Adequate iodine levels in healthy pregnant women. A cross-sectional survey of dietary intake in Turkey.

OBJECTIVES: To assess current iodine levels and related factors among healthy pregnant women.  METHODS: In this cross-sectional, hospital-based study, healthy pregnant women (n=135) were scanned for thyroid volume, provided urine samples for urinary iodine concentration and completed a questionnaire including sociodemographic characteristics and dietary habits targeted for iodine consumption at the Department of Obstetrics and Gynecology, School of Medicine,Mugla Sitki Koçman University, Mugla, Turkey, between August 2014 and February 2015. Sociodemographic data were analyzed by simple descriptive statistics. RESULTS: Median urinary iodine concentration was 222.0 µg/L, indicating adequate iodine intake during pregnancy. According to World Health Organization (WHO) criteria, 28.1% of subjects had iodine deficiency, 34.1% had adequate iodine intake, 34.8% had more than adequate iodine intake, and 3.0% had excessive iodine intake during pregnancy. Education level, higher monthly income, current employment, consuming iodized salt, and adding salt to food during, or after cooking were associated with higher urinary iodine concentration.   CONCLUSION: Iodine status of healthy pregnant women was adequate, although the percentage of women with more than adequate iodine intake was higher than the reported literature.

Transcervical intrauterine levobupivacaine or lidocaine infusion for pain control during endometrial biopsy.

BACKGROUND: Endometrial biopsy is a common procedure for the investigation of many gynecological disorders including abnormal uterine bleeding, postmenopausal bleeding, abnormal cytology and infertility. Most women experience some degree of discomfort and pain during the procedure. Pain may occur during dilation of the cervix for insertion of the catheter and during endometrial biopsy, which further aggravates pain by inducing uterine contraction. OBJECTIVES: To determine pain levels during endometrial biopsy by comparing intrauterine instillation of levobupivacaine or lidocaine with placebo in a randomized, double-blinded trial in pre- and postmenopausal women. METHODS: Ninety patients were allocated to either control or experimental groups before endometrial biopsy. The trial medication was intrauterine anesthesia, either 5 mL 0.9% saline (control group), or 5 mL 0.5% levobupivacaine or 2% lidocaine (experimental groups). Resident doctors used the same endometrial biopsy technique to minimize the risk of technical variation. All tissue specimens were sent for cytopathological examination. The pathologists, who were blinded to the study solution, analyzed all tissue specimens. The primary outcome measure was pain experienced during the procedure. Pain was assessed using a 10 cm visual analogue pain scale. All observed adverse effects were recorded until the patients were discharged. RESULTS: Pain scores of the intrauterine lidocaine and levobupivacaine groups were found to be significantly lower than the control group. There was no difference between the levobupivacaine and lidocaine groups with regard to pain scores. There was a moderately positive correlation between pain scores and endometrial thickness. No complications were observed due to the procedure. Most of the biopsy results were proliferative and secretory endometrium. Insufficient material causing inconclusive results was observed mostly in the control group. CONCLUSION: Transcervical intrauterine topical instillation of levobupivacaine or lidocaine causes pain relief during endometrial biopsy. However, further studies are needed to evaluate the effectiveness of intrauterine anesthesia, to determine optimal concentration, volume and waiting time according to the type of local anesthetic agent, and to assess the applicability of the method to other intrauterine procedures.

Relation between serum PAPP-A level and umbilical cord thickness during first trimester of pregnancy.

PURPOSE: To evaluate the relation between umbilical cord diameter versus pregnancy associated plasma protein-A (PAPP-A) level in first trimester women. METHOD: Cord diameter were measured and patients were divided into two groups according to frequency distribution analysis as below or above 3.7 mm for free loop diameter (FCD) and below or above 3.4 mm for cord measurement at umbilicus (ACD). Groups were compared with each other. RESULTS: Strong correlations were found between ACD versus PAPP-A. CONCLUSION: By using strong correlation between ACD versus PAPP-A, it may be possible to reduce unnecessary amniocentesis due to false positive screening results.

