Esra Bahar Gur

Mid-pregnancy vitamin D levels and postpartum depression.

OBJECTIVES Postpartum depression (PPD) is a common disorder that affects 10-15% of postpartum women, and it can have negative effects on both the mother and newborn. Recent studies have suggested that low levels of vitamin D are associated with poor mood and depression. The aim of this prospective study was to evaluate a possible association between PPD and serum levels of 25-hydroxy vitamin D3 (25(OH)D3), a reliable measurement of vitamin D, during mid-pregnancy. STUDY DESIGN The source population consisted of all pregnant women between 24 and 28 gestational weeks from June 2012 to October 2012 at Bornova Health Research and Application Hospital, Sifa University. In order to better evaluate a possible effect between vitamin D levels and PPD, individuals with characteristics that put them at risk for developing PPD were excluded from the study. Serum 25(OH)D3 levels were evaluated mid-pregnancy in the study group. Serum 25(OH)D3 concentrations ≤20ng/mL (50nmol/L) were classified as a mild deficiency and those ≤10ng/mL (25nmol/L) were classified as a severe deficiency. Pregnant subjects having complications during birth or with the newborn after delivery were excluded from the study. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess maternal PPD 1 week, 6 weeks, and 6 months after delivery. A Pearson correlation was used to measure the strength of the associations between the EPDS scores and vitamin D levels analyzed during the three time periods. A logistic regression analysis was used to determine the independent effects of vitamin D on PPD. RESULTS Six hundred and eighty-seven pregnant women were included in this study. After excluding women due to PPD risk factors (in two stages), 179 pregnant women were screened for vitamin D levels during mid-pregnancy and in the 6th month postpartum. Eleven percent of our study group had severe vitamin D deficiency and 40.3% had mild vitamin D deficiency. The frequency of PPD was 21.6% at the 1st week, 23.2% at 6th week, and 23.7% at the 6th month. There was a significant relationship between low 25(OH)D3 levels in mid-pregnancy and high EPDS scores, which is indicative of PPD for all three follow-up periods (p=0.003, p=0.004 and p<0.001, respectively). In addition, there was a significant negative correlation between vitamin D levels and EDPS at all three time points (r=-0.2, -0.2, -0.3, respectively). CONCLUSIONS Vitamin D deficiency in mid-pregnancy may be a factor affecting the development of PPD. More extensive studies are required to be carried out on this subject.

Uterine closure with unlocked suture in cesarean section: Safety and Quality

Objective: Comparing locked and unlocked uterine closure techniques in terms of bleeding control and uterine incision healing. Methods: The patients undergoing cesarean section in Sifa University Hospital between May - October 2012 were accepted to this prospective controlled study. Primarily, safety was evaluated. The hemoglobin count (HC) and serum creatine kinase (CK) levels of the patients in the locked (n = 47) and unlocked (n = 35) groups were measured just before and 24 hours after operation. Hemoglobin deficit, increase in CK and the additional hemostatic sutures were compared. Secondly, uterine scar healing was evaluated three months later. Scar thickness, niche and percentage of thinning of the scar region of the locked (n = 27) and unlocked (n = 32) groups were calculated and compared. Results: The hemoglobin deficit was similar in two groups. CK rise was less in the unlocked group but it was not significant (P = 0.082). Unlocked group needed more additional sutures (P = 0.016). The thickness of the niche and the percentage of thinning of the scar region were significantly less in the unlocked group (P= 0.002, P=0.000). Conclusions: Unlocked uterine closure technique is safe and has less damage to the myometrium.

Comparison between resveratrol and cabergoline in preventing ovarian hyperstimulation syndrome in a rat model.

Abstract Objective: The aim of this study is to investigate the effects of resveratrol in a rat model of ovarian hyperstimulation syndrome (OHSS) and compare with cabergoline. Design: Randomized controlled, animal study. Animal(s): Female Wistar rats. Material and methods: A rat OHSS model was used to investigate the effects of resveratrol compare with cabergoline administration for preventing OHSS. Body weight, ovary weight, diameter, vascular permeability (VP), vascular endothelial growth factor (VEGF), cyclooxygenase-2 (COX-2) expression (immunohistochemistry), and serum estradiol (E2) levels were then compared. Results: The ovarian VEGF concentration was significantly increased in the OHSS Groups (Groups 3–5) compared with the control groups (1 and 2). But vascular permeability, VEGF, and COX-2 expressions were reduced in animals treated with the resveratrol group compared with the cabergoline group (group 5) and the severe OHSS (group 3) group. Blood E2 levels were decreased in group treated with the resveratrol group compared with the cabergoline group (group 5) and severe the OHSS (group 3) group. Conclusion(s): Our results in a rat model suggest that resveratrol has a beneficial effect on OHSS by reducing the increases in ovarian daimeter, VP, and VEGF expression associated with OHSS. These effects may be mediated by the COX-2 inhibitory capacity of resveratrol.

