Effect of Oral High Molecular Weight Hyaluronic Acid (HMWHA), Alpha Lipoic Acid (ALA), Magnesium, Vitamin B6 and Vitamin D Supplementation in Pregnant Women: A Retrospective Observational Pilot Study.

Background-Pregnancy represents a nutritional challenge, since macro- and micronutrients intake can affect mother' health and influence negative outcomes. The aim of this retrospective pilot study is to evidence whether the oral supplementation with high molecular weight hyaluronic acid (HMWHA), in association with alpha lipoic acid (ALA), magnesium, vitamin B6 and vitamin D, in pregnant women, could reduce adverse effects, such as PTB, pelvic pain, contraction and hospitalization. Methods-Data were collected from n = 200 women treated daily with oral supplements of 200 mg HMWHA, 100 mg ALA, 450 mg magnesium, 2.6 mg vitamin B6 and 50 mcg vitamin D (treatment group) and from n = 50 women taking with oral supplements of 400 mg magnesium (control group). In both groups, supplementation started from the 7th gestational week until delivery. Results-Oral treatment with HMWHA, in association with ALA, magnesium, vitamin B6 and vitamin D in pregnant women, significantly reduced adverse events, such as PTB (p < 0.01), pelvic pain and contractions (p < 0.0001), miscarriages (p < 0.05) and admission to ER/hospitalization (p < 0.0001) compared with the control group. Conclusions-Despite HMWHA having been poorly used as a food supplement in pregnant women, our results open a reassuring scenario regarding its oral administration during pregnancy.

L-Arginine supplementation in pregnancy: a systematic review of maternal and fetal outcomes.

BACKGROUND/AIM OF THE STUDY: L-Arginine (L-Arg)/Nitric Oxide (NO) system is involved in the pathophysiology of relevant Obstetric conditions. This review aims at summarizing the effects of L-Arg supplementation in pregnancy looking at safety and efficacy. METHODS: We conducted a systematic review of the literature utilizing PubMed for studies published from inception to September 2022. The search included human and animal studies where L-Arg was supplemented pre-conceptionally or during pregnancy, by either oral or intravenous route. The main perinatal outcomes were focused. RESULTS: Among 1028 publications, 51 studies were eligible for inclusion, 25 were performed in women, and the remnant in animals. Compared to controls/placebo, the supplementation with L-Arg reduced the development of pre-eclampsia (four studies), decreased blood pressure, and reduced the need for antihypertensive drugs in women with Hypertensive Disorders of Pregnancy (HDP, eight studies). In women carrying growth retarded fetuses, L-Arg improved fetoplacental circulation, birth weight and neonatal outcomes (five studies), while in the case of threatened preterm birth, L-Arg reduced uterine contractions (two studies). In several animal species, L-Arg supplementation in pregnancy improved reproductive performance by increasing the litter number and size. Moreover, in pre-eclamptic and metabolic syndrome experimental models, maternal hypertension and fetal growth were improved. CONCLUSION: L-Arg displays biological activities in pregnancies complicated by HDP and growth restriction, both in women and animal models. L-Arg administration is safe and could be a candidate as an intervention beneficial to maternal and fetal outcomes, at least in moderate clinical disorders.

Nutraceuticals and polycystic ovary syndrome: a systematic review of the literature.

