiveness of acupuncture versus spinal-epidural anesthesia on labor pain: a randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness of acupuncture analgesia (AA) compared with combined spinal-epidural anesthesia (CSEA) for labor pain relief and labor outcomes. METHODS: We evaluated 131 primiparous women who received respiratory guidance during maternal uterine contractions and received either AA (n = 43), CSEA (n = 45), or no additional treatment (control, n = 43). The groups were compared regarding visual analog scale (VAS) scores for abdominal and back pain, and labor outcomes. RESULTS: The abdominal VAS scores of the AA and CSEA groups were significantly lower than that of the control group. In addition, the VAS scores of the CSEA group were significantly lower than that of the AA group at 10 and 60 min after intervention. The back pain VAS scores of the AA and CSEA groups were significantly lower than that of the control group at 5, 10, and 60 min after intervention. The duration of the active phase of labor in the CSEA group was significantly longer than that of the AA and control groups. The rates of oxytocin use (4.70%), urinary retention (4.70%), and postpartum hemorrhage [(273.7 ± 53.6) mL] in the AA group were significantly lower than in the CSEA group [46.70%, 24.20%, and (320.0 ± 85.6) mL, respectively]. CONCLUSION: Both AA and CSEA were effective for labor pain relief, CSEA provided more effective pain relief, while AA was associated with a shorter duration of labor and fewer adverse effects.and each has its advantages and disadvantages.

Telbivudine treatment of hepatitis B virus-infected pregnant women at different gestational stages for the prevention of mother-to-child transmission: Outcomes of telbivudine treatment during pregnancy.

This prospective study evaluated the viability of telbivudine for blocking mother-to-child transmission (MTCT) of hepatitis B virus (HBV) infection.Pregnant women positive for the hepatitis B surface antigen began telbivudine treatment before 14 weeks of gestation (i.e., early), between 14 and 28 weeks of gestation (late), or not at all (control). In the late-treatment group, 55 women terminated telbivudine therapy within puerperium. All neonates underwent routine hepatitis B immunoglobulin plus vaccination. Mothers and infants were followed for 7 months after birth.Pregnancy outcomes were similar among the 3 groups. HBV MTCT rates in the early and late treatment and control groups were 0, 0, and 4.69%, respectively. The rates of infant vaccination success among the 3 groups were similar, as were neonatal outcomes including birth weights, asphyxia, hyperbilirubinemia, Apgar score, birth defects, and weight and height at 7 months. Puerperal discontinuation of telbivudine did not increase the alanine transaminase value at 7 months after birth, but increased serum HBV DNA levels, and rates of positive hepatitis Be-antigen.Telbivudine treatment in HBV-infected pregnant women was associated with lower serum HBV DNA levels and reduced rates of HBV MTCT; there were no associated changes in pregnancy or neonatal outcomes at birth or 7 months after birth, or in the rate of infant vaccination success. Puerperal drug withdrawal after short-term antiviral therapy will not influence hepatic function, but may increase virus replication.

The Association of Pre-S/S Gene Mutations and Hepatitis B Virus Vertical Transmission.

