New insights into the vitamin D requirements during pregnancy

Pregnancy represents a dynamic period with physical and physiological changes in both the mother and her developing fetus. The dramatic 2-3 fold increase in the active hormone 1,25（OH）2D concentrations during the early weeks of pregnancy despite minimal increased calcium demands during that time of gestation and which are sustained throughout pregnancy in both the mother and fetus suggests an immunomodulatory role in preventing fetal rejection by the mother. While there have been numerous observational studies that support the premise of vitamin D＇s role in maintaining maternal and fetal well-being, until recently, there have been few randomized clinical trials with vitamin D supplementation. One has to exhibit caution, however, even with RCTs, whose results can be problematic when analyzed on an intent-to-treat basis and when there is high non-adherence to protocol （as if often the case）, thereby diluting the potential good or harm of a given treatment at higher doses. As such, a biomarker of a drug or in this case ＂vitamin＂ or pre-prohormone is better served. For these reasons, the effect of vitamin D therapies using the biomarker circulating 25（OH）D is a far better indicator of true ＂effect.＂ When pregnancy outcomes are analyzed using the biomarker 25（OH）D instead of treatment dose, there are notable differences in maternal and fetal outcomes across diverse racial/ethnic groups, with improved health in those women who attain a circulating 25（OH）D concentration of at least 100 nmol. L-1 （40 ng. mL-1）. Because ,an important issue is the timing or initiation of vitamin D treatment/supplementation, and given the potential effect of vitamin D on placental gene expression and its effects on inflammation within the placenta, it appears crucial to start vitamin D treatment before placentation （and trophoblast invasion）; however, this question remains unanswered. Additional work is needed to decipher the vitamin D requirements of pregnant women and the optimal timing of supplementation, taking into account a variety of lifestyles, body types, baseline vitamin D status, and maternal and fetal vitamin D receptor （VDR） and vitamin D binding protein （VDBP） genotypes. Determining the role of vitamin D in nonclassical, immune pathways continues to be a challenge that once answered will substantiate recommendations and public health policies.

SpyGlass cholangioscopy for management of choledocholithiasis during pregnancy

To the Editor: We read with great interest the article by Chong and Jalihal [1] regarding endoscopic management of biliary disorders during pregnancy which reaffirms that endoscopic retrograde cholangiopancreatography(ERCP)is safe and effective in managing choledocholithiasis during pregnancy. The authors use ERCP under fluoroscopic guidance with lead apron shielding as well as non-fluoroscopic cannulation using bile flow and bile aspiration as indicators of successful

Correlation Study of Color Doppler Examination of Deep Veins of Both Lower Extremities Combined with Fibrinolysis System in Hypertension during Pregnancy

Objective: To investigate the correlation between deep static color Doppler ultrasound of both lower extremities combined with fibrinolytic system detection in pregnancy-induced hypertension. Methods: A total of 70 normal pregnant women, 70 pregnant women with hypertension during pregnancy, and 50 healthy non-pregnant women in the same period were selected as the research objects. The deep veins of both lower limbs were examined by Rili Erlangshen’s color Doppler ultrasound diagnostic instrument (CDU), and the fibrinolysis system was tested by enzyme-linked immunosorbent assay (ELISA) method and automatic hemagglutination analyzer. Results: Compared with the non-pregnant group, the inner diameters of the left/right femoral vein (CFV) and popliteal vein (POV) in the normal pregnancy group and the pregnancy-induced hypertension group were significantly widened, and the peak blood flow spectrum was significantly reduced. The difference was statistically significant (P < 0.01);FIB, PLG, t-PA, PAI, D-Dimer were significantly increased, the difference was statistically significant (P < 0.01);Compared with the normal pregnancy group, the inner diameter of the left/right femoral vein (CFV) in the hypertensive pregnancy group was significantly wider than that in the normal pregnancy group, and the peak value of the left/right POV blood flow spectrum was significantly lower than that in the normal pregnancy group, the difference was statistically significant (P < 0.01), while the left/right popliteal vein (POV) inner diameter, left/right CFV blood flow peak value did not change significantly from the normal pregnancy group, and the difference was not statistically significant (P > 0.05);FIB, PLG, PAI, D-Dimer of the hypertensive disease group during pregnancy significantly increased, the difference was statistically significant (P < 0.01), while t-PA was not statistically significant (P > 0.05). Conclusion: Normal pregnant women have a hypercoagulable state compared with healthy non-pregnant women, and pregnant women with hypertension during pregnancy are more likely to be in a pre-thrombotic state than pregnant women with normal pregnancy. Deep vein CDU examination of both lower extremities combined with blood fibrinolysis monitoring is of great value in the prevention and treatment of hypertension during pregnancy.

