Congenital anomalies during Covid-19: artifact of surveillance or a real TORCH?

Infections in the first trimester of pregnancy can be teratogenic, but the possibility that Covid-19 could lead to birth defects is unclear. We examined whether SARS-CoV-2 infection during pregnancy or exposure to pandemic conditions were associated with the risk of congenital anomalies. We carried out a retrospective study of 420,222 neonates born in Quebec, Canada in two time periods: prepandemic (January 1, 2017 to March 12, 2020) vs. pandemic (March 13, 2020 to March 31, 2022). We classified pandemic births as early (first trimester completed before the pandemic) or late (first trimester during the pandemic), and identified patients with SARS-CoV-2 infections during pregnancy. We applied (1) adjusted log-binomial regression models to assess the association between SARS-CoV-2 infection and congenital anomalies, and (2) autoregressive interrupted time series regression to analyze temporal trends in the monthly number of defects in all patients regardless of infection. In total, 29,263 newborns (7.0%) had a congenital anomaly. First trimester SARS-CoV-2 infections were not associated with a greater risk of birth defects compared with no infection (RR 1.07, 95% CI 0.59-1.95). However, births during the late pandemic period were more likely to be diagnosed with congenital microcephaly compared with prepandemic births (RR 1.44, 95% CI 1.21-1.71). Interrupted time series analysis confirmed that the frequency of microcephaly increased during the late pandemic period, whereas other anomalies did not. We conclude that Covid-19 is likely not teratogenic, but enhanced surveillance of anomalies among late pandemic births may have heightened the detection of infants with microcephaly.

Use of medication in pregnancy on the rise: Study on 1.4 million Danish pregnancies from 1998 to 2018.

INTRODUCTION: Maternal demographics have evolved, and more women than ever enter pregnancy with preexisting comorbidity and with potentially complex medication exposure, including polypharmacy (concomitant intake of multiple medications). This study aims to describe the evolution of medication use in pregnancy in Denmark from 1998 to 2018 with special focus on polypharmacy, patterns of use, and underlying demographics. MATERIAL AND METHODS: A Danish nationwide historical registry study based on all clinically recognized pregnancies with a gestation ≥10 weeks between 1998 and 2018. Medication use was estimated by redemption of prescriptions during pregnancy. RESULTS: Among a total of 1 402 327 clinically recognized pregnancies, redemption of at least one prescription medication during pregnancy increased from 56.9% in 1998 to 63.3% in 2018, coinciding with an increased use of polypharmacy (from 24.8% in 1998 to 35.2% in 2018). The prevalence of pregnant women who used medications for chronic conditions increased more than the prevalence of women treated for occasional or short-time conditions. Redemption of one or multiple prescription medications during pregnancy was mostly seen among pregnant women ≥35 years of age. However, pregnant women <25 years old exhibited the largest increase in medication use during the study period. CONCLUSIONS: Medication use in general, and polypharmacy in particular, increased from 1998 to 2008, possibly as the result of an increased prevalence of pregnant women with chronic conditions requiring pharmacological treatment. Notably, a marked maternal age-based discrepancy in usage pattern was observed, highlighting the need for further research in this area. The rise in the prevalence of polypharmacy during pregnancy underscores the need for pharmacovigilance to monitor adverse effects. Future studies should investigate the patterns of polypharmacy and the accompanying maternal and fetal risks.

Resolvin D1 level during different trimesters of pregnancy for predicting the risk of fetal growth retardation in elderly pregnancy.

