Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 4.478
Filtrar
1.
BMJ Case Rep ; 13(8)2020 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-32784239

RESUMO

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has presented many diagnostic challenges and uncertainties. Little is known about common pathologies complicating pregnancy and how their behaviour is modified by the presence of SARS-CoV-2. Pregnancy itself can alter the body's response to viral infection, which can cause more severe symptoms. We report the first case of a patient affected with sudden-onset severe pre-eclampsia complicated by acute fatty liver disease of pregnancy, HELLP (haemolysis, elevated liver enzymes and low platelet) syndrome and acute kidney injury following SARS-CoV-2 infection. Although an initial diagnostic dilemma, a multidisciplinary team approach was required to ensure a favourable outcome for both the mother and the baby. Our case report highlights the need for health professionals caring for pregnant women to be aware of the complex interplay between SARS-CoV-2 infection and hypertensive disorders of pregnancy.


Assuntos
Lesão Renal Aguda/complicações , Betacoronavirus , Infecções por Coronavirus/complicações , Fígado Gorduroso/complicações , Síndrome HELLP/diagnóstico , Pneumonia Viral/complicações , Pré-Eclâmpsia/diagnóstico , Complicações Infecciosas na Gravidez/diagnóstico , Lesão Renal Aguda/sangue , Lesão Renal Aguda/diagnóstico , Adulto , Infecções por Coronavirus/sangue , Fígado Gorduroso/sangue , Fígado Gorduroso/diagnóstico , Feminino , Síndrome HELLP/sangue , Humanos , Testes de Função Renal , Pandemias , Pneumonia Viral/sangue , Pré-Eclâmpsia/sangue , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/sangue
2.
PLoS One ; 15(6): e0232749, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32574162

RESUMO

BACKGROUND: Maternal obesity is increasing worldwide but the consequences for maternal physiology and fetal growth are not fully understood. OBJECTIVE: To study whether changes in glucose and lipid metabolism during pregnancy differ between women with normal weight and overweight/obesity, and investigate which of these metabolic factors are associated with birthweight. DESIGN: Prospective, longitudinal study. SETTING: Department of Obstetrics, Oslo University Hospital, Rikshospitalet. POPULATION: 1031 healthy pregnant women with singleton pregnancies. METHODS: Blood samples from early and late pregnancy were analyzed for fasting glucose, insulin and lipids (total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides). Associations between metabolic factors and birthweight (z-scores) were explored by linear regression models. Main Outcome Measures: Group-dependent longitudinal changes in glucose and lipids and their association with birthweight (z-scores). RESULTS: Compared to women with normal weight (BMI < 25), women with overweight (BMI 25-29.9) and obesity (BMI > 30) had significantly higher fasting glucose (4.54, 4.68 and 4.84 mmol/l), insulin (23, 33 and 50 pmol/l), total cholesterol (4.85, 4.99 and 5.14 mmol/l), LDL-C (2.49, 2.66 and 2.88 mmol/l) and triglycerides (1.10, 1.28 and 1.57 mmol/l), but lower HDL-C (1.86, 1.75 and 1.55 mmol/l). BMI (B 0.05, 95% CI 0.03-0.06, p<0.001), gestational weight gain (GWG) (B 0.06, 0.05-0.08, p<0.001) and an increase in fasting glucose (B 0.30, 0.16-0.43, p<0.001) were positively associated with birthweight, whereas a decrease in HDL-C (B -0.72, -0.96- -0.53, p<0.001) had a negative association with birthweight. CONCLUSIONS: Overweight/obesity was associated with an unfavorable metabolic profile in early pregnancy which was associated with increased birthweight. However, modifiable factors like gestational weight gain and an increase in fasting glucose were identified and can be targeted for interventions.


Assuntos
Peso ao Nascer , Glicemia , Índice de Massa Corporal , Lipídeos/sangue , Obesidade/epidemiologia , Complicações na Gravidez/epidemiologia , Adulto , Feminino , Ganho de Peso na Gestação , Humanos , Insulina/sangue , Estudos Longitudinais , Obesidade/sangue , Gravidez , Complicações na Gravidez/sangue , Estudos Prospectivos
3.
PLoS One ; 15(6): e0233890, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32542014

RESUMO

BACKGROUND: Allergic conditions and respiratory tract infections (RTIs) are common causes of morbidity and mortality in childhood. The relationship between vitamin D status in pregnancy (mothers), early life (infants) and health outcomes such as allergies and RTIs in infancy is unclear. To date, studies have shown conflicting results. OBJECTIVE: This systematic review aims to gather and appraise existing evidence on the associations between serum vitamin D concentrations during pregnancy and at birth and the development of eczema, wheezing, and RTIs in infants. DATA SOURCES: PubMed, MEDLINE, ProQuest, Scopus, CINAHL, Cochrane Library and Academic Search Premier databases were searched systematically using specified search terms and keywords. STUDY SELECTION: Articles on the associations between serum vitamin D concentrations during pregnancy and at birth and eczema, wheezing, and RTIs among infants (1-year-old and younger) published up to 31 March 2019 were identified, screened and retrieved. RESULTS: From the initial 2678 articles screened, ten met the inclusion criteria and were included in the final analysis. There were mixed and conflicting results with regards to the relationship between maternal and cord blood vitamin D concentrations and the three health outcomes-eczema, wheezing and RTIs-in infants. CONCLUSION: Current findings revealed no robust and consistent associations between vitamin D status in early life and the risk of developing eczema, wheezing and RTIs in infants. PROSPERO registration no. CRD42018093039.


