Preconception Vitamin D Level and In Vitro Fertilization: Pregnancy Outcome.

OBJECTIVE: Vitamin D deficiency impairs female fertility and the success of in vitro fertilization (IVF). The recommended serum 25-hydroxyvitamin D (25(OH)D) level in IVF-conceived pregnancies is still debated. We aimed to explore the relationship of the preconception serum 25(OH)D level with pregnancy outcome following IVF treatment. We also explored the utility of the currently recommended serum 25(OH)D cutoff of ≥50 nmol/L for women undergoing IVF therapy. METHODS: Retrospective cohort of women who had undergone IVF therapy. Of the women who started IVF therapy (n = 354), 218 completed the study. They were divided into 2 groups: (1) women who achieved a successful pregnancy (pregnant group, n = 160) and (2) those who did not achieve a successful pregnancy (nonpregnant group, n = 58). Preconception serum samples were analyzed for reproductive hormones, fasting glucose, insulin, and 25(OH)D levels. RESULTS: Overall, the median (interquartile range) age, body mass index, and hemoglobin A1c level were 32 (6) years, 25.7 (7.4) kg/m2, and 5.2% (0.6%), respectively. The 25(OH)D level was significantly higher at preconception in the pregnant group (56.4 [21.4] vs 47.9 [29.16] for nonpregnant, P = .001). The preconception 25(OH)D level was a significant predictor of IVF outcome (B = 0.04; 95% CI, 1.01-1.06; P = .001), with greater IVF success associated with a serum 25(OH)D level of ≥50 nmol/L (odds ratio, 0.46; P = .01). CONCLUSION: Preconception 25(OH)D sufficiency (≥50 nmol/L) is associated with successful pregnancy outcome following IVF therapy.

Knowledge and attitude of reproductive-aged women towards planned oocyte cryopreservation in the United Arab Emirates.

BACKGROUND: Delayed conception is associated with a decline in oocyte number and quality. Oocyte cryopreservation techniques are used for medical or non-medical (elective) reasons. We aim to assess the knowledge and attitudes towards planned oocyte cryopreservation (POC) among reproductive-aged women in the United Arab Emirates (UAE) and to investigate the factors interfering with their decisions. METHODS: A cross-sectional study on 422 women (18-38 years) living in the UAE, using an online questionnaire with three sections: sociodemographic, knowledge, and attitudes towards POC. RESULTS: 91.2% of participants have heard of POC, 84.1% hold a bachelor's degree or higher, 65.4% with medical background, 54.3% employed, and 79.2% live in Sharjah and Dubai. Consideration of POC was significantly associated with age (p = 0.011), employment (p = 0.002), the Emirates they live (p < 0.001), and if they have heard of POC (p = 0.036). Mean knowledge score was 44.44%, which was significantly higher among those considering POC (49.66% vs. 40.55%), and social media was their main source of information. About 57% will not consider POC, mainly due to cost, cultural issues, and safety. Determinants of knowledge score were marital status (B = 0.44; 95%CI: 0.09-0.79; p value = 0.014) and education level (B = 0.35; 95%CI: 0.13-0.58; p value = 0.002), and after adjustment, only the education level remained significantly associated with knowledge score (B = 0.24; 95%CI: 0.01-0.47; p value = 0.042). CONCLUSION: Despite many participants being motivated to undergo POC, majority had poor knowledge, and cost was the main barrier. The main determinant of the knowledge score was education level. Awareness among couples of consequences of delaying childbearing and comprehensive information from medical practitioners are highly needed.

Early Predictors of Gestational Diabetes Mellitus in IVF-Conceived Pregnancies.

