A Study of Maternal and Umbilical Cord Blood Lead Levels in Pregnant Women.

Lead is a highly toxic element which can cross the placental barrier and enter the fetus during pregnancy. Parental lead exposure has adverse effect on infant as well as on maternal health. As part of our program to investigate the lead poisoning in human population we investigated the maternal blood lead levels (MBLL) and umbilical cord blood lead (UBLL) levels in 200 pregnant women and collected their socio-demographic details. In the study we found high lead levels in both maternal and umbilical cord blood samples. The results showed 47.5% maternal blood (n = 95) detected with lead while 38.5% umbilical cord blood (n = 77) samples had lead concentration higher than that of reference range of ≤ 5 µg/dL. We also found that the Spearman's correlation coefficient (rs) revealed a strong positive correlation between the MBLL and UBLL (rs = 0.63). The results from socio-demographic questionnaire demonstrated that the recent home painting (p = 0.002) and residing close proximity to traffic congestion (p = 0.05) were significantly associated with MBLL. Education, mother age, fuel and water sources were not significantly associated with MBLL. Iron and calcium deficiency along with tiredness, lethargy, abdominal pain were also reported in women having high lead level > 5 µg/dL. Concludingly, on the basis of results obtained it may be stated that we found elevated BLLs in both pregnant women as well as in umbilical cord blood. The prevalence of elevated lead levels in mothers will expose the fetus to lead through placental barriers mobilization and it can have long term adverse effects on the developing fetus. Therefore, it is recommended that screening of blood lead levels be carried out in high-risk women based on their social, occupational, environmental, and individual factors. In addition, stringent regulations on lead-based products are also required from government agencies/authorities to reduce environmental lead burden and toxicity. Moreover, public awareness programs should be organized on hazardous effect of lead.

Comparison of the levels of 25(OH) vitamin D3 in women with gestational diabetes mellitus and normoglycemic pregnant women.

INTRODUCTION: Gestational diabetes mellitus (GDM) is a public health problem that currently affects a large part of the female population and has short- and long-term consequences for the fetus and the mother. It has been reported that GDM affects 1%-14% of all pregnancies, and that its incidence has been steadily rising. In recent years while exploring the etiological factors responsible for the emergence of insulin resistance particularly that of transient nature, vitamin D has emerged as one of the possible factors. Although systematic review and metaanalysis of observational studies show that low blood vitamin D level during pregnancy is associated with 1.8 times higher odds of GDM as compared to those having normal blood vitamin D levels; however, individual observational studies about maternal vitamin D status and risk of GDM are conflicting, The aim of this study is to compare the levels of 25(OH) vitamin D in women with gestational diabetes mellitus and normoglycemic pregnant women to assess the pathogenic role of vitamin D in the causation of GDM. MATERIALS AND METHODS: This study was conducted in the Department of Obstetrics and Gynecology, Era's Lucknow Medical College and Hospital (ELMCH), Lucknow from December 2018 to November 2020 The present study was an analytical case-control study, in which a total of 30 pregnant women in 24-28 weeks of gestation diagnosed as GDM using Diabetes in Pregnancy Study Group criteria were enrolled as cases while another 30 pregnant women in same gestational age range with normoglycemic profile were enrolled as controls. The 25(OH)D levels were assessed by the chemiluminecence immunoassay. The statistical analysis was performed using SPSS (Statistical Package for Social Sciences) Version 21.0. RESULTS: On multivariate analysis, vegetarian diet and GDM were found to be significantly associated with vitamin D deficiency. The present study endorsed the relationship between vitamin D deficiency and GDM and showed a high prevalence of vitamin D deficiency, and that too at severe level could result in GDM. Appropriate awareness and intervention strategies are warranted on a larger sample.

Mid-trimester glycosylated hemoglobin levels (HbA1c) and its correlation with oral glucose tolerance test (World Health Organization 1999).

AIM: The aim of the present study was to assess the role of hemoglobin A1c (HbA1c) in screening of gestational diabetes mellitus (GDM) and to compare its efficacy with 75 g oral glucose tolerance test (OGTT) (World Health Organization [WHO]) screening criteria. METHODS: A prospective observational study was performed on a total of 260 women attending antenatal outpatient department of our hospital at 24-28 weeks of gestation. All women underwent 75-g OGTT testing, and WHO 1999 criteria was used for diagnosis of GDM. Also, a HbA1c test was performed for the same women. RESULTS: Prevalence of GDM was found to be 19.6% by OGTT. Mean HbA1c values in GDM was significantly higher than non-GDM. HbA1c correlated well with both fasting and 2 h postprandial levels but there was better correlation with 2-h postprandial level. CONCLUSION: The incidence of gestational diabetes is rising in South-East Asian countries, especially in India. HBA1c could be a potential screening test for GDM.

Automated lead toxicity prediction using computational modelling framework.

