Immune Response to SARS-CoV-2 in Vaccine-naive Pregnant Women: Assessment of IgG and IgA Antibody Profile at Delivery and 42 Days Postpartum.

This prospective cohort study assessed the SARS-CoV-2 IgG and IgA Ab profiles at delivery and 42 d postpartum in unvaccinated SARS-CoV-2-positive pregnant women and determined the association with the timing and the clinical course of the infection. A total of 387 vaccine-naive women with confirmed SARS-CoV-2 infection during pregnancy were included. IgG and IgA Abs were detected in maternal blood at delivery and 42 d postpartum using ELISA kits. The relationships between Ab detection and value and clinical features, including the timing of the infection, were analyzed using univariate and multivariate logistic and linear regression models. The mean gestational age at infection was 31 4/7 wk of pregnancy. Symptoms of SARS-CoV-2 infection were present in 88.1% of women. IgG and IgA Abs were detected in 45.7 and 58.9% at delivery, respectively, increasing to 72.7 and 76.8% at 42 d postpartum. Detection of IgG and IgA Abs in maternal blood at delivery was independently associated with symptomatic infection (adjusted odds ratio [OR] 3.13, 95% confidence interval (CI): 1.47-6.69 and adjusted OR 3.62, 95% CI: 1.8-7.26, respectively), but not with the time from positive swab to delivery or gestational age at positive swab. Detection of Abs at 42 d postpartum was also strongly associated with the detection of Abs at delivery (OR 29.97, 95% CI: 10.11-88.82 for IgG and OR 13.09, 95% CI: 6.37-26.9 for IgA). Vaccine-naive pregnant women exhibit a significant and durable immune response to SARS-CoV-2, which is more pronounced in symptomatic women but independent of gestational age at diagnosis or the diagnosis-to-delivery interval.

Neonatal Thyrotoxicosis in Infants of Mothers with Graves' Disease Treated for Radioiodine-Induced Hypothyroidism: A Literature Review.

Fetal and neonatal thyrotoxicosis occurs in up to 5% of pregnancies in mothers with Graves' disease (GD). This condition is caused by stimulating antibodies against the thyrotropin receptor (TRAbs) that cross the placenta and may stimulate the fetal thyroid, typically in the second half of pregnancy. GD is often treated with radioiodine, resulting in hypothyroidism in most patients, but TRAbs can persist for several years. Even if a pregnant mother is hypothyroid after radioiodine therapy or surgery, her TRAbs can still, although rarely, induce fetal hyperthyroidism. In this review, we first present two cases of neonatal hyperthyroidism in mothers with GD who became hypothyroid after prior radioiodine therapy, identified through a 10-year analysis of the National Perinatal System in Slovenia. Based on these cases, we provide an overview of existing data on this rare clinical condition in neonates. We also discuss the underlying mechanisms and clinical outcomes based on currently available data. In conclusion, our review highlights the importance of careful monitoring during pregnancy in all women with GD, even in those well managed after radioiodine therapy or surgery.

Maternal Fatigue after Postpartum Anemia Treatment with Intravenous Ferric Carboxymaltose vs. Intravenous Ferric Derisomaltose vs. Oral Ferrous Sulphate: A Randomized Controlled Trial.

