Vitamin D deficiency in pregnancy may affect fetal thymus development.

OBJECTIVES: The aim of our study was to evaluate the association of vitamin D deficiency (VDD) during pregnancy with thymus size in full-term fetuses. MATERIAL AND METHODS: In this prospective study, we evaluated mid-pregnancy serum 25-hydroxyvitamin D3 (25(OH)D3) concentrations. The fetal thymus size was measured by ultrasound in the third trimester. Neonatal 25(OH)D3 levels were evaluated by umbilical cord blood sampling. Correlation of maternal and neonatal vitamin D levels and association between thymus size and both, maternal and neonatal vitamin D concentrations were investigated. RESULTS: Serum 25(OH) D3 concentrations were within the normal range in 48 (29.8%) mothers and 10 (13.1%) new-borns. A strong correlation between mid-pregnancy maternal and neonatal 25(OH)D3 concentration (r = 0.8, p < 0.001) was found. A significant linear correlation was observed between both, maternal and neonatal 25(OH)D3 concentrations and thymus perimeter length (r = 0.45, p = 0.04 and r = 0.43, p < 0.01, respectively). Both, maternal and fetal VDDs were associated with decreased thymus perimeter (p = 0.04, p = 0.03). CONCLUSIONS: Vitamin D deficiency during pregnancy may be associated with smaller fetal thymus. Our data suggest that VDD in pregnancy may lead to systemic inflammatory response in the fetus.

Thyroid antibodies in euthyroid and subclinical hypothyroidic pregnant women with autoimmune hypothyroidism: effects on hematological parameters and postpartum hemorrhage.

OBJECTIVES: The aim of the study was to investigate the relationship between thyroid antibodies and hematological parameters in euthyroid or subclinical hypothyroidic (S H) pregnant women with autoimmune hypothyroidism and to verity whether these pregnant women are affected by a higher rate of postpartum hemorrhage. MATERIAL AND METHODS: Thirty-six out hyroid and 21 S H pregnant women with autoimmune thyroid disease and 52 healthy pregnant women were evaluated. The relationship between thyroid hormones, thyroid antibodies level, the dosage of Levotroxin (LT4) and hematological parameters and the amount of postpartum bleeding was investigated. RESULTS: The mean platelet volume (MPV), was significantly higher in the SH group than in the euthyroid group and in the euthyroid group than healthy group (p<0.001). Hemoglobin (Hb) was significantly lower in both the SH group and the euthyroid group than control group (p<0.001). Other hematological parameters and the amount of postpartum bleeding did not differ between the groups. The correlation between Hb and fT3, FT4 was significant and positive, whereas between Hb and T SH was significant and negative (r=0.3 p<0.01, r=0.2 p=0.01, and r = -0.18 p=0.04, respectively). There was a significant and negative correlation between the PLT count and FT4, PT and FT3 (r = -0.2 p=0.01, r = -0.3 p<0.01, and r = -0.3 p<0.01, respectively). CONCLUSION: It has been described that being thyroid antibody-positive (TAb+) may be a risk factor for anemia and high MPV. However euthyroid and SH pregnant women with thyroid antibodies do not differ in terms of other coagulation parameters and postpartum hemorrhage from healthy controls.

Myo-inositol is a promising treatment for the prevention of ovarian hyperstimulation syndrome (OHSS): an animal study.

