Management of foetal hyperthyroidism in a mother with autoimmune hypothyroidism: A case report.

Foetal hyperthyroidism is mediated by transplacental passage of thyroid stimulating antibodies (TSAbs) and affects mothers with autoimmune (AI) thyroid disease. We report a case of a 33-year-old woman with a history of AI hypothyroidism and raised TSI after 2 stillbirths with suspect foetal hyperthyroidism. At 20.5 gestational weeks (GW) of her third pregnancy, foetal tachycardia and goitre were detected. TSI levels were 30.9mUI/mL. Methimazole (MMI) was started and adjusted based on ultrasound signs (foetal heart rate and thyroid gland vascularisation). The neonate was born at 35GW and cord blood revealed decreased TSH and normal free T4. MMI was started in the neonate at 2 days of life due to the appearance of asymptomatic hyperthyroidism. This case illustrates a rare recurrence of foetal hyperthyroidism in a mother with AI hypothyroidism. Pregestational thyroidectomy, TSAbs determination, early ultrasound diagnosis and foetal therapy helped us to improve obstetric outcomes.

The influence of obesity and diet quality on fetal growth and perinatal outcome / Influencia de la obesidad y la calidad de la dieta en el crecimiento fetal y resultados perinatales

Background: maternal obesity is associated with an increase of both maternal and fetal complications as macrosomia.Aim:to assess the quality of diet in a cohort of pregnant women in terms of Mediterranean diet (MD) adherence and to examine the association between diet quality, obesity, weight gain and fetal growth and perinatal complications. Methods: Mediterranean Diet Adherence Screener (MEDAS) was applied to assess diet quality in 542 pregnant women. Fetal biometric measurements at third-trimester ultrasound were collected and perinatal outcomes were recorded. Results: only 35 % of pregnant women presented a good quality of diet, in terms of adherence to MD. Diet quality significantly increased with lower values of body mass index (BMI) and higher maternal age. Higher BMI was significantly associated with a higher abdominal circumference and estimated fetal weight at the third trimester, a higher risk of hypertension disorder, induction of labor and a higher birthweight. A statistically significant association between diet quality and ultranosographic measures or perinatal outcome was not found. However, a higher weight gain across gestation was significantly associated with a higher risk of gestational diabetes, a higher gestational age at delivery and a higher birthweight. Conclusion: most of our pregnant women did not showed a great diet quality, but there was no evidence that diet quality affected pregnancy complications. On the contrary, pre-pregnancy BMI was related to fetal and neonatal growth and obstetric outcomes, similarly to weight gain across gestation. (AU)

Introducción: la obesidad materna se asocia con un aumento de complicaciones maternas y fetales, como la macrosomía.Objetivo:evaluar la calidad de la dieta en una cohorte de mujeres embarazadas en términos de adherencia a la dieta mediterránea (DM) y examinar la asociación entre la calidad de la dieta, la obesidad, el aumento de peso y el crecimiento fetal y las complicaciones perinatales. Métodos: se aplicó el Mediterranean Diet Adherence Screener (MEDAS) para evaluar la calidad de la dieta en 542 mujeres embarazadas. Se recogieron las medidas biométricas fetales en la ecografía del tercer trimestre y se registraron los resultados perinatales. Resultados: solo el 35 % de las gestantes presentó una buena calidad de alimentación en términos de adherencia a la DM. La calidad de la dieta aumentó significativamente con valores más bajos de índice de masa corporal (IMC) y mayor edad materna. Un IMC más alto se asoció significativamente con una mayor circunferencia abdominal y peso fetal estimado en el tercer trimestre, un mayor riesgo de trastorno hipertensivo, inducción del parto y mayor peso al nacer. No se encontró una asociación estadísticamente significativa entre la calidad de la dieta y las medidas ecográficas o el resultado perinatal. Sin embargo, un mayor aumento de peso durante la gestación se asoció significativamente con un mayor riesgo de diabetes gestacional, mayor edad gestacional al momento del parto y mayor peso al nacer. Conclusiones: la mayoría de nuestras gestantes no mostró una buena calidad de la dieta, pero no hubo evidencia de que la calidad de la dieta afectara las complicaciones del embarazo. Por el contrario, el IMC pregestacional se relacionó con el crecimiento fetal y neonatal y los resultados obstétricos, de manera similar al aumento de peso durante la gestación. (AU)

The influence of obesity and diet quality on fetal growth and perinatal outcome.