BackgroundThis study proposes a review of nutraceuticals used in the treatment of typical symptoms of Polycystic Ovary Syndrome (PCOS).The aim is to provide a classification of the most widely used nutraceutical supplements identifying the most effective nutraceuticals on glucose and insulin metabolism, the androgenic hormone profile, fertility, ovulatory capacity, inflammation, and oxidative stress.Material and MethodsWe included randomized controlled trials on PCOS patients undergoing administration of nutraceuticals, in particular vitamin D, vitamin E, probiotics, and inositols. These administrations are variable in terms of dosage, single supplementation, or combined with other compounds, dosage, and duration of the intervention.ResultsThe supplementation of inositols, at the physiologic ratio of 40: 1 of myo- and D-chiro-inositols, resulted to be the most effective in improving the glucose homeostasis and fertility, with a restoration of ovulatory capacity and menstrual regularity. Other nutraceuticals are particularly effective in reducing hyperandrogenism, with promising results demonstrated by the combinations of vitamin D and probiotics, vitamin E and coenzyme Q10, and the enrichment of inositol therapy with group B vitamins. An improvement in the inflammatory status and antioxidant capacity is obtained with the co-supplementation of probiotics and selenium or with vitamin E combined with omega 3.ConclusionsInositol supplementation is effective in the treatment of insulin resistance and fertility. Probiotics reduced hyperandrogenism, inflammatory and oxidative conditions, and resulted more effective when combined with selenium. Although these results proved to be satisfactory, further studies are needed with larger samples and a more homogeneous analysis of the outcomes.

Cancer screenings among sexual and gender minorities by midwives' point of view.

INTRODUCTION: Although women belonging to sexual and gender minorities are more at risk of gynecological and breast cancer, pieces of evidence have been provided that this population finds hardships getting involved in cancer screening programs. This happens because they tend to avoid clinical settings because of fear of discrimination, heteronormative assumptions, heterosexism, classism, and homophobic slurs by healthcare professionals. On the other hand, medical programs that allow healthcare providers to have experience with LGBTQ people are scarce and there are no specific tools to assess sexual cancer risks in this population. EVIDENCE ACQUISITION: Studies included were obtained searching MEDLINE with keywords "lesbians," "queer women," "trans women," "LGBTQ women," "cervical cancer screening," "pap test," "oncology screening," "mammogram" and "prevention." Furthermore, 1577 papers were found. After filtering for species, sex, language, and time range, 820 papers were left. The number of works included was 24 after title screening and 20 after abstract screening and full-text screening. EVIDENCE SYNTHESIS: More research will be needed to develop tools with an inclusive, non-judgmental, and open language capable of engaging the LGBTQ community. Cancer screening programs involve a large variety of healthcare providers including midwives. CONCLUSIONS: Midwives are multifaceted healthcare professionals whose large competence spectrum includes a variety of knowledge and skills going from antenatal care to education and research and they may efficiently provide cancer screenings. Midwives have been asking for more specialistic roles and calling for specific instruction to face the complex and ever-changing reality.

Effect of L-arginine supplementation in pregnant women with chronic hypertension and previous placenta vascular disorders receiving Aspirin prophylaxis: a randomized control trial.