OBJECTIVE: Gestational diabetes mellitus (GDM) is associated with adverse maternal and fetal outcomes. This study aimed to identify early and reliable GDM predictors that would enable implementation of preventive and management measures. METHODS: The participants were a 28-week prospective cohort of in vitro fertilization (IVF)-conceived pregnant women (≤39 years, body mass index [BMI] 18.5-38 kg/m2) without a known history of diabetes mellitus. Fasting blood samples were analyzed at baseline (pre-IVF) and 12 weeks' gestation for reproductive hormones, glucose, serum insulin, lipids, thyroid function, adiponectin, and lipopolysaccharide-binding protein. At 28 weeks, a 75-g oral glucose tolerance test was used to screen for GDM. RESULTS: For the overall group at baseline, 22% had BMI ≥30 kg/m2, 45% had polycystic ovary syndrome, 16% had hemoglobin A1C of 5.7% to 6.1%, and 14% had a past history of GDM. At 28 weeks of gestation (n = 158), 34 women had developed GDM and 124 had not. Significant baseline predictors of GDM onset included greater BMI (29.0 vs 25.8 kg/m2), older age (34 vs 32 years), higher levels of follicle-stimulating hormone/luteinizing hormone ratio (1.2 vs 1.0), hemoglobin A1C (5.5 vs 5.2%), insulin (10.6 vs 7.1 µIU/mL), homeostatic model assessment of insulin resistance (2.2 vs 1.7), total cholesterol (199 vs 171 mg/dL), and low-density lipoprotein cholesterol (123 vs 105 mg/dL), and lower triglyceride levels (74 vs 76 mg/dL). Significant 12-week GDM predictors included greater maternal weight gain (delta: 3.4 vs 1.5 kg) and higher levels of insulin (11.3 vs 7.6 µIU/mL), triglycerides (178 vs 120 mg/dL), and homeostatic model assessment of insulin resistance (2.3 vs 1.5). Twelve-week BMI is a predictor of GDM following adjustment for polycystic ovary syndrome status and maternal age. CONCLUSION: While preconception maternal BMI, age, and follicle-stimulating hormone/luteinizing hormone ratio are predictors of subsequent development of GDM, early IVF-conceived gestational weight gain is the best predictor of GDM onset.

Impact of coronavirus 2019 on mental health and lifestyle adaptations of pregnant women in the United Arab Emirates: a cross-sectional study.

BACKGROUND: In light of the pandemic, pregnant women are particularly vulnerable to increased psychological distress and in need of imperative preventive measures. This study aimed to investigate the impact of the pandemic on mental health, lifestyle adaptations, and their determinants among pregnant women in the United Arab Emirates. METHODS: A survey was conducted electronically between June and August 2020. Pregnant women were recruited from prenatal clinics in the UAE and invited to participate in an online survey developed on Google Forms. The questionnaire included socio-demographic characteristics, the Impact of Event Scale- Revised, the Perceived Support Scale and lifestyle-related factors. RESULTS: A total of 384 pregnant women completed the questionnaire of whom 20.6% were in their 1st trimester, 46.1% in their 2nd and 33.3% in their 3rd trimester. The mean IES-R score for the respondents was 26.15 ± 13.55, corresponding to a mild stressful impact, which did not differ significantly among trimesters of pregnancy. Pregnant women expressed increased stress from staying home (64%), work (40%), feeling frightened (66%) and apprehensive (59%). Women reported increased support and sharing their feelings with family members (59%), mainly in the 1st and 3rd trimester of pregnancy (P < 0.05). There was a greater attention to mental health (48%), resting time (55.3%), and relaxing time (57.3%); while a decreased amount of time was spent engaging in physical activities (53.6%), which differed significantly between trimesters (P = 0.02). CONCLUSIONS: The COVID-19 pandemic was associated with a mild stressful impact among pregnant women in the UAE, braced by strong family support and self-care mental health behaviors.

Effects of in vitro fertilization (IVF) therapies on metabolic, endocrine and inflammatory status in IVF-conceived pregnancy.

RATIONALE: In vitro fertilization (IVF) is a common treatment for infertility. In mice, IVF is associated with development of glucose intolerance. However, human data are limited regarding the metabolic, endocrine and inflammatory effects of IVF therapy in IVF-conceived pregnancies. OBJECTIVE: To explore effects of IVF therapies on metabolic, endocrine and inflammatory parameters in IVF-conceived pregnancy. METHODOLOGY: Twelve-week prospective observational study of adult normoglycaemic women, BMI 18.5-38 kg/m2 and ≤ 39 years awaiting IVF therapy. Fasting blood samples were collected at baseline and 12 weeks, and serum analysed for reproductive hormones, glucose, lipids, insulin sensitivity, thyroid status, adiponectin inflammatory marker and lipopolysaccharide-binding protein (LBP). RESULTS: Two hundred and seventy-five women were analysed: 158 IVF-conceived pregnant women and 117 with failed IVF. Compared with baseline, nonpregnant women had significant (P < .001) increases in 12-week glucose (86.04-87.62 mg/dL), insulin (8.72-9.37 µIU/mL), HOMA-IR (1.9-2.1), T-Chol (169.5-174.9 mg/dL), TG (71.0-83.7 mg/dL) and HDL-C (52.0-54.11 mg/dL) levels. At 12 weeks, pregnant women also had (P < .001) increases in T-Chol (177.5-199.5 mg/dL), TG (73.5-126.78 mg/dL) and HDL-C (55.3-65.1 mg/dL), while a significant reduction in glucose (86.15-82.19 mg/dL), HbA1c (5.3-5.08%) and TSH (1.71-1.36 µIU/mL) levels from baseline. Adiponectin and LBP levels remained the same in either group. CONCLUSION: In vitro fertilization hormonal therapy impairs glucose and insulin levels; these effects are masked in early pregnancy. Changes in lipid profile occur following IVF therapies regardless of pregnancy outcome. Neither adiponectin nor LBP is affected by IVF therapies and during early IVF-conceived pregnancy.

