Hyun-Kyong Ahn

Factors associated with a positive intake of folic acid in the periconceptional period among Korean women

OBJECTIVE We aimed to investigate the factors associated with a positive intake of folic acid (FA) during the periconceptional period among Korean women. DESIGN In a cross-sectional study of demographic, obstetric and socio-economic data, history of periconceptional intake of FA and awareness of the benefits of FA supplementation in pregnancy were obtained and analysed using the chi2 test, followed by multiple logistic regression analysis. SETTING The Maternity School, Cheil General Hospital and Womens Healthcare Center, Seoul, South Korea, between October 2005 and March 2006. SUBJECTS In total 1313 pregnant women participating in a two-day training course available every month. RESULTS After excluding subjects with incomplete or inconsistent data, there were 1277 women included in the analysis. Participants were aged 29.4 (sd 2.9) years and had a mean gestational age of 27.9 (sd 7.1) weeks. Only 131 (10.3 %) women took FA during the periconceptional period. According to multiple logistic regression analyses, the adjusted OR for FA supplementation was 1.79 (95 % CI 1.10, 2.91) in women who had previous spontaneous abortions, 4.10 (95 % CI 2.43, 6.78) in women who planned their pregnancy and 6.63 (95 % CI 2.08, 21.12) in those who were aware of the protective effects of FA. CONCLUSIONS Periconceptional intake of FA was more likely among Korean women with a history of previous spontaneous abortion, who planned their pregnancy or who were aware of the protective effects of FA during pregnancy. However, the proportion of women who took FA in the periconceptional period was low.

Blood levels of phosphatidylethanol in pregnant women reporting positive alcohol ingestion, measured by an improved LC-MS/MS analytical method

Objective. A reliable biomarker of low alcohol exposure during pregnancy is needed to clarify the controversy on the teratogenicity of low-to-moderate alcohol levels. Methods. Blood samples were obtained from 13 pregnant women who self-reported alcohol ingestion between 2.5 and 20 drinks/week, and from 26 controls. Total lipids were extracted, and phosphatidylethanol (PEth) species 16:0/16:0, 16:0/18:1, and 16:0/18:1 were separated by high-performance liquid chromatography (HPLC) on a reverse-phase phenyl column. These PEth species were quantified by MS/MS using phosphatidylpropanol as internal standard, with electrospray ionization and MRM. Results. PEth species were not detected in women who abstained from alcohol ingestion during pregnancy, whereas PEth-16:0/18:1 was > 5 nmol/L in those with positive alcohol ingestion. PEth species were detected for up to 4 weeks after cessation of exposure. Conclusions. PEth-16:0/18:1 was detected in pregnant women at 4–6 weeks after their last low-to-moderate alcohol ingestion, and therefore appears to be a reliable biomarker of prenatal alcohol exposure to study the teratogenicity of alcohol at these exposure levels.

Characterization of phosphatidylethanol blood concentrations for screening alcohol consumption in early pregnancy

Objective. Phosphatidylethanol (PEth) is formed endogenously by the direct action of ethanol, and has a half-life long enough to make it a reliable biomarker of alcohol exposure in early pregnancy. In this study, we aimed to characterize PEth blood concentrations to differentiate different levels of alcohol exposure in pregnant women. Methods. The study consisted of 305 consecutive pregnant women who had been referred to our hospital for antenatal care. Of them, 117 self-reported alcohol ingestion in the first trimester of pregnancy and 188 were abstainers. Total PEth concentration in whole blood was quantified by liquid chromatography-mass spectrometry (LC-MS/MS). Alcohol ingestion was classified according to the United States National Institute on Alcohol Abuse and Alcoholism into light drinkers: ≤ 3 drinks/week, moderate drinkers: 3–7 drinks/week, and heavier drinkers: > 7 drinks/week (a standard drink = 14 g of ethanol). Results. Participants had quantifiable PEth blood levels 3–4 weeks after the last drink. There were 4.8% abstainers who had positive PEth concentrations; all of them reported a positive history of alcohol consumption before conception. PEth blood concentrations were significantly correlated to drinks per occasion (r = 0.44; P < 0.001) and days drinking per week (r = 0.34; P < 0.001). However, almost 74% of participants with ≤ 3 drinks/week of alcohol, and 46% with 3–7 drinks/week, had PEth blood concentrations below the lower limit of quantification (LLOQ). The area under the curve (AUC) generated by a receiver operation characteristic curve (ROC) analysis increased as the cutoff value of PEth blood concentration increased. However, the cutoff values were below or close to the LLOQ. Conclusions: Our study presents a formal characterization of PEth blood concentrations for screening alcohol ingestion in first-trimester pregnant women. However, caution is recommended for overrepresenting either negative or positive results.

Peripheral Blood NK Cell Cytotoxicities are Negatively Correlated with CD8+ T Cells in Fertile Women but not in Women with a History of Recurrent Pregnancy Loss

We aim to investigate NK cell cytolytic activities and its relationship to other lymphocyte subsets in peripheral blood of women with a history of recurrent pregnancy loss (RPL).

Fetal and neonatal outcomes in women reporting ingestion of licorice (Glycyrrhiza uralensis) during pregnancy.