(1) Background: Postpartum anemia is a common maternal complication and is recognized as a cause of impaired quality of life, reduced cognitive abilities, and fatigue. Efficient iron supplementation for the treatment of postpartum anemia is an essential component of high-quality maternal care. The optimal mode of iron supplementation has not been determined yet, whether oral or intravenous. The objective of this study was to compare postpartum anemia treatment with intravenous ferric carboxymaltose, intravenous ferric derisomaltose, and oral ferrous sulfate. (2) Methods: A single-center, open-label, randomized controlled trial. Women with hemoglobin < 100 g/L within 48 h postpartum were randomly allocated to receive intravenous ferric carboxymaltose, intravenous ferric derisomaltose, or oral ferrous sulfate. Intravenous iron was given in one or two doses, while ferrous sulfate was given as two 80 mg tablets once daily. The primary outcome was maternal fatigue measured by the Multidimensional Fatigue Inventory (MFI) six weeks postpartum. Hemoglobin, ferritin, and transferrin saturation levels were analyzed as secondary outcomes. A Kruskal-Wallis test was used for group comparison (p < 0.05 significant). (3) Results: Three hundred women were included. The MFI score at six weeks postpartum did not differ between groups (median 38 (inter-quartile range (IQR) 29-47) in the ferric carboxymaltose group, median 34 (IQR 26-42) in the ferric derisomaltose group, and median 36 (IQR 25-47) in the ferrous sulfate group; p = 0.26). Participants receiving oral iron had lower levels of hemoglobin (135 (131-139) vs. 134 (129-139) vs. 131 (125-137) g/L; p = 0.008), ferritin (273 (198-377) vs. 187 (155-246) vs. 24 (17-37) µg/L; p < 0.001) and transferrin saturation (34 (28-38) vs. 30 (23-37) vs. 24 (17-37) %; p < 0.001) than those receiving ferric carboxymaltose or ferric derisomaltose. (4) Conclusions: Intravenous ferric carboxymaltose, intravenous ferric derisomaltose, and oral ferrous sulfate had similar impacts on maternal fatigue at six weeks postpartum despite improved laboratory parameters in the intravenous groups.

Effect of Ultrasonic and Hydrothermal Treatment on Digestibility and Antioxidant Properties of Whole Wheat Flour with Different Amylose Content§.

Research background: The consumption of whole grain cereal flour contributes to increased intake of dietary fibre and phenolic compounds beneficial to human health. However, whole grain flour also has some disadvantages, such as poor baking properties and lower technological quality. Applying ultrasonic and hydrothermal treatments can provide new opportunities to modify and improve the baking and biofunctionality of flour as well as the quality of baked goods. Experimental approach: The whole grain flour samples of six wheat varieties with different amylose content were studied. The original chemical composition and viscosity profiles of the flour were determined. The flour samples were subjected to ultrasonic treatment at a frequency of 30 kHz and temperature of 40 °C for 10 min and hydrothermal treatment on a magnetic stirrer with heating for 3 min after reaching the boiling point. The treatments were carried out to determine their influence on the studied digestible and antioxidant properties of the flour. A multistep in vitro enzymatic digestibility protocol simulating the digestion process in the human gastrointestinal tract was applied to the untreated and treated whole grain flour samples. Total free phenolic compound content and total antioxidant capacity were also determined. Results and conclusions: Hydrothermal treatment had a positive effect on the digestibility of the whole grain flour, especially in waxy wheat genotypes compared to those with high amylose content, due to the formation of resistant starch. The hydrothermal treatment had an overall negative effect on the antioxidant capacity of the flour samples, while ultrasonic treatment generally increased the analytical values of total free phenolic compounds by enhancing their extractability. These findings can provide valuable information for the development of new whole wheat foods. Novelty and scientific contribution: To the best of our knowledge, this type of study of the effects of ultrasound and hydrothermal treatment on the digestibility and antioxidant properties has not yet been performed on whole wheat flour with different amylose content. Waxy and high-amylose wheat varieties are considered novel raw materials because of their unique properties in bread making, such as improved bread texture and increased dietary fibre content.

Oral microbiome and preterm birth.

Background: The etiology of preterm birth (PTB) is heterogeneous and not yet well known. Maternal periodontal disease has been investigated for decades and is a known risk factor for adverse pregnancy outcomes. However, no particular bacterial species or higher taxonomic order has been found as causative of PTB, leading to studies of the whole oral microbiome. In order to determine if and how the composition of the oral microbiome is associated with PTB, we performed a large case-control study including women with term (TB) and PTB. Methods: We compared oral microbiomes in PTB to TB, to examine differences in the microbial richness, diversity, and differential abundance of specific taxa. We obtained oral swab samples from 152 Caucasian pregnant women who were classified as either PTB (≤36 6/7 weeks, n = 61) or TB (≥38 0/7 weeks, n = 91) in exclusion of any other major medical or obstetric conditions. The oral microbiomes of these women were characterized by 16S ribosomal RNA (rRNA) gene sequencing of the V3-V4 region on the MiSeq platform. Results: The dominant microorganisms at the phylum level in all pregnant women regardless of birth week outcomes as belonging to Firmicutes, Proteobacteria, Bacteroidetes, Fusobacteria, and Actinobacteria. The phyla Firmicutes and Bacteroidetes were relatively more abundant in women with a PTB than in women with a TB, while Proteobacteria was less prevalent in women with a PTB. At the genus level, Veillonella, Prevotella, and Capnocytophaga were enriched in the PTB, and while many of the members of these genera could not be resolved to the species level, Veillonella massillensis was shown to be increased in the PTB group. Conclusion: We identified the genera Veillonella, Prevotella, and Capnocytophaga in the maternal oral microbiome as being associated with PTB independently of clinically apparent infection, uterine anomalies, and other pregnancy complications, including placenta previa, and placental abruption. The clarification of the role of those taxa in the etiology of PTB merits further research.