PURPOSE: To evaluate the efficacy of myo-inositol (MI) pretreatment in OHSS. METHODS: In this experimental OHSS rat model, 42 immature Wistar albino female rats were divided into 6 groups: (1) the control group, (2) the ovarian stimulation group, (3) the OHSS group, (4) the OHSS + Metformin group, (5) OHSS + MI group, (6) OHSS + Metformin + MI group. OHSS was established after treatment with metformin and myo-inositol for 14 days, in the meanwhile the treatment of metformin and myo-inositol was also continued. All animals were killed 48 h after hCG administration and were compared in terms of vascular permeability, ovarian weight and diameter, ovarian VEGF, COX-2 and PEDF expression (immunohistochemistry), serum PEDF and estradiol (E2) levels. RESULTS: Vascular permeability, VEGF and COX-2 expressions were reduced in animals treated with MI and/or metformin. While PEDF expression was increased in the groups taking metformin, there was no difference in PEDF expression in the group taking MI and OHSS group. There was no significant difference in serum PEDF levels between groups. Blood E2 levels were decreased in groups treated with MI or metformin compared to the OHSS group. CONCLUSIONS: Our data demonstrate that myo-inositol is effective in preventing OHSS, similar to metformin. Although the two drugs are thought to act through distinct mechanisms, there is no apparent benefit to co-treatment with both drugs in an animal model of OHSS. Administration of myo-inositol prior to IVF treatment may favor the control of ovulation induction. Further studies are necessary to elucidate the mechanism of action and further support our findings.

Prophylactic vitamin D supplementation in ovarian hyperstimulation syndrome: an animal study.

PURPOSE: To investigate the effect of vitamin D in ovarian hyperstimulation syndrome (OHSS). METHODS: In this animal study, 28 immature female Wistar rats were divided into four groups: group 1 (control); group 2 (ovarian stimulation); group 3 (OHSS group); group 4 (OHSS + vitamin D group). All groups were killed 48 h after hCG administration and were compared in terms of vascular permeability, ovarian weight, ovarian diameter, vascular endothelial growth factor (VEGF) expression (immunohistochemistry) in ovarian tissue and pigment epithelium-derived factor (PEDF) level in the serum (ELISA test) with the Kruskal-Wallis and Mann-Whitney U tests. RESULTS: VEGF expression in the vitamin D group was similar to that in the OHSS group. However, the PEDF level was significantly higher in the vitamin D group (p = 0.013). CONCLUSIONS: Prophylactic vitamin D supplementation is not sufficiently effective in preventing OHSS. Vitamin D effectively increases PEDF, which has an opposing effect on VEGF, which plays a key role in OHSS. Thus, the protective effect of Vitamin D on OHSS should be investigated with a vitamin D deficient model in the study group.

The effect of place of residence and lifestyle on vitamin D deficiency in pregnancy: Comparison of eastern and western parts of Turkey.

OBJECTIVE: The aim of this study was to determine the prevalence and the predictive factors of vitamin D deficiency in pregnancy and the compliance with "The National Vitamin D Support Program" at Turkey's easternmost and westernmost provinces. MATERIAL AND METHODS: Lifestyles of women at 24-28 weeks of pregnancy were assessed using a questionnaire form, and serum 25-hydroxyvitamin D3 (25(OH)D3) levels were measured. RESULTS: Vitamin D deficiency (≤20 ng/mL) in pregnant women had a prevalence of 27.8% in Izmir and 76.3% in Erzurum. The compliance of "The National Vitamin D Support Program" was 8% in Izmir and 32.6% in Erzurum. Clothing style, fish consumption, seaside holiday duration, and 1200 IU/day vitamin D replacement had an effect on 25(OH)D3 levels in pregnant subjects in Izmir, whereas only holiday duration and 1200 IU/day vitamin D replacement affected 25(OH)D3 levels in Erzurum. However, when a threshold for 25(OH)D3 level was considered ≥32 ng/mL, lifestyles did not affect 25(OH)D3 level. CONCLUSION: The effect of lifestyle on 25(OH)D3 level in pregnancy is limited, especially in cold regions. We recommended increasing the compliance with "The National Vitamin D Support Program" at the follow-up of all pregnant women, irrespective of region and season.

Impact of prognostic factors on survival rates in patients with ovarian carcinoma.