Assuntos
Eczema/epidemiologia , Hipersensibilidade/epidemiologia , Complicações na Gravidez/epidemiologia , Sons Respiratórios , Infecções Respiratórias/epidemiologia , Deficiência de Vitamina D/epidemiologia , Vitamina D/sangue , Adulto , Estudos de Coortes , Bases de Dados como Assunto , Feminino , Humanos , Lactente , Recém-Nascido , Morbidade , Gravidez , Complicações na Gravidez/sangue , Deficiência de Vitamina D/sangue
4.
PLoS One ; 15(5): e0232634, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32469905

RESUMO

OBJECTIVE: During pregnancy, inhibin A is mainly derived from the placenta and regulates the implantation and differentiation of embryos. Our aim was to assess whether second trimester serum inhibin A was associated with an increased risk of adverse pregnancy outcomes. METHODS: We investigated the serum levels of Inhibin A during the second trimester in pregnancy, and analyzed associations between the Inhibin A and the risk of adverse pregnancy outcome. 12,124 pregnant women were enrolled in this study between January 2017 and July 2019 at the Obstetrics & Gynecology Hospital of Fudan University. Multivariate logistic regression analysis was conducted to estimate the relative risk between Inhibin A and adverse pregnancy outcome. RESULTS: Compared with the group without adverse pregnancy outcome, during the second trimester of pregnancy, age and Inhibin A were risk factors for pre-eclampsia, gestational diabetes mellitus and preterm delivery; Inhibin A was risk factors for low birth weight. Gravidity and Inhibin A were risk factors for macrosomia; while parity was a protective factor against pre-eclampsia, gestational hypertension and low birth weight. CONCLUSION: Elevated Inhibin A levels in pregnancy are significantly associated with pre-eclampsia, GDM, macrosomia, low birth weight and preterm delivery.


Assuntos
Inibinas/sangue , Complicações na Gravidez/epidemiologia , Segundo Trimestre da Gravidez/sangue , Adulto , China/epidemiologia , Diabetes Gestacional/sangue , Diabetes Gestacional/epidemiologia , Feminino , Macrossomia Fetal/sangue , Macrossomia Fetal/epidemiologia , Humanos , Recém-Nascido de Baixo Peso/sangue , Pré-Eclâmpsia/sangue , Pré-Eclâmpsia/epidemiologia , Gravidez , Complicações na Gravidez/sangue , Resultado da Gravidez , Nascimento Prematuro/sangue , Nascimento Prematuro/epidemiologia , Fatores de Risco
5.
PLoS One ; 15(4): e0231657, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32302333

RESUMO

INTRODUCTION: Low levels of vitamin D in pregnancy have been associated with the risk of a variety of pregnancy outcomes. Few studies have investigated vitamin D concentrations throughout pregnancy in healthy women, and most guidelines recommend high vitamin D levels. In the present study, we investigated 25-hydroxyvitamin D concentrations in healthy Caucasian Danish women in relation to season, gestational age and possible vitamin D-linked complications. MATERIALS AND METHODS: Eight hundred and one healthy Caucasian Danish women with an expected normal pregnancy were recruited among 2147 women attending first trimester screening. Seven blood samplings were planned throughout the pregnancy and delivery period. The 25-hydroxyvitamin D2 (25(OH)D2) and 25-hydroxyvitamin D3 (25(OH)D3) concentrations were measured by LC-MS/MS and total 25-hydroxyvitamin D (25(OH)D) were calculated. RESULTS: A total of 3304 samples from 694 women were available for 25(OH)D measurements. The mean (25th-75th percentiles) concentrations of 25(OH)D, 25(OH)D3, and 25(OH)D2 were 54.6 (38.8-68.6) nmol/L, 52.2 (36.4-66.4) nmol/L, and 2.4 (2.2-2.2) nmol/L, respectively. Season was the strongest predictor of 25(OH)D concentration, with the lowest values observed in winter and spring, where only 42% and 41% of samples, respectively, were above 50 nmol/L. Nearly all women had values below the suggested optimal level of 75 nmol/L, independent of season. 25(OH)D peaked at gestational weeks 21-34. Plasma 25(OH)D2 levels were low in all seasons. Women with complications during pregnancy had higher 25(OH)D (estimated difference 9.8 nmol/L, standard error 2.7, p<0.001) than did women without complications, and women giving birth vaginally had lower 25(OH)D than did those delivering via elective (10.0 nmol/L, standard error 2.1, p<0.001) or emergency cesarean section (6.8 nmol/L, standard error 2.2, p<0.001). CONCLUSION: The 25(OH)D concentrations vary with both season and gestational age. Healthy women had lower 25(OH)D concentrations than recommended, without an association with an increased risk of pregnancy complications. Guidelines for vitamin D in pregnancy may require revision.