Resolvin D1 (RvD1) is potentially associated with fetal growth retardation (FGR) through alleviating maternal inflammation and its linkage with several pregnancy complications. Thus, this study detected RvD1 levels at different trimesters of pregnancy, aiming to investigate its role in predicting FGR risk of elderly pregnant women. This prospective, observational cohort study enrolled 165 elderly pregnant women aged ≥35 years. Serum RvD1 was detected at 10-13 weeks (early pregnancy), 20-23 weeks (middle pregnancy), and 30-33 weeks (late pregnancy) of gestational week by enzyme-linked immunosorbent assay. RvD1 was varied among different trimesters of pregnancy in elderly pregnant women (p < 0.001). FGR occurred in 25 (15.2%) women in this study. RvD1 at early (p = 0.009), middle (p = 0.002), and late (p = 0.003) pregnancy was decreased in women with FGR versus those without. By multivariate analysis, RvD1 at middle pregnancy (odds ratio (OR): 0.477, p < 0.001), pre-pregnancy body mass index (OR: 0.763, p = 0.025), and gestational diabetes mellitus (yes versus no) (OR: 0.071, p = 0.031) were independently correlated with declined FGR risk. While age (OR: 1.382, p = 0.009) was independently associated with elevated risk of FGR. Furthermore, the combination of these independent factors as a predictive model exhibited a good potential for assessing FGR risk (area under the curve: 0.802, 95% confidence interval: 0.711-0.894). In conclusion, RvD1 at different trimesters of pregnancy is negatively linked with the risk of FGR, whose level at middle pregnancy serves as an independent factor for FGR risk in elderly pregnant women.

Prevalence and influencing factors of anemia among pregnant women across first, second and third trimesters of pregnancy in monitoring areas, from 2016 to 2020: a population-based multi-center cohort study.

OBJECTIVE: To assess the prevalence of anemia among pregnant women across their entire pregnancy and the factors affecting it in the monitoring areas. METHODS: A total of 108,351 pregnant women who received antenatal health care and delivered from January 1, 2016 to December 31, 2020 in 15 monitoring counties of 8 provinces in the Maternal and Newborn Health Monitoring Program (MNHMP) of National Center for Women and Children's Health (NCWCH) were selected as the study subjects. The anemia status among the subjects across their first, second and third trimester of pregnancy and the influencing factors were analyzed. RESULTS: From 2016 to 2020, the prevalence of anemia at any stage during pregnancy in the monitoring areas was 43.59%. The prevalence of anemia among pregnant women across all three trimesters was 3.95%, and the prevalence of mild and moderate-to-severe anemia was 1.04% and 2.90%, respectively. Protective factors were living in the northern area (OR = 0.395) and being a member of an ethnic minority (OR = 0.632). The risk factors were residing in rural areas (OR = 1.207), with no more than junior high school education (OR = 1.203), having ≥ 3 gravidities (OR = 1.195) and multiple fetuses (OR = 1.478). CONCLUSIONS: Although the prevalence of anemia among pregnant women across all trimesters in the monitoring area was low, the severity of anemia was high. Since the prevalence of anemia among pregnant women across their entire pregnancy in the monitoring area is affected by many different factors, more attention should be paid to pregnant women living in rural areas, with low literacy, ≥ 3 gravidities and multiple fetuses for early intervention.

Associations of Trimester-Specific Exposure to Perchlorate, Thiocyanate, and Nitrate with Childhood Neurodevelopment: A Birth Cohort Study in China.

Studies about the impacts of maternal exposure to perchlorate, thiocyanate, and nitrate on offspring neurodevelopment are scarce. Based on a birth cohort in China, 1,028 mothers provided urine samples at three trimesters for determination of the three target analytes, and their offspring neurodevelopment was evaluated at 2 years old. Associations of maternal exposure to the three chemicals with offspring neurodevelopment were estimated using three statistical methods. Trimester-specific analyses using generalized estimating equation models showed that double increment of thiocyanate and nitrate during the first trimester was associated with 1.56 (95% CI: -2.82, -0.30) and 1.22 (-2.40, -0.03) point decreases in the offspring mental development index (MDI), respectively. Weighted quantile sum (WQS) regression analyses showed that the mixture exposure at the first and second trimesters was negatively associated with the offspring MDI (ß = -2.39, 95% CI: -3.85, -0.93; ß = -1.75, 95% CI: -3.04, -0.47, respectively) and thiocyanate contributed the most to the association (65.0 and 91.6%, respectively). Bayesian kernel machine regression analyses suggested an inverted U-shape relationship of maternal urinary thiocyanate with the offspring MDI. These findings suggested that prenatal exposure to the three chemicals (at current levels), especially thiocyanate and nitrate, may impair neurodevelopment. Early pregnancy seems to be the sensitive window.

