The correlation between women's various gynaecological diseases to ovarian cancer in Sulaimaniyah City, Iraq.

OBJECTIVE: To assess the relationship between benign gynaecological disorders and ovarian cancer (OC). METHODS: This retrospective observational study enrolled female patients with histologically-confirmed primary OC. Clinical and demographic data were collected using a questionnaire. Blood samples were analysed for tumour biomarker levels including cancer antigen (CA)-125, CA19-9, carcinoembryonic antigen, ß human chorionic gonadotropin (ß-hCG) and lactate dehydrogenase (LDH) using enzyme-linked immunosorbent assays. RESULTS: A total of 100 female patients were enrolled in the study. Of these, 44 patients had simple ovarian cysts (44%), 22 had uterine fibroids (22%), 15 had adenomyosis (15%), 13 had pelvic inflammatory disease (13%) and six had endometriosis (6%). There was a significant association between high grade serous OC histology with both benign ovarian and uterine diseases. There was a significant association between both adenomyosis and uterine fibroids and high grade OC. There was also a significant association between endometriosis and stages III/IV OC. With regard to tumour biomarkers, there was a significant association between ß-hCG and LDH biomarkers and benign uterine tumours. CONCLUSION: Benign gynaecological diseases are accompanied by the high risk of the development of OC. Common benign gynaecological diseases associated with OC were uterine fibroids and adenomyosis.

The Correlation between Hormonal Disturbance in PCOS Women and Serum Level of Kisspeptin.

BACKGROUND: Kisspeptin is a neuropeptide that upregulates gonadotropin-releasing hormone (GnRH) secretion. It is an essential element for the luteinizing hormone (LH) surge and ovulation. Women with polycystic ovary syndrome (PCOS) expose alteration in both GnRH and LH secretion levels. OBJECTIVE: This paper aims to evaluate serum kisspeptin levels in healthy and polycystic ovarian syndrome women. Furthermore, it investigates the effect of obesity and age on circulating kisspeptin levels in both normal and PCOS women. Moreover, it points out the correlation between kisspeptin and other hormonal parameters. Methods and Patients. One hundred women (60 are with PCOS and 40 are normal) were enrolled in the study. Five milliliter samples of blood from all the patients and control women were obtained twice during the menstrual cycle. All the study samples were classified depending on the age factor for several subgroups. RESULTS: Kisspeptin levels were higher in PCOS patients than those in the normal group. Kisspeptin correlated with serum free testosterone level (r=0.26). In healthy women, preovulatory kisspeptin levels were higher than follicular kisspeptin levels (P < 0.05), while this difference was insignificant in PCOS patients. The variation in serum kisspeptin levels between overweight/obese and normal-weight women was insignificant. In normal women, serum kisspeptin levels were higher in women >35 years than those <24 years at (P=0.03). CONCLUSION: The serum kisspeptin level is higher in PCOS women. Its levels fluctuate during the menstrual cycle, but these fluctuations are disturbed in PCOS women. The effect of BMI on serum kisspeptin levels is insignificant, and kisspeptin serum levels increase with age.

Correlation between birth weight and maternal body composition.

OBJECTIVE: To estimate which maternal body composition parameters measured using multifrequency segmental bioelectric impedance analysis in the first trimester of pregnancy are predictors of increased birth weight. METHODS: Nondiabetic women were recruited after ultrasonographic confirmation of an ongoing singleton pregnancy in the first trimester. Maternal body composition was measured using bioelectric impedance analysis. Multivariable linear regression analysis was performed to identify the strongest predictors of birth weight, with multiple logistic regression analysis performed to assess predictors of birth weight greater than 4 kg. RESULTS: Data were analyzed for 2,618 women, of whom 49.6% (n=1,075) were primigravid and 16.5% (n=432) were obese based on a body mass index (BMI) of 30 or higher. In univariable analysis, maternal age, BMI, parity, gestational age at delivery, smoking, fat mass, and fat-free mass all correlated significantly with birth weight. In multivariable regression analysis, fat-free mass remained a significant predictor of birth weight (model R=0.254, standardized ß=0.237; P<.001), but no relationship was found between maternal fat mass and birth weight. After adjustment for confounding variables, women in the highest fat-free mass quartile had an adjusted odds ratio of 3.64 (95% confidence interval 2.34-5.68) for a birth weight more than 4 kg compared with those in the lowest quartile. CONCLUSIONS: Based on direct measurements of body composition, birth weight correlated positively with maternal fat-free mass and not adiposity. These findings suggest that, in nondiabetic women, interventions intended to reduce fat mass during pregnancy may not prevent large-for-gestational-age neonates and revised guidelines for gestational weight gain in obese women may not prevent large-for-gestational-age neonates. LEVEL OF EVIDENCE: : III.

Miscarriage after sonographic confirmation of an ongoing pregnancy in women with moderate and severe obesity.

