Omer Kandemir

Intravenous versus oral iron for treatment of anemia in pregnancy: a randomized trial.

OBJECTIVE: The aim of this study was to compare the efficacy of intravenous iron to oral iron in the treatment of anemia in pregnancy. METHODS: In this randomized open-label study, 90 women with hemoglobin levels between 8 and 10.5 g/dL and ferritin values less than 13 &mgr;g/L received either oral iron polymaltose complex (300 mg elemental iron per day) or intravenous iron sucrose. The iron sucrose dose was calculated from the following formula: weight before pregnancy (kg) × (110 g/L – actual hemoglobin [g/L]) × 0.24 + 500 mg. Treatment efficacy was assessed by measuring hemoglobin and ferritin on the 14th and 28th days and at delivery, and the hemoglobin on the first postpartum day. Adverse drug reactions, fetal weight, hospitalization time, and blood transfusions were also recorded. RESULTS: Hemoglobin values varied significantly with time between groups (interaction effect, P < .001). The change in hemoglobin from baseline was significantly higher in the intravenous group than the oral group at each measurement; the changes with respect to subsequent hemoglobin were significantly higher on the 14th (P = .004) and 28th (P = .031) days. Ferritin values were higher in patients receiving intravenous iron throughout pregnancy. No serious adverse drug reactions were observed. Fetal weight and hospitalization time were similar in the 2 groups. Blood transfusion was required for only one patient in the oral group. CONCLUSION: Intravenous iron treated iron-deficiency anemia of pregnancy and restored iron stores faster and more effectively than oral iron, with no serious adverse reactions. LEVEL OF EVIDENCE: I

A quantitative evaluation of total antioxidant status and oxidative stress markers in preeclampsia and gestational diabetic patients in 24–36 weeks of gestation

OBJECTIVE To assess the plasma and serum maternal total antioxidant status, circulating levels of lipid peroxidation breakdown products (MDA), protein oxidation markers (AOPPs), myeloperoxidase (MPO) and lipid hydroperoxide (LHP) in preeclampsia, gestational diabetes mellitus (GDM) patients and compare them with noncomplicated normal pregnancies between 24 and 36 weeks of gestation. STUDY DESIGN 27 GDM, 27 preeclampsia and 29 noncomplicated singleton pregnancies were included. The blood samples were taken at the diagnosis of disease. RESULTS TAS was decreased in GDM and preeclampsia when compared to normal pregnancies. MDA levels were higher only in GDM group than normal pregnancies. AOPP levels were increased but MPO and LHP levels were not changed both in GDM and preeclampsia when compared to normal pregnancies. CONCLUSIONS We concluded that increased oxidative stress and reduction in antioxidant defense mechanisms may contribute to disease processes both in GDM and preeclampsia.

Prevalence of gestational diabetes mellitus and gestational impaired glucose tolerance in pregnant women evaluated by National Diabetes Data Group and Carpenter and Coustan criteria.

To determine the prevalence of gestational diabetes mellitus (GDM) and gestational impaired glucose tolerance (GIGT) using National Diabetes Data Group (NDDG), and Carpenter and Coustan (CC) criteria.

Efficacy of citalopram on climacteric symptoms.

Objective: The aim of this study was to evaluate the efficacy of citalopram for climacteric symptoms and to assess the combined effect of citalopram and hormone therapy (HT) on climacteric symptoms in women inadequately responsive to HT alone. Design: The study included 100 postmenopausal women who were allocated into one of four groups: (1) citalopram, (2) placebo, (3) citalopram + HT, or (4) placebo + HT. The women who were unable or unwilling to take HT were randomly placed in groups 1 and 2. The women who were inadequately responsive to HT were randomly placed in groups 3 and 4. The initial dose of citalopram was 10 mg/day in groups 1 and 3. After 1 week, the dose was increased to 20 mg/day. After starting the medication, follow-up visits took place during the fourth and eighth weeks of treatment. During the first and eighth weeks, women completed two questionnaires: a modified Kupperman index and the Menopause-Specific Quality of Life Questionnaire. Results: Mean hot flash scores significantly improved in all groups (P < 0.05). The reduction rates were 37% in group 1, 13% in group 2, 50% in group 3, and 14% in group 4. Psychosocial complaints and mean values on the Kupperman index significantly decreased in all groups (P < 0.05). Physical well-being significantly improved in groups 1, 3, and 4 (P < 0.05). The decrease in all scores was significantly greater in groups 1 and 3 compared to groups 2 and 4 (P < 0.01). Conclusion: Citalopram is an effective alternative treatment option for patients who do not want to take HT for the alleviation of climacteric symptoms. Adjuvant treatment with a selective serotonin reuptake inhibitor increases the effectiveness of HT for the treatment of climacteric symptoms in women who had responded inadequately to HT.