Maternal blood concentrations of toxic metal(loid)s and trace elements from preconception to pregnancy and transplacental passage to fetuses.

Intrauterine exposure to heavy metals may adversely affect the developing fetus and health later in life, while certain trace elements may be protective. There is limited data on their dynamic fluctuation in circulating concentration of women from preconception to pregnancy and the degree of transplacental passage to fetus. Such information is critically needed for an optimal design of research studies and intervention strategies. In the present study, we profiled the longitudinal patterns and trajectories of metal(loid)s and trace elements from preconception to late pregnancy and in newborns. We measured whole blood metal(loid)s in women at preconception, 16, 24 and 32 weeks of gestation and in cord blood in 100 mother-newborn pairs. Our data showed that the mean concentrations of mercury (Hg), lead (Pb), rubidium (Rb), manganese (Mn), and iron (Fe) were lower during early-, mid-, and late-pregnancy than at preconception. Copper (Cu), and calcium (Ca) concentrations increased after pregnancy (Cu 798 versus 1353, 1488, and 1464 µg/L). Concentrations at preconception were correlated with those during pregnancy for all examined metal(loid)s. Maternal Hg, Pb, and Se concentrations at late-pregnancy were correlated with those in newborn cord blood in various degrees (correlation coefficients: Hg 0.66, Pb 0.29, Se 0.39). The estimated placental transfer ratio for toxic metal(loid)s ranging from 1.68 (Hg) to 0.18 (Cd). Two trajectory groups were identified for Hg, Pb, Cd, Se concentrations. Hg concentrations may be correlated with maternal education levels. The study is the first to present longitudinal circulating concentration trajectories of toxic metal(loid)s and trace elements from preconception to pregnancy stages. A high degree of transplacental passage was observed in toxic metals Pb and Hg which may pose hazards to the developing fetus.

Pregnant women's mental health during the COVID-19 pandemic according to the trimester of pregnancy.

AIM: This study aimed to analyse the psychological impact of the COVID-19 pandemic on pregnant women according to the pregnancy trimester, comparing their psychopathological symptomatology, pregnancy-specific stress, resilience and perceived stress to those of women pregnant before the pandemic. METHODS: A total of 797 pregnant women participated in the study, one group of 393 women pregnant before the pandemic and the other of 404 women pregnant during the pandemic. Student-t test was used to analyse continuous data and the Chi-square test was used for categorical data. RESULTS: Psychopathological symptomatology was significantly higher in six subscales of the SCL-90-R in pregnant women during COVID-19: somatisation, interpersonal sensitivity, depression, anxiety, phobic anxiety, obsessions-compulsions, mainly on the first two trimesters. There is also a higher level of pregnancy-specific stress in pregnant women during the pandemic on the first two trimesters, most likely due to the hypervigilance and fears related to the COVID-19 disease. Nevertheless, perceived stress, usually elevated during pregnancy, was lower in women pregnant during the pandemic in comparison to those pregnant before, as a positive consequence of being on lockdown and diminishing the exposure to daily stressful situations. CONCLUSIONS: Knowing the struggles these women go through during each trimester of pregnancy can be the key to a better health professional-patient relationship, consequently having a positive impact on their mental and physical health.

Prognosis of pregnancy-associated breast cancer: inferior outcome in patients diagnosed during second and third gestational trimesters and lactation.

