Role of serum levels of irisin and oxidative stress markers in pregnant women with and without gestational diabetes.

Irisin regulates glucose levels, lipid levels, insulin sensitivity, and low-grade inflammation. Gestational diabetes mellitus (GDM) is a common metabolic complication of pregnancy, and is associated with increased rates of perinatal problems. Oxidative stress biomarkers have a role in the pathogenesis of patients with GDM. In total, 94 patients were included in our study including 46 control patients and 48 patients with GDM. Fasting blood glucose, HOMA-IR, total oxidative stress (TOS), irisin, and oxidative stress index (OSI) levels of the patients were measured. Serum OGTT, OSI, irisin HOMA, TOS, and insulin levels were statistically significantly higher in the patient group than in the control group. This was the first study to investigate the relation between serum irisin levels and oxidative stress markers in patients with GDM. The results revealed that irisin is an oxidative stress marker and a metabolic protective hormone.

Hyperemesis gravidarum and its relation with maternal body fat composition.

The objective of this study was to determine if maternal body fat composition and body mass index were associated with hyperemesis gravidarum (HG) in the first trimester of pregnancy. Healthy pregnant women (n = 30) without nausea and vomiting (control group) and women with HG (n = 54; study group), all with singleton pregnancy at 6-14 weeks gestational age, were included. Body mass index was measured before and during pregnancy. Visceral adipose tissue (VAT) and subcutaneous fat thickness were measured during pregnancy. Comparison of the groups revealed that VAT and pre-pregnancy body mass index but not subcutaneous fat thickness were significantly higher in the HG group versus controls. VAT and pre-pregnancy body mass index predicted 83.8% and 67.1% of HG cases, respectively. VAT and pre-pregnancy body mass index were correlated with the development of hyperemesis gravidrum and hence could be considered as predictive markers for HG.

Levels of thrombin-activatable fibrinolysis inhibitor and platelet-activating factor in recurrent pregnancy loss patients.

OBJECTIVE: The aim of this study was to investigate factors associated with thrombosis that may contribute to recurrent pregnancy loss (habitual abortion), specifically differences in serum levels of platelet-activating factor and thrombin-activatable fibrinolysis inhibitor (carboxypeptidase B2) between women with a history of recurrent miscarriage and those with no recurrent miscarriage history. MATERIALS AND METHODS: A case-controlled, prospective study design was adopted to compare women with a history of two or more first-trimester miscarriages (n = 42) with those with no history of recurrent miscarriage (n = 36). Participants were recruited from the Department of Obstetrics and Gynecology of Turgut Ozal University Hospital. Platelet-activating factor and thrombin-activatable fibrinolysis inhibitor levels in serum samples were measured by an enzyme-linked immunosorbent assay. RESULTS: Platelet-activating factor levels were significantly (p = 0.018) higher in the recurrent miscarriage group. There was no difference in levels of thrombin-activatable fibrinolysis inhibitor expression between the groups. CONCLUSION: Platelet-activating factor is significantly higher in serum of patients with a history of recurrent miscarriage than in those without such a history, with potential implications for placental function and fetal growth, which could be relevant to miscarriage recurrence. Larger studies are indicated to further examine these findings.

Frequency of isolated maternal hypothyroxinemia in women with gestational diabetes mellitus in a moderately iodine-deficient area.

AIM: To investigate frequency of isolated maternal hypothyroxinemia (IMH) in women with gestational diabetes mellitus (GDM) using both the method specific trimester range (MSTR) and the standard reference range (SRR). METHODS: Our study included 50 GDM patients (case group) and 60 non-GDM pregnant (control group). Glucose, insulin, HOMA-IR, fT4 and TSH values were measured when pregnancy was confirmed in all participants. Thyroid function tests were measured in each trimester using the SRR and the MSTR. RESULTS: In the second and third trimesters, mean fT4 levels were significantly lower in the case group compared to the control group, based on the SRR (p < 0.001). Mean fT4 levels were within the normal reference range in both groups, based on the MSTR; however, the levels were significantly lower in the case group (p < 0.001). Using the SRR, IMH frequencies in the second and third trimesters, in the case group were 56 and 86%, respectively, and were 13.3 and 46.7%, respectively, in the control group (p < 0.001). Using the MSTR, the IMH frequencies in the second and third trimesters were 8 and 14%, respectively; there were no instances of IMH in the control group. CONCLUSION: This study shows that changes in glucose metabolism may affect the thyroid hormone levels (fT4). Additionally, evaluating thyroid function tests in GDM patients using the MSTR can give more accurate results.

Gut satiety hormones and hyperemesis gravidarum.