Glucose and protein metabolic responses to an energy- but not protein- restricted diet in type 2 diabetes.

AIMS: To test the effect of energy restriction with maintained protein intake on body composition and on insulin sensitivity of glucose and protein metabolism in adults with type 2 diabetes (T2D). MATERIALS AND METHODS: After 3 days of an isoenergetic diet with 1.2 g/kg/d protein, obese adults with T2D (three women, two men) followed a 5-week diet providing 60% of energy requirements with 45% carbohydrate, and with protein maintained at pre-intervention level. Isotopic tracers were used to quantify whole-body glucose (3-3 H-glucose) and protein (13 C-leucine) metabolism pre- (day 4) and post-intervention (day 39), in the postabsorptive state and during a hyperinsulinaemic, isoglycaemic, isoaminoacidaemic clamp. Body composition was measured using dual-energy x-ray absorptiometry. RESULTS: After energy restriction, 6% weight loss occurred via total body (11%) and visceral fat losses (25%), but lean mass was preserved. Fasting glucose level, serum insulin level, homeostatic model assessment of insulin resistance index and C-peptide level decreased significantly (29%, 38%, 54% and 38%, respectively) as did other cardiometabolic risk factors. Between clamp studies, postabsorptive protein turnover and oxidation rates decreased (12% and 32%), resulting in less negative net balance, consistent with protein conservation. The rates of glucose turnover decreased, and glucose metabolic clearance rate improved (24%). During the clamp, protein flux was lower (9%) and breakdown suppressed (12%), and net balance became less negative but not different. Although glucose turnover did not differ, metabolic clearance improved by 47%. CONCLUSIONS: In obese adults with T2D, an energy-restricted diet with maintained protein intake of ~1.2 g/kg/d improved the kinetics of protein metabolism (particularly in the postabsorptive state), and preserved lean body mass and increased glucose metabolic clearance rate.

Impact of contraception and IVF hormones on metabolic, endocrine, and inflammatory status.

Assisted reproductive technologies (ART) represent commonly utilized management strategies for infertility with multifactorial causes (including genetically predisposed diseases). Amongst ART, in vitro fertilization (IVF) is the most popular. IVF treatment may predispose the mother to increased risks and complications during pregnancy, and there may be adverse fetal outcomes. Hormonal therapies, including oral contraceptives, may impair glucose and lipid metabolism, and promote insulin resistance and inflammation. IVF treatment involves administration of reproductive hormones, similar in composition but in much higher doses than those used for oral contraception. The provision of IVF reproductive hormones to mice associates with glucose intolerance. In addition, the physiological and hormonal changes of pregnancy can trigger an inflammatory response, and metabolic and endocrine changes. There is controversy regarding the potential effects of IVF hormonal therapies in the promotion of diabetogenic and inflammatory states, additional to those that occur during pregnancy, and which may therefore predispose women with IVF-conceived pregnancies to adverse obstetric outcomes compared with women with spontaneously conceived pregnancies. This review summarizes the limited published evidence regarding the effect of IVF-based fertility therapies on glucose homeostasis, insulin resistance, cardio-metabolic profile, and markers of inflammation.

Associations of smartphone addiction, chronotype, sleep quality, and risk of eating disorders among university students: A cross-sectional study from Sharjah/United Arab Emirates.

