First-Trimester Abdominal Adipose Tissue Thickness to Predict Gestational Diabetes.

OBJECTIVE: To estimate the discriminative capacity of first-trimester subcutaneous (SATT), visceral (VATT), and total (TATT) adipose tissue thickness in predicting gestational diabetes mellitus (GDM), including that requiring insulin. METHODS: We prospectively recruited a cohort of 1048 nulliparous women. Ultrasound images were used to determine abdominal SATT, VATT, and TATT at 11 to 14 weeks' gestation. Multivariate logistic regression models were used to predict GDM, as well as insulin-requiring GDM. Model discrimination was expressed as area under the curve (AUC). RESULTS: SATT (AUC 0.66, 95% CI 0.59-0.73), VATT (AUC 0.65, 95% CI 0.58-0.73), and TATT (AUC 0.68, 95% CI 0.61-0.76) were each associated with subsequent GDM. The respective AUC values for insulin-requiring GDM were 0.70 (95% CI 0.61-0.79), 0.73 (95% CI 0.65-0.82), and 0.76 (95% CI 0.67-0.84). At a false-positive rate of 10%, the detection rate for insulin-requiring GDM was 19% for maternal age ≥35 years, 31% for a BMI ≥31.6 kg/m2, and 31% for TATT ≥61 mm, increasing to 42% in the model comprising all three measures. CONCLUSION: First-trimester ultrasound measurement of adipose tissue is associated with a higher chance of developing GDM, especially insulin-requiring GDM.

Comparative Study of Abdominal Versus Transvaginal Ultrasound for Uterine Artery Doppler Velocimetry at 11 to 13 Weeks.

OBJECTIVES: To compare the first-trimester uterine artery pulsatility index (PI) measured by abdominal and transvaginal ultrasound (US). METHODS: We performed a prospective study of singleton pregnant women recruited at 11 to 13 weeks' gestation. The mean uterine artery PI was obtained by abdominal followed by transvaginal US. The mean of the left and right uterine artery PIs was used, and differences between approaches were computed. The intraclass correlation coefficient and a Bland-Altman plot were used to compare the two approaches. RESULTS: Data were available for 940 participants, including 928 (99%) with uterine artery PIs obtained on both uterine sides. The mean uterine artery PI decreased with gestational age in both approaches (P < .001). We observed a moderate correlation between abdominal and transvaginal mean uterine artery PIs (intraclass correlation coefficient, 0.72; 95% confidence interval, 0.69 to 0.75). Values obtained by abdominal US (median, 1.70, interquartile range, 1.35 to 2.09) were greater than those obtained by transvaginal US (median, 1.65; interquartile range, 1.37 to 1.99). There was a significant increase in differences as average measurements became higher (P < .01). CONCLUSIONS: The first-trimester mean uterine artery PI decreases with gestational age in both approaches. Abdominal US could be associated with greater uterine artery PI values than transvaginal US, especially at higher measurements. The first-trimester uterine artery PI for prediction of adverse perinatal outcomes should be adjusted for gestational age and possibly for the US approach.

Blood pressure and endothelial function in healthy, pregnant women after acute and daily consumption of flavanol-rich chocolate: a pilot, randomized controlled trial.

BACKGROUND: Several randomized clinical trials (RCTs) indicate that flavanol-rich chocolate has beneficial effects on flow-mediated dilation (FMD) and blood pressure (BP). However, no RCTs have evaluated these outcomes in pregnant women. The objective of this 2-group, parallel, double-blind RCT was to examine the effects of flavanol-rich chocolate on FMD and BP in pregnant women with normal BP. METHODS: Forty-four healthy, pregnant women were randomized to the high-flavanol (n = 23) or low-flavanol (n = 21) chocolate consumption for 12 weeks. At randomization (0, 60, 120 and 180 min after a single 40-g dose of chocolate), 6 and 12 weeks after daily 20-g chocolate intake, we evaluated plasma concentrations of flavanols and theobromine, as well as the FMD and BP. RESULTS: Plasma epicatechin was significantly increased (p < 0.001) 180 min after the consumption of 40-g high-flavanol chocolate compared to low-flavanol chocolate. Theobromine concentrations were significantly higher 180 min and 12 weeks after the intake of experimental chocolate or low-flavanol chocolate (p < 0.001). FMD was not different between the 2 groups at all pre-defined time periods. No other significant within-group or between-group changes were observed. CONCLUSION: These results confirm the feasibility of a large-scale RCT comparing daily consumption of flavanol-rich chocolate to an equivalent placebo during pregnancy and demonstrate higher plasma epicatechin and theobromine concentration in the intervention group after acute ingestion TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01659060.

