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1.
Ann Clin Biochem ; 58(5): 537-546, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34120478

RESUMO

BACKGROUND: Gestational TSH and FT4 reference intervals may differ according to assay method, but the extent of variation is unclear and has not been systematically evaluated. We conducted a systematic review of published studies on TSH and FT4 reference intervals in pregnancy. Our aim was to quantify method-related differences in gestation reference intervals, across four commonly used assay methods, Abbott, Beckman, Roche and Siemens. METHODS: We searched the literature for relevant studies, published between January 2000 and December 2020, in healthy pregnant women without thyroid antibodies or disease. For each study, we extracted trimester-specific reference intervals (2.5-97.5 percentiles) for TSH and FT4 as well as the manufacturer-provided reference interval for the corresponding non-pregnant population. RESULTS: TSH reference intervals showed a wide range of study-to-study differences with upper limits ranging from 2.33 to 8.30 mU/L. FT4 lower limits ranged from 4.40 to 13.93 pmol/L, with consistently lower reference intervals observed with the Beckman method. Differences between non-pregnant and first trimester reference intervals were highly variable, and for most studies, the TSH upper limit in the first trimester could not be predicted or extrapolated from non-pregnant values. CONCLUSIONS: Our study confirms significant intra- and intermethod disparities in gestational thyroid hormone reference intervals. The relationship between pregnant and non-pregnant values is inconsistent and does not support the existing practice in many laboratories of extrapolating gestation references from non-pregnant values. Laboratories should invest in deriving method-specific gestation reference intervals for their population.


Assuntos
Primeiro Trimestre da Gravidez/sangue , Gravidez/sangue , Tireotropina/sangue , Tiroxina/sangue , Adulto , Feminino , Humanos , Valores de Referência , Testes de Função Tireóidea
2.
Nutrients ; 13(5)2021 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-34066873

RESUMO

To evaluate whether women with anaemia or high haemoglobin (Hb) in early pregnancy would be at higher risk of miscarriage, this population-based cohort study involved 9453 women whose pregnancies were monitored at primary care centres between 2007 and 2012. The computerised clinical histories were used to collect: Hb measurements (up to 14 weeks of gestation), miscarriage before or by 24 weeks of gestation, and other maternal characteristics. The relation between anaemia (Hb < 110 g/L), normal Hb (110-140 g/L, reference), and high Hb concentrations (≥140 g/L) with miscarriage were expressed as adjusted OR with 95%CI. Restricted cubic spline models were applied to evaluate the dose-response relationships. A total of 520 (5.5%) women were recorded as having a miscarriage. The rate of miscarriage in anaemia, normal Hb, and high Hb concentrations was 8.4%, 5.1%, and 10.2%, respectively. Compared with women with normal Hb at the first trimester, the multivariable-adjusted OR for miscarriage was 2.11 (95%CI, 1.38-3.21) for women with anaemia and 1.83 (95%CI, 1.29-2.58) for women with high Hb. Hb concentrations showed a U-shaped association with miscarriage, with the lowest incidence among women with Hb of 120-130 g/L. These data highlight the importance of considering anaemia and high Hb levels in early pregnancy as harmful indicators for miscarriage.


Assuntos
Aborto Espontâneo/epidemiologia , Anemia/epidemiologia , Hemoglobinas/análise , Complicações Hematológicas na Gravidez/epidemiologia , Primeiro Trimestre da Gravidez/sangue , Aborto Espontâneo/etiologia , Adulto , Anemia/complicações , Estudos de Coortes , Feminino , Humanos , Incidência , Razão de Chances , Gravidez , Complicações Hematológicas na Gravidez/etiologia , Fatores de Risco
3.
Fertil Steril ; 116(3): 809-819, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34053677

RESUMO

OBJECTIVE: To compare the performance of kisspeptin and beta human chorionic gonadotropin (ßhCG), both alone and in combination, as biomarkers for miscarriage throughout the first trimester. DESIGN: Prospective, nested case-control study. SETTING: Tertiary Centre, Queen Charlotte Hospital, London, United Kingdom. PATIENT(S): Adult women who had miscarriages (n = 95, 173 samples) and women with healthy pregnancies (n = 265, 557 samples). INTERVENTION(S): The participants underwent serial ultrasound scans and blood sampling for measurement of plasma kisspeptin and ßhCG levels during the first trimester. MAIN OUTCOME MEASURE(S): The ability of plasma kisspeptin and ßhCG levels to distinguish pregnancies complicated by miscarriage from healthy pregnancies unaffected by miscarriage. RESULT(S): Gestation-adjusted levels of circulating kisspeptin and ßhCG were lower in samples from women with miscarriages than in women with healthy pregnancies by 79% and 70%, respectively. The area under the receiver-operating characteristic curve for identifying miscarriage during the first trimester was 0.874 (95% confidence interval [CI] 0.844-0.904) for kisspeptin, 0.859 (95% CI 0.820-0.899) for ßhCG, and 0.916 (95% CI 0.886-0.946) for the sum of the two markers. The performance of kisspeptin in identifying miscarriage improved with increasing length of gestation, whereas that of ßhCG worsened. A decision matrix incorporating kisspeptin, ßhCG, and gestational age had 83% to 87% accuracy for the prediction of miscarriage. CONCLUSION(S): Plasma kisspeptin is a promising biomarker for miscarriage and provides additional value to ßhCG alone, especially during later gestational weeks of the first trimester.