Analysis on Family History of Diabetes, Weight Gain during Pregnancy and Pre-pregnancy Body Mass Index on 82 Pregnant Women with Gestational Diabetes Mellitus

Objective:To investigate the effects of family history of diabetes mellitus,Gestational Weight Gain(GWG)and Body Mass Index(BMI)before pregnancy on Gestational Diabetes Mellitus(GDM).Method:82 pregnant women with GDM who were hospitalized and delivered in the obstetrics department of our hospital from September 2017 to September 2019 were selected as the observation group,and 60 pregnant women with normal glucose tolerance test in the same period were selected as the control group;The relationship between family history of diabetes,weight gain during pregnancy and pre-pregnancy Body Mass Index and GDM were analyzed.Results:The age,pre-pregnancy weight and weight gain during pregnancy were significantly higher in the observation group than in the control group(P<0.05),and the family history of diabetes and pre-pregnancy Body Mass Index were higher in the observation group than in the control group(P<0.05),and the differences were statistically significant.Conclusion:It is suggested that family history of diabetes is related to gestational diabetes mellitus.Excessive GWG growth during pregnancy and high Body Mass Index before pregnancy may increase the risk of gestational diabetes mellitus in pregnant women.

Serum Calcium Ionised Rate and Materno-Perinatal Prognosis in Arterial Hypertension in Pregnancy at the Reference General Hospital of Panzi

Hypertensive disorders of pregnancy are among the leading causes of severe maternal morbidity and mortality, particularly in developing countries. Hypertensive disorders of pregnancy are among the leading causes of severe maternal morbidity and mortality, particularly in developing countries, maternal hypocalcaemia being a factor favouring the onset of arterial hypertension during pregnancy. The aim was to determine the maternal and perinatal prognosis of patients with hypertensive disorders of pregnancy as a function of serum ionised calcium levels. Material and Methods: A cross-sectional analytical study of 114 patients with arterial hypertension during pregnancy or during pregnancy or in the postpartum period at the HGR/Panzi from 1 January 2021 to 30 June 2022, text was entered using Microsoft Office Word 2010 and the tables were analysed using Excel 2010. The data was analysed using SPSS version 20.0 and Stata 14.0. The associations of the variables were calculated using Pearson's chi-square test, with a significance threshold set at a value of p < 0.05. Study of risk factors, Odds ratios and their confidence intervals were estimated in a univariate analysis. The most determining factors were identified by multivariate analysis using the Forward conditional logistic regression model. Results: The mean gestational age was 34.43 ± 4.327 amenorheas weeks, 46.6% of patients had a vaginal delivery, 66.65% of which were indicated for maternal prognosis, maternal complications were associated with maternal hypocalcaemia in 81, 82% (P = 0.043) and an OR = 3.255 (P = 0.0158) threefold risk that the patient presenting with a complication is likely to be in a state of hypocalcaemia at 95% confidence index, and fetal prognosis was not significantly related to maternal calcaemia. Conclusion: Maternal hypocalcaemia is one of the factors that can influence maternal-foetal complications maternal-fetal complications, early management and prevention of this pathology is pathology is important to reduce maternal-fetal morbidity and mortality.