Assuntos
25-Hidroxivitamina D 2/sangue , Calcifediol/sangue , Complicações na Gravidez/sangue , Gravidez/sangue , 25-Hidroxivitamina D 2/deficiência , Adulto , Calcifediol/deficiência , Dinamarca/epidemiologia , Feminino , Idade Gestacional , Humanos , Estudos Longitudinais , Complicações na Gravidez/epidemiologia , Estações do Ano
6.
Scand J Immunol ; 92(1): e12892, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32335925

RESUMO

Mannose-binding lectin (MBL) is an important component of the innate immunity, and it is responsible not only for opsonization of micro-organisms, but also for efferocytosis. The aim of this study was to investigate whether MBL concentrations and lectin complement pathway activity are altered in non-pregnant women with previous adverse pregnancy outcomes. Patients were divided into four groups on the basis of their history of pregnancy complications, including control patients who had uncomplicated pregnancies and term deliveries (control, n = 33), and three groups of patients with a history of pregnancy complications, including preterm labour (n = 29), recurrent miscarriage (n = 19) or unexplained intrauterine foetal death (IUFD; n = 17). All women enrolled in the study had an interval of three to six months following their previous pregnancy, and they agreed to have a blood sample taken. We found significantly higher MBL concentrations and functional activity of the lectin complement pathway in healthy controls who had previous uneventful term pregnancies (1341 ng/mL; activity 100% (IQR: 62%-100%)), compared to women with the history of IUFD (684 ng/mL, P = .008; activity 8.5% (IQR: 0%-97.8%), P = .011), recurrent miscarriage (524 ng/mL, P = .022; activity 44% (IQR: 4%-83%), P = .011) or preterm labour (799 ng/mL, P = .022; activity 62.5% (IQR: 0%-83%), P = .003). Our results suggest that inadequate function of the complement lectin pathway is associated with a higher risk of preterm labour, recurrent miscarriage and unexplained intrauterine foetal death.


Assuntos
Lectina de Ligação a Manose da Via do Complemento/imunologia , Lectina de Ligação a Manose/sangue , Complicações na Gravidez/sangue , Adulto , Feminino , Humanos , Imunidade Inata/imunologia , Gravidez , Complicações na Gravidez/epidemiologia , Resultado da Gravidez , Estudos Prospectivos , Fatores de Risco
7.
Am J Surg ; 219(5): 855-859, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32245608

RESUMO

BACKGROUND: The diagnosis of acute appendicitis (AA) in pregnancy remains challenging. We investigated which preoperative clinical factors are most predictive of AA in pregnant women. METHODS: 164 pregnant patients undergoing magnetic resonance imaging for suspected AA were retrospectively reviewed. Logistic regression was used to compare those with pathologically confirmed AA and those without. RESULTS: 28 patients (17.1%) had pathologically confirmed AA. 42.9% (n = 12) were perforated at the time of operation. Factors associated with AA included history of emesis (p = 0.005), migratory abdominal pain (p = 0.006), rebound tenderness (p = 0.01), elevated white blood cell count (p = 0.003), elevated Alvarado Score (p < 0.001), elevated neutrophil count (p = 0.021), and left shift (p = 0.001). As a screening test, a left shift with neutrophils >70% provided a sensitivity and negative predictive value of 100.0%. DISCUSSION: Every patient in our series with AA had a left shift. Neutrophil count and percentage should be considered in the diagnostic evaluation of these patients to better guide resource utilization and treatment.


Assuntos
Apendicite/sangue , Neutrófilos , Complicações na Gravidez/sangue , Doença Aguda , Adolescente , Adulto , Apendicectomia , Apendicite/diagnóstico por imagem , Apendicite/cirurgia , Feminino , Humanos , Perfuração Intestinal , Imagem por Ressonância Magnética , Valor Preditivo dos Testes , Gravidez , Complicações na Gravidez/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade
8.
Medicine (Baltimore) ; 99(17): e19663, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332610

RESUMO

Hyperglycemia in pregnancy (HIP) is related to adverse pregnancy outcomes. However, women with hyperglycemia in the second and third trimester of pregnancy (HISTTP) were not been observed. We aim to reveal associations between HISTTP and prematurity. To confirm which risk factor is better in predicting preterm delivery.This retrospective study included 660 patients, of which 132 have HISTTP and 528 have euglycemia. Univariate analysis was used to extract risk factors and multivariates logistic regression analysis to obtain odds ratio (OR) for prematurity. Mean decrease gini (MDG) in random forest algorithm was used to rank the risk factors.HISTTP women have higher prepregnancy BMI and a higher percentage of family history of hypertension, maternal adiposity, maternal anemia, gestational diabetes mellitus (GDM), prematurity, neonatal asphyxia in 1-minute (P < .05). Univariate analysis of prematurity showed that preterm women had higher rate of HISTTP (P < .01), second births, elderly pregnancy, hypertention, family history of hypertention and multiple perinatal infant (P < .05). Multivariate logistic regression analysis indicates that HISTTP (OR = 2.984, P = .0017), maternal hypertension (OR = 5.208, P = .001) and multiple perinatal infants (OR = 59.815, P < .0001) are independent risk factors for prematurity. After ranked the MDG, the top 3 risk factors were multiple perinatal infants, maternal hypertension, HISTTP. MDG of HISTTP is higher than that of GDM.Women with HISTTP deserve to be concerned, whose prematurity rate are increased. HISTTP is an independent risk factor and a better predictor of prematurity.