BACKGROUND: HBV Pre-S/S gene mutations can occur before or after implementation of combined vaccination program. HBV Prs-S/S gene mutation is a risk factor of vaccination failure and frequently causes HBV vertical transfection. OBJECTIVES: To assess the association of hepatitis B virus (HBV) S gene mutations with vertical transmission. PATIENTS AND METHODS: In this prospective nested case-control study, a total of 60 pregnant women with positive serum HBsAg and HBV DNA ≥ 10(7) IU/mL were divided into a case group (15 cases with vaccination failure) and a control group (45 cases with vaccination success) according to whether their infants tested positive for HBV infection. Mothers and their children in the case group were further sub-divided into groups including mothers, newborns and infant (the same newborns at age of seven months). The pre-S/S gene mutations were detected by PCR and sequenced and its association with vertical transmission of HBV was analyzed. RESULTS: HBV genotype B was the dominant genotype in the both groups' mothers. Each mother-child pair in case group had the same HBV genotype. There were no significant differences in mutation frequencies of HBV Pre-S/S gene between case and control groups' mothers (Fragment 1 (M): 2 vs. 4, P > 0.05; Fragment 2 (M): 10 vs. 10, P > 0.05), or among the mothers, newborns and infants in the case group (Fragment 1 (M): 2, 2, and 3, respectively, P > 0.05; Fragment 2 (M): 10, 10 and 10 respectively, P > 0.05). Mutation site analysis of the both groups' mothers demonstrated 108 different mutation sites in the HBV pre-S/S gene, with 105 silent mutations and 5 missense mutations including ntA826G, ntC531T, ntT667C, ntC512T and ntC546A. Among 15 mother-newborn-infant pairs with successful PCR and sequence in case group, 7 (41.17%) mother-newborn pairs, 9 (60.00%) mother-infant pairs and 3 (20.00%) infant-newborn pairs had different mutation sites. CONCLUSIONS: HBV in children due to vaccination failure was resulted from vertical transmission. HBV Pre-S/S gene mutations were prevalent and could occur before or after vaccination. Therefore, simply analyzing mutation frequency of HBV gene was not of value. To advance blocking HBV vertical transmission, future studies should focus on specific mutation sites, potentially associated with vaccination failure.

Arsenic-induced anti-angiogenesis via miR-425-5p-regulated CCM3.

Human exposure to drinking water contaminated with arsenic is a serious global health concern and it predisposes people to cardiovascular diseases, such as hypertension, atherosclerosis, and microvascular diseases. Although accumulating evidence supports a role for angiogenesis responses to arsenic in the pathogenesis of the cardiovascular disease, the detailed molecular mechanism is not well understood. We aimed to determine the role and mechanism of microRNA (miRNA) in arsenic-induced angiogenesis. In our present study, sodium arsenite (NaAsO2) inhibited angiogenesis by decreasing cells proliferation, migration and tube formation in HUVECs. After NaAsO2 treatment, we found the expression of microRNA-425-5p (miR-425-5p) was reduced in vitro and in vivo and over-expression of miR-425-5p reversed the NaAsO2-induced anti-angiogenesis through its direct target cerebral cavernous malformation 3 (CCM3). Furthermore, we showed that NaAsO2 up-regulated CCM3 expression in vitro and in vivo. In addition, we demonstrated that inhibition of Notch and activation of VEGF/p38 signaling were involved in miR-425-5p blocking NaAsO2-induced anti-angiogenesis.

Utility of Pregestational Body Mass Index and Initial Fasting Plasma Glucose in Predicting Gestational Diabetes Mellitus.

OBJECTIVE: The present study aimed to evaluate the pregestational body mass index (preBMI) and initial fasting plasma glucose (FPG) in predicting gestational diabetes mellitus (GDM) in southern Chinese women. STUDY DESIGN: A total of 327 pregnant women were recruited from the third affiliated hospital of Sun Yat-Sen University, Guangzhou, China. The preBMI and initial FPG at 16-18 weeks' gestation were measured. Oral glucose tolerance test was performed at 24-28 weeks' gestation. The sensitivity and specificity of preBMI and initial FPG as predictors for GDM were evaluated by receiver-operator characteristic curve analysis. RESULTS: Both preBMI and initial FPG correlated with the 0-hour, 1-hour and 2-hour plasma glucose during oral glucose tolerance test (P < 0.05). The area under receiver-operator characteristic curve was 0.63 (95% CI: 0.57-0.68) for preBMI and 0.68 (95% CI: 0.61-0.72) for initial FPG in diagnosing GDM. The optimal cutoff for preBMI was 21.5 kg/m(2) (sensitivity 52.1% and specificity 69.2%) and 4.6 mmol/L (sensitivity 64.6% and specificity 65.2%) for initial FPG. Interestingly, the initial FPG had a better sensitivity compared to preBMI when the specificity was the same. Multivariate logistic regression analysis showed that initial FPG but not preBMI was the independent risk factor for the later development of GDM. After adjustment for the preBMI and the maternal age, the odds ratios of initial FPG and parity were 3.57 (95% CI: 1.72-7.45) and 2.11 (95% CI: 1.20-3.72). CONCLUSIONS: Although both preBMI and initial FPG could be used as indicators for GDM, the initial FPG may be more suitable for predicting GDM in southern Chinese women.