Effect of number of abnormal oral glucose tolerance test (OGTT) values on birthweight in women with gestational diabetes.

BACKGROUND & OBJECTIVES: To examine the effect of abnormal oral glucose loading (OGL) and number of abnormal oral glucose tolerance test (OGTT) values on foetal weight in Turkish pregnant women. METHODS: This retrospective study included 810 pregnant women between 24 and 28 wk of gestation who were screened for gestational diabetes mellitus (GDM). Women were grouped according to degree of glucose intolerance and compared for clinical, biochemical parameters. Women who delivered macrosomic infants were compared with those who delivered normal infants. RESULTS: GDM was detected in 70 (8.6%) women. Median age and infant birthweight of GDM cases were higher than the other groups. Infants of women with GDM weighted 200 g more than infants of non-GDM cases. No difference was found in terms of birthweight between diabetes cases with 2, 3 or 4 OGTT values abnormality. INTERPRETATION & CONCLUSIONS: The number of abnormal OGTT values in GDM cases had no effect on foetal weight. Macrosomia was observed more in GDM cases than in non-GDM cases. Birthweight was significantly higher in women with GDM despite the therapy used for regulation of blood glucose. This may be related to ethnical, dietary, nutritional differences, and treatment compliance in our study population.

First-trimester reference ranges for decidual thickness and its relation to progesterone levels.

AIMS: The present study aimed to provide normal reference ranges for decidual thickness measured ultrasonographically in healthy first-trimester pregnancies and to evaluate whether there was a relationship between decidual thickness and serum progesterone levels. METHODS: Decidual thickness of 173 women with a healthy gestation between 6+0 and 9+6 weeks was measured ultrasonographically and serum progesterone concentration was determined. Distribution of decidual thickness at each gestational week and its relation with serum progesterone levels was evaluated. RESULTS: Mean decidual thickness was 6.8, 5.7, 5.5, and 6.1 mm at 6th, 7th, 8th, and 9th gestational weeks, respectively. Decidual thickness showed a mild negative correlation with gestational week (ρ=-0.207, P=0.006) and a mild positive correlation with serum progesterone concentrations (ρ=0.191, P=0.021). CONCLUSION: The present study provided normal reference ranges for decidual thickness in healthy pregnancies in the first trimester. The association found between decidual thickness and progesterone levels might shed light on further studies investigating the predictive factors of pregnancy loss and might lead to changes in the management of threatened miscarriage.

Transcervical intrauterine levobupivacaine infusion or paracervical block for pain control during endometrial biopsy.

The aim of this study was to determine pain during endometrial biopsy by comparing the use of intrauterine instillation of levobupivacaine or paracervical block with a placebo in a randomized, double-masked trial in premenopausal and postmenopausal women. A total of 90 women were enrolled in the study. Patients were allocated to either the control or case groups. Group 1 consisted of 30 cases with intrauterine anesthesia with 5 ml 0.5% levobupivacaine. Group 2 consisted of 30 patients who underwent paracervical block with lidocaine. No analgesic agent was given to the remaining 30 patients; these cases comprised the control group. The primary outcome measures were pain or discomfort experienced during the procedure. When the pain scores of the different groups were compared, the scores in the intrauterine levobupivacaine and paracervical block groups were found to be significantly lower compared to those in the control group. There was no difference between the levobupivacaine and paracervical block groups in terms of pain scores. There was a marked positive correlation between biopsy indications and pain scores. Pain scores were lower in cases with the indication of polymenorrhea, hypermenorrhea and metrorraghia compared to those in the cases with other indications. In conclusion, the transcervical intrauterine instillation of levobupivacaine or paracervical block with lidocaine brings about pain relief during and after endometrial biopsy.

Does assisted reproductive technology itself or polycystic ovary syndrome as a cause of infertility have any effect on first trimester serum screening results?