PURPOSE: Pregnancy-associated breast cancer, although most commonly defined as breast cancer diagnosed during pregnancy or ≤1 year following delivery, knows a variety of definitions, likely related to the diversity of reported clinicopathological features and prognosis. More insight into the different breast cancer subgroups during pregnancy, time after delivery and the postpartum period is therefore warranted. METHODS: Patients with breast cancer diagnosed during pregnancy or ≤6 months postdelivery were included, and subdivided according to gestational trimester, and postpartum patients according to lactational status. Subgroups were compared to matched non-PABC patients, to investigate the influence of pregnancy and lactation on clinical course and outcome. RESULTS: Overall, 662 PABC patients were included (median age 34 years, median follow-up 6.5 years). PABC patients showed an advanced stage at diagnosis and an inferior 5-years-OS (75.4% vs. 83.2%, p = 0.000) compared to 1392 matched non-PABC patients. In subgroup analysis, first trimester PABC patients showed a significantly lower tumor size and stage as compared to other trimesters. Patients diagnosed during the first trimester and postpartum non-lactating patients had a relatively good OS (81.3% and 77.9%, respectively) versus patients diagnosed during the second and third trimesters and during lactation (OS 60.0%, 64.9% and 65.6%, respectively, p = 0.003). CONCLUSION: In this large (uniquely specified) PABC cohort, an inferior outcome was found for patients diagnosed within the second and third gestational trimesters and during lactation. These findings indicate that PABC is clinically a heterogeneous group of breast cancer patients that should be redefined based on trimester of diagnosis and lactational status.

Management of pregnant women with COVID-19: A tertiary pandemic center experience on 1416 cases.

The aim of this study is to share the comprehensive experience of a tertiary pandemic center on pregnant women with COVID-19 and to compare clinical outcomes between pregnancy trimesters. The present prospective cohort study consisted of pregnant women with COVID-19 who were followed up at Ankara City Hospital between March 11, 2020 and February 20, 2021. Clinical characteristics and perinatal outcomes were compared between the pregnancy trimesters. A total of 1416 pregnant women (1400 singletons and 16 twins) with COVID-19 were evaluated. Twenty-six (1.8%) patients were admitted to the intensive care unit (ICU) and maternal mortality was observed in six (0.4%) cases. Pregnancy complications were present in 227 (16.1%) cases and preterm labor was the most common one (n = 42, 2.9%). There were 311, 433, and 672 patients in the first, second, and third trimesters of pregnancy, respectively. Rates of mild and severe/critic COVID-19 were highest in the first and second trimesters, respectively. The hospitalization rate was highest in the third trimester. Pregnancy complications, maternal mortality, and NICU admission rates were similar between the groups. The course of the disease and obstetric outcomes may be different among pregnancy trimesters. A worse course of the disease may be observed even in pregnant women without any coexisting health problems.

Sexual Intercourse Frequency During Pregnancy: Weekly Surveys Among 237 Young Women From A Random Population-Based Sample.