Effect of Anthocyanin-Enriched Brine on Nutritional, Functional and Sensory Properties of Pickled Baby Corn.

Considering the great potential of black soybean seed coat as a source of bioactive compounds, the objective of this study was to investigate the effect of anthocyanin-rich brine from the seed coat on functional properties of pickled baby corn, as well as its sensory properties. Given that the ears of sweet corn, popping corn and semi-flint corn were used for pickling in the pre-pollination phase, the effect of genotype and its growing stage on the chemical composition of Baby corn product was also taken into consideration. The brine of black soybean with a total anthocyanins content of 11,882.9 mg CGE/kg (cyanidin 3-glucoside equivalent) and an antioxidant capacity of 399.5 mmol Trolox Eq/kg determined by QUENCHER method had a positive impact on the functional potential of baby corn products. The content of total anthocyanins in the obtained products ranged from 748.6 to 881.2 mg CGE/kg, the predominant anthocyanin was cyanidin-3-glucoside (184.6 to 247.5 µg/g), while their colour was red. Compared to the commercial sample, baby corn products pickled in the enriched solution had a 26% to 46% and 17% to 26% higher content of total free phenolic compounds and antioxidant capacity, respectively. Contrarily, the control sample had higher sugar and fibre content. As established, pickled popping corn had the best sensory properties.

Microencapsulates of Blue Maize Polyphenolics as a Promising Ingredient in the Food and Pharmaceutical Industry: Characterization, Antioxidant Properties, and In Vitro-Simulated Digestion.

An anthocyanin-rich blue maize waste product was used for anthocyanin extraction. To preserve bioactive phenolic compounds, a spray-drying technique was employed using conventional wall material maltodextrin (MD), with novel one, hydroxypropyl-ß-cyclodextrin (HPBCD). The obtained spray-dried maize extract (SME) and microencapsulates were analyzed based on physicochemical powder properties, chemical analysis, antioxidant activity, and digestibility. The examined microencapsulates demonstrated good powder properties, exhibited a high powder yield (up to 83%), and had a low moisture content (less than 5%). HPBCD and MD + HPBCD combinations demonstrated superior powder properties in the terms of decreasing the time necessary for rehydration (133.25 and 153.8 s, respectively). The mean average particle diameter ranged from 4.72 to 21.33 µm. DSC analyses signified high powder thermal stability, around 200 °C, related to the increasing preservation with biopolymer addition. The total phenolic and anthocyanin compounds ranged from 30,622 to 32,211 mg CE/kg (CE-catechin equivalents) and from 9642 to 12,182 mg CGE/kg (CGE-cyanidin 3-glucoside equivalents), respectively, associated with good bioactive compound protection. Microencapsulates with both carriers (15% MD and 15% HPBCD) had the highest digestibility (73.63%). Our results indicated that the microencapsulates created with the active ingredient and the wall materials (MD and HPBCD) could protect phenolic compounds/anthocyanins against ABTS radicals (63.53 and 62.47 mmol Trolox Eq/kg, respectively).

Acrylamide in Corn-Based Thermally Processed Foods: A Review.

Widely consumed thermally processed corn-based foods can have a great contribution to acrylamide dietary intake, thus bearing a high public health risk and requiring attention and application of strategies for its reduction. This paper reviews the literature on the acrylamide content of corn-based food products present in the market around the world. The potential of corn for acrylamide formation due to its content of free asparagine and reducing sugars is described. Human exposure to acrylamide from corn-based foods is also discussed. The content of acrylamide in corn/tortilla chips, popcorn, and corn flakes, as widely consumed products all over the world, is reported in the literature to be between 5 and 6360 µg/kg, between

Perinatal outcomes in women with severe acute respiratory syndrome coronavirus 2 infection: comparison with contemporary and matched pre-COVID-19 controls.