OBJECTIVE: To determine whether assisted reproductive technology (ART) itself or polycystic ovary syndrome (PCOS) as a cause of infertility has any effect on first trimester serum screening results. STUDY DESIGN: First trimester serum screening results of ART pregnancies of women with PCOS (IVF-P group) were compared with those of women who underwent ART due to malefactor infertility (IVF-H group) and women who conceived spontaneously. RESULTS: Comparison of the groups for crown-rump length (CRL) and nuchal translucency revealed no significance. There was significant difference between the IVF-H and IVF-P groups in terms of free beta-human chorionic gonadotropin (beta-hCG) levels. Although comparison of groups revealed no significance, pregnancy-associated plasma protein A (PAPP-A) values were higher in the IVF-P group than in the IVF-H group. CONCLUSION: CRL and nuchal translucency measurements were not affected by in vitro fertilization procedures or the presence of maternal PCOS. Use of ART decreased PAPP-A and increased free beta-hCG levels. Although not significant, PAPP-A was higher in PCOS patients who conceived with ART, which may in turn increase false negative rates in these cases.

Impact of adrenal versus ovarian androgen ratio on signs and symptoms of polycystic ovarian syndrome.

The aim of this study was to examine the effect of adrenal versus ovarian androgen (dehydroepiandrosterone sulfate/total testosterone [DHEAS/TT]) on clinical presentation and related metabolic disturbances in Turkish women with polycystic ovarian syndrome (PCOS). Two hundred eighty PCOS cases were taken into the study. For all cases, the DHEAS/TT ratio was calculated. The median value of this ratio was 4.40. Patients with an androgen ratio lower than 4.40 were included in Group 1 and cases with a ratio higher than 4.40 were Group 2. The two groups were compared in terms of hormonal, biochemical and clinical parameters. Body mass index and waist circumference were lower, the Ferriman-Gallwey score was higher and the cycle length was shorter in Group 2. High DHEAS level was associated with better lipid profiles and lower levels of inflammatory markers, meaning good metabolic control in these women, in spite of increased hirsutism rates. In patients with PCOS, both androgens are usually high in proportion to each other. Therefore, it would be more meaningful to use the DHEAS/TT ratio for an assessment of the metabolic and phenotypic effects of PCOS.

Effect of dose and duration of micronized progesterone treatment during the first trimester on incidence of glucose intolerance and on birth weight.

OBJECTIVE: The aim was to investigate the potential effect of oral progesterone therapy during the first trimester on glucose metabolism and on birth weight, and to assess the existence of dose-related differences. METHODS: One hundred and fifty women with a history of imminent abortion and who used micronized progesterone (MicP) (200-600 µg/day for 4-6 weeks), and 150 healthy pregnant women as a control group, were included in the study. Fasting blood glucose (FBG), hemoglobin A1c (HbA1c) and OGL were measured between 24 and 28 weeks of gestation. Patients were followed up to term and birth weight was recorded. RESULTS: Risk of abnormal FBG and OGL was increased by 4.5- and 9.4-fold, respectively, in patients receiving MicP (p < 0.001). Median birth weight and gestational age were 3,599 g (500) and 39.0 weeks (1.3) for the MicP exposed group and 3,120 g (210) and 39.4 weeks (1.5) for the control group, respectively. Median birth weight was significantly higher in the MicP-exposed group for a similar gestational age (p < 0.001). There were no dose-related differences between groups. CONCLUSION: MicP therapy during the first trimester of pregnancy might have undesirable effects on glucose metabolism, which stresses the need of larger studies to confirm this association.

Can serum ferritin, vitamin B(12) and folic acid levels affect serum screening tests during pregnancy?

OBJECTIVE: To examine the relation of serum folate, vitamin B(12) and ferritin levels to 1st and 2nd trimester serum screening markers. METHODS: Fetal crown-rump length (CRL), nuchal translucency (NT), and first and second trimester serum screening tests of 228 pregnant women were obtained. In all cases, serum vitamin B(12), folic acid and ferritin levels were analyzed during the 11-14 week period. Levels below <15 µg/L, 3 ng/mL and 211 pg/mL were accepted as nutrient deficiency for serum ferritin, folic acid and vitamin B(12), respectively. Results of serum screening markers of women below and above these values were compared with each other. RESULTS: Comparison of groups with ferritin levels <15 and >15 µg/L for 1st and 2nd trimester serum screening parameters revealed significant differences between groups in terms of pregnancy associated plasma protein-A (PAPP-A), free ß-human chorionic gonadotropin (fb-hCG), AFP and hCG. Comparison of women with low versus normal B(12) levels revealed significant differences in terms of NT, PAPP-A and fb-hCG. CONCLUSION: Although sufficient, number of cases is limited in this study so results cannot be generalized to all population. It could be advised that in addition to folic acid supplementation, deficiencies of ferritin and B(12) must be corrected in patients considering pregnancy or early 1st trimester pregnant women to obtain more accurate serum screening results.