BACKGROUND: The aim of the study is to evaluate the effects of supplementation with Arginine (L-Arg) 3g, (together with Magnesium (Mg) 350 mg and Salicilate (Sal) 100 mg) on maternal blood pressure (BP), uterine artery doppler PI and neonatal outcomes in women with high-risk pregnancy for chronic hypertension (CH) and other previous placenta vascular disorders (PVD) already treated with low dose of aspirin (LDA), as recommended by guidelines. METHODS: We enrolled women affected by CH and other previous PVD referred to the High-Risk Clinic of the Department of Maternal and Child's Health at the University Hospital of Modena and Reggio Emilia from September 2017 to June 2019. The study design was a controlled, randomized trial of oral supplementation of L-Arg 3g (together with Mg 350 mg and Sal extract 100 mg) + LDA 100 mg/day versus only LDA 100 mg/day. Inclusion criteria were: singleton pregnancy; diagnosis of chronic hypertension, previous preeclampsia <34 weeks, previous intrauterine growth restriction (IUGR) <10th centile or previous stillbirth (SB) related to placenta vascular disorders; gestational age <14 weeks. Each woman was enrolled between 12-14 weeks gestation and underwent 24-hour ambulatory BP monitoring with an automatic device (SpaceLab 92710, Critikon, WA), repeated at 18-20th and 24-26th weeks. Moreover Uterine artery Doppler ultrasound evaluation including PI were performed at 18-20 weeks gestation and repeated at 24-26th weeks. Pregnancy outcomes data were collected in a password protected database. RESULTS: Seventy-nine women agreed to participate in the study. No significant differences between the demographic characteristics in the two groups were found at enrolment (Group LDA + L-Arg: 30 patients versus Group LDA: 49 patients). In the LDA-L-Arg group there is no significant increase in both systolic (127.22±12.02 and 132.75±7.51 mmHg, P=0.002) and diastolic (75.85±8.53 and 83.63±6.05 mmHg, P=0.0000) BP values at 24-26 weeks reveled in the LDA group. The value of the uterine artery Doppler median PI>95th centile at 24-26 weeks show a significant reduction in the LDA+L-Arg group respect the LDA group (seven women, 23.3% vs. 21 women, 42.9%; P=0.04). A significantly lower percentage of women received new antihypertensive drugs in the LDA+ L-Arg group than the LDA group (6.7% vs. 24.5%) (P=0.02). There was neither statistically significant difference in perinatal outcomes between the two groups, except for trend of significance. CONCLUSIONS: Although we found only trends of improvements of perinatal outcomes in LDA+L-Arg group, considering the promising results on BP values, uterine artery PI and the low need to start a new antihypertensive treatment, thus the resulting impact in reducing pregnancy medicalization, number of maternal-fetal well-being monitoring visits and the need of induction of labor, we believe that further studies should be performed to enlarge our observation and clarify the role of L-Arg 3g supplementation as a protective integration in high-risk pregnancies already in prophylaxis with LDA.

Advanced midwifery practice: intrapartum ultrasonography to assess fetal head station and comparison with vaginal digital examination.

BACKGROUND: Vaginal digital examination is considered the gold standard to evaluate patients during labor and delivery. However, transperineal ultrasound has been suggested as an effective tool in determining fetal head station during labor. Angle of progression (AOP), head-perineal distance (HPD) and head-symphysis distance (HSD) are reliable parameters to assess fetal head station during labor. The study aims were to evaluate how midwives can use AOP, HSD, HPD to assess the accuracy of digital vaginal exploration limited to the fetal head station. METHODS: Trained midwives for ultrasound analyses performed transperineal ultrasounds during the first stage of labor with 2D-convex probe in 62 pregnant women at term with a single fetus in cephalic presentation. Immediately before the intrapartum ultrasound, the birth attendant performed a digital examination to assess cervical dilatation and head station. The ultrasound scans were compared to the digital vaginal examination through the Tutschek's formula. RESULTS: AOP was wider in women who delivered vaginally without any complication if compared to "complicated delivery" group. HPD and HSD were greater in women who underwent an operative vaginal delivery or caesarean section. The vaginal exploration accuracy was 34%, but when ±1 cm was considered as tolerated, the overall accuracy was 74.19%. CONCLUSIONS: Midwives may include ultrasounds in their clinical practice after adequate training or under the supervision of an ultrasound professional as an adjunct tool during labor to evaluate its progress and prevent any deviation from physiology.

The appropriate counseling on prenatal screening test for foreign women in Emilia-Romagna.

OBJECTIVE: The increase in the migratory phenomenon entails the need to adapt obstetric care to the population which includes foreign pregnant women. In this context, it emerged a little adherence to the prenatal screening test among foreign women compared to Italian women, which is assumed to be attributable to an inadequate counseling. This study aims to evaluate midwife's perception of the  counseling effectiveness in foreign women for the combined test and subsequently assess its adequacy through an external evaluation. METHODS: this is a cross-sectional study conducted from September to November 2019. An ad hoc questionnaire was administered to midwives working in the territorial district of the Emilia-Romagna Region, investigating their counseling skills. Then an external evaluation of the counseling was conducted by observing the interview between the midwives and the patients (N = 10), to analyze its appropriateness. RESULTS: Seventy-five midwives completed the questionnaire with a positive response rate of 57.2%. In general, 69.3% of midwives are satisfied with the training received from the regional course, but 85% found many difficulties in counseling foreign women. The 14% of midwives state that they always have the cultural and linguistic mediator available and 44% of them state that they use brochures translated into several foreign languages. In the interviews observed, the counseling to foreign women was found to be shorter and more limited than that provided to Italian women. CONCLUSIONS: Most of the consulting midwives declare that they feel prepared to perform a correct prenatal counseling also for foreign women, but the external evaluation of the interviews, and the regional data on adherence to the antenatal screening of foreign women, show many critical points. It becomes necessary to carry out further studies that investigate not only the counseling skills of midwives, but also the needs of assisted women about prenatal diagnosis.