Background: Lead, an environmental toxicant, accounts for 0.6% of the global burden of disease, with the highest burden in developing countries. Lead poisoning is very much preventable with adequate and timely action. Therefore, it is important to identify factors that contribute to maternal BLL and minimise them to reduce the transfer to the foetus. Literacy and awareness related to its impact are low and the clinical establishment for biological monitoring of blood lead level (BLL) is low, costly, and time-consuming. A significant contribution to an infant's BLL load is caused by maternal lead transfer during pregnancy. This acts as the first pathway to the infant's lead exposure. The social and demographic information that includes lifestyle and environmental factors are key to maternal lead exposure. Results: We propose a novel approach to build a computational model framework that can predict lead toxicity levels in maternal blood using a set of sociodemographic features. To illustrate our proposed approach, maternal data comprising socio-demographic features and blood samples from the pregnant woman is collected, analysed, and modelled. The computational model is built that learns from the maternal data and then predicts lead level in a pregnant woman using a set of questionnaires that relate to the maternal's social and demographic information as the first point of testing. The range of features identified in the built models can estimate the underlying function and provide an understanding of the toxicity level. Following feature selection methods, the 12-feature set obtained from the Boruta algorithm gave better prediction results (kNN = 76.84%, DT = 74.70%, and NN = 73.99%). Conclusion: The built prediction model can be beneficial in improving the point of care and hence reducing the cost and the risk involved. It is envisaged that in future, the proposed methodology will become a part of a screening process to assist healthcare experts at the point of evaluating the lead toxicity level in pregnant women. Women screened positive could be given a range of facilities including preliminary counselling to being referred to the health centre for further diagnosis. Steps could be taken to reduce maternal lead exposure; hence, it could also be possible to mitigate the infant's lead exposure by reducing transfer from the pregnant woman.

Genetic Variants in Interleukin-10 Gene Association with Susceptibility and Cervical Cancer Development: A Case Control Study.

Objectives Cervical cancer (CC) is one of the most destructive disease caused by persistent HPV infection which affects women worldwide, especially in developing countries. The genetic basis of host immune response especially cytokine function has been shown to influence CC susceptibility. Studies have demonstrated that IL-10 gene polymorphism have been associated with numerous malignancies, but in context to CC results were inconclusive. Though, aim of our study to investigate the association between IL-10 -1082A/G and -819C/T promoter polymorphism and CC susceptibility. Material and Methods This study comprised 192 women with CC and 200 controls. HPV detection was done by RT-PCR and genotyping was assessed through PCR-RFLP method. Serum concentration of IL-10 measured by ELISA. Results Women with AG and AG+GG genotypes of IL-10 -1082A/G had two-fold increased risk of CC [OR, 2.35 (95% CI, 1.54-3.58), p  = 0.005], [OR, 2.03 (95% CI, 1.36-3.04), p  = 0.0005] compared to controls. Women with G allele of -1082A/G polymorphism had linked with CC susceptibility [OR, 1.39 (95% CI, 1.02-1.88), p  = 0.036] compared to controls. No significant difference was found between patients and controls in the genotype or allele frequencies of IL-10 -819C/T polymorphism [OR, 1.00 (95% CI, 0.63-1.58), p  = 0.99]. The level of serum concentration of IL-10 was significantly higher in cases compared to controls. Conclusion These findings help to understand that polymorphism of IL-10 -1082A/G gene is associated with increased risk of CC development and can serve as a marker of genetic susceptibility to CC.

A rare case of giant vaginal fibromyoma.

Vaginal fibroids rarely exist as a primary vaginal tumor. Approximately 300 cases have been reported in the literature. Here we are reporting a rare case of giant vaginal fibromyoma. It was diagnosed as cervical fibroid polyp preoperatively but found to be vaginal fibromyoma peroperatively.

Abdominal pregnancy: Methods of hemorrhage control.

Abdominal pregnancy is an extremely rare form of ectopic pregnancy, mostly occurring secondarily after tubal rupture or abortion with secondary implantation anywhere in the peritoneal cavity. Massive intra-abdominal hemorrhage is a life threatening complication associated with secondary abdominal pregnancy. Various methods and techniques have been reported in the literature for controlling hemorrhage. Here, we report a case of massive intraperitoneal haemorrhage following placental removal controlled by abdominal packing and review the literature for diagnostic and management challenges.

Acquired gynatresia.

Vaginal stenosis (gynatresia) is commonly congenital, occurring as a part of Mayer-Kustner-Hauser syndrome. Those occurring postabortal or postpartum are rarely seen nowadays. Here, we report two cases, one in which there was complete stenosis postpartum following a retained gauze and another case, with chemical vaginal burns following attempted abortion by a local untrained midwife.