OBJECTIVE: To compare the incidence of spontaneous miscarriage in women with moderate to severe obesity to that in women with a normal BMI after sonographic confirmation of the foetal heart rate in the first trimester. METHODS: Women were enrolled in a prospective observational study at their convenience in the first trimester after an ultrasound confirmed an ongoing singleton pregnancy with foetal heart activity present. Maternal height and weight were measured digitally and BMI was calculated. RESULTS: In the 3,000 women enrolled, the miscarriage rate overall was 3.9% (n = 117). The mean gestational age at enrolment was 11.1 weeks. In the class 2-3 (BMI > 34.9 kg/m(2)) obese primigravidas the miscarriage rate was 11.3% (n = 8) compared with 2.7% (n = 24) in the normal BMI category (p = 0.003), and 3.7% (n = 5) in the class 1 obese category (not significant). In multigravidas, there was no increased rate of miscarriage among class 2-3 obese women compared with multigravidas in the normal BMI category. The mean body composition values showed that primigravidas who miscarried had both increased fat and fat-free masses compared with those who did not, but multigravidas who miscarried had a similar fat mass and fat-free mass with those who did not. CONCLUSIONS: In women with sonographic evidence of foetal heart activity in the first trimester, the rate of spontaneous miscarriage is low. It was increased in moderate to severely obese primigravidas, but was not increased in other obese women compared to women in the normal BMI category.

Body Mass Index (BMI) and Glucose Intolerance during Pregnancy in White European Women.

BACKGROUND: The risk of gestational diabetes mellitus (GDM) in accordance to Body Mass Index (BMI) is often based on studies where the calculation of BMI is frequently self-reported and is usually unreliable. We evaluated the risk of an abnormal oral glucose tolerance test (OGTT) in a population where BMI was measured and selective screening for GDM was practiced. METHODS: We carried out a prospective observational study where 1935 white European women with a singleton pregnancy were recruited. In the first trimester maternal height and weight were measured digitally. Statistical analysis was performed using SPSS version 15.0. BMI centiles were calculated from the study population. A Chi-square test was used to test the differences in categorical variables between the groups. A p-value <0.05 was considered significant. RESULTS: In 1935 women, 547 OGTTs were performed and 70 of these were abnormal. The prevalence of an abnormal OGTT was higher in women with Class 2 and 3 obesity compared to women with Class 1 obesity (23.3% vs. 10.1%, respectively; p= 0.008). The frequency of an abnormal OGTT was higher in women with a BMI ≥90th centile (≥33.1 kg/m (2) ) compared to women with a BMI between the 80th and 90th centiles (≥29.3 and <33.1 kg/mm (2) ), (21.5% vs 8.1% respectively; p = 0.005). CONCLUSION: When BMI is measured, we recommend to increase the cut-off point for selective screening of GDM to ≥33.0 kg/m (2) . This may decrease unnecessary obstetric interventions and healthcare costs.

The risk of caesarean section in obese women analysed by parity.

OBJECTIVE: This study looked at the association between caesarean section (CS) and Body Mass Index (BMI) in primigravidas compared with multigravidas. STUDY DESIGN: We enrolled women at their convenience, in the first trimester after an ultrasound examination confirmed an ongoing pregnancy. Weight and height were measured digitally and BMI calculated. After delivery, clinical details were again collected from the Hospital's computerised database. RESULTS: Of the 2000 women enrolled, there were 50.4% (n=1008) primigravidas and 49.6% (n=992) multigravidas. Of the 2000 8.5% were delivered by elective CS and 13.4% were delivered by emergency CS giving an overall rate of 21.9%. The overall CS rate was 30.1% in obese women compared with 19.2% in the normal BMI category (p<0.001). In primigravidas the increase in CS rate in obese women was due to an increase in emergency CS (p<0.005) and in multigravidas the increase was due to an increase in elective CS (p<0.01). In obese primigravidas 20.6% had an emergency section for fetal distress. In obese multigravidas 17.2% had a repeat elective CS. CONCLUSION: The influence of maternal obesity on the increase in CS rates is different in primigravidas compared with multigravidas.

Maternal leptin and body composition in the first trimester of pregnancy.

BACKGROUND: Leptin is produced mainly by adipocytes. Levels are increased in women with obesity and during pregnancy. Increased levels are also associated with pregnancy complications such as, pre-eclampsia and gestational diabetes mellitus. OBJECTIVE: We studied what component of body composition correlated best with maternal leptin in the first trimester of pregnancy and, whether maternal leptin correlated better with visceral fat rather than fat distributed elsewhere. SUBJECTS AND METHODS: Women were recruited in the first trimester. Maternal adiposity was measured using body mass index and advanced bioelectrical impedance analysis. Maternal leptin was measured using an enzyme-linked immunosorbent assay technique. RESULTS: Of the 100 subjects studied, the mean leptin concentration was 37.7 ng/ml (range: 2.1-132.8). Leptin levels did not correlate with gestational age in the first trimester, maternal age, parity or birth weight. Serum leptin correlated positively with maternal weight and body mass index, and with the different parameters of body composition. On multiple regression analysis, serum leptin correlated with visceral fat but not fat distributed elsewhere. CONCLUSIONS: Visceral fat is the main determinant of circulating maternal leptin in the first trimester of pregnancy. This raises the possibility that maternal leptin in early pregnancy may be a marker for the development of metabolic syndrome, including diabetes mellitus.