PURPOSE: The aim of the present study was to invesitigate the impact of significant clinico-pathological prognostic factors on survival rates and to identify factors predictive of poor outcome in patients with ovarian carcinoma. MATERIALS AND METHODS: A retrospective chart review of 74 women with pathologically proven ovarian carcinoma who were treated between January 2006 and April 2011 was performed. Patients were investigated with respect to survival to find the possible effects of age, gravida, parity, menstruel condition, pre-operative Ca-125, treatment period, cytologic washings, presence of ascites, tumor histology, stage and grade, maximal tumor diameter, adjuvan chemotherapy and cytoreductive success. Also 55 ovarian carcinoma patients were investigated with respect to prognostic factors for early 2-year survival. RESULTS: The two-year survival rate was 69% and the 5-year survival rate was 25.5% for the whole study population. Significant factors for 2-year survival were preoperative CA-125 level, malignant cytology and FIGO clinical stage. Significant factors for 5-year survival were age, preoperative CA-125 level, residual tumor, lymph node metastases, histologic type of tumor, malignant cytology and FIGO clinical stage. Logistic regression revealed that independent prognostic factors of 5-year survival were patient age, lymph node metastasis and malignant cytology. CONCLUSIONS: We consider quality registries with prospectively collected data to be one important tool in monitoring treatment effects in population-based cancer research.

Uterine closure with unlocked suture in cesarean section: Safety and Quality.

OBJECTIVE: Comparing locked and unlocked uterine closure techniques in terms of bleeding control and uterine incision healing. METHODS: The patients undergoing cesarean section in Sifa University Hospital between May - October 2012 were accepted to this prospective controlled study. Primarily, safety was evaluated. The hemoglobin count (HC) and serum creatine kinase (CK) levels of the patients in the locked (n = 47) and unlocked (n = 35) groups were measured just before and 24 hours after operation. Hemoglobin deficit, increase in CK and the additional hemostatic sutures were compared. Secondly, uterine scar healing was evaluated three months later. Scar thickness, niche and percentage of thinning of the scar region of the locked (n = 27) and unlocked (n = 32) groups were calculated and compared. RESULTS: The hemoglobin deficit was similar in two groups. CK rise was less in the unlocked group but it was not significant (P = 0.082). Unlocked group needed more additional sutures (P = 0.016). The thickness of the niche and the percentage of thinning of the scar region were significantly less in the unlocked group (P= 0.002, P=0.000). CONCLUSIONS: Unlocked uterine closure technique is safe and has less damage to the myometrium.

Mid-pregnancy vitamin D levels and postpartum depression.

OBJECTIVES: Postpartum depression (PPD) is a common disorder that affects 10-15% of postpartum women, and it can have negative effects on both the mother and newborn. Recent studies have suggested that low levels of vitamin D are associated with poor mood and depression. The aim of this prospective study was to evaluate a possible association between PPD and serum levels of 25-hydroxy vitamin D3 (25(OH)D3), a reliable measurement of vitamin D, during mid-pregnancy. STUDY DESIGN: The source population consisted of all pregnant women between 24 and 28 gestational weeks from June 2012 to October 2012 at Bornova Health Research and Application Hospital, Sifa University. In order to better evaluate a possible effect between vitamin D levels and PPD, individuals with characteristics that put them at risk for developing PPD were excluded from the study. Serum 25(OH)D3 levels were evaluated mid-pregnancy in the study group. Serum 25(OH)D3 concentrations ≤20ng/mL (50nmol/L) were classified as a mild deficiency and those ≤10ng/mL (25nmol/L) were classified as a severe deficiency. Pregnant subjects having complications during birth or with the newborn after delivery were excluded from the study. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess maternal PPD 1 week, 6 weeks, and 6 months after delivery. A Pearson correlation was used to measure the strength of the associations between the EPDS scores and vitamin D levels analyzed during the three time periods. A logistic regression analysis was used to determine the independent effects of vitamin D on PPD. RESULTS: Six hundred and eighty-seven pregnant women were included in this study. After excluding women due to PPD risk factors (in two stages), 179 pregnant women were screened for vitamin D levels during mid-pregnancy and in the 6th month postpartum. Eleven percent of our study group had severe vitamin D deficiency and 40.3% had mild vitamin D deficiency. The frequency of PPD was 21.6% at the 1st week, 23.2% at 6th week, and 23.7% at the 6th month. There was a significant relationship between low 25(OH)D3 levels in mid-pregnancy and high EPDS scores, which is indicative of PPD for all three follow-up periods (p=0.003, p=0.004 and p<0.001, respectively). In addition, there was a significant negative correlation between vitamin D levels and EDPS at all three time points (r=-0.2, -0.2, -0.3, respectively). CONCLUSIONS: Vitamin D deficiency in mid-pregnancy may be a factor affecting the development of PPD. More extensive studies are required to be carried out on this subject.