BACKGROUND: Significant differences in sexual frequency during pregnancy have been documented in cross-sectional and once-per-trimester longitudinal studies, with the highest sexual frequency in the first trimester and the lowest in the third trimester. However, changes in sexual frequency may be more complex than these comparisons suggest; patterns of sexual frequency have not been assessed using frequent (e.g., weekly) assessments throughout a woman's pregnancy. AIM: To assess changes in the frequency of sexual intercourse across all weeks of pregnancy. METHODS: We used data from 237 women (54% White; 43% Black) who reported a pregnancy during the Relationship Dynamics and Social Life (RDSL) study. RDSL was based on a random population-based sample of 992 women in the United States, aged 18 or 19, who completed a baseline interview and brief weekly follow-up surveys for 2.5 years. We used generalized multilevel modeling to fit and compare linear, quadratic, and piecewise (via b-splines) models. OUTCOME: Weekly probability of sexual intercourse. RESULTS: Sexual intercourse frequency clearly declined across pregnancy, yet the pattern followed the course of common pregnancy symptomology (i.e., nausea, fatigue) more closely than trimester cutoffs. The best fitting model demonstrated that the probability of sexual intercourse declined sharply (∼18% each week) between conception and 11 weeks, subsequently increased by ∼3% each week between weeks 11 and 21, and then declined steadily (∼6% each week) through the end of pregnancy. CLINICAL TRANSLATION: Documenting more precise patterns of change in sexual frequency during pregnancy provides important information to many who wish to maintain sexual intimacy while pregnant, or to those who would otherwise find the sexual disruptions particularly challenging. STRENGTHS & LIMITATIONS: This study is the first to document changes in sexual intercourse frequency throughout all weeks of pregnancy as they naturally occurred among a representative sample of young women. The focus on sexual intercourse limits the findings to only one aspect of human sexuality. The narrow age range of the sample precludes generalization to all pregnant women. CONCLUSION: Changes in sexual frequency are more complex than the general declines suggested by other studies; within-trimester patterns reveal the shortcomings in understanding sexual behavior changes when aggregated by trimester, such as severely underestimating the degree of fluctuation in the first trimester. Pregnancy symptomology may be most favorable to intercourse towards the end of the first and beginning of second trimesters, and least favorable near the end of the pregnancy. Shari M. Blumenstock, Jennifer S. Barber. Sexual Intercourse Frequency During Pregnancy: Weekly Surveys Among 237 Young Women From A Random Population-Based Sample. J Sex Med 2022;19:1524-1535.

Posthemithyroidectomy Pregnancy Thyroid Function Surveillance: Frequency, Adherence, and Guideline Impact.

OBJECTIVE: Posthemithyroidectomy women are at an increased risk for gestational subclinical hypothyroidism. Therefore, the American Thyroid Association (ATA) recommends increased thyroid function surveillance for this subgroup of pregnant women. The purpose of this study was to evaluate the frequency of thyroid function surveillance during pregnancy in posthemithyroidectomy women and to evaluate the adherence to the 2017 ATA guidelines and its possible impact since being published on thyroid function surveillance rates. METHODS: A retrospective study of pregnant posthemithyroidectomy women operated at our institution between 1997 and 2020 was performed. The study cohort was subdivided by pregnancy dates before 2018 and 2018 onward to evaluate the impact of the 2017 ATA guidelines. Adherence to the guidelines was defined as at least 1 thyroid-stimulating hormone test in each trimester. RESULTS: After exclusions, a total of 120 pregnancies conceived by 66 women who underwent hemithyroidectomy surgeries were included in this study. Overall, serum thyroid-stimulating hormone examinations were performed during the first, second, and third pregnancy trimesters in 86.6%, 40%, and 16.6% of pregnancies, respectively (P <.005). The examination rate since 2018 was 88%, 40%, and 8% for the first, second, and third trimesters, respectively (P <.005). CONCLUSION: Adherence to the latest ATA guidelines is low, and its publication in 2017 did not increase the thyroid function surveillance rate in posthemithyroidectomy women. Better patient education regarding the risks of gestational hypothyroidism following hemithyroidectomy and improved communications among treating surgeons, obstetricians, and endocrinologists may improve these rates.

Development and validation across trimester of the Prenatal Eating Behaviors Screening tool.