Assuntos
Hiperglicemia/complicações , Adulto , Índice de Massa Corporal , Feminino , Idade Gestacional , Humanos , Hiperglicemia/sangue , Hiperglicemia/fisiopatologia , Recém-Nascido , Modelos Logísticos , Razão de Chances , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/fisiopatologia , Segundo Trimestre da Gravidez/sangue , Segundo Trimestre da Gravidez/metabolismo , Terceiro Trimestre da Gravidez/sangue , Terceiro Trimestre da Gravidez/metabolismo , Nascimento Prematuro/sangue , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Estatísticas não Paramétricas
9.
Rev Med Suisse ; 16(689): 670-674, 2020 Apr 08.
Artigo em Francês | MEDLINE | ID: mdl-32270932

RESUMO

The antiphospholipid syndrome (APS) is a complex autoimmune -disease characterized by the expression of antiphospholipid -antibodies (APL) and a variety of clinical presentation. The latest classification defines APS by the occurrence of vascular thrombosis and/or typical obstetrical morbidity together with persistently -detectable APL at least 12 weeks apart. The latest recommendation proposes a risk profile based on the type and titer of APL detected, in order to guide the intensity of prophylactic measures. Based on current knowledge, novel oral anticoagulants should not be used in APS, particularly in patients with a high-risk APL profile or arterial thrombosis. Beyond the mere aspect of anticoagulant treatment, immunomodulatory approaches to the APS such as hydroxychloroquine are under investigation.


Assuntos
Anticorpos Antifosfolipídeos/sangue , Síndrome Antifosfolipídica , Trombose , Adulto , Anticoagulantes/uso terapêutico , Síndrome Antifosfolipídica/sangue , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/tratamento farmacológico , Feminino , Humanos , Hidroxicloroquina/uso terapêutico , Conhecimento , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/tratamento farmacológico , Fatores de Risco , Trombose/sangue , Trombose/tratamento farmacológico , Trombose/etiologia
10.
Anticancer Res ; 40(4): 1997-2001, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32234889

RESUMO

BACKGROUND/AIM: The liver of pregnant women undergoes physiological and pathological changes and the changes in liver enzyme activity and release reflect changes in serum enzymatic activity. We aimed to assess the activity of alcohol dehydrogenase (ADH) isoenzymes, and aldehyde dehydrogenase (ALDH) in the sera of women with intrahepatic cholestasis of pregnancy (ICP), the most common pregnancy-related liver disease. PATIENTS AND METHODS: Serum samples were taken from 40 women with ICP in the second or third trimester of pregnancy. Serum samples were also obtained from 40 healthy pregnant women at the same time of pregnancy and 40 healthy non-pregnant women. Class I and II of ADH and ALDH activity was measured by a spectrofluorometric method. Class III, IV ADH and total ADH activity was measured by photometric methods. RESULTS: The total ADH activity was significantly higher in women with ICP than in healthy pregnant and non-pregnant women (about 42%). The median total activity of ADH was 1067 mU/l in women with ICP, 628 mU/l in healthy pregnant and 605 mU/l in non-pregnant women. A statistically significant increase in class I ADH isoenzymes was found in the sera of pregnant women with ICP. The median activity of this class in the ICP group increased about 62% and 80% in comparison to the healthy pregnant women and non-pregnant women, respectively. CONCLUSION: The activity of class I ADH isoenzymes in the sera of women with ICP is statistically significantly increased and may have a diagnostic significance.


Assuntos
Álcool Desidrogenase/sangue , Aldeído Desidrogenase/sangue , Colestase Intra-Hepática/sangue , Fígado/enzimologia , Complicações na Gravidez/sangue , Adulto , Estudos de Casos e Controles , Colestase Intra-Hepática/enzimologia , Colestase Intra-Hepática/patologia , Feminino , Humanos , Isoenzimas/sangue , Fígado/patologia , Oxirredução , Gravidez , Complicações na Gravidez/enzimologia , Complicações na Gravidez/patologia , Espectrometria de Fluorescência
11.
Br J Nutr ; 124(4): 432-439, 2020 08 28.
Artigo em Inglês | MEDLINE | ID: mdl-32213215

RESUMO

Previous studies have shown conflicting findings regarding the relationship between maternal vitamin D deficiency (VDD) and fetal growth restriction (FGR). We hypothesised that parathyroid hormone (PTH) may be an underlying factor relevant to this potential association. In a prospective birth cohort study, descriptive statistics were evaluated for the demographic characteristics of 3407 pregnancies in the second trimester from three antenatal clinics in Hefei, China. The association of the combined status of vitamin D and PTH with birth weight and the risk of small for gestational age (SGA) was assessed by a multivariate linear and binary logistic regression. We found that declined status of 25-hydroxyvitamin D is associated with lower birth weight (for moderate VDD: adjusted ß = -49·4 g, 95 % CI -91·1, -7·8, P < 0·05; for severe VDD: adjusted ß = -79·8 g, 95 % CI -127·2, -32·5, P < 0·01), as well as ascended levels of PTH (for elevated PTH: adjusted ß = -44·5 g, 95 % CI -82·6, -6·4, P < 0·05). Compared with the non-VDD group with non-elevated PTH, pregnancies with severe VDD and elevated PTH had the lowest neonatal birth weight (adjusted ß = -124·7 g, 95 % CI -194·6, -54·8, P < 0·001) and the highest risk of SGA (adjusted risk ratio (RR) = 3·36, 95 % CI 1·41, 8·03, P < 0·01). Notably, the highest risk of less Ca supplementation was founded in severe VDD group with elevated PTH (adjusted RR = 4·67, 95 % CI 2·78, 7·85, P < 0·001). In conclusion, elevated PTH induced by less Ca supplementation would further aggravate the risk of FGR in pregnancies with severe VDD through impaired maternal Ca metabolism homoeostasis.


