Third-trimester persistent maternal hypotension effects on late-onset small for gestational age and adverse perinatal outcomes.

INTRODUCTION: The purpose of the current study was to examine whether third-trimester persistent maternal hypotension is related to small for gestational age (SGA) and adverse perinatal outcomes. METHODS: In this large retrospective cohort study, 6560 pregnant women were enrolled and divided into two groups according to maternal tension status: a normotensive group (n: 6290) and a persistent maternal hypotensive group (n: 270). Persistent maternal hypotension was defined as an SBP <100 mmHg and/or DBP <60 mmHg at three antenatal visits: visit 1 (260/7-296/7 gestation weeks), visit 2 (300/7-336/7 gestation weeks), and visit 3 (340/7-366/7 gestation weeks). Following the Delphi consensus criteria, a fetal growth restriction diagnosis was employed. The presence of an SGA neonate was the primary outcome of the study. SGA was defined as fetal abdominal circumference below the 10th percentile or fetal birth weight below the 10th percentile in the absence of abnormal Doppler findings. The secondary outcomes were defined as the presence of other adverse perinatal outcomes. RESULTS: The baseline characteristics of the study population were similar. We found that SGA rates were 6.3% in the control group and 7.0% in the persistent maternal hypotension group, which were statistically similar. In the present study, the secondary outcomes which prematurity, low 5-min Apgar score, and NICU admission were similarly between groups. DISCUSSION: Our results indicate that third-trimester persistent hypotension is not associated with SGA neonates or adverse perinatal outcomes. Hence, it can be concluded that third-trimester persistent hypotension is a physiological phenomenon during pregnancy that should not cause anxiety in mothers.

Effect of third trimester maternal vitamin D levels on placental weight to birth weight ratio in uncomplicated pregnancies.

OBJECTIVES: Vitamin D has critical role for the fetal and placental development. Today, placental weight (PW), fetal birth weight (BW), and the PW/BW ratio are used as markers of fetal development. The aim of this study is to evaluate the relationship between vitamin D levels and these markers in uncomplicated pregnancies. METHODS: This study included 108 women with uncomplicated pregnancies, defined as full-term and healthy pregnancies without perinatal complications. Vitamin D levels <12 ng/mL were classified as deficient, 12-20 ng/mL as insufficient, and >20 ng/mL as normal. Postnatal BW and PW were compared according to maternal serum vitamin D levels. RESULTS: Maternal age, maternal height, maternal weight, body mass index, nulliparity, gestational age at delivery, mode of delivery, and fetal gender were similar between groups. Postnatal BW, PW, fetal height at birth, and fetal head circumference parameters were similar between the groups. The PW/BW ratio was 21.77±2.20 in the vitamin D deficient group, 21.20±2.40 in the insufficient group, and 19.98±2.37 in the normal group (p=0.012). In addition, there was a significant negative correlation between vitamin D level and the PW/BW ratio (p=0.012, r=0.031). CONCLUSIONS: Our results indicated that PW/BW ratio which is the marker for prediction adverse perinatal outcomes were significantly increased in the presence of vitamin D deficiency and insufficiency.

Severe Intrahepatic Cholestasis Pregnancy Is Associated With Maternal Endothelial Dysfunction: A Case-Control Study.