OBJECTIVES: To compare perinatal outcomes in women with vs. without severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS: Perinatal outcomes in SARS-CoV-2 positive pregnant women who delivered at our institution between October 27th 2020 and January 31st 2021 were compared to SARS-CoV-2 negative pregnancies (contemporary controls) and historical 2019 controls matched by maternal age, pre-pregnancy body mass index and parity. Testing was performed based on symptoms or close contact at any time during pregnancy and as part of universal screening at hospital admission. Multivariable log-linear regression models were used adjusting for potential confounders (p < 0.05 statistically significant). RESULTS: One thousand three hundred seventeen women delivered at our institution during the study period. 1,124 (85%) tested negative and 193 (15%) positive for SARS-CoV-2. 189 (98%) were infected during third trimester. 19 (10%) were asymptomatic, 171 (89%) had mild to moderate coronavirus disease 2019 (COVID-19), and 3 (2%) were critically ill with one case of maternal death. There were no significant differences in preterm birth, small-for-gestational-age birth weight, congenital anomalies, operative delivery, intrapartum hypoxia, and perinatal mortality in SARS-CoV-2 positive pregnancies compared to contemporary reference group or historical controls from pre-COVID-19 period. Labor was more commonly induced in SARS-CoV-2 positive women compared to reference SARS-CoV-2 negative group (68 [35%] vs. 278 [25%], adjusted odds ratio 1.62; 95% confidence interval 1.14-2.28). CONCLUSIONS: SARS-CoV-2 infection in pregnancy was not strongly associated with adverse perinatal outcomes. While the majority of SARS-CoV-2 positive women had no or mild/moderate symptoms, 2% were critically ill, with one case of maternal death.

Usefulness of COVID-19 screen-and-test approach in pregnant women: an experience from a country with low COVID-19 burden.

OBJECTIVES: Information on the usefulness of screen-and-test strategies of pregnant women for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is lacking. METHODS: We retrospectively reviewed the Ljubljana Maternity Hospital database and searched for pregnant women, who were admitted to the hospital between March 15 and May 16, 2020, for a planned procedure or hospitalization. Their medical records were examined and SARS-CoV-2 test results were retrieved. RESULTS: During the two-month period analyzed, there were a total of 265 scheduled admissions of pregnant women to our hospital. Two hundred two (76.2%) were tested for SARS-CoV-2 1 day prior to admission. All tested negative for SARS-CoV-2 RNA, regardless of having coronavirus disease 2019 (COVID-19)-compatible signs or symptoms (n=28) or not (n=174). CONCLUSIONS: In a population with a low SARS-CoV-2 burden, usefulness of universal testing of pregnant women before admission to the hospital is limited. We recommend that obstetric units in regions with low SARS-CoV-2 burden enforce rational use of personal protective equipment and diligent screening protocols using targeted questionnaires, whereas SARS-CoV-2 laboratory testing should be performed only in screen-positives: those with high clinical suspicion of COVID-19 and/or suspected epidemiological history.

Maternal characteristics of preterm singleton birth following assisted reproduction: a population-based study.

OBJECTIVE: To identify pregestational maternal characteristics that are associated with an increased risk for preterm births (PTB) of assisted reproductive technology (ART) singleton pregnancies. PATIENTS AND METHODS: We evaluated the Slovenian National Perinatal Information System (NPIS). We included all ART singletons born during the period 2006-2015. We compared births before and after 36 completed weeks' gestation for maternal age, parity, prepregnancy BMI, height, previous PTB, preexisting hypertension and diabetes, and history of uterine gynecological operations. RESULTS: Chronic hypertension (OR 2.5, 95% CI 1.3-4.8), previous preterm birth (OR 2.4, 95% CI 1.5-3.7), pregravid obesity (OR 1.6, 95% CI 1.2-2.1) and an existing indication for cerclage (OR 6.2, 95% CI 3.7-10.5) were associated with an increased risk of PTB. CONCLUSIONS: Chronic hypertension, previous PTB, pregravid obesity and an existing indication for cerclage are associated with increased risk of PTB among ART pregnancies.