Body Mass Index and spontaneous miscarriage.

OBJECTIVE: We compared the incidence of spontaneous miscarriage in women categorised as obese, based on a Body Mass Index (BMI) >29.9 kg/m(2), with women in other BMI categories. STUDY DESIGN: In a prospective observational study conducted in a university teaching hospital, women were enrolled at their convenience in the first trimester after a sonogram confirmed an ongoing singleton pregnancy with fetal heart activity present. Maternal height and weight were measured digitally and BMI calculated. Maternal body composition was measured by advanced bioelectrical impedance analysis. RESULTS: In 1200 women, the overall miscarriage rate was 2.8% (n=33). The mean gestational age at enrolment was 9.9 weeks. In the obese category (n=217), the miscarriage rate was 2.3% compared with 3.3% in the overweight category (n=329), and 2.3% in the normal BMI group (n=621). There was no difference in the mean body composition parameters, particularly fat mass parameters, between those women who miscarried and those who did not. CONCLUSIONS: In women with sonographic evidence of fetal heart activity in the first trimester, the rate of spontaneous miscarriage is low and is not increased in women with BMI>29.9 kg/m(2) compared to women in the normal BMI category.

Maternal weight and body composition in the first trimester of pregnancy.

OBJECTIVE: Previous studies on weight gain in pregnancy suggested that maternal weight on average increased by 0.5-2.0 kg in the first trimester of pregnancy. This study examined whether mean maternal weight or body composition changes in the first trimester of pregnancy. DESIGN: Prospective observational study. POPULATION: We studied 1,000 Caucasian women booking for antenatal care in the first trimester of pregnancy. SETTING: Large university teaching hospital. METHODS: Maternal height and weight were measured digitally in a standardized way and Body Mass Index (BMI) was calculated. Maternal body composition was measured using segmental multifrequency Bioelectrical Impedance Analysis (BIA). Sonographic examination confirmed the gestational age and a normal ongoing singleton pregnancy in all subjects. MAIN OUTCOME MEASURES: Maternal weight, maternal body composition. RESULTS: The mean BMI was 25.7 kg/m(2) and 19.0% of the women were in the obese category (> or =30.0 kg/m(2)). Cross-sectional analysis by gestational age showed that there was no change in mean maternal weight, BMI, total body water, fat mass, fat-free mass or bone mass before 14 weeks gestation. CONCLUSIONS: Contrary to previous reports, mean maternal weight and mean body composition values remain unchanged in the first trimester of pregnancy. This has implications for guidelines on maternal weight gain during pregnancy. We also recommend that calculation of BMI in pregnancy and gestational weight gain should be based on accurate early pregnancy measurements, and not on self-reported or prepregnancy measurements.

Are there sex differences in Fetal Abdominal Subcutaneous Tissue (FAST) measurements?

OBJECTIVE: To determine if Fetal Abdominal Subcutaneous Tissue (FAST) measurements using antenatal ultrasound differ between male and female fetuses. STUDY DESIGN: Women who had an ultrasound examination for fetal growth between 20 and 40 weeks gestation were studied. Women with diabetes mellitus were excluded. The fetal anterior abdominal subcutaneous tissue was measured on the anterior abdominal wall in millimetres anterior to the margins of the ribs, using magnification at the level of the abdominal circumference. The fetal sex was recorded after delivery. RESULTS: A total of 557 fetuses were measured, 290 male and 267 female. The FAST measurements increased with gestational age. The FAST increased at the same rate for both male and female fetuses and at any given week there was no sex difference. CONCLUSIONS: The increased fat composition in females reported after birth was not found in abdominal wall subcutaneous fat measurements using ultrasound during pregnancy. Antenatal centile charts for FAST do not need to be based on sex.

Body Mass Index (BMI) in women booking for antenatal care: comparison between selfreported and digital measurements.

OBJECTIVE: We set out to compare measurement of Body Mass Index (BMI) with selfreporting in women early in pregnancy. STUDY DESIGN: We studied 100 women booking for antenatal care in the first trimester with a normal ongoing pregnancy. Selfreported maternal weight and height were recorded and the Body Mass Index was calculated. Afterwards maternal weight and height were digitally measured and actual BMI was calculated. RESULTS: If selfreporting is used for BMI classification, we found that 22% of women were classified incorrectly when BMI was measured. 12% of the women who were classified as having a normal selfreported BMI were overweight and 5% classified as overweight were obese. Similar findings have been reported outside pregnancy. CONCLUSIONS: These findings have implications for clinical practice, and for research studies exploring the relationship between maternal adiposity and pregnancy complications.