Intermediate hyperglycemia in early pregnancy:A South Asian perspective

“Intermediate hyperglycemia in early pregnancy(IHEP)”refers to mild hyperglycemia detected before 24 gestational weeks(GW),satisfying the criteria for the diagnosis of gestational diabetes mellitus.Many professional bodies recommend routine screening for“overt diabetes”in early pregnancy,which identifies a significant number of women with mild hyperglycemia of undetermined significance.A literature search revealed that one-third of GDM women in South Asian countries are diagnosed before the conventional screening period of 24 GW to 28 GW;hence,they belong in the IHEP category.Most hospitals in this region diagnose IHEP by oral glucose tolerance test(OGTT)using the same criteria used for GDM diagnosis after 24 GW.There is some evidence to suggest that South Asian women with IHEP are more prone to adverse pregnancy events than women with a diagnosis of GDM after 24 GW,but this observation needs to be proven by randomized control trials.Fasting plasma glucose is a reliable screening test for GDM that can obviate the need for OGTT for GDM diagnosis among 50%of South Asian pregnant women.HbA1c in the first trimester predicts GDM in later pregnancy,but it is not a reliable test for IHEP diagnosis.There is evidence to suggest that HbA1c in the first trimester is an independent risk factor for several adverse pregnancy events.Further research to identify the pathogenetic mechanisms behind the fetal and maternal effects of IHEP is strongly recommended.

Clinical Observation of Disposal Uterine Cavity Observation and Suction Surgery System on Terminating Pregnancy in Very Early Pregnancy

Objective: To compare the clinical effects of uterine cavity observation and suction surgery system with ultrasound guided induced abortion in very early pregnancy induced abortion surgery. Method: Select 80 patients who requested termination of pregnancy due to early pregnancy from August 2022 to April 2023, and analyze the data. 40 patients who underwent ultrasound-guided induced abortion to terminate pregnancy were included in the control group, and 40 patients who underwent uterine cavity observation surgery to terminate pregnancy were included in the observation group. Compare the surgical time, number of times the straw enters the uterine cavity, incidence of complications, and menstrual recovery time between the two groups. Results: There was no statistically significant difference in the surgical time between the observation group and the control group, but the number of times negative pressure straws entered the uterine cavity and the incidence of surgical complications in the observation group were significantly lower than those in the control group (P Conclusion: Applying the uterine cavity observation and suction surgical system to terminate pregnancy in very early pregnancy has the advantages of minimal damage to the uterus and low incidence of surgical complications, greatly protecting the patient’s fertility.

Factors Associated with Early Pregnancy among Adolescent Girls in Schools in Bohicon, Benin in 2022

Introduction: The growing phenomenon of early pregnancies in Benin has adverse consequences on the lives of adolescent girls, impacting various social, health, economic, and educational aspects. This study aims to identify the factors associated with early pregnancies in the municipality of Bohicon in 2022. Materials and Methods: This is a case-control study conducted in Bohicon, involving 47 cases and 94 controls from 16 secondary and technical schools. Cases were selected exhaustively, while controls were randomly drawn from girls aged 10 to 19 in the same class who had never been pregnant. Matching was based on the type of institution and class. Data were collected through a questionnaire and analyzed using Epi info 7.2.1.0 and STATA 15 software, employing multiple conditional logistic regression (5% significance threshold) to identify factors related to early pregnancies. Results: The average age of adolescents was 17.63 years ± 0.09 for cases and 17.12 years ± 0.13 for controls. Associated factors included age over 16 years (p = 0.049), the marital status of the adolescent (single) (p = 0.001), and the monthly pocket money of the adolescent less than 10,000 FCFA (p = 0.031). Conclusion: Three factors related to early pregnancies were identified. To counteract this phenomenon and promote responsible sexuality among adolescents, it is essential to strengthen communication efforts aimed at modifying behaviors.