Abuse of pregnant women in the healthcare system.

Objective: The purpose of this study was to determine the incidence of abuse in healthcare system during pregnancy and its impact on pregnancy outcomes.Materials and methods: A validated screening Norvold Abuse Questionnaire for the identification of female victims of four kinds of abuse: emotional, physical, sexual, and the abuse in the healthcare system was anonymously offered to all women in the first 2 days postpartum.Results: The study group consisted of 1018 women, 6.2% of which reported experiencing abuse in healthcare system during pregnancy. Affected women had a higher incidence of preterm delivery (OR 2.4; 95% CI 1.2-4.8) and cesarean section rate (OR 2.0; 95% CI 1.1-3.6). Sexual abuse and abuse in healthcare system during childhood were associated with abuse in healthcare system during pregnancy (OR 4.4; CI 95% 1.2-16.2 and OR 6.9; CI 95% 1.3-35.4, respectively).Conclusions: Our study indicates that as many as 6.2% of pregnant women experience abusive encounters with perinatal care providers. These pregnancies eventually end more often preterm and by cesarean section. This possibly causal relationship should be further explored.

Vaginal Microbiome Signature Is Associated With Spontaneous Preterm Delivery.

Background: Preterm delivery (PTD) represents an important public health and therapeutic challenge. Despite the reported link between the composition of vaginal microbiome and PTD, previous studies were inconsistent in their conclusions and utilized non-uniform designs. We performed an independent case-control study carried out on the Slovenian population, where we re-evaluated the role of the vaginal microbiome in PTD. Methods: Vaginal microbiomes of pregnant women who delivered preterm were compared to those delivered at term to examine differences in the microbial richness, diversity, and differential abundance of specific taxa. We obtained vaginal swab samples from 155 Caucasian women who were classified as either term (≥380/7 weeks, n = 107) or preterm (≤366/7 weeks, n = 48) in exclusion of any other medical or obstetric conditions. The vaginal microbiomes of these women were characterized by 16S ribosomal RNA (rRNA) gene sequencing of the V3-V4 region on the MiSeq platform. Results: Women who experienced PTD had a higher microbial richness (Chao1, P = 0.011) and alpha diversity (Shannon, P = 0.00059) than women with term deliveries. We report that overall vaginal microbial community composition (beta-diversity) was significantly different by delivery gestational age category (P WeightedUnifrac < 0.001). Women who delivered preterm had decreased Lactobacilli spp. abundance as well as increased abundance of Gardnerella and other bacterial vaginosis (BV) and aerobic vaginitis (AV) associated genera including Atopobium, Sneathia, Gemella, Megasphaera, Dorea, Streptococcus, and Escherichia/Shigella. Conclusions: In the present study, we provide further evidence that vaginal microbiome composition is associated with PTD.

Contextual-relationship and stress-related factors of postpartum depression symptoms in nulliparas: a prospective study from Ljubljana, Slovenia.

BACKGROUND: For a significant proportion of women, postpartum depression (PPD) is the first mood episode in their lives, yet its aetiology still remains unclear. Insecure attachment in close adult relationships is considered to be a risk factor for depressive symptoms. This study aimed to gain further insight into the risk factors for postpartum depression symptoms (PPDS) of nulliparas in Slovenia and to examine vulnerability to developing depressive symptoms, with an emphasis on contextual and stress-related characteristics. METHODS: The sample consisted of 156 nulliparas in the third trimester of pregnancy enrolled in a childbirth preparation program. The following instruments were applied: Experiences in Close Relationships-Revised, the Edinburgh Postpartum Depression Scale (EPDS), the Zung Anxiety Scale and a question battery designed by the research team including questions about emotional support and work-related stress. Logistic regression was used to test the association between demographic, social, environmental, personality and attachment variables and PPD of nulliparas (EPDS ≥10), controlling for baseline (prepartum) depression score. A multivariable linear regression model was built with the postpartum EPDS continuous score as a dependent variable. RESULTS: 28/156 (17,9%) were evaluated as being at risk for depression (EPDS≥10) in the last trimester and 25/156 (16%) at six weeks postpartum. The results of the logistic regression model controlled for prepartum depression score showed that increased risk for developing PPDS was associated with anxiety level postpartum, intimate-partner-attachment anxiety postpartum, and elevated stress due to loss of employment or an unsuccessful search for employment in the previous year. The results of the multivariable regression model, however, showed the association with education and postpartum anxiety with PPDS continuous score; EPDS after giving birth was higher for more educated and more anxious primiparas. CONCLUSIONS: Our findings demonstrate the importance of anxiety symptoms and higher education level in assessments of nulliparas' mental health. The results of our study show and confirm the results of previous research that anxiety symptoms in the immediate postpartum period are likely to be associated with depressive symptoms in nulliparas. The results also suggest that higher level of education of first-time mothers might not be a protective factor, especially for nulliparas with the university level of education. Further studies on larger samples should be considered.