Assuntos
Aborto Espontâneo/sangue , Kisspeptinas/sangue , Primeiro Trimestre da Gravidez/sangue , Aborto Espontâneo/diagnóstico por imagem , Aborto Espontâneo/etiologia , Biomarcadores/sangue , Estudos de Casos e Controles , Gonadotropina Coriônica Humana Subunidade beta/sangue , Regulação para Baixo , Feminino , Idade Gestacional , Humanos , Valor Preditivo dos Testes , Gravidez , Estudos Prospectivos , Ultrassonografia Pré-Natal
4.
BMC Pregnancy Childbirth ; 21(1): 342, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33931032

RESUMO

BACKGROUND: Alcohol consumption during pregnancy is associated with major birth defects and developmental disabilities. Questionnaires concerning alcohol consumption during pregnancy underestimate alcohol use while the use of a reliable and objective biomarker for alcohol consumption enables more accurate screening. Phosphatidylethanol can detect low levels of alcohol consumption in the previous two weeks. In this study we aimed to biochemically assess the prevalence of alcohol consumption during early pregnancy using phosphatidylethanol in blood and compare this with self-reported alcohol consumption. METHODS: To evaluate biochemically assessed prevalence of alcohol consumption during early pregnancy using phosphatidylethanol levels, we conducted a prospective, cross-sectional, single center study in the largest tertiary hospital of the Netherlands. All adult pregnant women who were under the care of the obstetric department of the Erasmus MC and who underwent routine blood testing at a gestational age of less than 15 weeks were eligible. No specified informed consent was needed. RESULTS: The study was conducted between September 2016 and October 2017. In total, we received 1,002 residual samples of 992 women. After applying in- and exclusion criteria we analyzed 684 samples. Mean gestational age of all included women was 10.3 weeks (SD 1.9). Of these women, 36 (5.3 %) tested positive for phosphatidylethanol, indicating alcohol consumption in the previous two weeks. Of women with a positive phosphatidylethanol test, 89 % (n = 32) did not express alcohol consumption to their obstetric care provider. CONCLUSIONS: One in nineteen women consumed alcohol during early pregnancy with a high percentage not reporting this use to their obstetric care provider. Questioning alcohol consumption by an obstetric care provider did not successfully identify (hazardous) alcohol consumption. Routine screening with phosphatidylethanol in maternal blood can be of added value to identify women who consume alcohol during pregnancy.


Assuntos
Consumo de Bebidas Alcoólicas/sangue , Glicerofosfolipídeos/sangue , Adulto , Biomarcadores/sangue , Estudos Transversais , Feminino , Idade Gestacional , Humanos , Modelos Logísticos , Países Baixos , Gravidez , Primeiro Trimestre da Gravidez/sangue , Estudos Prospectivos , Autorrelato , Adulto Jovem
5.
Diabetes Res Clin Pract ; 176: 108866, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34023339

RESUMO

AIMS: We aimed to explore the mediating role of plasma retinol-binding protein 4 (RBP4) in the relationship between sleep quality and insulin resistance (IR) among pregnant women. METHODS: We conducted a cross-sectional study including 263 pregnant women in the first trimester. Sleep quality was evaluated by Pittsburgh Sleep Quality Index (PSQI). The ELISA and homeostasis model assessment (HOMA) was used to analyze plasma RBP4 and estimate IR. The mediating model was used to analyze the mediating role of RBP4 in the relationship between PSQI score and IR. RESULTS: In the multivariable linear regression model, the three terms were positively related with each other, PSQI score was positively associated with IR levels (ß = 0.55, p < 0.05). In the mediating model, RBP4 levels mediated completely the relationship between PSQI scores and IR levels (ß = 0.29, p < 0.0001). The indirect effect of RBP4 in the relation between sleep quality and IR explained 89.10% of total effect. CONCLUSIONS: RPB4 may play a complete mediating role in the relation between sleep quality and insulin resistance in early pregnancy. Improvements in sleep quality in the first trimester may provide a pathway to reduce plasma RBP4, which is beneficial for less IR and GDM prevention.


Assuntos
Resistência à Insulina/fisiologia , Primeiro Trimestre da Gravidez/fisiologia , Proteínas Plasmáticas de Ligação ao Retinol/metabolismo , Sono/fisiologia , Adulto , Estudos Transversais , Diabetes Gestacional/sangue , Diabetes Gestacional/prevenção & controle , Feminino , Humanos , Gravidez/metabolismo , Primeiro Trimestre da Gravidez/sangue , Gestantes , Proteínas Plasmáticas de Ligação ao Retinol/fisiologia , Adulto Jovem
6.
Diabetes Res Clin Pract ; 176: 108868, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34023341

RESUMO

AIMS: To assess whether early pregnancy HbA1c can predict gestational diabetes mellitus (GDM) and adverse birth outcomes in Australian women. METHODS: Prospective study of 466 women without diabetes, aged ≥16-years at first antenatal presentation. Recruitment was from 27 primary healthcare sites in rural and remote Australia from 9-January 2015 to 31-May 2018. HbA1c was measured with first antenatal investigations (<20-weeks gestation). Primary outcome measure was predictive value of HbA1c for GDM, by routine 75 g oral glucose tolerance test (OGTT; ≥24-weeks gestation), and for large-for-gestational-age (LGA) newborn. RESULTS: Of 396 (129 Aboriginal) women with routine OGTT, 28.8% had GDM (24.0% Aboriginal). HbA1c ≥5.6% (≥38 mmol/mol) was highly predictive (71.4%, 95% CI; 47.8-88.7%) for GDM in Aboriginal women, and in the total cohort increased risk for LGA newborn (RR 2.04, 95% CI; 1.03-4.01, P = 0.040). There were clear differences between Aboriginal and non-Aboriginal women: 16.3% v 5.2% (P < 0.001) had elevated HbA1c whereas 12.4% v 29.6% (P < 0.001) developed hyperglycemia during pregnancy. CONCLUSIONS: Early pregnancy HbA1c ≥5.6% (≥38 mmol/mol) identifies Aboriginal women with apparent prediabetes and elevated risk of having an LGA newborn. Universal HbA1c at first antenatal presentation could facilitate earlier management of hyperglycemia and improved perinatal outcome in this high-risk population.