Thyroid Stimulatory Hormone (tsh) Reference Ranges In The Normal Pregnant Women Of Lucknow

Maternal hypothyroidism is known to be associated with adverse perinatal outcomes. This study was done to evaluate the normal reference range of TSH in pregnant women. 483 pregnant women on their first visit to Obstetrics OPD in Era's Lucknow Medical College and hospital were tested for TSH and TPO antibody using ELISA method. 25 out of 483 were positive for TPO Antibody. Of the remaining 458 patients, 142 were in first trimester, 222 were in second trimester and 94 were in third trimester. The TSH values ranged from 0.043 mIU/L to 10.1 mIU/L (mean = 2.34 mIU/L). The reference range of TSH values in all the trimesters are, 0.35 to 5.82(1st trimester), 0.28 to 5.82(2nd trimester) and 0.11 to 6.8(3rd trimester). The reference range of TSH values among the normal pregnant women of Lucknow and its surrounding areas were found to be higher than those recommended by the test kit

The Correlation Of Shape Of Yolk Sac With Spontaneous Abortion- An Ultrasonographic Study

The pregnancy is one of the most fascinating experiences which a woman undergoes in her life and of the whole, the first trimester is a vital time as the pregnancy gets established. The last menstrual period (LMP) is generally used as a landmark for pregnancy dating, and the first trimester of pregnancy is defined as 12 weeks after the LMP. The first recognizable structure inside the gestational sac is the yolk sac, which should be detectable as a regularly rounded extra-amniotic structure when the gestational sac reaches dimensions of 8 to 10 mm. In a normal pregnancy it should be possible to observe the yolk sac between 6-12 weeks of pregnancy or when it reaches 10 mm in size. Ultrasonography shows the yolk sac as a round structure that is made up of an anechoic center bordered by a regular well-defined echogenic rim. The normal shape of yolk sac is circular. The yolk sac appears at 6 weeks, thereafter increases in size, attains its maximum diameter at 10 weeks and then it starts decreasing in size. It disappears at 12 weeks. Aim and Objectives of the present study is to study the shape of yolk sac in pregnant females, in the first trimester of pregnancy and to find it's correlation with spontaneous abortion. We studied 72 pregnant females, who were in their first trimester of pregnancy, referred by Department of Obstetrics and Gynaecology. The shape of yolk sac was observed by transvaginal sonography and its correlation with spontaneous abortion was studied. Yolk sac was present in 70 cases (97.22%) and in two cases (2.78%), it was absent. In 68 (97.14%) cases the shape of yolk sack was circular. It was irregular (1.4%) and oblong (1.4%) in one case each.

Βhcg For Screening Of Gestational Hypertension : A Prospective Observational Study In North Indian Population

To measure maternal serum beta human chorionic gonadotropin during 13-24 weeks of pregnancy and compare the same between those who develop pregnancy induced hypertension with those who do not. In a prospective study βhCG levels were estimated in 75 antenatal women in the second trimester (12-24 weeks) by ELISA technique. Results were noted in terms of development of preeclampsia, mean serum levels of the marker, mode of delivery and complications. During the course of study, a total of 8 (10.7%) patients developed hypertension. Thus incidence of pregnancy induced hypertension was 10.7%. A significant rise of mean serum βhCG level (32022MIU/ml, mean)was present in those who developed preeclampsia.The marker can prove an important role in early recognition of a pregnancy related complication and provides the obstetrician ample opportunity to guide the management during pregnancy.

Pattern and determinants of breast feeding and contraceptive practices among mothers within six months postpartum.

The present study aims to determine the patterns of breast feeding, return of menstruation, and contraceptive practices in the first six months postpartum in women visiting the outpatient department at a teaching hospital in Lucknow, Northern India. Mothers of infants between six to eight months of age visiting the outpatient department of Era's Lucknow Medical College were interviewed regarding breast feeding practices, return of menstruation, sexual activity, and contraceptive practices within the first six months postpartum using a structured questionnaire. Of all women interviewed only 75.8% practiced exclusive breast feeding with the mean duration of exclusive breast feeding (EBF) being 3.5 months with only 41% practicing EBF for six months, 28% were sexually active within six weeks postpartum, 64.5% women had a return of menstruation within six months. Contraception was practiced by only 54.4% women with a barrier method such as a condom, being the most common. Better education was the only factor significantly affecting EBF (p < 0.004) and use of contraception (p < 0.027). There were a total of 10 pregnancies within six months postpartum. In conclusion, optimal breast feeding practices are poor in this part of the country and lactational amenorrhoea cannot be effectively and reliably used as a method of contraception. Therefore, optimal breast feeding practices, timely introduction of contraception and institutional delivery need to be encouraged.

Second trimester pregnancy termination with 400 µg vaginal misoprostol: efficacy and safety.

The present study was designed to evaluate the efficacy and safety of misoprostol (400 µg) given intravaginally repeated at 6 hourly intervals for a maximum of 6 doses for second-trimester pregnancy terminations. The study was conducted on women who had to undergo pregnancy termination between 13 and 26 weeks of gestation for various indications but mainly intrauterine death over a period of 2 years. A standard regime of 400 µg of misoprostol 6 hourly intravaginally was given until a maximum of 6 doses. Sixty women underwent second trimester terminations. The mean induction abortion interval was 11.8 h. The success rate at the end of 48 h was 96.6%. Side-effects were in the form of incomplete abortion, excessive blood loss, and fever. No patient had a uterus rupture. Intravaginal misoprostol 400 µg given 6 hourly seems to be an effective, safe, and acceptable method for second trimester pregnancy terminations.