OBJECTIVE: The aim of the present study was to evaluate maternal serum endocan levels, which are markers of vascular pathologies and strongly associated with vascular inflammation and endothelial dysfunction, in pregnancies complicated by intrahepatic cholestasis of pregnancy (ICP). METHODS: The study comprised 30 pregnant women with mild ICP, 30 pregnant women with severe ICP, and 30 healthy pregnant women as a control group. The inclusion criteria were women with ICP, which was diagnosed based upon the presence of pruritus associated with elevated total bile acid (TBA) levels (> 10 µm/L), elevated aminotransferases, or both, and the absence of diseases that may produce similar laboratory findings and symptoms. Severe ICP was defined as TBA > 40 µmol/L. After diagnosis for ICP, blood samples were obtained before medication during hospitalization to analyze maternal serum endocan levels. RESULTS: Gestational age at delivery, delivery induction rates, birth weight, and newborn intensive care unit (NICU) admission rates were significantly higher in the severe ICP group than in the control group and mild ICP group. Gestational age for all groups when blood was sampled was similar. Maternal serum TBAs and aminotransferase levels were significantly higher in the severe ICP group than in the control group and mild ICP group. The mean serum endocan levels were 10.9 ± 2.6 ng/mL in the control group, 12.5 ± 2.8 ng/mL in the mild ICP group, and 24.3 ± 4.8 ng/mL in the severe ICP group (p < 0.001). CONCLUSION: Our results indicated that maternal serum endocan levels were increased in the presence of severe ICP and it can be speculated that increased bile acid levels were associated with maternal endothelial dysfunction.

Evaluation of Altmetric Analysis Scores of the Top 100 Articles on Polycystic Ovary Syndrome Published in the Last 10 Years.

OBJECTIVE: In the current study, we analyzed the 100 most cited articles with the topic, title, and keywords of polycystic ovary syndrome (PCOS) published in all journals in terms of traditional metrics and the altmetric score (AS). METHODS: The term "polycystic ovary syndrome (PCOS)" was searched in the Web of Science (WoS) database and filtered for articles published in all journals. Bibliographic data and AS were obtained for 100 highly cited papers from January 2012 to July 2022. Descriptive statistics were reported and correlation analysis between traditional bibliographies and the AS was performed. RESULTS: The Journal of Clinical Endocrinology & Metabolism, with 14 articles, had the most publications on the Top 100 list. When the studies were classified according to subtypes, 56 papers were original scientific papers with mean AS of 32.5 (15.3-52.7), whereas 44 papers were reviews and meta-analyses with AS of 16.0 (8.6-43.2). The AS was positively correlated with H-index, total WoS citation number of article and Q category. There were no correlations with impact factor (IF), five-year IF, journal impact factor (JIF) percentile and journal citation indicator (JCI) value. CONCLUSION: Our results suggest that the AS is related with article total WoS citation number, journal Q category, and journal H-index. Effective communication on social media can promote scientific productivity and have a positive impact on society.

Evaluation of maternal serum progesterone-induced blocking factor levels in pregnancies complicated with early- and late-onset preeclampsia.

The aim of present study was to evaluate maternal serum progesterone-induced blocking factor (PIBF) levels in pregnancies complicated with early-onset (EO-PE) and late-onset (LO-PE) preeclampsia. Patients with preeclampsia were divided in two groups according to preeclampsia onset and compared to healthy control group: EO-PE and LO-PE defined as being diagnosed before 340/7 and ≥340/7 weeks, respectively. Maternal age, nulliparity, BMI at blood sampling, smoking, history of caesarean section and ethnicity were statistically similar among the groups. Statistically significant differences were found between the eo-PE and lo-PE preeclampsia groups in terms of gestational age at delivery, mean birth-weight percentile and foetal growth restriction rates. The mean serum PIBF level was 528.6 ± 220 ng/mL in the eo-PE and 615.3 ± 269.1 ng/mL in the lo-PE preeclampsia and 782.3 ± 292.4 ng/mL in the control groups; the difference among groups was statistically significant. Our results indicated that decreased PIBF levels play an important immunologic role in preeclampsia onset. IMPACT STATEMENTWhat is already known on this subject? Maternal lymphocytes secrete PIBF that provides the immunological effects of progesterone during pregnancy by activating T-helper type 2 (Th2) cells and inhibiting any activated uterine natural killer (uNK) cells. The recent studies results have shown that there is disproportion in the Th1/Th2 rate in women with preeclampsia. This purports that Th1-mediated immunity is promoted through Th2-mediated immunity, which can be involved in the pathogenesis of preeclampsia.What do the results of this study add? In this study we found that PIBF levels in maternal serum were significantly lower in the EO-PE group than in LO-PE and control group. Our results indicated that decreased PIBF levels play an important immunologic role in preeclampsia onset.What are the implications of these findings for clinical practice and/or further research? We can speculate that first trimester maternal serum PIBF levels may be a useful biomarker for prediction of EO-PE. Using serum PIBF levels within the first trimester combined with Doppler values for the uterine artery, and some biochemical markers to predict onset and severity of preeclampsia appear to be a new screening method.

