Kristi Borowski

Pregnancy Complications and the Risk of Metabolic Syndrome for the Offspring

Metabolic syndrome is a growing problem globally, and is a contributor to non-communicable diseases such as type II diabetes and cardiovascular disease. The risk of developing specific components of the metabolic syndrome such as obesity, hyperlipidemia, hypertension, and elevated fasting blood sugar has been largely attributed to environmental stressors including poor nutrition, lack of exercise, and smoking. However, large epidemiologic cohorts and experimental animal models support the “developmental origins of adult disease” hypothesis, which posits that a significant portion of the risk for adult metabolic conditions is determined by exposures occurring in the perinatal period. Maternal obesity and the rate of complications during pregnancy such as preterm birth, preeclampsia, and gestational diabetes continue to rise. As our ability to reduce perinatal morbidity and mortality improves the long-term metabolic consequences remain uncertain, pointing to the need for further research in this area.

Longitudinal characterization of renal proximal tubular markers in normotensive and preeclamptic pregnancies

Glomerular damage is common in preeclampsia (PE), but the extent and etiology of tubular injury are not well understood. The aim of this study was to evaluate tubular injury in patients with PE and to assess whether it predates clinical disease. We performed a prospective cohort study of 315 pregnant women who provided urine samples at the end of the second trimester and at delivery. This analysis included women who developed PE (n = 15), gestational hypertension (GH; n = 14), and normotensive controls (NC; n = 44). Urinary markers of tubular injury, α1-microglobulin (A1M), retinol-binding protein (RBP), kidney-injury molecule-1 (KIM1), complement C5b-9, tissue inhibitor metalloproteinase-2 (TIMP-2), and insulin-like growth factor binding protein-7 (IGFBP-7) were measured by enzyme-linked immunosorbent assay (ELISA) and reported in relation to urine creatinine concentration. Second-trimester concentrations of all markers were similar among groups. At delivery, A1M concentrations were higher in the PE group than in the GH and NC groups as an A1M/creatinine ratio >13 (66.7, 8.3, and 35%, respectively, P = 0.01). Concentrations of C5b-9 were higher in the PE group than in the GH and NC groups (medians 9.85, 0.05, and 0.28 ng/mg, respectively, P = 0.003). KIM1, RBP, TIMP-2, and IGFBP-7 concentrations did not differ among groups at delivery. In conclusion, proximal tubular dysfunction, as assessed by A1M and C5b-9, developed during the interval between the end of the second trimester and delivery in patients with PE. However, this was not matched by abnormalities in markers previously associated with tubular cell injury (KIM-1, IGFBP-7, and TIMP-2).

Preeclampsia/Eclampsia candidate genes show altered methylation in maternal leukocytes of preeclamptic women at the time of delivery

ABSTRACT Objective: To analyze methylation profiles of known preeclampsia/eclampsia (PE) candidate genes in normal (NL) and preeclamptic (PE) women at delivery. Methods: A matched case–control study comparing methylation in 79 CpG sites/33 genes from an independent gene set in maternal leukocyte DNA in PE and NL (n = 14 each) on an Illumina BeadChip platform. Replication performed on second cohort (PE = 12; NL = 32). Results: PE demonstrates differential methylation in POMC, AGT, CALCA, and DDAH1 compared with NL. Conclusion: Differential methylation in four genes associated with PE may represent a potential biomarker or an epigenetic pathophysiologic mechanism altering gene transcription.

Persistent Notochord in a Fetus with COL2A1 Mutation.

Multiple anomalies including micromelia, poor mineralization of the vertebrae, and a persistent notochord were identified on second trimester ultrasound in a fetus with a COL2A1 mutation. To our knowledge, this represents the first case of a persistent notochord associated with a COL2A1 mutation in humans. In this case report, we describe ultrasound and postmortem findings and review the pathogenesis associated with a persistent notochord.