Individual and Contextual Factors of Nulliparas' Levels of Depression, Anxiety and Fear of Childbirth in the Last Trimester of Pregnancy: Intimate Partner Attachment a Key Factor?

BACKGROUND: Depression, anxiety and fear of childbirth have numerous consequences for women and their developing offspring. Insecure attachment in close adult relationships is considered to be a risk factor for depressive symptoms. This study aims to gain further insight into the risk factors for depressive and anxiety symptoms in nulliparous women during the third trimester of pregnancy regarding the main contextual relations, with an emphasis on partner attachment. METHODS: A group of 325 nulliparas in the third trimester of pregnancy was enrolled in a childbirth preparation program. The following instruments were applied: Experiences in Close Relationships-Revised, the Edinburgh Depression Scale, the Zung Anxiety Scale, and a questionnaire regarding fear of childbirth. Three separate multiple linear regression models were built to explore the associations between demographic, social and attachment variables and mental health functioning. RESULTS: Highly educated nulliparas and those with a higher level of co-workers' emotional support experienced a lower level of anxiety when other predictors in the model were held constant. Of all the predictors in the model, only attachment anxiety and co-workers' support were statistically significantly associated with the level of depression. Attachment anxiety was significantly associated with all three mental health indicators (level of depression, anxiety and fear of childbirth). CONCLUSIONS: The results suggest that intimate attachment anxiety could be a key contextual factor for mood and anxiety mental health functioning during the third trimester of pregnancy, accessible to change. Our results could facilitate the formulation of interventions for reducing antenatal depressive symptoms.

Effect of pre-gravid body mass index on outcomes of pregnancies following in vitro fertilization.

PURPOSE: To examine the effect of pre-gravid body mass index (BMI) on perinatal outcomes in in vitro fertilization (IVF) singleton pregnancies. METHODS: Retrospective population-based cohort study. All singleton pregnancies delivered at ≥ 22 weeks' in Slovenia between 2002 and 2015 were included. Logistic regression analysis was used to examine the relationship between BMI category and outcomes, controlling for potential confounding variables. Interaction term was included to evaluate whether effects of obesity on perinatal outcomes differ in IVF vs. non-IVF pregnancies. We counted the frequencies of hypertensive disorders of pregnancy, gestational diabetes, cesarean delivery, preterm births, and small as well as large for gestational age neonates, neonatal respiratory distress syndrome, neonatal intraventricular hemorrhage, and perinatal deaths. RESULTS: Pre-gravid overweight and obesity were associated with higher rates of hypertensive disorders, gestational diabetes, and cesarean deliveries in both IVF and non-IVF pregnancies. Pre-gravid underweight was associated with small for gestational age neonates in IVF and non-IVF pregnancies. There was a significantly lower effect of pre-gravid obesity on the incidence of hypertensive disorders (odds ratio (OR) 0.7; 95% confidence interval (CI) 0.5-0.9) and cesarean delivery (OR 0.8; 95% CI 0.7-0.99) in IVF vs. non-IVF pregnancies. The effect of pre-gravid obesity on neonatal mortality was significantly greater in IVF compared to non-IVF pregnancies (OR 4.6; 95% CI 1.4-15.8). CONCLUSIONS: Pre-gravid BMI has an important effect on perinatal outcomes in pregnancies following IVF.