UNLABELLED: Hyperemesis gravidarum (HG) is described as unexplained excessive nausea and vomiting during pregnancy. Some gut hormones that regulate appetite may have important role in etiopathogenesis of HG and weight changes during pregnancy. In this study, levels of gut satiety hormones were evaluated in pregnant women with HG. METHODS: This prospective case-control study was conducted in 30 women with HG and 30 healthy pregnant women without symptoms of HG. Fasting venous blood samples were taken from all subjects for measurement of plasma gut hormone levels; obestatin (pg/mL), peptide YY (PYY), pancreatic polypeptide (PP) and cholecystokinin (CCK). RESULTS: Plasma PYY and PP levels were significantly higher in HG group. The most important parameter in diagnosis of HG was plasma PP level. Simple use of PP level led to the diagnosis 91.1 % of HG cases correctly. The single most important parameter in the prediction of HG was also PP level. CONCLUSION: Anorexigenic gut hormones might have important role in etiopathogenesis of hyperemesis gravidarum and weight changes during pregnancy.

Use of aromatase inhibitors in practice of gynecology.

PURPOSE: The conversion of androgens into estrogens by aromatase is called aromatization and is inhibited by aromatase inhibitors (AIs). The aim of this article is to evaluate the use of aromatase inhibitors in gynecological diseases such as endometriosis, leiomyoma, estrogen- dependent gynecologic neoplasia and infertility. METHODS: This is a review of literature combined with experience and use of aromatase inhibitors in practice of gynecology. CONCLUSION: AIs are promising agents in treatment of estrogen dependent disease. However lack of experience, side effects and cost are limiting factors for using these agents in infertility treatment. However there is need for larger, well designed randomized trials to generate robust data in order to establish the true potential of aromatase inhibitors.

Effects of cesarean section on mean platelet volume.

Mean platelet volume (MPV) is a risk factor for cardiovascular complications, cerebrovascular disorders, and low-grade inflammatory conditions prone to arterial and venous thromboses. Cesarean delivery is the most important risk factor for pulmonary embolism, stroke, and intracranial venous thrombosis. The hypothesis is that increase in the prevalence of cesarean section and high MPV may be associated with cardiovascular complications such as stroke along with intracranial complications in addition to known systemic and surgical complications. In this study, platelet counts and MPV for postpartum women who delivered by cesarean section and normal vaginal parturition are compared. The subjects were divided in two groups, one was study group consisting of 118 patients giving birth by cesarean section and the other was the control group consisting 94 patients giving birth by normal vaginal parturition. Peripheral venous blood samples in EDTA tubes were collected from all the subjects 1 week before and after the delivery for their prenatal and postpartum periods, respectively. The values were compared between the groups and also before and after the delivery. In the cesarean group, while the MPV level was 8.60 (1.64) fl in the prenatal period, it increased to 9.10 (2.00) fl in the postnatal period (p < 0.001). Group effect, time effect (independent from group effect), and group*time interaction effect were statistically significant for MPV variable (p = 0.032, p < 0.001, and p = 0.012, respectively). This study concluded that MPV, along with several other factors, may be used as a prognostic, independent, and therapeutic marker in patients who are inclined to thrombotic events after cesarean section.

Effect of music on labor pain relief, anxiety level and postpartum analgesic requirement: a randomized controlled clinical trial.

BACKGROUND/AIMS: The control of labor pain and the prevention of suffering are major concerns of clinicians and their patients. The aim of this study was to evaluate the effect of music on labor pain and anxiety, maternal hemodynamics, fetal-neonatal parameters and postpartum analgesic requirement in primiparous women. METHODS: Overall, 156 primiparous women who expected vaginal delivery were recruited and randomly assigned to a music group (n = 77) or a control group (n = 79). Women in the music group listened to music during labor. Pain intensity and anxiety level were measured using a visual analogue scale (0-10 cm). The two groups were compared in terms of pain severity, anxiety level, maternal hemodynamics, fetal-neonatal parameters and postpartum analgesic requirement. RESULTS: Mothers in the music therapy group had a lower level of pain and anxiety compared with those in the control group at all stages of labor (p < 0.001). A significant difference was observed between the two groups in terms of maternal hemodynamics and fetal heart rate after intervention (p < 0.01). Postpartum analgesic requirement significantly decreased in the music therapy group (p < 0.01). CONCLUSION: Listening to music during labor has a positive impact on labor pain and anxiety, maternal-fetal parameters and analgesic requirement.

The role of Human Dectin-1 Y238X Gene Polymorphism in recurrent vulvovaginal candidiasis infections.

Recurrent vulvovaginal candidiasis (RVVC) is defined as having four or more symptomatic vulvovaginal candidiasis (VVC) attacks within a year. This study aimed to investigate whether Human Dectin-1 Y238X Gene Polymorphism plays a role in RVVC pathogenesis. In order to examine and explore this aim, an experimental study was undergone. The clinical study design was conducted with 50 women diagnosed with RVVC and had four or more symptomatic VVC attacks who were included in the experimental group; while 50 women who did not have previous RVVC history and diagnosis and did not have vaginal discharge and itching in the past year were included in the control group. Blood samples were collected from these patients and transferred to EDTA tubes, to investigate the Dectin-1 Y238X gene polymorphism, and stored at -80°. When Dectin-1 genotypes were compared, there was no significant difference between the two groups (p = 0.452, p = 0.615, p = 0.275). History of familial RVVC was significantly higher in the experimental group (p = 0.001). When the multivariate analysis was used to evaluate factors that could determine RVVC frequency, history of familial RVVC was found to increase the frequency of RVVC attacks by 3.3 units. This study is the first-of-its-kind to investigate the correlation between Dectin-1 Y238X polymorphism, which has not been previously studied in the Turkish population, and RVVC. The result of this study suggests that there is no correlation between this polymorphism and RVVC.