A new method of positioning at delivery compared with the dorsal recumbent position: an exploratory retrospective study of obstetric outcomes.

BACKGROUND: In the last 30 years, several initiatives have aimed to reintroduce a certain freedom in positioning during labour. The objective of this study was to compare an alternative method of positioning at delivery (APOR B method) with the dorsal recumbent (supine) position. METHODS: We undertook a comparative, retrospective study of 276 singleton deliveries at ≥ 36 weeks. The APOR B method used by two general practitioners (GPs) was compared with the dorsal recumbent position used by two other GPs with similar years of experience. We assessed obstetric outcomes with logistic regression analyses. RESULTS: The study populations were similar except for more cases of induced labour (40% vs. 27%, P = 0.030) and earlier gestational age at delivery (mean ± SD 39.1 ± 1.4 vs. 39.4 ± 1.0 weeks of amenorrhea, P = 0.032) in the APOR B group (adjustment provided). Mode of delivery and perineal outcomes were similar, with 74% and 72% (P = 0.816) of spontaneous vaginal deliveries and 38% and 44% (P = 0.368) of intact perineums for APOR B and dorsal recumbent positions, respectively. Women in the APOR B group were less likely to have vaginal tears (15% vs. 28%, aOR 0.45, 95% CI 0.23 to 0.89). No differences were observed in the frequency of abnormal fetal heart rate, Apgar score < 7 at five minutes, dystocia, and blood loss. However, umbilical cord arterial pH < 7.20 was more frequent in the APOR B group (32% vs. 20%, aOR 2.0, 95% CI 1.1 to 3.8). CONCLUSION: The outcomes of the two methods of positioning at delivery were mostly equivalent, except for fewer vaginal tears and lower umbilical cord arterial pH in the APOR B group. These findings will need to be further assessed in randomized controlled trials.

Contexte : Au cours des 30 dernières années, plusieurs initiatives ont visé à permettre de nouveau un certain degré de liberté pour ce qui est du positionnement pendant le travail. Cette étude avait pour objectif de comparer une méthode non conventionnelle de positionnement au moment de l'accouchement (méthode APOR B) au décubitus dorsal (position couchée). Méthodes : Nous avons mené une étude comparative rétrospective qui portait sur 276 accouchements faisant suite à une grossesse monofœtale à ≥ 36 semaines. La méthode APOR B utilisée par deux omnipraticiens a été comparée au décubitus dorsal utilisé par deux autres omnipraticiens comptant une expérience similaire. Nous avons évalué les issues obstétricales au moyen d'analyses de régression logistique. Résultats : Les populations d'étude étaient semblables, sauf en ce qui concerne la présence d'un plus grand nombre de cas de déclenchement du travail (40 % vs 27 %, P = 0,030) et la présence d'un âge gestationnel moins avancé au moment de l'accouchement (39,1 ± 1,4 vs 39,4 ± 1,0 semaines d'aménorrhée, P = 0,032) au sein du groupe « APOR B ¼ (correction fournie). Le mode d'accouchement et les issues périnéales étaient semblables : 74 % et 72 % (P = 0,816) d'accouchements vaginaux spontanés, et 38 % et 44 % (P = 0,368) de périnées intacts au sein des groupes « APOR B ¼ et « décubitus dorsal ¼, respectivement. Les femmes du groupe « APOR B ¼ étaient moins susceptibles de subir des déchirures vaginales (15 % vs 28 %, RCc, 0,45; IC à 95 %, 0,23 - 0,89). Aucune différence n'a été constatée en ce qui concerne la prévalence des cas de fréquence cardiaque fœtale anormale, d'indice d'Apgar < 7 à cinq minutes, de dystocie et de perte sanguine. Toutefois, la présence d'un pH artériel de cordon ombilical < 7,20 était plus fréquente au sein du groupe « APOR B ¼ (32 % vs 20 %, RCc, 2,0; IC à 95 %, 1,1 - 3,8). Conclusion : Les issues des deux méthodes de positionnement au moment de l'accouchement étaient essentiellement équivalentes, exception faite d'un nombre inférieur de déchirures vaginales et d'un pH artériel de cordon ombilical moindre au sein du groupe « APOR B ¼. Ces constatations devront faire l'objet d'une analyse plus poussée dans le cadre d'essais comparatifs randomisés.