Assuntos
Diabetes Gestacional/diagnóstico , Hemoglobina A Glicada/análise , Grupo com Ancestrais Oceânicos , Estado Pré-Diabético/diagnóstico , Resultado da Gravidez , Adolescente , Adulto , Austrália/etnologia , Estudos de Coortes , Diabetes Gestacional/sangue , Diabetes Gestacional/etnologia , Diabetes Gestacional/etiologia , Feminino , Idade Gestacional , Teste de Tolerância a Glucose , Hemoglobina A Glicada/metabolismo , Humanos , Recém-Nascido , Masculino , Grupo com Ancestrais Oceânicos/etnologia , Estado Pré-Diabético/sangue , Estado Pré-Diabético/complicações , Estado Pré-Diabético/etnologia , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/etnologia , Resultado da Gravidez/etnologia , Primeiro Trimestre da Gravidez/sangue , Prognóstico , Estudos Prospectivos , Fatores de Risco , Adulto Jovem
7.
BMC Pregnancy Childbirth ; 21(1): 298, 2021 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-33849467

RESUMO

BACKGROUND: Improvement in the accuracy of identifying women who are at risk to develop gestational diabetes mellitus (GDM) is warranted, since timely diagnosis and treatment improves the outcomes of this common pregnancy disorder. Although prognostic models for GDM are externally validated and outperform current risk factor based selective approaches, there is little known about the impact of such models in day-to-day obstetric care. METHODS: A prognostic model was implemented as a directive clinical prediction rule, classifying women as low- or high-risk for GDM, with subsequent distinctive care pathways including selective midpregnancy testing for GDM in high-risk women in a prospective multicenter birth cohort comprising 1073 pregnant women without pre-existing diabetes and 60 obstetric healthcare professionals included in nine independent midwifery practices and three hospitals in the Netherlands (effectiveness-implementation hybrid type 2 study). Model performance (c-statistic) and implementation outcomes (acceptability, adoption, appropriateness, feasibility, fidelity, penetration, sustainability) were evaluated after 6 months by indicators and implementation instruments (NoMAD; MIDI). RESULTS: The adherence to the prognostic model (c-statistic 0.85 (95%CI 0.81-0.90)) was 95% (n = 1021). Healthcare professionals scored 3.7 (IQR 3.3-4.0) on implementation instruments on a 5-point Likert scale. Important facilitators were knowledge, willingness and confidence to use the model, client cooperation and opportunities for reconfiguration. Identified barriers mostly related to operational and organizational issues. Regardless of risk-status, pregnant women appreciated first-trimester information on GDM risk-status and lifestyle advice to achieve risk reduction, respectively 89% (n = 556) and 90% (n = 564)). CONCLUSIONS: The prognostic model was successfully implemented and well received by healthcare professionals and pregnant women. Prognostic models should be recommended for adoption in guidelines.


Assuntos
Diabetes Gestacional/prevenção & controle , Fidelidade a Diretrizes/estatística & dados numéricos , Programas de Rastreamento/organização & administração , Modelos Estatísticos , Primeiro Trimestre da Gravidez/sangue , Adulto , Glicemia/análise , Diabetes Gestacional/sangue , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Estudos de Viabilidade , Feminino , Seguimentos , Implementação de Plano de Saúde , Estilo de Vida Saudável , Humanos , Programas de Rastreamento/normas , Anamnese , Pessoa de Meia-Idade , Países Baixos , Guias de Prática Clínica como Assunto , Gravidez , Prognóstico , Estudos Prospectivos , Medição de Risco/métodos , Fatores de Risco
8.
Psychoneuroendocrinology ; 128: 105210, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33866067

RESUMO

BACKGROUND: The outbreak of COVID-19 epidemic has induced entire cities in China placed under 'mass quarantine'. The majority of pregnant women have to be confined at home may be more vulnerable to stressors. In our study, we aimed to explore the effects of the epidemic on maternal thyroid function, so as to provide evidence for prevention and intervention of sustained maternal and offspring's health impairment produced by thyroid dysfunction. METHODS: The subjects were selected from an ongoing prospective cohort study. we included the pregnant women who receive a thyroid function test during the COVID-19 epidemic and those receiving the test during the corresponding lunar period of 2019. A total of 7148 pregnant women with complete information were included in the final analysis. Multivariate linear and logistic regression models were used for analyzing the association of COVID-19 pandemic with FT4 levels and isolated hypothyroxinemia. RESULTS: We found a decreased maternal FT4 level during the period of the COVID-19 pandemic in first and second trimesters (ß = -0. 131, 95%CI = -0.257,-0.006,p = 0.040) and in first trimester (ß = -0. 0.176, 95%CI = -0.326,-0.026,p = 0.022) when adjusting for 25 (OH) vitamin D, vitamin B12, folate and ferritin and gestational days, maternal socio-demographic characteristics and health conditions. The status of pandemic increased the risks of isolated hypothyroxinemia in first and second trimesters (OR = 1.547, 95%CI = 1.251,1.913, p < 0.001) and first trimester (OR = 1.651, 95%CI = 1.289,2.114, p < 0.001) when adjusting for the covariates. However, these associations disappeared in the women with positive TPOAb (p > 0.05). Additionally, we found associations between daily reported new case of COVID-19 and maternal FT4 for single-day lag1, lag3 and multi-day lag01 and lag04 when adjusting for the covariates (each p < 0.05). CONCLUSIONS: Mass confinement as a primary community control strategy may have a significant cost to public health resources. Access to health service systems and adequate medical resources should be improved for pregnant women during the COVID-19 pandemic.