Evaluation of the ovarian reserve function in patients with metabolic syndrome in relation to healthy controls and different age groups.

OBJECTIVE: To evaluate the ovarian reserve function in female patients with metabolic syndrome (MetS). METHODS: This study evaluated 136 subjects, 67 with MetS and 69 controls. Subjects were divided into three age groups. Group I included 49 subjects aged 20-29 years, 22 with MetS and 27 controls; group II included 45 subjects aged 30-39 years, 22 with MetS and 23 controls; and group III included 42 subjects aged 40-49 years, 23 with MetS and 19 controls. Demographic characteristics, anthropometrics, blood biochemistry, and gonadotrophic hormones were compared as total ovarian volume and antral follicle count on ovarian transvaginal ultrasonography. RESULTS: Serum levels of FSH, LH, E2 and progesterone were similar in the MetS and control groups, while testosterone levels were significantly higher in MetS patients than controls, both in the overall population (p = 0.024) and in those aged 20-29 years (p = 0.018). Total ovarian volume was significantly lower in MetS patients than controls, in both the overall population (p = 0.003) and those aged 20-29 years (p = 0.018), while antral follicle counts were similar. Ovarian volume correlated positively with antral follicle count (AFC) (r = 0.37; p < 0.001) and negatively with age (r = 0.34; p < 0.001) and FSH concentration (r = 0.21; p = 0.013). AFC was negatively correlated with age (r = 0.36; p < 0.001). CONCLUSION: Ovarian reserve function is significantly lower in MetS patients than in healthy control subjects, particularly in women aged 20-29 years.

Effect of music therapy during vaginal delivery on postpartum pain relief and mental health.

BACKGROUND: Childbirth is an important experience in a woman's life, and unfavorable birth experiences have been shown to negatively impact postpartum maternal health. Aim of this study was to evaluate the effects of music therapy on postpartum pain, anxiety level, satisfaction and early pospartum depression rate. METHODS: Totally 161 primiparous women were recruited and randomized either music group (n=80) or a control group (n=81). Women in the music group listened to self-selected music during labor. Postpartum pain intensity, anxiety level and satisfaction rate were measured using the visual analog scale (VAS), postpartum depression rate was assessed with Edinburg Postpartum Depression Scale (EPDS) at postpartum day one and day eight. RESULTS: Mothers in the music therapy group had a lower level of postpartum pain and anxiety than the control group and it was statistically significant at all time intervals (1, 4, 8, 16 and 24h, p<0.001). A significant difference was observed between the two groups in terms of satisfaction rate (p<0.001) and postpartum depression rate at postpartum day one and day eight (p<0.05). LIMITATIONS: We only measured the effect of music therapy on early postpartum depression rate. Effect of music on late postpartum depression rate should be investigated in future. CONCLUSIONS: Using music therapy during labor decreased postpartum anxiety and pain, increased the satisfaction with childbirth and reduced early postpartum depression rate. Music therapy can be clinically recommended as an alternative, safe, easy and enjoyable nonpharmacological method for postpartum well-being.

Fetal magnetic resonance imaging in obstetric practice.

Ultrasonography (USG) is the primary imaging method for prenatal diagnosis of fetal abnormalities since its discovery. Although it is the primary method of fetal imaging, it cannot provide sufficient information about the fetus in some conditions such as maternal obesity, oligohydramnios and engagement of the fetal head. At this stage, magnetic resonance imaging (MRI) facilitates examination by providing more specific information. The need and importance of fetal MRI applications further increased by the intrauterine surgery which is currently gaining popularity. Some advantages of fetal MRI over USG are the good texture of contrast, a greater study area and visualization of the lesion and neighbourhood relations, independence of the operators. Also it is not affected by maternal obesity and severe oligohydramnios. However, MRI is inadequate in detecting fetal limb and cardiac abnormalities when compared to USG. MRI is not used routinely in pregnancy. It is used in situations where nonionizing imaging methods are inadequate or ionizing radiation is required in pregnant women. It is not recommended during the first trimester. Contrast agent (Godalinium) is not used during pregnancy. It is believed that MRI is not harmful to the fetus, although the biological risk of MRI application is not known. MRI technique is superior to USG in the detection of corpus callosum dysgenesis, third-trimester evaluation of posterior fossa malformations, bilateral renal agenesis, diaphragmatic hernia and assessment of lung maturation. Especially, it is the method of choice for evaluation of central nervous system (CNS) abnormalities. Fetal MRI has a complementary role with USG. It provides important information for prenatal diagnosis, increases diagnostic accuracy, and in turn affects the prenatal treatment, prenatal interventions and birth plan.