Human chorionic gonadotropin improves endometriosis through downregulation of leptin expression in rats.

OBJECTIVE: To investigate whether and how human chorionic gonadotropin (HCG) treatment ameliorates endometriosis in an endometriotic rat model. METHODS: Twenty-four endometriosis rats were established and were randomly divided into four groups, and then the rats were treated with 19.4, 25.8, and 51.6 IU/100 g weight/day of HCG, respectively. The control group was treated with 0.9% NaCl. After 15 days (3 estrous cycles), the ectopic lesion volume and the expression of leptin protein in eutopic and ectopic endometrium were investigated. RESULTS: After HCG treatment, the volumes of endometriotic lesions were significantly smaller than those before treatment. During endometriosis development, the expression of leptin protein in eutopic and ectopic endometrium was remarkably increased. HCG administration reversed leptin upregulation in endometriotic tissues. CONCLUSION: HCG therapy appears to be an effective treatment for endometriosis in rats through down-regulation of leptin expression in eutopic and ectopic endometrium.

[Application of methylation-specific multiplex ligation-dependent probe amplification for the study of DNA methylation in placenta tissues].

OBJECTIVE: To study the feasibility of using methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) for the detection of DNA methylation in placenta tissue. METHODS: For blood cells from 13 non-pregnant women and 9 euploid placenta, the ratios of DNA methylation were evaluated for 4 genes including CGI149, CGI113, HLCS and ACTB with MS-MLPA and bisulfite sequencing, respectively. RESULTS: The methylation ratio of the ACTB gene was 0-0.1 for the blood cells when the digestion control was completely digested. The cutoff value for the methylation ratio of MS-MLPA has been determined as 0.1. For the 9 placenta samples, results of MS-MLPA and bisulfite sequencing were concordant for all of the four genes. CONCLUSION: MS-MLPA is an effective alternative to bisulfite sequencing for the assessment of methylation ratios in placental tissues.

Placental methylation markers in normal and trisomy 21 tissues.

OBJECTIVE: The objective of this study is to combine multiplex ligation-dependent probe amplification (MLPA) and bisulfite sequencing to determine DNA methylation markers for noninvasive prenatal diagnosis of Down syndrome. METHODS: DNA methylation ratios (MR) of four fragments (CGI149, CGI045, HLCS-1, and HLCS-2) on chromosome 21 were evaluated in blood cells from 13 nonpregnant women, 15 euploidies, and 11 Down Syndrome (DS) placentae. Ratios were measured by bisulfite sequencing and methylation-specific (MS)-MLPA. RESULTS: The MS-MLPA and bisulfite sequencing results were concordant. CGI149, CGI045, and HLCS-2 were unmethylated in all nonpregnant blood cells. CGI149, CGI045, HLCS-1, and HLCS-2 were methylated in most of the euploid (13, 11, 15, and 15, respectively) and DS placentae (10, 11, 11, and 11, respectively). The median placental DNA MR in CGI149 was 0.4578 (interquartile range, 0.3568-0.5169) and 0.5918 (interquartile range, 0.5618-0.6659) in euploid and DS placentae, respectively (p = 0.001). Using placental MR at 0.5390 as a threshold, we detected DS at 90.9% sensitivity and 93.3% specificity. CONCLUSION: The MS-MLPA is an effective alternative to bisulfite sequencing in assessing placental MR. CGI149 is a potential marker for the noninvasive diagnosis of Down syndrome.

Development of strategies for screening, predicting, and diagnosing intrauterine HBV infection in infants born to HBsAg positive mothers.