Assuntos
COVID-19/prevenção & controle , Complicações na Gravidez/sangue , Quarentena , Doenças da Glândula Tireoide/sangue , Tiroxina/sangue , Adulto , China/epidemiologia , Feminino , Humanos , Gravidez , Complicações na Gravidez/epidemiologia , Primeiro Trimestre da Gravidez/sangue , Segundo Trimestre da Gravidez/sangue , Estudos Prospectivos , Quarentena/estatística & dados numéricos , Doenças da Glândula Tireoide/epidemiologia
9.
Nutrients ; 13(3)2021 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-33799943

RESUMO

Iodine is an essential micronutrient for the synthesis of thyroid hormones. The proper functioning of the thyroid axis is essential for the normal development of the nervous system, especially in the first trimester of gestation. The aim of the present study was to analyze the perinatal outcomes, anthropometry, and APGAR test scores of newborns and to relate them to maternal thyroid status. A total of 190 newborns participated in the study. No correlation was found between thyroid stimulating hormone (TSH) and maternal ioduria values in the first trimester of gestation with the weight or length of the newborn, or the APGAR score at one minute after birth. However, we found significant differences between the APGAR scores of children whose mothers had an iodine sufficiency level in the first trimester compared to the children of mothers with iodine deficiency. Similarly, the APGAR scores of children whose mothers had a TSH > 4 have significantly better APGAR scores than the children of mothers with a TSH < 4. Likewise, we found significant differences between the measurements of the newborns depending on whether their mothers smoked. The children of mothers who took iodine supplements or iodized salt obtained the highest APGAR score at one and five minutes after birth. It is essential to focus on recommending adequate consumption of iodine supplements and iodized salt prior to gestation and at least during the first trimester to achieve better fetal well-being.


Assuntos
Iodo/análise , Resultado da Gravidez , Primeiro Trimestre da Gravidez/sangue , Primeiro Trimestre da Gravidez/urina , Tireotropina/sangue , Adulto , Antropometria , Índice de Apgar , Suplementos Nutricionais/estatística & dados numéricos , Feminino , Humanos , Hipotireoidismo/sangue , Hipotireoidismo/urina , Recém-Nascido , Iodo/deficiência , Iodo/urina , Fenômenos Fisiológicos da Nutrição Materna , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/urina , Cuidado Pré-Natal/estatística & dados numéricos , Cloreto de Sódio na Dieta/análise , Glândula Tireoide/fisiopatologia
10.
Gynecol Obstet Invest ; 86(1-2): 193-199, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33906193

RESUMO

BACKGROUND: Inflammatory response state is related to the pathogenesis of gestational diabetes mellitus (GDM). OBJECTIVE: To investigate the changes of serum sex hormone-binding globulin (SHBG), homocysteine (Hcy), and hypersensitive CRP (hs-CRP) levels during pregnancy and their relationship with GDM. METHODS: The nested case-control study method was used. Sixty nonobese single pregnant women diagnosed with GDM were divided into the GDM group (GDM, n = 60), together with another 60 pregnant women with normal glucose tolerance who were matched in the same period and divided into the control group (control, n = 60). The serum Hcy, hs-CRP, and SHBG levels were measured. RESULTS: The serum levels of Hcy and hs-CRP were significantly higher in the GDM group compared with the control group, and serum levels of SHBG was significantly lower in the GDM group compared with the control group at different stages of pregnancy. The serum levels of Hcy and hs-CRP in pregnant women increased with the increase of gestational age, and serum levels of SHBG decreased with the increase of gestational age. Increased Hcy and hs-CRP levels in the second trimester and decreased SHBG levels in the first trimester were related to GDM. The odds ratio (OR) and 95% confidence interval (CI) were as follows: OR: 4.5, 95% CI: 1.5-13.0; OR: 4.2, 95% CI: 1.5-10.1; and OR: 0.4, 95% CI: 0.3-0.7, respectively. CONCLUSION: Increased Hcy and hs-CRP in the second trimester and decreased SHBG in the first trimester were independent predictors of GDM, which provides a new idea for early prevention and treatment of GDM.


Assuntos
Proteína C-Reativa/análise , Diabetes Gestacional/sangue , Homocisteína/sangue , Globulina de Ligação a Hormônio Sexual/análise , Adulto , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Idade Gestacional , Humanos , Gravidez , Primeiro Trimestre da Gravidez/sangue , Segundo Trimestre da Gravidez/sangue
11.
An. sist. sanit. Navar ; 44(1): 23-31, ene.-abr. 2021. tab, graf
Artigo em Inglês | IBECS | ID: ibc-201844

RESUMO

BACKGROUND: To investigate the value of a single determination of hyperglycosylated hCG (hCG-H) for predicting the clinical outcome of patients with threatened abortion in the first trimester of pregnancy. METHODS: Prospective study performed on 86 consecutively selected women with a diagnosis of threatened abortion and viable intrauterine pregnancy in the first trimester of pregnancy, conducted in two tertiary care hospitals. All patients underwent a single blood sample to determine hCG-H and total hCG serum levels and a transvaginal ultra-sound 12-24 hours after diagnosis. Patients were monitored to determine whether the outcome was a miscarriage before the 20th week of pregnancy. RESULTS: Forty-three women (50%) had a miscarriage during the follow-up. We observed a very high correlation between hCG-H and total hCG (r = 0.91, p < 0.001). Median hCG-H and total hCG from pregnancies with normal outcome was significantly higher than those ending in abortion. hCG-H and total hCG were very similar predictors of pregnancy outcomes (AUC: 0.90 and 0.89, respectively). The ratio hCG-H / total hCG was a poor predictor (AUC: 0.64). CONCLUSION: A single hCG-H assay is helpful for predicting pregnancy outcomes in women with first trimester threatened abortion and viable or potentially viable pregnancy at the time of presentation. However, hCG-H is not a better predictor than total hCG