Maternal intake of licorice from dietary sources has been associated with adverse maternal and fetal outcomes. We prospectively studied the outcome of 185 singleton pregnancies who took over-the-counter or naturopathic formulations containing licorice during their pregnancy, and 370 age-matched singleton pregnant controls that were not exposed to any potential teratogen. The indication in 56.8% of the women taking licorice was for cough and cold control, with the maximum dose of 2104 mg/day and exposure occurring between the 4th day and 25th week of gestation. The rate of stillbirths was marginally higher among women who took licorice than those who did not (OR = 7.9; 95% CI 0.9-71.5; p = 0.048), and significantly higher when compared to the general population in the Republic of Korea (OR = 13.3; 95% CI 4.9-35.8; p < 0.001). Other fetal outcomes assessed in the study were similar between the two study groups, e.g., the OR of major malformations was 3.9 (95% CI 0.4-43.5; p = 0.27). In conclusion, the present study suggests that licorice is not a major teratogen. However, whether licorice may increase the risk of stillbirths requires careful consideration in further studies with a larger sample size.

Exposure to Rosiglitazone and Fluoxetine in the First Trimester of Pregnancy

Rosiglitazone is a thiazolidinedione oral hypoglycemic drug that seems to be a promising alternative not only as an oral hypoglycemic agent but also for women with polycystic ovary syndrome. However, information regarding exposure to rosiglitazone in pregnancy is limited to two previous case reports. In the first case, a 35-year-old woman was exposed until the 8th week of pregnancy to 4 mg/day rosiglitazone and to glicazide, acarbose, atorvastatin, spironolactone, hydrochlorothiazide, carbamazepine, thiridazine, amitryptiline, chlordiazepoxide, and pipenzolate bromide (1). The second case was a woman exposed to 4 mg/day rosiglitazone between gestational weeks 13 and 17 (2). The two cases delivered normal babies at gestational weeks 36 and 37, …

Obstetrical Outcome of Anti‐Inflammatory and Anticoagulation Therapy in Women with Recurrent Pregnancy Loss or Unexplained Infertility

Women with a history of recurrent pregnancy losses (RPL) and unexplained infertility (UI) have a high incidence of preeclampsia (PE) and other obstetrical complications. We aimed to investigate the incidence of PE and other obstetrical complications in women with RPL or UI who were treated with anti‐inflammatory and anticoagulant treatment.

Genome-wide microRNA expression profiling in placentas of fetuses with Down syndrome

INTRODUCTION Down syndrome (DS) is the most common aneuploidy, caused by an extra copy of all or part of chromosome 21 (chr21). Differential microRNA (miRNA) expression is involved in many human diseases including DS. However, the genome-wide changes in miRNA expression in DS fetal placentas have yet to be determined, and the function of these changes is also unclear. METHODS We profiled genome-wide miRNA expression in placenta samples from euploid or DS fetuses by using microarray technology and predicted the functions of differentially expressed miRNAs using bioinformatics tools. RESULTS Thirty-four miRNAs were significantly differentially expressed in the DS placenta compared with the normal placenta (16 up-regulated and 18 down-regulated). However, expression of chr21-derived miRNAs did not change. Predicted target genes included 7434 genes targeted by up-regulated miRNAs and 6071 genes targeted by down-regulated miRNAs. Seventy-six of these target genes were located on chr21 (10 genes controlled by down-regulated miRNAs and 34 genes by up-regulated miRNAs, and 32 genes by both). Target genes on chr21 were significantly associated with DS and DS-related disorders, such as mental retardation, neurobehavioral manifestations, and congenital abnormalities. DISCUSSION To our knowledge, this is the first genome-wide study to comprehensively survey placental miRNAs in DS fetuses. Our results provide new insight into miRNA expression in placentas of fetuses with DS. Additionally, our findings indicate that the differentially expressed miRNAs in the DS placenta may potentially affect various pathways related to DS pathogenesis.

Dose‐response and time‐response analysis of total fatty acid ethyl esters in meconium as a biomarker of prenatal alcohol exposure

Little is known on how the dose and timing of exposure co‐influence the cumulative concentration of fatty acid ethyl esters (FAEEs) in meconium. The objective of the study was to assess the cumulative concentration of FAEEs in meconium as a biomarker of light, moderate, or heavy prenatal alcohol exposure occurring at either first, second, or third trimesters of pregnancy.

Association between maternal weight gain rate of each trimester and neonatal birth weight

목적 임신부의 임신분기별 체중증가율을 조사하여 신생아 체중과의 연관성을 알아보고자 하였다. 연구방법 제일병원에서 임신 10주 이전에 외래에 등록하여 정기적인 산전진찰을 받고, 만삭의 단태아를 출산한 산모를 대상으로 하였고, 의무기록을 조사한 후향적 연구이다. 임신 전부터 만성적 내과 질환을 앓고 있었던 산모와 임신성 당뇨병으로 진단된 산모는 연구대상에서 제외하였다. 산모의 나이, 출산력, 임신 전 체질량지수, 출산주수를 보정한 뒤, 출산력에 따라 임신분기별 체중증가율(kg/wk)과 출생체중 사이의 상관성을 분석하였다. 결과 전체 2,105명의 산모가 포함되었으며 미산부가 1,266명, 경산부가 839명이었다. 상관 분석에서, 출산력에 관계 없이 미산부와 경산부 모두에서 임신2분기의 체중증가율이 다른 분기들에 비해 신생아 출생체중과 가장 밀접하게 연관되었다. 결론 산전진찰 시 적절한 체중의 신생아를 출산하기 위하여 산모의 2분기 체중증가에 더욱 주의를 기울여야 할 것이다.