First-trimester maternal serum betatrophin levels are decreased in pregnancies complicated by gestational diabetes mellitus.

INTRODUCTION: The purpose of the present study was to compare maternal serum betatrophin levels during the first trimester from healthy pregnancies to those complicated by gestational diabetes mellitus (GDM). METHODS: In this prospective study, 320 pregnant women were evaluated in their first trimester, and 145 pregnant women who met the inclusion criteria were divided into the following two groups according to GDM screening results: GDM (n:20) and non-diabetic healthy control (n: 125). Samples of maternal serum fasting insulin, fasting blood glucose, hemoglobin (HB)A1c, and betatrophin levels obtained from the women's blood samples between 11+0/7 -13+6/7 gestational weeks during first trimester nuchal translucency screening. 75-g oral glucose tolerance test protocol was preferred for GDM scanning between 24+0/7 -28+0/7 gestational weeks. RESULTS: Maternal age and first-trimester body mass index (BMI) were higher in the GDM group than in the control group. Gestational age at blood draw was similar between the groups. First-trimester fasting insulin, fasting glucose, hemoglobin (Hb)A1c, thyroid-stimulating hormone, triiodothyronine (sT3), and thyroxine (sT4) were statistically similar between groups. First trimester Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) was 2.67 ± 1.42 in the GDM group and 2.12 ± 1.61 in the control group and not statistically different. Maternal age and BMI adjusted first-trimester maternal serum betatrophin levels were 11.58 ± 6.40 ng/mL in the GDM group and 31.11 ± 3.00 ng/mL in the control group and was statistically lower in the GDM group (p < 0.001). DISCUSSION: Our results indicated that first trimester maternal serum betatrophin levels are decreased in pregnancies complicated by GDM and first trimester betatrophin levels could be an early screening tool for GDM to allow better pregnancy management.

New ultrasonographic midtrimester scoring method for predicting spontaneous preterm birth in uncomplicated asymptomatic twin pregnancies.

OBJECTIVES: The aim of the present study was to evaluate a new ultrasonographic scoring method that could predict spontaneous preterm birth (sPTB) in uncomplicated twin pregnancies during routine anomaly screening in the midtrimester. METHODS: This prospective study included women with a monochorionic diamniotic (MCDA) or dichorionic diamniotic (DCDA) twin pregnancy gestational ages from 170/7 through 226/7. A new ultrasonographic score between 0 and 5 points was calculated using cervical length (CL), uterocervical angle (UCA), and cervical dilatation status during routine anomaly screening in the midtrimester. The primary outcome of the study was the prediction of sPTB < 32 and <34 gestational weeks. RESULTS: A total of 118 pregnant women with twins were evaluated, 31 of whom delivered before 34 gestational weeks an 87 of whom delivered after 34 gestational weeks. The sensitivity and specificity values were separately calculated for scores of 3.5 and 2.5 for predicting sPTB < 32 gestational weeks. The cut-off value of 3.5 provided a sensitivity of 80% and a specificity of 82%. When the score was 2.5, the sensitivity and specificity were 86 and 71%, respectively. To determine a score for predicting sPTB < 34 gestational week cut-off value of 3.5 provided a sensitivity of 80% and a specificity of 90%. When the score value was 2.5, the sensitivity and specificity of the method were 83 and 81%, respectively. CONCLUSIONS: Our results indicated that the midtrimester new scoring is a simple technique that can be easily used as an improved tool for predicting the risk of sPTB in women with a twin pregnancy.