Blood pressure and cardiovascular risk factors in women treated for climacteric symptoms with acupuncture, phytoestrogens, or hormones.

OBJECTIVE: To evaluate the response of cardiovascular risk factors to the treatment of climacteric symptoms. METHODS: In this prospective study, women reporting climacteric symptoms were randomized to 3 months of treatment with either acupuncture (n = 19), phytoestrogens (75 mg soy isoflavones, BID; n = 22), or low-dose hormone therapy (HT; 0.3 mg conjugated equine oestrogens plus 1.5 mg medroxyprogesterone acetate; n = 20). Greene's climacteric scale, blood pressure (BP), lipids, glucose, insulin, and homeostatic model assessment of insulin resistance were assessed before and after treatment. Observed changes were compared by analysis of variance. RESULTS: HT and acupuncture reduced Greene climacteric score to a similar extent, but the effect of phytoestrogens was significantly lower (P < 0.05). With acupuncture, systolic (-7.4 ±â€Š15.3 mm Hg; P < 0.05) and diastolic BP (-8.3 ±â€Š7.7mm Hg; P < 0.01) decreased, and the same occurred with phytoestrogens (-8.4 ±â€Š9.0 mm Hg [P < 0.01] and -6.6 ±â€Š7.9 mm Hg [P < 0.01]). Neither BP systolic (1.9 ±â€Š17.5 mm Hg) nor BP diastolic (-1.4 ±â€Š9.6 mm Hg) changed during HT. Low-density lipoprotein cholesterol decreased with phytoestrogens (-9.9 ±â€Š19.6 mg/dL; P < 0.05), and triglycerides increased with both HT (34.5 ±â€Š12.2 mg/dL; P < 0.01) and phytoestrogens (17.41 ±â€Š24.4 mg/dL; P < 0.01). A slight but significant increase in homeostatic model assessment of insulin resistance (0.14 ±â€Š0.5; P < 0.05) was observed after HT. CONCLUSIONS: Treatment of climacteric symptoms with acupuncture and phytoestrogens, but not HT, is associated with a clear BP reduction, and phytoestrogens with potentially positive alterations in low-density lipoprotein cholesterol level. TRIAL REGISTRATION: EudractCT Number 2008-006053-41. : Video Summary:http://links.lww.com/MENO/A637.

Evaluation of midwifery students' satisfaction with regards to clinical internship.

BACKGROUND AND AIM OF THE WORK: The clinical internship is fundamental for the training of the future socio-health professional. Through the practical activity, the student develops professional skills, critical thinking and decision-making ability, internalizing the complexity of the professional role. While in the nursing field there are several tools for assessing the clinical experience of students, in the obstetric field there is a lack of validated tools. Therefore, the purpose of this work was to investigate the perception of the students of the Degree Course in Midwifery regarding the internship experience. METHOD: The study was conducted at the obstetric clinical internship where students carry out practical activities and involved all the students of the Degree Course in Midwifery at the University of Modena and Reggio Emilia. The data were collected through an anonymous online questionnaire (Google Model), which was inspired by the nursing CLES + T, simplified and adapted to the obstetric field. RESULTS: In total, 54 students took part in the research (81.8% of all students enrolled in the degree program examined). They were mainly of Italian nationality (98.1%), women (94.4%), aged between 18-22 years (85.2%). In general, the third-year students were more satisfied with the internship experience than the second- and first-year students, most likely for having achieved a degree of autonomy of care, awareness and greater professional motivation.  Conclusions. The results indicate the need to periodically investigate the quality and satisfaction of the clinical internships to ensure increasingly effective obstetric training.

