Fatma Eskicioglu

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.

Sexual life following total abdominal hysterectomy.

AimThe goal of this study was to evaluate the effect of total abdominal hysterectomy (TAH) on sexual lives of patients in the postoperative period.Materials and methodsEighty-six patients who accepted to participate a phone-questionnaire were recruited in the study after TAH or TAH + BSO. They were asked about sexual desire, pain during sexual intercourse, frequency and satisfaction of sexual intercourse at pre- and postoperative periods, and loss of “feeling a woman” in the postoperative period. Sexual desire, pain during sexual intercourse, loss of “feeling a woman” questions were answered as “yes” or “ no”, number of weekly sexual intercourse was recorded, and satisfaction was graded as no = 0, mild = 1 and complete = 2 points.ResultsWhile sexual desire and frequency were found to be significantly lower (p=0.026 and p=0.01 respectively), no difference was noted in dyspareunia and satisfaction. When the patients were divided into two groups according to the presence of endogenous or exogenous estrogen, no difference was seen between the two groups in the postoperative period.ConclusionWe concluded that the effect of TAH or TAH+BSO operations were mainly on sexual desire and the number of weekly intercourse, and estrogen in the postoperative period did not make any difference between the two groups.

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.

The association of HLA-G and immune markers in recurrent miscarriages.

Abstract Objective: To determine role of human leukocyte antigen (HLA)-G, CD8, CD16, CD56, interferon (IFN)-γ, and tumor necrosis factor (TNF)-α for recurrent miscarriages in feto–maternal interface. Method: Chorion and decidua samples were obtained from 11 women with unwanted pregnancies (healthy pregnancy, HP) and 10 women with missed abortion diagnosis after at least two pregnancy losses (recurrent miscarriage, RM). In addition, endometrial tissues were obtained from 10 non-pregnant women (NonP). The expressions of markers were evaluated using the Western blot analysis. The values obtained between different groups were compared. Results: The highest protein expression of CD56 was found in the HP compared to NonP and RM. Meanwhile, the lowest protein expression of CD16 was observed in the NonP compared to HP and RM. The HLA-G expression exhibited the highest level in HP; however, there was no statistically significant difference between groups. CD8 and IFNγ expressions were lowest in the NonP group; however, TNF-α was highest in the RM group. Conclusions: The CD56 expression of uterine NK cells may be an indicator of a HP. However, not statistically significant, the increased expression of CD16, CD8, and also significantly increased expression of TNF may be associated with the predominant cytotoxic activity in the maternal immune system in patients with RM. Although there was no change in the expression of HLA-G, this finding may mean that the maternal immune system is unresponsive to HLA-G-mediated immunosuppressive signals originating from the fetus in these cases.

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

Complete blood count parameters may have a role in diagnosis of gestational trophoblastic disease.

Objective: The goal of this study was to investigate whether gestational trophoblastic disease (GTD) and healthy pregnancy differ with respect to complete blood count parameters and these parameters can be used both to explain the pathophysiologic mechanisms and differentiate the two conditions from each other. Methods: The data obtained from 37 women with GTD and 61 healthy pregnancies (control group) regarding platelet (PLT), mean PLT volume (MPV) and PLT distribution width (PDW), and white blood cell (WBC) levels were evaluated. Patients with GTD were further subdivided into two groups composed of 20 partial mole (PM) and 17 complete mole (CM) cases. Results: PDW and WBC were lower in the GTD than the control. There were no differences for PLT and MPV. WBC was lower in PM and both WBC and PDW were lower in CM compared with control. ROC curve analysis revealed an area under curve (AUC) 75.5% for WBC and AUC 69.3% for PDW. A cut-off value was determined 8.19 for WBC with 81.0% sensitivity and 54.1% specificity. While, 15.85 were accepted for PDW, with 87.9% sensitivity and 44.4% specificity. Conclusion: Lower WBC in GTD may suggest that molar pregnancy requires a lower inflammatory reaction facilitating trophoblastic invasion. Lower PDW as an indicator of platelet activation in CM may suggest that CM requires less PLT activation than healthy pregnancy that needs stronger trophoblast invasion for normal placental development. Decreased PDW levels especially < 15.85 and WBC levels < 8.19 may alert clinicians for risk of GTD.

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.

Adnexal Torsion with Dystrophic Calcifications in an Adolescent: A Chronic Entity?

Intermittent pelvic pain caused by ovarian cysts in adolescence may be due to torsion or partial torsion of the ovary. We present a case of 18-year old adolescent with symptomatic left ovarian torsion with calcifications demonstrated by pelvic MRI and ultrasonography prior to surgery. The pathologic investigation demonstrated dystrophic calcifications. We speculated that the pattern of the intermittent pain in the story of the patient and the dystrophic calcifications in pathologic investigation which is thought that it might have been potentially developed as a result of chronic hypoxia due to intermittent partial torsions over a period of two years.

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...