Rapid screening tools are useful for identifying at-risk patients and referring them for further assessment and treatment, but none exist that consider the unique medical needs of pregnant women with eating disorders (EDs). There is a need for a rapid, sensitive, and specific screening tool that can be used to identify a potential ED in pregnancy. We started with a set of 25 questions, developed from our qualitative work along with other ED screening tools, and tested on a development (n = 190) and validation sample (n = 167). Statistical analysis included factor analysis and logistic regressions with ROC curves. Development and validation samples were combined for trimester analysis (n = 357). Refining the tool to 12 items demonstrated strong internal reliability (development alpha = 0.95, validation alpha = 0.91). With correlated errors, questions demonstrated acceptable CFA fit (development: GFI: 0.91, RMSEA: 0.10, NNFI: 0.95; validation: GFI: 0.85, RMSEA: 0.14, NNFI: 0.86). Similar fits were seen by trimester: first trimester n = 127, GFI: 0.89, RMSEA: 0.12, NNFI: 0.94; second trimester n = 150, GFI: 0.83, RMSEA: 0.14, NNFI: 0.88; third trimester n = 80, GFI: 0.99, NNFI: 0.99. Validation against current ED diagnosis demonstrated acceptable sensitivity and specificity using a cutoff of 39 (development sensitivity = 80.7%, specificity = 79.7%, OR = 16.42, 95% CI: 7.51, 35.88; validation sensitivity = 69.2%, specificity = 86.5%, OR: 17.43, 95% CI: 6.46, 47.01). Findings suggest the PEBS tool can reliably and sensitively detect EDs across pregnancy trimesters with 12 questions. A further implication of this work is to reduce health and mental health treatment disparities through this standard and rapid screening measure to ensure early identification and treatment.

Depression and quality of life among pregnant women in first and third trimesters in Abeokuta: A comparative study.

Background: Pregnancy is a dynamic time during which a woman's emotional state may undergo extensive change. There have been conflicting views about the magnitude of emotional turmoil that occurs during pregnancy. Some investigators suggest that pregnancy is a time of particularly good psychological adjustment; others have reported high levels of psychological challenge. Aim: Our study aimed to compare the prevalence and correlates of depression in the first and third trimesters of pregnancy and to determine the relationship between quality of life and depressive disorder. Setting: The antenatal clinic of the State Hospital, Ijaiye. Method: A descriptive, comparative study of depressive disorder and the quality of life between first- and third-trimester pregnant women (confirmed through a pregnancy test and an abdominopelvic ultrasound). Result: For each trimester, 285 participants were recruited. The prevalence of depression among the pregnant women who participated in the study was 7.2%. In the first trimester of pregnancy, the prevalence of depression was 30 (10.5%), while it was 11 (3.9%) in the third trimester of pregnancy. Collectively, the relationship between depression and QoL was significant in the overall domain, satisfaction with general health domain (t = 2.27; p = 0.03), psychological domain (t = 2.74; p = 0.010, and environmental domain (t = 4.57; p ≤ 0.01). Conclusion: Our study also highlights the need to pay closer attention to the psychological well-being and quality of life of all pregnant women and not just on their physical health and the baby's well-being.

Health-related quality of life in different trimesters during pregnancy.

BACKGROUND: Pregnant women experience physical, physiological, and mental changes. Health-related quality of life (HRQoL) is a relevant indicator of psychological and physical behaviours, changing over the course of pregnancy. This study aims to assess HRQoL of pregnant women during different stages of pregnancy. METHODS: This cross-sectional study was performed using the The EuroQoL Group's five-dimension five-level questionnaire (EQ-5D-5L) to assess the HRQoL of pregnant women, and demographic data were collected. This study was conducted in a regional university hospital in Guangzhou, China. RESULTS: A total of 908 pregnant women were included in this study. Pregnant women in the early 2nd trimester had the highest HRQoL. The HRQoL of pregnant women rose from the 1st trimester to the early 2nd trimester, and dropped to the bottom at the late 3rd trimester due to some physical and mental changes. Reports of pain/discomfort problem were the most common (46.0%) while self-care were the least concern. More than 10% of pregnant women in the 1st trimester had health-related problems in at least one dimension of whole five dimensions. In the whole sample, the EuroQoL Group's visual analog scale (EQ-VAS) was 87.86 ± 9.16. Across the gestational stages, the HRQoL remained stable during the pregnancy but the highest value was observed in the 1st trimester (89.65 ± 10.13) while the lowest was in the late 3rd trimester (87.28 ± 9.13). CONCLUSIONS: During pregnancy, HRQoL were associated with gestational trimesters in a certain degree. HRQoL was the highest in the early 2nd trimester and then decreased to the lowest in the late 3rd trimester due to a series of physical and psychological changes. Therefore, obstetric doctors and medical institutions should give more attention and care to pregnant women in the late 3rd trimester.