This study aimed at developing strategies for screening, predicting, and diagnosing intrauterine HBV infection in infants born to HBsAg positive mothers. A total of 1,360 infants born to 1,355 HBsAg positive mothers were followed for 1 year. All newborn infants received active and passive immunization within 24 hr after birth. Maternal and infant blood samples were collected and tested for the status of serum HBsAg, HBeAg, and HBV DNA positivity. The accuracy of infant HBsAg positivity, HBV DNA positivity, HBsAg and HBV DNA double positivity, and HBsAg and/or HBV DNA positivity at birth in the diagnosis of intrauterine HBV infection was evaluated by receiver operating characteristic curve analysis. Of 1,360 infants, 145 tested positive for HBsAg and/or HBV DNA at birth. Twenty-one (1.5%) infants, who were diagnosed with intrauterine HBV infection, showed HBsAg positivity from birth to 7 and 12 months of age. Infant HBsAg positivity at birth had the highest sensitivity in predicting intrauterine HBV infection, while neonatal HBsAg and HBV DNA double positivity had the highest specificity. These findings suggest that infants, who were born to HBsAg positive mothers and were positive for both HBsAg and HBV DNA at birth, may be at a higher risk for intrauterine HBV infection. HBsAg positivity at birth may be a good marker for screening intrauterine HBV infection. Infant HBsAg positivity both at birth and 7 months of age may be used as a diagnostic criterion to simplify diagnostic procedures and improve diagnostic efficiency.

[Identification of risk factors related to the failure of immunization to interrupt hepatitis B virus perinatal transmission].

OBJECTIVE: To explore the factors influencing failure of an immunization to interrupt perinatal (mother-to-child) transmission of hepatitis B virus (HBV). METHODS: Between June 2006 and March 2010, a total of 1355 pregnant women testing positive for the hepatitis B surface antigen (HBsAg), at gestational weeks 20 to 42, and without use of antiviral or immunomodulatory drugs during the pregnancy were prospectively recruited to the study. The mothers were given a choice of receiving hepatitis B immunoglobulin (HBIG; three 200 IU intramuscular injections give at four-week intervals starting from gestation week 28) or not. All neonates (1360, including five sets of twins) received hepatitis B vaccine (10 mug) plus HBIG (200 IU) combined immunization within 24 h of birth, as early as possible. Peripheral venous blood samples were collected from the neonates within 24 h of birth and at 7 and 12 months of age for detection of HBV markers, including hepatitis B e antigen (HBeAg) and HBV DNA. The infants were classified according to HBV perinatal transmission status (infection group and non-infection group) and various factors (maternal-related: age, gravidity, parity; pregnancy/birth-related: threatened premature labor, complications; neonate-related: sex, birth weight, apgar score) were compared between the two groups by using non-conditional logistic regression analysis to determine their potential influence on failure of immunization to inhibit transmission. RESULTS: After 12 months of follow-up, 1.54% (21/1360) of the neonates had presented with HBV infection. Analysis of the HBV-infected neonates revealed differences in infection rates between neonates born to mothers with HBIG injection (2.22% vs. without HBIG injection: 1.11%, P less than 0.05) and caesarean section (1.35% vs. vaginal delivery: 1.73%) but neither reached statistical significance (P less than 0.05); only the practice of breastfeeding showed a significant difference for infection rate, with neonates fed artificial formula having higher infection rate (3.13%) than the breastfed neonates (0.27%, P less than 0.05). The neonate HBV infection rate was also significantly higher for neonates born to HBeAg-positive mothers (4.44% vs. HBeAg-negative mothers: 0%, P less than 0.05) and HBV DNA-positive mothers (3.13% vs. HBV DNA-negative mothers: 0%, P less than 0.05). When the mothers were stratified by serum level of HBV DNA, there was a significant difference in HBV-infected neonates born to mothers with more than or equal to 1*10(7) IU/ml(6.01% vs. 10(3)-10(6) IU/ml: 0.56% and less than 1*10(3) IU/ml: 0%, both P less than 0.05). Logistic regression analysis indicated that the independent risk factors for HBV perinatal transmission despite immunization were maternal serum HBeAg-positive status (relative risk (RR)=31.74, 95% confidence interval (CI): 3.88-259.38) and maternal HBV DNA of ≥ 107 copies/mL (RR=22.58, 95% CI: 4.75-107.40). CONCLUSION: Failure of vaccine plus HBIG to interrupt mother-to-child transmission of HBV is influenced by maternal serum HBeAg-positive status and maternal HBV DNA of ≥107 copies/mL.