Assessment of intrahepatic cholestasis in pregnancy and the effect of disease severity on transient tachypnea in the newborn in uncomplicated fetuses.

OBJECTIVES: Considering the effects of bile-acid levels on fetal lungs and pulmonary surfactants, we hypothesized that in the presence of intrahepatic pregnancy cholestasis (ICP), poor neonatal respiratory problems are observed in relation to the severity of the disease. Delivery timing with the presence of ICP is scheduled during late-preterm and early term gestational weeks. The aim of this study was to assess ICP and disease severity effects on transient tachypnea of the newborn (TTN) in uncomplicated fetuses. METHODS: This study comprised 1,097 singleton pregnant women who were separated into three groups-control, mild ICP, and severe ICP. The pregnant women diagnosed with ICP between January 2010 and September 2020 was investigated using the hospital's database. For the control group, healthy pregnant women who met the same exclusion criteria and were similar in terms of maternal age, gestational age at delivery, and mode of delivery were analyzed. RESULTS: The TTN rate was 14.5% in the severe ICP group, 6.5% in the mild ICP group, and 6.2% in the control group. The TTN rate in the severe ICP group was significantly higher than that in the other groups (p<0.001). Similarly, the rate of admission to the neonatal intensive care unit was significantly higher in the severe ICP group than in the other groups (p<0.001). According to Pearson correlation analyses, maternal serum bile-acid levels were positively correlated with TTN (r=0.082; p=0.002). CONCLUSIONS: Severe ICP, but not mild ICP, and serum bile-acid levels were positively correlated with increased TTN risk and reduced pulmonary surfactant levels.

The role of the brain-sparing effect of growth-restricted fetuses in newborn germinal matrix/intraventricular hemorrhage.

OBJECTIVES: The aim of the study was to evaluate the effect of the brain-sparing effect (BSE) of fetal growth restriction (FGR) in newborn germinal matrix/intraventricular hemorrhage (GM/IVH). METHODS: A total of 320 patients who delivered prior to the 34th gestational week were analyzed from data records. 201 patients were divided into two groups according to cerebro-placental ratio (CPR): early fetal growth restriction (FGR) with abnormal CPR group (n=104) and appropriate for gestational age with normal Doppler group (control) (n=97). Using the normal middle cerebral artery (MCA) Doppler as a reference, multivariate logistic regression analysis was used to assess the association between the BSE and the primary outcome. RESULTS: The rate of Grade I-II germinal matrix/intraventricular hemorrhage (GM/IVH) was 31(29.8%) in the group possessing early FGR with abnormal CPR and 7(7.2%) in the control group, showing a statistically significant difference. The rate of grade III-IV GM/IVH was 7(6.7%) in the group possessing early FGR with abnormal CPR and 2 (2.1%) in the control group, showing no statistically significant difference. We found that gestational age at delivery <32 weeks was an independent risk factor for GM/IVH. In addition, we found that other variables such as the presence of preeclampsia, fetal weight percentile <10, emergency CS delivery, 48-h completion after the first steroid administration and 24-h completion rate after MgSO4 administration were not independently associated with the primary outcome. CONCLUSIONS: Our results indicate that the rate of GM-IVH was increased in the group possessing early FGR with abnormal CPR; however, multivariate logistic regression analysis showed that BSE was not an independent risk factor for GM/IVH.

Evaluation of the diagnostic accuracy of a combination of first-trimester ultrasound and maternal demographic characteristics for detecting abnormally invasive placenta.