The Current State of Ultrasound Training in Obstetrics and Gynecology Residency Programs: Ultrasound Training in OB-GYN Residency Programs

We evaluated the current state of ultrasound training in obstetrics and gynecology (OB‐GYN) residency programs across the United States.

Perceived Barriers to Exercise in the First Trimester of Pregnancy

Regular physical activity has been shown to improve pregnancy outcomes. We sought to identify barriers to exercise during the first trimester of pregnancy. Five hundred forty-nine pregnant women in their first trimester rated barriers to exercise on a scale of 1 (not a barrier) to 5 (a huge barrier) and recorded physical activity (minutes/week). Women were placed into one of three classifications, nonexercisers (zero exercise), infrequent exercisers (<150 minutes/week), or exercisers (≥150 minutes/week). The greatest barriers (mean) were nausea/fatigue (3.0) and lack of time (2.6). Exercisers reported significantly lower barrier levels. Nausea/fatigue was a greater barrier for nonexercisers compared to exercisers (3.6 vs 2.8, p < .001). Focusing education and interventions on these barriers may help pregnant women achieve healthy exercise levels.

Prenatal Physical Activity in the Development and Management of Gestational Diabetes Mellitus [9I]

INTRODUCTION: We aimed to evaluate the association of exercise with incidence of gestational diabetes mellitus (GDM) and the necessity for GDM treatment. METHODS: This was a prospective analysis of women who received prenatal care at Mayo Clinic Rochester. Subjects were surveyed about their exercise habits throughout pregnancy. Clinical data was collected via electronic medical record. Exercise was separated into three categories: no exercise, less than 150 minutes of exercise per week and greater than or equal to 150 minutes of exercise per week. RESULTS: 512 women with a mean age of 30.5 (SD 4.5) met inclusion criteria, and 43 were diagnosed with GDM (8.4%). GDM patients were older (32.2 v. 30.4, P<.01), had a higher pre-pregnancy BMI (29.9 v. 25.2, P<.01) and were more likely to have a GDM history (P<.01). GDM patients gained less weight (9.5 v. 13.4 kg, P<.01) and were more likely to have a cesarean delivery (P=.02). GDM patients were less likely to achieve the recommended amount of exercise during their pregnancy (P=.03). However, in the overall cohort, amount of exercise during pregnancy was not associated with developing GDM. The amount of exercise during pregnancy was also not significantly associated with the need for GDM treatment. CONCLUSION: Although those who developed GDM were less likely to achieve 150 minutes of exercise per week, exercise level was not significantly associated with developing GDM most likely due to low sample size. Further investigation into the role of exercise in prevention of GDM is necessary.

Effect of Exercise During Pregnancy on Labor and Delivery Outcomes [4I]

INTRODUCTION: The recommended ACOG guidelines for pregnant women without medical or obstetric complications suggest an accumulation of 30 minutes or more of moderate exercise daily, on most, if not all days. There are many benefits to prenatal exercise, but published results vary regarding the benefit of exercise on labor and delivery outcomes. METHODS: This was a prospective analysis of women receiving prenatal care at Mayo Clinic enrolled during September 2013 and August 2014. Participants completed surveys during each trimester describing physical activity level. Clinical data was abstracted from their electronic medical record. We compared women that met the recommended exercise guidelines of (more than 150 minutes of exercise per week) in 0, 1st, 2nd, or 3rd trimesters, and then further analyzed those that exercised in at least one trimester and compared them to those that never met exercise criteria in any trimester. RESULTS: 462 women met eligibility for inclusion, with an average age of 30.7 (SD 4.4) and BMI of 25.5 (SD 5.7). We found no statistical significance in either group comparison (defined as a P value less than .05) between fetal weight, weight gain during pregnancy, gestational age at delivery, length of first and second stage labor, induction of labor, episiotomy, and perineal laceration between the two groups. CONCLUSION: There are undoubtedly benefits to exercise during pregnancy, but this cohort failed to find any beneficial influence of exercise on labor and delivery outcomes. Further research is needed to identify prenatal factors that influence labor and delivery outcomes.