FUNDAMENTO: Investigar el valor de una única determinación de hCG hiperglicosilada (hCG-H) para predecir el resultado clínico de pacientes con amenaza de aborto en el primer trimestre del embarazo. MÉTODOS: Estudio prospectivo realizado en 86 mujeres, seleccionadas consecutivamente, con diagnóstico de amenaza de aborto y embarazo intrauterino viable en el primer trimestre de embarazo, realizado en dos hospitales de tercer nivel. A todas las pacientes se les realizó una única extracción sanguínea para determinar los niveles séricos de hCG-H y hCG total, y una ecografía transvaginal 12-24 horas después del episodio de sangrado. Se realizó seguimiento de las pacientes para determinar si el resultado fue un aborto espontáneo antes de la semana 20 de embarazo. RESULTADOS: Cuarenta y tres mujeres (50%) sufrieron un aborto espontáneo durante el seguimiento. Se observó una correlación muy alta entre hCG-H y hCG total (r = 0,91, p < 0,001). La mediana de hCG-H y hCG total de los embarazos con resultado normal fue significativamente mayor que la de aquellos que terminaron en aborto. La hCG-H y la hCG total fueron predictores muy similares del resultado del embarazo (AUC: 0,90 y 0,89, respectivamente). La relación hCG-H / hCG total fue un mal predictor (AUC: 0,64). CONCLUSIÓN: La determinación única de hCG-H es útil para predecir el resultado del embarazo en mujeres con amenaza de aborto en el primer trimestre y embarazo viable en el momento de la presentación clínica. Sin embargo, la hCG-H no es mejor predictor que la hCG total


Assuntos
Humanos , Feminino , Gravidez , Adulto , Valor Preditivo dos Testes , Ameaça de Aborto/sangue , Primeiro Trimestre da Gravidez/sangue , Receptores do LH/sangue , Aborto Espontâneo/diagnóstico , Ameaça de Aborto/diagnóstico , Receptores do LH/análise , Aborto Espontâneo/sangue , Estudos Prospectivos , Idade Gestacional , Curva ROC
12.
Diabetes Res Clin Pract ; 174: 108736, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33705819

RESUMO

AIMS: To evaluate the importance and usefulness of fasting plasma glucose (FPG) in the first trimester in predicting adverse pregnancy outcomes. METHODS: A retrospective study of 22,398 singleton pregnancies was conducted. Participants were divided into subgroups according to first-trimester FPG (low FPG, FPG < 5.1 mmol/L; medium FPG, 5.1 mmol/L ≤ FPG < 5.6 mmol/L; high FPG, 5.6 ≤ FPG < 7.0 mmol/L) and oral glucose tolerance test(OGTT) results (normal and abnormal) during pregnancy. Patient characteristics and risk of adverse pregnancy outcomes were compared. Then, the whole population of women with abnormal OGTT served as a reference, and the relative risks of maternal and neonatal complications in normal OGTT women were analyzed by categorical analyses and logistic regression. Subgroup analyses were performed according to pre-pregnancy body mass index (BMI). RESULTS: The frequency of adverse pregnancy outcomes increased with increasing FPG levels during the first trimester, regardless of OGTT results. High FPG + Abnormal OGTT had the worst outcome. Compared to the whole population of women with abnormal OGTT, Normal OGTT + Medium FPG showed the same risk of PIH and macrosomia. Normal OGTT + High FPG showed the same risk of PIH, macrosomia as well as LGA and preterm birth. Additionally, Normal OGTT + Medium FPG + BMI ≥ 24 kg/m2 showed significantly higher risk of PIH (OR = 1.867, 1.245-2.800), macrosomia (OR = 1.748, 1.304-2.344) and LGA (OR = 1.274, 1.019-1.593). Furthermore, the OR value for PIH was 3.759 (1.680-8.412) in Normal OGTT + High FPG + BMI ≥ 24 kg/m2 compared to women with abnormal OGTT. CONCLUSIONS: First-trimester FPG values can help identify women at increased risk for adverse pregnancy outcomes. Increased attention and management should be given to women with early pregnancy FPG ≥ 5.10 mmol/L despite a normal OGTT, especially if their BMI ≥ 24 kg/m2.


Assuntos
Glicemia/metabolismo , Diabetes Gestacional/epidemiologia , Jejum/sangue , Teste de Tolerância a Glucose/métodos , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Primeiro Trimestre da Gravidez/sangue , Adulto , Feminino , Humanos , Recém-Nascido , Gravidez , Estudos Retrospectivos
13.
Ann Clin Lab Sci ; 51(1): 97-101, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33653786

RESUMO

OBJECTIVE: There are few published researches on blood groups, hematological parameters [hemoglobin, red cell distribution width (RDW), white blood cells (WBCs), mean platelets volume (MPV)] and gestational diabetes mellitus (GDM). The aim of this study was to investigate the association of haematological indices with GDM in early pregnancy. METHODS: The study was carried out at Saad Abuelela Hospital (Khartoum, Sudan) during March-November of 2018. Pregnant Sudanese women in early pregnancy (gestational age <14 weeks) were enrolled in the study. The details of the medical and obstetrics history were recorded. The women were then followed up until 24-28 weeks of gestation when a 75-gram oral glucose tolerance test was performed. RESULTS: Two hundred and fifty-three women at 10.2 week of gestational age completed the follow-up. The mean (SD) of the age and gravidity at the initial antenatal visit were 28.03 (5.6) years, 2.32 (2.41). The mean (SD) of body mass index (BMI) was 27.28 (24.41-30.80) kg/m2. Fifty women (19.8%) had GDM. Age, parity, BMI, place of residence, employment and education were not significantly different between the two groups. Moreover, there was no significant difference in the blood groups and hematological parameters between women with and without GDM. CONCLUSION: In this study, the blood groups and other hematological parameters were not different between women with and without GDM.


