Dorota Bomba-Opoń

Pregnancy risk in female kidney and liver recipients: a retrospective comparative study.

Objective: To determine and compare maternal, neonatal and graft outcomes in pregnant women after kidney or liver transplantation, who had delivered from 1 January 2005 to 1 February 2010. Methods: A retrospective, single-center study provided in Warsaw, Poland. Results: Complete data were collected in 38 deliveries in 37 women. Preexisting hypertension was present in 15 of 19 (79%) pregnant kidney recipients and in 2 of 19 (10.5%) women after liver transplantation (p < 0.000). The incidence of preeclampsia was also more often in pregnant kidney recipients (p = 0.04). Mean gestational age at labor was lower in the kidney group (34.9 ± 3.56 vs. 37.5 ± 1.62, p = 0.000). A similar relation was observed in the frequency of preterm deliveries before 37 weeks of gestation (42% vs. 11%, respectively, p = 0.02) and neonates small for gestational age (47% vs. 11%, respectively, p = 0.008). Cesarean sections were performed in approximately 79% (15/19) and 95% (18/19) liver and kidney posttransplant pregnancies, respectively. Four of 38 infants presented structural malformations. Conclusions: Pregnancies after kidney transplantation are complicated with a higher prevalence of prematurity and worse neonatal prognosis, which depends mainly on the underlying condition.

Potential first trimester metabolomic biomarkers of abnormal birth weight in healthy pregnancies

Macrosomia and low birth weight (LBW) can be associated with pregnancy complications and may affect the long‐term health of the child. The aim of this study was to evaluate the metabolomic serum profiles of healthy pregnant women to identify early biomarkers of macrosomia and LBW and to understand mechanisms leading to abnormal fetal growth not related to mothers body mass index or presence of gestational diabetes.

First trimester maternal serum vitamin D and markers of preeclampsia

Abstract Objective: There is evidence that vitamin D deficiency is associated with preeclampsia. The aim of the study was to determine if maternal levels of vitamin D at 1st trimester were related to markers of preeclampsia. Material: Serum levels of 25-hydroxy-vitamin D (25OHD), PAPP-A, PlGF, uterine artery pulsatility index and mean arterial pressure were measured in 280 pregnant women. Results: Preeclampsia markers were not related to 25OHD concentration. Conclusion: First trimester maternal serum concentration of vitamin D does not seem to be connected with markers of preeclampsia.

Maternal weight gain in women with gestational diabetes mellitus.

Abstract Objective: The aim of the study was to examine the perinatal outcomes in gestational diabetes in women with body mass index (BMI)-adjusted gestational weight gain (GWG) according to the Institute of Medicine (IOM) 2009 recommendations. Material and methods: The clinic’s database was used to analyze 675 singleton GDM pregnancy outcomes. GWG for the entire pregnancy was compared to IOM recommendations and adjusted for prepregnancy BMI categories: underweight <18.5; normal 18.5–24.9; overweight 25–29.9; and obese >30. The study group was divided into three categories: below IOM limits, within IOM limits and above IOM limits. Results: Only 37% of women achieved the proper weight gain (n=256). Almost 30% of women with GDM (n=196) had an excessive weight gain. GWG above limits was associated with a significantly higher neonatal measurements and a higher rate of large-for-gestational-age neonates. In underweight and normal-prepregnancy-weight women, no relation between GWG and birth-weight percentile was noted. For the overweight and obese women, a positive significant correlation between GWG until GDM diagnosis and birth-weight percentile was noted (P=0.002), which was not present when GWG until delivery was considered. Conclusions: Limited weight gain in overweight and obese women with gestational diabetes mellitus results in favourable pregnancy outcomes.

IVF versus spontaneous twin pregnancies – which are at higher risk of complications?