OBJECTIVE: The aim of present study was to evaluate the diagnostic accuracy of using a combination of a first-trimester ultrasound and the maternal demographic characteristics in detecting abnormally invasive placenta (AIP). STUDY DESIGN: This prospective case-control study comprised 540 women who meet the inclusion criteria and who were included in the final analysis. Patients scored points based on a range between 0 and 13 for the ultrasonographic and clinical findings within first trimester. The primary outcome of the study was whether placenta accreta, increta, and percreta could be predicted early in pregnancy. RESULTS: The cutoff value of 5.5 provided a sensitivity of 100% and a specificity of 88% and the diagnostic odds ratio (DOR at 95% confidence interval [CI]) was 208 (12-3543), at 95%CI) was 0, and the positive likelihood ratio (LR + at 95%CI) was 8.25 for placenta percreta. The cutoff value of 6.5 provided a sensitivity of 92% and a specificity of 93% and DOR at 95%CI was 201.5 (25.5-1583.1), LR- at 95%CI was 0.08, and LR + at 95%CI was 15.32 for placenta percreta. The cutoff value of 4.5 provided a sensitivity of 100% and a specificity of 90% and DOR at 95%CI was 615 (37-10207), LR- at 95%CI was 0, and LR + at 95%CI was 11.7 for accreta and increta, respectively. The cutoff value of 5.5 provided a sensitivity of 87% and a specificity of 92% and DOR at 95%CI was 86.8 (28.9-260.8), LR- at 95%CI was 0.14, and LR + at 95%CI was 11.7 for placenta accreta and increta, respectively. CONCLUSION: The results of the present study indicated that this novel scoring provided high diagnostic accuracy for detecting all types of AIP during the first trimester.

Evaluation of midtrimester ductus venosus diameter and peak systolic velocity to predict late onset small for gestational age fetuses.

OBJECTIVE: The ductus venosus, a small blood vessel in the fetal venous system, has extraordinary physiologic significance because it connects the umbilical vein to the inferior vena cava in the fetus circulation system and transports highly oxygenated blood from the placenta to the fetus' heart. Hence, assessment of ductus venosus flows is helpful in evaluating fetal hemodynamics. Considering the critical function of the ductus venosus, we hypothesized that the diameter of the midtrimester ductus venosus and its peak velocity index can be related to adequate fetal growth; therefore, the aim of this study was to evaluate the role of the midtrimester umbilical venous blood flow, ductus venosus diameter, and ductus venosus peak systolic velocity to help predict uncomplicated deliveries of late onset small for gestational age (SGA) fetuses. METHODS: In this prospective study we analyzed the pregnancies and deliveries of 398 pregnant women who met the inclusion criteria and divided them into three groups according to fetal birth weight as follows: birth weight <3 percentile SGA group (n = 16), birth weight 3-10 percentile SGA group (n = 42), and appropriate for the gestational age (AGA) group (n = 340). The midtrimester ductus venosus diameter and peak sistolic velocity, umbilical venous blood flow, and umbilical artery pulsatility index (PI) were recorded. In the absence of congenital anomalies, the diagnosis of fetal growth restriction (FGR) is made according to Delphi consensus criteria. In the absence of abnormal Doppler findings, late FGR was defined as occurring ≥32 weeks. RESULTS: Maternal age, nulliparity, mean gestational age at ultrasound evaluation, ethnicity, body mass index, and previous cesarean delivery rates were similar among the groups. In addition, mid-trimester fetal biometric measurements and amniotic fluid volume were similar among the groups. The gestational age at delivery, prematurity, fetal birth weight, vaginal delivery rates, and rate of admission to the neonatal intensive care unit were significantly different among the groups. The mean mid-trimester umbilical vein blood flow to abdominal circumference ratio (UVBF/AC) was similar among the groups (p=.740). In the <3 group, the mean peak systolic velocity of the ductus venosus was significantly lower and the mean diameter of the ductus venosus significantly higher than those in the 3-10 and AGA groups (both p<.001). Although the values are below the 95th percentile mid-trimester umbilical artery PI was significantly higher in the <3 percentile SGA group than in the 3-10 percentile SGA and AGA groups. CONCLUSION: Our results suggest that the diameter and peak systolic velocity of the mid-trimester ductus venosus are useful noninvasive measurements that provide prediction of late onset SGA fetuses.

Umbilical cord N-terminal procollagen of type l collagen (P1NP) and beta C-terminal telopeptide (ßCTX) levels in term pregnancies with vitamin D deficiency.

