Association of maternal serum vitamin D level with fetal pulmonary artery Doppler indices and neonatal respiratory distress syndrome.

PURPOSE: Respiratory distress syndrome (RDS) is potentially fatal in infants. The present study investigated the association of maternal serum vitamin D level with fetal pulmonary artery Doppler indices and neonatal RDS. METHODS: This cross-sectional-analytical study was conducted on 260 mothers admitted for delivery. The maternal serum 25-hydroxyvitamin D level was measured and fetal main pulmonary artery Doppler indices were evaluated. The neonate's weight, apgar score, RDS, Umbilical cord arterial pH and neonatal intensive care unit admission were recorded. RESULTS: There was a significant relationship between RDS and the low level of vitamin D in the mother's serum. Mothers with low vitamin D had higher fetal pulmonary artery pulsatility index (PI) and peak systolic velocity (PSV) and lower acceleration time (AT) to ejection time (ET) ratio. Also, in neonates with RDS, pulmonary artery PI was higher, and PSV and the ratio of AT to ET were significantly lower than neonates without RDS. Neonates with lower one and 5-min apgar scores were born from mothers with lower vitamin D levels. CONCLUSION: Serum levels of vitamin D in pregnant mothers as well as fetal pulmonary artery Doppler indices are correlated to RDS. There is a significant relationship between the serum level of vitamin D in pregnant mothers and fetal pulmonary artery Doppler indices.

The association of parathyroid hormone with serum 25-hydroxyvitamin during pregnancy.

It is currently debated whether vitamin D requirements during pregnancy differ from those during non-gravid states. In current analyses, we aimed to determine the best model for the association between PTH and serum 25-hydroxyvitamin D (25(OH)D) and the threshold for circulating 25(OH)D at which serum parathyroid hormone (PTH) is suppressed. This multicenter prospective cross-sectional study was conducted on 227 Iranian pregnant women aged 15-45 years in their third trimester of pregnancy. The locally weighted smoothing scatter plot (LOWESS) was used to determine the curvilinear shape of the 25(OH)D/PTH relationship. Linear and non-linear methods were employed to determine the best fit and cut-point for serum 25(OH)D concentration. The median serum 25(OH)D and corresponding serum PTH concentration were 17⋅26 (13⋅44-23⋅08) ng/ml and 19⋅46 (15⋅08-25⋅04) pg/ml in our study population, respectively. The LOWESS curve suggested a non-linear and monotonic with a negative slope relation between PTH (pg/ml) and serum 25(OH)D (ng/ml). The optimal model for the association between PTH and serum 25(OH)D was a one-term fractional polynomial (FP1) (AIC = 1640⋅463). The FP1 analysis identified the 25(OH)D threshold of 12⋅48 ng/ml at which serum PTH rapidly rose. The expected degree of PTH stimulation seems to have a linear trend as 25(OH)D falls below 40 ng/ml. 25(OH)D (ng/ml) and PTH (pg/ml) had a non-linear and monotonic relationship with a negative slope. Our data suggest that a 25(OH)D threshold of 12⋅48 ng/ml is sufficient for parathyroid hormone suppression, which could be used to screen for deficient individuals.

Prevalence of calcium and vitamin D deficiency and their association with feto-maternal outcomes in a sample of Iranian pregnant women.

BACKGROUND: Calcium and vitamin D deficiency is common among Iranian women of childbearing age and poses adverse effects on pregnancy outcomes. The aim of the current study was to determine the prevalence of vitamin D and calcium in a sample of Iranian pregnant women and to assess its correlation with the feto-maternal outcomes. METHODS: In this prospective cross-sectional study, a sample of pregnant women between 15 to 45 years who were in the third trimester were recruited from a number of hospitals in Tehran. Data were collected by the means of a self-developed questionnaire, interviews, physical examination, and paraclinical tests including measuring the serum level of calcium, vitamin D, parathormone (PTH) and phosphorous (Pi). The questionnaire obtained information on age, level of education, socio-economic status, parity, gravidity, calcium intake during pregnancy, as well as feto-maternal outcomes. RESULTS: We included a total number of 233 singleton pregnancies. Most of the subjects (58.4%) had vitamin D deficiency and 12.0% suffered from severe vitamin D deficiency. Vitamin D deficiency was adversely associated with the years of education (p= 0.007), serum level of parathormone (p< 0.001). The Metabolic Equivalent of Task (MET) (p< 0.001), the exercise sequence per week (p< 0.001), sun exposure (p< 0.001), higher rate of sunscreen usage (p= 0.011) and higher BMI (p= 0.005). Vitamin D deficiency was associated with higher rate of cesarean delivery (p= 0.024), higher rate of diastolic hypertension (p= 0.019), higher rate of neonatal jaundice (p= 0.009) and higher rate of neonatal respiratory infections (p< 0.001). Serum level of PTH was a significant risk factor for severe vitamin D deficiency while calcium D supplementation, MET and sunscreen were significant protective factors. CONCLUSION: The prevalence of vitamin D deficiency during pregnancy among Iranian women is extremely high and is associated with adverse pregnancy outcomes including cesarean delivery, neonatal jaundice and neonatal respiratory infections. Low vitamin D supplementation and sun exposure, lack of physical activity and high BMI are the etiologies. Increasing the knowledge along with vitamin D supplementation during the pregnancy is recommended in Iranian population.