Objective: To analyze the course of twin pregnancies, deliveries and neonatal outcome after in vitro fertilization (IVF) and compare them with spontaneous twins (ST). Methods: The studied material consisted of 131 women in twin pregnancies: 43 patients with IVF and 83 with ST, who delivered at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw in years 2005–2009. Results: Complications of pregnancy, especially imminent abortion and imminent preterm delivery, were significantly more often diagnosed in IVF versus ST. The rate of preterm delivery was similar in both groups. The vast majority of all analyzed twin pregnancies were delivered by cesarean section. The dominant indication was other than cephalic presentation of either one of the twins. Regardless of the group, all cases of neonatal mortality were a result of sepsis and extreme prematurity. The length of hospitalization and treatment period depended mostly on prematurity. It was also dependent on the method of conception – IVF was in favor of shorter treatment time. Conclusions: The method of conception seems not to have a negative impact on the course of pregnancy, risk of preterm delivery and obstetric outcome. Neonatal complications of IVF and spontaneous twins are mostly a result of prematurity.

Vaginal progesterone after tocolytic therapy in threatened preterm labor

Objective: The aim of this study was retrospective evaluation of progesterone efficacy in pregnant patients with preterm uterine contractions. Material: 190 women hospitalized at 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, in 2007–2010, with symptoms of threatened preterm labor were enrolled in the study. 94 women were treated with tocolytics and steroids (control group), while 96 women received additionally 200 mg of progesterone vaginally until delivery or 34th weeks of gestation (progesterone group). Results: The mean gestational age at admission was 27 weeks in progesterone group and 28 weeks in control group. Cervical length was similar in both groups. There were no significant differences in week of delivery between groups, but the progesterone group had significant increase in prolongation of pregnancy (7.6 versus 6.3 weeks, p = 0.039). Vaginal progesterone was associated with reduction of delivery before 34 weeks (9.8% versus 35.3%; p = 0.002) and neonatal birth weight <1500 g (3.2% versus 20.6%; p = 0.011) only in patients presenting with uterine contractions after 27 weeks. Conclusion: The administration of vaginal progesterone after tocolysis in threatened preterm labor is associated with prolongation of pregnancy. The reduction of deliveries before 34 weeks was observed in patients presenting with contractions after 27 weeks gestation.

The anterior cervical angle as a new biophysical ultrasound marker for the prediction of spontaneous preterm birth‐ a proof of principle study

Current prenatal screening protocols during the first and second trimesters identify only approximately 55% and 69% of cases of spontaneous preterm birth (PTB), respectively. Thus, spontaneous PTB remains one of the least predictable complications of pregnancy1,2. We present the concept of a novel ultrasound parameter, the anterior cervical angle (ACA) (Figure 1), which has the potential to become an additional predictor of spontaneous PTB. The angle between the uterine wall and the cervical canal has been studied in the context of successful induction of labor; however, to our knowledge, this is the first account of the ACA being considered as a potential ultrasound marker of spontaneous PTB. The pathophysiological principle is purely physical and follows the rules of gravity and trigonometry. The force of the pregnant uterus is shifted towards the cervix and, depending on the angle of inclination, the cervical canal is either ‘pressed shut’ in cases of an acute angle or ‘pressed open’ in cases of an obtuse angle. This shift in cervical angle is used by one of the most effective interventions in preventing spontaneous PTB; the vaginal Arabin pessary was designed not only to enclose but also to incline and Figure 1 Transvaginal ultrasound images showing measurement of the anterior cervical angle in the first (a) and second (b) trimesters. After obtaining an appropriate view of the cervix according to accepted guidelines, the anterior uterine wall is visualized. The internal and external cervical ora, including the isthmus, are identified and a line between them is drawn. A second line is drawn parallel to the lower aspect of the anterior uterine wall, passing through the internal cervical os. The angle created by the two lines at the internal os is measured.