Ultrasonographic visceral fat thickness in the first trimester can predict metabolic syndrome and gestational diabetes mellitus.

The aim of this study is to evaluate whether ultrasonographic visceral fat thickness measurement in the early gestational period is useful for predicting the development of gestational diabetes mellitus (GDM) and metabolic syndrome (MS). The visceral fat thickness and subcutaneous fat thickness were measured via ultrasound at the first prenatal visit. The correlation between visceral and subcutaneous fat thickness and MS parameters, such as dyslipidemia, hypertension, and insulin resistance, was assessed. We also compared the use of visceral fat thickness measurement with body mass index (BMI) and waist circumference (WC) measurements for predicting the development of GDM. The subcutaneous fat thickness was found to be similar in the normal glucose metabolism and GDM groups at the first visit, whereas the visceral fat thickness was found to be considerably higher in the GDM groups (p = 0.04). The visceral fat thickness in the early stage of the gestation was correlated with hyperglycemia, dyslipidemia, high diastolic blood pressure, and insulin resistance. In contrast to subcutaneous fat thickness, BMI, and WC, only the visceral fat thickness was correlated with insulin resistance. The subcutaneous and visceral fat thicknesses at the first visit were significantly higher in the MS group (p = 0.02). There was a good correlation between visceral and subcutaneous fat thicknesses (r = 0.492, p < 0.001); however, there were poor correlations between visceral fat thickness and BMI and WC (r = 0.338, p = 0.01; r = 0.312, p = 0.02). The visceral fat thickness seemed to be a more sensitive predictor of GDM than WC and BMI. The optimal cutoff points for predicting GDM were visceral fat thickness 19.5 mm [area under curve (AUC) = 0.66, p = 0.043], WC 103.5 cm (AUC = 0.64, p = 0.079), and BMI 34.5 (AUC = 0.64, p = 0.069). Ultrasonographic visceral fat thickness measurement in the early period of gestation may be an easy, safe, and cost-effective scan test for predicting the development of metabolic diseases and GDM.

Preoperative serum CA 125 level in the prediction of the stage of disease in endometrial carcinoma.

OBJECTIVE: To evaluate whether a preoperative serum CA-125 level in patients with endometrial carcinoma can provide additional information in determining the stage of disease, and which cutoff value is optimal in this respect. STUDY DESIGN: Retrospective chart review of 147 women with pathologically proven endometrial carcinoma who were treated between January 1999 and May 2009. The associations of preoperative CA-125 levels with the tumor stage, histologic type and grade, and the lymph node positivity were examined. To determine the values of cutoff point levels for serum tumor marker CA-125, the levels of 20 IU/ml and 35 IU/ml were compared. RESULTS: High CA-125 levels significantly correlated with advanced stage and lymph node metastases. The ROC curve determined that the best cutoff value was 20 U/ml. The sensitivity and specificity of a CA-125 cutoff level of 20 U/ml were 75% and 69.51%, respectively, with a positive predictive value of 80.6% and negative predictive value of 84.9%. CONCLUSION: The current study suggests that measurement of preoperative CA-125 is a clinically useful test in endometrial carcinoma patients. CA-125 appears to be a significant independent predictor of the advanced stage of the disease as well as lymph node metastases. The results complement a growing body of literature that supports the relationship between CA-125 level and stage of disease but more studies are needed to establish the appropriate cutoff level for serum CA-125 in this respect.