Assuntos
Antígenos de Grupos Sanguíneos/análise , Diabetes Gestacional/sangue , Diabetes Gestacional/metabolismo , Sistema ABO de Grupos Sanguíneos/genética , Sistema ABO de Grupos Sanguíneos/metabolismo , Adulto , Glicemia , Antígenos de Grupos Sanguíneos/genética , Antígenos de Grupos Sanguíneos/metabolismo , Índice de Massa Corporal , Jejum/sangue , Feminino , Idade Gestacional , Teste de Tolerância a Glucose , Testes Hematológicos/métodos , Humanos , Gravidez , Primeiro Trimestre da Gravidez/sangue , Fatores de Risco , Sudão
14.
J Clin Endocrinol Metab ; 106(5): 1427-1436, 2021 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-33524128

RESUMO

CONTEXT: Maternal oxidative stress in pregnancy can arise through a multitude of sources and may have lifelong consequences for the child. Animal studies suggest that prenatal oxidative stress may contribute to metabolic dysfunction and excessive weight gain in the offspring. However, this relationship has been studied minimally in humans. OBJECTIVE: Determine the association between prenatal oxidative stress biomarkers and child weight and body mass index (BMI) z-scores from birth to age 6. METHODS: Within The Infant Development and the Environment Study (TIDES) prospective pregnancy cohort, we calculated age- and sex-specific Z-scores for child weight and BMI, measured between birth and age 6 (N = 736). Three oxidative stress biomarkers were quantified in third-trimester urine, including 8-iso-prostaglandin F2α (8-iso-PGF2α), its primary metabolite, and prostaglandin F2α (PGF2α). We examined associations between each biomarker and Z-scores using linear regression as well as group-based trajectory modeling. RESULTS: Prenatal 8-iso-PGF2α and its metabolite were associated with lower birth weight and higher weight at age 4. For example, an ln-unit increase in 8-iso-PGF2α was associated with 0.17 SD higher weight at age 4 (95% CI 0.01, 0.33). These biomarkers were also associated with higher BMI at age 4. Finally, within 4 unique weight trajectories (low, normal, high, and low-high), children of mothers with higher 8-iso-PGF2α were 2.56 times more likely (95% CI 1.22, 5.41) to be in the low-high trajectory than children in the normal group. CONCLUSION: We observed associations between third-trimester oxidative stress and lower birth weight as well as higher early childhood weight and BMI. These findings have important implications for understanding the developmental origins of childhood weight gain and metabolic disease.


Assuntos
Desenvolvimento Infantil/fisiologia , Estresse Oxidativo/fisiologia , Gravidez/sangue , Adulto , Biomarcadores/sangue , Trajetória do Peso do Corpo , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Mães , Oxirredução , Primeiro Trimestre da Gravidez/sangue , Efeitos Tardios da Exposição Pré-Natal/sangue , Efeitos Tardios da Exposição Pré-Natal/metabolismo , Estados Unidos
15.
Dis Markers ; 2021: 8862494, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33552314

RESUMO

Objective: To examine differences in maternal serum levels of adipokines (adiponectin, leptin, and resistin) and inflammatory markers (tumor necrosis factor-alpha (TNF-α) and interlukin-6 (IL-6)) from early to midpregnancy among Arab women with or without gestational diabetes mellitus (GDM), along with their links to GDM risk. Methods: This is a multicenter prospective study involving 232 Saudi women attending obstetric care. Both circulating adipokine and markers of inflammation were observed at the first (eight to 12 weeks) and second trimesters (24 to 28 weeks). GDM was screened at 24 to 28 weeks using the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria. Results: Age and body mass index- (BMI-) matched circulating TNF-α was significantly higher in women with GDM in comparison to non-GDM women (p = 0.01). Adiponectin and resistin significantly decreased from the first to second trimester in women without GDM (p = 0.002 and 0.026, respectively). Leptin presented a significant rise from the first to second trimester in both groups, with a higher increase in women with GDM (p = 0.013). Multivariate logistic regression analysis revealed that TNF-α was significantly correlated with GDM (p = 0.03). However, significance was lost after adjustments for maternal and lifestyle risk factors (OR 23.58 (0.50 to 1119.98), p = 0.11). Conclusion: Inflammatory and adipocytokine profiles are altered in Arab women with GDM, TNF-α in particular. Further studies are needed to establish whether maternal inflammatory and adipocytokine profile influence fetal levels in the same manner.