AIMS: The aim of the present study was to evaluate umbilical cord N-terminal procollagen of type l collagen (P1NP) and beta C-terminal telopeptide (ßCTX) levels in term pregnancies with vitamin D deficiency. MATERIALS AND METHODS: Ninety-two pregnant women between 19 and 35-years-old who delivered at term gestational age were included in the study and divided into deficient (n = 32), insufficient (n = 30), and normal (control) vitamin D levels (n = 30). RESULTS: Maternal demographic characteristics and biochemical parameters were similar among groups. The mean umbilical cord P1NP level was 221.4 (211.7-231.0, 95%CI) pg/mL in the vitamin D deficiency group, 282.5 (271.2-293.8, 95%CI) pg/mL in the vitamin D insufficiency group, and 280.9 (270.9-290.8, 95%CI) pg/mL in the control group and significantly lower in vitamin D deficiency group than others (p < .001). Umbilical cord P1NP level was similar in the vitamin D insufficiency group and control group (p = .971). The mean umbilical cord ßCTX level was 5530, 9 (5511.5-5550.3, 95%CI) pg/mL in the vitamin D deficiency group, 5516.3 (5498.4-5534.2, 95%CI) pg/mL in the vitamin D insufficiency group, and 5510 (5491.4-5528.5, 95%CI) pg/mL in the control group, which was statistically similar among the groups (p = .251). CONCLUSION: Our results indicated that vitamin D deficiency during pregnancy affects fetal bone osteoblast activity.

Fetal Pulmonary Artery Acceleration/Ejection Ratio for Transient Tachypnea of the Newborn in Uncomplicated Term Small for Gestational Age Fetuses.

OBJECTIVE: Transient tachypnea of the newborn (TTN) is the leading cause of neonatal morbidity in preterm deliveries and has been reported in term small-for-gestational-age (SGA) fetuses; therefore, determination of fetal lung maturity before delivery is extremely important. Our present study aimed to evaluate the ratio of fetal pulmonary artery acceleration time to ejection time (At/Et) in uncomplicated term SGA fetuses and whether this ratio changes with TTN. STUDY DESIGN: One hundred seventy-five pregnant women with uncomplicated pregnancies who delivered after 37 gestational weeks were included in this cross-sectional study. Participants were divided by birth weight percentiles into SGA (n = 86) and healthy control groups (n = 89). All participants underwent ultrasound examination to determine fetal pulmonary artery At/Et. After delivery, the neonates were grouped according to diagnosis of TTN (i.e., TTN-positive SGA group [n = 14], TTN-negative SGA group [n = 72], and TTN-negative control group [n = 86]), and the fetal pulmonary artery At/Et was compared between the two. RESULTS: Maternal demographic characterizes were similar between groups. At/Et was 0.309 ± 0.181 in the SGA group and 0.348 ± 0.213 in the control group and was significantly lower in the SGA group. At/Et was 0.290 ± 0.007 in the TTN-positive SGA group, 0.313 ± 0.017 in the TTN-negative SGA group, and 0.351 ± 0.186 in the TTN-negative control group, a significant difference. Additionally fetal pulmonary artery At/Et was found to be inverse correlated with TTN. (-0,464 P = 0.000). The cut-off value of 0.298 provided optimal specificity of 93.0 % and sensitivity of 81.0 % for subsequent diagnosis of TTN in term SGA newborns in the neonatal period. CONCLUSION: The risk for TTN increases in uncomplicated term SGA fetuses. The fetal pulmonary artery At/Et appears to be a noninvasive useful method by which to predict TTN in these fetuses.

Effect of the anterior uterocervical angle in unexplained infertility: a prospective cohort study.