Clinical Observation on Termination of Early Pregnancy of 213 Cases after Caesarian Section with Repeated Use of Mifepristone and Misoprostol

Objective To investigate the efficacy and safety in women after caesarian section for termination of early pregnancies by treatment, or repeated treatment with mifepristone and misoprostol. Subjects and Methods A total of 213 pregnant women with amenorrhea of 34~69 d after caesarian section who asked for medical abortion were recruited, including 63 cases undergoing their second medical abortion. A total amount of mifeprisstone of 150 mg given in separate doses (25 mg×4 and 50 mg at the first time) was administered orally within 3 d, followed by misoprostol of 0.6 mg orally in the morning of d 3. Results The complete abortion rate was 92.5%, incomplete abortion was 4.7% and failure was 2.8%. Conclusion The sequential use of mifepristone and misoprostol could be successfully and repeatedly used for induced abortion in those women with a caesarian section history. Its efficacy was similar to that for ordinary population. Its safety and effectiveness were satisfactory.

Expression of TET and 5-HmC in Trophoblast Villi of Women with Normal Pregnancy and with Early Pregnancy Loss

Increasing evidence suggests that epigenetic dysfunction may influence the stability of normal pregnancy. The ten-eleven translocation （TET） family and 5-hydroxymethylcytosine （5-hmC） were found to be linked with epigenetic reprogramming. The present study aimed to examine the expression of the TET family and 5-hmC in the villi of human embryos and compared their expression between normal pregnancy and early pregnancy loss （EPL）. Embryonic villi were collected from normal pregnant women （control） experiencing medical abortion and from EPL patients at gestation ages of 6, 7 and 8 weeks. The mRNAs of TET family were analysed using quantitative polymerase chain reaction （qPCR）, and TET proteins using Western blotting and immunohistochemical analysis. The MethylFlashTM Kit was used to quantify the absolute amount of 5-methylcytosine （5-mC） and 5-hmC. Our results showed that the expression of the TETs and 5-hmC in the normal villus decreased with increasing gestational age. Immunohistochemistry revealed that the TET proteins were expressed in the cytoplasm of trophoblasts and their expression was the highest in the 6-week tissue samples, which was consistent with the qPCR and Western blot results. The expression of TET1, TET2, and TET3 was lower in the villi in EPL group than in normal pregnancy group （P〈0.05 for all）. It was concluded that the TET family and 5-hmC are critical in epigenetic reprogramming of human embryo. The findings also suggest that a deficiency of TETs in the villus might be associated with human EPL.

Influence of Early Pregnancy Termination by Focused Ultrasound Beams on Menstrual Recovery of Macaques

Objective To explore the effects on macaques’ menstrual recovery after terminating early pregnancy by focused ultrasound beams (FUB) Methods FUB was used to terminate early pregnancy in 5 macaques with gestation duration ranging from 37-66 d. Two circles after the recovery of menstruation, color Doppler flow imaging (CDFI) and magnetic resonance imaging (MRI) were used to estimate the shape, size and blood flow of uterus, and pathological examinations were performed to check against any lesions to uterine endometrium and ovary. Results Forty days after FUB abortion, menstruation recovered and the volume and duration of each macaque’s menstruation were not changed compared with those be- fore gestation. CDFI and MRI suggested that the size and shape of uterus were normal. The endometrial line was clear and no lesions were found in adjacent organs. Conclusion FUB termination of early pregnancy in macaques did not damage their ovarian tissue and had no influence on subsequent menstrual recovery.Key words: focused ultrasound beams (FUB); macaque; early pregnancy; menstrual recovery

Research Progress about Nature of Early Pregnancy Factor

Platelet-activating factor (PAF) exhibits a variety of biological activities and it be thought to involved in various pathophysiological process. In this paper, some studies were summarized about those roles of PAF in a variety productive processes of female of mammalian that include fertilization, implantation and parturition, and that was involved in the concentration, degradation and some assay methods of PAF. The relationship between PAF and early pregnancy factor(EPF was reviewed.

Effect of Low Dose of Mifeprostone in Capsules combined with Misoprostol on Termination of Early Pregnancy

ve In this double-blind randomized trial, we compare the effect of 75 mg mifeprostone in capsules on termination of early pregnancy was compared with that of 150 mg in tablets combined with misoprostol.