Assuntos
Adipocinas/sangue , Diabetes Gestacional/sangue , Interleucina-6/sangue , Fator de Necrose Tumoral alfa/sangue , Adulto , Árabes , Biomarcadores/sangue , Feminino , Humanos , Gravidez , Primeiro Trimestre da Gravidez/sangue , Segundo Trimestre da Gravidez/sangue
16.
Nutrients ; 13(2)2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33572898

RESUMO

Although adequate vitamin D status during pregnancy is essential for maternal health and to prevent adverse pregnancy outcomes, limited data exist on vitamin D status and associated risk factors in pregnant rural Bangladeshi women. This study determined the prevalence of vitamin D deficiency and insufficiency, and identified associated risk factors, among these women. A total of 515 pregnant women from rural Bangladesh, gestational age ≤ 20 weeks, participated in this cross-sectional study. A separate logistic regression analysis was applied to determine the risk factors of vitamin D deficiency and insufficiency. Overall, 17.3% of the pregnant women had vitamin D deficiency [serum 25(OH)D concentration <30.0 nmol/L], and 47.2% had vitamin D insufficiency [serum 25(OH)D concentration between 30-<50 nmol/L]. The risk of vitamin D insufficiency was significantly higher among nulliparous pregnant women (OR: 2.72; 95% CI: 1.75-4.23), those in their first trimester (OR: 2.68; 95% CI: 1.39-5.19), anaemic women (OR: 1.53; 95% CI: 0.99-2.35; p = 0.056) and women whose husbands are farmers (OR: 2.06; 95% CI: 1.22-3.50). The risk of vitamin deficiency was significantly higher among younger pregnant women (<25 years; OR: 2.12; 95% CI: 1.06-4.21), nulliparous women (OR: 2.65; 95% CI: 1.34-5.25), women in their first trimester (OR: 2.55; 95% CI: 1.12-5.79) and those with sub-optimal vitamin A status (OR: 2.30; 95% CI: 1.28-4.11). In conclusion, hypovitaminosis D is highly prevalent among pregnant rural Bangladeshi women. Parity and gestational age are the common risk factors of vitamin D deficiency and insufficiency. A husband's occupation and anaemia status might be important predictors of vitamin D insufficiency, while younger age and sub-optimal vitamin A status are risk factors for vitamin D deficiency in this population.


Assuntos
Complicações na Gravidez/epidemiologia , Cuidado Pré-Natal/estatística & dados numéricos , Deficiência de Vitamina D/epidemiologia , Adulto , Bangladesh/epidemiologia , Estudos Transversais , Dieta/efeitos adversos , Dieta/estatística & dados numéricos , Emprego/estatística & dados numéricos , Feminino , Idade Gestacional , Humanos , Modelos Logísticos , Estado Nutricional , Paridade , Gravidez , Complicações na Gravidez/etiologia , Primeiro Trimestre da Gravidez/sangue , Prevalência , Fatores de Risco , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , Cônjuges/estatística & dados numéricos , Vitamina D/análogos & derivados , Vitamina D/sangue , Deficiência de Vitamina D/etiologia , Adulto Jovem
17.
Arch Gynecol Obstet ; 303(3): 645-652, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33515274

RESUMO

PURPOSE: Our objective of this study was to investigate whether first trimester serum pregnancy-associated plasma protein-A (PAPP-A) differed amongst pregnancies with placenta previa-accreta and non-adherent placenta previa and healthy pregnancies by a retrospective cohort analysis. METHODS: A total of 177 pregnant females were included in the study, as follows: 35 cases of placenta previa-accreta, 30 cases of non-adherent placenta previa, and 112 cases of BMI and age matched, healthy pregnant controls. PAPP-A multiples of the median (MoM) were acquired from laboratory data files in 1 January 2017-30 September 2019. The probable maternal serum biochemical predictor of placenta accreta was analyzed by using multiple logistic regression analysis. RESULTS: PAPP-A MoM of placenta previa-accreta group was significantly higher than those of the non-adherent placenta previa group and control group (p = 0.009 < 0.05, p < 0.001). Serum PAPP-A was found to be significantly positively associated with placenta accreta after adjusted gestational week at time of blood sampling, BMI, age, smoking, and previous cesarean section history (OR: 3.51; 95% CI: 1.77-6.94; p = 0.0003 < 0.05). In addition, smoking (OR: 9.17; 95% CI: 1.69-49.62; p = 0.010 < 0.05) and previous cesarean section history (OR: 2.75; 95% CI: 1.23-6.17; p = 0.014 < 0.05) were also significantly associated with placenta accreta. CONCLUSION: Increased first trimester serum PAPP-A was significantly positively associated with placenta accreta, suggesting that the potential role of PAPP-A in identifying pregnancies at high risk for placenta accreta. Smoking and previous cesarean section history may be the risk factors for accreta in placenta previa patients.


Assuntos
Placenta Acreta/sangue , Placenta Prévia/sangue , Primeiro Trimestre da Gravidez/sangue , Proteína Plasmática A Associada à Gravidez/análise , Adulto , Cesárea , Feminino , Idade Gestacional , Humanos , Gravidez , Proteína Plasmática A Associada à Gravidez/metabolismo , Estudos Retrospectivos , Fatores de Risco
18.
Nutrients ; 13(2)2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33499257

RESUMO

An optimal fatty acid (FA) profile during pregnancy, especially docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), is essential for the health of the mother and child. Our aim was to identify the socioeconomic and maternal lifestyle factors associated with serum FA concentration in pregnant women. A longitudinal study was conducted on 479 pregnant women, who were assessed during the first (T1) and third (T3) trimesters of pregnancy. Data on maternal characteristics, food consumption, and lifestyle were collected. Serum FA concentrations were analysed by a gas chromatography-mass spectrometry combination. The multiple linear regression showed that high educational level and older age were significantly associated with higher EPA and DHA concentrations and lower values of n-6/n-3 and arachidonic acid (AA)/EPA in T1 and/or T3. Regarding diet-fish and seafood consumption increased EPA concentration and reduced n-6/n-3 and AA/EPA values in both trimesters, whereas its consumption increased DHA concentration only in T1. Smoking was associated with lower DHA concentration in T1 and higher values of n-6/n-3 ratio in both trimester. Overweight and obesity were associated with higher values of n-6/n-3 ratio and AA/EPA ratio in T1. A statistically non-significant association was observed with saturated fatty acids (SFA) and monounsaturated fatty acids (MUFA). In conclusion, high educational levels, older age, fish, seafood consumption, and/or non-smoking, are factors that influence better omega-3 polyunsaturated fatty acid (n-3 PUFA) profile in both trimesters of pregnancy. Further research is needed to go in-depth into these findings and their health consequences.