Is there any relation between umbilical artery and vein diameter and estimated fetal weight in healthy pregnant women?

PURPOSE: The aim of this study was to investigate the relation between umbilical vessel diameter and estimated fetal weight (EFW) and other fetal biometric parameters, and to assess the role of umbilical vessel diameter in prediction of EFW. Umbilical vein/umbilical artery (UV/UA) ratio and its relation to EFW were also examined. METHODS: A prospective study was designed to assess the sonographic diameter of UA and UV in 720 low-risk pregnant women at 20-40 weeks' gestation. Fetal biometry, EFW, and umbilical vessel measurements were performed. RESULTS: There were strong correlations between umbilical vessel diameter versus gestational age and EFW. Umbilical vessel diameters increased linearly up to 34 weeks, after which they plateaued. No relation was found between EFW versus UV/UA ratio and gestational age versus UV/UA. CONCLUSION: Based on these findings, it is not possible at present to recommend the use of umbilical vessel diameters for prediction of EFW after 34 weeks, but it may be helpful under 34 weeks. UV/UA ratio is not useful for prediction and management of complicated pregnancies.

Gestational diabetes: comparision of the carpenter and the coustan thresholds with the new thresholds of Turkish women and implications of variations in diagnostic criteria.

OBJECTIVE: To find optimal 100-g 3-h oral glucose tolerance test (OGTT) threshold levels for diagnosis of gestational diabetes (GDM) in Turkish pregnant women. METHODS: This study was conducted with 808 women screened for GDM between 24-28 weeks of gestation using the 1-h 50-g glucose challenge test (GCT) with a subsequent 3-h 100-g OGTT for confirmation if screen was positive. The glucose values obtained were analysed by both the Carpenter and Coustan (C&C criteria) and National Diabetes Data Group (NDDG) criteria for the diagnosis of GDM and IGT. Optimal OGTT cutoff values for Turkish population were calculated by ROC curve analysis. RESULTS: The new diagnostic criteria, based on the result of the 100-g OGTT obtained from the healthy pregnant women, were 82.5, 171.5, 151.5, and 111.5 mg/dl at 0, 1, 2, and 3 h. The prevalence of GDM was 15.7% by the new criteria, 8.1% by C&C criteria, and 5.6% by the NDDG criteria. According to new criteria, 7.7% of infants of diabetic mothers had macrosomia. This ratio was 2.6% for non diabetic women. CONCLUSIONS: Ethnic differences, enviromental factors and nutritional habits may effect development of GDM. Application of some pre-determined nomograms to all races and ethnic groups can lead errors.

The impact of birth weight and maternal history on acne, hirsutism, and menstrual disorder symptoms in Turkish adolescent girls.

The aim of the study was to determine the association between birthweight, maternal medical history and acne, hirsutism, and menstrual disorder symptoms in Turkish adolescent population. Self-administered questionnaires were distributed to all volunteer female students at 15 secondary schools. The subjects' body mass index, birthweight, age at menarche, pattern of menstrual cycle, and presence of acne or hirsutism problems were recorded. Maternal obstetric parameters, menstrual cycle, presence of acne or hirsutism at present and at adolescent period were also asked. The impact of birthweight and maternal history on acne, hirsutism, and menstrual disorder symptoms was evaluated. The results of the study showed that after exclusion of subjects born prematurely, total of 1,309 students filled the questionnaires properly and included in the study. Of these students, 174 had low birthweight (LBW) (<2,500 g), 925 had appropriate (2,500-4,000 g), and 210 had high birthweight (>4,000 g). LBW students had higher incidence of menstrual disorder and acne problems (P = 0.032 and P = 0.011, respectively). Maternal acne and hirsutism problems were significantly often in LBW group. Multivariate analysis showed that LBW was a predictor of acne, hirsutism, and menstrual disorder at adolescent period (P = 0.001; P = 0.01, and 0.02, respectively). In addition, maternal menstrual disorder was also a predictor of menstrual disorder (P = 0.035). We concluded that LBW is a good predictor of acne, hirsutism, and menstrual disorder problems in Turkish adolescent population.