Assuntos
Retardo do Crescimento Fetal/epidemiologia , Hormônio Paratireóideo/sangue , Complicações na Gravidez/epidemiologia , Segundo Trimestre da Gravidez/sangue , Deficiência de Vitamina D/sangue , Adulto , Peso ao Nascer , China/epidemiologia , Feminino , Retardo do Crescimento Fetal/sangue , Retardo do Crescimento Fetal/etiologia , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Modelos Logísticos , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/etiologia , Estudos Prospectivos , Vitamina D/análogos & derivados , Vitamina D/sangue , Deficiência de Vitamina D/complicações
12.
BJOG ; 127(9): 1154-1164, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32175668

RESUMO

OBJECTIVE: Data regarding low maternal haemoglobin concentration and severe maternal morbidity (SMM) are limited and potentially biased. This study evaluated the relation between early maternal haemoglobin concentration and SMM or maternal mortality. DESIGN: Population-based cohort study. SETTING: Ontario, Canada, in a public healthcare system. POPULATION: 737 393 births with a routine outpatient haemoglobin measured at a calculated gestational age of 2-16 weeks. METHODS: The relation between early-pregnancy outpatient blood haemoglobin concentration and each study outcome was expressed as adjusted relative risks (aRR) and absolute risk differences (aRD), with 95% confidence intervals (CI), generated by modified Poisson regression. MAIN OUTCOME MEASURES: The primary outcome was SMM or maternal mortality, from 23 weeks' gestation to 42 days postpartum. RESULTS: The mean (SD) haemoglobin concentration was 126.9 (9.3) g/l. Overall, SMM or death occurred in 13 514 pregnancies (1.8%). Relative to a haemoglobin level of 125-129 g/l, the aRR was 1.07 (95% CI 1.02-1.13) and aRD (0.09%, 95% CI 0.01-0.18) at 120-124 g/l; aRR 1.31 (95% CI 1.17-1.46) and aRD 0.47% (95% CI 0.24-0.69) at 105-109 g/l; and aRR 4.53 (95% CI 3.59-5.72) and aRD 5.94% (95% CI 4.12-7.76) at <90 g/l. In all, 5961 women (0.8%) required red cell transfusion, with significantly higher risks at all haemoglobin concentrations below 125-129 g/l, peaking at a haemoglobin level <90 g/l (aRR 11.82, 95% CI 9.30-15.03). CONCLUSION: There is a gradual increase in the risk of SMM or death, as well as red cell transfusion, starting from the lower level of the normal range of haemoglobin of non-pregnant women. TWEETABLE ABSTRACT: Women with low haemoglobin in early pregnancy are at higher future risk of morbidity, death and blood transfusion.


Assuntos
Anemia/sangue , Anemia/epidemiologia , Transfusão de Eritrócitos/estatística & dados numéricos , Hemoglobinas/metabolismo , Complicações na Gravidez/sangue , Complicações na Gravidez/epidemiologia , Adulto , Anemia/mortalidade , Anemia/terapia , Feminino , Humanos , Mortalidade Materna , Ontário/epidemiologia , Gravidez , Complicações na Gravidez/mortalidade , Complicações na Gravidez/terapia , Primeiro Trimestre da Gravidez/sangue , Estudos Retrospectivos , Fatores de Risco
13.
Arch Endocrinol Metab ; 64(1): 89-95, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32187263

RESUMO

Clinical and subclinical hypothyroidism are the most common hormonal dysfunctions during pregnancy. Insufficient maternal thyroid hormones (THs) in the early stages of pregnancy can lead to severe impairments in the development of the central nervous system because THs are critical to central nervous system development. In the fetus and after birth, THs participate in neurogenic processes, cell differentiation, neuronal activation, axonal growth, dendritic arborization, synaptogenesis and myelination. Although treatment is simple and effective, approximately 30% of pregnant women in Brazil with access to prenatal care have their first consultation after the first trimester of pregnancy, and any delay in diagnosis and resulting treatment delay may lead to cognitive impairment in children. This review summarizes the effects of clinical and subclinical hypothyroidism on fetal neurodevelopment, behavior and cognition in humans and rodents. Arch Endocrinol Metab. 2020;64(1):89-95.