OBJECTIVE: The present study aimed to evaluate an anatomical region, the anterior uterocervical angle (UCA), to determine whether it plays a role in unexplained infertility. METHODS: In this prospective, cross-sectional study, unexplained infertile and healthy fertile (controls) women were compared. The longitudinal and transverse axes of the uterine cervix and uterine corpus were measured by transvaginal ultrasonography. The UCA was determined as the angle between two lines. One line was drawn between the internal and the external os, and the other was drawn through the internal cervical os and was parallel to the lower side of the front part of the uterine wall in the internal os. Demographic characteristics and uterocervical ultrasonographic measurements were compared between the two groups. RESULTS: Eighty participants, aged from 20 to 35 years, were enrolled (unexplained infertile [n = 30] and healthy fertile women [n = 50)]. The mean lengths of the uterine corpus longitudinal axis, uterine corpus transverse axis, and uterine cervix longitudinal axis were similar between the groups. The mean UCA was significantly higher in healthy fertile women (131.9 ± 22.9 degrees) than in women with unexplained infertility (114.2 ± 17.3 degrees). CONCLUSION: The present study shows that a narrow anterior UCA is associated with unexplained infertility.

The Effect of Iron Deficiency Anemia Early in the Third Trimester on Small for Gestational Age and Birth Weight: A Retrospective Cohort Study on Iron Deficiency Anemia and Fetal Weight.

AIM: The aim of the present study was to evaluate the relationship between iron deficiency anemia and small for gestational age (SGA) in early third trimester pregnancies. METHODS: A total of 4800 pregnant women who met the inclusion criteria were analyzed retrospectively. We included pregnant women who had iron deficiency anemia between 26+0 and 30+0 weeks of gestation and delivered singletons between 37+0 and 41+6 weeks of gestation. Patients were divided into four groups according to anemia level: (1) hemoglobin (Hb) < 7 mg/dl (n = 80), (2) Hb 7-9.9 mg/dl (n = 320), (3) Hb 10-10.9 mg/dl (n = 1300), and (4) Hb > 11 mg/dl (n = 3100, control group). The primary outcome of this study was the presence of SGA. RESULTS: The demographic and obstetric characteristics were similar among all the groups. Maternal age, BMI <30 kg/m2, nulliparity rates, and previous cesarean delivery rates were similar among groups. Ethnicity was significantly different in the severe and moderate anemia groups (<0.001). Mean fetal weight was 2900 ± 80 g in the severe anemia group, 3050 ± 100 g in the moderate anemia group, 3350 ± 310 g in the mild anemia group, and 3400 ± 310 g in the control group. Fetal weight was significantly lower in the severe and moderate anemia groups compared to the mild anemia and control groups (<0.001). The SGA rate was 18.7% in the severe anemia group, 12.1% in the moderate anemia group, 5.3% in the mild anemia group, and 4.9% in the control group. SGA was significantly higher in the severe and moderate anemia groups compared to the mild anemia and control groups (<0.001). CONCLUSION: The results of this study indicated that early third trimester severe and moderate iron deficiency anemia was associated with SGA. Iron deficiency anemia in pregnant women may lead to low birth weight.

The Effect of Immigration on Adverse Perinatal Outcomes: Analysis of Experiences at a Turkish Tertiary Hospital.

INTRODUCTION: In literature, it is well documented that migration is associated with adverse perinatal outcomes in many countries over the world. But in Turkey, health care providers and obstetricians had to face the effects of migration for the first time after civil war in Syria. Hence, this situation motivated us to conduct the current research in Turkey. Also we aimed to evaluate the effect of immigration on adverse perinatal outcomes, comparing the obstetric results of a native population and an immigrant population, and focusing on relevant indicators of perinatal health. METHODS: Information from the hospital database of pregnant women who had vaginal or cesarean delivery was evaluated. The patients were divided into two groups, native women and immigrant women, according to their ethnic origin. Adverse perinatal outcomes were compared between groups using multivariate regression models. Adjusted odds ratio (aOR) and 95% confidence interval (CI) were calculated. RESULTS: A total of 6311 patients were evaluated, of which 4271 were classified as native and 2040 were classified as immigrants. Mean hemoglobin level before delivery was significantly lower in the immigrant group. Preterm delivery (aOR: 1.41; 95% CI: 1.19-1.65), stillbirth (aOR: 1.88; 95% CI: 1.09-3.23), red blood cell transfusion requirement (aOR: 3.12; 95% CI: 2.02-3.98), unplanned birth rates before hospital arrival (aOR: 2.25; 95% CI: 1.53-3.31), and postpartum infection rates (aOR:2.12; 95% CI: 1.48-3.08) were significantly increased in the immigrant group compared with native group, even considering adjustment for potential confounders. CONCLUSION: The immigration may be an important and independent risk factor for some adverse maternal and neonatal outcomes.