Are the first trimester volumetric measurements with two dimensional ultrasonography satisfactory?

OBJECTIVES: Aim was to examine volumetric measurement of first trimester structures with two-dimensional ultrasonography (2D US) and evaluate necessity of three-dimensional (3D) volume measurements instead of 2D during first trimester. METHODS: Using 2D transvaginal ultrasound imaging, the crown rump length (CRL), yolk sac (YS) and gestational sac (GS) diameters were recorded in 176 women with gestational age <11 weeks. Volume measurements were done by using a simplified formula for the volume of a prolate ellipsoid: V = 0.523 × length × height × width. RESULTS: The mean CRL value was 19.6 ± 8.8 mm. The mean YS, GS and embrionic volume (EV) varied from 0.02-0.13, 5.5-37.72, 0.024-3.31 cm(3) between 6(+6) and 10(+6) weeks, respectively. There was moderate positive correlation between EV versus GS volume and YS volume versus EV. CONCLUSIONS: 2D US still can provide adequate information in volumetric examination of regular shaped objects. But 3D US is useful in volumetric measurements of irregular shaped structures and for screening of fetal abnormalities.

Assessment of cardiomyopathy in fetuses of women with false positive oral glucose loading test.

OBJECTIVE: To evaluate fetal asymmetric septal hypertrophy in women with a false positive oral glucose loading test (OGL). STUDY DESIGN: OGL was applied to 79 pregnant women at gestational age between 24 and 28 weeks. The first study group consisted of patients with a normal OGL. Cases having glucose levels above 130 mg/dL after 50 g OGL but a normal 100g oral glucose tolerance test (OGTT) formed a second group. M-mode echocardiography was then performed. Fetal septal and left ventricular posterior wall (LVPW) thicknesses in Group 1 and Group 2 were compared. RESULTS: Mean septal and LVPW thickness was slightly higher in the second group but there was no statistically significant difference between the two groups. CONCLUSIONS: Although statistically not significant, there is some increase in septal and ventricular wall thickness in cases with high OGL but normal OGTT. The study also provides evidence of the absence of prominent septal and ventricular thickening in these cases with minimal glucose intolerance.

Do threshold values of ovarian volume and follicle number for diagnosing polycystic ovarian syndrome in Turkish women differ from western countries?

OBJECTIVE: To find diagnostic values and thresholds of ovarian volume and follicle number for Turkish patients with polycystic ovarian syndrome (PCOS) and to clarify whether the Rotterdam ultrasound criteria are optimal for the diagnosis of PCOS in Turkish patients. STUDY DESIGN: Two hundred and fifty-one newly diagnosed PCOS cases according to Androgen Excess Society (AES) criteria (using clinical and biochemical parameters) and 65 regularly menstruating healthy, non-hirsute, normo-ovulatory volunteers as a control group were taken into the study. Evaluation of the ovaries and measurement of ovarian volumes of all cases were performed by transvaginal ultrasound. Ovarian volume (OV) and follicle number (FN) were recorded in all cases. RESULTS: Mean and median OV were 12.5 ± 8.1 and 10.1cm(3) in PCOS cases. Mean and median FN in the PCOS group were 9.8 ± 2.8 and 10, respectively. In the control group, the mean and median OV were 5.4 ± 1.8 and 5.5 cm(3). Mean and median FN of controls was 5 ± 1.5 and 5, respectively. There were statistically significant differences in both OV and FN between PCOS patients and controls (all p < 0.001). Cut off values for ovarian volume in PCOS cases for the Turkish population were determined by receiver-operating characteristics (ROC) analysis. The areas under the curve (AUCs) for mean OV and mean FN were 0.938 and 0.998, respectively, indicating a good diagnostic power of the tested variables. Combining sensitivity and specificity using the Youden index, setting the cut off value for threshold OV and FN at 6.43 cm(3) and 8, respectively, yielded the best compromise between sensitivity and specificity. CONCLUSION: There may be some differences in ultrasound characteristics of PCOS, resulting in differing diagnostic power and cut off points for different populations. OV and FN have powerful diagnostic value in determination of PCOS with different threshold values for different ethnicities.