Self-efficacy in breastfeeding support: a research on Italian midwifery students.

BACKGROUND AND AIM OF THE STUDY: Maternal breastmilk represents the best nourishment for the newborn baby during its first six months, as it offers several benefits for the health and well-being of babies and mothers. In order to promote, protect and support effectively mother and child during breastfeeding, it is essential for midwives to be properly educated and to acquire highly professionalizing skills. This study aimed to evaluate the level of self-efficacy of the students attending the Degree Course of Midwifery, regarding the support of mother and child in breastfeeding. METHOD: A questionnaire of 37 items (Blackmanet al, 2015) validated in Italian by Mazzeo Melchionda (2019), was sent on-line to students of ten different Midwifery Degree Courses to assess their level of self-efficacy regarding the management of breastfeeding. Statistical analysis was carried out using statistic software R3.4.3 (The Foundation for Statistical Computing). RESULTS: 158 questionnaires were collected from ten Italian Midwifery Degree Courses. The areas in which students showed a high level of self-efficacy in managing breastfeeding include: the benefits of breastfeeding; the child's tendency to take the breast within an hour from childbirth and the relevance of skin to skin contact and rooming-in. Low levels of self-efficacy concerned the comfortably breastfeeding in public places and avoiding giving formula to the baby in its first six weeks of life. CONCLUSIONS: Generally the students attending Midwifery Degree Courses show a high level of self-efficacy in assisting mothers during breastfeeding and they prove to have a good knowledge of the benefits of breastfeeding to improve the health of mothers and their children. (www.actabiomedica.it).

The midwifery-led care model: a continuity of care model in the birth path.

BACKGROUND AND AIM OF THE STUDY: The birth path is affected by a fragmentation in the patient care process, creating a discontinuity of this last one. The pregnant woman has to interface with many professionals, both during the pregnancy, the childbirth and the puerperium. However, during the last ten years, there has been an increasing of the pregnancy care operated by the midwife, who is considered to be the operator with the right competences, who can take care of every pregnancy and may avail herself of other professionals' contributions in order to improve the outcomes of maternal and neonatal health. AIM: To verify whether there are proofs of effectiveness that support the caseload midwifery care model, and if it is possible to apply this model in the birth path in Italy. METHODS: A revision of literature has been done using some search engine (Google, Bing) and specific databases (MEDLINE, CINAHL, Embase, Home - ClinicalTrials.gov). There has also been a consultation of the Italian regulations, the national guidelines and the recommendations of WHO. RESULTS: The search string, properly adapted to the three databases, has given the following results: MEDLINE 64 articles, CINAHL 94 articles, Embase 88 articles. From this selection, 14 articles have been extracted: 1 systematic review, 3 controlled random trial, 7 observational studies, 3 qualitative studies. CONCLUSIONS: The caseload midwifery care seems to be an effective and reliable organisational/caring method. It responds to the criterions of quality and security, to the needs of women not only during the pregnancy but also during the post-partum phase. For these reasons, it seems very useful also for the birth path in the Italian reality.

Acupuncture in Postdate Pregnancy Management.