Quantitative systematic review: Methods used for the in vivo measurement of body composition in pregnancy.

AIMS: Because of the increased overall prevalence of pre-pregnancy obesity among racial-ethnic groups, we conducted a review of published methods for body composition measurement during pregnancy considering at present there is no consensus on the best practices and type of study design that researchers should use for this purpose. DESIGN: Quantitative systematic review. DATA SOURCES: PubMed, EMBASE, Scopus, Web of Science, and Virtual Library of Health. Search dates from 1997-2016. REVIEW METHODS: Search of articles indexed in selected databases from 1997-2016. Studies were published in English, Spanish, and Portuguese. Graphs were carried out using data visualization software. RESULTS: From the 112 included studies, 70 were prospective cohorts, 30 cross-sectional studies, 10 randomized controlled trial, and two retrospective studies. Cross-sectional studies and randomized controlled trial depicted a positive correlation with significant trend. CONCLUSIONS: Although several methods for body composition measurement exist, only bioelectrical impedance analysis, displacement plethysmography, and displacement plethysmography show a significant growing trend. Use of data visualization allows understanding various associations among categorical variables, with a graphical display of their multidimensional behaviour. IMPACT: Public and private health-care institution evaluating pregnancy women. Health-care personnel, including nursing professional, dealing with measurements of body composition during pregnancy will find reading this manuscript beneficial.

Vitamin C and IL-6 level during third trimester of pregnancy with preeclampsia.

OBJECTIVE: To investigate the relationship between vitamin C intake and IL-6 level as a biomarker of oxidative stress during pregnancy. METHODS: Fourty pregnant women during third trimester were grouped into preeclampsia and non-preeclampsia, and surveyed using a Food Frequency Questionnaire. The ELISA assay for IL-6 expression was performed. Univariate and bivariate analyses were conducted using SPSS software ver. 20. RESULTS: Subjects in preeclampsia group were shown to consume slightly more vitamin C than the non-preeclampsia group, with median values of 76.37 (28.05 - 96.88) mg and 68.87 (8.57 - 198.53) mg, respectively (p = 0.36). A nonparametric correlation test showed no significant association between vitamin C and total IL-6 level, with p = 0.36 and r = -0.15. There was also no difference between vitamin C consumption and IL-6 level for each group, with r = -0.14 and r = -0.20, respectively. CONCLUSIONS: There was no statistically significant association between vitamin C intake and IL-6 level in women during third trimester of pregnancy (p = 0.36).

Can variability of serum electrophoretic fractions during pregnancy provide knowledge about maternal and fetal health.

AIM: Characteristics of variability of concentrations total protein and its electrophoretic fractions in serum of healthy pregnant women between successive trimesters and post-partum for initial classification of proteins involved in specific metabolic processes associated with pregnancy. METHODS: Total serum protein concentrations were measured by biuret method and serum protein fractions were electrophoretically separated in 166 serum samples collected from healthy pregnant women in three trimesters of pregnancy (1st, n = 55; 2nd, n = 42; 3rd, n = 39) and in post-partum (n = 30), and in 20 samples from nonpregnant controls. RESULTS: Across pregnancy, there were gradual, but occurring at different rates, decreases over time in serum total protein, albumin and gamma globulins compared to controls (P < 0.05). In 1st trimester, serum concentrations of total protein, albumin and gamma globulins were <10% lower than in nonpregnant state, with further decreases in 2nd and 3rd trimesters and in post-partum. The concentrations of alpha-1-, alpha-2-, beta-1- and beta-2-globulins were elevated compared to controls (P < 0.05) with different dynamics of change and with the highest percentage increase for alpha-1-globulin. CONCLUSION: Pregnancy-associated alterations in the serum concentrations of total protein and in its individual electrophoretic protein fractions in each trimester of pregnancy and differences versus normal ranges in nonpregnant healthy females could be a simple screening method for classification useful laboratory parameters that help obstetricians and gynecologists to make multidirectional judgments about the state of health of pregnant women.