Discrepancy in improvement of hearing loss between left and right ears after postmenopausal hormone therapy.

Physiological levels of estrogen would seem to have a possible protective effect on hearing function and estrogen replacement therapy may delay hearing loss in menopausal women. Treatment of healthy menopausal women with Tibolone for 6 months resulted in improvement in audiometry results at low frequencies which was more prominent on the right side. The reason of better improvement on the right side is not known. There might be some other factors modifying the condition or effect of the drug such as laterality. There might be hearing lateralization in menopausal women. Especially significant improvement on right ear might be explained by differences in distribution of estrogen receptor (ER) in the ear, in another words lateralization of ER concentration. ER-α and -ß might be more dense in the right ear, so give better response to estrogen treatment. Another reason might be difference in bone mineral density of sides of body which is lower on the right side. Similarly lower bone mineral density right ear bones would cause better response to estrogen therapy and better improvement in audiometry results on that side.

Relationship of ovarian volume with mean platelet volume and lipid profile in patients with polycystic ovary syndrome.

The aim of the present study was to evaluate the relationship between ovarian volume (OV) and mean platelet volume (MPV) in women with polycystic ovary syndrome (PCOS). Hormonal parameters and lipid profile of cases, and their relationship to OV were also assessed. Bilateral OV of 210 newly diagnosed PCOS patients and 100 healthy non-hirsute women were measured by ultrasonography. Blood samples were obtained for full blood count, hormone levels and for lipid profiles. It was found that MPV increased gradually as OV increased. This implies a higher risk of hypercoagulability and therefore an increased risk of future cardiovascular disease.

Are patients with positive screening but negative diagnostic test for gestational diabetes under risk for adverse pregnancy outcome?

OBJECTIVE: Our aim was to determine the obstetrics outcomes of patients with positive 1-h glucose challenge test (GCT), but negative diagnostic test for gestational diabetes. METHODS: Pregnancy records of 409 pregnants were reviewed. Patients were screened for gestational diabetes mellitus (GDM) with one-hour 50 g glucose challenge test (GCT) at 24-28 weeks of gestation. Patients with glucose challenge tests values > or = 130 mg/dL were refered for the 3 h, 100-g oral glucose tolerance test (OGTT). Positive GCT but negative for OGTT group (Group A) were compared retrospectively with the group of negative GCT (Group B) for obstetrics outcomes. RESULT: GDM and impared glucose tolerance (IGT) were diagnosed in 33 (7.6%) and 46 (10.5%) patients, respectively. We identified 141 (34.4%) patients with positive GCT but negative for OGTT (Group A) and 189 (46.2%) patients with negative GCT (Group B). Gestational weight gain, polyhydramnios, family history of diabetes mellitus were significantly higher in group A than group B (P < 0.05). Prevalance of preterm labor, hypertension, cesarean delivery, mean birthweight, proportion of babies admitted to neonatal intensive care unit were similar in both groups. CONCLUSION: There are some differences for pregnancy outcomes between pregnants with positive GCT but negative for OGTT and negative GCT. These patients should be followed up carefully during the antepartum and intrapartum period.

Myxedematous coma in a laboring woman suggested a pre-eclamptic coma: a case report.

Myxedematous coma in pregnancy is a rare incident. We present a case of Myxedematous coma in a laboring woman that suggested a pre-eclamptic coma and finalized with a healthy baby.