OBJECTIVES: Pharmacological labor induction is obtained through prostaglandins application and/or oxytocin infusion; however, the use seems to be related to fetal and maternal side effects. Traditional Chinese Medicine advocates the use of acupuncture to soften the cervix and induce uterine contractions. at which presented for The primary outcome was the rate of women admitted for labour induction in case of prolonged pregnancy at 41 + 5 weeks, and the secondary outcome was the rate of induction planning for other indications. METHODS: After obtaining informed consent, 375 undelivered women after 40 + 2 gestational age were enrolled for the study: 112 women received acupuncture and 263, routine care. Acupuncture was applied every odd day starting from 40 + 2 weeks up to 41 + 4 weeks. Women allocated to the control group received standard care. At 41 + 5 weeks, a pharmacological induction was planned. RESULTS: The rate of labor induction significantly differed between acupuncture and observation groups (19.6% vs. 38%; p < 0.01); in particular, women receiving acupuncture showed a lower rate of induction, indicating prolonged pregnancy (5.3% vs. 10.1%; p < 0.01). As far as the pharmacological device is concerned, no differences were observed with regard to the prostaglandins use, whereas oxytocin infusion rate was lower in the acupuncture group than in the observation group. CONCLUSIONS: The present study suggested that acupuncture applied at term of pregnancy seems to be effective in reducing the rate of labor induction which is performed for prolonged pregnancy at 41 + 5 weeks. Moreover, acupuncture also seems to be able to reduce oxytocin use; such a "saving" effect could play a role in childhood, considering that a recent study underlined the adverse effect of oxytocin on birth outcomes.

Castor oil for induction of labour: a retrospective study.

PURPOSE: The aim of this study is to investigate the safety and efficacy of castor oil to induce labour. MATERIALS AND METHODS: A retrospective observational case control study was conducted over five years. Castor oil was proposed to women referred to the Birth Centre (Castor Oil group (COG)). They were compared to women who chose to be followed by the traditional doctor-led unit (control group (CG)). Castor oil was administered in a 60 ml single dose in 200 ml of warm water. Inclusion criteria were gestational age between 40 and 41 weeks plus premature rupture of membranes between 12 and 18 hours or amniotic fluid index ≤4 or Bishop Score of ≤4 or absence of spontaneous labour over 41 + 4 weeks. RESULTS: Pharmacological induction of labour was required for 18 women in the COG (45%) and 36 in the CG (90%) (p < .001). The mode of delivery differed significantly between groups: women assuming castor oil showed a higher incidence of vaginal delivery, whereas the incidence of caesarean section was lower in the COG, but no statistical significance was reached. CONCLUSIONS: The use of castor oil is related to a higher probability of labour initiation within 24 hours. Castor oil can be considered a safe non-pharmacological method for labour induction.

Perinatal and maternal outcomes in a midwife-led centre in Italy: a comparison with standard hospital assistance.

BACKGROUND: In many countries midwives are the primary providers of care for childbearing women. The aim of the present study was to compare the outcomes of childbirth occurring in the birth benter (midwifery-lead) vs. the traditional delivery room organization (doctor-lead) of the Policlinico of Modena Hospital. METHODS: A prospective observational study was conducted over four years. At 35-36th week, women with a single, uneventful pregnancy, being classified at low-risk according to The National Institute for Health and Care Excellence (NICE) guidelines on intrapartum care, were offered to deliver with standard care assistance (SC) in a doctors-led unit or in the Birth Centre (BC). RESULTS: The number of women included was 3156. Overall emergency cesarean sections were lower in BC vs. SC group, and a significant decrease in the rate of augmentation of labor with intravenous oxytocin, in the use of episiotomy and operative deliveries in women of BC were recorded more than in the SC group. More women with intact perineum were present in BC group, while no significant differences in perineal tears was described between groups. CONCLUSIONS: Our results suggest that midwifery care can result in a decrease of medical interventions during labor, namely a reduction of cesarean section and episiotomy rate. Also, the BC remains a valid option for women who satisfy low-risk criteria and wish to give birth in a hospital setting. In Italy the concern to education of all midwives, obstetricians and women at a global level is urgently required, with specific focus on ethics, communication and philosophy of care to enable normalization and humanization of birth.

Acupressure on Self-Reported Sleep Quality During Pregnancy.