Objectives: As smartphone addiction (SA) becomes more prevalent among young adults, there is growing concern over its impact on dietary and lifestyle habits, such as disturbed sleep and eating patterns. However, limited literature exists particularly on the association between SA and eating disorders (ED). Thus, this study aims to study the prevalence of SA risk, poor sleeping quality, evening chronotype, and ED risk among university students in the UAE. It also aims to assess the associations between them, emphasizing the one between ED and SA risks. Methods: In this cross-sectional study, a self-administered online questionnaire was disseminated via convenience sampling. Pittsburgh Sleep Quality Index, Morningness-Eveningness Questionnaire, Eating Attitude Test-26 items, and Smartphone Addiction Scale-Short Version were used to measure sleep quality, chronotype, ED risk, and SA risk, respectively. Descriptive and analytical statistics were applied, and P < 0.05 was considered for statistical significance. Results: Out of 552 students (mean age: 21.2 ± 5.1 years), 71% had poor sleep quality, 33.9% reported evening chronotype, 37.9% had ED risk, and 56.2% had SA risk. SA risk was significantly associated with both poor sleep quality (OR = 2.93; 95% CI: 2.01-4.29; p < 0.001) and evening chronotype (p = 0.005). ED risk was significantly associated with poor sleep quality (p < 0.001). Poor sleep quality predicted ED risk best. Conclusion: High prevalence of SA, ED risk, and poor sleep quality was reported among university students in the UAE. Associations between poor sleep quality, evening chronotype, SA risk, and ED risk were further confirmed, with sleep quality predicting ED risk.

Relationship between Maternal Serum Thyroid-Stimulating Hormone and in vitro Fertilisation-Conceived Pregnancy Outcomes.

Background: Thyroid dysfunction impairs female fertility and pregnancy outcome. Optimal preconception and gestational TSH level is still debatable in IVF-conceived pregnancies. Aims: To explore the relationships of IVF success and pregnancy outcomes with maternal serum levels of TSH (at both preconception and 12-week IVF-conceived pregnancy). Also, to confirm or refute the recommended TSH level ≤2.5µIU/mL. Study Setting and Design: Retrospective cohort. Material and Methods: 158 IVF-conceived pregnant women and 117 age-matched controls non-pregnant (≤39years, BMI 18.5-38kg/m2) were recruited. Preconception and 12-week IVF-conceived pregnancy serum samples were analysed for reproductive hormones, fasting glucose, insulin and TSH levels. Data of pregnant women at 28 weeks for GDM screening (75-gram OGTT) and up until delivery were included. Statistical Analysis: Binary logistic regression used to predict association between preconception TSH levels and IVF success, and pregnancy outcomes. Association of delta change of hormones was determined with linear regression. Significance level P≤0.05 with 95% confidence interval (CI). Results: Overall, median (IQR) age was 32(6)years, BMI 25.4(6.9)kg/m2, HbA1c 5.2(0.52)% and TSH 1.82(1.4)µIU/mL. There was no significant association between preconception TSH level and IVF success rate. During the first trimester of IVF-conceived pregnancy, delta change in TSH level was associated with that of progesterone (P=0.03). 12-week gestation TSH level did not predict adverse pregnancy outcomes (i.e. onset of GDM, delivery type and premature delivery); but a higher TSH level predicted earlier delivery in weeks. There was a higher risk of delivery by caesarean section when TSH>2.5µIU/mL. Conclusion: Variation of maternal TSH within normal range (0.4-4.0µIU/mL) at preconception and 12-week gestation has no predictive effect on IVF success and pregnancy outcomes in IVF-pregnancy. Our data provide no support for a recommended preconception TSH level ≤2.5µIU/mL in IVF-conceived pregnancy, but rather promote a preconception TSH level within normal range.

Food safety knowledge among pregnant women in the United Arab Emirates amid the COVID-19 pandemic.

Studies have indicated shortcomings in food safety knowledge and practices among pregnant women in the Arab region. A high-risk group for having severe outcomes from foodborne illnesses. This study aimed to assess self-reported food safety knowledge and practices among pregnant women in the UAE during the COVID-19 pandemic. A total of 354 pregnant women residing in the UAE completed an online survey between October 2021 and January 2022. The questionnaire included socio-demographic information, food safety knowledge, and food practices during the COVID-19 pandemic. Correct answers for food safety knowledge were scored out of 50 and the total score was compared by sociodemographic characteristics. The total mean score for the study population was 26.7 ± 4.6 out of 50. Participants had good knowledge about foodborne diseases (81.3%) and personal hygiene practices (61.8%). While they were least knowledgeable about cross-contamination (43.3%) and temperature control practices (35.8%). Significantly higher knowledge scores were observed with higher levels of education and primigravida women (p<0.05). Knowledge about the COVID-19 virus and its relation to food safety was adequate for most participants. This study infers the need for food safety-related education and training programs to reduce the risk of foodborne disease among this vulnerable group. It also highlights the need to enhance the role of healthcare professionals as trusted sources of information in improving food safety during pregnancy.