Methods to generate and validate a Pregnancy Register in the UK Clinical Practice Research Datalink primary care database.

PURPOSE: Primary care databases are increasingly used for researching pregnancy, eg, the effects of maternal drug exposures. However, ascertaining pregnancies, their timing, and outcomes in these data is challenging. While individual studies have adopted different methods, no systematic approach to characterise all pregnancies in a primary care database has yet been published. Therefore, we developed a new algorithm to establish a Pregnancy Register in the UK Clinical Practice Research Datalink (CPRD) GOLD primary care database. METHODS: We compiled over 4000 read and entity codes to identify pregnancy-related records among women aged 11 to 49 years in CPRD GOLD. Codes were categorised by the stage or outcome of pregnancy to facilitate delineation of pregnancy episodes. We constructed hierarchical rule systems to handle information from multiple sources. We assessed the validity of the Register to identify pregnancy outcomes by comparing our results to linked hospitalisation records and Office for National Statistics population rates. RESULTS: Our algorithm identified 5.8 million pregnancies among 2.4 million women (January 1987-February 2018). We observed close agreement with hospitalisation data regarding completeness of pregnancy outcomes (91% sensitivity for deliveries and 77% for pregnancy losses) and their timing (median 0 days difference, interquartile range 0-2 days). Miscarriage and prematurity rates were consistent with population figures, although termination and, to a lesser extent, live birth rates were underestimated in the Register. CONCLUSIONS: The Pregnancy Register offers huge research potential because of its large size, high completeness, and availability. Further validation work is underway to enhance this data resource and identify optimal approaches for its use.

Assessing body dissatisfaction in Japanese women during the second trimester of pregnancy using a new figure rating scale.

During pregnancy, women re-evaluate their body image based on their increasing body weight. They are usually concerned about their body size, which leads to body dissatisfaction. In this study, we investigated body dissatisfaction among Japanese women during the second trimester, when they are recommended to gain adequate weight. A cross-sectional survey of body dissatisfaction among pregnant women was conducted using a new figure rating scale corresponding to body mass index with real-life photographs of women in their sixth month of gestation. Pregnant Japanese women expressed body dissatisfaction and preferred to be thinner by 1.6 kg/m2 of their body mass index. They perceived their body size as larger than their real size, and those with a higher body mass index had more body dissatisfaction, although they were of normal weight or underweight. The results indicated that the new figure rating scale could be a useful tool to identify pregnant women with higher body dissatisfaction during the second trimester, providing an opportunity to discuss adequate gestational weight gain with pregnant women.

D-dimer during pregnancy: establishing trimester-specific reference intervals.

Pregnancy is associated with an increased risk of venous thromboembolism (VTE). D-dimer is a biomarker used as an exclusion criterion of VTE disease, but its usefulness during pregnancy shows limitations because D-dimer levels physiologically increase through pregnancy. The aim of our study was to follow the changes of D-dimer levels and to establish trimester-specific reference intervals during normal pregnancy. This is a longitudinal prospective study in which the reference population finally included 102 healthy pregnant women. Plasma D-dimer levels were measured during the three trimesters of pregnancy, using a latex-based immunoturbidimetric assay. Reference intervals were calculated according to the Clinical and Laboratory Standards Institute recommendations. D-dimer levels increased progressively and significantly through pregnancy and peaked in the third trimester, in which D-dimer levels were above the conventional cut-off point (500 µg/L) in 99% of pregnant women. The following reference intervals were defined: first trimester: 169-1202 µg/L, second trimester: 393-3258 µg/L and third trimester: 551-3333 µg/L. The study provides reference intervals of D-dimer during the pregnancy using latex-based immunoturbidimetry on the ACL 300 TOP automated coagulation analyser. Further prospective studies of pregnant women with clinical suspicion of VTE are needed to validate these results.