The aim of this study was to investigate the short-term effect of acupression at the H7 point on sleep quality during pregnancy. After oral consent had been obtained, the midwife invited the women claiming to have poor sleep quality and anxiety symptoms to complete the Pittsburgh Sleep Quality Index questionnaire and the State-Trait Anxiety Inventory-1. Then, the same midwife, previously trained by an expert acupuncturist (I.N.), advised the women to put on the wrist overnight compression H7 Insomnia Control half an hour before going to bed and to take it off upon awakening, for 10 consecutive days and thereafter every odd day (active group). Women refusing to wear the device for low compliance toward acupression were considered as the control group. After 2 weeks, a second questionnaire evaluation was completed. In the active, but not in the control, group, a significant improvement of sleep quality was observed after H7 device application. The study suggests that H7 acupression applied for 2 weeks improves sleep quality in pregnant women. This preliminary result should serve to stimulate further studies on the long-term effects of acupression.

Myo-inositol may prevent gestational diabetes onset in overweight women: a randomized, controlled trial.

OBJECTIVE: To evaluate whether myo-inositol supplementation may reduce gestational diabetes mellitus (GDM) rate in overweight women. METHODS: In an open-label, randomized trial, myo-inositol (2 g plus 200 µg folic acid twice a day) or placebo (200 µg folic acid twice a day) was administered from the first trimester to delivery in pregnant overweight non-obese women (pre-pregnancy body mass index ≥ 25 and < 30 kg/m(2)). The primary outcome was the incidence of GDM. RESULTS: From January 2012 to December 2014, 220 pregnant women were randomized at two Italian University hospitals, 110 to myo-inositol and 110 to placebo. The incidence of GDM was significantly lower in the myo-inositol group compared to the placebo group (11.6% versus 27.4%, respectively, p = 0.004). Myo-inositol treatment was associated with a 67% risk reduction of developing GDM (OR 0.33; 95% CI 0.15-0.70). CONCLUSIONS: Myo-inositol supplementation, administered since early pregnancy, reduces GDM incidence in overweight non-obese women.

Poor Folate Intake in a North Italian Pregnant Population: an Epidemiological Survey.

BACKGROUND: The association between folic acid (FA) insufficiency and congenital malformations has been demonstrated in over the past two decades. The aim of the present study was to investigate the use and timing of folate intake among a large sample of pregnant women in a north Italian region. METHODS: A multicentre prospective cohort study was conducted over a 14-month period in the maternity wards of five general hospitals (2301 women). Data were collected via a face-to-face interview. RESULTS: Seven hundred sixty women (33%) took at least one product containing FA. Seven hundred thirty-three (31.8%) women consumed multivitamins containing 413 (17.9%) consumed products containing FA only and 17 (0.7%) 15 mg of levofolinic acid. Only 0.9% of all women took FA before pregnancy 72.5% of women who consumed FA started during the first trimester. The most common dosage was 0.4 mg (19.4%). CONCLUSIONS: Very few women in the population are taking FA before pregnancy. Moreover, while most women consuming FA started in the first trimester, it is likely that they did so after closure of the neural tube. An important action is the recommendation that periconceptional supplementation programmes be promoted.

Myo-inositol Supplementation for Prevention of Gestational Diabetes in Obese Pregnant Women: A Randomized Controlled Trial.