Vitamin D deficiency in pregnancy may affect fetal thymus development

OBJECTIVES The aim of our study was to evaluate the association of vitamin D deficiency (VDD) during pregnancy with thymus size in full-term fetuses. MATERIAL AND METHODS In this prospective study, we evaluated mid-pregnancy serum 25-hydroxyvitamin D3 (25(OH)D3) concentrations. The fetal thymus size was measured by ultrasound in the third trimester. Neonatal 25(OH)D3 levels were evaluated by umbilical cord blood sampling. Correlation of maternal and neonatal vitamin D levels and association between thymus size and both, maternal and neonatal vitamin D concentrations were investigated. RESULTS Serum 25(OH) D3 concentrations were within the normal range in 48 (29.8%) mothers and 10 (13.1%) new-borns. A strong correlation between mid-pregnancy maternal and neonatal 25(OH)D3 concentration (r = 0.8, p < 0.001) was found. A significant linear correlation was observed between both, maternal and neonatal 25(OH)D3 concentrations and thymus perimeter length (r = 0.45, p = 0.04 and r = 0.43, p < 0.01, respectively). Both, maternal and fetal VDDs were associated with decreased thymus perimeter (p = 0.04, p = 0.03). CONCLUSIONS Vitamin D deficiency during pregnancy may be associated with smaller fetal thymus. Our data suggest that VDD in pregnancy may lead to systemic inflammatory response in the fetus.

Endometrial pathology in postmenopausal women with no bleeding

Abstract Objective The aim of this study was to determine the rate of unexpected uterine pathology in postmenopausal women admitted to a gynecology clinic with symptoms other than vaginal bleeding and who were scheduled to undergo hysterectomy. Materials and methods We reviewed retrospectively the medical records of 283 postmenopausal patients who had gynecological surgery between September 2007 and January 2014. We reviewed their presenting symptoms on admission, the indications for surgery, and their transvaginal ultrasonographic findings. Postoperative histopathological results based on uterine specimens were also recorded. The results were analyzed statistically. Results Of 283 patients who had surgery, 209 had no vaginal bleeding at the time of admission. From this group, 75.6% were found to have unsuspected pathology, including endometrial hyperplasia, endometrial polyps, uterine fibroids, adenomyosis, and one case of endometrial carcinoma (0.5%). The remaining 74 patients had experienced postmenopausal bleeding and in 87.8% there were pathological findings including 13 cases (17.6%) of endometrial cancer (p = 0.0001). Conclusion Vaginal bleeding in postmenopausal women is indicative of a wide array of gynecological pathologies, including endometrial carcinoma. However, uterine fibroids, pelvic masses, or even endometrial cancer may develop without co-morbid vaginal bleeding. Therefore we advocate that postmenopausal women should undergo yearly screening and consultation, without waiting for an episode of vaginal bleeding.

The effect of vitamin D level in pregnancy on postpartum depression.

We read with interest the article by Robinson et al. (2014) Regarding the effect of vitamin D level in pregnancy and postpartum depression (PPD). The etiology of post partum depression (PPD) is not well understood. It has been hypothesized that rapid physiologic changes may play a role in its development. Additionally, physiologic, psychological, and social factors may affect the development of PPD. Neuroendocrine or immune system dysregulation may also contribute to the development of PPD (Ellsworth-Bowers and Corwin 2012). Vitamin D has regulatory functions in the immune system. It has been suggested that vitamin D may act as a potential neurosteroid. Epidemiologic evidence of a relationship between vitamin D and depression is limited. However, some studies have shown a meaningful relationship between vitamin D and depression in selective populations (Tolppanen et al. 2012). Murphy et al. (2010) postulated that there may be a negative correlation between vitamin D level and PPD. In this study, they monitored the vitamin D levels and depressive symptoms of 97 women, on a monthly basis, for the first seven postpartum months. When a dichotomous model, including both The Edinburgh Postnatal Depression Scale (EPDS) score and vitamin D level, was used, women with lower vitamin D levels had consistently higher rates of depression than women with higher vitamin D levels. Two studies have reported that there is a significant negative correlation between vitamin D levels in the first trimester of pregnancy and depressive symptoms in the second trimester (Cassidy-Bushrow et al. 2012; Brandenbarg et al. 2012). In Robinson et al.’s (2014) prospective cohort study, researchers found a significant correlation between vitamin D levels in pregnancy and PPD, which was diagnosed on the third day postpartum. We conducted a similar study. In our study, we investigated the relationship between vitamin D in the second trimester of pregnancy and PPD in the first 6 months after childbirth (Gur et al. 2014). We found that lower maternal 25-hydroxy vitamin D3 levels in the second trimester of pregnancy were associated with higher levels of postpartum depressive symptoms at 1 week, 6 weeks, and 6 months postpartum. Our study differs from the study of Robinson et al. in that we evaluated PPD three times in the first 6 months after childbirth. PPD usually begins in the first few months after childbirth. In the Diagnostic and Statistical Manual ofMental Disorders, Fourth Edition, PPD is defined as the onset of depression within 4 weeks after childbirth. PPD usually begins around 2 weeks after delivery (Vigod et al. 2010). Furthermore, in a Turkish study in which women were followed up for PPDwithmonthly visits in the first year after childbirth, it was found that the prevalence of PPD was highest in the second postpartum month (Dindar and Erdogan 2007). For this reason, our study contributes to the study of the relationship between vitamin D and PPD. In conclusion, the limited number of studies in the literature suggest that there may be a negative correlation between vitamin D level in pregnancy and PPD. More data is needed in order to obtain a significant conclusion on the relationship. E. B. Gur (*) :M. Genc : S. Guclu Faculty of Medicine, Department of Obstetrics and Gynecology, Sifa University, Bornova 35100, Izmir, Turkey e-mail: esrabaharg@yahoo.com