Assuntos
Encéfalo/embriologia , Disfunção Cognitiva/etiologia , Hipotireoidismo/complicações , Troca Materno-Fetal/fisiologia , Complicações na Gravidez/fisiopatologia , Animais , Encéfalo/fisiopatologia , Feminino , Humanos , Camundongos , Gravidez , Complicações na Gravidez/sangue , Resultado da Gravidez , Trimestres da Gravidez , Efeitos Tardios da Exposição Pré-Natal
14.
J Steroid Biochem Mol Biol ; 199: 105611, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32007562

RESUMO

Gestational hypercalcemia is associated with an increased risk of maternal, fetal and neonatal morbidity and mortality. Hypercalcemia may develop during pregnancy in individuals who were previously asymptomatic. The increased sensitivity during pregnancy may be related to physiological, gestational alterations in vitamin D and calcium metabolism and may be influenced by gene variants. The prevalence is unknown. We investigated the prevalence of hypercalcemia in trimester 3 (T3) in a population representative prospective cohort study (n = 1832) in South-West Sweden. Women with serum albumin (Alb) adjusted calcium (CaAlb) ≥ 2.65 mmol/L in T3 (n = 30) were matched to normo-calcemic controls, and markers of calcium and vitamin D metabolism were investigated in trimester 1 (T1) and T3. Serum concentrations of Ca, phosphate (P), Magnesium (Mg), Alb and creatinine (Cr), parathyroid hormone (PTH; T3 only), vitamin D metabolites (total 25(OH)D, 1,25(OH)2D, 24,25(OH)2D, and free 25(OH)D) were analysed in T1 and T3. CaAlb (Payne; inter-laboratory difference: UEA = 0.15 + 0.9*UGOT; UEA 2.54 = UGOT 2.65) and estimated glomerular filtration rate (eGFR; modified 4-variable MDRD) and vitamin D metabolites ratios (VMR) were calculated. Normally and non-normally distributed data were presented as mean (SD) or median (95 %CI). Group differences in relationships between vitamin D metabolites and with PTH were investigated with multiple regression analyses. Hypercalcemia in T3 was found in 1.7 % of women. PTH concentrations suggestive of primary hyperparathyroidism was found in 1 woman and none had 25(OH)D or 24,25(OH)2D concentrations in the toxicity range or suggestive of mutations in the CYP24A1 gene. CaAlb was significantly higher in hypercalcemic cases compared to controls in T1 (2.44 (2.30-2.80) vs 2.37 (2.25-2.49) mmol/L) and T3 (2.63 (2.52-2.78) vs 2.46 (2.31-2.58) mmol/L). Serum P was higher among cases than controls in T3 (1.12 (0.16) vs 1.07 (0.18) mmol/L) but not in T1 (1.12 (0.18) and 1.12 (0.16) mmol/L). PTH in T3 was lower in cases (1.6 (1.6-2.8) vs 2.3 (2.1-2.8) pmol/L) but 1,25(OH)2D concentrations were similar. There were no significant group differences in serum 25(OH)D, free 25(OH)D, 24,25(OH)2D, Mg, Alb, Cr and eGFR. Regression analyses did not show significant differences between cases and controls in relationships between vitamin D metabolites and with PTH, except for the free 25(OH)D-PTH relationship and a higher free:total 25(OH)D ratio in cases at T1. In conclusion, most common causes of hypercalcemia were excluded in the majority of women. Hypercalcemic women had a relatively high serum 1,25(OH)2D concentration despite an appropriately suppressed PTH, suggestive of abnormal gestational adaptions.


Assuntos
Cálcio/sangue , Hipercalcemia/metabolismo , Complicações na Gravidez/metabolismo , Vitamina D/metabolismo , Adulto , Cálcio/metabolismo , Cálcio na Dieta/uso terapêutico , Creatinina/sangue , Feminino , Humanos , Hipercalcemia/sangue , Hipercalcemia/epidemiologia , Magnésio/sangue , Hormônio Paratireóideo/sangue , Hormônio Paratireóideo/metabolismo , Fosfatos/sangue , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/epidemiologia , Albumina Sérica/metabolismo , Suécia/epidemiologia , Vitamina D/sangue
15.
Arch. endocrinol. metab. (Online) ; 64(1): 89-95, Jan.-Feb. 2020. graf
Artigo em Inglês | LILACS | ID: biblio-1088770

RESUMO

ABSTRACT Clinical and subclinical hypothyroidism are the most common hormonal dysfunctions during pregnancy. Insufficient maternal thyroid hormones (THs) in the early stages of pregnancy can lead to severe impairments in the development of the central nervous system because THs are critical to central nervous system development. In the fetus and after birth, THs participate in neurogenic processes, cell differentiation, neuronal activation, axonal growth, dendritic arborization, synaptogenesis and myelination. Although treatment is simple and effective, approximately 30% of pregnant women in Brazil with access to prenatal care have their first consultation after the first trimester of pregnancy, and any delay in diagnosis and resulting treatment delay may lead to cognitive impairment in children. This review summarizes the effects of clinical and subclinical hypothyroidism on fetal neurodevelopment, behavior and cognition in humans and rodents. Arch Endocrinol Metab. 2020;64(1):89-95


Assuntos
Humanos , Animais , Feminino , Gravidez , Ratos , Complicações na Gravidez/fisiopatologia , Encéfalo/embriologia , Disfunção Cognitiva/etiologia , Hipotireoidismo/complicações , Troca Materno-Fetal/fisiologia , Complicações na Gravidez/sangue , Trimestres da Gravidez , Efeitos Tardios da Exposição Pré-Natal , Encéfalo/fisiopatologia , Resultado da Gravidez
16.
Nutrients ; 12(2)2020 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-31972973