Assuntos
Ácidos Docosa-Hexaenoicos/sangue , Ácido Eicosapentaenoico/análogos & derivados , Ácidos Graxos Ômega-3/sangue , Obesidade/sangue , Adulto , Fatores Etários , Escolaridade , Ácido Eicosapentaenoico/sangue , Ácidos Graxos Ômega-6/sangue , Feminino , Humanos , Estilo de Vida , Modelos Lineares , Estudos Longitudinais , Gravidez , Primeiro Trimestre da Gravidez/sangue , Terceiro Trimestre da Gravidez/sangue , Estudos Prospectivos , Alimentos Marinhos , Fumar , Espanha
19.
Int J Mol Sci ; 22(2)2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429954

RESUMO

Previous studies have described increased circulating cell-free DNA (cfDNA) in hypertensive disorders of pregnancy (HDP). Here, we aimed first to confirm this information using a simple, but sensible fluorescent assay, and second to investigate whether total cfDNA is associated with circulating factors known to be linked to the pathophysiology of HDP as well as with poor maternal-fetal outcomes. We studied 98 women with healthy pregnancies (HP), 88 with gestational hypertension (GH), and 91 with preeclampsia (PE). Total DNA was extracted from plasma using the QIAamp DNA blood mini kit and quantified using Quant-iT™ PicoGreen® dsDNA fluorescent detection kit. We found higher total cfDNA levels in GH and PE (197.0 and 174.2 ng/mL, respectively) than in HP (140.5 ng/mL; both p < 0.0001). Interestingly, total cfDNA levels were elevated in both male and female-bearing pregnancies diagnosed with either HDP, and in more severe versus less severe HDP cases, as classified according to responsiveness to antihypertensive therapy. In addition, total cfDNA was independently associated with HDP, and a cutoff concentration of 160 ng/mL provided appropriate sensitivity and specificity values for diagnosing GH and PE compared to HP (70-85%, both p < 0.0001). Moreover, high total cfDNA was associated with adverse clinical outcomes (high blood pressure, low platelet count, preterm delivery, fetal growth restriction) and high prohypertensive factors (sFLT-1, sEndoglin, MMP-2). These findings represent a step towards to the establishment of cfDNA as a diagnostic tool and the need to understand its role in HDP.


Assuntos
Ácidos Nucleicos Livres/sangue , DNA/sangue , Hipertensão Induzida pela Gravidez/sangue , Hipertensão/sangue , Adulto , Endoglina/sangue , Feminino , Retardo do Crescimento Fetal/sangue , Retardo do Crescimento Fetal/patologia , Humanos , Hipertensão/patologia , Hipertensão Induzida pela Gravidez/patologia , Metaloproteinase 2 da Matriz/sangue , Pré-Eclâmpsia/sangue , Pré-Eclâmpsia/patologia , Gravidez , Primeiro Trimestre da Gravidez/sangue , Nascimento Prematuro/sangue , Nascimento Prematuro/patologia , Receptor 1 de Fatores de Crescimento do Endotélio Vascular/sangue
20.
Br J Nutr ; 125(1): 71-78, 2021 01 14.
Artigo em Inglês | MEDLINE | ID: mdl-32660679

RESUMO

The present study reports on first-trimester reference ranges of plasma mineral Se/Zn/Cu concentration in relation to free thyroxine (FT4), thyrotropin (TSH) and thyroid peroxidase antibodies (TPO-Ab), assessed at 12 weeks' gestation in 2041 pregnant women, including 544 women not taking supplements containing Se/Zn/Cu. The reference range (2·5th-97·5th percentiles) in these 544 women was 0·72-1·25 µmol/l for Se, 17·15-35·98 µmol/l for Cu and 9·57-16·41 µmol/l for Zn. These women had significantly lower mean plasma Se concentration (0·94 (sd 0·12) µmol/l) than those (n 1479) taking Se/Zn/Cu supplements (1·03 (sd 0·14) µmol/l; P < 0·001), while the mean Cu (26·25 µmol/l) and Zn (12·55 µmol/l) concentrations were almost identical in these sub-groups. Women with hypothyroxinaemia (FT4 below reference range with normal TSH) had significantly lower plasma Zn concentrations than euthyroid women. After adjusting for covariates including supplement intake, plasma Se (negatively), Zn and Cu (positively) concentrations were significantly related to logFT4; Se and Cu (but not Zn) were positively and significantly related to logTSH. Women taking additional Se/Zn/Cu supplements were 1·46 (95 % CI 1·09, 2·04) times less likely to have elevated titres of TPO-Ab at 12 weeks of gestation. We conclude that first-trimester Se reference ranges are influenced by Se-supplement intake, while Cu and Zn ranges are not. Plasma mineral Se/Zn/Cu concentrations are associated with thyroid FT4 and TSH concentrations. Se/Zn/Cu supplement intake affects TPO-Ab status. Future research should focus on the impact of trace mineral status during gestation on thyroid function.


Assuntos
Cobre/sangue , Primeiro Trimestre da Gravidez/sangue , Selênio/sangue , Hormônios Tireóideos/sangue , Oligoelementos/sangue , Zinco/sangue , Adulto , Suplementos Nutricionais/estatística & dados numéricos , Feminino , Humanos , Gravidez , Complicações na Gravidez/sangue , Valores de Referência , Doenças da Glândula Tireoide/sangue , Testes de Função Tireóidea
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