CALCIUM SUPPLEMENTATION DURING PREGNANCY FOR REDUCING PREGNANCY INDUCED HYPERTENSION

Pregnancy induced hypertension (PIH) is a common complication in pregnancy and prenatal stage. Because the direct and indirect relationship between low calcium intake and many diseases, such as rachitis, young age myopia and hypertension, calcium supplementation has been a hot topic among nutritionists, Randomized trials of calcium supplementation during pregnancy were conducted in 212 healthy primipara. They were divided into 4 groups and pave 120mg, 240mg, Ig or 2g of calcium daily from 20 to 28wks of gestation up to delivery respectively. As a result, the incidence of PIH was 8.9%, 7.5%, 8% and 4% respectively in these groups, The control group (106 pregnant women) who did not receive calcium gave an incidence of 18%. Supplementation of 2g of calcium daily showed significant resutls in lowering the incidence of PM (P<0.05) without any adverse effects. In 1992 calcium supplementation was widely used in antenatal clinic. 200 cases with intake of 2g calcium were compared with corresponding non-calcium supplementation cases, and the incidence of PIH was 7.5% and 16.5% (P< 0.005) respectively. Mediating parathyroid hormone and renin activity are thought to be the effect of calcium on decreasing the incidence of PIH,

Smoking During Pregnancy Cuts Child Lung Capacity

“美烟草巨头被判赔偿1450亿美元”成为人们的街谈巷议。吸烟的危害早已不是什么新鲜话题。但是,科研人员还是不断地在向人们披露他们发现的吸烟的新的危害。本文警告:孕妇吸烟,其婴儿的肺活量明显降低——Thechildren whose mothers smoked during pregnancy had poorer lung functions thanchildren whose mothers didn’t.

Chocolate During Pregnancy Has Good Impact on Baby

在传统的观念中,巧克力是美味高脂的代名词,令几多爱关女士垂涎欲 滴却又望而却步。但不想其对孕妇却有如下神奇功效:Eating chocolate is good for the baby。因此,为了下一代的健康,请孕妇尽情享用吧!

Status,outcome,and related factors of postpartum hypertension in the Shanghai community

BACKGROUND Postpartum hypertension poses a considerable health risk.Despite research on gestational hypertension,comprehensive studies focusing on postpartum hypertension in communities are limited.Understanding its prevalence and associated risk factors is crucial for effective prevention and management.AIM To provide insights for postpartum hypertension’s prevention and management.METHODS In total,3297 women who gave birth between June 2021 and December 2022 in Xuhui District,Shanghai were selected.Blood pressure was measured thrice within one month post-delivery during home visits.Eighty-six women with hypertension were followed up for four months to analyze hypertension persistence and its related risk factors.A predictive model for persistent postpartum hypertension was established and verified using the Nomo diagram model.RESULTS Hypertension prevalence 1 month post-delivery was 2.61%(86/3297).Among the 86 pregnant women,32(37.21%)had persistent hypertension at four months post-delivery.Multivariate logistic regression analysis revealed that older age[odds ratio(OR)=1.212;95%confidence interval(CI):1.065–1.380]and higher pre-pregnancy body mass index(BMI)(OR=1.188;95%CI:1.006–1.404)were associated with hypertension(OR=10.781;95%CI:1.006–1.404)during pregnancy.A 95%CI of 1.243–93.480 is a risk factor for persistent postpartum hypertension.The Nomograph model accurately predicted the risk of persistent postpartum hypertension,demonstrating high precision.CONCLUSION In Xuhui,older age,higher pre-pregnancy BMI,and gestational hypertension are risk factors for persistent postpartum hypertension.Our prediction model can identify high-risk individuals,thereby improving patient quality of life.