TRANSVAGINAL COLOR DOPPLER STUDY OF UTEROPLACENTAL CIRCULATION IN NORMAL EARLY PREGNANCY

A cross sectional transvaginal color Doppler study of the uteroplacental circulation was performed on 105 pregnant women with normal intrauterine pregnancy. Gestational age was ranged from 4 to 12 weeks. The blood flow velocity waveforms were obtained from four separate parts of the uteroplacental circulation: uterine, arcuate, radial, and spiral arteries. The resistance index (RI) and peak systolic velocity (PSV) were analyzed. The RI significantly decreased and PSV increased with advancing gestation in uterine artery and its branches (P<0 05). The RI gradully decreased from uterine artery through arcuate, radial to spiral arteries (P<0 05). At the same time, the PSV decreased from uterine artery then arcuate to radial artery, but PSV in spiral arteries were higher than that in radial artery (P<0 05). The results showed that transvaginal color Dopper ultrasonography was a simple, reliable method to assess the uteroplacental circulation in the early pregnancy; the detection of PSV was useful parameter for better understanding of physiological and pathophysiological hemodynamic changes as well as RI.

ISOLATION AND CHARACTERIZATION OF EARLY PREGNANCY FACTOR

Early pregnancy factor (EPF) was purified from the pooled sera of 21 0 pregnant women at 3- 8 weeks of gestation. Sera from healthy nonpregnant women were used as control. The samples (G-Ⅱ . G-Ⅲ and G-Ⅳ) obtained from pregnant women had EPF activity but no HCG activity. Polyacrylamide gel electrophoresis showed that the major bands in pregnant G-Ⅲ and G-Ⅳ were at similar positions in tube gels. The results of SDS-PAGE showed 3 bands in pregnant G-Ⅳ: 57. 0 kD. 38. 0 kD and 19. 0 kD. The basic active form of EPF may be a small peptide of 1 9. 0 kD. The isoelectric points of pregnant G-Ⅳ were 6. 45 and 8. 20.

Implementation and Evaluation of Infertility Reflection in Early Pregnancy after the Use of Assisted Reproductive Technology: A Feasibility Study

Background: This study aims to evaluate the infertility reflection in early pregnancy after assistive reproductive therapy (ART), including 1) process evaluation (the use and evaluation of infertility reflection) and 2) outcome evaluation (satisfaction of care needs, anticipatory anxiety towards the loss of a pregnancy or fetus, cognition of infertility experience, and depression and anxiety). Methods: This program evaluation study used a one-group pre-post-test design. The participants were 50 primiparas who had undergone ART at two fertility treatment facilities in a metropolitan area in Japan. For the infertility reflection, they conducted an online reflection. Data were collected three times: at the 5th week of pregnancy (Time 1), the 8th week of pregnancy as the final consultation at the clinic (Time 2), and the 16th week of pregnancy as the final point of early pregnancy (Time 3). Results: The data from 40 participants were analyzed. More than 80% of the users of the online reflection positively evaluated the appropriateness and usefulness of the methods and contents. Organized thoughts and feelings by reflection were shown as the reasons for the usefulness. The evaluation of the online reflection showed a relatively strong correlation with the Care Need Satisfaction Scale (CNSS) for both Time 2 and Time 3, but the online reflection did not show a significant correlation with the other outcome variables. There were no significant differences in outcome variables between users and non-users of online reflection between Time 2 and Time 3. Conclusions: Attempts at the reflection in early pregnancy require modified methods that do not have a negative impact and lead to the fulfillment of needs.

''Blue Dream Pregnancy Test Strip''For Detecting Early Pregnancy

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Deep vein thrombosis in early pregnancy:A retrospective study

Objective:To investigate the clinical characteristics,management,and prognosis of deep vein thrombosis(DVT)during early pregnancy.Methods:We conducted a retrospective study among women with DVT during their first trimester of pregnancy who were admitted to the obstetrics department of Peking University People's Hospital between March 2008 and May 2021.We analyzed clinical data of eight patients,including their general condition,obstetric characteristics,diagnosis,treatment,and gestational outcomes.Results:Risk factors for DVT in the first trimester included personal history of DVT,thrombophilia and immune diseases,and DVT was more likely to affect the left leg.The main manifestation of DVT was pain or swelling of the affected limbs.D-dimer levels after anticoagulant treatment showed a downward trend compared with those before treatment(P=0.09),while D-dimer levels increased significantly after delivery compared with those before delivery(P=0.03).All the patients started on low-molecular-weight heparin(LMWH)therapy after a diagnosis of DVT.Temporary inferior vena cava(IVC)filters were implanted in 3 patients with mixed thrombosis before delivery,but were removed after the operation.Except for 1 case with thrombophilia who refused treatment,others underwent anticoagulation therapy from 6 weeks to 1 year postpartum.Seven patients achieved a successful delivery with live births.Conclusion:During early pregnancy,DVT was more common in women with maternal risk factors.More cases of venous thromboembolism(VTE)were observed in the left leg.For women with a high risk of DVT,medical intervention,early identification,accurate diagnosis and precise treatment during early pregnancy should be promoted.

Medication Rules of Traditional Chinese Medicine for Treating Threatened Abortion in the Early Stage of Pregnancy with Subchorionic Haematoma Based on Data Mining

Objective:Using data mining technology to explore the rules of traditional Chinese medicine(TCM)in the treatment of threatened abortion in the early stage of pregnancy with sub-chorionic haematoma(SCH).Methods:Literature of TCM in the treatment of threatened abortion in the early stage of pregnancy with SCH were retrieved from CNKI,VIP,WANFANG and Pubmed,EMBASE.The literature information database was established to be used for descriptive analysis,association rule analysis and cluster analysis of relevant data.Results:A total of 100 literatures were included,involving 114 Chinese herbs.The efficacy of Chinese herbs were mainly tonic drugs,hemostatic drugs,heat-clearing drugs,dissolving blood stasis and hemostatic drugs.The medicinal properties were mostly mild and warm,and the taste of the drug was mainly sweet,bitter and pungent.The liver meridian,spleen meridian and kidney meridian were frequently used.The commonly used drug pair combination was"Xu duan(Radix dipsaci,续断)-Tusizi(Semen Cuscutae,菟丝子)",and the core combination was"Tusizi-Xu duan-Ejiao(Donkeyhide gelatin,阿胶)-Baizhu(Atractylodes macrocephala,白术)-Dangshen(Codonopsis pilosula,党参)".Commonly used drugs for removing blood stasis and hemostasis were with Sanqi(Panax notoginseng,三七),Puhuang(cattail pollen,蒲黄),and Qiancao(Radix Rubiae,茜草).Conclusion:Data mining traditional Chinese medicine for the treatment of threatened abortion in the early stage of pregnancy with SCH clinically commonly used drug efficacy,taste,meridian,commonly used drug pairs,core combination and commonly used blood stasis hemostatic drugs,has important reference significance for the treatment of threatened abortion in the early stage of pregnancy combined with SCH.

Excessive gestational weight gain in early pregnancy and insufficient gestational weight gain in middle pregnancy increased risk of gestational diabetes mellitus

Background:Gestational weight gain(GWG)is associated with the risk of gestational diabetes mellitus(GDM).However,the effect of weight gain in different trimesters on the risk of GDM is unclear.This study aimed to evaluate the effect of GWG on GDM during different trimesters.Methods:A birth cohort study was conducted from 2017 to 2020 in Shenzhen,China.In total,51,205 participants were included comprising two models(early pregnancy model and middle pregnancy model).Gestational weight(kg)was measured at each prenatal clinical visit using a standardized weight scale.Logistic regression analysis was used to assess the risk of GDM.Interaction analysis and mediation effect analysis were performed in the middle pregnancy model.Results:In the early pregnancy model,the risk of GDM was 0.858 times lower(95%confidence interval[CI]:0.786,0.937)with insufficient GWG(iGWG)and 1.201 times higher(95%CI:1.097,1.316)with excessive GWG after adjustment.In the middle pregnancy model,the risk of GDM associated with iGWG increased 1.595 times(95%CI:1.418,1.794)after adjustment;for excessive GWG,no significant difference was found(P=0.223).Interaction analysis showed no interaction between GWG in early pregnancy(GWG-E)and GWG in middle pregnancy(GWG-M)(F=1.268;P=0.280).The mediation effect analysis indicated that GWG-M plays a partial mediating role,with an effect proportion of 14.9%.Conclusions:eGWG-E and iGWG-M are associated with an increased risk of GDM.Strict control of weight gain in early pregnancy is needed,and sufficient nutrition should be provided in middle pregnancy.

Pregnancy-associated glycoproteins as a potential marker for diagnosis of earlypregnancy in goats: A scoping reviewing

Early diagnosis of pregnancy plays an important role to minimize reproductive losses in farm animals.There are several methods for pregnancy diagnosis like profiling of reproductive hormones(such as progesterone and estrone sulfate),but sometimes they provide false-positive results.Embryo specific pregnancy markers,which delineate the presence and viability of the embryo,are considered as perfect for pregnancy determination.Pregnancy-associated glycoproteins are distinguished as the best indicator for the determination of early pregnancy,fetal number,and birth weight of kids.Pregnancy-associated glycoproteins are structurally correlated to aspartic proteinase and are communicated in the external epithelial cell layer of the placenta.They have been found to share about half amino acid sequence identity with pepsinogen,pepsin,cathepsin D and E.Dislike different individuals from aspartic proteinase family,numerous pregnancy-associated glycoproteins appear to be latent compound as a result of amino acid substitutions in and around the catalytic site.This review is to discuss the scope and prospects of pregnancy-associated glycoproteins as a pregnancy marker in farm animals,more specifically in goats.

Do specific ultrasonography features identified at the time of early pregnancy loss predict fetal chromosomal abnormality? e A systematic review and meta-analysis

To investigate the association of specific ultrasonography features identified during the diagnosis of early pregnancy loss(EPL)and abnormal karyotype.This was a systematic review and meta-analysis conducted in accordance with PRISMA criteria.We searched PubMed,Cochrane and Ovid MEDLINE from 1977 to Jan 2017 to identify the articles that described EPL with karyotype and ultrasonography features.Risk differences were pooled to estimate the chromosomal abnormality rates in ultrasonography features,including pre-embryonic,enlarged yolk sac(YS),short crown rump length(CRL),small gestational sac(GS),symmetrical arrested growth embryo,or gestational sac with only a YS.Quality assessment of included studies was performed using Strengthening the Reporting of Observational Studies in Epidemiology(STROBE)checklists for Observational Studies(2007 version).Thirteen studies were included in the meta-analysis.Chromosomal abnormality was more likely to occur in embryonic EPL and enlarged YS.On the other hand,short CRL,small GS,symmetrical arrested growth embryo,or gestational sac with only a YS,were not associated with an increased risk of fetal chromosomal abnormality.Ultrasonography features at the time of diagnosis of EPL have limited predictive value of fetal chromosomal abnormality.

Clinical Pharmacodynamics of Mifepristone（RU486） for Termination of Early－Pregnancy

Twenty-four healthy female volunteers with amenorrhea for seven weeks or less.asking for legal termination of pregnancy were recruited and divided into 4 groups (6 each). The subjects were orally administered with RU486 of 50mg (Group Ⅰ). 50mg Q12hx 6 (GrouP Ⅱ),200mg(GrouP Ⅲ)or 600mg(Group Ⅳ).Vacuum aspiration(GrouP Ⅰ)or Methyl Carprost Suppository(PGOS 1.0mg)(GrouP Ⅱ-Ⅳ)was given 72h after the firsl dose followed by a 6--hour medl'cal survel'llance.Blood samples were collected on day 1-6,8,15,43 to measure the serum levels of β-hCG,E2,P,PRL,ACTH, Cortisol,T3,T4 and TSH in each subject.The results showed that no significant dose-effect relationship was observed in terms of clinical efficacy,vaginal bleeding or side effects.All four groups shared the same tendency of changes in serum levels of β-hCG,E2 and P.β-hCG levels increased by 50-100% (P<0.01)24h prior to treatment,and continued ic ipcrease following lreatment until the sac expulsion.EZ levels l'n each group reinal'ned higher than pre-treatment values with the gradual decline in P levels.β-hCG,E2 and P decreased drastically after abortion,levels of β-hCG,E2,P on day 5 were only 35-60% (P<0.01),32-46%(P<0.01)and 30-56%(P<0.01)of those on day 4 respectively.The mean PRL levels on day 2-4 in each group increased obviously but declined gradually following the sac ex.pulsion.During treatment,the respective cortisol levels increased dramatically,the average levels ofcortisol on day 2-4 were 30-40%(P<0.05) l'n GrouP Ⅰ-Ⅲ and 60%(P< 0.01) in Group Ⅳ higher as compared with day 1 values, while decreased rapidly af ter termination of pregnancy as indicated that cortisol levels on day 5 were only 67-81%(P<0.05) of those on day 4.The changes in ACTH,T3,T4,TSH levels were of no statistic sigulAance(P>0.05).This study indicated that RU486 has no dose-effect relationship when used for interruption of early pregnancy and its main action site seems neither in ovary nor in villi.It has some effects on pituitary-adrenal axis,especially in large dosage,however,it has no obvious impact on pituilary-thyroid axis.It seems that the changes in PRL serum levels were directly due to the drug itsed ifs clinical significance should be further studied.

The analysis of the changes of maternal thyroid autoantibodies during early pregnancy

Objective To investigate the changes and related factors of maternal thyroid autoantibodies during early pregnancy.Methods Urinary iodine concentration（UIC）,serum thyroid stimulating hormone（TSH）,free thyroxine（FT4）,thyroid-peroxidase antibody（TPOAb）,thyroglobulin antibody（Tg Ab）concentrations were determined in 7 190 women during early pregnancy in an iodine-sufficient region of China.Results The prevalence of TPOAb positivity and Tg Ab positivity was 8.

Study on the correlation and predictive value of serum pregnancyassociated plasma protein A, triglyceride and serum 25-hydroxyvitamin D levels with gestational diabetes mellitus

BACKGROUND Gestational diabetes mellitus(GDM)is a concern due to its rapid increase in incidence in recent years.AIM To investigate the correlation and predictive value of serum pregnancyassociated plasma protein A(PAPP-A),triglyceride(TG),and 25-hydroxyvitamin D[25-(OH)D]with GDM in early pregnancy.METHODS A total of 99 patients in early pregnancy admitted to Peking University International Hospital from November 2015 to September 2017 were included,and underwent a fasting glucose test and oral glucose tolerance test screening at 24-28 wk of pregnancy.Of these cases with GDM,51 were assigned to group A and the remaining 48 cases without GDM were enrolled in group B.Serum PAPP-A,TG and 25-(OH)D in the two groups were compared and their correlation with blood sugar was analyzed.In addition,their diagnostic value in GDM was determined using receiver operating characteristic(ROC)curve analysis.RESULTS Group A had markedly lower serum PAPP-A and 25-(OH)D levels and a significantly higher serum TG level than group B,with statistical significance(P<0.05).Furthermore,Pearson analysis identified that PAPP-A and 25-(OH)D levels were negatively correlated with fasting blood glucose(FBG)levels(r=-0.605,P<0.001),(r=-0.597,P<0.001),while TG and FBG levels were positively correlated(r=0.628,P<0.001).The sensitivity,specificity,area under the curve(AUC)and optimal cut-off value of serum PAPP-A level in the diagnosis of GDM were 72.55%,82.35%,0.861 and 16.340,respectively,while the sensitivity of TG in diagnosing GDM was 86.27%,the specificity was 66.67%,the AUC was 0.813,with an optimal cut-off value of 1.796.The corresponding sensitivity,specificity,AUC and optimal cut-off value of serum 25-(OH)D were 64.71%,70.59%,0.721 and 23.140,respectively.Moreover,multivariate logistic regression analysis revealed that FBG,vascular endothelial growth factor,Flt-1,serum PAPP-A,TG,and 25-(OH)D were related risk factors leading to GDM in patients.CONCLUSION Serum PAPP-A,TG,and 25-(OH)D levels are all correlated with blood glucose changes in GDM,and are independent factors affecting the occurrence of GDM and have certain value in the diagnosis of GDM.