Effect of Gestational Weight Gain on Perinatal Outcomes in Low Risk Pregnancies with Normal Prepregnancy Body Mass Index.

OBJECTIVE: This study aimed to clarify the effect of gestational weight gain (GWG) on perinatal outcomes in low risk pregnancies with normal prepregnancy body mass index (BMI). STUDY DESIGN: A total of 572 low-risk pregnant women with a normal prepregnancy BMI were included. GWG and inadequate or excessive weight gain were defined according to the United States Institute of Medicine updated guidelines. Adverse perinatal outcomes were compared among inadequate, normal, and excessive weight gain groups. RESULTS: Of the 572 pregnant women enrolled, 62 belonged to inadequate GWG group, 80 to excessive GWG group, and 430 to normal GWG group. Maternal age, prepregnancy BMI, gravity, parity, and previous cesarean delivery rates were similar among groups. Adverse perinatal outcomes were not statistically significant among groups. Fetal weight was significantly lower in inadequate weight gain group compared to normal weight gain group (p<0.001) and fetal weight was significantly lower in normal weight gain group compared to excessive weight gain group (p<0.001). Additionally, low birth weight <2.5kgs, birth weight > 4.0kgs, and SGA and LGA rates were similar among groups (P = 0.765, P = 0. 711, P = 0. 702, and P = 0.414, respectively). Although gestational age at delivery was term in normal percentile it was significantly lower in the inadequate weight gain group compared to others (P=0.010). CONCLUSIONS: This study showed that an inadequate or excessive weight gain in low-risk pregnancies with a normal prepregnancy BMI did not increase the risk of adverse perinatal outcomes.

Wnt signaling pathway in early- and late-onset preeclampsia: evaluation with Dickkopf-1 and R-Spondin-3 glycoproteins.

OBJECTIVE: Wnt signaling has been identified as an essential pathway that can direct cell proliferation, migration, and tissue homeostasis. This study aimed to evaluate the role of Wnt signaling pathway in early-onset and late-onset preeclampsia (PE) using serum Dickkopf-1 and R-Spondin-3 glycoproteins. STUDY DESIGN: A total of 80 pregnant women were included in this study. The patients were divided into three groups: (1) control (2) early-onset PE, and (3) late-onset PE. The serum levels of Dickkopf-1 and R-Spondin-3 were measured using an enzyme-linked immunosorbent assay. RESULTS: Of the 80 pregnant women enrolled in the study, 27 were control, 27 had early-onset PE, and 26 had late-onset PE. No differences were found in the maternal age, gravida, parity, and body mass index among the groups (P = 0.536, 0.230, 0.202, and 0.642, respectively). The serum level of Dickkopf-1 was significantly higher in the early-onset PE group compared with the control group (P = 0.006). The serum level of Dickkopf-1 was statistically similar in control group compared to late-onset PE group (P = 0.064). However, no significant difference was found in the serum levels of Dickkopf-1 and R-Spondin-3 between the early- and late-onset PE groups (P > 0.05). Additionally, the Spearman's correlation analysis revealed a significant negative correlation between maternal serum level of Dickkopf-1 and maternal age (r = - 0.522, P = 0.005). CONCLUSION: The increased serum level of Dickkopf-1 might be associated with the process of pathogenesis of early-onset PE. Further studies would elucidate their exact roles in the pathogenesis of PE.