Introduction: .Background: maternal obesity is associated with an increase of both maternal and fetal complications as macrosomia. Aim: to assess the quality of diet in a cohort of pregnant women in terms of Mediterranean diet (MD) adherence and to examine the association between diet quality, obesity, weight gain and fetal growth and perinatal complications. Methods: Mediterranean Diet Adherence Screener (MEDAS) was applied to assess diet quality in 542 pregnant women. Fetal biometric measurements at third-trimester ultrasound were collected and perinatal outcomes were recorded. Results: only 35 % of pregnant women presented a good quality of diet, in terms of adherence to MD. Diet quality significantly increased with lower values of body mass index (BMI) and higher maternal age. Higher BMI was significantly associated with a higher abdominal circumference and estimated fetal weight at the third trimester, a higher risk of hypertension disorder, induction of labor and a higher birthweight. A statistically significant association between diet quality and ultranosographic measures or perinatal outcome was not found. However, a higher weight gain across gestation was significantly associated with a higher risk of gestational diabetes, a higher gestational age at delivery and a higher birthweight. Conclusion: most of our pregnant women did not showed a great diet quality, but there was no evidence that diet quality affected pregnancy complications. On the contrary, pre-pregnancy BMI was related to fetal and neonatal growth and obstetric outcomes, similarly to weight gain across gestation.

Introducción: Introducción: la obesidad materna se asocia con un aumento de complicaciones maternas y fetales, como la macrosomía. Objetivo: evaluar la calidad de la dieta en una cohorte de mujeres embarazadas en términos de adherencia a la dieta mediterránea (DM) y examinar la asociación entre la calidad de la dieta, la obesidad, el aumento de peso y el crecimiento fetal y las complicaciones perinatales. Métodos: se aplicó el Mediterranean Diet Adherence Screener (MEDAS) para evaluar la calidad de la dieta en 542 mujeres embarazadas. Se recogieron las medidas biométricas fetales en la ecografía del tercer trimestre y se registraron los resultados perinatales. Resultados: solo el 35 % de las gestantes presentó una buena calidad de alimentación en términos de adherencia a la DM. La calidad de la dieta aumentó significativamente con valores más bajos de índice de masa corporal (IMC) y mayor edad materna. Un IMC más alto se asoció significativamente con una mayor circunferencia abdominal y peso fetal estimado en el tercer trimestre, un mayor riesgo de trastorno hipertensivo, inducción del parto y mayor peso al nacer. No se encontró una asociación estadísticamente significativa entre la calidad de la dieta y las medidas ecográficas o el resultado perinatal. Sin embargo, un mayor aumento de peso durante la gestación se asoció significativamente con un mayor riesgo de diabetes gestacional, mayor edad gestacional al momento del parto y mayor peso al nacer. Conclusiones: la mayoría de nuestras gestantes no mostró una buena calidad de la dieta, pero no hubo evidencia de que la calidad de la dieta afectara las complicaciones del embarazo. Por el contrario, el IMC pregestacional se relacionó con el crecimiento fetal y neonatal y los resultados obstétricos, de manera similar al aumento de peso durante la gestación.

Diffuse trophoblast damage is the hallmark of SARS-CoV-2-associated fetal demise.

Placental pathology in SARS-CoV-2-infected pregnancies seems rather unspecific. However, the identification of the placental lesions due to SARS-CoV-2 infection would be a significant advance in order to improve the management of these pregnancies and to identify the mechanisms involved in a possible vertical transmission. The pathological findings in placentas delivered from 198 SARS-CoV-2-positive pregnant women were investigated for the presence of lesions associated with placental SARS-CoV-2 infection. SARS-CoV-2 infection was investigated in placental tissues through immunohistochemistry, and positive cases were further confirmed by in situ hybridization. SARS-CoV-2 infection was also investigated by RT-PCR in 33 cases, including all the immunohistochemically positive cases. Nine cases were SARS-CoV-2-positive by immunohistochemistry, in situ hybridization, and RT-PCR. These placentas showed lesions characterized by villous trophoblast necrosis with intervillous space collapse and variable amounts of mixed intervillous inflammatory infiltrate and perivillous fibrinoid deposition. Such lesions ranged from focal to massively widespread in five cases, resulting in intrauterine fetal death. Two of the stillborn fetuses showed some evidence of SARS-CoV-2 positivity. The remaining 189 placentas did not show similar lesions. The strong association between trophoblastic damage and placenta SARS-CoV-2 infection suggests that this lesion is a specific marker of SARS-CoV-2 infection in placenta. Diffuse trophoblastic damage, massively affecting chorionic villous tissue, can result in fetal death associated with COVID-19 disease.