Maternal and neonatal outcomes and determinants of iodine deficiency in third trimester of pregnancy in an iodine sufficient area.

BACKGROUND: Mild to moderate iodine deficiency in pregnant women may expose them to the increased risk of the development of goiter and thyroid disorder. There is a relationship between low maternal UIC (Urinary iodine concentration) in pregnancy and diminished placental weight and neonatal head circumference. The current study was an attempt to assess iodine nutritional status, its determinants and relationship with maternal and neonatal outcomes. METHODS: In this population based cross-sectional study, which was conducted from April 2017 to September 2018, information was collected from 884 women of 20-45 years old who referred for periodic pregnancy visits. UIC was measured in random urine samples by applying a manual method which was based on the Sandell-Kolthoff technique. Information related to neonatal and maternal complications was collected from the individuals enrolled in the study through systematic follow-ups of the research team in each hospitals and the referral of trained midwives to the place of delivery and the retrieval of the case files. RESULTS: The results showed that out of 884 participants 838 (94.8%) had a urinary iodine concentration of more than 150 micrograms/litre and 46 (5.2%) showed urinary iodine concentrations less than 150 micrograms/litre. The median (IQR) urinary iodine concentration in the third trimester was 176 (165-196) µg/l. According to the WHO criteria 46 of the participants (5.2%) had insufficient urinary iodine concentrations, 805 (91.06%) had adequate urinary iodine concentrations while 33 (3.73%) showed more than adequate levels. There were no participants with urinary iodine concentrations higher than 500 micrograms/litre. The main influencing factors on maternal iodine deficiency in this study were weight gain during pregnancy (Odds Ratio (OR) =0.88, 95% CI: 0.82-0.95), number of previous pregnancy (OR = 0.59, 95% CI: 0.39-0.89) the interval between the most recent pregnancies (OR = 0.78, 95% CI: 0.64-0.95), whether or not the pregnancy has been Planned (OR = 2.92, 95% CI: 1.29-6.58) and nutritional complement consumption (OR = 3.64, 95% CI: 1.44-9.1). The need for a neonatal intensive care unit (NICU) admission (OR = 4.64, 95% CI: 1.81-11.9) and preterm birth (OR = 3.29, 95% CI: 1.51-7.1) were significantly related with maternal iodine deficiency before delivery. Also there is no significant differences regarding the mean maternal urinary iodine concentration between the normal and different maternal complications groups (p = 0.47). CONCLUSION: Iodine deficiency in pregnant women can be improved by appreciate planning for pregnancy, proper inter-pregnancy time interval (> 12 months to < 5 years), appropriate nutrition during pregnancy. Besides, controlling maternal urinary iodine concentrations is important to prevent neonatal complications such as preterm delivery and NICU admission.

Comparison between the effect of regular human insulin and NPH with novo-rapid and levemir insulin in glycemic control in gestational diabetes.

BACKGROUND: Gestational diabetes mellitus (GDM) is one of the prevalent adverse conditions among pregnant women which needs delicate monitoring and control. GDM is a state in which the pregnant women's blood glucose level exceeds the normal range. Our goal was to determine the best therapeutic method to control the blood glucose level among GDM patients by comparing of the efficacy between two Insulin consisting, Novo-rapid + Levemir Insulin and Regular + NPH Insulin. METHOD: In this double-blind, randomized clinical trial study, we enrolled 100 women with GDM as an inpatient. In group A, patients underwent treating with Regular + NPH Insulin, and in group B, patients underwent treating with Novo-rapid + Levemir Insulin. Patient's demographic and clinical information gathered by specified several times during the study and analysis performed by SPSS21. RESULTS: Despite significant changes in the two groups patient's blood glucose levels; we could not find any remarkable differences between the two groups. In the case of patient and health care system satisfaction and the length of the hospitalization group, B was better than group A. CONCLUSION: Altogether, The Novo-rapid and Levemir Insulin in comparing with the Regular and NPH Insulin were practically advantageous due to the simple using method and short hospitalization period of the patient. Thus, we prefer and suggest this beneficial method (using Novo-rapid and Levemir Insulin) to reach therapeutic goals.