Anterior cervical angle as a new biophysical ultrasound marker for prediction of spontaneous preterm birth

Current prenatal screening protocols during the first and second trimesters identify only approximately 55% and 69% of cases of spontaneous preterm birth (PTB), respectively. Thus, spontaneous PTB remains one of the least predictable complications of pregnancy1,2. We present the concept of a novel ultrasound parameter, the anterior cervical angle (ACA) (Figure 1), which has the potential to become an additional predictor of spontaneous PTB. The angle between the uterine wall and the cervical canal has been studied in the context of successful induction of labor; however, to our knowledge, this is the first account of the ACA being considered as a potential ultrasound marker of spontaneous PTB. The pathophysiological principle is purely physical and follows the rules of gravity and trigonometry. The force of the pregnant uterus is shifted towards the cervix and, depending on the angle of inclination, the cervical canal is either ‘pressed shut’ in cases of an acute angle or ‘pressed open’ in cases of an obtuse angle. This shift in cervical angle is used by one of the most effective interventions in preventing spontaneous PTB; the vaginal Arabin pessary was designed not only to enclose but also to incline and Figure 1 Transvaginal ultrasound images showing measurement of the anterior cervical angle in the first (a) and second (b) trimesters. After obtaining an appropriate view of the cervix according to accepted guidelines, the anterior uterine wall is visualized. The internal and external cervical ora, including the isthmus, are identified and a line between them is drawn. A second line is drawn parallel to the lower aspect of the anterior uterine wall, passing through the internal cervical os. The angle created by the two lines at the internal os is measured.

Pregnancy in the liver transplant recipient.

During gestation, the womans body undergoes various changes, and the line between physiology and pathology is very thin even in healthy women. Today, many of the liver transplant recipients are young women, who at one point in their lives may consider the possibility of pregnancy. Clinicians have to counsel them about the time of conception, the risk of miscarriage, the deterioration of the mothers health status, and the risk of birth defects. This review, based on our 20 years of clinical experience and up‐to‐date literature, provides comprehensive guidelines on pregnancy management in liver transplant recipients. Pregnancy in liver transplant recipients is possible but never physiological. Proper management and pharmacotherapy lowers the incidence of complications and birth defects. Critical factors for perinatal success include stable graft function before pregnancy, proper preparation for pregnancy, and cautious observation during its course. Liver Transplantation 22 1408–1417 2016 AASLD.

First and third trimester serum concentrations of adropin and copeptin in gestational diabetes mellitus and normal pregnancy.

OBJECTIVES Gestational diabetes mellitus (GDM) is a metabolic disease diagnosed in 1.7% up to 11.6% pregnancies. The prevalence of adverse pregnancy outcome is significantly higher in the case of early onset of diabetes mellitus. Adropin is a hormone promoting carbohydrate oxidation over fat oxidation, and influence nitric oxide synthase. Copeptin is a cleavage product of the vasopressin precursor recently correlated with diabetes mellitus. The aim of the study was to determine maternal serum adropin and copeptin concentrations in women with early and late manifestation of GDM and to discuss their potential role as biochemical markers of insulin resistance. MATERIAL AND METHODS Case-control study on 58 pregnant Caucasian women. Serum levels of adropin and copeptin were assessed in patients with early onset (GDM1) and classical gestational diabetes mellitus (GDM2). Complications such as macrosomia and hypotrophy were evaluated. RESULTS There was no significant difference between the study and the control group (age, BMI, parity). Fetal growth disturbance rate was 37.5% in GDM1, 11% in GDM2 and 6% in controls. Adropin concentration in GDM patients was significantly higher than in control group (p < 0.001), but there was no difference between GDM1 and GDM2 group. High serum concentration of adropin positively correlated with elevated HbA1c (p < 0.05). The groups did not differ in terms of copeptin serum concentration. CONCLUSIONS High adropin serum concentration in GDM patients is associated with increased risk of fetal growth disturbances, possibly due to improper placentation. According to our prospective study, neither copeptin nor adropin serum concentration are useful to discriminate between early and late onset of gestational diabetes mellitus.