RESUMO

Lutein and zeaxanthin play important roles in visual functions, but their influence on early visual development is unclear. We related maternal lutein and zeaxanthin concentrations during pregnancy to offspring visual acuity (VA) in 471 mother-child pairs from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort. Maternal concentrations of plasma lutein and zeaxanthin were determined at delivery. We measured uncorrected distance of VA in 3-year old children using a LEA Symbols chart; readings were converted to the logarithm of Minimum Angle of Resolution (logMAR), with >0.3 logMAR indicating poor VA. Associations were examined using linear or Poisson regression adjusted for confounders. The median (inter-quartile range) of maternal lutein and zeaxanthin concentrations were 0.13 (0.09, 0.18) and 0.09 (0.07, 0.12) µmol/L, respectively. A total of 126 children had poor VA. The highest tertile of maternal zeaxanthin concentration was associated with 38% lower likelihood of poor VA in children (95% CI: 0.42, 0.93, p-Trends = 0.02). Higher maternal lutein concentrations were associated with a lower likelihood of poor VA in children (RR 0.60 (95% CI: 0.40, 0.88) for middle tertile; RR 0.78 (95% CI: 0.51, 1.19) for highest tertile (p-Quadratic = 0.02)). In conclusion, lutein and zeaxanthin status during pregnancy may influence offspring early visual development; but the results require confirmation with further studies, including more comprehensive measurements of macular functions.


Assuntos
Luteína/sangue , Fenômenos Fisiológicos da Nutrição Materna , Complicações na Gravidez/sangue , Acuidade Visual , Zeaxantinas/sangue , Adulto , Pré-Escolar , Feminino , Humanos , Luteína/deficiência , Masculino , Testes para Triagem do Soro Materno , Avaliação de Resultados em Cuidados de Saúde , Gravidez , Efeitos Tardios da Exposição Pré-Natal/etiologia , Singapura , Transtornos da Visão/etiologia , Zeaxantinas/deficiência
17.
BMC Endocr Disord ; 20(1): 1, 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-31900145

RESUMO

BACKGROUND: Mannan-binding lectin (MBL) is a main component of the lectin pathway of the complement system. Lower MBL levels are associated with, among other conditions, hypothyroidism and adverse pregnancy outcomes. In turn, adverse pregnancy outcomes and infertility may result from hypothyroidism, even in patients with high normal Thyroid-stimulating hormone (TSH). The aim of this study was to determine if MBL level differs between women of reproductive age with low normal (< 2.5 mIU/l) and high normal (≥2.5 mIU/l) TSH. Associations with other parameters potentially affected by hypothyroidism were also evaluated. METHODS: Ninety five (95) patients with normal thyroid tests (TSH 0.27-4.2 mIU/l), aged 18-48 years, were prospectively enrolled. Several laboratory parameters were measured, including MBL level, thyroid tests and lipid profile. RESULTS: Serum MBL level was lower in women with TSH ≥ 2.5 mIU/l than with TSH < 2.5 mIU/l. This association was confirmed by univariate regression analysis. MBL level was significantly lower in patients with abnormally low HDLC/cholesterol ratio and a positive correlation was found between MBL level and HDL/cholesterol ratio. CONCLUSION: In women of reproductive age with normal thyroid tests, lower MBL is associated with high normal TSH and with less favourable lipid profile. Therefore treatment with L-thyroxine should be considered in women of reproductive age with TSH ≥ 2.5 mIU/l.


Assuntos
Biomarcadores/sangue , Hipotireoidismo/diagnóstico , Lectina de Ligação a Manose/sangue , Complicações na Gravidez/diagnóstico , Tireotropina/sangue , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Hipotireoidismo/sangue , Pessoa de Meia-Idade , Gravidez , Complicações na Gravidez/sangue , Resultado da Gravidez , Prognóstico , Adulto Jovem
18.
J Perinatol ; 40(3): 488-496, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31913325

RESUMO

OBJECTIVE: To examine the association between maternal erythrocyte long-chain omega-3 PUFA (n-3 LCPUFA), measured in early pregnancy, and pregnancy and birth outcomes. STUDY DESIGN: One hundred and eight healthy women with a singleton pregnancy were included. Erythrocyte fatty acids were analyzed using gas chromatography. Gestational length, birth anthropometric measures, and pregnancy-associated complications were collected from hospital medical records. RESULTS: We observed significant positive associations between maternal docosahexaenoic acid (DHA) levels (p = 0.024) and omega-3 index values (p = 0.021) and gestational length in adjusted linear regression models. Each point in maternal DHA level was associated with 2.19 days longer gestational duration (ß = 2.19; 95% CI 0.29-4.09). No consistent associations were found between n-3 PUFA levels and composite pregnancy outcome. CONCLUSION: These findings suggest that the gestational length is positively affected by maternal n-3 LCPUFA status as soon as the early stages of pregnancy.