Does brucellosis in human pregnancy increase abortion risk? Presentation of two cases and review of literature

Brucellosis is one of the most common zoonotic diseases that can be encountered during pregnancy. We present two pregnant women with brucellosis. One of them delivered normally and the other patient had an abortion. We reviewed the literature regarding the clinical course of brucellosis in pregnant women. Brucellosis during pregnancy can be associated with abortion, congenital and neonatal infections and infection of the delivery team. Therefore treatment with a combination of rifampicin and trimethoprim‐sulfamethoxazole should be started as soon as it is diagnosed to prevent possible complications.

Prenatal diagnosis of Pena-Shokeir syndrome phenotype by ultrasonography and MR imaging

Pena-Shokeir syndrome phenotype is characterized by neurogenic arthrogryposis, facial anomalies, polyhydramnios and lung hypoplasia. Prenatal US is crucial in showing Pena-Shokeir syndrome phenotype in addition to demonstrating reduced fetal movements or akinesia as an underlying aetiological factor as early as the 14th week of gestation. Several reports of prenatal diagnosis of Pena-Shokeir syndrome phenotype by US have been published. In this report, MRI findings providing prenatal diagnosis are presented.

Cigarette smoking and pregnancy: Results of a survey at a Turkish women's hospital in 1,020 patients

Summary We aimed to investigate the level of knowledge about the effects of cigarette smoking and status before and during pregnancy. The study was performed on 1,020 pregnant women who attended the clinic for a routine visit. The questionnaire consisting of questions about sociodemographic data, smoking habits and knowledge about harmful effects of smoking on fetus (miscarriage, intrauterine growth retardation, pre-term birth, fetal mortality-morbidity, postpartum infant death, pre-term premature rupture of membranes, lung disease, attention deficit) was administered. Data were analysed by SPSS 10.0 using χ2-test and binary regression analysis. Mean age was 26.3 years. Smoking rates before and after pregnancy were 34.7% and 14%, respectively. Passive smoking was seen in 69.2%. The number of cigarettes smoked before pregnancy had a significant impact on continuation of smoking during pregnancy [OR (95% CI) 29.94 (12.88–69.64)]. For passive smoking at home for a young age [OR (95% CI) = 1.33 (1.01–1.76)] had a positive impact and university education [OR (95% CI) = 0.40 (0.24–0.67)] had a negative impact. Most pregnant women (97.5%) knew smoking was harmful. Awareness of intrauterine fetal death as a harmful effect was the single most important factor associated with quitting active and passive smoking. Despite some level of knowledge of pregnant women regarding adverse effects of smoking, there is a strong need for education on quitting smoking during pregnancy. Prevention of passive smoking should have the highest priority.