The Diagnostic Significance of Ultrasound and Ultrasound-guided Coarse Needle Biopsy in Breast Cancer in Pregnancy

Objective:To explore the significance of ultrasound and ultrasound-guided coarse needle biopsy in the clinical diagnosis of breast cancer patients in pregnancy.Methods:A total of 10 patients with breast cancer in pregnancy were selected to study from October 2018 to October 2019 in our hospital,who were given preoperative ultrasound results and ultrasound-guided coarse-needle biopsy histopathology,and the results were analyzed.Results:All the 10 patients showed thickening of the mammary gland body,appeared to pick up disorderly situation,most of the dilated catheter,including 8 patients with solid hypoechoic mass,irregular shape,and“crab foot”edge burr.The corresponding aspect ratio value was greater than 1.The other 2 patients presented with cystic mixed masses with poor boundary definition,irregular shape,and mostly accompanied by posterior echo enhancement.Conclusion:Simple ultrasound diagnosis for patients with breast cancer during pregnancy has some errors,and should be used in combination with ultrasound-guided coarse needle biopsy operation.This method has a high clinical diagnosis rate and significant clinical application value,so it is worth promoting.

The Recollection of Morning Sickness and Their Support System as Documented by Women Post Pregnancy

Nausea during pregnancy affects about ten percent of all pregnant women. The causes of nausea and vomiting during pregnancy are unclear. The condition can lead to dehydration, electrolyte derangement, impaired organ function and lead to serious health issues or even death if left untreated. The treatment conducted today is symptomatic and is not completely satisfactory. Objective: The purpose of the study was to describe women’s experience of morning sickness and their experience of support. Design: Data was collected through a semi-structured questionnaire and analyzed by qualitative content analysis. Participants: Nine women responded to the survey. Results: The result shows that women who suffer from morning sickness during pregnancy feel a loss of control over their lives which has a significant impact on their mental and physical health making it difficult to function normally. Feelings of isolation, loneliness and alienation are common. It is essential that midwives are attentive in order to provide the help and support that these women require. Conclusion: It is essential that the personnel providing the care are knowledgeable about the condition. More research is necessary to find the root cause of the condition in order to develop effective strategies for treatment.

Viruses and autism: A Bi-mutual cause and effect

Autism spectrum disorder(ASD)is a group of heterogeneous,multi-factorial,neurodevelopmental disorders resulting from genetic and environmental factors interplay.Infection is a significant trigger of autism,especially during the critical developmental period.There is a strong interplay between the viral infection as a trigger and a result of ASD.We aim to highlight the mutual relationship between autism and viruses.We performed a thorough literature review and included 158 research in this review.Most of the literature agreed on the possible effects of the viral infection during the critical period of development on the risk of developing autism,especially for specific viral infections such as Rubella,Cytomegalovirus,Herpes Simplex virus,Varicella Zoster Virus,Influenza virus,Zika virus,and severe acute respiratory syndrome coronavirus 2.Viral infection directly infects the brain,triggers immune activation,induces epigenetic changes,and raises the risks of having a child with autism.At the same time,there is some evidence of increased risk of infection,including viral infections in children with autism,due to lots of factors.There is an increased risk of developing autism with a specific viral infection during the early developmental period and an increased risk of viral infections in children with autism.In addition,children with autism are at increased risk of infection,including viruses.Every effort should be made to prevent maternal and early-life infections and reduce the risk of autism.Immune modulation of children with autism should be considered to reduce the risk of infection.