OBJECTIVE: To evaluate whether myo-inositol supplementation, an insulin sensitizer, reduces the rate of gestational diabetes mellitus (GDM) and lowers insulin resistance in obese pregnant women. METHODS: In an open-label, randomized trial, myo-inositol (2 g plus 200 micrograms folic acid twice a day) or placebo (200 micrograms folic acid twice a day) was administered from the first trimester to delivery in pregnant obese women (prepregnancy body mass index 30 or greater. We calculated that 101 women in each arm would be required to demonstrate a 65% GDM reduction in the myo-inositol group with a statistical power of 80% (α=0.05). The primary outcomes were the incidence of GDM and the change in insulin resistance from enrollment until the diagnostic oral glucose tolerance test. RESULTS: From January 2011 to April 2014, 220 pregnant women at 12-13 weeks of gestation were randomized at two Italian university hospitals, 110 to myo-inositol and 110 to placebo. Most characteristics were similar between groups. The GDM rate was significantly reduced in the myo-inositol group compared with the control group, 14.0% compared with 33.6%, respectively (P=.001; odds ratio 0.34, 95% confidence interval 0.17-0.68). Furthermore, women treated with myo-inositol showed a significantly greater reduction in the homeostasis model assessment of insulin resistance compared with the control group, -1.0±3.1 compared with 0.1±1.8 (P=.048). CONCLUSION: Myo-inositol supplementation, started in the first trimester, in obese pregnant women seems to reduce the incidence in GDM through a reduction of insulin resistance. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01047982.

A challenging case of pregnancy with placenta accreta and very rare irregular antibodies versus Cromer blood group system: a case report.

INTRODUCTION: This report describes the challenges of treating a pregnant woman who had a rare case of critical placenta accreta with concurrent Cromer system anti-Tc(a) and anti-Kidd A alloantibodies. No previous case of such alloimmunization in a patient with placenta accreta has been reported. CASE PRESENTATION: A 28-year-old African woman with anti-Cromer Tc(a) antibodies, anti-Kidd A antibodies and placenta accreta was admitted to the obstetric emergency department at our university hospital with persistent vaginal bleeding. Her rare Cromer blood group system antibodies had been diagnosed 1 month earlier; no compatible blood had been found despite a worldwide search. We performed a cesarean section after placement of Fogarty balloons in her uterine arteries with preoperative endovascular interventional radiology. Other therapeutic interventions included preoperative iron administration to raise hemoglobin and the scheduled predeposit of autologous blood. Intraoperative therapeutic management was aimed at preventing coagulopathy and massive bleeding. With the use of alternative medical techniques determined during perioperative planning, her intraoperative blood loss was only 1000 mL, despite the placenta accreta. She was discharged from the hospital 4 days after cesarean section. CONCLUSIONS: To the best of our knowledge, this is the first report of an alloimmunized patient with two different alloantibodies and concurrent high risk of bleeding because of placenta accreta. The close collaboration among obstetricians, anesthesiologists, interventional radiologists, blood bank pathologists and intensive care doctors prevented serious consequences in this patient. The exceptional feature of this case is the patient's double risk: the placenta accreta and the inability to transfuse compatible blood. These two extreme situations challenged the multidisciplinary medical team.

Dietary interventions, lifestyle changes, and dietary supplements in preventing gestational diabetes mellitus: a literature review.

Gestational diabetes mellitus (GDM) is associated with increased rates of fetal morbidity and mortality, both during the pregnancy and in the postnatal life. Current treatment of GDM includes diet with or without medications, but this management is expensive and poorly cost-effective for the health care systems. Strategies to prevent such condition would be preferable with respect to its treatment. The aim of this literature review was to evaluate studies reporting the efficacy of the most used approaches to prevent GDM as well as evidences of efficacy and safety of dietary supplementations. Systematic literature searches were performed in electronic databases, covering the period January 1983 to April 2014. Randomized controlled clinical trials were included. Quality of the articles was evaluated with the Jadad scale. We did not evaluate those articles that were already entered in the most recent systematic reviews, and we completed the research with the trials published thereafter. Of 55 articles identified, 15 randomized controlled trials were eligible. Quality and heterogeneity of the studies cannot allow firm conclusions. Anyway, trials in which only intake or expenditure has been targeted mostly reported negative results. On the contrary, combined lifestyle programs including diet control (orienting food intake, restricting energy intake) associated with moderate but continuous physical activity exhibit better efficacy in reducing GDM prevalence. The results from dietary supplements with myoinositol or probiotics are promising. The actual evidences provide enough arguments for implementing large-scale, high-quality randomized controlled trials looking at the possible benefits of these new approaches for preventing GDM.