Maternal cardiac risks in pre-eclamptic patients

Objective: To investigate the relationship between pre-eclampsia (PE) and maternal cardiac risk factors. Material-methods: A total of 41 pregnant women were included in this study. Patient groups consisted of 25 PE patients and 16 normal pregnant women as a control group. We measured the serum total cholesterol, high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), homocystein, apoprotein A1, apoprotein B100, lipoprotein (a), high sensitivity C-reactive protein (hsCRP), cystatin C levels as cardiac risk factors. Serum low-density lipoprotein (LDL) and very low density lipoprotein (VLDL) cholesterol levels were calculated using Friedwald equation. Results: The levels of TG, LDL-C, homocysteine, apoprotein B100 and cystatine C were higher in the PE patients than those in the control group (p < 0.05). HDL-C and apolipoprotein’s AI levels were lower than those of normotensive pregnants (p < 0.05). HsCRP levels were also higher in the patient group but the difference was not statistically significant. Conclusion: PE is an important and as yet, incompletely understood disorder of pregnancy. Our study showed that the blood levels for some cardiac risk factors were increased in women with PE, which may contribute to its multisystem pathology. Consideration should be given to monitoring women with PE for these cardiac risk factors in pre-eclamptic women both during pregnancy, as well as later in life.

Cord blood oxidative stress markers correlate with umbilical artery pulsatility in fetal growth restriction

Objective: To compare cord blood oxidative stress markers (OSM) between intrauterine small fetuses with high umbilical artery (UA) Doppler indices and normal indices. Methods: Forty women who had oligohydramnios and intrauterine growth-restricted fetuses with abnormal (n = 20, group I) or normal Doppler indices (n = 20, group II) were included. All patients underwent fetal Doppler ultrasound studies. Cord blood was collected at birth and six OSMs (ischemia-modified albumin (IMA), hepatocyte growth factor (HGF), malondialdehyde (MDA)) levels, total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI) were studied. Results: The mean cord blood IMA, MDA, TOS, and OSI values for group I were significantly increased when compared to the group II (p < 0.001 for IMA, MDA, TOS, and OSI). However the mean cord blood HGF and TAS values were statistically significantly decreased in group I, compared with group II (p < 0.001 for HGF, and TAS). A significant positive (for IMA, MDA,TOS levels, and OSI ratio) and negative (for HGF and TAS levels) correlations between UA pulsatility index (PI) and cord blood OSM were found. Conclusion: The correlation between cord blood OSM and Doppler blood flow changes shown in this study may contribute to understanding the underlying oxidative stress-related mechanisms.

Gestational Diabetes and Gestational Impaired Glucose Tolerance in 1653 Teenage Pregnancies: Prevalence, Risk Factors and Pregnancy Outcomes

STUDY OBJECTIVE The aim of this study was to determine the prevalence of gestational diabetes mellitus (GDM) and gestational impaired glucose tolerance (GIGT) in adolescent pregnancies, associated risk factors, and pregnancy complications. DESIGN Retrospective study. SETTINGS Community-based teaching hospital. PARTICIPANTS Results of 1653 pregnant women age ≤ 19 years in 2005-2007 were reviewed. INTERVENTION All pregnant women screened with 50-g glucose challenge test (GCT) and patients with a GCT result ≥ 140 mg/dl underwent a 3-hour 100-g oral glucose tolerance test (OGTT). MAIN OUTCOME MEASURES GDM was diagnosed with at least two abnormal results and GIGT was diagnosed with one abnormal result. GDM and GIGT cases were evaluated for the presence of any associated risk factors and effects of presence of risk factors on pregnancy outcomes. RESULTS The prevalence of GDM was 0.85% (95% CI, 0.41-1.29), GIGT was 0.5% (95% CI, 0.15-0.81) and GDM+GIGT was 1.35% (95% CI, 0.78-1.88) by Carpenter and Coustan criteria. 68% of patients had at least one of the risk factors including body mass index ≥ 25, family history of diabetes and polycystic ovary syndrome (PCOS). Only 9.1% (n = 2) of them required insulin for glucose regulation during pregnancy with 9.1% (n = 2) macrosomia rate. All patients were primiparous and cesarean delivery rate was 27.3% (n = 6). We could not find any effect of presence of risk factors on pregnancy outcomes in GDM and GIGT cases. CONCLUSION We demonstrated that GDM and GIGT are strongly associated with high BMI before pregnancy, PCOS, and family history of diabetes. Since GDM is a state of prediabetes, it is important to diagnose in adolescent pregnancies considering their life expectancy to take preventive measures to avoid diabetes mellitus.