Evaluation and statistical optimization of a method for methylated cell-free fetal DNA extraction from maternal plasma.

PURPOSE: Methylated cell-free fetal DNA (cffDNA) in maternal plasma can potentially be used as a biomarker for accurate noninvasive prenatal testing (NIPT) of fetal disorders. Recovery and purification of cffDNA are key steps for downstream applications. In this study, we aimed to developed and evaluated different aspects of an optimized method and compared its efficiency with common methods used for extraction of methylated cffDNA. METHODS: Single factor experiments, Plackett-Burman (PB) design, and response surface methodology (RSM) were conducted for conventional Triton/Heat/Phenol (cTHP) method optimization. The total cell-free DNA (cfDNA) was extracted from pooled maternal plasma using the optimized method called the Triton/Heat/Phenol/Glycogen (THPG), cTHP method, a column-based kit, and a magnetic bead-based kit. In the next step, methylated cfDNA from the extracted total cfDNA was enriched using a methylated DNA immunoprecipitation (MeDIP) kit. Real-time quantitative polymerase chain reaction was performed on the RASSF1 gene and hyper region to determine the genomic equivalents per milliliter (GEq/ml) values of the methylated cfDNA and cffDNA, respectively. RESULTS: The optimum values of the significant factors affecting cfDNA extraction from 200 µl of plasma were 3% SDS, 1% Triton X-100, 0.9 µg/µl glycogen, and 0.3 M sodium acetate. The GEq/ml values of methylated cffDNA extracted using the THPG method were significantly higher than for the tested extraction methods (p < 0.001). CONCLUSIONS: Our results indicate that the THPG method is more efficient than the other tested methods for extraction of low copy number methylated cffDNA from a small volume of maternal plasma.

Altered methylation and expression patterns of genes regulating placental nitric oxide pathway in patients with severe preeclampsia.

Pre-eclampsia is a common pregnancy disorder syndrome whose molecular mechanism is not clear. Nitric oxide (NO) is a key regulator of placentation. Reduction of NO has previously been associated with endothelial dysfunction in pre-eclamptic women. Therefore, we measured expression and methylation of some placental genes that were involved in NO pathway like named ARG II, PRMT1 and DDAH2 in pre-eclampsia and normal pregnancies in order to determine whether impairment of expression of these genes in the pre-eclamptic placenta could contribute to development of disease. ARG II, PRMT1 expressions as well as DDAH2 expression and methylation, in placentas collected from 59 patients with preeclampsia and 40 normotensive pregnancies were measured using real-time PCR and methylation specific PCR, respectively. The relationship among ARG II, PRMT1 and DDAH2 expressions was analyzed statistically. ARG II expression was increased, PRMT1 expression was not significantly changed. DDAH2 expression was decreased and qualitative methylation patterns were 32/59 and 21/40 in placentas from patients with pre-eclampsia compared with control group, respectively. The alterations in ARG II and DDAH2 expressions in pre-eclampsia patients maybe correlated with decreased eNOS expression. These findings indicate that ARG II and DDAH2 may be involved in pre-eclampsia pathogenesis and could be potential therapeutic targets for this disease.

A Case with late onset of ambiguous genitalia.

BACKGROUND: Ambiguous genitalia is an uncommon situation that happens between 1 and 2 per every 1000 live births and falls under the umbrella diagnosis of disorders of sexual development. CASE: In this article, we report a case of male pseudohermaphroditism with ambiguous genitalia. The proband was a 12 yr old girl without any uterus or ovarian tissues. Karyotype of the case is 46, XY. Genes involved in sexual differentiation such as AR, SRD5A2, LH, LHR, FSH, 17 B HSD and SRY genes were sequenced in both directions. No mutations were found in these genes either. CONCLUSION: It seems advisable to be cautious in similar cases, and revise protocol for tracing the genes involved in the patients.