Clinical feature and predictive factor analysis for spontaneous regression of retinopathy of prematurity in a Chinese population

AIM:To investigate the ratio of spontaneous regression of retinopathy of prematurity(ROP)and to explore the possible relevant predictive factors.METHODS:A retrospective review of 405 infants who were diagnosed with ROP and mother during pregnancy were collected.Stage,zone,and duration of ROP were recorded.Statistical analysis was performed on 51 possible predictive factors.RESULTS:Totally 356 infants showed spontaneous regression.The incidence was 100%,95.3%,and 22.7%in stage 1,2,and 3,respectively.The 13.4%of the ROP with plus disease eventually resolved spontaneously.All affected eyes of aggressive posterior retinopathy of prematurity(APROP)failed to spontaneously regress.The mean duration of ROP was 7.2wk in patients with spontaneous resolution of ROP.Days of mechanical ventilation(OR=0.981,95%CI,0.965-0.997,P=0.021),retinal hemorrhage(OR=0.173,95%CI,0.064-0.470,P=0.001),delivery pattern(OR=2.750,95%CI,1.132-6.681,P=0.025),maternal anemia in pregnancy(OR=0.142,95%CI,0.036-0.563,P=0.005),the stages(at initial diagnosis OR=0.183,95%CI,0.041-0.816,P=0.026;at final diagnosis OR=0.031,95%CI,0.006-0.167,P<0.001),and with plus disease or not(OR=0.005,95%CI,0.001-0.031,P<0.001)were independent predictive factors of the spontaneous regression of ROP.CONCLUSION:Most mild ROP can spontaneously resolve.Active treatment is still recommended for stage 3 ROP,zone I ROP,AP-ROP,and ROP with plus disease.Prolonged mechanical ventilation and concurrent retinal hemorrhage reduce the likelihood of spontaneous ROP resolution.The pattern of delivery and the mother's anemia during pregnancy can also affect the prognosis of ROP.

Impact of different stereoisomers of inositol on insulin sensitivity of gestational diabetes mellitus patients

BACKGROUND Inositol is a hexa-carbon polyol,a naturally soluble vitamin,often found in various foods.AIM To discuss the impact of different stereoisomers of inositol on insulin sensitivity of gestational diabetes mellitus(GDM)patients.METHODS Eighty GDM pregnant women were divided into four groups according to their treatment received:A group(placebo folic acid 400μg/d),B group[myo-inositol(MI)1500 mg,twice a day],C group[D-chiro-inositol(DCI)250 mg,twice a day],and D group(inositol MI and inositol DCI 1500 mg/250 mg,twice a day).Each patient routinely used dietary guidance adjustments and did some safe and effective aerobic exercise in addition to receiving placebo or inositol from GDM diagnosis to delivery.Triglyceride,total cholesterol,fasting plasma glucose,oral glucose tolerance test postprandial glucose(2 h postprandial blood glucose),fasting insulin,fasting plasma glucose,and glycosylated hemoglobin levels and Homeostasis Model Assessment-insulin resistance(HOMA-IR)and Homeostasis Model Assessment-insulin sensitivity index(HOMA-ISI)scores were determined before treatment and 8 wk after treatment onset.Adverse maternal and infant outcomes,including hypoglycemia,excessive amniotic fluid,premature infants,macrosomia,fetal distress etc.,were also recorded.RESULTS There was no statistical difference in the baseline data of each group.The levels of 2 h blood glucose,glycosylated hemoglobin,fasting insulin,total cholesterol,and triglyceride in the B,C,and D groups were significantly lower than those in the control group(A group)after treatment(P<0.05).Moreover,compared with the B group,the level of the above indexes in the C and D groups decreased more significantly,and the differences were statistically significant(P<0.05).The HOMA-IR of B,C,and D groups decreased significantly,and the HOMA-ISI increased significantly compared with the A group,and the differences were statistically significant(P<0.05),among which the decrease of HOMA-IR and the increase of HOMA-ISI were more significant in the C and D group compared with the B group(P<0.05).The occurrence rate of adverse maternal and infant outcomes in the C and D group was significantly lower than that in the control group(A group),and the differences were statistically significant(P<0.05).CONCLUSION Treatment with different inositol stereoisomers(inositol MI and inositol DCI)can improve insulin sensitivity and reduce insulin resistance in diabetic patients,and inositol DCI has a better curative effect than inositol MI.