Assuntos
Ácidos Graxos Ômega-3/sangue , Resultado da Gravidez , Primeiro Trimestre da Gravidez/sangue , Segundo Trimestre da Gravidez/sangue , Adulto , Bélgica , Estudos de Coortes , Ácidos Docosa-Hexaenoicos/sangue , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Modelos Lineares , Modelos Logísticos , Gravidez , Complicações na Gravidez/sangue , Curva ROC
19.
Int J Mol Sci ; 21(2)2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31936594

RESUMO

The aim of the study was to examine the effect of previous pregnancies and classical cardiovascular risk factors on vascular endothelial function in a group of 264 young and middle-aged women 3 to 11 years postpartum. We examined microvascular functions by peripheral arterial tonometry and EndoPAT 2000 device with respect to a history of gestational hypertension, preeclampsia, fetal growth restriction, the severity of the disease with regard to the degree of clinical signs and delivery date. Besides, we compared Reactive Hyperemia Index (RHI) values and the prevalence of vascular endothelial dysfunction among the groups of women with normal and abnormal values of BMI, waist circumference, systolic and diastolic blood pressures, heart rate, total serum cholesterol levels, serum high-density lipoprotein cholesterol levels, serum low-density lipoprotein cholesterol levels, serum triglycerides levels, serum lipoprotein A levels, serum C-reactive protein levels, serum uric acid levels, and plasma homocysteine levels. Furthermore, we determined the effect of total number of pregnancies and total parity per woman, infertility and blood pressure treatment, presence of trombophilic gene mutations, current smoking of cigarettes, and current hormonal contraceptive use on the vascular endothelial function. We also examined the association between the vascular endothelial function and postpartum whole peripheral blood expression of microRNAs involved in pathogenesis of cardiovascular/cerebrovascular diseases (miR-1-3p, miR-16-5p, miR-17-5p, miR-20a-5p, miR-20b-5p, miR-21-5p, miR-23a-3p, miR-24-3p, miR-26a-5p, miR-29a-3p, miR-92a-3p, miR-100-5p, miR-103a-3p, miR-125b-5p, miR-126-3p, miR-130b-3p, miR-133a-3p, miR-143-3p, miR-145-5p, miR-146a-5p, miR-155-5p, miR-181a-5p, miR-195-5p, miR-199a-5p, miR-210-3p, miR-221-3p, miR-342-3p, miR-499a-5p, and miR-574-3p). A proportion of overweight women (17.94% and 20.59%) and women with central obesity (18.64% and 21.19%) had significantly lower RHI values at 10.0% false positive rate (FPR) both before and after adjustment of the data for the age of patients. At 10.0% FPR, a proportion of women with vascular endothelial dysfunction (RHI ≤ 1.67) was identified to have up-regulated expression profile of miR-1-3p (11.76%), miR-23a-3p (17.65%), and miR-499a-5p (18.82%) in whole peripheral blood. RHI values also negatively correlated with expression of miR-1-3p, miR-23a-3p, and miR-499a-5p in whole peripheral blood. Otherwise, no significant impact of other studied factors on vascular endothelial function was found. We suppose that screening of these particular microRNAs associated with vascular endothelial dysfunction may help to stratify a highly risky group of young and middle-aged women that would benefit from early implementation of primary prevention strategies. Nevertheless, it is obvious, that vascular endothelial dysfunction is just one out of multiple cardiovascular risk factors which has only a partial impact on abnormal expression of cardiovascular and cerebrovascular disease associated microRNAs in whole peripheral blood of young and middle-aged women.


Assuntos
Doenças Cardiovasculares/genética , Endotélio Vascular/fisiopatologia , Epigênese Genética , Complicações na Gravidez/genética , Adulto , Doenças Cardiovasculares/sangue , Feminino , Humanos , Modelos Logísticos , MicroRNAs/genética , MicroRNAs/metabolismo , Pessoa de Meia-Idade , Obesidade/genética , Obesidade/fisiopatologia , Gravidez , Complicações na Gravidez/sangue , Fatores de Risco , Adulto Jovem
20.
Obes Facts ; 13(1): 58-65, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31991405

RESUMO

INTRODUCTION: Bariatric surgery confers a high risk for nutritional deficiencies that could affect physiologic adaptation of lipids during pregnancy. We aimed to evaluate differences in serum lipids in pregnant women after bariatric surgery compared to obese and lean mothers. METHODS: 25 women with a history of Roux-en-Y gastric bypass (RYGB), 19 obese and 19 normal-weight controls were included at the 24th-28th gestational week for determination of fasting lipids with follow-up in a subgroup after delivery. Data on neonatal biometry were additionally assessed. RESULTS: Women after RYGB showed lower total-cholesterol (TC), low-density lipoprotein C (LDL-C), non-high-density lipoprotein C (non-HDL-C) and triglycerides (TG) compared to obese mothers. Despite their higher BMI, women after RYGB showed lower TC, LDL-C and non-HDL-C than normal-weight mothers. Ultrasensitive C-reactive protein was lower in RYGB mothers than in obese ones, reaching values of lean controls. Differences remained unchanged in BMI-matched comparison. Birth weight percentiles of RYGB offspring were associated with maternal TC (r = 0.59, p = 0.021), LDL-C (r = 0.71, p = 0.003), non-HDL (r = 0.59, p = 0.021) but not HDL-C or TG. After delivery, lipids decreased in all women; however, TC and LDL-C showed more attenuated decline in mothers after RYGB than control women. CONCLUSION: Pregnancies after RYGB show alterations of physiologic patterns in lipid profile. Further studies are required to evaluate whether imbalances in maternal lipids constitute a risk for abnormal fetal growth in this special cohort.


Assuntos
Cirurgia Bariátrica , Lipídeos/sangue , Mães , Obesidade Mórbida/cirurgia , Adulto , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Obesidade Mórbida/sangue , Gravidez , Complicações na Gravidez/sangue , Triglicerídeos/sangue , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA