Christof Worda

Does the mode of delivery influence sexual function after childbirth

OBJECTIVE The aim of the study was to evaluate the influence of the mode of delivery on female sexuality 12-18 months after childbirth. METHODS Fifty-five primiparae who delivered vaginally without complication and 44 who underwent elective cesarean section after 37 weeks of gestation were included. Sexual function was assessed by a validated self-reported questionnaire, the Female Sexual Function Index (FSFI), 12 months after birth and compared between groups. Additionally, we have analyzed subjective stress variables recorded after birth between the two groups. RESULTS Women with cesarean section were older (p = 0.002) and had a higher body mass index (BMI) (p =0.02). The total score of the FSFI was not significantly different between the groups. Patients recall of dyspareunia at 3 months after childbirth was higher in those who underwent vaginal delivery (p < 0.001). CONCLUSIONS We suggest that there is no significant difference in sexual function 12-18 months after childbirth between women who delivered vaginally without episiotomy, heavy perineal laceration, or secondary operative interventions and women who underwent elective cesarean section.

Human papillomavirus in the cervix and placenta.

Objective To determine the prevalence and association of human papillomavirus (HPV) infection in the cervices and placentas of pregnant women. Methods Cervical samples were taken from 179 of 226 women who had placental biopsies because of abnormal ultrasound findings or were older than 35 years, to detect HPV infections with hybrid capture II tests. Polymerase chain reaction (PCR) was done on placental tissue of 147 of the 226 women to detect HPV DNA. Results We found 44 of 179 women (24.6%, 95% confidence interval 18.3, 31.0) to test positive for HPV in their cervices. Logistic regression analyses showed decreased prevalence of HPV infection with increased maternal age (P = .039). The HPV DNA E6 PCR from the villus tissue was negative in the 147 cases examined. However, a significant contingency coefficient between low-risk HPV infection and elevated risk of chromosome aberration was found (&phis; = V = 0.15, P = .050). Conclusion The infection rate of 24.6% in women without clinical symptoms of HPV infection was high, but there seemed to be no virus transmission to the placenta in women with subclinical infections. Low-risk cervical HPV infection might be associated with a slightly higher risk of abnormal fetal karyotype.

Prevalence of Cervical and Intrauterine Human Papillomavirus Infected in the Third Trimester in Asymptomatic Women

Objective: To study the prevalence and association of human papillomavirus (HPV) infection in the cervix of pregnant women without visible signs of genital HPV infection undergoing cesarean delivery in the third trimester and to investigate a possible HPV transmission to the fetus. Methods: All women underwent cesarean delivery between 37 and 40 weeks of gestation. Cervical samples were taken prior to cesarean delivery. Furthermore, amniotic fluid, placental tissue, and cord blood were sampled and polymerase chain reaction (PCR) or Hybrid Capture II test (Digene Corp, Beltsville, MD) was performed to detect HPV DNA. Results: We found that 56 (36.6%) of 153 women were positive for HPV in the cervix. Logistic regression analyses showed a decrease of prevalence of HPV infection with increasing maternal age (P = .02). No HPV DNA could be detected in the amniotic fluid or cord blood, whereas eight placental specimens were positive for HPV DNA. Conclusion: The infection rate in women without clinical symptoms of HPV infection is high, but there was no HPV found in the amniotic fluid and in cord blood in women with subclinical infection in the third trimester.

Gestational diabetes mellitus is associated with increased C-reactive protein concentrations in the third but not second trimester

Objective Serum C‐reactive protein (CRP) concentrations were measured longitudinally throughout pregnancy to test the hypothesis that CRP could relate more closely to glucose tolerance than to adiposity.

Calpain-10 haplotype combination and association with gestational diabetes mellitus.

OBJECTIVE: Gestational diabetes mellitus (GDM) is a frequent complication of pregnancy. Epidemiologic and pathophysiologic data suggest a close link of this disease to non-insulin-dependent diabetes mellitus. Within the calpain-10 gene various single-nucleotide polymorphisms have been identified that increased the risk for non-insulin-dependent diabetes mellitus. Therefore, we examined single-nucleotide exchanges of this gene in women with GDM. METHODS: A total of 875 unselected women were prospectively screened for GDM. Eighty women of this population, 40 patients with an abnormal oral glucose tolerance test and 40 normal controls, were randomly selected. DNA samples isolated from sera of the control and study groups were analyzed with respect to single-nucleotide polymorphisms of the calpain-10 gene at positions 43, 19, and 63 using polymerase chain reaction amplification and restriction analysis. RESULTS: Women with GDM were more likely to be homozygous for the allele 1 of single-nucleotide polymorphism 63 (P = .02 by χ2 test). With respect to single-nucleotide polymorphisms 19 and 43, no significant differences in allele distribution were detected between controls and women with GDM. When comparing the different haplotypes for calpain-10 (single-nucleotide polymorphisms 43, 19, and 63), all women with the haplotype combination 121/221 (n = 8) had gestational diabetes (P = .005 by Fisher exact test). CONCLUSION: Our results indicate that the haplotype 121/221 of the calpain-10 gene may be associated with disturbances of glucose metabolism during pregnancy. LEVEL OF EVIDENCE: II-1

Plasminogen activator inhibitor 1 gene polymorphism and gestational diabetes mellitus.

OBJECTIVE: Plasminogen activator inhibitor 1 is thought to play a role in the pathogenesis of obesity and insulin resistance. Therefore, we examined a single nucleotide exchange in this gene in women with gestational diabetes mellitus. METHODS: A total of 887 unselected women were prospectively screened for gestational diabetes mellitus by oral glucose testing between the 24th and 28th weeks of gestation. Eighty white women of this collective, 40 patients with a pathological oral glucose tolerance test and 40 normal control subjects, were randomly selected. DNA samples were isolated from the sera and analyzed for the functional −675 4G/5G promotor polymorphisms of the plasminogen activator inhibitor 1 gene. RESULTS: Women with gestational diabetes mellitus were significantly older and had a significantly higher body mass index (BMI) than those who did not have gestational diabetes mellitus. Women with normal glucose tolerance were significantly more often homozygous for the 5G allele (P = .01), independently of maternal age or BMI. Low fasting glucose values in the oral glucose tolerance test were significantly related to homozygosity for 5G (P = .02). CONCLUSION: Homozygosity for the 5G allele of the plasminogen activator inhibitor 1 gene is associated with normal glucose tolerance in pregnant women. These findings further support a possible role of plasminogen activator inhibitor in the development of gestational diabetes mellitus. LEVEL OF EVIDENCE: II-2

IADPSG and WHO 2013 Gestational Diabetes Mellitus Criteria Identify Obese Women With Marked Insulin Resistance in Early Pregnancy

Implementation of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) and the World Health Organization 2013 (WHO 2013) recommendations leads to an increased prevalence of gestational diabetes mellitus (GDM) due to more stringent criteria and early screening of women at high risk for diabetes in pregnancy (DIP) (1,2). IADPSG members now recommend that their GDM criteria should not be used in early pregnancy but have not provided alternative criteria (3). We have compared the characteristics of overweight/obese women early in pregnancy, with and without GDM using the new criteria, to assess whether those testing positive are metabolically distinct. Pregnant women with a BMI ≥29.0 kg/m2 underwent a 75-g oral glucose tolerance test in early pregnancy as part of enrollment into the DALI (Vitamin D And Lifestyle Intervention for GDM prevention) pilot and lifestyle Pan-European multicenter trials (4). GDM and DIP were diagnosed using WHO 2013 criteria. A high rate of GDM (237/1,035 or 22.9%: DIP 0.5%; total hyperglycemia in early pregnancy 23.4%) was found at a …

Mean, lowest, and highest pulsatility index of the uterine artery and adverse pregnancy outcome in twin pregnancies

OBJECTIVE The objective of the study was to assess the use of mean, lowest, and highest pulsatility index (PI) of the uterine arteries to screen for adverse pregnany outcome in twin pregnancies. STUDY DESIGN This was a screening study of 423 twin pregnancies. Relationship between PI at 20-22 weeks and adverse pregnancy outcome was evaluated. RESULTS Mean, lowest, and highest PI above the 95th centile were significant risk factors for preeclampsia and adverse pregnancy outcome in monochorionic and dichorionic twins. We calculated a sensitivity for preeclampsia for mean, highest, and lowest PI of 35%, 29%, and 27%, respectively. CONCLUSION Increased mean, lowest, and highest PI is associated with a higher risk of preeclampsia and adverse pregnancy outcome in twins. We observed the highest sensitivity and specificity by using highest PI. The high incidence of preeclampsia in twins makes it attractive to use the PI of the uterine artery for risk stratification in twins.

Peroxisome Proliferator-Activated REceptor γ Coactivator-1α Gene Variations Are Not Associated With Gestational Diabetes Mellitus

Objective: Epidemiologic, pathophysiologic, and genetic data suggest a close link between gestational diabetes mellitus (GDM) and type 2 diabetes. Previous studies yielded controversial results on the impact of peroxisome proliferator-activated receptor γ coactivator-1α (PGC-1) gene variations on the development of type 2 diabetes mellitus. Therefore, we examined two common single nucleotide polymorphisms (SNP) of this gene in women with GDM. Methods: We assesed a total of 875 women by oral glucose tolerance testing (OGTT). Two hundred women of this population, 100 patients with an abnormal OGTT and 100 normal controls, were randomly slected. DNA samples isolated from the blood of the control and study groups were analyzed with respect to the SNP Gly482Ser and Thr394Thr of the PGC-1 gene using polymerase chain reaction (PCR) amplification and restriction analysis. Furthermore, a potential interaction between the Gly482Ser and the Thr394Thr variant on the risk of GDM was investigated. Results: Women with GDM were significantly older (32.2 ± 5.5 years vs 29.7 ± 6.1 years; P = .005), had higher body mass indices (BMI; 28.0 ± 7.1 kg/m2 vs 25.0 ± 5.7 kg/m2; p = .002) and displayed higher memoglobin A1c (HbA1c) values (5.6 ± 0.9 vs 4.9 vs 4.9 ± 0.5; P <.001). There was no significant difference between the allele distribution of the two polymorphisms in women with and without GDM. No significant associations between the two polymorphisms and BMI or OGTT values were observed. When the different haplotype combinations of the two loci were analyzed for the risk of GDM, on significant association could be found. Conclusion: Based on our data, the Gly-482Ser and the Thr394Thr polymorphisms of the PGC-1 gene are not associated with the development of GDM.

Postoperative gum chewing after gynecologic laparoscopic surgery: a randomized controlled trial.

OBJECTIVE: To investigate the effect of postoperative gum chewing on bowel motility after laparoscopic gynecologic surgery. METHODS: In this randomized controlled trial, patients were allocated to either postoperative gum chewing every 2 hours for 15 minutes or standard postoperative care without gum chewing. The studys primary end points were time to first regular bowel sounds and time to first passage of flatus after surgery. Secondary end points were time of operation to first defecation, patient satisfaction concerning postoperative gum chewing, potential side effects of postoperative gum chewing, and potential effect of gum chewing on postoperative pain therapy. RESULTS: One hundred seventy-nine patients were included in this trial. We found a significantly shorter interval between surgery and passage of first flatus in the intervention group compared with the control group (median 6.2 hours compared with 8.1 hours; P=.002) and a significantly higher rate of regular bowel sounds 3 hours (76% compared with 47%; P<.001) and 5 hours (91% compared with 78%; P=.01) after surgery. Fewer opioid analgetics were administered to patients allocated to the intervention group (P=.02). There was no significant difference in time to first defecation between groups (median 26.3 hours compared with 29.0 hours, P=.165). Gum chewing was well tolerated and well accepted by patients, and no intervention-related side effects were observed. CONCLUSION: Gum chewing seems to have beneficial effects on bowel motility when used as an adjunct treatment in postoperative care after minimally invasive surgery. Gum chewing should be recommended to patients after gynecologic laparoscopic surgery. CLINICAL TRIAL REGISTRATION: www.ClinicalTrials.gov, NCT 01549353. LEVEL OF EVIDENCE: I