Non-Invasive Positive Pressure Ventilation (NIPPV) in the Pregnant Patient: A Case Series

Rationale: Acute respiratory failure is an uncommon complication of pregnancy. However, it is the most frequent organ dysfunction associated with obstetric admissions to an intensive care unit. The obstetric population is a different group due to its physiology and the presence of the fetus that lacks evidence in the literature within the subject of ventilatory support. Noninvasive positive pressure ventilation (NIPPV) is often avoided due to the lack of knowledge on the safety and efficacy of this modality. Currently, there are no guidelines for the management of respiratory failure in pregnancy. Objectives: To provide evidence in support of the use of NIPPV as a safe and reasonable modality for pregnant patients with respiratory failure. Methods: We retrospectively reviewed medical records of 29 pregnant patients of the Obstetric Critical Care Unit of a tertiary hospital in Panamá City who received NIPPV from 2013 to 2015. Failure to response was defined as the lack of increase in the paO2/FiO2 ratio or clinical deterioration 6 hours after initiating NIPPV. Demographics, indication for NIPPV, duration of treatment, as well as maternal and fetal outcomes were collected. Measurements and Main Results: Mean age was 28.4 ± 6 years, mean body mass index 27.4 ± 3.3, and mean gestational age at admission was 305/7 ± 5 weeks. Twenty-four patients (82.8%) met the criteria for acute lung injury (ALI) and an additional two (6.9%) for acute respiratory distress syndrome (ARDS). The mean duration of ventilation was 50.6 ± 17.27 hours. Statistically significant differences were noted between the paO2/FiO2 ratios in failure and successful patients within 2 hours of NIPPV therapy (P = 0.007) and paO2/FiO2 ratio within 6 hours of NIPPV therapy (P = 0.03). Success was defined when the patient was administered NIPPV, resulting in an improvement (increase in pa/FiO2 ratio) of her ventilatory parameters. Three patients (10.3%) failed to respond to NIPPV and needed to be converted to invasive mechanical ventilation. Patients who required intubation had a longer duration of ICU stay (P = 0.006) and overall hospital stay (P = 0.03). None of patients presented aspiration during NIPPV therapy. Conclusion: The current series is the largest report of pregnant patients requiring ventilatory support who received NIPPV as first line of therapy. This report shows the usefulness of this ventilation modality, avoiding intubation with its risks, of a significant number of patients, especially ventilator-associated pneumonia.

Effects of Serum Cortisol Levels on Perinatal Prognosis in Patients with Hypertensive Disorder

Objective:To investigate the effect of serum cortisol level on perinatal prognosis in patients with hypertensive disorder during pregnancy.Methods:In this study,different degrees of patients with hypertensive disorder during pregnancy who were admitted from August 2018 to August 2019 in our hospital were selected as the research subjects,and divided into groups according to the severity of the patients’conditions.The 120 patients were divided into gestational hypertension group,preeclampsia group and eclampsia group,with 40 cases each,and another 40 healthy pregnant women were selected.The detection of serum cortisol levels was carried out for the above 4 groups of pregnant women.Results:The serum cortisol level in the control group was(260.35±10.96)nmol/L.The case number of neonatal asphyxia was 1(2.50%),the case number of premature births was 1(2.50%),the number of fetal growth restriction was 1(2.50%),the number of deaths was 0,and the other three groups were higher than this.It showed as gestational hypertension<preeclampsia<eclampsia.The Apgar score of pregnant women in the control group was(9.13±0.29),the ZL index was(1.07±0.07),and the other three groups were lower than this.It showed as gestational hypertension>preeclampsia>eclampsia.There were significant differences between groups(all P<0.05).Conclusion:Early detection of serum cortisol levels in pregnant women is beneficial to timely improve the symptoms of gestational hypertension,thereby suppressing the effects of serum cortisol on perinatal infants and improving the prognosis of newborns.