Relationship between mean platelet volume and vitamin D deficiency in gestational diabetes mellitus.

OBJECTIVE To investigate whether vitamin D deficiency is associated with high mean platelet volume (MPV) in pregnancies diagnosed with gestational diabetes mellitus (GDM) compared to healthy pregnancies. SUBJECTS AND METHODS This study included 200 pregnant women. 25-hydroxyvitamin D3(25(OH)D3) and MPV values were monitored between pregnant women with GDM and normal glucose metabolism. Correlation between 25(OH)D3 and MPV was calculated both in GDM and healthy pregnancies. Both 25(OH)D3 level in different MPV percentile (≤ 50, 50-75, 75-90, ≥ 90 percentile) and MPV value in different 25(OH)D3 level (≤ 10, 10-20, ≥ 20 ng/mL) were calculated. RESULTS Low 25(OH)D3 level and high MPV were observed both in GDM group (p = 0.007, p = 0.06, respectively) and in glucose metabolism disorders (GMD) group (p = 0.03, p = 0.04, respectively). There was no significant relationship between 25(OH)D3 and MPV in healthy pregnancies. Whereas, it is observed that there is a negative, but statistically insignificant correlation between MPV and 25(OH)D3 pregnant women with GMD (r = 0.1, r = -0.7, respectively). MPV values had significantly higher in vitamin D deficient group than pregnant women with normal 25(OH)D3 level in GMD group (p = 0.04). The optimal 25(OH)D3 cut off point for predicting future cardiovascular risk was 10.4 ng/ mL (area under curve (AUC) = 0.58). CONCLUSIONS Vitamin D deficiency may contribute to an increased risk for future cardiovascular diseases and a risk of thrombotic complications in pregnant women with GDM.

Investigation of the relationship between salivary cortisol, dehydroepiandrosterone sulfate, anxiety, and depression in patients with hyperemesis gravidarum

Abstract Background: The aim of this study was to determine the relationship of the salivary levels of dehydroepiandrosterone sulfate (DHEA-S) and cortisol with factors related to depression and anxiety in patients with hyperemesis gravidarum (HG). Methods: Forty patients with a diagnosis of HG were selected for the study and matched with 40 control patients according to body mass index, parity, and age. Symptoms of depression and anxiety were investigated using the Beck Depression Inventory and Beck Anxiety Inventory for Adults, respectively. Saliva samples were collected in the morning and at night and subjected to enzyme-linked immunosorbent assay for the determination of DHEA-S and cortisol levels. Results: We observed a positive correlation between increased levels of depression and anxiety and increased salivary levels of cortisol and DHEA-S in patients with HG. Conclusions: Salivary cortisol and DHEA-S levels, as well as mood disorders, should be monitored in patients with HG, although further large, prospective studies are needed to confirm our results.

Ultrasonographic visceral fat thickness measurement may be a good scan test for prediction of gestational diabetes mellitus

We were interested to read the article by Bolgnanni et al. regarding the location of waist circumference (WC) measurements for predicting gestational diabetes mellitus (GDM) [1]. Obesity is a major...

Asymptomatic cervical diverticulum: An unusual case

Herein is presented the case report of a patient who had secondary infertility. Hysterosalpingography (HSG) and subsequent diagnostic hysteroscopy revealed an asymptomatic cervical diverticulum. In vitro fertilization (IVF) was suggested for infertility due to bilateral tubal occlusion. We also informed the patient that her diverticulum does not require surgical intervention due to the absence of symptoms.