Meena Khandelwal

Dietary intake of myo-inositol and neural tube defects in offspring of diabetic rats

OBJECTIVE Embryopathy in diabetic mothers occurs at a rate four to five times higher than that observed in the general population. The current investigation was undertaken to assess the use of dietary myo-inositol supplementation as a pharmacologic prophylaxis to obviate the teratogenic effects of hyperglycemia in an in vivo study. STUDY DESIGN Seventy Sprague-Dawley rats were mated and after conception were randomly divided into five groups: one group was nondiabetic normal controls and four groups had diabetes experimentally induced with streptozotocin. Of the diabetic groups, one received the usual diet, whereas the others received, respectively, 0.08, 0.16, and 0.5 mg/day supplemental myo-inositol orally. RESULTS With the myo-inositol supplementation (0.08 mg/day), the incidence of neural tube defects was significantly reduced from 20.4% to 9.5% (p < 0.01). The most effective dosage of myo-inositol was 0.08 mg/day. Increasing the dose of myo-inositol beyond that level did not significantly reduce the rate of neural tube defects. However, the resorption rate was increased to 29.8%. CONCLUSION These data demonstrate that myo-inositol supplementation reduces the incidence of diabetic embryopathy and may serve as a pharmacologic prophylaxis against diabetes-induced congenital malformations.

Betamethasone dosing interval: 12 or 24 hours apart? A randomized, noninferiority open trial

OBJECTIVE We sought to determine whether the incidence of neonatal respiratory distress syndrome (RDS) is similar with 12- vs 24-hour dosing interval of betamethasone. STUDY DESIGN This was a prospective, randomized, open, noninferiority trial. Mothers (n = 228) with a singleton or multiple pregnancies (fetuses = 260), between gestational age of 23-34 weeks, at risk for preterm delivery, received standard 2 doses of betamethasone either 12 or 24 hours apart in 2:1 ratio, respectively. RESULTS Incidence of RDS was similar in the 2 cohorts (36.5% vs 37.3%; P = not significant). Women unable to receive the complete course of corticosteroids with the 24-hour interval can be reduced by half with the 12-hour interval. However, increased incidence of necrotizing enterocolitis was seen with 12-hour dosing (6.2% vs 0%; P = .03). CONCLUSION The 12-hour dosing interval is equivalent to the 24-hour dosing interval for prevention of RDS in neonates of mothers delivering prematurely. A larger multicenter study is needed to confirm our findings.

Monoamniotic Monochorionic Twins-Can They Be Delivered Safely Via Vaginal Route? [9].

INTRODUCTION: Current ACOG technical bulletin #144, 2014 states “Women with monoamniotic twin gestations should undergo cesarean delivery to avoid an umbilical cord complication of the nonpresenting twin at the time of the initial twins delivery.” To assess feasibility of vaginal delivery, we compared neonatal outcomes after attempted VD versus planned cesarean delivery (CD). METHODS: This retrospective cohort study from 2 tertiary-care centers, reviewed all viable MoMo twin pregnancies beyond 24 weeks gestation, delivered over last 15 years. Independent T test and Fisher exact test were used for statistical analysis. RESULTS: Of 29 women with MoMo twins, 15 underwent planned CD and 14 attempted VD. Of the 14 women who attempted VD: 6 underwent IOL; 10 successfully delivered both neonates vaginally with median interval of 3 minutes between the twins; 3 underwent CD for non-reassuring fetal tracing; 1 required CD for the 2nd twin. Despite similar GA at delivery (32.7 vs 33.3 weeks; P=.5) and fetal loss rate (2/15 vs 1/14; P=NS), incidence of intracranial hemorrhage was significantly lower in the vaginally delivered neonates (0 vs 8; P=.006); lower trends were also noted in neonatal length of stay (18 vs 25, P=.09) and respiratory complications. Entangled cords were noted in 28/29 pregnancies at birth. Women with prior CD more often chose repeat CD. Composite maternal outcomes were similar in the 2 groups. CONCLUSION/IMPLICATIONS: VD appears to be safe in appropriately identified MoMo twins. Current practice and recommendations are based on theoretical risks. This study, though small, provides valuable data on option of vaginal delivery for MoMo twins.